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Dr. Harold McGee, PhD, is a renowned author on the topics of food chemistry and culinary science. He explains how cooking methods, types of cookware and temperature can be used to transform food and drink flavors and presents simple but powerful ways to improve nutrient availability. We also discuss how our individual biology, genetic and cultural backgrounds shape our taste preferences. Whether you're a seasoned cook or someone who simply loves to eat, our conversation will change how you think about food and cooking, give you actionable tools to try and deepen your appreciation of the experience of eating and drinking. Read the episode show notes at hubermanlab.com. Thank you to our sponsors AG1: https://drinkag1.com/huberman Eight Sleep: https://eightsleep.com/huberman Our Place: https://fromourplace.com/huberman Mateina: https://drinkmateina.com/huberman Function: https://functionhealth.com/huberman Timestamps 00:00:00 Harold McGee 00:02:21 Food Chemistry, Using Copper, Modern vs Traditional Techniques 00:09:59 Sponsors: Eight Sleep & Our Place 00:13:33 Cooking, Food & Heat, Taste & Smell 00:22:10 Umami, Savory Tastes, Braising & Meat 00:29:56 Chemistry of Cooking & Eating, Sugars & Conjugates; Slowly Enjoying Food 00:36:14 Savory Meal & Dessert; Food Course Order; Palate Cleansers 00:43:56 Salt, Baseline & Shifting Taste Preferences 00:47:18 Sponsors: AG1 & Mateina 00:50:07 Whole vs Processed Foods, Taste & Enjoyment 00:53:37 Brewing Coffee, Water Temperature, Grind Size 01:00:33 Tea & Tannins, Growing Tea Plants; Tea & Meals, Polyphenols 01:08:16 Food Combinations, Individual Tolerance; Is there an Optimal Diet? 01:11:34 Onions & Garlic, Histamines, Tool: Reduce Crying when Cutting Onions 01:13:55 Gut Sensitivities & Food, Capsaicin & Spicy Foods 01:17:21 Supertasters & Taste Buds, Bitter Taste, Chefs 01:21:57 Sponsor: Function 01:23:45 Salt & Bitter, Salting Fruit, Beer or Coffee, Warming Beer 01:26:11 Human History of Alcohol & Chocolate 01:29:25 Wine Expense vs Taste, Wine Knowledge 01:35:49 Cheese Making, Aged Cheese & Crystals, Tyrosine; Smoke Flavors, Distilling 01:44:30 Fermentation, “Stink Fish”, Caviar, Traditional & New Foods 01:50:42 Personal Journey, Astronomy, Poetry & Food 01:54:55 Beans & Gas, Tool: Soaking Beans 01:57:23 Gut Microbiome, Fermented Foods; Kids & Food Aversions 02:00:47 Cilantro & Divergent Tastes; Microwave Popcorn, Parmesan Cheese 02:04:46 John Keats Poetry, To Autumn; Acknowledgements 02:10:48 Zero-Cost Support, YouTube, Spotify & Apple Follow & Reviews, Sponsors, YouTube Feedback, Protocols Book, Social Media, Neural Network Newsletter Disclaimer & Disclosures Learn more about your ad choices. Visit megaphone.fm/adchoices
What if everything we've accepted as “normal” the stress, the sickness, the disconnection is actually far from what it means to be fully human? The Real Human Baseline is a wake-up call and a roadmap. Hosted by Eva Payne, this podcast explores what life could look like if we remembered who we really are beyond the systems, the trauma, and the noise. Each episode unpacks what it means to live as an optimized human: physically, emotionally, and spiritually aligned. We'll dive into what society could become when we build from coherence instead of chaos. From nervous system regulation to regenerative education, from purpose-driven work to frequency-based healing, we paint a picture of a world you may have sensed… but never seen laid out clearly, until now. This is not about escaping reality. It's about reclaiming it. You're not here to fit into the old world. You're here to help build the new one. 0000014E 0000014E 00002B47 00002B47 000E3F70 000E3F70 00007E86 00007E86 00015498 00015498
In this episode, Scott sits down with Danielle Adams—a powerhouse productivity strategist and executive operations expert—on a mission to help overworked entrepreneurs reclaim their time without sacrificing income or impact. If you've been feeling stuck, scattered, or burnt out, this conversation offers clarity, structure, and real hope.-✨ What you'll learn:Why hustle fatigue is real—and how to reconnect with your deeper “why” to find fulfillment againThe difference between rest and escape, and why knowing yourself is the key to rechargingHow to stop being the bottleneck in your business by building systems that run without youWhy being productive isn't about doing more—it's about doing what matters mostWhat Danielle means by “schedule the life you want,” and how to start doing it today-If you're ready to finally scale your business and protect your peace, Danielle has the blueprint.---Episode Markers:(0:00) - Scott's Intro(1:05) - Becoming Lela(3:30) - Starting in Coaching & Deep Listening(4:50) - The Story Your Telling Yourself(7:15) - Conscious vs. Sub Conscious(9:30) - Difference Between Therapy & Coaching(12:15) - Pausing and Doing the Deep Work(15:10) - Internal + External Audits: The Starting Point of Deep Work(17:00) - Leaky Energy and the Myth of 'More Is Better'(19:10) - When Ego, Fear, and Success Get Tangled(20:30) - The Power of Saying No and Making Space(22:40) - Can Anyone Become That Always-Positive Person?(24:00) - Creating a Baseline of Calm and Ease(26:20) - How to Truly Take Time Off (and Not Fake It)(31:00) - Scarcity, Time, and Why We Expand to Fill It(32:45) - Two Powerful Client Transformations(36:25) - Where to Find Lela + Final Thoughts---Scott Grates' Links:Referrals Done Right Book Pre Sales - https://www.referralsdonerightbook.comReferrals Done Right FB Group - https://www.facebook.com/groups/296359076662332Insurance Agency Optimization - https://www.agencyoptimization.comScott Grates Website - https://www.scottgrates.comLove Living Local - https://www.instagram.com/lovelivinglocal315Scott's FB - https://www.facebook.com/scott.grates.1Instagram - https://www.instagram.com/scottgratesTikTok - https://www.tiktok.com/@scott.grates---Lela's Links:Website - https://lelagrace.coIG - https://www.instagram.com/lela_graceLinkedin - https://www.linkedin.com/in/lela-tuhtan-ma-5599573
What's Your Baseline? Enterprise Architecture & Business Process Management Demystified
We are off for a few weeks, but instead of leaving you without your regular What's Your Baseline? fix , we decided to do something different this summer.Since we started the podcast almost four years ago, we have grown quite a bit, and back in Season 2 we did a little "side show" and produced the "What's Your Baseline? Shorts" - 15 minutes, one topic, barely an edit. And this week, we are re-releasing Shorts 1, in which we are discussing the age-old question of "EPC versus BPMN". Enjoy!(And here are the show notes from the initial release)This is the first episode of the What's Your Baseline Shorts series. We are talking about the topic of process notations, especially if you should choose the BPMN or the EPC notation.High-level topics include:What are EPC and BPMN?A bit of historySpecialties of each notation, and difficulties that might ariseData exchange with BPMNExternal standardsPlease reach out to us by either sending an email to hello@whatsyourbaseline.com or leaving us a voice message by clicking here.The full show notes, including graphics, further links, credits, and transcript, are available at whatsyourbaseline.com/shorts1.
THE LANCET 2003;362:772-776Background: Angiotensin converting enzyme inhibitors (ACEi) reduce mortality and morbidity in patients with systolic heart failure (see CONSENSUS and SOLVD trials). However, registry data showed that up to 20% of patients with systolic heart failure were not taking ACEi. One of the frequent causes for intolerance to ACEi is cough. Angiotensin converting enzyme inhibitors work by blocking the conversion of angiotensin I to angiotensin II, a key step in the renin–angiotensin–aldosterone system (RAAS). Angiotensin II receptor blockers were tolerated in patients with systolic heart failure who were intolerant to ACEi. However, data on long term effectives as an alternative to ACEi were lacking.Cardiology Trial's Substack is a reader-supported publication. To receive new posts and support our work, consider becoming a free or paid subscriber.The Candesartan in Heart failure: Assessment of Reduction in Mortality and morbidity (CHARM)-Alternative trial sough to assess if the angiotensin-receptor blocker (ARB) candesartan, could improve outcomes in patients with systolic heart failure who are intolerant to ACEi.Patients: Eligible patients had left ventricular ejection fraction of 40% or less and NYHA class II, III or IV symptoms of at least 4 weeks duration. Patients had also to be intolerant to ACEi.Exclusion criteria were not provided in the main manuscript.Baseline characteristics: Patients were recruited from 618 centers in 26 countries. The trial randomized 2,028 patients – 1,013 randomized to receive candesartan and 1,015 to receive placebo.The average age of patients was 67 years and 68% were men. The average left ventricular ejection fraction was 30%. Cardiomyopathy was ischemic in 68% of the patients. The NYHA class was II in 48% of the patients, III in 49% and IV in 4%.Approximately 50% had hypertension, 27% had diabetes, 61% had prior myocardial infarction, 9% had stroke, 25% had atrial fibrillation and 14% were current smokers.At the time of enrollment, 85% were taking a diuretic, 46% were taking digoxin, 55% were taking beta-blockers and 24% were taking spironolactone.The most common reasons for ACEi intolerance were cough in 72% of the patients, hypotension in 13%, renal dysfunction in 12% and angioedema or anaphylaxis in 4%.Procedures: The trial was double-blinded. Patients were assigned in a 1:1 ratio to receive candesartan starting at 4 or 8mg once daily or placebo. The treatment was doubled every two weeks to a target dose of 32mg once daily.After randomization, follow up occurred at 2, 4, and 6 weeks, 6 months and every 4 months thereafter.Endpoints: The primary outcome was a composite of cardiovascular death or heart failure hospitalizations. All deaths were classified as cardiovascular unless there was a clear non-cardiac cause.Analysis was performed based on the intention-to-treat principle. The estimated sample size to have 80% power at 5% alpha was 2,000 patients. The sample size calculation assumed 18% relative risk reduction in the primary outcome with candesartan assuming a 15% annual event rate in the placebo arm.Results: The median follow up time was 34 months. The mean candesartan daily dose was 23mg at 6 months.Candesartan reduced the primary endpoint of cardiovascular death or heart failure hospitalizations (33.0% vs 40.0%, adjusted HR: 0.70, 95% CI: 0.60 – 0.81; p< 0.001). Candesartan reduced the individual components of the primary outcome - (21.6% vs 24.8%; p= 0.02) for cardiovascular death and (20.4% vs 28.2%; p< 0.001) for heart failure hospitalizations. All-cause death was also lower with candesartan (26.2% vs 29.2%, adjusted HR: 0.83, 95% CI: 0.70–0.99; p= 0.033). The number of patients who had any hospitalization as well as the total number of hospitalizations were numerically but not statistically significantly lower with candesartan (60.2% with candesartan vs 63.3%; p= 0.16) and (1,718 vs 1,835; p= 0.06).Candesartan was associated with more hypotension (3.7% vs 0.9%), more increase in creatinine (6.1% vs 2.7%) and more hyperkalemia (1.9% vs 0.3%). Angioedema occurred in three patients in the candesartan group and none in the placebo group. Cough occurred in two patients taking candesartan and four taking placebo.Authors reported no significant subgroup interactions, however, a corresponding graph was not provided.Conclusion: In patients with systolic heart failure who are intolerant to ACEi, candesartan reduced the primary composite outcome of cardiovascular death or heart failure hospitalizations with a number needed to treat of approximately of 14 patients over 34 months of follow up. Candesartan also reduced all-cause death with a number needed to treat of approximately 33 patients. Adverse events including hypotension, increase in creatinine and hyperkalemia were more common with candesartan.The reduction in the primary endpoint with candesartan was significant and offers an alternative for patients who are unable to tolerate ACEi. Of note, 72% of the patients enrolled in the trial were intolerant to ACEi due to cough. This trial did not include a head-to-head comparison between ARBs and ACEi, and therefore does not address which agent should be preferred as first-line therapy. Only 24% of participants were receiving spironolactone. The combination of ARBs with spironolactone, may increase the risk of adverse events, particularly hyperkalemia and kidney injury.Cardiology Trial's Substack is a reader-supported publication. To receive new posts and support our work, consider becoming a free or paid subscriber. Get full access to Cardiology Trial's Substack at cardiologytrials.substack.com/subscribe
HelixTalk - Rosalind Franklin University's College of Pharmacy Podcast
In this episode, we review the pharmacology, indications, adverse effects, monitoring, and unique drug characteristics of angiotensin receptor blockers (ARBs). Key Concepts ARBs are equally efficacious as ACE inhibitors when used for hypertension, heart failure with reduced ejection fraction (HFrEF), chronic kidney disease (CKD) with proteinuria, and post-MI care. Some limited evidence suggests that they might be better in reducing albuminuria in patients with diabetes. ARBs are generally better tolerated than ACEi due to a lower risk of angioedema and dry cough. While most ARBs are comparable to each other, small differences exists regarding hepatic metabolism (CYP metabolism for losartan, telmisartan, and azilsartan), degree of blood pressure lowering (generally better with azilsartan, olmesartan, valsartan, and candesartan), and additional pharmacological effects (telmisartan with PPAR-Y agonism, losartan with uricosuric effect). ARBs are contraindicated in pregnancy, those with bilateral renal artery stenosis, and those with previous angioedema to ARBs. The most common adverse effects include hypotension and hyperkalemia, but in rare cases acute renal impairment can also occur. Baseline serum creatinine and potassium should be monitored in patients taking ARBs. After initiation or dose adjustment, blood pressure, serum creatinine, and potassium should be repeated in 1-2 weeks. Signs and symptoms of hypotension as well as angioedema should be monitored throughout the treatment period.
