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We hit the ground running and don't stop until lunch (if even then) so frequently that being dehydrated is almost a way of life. Learn more about how important hydration is to a full, productive life. Katrina Klein, RDH, CEAS, CPT Read by Jackie Sanders https://www.dentistryiq.com/dentistry/article/55277117/wellness-corner-we-are-not-part-camel-the-real-cost-of-working-dehydrated
When it comes to polishing, one size does not fit all. Katrina Klein has recommendations to improve the experience for pros and patients. Katrina Klein, RDH, CEAS, CPT Read by Jackie Sanders https://www.rdhmag.com/patient-care/article/55265000/selective-polishing-a-new-era-in-dental-hygiene
Sustentabilidade e mudanças climáticas foram pautas do encontro que impulsionará novas parcerias de pesquisa
Pilar Amor hace referencia esta semana a diferentes iniciativas que ayudan a los mayores a sobrellevar la soledad no deseada como los menús que se ofrecen en los CEAS de la capital y que ayudan a hacer amistades
If you've ever felt boxed in by dental office culture, this article explores how dental hygienists can reclaim their role, elevate patient care, and find the right practice fit to thrive. Katrina Klein, RDH, CEAS, CPT Read by Jackie Sanders https://www.rdhmag.com/patient-care/article/55249026/dont-box-me-in-five-ways-to-push-for-comprehensive-dental-hygiene
Dr. Amanda A. Carpenter, PT, CProT, CEAS, is transformational life and leadership coach. __________________________ Amanda is a transformational coach, author, speaker, and the CEO of IAH.fit, a platform dedicated to helping individuals achieve holistic wellness through innovative fitness solutions. With a compelling personal story and a dynamic approach to personal growth, Amanda's work resonates deeply with entrepreneurs, leaders, and anyone seeking to navigate life's challenges with grace and resilience. You can learn more about Amanda through her LinkedIn profile. Amanda's message is clear: resilience is not about avoiding challenges but about using them as a platform for growth. She recounts moments of profound struggle that shaped her perspective and taught her the value of self-awareness. Her coaching philosophy centers on the idea that transformation begins with embracing vulnerability and committing to personal growth. “When you lean into discomfort, you discover your true strength,” Amanda shares. This principle is not only central to her coaching but also a guiding light for her clients who seek to lead with authenticity and courage. One of Amanda's key insights in this episode is the distinction between reacting and responding to life's challenges. She encourages leaders to cultivate mindfulness and intentionality, enabling them to respond thoughtfully rather than react impulsively. Amanda also highlights the significance of aligning actions with core values. By staying true to one's principles, she believes leaders can inspire trust and foster meaningful connections. This authenticity, she asserts, is a cornerstone of effective leadership. Through her engaging storytelling and actionable advice, Amanda invites listeners to reframe their challenges as opportunities for growth. Her practical strategies and relatable anecdotes provide a roadmap for navigating adversity while staying grounded in one's values. Resilience is not innate; it's a skill that can be developed through intentional practices like mindfulness and self-reflection. Take Action: Identify one recent challenge and reflect on how it has helped you grow. Journal your insights. The Power of Vulnerability Vulnerability is a strength, not a weakness. Embracing it fosters genuine connections and personal growth. Take Action: Share a personal story of growth with your team or community to inspire authenticity. Respond vs. React Thoughtful responses, grounded in mindfulness, are more effective than impulsive reactions. Take Action: Practice pausing before reacting in a challenging situation this week. Reflect on the difference it makes. Aligning Actions with Values Staying true to your values builds trust and strengthens leadership. Take Action: List your top three core values and assess how your recent decisions align with them. Turning Setbacks into Setups Every setback holds the potential for a comeback. Reframing challenges as opportunities fuels resilience. Take Action: Reframe a current obstacle as an opportunity and outline steps to leverage it for growth. Connect with Amanda A. Carpenter IAH.fit Website https://iah.fit/ LinkedIn Profile https://www.linkedin.com/in/amanda-a-carpenter Amanda's insights challenge us to embrace discomfort, lead with authenticity, and turn challenges into opportunities for growth. What's your biggest takeaway from this episode? Write it on a paper napkin and share it on social media with the hashtag #PaperNapkinWisdom. Let's continue the conversation about resilience, authenticity, and leadership!
Your weekly dose of information that keeps you up to date on the latest developments in the field of technology designed to assist people with disabilities and special needs. Special Guest: Brian Norton ATP, CEAS – Director of AT – Easterseals Crossroads Things discussed in our show today: Microsoft Adaptive Controller: https://bit.ly/3u8qUh3 Sony PlayStation Access […]
End-of-Year Episode! Matt catches up with ADHA officers on crucial dental hygiene issues, recent concerning proposals that impact the profession, patient care and scope of practice, and how the organization is opposing and addressing these. They look back at 2024 successes and look forward at the work ahead in 2025 work on professional autonomy, recruitment, education, policy, leadership development and more. The key is involvement through membership, upcoming leadership opportunities, advocacy, events and ADHA25 in Long Beach, CA. Guests: ADHA President Erin Haley-Hitz, RDH, BSDH, MS, FADHA, MAADH; President-Elect Lancette VanGuilder, BS, RDH, PHEDH, CEAS, FADHA; Vice President Jessica August, MSDH, CDA, RDH, FADHA Host: Matt Crespin, MPH, RDH, FADHA Important Links: www.adha.org/news www.adha2025.org https://alec.org/model-policy/dental-access-model-act/
Send us a textVic leads the show with his thoughts on the Zach Bryan situation We learned Bakersfield has a "poop patrol" and its exactly what it sounds likeJim Halpert aka John Krasinski is the sexiest man alive. Vic gives his personal top 7How do you tell a server you were not done eating your food after she pulls the plate away prematurely without looking like a total hogSTFU of the week! - Older people telling you the secret to longevity is Dr. Pepper and cigarettes!!!!Nintendo 64 is set to release their console in 4k next year. HUGE news for Ceas and VicCouples are now turning to "kinky sex" to save their relationshipThursday night football picks and Tyson vs Paul predictionsHAPPY BIRTHDAY Ceas & MORE!!!Find Vic: @vicdradioFind the pod:@ilysayitbackpod
Send us a textVic gives a recap of the magical evening with Colbie Caillat. It lived up to every expectationHalloween parties are in full effect, Vic and Ceas give their top 5 slutties Halloween costumes Vic has a theory on why women are obsessed with HalloweenBlind water test to prove Arrowhead water is actually not absolutely disgusting anymore. SHOCKING STUFFSTFU of the week - Baby Boomers who talk crap about other generationsDodgers vs Yankees is the World Series we deserve! Vic makes his bold predictionVic had his first mini viral videobonus STFU of the week - poor sad fan who really didn't do anything wrongFind Vic: @vicdradioFind the pod:@ilysayitbackpod
En la recta final de su gestión, Armando Padilla, habla de la complicada relación que ha tenido con CFE. Las redes de distribución requieren cambios, es la principal debilidad de la institución, explica. ¿Requiere la CEAS una reingeniería? ¿Qué pendientes heredará? Previo señalamiento de que la infraestructura creció en este sexenio, reporta que la entrega-recepción avanza sin contratiempo. ¿Qué viene para él, llegó el tiempo de jubilarse? Conoce aquí toda la información
Dr. Bethany Valachi, PT, DPT, MS, CEAS is author of the book, “Practice Dentistry Pain-Free: Evidence-based Strategies to Prevent Pain & Extend Your Career,” clinical instructor of ergonomics at OHSU School of Dentistry in Portland, Oregon and Ergonomics Editor for DPR magazine. Bethany is a doctor of physical therapy who has worked exclusively with dental professionals for over 20 years. She is recognized internationally as an expert in dental ergonomics and has provided over 700 dental lectures worldwide, which have provided pain relief to thousands of dental professionals. Bethany is also a prolific author who has published more than 70 articles in peer-reviewed dental journals, and produced a series of dental ergonomic & exercise Online CE Video Courses. Bethany Valachi is a Certified Ergonomic Assessment Specialist and consults with universities and practicing dental professionals to improve ergonomics. She is also member of the National Speaker's Association and is an AGD PACE approved CE provider. Prior to physical therapy, Bethany was a classical piano performance major. She is now exploring blues piano, enjoys riding her horse in dressage competition and on the trails, downhill skiing, mountain biking, scuba diving and exploring nature with her husband, Dr. Keith Valachi, DDS.
Join the Sanders sisters and immunization expert Lancette VanGuilder, BS, RDH, PHEDH, CEAS, as they discuss immunizations in dental practices and how to navigate potentially tricky conversations. About Lancette Lancette VanGuilder, BS, RDH, PHEDH, CEAS, graduated from the University of South Dakota in 1995 and has spent the last two decades actively involved in the dental industry as a leader, speaker, clinician, and public health advocate. Lancette is the current Vice-President of the American Dental Hygienists Association. She is a past president of the Nevada Dental Hygienists Association, is a past recipient of the Nevada Dental Hygienist of the Year and received the Innovative Career Vision Award for her work in all 7 professional roles of the dental hygienist. In 2018 she received the ADHA Irene Newman Professional Achievement award, recognizing her for her contributions to advancing the art and science of the dental hygiene profession over the last 15 years. She was selected as one to the Top 6 Dental Hygienists to know in 2021, by the national publication Dimensions in Dental Hygiene for being a mover and shaker in dentistry. In 2022, she received global recognition, receiving the Denobi “All-Star” award for her public health, mobile dentistry, advocacy, speaking and vaccine accomplishments. Most recently, she received one of the highest honors given by the American Dental Hygienists Association by being recognized with the 2022 ADHA Award of Excellence. This award has only been given to a small number of select individuals over the last 100 years. Lancette has received advanced education for complete health dentistry, including sleep related disordered breathing disorders and brain health. She received her Certificate in Alzheimer's Prevention and Reversal, ReCODE, from Apollo Health and her training in airway health from Institute for Craniofacial Sleep Medicine. Lancette is an internationally recognized continuing education speaker and is recognized as a key leader and mentor in the dental industry. She serves as the clinical director for Sierra Sleep, Airway and Wellness Center in Reno, Nevada. In addition, she works as a clinician in private practice, owns a mobile dentistry business, a national AGD PACE continuing education company and provides ergonomic coaching. Amidst the pandemic, she became a proud COVID vaccinator with Battle Born Medical Corp and has traveled across the globe advocating for vaccine administration by dental hygienists. She co-founded The RISE Experience and Abundant life. RISE retreats provide education and support for women in healthcare who want to make an impact in the world and pursue entrepreneurship in dentistry. Abundant life is a wellness hub for dental professionals to have access to resources to support the 8 pillars of health. Lancette is most proud of her work transforming healthcare, increasing access to care and bridging the medical-dental divide. Find Lancette Here: Facebook LinkedIn Lancette's Podcast The ADHA's Website
”Al 12-lea ceas”, așa se numește o campanie lansată de organizația Viitor Plus, care-și propune să atragă atenția asupra încălcării legislației în domeniul deșeurilor și asupra riscurilor pentru mediu și sănătate care decurg de aici. Președinta asociației Viitor Plus, Teia Ciulacu, a fost invitată la emisiunea Planeta Verde.Este gestionarea deșeurilor în România un eșec? Cine e de vină? Cât se implică cetățenii și care sunt obligațiile instituțiilor statului?Viitor Plus și-a propus să prezinte cazuri concrete de încălcări ale legislației de mediu privind gestionarea deșeurilor. Ce anume va face și cum va încuraja oamenii să se implice și să sesizeze autoritățile atunci când observă încălcarea legislației?Detalii despre campanie, aici.
