Podcasts about avd

In this version, Eugenia and Jeff discuss how ControlUp can help customers get more value of their Microsoft investment.Real-time troubleshooting and remediation for Microsoft IntuneEnd-to-end visibility for AVD and Windows 365Get control over your Windows 10 to Windows 11 MigrationsMake Microsoft Teams as reliable as a landlineBe alerted when any Microsoft Online Service goes down

Send us a textGet the vidIQ plugin for FREE: https://vidiq.ink/boostpluginWant a 1 on 1 coach? https://vidiq.ink/theboost1on1Check out the video version here: https://youtu.be/0HPucaCMwrQIn this episode of Tube Talk, Travis and Dan tackle a variety of listener questions, focusing on monetization strategies, audience engagement, and the challenges of going full-time on YouTube. They discuss the intricacies of YouTube metrics, the importance of niche consistency, and how to navigate content creation with kids. The conversation also touches on the impact of viral videos on channel analytics and the significance of maintaining audience trust through transparency and thoughtful sponsorships.TakeawaysMonetization for music channels can be challenging due to copyright issues.YouTube metrics like CTR and AVD are important but not the only indicators of success.Finding a niche and being consistent is crucial for audience engagement.Engaging with your audience and understanding their expectations can lead to better content.Transparency with your audience about your main channel can have pros and cons.Sponsorships should align with your content and audience to maintain trust.Viral videos can skew analytics and affect future content performance.Improving voice and presentation skills can enhance viewer engagement.Managing your finances and understanding taxes is essential for full-time creators.Creating family-friendly content requires careful consideration of COPPA regulations.

Welcome to Episode 395 of the Microsoft Cloud IT Pro Podcast. In this episode, we dive into Azure Virtual Desktop (AVD) and how it enables organizations to deliver secure, scalable Virtual Desktop Infrastructure (VDI) in the cloud. Whether you're looking to modernize remote work, enhance security, or optimize IT costs, AVD provides a flexible solution for accessing virtualized Windows desktops and applications from anywhere.Topics covered include: What is Azure Virtual Desktop? A breakdown of AVD's features, benefits, and common use cases. Deployment essentials – Setting up host pools, session hosts, and assigning users. Configuration best practices – Managing user profiles with FSLogix and securing AVD with Microsoft Intune. Cost estimation – Key factors affecting pricing and how to optimize expenses. Getting started – Steps to connect via the Remote Desktop client on multiple platforms. Whether you're an IT admin or just exploring VDI in Azure, this episode is packed with insights to help you get started. Tune in and take your remote desktop strategy to the next level! Your support makes this show possible! Please consider becoming a premium member for access to live shows and more. Check out our membership options. Show Notes Azure Virtual Desktop documentation Understand and estimate costs for Azure Virtual Desktop Azure Virtual Desktop Azure Virtual Desktop documentation for users Get started with the Remote Desktop client FSLogix for user profiles Managing with Intune Manage the operation system of sessions hosts (with Intune) About the sponsors Would you like to become the irreplaceable Microsoft 365 resource for your organization? Let us know!

In this episode, I cover vulnerabilities patched in this month's Windows Updates and some vulnerabilities patched by other vendors. I also cover a newly published exploit, a large scale brute force attack under way, resources for AVD and more! Reference Links: https://www.rorymon.com/blog/new-outlook-app-forced-on-win10-patch-tuesday-news-openai-to-cancel-o3/

In today's episode, we're revisiting an inspiring birth story featuring Emily Chandler and Taylor Washburn, graduates of the Evidence Based Birth® Childbirth Class. They share their journey of navigating an informed and empowered hospital birth experience, along with the challenges they faced during an extended hospital stay for their newborn's jaundice diagnosis.   Emily, a marine scientist, and Taylor, a teacher and rowing coach in the Boston area, enjoy an active lifestyle filled with hiking, biking, and rowing. While preparing for parenthood, Emily immersed herself in learning about pregnancy, birth, and the state of maternity care in the U.S. This journey led them to take the EBB Childbirth Class with instructor Chanté Perryman, where they gained valuable knowledge and advocacy skills.   Emily and Taylor share how the EBB Childbirth Class empowered them to make informed decisions about their birth plan—including Taylor's memorable experience of “catching” their baby. They also highlight the importance of the advocacy skills they learned, which helped them effectively communicate with healthcare providers and navigate unexpected challenges, such as breastfeeding difficulties and securing the right support during their baby's jaundice treatment.   Be sure to listen all the way to the end of the episode for an exciting update from our guests!   Content Note: This episode covers topics such as extended hospital stays, breastfeeding challenges, jaundice testing and treatment, and the racial disparities affecting Black and Brown infants with jaundice. (00:03:15) Doula Guidance During Pregnancy (00:09:24) Minimal Intervention Birth Plan Worries (00:17:45) Unexpected Labor Challenges (00:24:45) Efficient and Caring Nurse's Impact (00:34:34) Newborn's Breastfeeding and Jaundice Journey (00:40:03) Newborn Care and Feeding Challenges (00:43:17) Optimal Umbilical Cord Clamping Timing (00:47:27) Risk Factors for Infant Jaundice (00:52:18) Jaundice Warning Signs and Emergency Help (00:55:57) Home Birth Journey and EBB Impact Resoures: Get the Evidence Based Birth® Pocket Guide to Newborn Procedures here You can learn more about jaundice here at the Mayo Clinic site, or here at the Cleveland Clinic website. Access the Evidence Based Birth Signature Articles on: The Evidence on Premature Rupture of Membranes here The Evidence on Group B Strep here The Evidence on Pitocin in the Third Stage here Listen to EBB 145- Fatherhood and Advocacy in Birth with JacMichael Perryman here Listen to EBB 244 – Evidence on AROM, AVD and Internal Monitoring here Learn more about Chanté Perryman's EBB Childbirth Class and services here Learn more about the Nest Collaborative here For more information about Evidence Based Birth and a crash course on evidence based care, visit www.ebbirth.com. Follow us on Instagram and YouTube! Ready to learn more? Grab an EBB Podcast Listening Guide or read Dr. Dekker's book, “Babies Are Not Pizzas: They're Born, Not Delivered!” If you want to get involved at EBB, join our Professional membership (scholarship options available) and get on the wait list for our EBB Instructor program. Find an EBB Instructor here, and click here to learn more about the EBB Childbirth Class.

"Hoy en Gourmet FM, tenemos el placer de hablar con Ricardo Gasparri, propietario de El Otro Vino, una vinoteca valenciana que combina esencia argentina y una apuesta clara por los vinos singulares. Este proyecto se ha convertido en un referente para los amantes del vino en Valencia, gracias a su selección de etiquetas provenientes de pequeños productores y su enfoque en destacar el trabajo artesanal detrás de cada botella. Ricardo ha sabido construir un espacio que no solo es una tienda, sino también un lugar de encuentro para la comunidad vinícola. Sin embargo, como tantos otros, ha enfrentado los retos que ha supuesto la reciente DANA en la Comunidad Valenciana. Hoy queremos conocer cómo ha vivido esta situación, cómo ha impactado en El Otro Vino y qué aprendizajes se lleva para el futuro. Para pedidos: Web: elotrovino.com Ubicación: Avd. Blasco Ibáñez, 28, Aldaia, Valencía. Teléfono: 696550528 Con Fran León.

Welcome to Episode 391 of the Microsoft Cloud IT Pro Podcast. In this episode, Scott sits down with Kamal Srinivasan from Parallels to talk how you can think about delivering applications and desktops to your users in post-Citrix world. As the traditional “Citrix” model faces disruption, we explore how remote work, hybrid scenarios, and cloud-based computing are redefining how organizations deliver applications and desktops to end users. Key topics include: The shift away from static, on-prem desktops to dynamic, cloud-based compute. How to optimize app delivery by building on top of Microsoft's Azure Virtual Desktop (AVD) platform. Bridging the gap between legacy systems and cloud-based solutions, enabling businesses to roll out remote desktop solutions like AVD and Parallels RAS gradually while scaling down on-prem infrastructure. The changing role of IT admins in supporting a workforce that operates anywhere, anytime. Listen in and learn how your organization can streamline operations and empower your workforce with flexible, efficient application and desktop delivery. Like what you hear and want to support the show? Check out our membership options. Show Notes Parallels Parallels RAS Parallels RAS Resources Parallels Secure Workspace Enhance your Azure Virtual Desktop experience with Parallels RAS Windows 365 Link Episode 390: Microsoft Ignite 2024: Windows 365 Link About the sponsors Would you like to become the irreplaceable Microsoft 365 resource for your organization? Let us know!

This episode delves into the pressing need to reevaluate the management strategies for Aortic Valve Disease (AVD) worldwide. With a focus on South Asian and Sub-Saharan African nations, the discussion highlights how low-income countries predominantly rely on surgical aortic valve replacement (SAVR) using mechanical valves. The episode explores the unique challenges faced in these regions, where patients are generally younger compared to those in high-income countries, and the disease often stems from rheumatic origins. The conversation aims to shed light on the disparities in treatment approaches and the necessity for tailored solutions that address the distinct characteristics of AVD in diverse global contexts.

As part of Oncology On the Go, CancerNetwork® spoke with Andrew M. Evens, DO, MBA, MSc, about developments in the treatment landscape for adolescents and young adults (AYA) with lymphoma. He highlighted collaboration between adult and pediatric oncologists that may better standardize treatment for this population.  Evens is the deputy director for clinical services at the Rutgers Cancer Institute and system director of medical oncology and oncology lead at RWJBarnabas Health Medical Group. Of note, Evens discussed an effort to “harmonize” efforts between adult and pediatric oncologists in treating AYA patients who may receive different treatment regimens, despite being similar in age. Furthermore, he highlighted 2 prominent trials that illustrated collaborative efforts from both adult and pediatric oncologists: the phase 3 SWOG S1826 trial (NCT03907488) and the phase 3 AHOD2131 trial (NCT05675410). Regarding the SWOG trial, Evens highlighted the greater efficacy and tolerability of nivolumab (Opdivo) with doxorubicin hydrochloride (Adriamycin), vinblastine sulfate, and dacarbazine (AVD) vs the standard of care brentuximab vedotin (Adcetris) plus AVD.  “You could say it was, generally speaking, a double winner. [The nivolumab combination] was more effective at 2 years; the progression-free survival [PFS] was greater than 90%, [which was] a remarkable output. When I say a double winner, it was also largely better tolerated. There was less neuropathy, [fewer] infections, and less sepsis [vs brentuximab vedotin plus AVD]. Surprisingly, to a certain extent, [there were] not many immune-related adverse events outside of thyroid [events],” Evens said. Furthermore, Evens discussed how collaboration between adult and pediatric oncology has impacted developments in the AYA lymphoma sphere. He placed a particular emphasis on the efforts of the Lymphoma Research Foundation, which convened multiple AYA lymphoma symposiums and established an AYA consortium. He then outlined unmet needs for this patient population, which included mitigating late toxicities following treatment and addressing inconsistencies in guidelines for lymphoma treatment in the AYA group. Evens then discussed mitigating disparities and addressing barriers to care, underscoring a need to navigate the complexities of treatment for a patient population with a myriad of stressors. He concluded by highlighting resources available to AYA lymphoma groups, which include educational, medical, and psychosocial resources to best educate patients and express to them that they are not alone.  “At the end of the day, be an advocate. Be an advocate for yourself. Be an advocate for others and know that there are [many] resources and people out there to help. We want to make sure nobody has to go through this alone, and that they have the medical and other psychosocial resources available to them,” Evens concluded.

Ved Tore Julsrud Berg, overlege, professor dr.med. Avd. for endokrinologi, sykelig overvekt og forebyggende medisin, Oslo universitetssykehus Institutt for klinisk medisin, Universitetet i Oslo.Foredragsserien Om aldring publiserer hver måned et nytt foredrag om temaer knyttet til aldring og helse, med hovedfokus på eldres psykiske helse. Undervisningen er gratis, nettbasert og varer i cirka 20 minutter. Foredragene kan også høres som podkast. Hosted on Acast. See acast.com/privacy for more information.

How can you secure your company information with Azure Virtual Desktop? Richard talks to Jim Duffy about his work helping companies comply with NIST SP 800-171 security standards. These are the new standards required for Department of Defense contracting - including all subcontractors and suppliers. The security standard is thorough, with over 100 requirements. And you have to be audited to show that you comply! Even if you don't work with the government, the NIST security standard is excellent, and Jim talks about how you can use AVD to create a secure enclave for protecting data. And if you need help complying with NIST 800-171, Island Systems can help!LinksAzure Virtual DesktopNIST SP 800-171 Rev 3Secure Future InitiativeIsland SystemsRecorded August 12, 2024

Hohe Benzinpreise, überteuerte Essenspreise und teils dreckige Sanitäranlagen: Das erwartet einen an deutschen Autobahnraststätten. "Ich glaube, dass man hier ein Monopol ausnutzt", sagt Lutz Leif Linden, Automobilclub von Deutschland (AvD). Von WDR 5.

This episodes' special guest is—Jack Chamberland, Event Coordinator for "A Salute to Soldiers." Jack is deeply involved with an organization that has made a tremendous impact on our veteran community, America's VetDogs (AVD). We're excited to hear about his journey and the incredible work being done by AVD. 

La Sevillana, parada obligatoria junto a la Glorieta Olímpica. Abierta desde el pasado 4 de abril, esta nueva cervecería ha llenado de muy buen ambiente la esquina norte de la Avd. Concejal Alberto Jiménez Becerril

Summary In this episode of the Blue Security Podcast, Andy and Adam discuss new features and updates in Intune, including autopilot for existing devices, Intune enrollment attestation, and mobile application management (MAM). They explain how autopilot for existing devices allows organizations to enroll on-premise joined devices into autopilot using config man and a task sequence. They also highlight the importance of monitoring device enrollments and implementing security measures such as requiring a pin for app access and blocking third-party keyboards. Takeaways - Autopilot for existing devices allows organizations to enroll on-premise joined devices into autopilot using config man and a task sequence. - Monitoring device enrollments and implementing security measures such as requiring a pin for app access and blocking third-party keyboards are important for protecting corporate data. -Intune enrollment attestation stores the MDM ID in the TPM of the device, preventing attacks that export the MDM device to attack other devices. -Mobile application management (MAM) is a lightweight way to protect corporate data on unmanaged devices, and it can be used in conjunction with MDM on managed devices. -MAM capabilities are now available for Windows 365 and AVD clients on Windows, iOS, PadOS, and Android clients, allowing for more secure access to corporate data. ---------------------------------------------------- YouTube Video Link:⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ ⁠https://youtu.be/R8GYUQjr7ds⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ ---------------------------------------------------- Documentation: https://techcommunity.microsoft.com/t5/intune-customer-success/support-tip-upcoming-changes-for-deploying-windows-autopilot-for/ba-p/4181554 https://learn.microsoft.com/en-us/autopilot/existing-devices https://learn.microsoft.com/en-us/mem/intune/enrollment/windows-enrollment-attestation#resources https://techcommunity.microsoft.com/t5/windows-it-pro-blog/mam-preview-for-windows-365-and-azure-virtual-desktop/ba-p/4171051 https://learn.microsoft.com/en-us/mem/intune/protect/mobile-threat-defense ---------------------------------------------------- Contact Us: Website: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://bluesecuritypod.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Twitter: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://twitter.com/bluesecuritypod⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Linkedin: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.linkedin.com/company/bluesecpod⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Youtube: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.youtube.com/c/BlueSecurityPodcast⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ ----------------------------------------------------------- Andy Jaw Twitter: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://twitter.com/ajawzero⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ LinkedIn: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.linkedin.com/in/andyjaw/⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Email: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠andy@bluesecuritypod.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ ---------------------------------------------------- Adam Brewer Twitter: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://twitter.com/ajbrewer⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ LinkedIn: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.linkedin.com/in/adamjbrewer/⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Email: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠adam@bluesecuritypod.com

