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  • Oct 14, 2021LATEST
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Help 4 HD Live!
HDClarity

Help 4 HD Live!

Play Episode Listen Later Oct 14, 2021 43:00


Dr. Wild is a Professor of Neurology at University College London, a Consultant Neurologist at the National Hospital for Neurology and Neurosurgery in London's Queen Square, and Associate Director of UCL Huntington's Disease Centre. He runs clinics in general neurology, neurogenetic movement disorders and Huntington's disease. He leads a team of researchers aiming to accelerate the development of new therapies to make a real difference for people impacted by Huntington's disease. Dr. Wild believes that “Scientists have a duty to make their work accessible and understandable to the people who need it most.” So in 2010, I co-founded HDBuzz, an online source of reliable, impartial, easy-to-understand information about HD research. HDBuzz is now the world's foremost HD research news source. In recognition of this, he was awarded the 2012 Michael Wright Community Leadership Award by the Huntington Society of Canada and the 2014 Research Award by the Huntington's Disease Society of America (which is where I first met Dr. Wild). He has authored 7 book chapters and over 80 peer-reviewed publications. He serves on the Medical Advisory Panel of the Huntington's Disease Association, the Association of British Neurologists Neurogenetics Advisory Panel, and the Translational Neurology Panel of the European Academy of Neurology. He is the Associate Editor of the Journal of Huntington's Disease and advises the steering committee to the UK All-Party Parliamentary Group on Huntington's disease. He is the co-Lead Facilitator of the European Huntington's Disease Network‘s Biomarkers Working Group. For more information about HDClarity, please visit www.hdclarity.net

Honestly Bilal
Equity in Ophthalmology-Episode 3

Honestly Bilal

Play Episode Listen Later Oct 14, 2021 50:34


In this episode, Arhem chats with Dr. Bonnie An Henderson. Dr. Henderson is the contributing author of Chapter 4 of Women in Ophthamology (https://www.springer.com/gp/book/9783030593346). Dr. Henderson is a past President of the American Society of Cataract and Refractive Surgery and curently is a Clinical Professor at Tufts University School of Medicine. Previously, she was the Director of the Cataract and Comprehensive Ophthalmology Service at Massachusetts Eye and Ear Infirmary. Dr. Henderson is the Associate Editor for the Journal of Refractive Surgery. She has authored over 125 articles, papers, book chapters, and abstracts and has delivered over 275 invited lectures worldwide. She has published 5 textbooks in cataract and refractive surgery. Dr. Henderson has received an Achievement Award, the Secretariat Award, and the Senior Achievement Award by the American Academy of Ophthalmology, “Best of” awards from the American Society of Cataract and Refractive Surgery for her research and films, and the “Teacher of the Year” award from Harvard Medical School. She was awarded the Visionary Award by the American- European Congress of Ophthalmic Surgery and received the Suzanne Veronneau-Troutman Award from Women in Ophthalmology. Dr. Henderson completed her ophthalmology residency at Harvard Medical School, Massachusetts Eye and Ear Infirmary. She graduated from Dartmouth College and from Dartmouth Medical School with high honors.

Back in Control Radio
Unwanted Repetitive Thoughts and the Ironic Effect

Back in Control Radio

Play Episode Listen Later Oct 13, 2021 32:00


In this episode, Dr. David Hanscom talks with Dr. Joshua Smyth about the nature and mechanisms for unwanted repetitive thought (URT) patterns. These are thought patterns that persist over time and can have a negative effect on a person's health and psychology. Dr. Smyth explains that these thoughts often have lots of very emotional associations and can be very experiential / visual. Ironically because of this, trying to suppress them consciously typically just reinforces them. They can damage our health because they trigger the body's threat response. Joshua Smyth is a Distinguished Professor of Biobehavioral Health and of Medicine at Penn State and Hershey Medical Center and serves as Associate Director of Penn State's Social Science Research Institute (SSRI). Smyth is an internationally recognized expert on ambulatory assessment and intervention, with a focus on the interplay of stress, emotion, physiology and behavior in everyday life.   He is a Fellow of the Royal Society of Medicine, the Academy of Behavioral Medicine Research, and the Society of Behavioral Medicine. Dr. Smyth has served as an editorial referee for more than four dozen journals, served as Editor and Associate Editor for several journals, and has been active in Society leadership for the American Psychosomatic Society, the Society of Behavioral Medicine, and the Society for Ambulatory Assessment. Dr. Smyth has widely shared his research in interviews with ABC, CBS, CNN, NBC, PBS, Newsweek, Time and the New York Times, among many others, and recently published (with James Pennebaker) a popular science book on expressive writing interventions. Finally, he is an active and engaged teacher, and has received numerous accolades and awards for teaching and mentoring of students and trainees.

The Roundtable
10/12/21 RT Panel

The Roundtable

Play Episode Listen Later Oct 12, 2021 78:13


The Roundtable Panel: a daily open discussion of issues in the news and beyond.Today's panelists are WAMC's Alan Chartock, investigative journalist and UAlbany Adjunct Professor Rosemary Armao, The Empire Report's J.P. Miller, and former Associate Editor of The Times Union Mike Spain.