Welcome to The Nonlinear Library, where we use Text-to-Speech software to convert the best writing from the Rationalist and EA communities into audio. This is: Extraordinary cost-effectiveness analyses call for theoretical buttressing, published by Seth Ariel Green on June 25, 2024 on The Effective Altruism Forum. What needs to be true for an estimate to be reasonable? Pure Earth is a GiveWell grantee that works to reduce lead and mercury exposure. In an August 2023 post, they provided a "preliminary analysis" suggesting that their lead reduction program in Bangladesh "can avert an equivalent DALY for just under $1." By contrast, they estimate that GiveDirectly "has a cost-effectiveness of approximately $836 per DALY-equivalent averted." About 86% of the money GiveDirectly spends goes directly to recipients, so an $836 donation to GiveDirectly results in about~$719 going directly to a very poor person. In effect, Pure Earth is claiming that either GiveDirectly can give a person in poverty $719, or Pure Earth can spend $1 helping people in Bangladesh, and these would be about equally good for human welfare. Pure Earth calls this an "extraordinary result" and forthrightly identifies places where their analysis might go wrong. But what I'm missing is a sense of why their analysis might be right -- a story about why this extraordinary opportunity exists. In other words, theory. I find this to be a pretty common lacuna in effective altruist CEAs.[1] Our explanations tend to be technical but not contextual. They tend to focus on our assumptions about the world at large but lack granularity about social and political conditions. But for my tastes, any claim that that boils down to 'we can help poor people more effectively than they can help themselves' requires theoretical buttressing in the form of a plausible story. What kinds of theories might suffice? In the case of lead reduction in spices, six come to mind. 1. Poor people are generally bad at managing their own affairs and need external guidance. (I do not find this very plausible.) 2. There is extraordinary political gridlock that an external organization is especially well-suited to solving. (Pure Earth says that the "project's impact lies not in identifying and enforcing food safety regulations, but rather in expediting its implementation by several years.") 3. There is a narrow opportunity for positive impact stemming from deep insight about a particular context. 4. There is a market failure, e.g. a collective action problem, where a push from an NGO can create a self-sustaining equilibrium. 5. There is a cognitive bias and/or cultural failure that leads people to undervalue something that is good, or overvalue something that is bad, and they need a push in the right direction. 6. Unconditional cash transfers engender negative spillovers, whereas public health interventions typically have positive spillovers. The story will vary from case to case. For New Incentives, I assume it's some version of theories 4, 5, and 6. For anti-malarial interventions, I am not sure (and am generally a skeptic). For Pure Earth, I am also not sure, because I am not an expert. As a potential donor, I am looking for explanation about aspects of the world that I don't understand. I can potentially back that story out of a spreadsheet. But I'd prefer to hear it directly. 1. ^ I use Pure Earth to illustrate because their CEA was on the far tail of the distribution, so it stuck in my memory, but this point could be made about many cost-effective analyses posted the forum. As far as I can tell, Pure Earth is doing great work on an important, neglected, and tractable issue. Thanks for listening. To help us out with The Nonlinear Library or to learn more, please visit nonlinear.org
Welcome to The Nonlinear Library, where we use Text-to-Speech software to convert the best writing from the Rationalist and EA communities into audio. This is: We should value income doublings equally across time and place (Founders Pledge), published by NicoT on June 23, 2024 on The Effective Altruism Forum. Hi! I'm Nico and I'm on the research team at Founders Pledge. We noticed that the way we compare current to future income benefits is in tension with how we compare income benefits across interventions. However, aligning these two comparisons - choosing the same function for utility from consumption for both - might lead to large changes in our CEAs. So, we are now thinking about how to choose the right approach. Since our framework is based on GiveWell's, which is used by other organisations, too, I expect that we're facing the same issues. I'm posting here as a way of thinking out loud and with the hope of getting input from others. Summary Founders Pledge and GiveWell both use different values of η (elasticity of marginal utility from consumption) when modelling isoelastic utility from consumption depending on the context. Across interventions, we assume η=1. Over time within an intervention, we assume η1.59. We should choose the same η for both models as having different η values leads us to prefer doubling the incomes of richer people relative to poorer people. Practically, this inconsistency leads to strange conclusions in existing CEAs. Taking GiveWell's Unlimit Health (deworming) CEA as a stylised example: For two people in Madagascar, we value doubling the income of someone who makes $2,500 30% as much as for someone who makes $500. When the person making $2,500 lives in Côte d'Ivoire, however, we value doubling their income the same (100% as much) as for the person in Madagascar who makes $500. Resolving this isn't straightforward and has large implications for our prioritisation. For example: Using η=1 everywhere - which implies that income doublings have the same value regardless of absolute income levels - doubles the cost-effectiveness of education and deworming programs and makes economic growth and poverty graduation interventions look substantially better. Using η=1.87, which is implied by our discount rate, everywhere requires our evaluations to take into account the income levels of recipients and prioritise lower-income regions more. An income doubling in Malawi would be worth roughly 1.9x as much as in Ethiopia, 3.4x as much as in Kenya, 6.4x as much as in Egypt, and 75x as much as in the US. The same is true within countries: in India, an income doubling in Bihar would be worth 3.4x as much as an income doubling in Andhra Pradesh. I'm hoping this post will start a conversation around what the right value of η is. Our inconsistent η values Summary: GiveWell's framework, which we use, explicitly uses log-utility from consumption, which implies isoelastic utility with η=1. However, our (and GiveWell's) discount rate uses η1.59. We use η=1 when comparing between interventions/places. But we use η1.59 for comparisons across time, where income doublings are worth 2.6% less in a year from now solely because incomes will be higher then. We should use the same η for comparisons across time and place. Not doing so leads us to prefer doubling the incomes of richer vs poorer people (see next section). We use η=1 (log-utility) to compare the value of income benefits across people or interventions[1]. That assumption is convenient because it allows us to disregard absolute income levels: an income doubling is as valuable from $250 to $500 as it is from $2.5k to $5k. Because of that, we can make statements like "the value of a 10% income increase from a deworming program in India equals the value of a 10% income increase from a cash transfer program in Kenya" without knowing the incomes of the recipients. At the same time, we use η1.59 when comparing the value of income benefits in different years within an inte...
This week, Yotto plays new music from AME, Tinlicker, Gorgon City, GENESI, Max Styler, Trance Wax, Adriatique and many more. ODD ONE OUT INTRO 00:00:001. TIAEM & CEAS & Astral Field - Calling 00:00:532. Gorgon City ft. NORTH - Breathe You In 00:04:303. Disfreq & Notre Dame ft. Kim Wilde - The Bridge 00:07:224. Einmusik, Pretty Pink - Ayana 00:10:245. Tinlicker - Blowfish 00:13:426. Jamek Ortega - Voices 00:18:327. GENESI - Slow Down 00:23:528. Tim Engelhardt - Falling 00:29:129. Adriatique, Solique, Also Astir - Changing Colors 00:33:5010. Max Styler - Follow Me 00:38:3611. ATRIP - Ginger (Feel Good) 00:41:0812. AME - Asa 00:43:2513. The Pressure x Trance Wax - Nothings Gonna Hurt You 00:50:0214. Degrees Of Motion - Do You Want It Right Now 2007 (Haji & Emanuel Remix) 00:54:23
Abastecer de agua, de energía y atender los problemas de drenaje serán las prioridades del próximo gobierno de Nacajuca asegura el edil electo Roberto Ocaña. ¿Pedirá administrar el servicio de agua potable, hoy en manos de CEAS? Adelanta que habrá auditorias al gobierno saliente por obras mal hechas que le han denunciado. ¿Ya habló con la presidente saliente? ¿Tiene definido al equipo que “le acompañará? ¿Qué posición tiene sobre la delimitación de Tierra Amarilla? Escucha aquí la conversación.
Welcome to The Nonlinear Library, where we use Text-to-Speech software to convert the best writing from the Rationalist and EA communities into audio. This is: Charity Entrepreneurship Is Overestimating the Value of Saving Lives by 10%, published by Mikolaj Kniejski on June 12, 2024 on The Effective Altruism Forum. I got this idea after I read a few of CE (Charity Entrepreneurship) cost-effectiveness estimates when I was preparing my application for the CE research training program. Although this is not a major pressing improvement, this definitely is an iterative improvement over the current methodology and I haven't seen anyone else raising this point yet. CE uses DALYs averted as a measure of impact: DALYs (Disability-Adjusted Life Years): A measure of disease burden, expressed in years lost to disability or early death. Dying one year before your expected life span causes 1 DALY. DALYs are averted when we save someone from dying early, or when we reduce the number of sick people or the duration of their sickness. DALYs for a disease are the sum of YLLs and YLDs: . Years of Life Lost (YLLs): Calculated as the difference between the age at death and the life expectancy. Death is the worst possible outcome, and it gets one DALY per person per year. Years Lived with Disability (YLDs): Calculated by multiplying the severity of an illness or disability by its duration. DALYs averted: I like to think of DALYs averted as the difference between DALYs without intervention and DALYs with intervention. This captures the notion of counterfactuality, meaning our estimate should reflect the difference between a world where the intervention happened and one where it didn't. For example, if an intervention saves a person who would have otherwise died at 30 and the life expectancy is 70, 40 YLLs are averted (without considering temporal discounting and age-weighing). If the intervention reduces a year of severe disability (with a disability weight of 0.5), 0.5 YLDs are averted. When Charity Entrepreneurship estimates the number of DALYs that an intervention would avert, it uses a pre-made table by GiveWell. This table includes age weighting (which gives years in around 20-30 more value) and applies temporal discounting at 4% per year. CE uses the average values (last column). Table 1: GiveWell estimates of value of life saved at various ages of death. The table is available here and made using a formula that you can find here. Age of death Life expectancy (years) YLL incorporating discount and age-weighting Females Males Females Males Average 0 82.5 80 33.13 33.01 33.07 5 77.95 75.38 36.59 36.46 36.53 15 68.02 65.41 36.99 36.80 36.90 30 53.27 50.51 29.92 29.62 29.77 45 38.72 35.77 20.66 20.17 20.41 60 24.83 21.81 12.22 11.48 11.85 70 16.2 13.58 7.48 6.69 7.09 80 8.9 7.45 3.76 3.27 3.52 90 4.25 3.54 1.53 1.30 1.42 100 2 1.46 0.57 0.42 0.50 CE takes the exact values from the table. When an intervention saves someone who is 30 years old they literally take the value 29.77 DALYs which only includes temporal discounting and age-weighing. This implicitly assumes that the subject would live a perfectly healthy life to the life expectancy used in the estimation. The full value of e.g. 29.77 DALYs averted was calculated assuming the subject lives healthy to the life expectancy. He is not going to - The subject is almost definitely going to get sick and will fail to realize the full value. Why This Matters We want our cost-effectiveness analyses (CEAs) to measure counterfactual impact. The difference between the world where the intervention happened and the one where it didn't should be the key result. If we take the full value of the life saved, we will overestimate the value by the DALYs the subject will incur while being sick. This is crucial when choosing between interventions that improve lives compared to interventions that save lives. Is CE really making this mistake? I'm pretty sure they do. Here, I try to show the exact place where it hap...
