Podcasts about Arnis

Schaar, Jörn www.deutschlandfunk.de, Deutschland heute

Radio Marija ir klausītāju veidots radio, kas nes Dieva Vārdu pasaulē. Radio Marija balss skan 24 stundas diennaktī. Šajos raidījumos klausītājiem kā saviem draugiem neatkarīgi no viņu reliģiskās pārliecības cenšamies sniegt Kristus Labo Vēsti – Evaņģēliju, skaidru katoliskās Baznīcas mācību. Cenšamies vairot lūgšanas pieredzi un sniegt iespēju ielūkoties visas cilvēces kultūras daudzveidībā. Radio Marija visā pasaulē darbojas uz brīvprātīgo kalpošanas pamata. Labprātīga savu talantu un laika ziedošana Dieva godam un jaunās evaņģelizācijas labā ir daļa no Radio Marija harizmas. Tā ir lieliska iespēja ikvienam īstenot savus talantus Evaņģēlija pasludināšanas darbā, piedzīvojot kalpošanas prieku. Ticam, ka Dievs īpaši lietos ikvienu cilvēku, kurš atsauksies šai kalpošanai, lai ar Radio Marija starpniecību paveiktu Latvijā lielas lietas. Radio Marija ir arī ģimene, kas vieno dažādu vecumu, dažādu konfesiju, dažādu sociālo slāņu cilvēkus, ļaujot katram būt iederīgam un sniegt savu pienesumu Dieva Vārda pasludināšanā, kā arī kopīgā lūgšanas pieredzē. "Patvērums Dievā 24 stundas diennaktī", - tā ir Radio Marija Latvija devīze. RML var uztvert Rīgā 97.3, Liepājā 97.1, Krāslavā 97.0, Valkā 93.2, kā arī ar [satelītuztvērēja palīdzību un interneta aplikācijās](http://www.rml.lv/klausies/).

A special RRM episode.

17. gadsimtā notika kāds pavērsiens astronomijas vēsturē, kas kardināli mainīja cilvēku izpratni par Visuma uzbūvi. Šī pāreja notika pateicoties zinātnes attīstībai un tostarp optisko teleskopu nonākšanai astronomu rokās. Sākot ar dāņu astronomu Tiho Brahi, kas pēdējais ar neapbruņotu aci veica īpaši precīzus mērījumus, turpinot ar Galileo Galileju, Džovanni Kasīni un  citiem. Pievēršamies šīm personībām astronomijas vēsturē un viņu veikumam. Stāsta Latvijas Universitātes Astronomijas institūta pētnieks Ilgonis Vilks un un Latvijas Astronomijas biedrības pārstāvis Mārtiņš Gills. Vispirms stāsts par kādas pašmāju observatorijas tapšanu Jau vairākus gadus astronomijas interesenti var ciemoties Suntažu „Kaltiņos”, kur nelielā observatorijā ir iespēja vērot debesjumu. Par to, kā padomju laikos būvētā skābbarības tornī Arnis un Anna Ginteri izbūvēja vietu, kur ir stacionāri novietots teleskops un izveidota lekciju telpa, kā arī par to, no kā jāsargā teleskopa lēca, stāsta observatorijias saimnieki. Arnis Ginters, tāpat kā sieva Anna Gintere ikdienā strādā IT jomā, bet abiem nopietna aizraušanās jau gadiem ilgi ir astronomija. Annu Ginteri, iespējams,   mūsu regulārie klausītāji ir pamanījuši kā eksperti, kuru bieži intervējam par astronomiskiem jautājumiem šajā raidījumu ciklā. Bet šoreiz nerunāsim par objektiem izplatījumā, bet gan par Ginteru ģimenes izveidoto observatoriju Suntažos. Kad Arnis 2008. gadā atguva senču īpašumu, līdzās mājai atradās skābbarības tornis, un tā kā abi tolaik jau nopietni aizrāvās ar astronomiju, tad Ginteru ģimenē jau bija iegādāts neliels pārnēsājamais teleskops, ko Anna un Arnis  bieži nesa uz minēto torni un vēroja naksnīgās  debesis.  „Tas bija slinkums, kas mūs iedvesmoja šo torni pārbūvēt par observatoriju,” smej Arnis. „Jo mums apnika nēsāt turp un atpakaļ to teleskopu.” Un tā laika gaitā tornis tika pārbūvēts, lai ne tikai paši Ginteri, bet arī citi astronomijas interesenti var lūkoties zvaigznēs un arī klausīties lekcijas par tām.      

Šogad ūdensputnu medību sezona sāksies 21.augustā - trešdien, un tad līdz 15.septembrim - medīt varēs trešdienās, sestdienās un svētdienās. Par grozījumiem Medību noteikumos attiecībā uz ūdensputnu medībām stāsta Andris Stīpnieks. Runājam par to, kā atšķirt dažādus putnus, par to, kādēļ medniekiem "atņēma" tradīcijas un cik liela nozīme ir tam, kā uzvedamies. Arnis no SIA Ieroči stāsta par dažādām aktualitātēm un interesantiem gadžetiem. Ir arī konkursiņš no SIA Ieroči. Epizode ar SIA Ieroči atbalstu! https://siaieroci.lv/ Tel. +371 25615600 e-pasts: info@siaieroci.lv Pievienojieties šim kanālam, lai iegūtu piekļuvi privilēģijām. https://www.youtube.com/channel/UCqB3nyhYHXKobopia9d7xgA/join

“Super Dan” Anderson is the founder of American Freestyle Karate, multiple times World Champion, prolific author, and much more. We had an excellent conversation and also recorded a bonus part available on Patreon: https://www.patreon.com/posts/108197249/ The links mentioned are here: https://wimsblog.com/145 Enjoy. Support the podcast and get instant access to dozens of bonus episodes and HUNDREDS of exclusive videos: https://www.patreon.com/wimdemeere New book/video email notification list: http://www.wimdemeere.com/notification/ My blog: http://www.wimsblog.com/ Facebook:https://www.facebook.com/WimDemeerePage/ Twitter: https://twitter.com/wimdemeere Instagram: https://www.instagram.com/wimdemeere/ Facebook group: https://www.facebook.com/groups/YouAreNotAres Merch: https://wim-demeere-merch.creator-spring.com/

Vergangenes Wochenende haben wir noch ein paar Ausflüge mit meinen Eltern unternommen unter anderem nach Arnis und Kappeln. Während die beiden auf Frl. Hund aufgepasst haben, waren die Herzdame und ich bei Methodisch Inkorrekt und ihrer Tour zum 10-Jährigen ihres Podcasts in Hamburg. Außerdem erzähle ich von der Arbeit und von Netflix-Entdeckungen. Die Episode endet mit dem Trailer für Podstock. Kommt alle, es wird super.

Hokeja čempionātam ritot pilnā sparā, šoreiz lielais uzsvars uz dažādām spēlēm, kas tā vai citādi atsauc atmiņā vareno ledus spēli. Jau ievadā Kristaps pieminēs bērnu trenēšanu ar dažādām spēlēm, tai skaitā Icecool, kas ir vēl lielāks rikošetu meistars kā Polijas izlase. Svaigs un Gards Toms dosies ceļojumā uz Japānu, lai atklātu noslēpumu, kāpēc japāņi vairs nepiedalās pasaules čempionātā. Tas viss - plānojot un pērkot vilciena biļetes, spēlē Let's go! To Japan. Kristaps godinās čempionāta mājiniekus, spēlējot jaunāko CGE naudas kaltuves spēli Kutna Hora: The city of Silver, kur cīnīsies par resursiem tikpat sūri, kā hokeja fani starplaikos cīnās, lai paspētu pēc alus un apmeklēt labierīcības. Turpinājumā tiek miksētas divas maiņas, jo segments Kreisais ciemiņš apvienojas ar Kampaņnieku. Visi trīs tiesneši: Kristaps, Toms un Arnis pārrunās Undaunted: Stalingrad kampaņas pieredzi un nolems, vai paturēt to starp spēlēm vai arī sūtīt uz noraidīto soliņu. Epizodes noslēgumā, protams, Kreisais Top 5, par spēlēm, kas, līdzīgi kā hokejs, arī ir pretējo frakciju spēles, proti, noskaidrosim labākās divu spēlētāju spēles jeb - Sēdies, divi! Klausies epizodi - https://anchor.fm/kreisais-tokens  Spotify - https://open.spotify.com/search/Kreisais%20tokens Seko mums: Instragram - https://www.instagram.com/kreisaistokens/  Facebook - https://www.facebook.com/Kreisais-Tokens-108903727367874

Mežs un medības, tās ir viena no otras neatraujama lieta, cieši saistīta. Šoreiz uz podkāstu viesos aicinām Latvijas Meža īpašnieku biedrības valdes priekšsēdētāju Arni Muižnieku, kurš arī pats ir mednieks. Runājam par līdzsvara meklēšanu, lēmumu pieņemšanu, iespējamām sekām un vēl daudzām citām tēmām. Epizode top sadarbībā ar Medību saimniecības attīstības fondu. Pievienojieties šim kanālam, lai iegūtu piekļuvi privilēģijām. https://www.youtube.com/channel/UCqB3nyhYHXKobopia9d7xgA/join

Raidierakstā satiekas divi mūziķi – Amanda Lapa, kura vēl tikai uzsāk savu mūziķes karjeru un Arnis Slobožaņins no grupas “Dabasu Durovys”, kas apvienojusies 2006. gadā, izdevusi sešus studijas albumus un regulāri muzicē kā Latvijā, tā ārpus tās. Saruna par izaicinājumiem, ar kuriem saskaras gan pieredzējuši, gan jauni mūziķi un par jaunumiem, kurus sagatavojuši abi mūziķi – grupas albumu “Dīnys i nadīnys” un Amandas singlu “Kas es esmu”. Raidījumā arī atklāsim, ko sagaidīt grupas “Dabasu durovys” koncertā “Dīnys i nadīnys”, kurs notika 17. maijā Daugavpils Kultūras pilī. Raidījumu vada Arnis Malakovs un Adrians Zelčs. Breinojamīs kūpā!

