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This is Coronavirus 411, the latest on Omicron and other COVID variants and new hotspots for December 6th, 2021.At least 12 U.S. states have now identified Omicron cases, but US health officials remain more concerned about Delta. It's accounting for 99.9% of all new infections and those infections are going up. Results from studies to gauge the severity and transmissibility of Omicron are expected in a few weeks. Cases of Omicron remain mild but that is not true of Delta. In Brussels, Belgium, police turned water cannons and tear gas on protesters against the tightening of COVID restrictions that aim to counter a surge of coronavirus infections. Thousands participated after the government tightened rules for the third week in a row. But an avalanche of new cases has strained the country's health services.The company's President says Moderna could have a vaccine booster shot that targets the Omicron variant ready for authorization by March. Although the drumbeat of messaging has been that the existing vaccines protect fine against Omicron, he told the Financial Times he thinks the existing vaccines will be less effective against it than they've been against Delta and they've already started work on a new booster.A new analysis in The American Journal of Cardiology has revealed a possible link between the vaccines and elevated risk of Myopericarditis, an inflammation of the heart muscle. The CDC had almost 2,000 reports of the condition just in 2021 in people who got the vaccine. This is mostly happening in men 25 to 44, but most cases with clinical symptoms seem to resolve within six days.Speaking of men and COVID, a study out of Colorado State suggests men spread coronavirus particles more frequently than women or children. The study was originally to see how the performing arts could safely return to the stage. After doing things like making subjects sing “Happy Birthday” over and over, they learned singing spreads more virus than instruments, adults emit more particles than kids, people who talk loud emit more virus, and men emit more than women, theoretically because they have bigger lungs. In the United States cases were up 19%, deaths are up 5%, and hospitalizations are up 18% over 14 days. The 7-day average of new cases has been trending up since November 29. The five states that had the most daily deaths per 100,000 are Wyoming, Montana, Kentucky, Michigan, and West Virginia. There are 9,637,520 active cases in the United States.The five states with the greatest increase in hospitalizations per capita: Delaware 62%, Connecticut 60%, Rhode Island 55%, Indiana 49%, and Illinois 45%.The top 10 counties with the highest number of recent cases per capita according to The New York Times: Allen, KS. Bennington, VT. Koochiching, MN. Sullivan, NH. Jackson, IA. Benton, MN. Waseca, MN. Mille Lacs, MN. St. Clair, MI. And Socorro, NM. There have been at least 788,363 deaths in the U.S. recorded as Covid-related.The top 3 vaccinating states by percentage of population that's been fully vaccinated: Vermont at 73.5%, Rhode Island at 73.3%, and Maine at 72.9%. The bottom 3 vaccinating states are Wyoming at 46%, Alabama at 46.4%, and Mississippi at 47.1%. The percentage of the U.S. that's been fully vaccinated is 59.6%.Globally, cases were up 13% and deaths were up 2% over 14 days, with the 7-day average trending up since October 15. There are once again over 21 million active cases around the world, at 21,146,420.The five countries with the most new cases: The U.K. 43,992. France 42,252. Germany 35,983. The United States 35,065. And Russia 32,602. There have been at least 5,255,544 deaths reported as Covid-related worldwide. For the latest updates, subscribe for free to... See acast.com/privacy for privacy and opt-out information.

This lecture was delivered at the College of William and Mary on October 22, 2021. For more information on upcoming events, please visit our website at www.thomisticinstitute.org. About the speaker: Bradley Lewis specializes in political and legal philosophy, especially in classical Greek political thought and in the theory of natural law. He holds a B.A. from the University of Maryland and a Ph.D. from the University of Notre Dame. He has published scholarly articles in Polity, History of Political Thought, the Southern Journal of Philosophy, Philosophy and Rhetoric, Communio, the Josephinum Journal of Theology, the Pepperdine Law Review, the Oxford Journal of Law and Religion, and the Proceedings of the American Catholic Philosophical Association, as well as chapters in a number of books. He is currently working on a book project provisionally titled “The Common Good and the Modern State.” He is also a fellow of the Institute for Human Ecology and serves as associate editor of the American Journal of Jurisprudence.

WE finally start counting our jokes that don't work. Wes theorizes on the anatomy of the BLT appliances, and Ethan tries to think about sports.   The producers of this show would also like to apologize to the cast of The American Journal of Losers for the baseless attacks on their character.   Review: Brave Little Toaster Quiz (Starts at 00:42:47): The Sandlot Twitter: @WEAintSeenNothinYet Facebook:@WEAintSeenIt Ethan: @PowerfulGoose, letterboxd: egeese Wesley: @babyweswee, letterboxd: babyweswee

Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode covers suicide epidemiology, and prevention with Dr. Juveria Zaheer, a Clinician Scientist with the Institute for Mental Health Policy Research, and Education Administrator in the Gerald Sheff and Shanitha Kachan Emergency Department at CAMH in Toronto, Ontario. She is also an Assistant Professor in the Department of Psychiatry at the University of Toronto. She utilizes both quantitative and qualitative methods to better understand suicide and identify areas of potential improvement.    The learning objectives for this episode are as follows:   By the end of this episode, you should be able to… Develop an awareness of suicide risk and prevalence, as it pertains to the general population and psychiatric populations Incorporate additional contextual information into suicide risk assessment that goes beyond SADPERSONS and other list-based approaches  Develop a deeper understanding of how to approach and help individuals with suicidal thoughts and behaviours    Guest expert: Dr. Juveria Zaheer    Hosts: Dr. Chase Thompson (PGY4)   Episode production: Dr. Weam Sieffien, Dr. Vincent Tang, and Dr. Chase Thompson    Audio editing: Dr. Chase Thompson   Show notes: Dr. Chase Thompson   00:00 – Introduction 01:14 – Learning objectives 04:00 – Overview of suicide rates across populations 07:20 - Sex and gender differences in suicide 08:50 - Suicide following discharge from hospital 14:10 - Finding suitable dispositions for individuals dealing with suicidal thoughts and behaviors 20:50 - Meeting patients and families where they are at 23:30 - Suicide safety plans  28:30 - Evidence-based approaches to suicide prevention  32:30 - Commentary on strength of evidence for interventions in suicide prevention 38:40 - Addressing suicidality in borderline personality disorder 47:00 - Ethics of involuntary hospitalization for suicidality 50:00 - Future of suicide prevention  References: Borecky, A., Thomsen, C., & Dubov, A. (2019). Reweighing the ethical tradeoffs in the involuntary hospitalization of suicidal patients. The American Journal of Bioethics, 19(10), 71-83. Cipriani, A., Hawton, K., Stockton, S., & Geddes, J. R. (2013). Lithium in the prevention of suicide in mood disorders: updated systematic review and meta-analysis. Bmj, 346. Chung, D., Hadzi-Pavlovic, D., Wang, M., Swaraj, S., Olfson, M., & Large, M. (2019). Meta-analysis of suicide rates in the first week and the first month after psychiatric hospitalisation. BMJ open, 9(3), e023883. Chung, D. T., Ryan, C. J., Hadzi-Pavlovic, D., Singh, S. P., Stanton, C., & Large, M. M. (2017). Suicide rates after discharge from psychiatric facilities: a systematic review and meta-analysis. JAMA psychiatry, 74(7), 694-702. Guzmán, E. M., Cha, C. B., Ribeiro, J. D., & Franklin, J. C. (2019). Suicide risk around the world: a meta-analysis of longitudinal studies. Social psychiatry and psychiatric epidemiology, 54(12), 1459-1470. Kessler, R. C., Bossarte, R. M., Luedtke, A., Zaslavsky, A. M., & Zubizarreta, J. R. (2020). Suicide prediction models: a critical review of recent research with recommendations for the way forward. Molecular psychiatry, 25(1), 168-179. Mann, J. J., Apter, A., Bertolote, J., Beautrais, A., Currier, D., Haas, A., ... & Hendin, H. (2005). Suicide prevention strategies: a systematic review. Jama, 294(16), 2064-2074. Miller, I. W., Camargo, C. A., Arias, S. A., Sullivan, A. F., Allen, M. H., Goldstein, A. B., ... & Ed-Safe Investigators. (2017). Suicide prevention in an emergency department population: the ED-SAFE study. JAMA psychiatry, 74(6), 563-570. Sakinofsky, I. (2014). Preventing suicide among inpatients. The Canadian journal of psychiatry, 59(3), 131-140. Stanley, B., Brown, G. K., Brenner, L. A., Galfalvy, H. C., Currier, G. W., Knox, K. L., ... & Green, K. L. (2018). Comparison of the safety planning intervention with follow-up vs usual care of suicidal patients treated in the emergency department. JAMA psychiatry, 75(9), 894-900. Zaheer, J., Jacob, B., de Oliveira, C., Rudoler, D., Juda, A., & Kurdyak, P. (2018). Service utilization and suicide among people with schizophrenia spectrum disorders. Schizophrenia research, 202, 347-353. Zaheer, J., Links, P. S., & Liu, E. (2008). Assessment and emergency management of suicidality in personality disorders. Psychiatric Clinics of North America, 31(3), 527-543. CPA Note: The views expressed in this podcast do not necessarily reflect those of the Canadian Psychiatric Association (CPA). For more PsychEd, follow us on Twitter (@psychedpodcast), Facebook (PsychEd Podcast), and Instagram (@psyched.podcast). You can provide feedback by email at psychedpodcast@gmail.com. For more information, visit our website at psychedpodcast.org.

Tune in on Monday, 11/22/21 at 6:30am EST, for a brand new episode of The Doctor Whisperer Show featuring Alternative Psychiatrist, Dr. Mark Sylvester of Alternative Psychiatry! In this episode, we discussed how to navigate though the holidays in a pandemic with your family.  We shared our best tips on what to say and what not to say to encourage a gracious season filled with love and harmony.  There are certain topics we feel strongly that shall remain nameless during your family dinners.  We wish you all a happy and loving holiday season. ▪︎ ▪︎ ▪︎ Mark Sylvester, MD, ABAM, was born and raised in Sarasota, Florida. He received his medical education at the University of Miami and training at the University of Florida College of Medicine. Dr. Sylvester received graduate education in Neuropsychopharmacology and Psychobiology. He is board certified in Psychiatry & Neurology as well as Addiction Medicine. In addition to caring for his patients with Alternative Psychiatry, where he practices Functional Psychiatry and Integrative Health, he also currently serves as medical director of Centerpointe Counseling and Recovery, Sarasota Addiction Specialists, and the Suncoast Harm Reduction Project aimed at reducing opioid related overdose deaths. Dr. Sylvester is an adjunct faculty member at Lake Erie College of Osteopathic Medicine (LECOM) where he lectures and clinically trains medical students. He is active in research and is published in the Journal of Biomechanics, Journal of Global Drug Policy, and American Journal of Psychiatry, on topics related to biomechanics, obesity/food addiction, professionalism, addiction in clinical practice, and psychiatric symptoms in end-of-life care. ▪︎ ▪︎ ▪︎ Thank you to TieTechnology for sponsoring the show! #mentalhealth #theholidays #Holidays #holidayseason --- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app --- Send in a voice message: https://anchor.fm/thedoctorwhisperer/message

CardioNerds Tommy Das (Program Director of the CardioNerds Academy and cardiology fellow at Cleveland Clinic) and Rick Ferraro (Director of CardioNerds Journal Club and cardiology fellow at the Johns Hopkins Hospital) join Dr. Erin Michos (Associate Professor of Cardiology at the Johns Hopkins Hospital and Editor-In-Chief of the American Journal of Preventative Cardiology) for a discussion about the effect of DHA and EPA on triglycerides and why DHA/EPA combinations may have exhibited limited benefits in trials. This episode is part of the CardioNerds Lipids Series which is a comprehensive series lead by co-chairs Dr. Rick Ferraro and Dr. Tommy Das and is developed in collaboration with the American Society For Preventive Cardiology (ASPC). Relevant disclosures: None Pearls • Notes • References • Guest Profiles • Production Team CardioNerds Lipid Series PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Pearls The best intervention for heart disease is prevention! The InterHeart trial showed that 9 modifiable risk factors (dyslipidemia, smoking, hypertension, diabetes, abdominal obesity, dietary patterns, physical activity, consumption of alcohol, and psychosocial factors) predict 90% of acute myocardial infarction. So many acute events can be prevented1.Atherosclerotic vascular disease events increase across a range of triglyceride levels, even from 50-200mg/dL. So even in a relatively normal range, lower triglycerides seem to be better. Over ¼ of US adults have triglycerides over 150.While 8% of US adults take fish oil supplements, multiple meta-analyses have failed to show any benefit to the use of dietary omega-3 supplementation2. Dietary supplements these are not meant for medical use and are not studied or regulated as such! Show notes 1. What are DHA and EPA? DHA, or docosahexaenoic acid, and EPA, or eicosapentaenoic acid, are n-3 polyunsaturated fatty acids, also known as omega-3 fatty acids. These compounds have been of considerable interest for over two decades given observed association of high dietary omega-3 fatty acid intake with reduced cardiovascular events3. As both are important omega-3 fatty acids, trials on the benefits of DHA and EPA have often focused on the two compounds in combination. 2. What was the GISSI-Prevenzione Trial and why was it Important? GISSI-Prevenzione trial (Lancet 1999), was one of the earliest trials to study DHA and EPA4. In this trial, the authors evaluated the effect of omega-3 supplementation as a combination pill of DHA and EPA on cardiovascular events and death in patients with recent myocardial infarction (the last three months). Over a 3.5-year follow-up period, participants treated with DHA/EPA combination experienced a significant reduction in death, nonfatal MI, and stroke.As this was an early trial, patients were largely not on statins, as these were not supported at the time of study initiation (Only 5% were on cholesterol-lowering medications at baseline, and only 45% were on cholesterol-lowering therapy at study completion). The benefits seen in this trial may not extend to modern practice with patients on contemporary background therapy.The trial participants were also not representative of our modern patients for a variety of other reasons. 85% of participants in the trial were men. 42.2% of patients in EPA/DHA arm were current smokers, and 35.4% were prior smokers. Only 14.2% of patients had diabetes and 14.7% with BMI >30.Notably, the decrease in triglycerides in this trial was only 3%, implying that triglyceride lowering did not entirely explain the benefit in cardiovascular events seen. 3. What about the data after the GISSI-Prevensione Trial? After this positive trial for DHA/EPA in combination, subsequent trial data in support of DHA/EPA has been less robust.

Lisa Miller is the New York Times best selling author of The Spiritual Child and a professor in the clinical psychology program at Teachers College, Columbia University. She is the founder and director of the Spirituality Mind Body Institute, the first Ivy League graduate program in spirituality and psychology and for over a decade has held joint appointments in the department of psychiatry at. Columbia University medical school. Her innovative research has been  published in more than one hundred empirical , peer-reviewed articles in leading journals, including Cerebral Cortex, The American Journal of Psychiatry, and the Journal of the American Academy of Child and Adolescent Psychiatry. She lives in Connecticut with her husband and their three children…and her latest book, The Awakened Brain: The New Science of Spirituality and Our Quest for An Inspired Life is out now.   In this episode we speak about everything from: ~ receiving spiritual information and how to know it's true ~ why women are more naturally aligned with spiritual connection ~ the power of awakened awareness and awakened relationships ~ how transcendent awareness reduces depression (which affects women more than men) ~ the detriment of NOT listening to the mystical wisdom you receive ~ what the emerging new woman is and how you can heed the call ~ a guided practice Lisa takes you through to connect with your Higher Self ~ and much more!     Connect with Dr. Lisa Miller Website |  https://www.lisamillerphd.com/        *****   MENTORING + FREE MOJO CHECK LIST    Burnt out and Stressed? Disconnected from your body? Lost your enthusiasm for life? Craving confidence + feminine radiance?   You need to talk with me ASAP.   You are being gifted with an opportunity to have a complimentary Mojo Mentoring session with me*. And yes, we can uncover what's in the way and ignite your mojo…PLUS, as soon as you book your call, you receive a FREE Mojo Check List to get your engines revved right away.   Click the link and reserve your spot now: https://mojo.deborah-kagan.com/mentoring * a limited number of sessions are available     *****   Connect with Deborah Website | http://therealundressed.com/ Instagram | https://www.instagram.com/therealundressed/   https://www.instagram.com/deborahkagan/ Facebook | https://www.facebook.com/mojorecoveryspecialist/     Subscribe to The Real Undressed Podcast iTunes | https://podcasts.apple.com/us/podcast/the-real-undressed-with-deborah-kagan/id1494643770 Spotify | https://open.spotify.com/show/1eOQaw6kryBsXo7Jb6qEnv   Please remember to: Subscribe Rate Review the podcast. I read every single one and your feedback is valuable.  

Videos for Today: 1. DR Peter C. Gøtzsche Comments – 3 mins   2. PARENTS IN NY TAKE TO THE STREETS TO WARN IGNORANT PARENTS INJECTING THEIR CHILDREN WITH PFIZER SHOT   3, DANIEL NAGASE – EFFECTS OF CV VX ON THE IMMUNE SYSTEM DEVELOPMENT IN CHILDREN   4.The Great Narrative: A call to action speaker Freeke Heijman (start 3 min mark)    5. COMMERCIAL PILOT CODY FLINT: “I DON'T KNOW IF I WILL EVER BE ABLE TO FLY A PLANE AGAIN.”   6. Study, Experts: Vaccinated Are Spreading COVID-19 start 23 seconds in    7. RFK CLIP Start 50 seconds in    Everyone missed this one… vaccinated people are up to 9X more likely to be hospitalized than unvaccinated people Australian War Propaganda Keeps Getting Crazier Are we seeing some new form of Covid-19 Vaccine induced Acquired Immunodeficiency Syndrome? – Official Government data suggests the Fully Vaccinated are on the precipice of disaster as their Immune Systems are being decimated $285 Billion Tax Cut for the Rich Is Now 2nd Most Expensive Piece of Build Back Better Wall Street's Takeover of Nature Advances with Launch of New Asset Class  Court Deals New Blow to ‘Fatally Flawed' Biden Vaccine Mandates, But What Does That Mean?     Study: Sustainable eating is cheaper and healthier Oxford University, November 11, 2021 Oxford University research has today revealed that, in countries such as the US, the UK, Australia and across Western Europe, adopting a vegan, vegetarian, or flexitarian diet could slash your food bill by up to one-third. The study, which compared the cost of seven sustainable diets to the current typical diet in 150 countries, using food prices from the World Bank's International Comparison Program, was published in The Lancet Planetary Health. It found that in high-income countries: Vegan diets were the most affordable and reduced food costs by up to one third. Vegetarian diets were a close second. Flexitarian diets with low amounts of meat and dairy reduced costs by 14%. By contrast, pescatarian diets increased costs by up to 2%. “We think the fact that vegan, vegetarian and flexitarian diets can save you a lot of money is going to surprise people,” says Dr. Marco Springmann, researcher on the Oxford Martin Programme on the Future of Food. “When scientists like me advocate for healthy and environmentally-friendly eating, it's often said we're sitting in our ivory towers promoting something financially out of reach for most people. This study shows it's quite the opposite. These diets could be better for your bank balance as well as for your health and…the planet.” Miguel Barclay, author of the bestselling “One Pound Meals” series of cookbooks, says, “I definitely agree that cutting down your meat, or cutting it out completely, will save you money. I've written seven budget cookbooks and have costed up hundreds of recipes, and without doubt vegan and vegetarian meals consistently come in at a much lower price than recipes with meat.” The study focused on whole foods and did not include highly-processed meat replacements or eating at restaurants or takeaways. The study also found that in lower income countries, such as on the Indian subcontinent and in sub-Saharan Africa, eating a healthy and sustainable diet would be up to a quarter cheaper than a typical Western diet, but at least a third more expensive than current diets. To analyze what options could improve affordability and reduce diet costs, the study looked at several policy options. It found that making healthy and sustainable diets affordable everywhere is possible within the next 10 years when economic development, especially in lower income countries, is paired with reductions in food waste and a climate and health-friendly pricing of foods. “Affording to eat a healthy and sustainable diet is possible everywhere, but requires political will,” according to Dr. Springmann. “Current low-income diets tend to contain large amounts of starchy foods and not enough of the foods we know are healthy. And the western-style diets, often seen as aspirational, are not only unhealthy, but also vastly unsustainable and unaffordable in low-income countries. Any of the healthy and sustainable dietary patterns we looked at are a better option for health, the environment, and financially, but development support and progressive food policies are needed to make them both affordable and desirable everywhere.” The study, “The global and regional costs of healthy and sustainable dietary patterns: a modeling study,” is published in The Lancet Planetary Health on 10 November 2021. Country-level results are available here. Green One Pound Meals by Miguel Barclay is published on 30 December. It features planet-friendly recipes and includes tips and ideas for shopping smart and avoiding food waste. Meta-analysis concludes resveratrol beneficially modulates glycemic control in diabetics Zagazig University and Suez Canal University (Egypt), October 29 2021.  Findings from a meta-analysis of clinical trials published on October 16, 2021 in Medicina Clinica (Barcelona) revealed an association between supplementing with resveratrol and improvements in glycemic control. “Type 2 diabetes mellitus (T2DM) is a progressive meta-inflammatory disorder, which induces micro and macrovascular complications,” Ibrahim A. Abdelhaleem and colleagues wrote. “Resveratrol is a nutraceutical known to have antioxidant and anti-inflammatory properties.” “This systematic review and meta-analysis is the first to consider resveratrol's efficacy on glycemic and cardiometabolic parameters in patients with T2DM.” Sixteen randomized trials that included a total of 871 diabetic men and women were selected for the meta-analysis. The trials compared resveratrol to a placebo with or without concurrent antidiabetic medications or other drug treatment. Resveratrol doses of 500 milligrams or more were associated with lower fasting blood glucose, fasting serum insulin, insulin resistance, total cholesterol, LDL cholesterol and diastolic blood pressure in comparison with a placebo. Resveratrol was associated with a greater reduction in hemoglobin A1c (a marker of long-term glucose control) compared to a placebo in trials of three months duration. When HDL cholesterol levels were analyzed, resveratrol was superior to a placebo in trials of less than two months duration. Resveratrol was also associated with a reduction in systolic blood pressure compared to measurements obtained in the placebo group. Furthermore, triglycerides were lower in association with resveratrol in trials that lasted six to twelve months. “We concluded that resveratrol appropriately improved insulin sensitivity by decreasing insulin resistance, fasting blood glucose, fasting serum insulin, and hemoglobin A1c,” the authors concluded. “In addition, it improved other cardiometabolic parameters, including triglycerides, total cholesterol, LDL cholesterol, and systolic and diastolic blood pressure. The most appropriate glycemic control effect was fulfilled when consumed for at least one month with doses of 500 mg or more.” Exercise linked to better mental health Kaiser Permanente Research, November 11, 2021 Kaiser Permanente research published on November 11 in Preventive Medicine showed people who exercised more during the initial lockdown period of the COVID-19 pandemic experienced less anxiety and depression than those who didn't exercise. It also showed that people who spent more time outdoors typically experienced lower levels of anxiety and depression than those who stayed inside. More than 20,000 people participated in the survey-based study from 6 regions served by Kaiser Permanente across the United States, which included Hawaii, Colorado, Georgia, and the mid-Atlantic states, as well as Southern and Northern California. “What these study findings tell us is that even during an active pandemic or other public health crisis, people should be encouraged to be physically active to help maintain their physical and mental health,” said the study's lead author Deborah Rohm Young, PhD, the director of the Division of Behavioral Research for the Kaiser Permanente Southern California Department of Research & Evaluation. “Parks and other nature areas should remain open during public health emergencies to encourage outdoor physical activity.” In March 2020, COVID-19 developed into a worldwide pandemic. With no known treatment, public health officials attempted to reduce its spread by limiting human interactions through stay-at-home policies. Businesses temporarily closed or changed their practices to prevent the spread of the virus, affecting the economy and many people's jobs. These stressful factors, along with fewer opportunities to socialize with friends and family, increased symptoms of depression and anxiety for many people. Since it is known that physical activity and time spent in nature are associated with improved mental health, researchers at Kaiser Permanente in Southern California sought to determine how exercise and time outdoors was associated with people's mental health during the height of the pandemic. In April 2020, researchers sent a series of COVID-19 surveys to more than 250,000 participants in the Kaiser Permanente Research Bank — a collection of lifestyle surveys, electronic health record data, and biospecimens, which Kaiser Permanente members volunteered. People who reported COVID-19 symptoms were not included in this analysis, resulting in 20,012 respondents. They each completed at least 4 surveys between April and July 2020. White women older than 50 accounted for a high proportion of the respondents. Most respondents said they were retired and generally adhered to the “safer-at-home” orders during the period of the survey. The study found that: Reports of anxiety and depression decreased over time Anxiety and depression scores were higher for females and younger people, and lower for Asian and Black people compared with white respondents Participants who reported no physical activity reported the highest depression and anxiety compared to people who had exercised Spending less time outdoors was associated with higher depression and anxiety scores People who had increased their time outdoors the most reported the highest anxiety scores, but the research could not explain the finding “What we learned from these findings is that during future emergencies it will be important to carefully weigh the decisions to close parks and outdoor areas against the negative impact those closures may have on people's mental health,” said Dr. Young. Bedtime linked with heart health University of Exeter (UK), November 9, 2021 Going to sleep between 10:00 and 11:00 pm is associated with a lower risk of developing heart disease compared to earlier or later bedtimes, according to a study published today in European Heart Journal—Digital Health, a journal of the European Society of Cardiology (ESC). “The body has a 24-hour internal clock, called circadian rhythm, that helps regulate physical and mental functioning,” said study author Dr. David Plans of the University of Exeter, UK. “While we cannot conclude causation from our study, the results suggest that early or late bedtimes may be more likely to disrupt the body clock, with adverse consequences for cardiovascular health.” While numerous analyses have investigated the link between sleep duration and cardiovascular disease, the relationship between sleep timing and heart disease is underexplored. This study examined the association between objectively measured, rather than self-reported, sleep onset in a large sample of adults. The study included 88,026 individuals in the UK Biobank recruited between 2006 and 2010. The average age was 61 years (range 43 to 79 years) and 58% were women. Data on sleep onset and waking up time were collected over seven days using a wrist-worn accelerometer. Participants completed demographic, lifestyle, health and physical assessments and questionnaires. They were then followed up for a new diagnosis of cardiovascular disease, which was defined as a heart attack, heart failure, chronic ischaemic heart disease, stroke, and transient ischaemic attack. During an average follow-up of 5.7 years, 3,172 participants (3.6%) developed cardiovascular disease. Incidence was highest in those with sleep times at midnight or later and lowest in those with sleep onset from 10:00 to 10:59 pm. The researchers analyzed the association between sleep onset and cardiovascular events after adjusting for age, sex, sleep duration, sleep irregularity (defined as varied times of going to sleep and waking up), self-reported chronotype (early bird or night owl), smoking status, body mass index, diabetes, blood pressure, blood cholesterol and socioeconomic status. Compared to sleep onset from 10:00 to 10:59 pm, there was a 25% higher risk of cardiovascular disease with a sleep onset at midnight or later, a 12% greater risk for 11:00 to 11:59 pm, and a 24% raised risk for falling asleep before 10:00 pm. In a further analysis by sex, the association with increased cardiovascular risk was stronger in women, with only sleep onset before 10:00 pm remaining significant for men. Dr. Plans said: “Our study indicates that the optimum time to go to sleep is at a specific point in the body's 24-hour cycle and deviations may be detrimental to health. The riskiest time was after midnight, potentially because it may reduce the likelihood of seeing morning light, which resets the body clock.” Dr. Plans noted that the reasons for the observed stronger association between sleep onset and cardiovascular disease in women is unclear. He said: “It may be that there is a sex difference in how the endocrine system responds to a disruption in circadian rhythm. Alternatively, the older age of study participants could be a confounding factor since women's cardiovascular risk increases post-menopause—meaning there may be no difference in the strength of the association between women and men.” He concluded: “While the findings do not show causality, sleep timing has emerged as a potential cardiac risk factor—independent of other risk factors and sleep characteristics. If our findings are confirmed in other studies, sleep timing and basic sleep hygiene could be a low-cost public health target for lowering risk of heart disease.” Garlic compounds may boost cardio health indirectly via gut microbiota National Taiwan University, November 6 2021 Allicin from garlic may prevent the metabolism of unabsorbed L-carnitine or choline into TMAO, a compound linked to an increased risk of cardiovascular diseases, says a new study from the National Taiwan University. TMAO – or trimethylamine N-oxide – has been known to be generated from dietary carnitine through metabolism of gut microbiota, and was recently reported to be an “important gut microbiota-dependent metabolite to cause cardiovascular diseases,” explained Taiwanese researchers in the Journal of Functional Foods . While antibiotics have been found to inhibit TMAO production, concerns over side effects and resistance have limited their use. This has led researchers to examine the potential of natural alternatives. New data indicated that carnitine-fed lab mice showed a “remarkable increase in plasma TMAO levels”, compared with lab mice fed a control (no carnitine). However, when allicin supplements were provided with the carnitine diet, TMAO levels were significantly reduced. “Surprisingly, the plasma TMAO levels in the mice of ‘carnitine diet + allicin' treatment group were as low as that of chow diet [control] group,” wrote the researchers. “This result indicated that the metabolic capacity of mice gut microbiota to produce TMAO was completely inhibited by allicin supplement even though provided with carnitine-rich environment in the gut. “It means the functional alteration of gut microbiota induced by carnitine diet can be prevented by addition of another substance with antimicrobial potential derived from food, such as allicin.” Garlic and heart health The study adds to the body of scientific literature supporting the potential heart health benefits of garlic and the compounds it contains. Consumer awareness of the health benefits of garlic, mostly in terms of cardiovascular and immune system health, has benefited the supplements industry, particularly since consumers seek the benefits of garlic without the odors that accompany the fresh bulb. The benefits have been linked to the compound allicin, which is not found in fresh garlic: It is only formed when garlic is crushed, which breaks down a compound called diallyl sulphide. Study details “This may offer an opportunity to take advantage of plants' delicately designed defense system against microorganisms, to protect ourselves by modulating gut microbiota to a healthier status,” wrote the researchers The Taiwanese researchers divided male C57BL/6(B6) mice into four groups: One group received only the control chow diet; the second group received the carnitine diet (carnitine added to drinking water at a level of 0.02%); the third group received the carnitine diet with supplemental allicin; and the final group received the control diet plus the allicin supplement for six weeks. Results showed that the second group (carnitine diet) had TMAO levels 4–22 times greater than those observed in the control group. However, these increases were attenuated in the carnitine + allicin group, said the researchers. “Our study suggests that antimicrobial phytochemicals such as allicin effectively neutralize the metabolic ability of TMAO production of gut microbiota induced by daily intake of L-carnitine,” wrote the researchers. “It may offer an opportunity for us to take advantage of plants' delicately designed defense system against microorganisms, to protect ourselves by modulating gut microbiota to a healthier status. “Our research also suggested that allicin and dietary fresh garlic containing allicin might be used as functional foods for the prevention of atherosclerosis,” they concluded. Drug used to prevent miscarriage increases risk of cancer in offspring University of Texas Health Science Center, November 9, 2021 Exposure in utero to a drug used to prevent miscarriage can lead to an increased risk of developing cancer, according to researchers at The University of Texas Health Science Center at Houston (UTHealth Houston). The study was published today in the American Journal of Obstetrics and Gynecology. The drug, 17α-hydroxyprogesterone caproate (17-OHPC), is a synthetic progestogen that was frequently used by women in the 1950s and 1960s, and is still prescribed to women today to help prevent preterm birth. Progesterone helps the womb grow during pregnancy and prevents a woman from having early contractions that may lead to miscarriage. “Children who were born to women who received the drug during pregnancy have double the rate of cancer across their lifetime compared to children born to women who did not take this drug,” said Caitlin C. Murphy, PhD, MPH, lead author on the study and associate professor in the Department of Health Promotion and Behavioral Sciences at UTHealth School of Public Health in Houston. “We have seen cancers like colorectal cancer, pancreatic cancer, thyroid cancer, and many others increasing in people born in and after the 1960s, and no one really knows why.” Researchers reviewed data from the Kaiser Foundation Health Plan on women who received prenatal care between June 1959 and June 1967, and the California Cancer Registry, which traced cancer in offspring through 2019. Out of more than 18,751 live births, researchers discovered 1,008 cancer diagnoses were made in offspring ages 0 to 58 years. Additionally, a total of 234 offspring were exposed to 17-OHPC during pregnancy. Offspring exposed in the womb had cancer detected in adulthood more than twice as often as offspring not exposed to the drug – 65% of cancers occurred in adults younger than 50. “Our findings suggest taking this drug during pregnancy can disrupt early development, which may increase risk of cancer decades later,” Murphy said “With this drug, we are seeing the effects of a synthetic hormone. Things that happened to us in the womb, or exposures in utero, are important risk factors for developing cancer many decades after we're born.” A new randomized trial shows there is no benefit of taking 17-OHPC, and that it does not reduce the risk of preterm birth, according to Murphy. The U.S. Food and Drug Administration proposed in October 2020 that this particular drug be withdrawn from the market.