Welcome to The Nonlinear Library, where we use Text-to-Speech software to convert the best writing from the Rationalist and EA communities into audio. This is: The Centre for Effective Altruism is spinning out of the Centre for Effective Altruism, published by OllieBase on April 1, 2024 on The Effective Altruism Forum. The Centre for Effective Altruism (CEA), an effective altruism (EA) project which recently spun out of Effective Ventures (EV) is spinning out of the newly established Centre for Effective Altruism (CEA). The current CEO of CEA (the Centre for Effective Altruism), Zach Robinson, CEO of CEA and Effective Ventures (CEOCEV), will be taking the position of Chief Executive Administrator (CEA) for CEA (CEA), as the venture spins out of CEA (CEA). The cost-effectiveness analysis (CEA) for this new effective venture suggested that this venture will be high-EV (see: EA). CEA's CEA's CEA ventures that the new spun-out CEA venture's effectiveness is cost-effective in every available scenario (CEAS). CEA's new strategy, See EA will take effect: See: Gain a better understanding of where the community is, who is part of it and where it could go EA: Effective altruism. No need to complicate things. To provide some clarity on this rather confusing scenario, here is a diagram: Thanks for listening. To help us out with The Nonlinear Library or to learn more, please visit nonlinear.org
The Centre for Effective Altruism (CEA), an effective altruism (EA) project which recently spun out of Effective Ventures (EV) is spinning out of the newly established Centre for Effective Altruism (CEA). The current CEO of CEA (the Centre for Effective Altruism), Zach Robinson, CEO of CEA and Effective Ventures (CEOCEV), will be taking the position of Chief Executive Administrator (CEA) for CEA (CEA), as the venture spins out of CEA (CEA). The cost-effectiveness analysis (CEA) for this new effective venture suggested that this venture will be high-EV (see: EA). CEA's CEA's CEA ventures that the new spun-out CEA venture's effectiveness is cost-effective in every available scenario (CEAS). CEA's new strategy, See EA will take effect: See: Gain a better understanding of where the community is, who is part of it and where it could go EA: Effective altruism. No need to complicate things. To provide some clarity on [...] --- First published: April 1st, 2024 Source: https://forum.effectivealtruism.org/posts/WgneAKfjRJkYsTs3p/the-centre-for-effective-altruism-is-spinning-out-of-the --- Narrated by TYPE III AUDIO.
Obese patients present ergonomic challenges for dental hygienists. To avoid injury, gently guide patients about how they can help during their appointment. Katrina Klein, RDH, CEAS, CPT Read by: Jackie Sanders
World News in 7 minutes. Tuesday 12th March 2024. Today: Spain bombing anniversary. Switzerland missing skier. Sweden environmental activists. Sudan ceasefire. Libya unified government. India Citizenship Amendment Act. Indonesia flooding. Pakistan finance minister. N Korea Mongolia talks. US Blinken Jamaica. Bolivia state of emergency. 96th Oscars awards.With Juliet MartinIf you enjoy the podcast please help to support us at send7.org/supportSupporters can read the transcripts at send7.org/transcriptsSupporters can try our weekly news quiz at send7.org/quizContact us at podcast@send7.org or send an audio message at speakpipe.com/send7Please leave a rating on Apple podcasts or Spotify.SEND7 (Simple English News Daily in 7 minutes) tells the most important world news stories in intermediate English. Every day, listen to the most important stories from every part of the world in slow, clear English. Whether you are an intermediate learner trying to improve your advanced, technical and business English, or if you are a native speaker who just wants to hear a summary of world news as fast as possible, join Stephen Devincenzi, Ben Mallett and Juliet Martin every morning. Transcripts can be found at send7.org/transcripts. Simple English News Daily is the perfect way to start your day, by practising your listening skills and understanding complicated stories in a simple way. It is also highly valuable for IELTS and TOEFL students. Students, teachers, and people with English as a second language, tell us that they listen to SEND7 because they can learn English through hard topics, but simple grammar. We believe that the best way to improve your spoken English is to immerse yourself in real-life content, such as what our podcast provides. SEND7 covers all news including politics, business, natural events and human rights. Whether it is happening in Europe, Africa, Asia, the Americas or Oceania, you will hear it on SEND7, and you will understand it.For more information visit send7.org/contact
Welcome to The Nonlinear Library, where we use Text-to-Speech software to convert the best writing from the Rationalist and EA communities into audio. This is: How We Plan to Approach Uncertainty in Our Cost-Effectiveness Models, published by GiveWell on January 3, 2024 on The Effective Altruism Forum. Author: Adam Salisbury, Senior Research Associate Summary In a nutshell We've received criticism from multiple sources that we should model uncertainty more explicitly in our cost-effectiveness analyses. These critics argue that modeling uncertainty, via Monte Carlos or other approaches, would keep us from being fooled by the optimizer's curse[1] and have other benefits. Our takeaways: We think we're mostly addressing the optimizer's curse already by skeptically adjusting key model inputs, rather than taking data at face value. However, that's not always true, and we plan to take steps to ensure we're doing this more consistently. We also plan to make sensitivity checks on our parameters and on bottom-line cost-effectiveness a more routine part of our research. We think this will help surface potential errors in our models and have other transparency and diagnostics benefits. Stepping back, we think taking uncertainty more seriously in our work means considering perspectives beyond our model, rather than investing more in modeling. This includes factoring in external sources of evidence and sense checks, expert opinion, historical track records, and qualitative features of organizations. Ways we could be wrong: We don't know if our parameter adjustments and approach to addressing the optimizer's curse are correct. Answering this question would require comparing our best guesses to "true" values for parameters, which we typically don't observe. Though we think there are good reasons to consider outside-the-model perspectives, we don't have a fully formed view of how to bring qualitative arguments to bear across programs in a consistent way. We expect to consider this further as a team. What is the criticism we've received? In our cost-effectiveness analyses, we typically do not publish uncertainty analyses that show how sensitive our models are to specific parameters or uncertainty ranges on our bottom line cost-effectiveness estimates. We've received multiple critiques of this approach: Noah Haber argues that, by not modeling uncertainty explicitly, we are subject to the optimizer's curse. If we take noisy effect sizes, burden, or cost estimates at face value, then the programs that make it over our cost-effectiveness threshold will be those that got lucky draws. In aggregate, this would make us biased toward more uncertain programs. To remedy this, he recommends that (i) we quantify uncertainty in our models by specifying distributions on key parameters and then running Monte Carlo simulations and (ii) we base decisions on a lower bound of the distribution (e.g., the 20th percentile). Others[2] have argued we're missing out on other benefits that come from specifying uncertainty. By not specifying uncertainty on key parameters or bottom line cost-effectiveness, we may be missing opportunities to prioritize research on the parameters to which our model is most sensitive and to be fully transparent about how uncertain our estimates are. (more) What do we think about this criticism? We think we're mostly guarding against the optimizer's curse by skeptically adjusting key inputs in our models, but we have some room for improvement. The optimizer's curse would be a big problem if we, e.g., took effect sizes from study abstracts or charity costs at face value, plugged them into our models, and then just funded programs that penciled above our cost-effectiveness bar. We don't think we're doing this. For example, in our vitamin A supplementation cost-effectiveness analysis (CEA), we apply skeptical adjustments to treatment effects to bring them closer to what we consider plausible. In our CEAs more broadly, we triangulate our cost e...
Your weekly dose of information that keeps you up to date on the latest developments in the field of technology designed to assist people with disabilities and special needs. Special Guest: Brian Norton ATP, CEAS – Director of AT – Easterseals Crossroads Things discussed in our show today: Microsoft Adaptive Controller: https://bit.ly/3u8qUh3 Sony PlayStation Access […] The post ATU652 – Black Friday Holiday Special with Brian Norton first appeared on Assistive Technology at Easter Seals Crossroads.
WOW!! Today I achieved exactly 80% of our project goal. Very Happy!! Thanks for your all kind supports.. : ) #3632 (904 left): Nov. 24, 2023: From ancient melody have ceased (Japanese version)" from Aug. 24, 2023) Today's pure primal piano music here. Happy if this music makes you feel peaceful.. : ) Looking for absolute natural beauty every day for Piano Ten Thousand Leaves. Target number is 4536 and 3632(80.0%) (Only 904 pieces remain) achieved today. Find my project.. : ) This piece may might have good 1/f fluctuation characteristic although I stopped investigating it each piece. My new message: "Does it make sense to preserve it for 1000 years?" Today's cover ART is created by #Midjourney (Art Generating #AI), according to my wish. Happy if you like it. Today's chairhouse's daily video magazine of piano ten thousand leaves music & music sheet and piano-roll display https://youtu.be/BME5QeZAuzk I'm now making Archive site of Piano Ten Thousand Leaves project by utilizing #wordpress. Basically nice direction I've already gotten.. : ) Currently 1100 pieces already achieved. But this week I need to do something else, so I'm going to stop this task for a bit. ######## NEW 24th SELECTION ALBUM JUST RELEASED ######## "Deep Forest Girl" - the 24th selection album of piano ten thousand leaves Youtube: Full(20 songs, 50 minutes) and HD video by Midjourney - AI https://youtu.be/-pvjcnFysTk spotify https://open.spotify.com/intl-ja/album/6zftjWuL7JMF0vNYgLTSaQ apple music https://music.apple.com/jp/album/deep-forest-girl-piano-ten-thousand-leaves-volume-24/1692518303 amazon music https://www.amazon.co.jp/s?k=chair+house+%E6%B7%B1%E3%81%84%E6%A3%AE%E3%81%AE%E5%B0%91%E5%A5%B3+-+%E3%83%94%E3%82%A2%E3%83%8E%E4%B8%87%E8%91%89%E9%9B%86+-+%E7%AC%AC24%E5%B7%BB&i=digital-music&ref=nb_sb_noss_2 line music https://music.line.me/webapp/album/mb0000000002e6f6be AWA: https://s.awa.fm/album/bd73bf6d8ea694823e31 Other Every music streaming services in the world https://linkco.re/yDNpmUYN?lang=en
Your weekly dose of information that keeps you up to date on the latest developments in the field of technology designed to assist people with disabilities and special needs. Special Guest: Brian Norton ATP, CEAS – Director of AT – Easterseals Crossroads More about this project and other great services: Web: www.eastersealstech.com Phone: 888-466-1314 Bridging […] The post ATU651 – Public Library Accessible Workstations with Brian Norton first appeared on Assistive Technology at Easter Seals Crossroads.
