Podcasts about Churchwell

Former UCLA linebacker Josh Woods and Orange County Register reporter James H. Williams talk with defensive back Kenny Churchwell III. Churchwell spent six seasons with the football program and talks about his interactions with former head coach Chip Kelly and current head coach DeShaun Foster. Churchwell also talks about being the Bruin that had to lead the drills during the 2024 UCLA Pro Day and much more. Sign up for the free UCLA athletics newsletter New merch available: We have two shirts in the Bleav Network shop and part of the proceeds help support the podcast. Shirt No. 1: The I Bleav in UCLA Football Shirt No. 2: Bleav in UCLA football Interact with us:  Josh and James want your feedback and reactions to what you heard on the podcast. Feel free to share your thoughts with them: Josh Woods – Twitter | Instagram James H. Williams –Twitter | Instagram Follow the show's Twitter account – @BleavUCLA

Award-winning Author, Speaker and Animal Advocate Linda Churchwell joins the show to share her story of her prior life as a drug user and dealer. In her testimony, Linda tells us about the scariest moment of her life when two thugs showed up and demanded money and drugs. Then God stepped in and the rest, as they say, is history... 

Holy Eucharist Rite II

Torn N 2 with Gregory T. Roberts and Melvin Burns II with guests Louis Churchwell regarding mental health resources in underserved/African American communities.

Holy Eucharist Rite II

Holy Eucharist, Rite II

Holy Eucharist Rite II

Holy Eucharist Rite II

Holy Eucharist Rite II

Brandi Churchwell, 13th Juror Podcast, Conspiracy in Canton series discussing John O'Keefe/Karen Read case. --- Support this podcast: https://podcasters.spotify.com/pod/show/theyoungjurks/support

Holy Eucharist Rite II

This week we look at technology's effects on the future of work and how it's shifting the job market. How can we think through the human need based on the Christian vision of a person, while also seizing opportunities in an increasingly changing market?   Resources Referenced Book: Knowing God's Will Book: The Call Acton.org Connect with Dan Churchwell: Twitter | Dchurchwell@acton.org   Thanks To Our Sponsors We love the Pour Over and we think you will too! The Pour Over provides concise, politically neutral, and entertaining summaries of the world's biggest news paired with reminders to stay focused on eternity. Subscribe in just one click...click here! -- One of the best ways to support the show is by becoming a Patron. Your support helps us continue producing this show. Follow us on social: Instagram Twitter Editing and support by The Good Podcast Co. If you would like to sponsor this show, email sponsor@thegoodpodcast.co

Holy Eucharist Rite II

Holy Eucharist Rite II

Holy Eucharist Rite II

On today's episode hear from Entrepreneur Extraordinaire Yolanda Churchwell as she shares key systems and  practices that every entrepreneur needs to implement in order to sustain a high level of success!  Her company the Business Assistance Group provides done-for-you support, to strategy, to structure creations and implemention.  Allowing you to focus on keeping the main thing the main thing while she assures your behind the scenes success is in the BAG!  Be sure to connect with Yolanda on linkedin And for more on the Women Leaders Association and how you can get involved with a chapter near you, head over to womenleaderspodcast.com 