Circulation on the Run
Circulation October 12, 2021 Issue

Circulation on the Run

Play Episode Listen Later Oct 11, 2021 27:23


Please join author Milton Packer and Associate Editor Justin Ezekowitz as they discuss the Perspective "Heart Failure and a Preserved Ejection Fraction: A Side-by-Side Examination of the PARAGON-HF and EMPEROR-Preserved Trials." Dr. Carolyn Lam: Welcome to Circulation on the Run, your weekly podcast summary and backstage pass to the Journal and its editors. We're your co-hosts. I'm Dr. Carolyn Lam, Associate Editor from the National Heart Center. Dr. Greg Hundley: And I'm Dr. Greg Hundley, associate editor, director of the Pauley Heart Center at VCU Health in Richmond, Virginia. Dr. Carolyn Lam: Greg, it really is so great to be back with you chatting about the papers here in the Journal. Thank you for going solo and for just being the greatest partner on earth. Thank you for that. For everyone listening in, we are back with some gusto and especially with this feature discussion today. You are not going to want to miss it. We are talking to Dr. Milton Packer as well as Dr. Justin Ezekowitz. We are going to compare PARAGON and EMPEROR-Preserved trials in heart failure with preserved ejection fraction. A really interesting discussion you're not going to want to miss, but now let's start with some papers in today's issue. I'd like to start, please. Dr. Greg Hundley: You bet. Dr. Carolyn Lam: Greg, you know the optimal duration of antiplatelet therapy in patients with high bleeding risk with or without oral anticoagulation after coronary stenting? Well, that still remains a question. Today's paper is a pre-specified subgroup analysis of the MASTER DAPT trial and reports on the outcomes of patients with or without an oral anticoagulation indication in this study. Dr. Greg Hundley: Right, Carolyn. Remind us. What was the MASTER DAPT trial? What did it test? Dr. Carolyn Lam: Ah. MASTER DAPT investigated an abbreviated or one-month versus a non-abbreviated or three to 12-month dual antiplatelet therapy and a stopping of antiplatelet therapy at six months strategy after coronary stenting in an all-comer population at high bleeding risk. Dr. Greg Hundley: Carolyn, what did this subgroup analysis of outcomes in patients with and without oral anticoagulation show? Dr. Carolyn Lam: At 12 months of follow-up, ischemic and net risk did not differ with abbreviated versus non-abbreviated anti-platelet regimens in both subgroups, although significantly fewer clinically relevant bleeding events occurred in the group without an oral anticoagulation indication. Whereas only numerically fewer bleeding events occurred in the group with an oral anticoagulation indication that did not reach statistical significance. This subgroup analysis from the MASTER DAPT trial really adds additional evidence that dual antiplatelet therapy beyond one month in patients with or without an indication for oral anticoagulation really has no benefit and only increases bleeding risk. Dr. Greg Hundley: Oh, very important finding, Carolyn. Great research. Well, Carolyn, how the extracellular matrix microenvironment modulates the contractile phenotype of vascular smooth muscle cells and confers vascular homeostasis really remains elusive. Thus, these investigators led by Professor Wei Kong at Peking University applied protein-protein interaction network analysis to explore novel extracellular matrix proteins associated with the vascular smooth muscle cell phenotype. Dr. Carolyn Lam: Huh. Interesting. What did they find, Greg? Dr. Greg Hundley: Right, Carolyn. By combining an in-vitro and an in-vivo genetic mice vascular injury model, they identified nidogen-2, a basement membrane glycoprotein, as a key extracellular matrix protein for maintenance of vascular smooth muscle cell identity. Nidogen-2 exerted its protective function via direct interaction and modulation of Jagged1-Notch3 signaling. Dr. Carolyn Lam: Wow! Nidogen-2 and Jagged1-Notch3. I always learn so much. What are the clinical implications, Greg? Dr. Greg Hundley: Right, Carolyn. Perhaps targeting nidogen-2 to precisely modulate Jagged1-Notch3 signaling, well, that may provide novel therapeutic strategy for atherosclerosis and post-injury restenosis. Dr. Carolyn Lam: Very nice. Well, in the next paper, we discuss inflammation in heart failure. We know that inflammation contributes to the pathogenesis of heart failure, but there is limited understanding of inflammation's potential benefits. Interesting, huh? Well, these authors, Dr. Wollert and colleagues from Hannover Medical School in Germany, identified an adaptive crosstalk between inflammatory cells and cardiomyocytes that protects against persistent afterload stress-induced heart failure in mice. Monocytes and macrophages produced myeloid-derived growth factor in the pressure overloaded myocardium to augment SERCA2a expression in cardiomyocyte's calcium cycling and contractility. Myeloid-derived growth factor plasma concentrations were also found to be elevated in patients with aortic stenosis and to decline after aortic valve implantation indicating that pressure overload also triggers myeloid-derived growth factor release in humans. Dr. Greg Hundley: Carolyn, really informative preclinical science, but what are the clinical implications? Dr. Carolyn Lam: Ah. These observations molecularly defined a feature of the inflammatory response to hemodynamic overload that protects against heart failure development. Inflammation's beneficial trade therefore need to be considered when developing inflammation as a therapeutic target in heart failure. All of this is really discussed in a lovely editorial entitled Inflammation and Heart Failure: Friend or Foe? That's by Drs. Hajjar and Leopold. Dr. Greg Hundley: Great job, Carolyn. Well, my next paper focuses on resistant hypertension. Carolyn, although lifestyle modifications generally are effective in lowering blood pressure among patients with unmedicated hypertension or those treated with one to two antihypertensive agents, the value of exercise and diet for lowering blood pressure in patients with resistant hypertension is unknown. To address this, Professor James Blumenthal and co-authors at Duke University Medical Center enrolled 140 patients with resistant hypertension with an average age of 63 years, 48% women, 59% black, 31% diabetes, and 21% with chronic kidney disease and randomly assigned them to A, a four-month cardiac rehab center-based program of lifestyle modification. We're going to call that C-LIFE, consisting of dietary counseling, behavior and weight management, and exercise. Or number 2 or the B, a single counseling session providing standardized education and physician advice. We'll call that SEPA. Dr. Greg Hundley: The primary endpoint was clinic measured systolic blood pressure. Secondary endpoints included 24-hour ambulatory blood pressure and selective cardiovascular disease biomarkers including baroreflex sensitivity to quantify the influence of baroreflex on heart rate; high-frequency heart rate variability to assess vagally-mediated modulation of heart rate; flow-mediated dilation to evaluate endothelial function; and pulse wave velocity to assess arterial stiffness; and then finally left ventricular mass to characterize left ventricular structure and remodeling. Dr. Carolyn Lam: Wow! That is a very, first of all, important clinical question. Then also, just very intricate methodology in assessing this. What did they find? Dr. Greg Hundley: Right, Carolyn. Between-group comparisons revealed that the reduction in clinic systolic blood pressure was greater in C-LIFE compared with SEPA. Next, 24-hour ambulatory systolic blood pressure also was reduced in C-LIFE with no change in SEPA. Then next, compared with SEPA, C-LIFE resulted in greater improvements in baroreflex sensitivity, high-frequency heart rate variability, and flow-mediated dilation. There was no between-group differences in pulse wave velocity or LV mass. Dr. Greg Hundley: Carolyn, diet and exercise can lower blood pressure in patients with resistant hypertension. When delivered in a cardiac rehabilitation setting, a four-month program of diet and exercise as adjunctive therapy, results in a significant reduction in clinic and ambulatory blood pressure, and improvement in selected cardiovascular disease biomarkers. Dr. Carolyn Lam: Wow! Really nice, Greg. Okay. Well, looks like we're all going to round up already with what else there is in today's issue. Let me start. There's an exchange of letters between Drs. Fang and Vinceti regarding the article Blood Pressure Effects on Sodium Reduction: Dose-Response Meta-analysis of Experimental Studies. Dr. Greg Hundley: Right, Carolyn. I've got a few things in the mail bag. First, Professor Anker has a Research Letter regarding the Kidney Function After Initiation and Discontinuation of Empagliflozin in Heart Failure Patients With and Without Type 2 Diabetes: Insights From the EMPERIAL Trials. Dr. Gerstenfeld has an ECG challenge entitled Atrioventricular Block with Narrow and Wide QRS: The Pause That Refreshes. Then lastly, Dr. Donald Lloyd-Jones has an AHA update regarding the American Heart Association's focus on primordial prevention. Well, Carolyn, I can't wait to hear this fantastic feature discussion with you and Dr. Packer. How about we jump to that? Dr. Carolyn Lam: Great. Let's go, Greg. Dr. Carolyn Lam: Because side-by-side exam of PARAGON and EMPEROR is like side-by-side of... Dr. Justin Ezekowitz: You can compare our new and our old prime minister much like your paper did. Dr. Milton Packer: Yeah, yeah. Dr. Justin Ezekowitz: There are [crosstalk] and it could be viewed until they perform in the broader world how it goes. You don't quite know. Dr. Milton Packer: The only problem is you can't do a head-to-head comparison of the old prime minister and the new prime minister. Dr. Justin Ezekowitz: That is true except that the head-to-head comparison includes excellent care by both the new and the old. I think that comparison's going to be pretty equal. I think we can case-control that one. Dr. Carolyn Lam: I really liked that that was politically correct because we are recording. Everybody, welcome to the feature discussion. I am here with Dr. Milton Packer from Baylor and he really needs no introduction. We're discussing heart failure with preserved ejection fraction. As well as our associate editor, Dr. Justin Ezekowitz from University of Alberta. Hence, in case anybody's wondering, we were talking about the Canadian elections. Let's just launch straight into it, a side-by-side comparison of PARAGON and EMPEROR-Preserved. Dr. Packer... Milton, if I may, what in the world drove you to do this? Dr. Milton Packer: My God. Oh, my God. Yes. Dr. Carolyn Lam: Tell us about what drove you to do this and please, if you could just summarize the results. Dr. Milton Packer: Well, let me just say from the outset that this was a commentary, not an original research article. Dr. Carolyn Lam: Yes. Dr. Milton Packer: The commentary was motivated by two very straightforward observations. We had two large scale outcome trials of two different drugs in heart failure with a preserved ejection fraction. I was privileged to serve as you were, Carolyn, on the leadership committees of both trials. It's not as if we have involvement in only one trial. We have involvement in both trials and we are very proud of that involvement. Dr. Milton Packer: One trial came in with a effect size of about 13% on its primary endpoint with a borderline P-value. A second trial, EMPEROR-Preserved, came in with a 21% reduction and its primary endpoint with a really small and persuasive P-value. The two patient populations in the two trials were really amazingly similar. We wanted to understand why it was 21% in one trial and persuasively so and why it appeared to be smaller in the PARAGON trial with sacubitril/valsartan. We thought, well, maybe that difference was related to how endpoints were defined or maybe that difference was related to the influence of ejection fraction. The reason we got excited about that was that as almost everyone knows, PARAGON found an influence of ejection fraction on the effect of sacubitril/valsartan in patients with HFpEF. We found an influence of ejection fraction on the effect of empagliflozin in HFpEF in EMPEROR-Preserved. We wanted to understand whether that influence was similar in the two trials. Dr. Milton Packer: Just to make life simple, PARAGON had created certain cut points for ejection fraction. They had presented and previously published in Circulation endpoints based on those cut points of ejection fraction. All we did was we used their endpoints and their cut points, and we put the two trials side by side. We did not do a statistical comparison of the effect size. There're actually no P-values in the whole commentary. But what we wanted to see was: Was the shape of the ejection fraction influence relationship similar or different in the two trials? Well, very simple. In PARAGON, as has been reported, there was a linear relationship: as ejection fraction increased, the effect of sacubitril/valsartan got smaller. In EMPEROR-Preserved, there was also an attenuation at a highest ejection fraction, but the relationship wasn't linear. It was like a hockey stick. It was flat and then went up at an ejection fraction over 62.5, which was the cut point that PARAGON used. Dr. Milton Packer: When we compared patients between the low 40s and the low 60s, the effect size in empagliflozin appeared to be larger than the effect size of sacubitril/valsartan in that ejection fraction group using the same endpoints. In fact, for hospitalizations for heart failure, which is really what SGLT2 inhibitors do, it was twice as great with empagliflozin in EMPEROR-Preserved than with sacubitril/valsartan in PARAGON-HF. We thought this was really interesting. We put the pictures up side by side. We wrote a commentary and Circulation was so kind to accept it. Dr. Carolyn Lam: Oh, but Milton, you were very, honestly as always, very clever to have done this analysis. But if I could reiterate a few things for the audience, which is very important. First of all, as you rightly first pointed out, it's a perspective piece. It is not a head-on comparison with P-values. It could not be. Let's just also give the audience a bit of background in that PARAGON included patients with an ejection fraction of 45% and above. EMPEROR-Preserved was above 40. PARAGON looked at total heart failure hospitalizations and cardiovascular death as a primary outcome. EMPEROR looked at first cardiovascular death or heart failure hospitalization. Dr. Carolyn Lam: Let's just remember the designs were different. Of course in the comparison, PARAGON compared sacubitril/valsartan versus valsartan. I like the way you very carefully wrote in your study that it was more a study of neprilysin inhibition since it's sacubitril/valsartan against valsartan and it was empagliflozin versus placebo. We know that it's important to state that as a basis. Then really important to say to everybody out there, pick up our journal. You must look at this bigger. I myself have already cited it at least twice already, Milton, because people will just naturally ask that. "Are the results different because of ejection fraction or different endpoints?" What you did there in that beautiful figure is that you tried as best as you can to match it up in terms of ejection fraction bins and match it up in terms of hospitalizations. There. I just wanted to state those few things, but I'm really- Dr. Milton Packer: Oh, no. No. Carolyn, you're 100% right. That's why there are couple of things. I just want to underscore what you said because I think your points were spot on. First of all, we really lined up the endpoints and the ejection fraction. We tried our best to compare apples and apples. It would not have been a useful exercise for us to compare different endpoints and different ejection fraction subgroups. But I just want to make sure that everyone understands: I'm a big fan of sacubitril/valsartan and I'm a big fan of neprilysin inhibition. As you know, both PARADIGM-HF and PARAGON-HF weren't really tests of sacubitril/valsartan; they were tests of neprilysin inhibition. They were great tests at that. PARAGON in particular was a great test of that. We're comparing neprilysin inhibition and SGLT2 inhibition. Dr. Milton Packer: But here's my most important point: we do not want people to choose one over the other. That was not the intent. We think that there are data in patients with certain ejection fractions, let's say between 40 and 60, I'm just creating a range, where both interventions are appropriate. Now I understand there are cost considerations and I don't want to minimize that, but we are not suggesting that anyone prefer one drug over the other. All we wanted to do was we wanted to ask the question: Since the effect size in one trial seemed to be different than the effect size in the other trial, what were the ejection fraction subgroups that represented that difference? We found that the patients with ejection fractions greater than 60, 65% did not contribute to that difference. It was the patients with lower ejection fractions that contributed to the difference. I hope that's helpful. Dr. Carolyn Lam: Ah. That's wonderful. Justin, have you recovered from the talk about the Canadian elections? Dr. Justin Ezekowitz: Oh. I have indeed. Dr. Carolyn Lam: I'm on swinging. Dr. Justin Ezekowitz: I have indeed. Thanks for recognizing that Canada just had a major election we carried out in six weeks. But, Milton, I really enjoyed reading this. Maybe I can just ask you about two elements within this perspective piece, which is number 1, what's incredibly concordant is a lack of difference across cardiovascular death for both agents in both trials regardless of the trial differences and the potential differences in patient populations recruited; that's number 1. It's incredibly flat for cardiovascular death. Dr. Justin Ezekowitz: But number 2 is there is a danger in comparing trials even non-statistically. That's often a pitfall we get into, but we have to put some frame of reference on that. What is the one or two key things you think differ between PARAGON and EMPEROR-Preserved that you say, "You really need to look at these trials differently"? Those two questions came to mind when looking at this great figure that you produced. Dr. Milton Packer: Okay. The first question is so much easier and that is that these drugs don't reduce cardiovascular deaths. Full stop. It's really interesting because sacubitril/valsartan reduces cardiovascular death in people with ejection fractions of 40% or less, but not in patients with ejection fraction greater than that. The primary effect is heart failure hospitalizations. Empagliflozin didn't reduce cardiovascular death even in patients with the ejection fraction less than 40% or greater than 40%. What we're really, really talking about two drugs where the major effect is a reduction in heart failure hospitalizations. That comes out whether you do the analysis as time-to-first-event or total heart failure hospitalizations. Dr. Milton Packer: Of course, we're looking forward to the DELIVER trial with dapagliflozin. My own personal expectation is they're going to come out with a very striking effect on heart failure hospitalizations and not on cardiovascular deaths. Cardiovascular deaths in patients with HFpEF is really... It's a hard goal because only half of the deaths are cardiovascular. These patients have so many comorbidities that influence prognosis. The other thing, which is really important, is that heart failure hospitalizations only represented 18% of all hospitalizations in these patients; it's really small. I think of empagliflozin as being a treatment of the heart failure of HFpEF, not a treatment for HFpEF. I hope that makes sense. Justin, what was your second question? Dr. Justin Ezekowitz: Absolutely. Dr. Milton Packer: Oh, the differences between- Dr. Justin Ezekowitz: Yeah. Thank you, Milton. Dr. Milton Packer: Okay. There's always differences between two trials. As I said before, Carol and I were involved in both trials. They were done slightly at different times. They didn't overlap. Remember that the cut points in the two trials, one was 40%, one was 45%, really didn't matter to our analysis because we corrected for that in our ejection fraction subgroups. I was actually really much more impressed by the similarities than by the differences, but here's the catch. HFpEF is an incredibly heterogeneous disease. When we look at baseline characteristics, we're looking at means, medians, percentages. We're not picking up on any heterogeneity and there's a lot of heterogeneity. I actually think that HFrEF is a reasonably homogeneous disease. I think HFpEF is an incredibly diverse disease with a whole host of different disorders. What I'm amazed by is that we actually got an effect size that was greater than 20% in an all-comers HFpEF analysis. Dr. Milton Packer: But in all honesty, Justin, it wasn't really all-comers. We excluded people with BMIs over 45. There are a lot of patients who are obese and had BMIs greater than 45 who have HFpEF. By the way, especially in Texas. I didn't say that. We didn't enroll those patients. In all honesty, if I had to do it all over again, I would have. By the way, PARAGON didn't enroll them either. Dr. Carolyn Lam: Well, this is an incredible conversation. I know that we could just do a whole hour of chatting about what this implies for the higher ejection fraction, what this implies for how we should be treating heart failure. I don't even dare to ask for some last words maybe from both Justin and Milton, but recognizing that the time is short, anything else to add? Dr. Milton Packer: I think Justin should do last words. Dr. Justin Ezekowitz: Well, let me summarize by saying there is a hockey stick. We love hockey sticks in Canada. A simple and an excellent comparison. I think people should really look at that figure to understand it, but do not undertreat your patients with HFpEF and look at these with a grain of salt. Thanks for joining us, Milton. Thanks, Carolyn. Dr. Milton Packer: Thank you so much. Dr. Carolyn Lam: On behalf of Greg and I, you've been listening to Circulation on the Run. Thank you so much for joining us today and don't forget to tune in again next week. Dr. Greg Hundley: This program is copyright of the American Heart Association 2021. The opinions expressed by speakers in this podcast are their own and not necessarily those of the editors, or of the American Heart Association. For more, visit ahajournals.org.

The Johnny Beane Podcast
Talking with Matt Blackett LIVE! 10/8/21

The Johnny Beane Podcast

Play Episode Listen Later Oct 9, 2021 140:06


"Matt Blackett is a guitarist, writer, and consultant with four decades' experience in the music business. Matt was Associate Editor at Guitar Player magazine for 15 years, publishing interviews with Brian May, Jeff Beck, Tony Iommi, Jason Becker, Mark Knopfler, and many more. Matt is currently the Director of Market Development for EverTune, makers of the revolutionary EverTune bridge."