Occupational Therapy's Role in Work Rehab
Kaiser Kuo, the host of the Sinica Podcast, sat down with CEAS's David Fields during his visit to the UW campus. He discussed how he became interested in the political climate surrounding US & China relations, what drew him away from graduate school, and how his personal history influenced his desire to shed a light on information coming out of China. He asks that the listeners be cautious of anyone who calls themselves and "China expert" and that rather than the highly polarized viewpoints, consider things from multiple angles. Kaiser also recommends the best episodes from the Sinica backlog to get an newly interested party started.
Welcome to another episode of The Action and Ambition Podcast! Joining us today is Mike Pace, the Senior Channel Sales & Marketing Manager at Contour Design, a market leader in the research, development, and design of ergonomic computer hardware. Mike has helped successfully launch over 30 ergonomic products into the corporate B2B space and strives to make a positive impact on office workers' health and well-being, daily. He currently holds a CEAS ergonomic certification and is always looking for new ways to spread the gospel of ergonomics to business and industry leaders alike. Tune in to learn more about this!
On March 11, 2011, a 9.1 magnitude earthquake struck off the coast of northeastern Japan triggering a massive tsunami and shifting the earth on its axis. Nearly 20,000 residents in the Tōhoku region lost their lives, with many hundreds of thousands more injured, displaced, and left with horrific loss. Dr. Pilvi Posio shares her PhD research based on eight months of fieldwork in the town of Yamamoto in Miyagi prefecture, where 635 residents lost their lives. She began her research on long-term community recovery four years after the disaster, when national focus was shifting from recovery and restoration (fukkyū 復旧) to reconstruction (fukkō 復興 ). Learn how large-scale, government-funded initiatives, including the construction of three new compact cities away from the immediate coastal area, had the unintended effect of causing "reconstruction disaster” by aggravating resident anxieties and accelerating depopulation. In presenting her concept of Aspired Communities, Dr. Posio argues that community is best viewed not as a static, territorially-bound identity, but as a dynamic process, one which is continually constituted from a future-oriented outlook of collective aspiration. Pilvi Posio is a senior researcher at the Centre for East Asian Studies at the University of Turku, Finland, and is currently working on sustainability issues in Asia. Her dissertation can be found here. Satoko Naito received her PhD in Japanese literature from Columbia University and teaches as a docent at CEAS. The Nordic Asia Podcast is a collaboration sharing expertise on Asia across the Nordic region, brought to you by the Nordic Institute of Asian Studies (NIAS) based at the University of Copenhagen, along with our academic partners: the Centre for East Asian Studies at the University of Turku, and Asianettverket at the University of Oslo. We aim to produce timely, topical and well-edited discussions of new research and developments about Asia. About NIAS: www.nias.ku.dk Transcripts of the Nordic Asia Podcasts: http://www.nias.ku.dk/nordic-a... Learn more about your ad choices. Visit megaphone.fm/adchoices Support our show by becoming a premium member! https://newbooksnetwork.supportingcast.fm/new-books-network
On March 11, 2011, a 9.1 magnitude earthquake struck off the coast of northeastern Japan triggering a massive tsunami and shifting the earth on its axis. Nearly 20,000 residents in the Tōhoku region lost their lives, with many hundreds of thousands more injured, displaced, and left with horrific loss. Dr. Pilvi Posio shares her PhD research based on eight months of fieldwork in the town of Yamamoto in Miyagi prefecture, where 635 residents lost their lives. She began her research on long-term community recovery four years after the disaster, when national focus was shifting from recovery and restoration (fukkyū 復旧) to reconstruction (fukkō 復興 ). Learn how large-scale, government-funded initiatives, including the construction of three new compact cities away from the immediate coastal area, had the unintended effect of causing "reconstruction disaster” by aggravating resident anxieties and accelerating depopulation. In presenting her concept of Aspired Communities, Dr. Posio argues that community is best viewed not as a static, territorially-bound identity, but as a dynamic process, one which is continually constituted from a future-oriented outlook of collective aspiration. Pilvi Posio is a senior researcher at the Centre for East Asian Studies at the University of Turku, Finland, and is currently working on sustainability issues in Asia. Her dissertation can be found here. Satoko Naito received her PhD in Japanese literature from Columbia University and teaches as a docent at CEAS. The Nordic Asia Podcast is a collaboration sharing expertise on Asia across the Nordic region, brought to you by the Nordic Institute of Asian Studies (NIAS) based at the University of Copenhagen, along with our academic partners: the Centre for East Asian Studies at the University of Turku, and Asianettverket at the University of Oslo. We aim to produce timely, topical and well-edited discussions of new research and developments about Asia. About NIAS: www.nias.ku.dk Transcripts of the Nordic Asia Podcasts: http://www.nias.ku.dk/nordic-a... Learn more about your ad choices. Visit megaphone.fm/adchoices Support our show by becoming a premium member! https://newbooksnetwork.supportingcast.fm/east-asian-studies
On March 11, 2011, a 9.1 magnitude earthquake struck off the coast of northeastern Japan triggering a massive tsunami and shifting the earth on its axis. Nearly 20,000 residents in the Tōhoku region lost their lives, with many hundreds of thousands more injured, displaced, and left with horrific loss. Dr. Pilvi Posio shares her PhD research based on eight months of fieldwork in the town of Yamamoto in Miyagi prefecture, where 635 residents lost their lives. She began her research on long-term community recovery four years after the disaster, when national focus was shifting from recovery and restoration (fukkyū 復旧) to reconstruction (fukkō 復興 ). Learn how large-scale, government-funded initiatives, including the construction of three new compact cities away from the immediate coastal area, had the unintended effect of causing "reconstruction disaster” by aggravating resident anxieties and accelerating depopulation. In presenting her concept of Aspired Communities, Dr. Posio argues that community is best viewed not as a static, territorially-bound identity, but as a dynamic process, one which is continually constituted from a future-oriented outlook of collective aspiration. Pilvi Posio is a senior researcher at the Centre for East Asian Studies at the University of Turku, Finland, and is currently working on sustainability issues in Asia. Her dissertation can be found here. Satoko Naito received her PhD in Japanese literature from Columbia University and teaches as a docent at CEAS. The Nordic Asia Podcast is a collaboration sharing expertise on Asia across the Nordic region, brought to you by the Nordic Institute of Asian Studies (NIAS) based at the University of Copenhagen, along with our academic partners: the Centre for East Asian Studies at the University of Turku, and Asianettverket at the University of Oslo. We aim to produce timely, topical and well-edited discussions of new research and developments about Asia. About NIAS: www.nias.ku.dk Transcripts of the Nordic Asia Podcasts: http://www.nias.ku.dk/nordic-a... Learn more about your ad choices. Visit megaphone.fm/adchoices Support our show by becoming a premium member! https://newbooksnetwork.supportingcast.fm/anthropology
On March 11, 2011, a 9.1 magnitude earthquake struck off the coast of northeastern Japan triggering a massive tsunami and shifting the earth on its axis. Nearly 20,000 residents in the Tōhoku region lost their lives, with many hundreds of thousands more injured, displaced, and left with horrific loss. Dr. Pilvi Posio shares her PhD research based on eight months of fieldwork in the town of Yamamoto in Miyagi prefecture, where 635 residents lost their lives. She began her research on long-term community recovery four years after the disaster, when national focus was shifting from recovery and restoration (fukkyū 復旧) to reconstruction (fukkō 復興 ). Learn how large-scale, government-funded initiatives, including the construction of three new compact cities away from the immediate coastal area, had the unintended effect of causing "reconstruction disaster” by aggravating resident anxieties and accelerating depopulation. In presenting her concept of Aspired Communities, Dr. Posio argues that community is best viewed not as a static, territorially-bound identity, but as a dynamic process, one which is continually constituted from a future-oriented outlook of collective aspiration. Pilvi Posio is a senior researcher at the Centre for East Asian Studies at the University of Turku, Finland, and is currently working on sustainability issues in Asia. Her dissertation can be found here. Satoko Naito received her PhD in Japanese literature from Columbia University and teaches as a docent at CEAS. The Nordic Asia Podcast is a collaboration sharing expertise on Asia across the Nordic region, brought to you by the Nordic Institute of Asian Studies (NIAS) based at the University of Copenhagen, along with our academic partners: the Centre for East Asian Studies at the University of Turku, and Asianettverket at the University of Oslo. We aim to produce timely, topical and well-edited discussions of new research and developments about Asia. About NIAS: www.nias.ku.dk Transcripts of the Nordic Asia Podcasts: http://www.nias.ku.dk/nordic-a... Learn more about your ad choices. Visit megaphone.fm/adchoices Support our show by becoming a premium member! https://newbooksnetwork.supportingcast.fm/sociology
On March 11, 2011, a 9.1 magnitude earthquake struck off the coast of northeastern Japan triggering a massive tsunami and shifting the earth on its axis. Nearly 20,000 residents in the Tōhoku region lost their lives, with many hundreds of thousands more injured, displaced, and left with horrific loss. Dr. Pilvi Posio shares her PhD research based on eight months of fieldwork in the town of Yamamoto in Miyagi prefecture, where 635 residents lost their lives. She began her research on long-term community recovery four years after the disaster, when national focus was shifting from recovery and restoration (fukkyū 復旧) to reconstruction (fukkō 復興 ). Learn how large-scale, government-funded initiatives, including the construction of three new compact cities away from the immediate coastal area, had the unintended effect of causing "reconstruction disaster” by aggravating resident anxieties and accelerating depopulation. In presenting her concept of Aspired Communities, Dr. Posio argues that community is best viewed not as a static, territorially-bound identity, but as a dynamic process, one which is continually constituted from a future-oriented outlook of collective aspiration. Pilvi Posio is a senior researcher at the Centre for East Asian Studies at the University of Turku, Finland, and is currently working on sustainability issues in Asia. Her dissertation can be found here. Satoko Naito received her PhD in Japanese literature from Columbia University and teaches as a docent at CEAS. The Nordic Asia Podcast is a collaboration sharing expertise on Asia across the Nordic region, brought to you by the Nordic Institute of Asian Studies (NIAS) based at the University of Copenhagen, along with our academic partners: the Centre for East Asian Studies at the University of Turku, and Asianettverket at the University of Oslo. We aim to produce timely, topical and well-edited discussions of new research and developments about Asia. About NIAS: www.nias.ku.dk Transcripts of the Nordic Asia Podcasts: http://www.nias.ku.dk/nordic-a...
On this episode Jackie is joined by Katrina Klein, RDH, CEAS, CPT, founder of ErgoFitLife. As a certified body builder, speaker, author and ergonomic assessment specialist, Katrina shares how important exercise and equipment can be.
An open discussion with Stephanie Botts, BSDH, RDH, CEAS owner of Polished Posture. Stephanie and Jackie talk everything ergonomic, from in office coaching to podium presence and maintaining the busy life balance.
