Podcast appearances and mentions of Arjun Gupta

Host Meg Wolitzer is presents two stories from a live SELECTED SHORTS evening celebrating the O'Henry Prize, with guest editor Amor Towles, bestselling author of volumes including A Gentleman from Moscow.On today's show, Allegra Hyde imagines the very near future as a never-ending road trip, in “Mobilization,” read by Jane Kaczmarek.  And a family is disrupted by the arrival of a young woman in “The Import,” by Jai Chakrabarti, read by Arjun Gupta.

Oncologist Dr. Arjun Gupta's team has coined the term “time toxicity,”which refers to the significant time investment required for cancer patients and their caregivers to undergo cancer treatment and related activities. In this episode, he talks with Allison and Justin about how he came to be invested in the needs of caregivers and what his team has learned and hopes to accomplish with their research on time toxicity. Note: while Dr. Gupta's research focuses on cancer patients and caregivers, his learnings transfer to many if not all types of caregivers. --- Join us for an online support group related to this episode on Sunday, March 16, from 6:00-7:15 CT. Register here!

Actor and filmmaker Wade Allain-Marcus has a unique approach toward his involvement in a variety of films and television projects. It derives from factors like his mixed background, training in the Experimental Theatre Wing (ETW) at NYU, and growing up with parents in the business. The approach is one thing, but the result speaks for itself and is shaped by the ensembles he finds himself immersed into, such as the regular casts of HBO's Insecure or Netflix's Eric, the latter opposite Benedict Cumberbatch. From Lucy Forbes to Antoine Fuqua to John Singleton, Wade has worked with a variety of interesting directors who have affected his own approach to the craft. After making his directorial debut with Una y Otra y Otra vez, starring NYU classmate Gina Rodriguez, he directed the acclaimed French Dirty which premiered at the Los Angeles Film Festival in 2015, and dealth with topics including male-friendships and infidelity in the context of a love triangle. He shot the film with close friends and NYU classmates including Arjun Gupta and his spouse Melina Lizette. Following a host of acting projects, he joined the writer's room of Grownish, which he also directed an episode of, and recently directed Academy Award Nominee June Squibb in the BET remake of Don't Tell Mom the Babysitter's Dead. in our conversation, we discussed parental relationships and influence; the musicality of filmmaking; and why it's so difficult to trivialize his acting and directing credits.Opening Credits: Jangwa - V I CC BY 4.0; LaFaena - Car Drive I CC BY 4.0. Closing Credits: reed blue - INTROMATU_2006 I CC BY-NC-SA 3.0 US.

