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This case report describes a 35-year-old Caucasian male presenting with 5 weeks of progressive weakness in the proximal limbs and trunk and associated changes to the skin. The man was previously well and not taking any regular medications. There are many pathways this undifferentiated patient could go down. Consultant physician, Professor Josephine Thomas demonstrates a systematic way to work through the differential diagnoses as would be expected in a long-case presentation for basic physician training exams. She's the Clinical Dean for the Adelaide Medical School at the Northern Adelaide Local Health Network.GuestProf Josephine Thomas FRACP FRACGP FANZAPHE PhD (Northern Adelaide Local Health Network; University of Adelaide)HostsAssociate Professor Stephen Bacchi (Massachusetts General Hospital; University of Adelaide)Dr Caleb Chong (Northern Adelaide Local Health Network) ProductionProduced by Stephen Bacchi and Mic Cavazzini. Music licenced from Epidemic Sound includes ‘Rockin' for Decades' by Blue Texas and ‘Brighton Breakdown' by BDBs. Image created and copyrighted by RACP. Editorial feedback kindly provided by Dr Brandon Stretton and Ben Cook.Key Reference (Spoiler Alert)*****A case of haemorrhagic myositis with concurrent anti-Ro52 and anti-NXP-2 antibodies treated with plasmapheresis [Rheumatology. 2020]Please visit the Pomegranate Health web page for a transcript and supporting references. Login to MyCPD to record listening and reading as a prefilled learning activity. Subscribe to new episode email alerts or search for ‘Pomegranate Health' in Apple Podcasts, Spotify,Castbox or any podcasting app.
Understanding Person-Centered Care for Older Adults in Six Developing Countries: Ethiopia [Episode 4] Download the Transcript The impact of population aging is universally recognized and has been extensively studied in wealthier, developed nations. But we know much less about how aging is experienced in low- and middle-income countries and how developing countries are responding to the current challenges created by the aging of their populations. The rapid rate of population aging in many developing countries—fueled by falling fertility rates and a shift in the predominance of chronic diseases rather than acute and infectious illnesses—has left little time to anticipate and prepare for the consequences of aging populations. The GSA Interest Group on Common Data Elements for International Research in Residential Long-term Care has developed a limited podcast series to provide insights into how culture, competing population health priorities, political conflict, and resource limitations influence older adults, their families, and paid/formal caregivers in six nations along a trajectory of national development, including Brazil, China, East Jerusalem, Ethiopia, Ghana, and Thailand. Guest: Nigussie Tadesse Sharew, MS Nigussie is a doctoral student at the University of Adelaide, Adelaide Medical School in Australia, where he is studying the pharmacogenomics of drugs used in the treatment of mental health disorders. He holds two master's degrees in clinical epidemiology from the University of Groningen in the Netherlands and adult health nursing from Addis Ababa University in Ethiopia. He was an Assistant Professor at Debre Berhan University in Ethiopia, where he has served as Dean of the College of Health Science for three years and as head of the nursing department for two years. Host: Barbara Bowers, PhD, RN, FAAN, FGSA, Emerita Professor at the University of Wisconsin–Madison, School of Nursing; Founding Director of the UW–Madison School of Nursing's Center for Aging Research and Education Moderator: Jing Wang, PhD, RN, FAAN, Assistant Professor at the University of New Hampshire, College of Health and Human Services This podcast limited series is supported by the GSA Innovation Fund.
Semaglutide, branded as Ozempic or Wegovy, is an analogue of glucagon-like peptide 1 which has glucose-dependent effects on insulin secretion. In this episode we discuss how semaglutide performs as an antihyperglycaemic agent compared to previous GLP-1 analogues and the soon-to-be launched tirzepatide. This dual agonist also binds receptors to glucose-dependent insulinotropic polypeptide, GIP.GLP-1 and GIP are incretin hormones, secreted after food intake and involved in regulating gastric motility and appetite. The analogue therapies have resulted in weight loss of 10 to 20 percent in trials on patients with obesity or other weight-related comorbidities. For various reasons, however, they remain unsubsidised by the Pharmaceutical Benefits Scheme. This hasn't stopped social media influencers driving up off-label demand from the wider public, creating a problem for regulators and the diabetic patients most in need.GuestsProfessor Chris Rayner MBBS PhD FRACP (Gwendolyn Michell Professor, Adelaide Medical School; Consultant Gastroenterologist, Royal Adelaide Hospital) Professor Gary Wittert MBBch, MD, FRACP (Mortlock Professor, Adelaide Medical School; Senior Consultant Endocrinologist, Royal Adelaide Hospital)ProductionProduced by Mic Cavazzini DPhil. Music courtesy of Free Music Archive includes ‘Mister S' by Tortue Super Sonic. Music licenced from Epidemic Sound includes ‘Multicolor' and ‘Flower Fountain' by Chill Cole, ‘Blacklight' by John B Lund, and ‘Habitual' by Ava Low. Image by Ketut Subiyanto courtesy of Pexels. Editorial feedback kindly provided by RACP physicians Stephen Bacchi, Aidan Tan, David Arroyo, Joseph Lee, Jia-Wen Chong, Li-Zsa Tan, Fionnuala Fagan, Stella Sarlos and Marion Leighton.Please visit the Pomegranate Health web page for a transcript and supporting references. Login to MyCPD to record listening and reading as a prefilled learning activity. Subscribe to new episode email alerts or search for ‘Pomegranate Health' in Apple Podcasts, Spotify, Castbox or any podcasting app.
