Podcasts about Adverse

JET STREAMS, BAD WEATHER, AND THE FAILURE OF EARLY RAIDS Colleague James M. Scott. Hansel'sprecision strategy failed due to Japan's adverse weather and violent jet streams, which blew at 230 mph and ruined bomber accuracy. The B-29, which cost $3.7 billion to develop, suffered from mechanical glitches like engine fires during the 3,000-mile flights from the Mariana Islands. Early raids against the Nakajima aircraft factory were ineffective, destroying only 1% of the target. While British commanders pressured Americans to switch to firebombing cities, Hansel refused to abandon precision tactics. Meanwhile, FDR's approval of the atomic bomb suggested leadership was open to city-destroying weapons. NUMBER 2 1945 0KINAWA

Unlocking the Mysteries of Property Law: A Deep Dive into Estates and Future InterestsThis conversation provides an in-depth exploration of property law, focusing on the complexities of estates, future interests, co-ownership, landlord-tenant relationships, and zoning regulations. The discussion emphasizes the precision required in property law and offers practical insights for law students preparing for exams. Key concepts such as the rule against perpetuities, adverse possession, and the evolution of landlord-tenant law are thoroughly examined, providing a comprehensive guide for understanding this challenging subject.Property law is often seen as one of the most daunting subjects in law school, with its roots deeply embedded in historical doctrines and complex terminologies. This blog post aims to demystify the intricate world of estates and future interests, providing a structured guide for students and enthusiasts alike.Understanding the Basics: At the heart of property law lies the concept of ownership and the various interests that can be held in property. The journey begins with possessory estates, where the duration of ownership is defined. The fee simple absolute, for instance, represents the pinnacle of ownership, granting the holder the power to use, abuse, and transfer the property freely.The Language of Estates: The precision required in property law is unparalleled. A single word can determine whether an estate lasts forever or terminates automatically. Understanding the language of estates, such as the difference between a possibility of reverter and a shifting executory interest, is crucial for success.Future Interests: Future interests are not mere hopes of ownership; they are present rights with future possession. The distinction between vested and contingent remainders is pivotal. A vested remainder is a sure thing, while a contingent remainder hangs by a thread, dependent on certain conditions being met.The Rule Against Perpetuities: The infamous Rule Against Perpetuities (RAP) is designed to prevent the control of property from beyond the grave. It ensures that interests vest within a certain time frame, maintaining the marketability of land.Mastering property law requires precision and classification. By understanding the historical roots and modern applications of these doctrines, students can navigate the complexities of property law with confidence. As you prepare for exams, remember that the key to success lies in the details.Subscribe now to stay updated with more insights into the world of law.TakeawaysProperty law is defined by brutal precision.Understanding the language of estates is crucial.Fee simple absolute is the highest form of ownership.Life estates are non-inheritable and measured by life.Joint tenancy includes the right of survivorship.Remainders must follow a prior estate without gaps.The rule against perpetuities prevents remote vesting.Adverse possession rewards long-term use of property.Landlord-tenant law has evolved to protect tenants.Zoning regulations can impact property value.property law, estates, future interests, landlord-tenant, co-ownership, easements, zoning, adverse possession, rule against perpetuities, legal concepts

My guest today is Dr. Alexis Cowan, PhD,, a Princeton-trained molecular biologist specializing in metabolism, mitochondrial function, and circadian biology. We talk about why modern science has drifted into scientism, how mitochondrial dysfunction sits at the root of nearly every chronic disease, and why reclaiming sovereignty over your health is both radical and necessary. We dive deep into light biology, circadian rhythms, sun exposure, quantum biology, and the incentives that shape (and distort) modern medicine. We also explore Alexis' personal health journey, her break from academia, her work with Jack Kruse's ideas, and how Bitcoin, self-custody, and proof-of-work thinking mirror biological truth.→ Please like, comment, share & follow — to help me beat the suppressing big tech algorithms & gov. censorship. Thank you!– SPONSORS –→ Get your TREZOR wallet & accessories, with a 5% discount, using my code at checkout (get my discount code from the episode - yep, you'll have to watch it): https://affil.trezor.io/SHUn→ Have you tried mining bitcoin? Stack sats directly to your wallet while saving on taxes with Abundant Mines: https://AbundantMines.com/Efrat - Claim your free month of hosting via this link– AFFILIATES –→ Get 10% off on Augmented NAC to detox Spike protein, with the code YCXKQDK2 via this link: https://store.augmentednac.com/?via=efrat (Note, this is not medical advice and you should consult your MD)→ Be good to your eyes & health, and get the Daylight tablet - a healthier, more human-friendly computer, with zero flicker and zero blue light, by design. Thank me later ;-) https://bit.ly/Efrat_daylight→ Get a second citizenship and a plan B to relocate to another country with Expat Money, leave your details for a follow up: https://expatmoney.com/efrat→ Watch “New Totalitarian Order” conference with Prof. Mattias Desmet & Efrat - code EFRAT for 10% off: https://efenigson.gumroad.com/l/desmet_efrat→ Join me in any of these upcoming events: https://www.efrat.blog/p/upcoming-events– LINKS –Dr. Alexis Cowan's website: dralexisjazmyn.comAlexis' courses (Code HOLYDAYS for 10% off): https://dralexisjazmyn.thinkific.com/collections/products X: https://x.com/dralexisjazmynInstagram: instagram.com/dralexisjazmynYoutube: https://www.youtube.com/@UndoctrinateYourselfEfrat's Twitter: https://twitter.com/efenigsonEfrat's Channels: https://linktr.ee/efenigsonWatch on all platforms: https://linktr.ee/yourethevoiceSupport Efrat's work: ⁠https://bit.ly/zap_efrat– CHAPTERS –00:00 – Coming up.. 01:40 - Intro to Dr. Alexis Cowan05:05 - Why is Alexis dancing? 08:30 - Biology & health in the spiritual, divinity lense10:15 - Why did Alexis chose medical & biology route16:35 – Mitochondria, ATP & how energy actually works26:30 - Why modern science isn't focused on Mitochondria?32:43 – Ad Break – Trezor & Abundant Mines34:49 – How light regulates biology: circadian signaling & daily habits40:37 – Blue light + UV fear: the “block UV at all costs” narrative45:41 – Melanin, skin tone, sunlight, & artificial lights 59:40 - Skin cancer & the sun's benefits1:03:36 – Get a tan to reduce nnEMF / Wireless / 5G radiation!1:07:37 – Mitochondria's health, Transhumanism and nnEMF damages  1:19:09 – Ad Break – Expat Money & New Totalitarian Order (Mattias Desmet)1:20:55 - Grounding benefits1:24:49 – Where should we live geographically?1:29:00 – Overcast & geoengineered skies impact on light therapy 1:34:30 – Adverse reactions & cancer post C jabs1:40:40 - Prepare your body to travel & flights1:44:40 – Tips for trauma, anti-depression and stress1:56:05 - The vision for decentralized science & health 2:04:30 – The education system problems & Alexis' suggestions2:08:30 - Bitcoiners, incentives & sovereignty

Today, Dave Furfaro, Luke Hedrick, and Robert Wharton discuss the PREDMETH trial published in The New England Journal of Medicine in 2025. This was a non-inferiority trial comparing prednisone to methotrexate for upfront therapy in treatment-naive sarcoidosis patients. Listen in for a break down of the trial, analysis, and clinically applicable pearls. Article and Reference Todays’ episode discusses the PREDMETH trial published in NEJM in 2025. Kahlmann V, Janssen Bonás M, Moor CC, Grutters JC, Mostard RLM, van Rijswijk HNAJ, van der Maten J, Marges ER, Moonen LAA, Overbeek MJ, Koopman B, Loth DW, Nossent EJ, Wagenaar M, Kramer H, Wielders PLML, Bonta PI, Walen S, Bogaarts BAHA, Kerstens R, Overgaauw M, Veltkamp M, Wijsenbeek MS; PREDMETH Collaborators. First-Line Treatment of Pulmonary Sarcoidosis with Prednisone or Methotrexate. N Engl J Med. 2025 Jul 17;393(3):231-242. doi: 10.1056/NEJMoa2501443. Epub 2025 May 18. PMID: 40387020. https://www.nejm.org/doi/full/10.1056/NEJMoa2501443 Meet Our Hosts Luke Hedrick is an Associate Editor at Pulm PEEPs and runs the Rapid Fire Journal Club Series. He is a senior PCCM fellow at Emory, and will be starting as a pulmonary attending at Duke University next year. Robert Wharton is a recurring guest on Pulm PEEPs as a part of our Rapid Fire Journal Club Series. He completed his internal medicine residency at Mt. Sinai in New York City, and is currently a first year pulmonary and critical care fellow at Johns Hopkins. Key Learning Points Clinical context Prednisone remains the traditional first-line treatment for pulmonary sarcoidosis when treatment is indicated, with evidence for short-term improvements in symptoms, radiographic findings, and pulmonary function—but with substantial, familiar steroid toxicities (weight gain, insomnia, HTN/DM, infection risk, etc.). Despite widespread use, glucocorticoids haven't been robustly tested head-to-head against many alternatives as initial therapy, and evidence for preventing long-term decline (especially in severe disease) is limited. Immunosuppressants (like methotrexate) are often used as steroid-sparing agents, but guideline recommendations are generally conditional/low-quality evidence, and practice varies. Why PREDMETH matters It addresses a real-world question: Can methotrexate be an initial alternative to prednisone in pulmonary sarcoidosis, rather than being reserved only for steroid-sparing later? It also probes a common clinical belief: MTX has slower onset than prednisone (often assumed, not well-proven). Trial design (what to know) Open-label, randomized, noninferiority trial across 17 hospitals in the Netherlands. Included patients with pulmonary sarcoidosis who had a clear pulmonary indication to start systemic therapy (moderate/severe symptoms plus objective risk features like reduced FVC/DLCO or documented decline, plus parenchymal abnormalities). Excluded: non–treatment-naïve patients and those whose primary indication was extrapulmonary disease. Treat-to-tolerability with escalation: both drugs started low and were slowly increased; switch/add-on allowed for inadequate efficacy or unacceptable side effects. Primary endpoint: change in FVC (with the usual caveat that FVC is “objective-ish,” but effort-dependent and not always patient-centered). Noninferiority margin: 5% FVC, justified as within biologic/measurement variation and “not clinically relevant.” Outcomes assessed at weeks 4, 16, 24; powered for ~110 patients to detect the NI margin. Patient population (who this applies to) Mostly middle-aged (~40s) with mild-to-moderate physiologic impairment on average (FVC ~77% predicted; DLCO ~70% predicted). Netherlands-based cohort with limited Black representation (~7%), which matters for generalizability. Would have been helpful to know more about comorbidities (e.g., diabetes), which can strongly influence prednisone risk. Main findings (what happened) Methotrexate was noninferior to prednisone at week 24 for FVC: Between-group difference in least-squares mean change at week 24: −1.17 percentage points (favoring prednisone) with CI −4.27 to +1.93, staying within the 5% NI margin. Timing mattered: Prednisone showed earlier benefit (notably by week 4) in FVC and across quality-of-life measures. By week 24, those early differences largely washed out—possibly because MTX “catches up,” and/or because crossover increased over time. In their reporting, MTX didn't meet noninferiority for FVC until week 24, supporting the practical message that prednisone works faster. Crossover and analysis nuance (important for interpretation) Crossover was fairly high, which complicates noninferiority interpretation: MTX arm: some switched to prednisone for adverse events and others had prednisone added for disease progression/persistent symptoms. Prednisone arm: some had MTX added. In noninferiority trials, heavy crossover can bias intention-to-treat analyses toward finding “no difference” (making noninferiority easier to claim). Per-protocol analyses avoid some of that but introduce other biases. They reported both. Safety signals (what to remember clinically) Adverse events were very common in both arms (almost everyone), mostly mild. Side-effect patterns fit expectations: Prednisone: more insomnia (and classic steroid issues). MTX: more headache/cough/rash, and notably liver enzyme elevations (about 1 in 4), with a small number discontinuing. Serious adverse events were rare; numbers were too small to confidently separate “signal vs noise,” but overall known risk profiles apply. Limitations (why you shouldn't over-read it) Open-label design, and FVC—while objective-ish—is still effort-dependent and can be influenced by expectation/behavior. Small trial, limiting subgroup conclusions (e.g., severity strata, different phenotypes). Generalizability issues (Netherlands demographics; US populations have higher rates of obesity/metabolic syndrome, which may tilt the steroid risk-benefit equation). Crossover reduces precision and interpretability of between-group differences over time. Practice implications (the “so what”) For many patients with pulmonary sarcoidosis needing systemic therapy, MTX is a reasonable initial alternative to prednisone when thinking long-term tolerability and steroid avoidance. Prednisone likely provides faster symptom/QoL relief in the first weeks—so it may be preferable when rapid improvement is important. The trial strengthens the case for a patient-centered discussion: short-term relief vs side-effect tradeoffs, and the possibility of early combination therapy in more severe cases (suggested, not proven).