Radio Marija ir klausītāju veidots radio, kas nes Dieva Vārdu pasaulē. Radio Marija balss skan 24 stundas diennaktī. Šajos raidījumos klausītājiem kā saviem draugiem neatkarīgi no viņu reliģiskās pārliecības cenšamies sniegt Kristus Labo Vēsti – Evaņģēliju, skaidru katoliskās Baznīcas mācību. Cenšamies vairot lūgšanas pieredzi un sniegt iespēju ielūkoties visas cilvēces kultūras daudzveidībā. Radio Marija visā pasaulē darbojas uz brīvprātīgo kalpošanas pamata. Labprātīga savu talantu un laika ziedošana Dieva godam un jaunās evaņģelizācijas labā ir daļa no Radio Marija harizmas. Tā ir lieliska iespēja ikvienam īstenot savus talantus Evaņģēlija pasludināšanas darbā, piedzīvojot kalpošanas prieku. Ticam, ka Dievs īpaši lietos ikvienu cilvēku, kurš atsauksies šai kalpošanai, lai ar Radio Marija starpniecību paveiktu Latvijā lielas lietas. Radio Marija ir arī ģimene, kas vieno dažādu vecumu, dažādu konfesiju, dažādu sociālo slāņu cilvēkus, ļaujot katram būt iederīgam un sniegt savu pienesumu Dieva Vārda pasludināšanā, kā arī kopīgā lūgšanas pieredzē. "Patvērums Dievā 24 stundas diennaktī", - tā ir Radio Marija Latvija devīze. RML var uztvert Rīgā 97.3, Liepājā 97.1, Krāslavā 97.0, Valkā 93.2, kā arī ar [satelītuztvērēja palīdzību un interneta aplikācijās](http://www.rml.lv/klausies/).

In the sequel to last week's episode, we are back with Dr. Jonathan Davis, Director of the Heart Failure program from San Francisco General. We continue our tour of GDMT for HF, by covering SGLT2-i, MRAs, as well as some AKI and outpatient considerations. This is part 1 of 2 parts which will cover an overview of GDMT medications, and dive into Beta-blockers and ARNIs. Part 2 to come out next week! | 00.33 - Previously on Booster Shots | | 01.31 - Chapter 3: SGLT2-i | The now famous EMPA-REG OUTCOME trial [NEJM 2015] Empagliflozin in HFpEF (not discussed in this episode [NEJM 2021] | 04.24 - Chapter 4: MRAs | RALES trial demonstrating benefit in Morbidity/Mortality [NEJM 1999] | 10.04 - Organizing follow up | | 11.51 - Issues with AKI | | 15.10 - Some fun questions about Fun questions | | 16.54 - Summary of All The Things! | [The appearance of external hyperlinks does not constitute endorsements by UCSF of the linked websites, or the information, products, or services contained therein. UCSF does not exercise any editorial control over the information found therein, nor does UCSF make any representation of their accuracy or completeness. All information contained in this episode are the opinions of the respective speakers and not necessarily the views their respective institutions or UCSF, and is only provided for information purposes, not to diagnose or treat.] Music by Amit Apte. Medical Heart Vectors by Vecteezy

Radio Marija ir klausītāju veidots radio, kas nes Dieva Vārdu pasaulē. Radio Marija balss skan 24 stundas diennaktī. Šajos raidījumos klausītājiem kā saviem draugiem neatkarīgi no viņu reliģiskās pārliecības cenšamies sniegt Kristus Labo Vēsti – Evaņģēliju, skaidru katoliskās Baznīcas mācību. Cenšamies vairot lūgšanas pieredzi un sniegt iespēju ielūkoties visas cilvēces kultūras daudzveidībā. Radio Marija visā pasaulē darbojas uz brīvprātīgo kalpošanas pamata. Labprātīga savu talantu un laika ziedošana Dieva godam un jaunās evaņģelizācijas labā ir daļa no Radio Marija harizmas. Tā ir lieliska iespēja ikvienam īstenot savus talantus Evaņģēlija pasludināšanas darbā, piedzīvojot kalpošanas prieku. Ticam, ka Dievs īpaši lietos ikvienu cilvēku, kurš atsauksies šai kalpošanai, lai ar Radio Marija starpniecību paveiktu Latvijā lielas lietas. Radio Marija ir arī ģimene, kas vieno dažādu vecumu, dažādu konfesiju, dažādu sociālo slāņu cilvēkus, ļaujot katram būt iederīgam un sniegt savu pienesumu Dieva Vārda pasludināšanā, kā arī kopīgā lūgšanas pieredzē. "Patvērums Dievā 24 stundas diennaktī", - tā ir Radio Marija Latvija devīze. RML var uztvert Rīgā 97.3, Liepājā 97.1, Krāslavā 97.0, Valkā 93.2, kā arī ar [satelītuztvērēja palīdzību un interneta aplikācijās](http://www.rml.lv/klausies/).

We talk to Cardiologist Dr. Jonathan Davis, Director of the Heart Failure program from San Francisco General about goal directed medical therapy in heart failure with reduced ejection fraction (HFrEF). This is part 1 of 2 parts which will cover an overview of GDMT medications, and dive into Beta-blockers and ARNIs. Part 2 to come out next week! | 00.34 - Introduction | | 01.55 - Consult Q: GDMT for HF | Heart failure outcomes | 05.20 - GDMT medication summary and overview | | 07.17 - Effect on blood pressure and relative risk reduction for each drug | | 10.59 - What order to start in | Hint: ALL AT ONCE… if you can | 11.53 - Beta-blockers | When not to start (new HF in VOL), and when to re/start (almost all other times) Tartrate vs Succinate: duration of action | 15.40 - ARNI (Sacubitril-Valsartan) | Potent natriuresis effect Balancing the orthostatics | 20.37 - Outro | [The appearance of external hyperlinks does not constitute endorsements by UCSF of the linked websites, or the information, products, or services contained therein. UCSF does not exercise any editorial control over the information found therein, nor does UCSF make any representation of their accuracy or completeness. All information contained in this episode are the opinions of the respective speakers and not necessarily the views their respective institutions or UCSF, and is only provided for information purposes, not to diagnose or treat.] Music by Amit Apte. Medical Heart Vectors by Vecteezy

Uwe Dierks ist begeisterter Segler und hat sich so sehr in das Meer verliebt, dass er seinen Job als Physiker hingeschmissen hat. Danach hat er die @SoulSailingCrew gegründet und bringt nun sehr viele Skipper*innen mit einer Crew zusammen, sodass gemeinsame Segel-Abenteuer erlebt werden können.In dieser Folge nimmt uns Uwe Dierks mit aufs Meer. Wir erleben wunderschöne Segel-Romantik aber auch den Thrill eines Gewitters. Wir erfahren, welchen Stellenwert „die Crew“ auf einem Segelboot hat und lernen ganz nebenbei eine Menge Segelbegriffe.Natürlich sprechen wir auch darüber, wie Uwe seinen Job als Physiker geschmissen hat, und wie es ist, als Skipper die Verantwortung für die ganze Crew zu übernehmen. Uwe erzählt auch von dem „Nomadenleben“, dass er seit zwei Jahren führt.Nach Vorschlägen aus der Community haben Uwe und ich beschlossen, 2024 ein ganz besonderes Abenteuer zu organisieren: Eine „Helden der Meere“ Flottille auf dem Mittelmeer. Was da genau auf euch wartet und wie ihr euch anmelden könnt, erfahrt ihr unter diesem Link: https://soul-sailing-crew.com/segeltoerns/helden-der-meere-24/Falls ihr für die Opfer der Sturmflut in Arnis spenden wollt, dann könnt ihr das hier tun: https://www.kappeln.de/index.php?object=tx,2989.5&ModID=7&FID=2989.19728.1Die neue Kategorie Flaschenpost: Du hast ein Feedback, Fragen oder eigene Geschichten zum Podcast? Dann sende mir eine Sprachnachricht an chris@blue-awareness.comMein Tipp für deine Aufnahme: Suche dir einen ruhigen Ort und nimm eine Audiodatei / Sprachmemo mit deinem Handy auf. Sprich dabei nah am Handy aber nicht direkt ins Mikro, sonst kann das Störgeräusche geben.Mit „Ein Leben für den Ozean“ ist ein Buch zum Podcast erschienen. Es erzählt 10 Geschichten über die Held*innen der Meere und begeistert bildgewaltig für den Ozean. Ihr könnt es unter www.ein-leben-fuer-den-ozean.de bestellen.

Oktobrī ar atklāšanas koncertu tika nosvinēta dziesminieka Arņa Miltiņa 50 dziesmu nošu burtnīca, ko izdevusi “Austras biedrība”. Vēl pirms diviem gadiem nošu pierakstā iznāca Arņa Miltiņa bērnu dziesmu izlase “Lai mums labi iet”. Mūziķis pats šīs grāmatas dēvē par notīs un dziesmu tekstos pierakstītu, mūsu kopīgi piedzīvoto laiku, jo radušās dziesmas cieši saistītas gan ar Atmodas gadu noskaņām, gan koncertējot kopā ar Austras bērniem, gan darbojoties Rīgas pilsētas kultūras dzīves organizēšanā, pieredzēto. Arni Miltiņu sagaidu pie Radio durvīm, viņš šurp atminies ar velosipēdu, šī būšot otrā ziema, kad braucot visu gadu. Palūdzu ierakstīt autogrāfu, un Arnis ieraksta - “Svarīgi ir labie vārdi!”. Nu ja, Radio cilvēkiem ko tādu vajadzētu likt aiz auss. Labiem vārdiem ir nozīme. Arņa Miltiņa nosacīti “kopotajos rakstos”, nošu burtnīcā “Arnis Miltiņš. Dziesmas” apkopotas 50 dziesmas, sešpadsmit no tām klāt ir QR kodi, saites uz dziesmu videoierakstiem ar autora īsu pieteikumu, dziesmas stāstu. Ierakstos piedalās arī dēls Jānis un meita Laima. Tā ir tāda patiešām jauka mājas muzicēšana. Ar Vika jeb Viktora Kalniņa vārdiem tapusī “Mīļdziesmiņa” ilgus gadus bijusi Arņa Miltiņa vizītkarte Austras Pumpures dziesmu programmās. Šai ierakstā Arnis Miltiņš “Mīļdziesmiņu” dzied kopā ar Ievu Akurateri, ar kuru pirms 40 gadiem tapa klausītāju ārkārtīgi iemīļota programma, spēlēta koncertos trīs gadus no vietas, starp citu, jauni ieraksti ar Ievu Akurateri top arī šobrīd. Tāpat šobrīd top jauna koncertprogramma kopā ar jauno dziesminieci Melisu Deboru Kaškuru.