If you sat on and didn't like a saddle stool, it might be time to try again. Take it from Katrina Klein. At first, she didn't like it, and now she can't practice without it. by Katrina Klein, RDH, CEAS, CPT Read article here: https://www.rdhmag.com/ergonomics/seating/article/14280848/saddle-stools-dont-buy-until-you-try
Realitatea de la Chișinău pare o sursă inepuizabilă de idei cinematografice. Din întâmplări cu politicieni și gangsteri, Republica Moldova a alunecat, după un scurt respiro, direct în filmul războiului lui Putin. Salvată anul trecut de armata ucraineană, care a oprit avansul Rusiei spre Transnistria, Moldova se vede acum în fața altui înspăimântător scenariu – unul cu spioni și luări de ostatici, cu proteste și final necunoscut. Opozanții președintelui Maia Sandu au cerut dovezi imposibil de oferit. Susținătorii i-au luat în serios avertismentul, iar jurnaliștii au căutat să-l înțeleagă, mai ales în perspectiva unor noi proteste organizate de pro-ruși. Vitalie Cojocari e jurnalist Euronews România. A intrat, însă, în presă în Republica Moldova. Acolo s-a născut, când țara era încă parte din URSS, și tot acolo a căutat, în aceste zile, răspunsuri la câteva întrebări esențiale: De ce ar avea nevoie Vladimir Putin de un „cap de pod” la Chișinău, ca strategie în războiul din Ucraina? Se poate întoarce Republica Moldova la mâna oligarhilor pro-ruși? Are România încă o bombă cu ceas la graniță? Explicațiile – în acest episod On the Record. On the Record este un podcast săptămânal produs de Recorder. Partener: Aqua Carpatica.
On this episode Jackie has an open discussion with Cindy Purdy, BSDH, RDH, CEAS on the necessity of ergonomic health and the Thrive ergonomic program to assist the RDH with answers to their pain.
Welcome to The Nonlinear Library, where we use Text-to-Speech software to convert the best writing from the Rationalist and EA communities into audio. This is: Shallow Report on Hypertension, published by Joel Tan (CEARCH) on November 21, 2022 on The Effective Altruism Forum. Summary Taking into account the expected benefits of eliminating hypertension (i.e. improved health and greater economic output), as well as the tractability of sodium taxation policy advocacy, I find that the marginal expected value of sodium taxation policy advocacy to control hypertension to be 190,927 DALYs per USD 100,000, which is around 300x as cost-effective as giving to a GiveWell top charity. Key Points Importance: This is a strongly important cause, with 1.28 1010 DALYs at stake from now to the indefinite future. Around 84% of the burden is health related, while 16% is economic in nature. Neglectedness: Whatever governments/charities/businesses are doing to solve this problem (e.g. labelling laws/providing low sodium food in food banks/developing new hypertension drugs) may be making a difference, since age-standardized DALYs lost are falling, but (a) attribution is hard, and structural factors (e.g. more educated populations eating and exercising better, or economic development expanding access to healthcare) will also be behind the decline; and (b) all this is insufficient all the same, with population growth and ageing driving an increase in DALYs lost over time for the coming decades. Tractability: A moderately tractable solution in the form of sodium taxes is available. This is highly effective if and when implemented, but there is of course considerably uncertainty as to whether advocacy for taxes on food – which are highly unpopular – can succeed. Further Discussion This is a highly promising cause area that CEARCH will be conducting deeper research into, but it is important to note that early stage CEAs tend to be overoptimistic, and it is likely that this initial x300 GiveWell estimate will be revised downwards after more research and greater scrutiny, possibly extremely substantially (e.g. a one or two magnitude downgrade in cost-effectiveness). DALYs lost to hypertension have grown tremendously (43.5%) from 1990 to 2015, and it is certainly not just a rich world problem – over that same period, DALYs lost to hypertension in LMICs exploded (45% increase in high-middle income countries, 72% increase in middle income countries, 94% in low-middle income countries, and 86% in low income countries); and of the large countries, Bangladesh notably saw a fairly staggering near-tripling of DALYs lost. Growth in DALYs lost is driven not just by population growth and ageing, but also by urbanization and corresponding lifestyle changes (e.g. excessive dietary sodium, stress, sedentary lifestyle etc). Note that the analysis here does not model income effects from the tax (i.e. reduced purchasing power causing less consumption of healthy food) or substitution effects, whether positive (e.g. reducing sugar and fat consumption from food – such as junk food – that is high in not just salt but also sugar and fat) or negative (i.e. causing people to switch to low-salt high-sugar food or drinks); the analysis here also does not model the impact of industry reformulating food products in response to a sodium tax. My sense is that these balance out to some extent, but it is very hard to say. There is extremely high uncertainty over the calculations over how the problem will grow or shrink in the coming decades. This is certainly an area where expert advice and expert epidemiological modelling would be extremely valuable, and is something that CEARCH will pursue at deeper research stages. We underestimate the economic burden insofar as it focuses on the burden from hypertension (i.e. SBP of > 140 mm Hg) even though high systolic blood pressure (i.e. SBP of > 110-115 mm Hg) has adverse health consequences and presumably negative economic effects as well....
Welcome to The Nonlinear Library, where we use Text-to-Speech software to convert the best writing from the Rationalist and EA communities into audio. This is: GiveWell Misuses Discount Rates, published by Oscar Delaney on October 27, 2022 on The Effective Altruism Forum. Summary GiveWell currently uses a time discount rate of 4% for all their cost-effectiveness analyses (CEAs). I argue that it is a mathematical mistake to pick any single best guess value to use for the CEAs. Instead, GiveWell should use a probability distribution over possible discount rates. This is not just an aesthetic judgement for mathematical puritans; it materially changes the CEAs, notably by making all the deworming interventions more attractive relative to other interventions. This is because deworming interventions rely on multi-decadal effects, and so a lower discount rate would make them much more valuable. Epistemic Status On the object level, I cannot think of any reasons to justify GiveWell's current modelling choice over my proposal. However, I still doubt my conclusion because on the meta level it seems like an obvious thing that would be surprising if no one at GiveWell had ever thought of doing, which is evidence I am missing something important. Main GiveWell's CEAs are an impressive attempt to model many different factors in assessing the near-term impacts of various interventions.[1] I will ignore all of this complexity. For my purposes, it is sufficient to note that the CEA for most interventions is well characterised by decomposing impact into several constituents, and multiplying these numbers together. Consider Helen Keller International's Vitamin A Supplementation program: V=M×R×1C [2] where: V is cost-effectiveness [deaths/dollar], M is baseline mortality [deaths/year/child], R is mortality reduction [%], and C is treatment cost [dollars/child/year] Obviously, all of these terms are uncertain. Treatment costs we can estimate quite accurately, but there may be fluctuations in the price of labour or materials needed in the distribution. Mortality data is generally good, but some deaths may not be reported, and mortality rates will change over time. The mortality reduction is based on a solid-seeming meta-analysis of RCTs, but things change over time, and circumstances differ between the trial and intervention locations. GiveWell's model makes a subtle mathematical assumption, namely that the expectation of the product of these three random variables is equal to the product of their expectations: E[V]=E[M×R×1C]=E[M]×E[R]×E[1C] This is not, in general, true.[3] However, if the three random variables are independent, it is true. I cannot think of any plausible ways in which these three random variables correlate. Surely learning that the price of vitamin A tablets just doubled (C) does not affect how effective they are (R) or change the baseline of how many kids die (M). Thus, while GiveWell's method is mathematically unsound, it gives the correct answer in this case. It could well be that GiveWell has considered this, and decided not to explain this in their CEAs because it doesn't change the answer. I think this would be a mistake in communication, but otherwise benign. The one place where I believe this mathematical mistake translates into an incorrect answer is in the use of discount rates. From GiveWell's explanatory document: “The discount rate's primary effect in the cost-effectiveness analyses of our top charities is to represent how much we discount increases in consumption resulting from the long run effects of improved child health for our malaria, deworming and vitamin A charities (which we call "developmental effects"). It also affects the longer-run benefits from cash transfers. We don't discount mortality benefits in our cost-effectiveness analyses.” This figure shows the cost-effectiveness of all the charities in the CEA spreadsheet, when varying the discount rate.[4] Deworming interventions, shown in dashed lines, v...