The missing piece in your M.E/CFS recovery Have you ever felt like your body's stuck in shutdown mode — like it's trying to keep you hidden away in a cave? In this week's episode of the CFS Health Recovery Podcast, I'm joined by our brilliant medical consultant Dr. Olivia Lesslar. Together, we unpack a concept that's helped thousands of our clients break free from the push-crash cycle and finally make steady, consistent progress. It's called baseline - and it might just be the missing piece in your recovery. If you find yourself doing too much on a good day, then crashing for days after… Here are 4 ways we can help. 1. Join our free community to meet others, be inspired, and get more recovery info - https://www.facebook.com/groups/cfshealthrecoveryhub 2. Watch the newly released past members "Guest Panel" Workshop where they share their top 5 recovery secrets - https://www.cfshealth.com/guestpanelreplay 3. Get our free most popular recovery trainings:- Find your baseline - Stop pushing and crashing - https://www.cfshealth.com/baseline - The 3 stages of recovery and what to do in each one - https://www.cfshealth.com/the3stages - The "9 do's and don'ts" PDF - to decrease symptoms and improve energy - https://www.Cfshealth.com/pdf 4. Want to help professionally with a step-by-step recovery plan specific to you? Fill out the application form and the team will send you the details - https://www.cfshealth.com/form
Vision is common. The discipline to execute is rare. Do you have it? In today's Episode, hosts Clark Lunt and David Shaw sit down with Shaye Wali, a former tennis champion turned entrepreneur. Shaye details his extraordinary transition from the world of professional sports to the fast-paced sectors of private lending and software development. As the founder and CEO of Baseline, a revolutionary software platform, he shares the pivotal moments and challenges that shaped his career, offering valuable insights for aspiring entrepreneurs. Shaye's story is one of focus and resilience. He recounts the immense dedication required to rebuild the tennis program at Tulane University, a testament to his early leadership and determination and desire to travel the road less paved. This experience, he explains, laid the groundwork for his future endeavors. Following his passion for finance, he began his career at Morgan Stanley, where he gained a deep understanding of capital markets and real estate investments. However, the entrepreneurial spirit beckoned. Shaye identified a significant gap in the private lending market, an industry often bogged down by inefficiencies and outdated processes. This realization was the catalyst for his move into entrepreneurship. He emphasizes that the ability to adapt to the ever-changing landscape of real estate and private lending was crucial to his success. This journey culminated in the creation of Baseline, a cutting-edge software designed to streamline the entire private lending process. "We built Baseline to empower lenders," Wali states. "Our goal is to provide a seamless, efficient platform that allows them to manage their operations, from loan origination to servicing, with greater ease and accuracy." The software aims to enhance efficiency, improve data management, and ultimately help private lenders scale their businesses. Shaye's narrative serves as a powerful example of how skills honed in one discipline can be successfully transferred to another. His journey from the tennis court to the boardroom highlights the universal importance of focus, the courage to pivot, and the drive to innovate. For those in the real estate and private lending industries, Shaye Wali's story is not just inspiring; it's a roadmap for navigating the complexities of the modern financial world.Connect with Shaye Wali: https://www.linkedin.com/in/shayewali/ or https://www.baselinesoftware.com/TakeawaysShaye's journey from tennis to tech showcases resilience.Corporate experience at Morgan Stanley shaped the entrepreneurial mindset.The importance of focus in achieving success.Transitioning from employee to entrepreneur requires courage.Private lending offers scalability and flexibility.The evolution of private lending is driven by technology.Chapters00:00 Introduction to Shaye Wali and His Journey03:27 From Pakistan to Florida: The Early Years05:28 Tennis and the Path to College06:58 Building a Tennis Program at Tulane09:46 Transitioning to Morgan Stanley12:00 The Realization of Entrepreneurial Spirit14:38 The Shift to Real Estate17:20 Navigating the Real Estate Market19:48 The Move to Private Lending22:19 Burning the Boats: Taking the Leap24:36 The Evolution into Private Lending30:11 The Journey into Private Lending35:19 Scaling the Private Lending Business40:10 Transitioning to Software Solutions46:11 The Future of Private Lending and Software49:56 Rapid Fire Insights and Final Thoughts58:30 Introduction and Call to Action59:01 Introduction to Burn Your Boats Wealth Podcast59:30 Engagement and Community Building Hosted on Acast. See acast.com/privacy for more information.
In this week's episode, Josh and I are talking about the absolute domination by the Reds in this years Ohio Cup. We talk about what the Reds did well and what the Guardians did not do. We also break down the two big moves that affect the Browns (Aaron Rodgers and Nick Chubb).
Alex Greenwood sits down with certified executive coach and PR veteran Katie Neal to tackle one of the PR world's dirtiest secrets: burnout.What makes PR a perfect storm for overwork and perfectionism? How do you tell “normal busy” from “I-can't-get-out-of-bed” exhaustion? Katie breaks it down with empathy and no-nonsense advice.In this episode you'll learn:The Burnout Spectrum: From mild fatigue to full-blown collapse—where do you fall?PR's Pressure Cooker: Why tight deadlines, client expectations, and the 24/7 news cycle fuel workaholismBoundary Bootcamp: Simple, actionable ways to carve out “off” time and actually keep itValues-Driven Work: How aligning on what matters most can guard against depletionLeadership's Role: What managers must do (and stop doing) to foster a truly sustainable cultureWhether you're just starting to feel the heat or you've already hit the wall, Katie's insights will help you reclaim your energy—and your career.Visit the Katie Neal Coaching & Consulting website.Follow Katie on LinkedIn.Take a Survey for a Chance to WinHey friends—can you do me a quick favor? I'm running a short survey to get your take on my podcasts and All the Fits That's News newsletter. It only takes about 2 minutes, and your feedback will help shape what comes next.Whether you're a regular listener or just pop in occasionally, I'd really value your input. Bonus: you can enter to win a $20 Amazon gift card just for participating.The survey closes once we hit our target number of responses—or by June 30, 2025, whichever comes first.
