Podcasts about arpi

Dr. Rohan Garje shares the updated recommendations for the ASCO guideline on systemic therapy for patients with metastatic castration-resistant prostate cancer. He discusses the systemic therapy options for patients based on prior therapy received in the castration-sensitive and non-metastatic castration-resistant settings. He emphasizes personalizing treatment choices for each individual, considering patient-specific symptoms and signs, treatment-related toxicities, potential drug interactions, cost, and access. He also reviews recommendations on response assessment. The conversation wraps up with a discussion of potential future updates to this guideline, as the guideline transitions into a “living guideline” on mCRPC. Read the full guideline update, “Systemic Therapy in Patients with Metastatic Castration-Resistant Prostate Cancer: ASCO Guideline Update”. Transcript This guideline, clinical tools, and resources are available at www.asco.org/genitourinary-cancer-guidelines. Read the full text of the guideline and review authors' disclosures of potential conflicts of interest in the Journal of Clinical Oncology.      Brittany Harvey: Hello and welcome to the ASCO Guidelines Podcast, one of ASCO's podcasts delivering timely information to keep you up to date on the latest changes, challenges and advances in oncology. You can find all the shows, including this one at asco.org/podcasts. My name is Brittany Harvey and today I'm interviewing Dr. Rohan Garje from Miami Cancer Institute Baptist Health South Florida, lead author on, “Systemic Therapy in Patients with Metastatic Castration-Resistant Prostate Cancer: ASCO Guideline Update.” Thank you for being here today, Dr. Garje. Dr. Rohan Garje: Absolutely. Thank you so much for having me, Brittany. Brittany Harvey: And then before we discuss this guideline, I'd like to note that ASCO takes great care in the development of its guidelines and ensuring that the ASCO Conflict of Interest Policy is followed for each guideline. The disclosures of potential conflicts of interest for the guideline panel, including Dr. Garje, who has joined us here today, are available online with the publication of the guideline in the Journal of Clinical Oncology, which is linked in the show notes. So then, to start on the content of this guideline, first, could you provide us an overview of the purpose of this guideline update? Dr. Rohan Garje: Sure. So ASCO has guidelines for prostate cancer and the specific guideline which we have updated for metastatic castrate-resistant prostate cancer was originally published in 2014. It's almost a decade. It's been a long time due for an update. Over the last decade, we have seen a lot of advances in the treatment of prostate cancer, specifically with regards to genomic testing, newer imaging modalities, and also the treatment landscape. Now we have newer options based on genomic targets such as PARP inhibitors, we have radiopharmaceuticals, a newer variant of chemotherapy, and also some specific indications for immunotherapy which were not addressed previously. Because all these advances have been new, it was really important for us to make an update. In 2022, we did make a rapid update with lutetium-177, but these additional changes which we have seen made it an appropriate time frame for us to proceed with a newer guideline. Brittany Harvey: Absolutely. It's great to hear about all these advances in the field to provide new options. So I'd like to next review the key recommendations from this guideline. So let's start with the overarching principles of practice that the panel outlined. What are these key principles? Dr. Rohan Garje: As a group, all the panel members came up with some ground rules: What are necessary for all our patients who are being treated for metastatic CRPC? First, the founding aspect was a definition for what is metastatic CRPC. So we defined metastatic CRPC as castrate level of testosterone with evidence of either new or progressive metastatic disease on radiological assessments or patients who have two consecutive rising PSAs in the setting of existing metastatic disease. We also emphasized on the need for germline and somatic testing for patients with metastatic prostate cancer at an earliest available opportunity because it is critical to select appropriate treatment and also right treatment for patients at the right time. And we actually have a concurrent guideline which addresses what genes to be tested and the timing. The other principles are patients should continue to receive androgen deprivation therapy or undergo surgical castration to maintain castrate level of testosterone. Now the key aspect with these guidelines is personalizing treatment choices. As you can see the evolution of treatment options for prostate cancer, the drugs that were initially developed and approved for prostate cancer were primarily in castrate-resistant settings, but now most of these drugs are being utilized in castrate-sensitive. So, when these patients develop castration resistance, the challenges are there are no appropriate particular drug-specific guidelines they meet. So, it's very important for the clinicians to be aware of what treatments have been received so far prior to castration resistance so that they can tailor the treatment to patient specific situations. In addition, prior to choosing a therapy, it is important for the physicians to consider patient specific symptoms or signs, treatment-related toxicities, potential drug interactions, cost, and also access to the drugs. There may be multiple treatment options available for the patients, but for a patient specific scenario, there may be a drug that may be more promising than the others. So, it is important to tailor the drug choices based on patients' unique circumstances. The panel also recommends to early integrate palliative and supportive care teams for symptom management and also discuss goals of care with the patient as each patient may have unique needs and it's important for physicians to address those concerns upfront in the care. The panel also suggests patients to receive RANK ligand inhibitors such as denosumab or bisphosphonates such as zoledronic acid to maintain the bone strength to prevent skeletal-related events. Finally, I would like to also emphasize this point about the lack of randomized clinical trial data for optimal sequencing of therapies for patients with metastatic CRPC. As I previously alluded, we have taken into account all ongoing clinical trials, prior published data, and came up with a format of preferred drugs based on prior treatments and, I think, by following these several clinical principles which I just mentioned, we can optimally choose and utilize best treatments for patients with metastatic CRPC. Brittany Harvey: Absolutely. These principles that you just outlined are important for optimal patient care, and then I want to touch on one of those things. You talked importantly about the treatments received so far. So in the next set of recommendations, the role of systemic therapy was stratified by the prior therapy received in the castration-sensitive and non-metastatic castration-resistant setting. So starting with what does the panel recommend for patients who are previously treated with androgen deprivation therapy alone in these previous settings and whose disease has now progressed to metastatic castration-resistant prostate cancer? Dr. Rohan Garje: There are multiple treatment options based on prior treatment received. So for patients who received only ADT for their castration-sensitive disease, the panel strongly urges to get HRR testing to check for homologous recombinant repair related changes, specifically for BRCA1 and BRCA2 mutations, because we have three studies which have really shown significant clinical benefit for patients who have BRCA1 and BRCA2 mutations with drugs such as the combination of talazoparib and enzalutamide or olaparib with abiraterone or niraparib with abiraterone. Unless we test for those mutations, we'll not be able to give these agents upfront for the patients. In the HRR testing, if patients have HRR alterations but they are in genes which are non-BRCA, the guideline panel recommends to utilize talazoparib and enzalutamide based combination therapies. Now, if they don't have HRR alterations then there are multiple treatment choices available. It could either include androgen receptor pathway inhibitors such as abiraterone with prednisone. We could also consider docetaxel chemotherapy. The alternate choices for androgen receptor pathways include enzalutamide or the newer agents such as apalutamide and docetaxel. So, as you can see there are multiple options available, but the panel definitely emphasizes to test for HRR testing because this gives patients access to more precision therapies at this point. There may be various scenarios where a unique drug may be available for a specific patient situation. For example, patients who have very limited disease burden and may have one or two metastatic lesions, after a multidisciplinary discussion, targeted local therapies such as radiation or potentially surgery could also be offered. In select patients who have very indolent disease where they are castrate-resistant based on slow rising PSA, low-volume disease or asymptomatic disease can consider sipuleucel-T. And in patients who have bone-only metastatic disease, we could also consider radium-223, which is primarily now utilized for patients who have symptomatic bone disease. Brittany Harvey: Great. I appreciate you reviewing all those options and talking about how important it is to tailor treatment to the individual patient. So then the next category of patients, what is recommended for those who have been previously treated with ADT and an androgen receptor pathway inhibitor and whose disease has now progressed to metastatic castration-resistant prostate cancer? Dr. Rohan Garje: So for patients who received ADT along with an androgen receptor pathway inhibitor, which we consider would be a most common cohort because most patients now in castration-sensitive setting are receiving androgen receptor pathway inhibitor. It was different in the past where five or six years back ADT alone was the most common treatment, but fortunately, with enough awareness and education, treatment choices have improved. Patients are now receiving ADT and ARPI as the most common choice of drug. Once again, at this point the panel emphasizes to consider HRR testing in there is enough data for us to suggest that patients who have alterations in the HRR pathway definitely will benefit with the PARP inhibitor. You know the multiple options, but specifically we speak about olaparib. And then if they are HRR-negative, we prefer patients receive agents such as docetaxel or if they are intolerant to docetaxel, consider cabazitaxel chemotherapy, options such as radium-223, and if they have a specific scenario such as MSI-high or mismatch repair deficiency, pembrolizumab could also be considered. The panel also discussed about the role of a second ARPI agent. For example, if patients progressed on one androgen receptor pathway inhibitor, the second androgen receptor pathway inhibitor may not be effective and the panel suggests to utilize alternate options before considering androgen receptor pathway inhibitor. There may be specific scenarios where a second ARPI may be meaningful, specifically, if alternate choices are not feasible for the concern of side effects or toxicities or lack of access, then a potential ARPI could be considered after progression on ARPI, but the panel definitely encourages to utilize alternate options first. Brittany Harvey: Great. Thank you for outlining those options as well for those patients. So then the next category, what is recommended for patients who have been previously treated with ADT and docetaxel? Dr. Rohan Garje: For patients who received ADT and docetaxel and were never treated with androgen receptor pathway inhibitors, the panel again emphasizes on HRR testing. If they have BRCA1 and 2 mutations, the combination therapies of talazoparib with enzalutamide, olaparib with abiraterone, or niraparib with abiraterone are all good choices. If they don't have BRCA mutations but they have other HRR mutations, the panel suggests to potentially utilize talazoparib with enzalutamide. And if they do not have any HRR alterations, the options could include androgen receptor pathway inhibitors such as abiraterone or enzalutamide. I want to emphasize that these are preferred options, but not the only options. As you can see, there are multiple options available for a particular clinical situation - so the ability of the physicians to access particular combinations, the familiarity of those drugs or the patient's unique situation where they have other medications which can potentially interact with a choice of agents. So I think based on access, based on cost and patients' concurrent illness with potential drug interactions can make one particular combination of therapy better over the other options. Brittany Harvey: Absolutely. That's key to keep in mind that access, contraindications, and cost all play a role here. So then the next set of recommendations. What are the key recommendations for patients who have previously been treated with ADT, an androgen receptor pathway inhibitor, and docetaxel who now have mCRPC? Dr. Rohan Garje: Yes. In this group, the options remain, again, broad. We utilize PSMA imaging here specifically and if they are positive on PSMA imaging, lutetium-177 is a good option. If they do not have PSMA-positive disease on PSMA imaging but if they have HRR alterations, olaparib could be utilized. And if they are negative on PSA imaging, they don't have HRR alterations, then alternate options could include cabazitaxel, radium-223. And if they have MSI-high or deficiency in mismatch repair, pembrolizumab could be utilized in this setting. Brittany Harvey: Thank you for outlining those options as well. So then next the panel addressed treatment options for de novo or treatment emergent small cell neuroendocrine carcinoma of the prostate. What are those key recommendations? Dr. Rohan Garje: Yes. This is a very high unmet need group because there are limited clinical trials, especially prospective clinical trials addressing treatment options for this group. Most of our current guidelines are always an extrapolation from lung small cell cancer based guidelines, but the panel recommends to utilize cisplatin or carboplatin along with etoposide as a preferred choice for this group. Also, an alternate option of carboplatin along with cabazitaxel could be considered for this cohort. The panel also encourages participation in clinical trials. There are numerous trials ongoing now in smaller phase studies and I think it's important for patients to consider these trials as well, because this will give them access to newer agents with potential biological targets. In addition to these agents in specific scenarios or potentially case by case basis, because we don't have prospective data, so we have made it as a select case by case basis to consider adding immunotherapy along with platinum-based chemotherapy followed by maintenance immunotherapy, which is currently a standard of care in small cell lung cancer. But the data is so limited in prostate cancer, so the panel suggested that it has to be a case by case basis only. The alternate options also include lurbinectedin, topotecan, tarlatamab upon progression on platinum-based chemotherapy. Brittany Harvey: Yes. It's important to have these recommendations in these unique situations where there is really a lack of data. So then the final set of recommendations I'd like to cover, what does the panel recommend for how clinicians should assess for response while patients are on systemic therapy and what scans are recommended for this response assessment? Dr. Rohan Garje: Yes. Again, this is another strong emphasis of the panel for global assessment of the patients. Traditionally, patients and physicians per se are heavily reliant on PSA as an accurate marker for response. This is in fact true in earlier phases of prostate cancer either in castrate-sensitive setting or localized prostate cancer setting. But as patients evolve into castrate-resistant, we don't want to heavily rely on PSA alone as a marker of response. The panel suggests to incorporate clinical response, radiological response, and also include PSA as a component, but not just rely primarily on PSA. So the panel also suggests that patients should get a bone scan and a CT scan every three to six months while on treatment to assess for appropriate response or for progression. And now one key important aspect, we are all aware about the evolving role of PSMA-based imaging with several of these new agents that are currently available. We do acknowledge these scans definitely have an important role in the care for patients with metastatic prostate cancer. Currently, the utility is primarily to select patients for lutetium-based therapy and also in situations where the traditional scans such as technitium 99 bone scan or CT scan are equivocal, then a PSMA-based imaging can be helpful. Now we are also aware that there are newer studies coming up, prospective data coming up for the role of PSMA-based imaging for response assessment. We are hoping to update the guidelines if we get access to newer data, but currently we have not recommended the utility of PSMA-based imaging for response assessments. Brittany Harvey: Understood. And I appreciate you describing where there is data here and where there's a lack of data to currently recommend. And we'll look forward to future updates of this guideline. Coming back to – at the start you mentioned how much has changed since the last guideline update. So Dr. Garje, in your view, what is the importance of this update and how will it impact both clinicians and patients with metastatic castration-resistant prostate cancer? Dr. Rohan Garje: The updated guidelines are designed to have a significant impact on clinical practice and also patient outcomes by providing clinicians with a comprehensive evidence-based framework for managing patients with metastatic CRPC. And also, by using these guidelines can make informed decisions, can select therapies tailored to patients' unique genomic status, clinical situation, where they are in the course of the cancer based on what they received previously. Also utilizing these guidelines, we can potentially improve patient outcomes, improve survival, and importantly have efficient use of healthcare resources. Brittany Harvey: Absolutely. We're always looking for ways to improve patient outcomes and survival. I want to wrap us up by talking a little bit about the outstanding questions in this field. So earlier you had mentioned about prospective data to come about PSMA PET scans, but what other outstanding questions are there for patients with metastatic castration-resistant prostate cancer? And what evidence is the panel looking forward to for future updates? Dr. Rohan Garje: We do have now rapidly evolving data specifically about the utility of the radiopharmaceutical lutetium-177 prior to chemotherapy. We are hoping that with newer data we can make some changes to the guideline based on that. We are also looking at newer drugs that are coming up in the pipeline, for example, androgen receptor degraders. We are looking at data that might potentially help based on bispecific T-cell engagers and newer radiopharmaceuticals. So I think in the next few years, we will definitely update all the guidelines again. But this time we are trying to do it more proactively. We are following a newer model. We are calling it as ‘living guidelines' where we are actually utilizing week by week updates where we look at the literature and see if there is any potential practice impacting change or publication that comes up. And we are trying to incorporate those changes as soon as they are available. That way patients and practicing physicians can get the latest information available through the guidelines as well. Brittany Harvey: That's great to hear. Yes, we'll await this data that you mentioned to continuously update this guideline and continue to improve patient outcomes for the future. So Dr. Garje, I want to thank you so much for your time to update this guideline. It was certainly a large amount of recommendations, and thank you for your time today, too. Dr. Rohan Garje: Thank you so much for having me here. And it's always nice talking to you. Brittany Harvey: And finally, thank you to our listeners for tuning in to the ASCO Guidelines podcast. To read the full guideline, go to www.asco.org/genitourinary-cancer-guidelines. You can also find many of our guidelines and interactive resources in the free ASCO Guidelines app, which is available in the Apple App Store or the Google Play Store. If you have enjoyed what you've heard today, please rate and review the podcast and be sure to subscribe so you never miss an episode. 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.

SIKIYORSA TUTUKLA SIKMIYORSA ÇARPIŞ

Dr. Neeraj Agarwal and Dr. Peter Hoskin discuss key abstracts in GU cancers from the 2025 ASCO Genitourinary Cancers Symposium, including novel therapies in prostate, bladder, and kidney cancer and the impact of combination therapies on patient outcomes. TRANSCSRIPT Dr. Neeraj Agarwal: Hello, and welcome to the ASCO Daily News Podcast. I'm Dr. Neeraj Agarwal, the director of the Genitourinary Oncology Program and professor of medicine at the Huntsman Cancer Institute at the University of Utah, and editor-in-chief of ASCO Daily News. Today, we'll be discussing practice-informing abstracts and other key advances in GU oncology featured at the 2025 ASCO Genitourinary Cancers Symposium. Joining me for this discussion is Dr. Peter Hoskin, the chair of this year's ASCO GU Symposium. Dr. Hoskin is a professor in clinical oncology in the University of Manchester and honorary consultant in clinical oncology at the Christie Hospital, Manchester, and University College Hospital London, in the United Kingdom. Our full disclosures are available in the transcript of this episode. Peter, thank you for joining us today. Dr. Peter Hoskin: Thank you so much, Neeraj. I am very pleased to be here. Dr. Neeraj Agarwal: The GU meeting highlighted remarkable advancements across the spectrum of GU malignancies. What stood out to you as the most exciting developments at the ASCO GU Symposium?  Dr. Peter Hoskin: The theme of this year's meeting was "Driving Innovation, Improving Patient Care," and this reflected ASCO GU's incredible milestone in GU cancer research over the years. We were thrilled to welcome almost 6,000 attendees on this occasion from over 70 countries, and most of them were attending in person and not online, although this was a hybrid meeting. Furthermore, we had more than 1,000 abstract submissions. You can imagine then that it fostered fantastic networking opportunities and facilitated valuable knowledge and idea exchanges among experts, trainees, and mentees. So, to start I'd like to come back to you for a second because the first day started with a focus on prostate cancer and some of the key clinical trials. And congratulations to you, Neeraj, on sharing the data from the TALAPRO-2 trial, which we were eagerly awaiting. I'd love to get your thoughts on the data that you presented. Could you tell us more about that trial, Abstract LBA18?  Dr. Neeraj Agarwal: Yes, Peter, I agree with you. It was such an exciting conference overall and thank you for your leadership of this conference. So, let's talk about the TALAPRO-2 trial. First of all, I would like to remind our audience that the combination of talazoparib plus enzalutamide was approved by the U.S. FDA in June 2023 in patients with metastatic castration-resistant prostate cancer harboring HRR gene alterations, after this combination improved the primary endpoint of radiographic progression-free survival compared to enzalutamide alone in the randomized, double-blind, placebo-controlled, multi-cohort phase 3 TALAPRO-2 trial. In the abstract I presented at ASCO GU 2025, we reported the final overall survival data, which was a key alpha-protected secondary endpoint in cohort 1, which enrolled an all-comer population of patients with mCRPC. So, at a median follow-up of around 53 months, in the intention-to-treat population, the combination of talazoparib plus enzalutamide significantly reduced the risk of death by 20% compared to enzalutamide alone, with a median OS of 45.8 months in the experimental arm versus 37 months in the control arm, which was an active control arm of enzalutamide. This improvement was consistent in patients with HRR alterations with a hazard ratio of 0.54 and in those with non-deficient or unknown HRR status, with a hazard ratio of 0.87. In a post hoc analysis, the hazard ratio for OS was 0.78 favoring the combination in those patients who did not have any HRR gene alteration in their tumors by both tissue and ctDNA testing. Consistent with the primary analysis, the updated rPFS data also favored the experimental arm with a median rPFS of 33.1 compared to 19.5 months in the control arm, and a hazard ratio of 0.667. No new safety signals were identified with extended follow-up. Thus, TALAPRO-2 is the first PARP inhibitor plus ARPI study to show a statistically significant and a clinically meaningful improvement in OS compared to standard-of-care enzalutamide as first-line treatment in patients with mCRPC unselected for HRR gene alterations. Dr. Peter Hoskin: Thank you, Neeraj. That's a great summary of the data presented and very important data indeed. There was another abstract also featured in the same session, Abstract 20, titled “Which patients with metastatic hormone-sensitive prostate cancer benefit more from androgen receptor pathway inhibitors? STOPCAP meta-analyses of individual participant data.” Neeraj, could you tell us more about this abstract? Dr. Neeraj Agarwal: Absolutely, I would be delighted to. So, in this meta-analysis, Dr. David Fischer and colleagues pooled individual participant data from different randomized phase 3 trials in the mHSPC setting to assess the potential ARPI effect modifiers and determine who benefits more from an ARPI plus ADT doublet. The primary outcome was OS for main effects and PFS for subgroup analyses. Prostate cancer specific survival was a sensitivity outcome. The investigators pooled data from 11 ARPI trials and more than 11,000 patients. Overall, there was a clear benefit of adding an ARPI on both OS and PFS, with hazard ratios of 0.66 and 0.51, respectively, representing a 13% and 21% absolute improvement at 5 years, respectively, with no clear difference by the class of agent. When stratifying the patients by age group, the effects of adding an ARPI on OS and PFS were slightly smaller in patients older than 75, than in those younger than 65, or aged between 65 and 75 years. Notably, in the trials assessing the use of abiraterone, we saw very little OS effects in the group of patients older than 75, however there was some benefit maintained in prostate-cancer specific survival, suggesting that other causes of death may be having an impact. The effects of the other ARPIs, or ‘lutamides' as I would call them, were similar across all three age subgroups on both OS and PFS. Therefore, the majority of patients with mHSPC benefit from the addition of ARPIs, and the benefits/risks of abiraterone and other ‘amides' must be considered in older patients.  Dr. Peter Hoskin: Thanks, Neeraj. Another great summary relevant to our day-to-day practice. Of course, there's ongoing collection of individual patient data from other key trials, which will allow robust comparison of ARPI doublet with triplet therapy (including docetaxel), guiding more personalized treatment.   Dr. Neeraj Agarwal: I agree with you, Peter, we need more data to help guide personalized treatment for patients with mHSPC and potentially guide de-escalation versus escalation strategies. Now, moving on to a different setting in prostate cancer, would you like to mention Abstract 17 titled, “Overall survival and quality of life with Lu-PSMA-617 plus enzalutamide versus enzalutamide alone in poor-risk, metastatic, castration-resistant prostate cancer in ENZA-p (ANZUP 1901),” presented by Dr. Louise Emmett? Dr. Peter Hoskin: Of course I will. So, ENZA-p was a multicenter, open-label, randomized, phase 2 trial conducted in Australia. It randomized 163 patients into adaptive doses (2 or 4 cycles) of Lu-PSMA-617 plus enzalutamide versus enzalutamide alone as first-line treatment in PSMA-PET-CT-positive, poor-risk, mCRPC. The interim analysis of ENZA-p with median follow-up 20 months showed improved PSA-progression-free survival with the addition of Lu-PSMA-617 to enzalutamide. Here, the investigators reported the secondary outcomes, overall survival, and health-related quality of life (HRQOL). After a median follow up of 34 months, overall survival was longer in the combination arm compared to the enzalutamide arm, with a median OS of 34 months compared to 26 months; with an HR of 0.55. Moreover, the combination improved both deterioration-free survival and health-related quality of life indicators for pain, fatigue, physical function, and overall health and quality of life compared to the control arm. Consistent with the primary analysis, the rPFS also favored the experimental arm with a median rPFS of 17 months compared to 14 months with a HR of 0.61. So, the addition of LuPSMA improved overall survival, and HRQOL in patients with high-risk mCRPC. Dr. Neeraj Agarwal: Thank you, Peter. Great summary, and promising results with Lu-177 and ARPI combination in first line treatment for mCRPC among patients who had two or more high risk features associated with early enzalutamide failure. Before we move on to bladder cancer, would you like to tell us about Abstract 15 titled, “World-wide oligometastatic prostate cancer (omPC) meta-analysis leveraging individual patient data (IPD) from randomized trials (WOLVERINE): An analysis from the X-MET collaboration,” presented by Dr. Chad Tang?  Dr. Peter Hoskin: Sure. So, with metastatic-directed therapy (MDT), we have a number of phase 2 studies making up the database, and the X-MET collaboration aimed to consolidate all randomized data on oligometastatic solid tumors. This abstract presented pooled individual patient data from all the published trials involving patients with oligometastatic prostate cancer who received MDT alongside standard of care (SOC) against SOC alone. The analysis included data from five trials, encompassing 472 patients with oligometastatic prostate cancer, and followed for a median of 41 months. Patients were randomly assigned in a 1:1 ratio to receive either MDT plus SOC or SOC alone. The addition of MDT significantly improved PFS. The median PFS was 32 months with MDT compared to 14.9 months with SOC alone, with an HR of 0.45. Subgroup analyses further confirmed the consistent benefits of MDT across different patient groups. Regardless of factors like castration status, receipt of prior primary treatment, stage, or number of metastases, MDT consistently improved PFS. In patients with mHSPC, MDT significantly delayed the time to castration resistance by nine months, extending it to a median of 72 months compared to 63 months in the SOC group with an HR of 0.58. In terms of OS, the addition of MDT improved the 48-month survival rate by 12%, with OS rates of 87% in the MDT+SOC group compared to 75% in the SOC alone group. Dr. Neeraj Agarwal: Thank you, Peter. These data demonstrate that adding MDT to systemic therapy significantly improves PFS, rPFS, and castration resistance-free survival, reinforcing its potential role in the treatment of oligometastatic prostate cancer. So, let's switch gears to bladder cancer and start with Abstract 658 reporting the OS analysis of the CheckMate-274 trial. Would you like to tell us about this abstract?  Dr. Peter Hoskin: Yes, sure, Neeraj. This was presented by Dr. Matt Milowsky, and it was additional efficacy outcomes, including overall survival, from the CheckMate-274 trial which evaluated adjuvant nivolumab versus placebo in patients with high-risk muscle-invasive bladder cancer after radical surgery. The phase 3 trial previously demonstrated a significant improvement in disease-free survival with nivolumab. With a median follow-up of 36.1 months, disease-free survival was longer with nivolumab compared to placebo across all patients with muscle-invasive bladder cancer, reducing the risk of disease recurrence or death by 37%. Among patients who had received prior neoadjuvant cisplatin-based chemotherapy, nivolumab reduced this risk by 42%, whilst in those who had not received chemotherapy, the risk was reduced by 31%. Overall survival also favored nivolumab over placebo, reducing the risk of death by 30% in all patients with muscle-invasive bladder cancer and by 52% in those with tumors expressing PD-L1 at 1% or higher. Among patients who had received prior neoadjuvant chemotherapy, nivolumab reduced the risk of death by 26%, whilst in those who had not received chemotherapy, the risk was reduced by 33%. Alongside this, the safety profile remained consistent with previous findings. Dr. Neeraj Agarwal: Thank you, Peter, for such a nice overview of this abstract. These results reinforce adjuvant nivolumab as a standard of care for high-risk muscle-invasive bladder cancer, offering the potential for a curative outcome for our patients. Dr. Peter Hoskin: I agree with you Neeraj. Perhaps you would like to mention Abstract 659 titled, “Additional efficacy and safety outcomes and an exploratory analysis of the impact of pathological complete response (pCR) on long-term outcomes from NIAGARA.” Dr. Neeraj Agarwal: Of course. Dr. Galsky presented additional outcomes from the phase 3 NIAGARA study, which evaluated perioperative durvalumab combined with neoadjuvant chemotherapy in patients with muscle-invasive bladder cancer. The study previously demonstrated a significant improvement in event-free survival and overall survival with durvalumab compared to chemotherapy alone, with a manageable safety profile and no negative impact on the ability to undergo radical cystectomy. Among the 1,063 randomized patients, those who received durvalumab had a 33% reduction in the risk of developing distant metastases or death and a 31% reduction in the risk of dying from bladder cancer compared to those who received chemotherapy alone. More patients who received durvalumab achieved a pathological complete response at the time of surgery with 37% compared to 28% in the chemotherapy-alone group. Patients who achieved a pathological complete response had better event-free survival and overall survival compared to those who did not. In both groups, durvalumab provided additional survival benefits, reducing the risk of disease progression or death by 42% and the risk of death by 28% in patients with a pathological complete response, while in those patients without a pathological complete response, the risk of disease progression or death was reduced by 23% and the risk of death by 16% when durvalumab was added to the chemotherapy. Immune-mediated adverse events occurred in 21% of patients in the durvalumab group compared to 3% in the chemotherapy-alone group, with grade 3 or higher events occurring in 3% compared to 0.2%. The most common immune-related adverse events included hypothyroidism in 10% of patients treated with durvalumab compared to 1% in the chemotherapy-alone group, and hyperthyroidism in 3% versus 0.8%. At the time of the data cutoff, these adverse events had resolved in 41% of affected patients in the durvalumab group and 44% in the chemotherapy-alone group. Dr. Peter Hoskin: Thank you, Neeraj, for the great summary. These findings further support the role of perioperative durvalumab as a potential standard of care for patients with muscle-invasive bladder cancer. Dr. Neeraj Agarwal: I concur with your thoughts, Peter. Before wrapping up the bladder cancer section, would you like to mention Abstract 664 reporting updated results from the EV-302 trial, which evaluated enfortumab vedotin in combination with pembrolizumab compared to chemotherapy as first-line treatment for patients with previously untreated locally advanced or metastatic urothelial carcinoma? Dr. Peter Hoskin: Yes, of course. Dr. Tom Powles presented updated findings from the EV-302 study, and in this abstract presented 12 months of additional follow-up for EV-302 (>2 y of median follow-up) and an exploratory analysis of patients with confirmed complete response (cCR). The study had a median follow-up of 29.1 months and previously demonstrated significant improvements in progression-free survival and overall survival with enfortumab vedotin and pembrolizumab. This is now the standard of care in global treatment guidelines. Among the 886 randomized patients, enfortumab vedotin and pembrolizumab reduced the risk of disease progression or death by 52% and the risk of death by 49% compared to chemotherapy. The survival benefit was consistent regardless of cisplatin eligibility or the presence of liver metastases. The confirmed objective response rate was higher with enfortumab vedotin and pembrolizumab at 67.5% compared to 44.2% with chemotherapy. The median duration of response was 23.3 months with enfortumab vedotin and pembrolizumab compared to 7.0 months with chemotherapy. A complete response was achieved in 30.4% of patients in the enfortumab vedotin and pembrolizumab group compared to 14.5% in the chemotherapy group, with the median duration of complete response not yet reached in the enfortumab vedotin and pembrolizumab group compared to 15.2 months in the chemotherapy group. Severe treatment-related adverse events occurred in 57.3% of patients treated with enfortumab vedotin and pembrolizumab compared to 69.5% in the chemotherapy group, while in patients who achieved a complete response, severe adverse events occurred in 61.7% of those treated with enfortumab vedotin and pembrolizumab compared to 71.9% with chemotherapy. Treatment-related deaths were reported in 1.1% of patients treated with enfortumab vedotin and pembrolizumab compared to 0.9% with chemotherapy, with no treatment-related deaths occurring in those who achieved a complete response. These findings clearly confirm the durable efficacy of enfortumab vedotin and pembrolizumab, reinforcing its role as the standard of care for the first-line treatment of patients with locally advanced or metastatic urothelial carcinoma, and no new safety concerns have been identified. Dr. Neeraj Agarwal: Thank you for this great summary. Moving on to kidney cancer, let's talk about Abstract 439 titled, “Nivolumab plus cabozantinib (N+C) vs sunitinib (S) for previously untreated advanced renal cell carcinoma (aRCC): Final follow-up results from the CheckMate-9ER trial.” Dr. Peter Hoskin: Sure. Dr. Motzer presented the final results from the phase 3 CheckMate-9ER trial, which compared the combination of cabozantinib and nivolumab against sunitinib in previously untreated advanced renal cell carcinoma. The data after more than five years follow-up show that the combination therapy provided sustained superior efficacy compared to sunitinib. In terms of overall survival, we see an 11-month improvement in median OS, 46.5 months for the cabo-nivo versus 35.5 months for sunitinib and a 42% reduction in the risk of disease progression or death, with median progression-free survival nearly doubling – that's 16.4 months in the combination group and 8.3 months with sunitinib. Importantly, the safety profile was consistent with the known safety profiles of the individual medicines, with no new safety concerns identified. Dr. Neeraj Agarwal: Great summary, Peter. These data further support the efficacy of cabo-nivo combination therapy in advanced renal cell carcinoma, which is showing a 11-month difference in overall survival. Dr. Peter Hoskin: Neeraj, before wrapping up this podcast, would you like to tell us about Abstract 618? This is titled “Prospective COTRIMS (Cologne trial of retroperitoneal lymphadenectomy in metastatic seminoma) trial: Final results.” Dr. Neeraj Agarwal: Sure, Peter. I would be delighted to. Dr Heidenrich from the University of Cologne in Germany presented the COTRIMS data evaluating retroperitoneal LN dissection in patients with clinical stage 2A/B seminomas. Seminomas are classified as 2A or B when the disease spreads to the retroperitoneal lymph nodes of up to 2 cm (CS IIA) or of more than 2 cm to up to 5 cm (CS 2B) in maximum diameter, respectively. They account for 10-15% of seminomas and they are usually treated with radiation and chemotherapy. However, radiation and chemo can be associated with long-term toxicities such as cardiovascular toxicities, diabetes, solid cancers, leukemia, particularly for younger patients. From this standpoint, Dr Heidenrich and colleagues evaluated unilateral, modified template, nerve-sparing retroperitoneal lymph node dissection as a less toxic alternative compared to chemo and radiation. They included 34 patients with negative AFP, beta-HCG, and clinical stage 2A/B seminomas. At a median follow-up of 43.2 months, the trial demonstrated great outcomes: a 99.3% treatment-free survival rate and 100% overall survival, with only four relapses. Antegrade ejaculation was preserved in 88% of patients, and severe complications such as grade 3 and 4 were observed in 12% of patients. Pathological analysis revealed metastatic seminoma in 85% of cases, with miR371 being true positive in 23 out of 24 cases and true negative in 100% of cases. It appears to be a valid biomarker for predicting the presence of lymph node metastases. These findings highlight retroperitoneal lymph node dissection is feasible; it has low morbidity, and excellent oncologic outcomes, avoiding overtreatment in 80% of patients and sparing unnecessary chemotherapy or radiotherapy in 10-15% of cases. Dr. Peter Hoskin: Great summary and important data on retroperitoneal lymphadenectomy in metastatic seminoma. These findings will help shape clinical practice. Any final remarks before we conclude today's podcast? Dr. Neeraj Agarwal: Before wrapping up this podcast, I would like to say that we have reviewed several abstracts addressing prostate, bladder, kidney cancers, and seminoma, which are impacting our medical practices now and in the near future. Peter, thank you for sharing your insights with us today. These updates are undoubtedly exciting for the entire GU oncology community, and we greatly appreciate your valuable contribution to the discussion and your leadership of the conference. Many thanks. Dr. Peter Hoskin: Thank you, Neeraj. Thank you for the opportunity to share this information more widely. I'm aware that whilst we have nearly 6,000 delegates, there are many other tens of thousands of colleagues around the world who need to have access to this information. And it was a great privilege to chair this ASCO GU25. So, thank you once again, Neeraj, for this opportunity to share more of this information that we discussed over those few days. Dr. Neeraj Agarwal: Thank you, Peter. And thank you to our listeners for joining us today. You will find links to the abstracts discussed today on the transcript of this episode. Finally, 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. 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. Neeraj Agarwal    @neerajaiims    Dr. Peter Hoskin Follow ASCO on social media:      @ASCO on Twitter      ASCO on Bluesky  ASCO on Facebook      ASCO on LinkedIn      Disclosures: Dr. Neeraj Agarwal: Consulting or Advisory Role: Pfizer, Bristol-Myers Squibb, AstraZeneca, Nektar, Lilly, Bayer, Pharmacyclics, Foundation Medicine, Astellas Pharma, Lilly, Exelixis, AstraZeneca, Pfizer, Merck, Novartis, Eisai, Seattle Genetics, EMD Serono, Janssen Oncology, AVEO, Calithera Biosciences, MEI Pharma, Genentech, Astellas Pharma, Foundation Medicine, and Gilead Sciences Research Funding (Institution): Bayer, Bristol-Myers Squibb, Takeda, Pfizer, Exelixis, Amgen, AstraZeneca, Calithera Biosciences, Celldex, Eisai, Genentech, Immunomedics, Janssen, Merck, Lilly, Nektar, ORIC Pharmaceuticals, Crispr Therapeutics, Arvinas Dr. Peter Hoskin: Research Funding (Institution): Varian Medical Systems, Astellas Pharma, Bayer, Roche, Pfizer, Elekta, Bristol Myers  

