Podcasts about authors dr

When it comes to girls' sports in interscholastic athletics, on the surface it appears they have equal opportunties compared to boys. In reality, there may be small things beneath the surface that communicate something different to the girls in an athletic department. Authors Dr. Tim Green and Dr. Allison Kelley talk in-depth about this topic in an article in the Summer 2025 IAA. Join us as we discuss the article and more together! Follow us on: Bluesky || Twitter || Facebook || Instagram || LinkedIn Music Track: Stadium Rock by Pufino Source: freetouse.com/music Copyright Free Background Music

Up next for our curriculum series is an episode on Nephrology! Take a listen so that you're prepared for our pre-test! Authors: Dr. Lara Melo Soares Pinho de Carvalho, PGY-3, and Dr. Ritika Kompella, Chief Medical Resident, UCONN  Host: Dr. Ritika Kompella, Chief Medical Resident, UCONN  Guest speakers:  Acute kidney injury in liver failure: Dr. Ruchir Trivedi, Associate Professor of Medicine, Department of Nephrology Paraproteinemia and Amyloidosis- Dr. Srimathi Manickaratnam, Department of Nephrology  Hyponatremia: Dr. Lalarukh Haider, Department of Nephrology

Meniscus tears have historically been treated with arthroscopy. However, compelling data has shown that this surgery does not work for degenerative meniscus tears. Physical therapy, conversely, has been shown to be a more effective measure for the degenerative meniscus tear, and is a more reasonable first-line measure compared to arthroscopic menisectomy. Still, the public's perception, guided by decades of advice from Sports Medicine Specialists that arthroscopy is the answer for all meniscus tears regardless of the chondral condition in the knee, has not changed with current evidence. This can create uncomfortable conversations with patients who have a degenerative meniscus tear and expect arthroscopy. Coming to us from the University of Buffalo, Drs. Nomi Weiss-Laxer and Leslie Bisson discuss their study examining patient perceptions and expectations of nonoperative treatment for degenerative meniscus tears.

Episode 131: Reimagining the Role of Teachers in Nature-Based Learning with Dr. Rachel Larimore and Dr. Claire WardenWelcome to episode 131 of our podcast, where we are excited to host Dr. Rachel Larimore and Dr. Claire Warden, authors of the enlightening book, "Reimagining the Role of Teachers in Nature-Based Learning." Join us as we dive into the dynamic world of nature-based education and explore transformative insights that promise to redefine how educators engage with their students.In This Episode, You'll Discover:Insights from the Authors: Dr. Larimore and Dr. Warden share compelling narratives and practical strategies from their latest work, transforming traditional teaching approaches through nature-based education.Integrating Nature into Learning: Discover how incorporating natural elements into curricula can enhance curiosity and student engagement, creating a more holistic and enriching learning experience.Redefining Educator Roles: Learn about the evolving role of educators as guides who facilitate learning experiences that harness the powerful benefits of the natural world.Real-World Applications and Strategies: Explore real-world examples and actionable strategies for educators interested in adopting nature-based teaching methods in their classrooms.About Our Guests:Dr. Rachel Larimore is an educator, consultant, and former nature-based preschool director. For nearly 30 years her work has focused on the intentional integration of nature to support young children's holistic development by learning with nature to expand their worlds and live rich, full lives. She has written multiple books including Preschool Beyond Walls: Blending Early Childhood Education and Nature-Based Learning, Evaluating Natureness: Measuring the Quality of Nature-based Classrooms in Pre-k Through 3rd Grade, and her newest book Reimagining the Role of Teachers in Nature-based Learning: Helping Children be Curious, Confident, and Caring. Rachel is the founder and Chief Visionary of Samara Early Learning, an organization focused on helping early childhood educators start nature-based schools or add nature-based approaches into their existing program. Prior to founding Samara, she spent more than a decade starting and directing one of the first nature-based preschools in the United States.Dr. Claire Warden is the Founder of the not-for-profit Living Classrooms and the International Association of Nature Pedagogy (IANP), CEO of Claire Warden Ltd., and Founder and Academic Advisor to the Mindstretchers Academy. She has recently been recognised for her original contribution in the field of education for her thesis ‘The Creation and Theorisation of Nature Pedagogy'. Her inspirational research and approach to experiential learning has developed through a variety of experiences including primary teaching, advisory work, lecturing in further education and development of the award winning Auchlone Nature Kindergarten in Scotland. Claire works with governments and associations around the world to create high quality nature-based models of education learning with nature inside, outside and beyond. Her philanthropic work includes international advisor to the Children and Nature Network, World Forum Foundation, International School Grounds Group and the board of National Trust Scotland.Tune In and Get Inspired!Join us for an enlightening conversation that promises to inspire educators, parents, and anyone interested in the profound impact of nature on learning. Whether you're a teacher looking to innovate your teaching methods or a nature enthusiast curious about education, this episode is rich with...

In this episode of Trending in Education, we talk with Dr. Eileen Wilson-Oyelaran and Dr. Terrence J. MacTaggart, co-authors of 'The New College President: How a Generation of Diverse Leaders is Changing Higher Education.' We delve into their respective backgrounds, the challenges faced by college presidents today, and the importance of diversity and resilience in leadership. Eileen and Terry share insights from their extensive research, including seven compelling case studies of university leaders who have thrived amidst adversity. We also discuss the future of higher education, the importance of mission-driven leadership, and how to identify and support potential candidates from diverse backgrounds. Don't miss this surprising deep-dive into what it takes to thrive in higher ed leadership in challenging times. Subscribe to Trending in Ed wherever you get your podcasts. Visit us at TrendinginEd.com for more.

Season 4: Episode 44 In this series, Mike celebrates authors. People who have a message and a story to share and who have done the hard work to get their message out there. In this episode, Mike interviews Laura Anderson, PhD, MA, Author of ⁠⁠⁠⁠⁠⁠⁠⁠When Religion Hurts You.⁠ ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Everything Numa⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ ⁠⁠⁠⁠⁠ ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Queer and Affirming Writer's Collective⁠⁠⁠⁠ Center for Trauma Resolution and Recovery⁠⁠⁠ Dr. Laura Anderson Instagram⁠

Historically, ACL repair resulted in poor outcomes and this procedure fell out of favor while ACL reconstruction became the gold-standard surgical approach for a torn ACL. Recently, thanks in part to the advent of more modern techniques, ACL repair has regained interest in the Sports Medicine community as a potentially viable option in certain situations that may provide advantages in comparison to ACL reconstruction. To this point, the literature comparing these two surgeries with modern techniques has been heterogenous in terms of quality and design, and results have been mixed. Drs. Kyle Kunze, MD and Benedict Nwachukwu, MD, MBA and their team from Hospital of Special Surgery (HSS) bring us this systematic review and meta-analysis to cull the best literature available. Their findings indicate that, while ACL repair may have an evolving role in our toolbox, its failure rate remains higher than that of ACL reconstruction and thus should be approached with caution.

Faith and Reason: In the Church Fathers and Ecclesiastical Authors | Dr.Mark Edwards by Angelicum Thomistic Institute

Welcome Back No-Problem Parents! Are you struggling to maintain your confidence as a parent while juggling school challenges? Our guest experts, Dr. Ardium and Dr. Wallace, introduce their groundbreaking book, "Wisest Learners," designed to transform your approach to your child's academic success. In this episode, we learn the three-step Parental Engagement Cycle (PEC)—modeling, Elucidation, and Feedback—and discuss the power of words and effective strategies to motivate your child from within. Whether you're dealing with toddler tantrums or teenage eye rolls, this episode is packed with invaluable advice to help you become the confident leader your kids crave.    Learn More about Wallace by clicking the links below: Our social media links: Facebook: http://smpl.ro/WisestLearnersFacebook Instagram: http://smpl.ro/WisestLearnersInstagram Tiktok: http://smpl.ro/WisestLearnersTiktok LinkedIn: http://smpl.ro/WisestLearnersLinkedIn Our website and our contact email: Website: http://smpl.ro/WisestLearnersWebsite Info: http://smpl.ro/WisestlearnersInfo   Thank you for tuning in to the No Problem Parenting podcast - Please take a minute to share the podcast, comment or leave a review.   FREE PARENTING RESOURCES: 60 Ways to Respond to Your Kids without Losing Your Cool Make it Right Technique PDF Everyday Essentials eBook   Better Sleep: Decrease Stress with the 7-Day free trial of NuCalm Enter Code: NOPROBLEM for 15% off all products.   Become the Confident Leader Your Kids Crave you to be! Become a No-Problem Parent Book Your 90-Minute Strategy Session Put your oxygen mask on first: Find More Resources Here   FB - IG - LinkedIn - YouTube - Twitter - Threads   Check out our Books! No-Problem Parenting; Raising Your Kiddos with More Confidence and Less Fear No Problem Parenting; Resources and Stories that Create Confidence and Connection   Hugs and High Fives, You Got This!   Jaci Finneman

From the publisher, Roaring Book Press: Witch Hunt: The Cold War, Joe McCarthy, and the Red Scare provides a gripping account of one of the most tumultuous periods in American history. Authors Dr. Andrea Balis and Elizabeth Levy delve into Senator Joe McCarthy's infamous hunt for communists during the 1950s Red Scare. Originally written for young adult and teen audiences, the book is written in a unique screenplay-style format with rich illustrations and includes interviews with individuals who recalled their childhood experiences of McCarthyism. With meticulous research and attention to detail, The authors shed light on the human stories behind historical events, filling in the critical gaps in historical knowledge, ensuring that the lessons of the past are not forgotten in today's rapidly changing world.Support our show at https://patreon.com/axelbankhistory**A portion of every contribution is given to a charity for children's literacy** "Axelbank Reports History and Today" can be found on social media at https://twitter.com/axelbankhistoryhttps://instagram.com/axelbankhistoryhttps://facebook.com/axelbankhistoryThe Family Histories PodcastJoin us and our guests as they reveal the fascinating lives of those in their family tree.Listen on: Apple Podcasts Spotify

This episode of The Shift Health Coach Podcast features  Dr. Donna Gaffney and Nicole Foster, discussing their new book, Courageous Well-Being for Nurses. The book offers nurses practical, research-backed strategies for maintaining well-being in the face of the demanding healthcare sector. We'll cover the development of their collaborative project, the impact of their work during the pandemic, and the essential practices they recommend for nurses to sustain their health and psychological resilience. Join us as we explore effective ways for nurses to integrate self-care into their daily routines and the benefits of community and advocacy in promoting professional well-being.More about the Authors:Dr. Donna Gaffney is a board certified psychiatric-mental health clinical nurse specialist and psychotherapist. She has long addressed stress, loss, and trauma in the lives of adults and children, communities, and healthcare professionals— providing clinical and educational interventions in theaftermath of personal trauma and crisis as well as national disasters. In addition to Courageous Well-Being for Nurses, she is the author of numerous academic publications and The Seasons of Grief: Helping Children Grow Through Loss. In 2021, she was awarded the American Psychiatric Nurses Association Award for Excellence in Practice-APRN. Donna lives in Los Angeles. You can learn more about Donna'swork at https://www.donnagaffney.com/Nicole C. Foster, MA, NBC-HWC, is a national board-certified health and wellnesscoach and holds a Masters in Psychology and Spirituality, Mind-Body from ColumbiaUniversity. In her coaching practice, she partners with clients of all ages and abilities tooptimize their well-being and reduce stress through evidence-based strategies. She isthe co-author of Courageous Well-Being for Nurses, published by Johns HopkinsUniversity Press (2023). Learn more about her work at www.NicoleCFoster.com and onInstagram @NicoleCFosterIf you are a health coach interested in joining other health coaches for growth and community visit Health Coach Growth Network on Facebook.Music by Alex Grohl and Pixabay click here to listen to learn more

This week on Facially Conscious, we have not one but two esteemed guests joining us to discuss new findings about the microbiome and what it means for your skincare. We welcome back the beloved Dr. Doris Day, an award-winning board-certified dermatologist and author of three insightful books, all available on her bio link on our website. Joining Dr. Day is the accomplished Thomas M. Hitchcock, Ph.D., a geneticist turned holobiontologist specializing in the skin biome, currently serving as CSO at Crown Laboratories. Together, they offer a sneak peek into their collaborative work, "Rebooting the Biome," providing invaluable insights into understanding the microbiome and nurturing the skin ecosystem. Don't miss out on this informative episode and stay tuned for their future appearances on our podcast. For more information about Dr. Doris Day and Dr. Thomas Hitchcock, visit our website today! **Disclaimer** Any articles or information we say "are in the show notes" can be found in our blog about this episode ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠blog⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ at ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠faciallyconscious.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠.  Have a question? Send us an email at ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠info@faciallyconscious.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ LIKE, FOLLOW & REVIEW US ON ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠INSTAGRAM⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠, & WHERE YOU LISTEN TO ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠PODCASTS⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠! Visit our website ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠faciallyconscious.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Join our new Patreon and  ⁠⁠⁠⁠⁠⁠Substack⁠⁠⁠⁠⁠⁠ for more content from Facially Conscious Follow Our Hosts On Instagram ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Trina Renea⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ - Medically-trained master esthetician and celebrities' secret weapon @trinareneaskincare and trinarenea.com ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Julie Falls⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠- Our educated consumer who is here representing you! @juliefdotcom ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Dr. Vicki Rapaport⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ -Board Certified dermatologist with practices in Beverly Hills and Culver City @rapaportdermatology and https://www.rapdermbh.com/ ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Rebecca Gadberry⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ - Our resident skincare scientist and regulatory and marketing expert. @rgadberry_skincareingredients Credits Produced and Recorded by The Field Audio --- Support this podcast: https://podcasters.spotify.com/pod/show/faciallyconscious/support