Read Michael's issue brief here: https://www.manhattan-institute.org/revitalizing-local-democracy-case-cycle-local-elections Michael T. Hartney joined the Boston College political science faculty in fall 2017. Previously he was Assistant Professor of Politics at Lake Forest College. Professor Hartney's main research and teaching interests include: state and local government, interest groups, and public policy. His scholarship has been published (or is forthcoming) in leading academic journals such as the American Journal of Political Science, the American Political Science Review, Perspectives on Politics, and Public Administration Review and has garnered media coverage in the Economist, New York Times, Washington Post, and Wall Street Journal. Hartney's forthcoming book (under contract with the University of Chicago Press) examines the causes and consequences of teacher union political power in the United States. At Boston College, Hartney teaches courses on the politics of education, environmental politics and policy, and US state and local politics. He is also a research affiliate at Harvard University's Program on Education Policy and Governance (PEPG), and, in 2020-21, a national fellow at Stanford University's Hoover Institution. Produced by Show-Me Opportunity

For nearly 70 years now, Americans have been bombarded with advice on how to lose weight. Countless diet books have become bestsellers. Some diets like Atkins keep coming back in sort of a recycled way. And there really hasn't been agreement, even among nutrition scientists, about which approach is best. Lots of attention has focused in recent years on carbohydrates, but over the years, protein and fat have had plenty of attention. In this podcast, our guest, Dr. David Ludwig of Harvard University, discusses this history and the reason for re-envisioning how best to lose weight – and for people to maintain the weight loss, perhaps the most important issue of all. Ludwig recently published a landmark, exquisitely designed and controlled study that tests whether limiting carbohydrates actually makes sense. This study, published in the "American Journal "of Clinical Nutrition 2021," has been generating lots of attention.   Interview Summary   Access the study: https://doi.org/10.1093/ajcn/nqab287     I'll begin by asking a question fundamental to this work. Why care so much about carbohydrates?   Great question, Kelly. Carbohydrates amount to at least half the calories in a typical diet today, which is interesting from a historical and evolutionary perspective. Because of the three major nutrients we eat, protein, fat, and carbohydrate, carbohydrate is the only one for which humans have virtually no requirement. Think of Northern populations, especially in the Ice Ages but also up to recently, such as the Inuit, that had access to only animal products and could eat plant products like berries maybe one or two or three months a year at most. So for nine months a year, they were eating only fat and protein. And yet, those populations were healthy. The women were fertile; they could breastfeed. And children grew normally. So recognizing that there's no absolute requirement for carbohydrates, the question then becomes: How much carbohydrate and what kind would be optimal for health and allow for the greatest flexibility, diversity and enjoyment in our diets?   So David, if the body doesn't have an innate need for these, presumably there's no biological driver to go out and seek these, why in the heck are people eating so much of this?   Well, carbohydrates are delicious. And the food industry certainly knows that and has taken advantage of that. In fact, when you step back and ask: What are the foods that we tend to binge on? They may have a combination of key flavors and nutrients. Oftentimes, we hear sugar, salt and fat. But I'll argue that there are virtually no binge foods that are just fat. Do people actually binge on butter? I mean, butter is very tasty. You might enjoy an initial bite. But very few people, perhaps with the exception of a major eating disorder, would sit down and eat a quarter pound, a stick of butter. But there are all sorts of high-carbohydrate binge foods. Sugary beverages are 100% sugar. Bread, baked potato chips, popcorn, especially the low-fat versions, these are easy to binge. And from one perspective, the key difference is the hormone insulin. Fat does not raise insulin. And so fat is digested slowly, and doesn't get directly stored in large amounts into body tissue. It has to be metabolized more slowly. Whereas carbohydrates, especially the processed ones, when eaten in large amounts, raise insulin to high levels. That insulin directs those incoming calories into storage. And a few hours later, blood sugar crashes and we get hungry again and are ready to have another blood sugar surge by indulging the next time in those foods.   So what question specifically was your study designed to address?   We conducted a large feeding study that had two parts. The parent study had 164 young and middle-aged adults, who were at least a little bit overweight, ranging from overweight to having obesity. And the first thing we did was bring their weight down by providing them all of their foods, delivered foods to their home, in a calorie-restricted way. You know, you cut back calories, and of course you're going to lose weight for a while. It doesn't address why people get hungry, and why they regain weight. But in the short term, we cut their calories, and they lost 10% to 12% of their weight. Then we stabilized them at their new, lower body weight, and then randomly assigned them to one of three groups: low, moderate or high-carbohydrate diets. And we kept them on these three different diets for another five months. And during this time, we were again delivering all of the meals to the participants. This was over 100,000 prepared meals throughout this time, so it was a really major effort. And during this low, moderate, and high-carbohydrate diet period, we adjusted calories to keep their weight the same. We wanted to keep them at that weight-loss anchor, 10% to 12% below where they started. The first study looked at what happened to their metabolism and their energy expenditure. And we found that when people were on the low-carb diet at the same weight as the other groups, they were burning about 200 calories a day more. So the study raised an interesting possibility, that the kind of calories you eat can affect the number of calories you burn. That from a biological perspective, all calories are not alike to the body.   David, this is fascinating work. I'd like to ask a strategy question. So this was an extremely intensive study of 164 people. And you mentioned the people were provided all their meals, very careful measurement and things like that. So the same amount of money, you could have studied many more people but just done a less intensive study with less supervision and fewer measurements of outcome. So why do the study in such an intensive way?   Right, there's always going to be a trade-off in design considerations. And you've identified a classic trade-off. You can study fewer people more intensively, or more people less intensively. Most weight loss trials have chosen the second route. They take a lot of people, and they try to study them for a long period of time, or at least some of them do: a year or ideally two years or longer. The problem is that without an intensive intervention, so what are we talking about? These studies would oftentimes have participants meet with a nutritionist once a month. They would get written educational materials, and maybe other kinds of behavioral support. But that's about it. And without greater levels of support and intervention, people characteristically can't stick to these diets over the long term. Maybe they make changes for two, three or four months. But by six months or a year, they're largely back to eating what they were originally. And the different diet groups don't look much different. So if the groups didn't eat in much of a different way throughout most of the study, why would we expect to see any differences in outcomes, such as weight or energy expenditure, or cardiovascular disease risk factors? So these studies don't test a dietary hypothesis very well. It leads to the mistaken conclusion that all diets are alike. Really, what the conclusion of these studies has to mean is that we need more intensive intervention in our modern toxic environment, if you will, to promote long-term change. And it's only when we get that long-term change can we actually figure out which diet is better and for whom.   So you've explained how the study was done and why you did it. What did you find?   So the first leg of the study, which was published in "BMJ" late in 2018, so just before the pandemic, showed that the kinds of calories you're eating can affect the number of calories you burn. And, that by cutting back on the total and processed carbohydrates, you can increase your metabolic rate. And that could be a big help in the long-term management of a weight problem. You know, you want your body on your side rather than fighting you when you're trying to maintain weight loss. And a faster metabolism would be a tremendous help if this is a reproducible finding and applies to the general population. We recently published in the September "American Journal of Clinical Nutrition," a second part of the study. And that asks: How do these different diets, low, moderate and high carbohydrate, affect cardiovascular disease risk factors? It's one thing to lose weight. Maybe a low carbohydrate diet helps you lose weight. But if your cardiovascular disease risk factors go up, that might not be such a good trade-off. So that's the aim of the second study. Because low-carbohydrate diets are often very high in saturated fat. So we wanted to find out what were the effects of this low-carbohydrate, high-saturated-fat on a range of risk factors.   So tell us specifically some of the cardiovascular risk factors that changed. And if you would, place the changes that you found in your participants in a context. Like are these big-deal changes? Are they small changes? Or put it in context, if you would?   The big problem with saturated fat is that it clearly raises LDL cholesterol, low-density lipoprotein cholesterol, which is a classic cardiovascular disease risk factor. It's the main one that's targeted by many of the drugs, such as statins. Yeah, I think there's no question that on a conventional high-carbohydrate diet, a lot of saturated fat is harmful. So the combination of bread and butter is not a good one. But the question we wanted to ask was: What happens when you get rid of a lot of that bread? Does the saturated fat still comprise a major risk factor? And so our low-carbohydrate diet was exceptionally high in saturated fat, as is characteristic of how these low-carb diets are usually consumed. It had 21% saturated fat, which compares to the 7% saturated fat on the high-carb, low-fat diet that's oftentimes recommended to people at risk for heart disease.   So what did we find? Well, the first thing we found was that LDL cholesterol was not adversely affected at all. There was no difference in LDL cholesterol between those getting 21% versus 7% saturated fat. Suggesting that when you substitute saturated fat for processed carbohydrates, from the standpoint of this key risk factor, it's pretty much a wash. However, the low-carbohydrate, high-saturated-fat diet benefited a range of other risk factors that go along with what we call the metabolic syndrome, the insulin resistance syndrome. Specifically, we saw strongly significant, from a statistical perspective, improvements in triglycerides, that's the total amount of fat in the bloodstream; HDL cholesterol, that's the good cholesterol that you want to be higher; and other lipids that indicate overall levels of insulin resistance. Suggesting that insulin resistance was improving. And we know that low-carbohydrate diets show promise for diabetes in other studies, in part because they do tend to improve insulin resistance and lower blood sugar. And so our study suggests that if you are pursuing a low-carbohydrate diet, and we can talk about the different degrees of restriction of carbohydrate, and at the same time you're reducing the processed carbohydrates, then the saturated fat might not really be such a problem.   So then if you take all this information in this, as I said, exquisitely designed intensive study and distill it into what dietary recommendations would be, what do you think is a reasonable proportion of fat, carbohydrate and protein in the diet? And what sort of things should people think about as they want to lose weight and keep the weight off?   One key qualification I need to mention is even though this was an intensive study with a relatively large number of people for a feeding study of this magnitude, we still don't know how generalizable these findings are to people at different ages, different body weights, different levels of susceptibility. So no one study can inform a change of clinical practice like this, especially in the world of nutrition where there's so many complicated and interacting factors. I will also venture to say that there's no one diet that's going to be right for everybody. We know that some people can do perfectly well on a high-carbohydrate, low-fat diet. I mean, think of the classic Asian agrarian societies where rates of obesity and diabetes are very low. But those societies tend to be highly physically active and the people insulin-sensitive. America is characterized by high levels of overweight and obesity, sedentary lifestyle. And these create insulin resistance as a highly prevalent problem. For societies such as ours, we think that high-carbohydrate diets that are raising insulin levels on the background of insulin resistance is a recipe for metabolic problems. And so for Americans, especially those struggling with weight, pre-diabetes, and even more so diabetes, a reasonable first step is to cut back on the processed carbohydrates. And I think that's an intervention that increasingly few experts would argue with. We're talking about concentrated sugars and refined grains. Where we start to get into the controversy is whether carbohydrates should be further reduced down to say 20% as in our study, which still leaves room for some unprocessed grains, beans, and a couple of servings of whole fruit a day, or even lower to what's called the ketogenic diet that's less than 10%. And that's where you really have to give up most carbohydrates and focus just on the proteins and fats. I think for people with diabetes, such a strict approach looks appealing in preliminary research studies. But again, this is going to need more research. And I would caution anybody with diabetes or anybody who's thinking about a ketogenic diet to discuss these kinds of dietary changes with their healthcare provider.   I realize your study wasn't meant to address this issue that I'm about to raise, but I'd appreciate hearing your instincts. One key, of course, to any recommended nutrition plan or diet, if you'd like to call it that, is whether people will stick to it. What do your instincts tell you, or data if you have it, on how readily people can adhere to this sort of an approach over the long term compared to other kinds of approaches?   Great question. And I'll approach that by saying: We all understand that if diet is a problem that's contributing to obesity, diabetes, heart disease, other chronic health problems, then we have to change our diet in one way or another regardless of what the mechanisms are. So I'll return the question to you by saying: Which do you think is going to be easier for most people over the long term: cutting back calories, getting hungry and trying to ignore that very intense drive to eat, or getting rid of certain kinds of foods that may be triggering hunger and making it so much harder to stick to a lower calorie intake?   As a doctor, as a pediatrician, and as a researcher, and also myself, I try to do N of 1 experiments on myself with any kind of a nutrition approach I might use with patients or with research participants. I've found that it's so much easier to just give up the processed carbohydrates and enjoy a range of other very satisfying, delicious, higher fat foods. And oftentimes, in my experience personally and I hear as reported by patients that the cravings for these highly processed carbohydrates go down. And lastly, I'll just say, it's not that these processed carbohydrates are inherently so irresistibly delicious. I mean, white bread, these common binge foods, white bread, unbuttered popcorn, baked potato chips, even though these are almost 100% carbohydrate yet they're commonly binged on not because they're so incredibly tasty. But I would argue because they're producing changes in our body that are driving overeating. So it's not that they're so tasty and we're getting so much enjoyment. We're eating these foods because we're driven to metabolically. And once you come off that blood sugar rollercoaster, it becomes much easier to say no.   When you mentioned before that with one approach, you're kind of fighting your body; and another approach, your body is becoming your ally in this process, I thought of going to the beach and, you know, you can go out and try to swim against the waves coming in, or you can ride the waves toward the beach. And one, of course, is a lot easier than the other. And it sounds that's kind of what you're talking about, isn't it?   When you line up biology and behavior, and clearly behavior, psychology, and our food environment are all factors that are going to have to be addressed. We don't want to make it much harder for people. So we do need to think in systems dynamics: the food supply, the environment. But on a strictly individual level, when you line up biology with your behavior, the effort required to accomplish your goals becomes less. You know, this is characteristic of so many areas of medicine and research. This is why we aim to identify the cause of a problem when you treat a cause. So let's use the example of fever. Fever you could say is a problem of heat balance: too much heat in the body, not enough heat out. And so from that perspective, you could treat any fever by getting into an ice bath. Couldn't you, right? The ice would pull the excess heat out of your body. But is that an effective treatment for fever? No, of course not. Because your body's going to fight back violently with severe shivering, blood vessel constriction. And you're going to feel miserable and you're going to get out of that ice bath quickly. In the case of obesity, the timeframe is much longer, but similar kinds of responses occur. The body fights back against calorie restriction because calorie restriction, according to this way of thinking, is an effect. It's not the cause. If the cause is the body's been triggered to store too much fat, then we have to address that problem by lowering insulin levels and producing a more stable blood sugar pattern after eating. If that happens, then the effort that you put into cutting back calories goes a lot further.   Bio:   David S. Ludwig, MD, PhD is an endocrinologist and researcher at Boston Children's Hospital. He holds the rank of Professor of Pediatrics at Harvard Medical School and Professor of Nutrition at Harvard School of Public Health. Dr. Ludwig is the founding director of the Optimal Wellness for Life (OWL) program, one of the country's oldest and largest clinics for the care of overweight children. For 25 years, Dr. Ludwig has studied the effects of diet on metabolism, body weight and risk for chronic disease – with a special focus on low glycemic index, low carbohydrate and ketogenic diets. He has made major contributions to development of the Carbohydrate-Insulin Model, a physiological perspective on the obesity pandemic. Described as an “obesity warrior” by Time Magazine, Dr. Ludwig has fought for fundamental policy changes to improve the food environment. He has been Principal Investigator on numerous grants from the National Institutes of Health and philanthropic organizations totaling over $50 million and has published over 200 scientific articles. Dr. Ludwig was a Contributing Writer at JAMA for 10 years and presently serves as an editor for American Journal of Clinical Nutrition. He appears frequently in national media, including New York Times, NPR, ABC, NBC, CBS and CNN. Dr. Ludwig has written 3 books for the public, including the #1 New York Times bestseller Always, Hungry? Conquer Cravings, Retrain your Fat Cells, and Lose Weight Permanently.  