Episode 154: Heart Failure and GDMTDr. Malave explains the four main medications that are part of the guideline-directed medical therapy of heart failure with reduced ejection fraction. Dr. Arreaza added comments and questions.  Written by Maria Fernanda Malave, MD. Edits by Hector Arreaza, MD.  You are listening to Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California, a UCLA-affiliated program sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. This podcast was created for educational purposes only. Visit your primary care provider for additional medical advice.Brief introduction: Heart failure (HF) is a common condition that affects about 23 million people in the world, and it is estimated that 50% of cases are due to heart failure with reduced ejection fraction (HFrEF). It is a major public health concern because of the high morbidity and mortality with a 5-year survival rate of 25% after hospitalization due to HFrEF.In recent years, the management of HFrEF has evolved due to increased evidence in favor of certain medications. Guideline-directed medical therapy (GDMT) is the foundation of medical therapy for these patients, and it is the result of multiple randomized controlled trials and reviews favoring four main drug classes: 1. renin-angiotensin system inhibitors (angiotensin-converting enzyme inhibitors -ACEi- and angiotensin receptor blockers -ARB), 2. evidence-based β-blockers, 3. mineralocorticoid inhibitors, and 4. sodium-glucose cotransporter 2 inhibitors -SGLT-2i-. The benefit of this therapy is mostly seen when these four groups of medications are used in conjunction. During this episode, we will provide some key elements about the prescription of these medications, but this is only an overview, and you are invited to continue learning from reputable sources.Definitions: HF is defined as the impairment of the heart to meet the metabolic demands of the body. It can be caused by multiple conditions that interfere with the filling up of the heart or conditions that prevent an effective ejection of blood out of the heart. Classification of HFrEF: Based on the EF by echocardiogram, heart failure can be classified as:Heart failure with preserved ejection fraction (HFpEF) when the EF is 50% or more.Heart failure with mildly reduced ejection fraction when EF ranges between 41-49%.Heart failure with reduced ejection fraction (HFrEF) when EF is 40% or less.GDMT: Once we make the diagnosis of HF, it is key to educate our patients and re-educate them every single visit about the importance of guideline-directed medical therapy (GDMT) and lifestyle modifications, because this can change the prognosis and exacerbation rates. Many patients think that since they are feeling well after starting GDMT they can stop it, but that's going to increase exacerbations, hospitalizations, and decrease quality of life. Key points to discuss with patients.First, discuss that GDMT are disease-modifying drugs that regulate the neurohormonal system to stop the progression of the disease. We should explain to our patients that medications should be taken despite feeling well. Also, patients should be educated about regular follow-ups and medication titration. We can even instruct our patients about increasing their furosemide dose if they observe signs of overload, such as a weight increase of 2-3 kgs in 3-4 days, tight rings, socks or bracelets, also Paroxysmal nocturnal dyspnea, dyspnea on exertion, and more.  Second, lifestyle modifications such as: quit smoking and alcohol. Additionally, in general, water restriction between 1.2-1.5L daily, salt restriction (there is no official recommendation about how many grams, but in general we recommend less than 2g daily). Third, it is highly recommended to do aerobic exercise that produces mild dyspnea since this improves cardiovascular capacity and decreases hospitalization risk. Patients should be encouraged to have their annual influenza vaccine and pneumococcal vaccine according to their own immunization schedule. According to the AFP journal, in September 2022, researchers found a clinically and statistically significant reduction in all-cause mortality for patients who received an influenza vaccine right after an MI, with a number needed to treat of 50, the effectivity of the vaccine may vary by season.GDMT, groups of medications:What are the basic medications any patient with HF should be on? At least, patients should be on angiotensin receptor blockers ARBs/ACEIs and Beta-blockers. Let's keep in mind that beta-blockers should be given cautiously in cases of exacerbation, but in general low doses are safe. We also have the angiotensin receptor/neprilysin inhibitors (ARNIs), a group of medications whose representative is the combination of sacubitril/valsartan, aka Entresto®. This medication should be the target once ARBs/ACEIs are tolerated. ARBs/ACEIs/ARNIs should be discontinued in the setting of advanced CKD, with a GFR of 30 or less. This applies to other medications used in HF such as SGLT-2 and mineralocorticoid receptor antagonist (MRA, such as spironolactone/eplerenone). Remember that SGLT-2 inhibitors should be started regardless diabetes status, and BB are safe in the setting of CKD. We also have other groups that are considered safe in patients with advanced CKD such as hydralazine/isosorbide dinitrate (combined or not), which are used in African Americans whose BP and HF symptoms do not improve with maximally tolerated dose of ARBs/ACEIs + BB.Ivabradine: Let's not forget about ivabradine, which is an SA node inhibitor like BB. Patients need to meet criteria such as a maximally tolerated dose of beta-blocker, heart rate of a least 70 or more and being on normal sinus rhythm to be started on this medication. Ivabradine does not improve survival as BB do, so even though they are not contraindicated in HF exacerbation, BB are still preferred since ivabradine does not decrease mortality.Titration and follow-ups in the HF management:-ARBs/ACEIs/ARNIs should be titrated approx. Q2 weeks until the maximally tolerated dose is achieved, ARNI should be titrated up Q2-4weeks. With these medications, we should monitor BP, potassium levels and Glomerular Filtration Rate (GFR). -BB can also be titrated up Q2weeks until the maximally tolerated dose is achieved. HR, BP and signs of congestion should be observed in patients on BB. Same for hydralazine/isosorbide, with BP follow-up. -MRA, such as spironolactone/eplerenone, these meds can be added in patients who remain symptomatic despite maximally tolerated doses of “ARBs or ACEIs or ARNIs” plus Beta-blockers. For MRA, potassium level, and GFR should be monitored every 2-3 days after initiation, 7 days after titration, monthly for 3 months, and then Q3 months. To start a patient on MRA, K+ must be lower than 5.Patients with HF should be followed up at least in a 2-week interval either via telephone, telemedicine, or clinic visit to assess symptoms, vital signs, bloodwork and to perform a physical exam. Monitoring EF: After 3-6 months of the patient´s stabilization, we should reorder an echo, EKG, BNP and Basic Metabolic Panel. The ejection fraction improves in all patients after GDMT initiation and compliance, and in some patients, this improvement is very significant, so we need to reassess EF after stabilization. Comorbidities: Also, let´s keep in mind that most of the patients have associated comorbidities such as Afib, diabetes, valve disease, or anemia. These comorbidities must be addressed either by starting anticoagulation, adjusting anti-diabetes medications, starting iron, or referring to cardiology if a valve replacement is needed.When to refer to Cardiology? Some patients will qualify for device therapy (ICD) as a primary prevention for ventricular arrhythmias that can degenerate either into torsades or ventricular fibrillation. These patients must be symptomatic, at least in 3 months of maximally tolerated GDMT, and EF between 30-35%. Symptomatic

Ēnu ekonomika pēdējos gados Latvijā saglabājas gandrīz nemainīgi augsta. Neiekasēto nodokļu apjoms tiek lēsts virs 2,7 miljardiem, kas valsts budžetā lieti noderētu. Lai gan daudzām valdībām ēnu ekonomikas apkarošana ir bijusi darāmo darbu sarakstu augšgalā, tomēr ar to nesokas. Krustpunktā lielajā intervijā vērtē ēnu ekonomikas pētnieks, Rīgas Ekonomikas augstskolas profesors Arnis Sauka.  

Ēnu ekonomika pēdējos gados Latvijā saglabājas gandrīz nemainīgi augsta. Neiekasēto nodokļu apjoms tiek lēsts virs 2,7 miljardiem, kas valsts budžetā lieti noderētu. Lai gan daudzām valdībām ēnu ekonomikas apkarošana ir bijusi darāmo darbu sarakstu augšgalā, tomēr ar to nesokas. Krustpunktā lielajā intervijā vērtē ēnu ekonomikas pētnieks, Rīgas Ekonomikas augstskolas profesors Arnis Sauka.  

Eskrima, Arnis und Kali sind moderne Nahkampfsysteme. Die philippinischen Kampfsportarten haben ihre Wurzeln in der Kampfkunst der alten Stämme. In dieser Folge spricht Thorsten Klangwarth über Kali. Zwischendurch gehts wie gewohnt mal wieder über Tische und Bänke. Von HongK Kong Filmen aus den 80ern in Pornokinos, über die Sinnfrage nach einer Selbstverteidigung "ohne" Sparring. Diese Folge wurde gesponsert von Upsters Energy!  Folge uns auf: Instagram: https://www.instagram.com/kampfsport_podcast Twitter: https://www.twitter.com/sge_shaolin YouTube: https://www.youtube.com/@Kampfsportpodcast TikTok: https://tiktok.com/kamsport_podcast ...oder spendiert uns einen Kaffee: Buy Me A Coffee: https://www.buymeacoffee.com/Hyenastyle Aber egal was ihr macht - bleibt so geil wie ihr seid!v Du möchtest deinen Podcast auch kostenlos hosten und damit Geld verdienen? Dann schaue auf www.kostenlos-hosten.de und informiere dich. Dort erhältst du alle Informationen zu unseren kostenlosen Podcast-Hosting-Angeboten. kostenlos-hosten.de ist ein Produkt der Podcastbude.Gern unterstützen wir dich bei deiner Podcast-Produktion.

Do you know about the extra cardiac effects and other effects of angiotensin receptor-neprilysin inhibitors (ARNIs)?    Credit available for this activity expires: 9/29/2024 Earn Credit / Learning Objectives & Disclosures: https://www.medscape.org/viewarticle/996323?ecd=bdc_podcast_libsyn_mscpedu

Atskatoties uz šīs vasaras lielāko notikumu, vēl vairāki jaunieši dalās ar piedzīvoto. Ikviens stāsts ir citādāks un aizkustina sirdi. Par piedzīvoto stāsta arī pr.Arnis Maziļevskis, kas pavadījis jauniešus ceļā. Arī jauniešu darba koordinatore Anda Aleksandrova, kas pamanījusi, ka šis ceļojums kardināli uzlabojis viņas attiecības ar Dievu.