One more unexpected episode before we dive into Gen V. But it's a fascinating one as we got talk about "Supes Ain't Always Heroes: Inside the Complex Characters and Twisted Psychology of The Boys" with Authors Dr. Lynn Zubernis and Dr. Matthew Snyder. Join us for a sneak peek at the book and a discussion about incredibly realistic characters and portrayals, Campbells (both of em) Hero's Journey, the compex case of Daddy Soldier Boy, and which Supe these psychologists would least like to treat. Thanks to Lynn & Matthew for joining us and helping us dive deeper into the show we all love. "Supes Ain't Always Heroes" is out on Dec 5th 2023 but is available for Pre-Order now from https://smartpopbooks.com/theboys/ Lynn also has several greats books about Kripke's other massive success "Supernatural" and runs @FangasmSPN on Twitter. Follow us on Twitter @Rantsmono or send your own rants to monorantspodcast@gmail.com [APOLOGIES FOR THE POOR AUDIO QUALITY IN PARTS. WE HAD AUDIO PROBLEMS RECORDING, BUT DID THE BEST WE COULD TO CLEAN IT UP]

Authors Dr. George “Jeep” Naum, DO & Vanessa Naum, MBA

Today on Write Now, Dr. Pamela hosts Best Selling Authors: Dr. Sarita Graham & Shamika Minisee from the recently released anthology Igniting the Millionaire: Become Her to Be Her!! When you ignite the millionaire within you, you're not just unlocking financial success, but you're also opening yourself up to a world of endless possibilities. That means you have no limits. It's time to focus, dream bigger, and BE FIERCE, BE HUNGRY. Be prepared to win and eat at the table! Dr. Sarita L. Graham is a world-class facilitator, advisor, cleric, and CEO and Founder of Sarita Lynne Ministries, a multi-dimensional conglomerate, servicing various communal and educational exigencies. In 2005, she brought life to The Princess House, a memorialized transitory housing haven, named for her late daughter; committed entirely to the sole purpose of rehabilitation, homelessness prevention, and the overall safety, of women. The quarterage proved itself quintessential, as its growing numbers led to more than two locations, including two male service-based wings; Isaiah's Place, in 2008 and Joshua's Safe place, in 2015, both designed to promote balance and responsible independent living, by preventing relapse and recidivism. To date, Dr. Sarita L. Graham has served more than 15000 men and women; helping them to transform their lives, obtain housing, a relationship with God, employment, and restoration. Her mantra is clear: She was born to live out her faith in action; to serve humanity through acts of love, humility, and essential purpose. Dr. Sarita L. Graham. Leader. Organizer. Humanitarian. www.saritalynneministries.com Shamika Minisee is CEO and Co-Founder of Presidential Concrete LLC and The Minisee Group and is on a mission to help women build and grow profitable careers and companies. Trained as a Contracting Professional, she has a unique 17-year background in strategic planning, communications, leadership, acquisition management on multi-billion development projects, research, professional writing, and business development, providing her clients with unique advantages. As an empowerment expert dedicated to helping others fully embrace their power and honor their potential, Shamika delivers a dynamic and motivational message with humor, passion, and inspiration. She has the makings of a major business entity with the persona, wit, and credentials to back it up. Connect with Shamika: linktr.ee/shamikaminisee Thank you for joining us today… For more about Dr. Pamela or to apply to be on one of her shows, go to https://linktr.ee/Purposewithpamela

Authors Dr. Evans Baiya and Professor Timothy Waema move into Stage 6 of the 7 Stages of Strategy: Strategic Execution. In this conversation with host Dale Dixon on their latest book, “Optimizing Strategy for Results,” (co-authored with Ron Price) they examine the importance of communication, repetition, feedback, and accountability for everyone in the organization. With simple, predictable workflows and continuous feedback, this stage will help you produce impactful results. Learn more about the 7 Stages of Strategy at optimizingstrategyforresults.com and purchase your copy of the book here.

We welcome Dr. Patrick McCulloch, co-program director of The Houston Methodist Sports Medicine Fellowship, and his current fellow, Dr. Matthew Kraeutler to discuss their study “Effects of Running on the Development of Knee Osteoarthritis: An Updated Systematic Review at Short-Term Follow-up” published in OJSM in March. The connection between running and osteoarthritic progression in the knee has been a topic of controversy for years. Common sense would say running must be bad for your knees, however could the health benefits of running actually play a protective role? We thank Drs. McCulloch and Kraeutler and their team for tackling this hot topic and sharing their discoveries with us.

MindShareTV InnovateHERs Podcast Series Episode 7 featuring Co-authors Dr. Barbara Kurshan & Kathy Hurley with Special Guest Dr. Anjlee Prakash, founder & chairperson of the Learning Links Foundation

Hello & Welcome to season four of the Fearless Fridays with Maryann podcast!  Over the next several weeks you will get a chance to meet the co-authors of my latest anthology - What Is Fearless Living?  You can purchase a paperback copy on Amazon. Thank you in advance for your support. I truly appreciate you. This special segment is meant for you to connect and learn a little bit about our authors and be inspired by their courage and fearlessness as they boldly share a little bit about themselves. In today's episode, we meet – Dr. Amira, and you will find her contact information at the end! I look forward to connecting with you, and I can be found... Website: https://www.maryannriveradannert.com IG: https://www.instagram.com/maryannriveradannert/ FB: https://www.facebook.com/TheFearlessLivingCoach Youtube: https://www.youtube.com/channel/UCS5Edcfs9t_j2zlP6r6Y2Dw Linkedin: https://www.bit.ly/maryannriveradannert Libsyn website: http://fearlessfridayswithmaryann.libsyn.com/website Bio and Contact for our guest: Dr. Amira earned a MHS from Lincoln University of PA, an Honorary Doctorate from TIUA and is the owner of Randolph Family Services, a thriving Coaching and Consulting firm. The axle of her rotation are her husband, children, and grandchildren. Website: www.randolphfamilyservices.com Website: https://randolphfamilyco.square.site  

Historically, results of direct ACL repair are poor. As such, it has been viewed as a substandard surgical option in comparison to ACL reconstruction, the modern gold-standard approach. However, ACL reconstruction is not without its flaws, and as technology and techniques have advanced, the idea of ACL repair has reemerged. Coming to us from Tripler Army Medical Center, Drs. Christian Cruz and Craig Bottoni share their results with ACL repair in their military population. Like studies from the past, the failure rate was high at 26%. However, those that succeeded had good to excellent results in an average return to full duty time that beats what is expected with ACL reconstruction. Drs. Cruz and Bottoni share their experience with this active population and why ACL repair may make sense in certain situations as well as when to avoid it.

Authors Dr. Joe Sallustio and Kate Colbert discuss their book "Commencement: The Beginning of a New Era of Higher Education." 

What is the Dyslexic Advantage? Discover insights from authors Dr. Brock and Dr. Fernette Eide. If you haven't read the Dyslexic Advantage book yet, it's a must-read as it has significantly shifted the global mindset about dyslexia. In Episode 90 of the podcast, we were honored to have Dr. Fernette Eide discuss the origins of the book. Now, we are excited to have both Drs. Brock and Fernette Eide join us to explore the updates in the second edition. Don't miss our engaging conversation, where we delve into topics such as dyslexia in the workplace, the future of AI and dyslexia, the importance of creativity, MIND strengths, and executive function. Sponsored by: Dyslexia Productivity Coaching: http://dyslexiaproductivitycoaching.com/ Links you might want to check: Website: https://www.dyslexicadvantage.org/ Dyslexic Advantage 2nd edition Book: https://tinyurl.com/dyslexicadvantagerevised Neurolearning Website: https://neurolearning.com/ Podcast Episode 90 with Fernette Eide: https://tinyurl.com/yc59k4ca Coaching Dyslexia in the workplace: https://www.dyslexiawork.com/ Dyslexia Quiz: https://bulletmapacademy.com/dyslexia-quiz/ Bulletmap Academy Page: https://bulletmapacademy.com Show notes: https://bulletmapacademy.com/blog/131/ Interested in being a guest? Email us at info@bulletmapacademy.com

Randi Braun, author of the women's leadership book Something Major: The New Playbook for Women at Work (New Degree Press, March 2023). Randi Braun is changing women's lives, one play at a time. Women are natural leaders, but they're burnt out. https://www.somethingmajorcoaching.com/. Carlos Nunez, MDMonday, March 13th for National Sleep Awareness Week and for Daylight Saving Time, with one of the nation's top sleep experts in Carlos Nunez, MD. More people than ever have trouble sleeping, with stress and electronics making these issues worse than ever. In fact, more than 54 million people in the US. have sleep apnea, and a shocking 80 percent of those are undiagnosed. The annual event is to celebrate sleep health and encourage the public to prioritize sleep.Dr. Kelly Rabenstein, author of Psychological Secrets for Emotional Success ( It's All About Love). This show is part of the Spreaker Prime Network, if you are interested in advertising on this podcast, contact us at https://www.spreaker.com/show/3240061/advertisement

The correct graft choice for ACL reconstruction remains a topic of debate.  Dr. Shelbourne and his group have published extensively on the merits of the contralateral patellar tendon autograft.  They presented their impressive results in this large-scale study published in OJSM in November and join us in this podcast to discuss their rationale, protocol, experience, and keys for success.

Our guests are Dr. Glenn and Phyllis Hill, founders of Connection Codes and co-authors of the book The Connection Codes. Tera Wages, president of Connection Codes, also joins the conversation. We discuss the core emotion wheel, how to navigate emotions in relationships, the power of connection, why most marriages aren't working, and more. Plus, check out the January Top Ten Leadership List. Make sure to visit http://h3leadership.com to access the list and all the show notes. Thanks again to our partner for this episode: GENERIS – Get your FREE Generosity Pulse Report at http://generis.com/h3. A FREE tool designed to provide insights and assess the health of generosity and giving in your Church. Generis will help accelerate generosity in your church, school, college or non-profit. Get started at http://generis.com/h3 to schedule a completely free Pulse Report and set up a complimentary 30-minute coaching session.

In this episode... Sofeast's CEO Renaud welcomes two guests, Dr. Allen J. Morrison & Dr. J. Stewart Black, to the podcast. These American leadership, strategy, business and manufacturing experts have recently written a new book "Enterprise China: Adopting a Competitive Strategy for Business Success" which was released on December 1st 2022. Renaud read an advance copy of the book before this interview and discusses China's strategies for economic success and also asks some questions about risk analysis and risk mitigation for companies buying products from China.   Show Sections 00:00 - Greetings & introduction of today's guests. 02:02 - What is 'Enterprise China' about? 03:27 - China's 3-pillar strategy to succeed economically. There are 3 strategic pillars to China's strategy for success. Reducing (or eliminating) their external dependency on importing key technology (03:39)  Dominate domestically (06:00) Winning globally (17:23) 20:55 - Why Western companies seeking growth by looking to the emerging markets may be too late in some cases. 23:44 - How should companies who buy from China do their risk analysis when considering diversifying supply chains to include other sources other than just China? 31:21 - How about a Zero-China strategy? 34:53 - Talking about the book 'Enterprise China,' when it's on sale, and where it can be purchased from. 36:00 - Wrapping up.   Related content... Can We Remove China From Our Supply Chains? [Podcast] Globalism 2.0: North American Importers To Move Supply Chains Out Of China Soon? [Podcast] Nearshoring To Mexico. An Alternative To China? [Podcast] How Sourcing From India Has Changed In 2022 (Part 1: Trends & Manufacturing Landscape) Interested in having a conversation about sourcing from other Asian countries? We can help you.   Get in touch with us Connect with us on LinkedIn Send us a tweet @sofeast Prefer Facebook? Check us out on FB Contact us via Sofeast's contact page Subscribe to our YouTube channel   Subscribe to the podcast  There are more episodes to come, so remember to subscribe! You can do so in your favorite podcast apps here and don't forget to give us a 5-star rating, please: Apple Podcasts Spotify Stitcher Google Podcasts TuneIn Amazon Podcasts Deezer iHeartRADIO PlayerFM Listen Notes Podcast Addict Podchaser

Technological advances have made virtual healthcare a reality.  The COVID-19 pandemic has accelerated the evolution and adoption of this telehealth option, and virtual care has become part of the sports medicine world.  Published in OJSM in October, the study "Telehealth Physical Therapy for Sports Medicine Rehabilitation: What is its Role in the Postpandemic Era?" out of Duke University examines demographic trends and patient satisfaction rates with virtual PT.  We welcome three of the study authors — sports medicine surgeon Dr. Brian Lau, MD, Christopher Antonelli, DPT, and lead author Billy Kim, BA to discuss their findings, their personal experiences, and where they think virtual sports medicine care goes from here.