Dr. James Muecke is an ophthalmic surgeon and ophthalmologist. James has also been recognized for his work globally, particularly in Southeast Asia, and has been awarded the Australian of the Year for 2020. Dr. James Muecke AM graduated with Honours from the University of Adelaide Medical School in 1987. Following his internship, James lived and worked as a doctor in Africa and subsequently as an eye surgeon in the Middle East, battling malaria, wild animals, and rebel soldiers. He founded Sight For All in 2008, turning his boundless energy into a fight against blindness in the Aboriginal communities of Australia and some of the poorest countries of Asia and Africa. His commitment to social impact and humanitarian endeavors has earnt him several awards including an Order of Australia in 2012, the Australian Medical Association's President's Leadership Award in 2013, and Ernst & Young's Social Entrepreneur for Australia in 2015. James is Australian of the Year for 2020. James is a researcher, a teacher, an author, a musician, a photographer, and a film producer, and uses his many skills to deliver passionate, fascinating, and at times confronting presentations about his life, his work, philanthropy, resilience, and social entrepreneurship. In this episode: Dr. Muecke's personal and professional journeys How sugar impacts eye health What our eyes can tell us about our health How his colleagues react to his interventions What's next Our Signature Question Welcome, Dr. Muecke!!! Follow Dr. Muecke: Website: https://medthink.com.au/?fbclid=IwAR1PYfplwMfqFoBSzU3MJKhjxGMOn69x9YAl9dOldagaWhv4vTYXkHQnxD8 Instagram: https://www.instagram.com/jsmuecke Facebook: https://www.facebook.com/drjamesmuecke/ ANNOUNCEMENTS:
It is 90 seconds to midnight on the Doomsday Clock. In large part due to developments in the war in Ukraine, the Bulletin of the Atomic Scientists moved the hands of the infamous timepiece forward.Just weeks earlier the Department of Energy announced the first reported controlled fusion reaction that was touted as a breakthrough for national defense and the future of clean energy.Given the history of that lab, there is reason for skepticism.In this episode of Breaking Green we will talk with Dr. Helen Caldicott.Born in Melbourne, Australia in 1938, Dr Caldicott received her medical degree from the University of Adelaide Medical School in 1961. She founded the Cystic Fibrosis Clinic at the Adelaide Children's Hospital in 1975 and subsequently was an instructor in pediatrics at Harvard Medical School and on the staff of the Children's Hospital Medical Center, Boston, Mass., until 1980 when she resigned to work full time on the prevention of nuclear war.In 1971, Dr Caldicott played a major role in Australia's opposition to French atmospheric nuclear testing in the Pacific; in 1975 she worked with the Australian trade unions to educate their members about the medical dangers of the nuclear fuel cycle, with particular reference to uranium mining.While living in the United States from 1977 to 1986, she played a major role in re-invigorating as President, Physicians for Social Responsibility, an organization of 23,000 doctors committed to educating their colleagues about the dangers of nuclear power, nuclear weapons and nuclear war. On trips abroad she helped start similar medical organizations in many other countries. The international umbrella group (International Physicians for the Prevention of Nuclear War) won the Nobel Peace Prize in 1985. Dr Caldicott has received many prizes and awards for her work, including the Lannan Foundation's 2003 Prize for Cultural Freedom and twenty one honorary doctoral degrees. She was personally nominated for the Nobel Peace Prize by Linus Pauling – himself a Nobel Laureate. The Smithsonian has named Dr Caldicott as one of the most influential women of the 20th Century. Don't miss an episode and subscribe to Breaking Green wherever you get your podcasts.This podcast is produced by Global Justice Ecology Project.Breaking Green is made possible by tax deductible donations from people like you. Please help us lift up the voices of those working to protect forests, defend human rights and expose false solutions. Simply text GIVE to 716-257-4187.
Dr Samantha Pillay graduated from the University of Adelaide Medical School in 1992 to become the first female urological surgeon in South Australia. From a very early age a physical condition prevented Dr Pillay from being able to walk. But it's made her all the more determined to pursue her dreams and to help others in need. Dr Pillay is the founder of Continence Matters, an online resource to educate the medical professional and the general public on bladder and continence issues. She's also an accomplished public speaker, an entrepreneur, and author of ‘The No Recipe Cookbook' and ‘When I'm a Surgeon'.See omnystudio.com/listener for privacy information.
Even if the body and pain is complex, the strategies we can use to recover from pain doesn't have to be! We're going on a “Magic School Bus” ride (cue 1994 PBS nostalgia) to our cellular systems on the nanomolecular level. Jump to 34:40 for simple biohacks to reset a hypersensitive biological system that happens during chronic pain. “Change is inevitable, how you change is not.” Huge things are possible when we know how our body works and actively use that knowledge to make changes to our cellular systems. Mark reminds us that without trust, transformation in finding relief from chronic pain is really hard. Professor Mark Hutchinson is the Director of the ARC Centre of Excellence for Nanoscale BioPhotonics (CNBP), an Australian Research Council Future Fellow, a Professor within the Adelaide Medical School at the University of Adelaide, and President of Science and Technology Australia, the peak body in Australia that represents 90,000 scientists. Mark explores the “other brain” and has pioneered research which has led to the discovery of novel drug activity at innate immune receptors. We cover topics like: Why we experience pain Strategies that speak the same language as our cellular systems Why our cells remember pain We have hundreds of cellular systems that turn on and off hundreds of switches in our body to stay in control and keep us safe. These switches determine why, when, and how much pain we experience in response to stimuli. When we feel a feather against our skin or step on a Lego, we're experiencing nociception. Over time, our baseline of what turns these switches on and off becomes more sensitive, resulting in hypernociception and allodynia that are caused from stimuli that normally wouldn't cause pain, but now does. Strategies that work with how our cellular systems function include: Eating well (eating plants borrows their defense mechanisms!) Going on a walk outside Playing in nature Having deep meaningful conversations (talking actually changes the structure of the central nervous system) Creating a positive and supportive environment Drinking hydrogenated water Mindfulness practices, “thinking well” breathing practices like Wim Hof supercharges your immune response and resilience When exploring strategies, your mindset matters! Having an expectation that the strategies can work influences the outcomes. It's critical to have a positive mindset that you can shift your pain, even it's only by a little bit. RESOURCES: Free sex and pelvic pain resources https://drsusieg.com/resources-for-pelvic-pain-in-men Online Pelvic Pain Relief Program for Men https://drsusieg.com/pelvic-pain-in-men-online-program CONNECT WITH MARK HUTCHINSON: Twitter: Prof_Hutchinson Science Technology Australia https://www.youtube.com/c/ScienceTechnologyAustralia Centre of Excellence for Nanoscale BioPhotonics https://www.mq.edu.au/research/research-centres-groups-and-facilities/innovative-technologies/centres/arc-centre-of-excellence-for-nanoscale-biophotonics CONNECT WITH ME (DR. SUSIE): Website: https://drsusieg.com/ Instagram: https://www.instagram.com/dr.susieg/ 15-minute call: https://drsusieg.com/pelvic-pain-specialist-15-minute-call Disclaimer: This information is not intended to substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of a healthcare professional with any questions you may have regarding treatment, medications/supplements, or any medical diagnoses. This information is intended for educational purposes only and is in no way to substitute the advice of a licensed healthcare professional.
