Podcasts about Adverse

In his weekly clinical update, Dr. Griffin and Vincent Racaniello discuss in shock how RFK is breaking his promise of not altering vaccine policies by appointing new members of the ACIP, next ACIP meeting on guidelines for the COVID and RSV vaccines, circulation of “human insect viruses” including West Nile virus, and an outbreak of mpox on a cruise ship, and the ongoing measles outbreak before Dr. Griffin reviews recent statistics on RSV, influenza and SARS-CoV-2 infections the Wasterwater Scan dashboard, how to reduce the use of antibiotics for RSV and influenza infections in children, approval of the moderna RSV mRNA vaccine, whether or not the NB.1.8.1 should be included in the fall 2025 vaccines, immunization recommendations for COVID-19 vaccines, where to find PEMGARDA, provides information for Columbia University Irving Medical Center's long COVID treatment center, where to go for answers to your long COVID questions, contacting your federal government representative to stop the assault on science and biomedical research, and a shout out for the special episode of TWiV with David Tuller on long COVID and ME/CFS. Subscribe (free): Apple Podcasts, RSS, email Become a patron of TWiV! Links for this episode RFK Jr. is sabotaging the vaccine program. Here's how to stop him (Washington Post) Innovaciones Alumbra (Alumbra Innovaciones) John T Walton (Wikiepedia) Walmart (Wikipedia) Sam Walton (Wikipedia) Condé Nast (Wikipedia) Christy Walton (Wikipedia) Vaccine Integrity Project ( CIDRAP) CIDRAP launches Vaccine Integrity Project (Twin Cities: University of Minnesota) Next ACIP meeting (CDC: ACIP) June meeting: MEETING OF THE ADVISORY COMMITTEE ON IMMUNIZATION PRACTICES (ACIP)(CDC: ACIP agenda) West Nile Virus and Other Nationally Notifiable Arboviral Diseases — United States, 2023 (CDC: MMWR) Clade II Mpox Infections Among Cruise Ship Passengers and Crew Members — United States, 2024 (CDC: MMWR) H5 bird flu: current situation (CDC: Avian Influenza) Wastewater for measles (WasterWater Scan) Measles cases and outbreaks (CDC Rubeola) Weekly measles and rubella monitoring (Government of Canada) Measles (WHO) Get the FACTS about measles (NY State Department of Health) Measles (CDC Measles (Rubeola)) Measles vaccine (CDC Measles (Rubeola)) Presumptive evidence of measles immunity (CDC) Contraindications and precautions to measles vaccination (CDC) Measles (CDC Measles (Rubeola) Measles vaccine recommendations from NYP (jpg) Adverse events associated with childhood vaccines: evidence bearing on causality (NLM) Measles Vaccination: Know the Facts (ISDA: Infectious Diseases Society of America) Deaths following vaccination: what does the evidence show (Vaccine) Influenza: Waste water scan for 11 pathogens (WastewaterSCan) US respiratory virus activity (CDC Respiratory Illnesses) Weekly surveillance report: clift notes (CDC FluView) Respiratory virus activity levels (CDC Respiratory Illnesses) Weekly surveillance report: clift notes (CDC FluView) Pediatric antibiotic use associated with respiratory syncytial virus and influenza in the United States, 2008-2018 (JID) FDA-CDC-DOD: 2025-2046 influenza vaccine composition (FDA) RSV: Waste water scan for 11 pathogens (WastewaterSCan) US respiratory virus activity (CDC Respiratory Illnesses) RSV-Network (CDC Respiratory Syncytial virus Infection) Novel Drug Approvals for 2025 (FDA) Effectiveness and impact of nirsevimab in Chile during the first season of a national immunisation strategy against RSV (NIRSE-CL) (LANCET: Infectious Diseases) Safety, Tolerability, and Immunogenicity ofmRNA-1345 in Adults at Increased Risk for RSV Disease Aged 18 to 59 Years (CID) Moderna Receives U.S. FDA Approval for RSV Vaccine, mRESVIA, in Adults Aged 18–59 at Increased Risk for RSV Disease (moderna) Waste water scan for 11 pathogens (WastewaterSCan) COVID-19 deaths (CDC) COVID-19 national and regional trends (CDC) Spatiotemporal Association of Coronavirus Disease 2019 Cases and Deaths With Exposure to Wildfire Particulate Matter in 2020 (OFID) COVID-19 variant tracker (CDC) SARS-CoV-2 genomes galore (Nextstrain) Next ACIP meeting (CDC: ACIP) Antigenic and Virological Characteristics of SARS-CoV-2 Variant BA.3.2, XFG, and NB.1.8.1 (biRxiV) Where to get pemgarda (Pemgarda) EUA for the pre-exposure prophylaxis of COVID-19 (INVIYD) Infusion center (Prime Fusions) CDC Quarantine guidelines (CDC) NIH COVID-19 treatment guidelines (NIH) Implementation of an online drug-drug interaction screener for the STRIVE ensitrelvir trial for COVID-19 (OFID) Drug interaction checker (University of Liverpool) Infectious Disease Society guidelines for treatment and management (ID Society) Molnupiravir safety and efficacy (JMV) Convalescent plasma recommendation for immunocompromised (ID Society) What to do when sick with a respiratory virus (CDC) Managing healthcare staffing shortages (CDC) Steroids,dexamethasone at the right time (OFID) Anticoagulation guidelines (hematology.org) Daniel Griffin's evidence based medical practices for long COVID (OFID) Long COVID hotline (Columbia : Columbia University Irving Medical Center) The answers: Long COVID Long COVID and ME/CFS with David Tuller (microbeTV) Reaching out to US house representative Letters read on TWiV 1228 Dr. Griffin's COVID treatment summary (pdf) Timestamps by Jolene Ramsey. Thanks! Intro music is by Ronald Jenkees Send your questions for Dr. Griffin to daniel@microbe.tv Content in this podcast should not be construed as medical advice.

In this podcast, Dr. Danny Nguyen from the City of Hope, Huntington Beach, CA, USA, and Dr. Edgardo S. Santos from the Oncology Institute of Hope and Innovation, Broward County, FL, USA, aim to educate on strategies to mitigate and manage dermatologic adverse events associated with amivantamab + lazertinib. This podcast is published open access in Targeted Oncology and is fully citeable. You can access the original published video podcast/vodcast article through the Targeted Oncology website and by using this link: https://link.springer.com/article/10.1007/s11523-025-01163-3. All conflicts of interest can be found online. Open Access This podcast is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, which permits any non-commercial use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The material in this podcast is included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc/4.0/.

Dr. David Clarke shares his 40-year journey as a medical consultant specializing in neuroplastic conditions—real physical symptoms generated by the brain in response to stress, trauma, or emotional challenges. He explains how these conditions affect 20% of adults and 40% of doctor visits, yet remain frequently misdiagnosed despite being highly treatable.• Neuroplastic symptoms are physical manifestations created by the brain in response to stress or trauma• These conditions affect strong individuals carrying burdens they've normalized, not "weak" or "neurotic" people• Adverse childhood experiences (ACEs) can create lasting impacts through stressful personality traits, triggers, and unrecognized emotions• Brain circuits physically change with chronic stress and can change back with appropriate treatment• The brain creates all sensations—even with physical injuries, pain signals originate in the brain• Long Covid and similar conditions may involve neuroplastic mechanisms that maintain symptoms after initial triggers• Recovery includes reframing self-perception from weakness to strength, setting boundaries, and processing emotions• Transformation extends beyond symptom relief to improved relationships and becoming "who you were meant to be"Visit Symptomatic Me to take a 12-item questionnaire assessing for neuroplastic symptoms, and check out "The Story Behind the Symptoms" podcast where Dr. Clarke interviews patients about their recovery journeys.Symptomatic.MeMessage the podcast! - questions will be answered on my youtube channel :) For more information about Long Covid Breathing courses & workshops, please check out LongCovidBreathing.com (music credit - Brock Hewitt, Rule of Life) Support the show~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~The Long Covid Podcast is self-produced & self funded. If you enjoy what you hear and are able to, please Buy me a coffee or purchase a mug to help cover costsTranscripts available on individual episodes herePodcast, website & blog: www.LongCovidPodcast.comFacebook @LongCovidPodcastInstagram Twitter @LongCovidPodFacebook Creativity GroupSubscribe to mailing listPlease get in touch with feedback, suggestions or how you're doing - I love to hear from you, via socials or LongCovidPodcast@gmail.com**Disclaimer - you should not rely on any medical information contained in this Podcast and related materials in making medical, health-related or other decisions. Please consult a doctor or other health professional**

The Georgia Fruit and Vegetable Growers Association and others are seeking detailed information about how the USDA calculates the Adverse Effect Wage Rate, and the EU says it's open to lowering tariffs on U.S. fertilizer imports.

Dr Erin Louise Bellamy founded Integrative Ketogenic Research and Therapies which uses principles of Metabolic Psychiatry to provide remote, highly personalized 1:1 Metabolic Therapy for both psychiatric conditions and overall metabolic health. Dr. Erin Bellamy has a PhD in Psychology, specializing in Ketogenic Diets & Depression from the University of East London. She also has an MSc in Psychiatric Research from the Institute of Psychiatry at King's College London. She is a Chartered Psychologist, an Associate Fellow of the British Psychological Society and an accredited member of the Society of Metabolic Health Practitioners. In this episode, Drs. Brian and Erin talk about… (00:00) Intro (01:36) How Dr. Erin became interested in Metabolic Psychiatry (05:38) Ketogenic diets and psychiatric conditions (15:39) Fasting and mental clarity (18:12) The areas in which clinical psychology is deficient in helping patients (23:46) Adverse childhood events, PTSD, and metabolic health (28:24) Binge eating, stress, and support groups (40:00) Food addiction and ketosis (43:59) Schizophrenia, autism, and ketosis (01:00:46) Outro/plugs For more information, please see the links below. Thank you for listening! Links: Please consider supporting us on Patreon: https://www.lowcarbmd.com/ Resources Mentioned in this Episode: Dr. Erin Bellamy on the Life's Best Medicine Podcast: https://lifesbestmedicine.com/podcast/episode-248-dr-erin-bellamy/ Dr. Erin Bellamy: Instagram: https://www.instagram.com/erinlouisebellamy/ X: https://x.com/erinlbellamy Integrative Ketogenic Research & Therapies: https://www.ikrt.org Dr. Brian Lenzkes:  Website: https://arizonametabolichealth.com/ Twitter: https://twitter.com/BrianLenzkes?ref_src=twsrc^google|twcamp^serp|twgr^author Dr. Tro Kalayjian:  Website: https://www.doctortro.com/ Twitter: https://twitter.com/DoctorTro Instagram: https://www.instagram.com/doctortro/ Toward Health App Join a growing community of individuals who are improving their metabolic health; together.  Get started at your own pace with a self-guided curriculum developed by Dr. Tro and his care team, community chat, weekly meetings, courses, challenges, message boards and more.  Apple: https://apps.apple.com/us/app/doctor-tro/id1588693888  Google: https://play.google.com/store/apps/details?id=uk.co.disciplemedia.doctortro&hl=en_US&gl=US Learn more: https://doctortro.com/community/ 