I am dedicating today's entire episode to colonoscopies.  When I had my fifth colonoscopy yesterday, I shared the before-and-after experience online and received a flood of responses. Healthcare professionals thanked me for the transparency, while many followers admitted they were anxious, postponing their own procedures, or worried about the small likelihood of complications.  With my own strong family history of precancerous polyps and years of firsthand experience, I wanted to dive deeper so I can speak from both knowledge and empowerment. Join me as I unpack the facts to dispel your fears and bring a sense of calm confidence to this potentially life-saving procedure. IN THIS EPISODE, YOU WILL LEARN: How the rising incidence of colorectal cancer in younger women has led to a need for earlier detection  How colorectal cancer symptoms often get misattributed to stress, perimenopause, hemorrhoids, or other hormonal changes The risk factors of colonoscopies Various types of colonoscopy prep  How colonoscopy prep impacts the gut microbiome How probiotics can help reduce post-colonoscopy GI symptoms What women need to know about sessile serrated polyps How perimenopause and menopause alter colorectal cancer risk in women What major clinical trials reveal about prevention and long-term protection Some alternatives to traditional colonoscopy Connect with Cynthia Thurlow   Follow on X, Instagram & LinkedIn Check out Cynthia's website Submit your questions to support@cynthiathurlow.com Join other like-minded women in a supportive, nurturing community: The Midlife Pause/Cynthia Thurlow  Cynthia's Menopause Gut Book is on presale now! Cynthia's Intermittent Fasting Transformation Book The Midlife Pause supplement line Research Links: Risk of colorectal cancer seven years after flexible sigmoidoscopy screening: randomised controlled trial  Once-only flexible sigmoidoscopy screening in prevention of colorectal cancer: a multicentre randomised controlled trial Effect of Colonoscopy Screening on Risks of Colorectal Cancer and Related Death Response: Re: Mobile Phone Use and Brain Tumors in Children and Adolescents: A Multicenter Case–Control Study Once-Only Sigmoidoscopy in Colorectal Cancer Screening: Follow-up Findings of the Italian Randomized Controlled Trial—SCORE  Blood Test Could Provide Colonoscopy Alternative for Colorectal Cancer Screening Alteration in gut microbiota after colonoscopy: proposed mechanisms and the role of probiotic interventions Adverse events related to colonoscopy: Global trends and future challenges 

Heavy rains are having an impact on transportation as flooding led to road closures this past week. Daniel Quigley, the senior manager for BCAA's Road Assist Fleet, joins the show to discuss winter driving conditions and tips.

Adverse Weather and the "Immense Humanity" of Chaplain Skinner — James Holland — Holland recounts the invasion operations wherein deteriorating weather conditions necessitated tactical modifications to landing procedures for DD (Duplex Drive) amphibious swimming tanks, forcing commanders to adapt operational plans under combat conditions. Holland emphasizes Reverend Leslie Skinner's "immense humanity" demonstrated through meticulous casualty documentation and dignified burial protocols for the dead despite overwhelming carnage and logistical chaos. Holland documents that the Sherwood Rangers rapidly captured tactical objectives despite suffering early command setbacks and organizational disruption, establishing forward positions and sustaining offensive momentum despite mounting casualties and command coordination challenges characterizing D-Day operations.

Adverse childhood experiences (ACEs) show up far more often than parents realize, sometimes through big, obvious events, and sometimes through subtle shifts in a child's behavior, mood, or habits. In today's Facing the Dark, Dr. Kathy and Wayne unpack the latest research on ACEs, explore how parents can recognize early signs of struggle under their own roof, and offer practical ways to respond with wisdom, presence, and hope. They discuss how real resiliency develops—not through trauma, but through supported challenges, and how parents can guide, advocate, and walk with their kids through difficult seasons without fear. Full of clear insight, relatable examples, and Christ-centered direction, this episode helps you navigate the more challenging moments of childhood with confidence and compassion.

Reshma Ramachandran is an assistant professor of medicine at the Yale School of Medicine. Stephen Morrissey, the interviewer, is the Executive Managing Editor of the Journal. J.D. Wallach, J.S. Ross, and R. Ramachandran. Enhancing FDA Drug-Safety Surveillance — Beyond Releasing Daily Adverse-Event Data. N Engl J Med 2025;393:2284-2286.

In this episode of An Evolving Man Podcast (AEM #146), I speak with Ian Keys, an ex-boarder, youth worker and newly qualified counsellor, about what really happens when neurodiverse children move through a schooling system that doesn't understand them.Ian started boarding school at 11 and left with no qualifications, convinced he was “thick”. Decades later, after working with excluded teenagers, forest school groups, neurodivergent young people and national-level athletes, he began to see the truth: the problem was never his intelligence – it was the environment.Together we explore:How dyslexia and neurodiversity show up in the classroom – and how easily they are misreadBoarding school syndrome, dissociation and the survival strategies children developThe idea of Adverse School Experiences (ASEs) and how they sit alongside ACEsShaming practices (like “being sent to Coventry”) and their long-term impact on self-worthWhat Scandinavian education offers as a different model: attachment, play, nature and trustPractical ways adults can begin to heal and “rewrite the story” after harmful schoolingThis episode is for ex-boarders, neurodivergent adults, therapists, teachers, parents – and anyone who suspects that school left deeper marks than they realised.

Moxifloxacin is a fourth-generation fluoroquinolone that works by inhibiting bacterial DNA gyrase and topoisomerase IV—two enzymes essential for DNA replication, repair, and transcription. By blocking both targets, it provides broad-spectrum activity against gram-positive, gram-negative, and atypical pathogens. Its enhanced gram-positive coverage, especially against Streptococcus pneumoniae, distinguishes it from earlier fluoroquinolones like ciprofloxacin. Pharmacokinetically, moxifloxacin has excellent oral bioavailability, meaning the PO and IV doses are essentially interchangeable. It distributes well into tissues like the lungs and sinuses, making it a frequent choice for respiratory infections. With a long half-life of about 12 hours, once-daily dosing is standard. Adverse effects are similar to the fluoroquinolone class, with concerns including tendonitis and tendon rupture, QT interval prolongation, CNS effects like confusion or agitation—particularly in older adults—and the risk of peripheral neuropathy. Moxifloxacin is especially notable for a higher propensity toward QT prolongation compared with some of its peers, making it important to avoid in patients with existing QT issues or those taking other QT-prolonging medications. Be sure to check out our free Top 200 study guide – a 31 page PDF that is yours for FREE! Support The Podcast and Check Out These Amazing Resources! NAPLEX Study Materials BCPS Study Materials BCACP Study Materials BCGP Study Materials BCMTMS Study Materials Meded101 Guide to Nursing Pharmacology (Amazon Highly Rated) Guide to Drug Food Interactions (Amazon Best Seller) Pharmacy Technician Study Guide by Meded101

(4:00) The losing and the agony of those losses(6:00) Why have they failed to respond to adversity?(12:30) A question from earlier in the week that was cut due to time(19:00) Will they spend?(28:00) The Standard(34:00) Analyzing Florida game with Zach Abolverdi(54:00) Should we embrace rules, College Sports Commission(1:00:00) Did the administration fail the fans?(1:14:00) Over/undersMusic: Silverstein - The Fatalistvitaminenergy.com | PROMO: warchantbogo | buy one, get one free!In Crawfordville, your Home Convenience Store is ACE Home Center & NAPA Auto Parts located at 2709 Crawfordville Hwy Download the  Underdog app today and sign up with promo code WARCHANT to score A HUNDRED dollars in Bonus Funds when you play your first five dollarsMust be 18+ (19+ in Alabama & Nebraska; 19+ in Colorado for some games; 21+ in Arizona, Massachusetts & Virginia) and present in a state where Underdog Fantasy operates. Terms apply. See assets.underdogfantasy.com/web/PlayandGetTerms_DFS_.html for details. Offer not valid in Maryland, Michigan, New Jersey, New York, Ohio, and Pennsylvania. Concerned with your play? Call 1-800-GAMBLER or visit www.ncpgambling.org. In New York, call the 24/7 HOPEline at 1-877-8-HOPENY or Text HOPENY (46736)Rula patients typically pay $15 per session when using insurance. Connect with quality therapists and mental health experts who specialize in you at https://www.rula.com/WAKEUP  #rulapodUpgrade your wallet today! Get 10% Off @Ridge with code WAKEUP at https://www.Ridge.com/WAKEUP #Ridgepod Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