Measuring Pain Through Blood Tests Milk Lines – Checking Mastitis Records 00:01:20 — Measuring Pain Through Blood Tests Part One: K-State's College of Veterinary Medicine hosted visitors from the land down under last week! Mark Hutchinson, a professor of medicine at the Adelaide Medical School, and two of his students, veterinarian and Ph.D. student Charlotte Johnston and post-doctoral researcher Dan Barratt join us to discuss their collaboration with K-State and their research focusing on blood tests to measuring pain in livestock. 00:12:08 — Measuring Pain Through Blood Tests Part Two: We continue our conversation with Adelaide Medical School researchers Mark Hutchinson, Charlotte Johnston, and Dan Barratt. Johnston and Barratt, students of Hutchinson, share more about their roles as a veterinarian and post-doctoral researcher on this team. They also discuss where they hope this research leads and plans for future collaborations at K-State in the future. 00:23:07 — Milk Lines – Checking Mastitis Records: Summer heat often causes somatic cell issues in the dairy herd, such as mastitis - K-State dairy specialist Mike Brouk advises producers to check their treatment records to identify what types of mastitis were found and to check with their veterinarian for available control options. Send comments, questions, or requests for copies of past programs to ksrenews@ksu.edu. Agriculture Today is a daily program featuring Kansas State University agricultural specialists and other experts examining ag issues facing Kansas and the nation. It is hosted by Samantha Bennett and distributed to radio stations throughout Kansas and as a daily podcast. K‑State Research and Extension is a short name for the Kansas State University Agricultural Experiment Station and Cooperative Extension Service, a program designed to generate and distribute useful knowledge for the well‑being of Kansans. Supported by county, state, federal and private funds, the program has county Extension offices, experiment fields, area Extension offices and regional research centers statewide. Its headquarters is on the K‑State campus in Manhattan.
Dr Samantha Pillay graduated from the University of Adelaide Medical School in 1992 to become the first female urological surgeon in South Australia. From a very early age a physical condition prevented Dr Pillay from being able to walk. But it's made her all the more determined to pursue her dreams and to help others in need. Dr Pillay is the founder of Continence Matters, an online resource to educate the medical professional and the general public on bladder and continence issues. She's also an accomplished public speaker, an entrepreneur, and author of ‘The No Recipe Cookbook' and ‘When I'm a Surgeon'. See omnystudio.com/listener for privacy information.
Dr Julia Kirby is a graduate of the University of Adelaide Medical School and completed her orthopaedic training in Victoria and Tasmania before commencing practice as a consultant orthopaedic surgeon in 2020. Dr Kirby has special interests in sports injury and orthopaedic trauma surgery, and prior to her orthopaedic training, she also completed a Master of Sports Medicine at The University of Queensland. Dr Kirby has recently completed a fellowship in adult knee surgery with OrthoSport Victoria and will soon be travelling to Dallas, Texas in the USA for a fellowship in paediatric sports orthopaedics at Texas Scottish Rite Hospital – but not before sitting down with me to tell her story!
Weighing about 3 pounds in the average adult, the brain is about 60% fat. The remaining 40% is a combination of water, protein, carbohydrates and salts. The brain itself is a not a muscle. It contains blood vessels and nerves, including neurons and glial cells. – John's Hopkins MedicineSo if 60% of your brain is fat, are you feeding it the right fats to promote structural health and optimal function? Most people don't realize that the structure and the function of the brain are intimately interconnected.Delia McCabeDr. Delia McCabe has dedicated her career to understanding how to nourish high functioning brains. We discuss, not only the necessary dietary foods, but also exercises and lifestyles that promote optimal function. This episode was one of the most informational episodes you'll hear and is chock full of strategies and actionable habits to stay at the top of your game.What you will learn from this episodeWhat the brain is made of and how to build a stronger structureThe importance of fat for brain healthHow you should consider macro nutrientsThe importance of the brain/gut connection and how to eat for healthThe 5 best foods to feed your brainHow and why you need to “work out” your brainThe impact of stress on brain healthHow sleep, sex and sweat improve brain functionAbout DeliaDelia shifted her focus from conventional talking therapy, after completing her Masters in Psychology. She had discovered that what we eat impacts brain function directly, and came to understand that until the brain is properly nourished no amount of talking can support optimal cognitive functioning.Delia has since immersed herself in the fascinating world of nutritional neuroscience and offers a focused, insightful, evidence-based approach into how specific foods can improve our mood, concentration, memory and learning ability and help us manage stress and remain calm and happy in our busy, stressful world, regardless of our age! Delia received her PhD from Adelaide Medical School and her present research focus is on the neurobiology of stress and nutrition.Delia's knowledge about the brains requirements foroptimal well being, her enthusiasm for sharing complex science in an easy-to-understand format, and her ability to share practical and actionable steps with her audience, make her a speaker that keeps her audience engaged and enthralled from start to finish.People who attend Delia's events and workshops describe them as ‘extremely engaging, enlightening, fascinating, and motivational!'Delia's first book, ‘Feed Your Brain – 7 Steps to a Lighter, Brighter You!' explains the science behind nutrition and brain health and was released mid-2016.Delia's second book, ‘Feed Your Brain – The Cookbook' was released in November 2017, and takes the science into your kitchen to enable the creation of delicious, brain-supportive meals.ResourcesDelia's WebsiteOmega 3 Supplement Recommendation Book Recommendations“7 Steps to a Lighter Brighter You” by Delia McCabe“7 Steps to a Lighter Brighter You – The Cookbook” by Delia McCabe“Spark” by John Ratey“The End of Alzheimer's” by Dale Bredesen
It is a great honour to have Australian of the Year 2020, Dr James Muecke on the podcast. Jamesgraduated with Honours from the University of Adelaide Medical School and then went on to train as an Ophthalmologist. He is the founding chairman of Sight For All, a not-for-profit organization dedicated to fighting avoidable blindness in the world. This organisation provides around 1 million eye treatments to those in need. Using his platform as Australian of the Year, James has focused his attention on raising awareness around the dangers of sugar, processed foods and the prevention of type 2 diabetes which is one of the leading causes of preventable blindness, ill-health and death in the world. James is seeking reform to the dietary guidelines and predatory marketing from the processed food industry in an attempt to improve the metabolic health of all Australians.