Dr. Shaalan Beg and Dr. Arjun Gupta discuss the rationale behind treatment breaks and assess the pros and cons based on feedback and data from patients with advanced-stage gastrointestinal cancers. TRANSCRIPT Dr. Shaalan Beg: Hello and welcome to the ASCO Daily News Podcast. I'm Dr. Shaalan Beg, an adjunct associate professor at UT Southwestern's Simmons Comprehensive Cancer Center in Dallas and senior advisor for clinical research at the National Cancer Institute. I'll be your guest host for the podcast today.  On today's episode, we'll be discussing treatment holidays in GI cancers. Treatment holidays, also known as drug holidays, are increasingly being discussed in clinical practice and involve voluntarily halting treatment for a duration determined by a health care provider if believed to be beneficial for a patient's well-being. We'll address the rationale behind treatment holidays and explore their potential risks and benefits. Joining me for this discussion is Dr. Arjun Gupta, a GI medical oncologist and health services researcher at the University of Minnesota. Dr. Gupta's research on treatment-related time toxicity has explored the benefits of taking a break from treatment.  Our full disclosures are available in the transcript of this episode.  Arjun, it's great to have you on the podcast today. Dr. Arjun Gupta: Thanks, Shaalan. It's a joy to be here. Dr. Shaalan Beg: Your research at the intersection of oncology, supportive care, and care delivery is extremely interesting and important in today's day and age. And you've done extensive work on the concept of time toxicity in cancer treatment. So as we think about these discussions in the clinic on treatment holidays and we talk about risks and benefits, I was hoping that you could help explain the concept of time toxicity in cancer treatment and what our listeners should remember from this. Dr. Arjun Gupta: Sure. So time toxicity is simply the time commitments that cancer care imposes on people with cancer and their loved ones, and the burden that comes along with these commitments. When we specifically think about time toxicity associated with a particular cancer treatment, such as chemotherapy, it's the time costs of pursuing, receiving, and recovering from cancer treatment. Now, we have to acknowledge that much of cancer care is essential. We need blood tests to monitor organ function, we need chemo to shrink tumors, and we need a caring oncologist to break bad news. But we have to remember that oncology care is delivered in an imperfect world. Appointments that should take 10 minutes can take 5 hours. People can have uncoordinated appointments, so they're coming to the clinic 3, 4, 5 times a week. And this affects, of course, not only the patient themselves but also their informal care partners and the entire network around them. And this cancer care can completely consume people's lives, leaving no time for rest, recovery, or pursuing joyful activities.  We interviewed patients and care partners in some qualitative work, and this was specifically people with advanced-stage gastrointestinal cancers. And we asked them what cancer care was like, and some of the words will shock you. People said things like, “It's like being on a leash.” “My life is like being on an extended COVID lockdown.” “Cancer is a full-time job.” A very experienced oncologist said, “It's like being on call. You may or not get called into the hospital, but you need to always be available.” And so this concept of time toxicity really applies to all people with cancer, but perhaps most so for people with advanced-stage, incurable cancer, when time is limited and when treatment regimens are perhaps not offering massive survival benefits. And in some cases, the time costs of pursuing the treatment can even overtake the very marginal survival benefit offered by the treatment. Dr. Shaalan Beg: This is particularly relevant for gastrointestinal cancers that, even in the world of advanced cancers, are highly burdensome in terms of their symptoms and the concept of being on call, whether you're a patient or a caregiver, and the burden that it has, I think will resonate with a lot of us, that it's always in the back of our mind on what if X, Y or Z were to happen? In the FOCUS4-N trial, a randomized trial from the UK, investigators assessed whether taking a treatment holiday for maintenance therapy for metastatic colorectal cancer would have a detrimental effect on progression free survival, overall survival, tolerability and toxicity. It looks like the study found that these decisions regarding maintenance therapy should be individualized, but there were not major differences in outcome. Can you comment on this and what applications that has for us in the clinic?  Dr. Arjun Gupta: Sure. But before diving into the FOCUS4-N clinical trial, I just wanted to share a story from the clinic yesterday. It happened in my clinic yesterday, but I'm sure it happens to thousands of patients across the world every single day. So it was the first visit for a patient with stage 4 colon cancer, and they had polymetastatic disease with disease in the lungs and the liver, no actionable biomarkers, and so very likely to be incurable. And so we discussed the usual port and palliative care appointments and chemotherapy backbone, and doing this every 2 weeks, and then doing scans after 4 to 6 doses of chemo to see how the cancer has responded. And then the patient looks up and asks that question, “Okay. So when does this end? When are we done? Do I need to do this forever and the rest of my life?” These are just such innocent and hopeful questions, because the truth is, there is no established end date. But I shared this story that right off the bat, people are looking for breaks. They've not even started chemo, they've not experienced physical or financial or time toxicity, but just psychologically, being on chemo long-term or forever is a very, very hard adjustment.  And so it's in this context that we should look at the FOCUS4-N clinical trial, which was a sub- study of a larger umbrella trial investigating whether continuing on maintenance chemo with oral capecitabine versus taking a treatment break from chemo affected the progression-free survival in people with metastatic colorectal cancer who had disease control after 4 to 6 months of upfront chemotherapy. So they randomized approximately 250 people. These people had largely been treated with FOLFOX or FOLFIRI. Most did not receive a biologic, and approximately half had partial response and half had stable disease. And then they did scans on these patients every two months or so. And the primary endpoint was progression free survival. The median PFS was approximately 4 months in the capecitabine arm and 2 months in the no treatment arm. Of course, as expected, side effects were higher in the capecitabine arm. But impressively, the overall survival was not different between these two arms. So what we're seeing here is that after this period of 4 to 6 months of intensive chemo, if we take a chemo break versus we get some oral chemotherapy, it may affect how quickly the cancer grows on scans, but it maybe does not affect how long patients live.  Now, how do these data apply for an individual patient? Now, these are incredibly nuanced and personal decisions and patients can and should choose what aligns best with their values. In some work done by Dr. Mike Brundage and colleagues in Canada, they asked 100 people with advanced cancer to consider hypothetical scenarios where a new treatment did not increase the overall survival, but potentially increased the progression free survival at the cost of some physical and other toxicities. And then they asked patients if and what PFS thresholds they would accept for this treatment. And around half of patients said no matter how big the PFS is, we do not want to accept the treatment because it causes some toxicity if I'm not going to live longer. Around a quarter of patients said that if the drug elongated progression free survival by three to six months, I would take it, because that's valuable to me even if I don't live longer. But surprisingly, 1 in 6 patients said that they would accept a treatment with no PFS benefit and no overall survival benefit, even at the cost of side effects. And there was a spectrum of reasons for these preferences that they maybe had the battle narrative that “I want to be a fighter, and I don't want to have any regrets,” just showing how complex people's attitudes and values can be. So the point is that continuing on maintenance treatment versus not doing it is not wrong. The point is we often don't even have these data to offer treatment breaks to patients so that they can make decisions that align with their goals.  So I think that's the biggest takeaway from the FOCUS4-N trial for me is that we have some hard data now to guide patients [FOCUS4-N Editorial]. Now, strictly speaking, when I'm talking to a patient about these data, doing oral capecitabine in 3-week cycles may not feel like much. It's perhaps a visit every 3 weeks for blood work and for meeting someone from the oncology team. There are no IV drugs given. If one does well, this might literally be one visit every 3 weeks. But we have to consider that things rarely go as smoothly as we plan them to. For someone living 100 miles away and having diarrhea and needing IV fluids, they may require 3 to 4 clinic visits for labs and monitoring.  