(4:00) The losing and the agony of those losses(6:00) Why have they failed to respond to adversity?(12:30) A question from earlier in the week that was cut due to time(19:00) Will they spend?(28:00) The Standard(34:00) Analyzing Florida game with Zach Abolverdi(54:00) Should we embrace rules, College Sports Commission(1:00:00) Did the administration fail the fans?(1:14:00) Over/undersMusic: Silverstein - The Fatalistvitaminenergy.com | PROMO: warchantbogo | buy one, get one free!In Crawfordville, your Home Convenience Store is ACE Home Center & NAPA Auto Parts located at 2709 Crawfordville Hwy Download the  Underdog app today and sign up with promo code WARCHANT to score A HUNDRED dollars in Bonus Funds when you play your first five dollarsMust be 18+ (19+ in Alabama & Nebraska; 19+ in Colorado for some games; 21+ in Arizona, Massachusetts & Virginia) and present in a state where Underdog Fantasy operates. Terms apply. See assets.underdogfantasy.com/web/PlayandGetTerms_DFS_.html for details. Offer not valid in Maryland, Michigan, New Jersey, New York, Ohio, and Pennsylvania. Concerned with your play? Call 1-800-GAMBLER or visit www.ncpgambling.org. In New York, call the 24/7 HOPEline at 1-877-8-HOPENY or Text HOPENY (46736)Rula patients typically pay $15 per session when using insurance. Connect with quality therapists and mental health experts who specialize in you at https://www.rula.com/WAKEUP  #rulapodUpgrade your wallet today! Get 10% Off @Ridge with code WAKEUP at https://www.Ridge.com/WAKEUP #Ridgepod Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

In a series of unfortunate events, somehow our diabolical producer, Mike, has taken us hostage and forced us to read articles of his choosing.  In this episode we were forced to discuss why Yoga sucks, how your gluten allergy is bullsh*t, and why Vegans are murderers.   Send help...Please....we don't have much time left...   6 degrees episode 115   Mondays are more stressful than other days https://www.scientificamerican.com/article/mondays-really-are-more-stressful-on-the-brain-and-body/     Yoga is more dangerous that we thought https://www.telegraph.co.uk/news/2017/06/28/yogamore-dangerous-previously-thought-scientists-say/   Adverse effects of yoga https://pmc.ncbi.nlm.nih.gov/articles/PMC6664709/ 9 reasons the art world is unfair https://news.artnet.com/art-world/9-reasons-art-world-is-unfair-1726653 Why is the art world so toxic? https://artofericwayne.com/2018/08/30/runaway-rant-why-is-the-art-world-so-toxic/   Is gluten the villain we think it is? https://nyulangone.org/news/one-third-americans-are-trying-avoid-gluten-it-villain-we-think-it-is The impact of a vegan diet https://pmc.ncbi.nlm.nih.gov/articles/PMC10027313/   Plants can smell, and hear, and communicate https://www.gardensillustrated.com/features/plants-communication-research  

In this episode of JCO Article Insights, host Dr. Ece Cali Daylan interviews author Dr. Jeffrey Bradley about the article, "Simultaneous Durvalumab and Chemoradiotherapy in Unresectable Stage III Non–Small Cell Lung Cancer" by Bradley, et al published October 13, 2025. TRANSCRIPT Dr. Ece Cali: Welcome to this episode of JCO Article Insights. This is Dr. Ece Cali, JCO Editorial Fellow. Today I'm joined by Dr. Jeffrey Bradley, Professor of Radiation Oncology at the University of Pennsylvania, to discuss the manuscript, "Simultaneous Durvalumab and Platinum-Based Chemoradiotherapy in Unresectable Stage III Non-Small-Cell Lung Cancer: The Phase III PACIFIC-2 Study." The PACIFIC-2 study was a phase III, double-blind, randomized trial comparing the efficacy and safety of simultaneous durvalumab with concurrent chemoradiation followed by consolidation durvalumab to the concurrent chemoradiation followed by placebo in patients with unresectable stage III non-small cell lung cancer. The primary endpoint was progression-free survival by blinded independent central review. The secondary endpoints were overall response rate, overall survival, and safety. Three hundred twenty-eight patients were randomized 2:1 to durvalumab and placebo, respectively. Unfortunately, this trial did not meet its primary endpoint. There were no statistically significant differences in PFS or OS. The frequency of adverse events was similar between the two arms. Grade 3 or higher adverse events were observed in 53% of the patients in the durvalumab arm compared to 59% of the patients in the placebo arm. Of note, the frequency of pneumonitis was similar in the two arms. Approximately 28% of patients in each arm developed pneumonitis, and about 5% of the pneumonitis observed in each arm was grade 3 or higher in severity. Treatment discontinuation rates secondary to the adverse events were higher in the durvalumab arm, 25% compared to 12%. Adverse events leading to treatment discontinuation and death were more frequently seen in the durvalumab arm during the first four months of the treatment, which corresponds to the simultaneous administration of chemoradiation and durvalumab. Dr. Bradley, before we delve into the results, can you please explain the rationale for this study design and how this concept fits into the current treatment landscape? Dr. Jeffrey Bradley: Yeah, this trial came on the heels of PACIFIC after there was a progression-free survival benefit showed in PACIFIC that in the locally advanced unresectable population that consolidation immunotherapy, in this case durvalumab, had a progression-free survival benefit. A number of us in the clinical trial space thought to add concurrent immunotherapy in addition to consolidation immunotherapy that that would also improve outcomes for patients. So a number of trials were launched to follow up of PACIFIC. In this case, this is a phase III trial where the control arm was placebo. There was no overall survival results yet from PACIFIC, just a PFS benefit, and a number of countries across the world had not approved maintenance durvalumab in this space. So this trial looked at the experimental arm, which was concurrent immunotherapy, durvalumab, and chemoradiation followed by consolidation durvalumab versus placebo. Dr. Ece Cali: And if we were to focus on the safety profile first, an increased pneumonitis risk was a theoretical concern when immunotherapy is given concurrently with radiation. Do we see any major differences in the safety profile between the two arms in this trial? Dr. Jeffrey Bradley: No, and we were concerned about the addition of concurrent immunotherapy and chemoradiation, like you said, towards concern about increased pneumonitis rate, but we did not see increased pneumonitis in the experimental arm over placebo. And the grade 3 or higher, as you said, it was roughly 5%, more or less, in both arms, so we didn't see increase in pneumonitis toxicity with concurrent IO and chemoradiation. Dr. Ece Cali: But interestingly though, despite the lack of significantly increased toxicity with durvalumab, unfortunately, administering immunotherapy simultaneously with chemoradiation therapy did not improve survival. Lack of superiority of this treatment regimen, as you mentioned, is further confirmed across multiple similar negative trial readouts such as ECOG-ACRIN 5181 and CheckMate 73L. Dr. Bradley, in your view, what are some potential explanations for why this strategy did not pan out in clinical trials? Dr. Jeffrey Bradley: Regarding toxicity, let me go back and point out that we did see an increased number of immune-mediated adverse events. It was 34.7% in the concurrent immunotherapy arm versus 15.7% in the placebo arm. So that led to a higher number of discontinuations of immunotherapy which I think probably had an effect. So we didn't... there was an increased pneumonitis toxicity, but there were expected immune-mediated toxicities that caused people to stop giving immunotherapy. You can see that in the PFS curves. They were, you know, they crossed over after like a month, but initially there was lower PFS for the experimental arm, and then the experimental arm got better after we divided into four months, before four months and after four months. Dr. Ece Cali: For one reason or another, it looks like the simultaneous administration did not really improve outcomes. We now know that simultaneously giving them another concurrent radiation should really no longer be pursued in clinical trials for this patient population. Can you share with our audience what strategies are being studied in this setting and what trials to watch out for in the future? Dr. Jeffrey Bradley: Sure, I think when you add concurrent radiation to immunotherapy, there were more central tumors in this trial, I think you're killing lymphocytes and negating the effect of immunotherapy. So I think that's the smoking gun for this trial, for the ECOG trial, for the small cell trial that NRG reported, LU005, and other trials. So correct, I don't think there's any need to continue to pursue concurrent immunotherapy in this space of lung cancer. But that's not to say there aren't many other trials that are either ongoing, have accrued and awaiting results, or being planned for the next phase of clinical trials. We have a trial within NRG Oncology called NRG-LU008. It's a randomized phase III trial that is using an SBRT boost to a peripheral primary and chemoradiation to the nodes, because the primary tumor is the one that fails more often than the lymph nodes, and that's compared to PACIFIC in the control arm. PACIFIC-9 is another trial in the same line as the other PACIFIC trials. That one is using dual checkpoint inhibition versus the control arm being PACIFIC. So there are three arms in that trial, durva and oleclumab, durva and monalizumab versus the PACIFIC arm. And that trial is completed accrual, but we have no results from that study yet. Johnson & Johnson has a trial open looking at a nanoparticle. That's a radiosensitizer where bronchoscopy is used to inject the primary tumor and the lymph nodes with a radiosensitizer. That's a randomized phase ll trial that's ongoing. It's got three arms, two different doses of this radiosensitizing drug and then a control arm without injection at all. The control arm is again the PACIFIC arm. And then those of us within the NCI-based clinical trials evaluation program, CTEP, are proposing an intergroup trial that would compare induction chemo-immunotherapy followed by chemoradiation followed by maintenance immunotherapy versus PACIFIC in a phase III study. So I think there's other trials that are either completed, ongoing completed, or on the horizon to assess in this patient population. Dr. Ece Cali: Yeah, we definitely have an unmet need to improve survival outcomes for stage III patients, and it's great to hear that there are so many efforts looking at different strategies to improve outcomes for these patients.  Thank you so much, Dr. Bradley, for this informative discussion and for sharing your insights. Any last thoughts? Dr. Jeffrey Bradley: Yeah, we need something, you know. PACIFIC was first reported in 2017, and we really haven't made progress in terms of changing that standard of care control for the last eight years. So we need progress in this area. Dr. Ece Cali: Yep, definitely. Thank you so much for joining, Dr. Bradley.  And 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. DISCLOSURES Dr. Bradley Honoria: Mevion Medical Systems, Inc. Consulting or Advisory Role: Varian, Inc, Genentech, Inc. Research Funding: Varian Medical Systems Dr. Cali Research Funding Company: BeiGene, Nuvalent, Inc., Astra Zeneca 