As part of National Diabetes Week, Dr Muecke has agreed for me to share with you his presentation he did for the 2021 Low Carb Lifestyle Long Weekend. Dr James Muecke AM graduated with Honors from the University of Adelaide Medical School in 1987. Following his internship, James lived and worked as a doctor in Africa and subsequently as an eye surgeon in the Middle East, battling malaria, wild animals, and rebel soldiers. He founded Sight For All in 2008, turning his boundless energy into a fight against blindness in the Aboriginal and mainstream communities of Australia and some of the poorest countries of Asia and Africa. Sight For All's comprehensive and sustainable projects are now impacting on the lives of over one million people each year. His commitment to social impact and humanitarian endeavors has earnt him a number of awards including an Order of Australia in 2012, the Australian Medical Association's President's Leadership Award in 2013, and Ernst & Young's Social Entrepreneur for Australia in 2015. James was Australian of the Year for 2020. James is a researcher, a teacher, an author, a musician, a photographer, and a film producer, and uses his many skills to deliver passionate, fascinating, and at times confronting presentations about his life, his work, philanthropy, resilience and social entrepreneurship. A neurological condition impacting on his dexterity has forced James into a premature retirement from surgery. Not letting his disability slow him down, James has redirected his vigor to crafting films, and has a number of powerful documentaries under his belt and several compelling projects in production. Website: www.sightforall.org Facebook - Sight For All Instagram - @sightforall LinkedIn - Sight For All Facebook - Dr James Muecke Instagram - @drjamesmuecke LinkedIn - James Muecke AM After the success of two virtual Low Carb Lifestyle Women's Health Summits in 2020 and 2021, I have decided to continue the conversations and community by creating a podcast. I look forward to brining to you many conversations, knowledge, insight and wisdom, and sharing many of the presentations that were within both the 2020 and 2021 Summit's. Contact: Tracey McBeath Web: https://www.traceymcbeath.com.au Facebook: https://www.facebook.com/traceymcbeathhealth Instagram: https://www.instagram.com/tracey_mcbeath_health Join the Low Carb Lifestyle Hub: https://www.traceymcbeath.com.au/low-carb-lifestyle-hub/ https://www.facebook.com/thelowcarblifestylehub or Instagram: https://www.instagram.com/the_lowcarb_lifestyle_hub Join Low Carb Melbourne on Facebook: https://www.facebook.com/groups/387154592536873 Are you a health practitioner and interested in learning how to bring low carb in to your practice with confidence? The Nutrition Network has a number of programs to help. For GP's; Dietitians; Nurses and Health Coaches. The Nutrition Network is run by the Noakes Foundation. To learn more, click here: http://bit.ly/nutritionnetwork
Vaccines are one of our biggest hopes in our fight against COVID-19. With so much anticipation, confusion and disinformation in the public sphere, Jennie Lenman invites Dr Helen Marshall onto the program to discuss how the new vaccines are being rolled out and whether the speeding up of trials should be cause for concern. Dr Marshall is the Senior Medical Practitioner and Director, Vaccinology and Immunology Research Trials Unit at the Women's and Children's Hospital, NHMRC Practitioner Fellow and Professor in Vaccinology at Adelaide Medical School and Deputy Director and Research Leader, Robinson Research Institute, The University of Adelaide.
Click here to buy my book Injured to Elite on Amazon!This episode will totally change your view on both the science of pain and on our brain itself! Today I am joined by one of the leading world expert on Pain Science, Dr.Mark Hutchinson who is a Professor within the Adelaide Medical School and is the Director of the ARC Centre of Excellence for Nanoscale BioPhotonics in Australia. His leading work on immunology of the brain and pain science has now discovered that our thoughts and emotions have an actual effect on our immunity and overall health. These so-called pattern recognition receptors and other molecules might just be the interface between our thoughts and actual immune response. This episode can be thought of as the science which is bringing serious western "clout" to eastern medicine. Special shout out to Dan O'Brien Director of Sport Medicine and Research at the National Basketball Players Association (NBPA) in New York who connected Dr.Hutchinson and I. You can kind of think of this episode as East Meets West medicine. Many of the things in this episode shared can not only impact your journey after injury but also help boost your immune system during these times as we continue our fight against the coronavirus. Enjoy!Learn More at http://www.injuredtoelite.comFollow me on Instagram Click Here to Follow Dr.Hutchinson on Twitter @prof_hutchinson
Delia has a background in psychology and received her PhD from Adelaide Medical School. Delia’s current research focus is on the neurobiology of stress and nutrition. We talked about good fats and oils and the not so good ones… be prepared to throw out your fry-pan and rethink your bulletproof coffee habit!
Joan Cerio welcomes Dr. Helen Caldicott who shares with us her knowledge of how nuclear weapons, nuclear disasters such as Fukushima, and global warming are threatening the existence of our planet. The single most articulate and passionate advocate of citizen action to remedy the nuclear and environmental crises, Dr. Helen Caldicott, has devoted the last 42 years to an international campaign to educate the public about the medical hazards of the nuclear age and the necessary changes in human behavior to stop environmental destruction. Dr. Caldicott received her medical degree from the University of Adelaide Medical School in South Australia in 1961. She founded the Cystic Fibrosis Clinic at the Adelaide's Children's Hospital and subsequently was an instructor in pediatrics at Harvard Medical School. While living in the US, she was the president of Physicians for Social Responsibility. She also helped start similar medical organizations in many other countries. One of these groups, the International Physicians for the Prevention of Nuclear War, won the Nobel Peace Prize in 1985. She also founded the Women's Action for Nuclear Disarmament. Dr. Caldicott has received many prizes and awards for her work, including the Lannan Foundation's 2003 Prize for Cultural Freedom and 21 honorary doctoral degrees. She was personally nominated for the Nobel Peace Prize by Linus Pauling, himself a Nobel Laureate. The Smithsonian has named Dr. Caldicott as one of the most influential women of the 20th Century. She has written for numerous publications and has authored seven books. She has also been the subject of several films, including the documentary If You Love This Planet, which won the Academy Award for best documentary in 1982. Dr. Caldicott is the President of The Helen CaldicottFoundation/NuclearFreePlanet.org. Her website is https://HelenCaldicott.com.