Holy Eucharist Rite I

Extra - Extra hear all about it Entrepreneurs!Tomorrow at 11:00 AM EST, on the Kim Jacobs Show, Kim will be talking with Yolanda K. Churchwell, the System Solutionist and CEO of The Business Assistance Group, 3x Bestselling Author, Certified Launch Manager, and Certified DISC Profile Analyst.Ms. Churchwell sees herself as a disrupter of the status quo and desires to help small business entrepreneurs take the hassle out of their hustle so they can make more money and have more free time. Whether a solopreneur or a CEO leading a team, her company The Business Assistance Group helps you scale your business by shifting from a list of things to do to having things done for you.You will also hear from Dr. Jo Dee Baer, our episode sponsor, about Summertime Health!Subscribe now and turn your notifications to all to receive an alert when we go live!HTTPS://YouTube.com/kimjacobsshowTo learn how you can start your own show from scratch visit: https://l.facebook.com/l.php?u=http%3A%2F%2FKimjacobsconsulting.com%2F%3Ffbclid%3DIwAR2PMS6egOI1kYpF6uf3EiQLn0mBIL_qJthg_JGsnZSBPUCR5yYb8hXlBp8&h=AT1ql79mOVKjoYhquBrn9rR5Rs_w-9dJ66I64qvhFflpyalMDIYcFZ2sxqE4502i7GfpLSQRO9ENSKBcvPC0NFDWpG8o4VpiXF5BhluqAZMZvt0kjky5wntq7Jf1BG3uvdayVAt81QNAxUEIVkENaQo&__tn__=-UK-R&c[0]=AT01_cmLXTGbM1jw9whJJCc4OR_7t_UY6sadmWeuEeqw28QlChfGl8aaRqjtKVHBsE4YWfoMjpxT9kd4u4xfaw7vhzEQXH0apImFsDxaTsbuM4iKsbn8FrdUQDNoeQLvSiC2wQD6_QIDRuHsp3TJTMtrAZtPSNo9OZbeWB4kZ5PjgXt8zgCJLisR9yFUduuMRVBzUhrv0T_eYrh0-1EE_Fc or call 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Holy Eucharist Rite II