Today is a very special day for me, I am not only starting a project that I longed for, but also I am starting it with one of my fav people in Los Angeles Arpi Alexanian.She has been in my life for more than 5 years and it is because of her that I am part of a book club, something that I always wanted to be part of.She is a creative director, she has worked on many cool projects that you certainly saw on TV or ads. She is also one of the directors behind the beautiful designs in Masterclass.Now, she has been working on her personal art, which we're gonna talk about more.  If that's not enough she is also a mom of a lovely boy!Bora ouvir!====Você pode contar pra gente o que achou desse episódio em nosso Podsite , no Instagram , ou no FacebookCréditosConvidada: Juliana MenezesApresentadora: Natália BaldochiEdição:  Natalia BaldochiArte do logo: Daniel CoutinhoIlustração: Arpine AleksanyanMúsicasI'm Happy by chillin_wolf Mission ready - Ketsa StudioNowhere to turn - Ketsa StudioCreative Commons Attribution-ShareAlike 3.0 Unported

Part 2 Highlights from a GU Cast Live Event! Dr Kim Chi (Medical Oncologist, Vancouver) and Dr Carmen Mir (Urologist, Valencia) joined the PROSPECT meeting in Melbourne to discuss high-risk prostate cancer and mHSPC, along with many experts from around Australia. On the eve of the meeting over dinner, Declan Murphy led a GU Cast-themed panel discussion on five hot topics in prostate cancer, featuring snippets from GU Cast over the past few months.Part 2 today features controversies in PLND, the somewhat notorious ARPI switch control arm beloved of mCRPC trials, and teh importnt topic of de-escalation in advanced prostate cancer. Part 1 recently in your feeds included PSMA conundrums and triplet vs doublet therapy.Even better on our YouTube channelThis is a Themed Podcast supported by our Gold Partners, Johnson & Johnson, who also support the PROSPECT meeting. Special thanks to David Chen for help with videography

Anders Arpi besöker podden och berättar om sina förhoppningar - och farhågor - inför det kommande frilanslivet. Bartek tipsar, råder och varnar utifrån sina egna erfarenheter.Anders Arpi på LinkedInAnders Arpi på världsvida webbenHostingen av Kompilator sponsras av Dekalfabriken

Сколько факторов аутентификации нужно использовать, чтобы учетные записи ваших пользователей были в безопасности? Зачем сбрасывать пароль каждые 30 дней? Есть ли методы аутентификации, которые, с одной стороны, достаточно безопасные, а с другой – удобные даже для вашей бабушки? Никита Хромушкин из Авито провел для нас максимально подробную лекцию про то, насколько проклято текущее состояние дел в аутентификации и какое светлое будущее нас ждет, когда человечество откажется от паролей! Партнёр эпизода – облачная платформа Yandex Cloud, которая проводит большую конференцию Yandex Scale для тех, кто создаёт цифровые решения. Генеративные нейросети, речевые технологии, сервисы для работы с данными и обеспечения безопасности, serverless‑подход – об этом и многом другом 25 сентября расскажут эксперты и партнёры облачной платформы. Участие бесплатное, приходите офлайн в МХАТ им. М. Горького или смотрите в онлайн-трансляции. Зарегистрироваться можно по ссылке: https://lnnk.in/aRpI Реклама. ООО "Яндекс.Облако", ИНН 7704458262, erid:2SDnjd7SVQN Также ждем вас, ваши лайки, репосты и комменты в мессенджерах и соцсетях!
 Telegram-чат: https://t.me/podlodka Telegram-канал: https://t.me/podlodkanews Страница в Facebook: www.facebook.com/podlodkacast/ Twitter-аккаунт: https://twitter.com/PodlodkaPodcast Ведущие в выпуске: Евгений Кателла, Егор Толстой Полезные ссылки: Неслучайный генератор случайных одноразовых кодов Тинькофф банка https://habr.com/ru/articles/462071/ OWASP Authentication Cheat Sheet (Про ошибки аутентификации и общие рекомендации) https://lnnk.in/htmx OWASP Multifactor Authentication Cheat Sheet (Факторы, плюсы, минусы, рекомендации, risk-based MFA) https://lnnk.in/hvmu NIST Digital Identity Guidelines / Authentication and Lifecycle Management (Про запрет использования секретных вопросов) https://lnnk.in/duq3 OWASP Password Storage Cheat Sheet (Про безопасное хранение паролей, bcrypt, work factor) https://lnnk.in/aNp7 OAuth 2.0 Authorization Code Grant Type - Fully Visualized (Article with Infographic) (Статья с инфографикой / sequence-диаграммой про OAuth) https://lnnk.in/aMqe OAuth Playground (Authorization Code with PKCE) (Интерактивная площадка для тестирования OAuth+PKCE) https://lnnk.in/aSpL OWASP Testing for OAuth Weaknesses (Руководство по тестированию уязвимостей OAuth) https://lnnk.in/aOp7 OWASP Authentication Testing (Руководство по тестированию аутентификации) https://lnnk.in/evl8 Open Policy Agent (Фреймворк политики безопасности) https://www.openpolicyagent.org/ Rego Sandbox for Open Policy Agent (Песочница для языка Rego) https://play.openpolicyagent.org/ FTC Data Breach Response Guide for Businesses (Гайд для бизнеса на случай утечки паролей) https://lnnk.in/aPpT Book: OAuth 2 in Action (Книга по OAuth2, возможна устаревшая с 2017) https://www.manning.com/books/oauth-2-in-action Book: Cryptography by Damir Sharifyanov (Книга по основам криптографии для новичков) https://lnnk.in/aQpU OWASP Testing Multi-Factor Authentication (Руководство по тестированию многофакторной аутентификации) https://lnnk.in/hxmj OWASP Testing for Bypassing Authorization Schema (Про тестирование обхода схем авторизации) https://lnnk.in/exl2 OWASP Testing for Cookies Attributes (Атрибуты Cookies: Secure, HTTP only, Path, Expires) https://lnnk.in/hzl9

Wellness + Wisdom | Episode 665 Wellness + Wisdom Podcast Host and Wellness Force Media CEO, Josh Trent, shares how to find your niche, and what do not and avoid if you want to become a spiritual coach. Today's Question Arpi: I'm just starting my business and like to learn about how spiritual coaches, emerging coaches can identify their specific niche and understand how they can help people. I'm very interested in manifestation, in inner child healing, in working with the feminine energy, also with money manifestation, removing money blocks. But I feel like emerging spiritual teachers, they need a lot of time and experimentation to understand the path that want to take.

BUFFALO, NY- July 17, 2024 – A new #editorial paper was #published in Oncotarget's Volume 15 on July 2, 2024, entitled, “Using early on-treatment circulating tumor DNA measurements as response assessment in metastatic castration resistant prostate cancer.” In this new editorial, researchers S.H. Tolmeijer, E. Boerrigter, N.P. Van Erp, and Niven Mehra from Radboud University Medical Center discuss metastatic castration resistant prostate cancer (mCRPC). mCRPC is lethal, but the number of life-prolonging systemic treatments available for mCRPC has expanded over the years. Real world data suggest that the most common first-line therapy for mCRPC was treatment with an androgen receptor pathway inhibitor (ARPI), being either enzalutamide or abiraterone, although more patients will nowadays receive ARPI and/or docetaxel already for hormone sensitive prostate cancer (HSPC). Recent clinical trial data suggest potential benefit of adding poly-ADP ribose polymerase inhibitors (PARPi) or lutetium-117-prostate-specific membrane antigen (LuPSMA) to first-line mCRPC treatment with ARPIs in a subset of patients. As these different drug classes are associated with different toxicity profiles and significant costs, it is highly important to identify which patients experience durable benefit from monotherapy ARPI and which patients would potentially benefit from treatment intensification or therapy switch. “Research by Tolmeijer et al. 2023, published in Clinical Cancer Research [13], suggests that the detection of circulating tumor DNA (ctDNA) at baseline and 4-weeks after treatment initiation can predict response durability to first-line ARPIs.” DOI - https://doi.org/10.18632/oncotarget.28599 Correspondence to - Niven Mehra - niven.mehra@radboudumc.nl Video short - https://www.youtube.com/watch?v=DTJ0vEnQ9SY Sign up for free Altmetric alerts about this article - https://oncotarget.altmetric.com/details/email_updates?id=10.18632%2Foncotarget.28599 Subscribe for free publication alerts from Oncotarget - https://www.oncotarget.com/subscribe/ Keywords - cancer, ctDNA, prostate cancer, liquid biopsy, biomarker, androgen receptor pathway inhibitors About Oncotarget Oncotarget (a primarily oncology-focused, peer-reviewed, open access journal) aims to maximize research impact through insightful peer-review; eliminate borders between specialties by linking different fields of oncology, cancer research and biomedical sciences; and foster application of basic and clinical science. Oncotarget is indexed and archived by PubMed/Medline, PubMed Central, Scopus, EMBASE, META (Chan Zuckerberg Initiative) (2018-2022), and Dimensions (Digital Science). To learn more about Oncotarget, please visit https://www.oncotarget.com and connect with us: Facebook - https://www.facebook.com/Oncotarget/ X - https://twitter.com/oncotarget Instagram - https://www.instagram.com/oncotargetjrnl/ YouTube - https://www.youtube.com/@OncotargetJournal LinkedIn - https://www.linkedin.com/company/oncotarget Pinterest - https://www.pinterest.com/oncotarget/ Reddit - https://www.reddit.com/user/Oncotarget/ Spotify - https://open.spotify.com/show/0gRwT6BqYWJzxzmjPJwtVh MEDIA@IMPACTJOURNALS.COM

Washington is piling pressure on Azerbaijan to sign a peace agreement with Azerbaijan that would allow Turkey to normalize its relations with Armenia. But Azerbaijan is resisting calls to finalize a draft peace agreement and wants further concessions from Armenia. Benjamin Poghosyan, a senior research fellow at the ARPI think tank in Yerevan, explains why.See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

Dr. Neeraj Agarwal and Dr. Jeanny Aragon-Ching discuss promising combination therapies and other compelling advances in genitourinary cancers in advance of the 2024 ASCO Annual Meeting. TRANSCRIPT Dr. Neeraj Agarwal: Hello and welcome to the ASCO Daily News Podcast. I'm Dr. Neeraj Agarwal, your guest host of the ASCO Daily News Podcast today. I'm the director of the Genitourinary Oncology Program and a professor of medicine at the University of Utah Huntsman Cancer Institute, and editor-in-chief of the ASCO Daily News. I'm delighted to be joined by Dr. Jeanny Aragon-Ching, a GU medical oncologist and the clinical program director of genitourinary cancers at the Inova Schar Cancer Institute in Virginia. Today, we will be discussing some key abstracts in GU oncology that will be featured at the 2024 ASCO Annual Meeting.  Our full disclosures are available in the transcript of this episode. Jeanny, it's great to have you on the podcast. Dr. Jeanny Aragon-Ching: Thank you so much, Dr. Agarwal. It's a pleasure to be here. Dr. Neeraj Agarwal: So, Jeanny, let's start with some bladder cancer abstracts. Could you tell us about the Abstract 4509 titled, “Characterization of Complete Responders to Nivolumab plus Gemcitabine Cisplatin versus Gemcitabine Cisplatin Alone in Patients with Lymph Node Only Metastatic Urothelial Carcinoma from the CheckMate 901 Trial.”  Dr. Jeanny Aragon-Ching: Of course, Neeraj, I would be delighted to. First, I would like to remind our listeners that the CheckMate 901 trial was a randomized, open-label, phase 3 study, in which this particular sub-study looked at cisplatin-eligible patients with previously untreated, unresectable, or metastatic urothelial carcinoma who were assigned to receive the combination of gemcitabine and cisplatin, followed by up to 2 years of nivolumab or placebo. Based on the data presented at ESMO 2023 and subsequently published in the New England Journal of Medicine, which shows significantly improved progression-free survival and overall survival in patients receiving the combination of gemcitabine, cisplatin, and nivolumab, this regimen was approved in March 2024 as a first-line therapy for patients with unresectable or metastatic urothelial carcinoma.  In the abstract that will be featured at ASCO this year, Dr. Matt Galsky and colleagues present a post-hoc analysis that aims to characterize a subset of patients with complete response as well as those with lymph node-only metastatic disease. In patients receiving the experimental treatment, 21.7% achieved a complete response, while 11.8% of the patients in the control arm achieved a complete response.  Among these complete responders, around 52% had lymph- node-only disease in both arms. Furthermore, when characterizing the subgroup of patients with lymph-node-only disease, those receiving the combination of gemcitabine-cisplatin plus nivolumab had a 62% reduction in the risk of progression or death and a 42% reduction in the risk of death compared to those treated with gemcitabine-cisplatin alone.  The median overall survival in the experimental arm in this subgroup was around 46.3 months, while it was only 24.9 months in the control arm. The ORR in patients with lymph-node-only disease receiving gem-cis plus nivo was about 81.5% compared to 64.3% in those treated with gem-cis alone. Dr. Neeraj Agarwal: Thank you, Jeanny, for the excellent summary of this abstract. We can say that nivolumab plus gemcitabine-cisplatin induced durable disease control and clinically meaningful improvements in OS and PFS compared to gem-cis alone in patients with lymph- node-only metastasis, and deserves to be considered as one of the options for these patients.  In a similar first-line metastatic urothelial carcinoma setting, Abstract 4502, also reported data on a recently approved combination of enfortumab vedotin and pembrolizumab. Can you tell us more about this abstract, Jeanny? Dr. Jeanny Aragon-Ching: Sure, Neeraj. So, as quick reminder to our audience, this regimen was tested in the EV-302 phase 3 trial, where patients with previously untreated, locally advanced or metastatic urothelial carcinoma were randomized to receive enfortumab vedotin, plus pembrolizumab or gemcitabine plus either cisplatin or carboplatin. These data were also first presented at ESMO 2023 and subsequently published in the New England Journal of Medicine. They showed that this immune based combination significantly improved both progression free survival and overall survival, which were the primary endpoints compared to chemotherapy. In this abstract, Dr. Shilpa Gupta from the Cleveland Clinic and colleagues present the results of patient reported outcomes based on quality-of-life questionnaires in this trial.  Time to pain progression and time to confirm deterioration were numerically longer in patients treated with EV plus pembro, and patients with moderate to severe pain at baseline receiving this combination had a meaningful improvement in the Brief Pain Inventory Short-Form worst pain from week 3 through 26. Dr. Neeraj Agarwal: Thank you, Jeanny. This means that patients treated with EV plus pembro did not only have improved survival compared with platinum-based chemotherapy, but also improvement in their quality-of-life and functioning, further supporting the value of this combination for patients with locally advanced or metastatic urothelial carcinoma. This is terrific news for all of our patients.   Before we wrap up the bladder cancer section, would you like to tell our listeners about Abstract 4565, which provides the data on the efficacy of trastuzumab deruxtecan in patients with bladder cancer? Dr. Jeanny Aragon-Ching: Yes, Neeraj; this is timely given the recent FDA approval, which we will talk about. The abstract is titled, “Efficacy and Safety of Trastuzumab Deruxtecan in Patients with HER2 Expressing Solid Tumors: Results from the Bladder Cohort of the DESTINY-PanTumor02 Study.” And as a quick reminder, the DESTINY-PanTumor02 was a phase 2 open-label study where trastuzumab deruxtecan, an antibody-drug conjugate targeting HER2 expression on cancer cells, was evaluated in patients with HER2-expressing locally advanced or metastatic disease who previously received systemic treatment or who had no other treatment options. The expression of HER2 was evaluated on immunohistochemistry by local or central testing.   The primary endpoint was confirmed objective response rate by investigator assessment. Secondary endpoints included duration of response, progression free survival, disease control rate, and safety. The primary analysis, which was published in the Journal of Clinical Oncology, showed an ORR of 37.1% and responses across all cohorts and the median duration of response was 11.3 months. Based on these results, fam-trastuzumab deruxtecan-nxki was just granted accelerated FDA approval for unresectable or metastatic HER2-positive solid tumors in April 2024.  So, back to this abstract; Dr. Wysocki and colleagues report the results of the bladder cancer cohort. This study included 41 patients with urothelial cancer and at a median follow up of around 12.6 months, the objective response rate among these patients was 39%, the median PFS was 7 months, and the duration of response median was 8.7 months. The disease control rate at 12 weeks was around 71%. Regarding the safety profile, 41.5% of patients experienced grade ≥3 drug related adverse events and interstitial lung disease or pneumonitis did occur in about 4 patients. Although there was no statistical comparison between different groups, the ORR was numerically highest among the HER2 3+ group with 56.3%.  Dr. Neeraj Agarwal: Thank you, Jeanny. So, these data support consideration of trastuzumab deruxtecan as a salvage therapy option for pre-treated patients with HER2 expressing urothelial cancers and show that we are extending our treatment options to include therapies with novel mechanisms of action. This is definitely exciting news for patients with bladder cancer. Dr. Jeanny Aragon-Ching: Yes, absolutely, Neeraj. Now, let's switch gears a bit to prostate cancer. Could you tell us about Abstract 5005 which is titled, “EMBARK Post Hoc Analysis of Impact of Treatment Suspension on Health Quality-of-Life?” Dr. Neeraj Agarwal: Of course, I'd be happy to. So, enzalutamide was recently granted FDA approval for the treatment of patients with non-metastatic castration-sensitive prostate cancer with biochemical recurrence at high-risk of metastasis, based on the results of the EMBARK trial, which was a phase 3 study where patients with high-risk biochemical recurrence were randomized to receive either enzalutamide with leuprolide, enzalutamide monotherapy, or placebo plus leuprolide. The primary endpoint was metastasis-free survival with secondary endpoints including overall survival and safety.  Results showed that patients receiving enzalutamide alone or enzalutamide plus leuprolide had significantly improved metastasis-free survival compared to those treated with leuprolide alone while preserving health-related quality-of-life.   One important aspect in the design of the trial was that patients who achieved undetectable PSA at week 37 underwent treatment suspension. The treatment was resumed if PSA rose to more than 2 ng/ml for patients who underwent radical proctectomy or when PSA rose to more than 5 ng/ml for those who did not undergo surgery.  In this abstract, Dr. Stephen Freedland and colleagues present a post-hoc analysis of health-related quality-of-life outcomes after treatment suspension between weeks 37 and 205. They found that treatment was suspended in 90.9% of patients receiving enzalutamide plus leuprolide, 85.9% of those receiving enzalutamide monotherapy, and 67.8% of those receiving leuprolide monotherapy. Among those patients who stayed on treatment suspension, a trend toward numerical improvement in health-related quality-of-life after week 37 was seen in all 3 arms and this reached clinically meaningful threshold at week 205 in pain questionnaires, physical well-being, urinary and bowel symptoms. For hormonal treatment side effects, all arms reached clinically meaningful improvement at the subsequent assessments of week 49 to week 97. However, patients slowly deteriorated, with clinically meaningful deterioration at week 205 relative to week 37 in patients receiving the combination of enzalutamide and leuprolide and those treated with leuprolide.    Concerning sexual activity, a clinically meaningful improvement was reported only in patients receiving enzalutamide plus leuprolide, possibly because sexual function was better preserved prior to suspension in the enzalutamide monotherapy arm and thus there was less opportunity for “improvement” while on suspension.  Dr. Jeanny Aragon-Ching: Thank you, Neeraj, for this great summary. This analysis confirms that treatment suspension in good responders might lead to a clinically meaningful improvements in health-related quality-of-life.   Now, moving on to patients with metastatic castration-resistant prostate cancer, what can you tell us, about Abstract 5008 titled, “Baseline ctDNA analyses and associations with outcomes in taxane-naive patients with mCRPC treated with 177Lu-PSMA-617 versus change of ARPI in PSMAfore”?  Dr. Neeraj Agarwal: Sure, Jeanny. The PSMAfore trial was a phase 3 study that compared the efficacy of 177Lu-PSMA-617 versus an ARPI switch in patients with mCRPC and prior progression on a first ARPI, and not previously exposed to docetaxel chemotherapy. The primary endpoint was rPFS and OS was an important secondary endpoint. The primary analysis presented at ESMO 2023 showed a significantly prolonged rPFS in patients receiving lutetium. In the abstract that will be featured at the 2024 ASCO Annual Meeting, Dr. Johann De Bono and colleagues present an exploratory analysis regarding the associations between baseline circulating tumor DNA and outcomes.  ctDNA fraction was evaluated in all samples as well as alterations in key prostate cancer drivers prevalent in more than 10% of participants.  The investigators sought to interrogate the association of ctDNA fraction or alterations with rPFS, PSA response, and RECIST response at data cutoff. They showed that median rPFS was significantly shorter in patients with a ctDNA fraction >1% compared to those with a fraction < 1% regardless of the treatment arm. Furthermore, ctDNA fraction >1% was also associated with worst RECIST response and PSA50 response. Regarding prostate cancer drivers, median rPFS was significantly shorter in patients with alterations in the AR, TP53 or PTEN in both treatment arms. There was no significant association between ctDNA alterations and PSA or objective responses. Dr. Jeanny Aragon-Ching: Thank you, Neeraj. So, these results show that the presence of a ctDNA fraction >1% or alterations in AR, P53 and PTEN were all associated with worse outcomes regardless of treatment with lutetium or change in the ARPI. These data are definitely important for counseling and prognostication of patients in the clinic and may guide the design of future clinical trials. Let's move on to kidney cancer. Neeraj, do you have any updates for us?  Dr. Neeraj Agarwal:  Sure. In Abstract 4512 titled, “A Multi-institution Analysis of Outcomes with First-Line Therapy for 99 Patients with Metastatic Chromophobe Renal Cell Carcinoma,” Dr. Sahil Doshi and colleagues present a retrospective, multi-institutional study comparing survival outcomes, including time-to-treatment failure and overall survival, between different first-line treatment options in patients with metastatic chromophobe renal cell carcinoma, where limited clinical trial data exists to guide systemic therapy. They categorized patients into 4 treatment groups: and immune checkpoint inhibitors + targeted therapy doublets (such as ICI VEGF TKI); pure immune checkpoint inhibitor monotherapy and doublets (such as ipilimumab plus nivolumab); targeted therapy doublets (such as lenvatinib plus everolimus), and targeted monotherapy (such as sunitinib).  They identified 99 patients, of whom 54 patients received targeted monotherapy, 17 received ICI VEGF-TKI, 14 received targeted doublet, and 14 patients received only ICI therapies. So the patients treated with any doublet containing a targeted agent had a 52% decrease in the risk of treatment failure and a 44% decrease in the risk of death compared to those treated with targeted monotherapy. The median time to treatment failure was 15 months with IO-targeted doublet, and the median overall survival was 56 months. Dr. Jeanny Aragon-Ching: Thank you, Neeraj. So, these results show that targeted doublet regimens resulted in a longer time to treatment failure and overall survival compared to any monotherapy in patients with chromophobe metastatic RCC and definitely provides valuable insights on treatment selection, albeit I would say there's still a small number of patients that were included in this retrospective analysis. Dr. Neeraj Agarwal: I completely agree this is a relatively small number of patients, but I decided to highlight the abstract given how rare the cancer is, and it is highly unlikely that we'll see large randomized clinical trials in patients with metastatic chromophobe renal cell carcinoma.  So, before we wrap up the podcast, what would you like to tell us about Abstract 5009 which is titled, “A Phase II Trial of Pembrolizumab Platinum Based Chemotherapy as First Line Systemic Therapy in Advanced Penile Cancer: HERCULES (LACOG 0218) Trial.” Dr. Jeanny Aragon-Ching: I'm glad you brought this up, Neeraj. As our listeners may know, advanced penile squamous cell carcinoma has a poor prognosis with limited treatment options. From this perspective, the results of the LACOG 0218 trial are very important. As you mentioned, this was a phase 2 single-arm study evaluating the addition of pembrolizumab to platinum-based chemotherapy as first-line treatment in patients with metastatic or locally advanced penile squamous cell carcinoma not amenable to curative therapy. Patients enrolled received chemotherapy, namely 5-Fluorouracil with cisplatin or carboplatin and pembrolizumab 200 mg IV every 3 weeks for 6 cycles, followed by pembrolizumab 200 mg IV every 3 weeks up to 34 cycles. The primary endpoint was confirmed overall response rate by investigator assessment.  In the 33 patients eligible for the efficacy analysis, the confirmed ORR by investigator assessment was 39.4% and included one complete response and 12 partial responses. The confirmed ORR was 75% in patients with high TMB and 55.6% in patients positive for HPV16, making TMB and HPV16 potential predictive biomarkers for efficacy in this study. Concerning the toxicity profile, any grade treatment-related adverse events were reported in around 92% of patients, and grade 3 or more treatment-related adverse events occurred in 51% of patients. 10.8% of patients discontinued treatment due to adverse events.  Dr. Neeraj Agarwal: Thank you, Jeanny. I would like to add that HERCULES is the first trial to demonstrate the efficacy of an immune checkpoint inhibitor in advanced penile squamous cell carcinoma with a manageable safety profile. Thus, the combination of ICI with platinum-based chemotherapy is a promising treatment for advanced penile squamous cell carcinoma and warrants further investigation.  Dr. Jeanny Aragon-Ching: I agree, Neeraj. Any final remarks before we conclude today's podcast? Dr. Neeraj Agarwal: Jeanny, I really want to thank you for your participation and valuable insights. Your contributions are always appreciated, and I sincerely thank you for taking the time to join us today. Dr. Jeanny Aragon-Ching: Thank you, Neeraj. It was a pleasure.  Dr. Neeraj Agarwal:  As we bring this podcast to an end, I would like to acknowledge the significant advances happening in the treatment of patients with genitourinary cancers. During our upcoming 2024 ASCO Annual Meeting, there will be an array of different studies featuring practice-changing data presented by researchers and physicians from around the globe. I urge our listeners to not only participate in this event to celebrate these achievements, but to also play a role in sharing these cutting-edge data with healthcare professionals worldwide. Through our collective efforts, we can surely optimize the benefits of patients on a global scale.   And thank you to our listeners for joining us today. You will find links to the abstracts discussed today on the transcript of this episode. Finally, 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 podcast. Thank you very much.   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. Neeraj Agarwal  @neerajaiims  Dr. Jeanny Aragon-Ching    Follow ASCO on social media:   @ASCO on Twitter     ASCO on Facebook     ASCO on LinkedIn       Disclosures:    Dr. Neeraj Agarwal:     Consulting or Advisory Role: Pfizer, Bristol-Myers Squibb, AstraZeneca, Nektar, Lilly, Bayer, Pharmacyclics, Foundation Medicine, Astellas Pharma, Lilly, Exelixis, AstraZeneca, Pfizer, Merck, Novartis, Eisai, Seattle Genetics, EMD Serono, Janssen Oncology, AVEO, Calithera Biosciences, MEI Pharma, Genentech, Astellas Pharma, Foundation Medicine, and Gilead Sciences    Research Funding (Institution): Bayer, Bristol-Myers Squibb, Takeda, Pfizer, Exelixis, Amgen, AstraZeneca, Calithera Biosciences, Celldex, Eisai, Genentech, Immunomedics, Janssen, Merck, Lilly, Nektar, ORIC Pharmaceuticals, Crispr Therapeutics, Arvinas     Dr. Jeanny Aragon-Ching:  Honoraria: Bristol-Myers Squibb, EMD Serono, Astellas Scientific and Medical Affairs Inc., Pfizer/EMD Serono  Consulting or Advisory Role: Algeta/Bayer, Dendreon, AstraZeneca, Janssen Biotech, Sanofi, EMD Serono, MedImmune, Bayer, Merck, Seattle Genetics, Pfizer, Immunomedics, Amgen, AVEO, Pfizer/Myovant, Exelixis,   Speakers' Bureau: Astellas Pharma, Janssen-Ortho, Bristol-Myers Squibb, Astellas/Seattle Genetics. 