Being Well Informed airs on Roku TV Sundays at 7 pm through RiseHer Network. This edition discusses Authors Dr. Tracy Robinson-Wood and Dr. Janie Ward's book, Sister Resisters. Also on this segment of the broadcast are judicial candidates discussing judicial reform. Candidates Rev. Ricky Nelson Jones and Marylin Pierre identify possible solutions to the judicial nominating process. 

“Our heartfelt desire is that the NeuroAffective Relational Model can support you and your clients and that this book will enhance the work you are all doing to heal our world.” - Laurence Heller and Brad Kammer, co-authors NARM creator Dr. Laurence Heller and Senior NARM Trainer and Training Director Brad Kammer are co-authors of the new book, The Practical Guide for Healing Developmental Trauma: Using the NeuroAffective Relational Model to Address Adverse Childhood Experiences and Resolve Complex Trauma, which will be released on July 26th, 2022.  Larry and Brad share their intention to help make learning about the NeuroAffective Relational Model more accessible to a greater number of people, for both clinicians and people learning for their own healing. They offer a sneak peek of what's included in the book: self-reflective exercises, annotated session transcripts, and more.  Join us for the virtual book launch party on July 26th from 10:00-11:00am Pacific TIme. To RSVP, please go to www.narmtraining.com/booklaunchparty. About Dr. Laurence Heller and Brad Kammer: Dr. Laurence Heller is the creator of the NeuroAffective Relational Model (NARM), Senior Faculty member, International Trainer, and author.  Brad Kammer, LMFT, LPCC, is a Somatic Psychotherapist and has worked in the field of trauma for over 20 years, specializing in working with Adverse Childhood Experiences (ACEs) and Complex Post-Traumatic Stress Disorder (C-PTSD).  Learn More and Pre-Order the Book!http://www.narmtraining.com/books To read the full show notes and discover more resources visit http://www.narmtraining.com/podcast *** NARM Training Institute http://www.NARMtraining.com View upcoming trainings: https://narmtraining.com/schedule Join the Inner Circle: https://narmtraining.com/online-learning/inner-circle *** The NARM Training Institute provides tools for transforming complex trauma through: in-person and online trainings for mental health care professionals; in-person and online workshops on complex trauma and how it interplays with areas like addiction, parenting, and cultural trauma; an online self-paced learning program, the NARM Inner Circle; and other trauma-informed learning resources.   We want to connect with you! Facebook @NARMtraining Twitter @NARMtraining YouTube Instagram @thenarmtraininginstitute

Authors Dr. Michael and Barbara Grossman talk about their upcoming release “Ageless Love-The Sexy Science of Falling in Love Forever” on the mind, body and spirit of creating and sustaining long happy relationships along with “The Marriage Map” and “Secrets to Deep & Effortless Meditation” and have taught thousands of couples practical skills to create a fulfilling romantic partnership for over 25 years! Dr. Barbara is a marriage and family therapist with over 6,500 hours of counseling while Dr. Michael is a Fellow of the American Academy of Anti-Aging Medicine and Regeneration Medicine using bio-identical hormone replacement and stem cells to assist men and women reverse aging! Find out about the amazing Dr. Barbara and Michael Goodman and their releases on all major platforms and www.fallinginloveforever.comtoday! #drbarbaragoodman #drmichaelgoodman #drmichaelandbarbaragrossman #agelesslove #fallinginloveforever #themarriagemap #meditation #romantic #antiaging #therapist #counseling #amazon #audible #iheartradio #spreaker #spotify #itunes #googleplay #applemusic #youtube #anchorfm #podbean #mikewagner #themikewagnershow #mikewagnerdrbarbaraandmichaelgrossman #themikewagnershowdrbarbarandmichaelgrossman --- Send in a voice message: https://anchor.fm/themikewagnershow/message Support this podcast: https://anchor.fm/themikewagnershow/support

Authors Dr. Michael and Barbara Grossman talk about their upcoming release “Ageless Love-The Sexy Science of Falling in Love Forever” on the mind, body and spirit of creating and sustaining long happy relationships along with “The Marriage Map” and “Secrets to Deep & Effortless Meditation” and have taught thousands of couples practical skills to create a fulfilling romantic partnership for over 25 years! Dr. Barbara is a marriage and family therapist with over 6,500 hours of counseling while Dr. Michael is a Fellow of the American Academy of Anti-Aging Medicine and Regeneration Medicine using bio-identical hormone replacement and stem cells to assist men and women reverse aging! Find out about the amazing Dr. Barbara and Michael Goodman and their releases on all major platforms and www.fallinginloveforever.comtoday! #drbarbaragrossman #drmichaelgrossman #drmichaelandbarbaragrossman #agelesslove #fallinginloveforever #themarriagemap #meditation #romantic #antiaging #therapist #counseling #amazon #audible #iheartradio #spreaker #spotify #itunes #googleplay #applemusic #youtube #anchorfm #podbean #mikewagner #themikewagnershow #mikewagnerdrbarbaraandmichaelgrossman #themikewagnershowdrbarbarandmichaelgrossman --- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app --- Send in a voice message: https://anchor.fm/themikewagnershow/message Support this podcast: https://anchor.fm/themikewagnershow/support

Authors Dr. Michael and Barbara Grossman talk about their upcoming release “Ageless Love-The Sexy Science of Falling in Love Forever” on the mind, body and spirit of creating and sustaining long happy relationships along with “The Marriage Map” and “Secrets to Deep & Effortless Meditation” and have taught thousands of couples practical skills to create a fulfilling romantic partnership for over 25 years! Dr. Barbara is a marriage and family therapist with over 6,500 hours of counseling while Dr. Michael is a Fellow of the American Academy of Anti-Aging Medicine and Regeneration Medicine using bio-identical hormone replacement and stem cells to assist men and women reverse aging! Find out about the amazing Dr. Barbara and Michael Goodman and their releases on all major platforms and www.fallinginloveforever.com today! #drbarbaragoodman #drmichaelgoodman #drmichaelandbarbaragrossman #agelesslove #fallinginloveforever #themarriagemap #meditation #romantic #antiaging #therapist #counseling #amazon #audible #iheartradio #spreaker #spotify #itunes #googleplay #applemusic #youtube #anchorfm #podbean #mikewagner #themikewagnershow #mikewagnerdrbarbaraandmichaelgrossman #themikewagnershowdrbarbarandmichaelgrossman

I spoke with Dr. Ron Lasky and Jim Hall, authors of the SMTA SMT Certification Courses (along with Phil Zarrow) about the content of these courses. I also spoke with two course students, Claire Hotvedt of Indium Corporation and Tom Watson of Kimball Electronics about their experience taking the courses and the value they received.SMTA offers two certification courses:• SMT Processes• Lean Six Sigma Green BeltEach SMTA Certification program is a three-day offering consisting of a 1.5-day workshop on topics in SMT Processes or Lean Six Sigma Green Belt. The program concludes on days two and three with an open and closed book examination (SMT Processes) and open book examination (Lean Six Sigma Green Belt.)This is not an entry-level program. Basic algebra will be used in the workshop and examination. This challenging examination requires both written answers and calculations with the intent to enable the attendee to establish competitive credentials as "Certified" by the SMTA in SMT Processes or Lean Six Sigma Green Belt.More information on the SMTA certification courses is available here:https://smta.org/page/certification

Mike Konrad speaks with Dr. Ron Lasky and Jim Hall, authors of the SMTA SMT Certification Courses (along with Phil Zarrow) about the content of these courses. He also speaks with course students, Claire Hotvedt of Indium Corp. and Tom Watson of Kimball Electronics about their experience taking the courses and the value they received. SMTA offers two certification courses: • SMT Processes • Lean Six Sigma Green Belt Each SMTA Certification program is a three-day offering consisting of a 1.5-day workshop on topics in SMT Processes or Lean Six Sigma Green Belt. The program concludes on days two and three with an open and closed book examination (SMT Processes) and open book examination (Lean Six Sigma Green Belt.) This is not an entry-level program. Basic algebra will be used in the workshop and examination. This challenging examination requires both written answers and calculations with the intent to enable the attendee to establish competitive credentials as "Certified" by the SMTA in SMT Processes or Lean Six Sigma Green Belt. More information on the SMTA certification courses is available here: https://smta.org/page/certification

In this episode of Build Momentum, we are joined by Dr. Barbara Kurshan and Laura Smulian.  Dr. Barbara "Bobbi" Kurshan is the president of Educorp Consultants Corporation and senior fellow and innovation advisor of the Graduate School of Education at the University of Pennsylvania, and a former education industry entrepreneur who has more than 40 years of experience in education, including developing the first children's software products for Microsoft. Laura Smulian is a writer, an editor, and an award-winning learning designer who spent the past seven years building out operations for quickly growing edtech startups in Latin America. She also launched a venture called the E-Ship Bootcamp, a four-week program that takes teams of students through the process of building their own startup from zero to launch.Some Questions I Ask:How did the InnovateHer project come together? (2:19)What do you want potential and future innovators to achieve through this book? (4:07)How do you describe the benchmark for entrepreneurial mindset throughout the book? (5:03)Would you share a snapshot of some of the people you included in the book? (21:40)What would you love to see women pursue to embark on their careers as purposeful innovators after reading the book? (23:30)In This Episode, You Will Learn:The beginning of InnovateHers (2:26)Key takeaways from reading the book (4:19)About the “Entrepreneurial Mindset Profile” (5:22)The story of innovator Lisa Hall (21:53)Actions to be taken after reading the book to be a purposeful innovator (23:46)Quotes:“I wanted them to see that the stories were personal, that they could do it too, and that there were certain things they needed to be aware of along the way so they wouldn't have the traps that women have had in the past.”“I'd like to see [people] share the book with young innovators. I think it's a great gift to give to somebody that you're mentoring. The other thing I want to see them do with it is to share their story. I'd like to build a community of people that are sharing their stories so people understand that we're all not that different, but we can learn from our entrepreneurial mindset.”“There's no one right way to rise to the top. It has nothing to do with external indicators and checking off boxes, but rather traits and skills that are powerful that we can build and work to leverage in order to rise to the top. There's not a formula for this; everyone was a little different.”Connect with InnovateHer:InnovateHer websiteDr. Barbara Kurshan's LinkedInLaura Smulian's LinkedInAbout the book:Transformational Leadership Secret websitePurchase “The Secret to Transformational Leadership” print or ebookStay in touch with Sarah Williamson:Free Case Study GuideWebsiteFacebook

The challenges minorities face in higher education is not a new conversation nor specific to the education industry. Difficulties in recruitment and retention of minority faculty, as well as the desire for many majority institutions to diversify, has been stated for years but with little to no true conversation and progress.    With the desire for change and their own experiences as black staff and faculty in higher education, Dr. Antija Allen and Justin Stewart sit down with your host, David Pluviose, to discuss their book We're Not OK: Black Faculty Experiences and Higher Education Strategies. From code-switching to the importance of representation in administration, tune in as they share their mission to not only bring awareness to the struggle of minoritized faculty but provide actionable strategies to better foster an inclusive environment for black faculty to feel valued and heard.    KEY POINTS: - Dr. Antija Allen and Justin Stewart's journey in higher education - What inspired We're Not OK? - The challenges of minoritized faculty in higher education  - Pairing awareness with an action plan for change  - Essential steps to minority faculty recruitment and retention  - How different demographics have responded to We're Not OK - Mental health impacts and strategies for minority faculty members    QUOTABLES: “You can read all the experiences, you can read the research about it, but now you can actually see an action plan. So another part of this book is, here's a way to foster an inclusive environment for black faculty.” “It's a conversation that we've been having for a long time. There's research that says it's been going on for 30 years, 40 years, 50 years. It can go on 10 years from now, 20 years from now, but it's a matter of when do we start making meaningful and impactful action? And ‘We're Not OK' is part of making those steps.”   PRODUCTS / RESOURCES: Visit the Diverse: Issues In Higher Education website: diverseeducation.com Or follow us on social media: Twitter: twitter.com/diverseissues Instagram: instagram.com/diverseissuesinhighereducation Facebook: facebook.com/DiverseJobs?_rdc=1&_rdr Linkedin: linkedin.com/company/diverse-issues-in-higher-education In The Margins is produced by Diverse: Issues In Higher Education and edited by Instapodcasts (visit at instapodcasts.com)