Holy Eucharist Rite II

Holy Eucharist Rite II

Holy Eucharist Rite II

Holy Eucharist Rite II

Holy Eucharist Rite II

Holy Eucharist Rite II

This week, please join author Xuerong Wen, Associate Editor Sandeep Das, and Guest Host Mercedes Carnethon as they discuss the article "Comparative Effectiveness and Safety of Direct Oral Anticoagulants and Warfarin in Patients With Atrial Fibrillation and Chronic Liver Disease: A Nationwide Cohort Study." Dr. Carolyn Lam: Welcome to Circulation on the Run, your weekly podcast summary and backstage pass of the journal and its editors. We're your co-hosts. I'm Dr. Carolyn Lam, associate editor from the National Heart Center and Duke National University of Singapore. Dr. Greg Hundley: And I'm Dr. Greg Hundley, associate editor, Director of the Poly Heart Center at VCU Health in Richmond, Virginia. Dr. Carolyn Lam: Greg, I'm so excited about today's feature paper. It deals with the important condition where atrial fibrillation exists in patients with chronic liver disease and what do we do for anticoagulation in these patients. It's a comparative effectiveness and safety study of direct oral anticoagulants compared with warfarin in these patients. A huge, wonderful, important study that we're going to discuss. But before we get there, I'd like to tell you about some papers in this issue and I'd like you to tell me about some too. You got your coffee? Dr. Greg Hundley: Absolutely. Dr. Carolyn Lam: All right. I'll go first In this paper that describes a quantitative prognostic tool for the mitral valve prolapse spectrum and it's derived from the new mitral regurgitation international database quantitative or MIDA-Q registry, which enrolled more than 8,000 consecutive patients from North America, Europe, Middle East. And these were patients all diagnosed with isolated mitral valve prolapse or MVP in routine clinical practice of academic centers, all of which also did prospective degenerative mitral regurgitation quantification. The MIDA-Q score was calculated based on characteristics collected in routine practice combining the established MIDA score, which integrated guideline based markers of outcomes like age, New York Heart Association status, atrial fibrillation, LA size, pulmonary artery pressure left ventricular and systolic, I mentioned, and ejection fraction. Integrating that with scoring points based on the degenerative mitral regurgitation quantitation that is measuring effective regurgitant orifice and volume. Dr. Greg Hundley: Very interesting Carolyn. So a scoring system that combines clinical information with what we might assess with echocardiography like regurgitant volume or regurgitant orifice area. So how well did this mortality risk score perform? Dr. Carolyn Lam: So the new score was associated with an extreme range of predicted survival under medical management and that ranged from 97% to 5% at five years for the extreme score ranges. And it was strongly, independently and incrementally associated with long-term survival over all the markers of outcomes. So the authors concluded, and these by the way were authors led by Dr. Maurice Serrano from Mayo Clinic, Rochester, Minnesota. These authors concluded that the score should allow integrated risk assessment of patients with mitral valve prolapse to refine clinical decision making in routine practice and ultimately reduce degenerative mitral regurgitation under treatment. Dr. Greg Hundley: Wonderful description Carolyn. Well I'm going to switch to the world of electrophysiology, Carolyn. And so as you know, the Brugada syndrome is an inherited arrhythmia syndrome caused by loss of function variants in the cardiac sodium channel gene SCN5A and that occurs in about 20% of subjects. And these authors led by Dr. Dan Roden at Vanderbilt University School of Medicine identified a family with four individuals diagnosed with Brugada syndrome, harboring a rare missense variant in the cardiac transcription factor, TBX5, but no SCN5A variant. And upon identifying these individuals, their objective was to establish TBX5 as a causative gene in Brugada syndrome and to define the underlying mechanisms by which it would be operative. Dr. Carolyn Lam: Oh wow. So a new gene variant. So what was the relationship? Dr. Greg Hundley: Right Carolyn? So using induced pluripotent stem cell derived cardiomyocytes from members of the affected family, multiple electrophysiologic abnormalities were detected in these cardiomyocytes including decreased peak and enhanced late cardiac sodium current. In these cells these abnormalities were entirely corrected by CRISPR/Cas9 mediated editing of that TBX5 variant and transcriptional profiling and functional assays in unedited and edited pluripotent stem cell derived cardiomyocytes showed direct SCN5A down regulation caused decreased peak sodium current and that reduced PDGF receptor expression and blunted signal transduction to phosphoinositide-3-kinase. And interestingly, PDGF receptor blockade markedly prolonged normal induced pluripotent stem cell derived cardiomyocyte action potentials. And also Carolyn interestingly in this study they did a separate analysis. It reviewed plasma levels of PDGF in the Framingham Heart Study and they found that they were inversely correlated with the QT corrected interval. And so Carolyn, these results established decrease SCN5A transcription by the TBX5 variant as a cause of Brugada syndrome and also reveal a new general transcriptional mechanism of arrhythmogenesis of enhanced late sodium current caused by reduced PDGF receptor mediated phosphoinositide-3-kinase signaling. Dr. Carolyn Lam: Wow. Wow, that's significant. Thanks Greg. So this next paper is also really important and could change the practice in the field of cardiac resynchronization therapy or CRT. You see, it suggests that the practice of what we do now, which is combining right bundle branch block with intraventricular conduction delay patients into a single non-left bundle branch block category when we select patients for CRT, that this may not be the way to go. So let's go back a bit and remember that benefit from CRT varies with QRS characteristics and individual trials are actually underpowered to assess the benefit for relatively small subgroups. So the current authors led by Dr. Friedman from Duke University Hospital and colleagues, therefore performed a patient level meta-analysis of randomized trials of CRT to assess the relationship between QRS duration and morphology with outcomes. Dr. Greg Hundley: Very interesting Carolyn. So another wonderful paper from the world of electrophysiology in trying to understand optimal mechanisms to resynchronize the ventricle in patients with differing bundle branch blocks or intraventricular conduction delays. So what did they find? Dr. Carolyn Lam: They found that patients with intraventricular conduction delays and a QRS duration of 150 