Podcasts about choice b

In this episode a quote from the introduction of Michael Langford's "Seven Steps to Awakening" is contemplated. "You, dear reader, have a choice. Choice A is to bring the imposter self and all forms of suffering to a final end and enjoy  the perfect Awareness-Love-Bliss of your true Self forever. Choice B is to continue to be controlled by the imposter self, identified with a temporary physical body..."

The following question refers to Section 8.5 of the 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure. The question is asked by Western Michigan University medical student & CardioNerds Intern Shivani Reddy, answered first by University of Southern California cardiology fellow and CardioNerds FIT Trialist Dr. Michael Francke, and then by expert faculty Dr. Shashank Sinha. Dr. Sinha is an Assistant Professor of Medical Education at the University of Virginia School of Medicine and an advanced heart failure, MCS, and transplant cardiologist at Inova Fairfax Medical Campus. He currently serves as both the Director of the Cardiac Intensive Care Unit and Cardiovascular Critical Care Research Program at Inova Fairfax. He is also a Steering Committee member for the multicenter Cardiogenic Shock Working Group and Critical Care Cardiology Trials Network and an Associate Editor for the Journal of Cardiac Failure, the official Journal of the Heart Failure Society of America. The Decipher the Guidelines: 2022 AHA / ACC / HFSA Guideline for The Management of Heart Failure series was developed by the CardioNerds and created in collaboration with the American Heart Association and the Heart Failure Society of America. It was created by 30 trainees spanning college through advanced fellowship under the leadership of CardioNerds Cofounders Dr. Amit Goyal and Dr. Dan Ambinder, with mentorship from Dr. Anu Lala, Dr. Robert Mentz, and Dr. Nancy Sweitzer. We thank Dr. Judy Bezanson and Dr. Elliott Antman for tremendous guidance. Enjoy this Circulation 2022 Paths to Discovery article to learn about the CardioNerds story, mission, and values. Question #30 Ms. V. Tea is a 55-year-old woman with a history of cardiac sarcoidosis, heart failure with mildly reduced ejection fraction (HFmrEF – EF 40%), and ventricular tachycardia with CRT-D who presents with recurrent VT. She has undergone several attempts at catheter ablation of VT in the past and previously had been trialed on amiodarone which was discontinued due to hepatotoxicity. She now continues to have episodic VT requiring anti-tachycardia pacing and ICD shocks despite medical therapy with mexiletine, metoprolol, and sotalol. Her most recent PET scan showed no active areas of inflammation. Currently, her vital signs are stable, and labs are unremarkable. What is the best next step for this patient? A Evaluation for heart transplant B Evaluation for LVAD C Dobutamine D Prednisone E None of the above Answer #30 Explanation The correct answer is A – evaluation for heart transplant. For selected patients with advanced heart failure despite GDMT, cardiac transplantation is indicated to improve survival and quality of life (Class 1, LOE C-LD). Heart transplantation, in this context, provides intermediate economic value. Clinical indicators include refractory or recurrent ventricular arrhythmias with frequent ICD shocks. Patient selection for heart transplant includes assessment of comorbidities, goals of care, and various other factors. The United Network of Organ Sharing Heart Transplant Allocation Policy was revised in 2018 with a 6-tiered system to better prioritize unstable patients and minimize waitlist mortality. VT puts the patient as a Status 2 on the transplant list. There was a contemporary analysis of patients with end-stage cardiomyopathy due to cardiac sarcoidosis, published in Journal of Cardiac Failure, in 2018 that demonstrated similar 1-year and 5-year survival after heart transplant between patients with and without cardiac sarcoidosis. Choice B (evaluation for LVAD) is incorrect. While bridge to transplant with LVAD is definitely a potential next step in patients with cardiac sarcoidosis, it is not recommended in patients presenting primarily with refractory ventricular arrhythmias due to granuloma-induced scarring. In this situation, patients benefit from direct heart transplant rather than bridge to transplant LVAD approa...

