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Send us a textCindy Murphy shares the heartbreaking story of her son Tristan, who struggled with schizophrenia and died by suicide while incarcerated after being handed a chainsaw during a prison work detail. Through her grief, Cindy has become a powerful advocate for mental health reform in the criminal justice system, working to pass the Tristan Murphy Act in Florida.• Tristan developed schizophrenia in his 30s, unusually late compared to typical onset in teens or early 20s• After his first psychotic episode, Tristan spent 8 months in jail before being declared incompetent to stand trial• When properly medicated, Tristan functioned well and maintained a relationship with his children• Florida ranks #1 in mental health needs but #49 in providing mental health services• The Tristan Murphy Act aims to identify mental health issues within 24 hours of arrest and divert people to treatment• Approximately 30% of prison inmates have mental health issues• New treatments like long-acting injectable medications can help people with schizophrenia maintain stability• The documentary "The Warehouse: The Life and Death of Tristan Murphy" is available on YouTubeIf you know anyone that would like to tell their story, send them to tonymantor.com/contact with their information so one day they may be a guest on our show. Please tell everyone everywhere about Why Not Me ? Embracing Autism and Mental Health Worldwide The World, the conversations we're having, and the inspiration our guests give to everyone that you are not alone in this world.https://tonymantor.comhttps://Facebook.com/tonymantorhttps://instagram.com/tonymantorhttps://twitter.com/tonymantorhttps://youtube.com/tonymantormusicintro/outro music bed written by T. WildWhy Not Me the World music published by Mantor Music (BMI)

Contributor: Travis Barlock, MD Educational Pearls: Wheezing is classically heard in asthma and COPD, but it can be the result of a wide range of processes that cause airflow limitation Narrowed bronchioles lead to turbulent airflow → creates the wheezing Crackles (rales) suggest pulmonary edema which is often due to heart failure Approximately 35% of heart failure patients have bronchial edema, which can also produce wheezing COPD and heart failure can coexist in a patient, and both of these diseases can cause wheezing It's vital to differentiate whether the wheezing is due to the patient's COPD or their heart failure because the treatment differs Diagnosing wheezing due to heart failure (cardiac asthma): Symptoms: orthopnea, paroxysmal nocturnal dyspnea Diagnostic tools: bedside ultrasound Treatment: diuresis and BiPAP for respiratory support Not all wheezing is asthma Consider heart failure in the differential and tailor treatment accordingly References 1. Buckner K. Cardiac asthma. Immunol Allergy Clin North Am. 2013 Feb;33(1):35-44. doi: 10.1016/j.iac.2012.10.012. Epub 2012 Dec 23. PMID: 23337063. 2. Hollingsworth HM. Wheezing and stridor. Clin Chest Med. 1987 Jun;8(2):231-40. PMID: 3304813. Summarized by Meg Joyce, MS1 | Edited by Meg Joyce & Jorge Chalit, OMS3 Donate: https://emergencymedicalminute.org/donate/  

In freight technology news, ⁠load board provider DAT announced its acquisition of payments platform Outgo⁠ last week. This strategic move aims to integrate the entire freight transaction process into the DAT One ecosystem, with a key benefit being that carriers can now potentially get paid much faster, sometimes within just 15 minutes. Outgo, founded in 2022 by former Uber and Convoy technologists, focused on bundling banking, factoring, and payment services, including a "fractional factoring" model giving carriers more control. This acquisition is seen as positioning DAT to become the freight industry's central exchange platform, competing with others like Triumph Financial who are also building their ecosystems. Turning to maritime trade, the ⁠Port of Long Beach recorded its strongest April on record⁠ last month. The port handled 867,493 twenty-foot equivalent units (TEUs), representing a 15.6% year-over-year increase attributed to importers frontloading tariff-affected cargo. Imports saw a significant 15.1% year-over-year rise, while exports slightly declined. Even with this record, the port anticipates a more than 10% drop-off in imports in May, with effects expected beyond the docks. In Washington D.C., lawmakers are processing a large volume of input from the trucking sector. The Department of Transportation (DOT) received ⁠over 900 recommendations for regulatory removal⁠ as part of implementing executive orders to cut bureaucracy. Approximately 30% of these recommendations came directly from the trucking industry and addressed regulations affecting drivers and carriers. Finally, mark your calendars for upcoming Freight Waves TV programming, including ⁠The Stockout⁠ and ⁠What the Truck?!?⁠. You can also find details on the Fraud Fighters Award winners and information on the upcoming ⁠Domestic Supply Chain Summit⁠ this week. Learn more about your ad choices. Visit megaphone.fm/adchoices

Approximately one third of our lives are spent working, which translates to over 90,000 hours over a lifetime. Not only is that, but many of us find our identity in our work and achievements, and when the career basket falls over at some point in our lives, it can create quite a mess. Join us this Sunday as Pastor Brandon discusses Paul's perspective on how he views his own resume in relation to a relationship with Jesus.

When it comes to raising a family, American Robins have got it down. Approximately eight days after the male and female mate, the female builds the nest.  A few days later, she lays eggs. She sits on the eggs for 18 hours a day, and the eggs hatch in about three weeks. Both parents feed the nestlings until they fledge, then Mom and Dad feed them for another three weeks, until the kids are on their own. Whew! Time for a break, right? Not a chance. Most robins raise two sets of young each season, and sometimes a third.This show brought to you by The Bobolink Foundation.More info and transcript at BirdNote.org.Want more BirdNote? Subscribe to our weekly newsletter. Sign up for BirdNote+ to get ad-free listening and other perks. BirdNote is a nonprofit. Your tax-deductible gift makes these shows possible.

Approximately 80% of orange cats are males, including the four orange cats owned by the Short Wave team. Scientists have long suspected that orange color was a sex-linked trait — hiding somewhere on the X chromosome. Now, scientists at Stanford University and Kyushu University in Japan have characterized the mutation responsible for orange cat coloration. Both groups published their results in the journal Cell Biology this week. Have a question about the animals all around us? Email us at shortwave@npr.org — we'd love to hear from you!Listen to Short Wave on Spotify and Apple Podcasts.Learn more about sponsor message choices: podcastchoices.com/adchoicesNPR Privacy Policy

Send us a textThe IEEE MTTS International Microwave Symposium attracts over 9,000 attendees and 500+ exhibitors to share cutting-edge developments in RF, microwave, and advanced packaging technologies. Tim Hancock and Jim Buckwalter from the IMS committee explain why this premier event, taking place in San Francisco's Moscone Center from June 15-20, has become increasingly relevant to professionals in advanced packaging and heterogeneous integration.• Approximately 15% of accepted papers directly address packaging and heterogeneous integration topics• Papers undergo rigorous double-blind review with an in-person committee meeting to ensure highest quality content• Technical focus includes laminate technology, chip stacking, thermal management, and other critical packaging technologies• Special workshops address 3D heterogeneous integration, millimeter-wave phased arrays, and advanced packaging solutions• Exhibition floor features 500+ companies providing networking opportunities and technology discovery• Student programs include design competitions, volunteer opportunities, and dedicated sessions for underrepresented groups• Early bird registration ends May 16th with regular registration continuing at ims-ieee.orgRegister at ims-ieee.org to secure your spot and book accommodations before they fill up.THE 2025 IEEE MTT-S IMSThe 2025 IEEE MTT-S IMS is the largest event for RF and microwave professionals in the world.Disclaimer: This post contains affiliate links. If you make a purchase, I may receive a commission at no extra cost to you.Support the showBecome a sustaining member! Like what you hear? Follow us on LinkedIn and TwitterInterested in reaching a qualified audience of microelectronics industry decision-makers? Invest in host-read advertisements, and promote your company in upcoming episodes. Contact Françoise von Trapp to learn more. Interested in becoming a sponsor of the 3D InCites Podcast? Check out our 2024 Media Kit. Learn more about the 3D InCites Community and how you can become more involved.

Anteris Technologies Global Corp. CEO Wayne Paterson joined Steve Darling from Proactive to provide an update on the company's progress during the first quarter of 2025, highlighting significant regulatory, clinical, and operational milestones following its successful $80 million initial public offering. A core focus of the quarter was the continued development of the company's DurAVR® transcatheter heart valve (THV), a first-in-class device designed for patients with severe aortic stenosis. Approximately $20.8 million of the IPO proceeds have been allocated to advancing DurAVR®, including funding for the pivotal PARADIGM clinical trial and related manufacturing and regulatory initiatives. Paterson emphasized that the company successfully submitted its Investigational Device Exemption (IDE) application to the U.S. Food and Drug Administration during the quarter—marking a significant regulatory milestone that clears the path for Anteris to initiate its U.S.-based clinical trial program. “Reaching over 100 patients treated with DurAVR® is a critical clinical milestone,” Paterson noted. “We are bringing a new class of valve technology to a space that hasn't seen true innovation in decades.” To support this expansion, Anteris has scaled its clinical field team, manufacturing, and quality operations, tripling its operational capacity in 2024. These enhancements position the company to manage increased clinical activity and meet regulatory demands as the PARADIGM Trial ramps up. Pending FDA approval of its IDE application, Anteris expects to commence the PARADIGM Trial in Q3 2025—a pivotal step toward broader commercial adoption of DurAVR®. #proactiveinvestors #anteristechnologiesglobalcorp #asx #avr #nasdaq #avr #DurAVR #TAVR #MedicalDevices #CardiologyInnovation #ClinicalTrials #StructuralHeart #FDAApproval #HeartValve #MedTechUpdates

Crisis Point, 3min., Romania Directed by Valentin Raileanu As a result of resource depletion, a virus outbreak stripping the afflicted of what makes them human and finally, war, humanity's sovereignty has fallen. In dwindling numbers, the survivors have been driven out of their homes in the search for safety, while a former soldier travels through the toxic environment in search of a cure. https://www.instagram.com/vali_stunt Get to know actor Diana Gheorghe What motivated you to make this film? Valentin Raileanu, a talented and successful stuntman, fight choreographer, camera operator, and my mentor in this wonderful field, has always had a passion for filmmaking and a wealth of insane ideas to bring to life. This passion led him to explore the subtleties of being a film director. When he proposed the idea of a post-apocalyptic short to me, I immediately knew we had to do it. I fell in love with the concept of showcasing a violent and harsh reality as a consequence of human recklessness. It was also a great opportunity for me to put my newly learned stunt skills to the test. Since I was young, I've loved acting and dreamed of participating in film festivals with my own projects. Even though this isn't our first project together, it is the first one we're submitting to festivals. From the idea to the finished product, how long did it take for you to make this film? Approximately 10 weeks in total, give or take a few days. Pre-production lasted 5 weeks (for choreography, camera rehearsal, and preview), followed by 1 week of shooting, and another 4 weeks for post-production (editing and FX). Subscribe to the podcast: https://twitter.com/wildsoundpod https://www.instagram.com/wildsoundpod/ https://www.facebook.com/wildsoundpod

Fear of the unknown can make surgery and anesthesia unnecessarily stressful. Approximately 90% of patients experience some degree of anxiety about "going under" before their procedure – worrying about pain, waking during surgery, or post-operative grogginess. But what if patients had reliable answers to their most pressing questions?The Anesthesia Patient Safety Foundation has developed a groundbreaking resource to address this need. In this episode, we introduce the Patient Guide to Anesthesia and Surgery – a comprehensive tool designed to demystify the perioperative experience. Salvador Gullo Neto, lead of the APSF Patient Engagement Workgroup, explains why patient involvement matters: "If the patient is the primary stakeholder in their own safety, why are they left out of these conversations?" We explore the guide's three detailed sections – Anesthesia FAQ, Surgery FAQ, and Pain Management FAQ – covering everything from different types of anesthesia to essential questions patients should ask their clinicians before surgery. The guide addresses common concerns like the risks of anesthesia, what to expect during recovery, and options for managing post-operative pain. For medical professionals, it serves as a valuable reference during patient consultations.Healthcare has evolved from being done "for" patients to being done "with" patients as active participants. This shift represents the future of medical care – a collaborative approach where informed patients and dedicated healthcare professionals work together to achieve the best possible outcomes. We hope that you will check out this invaluable resource today and share it with patients, colleagues, and loved ones. Visit APSF.org or check our show notes for more information.For show notes & transcript, visit our episode page at apsf.org: https://www.apsf.org/podcast/254-the-patients-guide-to-anesthesia-and-surgery/© 2025, The Anesthesia Patient Safety Foundation

The Manhattan Area Chamber of Commerce's HYPE program creates a community for young professionals through social events, professional development, and nonprofit engagement. Rebranded five years ago, HYPE (Helping Young Professionals Emerge) focuses on building connections and making Manhattan a place where 18-40 year olds want to live, work, and play.• Program operates through five pillars: play, engage, develop, connect, and Love MHK• Monthly "HYPE Happy Hour" on the last Thursday and "Lattes with Leadership" provide regular connection opportunities• Robust mentorship program pairs members with established business leaders for one-on-one development• Collaborates with GMCF Young Trustees on nonprofit engagement, including annual Nonprofit Happy Hour• Membership costs $50 annually, with special rates available for students and certain career fields• Approximately 300 members across Gary, Riley, and Pottawatomie counties• Creates belonging that helps retain talent in the Manhattan area• Next HYPE orientation scheduled for July 8th at the Manhattan Public LibraryFor more information, visit hypemhk.com or email amove@manhattan.orgGMCFCFAs