In the FOCUS4-N trial, 50% of patients on capecitabine had at least one treatment delay, denoting some toxicity. In a different but similar CAIRO3 clinical trial that tested capecitabine and bevacizumab, 10% of patients had to discontinue treatment due to toxicity. And so it's important to remember that what might seem a simple and low burden to us may be very burdensome to patients. In some work that we've done ourselves [published in The Oncologist], even a single simple appointment to a clinic, such as a lab test, often ends up taking patients hours and hours. So I think it's all of this that we have to consider when we present these data to patients.  Dr. Shaalan Beg: You've talked about the FOCUS4-N trial, you mentioned the CAIRO3 study as well. How do you see this playing in the clinic? Somebody may be looking to attend a child's wedding or a notable birthday or a trip with the family, and you have the data from these trials supporting you. What are the patient factors in terms of their disease factors, patient factors that you think of when you recommend such a treatment break to a patient? Or, let me flip that over. Who would be a patient that you would be uncomfortable offering a treatment break for with metastatic colorectal cancer?  Dr. Arjun Gupta: Yes, I think disease characteristics are a crucial consideration when we consider who we're even offering these treatment breaks to. I think, number one, is the overall disease burden, and if there's any critical visceral disease and how that's responded and how much it's responded to the upfront chemotherapy induction. I think patients where we're worried about having several sites of bulky disease, some that have not responded as well, I think we have to be very, very careful considering complete chemotherapy breaks. In the FOCUS4-N trial, in subgroup analysis, patients who had stable disease tended to not benefit as much from the chemotherapy break, perhaps indicating that it's really people whose disease is responding, who are doing well, who don't have as much disease burden, who may be better served by these treatment breaks. Dr. Shaalan Beg: Fantastic. I think that provides very good direction for our listeners on how they can apply the results of these trials in their clinic.  So we've talked about treatment breaks as a way to give people their time back and to reduce time toxicity. What are other treatment strategies that you have seen deployed to reduce the burden of receiving cancer treatments in general? Dr. Arjun Gupta: You specifically asked about treatment strategies, so I'll start with that before moving to more broad interventions. We actually interviewed patients and care partners to ask them this question, and one of the things that they said was having prospective information from their oncology care team just about what my expected burden was going to be. So I think people recognize that they need oncology care and the clinicians are trying to help them and it's a broken system, but just knowing that 1 in 4 days will be spent with health care contact or not, or you will spend two hours arguing on the phone with a payer, for example, preparing and supporting people for these burdens is very important. There are obviously some alternative treatment schedules. Certain chemotherapies can be given less frequently now. So if you look at cetuximab in GI cancers, for example, when the initial trials were done, it was given every week, but now we more and more use it every two weeks. And it might not seem like much, but it can open up an entire week for a patient when they can think that I don't need to go in this week at all. So these are just some minor adjustments that we can make in the clinic.  But patients often highlight things that may perhaps not be in the direct control of the oncologist, but in the direct control of us as an oncology community. And perhaps the most frequently cited suggestion was having more care coordination and navigation services. So patients really requested more flexibility in the site of care: “Can I come closer to home?'' In the timing of their care, ‘'Can I come in at 2:00 PM after I get childcare instead of coming in at 9:00 AM?” They really requested cluster scheduling or having appointments on the same day, if possible, instead of taking up Monday, Tuesday, Wednesday, Thursday, coming in so many times. And all of this could potentially be achieved by having a designated care coordinator, someone working directly with the patient and their care partner. And then some patients also highlighted the benefits of telemedicine and home-based care, where they were able to be home more.  But we have to also recognize that those things are not universally good and often can increase burdens on the patients and care partners. Also, I wanted to highlight some feedback we received from oncology clinicians. We asked a variety of oncology clinicians, including nurses, APPs, physicians, schedulers, and social workers, what they thought were the causes of patients' time burden. You'll be surprised to hear that when they started talking about patients' time burdens, they slowly started to talk about their own time burdens. And they said, ‘‘We really want to help people, but we're just doing prior authorization and spending hours on the electronic medical record. And please fix my own time toxicity, and I will fix the patients' time toxicity,” which I thought was very profound because I think everybody who goes into medicine goes into it for the right reasons, and we end up not providing perfect care, not because of us, but because of the system. I take this as a very, very positive sign and as a hope for change. Dr. Shaalan Beg: What inspired you to focus on this topic and your research?  Dr. Arjun Gupta: So I personally just hate waiting at the doctor's office. But yes, it's also been wise mentors, including you, Shaalan, during residency and fellowship, who always told me to keep my ear to the ground and listen to patients. And in full disclosure, time toxicity, and what we've done with it recently, it's nothing new. It's been around for decades. And I think our research group has just sort of named it and shamed it, and now more and more people are starting to think about it.   But I can point to two specific instances that I think of. One was when I was starting fellowship in 2018, I read a piece by Dr. Karen Daily in the Journal of Clinical Oncology, where she quoted Henry Thoreau and said, “The price of anything is the amount of life, or time, that you exchange for it.” And it really struck a chord with me, entering the oncology discipline and seeing what people with cancer go through.   And then the second instance is, I remember my granddad, who was perhaps the most formative person in my life. We were very, very close. And when I was about to enter medical school, he was undergoing chemotherapy for lymphoma. The image that's imprinted in my head is of him putting ketchup on gulab jamun. And I can see Shaalan salivating. But for the listeners who may not know, gulab jamun is an Indian sweet made out of milk, flour, sugar, ghee, molded into balls, deep fried and then served in sugar syrup. And my granddad could not taste anything. He could not taste gulab jamun. All he could taste was ketchup. And so he would put ketchup on everything. And at his oncologist visits when I would accompany him, they would discuss the good news about the cancer shrinking and there being a response, and he was happy, but he could just not taste his gulab jamuns. And it made me realize very early on that the tumor is not the only target.  Dr. Shaalan Beg: What a wonderful story. I think those are really hard to measure, quantify, and when patients do bring those stories into the clinic, I think you realize that you have a very special connection with those patients as well, and it does help us as clinicians give personalized advice. So thanks for sharing.  Arjun, thanks for sharing your valuable insights with us on the ASCO Daily News Podcast today. Dr. Arjun Gupta: Thanks so much for having me, Shaalan. Dr. Shaalan Beg: And thank you to our listeners for your time today. You'll find links to the studies discussed today in the transcript of the episode. Finally, if you value the insights that you hear on the podcast, please take a moment to rate, review, and subscribe wherever you get your podcasts.   Disclaimer: The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.   Find out more about today's speakers:  Dr. Arjun Gupta @guptaarjun90   Dr. Gupta's Research on Time Toxicity: ·      The Time Toxicity of Cancer Treatment, JCO ·      Consuming Patients' Days: Time Spent on Ambulatory Appointments by People With Cancer, The Oncologist ·      Evaluating the Time Toxicity of Cancer Treatment in the CCTG CO.17 Trial, JCO OP ·      Patients' considerations of time toxicity when assessing cancer treatments with marginal benefit, The Oncologist ·      Health Care Contact Days Experienced by Decedents With Advanced GI Cancer, JCO OP ·      Health Care Contact Days Among Older Cancer Survivors, JCO OP Dr. Shaalan Beg    @ShaalanBeg   Follow ASCO on social media:    @ASCO on Twitter   ASCO on Facebook   ASCO on LinkedIn     Disclosures:   Dr. Arjun Gupta: Employment (An Immediate Family Member): Genentech/Roche   Dr. Shaalan Beg:    Consulting or Advisory Role: Ispen, Cancer Commons, Foundation Medicine, Genmab/Seagen    Speakers' Bureau: Sirtex    Research Funding (An Immediate Family Member): ImmuneSensor Therapeutics    Research Funding (Institution): Bristol-Myers Squibb, Tolero Pharmaceuticals, Delfi Diagnostics, Merck, Merck Serono, AstraZeneca/MedImmune