Released 9 March 2022. Deterring a Chinese invasion of Taiwan without recklessly threatening a great-power war is both possible and necessary through a tailored deterrence package that goes beyond either fighting over Taiwan or abandoning it. This podcast analyzes the cutting-edge understandings of deterrence with empirical evidence of Chinese strategic thinking and culture to build such a strategy and the counter-arguments from  Part 1 of this series. Click here to read the original article. Episode Transcript:   Stephanie Crider (Host) (Prerecorded Conversations on Strategy intro) Decisive Point introduces Conversations on Strategy, a US Army War College Press production featuring distinguished authors and contributors who explore timely issues in national security affairs. The views and opinions expressed on this podcast are those of the podcast's guest and are not necessarily those of the Department of the Army, the US Army War College, or any other agency of the US government. The guests in speaking order on this episode are: (Guest 1 Dr. Roger Cliff)   (Cliff) Conversations on Strategy welcomes Dr. Roger Cliff. Dr. Cliff is a research professor of Indo-Pacific Affairs in the Strategic Studies Institute at the US Army War College. His research focuses on China's military strategy and capabilities and their implications for US strategy and policy. He's previously worked for the Center for Naval Analyses, the Atlantic Council, the Project 2049 Institute, the RAND Corporation, and the Office of the Secretary of Defense. (Host) The Parameters 2021-22 Winter Issue included an article titled, “Broken Nest: Deterring China from Invading Taiwan.” Authors Dr. Jared M. McKinney and Dr. Peter Harris laid out an unconventional approach to the China-Taiwan conundrum. Shortly after the article was published, Parameters heard from Eric Chan, who disagreed with them on many fronts. We've invited you here today, Roger, to provide some additional insight on the topic. Let's jump right in and talk about “Broken Nest: Deterring China from Invading Taiwan. What is the essence of Jared McKinney and Peter Harris's article “Broken Nest: Deterring China from Invading Taiwan?”   (Cliff) So this article is an attempt to find an innovative solution to the Taiwan problem that has bedeviled the United States since 1950. In this particular case, the author's goal is not to find a long-term, permanent solution of the problem, but simply to find a way to deter China from using force against Taiwan in the near term. Specifically, a way that doesn't entail risking a military conflict between two nuclear-armed superpowers. Their proposed solution is a strategy of deterrence by punishment, whereby even a successful conquest of Taiwan would result in unacceptable economic, political, and strategic costs for Beijing. The premise of the article is that China's military is now capable enough that it could conquer Taiwan, even if the United States intervened in Taiwan's defense. The result, they argue, is that the long-standing US deterrence-by-denial strategy for deterring a Chinese use of force against Taiwan—in other words, by threating Beijing with the risk that a use of force against Taiwan would fail—is no longer credible. Unlike most strategies of deterrence by punishment, the strategy that McKinney and Harris proposed does not primarily rely on military attacks on China. Instead, the punishment comes in the form of imposing other costs on China for a successful use of force against Taiwan. This has several elements. One is the United States selling to Taiwan weapon systems that will be most cost-effective and defending against a Chinese invasion. This would make a successful invasion of Taiwan more difficult and, therefore, more costly for China. Related to this, they also recommend that Taiwan's leaders prepare the island to fight a protracted insurgency,

The latest global climate report was released this Monday! The IPCC's AR6 Working Group 2 report summarizes the current climate science around adaptation, and the socio-economic and governance impacts of climate change. I'm excited to be joined by lead authors Dr. Libby Jewett, founding Director of the NOAA Ocean Acidification Program, and Dr. Kirstin Holsman,Read more The post 169: How Climate Change is Impacting Communities + Ecosystems | IPCC AR6 WG2 Lead Authors Dr. Libby Jewett + Dr. Kirstin Holsman of NOAA appeared first on ECO CHIC.

Let's Meet our Next Author - Dr. Ramesh Ramachandra is the founder and managing director of Singapore's headquartered Talent Leadership Crucible (TLC). She is an expert in family businesses who resolves deep-seated conflicts, navigates family successions tensions, onboards the next-gen, and builds trans-generational future and legacy. Dr. Ramesh provides executive coaching to C-suite executives worldwide and holds a Doctorate in Business Administration (DBA) from Singapore Management University, SMU, and a Master's in Business Administration (MBA) from Monash, Australia. Dr. Ramesh has been recognized by Asia Week as one of Asia's most influential women and by Barrier Breakers as a notable woman barrier breaker. She has also been featured in the Commonwealth Secretariat's publication as a case study on women's entrepreneurship. Her remarkable grassroots work in empowering women in decision-making, leadership, and enterprise development has made her a sought-after speaker. As a UNDP/UNIFEM consultant, she worked on a gendered enterprise development project in Pyongyang, North Korea. As an entrepreneur, she has successfully raised millions of dollars in venture funds, set up regional offices, managed business mergers, taken charge of public offering application processes as well as undertaken the liquidation of the failed business. Dr. Ramesh was born in Sri Lanka, educated in Singapore, Australia, and the United States, and currently lives with her family in Singapore/Vietnam. Learn the various forms of entrepreneurship all explained in plain and easy-to-understand English through this perfect guide for your entrepreneurial jump! The Big Jump into Entrepreneurship 2.0 Here's the link - https://www.amazon.com/dp/B09RWV2FG8 You Can Follow Dr. Ramesh on Insta, FB and LinkedIn at dr.ramesh.growthstrategist --- Support this podcast: https://anchor.fm/soulvelocity/support

Nika Kabiri has spent over two decades studying how people make decisions in various contexts, from business to politics to relationships. She teaches decision science at the University of Washington and works as a consultant helping businesses understand consumer decision-making. She's co-author of the bestselling book Money Off the Table: Decision Science and the Secret to Smarter Investing. She has also been featured in Business Insider, Yahoo News, Fast Company, and more, and has been a contributor to The Hill, Inside Sources, The Huffington Post, and others. Nika has a Ph.D. in Sociology from the University of Washington, where her academic focus was on choice theory and decision-making within constraints. She also has a JD from the University of Texas. Learn more about Nika at YourNextDecision.com.

In this Episode We discuss the book "Racism- Not Race" with Authors Dr. Joseph Graves and Dr. Alan Goodman.

Dr. Lois Marshall Barker & Ava Barker discuss their picture book Ava's Caribbean ABC. They express the importance of cultural affirmation. Dr. Lois Marshall Barker is a Grenadian native and creative currently living in Houston, Texas. She has over 14 years of experience in education. Dr. Barker has served as a high school ELA teacher, instructional coach and now a curriculum developer. She works closely with educators to revamp curriculum and structures to ensure all students are seen and have an opportunity to be successful as defined by them. Ava is a 12 year old creative and native Texan proud of Grenadian heritage. She is president of her school's Theatre Club and landing roles in productions of Junie B. Jones and The Super Non-Heroes . Ava is an avid reader of graphic novels and historical fiction. At school, Ava is very passionate about having access to books that reflect all stories including hers. She is also very vocal about teaching history beyond the eyes of the settlers making sure all perspectives and truths are told.

This week, Morgan gets the scoop on sugar & raising balanced eaters from Sugarproof authors Dr. Michael Goran and Dr. Emily Ventura. They share how their research led them to make connections between childhood ailments and the sugar consumption of the modern-day diet.  They take a deep dive into the effect of sugar on our children...all the way from hidden sugars in everyday supermarket foods to the critical growth theory.  Do different sugars have different effects on the body? Is Fruit Sugar worse than High Fructose Corn Syrup? Listen in to hear them debunk the "sugar is sugar" theory and for tips on how to improve healthy sugar consumption for kids at home! 

Authors Dr. Jackie Seidel from the University of Calgary and Dr. Darlene St. Georges from the University of Lethbridge join Deirdre Mitchell-MacLean to talk about their collaboration, released this fall. Visit https://www.jasonkenneypoetryproject.com/ to view, download, or purchase a copy.

In today's episode, Adham Elmously and Matt Spreadbury discuss diagnosis and management of type B aortic dissections with Drs Einar Brevik and Joseph Lombardi. An outline can be found on our website References Lombardi et al. Society for Vascular Surgery (SVS) and Society of Thoracic Surgeons (STS) reporting standards for type B aortic dissections. J Vasc Surg. 2020 Jan;71(3): P723-747 Lombardi JV et al. STABLE II Investigators. STABLE II clinical trial on endovascular treatment of acute, complicated type B aortic dissection with a composite device design. J Vasc Surg. 2020 Apr;71(4):1077-1087. Authors: Dr. Adham Elmously (@elmouslyMD) is a second-year vascular surgery fellow at the New York-Presbyterian Cornell/Columbia Program in New York, NY. Dr. Matthew Spredbury (@mattspreadbury) is a second-year vascular surgery resident at Haukeland University Hospital in Bergen, Norway. Guests: Dr. Joseph Lombardi (@VascSurgMD) is the Professor and Chief of Vascular Surgery at Cooper University Hospital in Camden, New Jersey, and the PI on the STABLE I and STABLE II trials. Dr. Einar Brevik (LinkedIn) is a consultant vascular surgeon and the previous president of the Norwegian Society of Vascular Surgery. Editor: Matt Smith Reviewers: Adam Johnson and Matt Chia Please share your feedback through our Listener Survey! Follow us on Twitter @audiblebleeding Learn more about us at https://www.audiblebleeding.com/about-1/ and #jointheconversation.

Skinwalkers at the Pentagon unmasks the massive scope of the Pentagon's landmark UFO study that ran from the Defense Intelligence Agency in Washington, D.C. The Advanced Aerospace Weapon System Applications Program, or AAWSAP investigated the “Tic Tac” and other “nuts and bolts” UFO events, analyzed intrusions of UFOs onto US military bases, as well as probed the plethora of bizarre phenomena that government investigators encountered on Skinwalker Ranch.Written by two program insiders and a respected journalist, Skinwalkers at the Pentagon comes to a conclusion that has never before been revealed!Encountering UFOs often led to the “attachment” of strange phenomena to military personnel who visited the Ranch and brought “something” home to their families, resulting in frightening eruptions of paranormal events in their households that terrorized and sometimes injured their children.By the end of the two-year program, more than 100 separate technical reports, some of which ran to hundreds of pages, were delivered to the Defense Intelligence Agency. Among them was a 149-page report on the Soviet (and now Russian) UAP investigation/analysis capability. Another details the design and build of a functional prototype for an autonomous Unidentified Aerial Phenomena surveillance platform.

5 Strong, Phenomenal Women come together and discuss their journey of navigating through life as a teenage Mother. Each Boss Lady drops golden nuggets on how to persevere through pain, show up and thrive against all odds. The accomplished Boss Ladies talk more about their best selling book, " Against all odds, and encourage others to answer to their calling, show up for themselves and walk in purpose. Meet the Authors: Dr. Cortesha Cowan Dr.Cowan is a two-time teen mom and is now the Founder/CVO of Mothers Helping Mothers Inc., Dr. Cowan is a business birthing coach, a best-selling author, contributing author, Loani Executive Global member, Ambassador Commonwealth Entrepreneur Club. Philanthropist, International Influencer. The Visionary Ambassador for DKsuomi Foundation in Nigeria. Dr. Cowan started Mothers Helping Mothers Nonprofit organization, which helps teen moms who've experienced homelessness and are pregnant. Dr. Cowan's services extend to Africa! IG:@corteshacowan Facebook: @corteshacowan Ruby(Latoya) Cole Ruby Cole became a teenage mother at the age of 17. Mrs. Cole is a Credit Center Specialist for a southern bank and founder and owner of Agitation Custom Crafts. As the owner of Agitation Customer Crafts, her goal is to bring the customer's imagination to life. Mrs. Cole is a certified life coach that is passionate about empowering women ages 40 and up. She works to help them realize it is never too late to start over. Mrs. Cole enjoys assisting women to be successful and finding their S.H.E. - Smart Honorable Excellence. She has always been good at motivating, and she thanks God for leading her on that path. IG: @personalgem76 Facebook:@latoyacole CieraHale Ciera Hale became a teenage mother at 13. She is now a serial entrepreneur, Nail Technician, Nonprofit founder/C.E.O. of New beginnings learning Center of Columbus Childcare Center, 1st Kids Inc Childcare Consulting services, and creator of S.H.E. is Me Non-profit. Ms. Hale believes that where's there is passion, there is potential. Ms. Hale uses her creativity with designing nails! She's the owner of Cee Meshine nails by Cee. Ms. Hale's goal is to reach at least one young lady through her story of overcoming. IG: @ms.hale_2u Facebook: @cierahale Dr. Tanikka Price, ESQ Dr. Tanikka Price, ESQ. became a teenage mother at 19 but experienced some traumatic events with her pregnancy. Dr. Price uses her training as a lawyer, her passion as a motivational speaker, and the knowledge she gained during her traumatic upbringing to develop and train others in dealing with trauma and living their best lives. She opened Price Legal Services Ohio, LLC in 2008 and has devoted herself to serving her community as an Attorney and currently as the Director of Education for The Healthcare Collaborative of Greater Columbus. As a Family Law Attorney, Dr. Price helped families navigate divorce, child custody, child support, and adoption. IG:@tanikkaprice Facebook: @tanikka.price Tanesha “The Singing Nurse” Owens Tanesha Owens is became a teenage mother at 17. She is now a Gospel singer and a Registered Nurse. Now being called "The Singing Nurse," she has blended the two ministries by hosting Blood Pressure screening and Organ Donor donations for the community that has been a great success. Tanesha also has a single titled It's You and recently released a song titled Free in 2021. IG:@ taneshathesingingnurse Facebook: @taneshathesingingnurse

We'll talk to the authors of the new book, Inflamed: Deep Medicine and the Anatomy of Injustice, and get the latest on the Newsom recall effort with Jeremy B. White of Politico's California Playbook. And, Joseph will interview the creator of "The Lower Bottoms", a new podcast about a rapidly gentrifying neighborhood in West Oakland.