Helping people change their habits to change their health is one of the main mechanisms that makes OT effective. But, I don't think we spend enough time thinking about how HARD it is to change our habits. The article we are looking at today focuses on changing lifestyle habits for adults at high risk of a cardiovascular incident, like a stroke. The author's aim is to conceptualize how engaging occupations can be used to facilitate health promoting habits.We'll use this article as a jumping off point to discuss both habit formation and Lifestyle Medicine with Ryan Balats Osal OTD, MS, OTR/L, NZROT, CEAS, CHC.In order to earn credit for this course, you must take the test within the OT Potential Club.You can find more details on this course here:https://otpotential.com/ceu-podcast-courses/lifestyle-medicine-otHere's the primary research we are discussing:Mälstam, E., Asaba, E., Åkesson, E., Guidetti, S., &; Patomella, A.-H. (2021). ‘Weaving lifestyle habits': Complex pathways to health for persons at risk for stroke. Scandinavian Journal of Occupational Therapy, 29(2), 152–164. Support the show
Many of us know the feeling of the tight shoulders, sore back, and tense jaw that come from long hours working at a computer. In the age of virtual work, it's all too common. What can we do to keep our body healthy while working? Today's guest, Emile Clarke, is here to tell us his best secrets for working and moving to reduce discomfort and pain. Emile Clarke is a Certified Ergonomic Specialist with an extensive background in outpatient Physical Therapy and Corrective Exercise. He has helped more than 6000 clients reduce their risk of injury and improve their overall functional fitness. His specialty is in office, vehicle, healthcare, and Industrial Ergonomics/ Injury prevention. Don't miss this conversation that will help you better understand how to optimize your ergonomics while working and how to live and move to reduce pain. Timestamps: 0:00 - Introduction 2:00 - What motivated Emile to become a physical therapy assistant? 6:03 - Can everyone optimize their bone and muscle health? 8:33 - Which conditions Emile specializes in 12:33 - Typical pain that shows up 17:30 - Are we sitting too much? 20:17 - Power of moving together 23:38 - Ergonomic recommendations 25:23 - What can we do to move our bodies optimally 28:24 - How to move with chronic pain? 35:22 - Breathwork 41:31 - Nutrition and hydration 44:55 - Morning routine 48:33 - How to work with Emile
Having correct ergonomics is vital to having a successful healthy career as a dental hygienist. We may think practicing as a hygienist is easy on the body but it's actually the complete opposite. This is why on this week's episode, ergonomic expert herself, Stephanie Botts, BSDH, RDH, CEAS takes us through her journey and how injuries affected her career. Stephanie is a dental hygienist with 14 years of experience, the founder of Posture Pros, a national public speaker, author, and a content creator. I promise you, you won't forget her name because when you're in the op reminding yourself to sit up straight and to have the patient turn instead of you it's because Stephanie taught you the importance of ergonomics. Tune it to increase the longevity of your career through better ergonomics! Instagram: @steph.posturepros https://www.rdhmag.com/resources/contact/14209264/stephanie-botts-bsdh-rdh-ceas https://www.posturepros.net/
On Episode 18 of the Stroke Alert Podcast, host Dr. Negar Asdaghi highlights two articles from the July 2022 issue of Stroke: “Impact of Shunting Practice Patterns During Carotid Endarterectomy for Symptomatic Carotid Stenosis” and “Socioeconomic Inequalities in Reperfusion Therapy for Acute Ischemic Stroke.” She also interviews Dr. Magdy Selim about his article “Effect of Deferoxamine on Trajectory of Recovery After Intracerebral Hemorrhage: A Post Hoc Analysis of the i-DEF Trial.” Dr. Negar Asdaghi: Let's start with some questions. 1) Is deferoxamine mesylate yet another failed agent for treatment of patients with intracerebral hemorrhage, or is deferoxamine getting us closer than ever to an approved therapy for this deadly form of stroke? 2) Are different strokes happening to different folks due to their disadvantaged socioeconomic status? 3) And finally, how does a surgeon's personal practice preference to either routinely or selectively use carotid shunting during carotid endarterectomy impact the recurrent risk of stroke or death in patients with symptomatic carotid disease? We'll tackle these questions and a lot more in today's podcast as we continue to cover the cerebrovascular world's latest and greatest because, without a doubt, this is the best in Stroke. Dr. Negar Asdaghi: Welcome back to the July issue of the Stroke Alert Podcast. My name is Negar Asdaghi. I'm an Associate Professor of Neurology at the University of Miami Miller School of Medicine and your host for the monthly Stroke Alert Podcast. The July 2022 issue of Stroke contains a range of really interesting papers that I'd like to highlight here. As part of our Cochrane Corner articles, giving us short summaries of the long systematic review of a given topic, we have two short articles, one on the issue of local versus general anesthesia for carotid endarterectomy, where we learn that based on the current evidence, there's no convincing difference between local versus general anesthesia in the risk of stroke and death within 30 days after the procedure. In the second Cochrane Corner article, titled "Information Provision for Stroke Survivors and Their Carers," we learn that stroke survivors and their caregivers routinely report dissatisfaction with information provided to them by their clinicians about their condition and how active approaches to information provision is superior to its passive forms in improving patients' involvement in their care, their satisfaction, and, ultimately and not surprisingly, their stroke outcome. Dr. Negar Asdaghi: As part of our original contributions in this issue of the journal, we have an important paper titled "The Risk of Early Versus Later Rebleeding From Dural AV Fistulas With Cortical Venous Drainage." We are reminded in this paper that cranial dural arteriovenous fistulas are classified based on their venous drainage into those with or those without cortical venous drainage, or CVD. Dural AV fistulas without CVD rarely cause intracranial bleeding, while those with CVD may cause hemorrhage. In this study, the authors show that the risk of rebleeding of dural AV fistulas with CVD presenting with hemorrhage is increased in the first two weeks after ICH, emphasizing the importance of early detection of these malformations by vascular imaging and early treatment of AV fistulas with cortical drainage. This paper is another analysis from the CONDOR registry. Our devoted Stroke Alert listeners recall that we covered this registry in more detail when we interviewed Dr. Amin-Hanjani last October on the outcomes of intracerebral hemorrhage patients found to have dural AV fistulas. I encourage you to review these articles in addition to listening to our podcast today. Dr. Negar Asdaghi: Later in the podcast, I have the distinct honor of interviewing Dr. Magdy Selim from Harvard Medical School on a critical analysis from i-DEF trial to examine the long-term outcome of patients with ICH who were randomized to receive deferoxamine versus placebo. As an expert in the field of intracerebral hemorrhage and a member of the recently published American Heart Association Guidelines Committee, Dr. Selim was not fazed at all about the neutral results of the trial. "The future of ICH is bright," he says, and in the interview, he tells us why. But first, with these two articles. Dr. Negar Asdaghi: Since its first reported successful surgery in 1953, carotid endarterectomy, or CEA, has become a common surgical procedure to prevent ischemic stroke in patients with carotid disease. CEA requires a temporary clamping of the carotid artery that is being worked on. During this time, the ipsilateral hemisphere is, of course, dependent on collateral flow from the posterior circulation or from the contralateral anterior circulation to maintain its perfusion pressure. Intraoperatively, various methods are used to monitor cerebral perfusion, and the risk of clamping-induced hypoperfusion is obviously variable for each patient depending on the patient's specific anatomy, their collateral status, and other risk factors. One way to protect the brain against possible clamp-induced ischemia is to do carotid shunting. The problem is that carotid shunting also comes with its own set of risks and problems. There's the risk of causing carotid dissection, embolization of pieces of the plaque during shunt insertion, or the risk of causing air embolism. Dr. Negar Asdaghi: There are also other shunt-related local complications that should be noted, such as possibility of causing injuries to the cranial nerves or development of neck hematoma related to the more extensive surgical exposure required for shunting. So, it's not surprising that the practice patterns with regards to shunting is quite variable amongst different surgeons. There are surgeons that are considered routine shunters, and those who are considered selective shunters, meaning that the shunt is inserted only in cases with a particular indication. The question is whether the surgeon's preference for shunting can impact the CEA outcomes. In the current issue of the journal, we have an interesting study led by Dr. Randall DeMartino from the Division of Vascular and Endovascular Surgery at Mayo Clinic, Rochester, where the authors look at the impact of shunting practice patterns during carotid endarterectomy on the following post-CEA outcomes: number one, in-hospital stroke and in-hospital death rates, and number two, combined stroke and death in patients with a recent symptomatic carotid disease, that is, carotid stenosis associated with a history of either ipsilateral stroke or TIA within the past 14 days of endarterectomy. Dr. Negar Asdaghi: So, the data for the study came from the ongoing Vascular Quality Initiative database, which comprises a network of more than 600 North American academic and community hospitals, and collects data on 12 different vascular procedures, one of which is CEA. The study included over 13,000 carotid endarterectomies performed from 2010 to 2019 for symptomatic carotid patients. This number came after they applied their exclusion criteria to all CEAs performed in the database during this timeframe, importantly excluding any asymptomatic carotid surgeries or those in whom surgery was performed after the two-week mark post qualifying TIA or stroke. Now, before we go over the results, let's go over some definitions used in the study. They had to classify surgeons to be able to do the study into two categories of routine versus selective shunters. So, what they did was to analyze all consecutive CEAs, whether they were done on symptomatic or asymptomatic carotids, in this database, aggregated at the surgeon level. Surgeons routinely shunting in over 95% of their procedures were gauged as routine shunters. Otherwise, they were classified as selective shunters. Dr. Negar Asdaghi: Now, coming to each case included in this study, each surgical case was, in turn, classified into four categories based on whether or not a shunt was actually used for that particular case: category one, no shunt used; category two, shunt used as a routine procedure; number three, shunt used for a preoperative, mostly anatomical indication; number four, shunt was used for an intraoperative indication, which, as we mentioned before, these are mostly intraoperative hemodynamic compromised situations. And here are the results: In total, 3,186 of surgeries, that is 24% of surgeries, were performed by routine shunters versus 76% by selective shunters. So, most surgeons were selective shunters in this study. The demographic of patients operated by the routine versus selective shunters were more or less similar with regards to the age of the patients, most of their vascular risk factors, and the degree of ipsilateral or contralateral carotid stenosis or occlusion, with a few notable exceptions, in that patients undergoing surgery by routine shunters were more likely White, more likely to have had a prior CABG, more likely to undergo the operation while taking a P2Y12 inhibitor antiplatelet agent, and these patients were more likely to have had a TIA rather than a stroke as their qualifying event, which probably explains why they were more likely to be operated on within 48 hours of symptom onset as well. So, the authors accounted for these differences when they did their multivariate analysis. Dr. Negar Asdaghi: The other thing to note was that overall, routine shunters used a shunt in 98.1% of their cases, whereas selective shunters used them in 46% of their cases. Now, in terms of their study outcomes, the shunting practice pattern did not impact the primary outcomes of in-hospital stroke or death, or a combination of these two outcomes, or even the odds of development of cranial nerve injuries or hemorrhage in the adjusted model, which is really good news here. But interestingly, in the final adjusted model, whether or not an actual shunt was placed during surgery did significantly increase the risk of postoperative stroke, with the odds ratio of 1.29, an effect that was entirely driven by the use of shunt by a surgeon classified as a selective shunter in this study. Dr. Negar Asdaghi: So, in simple terms, if a shunt was placed during CEA, it did increase the risk of stroke only if that surgeon was a selective shunter. Another interesting association was that amongst selective shunters, placing a shunt for a patient with a very recent ischemic event, that is, TIA or stroke within the past 48 hours prior to surgery, and placing a shunt for an intraoperative indication, meaning shunt placement was not pre-surgically planned, also significantly increased the risk of postoperative stroke. So, what we learned from the study is that, though a surgeon's shunting practice pattern did not have an impact on the overall postoperative risk of stroke or death, the placement of a shunt did indeed increase the risk of postoperative stroke only if it was placed by a surgeon who is a selective shunter, especially for an intraoperative indication in a patient with a recent ischemic event. Dr. Negar Asdaghi: So, shunts can be tricky, especially if they're done by a surgeon who doesn't place them routinely. So, my take-home message is that ultimately, like every other procedure in medicine, clinical outcomes are as much operator dependent as they are