milliseconds or more, CRT was associated with lower rates of heart failure hospitalizations and all cause mortality. The magnitude of CRT benefit among these patients with the interventricular conduction delay of 150 milliseconds or more and those with the left bundle branch block of 150 milliseconds or more were similar. In contrast, there was no clear CRT benefit for patients with a right bundle branch block of any QRS duration, although the authors could not rule out the potential for benefit at a markedly prolonged QRS duration. So they concluded that the practice of combining right bundle branch block with intraventricular conduction delay patients into a single non-left bundle branch block category when we make patient selections for CRT is not supported by the current data. And in fact, patients with an intraventricular conduction delay of 150 milliseconds or more should be offered CRT as is done for patients with a left bundle branch block of 150 milliseconds or more. Dr. Greg Hundley: Wow, Carolyn, so really interesting point. No clear CRT benefit for patients with right bundle branch block regardless of the QRS duration. Well we've got some other articles in the issue. I'll describe a couple from the mail bag. There's a Research Letter from Professor Lassen entitled "Risk of Incident Thromboembolic and Ischemic Events Following COVID-19 Vaccination Compared with SARS-COV2 Infection." Also Bridget Kuhn has a wonderful Cardiology News piece entitled "Collaborative Care Model Helps Heart Failure Patients Meet End-of-Life Goals." Dr. Carolyn Lam: There's an exchange of letters between Doctors Donzelli and Hippisley-Cox regarding that risk of myocarditis after sequential doses of COVID-19 vaccine, there's an AHA Update by Dr. Churchwell on continuous Medicaid eligibility, the lessons from the pandemic. There's an On My Mind paper by Dr. Parkhomenko on Russia's war in Ukraine and cardiovascular healthcare. Wow, what an issue. Thanks so much, Greg. Shall we go on to the feature discussion? Dr. Greg Hundley: You bet. Dr. Mercedes Carnethon: Well welcome to this episode of Circulation on the Run podcast. I'm Mercedes Carnethon, associate editor of the journal Circulation and Professor and Vice Chair of Preventive Medicine at the Northwestern University Feinberg School of Medicine. I'm very excited to be here today with Xuerong Wen and Sandeep Das, my fellow associate editor here at Circulation to talk about a wonderful piece by Dr. Wen and colleagues from the University of Rhode Island. So welcome this morning Xuerong and thank you so much for sharing your important work with us. Dr. Xuerong Wen: Thank you Dr. Carnethon. It was great meeting you all and I'm the Associate Professor of Pharmacoepidemiology and Health Outcomes at the University of Rhode Island. I'm happy to introduce my study to everyone. Dr. Mercedes Carnethon: Well thank you so much and thank you as well Sandeep for identifying this fantastic article and bringing it forth. Dr. Sandeep Das: Thanks Mercedes. It's great to be with you. Dr. Mercedes Carnethon: Great. Well let's go ahead and get into it. There's so much here to talk about. So Dr. Wen and colleagues studied the comparative effectiveness and safety of direct oral anticoagulants or DOACs and warfarin in patients with atrial fibrillation and chronic liver disease. So this is such an important topic. Can you tell us a little bit about what your study found? Dr. Xuerong Wen: So our study is a comparative effectiveness and the safety analysis using a national health administrative data from private health plans. So we compared the risk of hospitalized ischemic stroke, systemic embolism and major bleeding between DOACs and warfarin in patients with atrial fibrillation and chronic liver disease. So we also had to had compare to these primary outcomes between apixaban and rivaroxaban in the study population. So our studies show that among patients with atrial fibrillation and chronic liver disease, DOACs as a class was associated with lower risk of hospitalization of ischemic stroke and systemic embolism and major bleeding, compared with warfarin. And when compared risk outcomes between individuals apixaban has lower risks as compared to rivaroxaban. So that's our study results. Dr. Mercedes Carnethon: Well thank you so much. This seems like such an important question. We hear a lot about DOACs and some of their risks as well as their considerable benefits. I think what leaves me the most curious is why did you choose to pursue this question and in particular in patients with both atrial fibrillation and liver disease. So why was the intersection of these two particular conditions of interest to your study team? Dr. Xuerong Wen: That's a great question. So the liver actually plays a central role in both the synthesis of coagulation factors and the metabolism of anticoagulant drugs. And the clearance of the anticoagulants in liver ranges from 20% to 100% for DOACs and warfarin. So in clinical practice anticoagulation abnormalities and elevated risk of spontaneous or unprovoked venous thrombotic complications have been reported in patients with liver disease. While these patients with cirrhosis were excluded from the clinical trials of DOACs and also population based, the real world experience is very limited. So that is why we initiated this retrospective cohort study and based on the real world data in this specific population. Dr. Mercedes Carnethon: Oh, thank you so much for explaining that. I definitely learned a lot and really enjoyed reading the piece. I think it was very well organized and well written and I know that our readership will appreciate it. It obviously stood out to you as well, Sandeep. Can you tell me a little bit about why you thought that this would be an excellent piece for circulation? Dr. Sandeep Das: Yeah, absolutely. Thanks for the question. So in the broad field of what we call observational comparative effectiveness research, so basically that's using large observational data sets to try to answer important clinical questions and it's a really challenging thing to do. I mean we're all very familiar with the idea of using randomized trials to assess important clinical questions because of the structure of that design allows you to mitigate some of the effects of confounding. Here, it has to be done analytically. So what's the important factor that really drives you towards a great observational comparative effectiveness piece? So first the clinical importance. I feel a little guilty because I'm old enough to remember when warfarin was the only option available, but really as a clinician, or every patient, I really prefer DOACs over warfarin just for ease of use and lifestyle. So there's a huge sort of importance to the question. Second, the patients with chronic liver disease were excluded from the larger RCTs and the DOAC trials. So really we don't have the