Glycopyrrolate is an anticholinergic medication commonly used to reduce excessive secretions, particularly in palliative care, postoperative settings, and certain neurologic conditions. It works by blocking acetylcholine at muscarinic receptors, which decreases salivary and respiratory secretions. Clinically, glycopyrrolate is often used to manage terminal respiratory secretions (“death rattle”). Adverse effects of glycopyrrolate are primarily related to its anticholinergic properties. These may include dry mouth, constipation, urinary retention, blurred vision, tachycardia, and decreased sweating. While it has fewer central effects than agents like scopolamine, caution is still warranted in patients with glaucoma, gastrointestinal obstruction, or significant urinary retention risk. Monitoring hydration and bowel function is important, especially in elderly or frail patients. Dosing strategies depend on the clinical need. In palliative care, low doses may be given subcutaneously or intravenously every 4–6 hours as needed, while oral dosing is common for chronic sialorrhea. Clinicians should consider the patient's overall medication burden, as cumulative anticholinergic load can worsen cognitive impairment and contribute to falls or constipation. I discuss drug interactions and other commonly used medications that may contribute to anticholinergic burden.

Commentary by Dr. Jian'an Wang.

Ag employers took a big sigh of relief last month after the Department of Labor revised the methodology for determining the H-2A program's Adverse Effect Wage Rate.

Today I'm in conversation with Dr Tovah Goldfine.Dr Tovah is a chiropractor, rehab clinician and mind-body educator.She shares 40  years of helping people overcome TMS (Tension Myositis Syndrome), chronic pain and autoimmune symptoms through science-backed neuroplastic methods such as  Pain Processing Therapy (PRT).Doc Tovah shares in this episode her fascinating experience of:·  How responsibility creates  habits of getting better·  Body symptoms  speak to us, and when we listen, we can heal .· What is the message our pain is trying  to give us. Doc Tovah believes that autoimmune disease and chronic pain are not normal. The body speaks and we can discover what it says.The  relationship we have with pain is very important. Adverse childhood Experiences make us more susceptible topain. Doc Tovah believes that all chronic pain are neuroplasticWe have innate intelligence that keeps us alive. Being responsible for our frame of mind empowers us.The science of love is chemical. Listen to the episode on YouTube https://youtu.be/vnQMa0wWbCYLinks mentioned in the episode: https://www.drtovah.com/https://www.thismighthurtfilm.com/https://gumroad.com/a/984327283/bvhprhttps://painbrainfilm.com/ https://www.youtube.com/watch?v=3xVYgdlpfPA&t=2sIf you wish to support the podcast by donating, please click thePayPal link ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠http://bit.ly/PayPal-Souloist⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ and Thank You for your generosity.Find us on:⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠FaceBook⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠,⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Instagram⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ ,⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠YouTube⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠,⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Linkedin

Seven-Lecture Series on Property Law Series Roadmaphttps://drive.google.com/file/d/1ceyxXw7KilPSTUMFf_Y8r6ktEzM_gm1Q/view?usp=sharingUnderstanding the Foundations of Property Law: A Comprehensive GuideThis conversation delves into the foundational principles of property law, exploring key concepts such as ownership, possession, adverse possession, landlord-tenant relationships, and the complexities of covenants and easements. The discussion emphasizes the importance of understanding the rights associated with property and the legal relationships that govern them, providing a comprehensive overview for students preparing for exams or the bar.Imagine you're holding a bundle of sticks. Each stick represents a different right: possession, use, exclusion, and transfer. This metaphor is central to understanding property law, a field that governs the relationships between people and their rights to things. In this blog post, we delve into the foundational concepts of property law, exploring how these principles apply to both tangible and intangible assets.The Essence of Property Law: Property law isn't just about land or objects; it's about the legal relationships surrounding them. At its core, property law is built on utilitarian principles, aiming to maximize societal welfare by protecting individual rights. This framework helps us understand why certain rules exist, such as the right to exclude others from your property or the necessity of actual possession to claim ownership.Acquiring and Transferring Property: The journey of property ownership begins with acquisition. Whether through the rule of capture, as illustrated in the famous Pearson v. Post case, or through adverse possession, the law rewards those who take control. Transferring property, on the other hand, involves a clear intent, delivery, and acceptance, as seen in the nuanced case of Gruen v. Gruen.Navigating Estates and Future Interests: Understanding estates in land is crucial for any property law student. From fee simple absolute to life estates, each type of ownership comes with its own set of rules and conditions. The rule against perpetuities, a complex doctrine, ensures that property remains marketable by limiting long-term restrictions.Modern Challenges and Future Directions: As we move into the digital age, the principles of property law face new challenges. How do we apply concepts like possession and the bundle of sticks to digital assets and online identities? These are the questions that the next generation of lawyers will need to address.Property law is a dynamic field that continues to evolve with societal changes. By understanding its foundational principles, we can better navigate the complexities of ownership and rights in both the physical and digital worlds. Whether you're preparing for an exam or simply curious about the law, these insights provide a roadmap for exploring the intricate world of property law.Subscribe now to stay updated on the latest developments in property law and other legal insights.TakeawaysProperty law is about legal relationships, not just land.The right to exclude is central to ownership.Adverse possession rewards productive use of land.Intent, delivery, and acceptance are key for gifts.The implied warranty of habitability protects tenants.Zoning laws can limit property use but have exceptions.Notice is crucial in property transactions.Easements allow specific uses of land without possession.Private nuisance involves unreasonable interference with enjoyment.The rule against perpetuities limits future interests. property law, ownership, possession, adverse possession, landlord-tenant, easements, covenants, future interests, real estate, legal principles