Daniel Altman explains his Baseline Profitability Index, which helps investors figure out the success of foreign investments on three criteria. 1: How much the asset's value grows; 2: Preservation of Value; 3: Ease of returning the proceeds. The top countries on the index include India and Rwanda. He discusses demand for foreign direct investment by Americans and what it means for the global economy. ======== Schwab Network ========Empowering every investor and trader, every market day.Subscribe to the Market Minute newsletter - https://schwabnetwork.com/subscribeDownload the iOS app - https://apps.apple.com/us/app/schwab-network/id1460719185Download the Amazon Fire Tv App - https://www.amazon.com/TD-Ameritrade-Network/dp/B07KRD76C7Watch on Sling - https://watch.sling.com/1/asset/191928615bd8d47686f94682aefaa007/watchWatch on Vizio - https://www.vizio.com/en/watchfreeplus-exploreWatch on DistroTV - https://www.distro.tv/live/schwab-network/Follow us on X – https://twitter.com/schwabnetworkFollow us on Facebook – https://www.facebook.com/schwabnetworkFollow us on LinkedIn - https://www.linkedin.com/company/schwab-network/About Schwab Network - https://schwabnetwork.com/about
THE LANCET 2003;362:767-771Background: Angiotensin II which plays a role in ventricular remodeling and progression of heart failure can be produced by pathways independent of angiotensin convening enzyme. Preliminary studies showed that the combination of angiotensin II blockers with angiotensin-converting enzyme inhibitors (ACEi) improves hemodynamics and reduces ventricular remodeling.Cardiology Trial's Substack is a reader-supported publication. To receive new posts and support our work, consider becoming a free or paid subscriber.The Candesartan in Heart failure: Assessment of Reduction in Mortality and morbidity (CHARM)-Added trial sough to assess if adding the angiotensin-receptor blocker (ARB), candesartan, to ACEi could improve outcomes in patients with systolic heart failure.Patients: Eligible patients had left ventricular ejection fraction of 40% or less within the previous 6 months, and NYHA class II, III or IV symptoms. Patients with NYHA class II symptoms had to have cardiac-related hospitalization within 6 months. Patients also had to have treatment with ACEi at a constant dose for at least 30 days.Exclusion criteria were not provided in the main manuscript.Baseline characteristics: Patients were recruited from 618 centers in 26 countries. The trial randomized 2,548 patients – 1,276 randomized to receive candesartan and 1,272 to receive placebo.The average age of patients was 64 years and 79% were men. The average left ventricular ejection fraction was 28%. Cardiomyopathy was ischemic in 62% of the patients. The NYHA class was II in 24% of the patients, III in 73% and IV in 3%.Approximately 48% had hypertension, 30% had diabetes, 56% had prior myocardial infarction, 9% had stroke, 27% had atrial fibrillation and 17% were current smokers.At the time of enrollment, 90% were taking a diuretic, 58% were taking digoxin, 55% were taking beta-blockers, 17% were taking spironolactone and all but two patients were taking ACEi.Procedures: The trial was double-blinded. Patients were assigned in a 1:1 ratio to receive candesartan starting at 4 or 8mg once daily or placebo. The treatment was doubled every two weeks to a target dose of 32mg once daily.After randomization, follow up occurred at 2, 4, and 6 weeks, 6 months and every 4 months thereafter.Endpoints: The primary outcome was a composite of cardiovascular death or heart failure hospitalizations. All deaths were classified as cardiovascular unless there was a clear non-cardiac cause.Analysis was performed based on the intention-to-treat principle. The estimated sample size to have 80% power at 5% alpha was 2,300 patients. The sample size calculation assumed 16% relative risk reduction in the primary outcome with candesartan assuming an 18% annual event rate in the placebo arm.Results: The median follow up time was 41 months. The mean candesartan daily dose was 24mg at 6 months.Candesartan reduced the primary endpoint of cardiovascular death or heart failure hospitalizations (37.9% vs 42.3%, adjusted HR: 0.85, 95% CI: 0.75 – 0.96; p= 0.01). Candesartan reduced the individual components of the primary outcome - (23.7% vs 27.3%; p= 0.021) for cardiovascular death and (24.2% vs 28.0%; p= 0.018) for heart failure hospitalizations. There was no significant reduction in all-cause death (29.5% with candesartan vs 32.4%; p= 0.105). The number of patients who had any hospitalization was similar in both groups (66.8% with candesartan vs 67.5%; p= 0.7), however, the total number of hospitalizations was lower with candesartan (2,462 vs 2,798; p= 0.023).Serum creatinine at least doubled in 7% of the patients in the candesartan group vs 6% in the placebo group. In the subset of patients taking spironolactone, serum creatinine at least double in 11% of the patients taking candesartan compared to 4% of the patients taking placebo.Hyperkalemia, defined as serum potassium of 6 mmol/L or higher, occurred in 3% of the patients in the candesartan group vs 1% in the placebo group. In the subset of patients taking spironolactone, hyperkalemia occurred in 4% of the patients taking candesartan compared to 1% of the patients taking placebo.There were two cases of angioedema in the candesartan group and three in the placebo group. All patients were taking an ACEi.There were no significant subgroup interactions, including in patients taking both beta-blockers and ACEi at baseline.Conclusion: In patients with systolic heart failure, adding candesartan to an ACEi reduced the primary composite outcome of cardiovascular death or heart failure hospitalizations with a number needed to treat of approximately of 23 patients over 41 months of follow up. The total number of all-cause hospitalizations was reduced by 336 with candesartan. All-cause death was not significantly reduced with candesartan.While the results of the trial appear impressive, the high number of adverse outcomes with candesartan in patients taking spironolactone is concerning. Spironolactone led to significant reduction in all-cause mortality in patients with systolic heart failure, as seen in the RALES trial, and should be prioritized over adding candesartan. Notably, fewer than 20% of patients in the trial were on spironolactone at baseline; if more had been, the incremental benefit of candesartan would likely have been reduced due to an increased risk of adverse effects from triple neurohormonal blockade (ACEi, ARBs, and mineralocorticoid receptor antagonists). Furthermore, spironolactone acts by blocking the aldosterone receptor, which is downstream in the renin–angiotensin–aldosterone system. Since candesartan blocks angiotensin II upstream in the same pathway, simultaneous inhibition at multiple points may lead to diminishing benefit.Finally, the differences observed in the subgroup of patients on beta-blockers between this trial and Val-HeFT remain unclear and may simply reflect the play of chance. As we previously discussed, patients receiving both an ACEi and beta-blockers had worse outcomes with valsartan in the Val-HeFT trial.Cardiology Trial's Substack is a reader-supported publication. To receive new posts and support our work, consider becoming a free or paid subscriber. Get full access to Cardiology Trial's Substack at cardiologytrials.substack.com/subscribe
“He who has a why to live can bear almost any how.” — Friedrich NietzscheKevin Wathey is an expert in health tech, luxury hospitality, and peak performance.He is the co-founder of Baseline Health, a gamified platform that integrates user data, diagnostics, and DNA to deliver personalized insights and incentivize lasting habit change.Kevin is also developing Velara, an 18-acre luxury wellness resort in Costa Rica — designed to help people reconnect with themselves and extend their healthspan through personalized retreats and tech-enabled treatments.In this episode:• The mindset shift that turned Kevin's greatest challenge into his greatest strength.• Why most people fail at habit change — and the proven way to make habits stick.• What questions of self-reflection can transform your life.• How to optimize your environment for peak health and performance.Let's WIN THE DAY with Kevin Wathey!_
NWSL clubs came out of the international break a little rickety, and with plenty of fire. The guys whip around the league to hit the officiating controversy with Gotham, puzzle over Alex Straus's first game with Angel City, and debate Louisville's future (1:51). Then, they peel back the layers of a grubby contest in San Diego between the Wave and the Seattle Reign. Has San Diego been getting lucky in attack? Can the Reign continue their trench warfare in all of these 1-goal victories? Just how ridiculous was Sally Menti's finish? (27:10) Subscribe to our Patreon for only $6/month ($60/year) to get all of our exclusive bonus features! Art by Eli Elbogen Music by Devin Drobka's Bell Dance Songs
In this week's episode (Actually it's last week, but I was a little preoccupied this week!), Josh and I are discussing and predicting the MLB All-Star teams and give you our reason why we believe each player would make it.
N Engl J Med 2001;345:1667-1675Background: Angiotensin II is a peptide hormone that is part of the renin–angiotensin–aldosterone system (RAAS). Angiotensin II is a potent vasoconstrictor and growth-stimulating hormone. Data suggested that it plays a role in ventricular remodeling and progression of heart failure. Although treatment with angiotensin-converting enzyme inhibitors (ACEi) reduce angiotensin II levels, physiologically active levels of angiotensin II may persist despite long-term therapy.Cardiology Trial's Substack is a reader-supported publication. To receive new posts and support our work, consider becoming a free or paid subscriber.The Valsartan Heart Failure Trial (Val-HeFT) sough to assess whether the angiotensin-receptor blocker valsartan, could reduce mortality and morbidity when added to optimal medical therapy in patients with systolic heart failure.Patients: Eligible patients had left ventricular ejection fraction less than 40% and left ventricular dilation, in addition to having clinical heart failure for at least 3 months with NYHA class II, III or IV symptoms. Patient also had to have been receiving a fixed-dose drug regimen for at least two weeks, that could include ACEi, diuretics, digoxin, and beta-blockers.There were many exclusion criteria. We mention some here: Postpartum cardiomyopathy, acute myocardial infarction within 3 months, coronary artery disease likely to require intervention, serum creatinine >2.5 mg/dL and life expectancy less than 5 years.Baseline characteristics: Patients were recruited from 302 centers in 16 countries. The trial randomized 5,010 patients – 2,511 randomized to receive valsartan and 2,499 to receive placebo.The average age of patients was 63 years and 80% were men. The average left ventricular ejection fraction was 27%. Cardiomyopathy was ischemic in 57% of the patients. The NYHA class was II in 62% of the patients, III in 36% of the patients and IV in 2%.Approximately 26% had diabetes and 12% had atrial fibrillation.At the time of enrollment, 86% were taking a diuretic, 67% were taking digoxin, 35% were taking beta-blockers, and 93% were taking ACEi.Procedures: The trial was double-blinded. The trial had an initial run-in period for 2 - 4 weeks where patients received placebo twice daily. This was performed to confirm patients' eligibility, clinical stability and compliance.Patients were assigned in a 1:1 ratio to receive valsartan or placebo. Randomization was stratified according to whether or not they were receiving a beta-blocker.Valsartan was started at a dose of 40 mg twice a day, and the dose was doubled every two weeks to the target dose of 160 mg twice a day. Placebo doses were adjusted in a similar way.Follow up occurred at 2, 4, and 6 months and every 3 months thereafter.Endpoints: The trial had two primary end points. The first was all-cause mortality. The second was the combined end point of mortality and morbidity, which was defined as cardiac arrest with resuscitation, hospitalization for heart failure, or administration of intravenous inotropic or vasodilator drugs for four hours or more without hospitalization.The estimated sample size was 5,000 patients. The sample size calculation assumed 20% relative risk reduction in mortality with valsartan assuming 906 patients would die during the trial. This sample size would provide the trial 90% power at 0.02 alpha. Alpha was 0.02 instead of the traditional 0.05 since the trial had two primary endpoints and to adjust for the interim analyses.Results: The target valsartan dose of 160 mg twice a day was achieved in 84% of the patients. The reduction in systolic blood pressure was greater with valsartan vs placebo – mean of 5.2 ± 15.8 mm with valsartan compared to 1.2 ± 14.8 mm Hg with placebo, at 4 months.All-cause mortality was not different between both groups (19.7% with valsartan vs 19.4% with placebo, RR: 1.02, 95% CI: 0.88 – 1.18; p= 0.80). The second co-primary endpoint was reduced with valsartan (28.8% vs 32.1%, RR: 0.87, 95% CI: 0.77 – 0.97; p= 0.009). This was driven by reduction in hospitalizations for heart failure (13.8% vs 18.2%). Cardiac arrest with resuscitation was 0.6% with valsartan and 1.0% with placebo. All-cause hospitalization was numerically lower with valsartan, however, this was not statistically significance (2,856 vs 3,106; p= 0.14). The mean change in ejection fraction was higher with valsartan (4.0% vs 3.2%; p= 0.001). More patients had improvement in NYHA classification with valsartan (23.1% vs 20.7%; p