Dr Gregory Hundley: Welcome everyone to the June 18th edition of Circulation on the Run. I am Dr Greg Hundley, Professor of Internal Medicine and Director of the Pauley Heart Center at VCU Health in Richmond, Virginia. In today's issue we're deviating from our common format due to some scheduling difficulties. So, rather than our traditional coffee chat in this program I'm going to have a large gulp of coffee and present results from several exciting papers. Then we'll turn over the second half of our program to Dr Carolyn Lam for our feature discussion. Now, I promise this is a one-time deviation and we will return to our common chat format in early July. But, before I launch into my presentations I did want to introduce what will transpire with Carolyn. She will be discussing an exciting paper from the Adelaide Medical School at the University of Adelaide in Australia. Some have wondered whether the persistence of a patent arterial venous fistula post-kidney transplant may contribute to ongoing maladaptive cardiovascular remodeling. To address this issue Carolyn will be discussing with authors whether ligation of this AV fistula may reverse this maladaptive remodeling. And like you, I'm excited to listen to that discussion. But before that let me review several of the other distinctive papers on this issue. The first one is entitled “Individual Treatment Effect Estimation of Two Doses of Dabigatran on Stroke and Major Bleeding in Atrial Fibrillation.” They are the results from the RE-LY trial. The corresponding author is Professor Frank Visseren from the University Medical Center of Utrecht in Utrecht University. The study emanates from the randomized evaluation of long-term anticoagulation therapy or the RE-LY trial. In which high dose dabigatran, that's 150 milligrams twice daily, was found more effective in prevention of ischemic stroke and systemic embolism than low dose dabigatran which is 110 milligrams twice daily. But this occurred at that expense of an increased risk of gastrointestinal bleeds. Importantly however, the absolute treatment effect of dabigatran in both doses, likely differs between individuals. And therefore, individual treatment effect estimation has the potential to identify patients who have a favorable trade off and absolute benefit and harm from dabigatran compared with no treatment, and to select the optimal dose for each individual patient. So in this study, the investigative team derived and validated a prediction model for ischemic stroke and systemic embolism and major bleeding in patients with atrial fibrillation from three treatment arms of the RE-LY study. They had 11,955 individuals in the derivation cohort and 6,158 in the validation cohort. And they evaluated the patient characteristics of sex, age, smoking, anti-platelet drugs, prior vascular disease, diabetes, blood pressure, estimated glomerular filtration rate, and hemoglobin. Dr Gregory Hundley: Well, what were the results? Well the five-year absolute risk reduction, for ischemic stroke and systemic embolus minus the five-year absolute risk increase for major bleeding, when comparing the high to the low dose of dabigatran yielded a net benefit in 46% of patients. And therefore, the authors conclude that the absolute treatment benefits and harms of dabigatran in atrial fibrillation can be estimated based on readily available patient characteristics. And perhaps down the road such treatment effect estimations can be used for shared decision making before starting dabigatran treatment and to determine its optimal dose of administration. Well, how 'bout that? And let's go on to the second paper entitled “Empagliflozin and the Risk of Heart Failure Hospitalization in Routine Clinical Care: A First Analysis from the Empagliflozin Comparative Effectiveness and Safety, or EMPRISE Study. And the corresponding author for this study is Elisabetta Patorno from Brigham and Women's Hospital in the Harvard Medical School. So, as a background in a different study to this, the EMPA-REG OUTCOME trial showed that Empagliflozin an SGLT2 inhibitor was found to reduce the risk of hospitalization for heart failure by 35% on top of standard of care in patients with Type 2 diabetes and established cardiovascular disease. Well, the current study, The Empagliflozin Comparative Effective and Safety or EMPRISE Study was designed to assess empagliflozin's effectiveness, safety, and health care utilization in routine care from the period of time between August of 2014 through September of 2019. And the author's report on the first interim analysis in which they investigated the risk of hospitalization for heart failure among Type 2 diabetic patients initiating empagliflozin vs. sitagliptin. The investigators used two commercial and one federal Medicare claims data source from the U.S. and identified a one-to-one propensity score matched cohort of 16,443 pairs of Type 2 diabetes patients that were greater than 18 years of age initiating empagliflozin or sitagliptin. The average age of the participants was approximately 59 years. And almost 54% of the participants were males and approximately 25% had records of existing cardiovascular disease. So compared to sitagliptin the initiation of empagliflozin decreased the hospitalization for heart failure risk by 50% over a mean follow-up of 5.3 months. And the results were consistent in patients with and without baseline cardiovascular disease for both the empagliflozin 10 milligram or 25 milligram daily dose. Or analysis comparing empagliflozin vs. dipeptidyl peptidase-4 inhibitor class all comers. Thus, in conclusion, in this first interim analysis from EMPRISE, the investigative team showed that compared with sitagliptin the initiation of empagliflozin was associated with a decreased risk of hospitalization for heart failure among patients with Type 2 diabetes as treated in routine care with and without a history of cardiovascular disease. Dr Gregory Hundley: Well, now we're going to turn our attention to red meat. And this next study was entitled, The Consumption of Meat, Fish, Dairy Products, Eggs, and Risk of Ischemic Heart Disease. It's a Perspective study of 7,198 incident cases among 409,885 participants in the Pan European Epic Cohort. And the corresponding author is Professor Timothy Key from The University of Oxford. Some of the background here, met analysis of previous prospective studies have suggested that intake of processed meat maybe associated with a higher risk of ischemia heart disease whereas, unprocessed red meat might not. For dairy products and eggs, systematic reviews of prospective studies have reported no consistent evidence that higher intakes are associated with a higher risk of ischemic heart disease. Other studies have shown that fatty fish consumption may reduce the risk of ischemic heart disease, it is a rich source of long chain N3 fatty acids. And meta-analysis has suggested even an inverse association between overall fish consumption and mortality from ischemic heart disease. So, hear in this cohort: we're going to evaluate all of these. Accordingly Key, and his co-authors report the relationships of these foods with risk of ischemic heart disease in the European prospective investigation into cancer and nutrition, the EPIC study, and that again is a cohort of a half million men and women from nine European countries followed for 12 years to examine the association between the intake of animal foods and the occurrence of ischemic heart disease. The author's found that higher consumption of red, unprocessed and processed meat was positively associated with the risk of ischemic heart disease. None