What if parents could truly change the future just by having more open conversations about alcohol? In this episode host Anna Donaghey is joined by Jessica Lahey, educator and author of The Addiction Inoculation. Together, they explore the factors that influence substance use in young people, the power of prevention, and how honest dialogue can break cycles of dependence. This episode guides listeners through what they can do, no matter their own history with alcohol, to build resilience in the next generation.Here are the highlights:00:00 Introduction05:15 Talking about substance use prevention is challenging 09:47 Lack of learned strategies to manage stress and anxiety15:12 Adverse childhood experiences can lead to substance use disorders16:28 Teenagers understand consequences but weigh positive outcomes more 20:43 Empowering kids with self-efficacy can prevent substance use34:34 Kids need at least one trusted adult to confide in37:29 Kids may try substances due to feeling inadequate or out of place50:39 Reliable information for teenagers is key for understanding and trust. If you're a mum wanting to explore your relationship with alcohol, join ‘Mummy Doesn't Need Wine' here: https://www.facebook.com/groups/mummydoesntneedwineAnna's group coaching community ‘Unstuck!' helps identify your alcohol ‘stories' and beliefs, breaking the cycle of alcohol and all the shame that goes with it. For more information and to find out how to join, please follow this link: Unstuck! community informationTo further explore your relationship with alcohol, check out Anna's self-guided programme, The Big Drink Rethink Experiment: https://www.thebeliefscoach.com/the-big-drink-rethink-experimentAnd apply the code POD99 to purchase for just £99 as a podcast listenerFor the free resources accompanying this series, please head to https://www.thebeliefscoach.com/registrationIf you're loving the podcast and would like to give Anna a warm, fuzzy feeling of appreciation, then you can buy her a coffee:https://buymeacoffee.com/bigdrinkrethinkAbout the host Anna:Anna is a certified Alcohol Mindset Coach, trained by Annie Grace of This Naked Mind. Drawing on her own journey out of alcohol addiction, she now helps others explore and control their drinking. With a career spanning 25 years as a Strategist in the Advertising industry, she combines her own lived experiences, with great insight into what makes us tick and what influences us to behave the way we do. Connect with Anna:Website: thebeliefscoach.comLinkedIn: linkedin.com/in/annadonagheyInstagram:

Credits: 0.25 AMA PRA Category 1 Credit™   CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-436 Overview: Many patients with chronic obstructive pulmonary disease (COPD) are improperly treated with inhaled corticosteroids (ICS), increasing their risk of harm. This episode explores the latest evidence on long-term ICS risks and provides practical guidance to help you align COPD care with current guidelines—improving outcomes while minimizing adverse effects like pneumonia, cataracts, type 2 diabetes mellitus, and osteoporosis. Episode resource links: Pace WD, Callen E, Gaona-Villarreal G, Shaikh A, Yawn BP. Adverse outcomes associated with inhaled corticosteroid use in individuals with chronic obstructive pulmonary disease. Ann Fam Med. 2025;23(2):127-135. doi:10.1370/afm.240030 Pocket Guide to COPD Diagnosis, Management, and Prevention: A Guide for Healthcare Professionals. 2025 Edition. Global Initiative for Chronic Obstructive Lung Disease. https://goldcopd.org/2025-gold-report/ Guest: Jillian Joseph, PA-C   Music Credit: Matthew Bugos Thoughts? Suggestions? Email us at FranklySpeaking@pri-med.com   

Credits: 0.25 AMA PRA Category 1 Credit™   CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-436 Overview: Many patients with chronic obstructive pulmonary disease (COPD) are improperly treated with inhaled corticosteroids (ICS), increasing their risk of harm. This episode explores the latest evidence on long-term ICS risks and provides practical guidance to help you align COPD care with current guidelines—improving outcomes while minimizing adverse effects like pneumonia, cataracts, type 2 diabetes mellitus, and osteoporosis. Episode resource links: Pace WD, Callen E, Gaona-Villarreal G, Shaikh A, Yawn BP. Adverse outcomes associated with inhaled corticosteroid use in individuals with chronic obstructive pulmonary disease. Ann Fam Med. 2025;23(2):127-135. doi:10.1370/afm.240030 Pocket Guide to COPD Diagnosis, Management, and Prevention: A Guide for Healthcare Professionals. 2025 Edition. Global Initiative for Chronic Obstructive Lung Disease. https://goldcopd.org/2025-gold-report/ Guest: Jillian Joseph, PA-C   Music Credit: Matthew Bugos Thoughts? Suggestions? Email us at FranklySpeaking@pri-med.com   

In this episode of the Global Medical Device Podcast, Etienne Nichols and regulatory expert Mike Drues take a critical look at the FDA's Manufacturer and User Facility Device Experience (MAUDE) database. While intended to serve as a vital tool for post-market surveillance, the MAUDE database is fraught with issues—from late reporting and missing data to unclear mission alignment. Mike challenges MedTech professionals to rethink how we engage with the system, exposing how widespread underreporting and data hygiene problems not only weaken safety efforts but also increase legal risk. This eye-opening discussion reveals where the breakdowns are occurring, who's responsible, and what industry and regulators can do to fix it.Key Timestamps[02:30] What is the MAUDE database, and why does it matter?[06:10] The critical difference between reportable and non-reportable adverse events[11:20] Limitations of MAUDE: Why FDA warns against using it for rate comparisons[17:45] Underreporting, late submissions, and missing data: The disturbing stats[25:00] High-profile companies dominating late reporting violations[32:10] Legal consequences: What expert witnesses look for in MAUDE data[38:50] Is it poor systems or lack of regulatory understanding causing failures?[46:00] Recommendations for manufacturers: What responsible reporting looks like[53:20] How FDA could modernize the MAUDE database to better serve patients[1:01:30] Carrots or sticks: Creating incentives vs. penalties for compliance[1:09:00] Final thoughts: The true mission of MAUDE and how to fulfill itStandout Quotes"A report in the MAUDE database is just a historical record. It doesn't say why it happened or who's at fault—just that it happened."— Mike DruesThis quote underscores the limited utility of MAUDE reports and why interpretation requires caution."If you're not a medical device professional without your tools, then you're not really a medical device professional."— Etienne NicholsA poignant reminder that compliance and quality are human-led, not software-enabled by default.Top TakeawaysLate Reporting is Widespread and RiskyNearly 30% of MAUDE reports are filed late, with 10% submitted more than six months past due. This creates legal exposure and potential patient harm.MAUDE Is Misused—Despite FDA WarningsManufacturers commonly use MAUDE for competitive analysis or trend detection, even though the FDA explicitly warns against it.Three Companies Account for Over Half of Late ReportsLarge, well-resourced companies like Medtronic and Becton Dickinson are responsible for a disproportionate share of noncompliance.Electronic Tools Help, but Culture Matters MoreSoftware can support MDR timelines, but organizations still need internal processes and urgency to act responsibly.FDA and Industry Both Need to EvolveSuggestions include AI-driven cross-referencing, tiered reporting urgency, and incentive-based compliance recognition.ReferencesFDA MAUDE Database21 CFR 803.16 – MDR Reporting RequirementsEtienne Nichols on LinkedInMedTech 101: What Is MAUDE and Why Should You Care?Think of the MAUDE database as a public logbook of adverse events involving medical

Since Mircea has just gotten to Aspen for the summer, we thought it would be a great time to talk about adjusting to adverse playing conditions in pickleball. Today we talk altitude, wind, indoor, sun, cold, and hot, and how to adjust to them! Learn more about your ad choices. Visit megaphone.fm/adchoices

Dustin, Tony, and Kyle are on to talk about 10/22's, 777 grain 45-70 rounds, Akdas Alcor conversion kits, AR10's, bush plinking, and How to Stay Motivated as Gun Owners in the Current Adverse Climate. The post Episode 608 – How to Stay Motivated as Gun Owners in the Current Adverse Climate appeared first on Slam Fire Radio.

Aradul Matinal este o emisiune de informații matinale pentru minți matinale servite în eter și-n online de Basil Mureșan, Mihai Todoca și Mihai Molnar. Cel mai provincial morning show!Ne auzim în fiecare dimineață, de Luni până Vineri, de la 07:00 la 11:00 pe 99,1FM sau online pe ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠http://live.radioarad.ro⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Aradul Matinal⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠este cel mai provincial morning show! 99,1 FM

The Legal Team discusses some of the nuances around disclosing material adverse facts.

Labor challenges are among some of the most difficult issues facing farmers, especially for those who use the H-2A program.

Chaque jour, écoutez le Best-of de l'Afterfoot, sur RMC la radio du Sport !