Copper Fox Metals (TSXV: CUU | OTCQX: CPFXF | FSE: HPU) has received the results of two years' worth of Environmental Baselines Studies at its Schaft Creek Copper-Gold-Molybdenum-Silver Project in northwestern British Columbia.In this interview, President and CEO Elmer B. Stewart discusses what the studies revealed, the importance of Schaft Creek's archaeological assessment, and the company's collaboration with the Tahltan Nation. He also explains how these efforts support the future of the Schaft Creek Project, particularly as it moves toward the permitting stage.Learn more about Copper Fox Metals: https://copperfoxmetals.comWatch the full YouTube interview here: https://youtu.be/-9_tqSFD4ywAnd follow us to stay updated: https://www.youtube.com/@GlobalOneMedia?sub_confirmation=1
This week on Live Life in Motion, I'm joined by Chandler Benore, Director of Operations for Baseline GVL — a new, purpose-built indoor pickleball facility coming to the Haywood Road area of Greenville, SC. Chandler shares the inspiration behind the project, what sets Baseline apart from other facilities, and how it's been designed with both serious players and social connection in mind. From court materials and layout to community features like a smoothie bar, pro shop, and outdoor patio, every detail has been carefully considered. If you're into pickleball, community-building, or just love seeing bold ideas come to life, this one's for you. Baseline GVL:https://www.instagram.com/baselinegvl/ Live Life in Motion YouTube: GO Subscribehttps://www.youtube.com/@livelifeinmotionpodcast Pelham Medical Centerhttps://www.spartanburgregional.com/locations/pelham-medical-center
Wonder why you don't look like the other women who are lifting just like you in the gym? Build your Nutrition Baseline first. Do this and look and feel fitter and tighter in the next 3 weeks. Most women who train hard are missing a nutrition baseline. They dabble with macros before having a consistent routine that already checks most of the boxes.In this episode, I share the top 3 things you need to consider in your nutrition baseline. And then, I invite you to join my 3-week coaching program to create yours, Build Your Baseline. This round starts June 9th, click here to get signed up! [Take the Quiz] What are you missing to Be Fit, Well-Fed, and Fully Energized? Work with Jenny the Nutritionist in Create Your Shape:https://jennythenutritionist.com/create-your-shape/Follow Jenny the Nutritionist on Instagram:@jennythenutritionist
Freddie and Joel both just won masters, so you know we're talking about that, but we're also getting into a bunch of other topics. Like how to make money waterskiing, trick skiing scoring/trick values, who we think has the most “on water” time, waterski media and how it compares to wakeboard media, social media/influencers values to brands, onlyfans, and a whole lot more. Plus, the guys rip smelling salts to start the pod, and eat a Malort candy midway through. Hear all this and much more in Episode 84 of the Grab Matters Podcast!Follow Joel: https://www.instagram.com/joelpoland/Follow Freddie: https://www.instagram.com/thefredwinter/Follow Brooks (if you want): https://www.instagram.com/brkswilson/Support the show: https://www.patreon.com/GrabMattersPodcastThank you to this shows sponsors! Liquid Force: https://www.liquidforce.com/ Slingshot: https://slingshotsports.com/Malibu Just Ride Tour: https://www.malibuboats.com/just-ride-tourChapters00:00 - 1:00 Intro1:15 Masters recap16:00 Making money waterskiing24:20 Wakeboarding at the masters27:00 Water time32:30 Return to Baseline/Events39:30 LF'n Wheel of Questions57:40 Age in waterskiing58:00 Trick values1:05:45 Malibu Just Ride Tour1:06:00 Malort candy…?1:09:00 How to be a pro waterskier1:21:50 Slingshot Silhouette Challenge1:26:10 Patreon Question1:27:30 Waterski media1:40:00 Catch up with Brooks2:00:00 Social Media2:16:00 Season previewLinksReturn to Baseline: https://www.baselinewaterski.com/Brostock: https://brostock.com/Malibu Just Ride Tour: https://www.malibuboats.com/just-ride-tourShoot us a text!Patreon: https://www.patreon.com/GrabMattersPodcastWebsite: https://www.grabmatters.com/YouTube: https://www.youtube.com/@grabmatters/videosInstagram: https://www.instagram.com/grabmatters/TikTok: https://www.tiktok.com/@grabmatterspodcastFacebook: https://www.facebook.com/grabmatters
In this week's episode, Josh and I are discussing the many things that have been happening in sports this week. We discuss the big baseball news, while also discussing the MLB playoffs. We decided that only talking about that would be too short of an episode, so we said let's talk about our sport experience bucket list.
https://teachhoops.com/ n any field where performance and results matter, from the sports arena to the boardroom, possessing a "competitive edge" is often the crucial differentiator between success and mediocrity. This podcast delves into the multifaceted nature of what truly gives individuals and teams that vital advantage. We'll explore how the competitive edge isn't just about raw talent or resources, but a dynamic combination of mindset, strategic preparation, relentless innovation, and the ability to execute under pressure. Join us as we dissect the various components that forge a true competitive advantage. We'll uncover actionable strategies to help you identify your potential edges, cultivate them with intention, and sustain them in the face of evolving challenges. Whether you're an athlete, entrepreneur, professional, or anyone striving for peak performance, learn how to sharpen your unique strengths and consistently position yourself ahead of the curve. Learn more about your ad choices. Visit podcastchoices.com/adchoices
We're headed to Disney's Hollywood Studios for the next round of our “Eat It or Beat It” series—breaking down the most popular snacks in the park to determine which ones are worth the splurge and which you might want to skip. From galaxy-famous bites in Galaxy's Edge to theme park classics with a twist, we evaluate each snack based on taste, value, portion size, and overall experience.We dive into fan-favorite items like the Ronto Morning Wrap, Blue & Green Milk, and the cheesy goodness of the Umbaran Cheese Roll—plus sweet treats like the Wookiee Cookie, Lunch Box Tart, and Jack-Jack's Num Num Cookie. You'll even hear our thoughts on savory staples like Totchos, the Bavarian Pretzel at BaseLine, and the Sweet Cream Cheese Pretzel near the iconic Chinese Theatre.Whether you're team “Eat It” or “Beat It,” this episode is packed with honest takes and helpful snack strategies to make the most of your next visit to Hollywood Studios.Missed the first parts of the series? Be sure to check out:• Episode 750 – Magic Kingdom• Episode 759 – EPCOTMEI-Travel – Expertise. Ease. Value.No matter where you want to go, our trusted partner MEI-Travel, will handle the planning so you can focus on the memories. They offer free vacation planning services and have nearly 20 years of experience creating memorable vacations. Visit MEI-Travel for a fee-free, no-obligation quote today!Follow Us on Social MediaFacebook GroupFacebook: @MainStMagicTwitter: @MainStMagicTikTok: @MSMPodcastInstagram: @MainStMagicVisit Us Onlinewww.MainStMagic.comwww.MainStreetShirts.comGet Dining Alerts!Find last-minute and hard-to-find Disney dining reservations with MouseDining.com! Get text and email alerts when popular theme park dining reservations open up. Get last-minute seating! Get the next table! Set your alerts now! Get the next reservation!Visit our Partnerswww.MSMFriends.comThanks to TFresh Productions for our theme song
Join Will from the Tennis Tribe and Michelle as they have a chance to watch some of the best doubles players on the men's tour on one of THE windiest days of the year at the 2025 BNP Paribas Open in Indian Wells, CA! We break down their practice and make it relatable so you can use it in your own doubles practices. From serve and return strategies and what to do on blustery days! If you have any further questions or want to continue the conversation?! Email us at podcast@tennis-warehouse.com Shop with us for all your TENNIS needs all over the WORLD:
Circulation 1999;100:2312-2318Background: The CONSENSUS and SOLVD trials established the effectiveness of angiotensin converting enzyme inhibitors (ACEi) in reducing mortality and morbidity in patients with systolic heart failure. Both trials used enalapril with a target dose of 20mg twice a day (max dose) in the CONSENSUS trial and 10mg twice a day (medium dose) in the SOLVD trials. In real-world settings, ACEi are sometimes prescribed at lower doses, likely reflecting concerns about adverse effects or patients' tolerance. It was unclear whether the benefit from low doses of ACEi is comparable to high doses.Cardiology Trial's Substack is a reader-supported publication. To receive new posts and support our work, consider becoming a free or paid subscriber.The Assessment of Treatment with Lisinopril and Survival (ATLAS) trial sought to assess the efficacy and safety of low vs high doses of ACE inhibition in patients with systolic heart failure.Patients: Eligible patients had left ventricular ejection fraction of 30% or less and had NYHA class II, III or IV despite treatment with diuretics for two or more months.Patients were excluded if they had any of the following: Acute coronary syndrome or revascularization procedure within 2 months, history of sustained or symptomatic ventricular tachycardia, known intolerance to ACEi, serum creatinine >2.5 mg/dL, or any noncardiac condition that could limit survival.Baseline characteristics: The trial randomized 3,164 patients – 1,596 randomized to the low-dose arm and 1,568 to the high dose arm.The average age of patients was 64 years and 80% were men. The average left ventricular ejection fraction was 23%. Cardiomyopathy was ischemic in 65% of the patients. The NYHA class was II in 16% of the patients, III in 77% and IV in 7%.Data on baseline comorbid conditions were not provided in the main manuscript.Procedures: The study was double blinded. At the beginning of the study, all patients received open-label lisinopril for four weeks to assess who is able to tolerate the drug. Patients who were able to tolerate lisinopril 12.5 mg to15 mg daily for two or more weeks were randomized in a 1:1 ratio to receive low-dose or high-dose ACEi. The target dose of lisinopril in the lose dose group was 2.5 to 5.0mg daily and was 32.5 to 35mg daily in the high dose group.All patients received open-label lisinopril 2.5 to 5mg daily. This dose was selected by the investigator. In addition, patients received up to three 10mg tablets of lisinopril or matching placebo.Endpoints: The primary endpoint was all-cause mortality. Secondary end points included cardiovascular mortality, all-cause hospitalization and cardiovascular hospitalizations.Analysis was performed based on the intention-to-treat principle. The estimated sample size was 3,000 patients. This sample size had 90% power at 5% alpha to detect 15% relative risk difference in the mortality between both treatment groups assuming 19% 1-year mortality in the high dose group.Results: Of the 3,793 patients who entered the initial open-label tolerability phase, 83.4% were randomized. A total of 176/3,793 (4.6%) were withdrawn for possible side effects. The median follow-up time was 46 months.Target doses were achieved in 92.7% of the patients in the low-dose group and 91.3% in the high-dose group. Study medication was discontinued by 30.6% of patients in the low-dose group and 27.2% in the high-dose group.All-cause mortality was not significantly different between both treatment groups (44.9% with low dose vs 42.5% with high dose, HR: 0.92, 95% CI: 0.82 – 1.03; p= 0.128). Cardiovascular mortality was numerically lower in the high dose group but this was not statistically significant (37.2% vs 40.2%, HR: 0.90, 95% CI: 0.81 – 1.01; p= 0.073). All-cause hospitalization was lower in the high dose group (3,819 hospitalizations vs 4,397; p= 0.021). Hospitalizations for cardiac causes and hospitalizations for heart failure were also lower in the high dose group (2,456 vs 2,923; p= 0.05) and (1,199 vs 1,576; p= 0.002), respectively.Patients in the high-dose group experienced more dizziness (19% vs 12%), more hypotension (11% vs 7%), more worsening renal function (10% vs 7%), and more hyperkalemia (6% vs 4%), but reported less cough (11% vs 13%) and had less hypokalemia (1% vs 3%).There were no significant subgroup interactions for the primary outcome.Conclusion: In patients with systolic heart failure, high dose ACE inhibition did not significantly reduce mortality compared to low-dose but it led to significantly less hospitalizations. In this trial of 3,164 patients and with a median follow up of 46 months, there were 578 less hospitalizations in the high dose group.Based on these results, we recommend up-titrating ACEi and use higher doses if tolerated. Although, side effects were more common in the high dose group, these can generally be managed with reducing the dose in the outpatient settings.Cardiology Trial's Substack is a reader-supported publication. To receive new posts and support our work, consider becoming a free or paid subscriber. Get full access to Cardiology Trial's Substack at cardiologytrials.substack.com/subscribe
Huge thank you to our sponsors, Fusion Gaming Online.You can find them here: www.FusionGamingOnline.com. You want a 5% discount off all of your MTG order? Head over to Fusion Gaming Online and use exclusive promo code: CCONATION at checkout.Want your deck or topic featured on Commander Cookout Podcast?Check out the reward tiers at Patreon.com/CCOPodcast. There are a lot of fun and unique benefits to pledging. Like the CCO Discord or getting your deck featured on the show.Ryan's solo podcast, Commander ad Populum:https://www.spreaker.com/show/commander-ad-populumInterested in MTG/Commander History? Check out Commander History Podcast: https://www.spreaker.com/podcast/mtg-commander-history--6128728You can listen to CCO Podcast anywhere better podcasts are found as well as on CommanderCookout.com.Now, Hit our Theme Song!Social media:https://www.CommanderCookout.comhttps://www.Instagram.com/CommanderCookouthttps://www.Facebook.com/CCOPodcast@CCOPodcast and @CCOBrando on Twitterhttps://www.Patreon.com/CCOPodcasthttps://ko-fi.com/commandercookout