The Stand with Eamon Dunphy
Ep 1227: Trump Hits the Road on a High as Forlorn Biden Struggles in Washington

The Stand with Eamon Dunphy

Play Episode Listen Later Oct 9, 2021 30:01


Niall Stanage, Associate Editor of The Hill and White House Columnist, reports from Washington. The Stand is proudly sponsored by Tesco. Recorded 8/10/21

Building Abundant Success!!© with Sabrina-Marie
Episode 2214: Hyla Cass M.D. ~ Mental Health Awareness Month. Natural Approaches to Treat Anxiety, BiPolar Depression - Pt 1

Building Abundant Success!!© with Sabrina-Marie

Play Episode Listen Later Oct 7, 2021 31:41


Dr. Oz, E! Entertainment It's National Mental Health Awareness MonthThe Segment is for Educational Purposes, Always Consult Your Physician About this Information so it Can be Determined If it is Right for You.Nationally acclaimed innovator and expert in the fields of integrative medicine, psychiatry, and addiction recovery, Dr. Cass helps individuals to take charge of their health. One area is in withdrawing from both psychiatric medication and substances of abuse with the aid of natural supplements. Dr. Cass appears often as a guest on national radio and television, including The Dr. Oz Show, E! Entertainment, and The View, and in national print media. She has been quoted in many national magazines, blogs for the Huffington Post, and is the author of several best-selling books including: Natural Highs, 8 Weeks to Vibrant Health, Supplement your Prescription: What Your Doctor Doesn't Know About Nutrition, and her ebook, The Addicted Brain and How to Break Free. She has created her own line of innovative nutritional supplements. A member of the Medical Advisory Board of the Health Sciences Institute and Taste for Life Magazine, she is also Associate Editor of Total Health Magazine, she has served on the boards of California Citizens for Health and the American College for Advancement in Medicine (ACAM). A native of Toronto, she graduated from the University of Toronto School of Medicine, interned at Los Angeles County-USC Medical Center, and completed a psychiatric residency at Cedars-Sinai Medical Center/UCLA. She is a Diplomate of the American Board of Psychiatry and Neurology (ABPN), and of the American Board of Integrative Holistic Medicine (ABIHM).2021 All Rights Reserved © 2021 Building Abundant Success!! Join Me on ~ iHeart Radio @ https://tinyurl.com/iHeartBAS Spot Me on Spotify: https://tinyurl.com/yxuy23ba

KoopCast
Heat Acclimation Strategies with Julien Périard PhD | Koopcast Episode 97

KoopCast

Play Episode Listen Later Oct 7, 2021 75:25


Julien Périard is a Research Professor at the University of Canberra Research Institute for Sport and Exercise (UCRISE), where he leads the Environmental Physiology Research Group. Julien's research examines the physiological mechanisms that impact on health and performance in adverse environments (heat and altitude), along with strategies to mitigate their influence and harness their adaptive potential. He has worked with both amateur and professional athletes from various disciplines, along with National and International Federations (FIFA, UCI, World Athletics and World Triathlon). He has authored over 85 research publications in international journals, including an invited review in Physiological Reviews on exercise under heat stress. Julien has also edited a textbook on Heat Stress in Sport and Exercise. He currently serves as Associate Editor for Frontiers in Physiology and has served as Guest Editor for the British Journal of Sports Medicine and Scandinavian Journal of Science and Medicine in Sport.Exercise under heat stress: thermoregulation, hydration, performance implications, and mitigation strategies Julien's book- Heat Stress in Sport and ExerciseInformation on coaching-www.trainright.comKoop's Social Media Twitter/Instagram- @jasonkoop

Chopper's Politics
Liz Truss on trade deals, the trans debate and the next James Bond

Chopper's Politics

Play Episode Listen Later Oct 6, 2021 40:46


New foreign secretary Liz Truss gives The Telegraph's Associate Editor, Camilla Tominey the inside line on her first few weeks in the role. Did the appointment come as a surprise? After the fall of Kabul, will she recognise The Taliban as the leaders of Afghanistan? And, in her second role as Women and Equalities Minister, does she still have faith in police chief Cressida Dick following the disturbing revelations surrounding Sarah Everard's death? All this and more, including Ms Truss' take on who should play the next James Bond and whether she secretly enjoyed upsetting the French in the recent submarine row.Read more from Christopher Hope: https://www.telegraph.co.uk/authors/c/cf-cj/christopher-hope/ |Sign up for the Chopper's Politics newsletter: https://www.telegraph.co.uk/newsletters |For 30 days' free access to The Telegraph: https://www.telegraph.co.uk/chopper |Email: chopperspolitics@telegraph.co.uk |See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

JAMA Editors' Summary: On research in medicine, science, & clinical practice. For physicians, researchers, & clinicians.
Scopolamine Butylbromide for End-of-Life Death Rattle, Pulmonary Embolism Workups in COPD Exacerbation, Eosinophilic Esophagitis review, and more

JAMA Editors' Summary: On research in medicine, science, & clinical practice. For physicians, researchers, & clinicians.

Play Episode Listen Later Oct 5, 2021 9:23


Editor's Summary by Anne Cappola, MD, Associate Editor of JAMA, the Journal of the American Medical Association, for the October 5, 2021 issue.

The Roundtable
10/5/21 RT Panel

The Roundtable

Play Episode Listen Later Oct 5, 2021 81:41


The Roundtable Panel: a daily open discussion of issues in the news and beyond. Today's panelists are WAMC's Alan Chartock, Albany Chief City Auditor Dorcey Applyrs, investigative journalist and UAlbany Adjunct Professor Rosemary Armao, Tetherless World Professor of Computer, Web and Cognitive Sciences at RPI and Director of the RPI-IBM Artificial Intelligence research collaboration Jim Hendler, and former Associate Editor of The Times Union, Mike Spain.

Death To Tyrants Podcast
Ep. 177: Grab Political Power and Use It Against Your Enemies, with Pedro Gonzalez

Death To Tyrants Podcast

Play Episode Listen Later Oct 4, 2021 65:30


My guest this week is the Associate Editor at Chronicles Magazine and one of the best voices on the Right today, Pedro Gonzalez. Pedro and I discuss the right's issue with state power. The Left has been able to grab power and willfully use it to win every battle and gain power over every institution in the country. Is it worth it for the right and libertarians to "stick to their principles" if it means losing every battle? If your principles lead to a world with less freedom, maybe it's time to examine your principles. We also discuss the US military and the fact that it is being run by low-IQ losers. The chaotic rot that has infested every State institution has also infected the military. Pedro and I discuss the impact that author James Burnham has had on his thinking along with what we should learn from Huey P Long. This is an excellent discussion, and I think you'll enjoy it. Follow Pedro here: Read his articles and subscribe to Chronicles Magazine here: Purchase tickets for the Renegade University Texas event here: Buy tickets to the RU Texas after party with Kyle Ruff and Robbie Bernstein here: Sponsors: Texas Scorecard: , , Nomad Network: Paloma Verde CBD ( ): Enter code BUCK at checkout for 25% off any purchase over $75! ...and join their mailing list for an additional 10% off! Visit my website: Donate to the show here: Audio Production by Podsworth Media: Leave us a review and rating on iTunes! Thanks!

District of Conservation
EP 218: USCCA Reality Check Campaign with Beth Alcazar and Chris Cheng

District of Conservation

Play Episode Listen Later Oct 4, 2021 32:38


In Episode 218 of District of Conservation, Gabriella speaks with Beth Alcazar and Chris Cheng about their involvement in U.S. Concealed Carry Association's (USCCA) "Reality Check" campaign. Get to know them today! Beth is an Associate Editor at Concealed Carry Magazine and firearms instructor. Chris is a competitive shooter, Silicon Valley tech worker, and winner of Season 4 of The History Channel's Top Shot program. SHOW NOTES Order "Shoot to Win" by Chris Cheng Asian Pacific American Gun Owners Association Connect with Chris online: Facebook, Instagram, Twitter, YouTube, Medium Connect with Beth online: Facebook, Instagram, Twitter --- Support this podcast: https://anchor.fm/district-of-conservation/support

MagaMama with Kimberly Ann Johnson: Sex, Birth and Motherhood
EP 140: Bullshit, Lying, and the Truth with John V. Petrocelli

MagaMama with Kimberly Ann Johnson: Sex, Birth and Motherhood

Play Episode Listen Later Sep 30, 2021 73:24


In this episode, Kimberly and John discuss his newest book “The Life-Changing Science of Detecting Bullshit” which explains the differences between bullshitting, lying, and deciphering the truth. John explains many different facets of how humans are susceptible to bullshit and lying, especially from someone close or familiar to us, as well as how to have a productive conversation with someone who makes biased claims posing as truth.    Bio John V. Petrocelli is an experimental social psychologist and Professor of Psychology at Wake Forest University. His research examines the causes and consequences of BS and BSing in the way of better understanding and improving BS detection and disposal. Petrocelli's research contributions also include attitudes and persuasion and the intersections of counterfactual thinking with learning, memory and decision making. His research has appeared in the top journals of his field including the Journal of Personality and Social Psychology. Petrocelli also serves an Associate Editor of Personality and Social Psychology Bulletin.   What He Shares: —Difference between bullshitting and lying —How cross-field research is most credible —Questions to ask when someone makes a claim —Humility in seeking the truth —Seeking truth amid echo chambers and polarization    What You'll Hear: —Difference between bullshit and lying —Liar interested in truth in order to tell a successful lie —BSer doesn't care about truth, could state truth but BSer wouldn't know it —Liar doesn't believe what they're communicating and knows they're lying —BSer does believe in what they say —We assume BS has no harm or effects and that we cant detect it (false) --Those most confident in detecting BS are most duped by it (research shows) —Those who have strongest beliefs about something can be often most clueless about the evidence & truth --Research behind MMR vaccine and debunked link to autism —Cross-discipline agreements trend as most credible —Confirmation bias is only caring about what appears to be evidence or explanation that confirms our pre-existing beliefs or hypothesis —Preferences va attitudes —Own personal/professional experiences inform our beliefs —Data collection regarding experiences is messy and random --Information we get from personal and professional experience is often counterintuitive and not necessarily data we want to count —When people obtain good information, research shows tends to suggest people are pretty reasonable in inferences they make from information presented —-Major problem treating anecdotal, small data points of interest as much weight as we would give data on a mass scale —How do we know when something is credible? How do we tell inside of ourselves? How do we tell outside of ourselves? —Data shows only need to hear BS one time, mind tends to signal truth i —Mind signals truth is felt familiar (heard before) easily confuse familiarity with truth —Interpersonal BS (people we care about, communicate with frequently) is most potent --People we don't communicate with is somewhat potent —Who are they? What do they know? How do they know that claim? What is their agenda? —Calling BS and being challenged on our beliefs is rare to occur especially when it's easy to be locked into our echo chambers —Living in era where vehicles for expression, making recordings and content leads us exposed to many things an equalizer and messiness of truth and reality —Cultural ideas coming to forefront of there is no truth, everything is relative —“Gullability” (when are cues that suggest person isn't interested in truth) —We feel obligated to have opinions on things at an expanded magnitude from previous times —Passively receiving information vs. actively sorting through information for truth —BSers use abstract explanations/heady values and reasons and less hardcore genuine evidence —HOW do you know this is true? HOW do you think this claim might be wrong? —Listening and communicating to win or prove we're right doesn't get us as far  —Having intellectual humility  —Tribalism we see today resembles cults —Spade for other ways of knowing, mystery, and magic —What can't be studied or measured (“love”)   Resources Website: https://psychology.wfu.edu/about-the-department/faculty-and-staff/john-petrocelli/

What The Func?!
EPISODE 78: METABOLIC HEALTH, WITH DR. CASEY MEANS

What The Func?!

Play Episode Listen Later Sep 27, 2021 59:53


Laura & Clayton chat with Dr. Casey Means, a Stanford-trained physician, Chief Medical Officer and Co-founder of metabolic health company Levels, and Associate Editor of the International Journal of Disease Reversal and Prevention. They dig into metabolic health, glucose monitoring and wearables. On What The Health?!: Learn the facts about flax! What The Func?! is produced by the Functional Medicine Coaching Academy. Follow @drcaseyskitchen and @levels on IG! Follow us @whatthefunc on IG!

NBC Meet the Press
Sept. 26 — Sen. Cory Booker, DHS Sec. Alejandro Mayorkas

NBC Meet the Press

Play Episode Listen Later Sep 26, 2021 47:24


Sen. Cory Booker (D-N.J.) talks about negotiations over President Biden's spending bill and the collapse of police reform talks. Secretary Alejandro Mayorkas, Department of Homeland Security, talks to Chuck Todd about the Haitian migrant surge at the border. Bob Woodward, Associate Editor, The Washington Post and Robert Costa, National Political Reporter, The Washington Post, co-authors of “Peril” talk about the last days of the Trump presidency. Amy Walter, Leigh Ann Caldwell, Eddie Glaude, Jr. and Meghan McCain join the Meet the Press roundtable to talk about President Biden's imperiled agenda.