 As the diaspora figured out how to mobilize help, one Armenian parish in Greater Boston got to work. Rallying support, collecting items, and personally distributing to over 1,000 refugees in Armenia is no small feat. Here is the first-hand recount from Der Vasken and Yeretzgin Arpi Kouzouian who helped lead the charge and personally deliver these items throughout Armenia.   

Anders Arpi avslutar självsäkert Kompilators produktivitetstrilogi. Det blir en lång resa med många frågor, från hur man gör till vad man ens menar med ordet.Produktivitet lite lös term. Vad menar man egentligen? Produktivitet är mycket mer än ett system. Prioritering, tillfälle, motivation, och förmåga krävs. Det klassiska knepet att helt enkelt börja med något enkelt diskuteras ingående.Finns det ens objektiv produktivitet? Vad händer när ens projekt läggs ner, eller när man är det osynliga klistret som håller ihop hela gruppen? Och jobbet är ju en sak, men allt det där man gör utanför jobbet då? Hobbyprojekt och uppgifter som att ta hand om helt nya människor trots att man inte får sova, är man inte vansinnigt produktiv där många gånger, trots att det absolut inte känns så?Länkar081 och 082 - Tidigare avsnitt i produktivitetstrilogiAnders ArpiMarcus Aurelius självbetraktelserLaTeXLorem ipsumLörem ipsumGTDLutherI suspect that if you want to build a modern GPU, you just have to be able to sustain all that inefficiencyPotemkinbyarGlue personVBACitatKompilators produktivitetstrilogiLaddad med okunskap och självsäkerhetTyvärr ganska blött krutVad är min svaghet?Lura mig själv att sätta igångPositivt självbedrägeri50 sidor rapakalja med rubrikerMetastrukturera mitt görandeInte enligt LutherÖverbyggnaden av begränsningar

Anders Arpi avslutar självsäkert Kompilators produktivitetstrilogi. Det blir en lång resa med många frågor, från hur man gör till vad man ens menar med ordet.Produktivitet lite lös term. Vad menar man egentligen? Produktivitet är mycket mer än ett system. Prioritering, tillfälle, motivation, och förmåga krävs. Det klassiska knepet att helt enkelt börja med något enkelt diskuteras ingående.Finns det ens objektiv produktivitet? Vad händer när ens projekt läggs ner, eller när man är det osynliga klistret som håller ihop hela gruppen? Och jobbet är ju en sak, men allt det där man gör utanför jobbet då? Hobbyprojekt och uppgifter som att ta hand om helt nya människor trots att man inte får sova, är man inte vansinnigt produktiv där många gånger, trots att det absolut inte känns så?Länkar081 och 082 - Tidigare avsnitt i produktivitetstrilogiAnders ArpiMarcus Aurelius självbetraktelserLaTeXLorem ipsumLörem ipsumGTDLutherI suspect that if you want to build a modern GPU, you just have to be able to sustain all that inefficiencyPotemkinbyarGlue personVBACitatKompilators produktivitetstrilogiLaddad med okunskap och självsäkerhetTyvärr ganska blött krutVad är min svaghet?Lura mig själv att sätta igångPositivt självbedrägeri50 sidor rapakalja med rubrikerMetastrukturera mitt görandeInte enligt LutherÖverbyggnaden av begränsningar

Drs. Neeraj Agarwal and Jeanny Aragon-Ching discuss several key abstracts to be presented at the 2024 ASCO GU Cancers Symposium, including sequencing versus upfront combination therapies for mCRPC in the BRCAAway study, updates on the CheckMate-9ER and CheckMate-214 trials in ccRCC, and a compelling real-world retrospective study in mUC of patients with FGFR2 and FGFR3 mutations. TRANSCRIPT Dr. Neeraj Agarwal: Hello, everyone, and welcome to the ASCO Daily News Podcast. I'm Dr. Neeraj Agarwal, your guest host of the podcast today. I am the director of the Genitourinary Oncology Program and a professor of medicine at the University of Utah's Huntsman Cancer Institute, and editor-in-chief of ASCO Daily News. I am delighted to welcome Dr. Jeanny Aragon-Ching, a genitourinary oncologist and the clinical program director of Genitourinary Cancers at the Inova Schar Cancer Institute in Virginia. Today, we will be discussing key posters and oral abstracts that will be featured at the 2024 ASCO Genitourinary Cancer Symposium, which is celebrating 20 years of evolution in GU oncology this year.  You will find our full disclosures in the transcript of this podcast, and disclosures of all guests on the podcast at asco.org/DNpod.  Jeanny, it's great to have you on the podcast today to highlight some key abstracts for our listeners ahead of the GU meeting. Dr. Jeanny Aragon-Ching: Thank you so much, Neeraj. It's an honor to be here. Dr. Neeraj Agarwal: Jeanny, as you know, this year we are celebrating the 20th anniversary of the ASCO GU Cancers Symposium, and judging from this year's abstracts, it's clear that this meeting continues to play a major role in advancing GU cancer research. Dr. Jeanny Aragon-Ching: Indeed, Neeraj. This year's abstracts reflect the important strides we have made in GU cancers. So, let's start with the prostate cancer abstracts. What is your takeaway from Abstract 19 on BRCAAway, which will be presented by Dr. Maha Hussein, and of which you are a co-author? As our listeners know, several PARP inhibitor combinations with second-generation androgen receptor pathway inhibitors, or ARPIs, have recently been approved as first-line treatment for patients with metastatic castrate-resistant prostate cancer, or metastatic CRPC, and the question of sequencing PARP inhibitors and ARPIs instead of combining them has emerged. From that perspective, the results of the BRCAAway trial are very important. Can you tell us a little bit more about this abstract, Neeraj?  Dr. Neeraj Agarwal: I totally agree with you, Jeanny. The BRCAAway study attempts to answer the crucial questions regarding sequencing versus upfront combination of therapies in the mCRPC setting. It is a phase 2 trial of abiraterone versus olaparib versus abiraterone with olaparib in patients with mCRPC harboring homologous recombination repair mutations. Enrolled patients had mCRPC disease and no prior exposure to PARP inhibitors or ARPIs or chemotherapy in the mCRPC setting and had BRCA1 or BRCA2 or ATM mutations. As previously mentioned, these patients were randomized to 3 arms: abiraterone monotherapy at 1000 milligrams once daily, or olaparib monotherapy at 300 milligrams twice daily, or the combination of abiraterone and olaparib. The primary endpoint was progression-free survival per RECIST 1.1 or Prostate Cancer Working Group 3-based criteria or clinical assessment or death, so, whichever occurred first was deemed to be progression.   Secondary endpoints included measurable disease response rates, PSA response rate, and toxicity. This was a relatively small trial with 21 patients in the combination arm, 19 patients in the abiraterone monotherapy arm, and 21 patients in the olaparib monotherapy arm. It should be noted that 26% of patients had received docetaxel chemotherapy in the hormone-sensitive setting, and only 3% of patients had any prior exposure to an ARPI, and these were darolutamide or enzalutamide or in the non-metastatic CRPC setting.  The results are very interesting. The median progression-free survival was 39 months in the combination arm, while it was 8.4 months in the abiraterone arm and 14 months in the olaparib arm. An important finding that I would like to highlight is that crossover was also allowed in the monotherapy arms. Of the 19 patients receiving abiraterone, 8 crossed over to receive olaparib, and of the 21 patients receiving olaparib, 8 crossed over to the abiraterone arm. The median PFS from randomization was 16 months in both groups of patients who received abiraterone followed by olaparib or those who received olaparib followed by abiraterone. This is striking when compared to 39 months in patients who started therapy with the combination therapy of abiraterone with olaparib. Dr. Jeanny Aragon-Ching: Thank you so much for that wonderful summary, Neeraj. So the key message from this abstract is that combining olaparib and abiraterone upfront seems to be associated with improvement in PFS compared to just sequencing those agents. Dr. Neeraj Agarwal: Exactly, Jeanny. I would like to add that these results are even more important given that in real-world practice, only half of the patients with mCRPC receive a second-line treatment. Based on these results, upfront intensification with a combination of an ARPI plus a PARP inhibitor in the first-line mCRPC setting seems to have superior efficacy compared to sequencing of these agents. Dr. Jeanny Aragon-Ching: Thank you so much. Now, moving on to a different setting in prostate cancer, there were a couple of abstracts assessing transperineal biopsy compared to the conventional transrectal biopsy for the detection of prostate cancer. So let's start with Abstract 261. Neeraj, can you tell us a little bit more about this abstract? Dr. Neeraj Agarwal: Sure, Jeanny. So, in Abstract 261 titled "Randomized Trial of Transperineal versus Transrectal Prostate Biopsy to Prevent Infection Complications," Dr. Jim Hugh and colleagues led a multicenter randomized trial comparing these 2 approaches, so, transperineal biopsy without antibiotic prophylaxis with transrectal biopsy with targeted prophylaxis in patients with suspected prostate cancer. The primary outcome was post-biopsy infection. Among the 567 participants included in the intention-to-treat analysis, no infection was reported with the transperineal approach, while 4 were detected with the transrectal approach, with a p-value of 0.059. The rates of other complications, such as urinary retention and significant bleeding, were very low and similar in both groups. The investigators also found that detection of clinically significant cancer was similar between the 2 techniques and concluded that the transperineal approach is more likely to reduce the risk of infection without antibiotic prophylaxis. Dr. Jeanny Aragon-Ching: So the key takeaway from this abstract sounds like office-based transperineal biopsy is well-tolerated and does not compromise cancer detection, along with better antibiotic stewardship and health care cost benefits.  Moving on to Abstract 273, also comparing these two approaches, what would be your key takeaway message, Neeraj?  Dr. Neeraj Agarwal: In this Abstract 273, titled "Difference in High-Risk Prostate Cancer Detection between Transrectal and Transperineal Approaches," Dr. Semko and colleagues found that the transperineal biopsy based on MRI fusion techniques was also characterized by a higher possibility of detecting high-risk prostate cancer and other risk factors as well, such as perineural and lymphovascular invasion or the presence of cribriform pattern, compared to the conventional transrectal method. Dr. Jeanny Aragon-Ching: Thank you, Neeraj. So we can see that the transperineal approach is gaining more importance and could be associated with more benefits compared to the conventional methods.   Let's now switch gears to kidney cancer, Neeraj. Dr. Neeraj Agarwal: Sure, Jeanny. Let's start by highlighting Abstract 361, which discusses patient-reported outcomes of the LITESPARK-005 study. So what can you tell us about this abstract, Jeanny?  Dr. Jeanny Aragon-Ching: Thank you, Neeraj. So as a reminder to our listeners, based on the LITESPARK-005 trial, it was a Phase 3 trial looking at belzutifan, which is an inhibitor of hypoxia inducible factor 2 alpha or I'll just call HIF-2 alpha for short, was very recently approved by the FDA as a second-line treatment option for patients with advanced or metastatic clear cell renal cell carcinoma after prior progression on immune checkpoint and antiangiogenic therapies. The title of Abstract 361 is "Belzutifan versus Everolimus in Patients with Previously Treated Advanced RCC: Patient-Reported Outcomes in the Phase 3 LITESPARK-005 Study," and this will be presented by Dr. Tom Pells at the meeting. At a median follow-up of 25.7 months, the median duration of treatment with belzutifan was 7.6 months, while it was only 3.9 months with everolimus. At the time of data cutoff date for the second interim analysis, 22.6% of patients remained on belzutifan while only 5% remained on everolimus. In the quality of life questionnaires, the time of deterioration to various quality of life scores, as assessed by standardized scales, was significantly longer in patients randomized to the belzutifan arm compared to those in the everolimus arm. Also, patients in the everolimus arm had worse physical functioning scores. Dr. Neeraj Agarwal: Yes, Jeanny. In addition to the improved outcomes associated with belzutifan, patient-reported outcomes indicate better disease-specific symptoms and better quality of life among patients treated with belzutifan compared to everolimus. This is great news for patients with advanced renal cell carcinoma.  Now, Jeanny, can you please tell us about the two abstracts that reported longer follow-up of CheckMate 9ER and CheckMate 214 trials in untreated patients with advanced or metastatic renal cell carcinoma? Dr. Jeanny Aragon-Ching: Yes, Neeraj. So you are referring to Abstracts 362 and 363. Let's start with Abstract 362. This abstract reports the results after a median follow-up of 55 months in the CheckMate 9ER trial, comparing the combination of nivolumab and cabozantinib to sunitinib in patients with advanced RCC without any prior treatment, so first-line therapy. The primary endpoint was PFS per RECIST 1.1 as assessed by an independent central review. So there were key secondary outcomes including overall survival (OS), objective response rates, and safety. Consistent with prior analysis at a median follow-up time of 18.1 and 44 months, the combination of nivolumab and cabozantinib at a median follow up of 55.6 months continues to show a significant reduction in the risk of progression or death by 42% and in the risk of death by 23% compared to sunitinib.  Dr. Neeraj Agarwal: And Jeanny, what can you tell us about the efficacy results of this combination by IMDC risk categories? Dr. Jeanny Aragon-Ching: Similar to prior results in patients with intermediate to poor risk IMDC risk category, the combination treatment maintained significant efficacy and reduced the risk of progression or death by 44% and the risk of death by 27%. To put it simply, the update now shows a 15-month improvement in overall survival with the cabozantinib-nivolumab combination compared to sunitinib, which is amazing. Also, in patients with favorable IMDC risk group, which represented truly a small number of patients in the trial, there was a strong trend for improvement of outcomes as well. I would like to point out that no new safety concerns were identified. Dr. Neeraj Agarwal: So, it looks like the key message from this abstract is that with longer follow-up, the combination of nivolumab and cabozantinib maintains a meaningful long-term efficacy benefit over sunitinib, supporting its use for newly diagnosed patients with advanced or metastatic renal cell carcinoma.   Let's move on to Abstract 363, which compares nivolumab with ipilimumab to sunitinib in first-line advanced renal cell carcinoma. What would you like to tell us about this abstract, Jeanny? Dr. Jeanny Aragon-Ching: Yes, Neeraj. The title of this abstract is "Nivolumab plus Ipilimumab versus Sunitinib for the First-Line Treatment of Advanced RCC: Long-Term Follow-Up Data from the Phase 3 CheckMate 214 Trial." In this abstract, Dr. Tannir and colleagues report outcomes with the longest median follow-up in first-line advanced RCC setting for any clinical trial. So the median follow-up now is about 18 months. The primary endpoints were OS, PFS, and objective response rates, as assessed by an independent review according to RECIST 1.1 criteria in the intermediate to poor risk IMDC risk group, which is the intent-to-treat (ITT) analysis, while secondary outcomes included the same outcomes in the ITT population of patients. Although the progression-free survival was similar in both arms, the combination of nivolumab-ipilimumab reduced the risk of death by 28% compared to sunitinib in the ITT population of patients. When stratifying the results by IMDC risk groups, the combination arm of nivolumab-ipilimumab showed significant improvement in the intermediate to poor risk group, but there was no difference in the favorable risk group. But in the study, no new safety signals were identified. Dr. Neeraj Agarwal: Thank you, Jeanny, for such a comprehensive description of the results of these two studies. I'd like to add that the median overall survival of patients with metastatic renal cell carcinoma in the ITT population in the CheckMate 214 trial has now reached 53 months, which would have been unimaginable just a decade ago. This is wonderful news for our patients. So the key takeaway from these two abstracts would be that immune checkpoint inhibitor-based combinations remain the backbone of first-line advanced renal cell carcinoma treatment.  Dr. Jeanny Aragon-Ching: Absolutely, Neeraj. This is wonderful news for all of our patients, especially for those who are being treated for first-line therapy.  Now, let's move on to the bladder cancer abstracts. We have two exciting abstracts from the UNITE database. What are your insights on Abstract 537, titled "Outcomes in Patients with Advanced Urethral Carcinoma Treated with Enfortumab Vedotin After Switch-Maintenance of Avelumab in the UNITE Study"? Dr. Neeraj Agarwal: As our listeners know, enfortumab vedotin is an antibody-drug conjugate that binds to a protein called Nectin 4 expressed on bladder cancer cells. In this abstract, Dr. Amanda Nizam and colleagues describe outcomes in 49 patients receiving third-line enfortumab vedotin after prior progression on platinum-based therapy and maintenance avelumab. At a median follow-up of 8.5 months, the median progression-free survival was 7 months and the median overall survival was 13.3 months with enfortumab vedotin in this treatment-refractory setting, the objective response rates were 54%. The message of this study is that enfortumab vedotin is an effective salvage therapy regimen for those patients who have already progressed on earlier lines of therapies, including platinum-based and immunotherapy regimens. Dr. Jeanny Aragon-Ching: Thank you, Neeraj, for that comprehensive review.  I want to focus on another patient population in the UNITE database, which is the use of fibroblast growth factor receptor (FGFR) alterations. Can you tell us more about the sequencing now of erdafitinib and enfortumab vedotin in these patients with metastatic urothelial cancer, as discussed in Abstract 616? Dr. Neeraj Agarwal: Sure, Jeanny. As a reminder, erdafitinib is a fibroblast growth factor receptor kinase inhibitor approved for patients with locally advanced or metastatic urothelial carcinoma harboring FGFR2 or FGFR3 alterations after progression on platinum-based chemotherapy. However, the optimal sequencing of therapies in these patients is unclear, especially with enfortumab vedotin being approved in the salvage therapy setting and now in the frontline therapy setting.  So in this retrospective study, all patients with metastatic urothelial carcinoma had FGFR2 or FGFR3 alterations. Dr. Cindy Jiang and colleagues report outcomes in 24 patients receiving enfortumab vedotin after erdafitinib, 15 patients receiving erdafitinib after enfortumab vedotin, and 55 patients receiving enfortumab vedotin only. This is a multicenter national study. Interestingly, patients receiving both agents had a longer overall survival in a multivariate analysis, regardless of the treatment sequencing, than patients receiving enfortumab vedotin alone or only with a hazard ratio of 0.52. The objective response rate of enfortumab vedotin in the enfortumab vedotin monotherapy arm was 49%. When these agents were sequenced, the objective response with enfortumab vedotin was 32% after erdafitinib and 67% when used before erdafitinib. Dr. Jeanny Aragon-Ching: Thank you so much, Neeraj. I think these are important real-world data results, but I would like to point out that larger and prospective studies are still needed to confirm these findings, especially regarding the outcome of erdafitinib after enfortumab vedotin, particularly when the latter is used in the first-line setting. Dr. Neeraj Agarwal: I totally agree, Jeanny. Now, let's discuss some abstracts related to disparities in the management of patients with genitourinary cancers.  Dr. Jeanny Aragon-Ching: Sure, actually, I would like to discuss 2 abstracts related to disparities in patients with prostate cancer. So the first one, Abstract 265, titled "Patient-Provider Rurality and Outcomes in Older Men with Prostate Cancer." In this study, Dr. Stabellini, Dr. Guha and the team used a SEER Medicare-linked database that included more than 75,000 patients with prostate cancer. The primary outcome was all-cause mortality, with secondary outcomes included prostate cancer-specific mortality. The investigators showed that the all-cause mortality risk was 44% higher in patients with prostate cancer from rural areas who had a provider from a non-metropolitan area compared to those who were in a metropolitan area and had a provider also from a metropolitan area. Dr. Neeraj Agarwal: Those are very important data and highlight the healthcare disparities among the rural population with prostate cancer that still exist.  So what is your key takeaway from Abstract 267, titled "Rural-Urban Disparities in Prostate Cancer Survival," which is a population-based study? Dr. Jeanny Aragon-Ching: Of course. This abstract discusses, actually, a very similar issue regarding access to healthcare among rural versus urban patients. In this study, Dr. Hu and Hashibe and colleagues and team at the Huntsman Cancer Institute assessed all-cause death and prostate cancer-related death risk in a retrospective study in which patients with prostate cancer based on rural versus urban residencies looked at 18,000 patients diagnosed with prostate cancer between 2004 and 2017. 15% lived in rural counties. Similar to the prior abstract we talked about, patients living in rural areas had about a 19% higher risk of all-cause mortality and a 21% higher risk of prostate cancer-specific mortality in comparison to patients living in urban areas. Dr. Neeraj Agarwal: So Jeanny, we can say that both of these abstracts, led by different groups of investigators, highlight that patients with prostate cancer living in rural areas have inferior survival outcomes compared to those living in urban areas, and it is time to focus on the disparities experienced by the rural population with prostate cancer.  Dr. Jeanny Aragon-Ching: Yeah, absolutely Neeraj. I concur with your thoughts.  So, any final thoughts before we wrap up the podcast today? Dr. Neeraj Agarwal: Yes, before concluding, Jeanny, I want to express my gratitude for your participation and the valuable insights you have shared today. Your contributions are always appreciated, and I sincerely thank you for taking the time to join us today.   As we bring this podcast to a close, I would like to highlight the significant advances happening in the treatment of patients with genitourinary cancers during our upcoming 2024 ASCO GU meeting. Many studies featuring practice-impacting data will be presented by investigators from around the globe. I encourage our listeners to not only participate at this event to celebrate these achievements, but to also play a role in disseminating these cutting-edge findings to practitioners worldwide. By doing so, we can collectively maximize the benefit for patients around the world.  And thank you to our listeners for joining us today. You will find links to the abstracts discussed today in the transcript of this episode. Finally, 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 very much.  Disclaimer: The purpose of this podcast is to educate and inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guest speakers express their own opinions, experience, and conclusions. Guest statements on the podcast do not necessarily reflect 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. Neeraj Agarwal  @neerajaiims  Dr. Jeanny Aragon-Ching    Follow ASCO on social media:     @ASCO on Twitter     ASCO on Facebook     ASCO on LinkedIn       Disclosures:      Dr. Neeraj Agarwal:       Consulting or Advisory Role: Pfizer, Bristol-Myers Squibb, AstraZeneca, Nektar, Lilly, Bayer, Pharmacyclics, Foundation Medicine, Astellas Pharma, Lilly, Exelixis, AstraZeneca, Pfizer, Merck, Novartis, Eisai, Seattle Genetics, EMD Serono, Janssen Oncology, AVEO, Calithera Biosciences, MEI Pharma, Genentech, Astellas Pharma, Foundation Medicine, and Gilead Sciences    Research Funding (Institution): Bayer, Bristol-Myers Squibb, Takeda, Pfizer, Exelixis, Amgen, AstraZeneca, Calithera Biosciences, Celldex, Eisai, Genentech, Immunomedics, Janssen, Merck, Lilly, Nektar, ORIC Pharmaceuticals, Crispr Therapeutics, Arvinas     Dr. Jeanny Aragon-Ching:    Honoraria: Bristol-Myers Squibb, EMD Serono, Astellas Scientific and Medical Affairs Inc., Pfizer/EMD Serono  Consulting or Advisory Role: Algeta/Bayer, Dendreon, AstraZeneca, Janssen Biotech, Sanofi, EMD Serono, MedImmune, Bayer, Merck, Seattle Genetics, Pfizer, Immunomedics, Amgen, AVEO, Pfizer/Myovant, Exelixis,   Speakers' Bureau: Astellas Pharma, Janssen-Ortho, Bristol-Myers Squibb, Astellas/Seattle Genetics. 