Welcome to the Social-Engineer Podcast: The 4th Monday Series with Chris Hadnagy and Mike Holfeld. Chris and Mike will be covering cutting edge global news to help people remain safe, secure and knowledgeable in a world where it is hard to know what is real and what is fake news. Today Chris and Mike are joined by Seth Daniels. Seth is the Director of Customer Experience and a founding employee of Rapsodo Inc., an industry leader in sports technology. Seth helped launch Rapsodo in the United States in 2015, particularly on the Diamond Sports side focusing on baseball and softball. He's worked with all 30 MLB clubs, more than 90% of all D1 college programs and thousands of other amateur teams and organizations. [May 26, 2025] 00:00 - Intro 00:49 - Mike Holfeld Intro 01:03 - Today's Guest: Seth Daniels 02:01 - 24 Hours to Singapore 05:33 - Immediate Instant Reactions! 07:23 - Setting a Baseline 08:43 - Data: A Piece of the Puzzle 11:21 - Ohtani 13:06 - Age Appropriate 15:22 - Women's Sports 17:16 - Spin Doctors 19:56 - For the Hitters 22:29 - Finding the Sweet Spot 24:31 - Future Evolution 25:50 - Find Seth Daniels Online - rapsodo.com 26:14 - Don't Forget Golf 27:13 - Wrap Up 27:31 - Next Month: Congressman Darron Soto 27:58 - Outro - www.social-engineer.com - www.innocentlivesfoundation.org Find us online: - Chris Hadnagy - LinkedIn: linkedin.com/in/christopherhadnagy
In this week's episode, Josh and I are discussing the youth of baseball. We give you our U23 Major League Baseball team. We create a team of 9 hitters and 1 pitcher. They all have to be 23 or younger. Each pick is explained and there might be a few surprises. Oh, and of course, the Reds swept the Guardians!
In this week's episode of The Baseline NBA Podcast, we dive deep into our ongoing Autopsy Report series, breaking down the shocking and unceremonious playoff exits of the Boston Celtics and Cleveland Cavaliers. Once considered title contenders, both teams now face serious questions about their future with financial pressures looming and roster changes on the horizon. We analyze:What went wrong for the Celtics and CavaliersImpact of injuries, coaching decisions, and star performancesPotential offseason trades, free agency moves, and salary cap issuesFuture outlook for stars like Jayson Tatum, Jaylen Brown, Donovan Mitchell, and Darius GarlandThen, we shift gears and preview the 2025 Eastern Conference Finals between the New York Knicks and Indiana Pacers. A rivalry rekindled from last year's playoff showdown now reaches new heights. Can the Knicks finally return to the ECF for the first time since 2000, or will Tyrese Haliburton and the red-hot Pacers punch their ticket back to the Finals?PrizePicksPrizePicks (https://prizepicks.onelink.me/LME0/CLNS) (include in episode description)The basketball playoffs are here and the action is heating up on PrizePicks, THE BEST place to cash in on your favorite sports.Don't miss your last chance to add your favorite players from the court to your PrizePicks lineup! Whether it's Points, Rebounds, Assists, take your pick of More or Less for your shot to win up to 2,000 times your cash. Download the app and use code CLNS to get $50 instantly after you play your first $5 lineup!”PrizePicks also offers weekly promotions. Turn your playoff hot takes into tickets to basketball's championship series. Every Lineup you make will qualify for the Takes 2 Tickets Sweepstakes, which could get you and a guest a VIP trip to The ‘ShipEvery Tuesday, PrizePicks discounts several projections on the board, usually between 15% and 25%. They also offer Flex Fridays! Make sure you OPT IN and tap the checkbox in your lineup builder to be eligible for the Protected Play. Choose squares from any game on the board.If your lineup does not win, you get your net losses back in promo funds up to your promo limit as soon as the lineup settlesYou can also mix your selections across sports in your PrizePicks lineup! I might take Juan Soto for 2 RBIs and the Big Bodega Karl Anthony Towns for more than 26 points to combine my love of baseball and basketball.PrizePicks is simply the best place to win cash while watching sports! Join millions of users and sign up today with the promo code CLNS to get $50 after you play your first $5 lineup. The Baseline is rocking with Prize Picks and you should too. “PrizePicks. Run Your Game!”Become a supporter of this podcast: https://www.spreaker.com/podcast/the-baseline-nba-podcast--3677698/support.
Lancet 1999;353:2001-07Background: Beta-blockers directly reduce cardiac contractility and myocardial oxygen demand. For decades, they were avoided in patients with acute and chronic heart failure over concerns they would facilitate decompensation of the condition. The therapeutic cornerstones of treatment, prior to the modern era of clinical trials, focused on managing symptoms and quality of life with diuretics and inotropic agents like digoxin; however, new paradigms were arising that focused on addressing neurohormonal mechanisms of chronic disease that were over-activated in the failing heart. The first major success came with inhibition of the renin angiotensin aldosterone system with angiotensin converting enzyme inhibitors whose effect on mortality for patients with mild and severe forms of chronic heart failure were demonstrated in the V-HEFT II, CONSENSUS, and SOLVD trials. Additional benefits were demonstrated with the mineralocorticoid receptor antagonist spironolactone in the RALES trial. These drug classes primarily work by reducing afterload and volume retention. Appreciating why they work for improving cardiac performance and managing symptoms in heart failure patients is straightforward when we consider the major factors that effect cardiac stroke volume - preload, afterload and contractility; however, it is also noteworthy the effects these agents have on sudden death. How beta-blockade benefits the failing heart is less obvious (outside prevention of sudden death). Mechanistic studies in patients with chronic heart failure have consistently shown that when beta blockers are used for more than 1 month, left ventricular function improves. Beta blocker therapy appears to restore the density of beta-adrenergic receptors after they have been downregulated by the chronic overactivity of the sympathetic nervous system. The first major placebo-controlled RCT to demonstrate a mortality benefit used the non-selective beta blocker carvedilol. The trial was small and not originally designed to test mortality and was stopped early without clearly predefined stopping rules. Furthermore, 8% of total patients selected for participation in the trial were excluded prior to randomization after a 2 week, open-label run-in phase with the study drug, which saw 2% of all patients experience worsening heart failure or death representing 24 patients (the difference in total deaths between groups was 9 when the trial was stopped). The Metoprolol CR/XL Randomised Intervention Trial in Congestive Heart Failure (MERIT-HF) was the first large scale trial designed to test the hypothesis that beta-blockade with metoprolol controlled/extended release (CR/XL) added to optimum medical therapy reduces mortality in patients with chronic systolic heart failure.Patients: Patients were recruited from 313 sites in 13 European countries and the United States. Eligible patients were men and women between the age of 40 to 80 years with symptomatic heart failure (NYHA class II-IV) for >/= 3 months before randomization. They had to be on a diuretic and ACE inhibitor for at least 2 weeks. Other drugs, including digoxin, could also be used. Patients also had to have an EF of /=68 beats per minute.Patients were excluded if: they had an MI or unstable angina within 28 days; had an indication or contraindication for treatment with beta-blocker; beta blockade within 6 weeks; heart failure due to systemic disease (i.e., amyloidosis) or alcohol abuse; scheduled or performed cardiac transplant; an ICD; procedures such as CABG or PCI planned or performed in the past 4 months; 2nd or 3rd degree AV block unless a pacemaker was present; unstable or decompensated heart failure defined by pulmonary edema or hypoperfusion or supine systolic BP 25% deviation of the number of observed versus expected consumed placebo tablets during the run-in period.Baseline characteristics: The mean age of patients was 64 years and approximately 78% were male. Slightly more than 30% of patients were above the age of 70. The average EF was 28%. The average SBP was 130 mmHg and heart rate was 82 bpm. Most patients had mild to moderate heart failure, with 41% in NYHA Class II, 56% in Class III, and only 3% in Class IV. Ischemic cardiomyopathy accounted for 65% of cases and nonischemic causes accounted for 35%. Most patients were on an ACE inhibitor or ARB (95%) and diuretic (90%). Digoxin was used in 63%. Trial procedures: Prior to randomization, the study was preceded by a single-blind, 2-week placebo run-in period. Patients meeting eligibility were then randomized to placebo or metoprolol CR/XL. The starting dose of placebo or metoprolol CR/XL was 12.5 mg daily for patients in NYHA class III or IV and 25 mg daily for patients in NYHA class II. The dose was doubled every 2 weeks until the target dose of 200 mg daily was reached. Patients were followed every 3 months.Endpoints: The primary outcome was all-cause mortality. It was estimated that 3,200 patients would need to be followed for 2.4 years to detect a 30% relative reduction in mortality based on annual mortality rate of 9.4% in the placebo group. This would achieve at least 80% power with a 2-sided alpha of 0.04. Patients were recruited faster then planned and so the final sample size of 3,991 patients increased the power of the study.The study was monitored by an independent safety committee and predefined stopping rules for efficacy were based on all-cause mortality, done when 25%, 50%, and 75% of expected deaths had occurred. Results: The trial was stopped early after the 2nd preplanned interim analysis when 50% of expected deaths had occurred. The mean duration of follow-up at the time of stopping was 1 year. The mean daily dose of metoprolol CR/XL was 159 mg once daily, with 87% receiving 100 mg or more and 64% receiving the target dose of 200 mg daily. In the placebo group, the corresponding values were 179 mg daily, 91% and 82%. The study drug was discontinued permanently in 14% of patients in the metoprolol group and 15% in the placebo group. Six months after randomization, heart rate decreased by 14 bpm in the metoprolol group compared to only 3 bpm in the placebo group. Systolic blood pressure decreased less in the metoprolol group (-2.1 vs 3.5 mmHg).Compared to placebo, metoprolol significantly reduced all-cause mortality (7.3% vs 10.8%; RR 0.66; 95% CI 0.53—0.81). Cardiovascular mortality accounted for 91% of all deaths; with sudden death accounting for 58% and death from worsening heart failure accounting for 24% of all deaths. All 3 of these causes of death were significantly reduced by metoprolol. The relative and absolute effects on death were greatest for patients with NYHA class III heart failure.Conclusions: In this trial of stable patients with mild to moderate chronic systolic heart failure, who were optimized on an ACEi or ARB and diuretic, metoprolol CR/XL significantly reduced all-cause mortality. Approximately 30 patients would need to be treated with metoprolol compared to placebo for 1 year to prevent 1 death. This trial represents a significant win for beta blockade in patients with chronic systolic heart failure. While the NNT in this trial is slightly higher than in SOLVD, it is important to appreciate that follow-up time in SOLVD was more than 3x longer. Limitations to external validity in this trial include the run-in period and stringent inclusion and exclusion criteria. Our enthusiasm is also tempered by early stopping, which has been found to be associated with false positive or exaggerated results but this concern is mitigated to some extent in this trial because the rules for early stopping were clearly defined in the protocol.Cardiology Trial's Substack is a reader-supported publication. To receive new posts and support our work, consider becoming a free or paid subscriber. Get full access to Cardiology Trial's Substack at cardiologytrials.substack.com/subscribe
Recorded- May 20, 2025 Uploaded- May 20, 2025 The final preview is here! The Pioneer Preview is ready in full for you now. Intro- 00;00-05;00 PBL Preview- 05;00-42;30 Baseline- 05;00-10;08 Billings- 10;08-13;55 Boise- 13;55-17;21 Glacier- 17;21-19;33 Grand Junction- 19;33-22;44 Great Falls- 22;44-25;28 Idaho Falls- 25;28-28;24 Missoula- 28;24-29;17 Northern Colorado- 29;17-30;17 Oakland- 30;17-34;40 Ogden- 34;40-36;06 Rocky Mountain- 36;06-38;00 Yuba- 38;00-40;33 Prediction- 40;33-42;30 Outro- 42;30-END
In this episode, we normalize the conversations around understanding your fertility baseline and taking control of your fertility story through myStoria with Carly Malo. About Carly: With over 15 years of nursing experience, including 6 years specializing in fertility, Carly has witnessed firsthand the misinformation and lack of knowledge surrounding women's reproductive health. A master of her craft, Carly is poised to lead the myStoria Concierge Team, ensuring our users receive the support and guidance they need. Her dedication and expertise make her an invaluable asset in promoting informed and compassionate care.