Drs. John Sweetenham and Marc Braunstein discuss practice-changing studies in hematologic malignancies that were featured at the 2024 ASCO Annual Meeting, including the ASC4FIRST trial in chronic myeloid leukemia and IMROZ and CARTITUDE-4 in multiple myeloma.  TRANSCRIPT Dr. John Sweetenham: Hello, I'm Dr. John Sweetenham from UT Southwestern's Harold C. Simmons Comprehensive Cancer Center and host of the ASCO Daily News Podcast. On today's episode, we'll be discussing practice-changing abstracts and other key advances in hematological malignancies that were featured at the 2024 ASCO Annual Meeting. Joining me for this discussion is an old friend, Dr. Marc Braunstein, a hematologist and oncologist from the NYU Langone Perlmutter Cancer Center.  Our full disclosures are available in the transcript of this episode. Marc, it's great to have you back on the podcast again. There were some important studies in the heme space at the Annual Meeting this year, and we're very pleased that you're able to share your takeaways.  Dr. Marc Braunstein: Thank you, John. It's great to be back again. Dr. John Sweetenham: Let's start out, Marc, with LBA6500. This abstract reports the primary results of the ASC4FIRST trial, and this was a trial comparing asciminib with investigator selected tyrosine kinase inhibitors in newly diagnosed patients with chronic myeloid leukemia. Could you tell us a little about the trial and how you think it's going to impact clinical practice? Dr. Marc Braunstein: Absolutely. So, asciminib is an oral tyrosine kinase of the ABL kinase domain. As we know in CML, the BCR-ABL translocation is characteristic of the disease, and asciminib is approved for chronic phase CML with a T315I resistance mutation or for patients who have received 2 or more prior lines of therapy. So the ASC4FIRST trial was a randomized trial of 405 patients with newly diagnosed chronic phase CML who are randomized one to one to receive either asciminib at 80 milligrams once daily, or investigator's choice of a first generation TKI imatinib or one of three second generation TKIs nilotinib, dasatinib, or bosutinib. The primary endpoint of the study was the major molecular response, or MMR, at 48 weeks. Pretty much, the study met its primary endpoint with a 67% rate of MMR at 48 weeks, with asciminib versus 49% in patients treated with the investigator's choice of TKI. And in addition, the major molecular remission or MMR of 4.5, which is a deep remission, those rates were higher as well, with asciminib versus investigator's choice at a rate of 39% versus 21% when comparing the groups. Furthermore, when we looked at toxicity, there were fewer grade 3 or higher adverse events, with the asciminib at 38% versus either 44% with the first generation, or 55% with the second generation TKI, and fewer discontinuations as well with asciminib.  So I think this abstract is practice-changing. I think it offers compelling data to use asciminib upfront for chronic phase CML. Those who don't agree with that sentiment might argue that we want to see longer term follow up. There's a planned follow-up at 96 weeks. We would want to see the rate of progression to acute myeloid leukemia and of course overall survival as well. But I think the abstract certainly shows an improvement in outcomes with asciminib versus our current array of TKIs. Dr. John Sweetenham: Yeah, I think it certainly is, at least at minimum, potentially practice changing. I agree with you. Just one question, and this may be a little bit speculative, but do you have any thoughts about treatment free survival with asciminib and how that might line up against some of the other TKIs? Dr. Marc Braunstein: Yeah, that's a great question. The abstract did not necessarily address that, patients were treated until progression, but we know that with the current landscape of TKIs, that in patients who have achieved a deep MR of 4 or 4.5 for at least 2 years who discontinue their TKI, the rate of relapse is about 50%. The current study, the ASC4FIRST, doesn't address that, but I think it's a really good question about whether, for those patients who have achieved a deep remission, whether they can eventually stop asciminib down the line. Dr. John Sweetenham: Yeah, I guess it's one of those ‘watch this space' things.  So we'll see how the data mature out. And let's move on to what I think is another potentially practice-changing study, at least in certain parts of the world. And that's [the] LBA7000 study in classical Hodgkin lymphoma. As you remember, this was a German Hodgkin lymphoma study group trial which looked at the tolerability and efficacy of a novel regimen, BrECADD versus eBEACOPP for patients with advanced stage classical Hodgkin lymphoma in their study, which is known as GHSG HD21. Can you give us your thoughts and take home messages from this trial? Dr. Marc Braunstein: Yeah, John, absolutely. So the German HD21 study is a phase 3 study of 1,500 patients with classical Hodgkin lymphoma. The majority were stage 3 or 4, 84%, that compared two regimens BEACOPP to BrECADD. The major difference between these 2 groups being that the newer BrECADD regimen swaps out bleomycin for brentuximab vedotin, which is an anti-CD30 antibody drug conjugate. Also, in the BrECADD regimen they eliminate vincristine that's incorporated into BEACOPP. Those are kind of the global differences between these 2 regimens. And when comparing these, they looked at the primary endpoint of progression-free survival. Of note, in this study there was a PET adjusted approach where if patients achieved interim PET negativity after 2 cycles, that was followed by an additional 2 cycles of their treatment as opposed to 4 cycles if they were PET positive after the initial 2 cycles of their respective treatment. And of note, there were similar rates of PET2 negativity between both arms, about 58% in both arms.  So at a median follow-up of 48 months, the 4-year progression-free survival was significantly better with the brentuximab containing BrECADD regimen at 94% versus 91% with a hazard ratio of 0.66. And the overall survival of the BrECADD arm was 98.6%, which is very high and impressive. The 4-year overall survival was similar between the arms at around 98%, but of note, there were fewer severe adverse events with BrECADD, the brentuximab containing arm versus BEACOPP at about 42% versus 59% and interestingly less peripheral neuropathy with the brentuximab containing BrECADD. So we're doing extremely well in treating advanced stage classical Hodgkin lymphoma. So the bar is set very high. But in this study, the rates of progression-free survival and overall survival are very impressive.  While these intensive regimens tend to be used outside of the U.S., there are several notable benefits of the study, including greater than 50% PET2 negativity and high rates of progression-free survival at 4 years. In discussing this abstract, it's worth noting that there are other competing regimens, if you want to call it that, that are more commonly used in the U.S. So the ECHELON-1 study looked at brentuximab AVD compared with ABVD with bleomycin and it was a 94% versus 89% 6-year overall survival rate favoring the brentuximab containing A+AVD regimen. And lastly, more recently, the SWOG S1826 study that hasn't been published but was presented in abstract form looked at nivolumab AVD versus brentuximab AVD at a median follow up of 12 months showed a progression-free survival of 94% versus 86%. And that study still has yet to be published and needs to mature. But both of those regimens are in the NCCN guidelines. So, we're definitely pushing the bar higher in terms of improving responses in treating advanced classical Hodgkin lymphoma. Dr. John Sweetenham: I think that there's no question that these results from BrECADD are very impressive. But I'm taken back to what I think has been a kind of philosophic discussion in Hodgkin lymphoma now for a number of years about balancing disease control and efficacy against the potential short-term and long-term toxicity of the regimens, particularly when you have very effective salvage therapies for those patients who may suffer a relapse. So I think that this is a discussion over whether you take a very intensive, upfront approach to Hodgkin lymphoma versus something that may be less and slightly less intensive. I suspect that's a discussion that's going to continue for a long time. I don't know what you feel, but my own feeling about this is that this study will likely have a major influence over treatment of Hodgkin lymphoma, particularly in western Europe. Less likely in the US.., I would think. I don't know what your thoughts about that are. Dr. Marc Braunstein: Well, it's a great question. In SWOG S1826, that study did include pediatric patients. In HD21, the median age was 31 and did not include pediatric patients. So I think we have to be selective in terms of fitness and which patients may be better suited for different regimens. But I think what all these studies show is certainly when we incorporate novel immunotherapies, whether it's brentuximab vedotin, nivolumab, we improve progression-free survival and even overall survival. Dr. John Sweetenham: Absolutely.  So let's shift gears now and take a look at Abstract 7500, the IMROZ study. This was the study of isatuximab, bortezomib, lenalidomide and dexamethasone versus VRD alone for transplant ineligible patients with newly diagnosed multiple myeloma. I know we discussed this in our preview podcast a few weeks back, Marc, but I just wonder now, having seen the data in more detail, what do you think of the important takeaways? And again, are we looking at a new standard of care? Dr. Marc Braunstein: You know, there are many standards of care in multiple myeloma, but we're always looking to make improvements on the regimens we have at our disposal. So, just to recap, IMROZ is a phase 3 randomized study of the anti-CD38 monoclonal antibody isatuximab with the backbone of bortezomib, lenalidomide, dexamethasone or VRD versus VRD alone, specifically, in transplant ineligible newly diagnosed multiple myeloma patients age less than 80. They studied 446 patients in this study, randomized 3 to 2 to Isa-VRD versus VRD alone, with the primary endpoint of progression free survival. Now, similar to other studies where they included a monoclonal antibody up front, the study met its primary endpoint of improving progression-free survival with the quad regimen containing the monoclonal antibody isatuximab versus VRD alone.  So what was interesting about the study, it's really the first of its kind to be presented that specifically looked at transplant ineligible patients, which is presumably a less fit or perhaps more frail population that wouldn't go on to consolidation with stem cell transplant. And in this study, the progression-free survival at 5 years was 63% versus 45%, clearly superior when you included isatuximab. And the rates of complete remission and MRD negativity were all significantly improved, too. However, that was also met with slightly more grade 3 or higher treatment emergent adverse events, 92% versus 84% in the control arm. There are also 11% grade 5 treatment emergent adverse events with the isatuximab group versus 5.5% with VRD alone. Although there was no major difference in treatment discontinuation. One small caveat worth noting, too, is that high-risk patients in this study, when presented at ASCO, did not necessarily show a difference in benefit, although there wasn't necessarily a detriment either.  So, John, I think that clearly quadruplet regimens are superior in outcomes of efficacy to triplets, even in transplant-ineligible patients. But I think we have to tailor these treatments to individual patients because I think when it comes to transplant-ineligible patients, it's a spectrum of patients who may be more or less fit for quad regimens versus triplet regimens. It's also worth noting, though, that in this study, the patients are really only getting a quad regimen for 4 cycles. They get their Isa-VRD, and then you drop the bortezomib.  So when we think about quads, it's not that they're getting the quad regimen indefinitely, it's really for the induction cycles. But still, I think we have to be aware of potential safety issues. Dr. John Sweetenham: Okay, great. And let's stay on the theme of multiple myeloma, Marc, and talk a little bit about Abstract 7504, which was a subgroup analysis of the CARTITUDE-4 study. This is a report on the use of ciltacabtagene autoleucel versus standard of care in patients with functional high risk multiple myeloma. Can you give us your thoughts on this and maybe put it into a bit of context for us?  Dr. Marc Braunstein: Absolutely, John. It's really a great time to be in the field of multiple myeloma. We're making tremendous progress, but when we think about one of the unmet needs, it's just consistently the high-risk patients who have shorter responses and are at higher risk for poorer outcomes. Just to review, cilta-cel is one of the 2 available anti-BCMA CAR T-cell products available for the treatment of relapsed or refractory multiple myeloma. Very recently, the FDA approved cilta-cel for lenalidomide refractory patients after 2 or more prior lines of therapy based on the CARTITUDE-4 study, which was published by San-Miguel and colleagues in New England Journal of Medicine in July 2023. And that study randomized 419 patients with multiple myeloma with 1 to 3 prior lines of therapy to receive either cilta-cel or physician's choice of standard of care, which was either 1 of 2 triplet regimens, a pomalidomide, bortezomib, dexamethasone or daratumumab, pomalidomide and dexamethasone. It's worth noting that about 25% of the patients in the CARTITUDE-4 study had prior anti-CD38 antibody treatment previously and the carfilzomib was not included in one of the standard-of-care arms, and we know that those regimens containing carfilzomib do increase survival in relapsed myeloma.  Nevertheless, the primary outcome of progression-free survival was not reached in the CAR T-cell arm versus 11.8 months in the standard-of-care arm, with a significant reduction in progression of 74%. So clearly a positive study and CAR T-cell therapy is included in the NCCN guidelines for patients who have an early relapse from their myeloma. The current abstract by Costa et al focused specifically on a subgroup of 79 patients from CARTITUDE-4 in second line of treatment and looked at what they called functional high-risk myeloma, defined as progression of disease within 18 months of initial treatment or after stem cell transplant. Again, the study showed a retained benefit of cilta-cel with significant improvement in progression-free survival either not reached or 12 months with the control standard of care arm, as well as complete remission rate and rates of MRD negativity of 65% versus 10% in the control.  The overall survival outcome was still immature and not presented. Nevertheless, cilta-cel is clearly superior to standard-of-care triplet regimens. I think that for patients with high risk, they clearly derive a benefit from CAR T-cell therapy if they have short progression-free survival after initial therapy.  Dr. John Sweetenham: Thanks, Marc. So let's round this out by talking about another area of unmet need, I guess in a way in a difficult to treat patient group. And that's Abstract 7007, the SYMPATICO study. This is a study which looks at the efficacy and safety of ibrutinib and venetoclax in patients with mantle cell lymphoma who had a mutated TP53. Can you just briefly review this for us and tell us what you think we should be taking away from this studys? Dr. Marc Braunstein: So, mantle cell lymphoma typically has an aggressive behavior, but the subgroup of patients with a P53 mutation tend to have the poorest outcomes and do represent an area of unmet need. Although BTK inhibitors are making important improvements in mantle cell lymphoma, they have yet to be approved in newly diagnosed mantle cell lymphoma. Acalibutinib and zanubrutinib are FDA-approved BTK inhibitors for previously treated mantle cell lymphoma. Ibrutinib was withdrawn from the market in the U.S. for mantle cell lymphoma. Dr. Michael Wang's group presented late-breaking data from the phase 3 SYMPATICO trial at ASH 2023, in which 267 patients with relapsed refractory mantle cell lymphoma were randomized to receive either ibrutinib plus the BCL2 inhibitor venetoclax or ibrutinib plus placebo after 1 to 5 prior lines of therapy. And that study showed a 32 versus 22 months progression-free survival at a median follow up of 51 months. The current abstract, also by Dr. Wang and colleagues, looked at the subgroup of patients who had a P53 mutation and included an open label cohort of 44 patients in the first line of treatment and a relapse refractory cohort of 75 patients, and compared this subgroup of patients with P53 mutation to those without. When we look at the outcomes, the patients who did not have a P53 mutation clearly did better in terms of progression-free survival being not reached in first-line treatment compared to 22 months progression-free survival in those patients with first-line [treatment] with a P53 mutation. As well as in the relapsed refractory setting, the PFS without the P53 mutation was 47 months versus 21 months with the mutation. However, when you look at these patients treated with ibrutinib and venetoclax comparing whether they got treated in first line or the relapse refractory setting, the overall response rates are very similar at about 80% to 90% and the CR rates were very similar at about 55% to 58%, which to me suggests that although patients with P53 mutation do worse than those without it, whether they're treated in the first-line or the relapse setting with this combination of venetoclax, they tend to do somewhat similar, suggesting that you can overcome resistance to prior therapy in the relapse setting. So I think further data are certainly warranted to explore the role of combination therapies that include novel agents such as BTK inhibitors in the first line setting.  It's worth noting that the TRIANGLE study was recently published, and this study looked at including ibrutinib at various phases, including at induction in combination with intensive chemotherapy and during the maintenance phase. And that study showed encouraging outcomes in patients who received ibrutinib even without stem cell transplant compared to those who received stem cell transplant. So the role of BTKIs in mantle cell lymphoma is certainly evolving, and I think it offers a very effective intervention without the same kind of toxicities we see with cytotoxic chemotherapy that's traditionally used in mantle cell lymphoma. But I think the subgroup of patients with P53 mutation in this disease still represent an area of unmet need that unfortunately have worse outcomes. But novel agents may be able to overcome some of those adverse outcomes. Dr. John Sweetenham: Yeah, I agree. I think these are intriguing data, and obviously it needs more follow-up and probably more prospective studies. But nevertheless, I think there are some signals there for sure that need to be followed up on.  Marc, as always, it's great to have your insights on key advances in the heme space from ASCO. An important year this year, and we really appreciate your time and effort in sharing with us your thoughts on what we've learned this year. So thank you as always. Dr. Marc Braunstein: My pleasure. Dr. John Sweetenham: And thank you to our listeners for joining us today. You'll find links to the abstract discussed today in the transcript of this episode. Finally, if you value the insights that you hear on the ASCO Daily News Podcast, please take a moment to rate, review and subscribe wherever you get your podcasts.   Disclaimer: The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.   Find out more about today's guest:  Dr. Marc Braunstein  @docbraunstein    Follow ASCO on social media:   @ASCO on Twitter   ASCO on Facebook   ASCO on LinkedIn     Disclosures:  Dr. John Sweetenham:  Consulting or Advisory Role: EMA Wellness  Dr. Marc Braunstein:  Consulting or Advisory Role: Pfizer, Bristol-Myers Squibb/Celgene, Adaptive Biotechnologies, GlaxoSmithKline, ADC Therapeutics, Janssen Oncology, Abbvie, Guidepoint Global, Epizyme, Sanofi, CTI BioPharma Corp  Speakers' Bureau: Janssen Oncology  Research Funding (Institution): Janssen, Celgene/BMS   

In this episode I cover details on some of the first Co-Pilot+ PCs that shipped this week, I get into 3 vulnerabilities in vCenter that were disclosed this week, a new AVD feature and much more! Reference Links: https://www.rorymon.com/blog/3-major-vcenter-vulnerabilities-worrying-sql-security-news-co-pilot-pcs-shipping-now/