Celebrating Women Who Live to 100 and Beyond Encore Episode As we approach the end of the summer, I wanted to revisit some of my staff's favorite podcast episodes of all time. This week we start with my favorite episode with Dr. Amy D'Prix to celebrate our 100th episode. Dr. Amy and I discuss women's longevity and two special women in my life - my maternal grandmother, Nana Mo, and my paternal great aunt, Aunt Alice. While I love being a podcast host and enjoy all my interviewing experiences, I love this one because it highlights two special women in my life that taught me at a very young age that women could change the world.  Here are the original show notes and description. I hope you enjoy this encore episode as much as I enjoyed recording it. Happy Listening! kbk In this 100th podcast episode, I celebrate two women in my life who have lived to 100 years old and beyond with Dr. Amy, a life transitions expert. My Nana Mo and my Great Aunt Alice, each from different sides of my family lived to be 103 and 104 respectively. These women role modeled what it meant to be a feminist before it was fashionable. Dr. Amy shares her insights as to how to live a long, rewarding life and how having essential conversations with family members helps you share your legacy of stories, memories, and values. The first of a 3-part series on Breaking Money Silence® on Longevity, this episode is not to be missed!  Dr. Amy's Plan B Question: If there was a shift in my health or mobility, or the health and mobility of someone I love, what might I do differently? Dr. Amy S. D'Aprix, MSW, PhD, CPCA, is a life transitions expert and an internationally renowned authority on lifestyle issues relating to retirement, estate planning, aging, caregiving, and family dynamics.  “Dr. Amy,” as she is affectionately known, has worked with the financial services industry for more than twenty years, both with advisors and as a keynote speaker at client events. She has authored the book From Surviving to Thriving: Transforming Your Caregiving Journey and co-recorded a CD with an accompanying workbook titled, Building the Bonds of Friendship in Midlife and Beyond. She is also the creator of the Life Memories Journal and Caring Cards to inspire more meaningful inter-generational conversations. Dr. Amy is a frequent guest on radio and TV shows and has written numerous articles for print and online publications.  For more information, visit dramy.life. Show Notes: Books mentioned: Living to 100 Authors: Dr. Tom Perls, Dr. Margery H. Silver, with John Lauerman  Aging with Grace: What the Nun Study Teaches Us About Leading Longer, Healthier, and More Meaningful Lives  Author: David Snowden .et_bloom .et_bloom_optin_1 .et_bloom_form_content { background-color: #146a7d !important; } .et_bloom .et_bloom_optin_1 .et_bloom_form_container .et_bloom_form_header { background-color: #146a7d !important; } .et_bloom .et_bloom_optin_1 .et_bloom_form_content button { background-color: #f58023 !important; } .et_bloom .et_bloom_optin_1 .et_bloom_form_content .et_bloom_fields i { color: #f58023 !important; } .et_bloom .et_bloom_optin_1 .et_bloom_form_content .et_bloom_custom_field_radio i:before { background: #f58023 !important; } .et_bloom .et_bloom_optin_1 .et_bloom_form_content button { background-color: #f58023 !important; } .et_bloom .et_bloom_optin_1 .et_bloom_form_container h2, .et_bloom .et_bloom_optin_1 .et_bloom_form_container h2 span, .et_bloom .et_bloom_optin_1 .et_bloom_form_container h2 strong { font-family: "Open Sans", Helvetica, Arial, Lucida, sans-serif; }.et_bloom .et_bloom_optin_1 .et_bloom_form_container p, .et_bloom .et_bloom_optin_1 .et_bloom_form_container p span, .et_bloom .

In this podcast we speak to Dr Ramy Mansour and Dr Danoob Dalili, co-authors of “Musculoskeletal ultrasound imaging standards in the UK: a British Society of Skeletal Radiologists position statement”.

Dr. Georges is a passionate life and career coach, resume writer, award-winning author, motivational speaker, organizational trainer, and university lecturer who helps clients and students RESCRIPT dis-empowering self-talk, maximize their strengths, get unstuck, and take empowered action to achieve their life and career goals and dreams. She provides positive psychology-based life and career coaching and resume writing to clients across the nation, leads local community wellness groups, and delivers workshops and speaking engagements for corporations, educational institutions, non-profits, healthcare organizations, professional associations, and beyond. Colleen is also a Rutgers University Lecturer in counseling and women's leadership/social justice and a member of the Rutgers Speaker's Bureau. In her TEDx Talk, “Re-Scripting the Stories We Tell Ourselves,” she talks about the impact our internal dialogue has on our relationship with ourselves and the world around us. She received a Doctorate in Counseling Psychology from Rutgers University, is a Nationally Certified Psychologist, Licensed Professional Counselor, Certified Comprehensive Positive Psychology Coach, and holds over a dozen certifications in life/career coaching and positive psychology. Dr. Georges is author of the 8-time award-winning, international best-selling book, RESCRIPT the Story You're Telling Yourself, which received a Reader's Favorite 5-star review, was featured on New 12 Long Island's Elizabeth & Elisa Morning Show, and recognized in Aspire Magazine's Top 10 Inspiring Books List. Colleen is also a co-author of 10 best-selling self-growth books and a Huffington Post contributor. Her expertise has been featured in various media outlets including News12, RVNTV, Live Happy, Inspire Me Today, Mashable, Rewire Me, The Job Network, Care.com, New Jersey Family Magazine, and The Trenton Times. Learn More about Dr. Colleen Georges at: www.RESCRIPTBook.com www.ColleenGeorges.com

Andrew and Andrew talk about grief, loss, pain, lament, and living Brave. Andrew's excellent books and blog can be found on his individual website. His newest book is the The Sexually Healthy Man. I highly recommend his latest book. His website is filled with helpful surveys and writings; including his offerings. He offers individual, group, and marriage counseling with his wife Christy Bauman. Psychotherapists & Authors Dr. Christy V. Bauman, LMHC and Andrew J. Bauman, MA, LMHC have started the CCC to provide high-quality experiential, narrative-based psychotherapy from a Christian worldview. To fully engage both heartache and glory without easy answers. The CCC believes you cannot enter into liberation without gut-wrenching pain, we follow both a crucified and resurrected God. Our purpose is to walk with those who are wanting transformation and healing. Those who feel lost in their faith and/or stuck in their pain, and are running out of options. We work with both individuals and couples in crisis, those impacted by unwanted sexual behaviors and trauma. Andrew and Christy Bauman - A Brave Lament A Brave Lament Documentary is a film about the loss of their first son. It is a trailer which offers a small window into the relationships and rituals which aided this couple in their grief and sorrow. #abravelament #grief #stillborn Therapy Shorts - Their marriage podcast. Theology of the Womb- Christy's book on understanding God through a woman's body. Marriage Counseling Men and Woman Retreats The Winter Faith Podcast creates conversations on God, grief, and emotional growth. Birthed by Andrew Frazier in 2017. Follow @winterfaithpodcast on Instagram, Facebook, Twitter and YouTube. Support the show on Patreon. --- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app --- Send in a voice message: https://anchor.fm/winterfaithpod/message

MAX & Friends with Max Tucci  A conscious conversation with: Authors: Dr. Vishakha Desai  And Miguel Sancho    Join the conversation!    Dr. Desai discusses her book "World As Family: A Journey of Multi-Rooted Belongings. What does "World As Family" mean? Tune in to learn more about living a life with authenticity and loving with a heart filled with love.   Then...   Miguel Sancho joins Max to discuss his book "More Than You Can Handle: A Rare Disease, a Family in Crisis". Find out how to navigate through hardship. Miguel's story is one of courage and inspiration.

In this podcast, we speak to Dr Georg Schramm and Dr Claes Nøhr Ladefoged, co-authors of a recent BJR|Open Review on “Metal artifact correction strategies in MRI-based attenuation correction in PET–MRI”.

Your bags are packed and you are ready forts go and accelerate

Join in as we highlight Christian Authors. This week we have Author, Dr. Vinita Johnson talking about her book “Autopsy of a Dead Leader” and upcoming Ministry events.

We're kicking off our depression series with two wonderful women in science and research. Dr. Bonnie Kaplan and Dr. Julia Rucklidge spoke with us about the connection between micronutrients and mental health, their incredible work and their new book, The Better Brain: Overcome Anxiety, Combat Depression, and Reduce ADHD and Stress with Nutrition. They have so much experience and practical wisdom to share not only about the importance of what we put in our bodies for optimal brain function but how to be curious about the education we receive about nutrition and the importance of questioning where our food comes from - down to the soil. The team is mind-blown the entire episode and revisits the importance of JERF! Resources and Guest Favorites HEALTH: IT'S PERSONAL SHOWNOTES: https://www.thehippodcast.com/dr-julia-rucklidge-and-dr-bonnie-kaplan HEALTH: IT'S PERSONAL INSTAGRAM: https://www.instagram.com/thehippodcast HEALTH: IT'S PERSONAL FACEBOOK COMMUNITY: https://www.facebook.com/groups/healthitspersonal LOVE the work we are doing? Join our Patreon family, for bonus episodes, recipes, and connection: https://www.patreon.com/thehippodcast Listen, engage, subscribe and send us topics for us to explore that will help you on your journey. Join our email list for free resources and updates on Phronesis Health Initiative Courses. www.thehippodcast.com Curious how we're creating our gorgeous emails? Meet Flodesk! Get 50% off for life with this link. https://flodesk.com/c/Q0QN8C Listen, engage, subscribe and send us topics for us to explore that will help you on your journey. YouTube

10 Teams. 4 Weeks. 2 Words. 1 Incredible book collection. https://www.roomtoread.org/p-e-book-collection/ The Peace & Equality Book Collection brought together diverse writers and illustrators from the United States to create 10 books in just four weeks. The books, aimed at children ages 3-8, explore themes related to creating a more peaceful and just world, with the goal of recognizing the work we must continue to do as a society to create social, political, economic, and cultural systems grounded in peace and equality. Four Academy of Art grads were tapped to illustrate four titles and Academy instructor Julie Downing served as an art advisor for the project. In this special episode, we get to hear from them and the authors of these unique and fascinating books. For more about these great artists and authors check out their websites. Illustrators - Kris Duran - https://krisduran.com/ Peili Huang - https://www.peiliart.com/ Samantha Jo Phan - https://www.samjophan.com/ Authors - Dr. Artika R. Tyner - https://www.artikatyner.com/ Mon Trice - https://www.montrice.net/ Jocelyn Argueta - https://www.linkedin.com/in/jocelynargueta/ Julie Downing - https://www.juliedowning.com

On this episode of Catch Good Health® Radio, Erica talks with Authors Dr. Jennifer Love and Dr. Kjell Tore Hovik, regarding their book, When Crisis Strikes: 5 Steps to Heal Your Brain, Body, and Life from Chronic Stress. Dr. Love, a physician, and co-author Dr Hovik, a neuropsychologist, talk about their book, how they came […] The post CGH Radio 056: When Crisis Strikes, with Authors Dr. Jennifer Love & Dr. Kjell Tore Hovik first appeared on Catch Good Health®.

Editor-in-Chief Dr. Earl Silverman speaks with the team behind the paper Imaging Techniques: Options for the Diagnosis and Monitoring of Treatment of Enthesitis in Psoriatic Arthritis. Catherine Bakewell, Sibel Zehra Aydin, Veena K. Ranganath (absent), Lihi Eder and Gurjit S. Kaeley discuss the importance of early identification and treatment of enthesitis in patients with PsA. Read the full paper here https://doi.org/10.3899/jrheum.190512

Jason interviews Special Guests Dr. Allen Lycka & Harriet Tinka on their book,"The Secrets to Living A Fantastic Life: the 13 Golden Pearls Within."  Dr. Allen Lycka and Harriet Tinka share their harrowing and traumatic personal experiences with possibly facing imminent death and how it has changed their paradigms of the world.  Dr. Lycka was given a misdiagnosis of what he was told was a terminal illness and Harriet's experience related to a nearly fatal kidnapping and beating from a stalker.  Together and individually, they faced their experiences with courage and found insparation in each day that followed.  Dr. Lycka is a leading cosmetic dermatogist and he is now known for "Living a Fantastic Life and Turning Points."  He's a transformational speaker, thought leader, coach and mentor.  Harriet, a gorgeous former runway and magazine model, found new life as a transformational speaker, passionate life coach, blogger, Chartered Profesional Accountant, Football Official and Ultra-marathon runner.  Tinka has become a huge inspiration to women who have have faced domestic violence and she is the founder and CEO of the award-winning Social Enterprise, Empowered Me Inc., a company whose mission seeks to inspire women and girls to be their best.    Our guests have joined forces to share the wisdom they have gained from their traumatic expeiences in their new book.     For more information on Dr. Allen Lycka, please visit his website: www.drallenlycka.com.  For more information on Harriet Tinka, please visit her website:  www.empoweredme.ca.   