In this JCO Article Insights episode, host Michael Hughes summarizes "Co-Occurrence of Cytogenetic Abnormalities and High-Risk Disease in Newly Diagnosed and Relapsed/Refractory Multiple Myeloma" by Kaiser et al, published February 18, 2025, followed by an interview with JCO Associate Editor Suzanne Lentzsch. Transcript Michael Hughes: Welcome to this episode of JCO Article Insights. This is Michael Hughes, JCO's editorial fellow. Today I have the privilege and pleasure of interviewing Dr. Suzanne Lentzsch on the “Co-Occurrence of Cytogenetic Abnormalities and High-Risk Disease in Newly Diagnosed and Relapsed/Refractory Multiple Myeloma” by Dr. Kaiser and colleagues. At the time of this recording, our guest has disclosures that will be linked in the transcript. The urge to identify patients with aggressive disease, which is the first step in any effort to provide personalized medical care, is intuitive to physicians today. Multiple myeloma patients have experienced heterogeneous outcomes since we first started characterizing the disease. Some patients live for decades after treatment. Some, irrespective of treatment administered, exhibit rapidly relapsing disease. We term this ‘high-risk myeloma'. The Durie-Salmon Risk Stratification System, introduced in 1975, was the first formal effort to identify those patients with aggressive, high-risk myeloma. However, the introduction of novel approaches in therapeutic agents—autologous stem cell transplantation with melphalan conditioning, proteasome inhibitors like bortezomib, or immunomodulatory drugs like lenalidomide—rendered the Durie-Salmon system a less precise predictor of outcomes. The International Staging System in 2005, predicated upon the burden of disease as measured by beta-2 microglobulin and serum albumin, was the second attempt at identifying high-risk myeloma. It was eventually supplanted by the Revised International Staging System (RISS) in 2015, which incorporated novel clinical and cytogenetic markers and remains the primary way physicians think about the risk of progression or relapse in multiple myeloma. Much attention has been focused on the canonically high-risk cytogenetic abnormalities in myeloma, typically identified by fluorescence in situ hybridization: translocation t(4;14), translocation t(14;16), translocation t(14;20), and deletion of 17p. Much attention also has been focused on the fact that intermediate-risk disease, as defined by the RISS, has been shown to be a heterogeneous subgroup in terms of survival outcomes. The RISS underwent revision in 2022 to account for such heterogeneity and has become the R2-ISS, published here in the Journal of Clinical Oncology first in 2022. Translocations t(14;16) and t(14;20) were removed, and gain or amplification of 1q was added. Such revisions to core parts of a modern risk-stratification system reflect the fact that myeloma right now is in flux, both in treatment paradigms and risk-stratification systems. The field in recent years has undergone numerous remarkable changes, from the advent of anti-CD38 agents to the introduction of cellular and bispecific therapies, to the very technology we use to investigate genetic lesions. The major issue is that we're seeing numerous trials using different criteria for the definition of high-risk multiple myeloma. This is a burgeoning problem and speaks very much now to a critical need for an effort to consolidate all these criteria on at least cytogenetic lesions as we move into an era of response-adapted treatment strategies. The excellent article by Kaiser and colleagues, published in the February 2024 edition of the JCO, does just that in a far-ranging meta-analysis of data from 24 prospective therapeutic trials. All 24 trials were phase II or III randomized controlled trials for newly diagnosed and relapsed/refractory multiple myeloma. The paper takes a federated analysis approach: participants provided summaries and performed prespecified uniform analyses. The high-risk cytogenetic abnormalities examined were translocation t(4;14), gain or amplification of 1q, deletion of 17p, and translocation t(14;16), if included in the original trials. All of these were collected into zero, single, or double-hit categories, not unlike the system currently present in diffuse large B-cell lymphomas. The outcomes studied were progression-free survival and overall survival, with these analyses adhering to modified ITT principles. The authors also performed prespecified subgroup analyses in the following: transplant-eligible newly diagnosed myeloma, transplant non-ineligible newly diagnosed myeloma, and relapsed/refractory myeloma. They, in addition, described heterogeneity by the I2 statistic, which, if above 50%, denotes substantial heterogeneity by the Cochrane Review Handbook, and otherwise performed sensitivity analyses and assessed bias to confirm the robustness of their results. In terms of those results, looking at the data collected, there was an appropriate spread of anti-CD38-containing and non-containing trials. 7,724 patients were evaluable of a total 13,926 enrolled in those 24 trials: 4,106 from nine trials in transplant-eligible myeloma, 1,816 from seven trials in transplant non-ineligible myeloma, and 1,802 from eight trials in relapsed/refractory disease. ISS stage for all patients was relatively evenly spread: stage I, 34.5%; stage II, 37%; stage III, 24%. In terms of high-risk cytogenetic lesions, double-hit disease was present in 13.8% of patients, and single-hit disease was present in 37.4%. In terms of outcomes, Kaiser and colleagues found a consistent separation in survival outcomes when the cohort was stratified by the number of high-risk cytogenetic lesions present. For PFS, the hazard ratio was for double-hit 2.28, for single-hit 1.51, without significant heterogeneity. For overall survival, the hazard ratio was for double-hit disease 2.94, single-hit disease 1.69, without significant heterogeneity except in patients with double-hit disease at 56.5%. By clinical subgroups, hazard ratios remained pretty consistent with the overall cohort analysis. In transplant-eligible newly diagnosed myeloma, the hazard ratio for progression is 2.53, overall survival 4.17. For transplant non-ineligible, 1.97 progression, 2.31 mortality. Relapsed/refractory disease progression 2.05, overall mortality 2.21, without significant heterogeneity. Of trials which started recruitment since 2015, that is to say, since daratumumab was FDA approved and thus since an anti-CD38 agent was incorporated into these regimens, analysis revealed the same results, with double-hit myeloma still experiencing worse survival by far of the three categories analyzed. Risk of bias overall was low by advanced statistical analysis. In terms of subgroup analysis, double-hit results for transplant-eligible newly diagnosed myeloma may have been skewed by smaller study effects, where the upper bound of the estimated hazard ratio for mortality reached into the 15 to 20 range. In conclusion, from a massive amount of data comes a very elegant way to think about the role certain cytogenetic abnormalities play in multiple myeloma. A simple number of lesions - zero, one, or at least two - can risk-stratify. This is a powerful new prognostic biomarker candidate and, somewhat soberingly, also may confirm, or at least suggests, that anti-CD38 agents are unable to overcome the deleterious impact of certain biologic characteristics of myeloma. Where do we go from here? This certainly needs further a priori prospective validation. This did not include cellular therapies. The very scale at which this risk-stratification system operates, agnostic to specific genetic lesion, let alone point mutations, lends itself also to further exploration. And to discuss this piece further, we welcome the one and only Dr. Suzanne Lentzsch to the episode. Dr. Lentzsch serves as an associate editor for JCO and is a world-renowned leader at the bleeding edge of plasma cell dyscrasia research. Dr. Lentzsch, there are several new investigations which suggest that translocation t(4;14), for example, is itself a heterogeneous collection of patients. There are other studies which suggest that point mutations in oncogenes like TP53, which were not assessed in Kaiser et al., carry substantial detrimental impact. Is this classification system - no-hit, single-hit, double-hit - too broad a look at tumor genetics? And how do you think we will end up incorporating ever more detailed investigations into the genetics of multiple myeloma moving forward? Dr. Suzanne Lentzsch: Michael, first of all, excellent presentation of that very important trial. Great summary. And of course, it's a pleasure to be here with JCO and with you to discuss that manuscript. Let me go back a little bit to high-risk multiple myeloma. I think over the last years, we had a lot of information on what is high-risk multiple myeloma, and I just want to mention a couple of things, that we separate not only cytogenetically high-risk multiple myeloma, we also have functional high-risk multiple myeloma, with an early relapse after transplant, within 12 months, or two years after start of treatment for the non transplant patients, which is difficult to assess because you cannot decide whether this is a high-risk patient before you start treatment. You only know that in retrospective. Other forms of high-risk: extramedullary disease, circulating tumor cells/plasma cell dyscrasia, patients who never achieve MRD positivity, extramedullary multiple myeloma, or even age and frailty is a high risk for our patients. Then we have gene expression and gene sequencing. So there is so much information currently to really assess what is high-risk multiple myeloma, that is very difficult to find common ground and establish something for future clinical trials. So what Dr. Kaiser did was really to develop a very elegant system with information we should all have. He used four factors: translocation t(14;16), t(4;14), gain or amplification of 1q, and deletion of 17p. Of course, this is not the entire, I would say, information we have on high risk, but I think it's a good standard. It's a very elegant system to really classify a standard single-hit, double-hit, high-risk multiple myeloma, which can be used for all physicians who treat multiple myeloma, and especially, it might also work in resource-scarce settings. So, ultimately, I think that system is an easy-to-use baseline for our patients and provides the best information we can get, especially with a baseline, in order to compare clinical trials or to compare any data in the future. Michael Hughes: Thank you, Dr. Lentzsch. To the point that you made about this isn't the full story. There does, as you said, exist this persistent group of functional high-risk multiple myeloma where we see standard-risk cytogenetics, but these patients ultimately either exhibit primary refractory disease or very early relapse despite aggressive, standard aggressive treatment. How do you see risk-stratification systems incorporating other novel biomarkers for such patients? Is it truly all genetic? Or is next-generation sequencing, gene expression profiling, is that the answer? Or is there still a role for characterizing tumor burden? Dr. Suzanne Lentzsch: Excellent question, Michael, and I wish I would have the glass ball to answer that question. I see some problems with the current approach we have. First of all, to do the cytogenetics, you need good material. You only detect and identify what you have. If the bone marrow is of low quality, you have mainly peripheral blood in your bone marrow biopsy, you might not really fully have a representation of all cytogenetic changes in your bone marrow. So I think with a low-quality sample, that you might miss one or the other really cytogenetic high risk. So, having said this, I think circulating tumor cells, that might be something we will look into in the future, because circulating tumor cells are readily available, can be assessed without doing a bone marrow biopsy. And what is even more exciting, in addition to the circulating tumor cells or plasma cells, using them is next-generation sequencing. I think at the moment, we are more in a collection phase where we really try to correlate sequencing with our cytogenetics and especially to establish next-generation sequencing in all of our patients. But I think after that collection phase, maybe in the future, collecting peripheral blood and doing sequencing on peripheral blood samples might be the way to go. In addition, I don't want to forget the imaging. We started with a skeletal survey, and we know that you probably need to lose 30% of the bone before you see a lesion at all. So having imaging, such as diffusion-weighted imaging, whole-body MRI, is also, together with sequencing of the tumor cells, a step into the right direction. Michael Hughes: Thank you, Dr. Lentzsch. Bringing this back to the article at hand, how has Kaiser et al. changed the way we discuss myeloma with patients in the exam room? Dr. Suzanne Lentzsch: I think we have more data on hand. So far, we talked about standard risk and high risk, but I think right now, with a very simple system, we can go into the room and we can tell the patient, "Listen, you don't have any of those cytogenetic abnormalities. I think you have a standard risk. We might give you a simple maintenance treatment with Revlimid." But we might also go into the room and say, "I'm really concerned. You have so-called double-hit multiple myeloma. You have high-risk and at least two of those abnormal cytogenetics which we discussed, and I think you need a more intense maintenance treatment, for instance, double maintenance." I think we know that a high-risk multiple myeloma can be brought into a remission, but the problem that we have is to keep those patients into a remission. So, I think a more intense treatment, for instance, with a double maintenance, or with consolidation after transplant, and a longer and more intense treatment is justified in patients who have that truly high-risk multiple myeloma described here. Michael Hughes: Dr. Lentzsch, thank you so much for your time and your wisdom. Dr. Suzanne Lentzsch: My pleasure. Thank you for having me. Michael Hughes: Listeners, thank you for listening to JCO Article Insights. Please come back for more interviews and article summaries, and be sure to leave us a rating and review so others can find our show. For more podcasts and episodes from ASCO, please visit ASCO.org/podcasts.   The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.