Dr. John Sweetenham and Dr. Marc Braunstein look ahead at key abstracts across the spectrum of hematologic malignancies that will be presented at the 2024 ASCO Annual Meeting, including the OPTIC trial in chronic myeloid leukemia, treatment options for transplant-ineligible patients with multiple myeloma, and the 7-year analysis of the ECHELON-1 trial in classical Hodgkin lymphoma. TRANSCRIPT Dr. John Sweetenham: Hello, I'm Dr. John Sweetenham from UT Southwestern's Harold C. Simmons Comprehensive Cancer Center and the host of the ASCO Daily News Podcast. I'm delighted to be joined again this year by Dr. Marc Braunstein, a hematologist and oncologist at the NYU Perlmutter Cancer Center in New York. We're going to be discussing some of the key abstracts in hematologic malignancies that will be featured at the 2024 ASCO Annual Meeting.  Our full disclosures are available in the transcript of this episode, and disclosures of all guests on the podcast are available at asco.org/DNpod.  Marc, it's great to have you back on the podcast. Dr. Marc Braunstein: It's a pleasure to be back, John.  Dr. John Sweetenham: There are some exciting abstracts to be presented at this year's meeting, and I would like to begin, if we can, with Abstract 6501. As you know, this reports the four-year results from the OPTIC trial of ponatinib in patients with chronic-phase CML and the T315I mutation. Can you tell us about the trial and about these latest follow-up results? Dr. Marc Braunstein: Sure. Well, we've made tremendous progress in managing patients with CML in the past two decades using these oral tyrosine kinase inhibitors such as ponatinib. Ponatinib is a third-generation TKI that has activity in both Philadelphia-positive ALL as well as CML, and can overcome the resistance mutation you mentioned, called the T315I mutation, which is sometimes found following prior TKI therapy. The OPTIC study is a multicenter phase 2 randomized study of various doses of ponatinib in 283 chronic phase CML patients who had received 2 or more prior lines of therapy or those who had the presence of a T315I mutation, with the current analysis examining the major remission at 48 months, PFS, as well as OS. Of note, in this study, after patients have achieved a major remission with a transcript level of 1% or less, the study allowed for dose reduction of ponatinib from the original dose of either 45 milligrams or 30 milligrams to a reduced dose of 15 milligrams.  So, when we look at the results, we find that the patients who had the highest overall response rates and higher rates of molecular remission were those who received the 45-milligram dose. And remember, these patients were allowed to be dose-reduced to the 15-milligram dose once they achieved a molecular remission of 1% or less. In addition, the rates of overall survival were highest in the 45-milligram dose as well. When looking at the T315I subgroup, the rates of molecular remission, the depth of remission, and the rates of progression-free survival, in general, were lower in that subgroup, but still higher in the 45-milligram dose than the 35- milligram dose.  Furthermore, when looking at the rates of treatment-emergent adverse events leading to discontinuation, they were 8% in the 45-milligram dose compared to 14% in the 30-milligram dose and 5% in the patients who only received the 15-milligram dose. The authors have concluded that the 45-milligram dose, with the potential to be reduced to 15 milligrams after achieving 1% or less of the BCR-ABL transcript level, seems to be the right balance between efficacy and safety.  Dr. John Sweetenham: Thanks, Marc. In the longer term, do you think that this study will, in any way, affect the position of ponatinib in the treatment algorithm for CML? Is it going to remain as a second or third-line option, or do you think there's any chance it will be moved up? Dr. Marc Braunstein: Well, that's a great question. There are other TKIs, such as asciminib, that also target the T315I mutation, and that mutation tends to develop after prior first-line or second-line TKI therapy. But given its activity in both ALL and CML, I think it's certainly reasonable to expect that ponatinib will be used in earlier lines of therapy given its efficacy in later lines. Dr. John Sweetenham: Let's change gears and move the focus to acute myeloid leukemia. There has been a lot of discussion around frailty in many different malignancies, but the impact of frailty on outcomes in AML is maybe something that hasn't been quite so well studied. In Abstract 6506, investigators did a population-based study in Ontario, Canada, that assessed the patient's frailty risk and the impact that might have on outcomes. What are your takeaways from this study, and how do you think these data will help optimize treatment decisions?  Dr. Marc Braunstein: Yeah, I'm glad we're talking about this abstract John, because frailty scores are increasingly being used in hematologic malignancies to help guide goals and intensity of care. And as opposed to using age or performance status alone, these composite frailty assessment tools, such as the MFI tool that they used in this particular study, take into account multiple variables that are both physiologic, such as the patient's comorbidities, as well as social, and what kind of support system do they have, and things of that nature. And that accounts for their overall fitness. So, in this retrospective cohort study that was a population-based study in Ontario between 2006 and 2021, they looked at 5,450 patients retrospectively with acute leukemia and grouped those patients into 3 categories based on this frailty index. Patients who are either fit, somewhere in the middle between fit or frail, which they call pre-frail, or frail. And they looked at outcomes such as overall survival, comparing patients who got intensive chemotherapy regimens for induction or those who got non-intensive therapy for induction. Patients in either group could have been assigned to either fit, pre-frail, or frail although there are much more fit patients than those who got intensive induction.  And so, looking at their findings, it was noted that patients who were in the frail category, not entirely unexpectedly, had lower overall survival when compared to those who were fit or pre-frail. I think the value of a study like this is not just to highlight the benefit of frailty scores to help predict which patients may ultimately have a shorter survival, but also to help potentially guide which patients may be more suitable for intensive versus less intensive induction. I will note that this study was conducted in an era where we didn't have the same sorts of less intensive induction that are very effective in less fit patients, such as the combination of azacytidine and venetoclax, which is commonly used in less fit patients nowadays. So, the study may encompass patients who didn't have access to that therapy because it wasn't available during that time. But I think it still, overall, does highlight the fact that assessing fitness or frailty in acute myeloid leukemia is important for predictive value. Dr. John Sweetenham: I agree. Marc, I don't know what your thoughts are on this, but it goes either way. I mean, I think that, if I remember the numbers correctly, 25% of fit patients received non-intensive therapy. So, is there a missed opportunity there for that group of patients who actually may have tolerated the intensive therapy but it was never offered? Dr. Marc Braunstein: That's an excellent point, John, and I think that highlights the importance of frailty indices because they take into account much more than one particular factor, or even just a subjective assessment of the patient in real time when they're first presenting. And they may have disease-specific features that are decreasing, say one element of their assessment such as their performance status. So, really taking these composite fitness scores into account may actually allow you to escalate therapy in a patient who may actually be fit but maybe perceived as less fit when they present. Dr. John Sweetenham: Yeah. So, I think, as you mentioned, there are better treatment options out there now maybe than there were at the time this study was conducted. Nevertheless, there may still be that opportunity for more intensive therapy for some of these patients when they are more holistically assessed.  Let's move on and switch gears once again and talk about a study in multiple myeloma, the so-called IMROZ study, which is Abstract 7500. So, this is a study looking at treatment options for transplant-ineligible patients with newly diagnosed multiple myeloma. Some of these patients may not have a chance for subsequent therapy if they are not eligible for transplant. What are your thoughts on this study? Do you think we're closer to a new standard of care for patients who are not going to proceed to an autologous stem cell transplant?  Dr. Marc Braunstein: It seems like every year there's a new standard of care for newly diagnosed multiple myeloma because there's so much data emerging, which is just wonderful. So, I think as background, at the 2023 ASH meeting, the IsKia study was presented, which is a randomized phase 3 study in newly diagnosed transplant-eligible patients. And that was using isatuximab with carfilzomib, lenalidomide, and dexamethasone upfront and that study did show a benefit in terms of reducing minimal residual disease compared to carfilzomib, lenalidomide, and dexamethasone alone. But that study was looking at fit newly diagnosed patients who were going on to stem cell transplant. Right now, the standard of care for patients who are not eligible for transplant is generally to use a 2 or 3-drug regimen, such as daratumumab, lenalidomide, and dexamethasone, based on the phase 3 MAYA study. But this study is really unique in that it looks at using a quadruplet regimen in patients who are transplant ineligible or not intended to go for transplant.  So, the phase 3 IMROZ study was a randomized study of 446 patients that compared isatuximab, bortezomib, lenalidomide, and dexamethasone to bortezomib, lenalidomide, and dexamethasone alone. So, a quad versus a triplet regimen. The primary endpoint in this study was progression-free survival, but they also looked at secondary endpoints, such as complete response rate and minimal residual disease negativity.   Just to quickly highlight the results and then discuss the standard of care, the median duration of treatment in this study was 53 months in the quad regimen and 31 months in the control arm. At a median follow-up of about 60 months, the progression-free survival was not reached with the quad regimen versus 54 months in the triplet, and that was a significant difference. In addition, the safety profile was pretty much consistent with the class, there were a bit more grade three or higher treatment-emergent adverse events with the ESA-containing regimen, 92% versus 84%, but no difference in adverse events leading to discontinuation in either arm.   So, this study is certainly compelling in terms of using quadruplet-based regimens that contain an anti-CD38 monoclonal antibody for newly diagnosed patients who are not intended to undergo transplant. I think at the meeting, I will be interested to see the patient population that was included. Patients who are over the age of 80, for example, are excluded. So, I would like to know more about their fitness level and performance status. But I think it's clear, John, that using quad regimens over triplet regimens is just consistently superior in terms of efficacy outcomes. Dr. John Sweetenham: Right. I guess that, even though maybe we can't focus on the specific agents right now, it looks as if quad regimens are going to be the standard of care regimens for the future in this group. Do you think that is fair?  Dr. Marc Braunstein: Very likely. Dr. John Sweetenham: Absolutely. Well, that's a pretty challenging group of patients.   And so to move on again, let's talk about another, perhaps equally challenging group - patients with mantle cell lymphoma, particularly those who carry certain mutations. The so-called SYMPATICO study, which is reported in Abstract 7007, presents data on the efficacy and safety of ibrutinib and venetoclax in patients with mantle cell lymphoma who carry a TP53 mutation. We know that this mutation confers a high risk of early progressive disease and poorer outcomes when these patients are treated with standard chemoimmunotherapy for mantle cell. Trials to date have been limited to small single-arm studies. Can you tell us a little bit about this study and the outcomes and what you think it means for the future?  Dr. Marc Braunstein: As a background, although BTK inhibitors such as ibrutinib have yet to be approved for newly diagnosed mantle cell lymphoma, acalabrutinib and zanubrutinib, which are second-generation BTK inhibitors, are FDA-approved for previously treated mantle cell lymphoma. Ibrutinib was withdrawn from the market. The lead author of this abstract, Dr. Michael Wang, had presented a late-breaking data from the phase 3 SYMPATICO trial at ASH last year, in which 267 patients with relapsed or refractory mantle cell lymphoma after one to five prior lines of therapy were randomized to receive the combination of ibrutinib plus the BCL-2 inhibitor venetoclax or ibrutinib plus placebo. That study showed there was a 32 versus 22-month progression-free survival with a hazard ratio of 0.65 at a median follow-up of 51 months, indicating the PFS benefit of the combination of ibrutinib and venetoclax compared to ibrutinib with placebo.   So that leads us to this subgroup analysis in the current study being presented at ASCO, in which they looked at a subgroup of patients with mantle cell lymphoma who are at very high risk for treatment failure and early relapse - those are patients who have a mutation in TP53, which again is high risk for treatment failure. This abstract examined an open-label cohort of 44 first-line patients, as well as 75 patients who were in the relapse/refractory cohort, and compared to patients who either did or did not have the P53 mutation. When we look at the progression-free survival outcomes, the median progression-free survival in the first-line cohort of patients who did not have a P53 mutation was not reached, whereas those with the P53 mutation had a median progression-free survival of 22 months, which is still meaningful but still less than those who did not have a P53 mutation. Which again is not entirely unexpected. But the overall response rate of the combination of ibrutinib and venetoclax was very high at 90%, and the median duration of response was about 21 months.  Now comparing this to the relapse/refractory cohort, in those without a P53 mutation, the progression-free survival of the combination of ibrutinib and venetoclax was about 47 months versus those who don't have the P53 mutation was about 21 months with an overall response rate of 80%. I think one takeaway looking at this comparison of the first-line and relapse/refractory setting is that patients seem to do very similar in terms of overall response rate and progression-free survival, whether they were in the first line or in the later lines of treatment if they had the P53 mutation, which says that the combination of ibrutinib and venetoclax is effective no matter which phase of the disease the patient might be in, indicating its overall activity and being strong.    Dr. John Sweetenham: Yeah, I thought that was an interesting observation, actually, how similar the outcomes were in those two groups.  Dr. Marc Braunstein: No, I agree. And I think although patients with TP53 mutations did comparatively worse than those without the mutation according to progression-free survival, overall response rate, or complete remission rates, they did seem to be similar whether a patient was in first-line or relapsed refractory if they were P53 mutant and were treated with this combination. So, I think we need further data in the first line, such as the data that's awaiting publication from the TRIANGLE study, which is examining upfront ibrutinib. But certainly, BTK inhibitors have significant activity in either the first line or the relapse setting of mantle cell lymphoma.  Dr. John Sweetenham: Great. Thanks, Marc.  Let's wind up with one more abstract, and this is Abstract 7053. It's a 7-year analysis of the so-called ECHELON-1 study. This was a study comparing the standard of care, ABVD, with the same regimen with bleomycin substituted by brentuximab vedotin for patients with previously untreated advanced-stage classical Hodgkin lymphoma. The study at the time it was originally reported, resulted in a significant practice change in the first-line therapy of Hodgkin's lymphoma. We now have mature follow-up. What are your take-homes from this study? Dr. Marc Braunstein: The ECHELON-1 study has certainly been a practice-changing clinical trial where, as you said, brentuximab with the backbone of AVD was compared to ABVD, which was the prior standard. And this was examined in newly diagnosed patients with classical Hodgkin lymphoma who were at advanced-stage, stage 3 or 4. The publication, first of the progression-free survival, and more recently, in the New England Journal of Medicine in 2022, where we saw the 6-year overall survival was 94% with the brentuximab-containing arm versus 89% in the control arm, established the brentuximab AVD, or otherwise called AAVD, as the standard of care in advanced stage newly diagnosed classical Hodgkin lymphoma. The current study is now reporting 7-year follow-up on about 1,300 randomized patients who were enrolled in this impressive study.   Though at a median follow-up of 89 months now, the 7-year overall survival was quite similar, 94% versus 89%, again favoring the brentuximab-containing arm. In particular, this was driven by patients who had stage 4 disease or those patients who were aged less than 60 in subgroup analyses. So, what I take away from this abstract in the 7-year follow-up of the ECHELON-1 is that brentuximab with AVD remains the standard of care for previously untreated advanced-stage classical Hodgkin lymphoma. It is worth noting that the SWOG S1826 study that was presented at ASCO last year compared nivolumab with AVD compared to brentuximab AVD and did show a slight PFS advantage of 94% versus 86% with nivolumab AVD. Obviously, these were different studies with different patient populations enrolled, so we're really just cross-comparing different studies. But I think brentuximab AVD, given the survival benefit that is retained now at seven years in the current abstract, still remains the standard of care for advanced-stage classical Hodgkin lymphoma. The role of immune checkpoint inhibitors like nivolumab is making headway in terms of treating newly diagnosed patients as well. Dr. John Sweetenham: Yeah, thanks, Marc. I mean, one of the observations that I thought was of interest in this study was the outcome for patients who were PET-2 positive, when you compare AAVD and ABVD. It does seem as if even in those patients who are PET-2 positive, having had AAVD, they still apparently have a better outcome than those who received ABVD in that situation who were PET-2 positive. So, I think that's another interesting observation. I'm not quite sure what it means, except speaking to the overall superior efficacy of that regimen. Dr. Marc Braunstein: You make a great point, John, because it's worth noting that in ECHELON-1, a PET scan was done after cycle 2, but the study was not PET-adapted. So even if you had a positive PET, you continued for the full six cycles of treatment. But PET-2 status is often used in various studies of Hodgkin lymphoma to guide whether to give additional cycles or escalate therapy. So, I think the benefit of presenting those subgroups is that even if you were PET-2 positive, you still did better by continuing on the brentuximab-containing regimen. Dr. John Sweetenham: Yeah, exactly. I mean, the other important takeaway message, I think, is that the outcome for patients with advanced Hodgkin lymphoma seems to continue to steadily improve, which is great news and also really remarkable. And I'm excited to see there may be some additional data presented at one of the late-breaking abstracts in this year's meeting, so it will truly be interesting to see what that shows us as well.  Dr. Marc Braunstein: Incredible. Dr. John Sweetenham: Well, Marc, as always, thank you for sharing your insights with us today on the ASCO Daily News Podcast. We look forward very much to hearing the updated data from these abstracts at the meeting.  Dr. Marc Braunstein: As do I and thank you so much for inviting me again.  Dr. John Sweetenham: And thank you to our listeners for joining us today. You'll find links to the abstracts discussed today in the transcript of this episode. Finally, if you value the insights that you hear on the ASCO Daily News Podcast, please take a moment to rate, review, and subscribe wherever you get your podcasts. Disclaimer: The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.   Find out more about today's guest: Dr. Marc Braunstein @docbraunstein   Follow ASCO on social media:  @ASCO on Twitter  ASCO on Facebook  ASCO on LinkedIn    Disclosures:  Dr. John Sweetenham: Consulting or Advisory Role: EMA Wellness   Dr. Marc Braunstein: Consulting or Advisory Role: Pfizer, Bristol-Myers Squibb/Celgene, Adaptive Biotechnologies, GlaxoSmithKline, ADC Therapeutics, Janssen Oncology, Abbvie, Guidepoint Global, Epizyme, Sanofi, CTI BioPharma Corp Speakers' Bureau: Janssen Oncology Research Funding (Institution): Janssen, Celgene/BMS

Ever wondered about dentistry on our 4-legged friends?  Well Dr. Katherine Queck has made her career on taking excellent care of our precious friends while advocating for her specialty for over 30 years!  The DINKS had an absolute blast picking her brain on what a dental specialty clinic looks like for animals in comparison to what they look like for humans.   Another eye-opening and informative episode to enjoy!!Dr. Katherine Queck is the founder of The Hospital for Veterinary Dentistry and Oral Surgery, the Vet Education Center and the Center of Excellence. The flagship hospital is the only dental referral center located in Matthews, North Carolina with an additional location in  suburban Charleston, South Carolina. As a 1986 graduate of Iowa State University, Dr. Queck pursued her passion for dentistry and became a Fellow of the Academy of Veterinary Dentistry (AVD). In 1992, she relocated to Charlotte to establish a progressive dental clinic and became a national thought leader for her contributions in dentistry to the broader veterinary community. Dr. Queck is highly respected by her colleagues and was named Veterinarian of the Year by the NCVMA, Fellow of the Year by the Academy and served as Secretary of the AVD. As a Diplomate of the American Veterinary Dental College (AVDC), Dr. Queck is a board-certified specialist and a preferred service provider with over 35  years of experience in veterinary dentistry and oral surgery. She is committed to serve her clients, train dental residents and offer CE courses to general veterinarians and their staff. Globally recognized, Dr. Queck is a published international speaker and well-known Principal Investigator for field pilot and longitudinal studies bringing new innovations to the field of veterinary medicine. Dr. Queck enjoys outdoor activities with family and friends, including her Pet Family of 3 dogs and 1 cat.

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RFI: El Senado estadounidense aprobó a inicios de febrero un paquete de 90.000 millones de dólares de ayuda militar a Ucrania, Israel y Taiwán, impulsado por la administración Biden y apoyado por un pequeño grupo de Republicanos, pese al rechazo de Donald Trump.Ahora el proyecto debe pasar a la Cámara de representantes y eso no será tarea fácil, como lo explica la especialista en Defensa, Carla Martínez Machain, profesora de la Universidad de Buffalo. Carla Martínez Machain: 'Tradicionalmente, al menos los últimos treinta años, los republicanos han sido un partido internacionalista. Han estado a favor de las intervenciones militares de Estados Unidos que puedan votar. Lo que estamos viendo hoy en día es que están divididos. Los congresistas de la extrema derecha que apoyan a Donld Trump no están apoyando a Ucrania y también creo que se ha convertido en una lucha política interna en el sentido de que si se aprueba sería una victoria política para Joe Biden. Esto empezó como una negociación de que a cambio del paquete de financiamiento a Ucrania los republicanos pedían una reforma migratoria para la frontera sur, pero a estas alturas creo que esto no se va a realizar y que se va a negociar básicamente nada más que la ayuda financiera a Ucrania. Al pasar del Senado a la cámara baja, la Cámara de representantes y entonces el problema que tenemos es que aquí hay mayoría republicana. El presidente de la Cámara de representantes Mike Johnson no quiere que se deje pasar el voto, no lo pueden hacer solos los demócratas porque están en minoría, entonces tendrían que conseguir no sólo votos de algunos republicanos, pero también los votos de algunos demócratas, que son los más de izquierdas del partido que de momento no se planean  votar el paquete de ayuda financiera, porque el paquete también incluye ayudas a Israel."           RFI: Según altos oficiales del ejército estadounidense, el tiempo corre y de no recibir financiamiento de aquí a mayo, las operaciones relacionadas con Ucrania se pueden quedar sin fondos suficientes. Carla Martínez Machain: "Lo vimos recientemente con la caída de Avdíivka en manos de los rusos hace pocos días,  básicamente fue por falta de armas, porque los rusos tienen superioridad aérea, pero la ayuda financiera de Estados Unidos va a importar muchísimo Y eso va desde municiones hasta los aviones de caza F-16 como hemos oído recientemente  Si parece que les van a entregar algunos Dinamarca, Holanda, pero eso solo va a alcanzar para uno o dos escuadrones. Se va a tener que continuar con el programa de entrenamiento de los pilotos  de los caza F-16 y para eso también se necesita que se apruebe el paquete de ayudas financieras.”   

RFI: El Senado estadounidense aprobó a inicios de febrero un paquete de 90.000 millones de dólares de ayuda militar a Ucrania, Israel y Taiwán, impulsado por la administración Biden y apoyado por un pequeño grupo de Republicanos, pese al rechazo de Donald Trump.Ahora el proyecto debe pasar a la Cámara de representantes y eso no será tarea fácil, como lo explica la especialista en Defensa, Carla Martínez Machain, profesora de la Universidad de Buffalo. Carla Martínez Machain: 'Tradicionalmente, al menos los últimos treinta años, los republicanos han sido un partido internacionalista. Han estado a favor de las intervenciones militares de Estados Unidos que puedan votar. Lo que estamos viendo hoy en día es que están divididos. Los congresistas de la extrema derecha que apoyan a Donld Trump no están apoyando a Ucrania y también creo que se ha convertido en una lucha política interna en el sentido de que si se aprueba sería una victoria política para Joe Biden. Esto empezó como una negociación de que a cambio del paquete de financiamiento a Ucrania los republicanos pedían una reforma migratoria para la frontera sur, pero a estas alturas creo que esto no se va a realizar y que se va a negociar básicamente nada más que la ayuda financiera a Ucrania. Al pasar del Senado a la cámara baja, la Cámara de representantes y entonces el problema que tenemos es que aquí hay mayoría republicana. El presidente de la Cámara de representantes Mike Johnson no quiere que se deje pasar el voto, no lo pueden hacer solos los demócratas porque están en minoría, entonces tendrían que conseguir no sólo votos de algunos republicanos, pero también los votos de algunos demócratas, que son los más de izquierdas del partido que de momento no se planean  votar el paquete de ayuda financiera, porque el paquete también incluye ayudas a Israel."           RFI: Según altos oficiales del ejército estadounidense, el tiempo corre y de no recibir financiamiento de aquí a mayo, las operaciones relacionadas con Ucrania se pueden quedar sin fondos suficientes. Carla Martínez Machain: "Lo vimos recientemente con la caída de Avdíivka en manos de los rusos hace pocos días,  básicamente fue por falta de armas, porque los rusos tienen superioridad aérea, pero la ayuda financiera de Estados Unidos va a importar muchísimo Y eso va desde municiones hasta los aviones de caza F-16 como hemos oído recientemente  Si parece que les van a entregar algunos Dinamarca, Holanda, pero eso solo va a alcanzar para uno o dos escuadrones. Se va a tener que continuar con el programa de entrenamiento de los pilotos  de los caza F-16 y para eso también se necesita que se apruebe el paquete de ayudas financieras.”   