The Stand with Eamon Dunphy
Ep 1214: Incompetence Becoming the Trademark for Biden Administration

The Stand with Eamon Dunphy

Play Episode Listen Later Sep 25, 2021 30:14


Niall Stanage, Associate Editor of The Hill and White House Columnist, talks to Eamon. The Stand is proudly sponsored by Tesco. Recorded 24/9/21

JAMA Editors' Summary: On research in medicine, science, & clinical practice. For physicians, researchers, & clinicians.
Low Tidal Volume Mechanical Ventilation Using ECCO2R, Probiotics to Prevent VAP in the ICU, TAVR for Bicuspid Aortic Stenosis, Medical Schools in the US, and more

JAMA Editors' Summary: On research in medicine, science, & clinical practice. For physicians, researchers, & clinicians.

Play Episode Listen Later Sep 21, 2021 13:53


Editor's Summary by Kristin Walter, MD, Associate Editor of JAMA, the Journal of the American Medical Association, for the September 21, 2021, issue.

The Roundtable
9/21/21 RT Panel

The Roundtable

Play Episode Listen Later Sep 21, 2021 75:01


The Roundtable Panel: a daily open discussion of issues in the news and beyond. Today's panelists are WAMC's Alan Chartock, investigative journalist and UAlbany adjunct professor Rosemary Armao, The Empire Report's J.P. Miller, and former Associate Editor of The Times Union Mike Spain.

Broken Brain with Dhru Purohit
How to Improve Insulin Sensitivity and Regain Metabolic Health (Minisode #47)

Broken Brain with Dhru Purohit

Play Episode Listen Later Sep 20, 2021 28:55


How to Improve Insulin Sensitivity and Regain Metabolic Health | This episode is brought to you by Cozy Earth and Even.Obesity, type 2 diabetes, heart disease, polycystic ovarian syndrome, and Alzheimer's disease all have one big thing in common—they all involve a component of blood sugar dysregulation. Considering the rampant use of sugar and flour in our food supply, managing blood sugar is something we should all be thinking about if we want to protect or improve our health. Thanks to technological advances like continuous glucose monitoring, we can now understand how we respond to carbohydrates like never before. For one person, a sweet potato might be easy to handle metabolically. For another, it could mean a giant rise and fall of blood sugar with a corresponding insulin spike. Some of the foods you might assume are healthy may even be the worst offenders. Seeing this information in real-time lets us make better decisions with immediate pay off for how we feel, as well as long-term protection against chronic disease. In today's mini-episode, Dhru speaks with Dr. Casey Means and Dr. Ben Bikman about how our diet and lifestyle have fundamentally changed in a way that greatly impacts how we regulate blood sugar, and how it's wreaking havoc on our metabolic health. They also talk about optimal glucose ranges, and how we can use continuous blood glucose monitoring to dramatically improve our health. Dr. Casey Means is a Stanford-trained physician, Chief Medical Officer and Co-founder of metabolic health company Levels, an Associate Editor of the International Journal of Disease Reversal and Prevention, and a Lecturer at Stanford University. Her mission is to maximize human potential and reverse the epidemic of preventable chronic disease by empowering individuals with tools that can facilitate deep understanding of our bodies and inform personalized and sustainable dietary and lifestyle choices. Dr. Ben Bikman is a renowned metabolic research scientist, and a popular speaker on human metabolism and nutrition. Backed by years of research, Dr. Bikman's mission is to help the world appreciate the prevalence and relevance of insulin resistance. He is the author of, Why We Get Sick, which offers a thought-provoking yet real solution to insulin resistance and how to reverse pre-diabetes, improve brain function, shed fat, and prevent diabetes. Find Dhru's full-length conversation with Dr. Casey Means here: https://lnk.to/dhru-227/ Find Dhru's full-length conversation with Dr. Ben Bikman here: https://lnk.to/DrBenjaminBikman2/ Sign up for early access to Levels Metabolic Fitness Program here: levels.link/dhru For more on Dhru Purohit, be sure to follow him on Instagram @dhrupurohit, on Facebook @dhruxpurohit, on Twitter @dhrupurohit, and on YouTube @dhrupurohit. You can also text Dhru at (302) 200-5643 or click here https://my.community.com/dhrupurohit. Interested in joining The Dhru Purohit Podcast Facebook Community? Submit your request to join here: https://www.facebook.com/groups/2819627591487473/.This episode is brought to you by Cozy Earth and Even.I recently started using bamboo sheets from Cozy Earth, and it's a game changer. For one, these sheets help regulate temperature. One of the biggest tips all of the top sleep experts will give you is to make sure your sleep environment is cool. Studies actually show that sleeping in cooler temperatures leads to deeper and more restorative sleep. They are also the most comfortable sheets I've ever used. Right now, Cozy Earth is offering my audience 40% off. Just head over to https://cozyearth.com/ and use the discount code DHRUPODCAST.Prescription drugs can have some benefits when they're used the right way, but it's important to recognize that they can also deplete key nutrients. This company called Even has created a whole system to help you replenish what's been lost while using certain medications, such as antidepressants, statins, or birth control. Their products are created by physicians, nutritionists, and pharmacists who have identified the exact recipe to rebalance nutrient levels and biochemistry while taking certain meds. Right now, Even is offering my community free consultations and 20% off your first order. Just go to feeleven.com/dhru and use code DHRU20 to check out Even's line of supplements that specifically address medication-induced nutrient deficiencies. See acast.com/privacy for privacy and opt-out information.

Phronesis: Practical Wisdom for Leaders
Dr. Ali Dachner & Dr. Erin E. Makarius - From Departing Employees to Loyal Alumni

Phronesis: Practical Wisdom for Leaders

Play Episode Listen Later Sep 20, 2021 34:21


Dr. Alison M. Dachner is an Associate Professor of Management at the Boler College of Business, John Carroll University. She earned her Ph.D. from The Ohio State University. Dr. Dachner has experience working as Director of Education for an international call center as well as consulting on special projects in a variety of industries and companies, including NASA. Ali's research interests include how changes to the modern work environment and characteristics of certain populations (e.g., emerging adults) influence the design of strategies to most effectively engage, develop, transition, and retain employees and students. Her work has been published in Human Resources Management Review, Journal of Applied Psychology, Human Resource Development Quarterly, Journal of Management Education, and Academy of Management Annals. Ali is an Associate Editor for the Journal of Management Education. Her research can be found on Google Scholar and you can follow or connect with her on Twitter (@ProfDachner) or LinkedIn (Alison Dachner). Dr. Erin E. Makarius is an Associate Professor of Management at the College of Business at The University of Akron. She received her Ph.D. from The Ohio State University. Dr. Makarius has several years of experience in human resources and management, including working at and consulting with a variety of companies in the financial, insurance, and consumer products industries. Erin's research interests include boundary spanning in the form of technological, international, and organizational boundaries, with emphasis on the role of relationships and reputation in these processes. Her work has been widely published in journals such as the Journal of Management, Organization Science, Academy of Management Perspectives, Journal of World Business, and Organization Studies. Erin's research has received media coverage in the Wall Street Journal, Financial Management, Fox News, Forbes magazine, NPR, SHRM, and the Akron Beacon Journal, among others. She is on the editorial review board of the Journal of World Business. Her research can be found on Google Scholar and you can follow or connect with her on Twitter (@ProfMakarius) or LinkedIn (Erin Makarius).Harvard Business Review - Turn Departing Employees into Loyal AlumniQuote From This Episode"Companies should begin their off-boarding programs at the moment of hiring.""It's really about connections, and then maintaining those relationships, not only while you're at the firm, but beyond that formal organizational boundary and continuing that relationship after people leave."Resources Mentioned in This EpisodeThe Alliance by Reid Hoffman Remote Work Revolution by Tsedal Neeley Think Again by Adam Grant  About The International Leadership Association (ILA)The ILA was created in 1999 to bring together professionals with a keen interest in the study, practice, and teaching of leadership. Connect with Scott AllenWebsite

Everyday Wellness
Ep. 169 Why Should You Care About Your Metabolic Health? Empowering a Deep Understanding of Our Bodies with Dr. Casey Means

Everyday Wellness

Play Episode Listen Later Sep 18, 2021 63:11


I am delighted today to be interviewing Dr. Casey Means! She is a Stanford-trained physician, Chief Medical Officer and Co-founder of the metabolic health company Levels, an Associate Editor of the International Journal of Disease Reversal and Prevention, and a Lecturer at Stanford University. Her mission is to maximize human potential and reverse the epidemic of preventable chronic disease by empowering individuals with tools that can help facilitate a deep understanding of our bodies and inform personalized and sustainable dietary and lifestyle choices. Dr. Means was recently featured in the New York Times, Wall Street Journal, and more.  Dr. Means has an interesting story to tell. She trained as a surgeon and an ear, nose, and throat doctor. Her interest in the impact of diet, lifestyle, and nutrition on people's foundational health started at a relatively young age. She began focusing on nutrigenomics when she was still an undergraduate student at Stanford. It was an exciting time at Stanford because the human genome project was happening, and 23andMe was going online. She enjoyed learning about the correlation between nutritional compounds and gene expression and finding out that our genes are a blueprint and not our destiny. Dr. Means is joining me today to talk about metabolic dysfunction and using continuous glucose monitors for facilitating your personalized diet. Stay tuned to find out more! IN THIS EPISODE YOU WILL LEARN: Dr. Means talks about how her journey started and how she became interested in the impact of diet, lifestyle, and nutrition on people's foundational health. The shocking amount of refined sugar that gets consumed by the average American each year and the impact that has on their metabolic health. What chronic inflammation is, what it does in the body at the cellular level, and why that is so detrimental. What happens in your body when you are overfed, when your blood sugar stays elevated over time, and when your insulin is kept high. What you should, and should not eat to maintain your metabolic flexibility. The benefits of fasting. Some practical ways of pairing proteins to help reduce blood sugar fluctuations. The impact of sex hormones on blood sugar control. What a continuous glucose monitor is and how it works. Why you need to know what's going on in your gut microbiome. Why long-term adherence to a low carb or keto diet can cause reverse metabolic inflexibility. The correlation between blood sugar instability and debilitating hot flashes in women in perimenopause or menopause. Connect with Cynthia Thurlow Follow on Twitter, Instagram & LinkedIn    Check out Cynthia's website  Connect with Dr. Casey Means On her website    Dr. Casey's blog On Instagram @drcaseyskitchen and @levels On Twitter @drcaseyskitchen and @levels

The Stand with Eamon Dunphy
Ep 1206: Democratic Light Fading in The United States

The Stand with Eamon Dunphy

Play Episode Listen Later Sep 17, 2021 30:45


Niall Stanage, Associate Editor of The HIll and White House Columnist, reports from Washington. The Stand is proudly sponsored by Tesco. Recorded 17/9/21

The Red Box Politics Podcast
Chorley in Chorley Special

The Red Box Politics Podcast

Play Episode Listen Later Sep 17, 2021 37:16


Matt Chorley is live from a café in Chorley for the G7 Speakers Conference. The UK's speaker Sir Lindsay Hoyle gives him a tour of the market and star of 'The League of Gentleman' Steve Pemberton explains which of his characters were based on Chorley residents.PLUSThe Spectator's Political Editor James Forsyth and Associate Editor of the Lancashire Post Nicola Adam discuss the day's news including Michael Gove's plan for levelling up. See acast.com/privacy for privacy and opt-out information.

Woman's Hour
Dame Elizabeth Anionwu; Alison Goldsworthy; Linda Edwards; Ministerial reshuffle

Woman's Hour

Play Episode Listen Later Sep 16, 2021 58:00


With a career spanning five decades, Britain's first sickle cell and thalassemia nurse specialist, Prof Dame Elizabeth Anionwu revolutionised treatment of the disease. As an academic, she became a professor and dean of the nursing school at the University of West London, then established the Mary Seacole Centre for Nursing Practice, to address racial inequalities in the profession. When she retired she campaigned for a statue in honour of the pioneering Jamaican nurse, Mary Seacole. She speaks to Emma about her memoir ‘Dreams From My Mother' - a story of childhood, race, identity, family, hope and overcoming her upbringing which was marked by racism and abuse. Alison Goldsworthy was deputy chair of the Liberal Democrats Federal Executive while the party was in coalition government. Active in politics for a long time, she left the party in 2014. In 2013, she and others made public sexual harassment allegations against a senior colleague, allegations he has always strongly denied. Alison's book Poles Apart has just been published – she joins Emma to talk about what she learnt from that experience. Nobody likes paying parking fines, but would you go through a 5 year battle to beat one? Linda Edwards from Greater Manchester did just that - all over a £1 parking ticket she couldn't pay because the machine was broken. She joins Emma to explain why she stuck with it. Yesterday's reshuffle worked out pretty well for women in the Conservative party. Priti Patel stays in post, Liz Truss has been promoted to Foreign Secretary while retaining her Women and Equalities brief, and Nadine Dorries has been promoted to Culture Secretary. Women now occupy half of the great offices of state for the second time - the first being when Theresa May made Amber Rudd Home Secretary in 2016. But does any of that actually matter? Emma is joined to discuss by Sebastian Payne, author of Broken Heartlands: A Journey Through Labour's Lost England and Whitehall editor for the Financial Times, and Camilla Tominey, Associate Editor at the Telegraph.