Bartek får besök av dockerkapten Anders Arpi och diskuterar Docker. Bartek vill hitta bättre sätt att köra saker, och Anders går igenom hur det funkar med Docker från dockerfil via byggsystem och ut i molnet. Vad är fördelarna, hur funkar det att köra ett operativsystem inuti ett annat medan man utvecklar, och hur gör man egentligen med datalagring och nätverk?LänkarAndersGDPRSchrems IIDockerGAC - Global assembly cacheRedisDockerfileSwetugg - veckans sponsorPodmanOrbstackImagesContainrarDocker hubWSL - Windows subsystem for LinuxAlpine är ett exempel på ett litet Linux smidigt att skapa images utifrånECR - Elastic Container RegistryAzure app serviceAzure container instancesTitlarDär gamla hundar lär sig nya trickJag får svettiga handflator av AzureEn liten dator i en datorEnkelarbetad och tät isoleringSamma OS varje gångDe primära entiteternaSamma container som körsLegobitstänkVerkligheten kommer in och är äckligHöll mig i handen på happy pathenFel person att orkestrera

As I have always told our guests, our time together is a conversation, not an interview. This was never truer than with our guest this time, Andrew Leland. Andrew grew up with what most people would call a pretty normal childhood. However, as he discovered he was encountering night blindness that gradually grew worse. Back in the 1980s and early 90s, he was not getting much support for determining what was happening with his eyes. He did his own research and decided that he was experiencing retinitis pigmentosa, a degenerative eye disease that first affects peripheral vision and eventually leads to total blindness. I won't spend time discussing Andrew's journey toward how finally doctors verified his personal diagnosis.   Andrew was and is an incredible researcher and thinker. He comes by it naturally. In addition, he is quite a writer and has had material published by The New York Times Magazine, The New Yorker, McSweeney's Quarterly, and The San Francisco Chronicle, among other outlets. He comes by his talents honestly through family members who have been screenwriters and playwrights. Example? His grandfather was Marvin Neal Simon, better known to all of us as Neal Simon.   This year Andrew's first book was published. It is entitled, The Country of the Blind: A Memoir at the End of Sight. I urge you to get and read it.   Our conversation goes into detail about blindness in so many different ways. I am sure you will find that your own views of blindness will probably change as you hear our discussion. Andrew has already agreed to come on again so we can continue our discussions. I hope you enjoy our time together.     About the Guest:   Andrew Leland's first book is The Country of the Blind: A Memoir at the End of Sight. His_ writing has appeared in _The New York Times Magazine, The New Yorker, McSweeney's Quarterly, and The San Francisco Chronicle, among other outlets. From 2013-2019, he hosted and produced The Organist, an arts and culture podcast, for KCRW; he has also produced pieces for Radiolab and 99 Percent Invisible. He has been an editor at The Believer since 2003. He lives in western Massachusetts with his wife and son.     Ways to connect with Andrew:   Website: https://www.andrewleland.org/   About the Host: Michael Hingson is a New York Times best-selling author, international lecturer, and Chief Vision Officer for accessiBe. Michael, blind since birth, survived the 9/11 attacks with the help of his guide dog Roselle. This story is the subject of his best-selling book, Thunder Dog.   Michael gives over 100 presentations around the world each year speaking to influential groups such as Exxon Mobile, AT&T, Federal Express, Scripps College, Rutgers University, Children's Hospital, and the American Red Cross just to name a few. He is Ambassador for the National Braille Literacy Campaign for the National Federation of the Blind and also serves as Ambassador for the American Humane Association's 2012 Hero Dog Awards.   https://michaelhingson.com https://www.facebook.com/michael.hingson.author.speaker/ https://twitter.com/mhingson https://www.youtube.com/user/mhingson https://www.linkedin.com/in/michaelhingson/   accessiBe Links https://accessibe.com/ https://www.youtube.com/c/accessiBe https://www.linkedin.com/company/accessibe/mycompany/ https://www.facebook.com/accessibe/       Thanks for listening! Thanks so much for listening to our podcast! If you enjoyed this episode and think that others could benefit from listening, please share it using the social media buttons on this page. Do you have some feedback or questions about this episode? Leave a comment in the section below!   Subscribe to the podcast If you would like to get automatic updates of new podcast episodes, you can subscribe to the podcast on Apple Podcasts or Stitcher. You can also subscribe in your favorite podcast app.   Leave us an Apple Podcasts review Ratings and reviews from our listeners are extremely valuable to us and greatly appreciated. They help our podcast rank higher on Apple Podcasts, which exposes our show to more awesome listeners like you. If you have a minute, please leave an honest review on Apple Podcasts.     Transcription Notes    Michael Hingson ** 00:00 Access Cast and accessiBe Initiative presents Unstoppable Mindset. The podcast where inclusion, diversity and the unexpected meet. Hi, I'm Michael Hingson, Chief Vision Officer for accessiBe and the author of the number one New York Times bestselling book, Thunder dog, the story of a blind man, his guide dog and the triumph of trust. Thanks for joining me on my podcast as we explore our own blinding fears of inclusion unacceptance and our resistance to change. We will discover the idea that no matter the situation, or the people we encounter, our own fears, and prejudices often are our strongest barriers to moving forward. The unstoppable mindset podcast is sponsored by accessiBe, that's a c c e s s i  capital B e. Visit www.accessibe.com to learn how you can make your website accessible for persons with disabilities. And to help make the internet fully inclusive by the year 2025. Glad you dropped by we're happy to meet you and to have you here with us.     Michael Hingson ** 01:21 Welcome to another episode of unstoppable mindset where inclusion diversity in the unexpected meet. And we're gonna get to have a little bit of all of that today. I get to interview someone who I've talked to a couple of times and met a couple of months ago for the first time, I think the first time at a meeting, Andrew Leland is the author of the country of the blind. And he will tell us about that. And we will have lots of fun things to talk about. I am sure he's been a podcaster. He's an author. Needless to say, he's written things. And I don't know what else we'll see what other kinds of secrets we can uncover. Fair warning, right. So Andrew, welcome to unstoppable mindset.   Andrew Leland ** 02:01 Thank you. Thank you so much for having me. I'm happy to be here.   Michael Hingson ** 02:04 Well, I really appreciate you coming. Why don't you start by telling us a little about kind of the early Andrew growing up in some of that kind of stuff? Oh, sure. A lot of times go in a galaxy far, far away. Yeah. Right.   Andrew Leland ** 02:18 planet called the Los Angeles. I was born in LA. Yeah. And my parents moved to New York pretty quickly. And they split when I was two. So for most of my childhood, I was kind of bouncing in between, I live with my mom. But then I would go visit my dad on holidays. And my mom moved around a lot. So we were in New York, just outside the city. And then we moved to Toronto for two years, and then back to New York, and then to Santa Fe, New Mexico, and then to California, Southern California. So I lived a lot of places. And that was all before college. And yeah, what can I tell you about young Andrew, I, you know, I always was interested in writing and reading. And I come from a family of writers. My mom is a screenwriter, my grandfather was a playwright. My aunt is a novelist. And so and my dad, you know, remember when I was a kid, he had a column for videography magazine, and has always been super interested in digital technology, you know, from the earliest days of desktop publishing. And he worked for, like early days of USA Network, you know, so like this kind of shared interest that I inherited from my parents of, you know, creativity and media, I guess was one way you could put it, you know, storytelling and sort of like playing around with electronic media. And, you know, I grew up I was born in 1980. So by the time I was an adolescent, the internet was just starting to reach its tendrils into our lives. And I remember my dad bought me a modem. And when I was like, I don't know 14 or something. And I was definitely one of the first kids in my class to have a modem and you know, messing around on message boards and stuff. So that was very influential for me. You know, when it was around that time that I started to notice that I had night blindness, and I kind of diagnosed myself with retinitis pigmentosa on that early web, you know, before the days of WebMD or anything like that, but it just there didn't seem to be a lot of causes for adolescent night blindness. And so I kind of figured it out and then sort of just compartmentalized it like kick that information to the side somewhere dusty corner of my brain and just went about my life and then it wasn't until later my teenage years I'd already done a year in college I think in Ohio where I said you know what, this is getting a little more intrusive and then I've that my mom finally booked me an appointment at a at a real deal, you know, medical retinal Research Center and at UCLA. And then, you know, an actual retinal specialist said, Yep, you've got retina is pigmentosa. You'll you Will, you know, maintain decent vision into middle age and then it'll fall off a cliff. Once again, I just carried that information around for, you know, the next 20 years or so. And I'm 4040 How old am I? Mike? 22 years old? Right? Well, I actually I'm a December baby. So we gotta go, Okay, you got a couple of months to go a 42 year old medicine me. You know, and at this point in my life, you know, I had the, you know, I read about all this in the book, but I have a feeling that, like that part of his diagnosis way back when is coming true, you know, and I feel like, okay, it's all finally happening, and like, it's happening more quickly, but then my current doctor is kind of careful to reassure me that that's not actually happening. And that RP, you know, their understanding of it has evolved since then. And there's like, you know, different genetic profiles, and that, in fact, maybe I might have some residual useful vision for many years to come. But one of the things that I really wrestled with, both in the book and just in my life is the question of, you know, how much to claim to that site and how useful that site really is. And, and, and trying to figure out what, what it means to be blind, if I'm blind, you know, certainly legally blind, you know, I've half got about five or six degrees of, of central vision. You know, and so, so, so my so So, I've left your question behind at this point. But I wrote, I wrote this book, in some ways to answer that question of, like, where I, where I fit into this world of blindness? And am I an outsider, or am I an insider? like at what point do I get to be part of the club and all those really tricky questions that were really bothering me as a person, I got to kind of explore in the form of a book.   Michael Hingson ** 06:52 The interesting thing about what you said in the book, however, concerning Are you an outsider or an insider, Am I blind? Or am I not? is, of course a question that everyone wrestles with. And I personally like the Jernigan definition, have you ever read his article, a definition of blindness?   Andrew Leland ** 07:11 Oh, maybe tell me what he says. So what he says   Michael Hingson ** 07:15 is that you should consider yourself blind from a functional standpoint, when your eyesight decreases to the point where you have to use alternatives to vision to be able to perform tasks. Now, having said that, that doesn't mean that you shouldn't use the residual vision that you have. But what you should do is learn blindness techniques, and learn to psychologically accept that from a blindness standpoint, or from a from a functional standpoint, you are blind, but you do also have eyesight, then there's no reason not to use that. But you still can consider yourself a blind person, because you are using alternatives to eyesight in order to function and do things.   Andrew Leland ** 08:00 Yeah, no, I have heard that from the NFB I didn't realize its source was Jernigan. But I really aspire to live my life that way. You know, I think it's, there are some days when it's easier than others. But, you know, I'm here, learning, you know, practicing Braille, using my white cane every day, you know, like learning jaws and trying to try to keep my screen reader on my phone as much as possible. And it's funny how it becomes almost like a moral mind game that I play with myself where I'm like, okay, like, Wow, it's so much easier to use my phone with a screen reader. Like, why don't I just leave it on all the time, but then inevitably, I get to like a inaccessible website, or like, I'm trying to write and write a text message. And I'm like, Oh, am I really going to like use the rotor to like, go back up, you know, to these words, and so then I turn it back off, and then I leave it off. And I'm just like, constantly messing with my own head and this way, and I've heard from, from folks with ARPI, who are more blind than I am, who have less vision. And there is the sense that like, one relief of even though it's, you know, incontrovertibly, incontrovertibly inconvenient to have less vision, right? Like there's there's certain affordances that vision gives you that shouldn't make life easier. But But one thing that I've heard from these folks is that, you know, that kind of constant obsessing and agonizing over like, how much vision do I have? How much vision am I going to have tomorrow? How am I going to do this, with this much vision versus that much vision? Like when that goes away? It is a bit of a relief I've heard.   Michael Hingson ** 09:28 Yeah, I mean, if it ultimately comes down to you can obsess over it, you can stress about it. What can I do if I lose this extra vision or not? Is is a question but the other side of it is why assume that just because you lose vision, you can't do X or Y. And that's the thing that I think so many people tend to not really deal with. I believe that we have totally an inconsistent and wrong definition of disability. Anyway, I believe that everyone on the planet has a disability. And for most people, the disability is like dependents. And my case from then my way from making that is look at what Thomas Edison did in 1878. He invented the electric light bulb, which allowed people to have light on demand. So they could function in the dark, because they couldn't really function in the dark until they had light on demand, or unless they had a burning stick or something that gave us light. But the reality is, they still had a disability. And no matter how much today we offer light on demand, and light on demand is a fine thing. No, no problem with it. But recognize that still, without that light on demand, if a if a power failure happens or something and the lights go out, sighted people are at least in a world of hurt until they get another source for light on demand. Mm hmm. I was I was invited to actually Kelly and Ryan's Oscar after party to be in the audience this year. So we went to the Hollywood Roosevelt Hotel, which is fun. I used to go there for NFB of California conventions, a great hotel, man. So we got there about three o'clock on Thursday, on Saturday afternoon, and it was my niece and nephew and I and we were all there. And we just dropped our luggage off. And we're going downstairs when suddenly I heard screaming, and I asked my niece, what's going on. And she said, there's been a power failure in and around the hotel. And I'd love to try to spread the rumor that it was all Jimmy Kimmel trying to get attention. But no one's bought that. But but the but the point is that suddenly people didn't know what to do. And I said, doesn't seem like a problem to me. And you know, it's all a matter of perspective. But we really have to get to this idea that it doesn't matter whether you can see or not. And you pointed out very well, in your book that blindness is not nearly so much the issue psychologically, as is our attitude about blindness? Absolutely.   Andrew Leland ** 11:58 Yeah, I remember I interviewed Mark Riccobono, the current president of the National Federation of the Blind, and he made a very similar point, when we were talking about the nature of accommodations, which is something that I still I'm thinking a lot about is I think it's a very tricky idea. And a very important idea, which I think your your your idea of light dependency gets at, you know, in America, Bono's point was, you know, look, we have the the BR headquarters here in Baltimore, and we pay a pretty hefty electricity bill, to keep the lights on every month, and that, you know, the blind folks who work there, it's not for them, right? It's for all the sighted people who come and visit or work at the at the center. And in some ways, that's a reasonable accommodation, that the NFB is making for the sighted people that they want to be inclusive of right. And so that just even that idea of like, what is a reasonable accommodation? I think you're right, that we think of it as like the poor, unfortunate disabled people who need to be brought back to some kind of norm that's at the center. And there's the kind of reframing that you're doing when you talk about light dependency or that Riccobono is doing when he talks about, you know, his electricity bill, you know, it kind of gives the lie to puts the lie to that, that idea that, that the norm takes precedence. And the reality is that, you know, that we all need accommodations, like you say, and so what's reasonable, is really based on what, what humans deserve, which is which is to be included, and to be, you know, to have access equal access, that   Michael Hingson ** 13:38 ought to be the norm. Jacobus timbre wrote a speech called the pros and cons of preferential treatment that was then paired down to a shorter article called a preference for equality. And I haven't, I've been trying to find it, it's at the NFB center, but it isn't as readily available as I would like to see it. And he talks about what equality is, and he said, equality isn't that you do things exactly the same way it is that you have access and with whatever way you need to the same information. So you can't just say, Okay, well, here's a printed textbook, blind persons that's equal under the law, it's not. And he talks about the fact that we all really should be seeking equality and looking for what will give people an equal opportunity in the world. And that's really the issue that we so often just don't face, like we should. The fact of the matter is, it's a part of the cost of business, in general to provide electricity and lights. It's a part of the cost of business to provide for companies a coffee machine, although it's usually a touchscreen machine, but it's there. It's a cost of doing business to provide desks and computers with monitors and so on. But no one views provide Seeing a screen reader as part of the cost of business and nobody views providing a refreshable Braille display or other tools that might give me an equal opportunity to be a part of society, we don't view those as part of the cost of doing business, which we should, because that's what inclusion is really all about. You know, we don't, we don't deal with the fact or sometimes we do that some people are a whole lot shorter than others. And so we provide ladders or step stools, or whatever. But we don't provide cost of doing business concepts to a lot of the tools that say, I might need or you might need. Yeah,   Andrew Leland ** 15:37 yeah, it's one thing that I've been thinking about lately is, is really even just the challenge of understanding what those accommodations are. Because, you know, I think I think, practically speaking in the world, you know, you'll, you'll call up a blind person and say, What do you need, you know, like, we're trying to make this art exhibit or this, you know, business or this, you know, HR software accessible, what do you need, you know, and that one blind person might be like, well, I use NVDA, you know, or that one blind person might be low vision, right. And they might be like, I use a screen magnifier. And it's so difficult to understand, like, what the accommodations are, that would be, that would be adequate to cover, like a reasonable sample. And so just like, it's just so much more complicated than it originally seems, you know, when you have a really well meaning person saying, like, we really value diversity, equity and inclusion and accessibility. And but then like, the distance between that well meeting gesture, and then actually pulling off something that's fully accessible to a wide swath of the whatever the users are, is just, it's just unfair, quickly, huge. So that's something that I'm thinking about a lot lately is like how to how do you approach that problem?   Michael Hingson ** 16:46 Well, and I think, though, the at least as far as I can tell, I think about it a lot, as well, as I think any of us should. The fact is that one solution doesn't fit everyone, I'm sure that there are people, although I'm sure it's a minority, but there are people who don't like fluorescent lights as well as incandescent lights, and neither of them like other kinds of lighting as compared to whatever. And then you have people epilepsy, epilepsy who can't deal as well, with blinking lights are blinking elements on a webpage, there's there isn't ever going to be least as near as I can tell, one size that truly fits all, until we all become perfect in our bodies. And that's got a ways to go. So the reality is, I don't think there is one solution that fits everyone. And I think that you, you pointed it out, the best thing to do is to keep an open mind and say, Yeah, I want to hire a person who's qualified. And if that person is blind, I'll do it. And I will ask them what they need. You know, an example I could give you is, was it three years ago, I guess, four years ago, now actually, I was called by someone up in Canada, who is a lawyer who went to work for a college. And we were talking about IRA, artificial intelligent, remote assistance, a IRA, you know about IRA, you wrote about it. And she said, you know, a lot of the discovery and a lot of the documentation that I need to use is not accessible through even OCR to be overly accurate, because there will be deep degradations and print and so and so I can't rely on that. And certainly, Adobe's OCR isn't necessarily going to deal with all the things that I need. So I'd like to use IRA is that a reasonable accommodation? And I said, sure it is, if that's what you need in order to be able to have access to the information, then it should be provided. Now the laws are a little different up there. But nevertheless, she went to the college and made the case and they gave her iris so she could read on demand all day, any document that she needed, and she was able to do her job. And not everyone necessarily needs to do that. And hear in probably some quarters, maybe there are other accommodations that people could use instead of using IRA. But still, Ira opened up a VISTA for her and gave her access to being able to do a job and I think that we really need to recognize that one solution doesn't fit everything. And the best way to address it is to ask somebody, what do you need in order to do your job, and we will provide it or work it out. And here in the US, of course, given although they try to renege on it so much, but given the definition of what rehabilitation is supposed to do, they're supposed to be able to and help make people employable. They should be providing a lot of these tools and sometimes getting counselors to do that. Just like pulling teeth, I'm sure you know about that. Yeah,   Andrew Leland ** 20:02 I do. I do. I mean, it's interesting because I think in the face of that complexity of saying, like, Okay, we like interviewed a dozen blind people, and we like have this we know, our website is it's compatible with all the screen readers. And, you know, this event, like, you know, let's say you're doing an event, and the website is compatible with every screen reader, and it's got dynamic types. So the low vision users are happy, you know, and then the event starts and you're like, oh, wait, we forgot about the existence of deafblind people, and there's no cart, or captioners. Here. And, you know, and then the question for me another another thing I've been thinking about lately is like, how do you respond to that, you know, like, what is the? What is the response? And even just like on a kind of, like, a social level, like, is it scathing indictment, like you, you terrible people, you know, you have you have like, you don't care about deaf blind people. And so I hereby cancel you, and I'm going to, like, tweet about how terrible you are? Or is there like a more benign approach, but then you don't get what you need. And like, sort of, and I think, I think a lot of this is a function of my having grown up without a disability, really, you know, I mean, like, growing up, my I went through my, my full education, without ever having to ask for an accommodation, you know, maybe I had to sit a little closer to the board a little bit. But you know, nothing, nothing like what I'm dealing with now. And I think as a result, I am just now starting to wrap my head around, like, how when self advocates and what styles are most effective. And I think that's another really important piece of this conversation, because it's easy, I think, to walk into, you know, cafe x, or, you know, I just did it the other day, yesterday, last night, I saw this really cool looking new magazine about radio, which was an interest of mine, like great for radio producers. And it was print only, you know, and I wrote like, Hey, how can I get an accessible copy of this cool look in new magazine? And they're like, Oh, actually, we're, we're putting our resources all it were kind of a shoestring operation, all our resources are going into the print edition right now. You know, and then, so then I had a question before me, right? Like, do I say, like, Hey, everybody, like, we must not rest until you agitate for these people to make their accessible thing, or I just sort of wrote a friendly note. And I was like, there's a lot of like, blind radio makers out there who might find your stuff interesting. And I like, affectionately urge you to make this accessible. And then, you know, their hearts seems to be in the right place. And they seem to be working on making it happen. So I don't know what's your what's your thinking about that? Like how to respond to those situations.   Michael Hingson ** 22:34 So my belief is whether we like it or not, every one of us needs to be a teacher. And the fact is to deal with with what you just said, let's take the radio magazine, which magazine is it by the way? Oh, I   Andrew Leland ** 22:51 didn't want to call them out by name. Oh, I'm   Michael Hingson ** 22:52 sorry. I was asking for my own curiosity, being very interested in radio myself. So we   Andrew Leland ** 22:57 give them some good and bad press simultaneously. It's called good tape. Okay, it's brand new. And at the moment, it's as of this recording, it's print only. And,   Michael Hingson ** 23:06 and tape is on the way up a good tape. No, that's okay. Anyway, but no, the reason I asked it was mainly out of curiosity. But look, you you kind of answered the question, their heart is in the right place. And it is probably true that they never thought of it. I don't know. But probably, yeah, they didn't think of it. I've seen other magazines like diversity magazine several years ago, I talked with them about the fact that their online version is totally inaccessible. And they have a print version. But none of its accessible. And I haven't seen it change yet, even though we've talked about it. And so they can talk about diversity all they want, and they talk a lot about disabilities, but they don't deal with it. I think that it comes down to what's the organization willing to do I've, I've dealt with a number of organizations that never thought about making a digital presence, accessible or having some sort of alternative way of people getting to the magazine, and I don't expect everybody to produce the magazine and Braille. And nowadays, you don't need to produce a braille version, but you need to produce an accessible version. And if people are willing to work toward that, I don't think that we should grind them into the ground at all if their hearts in the right place. And I can appreciate how this magazine started with print, which is natural. Yeah, but one of the things that you can do when others can do is to help them see maybe how easy it is to create a version that other people can can use for example, I don't know how they produce their magazine, but I will bet you virtual Anything that it starts with some sort of an electronic copy. If it does that, then they could certainly make that electronic copy a version that would be usable and accessible to the end. And then they could still provide it through a subscription process, there's no reason to give it away if they're not giving it away to other people, but they could still make it available. And I also think something else, which is, as you point out in the book, and the country of the blind, so often, things that are done for us, will help other people as well. So great tape is wonderful. But how is a person with dyslexia going to be able to read it? Yeah, so it isn't just blind people who could benefit from having a more accessible version of it. And probably, it would be worth exploring, even discussing with him about finding places to get funding to help make that happen. But if somebody's got their heart in the right place, then I think by all means, we shouldn't bless them. We should be teachers, and we should help them because they won't know how to do that stuff.   Andrew Leland ** 26:10 Ya know, I love that answer to be a teacher. And I think there was I think there was a teacher Lee vibe in my, in my response to them, you know, like, this is a thing that is actually important and useful. And you ought to really seriously consider doing it. You know, I mean, I think if you think about the how people act in the classroom, you know, it's those kinds of teachers who, you know, who, who correct you, but they correct you in a way that makes you want to follow their correction, instead of just ruining your day and making you feel like you're a terrible person. But it's interesting, because if you, you know, I mean, part of a lot of this is the function of the internet. You know, I see a lot of disabled people out there calling out people for doing things and accessibly. And, you know, I feel I'm really split about this, because I really empathize with the frustration that that one feels like, there's an amazing film called, I didn't see you there by a filmmaker named Reed Davenport, who's a wheelchair user. And the film is really just, like, he kind of he mounts a camera to his wheelchair, and a lot of it is like, he almost like turns his wheelchair into a dolly. And there's these these, like, wonderful, like tracking shots of Oakland, where he lived at the time. And there's this there's this incredible scene where it's really just his daily life, like, you know, and it's very similar to the experience of a blind person, like, he'll just be on a street corner hanging out, you know, in somebody's, like, the light screen, you know, like, what do you what are you trying to do, man, and he's like, I'm just here waiting for my car, my ride, you know, like, leave me alone. You don't need to intervene. But there's this incredible scene where there are some workers in his building are like, in the sort of just sort of unclear like they're working. And there's an extension cord, completely blocking the path, the visible entrance to his apartment, and he can't get into his house. And he's just this, like, the, the depth of his anger is so visceral in that moment. You know, and he yells at them, and they're like, oh, sorry, you know, they kind of don't care, you know, but they like, they're like, just give us a second. And he's like, I don't have a second, like, I need to get into my house. Now. You know, he just has no patience for them. And it's understandable, right? Like, imagine you're trying to get home. And as a matter of course, regularly every week, there's something that's preventing you. And then and then and then you see him when he finally gets back into his apartment. He's just like, screaming and rage. And it's, you know, so that rage I think, is entirely earned. You know, like, I don't I don't think that one one should have to mute one's rage and how and be a kindly teacher in that moment. Right. But, so So yeah, so So I kind of see it both ways. Like, there are moments for the rage. And then I guess there are moments for the mortar teacher like because obviously, like the stakes of me, getting access to good tape magazine are very different than the stakes for read like getting into his apartment. Right?   Michael Hingson ** 28:53 Well, yes and no, it's still access. But the other part about it is the next time, that group of people in whatever they're doing to repair or whatever, if they do the same thing, then they clearly haven't learned. Whereas if they go, Oh, we got to make sure we don't block an entrance. Yeah, then they've learned a lesson and so I can understand the rage. I felt it many times myself, and we all have and, and it's understandable. But ultimately, hopefully, we can come down. And depending on how much time there is to do it, go pick out and say, Look, do you see what the problem is here? Yeah. And please, anytime don't block an entrance or raise it way up or do something because a person in a wheelchair can't get in. And that's a problem. I so my wife always was in a wheelchair, and we were married for two years she passed last November. Just the bye He didn't keep up with the spirit is what I tell people is really true. But I remember we were places like Disneyland. And people would just jump over her foot rests, how rude, you know, and other things like that. But we, we faced a lot of it. And we faced it from the double whammy of one person being in a wheelchair and one person being blind. One day, we went to a restaurant. And we walked in, and we were standing at the counter and the hostess behind the counter was just staring at us. And finally, Karen said to me, well, the hostess is here, I don't think she knows who to talk to, you know, because I'm not making necessarily eye contact, and Karen is down below, in in a wheelchair. And so fine. I said, maybe if she would just ask us if we would like to sit down, it would be okay. And you know, it was friendly, and it broke the ice and then it went, went from there. But unfortunately, we, we, we bring up children and we bring up people not recognizing the whole concept of inclusion. And we we really don't teach people how to have the conversation. And I think that that's the real big issue. We don't get drawn into the conversation, which is why diversity is a problem because it doesn't include disabilities.   Andrew Leland ** 31:16 Mm hmm. Yeah. I mean, that seems to be changing. You know, I mean, you have you know, you have a lot more experience in this realm than I do. But But But haven't you felt like a real cultural shift over the last, you know, 2030 years about disability being more front of mind in that conversation?   Michael Hingson ** 31:36 I think it's, it's shifted some. The unemployment rate among employable blind people, though, for example, hasn't changed a lot. A lot of things regarding blindness hasn't really, or haven't really changed a lot. And we still have to fight for things like the National Federation of the Blind finally took the American Bar Association, all the way to the Supreme Court, because they wouldn't allow people to use their technology to take the LSAT. Yeah, lawyers of all people and you know, so things like that. There's, there's so many ways that it continues to happen. And I realized we're a low incidence disability. But still, I think, I think the best way to really equate it. You mentioned in Goldstein in the book, Dan, who I saw, I think, is a great lawyer spoke to the NFB in 2008. And one of the things he talked about was Henry, mayor's book all on fire. And it's about William Lloyd Garrison, the abolitionist and he was looking for allies. And he heard about these, these two, I think, two ladies, the Grimm case, sisters who were women's suffragettes, and they and he said, Look, we should get them involved. And people said, no, they're dealing with women's things. We're dealing with abolition, it's two different things. And Garrison said, No, it's all the same thing. And we've got to get people to recognize that it really is all the same thing. The you mentioned, well, you mentioned Fred Schroeder and the American Association of Persons with Disabilities at various points in the book. And in 1997. Fred, when he was RSA Commissioner, went to speak to the AAPD talking about the fact that we should be mandating Braille be taught in schools to all blind and low vision kids. And the way he tells me the story, they said, Well, that's a blindness issue. That's not our issue, because most of those people weren't blind. And that's unfortunate, because the reality is, it's all the same thing.   Andrew Leland ** 33:41 Yeah, no, that's something, uh, Dan Goldstein was a really important person for me to meet very early on in the process of writing the book, because I mean, just because he's, he's brilliant. And yeah, such a long history of, of arguing in a very, you know, legalistic, which is to say, very precise, and, you know, method, methodical way. A lot of these questions about what constitutes a reasonable accommodation, you know, as in like, his, his, the lawsuits that he's brought on behalf of the NFB have really broken ground have been incredibly important. So he's, he was a wonderful resource for me. You know, one of the things that he and I talked about, I remember at the beginning, and then, you know, I had lunch with him earlier this week, you know, we still are talking about it. And it's exactly that that question of, you know, the thing that the thing that really dogged me as I pursued, writing this book, and one of the kinds of questions that hung over it was this question of identity. And, you know, like, the sense that like the NFB argues that blindness is not what defines you. And yet, there it is, in their name, the National Federation of the Blind by and like, Where does where does this identity fit? And, you know, and I think that when you talk about other identities like Like the African American civil rights movement, or, you know, you mentioned the suffragette movement, you know, the feminist movement. You know, and it's interesting to compare these other identity based civil rights movements, and the organized by movement and the disability rights movement. And think about the parallels, but then there's also I think, disconnects as well. And so that was one of the things that I was it was really, really challenging for me to, to write about, but I think it's a really important question. And one that's, that's really evolving right now. You know, one of the things that I discovered was that, you know, in addition to the sort of blind or disability rights movement, that's very much modeled on the civil rights model of like, you know, my the first time I went to the NFB convention in 2018, you know, the banquet speech that Mark Riccobono gave was all about the speech of women and the women in the Federation, you know, which, which someone told me afterwards like, this is all new territory for the NFB, like, you know, they don't, there, there hasn't traditionally been this sort of emphasis on, including other identities, you know, and I found that was, I found that interesting, but then also, I was so struck by a line in that speech, where Riccobono said, you know, the fact that they were women is not as important as the fact that they were blind people fighting for, you know, whatever was like the liberation of blindness. And, you know, so it's, there's still always this emphasis on blindness as, like, the most important organizing characteristic of somebody is a part of that movement. And it makes total sense, right, it's the National Federation of the Blind, and they're fighting that 70% unemployment rate. And, you know, I think by their lights, you don't get there by you know, taking your eyes off the prize in some ways. And, and so I was really struck by some of these other groups that I encountered, particularly in 2020, when a lot of the sort of identity right questions came to the fore with the murder of George Floyd, right. You know, and then I was attending, you know, because it was 2020 it was that the convention was online, and I you know, I read it, this is all in the book, I, I went to the LGBT queue meet up, and which, which is also like a shockingly recent development at the NFB, you know, there's this notorious story where President Maher, you know, ostentatiously tears up a card, at a at an NFB convention where there are LGBT. NFB is trying to organize and have an LGBTQ meet up and he sort of ostentatiously tears it up as soon as he reads what's on the card. You know, a lot of still raw pain among NF beers who I talked to about that incident, anyway, like that this this LGBTQ meetup, you know, there's, there's a speaker who's not part of the NFB named justice, shorter, who works in DC, she's, she's blind, you know, and she's part of what is called the, you know, the Disability Justice Movement, which is very much about decentering whiteness, from the disability rights struggle and centering, black, queer, you know, people of color, who are also disabled, and and in some ways, I've found the NFB struggling to, to connect with with that model. You know, I talked to a Neil Lewis, who's the highest ranking black member of the NFV, you know, and he wrote this really fascinating Braille monitor article in the wake of, of George Floyd's death, where he's sort of really explicitly trying to reconcile, like Black Lives Matter movement with live the life you want, you know, with with NFB slogans, and it's, it's a tough thing to do, he has a tough job and trying to do that, because because of the thing, you know, that that I'm saying about Riccobono, right, it's like he is blind is the most important characteristic, or where do these other qualities fit? So it's a very contemporary argument. And it's one that I think the the organized blind movement is still very actively wrestling with.   Michael Hingson ** 39:02 I think it's a real tough thing. I think that blindness shouldn't be what defines me, but it's part of what defines me, and it shouldn't be that way. It is one of the characteristics that I happen to have, which is why I prefer that we start recognizing that disability doesn't mean lack of ability. Disability is a characteristic that manifests itself in different ways to people and in our case, blindness as part of that. For Women. Women is being a woman as part of it for men being a man as part of it for being short or tall, or black or whatever. Those are all part of what defines us. I do think that the National Federation of the Blind was an organization that evolved because, as I said earlier, we're not being included in the conversation and I think that for the Federation and blindness is the most important thing and ought to be the most important thing. And I think that we need to be very careful as an organization about that. Because if we get too bogged down in every other kind of characteristic that defines people, and move away too much from dealing with blindness, we will weaken what the message and the goals of the National Federation of the Blind are. But we do need to recognize that blindness isn't the only game in town, like eyesight isn't the only game in town. But for us, blindness is the main game in town, because it's what we deal with as an organization. Well,   Andrew Leland ** 40:40 how do you reconcile that with the idea that you were talking about before with with, you know, with the argument that like, you know, with the historical example of, you know, it's the same fight the suffragettes and like it because it doesn't that kind of, isn't that kind of contradicting that idea that like, having the intersection of identities, you know, and these movements all being linked by some kind of grand or systemic oppression, you know, so it is it is relevant? Well,   Michael Hingson ** 41:06 it is, yeah, and I'm not saying it any way that it's not relevant. What I am saying, though, is the case of the Grimm case, sisters, he wanted their support and support of other supportive other people, Garrison did in terms of dealing with abolition, which was appropriate, their main focus was women's suffrage, but it doesn't mean that they can't be involved in and recognize that we all are facing discrimination, and that we can start shaping more of our messages to be more inclusive. And that's the thing that that I don't think is happening nearly as much as it ought to. The fact is that, it doesn't mean that blind people shouldn't be concerned about or dealing with LGBTQ or color, or gender or whatever. Yeah. But our main common binding characteristic is that we're all blind men. So for us, as an organization, that should be what we mostly focus on. It also doesn't mean that we shouldn't be aware of and advocate for and fight for other things as well. But as an organization, collectively, the goal really needs to be dealing with blindness, because if you dilute it too much, then you're not dealing with blindness. And the problem with blindness as being a low incidence disability, that's all too easy to make happen. Right?   Andrew Leland ** 42:35 Yeah. Yeah, it's interesting. Yeah, it's interesting, just thinking about that question of dilution versus strengthening, you know, because I think I think if you ask somebody in the Disability Justice Movement, the dilution happens precisely, with an overemphasis on a single disability, right, and then you lose these like broader coalition's that you can build to, you know, I think I think it comes down to maybe like the way that you are our analysts analyzing the structures of oppression, right, like, right, what is it that's creating that 70% unemployment? Is it something specifically about blindness? Or is it like a broader ableist structure that is connected to a broader racist structure? You know, that's connected to a broader misogynist structure? You know, and I think if you start thinking in those structural terms, then like, coalition building makes a lot more sense, because it's like, I mean, you know, I don't know what kind of political affiliation or what but political orientation to take with us, you know, but certainly the Disability Justice Movement is pretty radically to the left, right. And I think traditionally, the NFB, for instance, has had a lot more socially conservative members and leaders. And so it's, you know, that reconciliation feels almost impossibly vast to to think of like an organization like the NFB taking the kind of like, abolitionist stance that a lot of these disability justice groups take to say, like, actually, capitalism is the problem, right. So yeah, so I mean, the thought experiment only goes so far, like, what like a Disability Justice oriented NFP would look like. But you know, that I think there are young members, you know, and I do think it's a generational thing too. Like, I think there are NF beers in their 20s and 30s, who are really wrestling with those questions right now. And I'm really interested to see what they come up with.   Michael Hingson ** 44:29 I think that the biggest value that the NFB brings overall, and I've actually heard this from some ACB people as well, is that the ENFP has a consistent philosophy about what blindness is and what blindness is. And and that is probably the most important thing that the NFP needs to ensure that it that it doesn't lose. But I think that the whole and the NFP used to be totally As coalition building that goes back to Jernigan and Mauer, although Mauer started to change some of that, and I think it will evolve. But you know, the NFB. And blind people in general have another issue that you sort of brought up in the book, you talk about people who are deaf and hard of hearing, that they form into communities and that they, they have a culture. And we don't see nearly as much of that in the blindness world. And so as a result, we still have blind people or sighted people referring to us and and not ever being called out as blind or visually impaired. But you don't find in the deaf community that people are talking about deaf or hearing impaired, you're liable to be shot. It's deaf or hard of hearing. And yeah, the reality is, it ought to be blind or low vision, because visually impaired is ridiculous on several levels visually, we're not different and impaired. What that's that's a horrible thing to say. But as a as an as a group. I was going to use community, but I but I guess the community isn't, as well formed to deal with it yet. We're not there. And so all too often, we talk about or hear about visually impaired or visual impairment. And that continues to promote the problem that we're trying to eliminate. Mm   Andrew Leland ** 46:22 hmm. Yeah. Yeah, that question of blank community is fascinating. And yeah. And I do think that I mean, you know, from my reading the book, I certainly have found blank community. But, you know, if I really think about it, if I'm really being honest, I think it's more that I've met, it's, you know, my work on the book has given me access to really cool blind people that I have gotten to become friends with, you know, that feels different than, like, welcome to this club, where we meet, you know, on Tuesdays and have our cool like, blind, you know, paragliding meetups, you know, not that not that people aren't doing that, like, then they're a really, you know, I would like to get more if I lived in a more urban center, I'm sure it would be involved in like, you know, the blind running club or whatever, willing to hang out with blind people more regularly, but it doesn't feel like a big community in that way. And it's interesting to think about why. You know, I think one big reason is that it's not, it's not familial, in the same way, you know, Andrew Solomon wrote a really interesting book called far from the tree that gets at this where, you know, like, the when, when, when a child has a different identity than a parent, like, you know, deaf children of hearing adults, you know, there doesn't, there isn't a culture that builds up around that, you know, and it's really like these big deaf families that you have with inherited forms of deafness, or, you know, and then schools for the deaf, that, you know, and with deaf culture in particular, you know, really what we're talking about is language, you know, in sign language, right, creates a whole rich culture around it. Whereas, with hearing blind people, you know, they're more isolated, they're not necessarily automatically you have to, you have to really work to find the other blind people, you know, with, with travel being difficult, it's a lot easier to just like, Get get to the public library to meet up in the first place, and so on. So, yeah, it feels a lot more fractured. And so I think you do see groups more like the NFB or the ACB, who are organizing around political action, rather than, you know, like a culture of folks hanging out going to a movie with open audio description, although, I will say that the weeks that I spent at the Colorado Center for the Blind, you know, which is, you know, you can think of it as like a, you know, it's a training center, but in some ways, it's like an intentional blind community do right where you're like, that's like a blind commune or something. I mean, that is just a beautiful experience, that it's not for everyone in terms of their their training method. But if it is for you, like, wow, like for just such a powerful experience to be in a community, because that is a real community. And it nothing will radically change your sense of what it means to be blind and what it means to be in a black community than then living for a while at a place like that. It was a really transformative experience for me.   Michael Hingson ** 49:11 Do you think that especially as the younger generations are evolving and coming up, that we may see more of a development of a community in the blindness in the blindness world? Or do you think that the other forces are just going to keep that from happening? Well,   Andrew Leland ** 49:30 you know, one of the things that I discovered in writing the book was that, you know, and this is sort of contradicting what I just said, because there there is a blind community. And, you know, I read in the book like, at first I thought that blind techies were another subculture of blindness, like blind birders are blind skateboarders, right. But then the more I looked into it, the more I realized that like being a techie is actually like a kind of a basic feature of being a blind person in the world. You know, and I don't hear if it's 2023 or 1823, you know, because if you think about the problem of blindness, which is access to information, by and large, you know, you basically have to become a self styled information technologist, right? To, to get what you need, whether it's the newspaper, or textbooks or signs, road signs, or whatever else. So. So I do and I do think that like, you know, when my dad was living in the Bay Area in the 90s, you know, when I would go visit him, you know, he was a techie, a sighted techie. And, you know, he would always be part of like, the Berkeley Macintosh user group, just be like, these nerds emailing each other, or, you know, I don't even know if email was around, it was like, late 80s. You know, but people who have like the Mac 512, KS, and they would, they would connect with each other about like, Well, how did you deal with this problem? And like, what kind of serial port blah, blah, blah? And that's a community, right? I mean, those people hang out, they get rise together. And if there's anything like a blind community, it's the blind techie community, you know, and I like to tell the story about Jonathan mosun. I'm sure you've encountered him in your trailer. I know Jonathan. Yeah. You know, so I, when I discovered his podcast, which is now called Living blind, fully blind, fully, yeah. Yeah. I, I was like, oh, okay, here are the conversations I've been looking for, because he will very regularly cover the kind of like social identity questions that I'm interested in, like, you know, is Braille like, is the only way for a blind person to have true literacy through Braille? Or is using a screen reader literacy, you know? Or like, is there such a thing as blind pride? And if so, what is it? I was like? These are the kinds of questions I was asking. And so I was so delighted to find it. But then in order to, in order to get to those conversations, you have to sit through like 20 minutes of like, one password on Windows 11 stopped working when I upgraded from Windows 10 to Windows 11. And so like, what, you know, if you what Jaws command, can I use in and I was like, why is this? Why is there like 20 minutes of Jaws chat in between these, like, really interesting philosophical conversations. And eventually, I realized, like, oh, because that's like, what this community needs and what it's interested in. And so in some ways, like the real blind community is like the user group, which I think is actually a beautiful thing. Yeah.   Michael Hingson ** 52:14 Well, it is definitely a part of it. And we do have to be information technologists, in a lot of ways. Have you met? And do you know, Curtis Chang,   Andrew Leland ** 52:23 I've met him very briefly at an NFB convention. So Curtis,   Michael Hingson ** 52:28 and I have known each other Gosh, since the 1970s. And we both are very deeply involved in a lot of things with technology. He worked in various aspects of assistive technology worked at the NFB center for a while and things like that, but he always talks about how blind people and and I've heard this and other presentations around the NFB, where blind people as Curtis would put it, have to muddle through and figure out websites. And, and the fact is, we do it, because there are so many that are inaccessible. I joined accessibe two years ago, two and a half years ago. And there are a lot of people that don't like the artificial, intelligent process that accessibe uses. It works however, and people don't really look far enough that we're not, I think, being as visionary as we ought to be. We're not doing what we did with Ray Kurzweil. And look, when the Kurzweil project started with the NFB Jernigan had to be dragged kicking and screaming into it, but Ray was so emphatic. And Jim Gasol at the Washington office, finally convinced kindred again to let him go see, raised machine, but the rules were that it didn't matter what Ray would put on the machine to read it and had to read what Gasol brought up. Well, he brought it did and the relationship began, and it's been going ever since and, and I worked, running the project and the sense on a day to day basis, I traveled I lived out of hotels and suitcases for 18 months as we put machines all over and then I went to work for Ray. And then I ended up having to go into sales selling not the reading machine, but the data entry machine, but I guess I kept to consistently see the vision that Ray was bringing, and I think he helped drag, in some ways the NFB as an organization, more into technology than it was willing to do before. Interesting.   Andrew Leland ** 54:27 Yeah, I heard a similar comment. The one thing I got wrong in the first edition of the book that I'm correcting for subsequent reprints, but I really bungled the description of the Opticon. And my friend, Robert Engel Britton, who's a linguist at Rice University, who collects opera cones. I think he has got probably like a dozen of them in his house. You know, he helped me you know, because I didn't have a chance to use one. Right he helped me get a better version of it. But he also sent me a quote, I think it was from Jernigan was similar thing where like, I think they were trying to get the public I'm included with, you know, voc rehab, so that that students could not voc rehab or whatever like so that students could get blind students could use them. And it was the same thing of like, you know, this newfangled gizmo is not going to help, you know, Braille is what kids need. So I do that, that's all to say that that makes sense to me that resistance to technology, you know, and it's like, it's a, it's a, it's a sort of conservative stance of like, we understand that what blind people need are is Braille and access to, you know, equal access. And don't don't try to give us any anything else. And you know, and I think, to be fair, like, even though the Opticon sounded like an incredibly useful tool, as is, of course, the Kurzweil Reading Machine and everything that followed from it. There. There is, you know, talking, I talked to Josh Meili, for the book, who's who now works at Amazon, you know, he had this great story about his mentor, Bill, Gary, who, who would, who would basically get a phone call, like once a week from a well, very well meaning like retired sighted engineer, who would say like, oh, you know, what the blind need? It's like the laser cane, right? Or the Yeah, it's like, basically like a sippy cup for blind people like so that they don't spill juice all over themselves. And, you know, and Gary would very patiently be like, Oh, actually, they don't think that that would be helpful to do probably, yeah. Talk to a blind person first, maybe before you spend any more time trying to invent something that blind people don't need. So I think that resistance to like newfangled technology, there's a good reason for it. Well,   Michael Hingson ** 56:26 there is but the willingness to take the Opticon. Look, I think the fastest I ever heard of anybody reading with an optical was like 70 or 80 words a minute, and there are only a few people who did that. Yeah. You know, Candy Lynnville, the daughter of the engineer who invented it, could and Sue Mel Rose, who was someone I knew, was able to and a few people were but what the Opticon did do even if it was slow, yeah, it was it still gave you access to information that you otherwise didn't get access to. And, and I had an optic on for a while. And the point was, you could learn to read and learn printed letters and learn to read them. It wasn't fast. But you could still do it. Yeah. And so it, it did help. But it wasn't going to be the panacea. I think that tele sensory systems wanted it to be you know, and then you talked about Harvey Lauer who also develop and was involved in developing the stereo toner, which was the audience since the audio version of the optic comm where everything was represented audio wise, and, and I spent a lot of time with Harvey Harvey at Heinz a long time ago. But the the fact is, I think the question is valid is listening, and so on literacy is literacy, like Braille. And I think there is a difference there is, are you illiterate, if you can't read Braille, you point out the issues about grammar, the issues about spelling and so on. And I think that there is a valid reason for people learning Braille at the Colorado Center, they would tell you, for senior blind people, you may not learn much Braille, but you can learn enough to be able to take notes and things like that, or, or put labels on your, your soup cans, and so on. So it's again, going to be different for different people. But we are in a society where Braille has been so de emphasized. And that's the fault of the educational system for not urging and insisting that more people be able to use Braille. And that's something that we do have to deal with. So I think there is a literacy problem when people don't learn braille. But I also think that, again, there are a lot of things that Braille would be good for, but using audio makes it go faster. It doesn't mean you shouldn't learn braille, though, right? Yeah,   Andrew Leland ** 58:51 no, it's another I think it's interesting. And it's a related idea, this, this sense that technology, you know, this like, just sort of wave your hands and say the word technology as a sort of panacea, where I think, you know, it's, it's a tragic story where, where people will say, Oh, well, you know, little Johnny has, you know, some vision. So like, he could just use technology, like he doesn't need Braille. And it's fascinating to me, because I never really felt it. And maybe it's because I encountered Braille at a point in my development as a blind person that I really was hungry for it. But, you know, people talk about Braille the way they talked about the white cane, like the white cane, I felt so much shame about using in public, and it's such, it's just so stigmatized, whereas Braille, I just always thought it was kind of cool. But you know, you hear it so much from parents where they it's just like their heartbreak seeing their child reading with their fingers, which is, you know, and so as a result, they're like, why don't I just buy like a gigantic magnifier, that maybe in five years, you're not gonna be able to use anyway, but like, at least you're reading the same type of book that   Michael Hingson ** 59:56 half hour or 45 minutes until you start getting headaches. Exactly. And that, you know, I worked on a proposal once. I was an evaluator for it. We were in a school in Chicago, and one of the teachers talked about Sally who could see and Johnny, who was totally blind, literally, it was Sally and Johnny. And she said, Sally gets to read print, Johnny has to read Braille. Sally couldn't read print very fast. her eyesight wasn't good. Yeah, she got to read print. And Johnny had to read Braille. Yeah, it's the kind of thing that we we see all the time. And it's so unfortunate. So yeah, I, I do understand a lot of the technology resistance. But again, people like Ray helped us vision a little differently. But unfortunately, getting that conversation to other people, outside of the NFB community, like teachers and so on, is so hard because so many people are looking at it from a science point of view and not recognizing it as it should be. The the NFB did a video that did it. Several, they have had a whole series of things regarding Braille. But they interviewed a number of people who had some residual vision, who were never allowed to learn to read Braille. And invariably, these people say how horrible it was that they didn't get to learn to read Braille, they learned it later. And they're, they're reading slower than they really should. But they see the value of it. And it's important that we hopefully work to change some of those conversations. Yeah,   Andrew Leland ** 1:01:33 I mean, it gets back to our earlier in our conversation a