Today, Ontario Today hears from Jim Turk, director of the Centre for Free Expression at Toronto Metropolitan University and University of Ottawa law student Arjun Gupta, who drafted student letter along with both Jewish and Muslim student leaders, calling for respectful dialogue

Drs. Cardinale Smith and Raymond Osarogiagbon discuss key research featured at the 2023 ASCO Quality Care Symposium, including the role of AI in quality measurement and solution-focused approaches addressing care delivery, financial toxicity, and clinician well-being. TRANSCRIPT Dr. Raymond Osarogiagbon: Hello. I'm Dr. Raymond Osarogiagbon, your guest host of the ASCO Daily News Podcast today. I'm the chief scientist at the Baptist Memorial Healthcare Corporation and director of the Multidisciplinary Thoracic Oncology Program and the Thoracic Oncology Research Group at the Baptist Cancer Center here in Memphis, Tennessee. I have the distinct delight of serving as co-chair of the 2023 ASCO Quality Care Symposium. And I am delighted to welcome my colleague, Dr. Cardinale Smith, who served as chair of the Symposium. Dr. Smith is a professor in the Department of Medicine and Geriatrics and Palliative Medicine at the Tisch Cancer Institute at the Icahn School of Medicine at Mount Sinai in New York. Today, we'll be discussing solutions and key research to advance high-value, high-quality cancer care that were featured at the Symposium. You'll find our full disclosures in the transcript of this episode, and disclosures of all guests on the podcast are available at asco.org/DNpod. Dr. Smith, it's great to be speaking to you today. Dr. Cardinale Smith: Thank you. I'm excited to be speaking with you as well. Dr. Raymond Osarogiagbon: The Quality Care Symposium featured many novel approaches in care delivery, including innovative ways to advance health equity through supportive oncology. As a specialist in geriatrics and palliative medicine, your work has focused on supporting the needs of patients with cancer. What are the innovations in supportive oncology that you were excited about at the meeting? Dr. Cardinale Smith: I think we had several really fantastic sessions [on supportive oncology] at the meeting. One of the key things that came up around innovations in palliative care delivery was a roundtable discussion (“Innovations in Palliative Care Delivery for Structurally Marginalized Populations: A Roundtable Discussion”), and the speakers really focused on community-engaged approaches to the delivery of palliative and supportive care interventions. During the discussion, the speakers talked about utilizing the community voice and incorporating that into work to describe and enhance models of care delivery.  Dr. Manali Patel discussed her work on the transformative impact of patient navigators who focused on palliative care skills, in particular, communication, symptom discussions, and how that contributed to the improved outcomes of patients with advanced cancer. They saw reductions in mortality, lower acute care use, greater palliative care and hospice use, and lower total costs. Dr. Mao discussed a virtual mind-body fitness program to reduce unplanned hospitalizations among patients undergoing active cancer treatments. And Dr. Irwin presented her results of a randomized trial of patient-centered collaborative care for adults with serious mental illness who were newly diagnosed with cancer. I think these discussions just really centered on centering patients and focusing on supporting their care. And then finally, I was really excited to hear Dr. Deborah Mayer of UNC Lineberger Comprehensive Cancer Center, who received the Joseph Simone Quality Care Award, and she spoke about her distinguished career and how we can do better for our patients and ourselves (“Reflections on Improving Cancer Care: How Can We Do Better for Our Patients and Ourselves”). And what stood out for me was her recognition of the importance of “teaming,” and she really talked about acknowledging that before there was terminology for it. And it struck me because it remains so critically important in terms of how we advance the science and delivery of cancer. Dr. Raymond Osarogiagbon: Yeah, that Joseph Simone Award was amazing; I've got to tell you that Manali Patel's presentation blew me away. The video of the veterans talking about end-of-life care and the tough decisions, how they got to work, man, chills down my spine.  Dr. Cardinale Smith: Yeah, and I think what's even more incredible is that the folks who were helping to lead those conversations were not people who spent an incredible amount of time going to school to learn how to do this. They were folks from the community who were just engaging with people and conversations about their values. Dr. Raymond Osarogiagbon: What an original way to tackle the wicked problem. Just amazing. So improving clinician well-being was also a key topic at the meeting. Speakers addressed oncology workforce shortages and novel approaches for improving team-based care delivery. So, Cardi, what are your key takeaways from these sessions (“Building Clinician Well-Being Through Team-Based Care Delivery”) Dr. Cardinale Smith: Improving team-based care delivery is essential as the health care system can feel fragmented for patients, and, honestly, for us as clinicians as well. I think my takeaway [from this session] is that there has to be an organizational and systems-based approach to really improving this issue if we're going to make meaningful and impactful change. We were presented with data that shows that this really isn't a one size fits all approach, and what might work for physicians as a group does not work for APPs or nursing. And we really have to think about all of these different groups based on what they need.   Caroline Schenkel from the ASCO Center for Research and Analytics (CENTRA) presented impactful data on the state of the oncology workforce. And that data really assessed changes in the well-being of US-based ASCO physician members and compared the responses today in 2023 to a decade ago. And unfortunately, burnout and satisfaction with work life integration appears to have significantly worsened. And while that's not really surprising, it's disappointing. There were some factors that contributed to joy in work life, and that was speaking with and advising patients, as well as enhanced practice support inclusive of administrative patient care and staffing. So I do think that gives us some information that we can use to go forward to focus on strategies we should be really encouraging and leaning in towards. Dr. Raymond Osarogiagbon: I think it was Dr. Subbiah in this session who made the point – it's not just yoga, right? Don't tell people, “Go do yoga and get happy at work again.” You have to tackle the fundamental cause of the problem, which is this crazy workload and additional tangential obligations that we have that have taken over the core mission of patient care. Dr. Cardinale Smith: Absolutely. No one needs another pizza party. Dr. Raymond Osarogiagbon: Isn't that the truth? Dr. Cardinale Smith: I want to ask you some questions. I'm going to turn the tables on you now.  Dr. Raymond Osarogiagbon: Sure. Dr. Cardinale Smith: So let's talk about some emerging technologies. We had a session on artificial intelligence at the meeting that specifically focused on how AI will potentially impact quality care. Ray, tell me, what are some of your takeaways from these presentations? Dr. Raymond Osarogiagbon: Yeah, so AI, obviously, is a hot topic in this day and age. I had the privilege of chairing the session, “The Promise and the Perils of Artificial Intelligence (AI) in Oncology.” So we had a nice group of speakers. We had Danielle Bitterman from Dana-Farber telling us what AI is and what it promises to be for us. And then Andrew Hantel, who co-chaired the session with me, did a wonderful job describing for us the perils of AI. And then Julian Hong told us how AI promises to do all kinds of wonderful things in radiation oncology, so the huge promise of AI from back office to front office across this full spectrum of oncology, be it radiology, radiation oncology and so on and so forth, were covered.  And I would strongly urge that anybody who listens to this podcast should go to that session. Andrew Hantel talked about perils, for example, this AI black box. We don't really understand when [the AI black box] tells us this is the thing, this is the answer to your question, how does it arrive at that? How can we tell that the answers we're getting are correct or incorrect? And if we were wanting to validate, how do we go back, to do so is a real problem. And then one of the take-homes was, “You can call it all the things you want, but it's still fundamentally garbage in, garbage out.” So this machine learning, if the material fed into the machine is garbage, the answers you'll get back will still be garbage. And we had Dawn Hershman present a wonderful panorama of how AI is just another tool. It's not a panacea. We've still got the same problems. It's a new tool and we're still going to have to apply it using the same frameworks as we have always applied in all of science today.  And then there was an abstract that was presented from the UK as the young lady Bea Bakshi presented a paper, Abstract 74, “Accuracy of an AI Prediction Platform in Predicting Tumor Origin in a Real-World Study.” I would urge anybody who's interested in this to go back and watch that. Dr. Cardinale Smith: I was waiting a bit for them to talk to me about how the bots were going to take over, but I guess we're not quite there yet. And Dr. Lee Fleisher also added a lot of commentary. He was the former chief medical officer and director of the Center for Clinical Standards and Quality at the US Centers for Medicare and Medicaid Services (CMS). And he gave the keynote lecture, “Measuring and Driving Quality in the Future.” What did you think about some of what he had to add to this conversation? Dr. Raymond Osarogiagbon: Yeah, it was an interesting keynote. It was certainly one of the highlights of the program. He talked about measuring and driving quality of care in the future. And the thing that struck me was how he covered the full spectrum of the topics that we dealt with in the Symposium, including AI, which was quite remarkable.  Dr. Cardinale Smith: Yeah, I agree. I think he really did add an incredible amount to the conversation, and I think as much as we think CMS has control over so much of what we do, so much of it is controlled and regulated that in the end, they are just a body that oversees. And I think he really talked about that and hit that home.  Dr. Raymond Osarogiagbon: The one thing that struck me one of the throw away comments he made was how few physicians there were at CMS. What was it he said? Was it 30 something, 40 something on the regulatory side? Dr. Cardinale Smith: Yeah, it was less than 40, high 30s. Dr. Raymond Osarogiagbon: Surprising.   Dr. Cardinale Smith: Yeah. There aren't that many physicians that actually work there and yet they are driving so much of the decision-making.  Dr. Raymond Osarogiagbon: Yeah. Wow. So Cardi, let's talk about the session, the very beginning. I think you introduced that session on day one, “The Perfect Storm of High Cost Novel Therapeutics: Are We Leaving Patients Out? Dr. Cardinale Smith: It was an incredible way, in my opinion, to start the conference. I think that the speakers really came out strong, setting the stage on really the perfect storm. I think as we are developing more high-cost novel therapeutics, the first speaker, Haley Moss, talked about how all of these approvals are leading to these accelerated pricing of drugs and how really this is unsustainable. We continue to get new and new drugs that are working, right? I mean, we have longer life expectancies for patients with cancer.  Dr. Raymond Osarogiagbon: That's the good news, but somebody has to pay for it. Dr. Cardinale Smith: Correct. And the longer you live, the harder it is to be able to sustain this and people are going into bankruptcy for it. And then Arjun Gupta came in and talked about really thinking about these supportive care drugs and supportive care meds, and how we tend not to think about those medications, but they are medications that are not highly regulated and yet also are very costly. And I think what stood out for me most from the panel and this discussion was really the patient herself, Dr. Kelly Shanahan. She is a physician, an OBGYN who no longer practices and was diagnosed with metastatic breast cancer. And she really talked about how cancer put her into near bankruptcy and the cost implications to someone who we would consider in the top echelon of the financial spectrum.  Dr. Raymond Osarogiagbon: Yeah. You want to know what my favorite abstract was at this? It was Abstract 300, titled “Nationwide analysis of legal barriers impacting patients with cancer and caregivers.” Dr. Cardinale Smith: Okay, tell me about it. Dr. Raymond Osarogiagbon: Qasim Hussaini talked about how he had access to a unique data set of patients calling in for free legal assistance after diagnosis of their cancer. I was in awe of the uniqueness of his [and his co-authors'] approach. I don't think I've ever seen anybody tackle this problem in such an original way. I learned a lot from it, and I would definitely recommend that people go take a look at this Rapid Oral Abstract.  Dr. Cardinale Smith: Yeah. In fact, while we were sitting there in the conference, I was texting the director of oncology social work at my own institution and asking her if she heard of the organization that he worked with.   Dr. Osarogiagbon:  Yeah.  Dr. Smith: I'd like to highlight the last great session for our listeners. And it was really the last session of the conference, “Promises and Pitfalls of Liquid Biopsy Cancer Detection Tests in the Asymptomatic Population.” And I know sometimes folks don't always get to see or hear the last session. So, I would strongly encourage folks to check it out. I liked the session because it highlighted where we are in terms of thinking about diagnosing cancers among those who are asymptomatic. And it also highlighted a lot of questions that we have in terms of what we do with those results and who should be the responsible parties for that information? Does it fall to the primary care group? Does it fall to oncologists? And I think it was good to know that this is something that's top-of-mind for NCI and that they're really putting together a toolkit to think through this and to package that together for clinicians.  Dr. Raymond Osarogiagbon: I have to give you credit, Cardi. This was fabulous. The meeting was from end to end, just superb, and the attendance was record-breaking. Congratulations.  Dr. Cardinale Smith: Thank you. You are a fabulous partner. We had wonderful committee members, and the ASCO staff, as usual, is amazing. Dr. Raymond Osarogiagbon: Yes. We have to do this again in San Francisco next year.  Dr. Cardinale Smith: I'm looking forward to it.   Dr. Raymond Osarogiagbon: Thank you, Dr. Smith, for coming on the podcast to give us these highlights from the 2023 ASCO Quality Care Symposium. Our listeners will find the links to the sessions that we discussed on the transcript of this episode. Dr. Cardinale Smith: Thank you, Ray. It was my pleasure. Dr. Raymond Osarogiagbon: And thank you to our listeners for your time today. If you value the insights that you hear on the ASCO Daily News Podcast, please take a moment to rate, review, and subscribe wherever you get your podcasts. Thank you.   Disclaimer:  The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.   Follow today's speakers:  Dr. Cardinale Smith @cardismith Dr. Raymond Osarogiagbon @ROsarogiagbon   Follow ASCO on social media: @ASCO on Twitter ASCO on Facebook ASCO on LinkedIn   Disclosures: Dr. Cardinale Smith: Honraria: AstraZeneca Speakers' Bureau: Teva Dr. Raymond Osarogiagbon: Stock and Other Ownership Interests: Lilly, Pfizer, Gillead Honoraria: Medscape, Biodesix Consulting or Advisory Role: AstraZeneca, American Cancer Society, Triptych Health Partners, Genetech/Roche, National Cancer Institute, LUNGevity Patents, Royalties, Other Intellectual Property: 2 US and 1 China patents for lymph node specimen collection kit and metho of pathologic evaluation Other Relationship: Oncobox Device, Inc.