Download This Show - ABC RN
The Original Conspiracy Viral Video?

Download This Show - ABC RN

Play Episode Listen Later Sep 16, 2021 28:22


This week: How the conspiracy video Loose Change energized the "9/11 truther movement" and sparked an age of disinformation. Meanwhile, Facebook unveils Ray-Ban Stories which are designed for hands-free photos and videos. Plus, foldable phone sales are up and it's yet to be determined if they're the future or a fad, and how many mini-subscriptions are too many?   Guests: Alice Clarke, Award-winning freelance technology journalist & Cam Wilson, Associate Editor at Crikey

The Clement Manyathela Show
Blunders under Ramaphosa Presidency

The Clement Manyathela Show

Play Episode Listen Later Sep 15, 2021 22:29


  Clement Manyathela speaks to Ferial Haffajee, Associate Editor at Daily Maverick about the blunders and mishaps that have occurred during the Ramaphosa presidency. See omnystudio.com/listener for privacy information.

The Roundtable
9/14/21 RT Panel

The Roundtable

Play Episode Listen Later Sep 14, 2021 77:10


The Roundtable Panel: a daily open discussion of issues in the news and beyond. Today's panelists are WAMC's Alan Chartock, UAlbany Adjunct and investigative journalist Rosemary Armao, Tetherless World Professor of Computer, Web and Cognitive Sciences at RPI and Director of the RPI-IBM Artificial Intelligence research collaboration Jim Hendler, and former Associate Editor of The Times Union, Mike Spain.

The Steve Gruber Show
Noah Rothman, Continued

The Steve Gruber Show

Play Episode Listen Later Sep 13, 2021 8:30


Noah Rothman is the Associate Editor of Commentary and the author of Unjust: Social Justice and the Unmaking of America.  Continued.

The Steve Gruber Show
Noah Rothman, Yes, Biden blew it

The Steve Gruber Show

Play Episode Listen Later Sep 13, 2021 11:00


Noah Rothman is the Associate Editor of Commentary and the author of Unjust: Social Justice and the Unmaking of America. Yes, Biden blew it

Primal Blueprint Podcast
John V. Petrocelli

Primal Blueprint Podcast

Play Episode Listen Later Sep 8, 2021 61:48


Elle Russ chats with John V. Petrocelli - an experimental social psychologist who researches, writes, and speaks about the science of communication and decision making.  He is a Professor of Psychology at Wake Forest University, teaching social psychology and judgment and decision making.  He is also the author of The Life-Changing Science of Detecting Bullshit.  His research examines the causes and consequences of bullshit and bullshitting in the way of better understanding and improving bullshit detection and disposal.   Petrocelli's research contributions also include attitudes and persuasion and the intersections of counterfactual thinking with learning, memory and decision making.  His research and writings have been featured by the Wall Street Journal and in his popular TEDx Talk, Why BS is More Dangerous Than a Lie.  In addition to his research and position as an Associate Editor of the Personality and Social Psychology Bulletin, he has authored over 50 papers in his field's most prestigious journals, including the Journal of Personality and Social Psychology, Journal of Experimental Social Psychology, Personality and Social Psychology Bulletin, British Journal of Social Psychology, and Thinking and Reasoning.  He has received numerous awards for his teaching and research achievements.

20 Minute Leaders
Ep566: Mira Brancu | Founder & CEO, Brancu & Associates

20 Minute Leaders

Play Episode Listen Later Sep 8, 2021 22:13


Dr. Mira Brancu is a consulting psychologist, leadership coach, writer, and speaker. She leads Brancu & Associates, a boutique consulting firm that aims to help leaders lead teams and navigate large, complex organizations and helps organizations make it easier to navigate. She has a special passion for helping women gain the influence, power, leadership, and resiliency skills needed in today's diverse, complex, and ever-changing workplace. She has written about this in her new book, Millennials' Guide to Workplace Politics. Dr. Brancu is also an Associate Professor at Duke University, an Associate Editor of the Consulting Psychology Journal, and has a Psychology Today blog focused on women's leadership. 

Expo Presents: Transposition
Fractured Memory: JJ Peña on Trauma & Storytelling with K.B. Carle

Expo Presents: Transposition

Play Episode Listen Later Sep 7, 2021 29:03


Nonfiction flash writer JJ Peña joins us in our season finale to read “this is how i want you to remember me” from the Change in Perspective Flash 405 contest. Writer and judge K.B. Carle leads in the interview with JJ as they explore flash, memory, and the power storytelling. Read along at: http://expositionreview.com/flash-405/this-is-how-i-want-you-to-remember-me/ About JJ Peña: JJ Peña (pronouns he/they) is a queer, burrito-blooded writer. JJ is the winner of blue earth review's 2019 flash non-fiction contest, cutbank's 2019 big sky, small prose contest, mythic picnic's 2020 postcard prize, & Santa Clara Review's 2021 Flash Non-fiction contest. JJ's work is included in the Best Microfiction 2020 anthology & Wigleaf's Top 50 (Very) Short Fictions (2020). JJ is a 2021 Periplus fellow, holds a BA in both English and Anthropology, and an MFA in Creative Writing from the University of Texas at El Paso. JJ's stories have appeared or are forthcoming in Washington Square Review, Cincinnati Review, Massachusetts Review, & elsewhere. JJ serves as a flash fiction reader for Split Lip magazine About K.B. Carle: K.B. Carle lives and writes outside of Philadelphia, Pennsylvania. She is the Associate Editor at Fractured Lit. and an Editor at FlashBack Fiction. Her stories have appeared in Waxwing Magazine, matchbook, Bending Genres, No Contact Magazine, and have been nominated for Best of the Net, Best Small Fictions, and the Pushcart Prize. She can be found online at http://kbcarle.com or on Twitter @kbcarle. Links from the Podcast: JJ Peña's website: https://www.jjpena.com/ JJ's Insta: bootyshortsjesus JJ's Twitter: @heckaseuss K.B. Carle's website: https://www.kbcarle.com/ K.B.'s Insta: @kbcarle K.B.'s Twitter: @kbcarle K.B.'s workshop: The Narrative Mystique: Embodying the Unexpected Narrator in Flash Workshop with K.B. Carle Exposition Review Chapbook: http://expositionreview.com/2021/04/composition-rearview-chapbook-now-available/ Help us spread the word! Please download, review, and subscribe to Transposition. Thank you to Mitchell Evenson for intro and outro music, and the generous donations from our supporters that allow us to pay our authors. Exposition Review is a fiscally sponsored project of Fractured Atlas. Transposition is the official podcast of Exposition Review literary journal. Associate Producer: Mitchell Evenson Intro Music by Mitchell Evenson Hosted by Laura Rensing --- Support this podcast: https://anchor.fm/exposition-review/support