It has becoming a familiar refrain around the world , and is certainly good news for the prostate cancer community! This week, another androgen receptor pathway inhibitor (ARPI) became reimbursed for men with hormone-sensitive metastatic prostate cancer (mHSPC) in Australia. Darolutamide is already available for men with non-metastatic castration-resistant prostate cancer, and is now also available for men with mHSPC in combination with androgen deprivation therapy and chemotherapy. Therefore we continue on our mission at GU Cast to educate ourselves about the use of ARPIs in mHSPC. And yes, even simple urologists like us can get up to speed with these drugs!Declan and Renu are joined by fellow Urologist Associate Professor Joseph Ischia, one of our favourite prostate cancer experts. And a great podcaster himself! Check out the back catalogue of "Talking Urology" using the links below. Plus what is a "jiffy stent"??? This Themed Podcast is supported by Bayer, Silver Partners of GU Cast. Even better on our YouTube channel Link: https://www.talkingurology.com.au/

Sverige er ramt af en voldsspiral, hvor også uskyldige mennesker mister livet. Det skete for nyligt i Uppsala nord for Stockholm. Her bor debattør og journalist Ivar Arpi, som ikke længere kan genkende den by, han er opvokset i. Vi taler med Arpi, som mener, at Sverige lige nu er i krig.Vært: Alexander Wils Lorenzen.

Bartek, Anders Arpi, och Patrik Svensson diskuterar komplexitet. Designar vi för många saker som är för abstrakta? Och blir det verkligen bättre när man går åt andra hållet och som Go medvetet håller saker på en lägre nivå? Eller glider alla språk och miljöer gradvis mot varandra? Finns det en rätt balans? Eller är det till och med så att man själv måste gå igenom vissa saker och själv hitta en balans som passar en?Dessutom: Clean codes typsättningsproblem, och Bartek gillade faktiskt Javascript!LänkarAnders ArpiCarson GrossAvsnittet med Carson htmxPatrik SvenssonAnders och Bartek snackade .NET och GoGenericsLINQDRY - Don't repeat yourselfUnion typesNancy - Sinatrainspirerat webbramverkDependency injectionExpert beginnerClean codeCoffeescriptCitatS03E01Aspirerande medelålders molnskrikareMer och mer osäker på alltingGammaldags stilFalla tillbaka på den lägre nivånEn kulturgrejMicrosoft-JavaIdeomatiskt av en anledningDet är okej, Bartek

Bartek, Anders Arpi, och Patrik Svensson diskuterar komplexitet. Designar vi för många saker som är för abstrakta? Och blir det verkligen bättre när man går åt andra hållet och som Go medvetet håller saker på en lägre nivå? Eller glider alla språk och miljöer gradvis mot varandra? Finns det en rätt balans? Eller är det till och med så att man själv måste gå igenom vissa saker och själv hitta en balans som passar en?Dessutom: Clean codes typsättningsproblem, och Bartek gillade faktiskt Javascript!LänkarAnders ArpiCarson GrossAvsnittet med Carson htmxPatrik SvenssonAnders och Bartek snackade .NET och GoGenericsLINQDRY - Don't repeat yourselfUnion typesNancy - Sinatrainspirerat webbramverkDependency injectionExpert beginnerClean codeCoffeescriptCitatS03E01Aspirerande medelålders molnskrikareMer och mer osäker på alltingGammaldags stilFalla tillbaka på den lägre nivånEn kulturgrejMicrosoft-JavaIdeomatiskt av en anledningDet är okej, Bartek

Jornalista: Renata Araújo Tema: Café da manhã com um belo visual.