reference: Sri Aurobindo and the Mother, Looking from Within, Chapter 4, Ordeals and Difficulties, pp.90-91This episode is also available as a blog post at https://sriaurobindostudies.wordpress.com/2025/05/26/overcoming-the-obstruction-of-universal-adverse-forces/Video presentations, interviews and podcast episodes are allavailable on the YouTube Channel https://www.youtube.com/@santoshkrinsky871More information about Sri Aurobindo can be found at www.aurobindo.net  The US editions and links to e-book editions of SriAurobindo's writings can be found at Lotus Press www.lotuspress.com

This discussion provides an overview of fundamental concepts in real property law. They explain different types of ownership interests, including fee simple estates, outlining the rights associated with owning land and attached structures. The texts also discuss how property interests are transferred, covering topics like deeds, mortgages as security interests, and recording statutes. Furthermore, they explore nonpossessory interests in property, such as easements, covenants, and servitudes, which affect how land can be used, alongside the government's power of eminent domain and the restrictions imposed by zoning laws. The sources highlight the legal doctrines and procedures surrounding these concepts.TakeawaysNon-possessory rights include easements, profits, and covenants.Easements allow use of another's land; profits allow resource extraction.Covenants can be real or equitable, affecting enforcement options.The Restatement Third of Property aims to unify property interests under servitudes.Moral obligation to keep promises is a key reason for enforcing covenants.Dead hand control concerns arise with perpetual restrictions.Traditionally, courts favored enforcing easements over real covenants and equitable servitudes. The American Law Institute's Restatement (Third) of the Law of Property unified these concepts under the term "servitudes" to simplify and rationalize the law.A prospective owner could purchase the property at its lower, encumbered market price and simultaneously negotiate and pay the holder of the servitude an amount to release it. This allows the purchaser to acquire the property free of the restriction.The two essential conditions are that the property must be used for a "public purpose only," and the property owner must be "compensated at fair market value."Inverse condemnation is an action initiated by a property owner when government regulation is so substantial that it effectively amounts to a taking, even without formal condemnation proceedings. Direct eminent domain is the government explicitly using its power to take private property.The "bundle of rights" concept views property ownership not as a single right, but as multiple distinct rights that can be held separately. Key rights include the right to possess, use, exclude others, enjoy benefits, and transfer interests. (Any two of these are acceptable).Fee simple is an estate of indefinite duration in real property that can be freely transferred. It is considered the most common and absolute type of estate, granting the owner the greatest discretion over the property's disposal.An estate for years is a leasehold that endures for a fixed, predetermined period and ends automatically without notice. A periodic tenancy endures for successive intervals (e.g., month to month) until properly terminated by notice equal to the length of the period (or as prescribed by statute).In most jurisdictions, a landlord has a duty to make reasonable efforts to re-let vacated premises if a tenant wrongfully abandons the lease. This duty is to reduce the landlord's losses and prevent them from allowing the property to remain empty while still suing for the full rent owed.Adverse possession is a legal doctrine allowing a trespasser to acquire valid title to land by occupying it in a continuous, exclusive, open, notorious, and hostile manner for a statutory period. The public policy motivation is to reward productive land use, quiet title disputes, and resolve boundary issues, discouraging neglected property.A grant deed is written proof that the property title is owned free and clear of claims or liens and promises that the property hasn't been sold to anyone else. A quitclaim deed transfers whatever interest the grantor has in the property, without making any warranties or guarantees about the title.property law, non-possessory interests, easements, covenants, eminent domain, legal concepts, law students, property rights, zoning, land use

This legal lecture explores the fundamental concepts of real property transfer, focusing on how land interests move from one party to another, how financing is secured through mortgages, and how buyers and lenders ensure they have good title to the property. It covers the essential steps in a land sale, including the requirement for a written contract under the statute of frauds and exceptions like part performance, along with the implications of equitable conversion during the contract period. The lecture also details the requirements for deeds that convey legal ownership, explains the different types of deeds and the warranties they provide, and discusses the crucial concepts of delivery and acceptance. Furthermore, it examines how recording systems determine priority among competing interests, explains the different types of recording statutes (race, notice, race-notice), and defines various forms of notice. Finally, it introduces mortgages as security devices, discusses different foreclosure methods, and covers title assurance methods like abstract and opinion and, more commonly, title insurance, while also briefly touching upon adverse possession as another way to acquire ownership.TakeawaysUnderstanding the contract for the sale of land is fundamental.The statute of frauds requires written agreements to prevent disputes.Equity can intervene in handshake deals through part performance.The deed is crucial for transferring legal title.Different types of deeds offer varying levels of protection.Delivery and acceptance are key to a valid deed transfer.Recording deeds provides public notice and establishes priority.Mortgages serve as security interests for lenders.Title insurance protects against hidden defects in property titles.Adverse possession allows for acquiring title through long-term possession.real property, land transfer, mortgages, title assurance, property law, contract, deed, title insurance, foreclosure, adverse possession

This legal lecture explores the fundamental concepts of real property transfer, focusing on how land interests move from one party to another, how financing is secured through mortgages, and how buyers and lenders ensure they have good title to the property. It covers the essential steps in a land sale, including the requirement for a written contract under the statute of frauds and exceptions like part performance, along with the implications of equitable conversion during the contract period. The lecture also details the requirements for deeds that convey legal ownership, explains the different types of deeds and the warranties they provide, and discusses the crucial concepts of delivery and acceptance. Furthermore, it examines how recording systems determine priority among competing interests, explains the different types of recording statutes (race, notice, race-notice), and defines various forms of notice. Finally, it introduces mortgages as security devices, discusses different foreclosure methods, and covers title assurance methods like abstract and opinion and, more commonly, title insurance, while also briefly touching upon adverse possession as another way to acquire ownership.TakeawaysUnderstanding the statute of frauds is crucial for real estate contracts.Part performance can create enforceable obligations despite unwritten agreements.Equitable conversion shifts risk of loss to the purchaser upon contract execution.Different types of deeds offer varying levels of protection to grantees.Delivery and acceptance are essential for a deed to convey legal title.Recording systems determine priority among competing claims to property.Mortgages can be classified under lien theory, title theory, or intermediate theory.The equity of redemption allows mortgagers to reclaim property before foreclosure.Foreclosure processes can be judicial or non-judicial, impacting strategy.Adverse possession allows for title acquisition through continuous possession.Real Property Law, land transfer, mortgages, title assurance, conveyance, contracts, deeds, foreclosure, title insurance, adverse possession

Irbesartan is an angiotensin II receptor blocker (ARB) used primarily for the management of hypertension and diabetic nephropathy in type 2 diabetes. It selectively inhibits the binding of angiotensin II to the AT1 receptor found in vascular smooth muscle and the adrenal gland. This blockade results in vasodilation, reduced aldosterone secretion, decreased sodium and water retention, and ultimately lower blood pressure. Irbesartan is administered orally, with a typical starting dose of 150 mg once daily, which may be increased to 300 mg depending on the patient's clinical response and tolerability. Adverse effects of irbesartan are generally mild but can include hyperkalemia and dizziness. Hypotension may occur, especially in volume-depleted individuals or those on diuretics. Routine monitoring of renal function and serum potassium is recommended, especially in patients with underlying kidney disease or those taking potassium-sparing agents or supplements. Irbesartan is contraindicated in pregnancy due to the risk of fetal toxicity and should be discontinued as soon as pregnancy is detected.

Entre février 2023 et janvier 2024, Christophe donne des cours de DJ pour une association. Au total, il doit être payé 2.645 €. Problème, l'association n'a réglé qu'une facture de 839 €. Une association déjà connu par la rédaction de l'émission ! Thomas Renard revient sur quelques détails croustillants du dossier... Au micro de Chloé Lacrampe, un membre de l'équipe de "Ça peut vous arriver" revient sur les négociations difficiles et les moments off de ces 2h d'antenne !Distribué par Audiomeans. Visitez audiomeans.fr/politique-de-confidentialite pour plus d'informations.

What are Adverse Religious Experiences (AREs) and spiritual abuse? Aren't they the same thing as religious trauma? Join Andrew and Laura on this week's episode to discuss AREs, spiritual abuse, dynamics of power and control, how this relates to fundamentalism and how all of this…isn't religious trauma? You heard us correctly!  Andrew and Laura discuss all of this AND how these things can result in religious trauma on this episode of Sunday School Dropouts!This podcast is brought to you by the Center for Trauma Resolution and Recovery: an online trauma coaching company whose practitioners are trauma informed and trauma trained to work with individuals, couples and families who have experienced high control religion, cults, and religious trauma. For more information on the support that CTRR provides, for resources–including courses, workshops, and more–head to traumaresolutionandrecovery.com or follow us on Instagram: @traumaresolutionandrecovery The views and opinions expressed by Sunday School Dropouts are those of the hosts and not necessarily reflect the official policy or position of the Center for Trauma Resolution and Recovery. Any of the content provided by our guests, sponsors, authors, or bloggers are their own ideas and opinions.The Sunday School Dropouts podcast is not anti-religion but it is anti -harm, -power and control, -oppression and, -abuse and will speak to the harmful practices and messaging of fundamentalist groups. Follow Andrew on Instagram and TikTok @deconstruct_everything Follow Laura on Instagram and TikTok @drlauraeanderson or on her website: www.drlauraeanderson.com Hosts: Laura Anderson and Andrew KerbsMusic by Benjamin Faye Music @heytherebenji Editing and Production by Kevin Crowe

​Mike Matthews investigates the fascinating news from the week and Mike answers what is happening with people trying to buy a brand new car. Join Mike as he podcasts live from Café Anyway in podCastro Valley with Chely Shoehart, Floyd the Floorman, and John Deer the Engineer. Next show it's Benita, the Disgruntled Fiddle Player, and the Brewmaster.