Today's episode is proudly sponsored by Darkhorse Tech, your go-to Dental-driven IT solutions company!‍‍‍Picture this: You're running a dental practice, and your patients' trust and data are your top priority. Enter Darkhorse Tech, the guardians of your patients' information, the solution to your IT headaches, and the force behind your seamless tech integrations.Your practice deserves the best, and Darkhorse Tech delivers.Click this link for an exclusive offer: https://thedentalmarketer.lpages.co/darkhorse-deal/AND if you're listening before November 27th, 2023, take advantage of their Black Friday deal! https://thedentalmarketer.lpages.co/darkorse-black-friday-deal/‍Guest: Reuben KampBusiness Name: Darkhorse TechCheck out Reuben's Media:Website: https://www.darkhorsetech.com/Facebook: https://www.facebook.com/DarkhorseTechInstagram: https://www.instagram.com/darkhorsetech/Email: admin@darkhorsetech.com‍Other Mentions and Links:‍Companies/Software: Benco Open Dental Microsoft Azure Flex Mango Dentrix Ascend Eaglesoft CareStack Oryx Archy DEXIS Carestream‍Useful Terms: DHCP - service that hands out IP addressesDNS - how devices resolve internet addressesGateway - how you get to the internetHIPAA - Health Insurance Portability and Accountability Act‍People/Communities: Howard Farran (podcaster + blogger)‍Dentistry Dentistry Uncensored with Howard Farran (podcast)‍Dental Town (blog/website/community)‍Host: Michael Arias‍Website: The Dental Marketer Join my newsletter: https://thedentalmarketer.lpages.co/newsletter/‍Join this podcast's Facebook Group: The Dental Marketer Society‍‍My Key Takeaways:I'm moving to cloud based software. Do I still need IT support?How to spot out IT companies that may be dishonest.How does your IT company help with HIPAA compliance?The basics on IT with firewalls, antivirus, and internet connectivity. Why do we need reliable options for these?Why the D.I.Y. mentality is often not the right call with your IT solutions.‍Please don't forget to share with us on Instagram when you are listening to the podcast AND if you are really wanting to show us love, then please leave a 5 star review on iTunes! [Click here to leave a review on iTunes]‍p.s. Some links are affiliate links, which means that if you choose to make a purchase, I will earn a commission. This commission comes at no additional cost to you. Please understand that we have experience with these products/ company, and I recommend them because they are helpful and useful, not because of the small commissions we make if you decide to buy something. Please do not spend any money unless you feel you need them or that they will help you with your goals.‍Episode Transcript (Auto-Generated - Please Excuse Errors)Michael: All right. It's time to talk with our featured guests. Beloved person. Everybody adores him. Ruben Camp. How's Reuben: it going, man? You know how hard it is to be beloved and an IT guy at the same time. So, I'm doing great. Thanks, Michael. I've been doing this 11 years and just happy to be talking to you today.Michael: No, man. We appreciate it. We appreciate everything you're doing. I know you guys have, um, done a lot for the dental community, also startup community as well. Just practices in general. Um, at the same time, this is not your first episode with us. You've been with us, you've guided us through some processes.And at the same time, we're going to answer some of the most major questions today. But before we do that, if you can kind of give us a gist or a rundown, been doing this for Reuben: 11 years. That's right. Well, this is in Dark Horse. Um, Dark Horse is something that I started. It was, it was just me, you know, back in 2012.And, uh, we we've grown throughout the years. We got about 65 employees, about 1000 clients, uh, that are in the dental space. That's pretty much all we focus on is dental. So, uh, how I got into that is I used to be a Benco technician. So I used to do corporate it for, you know, the bad guys and, uh, you know, they really love selling birds and bibs and all that stuff.But it was kind of an afterthought. So I really wanted to. Um, you know, start a company where service was the, uh, the main forward, not selling consumables. So, Mm-Hmm. Uh, other Interesting. My dad was a dentist. That's how I got into this industry. I think everyone has a really interesting path about how you found dental.I know you do Michael as well. Right? We all kind of get dragged in somehow. Yeah. Um, you know, went to school, uh, at Chapel Hill to, to be a dentist and decided I didn't wanna do that. So, uh, yeah. Benco dark horse. Here we are. So you Michael: left Benco mainly because you were not seeing what you wanted to see, or what was the reason?Reuben: Yeah. So, I mean, there are a sales. Company first, right? So they're, you know, all the meetings and all the messaging and everything like that. It was, it was about how do we sell more product? How do we sell more CBCTs? How do we, you know, get more accounts and sell them consumables? You know, I call it burrs, bibs and everything else.and they had I. T. Because you know what? They didn't want shine or Patterson to be in that office. they almost like they had I. T. As a defensive mechanism, but not as like a core, something that they were putting a lot of resources in to develop. So, you know, I'm very passionate about what I do, uh, customer service and dental.That's kind of like, that's my niche. So, you know, let's say if Benco was 80, 20 sales to service, right? We have three people in sales out of 65 people. So you can see just by the demographics of our, you know, how we're made up. Most of our people are in places to support our clients, not to sell, you know, to shove something down their throat.So that was very important to me just as a service technician that started a company versus You know, we have a lot of competitors out there that have just either, you know, either bought an IT company and they're just trying to squeeze it for profits or, you know, someone who does not understand customer service, but hey, they're really good at a P& L statement.Yeah, yeah. Michael: Did you specialize that in Chapel Hill IT? Reuben: No, I had biochemistry because I was, uh, that's pre dental based. Anything that's in the sciences basically is pre dental. So that's, uh, computers. that's just been kind of my thing for, you know, for as long as I can remember, you know, nine, 10, 12, got into building computers and fixing them and started a company in high school called it's good computer solutions with and we run around and.Anybody that knows Ithaca, it's Cornell. So we fix it in Cornell professors at all hours of the day. And anyway, so it's just kind of been a passion self taught passion Michael: of mine. Yeah. Cause I was going to ask you out of all the. Things you were doing in Benco. Why did you pick to hone in on IT? Reuben: Uh, for that solution?You know, they wanted me to be a dual trained tech, right? They wanted me not only to go into an office install a computer system, sensors mount a CVCT, calibrate it, do all that stuff. But they were like, you know it would be really great if while you're there someone's, you know Cuspidor doesn't work if you could also be crushing on the mechanicals, you know, suction, all that stuff, you know, amalgam separators.And I was, uh, I was just so, I was so talented at the I. T. side of things that I never really got that opportunity to learn on it. And that's fine because that's not really a passion of mine. Um, You know, those, those systems are kind of gross. What goes down the drain when they get clogged up. Uh, so, uh, there's some very talented, we call them core service technicians, right?The core equipment in the office. and we'll leave it up to the professionals, but, Michael: Gotcha. Okay, man. Interesting. So then fast forward, you started Dark Horse Tech and this is where you're at now. Now, I know we're going to kind of talk about, and let's kind of jump into that if we can. A lot of people do have.Open dental, right? and so break it down to me. What are the confusions when it comes to having that and then I. Reuben: T. Absolutely. So kind of how we got here is, you know, dark horse version 1. 0 was we were a small regional upstate New York company. I mean, it's good. New York, small town, 30, 000 people, 30, 000 college students.And, you know, that was the old way of doing things. And then, you know, we got a break and Howard for and hired me. And Howard was in Phoenix, so that was our first, I can't drive to your office, right? And we nailed it. he was running Open Dental, in his office. And that really gave us the confidence, uh, and exposure, right?Went on his podcast, got a, got a forum to, introduce myself to the dental community, which at that time was still. Dental town now about a year after that interview, it's like everyone fled to Facebook groups and then I followed, them over there. so dark horse version 2. 0 is not just, you know, we're five minutes from your office.It's. Hey, we're dental specific. That's our edge. If you're in Hawaii, if you're in Alaska, if you're in rural Nebraska, we'll support you. No problem. You know, we'll make it work. And Dark Horse version 3. 0 has been cloud. Right? So, and that's kind of where we're segwaying in here today. Is open dentals, you know, great company.They're well known for their customer service. That's what I care about. Right? So when you hear me singing companies phrases, that means when you pick up the phone and call them, they treat you well, and they solve your problem. so we've always loved open dental. and so the confusion has come up just recently.So cloud. Open that up. There's two versions. There's the one you just that everyone pretty much has right now, which is you call them up. You buy a license key and you put it on your server. And right. It's a local system. And then there is. Open Dental's internal cloud offering, like literally they hosted at their HQ in Oregon, and that is a separate version.So there are only 2 versions of Open Dental. However, this is where the confusion comes in, like professionals like us, right? We use Microsoft and Azure as their cloud platform. We take the first version, the normal version, the one that works with, you know, Flex and Mango and Medento and Swell, all your third party integrations.We take the one that you've been running on your local server, and we put it in the cloud. So same version, integrations all work. that's still version 1. Version 2 is the one that OpenNL offers, and they have a pricing sheet online that you can look at, but it does not have integrations with third party.Which is tough for me because that's when I hear feedback about OpenDental, the products, right, the support's great, but people really love using all the third party integrations and they love the ability to switch, right? If something's not working for them, uh, there's nine other paperless companies you can go to, right?Um, you know, or like, you know, Flex is a great example, right? Flex is only written for OpenDental. And they do a really good job of what they do, right? Does not exist in any other practice management software. Cannot, cannot replicate it. But let's say the owner general manager flex pissed you off. You can switch software.So you can't do that with any other platform out there. So to break it down really simply. There's the off the shelf open dental, and that's the one that, you know, that we're in large part supporting putting in the cloud, um, creating awesome solutions for single practices, multi site practices and D.S. O. S. And then there's the internal open dental cloud offering. We honestly across our, you know, we have right now 1050 clients. We have zero people on that second version. So Mhm. that is where most of the confusion has come in the space when you try to have a conversation like over Facebook, over text. It's really hard to parse that out, and then when people call Open Dental, it gets even more confusing. Really? Michael: Okay. let me ask you, when it comes to cloud, do you still need IT for that? You still need Reuben: IT. So, HIPAA compliance are just, they're linked together, right? It's just like, alright, you read the, you know, what you need to do to, you know, to protect your patient's health information.Need to have a firewall? That doesn't go away. Uh, you need to have the antivirus software that does not go away. you need to have a backup system that does go away as long as you don't have 3D images, right? Those don't go to the cloud yet. Those stay local, right? this is something that a conversation needs to happen.It's really hard for me to like text somebody back and forth and explain all this. I'm glad this podcast exists because I can now cite it. Like, hey, before you even talk to me, listen to our conversation here. IT is absolutely reduced by going to Open Dental Cloud. Again, the first one, the off the shelf one I'm talking about, it is not erased, right?Michael: Open Dental will help you with Open Dental. Anything else in your practice, printers, security cameras, internal cameras, sensors, CVCTs, PCI compliance, all that is, is traditionally still on the company. Gotcha. Okay. So then what are the frustrations when trying to explain this then I guess, do people still understand it or they're more like.What, Reuben: you know, it's I. T. there's like, I can't give my full explanation because it crosses the border into I. T. jargon and the three letter, you know, acronyms start coming out and everyone's lost. So what we typically do we share our screen, right? We say, Hey, this is exactly how it's going to work on your office.Okay. Okay. Okay. Um, take the example of somebody that is on a server based open dental solution. Right now. We say, hey, you know what? It's the same version. We're going to put it in the cloud. Your staff is going to walk in the morning. They're going to see an open dental icon. They're double click on it and they're not even going to know what's in the cloud.Execution is actually very simple, right? from the customer's point of view, right? There's some expertise that goes into, migrating to the clouds, you know, getting the cloud server where it needs to be security. All that stuff takes technical expertise, but the staff walking in the morning, double clicking on open dental that does not change.So, um, that's why it's been such a successful implementation is because it's like it's still open dental that people know and love. Uh, it's just not on a local server in your office. And, you know, historically, the cloud has been slower, right? But with Microsoft's, you know, recent introduction of a couple of different protocols that are again, here comes the three letter acronyms.RDP is now AVD, which as a virtual desktop, we're seeing now that the cloud is faster than a local server. So it's not only that it's it's 2023. Of course, this should be in the cloud, is actually, just as fast or even faster than a local server. So it's, uh, you know, a really great time to talk about.This is when you're looking to replace your server. It's like, hey, do you want to, you know, do you want to write a check every 5 years? Right? And maintain that hardware. And when you replace it, there's downtime to transfer it, or you go to the cloud. You know, it's a really great time to, to talk to your IT company about, um, options.So you don't have to buy one time, part of our cost. Michael: Gotcha. So then it's easy. I guess, how often should you replace the server then? And then what really does cloud based I guess servers or softwares kind of cover, right? If you were to give us like bullet points of this is what it covers easily. Boom. And then how often should we replace the server?You're like, Nope, I'm still sticking with what I know. Trying to Reuben: servers five to seven years is a pretty safe, um, window of time, right? It is. If your server goes down, that means your patients are waiting. So, that is not worth something cheaping out on, right? It's kind of the brains of the operation.Now, if you go to the cloud now, you don't have to work at hardware anymore, right? And you look at Microsoft's data the industry. This is this is true for voiceover I. P. As it is for any cloud service. They talk about nines, right? They talk about what is your uptime? How many nines are there past the 99 percent point, right?And Microsoft has four nines. So that means you have about a minute and a half downtime a year. I've never seen it go down, but technically I guess it's gone down for a minute and a half on average every year. 99. 9999 percent uptime, which cannot be replicated at all by a local because all these services, you have Amazon, you have Google, you have Microsoft, just to name three.There's competition part, you know, the cost of storage is going down. The cost of servers is going down. It used to be, it didn't make a lot of sense for a single practice to go cloud, uh, only for multi site and now it's just, everyone should go cloud because it's, more cost effective. Hmm. Michael: So that's the key most cost effective then, right?Especially if people are trying to. Gotcha. Okay. So then going with that to you, Ruben, because you've, you've worked with hundreds of practices or you are working with hundreds of practices. Reuben: Hundreds of practices that use Open Dental and more, you know, more practices that use Dentrix and Eaglesoft and CareStack and Oryx and all those software.So, you know, I, I see the entire industry. We're kind of focusing here on Open Dental, but, um, I mean, Open Dental, it's no secret is, My favorite software, I don't know if I've still ever seen a negative comment about open dental. Michael: So then to you, what would be, if you're trying to be super cost.Effective, but efficient to start off, what would it be the best kind of like formula or stack to use for this? Reuben: So it all goes to fit, right? What makes, if we're, we're saying everything is equal, it's an easy answer. Right. but the problem is certain softwares are better suited for dentists. Right.There's, of course, the feature set standpoint, and you can only find this out by talking to these companies and doing demos. Is this going to work for my practice and how I manage and bill and all that stuff? Um, you know, and the other side of this is you want? Do you want something that's all inclusive, right?Let's let's take dentrics ascend. Uh, for example, you pay a higher bill, right? Then you would pay to open down, but you get every single service that you could want. The problem is you have to use all those services, right? There is no alternative. if you're a dentist that wants to use the best software, that's why open dental still exists, right?It may look, it's from like, it's from the 1990s and they haven't updated it, but you know, what makes it so powerful is. honestly, it's like the app store on, on Apple, right? It's a, it's a great phone, but you know, what's great about it? The app store, you can download whatever you want.It's got the best ecosystem out there. So you go into open now and you're like, you know, flex is a really great example. that program alone It's just so incredibly powerful, right? You don't have those options with an all inclusive software, but maybe you're a dentist and you're just like, you know, I don't want to worry about having to sign up for Open Dental and then Flex and then, you know, Practice by Numbers and then Mango Voice.I don't want to have to do all that. Right. Which is, you know, why companies like Archie exists because they'll, they'll say, Hey, we'll give you practice management. We'll give you phones through mango. It's included in your bill. We'll give you patient communication. We'll give you all this stuff. So you kind of have to ask the question of what kind of person are you?Are you justlet me sign up for 1 thing and I'll just use whatever they have. Or do you want to be able to be like. I want to work with the best, patient communication company. I want to work with the best clearinghouse. I want to work with the best, patient portal company, credit card company.That's who I am. That's what a lot of dentists are out there. I mean, Open Dental is still the number one software for startups. Um, when we see people have all the choice in the world, Open Dental is still being... over 50 percent of start up practices are still going open nettle. and that's why, it's more of an ease, uh, question, right? Single pane of glass, it's all here. Freedom of choice is on the other Michael: side. Gotcha. So one is more like all one subscription type. Yeah, like for example, like Oryx, right? If you were to just go with Oryx, all in one, exclusive, you know what I mean?Inclusive everything, Reuben: I'm going to get Oryx, uh, and I'm going to get phones. I'm done. Yeah. Michael: It's easy. Yeah. Yeah. Okay. But if you want the, like the other side, right? The freedom to choose. Reuben: So we have opened 400 startups. I've talked to most of these people and then, even, even more people, right.Because the ones that didn't go with us. Right. I, and I hear their story. And like, I think the reason Open Dental is appealing. Is because, let's go back to the 2012, you know, I'm leaving Benco, I'm risking, that's, that's a health insurance for our family that's half the income for our family and I'm leaving with nothing and I'm saying, like, you know, I have a dream to create a great it company and I'm, I'm going for it.Right. and that's who the startup people are, plus a million and a half dollars in debt, which I do not have. that's a whole nother layer. So, you know, when you talk to these people, they're like, this is my dream practice. I want it to be freaking awesome, right? And I'm not sure those companies can, can meet that standard, right?They're, they're trying to be the jack of all trades. because when you peel back the layer. You know, let's again, just let's go back to Ascend. That's like 10 different companies, right? They've stitched the software all together to make it all look and feel like a cohesive interface.But the practice management module is different than the image, right? That's a separate software, right? So you're talking about one company who's trying to develop and, you know, and push forward 10 different platforms. It's really hard to do, right? And it's one reason why we're like, Hey, mango, do your thing.Just frickin nail the phones, right? And a lot of I. T. companies do do phones. We just feel like it distracts from our core purpose, which is like. All right, we're going to be awesome at support. We're gonna be awesome at startups, which is basically support as well, you know, and we're gonna be great at the cloud, right?let's just focus on these three things. That is our competitive advantage. When you try to broaden in any segment, I mean, Dennis probably know this from trying to bring in, let's bring in ortho, let's bring in oral surgery in house, and you try to be A plus at all these different things, it's really hard.It's the same thing with software companies. Everything in the startup, it's a conversation. I listen to what people want and, you know, anytime they're just like, this has to work. I want this practice to be the, you know, the best patient experience. It can be it usually inevitably points to, to a single software company.Michael: Yeah. Okay, cool, man. That's awesome. And then, so with that kind of being said, I know cost kind of comes in the mind. That's the question that a lot of people really ask is how can they start cutting down on their I. T. or how can they minimize that I. T. bill or have you seen this? Where people are like, Hey, I just got like new fees on my it bill or something like that.What, what is up with that? Reuben: The new fees thing? Uh, well, I mean, if you add computers, it just depends how your IT is set up, right? there's. Uh, on the back end, I can tell you, as somebody who runs an I. T. company, we get charged per device, right? So it's natural for your I. T. company to then bill you. It's the fairest way to do it.We get charged for ten, you know, antivirus agents. You have nine servers, nine workstations and a server. That's ten. Lines up. So usually when you see I. T. bills go up office ads, a computer office ads, email services. It's, it's stuff like that. I mean, unless you're just working with, you know, shady folks that just move numbers, you don't notice, um, you know, we do price increases, uh, annually because we give our staff raises.Guess where the price increase comes from. what we hear from our clients, we want to work with the same people again and again. That's retention. And that means you got to give people a reason to stay here. Besides like, Hey. You like ribbon, you should stay here, but usually that means promotions and raises and all that good stuff.let's pivot to how do you cut down on IT costs, right? not someone who is, let's say, there's a lot of IT companies out there that prevent their clients from going to the cloud because they so fear, like, oh no, it's not ready yet, it can't do what you want to do. But they're really protecting their butts, right?They're like, oh, my client goes to the cloud. I'm going to lose revenue. So let's talk about that. Let's talk about how to lose IT companies revenue. so think about, any software out there. Dentrix. Uh, Eaglesoft open, right? We have a server uh, we have to back up that server and the office says, you know what?If that server goes down, I don't wanna be downed at all. Alright? So then we need a backup and disaster recovery system. So when we go cloud, let's just make it very, very simple. Let's leave three D out of it. Let's, let's treat it like it's a pediatric office and everything is two d imaging. I'll pick on Oryx for now, right? I know it's a good partner of ours. I know Rania. I love the products. When you go, or let's say you're on Open Dental and DEXIS imaging locally, you go Oryx, what goes away on the IT side? Well, I don't have to manage your server anymore. That is one of the highest costs on there.That goes away. I don't have to back up that server that I'm not managing anymore. So that goes away. So what does that leave? That leaves how much support you want, right? And so that's either you pay as needed or you want unlimited support for your practice. A firewall that is still a HIPAA requirement in antivirus software.I'm just trying to keep it as simple as possible, like there's patch management and all this stuff you have to keep your computers up to date that should, go along with the antivirus and all that stuff. But, some big stuff comes off, but you still have a lot of requirements, and things to protect on the network.Gotcha. Michael: Okay. So the requirements still stay, but now when you say the biggest expense, which is the servers, right? That kind of comes off, how much are we looking to shave off when that happens? Reuben: Yeah, so I mean, I can only talk about myself. Right. And our company. so again, the two biggest costs are support.Let's say you're paying for unlimited support. We call that our gold plan, right? Unlimited phone support and server management. So let's say an office is on a 600 a month plan with us unlimited support, and they go to a cloud based agreement. You could be looking at 150 a month in savings. Okay, Michael: but server management, right?Or the Reuben: server? Server, yeah, the server in the backup system going away, you could go down to 450. Michael: Okay, but everything else, the bare bones requirement. Reuben: Percent savings. Michael: So when it comes to like the, let's just say they did that and they went with the works, they did all that and they're like, Ruben, help me out here, man.Like I need, give me the bare bones that what we can do. How does that look? And, and is that feasible for the long run? And they're like, I want to grow, Reuben: but give me the bare bones. Well, depends on how much your staff calls in, right? If your staff doesn't call in. You should be on a bare bones plan, right?You shouldn't be on just like, Hey, cover me for HIPAA compliance, cybersecurity, make sure I don't get hacked. Let's go. the thing is most of our clients call in, they use the service they pay for. So it's, it's completely up to the client. I think it's a really. Smart decision as, uh, as a business owner, not to put a barrier between your staff needing help and like, Oh, you know, Dr.Clark's going to get a bill. If I pick up the phone, right? Things are broken. Your staff doesn't hesitate. It gets fixed done, right? That's the stuff that, you know, the dentist doesn't see while they're in the treatment room is like, you know, the scanner doesn't work. So your staff is so much less efficient because they had to, you know, create a workaround.Right. Because they know if they call, you know, Dr. Clarkson and get you know, bill in the mail 10 days from now, he's going to be like, Hey, Nancy, what the heck? Yeah, yeah, yeah, you're right. You know, it's uh, you know, And Michael: I feel like that kind of creates like more, uh, you're scared. You won't even tell the doctor, you know what I mean?You're like, oops, I pray, tell her you'll lie about it or something, right? In order to not feel, you're creating some type of weird environment in your office when you do that. Right, Reuben: right. I can't imagine how much stuff. Wouldn't get done if I was the bottleneck at my company, it's like, Oh, no, we can't reach out to that company until Ruben approves it.It's like, Oh, my God, I wouldn't get anything done. Um, but to answer your question, like, if you, let's say it's a, it's a medium or sized or smaller office. You stripped out the unlimited service and you're just like, Hey, I'm going to Oryx and I want no frills, right? Just give me, compliant and protected.You could easily be in the 200 to 300 range. Yeah. Yeah. Michael: But the unlimited, like give me an example, like why, or from your experience, if you can give me like the top three, why does staff call in a lot? Let me Reuben: just pull up our service board right now and just list off what people calling about your PCS compliance scan a PCI compliance scan, it's a test for I. T. Professionals. It's like, you know, what settings do you have on on your firewall? Do you have antivirus software? When were the last? So it's basically a test for I. T. People. That's a really great thing to offload to us because that thing takes like 30 minutes to complete.Right? questionnaire and then you have to schedule the scan. You have to know your internal IP address that spectrum gave you to run. Anyway, uh, that's one example. let's see. Questions about switching a panoramic PC to server PC. So this office, they have a imaging database on their pan PC and they want to.They want to talk to us about what it would take to move that to the server PC to consolidate that, um, create remote access, right? That's something that's included with all of our plans. Great remote access for, my new remote employee, uh, so that they can log into a lab computer, let's see, install remixes on computers that were just installed, uh, by the office.uh, workstation two cannot print, create new windows user on consultation computer. and then, oh, this one's great. Uh, shout out to Becky Scott from Lincoln Children's Dentistry. Help my son get fortnight to work on our office Wi Fi. So, you guys, you guys cover all kinds of help my son get fortnight to work.Yeah, I mean, there's... You cover everything. IT companies, uh, you know, we're, again, we're dental specific. We coach our people to call us on anything. There's, there's really two setups. There is the like IT company that say, Hey, that's a vendor problem. You need to call them directly. And then there's us, right.And, and some other really good companies in the space who have vendor management built in, and that's the expectation that like your staff. Is taking care of patients. They're not like waiting on hold with Carestream or, you know, gen X or Dexus, you know, they're, they gotta take care of patients. Like, yeah, wait on hold while, you know, while we're, you know, working at home or, or at hq.So, but Michael: that, I, I think that's really good to have though, because I feel like, uh, a lot of the times you waste time looking for it, right? When we can just go to you and then you give us the solution. Hey, it's a vendor, Hey, it's this. And so I'm sure you've heard of this a lot, and this is a question when I asked and the Dental Market Society Facebook group, like in other places, they send us this one a lot, uh, when VoIP, right?So they're saying kind of like we're having an issue with our phones and then VoIP says there is no issue or it can be any other vendor, right? That says there is no issue on our end. So then it falls back on you or what, what happens there? Reuben: Yeah. So, you know, in the example of the bad it company that says call your vendor, you're stuck in the middle as the client, that's the worst, you know, you feel helpless, kind of feel a little pissed off and you're like, what, and so our clients never have to feel like that anymore because we're just, we are them.In that scenario, we're hunting down the solution the ticket will not get closed until the issue is resolved. So let's talk about voiceover IP, right? A lot of, you know, a lot of people that is the standard. Now, of course, you should have it. It's really great if you have a hybrid, you want to offer jobs that are hybrid or even full remote, right?Voiceover IP is like the only way to pull that off. So you install your new phone system and you're having call quality issues. the number one most likely culprit is going to be your firewall. Okay, so if the phone company says, Hey, our servers are great. Everything looks really good until it hits your office.And so let's assume they're right. Yeah, you know, let's assume AWS is not having an issue. Firewall is gonna be number one. Internet quality is going to be number two. And number three is going to be the device that controls your network. Sometimes that's the server. Sometimes that's the firewall. But basically, you know, my, when you, when you go to Starbucks and you join the wifi, you're getting an IP address from something, right?You're not just, just magically connecting to the internet. Something is handing you an address. Okay, so those are the three things that again, if you have an I. T. Company, they're going to be able to diagnose that stuff pretty quickly. They're going to be able to run, let's say, in the Internet stability.They're going to be able to run a ping test. Let's say you spectrum. They can see is your Internet like a D. C. Current. Is it just flat? Or is it like, is it just Jerry? And it's all over the place. You know, voice needs a very, consistent connection to work well, not a lot of traffic, but just needs a stable connection.Firewall. Well, if you just leave the firewall stock unconfigured, it's just going to be constantly scanning that phone traffic, and then you're going to call quality issues. So, what we do is after the office let's say they get mango, they plug their, uh, yelling phones in, they show up on the network.we do a couple different things, but just to keep it simple, we whitelist them, right? we tell the firewall. These devices are safe. Don't hammer them. Right? Don't constantly bombard them with internal threat protection stuff. there's a couple other tips and tricks you could do, but it's more kind of for your, your I.T than like a D. I. Y. Stuff. So we won't talk about that. Yeah. And then there's the device that hands out I. P. Addresses. Right? So you could be out of I. P. Addresses, right? You have such a large office. You've maxed out. You plug that phone in. It doesn't even connect to the Internet. you could have I. P.Address conflicts, right? So, uh, you let's say, the phone's working great. You connect your laptop, That router gives, uh, your laptop the same address as the phone. One of those devices is going to win. Okay, uh huh. Right, so there could be an IP address conflict. Um, and I'll just throw out some, some other words if people are taking notes here and they're going to send it to their IT company.DHCP, that's what, that's the service that hands out IP addresses. DNS, that's how devices resolve internet addresses, right? Google. com is actually 8. 8. 8. 8. Okay, right. So when you type in google. com, it's touching a DNS server and it's saying, what is this? And it goes, Oh yeah, that's 8. Of course. Well, here you go.You don't know that's happening, but DHCP, DNS, and lastly, gateway. Gateway is just how you get to the internet. So I know that's, that's a lot of technical jargon, but you know, for the, for those of you who are DIY er, like furiously writing your, your IT company to email right now, just put all those words in there.Michael: Wait, quick question, leaving firewall stock? What does that mean? Like you said, if you just leave your firewall stock. Reuben: Okay. So let's say you get a firewall. Plug it in out of the box. You don't do anything. All right. What you're going, you're going to have phone issues. You're going to have issues with anything that is internal that needs to broadcast external.Okay. So think, think about. Open dental e services thing about, credit card, right? You have a credit card reader that thing needs to authenticate their credit card and come back if you leave it stock. It's going to turn off access to all of these devices that you rely on your practice to work on. Now, it's not going to not work 100 percent of the time.but these are the things that your I. T. commission should be doing. They should be whitelisting these known good devices. Um, so there are no issues and you don't have to worry about this stuff at all. Gotcha. Michael: Okay. Interesting. So this is basically why we hear all the time where they might be like, hey, it's not us.Call your IT company. Reuben: It's not us. It's you. Um, yeah. Uh, It's usually, it's also usually the firewall and, and not to get into a soapbox here. IT is, it's really hard because there's not like a set of standards. So again, anybody, including me, I should say, You know, self taught, just have a lot of experience, can be an IT person, right?So, you know, you come along and someone's like, Oh yeah, I can do all of that for half the price. Right. And it's just like, okay, but what are you getting? And it's like, uh, none of this stuff is HIPAA compliant. It's like, no wonder it's half price because it's not actually protecting your office. You know, you, do want to work honestly with folks that care about their patient's data.Right. Because that's what I care about doing a good job. but I tease one of those tough industries, right? There's not a lot of regulation in terms of, who can, um, be an I. T. person, if you're an I. T. person that's working with a dentist, you have their trust and you breach that trust by selling them something that is not HIPAA compliant.There are no ramifications for you. So it's, somewhat of a wild, like I'm in this, this position where, you know, I've been around long enough and I have the respects, uh, of a lot of people out there and there are other companies like medics dental, that, that do a really good job in this space. And, you know, we like to say we're the good guys, right?We don't cut corners. We do the right thing. We take care of our clients. But then there's the rest of the market and it's, really hard to have, conversations because the dentist is always stuck in the middle, right? They're hearing one thing like from a colleague. Oh, this endodontist who has five offices in Illinois uses this guy and pays him, pays him 40 bucks a month and that's everything you do.I'm like, yeah, okay. You know, it's half of these, like, okay. I want to fight to keep the client. The other half is like, this person has been fed a load of, you know, BS. And I'm not going to be the one that's going to be able to convince them that they were given wrong information by their endodontist friend.So it's like, yeah, it's just, mistake. In that scenario. Michael: No, that's good. Because in that scenario, what would be like the, I guess in your terms, like the BS, like the stuff where you're like, Ruben, I see that all the time, man, where I'm like, Oh, look, your fellow it person here just wants to let you know.And then they give you like a list of everything or whatever. And you're like. What? You know what I mean? it looks like they pretty much are saying like, we can do the same thing, but like, 40 bucks a month Reuben: I'll the name, but I'll give you a real example.So we had, we had a dentist that recently left us, right? Um, and they, they were under a, a one year startup deal. Right. So we give folks lower pricing, on the startup price. they just have to sign a one, just a one year term, uh, initial term. Then it's month to month after that. So it was like month six in this, dentist, uh, was struggling, right?Her practice wasn't growing as fast as she wanted to. So she was making calls to vendors to be like, Hey, what can you do for me? and this is was kind of alluding to the endodontist. This is, that's kind of the story, right? She talked to a colleague who used a guy, um, for his practices and was like, Hey, I'm really struggling, but I'm not going to hold somebody to a contract if I'm affecting their business. Yeah, yeah, that's not why I got into this industry, right? Is to make every single dollar I could from a dentist, and it's like, tell you what, let's make a deal here. Send me what they sent you if they are truly matching what we are providing.Like, just let's, let's part ways, right? Go there, save some money and, you know, let's part as friends. so got an email a week later and they're like, the plan is we're going to take your HIPAA compliant firewall and we're going to replace it with a home router for Best Buy. It's like, okay.And then we're going to take your HIPAA compliant backup system and we're going to install a free Dropbox. I'm like, okay, so I didn't even read the rest of the email. I just stopped there and I was like, all right, so let's let's figure out how to work together. They're not giving you a HIPAA compliant solution.You know, like, if I can help you in any way, take some pressure off your business, let's do it. And that email came back with basically, I was the bad guy for pointing out that they had been given bad advice. So I have two choices in this moment. I can keep continuing to try to work with this person or I can just let them go.And I chose to let them go. I don't want to have to be bad guy. I don't do high pressure sales. I don't do scare tactics. or if you trust another person. More than me if by all means, please go work with them, but you know, peace of mind sleep at night I told the doctor everything that they were not getting you know They were literally compromising their patients health information.can't work with that person, you know Michael: yeah, so they were more upset that you didn't agree with the other IT companies like Janky solutions, you know what I mean? Like, Oh, like, Hey, we're Reuben: just like a perfect they're doing what we're doing for less money, show me, cause I would love to know how to be more efficient.Just, I'm curious, like, how did, how is this possible? And it turns out the solution was, we're just going to pull stuff off a Best Buy that belongs in someone's home. And so you're good.Michael: That, that story really gets into the essence of the complexity of being an IT professional in healthcare.Yeah. Yeah. And we got to go one of these days, we got to do an episode about how important it is to be HIPAA compliant. Cause I know we kind of touched that. Well, we touched that in this episode, but we kind of touched that in previous ones of, it's mega important, you know.Um, in order to do that. So Reuben: it should be like car insurance, right? It should not be opt in, opt out. it's like, yeah, I kind of want to be a little compliant, but then I want to ignore all this stuff, you know, that actually costs a little compliant and like, who's safe. Henry Schein got hacked twice, Aspen Dental.And this is just this year, Aspen Dental had over a thousand practices get hacked. I don't know what it's going to take, and I try not to, you know, worry about all the dentists that didn't take my advice went down a different pathway, but. This is what I talk about. I want to work with people that care about protecting their patient.is a passion of mine. I want you to care about protecting your patient's health information. Yeah, Michael: and I like that about you, man. It's because, like, your transition... Every time I think Dark Horse has been running, you guys have been... Moving the needle closer and closer to quality, right? Over like, we got to get more sales, more people, more things.and every time you guys have ever sponsored, right? You're never like, how many leads are we getting or anything like that? It's more like, Hey man, like let's, let's. Let them know about this. Let's let the people know about that, right? important Reuben: stuff. My marketing strategy can be distilled down into two words.Good vibes. I just want, like, good vibes that kind of, you know, reverberate throughout the anals of the internet, right? Just like, uh, you know, someone has a question on, uh, you know, dental marketer group about imaging software. Whatever. We'll jump in. I'm not gonna solicit you. Here's an answer. Great.If you look me up and you want to reach out, that's awesome. But that has been for 11 years all organic growth. And why? Like, we love partnering with with you. Michael's just like, here's a podcast that is just about let's get as much information. Let's clear up confusion in the industry.I'm not asking you to work with me. Take all this information back to your IT company and protect yourself. And if you love your IT guy, keep working with him. I'm here if you want an option, but like, I really hope you care about compliance before you call. Michael: Yeah. And if you guys want to know how to get Fortnite to start working in your office.Reuben: That's the Michael: firewall. Yeah. I remember, uh,Ashley one time caught you, right? Like about a fridge or something Reuben: like that? so actually once called me when her power went out.Hey, my, uh, you know, my, uh, computers aren't turning on, I was like, can you call your electric company and that goes back to just like we, again, when we train our clients calls for anything, sometimes they do. Yeah. And no, no, no. Yeah. Call NYSEG or, you know, call your local power company.Uh, happy to help out and pick up the phone and all that. But yeah, no. Michael: That's awesome. Ruben, we appreciate your time, but before we say goodbye, can you tell our listeners where they can find you? Reuben: Oh, yeah. Um, I'm all over the internet. So you'll see me just popping around in and out of Facebook groups. Uh, my direct email is admin at dark horse tech.com and go right on our website and hit contact us. And that will, uh, generate a little, link to schedule a call with us. DM me on Facebook, you can DM me on Instagram. You'll see. Instagram, if you want to follow us at dark horse tech, that's where I post, you know, anytime we're doing a startup. I post all the pictures out there.Right? So if you're interested in working with us, or just interested in like, what are the newest latest startups looking like? we're, we're pretty much doing one or two startups a week, right? So we did about 87 just last year. and so yeah, follow along. that makes me feel good.Cause I'm the one doing all that posting. So please like, like my photos. Michael: Please like my photos. Awesome guys. So that's all going to be in the show notes below. So definitely go check it out. Follow Dark Horse Tech on their social media. And at the same time. Click on the first link in the show notes below to check out the exclusive deal that dark horse tech is giving you go ahead and do that.And Ruben, thank you so much for being with us. It's been a pleasure and we'll hear from you soon. Appreciate it, Michael.‍