N Engl J Med 1999;341:709-717Background: The renin–angiotensin–aldosterone system (RAAS) is activated in patients with systolic heart failure. While this activation initially helps increase blood volume and maintains blood pressure, chronic activation promotes cardiac fibrosis and remodeling. In patients with systolic heart failure, inhibition of the RAAS with angiotensin-converting enzyme inhibitors (ACEi) significantly reduced mortality and morbidity, as seen in the CONSENSUS and SOLVD trials.Cardiology Trial's Substack is a reader-supported publication. To receive new posts and support our work, consider becoming a free or paid subscriber.Preliminary data suggested that adding the aldosterone-receptor blocker spironolactone to ACEi, reduced the levels of atrial natriuretic peptide and did not lead to serious hyperkalemia.The Randomized Aldactone Evaluation Study (RALES) sought to test the hypothesis that spironolactone would significantly reduce the risk of all-cause death in patients with severe systolic heart failure.Patients: Eligible patients had left ventricular ejection fraction of 35% or less, had NYHA class IV heart failure within the 6 months before enrollment and NYHA class III or IV at the time of enrollment, and were treated with ACEi (if tolerated) and a loop diuretic.Patients were excluded if they had primary operable valvular disease (other than mitral or tricuspid regurgitation), congenital heart disease, unstable angina, primary liver failure, active cancer or any life-threatening condition, other than heart failure, prior heart transplant or awaiting heart transplant, serum creatinine >2.5 mg/dL, or serum potassium > 5.0 mmol/L.Baseline characteristics: Patients were recruited from 195 centers in 15 countries. The trial randomized 1,663 patients – 822 randomized to receive spironolactone and 841 to receive placebo.The average age of patients was 65 years and 73% were men. The average left ventricular ejection fraction was 25%. Cardiomyopathy was ischemic in 55% of the patients and non-ischemic in the rest. The NYHA class was III in 71% of the patients and IV in 29%.Data on baseline comorbid conditions were not provided.At the time of enrollment, 100% were taking loop diuretics, 94% were taking ACEi, 73% were taking digitalis, and 10% were taking beta-blockers. The mean daily dose of ACEi were as following: 63mg for captopril, 15mg for enalapril, and 14mg for lisinopril.Note: Max daily dose is 450mg for captopril, 40mg for enalapril, and 40mg for lisinopril.Procedures: The trial was double-blinded. Patients were assigned in a 1:1 ratio to receive spironolactone 25mg PO daily or placebo.The dose could be increased to 50mg daily after 8 weeks of treatment, If the patient had worsening heart failure and had no evidence of hyperkalemia. In the event of hyperkalemia, the dose could be lowered to 25 mg every other day. Laboratory testing including potassium were performed every 4 weeks for the first 12 weeks, then every 3 months for up to 1 year and every 6 months thereafter until the end of the study.Endpoints: The primary outcome was all-cause death. Secondary end points included death from cardiac causes, hospitalization for cardiac causes and change in the NYHA class.Analysis was performed based on the intention-to-treat principle. The planned sample size was not mentioned in the methods. However, the results mention that recruitment was complete. The sample size calculation assumed 38% mortality rate in the placebo group and that spironolactone would reduce mortality by 17% (relative risk reduction). The power of the study was set at 90% with a two-sided alpha of 5%.Results: Recruitment was complete in Dec, 1996 with follow up planned through Dec, 1999. However, the study was stopped early on Aug, 1998 after interim analysis showed significant reduction in mortality with spironolactone. The mean follow up time was 24 months. After 24 months of follow up, the mean daily dose of spironolactone was 26 mg.Spironolactone reduced all-cause death (35% vs 46%, RR: 0.70, 95% CI: 0.60 - 0.82; p< 0.001). Death from cardiac causes was also reduced with spironolactone (27% vs 37%, RR: 0.69, 95% CI: 0.58 - 0.82; p
In this week's episode, Josh and I are discussing the downfall of the Cavs season and discuss what they need to do next in order to not waste the talent they have. The question is who is to blame? Management? Coaching? Star players?
Recorded- May 9/11, 2025 Uploaded- May 12, 2025 The largest of all the previews. The Frontier League preview for all 18 teams and more is available for your listening pleasure right now! Intro- 00;00-01;00 AAPB Preview- 01;00-01;49;45 Baseline- 01;00-8;50 Brockton- 08;50-13;24 Down East- 13;24-19;56 Evansville- 19;56-24;20 Florence- 24;20-28;28 Gateway- 28;28-30;38 Joliet- 30;38-34;24 Lake Erie- 34;24-37;45 Mississippi- 37;45-40;05 New Jersey- 40;05-43;40 New York- 43;40-46;38 Ottawa- 46;38-50;00 Quebec- 50;00-54;06 Schaumburg- 54;06-56;53 Sussex County- 56;53-01;03;07 Tri-City- 01;03;07-01;06;39 Trois-Rivieres- 01;06;39-01;15;40 Washington- 01;15;40-01;20;58 Windy City- 01;20;58-01;32;45 Prediction- 01;34;00-01;49;45 Outro- 01;49;45-END
In this episode of Grounded: The regenerative farming podcast, Kyle and Stuart talk to Gabe Brown. Gabe is one of the most famous names in regen ag and soil health, with his bestselling book Dirt to Soil inspiring hundreds of thousands around the world. He is also one of the founders of Regenerate Outcomes' mentoring partners Understanding Ag, alongside Dr Allen Williams. Listen now for a wide-ranging discussion about Gabe's story, his work with Regenified, the importance of failure and why he chose to work with life over death.This podcast is brought to you by Regenerate Outcomes.Regenerate Outcomes supports farmers to grow profits and improve crop and livestock performance by building functional soil.Receive one-on-one mentoring from experienced regenerative farmers to increase the productivity of your soil, cut costs and reduce external inputs.Baseline and measure changes in soil carbon to generate verified carbon credits which you can retain or sell for additional income. No cost to join. No cost to leave.For more information go to www.regenerateoutcomes.co.uk
Did you know you can support The Rumcast on Patreon now and get bonus episodes, happy hours, and more? You can! Head to patreon.com/therumcast to check it out.You can watch the video version of this episode on YouTube.In this episode, we sat down with the founder and distiller behind one of the most interesting rum projects in the U.S. right now, Robyn Smith of rum et al., a chemical engineering PhD turned rum distiller.The premise behind Rum Et Al is simple but fascinating. Robyn started with a foundational, always-available rum she named Baseline. She's since released batches in which she introduces a "variable" to the Baseline recipe, such as dunder. This allows you to taste the exact differences that the variable brings to the flavor profile when tasted side by side. If you're a rum geek, it's a really cool tasting experience.During the episode, we discussed:How she went from chemical engineering PhD to rum distillerHer experience in R&D for Lost Spirits DistilleryHow rum et al. came to beAll the nerdy rum production detailsThe joys and challenges of being a one-woman operationCongeners vs. estersHow ester measurements translate to flavor profileWhat we might see from her nextAnd much more!Be sure to check out her YouTube channel, This Blog's Neat! These videos about her rum et al. releases are a great place to start:How Baseline Was MadeHow Variable (Dunderclap) Was MadeHow Variable (Tailspin) Was MadeHave you had a chance to try Robyn's rum? What stood out to you in the conversation? Let us know via email (host@rumcast.com) or social!