On the podcast: Setting sensible goals for paid marketing, how to measure and learn from the results, and why a single ad creative can completely change the trajectory of a company.Top Takeaways

Dr. Neeraj Agarwal and Dr. Jeanny Aragon-Ching discuss the CLEAR study in renal cell carcinoma, a new exploratory analysis combining the TheraP and VISION trials in metastatic urothelial cancer, and compelling advances in prostate cancer and across GU oncology in advance of the 2023 ASCO Annual Meeting.  TRANSCRIPT Dr. Neeraj Agarwal: Hello and welcome to the ASCO Daily News Podcast. I'm Dr. Neeraj Agarwal, your guest host for the ASCO Daily News Podcast today. I'm the director of the Genitourinary Oncology Program and a professor of medicine at the University of Utah Huntsman Cancer Institute, and editor-in-chief of the ASCO Daily News. I'm delighted to welcome Dr. Jeanny Aragon-Ching, a GU medical oncologist and the clinical director of the Genitourinary Cancers Program at the Inova Schar Cancer Institute in Virginia.   Today, we'll be discussing some key abstracts in GU oncology that will be featured at the 2023 ASCO Annual Meeting.  Our full disclosures are available in the show notes and disclosures of all guests on the podcast can be found on our transcript at asco.orgDNpod.   Jeanny, it's great to have you on the podcast today. Dr. Jeanny Aragon-Ching: Thank you so much, Dr. Agarwal, for having me. Dr. Neeraj Agarwal: Jeanny, let's begin with Abstract 4502 regarding long-term updated results on the CLEAR study. The abstract reports the final, prespecified overall survival analysis of the CLEAR trial, a four-year follow-up of lenvatinib plus pembrolizumab versus sunitinib in patients with advanced renal cell carcinoma. Dr. Jeanny Aragon-Ching: Yes, I would be happy to. So, just as a reminder, the combination of lenvatinib and pembrolizumab was initially approved by the FDA in August 2021 for first-line treatment of adult patients with advanced renal cell carcinoma. So, this was based on significant benefits that were seen in progression-free survival, which was a primary endpoint, but also showed improvement in the overall response rates compared with sunitinib in first-line advanced renal cell carcinoma.   So this abstract reports on longer-term follow-up now at a median of 49.8 months, and PFS favored the combination lenvatinib and pembrolizumab compared to sunitinib across all MSKCC risk groups, and PFS benefit versus lenvatinib and pembro compared to sunitinib was maintained with a hazard ratio of 0.47. And even overall survival was also maintained with the combination with a hazard ratio of 0.79, and the overall survival favored the combination across all risk groups. If we look at the CR rate, it was 18.3% for the combination compared to 4.8% with sunitinib, unless patients in the combination arm received subsequent anticancer therapies, and that's intuitive. And the PFS2 was also longer with the combination at 43 months compared to 26 months. Now, it is important to note that grade III or more treatment-related adverse events did occur in about 74% of the patients in the combination of lenvatinib and pembro, compared to 60.3% in patients with sunitinib. Dr. Neeraj Agarwal: Jeanny, this is good news. So the main message from the abstract is that sustained results from this combination of lenvatinib plus pembrolizumab are being seen even after a longer follow-up of more than four years.  Dr. Jeanny Aragon-Ching: Yes, I agree. So now, moving on, Neeraj, to a different setting in the RCC space, let's look at Abstract 4519, which is titled “Efficacy of First-line Immunotherapy-based Regimens in Patients with Sarcomatoid and/or Rhabdoid Metastatic Non-Clear Cell RCC: Results from the IMDC,” which will be discussed by Dr. Chris Labaki. So, Neeraj, based on this abstract, can you tell us a little bit more about the impact of these adverse pathologic risk features in non-clear cell RCC?  Dr. Neeraj Agarwal: Of course. So, using real-world patient data, the IMDC investigators compared the outcomes of patients with metastatic non-clear cell RCC who were treated with immunotherapy-based combination regimens versus those who were treated with VEGF-TKIs alone. They also assessed the impact of sarcomatoid and rhabdoid features on response to IO-based combinations versus VEGF-TKIs. Of 103 patients with metastatic non-clear cell RCC who had rhabdoid or sarcomatoid features, 32% of patients were treated with immunotherapy-based combinations.   After adjusting for confounding factors, the authors show that those treated with a combination of two immune checkpoint inhibitors or an immune checkpoint inhibitor with a VEGF-TKI combination had significantly improved overall survival, which was not reached in the immunotherapy combination group versus seven months within the VEGF-TKI group. Time to treatment failure and objective responses were also prolonged, significantly higher, and better in the immunotherapy groups compared with patients who were treated with VEGF-TKIs alone. Interestingly, if you look at those 430 patients with metastatic non-clear cell RCC who did not have sarcomatoid or rhabdoid features, they didn't seem to benefit with immunotherapy-based combinations.  Dr. Jeanny Aragon-Ching: This is an exciting update, Neeraj. What are the key takeaways from this abstract? Dr. Neeraj Agarwal: So the main takeaway is if you see a patient with advanced non-clear cell RCC who has sarcomatoid and rhabdoid features, there appears to be a rather substantial and selective benefit with IO-based combinations. And in this context, I would like to highlight the ongoing SWOG 2200 trial also known as PAPMET2 trial, which is comparing the combination of cabozantinib plus atezolizumab. So immuno-therapy-based combinations versus cabozantinib alone in advanced papillary renal cell carcinoma setting. So this trial is being led by Dr. Benjamin Maughan and Dr. Monty Pal. And I like to encourage our listeners to consider referring their patients for involvement in this federally funded trial so that we can validate the data from this retrospective study in a prospective way. So, Jeanny, let's now move on to another important disease type which is urothelial carcinoma. There is a very recent accelerated FDA approval of the drug combination of enfortumab vedotin and pembrolizumab for cisplatin-ineligible metastatic urothelial carcinoma patients. This is Abstract 4505, which is being presented by Dr. Shilpa Gupta and colleagues. Can you please tell us more about this update? Dr. Jeanny Aragon-Ching: Yeah, absolutely. So, as you mentioned, Neeraj, the FDA just granted accelerated approval in April 2023 for this combination of enfortumab vedotin or EV, which is and ADC, antibody drug conjugate against nectin-4 and the PD-1 inhibitor pembroluzimab. So it's a combination for patients with locally advanced or metastatic urothelial carcinoma who are considered cisplatin ineligible. So this is nearly a four-year follow-up.   So as a reminder, this was a phase 1b/2 trial that included 45 patients and it had a primary endpoint of safety and tolerability although the key secondary endpoints included confirmed overall responses, duration of response, progression-free survival, and the resist criteria was investigated via investigator and BICRs which is in a blinded independent central review. Even overall survival was a key secondary endpoint.  So, the bottom line was the confirmed overall response by BICR was 73.3%, the disease control rate was about 84%, and the CR rate was 15.6% with a PFS of close to 13 months, and a 12-month overall survival rate of 83%. However, it is important to cite that there were treatment-related adverse events including skin reactions in 66%, neuropathy occurred in 62%, and ocular disorders in 40%. And there was a little bit of pneumonitis in close to 9%, colitis, and hypothyroidism, so there are side effects to watch out for.  Dr. Neeraj Agarwal: So, Jeanny this is great. What is the key takeaway from this trial?  Dr. Jeanny Aragon-Ching: So I think the most important thing is we now have a new combination of EV and pembro which shows very promising responses and survival in part which led to the FDA accelerated approval in the cisplatin-ineligible population of patients. However, we must note that the phase 3 trial of EV302 will ultimately establish which approach is really beneficial for all of our cisplatin-ineligible patients, either a carboplatin-based chemotherapy regimen or a non-platinum-based regimen such as EV and pembro. Dr. Neeraj Agarwal: Thanks Jeanny, would you like to discuss any other study in the bladder cancer space? Dr. Jeanny Aragon-Ching: Absolutely. I think Abstract 4508 from Dr. Seth Lerner and colleagues will be very relevant to our colleagues. This abstract is SWOG S1011, which is a phase 3 surgical trial to evaluate the benefit of a standard versus an extended lymphadenectomy performed at the time of radical cystectomy for muscle-invasive bladder cancer.  Dr. Neeraj Agarwal: Yes. So this trial, as you said, is an important trial which randomized in a one-on-one fashion 618 patients with muscle-invasive bladder cancer undergoing radical cystectomy, and these patients were randomized to either standard lymph node dissection or an extended lymph node dissection. And standard lymph node dissection included, as we know, external and internal iliac and operative lymph node. The extended lymph node dissection included lymph nodes up to aortic bifurcation which included common iliac, presciatic, and presacral lymph nodes. At a median follow-up of approximately 6 years, there was no disease-free survival or overall survival benefit in patients undergoing an extended lymph node dissection compared to standard lymph node dissection. And extended lymph node dissection was also associated with greater morbidity and preoperative mortality. Dr. Jeanny Aragon-Ching: Very interesting data, Neeraj. So these results, I think, will be very useful for a lot of our surgical colleagues in both academia and the community who may still be inclined to perform extended lymphadenectomy during cystectomy. This study shows that it's actually not necessary. Dr. Neeraj Agarwal: Absolutely. So now let's move on to another disease type, which is very important - prostate cancer. There are several practice-informing abstracts that are worthwhile discussing. The first of these involves Abstract 5002, which looks at the impact of the PSA nadir as a prognostic factor after radiation therapy for localized prostate cancer, which will be presented by Dr. Praful Ravi and  colleagues. Jeannie, can you please tell us more about this abstract? Dr. Jeanny Aragon-Ching: Yeah, definitely. So this abstract, as you mentioned, Neeraj, is a prognostic impact of PSA nadir of more than or equal to 0.1 nanogram per ml within six months after completion of radiotherapy for localized prostate cancer - an individual patient data analysis of randomized trials from the ICECaP Collaborative. Basically, it refers to an attempt to evaluate early surrogate measures to predict for long term outcomes such as prostate cancer-specific survival, metastases-free survival, and overall survival. So they looked at a big registry from the ICECaP collaboration that included 10,415 patients across 16 randomized controlled trials. And those men underwent treatment for intermediate risk and high risk prostate cancer treated with either radiation therapy alone in about a quarter of patients, or they got RT with short-term ADT in about 58% of patients, and 17% of them got RT with long-term ADT.  So, after a median follow-up of ten years, what they found was, if you had a PSA nadir that is over or equal to 0.1 nanogram per ml within six months after completion of radiation therapy, it was associated with worse prostate cancer-specific survival, metastases-free survival, and overall survival. For instance, the five-year metastases-free survival for those who achieved a PSA nadir of less than 0.1 was 91% compared to those who did not, which was 79%. Therefore, they concluded that if you achieve a bad PSA of 0.1 or above within six months after you completed radiation, you had worse outcomes.  Dr. Neeraj Agarwal: Jeanny, what is the key takeaway message from this study? Dr. Jeanny Aragon-Ching: The key takeaway from this ICECaP analysis is that this information would be very important to augment a signal-seeking endpoint, especially for clinical trial development, so that we can develop further strategies to de-escalate for those who don't need systemic intensification or therapy intensification versus escalation for those who really do. Dr. Neeraj Agarwal: So, my radiation oncology colleagues need to watch out for those patients who do not achieve a PSA of less than 0.1 nanogram per ml within the first six months of finishing radiation therapy. Very interesting data.  Dr. Jeanny Aragon-Ching: Yes, absolutely. So. Neeraj another important abstract for our fellow clinicians, switching gears a little bit now, is Abstract 5011, which is titled “Do Bone Scans Overstage Disease Compared to PSMA PET?” This was an international, multicenter retrospective study with blinded, independent readers. Can you tell us more about this abstract? Dr. Neeraj Agarwal: Yes, a relatively small retrospective study, but still pertinent to our practice. So I'll summarize it. This study by Dr. Wolfgang Fendler and colleagues evaluated the ability of bone scans to detect osseous metastasis using PSMA PET scan as a reference standard. So in this multicenter retrospective study, 167 patients were included, of which 77 patients were at the initial staging of prostate cancer, 60 had biochemical recurrence after definitive therapy, and 30 patients had CRPC or castor-resistant disease.  These patients had been imaged with a bone scan and a PSMA PET scan within 100 days. And in all patients, the positive predictive value, negative predictive value and specificity for bone scan were evaluated at different time points. They had bone scan and PSMA PET scan and both were compared. And what they found was interesting. All these three values - positive predictive value, negative predictive value, and specificity for bone scan were 0.73, 0.82 and 0.82 in all patients, and in initial staging, it was even lower at 0.43 and 0.94 and 0.80.  So, without getting into too much detail regarding these numbers, I want to highlight the most important part of the study, that at the initial staging, 57% patients who had a positive bone scan had false positive bone scans. The interreader agreement for bone disease was actually moderate for bone scans and quite substantial for the PSMA PET scan.  Dr. Jeanny Aragon-Ching: So, Neeraj, what do you think is the key takeaway message here for our audience?   Dr. Neeraj Agarwal: The key takeaway message is that positive predictive value of bone scan was low in prostate cancer patients at initial staging, with the majority of positive bone scans being false positive. This suggests that a large proportion of patients which we consider to have low-volume metastatic disease by bone scan actually have localized disease. So in the newly diagnosed patients with prostate cancer, patients should ideally have a PSMA PET scan to rule out metastatic disease.   So, let's move on to another abstract I would like to discuss, which has important implications in treatment, especially now that lutetium 177 is approved, but frankly not available widely. Dr. Jeanny Aragon-Ching: Yeah, that's actually very timely. So the abstract you're referring to is 5045, which is being presented by Dr. Yu Yang Sun and colleagues entitled “Effects of Lutetium PSMA 617 on Overall Survival in TheraP Versus VISION Randomized Trials: An Exploratory Analysis.” So, Neeraj, can you tell us more about the relevance of this exploratory analysis? Dr. Neeraj Agarwal: Definitely. In this abstract, Dr. Yang Sun and colleagues assess the effect of lutetium PSMA on overall survival in two different trials, TheraP and VISION trials. So, just for our listeners' recollection, the phase 2 TheraP trial compared lutetium PSMA and cabazitaxel in patients with mCRPC who had progression on docetaxel and had significant PSMA avidity on gallium PSMA pet scan, which was defined as a minimum uptake of SUV max of 20 at least one site of disease and SUV max of more than 10 at all sites of measurable disease.  In this trial, 20 of 101 patients in the cabazitaxel arm crossed over to lutetium PSMA, and 32 of 99 patients in the lutetium PSMA arm crossed over to cabazitaxel. In the VISION trial, patients with mCRPC who previously progressed on at least one ARPI and one taxane-based therapy and had a positive gallium PSMA scan, and here, positivity was not stringently pre-specified as it was done in the context of TheraP trial. So, positive gallium pet scans were randomly assigned in two to one fashion to receive either lutetium PSMA plus best supportive care or standard of care versus standard of care.  And I'd like to highlight that the standard of care comprised ARPIs and bone protecting agents and these patients were not allowed to have cytotoxic chemotherapy such as cabazitaxel in the standard of care arm. Now, overall survival was similar in the lutetium PSMA group regardless of whether they got lutetium PSMA in the VISION trial or TheraP trial. There was no difference in overall survival with lutetium in the lutetium arms of VISION and TheraP trial with a hazard ratio of 0.92. And there was no difference in the overall survival between the lutetium PSMA and the cabazitaxel group in the TheraP trial if you use counterfactual analysis, assuming crossover had not occurred. So, quite interesting in my view. Dr. Jeanny Aragon-Ching: Yeah, thanks Neeraj for that wonderful synopsis and discussion. So, what is the key take home message then? Dr. Neeraj Agarwal: The main message in this new exploratory analysis, which combined both the TheraP and VISION trials, is that lutetium PSMA and cabazitaxel seem to be associated with similar overall survival benefit in these highly selected patients with PSMA positivity. Additionally, the difference in the observed effect of lutetium PSMA and overall survival in the TheraP and VISION trials may be actually better explained by the use of different treatments in the respective control arms of these trials. And these results, in my view, are quite pertinent for those patients and providers who do not have access to lutetium-177 therapy.  Let's go to another abstract that is currently relevant to our practice, given many patients with advanced prostate cancer who have concurrent diabetes; I'm talking about Abstract 5066. Jeanny, can you please tell us more about this abstract?  Dr. Jeanny Aragon-Ching: Certainly, Neeraj. So this abstract will be presented by Dr. Amy Shaver and colleagues. So it's also very relevant, since many men who are diagnosed with prostate cancer frequently also have a concomitant diagnosis of type 2 diabetes mellitus. So, this was a SEER-Medicare population database analysis that looked at men who were treated with either abiraterone or enzalutamide and also had concomitant diagnosis of type 2 diabetes mellitus (DM). And they were identified using ICD-9 and ICD-10 codes and they were all tied in to acute care utilization. So they looked at CMS research data codes and ER hospitalization visits six months after treatment initiation was recorded. So all in all, they took a sample of 11,163 men, of whom close to 62% were treated with abiraterone and about 38% were treated with enzalutamide.  So, of these, about 27% of them had type 2 DM, of whom 59% received abiraterone and about 41% had enzalutamide. So, the bottom line is, compared to those without diabetes mellitus, those who had type 2 diabetes had worse acute care utilization, which was 43% higher than those who got abiraterone compared to enzalutamide, and also had higher overall mortality. Therefore, the bottom line is, having type 2 diabetes mellitus, unfortunately, portends worse outcomes in men with prostate cancer, so careful attention needs to be paid to those who are starting out already with such comorbidities. So Neeraj, any final thoughts you have regarding this abstract and overall before we wrap up on the podcast today?  Dr. Neeraj Agarwal: Absolutely. So it looks like, based on this very important pertinent Abstract 5066, which talks about the impact of diabetes on our patients, I think we need to be very watchful regarding the impact of diabetes on our patients who are being treated with abiraterone or enzalutamide, especially drugs which are known to make the metabolic syndrome and diabetes worse. I think close monitoring and close attention to control of diabetes is very important. So with that, I would urge the listeners to come and join us at the Annual Meeting, not only to celebrate these successes but also to help disseminate this cutting-edge data to practitioners and maximize the benefit to our patients across the globe.   And thank you to our listeners for joining us today. You will find links to the abstracts we discussed today on the transcript of this episode. Finally, if you value the insights that you hear on our ASCO Daily News Podcast, please take a moment to rate, review and subscribe wherever you get your podcast.  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. Neeraj Agarwal @neerajaiims Dr. Jeanny Aragon-Ching Follow ASCO on social media:   @ASCO on Twitter   ASCO on Facebook   ASCO on LinkedIn     Disclosures:  Dr. Neeraj Agarwal:   Consulting or Advisory Role: Pfizer, Bristol-Myers Squibb, AstraZeneca, Nektar, Lilly, Bayer, Pharmacyclics, Foundation Medicine, Astellas Pharma, Lilly, Exelixis, AstraZeneca, Pfizer, Merck, Novartis, Eisai, Seattle Genetics, EMD Serono, Janssen Oncology, AVEO, Calithera Biosciences, MEI Pharma, Genentech, Astellas Pharma, Foundation Medicine, and Gilead Sciences  Research Funding (Institution): Bayer, Bristol-Myers Squibb, Takeda, Pfizer, Exelixis, Amgen, AstraZeneca, Calithera Biosciences, Celldex, Eisai, Genentech, Immunomedics, Janssen, Merck, Lilly, Nektar, ORIC Pharmaceuticals, Crispr Therapeutics, Arvinas  Dr. Jeanny Aragon-Ching: Honoraria: Bristol-Myers Squibb, EMD Serono, Astellas Scientific and Medical Affairs Inc., Pfizer/EMD Serono Consulting or Advisory Role: Algeta/Bayer, Dendreon, AstraZeneca, Janssen Biotech, Sanofi, EMD Serono, MedImmune, Bayer, Merck, Seattle Genetics, Pfizer, Immunomedics, Amgen, AVEO, Pfizer/Myovant,  Exelixis, Speakers' Bureau: Astellas Pharma, Janssen-Ortho, Bristol-Myers Squibb, Astellas/Seattle Genetics.

Anders Arpi berättar om att gå från .NET till Go. Varför gjorde han det? Hur skiljer sig verktygen och biblioteken? Och sist men inte minst: vad gillar Anders inte med Go-världen?Det kan vara skönt med ett språk som är lite långsammare att ändra på sig - där inte varenda trendig funktion packas in i årliga uppdateringar, och där filosofin ofta är att använda de byggstenar som finns istället för att dra in bibliotek för att lösa problem. Å andra sidan … ja, det kan bli för mycket av förändringsmotstånd ibland också.LänkarAnders ArpiFreeBSDAnders bloggpre-taggenJohn Skeets böckerLINQWriting an interpreter in Go, av Thorsten BallLeft-padGAC - Global Assembly CacheLodashThe Zen of PythonLearning Go, av Jon BodnerChannels och goroutinesCitatEn datornörd som alla andraHTML-programmeringMan lärde sig mycket, men man fick ingenting gjortBörja skriva en HTML-filTio års muskelminneEn aktiv, värderad medlem i teametEn officiell och tydlig vägÅsiktstungtAppklossarLeft-pad-livetOdelat defensivEn lugnare takt

Anders Arpi berättar om att gå från .NET till Go. Varför gjorde han det? Hur skiljer sig verktygen och biblioteken? Och sist men inte minst: vad gillar Anders inte med Go-världen?Det kan vara skönt med ett språk som är lite långsammare att ändra på sig - där inte varenda trendig funktion packas in i årliga uppdateringar, och där filosofin ofta är att använda de byggstenar som finns istället för att dra in bibliotek för att lösa problem. Å andra sidan … ja, det kan bli för mycket av förändringsmotstånd ibland också.LänkarAnders ArpiFreeBSDAnders bloggpre-taggenJohn Skeets böckerLINQWriting an interpreter in Go, av Thorsten BallLeft-padGAC - Global Assembly CacheLodashThe Zen of PythonLearning Go, av Jon BodnerChannels och goroutinesCitatEn datornörd som alla andraHTML-programmeringMan lärde sig mycket, men man fick ingenting gjortBörja skriva en HTML-filTio års muskelminneEn aktiv, värderad medlem i teametEn officiell och tydlig vägÅsiktstungtAppklossarLeft-pad-livetOdelat defensivEn lugnare takt

Linnea Rönnqvist pratar om evakueringen av svenskarna i Sudan och det snabba händelseförloppet som ledde upp till operationen.Karl Jansson pratar om ett historiskt mobiliseringmeddelande som sänds under måndagen. Vad kommer att sägas och var kan man höra det?Programmet gästas av Agnes Arpi som har varit med och gjort förlossningsgranskningen "Det svenska kejsarsnittet" vars första delar publiceras under måndagen.Dessutom i bakvagnen: Alla blickar mot Wrexham, Olle har hittat nyckelpigan, så fick Liseberg sitt namn och Lasse Holms blunder i TV. Hosted on Acast. See acast.com/privacy for more information.

Babs Drougge och Matilda Rånge på P3 Nyheter förklarar morgonens stora nyheter, alltid tillsammans med programledarna för Morgonpasset i P3: Margret Atladottir och David Druid. Det var ord och inga visor när klimatpolitiska rådet kom med sin årsrapport. De slog fast att regeringens politik väntas leda till att utsläppen ökar. Miljö- och klimatminister Romina Pourmokhtari säger att regeringen jobbar med en handlingsplan. Vi går igenom kritiken och hur Janne Anderssons och Bojan Djordjics bråk kommer in i det här.Sen blir det köttbonanza i P3 med "lejondieten" som trendar på Tiktok. Där måste man hålla sig till kött, salt och vatten. Vissa hävdar att det här kan bota massa grejer, men det saknas vetenskapliga bevis för att det skulle fungera. Någon som testat dieten är SvD:s Ivar Arpi.

PEKER VE ERDOĞAN İLK KEZ ÇARPIŞTI

Det är första gången vi pratar med varandra i syfte att andra ska lyssna. Ändå har dagens gäst, journalisten Agnes Apri, varit i offentligheten längre än jag. Arpi, menar jag. Av någon anledning stavas hennes efternamn oftare fel än mitt, trots att det är samma. När Twitter var ungt var hon en av de stora där, och jag var @TantAgnes storebror. Hon bloggade, skrev om soul, R&B och hiphop, vikarierade som ledarskribent på Expressen och GT – men bytte sedan bana. Bort från tyckandet, till det mer beskrivande. Bort från sociala medier, till mer privatliv. Hon är fortfarande journalist, och har kanske särskilt granskat vården de senaste åren. Det pratar vi om. Och om uppväxten, hur det är att vara “Ivar Arpis lillasyster”, om kommersiellt och altruistiskt surrogatmödraskap, om adoptionsskandalen, och om varför hon till slut valde att flytta från vårt älskade Göteborg (precis som jag gjort). Genom att bli betalande prenumerant gör man det möjligt för mig att fortsätta vara en självständig röst.Lägre produktionstakt…Som ni säkert har märkt har produktionstakten på Rak höger sjunkit de senaste två veckorna. Det beror delvis på att jag har haft en del andra uppdrag som har tagit mer tid än väntat, men främst på att jag har behövt vara hemma mer med familjen än under valrörelsen. Nu verkar dock båda sakerna klarnat och jag kan återigen skruva upp antalet artiklar och poddar här. Och i måndags fyllde jag 40 år. De senaste två-tre åren känns det som att jag har åldrats minst tio år, så att nu vara 40 känns som att den kronologiska åldern kommer lite närmare den fysiska och mentala åldern. Utgivaren ansvarar inte för kommentarsfältet. (Myndigheten för press, radio och tv (MPRT) vill att jag skriver ovanstående för att visa att det inte är jag, utan den som kommenterar, som ansvarar för innehållet i det som skrivs i kommentarsfältet.) This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit ivararpi.substack.com/subscribe

Matt Goodwin's Subcast welcomes Ivar Arpi to dive back into the recent Swedish elections, Brexit, academic freedom and more!GET WEEKLY NEWSLETTER https://mattgoodwin.substack.com/CONTACT MATT ON TWITTERhttps://twitter.com/GoodwinMJIvar's Substackhttps://ivararpi.substack.com/Ivar Arpi is a Swedish columnist and debater. He has written op-eds for Göteborgs-Posten, Hallandsposten and Svenska Dagbladet. Arpi supports freedom of speech and believes that pluralism of opinion is important for society to develop. He is also a writer for UnHerd. Hosted on Acast. See acast.com/privacy for more information.

Ivar Arpi tar upp folkutbytet och anklagas för medhjälp till terrordåd, men har Arpi verkligen förstått vad som pågår? Dessutom: Miljöpartiets Märta Stenevi lovar att "göra kaos" med sina meningsmotståndare; bör vi bli rädda?Direktsändning med Magnus Söderman Björn Björkqvist i det första avsnittet av våra dagliga sändningar. Den här veckan ligger programmen tillgängliga för alla i efterhand, men framöver bara för stödprenumeranter. Missa inte direktsändningarna på Spreaker klockan 10.

Ivar Arpi tar upp folkutbytet och anklagas för medhjälp till terrordåd, men har Arpi verkligen förstått vad som pågår? Dessutom: Miljöpartiets Märta Stenevi lovar att "göra kaos" med sina meningsmotståndare; bör vi bli rädda? Inlägget Våldsbejakande miljöpartister och Ivar Arpis folkutbyte dök först upp på Radio Svegot.

On today's What to Watch: Helen Mirren and Harrison Ford will star in the Yellowstone prequel series 1932, coming later this year to Paramount+. After three years, So You Think You Can Dance returns to Fox with longtime host Cat Deeley but with a new judging panel: Jojo Siwa, Twitch, and Matthew Morrison. On the season finale of The Resident, Conrad realizes it's finally time to say goodbye to Nic, Bell and Kit celebrate their engagement, and Devon gets an amazing offer, but it's out of state. On Mayans M.C., the club is reeling from a big death and now they're plotting their revenge while also questioning EZ's leadership. And on NBC, it's the season — and series — finally of Mr. Mayor, where Ted Danson's Neil faces off against Holly Hunter's Arpi during a recall election. Comedian Carlos Santos tells us why he loves Peacemaker so much. Plus, entertainment headlines — including new roles for Reba and Edie Falco, and casting news about the Hunger Games prequel's young Snow — and trivia. More at ew.com, ew.com/wtw, and @EW. Host/Producer: Gerrad Hall (@gerradhall); Producer: Ashley Boucher (@ashleybreports); Editor/Producer: Joshua Heller (@joshuaheller); Writer: Calie Schepp; Executive Producer: Chanelle Johnson (@chanelleberlin). Learn more about your ad choices. Visit megaphone.fm/adchoices

On today's What to Watch: On the season finale of The Resident, Conrad realizes it's finally time to say goodbye to Nic, Bell and Kit celebrate their engagement, and Devon gets an amazing offer, but it's out of state. On Mayans M.C., the club is reeling from a big death and now they're plotting their revenge while also questioning EZ's leadership. And on NBC, it's the season — and series — finally of Mr. Mayor, where Ted Danson's Neil faces off against Holly Hunter's Arpi during a recall election. Comedian Carlos Santos tells us why he loves Peacemaker so much. Plus, entertainment headlines — including new roles for Reba and Edie Falco, and casting news about the Hunger Games prequel's young Snow — and trivia. More at ew.com, ew.com/wtw, and @EW. Host/Producer: Gerrad Hall (@gerradhall); Producer: Ashley Boucher (@ashleybreports); Editor/Producer: Joshua Heller (@joshuaheller); Writer: Calie Schepp; Executive Producer: Chanelle Johnson (@chanelleberlin). Learn more about your ad choices. Visit megaphone.fm/adchoices

Q&A on the series Mr. Mayor with actor Bobby Moynihan. Moderated by Mara Webster, In Creative Company. When retired Los Angeles businessman Neil Bremer decides to run for mayor of his beloved city, he surprises everyone and wins the seat. With great ideas and commitment to the community, he optimistically sets out to get to work shaking up City Hall. However, he quickly discovers navigating politics is not business as usual. There are opinions to be heard, ribbons to be cut and foods to be eaten -- all in support of his fellow citizens. Luckily, he can rely on the know-how of his political-veteran deputy Arpi -- whose savvy and ambition make her equal parts friend and foil -- and the dedication of his offbeat staff to keep him on the right path, as well as some inspiration from his teenage daughter.