of the other animal foods examined were positively associated with this risk. And intakes of fatty fish, yogurt, cheese and eggs were modestly, inversely associated with the risk. In addition, the red and processed meat were associated with plasma non-HDL cholesterol and systolic blood pressure. And this finding is of interest as possibly these other variables could serve as mediator of the association between red or processed meat and future ischemic heart disease. It is important to note that while these results are of interest to those concerned with the future adverse cardiovascular effects related to the consumption of red meat, one cannot infer causality and other studies would need to be designed to address causal relationships. The last paper that I'm going to present during the coffee gulp, emanates from the basic science arena. And it is entitled The “Shear-Induced CCN1 Promotion of Atheroprone Endothelial Phenotypes and Arthrosclerosis. And the corresponding author is Dr Fan-E Mo from the National Cheng Kung University College of Medicine. Dr Gregory Hundley: The matricellular protein CCN1 has been implicated in arthrosclerosis based on its expression in arterial segments with evidence of arthrosclerosis. And this study evaluated the relationship between sheer stress, both laminar and oscillatory at the site of atherosclerotic liaisons and molecular markers of pathophysiologic process involved in the progression of arthrosclerosis. The authors found that sheer induced CCN1 and its receptor integrin, alpha six, beta one, instigate atheroprone phenotypic changes in endothelial cells via activating NF kappa beta. Because the activation of NF kappa beta further up regulates the expression of CCN1, alpha six, and beta one, atheroprone flow creates a positive feedback to sustain atherogenesis. In addition, disrupting CCN1, alpha 6 beta one engagement by a specific CCN1 mutation, or by a peptide antagonist unhindered atherogenesis in mice. So what are the clinical implications of these findings? That's something Carolyn would ask me. Well, it appears that CCN1 alpha 6 beta one engagement represents a novel therapeutic target for arthrosclerosis. These data demonstrate a causative role of CCN1 in atherosclerosis via modulating endothelial phenotypes. And CCN1 binds to its receptor integrin alpha 6 beta one to activate NF kappa beta, thereby instigating a vicious cycle to persistently promote atherogenesis. Perhaps in the future T1 me medics may further be optimized to treat arthrosclerosis. Well everyone, that concludes the first portion of this June 18 edition of Circulation on the Run and now it's time to move on to Carolyn's discussion of our featured paper. Dr Carolyn Lam: Cardiovascular disease remains the major cause of death in kidney transplant recipients. And today's featured paper has important implications for the management of this cardiovascular risk following kidney transplantation. I'm so excited to be discussing it, and I'm going to let the corresponding author Dr Toby Coates from Royal Adelaide Hospital tell us all about it, and so happy to also welcome our editorialist Dr Patrick Mark from University of Glasgow. Toby, could you please tell us what inspired you to do this remarkable study? Dr Toby Coates: We're very interested in obviously our patients surviving as long as they possible can after kidney transplantation. And we noticed that many of them having had a successful kidney transplant, still had functioning AV fistulas. Now of course the AV fistula, is a connection between the artery and the vein that enabled us to access the circulation after hemodialysis. Which around the world is probably the most, is the most common form of dialysis practice performed. So many of these patients sustained 20 years down the track after successful transplants still had these very large functioning left to right shunts, on the basis of their dialysis history. So we had a couple of patients who developed quite severe cardiac failure and we noticed that when we ligated the AV fistula, their back got dramatically better. So, as a consequence of that, we went to look at the ligature and we couldn't find any randomized control trial that told us what the best thing was to do, post-transplant with these fistulas. So we decided that what we would do be use the state of the art cardiac magnetic resonance imaging, or cardiac MRI to assist the cardiac function with myocardium thickness in our patients and then randomize a group of stable transplant patients to ligation or not. And then follow that up with cardiac MRI six months down the track to see what happened. And so that was the basis of the study that we performed. The first randomized controlled trial of the effect of ligation of the AV fistula on the left ventricular mass, that was the prominent one for trial. Dr Carolyn Lam: You know, Toby, just to let you know right there, I thought it was so incredibly novel. So I'm a heart failure specialist and we know that shunts are associated with high output cardiac failure, and yet, I personally had never questioned this, so I thought this is incredibly novel and it's important. But please, tell us all about the results. Dr Toby Coates: We were delighted to say that there was a very significant reduction in the left ventricle mass. In fact, the main decrease was 22.1 grams compared to the control arm in whom the cardiac mass actually went up 1.2 grams. So, then we mobilized the body surface area, the reduction of the left ventricular mass index dropped by 11.8 grams per metered square. Now, this is quite remarkable for me doing the study because I've never seen an intervention, I've never seen an intervention where every single patient improved with the ligation, every single patient there was an improvement in the cardiac parameters. Never seen anything like it in the pre and post of the ventricular mass it really came down. So that was quite remarkable. And the second thing that really impressed me at the time, was the improvement in the BMP's, and we measured the brain maturated peptide, and being a methodologist that's clearly something that's of interest to us and we saw a substantial reduction. It's statistically significant reduction in BMP as well. The patient themselves, some of them recorded quite significant improvement in exercise tolerance afterwards. And we had, as I mentioned before in a couple of patients, not in the study but outside of the study, subsequently when they're presented with profound right heart failure, the ligation of the AV fistula made a huge difference to them symptomatically. So that was sort of confirming all of the things that we thought along the way. Pleasingly we didn't see any change in kidney function. So, we were concerned that there might have been on the basis of some non-controlled studies in the past, that there might have been a deterioration in the estimated glomerular filtration rate, or eGFR. We didn't see that. And we didn't see any significant change in the blood pressure either. Which is some of us have previously reported. Closing the fistula itself, is a very trivial procedure. It's usually done as an outpatient, so a day procedure. So it's not resulting in coming to the hospital. And the only complications, really were lots of local redness and some pain, potentially from the fistula where in the ligated. So, we thought this was remarkable. An outpatient procedure that could significantly reduce the left ventricular mass by 22.1 grams over the six month period that was associated with minimal side effects and complications. And when you think about that, that's sort of