At the start of the twenty-first century, a study was released which brought the thirteenth century starkly into the present. A 2003 study led by Chris Tyler-Smith published in the American Journal of Human Genetics simply titled “The Genetic Legacy of the Mongols,” determined that an alarming number of men across Asia, from China to Uzbekistan, carried the same haplotype on their Y-chromosome, indicating a shared paternal lineage. 8% of the studied group, just over 2100 men from 16 distinct populations in Asia shared this haplotype, which if representative of the total world population, would have come out to about 16 million men. This was far beyond what was to be expected of standard genetic variation over such a vast area. The researchers traced the haplogroup to Mongolia, and with the BATWING program determined that the most recent common ancestor lived approximately 1,000 years ago, plus or minus 300 years in either direction. The study determined that this could only be the result of selective inheritance, and there was only man who fit the profile, who had the opportunity to spread his genes across so much of Asia and have them be continually selected for centuries to come; that was Chinggis Khan, founder of the Mongol Empire. Identifying him with the Y-Chromosome haplogroup, the C3* Star Cluster, the image of Chinggis Khan as the ancestor of 0.5% of the world population has become irrevocably attached to his name, and a common addition in the comment sections on any Mongol related topic on the internet will be the fact that he is related to every 1 in 200 men in Asia today. Yet, recent studies have demonstrated that this may not be the case, and that Chinggis Khan's genetic legacy is not so simple as commonly portrayed. I'm your host David, and this is Kings and Generals: Ages of Conquest.       Inside each human being are the genes we inherit from our parents. Distinct alleles within the thousands of genes of our 23 chromosomes affect the makeup of our bodies, from our physical  appearances to blood type. Each allele is inherited from our parents, who inherited from their parents, and so on, leaving in each human being a small marker of every member of their ancestry. Due to interbreeding and mixing over time, people living in a certain region will share  alleles, given that various members of their community shared ancestors at some point. A collection of these alleles is a haplotype, and a group of similar haplotypes with shared ancestry is a haplogroup. Tracing specific haplogroups attached to the Y-Chromosome, for instance, allows us to trace paternal ancestry of selected persons. It was the haplogroup dubbed the C3*star cluster that the researchers identified as Chinggis Khan's haplotype, though later research has redefined it to the C2* star cluster. Thus, while you may see it somewhat interchangeably referred to as C3 or C2, depending on how recent the literature you're reading is. Whoever carried the markers on their chromosome associated with this haplogroup, according to the study, was therefore a descendant of Chinggis Khan. The lineage, it should be noted, does not start with Chinggis Khan; it is detectable in the ancestors of the Mongols dating back at least to the fifth century BCE, to the Donghu people in eastern Mongolia and Manchuria. It is found in high frequencies in populations which had close contact with Mongols from Siberia to Central Asia, as as the Buryats, Udeges, Evens, Evenks, Kazakhs, and in lower frequencies in places conquered by the Mongol Empire. As demonstrated by the 2003 study, a map of these haplogroups lines up rather neatly with a map of the Mongol Empire at the time of Chinggis Khan's death.        The 2003 study found that 8% of the men sampled had high frequencies of haplotypes from a set of closely related lineages, the C2*  star cluster. With the highest numbers of this cluster found in Mongolia, it was the logical origin point for this cluster. Its frequencies in so many populations of the former Mongol Empire seemed to suggest it spread with Mongol imperial expansion. The researchers therefore identified Chinggis Khan and his close male-relatives as the likely progenitors. While the public has understood this as Chinggis Khan and his family raping a massive percentage of the thirteenth century human population, this was not quite what the study implied. Rather, the selective marriage into the Chinggisid royal family, with each son having high numbers of children, and so on for generations due to prestige associated with the lineage, was the cause for the haplogroup's spread.        The study decided that, since the haplogroups showed up in high frequencies among the Hazara of Afghanistan and Pakistan, and as they were deemed to be direct descendants of Chinggis Khan, then this must have meant no one else other than the Great Khan himself was the most recent common ancestor for this haplogroup. The high frequencies across Asian populations, an origin point in Mongolia, an estimated common ancestor approximately a thousand years ago, and association with the supposed Chinggisid Hazaras was the extent of the evidence the study had to make Chinggis Khan the progenitor.       When released, this study made headlines around the world. You'll find no shortage of articles stating that “Genghis Khan was a prolific article,” with the underlying, thought generally unstated, assumption that these genes were spread by a hitherto unimaginable amount of rape, “backed up” by the medieval sources where Chinggis is described taking his pick of conquered women after the sack of a city. It's a useful addition to the catalogue of descriptions to present the Mongols as mindless barbarians, with this study being essentially the scientific data to back up this presentation.  It's now become one of the key aspects of Chinggis Khan's image in popular culture.       However, as more recent studies have demonstrated, there are a number of problems with this evidence presented in the 2003 study. Firstly, later researchers have pointed out how indirect the evidence is for the connection of Chinggis Khan to the C2 lineage. The estimates for the most recent common ancestor can vary widely depending on the methods used; while some estimates can place a figure within Chinggis Khan's epoch, other estimates put the most recent common ancestor for the C2* cluster over 2,000 year ago. Even going by the 2003 study, it still gives a 600 year window for the most recent common ancestor, who still could have lived centuries before or after Chinggis Khan.   One of the most serious assumptions in the study was that the Hazara of Afghanistan were direct descendants of Chinggis KhanThis is an assumption which rests more on misconception than medieval materials. In fact, the thirteenth and fourteenth century sources indicate that Chinggis Khan spent only a brief time in what is now Afghanistan, only from late 1221 and throughout much of 1222, which he largely spent campaigning, pursuing Jalal al-Din Mingburnu and putting down local revolts before withdrawing. There is no indication that a Mongol garrison was left in the region by Chinggis, and it is not until the 1230s that Mongol forces returned and properly incorporated the region into the empire. Still, it was not until the end of the thirteenth century were Chinggisid princes actually staying in the region, when Chagatayid princes like Du'a's son Qutlugh Khwaja took control over the Negudaris. The sources instead describe waves of Mongol garrisons into Afghanistan which began almost a decade after Chinggis Khan's death, from the initial tamma garrisons under Ögedai Khaan's orders to Jochid troops fleeing Hulegu to Afghanistan in the 1260s. Later, from the late fourteenth century onwards, Afghanistan was the heart of the Timurid realm, and while the Timurids shared some descent from Chinggis through marriage, it's not exactly the process which would have led to high percentages of Chinggisid ancestry.Together, this strongly suggests that the Hazara would not bear Chinggisid ancestry in any considerable quantity.   Perhaps most prominently, there is little evidence that connects the C2* star cluster to known descendants of Chinggis Khan. The fact that no tomb of Chinggis Khan or any other known members of his family has been found, means that there is no conclusive means to prove what haplogroups he possessed. Without human remains which undeniably belong to one of his close male relatives or himself, Chinggis Khan's own haplogroup can not ever be reliably identified. Most royal Chinggisid lineages in the western half of the empire, such as that of the Ilkhanate or Chagatais, disappeared long before the advance of genetic sciences. You might think that looking in Mongolia, you'd find a lot of Chinggisids running about, but this is not the case. Even during the empire, many members of the Chinggisid family were spread across Asia, leaving by the end of the fourteenth century largely lines only from his brothers, and of his grandsons Ariq Böke and Khubilai. In the fifteenth century, a massive massacre of the royal family was carried out by the leader of the Oirats and the true master of Mongolia, the non-Chinggisid Esen Taishi. Mongolia was reunified some fifty years later under the Khubilayid prince Dayan Khan, and it was the descendants of his sons who made up the Chinggisid nobility for the next centuries. Then, in the 1930s Soviet supported purges resulted in the near annihilation of the Chinggisid princes, Buddhist clergy and other political enemies. From 1937-1939, over 30,000 Mongolians were killed, and the Dayan Khanid nobility nearly extinguished.   While it is true that today in Mongolia, you can find many people who claim the imperial clan name of Borjigin, this is largely because after democratization in Mongolia in 1990, Mongolians were encouraged to take clan names- a fact that, as many commenters have pointed out, historically the Mongols did not do, unless they were actually members of the Chinggisid royal family. While the 1918 census in Mongolia recorded only 5.7% of the population as being Borjigid, during the recent registering of clan names some 50% chose, of course, the most famous and prestigious name for themselves. Therefore, it's rather difficult to find a lot of a Chinggisids today.   The 2003 study relied on a random selection of people from across Asia, rather than looking specifically for individuals who claimed Chinggisid descent. Other studies which have sought out people who claim Chinggisid ancestry do not support the C2* Star cluster hypothesis of the 2003 study. A 2012 study by Batbayar and Sabitov in the Russian Journal of Genetic Genealogy of Mongolian individuals who could trace their lineage back to Chinggis Khan's fifteenth century descendant, Dayan Khan, found none of them matched the Star cluster proposed by the 2003 study. To overcome the previously mentioned issues about finding Chinggisids, to quote Batbayar and Sabitov, “In this study, seven patrilineal descendants of [...] Dayan Khan and two of Chinggis Khan's brothers' descendants were chosen for Y-chromosome DNA sequencing. Rather than testing a multitude of subjects, for the sake of accuracy, the most legitimate and proven descendants of Dayan Khan were selected. The DNA donors were selected based upon their official Mongol and Manchu titles and ranks, which were precisely recorded in Mongolian, Manchu, and Soviet documents.” Essentially, as close as you can get to a definite, unbroken paternal line from Chinggis Khan, given the 800 years since his death. When they compared the Dayan Khanid descendants, the descendants of Chinggis' brothers, and those who could reliable claimed ancestry from Chinggis' son Jochi, Batbayar and Sabitov demonstrated that essentially each lineage bore different haplogroups, and none, except for a small branch of the Jochids, bore the C2* star cluster of the 2003 study.    Study of the bodies of medieval Mongol burials have likewise yielded contrasting results when their DNA has been examined.  One of the most notable burials which has been studied is the Tavan Tolgoi suit, from eastern Mongolia. Essentially it was a burial of an extremely wealthy family, dated to the mid-thirteenth century. Adorned with jewelry and buried in coffins made of Cinnamon, which would have had to be imported from southeastern Asia, the researcher suggested due to such obvious wealth and power that they must have been Chinggisid. Their bodies showed haplogroups associated, interestingly enough, with western Asia populations, with effectively no descendants in modern Mongolian populations, and most definitely, not the C2* star cluster. This led to the 2016 study by Gavaachimed Lkhagvasuren et al., titled “Molecular Genealogy of a Mongol Queen's Family and her Possible kinship with Genghis Khan,” to suggest Chinggis must have borne this haplogroup, and possibly, western Asian ancestry. He also pointed to supposed descriptions of Chinggis Khan having red hair as possible supporting literary evidence.    But this is not reliable evidence. Firstly, none of the graves conclusively can be identified as Chinggisid.  The Chinggisid's known preference for burials on Burkhan Khaldun seems unlikely to make the Tavan Tolgoi burials a close relation.  Further, the “red hair” description of Chinggis Khan comes from a mistranslation of a phrase from Rashid al-Din's Compendium of Chronicles, where Chinggis remarks that young Khubilai lacked his grandfather's ruddy features, indicating not red hair, but a face red in colour; hardly uncommon for a man who spent his lifetime in the harsh winds of the steppe. Therefore, the Tavan Tolgoi burials seem more likely to represent a family, possibly of Qipchaq origin, taken from western Asia, incorporated into the Mongol military and gaining wealth and power- hardly unusual in the Mongol army, but revealing nothing of Chinggis' haplogroups. Other wealthy burials of nobility from the Mongol Empire in Mongolia and northern China have revealed differing chromosomal haplogroups, providing no answer as of yet to the question of the Great Khan's own genetic lineage.   Much like the 2003's study erroneous identification of the Hazaras as direct descendants of Chinggis Khan, a more recent study demonstrates the pitfalls of attempting to connect historical figures to genetic data. A 2019 study by Shao-Qing Wen et al. in the  Journal of Human Genetics looked at the y-chromosomal profiles of a family from northwestern China's Gansu-Qinghai area, who traced their ancestry back to Kölgen, a son of Chinggis Khan with one of his lesser wives. Importantly, this family also backed up their claims in genealogical records, and had inhabited the same region for centuries. After the expulsion of the Mongols, they had been made local officials [tusi 土司] by the succeeding Ming and Qing dynasties. This family, the Lu, did not match the C2* Star Cluster, but actually showed close affinity to other known descendants of Chinggis Khan, the Töre clan in Kazakhstan. The Töre  trace their lineage to Jani Beg Khan (r.1473-1480), one of the founders of the Kazakh Khanate and a tenth generation descendant of Chinggis Khan's first born son Jochi. Jochi, as you may recall, was born after his mother Börte was taken captive by Chinggis Khan's enemies, and was accused, most notably by his brother Chagatai, of not being their father's son. Chinggis, for the record, always treated Jochi as fully legitimate. As the Lu family in China traced themselves to Kölgen, who shared only a father with Jochi, then the fact that the Lu and the Töre belong to the same C2 haplogroup, with a  genealogical separation of about 1,000 years, would suggest that if this is in fact the Y-chromosomal lineage of Chinggis Khan, then Jochi's uncertain paternity could be laid to rest, and that he was a true son of Chinggis Khan.   This theory is comfortable and convenient, but other scholars have noted that the connection of the Lu to Toghan, the descendant of Kölgen, is very tenuous. The sources connecting the Lu clan to Kölgen's family were not compiled until the late Qing Dynasty, some four to five centuries after Toghan's death. The sources more contemporary to Toghan's life do not match the description of his life described in the histories used by the Lu clan, leading scholars to argue that, while the Lu clan does have Mongolian origin, and likely did have an ancestor with the very common medieval Mongolian name of Toghan, it seems likely that at some point the Lu clan's family compilers decided to associate their own ancestor with the more well known Chinggisid of the same name, and therefore claim for themselves Chinggisid ancestry and prestige- hardly an unknown thing by compilers of Chinese family trees. Therefore, the matter of Jochi's paternity still remains uncertain.       Perhaps the final nail in the coffin comes in the 2018 study by  Lan Hai-Wei, et al. in the European Journal of Human Genetics. Compiling data from previous studies that found issue with the 2003 hypothesis, they looked at groups with high frequencies of the C2* Star clusters like the Hazara or the Daur, a Mongolic-speaking people from Northeastern China who, based off of historical records, make no claims of Chinggisid descent. Newer estimates also suggest the most recent common ancestor for this lineage was over 2,600 years ago. In the most recent hypothesis then, it seems more likely that the star cluster identified by the 2003 study does not represent the lineage of Chinggis Khan, but was simply an incredibly common paternal lineage among ordinary inhabitants of the Mongolian plateau. Its presence in other peoples across Asia was not evidence of selective breeding into the Golden Lineage, but simply the movement of Mongolian troops into a region, and intermixing with the local population. In the case of the Hazaras, this is the exact scenario demonstrated by the historical sources, with waves of Mongol troops rather than a host of Chinggisids descending into the Hazarajat. The possibility cannot be excluded however, that while C2* was a dominant haplotype in thirteenth century Mongolia, that before 1200 it had already been spread across Central Asia by earlier nomadic expansions of Mongolia-based empires like the Göktürk Khaghanates or the Uighur. The Mongol expansion in the thirteenth century, then, would only be another wave of the spread of C2* across Eurasia.       While it is possible that Chinggis Khan and his close male relatives did in fact, carry the C2* star cluster, there is no evidence which directly or conclusively connects him to it. His known descendants through the line of Dayan Khan are of a different Y-chromosomal haplogroup. The descendants of Dayan Khan, himself a descendant of Chinggis Khan's grandson Khubilai, and the Kazakh Töre, descendants of Chinggis Khan's son Jochi, bear haplotypes so distant that their most recent common ancestor is estimated to have lived 4,500 years ago, which does not fair well for the likelihood of Jochi being Chinggis' son. A third known and tested branch, of the Shibanids in Uzbekistan and Kazakhstan, does match the C2* star cluster, but has less than 1,000 known members and again, are descended from Chinggis Khan via Jochi. Chinggis Khan then cannot be said to be the ancestor of 0.5% of the world's population, since his y-chromosomal marking remains unknown. Any attempts at identifying it conclusively can never be more than mere assumptions without finding the bodies of either the Khan or any of his close-male relatives- a prospect highly unlikely, given the Chinggisids' preference for secret graves. Thus, it seems that his haplotypes are but one more secret that Chinggis will keep with him.       Our series on the Mongols will continue, so be sure to subscribe to the Kings and Generals podcast to follow. If you enjoyed this, and would like to help us keep bringing you great content, please consider supporting us on patreon at www.patreon.com/kingsandgenerals, or sharing this with your friends. This episode was researched and written by our series historian, Jack Wilson. I'm your host David, and we'll catch you on the next one.  -SOURCES- Abilev, Serikabi, et al. “The Y-Chromosome C3* Star-Cluster Attributed to Genghis Khan's Descendants is Present at High Frequency in the Kerey Clan from Kazakhstan.” Human Biology 84 no. 1 (2012): 79-99.   Adnan, Atif, et al. “Genetic characterization of Y-chromosomal STRs in Hazara ethnic group of Pakistan and confirmation of DYS448 null allele.” International Journal of Legal Medicine 133 (2019): 789-793.   Callaway, Ewen. “Genghis Khan's Genetic Legacy Has Competition.” Scientific American. January 29th, 2015.   Derenko, M.V. “Distribution of the Male Lineages of Genghis Khan's Descendants in Northern Eurasian Populations.”  Russian Journal of Genetics 43 no. 3 (2007): 3334-337.   Dulik, Matthew C. “Y-Chromosome Variation in Altaian Kazakhs Reveals a Common paternal Gene Pool for Kazakhs and the Influence of Mongolian Expansions.” 6 PLoS One no. 3 (2011)   Gavaachimed Lkhagvasuren et al. “Molecular Genealogy of a Mongol Queen's Family and her Possible kinship with Genghis Khan.” PLoS ONE 11 no. 9 (2016)   Kherlen Batbayar and Zhaxylyk M. Sabitov. “The Genetic Origins of the Turko-Mongols and Review of The Genetic Legacy of the Mongols. Part 1: The Y-chromosomal Lineages of Chinggis Khan.” The Russian Journal of Genetic Genealogy 4 no. 2 (2012):    Lan-Hai Wei, et al. “Whole-sequence analysis indicates that the  Y chromosome C2*-Star Cluster traces back to ordinary Mongols, rather than Genghis Khan.” European Journal of Human Genetics 26, (2018): 230-237.   Lan-Hai Wei et al.  “Genetic trail for the early migrations of Aisin Gioro, the imperial house of the Qing Dynasty.” Journal of Human Genetics 62 (2017): 407-411.   Shao-Qing Wen et al., “Molecular genealogy of Tusi Lu's family reveals their apternal relationship with Jochi, Genghis Khan's eldest son.” Journal of Human Genetics 64 (2019): 815-820.   Ye Zhang et al. “The Y-chromosome haplogroup C3*-F3918, likely attributed to the Mongol Empire, can be traced to a 2500-year-old nomadic group.” Journal of Human Genetics 63 (2018): 231-238.   Yi Liu. “A Commentary on molecular genealogy of Tusi Lu's family reveals their paternal relationship with Jochi, Genghis Khan's eldest son.” Journal of Human Genetics 66 no. 5 (2020): 549–550.    Zakharov, I.A. “A Search for a “Genghis Khan” Chromosome.” Russian Journal of Genetics 46 no. 9 (2010): 1130-1131.     Zerjal, Tatiana, et al. “The Genetic Legacy of the Mongols.” American Journal of Human Genetics 72 (2003): 717-721.  

A paper just released in the American Journal of Clinical Nutrition challenges, and I mean really challenges conventional thinking about nutrition, weight gain, and what has caused the very rapid and profound increase in obesity rates over the last 50 years. This is a landmark paper by any standard, and saying that it will raise eyebrows is an understatement. The paper is authored by a number of distinguished nutrition scientists. The lead author is Dr. David Ludwig from Harvard University. Interview   David Ludwig MD, PhD is Professor of Nutrition at the Harvard School of Public Health, and Professor of Pediatrics in the Harvard Medical School. He has published innumerable books and papers on nutrition, contributors to obesity and diabetes, and what might be done with both practice and policy to improve things. He has a real remarkable breadth and scope of his work. David, Time Magazine once named you a warrior in work on obesity. This is exactly how I see you as well. You're really challenging the traditional ways of thinking, and as I said, you've broken new ground. So I'm proud to say that you and I have been friends for a number of years, and I'm also proud to say that we've written a number of things together. So thanks so much for being with us today. It's a real honor to have you.   Thanks, Kelly. Great to be with you. And I'm sitting here in my office looking at a plaque I have on the wall of an op-ed we wrote for the Washington Post almost two decades ago, so it's been a real honor and productive pleasure to know you.   The pleasure has been mine. So let's talk about the paper. So in this paper, you and your co-authors challenged the widely-embraced energy balance model. So can you say what the energy balance model is?   Well, the notion of energy balance is really just a restatement of physics, the first law of physics that says, that speaks to energy conservation, and it's commonly interpreted that in order to gain weight, you have to have a positive energy balance, that is you have to consume more calories than you burn off, and that to lose weight, you have to reverse that. You have to have a negative energy balance. You have to consume fewer calories than you burn off. But we argue first off that this doesn't tell us anything about causality, cause and effect, what's actually driving obesity. We use the example of a fever. Of course, a fever can only happen if the body generates more heat than it dissipates, more heat into the body than heat out of the body. But that's obvious that's, it's, you know, we don't need to be emphasizing that in textbooks. We don't need to be teaching patients that notion. The question is what's cause and what's effect? And the conventional way of thinking is that the positive energy balance is driving weight gain, is causing obesity. So we're surrounded by all these convenient, inexpensive, energy-dense, hyper-palatable, highly tasty foods. We lose control. We overeat them. We don't burn off those excess calories with our modern lifestyle, and so those excess calories get forced into fat cells, and we gain weight. So ultimately this view considers all calories are alike to the body, and that we have to eat fewer calories, and ideally burn more of them off by exercise to address the problem. So that's the conventional way of thinking.   So you have a different, and very science-based explanation for all of this that I'll get to in a minute, but before we do that, why did the field come to adopt this energy balance model?   Well, it does seem to make sense, and certainly over the short term, we know that this way of viewing things applies. If you force feed an animal, or if we just intentionally overeat ourselves, we can gain weight, and conversely, if we put ourselves on a low calorie diet, we can lose weight for a while, but characteristically, we know the body isn't a, you know, an inert energy storage depot. The body fights back in a dynamic way against changes in body weight and in energy balance, and this is something that almost every dieter has experienced, right? If it were just a matter of eating less and moving more, 150 calories less a day, that's a serving of juice, 150 calories out more a day, that's walking moderately for half hour, then virtually every weight problem should be solved within, you know, months to at most, a few years, but that's not the case. Very few people can adhere to, can stay with low calorie diets for very clear reasons. The first thing that happens is we get hungry, and hunger isn't a fleeting feeling. It's a primary biological signal that the body wants more calories. And even if we could, those few of us who are highly-disciplined, and can resist hunger, the body fights back in other ways, most notably by slowing down metabolism, which means that to keep the weight coming off, even as we're getting hungrier. We have to keep eating less and less, because the body's getting more efficient. So the conventional way of thinking about things, all calories are alike, calorie in calorie out, just eat less and move more. Doesn't seem to address the difficulty that people are facing, and recognize that despite a lot of attention to calorie balance, the obesity epidemic is getting worse and worse every year. I mean, the data just from the last year suggests that the weight gain during the pandemic was even faster than it was just prior.   Well, let's talk for a minute about what's at stake here. So vast numbers of people in the United States, both adults and children are overweight. This is increasingly becoming true of essentially every country in the world. The amount of weight that people have been gaining seems to be going up over time, and people find it very difficult, perhaps for the reasons you mentioned, to lose weight and keep it off, so it's a pretty dire situation then, and given the health consequences of excess weight, and the psychosocial implications of things, there's really a lot at stake here, isn't there?   Certainly so. We know that in childhood, obesity can affect virtually every organ system in the body, and set the stage for a lifetime increased risk of diabetes, heart disease, even many cancers. Among adults, the majority, and in fact 70% of adults in the United States have at least overweight, if not obesity, and this is becoming a huge driver of the chronic health burden on the healthcare system, and which so many patients themselves experience, in terms of diabetes, risk for heart disease, fatty liver, orthopedic problems, sleep apnea. So we have a problem that has gotten so much attention, and yet keeps getting worse with every effort that we can bring to bear. My coauthors and I have this new paper in American Journal of Clinical Nutrition, arguing it's time for new thinking. And the carbohydrate insulin model that we are proposing is perfectly consistent with the laws of physics around energy balance, but it suggests that we've been coming at the problem in exactly the opposite way than would be most effective.   So let's talk about that. So if you have a different explanation than the traditional energy balance model, what is it exactly?   So the usual way of thinking, as we considered earlier is that overeating causes weight gain, and that certainly happens in the short term, but that model has a hard time explaining why people are gaining weight year after year, and their bodies are wanting to hold onto those calories. So we argue that a metabolic perspective would better explain this continuing creep upward in the so-called body weight set point. So the carbohydrate insulin model suggests that we've had it backwards, that overeating is not the primary cause of weight gain, that the body's process of gaining weight, and storing too much fat is driving overeating. So overeating and a positive calorie balance certainly has to exist. That's a law of physics, but it's a downstream effect. It's not at the source of the problem. And so this may sound a little surprising. How could the body gaining weight cause us to overeat? Well, let's take the example of an adolescent during the growth spurt. We know a teenager might consume hundreds, or a thousand calories more than he or she might have a few years earlier, and that adolescent is growing really quickly, but which comes first? Is the overeating that that child is doing causing the growth, or is the rapid growth and the deposition of many calories into new body tissue causing that adolescent to get hungry and to eat more? Neither explanation violates any law of physics, but they have radically different implications to how we understand growth, and what we might do about growth disorders. In the case of the adolescent, it's clearly the other way. It's the growth that's driving the overeating, and how do we know that? Well, Kelly, neither you or I, no matter how much we're going to eat or overeat are going to grow any taller. So something in the body is regulating hunger, based on the needs of growth, and we argue that the same thing is happening in the case of obesity, that the aspects of our diet, importantly, including the processed carbohydrates that flooded our diet during the low fat years, that these are triggering fat cells in the body to hoard too many calories, to hold onto too many calories, so there are fewer calories available for the muscle, the liver, and the brain, and our body recognizes that. We get hungry, and we eat more as a consequence.   You mentioned the highly processed foods, especially carbohydrates that bombarded the American scene during the low fat craze. Explain more about that.   These processed carbohydrates, that at one point, just 20 to 30 years ago, people thought, and you can find many examples of this written in the literature. In fact, the first food guide pyramid is a clear illustration of the fact that all fats were considered unhealthy, because they have so many calories per bite, more than twice the calories per gram than carbohydrates. Whereas the bottom of the food guide pyramid, you know, we were supposed to eat six to 11 servings of grains, many of which were highly processed. Sugar was considered benign, and a good way to, and this is what they said, dilute out fat calories. The problem is that these processed carbohydrates, white bread, white rice, potato products, virtually all of the prepared breakfast cereals, and of course, concentrated sugars, and sugary beverages. So when you eat these foods in substantial amount, and it's worse if the meal is also low in fat and protein, because they tend to slow down digestion. So if you just eat a lot of these processed carbohydrates, the body digests it into glucose literally in minutes. So blood sugar shoots upwards 10, 20, 30 minutes later, and that causes a lot of the hormone insulin to be produced. I sometimes refer to insulin as the Miracle-Gro for your fat cells, just not the sort of miracle you want happening in your body. We know that when a person with diabetes gets started on insulin, they'll typically gain weight, and if insulin is given in excess dose, they'll gain a lot of weight. So insulin is the hormone that promotes fat storage, and we argue that basically just endocrinology 101, all these processed carbohydrates, by stimulating more insulin than we would normally make on a less processed, lower carbohydrate diet, are driving too many of the incoming calories from a meal into storage and fat cells, instead of into muscle where they can burn. And so when you store, all it takes us to store one gram of fat too much a day to explain basically the whole of obesity, if one looks from childhood to adulthood.   So David, provide some context for this, if you would. So what fraction of the American diet is comprised of these kinds of foods, and what would that number be if people followed the recommended dietary guidelines you suggested?   Well, back in the 1950s, it's not as if Americans were extremely healthy. We had much higher rates of heart disease, although much of that related to smoking, and we of course, had many fewer medications, and surgical procedures to help prevent or treat heart disease. But at that time, obesity rates were much, much lower, you know, about only one third of the rates they are today. And at that time in the 1950s, Americans ate about 40% of their calories as fat, and about 40% as carbohydrate, and maybe 15 to 20% as protein. Because of concerns around saturated fat and heart disease, which then got generalized to all fats being bad, well, we got the low fat diet of the 1980s, nineties, and the beginning of the century. Fat came down as a proportion of our diet. Carbs went up, but also the processing of those carbs. We got foods like the fat-free SnackWells cookies, a whole range of these fat-reduced products that simply took out fat, dumped in sugar and starch. These are after all processed foods, so they're not going to be putting in fruits and vegetables. And these products were considered healthy. We ate them as we were told to eat them, and at that time, obesity rates really exploded. And we're arguing that this is not just an association, that this change to our diet has played an important role in driving obesity, and that by bringing both the total amount of carbohydrates down, not necessarily a very low carb or ketogenic diet, but bringing them back down, maybe to what might oftentimes be characterized as a Mediterranean diet, focusing on getting rid of the processed carbs, eating more of the delicious and nutritious high fat foods, like nuts and nut butters, olive oil, avocado, even real dark chocolate. All of these high fat high, calorie foods look a whole lot healthier than the processed carbohydrates do in the best cohort studies.   You know, it's a somewhat hopeful message, isn't it? Because you're not just telling people you have to eat less of everything, but there are actually some things that are quite delicious where you can eat more, and maybe that hope will lead more people to try this sort of approach.   That is exactly the issue with the conventional approach. If all calories are alike, and overeating is the primary problem, then we really just have to control our appetites. We have to discipline ourselves. Yes, clearly the conventional thinking recognizes that environment has a lot to do with it, and psychology of behavior, but ultimately, one way or another, you have to cut back on calories, because overeating is driving the problem. But if the driver is at the fat cells, if the foods that we're eating are triggering our fat cells to store too many calories, and that's what's causing the hunger and the overeating, then just eating less doesn't solve the problem, and it actually could make it worse by slowing down your metabolism. So this model argues that a focus on what you eat, not how much is more effective. You focus on controlling the quality of the foods, importantly, the processed carbs, but there are other aspects that can help hormonal and metabolic response. That's what the person focuses on, and we let the body, based on our hunger levels, and satiety levels, determine how much we need to satisfy metabolic requirement.   So you've got what we call in the field a testable hypothesis, that people will do better if they follow the approach that you've mentioned, compared to the traditional approach. And you put that to a test in a study that we're going to be talking about in a second podcast. But before we get to that, what sort of pushback, if you had, as your paper has been published, are corporate interests involved in this picture at all?   Yeah, let me just say that we recognize that these ideas are not fully proven. There are animal studies, we've done one of them that provides what we could call a proof of concept, that when you give rodents, and this has been reproduced by many different groups. This is a very rigorous finding. When you give rodents high glycemic index, versus low-glycemic index starch, so that's fast-digesting, versus slow-digesting starch. You keep everything else the same, the ones that get the fast-digesting starch, that's like, all of those processed carbs we're eating that raise insulin a lot, well, they in fact show this whole sequence of events. Their insulin levels initially go up, they start getting fatter, and their energy expenditure goes down. They start moving less, and if you restrict their calories to that of the control animal, they're still fatter, because more calories wound up getting stored than burnt in muscle. So they wind up getting more fat tissue, and less lean tissue, even at the same total body weight when you prevent their weight from going up. So we argued that there's no way to explain that finding based on the conventional, calorie in, calorie out way of thinking. We need to examine whether this applies in humans, and to whom, you know? It may be that one model explains certain situations, or certain people better than the other, but it is a testable hypothesis. Unfortunately, this debate has become polarized, and we, in our article, specifically invite opponents to work with us on generating common ground. There's plenty of basis for common ground already, and in our article, which is freely available online at American Journal of Clinical Nutrition. We put out a diagrammatic model in which each step leads to another step, and each of these steps is testable. So we can figure out what we got right, what needs improvement, you know, and where common ground is. After all, this is what science is supposed to be about, to come up with new ways of thinking for intractable problems.   You know, you reminded me when you talked about the animal studies of work that occurred many decades ago on something that people in the field were referring to as the cafeteria diet. And I remember the slide that I used for years in my own talks that was given to me by Ted Van Itallie, one of the pioneers in the obesity field, that showed a rat sitting on top of basically a junk food diet, where they take animals, and in the cage, they would put Cheetos and Hershey bars, and marshmallows, and things like that. And the animals would eat a lot of those things, and gain an enormous amount of weight. But people were really attributing the weight gain to the fact that these were highly palatable foods. The animals would eat a lot of it just because it tasted really good, and that would bring a lot of calories, and that was the reason for the weight gain. And what you're saying is just, "Wait a minute, what happens to be that food that goes in there is a really important part of the picture," And that's been proven by controlling the calories in the experiment that you set.   Well, I think that's a really great point that you raised that it's easy to think in the cafeteria diet model, that the animals are getting fat because of the tastiness of the food, but these studies can't distinguish tastiness, and whatever that means, and we could come back to that point, because tastiness is elusive. It's a very squishy term to define, for reasons we can consider, but it's impossible in these studies to distinguish tastiness from the nutrient content of the foods, and they tend to be full of sugar and processed carbs. In fact, the few studies that have aimed to disentangle this provide clear support for the carbohydrate insulin model that tastiness by itself, when you control nutrients, does not result in obesity, but the nutrients, even in a bland or untasty diet does result in weight gain in animals.   Fascinating science. So, David, what do you think are some of the main policy implications of all this?   Well, there has been push back. Some of that relates to just the difficulty of paradigm change, amidst scientific uncertainty. You know, we need ultimately to be all working together on all sides of this. But in addition, there's resistance from the food industry that loves the notion that all calories are alike. All calories are alike, and there are no bad foods, and that you can drink a sugary beverage, have any kind of junk food, as long as you eat less of other things, or burn off those calories with physical activity. Whereas if this way of thinking, involving the carbohydrate insulin model, this opposite cause and effect conception is correct, then those foods have adverse effects on our metabolism above and beyond their calorie content. And that from that perspective, you really, can't just outrun a bad diet, that we really need to be thinking about how our food is influencing our hormones and metabolism, otherwise we're going to set ourselves up for failure, and that's not a message that many, although not all in the food industry like to hear, because it requires corporate responsibility for helping to create the nutritional nightmare that confronts so many of us, and especially children throughout so much of their days.   You reminded me about an interesting parallel with tobacco here, where the tobacco companies, you know, long after it was known that cigarettes were killing people, just said that it's not the tobacco that's killing the people, it's the fact that they're just consuming too much of it, and the food companies have made very much that same argument. And then the tobacco researchers said, "No, tobacco is bad in any amount, and even a little of it can be harmful." And that's not totally true of the processed foods you're talking about. I'm assuming people can have them in small amounts, but the parallel really kind of exists there, doesn't it? That these things are risky, and dangerous really, after you go beyond whatever that small amount is, and then you're going to have trouble, no matter what you're doing elsewhere in your diet?   The metaphor with tobacco is useful to a point, although it can also elicit some strong responses, because obviously, tobacco products aren't needed for survival, food clearly is. But I do think that there are some parallels that if these highly processed carbohydrates are undermining our metabolism, and also triggering, in part because of the metabolic changes. Fat cells communicate with the brain in many ways, including by releasing or withholding nutrients. If these foods are also triggering pathways in the brain that make managing calorie balance increasingly difficult, then we do really begin to need to think about food way beyond calorie issues, and that all calories aren't alike, and that the food industry may indeed have to manage the food supply in a way that makes weight control easier rather than harder.   The paper we were discussing today was published in September, 2021 in the American Journal of Clinical Nutrition and is publically available for free.   Bio: David S. Ludwig, MD, PhD is an endocrinologist and researcher at Boston Children's Hospital. He holds the rank of Professor of Pediatrics at Harvard Medical School and Professor of Nutrition at Harvard School of Public Health. Dr. Ludwig is the founding director of the Optimal Wellness for Life (OWL) program, one of the country's oldest and largest clinics for the care of overweight children. For 25 years, Dr. Ludwig has studied the effects of diet on metabolism, body weight and risk for chronic disease – with a special focus on low glycemic index, low carbohydrate and ketogenic diets. He has made major contributions to development of the Carbohydrate-Insulin Model, a physiological perspective on the obesity pandemic. Described as an “obesity warrior” by Time Magazine, Dr. Ludwig has fought for fundamental policy changes to improve the food environment. He has been Principal Investigator on numerous grants from the National Institutes of Health and philanthropic organizations totaling over $50 million and has published over 200 scientific articles. Dr. Ludwig was a Contributing Writer at JAMA for 10 years and presently serves as an editor for American Journal of Clinical Nutrition. He appears frequently in national media, including New York Times, NPR, ABC, NBC, CBS and CNN. Dr. Ludwig has written 3 books for the public, including the #1 New York Times bestseller Always, Hungry? Conquer Cravings, Retrain your Fat Cells, and Lose Weight Permanently.  

Every 17 seconds an American is diagnosed with diabetes.  This statistic is from the American Journal of Managed Care (2018).  Also, according to the CDC, 34 million Americans have diabetes which represents 11% of the population.  And another 85 million Americans are considered “pre-diabetes”  It's no wonder that Diabetes continues to high in the rankings for healthcare spend.  We have been told for decades that Type 2 diabetes can be prevented only through better diet and exercise.  In recent years we have begun to hear claims that Type 2 diabetes can be reversed and this is a gamechanger for people living with Type 2 diabetes.  Here to speak with us today about Type 2 diabetes and what his company is doing to reverse this dreaded disease is Sami Inkinen, the CEO & Founder of Virta Health.  As with most entrepreneurs, Sami has his own healthcare journey that inspired him to create Virta Health.  I am excited to hear what he will share with us today.  Show notes:  Podcast:  How I Built This with Guy Raz; Shoe Dog by Phil Knight.