Discussion autour du livre qui vient de paraître de GM Dani Faynot "Les Guerriers Magiciens" - Culture, histoire, origines du combat dans l'archipel des Philippines. Un livre de 400 pages à décorer dès à présent sur AMAZON.  Commandez votre exemple sur : Le site de l'école Arnis Doblete rapilon :  GM Dani Faynot est sociologue et anthropologue de formation, a dédié une grande partie de sa vie à étudier cette culture guerrière riche et complexe, notamment en dehors des sentiers battus de l'histoire et de la linguistique. En partant des premiers habitants et chasseurs des forêts vierges jusqu'aux vagues de migration en provenance de différentes parties de l'Asie, notre expert nous guide à travers un voyage passionnant dans l'histoire et l'évolution du combat aux Philippines. Vous découvrirez comment cette région est un véritable carrefour entre le Nord et le Sud de l'Asie, avec des influences de la Chine, du Japon, de Taïwan, de la Corée, de l'Indonésie, et bien d'autres. La colonisation espagnole, l'occupation japonaise, et l'influence américaine ont également laissé leur empreinte sur les arts martiaux philippins, modifiant les techniques, les armes, et les stratégies. Cependant, ce n'est qu'une partie de l'histoire. La deuxième partie de ce récit captivant se penche sur l'aspect ésotérique des arts martiaux philippins. Vous découvrirez comment cette culture profondément religieuse, mêlant le christianisme, l'islam, les traditions malaises, indiennes, et animistes, a influencé les croyances, les perceptions du monde, et même la manière de combattre. La magie, la foi, et le rapport à la mort jouent un rôle essentiel dans la mentalité des combattants, et cette intégration profonde fait des arts martiaux philippins une expérience unique et inextricable de leur culture. ⛩ Soutenir nos futurs projets En Terre Martiale ⭐️ 

Heute im Fokus: Die Stadt Arnis muss ihre Pläne für öffentliche Schnellladesäulen für E-Autos vorerst auf Eis legen. Auch Wallboxen für Privathaushalte werden nicht mehr genehmigt, weil sie Stromausfälle verursachen könnten. Woran das liegt, hört ihr hier.

No 15. septembra līdz 16. novembrim ISSP Galerijā būs skatāma Arņa Balčus izstāde "Scēna", kas pievēršas šodienas jauniešu alternatīvajai subkultūrai, dēvētai arī par "jauno scēnu" jeb vienkārši "scēnu". Kultūras rondo tiekamies ar fotogrāfu Arni Balčus. Par to, kas ir "scēna" un kā viņi dzīvo, saruna ar jauniešiem sarunas ar Dāvi, Paulu un Ventu. “Scēna” ir mūzikā sakņota kopiena Rīgā, kas savu kulmināciju piedzīvoja pēc pandēmijas, kad alternatīvās mūzikas grupu koncerti Depo, Republikā un Lastādijā kļuva par nozīmīgu platformu jauniešu socializācijai un radošai pašizpausmei. Šī izstāde, kuras kodolu veido Balčus fotogrāfijas, ir ne vien šī laikmeta fenomena dokumentācija, bet arī pašas subkultūras uzstādījums – izstādē varēs skatīt arī jauniešu darbus, notiks dažādi pasākumi ar viņu līdzdalību, tostarp koncerts un dzejas vakars. Šī izstāde plašākā mērogā runā par šodienas jauniešu izaicinājumiem, jo aiz krāšņiem grimiem un agresīvas mūzikas slēpjas mūsdienu jauniešu dzīves problēmas – vēlme pašapliecināties, dzīves jēgas meklēšana, identifikācijas problēmas, psihiskās saslimšanas, kā arī sarežģītās attiecības savā starpā, kur netrūkst konfliktu, pašnāvības mēģinājumu un vardarbības. Ķermenis vairumā gadījumu ir vienīgais, pār ko tiem ir vara, un tas kļūst ne tikai par savas identitātes apliecināšanas veidu, bet arī par protesta instrumentu. Līdzās mūzikai un mākslai arī sevis rētošana, tetovēšana, dzimuma fluiditāte, seksuāla pašnoteikšanās, antisociāla uzvedība ir kā iestāšanās pret nolemtības sajūtu, ka šajā pasaulē nav iespējams ko mainīt.  Izstādes atklāšana notiks 14. septembrī plkst. 18.00 ar trīs panku grupu – “ŠŅK”, “Defekts” un “Depustūtes” – koncertu.

SPORTS: PSC reaffirms commitment, promotion of Arnis in ASEAN | September 2, 2023Subscribe to The Manila Times Channel - https://tmt.ph/YTSubscribe Visit our website at https://www.manilatimes.net Follow us:Facebook - https://tmt.ph/facebookInstagram - https://tmt.ph/instagramTwitter - https://tmt.ph/twitterDailyMotion - https://tmt.ph/dailymotion Subscribe to our Digital Edition - https://tmt.ph/digital Check out our Podcasts:Spotify - https://tmt.ph/spotifyApple Podcasts - https://tmt.ph/applepodcastsAmazon Music - https://tmt.ph/amazonmusicDeezer: https://tmt.ph/deezerStitcher: https://tmt.ph/stitcherTune In: https://tmt.ph/tunein #TheManilaTimes Hosted on Acast. See acast.com/privacy for more information.

Brannon Beliso serves individuals, businesses, and companies in living their best life. As a critical thinker and influencer, his passion is to inspire the discovery of purpose.Brannon is a Tedx Talk speaker and has presented at Facebook, Stanford Health Care, Lululemon, Microsoft, Barclays Global, UCSF Medical Center, Century's Martial Arts Super Show, Kukkiwon's President's Summit, and the MyStudio Business Summit (held at Harvard) to name a few.Brannon is an 8th degree black belt and CEO of One Martial Arts in Millbrae and San Francisco. He is an author and the creator of Kids Love Life Skills, a character-building system partnered with over 300 schools. Brannon also serves small businesses and martial arts school owners throughout the world with his It's Time Consulting.Brannon practices Kenpo Karate and has also trained in Kung Fu, Jujitsu, Arnis, Boxing, and Kickboxing. He has competed in and won over 100 major competitions.Thank you to BetterHelp for sponsoring this episode. BetterHelp is the world's largest therapy service, and it's 100% online. With BetterHelp, you can tap into a network of over 30,000 licensed and experienced therapists who can help you with a wide range of issues.Get 10% off your first month at betterhelp.com/howtosurvivesociety Support the showThank you for listening to another episode of How To Survive Society.Thank you to BetterHelp for sponsoring this episode.BetterHelp is the world's largest therapy service, and it's 100% online.With BetterHelp, you can tap into a network of over 30,000 licensed and experienced therapists who can help you with a wide range of issues.To get started, you just answer a few questions about your needs and preferences intherapy. That way, BetterHelp can match you with the right therapist from their network, Then you can talk to your therapist however you feel comfortable, whether it's via text, chat, phone or video call. You can message your therapist at any time, and schedule live sessions when it's convenient for you. If your therapist isn't the right fit for any reason, you can switch to a new therapist at no additional charge.With BetterHelp, you get the same professionalism and quality you expect from in-office therapy, but with a therapist who is custom-picked for you, more scheduling flexibility, and at a more affordable price.Get 10% off your first month at https://www.betterhelp.com/howtosurvivesociety

Kā jau katru pēdējo mēneša pirmdienu, priesteris Arnis dalās ar uzrunu. Šajā raidījumā tā ir par Svēto Garu, kura nosūtīšanas svētkus svinējām vakar. Kāds ir Svētais Gars? Kā to uzņemt un ielaist savā dzīvē? Uz šiem jautājumiem atbild priesteris. Kā arī dienā, kad svinam bronzas medaļas ieguves dienu, viņš pieskaras arī hokeja un ticības dzīves līdzībām.

Imanta Ziedoņa dzimšanas dienas svinēšana “Es esmu viens. Es esmu neskaitāms ”, kur pie galda kopā būs Nora Ikstena, Māra Zālīte, Kaspars Znotiņš – ar dzeju, ar vārdu, ar domu par šodienu, bet Vestards un Aurēlija Šimkus – ar mūziku. Kultūras rondo saruna ar rakstnieci Noru Ikstenu un sarīkojuma vienu no scenārija autorēm Ivetu Šimkus. "Pavisam netālu no Tukuma, slavenā Rīgas mēra Džordža Armitsteda celtajā Jaunmoku pilī ir notikušas zīmīgas kopānākšanas, ar Imanta Zieoņa, viņa draugu un domubiedru dalību," tā rakstīts grāmatā „Ziedoņa ķiršu dārzs. Tukuma Imants”. Ar Jaunmokām saistīts arī kāds pārpratums, ko Imants savā manierē arī atrisinājis, bet Kultūras rondo par to Ragaciema - Tukuma brauciena laikā pastāstīja publicists Arnis Šablovskis. “Es skaitīju un nonācu pie Viena,” rakstīja Imants Ziedonis. Godinot dzejnieku 90. dzimšanas dienā, 19. maijā pl. 19.00 Jaunmoku pils Kolonnu zālē kafejnīcas atmosfērā notiks Imanta Ziedoņa dzimšanas dienas svinēšana “Es esmu viens. Es esmu neskaitāms ”. Improvizētā kafejnīcā pie Jāņa Straupes veidota simboliska galda mūžīgās sarunās pulcēsies Imanta Ziedoņa draugi un domubiedri. Kopā esot, svinēta tiks dzīve kā ceļš, ieraugot un apliecinot pasaules brīnumaino skaistumu. Ar sarunām, kurām nav ne sākuma, ne beigu, – gan tām, kuras jau notikušas un 2000. gadā pierakstītas Māras Zālītes grāmatā “To mēs nezinām”, gan ar tām, kuras notiks šeit un tagad. Laiks būs mūžīgā tagadne, nenoteiktā bija. Vieta – mūžīgā kafejnīca, kuru iekārtojusi Ieva Jurjāne kopā ar Jāni Straupi.