In recent years, the healthcare landscape has witnessed remarkable advancements in technology, particularly in the realm of medical devices and drug delivery systems. One of the most exciting developments is the emergence of needle-free injection technology, a solution that promises to revolutionize how medications are administered. This innovation addresses not only the discomfort and fear associated with needles but also the environmental impact of traditional injection methods. Lea Milovich, CEO and Co-Founder of FlowBeams, explains that the potential for needle-free injections to improve patient experience and reduce waste is significant.The Problem with Traditional InjectionsThe statistics surrounding the use of needles are staggering. Approximately one in five individuals worldwide harbors a fear of needles, a phobia that can deter them from seeking necessary medical treatments, including vaccinations and routine health checks. Furthermore, the sheer volume of needles used daily - over 44 million - contributes to a substantial environmental burden, with syringes, packaging, and other associated waste compounding the issue. This reality underscores the urgent need for an alternative method of drug delivery that minimizes both psychological barriers and ecological impact.The Solution: FlowBeams' Needle-Free TechnologyFlowBeams is at the forefront of this innovative solution, developing a needle-free injection device that utilizes laser-based technology to deliver medications without the use of traditional needles. The device operates by creating a bubble through localized heating of the liquid medication, which then propels the liquid through the skin at high velocities. This method is applicable to a wide range of substances, from cosmetic treatments like Botox to essential pharmaceuticals, including insulin and vaccines.One of the most compelling aspects of FlowBeams' technology is its versatility. The device can accommodate both refillable and disposable tanks, allowing for customization based on the needs of various industries. This adaptability ensures that the technology can be implemented across multiple sectors, catering to both cosmetic and medical applications.Addressing Broader Health ConcernsThe implications of needle-free injection technology extend beyond merely alleviating the fear of needles. For individuals requiring regular injections, such as those with diabetes or fertility issues, the ability to administer medications painlessly and conveniently can significantly enhance their quality of life. The technology has the potential to eliminate barriers that prevent people from adhering to their treatment regimens, ultimately leading to better health outcomes.Moreover, while the current focus of FlowBeams is on intradermal injections, the foundation laid by this technology may pave the way for future innovations in drug delivery. As research continues to evolve, the possibilities for expanding the applications of needle-free injections are vast, potentially addressing a broader spectrum of medical needs.The Future of Healthcare DeliveryLooking ahead, the vision for needle-free injection technology is one of accessibility and safety. Lea Milovich envisions a future where injections are no longer synonymous with pain and anxiety, but rather a seamless part of healthcare that prioritizes patient comfort. The success of this technology hinges on collaboration with industry partners who can help bring these innovations to market, ensuring that they reach the individuals who need them most.The recognition that FlowBeams received at CES 2025 with an Innovation Award in the beauty and personal care category underscores the growing interest and validation of this technology. As more stakeholders recognize the importance of needle-free solutions, the pathway to widespread adoption becomes clearer.Conclusion: Preventing Fear and Waste in HealthcareThe development of needle-free injection technology represents a significant leap forward in medical innovation, addressing both the psychological and environmental challenges posed by traditional injection methods. As companies like FlowBeams work to refine and promote this technology, the prospect of a needle-free future becomes increasingly attainable. By prioritizing patient comfort and environmental sustainability, needle-free injections have the potential to transform healthcare delivery for all, making it safer, more accessible, and ultimately more humane. In a world where health should be a priority, the ability to administer medications without the fear of needles is not just a technological advancement; it is a meaningful step towards a more inclusive and compassionate healthcare system.Interview by Scott Ertz of F5 Live: Refreshing Technology.Sponsored by: Get $5 to protect your credit card information online with Privacy. Amazon Prime gives you more than just free shipping. Get free music, TV shows, movies, videogames and more. The most flexible tools for podcasting. Get a 30 day free trial of storage and statistics.

In recent years, the healthcare landscape has witnessed remarkable advancements in technology, particularly in the realm of medical devices and drug delivery systems. One of the most exciting developments is the emergence of needle-free injection technology, a solution that promises to revolutionize how medications are administered. This innovation addresses not only the discomfort and fear associated with needles but also the environmental impact of traditional injection methods. Lea Milovich, CEO and Co-Founder of FlowBeams, explains that the potential for needle-free injections to improve patient experience and reduce waste is significant.The Problem with Traditional InjectionsThe statistics surrounding the use of needles are staggering. Approximately one in five individuals worldwide harbors a fear of needles, a phobia that can deter them from seeking necessary medical treatments, including vaccinations and routine health checks. Furthermore, the sheer volume of needles used daily - over 44 million - contributes to a substantial environmental burden, with syringes, packaging, and other associated waste compounding the issue. This reality underscores the urgent need for an alternative method of drug delivery that minimizes both psychological barriers and ecological impact.The Solution: FlowBeams' Needle-Free TechnologyFlowBeams is at the forefront of this innovative solution, developing a needle-free injection device that utilizes laser-based technology to deliver medications without the use of traditional needles. The device operates by creating a bubble through localized heating of the liquid medication, which then propels the liquid through the skin at high velocities. This method is applicable to a wide range of substances, from cosmetic treatments like Botox to essential pharmaceuticals, including insulin and vaccines.One of the most compelling aspects of FlowBeams' technology is its versatility. The device can accommodate both refillable and disposable tanks, allowing for customization based on the needs of various industries. This adaptability ensures that the technology can be implemented across multiple sectors, catering to both cosmetic and medical applications.Addressing Broader Health ConcernsThe implications of needle-free injection technology extend beyond merely alleviating the fear of needles. For individuals requiring regular injections, such as those with diabetes or fertility issues, the ability to administer medications painlessly and conveniently can significantly enhance their quality of life. The technology has the potential to eliminate barriers that prevent people from adhering to their treatment regimens, ultimately leading to better health outcomes.Moreover, while the current focus of FlowBeams is on intradermal injections, the foundation laid by this technology may pave the way for future innovations in drug delivery. As research continues to evolve, the possibilities for expanding the applications of needle-free injections are vast, potentially addressing a broader spectrum of medical needs.The Future of Healthcare DeliveryLooking ahead, the vision for needle-free injection technology is one of accessibility and safety. Lea Milovich envisions a future where injections are no longer synonymous with pain and anxiety, but rather a seamless part of healthcare that prioritizes patient comfort. The success of this technology hinges on collaboration with industry partners who can help bring these innovations to market, ensuring that they reach the individuals who need them most.The recognition that FlowBeams received at CES 2025 with an Innovation Award in the beauty and personal care category underscores the growing interest and validation of this technology. As more stakeholders recognize the importance of needle-free solutions, the pathway to widespread adoption becomes clearer.Conclusion: Preventing Fear and Waste in HealthcareThe development of needle-free injection technology represents a significant leap forward in medical innovation, addressing both the psychological and environmental challenges posed by traditional injection methods. As companies like FlowBeams work to refine and promote this technology, the prospect of a needle-free future becomes increasingly attainable. By prioritizing patient comfort and environmental sustainability, needle-free injections have the potential to transform healthcare delivery for all, making it safer, more accessible, and ultimately more humane. In a world where health should be a priority, the ability to administer medications without the fear of needles is not just a technological advancement; it is a meaningful step towards a more inclusive and compassionate healthcare system.Interview by Scott Ertz of F5 Live: Refreshing Technology.Sponsored by: Get $5 to protect your credit card information online with Privacy. Amazon Prime gives you more than just free shipping. Get free music, TV shows, movies, videogames and more. The most flexible tools for podcasting. Get a 30 day free trial of storage and statistics.

Intimidation of Endless Space Given in a Small Window of Time (approximately 10 minutes) is a new exhibition by graphic designer Lina Grumm and composer Ethan Braun at Artspace Aotearoa.  The exhibition tends to relationships between sound, space, the visual, and the body, inviting deep listening and limitless interpretation, and engendering a gallery in constant flux.  Sofia had a kōrero with Kaitohu Director of Artspace Aotearoa, Ruth Buchanan, about the show and the artists.

Approximately 20% of children in Canada will experience a mental illness, and supporting the caregivers, guardians, and parents of these children is crucial. To recognize Mental Health Week, the Ontario Caregiver Organization and Parents' Lifeline have partnered to host a free webinar that will offer parents some resources, tips, and strategies for supporting their child with a mental illness. Catherin Shea from Parents' Lifeline, and Amy Coupal, the CEO of Ontario Caregiver Organization, are joining Grant Hardy on The Pulse to share the details of this webinar and talk about the mental health crisis that Canadian youth are facing.  Check out the Pulse on YouTube!About AMIAMI is a media company that entertains, informs and empowers Canadians with disabilities through three broadcast services — AMI-tv and AMI-audio in English and AMI-télé in French — and streaming platform AMI+. Our vision is to establish AMI as a leader in the offering of accessible content, providing a voice for Canadians with disabilities through authentic storytelling, representation and positive portrayal. To learn more visit AMI.ca and AMItele.ca.Find more great AMI Original Content on AMI+Learn more at AMI.caConnect with Accessible Media Inc. online:X /Twitter @AccessibleMediaInstagram @AccessibleMediaInc / @AMI-audioFacebook at @AccessibleMediaIncTikTok @AccessibleMediaIncEmail feedback@ami.ca

Story at-a-glance Approximately 10% to 15% of Americans suffer from irritable bowel syndrome (IBS), a functional gastrointestinal disorder characterized by unpredictable symptoms that disrupt daily life Recent research reveals that psychological stress trains your body to misidentify safe foods as threats. This rewires your immune and nervous systems to produce pain responses in the gut Stress increases mast cell activity in the gut, which leads to nerve hypersensitivity and immune system changes that trigger IBS symptoms like bloating, pain, and altered digestion When stress becomes chronic, hormones like cortisol and CRF impair digestion, damage the gut lining, and throw off your microbial balance, worsening IBS symptoms Managing IBS involves comprehensive lifestyle strategies, including stress reduction techniques like mindfulness, exercise, improving sleep, and supporting gut health through diet and potential supplements

* Grabs 155 Mesa, AZ (August 20, 2017) * Nick speaks with Chris Sleigher and Kasey Beal about a grab they made on August 20, 2017 * Chris Sleigher (current BC), Captain at the time of the grab. * Kasey Beal (current Chief 1 of Golden [CO] FD, BC at the time of the grab. * Mesa Fire And Medical Department. * August 20, 2017, single-story, ordinary construction. * Approximately five minutes between arrival, time, and victim removal. * The weight of the victim was over 300 pounds. * The removal method was performing the Denver drill out of an elevated window. * Some of the takeaways were the IC was able to have tactical patience and understand the impacts of the flow path and victim removal. Trusting and training your cruise and departmental support and expect expectations through standard operation procedures. * YouTube video of Fairview Fire Review...https://youtu.be/Es67SVABGc0 * Takeaways-Ensure the 3-deep model for resources on working fires, especially with persons reported, backfill ambulances or rescues for firefighters, drop CyanoKits on smoke inhalation victims (us or them) strong command presence, predictable deployment of resources, commit on deck crews to support search, rescue and fire control, Plan B isn't Plan A harder.

Send us a textTim Murphy, former congressman and psychologist, shares his journey advocating for mental health reform through the Helping Families in Mental Health Crisis Act and highlights the systemic failures in America's approach to serious mental illness.• Serious mental illness requires different treatment approaches than general mental health concerns• Current Medicaid restrictions only allow 15-day hospital stays with a 190-day lifetime limit• HIPAA laws often prevent necessary communication between doctors and families of mentally ill patients• Approximately 40% of prison inmates have serious mental illness, with jails becoming de facto psychiatric facilities• SAMHSA (Substance Abuse and Mental Health Services Administration) lacks accountability for billions in spending• Schizophrenia alone costs America approximately $380 billion annually across healthcare, criminal justice, and social services• Assisted Outpatient Treatment provides court-ordered care for those with severe mental illness who lack insight into their condition• Mental health advocacy requires specific, actionable requests to legislators rather than general appeals• Reform needs include lifting hospital bed restrictions, modifying HIPAA laws, and implementing stronger program accountabilityVisit drtimmurphy.com to read articles with plans for advocacy and reform in mental health policy.https://tonymantor.comhttps://Facebook.com/tonymantorhttps://instagram.com/tonymantorhttps://twitter.com/tonymantorhttps://youtube.com/tonymantormusicintro/outro music bed written by T. WildWhy Not Me the World music published by Mantor Music (BMI)

Send us a textPsychotherapist Haley Graham shares her journey from pharmacist to mental health advocate after her son's struggle with school led her to found the Bounce Brighter Futures Foundation. Her personal experience with neurodivergence drives her passion for supporting children, parents, and teachers through therapeutic storytelling and compassionate understanding.• Founded Bounce Brighter Futures Foundation in 2019, now supporting 90 families weekly with 12 therapists• Approximately 50% of children seeking support are neurodivergent (autistic or ADHD)• School attendance difficulties often stem from not belonging in the system rather than just peer bullying• Cautions against therapists inadvertently teaching autistic children to mask better• Uses storytelling with woodland animals to help children explore mental health challenges• Created "Shadow Monster" story as metaphor for facing anxiety and OCD• Developing new book based on interviews with late-identified autistic adults• Believes autism itself isn't the problem—fitting into society creates mental health challenges• Emphasizes curiosity about children's experiences rather than trying to fix them• Advocates for thoughtfulness and empathy when supporting neurodivergent individualsFind Haley Graham on LinkedIn, Instagram (hayleygrahauthor), and at Bounce Brighter Futures website.https://tonymantor.comhttps://Facebook.com/tonymantorhttps://instagram.com/tonymantorhttps://twitter.com/tonymantorhttps://youtube.com/tonymantormusicintro/outro music bed written by T. WildWhy Not Me the World music published by Mantor Music (BMI)

The next few weeks are critical, says WKAR Public Media General Manager Shawn Turner. As Congress prepares to vote on the issue of federal funding for public media, the most important voices that will influence the decisions of lawmakers are yours.Approximately $1.60 is the amount each taxpayer contributes to federal funding for the Corporation for Public Broadcasting. That $1.60 is seed money for a national system of local public television and radio stations. Shawn Turner joins me now to expound on the value of public media. Americans receive a lot of public services in communities across the country for $1.60.Conversation Highlights:(1:08) - Public media provides an essential universal service. Together, public media broadcasters reach up to 99 percent of the American populations, regardless of zip code or income level, including in communities where commercial television can't succeed. The value extends well beyond radio and television.  (2:42) - Public media is the only free, national media resource that operates with a public service mission, not commercial interest. At WKAR Public Media from Michigan State University, we serve our mission to inform, educate, and inspire through sharing exceptional original content, connecting with community, fostering learning, and much more.  (3:43) - The noncommercial model is particularly important and unique in the children's media space. PBS stations reach more parents of young children than any other children's TV networks. 63 percent of parents surveyed named PBS KIDS® the most educational media brand for children, substantially outscoring the second-most highly rated brand, YouTube, at 13 percent.  (5:04) - Public media stations are locally operated and locally controlled, providing unique, local, essential services. They make their own programming decisions reflecting the unique needs of those living within their broadcast area. For WKAR, that local control means the ability to serve audiences across a region that includes a state capital, a Big Ten University, manufacturing facilities and family-owned farms. (6:24) – WKAR is committed to providing locally focused, balanced content that serves the needs and broad range of viewpoints across this varied community. Michigan hunting and fishing, DIY and travel shows, classical music, performing arts, drama, politics and government. There truly is something for everyone. (7:28) - The work and impact of any local public media station goes far beyond the broadcast. Stations engage in community events that celebrate local cultures and foster open discussion. Many have educational outreach efforts that connect educators and caregivers with free educational broadcast, streaming and gaming resources available from PBS KIDS.  (9:03) – How can listeners and viewers make their voices heard in support of WKAR and all public media?Listen to “MSU Today with Russ White” on the radio and through Spotify, Apple Podcasts, and wherever you get your shows.