In this episode Lucy D'Agostino McGowan and Ellie Murray chat with Hilary Parker about design thinking for data analysis, the Dunning-Kruger effect, and the potential data behind baby Yoda. Follow along on Twitter: Hilary: @hspter The American Journal of Epidemiology: @AmJEpi Ellie: @EpiEllie Lucy: @LucyStats

This week we're traveling back to 1940s LA with Zoot Suit! Join us to learn more about the zoot suit style, the history of the word "Chicano", the CIO's work on the Sleepy Lagoon murder trial, and the real fate of main character Henry Leyvas. * *Note: Sofia would like to let readers know that she had a long day prior to recording this and was bitten by the "um" bug, so thank you for your understanding. Sources: Film Background: Siskel and Ebert Review, Zoot Suit: https://siskelebert.org/?p=7033 Center Theater Group, "How 'Zoot Suit' Changed Theater Forever." https://www.centertheatregroup.org/news-and-blogs/news/2017/january/how-zoot-suit-changed-theatre-forever/ Robert Ito, "Zoot Suit, a Pioneering Play, Comes Full Circle," New York Times, available at https://www.nytimes.com/2017/01/26/theater/zoot-suit-a-pioneering-chicano-play-comes-full-circle.html Zoot Suit, IMDB: https://www.imdb.com/title/tt0083365/?ref_=nv_sr_srsg_0 Chicano: Google Books Ngram, Chicano: https://books.google.com/ngrams/graph?content=chicano&year_start=1800&year_end=2019&corpus=26&smoothing=3&direct_url=t1%3B%2Cchicano%3B%2Cc0#t1%3B%2Cchicano%3B%2Cc0 Jose Limon, "The Folk Performance of Chicano and the Cultural Limits of Political Ideology," Unpublished working paper, UCLA. Code Switch, "You Say Chicano, I Say. . ." Available at https://www.npr.org/transcripts/718703438 Henry Leyvas: "Enrique "Henry" Reyes Leyvas (1923-1971)," American Experience, PBS. https://www.pbs.org/wgbh/americanexperience/features/zoot-enrique-henry-reyes-leyvas/. "Sleepy Lagoon Trial: The Sleepy Lagoon Murder Trial of 12," Zoot Suit Discovery Guide. https://research.pomona.edu/zootsuit/en/trial/ . Sleepy Lagoon Trial Photos: https://digital.library.ucla.edu/catalog?f%5Bsubject_sim%5D%5B%5D=Sleepy+Lagoon+Trial%2C+Los+Angeles%2C+1942-1943&sort=title_alpha_numeric_ssort+asc Zoot Suits: Kathy Peiss, Zoot Suit: The Enigmatic Career of an Extreme Style, (University of Pennsylvania Press, 2011). https://www.jstor.org/stable/j.ctt3fhn0m Stuart Cosgrove, "The Zoot-Suit and Style Warfare," History Workshop 18 (1984): 77-91. https://www.jstor.org/stable/4288588. Steve Chibnall, "Whistle and Zoot: The Changing Meaning of a Suit of Clothes," History Workshop 20 (1985): 56-81. https://www.jstor.org/stable/4288649. Ralph H. Turner and Samuel J. Surace, "Zoot-Suiters and Mexicans: Symbols in Crowd Behavior," American Journal of Sociology 62, no.1 (1956): 14-20. https://www.jstor.org/stable/2773799. Catherine S. Ramirez, "Crimes of Fashion: The Pachuca and Chicana Style Politics," Meridians 2, no.2 (2002): 1-35. https://www.jstor.org/stable/40338497. Catherine S. Ramirez, "Saying "Nothin": Pachucas and the Languages of Resistance," Frontiers: A Journal of Women Studies 27, no.3 (2006): 1-33. https://www.jstor.org/stable/4137381. Alice McGrath: PBS, American Experience, "Zoot Suit Riots": https://www.pbs.org/wgbh/americanexperience/films/zoot/#transcript Joan Trossman Bien, "Outlaw Activist: Alice McGrath Turns 90," Ventura County Reporter, available at https://web.archive.org/web/20080606170822/http://www.vcreporter.com/cms/story/detail/?id=4917&IssueNum=133 Carlos Larralde, "Josefina Fierro and the Sleepy Lagoon Crusade, 1942-1945," Southern California Quarterly 92, 2 (2010) V. Ruiz, "Una Mujer Sin Fronteras," Pacific Historical Review 73, 1 (2004) Kenneth C Burt, "The Power of a Mobilized Citizenry and Coalition Politics: The 1949 Election of Edward R. Roybal to the Los Angeles City Council," Southern California Quarterly 85, 4 (2003)  

We'd love to hear from you (feedback@breakingbadscience.com)Look us up on social media Facebook: https://www.facebook.com/groups/385282925919540Instagram: https://www.instagram.com/breakingbadsciencepodcast/Website: http://www.breakingbadscience.com/Patreon: https://www.patreon.com/breakingbadscienceWhat causes a person to be so convinced they need to run faster, jump higher, or lift more that their own muscle tears their tendons from the bone? Combine that with something that can make a person lose impulse control and go into a rage bad enough to end like Chris Benoit and you really only have one possibility. So what are Steroids? Roids? Anabolics? Join hosts Shanti and Danny as we discuss what they are and what are their uses and misuses?ReferencesBeiner, J, et. al.; The Effect of Anabolic Steroids and Corticosteroids on Healing of Muscle Contusion Injury. American Journal of Sports Medicine. Jan-1999. 27:1 (2 - 9). Doi: https://doi.org/10.1177/03635465990270011101Salamin, O., et. al.; Erythropoietin as a Performance-Enhancing Drug: Its Mechanistic Basis, Detection, and Potential Adverse Effects. Molecular and Cellular Endocrinology. Mar-2018. 15:464 (75 - 87). Doi: https://doi.org/10.1016/j.mce.2017.01.033Wheeler, T.; Bulk Up Your Steroid Smarts. WebMD. 30-Jul-2021. https://www.webmd.com/a-to-z-guides/ss/slideshow-steroids-101Piacentino, D., et. al.; Anabolic-androgenic Steroid Use and Psychopathology in Athletes. A Systematic Review. Current Neuropharmacology. Jan-2015. 13:1 (101 - 121). Doi: https://doi.org/10.2174/1570159x13666141210222725Unger, C.; Hormone Therapy for Transgener Patients. Translational Andrology and Urology. Dec-2016. 5:6 (877 - 884). Doi: https://dx.doi.org/10.21037%2Ftau.2016.09.04Support the show (https://www.patreon.com/breakingbadscience?fan_landing=true)

Zinc might help to stave off respiratory infection symptoms and cut illness duration Western Sydney University (Australia), November 2, 2021   A zinc supplement might help stave off the symptoms of respiratory tract infections, such as coughing, congestion, and sore throat, and cut illness duration, suggests a pooled analysis of the available evidence, published in the open access journal BMJ Open. But the quality of the evidence on which these findings are based is variable, and it's not clear what an optimal formulation or dose of this nutrient might be, caution the researchers. Respiratory tract infections include colds, flu, sinusitis, pneumonia and COVID-19. Most infections clear up by themselves, but not all. And they often prove costly in terms of their impact on health services and time taken in sick leave. Zinc has a key role in immunity, inflammation, tissue injury, blood pressure and in tissue responses to lack of oxygen. As a result, it has generated considerable interest during the current pandemic for the possible prevention and treatment of COVID-19 infection. In response to calls for rapid evidence appraisals to inform self-care and clinical practice, the researchers evaluated zinc for the prevention and treatment of SARS-CoV-2, the virus responsible for COVID-19, and other viral respiratory tract infections. When that review was published, the results of several relevant clinical trials weren't yet available, so this current review brings the available evidence up to date.  The review includes 28 clinical trials involving 5446 adults, published in 17 English and Chinese research databases up to August 2020. None of the trials specifically looked at the use of zinc for the prevention or treatment of COVID-19. The most common zinc formulations used were lozenges followed by nasal spraysand gels containing either zinc acetate or gluconate salts. Doses varied substantially, depending on the formulation and whether zinc was used for prevention or treatment. Pooled analysis of the results of 25 trials showed that compared with dummy treatment (placebo), zinc lozenges or nasal spray prevented 5 respiratory tract infections in 100 people a month. These effects were strongest for curbing the risk of developing more severe symptoms, such as fever and influenza-like illnesses. But this is based on only three studies. On average, symptoms cleared up 2 days earlier with the use of either a zinc spray or liquid formulation taken under the tongue (sublingual) than when a placebo was used. During the first week of illness, participants who used sublingual or nasal spray zinc were nearly twice as likely to recover as those who used placebo: 19 more adults out of 100 were likely to still have symptoms a week later if they didn't use zinc supplements.  While zinc wasn't associated with an easing in average daily symptom severity, it was associated with a clinically significant reduction in symptom severity on day 3.  Side effects, including nausea and mouth/nose irritation, were around 40% more likely among those using zinc, but no serious side effects were reported in the 25 trials that monitored them.  However, compared with placebo, sublingual zinc didn't reduce the risk of developing an infection or cold symptoms after inoculation with human rhinovirus, nor were there any differences in illness duration between those who used zinc supplements and those who didn't. Nor was the comparative effectiveness of different zinc formulations and doses clear. And the quality, size, and design of the included studies varied considerably. "The marginal benefits, strain specificity, drug resistance and potential risks of other over-the-counter and prescription medications makes zinc a viable 'natural' alternative for the self-management of non-specific [respiratory tract infections], the researchers write.  "[Zinc] also provides clinicians with a management option for patients who are desperate for faster recovery times and might be seeking an unnecessary antibiotic prescription," they add. "However, clinicians and consumers need to be aware that considerable uncertainty remains regarding the clinical efficacy of different zinc formulations, doses and administration routes, and the extent to which efficacy might be influenced by the ever changing epidemiology of the viruses that cause [respiratory tract infections]," they caution. And how exactly zinc might exert its therapeutic effects on respiratory infections, including COVID-19, warrants further research, they conclude.     Drinking alcohol to stay healthy? That might not work, says new study Ulrich John of University Medicine (Germany), November 2, 2021 Increased mortality risk among current alcohol abstainers might largely be explained by other factors, including previous alcohol or drug problems, daily smoking, and overall poor health, according to a new study publishing November 2nd in PLOS Medicine by Ulrich John of University Medicine Greifswald, Germany, and colleagues. Previous studies have suggested that people who abstain from alcohol have a higher mortality rate than those who drink low to moderate amounts of alcohol. In the new study, researchers used data on a random sample of 4,028 German adults who had participated in a standardized interview conducted between 1996 and 1997, when participants were 18 to 64 years old. Baseline data were available on alcohol drinking in the 12 months prior to the interview, as well as other information on health, alcohol and drug use. Mortality data were available from follow-up 20 years later. Among the study participants, 447 (11.10%) had not drunk any alcohol in the 12 months prior to the baseline interview. Of these abstainers, 405 (90.60%) were former alcohol consumers and 322 (72.04%) had one or more other risk factor for higher mortality rates, including a former alcohol-use disorder or risky alcohol consumption (35.40%), daily smoking (50.00%), or fair to poor self-rated health (10.51%). The 125 alcohol abstinent persons without these risk factors did not show a statistically significantly difference in total, cardiovascular or cancer mortality compared to low to moderate alcohol consumers, and those who had stayed alcohol abstinent throughout their life had a hazard ratio of 1.64 (95% CI 0.72-3.77) compared to low to moderate alcohol consumers after adjustment for age, sex and tobacco smoking. "The results support the view that people in the general population who currently are abstinent from alcohol do not necessarily have a shorter survival time than the population with low to moderate alcohol consumption," the authors say. "The findings speak against recommendations to drink alcohol for health reasons." John adds, "It has long been assumed that low to moderate alcohol consumption might have positive effects on health based on the finding that alcohol abstainers seemed to die earlier than low to moderate drinkers. We found that the majority of the abstainers had alcohol or drug problems, risky alcohol consumption, daily tobacco smoking or fair to poor health in their history, i.e., factors that predict early death."   Quercetin helps to reduce the risk of pancreatic cancer Univ. of Hawaii and Univ. of Southern California, November 1, 2021 Quercetin, which is found naturally in apples and onions, has been identified as one of the most beneficial flavonols in preventing and reducing the risk of pancreatic cancer. Although the overall risk was reduced among the study participants, smokers who consumed foods rich in flavonols had a significantly greater risk reduction. This study, published in the American Journal of Epidemiology, is the first of its kind to evaluate the effect of flavonols – compounds found specifically in plants – on developing pancreatic cancer. According to the research paper, “only a few prospective studies have investigated flavonols as risk factors for cancer, none of which has included pancreatic cancer. “ Researchers from Germany, the Univ. of Hawaii and Univ. of Southern California tracked food intake and health outcomes of 183,518 participants in the Multiethnic Cohort Study for eight years. The study evaluated the participants' food consumption and calculated the intake of the three flavonols quercetin, kaempferol, and myricetin. The analyses determined that flavonol intake does have an impact on the risk for developing pancreatic cancer. The most significant finding was among smokers. Smokers with the lowest intake of flavonols presented with the most pancreatic cancer. Smoking is an established risk factor for the often fatal pancreatic cancer, notes the research. Among the other findings were that women had the highest intake of total flavonols and seventy percent of the flavonol intake came from quercetin, linked to apple and onion consumption. It is believed that these compounds may have anticancer effects due to their ability to reduce oxidative stress and alter other cellular functions related to cancer development. “Unlike many of the dietary components, flavonols are concentrated in specific foods rather than in broader food groups, for example, in apples rather than in all fruit,” notes the research study. Previously, the most consistent inverse association was found between flavonols, especially quercetin in apples and lung cancer, as pointed out in this study. No other epidemiological flavonol studies have included evaluation of pancreatic cancer. While found in many plants, flavonols are found in high concentrations in apples, onions, tea, berries, kale, and broccoli. Quercetin is most plentiful in apples and onions.   Researcher explains the psychology of successful aging University of California at Los Angeles, November 2, 2021 Successful aging can be the norm, says UCLA psychology professor Alan Castel in his new book, "Better with Age: The Psychology of Successful Aging" (Oxford University Press). Castel sees many inspiring role models of aging. French Impressionist Claude Monet, he notes, began his beloved water lily paintings at age 73. Castel cites hundreds of research studies, including his own, combined with personal accounts from older Americans, including Maya Angelou, Warren Buffett, John Wooden, Bob Newhart, Frank Gehry, David Letterman, Jack LaLanne, Jared Diamond, Kareem Abdul-Jabbar, John Glenn and Vin Scully. Castel notes that architect Gehry designed conventional buildings and shopping malls early in his career, and decades later designed the creative buildings he would only dream about when he was younger. Others who did much of their best work when they were older include Mark Twain, Paul Cezanne, Frank Lloyd Wright, Robert Frost and Virginia Woolf, he writes. "There are a lot of myths about aging, and people often have negative stereotypes of what it means to get old," Castel said. "I have studied aging for two decades, and have seen many impressive role models of aging, as well as people who struggle in older age. This book provides both science behind what we can to do age well and role models of successful aging. While some books focus on how to try to prevent or delay aging, 'Better with Age' shows how we can age successfully and enjoy the benefits of old age. I have combined the lessons the psychology of aging teaches us with insights from some of the people who have succeeded in aging well." Castel cites a 1979 study by Harvard University social psychologist Ellen Langer in which men in their 70s and 80s went to a week-long retreat at a motel that was re-designed to reflect the décor and music from 1959. The men, who were all dependent on family members for their care, were more independent by the end of the week, and had significant improvements in their hearing, memory, strength and scores on intelligence tests. Some played catch with a football. One group of the men, who were told to behave like they were 20 years younger, showed greater flexibility, and even looked younger, according to observers who saw photos of them at the start and end of the week. In another study, researchers analyzed Catholic nuns' diary entries made in the 1930s and 1940s, when the nuns were in their 20s, and determined their level of happiness from these diaries. More than 50 years later, 75 percent of the most cheerful nuns survived to age 80, while only 40 percent of the least happy nuns survived to 80. The happiest nuns lived 10 years longer than the least happy nuns. Happiness increases our lives by four to 10 years, a recent research review suggested. "As an added bonus," Castel writes, "those additional years are likely to be happy ones." Successful aging involves being productive, mentally fit, and, most importantly, leading a meaningful life, Castel writes. What are the ingredients of staying sharp and aging successfully, a process which Castel says can start at any age? He has several recommendations. Tips for longevity Walking or other physical exercise is likely the best method to ensure brain and body health, Castel writes. In a large 2011 study, older adults were randomly assigned to a group that walked for 40 minutes three times a week or a stretching group for the same amount of time. After six months and again after one year, the walking group outperformed the stretching group on memory and cognitive functioning tests. Too much running, on the other hand, can lead to joint pain and injuries. In addition, after one year, those who walked 40 minutes a day three times a week showed a 2 percent increase in the volume of the hippocampus—an important brain region involved in memory. Typically, Castel notes, the hippocampus declines about 1 percent a year after age 50. "Walking actually appears to reverse the effects of aging," Castel says in the book. Balance exercises are proven to prevent falls, can keep us walking and may be the most essential training activity for older adults, Castel writes. Each year, more than two million older Americans go to the emergency room because of fall-related injuries. A 2014 British study found that people who could get up from a chair and sit back down more than 30 times in a minute were less likely to develop dementia and more likely to live longer than those who could not. A good balance exercise is standing on one leg with your eyes open for 60 seconds or more, and then on the other leg. Those who did poorly on this were found in a study to be at greater risk for stroke and dementia. Like walking, sleep is valuable free medicine. Studies have shown a connection between insomnia and the onset of dementia. People who speak more than one language are at reduced risk for developing dementia, research has shown; there is some evidence being bilingual or multilingual can offset dementia by five years, Castel writes. One study found that among people between 75 and 85, those who engaged in reading, playing board games, playing musical instruments and dancing had less dementia than those who did none of those activities. "Lifelong reading, especially in older age, may be one of the secrets to preserving mental ability," Castel writes. Set specific goals. Telling yourself to "eat healthy" is not very likely to cause a change; setting a goal of "eating fewer cookies after 7 p.m." is better. Similarly, "walk four days a week with a friend" is a more useful goal than "get more exercise" and "call a friend or family member every Friday morning" is better than "maintain friendships." How can we improve our memory? When Douglas Hegdahl was a 20-year-old prisoner of war in North Vietnam, he wanted to learn the names of other American prisoners. He memorized their names, capture dates, methods of capture and personal information of more than 250 prisoners to the tune of the nursey rhyme, "Old MacDonald Had a Farm." Today, more than four decades later, he can still recall all of their names, Castel writes. Social connections are also important. Rates of loneliness among older adults are increasing and chronic loneliness "poses as large a risk to long-term health and longevity as smoking cigarettes and may be twice as harmful for retirees as obesity," Castel writes. The number of Americans who say they have no close friends has roughly tripled in the last few decades. There is evidence that people with more social support tend to live longer than those who are more isolated, and that older adults who lead active social lives with others are less likely to develop dementia and have stronger immune systems to fight off diseases. "Staying sharp," Castel writes, "involves staying connected—and not to the Internet." A 2016 study focused on "super-agers"—people in their 70s whose memories are like those of people 40 years younger. Many of them said they worked hard at their jobs and their hobbies. The hard work was challenging, and not always pleasurable, leaving people sometimes feeling tired and frustrated. Some researchers believe this discomfort and frustration means you are challenging yourself in ways that will pay off in future brain and other health benefits. Research has shown that simply telling older adults they are taking a "wisdom test" rather than a "memory test" or "dementia screening" actually leads to better results on the identical memory test, Castel writes. If you are concerned about your memory, or that of a loved one, it may be wise to see a neurologist, Castel advises. Castel, 42, said he is struck by how many older adults vividly recall what is most important to them. As Castel quotes the Roman philosopher and statesman Cicero: "No old man forgets where he has hidden his treasure."     Researchers find phthalates in wide variety of fast foods George Washington University Milken Institute School of Public Health, October 29, 2021 A team of researchers from The George Washington University Milken Institute School of Public Health, the Southwest Research Institute and the Chan School of Public Health, has found phthalates in a wide variety of fast foods. In their paper published in Journal of Exposure Science and Environmental Epidemiology, the group describes how they collected samples of fast food from several restaurants and tested them for phthalates and other chemicals meant to replace them—and what they found. Phthalates are esters of phthalic acid and are commonly used to make plastic substances more flexible. Prior research has shown that they can also increase durability and longevity making them popular for plastics makers. Researchers have found that consumption of phthalates can disrupt the endocrine system and by extension levels of hormones in the body. Research has also shown that they can lead to asthma in children and increased obesity.  In this new effort, the researchers built on prior work they conducted looking at urine samples of volunteers where they found that those who ate more fast food, tended to have more phthalates in their system. To learn more about the link between fast food and phthalate levels, the researchers visited six fast food restaurants in and around San Antonio, Texas, and collected 64 food items to be used as test samples. They also asked for a pair of the plastic gloves that were used by food preparers at the same establishments and obtained three of them. In studying the food samples, the researchers found DnBP in 81% of the samples and DEHP in 70% of them. They also noted that the foods with the highest concentrations of phthalates were meat-based, such as cheeseburgers or burritos. The team also found DINCH, DEHT and DEHA, chemicals that have begun replacing phthalates in many of the samples they collected. They note that it is not known if such replacements are harmful to humans if ingested. The researchers did not attempt to find out how the phthalates were making their way into the fast foods but suspect it is likely from residue on rubber gloves used by cooks who prepare them. It is also possible, they note, that they are coming from plastic packaging.   Removing digital devices from the bedroom can improve sleep for children, teens Penn State University, November 2, 2021 Removing electronic media from the bedroom and encouraging a calming bedtime routine are among recommendations Penn State researchers outline in a recent manuscript on digital media and sleep in childhood and adolescence. The manuscript appears in the first-ever special supplement on this topic in Pediatricsa nd is based on previous studies that suggest the use of digital devices before bedtime leads to insufficient sleep. The recommendations, for clinicians and parents, are:   1. Make sleep a priority by talking with family members about the importance of sleep and healthy sleep expectations; 2. Encourage a bedtime routine that includes calming activities and avoids electronic media use; 3. Encourage families to remove all electronic devices from their child or teen's bedroom, including TVs, video games, computers, tablets and cell phones; 4. Talk with family members about the negative consequences of bright light in the evening on sleep; and 5. If a child or adolescent is exhibiting mood or behavioral problems, consider insufficient sleep as a contributing factor. "Recent reviews of scientific literature reveal that the vast majority of studies find evidence for an adverse association between screen-based media consumption and sleep health, primarily delayed bedtimes and reduced total sleep duration," said Orfeu Buxton, associate professor of biobehavioral health at Penn State and an author on the manuscript. The reasons behind this adverse association likely include time spent on screens replacing time spent sleeping; mental stimulation from media content; and the effects of light interrupting sleep cycles, according to the researchers. Buxton and other researchers are further exploring this topic. They are working to understand if media use affects the timing and duration of sleep among children and adolescents; the role of parenting and family practices; the links between screen time and sleep quality and tiredness; and the influence of light on circadian physiology and sleep health among children and adolescents.

On today's episode of the LLVLC Show, Jimmy breaks down why the carbohydrate-insulin model of obesity needs serious consideration. “I still want to see that study comparing a junk food high-carb diet with steak and vegetables.” - Jimmy Moore GET STARTED WITH THE KETO CHOW STARTER BUNDLE at  JimmyLovesKetoChow.com   In today's episode, Jimmy presents a NEVER-BEFORE-SEEN episode of his show JIMMY MAKES SCIENCE SIMPLE (@jimmymakessciencesimple) to outline important new research he wanted you to know about. It's a study published in the September 2021 issue of the prestigious American Journal of Clinical Nutrition entitled “The carbohydrate-insulin model: a physiological perspective on the obesity pandemic”: https://academic.oup.com/ajcn/advance-article/doi/10.1093/ajcn/nqab270/6369073 This study presents a virtual who's who in the keto nutritional health research space with some very familiar names, including Dr. David Ludwig, Dr. Arne Astrup, Dr. Ronald Krauss, Gary Taubes, Dr. Jeff Volek, Dr. Eric Westman, Dr. William Yancy, and more! They propose a series of studies to challenge the “eat less, move more” theory to compare it with the carbohydrate-insulin model for obesity. These researchers make a compelling argument that a low-glycemic load diet (low-carb, ketogenic nutrition) should be seriously examined to help resolve the obesity pandemic. It's a thought-provoking perspective that you'll hear all about in this podcast.