The following question refers to Section 9.3 of the 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure.The question is asked by Keck School of Medicine USC medical student & CardioNerds Intern Hirsh Elhence, answered first by Cedars Sinai medicine resident, soon to be Vanderbilt Cardiology Fellow, and CardioNerds Academy Faculty Dr. Breanna Hansen, and then by expert faculty Dr. Anu Lala.Dr. Lala is an advanced heart failure and transplant cardiologist, associate professor of medicine and population health science and policy, Director of Heart Failure Research, and Program Director for the Advanced Heart Failure and Transplant fellowship training program at Mount Sinai. Dr. Lala is Deputy Editor for the Journal of Cardiac Failure. Dr. Lala has been a champion and role model for CardioNerds. She has been a PI mentor for the CardioNerds Clinical Trials Network and continues to serve in the program's leadership. She is also a faculty mentor for this very 2022 heart failure decipher the guidelines series.The Decipher the Guidelines: 2022 AHA / ACC / HFSA Guideline for The Management of Heart Failure series was developed by the CardioNerds and created in collaboration with the American Heart Association and the Heart Failure Society of America. It was created by 30 trainees spanning college through advanced fellowship under the leadership of CardioNerds Cofounders Dr. Amit Goyal and Dr. Dan Ambinder, with mentorship from Dr. Anu Lala, Dr. Robert Mentz, and Dr. Nancy Sweitzer. We thank Dr. Judy Bezanson and Dr. Elliott Antman for tremendous guidance.Enjoy this Circulation 2022 Paths to Discovery article to learn about the CardioNerds story, mission, and values. Question #23 Mrs. Hart is a 63-year-old woman with a history of non-ischemic cardiomyopathy and heart failure with reduced ejection fraction (LVEF 20-25%) presenting with 5 days of worsening dyspnea and orthopnea.   At home, she takes carvedilol 12.5mg BID, sacubitril-valsartan 24-46mg BID, empagliflozin 10mg daily, and furosemide 40mg daily.   On admission, her exam revealed a blood pressure of 111/79 mmHg, HR 80 bpm, and SpO2 94%. Her cardiovascular exam was significant for a regular rate and rhythm with an audible S3, JVD to 13 cm H2O, bilateral lower extremity pitting edema with warm extremities and 2+ pulses throughout.  What initial dose of diuretics would you give her? A Continue home Furosemide 40 mg PO B Start Metolazone 5 mg PO C Start Lasix 100 mg IV D Start Spironolactone Answer #23 Explanation The correct answer is C – start Furosemide 100 mg IV. This is the most appropriate choice because patients with HF admitted with evidence of significant fluid overload should be promptly treated with intravenous loop diuretics to improve symptoms and reduce morbidity (Class 1, LOE B-NR). Intravenous loop diuretic therapy provides the most rapid and effective treatment for signs and symptoms of congestion. Titration of diuretics has been described in multiple recent trials of patients hospitalized with HF, often initiated with at least 2 times the daily home diuretic dose (mg to mg) administered intravenously. Titration to achieve effective diuresis may require doubling of initial doses, adding a thiazide diuretic, or adding an MRA that has diuretic effects in addition to its cardiovascular benefits. Choice A is incorrect as continuing oral loop diuretics is not recommended for acute decongestion. Moreover, Ms. Hart has become congested despite her home, oral diuretic regimen. Choice B and D are incorrect as starting a thiazide diuretic or a mineralocorticoid receptor antagonist are not first-line therapy for acute HF. Rather, in patients hospitalized with HF when diuresis is inadequate to relieve symptoms and signs of congestion, it is reasonable to intensify the diuretic regimen using either: a.

The following question refers to Section 7.1 of the 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure.The question is asked by New York Medical College medical student and CardioNerds Intern Akiva Rosenzveig, answered first by Lahey Hospital and Medical Center internal medicine resident and CardioNerds Academy House Faculty Leader Dr. Ahmed Ghoneem, and then by expert faculty Dr. Clyde Yancy.Dr. Yancy is Professor of Medicine and Medical Social Sciences, Chief of Cardiology, and Vice Dean for Diversity and Inclusion at Northwestern University, and a member of the ACC/AHA Joint Committee on Clinical Practice Guidelines.The Decipher the Guidelines: 2022 AHA / ACC / HFSA Guideline for The Management of Heart Failure series was developed by the CardioNerds and created in collaboration with the American Heart Association and the Heart Failure Society of America. It was created by 30 trainees spanning college through advanced fellowship under the leadership of CardioNerds Cofounders Dr. Amit Goyal and Dr. Dan Ambinder, with mentorship from Dr. Anu Lala, Dr. Robert Mentz, and Dr. Nancy Sweitzer. We thank Dr. Judy Bezanson and Dr. Elliott Antman for tremendous guidance.Enjoy this Circulation 2022 Paths to Discovery article to learn about the CardioNerds story, mission, and values. Question #19 Ms. M is a 36-year-old G1P1 woman 6 months postpartum who was diagnosed with peripartum cardiomyopathy at the end of her pregnancy. She is presenting for a follow up visit today and notes that while her leg edema has resolved, she continues to have dyspnea when carrying her child up the stairs. She also describes significant difficulty sleeping, though denies orthopnea, and notes she is not participating in hobbies she had previously enjoyed. She is currently prescribed a regimen of sacubitril-valsartan, metoprolol succinate, spironolactone, and empagliflozin.  What are the next best steps? A Screen for depression B Counsel her to follow a strict low sodium diet with goal of < 1.5g Na daily C Recommend exercise therapy and refer to cardiac rehabilitation D A & C Answer #19 Explanation   The correct answer is D – both A (screening for depression) and C (referring to cardiac rehabilitation) are appropriate at this time. Choice A is correct. Depression is a risk factor for poor self-care, rehospitalization, and all-cause mortality among patients with HF. Interventions that focus on improving HF self-care have been reported to be effective among patients with moderate/severe depression with reductions in hospitalization and mortality risk. Social isolation, frailty, and marginal health literacy have similarly been associated with poor HF self-care and worse outcomes in patients with HF. Therefore, in adults with HF, screening for depression, social isolation, frailty, and low health literacy as risk factors for poor self-care is reasonable to improve management (Class 2a, LOE B-NR).  Choice C is correct. In patients with HF, cardiac rehabilitation has a Class 2a recommendation (LOE B-NR) to improve functional capacity, exercise tolerance, and health-related QOL; exercise training (or regular physical activity) for those able to participate has a Class 1 recommendation (LOE A) to improve functional status, exercise performance, and QOL. Choice B is incorrect. For patients with stage C HF, avoiding excessive sodium intake is reasonable to reduce congestive symptoms (Class 2a, LOE C-LD). However, strict sodium restriction does not have strong supportive data and is not recommended. There are ongoing studies to better understand the impact of sodium restriction on clinical outcomes and quality of life. The AHA currently recommends a reduction of sodium intake to