Assoc. Prof. Donald Lipardo, PhD shared with us their research entitled "Arnis-based Exercise Program for Balance Control in Community-Dwelling Older Adults: Study Protocol for a Pilot Randomized Controlled Trial." In this video, Dr. Lipardo explains why they chose arnis for their study, the details of the study protocol program, and what they hope to achieve through their research. He also discussed the challenges they have prepared for and their future plans for the study. Download and read about the research: https://soar.usa.edu/phjpt/vol1/iss3/3/ About the guest: Assoc Prof Donald Lipardo is a Faculty member in the College of Rehabilitation Sciences at the University of Santo Tomas. He is also part of the Center for Health Research and Movement Science at UST. --- Support this podcast: https://podcasters.spotify.com/pod/show/ptmealpodcast/support

Mēs meklējām Imantu Ziedoni viņa grāmatās kopā ar aktieri Kasparu Znotiņu, kurš radījis savu Dzejnieku iestudējumā "Ziedonis un Visums". Mūsu pieturas punkti un sarunu biedri – Imanta jaunākā māsa Anita Bumbure Ragaciemā un publicists Arnis Šablovskis Tukumā. Mums todien prātā bija pieturas punkti un pilna mašīna ar Ziedoņa grāmatām. Visi Rakstu sējumi. Arī "Trioletas", "Epifānijas", "Pasāžas", kas tapušas kopā ar Kurtu Fridrihsonu. Vēl "Nenoteiktā bija" kopā ar Noru Ikstenu un sarunas  ar Māru Zālīti. Un viss, ko Kaspars Znotiņš bija domājis un pieredzējis izrādes "Ziedonis un Visums" tapšanas laikā. Un vēl jau arī tas, kas mums bijis Ziedonis skolā un sarunās. Mēs meklējām Ziedoni pirms Ziedoņa, arī to, kuram galvā bija tādas ietilpīgas vīzijas. Piemēram – "Škūnis". Šodien, 3. maijā, – Imanta Ziedoņa 90. dzimšanas diena. Mums todien prātā bija pieturas punkti un sarunu biedri - Imanta jaunākā māsa Anita Bumbure Ragaciemā un publicists Arnis Šablovskis Tukumā. Bet tad viss notika ne pēc mūsu plāna, bet pēc kāda cita plāna. Kad atbraucām Rīgā, Kaspars Znotiņš steidzās uz izrādi, bet mums visiem palika kāda pēcsajūta, ka vajadzēja vēl to un to, un to pajautāt, vēl izlasīt un to vēl izrunāt. Tā tapa saruna Radio studijā. Tāds "Post Scriptum". Atgriežamies pie pieturas punktiem – Imanta Ziedoņa dzimtais Ragaciems. Mājas „Birutas”. Ragaciema kapi, kur tādā kalniņā tagad guļ Imants Ziedonis un Ausma Kantāne. Tajos kapos arī Imanta vecāki un otra māsa. Ragaciemā Imants ar saviem dagiem stādījis pūpolus, nu jau sen, bet mums tos vajag redzēt. Māsa Anita Bumbure mūs sagaida un Kasparam Znotiņam saka: Re, brālis arī atbraucis! Atvadāmies no Ragaciema un pamājam sveicienus Imantam un Ausmai Ragaciema kapos, un braucam uz Tukumu. Imantam arī patika  atbraukt uz Tukumu, jo te viņš bija savējais, te bija vēl skolotājas un skolas biedri, te viņš varēja būt Imants vēl pirms Ziedoņa. Imanta 77. dzimšanas dienā Mālkalnā iestādīja 77 ķiršus. Mums jāiet apskatīties, kā tie aug. Izrādās paši [Latvijas Radio] ar esam klāt bijuši un stādījuši. Apsēžamies Tukuma centrā, Katrīnas laukumā, kur uz kāda nama sienas slavenais Imnata Dzejolis par Tukumu, esam kopā ar Arni Šablovski, kurš mums saka: ķirši vēl neziedot, esot gudrāki par mums. Visu izrunāt nevar. Citai reizei vēl paliks jautājumi par dzejnieku un varu, par ticības paradoksiem un trejādībām, par spītīgo Ziedoni, par viņa vecākiem un vecvecākiem, par Ausmu, kas ienāca Imanta dzīvē kā balta gaisma. Paliks stāsti par viņa visādajām jubilejām, kas nu katrā noticis, uzvests, plānots vai radījis jaunu iedvesmu. Paliks stāsti par to, kā viņi gājuši dižkokus glābt, kā viņš spējis aizraut cilvēkus, bet tālāk teicis, nu, viņiem jāiet pašiem. Mēs paspējām tik ieraudzīt pūpolus Ragaciema kāpās. Bet ķirši vēl neziedēja todien. Mēs atgriezāmies Rīgā un satikāmies no jauna Radio studijā. Mums todien bija jautājumi galvā un pilna soma ar grāmatām.

Kā jau katru pēdējo mēneša pirmdienu "Dievs ir ļoti, ļoti labs" uzrunā priesteris Arnis. Lieldienu laikā viņš atgādina divas lietas. Pirmā būs pie sirds tiem, kam tuva Sv. māsa Faustīne, bet otrā palīdzēs mazāk baidīties no nelabā.

Kā jau katru pēdējo mēneša pirmdienu, Marijas skolas atbildīgais priesteris Arnis, pastāsta par kādu aktualitāti. Šobrīd tas ir gavēnis. Ja arī tev kā raidījuma vadītājam Jevgeņijam ir diena, kad liekas, ka gavēnī varētu iet labāk, te būs praksē un Bībelē balstīti padomi, kā nepadoties un saknē apkarot neveiksmes gavēņa laikā.

Iesoļojot gavēņa noslēguma daļā, priesteris Arnis Maziļevskis iesaka pārdomāt, kā uztvert ciešanas par kaut ko skaistu un svarīgākais - neiedomāties tos esam arī par dzīves jēgu.

Support My Podcast:  buymeacoff.ee/Aligned https://insighttimer.com/mariyakatrina Schedule your therapy sessions.

Brannon Beliso serves individuals, businesses, and companies in living their best life. As a critical thinker and influencer, his passion is to inspire the discovery of purpose.  Brannon is a Tedx Talk speaker and has presented at Facebook, Stanford Health Care, Lululemon, Microsoft, Barclays Global, UCSF Medical Center, Century's Martial Arts Super Show, Kukkiwon's President's Summit, and the MyStudio Business Summit (held at Harvard) to name a few. Brannon is an 8th degree black belt and CEO of One Martial Arts in Millbrae and San Francisco. He is an author and the creator of Kids Love Life Skills, a character-building system partnered with over 300 schools. Brannon also serves small businesses and martial arts school owners throughout the world with his It's Time Consulting. Brannon practices Kenpo Karate and has also trained in Kung Fu, Jujitsu, Arnis, Boxing, and Kickboxing. He has competed in and won over 100 major competitions. Brannon has been featured on Evening Magazine, CBS Morning News, KRON 4 Health, Martial Arts Success Magazine, and Dojo Digest. Brannon is the author of “Live, Learn, Grow,” a contributor to the internationally best seller, “Black Belt Power,” and has written features for several major martial art magazines, and blogs. He also penned the children's book, “The Adventures of Bray & Tey.” Brannon has been a featured guest on podcasts ranging from mindset to culture building to defining your purpose. He hosts a local Facebook live show and podcast, “Success Never Sleeps” and “Mindful Meditations.” Brannon is committed to being a student for life and serving others. Brannon is husband and father, the two things he is most dedicated to and proud of. Brannon IG Brannon FB Success Never Sleeps Podcast 