In this podcast Dr. Tan Arulampalam interviews Dr. Jianxing He from Guangzhou. Dr. He has faced the pandemic on the front lines of patient care in Guangzhou for the past months. Dr. He talks to Dr. Arulampalan about the evolution of the situation in Guangzhou. Authors: Dr. Tan Arulampalam and Dr. He Source: AIS | COVID-19 Resources Center powered by DialogEDU, in collaboration with Johnson & Johnson Institute https://covid19.aischannel.com/

Welcome to the inaugural Saturday Episode of The Kindness and Happiness Connection Podcast! Is there a practical guide for getting through the current or future pandemics and other crises? If so, where can I find it? Look no further! In today's episode of the Kindness and Happiness Connection Podcast Randy McNeely - The Kindness Giver shares a conversation with his co-host Dr. Elia Gourgouris - "The Happiness Doctor" and Kon Apostolopoulos - "Coach Kon" who have combined their decades of experience to produce a wonderful new book "7 Keys to Navigating a Crisis: A Practical Guide for Dealing with Pandemics & Other Disasters." What are the 7 Keys? 1️⃣ Self-Care 2️⃣ Awareness 3️⃣ Flexibility 4️⃣ Preparation 5️⃣ Initiative 6️⃣ Positive Attitude 7️⃣ Kindness Whether you're from India, Europe, Asia, Africa, Europe, South America or North America; whether you an individual, family, or in a position of organizational leadership, today's episode will be of interest and of help to you. Take a listen. You'll be glad you did! --- Send in a voice message: https://anchor.fm/kindness-happiness/message Support this podcast: https://anchor.fm/kindness-happiness/support

In this podcast Dr. Tan Arulampalam from the UK and Dr. Wenhui Lou from China, discuss about the impact of COVID-19 outbreak in healthcare providers daily routine. Dr. Wenhui Lou explains that there was a significant decrease in performing elective surgery procedures and other elective procedures. Different topics will be discussed during their conversation: PPE usage, hospital redistribution, task - shift for treating COVID-19 patients, telework, telemedicine and out-hospital patient management. Authors: Dr. Tan Arulampalam and Dr. Wenhui Lou Source: AIS | COVID-19 Resources Center powered by DialogEDU, in collaboration with Johnson & Johnson Institute https://covid19.aischannel.com/

Many people, especially service-based providers are taught their craft and how to help people. Often they are not taught marketing or how to run a business. Dr. Shawn Dill and Dr. Lacey Book share strategies to help you bring your message to as many people as possible so you can create the biggest impact possible. Dr. Shawn Dill is a graduate of Logan College of Chiropractic and is CEO of The Specific Chiropractic Centers. He offers consulting services to entrepreneurs and healthcare professionals through his website, ShawnDill.com. Shawn is founder of The Black Diamond Club, a community committed to mentoring, motivation, and business development for service professionals, and is a Book Yourself Solid® Certified Coach, having trained under bestselling author Michael Port. A highly sought-after speaker, Shawn makes numerous international appearances every year and has been featured on radio and television programs in countries around the world. Dr. Lacey Book is passionate about helping service professionals reach more people through marketing, sales, and mindset strategies. She accomplishes this with her husband through The Black Diamond Club. Lacey loves coaching service professionals who are just starting their businesses. She is an international speaker and gives back by coordinating three mission trips to other countries every year. Host Bonnie Groessl, MSN, is a best-selling author, international podcast host and business consultant. Bonnie and her husband, Mike Dauplaise, own and operate M&B Global Solutions, a company offering consulting, content marketing services and publishing services that fit the needs of entrepreneurs and small businesses who want to accelerate their journey to success. Shawn and Lacey's website: https://shawnandlacey.com/ Amazon Link “None of Your Business” https://amzn.to/2S43LGY Bonnie's website: http://bonniegroessl.com/ Go to https://bonnielinks.com/ for links to connect with me and get great free stuff and special offers to help you on your entrepreneur journey! You can also subscribe to the monthly newsletter and access over 50 gifts from previous guests!  

About The Self-hypnosis Diet: Use the Power of Your Mind to Reach Your Perfect WeightWhat's missing from the hundreds of diets on the market to help us achieve healthier bodies? "The most important element, teaches Dr. Steven Gurgevich, is not in the body but in your mind." As a key member of Dr. Andrew Weil's physician's training program, Dr. Gurgevich has brought hypnosis to the forefront of modern medicine. With The Self-Hypnosis Diet, he shows that anyone can use medical hypnosis to achieve long-term success in shifting our appetites to healthier foods and reaching our desired weight. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit healthmatters.substack.com

KEEPING STUDENTS SAFE EVERYDAY  with ASCD authors Dr. Amy Klinger and Amanda Klinger on their new book subtitled " How to prepare for and Respond to School Violence, Natural Disasters,and other Hazards" 

KEEPING STUDENTS SAFE EVERYDAY  with ASCD authors Dr. Amy Klinger and Amanda Klinger on their new book subtitled " How to prepare for and Respond to School Violence, Natural Disasters,and other Hazards" 

About Why Physicians Die by Suicide: Lessons Learned from Their Families and Others Who Cared Physicians are known to be a group of professionals who are at risk of taking their own lives. In this easy-to-read book, Dr. Michael Myers, a psychiatrist and specialist in physician health, attempts to explain the mystery of why some doctors, despite their calling and the adoration of their families, patients, students and colleagues, perish by suicide. He combines the powerful and gripping insights of dozens of bereaved people whom he interviewed for this project with disguised stories from his decades long clinical practice to shed some light on this national tragedy.About Carla FineCarla Fine is the author of nine books, including No Time to Say Goodbye: Surviving the Suicide of a Loved One; Touched by Suicide: Hope and Healing After Loss; Strong, Smart, and Bold: Empowering Girls for Life; and Married to Medicine: An Intimate Portrait of Doctors' Wives. She lectures frequently throughout the U.S. and internationally about how suicide affects those who have been left behind. Carla lives in New York City and her website is www.carlafine.com This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit healthmatters.substack.com

About Dr. Raphael Kellman's book The Microbiome Diet: The Scientifically Proven Way to Restore Your Gut Health and Achieve Permanent Weight LossThe groundbreaking program that connects the microbiome and gut health to healthy weight loss, complete with a 3-phase plan and recipesCutting-edge science has shown that the microbiome is the key to overall mental and physical health--and the secret behind healthy, sustainable weight loss. About Dr. Steve Barrer's book Exercise Will Hurt YouA (Philadelphia Magazine) Top Doc’s case for moderation in running, cycling, skiing, and other things we do because we think our bodies are invincible. When was it decided that exercise could only be good for you? Leading neurosurgeon Dr. Steve Barrer argues—based on his extensive career treating exercise-related injuries, a cornucopia of his own personal injuries from exercise over the years, and ample scientific data—that we ought to change the way we think about exercise. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit healthmatters.substack.com