Season 3 Episode 7- Dr. Arjun Gupta- Time Toxicity On today's episode of The PQI Podcast we welcome Arjun Gupta, MD.  Dr. Gupta is an Assistant Professor in the Division of Hematology, Oncology, and Transplantation at the University of Minnesota, Minneapolis. He is a gastrointestinal medical oncologist, a symptom management enthusiast, and a health services researcher. His research specifically examines cancer care access and delivery, the costs of cancer care, and the hidden burdens imposed on and faced by people with cancer and their caregivers while receiving this care.   Today we discuss time toxicity of cancer treatment and his related article in the Journal of Clinical Oncology. The article can be found here: https://ascopubs.org/doi/pdf/10.1200/JCO.21.02810.

Dr. Arjun Gupta, a GI medical oncologist at the University of Minnesota Masonic Cancer Center in Minneapolis, speaks with host Dr. John Sweetenham, associate director for Clinical Affairs at UT Southwestern's Harold C. Simmons Comprehensive Cancer Center, about the concept of time toxicity in cancer treatment. Dr. Gupta proposes a measure of time toxicity and a framework for how it could be implemented in research and clinical practice.   Transcript Dr. John Sweetenham: Hello, I'm John Sweetenham, the Associate Director for Clinical Affairs at UT Southwestern Harold C. Simmons Comprehensive Cancer Center, and host of the ASCO Daily News podcast. I'm delighted to welcome Dr. Arjun Gupta to the podcast today. He's an assistant professor and gastrointestinal medical oncologist at the University of Minnesota Masonic Cancer Center in Minneapolis. We'll be discussing the concept of time toxicity and its relevance for patients with cancer, especially those with advanced cancer who face treatment decisions in the context of limited time. Dr. Gupta will share his insights on how to measure time toxicity and discuss a framework for how it could be implemented in research and in clinical practice. My guest and I have no conflicts relating to our topic today. Our full disclosures are available in the show notes and disclosures of all guests on the podcast can be found on our transcripts at asco.org/podcasts. Dr. Gupta, it's great to have you on the podcast today. Dr. Arjun Gupta: I'm an avid listener of the podcast. It's a joy to be here. Dr. John Sweetenham: Thank you. It's a joy to have you on the podcast as well. We're particularly pleased to have you discuss this important topic that you and your co-authors addressed recently, in your commentary in the Journal of Clinical Oncology. Can you first explain the concept of time toxicity, particularly as it relates to cancer treatment? Dr. Arjun Gupta: Yes, we conceptualize time toxicity as the time spent in pursuing a treatment for cancer. Now, this includes time spent in coordinating treatments, in travel to treatments, in waiting rooms, in actually getting that treatment, in getting anticipated and unanticipated adverse events, follow up tests and rehabilitations, frequent visits to a health care facility, all of this time that a patient and their care partner are spending is what we think of as time toxicity. This concept of time toxicity is perhaps applicable to all patients but is perhaps most applicable to people with advanced solid tumors, who are facing treatment decisions in the context of limited time. And in some cases, the overall survival benefit, or the time benefit offered by treatment may actually be overtaken by the time spent in pursuing that treatment. So, that's how we came up with this concept of time toxicity. Dr. John Sweetenham: Thanks. In your article, you propose a measure of time toxicity provides a framework for how it could be implemented in research and in routine clinical practice. Can you tell us a little more about this? Dr. Arjun Gupta: The measure we describe and propose is days with physical health care system contact. This is the measure of time toxicity that we propose. So any day in which a patient has any contact with the health care system, whether that be for a 30-minute blood draw, whether that be for a 3-hour procedure, whether that be for a 6-hour chemotherapy infusion, a 12-hour visit to the urgent care center, or an overnight stay is treated the same. It's a day with physical health care system contact. And we recognize that not all of these are the same but for the patient and their care partner, these often represent that an entire day is lost. As a corollary, days not spent with health care contact are home days. So, in essence, your overall survival or the time from diagnosis to death is nothing but the sum total of time toxicity or days with health care system contact and home days. Now me and my mentors, Dr. Chris Booth, and Dr. Elizabeth Eisenhower spent a lot of time thinking about whether we should propose a metric at all, or wait for the science to be advanced even more. But there are a couple of reasons we decided to go forward and propose this metric. Even though there are some deficiencies that I'll come to. First of all, this metric recognizes that oncology care is delivered in multiple settings. It's delivered infrequent trips to the outpatient clinics and infusion centers, and patients often require inpatient admissions for rest and rehabilitation. My mentors, Dr. Chris Booth and Dr. Elizabeth Eisenhower, and I discussed long and hard whether we wanted to propose a metric or wait for the science of time toxicity to progress. Ultimately, we decided to propose this metric because it's practical and can easily be measured. It is patient-centered, which is perhaps the most important thing. And third, it recognizes that cancer care is delivered in multiple settings, both inpatient and outpatient. There are a couple of things that we need to keep in mind while thinking about this metric. The first is that people with cancer are often sick because of underlying cancer and cancer care and physical health care system contact by itself is not a bad thing. So, we need to separate the additional time imposed by a specific cancer treatment over and above the time toxicity of cancer itself, and we also need to keep in mind that this metric has some limitations in that decreased health care contact or decreased time toxicity could represent poor access to care and could widen disparities in health care access. Furthermore, care is increasingly being delivered in the home of patients. And while that may decrease time toxicity, and may be more comfortable for certain families, for unprepared families, this may be very burdensome. So, we recognize that this metric is not perfect but we hope that this can at least start conversations about time toxicity, to fulfill our ultimate goal for clinical trials to actually report time toxicity alongside more traditional endpoints. Dr. John Sweetenham: Yes, I think one of the things that really struck me from reading your commentary was the fact that of course, for a patient, a 1-hour or 30-minute trip to the laboratory for a blood draw can disrupt the whole day. And in many respects, that can be as disruptive as spending 12 hours in the emergency room from a family and caregiver perspective that really kind of sank home with me, I must say, having read the commentary. On that note, you know, could you give us some specific examples to show how time toxicity negatively impacts patients? Dr. Arjun Gupta: Yes, so for a couple of trials that we described in the paper, we demonstrated that the time toxicity associated with pursuing the treatment was actually more than the average survival benefit offered by the treatment. Now we have to keep in mind that traditionally, oncology clinical trials don't report time toxicity. So, this was my co-authors and myself getting together and getting a best-case scenario from clinical trial publications. But as an example, for people with advanced biliary tract cancers, or cholangiocarcinoma, in the second line, there was a recent trial that demonstrated that FOLFOX chemotherapy, on average, improved survival by 27 days. And we demonstrated through the trial level publication, that for the average patient who was getting the average number of chemotherapy doses, coming in for blood work, coming in for scans, coming in for oncology assessments, that for the average patient, the time toxicity was more than this 27-day benefit, it was 30 days. And so, this is a very clear example of a patient who potentially loses more time than what they gain. It's very important to recognize that patients may value these decisions differently, and we're not saying that this treatment is bad or should not be pursued. People have different values, and we should explore that, but the biggest issue right now is that oncologists don't have the data from clinical trials to even have these conversations with patients. Dr. John Sweetenham: Thanks. And so, I'll pick up on that point. Obviously, the literature is very full of studies that have looked at oncologists and their skills for wanting a better word at having the end-of-life discussions and goals of care discussions with their patients. Do you sense that there is or will be a reluctance on the part of oncologists to have these kinds of conversations about time toxicity for patients who may be nearing the end of their lives? Dr. Arjun Gupta: I don't think so at all. I will share that I've become much more humble since I've become an oncologist myself, and I've become less critical of oncologists. I think our jobs are incredibly difficult. And most, if not all, oncologists want to do the right thing and have these conversations. The 2 things that are missing right now are data. So, we just don't have the data, which is why we wrote this commentary as a call for clinical trials to report this. And the second is our own time toxicity or delay limitation of time in the clinic. A wise person recently said that the biggest technological advance in medicine will be more time with patients. So, I think we need more data on time toxicity and we need more time for ourselves with patients to have these conversations to help them reach the best decision for their own goals and values. Dr. John Sweetenham: Are there any other key takeaways that you would like to share with our listeners today? Dr. Arjun Gupta: I feel—yes. As the next steps, our team is looking at doing secondary analyses of completed clinical trials to show that using this metric of days with physical health care contact is feasible, even in the secondary analysis of clinical trials. While we advocate for this to be included prospectively in clinical trials. It's very important to note that in retrospective work, looking at time toxicity, we remember that the time toxicity of a treatment retrospectively represents not just the treatment itself, but the entire health care delivery system, and social determinants of health. So, we shouldn't get too far ahead of ourselves in interpreting treatments against each other. But that perhaps offers us an opportunity to look internally at ourselves and add our processes to see how we can improve. Lastly, there are several quality improvement initiatives going on to reduce time toxicity for patients, such as triage, and decreasing waiting room times, and we should perhaps advocate for and promote such work more broadly. Dr. John Sweetenham: Thanks so much, Dr. Gupta, for coming on to the podcast today and for sharing your thoughts on a subject, which I'm sure is going to be something that will provoke a lot of discussions and will make many of us think harder in the future. And we look forward to seeing your ongoing research in this area. Dr. Arjun Gupta: Thank you for this platform. Dr. John Sweetenham: Thank you to our listeners for your time today. If you're enjoying the content on the ASCO Daily News podcast, please take a moment to rate, review, and subscribe wherever you get your podcasts.   Disclosures: Dr. John Sweetenham: Consulting or Advisory Role: EMA Wellness Dr. Arjun Gupta: None disclosed.   Disclaimer: The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO the mention of any product or service organization activity or therapy should not be construed as an ASCO endorsement.