Circulation on the Run
Circulation September 7, 2021 Issue

Circulation on the Run

Play Episode Listen Later Sep 7, 2021 29:02


This week's episode features special Guest Host Mercedes Carnethon, as she interviews author Sung-Min Cho and Associate Editor Marc Ruel as they discuss the article "Cerebrovascular Events in Patients with Centrifugal-Flow Left Ventricular Assist Devices: A Propensity Score Matched Analysis from the Intermacs Registry." Dr. Carolyn Lam: Welcome to Circulation on the Run, your weekly podcast summary and backstage pass to the journal and its editors. We're your co-hosts. I'm Dr. Carolyn Lam Associate Editor from the National Heart Center and Duke National University of Singapore. Dr. Greg Hundley: And I'm Dr. Greg Hundley Associate Editor, Director of the Pauley Heart Center at VCU Health in Richmond, Virginia. Well, Carolyn, this week's feature, we're going to look at centrifugal flow, left ventricular assist devices and cerebrovascular events. But before we get to the feature, how about we grab a cup of coffee and jump into some of the other articles in the issue? And maybe how about I go first? Dr. Carolyn Lam: All right. I got my coffee. Dr. Greg Hundley: So my first paper comes from Professor Dali Luo from Capital Medical University. And it's pertaining to calsequestrin-1. So calsequestrin-1, and calsequestrin-2 isoforms buffer calcium and regulate its release from the sarcoplasmic reticulum of skeletal and cardiac muscle. Human inherited diseases associated with mutations of calsequestrin-1 or 2 include malignant hyperthermia and environmental heat stroke and catecholamingergic polymorphic ventricular tachycardia. However, patients with hypothermia, environmental heat stroke events often suffer from an arrhythmia for which the underlying mechanism remains unknown. Dr. Carolyn Lam: Wow. Okay. And what did the current paper do and find? Dr. Greg Hundley: Great, Carolyn. So what the authors found, calsequestrin-1, the skeletal isoform of it is indeed expressed in cardiomyocyte sarcoplasmic reticulum for mirroring in human hearts, mostly presenting as a polymeric form and interacting with the ryanodine 2 receptor in ventricles. Second, calsequestrin-1 deficiency cause sinus tachycardia in basal conditions. And this is a novel finding which may be associated with sinus beat regulation and ventricular arrhythmia as an independent arrhythmogenesis if a high concentration of volatile anesthetics are used. Next, these volatile anesthetics and heating to 41 degrees C can directly induce calsequestrin-1 oligomerization, thereby causing enhancement of diastolic calcium leak and premature calcium transience through a reduced regulatory effect of calsequestrin-1 on ryanodine 2 activity. And so Carolyn, this novel mechanism underlying the arrhythmia occurring in patients with malignant hypothermia or environmental heatstroke episodes may provide different strategies for heart disorders as an independent profile in these syndromes. And finally, the finding of calsequestrin-1 confirmational change induced by triggers in those with malignant hyperthermia and environmental heatstroke could lead to novel therapeutic approaches to prevent these types of episodes. And that may also very, very useful in treatment of heatstroke.   Dr. Carolyn Lam: Wow. Thanks Greg. Well, moving from this preclinical world to a very common clinical question of the diagnosis of acute myocardial infarction. Now we know that in patients presenting to the emergency department with symptoms suggestive of an MI, the European Society of Cardiology zero and one hour algorithm is recommended by current ESC NSTEMI guidelines with a class one recommendation. Now, what this does is it combines a very high safety for early rule-out and high accuracy for rule-in allowing a definite triage of about 70 to 75% of patients using the zero in one hour sample. Dr. Carolyn Lam: However, what is the most appropriate management of the 25 to 30% of patients who remain in the gray observed zone? So this is the question that the current paper addresses. Now to answer this, we also need some more background that a single center pilot study previously of patients in the observed zone had derived a cutoff of seven nanograms per liter for a zero and three hour high sensitivity cardiac troponin T change to identify patients also eligible for early rule-out or rule-in of NSTEMI. So the current study that we're talking about in today's issue from Dr. Christian Mueller from Cardiovascular Research Institute in Basil, Switzerland, and colleagues, really aimed to externally validate that previously proposed seven nanogram per liter change cutoff, and if necessary derive and internally as well as externally validate some new criteria for these patients in the observed zone of the ESC zero in one hour algorithm. Dr. Greg Hundley: Wow, Carolyn, so we're learning a lot about cutoff values and also algorithms here with high sensitivity cardiac troponin T. So what did they find here? Very interested to hear. Dr. Carolyn Lam: So in two large prospective multicenter diagnostic studies, they found that the proposed zero and three hour high sensitivity cardiac troponin T change of seven nanogram criteria, unfortunately provided suboptimal safety for ruling out NSTEMI in patients remaining in the observed zone of the ESC zero and one hour algorithm. So this had a sensitivity of only 33% and missed 80 patients with NSTEMI. So they derived their own novel criteria based on zero and three hour samples. And these novel criteria combined a three hour high sensitivity cardiac troponin T concentration of less than 15 nanograms per liter and a zero and three hour absolute change cutoff of four nanograms per liter. Dr. Carolyn Lam: And that combination provided a high safety for ruling out NSTEMI in these patients in the observed zone and with a sensitivity of 99% missing only one patient with NSTEMI. Another further thing they found was at a zero and three hour cardiac troponin T absolute change of greater or equal to six nanograms per liter triage, 63 patients, or 11% towards rule-in thus resulting in a specificity of 98%. So in summary, this novel criteria based on zero and three hour sample seemed to balance safety and efficacy well for the further decision making in patients who are remaining in the observed zone after the zero and one hour cardiac troponin T algorithm. Internal validation of these novel criteria and external validation in an independent international cohort showed robustness of performance metrics and further strengthen its possible clinical use.   Dr. Greg Hundley: Very nice, Carolyn. Lots of data there, and hopefully very important clarification on both the zones as well as the cutoff values for using cardiac troponin T. Well, Carolyn, my next paper again comes from the preclinical science world and it's from Dr. Anne Eichmann at Yale University School of Medicine, and it pertains to activin receptor-like kinase 1. And we're going to call that ALK1.   Dr. Greg Hundley: Kinase 1 and we're going to call that ALK1. And it's an endothelial transmenbrane serine threonine kinase receptor for BMP family ligands that plays a critical role in cardiovascular development and pathology. And loss of function mutations of the ALK1 gene cause type 2 hereditary hemorrhagic telangiectasias, a devastating disorder that leads to arteriovenous malformations. Dr. Carolyn Lam: Oh, okay. And what did the authors find? Dr. Greg Hundley: Dr. Carolyn Lam, ALK1 mutants displayed defective polarization against the direction of blood flow in capillary and venous endothelium as well as increased integran VEGF receptor 2 mediated P13K activation of YAP/TAZ signaling. Dr Carolyn Lam: Okay, Greg, that was super summarized but what are the clinical implications? Dr. Greg Hundley: Carolyn, pharmacological integrin inhibition using cilengitide or ATN-161, or YAP/TAZ inhibition using verteporfin, prevented AVM malformation in ALK1 mutant mice. And therefore for this study, the authors revealed that integrin and YAP/TAZ were novel affectors of ALK1 signaling in AVM pathogenesis that might be targeted for AVM treatment in patients with hemorrhagic telangiectasias. Dr. Carolyn Lam: Thank you, Greg. Well, let's review what else is in today's issue. There's an exchange of letters between Doctors Amadio and Valentine on cell-free DNA to detect heart allograph acute rejection. There's an AHA Update paper by Dr. Churchwell on preemption, a threat to building healthy, equitable communities. There's a Research Letter by Dr. Merkler on the association between cervical artery dissection and aortic dissection. Dr. Greg Hundley: And Carolyn, I've got a paper from Professor Daniels regarding the Clinical Implications of Basic Research getting inside the engine, the myosin modulation of hypertrophic cardiomyopathy and systolic heart failure. And then finally, there's an In Depth piece from Dr. Viskin entitled, “Polymorphic Ventricular Tachycardia: The Terminology, mechanism, diagnosis and Emergency Therapy.”   Dr. Carolyn Lam: Nice. Well, let's go on to our feature discussion. Can't wait. Dr. Greg Hundley: You bet.   Dr. Mercedes Carnethon: Welcome to this episode of Circulation on the Run, our podcast where we have an opportunity to talk with the authors of some of the top articles within our journal for a given week. And we've chosen today to focus on a set of articles, one of which is led by Dr. Sung-Min Cho from the Johns Hopkins University. And I'm really excited to have you with us today, Dr. Cho and joining us as well as the associate editor, Dr. Marc Ruel who handled the paper. And my name is Mercedes Carnethon from the Northwestern University's Feinberg School of Medicine. I guess without further ado, welcome to you both and we'll just jump right into it. Dr. Mercedes Carnethon: Dr. Cho, I'd love to hear a little bit more about your paper today. What made you choose to pursue this particular topic and what really inspired you? Dr. Sung-Min Cho: Thank you so much for the invitation and opportunity to talk today. During my training as a neuro person, I'm a neurointensivist by training and neurologist. I noticed that we are getting a lot of consults for LVAD associated strokes. When I took a closer look at the ENDURANCE trial, very showed really 29.7% stroke rate at two years and a few years later, we had this MOMENTUM 3 trial, which showed HeartMate 3 device had 10% stroke rate at two years. And we realized that a stroke is a major issue in this population and I wanted to study the incidence respecters and outcome of this strokes in LVAD population. However, despite the many observational studies in the past, we were really interested in looking at device specific stroke risk for current continuous flow LVADs and we wanted to look at the device specific risk and prevalence of these patients balancing co-morbidities each cohort. And that's why we conducted this study. Dr. Mercedes Carnethon: Great, well Sung-Min, it's not often that as an epidemiologist and cardiovascular epidemiologist that I actually get to talk with neurointensivists and get their insights on the importance of their work. Can you tell me a little bit about what you found and whether it surprised you? Dr. Sung-Min Cho: Population, we used the Intermacs registry database. This is well established database as all cardiologists and cardiothoracic surgeons know, and we defined a neurologic adverse event as stroke plus TIA, transient ischemic attack. We used a propensity score matching analysis to assess the association of HVAD with stroke risk, to balance for pre-implant risk factors. And basically after performing propensity score matching, we found that hazard of stroke was higher for patients with HVAD device compared to HeartMate 3. We kind of expected this based on the randomized control trials in the past but there was no head to head comparison between these two cohorts. This study really confirmed our suspicion that HeartMate 3 actually had lower hazard of a stroke compared to HeartMate 3. Dr. Mercedes Carnethon: Well, thank you so much. It's a really great explanation. And for those who haven't had a chance to dig into the issue yet, I really encourage you to read the piece. I found it to be very instructive. And I'm interested as well, Mark in your take about what excited you about this piece. Dr. Marc Ruel: Well, thank you very much Mercedes and Sung-Min it's really a pleasure to have you with us today. As you know, this has been a very impactful paper and you were very kind to share with us the study around your idea as to why you wanted to evaluate this question but even more than your idea and what led to the completion of the paper are the implications of your paper. And I think it would be great if you shared with us a little bit, what has been the path that your paper has led to and including amongst others, very likely a decision by the Medtronic to pull the HVAD out of market. It's interesting that your data, to my knowledge, correct me if I'm wrong, were presented first at the annual meeting of the Society of Thoracic Surgeons in January, 2021. And again, I want to reiterate that Circulation's very thankful that you chose to send your paper to our journal and we feel that it will give it full justice, like many other journals of would have had but we're really excited to have received your paper and give it the fullest consideration. Dr. Marc Ruel: Can you tell us a little bit about the implications and for lack of a better word, the storm that your paper has created in the field and your take on it? Dr. Sung-Min Cho: Right. That's a great question. Thank you for that. Like I said, as a neurologist, we see these patients after complication, patients having stroke and then we see these patients and we always wanted, cardiologists and cardiothoracic surgeons and neurologists, we always wondered which device carried more risk for stroke and TIA. And really our group actually worked on many papers in the past looking at single institutional data and also systematic review meta-analysis looking at this topic, but really HeartMate 3 came along a couple years ago, more recent device so we didn't have a lot of data. Dr. Sung-Min Cho: So intermex registry really helped since we didn't have a lot of data. So, INTERMACS Registry really provided opportunity for us to look at this specific question, really balancing those two chords to look at the risk of stroke in this HeartMate 3 and HVAD. And when we did that two years ago, we submitted a proposal to INTERMACS, and Dr. Kirklin from UAB, he really helped us to look at this data closely with his statistical team. And we had really a thorough statistical method to perform a propensity matching analysis. And we finally finished the analysis and presented in annual STS meeting in January, and it did really trigger a lot of attention to a lot of academic institutions and people who are practicing LVAD, and after that, when we finally submitted this paper to Circulation, we had to have a lot of discussion in between FDA and the Medtronic and discussing this implication of this paper. When it was finally published in Circulation, we are happy that there's a lot of attention and we made it through. Dr. Marc Ruel: Well, thank you, Dr. Cho, and maybe for the listener of this podcast, I would like to reiterate some of the salient points of your paper essentially, and correct me if I'm wrong, over 6,200 patients were included, about roughly 3,000 patients per group comparing the HeartMate 3 versus the HVAD. Dr. Marc Ruel: Now, as you alluded to the HVAD is the more ancient device, if you will. So there's a slightly longer follow-up, around 12 months on median, versus nine months with the HeartMate 3. And there's adjustment that has been made for this. And I think to me, really the key finding is that in the early acute phase around implantation, there is no real difference with regards to the risk adjusted incidents of neuro adverse events. However, once you pass the early implantation acute phase, in the chronic stable phase, there starts being really a signal that is detrimental to the performance of the HVAD versus the HeartMate 3. And I think your hazard ratio, correct me if I'm wrong, it's around 5.7 for neuro adverse events. Dr. Marc Ruel: So this is a very compelling hazard ratio, even coming out of an observational study with all the careful attention that you provided to adjust for residual confounding, et cetera. Dr. Marc Ruel: So obviously this is a very strong finding, but I would like you to perhaps comment on this, the patients are not the same. There's some indication that the HVAD patients may have been a little sicker, more RV dysfunction, more tricuspid regurgitation, higher INTERMACS-1 incidents more often on ECMO prior to an implant. What are your thoughts about this? Dr. Marc Ruel: Obviously, you've been very careful and the reader will note in the paper that many attempts have been made to account for those. But please give us your take around that 5.7 hazard ratio for neuro adverse event that you found. Dr. Sung-Min Cho: Right? In fact, we were really being careful adjusting those compounders. So we did a propensity matching has a primary analysis, but as you pointed out, as a secondary analysis, we wanted to look at multi-variable logistic regression analysis, looking at multi-hazard analytics. And when we did the secondary analysis, as you said, in the beginning early hazard period, the risk was similar, as time went on in the constant hazard period, the hazard ratio was 5.7 for HVAD compared to HeartMate 3, which gives a much higher risk of stroke and TIA for those patients with HVAD compared to HeartMate 3. Dr. Sung-Min Cho: So, that was really convincing to us. Confirming the findings from propensity matching analysis, showing that same findings were consistent throughout the different analysis. As we pointed out, HVAD patients actually were sicker, they had more ECMO, and they had more ventilation requirement or sicker patients INTERMACS level. Those are all carefully balanced in both propensity matching analysis and also multi-hazard analytics. And both of these analysis consistently showed that HVAD carried more risk of TIA and stroke compared to patients with HeartMate 3. Dr. Mercedes Carnethon: Thank you so much Sung-Min. You know what excites me as I think about choosing articles for journal clubs, when we're working with our trainees, the propensity matched approach and comparing it directly with what you're getting from multi-variable regression really provides an excellent methodological strategy to be able to generate results from these real world studies where it's not a randomized trial of who received which device, but we're able to yield practical conclusions that are actionable based on these findings when we have these well done analyses. And Marc alluded earlier to the actions that were taken in response to the findings from your study. Can you expand on those just a little bit more? Sung-Min Cho: Of course. So I guess, I don't know the real backstory, what was going on behind the scene, but I know for sure that STS leadership and INTERMACS leadership, they had a lot of discussion with the company who made HVAD device and also FDA, and I know that this study, the results of this study contributed to the decision they made back in June, pulling up HVAD device from the market. Sung-Min Cho: So I'm glad that this study could contribute to the science and hopefully this will help the patients in the future for device selection. So yeah. Dr. Marc Ruel: Sung-Min, I think it's fair to say that your study is probably, if not the most impactful in the field of ventricular assist devices, and I probably would personally think that it is, if not the single most impactful, certainly one of the two or three that are the most impactful. So congratulations to you and your team. Dr. Marc Ruel: If you still have a minute or two, I had a couple of more secondary questions? Dr. Marc Ruel In your analysis I noted that in the early acute phase, there are some protective predictors, such as performing the LVAD implant by sternotomy, which essentially results in about half of the neuro adverse events that you would otherwise observe. So I was a little intrigued by that. And high volume centers had about 1.8 hazard ratio. I suspect that's probably reflective of baseline risk and more acute illness in those patients coming. But if you have a chance, I'd love to hear your thoughts around this? Dr. Sung-Min Cho: Yeah, that's exactly what we thought actually is, initially we thought, hypothesized that surgical volume, the center volume will be associated with lower risk of stroke, but it was the other way around. But as you said, probably higher volume centers were getting sicker patients, so that's the association probably we were getting in the analysis. And we wanted to adjust for surgical techniques, sternotomy versus thoracotomy, and even after adjusting for that, HVAD remained a significant hazard per stroke, which showed in the table two and three, I think in the manuscript. Dr. Sung-Min Cho: And if I may, I want to say these couple of things. In the raw number, in the 6.4% of patients actually had TIA and strokes, neurological adverse events in HeartMate 3, at one year based on our study. And the risk goes up with a longer follow-up time of course. Moment3 trials had two-year follow-up, about 10% had stroke. And this is still, after HVAD is taken off the market, still there's a significant risk for stroke in these patients and based on autopsy and MRI studies although there is a very small studies--MRI studies, although they're a very small series, studies looking at MRI'd brains after explantation of LVAD. And it shows actually more than 95% of patients have cerebral micro bleeds, which is a marker for small vessel disease in the brain. I think this is an important issue, and although we show that one device had a lower risk of stroke, still question remains, are these patients have a high risk of stroke? And there is a need for improving biomedical engineering aspect, and I'm sure cardiologists and cardiothoracic surgeons know much better than I do regarding hemo-compatibility, especially for stroke. Dr. Sung-Min Cho: There is also a dire need for early detection and intervention for these events to improve the outcome for these patients, because once you have a stroke, the outcome is devastating, right? So I think there needs to be better medical management, neuroprotective agent, as well as neuro- monitoring methods, maybe biomarkers to predict stroke or TIA to come so we can intervene and prevent these really devastating complications. Dr. Marc Ruel: Mercedes, if I'm so allowed, I do have one final comment and question. Dr. Mercedes Carnethon: Most definitely. This has been delightful, so yes. Dr. Marc Ruel: Wonderful. So, first, Sung-Min, I want to thank you for working with us. We at Circulation were interested in your paper. You may recall you and I spoke on the phone offline when the decision to revise was made, and we went carefully over what the editors were anticipating would make your paper even better. And you were very responsive. You and your co-author's team were tremendous. And I think the paper that we have before us is absolutely very, very insightful and very important. And obviously tremendously impactful. So I want to thank you again for that. Dr. Marc Ruel: And my question is probably the very difficult question which is in everybody's mind at this point and I would like your take as a neurointensivist. You have someone who you have to care for who has a well-functioning HVAD, two years post implant. What would you recommend in terms of optimization for the prevention of neural adverse events? I realize we don't have all the information, but you are one of the few experts in the world who can probably provide us with a very valid take on this very difficult question. Dr. Sung-Min Cho: Yeah, it is indeed a difficult question. And that's what I am, including me a lot of neurointensivists, they are very interested in this topic. I think really, as I alluded before, only detection is really important, but it's really tough because either patients, they cannot get MRI. There's no way to know who's going to have stroke or not.   Dr. Sung-Min Cho: We know that a bacteremia is a huge risk factor for these patients. Whenever they have device infection, dry valve infection, bacteremia, their stroke risk goes up quite a bit. We have a lot of data on that. So we can carefully monitor these patients, follow these patients. There is some data that, within six days from infection, their stroke risk goes quite high up for these patients. Dr. Sung-Min Cho: But really, neuro-monitoring and biomarker study, there's so little data on this, but patients who are sick like this, not just LVAD patients but ECMO patients or ICU patients, are close neurologic monitoring and some markers to predict occurrence of a stroke or vascular event. I think that's something we really need to study and look into. Dr. Sung-Min Cho: Of course, we have a lot of biomarkers we can pick up from the brain, brain injury markers that we can study, and that has not been done in this space. And there are a lot of opportunities, I think, to look at that. And there's some signal based on Cleveland Clinic data that Randall Starling actually looked into, use of PDE5 inhibitor in this patient population, some protection against the ischemic stroke, and I think that's something also we should look into for neuroprotective agent. Dr. Mercedes Carnethon: Thank you so much! This has been such a delightful discussion this morning with Sung-Min Cho, the lead author of the study and the Associate Editor, Marc Ruel who handled it. Dr. Mercedes Carnethon: I really appreciate your attention. I hope the listeners enjoyed this episode of Circulation on the Run. Please join us again next time. Dr. Greg Hundley: This program is copyright of the American Heart Association, 2021. The opinions expressed by speakers in this podcast are their own and not necessarily those of the editors or of the American Heart Association. For more, visit ahajournals.org.  