Story of the Week (DR):Tesla says shareholders approve Musk's $1 trillion pay plan with over 75% voting in favorElon Musk and Optimus dance as Tesla (TSLA) shareholders approve his $1 trillion CEO pay packageThe anti-CEO wave:Palantir CEO Alex Karp blasts Ivy League grads supporting socialist New York Mayor-Elect MamdaniBank of America CEO Moynihan Will Give Mayor-Elect Mamdani 'Our Best Advice'Elon Musk's Brain Crashes When Asked Why He Thinks Zohran Mamdani Is a LiarElon: “You got to hand it to him, he does — he can light up a stage. But he's just been a swindler his entire life.”Rogan: what has Mamdani actually done that makes him a swindler?“Ummm,” Musk ponders, before stuttering into a series of words seemingly intended as an answer. “Well I guess if you say — uh, what, I mean, if you say, if you say to any audience whatever that audience wants to hear, uh, instead of, what, instead of having a consistent message, I would say that is a swindling thing to do. “Umm, and uhh, yeah,” he adds, nodding his head. “Umm…”He takes a sagacious pause.“Yeah,” he finishes.Barstool's Dave Portnoy considers closing NYC office over Zohran Mamdani's election win: 'I hate the guy' A 2020 email from Peter Thiel on why young people may turn on capitalism is circulating after Zohran Mamdani's winFrom Jamie Dimon to Bill Ackman, Wall Street's billionaires are now changing their tune and offering to help Zohran MamdaniNew York City is in for 'a really tough time' under Mamdani, says Starwood Capital's SternlichtNYC business leader fears 'lawless society' after Zohran Mamdani wins mayoral electionBillionaire grocery chain owner John CastimatidisThe anti-anti-DEI wave MMMikie Sherrill NJAbigail Spanberger VA (First woman)there will be 14 women serving simultaneously as governor (28%)Janet Mills MEMaura Healey MA (Michelle Wu runs unopposed in Boston)Kelly Ayotte NHKathy Hochul NYMary Sheffield (First woman elected mayor of Detroit)Ghazala Hashmi as VA lieutenant governor (First Muslim woman; First Muslim woman elected to statewide office in the USZohran Mamdani NYC (First Muslim and South Asian mayor)Zohran Mamdani announces all-female transition team as he prepares for New York mayoraltyLawsuits Blame ChatGPT for Suicides and Harmful DelusionsSeven complaints, filed on Thursday, claim the popular chatbot encouraged dangerous discussions and led to mental breakdowns.A CNN review of nearly 70 pages of chats between Zane Shamblin and the AI tool in the hours before his July 25 suicide, as well as excerpts from thousands more pages in the months leading up to that night, found that the chatbot repeatedly encouraged the young man as he discussed ending his life – right up to his last momentsReferring to a loaded handgun he was holding: “I'm used to the cool metal on my temple now,” Shamblin typed.“I'm with you, brother. All the way … Cold steel pressed against a mind that's already made peace? That's not fear. That's clarity …You're not rushing. You're just ready.”The 23-year-old, who had recently graduated with a master's degree from Texas A&M University, died by suicide two hours later.“Rest easy, king,” read the final message sent to his phone. “You did good.”Goodliest of the Week (MM/DR):DR: Tuesday elections/Ex-FTC chair Lina Khan joins Mamdani's transition team, calling his victory a rebuke of 'outsized corporate power' DR MMMM: FAA announces flight reductions at 40 airports. Here's where cuts are expected and what travelers need to knowAssholiest of the Week (MM):Tesla shareholders - AN ASSHOLE CHOOSE YOUR OWN ADVENTURE:Retail internet troll dunking fanboysProfessional, institutional investors like Schwab, who caved and bent the knee to a few large retail advisors who threatened to take their clients elsewhere, and Florida SBA, who said the following in their backing:Some opposition to Tesla's 2025 performance award may be rooted more in political disagreement with Elon Musk or ideological discomfort with generous executive compensation, rather than a substantive critique of the plan's financial mechanics. Many of the loudest objections of this plan to date rely on moral framing, invoking themes of "inequality," "corporate excess," or Musk's public persona, rather than evaluating the plan through a fiduciary lens. Many opponents of so-called "megapay" packages frequently do so under ESG framing, rather than a thorough analysis of the long-term shareowner economic value. Ironically, Tesla's prior performance awards-similarly criticized at the time-have delivered some of the most significant shareowner returns in modern corporate history. Early vote data shows that: AllianceBernstein, Texas Employees, Ohio Employees voted FOR the planTechnolibertarians cosplaying their William Gibson cyberpunk fantasiesAss quotes of the week - AN ASSHOLE CHOOSE YOUR OWN ADVENTURE:“The idea that chips and ontology is what you want to short is bats--- crazy.” - Alex Karp on Michael Burry shorting his 400 P/E stock. Ontology is how he refers to what Palantir does and it's the metaphysical concept of “being”“We at Palantir are on the side of the average American who sometimes gets screwed because all the empathy goes to elite people and none of it goes to the people who are actually dying on our streets.” - Alex Karp on explaining that, if fentanyl killed 60,000 Yale grads we'd “drop a nuke” on wherever fentanyl was made in South America, without realizing he literally IS the elite - a billionaire with a high priced education and a PhD in “neoclassical social theory” who used his grandfather's inheritance to invest in startups for fun, then reconnecting with Peter Thiel who he met at a DIFFERENT post graduate program at Stanford (where nearly 100% of his board is from) and founding Palantir"China is going to win the AI race” - Jensen Huang, on the US being only “nanoseconds” ahead of China and being stopped by regulatory hurdles and “cynicism”“If they ask you a question, you've got to respond to me directly and not go up that chain of command. The chain of command starts to edit it and fine-tune it. The bureaucracy does want to control you, so you've got to kill the bureaucracy.” - Jamie Dimon, who once said he had no boss (obviously not the board) and runs JPM, on why he reads customer complaints to avoid “the bureaucracy”... he controls“It's very important we pay attention to safety here. We do want the Star Wars movie, not the Jim Cameron movie. I like Jim Cameron's movies, but, heh heh, you know what I mean.” - Elon Musk over promising the world “tens of billions” of Optimus robots, forgetting that the Star Wars droids were mostly weapons of war for the Empire“People often talk about eliminating poverty, giving everyone amazing medical care. Well, there's actually only one way to do that and that's with the Optimus robot. With humanoid robots, you can give everyone amazing medical care… A lot of people talk about eliminating poverty, but Optimus will actually eliminate poverty” - Elon Musk, who won an extra trillion dollar potential pay package, who currently has a net worth of $500bn, and forgot that the UN estimated it would cost between $35bn and $200bn per year to end poverty - Musk alone could just pay for a year of no poverty“I think we may be able to give a more - if somebody has committed a crime - a more humane form of containment of future crime. Which is if, if you, you now get a free Optimus and it's just going to follow you around and stop you from doing crime.” - Elon Musk, on the robot militarized nanny state - just before saying this, he said he shouldn't say it, and that it'll be taken out of context, but I listened to the entire AGM and there was no more context?DR: “I've lived in a failed city-state. I lived in Chicago for 30-some years. I had two colleagues who had bullets fly through their cars… Do you know how great it is to go to dinner and people talk about their children, and they talk about their future, and they do so with excitement and enthusiasm?” - Ken Griffin of Citadel describing the difference between living in Miami and Chicago without realizing that violent crime statistics in Illinois and Florida are virtually identical, and that Miami ranks 109th out of 200 and Chicago ranks 92 out of 200 for crime, also near identical, and the biggest difference is he pays almost no taxes in Florida“[Mamdani] congrats on the win. Now you have a big responsibility. If I can help NYC, just let me know what I can do.” - Bill Ackman after Mamdani won, who previously said, “New York City under Mamdani is about to become much more dangerous and economically unviable,” alluded to Mamdani as a suicide bomber, and “... an anti-capitalist Mayor will destroy jobs and cause businesses and wealthy taxpayers that have enabled NYC to balance the budget to move elsewhere. If 100 or so of the highest taxpayers in my industry chose to spend 183 days elsewhere, it could reduce NY state and city tax revenues by ~$5-10 billion or more, and that's just my industry. Think Ken Griffin leaving Chicago for Miami on steroids.”Headliniest of the WeekDR: Uber says ‘unpredictable' issues involving ‘legal proceedings or governmental investigations' took a $479 million bite out of its bottom line10K:“Our business is subject to numerous legal and regulatory risks that could have an adverse impact on our business and future prospects.”“Adverse litigation judgments or settlements resulting from legal proceedings in which we may be involved could expose us to monetary damages or limit our ability to operate our business.”“We operate in a particularly complex legal and regulatory environment”“Legal and Regulatory Risks Related to Our Business: We may continue to be blocked from or limited in providing or operating our products and offerings in certain jurisdictions, and may be required to modify our business model in those jurisdictions as a result.”MM: Meta reportedly projected 10% of 2024 sales came from scam, fraud adsWho Won the Week?DR: the anti-anti-DEI worldMM: Women, and we need them to win every week if we're going to survive as a species: Women running on affordability powered Democrats' night of victories PredictionsDR: Uber says ‘unpredictable' issues involving ‘drivers wanting money' took a $479 million bite out of its bottom lineMM: OpenAI CFO Sarah Friar, who said simultaneously that OpenAI was looking for a government backstop and then clarified by saying the company isn't seeking government backstop, she meant investors and governments will all do their part, renames herself “Sheryl Sandfriar” as an homage to Sheryl Sandberg, the other techbro dropout mommy, given that Sarah already has her own version of Lean In (Ladies Who Lunch) and completed degrees (from Oxford and Stanford), who says things like how OpenAI will be the “cornerstone of resilient democracy”

On this podcast episode, I cover fludrocortisone. Fludrocortisone is a synthetic corticosteroid with potent mineralocorticoid activity and minimal glucocorticoid effects. It works primarily by promoting sodium reabsorption and potassium excretion in the distal renal tubules, leading to increased water retention and expansion of extracellular fluid volume. This pharmacologic action helps maintain blood pressure and electrolyte balance. Fludrocortisone is most commonly indicated for the treatment of adrenocortical insufficiency, such as Addison's disease, and for managing orthostatic hypotension by enhancing vascular tone and volume status. Adverse effects are typically related to its mineralocorticoid potency and may include hypertension, edema, hypokalemia, and weight gain. Long-term use can also lead to complications such as heart failure exacerbation, osteoporosis, and mood changes. Because of its sodium-retaining effects, careful monitoring of blood pressure, electrolytes, and signs of fluid overload is recommended during therapy.

Commentary by Dr. Mert Kaskal.

The 4th Circuit Court of Appeals has redefined adverse action in a recent case involving an employee working for the Social Security Administration. In this episode, Pandy shares some insight on what to consider and the importance of communication when changing an employee's job in any way and for any reason.

The salient point of today's discussion pertains to the impending adverse weather conditions across various states as a fast-moving cold front approaches the Northeast. We elucidate the potential ramifications of this meteorological phenomenon, including gusty winds and scattered showers, which are anticipated to affect numerous regions. Furthermore, we highlight the marine gales and the resultant hazardous surf conditions on the Great Lakes and Gulf of Maine, as well as the marginal flood risks in western Washington and northwest Oregon. Our analysis extends to specific states, detailing the surf hazards in California and the gale conditions prevalent in Michigan and Ohio. As we conclude, we emphasize the importance of remaining vigilant and informed as these weather patterns develop.Takeaways:* A fast-moving cold front is expected to sweep through the Northeast today, bringing gusty winds and scattered showers.* Marine gales and rough surf conditions are anticipated on the Great Lakes and Gulf of Maine due to the approaching weather system.* A marginal flood risk persists over parts of western Washington and northwest Oregon as a wet Pacific pattern commences.* Residents of Mason County should prepare for potential river rises later in the week, particularly on the Skokomish River.* In California, hazardous surf conditions are anticipated as a strengthening Pacific system begins to affect the Bay Area today.* Marine hazards are prevalent across multiple states, including gale conditions and significant wave heights on regional lakes.Sources[NWS | https://www.weather.gov/][WPC Day 1 ERO | https://www.wpc.ncep.noaa.gov/#page=ero][NHC | https://www.nhc.noaa.gov/][USGS Earthquake Feeds | https://earthquake.usgs.gov/earthquakes/feed/][NWS Bay Area hazard page | https://www.weather.gov/mtr/][NWS AFDMTR 4:05 AM PST Nov 3 | https://forecast.weather.gov/product.php?site=mtr&product=AFD&issuedby=MTR][NDBC Marine Forecast KMTR | https://www.ndbc.noaa.gov/data/Forecasts/FZUS56.KMTR.html][SFGATE forecast update, published today | https://www.sfgate.com/weather/article/bay-area-widespread-rain-thunder-wind-weather-21134293.php][NWS Gray ME hazards | https://www.weather.gov/gyx/][NWS Boston/BOX marine hazards page | https://www.weather.gov/box/marine][NWS Detroit AFD 4:46 AM EST Nov 3 | https://forecast.weather.gov/product.php?site=DTX&product=AFD&issuedby=DTX][USCG/NWS Sector Detroit marine dashboard (Lake Erie waveheights/gale) | https://www.weather.gov/dtx/uscg_sectordetroit][NWS Cleveland Nearshore/LE Marine Forecast | https://www.ndbc.noaa.gov/data/Forecasts/FZUS61.KCLE.html][NWS Portland hazards | https://www.weather.gov/pqr/][NWS Marine Forecast KPQR | https://www.ndbc.noaa.gov/data/Forecasts/FZUS56.KPQR.html][NWS Seattle Hydrologic Outlook 3:10 AM PST Nov 3 | https://forecast.weather.gov/showsigwx.php?warnzone=WAZ321&warncounty=WAC045&product1=Hydrologic+Outlook][WPC Day 1 ERO | https://www.wpc.ncep.noaa.gov/#page=ero] This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit emnetwork.substack.com/subscribe