The following question refers to Section 9.1 of the 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure.  The question is asked by Keck School of Medicine USC medical student & CardioNerds Intern Hirsh Elhence, answered first by Duke University cardiology fellow and CardioNerds FIT Ambassador Dr. Aman Kansal, and then by expert faculty Dr. Anu Lala. Dr. Lala is an advanced heart failure and transplant cardiologist, associate professor of medicine and population health science and policy, Director of Heart Failure Research, and Program Director for the Advanced Heart Failure and Transplant fellowship training program at Mount Sinai. Dr. Lala is deputy editor for the Journal of Cardiac Failure. Dr. Lala has been a champion and role model for CardioNerds. She has been a PI mentor for the CardioNerds Clinical Trials Network and continues to serve in the program's leadership. She is also a faculty mentor for this very 2022 heart failure decipher the guidelines series. The Decipher the Guidelines: 2022 AHA / ACC / HFSA Guideline for The Management of Heart Failure series was developed by the CardioNerds and created in collaboration with the American Heart Association and the Heart Failure Society of America. It was created by 30 trainees spanning college through advanced fellowship under the leadership of CardioNerds Cofounders Dr. Amit Goyal and Dr. Dan Ambinder, with mentorship from Dr. Anu Lala, Dr. Robert Mentz, and Dr. Nancy Sweitzer. We thank Dr. Judy Bezanson and Dr. Elliott Antman for tremendous guidance. Enjoy this Circulation 2022 Paths to Discovery article to learn about the CardioNerds story, mission, and values. Question #13 Mrs. Hart is a 63-year-old woman with a history of non-ischemic cardiomyopathy and heart failure with reduced ejection fraction (LVEF 20-25%) presenting with 5 days of worsening dyspnea and orthopnea. She takes carvedilol 12.5mg BID, sacubitril-valsartan 24-46mg BID, empagliflozin 10mg daily, and furosemide 40mg daily and reports that she has been able to take all her medications. What is the initial management for Mrs. H? A Assess her degree of congestion and hypoperfusion B Search for precipitating factors C Evaluate her overall trajectory D All of the above E None of the above Answer #13 Explanation The correct answer is D – all of the above.   Choice A is correct because in patients hospitalized with heart failure, the severity of congestion and adequacy of perfusion should be assessed to guide triage and initial therapy (Class 1, LOE C-LD). Congestion can be assessed by using the clinical exam to gauge right and left-sided filling pressures (e.g., elevated JVP, S3, edema) which are usually proportional in decompensation of chronic HF with low EF; however, up to 1 in 4 patients have a mismatch between right- and left-sided filling pressures. Hypoperfusion can be suspected from narrow pulse pressure and cool extremities, intolerance to neurohormonal antagonists, worsening renal function, altered mental status, and/or an elevated serum lactate. For more on the bedside evaluation of heart failure, enjoy Episode #142 – The Role of the Clinical Examination in Patients With Heart Failure – with Dr. Mark Drazner. Choice B, searching for precipitating factors is also correct. In patients hospitalized with HF, the common precipitating factors and the overall patient trajectory should be assessed to guide appropriate therapy (Class 1, LOE C-LD). Common precipitating factors include ischemic and nonischemic causes, such as acute coronary syndromes, atrial fibrillation and other arrhythmias, uncontrolled HTN, other cardiac disease (e.g., endocarditis), acute infections, anemia, thyroid dysfunction, non-adherence to medications or new medications. When initial clinical assessment does not suggest congestion or hypoperfusion, symptoms of HF may be a result of transient ischemia, arrhythmias, or noncardiac disease such as chronic pulmonary disease or pneumonia,