On 24 April 2013 the eight-story Rana Plaza building in Dhaka Bangladesh collapsed. The owners of a number of garment factories in the building had ignored the most basic safety regulations, and forced workers to keep working when it was clear the walls were cracking. In Bangladesh, workers are paid monthly, at the end of the month. The collapse happened on the 24th, and workers were threatened with non payment of wages, if they didn't enter the clearly unstable building. The confirmed death toll was 1,130. Approximately 2,500 injured people were rescued.Rana Plaza shows how little the fashion brands care about the lives of the workers that produce the clothes that make them insane profits. Guests today are Rupali Akter and Taslima Akter. Rupali is a survivor of the Rana Plazar collapse. She was in the building on the day, and she was buried under the rubble for 17 hours before being rescued. Taslima Akter is a photo journalist and activist. She was onsite in the immediate aftermath, documenting and bearing witness to the horror. Taslima is the Secretary and Rupali is the President of the Bangladesh Garment Workers Solidarity. Taslima is interpreting for Rupali in this interview.This interview was conducted in 2023, during an international solidarity visit to Melbourne to commemorate 10 years since the collapse. Today, 12 years later, not much has changed other than garment workers were instrumental in the self-imposed exile of Bangladesh Prime Minister Sheikh Hasina in 2024.

Approximately 1,500 former banana workers in Costa Rica say a US-made pesticide has left them sterile. Though banned in the United States in the 1970s, the chemical DBCP was still used by US fruit companies in countries with lax regulations. Decades later, those affected are still fighting for justice. In this episode: Yara Elmjouie (@yelmjouie), AJ+ presenter Episode credits: This episode was produced by Marcos Bartolomé with Phillip Lanos, Spencer Cline, Remas Alhawari, Khaled Soltan, Sarí el-Khalili, Noor Wazwaz, and our guest host, Manuel Rápalo. It was edited by Alexandra Locke. Our sound designer is Alex Roldan. Our video editors are Hisham Abu Salah and Mohannad Al-Melhem. Alexandra Locke is the Take’s executive producer. Ney Alvarez is Al Jazeera’s head of audio. Connect with us: @AJEPodcasts on Instagram, X, Facebook, Threads and YouTube

Send us a textThis week we look to deunk myths about rising autism rates and explain the genetic and environmental factors at play, while exploring the resurrection of dire wolves through genetic engineering and how puppy cognition predicts adult dog behavior.• CDC data shows autism diagnoses increased from 1 in 150 children in 2000 to 1 in 31 in 2022• Approximately 80% of autism cases stem from inherited genetic variations with 200+ genes linked to early brain development• Better screening, diagnosis, and awareness accounts for much of the increase in autism rates• Scientists have genetically engineered puppies with dire wolf traits using DNA from ancient remains• The three pups—Romulus, Remus, and Khaleesi—received 20 gene edits targeting coat color, body size, and facial features• Study of 1,400+ puppies shows early cognitive traits persist into adulthood• Puppies good at following pointing gestures became more trainable adults, while those with better impulse control grew into calmer dogs• Understanding puppy cognition allows for customized training approaches that support lifelong well-beingSome Links and Studies:https://www.sciencenews.org/article/autism-adhd-risk-not-linked-prenatal-exposure-antidepressantsS. Gilman et al. Rare de novo variants associated with autism implicate a large functional network of genes involved in formation and function of synapses. Neuron, Vol. 70, June 9, 2011. DOI:10.1016/j.neuron.2011.05.021D. Levy et al. Rare De Novo and Transmitted Copy-Number Variation in Autistic Spectrum Disorders. Neuron, Vol. 70, June 9, 2011. DOI 10.1016/j.neuron.2011.05.015Y. Sakai et al. Protein interactome reveals converging molecular pathways among autism disorders. Science Translational Medicine, Vol. 3, June 8, 2011. doi: 10.1126/scitranslmed.3002166Sanders et al. Multiple Recurrent De Novo CNVs, Including Duplications of the 7q11.23 Williams Syndrome Region, Are Strongly Associated with Autism. Neuron, Vol. 70, June 9, 2011. DOI:10.1016/j.neuron.2011.05.015C. Schaaf et al. Oligogenic heterozygosity in individuals with high-functioning autism spectrum disorder. Human Molecular Genetics. doi: 10.1093/hmg/ddr243. Available online: [Go to]C.P. Schaaf and H.Y. Zoghbi. Solving the autism puzzle a few pieces at a time. Neuron, Vol. 70, June 9, 2011. DOI: 10.1016/j.neuron.2011.05.025I. Voineagu et al. Transcriptomic analysis of autistic brain reveals convergent molecular pathology. Nature. doi: doi:10.1038/nature10110Our links:Our Website!  www.bunsenbernerbmd.comSign up for our Weekly Newsletter!Bunsen and Beaker on Twitter:Bunsen and Beaker on TikTokSupport the showFor Science, Empathy, and Cuteness!Being Kind is a Superpower.https://twitter.com/bunsenbernerbmd

Today's episode marks the start of our in-depth series on the potential harms of faith-based counseling, examining how scripture can sometimes be misused as a tool of control rather than healing. Approximately one-quarter of U.S. adults—about 28 percent—identify as evangelical Christians, and many turn to church-run counseling rather than licensed therapists. But what are the consequences when Christian nationalism, purity culture, and patriarchy influence the guidance given, leading to harmful practices and the reinforcement of abusive systems?In this first episode, I am joined by Peter Bell, host of the Sons of Patriarchy podcast, to explore how “Bible-only” therapy often silences survivors, how patriarchal theology shapes advice on relationships and mental health, and the critical warning signs when pastoral care shifts into manipulation and control. This conversation serves as the foundation for the important discussions that follow throughout the series.

fWotD Episode 2910: Aineta aryballos Welcome to Featured Wiki of the Day, your daily dose of knowledge from Wikipedia's finest articles.The featured article for Wednesday, 23 April 2025, is Aineta aryballos.The Aineta aryballos is an ancient Greek aryballos (a small, spherical flask or vase), made between approximately 625 and 570 BCE in the city of Corinth in southern Greece. Approximately 6.35 centimetres (2.50 in) in both height and diameter, it was intended to contain perfumed oil or unguent, and is likely to have been owned by a high-class courtesan (hetaira) by the name of Aineta, who may be portrayed in a drawing on its handle. The vase's illegal sale to the British Museum in 1865 led to the prosecution of its seller, the Athenian professor and art dealer Athanasios Rhousopoulos, and exposed his widespread involvement in antiquities crime. The vase is inscribed with a portrait, generally agreed to be that of a woman and probably that of Aineta, who is named in the inscription on the vase. Below the portrait are the names of nine men, usually taken to be Aineta's admirers or lovers. The Aineta aryballos is likely to have been found in a grave, probably that of Aineta. According to Rhousopoulos, it was discovered in Corinth around 1852. In 1877, Panagiotis Efstratiadis, the Ephor General of Antiquities in charge of the Greek Archaeological Service, had Rhousopoulos fined for selling the vase in contravention of Greek law. Writing in 2012 for the Center for Hellenic Studies, Yannis Galanakis called the case "a milestone in the trafficking of Greek antiquities", in that it represented a relatively rare successful use of state power against the illegal trade in ancient Greek artefacts.This recording reflects the Wikipedia text as of 00:30 UTC on Wednesday, 23 April 2025.For the full current version of the article, see Aineta aryballos on Wikipedia.This podcast uses content from Wikipedia under the Creative Commons Attribution-ShareAlike License.Visit our archives at wikioftheday.com and subscribe to stay updated on new episodes.Follow us on Mastodon at @wikioftheday@masto.ai.Also check out Curmudgeon's Corner, a current events podcast.Until next time, I'm neural Danielle.

Here's what to expect on the podcast:Kristina's journey in the health insurance industry.Some common misconceptions about health insurance.Why it's essential to understand your insurance benefits fully.The different types of insurance coverage.Practical steps employees can take when navigating confusing insurance policies.And much more! About Kristina:Kristina George has discovered her true calling after years of diverse job experiences. She is the co-author of a collaborative book that delves into finding passion, purpose, and the endless possibilities life holds. Kristina is the proud owner of a thriving health insurance agency in Wisconsin, where she and her team excel in problem-solving and helping others.Kristina's passion lies in assisting people to navigate and understand health insurance, particularly shaping her agency's focus toward helping employers reduce medical debt for their employees. Approximately three years ago, she began training agents nationwide on the Affordable Care Act, empowering them to protect their clients from medical debt. Connect with Kristina George!Website: https://nextstep-insurance.com/Email: kris@nextstep-insurance.comLinkedIn: https://www.linkedin.com/in/kristina-george-1a3677168/YouTube: https://www.youtube.com/@nextstepinsurance----- If you're struggling, consider therapy with our sponsor, BetterHelp.Visit https://betterhelp.com/candicesnyder for a 10% discount on your first month of therapy.*This is a paid promotionIf you are in the United States and in crisis or any other person may be in danger -Suicide & Crisis Lifeline Dial 988----- Connect with Candice Snyder!Website: https://www.podpage.com/passion-purpose-and-possibilities-1/Facebook: https://www.facebook.com/candicebsnyder?_rdrPassion, Purpose, and Possibilities Community Group: https://www.facebook.com/groups/passionpurposeandpossibilitiescommunity/Instagram: https://www.instagram.com/passionpurposepossibilities/LinkedIn: https://www.linkedin.com/in/candicesnyder/Shop For A Cause With Gifts That Give Back to Nonprofits: https://thekindnesscause.com/Fall In Love With Artists And Experience Joy And Calm: https://www.youtube.com/@movenartrelaxation

Ever wondered what actually happens to your recycling after it leaves your curb? Amanda Pratt, Senior VP of Communications at Rumpke, pulls back the curtain on recycling operations at North America's largest and most technologically advanced recycling facility, which is right here in Columbus, Ohio.The Rumpke Recycling and Resource Center, a $106 million investment that opened in 2024, processes an astonishing 60-70 tons of recyclables per hour using AI-powered optical scanners, advanced sorting technology, and a system designed to maximize recovery. The facility has expanded what Central Ohioans can recycle and now accepts those frustrating plastic clamshell containers alongside yogurt tubs, plastic cups and even greasy pizza boxes.What makes this story particularly powerful is the economic impact. Approximately 80% of materials collected stay right here in Ohio, supplying manufacturers that create new products and jobs. Beyond the industrial operation, Rumpke has partnered with COSI and OSU to create an immersive education center where visitors experience the complete lifecycle of recyclables—from consumer purchasing decisions to final products. School groups and community members can tour the facility and see firsthand how their recycling efforts make a difference.Lindsay and Bruce also talk with Amanda about common recycling myths and answer resident questions about everything from aluminum foil to Amazon packaging. With Dublin's waste diversion rate nearly 20% higher than the national average, this conversation offers both inspiration and practical guidance for anyone looking to reduce their environmental footprint not just for April's Earth Month but any month!

Approximately 6-10% of the general population and 15-50% of persons who are genetically prone to develop allergies are allergic to mold. Over 21 million people with asthma are suspected of having symptoms exacerbated by mold allergies.It's important to assess your house regularly to see any signs of potential water damage and mold growth. While bathrooms and basements are usual suspects for harboring mold, there are over 1,000 types of mold and we are exposed to them in various ways every day.That's why we're so glad to chat on IG Live with Integrative Health Practitioner Taylor Sappington. Taylor is an Integrative Health Practitioner who has really useful tips on her feed about mold.During this Live, we're going to discuss symptoms of mold exposure that are common and uncommon, as well as foods that are high mold, myths about mold, and so much more.Learn more about Taylor's services: https://beacons.ai/tayloredwellbeingGet tested for BPA, phthalates, parabens, and other hormone-disrupting chemicals with Million Marker's Detect & Detox Test Kit: https://www.millionmarker.com/

Approximately 80% of the immune system is in the gut; maintaining gut health is vital. The immune system defends against infections and diseases through various cells and barriers. Key supplements for immune support include Vitamin C, D3, Zinc, and probiotics, which enhance immune function and protect against pathogens.Get the notes for this podcast by joining our email list at Elev8YourLife.comDirections to join The Elev8 Tribe:1. Click the Link: Visit https://web.facebook.com/groups/10334779467352422. Join Group: Click the “Join Group” button.3. Answer Questions: Respond to any questions or agree to the group rules.4. Wait for Approval: An admin will approve your request, and you'll receive a notification once you're in.