patient dependent, and for every procedure, it's fair to say that practice makes perfect. Dr. Negar Asdaghi: It is now more than 25 years since intravenous thrombolytic therapy has been approved for treatment of patients with acute ischemic stroke and more than seven years since randomized control trials demonstrated the efficacy of mechanical thrombectomy to improve clinical outcome in ischemic stroke patients with large vessel occlusions. To date, reperfusion therapies are the only available acute treatments for select patients with ischemic stroke. What do we mean by "select"? "Select" meaning that not all patients will benefit from these therapies, making it absolutely necessary for clinicians to be up to date with various indications and contraindications to use these therapies. Needless to say that the criteria for reperfusion therapies do not and should not consider the socioeconomic status of patients, but sadly, socioeconomic inequalities seem to impact the use of reperfusion therapies. Dr. Negar Asdaghi: In this issue of the journal, in the study titled "Socioeconomic Inequalities in Reperfusion Therapy for Acute Ischemic Stroke," Dr. Øgendahl Buus from Aarhus University Hospital in Denmark and colleagues studied the impact of the socioeconomic status of stroke patients on the odds of receiving reperfusion therapies in the large nationwide Danish Stroke Registry, or DSR. Now a bit about the registry: DSR contains prospectively collected nationwide data on all stroke patients admitted to Danish hospitals. It's interesting to note that in Denmark, stroke patients are exclusively admitted to public hospitals, and all departments treating stroke patients are obligated to report data to DSR. Now, for this study, they included over 63,000 stroke patients from 2013 to 2018. After excluding hemorrhagic stroke, TIAs, and other exclusion criteria of the study, they arrived at their sample size of 37,187 patients that were included in this study. Dr. Negar Asdaghi: Now, a few definitions. The socioeconomic status of each patient was determined based on three parameters. Parameter number one, their educational level. It was categorized into three levels of low, medium, or high levels of education. Category number two, income level. This was calculated based on the average family equivalent disposable income, or FED income, during five years prior to stroke onset, again classified into three categories of high, medium, or low income. And the third factor was the employment status of the patient during the calendar year prior to the stroke onset, also categorized into three categories of employed, unemployed, and retired. And, of course, the authors used various definitions to be able to fit special situations into these categories. For instance, a person who is temporarily unemployed due to illness or other special situation was still categorized under the employed category. So, that gave them, in total, nine groups to analyze across these three categories. Dr. Negar Asdaghi: And here are their findings. The median age of total stroke patients in the cohort was 73.2 years, 44.1% were women, 41% categorized under low educational level, 68% retired, and 33.3% had low income levels. Not surprisingly, patients and hospital characteristics varied tremendously across these nine groups of education, employment, and income, and a univariate analysis in general, low socioeconomic status was associated with more severe strokes, living alone, living at an assisted living residency, having had prior stroke, high comorbidity index score, hypertension, and late hospital arrival. So, they accounted for these differences in their multivariate analysis. Dr. Negar Asdaghi: Now, overall, the treatment rates of IV thrombolysis was 17.6%, which is actually considered a very high percentage as compared to other registry-based studies, but the percentage of IV thrombolytic use dramatically varied based on the different socioeconomic designation. So, let's look at this. In the univariate analysis, for education, intravenous thrombolysis rates were 19.3% among patients with high educational level compared to 16.2% among patients with low educational level. Let's look at income. For income, IV thrombolytic treatment rates reach 20.7% for high-income patients compared to 14.8% for low-income patients. For employment status, thrombolytic rates were 23.7% among employed patients compared to 15.7% for unemployed patients. In their fully adjusted models, unemployed patients were less likely to receive IV lytics as compared to their employed counterparts. Dr. Negar Asdaghi: Now, for thrombectomy, socioeconomic gradients were also noted for these three categories. For education, thrombectomy rates were 4.5% among patients with high education level compared to 3.6% among patients with low educational level. For income, treatment rates were 3.2% among low-income patients compared to 4.7% among high-income patients. But arguably, the most robust differences were noted again across the category of employment. Employed patients were nearly twice more likely to receive thrombectomy as compared to unemployed patients, rates being 5.1% versus 2.8%, respectively. Now, when they adjusted their analysis to only those patients presenting within the reperfusion time windows in the fully adjusted models, unemployment and low income remain significant negative predictors of receiving both of these reperfusion therapies. So, what we learned from this study is that stroke patients who were unemployed, earned a relatively low income, or had fewer years of formal education were less likely to receive life-saving reperfusion therapies despite potentially being eligible for these treatments. Dr. Negar Asdaghi: Now, let's take a moment to really understand that data presented here are in the context of a tax-funded, universal healthcare offered across Denmark, where we can at least make the assumption that financial constraints potentially preventing access to therapies are likely minimized. There are many countries around the globe where patients or family members have to pay for these therapies before even receiving them. So, these findings from the current study from Denmark are alarming in that they point to possibly more robust inequalities across the globe in other healthcare systems. Dr. Negar Asdaghi: Intracerebral hemorrhage, or ICH, is an aggressive form of stroke, typically carrying a higher morbidity and mortality than its ischemic counterpart. Yet much of the research in the field of intracerebral hemorrhage has followed the ischemic stroke footsteps, including defining the optimal primary outcome for the randomized trials of ICH. For ischemic stroke, the 90-day functional outcome, as measured by the modified Rankin Scale, is commonly used as a primary outcome in clinical trials. There are many reasons for this selection, including the ease of use and the fact that the majority of functional recovery post-ischemic stroke occurs during the first 90-day time period. But time to maximum recovery and, importantly, the trajectory of recovery may be different in hemorrhagic as compared to ischemic stroke. Defining the long-term outcomes and longitudinal trajectory of recovery in ICH is, therefore, important to better understand its prognosis and, of course, selecting the appropriate primary outcome measure for future randomized trials of ICH. Dr. Negar Asdaghi: In the recent years, the safety and efficacy of various agents to improve ICH outcomes have been tested. Deferoxamine mesylate, an iron-chelating agent, is one such agent that was recently studied as part of the i-DEF multicenter randomized trial, and the main results of the study were published in Lancet Neurology in 2019. In the current issue of the journal, in the study titled "Effect of Deferoxamine on Trajectory of Recovery After Intracerebral Hemorrhage," we learn about the results of a post hoc analysis of i-DEF that looks at the trajectory of functional outcome in patients enrolled in the trial with a special attention on their continued recovery after the 90-day post-ICH mark. Dr. Negar Asdaghi: Joining me now is the senior author of this paper, Dr. Magdy Selim, who's also one of the primary investigators of i-DEF trial. Dr. Selim is a Professor of Neurology at Harvard Medical School and Chief of Stroke Division at Beth Israel Deaconess Medical Center in Boston. He's a world renowned researcher in the field of cerebrovascular disorders with special focus on treatment of patients with intracerebral hemorrhage. Dr. Selim has led and currently leads multiple National Institutes of Health-funded clinical trials of intracerebral hemorrhage, including the ongoing SATURN trial. I'm delighted to welcome him to our podcast today. Good afternoon, Magdy. Thank you for joining us today. Dr. Magdy Selim: Thank you, Dr. Asdaghi. It's really my pleasure to be here with you, and I'm certainly honored to do this today. Dr. Negar Asdaghi: That's great. Thank you. So, let's start with some background on deferoxamine and the literature supporting the use of deferoxamine before i-DEF. Dr. Magdy Selim: So, as you mentioned, deferoxamine is an iron chelator; it binds to iron and removes excess iron from the body. The unique thing about it is that it has other neuroprotective properties, which are good for hemorrhagic stroke and ischemic stroke. It also has anti-inflammatory and anti-apoptotic effects. It even lowers the blood pressure, which we know sometimes is helpful in intracerebral hemorrhage. The rationale behind this or why this would be effective really comes from animal studies. After you have a hemorrhage, there is hemolysis of the red blood cells, there is a release of hemoglobin degradation products, in particular, iron, and the accumulation of iron in the hematoma and the surrounding tissue triggers a cascade of molecular and cellular events that lead to what we call secondary injury, characterized by inflammation, hydroxyl radical formation, and cell death. And many animal studies, animal models of intracerebral hemorrhage, whether in pigs or in rats, young or aged rats, have shown that treatment with deferoxamine can reduce iron in the brain after intracerebral hemorrhage and also results in improved performance on behavioral tests. And that was the reason why we moved into clinical testing. Dr. Negar Asdaghi: So, a lot of encouraging data before the trial. Can we hear a little bit about the trial, its design, and inclusion criteria, please? Dr. Magdy Selim: Sure. So i-DEF was a phase 2 study, and actually it started as Hi-DEF, which was high dose deferoxamine, and then became i-DEF, which intermediate dose deferoxamine. So, it's a randomized, double blind, placebo control trial. We used something called futility design, which is actually sort of new in the stroke field. And we had 294 patients who had supratentorial hemorrhage that were randomized within 24 hours to either get placebo or deferoxamine. And deferoxamine initially was given at 62 mg per day for three days, but then we ran into some safety issues with this high dose, and that's why we lowered it to 32, and that became the intermediate dose, or the i-DEF. So, the only kind of thing unique about inclusion/exclusion criteria was that there was an age cutoff, patients had to be 80 or younger. They needed to have some deficit on the exam, so their NIH Stroke Scale had to be 6 or greater, and their GCS had to be greater than 6, and their modified Rankin before the onset of the hemorrhage had to be less than 1. Dr. Negar Asdaghi: And so, what were the primary and secondary outcomes in i-DEF? Dr. Magdy Selim: The primary outcome was twofold actually. One of them was safety. One of the issues we ran into with the high dose is that the drug is associated with increased risk for adult respiratory distress syndrome, ARDS. So, we wanted to make sure that this lower dose was safe, and it does not increase the instance of ARDS. The second thing was, as I said, we used something called the futility design, and we wanted to compare the outcome of patients treated with deferoxamine versus placebo to determine whether it's futile to move to a large phase 3 trial or not. And what we were looking at is a difference in outcome and modified Rankin 0 to 2 at 90 days, and the difference would be at least 12% in favor of deferoxamine in order for us to move forward. You asked about the secondary outcomes as well? Dr. Negar Asdaghi: Yes. Dr. Magdy Selim: So, actually, the secondary outcomes, they're relevant because they're relevant to the study that we just published. So, the secondary outcomes was also to look at modified Rankin 0 to 3, instead of 0 to 2, at 90 days and the difference between the two treatment groups. We wanted to look at the ordinal distribution of the Rankin at the same time point. And we also wanted to look at all the outcomes at six months, 180 days. And that came a little bit later in the course of the study because there was some evidence emerging at that time that maybe assessment of outcome later in intracerebral hemorrhage would be more accurate than assessing it early on. Dr. Negar Asdaghi: So, I want to come back to the secondary outcome, of course, that's sort of the topic of your current paper in this issue of the journal, but can you just briefly tell us, please, the primary outcome and the sort of results of what was published in 2019 with i-DEF before we move on to the current paper? Dr. Magdy Selim: Yeah. So, as I said, the primary outcome was the difference in the proportion of patients that achieved modified Rankin 0 to 2 at 90 days, and what we wanted to see is a difference of around 12%. Unfortunately, the primary outcome was neutral, we did not see that. But what we saw actually, almost all the secondary outcomes were positive, except for the primary outcome. So, when we looked at the secondary outcome using modified Rankin 0 to 3, instead of 0 to 2, the difference was 12.1%. When we looked at the difference in the modified Rankin 0 to 2 at six months, the difference was 15.6% in favor of deferoxamine, but these were secondary outcomes and not the primary outcomes. Dr. Negar Asdaghi: So, the trial is almost positive. It just depends on how you define the primary outcome, which is really a nice segue to your current study. In the current study, you looked at this secondary outcome in a longitudinal way and looked at the mRS of 0 to 2 at six months from ICH. Can you please tell us about this current paper? Dr. Magdy Selim: Yeah. So, one of the things that we did with i-DEF is that we were checking the modified Rankin at different time points for all the patients. So, we had it after one week, after one month, after two months, after