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The following question refers to Section 7.1 of the 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure. The question is asked by New York Medical College medical student and CardioNerds Intern Akiva Rosenzveig, answered first by Cornell cardiology fellow and CardioNerds Ambassador Dr. Jaya Kanduri, and then by expert faculty Dr. Clyde Yancy.Dr. Yancy is Professor of Medicine and Medical Social Sciences, Chief of Cardiology, and Vice Dean for Diversity and Inclusion at Northwestern University, and a member of the AHA/ACC/HFSA Heart Failure Guideline Writing Committee.The Decipher the Guidelines: 2022 AHA / ACC / HFSA Guideline for The Management of Heart Failure series was developed by the CardioNerds and created in collaboration with the American Heart Association and the Heart Failure Society of America. It was created by 30 trainees spanning college through advanced fellowship under the leadership of CardioNerds Cofounders Dr. Amit Goyal and Dr. Dan Ambinder, with mentorship from Dr. Anu Lala, Dr. Robert Mentz, and Dr. Nancy Sweitzer. We thank Dr. Judy Bezanson and Dr. Elliott Antman for tremendous guidance.Enjoy this Circulation 2022 Paths to Discovery article to learn about the CardioNerds story, mission, and values. Question #5 Ms. L is a 65-year-old woman with nonischemic cardiomyopathy with a left ventricular ejection fraction (LVEF) of 35%, hypertension, and type 2 diabetes mellitus. She has been admitted to the hospital with decompensated heart failure (HF) twice in the last six months and admits that she struggles to understand how to take her medications and adjust her sodium intake to prevent this.  Which of the following interventions has the potential to decrease the risk of rehospitalization and/or improve mortality? A Access to a multidisciplinary team (physicians, nurses, pharmacists, social workers, care managers, etc) to assist with management of her HF   B Engaging in a mobile app aimed at improving HF self-care   C Vaccination against respiratory illnesses   D A & C   Answer #5   The correct answer is D – both A (access to a multidisciplinary team) and C (vaccination against respiratory illness).   Choice A is correct. Multidisciplinary teams involving physicians, nurses, pharmacists, social workers, care managers, dieticians, and others, have been shown in multiple RCTs, metanalyses, and Cochrane reviews to both reduce hospital admissions and all-cause mortality. As such, it is a class I recommendation (LOE A) that patients with HF should receive care from multidisciplinary teams to facilitate the implementation of GDMT, address potential barriers to self-care, reduce the risk of subsequent rehospitalization for HF, and improve survival. Choice B is incorrect.  Self-care in HF comprises treatment adherence and health maintenance behaviors. Patients with HF should learn to take medications as prescribed, restrict sodium intake, stay physically active, and get vaccinations. They also should understand how to monitor for signs and symptoms of worsening HF, and what to do in response to symptoms when they occur. Interventions focused on improving the self-care of HF patients significantly reduce hospitalizations and all-cause mortality as well as improve quality of life. Therefore, patients with HF should receive specific education and support to facilitate HF self-care in a multidisciplinary manner (Class I, LOE B-R). However, the method of delivery and education matters. Reinforcement with structured telephone support has been shown to be effective. In contrast the efficacy of mobile health-delivered educational interventions in improve self-care in patients with HF remains uncertain. Choice C is correct. In patients with HF, vaccinating against respiratory illnesses is reasonable to reduce mortality (Class 2a, LOE B-NR). For example, administration of the influenza vaccine in HF patients has been shown to reduce...

Le soleil de la Jamaïque et du reggae, un groupe de notre plat pays, puis direction les États-Unis, un peu beaucoup passionnément, c'est le b.a.-ba de l'histoire du rock, ou l'abc, ou le CC ou le KS ou le REM ou le BB enfin, c'est la base quoi mais avec des lettres, une petite séquence vaut mieux qu'une longue intro ! Originaire de Manchester, 10cc veut dire 10 centimètres cubes comme en français ! Mais 10 centimètres cubes de quoi ? K's Choice, le groupe belge portait à l'origine le nom ‘'The Choice'', suite à leur première tournée US, ils apprennent qu'un groupe américain porte le même nom. Pourquoi K's Choice ? Originaire d'Athens dans l'état de Georgie, R.E.M. a cherché longtemps avant de trouver ces 3 lettres d'une efficacité redoutable, trouvé par Michael Stipe dans le dictionnaire. Pourquoi B.B dans B.B King ? Simplement le diminutif de "blues boy"… --- Du lundi au vendredi, Fanny Gillard et Laurent Rieppi vous dévoilent l'univers rock, au travers de thèmes comme ceux de l'éducation, des rockers en prison, les objets de la culture rock, les groupes familiaux et leurs déboires, et bien d'autres, chaque matin dans Coffee on the Rocks à 6h30 et rediffusion à 13h30 dans Lunch Around The Clock.