Hamed Kayello, Product Manager at Georgia-Pacific, joined us to talk about his webinar, “Advanced Design Against Adverse Conditions in a Commercial Roofing System.” Listen in as he chats about some common risk factors when it comes to roof damage, and the benefits of fiber glass gypsum-faced panels. Register for this free webinar

Sports Daily Full Show 7 May 2025

Today's guest is Marie Flanagan, Director of Product Management in Digital Projects and Solutions at IQVIA, who joins us to explore the overlooked intersection of AI and safety workflows in life sciences. As the industry experiences an explosion in the volume and diversity of data—from social media and call centers to audio and video files—Marie outlines the mounting challenges for pharmacovigilance and the opportunities AI is unlocking for healthcare and life sciences leaders. Marie discusses how advancements in voice-to-text transcription and automation are helping safety teams manage massive datasets, pinpoint potential risks, and reallocate human resources toward high-value activities like signaling and benefit-risk management. She also shares insights into where human expertise remains essential, particularly in interpreting complex clinical contexts that AI alone cannot fully capture. Want to share your AI adoption story with executive peers? Click emerj.com/expert2 for more information and to be a potential future guest on Emerj's flagship ‘AI in Business' podcast!

Marco Sammon joins Ben and Dan to unpack his latest paper, ‘Index Rebalancing and Stock Market Composition', beginning with how Marco's work (co-written by John Shim) compares to the Nobel Prize-winner Bill Sharpe's paper, ‘Arithmetic of Active Management.' We investigate the missing links in Sharpe's logic before defining “the market” and ascertaining the main objectives of index funds. Then, we dive deeper into the mechanics of Marco's paper, index and market tracking errors, why delayed rebalancing is more beneficial than instant rebalancing, and the role of technology in the modern tracking error obsession. We also assess the passive-active spectrum of index funds in portfolio management and learn how investors should choose their optimal excess return. To end, Marco shares practical applications for improving performance benchmarked against traditional indexes, and The Aftershow is all about bridging the gap between PWL Capital and you, our listeners. Key Points From This Episode:   (0:00:00) Key takeaways from Marco Sammon's latest paper and how it compares to Bill Sharpe's ‘Arithmetic of Active Management.' (0:08:10) Marco describes what's missing from the ‘Arithmetic of Active Management' logic. (0:09:11) Defining ‘the market', the main objective of an index fund, and how index funds track the market. (0:15:57) The mechanics of Marco's paper, ‘Index Rebalancing and Stock Market Composition.' (0:18:38) Factor exposure, index and market tracking errors, and how often index funds trade. (0:26:28) Rebalancing less frequently; why delayed does better than instant rebalancing. (0:31:59) The tech run-up and lazy rebalancing, and the modern tracking error obsession.  (0:36:51) Assessing the passive-active spectrum of index funds in portfolio management. (0:41:02) Exploring how investors should decide on their optimal excess return.  (0:45:14) How the rising index fund ownership of stocks impacts the implicit cost of indexing (0:46:58) Practical ways to improve performance benchmarked against traditional indexes. (0:52:30) The Aftershow: Canadian finances, more airtime for Cameron, and PWL – OneDigital.    Links From Today's Episode: Meet with PWL Capital — https://calendly.com/d/3vm-t2j-h3p Rational Reminder on iTunes — https://itunes.apple.com/ca/podcast/the-rational-reminder-podcast/id1426530582. Rational Reminder Website — https://rationalreminder.ca/  Rational Reminder on Instagram — https://www.instagram.com/rationalreminder/ Rational Reminder on X — https://x.com/RationalRemindRational Reminder on TikTok — www.tiktok.com/@rationalreminder Rational Reminder on YouTube — https://www.youtube.com/channel/ Rational Reminder Email — info@rationalreminder.caBenjamin Felix — https://pwlcapital.com/our-team/ Benjamin on X — https://x.com/benjaminwfelix Benjamin on LinkedIn — https://www.linkedin.com/in/benjaminwfelix/ Dan Bortolotti on LinkedIn — https://www.linkedin.com/in/dan-bortolotti-8a482310/ Episode 322: Prof. Marco Sammon: How are Passive Investors Affecting the Stock Market? — https://rationalreminder.ca/podcast/322 Episode 200: Prof. Eugene Fama — https://rationalreminder.ca/podcast/200  Episode 268: Itzhak Ben-David: ETFs, Investor Behavior, and Hedge Fund Fees — https://rationalreminder.ca/podcast/268  Episode 112: Michael Kitces: Retirement Research and the Business of Financial Advice — https://rationalreminder.ca/podcast/112  Marco Sammon — https://marcosammon.com/  Marco Sammon on LinkedIn — https://www.linkedin.com/in/marco-sammon-b3b81456/  Marco Sammon on X — https://x.com/mcsammon19  Marco Sammon | Harvard Business School — https://www.hbs.edu/faculty/Pages/profile.aspx?facId=1326895  Marco Sammon Email — mcsammon@gmail.com  John Shim on LinkedIn — https://www.linkedin.com/in/john-shim-2931271b/  Vanguard — https://global.vanguard.com/  Sheridan Titman on LinkedIn — https://www.linkedin.com/in/sheridan-titman-226b0811/  Alex Chinko — https://alexchinco.com/  Erik Stafford | Harvard Business School — https://www.hbs.edu/faculty/Pages/profile.aspx?facId=6625  Itzhak (Zahi) Ben-David on LinkedIn — https://www.linkedin.com/in/ibendavi/  Bill Ackman on X — https://x.com/billackman   ‘Millennium Loses $900 Million on Strategy Roiled by Market Chaos' — https://www.bloomberg.com/news/articles/2025-03-08/millennium-loses-900-million-on-strategy-roiled-by-market-chaos   Bogleheads — https://www.bogleheads.org/   The Money Scope Podcast Episode 8: Canadian Investment Accounts — https://moneyscope.ca/2024/03/01/episode-8-canadian-investment-accounts/  The Wealthy Barber Podcast — https://thewealthybarber.com/podcast/   Financial Advisor Success Podcast — https://www.kitces.com/blog/category/21-financial-advisor-success-podcast/  Financial Advisor Success Podcast Episode 433: When You 10X Your Advisory Firm To Over $20M Of Revenue…And Want To 10X Again, With Cameron Passmore — https://www.kitces.com/blog/cameron-passmore-pwl-capital-10x-revenue-growth-advisory-firm/   OneDigital — https://www.onedigital.com/  The Longview Podcast: Ben Felix   Papers From Today's Episode:    ‘The Arithmetic of Active Management' — https://www.jstor.org/stable/4479386    ‘Index Rebalancing and Stock Market Composition: Do Index Funds Incur Adverse Selection Costs?' — https://papers.ssrn.com/sol3/papers.cfm?abstract_id=5080459     ‘Luck versus Skill in the Cross-Section of Mutual Fund Returns' — https://papers.ssrn.com/sol3/papers.cfm?abstract_id=1356021    ‘The Passive-Ownership Share Is Double What You Think It Is' — https://papers.ssrn.com/sol3/papers.cfm?abstract_id=4188052    ‘Long-Term Returns on the Original S&P 500 Companies' — https://www.researchgate.net/publication/247884354_Long-Term_Returns_on_the_Original_SP_500_Companies     ‘The Price of Immediacy' — https://papers.ssrn.com/sol3/papers.cfm?abstract_id=1001762   ‘Competition for Attention in the ETF Space' — https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3765063    ‘Passive in Name Only: Delegated Management and “Index” Investing' — https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3244991      Jeremy Stein — “Unanchored” Strategy

Watch every episode ad-free & uncensored on Patreon: https://patreon.com/dannyjones Rick Strassman is best known for pioneering DMT research in humans and proposing that DMT could be a biological gateway to mystical or alternate realities. Currently, Dr. Strassman serves as a Clinical Associate Professor of Psychiatry at the University of New Mexico School of Medicine. His new book, "My Altered States: A Doctor's Extraordinary Account of Trauma, Psychedelics, and Spiritual Growth," is available now. SPONSORS http://morning.ver.so/danny - Use code DANNY for 15% off your first order. https://hims.com/danny - Start your FREE online visit today. https://whiterabbitenergy.com/?ref=DJP - Use code DJP for 20% off EPISODE LINKS https://x.com/rick_strassman https://www.rickstrassman.com FOLLOW DANNY JONES https://www.instagram.com/dannyjones https://twitter.com/jonesdanny OUTLINE 00:00 - Adverse effects of DMT 06:54 - Is DMT the source of human consciousness? 10:25 - Extended state DMT experiments 20:19 - DMT reveals a universal religion 29:08 - Psychedelic religion of mystical consciousness 35:10 - What Danny saw during DMT experiment 37:54 - Terrifying experience on 5-MeO DMT 41:39 - Melatonin & the pineal gland 52:43 - When DMT stops working 57:38 - DMT & NDE's 01:02:45 - Telepathic experiences on psychedelics 01:12:53 - Prophets of the bible 01:18:34 - The first anti-christ 01:31:42 - Drugs in antiquity 01:37:24 - CIA-funded LSD clinics w/ Charles Manson 01:40:13 - Rick's friendship with Joe Rogan 01:45:42 - Did ergot & psychedelics create religion? 01:53:12 - Government research on psychedelic soldiers 02:03:01 - Amphetamines & adderall 02:14:00 - Next species of humans will have telepathy 02:19:39 - John Mack's alien research vs. psychedelics 02:26:53 - Remembering previous lives 02:29:20 - Translating the book of Genesis 02:34:06 - DARPA research on buddhism Learn more about your ad choices. Visit podcastchoices.com/adchoices

Nearly forty medical drugs have been recalled by the Food and Drug Administrationover fears of faulty manufacturing. All of the medical drugs in question were produced byGlenmark Pharmaceuticals Inc at its factory in India and were initially recalled on March13. The FDA gave the recall a Class II risk level on April 8 th . If you take any medical drugs,over the counter or prescription standby for FDA warnings information.Special Guest – Larry Logsdon ‘How to Safely & Effectively Relieve AcidRefux/Heartburn'

In this podcast, Dr. Valentin Fuster discusses a study on pre-pregnancy obesity and its long-term effects on pregnancy outcomes and cardiovascular health later in life. The research highlights how pre-pregnancy obesity and overweight increase the risk of gestational diabetes, hypertension, and future cardiovascular disease, underscoring the need for early weight management and more research on treatments like GLP-1 receptor agonists.