Last time we spoke about Yamato's Last Stand. In the spring of 1945, as WW2 intensified, the US Marines commenced a fierce assault on Okinawa. Amidst heavy bombardment, the Japanese 32nd Army fortified their positions, preparing for a desperate counteroffensive. Codenamed Operation Ten-Ichi-Go, Japan's final bid involved the legendary battleship Yamato, tasked with a suicidal mission to confront the American fleet. On April 7, 1945, as the Yamato sailed towards its fate, American forces were ready. Hundreds of aircraft descended upon the ship in a coordinated attack, unleashing bombs and torpedoes. Despite its infamous firepower, Yamato struggled against the relentless onslaught. With its systems failing, Captain Aruga and Admiral Ito made the agonizing decision to go down with their ship. As the proud battleship sank, it symbolized both Japan's indomitable spirit and the crushing weight of defeat, forever etching its story into the annals of military history. This episode is the First Okinawa Counteroffensive Welcome to the Pacific War Podcast Week by Week, I am your dutiful host Craig Watson. But, before we start I want to also remind you this podcast is only made possible through the efforts of Kings and Generals over at Youtube. Perhaps you want to learn more about world war two? Kings and Generals have an assortment of episodes on world war two and much more  so go give them a look over on Youtube. So please subscribe to Kings and Generals over at Youtube and to continue helping us produce this content please check out www.patreon.com/kingsandgenerals. If you are still hungry for some more history related content, over on my channel, the Pacific War Channel you can find a few videos all the way from the Opium Wars of the 1800's until the end of the Pacific War in 1945.  Picking up from last time. The Japanese naval-air counteroffensive against Admiral Spruance's forces at Okinawa had been decisively defeated with minimal losses, allowing General Buckner's 10th Army to proceed with the land offensive largely without interference. While General Geiger's Marines advanced toward the sparse Japanese defenses in northern Okinawa, General Hodge's 24th Corps in the south encountered the main enemy line of resistance centered around the Shuri fortified zone. Initially, the 32nd Army had declined to launch a land counteroffensive in conjunction with Operation Ten-Go and the Yamato's suicide attack, fearing that the Americans might execute another amphibious landing at Machinato while the Japanese wasted their strength in a futile effort to reclaim the airfields. However, pressure from Tokyo and Formosa compelled General Ushijima to resume planning for this operation. Ultimately, it was decided that instead of initiating a broad counterattack, the Japanese would deploy a brigade-strength force overnight on April 12 to breach the American lines and advance approximately six miles. If successful, this would be followed by a general attack. Accordingly, Colonel Yoshida Masaru's 22nd Regiment was assigned to the 62nd Division and assembled northeast of Shuri, tasked with attacking through enemy lines east of the Ginowan Road and advancing toward Shimabuku. To bolster this offensive, General Fujioka was also instructed to deploy three reserve battalions for a three-pronged attack from the west aimed at Chatan. However, Colonel Yahara, 32nd Army operations chief, strongly opposed the counterattack plan, feeling that it was not in keeping with the army's defensive mission and that it would waste men. He succeeded in getting the 1st Battalion of the 22d Regiment and elements of the 23d IIB cut from the counterattack force. He made a dire prediction that the infiltrating units, unfamiliar with the terrain in their attack sectors, would get lost, confused, and cut to pieces during a night assault. Taking a sidenote here, I read Yahara's rather famous novel about his experience of the battle for Okinawa and I highly recommend it to all of you. It's a great insight into the perspective of the Japanese and how the leadership were beginning to change their mind on how to go about the war. Yahara, acting without Ushijima's knowledge, advised Fujioka to commit only four battalions to the attack, predicting it would inevitably fail. Meanwhile, the American offensive was still in progress. On April 9, as Major-General George Griner's 27th Division landed at the Orange Beaches near Kadena, the ships of Colonel Waltern Winn's 105th Regiment met with Admiral Blandy's Eastern Islands Attack and Fire Support Group at the Kerama Islands, preparing to move to Tsugen Island overnight. Following a preliminary air and naval bombardment, which saw some Japanese mortar fire in response, Winn's 3rd Battalion successfully landed on the morning of April 10. The Americans then advanced inland with light resistance, quickly securing the northern part of the island but failing to overrun the entrenched enemy positions in Tsugen village. The assault continued the next day against persistent opposition, but organized resistance gradually diminished, allowing the Americans to secure the rest of the island by nightfall, marking the conclusion of the Eastern Islands operation. On April 11, General Shepherd's Marines continued to probe for the main enemy positions in northern Okinawa; the 1st Battalion, 22nd Marines patrolled eastward from their new base at Shana Wan, while the 29th Marines advanced toward Manna. Due to this progress, Buckner decided to fully merge Phases I and II, ordering the 77th Division to capture Iejima on April 16. To the south, Colonel Albert Stebbins's 106th Regiment was attached to the 96th Division, moving toward that division's reserve area, while Colonel Gerard Kelley's 165th Regiment relieved the 17th Regiment in the corps service area. Most significantly, General Bradley continued his attacks on Kakazu Ridge, with the 1st Battalion, 381st Regiment attempting to assault the western slopes but halted short of the ridge crest by determined defenders. At the same time, the 3rd Battalion, 383rd Regiment pushed up the northwest slopes of Kakazu Ridge but was also pinned down by intense Japanese fire. Simultaneously, following an intense artillery bombardment, the 1st Battalion of the 32nd Regiment finally succeeded in breaking into Ouki. However, additional reinforcements were thwarted by heavy Japanese fire, forcing the troops to retreat. With no further advancements, the 7th Division and the 382nd Regiment were relegated to patrolling and mopping up their designated areas over the next few days. At sea, Admiral Ugaki resumed his kamikaze assaults that day, damaging the carriers Essex and Enterprise, the battleship Missouri, and eight destroyers. However, his primary operation commenced on April 12, when he launched approximately 380 aircraft for a second mass Kikisui attack, primarily targeting Admiral Turner's Task Force 51 west of Okinawa. Thanks to cryptanalysis warnings, Turner scrambled his own fighter planes, which successfully shot down 298 Japanese aircraft. Despite attempting numerous missions, Kanoya's specially trained 721st Kokutai Jinrai-Butai “Divine Thunder” unit had so far failed to launch a single Ohka suicide rocket against the Americans. On April 12, however, eight Betty bombers would finally launch six Ohkas against the 5th Fleet, although five Betties never returned. At RPS-14, about 70nm northwest of Okinawa, a Zero plowed into Mannert L. Abele's engine room at 14:40, its 500lb bomb exploding and leaving the destroyer dead in the water. One minute later an Ohka came screaming in at 575mph, slammed into Mannert L. Abele and exploded. She sank in five minutes, losing 97 dead. Mannert L. Abele was the first destroyer hit by an Ohka and the last sunk by one. Destroyer-minesweeper Jeffers, en route to assist Mannert L. Abele, observed a twin-engined bomber eight miles away drop a smoking “belly tank” that suddenly rocketed towards Jeffers “at terrific speed.” Numerous 40mm hits and hard maneuvering saw the Ohka miss Jeffers astern and disintegrate. Additionally 3 battleships, 14 destroyers, 2 destroyer minesweepers, and another landing craft were damaged. Meanwhile, Admiral Rawlings' Task Force 57 was ordered to strike the Shinchiku and Matsuyama airfields in northern Formosa, and over the next two days, 48 Avengers and 40 fighters successfully attacked Shinchiku and Kiirun Harbor. On Okinawa, the 6th Reconnaissance Company captured Bise Saki with minimal resistance, while the 29th Marines faced significant opposition southeast of Manna near Mount Yae-Take, indicating where the main enemy forces were located. This prompted Shepherd to reposition the 3rd Battalion, 22nd Marines to Awa as his new divisional reserve. At the same time, Japanese guerrillas managed to retake Ishikawa, which they would hold for the following two days. Facing south, the 96th Division made another attempt to capture Kakazu but was once again thwarted by the determined defenders. By this time, approximately 5,750 Japanese soldiers were estimated to have been killed in the southern region, while the 24th Corps suffered losses of 451 men killed, 2,198 wounded, and 241 missing. In the afternoon of April 12, 1945, in Warm Springs, Georgia, while sitting for a portrait by Elizabeth Shoumatoff, President Franklin D. Roosevelt said: "I have a terrific headache." He then slumped forward in his chair, unconscious, and was carried into his bedroom. The president's attending cardiologist, Howard Bruenn, diagnosed a massive intracerebral hemorrhage. At 3:35 pm, Roosevelt died at the age of 63. His declining health had been kept secret from the public, leading to shock and sorrow worldwide upon the news of his death. Harry Truman, who was serving as vice president in 1945, succeeded FDR as president. Meanwhile, back in Okinawa, Fujioka initiated his counteroffensive after a heavy artillery bombardment, advancing his four battalions to secretly infiltrate the American lines. On the eastern front, the 22nd Regiment struggled to advance due to becoming disoriented in unfamiliar terrain.  The night attacks suffered from several unexpected problems. Heavy shelling had changed the landscape, blasting away villages and thickets, so that even though night infiltrators knew their maps and thought they knew the terrain, they lacked the landmarks needed to tell them where they actually were. Moreover, frequent illumination shells forced the eyes of night infiltrators to adjust so many times that their capacity to adjust was lost. They became temporarily blinded and so were unable to move. Because of the unfamiliar terrain and flash blindness, the Japanese night fighters had difficulty reaching their assigned objectives. In fact, it was hard for them to reach their jumping-off points. Continuous naval bombardment of crossroads and bridges forced units to rush across in small groups between shells so that the units became strung out on the roads and difficult to control. It was hard to move heavy ammunition and supplies forward because of these interdiction points and the generally churned up roads. Even when units reached their northward assembly points safely by night, they were immediately exposed to aerial observation and artillery fire at dawn, since they lacked enough time to dig in. Units that attacked across American lines safely in darkness had the same problem: they lacked time to dig in and so were utterly exposed to artillery fire at morning light. Night attacks, like flanking maneuvers, were a kind of cure-all in prewar Japanese doctrine. But they failed to provide the expeditious results on Okinawa that IJA doctrine had led the 32d Army Staff to expect. Consequently, Yoshida's four infiltration attempts, each involving about a squad, were effectively repelled by troops from the 32nd, 184th, and 382nd Regiments before midnight. The only significant attack came from around 45 Japanese soldiers against the positions held by Company G of the 184th, which quickly returned fire, forcing the enemy to retreat to their caves and trenches. In contrast, the assault on the 96th Division on the western front was intense, sustained, and well-coordinated. The forward units of Major-General Nakajima Tokutaro's 63rd Brigade launched their own local offensive to maintain pressure on the thin line held by the 382nd and 383rd Regiments, while elements from the 23rd, 272nd, and 273rd Independent Battalions infiltrated the American lines and moved into the Ginowan area. The majority of the 272nd Division launched an assault on American positions at Kakazu Ridge, enduring intense naval and artillery fire but ultimately being repelled by the determined defenders after several hours of combat. By morning, the bodies of 317 enemy soldiers were counted on the ridge, whereas the Americans suffered 50 casualties. Meanwhile, the 273rd Division attacked along the west coast against the recently arrived 2nd Battalion of the 106th Regiment, which decisively repelled the Japanese assault and nearly annihilated the independent battalion. Despite this, some units from the 23rd and 272nd Independent Battalions managed to penetrate approximately 1,000 yards behind American lines between Nishibaru and Kaniku but became isolated after dawn on April 13. Throughout the day, Bradley's troops worked to eliminate these infiltrators, many of whom detonated explosives when trapped. When these units retreated into Japanese lines later that night, only half of their original numbers had survived. Just before midnight, the reserve 9th Company of the 22nd Regiment launched an attack against the 184th Regiment following preparatory artillery fire, but this offensive was quickly disrupted by artillery, mortars, and machine-gun fire. On April 14, Nakajima's forces attempted two more assaults on Kakazu in the early hours, but these attempts were similarly thwarted by artillery and machine-gun fire. Given the failures of the offensives, Ushijima had no choice but to order a suspension of the attack, resulting in a shift to a defensive posture for the Japanese. Over the two days of combat, the 24th Corps reported killing 1,594 Japanese soldiers and capturing four, with losses of fewer than 100 American troops. In the northern region, an extensive air and naval bombardment of Iejima commenced while the Fleet Marine Force Amphibious Reconnaissance Battalion landed on Minna Island, securing it without encountering resistance to position artillery units for General Bruce's upcoming attack, which would involve the 305th and 306th Regiments. Meanwhile, in northern Okinawa, the 29th Marines continued to advance against enemy positions at Yae-Take through vigorous patrolling, preparing for a morning assault the next day. Concerned about the pace of progress, Shepherd relieved Colonel Bleasdale of command, replacing him with veteran Colonel William Whaling. However, Shepherd recognized that taking the 1,200-foot summit would require more than one regiment, so he ordered the 4th Marines to move from the east coast to Yofuke and then to the southwest corner of the Motobu Peninsula. Additionally, Colonel Shapley's 3rd Battalion was tasked with moving to Kawada, while the reinforced 2nd Battalion of the 22nd Marines rapidly advanced up the west coast to secure Hedo Misaki. On April 14, Shepherd initiated a coordinated assault on Yae-Take, with Whaling's 3rd Battalion and Shapley's 2nd Battalion advancing from the area around Toguchi against unexpectedly light resistance, while the rest of the 29th Marines moved out from Itomi to clear the Itomi-Toguchi Road. Although the eastern front faced strong opposition and required a change in strategy to advance southwesterly for better elevation advantage, rapid progress was made on the west, prompting Shapley to commit his reserve 1st Battalion to secure the exposed right flank. At the same time, Whaling's 3rd Battalion and Shapley's 2nd Battalion continued their advance against significantly strengthened enemy resistance, ultimately capturing another ridge located 1,000 yards ahead. Initial opposition consisted of small enemy groups. These hostile covering forces employed every available means to delay and disorganize the advance, and to mislead the attackers as to the location of the battle position. The Japanese would lie in concealment, with weapons zeroed in on a portion of a trail, allowing a considerable number of Marines to pass before opening up on a choice target. An entire platoon was permitted to pass a point on a trail without interference, but when the company commander reached that point with his headquarters section, a burst of machine-gun fire killed him and several others. Officer casualties were excessively high. In an area in which there had been no firing for over half an hour, Major Bernard W. Green, commanding the 1st Battalion, 4th Marines, was killed instantly by machine-gun fire. No one else was hurt, although Major Green was standing with his operations and intelligence officers on either side of him. Lieutenant Colonel Fred D. Beans, Regimental Executive Officer, assumed command of the battalion. "It was like fighting a phantom enemy." For while the hills and ravines were apparently swarming with Japanese, it was difficult to close with them. The small enemy groups, usually built around a heavy Hotchkiss machine gun augmented by Nambus, would frequently change positions in the dense vegetation. Hostile volleys elicited furious Marine fusillades into the area from whence the firing had come. But after laboriously working their way to the spot, the Marines came upon only an occasional bloodstain on the ground. Neither live nor dead Japanese were to be found. One Marine registered his impression of these tactics by blurting out, "Jeez, they've all got Nambus, but where are they?" Meanwhile, the 29th Marines advanced 800 yards up steep slopes despite facing fierce opposition; however, the 1st Battalion eventually found itself pinned down by intense Japanese gunfire. Additionally, Shapley's 3rd Battalion crossed the island via motor march to relieve the 3rd Battalion of the 22nd Marines in division reserve, which then returned to its patrol base at Majiya. To the south, Hodge recognized the need for a full-scale effort to penetrate the fortified Shuri area, so he scheduled a corps attack involving three divisions abreast for April 19. In preparation, he dedicated the following four days to organizing the assault, with the 27th Division taking over from the 96th Division in the western region of its zone, while smaller local attacks were conducted to enhance forward positions. Aware of the impending major attack, the Japanese used this preparatory period to bolster their defenses with additional supporting weapons. Back to the north, on April 15, most of the 29th Marines consolidated their defenses on high ground and exerted constant pressure on the rear of the Yae-Take position through vigorous patrols to the west and northwest. On the other hand, Whaling's 3rd Battalion advanced east and south approximately 900 yards amidst heavy machine-gun, mortar, and artillery fire before being halted by a strong enemy position on Hill 210. Additionally, the 4th Marines faced fierce resistance as Shapley's battalions finally secured Hill 200 and a critical hill mass just southwest of Yae-Take. Fully aware that his primary positions would soon be overrun, Colonel Udo decided to transition to guerrilla tactics by nightfall, relocating his command to the mountainous regions of northern Okinawa via Itomi. In light of these developments, the 1st Battalion, 22nd Marines was placed into division reserve at Awa to allow Shapley's 3rd Battalion to prepare for the following day's assault. On April 16, the offensive resumed, with Whaling's 3rd Battalion swiftly capturing Hill 210 in conjunction with Shapley's 2nd Battalion. Meanwhile, the rest of the 4th Marines secured a ridge just below Yae-Take by midday, while the 29th Marines applied continuous pressure on the rear of Udo's fortified stronghold. While the 4th Marines was storming the fortified position on Yae-Take, the 29th Marines maintained relentless pressure against its rear. The opposition which faced the 29th was similar to that on the front of the 4th. From log-revetted bunkers and occasional concrete emplacements the enemy resisted the advance with increasing stubbornness, supported by machine-guns, mortars, and artillery concealed in ravines and in caves on the high ground. Rugged terrain and an acute supply situation also contributed to the difficulties confronting the 29th Marines in accomplishing its task of clearing the high ground flanking the Itomi-Toguchi Road. The enemy displayed his usual ability to exploit the terrain and derived the maximum benefit from his weapons emplaced in caves and pits and concealed by natural cover. Particularly noteworthy was his use of 20mm dual-purpose cannon against personnel. Fire from these weapons on battalion CPs was a daily occurrence. All roads and natural avenues of approach were covered. Any attempt to move over the easier routes was met with bitter and effective resistance. Consequently, "the method of reducing the enemy positions followed a pattern of 'ridgehopping'," covered by the fires of all supporting weapons. This tactic enabled the attacker to envelop the hostile defenses and reduce them in detail. Numerous abandoned positions and weapons encountered by the 29th indicated that the determination of the Japanese to resist diminished considerably when they were taken from the flank. In contrast to a coordinated advance with all units in contact across a broad front, the action in the zone of the 29th Marines was characterized by attacks that, even when delivered simultaneously, constituted a series of local patrol actions to seize critical positions, followed by mopping up activity within the area. In the afternoon, Shapley's 1st and 3rd Battalions assaulted the formidable mountain, gradually making their way up the steep slope under light and scattered small-arms fire. However, as the Marines reached the peak, they encountered intense fire at close range, which quickly forced them to pull back. After a fierce and close engagement, the 1st Battalion ultimately regained control of Yae-Take, managing to hold the summit against strong Japanese counterattacks, aided by artillery support and Shapley's 2nd Battalion. Meanwhile, at dawn on April 16, two battleships, four cruisers, and seven destroyers under Rear-Admiral Bertram Rodgers launched a heavy bombardment on Iejima, while aircraft bombed and rocketed the island, dropping tanks of napalm on and behind the beaches. Approximately 2,000 Japanese troops, led by Major Igawa Masashi, had destroyed Iejima's airfields and strengthened the central eastern region of the island in an effort to entice the invaders to approach the vulnerable southeastern beaches. Their aim was to annihilate them with concentrated fire from numerous hidden positions in the Pinnacle and the town of Ie. However, the Americans saw through this strategy. Bruce's plan involved landing Lieutenant-Colonel Joseph Coolidge's 305th Regiment on the Red Beaches along the southern coast of Iejima and Colonel Aubrey Smith's 306th Regiment on the Green Beach at the island's southwest tip. The 305th was tasked with advancing eastward to capture additional landing areas, while the 306th was to move north and take control of the airfield. Both regiments would then focus on neutralizing enemy strongholds at the island's eastern end. Following intense air and naval bombardments, amphibious tanks and subsequent waves of amphibious tractors surged toward the landing beaches that morning, supported by rocket fire from LCI gunboats. At 07:58, the forward elements of the 1st Battalion, 305th Regiment successfully landed on the southern coast of Iejima, just south of the airfield, while the 3rd Battalion landed on a different beach, 600 yards to the left, three minutes later. At 08:07, the first waves of the 306th Regiment made landfall on Green Beach. The 305th moved swiftly inland over high dunes and then turned east toward Ie, while the 306th advanced 2,000 yards inland to the airfield's western edge, with the reserve 3rd Battalion securing the island's western end. By the afternoon, the troops advanced rapidly, seizing the airfield with only light resistance, achieving a total gain of about 5,500 yards by nightfall. Conversely, the 305th faced stiffer opposition on its way to Ie, managing to advance only about 800 yards eastward while defending against strong nighttime counterattacks. During the night of 16 April the enemy launched a coordinated attack on the 3d Battalion of the 305th. The attack came with suicidal recklessness. The Japanese were supported by mortars and 70-mm. guns, and were armed with small arms, sharpened stakes, bags of hand grenades, and literally hundreds of satchel charges, some of which had been improvised from mortar shells. Japanese worked up to the perimeters in small groups and either threw their satchel charges at close range or blew themselves up in an effort to take Americans with them. Some of the human bombs were successful, but most of the Japanese were killed before they came within effective range. One American had his arm broken by the flying leg of a Japanese soldier who had blown himself up. After hours of wild fighting in the dark the enemy withdrew, leaving 152 of his dead in and around the 3d Battalion's position.  While back at sea, Admiral Mitscher's Task Force 58 had effectively launched attacks on Amami Oshima, Tokunoshima, Kikaijima, and southern Kyushu over the past four days, the Japanese responded with a series of scattered kamikaze assaults that caused damage to the battleship New York and four destroyers. On April 16, Ugaki initiated his third large-scale Kikisui attack, acutely aware that another failure in the air could spell the doom of Operation Ten-Go. Despite Mitscher's preemptive strikes against Kyushu, where Americans claimed to have destroyed 202 aircraft and damaged 79 at the cost of only nine planes, at least 289 Japanese attackers were still able to launch missions against Spruance's 5th Fleet. Although American interceptors and anti-aircraft fire recorded another 217 kills, the surviving kamikaze pilots managed to sink the destroyer Pringle and inflict damage on the carrier Intrepid, the battleship Missouri, three destroyers, two destroyer minesweepers, and two landing craft. Notably, the destroyer Laffey withstood six kamikaze impacts, four bomb hits, and numerous strafing runs, resulting in 32 fatalities and 71 injuries among its crew. The following day, a smaller attack on April 17 resulted in additional damage to the light carrier Bataan and one destroyer, yet Americans claimed another 49 kills. However, Ugaki had exhausted much of his strength since the invasion began and was left with approximately 598 operational planes. Meanwhile, fighting continued in northern Okinawa, where some surviving troops from Udo advanced toward Nakaoshi to escape the Motobu Peninsula. Supported by heavy artillery barrages and battleship gunfire, the 29th Marines slowly progressed over challenging terrain, encountering only light resistance, as they successfully secured the mountainous area ahead and connected with the 4th Marines. Shapley's 1st and 3rd Battalions continued their push northward toward the Itomi-Toguchi Road, swiftly advancing downhill and completely overwhelming all Japanese defenses in the region. By nightfall, the 4th and 29th Marines had positioned themselves along the elevated terrain overlooking the Itomi-Toguchi Road. The 305th resumed its assault, aiming to capture the high ground behind Red Beaches 3 and 4. The 1st Battalion encountered only minimal resistance along the coast, allowing them to make significant progress, while the 3rd Battalion quickly secured the high ground in its area before being halted by intense machine-gun fire from caves in the coral slopes to the north. A maneuvering strategy followed by an infantry-tank assault eventually neutralized this enemy position, enabling the advance to continue steadily until the 3rd Battalion reached the outskirts of Ie. Due to the strong resistance faced, Bruce opted to deploy Colonel Stephen Hamilton's 307th Regiment on the beaches southwest of Ie. The 2nd and 3rd Battalions were subsequently landed there and launched an attack northeast, quickly advancing approximately 400 yards despite increasingly fierce resistance, ultimately being halted by heavy enemy fire from Bloody Ridge and Government House Hill. Meanwhile, the 306th Regiment maintained its defensive position while probing the enemy's fortifications around Iegusugu. The next day, the 306th began to pivot its right flank and launched an attack toward the Pinnacle with two battalions, making notable progress throughout the day. Concurrently, the 307th continued its advance into Ie despite facing heavy resistance, quickly reaching a standstill in front of Government House Hill. As a result, with the 2nd Battalion effectively immobilized, the decision was made to deploy the 3rd Battalion around to the right flank to launch an assault toward the northeast in the eastern part of the town, while the 3rd Battalion of the 305th Regiment advanced eastward toward Iegusugu. After a heavy preparation by the artillery on Minna Shima, the 3d Battalion, 305th, attacked at 1130 on an 800-yard front. A house-to-house fight ensued amid the rubble of Ie. "Every street became a phase line," one observer reported. The necessity of forming a connecting link over the wide area between the 306th and the 307th made the fight harder. Artillery was ineffective against many enemy positions and could not be used freely because other friendly units were so close by. Self-propelled guns were held up by mines and debris in the narrow streets. After working about halfway through the northwestern section of the town, the troops withdrew to a more secure position on the outskirts, their right (south) flank then being 500 yards west of Government House Hill, and their left (north) flank 100 yards west of the base of Iegusugu. They had made a net gain of only about 350 yards for the day. Similarly, Hamilton's 3rd Battalion achieved moderate success, advancing to a position 300 yards north of the village of Agarii-mae. To protect its right flank, the 1st Battalion of the 305th Regiment positioned itself alongside the 3rd Battalion of the 307th Regiment and launched a northern attack, gaining approximately 1000 yards by day's end before withdrawing to a position about 600 yards east of Agarii-mae. Medium tanks and self-propelled guns covered the gap that developed between the two battalions of the 307th. These weapons put direct fire into caves, pillboxes, and enemy gun positions in the town of Ie and the Pinnacle. They could not be moved close to the enemy positions, however; deadly machine-gun and mortar fire held the infantry back and left the armor vulnerable to suicide attacks by Japanese armed with satchel charges, who hid in holes until the tanks and guns came within range. Meanwhile, after four days of intense fighting, activities in the Motobu area on April 18 were limited to reorganization, consolidating the gains from the previous day, patrolling the Itomi-Toguchi Road, and resupplying. Looking south, Griner called for a nighttime preliminary attack to secure the Machinato Inlet and the Urasoe-Mura Escarpment. As the area was shrouded in smoke during the afternoon, Company G of the 106th Regiment swiftly crossed the inlet and successfully secured Machinato by nightfall, while bridges were constructed at the inlet. The 106th then moved across the bridges, stealthily advancing toward the Urasoe-Mura Escarpment without encountering opposition. Near the summit, the troops launched a surprise ambush against the defenders, ultimately forcing the Japanese to retreat in chaos. With the escarpment secured by dawn, the 106th was prepared to participate in the general attack to the south. I would like to take this time to remind you all that this podcast is only made possible through the efforts of Kings and Generals over at Youtube. Please go subscribe to Kings and Generals over at Youtube and to continue helping us produce this content please check out www.patreon.com/kingsandgenerals. If you are still hungry after that, give my personal channel a look over at The Pacific War Channel at Youtube, it would mean a lot to me. The first Okinawa counteroffensive, as part of Operation Ten-Ichi-Go was not achieving results. Despite overwhelming sacrifices of men and supplies, it seemed hopeless for the Japanese on Okinawa. Those like Colonel Yahara could see the paint on the wall, much to their growing depression.