The Roundtable
9/7/21 RT Panel

The Roundtable

Play Episode Listen Later Sep 7, 2021 76:34


The Roundtable Panel: a daily open discussion of issues in the news and beyond. Today's panelists are WAMC's Alan Chartock, UAlbany Adjunct and investigative journalist Rosemary Armao, The Empire Report's J.P. Miller, and former Associate Editor of The Times Union, Mike Spain.

The FOX News Rundown
Texas Abortion Law In The National Spotlight

The FOX News Rundown

Play Episode Listen Later Sep 7, 2021 27:21


Texas has passed what is being considered one of the most restrictive abortion laws in the nation, banning abortions after six weeks into pregnancy which health care providers have estimated could affect around 85 percent of the abortions carried out in the state of Texas. Before midnight on Wednesday, September 1st, the Supreme Court voted 5-4 to refuse to block this law. Associate Editor at The Wall Street Journal John Bussey joins to break down exactly what this bill does, why the Supreme Court refused to block the law but did not rule on its constitutionality, and how this law deputizes private citizens to enforce the law via lawsuits against anyone who aids and abets an abortion. Bussey also explains how Roe v. Wade could be struck down by the conservative-leaning Supreme Court and what to expect nationally on abortion law in the near and distant future.   While the 2022 Midterm may be 14 months away, there's a lot at stake for both parties in next year's election. Democrats are hoping to maintain their narrow majority while Republicans are hoping for a red wave to regain both the House and Senate. FOX News National Politics reporter Paul Steinhauser joins to weigh in on if the issues like the Afghanistan withdrawal, coronavirus, inflation, and President Biden's performance will impact the races. He also discusses some of the battleground states to keep an eye on and if Republicans will be able to flip some seats.   Plus, commentary by former Rep. Jason Chaffetz, host of the Jason in the House podcast.

Hacks & Wonks
Week in Review: September 3, 2021

Hacks & Wonks

Play Episode Listen Later Sep 3, 2021 34:57


Today on the show Crystal is joined by a new co-host, Rich Smith, Associate Editor of The Stranger! They discuss competing plans to tackle homelessness in the mayoral race, a ridiculously racist email sent (recently!) by Bellevue School Board candidate Faye Yang, the deep need for accessibility to be central to transportation planning, and a rare alliance of landlords and renters threatening to sue King County to expedite the distribution of rental relief funds. As always, a full text transcript of the show is available below and at officialhacksandwonks.com. Find the host, Crystal Fincher on Twitter at @finchfrii and find today's co-host, Rich Smith, at @richsssmith. More info is available at officialhacksandwonks.com.   Resources “Bruce Harrell vows action on homelessness in parks, M. Lorena Gonzalez responds as Seattle mayoral race restarts” by Daniel Beekman of The Seattle Times: https://www.seattletimes.com/seattle-news/politics/bruce-harrell-vows-action-on-homelessness-in-parks-m-lorena-gonzalez-responds-as-seattles-mayoral-race-restarts/  “Compassion Seattle measure will now appear on November ballot after court rejects appeal” from the Associated Press via King 5: https://www.king5.com/article/news/politics/compassion-seattle-homeless-measure-appeal-ballot-rejection/281-93aaa118-a937-4021-a118-eca1622679aa  “Bellevue School Board Candidate Argued that Black and Latino Kids Have Lower IQs Due to Genetics, Cited Debunked Book” by Rich Smith from The Stranger: https://www.thestranger.com/slog/2021/08/30/60818943/bellevue-school-board-candidate-argues-that-black-and-latino-kids-have-lower-iqs-due-to-genetics-cites-debunked-book  “Report Calls for Radical Inclusion of Disabled Nondrivers in Transportation Planning” by Natalie Bicknell Argerious from The Urbanist: https://www.theurbanist.org/2021/09/02/report-calls-for-radical-inclusion-of-disabled-nondrivers-in-planning/  “Landlord and tenant groups threaten to sue King County to speed up rent assistance” by Heidi Groover from The Seattle Times: https://www.seattletimes.com/business/real-estate/in-rare-partnership-landlord-and-tenant-groups-demand-king-county-speed-up-rent-assistance/    Transcript:  Transcript will be uploaded in the next week.

RTÉ - Morning Ireland
President Biden again defends decision to withdraw from Afghanistan

RTÉ - Morning Ireland

Play Episode Listen Later Sep 1, 2021 5:47


Edward Luce, Washington DC-based Associate Editor of the Financial Times, discusses President Biden's defence of his decision to withdraw US troops from Afghanistan.

Peak Human - Unbiased Nutrition Info for Optimum Health, Fitness & Living
Part 134 - Dr. James DiNicolantonio on What Minerals (And Foods) To Eat for Peak Human Health

Peak Human - Unbiased Nutrition Info for Optimum Health, Fitness & Living

Play Episode Listen Later Aug 31, 2021 63:19


Dr. James DiNicolantonio is a cardiovascular research scientist and doctor of pharmacy at Saint Luke's Mid America Heart Institute in Kansas City, Missouri, and author of The Salt Fix, Superfuel, and The Mineral Fix.  A well-respected and internationally known scientist and expert on health and nutrition, he has contributed extensively to health policy and has even testified in front of the Canadian Senate regarding the harms of added sugars.  Dr. DiNicolantonio serves as the Associate Editor of Nutrition and British Medical Journal's (BMJ) Open Heart, a journal published in partnership with the British Cardiovascular Society.  He is the author or coauthor of approximately 200 publications in the medical literature. He is also on the editorial advisory boards of several medical journals.  He has shared his expertise on The Dr. Oz Show, The Doctors, and international news media outlets.   GET THE MEAT! http://NosetoTail.org GET THE FREE SAPIEN FOOD GUIDE! http://Sapien.org Try the Lumen device! Click here or use the code “foodlies” to get 10% off!   SHOW NOTES: [5:20] His new book: The Mineral Fix [6:10] Micronutrients run the show. [8:20] How to manage nutrient density [10:40] Calcium and magnesium in animal foods [14:50] How to offset acid retention from animal foods [17:20] Should you add baking soda to your water? [19:30] What are the safest plant foods? [21:05] The ratio of minerals to heavy metals [23:40] Best dietary sources of copper [25:45] Ancestral meats, like bison, are extremely nutrient dense [27:15] Chronic disease depletes minerals like copper [30:00] Why is copper so important? [34:00] Oysters & the immune system [36:20] Why don't animals have mineral issues? [38:10] The free-radical theory of aging [42:20] His list of superfoods [46:00] Plain water vs. Mineral water [51:30] Heat acclimatization & salt intake [53:50] Fermented foods, seaweed, and fortification [57:15] Magnesium, sulfur, and chromium     GET THE MEAT! http://NosetoTail.org GET THE FREE SAPIEN FOOD GUIDE! http://Sapien.org   Follow along: http://twitter.com/FoodLiesOrg http://instagram.com/food.lies http://facebook.com/FoodLiesOrg  

The Roundtable
8/31/21 RT Panel

The Roundtable

Play Episode Listen Later Aug 31, 2021 75:39


The Roundtable Panel: a daily open discussion of issues in the news and beyond. Today's panelists are WAMC's Alan Chartock, UAlbany Adjunct Professor and investigative journalist Rosemary Armao, Political consultant and lobbyist Libby Post, and former Associate Editor of the Times Union Mike Spain.

The Classical Ideas Podcast
EP 212: Heaven Narratives w/Dr. Brook Wilensky-Lanford

The Classical Ideas Podcast

Play Episode Listen Later Aug 31, 2021 43:36


Brook Wilensky-Lanford is the author of Paradise Lust: Searching for the Garden of Eden (Grove Press, 2011), and former editor-in-chief of the online magazine of religion, culture and politics Killing the Buddha. She received her PhD in American Religion from University of North Carolina at Chapel Hill and her M.F.A. in Nonfiction Writing from Columbia. An Associate Editor of The Commons at the Association for Public Religion and Intellectual Life, Brook is fascinated by utopias, origin stories, religious liberalism, and spirituality. Follow Dr. Wilensky-Lanford on Twitter: https://twitter.com/modmyth Visit Sacred Writes online: https://www.sacred-writes.org/

The Quicky
Is International Travel Really On The Horizon?

The Quicky

Play Episode Listen Later Aug 29, 2021 15:38


Qantas has released an emotional new ad depicting a number of people getting ready for the their first post-covid trip overseas, which had many of us in floods of tears thinking about what we have been missing since Australia's international border closed. But it is the timing of this ad that has caused the most intrigue, with many people wondering if it means the Government is planning to reopen the border sometime soon? The Quicky speaks to an international travel journalist and a Federal Minister to find out whether we really will be 'flying away' in the not-too-distant future. CREDITS  Host/Producer: Claire Murphy Executive Producer: Siobhán Moran-McFarlane Audio Producer: Ian Camilleri Guests: Dan Tehan - Federal Minister for Trade, Tourism and Investment Chris Chamberlin - International business travel journalist and Associate Editor of Executive Traveller Subscribe to The Quicky at... https://mamamia.com.au/the-quicky/ CONTACT US Got a topic you'd like us to cover? Send us an email at thequicky@mamamia.com.au Mamamia acknowledges the Traditional Owners of the Land we have recorded this podcast on, the Gadigal people of the Eora Nation. We pay our respects to their Elders past and present and extend that respect to all Aboriginal and Torres Strait Islander cultures. Support the show: https://www.mamamia.com.au/mplus/ See omnystudio.com/listener for privacy information.