three months, and after six months. And what we wanted really was a couple of things, just in patients with intracerebral hemorrhage without any treatment, what's the natural course of recovery? And the interesting thing we found out is that patients actually continue to improve over time, and that's what you expect, but what we didn't expect is that they even continue to improve after 90 days. Dr. Magdy Selim: We always used to think that maximum recovery is around 90 days from ischemic stroke literature, but we saw a lot of patients getting better after 90 days. And this turns out to be also the case with deferoxamine, but the interesting thing is that the percentage of patients that had a good outcome, modified Rankin 0 to 2, was higher with deferoxamine at day seven, at day 30, at day 60, not at 90 days, but again at six months. So, actually, it was higher at all time points except our primary endpoint. Dr. Negar Asdaghi: So, Magdy, you've already answered my next question, which is exactly what you alluded to, deferoxamine seemed to have improved the outcomes at all of those time points, except for the 90 day, which was the primary outcome of your trial. Why do you think the magic was lost at 90 days? Dr. Magdy Selim: This is really the million-dollar question. I think we obviously struggled over this. And we went back, we thought maybe there was misrating of the modified Rankin in some of the patients. We tried to correct for this. The difference was bigger, but still not significant. So, we don't really have a good reason to tell you why, at this particular time point, we didn't see the difference except bad luck, I think. But I mean, there are reasons, I think, the question that people actually ask me is the opposite, is why do you think a drug that you give for three days early on is going to make a difference after six months? And I think there are biological reasons to explain this. Dr. Magdy Selim: So, what happened is that those hemorrhage patients have a lot of other problems. They have increased ICP, they have hydrocephalus, they have intraventricular hemorrhage, and actually iron has been implicated in the development of hydrocephalus in chronic white matter injury. So, my explanation is that you start early on with the treatment, it does help, but it takes a while for it to kick in and for this kind of medical complication to resolve until actually you see the true effect of the drug. And maybe that's why you see the unmasking at the end between the two groups. Dr. Negar Asdaghi: Yeah, I think I want to recap this for our listeners. Very important to, again, think about those things that some of the acute therapies that we offer the patients may not have a measurable improvement outcome difference early on, certainly with intravenous thrombolysis, we saw that, whereas we saw measurable outcome difference at 90 days, or maybe in this case at six months, but not quite early on. So, it doesn't mean that they don't work. We just are unable to measure that difference and improvement early on. So, what do you think the future holds for deferoxamine? Are we going to see another trial? Dr. Magdy Selim: Well, I certainly hope so. We're working on some few ideas for that. A lot of people think that maybe we should just do the same thing, but look at six months as the primary outcome. But I think we're actually, that's probably not our primary thinking at this point in time. So, we have published other papers, other analysis, to show that the effect of deferoxamine actually relates to the volume of the hemorrhage. So, if the hemorrhage is very small, there is very minimal benefit. If the hemorrhage is very large, also there is very minimal benefit. And that's really to get kind of the big bang for your buck. You really want people who have mild-to-moderate size hemorrhages. So, we're thinking of a couple of ways to go about deferoxamine with this, whether alone or in combination with other interventions. So, hopefully, we'll have some stuff to share with you in the coming few years, two or three. Dr. Negar Asdaghi: We'll definitely look forward to reading about those or being involved in the trials as a site, but there's a great way of just actually talking about my next question. It's just completely different than the current paper. I wanted to digress a bit and talk about the recently published intracerebral hemorrhage guidelines, which just published a few months ago. You were part of the guidelines committee. Can you give us a little bit of your point of view of what are the top two most important updates from the guidelines in ICH treatment? Dr. Magdy Selim: Actually, the guidelines, for the first time this year, in the first page, they have the top 10 take-home messages or top 10 new ones. So, in my opinion, the most important ones, we usually tell you what to do, but here we tell you what not to do because we think it's not good for the patients. So, for example, using steroids just as a prophylactic therapy is actually not recommended. The same thing, we see a lot of people put patients with hemorrhage on hypertonic saline, hyperosmolar therapy, just prophylactically. I don't think there's any benefit that this helps as well, and the same thing for antiepileptic drugs. So, that was one important point. The second one was blood pressure lowering, and there is emphasis now that whatever you use to lower the blood pressure, you want to make sure that the blood pressure variability is very minimal and that there is a smooth kind of control over blood pressure that has been shown to be actually important in terms of help. I'm going to make them three, not two, because I think the third one is important. Dr. Negar Asdaghi: Okay. I'll give you one more then. Dr. Magdy Selim: Which is the first time we include this in the guideline, and with emphasis on the role of the home caregiver for hemorrhage patients and the psychological support, the education that they need, and the training that they need to actually care for these patients and how to improve their quality of life. So, I think that's an important aspect that we didn't touch upon before, and obviously very important. Dr. Negar Asdaghi: Very important points. Let me just review them again for our listeners. So, don't do steroids, hypertonics, and preemptive antiepileptic therapies. They don't work. The second point that you raise is reduction of blood pressure, important to keep that in mind, but paying attention to blood pressure variability. And the third one, the importance of social aspect of care of patients with intracerebral hemorrhage. That's great for us. Let me just end with one last question. Magdy, thank you so much for all of this wonderful take-home messages from the current study from i-DEF and also the guidelines. There's been a lot of excitement in the field of ischemic stroke with the success of reperfusion therapies, and yet not much for intracerebral hemorrhage. What is your hope in terms of future therapies for ICH? Dr. Magdy Selim: So, I happen to be one of the people who is very optimistic about the future of ICH. I think it's just a matter of time. But I think we need to make some changes. We need to really treat ICH as an emergency, so time is really important. And I think right now, you see a hemorrhage patient, they just put them on the side because they think that there's nothing to do. But the way I see the future evolving, and probably the breaking point to be, is that we can diagnose ICH in the field. You immediately lower the blood pressure, reverse coagulopathy if you can, and even kind of use hemostatic agents, if the FASTEST trial shows evidence to support that, and then you take them to the hospital where there might be some role for hematoma reduction using minimally invasive therapy and some other treatments like deferoxamine, or there are a lot of other agents to target the secondary injury at the same time. So, I think it's going to be a combination of things, and they need to happen in tandem and continuously, but we need to start quickly on these patients. Dr. Negar Asdaghi: Dr. Magdy Selim, it's been a pleasure interviewing you on the podcast. We look forward to having you back and covering more of your work. Thank you for joining us. Dr. Magdy Selim: Thank you very much for having me. Dr. Negar Asdaghi: And this concludes our podcast for the July 2022 issue of Stroke. Please be sure to check out this month's table of contents for a full list of publications, including a series of Focus Updates on the very topic of, you guessed it, intracerebral hemorrhage. These updates are great complements to the newly published American Heart Association guidelines for the management of patients with spontaneous intracerebral hemorrhage in May 2022. Dr. Negar Asdaghi: And with this, we end our July podcast and draw inspiration from one particular July story, which unfolded on July 20. In 1969, on this day, Commander Neil Armstrong and lunar module pilot Buzz Aldrin landed on the moon, and Armstrong became the first person to walk on the moon. The crew of Apollo 11 changed the course of history, landing humanity on another celestial body for the first time and later safely returning everyone back to earth. Armstrong, an experienced naval aviator, a test pilot, a decorated veteran, astronaut, and university professor, passed away in 2012 from complications of coronary artery disease, reminding us that every step we take in understanding, diagnosing, and treating vascular disorders is truly part of that giant leap to save the mankind. And what better way to do this than to stay alert with Stroke Alert. Dr. Negar Asdaghi: This program is copyright of the American Heart Association, 2022. The opinions expressed by speakers in this podcast are their own and not necessarily those of the editors or of the American Heart Association. For more, visit AHAjournals.org.
Disparaged as "Japanese devils" and "half-breed," some children with Chinese mothers and Japanese fathers born during the Second Sino-Japanese war long looked to Japan as their true homeland. Learn about this largely unseen group of individuals, just a few of the countless children born of war who have dealt with extreme social and political adversities as well as persistent questions of self identity. Kanako Kuramitsu speaks to Satoko Naito to share her research on children born of consensual relationships between Chinese mothers and Japanese fathers during and after the Second Sino-Japanese war, particularly those who migrated to Japan after the normalization of Sino-Japanese diplomatic relations in 1972. Her work highlights men and women who, while sharing the many hardships of other children born of war, stand out for their strong identification with their fathers and their paternal country. The participants of Dr. Kuramitsu's study underscore the far-reaching effects of military conflict while simultaneously reminding us of the complexity of each individual's life story. The animation film "Michiko," mentioned in the episode, is available to view here. Kanako Kuramitsu received her PhD from the University of Birmingham and is currently a visiting scholar at the Centre for East Asian Studies (CEAS) at the University of Turku in Finland. Satoko Naito studies and teaches Japanese literature and film as a docent at CEAS and holds a PhD from Columbia University. The Nordic Asia Podcast is a collaboration sharing expertise on Asia across the Nordic region, brought to you by the Nordic Institute of Asian Studies (NIAS) based at the University of Copenhagen, along with our academic partners: the Centre for East Asian Studies at the University of Turku, and Asianettverket at the University of Oslo. We aim to produce timely, topical and well-edited discussions of new research and developments about Asia. About NIAS: www.nias.ku.dk Transcripts of the Nordic Asia Podcasts: http://www.nias.ku.dk/nordic-asia-podcast Learn more about your ad choices. Visit megaphone.fm/adchoices Support our show by becoming a premium member! https://newbooksnetwork.supportingcast.fm/new-books-network
Disparaged as "Japanese devils" and "half-breed," some children with Chinese mothers and Japanese fathers born during the Second Sino-Japanese war long looked to Japan as their true homeland. Learn about this largely unseen group of individuals, just a few of the countless children born of war who have dealt with extreme social and political adversities as well as persistent questions of self identity. Kanako Kuramitsu speaks to Satoko Naito to share her research on children born of consensual relationships between Chinese mothers and Japanese fathers during and after the Second Sino-Japanese war, particularly those who migrated to Japan after the normalization of Sino-Japanese diplomatic relations in 1972. Her work highlights men and women who, while sharing the many hardships of other children born of war, stand out for their strong identification with their fathers and their paternal country. The participants of Dr. Kuramitsu's study underscore the far-reaching effects of military conflict while simultaneously reminding us of the complexity of each individual's life story. The animation film "Michiko," mentioned in the episode, is available to view here. Kanako Kuramitsu received her PhD from the University of Birmingham and is currently a visiting scholar at the Centre for East Asian Studies (CEAS) at the University of Turku in Finland. Satoko Naito studies and teaches Japanese literature and film as a docent at CEAS and holds a PhD from Columbia University. The Nordic Asia Podcast is a collaboration sharing expertise on Asia across the Nordic region, brought to you by the Nordic Institute of Asian Studies (NIAS) based at the University of Copenhagen, along with our academic partners: the Centre for East Asian Studies at the University of Turku, and Asianettverket at the University of Oslo. We aim to produce timely, topical and well-edited discussions of new research and developments about Asia. About NIAS: www.nias.ku.dk Transcripts of the Nordic Asia Podcasts: http://www.nias.ku.dk/nordic-asia-podcast Learn more about your ad choices. Visit megaphone.fm/adchoices Support our show by becoming a premium member! https://newbooksnetwork.supportingcast.fm/military-history
In this episode recorded live at ETI ToolTech 2022, we're joined by Lee Locklear, CEO of Chief Executive Officer at Cutting Edge Automotive Solutions a tool supplier out of Fairhope, Alabama (https://ceasusa.com/).This conversation is filled with inside baseball and behind-the-scene discussions about some of the most popular brands in the industry today. Support the show
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