Join Dr. Peter to go way below the surface and find the hidden meanings of obsessions, compulsions and OCD.  Through poetry and quotes, he invites you into the painful, distressing, fearful and misunderstood world of those who suffer from OCD.  He defines obsessions and compulsions, discusses the different types of each, and evaluates two conventional treatments and one alternative treatment for OCD.  Most importantly, he discusses the deepest natural causes of OCD, which are almost always disregarded in conventional treatment, which focuses primarily on the symptoms.   Lead-in OCD is not a disease that bothers; it is a disease that tortures. - Author: J.J. Keeler   “It can look like still waters on the outside while a hurricane is swirling in your mind.” — Marcie Barber Phares  Poetry or word picture (prayer of the scrupulous)  Aditi Apr 2017  Obsessive Compulsive Disorder.  OCD.  That is what we are addressing today. Here is what OCD is like for Toni Neville -- she says:  “It's like being controlled by a puppeteer. Every time you try and just walk away he pulls you back. Are you sure the stove is off and everything is unplugged? Back up we go. Are you sure your hands are as clean as they can get? Back ya go. Are you sure the doors are securely locked? Back down we go. How many people have touched this object? Wash your hands again.”  Introduction We are together in this great adventure, this podcast, Interior Integration for Catholics, we are journeying together, and I am honored to be able to spend this time with you.   I am Dr. Peter Malinoski, clinical psychologist and passionate Catholic and together, we are taking on the tough topics that matter to you.   We bring the best of psychology and human formation and harmonize it with the perennial truths of the Catholic Faith.    Interior Integration for Catholics is part of our broader outreach, Souls and Hearts bringing the best of psychology grounded in a Catholic worldview to you and the rest of the world through our website soulsandhearts.com  Today, we are getting into obsessions and compulsions -- a really deep dive into what's really going on with these experiences.  I know many of you were expecting me to discuss scrupulosity today -- And you know what?  I was expecting I would be discussing scrupulosity well, but in order to have that discussion of scrupulosity  be well-founded, we really need to get into understanding obsessions and compulsions first.  I have to bring you up to speed on obessions and compulsions before we get into scrupulosity, and there is a lot to know The questions we will be covering about obsessions and compulsions. What are Obsession and Compulsions? Getting into definitions.   Also What are the different types of obsessions and compulsions, the different forms that obsessions and compulsions can take What is the experience of OCD like?  From those who have suffered it.   Who suffers from obsessions and compulsions -- how common are they?  Who is at risk?  Why do obsessions and compulsions start and why do they keep going?  How do we overcome obsessions and compulsions?  How do we resolve them?   What does the secular literature say are the best treatments"  -- Medication and a particular kind of therapy called Exposure and Response Prevention Alternatives   Can we find not just a descriptive diagnosis, but a proscriptive conceptualization that gives a direction for healing, resolving the obsessions and compulsions  Not just symptom management. Definitions  Obsessions  DSM-5: Obsessions are defined by (1) and (2): Recurrent and persistent thoughts, urges, or impulses that are experienced, at some time during the disturbance, as intrusive and unwanted, and that in most individuals cause marked anxiety or distress.  The individual attempts to ignore or suppress such thoughts, urges, or images, or to neutralize them with some other thought or action (i.e., by performing a compulsion).  Not pleasurable   Involuntary My compulsive thoughts aren't even thoughts, they're absolute certainties and obeying them isn't a choice. - Author: Paul Rudnick  To resist a compulsion with willpower alone is to hold back an avalanche by melting the snow with a candle. It just keeps coming and coming and coming. - Author: David Adam   Individual works to neutralize the obsession with another thought or a compulsion.   From the International OCD Foundation:  Obsessions are thoughts, images or impulses that occur over and over again and feel outside of the person's control. Individuals with OCD do not want to have these thoughts and find them disturbing. In most cases, people with OCD realize that these thoughts don't make any sense.  Obsessions are typically accompanied by intense and uncomfortable feelings such as fear, disgust, doubt, or a feeling that things have to be done in a way that is “just right.” In the context of OCD, obsessions are time consuming and get in the way of important activities the person values.  Common Obsessions  Sources What is OCD? Article by the International OCD Foundation on their website  WebMD article How Do I Know if I Have OCD? By Danny Bonvissuto February 19. 2020  Northpointrecovery.com blog What Types of OCD Are There? Get the Breakdown Here by the Northpoint Staff from May 3, 2019  Article entitled Common Types of OCD: Subtypes, Their Symptoms and the Best Treatment by Patrick Carey dated July 6, 2021 on treatmyocd.com   Contamination Body fluids --- blood, urine, saliva, feces -   I gave my baby niece a serious illness when I held her --  I'm sure I got a disease from using the public restroom.   Germs for communicable diseases -- may be afraid to shake hands, worried about catching gonorrhea  Environmental contaminants -- radiation, asbestos  Household chemicals -- cleaners, solvents  Dirt  If you put the wrong foods in your body, you are contaminated and dirty and your stomach swells. Then the voice says, Why did you do that? Don't you know better? Ugly and wicked, you are disgusting to me. - Author: Bethany Pierce   Losing Control Giving in to an impulse to harm yourself --  I could jump in front of this bus right now.   Fear of acting on an impulse to harm others -- what if I stabbed my child with this knife?  Fear of violent or horrific images in your mind  Fear of shouting out insults or obscenities --  Fear of stealing things   Harm Fear of being responsible for some terrible event (causing a fire at an office building)  Fear of harming others because of not being careful enough (leaving a stick in your yard that fell from a tree in a wind storm that may trip and hurt an neighbor child)   Relationships Doubts about romantic partner -- is she the right one for me?  Is there a better one I am supposed to find?  What if we are not meant to be together, but we wind up marrying each other?  Is my partner faithful?   Unwanted Sexual Thoughts Forbidden or perverse sexual thoughts or images  Sexual obsessions involving children  Obsessions about aggressive sexual behavior toward others   Obsessions related to perfectionism Concern about evenness or exactness   need for things to be in their place Arranging things in a particular way before leaving home   Concern with a need to know or remember  Inability to decide whether to keep or discard things  Fear of losing things  Fear of making a mistake -- may need excessive encouragement from others  Needing to make sure that your action is just right -- I need to start this email over, something is not wright with the wording.   Obsessions about your Sexual Orientation Obsessions about being embarrassed in a public situation Getting a non-communicable disease such as cancer Superstitious ideas such as unlucky numbers or certain colors Religious Obsessions (Scrupulosity) Concern with offending God  Concerns about blasphemy  Concerns about right and wrong, morality.   Compulsions  Definitions  DSM-5 Compulsions are defined by (1) and (2): Repetitive behaviors (e.g., hand washing, ordering, checking) or mental acts (e.g., praying, counting, repeating words silently) that the individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly.  The behaviors or mental acts are aimed at preventing or reducing anxiety or distress, or preventing some dreaded event or situation; however, these behaviors or mental acts are not connected in a realistic way with what they are designed to neutralize or prevent, or are clearly excessive.  Most people with OCD have both obsessions and compulsions.   From the International OCD Foundation Compulsions are the second part of obsessive compulsive disorder. These are repetitive behaviors or thoughts that a person uses with the intention of neutralizing, counteracting, or making their obsessions go away. People with OCD realize this is only a temporary solution but without a better way to cope they rely on the compulsion as a temporary escape. Compulsions can also include avoiding situations that trigger obsessions. Compulsions are time consuming and get in the way of important activities the person values.   Common Compulsions in OCD  Sources What is OCD? Article by the International OCD Foundation on their website  WebMD article How Do I Know if I Have OCD? By Danny Bonvissuto February 19. 2020  Northpointrecovery.com blog What Types of OCD Are There? Get the Breakdown Here by the Northpoit Staff from May 3, 2019  Article entitled Common Types of OCD: Subtypes, Their Symptoms and the Best Treatment by Patrick Carey dated July 6, 2021   Washing and Cleaning Washing hands excessively or in a certain way  Excessive showering, bathing, toothbrushing, grooming  Cleaning items or objects excessively   Checking Checking that you did not or will not harm anyone  Checking that you did not or will not harm yourself  Checking that nothing terrible happened  Checking that you did not make a mistake  Checking specific parts of your body   Repeating Re-reading or re-writing   Repeating routine activities Going in and out of doors  Getting up and down from chairs   Repeating body movements Tapping  Touching  Blinking   Repeating activities in multiples Doing things three times, because three is a good, right or safe number   Mental Compulsions Mental review of events to prevent harm (to oneself others, to prevent terrible consequences)  Praying to prevent harm (to oneself others, to prevent terrible consequences)  Counting while performing a task to end on a “good,” “right,” or “safe” number  Cancelling” or “Undoing” (example: replacing a “bad” word with a “good” word to cancel it out)    Putting things in order or arranging things until it “feels right” or are in perfect symmetry Telling asking or confessing to get reassurance Avoiding situations that might trigger your obsessions  Obsessions and Compulsions go together  The vicious cycle of OCD -- Obsessive-Compulsive Disorder (OCD) at helpguide.org Obsessive thought  --  I could stab my nephew with this knife.  Anxiety -- that would be a terrible thing to happen, I can't let that happen  Compulsion -- Locking all the knives away, checking to make sure they are all accounted for when your sibling and her family are visiting  Temporary relief -- the knives are all there.  “A physical sensation crawls up my arm as I avoid compulsions. But if I complete it, the world resets itself for a moment like everything will be just fine. But only for a moment.” —  Mardy M. Berlinger Harm Obsession     Compulsion:  Keeping all knives hidden away somewhere What if I killed my nephew and I just can't remember?  Repeatedly going back to check if you ran someone over DSM-5 Obsessive-Compulsive Disorder Presence of obsessions, compulsions, or both:  The obsessions or compulsions are time-consuming (e.g., take more than 1 hour per day) or cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.  The obsessive-compulsive symptoms are not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition.  The disturbance is not better explained by the symptoms of another mental disorder   Specify if: With good or fair insight: The individual recognizes that obsessive-compulsive disorder beliefs are definitely or probably not true or that they may or may not be true.  With poor insight:  The individual thinks obsessive-compulsive disorder beliefs are probably true.  With absent insight/delusional beliefs: The individual is completely convinced that obsessive-compulsive disorder beliefs are true. 4%  With Tic disorder up to 30%   What is the experience of OCD Poem By Forti.no   Quotes: “You lose time. You lose entire blocks of your day to obsessive thoughts or actions. I spend so much time finishing songs in my car before I can get out or redoing my entire shower routine because I lost count of how many times I scrubbed my left arm.” — Kelly Hill  “Ever seen ‘Inside Out'? With OCD, it's like Doubt has its own control console.” — Josey Eloy Franco  “Imagine all your worst thoughts as a soundtrack running through your mind 24/7, day after day.” — Adam Walker Cleveland  “Picture standing in a room filled with flies and pouring a bottle of syrup over yourself. The flies constantly swarm about you, buzzing around your head and in your face. You swat and swat, but they keep coming. The flies are like obsessional thoughts — you can't stop them, you just have to fend them off. The swatting is like compulsions — you can't resist the urge to do it, even though you know it won't really keep the flies at bay more than for a brief moment.” — Cheryl Little Sutton  “It's like you have two brains — a rational brain and an irrational brain. And they're constantly fighting.” — Emilie Ford   Who 12 month prevalence is 1.2% with international prevalence rates from 1.1 to 1.8%  NIH Women have a higher prevalence 1.8% than men 0.5%.  Males more affected in childhood.  Lifetime prevalence 2.3%   Risk Factors:  DSM-5  Temperamental Factors Greater internalizing symptoms  Higher negative emotionality  Behavioral inhibition   Environmental Factors Childhood physical abuse  Childhood sexual abuse  Other stressful or traumatic events   Genetic Monozygotic concordance rates --.57  Dizygotic concordance rates .22   Physiological  Dysfunction in the orbitofrontal cortex, anterior cingulate cortex, and striatum have been implicated.   Streptococcal infection can precede the development of OCD symptoms in children Therapy  Exposure and Response Prevention (ERP) -- Developed originally in the 1970s Stanley Rachman's work a type of behavioral therapy  that exposes the person to situations that provoke their obsessions causing distress, usually anxiety which leads to  the urge to engage in the compulsion  that gives them the temporary relief.   The goal of ERP is to break the cycle of obsessions --> anxiety --> compulsion --> temporary relief.  So you are exposed to you anxiety provoking stimulus, and have the obsession, but you prevent the compulsive response, and you don't get the temporary relief.  Basic premise: As individuals confront their fears and no longer engage in their escape response, they will eventually reduce their anxiety. The goal is to habituate, or get used to the feelings of the obsessions, without having to engage in the compulsive behavior.  This increases the capacity to handle discomfort and anxiety.  Then one is no longer reinforced by the temporary anxiety relief that the compulsion provides.   Patrick Carey writes that: Any behavior that engages with the obsession– e.g. asking for reassurance, avoidance, rumination– reinforces it. By preventing these behaviors, ERP teaches people that they can tolerate their distress without turning to compulsions. It thereby drains obsessions of their power.  Division 12 of the APA   Essence of therapy: Individuals with OCD repeatedly confront the thoughts, images, objects, and situations that make them anxious and/or start their obsessions in a systematic fashion, without performing compulsive behaviors that typically serve to reduce anxiety. Through this process, the individual learns that there is nothing to fear and the obsessions no longer cause distress. From the IOCDF :  With ERP, the difference is that when you make the choice to confront your anxiety and obsessions you must also make a commitment to not give in and engage in the compulsive behavior. When you don't do the compulsive behaviors, over time you will actually feel a drop in your anxiety level. This natural drop in anxiety that happens when you stay “exposed” and “prevent” the compulsive “response” is called habituation. Instead, a person is forced to confront their obsessive thoughts relentlessly. The goal is to make the sufferer so accustomed to their obsessions that they no longer feel tempted to engage in soothing compulsions. Types of Exposure -- GoodTherapy.org article Imaginal Exposure: In this type of exposure, a person in therapy is asked to mentally confront the fear or situation by picturing it in one's mind. For example, a person with agoraphobia, a fear of crowded places, might imagine standing in a crowded mall.  In Vivo Exposure: When using this type of exposure, a person is exposed to real-life objects and scenarios. For example, a person with a fear of flying might go to the airport and watch a plane take off.  Virtual Reality Exposure: This type of exposure combines elements of both imaginal and in vivo exposure so that a person is placed in situations that appear real but are actually fabricated. For example, someone who has a fear of heights—acrophobia—might participate in a virtual simulation of climbing down a fire escape.   Steven Pence, and colleagues in a 2010 article in the American Journal of Psychotherapy:  "When exposures go wrong: Troubleshooting guidelines for managing difficult scenarios that arise in Exposure-based treatment for Obsessive-Compulsive Disorder The present article reviews five issues that occur in therapy but have been minimally discussed in the OCD treatment literature:  1) when clients fail to habituate to their anxiety -- they don't calm down2) when clients misjudge how much anxiety an exposure will actually cause3) when incidental exposures happen in session -- other fears in the fear hierarchy intrude.  4) when mental or covert rituals interfere with treatment -- covert compulsive behaviors5) when clients demonstrate exceptionally high anxiety sensitivity.  Stacey Smith Counseling at stacysmithcounseling.com -- ERP failures Utilizing safety behaviors  Not sitting with the anxiety until it dissipates -- distracting yourself  Not working through all the irrational, unhelpful thoughts  Not practicing often enough.   ERP criticisms  Can be really unpleasant for clients -- repeated exposures to terrifying stimuli -- can there be a better way? Concerns about safety and security   Concerns about flooding with anxiety  Ben Blum: Inside the Revolutionary Treatment That Could Change Psychotherapy Forever  elemental.medium.com July 21, 2020 Robert Fox is haunted by a memory of a germophobic woman with OCD whom he met once while she was hospitalized. As part of her ERP therapy, the therapists took her into the bathroom and had her wipe her hands over the toilet and sink and then rub them through her hair. She wasn't permitted to shower until the next morning.   Concerns about dropout rates.   Dropout rate of 18.7% across 21 ERP studies with 1400 participants Clarissa Ong and colleagues in 2016 article in the Journal of Anxiety Disorders Dropout rate of 10% among youth for ERP in a 2019 meta-analysis by Carly Johnco and her colleagues in the Journal "Depression and Anxiety" 11 randomized trials I'm concerned that it doesn't go deep enough  Not getting to root causes -- staying at the symptom level -- seeing symptoms as nonsensical One thing which I can't stress enough is that OCD is completely nonsensical and will not listen to reason. This is one of the most frightening things about having it. I knew that to anyone I told, there are Salvador Dali paintings that make more sense. - Author: Joe Wells   What is the fear really about.  Let's not just ignore it.  Fear is a response to something. Tracing back layers, going back through grief and anger, all the way to shame.  Shame episodes 37-49.   Doesn't get to any spiritual issues Medication  International OCD Foundation Drugs and dosages High doses are often needed for these drugs to work in most people.   Research suggests that the following doses may be needed:  fluvoxamine (Luvox®) – up to 300 mg/day  fluoxetine (Prozac®) – 40-80 mg/day  sertraline (Zoloft®) – up to 200 mg/day   paroxetine (Paxil®) – 40-60 mg/day   citalopram (Celexa®) – up to 40 mg/day*   clomipramine (Anafranil®) – up to 250 mg/day  escitalopram (Lexapro®) – up to 40 mg/day   venlafaxine (Effexor®) – up to 375 mg/day   How Do These Medications Work?  From the International OCD Foundation.  It remains unclear as to how these particular drugs help OCD. The good news is that after decades of research, we know how to treat patients, even though we do not know exactly why our treatments work. We do know that each of these medications affect a chemical in the brain called serotonin. Serotonin is used by the brain as a messenger. If your brain does not have enough serotonin, then the nerves in your brain might not be communicating right. Adding these medications to your body can help boost your serotonin and get your brain back on track.   Discussion of conventional approaches  Medication  I am not a physician -- I'm a psychologist and I don't have prescription privileges I don't give advice on medication choices or on dosages or anything like that.  If you think your medication is helping your OCD, I'm not going to argue with you about that --  I don't want to try to dissuade anyone from taking medication for psychological issues if they think it's helping them.   Here's the thing, though.  So much of your thinking about medication depends on what you see as the cause of the problem It makes sense to take medication if you think the obsessions and compulsions pop up because of chemical imbalances.   You take the medication to restore the chemical balance and reduce the symptoms.  So many of treatments for OCD treat the obsessions and compulsions as meaningless, as irrational, as just the random epiphenomena of consciousness, or just as nonsensical expressions of miswiring in the brain or just the effects of poorly balanced neurochemical in the brain.     And so these approaches, like ERP that and medication that target the obsessions and compulsions for eradication, that seek to vanquish them result in multiple problems  I think that is a major, major mistake.   And here is what I want to emphasize.  Obsessions and Compulsions are symptoms.  They are symptoms.  Obsessions and compulsions, as painful and as debilitating as they are for many people, those obsessions and compulsions are not the primary problem.  They are the effects of the primary problem.  Obsessions and compulsions happen late in the causal chain.  I see meaning in every obsession and in every compulsion.  I see a message in every obsession and compulsion.  A cry for help, a signal of deeper distress.   There are cases in which a psychological problem can be purely or primarily organic -- due to a medical condition -- for example due to head trauma that causes brain damage.  Or a brain tumor on the pituitary gland that disrupts your whole endocrine system, resulting in mood swings. But, Most of the time, though, psychological symptoms have psychological causes.   As a Catholic psychologist, I want to move much further back in the causal chain.  I want to address and resolve the underlying issues that give rise to the obsessions in the first place.   Self Help  Obsessive-Compulsive Disorder (OCD) at helpguide.org  Identify your triggers Can help you anticipate your urges  Create a solid mental picture and then make a mental note. Tell yourself, “The window is now closed,” or “I can see that the oven is turned off.”  When the urge to check arises later, you will find it easier to re-label it as “just an obsessive thought.”   Learn to resist OCD compulsions by repeatedly exposing yourself to your OCD triggers, you can learn to resist the urge to complete your compulsive rituals --  exposure and response prevention (ERP)  Build your fear ladder -- working your way up to more and more frightening things.   Resist the urge to do your compulsive behavior The anxiety will fade You're not going to lose control or have a breakdown Practice Challenge Obsessive thoughts Thoughts are just thoughts   Write down obsessive thoughts and compulsions Writing it all down will help you see just how repetitive your obsessions are.  Writing down the same phrase or urge hundreds of times will help it lose its power.  Writing thoughts down is much harder work than simply thinking them, so your obsessive thoughts are likely to disappear sooner.   Challenge your obsessive thoughts. Use your worry period to challenge negative or intrusive thoughts by asking yourself What's the evidence that the thought is true? That it's not true? Have I confused a thought with a fact?   Is there a more positive, realistic way of looking at the situation?  What's the probability that what I'm scared of will actually happen? If the probability is low, what are some more likely outcomes?   Is the thought helpful? How will obsessing about it help me and how will it hurt me?   What would I say to a friend who had this thought?   Create an OCD worry period. Rather than trying to suppress obsessions or compulsions, develop the habit of rescheduling them. Choose one or two 10-minute “worry periods” each day, time you can devote to obsessing.  During your worry period, focus only on negative thoughts or urges. Don't try to correct them. At the end of the worry period, take a few calming breaths, let the obsessive thoughts go, and return to your normal activities. The rest of the day, however, is to be designated free of obsessions.  When thoughts come into your head during the day, write them down and “postpone” them to your worry period.   Create a tape of your OCD obsessions or intrusive thoughts. Focus on one specific thought or obsession and record it to a tape recorder or smartphone.  Recount the obsessive phrase, sentence, or story exactly as it comes into your mind.  Play the tape back to yourself, over and over for a 45-minute period each day, until listening to the obsession no longer causes you to feel highly distressed.   By continuously confronting your worry or obsession you will gradually become less anxious. You can then repeat the exercise for a different obsession.   Reach our for support Stay connected to family and friends.  Join an OCD support group.  Manage Stress Quickly self-soothe and relieve anxiety symptoms by making use of one or more of your physical senses—sight, smell, hearing, touch, taste—or movement. You might try listening to a favorite piece of music, looking at a treasured photo, savoring a cup of tea, or stroking a pet.   Practice relaxation techniques. Mindful meditation, yoga, deep breathing, and other relaxation techniques can help lower your overall stress and tension levels and help you manage your urges. For best results, try practicing a relaxation technique regularly. Lifestyle changes Exercise regularly  Get enough sleep  Avoid alcohol and nicotine   Not sure this is going to work.  Doesn't get to root causes.   IFS as an alternative From Verywellmind.com  What is Internal Family Systems?  By Theodora Blanchfield, August 22, 2021    What Is Internal Family Systems (IFS) Therapy? Internal family systems, or IFS, is a type of therapy that believes we are all made up of several parts or sub-personalities. It draws from structural, strategic, narrative, and Bowenian types of family therapy. The founder, Dr. Richard Schwartz, thought of the mind as an inner family and began applying techniques to individuals that he usually used with families.  The underlying concept of this theory is that we all have several parts living within us that fulfill both healthy and unhealthy roles. Life events or trauma, however, can force us out of those healthy roles into extreme roles. The good news is that these internal roles are not static and can change with time and work. The goal of IFS therapy is to achieve balance within the internal system and to differentiate and elevate the self so it can be an effective leader in the system.   Parts:  Separate, independently operating personalities within us, each with own unique prominent needs, roles in our lives, emotions, body sensations, guiding beliefs and assumptions, typical thoughts, intentions, desires, attitudes, impulses, interpersonal style, and world view.  Each part also has an image of God and also its own approach to sexuality.  Robert Falconer calls them insiders.  Robert Fox and Alessio Rizzo  have done the most work with IFS to work with obsessions and compulsions.    Sources IFS and Hope with OCD with Alessio Rizzo and Robert Fox -- Episode 102 of Tammy Sollenberger's podcast The One Inside -- September 17, 2021  Podcast IFS Talks:  Hosts Aníbal Henriques & Tisha Shull  A Talk with Robert Fox on OCD-types -- Robert Fox   February 20, 2021   Robert Fox, IFS therapist with OCD  Ben Blum: Inside the Revolutionary Treatment That Could Change Psychotherapy Forever  elemental.medium.com July 21, 2020 https://elemental.medium.com/inside-the-revolutionary-treatment-that-could-change-psychotherapy-forever-8be035d54770   Robert Fox, a therapist in Woburn, Massachusetts, also wishes more people knew about IFS. Diagnosed with obsessive-compulsive disorder at age 21 after a lifetime of unusual compulsions, he spent 23 years receiving the standard care: cognitive behavioral therapy (CBT) and exposure response prevention (ERP). Neither had much effect, especially ERP, which involved repeatedly exposing himself to things he was anxious about in the hopes of gradually habituating to them. “When you think about it, it's a very painful method of therapy,” he says. Fox discovered IFS in 2008. Before, he had always been encouraged to think of his compulsions as meaningless pathologies. Now, for the first time, they began making sense to him as the behavior of protectors who were trying to manage the underlying shame and fear of exiles. After two particularly powerful unburdenings, his symptoms abated by 95% and stayed that way. “[OCD] used to be almost like kryptonite around my neck when I would have serious flare-ups,” he says. “I feel a lot of freedom and peace and I really owe it to Dick [Schwartz] and the model.” Concerns about ERP  ERP doesn't bring the curiosity -- why did this happen?   Obsessions are not irrational and Compulsions are not meaningless Alessio Rizzo Conventional OCD diagnosis and treatment ERP and medication -- nothing points back to underlying causes. Alessio Rizzo:  Evidence-based approaches for OCD that work -- they work by drawing a manager part into a role of suppressing OCD symptoms  Needing to continue ERP.   Causes:  Fox Repressed anger. -- not a parent who could witness   Intense shame that is dissociated Shame from childhood -- exiled  Shame from the OCD itself.  -- sarcasm from others, especially from his older brother.   “OCD is like having a bully stuck inside your head and nobody else can see it.” — Krissy McDermott   We hide what we are ashamed of -- not easy to treat.   Fox on his treatment:  Right. I didn't see it myself until one day I was out for a walk with my dog Gizmo around my block, walking around the block with him and I had been to all these lectures about shame and I was walking one day and all of a sudden it was like, it just came to me “Holy, Holy, Holy shit. I carry that shame.” And it was like a dark cloud that was overhead and just kind of followed me wherever I went. And it was actually not an awful thing to realize. That's what had been basically walking around on my back for so long. It was this deep shame. In agreement with how central I think shame is to OCD Obsessions and compulsions develop gradually and experiment with different ways of drawing attention away from the intensity of underlying experience.  All happens in silence in the inner world.   An obsession or compulsion distracts us from the pain of an exile.  If I'm worrying about the gas in the lawnmower overflowing and blowing up the house -- takes me away from the shame of feeling inadequate at work.   Needs to be powerful enough to hijack my mind So many layers of protectors  -- takes time Alessio Rizzo Post dated March 3, 2021 entitled "IFS and OCD -- A Comparison Between CBT and IFS for OCD.  https://www.therapywithalessio.com/articles/ifs-and-ocd-how-does-the-ifs-method-work-for-ocd In IFS, we use the language of parts to describe how we function. As a consequence, the OCD is considered a part of the person. This means that, even if the OCD seems quite a strong presence in the client's life, there is much more to a person than OCD.  At this stage CBT and IFS might look similar because CBT also encourages clients to label the anxieties and the intrusive thoughts that form the OCD and not engage with them.  The main difference between CBT and IFS is in how we relate to the OCD part.  One of the foundational elements of IFS is that all parts are welcome, and, therefore, the OCD part is not dismissed or ignored, but it is respected. Respect does not mean that the client will believe the content of intrusive thoughts or that they will follow up on whatever behaviour the OCD wants. IFS gives us a way to make sure that there is enough safety and calm before offering respect to the OCD part. This might take a different amount of attempts depending on the severity of the OCD, and on the strength of the relationship between therapist and client.  Healing OCD with IFS  The main difference between CBT and IFS is in the definition of “cure” of OCD.  CBT therapy has the ultimate goal of empowering the client to overcome OCD thoughts and anxieties by never engaging with them or by using exposure therapy to demonstrate that the OCD fears and obsessions have got no evidence to exist.  IFS believes that healing is the result of the re-organisation of parts so that extreme behaviour is substituted by more functional ways of thinking and acting, and, above all, IFS aims at healing the traumatic events that have led to the development of OCD symptoms.    The result of healing the trauma that fuels OCD is a spontaneous decrease of OCD anxieties and intrusive thoughts and, in my opinion, this form of healing is preferable to the one described by CBT. Using IFS language, the CBT approach aims at creating a new part in the system that is tasked with managing the OCD, while there is no attention paid to discovery and healing of the trauma that is fueling the OCD.Choosing the method that best suits you There is no way of saying what method works best for a person.  Therapy outcomes depend on many factors and not only on the method used. Sometimes the quality of the therapeutic relationship is the biggest healing factor, and it is ultimately up to the client to find the best combination of therapist and method that can best suit them. Colleen West, LMFT LMFT  December 20 post on her website colleenwest.com  Treating OCD with Internal Family Systems Parts Work Just a word about treating OCD with IFS versus Exposure and Response Prevention (ERP). Treating obsessive and compulsive parts with IFS is diametrically opposed to treating it in the Exposure and Response Prevention, the most commonly recommended approach. IFS treats OCD parts as what they are--managers and fire fighters, they have jobs to do. If you can help the exiles underneath these protectors, there will be less need for the OCD behaviors. (This might be complicated if there are still constant stressors in the client's life, for which they need the protection.)   IFS does work, and I have successfully treated people with full blown OCD who now have about 5% of their original symptoms only during moments of high stress, and they do not consider themselves OCD anymore. These clients have been helped by taking SSRIs as well, which I will say more about below.ERP works to suppress those same protectors that IFS seeks to understand/care for. It does "work", as people get a strategy for the thoughts that are driving them nuts, but the folks I know who have gone through this treatment find they have to do their 'homework' forever or the OCD comes back, and they always feel it threatening. In short, it is stressful, and the fight is never over.For anyone doing ERP, they have to commit fully to that approach, the homework is hours a day, and one cannot be halfhearted about it or it won't work. The good thing about ERP is that it gives people some control, which they strongly desire, because they feel so powerless. Next episode Episode 87, will come out on December 6, 2022 Scrupulosity --  I have such a different take -- Scrupulosity is what happens with perfectionism and OCD get religion.   Spiritual and Psychological elements.   In the last episode we really got into understanding perfectionism.  In this episode, we worked on really getting to know about obsessions and compulsions.  Next episode, we get much more into scrupulosity.  My own battle with scrupulosity.   Remember, you as a listener can call me on my cell any Tuesday or Thursday from 4:30 PM to 5:30 PM.  I've set that time aside for you.  317.567.9594.  (repeat) or email me at crisis@soulsandhearts.com.  Resilient Catholics Community.  Talked a lot about it in episode 84, two episodes ago.  We now have 106 on the waiting list.  Reopening the community on December 1 for those on the waiting list first.  Can learn a lot more about the RCC and you can sign up at soulsandhearts.com/rcc.  We have had heavy demand.  We may have to limit how many we bring in.  I am working to clear time in my calendar to review the Initial Measures Kits and help new members through the onboarding process -- all the individual attention takes time.  I'm also hiring more staff to help.   Pray for me.  Humility.  Childlike trust   Invocations        

The chromogen siblings talk with Dr. Diego Castrillon of the University of Texas Southwestern Medical Center at Dallas about precancerous lesions in the endometrium, and IHC biomarkers to identify these lesions described in his group's recent publication in the American Journal of Surgical Pathology: https://journals.lww.com/ajsp/Abstract/9000/Reliable_Identification_of_Endometrial_Precancers.97125.aspx And hear about his interests outside of pathology, including his Spotify playlist of 80's New Wave music: https://open.spotify.com/playlist/7HrLBxRVOY4nk2X7IRCEYj?si=1000a63760574749 Featured public domain music: Alpha Hydrae, Won't see it comin'.    

The 340 drug pricing program was first established in 1992 and allows participating hospitals to manufacture discounts on drugs used in an outpatient setting. In years since, federal agencies have clarified savings from the program should be directed at improving care for underserved patients. One method of doing this is providing uncompensated care, or charity care and other unreimbursed care, to uninsured or underinsured patients. In the years since its inception, debates around the program have centered on whether savings actually benefit the underserved as intended. To determine whether hospital provision of uncompensated care increased following hospital entry into the 340B program, Sunita M. Desai, PhD, and J. Michael McWilliams, MD, PhD, analyzed secondary data on 340B participation and uncompensated care provision from general acute care and critical access hospitals between 2003 and 2015. Their study “340B Drug Pricing Program and Hospital Provision of Uncompensated Care,” was published in the October issue of The American Journal of Managed Care and is now available online. On this episode of Managed Care Cast, Desai discusses the study's findings, what they mean, and next steps for the 340B program.

This talk was delivered on September 21, 2021 at Saint Louis University. For information on upcoming events, please visit our website at www.thomisticinstitute.org. About the speaker: V. Bradley Lewis is associate professor in the School of Philosophy in the Catholic University of America. He specializes in political and legal philosophy, especially that of the classical Greeks and in the Thomistic tradition, and is currently working on a book on the idea of the common good. In addition to these things he has served as a consultant on ethics to the federal government, testified before a congressional subcommittee about immigration, and currently serves as associate editor of the American Journal of Jurisprudence.