This episode challenges the dental industry's casual approach to gingivitis and reframes bleeding gums as a severe systemic health warning that demands attention! Melissa and Tabitha reveal why making gingivitis identification compelling to patients is crucial for oral and overall health outcomes. Link to Meissa's Post mentioned in the episode:  https://www.instagram.com/reel/DG0LnVGsrnT/?utm_source=ig_web_copy_link&igsh=MzRlODBiNWFlZA== Key Topics Covered

Show Notes: Cara Natterson moved to New York City where she worked for a drug rehabilitation center, and later moved to Baltimore, where she studied at Johns Hopkins Medical School. She eventually returned to L.A. and practiced pediatrics there. Her writing career began at the age of 31 when a co-worker asked her to read his manuscript, which inspired her to write her own book about raising kids. The Body Book Series and Less Awkward Company In 2008, Cara decided to leave clinical medicine and become a full-time writer. In 2011, after speaking at Mattel, she was signed on to write for the Body Book series from American Girl, which has since sold millions of copies. Cara then started touring the country, focusing on puberty education. During this time, she discovered that there was nothing else available for kids whose bodies, brains, feelings, and friends were changing. She launched her own business, Less Awkward, a company that created direct-to-consumer products designed for comfort and health like bras and socks. Cara has since expanded the company to focus on content across social media, podcasting, newsletter, and school curriculum. Health and Sex Education Curriculum In the past year, she has rolled out two platforms: a health and sex education curriculum for schools, which is already implemented in three states, and a membership for parents and trusted adults. Cara talks about the importance of understanding and discussing puberty in young people. She highlights the slower pace of puberty, with girls entering puberty at an average age of 8-9, and boys at an average age of 9-10. She emphasizes the importance of discussing the first signs of puberty, such as breast budding or testicular growth. She also highlights the importance of discussing the issue of first porn exposure, which is a significant concern for parents, family members, coaches, mentors, healthcare providers, and educators. She emphasizes the need to educate children about free porn, which is generally violent and aggressive, and calls for a less awkward approach to discussing this topic. By engaging in conversations about this topic, adults can help their children navigate the challenges of puberty and promote healthier lifestyles. Launching a Direct-to-Consumer Product Cara talks about the shift from a pediatrician to writer to entrepreneur. She initially went to medical school but, although she found it interesting, she also realized that she was more of a creative type. However, her background combined with her creative mind led to the drive to develop comfortable and healthy products. After a chat with a friend about bras, she was convinced that there was a need for comfortable bras for young girls. The two women partnered with a sewer who made a comfortable and healthy bra for their daughters, and later pulled together a team that developed the product over many years. They patented the product and launched the company during the COVID-19 pandemic. It was initially launched as a mask company, focusing on distribution and production channels instead of bras to supply the then current demand. Six months later they launched their bra products. She talks about the journey from design and development to launching the product and what she learned along the way. Cara's business ethos has always been to do well and to do good at the same time, and she has found this to be a recipe for success. The This Is So Awkward Podcast The conversation turns to Cara's podcast which she started with her partner, Vanessa Kroll Bennett. The podcast addresses the confusion about the length of puberty. It features background episodes and guest appearances with experts from various fields. In October 2023, they published a book called This Is So Awkward: Modern Puberty Explained, which explores the changes in puberty and how to talk about them, and it includes essays by kids about their experiences with acne, first periods, and heartbreaks. The podcast has expanded along with content on Instagram and TikTok. All of this content is also available on the website LessAwkward.com. They also have a school-based health and sex education curriculum called That Health Class. Navigating Today's Cultural Complexities Cara emphasizes the importance of pediatricians in understanding and managing the changes in puberty. She explains that kids and their adults are overwhelmed by the complexity of the world and the increased access to a wide and diverse range of information. Pediatricians often lack the time or bandwidth to provide anticipatory guidance for children, an especially big issue given the mental health crisis among children. Cara mentions that pediatricians often turn to the LessAwkward website where they have trained an AI bot on their content. Pediatricians are starting to use it as a healthcare solution when they don't have the time to answer questions but their patients want to be able to anticipate what's coming. The bot is reliable, gated, and trained on good data, making it engaging and entertaining. The levity and warmth of the content make it a valuable tool for pediatricians to recommend. Factors that Contribute to Early Puberty The American Girl Body Book series launched just after a 1997 study showed that girls were entering puberty earlier. It stated that the average age has shifted from 11 to 10, and a follow-up study in 2010 found it to be between eight and nine. The reason for this change is under investigation, but it is believed to be due to a number of factors, including stress, adverse childhood experiences, and antibiotics. Stress causes cortisol surges, which can either trigger the release of hormones like LH and FSH, or cause sex hormones to surge. Adverse childhood experiences, such as witnessing trauma or drug abuse, can increase the risk of entering puberty early. Evolutionary theory suggests that the human body is meant to reproduce before life ends, and so it makes sense that the general stress response might drive earlier development. She mentions Louise Greenspan, a woman who has been researching puberty for decades, has written a book called The New Puberty which further explores this topic. The Male Side of the Story Cara's parenting podcast has a diverse audience, with nearly 20% male listenership. She shares her experiences with male listeners and the challenges they face in connecting with their children. She wrote Decoding Boys, and states, with a degree of jocularity, that there is no data on the connection between testosterone and silence, but it is common among males, especially in their tween years. She shares personal strategies to help connect with tween or teen boys, as they do want to talk and share their thoughts with trusted adults. In the book, Cara shares strategies she has used, and in this conversation, she shares a personal experience on how she encouraged her son to talk to her.  Influential Harvard Courses and Professors Cara's career highlights her interest in sociology and biological anthropology, which she combined at Harvard. She wrote a junior paper about female genital mutilation in Africa and a thesis about HIV prevention in teenagers in Boston suburbs. She had a vivid memory of her thesis advisor, Irven DeVore, who was an interesting thinker and helped her fit her thesis idea into the curriculum. Timestamps: 02:12: Transition to Entrepreneurship  05:46: Insights on Puberty and Parenting 09:20: Launching Less Awkward  15:42: Content Creation and Engagement  29:05: Raising Boys and Communication Strategies  35:15: Daily Routine and Collaboration  37:19: Impact of Social Media and Content Creation  39:14: Influence of Harvard Education  Links: Website: https://lessawkward.com/ Podcast: https://lessawkward.com/podcast-this-is-so-awkward-2/ Instagram: less.awkward TikTok: less.awkward Cara's Instagram: caranatterson Featured Non-profit: The featured non-profit of this episode of The 92 Report is recommended by Chris Hull who reports: “Hi. I'm Chris Hull from Harvard's fabulous class of 1992. The featured nonprofit of this episode of The 92 report is The Funds for American Studies. TFAs is an educational nonprofit that develops courageous leaders by providing students who otherwise wouldn't get a chance to come to DC to learn about how to make a difference. I've been honored to have worked with TFAs for more than three decades, since they've allowed me to study at Georgetown. At the same time, I did an internship in Washington, which helped transform my life as it has for so many others over the last half century that it's existed, who otherwise couldn't possibly afford to do such a thing. You can learn more about their work@tfas.org.” To learn more about their work, visit: work@tfas.org

CME credits: 1.00 Valid until: 21-11-2026 Claim your CME credit at https://reachmd.com/programs/cme/ProactiveAdverseEffectManagementinmCRCImprovingTolerabilitytoOptimizePatientOutcomes/32945/ In this series, Dr. Fortunato Ciardiello and Dr. Jenny Seligmann review the management of metastatic colorectal cancer (mCRC), with a focus on timing and methodology of molecular testing, targeted treatment combinations for BRAF-mutant mCRC, the management of treatment-related adverse events.

CME credits: 1.00 Valid until: 21-11-2026 Claim your CME credit at https://reachmd.com/programs/cme/CaseConsultAdverseEffectMonitoringManagementandMitigationDuringTargetedTherapyforBRAFMutantmCRc/33134/ In this series, Dr. Fortunato Ciardiello and Dr. Jenny Seligmann review the management of metastatic colorectal cancer (mCRC), with a focus on timing and methodology of molecular testing, targeted treatment combinations for BRAF-mutant mCRC, the management of treatment-related adverse events.

Welcome to episode 118 of Growers Daily! We cover:   the fascinating world of shade cloth colors, maximizing vermicompost and what to do about those overwintered carrots. We are a Non-Profit! 

Depending on who you talk to, labor reform is desperately needed in agriculture, with costs soaring, pricing out more and more farmers every day.

Depending on who you talk to, labor reform is desperately needed in agriculture, with costs soaring, pricing out more and more farmers every day.

Send us a textIn this episode, Dr. Chastain and Ginger will help you understand:Assessment of cattle welfareInjuries from poor handling facilitiesHandling methods adverse to the health and safety of cattleLink to show notes: BetterAnimalHandling.com

Adverse possession allows a person to claim ownership of land that they have occupied for more than ten years without the owner's permission. In this decision, the Supreme Court clarifies the law surrounding how and when these claims should be made. https://uklawweekly.substack.com/subscribe Music from bensound.com

Drug interactions can cause more complex side effects than the side effects of a single drug, and can even contribute to dementia. Join me as I interview Hal Cranmer, owner of several assisted living homes, and Dr. Roshani Sanghani, board-certified endocrinologist, to discuss the side effects of multiple medications. Assisted Living Home: https://aparadiseforparents.com/Epocrates:https://www.epocrates.com/Taking the following drugs for an extended period of time may potentially increase your risk for dementia. 1. Drugs that block acetylcholineThis includes Benadryl, certain drugs for depression, and drugs that treat overactive bladder. 2. BenzodiazepineDrugs such as Valium and Xanax treat anxiety, insomnia, and seizures, affecting the central nervous system and brain.3. PPIsProton pump inhibitors, such as Prilosec and Nexium, that treat indigestion and heartburn may increase the risk of cognitive decline.4. Opioids Morphine, oxycodone, and other opioids that sedate the brain significantly affect cognitive function and may lead to dementia. Hal Cranmer owns several assisted living homes and sees first-hand the consequences of giving someone several drugs at once. Many residents in assisted living homes are on 20 to 30 medications. In Hal's facilities, he focuses on providing his residents with a healthy diet and eliminating sugar and ultra-processed foods. Many of Hal's residents have been able to get off their medication. Multiple medications often involve multiple doctors with multiple viewpoints. Each doctor focuses only on specific parts and functions of the body rather than the body as a whole. Adverse drug reactions are unexpected side effects directly caused by drugs. Around 90% are underreported. Adverse drug reactions are responsible for 10% of all hospital visits and are the 4th leading cause of death. Dr. Roshani Sanghani, a board-certified endocrinologist, uses epocrates.com to help keep track of drug interactions. She points out the problem of specialists focusing on and prescribing treatment for one body part and not considering the patients' other medications. The biggest contributor to chronic disease is diet. Medications are often prescribed to treat the symptoms caused by consuming ultra-processed foods. A healthy diet can turn this cycle around.