This week, please join authors Mikhail Kosiborod and Christian Schulze and Editorialist Stefan Anker as they discuss the original articles "Effects of Empagliflozin on Symptoms, Physical Limitations and Quality of Life in Patients Hospitalized for Acute Heart Failure: Results From the EMPULSE Trial" and "Effects of Early Empagliflozin Initiation on Diuresis and Kidney Function in Patients With Acute Decompensated Heart Failure (EMPAG-HF)" and the editorial "SGLT2 Inhibitors: From Antihyperglycemic Agents to All-Around Heart Failure Therapy." Dr. Carolyn Lam:             Welcome to Circulation on the Run, your weekly podcast summary and backstage pass to the journal and its editors. We're your co-hosts. I'm Dr. Carolyn Lam, Associate Editor from the National Heart Center and Duke National University of Singapore. Dr. Greg Hundley:           And I'm Dr. Greg Hundley, associate editor, director of the Pauley Heart Center at VCU Health in Richmond, Virginia. Dr. Carolyn Lam:             I'm so excited about the feature discussion this week. It is a paired feature along with their editorial and it's all focused on SGLT2 inhibitors. The first, results from the EMPULSE trial, Effects of Empagliflozin on Symptoms, Physical Limitations and Quality of Life in Patients Hospitalized for Acute Heart Failure; and the second, the EMPAG-heart failure trial, The Effects of Early Empagliflozin Initiation on Diuresis and Kidney Function in Patients with Acute Heart Failure. Incredibly important topics, incredibly important discussion. Wait up for it. We're just going to tell you a little bit more about two other original papers in today's issue, and I'm going to go first, Greg. Is that okay? Dr. Greg Hundley:           You bet. Dr. Carolyn Lam:             Now, really interesting topic here. We have strong evidence supporting the effective blood pressure and cardiovascular disease risk lowering properties of healthy diet such as the DASH diet, Mediterranean diet, and so on and so on. But what about the diet consumed by a fifth of the entire world's population? The Chinese cuisine. Interestingly, today's paper addresses just that. This is from authors, Dr. Wu, from Peking University Clinical Research Institute and colleagues who performed a multicenter patient and outcome assessor blind randomized feeding trial among 265 participants with baseline systolic blood pressure of 130 to 159 in four major Chinese cuisines. And these are the Shandong, Huaiyang, Cantonese, and Szechuan cuisines, and here's how they did it. After a seven day run in period on a control diet matching the usual local diets, participants were randomized to continue with the control diet or the cuisine based Chinese heart healthy diet for another 28 days. The primary outcome was systolic blood pressure. The study developed the first heart healthy Chinese diet that fits Chinese food culture and emphasizes its palatability by involving master shifts in developing the recipes. Dr. Greg Hundley:           Oh wow. Carolyn, this is really interesting, especially one fifth of the world's population in studying a heart healthy diet. So did it work? I can't wait to hear the results. Dr. Carolyn Lam:             Well, the change in systolic and diastolic blood pressure from baseline to the end of the study in the control group was five millimeters mercury and 2.8 millimeters mercury reduction, respectively. The net difference of change between the two groups in systolic and diastolic blood pressure were a reduction of 10 and almost four millimeters mercury, respectively. The effect size did not differ among cuisines, and so in summary, with a patient and assessor blind randomized feeding trial, this study really demonstrated that the blood pressure lowering effect of the Chinese heart health diet could indeed be substantial, and importantly, be compatible with medications while palatable and affordable in Chinese adults with high blood pressure, and so these results support the idea that food is medicine and will give many patients with high blood pressure the confidence to adopt heart healthy diets in their lifestyle treatment. Dr. Greg Hundley:           Wow, Carolyn, that is really an interesting article. So many of these articles today could all be features in and of themselves. That was just outstanding. Well, my next paper comes to us from the world of preclinical science, and it's from Dr. Sean Wu from Stanford University School of Medicine. So Carolyn, immune checkpoint inhibitors are monoclonal antibodies that are used to activate the immune system against tumor cells. Now, despite their therapeutic benefits, immune checkpoint inhibitors have the potential to cause immune mediated adverse events such as myocarditis, a rare but serious side effect with up to 50% mortality in affected patients. Now histologically, patients with immune checkpoint inhibitor of myocarditis have lymphocytic infiltrates in the heart implicating T-cell mediated mechanisms. However, the precise pathologic immune subsets and molecular changes in immune checkpoint inhibitor myocarditis are unknown. Dr. Carolyn Lam:             Wow. So insights into the etiology of these immune checkpoint associated myocarditis cases must be very important. So what did they find? Dr. Greg Hundley:           Right, Carolyn? So clonal cytotoxic, TEMRA CD8+ cells were found to be significantly increased in the blood of patients with immune checkpoint inhibitor myocarditis corresponding with an analogous increase in effector cytotoxic CD8+ cells in the blood and hearts of PD-1 deficient mice with myocarditis. These expanded effector CD8+ cells had unique transcriptional changes, including upregulation of the chemokines CCL5, CCL4, and CCL4L2, and they may serve as attractive diagnostic therapeutic targets for reducing life threatening cardiac immune related adverse events in immune checkpoint inhibitor treated cancer patients, and Carolyn, just like so many of our articles, there's a very nice accompanying editorial by Professor Gianluigi Condorelli that also offers an update on current research pertaining to non-systemic steroid therapy to treat immune mediated myocarditis. Well, Carolyn, how about we jump to some of the other articles in the issue? Dr. Carolyn Lam:             Oh, you bet, Greg. There's an exchange of letters between Drs. Madias and Knops regarding the article “Efficacy and Safety of Appropriate Shocks and Antitachycardia Pacing in Transvenous and Subcutaneous Implantable Defibrillators: The Analysis of All Appropriate Therapy in the PRAETORIAN Trial.” Dr. Greg Hundley:           And also in the mail bag, Professor Mark has a Research Letter entitled “Effect of Empagliflozin on Kidney Biochemical and Imaging Outcomes in Patients with Type 2 Diabetes, or Prediabetes, and Heart Failure with Reduced Ejection Fraction, The SUGAR-DM-HF Study,” and our own Tracy Hampton has several synopses from articles published elsewhere in our piece on cardiovascular news. Well, how about we get onto that feature forum discussion, two papers, two editorialists. I can't wait. Dr. Carolyn Lam:             Me too. Let's go, Greg. Dr. Greg Hundley:           Welcome, listeners to this July 26th feature forum discussion. So remember, listeners, for forum discussions, we have several manuscripts that focus on a singular topic and we bring together the authors, our associate editors, and also an editorialist, and today, I want to introduce, we have with us Dr. Mikhail Kosiborod from Mid America Heart Institute in Kansas City, Missouri, Dr. Christian Shults from University Hospital Jena in Germany, Stefan Anker from Charité in Berlin, Germany, and our Associate Editors, Brendan Everett from Brigham and Women's Hospital in Boston, Massachusetts, and Justin Grodin from University of Texas Southwestern Medical Center in Dallas, Texas. Welcome, gentleman, and we'll start with you, Mikhail. Could you describe for us the background information that went into the preparation of your study and what was the hypothesis that you wanted to address? Dr. Mikhail Kosiborod:   Well, thanks very much, Greg. The background for the study, which was the secondary analysis of the EMPULSE trial was patients that are hospitalized with acute decompensated heart failure represent a very high risk group. We know that they have high risk of death and hospitalizations, and we also know that they have very poor health status that's very high burden of symptoms, physical limitations, and poor quality of life, and so addressing those treatment goals, trying to reduce the risk of clinical events like death and hospitalizations and improve the symptoms and physical limitations in this patient population are very important treatment goals. Now we previously demonstrated in the main results of the EMPULSE trials that using empagliflozin initiating empagliflozin SGLT2 inhibitor in this patient population as compared with placebo provided a significant total clinical benefit, which was a composite of total death, repeat hospitalizations for heart failure, or a change in a Kansas City cardiomyopathy questionnaire, which is a kind of a gold standard measure of patient's health status. What we tried to do in a much more granular fashion in this study is to understand the effects of empagliflozin as compared with placebo on this very important outcome, the Kansas City cardiomyopathy questionnaire, and we actually evaluate all of the key domains and composite symptoms, physical limitations, as well as quality of life. Dr. Greg Hundley:           Very nice, and Mikhail, can you describe for us what study population specifically, and then what was your study design? Dr. Mikhail Kosiborod:   Well, this was a population of patients that were hospitalized with heart failure and that EMPULSE was unique in its design because first of all, previous SGLT2 inhibitor trials mostly focused on patients with chronic heart failures that were in an outpatient setting, including prior trials of empagliflozin, and EMPULSE really focused on acutely hospitalized patient population, but it included patients regardless of ejection fraction. So as they were hospitalized with decompensated heart failure and reduced or preserved ejection fraction. They were enrolled regardless of if they had type 2 diabetes, they were enrolled essentially, regardless of kidney function, only patients with EGFR of less than 20 were excluded, and also importantly, was this study and a unique feature of the study in particular was that we enrolled patients whether they had acute de novo heart failure. That means that was a new diagnosis of heart failure that was bad enough for them to be hospitalized or worsening chronic heart failure requiring hospitalization. So it was really an all-comer trial for patients acutely hospitalized for heart failure. So we had just over 500 patients and they were randomized in the hospital. After a brief period of stabilization, we use empagliflozin, 10 milligrams daily or placebo and treated for 90 days, and the primary outcome at 90 days was a total clinical benefit that I described that was a composite, hierarchical composite of total death hospitalizations, repeat hospitalizations for heart failure and changing KCCQ. In this study, again, we focused predominantly on KCCQ, trying to understand the effects on health status, again, symptoms, physical limitations, and quality of life. Dr. Greg Hundley:           Excellent. And Mikhail, what were your study results? Dr. Mikhail Kosiborod:   Well, what we observed, a couple of things. One is we first examined the effects of empagliflozin on the primary endpoint across the range of KCCQ and baseline, and what we found was that regardless of the degree of symptomatic impairment and baseline, empagliflozin was consistent in providing them total clinical benefits that I described previously, and then kind of shifting to what I think is the most interesting findings, the effects of empagliflozin versus placebo on KCCQ, what we found was that as you would imagine in this population of patients that were acutely hospitalized with heart failures, that had very poor health status, very low KCCQ at baseline, and within the first 90 days, which was observation period, both groups of patients had substantial improvements in KCCQs. As one would expect after acutely decompensated episode of heart failure and treatment in a hospital, everyone got better. But patients treated with empagliflozin had significantly greater improvement in KCCQs than those that were treated with placebo, and that was first of all, a very substantial difference between the two groups. It was more than five points in favor of empagliflozin already at 15 days and was highly statistically significant, and it was maintained throughout the 90 day treatment period. So the fact that we saw both a clinical meaningful and statistically significant improvement in just 15 days, I think is a very important clinical message, and then finally, I guess what I will mention is these benefits of empagliflozin while main outcome we looked at was KCCQ total symptoms, we're focusing on the symptoms, but it was consistent when we looked at physical limitations as well as quality of life. So really, all key domains of KCCQ were impacted in a similar way. Dr. Greg Hundley:           Very nice. So in acute heart failure, marked symptomatic improvement after the administration of the SGLT2 inhibitor empagliflozin at 10 milligrams per day. Well, now listeners, we're going to turn to our associate editor, Dr. Brendan Everett, and Brendan, again, you have many papers come across your desk. What attracted you to this particular manuscript? Dr. Brendan Everett:      Well, thanks, Greg, and I think this manuscript caught my eye because of the importance of the clinical question, and Mikhail outlined why I think that was really relevant. So we understand that this class of medications or SGLT2 inhibitors have important effects on outcomes like re-hospitalization in patients with heart failure, and what was particularly striking about this paper is that it took patients rather than those with chronic heart failure, but as Mikhail mentioned, enrolled a patient population that was actually in the hospital, and I think this was an important frontier for this particular question about when to start the SGLT2 inhibitor and what kind of benefits there might be. Furthermore, I think the fact that they did not select the population based on ejection fraction was particularly striking, and of course, I think is remarkable, but now old news, they did not select on the presence or absence of diabetes as well. And so those three components really attracted me to the paper. I also think the outcome is one that really is valuable and worth exploring, and specifically, I'm talking about how patients feel on the medication after a hospitalization for heart failure. Appropriately, we focused on re-hospitalization for heart failure and cardiovascular death in prior trials in this space, and I think we need to embellish those findings or further deepen those findings with a perspective on how patients actually feel when they get the medication, and of course, it goes without saying that what's particularly important here also is that it was a randomized placebo controlled trial, and so the results have some element of internal validity that I think is really important. So those were the things, Greg, that really attracted my attention as I read the paper for the first time. Dr. Greg Hundley:           Thank you so much, Brendan. Well, listeners, we've got a second paper today and we're next going to hear from Dr. Christian Shults, and he also is focusing on really another aspect of the administration of empagliflozin in patients with acute heart failure and that pertains to the renal function of the patients. So Christian, could you describe for us the background pertaining to your study and what was the hypothesis that you were intending to address? Dr. Christian Schulze:     Thanks, Greg. Well, it's great to introduce all study here in this running. So our study impacted those in acute decompensated heart failure. The impact HF trial was a study based on the hypothesis that we wanted to test, whether empagliflozin has effects in acute decompensated heart failure, and we focused on the patient population that was not addressed in EMPULSE, patients that came to the ER and needed to be treated right away, and we wanted to know and this was our main hypothesis, but are the diuretic and [inaudible 00:17:11] effects of the SGLT2 inhibitor on this case, empagliflozin, actually had an impact on diuretic regimens and kidney functions since this is one of the main end points that limits treatment, and also is one of the outcomes of patients with acute decompensated heart failure in the hospital. Dr. Greg Hundley:           Very nice. And so Christian, what study design did you implement and who was included in your study population? Dr. Christian Schulze:     So we also used the