The following question refers to Section 4.3 of the 2021 ESC CV Prevention Guidelines. The question is asked by CardioNerds Academy Intern Dr. Maryam Barkhordarian, answered first by pharmacy resident Dr. Anushka Tandon and then by expert faculty Dr. Kim Williams. Dr. Williams is Chief of the Division of Cardiology and is Professor of Medicine and Cardiology at Rush University Medical Center. He has served as President of ASNC, Chairman of the Board of the Association of Black Cardiologists (ABC, 2008-2010), and President of the American College of Cardiology (ACC, 2015-2016). The CardioNerds Decipher The Guidelines Series for the 2021 ESC CV Prevention Guidelines represents a collaboration with the ACC Prevention of CVD Section, the National Lipid Association, and Preventive Cardiovascular Nurses Association. Question #15 Your patient mentions that she drinks “several” cups of coffee during the day. She also describes having a soda daily with lunch and occasionally a glass of wine with dinner. Which of the following recommendations is appropriate?  A. Coffee consumption is not harmful and may even be beneficial, regardless of the number of drinks per day. B. Drinking two glasses of wine/day is safe from a cardiovascular prevention standpoint. C. Soft drinks (and other sugar-sweetened beverages) must be discouraged. D. None of the above Listen to this podcast episode!  Answer #15 The correct answer is C.  Soft drinks (and other sugar-sweetened beverages) must be discouraged. Sugar-sweetened beverages have been associated with a higher risk of CAD and all-cause mortality. The ESC guidelines give a class I recommendation for restriction of free sugar consumption (in particular sugar-sweetened beverages) to a maximum of 10% of energy intake. This is a class IIa recommendation in the ACC/AHA guidelines. Choice A is incorrect because: the consumption of nine or more drinks a day of non-filtered coffee (such as boiled, Greek, and Turkish coffee and some espresso coffees) may be associated with an up to 25% increased risk of ASCVD mortality. Moderate coffee consumption (3-4 cups per day) is probably not harmful, and perhaps even moderately beneficial. Choice B is incorrect: It is a class I recommendation to restrict alcohol consumption to a maximum of 100 g per week. The standard drink in the US contains 14 g of alcohol, so 100 mg of alcohol translate to: o   84 ounces of beer (5% alcohol) o   Or 56 – 63 ounces of malt liquor (75% alcohol) or o   Or 35 ounces of wine (12% alcohol) or ONE 5 fl oz glass of wine/day. o   Or 31.5 ounces of distilled spirits (40% alcohol). The ACC/AHA guidelines recommended limiting alcohol consumption only for the management of hypertension to: ≤2 drinks daily for men and: ≤1 drink daily for women. Main Takeaway The main takeaway: ASCVD risk reduction can be achieved by restricting sugar-sweetened beverages to a maximum of 10% of energy intake. Guideline Location Section 4.3.2, Page 3271 CardioNerds Decipher the Guidelines - 2021 ESC Prevention Series CardioNerds Episode Page CardioNerds Academy Cardionerds Healy Honor Roll CardioNerds Journal Club Subscribe to The Heartbeat Newsletter! Check out CardioNerds SWAG! Become a CardioNerds Patron!

The following question refers to Section 4.3 of the 2021 ESC CV Prevention Guidelines. The question is asked by Dr. Maryam Barkhordarian, answered first by pharmacy resident Dr. Anushka Tandon, and then by expert faculty Dr. Noreen Nazir. Dr. Noreen Nazir is Assistant Professor of Clinical Medicine at the University of Illinois at Chicago, where she is the director of cardiac MRI and the preventive cardiology program. The CardioNerds Decipher The Guidelines Series for the 2021 ESC CV Prevention Guidelines represents a collaboration with the ACC Prevention of CVD Section, the National Lipid Association, and Preventive Cardiovascular Nurses Association. Question #9 Mr. A is a 28-year-old man who works as an accountant in what he describes as a “desk job” setting. He shares that life got “a little off-track” for him in 2020 between the COVID-19 pandemic and a knee injury. His 2022 New Years' resolution is to improve his overall cardiovascular and physical health. He has hypertension and a family history of premature ASCVD in his father, who died of a heart attack at age 50. Prior to his knee injury, he went to the gym 3 days a week for 1 hour at a time, split between running on the treadmill and weightlifting. He has not returned to the gym since his injury and has been largely sedentary, although he is trying to incorporate a 20-minute daily walk into his routine. Which of the following exercise-related recommendations is most appropriate? A. A target of 75-150 minutes of vigorous-intensity or 150-300 minutes of moderate-intensity aerobic physical exercise weekly is recommended to reduce all-cause mortality, CV mortality, and morbidity. B. Bouts of exercise less than 30 minutes are not associated with favorable health outcomes. C. Exercise efforts should be focused on aerobic activity, since only this type of activity is associated with mortality and morbidity benefits. D. Light-intensity aerobic activity like walking is expected to have limited health benefits for persons with predominantly sedentary behavior at baseline. Answer #9 The correct answer is A. There is an inverse relationship between moderate-to-vigorous physical activity and CV morbidity/mortality, all-cause mortality, and incidence of type 2 diabetes, with additional benefits accrued for exercise beyond the minimum suggested levels. The recommendation to “strive for at least 150-300 min/week of moderate-intensity, or 75-150 min/week of vigorous-intensity aerobic physical activity, or an equivalent combination thereof” is a Class 1 recommendation per the 2021 ESC guidelines, and a very similar recommendation (at least 75 minutes of vigorous-intensity or 150 minutes of moderate-intensity activity) is also Class 1 recommendation per 2019 ACC/AHA primary prevention guidelines. Both the ESC and ACC/AHA provide examples of activities grouped by absolute intensity (the amount of energy expended per minute of activity), but the ESC guidelines also offer suggestions for measuring the relative intensity of an activity (maximum/peak associated effort) in Table 7, which allows for a more individualized, customizable approach to setting activity goals. Importantly, individuals who are unable to meet minimum weekly activity recommendations should still be encouraged to stay as active as their abilities and health conditions allow to optimize cardiovascular and overall health. Choice B is incorrect, as data suggests physical activity episodes of any duration, including