In this engaging episode of Shark Theory, host Baylor Barbee turns an impromptu challenge into a profound life lesson using a seemingly simple birthday cake as a metaphor. Challenged to find inspiration from a cake, Baylor explores the parallels between cake-making and personal growth, emphasizing the importance of the "oven" moments in life where ingredients—often appearing unpalatable on their own—combine under pressure to create something beautiful. He eloquently connects this analogy to the importance of recognizing and valuing one's unique life ingredients, or skills, highlighting the necessity of adversity as a refining force that ultimately leads to success. Baylor delves into the transformative power of adversity, encouraging listeners to embrace challenges as essential steps to unlocking their full potential. He stresses that facing setbacks isn't about giving up but recognizing these moments as a crucial part of the refining process that life demands. With a vivid tie to his own experiences, including how the COVID-19 pandemic tested the principles outlined in his book "Opportunity Engineer," Baylor reiterates the opportunity inherent in every obstacle. This episode is a call to action for listeners to inventory their skills, embrace adversity, and actively shape their lives into a celebrated masterpiece. Key Takeaways: The metaphor of cake-making illustrates personal growth, with each ingredient representing the skills and experiences that shape our lives. Adverse situations, much like the oven for a cake, serve as a necessary component for refining and realizing our true potential. Identifying personal skills and taking inventory of one's life is crucial to understanding what one can offer to the world. Viewing adversity through a positive lens can turn setbacks into opportunities, reinforcing resilience and capability. The importance of proactive engagement in life's "cooking process," aligning one's passions and skills to bring something meaningful into the world. Notable Quotes: "Everybody wants the finished product, but nobody realizes the ingredients that lead up to it and what the cake has to go through." "The fire in life is the adversities we face. It's the setbacks, it's the obstacles." "When somebody puts you to the fire, are they finding out that you're real? Or are they finding out that you're a fraud?" "If I can put my head down and work through this adversity, then I can see what I'm truly made of." "What are you cooking? What are you putting into the world?"

0:00 Intro2:25 Adverse Selection Deep Dive 40:35 Betting News1:14:35 How to Tell your Friends & Family You are a Pro Degen1:27:11 Live EV Betting v. Live Arbing1:34:25 Dealing with Downswings1:52:37 Why GP NO MORE PICKS?!?Welcome to The Risk Takers Podcast, hosted by professional sports bettor John Shilling (GoldenPants13) and SportsProjections. This podcast is the best betting education available - PERIOD. And it's free - please share and subscribe if you like it.My website: https://www.goldenpants.com/ Follow SportsProjections on Twitter: https://x.com/Sports__ProjWant to work with my betting group?: john@goldenpants.comWant 100s of +EV picks a day?: https://www.goldenpants.com/gp-picks

Dr. Mellar Davis discusses the joint guideline from MASCC, ASCO, AAHPM, HPNA, and NICSO on opioid conversion in adults with cancer. He reviews the limited evidence, and the formal consensus process used to develop the guideline. He shares the key recommendations on pre-conversion assessment, how opioid conversion should be conducted, including opioid conversion ratios, and post-conversion assessment. We touch on gaps and questions in the field and the impact of these new recommendations.  Read the full guideline, “Opioid Conversion in Adults with Cancer: MASCC-ASCO-AAHPM-HPNA-NICSO Guideline” at www.asco.org/supportive-care-guidelines. TRANSCRIPT This guideline, clinical tools, and resources are available at http://www.asco.org/supportive-care-guidelines. Read the full text of the guideline in the Supportive Care in Cancer, https://link.springer.com/article/10.1007/s00520-025-09286-z   Brittany Harvey: Hello and welcome to the ASCO Guidelines podcast, one of ASCO's podcasts delivering timely information to keep you up to date on the latest changes, challenges and advances in oncology. You can find all the shows, including this one at asco.org/podcasts. My name is Brittany Harvey and today I'm interviewing Dr. Mellar Davis from Geisinger Medical Center, lead author on “Opioid Conversion in Adults with Cancer: Multinational Association of Supportive Care and Cancer, American Society of Clinical Oncology, American Academy of Hospice and Palliative Medicine, Hospice and Palliative Nurses Association, Network Italiano Cure di Supporto and Oncologia Guideline.” Thank you for being here today, Dr. Davis. Dr. Mellar Davis: Thank you. I'm glad to be here. Brittany Harvey Before we discuss this guideline, I'd like to note that ASCO takes great care in the development of its guidelines and ensuring that the ASCO Conflict of Interest Policy is followed for each guideline. The disclosures of potential conflicts of interest for the guideline panel, including Dr. Davis, who has joined us here today, are available online with the publication of the guideline, which is linked in our show notes. So then, to dive into the content here, Dr. Davis, can you provide an overview of both the scope and purpose of this guideline on opioid conversion in people with cancer? Dr. Mellar Davis: This is an important topic in management of cancer pain and this topic came up as a result of a survey that MASCC had done, which involved 370 physicians in 53 countries. They were queried about how they change or convert one opioid to another, which is a common practice, and we found that there was quite a divergence in opioid conversion ratios. To step back a little bit, about two thirds of patients with advanced cancer have moderate to severe pain and most of the time they're managed by opioids. But about 20% or 40% require a switch either because they have an adverse reaction to it or they don't respond to it, or the combination of both. Rarely, it may be that they need a route change, perhaps because they have nausea or vomiting. So, the opioid conversion works basically because of the complexity of the new opioid receptor which has at least four exons to it as a result of that non-cross tolerance between opioids. As a result of the survey, we convened a group of specialists, 14 international specialists, to look to see if we could develop an international guideline. And we did a systematic review which involved viewing 21,000 abstracts and we came up with 140 randomized trials and 68 non-randomized trials. And after reviewing the data, we found that the data was really not strong enough to provide a guideline. As a result, ASCO, MASCC, the AAHPM, the HPNA and the Italian Group formed a supportive network that allowed us then to do a Delphi guideline based upon ASCO modified criteria for doing Delphi guidelines. And so we then involved 27 additional international experts informing the guideline to it. And this guideline is then the result of the Delphi process. It consists basically of a pre-conversion ratio recommendations, conversion ratios, which is actually a major contribution of this guideline, and then what to do after converting someone to another opioid. Our target audience was not only oncologists, but also we wanted to target nurses, pharmacists, hospitalists, primary care physicians, patients and caregivers. Brittany Harvey: I appreciate that background information, particularly on the evidence that is underpinning this and the lack of quality of evidence there, which really transformed this into a formal consensus guideline. We're glad to have all of these organizations coming together to collaborate on this guideline. So then next I'd like to review the key recommendations. So starting with, what is recommended for pre-conversion assessment? Dr. Mellar Davis: In regards to pre-conversion, physicians and clinicians need to be aware of pain phenotypes. That is, there are pains that are more opioid refractory than others, such as neuropathic pain, hence, they may be more resistant to the opioid that you're converting to. One needs to be aware of the fact that patients may not be compliant, they're either afraid of opioids not taking what was prescribed, so it's important to query patients about whether they are taking their opioid as prescribed. Occasionally, there are patients who will divert their medication for various reasons. Pain may be poorly controlled also because of dosing strategies that are poorly conceived, in other words, giving only ‘as needed' opioids for continuous cancer pain. And there are rare circumstances where an opioid actually induces pain and simply reducing the opioid actually may improve the pain. The other issue may be cancer progression. So that poorly controlled pain or rapidly increasing pain may actually be a result of progressive cancer and changing treatment obviously will be important. And you need to assess the pain severity, the quality of the pain, the radiating localizing effects, which does require not only a physical exam but also radiographic examinations. But the other thing that's very important in opioid conversions are pain scales with function. A significant number of patients don't quite understand a numerical scale which we commonly use: 0 to 10, with 10 being severe pain and 0 being no pain. They may in fact focus more on function rather than on pain severity or pain interference with daily activities or roles. Sometimes patients will say, “Oh, my pain is manageable,” or “It's tolerable,” rather than using a numerical scale. Choices of opioids may be based on cost, drug-drug interactions, organ function, personal history or substance use disorder so that one will want to choose an opioid that's safe when converting from one to another. And obviously social support and having caregivers present and understanding the strategy in managing pain will be important. Brittany Harvey: Thank you, Dr. Davis, for reviewing those pre-conversion assessment considerations and particularly the challenges around some of those. So, following this pre-conversion assessment, what are the recommendations on how opioid conversion should be conducted? Dr. Mellar Davis: Opioid conversions are basically the safe dose. People have used the term ‘equianalgesia', but the panel and the consensus group felt that that would be inappropriate. So a conversion ratio is the dose at which the majority of patients will not experience withdrawal or adverse effect. It would be the safe dose. Thereafter, the dose will need to be adjusted. So, in converting, that's only the first step in managing pain, the doses need to be adjusted to the individual thereafter. There are a significant number of conversions that are done indirectly, that is that there has not been a study that has looked at a direct conversion from one opioid to another in which one needs to convert through another opioid. We call that a ‘morphine equivalent daily dose'. So, most of the time a third opioid is used in the conversion. It allows you then to convert when there hasn't been a direct study that has looked at conversion between those two opioids, but it is less accurate and so one has to be a little bit more careful when using morphine daily equivalents. We found, and I think this is the major advantage to the guideline, is that commonly used opioids - oxycodone, morphine, hydromorphone - we did establish conversion ratios to which we found in the MASCC guideline they were widely divergent and hope that actually, internationally, they will be adopted. We also found some conversion ratios for second-line opioids. However, we felt also that an opioid like methadone, which has a unique pharmacology, should be left to experts and that experts should know at least several ways of converting from morphine usually to methadone. There is what appears to be a dose-related increased potency of methadone relative to morphine, which makes it more difficult, particularly at higher doses, to have an accurate conversion ratio. Most patients will have transient flares of pain. We came up with two suggestions. One is using a 10 or 15% of the around-the-clock dose for the breakthrough dose, but we also realized that there was a poor correlation between the around-the-clock dose and the dose used for transient flares of pain. And so the breakthrough dose really needs to be adjusted to the individual responses. There was also a mention of buprenorphine. One of the unique things about buprenorphine is that if you go from high doses of a drug like morphine to buprenorphine in a stop-start dosing strategy, you can precipitate withdrawal. And so one has to be careful and have some experience in using buprenorphine, which can be an effective analgesic. Brittany Harvey: Yes, I think that the conversion ratios that you mentioned that are in Table 3 in the full guideline are a really useful tool for clinicians in practice. And I appreciate the time that the panel and the additional consensus panel went through to develop these. I think it's also really key what you mentioned about these not being equianalgesic doses and the difficulties in some of these conversions and when people need to really look to specialists in the field. So then, following opioid conversion, what assessments are recommended post-conversion? Dr. Mellar Davis: Post-conversion, probably the cardinal recommendation is close observation for response and for toxicity. And I think that probably summarizes the important parts of post-conversion follow up. So assessment should be done 24-48 hours after conversion and patients followed closely. Assessment scales should include patient personalized goals. Now, it used to be in the past that we had this hard stop about a response being below 4 on a 0 to 10 scale, but each patient has their own personal goals. So they gauge the pain severity and their function based upon response. So a patient may function very well at “a severity of 5” and feel that that is their personal goal. So I think the other thing is to make sure that your assessment is just not rote, but it's based upon what patients really want to achieve with the opioid conversion. The average number of doses per day should be assessed in the around-the-clock dose so those should be followed closely. Adverse effects can occur and sometimes can be subtle. In other words, a mild withdrawal may produce fatigue, irritability, insomnia and depression. And clinicians may not pick up on the fact that they may be actually a bit under what patients have or they're experiencing withdrawal syndrome. It's important to look for other symptoms which may be subtle but indicating, for instance, neurotoxicity from an opioid. For instance, visual hallucinations may not be volunteered by patients. They may transiently see things but either don't associate with the opioid or are afraid to mention them. So I think it's important to directly query them, for instance, about visual hallucinations or about nightmares at night. Nausea can occur. It may be temporary, mild, and doesn't necessarily mean that one needs to stop the second opioid. It may actually resolve in several days and can be treated symptomatically. Pruritus can occur and can be significant. So close observation for the purposes of close adjustments are also necessary. As we mentioned, you want to start them on an around-the-clock of breakthrough dose, but then assess to see what their response is and if it's suboptimal then you'll need to adjust the doses based both upon the around-the-clock and the breakthrough dose or the dose that's used for breakthrough pain. Also looking at how patients are functioning, because remember that patients frequently look at pain in terms of function or interference with their roles during the day. So, if patients are able to do more things, that may, in fact, be the goal. Brittany Harvey: Thank you for reviewing all of these recommendations across pre-conversion assessment, how opioid conversion should be conducted, including conversion ratios, and what assessments are recommended after opioid conversion. I think it's really important to be watching for these adverse events and assessing for response and keeping in mind patient goals. So, along those lines, how will these guideline recommendations impact both clinicians and people with cancer? And what are the outstanding questions we're thinking about regarding opioid conversion? Dr. Mellar Davis: I think it's important to have a basic knowledge of opioid pharmacology. There's, for instance, drugs that are safer in liver disease, such as morphine, hydromorphone, which are glucuronidated. And there are opioids that are safer in renal failure, such as methadone and buprenorphine, which aren't dependent upon renal clearance. I think knowing drug-drug interactions are important to know. And sometimes, for instance, there may be multiple prescribers for a patient. The family physician's prescribing a certain medication and the oncologist is another, so being aware of what patients are on, and particularly over-the-counter medications which may influence opioid pharmacokinetics. So complementary medications, for instance, being aware of cannabis, if patients are using cannabis or other things, I think, are important in this. There are large gaps and questions and that's the last part of the guideline that we approach or that we mentioned that I think are important to know. And one is there may be ethnic differences in population in regards to clearance or cytochrome frequencies within communities or countries, which may actually alter the conversion ratios. This has not been explored to a great extent. There's opioid stigmata. So we are in the middle of an opioid crisis and so people have a great fear of addiction and they may not take an opioid for that reason, or they may have a relative who's been addicted or had a poor experience. And this may be particularly true for methadone and buprenorphine, which are excellent analgesics and are increasingly being used but may in fact have the stigmata. There are health inequalities that occur related to minority groups that may in fact not get the full benefit of opioid conversions due to access to opioids or to medical care. Age, for instance, will cause perhaps differences in responses to opioids and may in fact affect conversion ratios. And this may be particularly true for methadone, which we have not really explored to a great extent. And finally, the disease itself may influence the clearance or absorption of an opioid. So for a sick patient, the opioid conversion ratio may be distinctly different than in a healthy individual. This is particularly seen with transdermal fentanyl, which is less well absorbed in a cachectic patient, but once given IV or intravenously has a much longer half life due to alterations in the cytochrome that clears it. And so conversion ratios have frequently been reported in relatively healthy individuals with good organ function and not that frequently in older patient populations. So just remember that the conversion ratios may be different in those particular populations. Brittany Harvey: Yes. So I think a lot of these are very important things to consider and that managing cancer pain is key to quality of life for a lot of patients and it's important to consider these patient factors while offering opioid conversion. I want to thank you so much for your work to review the existing literature here, develop these consensus-based recommendations and thank you for your time today, Dr. Davis. Dr. Mellar Davis: Thank you. Brittany Harvey: And thank you to all of our listeners for tuning in to the ASCO Guidelines podcast. To read the full guideline, go to www.asco.org/supportive-care-guidelines. You can also find many of our guidelines and interactive resources in the free ASCO Guidelines app available in the Apple App Store or the Google Play Store. If you have enjoyed what you've heard today, please rate and review the podcast and be sure to subscribe so you never miss an episode.   The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.  