answer to the question already. It's an important question. Obviously the bleeding risk is tied up with the liver, warfarin directly antagonizes vitamin K, so there's real questions about safety and so this is the perfect storm and then on top of it was a really well done and well executed study. So when this came across my desk, the very first thing I thought was not, "Is this something that we're interested?" But rather, "How do we make it better? How do we make it more useful to the reader?" This had me from hello. Dr. Mercedes Carnethon: Well thanks so much. We rarely have the opportunity when we read an article to be able to ask the authors questions. So Sandeep, I know that you had mentioned that you had some follow up questions as well. Dr. Sandeep Das: Yeah. So the real thought that I have then is would you argue based on this that we know enough that we should change our practice? And that do you feel comfortable advocating that people now prescribe DOACs to these patients? Dr. Xuerong Wen: I would say yes. Okay. Although this is not a clinical trial, but our study is actually systematically compare the effectiveness and safety between DOAC users and also the warfarin users. And if you look at our table one, we compare with so many variables between these two users and we use the propensity score adjustment and we after propensity score weighting and the two control group almost balanced. And I know right now FDA actually suggested that emulate the trial using the large real world data to do the emulated trial. So our study actually conducted is based on the large population using large data and we use the propensity score weighting to control all this potential compounding factors. Although there are still some limitations in this study. I think we mentioned that in the discussion section and we discussed all potential compounding factors that still may exist. And also there are some misclassifications and out of all this limitations and we still found the two drugs performed differently in this specific population. So we feel that comfortable to say that a DOAC drug performs better than warfarin. And also I think based on other studies that based on the clinical trial in the general population, DOAC drug is performs much better than warfarin and considering that the clearance in liver for DOAC is less than warfarin. So plus all this information together, I think DOAC may be safer than wafarin in the patients with AF and chronic liver disease. Dr. Sandeep Das: Yeah, I would say that I agree that these data, even if you're skeptical about observational CT generally, which I admit that I tend to be, these are really reassuring data that at least the DOACs are... There's absolutely nothing that suggests that they're any worse than warfarin and all of the sort of soft indications for ease of use and patient happiness really would seem to favor DOACs. So I think this is the sort of rare observational CT paper that may actually change my practice. Dr. Mercedes Carnethon: I have a follow-up question, Xuerong, related to the design and as well your strategy to address differences between the groups. So inverse probability weighting is certainly a standard in the field to be able to manage differences between groups when you have a situation where can't, where it's not a randomized trial. Do you as well, and educate me, I admit I'm an epidemiologist whose methodological skills are sometimes challenged. Do you have the opportunity using this design and with inverse probability weighting to evaluate subgroup effects? So my specific question is were you able to determine whether or not these associations were similar based on age and gender in particular? Dr. Xuerong Wen: That's a great question. We did conducted a lot of subgroup study but not by age or gender. We conducted I think this study in a lot of subgroups using the propensity score weighting, but the subgroup that I think we did a subgroup like a patient with a different chronic liver disease. So that's what we did. And we also tested different methods inverse probability score weighting. So we did trimming and we used a different percentage of trimming and to see how that affect the study results. So we have done a lot of subgroup studies. We did not check the age and the gender, but that's a very good point. Maybe later, well I'll ask my student to do that. Dr. Mercedes Carnethon: Well, you're a good mentor. So I think that is a really certainly an appropriate approach. Sandeep, did you have additional questions? Dr. Sandeep Das: No, I wish I had thought of yours before you did. I think exactly the older age, women, racial ethnic groups that are underrepresented historically in trials. I think that that's really, again, the sweet spot of this observational research. We definitely, and NH definitely working on trying to increase enrollment of all these groups in our CTs. However, while we wait for that, I think that's exactly what we should be doing. Dr. Mercedes Carnethon: Well that's great. And Xuerong, you really alluded to really, I think what is one of my final questions related to what do you think based on what you have observed in this study, what do you see as the next steps in the research field for your team, your students, or other people who are carrying out this type of work? Dr. Xuerong Wen: Well, that's a great question. We currently have a couple of more manuscripts ongoing in this field, and we will continue conducting the comparative effectiveness and analysis to compare drugs head to head as well as developing and implementing new methodologies to this field. And we hope our study provides real world evidence for clinical decision making, prescribing anticoagulants to patients with atrial fibrillation and chronic liver disease. We also expect the physicians and researchers more and more value the real world data studies, especially when clinical trials are not feasible or ethical. Dr. Mercedes Carnethon: Well, thank you so much. That was such an excellent vision that you provided us with and we're just very grateful that you submitted this fantastic work to the journal Circulation. I know that our readers will enjoy really digging in. The podcast is meant as a teaser to bring you to the journal so that you can read about this wonderful work by Dr. Wen and colleagues. So again, thank you. I'm Mercedes Carnethon, joined with my associate editor partner here, Dr. Sandeep Das. And thank you very much for spending your time with us today, Dr. Wen. Dr. Xuerong Wen: Thanks for this great opportunity to disseminate my study with us, thank you. Dr. Sandeep Das: Thanks Mercedes. Dr. Mercedes Carnethon: Thank you for joining us for this episode of Circulation on the Run. Dr. Greg Hundley: This program is copyright of the American Heart Association 2023. 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, please visit ahajournals.org.