Let’s Go There with Shira & Ryan
8/27 Our Therapy Session Ft. David Archuleta

Let’s Go There with Shira & Ryan

Play Episode Listen Later Aug 28, 2021 55:33


Happy Friday! We have a very special show today! American Idol alum David Archuleta joins us, and we get deep. Also, there's been a lot of confusion around booster shots- so we are breaking down what you need to know. Plus, why you can't blame your metabolism for your weight gain as you age. Let's go there!   Special guests: Anita Kumar - White House Correspondent & Associate Editor at POLITICO. Kavita Patel - Primary care physician, is a nonresident fellow at the Brookings Institution.  Herman Pontzer - Author of the book Burn on human metabolism and professor at Duke University. David Archuleta - Singer, songwriter. See omnystudio.com/listener for privacy information.

The One You Feed
425: Therese Borchard on Strategies for Depression

The One You Feed

Play Episode Listen Later Aug 27, 2021 39:02


Therese Borchard is the author of Beyond Blue and The Pocket Therapist. She blogs for Everyday Health and is an Associate Editor and a regular contributor to Psych Central. She writes about her own struggles with depression.In this episode, Eric and Therese discuss her book, Beyond Blue: Surviving Depression & Anxiety and Making the Most of Bad GenesBut wait – there's more! The episode is not quite over!! We continue the conversation and you can access this exclusive content right in your podcast player feed. Head over to our Patreon page and pledge to donate just $10 a month. It's that simple and we'll give you good stuff as a thank you!In This Interview, Therese Borchard and I Discuss Strategies for Depression and …Her book, Beyond Blue: Surviving Depression & Anxiety and Making the Most of Bad GenesHer struggle with treatment-resistant depressionHow she combined a holistic and traditional approach to treating her depressionAvoiding important conversations when hungry, angry, lonely, and tired (HALT)The importance of connecting with others who share the same challengesWhy there are not more depression support groupsThe difference between mental health and 12 step cultureLearning to live with the messiness of life and accepting things as they areTherese Borchard Links:Therese's WebsiteProject Hope and BeyondFacebookTwitterIf you enjoyed this conversation with Therese Borchard, you might also enjoy these other episodes:Brent Williams on Recovering From DepressionMark Henick on Suicide and DepressionSee Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

PRS Global Open Keynotes
“Is there Gender Bias in Plastic Surgery?” with Alexandra Bucknor MD and Heather Furnas MD

PRS Global Open Keynotes

Play Episode Listen Later Aug 24, 2021 24:34


In this episode of the PRS Global Open Keynotes Podcast, Dr. Alexandra Bucknor and Dr. Heather Furnas discuss implicit bias within the field of plastic surgery using a gender-specific Implicit Association Test (IAT), specifically looking at gender and career stereotypes. This episode discusses the following PRS Global Open article: “Testing for Implicit Gender Bias among Plastic Surgeons” by Alexandra Bucknor, Ledibabari M. Ngaage, Kirsten J. Taylor, Parisa Kamali, Hinne A. Rakhorst, Irene M. J. Mathijssen and Heather Furnas. Read it for free on PRSGlobalOpen.com: https://bit.ly/GenderBiasinPS Dr. Bucknor is a Plastic Surgery Registrar at Queen Victoria Hospital in East Grinstead, United Kingdom. Dr. Furnas is a board-certified plastic surgeon, Adjunct Clinical Associate Professor of Plastic Surgery, the Plastic Surgery Focus Section Editor of “Plastic and Reconstructive Surgery,” and an Associate Editor on the Editorial Board of “PRS Global Open.” Your host, Dr. Damian Marucci, is a board-certified plastic surgeon and Associate Professor of Surgery at the University of Sydney in Australia. #PRSGlobalOpen #KeynotesPodcast #PlasticSurgery

The Roundtable
8/24/21 RT Panel

The Roundtable

Play Episode Listen Later Aug 24, 2021 66:43


The Roundtable Panel: a daily open discussion of issues in the news and beyond. Today's panelists are WAMC's Alan Chartock, UAlbany Adjunct and investigative journalist Rosemary Armao, The Empire Report's J.P. Miller, and former Associate Editor of The Times Union, Mike Spain.

The FOX News Rundown
Jobless Claims Hit Pandemic Low, But Delta Is Shaking Consumers

The FOX News Rundown

Play Episode Listen Later Aug 23, 2021 27:55


The U.S. economy continued to bounce back this month, bringing jobless claims to a low for the pandemic, however, the market and businesses still have a long road to recovery. Inflation continues to rise despite assurance from the Federal Reserve that the inflation would be only transitory, multiple industries are facing labor shortages due to a record number of Americans leaving their jobs and the Delta variant is spreading quickly throughout the country. Associate Editor at The Wall Street Journal John Bussey joins to explain how jobless claims can decrease while American workers are quitting at record rates, the way the Delta variant will impact consumer spending habits, and strong signals from the Fed that the inflation the U.S. is facing is not as temporary as originally expected.   Throughout American history, some events have remained unexplained or at least subject to debate. Some famous conspiracy theories that still get attention to this day include D.B. Cooper, President John F. Kennedy's assassination and Area 51. Best-selling author and FOX Nation host Brad Meltzer joins to talk about his new FOX Nation series, “Greatest Conspiracies OF All Time.” He explains why Americans especially are obsessed with them and if he thinks in a few years from now if we will be doing a deep dive into the coronavirus lab leak in Wuhan, China.   Plus, commentary by Guy Benson, host of the Guy Benson Show.

Fast Keto with Ketogenic Girl
PROTEIN SERIES: World Protein Expert Dr. Don Layman

Fast Keto with Ketogenic Girl

Play Episode Listen Later Aug 19, 2021 78:47


Hi friends!! This episode is part of the special Protein Series we are featuring this summer with some of the TOP experts in the world on protein! Every week we will be playing the BEST of episodes on protein that you may have missed including Dr. Stu Phillips, Dr. Ted Naiman, Dr. Jose Antonio, Dr. Don Layman (his first episode on Fast Keto) and more! It will also include some of the episodes that I have done on my high protein experiment as I still get a LOT of questions on this! This is the first time that Dr. Don Layman was on Fast Keto! Dr. Donald Layman is Professor Emeritus in the Department of Food Science & Human Nutrition at the University of Illinois at Urbana-Champaign. Dr. Layman has been a leader in research about protein, nutrition for athletic performance, obesity, diabetes and cardiovascular health. Dr. Layman has over 100 peer-reviewed publications. He has received numerous awards for his research from the American Society for Nutrition and the National Institutes for Health and for his nutrition teaching. Dr. Layman currently serves as Associate Editor of the Journal of Nutrition Education and Behavior and on the editorial boards of Nutrition & Metabolism, and Nutrition Research and Practice. Dr. Layman has an extensive consulting background including work with NASA, the Shriners Children's Hospital, the US Air Force plus numerous food companies and organizations including Kraft Foods, Nestlé, Agropur and the National Dairy Council. Dr. Layman earned his doctorate in human nutrition and biochemistry at the University of Minnesota.  Follow @ketogenicgirl on Instagram to see visuals and posts mentioned on this podcast. Try the FREE calorie & macro calculator HERE Get Your FREE ebook on keto here: https://www.ketogenicgirl.com/pages/free-ebook Try the High Protein Keto Meal Plans & Coaching: https://www.ketogenicgirl.com Special thank you to Fast Keto sponsors: Try Proper Good's new Keto line of Soups! They are made with good for you ingredients and fit your keto macros! Easy, portable and ready to eat in just 90 minutes! Use the code KETOGENIC15 for 15% off your order at www.eatpropergood.com - Try Athletic Greens! ONE tasty scoop of Athletic Greens contains 75 vitamins, minerals and whole food-sourced ingredients, including a multivitamin, multimineral, probiotic, greens superfood blend and more, that all work together to fill the nutritional gaps in your diet, increase energy and focus, aid with digestion and supports a healthy immune system, all without the need to take multiple products or pills. Visit www.athleticgreens.com/ketogenicgirl and join health experts, athletes and health conscious go-getters around the world who make a daily commitment to their health every day. Again, simply visit www.athleticgreens.com/ketogenicgirl and get your FREE year supply of Vitamin D and 5 free travel packs today. Pregnant or nursing women should seek professional medical advice before taking this or any other dietary supplement. - Prior to beginning a ketogenic diet you should undergo a health screening with your physician to confirm that a ketogenic diet is suitable for you and to rule out any conditions and contraindications that may pose risks or are incompatible with a ketogenic diet, including by way of example: conditions affecting the kidneys, liver or pancreas; muscular dystrophy; pregnancy; breast-feeding; being underweight; eating disorders; any health condition that requires a special diet [other conditions or contraindications]; hypoglycemia; or type 1 diabetes. A ketogenic diet may or may not be appropriate if you have type 2 diabetes, so you must consult with your physician if you have this condition. Anyone under the age of 18 should consult with their physician and their parents or legal guardian before beginning such a diet]. Use of Ketogenic Girl videos are subject to the Ketogenicgirl.com Terms of Use and Medical Disclaimer. All rights reserved. If you do not agree with these terms, do not listen to, or view any Ketogenic Girl podcasts or videos.  

The Doctor's Farmacy with Mark Hyman, M.D.
The Secret to Longevity, Reversing Disease and Optimal Health: Fixing Metabolism with Dr. Casey Means

The Doctor's Farmacy with Mark Hyman, M.D.

Play Episode Listen Later Aug 11, 2021 59:49


The Secret to Longevity, Reversing Disease and Optimal Health: Fixing Metabolism | This episode is brought to you by Joovv, ButcherBox, BiOptimizersThere are three key biomarkers that can show us where a person's metabolic health falls: blood sugar, blood pressure, and cholesterol. When we see these are higher than the optimal range, one of the main drivers they all relate back to is insulin resistance. Dysfunction in our metabolic health paves the road for chronic disease. That's why it's so important to regulate our blood sugar and insulin responses. Now, with the help of continuous glucose monitors, that's becoming easier and more personalized than ever before. Today, I'm excited to talk to Dr. Casey Means about the importance of metabolic health for longevity and how we can use real-time feedback to cut through the mixed messages on nutrition and hone in our diets. Dr. Casey Means is a Stanford-trained physician, Chief Medical Officer and Co-founder of metabolic health company Levels, an Associate Editor of the International Journal of Disease Reversal and Prevention, and a Lecturer at Stanford University. Her mission is to maximize human potential and reverse the epidemic of preventable chronic disease by empowering individuals with tools that can facilitate deep understanding of our bodies and inform personalized and sustainable dietary and lifestyle choices. Dr. Means' perspective has been recently featured in the New York Times, Wall Street Journal, Men's Health, Forbes, Business Insider, Techcrunch, Entrepreneur Magazine, Metabolism, Endocrine Today, and more.This episode is brought to you by Joovv, ButcherBox, BiOptimizers.Joovv is offering Doctor's Farmacy listeners an exclusive discount on Joovv's Generation 3.0 devices. Just go to Joovv.com/farmacy and use the code FARMACY. Some exclusions do apply. Right now ButcherBox has a special offer for new members. If you sign up today, you'll get 2 100% grass-fed ribeyes free in your first box plus $10 off by going to butcherbox.com/farmacy. BiOptimizers is offering Doctor's Farmacy listeners 10% off your Magnesium Breakthrough order. Just go to magbreakthrough.com/hyman and use code HYMAN10 to receive this amazing offer.Here are more of the details from our interview: Why Dr. Means left her role as an ENT surgeon to pursue Functional Medicine and work to improve metabolic health across the population (5:09)Indicators of poor metabolic health and how metabolism works (13:47)The same foods can affect blood sugar levels differently for different people (24:23)What happens to your body when your blood sugar is out of control? (30:58)Insulin resistance as a precursor to obesity and a range of chronic diseases (33:15)How wearing a continuous glucose monitor can lead to personal empowerment around our own health and improve the doctor-patient relationship (38:54)Insulin's role in weight gain and loss (45:17)Lessons learned from Levels users (47:23)How the time of day that you eat can cause variation in glucose levels (50:10)Changing dietary behavior (53:41)Skip the line to participate in Levels early access program today with the link levels.link/hyman.Follow Dr. Casey Means on Instagram @drcaseyskitchen and on Twitter @drcaseyskitchen.Keep up to date with Levels at levelshealth.com/blog and on Instagram @levels and on Twitter @levels. See acast.com/privacy for privacy and opt-out information.