Dr. Janet Patterson, Research Speech-Language Pathologist at the VA Northern California Healthcare System, speaks with Rob Cavanaugh of the University of Pittsburgh, about dosage in delivering aphasia treatments, and about the difference between dosage in research settings and dosage in clinical settings.       In today's episode you will hear about: The concept of voltage drop, its definition, and how it applies to aphasia rehabilitation, Opportunity cost and factors that affect the ability to deliver a treatment protocol with fidelity to the research evidence, and Mindful clinical decision-making to assure delivery of the best and most efficient treatment possible within existing clinical parameters.     Janet Patterson: Welcome to this edition of Aphasia Access Podversations, a series of conversations about community aphasia programs that follow the LPAA model. My name is Janet Patterson, and I am a Research Speech-Language Pathologist at the VA Northern California Healthcare System in Martinez, California. Today I am delighted to be speaking with my friend and an excellent researcher, Rob Cavanaugh, from the University of Pittsburgh. Rob and I have had several conversations about aspects of aphasia rehabilitation, beginning when he was a Student Fellow in the Academy of Neurologic Communication Disorders and Sciences. Our conversation today centers on a topic we both have been thinking about, dosage and aphasia treatment.    As Rob and I start this podcast, I want to give you a quick reminder that this year we are sharing episodes that highlight at least one of the gap areas in aphasia care identified in the Aphasia Access White Paper, authored by Dr. Nina Simmons-Mackie. For more information on this White Paper, check out Podversations Episode 62 with Dr. Liz Hoover, as she describes these 10 gap areas, or go to the Aphasia Access website.    This episode with Rob Cavanaugh focuses on gap area 4 - Insufficient intensity of aphasia intervention across the continuum of care. Treatment intensity is not a singular concept, but rather has several components to it, including decisions about dosage. Much has been written about intensity in aphasia rehabilitation, however, as yet there is no clear and convincing argument about what, exactly, is the best intensity for delivering an aphasia treatment to an individual with aphasia. I hope our conversation today can begin to shed some light on this topic.    Rob Cavanaugh is a third year Ph.D. candidate in the Department of Communication Sciences and Disorders at the University of Pittsburgh. Before moving to Pittsburgh, he worked as a clinical speech-language pathologist in Charlotte, North Carolina, in outpatient and inpatient rehabilitation settings. His research interests focus on identifying implementation gaps in aphasia rehabilitation, improving patient access to therapy services through technology, improving treatment outcomes, and advancing statistical methods used in aphasia research. Rob received his master's degree in Speech and Hearing Sciences from the University of North Carolina at Chapel Hill. He is currently doing interesting work at Pitt, and I look forward to our conversations, Rob, today and in the future. Welcome, Rob to Aphasia Access Podversations.   Rob Cavanaugh: Thanks Janet, it's great to be here, and I'm really excited to talk about dosage and aphasia treatment.    Janet: Great! I think the only thing I'm going to have to worry about Rob, is keeping us contained because we could probably talk for days on this subject, and our listeners would get tired of hearing us.    Rob: That is definitely true.   Janet: Today, as I said, Rob, I'd like to talk to you about dosage and aphasia treatment.  You and your colleagues recently published a paper in AJSLP that compared dosage in research papers and dosage in clinical practice. The team did great work, and I think it's an impressive paper. As we try to create an effective and efficient treatment program for our clients with aphasia, one of the elements we consider is dosage of the treatment we select. Simply defined, dosage can be thought of as the amount of treatment provided at one time, how often that treatment is provided, and the length of time the treatment lasts. We sometimes hear the terms session length, frequency and duration. Would you agree with that definition, Rob?    Rob: Thanks, Janet. I'm really excited about this work, and I want to take a minute to acknowledge the research team on this project before we really get into dosage because it really was a big team effort. Christina Kravetz is a clinical speech language pathologist here in Pittsburgh, Yina Quique, who is now a postdoctoral fellow at Northwestern, Lily Jarold who is now working on her clinical master's degree at the University of South Carolina, and Brandon Nguy who I think you had on an Aphasia Access Podversations a couple weeks ago to talk about his presentation and some of his work analyzing demographic trends in these data. I should also acknowledge our funding sources, which include the School of Health and Rehabilitation Sciences here at Pitt, and the National Center for Advancing Translational Sciences.   I think that's a good definition to get us started talking about dosage. We know that the amount of treatment is most often reported in terms of time, how many minutes in a treatment session, or how often sessions occur, or how many total sessions are there. But perhaps I can add one more dimension to our discussion about dosage, which is that it's not just how much treatment occurs in terms of time, but also what the treatment is made up of, what are the activities that we're doing within the treatment? How many times do we do them in a session? Or how many times do we do the activities per hour of treatment? As much as I'd like to think of dosage and aphasia treatment as an analogy to taking an antibiotic, such as when you have strep throat or some infection, you take 250 milligrams twice a week for two weeks. Dosage in aphasia rehabilitation is probably not that straightforward, right? Our treatments are complex and holistic and answering questions like how much of something gets really tricky really quickly.   Janet: I can imagine, and you know, when we first started talking about dosage several years ago, people used exactly that analogy. It's hard to appreciate that analogy because therapy is not this little unit of a pill or a tablet, it's a complex interaction between people. When we think about dosage, sometimes as clinicians we can decide dosage for our treatment, but sometimes it may be imposed upon us by an external source, such as our workplace or healthcare funder. And while it's important that we take guidance from the literature to determine dosage, I am not sure that that always happens. Rob, you are both an aphasia clinician and an aphasia researcher, how did you get interested in thinking about dosage as it relates to aphasia treatment?   Rob: I am a clinician by training, and that's really the viewpoint with which I started. Like you mentioned, I worked primarily in outpatient rehab settings, where most of the individuals who came into our clinic were home from the hospital, and they were working to recover from a recent stroke or traumatic brain injury or brain cancer, or some similar life-changing event. I think you're right, that practical dosage in a clinical setting like this is some combination of the clinical decision-making that we do as expert speech-language pathologists, and then all of these real-world constraints around us such as insurance, clinician availability, or the client's ability get to the clinic on a regular basis. I was fortunate to have excellent mentors and I'm going to acknowledge them. MaryBeth Kerstein, and Lisa Hunt and Missy Davis at Carolinas Rehab, were expert clinicians for me as a novice coming in. They really knew how to navigate their clinic, what they wanted to do from a clinical standpoint, and then what they were looking at in the insurance paperwork, and what to do when the patient said, “Well, I can only get here once a week”. My interest in dosage really comes from the perspective of, I've got this treatment, and it requires a lot of dosage and I want to fit it into a very narrow window of time. As a clinician you're grateful to have twice weekly sessions for six or eight weeks, and then you read a treatment study and it said that it provided treatment for 20 or 30, or even 60 hours. That's really hard to do in practice. So you know, we want to be confident that if I'm going to go with a treatment, if I'm going to choose it, I'm not wasting someone's time because I don't have enough of it for the treatment to be effective. And I'm also not wasting time by doing too much of it.   Janet: That's so important to think about Rob. You also mentioned something else, patient characteristics. Can an individual get to the clinic as much as they need to? Are they motivated to participate in this treatment? Those pieces must factor into your decision as well.   Rob: Sure, and you know, I think about some of our really high intensity treatments. Here at the Pittsburgh VA, we recently completed an ongoing study of semantic feature analysis which provides 60 hours of SFA. That's a lot of time to be doing a single treatment and so certainly motivation is a really important piece that we have to fit into the conversation about dosage.   Janet: As an aside, I'm sure you know, we're doing some investigation into motivation and what it means and how it works and how we can best use it in treatment, but it certainly is part of the decisions that you make when you when you select a treatment. I am glad that you're thinking about these pieces, because they're all focused on getting the most effective, efficient treatment that we can for a patient, and you're right, not wasting time or resources.    In your recent publication, Rob, you approach the topic of treatment dosage by identifying the gap between the dosage reported in research studies and the dosage used in clinical practice. By the way, the link to that paper is at the end of these Show Notes. It appeared in AJSLP so our listeners can access that paper and read your work for themselves. In that paper, you and your colleagues use the term voltage drop to describe this difference between research and clinical application. Will you explain the term voltage drop to us and describe how you see its relevance to aphasia treatment?   Rob: Sure, so voltage drop is this idea that when you take an intervention that worked in a controlled research setting, and we saw some good results, and then you implemented that scale in the real world. You give it to clinicians and while they might use it in their clinical practice, there can be a reduction in how effective that intervention is, right? The real world is messy, it's often hard to implement the research protocol with high fidelity, or there are good reasons to alter the protocol for individual situations, but we don't know how those alterations might affect the outcomes – this is voltage drop. This idea has been around in the implementation science literature for quite some time. I actually first heard this term on another podcast called Freakonomics, which is very different from what we're talking about today. It was in the context of how do you scale up social interventions like universal pre-kindergarten, and the challenges that come with finding something that works in one situation and trying to bring it to the whole country? And I thought, “Oh, this is exactly what I've been worrying about in our clinical practice world.” How do we take something that works in a small, controlled setting and make it work in larger settings throughout the country, in clinical settings? The term voltage drop seemed like a great way to motivate the conversation in our paper about dosage. If we can't implement the same dosage in clinical practice that we see in research, we could see a voltage drop in our treatment effectiveness for people with aphasia.   Janet: Right. I like that that term. Rob, as I was listening to you talk about this term voltage drop, it reminded me of phases in research, where you start out by demonstrating that the technique works in a research environment, and then moving it to a clinical environment to see exactly how it does work. I also thought about how we as clinicians need to be mindful that when we implement a treatment, if we can't meet the conditions in the research treatment, if we aren't taking into consideration this potential voltage drop as we implement treatment, we may not be doing the best job for patients. Does that make sense to you?   Rob: Yeah, I think it's a really hard balance as a clinician. You might have treatment which you feel like would be particularly helpful for someone. But the literature says this treatment has been implemented for 30 or 40 or 60 hours in the research lab and you're looking at the paperwork for this person which says that they have 20 visits, and you're wondering how you're going to make that work? Should you use a different treatment that doesn't seem to have as much dosage in the literature, or should you try to fit that treatment into what you have with that person? I think those are questions we don't have good answers to yet and clinicians struggle with all the time.   Janet: Which leads me to my next question for you. As clinicians recognizing the situation, how should we use this concept of voltage drop as we determine an individual's candidacy for a particular aphasia treatment technique, and determine treatment dosage in our own clinical settings? That's a loaded question, by the way!   Rob: That's a great question. I think this area of research has a long way to go before we really have any definitive answers. I think this idea of voltage drop right now perhaps is just something that can play a role in our clinical decision-making process when we go about implementing the aphasia treatment literature with our clients on a daily basis. For example, we often deviate from the evidence base in ways we think will improve our treatment outcomes, right? We personalize our treatment targets so that they're motivating and relevant for our client's goals. We might integrate multiple treatment approaches together or provide two complimentary approaches at the same time to address multiple goals. These adjustments reduce how closely our practice matches the evidence base for a treatment, but hopefully they improve the outcomes. On the other hand, we often have to make these compromises that we're talking about and deviate from published protocols because of practical constraints in ways that could reduce effectiveness. Not being able to even approximate a published treatment's dosage because of insurance or clinician availability or transportation has the potential to reduce treatment effectiveness. I think these factors probably should play a role in whether or not we choose a particular treatment approach. Maybe we use the difference in the published dosage versus what face to face time we know we're going to have to make a determination about how much home practice we suggest the person do. Or maybe we say there's just too big of a difference in what I know I can do with this person, and I need to think about other treatment options.    I'd also like to add maybe an important caveat here, which is that I don't know of any aphasia treatment, and I would love for somebody to email me and tell me what study I haven't read yet, but I don't know of any literature that has established an optimal dosage for even an average person with aphasia, and certainly none that say if you see a person with aphasia with a certain profile you need to provide at least X minutes of this treatment for it to be effective. Most of our evidence base tells us about the average effect size across participants for a single dosage. And it's really hard to extrapolate this information to make decisions about an individual person with aphasia.   Janet: I think you're absolutely right, Rob. I have not read a paper about optimal dosage for any kind of a treatment either. And one of the things that I was thinking about as you were talking is that I want to assure clinicians that we're in a messy world here trying to figure out dosage and intensity. I want clinicians to be able to continue to walk through their clinical decision-making without trying to figure out how all these pieces fit together in treatment. The words that came to my mind, as you were talking about strategies that clinicians might use as they decide whether they want to use a particular treatment or not, is mindful clinical decision-making. If you choose a treatment knowing that you cannot deliver the number of sessions that are listed in the research literature, then what are you balancing or what are you giving up in order to implement that treatment? It's mindful decision-making, as you apply a treatment. Does that make any kind of sense to you in terms of looking at dosage?   Rob: Yep. I think that makes a lot of sense. It brings up this idea to me of opportunity cost, right? Imagine a decision tree of things or directions you could go as a clinician, and every branch of that tree that you could take means that you don't get to take the other branch. This could be a paralyzing decision-making process if you try to incorporate too much, but maybe dosage is one of those key elements that you say, “I'm going to prioritize, making sure dosage is at least approximate. Maybe I can't get 30 hours, but I can get close, so I feel confident that's not going to limit my treatment's effectiveness.”   Janet: I think it is important to pay attention to dosage. Don't just proceed with random assumptions about dosage but pay attention to it as you're deciding to implement a treatment.   We've talked a lot about the background and the importance of dosage and mindful clinical decision-making from a clinical perspective. I hope our readers know by this time that that the comments you're making are based in science, so I want to talk for a little bit about your paper in AJSLP, if we can. I mentioned already that the reference is listed below in Show Notes that accompany this podcast, and our listeners can also find it by searching the ASHA publications website, and also your University of Pittsburgh website, on the Communication Sciences and Disorders page and the Language and Cognition Lab page. You have two methods in this paper, analyzing hospital billing data, and also conducting a scoping review of the literature. Without delving too far into the details, will you tell us about these methods and how they allowed you to then examine the research-practice dosage gap?9   Rob:  Sure, I'm happy to summarize. I learned, you know, halfway through this project that I bit off quite a quite a bit of research. It was a pretty large project for me as a doctoral student! Our driving research purpose for this study was to estimate how well the typical dosage that was provided in clinical practice approximated what was provided in the research literature. There are two elements here, what's typical in clinical practice and what's typical in research. In particular, I was interested in outpatient clinical practice, because this is often the last stop in our rehabilitation medical model for people with aphasia, and it's where my clinical experiences had mostly been. To estimate dosage in clinical practice, we looked at billing data from a large regional provider in western Pennsylvania. Every time an SLP sees a client they have to bill a specific code to the insurance company for that visit. These codes are attached the electronic medical record and we were able to use resources in Pitt's Department of Bioinformatics to extract these billing codes. We counted them all up for people with a diagnosis of stroke and aphasia who were seen by a speech-language pathologist. We looked to see how many were there? How often do they occur? Over how many weeks did they occur? We don't, of course, know the extent to which these specific providers match the rest of the US or certainly not international clinics, but we felt like this was a good start, given the lack of information in the literature.    Then on the research side, we wanted to estimate the typical dosage for studies that had been published recently. If we looked back 30 years, we'd probably still be reading research articles, so we used a scoping review format because our research question was really focused broadly on dosage rather than the specific study designs, the quality of the studies, or the outcomes, we just wanted an estimate of the dose. I have to give a shout out here to Rose Turner, the librarian on our team at Pitt, who guided this aspect of the study, I strongly recommend anyone use a librarian for reviews like this, we could not have done it without her. We started with over 4500 study records which matched our search terms and we whittled them down to 300 articles.   Janet: That's a lot of work, Rob.    Rob: It was definitely a lot and I will say we have a team, right? This was not me, this was a team effort. We ended up with about 300 articles, which essentially describe the aphasia treatment literature over the past 10 years or so. These were not studies that were provided in the hospital, these are mostly community-based treatment studies. They didn't have any extras, like the people receiving treatment weren't also receiving a specific medication or some kind of brain stimulation, it was just behavioral treatment. We pulled the dosage out of these studies and then we compared them to what we found from our billing data.   Janet: I read the paper a few times, and I'm not unfamiliar with a scoping review or with gathering data from clinical records. I found myself as I was reading that paper thinking this must have taken you years and years and years, which of course, I know it didn't, but your team really has, I think, produced a great paper that is going to be a good foundation for us to think about dosage.   That's a wonderful summary of the methods you used and anybody who reads your paper will appreciate the summary that you just gave. What messages did you glean from the data that you collected? I am thinking of the specific research conclusions, and also messages that maybe might help us as clinicians?   Rob: Sure, so I don't think it's a surprise to any clinician out there that there was a meaningful gap in dosage between the research studies we looked at and the billing data. This was particularly true for the number of treatment hours. Research studies provided on average about 12 more hours of treatment than we found in the clinical billing data. That's per episode of care. Think about a person who comes into the clinic, has an evaluation, receives a number of treatment sessions, and is discharged. On average, that episode of care has about 12 hours less than your typical research study. This largely confirmed our hypothesis going in that we would see a gap here. Interestingly, clinical practice seemed to provide treatment over a longer period of time. The total number of weeks was longer than what was typically done in research studies. You might take a conclusion away that in at least outpatient clinical practice, treatment might be a little bit more distributed over time and less intensive than treatment provided in our research literature.    I think it's important to highlight that this is a really rough comparison of dosage, right? Billing data are not really specific to the clinician patient interaction. It's just the code that the clinician punches into their software when they're done. We've glanced over some important aspects here that we just weren't able to look at. For example, dose form, or how many times each element of a treatment was completed, is not something our study was able to look at. These are some of the most important aspects of treatment, and what I try to do as a clinician, such as goal setting, and counseling and education, the time working on our communication goals outside of impairment focused tasks. Those elements aren't often part of treatment studies, but they're absolutely part of clinical practice, and they take a lot of time. That's an unaccounted-for difference that could mean that we've underestimated this gap and dosage. On the other hand, clinicians often assign home practice; we work on something in the face-to-face session and then I say, great, you've done an amazing job, I want you to practice this 20 minutes a day until the next time you come in, something like that. We didn't have a way of tracking home practice in our study. Perhaps home practice is an effective way of making up this dosage gap. But we're not able to understand what role it might play based on these data.   Janet: I think you're right about that, and it makes a whole lot of sense. This is a start in our direction of trying to really understand more carefully what dosage means. Does it mean this large thing? Does it mean very specifically, how many times are we delivering the active ingredient in a specific therapy? There's so much more that we need to know, and I think you have figured out by now that I think dosage matters, I think it matters a lot. I think it matters a lot more than we've ever really paid attention to. I know also, and you've certainly described this, every day in clinical practice we make decisions about an individual's candidacy for rehabilitation, including that what we think as clinicians is the best match between a treatment, a patient's personal and aphasia characteristics that they bring to the rehabilitation enterprise, and the likelihood of an optimal outcome. If we get it wrong, because of a mismatch in dosage, we may not successfully translate research into practice, and we may not make that much of a difference in our patient's life, or at least we may not make as much difference as we hope to. In the case of a potential mismatch, how do you see that affecting our clients, their families, and our healthcare system, because we do have to think about all of these pieces of the aphasia rehabilitation enterprise.     Rob: I think you're right you know, this is just a start. When I started my doctoral program at Pitt Dr. Evans and I were working on grants, and we would always write a statement like, treatment services are limited, and then I'd go try to find the citation for that line, and it's hard to find. Dr. Simmons-Mackie's White Paper is fantastic and provides a little bit of evidence to that regard but there aren't a lot of numbers. So, I think you're right that this is not the end of the story, I'm hopeful this study is a start. I think if you buy into this idea that too much of a gap in dosage could result in voltage drop in our treatment effectiveness and poor outcomes, I'm concerned that our ability to help people with aphasia and their families recover and adjust and thrive with their new reality is diminished in real world clinical practice. That's a big concern for me, and that's the reason that I am a speech-language pathologist and working with people with aphasia. I think that's something we need to understand better as a field. I'm also aware that when somebody decides to come to treatment, they're dedicating time and energy to themselves and trusting us as clinicians that we know how to best use their time and energy. The time spent coming into the clinic or doing home practice could just as easily be spent with family or friends or in other fulfilling activities, so I want to be respectful of their time.    With regard to how this could affect our health care system, I don't know that I have a great answer for you. Sometimes I wonder whether the current medical model is really a good fit for chronic conditions like aphasia. The gap in dosage might just be one manifestation of the challenges that clients and families and clinicians face every day, in figuring out how to make affordable and effective and motivating treatment options available for people long term. That's got to be a priority for us moving forward, because I'm not sure that our current model really fills that need.   Janet: Rob, I agree with you on that, and I'm thrilled that you and your colleagues are making this initial attempt to try to figure out how we can best match the treatment and the clients in terms of dosage, to achieve the optimal outcome that we possibly can.   You know, Rob, that I think that this conversation is fascinating, and we could talk all day. My belief is you and your team have just scratched the surface about treatment delivery information that we must be mindful of, in both our research and our clinical practice. A lot today that we've talked about really relates to clinical practice, but I imagine there are just as many thoughts or concerns or cares that we need to take when engaging in a research protocol to evaluate the success of a treatment.    Rob, as we draw this interview to a close, what pearls of wisdom or lessons learned do you have for our listeners, both researchers and clinicians, about dosage and aphasia rehabilitation, bridging the research-practice dosage gap, and reducing the voltage drop as we implement aphasia treatment.   Rob: Yeah, it's a tall order.   I don't think there's a quick fix, certainly, but I I'm going to summarize and expand on some of our recommendations from the paper. One thing that's important, I think, as we move forward is that, as researchers, we need to be really thoughtful about our selection of dose. As you mentioned, with regard to the stage of research, maybe our selection of dosage in early-stage research reflects our underlying research questions and issues of statistical power and funding constraints. For later stage research that's starting to think about clinical outcomes, we need to provide a clear justification for deviating from a dosage that's not attainable in clinical settings. In the same vein, I think as researchers we can do more to provide easily accessible and hopefully free materials to clinicians to facilitate home practice and to augment the limited face-to-face time that clinicians might have with their clients. Software and app development are getting there, and I think they're improving how easy it is to do home practice. To me a treatment study that you want to be out in the real world is only going to be successfully done if you really give clinicians easy access to tools where they can implement it. I know, just like many clinicians know, their time is really limited particularly between seeing patients, and so I don't want to make them do a whole lot of work to implement my intervention.    The second recommendation from our paper is that we need more research on the role of dose. We've talked about one challenge in this line of work, which is that dosage requirements are probably a function of an individual's language profile, almost certainly a function of their individual language profile, and their individual circumstances. If you compare one dose to another in some group trial, it only gives you so much information about what dose is best for a given individual. I think this is a problem our field is going to have to solve. Our lab is working on one solution that we're really excited about, which is to base treatment dosage not on the number of minutes, or how often you see someone, but on their real time performance on individual treatment items, like their ability to produce a specific sentence in script training or name a word, if you give them a picture. Our lab is not really thinking about dosage in terms of treatment time, right now we're thinking about dosage at the item level individually for each person. We're finding some strong preliminary evidence that complex algorithms can tailor item level dosage to real time performance and can make treatment potentially more effective and more efficient in terms of how much we can do in a period of time. But we have a lot more work to do, establishing this in a larger sample size and making sure that it translates well to clinical practice.    This brings me to the last recommendation, which is we need more research that looks at how can we implement our research in clinical practice. I believe there was a paper that came out in AJSLP recently (Roberts et al., 2021) which found that 1% of studies published in the Asha journals were implementation focused. I think that number is too low. We need more implementation-focused research that has contributions from all stakeholders, people with aphasia and their families and clinicians and researchers. It's going to take a team working together to ensure that we can translate our evidence base to clinical practice without voltage drop. I think that's where I would love to see our field headed.    Janet: Rob, I love the recommendations from your paper and the way that you just described them. It's exciting to be in this time in our field, where people like yourself and your team are thinking about the idea that we've got some great therapies, now how do we deliver them in ways that are sensitive to the needs of the clinician and the needs of the client and delivered in a mindful way of clinical decision-making.    Thank you for all of those recommendations and for your work. You're going to do more, right?   Rob: Thank you for having me. Yes, there will be more.   Janet: This is Janet Patterson, and I'm speaking from the VA in Northern California, and along with Aphasia Access, I would like to thank my guest, Rob Cavanaugh, for sharing his knowledge and experiences with us as he and his colleagues investigate treatment parameters, including dosage, in aphasia rehabilitation. We look forward to seeing many additional articles on this topic from Rob and his colleagues.    On behalf of Aphasia Access, we thank you for listening to this episode of The Aphasia Access Conversations Podcast. For more information on Aphasia Access, and to access our growing library of materials, please go to www.aphasiaaccess.org. If you have an idea for a future podcast topic, please email us at info@aphasiaaccess.org. Thank you again for your ongoing support of Aphasia Access.       References and links from this episode:   University of Pittsburgh Department of Communication Sciences and Disorders Language Rehabilitation and Cognition Lab https://lrcl.pitt.edu  @pittlrcl    University of Pittsburgh  Department of Communication Sciences and Disorders @PittCSD      Cavanaugh, R., Kravetz, C., Jarold, L., Quique, Y., Turner, R., & Evans, W. S. (2021). Is There a Research–Practice Dosage Gap in Aphasia Rehabilitation? American Journal of Speech-Language Pathology. https://doi.org/10.1044/2021_AJSLP-20-00257   Roberts, M. Y., Sone, B. J., Zanzinger, K. E., Bloem, M. E., Kulba, K., Schaff, A., Davis, K. C., Reisfeld, N., & Goldstein, H. (2020). Trends in clinical practice research in ASHA journals: 2008–2018. American Journal of Speech-Language Pathology, 29(3), 1629–1639. https://doi.org/10.1044/2020_AJSLP-19-00011

In this podcast, The American Journal of Managed Care's associate editorial director, Mary Caffrey, speaks with Michelle Afkhami, MD, from City of Hope, about best practices for oncology organizations to leverage molecular/genomic testing, the importance of identifying RET-positive patients early so they can receive targeted treatment, and more.

My guest today is Nicholas Sambanis, Presidential Distinguished Professor of Political Science and Director of the Identity & Conflict Lab at the University of Pennsylvania. He writes on conflict processes with a focus on civil wars and other forms of inter-group conflict. Published work in these research areas has appeared in several journals, including the American Political Science Review, International Organization, American Journal of Political Science, World Politics, Science, and Proceedings of the National Academy of Sciences. With Michael Doyle, he co-authored Making War and Building Peace (Princeton University Press, 2006), the first book to analyze the impact of United Nations peace operations in post-conflict transitions; with Paul Collier and other colleagues, he co-authored Breaking the Conflict Trap: Civil War and Development Policy, one of the first quantitative studies of the causes of civil war around the world. In a two-volume book project, Understanding Civil War: Evidence and Analysis, he developed a nested, mixed-methods research design for the analysis of causes of civil war onset in a systematic comparative analysis of over 20 cases of civil war. Sambanis has taught at Yale and Penn.  At Penn, he founded the Identity & Conflict Lab (PIC Lab), an inter-disciplinary lab working on a broad range of topics related to inter-group conflict. PIC Lab covers topics ranging from violent to non-violent forms of conflict in different regions of the world. Topics of current interest are the effects of external intervention on peace-building after ethnic war; the analysis of violent escalation of separatist movements; conflict between native and immigrant populations; and strategies to mitigate bias and discrimination against minority groups. He studies these questions with a focus on the connection between identity politics and conflict processes drawing on social psychology, behavioral economics, and the comparative politics and international relations literatures in political science.  Ongoing projects include research on the long-term legacies of violence exposure; the sources of ethnic and national identification among minority groups; the effects of integrative institutions in overcoming ethnic conflict; and on strategies to reduce bias and discrimination toward immigrants and refugees. In today's episode, we discuss his latest book which will be published later this year, coauthored with Danny Choi and Mathias Poertner, examining bias and discrimination against immigrants, using Germany as a case study.