Today's episode is a unique episode well for a unique week. If you are listening to this when it is released, it is the Monday of Holy Week. Approximately 6 days before Easter weekend festivities kick off, of course depending on when those festivities actually begin.  Is there a way to make Holy Week less stressful? Is there a way for you to get what you need to get done and actually enjoy Easter weekend with your church family.I think so. I think it's possible to calm the chaos.So hears my pep talk to help you prepare for Holy Week & Easter Weekend. 5 steps you can take to calm the chaos of Easter Week.

Spring Break Alert! Get your bus ticket to Cabo and/or Wabo, because it's time for a springtime April catch-up! Tony and TJ 1969 Xmas Flexi Disc the heck out of this episode, as they review the latest Beatle film news, and more! Plus, newly crowned 8th Beatle Yoko Ono takes the spotlight, with a deluxe reissue of our early-ass look at Approximately Infinite Universe; now in Dolby NR! EPISODE LINKS Like and subscribe! Please support our scrappy show. Score some sweet merch or find us on Patreon. Come hang with us on Facebook/Twitter/Instagram! Drop us a review on Apple Podcasts! ----- Originally reissued August 12, 2023 Yang Yang! You've given me a Yang Yang! And we're thinking of Yoko…so we've decided to reach into our archives for a limited, deluxe remix/remaster/reissue/bonus Gnome edition of our vaunted 4th episode in 2020, where we deep-dished a Tony favorite: Yoko Ono's “Approximately Infinite Universe”! Did you know it's TWO albums? Well hell yeah, it is! Good for Tony. Butt, what about T.J.? Well, there are even more questions that must be answered, such a$:

Anne Reinke and Joe Lynch discuss beyond the rails and roads: the state of intermodal. Anne is the President & CEO at the Intermodal Association of North America (IANA), North America's leading industry trade association representing the combined interests of the intermodal freight industry. About Anne Reinke Anne Reinke became the Intermodal Association of North America's third President & CEO in December of 2024.  Immediately preceding her appointment at IANA, Anne was President & CEO of the Transportation Intermediaries Association for four years. Anne has a long career in transportation policy, with a stint at the Association of American Railroads, 16 years at CSX Corporation, eight of which as Vice-President for Government Affairs, and a political appointment as a Deputy Assistant Secretary at the U.S. Department of Transportation. She received a B.A. from Rice University in Houston, TX and a J.D. from Wake Forest School of Law in Winston-Salem, NC.  She is a Washington, DC native; she, her husband, her two sons and her dog live in Alexandria, VA. About Intermodal Association of North America (IANA) IANA is North America's leading industry trade association representing the combined interests of the intermodal freight industry. IANA's membership roster of over 1,000 corporate members includes railroads; water carriers and stacktrain operators; port authorities; intermodal truckers and over-the-road highway carriers; intermodal marketing and logistics companies; and suppliers to the industry such as equipment manufacturers, intermodal leasing companies and technology firms. IANA's associate (non-voting) members include shippers, academic institutions, public sector organizations and non-profit associations. Key Taways: Beyond The Rails and Roads: The State of Intermodal Industry Representation: IANA is North America's leading trade association representing the combined interests of the intermodal freight industry, encompassing railroads, water carriers, port authorities, intermodal truckers, logistics companies, and equipment suppliers. Extensive Membership: The association boasts a diverse membership of over 1,000 corporate members, including Class I, short-line, and regional railroads; water carriers and stacktrain operators; port authorities; intermodal truckers; over-the-road highway carriers; intermodal marketing and logistics companies; and suppliers such as equipment manufacturers, leasing companies, and consulting firms. Mission and Vision: IANA's mission is to promote the growth of efficient intermodal freight transportation through innovation, education, and dialogue. Its vision includes advocating for the benefits of intermodal transportation, providing a neutral forum for industry stakeholders, influencing legislative and regulatory environments, promoting efficient business processes, and delivering excellence through its operations. Educational Initiatives: In collaboration with academic institutions like the Delft University of Technology and the University of Maryland Smith School of Business, IANA offers an online intermodal course comprising eight modules that cover various aspects of intermodal operations, benefiting both newcomers and seasoned professionals in the industry. Policy Advocacy: IANA actively monitors federal and state legislative and regulatory initiatives affecting the intermodal supply chain, providing education and insights to policymakers to shape favorable policies and regulations for the industry. Annual Intermodal EXPO: The association organizes the Intermodal EXPO, a premier event that brings together industry professionals to explore technological advancements, discuss industry trends, and network with peers. The next EXPO is scheduled for September 15-17, 2025, in Los Angeles, CA. Unified Intermodal Interchange Agreement (UIIA): IANA administers the UIIA, a standardized contract that outlines the rules for the interchange of equipment between intermodal trucking companies and equipment providers, streamlining operations and reducing the need for multiple contracts and insurance filings. Approximately 95% of North American equipment interchanges are managed under the UIIA, with over 13,000 intermodal trucking companies participating. Learn More About Beyond The Rails and Roads: The State of Intermodal Anne Reinke | Linkedin IANA | Linkedin IANA Homepage | UIIA What is Intermodal? U.S. Trade and Tariffs Events Amazon.com: The Box: How the Shipping Container Made the World Smaller and the World Economy Bigger - Second Edition with a new chapter by the author eBook : Levinson, Marc: Books The Voice of 3rd Party Logistics with Anne Reinke | The Logistics of Logistics The State of Freight with Anne Reinke | The Logistics of Logistics Trucking Through Trouble with TIA & Anne Reinke | The Logistcs of Logistics The Logistics of Logistics Podcast If you enjoy the podcast, please leave a positive review, subscribe, and share it with your friends and colleagues. The Logistics of Logistics Podcast: Google, Apple, Castbox, Spotify, Stitcher, PlayerFM, Tunein, Podbean, Owltail, Libsyn, Overcast Check out The Logistics of Logistics on Youtube  