Dr. Carolyn Lam:               Welcome to Circulation on the Run, your weekly podcast summary and backstage pass to the journal and its editors. I'm Dr. Carolyn Lam, associate editor from the National Heart Center and Duke National University of Singapore.                                                 Today's feature paper is going to cause us to rethink the way we prognosticate patients with pulmonary arterial hypertension following their initial management. Think you know the hemodynamic variables? Well, stay tuned for this discussion coming right up after these summaries:                                                 Our first original paper this week shows for the first time the predictive value of coronary artery calcification progression for coronary and cardiovascular events in a population base study. Authors Dr. Erbel and Lehmann from University Hospital Essen in Germany and their colleagues evaluated several progression algorithms between CTs performed at baseline and after a mean of five years for the risk prediction of coronary and cardiovascular events in a population base cohort of more than 3,200 participants initially free from cardiovascular disease.                                                 The authors found that coronary artery calcification progression added some predictive value to the baseline CT and risk assessment, and even when the five-year risk factors were taken into account. However, the progression yielded no additional benefit when the five-year coronary artery calcification results were taken into account instead of the baseline coronary artery calcification results.                                                 Double zero coronary artery calcification scans in a five-year interval meant an excellent prognosis, which was better than the prognosis for incident coronary artery calcification after five years. Thus, the authors concluded that sophisticated coronary artery calcification progression algorithms may be unnecessary and clinicians can instead rely on the most recent risk and coronary artery calcification assessment.                                                 The next paper demonstrates for the first time cell-specific effects of Smad3 signaling in the infarcted myocardium. Now, in the infarcted heart, Smad3 signaling is known to be activated in both cardiomyocytes and the interstitial cells. In the current paper, co-first authors, Doctors Kong and Shinde, corresponding author Dr. Frangogiannis from Albert Einstein College of Medicine in New York, and their colleagues hypothesized that cell-specific actions of Smad3 may regulate, repair, and remodeling in the infarcted myocardium.                                                 In order to dissect the cell-specific Smad3 actions in myocardial infarction, these authors generated mice with Smad3 loss specifically in activated fibroblasts or in cardiomyocytes. They found that fibroblast-specific Smad3 activation played a critical role in repair following myocardial infarction by restraining fibroblast proliferation and contributing to scar organization by stimulating integrin synthesis.                                                 On the other hand, cardiomyocyte-specific Smad3 signaling did not affect acute ischemic injury, but triggered nitrosative stress and induced matrix metalloproteinase expression in the remodeling myocardium, thereby promoting cardiomyocyte death and contributing to systolic dysfunction.                                                 In summary therefore, these authors demonstrated the cellular specificity of Smad3-dependent actions that stimulate distinct cellular responses in fibroblasts versus cardiomyocytes in the healing myocardial infarction. The implications are that nonspecific therapeutic targeting of Smad3 signaling in pathologic conditions may interfere with both detrimental and beneficial actions. On the other hand, design of interventions with specific cellular targets may be needed for the development of safe and effective therapies.                                                 Good news from the next paper! Genetically predetermined high blood pressure and its complications may be offset by healthy lifestyle. Well, at least, to some extent. First author, Dr. Pazoki, co-corresponding authors Dr. Elliott from Imperial College London and Dr. Tzoulaki from University of Ioannina in Greece aimed to investigate the extent to which lifestyle factors could offset the effect of an adverse blood pressure genetic profile as well as its effects on cardiovascular disease risk.                                                 To do this, they constructed a genetic risk score for high blood pressure using 314 published blood pressure loci in more than 277,000 individuals without previous cardiovascular disease from the UK Biobank study. They scored participants according to their lifestyle factors including body mass index, healthy diet, sedentary lifestyle, alcohol consumption, smoking, and urinary sodium excretion levels measured at recruitment. They examined the association between tertiles of genetic risk and tertiles of lifestyle score with blood pressure levels and incident cardiovascular disease.                                                 They found that adherence to a healthy lifestyle was associated with lower blood pressure regardless of the underlying blood pressure genetic risk. Furthermore, adherence to a healthy lifestyle was also associated with lower risk of myocardial infarction, stroke, and the composite cardiovascular disease at all levels of underlying blood pressure genetic risk. Healthy compared to unhealthy lifestyle showed a 30%, 31%, and 33% lower risk of cardiovascular disease respectively among participants at low, middle, and high genetic risk groups. Thus, these results strongly support population-wide efforts to lower blood pressure and subsequent cardiovascular disease risk through lifestyle modification.                                                 The final paper is an aggregate report from two large randomized trials, which demonstrate for the first time that more potent antiplatelet therapy further lowers venous thromboembolism risk relative to aspirin alone. First author Dr. Cavallari, corresponding author Dr. Bonaca, and colleagues from the TIMI Study Group in the Brigham and Women's Hospital ascertained and characterized symptomatic venous thromboembolism events in more than 47,600 patients randomized in the TRA 2°P-TIMI 50 and PEGASUS-TIMI 54 trials. They evaluated risk of symptomatic venous thromboembolism over time, independent risk factors for venous thromboembolism, and the efficacy of more intensive antiplatelet strategies at reducing venous thromboembolism risk.                                                 They found that the rate of venous thromboembolism in patients with atherosclerosis was 0.3% per year while on treatment with at least one antiplatelet agent. This risk increased independently with the number of symptomatic vascular territories. Furthermore, more intensive antiplatelet therapy with Vorapaxar and Ticagrelor in this case reduced the risk of venous thromboembolism.                                                 These data suggested a relationship between atherosclerosis burden and venous thromboembolism risk. The data also support the inclusion of venous thromboembolism as a prospective endpoint in long-term secondary prevention trials evaluating the risks versus benefits of antiplatelet therapies in patients with atherosclerosis.                                                 Well, that wraps it up for our summaries. Now for our feature discussion.                                                 For our feature discussion today, we are talking about pulmonary arterial hypertension. We've learned so much from registries about prognostication of pulmonary arterial hypertension at the time of diagnosis. But these registries have only provided limited insight into the impact of therapies on long-term outcomes and how we're supposed to use variables after initiation of therapy to determine prognosis.                                                 Well, that gap is being filled by today's paper in circulation. I'm so pleased to have the first and corresponding author with us, Dr. Jason Weatherald from University of Calgary, as well as Dr. Kelly Chin, associate editor from UT Southwestern, to discuss this very important paper.                                                 Jason, congratulations on this paper. Could you tell us a bit more about what you did and why you did it, and what's exciting about what you found? Dr. Jason Weatherald:   This is a study that started during my research fellowship last year when I was spending time in Paris with the group of Professor Olivier Sitbon and Marc Humbert. We started this study based on some other recent papers showing the importance of pulmonary arterial compliance, and some smaller studies that emphasized the importance of hemodynamic variables after treatment initiation and the prognostic importance of that. We wanted to look at the relative importance of pulmonary arterial compliance as well as the stroke volume in the cardiac index in newly diagnosed patients.                                                 We looked at a 10-year cohort from the French registry of patients who had right heart catheterizations at baseline and then after treatment initiation. We looked at prognostic variables, both at baseline and at the first follow-up after initial treatment. The interesting result is that we found that actually pulmonary arterial compliance is not the most important prognostic variable, but it seemed that the stroke volume index, which was calculated from the cardiac index and the heart rate, was the most significant independent predictor of long-term survival from the hemodynamic perspective. Dr. Carolyn Lam:               Kelly, could you help point out why this is so important in clinical practice? You see a lot of these patients. In what way did this paper make you think differently about them? Dr. Kelly Chin:                    I think there's a couple different areas that really struck me. The first one was, as you mentioned in the introduction, the importance of post treatment values versus baseline values. This is not to say that the baseline values aren't important because it does still associate with survival and it's very important when choosing therapy, but as PAH therapies have become more effective, we would hope to see that the baseline severity matters less and that, indeed, seems to be what we're seeing here. That also reinforces the importance of serial reassessment to see how your patient is doing and make further decisions for therapy.                                                 The second key finding, I think, is what Jason was just talking about with which hemodynamic measures do we really want to be keeping a close eye on? Here's where, in the stepwise analysis, they found that the right atrial pressure and then, the surprising one, the stroke volume index were the key measures that were associated.                                                 Interestingly, cardiac index fell out of that model. That isn't to say that cardiac index wasn't associated with outcome. It was a predictor in the univariate analysis. But I think when you step back and you think about the comparison between those two, if you have a patient who's maintaining their cardiac index only by becoming tachycardic, they're probably not doing nearly as well as a patient who has a normal heart rate and a normal stroke volume index.                                                 I think this really struck me as something, "Hey, when I'm in the cath lab, I probably need to be thinking about this and reporting it out, so everybody's seeing it right there on the report", which is not something we've been doing. Dr. Carolyn Lam:               Thanks Kelly. That makes so much sense. What I really appreciated about the paper as well is that they gave us practical thresholds through their receiver operating characteristic analyses. Just for everyone to know, the threshold value for stroke volume index was 38 mils per minute per meter square, right? And the right atrial pressure threshold was 9 mils of mercury. These are sort of very important, 38 and 9, and practical to keep in mind. Really appreciate that Jason.                                                 The other thing that struck me is these are just very much saying that right ventricular function is important. Is it not, Jason? Dr. Jason Weatherald:   Yeah, I agree. I think that's one of the interesting insights from the study is that we focused mostly on the cardiac index, but it can be misleading in certain patients like Kelly said who perhaps do respond to therapy by increasing the cardiac index but predominantly through increased heart rate. That can be somewhat misleading if you don't really step back and look at it.                                 What I found interesting, too, is that when we looked at subgroups of patients who, in the clinic, you generally think are low risk patients who had good six-minute walk distance, very few symptoms NYHA functional class I or II, and had a cardiac index above the current recommended target of 2.5, that there was almost a third of patients with a low stroke volume index in that category and that seemed to be the majority of patients who died over long-term follow-up within five years.                                                   I think that's really telling about the importance of right ventricular function and just looking at the cardiac index itself can perhaps mislead you if you don't take all of those other factors into consideration. Dr. Carolyn Lam:               Yeah, that's just such a great point and important. That even those classified that we would not have picked up as high risk are the usual measures that we look at. If you look at stroke volume index, they still distinguish those who do better than those who do worse. This is something that was also highlighted, I think, in the accompanying editorial, Kelly, that you invited by Lewis Rubin from New York.                                                 Kelly, what do you think are the real take home messages from this? Dr. Kelly Chin:                    I think he does make a big point that the functional status of the right ventricle is a primary goal of therapy, and that we should definitely be paying attention to it and that there's more than one way to do this. There's the hemodynamic measurements, there's also exercise capacity and functional class, which really do associate with how well the right heart is functioning, both at rest and exercise. I think he also comes back to the serial measurements and the importance of reassessment. Dr. Carolyn Lam:               Yeah, as you had also so elegantly summarized earlier. But, a quick question to both of you. What do we do now about other measures of right heart function? I mean, magnetic resonance imaging seems to be used increasingly for this. Where does this fall in? And what does this say about the routine clinical parameters that we usually look at, like six-minute walk? Jason? Dr. Jason Weatherald:   I have a couple points on that. Number one, I fully agree and our results are really in keeping with the previous smaller studies looking at cardiac magnetic resonance and showing the importance of the stroke volume on imaging. From personal experience, although MR is wonderful, there's a good population of patients who don't really tolerate MR, especially for serial measurements, and there's other contraindications, so I think hemodynamics will continue to fill an important role and are still useful in the patient where you can't figure out exactly what's going on and why they're getting worse.                                                 At this point, I think it's complementary and certainly I think there's some centers in many countries that don't have cardiac MR widely accessible, especially for serial follow-ups, so I think they're really complementary and that our results support imaging studies.                                                 I would say the next thing about the study is that, in the multi variable models that exercise distance, the six-minute walk distance and functional capacity remained independent predictors, so I think, it just highlights the importance and the robustness of these measures, even though NYHA functional class is subjective, it remains a very powerful predictor at baseline and during follow-up. To me, it speaks to the importance of looking at multiple parameters and coming to a multidimensional assessment of risk and PAH and not focusing on one particular variable for making decisions in the clinic. Dr. Kelly Chin:                    I definitely agree with the multidimensional look at a patient function and heart and catheterization. What I was going to say was I also liked, Jason, the use of "complementary" when talking about catheterization and MRI. I see MRI filling a similar niche to echo for many patients. I think if you get an echo and it looks great, heart size is good, heart function is good, I don't see a whole lot of reason to add an MRI, too. We're always routinely doing catheterizations, at least early post treatment, to reassess.                                                 But I do see a role for MRI in some of our patients who are doing not well at all, but we're not quite sure if they're doing poorly enough that it's time for transplant, and I'm trying to decide if the RV is growing or not. It's clearly big, but is it getting bigger each six months that we're looking at it? Sometimes MRI just seems to provide so much more precision than we can get with echo and certainly you're not getting any of those types of measures off of your catheterization. Dr. Carolyn Lam:               Maybe one last question Jason. It's so interesting. What is the future? What are the gaps that you're looking to fill at the moment? Dr. Jason Weatherald:   Ideally, I think it would be a noninvasive way to look at the right ventricle that is cheap, reproducible, and gives us the same confidence that invasive hemodynamics do. Although I find echo is indispensable and MRI is very useful, I think at the end of the day, we all go back to the right heart catheterization and we need to find something that can replace that, but give us the same confidence in what we think we're measuring and that it reflects treatment changes and clinical worsening. Dr. Carolyn Lam:               And Kelly, what do you think should be next steps? Dr. Kelly Chin:                    I have to say I really liked this study. I thought it moves us forward in assessment of prognosis for this population of patients in a really big way. It was large and included a large number of measures that were done very carefully. You always want to see replication.                                                 But, what I'd also like to see is the other forms of pulmonary arterial hypertension. You know this focused mainly on the idiopathic PAH patients, so what happens in connective tissue disease, and also what happens late after treatment, because I think we sometimes see a little bit of a different phenotype in patients that we've treated for many years and sometimes hemodynamics have improved, but in different ways than what we see early on with initial therapies. Dr. Carolyn Lam:               You've been listening to Circulation on the Run. Tune in again next week.  