“Am I going to be okay?” Getting a tarot reading is a personalized way to get to your baseline. Different divination modalities, like Oracle or Lenormand, can keep you baseline because you don't manifest or read the information. As a reader, you can do a lot of pre-reading. You can get a therapist to help you through the tough times. You can have Hilary do a tapping session to help you find baseline. Self-care is rule number one for getting back to baseline. Drink Water. Find community. Limit your exposure to news cycles. Go outside and get sun (if you can). Homework: Try creating something before consuming any content. Resources Mentioned Podcasts: World Gone Wrong Podcast Episode 103 - Why does your Dad know so much about body-snatchers. This is where Jaymi got her use of baseline versus being “just okay.” They discuss this around the 15:10 mark. However, Jaymi recommends the whole series because it's just fun. Jim Harold's Campfire Writing Excuses Almost Plausible Queen Herbie House Books: We Need Your Art by Amie McNee Decks and Modalities: Arcana Folia Oracle Kendra's Vintage Petit Lenormand (Hilary's first Lenormand deck) Theresa Reed's Patreon (for her astrological insights) Random: This is Fine dog cartoon 4thewords.com Melissa has changed her rates to help those who are not baseline. So, visit her website and sign up for a reading now. Catch Hilary and Melissa on Instagram for live readings (InstaReads). Follow them both and get a quick reading. Do you like what you hear? Send feedback to us at cardslingerscc@gmail.com. Follow us on Instagram at www.instagram.com/cardslingerscc. We also have a YouTube channel at youtube.com/@cardslingerscc. Eventually, we will back up the episodes and have more live content. Support our podcast with books or decks. We're adding all the books from each episode to our Cardslingers CC bookshop.org store. Each purchase from this store gives us a percentage to cover our costs! www.bookshop.org/shop/cardslingerscc. Reminder: We will NEVER DM you for a reading on any social media site. We schedule all readings and conversations through our personal websites.
N Engl J Med 1991;325:293-302N Engl J Med 1992;327:685-691Cardiology Trial's Substack is a reader-supported publication. To receive new posts and support our work, consider becoming a free or paid subscriber.Background: Systolic heart failure affects millions worldwide and is associated with high mortality and morbidity. If left untreated, the one-year mortality ranges from 15-50%, depending on the severity of the disease.The CONSENSUS trial found mortality benefit with the use of the angiotensin converting enzyme inhibitor (ACEi) enalapril in patients with New York Heart Association (NYHA) class IV heart failure. Data on less severe heart failure were lacking.The Studies of Left Ventricular Dysfunction (SOLVD) sought to assess whether an ACEi, enalapril, would reduce mortality in patients with low left ventricular ejection fractions defined as 35% of less.Patients: Eligible patients had left ventricular ejection fraction of 35% or less. The ejection fraction was measured using radionuclide techniques in 68% of the patients, contrast angiography in 11%, and two-dimensional echocardiography in 21%.Patients were excluded if they were over 80 years of age, or if they had significant valvular disease requiring surgery, unstable angina pectoris, angina requiring revascularization procedures, myocardial infarction during the previous month, severe pulmonary disease, serum creatinine >2 mg/ dl, or any other disease that might significantly impact survival.At the end of the run-in period for placebo, patients who had overt congestive heart failure were enrolled in the Treatment trial, and patients who were not having overt congestive heart failure were enrolled in the Prevention trial.Baseline characteristics: Patients were recruited from 83 hospitals linked to 23 centers in the United States, Canada, and Belgium.The Treatment trial randomized 2,569 patients – 1,285 patients randomized to receive enalapril and 1,284 randomized to receive placebo. The average age of patients was 61 years and 80% were men. The average left ventricular ejection fraction was 25%. Approximately 42% had hypertension, 26% had diabetes, 71% had ischemic heart disease and 22% were current smokers. The NYHA class was I in 11% of the patients, II in 57% of the patients, III in 30% and IV 2%. At the time of enrollment, 8% were taking beta-blockers, 67% were taking digitalis, 85% were taking diuretics, 9% were taking potassium-sparing diuretics and 51% were taking vasodilators (other than ACEi).The Prevention trial randomized 4,228 patients – 2,111 patients randomized to receive enalapril and 2,117 randomized to receive placebo. The average age of patients was 59 years and 89% were men. The average left ventricular ejection fraction was 28%. Approximately 37% had hypertension, 15% had diabetes, 83% had ischemic heart disease and 23% were current smokers. The NYHA class was I in 67% of the patients and II in 33%. At the time of enrollment, 24% were taking beta-blockers, 12% were taking digitalis, 17% were taking diuretics, 4% were taking potassium-sparing diuretics and 46% were taking vasodilators (other than ACEi).Procedures: A total of 7,402 patients were deemed eligible across both the Treatment and Prevention trials.Eligible patients for either trial entered a run-in and stabilization phase. Patients were given enalapril 2.5 mg twice daily in a single-blind fashion for 2 - 7 days to identify patients who could not tolerate even a small dose of the drug or those who were unable to comply with the regimen. A total of 310/7402 patients (4.2%) were excluded from the study during this phase. Following the active dosing phase, patients were placed on a regimen of matching placebo in a single-blind manner for 14 - 17 days. This allowed identification of individuals whose clinical condition deteriorated after drug withdrawal or who demonstrated poor compliance. During this phase, 295/ 7,092 patients (4.2%) were excluded from the study.At the end of the run-in period for placebo, patients who had overt congestive heart failure were enrolled in the Treatment trial, and patients who were not having overt congestive heart failure were enrolled in the Prevention trial.After that patients were randomized in a 1:1 ratio to receive enalapril or placebo.Treatment with enalapril or placebo was initiated at 2.5 mg or 5 mg twice daily, based on the patient's clinical status and physician judgment. The dose was titrated up to 10 mg twice daily if tolerated without symptomatic hypotension or worsening renal function. After randomization, follow-up visits occurred at two weeks, six weeks, four months, and every four months thereafter until study completion.Endpoints: The primary outcome for both trials was all-cause mortality. Heart failure hospitalization was assessed as a secondary outcome.The estimated sample size was 2,500 patients for the treatment trial and 4,600 for the prevention trial. These sample sizes would provide 90% power at 5% two-sided alpha to detect 25% relative risk reduction in mortality, with the use of enalapril. The estimated 3-year mortality in the control group was 32% in the Treatment trial and 17% in the Prevention trial.Authors reported risk reduction which was calculate as (1 – relative risk)*100.Results: A total of 39,924 patients with a left ventricular ejection fraction of 35% or less were identified. Of these, 6.4% were enrolled in the Treatment trial and 7.4% in the Prevention trial. Among the excluded patients, the main reasons were prior use of an ACEi (28%), cardiovascular problems (12%), contraindications to using ACEi (11%), lack of patient consent (11%), administrative reasons (21%), cancer or other life-threatening illnesses (12%), and other miscellaneous reasons (5%).The average follow up time was 41.4 months in the Treatment trial and 37.4 months in the Prevention trial.In the Treatment trial, enalapril reduced all-cause mortality (35.2% vs 39.7%, risk reduction: 16%, 95% CI: 5% – 26%; p< 0.0036). The majority of deaths (89%) were cardiovascular and the majority of these (79%) were heart failure or arrhythmia related. Enalapril also reduced all-cause hospitalization (69.5% vs 74.0%; p= 0.006). The total number of hospitalizations for heart failure was also reduced with enalapril – 683 vs 971. Subgroup analysis showed a numerical increase in death, with enalapril, in patients with an ejection fraction of 30-35% - this was not statistically significant.In the Prevention trial, enalapril did not have a significant effect on mortality (14.8% with enalapril vs 15.8% with placebo, risk reduction: 8%, 95% CI: -8% – 21%; p= 0.30). Enalapril significantly reduced the development of heart failure (20.7% vs 30.2%; p< 0.001). Total number of hospitalizations for heart failure was also significantly reduced with enalapril – 306 vs 454. The reduction in the development of heart failure was seen across all ejection fractions below 35%, although the benefit was larger with lower ejection fractions.In both trials, the benefit of enalapril was seen early after treatment initiation.Conclusion: In patients with left ventricular ejection fraction of 35% or less and overt congestive heart failure, enalapril reduced all-cause mortality with a number needed to treat of approximately 22 patients. In patients with a left ventricular ejection fraction of 35% or less and without overt congestive heart failure, enalapril had no significant effect on mortality but it reduced the development of heart failure with an number needed to treat of approximately 11 patients.The SOLVD trials provide strong evidence supporting the use of ACEi in patients with systolic heart failure. The role of ACEi in systolic heart failure has been examined across diverse patient groups, and the totality of evidence consistently supports their use. However, when examining the SOLVD trials in isolation, it is important to recognize the selective nature of enrollment, which limits the trials' external validity. Additionally, the use of a run-in period introduces bias in favor of enalapril, although this concern is less significant when the primary outcome is all-cause mortality.Cardiology Trial's Substack is a reader-supported publication. To receive new posts and support our work, consider becoming a free or paid subscriber. Get full access to Cardiology Trial's Substack at cardiologytrials.substack.com/subscribe
Introduction In this post, I present what I believe to be an important yet underexplored argument that fundamentally challenges the promise of cultivated meat. In essence, there are compelling reasons to conclude that cultivated meat will not replace conventional meat, but will instead primarily compete with other alternative proteins that offer superior environmental and ethical benefits. Moreover, research into and promotion of cultivated meat may potentially result in a net negative impact. Beyond critique, I try to offer constructive recommendations for the EA movement. While I've kept this post concise, I'm more than willing to elaborate on any specific point upon request.From industry to academia: my cultivated meat journey I'm currently in my fourth year (and hopefully final one!) of my PhD. My thesis examines the environmental and economic challenges associated with alternative proteins. I have three working papers on cultivated meat at various stages of development, though [...] ---Outline:(00:13) Introduction(00:55) From industry to academia: my cultivated meat journey(01:53) Motivations and epistemic status(03:39) Baseline assumptions for this discussion(03:44) Cultivated meat is environmentally better than conventional meat, but probably not as good as plant-based meat(06:29) Cultivated meat will remain quite expensive for several years, and hybrid plant-cell products will likely appear on the market first(08:58) Cultivated meat is ethically better than conventional meat(10:26) The main argument: cannibalization rather than conversion(16:46) Strategic drawbacks of the current focus(19:11) The evidence that would make me eat my words (and maybe cultivated meat)(20:37) What Id like to see change in the Effective Altruism approach to cultivated meat(22:14) Answer from GFI Europe--- First published: April 30th, 2025 Source: https://forum.effectivealtruism.org/posts/TYhs8zehyybvMt5E4/cultivating-doubt-why-i-no-longer-believe-cultivated-meat-is --- Narrated by TYPE III AUDIO. ---Images from the article:Apple Podcasts and Spotify do not show images in the episode description. Try Pocket Casts, or another podcast app.