Las páginas pro-Kremlin de las redes sociales difundieron noticias falsas de que el presidente de Ucrania, Volodymyr Zelenskyy, había ordenado al ejército ucraniano abandonar inmediatamente Avdíivka, en la región de Donetsk.

Welcome back, loyal Data Center Therapy listeners!  As summer gives way to fall, we're dropping another fresh and topical episode onto the hot podcast grill for your informational delight (with a dash of fun thrown in for good measure.)  Your host, Mr. Matt “My Stack Overflowed” Cozzolino joins IVOXY End User Compute specialists Ryan "Universal Broker" Grelck and Aaron "Auto-Scaling" Hagman for a deep dive into the new and cloud-enabled world that is Microsoft Azure Virtual Desktop, and Windows 365.   In just thirty-two minutes, you, our listeners will get to learn about: What Azure Virtual Desktop is, why it exists, and what the implications are for mobility and security. What kinds of capabilities AVD has for integration with VNETs, storage, profiles, domains and Entra ID (formerly Azure Active Directory.) Why some organizations use multi-session desktops. How Windows 365 differs from AVD, and how it's two flavors (Business and Enterprise) differ from each other. What MSIX App Attach is, how it's similar to Horizon's AppVolumes, and how Horizon on Azure is now a thing. What the future of Windows Software Update Services is, how Intune and Group Policy interact, and what ADMX/ADML templates are. And many of the reasons businesses ultimately choose to implement AVD, including a focus on budget, CAPEX/OPEX, security or performance considerations. Along the way the crew also discusses Azure Arc, VPN tunnels and Express Routes, GPU-enabled cloud desktop instances, Windows Update for Business, thin clients and much more. If you like what you hear, please be sure to like, subscribe and share wherever you find quality podcasts like Data Center Therapy.  If you're interested in learning more about AVD or Windows 365, please reach out to your IVOXY Account Manager and we'd be happy to help guide you on your journey.  Thanks for listening!  Be safe, be informed, manage your virtual desktop environment like a boss, and catch you on the next fresh episode!

Discussing two important lymphoma studies, POLARIX which led to the approval of Polatuzumab in DLBCL patients and SWOG S1826 comparing Nivolumab vs. BV with AVD in Hodgkin's Lymphoma patients with Dr. Jonathan Friedberg. In discussion with the lead author, Dr. Jonathan Friedberg - Director of Wilmot Cancer Institute, Professor of Medicine at University of Rochester Medical Center, and Editor-in-Chief at Journal of Clinical Oncology (JCO).

Featuring a slide presentation and related discussion from Dr Jeremy Abramson, including the following topics: Long-term follow-up data with Bruton tyrosine kinase (BTK) inhibitors as monotherapy for chronic lymphocytic leukemia (CLL): The CLL12 and SEQUOIA trials (0:00) Extended follow-up results with venetoclax combined with anti-CD20 antibodies or a BTK inhibitor for CLL: The CLL14, MURANO and GLOW trials (5:27) Primary analysis of the TRANSCEND CLL 004 trial evaluating lisocabtagene maraleucel for relapsed/refractory (R/R) CLL (12:40) Genomic evolution and resistance to pirtobrutinib in patients with covalent BTK inhibitor-pretreated CLL in the Phase I/II BRUIN study (16:24) Chimeric antigen receptor (CAR) T-cell therapy data with axicabtagene ciloleucel and lisocabtagene maraleucel for R/R follicular lymphoma (FL) (18:24) Bispecific antibodies as treatment for R/R FL: mosunetuzumab, epcoritamab, odronextamab and TNB-486 (22:57) Novel treatment approaches for mantle cell lymphoma (MCL): First-line acalabrutinib/rituximab and lisocabtagene maraleucel for R/R disease (32:54) Updated results from studies evaluating loncastuximab tesirine, such as LOTIS-2, and CAR T-cell therapy, such as TRANSFORM and ZUMA-7, for R/R diffuse large B-cell lymphoma (39:29) Ongoing follow-up from pivotal trials of bispecific antibodies for large B-cell lymphomas (46:01) SWOG-S1826: Results from the Phase III trial evaluating nivolumab with doxorubicin/vinblastine/dacarbazine (AVD) versus brentuximab vedotin with AVD for advanced-stage classic Hodgkin lymphoma (51:48) CME information and select publications

Ben Murphy joins Scott Hanselman to walk through Azure Virtual Desktop (AVD) Insights, which is a native monitoring solution that gives you visibility into connection characteristics and optimization opportunities for your AVD environment. Chapters 00:00 - Introduction 00:50 - Macro and micro analysis 01:33 - Overview tab 03:33 - Connection Diagnostics tab 04:44 - Connection Performance tab 05:37 - Utilization tab 12:20 - Clients tab 14:57 - Configuring AVD Insights 16:30 - Wrap-up Recommended resources Use Azure Virtual Desktop Insights to monitor your deployment Estimate Azure Virtual Desktop monitoring costs Autoscale scaling plans and example scenarios in Azure Virtual Desktop Azure Virtual Desktop Insights glossary Create a Pay-as-You-Go account (Azure) Create a free account (Azure) Connect Scott Hanselman | Twitter: @SHanselman Azure Friday | Twitter: @AzureFriday Azure | Twitter: @Azure

Ben Murphy joins Scott Hanselman to walk through Azure Virtual Desktop (AVD) Insights, which is a native monitoring solution that gives you visibility into connection characteristics and optimization opportunities for your AVD environment. Chapters 00:00 - Introduction 00:50 - Macro and micro analysis 01:33 - Overview tab 03:33 - Connection Diagnostics tab 04:44 - Connection Performance tab 05:37 - Utilization tab 12:20 - Clients tab 14:57 - Configuring AVD Insights 16:30 - Wrap-up Recommended resources Use Azure Virtual Desktop Insights to monitor your deployment Estimate Azure Virtual Desktop monitoring costs Autoscale scaling plans and example scenarios in Azure Virtual Desktop Azure Virtual Desktop Insights glossary Create a Pay-as-You-Go account (Azure) Create a free account (Azure) Connect Scott Hanselman | Twitter: @SHanselman Azure Friday | Twitter: @AzureFriday Azure | Twitter: @Azure