N Engl J Med 2024;391:1673-1684Background: Non-ST elevation myocardial infarction (NSTEMI) is the most common acute coronary syndrome subtype in adults over 75 years old. However, these patients were underrepresented in landmark NSTEMI trials. Older adults with multiple comorbidities face an increased risk of mortality. While NSTEMI contributes to this risk, they also have competing risks such as advanced age, frailty, and chronic kidney disease. The presence of competing risks means that aggressively managing one condition may have a smaller impact on overall mortality compared to a younger, otherwise healthy adult with myocardial infarction, whose primary risk of death stems from the myocardial infarction itself. Additionally, comorbid conditions like advanced kidney disease and diffuse atherosclerosis can increase the risks associated with revascularization.Cardiology Trial's Substack is a reader-supported publication. To receive new posts and support our work, consider becoming a free or paid subscriber.A patient-level meta-analysis of smaller trials, including 1,479 patients, found that in elderly patients with NSTEMI, an invasive strategy reduced myocardial infarction and urgent revascularization but not mortality.The Older Patients with Non–ST-Segment Elevation Myocardial Infarction Randomized Interventional Treatment (SENRIOR-RITA) trial sought to assess invasive vs conservative management of elderly patients with NSTEMI, in a more pragmatic design.Patients: Eligible patients had to have type I NSTEMI and be 75 years or older.Patients were excluded if they had cardiogenic shock or life expectancy less than 1 year.Baseline characteristics: The trial randomized 1,518 patients from hospitals across England and Scotland – 753 randomized to invasive strategy and 765 to conservative strategy.The average age of patients was 82 years and 55% were men. Approximately 65% had hypertension, 31% had diabetes, 31% had hyperlipidemia, 31% had prior myocardial infarction, 15% had prior stroke or TIA, 21% had kidney disease, 15% had chronic obstructive pulmonary disease, and 5% were current smokers.The average Charlson comorbidity index was 5.Procedures: Patients were randomly assigned in a 1:1 ratio to undergo invasive or conservative strategy.In the invasive strategy, patients underwent coronary angiogram, and revascularization was performed as appropriate. In the conservative arm, patients were treated (unless contraindicated) with aspirin, a P2Y12 receptor antagonist, statin, beta-blocker and an angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker. Patients in the conservative arm were allowed to have a coronary angiogram if they had worsening clinical status.Endpoints: The primary end point was a composite of cardiovascular death or nonfatal myocardial infarction. Secondary outcomes included all-cause death, subsequent coronary revascularization, hospitalization for heart failure, stroke and bleeding.Analysis was performed based on the intention-to-treat principle. The trial aimed to detect a hazard ratio of 0.78, assuming a 20% risk of the primary outcome in the conservative arm. A sample size of 1,668 patients with at least 688 primary outcome events would provide 90% power at 5% alpha, while 520 events would provide 80% power.Results: Among the patient randomized to the invasive arm, 90% underwent coronary angiography and 50% underwent revascularization. The medium number of days from admission to coronary angiography was 5. Among patients randomized to the conservative arm, 5.6% underwent coronary angiography within 7 days. The median follow-up time was 4.1 years.The primary outcome was not significantly different between both groups (25.6% with invasive vs 26.3% with conservative, HR: 0.94, 95%: 0.77 - 1.14; p= 0.53).There was also no difference in all-cause death (36.1% vs 32.3%), cardiovascular death (15.8% vs 14.2%), stroke (4.2% vs 5.2%), hospitalization for heart failure (10.9% vs 10.7%), or major bleeding (8.2% vs 6.4%) “incidence for invasive mentioned first”. Future coronary revascularization was more frequent in the conservative arm (13.7% vs 3.9%). Non-fatal myocardial infarction was significantly lower with an invasive strategy (11.7% vs 15.0%).Procedural related complications occurred in less than 1% of the patients.There were no significant subgroup interactions for the primary outcome.Conclusion: In older patients with NSTEMI, an invasive strategy compared to conservative strategy, did not reduce the primary composite endpoint of cardiovascular death or nonfatal myocardial infarction, over a median of 4.1 years.The trial enrolled fewer patients than planned, and the lower-than-expected event rate reduced its statistical power. Additionally, the median 5-day delay before coronary angiography may have biased the results toward the conservative strategy.Despite its limitations, this trial demonstrates that a conservative approach is a reasonable option for selected older patients with NSTEMI. It also highlights that, although enrolling older patients with comorbidities in trials is challenging, it is feasible, and greater effort is needed to include more of this population in future trials.Finally, in this trial of patients with myocardial infarction, about one-third died over a median of 4.1 years, with less than half of these deaths attributed to cardiovascular disease. Even if an invasive strategy had reduced cardiovascular mortality, its impact on all-cause mortality would have been less significant. This concept extends beyond this trial; when interventions are applied to older patients with multiple competing risks, their overall benefit diminishes.Cardiology Trial's Substack is a reader-supported publication. To receive new posts and support our work, consider becoming a free or paid subscriber. Get full access to Cardiology Trial's Substack at cardiologytrials.substack.com/subscribe

JAMA Intern Med 2023;183:407-415Background: As we have previously discussed, trials comparing invasive versus conservative management in patients with non-ST elevation myocardial infarction (NSTEMI) have yielded mixed results. The average age of participants in these studies was in the 60s, and multiple comorbidities were relatively uncommon. However, many NSTEMI patients seen in clinical practice are older and have multiple comorbidities. These patients have worse prognosis and have competing risks for mortality. Whether an invasive strategy provides a benefit for this population remains uncertain.Cardiology Trial's Substack is a reader-supported publication. To receive new posts and support our work, consider becoming a free or paid subscriber.The MOSCA-FRAIL trial sought to compare invasive vs conservative strategy in older adults with frailty and NSTEMI.Patients: Eligible patients had to have NSTEMI, be 70 years or older, and have frailty defined by 4 points or greater on the Clinical Frailty Scale.Patients were excluded if they were known to have nonrevascularizable coronary artery disease, significant concomitant non-ischemic heart disease, or life expectancy less than 12 months.Baseline characteristics: The trial randomized 167 patients from 13 hospitals in Spain – 84 randomized to invasive strategy and 83 to conservative strategy.The average age of patients was 86 years and 47% were men. Approximately 92% had hypertension, 56% had diabetes, 77% had hyperlipidemia, 31% had prior myocardial infarction, 27% had history of atrial fibrillation, 18% had prior stroke, 44% had chronic kidney disease, and 3% were current smokers.Procedures: Patients were randomly assigned in a 1:1 ratio to undergo invasive or conservative strategy.In the invasive strategy, patients underwent coronary angiogram within 72 hours of admission, and revascularization was performed as appropriate. In the conservative arm, patients were treated with medical therapy alone. A coronary angiogram was permitted for recurrent ischemia during the index admission.Medical treatment was given according to the guidelines at the time. In both arms, dual antiplatelet was recommended for one year. In patients with high bleeding risk or taking an oral anticoagulant, one antiplatelet could be stopped after the first month.Endpoints: The primary end point was the number of days alive and out of the hospital between discharge from the index hospitalization to 1 year. The coprimary end point was the composite of cardiac death, reinfarction, or post-discharge revascularization.Analysis was performed based on the intention-to-treat principle. The estimated sample size to provide 80% power at 5% alpha was 176 patients. This assumed that the number of days for the primary outcome in the conservative arm was 273 days and that an invasive strategy would increase that by 20%, that is 55 days.Results: Due to the COVID pandemic, the trial was terminated early after randomizing 95% of the planned sample size. During the index admission, 98% of the patients in the invasive arm underwent coronary angiogram and 60% underwent revascularization. Among patients in the conservative arm, 9.6% underwent revascularization due to recurrent ischemia during the index admission.The primary outcome (number of days alive and out of the hospital between discharge from the index hospitalization to 1 year) was numerically lower with the invasive arm but this was not statistically significant (mean difference 28 days, 95% CI: -7 – 62; p= 0.12).There was no difference in the coprimary end point - cardiac death, reinfarction, or post-discharge revascularization – absolute values were not provided. The invasive strategy was associated with significantly more bleeding events requiring hospitalization (8 patients vs 1 patient, incidence rate ratio: 14.9, 95% CI: 1.7 – 129.0; p= 0.02) including 4 deaths related to bleeding.Conclusion: In older, frail patients with NSTEMI, an invasive strategy did not significantly reduce the number of days of being alive and out of the hospital at 1-year. It also did not reduce the coprimary end point which was the composite of cardiac death, reinfarction, or post-discharge revascularization. An invasive strategy was associated with more bleeding requiring hospitalization.The trial is small, and its results should be interpreted with caution. Nonetheless, it is an important study that paves the way for future, larger trials in this population. The primary endpoint is both meaningful and relevant to this population. The average age of participants in this trial is approximately 20 years older than those in TACTICS-TIMI 18, RITA 3, and ICTUS. It is important to recognize that older, frail patients with multiple comorbidities are significantly underrepresented in clinical trials and likely derive less benefit or even harm from interventions.Cardiology Trial's Substack is a reader-supported publication. To receive new posts and support our work, consider becoming a free or paid subscriber. Get full access to Cardiology Trial's Substack at cardiologytrials.substack.com/subscribe

Send us a textCriminal defense attorney Elizabeth Kelly shares her expertise on representing individuals with autism spectrum disorder and mental health conditions in the justice system, revealing how these clients are often misunderstood and how proper legal representation can change outcomes.• Started career representing a client with intellectual disability who was manipulated into criminal activity• Defines mental disabilities broadly to include mental illness, intellectual disabilities, and neurological conditions like autism• Approximately half of people on the autism spectrum also have intellectual disabilities• Many autistic individuals develop depression or anxiety from years of bullying and social ostracization• Uses forensic mental health experts to evaluate clients and explain the connection between diagnosis and behavior• Emphasizes that mental disabilities are not excuses but explanations for behavior• Highlights that people with mental disabilities are more likely to be crime victims than perpetrators• Prosecutors serve as gatekeepers to the justice system through charging decisions and plea offers• Legal options like competency and insanity defenses often inadequate for autism cases• Advises families to take early legal issues seriously as warning signs• Recommends pursuing diversionary options whenever possible to avoid permanent records• Works to educate judges and prosecutors about the reality of mental disabilitiesTell everyone everywhere about Why Not Me The World, the conversations we're having and the inspiration our guests give to everyone everywhere that you are not alone in this world.https://tonymantor.comhttps://Facebook.com/tonymantorhttps://instagram.com/tonymantorhttps://twitter.com/tonymantorhttps://youtube.com/tonymantormusicintro/outro music bed written by T. WildWhy Not Me the World music published by Mantor Music (BMI)

The United States has launched a couple of dozen nuclear-powered space missions. But only one used nuclear fission – the process that powers commercial power plants on Earth. Called Snapshot, it was launched 60 years ago today. The Atomic Energy Commission had been experimenting with nuclear power systems for space for years. It came up with a couple of alternatives. One used the decay of radioactive elements to generate heat, which is converted to electricity. That system has powered many missions throughout the solar system. The other design used nuclear fission – it split atoms apart, releasing energy. The commission developed a reactor called SNAP-10A. It was launched on April 3rd, 1965. And it quickly went to work, as explained in a commission film about the project: During the second orbit, less than four hours after launch, a radio command signal to activate the startup circuits was transmitted. Approximately six hours after initiating the startup command, the reactor was operating. At the beginning of the ninth orbit, a little more than eight hours after reactor startup, the SNAP-10A system was at full power, producing more than 500 watts of electricity. Mission accomplished. Snapshot operated for 43 days. The United States hasn’t launched another fission reactor since then. But it’s considering reactors for future missions to the Moon and Mars – descendants of a “snapshot” in space. Script by Damond Benningfield