In this episode, Jay and Theo chat with Arjun Gupta, Senior Software Engineer at Josh Talks, to learn about the company's mission to empower the youth of India, with relatable role models and e-learning. The media platform targets young people in smaller towns across India with content in ten vernacular languages. Arjun likens Josh Talks to an elder brother, guiding users through critical life decisions and mentoring them to improve their lives. Josh Talk's ten YouTube channels currently have 14 million subscribers, with videos garnering about 70 million views each month. The success of Josh Talks led to the launch of an e-learning application, Josh Skills, to upskill young people and better-equip them to find employment. The flagship course is Spoken English, as this remains a common reason employers reject job applicants. A popular feature of Josh Skills is P2P, a peer to peer service allowing users to click a button to talk to friends within the Josh community, practicing their spoken English skills. To improve completion rates, Arjun shares how his team is currently working on ways to gamify the learning process, with subscribers competing in trivia contests to climb the leaderboard. But interactive features like this don't come without technical challenges, which is where Google Cloud can help. To make game play within the app as real-time as possible, Josh Talks will scale its servers to handle the increased load with minimum latency. Josh Talks long-term vision is to support subscribers from school age (14-15) until they are settled into their careers (30-35), which is why Josh Talks is building an infrastructure capable of supporting multiple tools and products so it can grow alongside them.

In a year where the world was forced to stay indoors, Arjun Gupta's passion for strength and fitness training meant that he found a way to continue his fitness journey with a myriad of body weight exercises and anything he had at his disposal. His interest in the sports & fitness worlds has led him to a Master of Business in Sports Management degree from the Deakin University (Melbourne, Australia) and he now works as a trainer in Mumbai, sharing guidance on some of his approaches to keeping fit through social media (@thatguyonseaface). Having started off as a runner and having played sports throughout his life (football, cricket, tennis, volleyball), Arjun had to get over his initial retincence to join a gym or do any kind of strength training. Based on his own experiences as well as his learnings from being a trainer, we get his advice on how to get started in the area of strength training for those looking to learn but unsure of how to go about it. He even guides us through a couple of tips & tricks using your body weight and whatever you might have access to (book bags, bottles, skipping ropes) to get in a work out with limited space and without a gym membership. During this podcast, we dive into how he developed his interest in the world of health & fitness, and how he went from being Arjun Gupta to @thatguyonseaface. We also delve into peoples' perceptions of fitness, drawing the distinction between being aesthetically fit versus feeling fit. Broader than physical wellbeing we get into mental wellbeing, and how the two tie in together. Stay till the end for the rapid fire segment, where we find out some dietary myths, his best / worst work out experiences, how he manages to enjoy his favorite foods while staying healthy....and who has a better body to aspire to - Tiger or Jackie Shroff?!?!?!? Make sure to look up Arjun on Instagram for a whole lot more gyan and guidance on health & fitness: @thatguyonseaface -- Leave your comments on thoughts and suggestions for upcoming episodes. Like, Share, Subscribe/Follow our page for episodes every week! https://linktr.ee/AllAboutSportsThePodcast --- Support this podcast: https://anchor.fm/allaboutsports-thepodcast/support

We discuss the pilot episode of The Magicians, from how a book translates to screen, to why we hate bugs, to all the ways Brakebills is not an ethical institution.Find us on Twitter: @inmyqueuepod • @adinaterrific • @karaaa_powellAnd check out our brand new Instagram: @inmyqueuepodor send comments, questions,  and show suggestions to us at itsinmyqueuepod@gmail.com!

Welcome to the second Episode of Humanity ki chain, Mental Health Awareness Audio Series. This Mental health awareness series is a small attempt from my side to spread some mental health awareness and enable people to talk. The more we talk about it, the more we will be able to break the stigmas attached to it. Mental Health is as important as Physical Health and it is not possible to drive a massive change alone, so let's join together and spread some positivity. The second guest joining me in this initiative of mine is Mr. Arjun Gupta. A Mental Health Activist. He has been raising Mental Health Awareness through his blogs. After having battled severe clinical depression, Arjun is currently pursuing a post-graduate degree in Psychology from Delhi University. He has recently published a book that is an eye-opener for many. The link to Arjun Gupta's Mental Health Book is here: Shhh! Don't Talk about Mental Health: Why Being Quiet Is No Longer an Option-- https://amzn.to/2pRUMgj​ His Social Media handles: Instagram https://www.instagram.com/_knightofsteel​ Facebookhttps://www.facebook.com/knightofsteel/​ Blog: https://knightofsteel.com. You can reach out to me at priyanka@sanitydaily.com --- Send in a voice message: https://anchor.fm/priyankanair/message

This episode is a love letter: to the cast, the crews, the writers, and the fans. It is about the power of fiction to change lives and bring people together, and it is about what it means to love it. In our final episode breakdown (but not our final episode), we're joined by Arjun Gupta, Olivia Taylor Dudley, and Lev Grossman, who share what the show has meant to them -- including their favorite moments, onscreen and off, from the entire series -- and listen as we share what it has meant to us. Thank you for 5 wonderful years. It's been magical.

This BONUS episode is an interview with Dr. Arjun Gupta, a second-year hem/onc fellow at Johns Hopkins University, on his new paper out TODAY in JAMA Oncology titled ''Use of Bone-modifying Agents among Medicare Beneficiaries with Multiple Myeloma''. Use of bone-modifying agents: doi.org/10.1001/jamaoncol.2019.5426 Back us on Patreon! www.patreon.com/plenarysession

Dr Bill Nelson speaks with Dr Arjun Gupta about an essay he's written for JAMA Oncology about the special relationship he developed with his first patient.