Welcome to MAFSLessons! Comedians Omar Abid & Kelly Rickard return for this second very special episode where they talk about Olivia, Sexist John & tarot. Join the conversation over on Twitter, Instagram and Facebook @MAFSLessons

The following question refers to Section 3.3 of the 2021 ESC CV Prevention Guidelines. The question is asked by CardioNerds Academy Intern student Dr. Adriana Mares, answered first by Brigham & Women's medicine intern & Director of CardioNerds Internship Dr. Gurleen Kaur, and then by expert faculty Dr. Allison Bailey.Dr. Bailey is an advanced heart failure and transplant cardiologist at Centennial Heart. She is the editor-in-chief of the American College of Cardiology's Extended Learning (ACCEL) editorial board and was a member of the writing group for the 2018 American Lipid Guidelines. The CardioNerds Decipher The Guidelines Series for the 2021 ESC CV Prevention Guidelines represents a collaboration with the ACC Prevention of CVD Section, the National Lipid Association, and Preventive Cardiovascular Nurses Association. Question #2 Mr. Early M. Eye is a 55-year-old man with a history of GERD who is seeing you in clinic as he is concerned about his family history of early myocardial infarction and would like to discuss if he should be taking a statin for cardiovascular prevention. He has never smoked tobacco. His 10-year CVD risk is estimated to be 8%. Which imaging modality is recommended by the ESC guidelines to reclassify his CVD risk?A. Coronary Artery Calcium (CAC) scoringB. Echocardiography C. Ankle brachial index D. Contrast enhanced computed tomography coronary angiography (CCTA)E. None of the above Answer #2 The correct answer is A.Coronary artery calcium (CAC) scoring can reclassify CVD risk upwards and downwards and should specifically be considered in patients with calculated risk scores that are around decision thresholds. CAC scores which are high-than-expected for age and sex increase estimated future CVD risk. Notably, CAC scoring may also be used to “de-risk” if CAC is absent or lower-than-expected. The 2021 ESC Prevention Guidelines give a Class IIb (LOE B) recommendation to consider CAC scoring to improve risk classification around treatment decision thresholds. However, one limitation of CAC is that it does not provide direct information on total plaque burden or stenosis severity. In addition, there is also a Class IIb (LOE B) recommendation to use plaque detection by carotid ultrasound as an alternative when CAC scoring is unavailable or not feasible. Plaque assessed through carotid ultrasound is defined as presence of wall thickening that is >50% greater than the surrounding vessel wall or a focal region with intima-media thickness measurement >1.5mm that protrudes into the lumen.Similar to the ESC Prevention Guidelines, the 2019 ACC/AHA guidelines on primary prevention of CVD also have a Class IIa recommendation for using CAC score, and explicitly mention its use for adults at intermediate risk (>7.5% to 100 Agatson units to reclassify risk upwards and CAC of 0 to reclassify risk downwards. However, the guidelines also mention that clinicians should not down-classify risk in patients who have CAC of 0 if they are current smokers, have diabetes, have a family history of ASCVD, or have chronic inflammatory conditions. Furthermore, the 2018 ACC/AHA Cholesterol guidelines have a Class IIa recommendation that if CAC is 0, it is reasonable to withhold statin therapy and reassess risk in 5 to 10 years, as long as higher risk conditions that we just discussed are absent. If CAC is 1-99, it is reasonable to initiate statin therapy for patients ≥ 55 years of age.Choice B is incorrect. Echocardiography is not recommended to improve CV risk prediction due to lack of convincing evidence that it improves CVD risk reclassification.Choice C is incorrect. While the 2013 ESC guidelines mentioned that ABI may be considered as a risk modifier in CVD risk estimation, the newer 2021 guidelines state that ankle brachial index has limited potential in terms of reclassification risk, though an individual patient data meta-analysis showed th...

Choice A or Choice B? We're met with this conundrum over and over again in life, and yet, there are certain choices that are far more consequential than others. This episode of KnockBack is dedicated to such forks in the road, where two or more options are presented, and whichever choice you make will resonate far beyond that point in time, perhaps for the rest of your life. From jobs and living situations to education and the start and stop of relationships, these are 10 moments from the lives of the Brothers Moriarty that -- if a different path was taken -- would have likely meant this very show wouldn't exist at all. How meta. Learn more about your ad choices. Visit megaphone.fm/adchoices

News at the Top – Legal Fight for Health-Care Choice British Columbia’s top court has ruled against private options for Canadian patients facing long wait times, but the fight isn’t over. Link: https://www.yourhealthcantwait.ca/ Deep Dive – B.C. Carbon Tax Not Working (Again) 8:33 Despite rosy projections about the province’s carbon tax, British Columbia’s carbon emissions are going up. B.C. Director Kris Sims blows the whistle on rising emissions. Link: https://www.taxpayer.com/newsroom/b.c.-emissions-up-despite-carbon-tax?id=18615 Sign the PETITION: https://www.taxpayer.com/petitions/scrap-the-federal-carbon-tax Waste Watch – Corporate Welfare Refinery Fail 18:50 The Alberta government is losing a gamble with taxpayers’ money on a refinery and we’re reminding Premier Jason Kenny about his promises to do away with corporate welfare. Link: https://www.policyschool.ca/news/morton-sturgeon-refinery-costs-continue-mount/ Sign the PETITION: https://www.taxpayer.com/petitions/end-corporate-welfare-in-alberta Like this show? Subscribe and give us 5-stars!