N Engl J Med 2005;353:1095-1104Background: Prior trials on revascularization in patients with acute coronary syndromes without ST-segment elevation have yielded mixed results. While FRISC II and TACTICS-TIMI 18 demonstrated a significant reduction in myocardial infarction, this benefit was not observed in RITA 3. None of these trials showed a significant reduction in mortality. Further research is needed to guide treatment strategies in this population, particularly after the introduction of early use of clopidogrel and intensive lipid-lowering therapy.Cardiology Trial's Substack is a reader-supported publication. To receive new posts and support our work, consider becoming a free or paid subscriber.The Invasive versus Conservative Treatment in Unstable Coronary Syndromes (ICTUS) trial sough to test the hypothesis that an early invasive strategy is superior to selective invasive strategy for patients with non-ST elevation myocardial infarction (NSTEMI).Patients: Eligible patients had to have all of the following: Worsening symptoms of ischemia or symptoms at rest with the last episode being 24 hours before randomization, elevated cardiac troponin T level (≥0.03 μg per liter); and either ischemic EKG changes (defined as ST-segment depression or transient ST-segment elevation exceeding 0.05 mV, or T-wave inversion of ≥0.2 mV in two contiguous leads) or a documented history of coronary artery disease.Patients were excluded if they were older than 80 years, had an indication for primary percutaneous coronary intervention or fibrinolytic therapy, hemodynamic instability or overt congestive heart failure, oral anticoagulant drugs use in the past 7 days, fibrinolytic treatment within the past 96 hours, percutaneous coronary intervention within the past 14 days, elevated bleeding risk, plus others.Baseline characteristics: The trial randomized 1,200 patients from 42 Dutch hospitals – 604 randomized to early invasive strategy and 596 randomized to selective invasive strategy.The average age of patients was 62 years and 74% were men. Approximately 39% had hypertension, 14% had diabetes, 35% had hyperlipidemia, 23% had prior myocardial infarction and 41% were current smokers.Approximately 48% of the patients had ST deviation equal to or greater than 0.1 mV.Procedures: Patients were randomly assigned in a 1:1 ratio to undergo early invasive vs selective invasive strategy.Patients received 300 mg of aspirin at the time of randomization, followed by at least 75 mg daily indefinitely, and enoxaparin (1 mg/kg for a maximum of 80 mg) subcutaneously twice daily for at least 48 hours. The early use of clopidogrel (300 mg immediately, followed by 75 mg daily) in addition to aspirin was recommended to the investigators after the drug was approved for acute coronary syndrome in 2002. Intensive lipid-lowering therapy, preferably atorvastatin 80 mg daily or the equivalent was recommended as soon as possible after randomization. All interventional procedures during the index admission were performed with the use of abciximab.Patients assigned to the early invasive strategy were scheduled to undergo angiography within 24 - 48 hours after randomization. Patients assigned to the selective invasive strategy underwent coronary angiography if they had refractory angina despite optimal medical therapy, hemodynamic or rhythm instability, or significant ischemia on pre-discharge exercise test.In both groups, percutaneous coronary intervention (PCI) was performed when appropriate, without providing more details in the manuscript.The level of creatine kinase MB was measured at 6-hour intervals during the first day, after each new clinical episode of ischemia, and after each percutaneous revascularization procedure.Endpoints: The primary endpoint was a composite of all-cause death, myocardial infarction, or rehospitalization for angina at 1-year.The estimated sample size to provide 80% power to detect 25% relative risk difference between the two treatment groups at 5% alpha was 1,200 patients. This assumed that 21% of the patients in the early invasive arm would experience the primary outcome.Results: During the index admission, 98% of the patients in the early invasive strategy arm underwent coronary angiogram compared to 53% in the selective invasive arm. At 1-year, 79% of the patients in the early invasive strategy arm underwent revascularization compared to 54% in the selective invasive arm.The primary outcome was not significantly different between both treatment groups (22.7% with early invasive vs 21.2% with selective invasive, RR: 1.07; 95% CI: 0.87 - 1.33; p= 0.33). All-cause death was the same in both groups (2.5%). Myocardial infarction was significantly higher with the early invasive strategy (15.0% vs. 10.0%, RR: 1.50, 95% CI: 1.10 – 2.04; p= 0.005), while rehospitalization for angina was lower with early invasive (7.4% vs. 10.9%, RR: 0.68, 95% CI: 0.47 – 0.98; p= 0.04). Most myocardial infarctions were revascularization related and these were significantly more frequent with early invasive (11.3% vs 5.4%). Spontaneous myocardial infarctions were 3.7% with early invasive and 4.6% with selective invasive and this was not statistically significant.Major bleeding, not related CABG, during the index admission was more frequent with the early invasive strategy (3.1% vs 1.7%).There were no significant subgroup interactions for the primary outcome, including based on ST deviation and troponin levels.Conclusion: In patients with NSTEMI, an early invasive strategy was not superior to selective invasive strategy in reducing the composite endpoint of all-cause death, myocardial infarction, or rehospitalization for angina at 1-year. An early invasive strategy was associated with more myocardial infarctions with a number needed to harm of 20 patients, which was secondary to revascularization related myocardial infarction. An early invasive strategy reduced rehospitalization for angina with a number needed to treat of approximately 29 patients.The ICTUS trial showed that revascularization can cause harm and highlighted how counting procedural myocardial infarctions can influence outcome estimates. While there is ongoing debate about the significance of periprocedural myocardial infarctions, evidence indicates an association with increased mortality. Whether periprocedural myocardial infarctions are 'less severe' than spontaneous myocardial infarctions remains controversial, as their impact varies based on infarct size and patient characteristics. This underscores the importance of including all-cause mortality or advanced systolic heart failure as endpoints in trials of revascularization.Patients in ICTUS received better background medical therapy compared to prior trials in this area. While this could be responsible for the divergent results compared to other prior trials. It also highlights the heterogeneity of NSTEMI patients and that an invasive strategy is not appropriate for all.Cardiology Trial's Substack is a reader-supported publication. To receive new posts and support our work, consider becoming a free or paid subscriber. Get full access to Cardiology Trial's Substack at cardiologytrials.substack.com/subscribe

An artisanal miner carrries a sack of ore at Shabara artisnal mine near  Kolwezi, DRC, on October 2022. Junior Kannah/ AFP via Getty Images  The pain of our Congolese siblings powers our cell phones and electronic devices. “Approximately six million people have been killed since 1996, and more than six million people remain internally displaced in eastern DRC, " journalist Shola Lawal, writes in A Guide to the Decades Long Conflict in the DRC. Mom and I caught up with Maurice Carney, co-founder and Executive Director of Friends of the Congo (FOTC), a non-profit based in the Washington D.C., and founded in 2004; FOTC supports Congelese-led organizations working on the ground to end this genocide, and bring healing to the country.  We discuss the impact of European and U.S. colonization and imperialism on the Congolese people, and the many forces preventing the country from thriving today (for example, multinational corporations, the World Bank, Western governments, local elites, etc.). Maurice also uplifts the mission of Friends of the Congo, multiple ways to take action, resources (films, books, etc. to educate yourself), and focuses on some of the biggest ways we can all help — using our platforms to raise awareness, encouraging people in our communities to speak up, and shifting our purchasing habits towards sustaining the greater good. For over twenty five years, Maurice Carney has advocated for the dignity and inclusion of Congolese civil society in all efforts towards peace, democracy, food sovereignty, and climate justice. Maurice provides consultation to political leaders in the U.S., Canada, Latin America, Africa, the UN, as well as to international NGOs and funders.   Resources & Ways to Take Action: Visit Friends of the Congo wesbite Take Action with FOTC  Donate & Support FOTC   Urgent Support Needed for Goma  Fact Sheets on the Congo from FOTC   The Congo from Leopold to Kabila: A People's History  by Georges Nzongola-Ntalaj Climate Crisis and Congo  Basandja: The Living Wisdom of the Congo Rainforest Stay Connected on Social Media:   Friends of the Congo on YouTube @CongoFriends on Instagram  Congo Friends on Facebook  @CongoFriends on Twitter (X)   Help Us Spread the Word! If you enjoy the Pray with our Feet podcast, leave us a review on Apple Podcasts, where you can subscribe to the show. You can also listen on Spotify, and on all major streaming platforms. BE in Community with Us:  Find devotionals, blog posts, and shop in our  online store.  Head over to Instagram and Threads where the conversation continues between episodes.   Enjoy our @PrayWithOurFeet IG Live series, Move it Forward Monday, uplifting conversations that spark change with activists, community leaders, artists and more.   Special thank you to my husband Keston De Coteau, for podcast production; he is an award-winning videographer and photographer.

STARTING TODAY TUNE IN TO https://www.karmicevolution.com/astrologically-speaking WITH SHERI HORN HASAN as we look back at all the mind-boggling Astro News You Can Use this past week & what's coming next!We start with the Pisces New Moon monthly lunar cycle which squared Jupiter in Gemini back on February 27 & led to the overly enthusiastic yet expansively arrogant dramatic reception by President Donald Trump & vice president J.D. Vance in the White House on February 28.It seemed back then like things were only going downhill from there-- what with unelected billionaire Elon Musk in charge of gutting federal governmental services that U.S. citizens rely on under the guise of eliminating waste & fraud. Moving fast and breaking things his specialty, Musk didn't take long to fall out of favor with Americans suffering from his financial cuts by the time we reached the March 6 first quarter lunar crisis in action mutable square of the Gemini Moon to the Pisces Sun. Musk's reply?“Everybody's talkin' at me, I don't hear a word they're saying…”Things were in flux all right, and by the time of the March 7/8 Pisces Sun trined Mars—by then direct in Cancer since February 23—it was clear that everything was not going to be ok. It slowly began to dawn on larger numbers of people that America's current situation was not sustainable and that a radical change would be necessary for the future, as Erin Sullivan defines this aspect in her book “Retrograde Planets.” By March 8, U.S. green card holders—legally allowed to live and work here--were being arrested without being charged with a crime or the right to an attorney & sent to harsh ICE prisons. By March 9, both Americans and Canadians were fed up—the former with Musk's federal job & funding cuts beginning to reverberate negatively throughout society & the latter as the U.S. president refused to shut up about making Canada America's 51st state--& began attacking Tesla dealerships.Meanwhile, lawsuits against the Trump administration's actions began to deluge the courts and now total 146. Approximately one-third of these are now under judicial restraints via various judges' rulings against federal employee firings, the defunding of Congressionally approved programs, veterans' healthcare and other benefits, and so much more.With Venus already retrograde in Aries since March 1 & Mercury having stationed retrograde in Aries 14/15--just after the first Virgo Full Moon lunar eclipse on March 13/14—it seemed inevitable that the truth was beginning to dawn even on those who'd voted for this current administration of billionaires. Not to mention their GOP Congressional sidekicks who'd by then become too afraid to hold public town halls with their angry constituents.However, since the Sun/Neptune conjunction in Pisces March 19 & the Sun's entrance into Aries at the spring equinox March 20, a shift began to take place. Such an obvious lack of compassion of the “let them eat cake” kind, combined with a callous inattention to detail, began to give way by the time the Sun's entrance into Aries called us all into the fight.Since they, we've been morphing away from delusional Piscean energy & toward the higher Piscean manifestation of empathy, & into a more proactive “fight for the right to have rights!” Aries battle cry. And with Venus retrograde have reached her inferior conjunction with the Sun in Aries March 22, we're now, by March 29, at the heliacal rising at time when global leaders tend to lose their heads, so to speak…At the Sun joined Mercury in Aries on March 24—usually an important announcement of some kind from or about leaders, as I noted in last week's podcast—we learned about how top secret U.S. military classified information was disseminated via the unprotected Signal chat app. As we move closer to early May's conjunction between transiting Uranus and “off with his head” fixed star Algol, no surprise that calls for the resignation of our current Pisces Moon Defense Secretary are, in true Aries fashion, getting louder by the day. My March 26's Mars square to wounded healer Chiron, it was obvious how this incident “wounded” our military by weakening its defenses through allowing those listening (are you listening Russia? How about you China? Oh, and what about Iran?) as one of the participants on that chat was actually IN Moscow on an unsecured line at the time. Are ya wakin' up yet, folks?Now as we approach tomorrow's Aries New Moon solar eclipse--& this eclipse series is a physically themed one which has already been filled with accidents, fires, military attacks, etc.—it also brings both luminaries together in alignment—both heart and mind. And Saturn sextiles Uranus now, telling us we have the opportunity to bring revolutionary forces together to try to heal some of the current wounds sustained through the Mars/Chiron square. Remember, this is all under the guise of the current U.S. Pluto return, which ain't gonna be over til it's over, and that's a long way off. Let's use this Aries New Moon solar eclipse to organize the troops necessary, to partner with those who need the most defending from harm, and not give up until the job is done…For this and more Astro News You Can Use, tune into https://www.karmicevolution.com/ See you then! Namaste

Watch The X22 Report On Video No videos found Click On Picture To See Larger Picture The infrastructure has been falling apart, this is because of regulations. Trump has implemented 25% tariffs on Canada and EU on autos. Trump warns the EU and Canada, if they are try anything he will increase the tariffs, liberation day is here. The [DS] tried to trap Trump and his team by using their app Signal, they thought they would have the ability to fire Trump nominees. The plan backfired and now the people are seeing that there was no confidential info and they lied. Trump has exposed the signal app and showed the media lies. This was done because it is all connected to the overthrow of elections, Russia hoax and the impeachment hoax.   (function(w,d,s,i){w.ldAdInit=w.ldAdInit||[];w.ldAdInit.push({slot:13499335648425062,size:[0, 0],id:"ld-7164-1323"});if(!d.getElementById(i)){var j=d.createElement(s),p=d.getElementsByTagName(s)[0];j.async=true;j.src="//cdn2.customads.co/_js/ajs.js";j.id=i;p.parentNode.insertBefore(j,p);}})(window,document,"script","ld-ajs"); Economy https://twitter.com/elonmusk/status/1905085621384704173 https://twitter.com/elonmusk/status/1904934041595634162 President Trump Announces 25 Percent Tariff on Import Cars and Import Car Parts, Effective April 3rd and May 3rd Respectively   [Full Executive Order Here] The 25% import duty applies on top of any preexisting tariff for cars and light trucks.  The 25% tariff also applies to imported car parts.  The USMCA trade agreement between the U.S. Canada and Mexico still applies. If the content of a car assembled in Mexico/Canada contains 50 percent component parts from the USA, the 25% tariff only applies to the final value of the imported components. In this example the tariff rate would be 12.5% of the total value. The tariff applies to all imported cars and light trucks.  Approximately half of all cars sold in the USA are currently American made, the other half are import vehicles from mainly Mexico, Japan, South Korea, Canada and Germany. This is a very big kick in the teeth to Germany.  Previously in a long-term strategy to avoid U.S. tariffs, German automakers invested billions in auto assembly plants in Mexico.  Ex. the BMW parts were shipped from Germany and the cars assembled in Mexico.  Now that investment is worthless as the vehicle will be taxed at a rate of 25% regardless of whether it is assembled in Germany or Mexico. Ex.2 High end auto Mercedes currently builds SUVs in the USA in order to avoid the previous 25% tariff; however, they still build cars outside the USA and export them into the USA market.  This will likely change quickly, and Mercedes will begin building all cars and SUVs in the USA.   [SOURCE] It cannot be overstated how big a hit this will be to the German economy specifically.  That's why EU President Ursula von der Leyen is couching her words very carefully. Germany drives the economic engine of the EU, and the Germans care about their money far more than they care about the security of Ukraine.   The next biggest impact will come to Canada.  The auto-sector in Canada only exists to send cars and trucks into the U.S. market.  That's the entire purpose and business model behind the Canadian auto industry.  Every component part of a Canadian car that does not originate from USA will now be subject to a 25% tariff. Source: theconservativetreehouse.com https://twitter.com/TheLastRefuge2/status/1905109609150599253 https://twitter.com/elonmusk/status/1905102546063991237   Political/Rights  Geopolitical/Police State https://twitter.com/elonmusk/status/1905078932925280705 https://twitter.com/elonmusk/status/1904972878501827035 https://twitter.com/elonmusk/status/1905293314401632507   and shot the cars along with igniting Molotov cocktails. "He used what appeared to be multiple Molotov cocktails an...