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Dr. Carolyn Lam: Welcome to Circulation on the Run, your weekly podcast summary and backstage pass to the journal and its editors. I'm Dr. Carolyn Lam, associate editor from the National Heart Center and Duke National University of Singapore. Our feature discussion is regarding the exciting results of the masked hypertension study showing that clinical blood pressure underestimates ambulatory blood pressure, but first here's your summary of this week's issue.     The first study reviews the largest clinical experience so far with pulmonary vein stenosis following ablation for atrial fibrillation. First author Dr. Fender, corresponding author Dr. Packer and colleagues from Mayo Clinic Rochester, Minnesota evaluated the presentation of 124 patients with severe pulmonary stenosis between 2000 and 2014 and examined the risk for re-stenosis after intervention utilizing either balloon angioplasty alone or balloon angioplasty with stenting. All 124 patients were identified as having severe pulmonary vein stenosis by CT in 219 veins. 82% were symptomatic at diagnosis with the most common symptoms being dyspnea, cough, fatigue and decreased exercise tolerance. 92 veins were treated with balloon angioplasty, 86 with stenting and 41 veins were not intervened on. The acute procedural success rate was 94% and did not differ by initial management. Overall, 42% of veins developed re-stenosis, including 27% of veins treated with stenting and 57% of veins treated with balloon angioplasty.     The three-year overall rate of re-stenosis was 37% with 49% of balloon angioplasty treated veins compared to 25% of stented veins developing re-stenosis. This was a difference that remained significant even after adjusting for age, CHADS2 VASC score, hypertension and time period of the study with an adjusted [inaudible 00:02:30] ratio of 2.46 for risk of re-stenosis with balloon angioplasty versus stenting. In summary, this study shows that the risk for pulmonary vein re-stenosis is significant following atrial fibrillation ablation. The diagnosis is challenging due to non-specific symptoms and while there is no difference in acute success by type of initial intervention, stenting significantly reduces the risk of subsequent pulmonary vein re-stenosis compared to balloon angioplasty.     The next paper shows that the index of microvascular resistance, which is a novel invasive mreasure of coronary microvascular function, has emerging clinical utility as a test for the efficacy of myocardial re-perfusion in invasively managed patients with acute ST elevation myocardial infarction. In this study by first author Dr. [Carrick 00:03:30], corresponding author Dr. Barry and colleagues from the University of Glasgow in Scotland, index of microvascular resistance and coronary flow reserve were measured in the culprit artery at the end of percutaneous coronary intervention in 283 patients with ST elevation myocardial infarction. Authors found that compared with standard clinical measures of the efficacy of myocardial re-perfusion, such as ischemic time, ST segment elevation and angiographic blush grade, the index of microvascular resistance was more consistently and strongly associated with myocardial hemorrhage, microvascular obstruction, changes in left ventricular ejection fraction and left ventricular end diastolic volume at six months as well as all caused death of heart failure during the median follow up of 845 days.     In fact, compared with an index of microvascular resistance greater than 40, the combination of this index and coronary flow reserve less than two did not have incremental prognostic value. The take-home message is therefore that an index of microvascular resistance above 40 represents a prognostically validated reference test for failed myocardial re-perfusion at the end of primary percutaneous coronary intervention. This study supports further research into microvascular resistance based therapeutic strategies in these patients.     The next study provides experimental data regarding molecular mechanisms underlying calcific aortic valve disease. First author, Dr. Haji, and corresponding authors Dr. Matthew and [Bose 00:05:24] from the Quebec Heart and Lung Institute in Canada performed genomic profiling and in-depth functional assays in human aortic valves. They demonstrated for the first time that the promotor region of the long non-coding RNA H19 is hypomethylated in patients with calcific aortic valve disease. This hypomethylation in turn increases H19 expression in the valve interstitial cells where it prevents Notch 1 transcription by blocking or out-competing P53's recruitment to the Notch 1 promotor. Thus, H19 appears to be the missing link connecting Notch 1 to idiopathic calcific aortic valve disease. It may therefore represent a novel target in calcific aortic valve disease to decrease osteogenic activity in the aortic valve.     The next paper describes the largest cohort of mycotic abdominal aortic aneurysms to date and is from Dr. [Sorelias 00:06:37] and colleagues of Uppsala University in Sweden.  These authors identified all patients treated for mycotic abdominal aortic aneurysms in Sweden between 1994 and 2014. Among the 132 patients, they noted that the preferred operative technique shifted from open repair to endovascular repair after 2001 with the proportion treated with endovascular repair increasing from 0% in 1994 to 2000 to 60% in the 2008 to 2014 period. Survival at three months was lower for open repair compared to endovascular repair at 74% versus 96% respectively with a similar trend present at one year. A propensity score adjusted analysis confirmed the early better survival associated with endovascular repair. During a median follow up of 36 months for open repair and 41 months for endovascular repair. There was no difference in long-term survival, infection-related complications or re-operation. The take-home message is that endovascular repair appears to be a durable surgical option for treatment of mycotic abdominal aortic aneurysms.     The final study provides insights into the molecular mechanisms by which aldosterone triggers inflammation and highlights the particular role of NLRP3 inflammasome, which is a pivotal immune sensor that recognizes endogenous danger signals and triggers sterile inflammation. Authors Dr. Bruden [Esimento 00:08:32], Dr. [Tostes 00:08:33] and colleagues from the University of Sao Paulo in Brazil analyzed vascular function and inflammatory profiles of wild-type NLRP3 knockout, caspase-1 knockout and interleukin-1 receptor knockout mice, all treated with vehicle or aldosterone while receiving 1% saline. They found that mice lacking the interleukin-1 beta receptor or lacking inflammasome components such as NLRP3 and caspase-1 were protected from aldosterone-induced vascular damage. In-vitro, aldosterone stimulated NLRP3-dependent interleukin-1 beta secretion by bone marrow derived macrophages. Chimeric mice reconstituted with NLRP3 deficient hematopoietic cells showed that NLRP3 in immune cells mediated the aldosterone-induced vascular damage.     In addition, aldosterone increased the expressions of NLRP3, caspase-1 and mature interleukin-1 beta in human peripheral blood mononuclear cells. Finally, hypertensive patients exhibited increased activity of NLRP3 inflammasome. Together these data demonstrate that NLRP3 inflammasome via activation of interleukin-1 receptor is critically involved in the deleterious vascular effects of aldosterone, thus NLRP3 is a potential target for therapeutic interventions in conditions with high aldosterone levels.     That wraps it up for our summaries. Now for our feature discussion.     On today's podcast we are going to be discussing the very important issue of masked hypertension. This is an issue that gets a lot less attention than I think compared to white coat hypertension. I'm so pleased to have the first and corresponding author of the masked hypertension study, Dr. Joseph Schwartz, from Stony Brook University and Columbia University in New York. Welcome to the show, Joe.   Dr. J. Schwartz: My pleasure. I'm delighted to join you.   Dr. Carolyn Lam: We have a regular on the show today as well, Dr. Wanpen Vongpatanasin, associate editor from UT Southwestern. Welcome back Wanpen.   Dr. Wanpen V.: Thank you so much. Happy to be here.   Dr. Carolyn Lam: Joe, I want to start by addressing the common misperception that ambulatory blood pressure is usually lower than clinical blood pressure. That seems to make a lot of sense to us clinically because, for example, I always use ambulatory blood pressure to diagnose white coat hypertension and so the assumption there is that my clinically measured blood pressure is higher than what I'm going to be finding if this patient measures the blood pressure on an ambulatory 24-hour basis. It's also from the cutoffs that we use. For example, ambulatory blood pressure we use a 24-hour cutoff of 130/80 to make the diagnosis whereas with clinical blood pressure we use a cutoff of 140/90 so all of this kind of reinforces that ambulatory blood pressure is usually lower. Your study, though, tells us otherwise so please fill us in here.    Dr. J. Schwartz: You're right that in the doctor's office there are a certain set of people who probably get anxious when they're around a doctor and with that anxiety may cause a temporary increase in their blood pressure, a temporary elevation, and that's the basis of where we think white coat hypertension comes from. That's a very widespread belief among doctors and it's even been in previous guidelines, there have been statements to that effect. When I talk to people out in the general public and tell them I'm doing a study comparing blood pressure out in the real world compared to blood pressure in the doctor's office, all of them tell me, "Well, usually when I'm in a doctor's office that's a relatively calm period for me unless there's really something wrong with me and out in the everyday world I have to face a variety of stressors. I have deadlines. I have places I need to get to. Sometimes I have people yelling at me. Sometimes I'm just in a hurry."     All these things elevate your blood pressure out in the real world and so when we were trying to recruit people for the study, and we were very agnostic in recruiting them, telling them that we were interested in the differences in blood pressures between the doctor's office and the ambulatory blood pressure and they might go in either direction. When I told them about the fact that their ambulatory blood pressure or real world blood pressure might be higher than in the doctor's office, the vast majority of people nodded affirmatively and said, "It wouldn't surprise me at all."   Dr. Carolyn Lam: Could you define masked hypertension compared to white coat hypertension and tell us a little bit about the population you studied.   Dr. J. Schwartz: Sure. First with the definition. I'm going to say something a little bit different from something you said before. You mentioned cutoffs that we typically used for ambulatory blood pressure of 130/80 and those are the cutoffs that are used if you compute an average blood pressure over the entire 24 hours. What many people do, and what we did for this study, was compare the average blood pressure when people were awake to their blood pressure in the doctor's office because obviously in the doctor's office everybody is awake. The typical cutoffs there are 135/85, recommended by numerous guidelines in this country and with our international collaborators. The definition of masked hypertension is having a blood pressure in the clinic setting that's below 140/90 but having an ambulatory blood pressure where either the systolic blood pressure is above 135 or the diastolic is above 85 millimeters of mercury.     In terms of the sample, for years I've had a particular strategy for trying to recruit participants. I do worksite-based studies and so I identify large organizations that will allow me to recruit their employees and then what we did for this study is go to individual departments, both here at Stony Brook University, at Columbia University, at a residential veterans' home that's affiliated with Stony Brook University and then also at a local private hedge fund management company. We would go to these sites, I talk to the head of a department and tell them a little bit about masked hypertension and what the study was about and ask them if they would be willing to have their employees participate in the study. Once I had the okay from the department head then we would conduct public health screenings, blood pressure screenings. My staff and I would go into the department for multiple days and invite anybody who was interested to have their blood pressure taken on site and while we were taking those blood pressures carefully.     The proper way to take those is to take three readings and leave a minute or two interval between them and rather than just have silence then between the readings we would tell them a little bit about our study. At the end of the study if they didn't have extremely high blood pressure and were not taking blood pressure medication we would ask them if they might be interested in participating in the study that we just described. That's how we identified potential participants and about 2/3 of the people that we talked to who looked eligible indeed chose to participate.                   Dr. J. Schwartz: The one other thing I might mention that I think we mentioned, I hope we mentioned as a limitation of the study, is that everybody in the study had health insurance and at least until recently there were very large portions of the population that didn't have health insurance, everybody by virtue of their employment by the organizations that participated in the study, did have employer-based health insurance.   Dr. Carolyn Lam: Thanks for clarifying the population so well. Could you just give us the top line of your findings. How big a difference did you find, which direction and that intriguing effect of age?   Dr. J. Schwartz: Sure. The first thing we found is that on average the systolic blood pressure is seven millimeters mercury higher out in everyday life than it is in the clinic setting where we take our clinic readings. I should mention that unlike most studies, and all studies at the time that we began our study, we brought people in three separate times to take the clinic blood pressure. Up until that, almost all of the studies of ambulatory blood pressure monitoring only had clinic blood pressures from a single visit. I think we have a very reliable measure of the clinic blood pressure as well as reliable measure of ambulatory blood pressure. We see a seven millimeter difference in the systolic blood pressure and a 2 millimeter difference, again the ambulatory being higher for diastolic blood pressure.     What's more remarkable is if you think about what's a sizable difference. If you think if we perhaps somewhat arbitrarily say 10 millimeters of systolic blood pressure is a large difference. More than 35% of the population has an ambulatory blood pressure that is more than 10 millimeters higher than their clinic blood pressure whereas only 3% of our sample had that large a difference in the opposite direction, what many people would call a white coat effect. It's more than a 10 to 1 difference in numbers of people who have elevated ambulatory versus elevated clinic.     You asked me to mention something about the age difference. When you look at how that difference in systolic blood pressure varies by age, it's quite a bit larger for people who are younger. If you're under 30 the difference is, on average, 10 millimeters rather than seven millimeters and if you go up as you approach 60 years of age or so the difference becomes relatively small, perhaps in the neighborhood of two millimeters. We don't have enough people because it's a working population over 65 to say very much about what would happen. In fairness to prior research, which often is on older populations and particularly hypertensive populations, the studies that have historically shown that ambulatory blood pressure tends to be lower than clinic blood pressure are in these older populations and populations that have elevated blood pressure to start with.     My speculation there, and you haven't asked me to mention it but I will, is that older people and those with hypertension have a reason to be more nervous or more anxious when they go to the doctor than people who are not taking medication and probably don't even know that they have hypertension. People who are just being screened perhaps during a routine physical for the possibility of hypertension, because the doctors take a blood pressure reading every time you go in, they're doing that in order to see whether you might have hypertension, but most people who are going in for what we call a well patient visit are not nervous about their blood pressure being high.   Dr. Carolyn Lam: I have to say, the take-home message for me when I read this was, I am not paying enough attention to masked hypertension and then another thing was, maybe I need to think about more white coat hypertension in the older and masked hypertension in the younger. Wanpen, do you think it's as simple as that? What were your take-home messages?   Dr. Wanpen V.: I think this is a very important study that examines this in a systematic way. I'm not surprised that Joe found as much masked hypertension here. I think that he's absolutely right. We looked at this in Dallas Heart Study as well recently and we found that in the population-based sample in Dallas almost 20% of people have masked hypertension and white coat we found only like 3% and the average in the Dallas Heart Study was very close to those samples, about mid-40s. I think that's a very important finding in that the people with masked hypertension would not be suspected otherwise to have problems. Also, in the Dallas Heart Study they used home readings but Dr. Schwartz used ambulatory blood pressure monitoring. Unless extra out of office monitoring is being done we will totally miss these people who are more likely to have target organ damage from high blood pressure. I think that's absolutely important.   Dr. Carolyn Lam: Actually, Wanpen you brought up something I was going to bring up as well. Where does home blood pressure fit in with this? Do you think it's home blood pressure versus ambulatory blood pressure?   Dr. Wanpen V.: The US Preventive Services Task Force has issued a little bit of recommendations recently that we need to either use ambulatory blood pressure monitoring or home blood pressure monitoring to confirm diagnosis of hypertension in the office. If someone shows up with elevated blood pressure in the office either home blood pressure or ambulatory blood pressure needs to be done. If we just followed that guidelines we're still going to miss people with masked hypertension because by definition they don't have elevated blood pressure in the office. I think that from these findings and Dr. Schwartz' study I think to catch these people we really need to pay attention to people with pre-hypertension type of blood pressure because it seems like those are the group that has the most probability to have elevated ambulatory blood pressure so anyone with borderline blood pressure in the clinic, those are the ones who the doctor needs to tell the patient to monitor blood pressure at home or order ambulatory blood pressure themselves if that's available in their facility.   Dr. Carolyn Lam: Wanpen, I fully agree. What an important message. Joe, I'd like to give you the final word but I'd love to hear how you have maybe taken this into your own practice.   Dr. J. Schwartz: I think we mostly focused on and indeed the paper mostly focuses on the difference between clinic blood pressure and ambulatory blood pressure. When we talk about the young people, the young people have a bigger difference but those differences are for the most part all in the normal range. You might see a 10- or a 12-point difference but it might be that the ambulatory is 124 and the clinic is 112 and no doctor is going to worry about that very much. There are really always two things that we're trying to look at simultaneously: The first is what is that difference between the ambulatory and the clinic, but the second is for whom does the clinic stay under the threshold for diagnosis of hypertension but the ambulatory is over? That's the diagnosis of masked hypertension.     We haven't said it today so I'll say it: Of those people who had normal clinic blood pressures averaged across three repeated visits, 15.7% of them had elevated ambulatory blood pressure and would have been diagnosed as having hypertension based on their average daytime ambulatory blood pressure reading. That's one message.     The last message is unfortunately there is almost no research yet telling us what we should do in terms of treating people with masked hypertension. We are now at the point where we can identify these people and we're also at the point where we now know that there are a lot of such people and we don't even have any research to base guidelines on for deciding what we should do with them. The most obvious thing is to recommend lifestyle changes. If they're overweight we could suggest that they lose weight. We could suggest that they exercise more. We might think about treating some of those people, especially if their ambulatory blood pressure is well above 140/90. There are no statements out in the literature by any of the organizations, and in fact there's no research examining whether there's a benefit or not a benefit to perhaps putting some of those people on medications. I think that's a big question that future research needs to address.   Dr. Carolyn Lam: Joe, thank you so much. I think your last statements just really emphasize how important this paper is. It increases awareness and it's going to open the door to much more needed research in this area. Thank you so much. Thank you Joe and Wanpen for being on the show today.     Thank you listeners for joining us. Don't forget to join us next week for even more news and exciting discussions.  

   The Sharvette Mitchell Radio Show airs every Tuesday at 6:00 p.m. EST. Find out more about our host and guests at www.Sharvette.com First segment Dr. Alice Millsap appearing at 6:00pm.Second segment Casey Grant appearing at 6:30pm.  

So many folks are suffering in silence - from depression to other emotional issues. Authors Dr. Dan Collins (The Trauma Zone) and PR Maven Terrie M. Williams (Black Pain) will talk about what can we do about it. Real talk for real issues - pointing us to a REAL LORD of all.