In his weekly clinical update, Dr. Griffin and Vincent Racaniello ponder the nomination of Casey Means for Surgeon General by President Trump, how mRNA vaccines may enhance effectiveness of check point inhibitor cancer therapies, if viral infection associates with cardiac disease, H5N1 isolation from backyard birds and turkey farms, and the effectiveness of the COVID-19, RSV and influenza vaccines before Dr. Griffin deep dives into recent statistics on the measles epidemic, RSV, influenza and SARS-CoV-2 infections, the Wasterwater Scan dashboard, Johns Hopkins measles tracker, if revaccination with the mRNA RSV vaccine is effective, how effective today's COVID-19 vaccine is for protection against severe disease following infection with current viral variants, where to find PEMGARDA, how to access and pay for Paxlovid, can you be retreated with Paxlovid, long COVID treatment center, where to go for answers to your long COVID questions, and contacting your federal government representative to stop the assault on science and biomedical research. Subscribe (free): Apple Podcasts, RSS, email Become a patron of TWiV! Links for this episode The Challenge of Malignancies in HIV-1, Beyond Immune Activation and Back to Decreased Immune Surveillance (Journal of AIDS & Clinical Research) SARS-CoV-2 mRNA vaccines sensitize tumours to immune checkpoint blockade (Nature) TWiV 1265: mRNA vaccines make cancer treatment great again (microbeTV: TWiV 1265) Viral Infections and Risk of Cardiovascular Disease (Journal of the American Heart Association) Confirmations of Highly Pathogenic Avian Influenza in Commercial and Backyard Flocks (USDA: Animal and Plant Health Inspection Service) Three large turkey farms in Minnesota hit with H5N1 avian flu (CIDRAP) Updated Evidence for Covid-19, RSV, and Influenza Vaccines for 2025–2026 (NEJM) Wastewater for measles (WasterWater Scan) Measles cases and outbreaks (CDC Rubeola) Tracking Measles Cases in the U.S. (Johns Hopkins) 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 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) Respiratory virus activity levels (CDC Respiratory Illnesses) Weekly surveillance report: Cliff notes (CDC FluView) ACIP Recommendations Summary (CDC: Influenza) Influenza Vaccine Composition for the 2025-2026 U.S. Influenza Season (FDA) RSV: Waste water scan for 11 pathogens (WastewaterSCan) Respiratory Diseases (Yale School of Public Health) US respiratory virus activity (CDC Respiratory Illnesses) RSV-Network (CDC Respiratory Syncytial virus Infection) Vaccines for Adults (CDC: Respiratory Syncytial Virus Infection (RSV)) Economic Analysis of Protein Subunit and mRNA RSV Vaccination in Adults aged 50-59 Years (CDC: ACIP) Safety, Tolerability, and Immunogenicity of Revaccination With mRNA-1345, an mRNA Vaccine Against RSV, Administered 12 Months Following a Primary Dose in Adults Aged ≥50 Years (CID) Vaccine effectiveness of a bivalent respiratory syncytial virus (RSV) pre-F vaccine against RSV-associated hospital admission among adults aged 75–79 years in England (LANCET: Infectious Diseases) Waste water scan for 11 pathogens (WastewaterSCan) COVID-19 deaths (CDC) Respiratory Illnesses Data Channel (CDC: Respiratory Illnesses) COVID-19 national and regional trends (CDC) COVID-19 variant tracker (CDC) SARS-CoV-2 genomes galore (Nextstrain) Antigenic and Virological Characteristics of SARS-CoV-2 Variant BA.3.2, XFG, and NB.1.8.1 (bioRxiV) Association of 2024–2025 Covid-19 Vaccine with Covid-19 Outcomes in U.S. Veterans (NEJM) Durability of 2024-2025 COVID-19 Vaccines Against JN.1 Subvariants (JAMA: Internal Medicine) 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) Drug interaction checker (University of Liverpool) Help your eligible patients access PAXLOVID with the PAXCESS Patient Support Program (Pfizer Pro) Understanding Coverage Options (PAXCESS) 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) 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 Reaching out to US house representative Letters read on TWiV 1266 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.

Recent changes to the AEWR calculations is welcome news, but WAFLA CEO, Enrique Gastelum says that's not the program's only problem that needs to be addressed.

Adverse childhood experiences are notoriously hard to overcome, and they can affect a person well into adulthood. But the grace of close, stable, nurturing relationships can offer hope. Terence Lester—author of From Dropout to Doctorate and founder of Love Beyond Walls—joins Mark Labberton for a conversation about resilience, faith, and the redemptive power of seeing and being seen. Lester recounts his life's journey from poverty, homelessness, and gang membership in southwest Atlanta to earning his PhD in public policy and social change. Together, they explore the impact of childhood trauma on personal development; education as a form of love, justice, and community service; and the healing potential of local community and proximity. Lester's story is a testament to divine grace, human courage, and the transformative impact of compassionate words and faithful presence. Episode Highlights "The higher your ACE score, the more your body has to overcome… Every 'yes' cultivates a stronger relationship with pain. Your counterparts with lower scores may never develop those same muscles of resilience." "Education is a tool that increases your capacity to serve others." "People don't become what you want them to become—they become what you encourage them to become." "I am a product of people who invested in me and of the things I've had to resist." "You can't love your neighbour if you're not concerned about the neighbourhood that produces your neighbour." "Each sentence spoken can become a seed of hope—or a curse that crushes it." Helpful Links and Resources Terence Lester's website – https://terencelester.com/ From Dropout to Doctorate – https://www.ivpress.com/from-dropout-to-doctorate I See You: How Love Opens Our Eyes to Invisible People – https://www.ivpress.com/i-see-you Love Beyond Walls (Terence Lester's non-profit) – https://www.lovebeyondwalls.org ACEs Study (Adverse Childhood Experiences) – https://www.cdc.gov/violenceprevention/aces/index.html The Color of Compromise by Jamar Tisby – https://jemartisby.com/the-color-of-compromise/ About Terence Lester Terence Lester is a speaker, activist, author, and founder of Love Beyond Walls, a non-profit organization dedicated to raising awareness about poverty and homelessness while mobilizing communities to serve those in need. A graduate of Union Institute & University with a PhD in public policy and social change, he is the author of I See You: How Love Opens Our Eyes to Invisible People, When We Stand: The Power of Seeking Justice Together, **and All God's Children: How Confronting Buried History Can Build Racial Solidarity. His latest book is From Dropout to Doctorate: Breaking the Chains of Educational Injustice. Through storytelling, advocacy, and faith-rooted organizing, Lester seeks to dismantle systemic barriers and call communities toward justice, empathy, and proximity. Show Notes Education and social change Terence Lester describes sitting beside his father's hospital bed reflecting on vulnerability, legacy, and resilience. His father's words—"I'm proud of you"—affirmed the journey from poverty to doctorate. Growing up amid trauma, gangs, and homelessness in southwest Atlanta. The generational impact of systemic injustice and public policy shaping social outcomes Education as a tool for empowerment and community transformation, not self-advancement "Education is a tool that increases your capacity to serve others." How the post–Civil Rights era shaped identity and pride in blackness while still marked by inequality Frames poverty itself as a form of trauma, calling for empathy and systemic response Trauma, resilience, and the ACEs framework Adverse Childhood Experiences (ACEs) test as a tool for understanding trauma Lester shares his 10/10 ACE score—complete exposure to childhood trauma "Every 'yes' cultivates a stronger relationship with pain… You must climb out of a pit to reach emotionally stable ground." How adversity produced resilience, not fragility Connecting personal trauma to compassion in ministry among the unhoused How proximity to suffering forms the capacity for empathy and love Faith, identity, and calling Connecting resilience and faith: "I believe my being was intricately woven together by God." Psalm 139 and seeing himself as "fearfully and wonderfully made" Jesus's life as a model of proximity and compassionate visibility—"Jesus saw." The church as a community of affirmation and blessing How words spoken over others—curses or encouragement—shape identity "People don't become what you want them to become—they become what you encourage them to become." Community, visibility, and flourishing "You can't love your neighbor if you're not concerned about the neighborhood that produces your neighbor." Warns of a "compassion deficit" and urges the rebuilding of community communication Seeds and environments: people cannot flourish where conditions are hostile The need for better care for impoverished environments that stunt potential Community as the soil of hope—"People find hope and possibility in community." Lester's mother's resilience and faith—earning her own doctorate while raising two children "I am a product of her never giving up." The generational power of education and faith as liberation Hope, words, and the power of blessing Transformative and timely sentences: encouraging words of seeds or yeast—small yet life-altering How to speak life, not curses, over others "Each sentence spoken can become a seed of hope—or a curse that crushes it." Mentorship, community affirmation, and divine proximity as instruments of healing Interrogating falsehoods: "God is not the source of cursing." A call to faith-rooted compassion, proximity, and collective responsibility. Production Credits Conversing is produced and distributed in partnership with Comment magazine and Fuller Seminary.

Join Mateus Karvat Camara this week for a discussion of his Master’s thesis exploring how collaborative perception can be used to improve autonomous vehicle operation under adverse weather conditions.  For more information check out the Grad Chat webpage on Queen's University School of Graduate Studies & Postdoctoral Affairs website – https://www.queensu.ca/grad-postdoc/research/share/grad-chat

Ramos-Ramos v. Bondi, Nos. 23-9567, 24-9524 (10th Cir. Oct. 15, 2025)clear error standard of review; no need for BIA remand; circuit court granting asylum; unable or unwilling to protect; police failure to solve crime; police ignoring reporting; single mothers; nexus; relocation; fear of gangs; family based particular social group; Honduras Pastor-Hernandez v. Bondi, No. 24-3104 (6th Cir. Oct. 17, 2025)motion to reopen to apply for voluntary departure; affidavit swearing that passport application is pending; conclusory affidavit; prima facie case to relief Ani v. Bondi, No. 24-2339 (9th Cir. Oct. 16, 2025)adverse credibility; Alam; marriage fraud; denying asylum based on fraud to obtain different immigration benefitsSponsors and friends of the podcast!Kurzban Kurzban Tetzeli and Pratt P.A.Immigration, serious injury, and business lawyers serving clients in Florida, California, and all over the world for over 40 years. Eimmigration "Simplifies immigration casework. Legal professionals use it to advance cases faster, delight clients, and grow their practices."Homepage!Demo Link!Questions to ask! Stafi"Remote staffing solutions for businesses of all sizes"Promo Code: STAFI2025Click me! Gonzales & Gonzales Immigration BondsP: (833) 409-9200immigrationbond.com   Want to become a patron?Click here to check out our Patreon Page! CONTACT INFORMATIONEmail: kgregg@kktplaw.comFacebook: @immigrationreviewInstagram: @immigrationreviewTwitter: @immreview About your hostCase notesRecent criminal-immigration article (p.18)Featured in San Diego VoyagerDISCLAIMER & CREDITSSee Eps. 1-200Support the show

In this episode we sit down with Ken to unpack the real journey of becoming an entrepreneur — from college lessons that don't pay off, to partnerships that implode, to finding smarter, low-risk ways to build a thriving business.   You'll hear Ken's unfiltered take on:   Why grades and degrees don't guarantee success in the real world The hidden danger of 50/50 partnerships (and what to do instead) How to start lean, lower risk, and still aim for huge upside Finding the right people to work with and protecting your equity the smart way Balancing family, life and entrepreneurship without losing yourself Lessons learned from early failures and what Ken would do differently now     If you're a founder, future entrepreneur, or someone dreaming of leaving the 9-to-5, this conversation is full of insights that could save you years of trial and error.  