This week we discuss three paired papers on precision oncology published in Nature Medicine and then, later in the episode, go in-depth on the implications of these negative studies with Dr. Talal Hilal of the Mayo Clinic. We also discuss the use of magic mouthwash for oral mucositis with Plenary Session fan, Dr. Arjun Gupta of Johns Hopkins University. WINTHER: doi.org/10.1038/s41591-019-0424-4 TARGET: doi.org/10.1038/s41591-019-0380-z I-PREDICT: doi.org/10.1038/s41591-019-0407-5 Magic mouthwash: doi.org/10.1001/jamainternmed.2018.6223 Back us on Patreon! www.patreon.com/plenarysession

Arjun Gupta and Elle Lipson join us to talk about episode 407, "The Side Effect" and the message at its heart, plus a deep dive into who Penny 40 sees at the end of the episode. This episode is noisier than normal -- a side effect, if you will, of Arjun's environment in Bombay. We think you'll enjoy it anyway, but you might want to listen to it in your car or over a speaker instead of on headphones!

Dr. Arjun Gupta speaks with Martin Brodsky, PhD, ScM and Daneen Sekoni, MHSA on the value of engaging speech and language pathologists, and audiologists.

After leaving Point-of-Exile, Sally runs into friends old and new. Petra plans a party. Created by Daniel Manning & Mischa Stanton. Written by Daniel Manning, Mischa Stanton, Eli Barraza & Tau Zaman (with story support from Danielle Shemaiah & Julian Mundy). Directed & produced by Mischa Stanton. Featuring Kristen DiMercurio as Sally Grissom, Katie Speed as Esther Roberts, Lia Peros as Petra Marquez, L. Jeffrey Moore as Lou Gaines, Zach Ehrlich as Jack Wyatt, Lauren Shippen as Maggie Elbourne, Arjun Gupta as Nikhil Sharma, and Bernardo Cubrìa as Mateo Morales, as well as Eric Silver, Michael Fisché, and Brandon Grugle, with special thanks to Isabel Atkinson. Original music by Mischa Stanton and by Eno Freedman-Brodmann. Please support us on Patreon http://patreon.com/arsparadoxica RED | 16 15 15 22 11 07 04 20 18 26 03 12 21 15 04 16 12 13 04 21 14 09 06 06 09 25 11 03 14 15 11 06 | WEATHER IN MEMPHIS: banjoes A product of the Whisperforge http://whisperforge.org

Though they are glad to return to Point-of-Exile once more after a long mission, our heroes may not be the same people they were when they left. Some for the better, others… less. Created by Daniel Manning & Mischa Stanton. Written by Mischa Stanton & Danielle Shemaiah (with Daniel Manning, Eli Barraza, Julian Mundy & Tau Zaman). Directed & produced by Mischa Stanton. Featuring Kristen DiMercurio as Sally Grissom, Katie Speed as Esther Roberts, Lia Peros as Petra Marquez, L. Jeffrey Moore as Lou Gaines, Preston Allen as Bridget Chambers, Reyn Beeler as Chet Whickman, Arjun Gupta as Nikhil Sharma, and Tina Huang as Tonya LeMartine, as well as Rob Slotnick as Bill Donovan, Susanna Kavee as Helen Partridge, Bernardo Cubria as Mateo Morales, Sammi Lappin as Miriam Roberts, and Rina Cerame, with special thanks to Isabel Atkinson. Production help this week from Brandon Grugle. Original music by Mischa Stanton and by Eno Freedman-Brodmann. “When I’m Not Here,” written by Tau Zaman, arranged by Evan Cunningham, performed by Evan, Chris Tedesco on trumpet, and vocals by Susanna Kavee. Please support us on Patreon http://patreon.com/arsparadoxica BLUE | 20 09 05 16 03 05 26 24 12 22 09 25 12 05 13 21 14 19 06 22 09 09 17 09 03 05 24 22 05 04 17 14 13 07 | WEATHER IN TULSA: queer A product of the Whisperforge http://whisperforge.org

Petra, Lou and the 77s infiltrate the KTNK stronghold to rescue Sally. But while inside, they might find more than they bargained for. They may have to pay a dear price to retrieve her. Created by Daniel Manning & Mischa Stanton. Written by Eli Barraza & Danielle Shemaiah (with Daniel Manning, Mischa Stanton, Julian Mundy & Tau Zaman). Directed & produced by Mischa Stanton. Featuring Kristen DiMercurio as Sally Grissom, Katie Speed as Esther Roberts, Lia Peros as Petra, L. Jeffrey Moore as Lou Gaines, and Arjun Gupta as Nikhil Sharma, as well as Ego Mikitas as Adler, Emma Sherr-Ziarko as Karla, Sheldon Brown as David Marian, Zach Libresco as 77 Agent Gordon, Danielle Shemaiah as 77 Agent Alec, Mischa Stanton, Pasha Sol, Karim Kronfli, Erin Bark, and Kessi Riliniki, with special thanks to Isabel Atkinson. Translation by Pasha Sol. Fight choreography by Danielle Shemaiah. Production help from Jeffrey Gardner. Original music by Mischa Stanton and by Eno Freedman-Brodmann. Please support us on Patreon http://patreon.com/arsparadoxica GREEN | 05 13 22 12 09 03 25 26 08 06 16 11 20 24 17 16 12 13 12 11 15 25 15 23 16 17 09 11 26 03 | WEATHER IN TULSA: frogs | LUCKY NUMBER: eight hundred sixty two A product of the Whisperforge http://whisperforge.org  

One promise of electronic medical records (EMRs) was to reduce medication errors. That may not have occurred since one type of error, illegible orders, has been replaced by another: Order sets may incorrectly match a patient and necessary treatments. In this JAMA Performance Improvement podcast, we review a case in which guideline-based care was incorporated into an order set, then the guideline changed but the order set did not, resulting in a post-STEMI patient receiving β-blockers when they were contraindicated. Interviewees included Arjun Gupta, MD, University of Texas Southwestern Medical Center, and Jennifer L. Rabaglia, MD, MSc, Parkland Health and Hospital System, Dallas, Texas. Learning Objectives: To understand the role of β-blocker treatment in patients with acute myocardial infarction; to understand how EMR order sets should be developed and maintained. https://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.2018.0845

AFTERBUZZ TV — The Magicians is a weekly "after show" for fans of Syfy's The Magicians. In this show, hosts Adrian Snow, Joelle Monique, and Kari Lane discuss episode 11 with special guest Arjun Gupta. ABOUT THE MAGICIANS: The Magicians is a fantasy television series that premiered on Syfy and Showcase on December 16, 2015, as a special preview. The rest of the series is scheduled to premiere on January 25, 2016. It is based on the novel of the same name by Lev Grossman. A 13-episode series order was placed in May 2015. Michael London, Janice Williams, John McNamara, and Sera Gamble serve as executive producers. Follow us on http://www.Twitter.com/AfterBuzzTV "Like" Us on http://www.Facebook.com/AfterBuzzTV Buy Merch at http://shop.spreadshirt.com/AfterbuzzTV/ --- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app Support this podcast: https://anchor.fm/themagicians/support Learn more about your ad choices. Visit megaphone.fm/adchoices

Sally pines for a friend. Esther struggles to catch up without her usual resources. Chet's on his way out. One last secret play before the new Director comes to town. Created by Daniel Manning & Mischa Stanton. Written by Tau Zaman (with Daniel Manning, Mischa Stanton, Eli Barraza, Julian Mundy & Danielle Shemaiah). Directed & produced by Mischa Stanton. Featuring Kristen DiMercurio as Sally Grissom, Katie Speed as Esther Roberts, Lia Peros as Petra, Reyn Beeler as Chet Whickman, Arjun Gupta as Nikhil Sharma, and Tina Huang as Tonya LeMartine, with special thanks to Isabel Atkinson. Production help from Brandon Grugle. Original music by Mischa Stanton and by Eno Freedman-Brodmann. Please support us on Patreon http://patreon.com/arsparadoxica RED | 04 26 03 15 18 05 01 16 01 05 26 24 09 05 21 04 16 08 19 03 | WEATHER IN TULSA: WILDFIRES | SIGN: CANCER A product of the Whisperforge http://whisperforge.org

Arjun Gupta (Penny) guests to give us the lowdown on "Be the Penny," from watching his own funeral, to growing up from beyond the grave, to the secrets behind Penny's suit. Plus, working with Shannon Kohli on her directorial debut, trying not to crack up at Dustin Ingram, and Arjun...raps? Make sure you listen to this one all the way through.