N Engl J Med 1987; 314:1429-35Background Prior to the publication of this study, digoxin and diuretics were the mainstay of chronic heart failure management. No therapy had yet been shown to reduce mortality or improve heart failure outcomes in patients with severe disease. The results of the V-HEFT trial had been published in the prior year, which demonstrated that the vasodilator combination of hydralazine and isosorbide reduced death in patients with chronic, stable heart failure. CONSENSUS was the first study to test whether vasodilator therapy in general, and angiotensin converting enzyme inhibitors in particular could modify heart failure disease trajectory for those with severe disease when used as part of chronic disease management. The CONSENSUS trial was designed to test the hypothesis that Enalapril compared to placebo reduced mortality in patients with severe (NYHA IV) congestive heart failure.Patients Men and women with severe (NYHA IV) congestive heart failure and cardiomegaly based on heart size >600 ml/m2 in men or >550 ml/m2 in women were recruited from 35 centers in Finland, Norway and Sweden. Measurement of LV function was not required. Patients were excluded if they had 1) acute pulmonary edema, 2) hemodynamically important aortic or mitral valve stenosis, 3) MI within the previous 2 months, 4) unstable angina, 5) planned cardiac surgery, 6) right heart failure due to pulmonary disease, or 7) serum creatinine >3.4 mg/dL.It is not specified whether patients could be recruited from the inpatient or outpatient setting or both but prior to randomization, a 14-day period was allowed to stabilize patients on digoxin and diuretics. If during this period, their condition improved to NYHA class III or less they were not randomized.Baseline characteristics The majority of participants were male (70%) and their average age was 70. The average heart rate and blood pressure were 80 bpm and 120/75 mmHg and the average serum creatinine was about 1.5 mg/dL. Coronary artery disease was present in over 70% of participants and nearly 50% had suffered a previous heart attack. Hypertension and diabetes were present in over 20% and atrial fibrillation in 50%. The use of medications at baseline was evenly distributed between groups with nearly all patients being on digoxin and furosemide. About 50% of participants were also taking spironolactone as well as other vasodilator drugs. About 50% of patients had heart failure for more than 4 years.Procedures Treatment with enalapril or an identical placebo was initially started in the hospital with a dose of 5 mg twice a day. After 1 week it was increased to 10 mg twice a day if the patient did not have symptoms of hypotension or other side effects. According to the clinical response, a further increase in dosage could occur up to a maximum dose of 20 mg twice a day.Patients were evaluated after 1, 2, 3, 6, and 16 weeks, 6, 9, and 12 months and at the end of the study. In patients with worsening symptoms, additional vasodilator therapy with isosorbide dinitrate, hydralazine, or prazosin, in that sequence was recommended.Early in the trial the occurrence of symptomatic hypotension led to revision of the protocol after 67 patients had been randomized. No patient's treatment was unblinded but in patients with 1) serum sodium
Stuart Knight has written, produced and starred in shows that have been seen by over one million people, has written best selling books and is the founder of The Human Connection Group. Top 3 Value Bombs 1. The more that you experiment, the more successful you will become. Throw everything at the wall and see what sticks and if it falls off the wall, figure out a way to make it stick. 2. If it is a feeling , we connect but if it's a thinking, we did not connect. 3. Don't be afraid to ask the big question because those big questions will lead to big answers and big answers lead to big relationships. Deeper Connection. With Others. With Yourself. The world's biggest resource for people harnessing the power of human connection - The Human Connection Group Sponsors ThriveTime Show Become the next success story, schedule a free consultation and request tickets to join Football Star, Tim Tebow and President Trump's Son, Eric Trump at Clay Clark's next business conference today at: ThrivetimeShow.com/eofire ZipRecruiter Enjoy the benefits of speed hiring with new ZipIntro! Only from ZipRecruiter. Post jobs today, talk to qualified candidates tomorrow. Try ZipIntro for free at ZipRecruiter.com/fire
This 2-part podcast was inspired by a Solo Cleaning School Elite member, Dave Reeks. Dave started implementing the ISO Model in early 2022, operating The Finest Clean in South Wales, Australia. I am so proud of his diligence and commitment. Dave has grown from an Initializer to the Stabilizer phase of the ISO Model in 6 months. I recently did an Optimizer's Workshop with him to help him hit his next goal. He is a male solo cleaner like I was and growing quickly with almost 20 house cleaning customers in a short time. Dave recognized the need to keep his body operating at peak performance and wondered if I had any tips for other solo cleaners. Thank you Dave for this question! Yes! I do. I was a solo cleaner from age 28 to 44. There have been seasons of physical domination when I could stay up all night and clean and clean and clean. I have also struggled with fatigue, injury, and chronic disease. Regardless of the season, I had no choice but to keep going... and I did. In this initial episode, we will deconstruct the habits of multiple peak performers from professional sports to learn from them. Then in the second episode, I also will share several keys to solo longevity that I have learned along the way from my triumphs and struggles. I believe this will help all cleaning companies as we all have people cleaning, whether it is us or a team we've hired.Disclaimer: I am not a medical doctor. I am sharing what I've personally done for cleaning longevity. See your doctor before making any major changes to your routine. Baseline your level of health now and set goals on where you'd like to go. Use this podcast as a guide.Let's start with an analogy that takes me down vehicle memory lane. The joke in high school was that Ford stood for "fix or repair daily" and "fails on race day". My friends with Hondas boasted on their longevity and reliability. Hondas were the gold standard. My cars from age 16 to now have been in this order: Honda, Ford, Ford, Mitsubishi, Honda, Honda, Honda, Honda, Ford, Honda, Ford. Isn't that funny. I've owned 6 Hondas and 4 Fords. I won't go over every detail on our cars as that is probably boring. I will just say this. All of my cars have been great. I have so many memories from each. But I do generally agree after owning 4 Fords and 8 Hondas (my wife owned 2 Honda Odysseys) that the Hondas are way more reliable and spend less time in the shop. Sure there were some duds. We had an Odyssey that lasted 2 years and needed a new engine at 150,000 miles. We own a Ford Fiesta with 100,000 miles and a Honda Pilot with 140,000 miles and both are running great. But there is not doubt that our Hondas have been cheaper to operate and lasted a lot longer as 5 of the 8 were over 200,000 miles when we got rid of them.Read the rest of this article at the Smart Cleaning School website
his week on The Baseline NBA Podcast, we're joined by ESPN NBA reporter Kendra Andrews for a power-packed episode you don't want to miss. Right as the news broke that the Denver Nuggets fired head coach Michael Malone, Kendra jumped on with us to give her immediate reaction and expert insight into what this means for the reigning champs and their future.But we didn't stop there. Kendra also weighed in on the state of the WNBA, previewing top prospects ahead of the 2025 WNBA Draft, and dropped some serious knowledge on how the league is evolving. We also asked the burning question: Is Paige Bueckers ready for the WNBA Spotlight? Kendra keeps it real and delivers must-hear perspective. Whether you're a hardcore NBA junkie or hyped for the next era of the WNBA, this episode delivers exclusive analysis, next-level insight, and that signature Baseline breakdown you love. Subscribe, Rate & Review – and don't forget to follow us on all platforms @NBABaseline for more unfiltered hoops talk every week!Become a supporter of this podcast: https://www.spreaker.com/podcast/the-baseline-nba-podcast--3677698/support.
This week Kate, Gary, Mark and Henry discuss discontinuation of benzodiazepines and treatment of insomnia, the value of baseline cognitive testing of college athletes, vonoprazan vs PPI for preventing and treating ulcers, and whether herpes zoster vaccine reduces dementia risk.Show links:Essential Evidence Plus: www.essentialevidenceplus.comTapering benzos: https://pubmed.ncbi.nlm.nih.gov/39374004/ Baseline neuro eval for athletes: pubmed.ncbi.nlm.nih.gov/39741470/ David Kaufman, “We Need You in the Locker Room” https://thesagergroup.net/books/in-the-locker-room Vonoprazan vs PPIs for ulcers: https://pubmed.ncbi.nlm.nih.gov/39294424/ Zoster and dementia: https://pubmed.ncbi.nlm.nih.gov/40175543/
Jon Heyman: Baseline number to sign Kyle Tucker is at least $500 million full 1046 Mon, 07 Apr 2025 14:45:46 +0000 EVnzvMeKD0JfZNMS6RJeGiOEJ6vqrumQ mlb,chicago cubs,sports Mully & Haugh Show mlb,chicago cubs,sports Jon Heyman: Baseline number to sign Kyle Tucker is at least $500 million Mike Mulligan and David Haugh lead you into your work day by discussing the biggest sports storylines in Chicago and beyond. Along with breaking down the latest on the Bears, Blackhawks, Bulls, Cubs and White Sox, Mully & Haugh routinely interview the top beat writers in the city as well as team executives, coaches and players. Recurring guests include Bears receiver DJ Moore, Tribune reporter Brad Biggs, former Bears coach Dave Wannstedt, Pro Football Talk founder Mike Florio, Cubs president of baseball operations Jed Hoyer and Cubs pitching coach Tommy Hottovy.Catch the Mully & Haugh Show live Monday through Friday (5 a.m.- 10 a.m. CT) on 670 The Score, the exclusive audio home of the Cubs and the Bulls, or on the Audacy app. For more, follow the show on X @mullyhaugh. 2024 © 2021 Audacy, Inc. Sports False https://player.amper
TGIF, with the NFL Draft being less than three weeks away, we start to filter, decipher and assess the state of the division as it pertains to the 2025 draft. We'll use the latest 1st rd mock from NFL Analyst Lane Zierline and discuss the picks he's projected to the AFC North teams. Then, of course we'll throw our hands up at those projections and tell you how it's really going down. Tap-in with the “Homies” Tate, Big-G, Pay & B-Dirt on YouTube or wherever you listen to your audio podcasts. Learn more about your ad choices. Visit megaphone.fm/adchoices
The Rich Zeoli Show- Hour 3: 5:05pm- In response to President Donald Trump's tariff announcement, futures on the S&P 500 are initially down just over 1%. Notably, Canada and Mexico—two of the United States' top trading partners—were not explicitly mentioned for new tariffs. 5:15pm- Will the Trump Administration remove tariffs on countries that remove tariffs on American-made goods? Trump stated: “To all foreign presidents, prime ministers, kings, queens, ambassadors, and everyone else who will soon be calling to ask for exemptions to these tariffs, I say—terminate your own tariffs, drop your barriers, don't manipulate your currencies…and start buying tens of billions of dollars of American goods.” 5:20pm- Listeners call into the show and react to President Donald Trump's executive order establishing new tariffs on foreign nations. Will this move negatively impact the U.S. economy? Or will it result in other countries removing their tariffs on American-made goods—resulting in truly free trade. 5:30pm- Israel currently places a 33% tariff on imported American products. However, in anticipation of President Donald Trump's “Liberation Day” announcement, Israeli Finance Minister Bezalel Smotrich signed a plan to eliminate tariffs on all American imports. Trump's tariff on Israeli products would be 17%. Weekday afternoons on Talk Radio 1210 WPHT, Rich Zeoli gives the expert analysis and humorous take that we need in this crazy political climate. Along with Executive Producer Matt DeSantis and Justin Otero, the Zeoli show is the next generation of talk radio and you can be a part of it weekday afternoons 3-7pm.
Keywords: Jeep Talk Show, Round Table, Hot or Not Jeep mods, beadlocks vs all-terrains, lift vs lockers, soft top vs hard top, manual vs automatic, rock lights debate, Easter Jeep Safari 2025, Tyree Lights, YJL at EJS, Hot Springs Jeep event, Jeep community podcast Description: Join Tony and the Jeep Talk Show crew for a lively Round Table episode as we dive into a “Hot or Not” debate inspired by Chick Chat's Natalie and Janet!