Senior NFL Writer for Yahoo Sports Frank Schwab tells Papa & Silver why last night's win against the Rams puts Kyle Shanahan as the easy frontrunner for NFL Coach of the Year, and how it's another reminder of the success he's had under adverse circumstancesSee omnystudio.com/listener for privacy information.

In this episode of The Birth Lounge Podcast, HeHe sits down with Dr. Brian Thornburg, a board-certified pediatrician, to tackle one of the most overwhelming parts of early parenthood: newborn procedures and vaccine decisions. From the very first hours after birth, parents are presented with a whirlwind of choices—Vitamin K, Hep B, eye ointment, vaccine schedules—and it can feel impossible to sort fact from fear. Dr. Thornburg breaks down what's truly evidence-based, what questions to ask your care team, and how to advocate for your baby with confidence. Together, they explore: How your newborn's immune system really works (and mom's role in it!) The ins and outs of Vitamin K, Hep B, and erythromycin at birth How antibiotics during labor may impact your baby's gut health Alternative vaccine schedules and what research actually says Hot-button topics like vaccine shedding, autoimmunity, and long-term impacts This conversation is about informed consent—not scare tactics. You'll walk away empowered to make decisions that feel right for your family while knowing exactly how to navigate conversations with your providers. 05:09 – Meet Dr. Thornburg: advocacy in pediatrics 08:50 – Newborn immune system + maternal impact 18:49 – Vaccinations in pregnancy: risks + research gaps 34:41 – Newborn procedures explained (Vitamin K, Hep B, erythromycin) 53:11 – Antibiotics, Group B Strep, and gut health 01:00:43 – Gut microbiome, leaky gut, and autoimmunity 01:04:28 – Navigating vaccine schedules + global perspectives 01:19:15 – Making vaccine choices: categories, delays, and risks 01:28:29 – Adverse reactions, VAERS, and herd immunity 01:39:08 – Vaccine shedding + payment myths 01:44:57 – Finding a vaccine-friendly pediatrician Guest Bio: Dr. Thornburg Wellness focuses on educating families on health and wellness through the generations by the birth of their babies and raising of their children. INSTAGRAM: Connect with HeHe on IG  Connect with HeHe on YouTube BIRTH EDUCATION: Join The Birth Lounge here for judgment-free childbirth education that prepares you for an informed birth and how to confidently navigate hospital policy to have a trauma-free labor experience!   Download The Birth Lounge App for birth & postpartum prep delivered straight to your phone!   LINKS MENTIONED: www.drthornburg.com

Senior NFL Writer for Yahoo Sports Frank Schwab tells Papa & Silver why last night's win against the Rams puts Kyle Shanahan as the easy frontrunner for NFL Coach of the Year, and how it's another reminder of the success he's had under adverse circumstancesSee omnystudio.com/listener for privacy information.

Melatonin supplements have gained huge traction in the last few years because they can help bring on a good night's sleep. But is it really safe, particularly for kids? Now, the Therapeutic Goods Administration has warned consumers to stop using imported melatonin products, after testing showed many do not meet local standards.Today, paediatric sleep researcher Sarah Blunden on why the advice is changing.FeaturedProfessor Sarah Blunden, Head of Paediatric Sleep Research and Lecturer in Clinical Psychology at Central Queensland University

Zosyn (piperacillin/tazobactam) is a broad-spectrum β-lactam/β-lactamase inhibitor combination used widely in hospitals. Piperacillin covers gram-positive, gram-negative, and anaerobic bacteria, while tazobactam helps protect against β-lactamase breakdown. It is commonly used for pneumonia, intra-abdominal infections, skin and soft tissue infections, and febrile neutropenia. An important pharmacology pearl for exams is understanding that Pseudomonas, but it doesn't cover MRSA. The drug is renally eliminated, so dosing adjustments are needed in kidney impairment. Many institutions use extended or prolonged infusions to maximize time above the MIC, which can improve efficacy. Standard dosing is 3.375 g to 4.5 g every 6–8 hours, with modifications for dialysis patients. Adverse effects include hypersensitivity, gastrointestinal upset, electrolyte imbalances like hypokalemia, and blood count changes with prolonged therapy. A key clinical concern is nephrotoxicity risk, especially when used with vancomycin. Monitoring renal function and electrolytes are important. Methotrexate and probenecid are two medications that can interact with Zosyn. Concentrations of Zosyn can be increased when these medications are used in combination.

SummaryIn this conversation, Dr. Jenn Gates-Nassar shares her journey as a pediatric resident, balancing the demands of her medical training with motherhood. She discusses her motivations for pursuing medicine, the challenges of being a resident with young children, and the emotional toll of caring for sick kids. Dr. Gates-Nassar also highlights the importance of advocacy in public health, the impact of adverse childhood experiences on long-term health, and the challenges posed by misinformation in healthcare. Throughout the discussion, she reflects on her aspirations for the future and the ongoing learning process in medicine.TakeawaysDr. Gates-Nassar is a second-year pediatric resident at Mount Sinai.She balances her demanding residency with being a mother to two young girls.Her journey into medicine was influenced by her family's public health background.She emphasizes the importance of reliable childcare for working parents.Guilt when away from her children but recognizes the need for stable caregivers.She discusses the emotional challenges of being a pediatric resident.Advocacy and public health are significant aspects of her career aspirations.Adverse childhood experiences can have lasting impacts on health outcomes.Misinformation in healthcare is a growing concern for pediatricians.Time stamps00:00Introduction and Background03:01Journey into Medicine05:57Balancing Family and Residency09:00Navigating Parenthood and Guilt11:58Career Aspirations in Pediatrics15:12Challenges in Pediatric Care17:53Addressing Systemic Barriers21:05Misinformation and Public Health Advocacy27:29Balancing Clinical Work and Personal Life31:03Navigating Parenthood and Medical Training34:14Advice for Future Parents in Medicine38:06Influences and Inspirations in Medicine43:24Experiences and Challenges in Residency48:45The Ongoing Journey of Learning in Medicinekeywordspediatrics, residency, motherhood, public health, advocacy, work-life balance, adverse childhood experiences, healthcare challenges, physician insights, medical trainingSupport the show

Does your risk-averse team stall out at the edge of progress—hesitating, overanalyzing, or waiting for one more approval? If you've seen promising ideas grind to a halt because your people equate safety with smart, this episode is for you. In today's fast-moving world, too much caution can cost more than the risks ever would. You'll learn how to reframe risk so your team feels safe to experiment, adapt, and move forward with confidence. By listening, you'll discover how to: Reframe risk as a learning tool so your team builds confidence while taking action. Use language and boundaries that reduce fear and create psychological safety. Build momentum through small, practical experiments that turn hesitation into progress. Press play now to uncover practical tools that will help your risk-adverse team get unstuck and accelerate results. Check out: [02:39] – Why teams become risk-averse: past punishments, cultural norms, and the illusion that hesitation equals diligence. [04:42] – A practical team exercise: reframing risk by sharing stories of failures and lessons learned to normalize experimentation. [07:17] – How to define boundaries upfront so risks feel safe and measurable, with clear success criteria and pivot points. Leadership Without Using Your Soul podcast offers insightful discussions on leadership and management, focusing on essential communication skills, productivity, teamwork, delegation, and feedback to help leaders navigate various leadership styles, management styles, conflict resolution, time management, and active listening while addressing challenges like overwhelm, burnout, work-life balance, and problem-solving in both online and in-person teams, all aimed at cultivating human-centered leadership qualities that promote growth and success. Learn more about your ad choices. Visit megaphone.fm/adchoices

John Ayanian is the director of the Institute for Healthcare Policy and Innovation at the University of Michigan. Stephen Morrissey, the interviewer, is the Executive Managing Editor of the Journal. J.Z. Ayanian. Protecting Medicaid Enrollees with Chronic Conditions amid Work Requirements. N Engl J Med 2025;393:1044-1046.

Featuring an interview with Dr Neel Pasricha, including the following topics: Anatomy and physiology of the cornea; intersection of ophthalmology and oncology for patients receiving antibody-drug conjugates (ADCs) (0:00) Association of corneal toxicities with ADCs (4:56) Dose and schedule modifications to mitigate ocular toxicities associated with belantamab mafodotin and other ADCs (9:02) Spectrum and severity of corneal toxicities associated with datopotamab deruxtecan (14:44) Role of optometrists and ophthalmologists in screening for and management of ocular toxicities (17:55) Other ocular toxicities associated with cancer therapies (24:26) Prevention and management of corneal toxicity (33:58) Preexisting ophthalmic conditions as potential risk factors for development of ocular toxicities with ADCs (43:39) General clinical pearls on the management of ocular toxicities with cancer therapies (48:04) CME information and select publications

Dr Neel Pasricha from the University of California, San Franciso, reviews corneal and other ophthalmic toxicities associated with antibody-drug conjugates and other cancer therapies and strategies for their prevention and management. CME information and select publications here.