randomized two arm study design. We included patients with acute decompensated heart failure independent of left ventricular ejection fraction. Patients needed to have an NT-proBNP of more than 500. The average NT-proBNP in fact was 4,300 in our entire patient population, and we included patients within 12 hours of presentation. So many of these patients have been recruited in the ER, they presented two hour cardiology heart failure service, and then were immediately randomized to the trial in the two arms, and we tested not 10 milligrams of empagliflozin. We actually tested 25 milligrams of empagliflozin based on in-house data that 25 milligrams potentially had a stronger diuretic effect compared to 10 milligrams. Dr. Greg Hundley:           And what did you find? Dr. Christian Schulze:     So we followed patients for five days. It was a relatively short period of time. It was designed to address the in-house phase of patients with acute decompensated heart failure. The mean duration of stay was 6.3 days in the hospital so this was exactly the time that we wanted to test. We had a 30 day endpoint for safety issues, and what we could see is that patients on 25 milligrams on empagliflozin on top of standard diuretic regimens and medical care had 25% higher diuretic outputs compared to patients in the placebo group. We also found no differences in markers of renal injury dysfunction, and could in fact confirm that after 30 days, patients in the empagliflozin group had a better EGFR compared to patients in the placebo group. On top, we saw a more rapid decrease in body weight and also a more profound decrease in NT-proBNT values. Dr. Greg Hundley:           And Christian, just for our listeners to put a little bit of this in perspective, what was the range of serum creatinine for the patients that were enrolled in your study? Dr. Christian Schulze:     So the main EGFR in the entire population was around 60 and the creatinine values were around 107 on average in the entire cohort. So this is a very typical population. We had around 30% of the population with de Novo heart failure, around 20 to 30% of the population was pre-treated for preexisting heart failure. So very typical population of patients with heart failure presenting to the emergency room. Dr. Greg Hundley:           And did you have any kind of lower level EGFR cutoff, I mean, for enrollment into this study? Dr. Christian Schulze:     So when we designed the trial, we actually still had the sub classification of diabetes or impaired glucose or homeostasis as an inclusion criteria. We dropped it before we started the trial because the data came out that this is actually, in fact, not a critical issue for patients with heart failure. So diabetes was not a subgroup in our trial and the lower limit of EGFR was actually a thoroughly defined protocol. Dr. Greg Hundley:           Very nice. Well, listeners, now we're going to turn to our second associate editor, Dr. Justin Grodin from University of Texas Southwestern Medical Center in Dallas, Texas, and Justin, similar to Brendan, and you see many papers come across your desk and so what attracted you to this particular paper by Christian and his colleagues? Dr. Justin Grodin:            Well, Greg, I think first and foremost, and I think very similar to Brendan, but I think what's always striking is if I may just take a step back, decompensated heart failure in the United States is the number one cause for hospitalization among Medicare beneficiaries. So I think really, the brunt and really the truly public health message of the disease is very important in the applicability, and even though that decompensated heart failures is one of the most common things that we ever encounter when we practice, internists, cardiologists, et cetera, we have very, very little clinical trial guidance that tells us how to decongest individuals when they're hospitalized with swelling and heart failure and a lot of these individuals can be quite ill, and we have some clinical trial data, but largely, we have a lot of negative studies or inconclusive studies in this space. So certainly, what drew me to this trial was definitely that context, and obviously, based on the mechanistic data with SGLT2 inhibitors, I think one of the natural questions, which Christian addresses, is that we know that up front, they do augment natriuresis. So I think it's very compelling to marry those two together because this is what many of us that use these medications regularly have been asking is whether or not they would have some efficacy in that regard, and then another thing that caught my eye and me as a cardiorenal investigator was, just as Christian highlighted, was we have a clinical trial that randomly assigned individuals, really that were ill and many of whom were not stabilized within 12 hours of presentation, and we're talking about patients that are coming into the hospital at all times during the day in and I think that's very remarkable that we have something with standard... We have a study with standardized assessments where we're really trying to ask a very practical, pragmatic question, which is do these therapies lower the sodium balance in individuals with decompensated heart failure, and I think what's important is largely, we've got a lot of medications that supplement loop diuretics, which are the class of drugs that the majority of us use, and we have a lot of other therapies that we use that really have very little data or poor data that guide us such as thiazide diuretics, carbonic and hydrase inhibitors, mineralocorticoid receptor antagonists, and so here, we have a clinical trial that asks a question that's on many people's minds. And then we do have very compelling, at least short term pragmatic and mechanistic data that does tell us that these individuals do have a greater natriuretic effect when empagliflozin is used as an adjunct to standardized loop diuretic therapy. So it's a very practical clinical question, and I think what's very important, and we could debate probably all day about the implications of GFR change and kidney function change while we're decongesting somebody with diuretics, but I think what's reassuring to all the clinicians is we really didn't see an effect on kidney function despite a greater natriuretic effect or enhanced diuretic effect, if you will, with the use of empagliflozin. Dr. Greg Hundley:           Very nice. Well, thank you, Justin. Listeners, now we have an editorialist and as you know, editorialists really help us put the scientific presentation of an original manuscript into the perspective of really the global theme of a topic, and we have Stefan Anker from Berlin, and Stefan, can you describe for us how do we put these two manuscripts and results that we've heard about really in the context now of moving forward with the use of SGLT2 inhibitors in the management of patients with acute decompensated heart failure? Dr. Stefan Anker:            Thank you so much. Really, I think these two papers, on the one hand, enhance our certainty about early use, and on the other hand, possibly show us that there might be even more to achieve by, on the one hand, moving even earlier with the application of SGLT2 inhibitors or possibly consider the higher dose. Now let's take one step back. These drugs were developed in type two diabetes and the first successful trial was the [inaudible 00:25:42] outcome trial. Many people have forgotten that this trial tested two doses and not only one, the 10 and the 25 milligram dose, and of course, with the success for improving kidney outcomes and heart failure hospitalization outcomes, we move forward into these two specialist areas, on the one hand, broadening it to the non-diabetic communities, but on the other end, narrowing it by focusing on the 10 milligram dose regardless of whether there is [inaudible 00:26:12]. And we basically now learn A, to use these drugs even earlier than we did in the big trials and we can now be sure to start their use in the hospital, and if you take the average change in quality of life results seen, you actually get a better result for the patient on quality of life when you start earlier than when you start late in the ambulatory studies where basically, in the chronic setting, maybe you have one and a half to two points difference. Here, you now have four and a half points in the study shown by Mikhail, and of course, it's also good to know that you can start this in any type of patient, regardless of their quality of life. The impact study from Christian, they basically moved it now even earlier, moving into the hospital space is possible based on EMPULSE. Moving it into the acute admission space is at least a consideration now based on what Christian here has shown. And he is actually addressing the one question I hear very often in my presentations about SGLT2 inhibitors, what about this 25 milligram dose? Is there a place for this in cardiology as well, and a possible place is shown here, not only that this is a safe thing to do, but also you get urinary output. Of course, we may in the future, want to see this compared, directly compared to the 10 milligram dose, but of course, the world is not created in one day, but needs more than one and so really, I think these two studies, on the one hand, address an important issue, when to start using them. On the other hand, show us a little bit of a glimpse to the future. Dr. Greg Hundley:           Very nice, Stefan, and listeners, we get to take advantage of having these authors, editors, and editorialists together and ask them what they see as the next study to be performed in this sort of sphere of research. So Mikhail, we'll start with you. In 30 seconds or less, what do you see as the next study to be performed in this arena of research? Dr. Mikhail Kosiborod:   I think, Greg, what we've learned recently, including from the EMPULSE trial, we have this population of patients in a hospital with heart failure's a huge issue as Justin mentioned, and until recently, we had very little [inaudible 00:28:31] for them beyond the usual kind of decongestion with loop diuretics and trying to make them feel better, but you look at outcome data. It really was a dearth of effective therapies that have meaningful impact on important outcomes. Now that's changing, SGLT2 inhibitors is one example. There are some other recent examples in this patient population, like a firm HF and iron deficient patients with heart failure. But the bottom line is it's no longer kind of a desert, if you will, of positive trials. We now have something we can do and I think what this proves is that we need to actually invest more, both in terms of resources and time to really do what we we're being able to do in other areas of heart failure and those patients with chronic, half and half where we can start developing pillars of therapy that can actually truly improve outcomes with this patient population and there is a lot going on that makes me optimistic that's going to be the case in the coming years. Dr. Greg Hundley:           Very nice. And Brendan? Dr. Brendan Everett:      Well, I think both trials mentioned today really pushed our understanding of this population forward. I think the biggest clinical question that I face when I'm caring for these patients is that we have four, at least, guideline directed therapies, right? We have beta blockers, we have ARBs, ACE inhibitors and ARNIs. We have mineral receptor antagonists and we have SGLT2 inhibitors. So which do we use in what order and how do we start them, and what kind of parameters do we use to guide us if we're limited either by renal function or by blood pressure or by some other factor. And we often, if not always, have one of those constraints that we're dealing with and so I would say the next step for me is trying to sort out which of these therapies and what order ought to be our highest priority for patients with acute decompensated heart failure as we move quickly from the acute decongestion stage towards discharge and a chronic therapy that will then be followed as an outpatient over the ensuing days and months. Dr. Greg Hundley:           Very nice. And Christian. Dr. Christian Schulze:     Thank you again, and Brandon pointed out very nicely. I mean, we have good evidence now for chronic heart failure treatment. We have the four columns of heart failure medical therapy. Questions that remain open is what do we do with all these patients that are now guideline medicated, come to the hospital with an acute decompensation? Should we carry on with the medication? Should we terminate and in particular, should be carry on with full dose, 50% dose of SGLT2 inhibitors, and the next question is, what dose should we use, in fact, for SGLT2 inhibitors? Is it in group effects or is sotagliflozin comparable to empagliflozin, and then is there a role for a step by scheme that we initially have in high dose therapy that we then downgrade to 10 milligrams on the chronic heart failure treatments, and then of course, quality of life is very important. We should ask this question also in this patient population that is early on treated, do we see benefits that carry on in the outpatient setting and do we see an effect of early treatment on long term benefits? Dr. Greg Hundley:           Justin? Dr. Justin Grodin:            Well, I would have to agree with all of my colleagues here on this call. I think all have raised really good points, but I think one very simple, and I'll echo some of Brendan's statements, but one very simple question is we know that when we decongest people and initiate a negative salt balance in the hospital for decompensated heart failure, we cause neurohormonal activation and there are a lot of downstream untoward effects from chronic decongestive therapies, and I think one of the more compelling things is we still yet have defined what is the best way to decongest individuals with swelling or volume overload in the hospital. Here, we have compelling studies with SGLT2 inhibitors for quality of life and really, the way patients feel. And this is really what's important to them, and then something very pragmatic to clinicians and let's make people pee more, but I think one of the compelling questions, and I don't know if it will be answered, is we have a lot of choices for supplemental therapies and different diuretic strategies when patients come in the hospital for decompensated heart failure, and I do think that these studies do move the needle with SGLT2 inhibitors. I think that's abundantly clear, but we still don't know what is the best way to dry out my patient or make my patient pee so that they feel better, but I do think that these studies do at least set the stage that there's some compelling advantages to SGLT2 inhibitors. Dr. Greg Hundley:           And then lastly, Stefan. Dr. Stefan Anker:            Thank you. Besides the detailed points mentioned by many, and Christian, totally support 25 versus 10 milligram, how long 25 milligram, if at all in the future. Besides this, I'm interested in the big picture question. So what about the post myocardial infarct congestion/heart failure situation, and there will be two trials in the next 18 to 24 months that report on this, and my pet kind of area is actually to treat heart failure where nobody thinks it is heart failure, and what I mean is for instance, advanced cancer patients, cardiac wasting cardiomyopathy. So the heart failure in sick cancer patients, and indeed, we are planning to do exactly that now in a study focusing on hospice care patients to really improve the quality of life, the very thing focus here on the EMPULSE trial. Dr. Greg Hundley:           Well, listeners, we want to thank our authors, Dr. Mikhail Kosiborod from Mid America Heart Institute in University of Missouri, and Christian Shults from the University Hospital in Jena, Germany. Also, our associate editors, Dr. Brendan Everett from Brigham and Women's Hospital in Boston, and Dr. Justin Grodin from University of Texas Southwestern in Dallas, Texas, and also, our editorialist, Dr. Stefan Anker from Charité in Berlin, Germany for bringing us these two manuscripts pertaining to two randomized clinical trials regarding the administration of the SGLT2 inhibitor, empagliflozin in acute heart failure, demonstrating first, marked improvement in heart failure symptoms and health related quality of life. And second, in those with estimated GFRs greater than 30 mls per minute, an augmentation of natriuresis in the setting of the co-administration of diuretics without deterioration in renal function. Well, on behalf of Carolyn and myself, we want to wish you a great week and we will catch you next week on the run. This program is copyright of the American Heart Association, 2022. The opinions expressed by speakers in this podcast are their own and not necessarily those of the editors or of the American Heart Association. For more, please visit ahajournals.org.