equivalent really to taking an anti-hypertensive medication for six months. That magnitude of reduction with ventricular mass which clearly from the patient's point of view is much preferable to adding more medication to an already over-burdened tablet loading in your patients with kidney transplants. So we were very pleased with that result altogether. Dr Carolyn Lam: Thank you Toby, and we in turn were very pleased to be publishing this in Circulation. Likewise, Patty, if I may, I love your editorial. First, let me tell everybody who's listening out there. Go pick up the editorial and look at the figure. It is so cool. It shows pros and cons of arterial venous fistula ligation in these patients. But could you please share some thoughts Patty? I mean you covered the perspective just so well. Patrick Marks: I must give the credit to my co-author who actually drew the figure himself. So Chris Eaves rather myself. We were really impressed with the study and we're really delighted to write an editorial for it. It's just one of those studies that I have to say, you know, you kick yourself and you wish you'd done it. With all the world of observational data showing that creation of a fistula appears to be associated with an increase in LV mass obstruction by echo and angio and bicartic MR in smalls studies. But it's taken a long stat to move from that to actually doing a randomized control of ligating the fistula in people with you know, stable functioning transplants. We were really, really impressed with Toby and his team for undertaking this study. And until we'd gone through the results, they're really very impressive. The magnitude of reduction LV mass is very impressive and also the changing BMP was really nice to see. One of my comments of the study were, was interesting because as methodologists we are aware of the idea arteriovenous fistula as being the axis for dialysis. And we sometimes feel uncomfortable by ligating this because we know if the transplant was to fail, how much patients need a functioning fistula. And that's the one thing I'm still curious, like and I still offered some comments in the editorial were, that while there's doubt that the cardiovascular benefits demonstrated by Toby's study are really very impressive. I wondered about the implications out with the study came down the line, you know would there be some of these patients whose kidney transplant function would decline? And there may be regret of losing the access. We mentioned there is some inconvenience, it is an operative procedure to loosen the fistula. So there are some things to think about in the study, but overall, I can't help saying just how impressed I am that they managed to do this trial in a proper randomized, controlled trial form. It's really, really impressive in using the cardiac MR endpoint is it seems quite a secure way of assessing this. Dr Carolyn Lam: Those are great points, Patty. Toby, any response to that. Dr Toby Coates: Look it's really very interesting as a transplant pathologist for the last 20 years, one of the biggest, I guess it's a bit of a misconception. When a fistula has been present for 10 or 15 years and still there to come back and try and reuse it for dialysis access after that period of time, in my experience anyway, also very difficult to reuse those fistulas and the surgeons end up having to create a new one anyway. They frequently become quite aneurismal, they get very large and unsightly and the volume of the shunt is significant and often we find that as an access they don't work as well. So I personally don't have a huge concern about closing them. Now I agree with you, these patients were stable, longstanding and we assessed that the risk is, we need to go back onto hemodialysis was small. But you are absolutely right, I mean, it is possible that something could have come out of the blue and maybe a patient would be disappointed that that access that they'd had for so many years was no longer available. So that is, the caveat on the study, but thankfully so far out, some of these patients five or six years down the track, we haven't had anybody need to go back on dialysis, so it's been good. Dr Carolyn Lam: Yeah, it really says to me as well, that patient selection is important exactly like you emphasized, and you, in the editorial Patty. But from a cardiology standpoint, too, are there plans to perhaps do studies with hard, clinical endpoints? What do you think are the next steps? Maybe I'll let Toby go first, then Patty. Dr Toby Coates: We think now with this study done, the next thing is to have a larger study with significant cardiovascular endpoints. Which I obviously would be cardiac failure and acute coronary events. So the two things that would seem in my mind, and I think that needs to be multi-centered, preferable international if we can. And one of the really positive things about the highlight from the American Heart Association is that we've had people reach out to us from France and all around the globe saying that they'd be interested in participating, you know in a multi-centered trial. So, I think that's what we need to do, and clearly you don't it’ll have to be a constant endpoint, or not. I'd be interested in Patty's thoughts about that, right if you had some guidelines and some suggestions. And then obviously would be randomized, controlled trial looking at those hard endpoints with probably some sidearms doing cardiac MRI as well, and potentially more heart functioning tests. So yes, I think this is just the beginning, we do need a hard endpoint trial to really nail this completely. Patrick Marks: Yeah, I'll just come in there and just come on to that Toby. I completely concur with what you said. I think there's been quite a provocative editorial a few years back, and suggesting that while there's lots of studies in chronic kidney disease, end stage renal disease, kidney transplant patients avoid LV mass, really it hasn't yet been translated into actually leading studies in the integration of LV mass and end stage renal failure haven't really yet translated into mortality benefits. And I think we need to move to a bigger study. It's really beautiful that you've been able to demonstrate LV mass falls naturally with ligation. And it's impressive that it just happens so consistently across your population in the intervention arm. But we need to move on to a longer trial with hard clinical endpoints. Certainly heart failure, certainly cardiovascular mortality, [be]cause there's plenty of reasons to believe that producing LV mass in these patients might have benefit both for heart failure, whether that's heart failure, heart injection fraction, or whatever, I'll leave that to Carolyn's judgment to help us with that. But also, if we can reduce LV mass and then we may be able to reduce arrhythmia burden which again is when these things we worry about in end stage renal disease, again, your answer for that is, that in addition to the heart endpoints you should be able to also add in some patient afforded outcomes in a larger study. Or something like an exercise tolerance quota of quality of life. All this has started has journey from the surrogate endpoint of left ventricular mass into a bigger outcome study and I can't wait to see how you get on with it. Dr Carolyn Lam: I can't wait either. And I'm sure the audience is sharing all our enthusiasm as well. Thank you so much Toby and Patty. I really learned so much. You heard it right here on Circulation on the Run. Thank you for joining us this week. Don't forget to turn in again next week. This program is copyright American Heart Association 2019.