When Good Morning America's executive producer saw her doctor for joint pain, she never expected to be diagnosed with psoriatic arthritis—or that the medication prescribed to help her would trigger a life-threatening drug reaction. In Part 1 of this two-part episode, she shares her harrowing medical journey, from missed warning signs and delayed diagnosis to a year-long battle with the powerful steroid prednisone. We break down DRESS Syndrome, why medications are often overlooked as the cause of new symptoms, and the serious risks of steroids. Stay tuned for Part 2, where we explore how Cat's personal health crisis now shapes the national health news she brings to audiences on GMA3. Key Takeaways Don't ignore persistent symptoms. If you have fever, vomiting, or other concerning signs for more than 2 days, get medical care. Medications should always be on the suspect list. Adverse drug reactions don't always show up as a rash. They are great imitators of disease and may involve any organ system and without a rash. Oral steroids are powerful, but risky. They should never be the automatic go-to. If your doctor prescribes steroids, ask about alternatives and make sure there's a clear plan to taper off. Links GMA3: https://www.goodmorningamerica.com/author/gma3 Connect with Archelle ArcHealth Newsletter: https://www.archellemd.com/newsletter Email: SpeakUpForYourHealth@gmail.com Instagram:  https://instagram.com/speakupforyourhealth Facebook: https://www.facebook.com/speakupforyourhealth #arthritis #jointpain #sulfadrugs #drugallergy #GoodMorningAmerica #patientcare #patientadvocacy #prednisone

Editor's Summary by Kirsten Bibbins-Domingo, PhD, MD, MAS, Editor in Chief, and Preeti Malani, MD, MSJ, Deputy Editor of JAMA, the Journal of the American Medical Association, for articles published from February 1-7, 2025.

This episode is brought to you by Pique Life and Birch Living.  We used to think that the circadian rhythm only affected sleep. However, emerging science shows it's deeply connected to metabolism, cognition, chronic disease risk, and many other critical aspects of health. Our biology is designed to function in harmony with the natural light-dark cycle, but modern society has significantly disrupted this balance. Today on The Dhru Purohit Show, we bring you a special compilation episode featuring Dhru's conversations with leading experts on the critical role circadian rhythms play in our health and well-being. Dr. Satchin Panda delves into his groundbreaking research on circadian biology, revealing how leveraging your circadian rhythm can significantly improve sleep, reduce the risk of chronic diseases, and enhance cognitive function. He also shares how time-restricted eating, exercise, and light exposure can help program your circadian rhythm, with a special focus on the importance of these tools for shift workers. Dr. Moore-Ede discusses the dangers of chronic blue light exposure and its profound impact on health, highlighting research that reveals how it disrupts circadian rhythms. He also examines the connection between light exposure and obesity and explains why these risks remain underrepresented in mainstream media. Dr. Satchin Panda, a professor at the Salk Institute and founder of the UC San Diego Center for Circadian Biology, is a leading researcher in circadian biology. Dr. Martin Moore-Ede, a former Harvard Medical School professor and expert in circadian rhythms, has conducted groundbreaking research on light's role in regulating sleep-wake cycles and overall health. In this episode, Dhru and his guests dive into: Why when we eat is more important than what we eat (01:38) Effects of chronic late-night eating (08:18) Adverse effect of disrupting our circadian rhythm (16:25) What is sleep debt (19:21) Paying attention to when you eat (30:16) Research on time-restricted eating (34:08) Why sleeping with the lights on is damaging to your health (39:01) Why sun exposure is critical for good health (41:55) Dr. Martin's recommended time for sun exposure (49:28) The link between blue light and obesity (51:42) Master clock of the circadian rhythm, cortisol, melatonin, and others (54:06) Why doctors aren't talking about the harmful effects of blue lights (59:03) Blue lights in hospitals and how they prevent healing (01:04:47) Also mentioned: Full episode with Dr. Satchin Panda Full episode with Dr. Martin Ede-Moore This episode is brought to you by Pique Life and Birch Living.  Right now, Pique Life is offering 15% off the Radiant Skin Duo plus a free beaker and frother when you go to piquelife.com/dhru. To get 25% off your Birch Living mattress plus two free eco-rest pillows, head over to birchliving.com/dhru today. Learn more about your ad choices. Visit megaphone.fm/adchoices