Kad uzņēmumam nepieciešams aizdevums, primāri atbalsts tiek meklēts bankās. Tomēr tas ne vienmēr ir variants, kas der ātrai problēmas risināšanai. Kādas priekšrocības ir nebanku finansētājiem? Kas tiek ņemts vērā, piešķirot finansējumu? Par to sarunā ar DIENA PĒC autoru Oskaru Priedi dalījās Arnis Blūmfelds, ERST Finance izpilddirektors.Epizode tapusi sadarbībā ERST Finance.Support the show

Nav noslēpums, ka mūsdienās komunikācija un latviešu valodas lietošana, īpaši jauniešu vidū, arvien biežāk dzirdama ar anglicismiem un barbarismiem. Sarakstēs teksta vietā tiek izmantotas emociju zīmes. Kā saglabāt korektu latviešu valodas lietošanu un cik ļoti laika gaitā ir mainījusies mediju ziņu rakstīšana un saziņa ar auditoriju? Sarunā ar DIENA PĒC autoriem Kristapu Pētersonu un Oskaru Priedi atklās TV un radio diktors Arnis Krauze.Support the show

How do you counsel patients on beta blockers? Is one beta-blocker better than the other? What is preferred: ACEi, ARBs or ARNIs? What are the pros and cons of each? How does spironolactone compare to eplerenone? When do you stop mineralocorticoid receptor antagonist? What are risks with SGLT2 inhibitors? How do you initiate GDMT? Which meds do you start first and in what order?Show notes, Transcript and References:  https://www.coreimpodcast.com/2022/05/11/5-pearls-on-guideline-directed-medical-therapy/Sponsor: https://go.amboss.com/GDMTGet CME-MOC credit with ACP: https://www.acponline.org/cme-moc/cme/internal-medicine-podcasts/core-im Time stamps:03:13 Pearl 112:14 Pearl 220:36 Pearl 326:42 Pearl 432:16 Pearl 5Tags: IM Core, CoreIM, heart failure with reduced ejection fraction, GDMT, treatment, cardiology

Today, Dr. James Fang, Chief of Cardiovascular Medicine at the University of Utah, and AHA/ACC/HFSA Heart Failure Guideline Committee Member, joins us to talk about the new heart failure guidelines, published in April 2022.  We talk about the new classifications, including HF with improved EF and HF with mildly reduced EF, and new recommendations for medical therapy for all the heart failure types. How do you start someone on GDMT? Who should get SGLT-2 inhibitors? How can we get more people on ARNIs? Dr. Fang provides lots of clinical pearls and practical wisdom for applying these new recommendations. Check it out! 2022 Heart Failure GuidelinesMusic from Uppbeat (free for Creators!):https://uppbeat.io/t/soundroll/dopeLicense code: NP8HLP5WKGKXFW2R

Host: Javed Butler, MD, MBA, MPH Guest: Nancy M. Albert, PhD, CCNS, CHFN, CCRN, NE-BC, FAHA, FCCM, FHFSA, FAAN Based on the 2021 American College of Cardiology Expert Consensus Decision Pathway recommendations, it might be time to rethink our approach to heart failure. But what exactly do the latest recommendations say regarding the role of angiotensin receptor-neprilysin inhibitors (ARNis) in the treatment of heart failure with reduced ejection fraction? Joining Dr. Javed Butler to answer that key question is Dr. Nancy Albert.

Raidījums veidots sadarbībā ar kristīgo mediju TUVUMĀ.lv. Raidījumu vada Augusts Kolms.

I had a great time interviewing Hock Hochheim and he was very generous with both his time and the answers to my questions. Hock obviously has loads of experience and knowledge and we managed to cover a lot of ground on a variety of topics. I hope you enjoy this as much as I did talking to him! The bonus episode with Hock is right here: https://www.patreon.com/posts/60898368 The links mentioned in this episode are available at: https://wimsblog.com/74

Arnis Ritups holds a Ph.D. in philosophy from KULeuven (Belgium), he specializes in Aristotle and his Greek commentators. He is also a Latvian translator of Descartes' “Meditations on the First Philosophy”; a part-time lecturer at Latvian University, KU Leuven, Stockholm School of Economics in Riga, and Latvian Academy of Fine Arts. He is a publisher of an intellectual magazine “Rigas Laiks”, published in Latvian (since 1993), Russian (since 2012), and English (annually since 2016). Arnis is a conversation partner with many interesting people around the world. He is engaged in a series of interviews with the world's most interesting scientists. He looks to find what are their answers to the Big Questions, and what do they think about the knowledge, the unknown, and the unknowable. ================================ SUPPORT & CONNECT: Support on Patreon: https://www.patreon.com/denofrich Twitter: https://twitter.com/denofrich Facebook: https://www.facebook.com/denofrich YouTube: https://www.youtube.com/denofrich Instagram: https://www.instagram.com/den_of_rich/ Hashtag: #denofrich © Copyright 2022 Den of Rich. All rights reserved.

The why of this show and the importance of doing this in your own Filipino Martial Arts journey.  

Hello World!  Finally, it's live! After a few misfires, I'm on it.   Let me know what you think!  Check out my instagram @eskrimador  

Michael Fralick and John Fralick, both general internists in Toronto, kick off The Rounds Table for the New Year.  They cover four articles in a rapid-fire style, including: angiotensin receptor-neprilysin inhibitors (ARNIs) in decompensated heart failure (HF), linagliptin and major cardiovascular events, reduced dietary salt intake in heart failure, and dapagliflozin and cardiovascular outcomes. Sacubitril/valsartan ...The post Salty or Sweet: ARNIs, Reduced Salt Intake in HF, and Cardiovascular Safety of Diabetes Medications appeared first on Healthy Debate.

Michael Fralick and John Fralick, both general internists in Toronto, kick off The Rounds Table for the New Year.  They cover four articles in a rapid-fire style, including: angiotensin receptor-neprilysin inhibitors (ARNIs) in decompensated heart failure (HF), linagliptin and major cardiovascular events, reduced dietary salt intake in heart failure, and dapagliflozin and cardiovascular outcomes. Sacubitril/valsartan ... The post Salty or Sweet: ARNIs, Reduced Salt Intake in HF, and Cardiovascular Safety of Diabetes Medications appeared first on Healthy Debate.