ASCO: You're listening to a podcast from Cancer.Net. This cancer information website is produced by the American Society of Clinical Oncology, known as ASCO, the voice of the world's oncology professionals. The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guests' statements on this podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement. Cancer research discussed in this podcast is ongoing, so data described here may change as research progresses. The theme of the 2023 American Society of Clinical Oncology (ASCO) Annual Meeting was “Partnering With Patients: The Cornerstone of Cancer Care and Research.” From June 2 to 6 in Chicago, Illinois, and online, cancer researchers and clinicians from around the world gathered to discuss the latest cancer research and how to ensure that all people receive the cancer care they need. In the Research Round Up series, members of the Cancer.Net Editorial Board discuss the most exciting and practice-changing research in their field presented at the meeting, and explain what it means for people with cancer. In today's episode, our guests will discuss new research in breast cancer, lymphoma, multiple myeloma, and brain tumors. First, Dr. Norah Lynn Henry discusses new research in early stage and metastatic breast cancer. Dr. Henry is Professor and Interim Chief of the University of Michigan's Division of Hematology/Oncology in the Department of Internal Medicine and the Breast Oncology Disease Lead at the Rogel Cancer Center. She is also the 2023 Cancer.Net Associate Editor for Breast Cancer. You can view Dr. Henry's disclosures at Cancer.Net. Dr. Henry: Hi, I'm Dr. Lynn Henry, a breast cancer oncologist from the University of Michigan Rogel Cancer Center. Welcome to this quick summary of the most exciting new research in breast cancer that was presented at the 2023 ASCO Annual Meeting. I have no conflicts of interest for any of the trials that I will talk about. First, I'm going to give a very brief overview of the types of breast cancer, then talk about some research that was presented on both early-stage and metastatic breast cancer. As a reminder, there are multiple kinds of breast cancer. Some breast cancers are called hormone receptor-positive or estrogen receptor-positive and are stimulated to grow by the hormone estrogen. We treat those cancers with anti-estrogen or anti-endocrine treatments, which block estrogen or lower estrogen levels. Other breast cancers are called HER2-positive. These are often more aggressive cancers. But because they have extra copies of HER2, they often respond to treatments that block HER2. Finally, there are breast cancers that don't have hormone receptors or HER2. These are called triple-negative breast cancer and are also often aggressive cancers. Most of the results I'm going to highlight today are treatments for estrogen receptor-positive and HER2-negative breast cancer. One of the main stories from the ASCO Annual Meeting was the result of the NATALEE trial. At the present time, for patients with estrogen receptor-positive, HER2-negative early-stage breast cancer who were at high risk of having their breast cancer come back, the currently recommended treatment is anti-endocrine therapy. Based on the results of a prior trial called monarchE, we also consider adding a medicine called abemaciclib, which turns off some enzymes in the cell that are called CDK4 and CDK6, which are known to make estrogen receptor-positive breast cancer cells grow. Abemaciclib can further reduce the risk of cancer recurrence compared to endocrine therapy alone, but it does have some side effects, most commonly, diarrhea. In the NATALEE trial, which was presented for the first time at this ASCO meeting, researchers studied a similar type of medication called ribociclib. It acts similarly to abemaciclib, although it is more likely to cause low blood counts and less likely to cause diarrhea. Ribociclib is currently routinely used in combination with anti-endocrine therapy to treat patients with metastatic estrogen receptor-positive breast cancer but is not yet routinely used in the early-stage setting. In the NATALEE trial, patients with estrogen receptor-positive, HER2-negative early-stage breast cancer who are at high risk of breast cancer recurrence were enrolled. Half the patients were treated with just standard anti-endocrine therapy and half also received ribociclib for 3 years. After the 3-year treatment period, those who received both ribociclib and anti-endocrine therapy were about 25% less likely to have their cancer come back compared to those who received only anti-endocrine therapy. Overall, the medication was quite well tolerated. It is important to note that this drug is not yet FDA-approved in the setting. The remaining trials I will highlight are for treatment of metastatic breast cancer. There were many trials examining how best to use drugs that we are actually already using in the clinic. For example, many presentations were about the CDK4/6 inhibitors that I just mentioned. Typically, patients who have just been diagnosed with estrogen receptor-positive, HER2-negative metastatic breast cancer get treated with anti-endocrine therapy plus a CDK4/6 inhibitor. One trial called SONIA examined whether this is the right approach, or whether patients should just get the anti-endocrine therapy up front and hold off on starting the CDK4/6 inhibitor medication until a later time. It appears that this delayed approach would reduce symptoms as well as cost of the medication, while not reducing benefit from the treatment. Therefore, it appears it is likely fine for some patients to get just anti-endocrine therapy alone initially. However, we don't know how to identify those patients. Researchers are still figuring out which patients should follow this new treatment plan and which should keep getting the double therapy at the beginning. Some more to come in the future. There was a different trial called PADA-1 that included patients taking anti-endocrine therapy and the CDK4/6 inhibitor, palbociclib, upfront. Those patients were monitored using a blood test, looking for a mutation or a change in the estrogen receptor in the cancer. Patients who had that mutation either remained on the same treatment that they'd been on or switched to the next line of therapy, even though their scans didn't show any progression of their cancer. Overall, this switching strategy looks like a very promising approach for managing patients since it may help patients' cancer respond to treatment for a longer period of time. Although this approach is not yet officially recommended according to our guidelines. In another example, many patients with all types of metastatic breast cancer are treated with a drug called capecitabine, also known as Xeloda. Although this drug is effective for many cancers, many patients experience hand-foot syndrome, nausea, diarrhea, and mouth sores. In the X7-7 clinical trial, the researchers compared the official standard FDA-approved dose based on a patient's height and weight and given for 14 days followed by 7 days off. That was compared to a fixed dose of treatment given 7 days on and 7 days off. The trial found that the fixed-dose regimen was easier to tolerate, but importantly, the benefit from the 2 doses and schedules of treatment appears to be similar. Therefore, we will likely be using this lower dose, 7 days on and 7 days off, for most of our patients who receive treatment with capecitabine for metastatic breast cancer, since it is likely to improve their quality of life while not negatively impacting the potential benefit they receive from the therapy. There were a lot of other research findings presented that are related to treatment for both early-stage and metastatic breast cancer at the meeting. Importantly, we got glimpses of the many new drugs on the horizon for treatment of breast cancer, including a new antibody-drug conjugate against HER2, as well as other new anti-endocrine and targeted treatments. We eagerly await the results of large, randomized trials so the drugs that work can be used to treat patients with breast cancer. But for now, that's it for this quick summary of important research from the 2023 ASCO Annual Meeting. Stay tuned to Cancer.Net for future updates from upcoming breast cancer conferences. Thank you. ASCO: Thank you, Dr. Henry. Next, Dr. Christopher Flowers discusses new research in lymphomas and multiple myeloma. Dr. Flowers is the Chair of the Department of Lymphoma/Myeloma at The University of Texas MD Anderson Cancer Center and Division Head ad interim of Cancer Medicine. He is also the 2023 Cancer.Net Associate Editor for Lymphoma. You can view Dr. Flowers' disclosures at Cancer.Net. Dr. Flowers: Hello. I'm Dr. Christopher Flowers, professor and chair of the Department of Lymphoma and Myeloma and interim division head for cancer medicine at the University of Texas MD Anderson. And it's my pleasure to talk to you today in this Cancer.Net podcast about latest updates in the hematological malignancies focused on lymphoid cancers from the American Society of Clinical Oncology Annual Meeting. The ASCO Annual Meeting every year is an exciting time for latest updates in the care of patients with cancer. And in particular this year, there were 3 abstracts that I'd like to highlight that were presentations at this meeting about lymphoid malignancies that have potential significant impact for patients over time. The first 2 come from a special session that was on late-breaking abstracts that were latest advances from clinical trials. The first is from the ZUMA-7 trial. This is a trial looking at axicabtagene ciloleucel, a chimeric antigen receptor T-cell therapy, or CAR T-cell therapy. The CAR T-cell trial in question here was led by Jason Westin, who's a colleague of mine at MD Anderson. And MD Anderson is a partner with Kite pharmaceutical company that is a manufacturer of this and has a research alliance with that group. In the ZUMA-7 trial, this was a trial that involved the use of CAR T-cell therapy in comparison to standard-of-care therapy, which typically would be aggressive chemoimmunotherapy followed by autologous stem cell transplantation for patients with relapse of large B-cell lymphoma. As many of you may know, large B-cell lymphoma is a kind of lymphoma that is potentially curable with standard frontline therapy. And when patients relapse, the standard of care historically had been for patients to receive autologous stem cell transplantation, which is also potentially a curative therapy. This trial to do a ZUMA-7 trial compared patients who received the typical standard of care, the autologous stem cell transplant following the aggressive chemoimmunotherapy regimen for patients who had relapsed early after their initial therapy, so within 12 months, or were refractory, meaning that they did not respond to their initial therapy. And this was compared to the axicabtagene ciloleucel or axi-cel CAR T-cell therapy. The initial publication of the trial came out in the New England Journal of Medicine in 2022 and showed that the event-free survival for patients who receive CAR T-cell therapy was superior. This update of the ZUMA-7 trial at the ASCO Annual Meeting that was presented by my colleague, Jason Westin, discussed the overall survival of the study, and in this update, it showed that overall survival was also improved for patients who received axi-cel as opposed to standard-of-care therapy. And now with a median follow-up of a little bit more than 47 months, axi-cel demonstrated superiority that was statistically significant and clinically meaningful over the traditional standard of care. In that same session, there was another trial looking at CAR T-cell therapy for patients with multiple myeloma. This was a BCMA-targeted CAR T-cell therapy that was presented by Dr. Dhakal in that session providing results from the CARTITUDE-4 global randomized phase 3 clinical trial. That was a trial that involved 419 patients where patients were randomized to cilta-cel CAR T-cell therapy for myeloma or standard-of-care therapy, which in this case included combination therapy. And in this trial, this showed that single agent with a single cell-to-cell infusion significantly improved progression-free survival versus standard of care for patients with multiple myeloma who had 1 to 3 prior lines of therapy and were refractory to lenalidomide. This is also a meaningful advance for patients with this disease. And the final abstract that I'll mention is an abstract that was presented by Dr. Alex Herrera from City of Hope and was presented in the Plenary session. And it was really exciting to see a Plenary session presentation focusing on lymphomas. So this trial presented by Dr. Herrera was led by the Southwest Oncology Group. Dr. Sara Ahmed from MD Anderson, from my institution, was a participant and actively engaged in this clinical trial. This trial was a success in a number of ways. First, it involved both pediatric and adult patients and is one of the first trials of its kind to involve both large populations of patients with pediatric lymphomas as well as adults with lymphomas. It helps to consolidate the approaches that we use for Hodgkin lymphoma, both in the pediatric population and the adult population. It also represents a major advance in the ways that we conduct clinical trials in the United States in that this clinical trial finished ahead of schedule in terms of completion of the trial with collaboration from the adult and pediatric groups across the National Clinical Trials Network. As I mentioned, this was presented by Dr. Alex Herrera in the Plenary session and involved patients with stage 3, 4 Hodgkin lymphoma, where patients were randomized 1 to 1 either to receive an anti-PD-1 therapy, nivolumab, with chemotherapy, the AVD chemotherapy regimen, or the antibody-drug conjugate, brentuximab vendotin, combined with that same AVD chemotherapy. And what this showed in 994 patients who were enrolled from 2019 to 2022 was that there was a benefit for patients who received the combination of nivolumab AVD or NAVD versus the group that received brentuximab and AVD. It improved the progression-free survival in patients with advanced-stage Hodgkin lymphoma. In this trial, few immune-related adverse events were observed and a lesser number of patients went on to receive radiation therapy, which is also a benefit for patients with Hodgkin lymphoma. And this concludes my presentation of abstracts at the ASCO Annual Meeting and really exciting advances for patients with lymphoma that were presented this year. ASCO: Thank you, Dr. Flowers. Finally, Dr. Roy Strowd discusses new research in treating brain tumors, including those in people with von Hippel Lindau syndrome. Dr. Strowd is a neurologist and neuro-oncologist at Atrium Health Wake Forest Baptist Comprehensive Cancer Center. He is also the 2023 Cancer.Net Associate Editor for Central Nervous System Tumors. You can view Dr. Strowd's disclosures at Cancer.Net. Dr. Strowd: Hello, everyone. This is Roy Strowd. I'm a physician neuro-oncologist at Wake Forest University School of Medicine in our comprehensive cancer center. And I'm really excited to be with you for this podcast on important CNS or brain tumor updates from the 2023 ASCO Annual Meeting. I don't have any relevant disclosures for the research that we'll discuss today. It was a really exciting meeting. It was actually a really fun meeting to be a brain tumor doctor at ASCO this year. So I'm really excited to talk with you about some important updates. And I think it's actually a really important time to be a patient and a caregiver and know some of the things going on in brain tumor care. So I'm going to dive into 3 studies. And one that we just have to talk about, and this was a really exciting study called the INDIGO study. At ASCO, if you present a study, you want to have a Plenary presentation, you want to be up on the big stage presenting your work. And brain tumor studies aren't always on the big stage. We just haven't had enough really good treatments out there for brain tumor patients over the years. And this year, we had a Plenary presentation, a really big study, making a big splash. And that was this INDIGO study. So I'm going to spend a few minutes talking about that study. I want brain tumor patients and caregivers to know about this and know about some of the important updates from the Annual Meeting. The study was called the INDIGO study, and it's a phase 3 study. So when you think about clinical trials, there's a phase 1, phase 2, phase 3. That phase 3 is that last step, that last hurdle that a drug needs to overcome to move towards approval. And a positive phase 3 study is really exciting for the field and means that we may have a new treatment that will change how we take care of brain tumor patients. And that's what this study was. It was also a really unique study. So it's looking at a different group of brain tumor patients, patients that have an IDH mutant glioma. Most common brain tumors that we see are the glioblastomas. And those are often and really, by rule, IDH wild-type. IDH is a gene. It's called the isocitrate dehydrogenase gene. And it's one of these really important genes for us to understand how brain tumors are going to work and how they act and it turns out, with this study, how they may respond to treatment. So this study looked at enrolling patients that had an IDH-mutant low-grade glioma, or a grade 2 glioma. Those are those often slower-growing, but they continuously grow tumors that occur early in life, typically in the 30s or 40s for young people. And we haven't really had a lot of good treatments for these patients. And so this study looked at giving a new drug that's called vorasidenib. It's hard to say vorasidenib. And it's an IDH mutant inhibitor. So it attacks that IDH mutant gene that makes these tumors what they are. And it's been undergoing development for many years. It's an exciting treatment because it's what we call a molecularly targeted treatment. It specifically targets that IDH gene that makes the low-grade tumors low-grade tumors. This study enrolled 331 patients, so a large group of patients. Half of those patients received the drug, the vorasidenib, and half received placebo. And that's pretty uncommon in cancer. We don't often do studies that are placebo-controlled studies. But for these patients, there's often not a good treatment early in the course, they get surgery. And for patients that don't need an additional treatment, we do surgery and then we wait and watch and see what happens. And that gives us an opportunity as a brain tumor community to figure out whether this type of treatment will help prevent the need for a next treatment, prevent the need for radiation and chemotherapy. And so that's what was looked at in this study. And there was some really exciting data. So I'm going to go through a few numbers, but we just got to talk about these numbers because they're really important. So at 14 months, 28% of the patients receiving the drug vorasidenib had progressions. That's about a quarter of patients compared to half that received placebo. So that's a big improvement in the number of patients whose tumor grew. So this drug prevented tumor growth in these patients. And that's exactly what we want. That's why we develop drugs, is to prevent tumor growth. When we look at the time that those patients had until they needed a next treatment or until their tumor grew, it was over 2 years of time patients receiving the drug when their tumor grew versus less than a year, 11 months for those receiving placebo. So it's adding a lot of time for brain tumor patients without tumor growth or without needing another treatment. And typically, these patients with low-grade gliomas would need something like radiation therapy or chemotherapy. And those are good treatments, and we need those treatments. But they can have toxicity. And so this is the type of drug that could prevent that toxicity, cognitive decline, other problems that can happen with chemotherapy that those patients didn't potentially suffer. So there are some important things that we learned from the INDIGO study that I would want you to take away, kind of what do these data mean? The first is that we can target this IDH gene. And that's really important for our field. And it means if you're a brain tumor patient, knowing whether your tumor is IDH mutant or IDH wild-type is important, and that's something I want brain tumor patients to ask me as a neuro-oncologist and ask their cancer doctor because that's important in deciding treatment for them. The second is this medicine vorasidenib, it gets into the brain. And that's one of the big challenges that we have in brain tumor care in developing drugs is we need things that get into the brain. And this study really shows that this is a good medicine. There's a number of IDH inhibitors, but this medicine vorasidenib is one that we want to specifically think about for our patients. And this is a practice-changing study. So for the first time, we now have a treatment that works for grade 2 gliomas and really prevents the need for radiation therapy and chemotherapy. So those are 3 important things to take away from this. There's a number of things that we don't yet know. This medicine is not available. So patients coming in and emailing me and calling me, we don't have it yet. And after a big phase 3 study like this, this is announced. There's still a number of steps that need to happen to make sure that this can be delivered to patients safely and we can get it out there. And that's in partnership with groups like the FDA, the Food and Drug Administration, and others. So this is an important conversation to have with patients, neuro-oncologists, and to know that this is something that's on the horizon. Two other things is we don't know if this is going to work for all brain tumors. In particular, for these IDH wild-type glioblastomas, the most common brain tumor, this probably is not a good therapy that we don't have any data to suggest that it would work. They don't have that IDH mutation. And so this is important for some brain tumor patients but not for everybody. And that needs to prompt a conversation with the cancer doctor. And it may not work at all times. So there's some data to suggest that this is really a drug that's best given early in the course of treatment and not later on. And so it is something that I want my patients to be aware of at the first time that I see them so we can be deciding what kind of the right time is. So I want to give folks 2 take-homes from this study and summarize a few of these things that we heard about because it's such an important study. So what are the 2 take-homes from the INDIGO Study? The first that I wrote down is targeting IDH mutation in glioma works. And that's a groundbreaking discovery from this. This is really important for our field. IDH mutations have been important to diagnose brain tumors but have never been really a therapeutic target. And this changes the landscape, and we can now target IDH mutations in gliomas. And that's really important. The second thing, the second real take-home message, is we can safely delay radiation therapy and chemotherapy in some patients with these lower-grade gliomas, potentially with IDH mutation and IDH inhibition. And that's really important. Chemotherapy and radiation therapy are important, but if we can delay those treatments and prevent side effects, that could be helpful for some of our patients. So really important update from ASCO and what I want to spend most of the time on our podcast focusing on this INDIGO study. But there were a bunch of other things going on in brain tumors at ASCO, as there always are. And I want to highlight 2 studies about some things that the groups of patients may be interested in knowing that happened at the meeting. The first is a study called the INB-200 study. And this is a phase 1 study, so it's earlier in development. But it's an immunotherapy study. And brain tumor patients and caregivers will know that we've really wanted to find an immunotherapy that works for brain tumors. And we haven't yet. And we're still not there, but this study is an important step in that direction. So this study from a group at the University of Alabama looked at something called gamma delta T cells. And T cells are really important. They're part of the anti-tumor response. They're what the body uses to attack the tumor. So we like those T cells. And particularly, these gamma delta T cells are important in targeting tumor cells in glioblastoma cells. They're also unique. They can avoid the toxicity of chemotherapy. Radiation therapy and chemotherapy suppresses the T cells. They make some go down, or decreased in number, which is not what we want. And these gamma delta T cells were genetically created so that they were resistant to chemotherapy. And that's really, really important. We want an immunotherapy that works and one that isn't suppressed by our other treatments. And that's been a real barrier for glioma patients. So in this phase 1 study, they found the right dose of these gamma delta T cells, and that's the goal of a phase 1 study. But there were some early signs that this may be changing the tumor. One of the patients underwent surgery before and after they got this infusion. And we were able to see this. Investigators were able to see the gamma delta T cells up in the tumor. So this doesn't change practice. Patients don't need to go out and seek out the gamma delta T cells yet. But it's one of those early findings that says that we need to keep looking at immunotherapy. And as a community, this is something we need to keep focusing on. And then the last abstract and study I wanted to focus on is for a rare disease. This would not be something that would be relevant for all of our listeners and the brain tumor patients but for a subgroup of patients that have a condition called VHL, or von Hippel-Lindau. And von Hippel-Lindau is a genetic condition. So, most brain tumors are not inherited. You don't get it from a mom or a dad or pass it on, except for these patients, you do. And it comes from a gene that's inherited in families called the VHL or the von Hippel-Lindau gene. And these patients are predisposed to get tumors all throughout the body and the kidneys and the brain and the eye. And this is a lifelong disease where these tumors can really grow slowly over time and cause significant problems. And in the past few years, there's been a new treatment called belzutifan. Belzutifan is the name of this drug that has been shown to be effective in the kidney tumors for patients with VHL. And at ASCO this year, there was a new study showing that it's also effective in treating the brain tumors for these patients. And that's really important. We just haven't had a treatment other than surgery or radiation therapy for these tumors. And oftentimes, they grow after surgery and radiation therapy and we need an additional treatment. So in this study, the investigators looked at, "Does this drug belzutifan work for treating the CNS tumors, hemangioblastoma?" And found that around 50% of patients had a response, so a shrinkage in the size of the tumor. 90% of patients had control of their brain tumor disease, which is really important. And it worked really quickly, so it worked in about 3 to 5 months, which is shorter than what we would see for the kidney tumors. So that's exciting news for VHL patients, patients with von Hippel-Lindau, and another important update from the 2023 ASCO. So thanks for listening to this update of CNS brain tumors at the 2023 ASCO Annual Meeting. Again, I'm Roy Strowd, a neuro-oncologist at Wake Forest University School of Medicine. Delighted to bring you this brief summary of new research in the field. ASCO: Thank you, Dr. Strowd. You can find more research from recent scientific meetings at www.cancer.net. Cancer.Net Podcasts feature trusted, timely, and compassionate information for people with cancer, survivors, and their families and loved ones. Subscribe wherever you listen to podcasts for expert information and tips on coping with cancer, recaps of the latest research advances, and thoughtful discussions on cancer care. And check out other ASCO Podcasts to hear the latest interviews and insights from thought leaders, innovators, experts, and pioneers in oncology. Cancer.Net is supported by Conquer Cancer, the ASCO Foundation, which funds lifesaving research for every type of cancer, helping people with cancer everywhere. To help fund Cancer.Net and programs like it, donate at CONQUER.ORG/Donate.