A special interview with Arpi Nalbandian of Tileometry at Coverings 2022 in Las Vegas on April 5, 2022.00:00 Intro 00:23 Welcome to the show, Arpi Nalbandian01:06 Arpi, What's Different About Coverings This Year?02:02 Products Exemplifiy the Wellness Trend in Tile02:50 What Products are Interesting This Year?04:33 Just What Makes Tile Biophilic?05:21 Themes in Tile at Coverings 202206:16 Is Porcelain Slab Taking Over the Show?07:55 The Direction of Tile Design Today09:42 A Word from Quantra10:56 Who is Arpi Nalbandian?12:18 What is Tilometry?14:19 Emerson, What's Different About Coverings This Year?15:25 How is the Stone Trade Looking at Porcelain Slabs?17:55 U.S.: Different Materials and Manufacturing Challenges19:51 Who is Emerson Schwartzkopf and Why is He Here?20:48 Radio Stone Update Podcast: A Short History21:31 Going to Italy and the Marmomac Stone Show23:20 The Real Difference with European Tile Shows25:04 Tile and Quartz Surfaces: More Than Copies of Calacatta26:59 Wrapping it Up

Arpi Agdere is currently the Art Producer at Wieden + Kennedy. Originally from Istanbul Turkey, Arpi worked for 7 years as an in-house art producer at Vans in Los Angeles and has experience working on both sides of the camera as well as within production companies and creative studios. She has a BFA from Art Center College of Design and is deeply rooted in fine art. She also loves giving back to the art community by doing portfolio reviews and providing mentorships for creatives at every age.   In their conversation, Heather and Arpi explore the joys and the challenges of being an Art Producer in this day and age and how COVID protocols are simply part of production now.    In an industry where the rules are always changing, it's helpful to hear from those on the front lines. Heather Elder is the visionary behind NotesFromARepsJournal.com; visit HeatherElder.com for industry updates, stunning photography and video, and the artists behind the work.   More about our guest: Find Arpi Agdere on LinkedIn here.   More about your host: Heather Elder's Bio Heather Elder's Blog Heather Elder on Instagram Heather Elder on Twitter Heather Elder on LinkedIn Heather Elder on Facebook

Episode Summary Talk about a man on a mission and a man with a vision, meet Dr. Kirk Adams. Dr. Adams was one of the fortunate children who happen to be blind and whose parents did not stifle his growth but let him explore his world no matter where it led. As an adult, Kirk worked for a time in the financial world, but later he found that his talents went more toward him working in the not-for-profit world. Today, Dr. Adams leads one of the largest and well-known agencies in the world serving blind people. The AFB today conducts a great deal of research about blindness and explores how to help lead blind persons to be more fully integrated into society. This week you get to experience Kirk's visions and thoughts first-hand. I hope you will come away with a different and more inclusive attitude about what blindness really should mean in our world. If you are an employer, take Kirk's positivity to heart and consider hiring more blind people in your business. About the Guest Kirk Adams, Ph.D. President and CEO American Foundation for the Blind As president and chief executive officer of the American Foundation for the Blind (AFB), Kirk Adams, Ph.D. is a longtime champion of people who are blind or visually impaired and is committed to creating a more inclusive, accessible world for the more than 25 million Americans with vision loss. Dr. Adams has led AFB to a renewed focus on cultivating in-depth and actionable knowledge and promoting understanding of issues affecting children, working-age adults, and older people who are blind or visually impaired. His role involves pursuing strategic relationships with peers, policymakers, employers, and other influencers to engender and accelerate systemic change. Dr. Adams frequently serves as a keynote speaker at conferences across the country, on topics including education, vocational rehabilitation and workforce participation, vision loss and aging, and technology. He has consulted with top leadership at Google, Facebook, Microsoft, as well as key leaders in the finance, public policy, nonprofit, and tech sectors to discuss topics ranging from product and digital accessibility to civil and disability rights. Before joining AFB, Dr. Adams was president and CEO of The Lighthouse for the Blind, Inc. He was a member of the Governor's Task Force on Disability Employment and the Seattle Public Library's Strategic Plan Advisory Committee and served on the boards of the National Industries for the Blind, and the National Association for the Employment of People Who Are Blind. Dr. Adams graduated magna cum laude with a Bachelor of Arts in economics from Whitman College in Walla Walla, Washington, and earned his master's in not-for-profit leadership at Seattle University in Washington. In 2019, he completed his doctorate in Leadership and Change at Antioch University in Yellow Springs, Ohio. In 2020, he was awarded a Doctor of Humane Letters from SUNY Upstate Medical University. About the Host: Michael Hingson is a New York Times best-selling author, international lecturer, and Chief Vision Officer for accessiBe. Michael, blind since birth, survived the 9/11 attacks with the help of his guide dog Roselle. This story is the subject of his best-selling book, Thunder Dog. Michael gives over 100 presentations around the world each year speaking to influential groups such as Exxon Mobile, AT&T, Federal Express, Scripps College, Rutgers University, Children's Hospital, and the American Red Cross just to name a few. He is an Ambassador for the National Braille Literacy Campaign for the National Federation of the Blind and also serves as Ambassador for the American Humane Association's 2012 Hero Dog Awards. https://michaelhingson.com https://www.facebook.com/michael.hingson.author.speaker/ https://twitter.com/mhingson https://www.youtube.com/user/mhingson https://www.linkedin.com/in/michaelhingson/ accessiBe Links https://accessibe.com/ https://www.youtube.com/c/accessiBe https://www.linkedin.com/company/accessibe/mycompany/ https://www.facebook.com/accessibe/ Thanks for listening! Thanks so much for listening to our podcast! If you enjoyed this episode and think that others could benefit from listening, please share it using the social media buttons on this page. Do you have some feedback or questions about this episode? Leave a comment in the section below! Subscribe to the podcast If you would like to get automatic updates of new podcast episodes, you can subscribe to the podcast on Apple Podcasts or Stitcher. You can also subscribe in your favourite podcast app. Leave us an Apple Podcasts review Ratings and reviews from our listeners are extremely valuable to us and greatly appreciated. They help our podcast rank higher on Apple Podcasts, which exposes our show to more awesome listeners like you. If you have a minute, please leave an honest review on Apple Podcasts. Transcription Notes Ad  00:01 On April the 16th at 2pm North American instant time, blind musicians from across the globe are getting together for an online benefit concert for Ukraine. It's called we're with you, and all money raised goes to the World Blind unions unity fund for Ukraine. To learn more, including how to listen and how to perform it were with you visit mushroom m.com/withYou that is mushroomfm.com/withYou   Michael Hingson  00:30 access cast and accessibly initiative presents unstoppable mindset. The podcast we're inclusion, diversity and the unexpected meet Hi, I'm Michael Hinkson, Chief vision officer for accessibility and the author of the number one New York Times best selling book thunder dog, the story of a blind man, his guide dog and the triumph of trust. Thanks for joining me on my podcast as we explore our own blinding fears of inclusion and acceptance and our resistance to change. We will discover the idea that no matter the situation, or the people we encounter, our own fears, and prejudices often are our strongest barriers to moving forward. The Unstoppable mindset podcast is sponsored by excessive B, that's a cc E, SSI, capital B E, visit www.accessibility.com To learn how you can make your website accessible for persons with disabilities. And to help make the internet fully inclusive by the year 2025. Glad you dropped by we're happy to meet you and to have you here with us.   Michael Hingson  01:50 Hi again, and welcome to another episode of Unstoppable Mindset today. I'm really honored and proud and pleased to invite and have someone on the podcast who I've known for a while and he's he's moved up through the world of working with blind persons and disabilities over the years. When I first met Kirk Adams, he was the CEO of the Lighthouse for the Blind in Seattle. He is now the would it be CEO Kirk, President and CEO, President and CEO of the American Foundation for the Blind. But more important than that, I mean, that's just a little thing more important than that. In 2019, he became a PhD he became as my mother used to say a doctor. Anyway, so Kirk Adams, welcome to unstoppable mindset.   Kirk Adams  02:39 Well, it's a pleasure. Thanks for having me.   Michael Hingson  02:42 So you, you have been involved in in the blindness world for a while, tell us sort of maybe some of the early parts about you that that, that you want to talk about growing up and how you ended up being involved in blindness and advocacy and all that stuff?   Kirk Adams  02:59 Well, it's, it's interesting, and I'll just kind of start where I am, and then I'll zip all the way back. But I'm very, very interested in social justice, and a more inclusive society. And of course, the way I come at that is through my lived experience of blindness, and working hard, day and night, to create more opportunities for inclusion for people who are blind in society. And in particular, I'm very interested in employment. As we all know, the workforce participation rate for people are blind is about 30, or 35%, which is about half of the general population. And I say whatever outcomes you're looking at, it's either half as good or twice as bad for people who are blind compared to the general population. As far as employment goes, but, you know, I'm at AFP. Now we're a very much a research focused organization. And when we do research and we look at the factors that lead to successful employment for blind adults, I through good fortune, and mostly not, not on any effort of my own, I lived a life that gave me a lot of those success factors. So it really started when I my retinas detached when I was in kindergarten. I became totally blind within a couple days had a bunch of emergency retinal surgeries that weren't successful. This was pre laser surgery. And so my parents were told Kirk cannot come back to school here at the neighborhood school, he needs to go to the state school for blankets, and we live north of Seattle. My parents visited the Washington State School in Vancouver were not very impressed with what they saw there. They were both teachers just starting out on their careers. And my retinal specialists, you University of Oregon medical school in Portland, said you should check out the Oregon State School and Salem, it's great. They visited, they liked it, they quit their jobs moved. So I could go to Oregon State School. And the success factor here is I was totally blind. There was no question. Does he need to learn braille? Does he need to use a cane? There's there's so many kids with, you know, varying levels of vision that are not, unfortunately, not always given the right instructional curriculum. So kids are using magnification and audio and not learning braille. But there was no question. And we know that strong blindness skills are a strong predictor of successful employment. So I've learned to read and write Braille as a first grader, and type on a typewriter and use a white cane. And a little aside, the one of the happiest days for me is when the Braille book review comes and one came last week, and they're in the children's book section is a book by Michael Hinkson. Running with Roselle anyway. Yeah, so there it is. I put it on my request list. I'll be reading it.   Michael Hingson  06:17 And let me know what you think.   Kirk Adams  06:20 And then, you know, my parents, although they didn't know any blind people we grew up in. I grew up in small towns, we're not connected with with blindness organizations, they instinctively did a couple things, right. One is they had very high expectations of me, they expected me to get good grades, and expected me to participate in sports. Expected expected me to do chores, and I didn't always helped me figure out how to do it. But the high expectations were there. And we see that as well as a predictor that the parents when schools have high expectations of blind kids, they, they they do do well.   Michael Hingson  07:05 Back thinking back on your parents, not telling you how to do it. What what do you think of that? And I'm sure it's different than what you thought at the time. But what do you say experiences?   Kirk Adams  07:16 Well, I'd say I learned how to it was sink or swim. So I learned how to swim. I was in public school, I was the only blind kid and all my schooling, I kind of had to wing it a lot. And I don't I don't think my psycho social deeds were attended to much, but I did, I did learn. And this was another another point, living every day as a blind person, you have opportunities to develop characteristics and some really unique ways and some strengths that the average person may not have around resilience and problem solving and grit and determination and how to work with teams. How to communicate, I got when I when I went to college, and I had some money from the Commission for the Blind to hire readers. So I was 18 years old. I was interviewing and hiring and sometimes firing employees readers and now invoicing and take taking care of the the the the accounts and and those things that my classmates were, we're not doing. The other the other thing I had early work experience. I was really into sports. My dad was a high school basketball coach, I wrestled ran cross country, and I became the sports editor for the high school paper. And the sports editor for the high school paper got to write a weekly high school sports column for the city weekly paper. So I was a I was a 16 year old sports columnist writing a weekly column for the Snohomish Tribune, showing up my timesheet and getting a check and happily spending that minimum wage. Thing was three 325 an hour, something like that. So again, I had some of these early I had some of these success factors that lead to successful employment for people who are blind. And my opportunity at AF B is to create those opportunities for lots of other blind people. So we develop programs that seek seek to level the playing field for people who are blind, we are focused on employment. And I had the experience as a young college graduate with a good track record and school Phi Beta Kappa and Akun laude and a four point in my field of econ and could not you could not get a job like many young blind people. We are the most highly educated, most underemployed disability group as far as college, college graduation, things like that. So I wanted a job in finance, I started applying for jobs, I wanted to live in Seattle, I went to college in Walla Walla needed to live where there was a bus system. I, you know, sent sent in resumes and cover letters, would get a phone interview, would be invited in for the in person interview, and then the employer would be very confused about why a blind person is coming at applying for this job. How in the world could they do it? So you know, disclose disclosing your disability is the thing, when do you do it? So I wasn't disclosing until I walked in with my cane, and my slate and stylus, and some braille paper in a folder. And then I started disclosing in my cover letter playing, I'm totally blind. This is how I do what I do. This is how I'll do the job. And then I wasn't even getting phone interviews. So yeah, I guess cast my net wider and wider and wider. And I applied for a job with a securities firm a sales job selling tax free municipal bonds. And the sales manager had also gone to Whitman College had also been an econ major, like 15 years before me. So he called some of the professors that we had, and they said, Sure, Kurt can sell tax free bonds over the phone. So I did that for 10 years, straight commission 50 cold calls a day every day builds build strong bones. And when I turned 30, had a had an opportunity to make a change. The firm I was with was purchased by another firm and just a good inflection point. And I got the What color's your parachute book, out of the Talking Book and Braille library and read it and did all the exercises and got clear that I wanted to be in the nonprofit sector. And I wanted to be in a leadership role. And I wanted to devote the rest of my working life to creating opportunities for people who are blind. So the next little blind kid could have an easier, easier time of it. And I got very interested in leadership, I went back to school and got a master's degree in not for profit leadership, got involved in nonprofit fundraising, was hired by the lighthouse, Seattle to start their fundraising program and foundation and eventually became the CEO there simultaneous to that. Again, really believing leadership is key to changing our world. I went back to school, as you mentioned, and earned a PhD in leadership and change through Antioch University.   Michael Hingson  13:09 I know the first time the first time I heard you speak was when you came to the National Federation blind convention after just becoming I think the CEO in Atlanta, in Atlanta, I had gone to work for Guide Dogs for the Blind, we were having challenges at gdb because people would not create documentation in an accessible format before meetings. And I recall you talking about the concept of no Braille, no meeting, no   Kirk Adams  13:40 Braille no meeting,   Michael Hingson  13:41 I took right back to them. And it helped a little bit. But it was amazing to see that there was such resistance at such a prestigious organization to hiring and being open to hiring blind people given what they do. And it was, it was a real challenge. Bob Phillips, who was the CEO at the time, created the job that that I had, and I'm sure there will I know there was a lot of resistance to it, but he was the CEO and made it happen. But still, the culture was not oriented toward being open for blind people to to have jobs there. And there are a few blind people working there now, but not even what there was several years ago, which is unfortunate, because there are a lot of things that that could be accomplished by blind people in various aspects of that organization. And as you point out of most organizations, you and I had a lot of very similar life experiences growing up, which is, I think, just evidence of what needs to be done for for kids who are blind and I'm defining blind, as Ken Jernigan used to which was your blind when you lose it If I sight that you have to use alternatives to be able to accomplish tasks and I gather you agree with that. When you were in college, did you have an Office for Students with Disabilities on campus? And if so, how did know?   Kirk Adams  15:14 You didn't know? Yeah. I went to Whitman College, which was small. You know, I graduated from high school in 1979. So I got a, you know, had the four track cassette player and I got is read by volunteers by Recording for the Blind. And the state provided me with a Perkins Brailler, and the cutting edge technology of an IBM Selectric typewriter with a recent. That's, that's what I had.   Michael Hingson  15:46 Well, I asked the question because when I went to, to UC Irvine, we had an office. And Jan Jenkins, early on when I started there, said to me, she lectured me, she said, I want you to understand what I do here, and this is her. She said, I'm here to assist, you need to take responsibility for doing things like going to professor's if you want books in braille, and getting the the books and, and doing the things that you do. But my job here as a principal in the university is if you can't get the cooperation you want, then you come to me, and I'll help you do it, which is such a refreshing attitude, even today. Because in the office is for students with disabilities, mostly today, you come into our office to take a test or we'll get the information for you, we'll get the things for you. And as you pointed out so eloquently, students as a result, don't learn to do it. And and like you I had to hire and fire readers. And and do all of the the same sorts of things that that you had to do. And it's the only way for us to succeed.   Kirk Adams  16:57 Absolutely. And again, if you if you look at research, and you look at what employers say they want employees for the 21st century, its employees who are resilient and flexible and have grit, and are problem solvers, and are creative and know how to analyze and manage risks and know how to work in teams of diverse people. And in my conversation as well. If you're looking to win the talent, war, blind people, by the fact of living everyday lived experience of blindness, learn, learn how to do all those things and develop those capabilities, develop those characteristics.   Michael Hingson  17:39 I think I've told the story on this podcast before but I like you debated often about whether to say that I'm blind when I'm writing a cover letter for a resume. And in 1989, I was looking for a job. And my wife and I were talking and we found this great job in a newspaper. It was perfect. And I said to her I said well, I say in the cover letter that I'm blind and my wife like wives all over can can say this. She said you're an idiot. And I said why? And she said you What is it you've always said that you learn when you took a Dale Carnegie sales course when you started out selling for Kurzweil? Well, she was ahead of me as often is the case. And finally, she said, you've said that you tell every sales person you've ever hired and every person that you've ever managed in sales, turn perceived liabilities into assets. And I think that's the key. Because blindness isn't a liability. It's a perceived liability. And what I did is I went off and I wrote a letter based on that. And I actually said that I'm blind. And the way I did it was I said in the last paragraph, so the letter, the most important thing that you need to know about me is that I'm blind because as a blind person, I've had to sell all of my life just to be able to survive and accomplish anything I've had to sell to convince people to let me buy a house, take my guide dog on an airplane, pre ACA, nada, rent an apartment and all that. So when you're hiring someone, do you want to hire somebody who just comes in for eight or 10 hours a day and then goes home after the job is done? Or do you want to hire somebody who truly understands sales for the science and art that it is and sells as a way of life? So I mean, that that I think is the whole point of perceived liabilities? Well, I did get a phone call from them. They were impressed by that. And I got the job and worked there for eight years. Fantastic. And I think we all need to learn how to win whatever job that we do to take that same sort of approach because I think most any job could adapt that same concept to say why blindness is a perceived liability on the part of the employers and why we're best for the job because of the way we live.   Kirk Adams  19:59 Perfect. Now I'm thinking about Carol Dweck work on the growth mindset versus the fixed mindset. So it all, it all holds together, you know, access strikes based asset, space, philosophy, etc?   Michael Hingson  20:17 Well, it does. And, you know, blindness is a perceived liability, and is all for us only as much of a liability as we allow it to be.   Kirk Adams  20:26 I think that's background expectations, too. As I mentioned, before my parents held high expectations of me, therefore, I hold high expectations of myself. Yeah, I know that not every blind kid is in a family situation like that. I've talked to many blind parents who are Parents of Blind Children, rather, who don't first learning their child is blind or going to be blind, just despair, and, you know, feel that their child has no future. And will, there'll be a caretaker role. And so it's really, really important that the high expectations get established early on. And like I say, not not every point blank kid is born into a family that's going to do that, automatically. So that's, that's an opportunity for all of us who are blind, to talk to parents of blind kids, and something I really enjoy doing, and letting them know that, you know, your, your kiddo can do whatever they want to do, as long as they are given the right tools and supports, and the opportunity.   Michael Hingson  21:36 Yeah, how do we get parents who feel desperation and so on? How do we get them to change their minds?   Kirk Adams  21:48 Well, I think that's exposure. And I think exposure to blind adults, successful blind adults, I am a big advocate for both consumer groups. So if someone's listening and are not connected with plain adults playing people, for the National Federation of blind American Council of the Blind, comes in different flavors, they have chapters and and different groups and affinity groups. And I would suggest checking it out. I think that's one way. I think that's an important way in the same in the workplace. And, you know, again, I'll keep harping on research. You know, it's shown that if a department or a manager hires a blind person, they're much more likely to hire another blind person, you know, then than another department hiring their first blind person. So, you know, familiarity, understanding the capabilities, and understanding that people are people with the same emotions and tribes and hopes and dreams and all the things I will before before I forget, I'm mentioned at work workplace technology study that we just did. And it was very well designed. We did We did focus groups interviewed then created a, an online survey then did in depth, in depth interviews, just to understand the dynamics of technology in the workplace, for people who are applying, what's working, what's not working, what tools do people use for which functions, and it's available on our website, so FB dot o RG? Easy, easy website to remember that we've done. We've done four or five, I think, really important studies in the last couple of years and and all that data is there.   Michael Hingson  23:36 You were talking a little bit earlier about what employers are looking for in terms of being flexible and so on? Where does loyalty fit into all that in today's world? You know, you used to hear about people staying in jobs for most of their whole time. And now it's a lot different. But where does loyalty fit?   Kirk Adams  24:01 That is a super interesting question. And I don't think there's clarity on that. And I was just reading an article this morning about the 10 greatest risks faced by corporate corporate boards, and one of them was the uncertainty of what the workplace is going to look like, in the future. Strategically, how do you build your workforce and your talent pool, not knowing exactly what the workplace is going going to look like? So a couple a couple things that come to mind. One One is that people change careers. I can't cite this. I can't cite the numbers, but something like seven, seven or eight job changes now and a lifetime of work. And the trick is to manage that person's career path. While keeping them in your organization, if you value them, and you find that they're a great contributor, and you don't want to lose them. So it's a different type of conversation, what? You, you try it HR, you don't like it that much, you'd rather be in it, how to recreate a pathway to keep a person within the organization. And then then the next thing we have, we've had the great resignation here with COVID. And so many people, it's been a wake up call for so many people to say, Hey, I'm Life is too short, I want to do something that's meaningful, I want to do I want to live well, I moved from the East Coast back to Seattle, to be closer to closer to family. So people are making those kinds of life based decisions that I think are much greater right now. I would say that the shifting landscape and employment I believe will create more opportunities for people who are blind as remote work, telework and hybrid work situations become normalized. You know, there, there is language in our statutes that says, setting up a person to work with a disability work from home is the accommodation of last resort. That was the, you know, the assumption was that everyone needed to go into the office, and everyone needed to be in a building with their co workers. And to set up a person to work for from home was the the last accommodation that should be considered. And I think that's, that's been flipped. Now. So I'm really, I'm really excited to see what it's going to look like.   Michael Hingson  26:44 I think that it is a, it is a moving target for everyone. And the key is to not allow blind people to be part of that flip. And I think that's that you're exactly right, it will be interesting to see where it goes, I asked you that question, because one of the things that I've often heard is, a blind person who is hired to work somewhere, will tend to be more loyal and want to stay there, rather, and will do a better job as a result rather   Kirk Adams  27:17 than and that's going out of that and that's verifiable. Look at Disability Research, DuPont did a really long longitudinal study 5060s 70s that people with disabilities are, they have less turnover, you have less absenteeism. Morale, in work groups goes up. customer perceptions improve. So there's there's a lot of there's good business cases for employers to include people with disabilities.   Michael Hingson  27:55 Yeah, it makes good sense. And, and, you know, we, we see in so many different ways that there are advantages to being blind, which which all of us also need to learn how to explain. And an emphasize another one that comes to mind. We've used it excessively a fair amount is the concept of brand loyalty, which is a little different. But the Nielsen Company did a study in 2016, talking about the fact that people with disabilities in general, and I'm going to narrow it to blind people tend to be a lot more brand loyalty to the companies online that give them access to their stuff, because they don't have to slave and work so hard to get access to it. And they're going to continue to work with those companies. That make sense to me. It is, it is just absolutely relevant that that we need to to get more of those messages out and make it happen. Of course, that's one of the reasons that we have unstoppable mindset is to hopefully educate people about some of these things, because it makes perfect sense to do. And there's no reason why we can't get get better access. It's just a matter of educating employers and a lot of decision makers who are not blind that we're, we're actually an asset to them.   Kirk Adams  29:16 Yeah, and I again, I'll mention an AFP. I think one of our crown jewels is our annual leadership conference. It'll be May 2 and third in Arlington, Virginia. When I first went to work for the satellite house in 2000, the person who hired me said if you want to get to know the blindness field, you need to go to the AFP conference. So I went to my first in 2001 I've never missed and it's it's fairly unique in that we bring together all the stakeholders so we bring leaders from voc rehab for the the federal agencies, nonprofit CEOs, corporate diversity, inclusion and access ability folks, academic researchers, blindness advocates advocates into the same space. And that's a really interesting thing to do. Because those groups don't often talk to one another. Although they, they would, they would all say they share a common goal in improving employment outcomes for people are blind. There's a really cool research study where they asked VR counselors and HR hiring managers, the same set of questions. And the one that stands out to me was the question was what what is the greatest barrier to successful employment of people who are blind, and the the VR counselor said, attitudes of employers, perceptions of the employer, and the employer said, lack of understanding of our business needs on the point of VR. So, you know, both groups would say they are very dedicated to improving employment outcomes, but but they come at it from from different angles. So, AFP Leadership Conference is a place where we, we bring all those stakeholders together in conversation. So it's, it's pretty cool.   Michael Hingson  31:14 And hopefully, you can get them to communicate a little bit more with each other. Yes. I don't know. It is it is interesting. Do you ever watch the ABC ABC show? What would you do? I have not. Have you ever heard of it?   Kirk Adams  31:30 I don't think   Michael Hingson  31:31 so. Duncan Jonas, has run the show in the summer, every year for a number of years. And one of the the whole premise of the show is that they bring in actors to play roles. And see how the, the people who are around them react. So for example, on one show is actually one of the first shows they brought in a an actor to play a barista at a coffee shop. And this was, I think, put on or created by the Rochester Institute for the Deaf. They brought in two women, deaf people, and there was a job posting and they went in and applied for the job. And the whole process for the decrease barista was to simply say, No, you're deaf, you can't do the job. And, and he did a really good job of that. But these, these two deaf people kept saying, well, we could do the job. This is a kitchen job. You're not asking for me to even interact with customers all the time. And he said, Well, what if there's something I need you to do? Well, you can write it down, or I can read lips, and he just continued to resist, which was great. But during the day that they did this, there were three HR people who came in. And they after listening to all this for a while, pulled the barista aside, and they said, you're handling this all wrong, these people have more rights than the rest of us. Just take the application and write on it. It's not a good fit. But don't don't keep arguing. It was it was fascinating that the HR people did that. So there is a there is a problem with HR. But again, that's what we have to help educate in, in all that we do too. So I'm glad to to see what you're doing and that you are bringing people together. I've I've been to a couple of the leadership conferences, but not not lately.   Kirk Adams  33:34 Well, we'll see. We'll see you in May. But I've got to work that out. But the workplace technology study I mentioned earlier, there's there's real data there from real people. Current so we can show HR managers that, hey, blind people report that part of your recruiting process involves some sort of online exercise or test 60% of your blind and low vision, people are having challenges accessibility challenges with that, you know, 30% of the people you're hiring, are having problems with your employee onboarding processes. So you know, there's anecdotal stories, there's complaints, but now we have real data. So it's really intended for the HR manager, the IT manager, and assistive technology developers to really show what's what's actually happening. You know, how your blind employees are needing to take work home and use their own equipment and work more hours. And, you know, they're having having to ask sighted colleagues to do essential steps in their processes. And I know people hear those stories, but now we've got we've got numbers and we got statistics. And you know, and I HR person doesn't want to say Yeah, 30% of this group of people is having problems with my onboarding process. You know that that's, that's a number that is going to get some attention, we think.   Michael Hingson  35:12 We hope so. And we hope that we can continue to find ways to, to get people to be a little bit more aware of all this, because accessibility to the tools is, is one of the biggest challenges we face. You know, that's why I joined accessibe. B last year, because I saw that there were opportunities and accessibility has even expanded a lot. And is saying that what it does to create internet access, which began with an artificial intelligence system that does a good job with some websites and a significant part of websites, but also doesn't necessarily do everything in an accessible he has now put together additional processes to create human intervention to help with the rest of it. But excessive he also wants to educate people about web access, whether they use excessive these products or not, because the feeling is we've got to do more to educate people in that exactly what makes sense to do.   Kirk Adams  36:13 Yes, and as I mentioned, before, we began our recorded part of our conversation, FB, NFB ACB, and the national rights Disability Network have drafted a joint letter to the Department of Justice, asking them to implement the web and app accessibility regulations that they are empowered to enact. And we have sign on letter. Again, you can go to afp.org, for more information, and we're looking for disability and civil rights organizations who want to join us and Ernie urging the Department of Justice to do that. Because it's so meaningful. I am a I'm not a high tech person. I like you said, I'm brand loyal to a small, small number of retail websites. But we also did a study last year, as part of what Mississippi State National Research and Training Center on blindness was doing. They contracted with AFP, we looked at 30 corporate websites, and we looked at specifically at their recruiting and hiring portals. And there's lots of accessibility issues. So they're there. So   Michael Hingson  37:42 five away compliance for the government. Yeah.   Kirk Adams  37:45 Yes. So whatever we add FB can do to change that landscape to change the way institutions, government, nonprofit corporate address, inclusion, put it under the umbrella of digital inclusion. You know, I think it's somewhat similar to we've more from diversity to inclusion. In our language, I think we've more from the digital divide to digital inclusion, which I think as a much more proactive concept.   Michael Hingson  38:21 A speech I've given for years is actually titled moving from diversity to inclusion, because diversity is doesn't even include us anymore. Which is unfortunate. And so we've got to go to to something that makes more sense. And you're either inclusive or you're not, you can't be partially inclusive, because then you're not inclusive.   Kirk Adams  38:40 There you go. Like it makes I'm sorry, I'm sorry, I'm stealing that one here. Welcome   Michael Hingson  38:46 to have it, it's You go right ahead. Because you either are inclusive, or you're not, it's a quantum jump in you can't be partially inclusive and say you're inclusive. You shouldn't be able to say you're partially diverse. And so you're diverse, because but but you know, that ship has kind of sailed. But I think it is something that that we need to do. And it's all about education. And it's all about finding ways to give kids at a young age the opportunity that you talked about Braille earlier. How do we get the educational world to recognize, again, the value of Braille and what's happening with that? Oh, boy. I know that was a loaded question.   Kirk Adams  39:36 That's that's that's my my personal soapbox, which I can can get oh, I don't know how to do it, other than frame it in terms of literacy. It is a literacy question. Reading is reading listening to something as listening to something writing is reading writing, you know, if if we didn't need to read and write and cited kids wouldn't be taught how to read and write. It's just a matter of efficiency and efficacy and art and being being a human human being in a literate society. So there's some there. There are some numbers embedded in some of our research, that that show the number of employed respondents who are Braille readers or use Braille displays. There are some there were some numbers generated 30 years ago that indicated that 90% of of blind people who are employed read Braille, that doesn't appear to be the case. Now, based on what we can infer from from our surveys. Does that I'm not sure what that means. So I I will say, to answer your question, I don't know. And we need to figure it out. So I will take 10 I think that's some deep research questions. But I would be energized to explore   Michael Hingson  41:15 take what you said to another level, let's let's say your right 30 years ago, 90% of employed blind people were Braille readers. And that number has dropped. Just for the sake of discussion, let's say significantly. The other thing that immediately comes to mind is how far people who are blind especially who are not Braille readers today are advancing as opposed to Braille readers. Because Braille is the, the means of reading and writing, I know so many people who are partially blind, who have grown up, not having the opportunity to learn to read Braille, who are very blunt about saying, if we had only been able to learn to read and write Braille, we would have been a lot better off because it's just so much slower and harder for us today.   Kirk Adams  42:14 Yeah, so I hear people with those same, same regrets. And, again, it's back to what I said earlier that as a, becoming totally blind at age five, there was no question I knew I was going to learn braille, and I was instructed in Braille. And, you know, it wasn't a question or debate. Who, who, you know, who knows what would have happened if I would have had enough usable vision to read with magnification? So I like I guess, along the same lines, is what you mentioned about Doctor turning his definition of blind, you know, if, if a child cannot read at the same rate as their sighted classmate using magnification, they need to learn braille, so they can read read just as fast as their kid at the next desk, you know,   Michael Hingson  43:03 otherwise, why do we teach sighted kids to read just let them watch TV which is, which is another, which is another technology and art form or whatever, that that isn't as creative in some ways as it used to be, but they're also good shows. So I guess we got to cope with that, too.   Kirk Adams  43:24 But yeah, audio description is not not our thing. Although we appreciate it immensely. And I know some other blindness organizations are really carrying the torch to increase the amount of audio description. But that just brings to mind that accessibility and innovation around accessibility for people with with particular disabilities is good for everybody. Yeah, and I know, my, my wife, she's puttering around the kitchen, and there's a movie on, she'll put the audio audio description on, you know, so she can, she can follow it. When I was at the lighthouse in Seattle, we worked with Metro Transit to put larger bus numbers with contrasting colors, because we have had a lot of employees with ARPI. A lot of Dateline, employees with ushers, and they did enlarge the bus numbers and put them in contrasting colors. And they said they had more positive comments from their general ridership about that than anything they've done. Because it made it easier for people with 2020 vision to see if that was their bus coming. Sure. So simple, simple example. But yeah, one of   Michael Hingson  44:45 the things that one of the things that really surprises me still, and I've mentioned it before, and so it's one of my soap boxes is Apple, put voiceover partly because they were compelled To do it, but put VoiceOver on iPhones, iPods, iTunes, you and all that, but on iPhones and iPods and the Mac, they put voiceover, they created it. But I'm very surprised that in the automotive world, they haven't done more to make voiceover a part of the driver experience so that people don't have to go look at screens on their iPhones or whatever. As opposed to being able to use VoiceOver, because clearly, it would be a very advantageous thing. And I also think of like the Tesla, which uses a screen including a touchscreen for everything. And my gosh, yeah, you can do a little bit more of that, because the Tesla has co pilot that allows you to interact in some other ways, although you're still supposed to keep your hands on the wheel and all that, but why aren't they using voice technology more than they are?   Kirk Adams  45:53 That's a good question that I can't answer.   Michael Hingson  45:56 I know, it's, it's, I've never heard a good explanation of it as to why they don't. And it makes perfect sense to do it. The voices are very understandable, much less dealing with Android and so on. But no one is using the voice technology and the voice output to take the place of of screens, which is crazy, much less voice input. So it is it is a mystery. And it is one of those things that it would be great if people would would consider doing more of that the automotive industries missing out and of course, we as blind people are the ones who bring that opportunity to them will take credit.   Kirk Adams  46:34 There you go. Well, you know, when when I was walking around with my four track, cassette player listening to textbooks, I was the, you know, the the oddity in school, and now everyone listens to Audible books. Right, right.   Michael Hingson  46:51 It's a common thing. And now not only that, you can use things like bone conducting headphones, so you can listen to your audio as you walk around and still hear what else is going on. So you're a little bit safer.   Kirk Adams  47:05 Yeah, I don't know how far afield you want to get in this conversation. But you know, indoor wayfinding navigation systems, many people are trying to figure that that out, you know, the GPS systems work pretty well when you're outdoors. But when when you're indoors, what are the wayfinding tools that are that are emerging? And you know, I'm thinking about haptics and, yes, different modes of receiving information than then audibly, because most of the adaptations accommodations for people who are blind tend to be audible. And if you get 234 things going at once you get you get a diminishing marginal utility there. And then at some point, you know, becomes counterproductive if too much is going on audibly. So I'm, I'm I went to Consumer Electronics Show ces for the first time, this past January. And I was very interested, I was very interested in kind of the the emerging use of different modes of conveying information, either through vibration or temperature or airflow, different types of information. So lots of smart people out there, trying to figure out ways to make make us all live better.   Michael Hingson  48:35 Yeah, I will have to hunt down Mike Mae and get him on the show, because he can certainly talk our ears off about indoor navigation integration, you should haven't done that. I've got to get hold of Mike, I think that would be cool. But it is all part of as you said, making all of our lives better. And the whole concept of virtual reality is something that all of us can take advantage of and use. And again, a lot of the things that that come about because of some of these developments actually started with with blindness. I mean, look at Ray Kurzweil with the Kurzweil Reading Machine, he developed the technology to be able to let a camera build a picture of a page of print. And his first choice was to develop a machine that would read out loud of course for blind people. Percy took it further after that, and now OCR is a way of life but it did start with Ray without machine, the Kurzweil Reading Machine for the blind.   Kirk Adams  49:37 Yep. Remember, it becomes a washing machine. Now Yeah, we can just now you can do with your iPhone.   Michael Hingson  49:43 You can and better how much our computer processes have have evolved over the years. It's really pretty incredible, isn't it? It really, really is. And you know, but technology is all around us. And it, it is a it is a good thing. But again, it's all about how we use it and how we envision it being used. So it again, it gets back to the discussion that we had about Braille. You know, people say, Well, you don't need Braille because you can use recordings and all right, well, that's just not true. Why is it that we should be treated differently? Why should our exposure to being able to read and write be different than people who have eyesight because reading and writing with Braille is really equivalent to reading and writing with, with printed page or pens and pencils, or typewriters now that I knew mentioned running with Roselle earlier, I remember, sitting on an airplane going, I think I was flying back to California from somewhere. And we were going through many revisions of running with Roselle at the time and Jeanette Hanscom, who was my colleague in writing that who writes children's books, so she was able to make the words something that we felt would be more relevant for kids, although I gotta tell you more adults by running orthros health and then children do so I've heard. But I spent the entire time flying from the East Coast to the West Coast, going through an editing, running with Roselle. And I was using a computer that talked but I also know that the skills that I learned as a braille reader gave me the ability to catch nuances and so on, that I never would have been able to learn to catch if I hadn't learned how to truly be able to read a book. And we edited the book. And you know, it is where it is today.   Kirk Adams  51:45 Well, it's on its way to me from the Talking Book and Braille library. I look forward to reading it. Congratulations on yet another publication Good on you.   Michael Hingson  51:56 Well, thank you, we're working now towards another one. Writing about fear, and especially with the pandemic all around us. And, gosh, fear has taken on many forms, some of which are understandable, and some of which are ridiculous. But we're we're looking at the fact that well, when I left the World Trade Center, I didn't exhibit fear. And that was because I learned what to do, and approach to the day when an unexpected emergency happen from a standpoint of knowledge. And I had actually, as I realized, over the last couple of years developed a mindset that if something were to occur, I mean, obviously something could happen. And we could have been smashed by something, but but without that happening, I could step back and quickly analyze whatever situation was occurring as we were going down the stairs or getting out. And I could focus on that and let the fear that I had not overwhelm me, but rather instead be a mechanism to keep me focused. So it's developing the mindset. So we're, we're working on it, and we've got proposal out to publishers, so we're hoping that that's going to go well. And, you know, we'll   Kirk Adams  53:18 see. Well, as mentioned earlier, I am president and CEO of the American Foundation for the Blind. And as such, I am scheduled to be on a zoom call with our Finance and Investment Committee of our Board of Trustees.   Michael Hingson  53:33 Well, we're gonna we're gonna let you go. But I'd like you to want to tell us if people want to reach out or if he wherever you want them to go to to learn more about AARP or you and reach out to you yeah,   Kirk Adams  53:45 FB dot o RG is the website. My email address, if you want to email me is my first initial K my last name Adams, K da ms at AFB dot o RG. And AFP and myself are present on social media. And you can find us easily and we'd love to connect. Get your thoughts, share our thoughts. Check out the Leadership Conference, May 2 and third in Arlington, Virginia and go to fb.org and look at our research.   Michael Hingson  54:20 Well, perfect. Well thank you very much for being with us today on unstoppable mindset. We very much appreciate your your time and hope that we'll be able to chat some more.   Kirk Adams  54:29 All right, Michael, keep up the good work.   Michael Hingson  54:32 We'll do it. If you'd like to learn more about unstoppable mindset, please visit www dot Michael hingson.com/podcast Or go to wherever you listen to other podcasts. We have a number of episodes up we'd love to also hear from you. You can reach me directly at Michael H AI that's ni ch AE L H AI at accessibly ACs. c e ss ibe.com. So Michael hai at accessible comm we'd love to hear from you. If you've got suggestions of people you think that we ought to have on the podcast, please let me know. We're always looking for guests if you want to be a guest, let us know about that as well. And most important of all, please, after listening to this, we'd appreciate it if you would give us a five star rating in wherever you're listening to podcasts. The ratings help us and they help us show other people that we're doing something of interest. So if you feel that way, please give us a five star rating. Thanks again for visiting us today. And we'll see you next week with another episode of unstoppable mindset the podcast where inclusion, diversity and the unexpected meet.   Michael Hingson  55:51 You have been listening to the unstoppable mindset podcast. Thanks for dropping by. I hope that you'll join us again next week, and in future weeks for upcoming episodes. To subscribe to our podcast and to learn about upcoming episodes, please visit www dot Michael hinkson.com/podcast. Michael Hinkson is spelled ma ch AE l h i n g s o n y you're on the site. Please use the form there to recommend people who we ought to interview in upcoming editions of the show. And also, we ask you and urge you to invite your friends to join us in the future. If you know of any one or any organization needing a speaker for an event, please email me at speaker at Michael hinkson.com. I appreciate it very much. To learn more about the concept of blinded by fear, please visit www dot Michael hinkson.com forward slash blinded by fear and while you're there, feel free to pick up a copy of my free ebook entitled blinded by fear. The Unstoppable mindset podcast is provided by access cast an initiative of accessibility and is sponsored by SSP. Please visit www.accessibly.com accessibly is spelled a cc e SSI B E. There you can learn all about how you can make your website inclusive for all persons with disabilities and how you can help make the internet fully inclusive by 2025. Thanks again for listening. Please come back and visit us again next week.