Dr. Arif Kamal discusses the Palliative Care Program at Duke University with Dr. Arjun Gupta, Costs of Care Learning Network Fellow.

BTB presents awesome on-location interviews from the 2016 New York Comic Con (www.newyorkcomiccon.com)! We present three stars from the new hit SyFy show, The Magicians with Olivia Taylor Dudley, Arjun Gupta and Hale Appleman! Don't miss the stars of The Magicians talk about the upcoming second season!

AFTERBUZZ TV — The Magicians is a weekly "after show" for fans of Syfy's The Magicians. In this show, hosts Adrian Snow and Kari Lane discuss episode 3 with special guestArjun Gupta. ABOUT THE MAGICIANS: The Magicians is a fantasy television series that premiered on Syfy and Showcase on December 16, 2015, as a special preview. The rest of the series is scheduled to premiere on January 25, 2016. It is based on the novel of the same name by Lev Grossman. A 13-episode series order was placed in May 2015. Michael London, Janice Williams, John McNamara, and Sera Gamble serve as executive producers. Follow us on http://www.Twitter.com/AfterBuzzTV "Like" Us on http://www.Facebook.com/AfterBuzzTV Buy Merch at http://shop.spreadshirt.com/AfterbuzzTV/ --- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app Support this podcast: https://anchor.fm/themagicians/support Learn more about your ad choices. Visit megaphone.fm/adchoices

AFTERBUZZ TV — The Magicians is a weekly "after show" for fans of Syfy's The Magicians. In this show, hosts Adrian Snow and Kari Lane discuss episode 3 with special guestArjun Gupta. ABOUT THE MAGICIANS: The Magicians is a fantasy television series that premiered on Syfy and Showcase on December 16, 2015, as a special preview. The rest of the series is scheduled to premiere on January 25, 2016. It is based on the novel of the same name by Lev Grossman. A 13-episode series order was placed in May 2015. Michael London, Janice Williams, John McNamara, and Sera Gamble serve as executive producers. Follow us on http://www.Twitter.com/AfterBuzzTV "Like" Us on http://www.Facebook.com/AfterBuzzTV Buy Merch at http://shop.spreadshirt.com/AfterbuzzTV/ --- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app Support this podcast: https://anchor.fm/themagicians/support Learn more about your ad choices. Visit megaphone.fm/adchoices

Arjun Gupta (Penny) joins Clara and Dani to answer questions from fans and discuss Episode 201, "€œKnight of Crowns."€ We talk cast chemistry, Hogwarts houses, and the importance of authenticity –€“ especially when it comes to showing your patootie on television. Mixed and edited by Lanier Sammons.

Angie Light returns for another episode with the internet’s favorite peanut gallery, One Star Cinema. This week we watched The Diabolical or “Hey, wasn’t she on Heroes?” This film stars Ali Larter, Arjun Gupta, Max Rose, and is directed by Alistair Legrand. Have you subscribed yet? Well here,  just click this and get that handled! […]

Petra and Carmen have been recruited for a special training protocol within ODAR. Their mission: Grow up through history backwards, make no connection with the world around them, in an attempt to Stave Off the deadly effects of Butterfly Syndrome. Helped along by their chaperone Van, their peers, and a mysterious guide who offers lemon drops with a side of dissenting opinions on the way things ought to be, can the girls become proper ODAR agents before their last connection to anything in the world–each other–falls apart? **WARNING: This episode contains depictions of manipulation & implied harm of children. Listener discretion advised. Created by Daniel Manning & Mischa Stanton. Written by Eli Barraza, directed & produced by Mischa Stanton. Featuring Elyse Cain & Lia Peros as Petra, Ai-Chan & Gabriela Milo as Carmen, Ian McQuown as Van, Katie Speed as Esther Roberts, and Arjun Gupta as Nikhil Sharma, as well as Richard Malmos, Katie Hume, On Shiu, Bonnie Williams, David Gallic, Billy Finn, and Erin Bark, with special thanks to Isabel Atkinson. Production help from Danielle Shemaiah, Ryan Estrada, and David Rheinstrom. Thanks to Mykki and her kids at the Khan Lab School. Original music by Mischa Stanton and by Eno Freedman-Brodmann. A product of the Whisperforge http://whisperforge.org 

A SPECIAL EPISODE! Arjun Gupta (Nurse Jackie, The Magicians) and Adam Lustick(No Joke podcast, Harvard Sailing Team) stop by to chat with Billy and Utkarsh about race relations in hollywood, not watching movies with only white people in them, Indians acting either white or black, and Arjun takes a deep dive on the diversity of thought over race and ethnicity. Oh. And Utkarsh and Arjun talk about squashing their longstanding beef. DO NOT MISS HISTORY BEING MADE!!!

On the Overthinking It Podcast, the Overthinkers and special guest Arjun Gupta tackle Disney’s new animated film “Zootopia.” Episode 401: Stop Shaming the Bunny originally appeared on Overthinking It, the site subjecting the popular culture to a level of scrutiny it probably doesn't deserve. [Latest Posts | Podcast (iTunes Link)]

Arjun Gupta is an actor, producer, podcaster, and service member who has appeared in TV shows such as "Nurse Jackie" and "How To Get Away With Murder". His latest work is the SyFy series "The Magicians". He plays the role of Penny a drifter with supernatural abilities that attends a university for spellcasters. Arjun chats with is about his podcast American Desis, his work with the homeless, and the normalization of people of color and marginalized groups in media. Enjoy this #BGNPodcast extra! Co-hosted by Caron and Afiya Music by Sammus and Shubzilla

As we recently learned, Arjun Gupta has been named the official spokesperson of "Uplift Humanity", a service organization dedicated to the rehabilitation of juvenile inmates in South Asia. Part of his duties as spokesperson was selecting a winner in a video submission contest with the volunteers of Uplift. Today we have the pleasure of speaking with that winner: Pooja Patel. Pooja Patel is a South Asian high school student in New Jersey who is advocating for human rights and education in third world countries- I know, she's' a better person than all of us-. We spoke with her about Uplift Humanity, how it operates, the bonds she formed while she was there, and how the volunteers ended up learning more than the juveniles they were supposed to be teaching. We also discuss why she was drawn to this project, and try to further explore the mindset of our South Asian-American youth- a subject that fascinates Arjun and myself because we're super old. In much the same way that she learned more from the youths she counseled than she taught, Arjun and I learned more from Pooja than we probably ever could have taught her. It was truly a pleasure to talk to such a mature, intelligent, thoughtful young lady. The future is in good hands.

Welcome to American Desis. This is a show where two young men, Akaash Singh and Arjun Gupta, explore what it means to be a South Asian in America today. They navigate issues such as assimilation, cultural appropriation and preservation, shame, language and accents, and even names.  In their inaugural episode, Akaash and Arjun tell you why they started this podcast, what they are trying to accomplish, and they introduce you, the listeners, to their unique format. After releasing an interview with a guest one day, they release a discussion episode a few days later. During the discussion episode, Akaash and Arjun speak on things that came up during the interview and how they personally relate to these issues. In an effort to further build a community, they read and respond to tweets, website responses, and Facebook messages from the listeners.. To give you an idea of what the discussion will be like: in this first episode Akaash and Arjun speak about a Facebook message that was sent to them recently which deals with insecurity and how it affects their ethnic identity. They also engage with some tweets about how sex fits in to the shifting the western identity of Indians and whether racism plays into South Asian success.   So who are these guests? Where do they come from? And is this discussion fun? Well, I guess you gotta listen to this episode to find out!