Nuclear power has been heralded as a safe, clean, and necessary source of energy for the modern developed society, but what are the risks inherent in developing and using nuclear energy, and what examples can we look to that stand in the face of this assertion? Dr. Helen Caldicott discusses the lasting and long-term impacts the development of nuclear energy has had on the health of living beings on this planet since the first nuclear tests in the 1940’s. The most glaring example of the dangers posed by nuclear power comes from Dr. Caldicott’s examination of the meltdown of several nuclear power units at the Fukushima Daiichi Nuclear Power Plant in Ōkuma, Fukushima Prefecture, Japan in March 2011 after a 9.0 magnitude earthquake and tsunami impacted the power plant and caused several facilities to collapse. To this day, highly radiated water enters the Pacific Ocean from this source — the effects of which work its way up the food chain through genetic mutations, impacting the health of every living thing on Earth — including human life. Dr. Caldicott describes the hubris and insanity required to produce such a toxic and everlasting problem on this planet, as well as other subjects relating to the subject of nuclear power, nuclear waste, and the nuclear weapons testing that occurred during the Cold War era. Dr Helen Caldicott has devoted the last forty-two years to an international campaign to educate the public about the medical hazards of the nuclear age and the necessary changes in human behavior to stop environmental destruction. Born in Melbourne, Australia in 1938, Dr Caldicott received her medical degree from the University of Adelaide Medical School in 1961. She founded the Cystic Fibrosis Clinic at the Adelaide Children’s Hospital in 1975 and subsequently was an instructor in pediatrics at Harvard Medical School and on the staff of the Children’s Hospital Medical Center, Boston, Mass., until 1980 when she resigned to work full time on the prevention of nuclear war. She has written for numerous publications and has authored several books, including 'Nuclear Madness,' 'The New Nuclear Danger: George Bush’s Military Industrial Complex,' 'Nuclear Power is Not the Answer,' and edited the 2017 book ‘Sleepwalking to Armageddon: The Threat of Nuclear Annihilation.’ Learn more about Dr. Caldicott’s years of work at her website: https://www.helencaldicott.com This is a segment of episode #152 of Last Born In The Wilderness “Folly Of Man: Fukushima, Nuclear Power, & Unending Consequences w/ Dr. Helen Caldicott.” Listen to the full episode: http://bit.ly/LBWcaldicott WEBSITE: https://www.lastborninthewilderness.com PATREON: http://bit.ly/LBWPATREON DONATE: Paypal: http://bit.ly/LBWPAYPAL Ko-Fi: http://bit.ly/LBWKOFI FOLLOW & LISTEN: SoundCloud: http://bit.ly/LBWSOUNDCLOUD iTunes: http://bit.ly/LBWITUNES Google Play: http://bit.ly/LBWGOOGLE Stitcher: http://bit.ly/LBWSTITCHER RadioPublic: http://bit.ly/LBWRADIOPUB YouTube: http://bit.ly/LBWYOUTUBE SOCIAL MEDIA: Facebook: http://bit.ly/LBWFACEBOOK Twitter: http://bit.ly/LBWTWITTER Instagram: http://bit.ly/LBWINSTA
In this episode, I speak with Dr. Helen Caldicott — the "single most articulate and passionate advocate of citizen action to remedy the nuclear and environmental crises.”✇ We discuss the fallout of the current situation regarding the nuclear meltdown of the Fukushima Daiichi Nuclear Power Plant in 2011, the myths and lies that surround nuclear power as a sustainable energy source, the danger posed by having nuclear power plants near coastlines and large bodies of water around the world, the current state of the nuclear power industry, as well as other subjects relating to nuclear power and the dangers it poses for life on Earth. Nuclear power has been heralded as a safe, clean, and necessary source of energy for the modern developed society, but what are the risks inherent in developing and using nuclear energy, and what examples can we look to that stand in the face of this assertion? Dr. Helen Caldicott discusses the lasting and long-term impacts the development of nuclear energy has had on the health of living beings on this planet since the first nuclear tests in the 1940’s. The most glaring example of the dangers posed by nuclear power comes from Dr. Caldicott’s examination of the meltdown of several nuclear power units at the Fukushima Daiichi Nuclear Power Plant in Ōkuma, Fukushima Prefecture, Japan in March 2011 after a 9.0 magnitude earthquake and tsunami impacted the power plant and caused several facilities to collapse. To this day, highly radiated water enters the Pacific Ocean from this source — the effects of which work its way up the food chain through genetic mutations, impacting the health of every living thing on Earth — including human life. Dr. Caldicott describes the hubris and insanity required to produce such a toxic and everlasting problem on this planet, as well as other subjects relating to the subject of nuclear power, nuclear waste, and the nuclear weapons testing that occurred during the Cold War era. Dr Helen Caldicott has devoted the last forty-two years to an international campaign to educate the public about the medical hazards of the nuclear age and the necessary changes in human behavior to stop environmental destruction. Born in Melbourne, Australia in 1938, Dr Caldicott received her medical degree from the University of Adelaide Medical School in 1961. She founded the Cystic Fibrosis Clinic at the Adelaide Children’s Hospital in 1975 and subsequently was an instructor in pediatrics at Harvard Medical School and on the staff of the Children’s Hospital Medical Center, Boston, Mass., until 1980 when she resigned to work full time on the prevention of nuclear war. She has written for numerous publications and has authored several books, including 'Nuclear Madness,' 'The New Nuclear Danger: George Bush’s Military Industrial Complex,' 'Nuclear Power is Not the Answer,' and edited the 2017 book ‘Sleepwalking to Armageddon: The Threat of Nuclear Annihilation.’✇ ✇Source: http://bit.ly/CaldicottBio Episode Notes: - Learn more about Dr. Caldicott’s years of work at her website: https://www.helencaldicott.com - Learn more about Dr. Caldicott’s most recent book ‘Sleepwalking to Armageddon: The Threat of Nuclear Annihilation’: http://bit.ly/CaldicottSA - Dr. Caldicott founded the US-based Nuclear Policy Research Institute (NPRI), which became Beyond Nuclear: http://www.beyondnuclear.org - The song featured in this episode is “Loops” by Kneebody & Daedelus from the album Kneedelus. - WEBSITE: https://www.lastborninthewilderness.com - PATREON: http://bit.ly/LBWPATREON - DONATE: Paypal: http://bit.ly/LBWPAYPAL Ko-Fi: http://bit.ly/LBWKOFI - FOLLOW & LISTEN: SoundCloud: http://bit.ly/LBWSOUNDCLOUD iTunes: http://bit.ly/LBWITUNES Google Play: http://bit.ly/LBWGOOGLE Stitcher: http://bit.ly/LBWSTITCHER RadioPublic: http://bit.ly/LBWRADIOPUB YouTube: http://bit.ly/LBWYOUTUBE - SOCIAL MEDIA: Facebook: http://bit.ly/LBWFACEBOOK Twitter: http://bit.ly/LBWTWITTER Instagram: http://bit.ly/LBWINSTA
In this podcast, Dr. Alison Christy interviews Lyndsey Collins-Praino from the Adelaide Medical School about her article, Medullary Astrogliosis in Sudden Infant Death Syndrome Varies With Sleeping Environment: Evidence for Different Mechanisms of Death in Alone Versus Co-sleepers? She also interviews Kathryn McFadden from the University of Michigan. To read Dr. Lucy Rorke-Adams' autobiography mentioned in this podcast, please click here.
Dr. Anthony Corbet was born in Perth, Australia. He graduated from the Adelaide Medical School in 1963; he trained in Pediatrics and Neonatology at Sydney and Montreal. He held professorial/research positions at Baylor College of Medicine in Houston. Since 1994, Dr. Corbet has practiced at the Children’s Hospital in San Antonio. Book Cover shows the Chapel of St George at Windsor (where King Edward IV and Queen Elizabeth Woodville were buried in a common tomb.) Dr. Corbet can be contacted at AuthorCorbetPhD@Yahoo.com More information can be found on Facebook and Twitter.