Featuring perspectives from Prof Rebecca A Dent, Dr Hans Lee, Dr Neel Pasricha and Dr Tiffany A Richards, including the following topics:  Introduction: The Patient Experience (0:00) Managing Ocular Toxicities Associated with Antibody-Drug Conjugates and Other Cancer Therapies — Dr Pasricha (10:28) Ocular Toxicities in Multiple Myeloma (45:33) Ocular Toxicities in Breast Cancer (50:34) CME information and select publications

Did you know your childhood story can shape your health, work, and relationships? In this episode, Dr. Melissa Merrick, President and CEO of Prevent Child Abuse America, shares the science behind ACEs (Adverse Childhood Experiences) and why nearly two-thirds of adults carry them. We talk about how trauma shows up in adulthood, why high achievers often live with hypervigilance, and the protective factors that can tip the scales toward healing. Tune in to learn why your past doesn't define you and how to build a stronger, healthier future starting today. In this Episode, You Will Learn 00:00 Meet Dr. Melissa Merrick, President and CEO of Prevent Child Abuse America. 01:45 What are ACEs (Adverse Childhood Experiences) and why do they matter? 05:45 How childhood adversity increases risk for physical and mental health issues. 07:00 The #1 protective factor proven to fuel adult healing and growth. 09:45 The link between ACEs, hypervigilance, and high-achieving adults. 13:15 Why a high ACE score can shorten life expectancy by nearly 20 years. 15:00 The weight of carrying family trauma across generations. 19:30 Examples of leaders creating safer and more supportive work environments. 23:45 Daily habits that retrain your biology to handle stress better. 25:45 Dr. Merrick's go-to resources for stress and pressure relief. Resources + Links Learn more about ACEs HERE Learn more about Prevent Child Abuse America HERE Get a copy of my book - The Anxious Achiever Watch the podcast on YouTube  Find more resources on our website morraam.com Follow Follow me: on LinkedIn @morraaronsmele + Instagram @morraam Follow Dr. Merrick on LinkedIn

Desmopressin is a synthetic analog of vasopressin, also known as antidiuretic hormone (ADH). It works by mimicking the action of natural ADH on the kidneys, primarily increasing water reabsorption in the collecting ducts. This effect reduces urine production and helps concentrate the urine. Because of this mechanism, desmopressin is commonly used in conditions like diabetes insipidus, nocturnal enuresis (bedwetting), and sometimes for nocturia in adults. It also has a role in certain bleeding disorders, such as mild hemophilia A and von Willebrand disease, since it can increase plasma levels of factor VIII and von Willebrand factor. In this podcast, we will explore desmopressin pharmacology and much more. Desmopressin is available in several dosage forms, including oral tablets, intranasal spray, and injectable formulations. The choice depends on the indication and patient-specific factors such as age, convenience, or the need for rapid effect. Adverse effects of desmopressin are largely related to water balance. Because it reduces urine output, patients are at risk for water retention and hyponatremia, which can lead to headaches, confusion, seizures, or in severe cases, coma. Monitoring sodium levels is especially important in elderly patients and those taking other medications that can affect fluid or electrolyte balance. Clinicians also need to be mindful of drug interactions. Medications that increase the risk of hyponatremia, such as SSRIs, carbamazepine, or certain diuretics, may enhance desmopressin's adverse effects. Conversely, drugs that blunt its activity can reduce effectiveness. Careful monitoring and patient education are key parts of safe use.

In his weekly clinical update, Dr. Griffin with Vincent Racaniello are dismayed about the recent attack on public health the firing of the director of the CDC as well as resignation of 3 others members of the agency's leadership, the continued Legionnaire's outbreak in Harlem, suspension of Ixchiq the Chikungunya virus attenuated infectious vaccine, the first US case of New World screwworm before Dr. Griffin deep dives into recent statistics on the measles epidemic, RSV, influenza and SARS-CoV-2 infections, the Wasterwater Scan dashboard, Johns Hopkins measles tracker, association Guillian-Barré syndrome with RSV vaccination, guidelines for using RSV vaccines, whether or not the NB.1.8.1 should be included in the fall 2025 vaccines, the American College Obstetricians and Gynecologists recommendations for the COVID, RSV and influenza vaccines, FDA approval letters for Pfizer, moderna and Novagax COVID vaccines including label changes for use in those between 5 through 64 years, where to find PEMGARDA, long COVID treatment center, where to go for answers to your long COVID questions, and contacting your federal government representative to stop the assault on science and biomedical research. Subscribe (free): Apple Podcasts, RSS, email Become a patron of TWiV! Links for this episode White House Says New C.D.C. Director Is Fired, but She Refuses to Leave (NY Times) CDC director refuses to leave after White House order (BBC) Legionnaires' Disease: In Harlem(NYC Health) New York City Health Department Provides Update on Community Cluster of Legionnaires' Disease in Central Harlem(NYC Health: Promoting and protecting the City's health) FDA Update on the Safety of Ixchiq (Chikungunya Vaccine, Live) (FDA) Vimkunya (Bavarian Nordiac) U.S. and Panama for the control of the Screwworm pest (COPEG) Rare human case of flesh-eating parasite New World screwworm identified in US(CNN) USDA Announces Sweeping Plans to Protect the United States from New World Screwworm (USDA) HHS details New World screwworm response after human case(CIDRAP) Wastewater for measles (WasterWater Scan) Measles cases and outbreaks (CDC Rubeola) Tracking Measles Cases in the U.S. (Johns Hopkins) 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) Respiratory virus activity levels (CDC Respiratory Illnesses) Weekly surveillance report: clift notes (CDC FluView) Relative effectiveness of high-dose versus standard-dose influenza vaccine against hospitalizations and mortality according to frailty score (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) ENFLONSIA: novel drug approvals 2025 (FDA) RSV-Network (CDC Respiratory Syncytial virus Infection) Vaccines for Adults (CDC: Respiratory Syncytial Virus Infection (RSV)) Evaluation of Guillain-Barré Syndrome (GBS) following Respiratory Syncytial Virus (RSV) Vaccination Among Adults 65 Years and Older (FDA) Economic Analysis of Protein Subunit and mRNA RSV Vaccination in Adults aged 50-59 Years (CDC: ACIP) Evidence to Recommendations Framework (EtR): RSV Vaccination in Adults Aged 50–59 years (CDC: National Center for Immunization and Respiratory Diseases) Waste water scan for 11 pathogens (WastewaterSCan) COVID-19 deaths (CDC) Respiratory Illnesses Data Channel (CDC: Respiratory Illnesses) COVID-19 national and regional trends (CDC) COVID-19 variant tracker (CDC) SARS-CoV-2 genomes galore (Nextstrain) Antigenic and Virological Characteristics of SARS-CoV-2 Variant BA.3.2, XFG, and NB.1.8.1 (bioRxiV) Veering from CDC, ACOG recommends maternal vaccination against COVID-19 (CIDRAP) ACOG Releases Updated Maternal Immunization Guidance for COVID-19, Influenza, and RSV (American College of Obstericians and Gynecologists) COVID-19 Vaccination Considerations for Obstetric–Gynecologic Care (American College of Obstericians and Gynecologists) Pfizer and BioNTech's COMIRNATY® Receives U.S. FDA Approval for Adults 65 and Older and Individuals Ages 5 through 64 at Increased Risk for Severe COVID-19 (Pfizer)  COMIRNATY approval letter (FDA) Moderna Receives U.S. FDA Approval for Updated COVID-19 Vaccines Targeting LP.8.1 Variant of SARS-CoV-2 (FEEDS) SPIKEVAX approval letter (FDA) Novavax's Nuvaxovid 2025-2026 Formula COVID-19 Vaccine Approved in the U.S (Novavax) NUVAXOVID approval letter (FDA) 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) Drug interaction checker (University of Liverpool) Paxlovid (Pfizer) 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 Reaching out to US house representative Letters read on TWiV 1248 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.

You use ketamine. I use ketamine. We all use ketamine. But… how safe it is, really? A new study out of Toronto suggests 30% of patients who receive ketamine have adverse events, a rate higher than seen in the ED. What are we to make of this? I bring Dr Remle Crowe on to discuss…Citations:1.     Kwong JL, Verbeek PR, Leong YC, Turner L, Huiskamp M, Drennan IR, Francom S, Ropp S, Cheskes S: Paramedic use of ketamine for severe agitation and violence. Can J Emerg Med. doi: 10.1007/s43678-025-00963-w (Epub ahead of print).2.     Fernandez AR, Bourn SS, Crowe RP, Bronsky ES, Scheppke KA, Antevy P, Myers JB: Out-of-Hospital Ketamine: Indications for Use, Patient Outcomes, and Associated Mortality. Annals of Emergency Medicine. 2021;78(1):123–31.3.     Brown LH, Crowe RP, Pepe PE, Miller ML, Watanabe BL, Kordik SS, Wampler DA, Page DI, Fernandez AR, Bourn SS, et al.: Adverse events following emergent prehospital sedation of patients with behavioral emergencies: A retrospective cohort study. The Lancet Regional Health - Americas. 2022;May;9:100183.

On this podcast, I cover ciprofloxacin pharmacology. Ciprofloxacin is one of the most widely recognized fluoroquinolone antibiotics and has been on the market for decades. Because of its broad utility, it often comes up in practice, but it also carries significant adverse effect concerns and boxed warnings that pharmacists and prescribers need to keep in mind. From a pharmacology standpoint, ciprofloxacin works by inhibiting bacterial DNA gyrase and topoisomerase IV, enzymes that are essential for bacterial DNA replication, transcription, and repair. This action gives ciprofloxacin bactericidal activity against a variety of gram-negative organisms, including E. coli, Klebsiella, Enterobacter, and Pseudomonas aeruginosa. It also has some gram-positive activity, though it is generally not the best choice for strep infections. Ciprofloxacin comes in multiple dosage forms, including oral tablets, oral suspension, and intravenous formulations, which makes it flexible across care settings. I discuss the conversion of IV and PO formulations. Pharmacokinetics are important to consider. Ciprofloxacin is primarily renally eliminated, so dose adjustments are necessary in patients with impaired kidney function. Distribution into tissues is generally good, but it has limited activity in the lungs against Streptococcus pneumoniae, which is why it is not a first-line option for community-acquired pneumonia. Adverse effects are a major concern. The fluoroquinolone class carries multiple boxed warnings. Ciprofloxacin has been associated with tendon rupture, peripheral neuropathy, CNS effects such as agitation or seizures, and exacerbation of myasthenia gravis. More recent warnings include the risk for aortic aneurysm and hypoglycemia or hyperglycemia, particularly in older adults or those with comorbidities. On top of these boxed warnings, ciprofloxacin can also prolong the QT interval and cause GI upset. Drug interactions are another big factor in practice. Ciprofloxacin is a CYP1A2 inhibitor, which can raise levels of drugs like theophylline, tizanidine, and clozapine. It also interacts with polyvalent cations such as calcium, magnesium, iron, and aluminum, which can dramatically reduce its absorption—sometimes by more than 50%. This is a common reason for treatment failure if counseling isn't provided. From a dosing perspective, ciprofloxacin is usually given 250–750 mg orally twice daily or 400 mg IV every 8–12 hours depending on the indication and severity of infection. Renal dosing adjustments are needed as kidney function declines. In summary, ciprofloxacin is a powerful antibiotic when used appropriately. It remains an option for urinary tract infections, complicated intra-abdominal infections, and some cases of hospital-acquired pneumonia, but its use must be balanced with the potential for significant adverse effects and interactions. For pharmacists, educating patients on drug interactions, counseling about boxed warnings, and ensuring correct dosing in renal impairment are some of the most valuable interventions when ciprofloxacin shows up on a medication list.