I. An Adulterous People -v.4-- A. Old Covenant Echoes- B. New Covenant Marriage- C. Marital Exclusivity-II. A Jealous God -v.5--III. The Grace to Obey -v.6-- A. A Choice- B. A Promise-IV. Applications

  Session 18 As always, I'm joined by Dr. Karen Shackelford from Board Vitals. If you haven't yet, check out Board Vitals and use the promo code BOARDROUNDS to save 15%. They have a huge database and question bank to help you get the practice you need to get the score that you need. [01:35] Question of the Week An older patient comes in with a painful rash. We have a 64-year-old female who presents complaining of a severe painful rash that is localized to the left side of her upper back and neck. She knows that the area of the rash feels hot and burning and extremely painful. She is otherwise healthy with no significant past medical history. On exam, her vital signs were within normal limits. And her exam is significant, primarily, because she has a large, red vesicular rash running along her left shoulder in confluent patches. She remarks that the lesions were smaller a few days ago and they quickly start to bubble over into larger 02:39. The physician performed a Tzanck smear to confirm her suspicions. She found the test to be positive for multinucleated giant cells. The patient will have which of the following characteristics? (A) Gram-positive, catalase-positive, beta-hemolytic and arranged in clusters (B) Branching pseudohyphae with budding yeast cells (C) Enveloped-virus with double-stranded DNA (D) Enveloped-virus with positive-strand RNA virus [04:30] Thought Process The correct answer is C. Varicella zoster virus would probably come to mind as well as shingles as the Tzanck smear showed multinucleated giant cells – herpes simplex virus 1 and 2 (HSV 1 and 2) as well as pemphigus vulgaris. Other findings you would probably see on the Tzanck smear would include acantholytic cell and keratinocyte ballooning. This test is not typically performed usually as a clinical diagnosis. But it can be performed in the office. The patient can be immunocompromised with atypical looking lesion or atypical presentation. So we'd think of herpes and varicella zoster. For the other answer choices, Choice A is Staphylococcus aureus, which isn't a choice for a skin infection. Choice B is a fungus. A fungal disease like Candida can cause a really nasty rash. But it won't be the vesicular nor the dermatomal, which this question suggests. Varicella zoster virus is latent in the sensory ganglion so it tends to erupt on one or two contiguous dermatomes, although it can erupt outside of the dermatome. But it's not going to be a big eruption and just one or two vesicles scattered somewhere else from reactivation of the viral particles. Option D is Rubella. It causes a rash and it's usually tested for IgM antibodies. If a test is needed, it's not the Tzanck smear. [07:45] Possible Question Points About the Herpes Virus About 30% of Americans will have it at some point in their lives coming from reactivation of the virus. It causes two clinically distinct diseases including chicken pox. Chicken pox would be characterized by vesicular lesions but they're on different stages of development. They're concentrated on the face and the trunk. It's an airborne virus that invades the lymphoid tissue in the nose or nasopharynx. The virus overcomes local host defenses. The epidermal cells usually react by making alpha-interferons. That's the incubation period. When the virus can overcome the local host defenses, then you've got a viremia. Then the virus downregulates your immune response through a variety of mechanisms, such as the inhibition of the expression of interferon response genes. When the virus remains latent for years in most cases, you're more at risk of reactivation as you get older because you have a diminished T-cell response. This is the same reason that people with immuno-compromise are more likely to erupt with shingles. It's a unilateral vesicular eruption, usually in the dermatome. The reactivated varicella can travel either way. It can travel peripherally through the sensory ganglion and go down the sensory nerve. This results in a skin infection or the characteristic rash. It can also reactivate and move centrally from the ganglion. This is seen in those who are severely immuno-compromised. But this results in some of the complications associated with herpes zoster like meningitis-encephalitis. Some of the syndromes include the Ramsay Hunt syndrome but it's a random thing. It occurs whenever the virus replicates in the geniculate ganglion. It travels down the 8th nerve and you have vesicles on the auricle or in the ear canal – ipsilateral facial paralysis. Herpes 11:12 is a pretty significant complication. You have to recognize it really early on because it can cause blindness. You can get herpes keratitis and acute retinal nephrosis. The treatment is going to be an antiviral ganciclovir or acyclovir. Postherpetic neuralgia is another big complication with severe significant pain (3 out of 10 and higher for about 90 days or more). Some people can have sensory changes. It can be intensely pruritic. If you get vesicular lesions on the nose then the nerve distribution is pretty worrisome so you have to be aware of that. [12:50] Board Vitals Check out Board Vitals and use the promo code BOARDROUNDS to save 15% off your QBank purchase. Whether you're studying for the COMPLEX or USMLE, Board Vitals has the QBank you need to help prepare you the best possible way. Links: Board Vitals (use the promo code BOARDROUNDS to save 15%)