Configure Azure Virtual Desktop infrastructure to run efficiently. Drive up utilization with scaling plans. Scale session host VMs in a host pool up or down automatically, without paying for idle resources. Ensure your VM images are up-to-date with required software, configurations, and Windows updates. Gain an end-to-end view of your services' performance by utilizing Azure Virtual Desktop Insights at Scale, which provides comprehensive visibility into how your services are running, and access a consolidated view of all your host pools and subscriptions for easy monitoring. Azure Expert, Matt McSpirit, walks through part four in our series on Azure Virtual Desktop. ► QUICK LINKS: 00:00 - Introduction  00:23 - Scaling plans 03:29 - Personal scaling plans 04:30 - Up-to-date VM images 07:13 - Azure Virtual Desktop Insights at Scale 09:02 - Session History chart 10:06 - Wrap up ► Link References: Check out our complete playlist at https://aka.ms/AVDMechanicsSeries ► Unfamiliar with Microsoft Mechanics? As Microsoft's official video series for IT, you can watch and share valuable content and demos of current and upcoming tech from the people who build it at Microsoft. • Subscribe to our YouTube: https://www.youtube.com/c/MicrosoftMechanicsSeries • Talk with other IT Pros, join us on the Microsoft Tech Community: https://techcommunity.microsoft.com/t5/microsoft-mechanics-blog/bg-p/MicrosoftMechanicsBlog • Watch or listen from anywhere, subscribe to our podcast: https://microsoftmechanics.libsyn.com/podcast ► Keep getting this insider knowledge, join us on social: • Follow us on Twitter: https://twitter.com/MSFTMechanics • Share knowledge on LinkedIn: https://www.linkedin.com/company/microsoft-mechanics/ • Enjoy us on Instagram: https://www.instagram.com/msftmechanics/ • Loosen up with us on TikTok: https://www.tiktok.com/@msftmechanics

Featuring perspectives from Dr Ian W Flinn, including the following topics: Hodgkin Lymphoma Introduction (0:00) Case: A man in his late 30s with well-controlled HIV and newly diagnosed Stage IV classic Hodgkin lymphoma receives brentuximab vedotin with doxorubicin/vinblastine/dacarbazine (AVD) — Neil Morganstein, MD (2:30) Case: A man in his early 60s with classic Hodgkin lymphoma with a left lower lung mass and extensive regional lymphadenopathy receives brentuximab vedotin with AVD on the Phase III SWOG-S1826 trial — Ranju Gupta, MD (6:45) Mantle Cell Lymphoma (MCL) Case: A man in his late 50s with newly diagnosed MCL blastoid variant — Zanetta S Lamar, MD (16:27) Case: A man in his mid 50s with newly diagnosed Stage IV MCL — Shams Bufalino, MD (21:23) Follicular Lymphoma Case: A man in his mid 60s with incidental diagnosis of Grade IIIA follicular lymphoma after admission to the hospital for a stroke — Bhavana (Tina) Bhatnagar, DO (36:28) Case: A woman in her late 30s with extensive lymphadenopathy is diagnosed with Grade I/II follicular lymphoma and receives bendamustine/rituximab — Dr Morganstein (39:04) Diffuse Large B-Cell Lymphoma (DLBCL) Case: A physically independent man in his early 80s with DLBCL and multiple comorbidities, including cardiac issues and peripheral neuropathy, experiences disease progression after R-GCVP — Syed F Zafar MD (49:53) Case: A man in his mid 70s who presented with rapidly progressive proptosis of the left eye is diagnosed with DLBCL and receives R-CHOP and methotrexate CNS prophylaxis — Dr Lamar (55:21) CME information and select publications

Drs. John Sweetenham and Marc Braunstein discuss advances in hematologic malignancies featured at the 2023 ASCO Annual Meeting, including the potentially practice-changing SWOG-S1826 study in Hodgkin lymphoma, the promise of bispecific antibodies in B-cell malignancies, and a novel approach to deliver vital anti-myeloma medications that could improve patient quality of life and alleviate barriers to care. TRANSCRIPT   Dr. John Sweetenham: Hello, I'm John Sweetenham, the associate director for cancer network clinical affairs at UT Southwestern's Harold C. Simmons Comprehensive Cancer Center and the host of the ASCO Daily News Podcast.    The 2023 ASCO Annual Meeting featured some exciting new data on hematologic malignancies. I'm delighted to have Dr. Marc Braunstein return to the podcast to discuss some of these potentially practice-changing studies and new approaches in the heme space. Dr. Braunstein is a hematologist and oncologist at the NYU Perlmutter Cancer Center.    You'll find our full disclosures in the transcript of this episode, and disclosures of all guests on the ASCO Daily News Podcast are available on our transcripts at asco.org/DNpod.   Marc, it's great to have you back on the podcast, and thanks for being here again.   Dr. Marc Braunstein: Thank you, John. It's great to be back.   Dr. John Sweetenham: Marc, we already mentioned that there are some potentially practice-changing studies that were reported at ASCO this year. And among those, LBA4, which was presented in the Plenary Session, was a study which explored the treatment of advanced Hodgkin lymphoma. This was the Southwest Oncology Group study S1826. Could you give us your insights on this?    Dr. Marc Braunstein: Sure, happy to discuss S1826. So as background, you know, the ECHELON-1 study, which was published in the New England Journal of Medicine in 2022 showed a 40% decrease in the risk of death at six years follow-up by adding brentuximab to AVD compared to bleomycin AVD. And that was in high risk or advanced-stage patients and that led to adoption of brentuximab for upfront use in patients with classical Hodgkin lymphoma in advanced stage.    Also of note, immune checkpoint inhibitors such as pembrolizumab or nivolumab do have activity in the relapse setting. The SWOG S1826 study was a randomized control study looking at the use of the PD-1 inhibitor nivolumab plus AVD versus brentuximab AVD in patients with advanced stage classical Hodgkin lymphoma who are at least twelve years of age. And the primary endpoint in the study was progression-free survival.     It was a large study which enrolled 976 patients and randomized them one to one to either nivo AVD or brentuximab AVD. The median age in the study was 27 and the median follow-up was 12 months. And what the study found, which could be practice-changing, was that the primary endpoint of progression-free survival was superior in the nivolumab arm with a hazard ratio of 0.8 and a one-year PFS of 94% versus 86%, favoring the nivolumab arm. And while there were side effects associated with the class of medications, for example, hypo or hyperthyroidism was more frequent in the nivolumab group, whereas peripheral neuropathy was higher in the brentuximab group, I think that these results are particularly encouraging for how we can continue to improve outcomes for patients with advanced-stage classical Hodgkin lymphoma. And this may be practice-changing in terms of whether we use upfront immune checkpoint inhibitors in combination with our standard chemotherapy backbone.    Dr. John Sweetenham: Yeah, absolutely. There are a couple of things that occur to me. One in particular which is unique about this study, and the fact that it was for patients who are 12 years and older in many respects represents a first because I can't think of another large, randomized study of this type which has attempted to align pediatric and adult care of patients with Hodgkin lymphoma. So, I think it's something of a landmark in that regard. I don't know if you'd agree with that.    Dr. Marc Braunstein: I agree, especially with the range of ages from 12 to 83. It's a pretty broad population by age, but I agree it does kind of reconcile those two groups in a disease that has a bimodal presentation and clearly shows that immune checkpoint inhibitors are both potent and well tolerated in different age groups.    Dr. John Sweetenham: The other question that I have about this study is we haven't seen so far in this study an overall survival benefit to the nivo arm, which is maybe not surprising, but in terms of the practice-changing potential of this study, do you think that will matter?   Dr. Marc Braunstein:  I think that's an excellent question, John. Initially, the ECHELON-1 study only showed progression-free survival, and then the update did show overall survival. And so if we take the lead from that study, we expect to see an overall survival benefit in the SWOG study as well with nivolumab, but it remains to be seen. But I think that the data presented thus far at the Plenary Session is compelling enough to consider using nivolumab upfront.   Dr. John Sweetenham: Yeah, I absolutely agree. And then I guess the other question that we're going to have to wait probably several years to know is what happens in terms of relapse? So, for the minority of these patients who do relapse, how salvageable, if that's the right word, are they going to be with a second- or third-line regimen? But I think that's clearly something for the future, and it's a very interesting, exciting outcome from this study.   Dr. Marc Braunstein: Absolutely.    Dr. John Sweetenham: Let's move on. Marc, again, we're still in the lymphoma world here, but looking at high-risk follicular lymphoma. And this was Abstract 7506, looking at epcoritamab plus the R2 regimen in patients with follicular lymphoma. Could you walk us through this one?    Dr. Marc Braunstein: Yeah, absolutely. Bispecific T-cell engaging antibodies are showing impressive efficacy in relapsed and refractory non-Hodgkin lymphoma. Epcoritamab is a bispecific antibody that binds to CD3 on T-cells and CD20 B-cells. And this antibody is currently approved for diffuse large B-cell lymphoma patients after two or more prior lines of treatment.    In this study presented by Merryman and colleagues, they explored the addition of epcoritamab to standard lenalidomide-rituximab. In 109 patients with relapsed or refractory follicular lymphoma who had at least one prior therapy, and, of note, the study was enriched for high-risk patients for progression, including those who had progression of disease within 24 months of their initial treatment and those patients who had been refractory to prior anti-CD20 treatment. This study enrolled 109 patients with relapsed refractory follicular lymphoma. The median age was 65 and 56% of patients had FLIPI scores on the higher end of the spectrum from three to five, and 61% had stage 4 disease. Also of note, 38% of patients had progression of disease within 24 months of their prior treatment. So at a median follow-up of 8.8 months, the overall response rate was impressive at 97%, and 82% of patients were still on treatment at that time.     Now, of course, with this mechanism of action of bispecific antibodies, there is a risk of both cytokine release syndrome and immune-related neurotoxicity. The rates of CRS were primarily low grade, there were only 2% grade 3, and of note, most occurred after the first dose. And in terms of ICANS or neurological toxicity, there were no grade 3 adverse events, and those occurred in only two patients. Finally, the estimated six months progression-free survival was 93%. So, if we cross-compare these results historically to the R-squared regimen, which was published to be about 80%, just cross comparing, so it's not exactly the same study, this clearly shows high activity on par or better with R-squared alone. Although this study was not a randomized study, I think the addition of epcoritamab certainly shows high overall response rates and we'll need randomized data to confirm the efficacy, but it's definitely encouraging in high-risk follicular lymphoma patients.   Dr. John Sweetenham: Thanks, Marc. I agree. I think these data are really enticing, in as much as the response rates are so high, but of course, it is follicular lymphoma, so we'll have to wait a while. But the thing that it does make me reflect on is that bispecific antibodies really are turning out to be remarkably effective in a range of B cell malignancies, so, it's very interesting to continue to watch this space.    I'm going to change gears now and talk about something completely different for a moment. And this was Abstract 1536. I think that many of us are in a position where we're now looking at how we deliver our clinical services, and particularly inpatient services, to patients with hematologic malignancy. And this study addressed that very specifically. Can I have your thoughts on that?   Dr. Marc Braunstein: Sure. In the context of how our therapies are improving, our approaches to how we manage patients clinically is changing too, in many ways for the better. So, various models exist for, you know, which practitioners manage oncology patients who happen to be admitted to the hospital. This abstract, which was performed by authors at a large medical center in New York, describes the use of a dedicated hematologic malignancy hospitalist for managing medicine-related issues. And the authors did comparisons of that service to a service primarily managed by oncologists. The authors compared things such as length of stay, whether the patients were discharged by noon, which is a hospital metric that's used for facilitating turnover of patients and space availability, as well as 30-day readmission rates among patients cared for by an oncology attending versus this heme malignancy hospitalist between July of 2021 and July 2022.    The outcomes showed that admissions to the heme malignancy hospitalists were, although less because that service was primarily for patients who required medicine-related issues as opposed to primarily oncologic issues, there were 95 admissions to that service versus 669 to the oncology service. There was a significantly shorter length of stay on the heme malignancies hospitalist service by about 2 to 5 days compared to the oncology hospitalist service. The rates of patients who were discharged by noon or the length of stay were similar between the two groups.    So, while this study is confounded by differences in acuity of disease between the services, using a dedicated heme malignancy hospitalist has many benefits, not just to offload the oncology-managed service, which may have a higher level of acuity, but also allow for a deviation of care for medicine-specific issues, to a hospitalist that's specifically trained in managing patients with hematologic malignancies and then dedicating the oncology specialty service to those who need acute oncologic care, such as those with leukemia or other high acuity diseases.    Dr. John Sweetenham: Thanks, Marc. I think it is really interesting to see some outcome data for this model of care. A number of centers I know are looking at an APP-led inpatient service for these types of patients, too, so it's going to be very interesting to see how further studies of these kinds of approaches continue to develop.    And on a related theme of changes in patterns of care, Abstract TPS1609 looked at home infusion and of course, this is something that really started to attract a lot more attention during the COVID-19 pandemic. But I wonder if you could walk us through some of the details of this poster.    Dr. Marc Braunstein: This study was presented as a poster proposing a prospective study looking at home infusion of the anti-CD38 monoclonal antibody daratumumab, which has a vital role in managing patients with newly diagnosed or relapsed multiple myeloma. And monoclonal antibodies have really revolutionized the care of patients with multiple myeloma, but often their infusion schedule is weekly or biweekly, and it does require relatively frequent visits to an infusion center.    So, this single-arm, open-label study is going to examine whether we can provide home administration of subcutaneous daratumumab and assess whether it improves quality of life and assess its safety. So, in this study, a visiting nurse will come and deliver the medication after patients take their pre-medications at home prior to the arrival of the infusion nurse. And then the investigators will provide quality of life questionnaires prior to and after the infusions and at the end of the study, and they'll be looking at any barriers to adherence, any barriers to the logistics of this home infusion arrangement.    And I think that this has a lot of potential not just to improve quality of life, but also to facilitate care to patients who may be frail, who may not have good caregiver support, who may have barriers in traveling to an infusion center or perhaps in places that are more resource-deprived and don't have local infusion centers. This could be a potential approach to delivering vital anti-myeloma medications at home, and I'm looking forward to seeing the results.    Dr. John Sweetenham: Yeah, I agree. I think a lot of us still have anxieties about the safety of this approach, but I think there are increasing data to suggest that home infusion is not only safe but also, as you mentioned, is a big enhancer of the quality of life of these patients. And so, very interesting to see how this plays out in prospective studies.    So, to close out, I wonder if you could walk us through Abstract 7072, a poster looking at the issue of clonal hematopoiesis.    Dr. Marc Braunstein: Clonal hematopoiesis, which is a phenomenon in which the blood cells acquire somatic mutation, is associated with both cardiovascular disease adverse outcomes as well as hematologic malignancy. It's been shown to be a precursor for diseases such as leukemia. So, this relatively small study from MD Anderson Cancer Center examined clonal hematopoiesis in 78 patients with malignancies, 70% of which had a history of cancer, and the authors described outcomes associated with clonal hematopoiesis.    So, again, 78 patients were examined, and 76% of them had a history of malignancy, and 73% had other comorbidities. And the authors demonstrated clonal hematopoiesis by the finding of specific mutations in the blood associated with clonal hematopoiesis. The authors essentially looked at outcomes such as mortality. They noted that only 20% of the patients developed a myeloid neoplasm, and that's relevant because, again, clonal hematopoiesis is a precursor for myeloid neoplasms. They also noted that most patients had died from a primary malignancy rather than a myeloid neoplasm, which is not too surprising considering that most patients with clonal hematopoiesis will not develop a hematologic malignancy, but it is a marker for the potential transformation.    And so, I think the authors conclude that clonal hematopoiesis is important for monitoring patients who are at risk for potential myeloid transformation and hematologic malignancy, but it's not necessarily the case that patients who have a background of malignancy will often develop a myeloid malignancy. I think there are many implications of clonal hematopoiesis for cancer in general in terms of the risk of secondary malignancies in those treated with adjuvant chemotherapy, in terms of how we monitor patients who actually more and more are going to have this detected as we use more next-generation sequencing and liquid biopsies.     So, I look forward to future studies that are exploring how to actually prospectively assess clonal hematopoiesis and use it for clinical stratification for things like adjuvant chemotherapy or monitoring for risks of hematologic malignancy.    Dr. John Sweetenham: Thanks, Marc. I agree. Very important for the future, especially as we gain more and more sequencing data.    So, Marc, in conclusion, I want to thank you very much for sharing your insights with us today on the ASCO Daily News Podcast. It's been great to talk with you again.    Dr. Marc Braunstein: My pleasure. Happy to be back, and I look forward to a future podcast session.  Dr. John Sweetenham: And thank you to our listeners for joining us today. You'll find links to the abstracts discussed today in the transcripts of this episode. Finally, if you value the insights that you hear on ASCO Daily News Podcast, please take a moment to rate, review, and subscribe wherever you get your podcasts.   Disclaimer:   The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.    Find out more about today's speakers:   Dr. John Sweetenham   Dr. Marc Braunstein   @docbraunstein      Follow ASCO on social media:    @ASCO on Twitter    ASCO on Facebook    ASCO on LinkedIn       Disclosures:   Dr. John Sweetenham:   Consulting or Advisory Role: EMA Wellness   Dr. Marc Braunstein:   Consulting or Advisory Role: Pfizer, Bristol-Myers Squibb/Celgene, Adaptive Biotechnologies, GlaxoSmithKline, ADC Therapeutics, Janssen Oncology, Abbvie, Guidepoint Global, Epizyme, Sanofi, CTI BioPharma Corp   Speakers' Bureau: Janssen Oncology   Research Funding (Institution): Janssen, Celgene/BMS        

What's good everyone it's y'all boy JayEm Da Anamaly coming to you straight out of Astoria Queens Ny . Today we got a special mix for our friends at the Slon Store in Osaka, Japan ! Big thank you to AVD for giving us the opportunity to bring y'all some dope music and good vibes !

An enormous victory for the US Cannabis Vaping sector happened, and most completely missed it.The recent “definitive victory” by AVD was a critical win for the cannabis industry.A monopoly would have jeopardized the entire category and potentially put a stranglehold on crucial hardware. This ruling ensures that competition continues and allows brands and consumers to not suffer at what could have been.The bigger question remains, is this IP battle the first of many?We sat down with Alex Kwon, Founder and CEO of AVD, to discuss the following:USITC cannabis vaping disputeWartime CEO strategiesBuilding a Diversified Supply ChainForward-thinking disruption tacticsAbout AVD:In our former lives, we were extractors and processors. And, probably like you, we were looking for vape hardware equal to our oils. Except we couldn't find consistently reliable cartridges. That were correctly designed. Didn't burn our oil. And were priced for the market.So we said to ourselves, “We know exactly how the perfect cartridge should perform. After all, we've been in the industry for 20-plus years. From cultivation to managing licensed extraction labs to processing and formulation.  We're perfectly positioned to engineer and manufacture our own hardware.” Guest Links:https://avd710.com/https://www.instagram.com/avd710/https://www.linkedin.com/company/avd710/Follow us: Our Links.At Eighth Revolution (8th Rev), we provide services from capital to cannabinoid and everything in between in the cannabinoid industry.8th Revolution Cannabinoid Playbook is an Industry-leading report covering the entire cannabis supply chain The Dime is a top 5% most shared  global podcast The Dime is a top 50 Cannabis Podcast Sign up for our playbook here:

An enormous victory for the US Cannabis Vaping sector happened, and most completely missed it.The recent “definitive victory” by AVD was a critical win for the cannabis industry.A monopoly would have jeopardized the entire category and potentially put a stranglehold on crucial hardware. This ruling ensures that competition continues and allows brands and consumers to not suffer at what could have been.The bigger question remains, is this IP battle the first of many?We sat down with Alex Kwon, Founder and CEO of AVD, to discuss the following:USITC cannabis vaping disputeWartime CEO strategiesBuilding a Diversified supply chainForward-thinking disruption tacticsAbout AVD:In our former lives, we were extractors and processors. And, probably like you, we were looking for vape hardware equal to our oils. Except we couldn't find consistently reliable cartridges. That were correctly designed. Didn't burn our oil. And were priced for the market.So we said to ourselves, “We know exactly how the perfect cartridge should perform. After all, we've been in the industry for 20-plus years. From cultivation to managing licensed extraction labs to processing and formulation.  We're perfectly positioned to engineer and manufacture our own hardware.” Guest Links:https://avd710.com/https://www.instagram.com/avd710/https://www.linkedin.com/company/avd710/Follow us: Our Links.At Eighth Revolution (8th Rev), we provide services from capital to cannabinoid and everything in between in the cannabinoid industry.8th Revolution Cannabinoid Playbook is an Industry-leading report covering the entire cannabis supply chain The Dime is a top 5% most shared  global podcast The Dime is a top 50 Cannabis Podcast Sign up for our playbook here:

In this Mini Q&A episode of the EBB podcast, I will be answering a variety of questions that have recently been asked of us, including:   1.    What if my hospital won't let my healthy newborn go home before 48 hours? 2.    Are modern ultrasounds better at detecting big babies? 3.    What's the maximum time a vacuum can be used during a vacuum assisted delivery? 4.    Does EBB have any new resources I should know about?   References/Resources: Read the AAP Guidelines on Hospital Stays for Healthy Term Newborn Infants here  Visit the NAABB here Read the U.S. Department of Labor article on the Newborns' and Mothers' Protection Act here  Read the UpToDate article on vacuum assisted delivery (subscription only) here  Resources Read the New Evidence Based Birth® Signature Article on Anti-Racism in Health Care and Birth Work (and links to all the free handouts) here   Check out the EBB Pocket Guide to Interventions here  Listen to the following EBB Podcast Episodes:  EBB Podcast 190 Updated Evidence on Big Babies  here  EBB Podcast 244 Evidence on AROM, AVD and Internal Monitoring here  EBB Podcast 265 Evidence on Anti-Racism in Healthcare and Birthwork here  Find an EBB Childbirth Class here Go to our YouTube channel to see video versions of the episode listed above!! For more information and news about Evidence Based Birth®, visit www.ebbirth.com. Find us on:  TikTok Instagram Pinterest Ready to get involved?  Check out our Professional membership (including scholarship options) here  Find an EBB Instructor here  Click here to learn more about the Evidence Based Birth® Childbirth Class.