Welcome back to Therapy Chat! This week, in a replay episode, host Laura Reagan, LCSW-C shares two past episodes from earlier this year. Laura interviewed infant and child therapy specialist Dr. Janet Courtney, who shares why she uses play therapy and expressive arts in her work with traumatized children and families. In part two she speaks about infant mental health and how she works with traumatized infants and their families. About this episode's guest: Janet A. Courtney, PhD, RPT-S is Founder of FirstPlay® Therapy (an infant play therapy model) and founder of the FirstPlayCafe blog. Dr. Courtney is author of, “Healing Child and Family Trauma through Expressive and Play Therapies: Art, Nature, Storytelling, Body and Mindfulness,” and author and Editor of the groundbreaking books, “Infant Play Therapy: Foundations, Models, Programs and Practice, “ and “Touch in Child Counseling and Play Therapy: An Ethical and Clinical Guide.”  She is a TEDx Speaker, a Registered Play Therapy Supervisor, and past chair of the Ethics and Practice committee for the Association of Play Therapy and past President of the Florida Association for Play Therapy. Since 1997 she was an Adjunct Professor in the School of Social Work at Barry University, Miami Shores, Florida. Her research into practitioner experiences of training in touch and Developmental Play Therapy is published in the American Journal of Art Therapy and the International Journal of Play Therapy.    She offers a certification to practitioners in FirstPlay Therapy® and provides training to professionals in the Ethical and Clinical Competencies of Touch, Expressive Play Therapies, and nature-based Play Therapy. Dr. Courtney has created a unique form of therapeutic storytelling called, FirstPlay Kinesthetic Storytelling® that can be found in her children's book, The Magic Rainbow.  Resources Website: www.FirstPlayTherapy.com and www.FirstPlaycafe.com Thank you to this week's sponsors! Sunset Lake CBD is created on a small farm outside of Burlington, Vermont that is a producer for Ben & Jerry's Ice Cream.  Sunset Lake CBD customers support regenerative agriculture that preserves the health of the land and creates meaningful employment in the community. Farm workers are paid a living wage, and employees own the majority of the company. Therapy Chat listeners, get 20% off your entire order of Sunset Lake CBD products using promo code CHAT at www.sunsetlakecbd.com.  Help us make Trauma Therapist Network the best resource it can be! Send a message about resources you think should be included in the Trauma Therapist Network Site using the form on this page. Looking for a trauma therapist or are you a trauma therapist wanting to join the network? Check it out at: www.traumatherapistnetwork.com! Therapy Chat and Trauma Chat podcasts are also found on the site. Follow Therapy Chat on Instagram Follow Trauma Chat on Instagram Podcast produced by Pete Bailey - https://petebailey.net/audio

Learn about the Space for Art Foundation; how screen time helped kids in lockdown; and mold vs. cleaning product safety.  More from NASA astronaut Nicole Stott: Pick up "Back to Earth: What Life in Space Taught Me About Our Home Planet — and Our Mission to Protect It" https://www.sealpress.com/titles/nicole-stott/back-to-earth/9781541675049/  Website: https://www.npsdiscovery.com/  Follow @Astro_Nicole on Twitter: https://twitter.com/Astro_Nicole   Space for Art Foundation: https://www.spaceforartfoundation.org/ "Screen time" can be a social lifesaver for teens in lockdown — as long as it's the right kind by Cameron Duke Anwar, Y. (2021, September 2). Teenagers aren't as lonely in lockdown if interacting positively online. Berkeley News. https://news.berkeley.edu/2021/09/02/teenagers-arent-as-lonely-in-lockdown-if-interacting-positively-online/  Magis‐Weinberg, L., Gys, C. L., Berger, E. L., Domoff, S. E., & Dahl, R. E. (2021). Positive and Negative Online Experiences and Loneliness in Peruvian Adolescents During the COVID‐19 Lockdown. Journal of Research on Adolescence, 31(3), 717–733. https://doi.org/10.1111/jora.12666  Which is worse, mold or cleaning products? by Ashley Hamer (Listener question from Molly) Basic Facts about Mold and Dampness. (2021). https://www.cdc.gov/mold/faqs.htm  ‌Weinhold, B. (2007). A Spreading Concern: Inhalational Health Effects of Mold. Environmental Health Perspectives, 115(6). https://doi.org/10.1289/ehp.115-a300  ‌Cleaning Supplies and Household Chemicals. (2015). Lung.org; https://www.lung.org/clean-air/at-home/indoor-air-pollutants/cleaning-supplies-household-chem  ‌Alexander, R. (2018, February 22). How Your Housecleaning Products Can Be Bad for Your Lungs. Healthline; Healthline Media. https://www.healthline.com/health-news/how-your-housecleaning-products-can-be-bad-for-your-lungs  Dumas, O., Boggs, K. M., Quinot, C., Varraso, R., Zock, J., Henneberger, P. K., Speizer, F. E., Le Moual, N., & Camargo, C. A. (2019). Occupational exposure to disinfectants and asthma incidence in U.S. nurses: A prospective cohort study. American Journal of Industrial Medicine, 63(1), 44–50. https://doi.org/10.1002/ajim.23067  ‌Svanes, Ø., Bertelsen, R. J., Lygre, S. H. L., Carsin, A. E., Antó, J. M., Forsberg, B., García-García, J. M., Gullón, J. A., Heinrich, J., Holm, M., Kogevinas, M., Urrutia, I., Leynaert, B., Moratalla, J. M., Le Moual, N., Lytras, T., Norbäck, D., Nowak, D., Olivieri, M., & Pin, I. (2018). Cleaning at Home and at Work in Relation to Lung Function Decline and Airway Obstruction. American Journal of Respiratory and Critical Care Medicine, 197(9), 1157–1163. https://doi.org/10.1164/rccm.201706-1311oc  Follow Curiosity Daily on your favorite podcast app to learn something new every day withCody Gough andAshley Hamer. Still curious? Get exclusive science shows, nature documentaries, and more real-life entertainment on discovery+! Go to https://discoveryplus.com/curiosity to start your 7-day free trial. discovery+ is currently only available for US subscribers. See omnystudio.com/listener for privacy information.

"Food Quality in the U.S. - Part 2" - Shortly after we recorded the food quality episode (Episode 45) couple weeks ago, Coach Hidi stumbled on a research article published in the American Journal of Clinical Nutrition, arguing that the root causes of obesity epidemic in U.S. are more related to food quality than how much we eat. Coach Michelle and Coach Hidi sat down this week to dissect the article and expand on the findings of the article. Thank you for listening as always, please don't forget to subscribe to our show on iTunes!

Episode 202 Professor Erin A. Cech, PhD. Dan Sterenchuk and Tommy Estlund are honored to have as our guest, Professor Erin A. Cech, PhD. Erin A. Cech is an Associate Professor in the Department of Sociology and Associate Professor by courtesy in the Department of Mechanical Engineering. Cech joined the University of Michigan in 2016. Before coming to UM, she was a Postdoctoral Fellow at the Clayman Institute for Gender Research at Stanford University and was on faculty at Rice University. She earned her Ph.D. in Sociology in 2011 from the University of California, San Diego and undergraduate degrees in Electrical Engineering and Sociology from Montana State University. Cech's research examines cultural mechanisms of inequality reproduction--specifically, how inequality is reproduced through processes that are not overtly discriminatory or coercive, but rather those that are built into seemingly innocuous cultural beliefs and practices. She investigates this puzzle through three avenues of research. First, she uses quantitative and qualitative approaches to examine inequality in science, technology, engineering and math (STEM) professions--specifically, the recruitment and retention of women, LGBT, and under-represented racial/ethnic minority students and practitioners and the role of professional cultures in this inequality. Second, Cech examines how cultural definitions of “good work” and “good workers” can anchor inequality in the workforce. For example, she examines the role of the “passion principle” in the reproduction of occupational inequalities: how seemingly voluntary and self-expressive career decisions help reproduce processes like occupational sex segregation. Finally, she studies how cultural understandings of the extent and origin of inequality help to uphold unequal social structures. Cech's research is funded by multiple grants from the National Science Foundation. She is a member of the editorial board of the American Journal of Sociology and her research has been cited in The New York Times, Harvard Business Review, Time, The Washington Post, The Guardian, Forbes, Chronicle of Higher Education and the news sections of Science and Nature. Cech's first book, The Trouble with Passion: How Searching for Fulfilment at Work Fosters Inequality (University of California Press) is out Nov 9th, but it is available for preorder at the link below, or through Barnes & Noble, Amazon, etc. https://www.ucpress.edu/book/9780520303232/the-trouble-with-passion Professor Cech's website: https://erinacech.com has information about her other research and links to talks and presentations. Note: Guests create their own bio description for each episode. Tommy and Dan requested and were provided with a review copy of the book in preparation for interviewing Professor Cech. Thank you to the publisher and Professor Cech for providing us with these review copies! The Curiosity Hour Podcast is hosted and produced by Dan Sterenchuk and Tommy Estlund. The Curiosity Hour Podcast is listener supported! The easiest way to donate is via the Venmo app and you can donate to (at symbol) CuriosityHour (Download app here: venmo.com) The Curiosity Hour Podcast is available free on 13 platforms: Apple Podcasts, Google Podcasts, Spotify, Amazon Music, Audible, Soundcloud, TuneIn, iHeartRadio, Stitcher, Podbean, PlayerFM, Castbox, and Pocket Casts. Disclaimers: The Curiosity Hour Podcast may contain content not suitable for all audiences. Listener discretion advised. The views and opinions expressed by the guests on this podcast are solely those of the guest(s). These views and opinions do not necessarily represent those of The Curiosity Hour Podcast. This podcast may contain explicit language. The Public Service Announcement near the end of the episode solely represents the views of Tommy and Dan and not our guests or our listeners.

Missy Stone & Fr. Paul Sullins: In Part One: Missy who is CEO of Reprotection, joins Molly to talk about how her organization is working across the nation to enforce common sense abortion regulations through insisting that medical boards and departments enforce their state abortion laws. In Part Two:  Fr. Paul Sullins who is Sr. Research Associate at The Ruth Institute, discusses the recent correction in the American Journal of Psychiatry to serious errors in a study promoting so-called gender reassignment surgery.

According to American Journal of Pharmaceutical Education, there are over 100 pharmacy schools and less than 30% offer an APPE rotation focused on pharmacogenomics (PGx). We need more pharmacists that are practicing PGx in the field to become preceptors to pharmacy students. My two amazing students on their first virtual PGx rotation with me speak about their experience. Noel Tint, BSPS, and Erica Feith are both PharmD candidates 2022 from Saint Louis College of Pharmacy at the University of Health System and Pharmacy. Link: www.ncbi.nlm.nih.gov/pmc/articles/PMC7779881/ Learn more about your ad choices. Visit megaphone.fm/adchoices

Does your diet allow you to go to happy hour?! What about enjoying your kid's birthday party? Or weekend getaways with friends?   Today we are on a search for science and sustainability in popular diet trends.    A lot of the time, food is more than just fuel, it is a way to connect with friends, family, and yourself! It's important to take these things into consideration when establishing your own relationship with food.  In this episode I am covering a framework that you can use to evaluate whatever diet it is that's trending to decide if it's something you actually want to do. I break down keto, intermittent fasting, detox and cleanses, and the vegan diet to see where they all fall on the sustainability spectrum. I also go over what actually happens to the body when we fall into yoyo dieting and how it may be more harmful to our health than carrying a few extra pounds.   Lots of science and fun nutrition facts coming your way!  For more in intermittent fasting be sure to check out this episode!  References: (1) Golden, N. H., Schneider, M., & Wood, C. (2016). Preventing Obesity and Eating Disorders in Adolescents. Pediatrics, 138(3). doi:10.1542/peds.2016-1649 (2) The National Center on Addiction and Substance Abuse (CASA) at Columbia University. Food for Thought: Substance Abuse and Eating Disorders. The National Center on Addiction and Substance Abuse (CASA) Columbia University; New York: 2003 (3)  Neumark-Sztainer, D. (2005). I'm, Like, SO Fat!. New York: Guilford (4) Golden, N. H., Schneider, M., & Wood, C. (2016). Preventing Obesity and Eating Disorders in Adolescents. Pediatrics, 138(3). doi:10.1542/peds.2016-1649 (5) Grodstein, F., Levine, R., Spencer, T., Colditz, G. A., &Stampfer, M. J. (1996). Three-year follow-up of participants in a commercial weight loss program: Can you keep it off? Archives of Internal Medicine 156(12), 1302. (6) Neumark-Sztainer D., Haines, J., Wall, M., & Eisenberg, M. ( 2007). Why does dieting predict weight gain in adolescents? Findings from project EAT-II: a 5-year longitudinal study. Journal of the American Dietetic Associatio, 107(3), 448-55 (7)Harvey K.L., Holcomb L. E., Kolwicz S. C. (2019). Ketogenic Diets and Exercise Performance. Nutrients. (11)2296. (8) Mattson M.P., Longo V.D., Harvie M. Impact of intermittent fasting on health and disease process. Aging ResRev. 2017 10 (39) 46-58.  (9) Cho et al., 2016 (10) Sainsbury et al., 2018 (11) Rynders CA et al, 2019  (12) Dr. Stacy Sims “Roar: How to Match Food and Fitness to You Female Physiology for Optimum Performance, Great Health, and a Strong, Lean Body For Life.” (2016). (13) Tantamango-Bartley Y, Jaceldo-Siegl K, Fan J, Fraser G. Vegetarian diets and the incidence of cancer in a low-risk population. Cancer Epidemiol Biomarkers Prev. 2013;22(2):286-294. (14) Key TJ, Appleby PN, Crowe FL, Bradbury KE, Schmidt JA, Travis RC. Cancer in British vegetarians: updated analyses of 4998 incident cancers in a cohort of 32,491 meat eaters, 8612 fish eaters, 18,298 vegetarians, and 2246 vegans. Am J Clin Nutr. 2014;100(Supplement 1):378S-385S. (15) Hokin BD, Butler T. Cyanocobalamin (vitamin B-12) status in Seventh-day Adventist ministers in Australia. Am J Clin Nutr. 1999;70(3 Suppl):576S-578S. (16) Bardone-Cone AM, Fitzsimmons-Craft EE, Harney MB, et al. The inter-relationships between vegetarianism and eating disorders among females. J Acad Nutr Diet. 2012;112(8):1247–1252. (17)  Fuhrman J., Ferreri DM. Fueling the Vegetarian (Vegan) Athlete. Curr. Sports Med. Rep., Vol. 9, No. 4, pp. 233Y241 (18) “Detoxes” and “Cleanses” : What You Need to Know. (n.d.) Retrieved June 26, 2020 from https://www.nccih.nih.gov/health/detoxes-and-cleanses-what-you-need-to-know (19) CPR Monthly: Examining Popular Detix Diets- Today's Dietitians. (n.d.). Retrieved June 26, 2020, from https://www.todaysdietitian.com/newarchives/1016p52.shtml (20) Publishing, H (n.d.) The dubious practice of detox. Retrieved June 26, 2020, from  https://www.health.harvard.edu/staying-healthy/the-dubious-practice-of-detox (21)  Makkapati, S., D'Agati, V. D., & Balsam, L. (2018). "Green Smoothie Cleanse" Causing Acute Oxalate Nephropathy. American journal of kidney diseases : the official journal of the National Kidney Foundation, 71(2), 281–286. https://doi.org/10.1053/j.ajkd.2017.08.002 (22) Jane E. Getting, PA-C., James R. Gregoire, MD (2018). Oxalate Nephropathy Due to ‘juicing': case report and review. The American Journal of Medicine. (23) Seidelmann SB., Claggett B., Cheng S., Henglin M., Shah A., Steffen LM., Folsom AR., Rimm EB,. Willett WC., Solomon SD. Dietary carbohydrate intake and mortality: a prospective cohort study and meta- analysis. Lancet Pub Health. 2018; 3(9):e419-e428.

According to a recently published review in the American Journal of Clinical Nutrition, what we think we know about what causes obesity — and why so little progress has been made in the field — is wrong and has been for years. And new data from the Robert Wood Johnson Foundation shows that 1 in 6 young people ages 10-17 nationwide and more than 1 in 5 Texas youths are obese, with sharp disparities along racial and socioeconomic lines.

The idea that race is a biological reality has hung on longest and strongest in the parts of biological anthropology that deal with skeletal remains. In this episode we talk with two forensic anthropologists, Sean Tallman and Allysha Winburn, about how typological notions of race and ancestry have changed over time in this segment of the discipline. They have published a recent paper discussing this change (Tallman, S. D., Parr, N. M., & Winburn, A. P. (2021). Assumed Differences; Unquestioned Typologies: The Oversimplification of Race and Ancestry in Forensic Anthropology. Forensic Anthropology, Early View, 1-24. doi:https://doi.org/10.5744/fa.2020.0046). Additional resources: J. Bindon, M. Peterson, & L. J. Weaver (Producer). (2017, 11/14/2017). Race and the Human Genome Project [Retrieved from http://speakingofrace.ua.edu/podcast/race-and-the-human-genome-project Bindon, J. R. (2020). Race in the wake of the Human Genome Project. Retrieved from https://www.researchgate.net/publication/342215956_Race_in_the_wake_of_the_Human_Genome_Project Crews, D. E., & Bindon, J. R. (1991). Ethnicity as a taxonomic tool in biomedical and biosocial research. Ethnicity & disease, 1(1), 42-49. Dixon, R. B. (1923). The Racial History of Man. New York: C. Scribner's Sons. Holden, C. (2008). Personal genomics. The touchy subject of ‘race'. Science (New York, N.Y.), 322(5903), 839. Hooton, E. A. (1931). Up from the Ape. New York: Macmillan. Lieberman, L., Kirk, R. C., & Littlefield, A. (2003). Perishing Paradigm: Race—1931–99. American Anthropologist, 105(1), 110-113. Morning, A. (2011). The nature of race. Berkeley: University of California Press. Wagner, J. K., Yu, J. H., Ifekwunigwe, J. O., Harrell, T. M., Bamshad, M. J., & Royal, C. D. (2017). Anthropologists' views on race, ancestry, and genetics. American Journal of Physical Anthropology, 162(2), 318-327.

Dr. Peter McCullough is a distinguished internist, cardiologist, and epidemiologist who has been front and center speaking against the policies and medical flaws in official actions to deal with the covid pandemic. For many he has become regarded as one of the world's experts on Covid-19. Dr. McCullough is also the Chief Medical Advisor for the Truth for Health Foundation, president of the Cardiorenal Society of America Editor in Chief of the peer reviewed journal Reviews in Cardiovascular Medicine and a senior associate editor of the American Journal of Cardiology.  In addition to his internal medicine practice, he also manages common infectious diseases as well as cardiovascular complications associated with viral infection and injuries following Covid-19 vaccination. Since the time the pandemic was declared, Dr. McCullough took a lead in the medical response. He published the first synthesis of sequenced multi-drug treatment for ambulatory patients infected with the SARS-2 virus in the American Journal of Medicine.  He has now published 46 peer-reviewed papers on the infection, reviewed thousands of reports, and has published an additional 700 papers and studies. You can keep up with Peter's reports and analyses on the website AmericaOutLoud.com

In our second special  birthday episode, host JJ is joined by Joan Peterson, a longtime Brady chapter member and leader, who became a gun violence prevention and domestic violence activist after her sister, Barbara Lund, was murdered. Barbara and her boyfriend, former Iowa state legislator Kevin Kelly, were killed by Lund's estranged husband. Together, they detail why domestic violence cannot be left invisible. Then, hosts Kelly and JJ are joined by Kate Ranta (author of Killing Kate: A Story of Turning Abuse and Tragedy into Transformation and Triumph and gun violence prevention advocate) and American journalist, writer, and professor Rachel Louise Snyder. Snyder's eye-opening book, No Visible Bruises: What We Don't Know About Domestic Violence Can Kill Us, is an absolutely essential read for those who want to address private violence, and addresses how in the US, 1 in 5 women report experiencing severe physical violence from an intimate partner during their lifetime. Terrifyingly, when guns are introduced into that terrorism, the risk of serious death and injury only increases, with the American Journal of Public Health reporting that in domestic violence situations the risk of death is five times greater when a gun is present. If you or someone you know may be at risk, please call the National Domestic Violence Hotline at 1-800-799-SAFE (7233), or by text at the same number by texting the word "START." There are also advocates available online 24/7 at thehotline.org. Mentioned in this podcast:Warning Signs of Abuse (National Domestic Violence Hotline)Domestic Violence High Risk Team Model (Jeanne Geiger Crisis Center)What Are Extreme Risk Laws (Brady) Pass the Violence Against Women Reauthorization Act of 2021 (Brady) A version of this podcast initially ran as "What We Don't Know About Domestic Violence (and Guns) is Deadly."For more information on Brady, follow us on social media @Bradybuzz or visit our website at bradyunited.org.Full transcripts and bibliographies of this episode are available at bradyunited.org/podcast.National Suicide Prevention Lifeline: 1-800-273-8255.Music provided by: David “Drumcrazie” CurbySpecial thanks to Hogan Lovells for their long-standing legal support℗&©2019 Red, Blue, and BradySupport the show (https://www.bradyunited.org/donate)

With mandates being enforced on a large scale, people are finally pushing back against this authoritarian nonsense. Up to 50% of the Chicago Police Department is threatening to walk off the job if they are forced to comply with these mandates. Hopefully, more will follow their example. A U.S. judge says the jailing of Capitol riot defendants have had their civil rights violated. Will these political prisoners start to see justice or continue to be unjustly punished? A federal judge in Texas temporarily restrained United Airlines from placing employees on unpaid leave who receive religious exemptions from COVID-19. In a similar move, the L.A. County Sheriff said he won't enforce the mandates being put in place by the city because they aren't the “vaccine police.” Will this pushback have a genuine impact, or will the resistance be met with more force? Joe Rogan had CNN medical expert Sanjay Gupta on to discuss the network's portrayal of Rogan. When confronted with CNN's outright lies, Gupta had little to say to justify the network's actions. The veil is lifting and people en masse are beginning to see this fraud for the deception it really is. We're joined in-studio by David Reaboi, author of “Late Republic Nonsense” on Substack and Harrison Smith, host of "The American Journal." David Reaboi: Twitter - @davereaboi Website: www.davereaboi.com Substack: https://davereaboi.substack.com/welcome Harrison Smith: Twitter - @harrison_of_tx Banned.Video: https://banned.video/channel/the-american-journal Note: The content of this video does not provide medical advice. Please seek the advice of local health officials for any COVID vaccine questions & concerns. Subscribe to You Are Here YouTube: https://bit.ly/2XNLhQw Watch MORE You Are Here on BlazeTV: https://bit.ly/38WB2vw Check out Elijah Schaffer's YouTube channel: https://bit.ly/3C0yWH8 Check out Sydney Watson's YouTube channel: https://bit.ly/2YIedK5 Follow Sydney Watson on Twitter: https://twitter.com/SydneyLWatson Follow Elijah Schaffer on Twitter: https://twitter.com/ElijahSchaffer Learn more about your ad choices. Visit megaphone.fm/adchoices

A new study in the American Journal of Psychiatry that looked at remission rates for Attention Deficit Hyperactivity Disorder found that only one in 10 children are likely to be symptom-free in adulthood. An ADHD expert and author discusses the latest news and gives advice on treatment options.

October is National Depression and Mental Health Screening Month. In honor of this important month, The Doctor Whisperer Show will be dedicated to #MentalIllnessAwareness all month long. Tune in on Monday, 10/11/21 at 6:30am EST, for a brand new episode of The Doctor Whisperer Show featuring Functional Psychiatrist, Mark Sylvester M.D., of Alternative Psychiatry. BTW- This will be the FIRST show ever in the history of TDW Show that will be presented in GALLERY VIEW! So excited about this new show format! ▪︎ ▪︎ ▪︎ Mark Sylvester, MD, ABAM, was born and raised in Sarasota, Florida. He received his medical education at the University of Miami and training at the University of Florida College of Medicine. Dr. Sylvester received graduate education in Neuropsychopharmacology and Psychobiology. He is board certified in Psychiatry & Neurology as well as Addiction Medicine. In addition to caring for his patients with Alternative Psychiatry, where he practices Functional Psychiatry and Integrative Health, he also currently serves as medical director of Centerpointe Counseling and Recovery, Sarasota Addiction Specialists, and the Suncoast Harm Reduction Project aimed at reducing opioid related overdose deaths. Dr. Sylvester is an adjunct faculty member at Lake Erie College of Osteopathic Medicine (LECOM) where he lectures and clinically trains medical students. He is active in research and is published in the Journal of Biomechanics, Journal of Global Drug Policy, and American Journal of Psychiatry, on topics related to biomechanics, obesity/food addiction, professionalism, addiction in clinical practice, and psychiatric symptoms in end-of-life care. ▪︎ ▪︎ ▪︎ Thank you to TieTechnology for sponsoring the show! --- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app --- Send in a voice message: https://anchor.fm/thedoctorwhisperer/message

Hosts Roz and Josh are joined by Carrie Thiessen, MD, PhD (University of Wisconsin) to discuss the key articles of the October issue of American Journal of Transplantation.

Professor of Social Architecture at the University of California, Galen Cranz hasn't had conventional chairs in her house for some 20 years, out of concern for how damaging they are to our health. She prefers stools, including ones that wobble. She doesn't want us to keep still. Professor Cranz says right-angled chairs force a C-slumped spine, causing the chest to cave in, the pelvis to crunch, the lower back to collapse, our head to jut forward putting pressure on our neck. Many of us are left with all sorts of aches and pains, especially as we spend long hours in front of a computer. Professor Cranz concurs with research published in the American Journal of Public Health suggesting sitting for prolonged periods can be more damaging to our heart health than smoking. But, as she tell Kathryn Ryan, she has some solutions. Professor Cranz is a designer, a consultant specialising in chairs and body conscious design, author of The Chair: Rethinking Culture, Body, and Design and a certified Alexander Technique teacher.

A new study in the American Journal of Obstetrics and Gynecology shows that up to 15% of pregnant people who catch the coronavirus ending up hospitalized. Houston Methodist Hospital emergency room doctor Anh Nguyen is pregnant and got the booster shot. She joins us to discuss. And, every September, thousands of people flock to the small town of Meeker, Colorado, to watch sheepdogs compete. CPR's Stina Sieg went to this year's competition.