[MUSIC PLAYING] Welcome to the self-evaluation episode of the ASCO University Weekly Podcast. My name is Teviah Sachs, and I am an Assistant Professor of Surgery at the Boston University School of Medicine and Surgical Oncologist at Boston Medical Center. Today we will feature a self-evaluation question on the treatment of gastric cancer. And we begin by reading the question stem. A 53-year-old Hispanic woman presents to her primary care physician after noticing black tarry stools for the last three weeks, and complains of mild fatigue. A stool guaiac test is performed in the office, and is found to be hemoccult positive. Her laboratory tests were notable for a white blood cell count of 6,400, a hemoglobin of 9.2, and hematocrit of 27.3%, with platelets of 653. The mean corpuscular volume was 77, blood urea nitrogen was 40, and creatinine was 1.3. A CT scan of the chest, abdomen, and pelvis was performed with IV contrast, and was notable only for nonspecific thickening of the gastric fundus. She was referred to a gastroenterologist, who performed an esophagogastroduodenoscopy, or EGD, which revealed an ulcerative mass along the greater curvature of the gastric fundus, with no evidence of active bleeding. This lesion was biopsied, and the pathology results confirmed adenocarcinoma, with signet ring cell features. A subsequent staging PET scan did not reveal any evidence of metastatic disease. What is the most appropriate next step in the management of this patient? Choice A, recommend subtotal gastrectomy. Choice B, recommend neoadjuvant therapy using epirubicin, oxaliplatin, and capecitabine, or EOX. Choice C, recommend endoscopic ultrasound. Choice D, recommend palliative radiation to control the bleeding. Or choice E, start the patient on oral iron after transfusion of two units of blood. [MUSIC PLAYING] In order to determine the appropriate treatment plan, we first need to know the local staging of the tumor based on endoscopic ultrasound, or EUS. Therefore, the answer would be choice C. Based on the findings of the endoscopic ultrasound, the next step for management can be better determined, whether it be endoscopic mucosal resection, surgical resection, or neoadjuvant chemotherapy with or without radiotherapy. Briefly the rationale for the other choices presented in this question do not represent the most appropriate therapy for the following reasons. Subtotal gastrectromy should not be entertained until staging endoscopic ultrasound is completed. If the lesion is a T1A lesion and amenable to endoscopic mucosal resection, then that would be more appropriate. Whereas if the lesion is a T4 lesion, with or without local regional adenopathy and ultrasonic evaluation, neoadjuvant therapy with EOX would be more appropriate. As for choice D, palliative radiotherapy is not indicated, as there is no active or uncontrollable bleeding, and there is no evidence of distant disease. Lastly, choice E, starting the patient on oral iron after transfusion of two units of blood is incorrect, because this patient doesn't warrant transfusion at this time, as she is asymptomatic other than mild fatigue. Thank you for listening to this week's episode of ASCO University Weekly Podcast. For more information on the treatment of gastric cancer, including opportunities for self-evaluation and board review, visit the comprehensive e-learning center at university.asco.org. [MUSIC PLAYING] The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care, and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.

What you'll hear: Why and how a career in classical music doesn’t have to be as narrow and limited as Choice A or Choice B   The most effective and powerful way to work through a personal or professional crisis   How putting so much emphasis and effort on the “big” events and moments of your life actually *creates* failure   The precarious spot you put yourself in when the only definition you have of yourself is “I’m a guy/gal who plays _______ (instrument)” (hint: you are so much more!)   … and much more More about Mark and 21CM.org: http://21cm.org/  https://music.depauw.edu/faculty-staff/  Mentioned on the show: http://project440.org/  http://www.mikeblockmusic.com/ http://www.awadagin.com/biography.htm  http://www.yo-yoma.com/ http://artofthepiano.org/  https://www.silkroad.org/posts/gmw-2017  Join the STARTING LINE CHALLENGE that starts Monday 12/11! https://www.facebook.com/groups/ccstartinglinechallenge/  I want to thank Ficks Music for sponsoring Crushing Classical. When you’re looking for high quality sheet music, look no further than  https://www.ficksmusic.com/discount/CRUSH Use the link above to get 10% off your order!  

Proverbs chapter 2 focuses on God’s Word as our protection and shield. We see the importance of choosing the right path over the appeal of the world’s path in every decision we make. God’s wisdom here is protection against the promise of easy money and easy love relationships. The choice we make brings either joy in life or a death-like existence. The world entices us to abandon the path of righteousness and to walk in dark carnality. The only way to discern a beguiling lie from life-giving Truth is to know the nuances of difference through God’s Wisdom offered in the inspired scripture.

Kevin and Sky discuss bear attacks, toddler fight clubs, Snooki delivers baby, and their original segment "Make a Choice"!