Moving to Azure Virtual Desktop (AVD) has never been easier! Richard talks to Jen Sheerin about her work with the Azure Virtual Desktop Accelerator tools. Jen describes how moving workloads to AVD is part of the Cloud Adoption Framework that helps you integrate virtual desktop workloads with standard security and licensing practices. The conversation explores the different folks who use the accelerator - even for greenfield implementations of new virtual desktops! There are more great tools to help you optimize your AVD implementation. Check the links in the show notes!Links:Azure Virtual DesktopRemote Desktop ServicesMicrosoft Cloud Adoption FrameworkAVD Remote Desktop Web ClientBicepAzure Virtual Desktop AcceleratorVirtual Desktop Optimization ToolWindows 10 vs Windows 11 BenchmarkLicense Universal PrintRecorded April 7, 2023

Michael Brosgart is the Chief Operating Officer of Advanced Vapor Devices (AVD), is a vape hardware manufacturer that specializes in building reliable cartridges, disposables, and batteries specifically designed for cannabis oils. Prior to joining AVD, Michael was the Vice President of Sales and Marketing at cannabis investment leader The Arcview Group, where he worked with some of the top brands in the cannabis industry.

On this episode, Keith & Geoff welcome Marvin Etzioni into Thunderlove Studio - he is also known as the Mandolin Man. Etzioni is best known as a founder and bassist for the band Lone Justice. He is also a noted songwriter, composer, and record producer. He has released three solo albums in addition to performing with loads of artists. In 1982, Etzioni met Ryan Hedgecock, who shared his love for country and roots music. Hedgecock was already performing with Maria McKee. Hedgecock and McKee asked Etzioni to back them on bass duties, along with drummer Don Heffington and the band Lone Justice was launched. Etzioni was a member of Lone Justice from 1983 to 1986, during which he encouraged them to write original material, and contributed the songs "East of Eden," "Working Late," "You Are the Light," and "Soap, Soup and Salvation" (written with McKee). Marvin has produced for numerous artists, including Peter Case, Counting Crows, and Toad the Wet Sprocket. Etzioni's compositions have been covered by Cheap Trick, Victoria Williams, Julie Miller and Judy Collins. Etzioni produced and wrote songs with the Williams Brothers (Andy Williams' nephews Andrew and David).  Together with David Williams, Etzioni co-wrote "Can't Cry Hard Enough" which became his most successful song. In the 1990s, Etzioni recorded and released three albums: The Mandolin Man (1991), Bone (1992) and Weapons of the Spirit (1994).Etzioni employs the analog-vinyl-digital (AVD) technique, in which his master tapes are converted first to vinyl, and the vinyl is recorded to digital for the final product. In 2012, Etzioni released the 2-disc album Marvin Country on Nine Mile Records. On the album, which had been in development since 1985, Etzioni played mandolin, mandocello, guitar, bass, piano, Mellotron, porchboard and keyboards. Included are duets with Lucinda Williams ("Lay It on the Table"),Steve Earle ("Ain't No Work in Mississippi"), Richard Thompson ("It Don't Cost Much"), Buddy Miller ("Living Like a Hobo"), John Doe ("The Grapes of Wrath"), Maria McKee ("You Possess Me"), and the Dixie Hummingbirds ("You Are the Light"). For most songs, the backing band was Heffington (drums), Steve Fishell (pedal steel), Gurf Morlix (bass), Tammy Rogers (fiddle), and Buddy Miller and Duane Jarvis (guitar). LINKS Marvin Etzioni  Marvin Etzioni Bandcamp George Jones The Clash Toad the Wet Sprocket Counting Crows  The Bangles Alt Country T-Bone Burnett Martinis and Bikinis

Configure Azure Virtual Desktop with the enterprise-grade configurations you'll want in place for secure authentication, improved connectivity, flexible user data, and service resiliency. If you're new to Azure Virtual Desktop, check out our overview and quick setup videos in the our playlist at https://aka.ms/AVDMechanicsSeries In this show, we cover: - Your options using Azure Active Directory to achieve single sign on and passwordless authentication - The newest experiences for using Web Authentication (WebAuthn) to redirect additional authentication factors to local devices - RDP Shortpath to optimize connectivity to remote hosts - Your options using FSLogix to manage profile containers - Architecting your Azure Virtual Desktop configuration for resiliency, and - Using Confidential Computing virtual machines to meet even the highest security requirements ► QUICK LINKS: 00:00 - Azure Virtual Desktop enterprise configurations 00:34 - Secure Authentication options in Azure Virtual Desktop 02:15 - Optimizing Connectivity to Azure Virtual Desktop hosts 03:12 - FSLogix user profile container options 05:12 - Architecting for high availability and service resiliency 06:58 - Confidential computing in Azure Virtual Desktop ► Link References: Azure Virtual Desktop playlist on Mechanics: https://aka.ms/AVDMechanicsSeries Azure Virtual Desktop connectivity options: https://aka.ms/AVDConnectivity FSLogix High Availability configuration guidance: https://aka.ms/FSLogixHA ► Unfamiliar with Microsoft Mechanics?  As Microsoft's official video series for IT, you can watch and share valuable content and demos of current and upcoming tech from the people who build it at Microsoft. • Subscribe to our YouTube: https://www.youtube.com/c/MicrosoftMechanicsSeries • Talk with other IT Pros, join us on the Microsoft Tech Community: https://techcommunity.microsoft.com/t5/microsoft-mechanics-blog/bg-p/MicrosoftMechanicsBlog • Watch or listen from anywhere, subscribe to our podcast: https://microsoftmechanics.libsyn.com/podcast ► Keep getting this insider knowledge, join us on social: • Follow us on Twitter: https://twitter.com/MSFTMechanics  • Share knowledge on LinkedIn: https://www.linkedin.com/company/microsoft-mechanics/ • Enjoy us on Instagram: https://www.instagram.com/msftmechanics/ • Loosen up with us on TikTok: https://www.tiktok.com/@msftmechanics  

In this episode we talk with Emily Chandler and Taylor Washburn, EBB Childbirth Class graduates about their experiences in the childbirth class; their informed and empowered hospital birth; and how they navigated an extended hospital stay for newborn jaundice.   Emily, is a marine scientist, and Taylor, is a teacher and rowing coach in the Boston area. Together, they love hiking, biking, rowing, and taking advantage of the great outdoors. And they're also very busy taking care of their baby. While pregnant, Emily dove headfirst into learning about pregnancy, birth, and the state of maternity care in the United States. Emily and Taylor took the Evidence Based Birth Childbirth Class with EBB instructor Chanté Perryman.   Emily and Taylor share their experiences in the EBB Childbirth Class and how that informed many of the decisions they made regarding their birth plan, including Taylor being both inspired and empowered to “catch” their baby. They also share how they used the advocacy skills learned in class to better communicate with their providers and each other. After experiencing the birth they desired, complications arose when Emily experienced difficulty breastfeeding and inadequate lactation support. Difficulty was further exasperated when their newborn was diagnosed with jaundice leading to an extended hospital stay. Content Warnings: extended hospital stay due to newborn jaundice, “yellow baby,” difficulty breastfeeding, syringe feeding, lack of lactation support poor latch, heel pricks and bilirubin testing, treatment for elevated bilirubin, poor outcomes for Black and Brown infants with jaundice Resources: Access the CDC article on Jaundcie here Access the Evidence Based Birth® Signautre Articles on:  The Evidence on Premature Rupture of Membranes here  The Evidence on Group B Strep here  The Evidence on Pitocin® in the Third Stage here Listen to EBB 145- Fatherhood and Advocacy in Birth with JacMichael Perryman here Listen to EBB 244 - Evidence on AROM, AVD and Internal Monitoring here  Learn more about Chanté Perryman's EBB Childbirth Class and services here or on her Instagram account @babydreamsmc Learn more about The Nest Collaborative for lacation support here References:  Here are the scientific references on jaundice for the blog article: ·      Dunn, P. M. (2003). Dr Erasmus Darwin (1731–1802) of Lichfield and placental respiration. Arch Dis Child Fetal Neonatal Ed;88:F346– 8. ·      Katheria, A. C., Lakshminrusimha, S., Rabe, H., et al. (2017). Placental transfusion: a review. Journal of Perinatology; 37:105-111. ·      McDonald, S. J., Middleton, P., Dowswell, T., et al. (2013). Effect of timing of umbilical cord clamping of term infants on maternal and neonatal outcomes. Cochrane Database of Systematic Reviews, Issue 7. Art. No.: CD004074 ·      Ashish, K. C., Rana, N., Malqvist, M., et al. (2017). Effects of Delayed Umbilical Cord Clamping vs. Early Clamping on Anemia in Infants at 8 and 12 months: A Randomized Clinical Trial. JAMA Pediatr;171(3):264-270. ·      Mercer, J. S., Erickson-Owens, D. A., Deoni, S. C. L., et al. (2018). Effects of Delayed Cord Clamping on Four-Month Ferritin Levels, Brain Myselin Content, and Neurodevelopment: A Randomized Controlled Trial. ·      Andersson, O., Lindquist, B., Lindgren, M., et al. (2015). Effect of delayed cord clamping on neurodevelopment at 4 years of age: a randomized clinical trial. JAMA Pediatr;169:631–8. ·      CDC article on Jaundice: https://www.cdc.gov/ncbddd/jaundice/facts.html   Go to our YouTube channel to see video versions of the episode listed above!! For more information and news about Evidence Based Birth®, visit www.ebbirth.com. Find us on:  TikTok Instagram Pinterest Ready to get involved?  Check out our Professional membership (including scholarship options) here  Find an EBB Instructor here  Click here to learn more about the Evidence Based Birth® Childbirth Class.  

Brian invited Ernie Costa to join him for this podcast. Ernie is a Team… The post Podcast #118: Going Deep on Microsoft Azure Arc, Cloud, Managed SQL, AVD, HCI and More! appeared first on StorageReview.com.

On this week's episode of the podcast I cover an update about the major HSE cyber attack,  information of a new ransomware attack on ESXi hosts, details of new Windows 365 and AVD features plus more! Reference Links: https://www.rorymon.com/blog/ransomware-targeting-esxi-msix-update-bing-ai-preview-launches/

Featuring perspectives from Drs Jonathan Friedberg, Brad Kahl, David Maloney, Loretta Nastoupil and Sonali Smith, including the following topics: Diffuse Large B-Cell Lymphoma (DLBCL)  Introduction (0:00) Case: A woman in her early 60s with DLBCL with renal and subcutaneous involvement — Erik Rupard, MD (2:36) Cases: An otherwise healthy woman in her mid 80s with an orbital mass diagnosed with Stage IE DLBCL and a man in his early 80s with Stage IIIB DLBCL, GCB type and LVEF 35% to 40% due to prior myocardial infarction and coronary artery disease — Bhavana (Tina) Bhatnagar, DO and Yanjun Ma, MD (7:10) Dr Friedberg presentation (11:54) Follicular Lymphoma  Case: A man in his late 60s with progressive Grade I/II follicular lymphoma after observation for many years — Neil Morganstein, MD (29:07) Case: A woman in her early 60s with Grade II follicular lymphoma who received bendamustine/rituximab and maintenance rituximab — Jennifer L Dallas, MD (33:11) Dr Nastoupil presentation (38:36) Hodgkin Lymphoma  Case: A woman in her early 80s with newly diagnosed classical Hodgkin lymphoma — Kapisthalam (KS) Kumar, MD(51:21) Cases: A woman in her late 30s with newly diagnosed classical Hodgkin lymphoma and a man in his early 60s with newly diagnosed Stage IV classical Hodgkin lymphoma who receives brentuximab/vedotin with AVD (doxorubicin/vinblastine/dacarbazine) — Susmitha Apuri, MD and Amany R Keruakous, MD, MS (55:21) Dr Smith presentation (1:10:17) Chimeric Antigen Receptor (CAR) T-Cell Therapy for Non-Hodgkin Lymphoma   Cases: A man in his late 50s who presents with a large cecal mass and mesenteric adenopathy and is diagnosed with “double hit” DLBCL and a woman in her early 70s with DLBCL treated with R-CHOP, now with progressive disease 6 months later — Vignesh Narayanan, MD and Rahul Gosain, MD (1:14:56) Case: A woman in her early 70s with rapid relapse after R-CHOP then R-ICE (rituximab/ifosfamide/carboplatin/etoposide) and ASCT who achieves a complete response with CAR T-cell therapy but experiences significant pancytopenias — John Yang, MD (1:22:10) Dr Maloney presentation (1:25:24) Mantle Cell Lymphoma (MCL)  Case: A man in his late 70s with high-risk relapsed MCL after BR and maintenance rituximab x 3 years — Raman Sood, MD (1:39:10) Case: A man in his mid 80s who received prior treatment for prostate cancer and presents with low-volume indolent MCL with a TP53 mutation — Spencer H Bachow, MD (1:42:47) Dr Kahl presentation (1:45:29) CME information and select publications

EBB 244: Evidence on Artificial Rupture of Membranes, Assisted Vaginal Delivery, and Internal Monitoring.   We are so excited to announce the upcoming release of a new Evidence Based Birth(R) Pocket Guide, all about Interventions! To give you a sneak peek to the Invention Pocket Guide,  we are diving into the research and evidence on artificial rupture of membranes, assisted vaginal delivery an internal monitoring.   Content note: Discussion of the benefits and risks of these interventions, including forceps and vacuum-assisted deliveries, which can be associated with birthing trauma for birthing people and babies, as well as the risk of mortality. Resources: Make sure you're on the Pocket Guide wait list by going here  Amniotomy References: Kawakita, T., Huang, C-C, and Landy, H. J. (2018). Risk Factors for Umbilical Cord Prolapse at the Time of Artificial Rupture of Membranes. AJP Rep 8(2): e89-e94. https://pubmed.ncbi.nlm.nih.gov/29755833/ Simpson, K. R. (2020). Cervical Ripening and Labor Induction and Augmentation, 5th Edition. AWHONN Practice Monograph 24(4): PS1-S41. https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-019-2491-4 Smyth, R. M., Markham, C. & Dowswell, T. (2013). Amniotomy for shortening spontaneous labour. Cochrane Database Syst Rev 6:CD006167. https://pubmed.ncbi.nlm.nih.gov/23780653/ Alfirevic, Z., Keeney, E., Dowswell, T., et al. (2016). Methods to induce labour: a systematic review, network meta-analysis and cost-effectiveness analysis. BJOG 123(9):  1462-1470. https://pubmed.ncbi.nlm.nih.gov/27001034/  de Vaan, M. D. T., ten Eikelder, M. L. G., Jozwiak, M., et al. (2019). Mechanical methods for induction of labour. Cochrane Database of Systematic Reviews 10: CD001233. https://www.cochrane.org/CD001233/PREG_mechanical-methods-induction-labour Simpson, K. R. (2020). Cervical Ripening and Labor Induction and Augmentation, 5th Edition. AWHONN Practice Monograph, 24(4), PS1-S41. https://nwhjournal.org/article/S1751-4851(20)30079-9/abstract   Assisted Vaginal Delivery References: NHS article on forceps or vacuum delivery https://www.nhs.uk/pregnancy/labour-and-birth/what-happens/forceps-or-vacuum-delivery/ Bailey, P. E., van Roosmalen, J., Mola, G., et al. (2017). Assisted vaginal delivery in low and middle income countries: an overview. BJOG 124(9): 1335-1344. https://pubmed.ncbi.nlm.nih.gov/28139878/ CDC Wonder Database Feeley, C., Crossland, N., Betran, A. P., et al. (2021). Training and expertise in undertaking assisted vaginal delivery (AVD): a mixed methods systematic review of practitioners views and experiences. Reprod Health 18(1): 92. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8097768/ Crossland, N., Kingdon, C., Balaam, M. C. (2020). Women's, partners' and health care providers' views and experiences of assisted vaginal birth: a systematic mixed methods review. Reprod Health 17:83. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7268509/ Hook, C. D., Damos, J. R. (2008). Vacuum-Assisted Vaginal Delivery. Am Fam Physician 78(8): 953-960. https://www.aafp.org/afp/2008/1015/p953.html Tsakiridis, I., Giouleka, S., Mamopoulos, A., et al. (2020). Operative vaginal delivery: a review of four national guidelines. J Perinat Med 48(3): 189-198. https://pubmed.ncbi.nlm.nih.gov/31926101/ Verma, G. L., Spalding, J. J., Wilkinson, M. D., et al. (2021). Instruments for assisted vaginal birth. Cochrane Database Syst Rev. https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD005455.pub3/full   Internal Monitoring References: Euliano, T. Y., Darmanjian, S., Nguyen, M. T., et al. (2017). Monitoring fetal heart rate during labor: A comparison of three methods. J Pregnancy 2017: 8529816. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5368359/ Neilson, J. P. (2015). Fetal electrocardiogram (ECG) for fetal monitoring during labor. Cochrane Database Syst Rev 12: CD000116. https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD000116.pub5/full Harper, L. M., Shanks, A. L., Tuuli, M. G., et al. (2013). The risks and benefits of internal monitors in laboring patients. Am J Obstet Gynecol 209(1): 38.e1-38.e6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3760973/ Bakker, J. J. H., Verhoeven, C. J. M., Janssen, P. F., et al. (2010). Outcomes after internal versus external tocodynamometry for monitoring labor. N Engl J Med 362(4): 306-13. https://www.nejm.org/doi/10.1056/NEJMoa0902748?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200www.ncbi.nlm.nih.gov Frolova, A. I., Stout, M. J., Carter, E. B., et al. (2021). Internal fetal and uterine monitoring in obese patients and maternal obstetrical outcomes. Am J Obstet Gynecol MFM 3(1): 100282. https://pubmed.ncbi.nlm.nih.gov/33451595/ Bakker, J. J. H., Janssen, P. F., van Halem, K. (2013). Internal versus external tocodynamometry during induced or augmented labor. Cochrane Database Syst Rev 8: CD006947. https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD006947.pub3/full van Halem, K., Bakker, J. J. H., VerHoeven, C. J., et al. (2011). Does use of an intrauterine catheter during labor increase risk of infection? J Maternal Fetal Neonatal Med 25(4): 415-418. https://www.tandfonline.com/doi/abs/10.3109/14767058.2011.582905 For more information and news about Evidence Based Birth®, visit www.ebbirth.com. Find us on:  TikTok Instagram  Pinterest   Ready to get involved?  Check out our Professional membership (including scholarship options) here  Find an EBB Instructor here  Click here to learn more about the Evidence Based Birth® Childbirth Class.

If you are just a starter in the real estate industry and you have been thinking a lot about the things you should consider, the things you should do, and the things you must avoid, then we are the right people that you should talk to! I've been through it. We've built 13 YouTube channels across the country and we are willing to share with you our experiences throughout the process. My partner, Jackson Wilkey, and I started our path in this business in 2019 and we have never looked back.How's the book coming along?How active on Facebook should we be? Socially that is.When do you expect the early release to happen?Tutorial on the dollar a day on how to make it work or can you give a small explanation right now?Do you think the newer iPhones are good enough to get good rolling? I also have a canon m50 but the phone is more convenient.A Buddy of mine is getting ready to send me a GoPro here 8 black. What other accessories would you suggest?I took your advice on longer videos and my AVD shoot up to 9 mins.When people ask me questions in comments on my videos, how do you ask them to call you? Or they are just not interested yet if they don't call you?What are your real thoughts on shots?I can't imagine the amount of work you guys are putting in for junk mail.I want to set up a cool backdrop for my sit-down videos. What types of lighting should I use? How do I set it up?Thoughts on the DJI mini 3? I have a mini 2 and wonder if it is worth upgrading.I have received a mail from YouTube for handles rolling out in the next few weeks. What do you think about handles?Do you use a script and teleprompter for your real estate videos?Have you recorded any videos in certain subdivisions or neighborhoods with people's homes in the background and those people complaining about their houses being in the video?Can the JunkMail thumbnails you send be edited?Will there be a batch shooting option for the sub-service? If someone didn't want to do it on a daily?Youtube community page/ have you used it? I see some channels using it and I thought it was cool. They are making it for smaller channels too. These are just a few of the questions that were posed during our live Q&A podcast, and you're about to hear all of the answers, so stay tuned!

Several recent large trials just released long term follow-up results on overall survival. We look at what how treatment principles may change based on these mature data. ECHELON-1 - Hodgkin's (A+AVD vs. ABVD) POLO - Pancreatic (olaparib maintenance vs. placebo) Keynote 355 - mTNBC (pembrolizumab + chemo vs. chemo) APHinity - adjuvant HER+ breast (pertuzumab/trastuzumab vs. trastuzumab) E1912 - CLL (ibrutinib/rituximab vs. FCR)