In this episode, Dr. Travis Marn interviews Dr. Jori Hall, winner of the 2021 Qualitative Research SIG's Outstanding Book Award. The conversation revolves around Dr. Hall's book "Focus Groups: Culturally Responsive Approaches for Qualitative Inquiry and Program Evaluations." The following text is a transcript of the conversation. ---Travis Marn  00:11Hello everyone and welcome to qualitative conversations, a podcast series hosted by the Qualitative Research Special Interest Group of the American Educational Research Association. I am Travis Marn, the current chair of the Qualitative Research Special Interest Groups Outstanding Book Award Committee. I'm excited to be joined today by Dr. Jori Hall, who was the recipient of the 2021 outstanding Book Award for her book, "Focus Groups: Culturally Responsive Approaches for Qualitative Inquiry and Program Evaluations" published by Meyer Education Press in 2020. Dr. Jori Hall is a multidisciplinary researcher, evaluator, and professor at the University of Georgia. Her work focuses on social inequalities and addresses issues of evaluation and research methodology, cultural responsiveness, and the role of values in privilege within the fields of education and health. She has contributed to numerous peer-reviewed journals and other publications like the "Handbook of Mixed Methods Research" and the "Oxford Handbook of Multi- and Mixed-Methods Research." She has evaluated programs funded by the National Science Foundation, the Robert Wood Johnson Foundation, and the International Baccalaureate Foundation. In recognition of her evaluation scholarship, Dr. Hall was selected as the Leaders of Equitable Evaluation and Diversity Fellow by the Annie E. Casey Foundation. Thank you for joining me here today, Dr. Hall. It's a privilege to have you with us.Jori Hall  01:32Hey, Travis, it's an honor to be here. Thank you for having me.Travis Marn  01:36So we had a highly competitive field last cycle and your book stood out immediately to members of the committee. The committee was very impressed with how you evolved a common qualitative method like the focus group, and innovatively lensed through cultural responsiveness. Considering the rapidly changing context of what it means to conduct qualitative research with and in marginalized communities, your book is exceptionally timely and innovative. The committee was impressed with how welcoming your book was to new researchers, while not losing any of the depth and complexity of your topic. The feeling of the committee about your book can best be summed up by the very first sentence a member of the committee sent after they read your book, quote, "this book is a must read text for any qualitative researcher and program evaluator who is considering working with focus groups, or already doing so." Your book richly deserved our 2021 Outstanding Book Award.Jori Hall  02:27Well, that is humbling to hear. I appreciate you sharing that I don't think I heard that quote. So again, thank you so much. And I will say, if it is something that is digestible it is because I have spent years teaching courses on qualitative inquiry and I don't lose sight of the fact that I am constantly trying to communicate to novice and even seasoned researchers alike, how it is to think about qualitative research and how to use it in ways that are responsive. And so I'm glad that that came across in the book, because it's something that I'm always challenged by always thinking about how to best describe any particular method. But in this case, focus groups. I do think that focus groups, as you said, is something that is underutilized. It's a common method, people heard of it before, but in some respects, it is underutilized. And given today's climate, with everything being online due to COVID, there are ways to think about it that can be creative, that can be culturally responsive. And that can even bring some rich information to any research project. So I hope people can see that as they encounter the book and take it up.Travis Marn  03:52I think the accessibility and how easy to read and how well structured the book just lends itself to being a work that anyone can use any kind of researcher, whether you're just starting out, or whether like you said they're seasoned researcher, like I appreciate it, you have whole chapters on like online focus groups, and how to do indigenous focus, focus groups, and all the way from design to analysis, your book, it's really kind of an all in one for anyone looking to conduct high quality focus groups. So we definitely with the committee, we really appreciated that about your book. So why don't you just tell us about your book?Jori Hall  04:31Wow, that's a big question, but I appreciate it. So the book tried to do different things. And I'm glad that it was executed well, because it was it was quite a challenge. I wanted to tackle some topics that don't get a lot of light or when they do get light. It's within the context of a larger methodological handbook, for example, and one chapter or one section is devoted to focus groups. So I'm very excited that we have an entire book dedicated to focus group and highlights how to do those were different types of folks. And so that's what the book is about. That's what I aim to do is to say, "Okay, here's a relatively common method that's underutilized. How can we think about that with respect to different types of groups," and I thought about which groups that I wanted to focus on. And there's so many more groups that deserve attention. But again, the book had limits, I have limits. And so these were the ones that rose to the top based on my experience. And I also wanted to have examples, right? I feel like oftentimes, you could share information. But to make it more concrete, give folks an example. Let them see how it was done in practice. And so the reason why those particular groups got selected the older adults is a group I looked at, I looked at indigenous folk, I look at Black women, like you were saying, and I had really strong examples, from practice taken from former students, current evaluators, current researchers that are in the field trying to make this work happen. And I wanted to be also very transparent, and very realistic about how it is this methodology gets implemented. And that's to say, it is challenging work. It's not easy to make those connections in the context of research. So within the examples that are sprinkled throughout the book, there are lessons learned, what would you have done differently, so people reading the examples can benefit from that those lessons learned? I think they're highly instructive. And I'll just say too, one of the things that's unique about focus groups, and I try to convey this in the book is that different from individual interviews, the most fascinating thing is, you get what I call a twofer trap. And a twofer is you get the interview data, but you also get observational data. And so you get to witness how it is people construct meaning. And I think in real time, and it's very dynamic. And I think that that's really fascinating. So they have a method where you get interview data, and observational data is something that is unique to focus groups, I think and, again, that's that's what I wanted to put in the book. To get across that we need to take advantage more so of the observational data that focus groups can provide the dynamics between the participants themselves. And lastly, I'll say, there is a social justice component that I tried to weave through as well. And this is hugely important given the culturally responsive orientation that I have Travis, because one thing I'm trying to say in the book is this focus groups in and of themselves, do not require you to do anything with the data beyond you know, collected from the focus group, moderate all of it. But the the lens that I'm coming from the perspective that I'm coming from is saying to be culturally responsive also includes being active action about data, right, doing something with the data, that's a benefit to the particular community. And so to think carefully about those things, how can it benefit the community? So there's lots of other things in the book, but those are some of the main things that I set out to accomplish with the book, Travis.Travis Marn  08:25And I think the examples that you were talking about the chapter on indigenous focus groups, to me was just so insightful, even someone I've never done, focus group before. And reading it really kind of showed me how much goes into kind of that social justice focused focus group. And so I'm wondering, how did you pick which groups that you wanted to kind of highlight in the book? Jori Hall  08:50Yeah, and I was alluded to this a little bit before, but again, it came out because these are the kinds of groups that I personally worked with. And then also, for the case examples, I wanted to make sure for whatever groups I decided to put in the book that I had strong case examples. And so those happen to be the ones that I have strong case examples for I have been working, teaching, conducting research at UGA University of Georgia for over a decade. And because of that, Travis, I've worked with a lot of students, a lot of graduate students, and I called on some of those former graduate students to help me think about the cases in the book. So all of these things to have is what I'm saying is all these things kind of work together to make the decisions about which ones rose to the top. And you know, even within each group, there are there is so much diversity, right? There's no one indigenous group. And so, and I just wanted to celebrate that and and I hope that comes across that I'm not suggesting that there is one type of anything, but that and that there's diversity within the groups that I'm talking about. So I hope that that comes across,Travis Marn  10:09I think it definitely does in your work and through your examples. So I'm gonna ask you a really this is a really small question. So I hope you can answer this one, what makes for a culturally responsive focus group?Jori Hall  10:21Right. So this is something that I talked about when I did a webinar for the CDC recently, and as part of that webinar, I tried to make this very point clear, and I had a slide. And I had on one side of the slide, traditional focus group, what that is, it was a definition. And then on the other side, I had culturally responsive focus group. And you can see side by side, we don't have that now, nobody can see my slides, because this is a podcast, right? But the point I was making is that a traditional focus group is defined as a group discussion that you have, with particular people about a certain topic, nothing about that definition suggests anything about being culturally responsive, or social justice, or empowerment or anything like this. So there's no commitment to those kinds of things in a traditional focus group, and actually some of the history of focus group, how did the methodology itself come about, it's through marketing. And so it has its own history. And what I'm saying is, okay, focus group has a unique history, it comes out of marketing techniques, when people trying to get information about different things different I don't know, you can think of different items in the store or different interventions, and people want it to have groups come together and give their opinion about those things. And then it moves into social science. And now what I'm saying is, we can enhance the traditional focus group from how it was previously done to be squarely focused on social justice kinds of aims and orientations. And I was just gonna say this as well. That's what makes it different. But also, when we say social justice, that means so many different things. And we have to even clarify what that means, given the people that we're working with. So it's just a real, intentional approach around actionable data, working with the community, thinking better about them in terms of the protocol, the questions we're asking and having them participate to some extent in that in terms of giving their feedback about what they want to, you know, share, and how could it be beneficial to them?12:48And so you suggest that multicultural validity and inquirer reflexivity as criteria for establishing qualitative rigor and focus groups. Can you tell us more about that?12:58Sure, it's kind of hard to do in a little bit of time. But I will refer people to the person that I drew from in those discussions, Travis, and that is the work of Karen Kirkhart. And Karen Kirkhart is a very wonderful, thoughtful, culturally responsive inquirer. And I drew on her word to explain those things primarily, and Hazel Symonette as well in terms of reflexivity. But Karen Kirkhart has articles and things about multicultural validity, as she says a lot of things about that, that folks can go and look at later. But one point that I tried to make in the book and for the purposes of the podcast, I'll say is consequential validity is part of that. And what that means is thinking about the consequences of our focus groups for the people that are participating. We don't want to put people in harm's way. We don't want to put people in jeopardy. And so what are the consequences of these people, whoever they are participating in your focus group. And that's one of the aspects of multicultural validity. The other thing that Karen Kerr cart makes very clear that I appreciate is that this isn't some other kind of validity. This actually is part of regular validity, if you will, and does do a lot to enhance the credibility quality of the work. And you also mentioned reflexivity. I drew on the work of Hazel Symonette and she does a very good job of speaking on this, but I won't do it justice but I will say the main point with reflexivity is to as researchers evaluators, is to not just think about what's happening, but create an action plan in response to things so it's not just reflection as an "Oh, I sit and think about what happened that was horrible or that was great." But what are you now going to to do and that's reflexivity, how are you now going to adopt the design if the protocol isn't working? Now what? So that's what I'll say about those two things. I won't do them justice in the podcast, but certainly both can, you know, go back and follow up on that.Travis Marn  15:18And they can read your book for even more insights. And that's something reflexivity is definitely something just so vital to all qualitative researchers. One thing that I'm interested in is novice researchers who are kind of looking to bring social justice into focus their focus group method, where do novice researchers were can they start to kind of go down this path of social justice in focus groups?Jori Hall  15:43That is a great question, where to begin? I think a great philosopher Winnie the Pooh said, "start at the beginning." I don't know if it was Winnie the Pooh, but I always like that, um, anyway, I think that one of the things to do is to learn about the strengths and the limitations of focus groups. So when I work with graduate students, which I tend to do a lot, I tried to suggest to them very strongly that whatever method you're interested in, you want to know the ins and outs of the method, what can it afford? And what are the limitations? And I think that's a good starting place, and really understanding that so then before you decide where it could fit into a design, you already know that it may be more appropriate here and less appropriate there. Beyond that, I think once you figure out the strengths and limitations of focus groups, I think you need to think about if you know who your participants are, how might they respond to a focus group discussion, and getting feedback about that, before any final decisions are made about where it fits in your design, culturally responsive approach would implore you to get feedback on that. And you can get feedback on that from, you know, another expert in the field, or someone in the community that you intend to work with or working with. But those are the two places that I would encourage folks to begin,Travis Marn  17:16I think there's no substitute for just knowing the method in and out. And your book, I think provides such a great set of tools for our novice researchers to really engage with the focus group. So shifting topics a little bit. A lot of people who listen to this podcast are people who are writing books or want to write books. So I'd be very curious. So can you describe your process for writing and publishing this book?Jori Hall  17:39Travis, it was bananas. Writing a book is more than a notion, right? Like, let's just be honest. So but in all seriousness, one of the first things is to write a proposal, and usually publishers out there, if you intend to go with a publisher, they have a template for you. And they will tell you exactly the things to include in our proposal. One of the key things, there's a lot of key things, but one of the key things that you want to think about is if you're writing your book, what are the books that are related to the kind of book you want to write about? So for me, it was what's already out there in terms of books on focus groups, and I wanted to pitch how my book is different from those books, right? Like, what is it that my book is doing that those other books aren't doing or aren't doing as well, or that I will do differently. And so I would encourage people who are interested in writing a book to survey what books are out there that are related to the kind of book that they would like to write, and you need a sample of let's say, like, you know, a handful or so and then from there, carefully begin to articulate how your book is going to do something different or stand out above those books, right? And how is it going to contribute to whatever literature you're trying to contribute to?Travis Marn  19:00And so the actual writing of the book, how can you describe the writing process?Jori Hall  19:05Sure, well, that was bananas, too. But what helped is that I talked to people who, who wrote books, to get feedback from them how they went through the process. But ultimately, Travis, you know how it is, is, you have to come to your own way of doing something, you have to adapt it for yourself, you have to figure out what works for you. And what worked for me was plotting out my writing time and sticking to it. So what that means is we're on semesters, so I had goals for each semester about where I wanted to go with the book. And I will plot that out for myself and then weekly goals, I will play that out for myself. Of course you negotiate with the publishers the timeline for the book, but you still have to figure out if the book is due two years from now. How do you write so that it is done, and we have benchmarks for yourself. The other thing I did for myself was I took myself on my own writing retreat. So I kind of eliminated distractions from just typical everyday life. And I said, Okay, I rented an Airbnb, for example, and plop myself in front of the laptop and plugged away and took breaks. And lastly, I will say, with the brakes, rest this, this may not seem important, but it is, rest is important. And health is important. Because what I've come to find out, you have to have a sound mind, and healthy body in order to be thoughtful, right. So all of these things play a role. If you're stressed out, if you're tired, that doesn't really produce your best writing. It's not your best self. So take care of yourself. Taking care of yourself along the way, is really, really important, given the stressors of everyday life in the stress of writing a book. So those are the things that come to mind straight away.Travis Marn  21:06It's very interesting to take care of yourself while trying to produce this work. I think that's a such a good thing, just to have researchers remember that they're human, and not robots producing this work? Did you write the book sequentially? Or did you jump around in the writing process?Jori Hall  21:24Yeah, so I explained this to students like research itself, it's dynamic, I jumped all over the place, because what would happen is I would get into a chapter, and I would be inspired by something which would then trigger a thought for another chapter. So I would create little notes for myself to incorporate it in another chapter. And I will come back to it. And so it evolved, I learned different ways of saying things. And as I read more, I was simultaneously reading a little bit as I wrote the book, and I think reading to me, is so helpful with writing is so helpful. So although I had goals to complete certain chapters, certain sections, believe me, I did have to go back into a section from time to time to beef it up, or to streamline it, to say it in a way that I felt like was more clear, more coherent. And then in the end, I had other people as much as I could provide feedback to make sure that the points that I were trying to, you know, trying to make came across. Travis Marn  22:34Was there any part of the book that was especially meaningful for you? Jori Hall  22:37Hmm, that's another good question. Wow you just come in with all these awesome questions, Travis.Travis Marn  22:42Um, I try. Jori Hall  22:46I think, for me, it wasn't so much a particular section. It's just I wanted to contribute, work that would support people that are vulnerable, that are put in these situations. And I wanted to contribute research and thinking about research that would give other researchers permission to tailor their work in a way that would not just benefit the literature, but would actually help somebody would actually be meaningful, and not give up on rigor, because I think there is this undercurrent, and maybe it's not an undercurrent, maybe it's this explicit thing that if you're culturally responsive, somehow you're giving up on rigor and objectivity or something like this. And I just wanted to contribute something that suggests no, actually doing these things enhances rigor. And you can also help someone along the way how, and to what extent, sure, that varies, and we could, you know, talk about that. But I think that that's what drove me to do it. And like with anything I see where you can be improved now. And, you know, I hope to continue this conversation about focus groups and being culturally responsive. So it's just a humble attempt to do that, Travis.Travis Marn  24:15A humble attempt and an outstanding outcome I think in that process, the book's just fantastic. So where can people access your ongoing work?24:25Sure. So Wow, that's awesome question, too. I the book is on Amazon and all the other things and then I'm still trying to crank out different articles, most of my articles, land in evaluation journals. And so the American Journal of Evaluation is where some of my articles are, that's the home for many of them. But what's also fun and interesting is you might find my name in some health journals. And that's because I also work with people in health disciplines and to think about, you know, methods and analyzing focus group data. So I'm sprinkled throughout different disciplines in different journals and things like this because I truly believe in collaboration, Travis, I truly believe in interdisciplinary work. I think it strengthens whatever we're trying to accomplish. And so yeah, I enjoy working with others.Travis Marn  25:21And I believe people can follow you on Twitter as well. Jori Hall  25:24Oh yeahTravis Marn  25:25Your hour by hour thoughts as well. Jori Hall  25:27That's right, that's right Travis. Travis Marn  25:29It was an honor to read your book as a committee member. And it's been a privilege to have you here and I want to offer the committee's congratulations again, your book very much deserved our 2021 Outstanding Book Award. Thank you again.Jori Hall  25:42Thank you. This was a treat to talk to you today. Thanks for having me.QR SIG AD  25:52The Qualitative Research Special Interest Group was established in 1987 to create a space within the American Educational Research Association for the discussion of ethical, philosophical and methodological issues in qualitative research. We invite you to consider joining the qualitative research SIG today. For members of AERA the annual fee for joining qualitative research special interest group for regular non-graduate student members is $10. And the annual fee for graduate students is $5. As members of the QR SIG, you will gain access to a network of fellow qualitative scholars as well as are many activities ranging from mentoring opportunities to our podcast series, To updates and news related to recent quality publications and jobs. Please visit the American Educational Research Association's website at www.aera.net to join the qualitative research SIG today.

Joey finally read a book so now The American Journal of Losers needs to spend two whole episodes dissecting the story of “The Most Cyberbullied Kid in the World” and his crusade against foul language. In part one, the boys give their bullying credentials and read some stories about the many lives that have been ruined by cursing. Watch the NCC music videoSources:The book: The No Cussing Club: 9780945713081: McKay Hatch: BooksThe Hug Card Gives People Permission to Hug and to Heal – The Arizona Beehive5 reasons swearing is a sign of intelligence, helps manage pain and moreAdam McShane, Joey Bednarski, and Cosmo Nomikos are stand up comedians based out of Chicago, IL.AJL is part of the Lincoln Lodge Podcast Network: https://www.thelincolnlodge.com/podcasts

In this episode I'm talking to Kevin C. Klatt, PhD, RD, a registered dietitian and postdoctoral fellow at the Baylor College of Medicine. We discuss nutrition science, research and the dark side of wellness that is oftentimes overlooked. Dr. Klatt explains how those of us without scientific backgrounds can navigate all of the information out there and discern what is legitimate and what is not, and we explore why so many turn to food as a “cause and a cure.” We also discuss the most egregious claims he has seen on the internet; how to become your own researcher; tips for eating to reduce risk of chronic disease; why we tend to make causal links between what we eat and how we feel, and so much more.   Dr. Klatt received his PhD in Molecular Nutrition from Cornell University and completed his dietetic internship at the National Institutes of Health Clinical Center. He is the Inaugural Dennis M. Bier Young Career Editor at the American Journal of Clinical Nutrition and is an active member of the executive committee of the Research Dietetics Practice Group of the Academy of Nutrition and Dietetics.    www.Sakara.com/BLONDEFILES for 20% off your first order. www.Dipseastories.com/BLONDE for your extended 30 day free trial. www.Getcanopy.co with code BLONDE10 at checkout for an additional 10% off your purchase. www.Helloned.com/BLONDE for 15% off your first one-time purchase or 20% off your first subscription plus free shipping.   Produced by Dear Media

Today's guest is Dr. Lisa Miller, whose doing some of the most valuable work on the science behind spirituality in the world right now. That's not to say this is a cold, sterile conversation about the topic. It is anything but that, and Lisa is one of my favorite guests we've ever had. Do yourself a favor and don't miss this essential 40 minutes.Dr. Lisa Miller is the New York Times bestselling author of The Spiritual Child and a professor in the clinical psychology program at Teachers College, Columbia University. She is the founder and director of the Spirituality Mind Body Institute, the first Ivy League graduate program in spirituality and psychology, and has held over a decade of joint appointments in the department of psychiatry at Columbia medical school.Her innovative research has been published in more than one hundred empirical, peer-reviewed articles in leading journals, including Cerebral Cortex, The American Journal of Psychiatry, and the Journal of the American Academy of Child and Adolescent Psychiatry.Her new book is The Awakened Brain, a brilliant work from a brilliant mind.Listen as we discuss:How do scientists define spirituality?MRI studies have allowed us to characterize the neurological seat of awareness.We are not alone. What does that mean?The poison of radical materialism.The dangers of "I gotta..." mindset and MRI proof that it's part of the addicted brain.We're designed to only see glimpses of the plane of truth.Take your intuition and wisdom as hard data.The best experiences of our lives are the ones that happen off the plan.People that are awakened are more likely to have depression.We all have the capacity for awakened awareness.Life is playing at a particularly frequency in one big symphony.Reprogramming ourselves from "achieving awareness" to "awakened awareness."Honor your knowing!Instagram: @mo_gawdatFacebook: @mo.gawdat.officialTwitter: @mgawdatLinkedIn: /in/mogawdatWebsite: mogawdat.comConnect with Dr. Lisa Miller on Twitter @lisamillerphd and on her website, lisamillerphd.comSome big news. I'm hosting my first sweepstakes. My new book, Scary Smart, is releasing September 30th. Pre-order your copy here, send a screenshot of your proof of pre-order to win@mogawdat.com, and win a signed copy, dinner with me, or access to an exclusive online talk. Hope to meet you all soon enough!Don't forget to subscribe to Slo Mo for new episodes every Sunday. Only with your help can we reach One Billion Happy #onebillionhappy.

This episode is a conversation with Stephan Van Vliet. He earned his PhD in Kinesiology and Community Health & received post-doctoral training at the Center for Human Nutrition in the Washington University in St Louis School of Medicine. Dr. van Vliet also holds a Masters in Nutrition Science. He performs clinical and translational studies to evaluate the effects of whole food ingestion and physical activity interventions on body composition, physical function, inflammation, insulin action, and intracellular signaling pathways involved in regulating muscle mass with advancing age. His work has been published in the American Journal of Clinical Nutrition, the Journal of Nutrition, and the Journal of Physiology. Currently, his newest research studies the impact of agricultural production systems on nutrient density, and metabolic health of consumers as well as animals.Overview:The complexity of whole food sourcesMetabolomics as a research technique & metabolites in foodEmerging research about phytonutrients in meat, fat and organsPhytonutrient difference in Grainfed vs Grassfed cowsThe impact that cattle grazing on biodiverse pastures vs monospecies pastures has on the level of phytonutrients in the meatResearch on how animal and crop management practices could impact ecosystem health and nutrient-density of the animal meatWhy it is difficult to navigate the discussion around red meat consumption and human healthStudy on meat in the context of a standard American diet vs traditional American dietStudy that compared the nutrient quality of plant-based meat vs meat from real animalsStudy that compared the consumption of whole eggs vs. egg whites for maximum muscle synthesis in humansConnect with Stephan:https://twitter.com/vanvlietphdhttps://scholar.google.com/citations?user=L5KcySQAAAAJSupport the podcast on Patreon:https://www.patreon.com/poldiwielandDo you follow the podcast on social media yet?IG: https://www.instagram.com/poldiwieland/Twitter: https://twitter.com/theyearofplentyFacebook: https://www.facebook.com/theyearofplenty/Thank you for subscribing and sharing the show with your family and friends.Subscribe with this link:www.theyearofplenty.comOr subscribe directly using your podcast app. The show is available on Apple Podcasts, Spotify, Google Podcasts and many other platforms!Please rate and review the show in the Apple Podcast app. This always helps the show get ranked so that more curious foodies can explore real food and drink with us.I want to hear from you! Take the LISTENER SURVEY: https://www.surveymonkey.com/r/KZW53RT

Mississippi leads the way… Grind sets a record… McKayla Maroney senate testimony… Christians who aren't really Christians… Inspiration4 takes off… SpaceX gets pennies… Tesla goes to tribal lands… NASA has no plans for aliens… Subscribe to the YouTube Channel… Email to Chewingthefat@theblaze.com Subscribe www.blazetv.com/jeffy Promo code jeffy… VMA's rating down… Britney wipes Instagram acct… Time 100 / 2021… Christopher Bensch VP of Collections / Toy Hall Fame / 2021 Nominations museumofplay.org Twitter: @museumofplay Facebook: @thestrongmuseum The Strong is home to the International Center for the History of Electronic Games, National Toy Hall of Fame, World Video Game Hall of Fame, Brian Sutton-Smith Library and Archives of Play, Woodbury School, and the American Journal of Play.  Learn more about your ad choices. Visit megaphone.fm/adchoices

American Thought Leaders- PART 2: Dr. Robert Malone on Ivermectin, Escape Mutants, and the Faulty Logic of Vaccine Mandates. AMERICAN THOUGHT LEADERS PART 2: Dr. Robert Malone on Ivermectin, Escape Mutants, and the Faulty Logic of Vaccine Mandates In part one of this American Thought Leaders episode, mRNA vaccine inventor Dr. Robert Malone explained the latest research on COVID-19 vaccines, booster shots, and natural immunity. Now in part two, we take a closer look at repurposed drugs like ivermectin and how a universal vaccination policy could actually backfire—and bring about the emergence of vaccine-resistant escape mutants. At their core, vaccine mandates are not just unethical and divisive, but also “impractical and unnecessary,” says Dr. Malone. You can watch the first part of this episode here. Below is a list of references mentioned or related to the discussion in this episode:  “Ivermectin for preventing and treating COVID-19” — The Cochrane Database of Systematic Reviews “Use of Ivermectin Is Associated With Lower Mortality in Hospitalized Patients With Coronavirus Disease 2019” — Chest Journal “Review of the Emerging Evidence Demonstrating the Efficacy of Ivermectin in the Prophylaxis and Treatment of COVID-19” — American Journal of Therapeutics “Effects of Ivermectin in Patients With COVID-19: A Multicenter, Double-Blind, Randomized, Controlled Clinical Trial” — Clinical Therapeutics “Dexamethasone in Hospitalized Patients with Covid-19” — The New England Journal of Medicine “ACTIV-6: COVID-19 Study of Repurposed Medications” — NIH “Convergent antibody responses to the SARS-CoV-2 spike protein in convalescent and vaccinated individuals” — Cell Reports “Reduced sensitivity of SARS-CoV-2 variant Delta to antibody neutralization” — Nature The SARS-CoV-2 Delta variant is poised to acquire complete resistance to wild-type spike vaccines (Note: This is a preprint) “Mutation rate of COVID-19 virus is at least 50 percent higher than previously thought” — Phys.org “Infection and Vaccine-Induced Neutralizing-Antibody Responses to the SARS-CoV-2 B.1.617 Variants” — The New England Journal of Medicine “Why is the ongoing mass vaccination experiment driving a rapid evolutionary response of SARS-CoV-2?” — Trial Site News “The emergence and ongoing convergent evolution of the N501Y lineages coincides with a major global shift in the SARS-CoV-2 selective landscape” (Note: This is a preprint) “The Lambda variant of SARS-CoV-2 has a better chance than the Delta variant to escape vaccines” (Note: This is a preprint) “Imperfect Vaccination Can Enhance the Transmission of Highly Virulent Pathogens” — PLOS Biology “Vaccinated and unvaccinated individuals have similar viral loads in communities with a high prevalence of the SARS-CoV-2 delta variant” (Note: This is a preprint). “Fauci: Amount of virus in breakthrough delta cases ‘almost identical' to unvaccinated” — The Hill CDC: “Outbreak of SARS-CoV-2 Infections, Including COVID-19 Vaccine Breakthrough Infections, Associated with Large Public Gatherings — Barnstable County, Massachusetts, July 2021” “Predominance of antibody-resistant SARS-CoV-2 variants in vaccine breakthrough cases from the San Francisco Bay Area, California” (Note: This is a preprint) “New delta variant studies show the pandemic is far from over” — ScienceNews “Read: Internal CDC document on breakthrough infections” — The Washington Post “New UCSF study: Vaccine-resistant viruses are driving ‘breakthrough' COVID infections” — The Mercury News “Comparing SARS-CoV-2 natural immunity to vaccine-induced immunity: reinfections versus breakthrough infections” (Note: This is a preprint) “Having SARS-CoV-2 once confers much greater immunity than a vaccine—but vaccination remains vital” — Science “Differential effects of the second SARS-CoV-2 mRNA vaccine dose on T cell immunity in naïve and COVID-19 recovered individuals” (Note: This is a preprint) “SARS-CoV-2 variants of concern and variants under investigation in England” — Public Health England “Safety of the BNT162b2 mRNA Covid-19 Vaccine in a Nationwide Setting” — The New England Journal of Medicine “Real-World Study Captures Risk of Myocarditis With Pfizer Vax” — MedPage Today CDC: “Effectiveness of COVID-19 Vaccines in Preventing SARS-CoV-2 Infection Among Frontline Workers Before and During B.1.617.2 (Delta) Variant Predominance — Eight U.S. Locations, December 2020—August 2021” “CDC: Covid-19 Vaccine Effectiveness Fell From 91% To 66% With Delta Variant“ — Forbes “SARS-CoV-2 infection induces long-lived bone marrow plasma cells in humans” — Nature “Causes and consequences of purifying selection on SARS-CoV-2” — Genome Biology and Evolution “The reproductive number of the Delta variant of SARS-CoV-2 is far higher compared to the ancestral SARS-CoV-2 virus” — Journal of Travel Medicine Subscribe to the American Thought Leaders newsletter so you never miss an episode. 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Is Dairy Good For Us? | This episode is brought to you by ButcherBoxWe have no biological requirement for dairy, and yet, we've been told over and over again that this food is a great source of calcium and that milk makes healthy bones and we should drink it daily. However, the research shows that none of this is true. In fact, close to 70 percent of the world's population is genetically unable to properly digest milk and other dairy products—a problem known as lactose intolerance. But even if you aren't lactose intolerant, consuming dairy can lead to weight gain, bloating, acne, gas, allergies, eczema, brittle bones, and sometimes even cancer.In this mini-episode, Dr. Hyman discusses why he often works with patients to eliminate dairy in conversations with his colleagues Lisa Dreher and Dr. Elizabeth Boham. He also speaks with Dr. David Ludwig about his recent research on milk and dairy products.Lisa Dreher is a registered dietitian who got her undergraduate nutrition degree at the Rochester Institute of Technology and completed a dietetic internship through Cornell University. Lisa first worked in the acute care hospital setting and became a Clinical Nutrition Specialist working in Pediatric Gastroenterology at the University of Rochester Medical Center. At the same time, she pursued her Masters degree in Nutrition and Integrative Health from the Maryland University of Integrative Health and started practicing integrative and functional nutrition in private practice before joining UWC in 2015. She has since received additional training through the Institute for Functional Medicine. Over the past 10 years, Lisa has delivered several public health lectures on the role of food as medicine and her work has been showcased in Reader's Digest, on National Public Radio, and she was featured in the Broken Brain 2 series. She also developed the Digestive Health and Gut Microbiome training module for the Dietitians in Integrative and Functional Medicine practice group through the Academy of Nutrition and Dietetics. Elizabeth Boham is a physician and nutritionist who practices Functional Medicine at The UltraWellness Center in Lenox, MA. Through her practice and lecturing she has helped thousands of people achieve their goals of optimum health and wellness. She witnesses the power of nutrition every day in her practice and is committed to training other physicians to utilize nutrition in healing. Dr. Boham has contributed to many articles and wrote the latest chapter on Obesity for the Rankel Textbook of Family Medicine. She is part of the faculty of the Institute for Functional Medicine and has been featured on the Dr. Oz show and in a variety of publications and media including Huffington Post, The Chalkboard Magazine, and Experience Life. Her DVD Breast Wellness: Tools to Prevent and Heal from Breast Cancer explores the Functional Medicine approach to keeping your breasts and whole body well.David S. Ludwig, MD, PhD is an endocrinologist and researcher at Boston Children's Hospital. He holds the rank of Professor of Pediatrics at Harvard Medical School and Professor of Nutrition at Harvard School of Public Health. Dr. Ludwig is co-director of the New Balance Foundation Obesity Prevention Center and founder of the Optimal Weight for Life program, one of the country's oldest and largest clinics for the care of overweight children. For more than 25 years, Dr. Ludwig has studied the effects of dietary composition on metabolism, body weight, and risk for chronic disease. Described as an “obesity warrior” by Time Magazine, Dr. Ludwig has fought for fundamental policy changes to improve the food environment. He has been a Principal Investigator on numerous grants from the National Institutes of Health and philanthropic organizations and has published over 200 scientific articles. Dr. Ludwig was a Contributing Writer at JAMA for 10 years and presently serves as an editor for The American Journal of Clinical Nutrition and The BMJ. He has written 3 books for the general public, including the #1 New York Times bestseller Always, Hungry? Conquer Cravings, Retrain Your Fat Cells, and Lose Weight Permanently.This episode is brought to you by ButcherBox. Right now ButcherBox has a special offer for new members. If you sign up today you'll get 2 ribeye steaks free in your first box plus $10 off by going to butcherbox.com/farmacy.Find Dr. Hyman's full-length conversation with Lisa Dreher, “A Simple Diet Experiment That May Solve Most Of Your Health Issues” here: https://DrMarkHyman.lnk.to/FeJHNRJ3 Find Dr. Hyman's full-length conversation with Dr. Elizabeth Boham, “Acne, Weight Gain, Facial Hair, Hair Loss, Infertility: Is PCOS The Cause?” here: https://DrMarkHyman.lnk.to/68G64S1YFind Dr. Hyman's full-length conversation with Dr. David Ludwig, “Why Most Everything We Were Told About Dairy Is Wrong” here: https://DrMarkHyman.lnk.to/DrDavidLudwig See acast.com/privacy for privacy and opt-out information.