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Diamant Salihu om hederskulturen i gängen. Karin Olsson och Magnus Alselind diskuterar knarktwitter och myset mellan Strage och Arpi.

Eddy nos presenta una entrevista con Mark Post, experto en biotecnología, quien, en el marco del SingularityU Summit, nos explica cómo es que se crea carne para hamburguesas a base de células madre sin tener que implicar la muerte de algún animal; Eddy tuvo la oportunidad de platicar con Arpi Alto, una artista fuera de serie originaria de Armenia quien nos deleita con su inigualable voz.

KONEČNE! Vykašlali sme sa na online priestor a stretli sa face-to-face. Mišo, Zvolo a Arpi v neľútostnom súboji na "majkoch" rozobrali posledné kolo Fortuna ligy, popravu Staňa, prvé liptovské derby, stále lepšiu Trnavu, zmeny v Pohroní.... No je toho naozaj veľa! _______________________________________ Aj o tom je najnovší diel podcastu Bavme sa o lige. Instagram Bavme sa o lige ▶▶▶ https://www.instagram.com/bavmesaolige/ Instagram KickOff ▶▶▶ https://www.instagram.com/kickoffpodcast Facebook ▶▶▶ https://www.facebook.com/KickOffFutbalPodcast Svoj najobľúbenejší futbalový podcast si môžeš vypočuť aj tu: Spotify ▶▶▶ https://open.spotify.com/show/6s2FRZN0Nu8HCbkTCRTCYO Apple Podcasts ▶▶▶ https://podcasts.apple.com/cz/podcast/kickoff/id1505959435 Google Podcasts ▶▶▶ https://cutt.ly/MyY2od6 Anchor ▶▶▶ https://anchor.fm/kickoffpodcast Stitcher ▶▶▶ https://www.stitcher.com/podcast/kickoff Autori: Michal M. ▶▶▶ https://www.instagram.com/michal1m Andrej Zvolenský ▶▶▶ https://www.instagram.com/andrej.zvolo/ Marek Arpáš ▶▶▶ https://www.instagram.com/marek_arpas/

Ivar Mahmud Arpi gästar gänget. Hanif håller polisförhör. Chang försvarar sharia. Ashkan försvarar marxism. Omar och Mustafa är oense om kyskhet. ----------------------- OBS. Det här är inte hela avsnittet. Vill du få tillgång till fullversionen av våra avsnitt och alla exklusiva avsnitt? Stöd oss på Patreon. Är du i en sits där du har det svårt med ekonomin, är mellan två jobb eller så? Inga problem. Skicka ett mail till oss på hej@sistamaltiden.se så ser vi till att du får lyssna gratis tills du har råd. Sista Måltiden Shop: https://sistamaltiden.se Sista Måltiden Swish: 123 605 59 90 Är du Patreon och vill få tillgång till alla avsnitt i sin helhet? Vill du bli Patreon för att få tillgång till allt? Tryck här. See acast.com/privacy for privacy and opt-out information.

Ivar Mahmud Arpi gästar gänget. Hanif håller polisförhör. Chang försvarar sharia. Ashkan försvarar marxism. Omar och Mustafa är oense om kyskhet. ----------------------- OBS. Det här är inte hela avsnittet. Vill du få tillgång till fullversionen av våra avsnitt och alla exklusiva avsnitt? Stöd oss på Patreon. Är du i en sits där du har det svårt med ekonomin, är mellan två jobb eller så? Inga problem. Skicka ett mail till oss på hej@sistamaltiden.se så ser vi till att du får lyssna gratis tills du har råd. Sista Måltiden Shop: https://sistamaltiden.se Sista Måltiden Swish: 123 605 59 90 Är du Patreon och vill få tillgång till alla avsnitt i sin helhet? Vill du bli Patreon för att få tillgång till allt? Tryck här. Our GDPR privacy policy was updated on August 8, 2022. Visit acast.com/privacy for more information.

Cancer and Chemotherapy have effects on all aspects of an individual and their family's lives. Join us on Love, Mia Vita for a discussion on stories and guidance around how to help yourself, your significant other, or your friend who is undergoing body image and intimacy issues as a result of chemotherapy. Advice from Dr. Deb Saltman, Traci Owen (Oncology Sexual Health Specialist), and Mrs. Arizona, Arpi Hamilton, a breast cancer survivor, makes this an incredible episode you do not want to miss!

Jaksossa Harryn arpeen koskee ja hän pohtii, mistä se johtuu. Hän myös muistaa kummisetänsä olemassaolon ja kirjoittaa Siriukselle kirjeen kysyäkseen neuvoa. Tervetuloa mukaan! Seuraa meitä Instagramissa @laituripodcast ja etsi meidät Facebookista nimellä Laituri 9 ja 3/4 -podcast. Tuotanto by Terhi ja Anna. Music by Terhi. See acast.com/privacy for privacy and opt-out information.

There have been plenty of big changes & shifts in the home inspection industry this past year. From the pandemic to big acquisitions to new ways of thinking about our business. As the case with any industry (and life), we must adapt. We must stay ahead of the curve as a business and help support you as our Spectora family in staying ahead of trends that impact you and your livelihood. Kevin & Mike discuss recent acquisitions, how it could impact Spectora and all home inspectors, and kick around ideas on how inspectors can ethically and selectively be in control of their user's experience and increase ARPI (average revenue per inspection) by partnering with services & products that consumers want. Could there be a race to the bottom in prices? Could large companies try to make home inspections a complete commodity? How are you planning to adapt as big money comes into our space?  

Bulletins chefredaktör Ivar Arpi lämnar tillsammans med flera tunga namn efter en infekterad konflikt med ägarna som har skett i öppen dager. Anton och Jonas diskuterar Bulletin satsningen och konflikten. Följ oss på Odysee:https://odysee.com/$/invite/@Palaestra:4✅Stöd vår kanal✅ Dela, gilla, kommentera och donera: ▶️SWISH: 123 0265 298▶️BankGiro: 743-9433▶️Kontonummer SEB: 5403 10 554 55 ▶️ IBAN: SE3550000000054031055455▶️PATREON: https://www.patreon.com/palaestramedia ▶️Paypal: paypal.me/palaestra

Som ung slogs han med knytnävarna och som vuxen med orden Ivar Arpi räds inte konflikter. Just nu frontar han en maktkamp mellan Bulletins redaktionsledning och dess ägare. Hur ska det sluta?

Bulletin en nu konservativ mediasatsning med Paulina Neuding med flera. Anton och Jonas diskuterar vad man kan läsa in i det här projektet som ännu inte lanserats, så det blir givetvis en del spekulationer. Se vår nya kanal Boer Project: https://www.youtube.com/channel/UC59kZYQ-N79bBVAayONexEAOch hemsidan:Boerproject.com ✅Stöd vår kanal✅ Dela, gilla, kommentera och donera: ▶️SWISH: 123 0265 298▶️BankGiro: 743-9433▶️Kontonummer SEB: 5403 10 554 55 ▶️ IBAN: SE3550000000054031055455▶️PATREON: https://www.patreon.com/palaestramedia ▶️Paypal: paypal.me/palaestra

Haruki Murakami - Şarpi Keklerinin Yükselişi, Çöküşü Çeviren: Nurgök Özkale (İshak Edebiyat, 2020) Seslendiren: Yusuf Can Gökkaya

En ce début de semaine, je serai bref et très musical pour vous donner du courage pour les 5 jours avant le week-end prochain, en vous parlant de la jeune Arpi Alto, c'est son nom de chanteuse, elle a 15 ans et pour faire monter les vues sur les réseaux sociaux elle n'a pas hésité à jouer de son étrange ressemblance avec l'actrice Julia Roberts. Au point d'avoir les mêmes cheveux frisés, de porter la même robe rouge fendue comme dans le film Pretty Woman, à tel point que beaucoup d'internautes ont pris cette jeune intrigante, nommée Arpi Petrosyan...

In this episode, I had an incredible conversation alongside one of the most prominent people at Stanford University! During the episode, we discussed a number of things from his start in poetry and storytelling to how he wants to leave his mark and legacy through Youtube and the overall impact he intends to have on the education industry. My favorite aspect of the conversation was discussing public perception and his thoughts on where attention is lacking and how it can be substituted elsewhere. Arpi's channel continues to draw in viewers and people love watching HIM. His personality and unique style make him a pleasure to watch and I can't wait to see him prosper within the coming years. --- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app --- Send in a voice message: https://anchor.fm/zayn-patel/message Support this podcast: https://anchor.fm/zayn-patel/support

Fredrik snackar C# med Anders Arpi, en utvecklare som till skilnad från Kodsnacks standardpanel har bra koll på språket och hela .NET. Vi snackar lite om .NET genom tiderna, Microsofts omvandling från ett Windowsfokuserat företag till ett som gör produkter utvecklare gillar och har nytta av oavsett språk och miljö, och givetvis C#. Vi snackar om den inspiration från funktionella språk som letat sig in de senaste åren, LINQ, tupler, pattern matching, och vad som skaver med async. Vi snackar också lite om hur språket utvecklas, vad som är nytt och hett (sa någon Blazor?), hur allt nytt kan göra det svårare för nya utvecklare att komma in i ett språk, och om den stora best som är Visual studio. Känner du, precis som Anders gjorde, att något ämne är underrepresenterat i podden? Hör av dig! Råkar du dessutom veta att du eller någon annan gärna snackar om ämnet är chanserna riktigt goda att vi kan få till ett avsnitt! Ett stort tack till Cloudnet som sponsrar vår VPS! Har du kommentarer, frågor eller tips? Vi är @kodsnack, @tobiashieta, @antikristoffer, och @bjoreman på Twitter, har en sida på Facebook och epostas på info@kodsnack.se om du vill skriva längre. Vi läser allt som skickas. Gillar du Kodsnack får du hemskt gärna recensera oss i iTunes! Du kan också stödja podden genom att ge oss en kaffe (eller två!) på Ko-fi. Länkar Anders Arpi C# Polyglot Microsoft äger Github, ocskå Visual studio code .NET core .NET framework Mono Unity Xamarin Miguel de Icaza .NET 5 Azure Winforms VB.NET - Visual basic F# Advent of code XML literals i VB.NET async och await i C# Tuples i C# Pattern matching i C# ES6 Analyzers för .NET Roslyn AST LINQ Out-variabler C# 9 Record types Struct i C# Pass by reference eller pass by value Nuget Anders Hejlsberg Typescript .NET foundation RFC Swift Swifts ägande- och utvecklingsprocess Lambda i C# Delegater i C# Problem med async i C# Varianter på async-edge-cases och varianter på lösningar The Java generics FAQ Rider Webassembly Blazor Hur Blazor började Silverlight Boo Xamarin.forms .NET Maui Årets Build-konferens Titlar Kladda runt och ha kul i andra språk Bli förvirrad på nytt Inte så gift med Microsoft En tendens att köpa saker En enklare bild av “Vad är .net?” En elefant som bara dog Det finns, absolut VB.net är också bra, förresten Bra på att vänta med features C sharper Abstraktionen läcker inte på en vecka Alla fungerar i vissa fall Som bäst okej

Արփի Կարապետյանը (www.arpikarapetyan.com) միջազգային որակավարում ունեցող ՄՌ մասնագետ է (SHRM-SCP, SPHRi), միջազգայնորեն որակավորված քոուչ (EPC), թրեյներ և խորհրդատու: Նա հանդիսանում է zoom in! կարիերայի կողմնորոշման ծրագրի հիմնադիր և հեղինակ (www.zoomin-now.com), որը նախատեսված է մասնակիցներին օգնելու ճանաչել սեփական անձը, բացահայտել ուժեղ կողմերը, ձգտումները, հնարավորությունները և կազմել հետագա զարգացման գործողությունների ծրագիր: Բացի այդ, Արփին հանդիսանում է Cascade People and Business (www.cascade.am) ընկերության հիմնադիրն և գլխավոր տնօրենը, Հայաստանի ՄՌ Ասոցիացիայի (www.hrcommunity.am) հիմնադիրը և նախագահը, Տարածաշրջանային ՄՌ կոնֆերանսի (www.hrconference.biz) հիմնադիրը, որն ամեն տարի իր շուրջ է հավաքում միջազգայնորեն ճանաչված մասնագետների, փորձառու և ոգեշնչող խոսնակների ավելի քան 20 երկրից:

As many stay at home orders are being extended, a lot of you may be choosing to utilize this time to update or re-vamp your website. But, what features actually add value and which are just for show? On today’s episode, Website Designer and SEO Specialist, @just.arpi.design.agency shares 8 ways to improve the overall customer experience on your website. Arpi is a website design expert and SEO specialist. She started her agency in 2011 and has been helping more than 300+ entrepreneurs, bloggers, and brands ever since. Her passion lies in helping them with an effective website with SEO and marketing tactics that engages their audience, sets their brand apart, and ultimately lands them more sales and leads. In this process, she equips her clients with the best business strategies out there which include, social media marketing and content marketing.   https://www.instagram.com/just.arpi.design.agency/ https://www.youtube.com/channel/UCnx5AisZWN2ii7v2Njvq5xQ  

On this episode, Arpi Hamilton, joined us on the podcast. Apri found a pea size lump in her breast in September 2016. Though she was experiencing symptoms, she ignored those symptoms until December 2016. She scheduled an appointment with her gynecologist and had to beg to get a mammogram ordered. Arpi shares her treatment, how her journey has helped not only herself but also her coworkers at Cancer Treatment Centers of America. She also talks about the struggles she still faces 3 years later. For complete show notes, please visit www.behindthepinkribbon.com. New episodes of Behind the Pink Ribbon are release every Tuesday and Thursday at noon Mountain Standard Time. Subscribe and listen weekly on your favorite podcast player. Follow us on Facebook, Instagram, and Twitter.

When you follow the path that is your true calling, the road opens up before you. Artist Arpi Krikorian talks about returning to her first love, how her work ended up at The Metropolitan Museum of Art, and her visionary new project. You can reach Arpi at: www.arpikrikorian.com On Instagram @arpikrikorian On Facebook @arpikrikorian.studio  

Société: ARPI, Association régionale professionnelle pour l'insertion

I veckans omgång av nyhetsfrågesporten Lantzkampen tävlar journalisterna Alexandra Pascalidou och Anneli Carnelid mot två personer som också har pennan som vapen, Qaisar Mahmood, författare och enhetschef på Riksantikvarieämbetet och frilansskribenten Ivar Arpi. Hur bra har de följt med i veckans händelser? Programledare: Annika Lantz Domare: Sara Lövestam