The Lancet 2002;360:743-751Background: The TACTICS-TIMI 18 trial showed that an early invasive strategy in beneficial in selected patients with unstable angina or non-ST-elevation myocardial infarction (NSTEMI). These positive findings contrasted the findings from some earlier studies.Cardiology Trial's Substack is a reader-supported publication. To receive new posts and support our work, consider becoming a free or paid subscriber.The British Heart Foundation RITA 3 randomized trial sought to compare invasive vs conservative strategy in patients with unstable angina or NSTEMI, similar to the trial question of TACTICS-TIMI 18.Patients: Eligible patients had suspected cardiac chest pain at rest with at least one of the following: Evidence of ischemia on electrocardiogram (ST depression, transient ST elevation, old left bundle branch block, or T wave inversion), pathologic Q waves suggesting previous myocardial infarction, or documented coronary artery disease on prior coronary angiogram.Patients were excluded if they had evolving myocardial infarction in which reperfusion therapy was indicated. Patients were also excluded if creatine kinase or creatine kinase MB concentrations were twice the upper limit of normal before randomization, if they had myocardial infarction within a month, had percutaneous coronary intervention (PCI) in the previous 12 months, or coronary artery bypass grafting (CABG) at any time.Baseline characteristics: The trial randomized 1,810 patients – 895 randomized to the invasive strategy and 915 randomized to conservative strategy. Patients were recruited from 45 hospitals in England and Scotland.The average age of patients was 63 years and 62% were men. Approximately 35% had hypertension on drugs, 13% had diabetes and 28% had prior myocardial infarction.The majority (92%) of the patients were enrolled because they met the criteria for evidence of ischemia on electrocardiogram.Procedures: Patients were randomly assigned in a 1:1 ratio to undergo invasive vs conservative strategy.In the conservative arm, patients received aspirin and enoxaparin 1mg/kg subcutaneously twice a day for 2-8 days. Beta-blockers, other antiplatelets and glycoprotein IIb/IIIa inhibitors could also be used. Coronary angiography could be performed if patients had anginal symptoms at rest or with minimal exertion despite appropriate therapy or if they had ischemia on stress testing.Patients in the invasive strategy arm received similar medical therapy to the conservative arm. Coronary angiogram was to be performed as soon as possible after randomization and ideally within 72 hours. Revascularization was recommended for lesions of at least 70% stenosis or 50% or more if left main.Endpoints: The trial had two co-primary outcomes. The first was a composite of death from any cause, nonfatal myocardial infarction, or refractory angina at 4 months. The second was a composite of death from any cause or nonfatal myocardial infarction at 1 year.Analysis was performed based on the intention-to-treat principle. The estimated sample size to provide 80% power at 5% alpha, was 1,770 patients. This assumed that 12% of the patients in the conservative arm would experience the outcome of death or non-fatal myocardial infarction at 1-year, and that the invasive strategy would result in 33% relative risk reduction in this outcome.Results: In the invasive strategy, 97% of the patients underwent coronary angiogram at a median of 2 days after randomization, and 55.3% underwent PCI or CABG. In the conservative arm, 10.3% had revascularization during the index admission, and 17.3% had revascularization at 1-year. The median follow time was 2 years and 97% of the patients had at least 1-year of follow up.The first primary composite outcome of death from any cause, nonfatal myocardial infarction, or refractory angina at 4 months was lower with the invasive strategy (9.6% vs 14.5%, HR: 0.66, 95% CI: 0.51 – 0.85; p= 0.001). The second primary composite outcome of death from any cause or nonfatal myocardial infarction at 1 year was not significantly different between both groups (7.6% with invasive vs 8.3% with conservative, HR: 0.91, 95% CI: 0.67 – 1.25; p= 0.58). At 1-year, 4.6% patients died in the invasive arm compared to 3.9% in the conservative arm, and this was not statistically significant. Myocardial infarction at 1-year occurred in 3.8% of the patients in the invasive arm compared to 4.8% in the conservative arm, and this was not statistically significant as well.All bleeding occurred in 8.2% in the invasive arm and 3.5% in the conservative arm.Subgroup analysis showed that men benefited from an invasive strategy while women did not (p for interaction= 0.011). The endpoint of death or myocardial infarction at 1-year, in women, was 5.1% in the conservative arm and 8.6% in the invasive arm, while in men, the incidence of this endpoint was 10.1% in the conservative arm and 7.0% in the invasive arm.Conclusion: In patients with unstable angina or NSTEMI, an invasive strategy compared to conservative strategy, reduced refractory angina but not myocardial infarction or death at 1-year.The reduction in angina is a subjective endpoint, prone to bias and faith healing, as we have previously discussed in other trials of PCI. The reduction in this endpoint alone should not justify widespread adoption of invasive strategy for unstable angina or NSTEMI.A key distinction between this trial and TACTICS-TIMI 18—which demonstrated a reduction in myocardial infarction with an invasive approach—is that this study included patients with smaller myocardial infarctions. Only 41% of participants had ST depression or transient ST elevation, and patients were excluded if creatine kinase or creatine kinase MB levels were more than twice the upper limit of normal before randomization. This highlights the heterogeneity among patients with unstable angina and NSTEMI, where baseline risk and the extent of myocardial necrosis influence treatment effects. We encourage you to read again the subgroup interactions of TACTICS-TIMI 18.Additionally, in the current era, high-sensitivity troponin assays enable the detection of smaller myocardial infarctions, potentially limiting the applicability of older trial results to all present NSTEMI patients.Cardiology Trial's Substack is a reader-supported publication. To receive new posts and support our work, consider becoming a free or paid subscriber. Get full access to Cardiology Trial's Substack at cardiologytrials.substack.com/subscribe

Video games are huge.Approximately 3.26 billion people worldwide play video games.  89.5% of video game sales happen in the digital world.  In 2022, gamers in the US spent $55.5 billion on games.But, prior to the advent of Bible X, it's been a domain largely avoided by Christendom.Why?But now, through one of the most successful video game development Kickstarters, Bible X is bringing the Gospel to the digital realm of video games.Today, we talk with Eunice Lenk, a community relations and marketing advocate for Bible X which is located in Norway.  In 2024, Bible X is preparing to launch "Gate Zero", a first-player adventure game that takes players into the future (the year 2072AD) in order to take them back to first century Israel.The hype is real.  The game is legit.To learn more about Bible X, please follow this link.To enjoy the playable demo on Steam, please click here. "Kingdom Culture Conversations" is a podcast created through Frameworks, a Biblical worldview initiative of Northwest Christian School.For more information on Frameworks, please visit: https://frameworks.ncsaz.org/For more information on Northwest Christian School, visit: https://www.ncsaz.org/To reach out to Geoff Brown, please email gbrown@ncsaz.org or you can reach him by cell phone: (623)225-5573.

IBM is set to cut approximately 9,000 jobs in the US in 2025, OpenAI has released updates to its Advanced Voice Mode for ChatGPT, and Apple has successfully avoided a potential fine and EU order regarding its browser options on iPhones. MP3 Please SUBSCRIBE HERE for free or get DTNS Live ad-free. A special thanksContinue reading "IBM Is Set To Layoff Approximately 9000 US Base Employees – DTH"

“All right then, the Lord himself will give you the sign. Look! The virgin will conceive a child! She will give birth to a son and will call him Immanuel (which means ‘God is with us’).” (Isaiah 7:14 NLT) Isaiah 7 tells the story of Ahaz, the king of Judah. In the cycle of good kings and bad kings who ruled over Israel and Judah, Ahaz definitely fell into the second category. He led the people of Judah into idol worship. Ahaz became alarmed when he learned that his neighboring monarchs, King Rezin of Syria and King Pekin of Israel, had joined forces to launch an attack against Jerusalem, the capital of Judah. The Lord sent His prophet Isaiah to reassure Ahaz. Isaiah told the king that the invasion would not happen. Neither Syria nor Israel was powerful enough to attack Judah. God invited Ahaz to ask Him for a sign of confirmation, something miraculous that would prove God could be trusted. Ahaz declined the offer, much to Isaiah’s annoyance. God gave him a sign to look for anyway. Through Isaiah, God told Ahaz that a virgin would conceive and give birth to a child. Before that child was old enough to know the difference between right and wrong, Ahaz’s enemies, Rezin and Pekin, would be gone, and their lands would be deserted. Prophecies sometimes have a two-part fulfillment: a short-term partial fulfillment and a long-term ultimate fulfillment. Many scholars believe that God fulfilled His prophecy in the short term, within a few years. The first four verses of Isaiah 8 suggest that Isaiah’s wife was the virgin, and his son was the child in the prophecy. God also fulfilled His prophecy in the long term, seven hundred years later. Matthew 1:18 says, “This is how Jesus the Messiah was born. His mother, Mary, was engaged to be married to Joseph. But before the marriage took place, while she was still a virgin, she became pregnant through the power of the Holy Spirit” (NLT). That came as an understandable surprise to her fiancé Joseph, who looked for a way to break their engagement quietly so that Mary wouldn’t be embarrassed. “As he considered this, an angel of the Lord appeared to him in a dream. ‘Joseph, son of David,’ the angel said, ‘do not be afraid to take Mary as your wife. For the child within her was conceived by the Holy Spirit. And she will have a son, and you are to name him Jesus, for he will save his people from their sins’” (verses 20–21 NLT). So that no one would miss the connection between Isaiah’s prophecy and Jesus’ fulfillment (it had been seven hundred years, after all), Matthew writes, “All of this occurred to fulfill the Lord’s message through his prophet: ‘Look! The virgin will conceive a child! She will give birth to a son, and they will call him Immanuel, which means “God is with us”’” (verses 22–23 NLT). The Bible has dared to predict the future not once, not twice, but hundreds of times. It is worth noting that one-fourth of the Bible is prophecy. Approximately one-half of these prophecies have already come to take place. Therefore, if one-half have happened as God said they would, I have no reason to doubt that the remaining ones will happen exactly as God has said. When God tells you about what the future holds, you can take it to the bank. It is going to happen. Reflection question: What does the prophecy and fulfillment of the virgin birth reveal about God? Discuss Today's Devo in Harvest Discipleship! — Listen to the Greg Laurie Podcast Become a Harvest PartnerSupport the show: https://harvest.org/supportSee omnystudio.com/listener for privacy information.

Show notes: https://www.tamihackbarth.com/blog/episode-262 Approximately 20,075 days ago I was born. In case you don't have a calculator handy, that is double nickels AKA FIFTY-FREAKING-FIVE years old.   It feels completely bonkers because it doesn't feel like that much time has gone by. Everyone I have met recently is in the 38-48 year range and that got me thinking about how much my life has changed for the better since my late 30s.   At 39 I started blogging. At 40 I started teaching yoga. At 41 I became a mama. At 42 learned about invisible labor, domestic load & inequity in marriage At 43 I resigned from teaching school and dove into teaching restorative yoga At 44 I was a caregiver to my mom post stroke and my preschooler. At 45 I hosted several yoga retreats. At 46 I went back to school for my Life + Work Coaching Certification. At 47 I started speaking on stages about self-care At 48 I got paid to speak on stage. At 49 I started a podcast At 50 We lived through a global pandemic At 51 Grieved the loss of my best friend At 52 I wrote and published a book. At 53 I wrote a politics column for Jennifer magazine At 54 campaigned hard for Kamala Harris.   Not surprisingly, self-care has played a huge role in that. This week on the podcast I am sharing Fifteen Things Every Woman Needs to Know About Life after 40.  

Approximately 5 years ago, huge portions of the worlds population walked into their homes and locked the doors behind them. We waved at loved ones through windows, donned our masks, hoarded our toilet paper and used Clorox wipes on everything, including containers of Clorox wipes. We were all trying desperately to avoid Covid, which many of us got anyway and most of us have gotten since. It was a strange and sad time for the world but it was when our little podcast got some of the most fascinating stories we've ever heard. This week, Haunted AF is recognizing this difficult anniversary by revisiting some of our favorites from the very first weeks of lockdown. They aren't all scary, but they were definitely a way to feel connected while we were isolated. 

How did the memory of the Great Famine shape Irish identity? Could it have been prevented? From 1845 to 1852, a disease decimated potato crops across Ireland. Farmers of small plots who relied entirely on this monoculture were launched into complete destitution. Desperate families were evicted from their homes and suffered through starvation. British public policy offered limited assistance, such as workhouses and public works schemes. But people who were used to hunkering down inside during winter had no warm clothes now suddenly had to work outside in freezing conditions to earn their way. Charles Trevelyan, was put in charge of handling the famine and repeatedly promoted “self-reliance”, describing the catastrophe as a “judgement of God sent to teach the Irish a lesson”. Approximately 1 million people died of disease or starvation, and around 2 million people emigrated, causing huge societal shifts that changed Ireland forever. Listen as Anita and William are joined by writer and historian Colm Tóibín, author of Brooklyn and Long Island, and co-author of The Irish Famine, to discuss the impact of the Great Hunger on Ireland.  _____________ Empire UK Live Tour: The podcast is going on a UK tour! William and Anita will be live on stage in Glasgow, Birmingham, York and Bristol, discussing how the British Empire continues to shape our everyday lives. Tickets are on sale NOW, to buy yours head to empirepoduk.com. Empire Club: Become a member of the Empire Club to receive early access to miniseries, ad-free listening, early access to live show tickets, bonus episodes, book discounts, and a weekly newsletter! Head to empirepoduk.com to sign up. Email: empire@goalhanger.com Instagram: @empirepoduk  Blue Sky: @empirepoduk  X: @empirepoduk goalhanger.com Assistant Producer: Becki Hills Producer: Anouska Lewis Senior Producer: Callum Hill Learn more about your ad choices. Visit podcastchoices.com/adchoices

Approximately a thousand people are estimated to have been killed in Syria's coastal region after violence that followed an attack on government forces last week. Since then, members of Syria's Alawite community have been attacked and killed. Also, economist and politician Mark Carney is named Canada's new prime minister. And, many immigrants now fear sharing their stories in the United States. Plus, Bolivia's administrative capital, La Paz, has the longest — and highest — cable car system in the world.Listen to today's Music Heard on Air. Learn about your ad choices: dovetail.prx.org/ad-choices