Holy Eucharist Rite II

Holy Eucharist Rite II

Holy Eucharist Rite II

Holy Eucharist Rite II

Holy Eucharist Rite II

Holy Eucharist Rite II

Holy Eucharist Rite II

Holy Eucharist Rite II

CHANGING THE GAME Through Real Estate EP:28 #housingcrash2022 #commercialrealestate #ccim #howtogetintocommercial This Week on the podcast we had the opportunity to talk to Timothy Churchwell president of CCIM Mid Atlantic, Director of Exit Commercial Department. In this episode Tim talked about the federal reserve and how high interest rates will go, what is the best investment in real estate that NOONE is talking about. He broke down in detail the process for a commercial property and how it differs against residential properties. If you looking to get into commercial real estate and DO NOT KNOW WHERE TO START THIS IS THE EPISODE FOR YOU!! *****DISCLAIMER**** I AM NOT A CPA, ATTORNEY, INSURANCE, CONTRACTOR, LENDER, OR FINANCIAL ADVISOR. THE CONTENT IN THESE VIDEOS SHALL NOT BE CONSTRUED AS TAX, LEGAL,INSURANCE, CONSTRUCTION, ENGINEERING, HEALTH OR SAFETY, ELECTRICAL, FINANCIAL ADVICE, OR OTHER AND MAY BE OUTDATED OR INACCURATE; IT IS YOUR RESPONSIBILITY TO VERIFY ALL INFORMATION YOURSELF. THIS IS A PODCAST AND YOUTUBE VIDEO FOR ENTERTAINMENT PURPOSES ONLY

Holy Eucharist Rite II

Tom Riello talked about pro abortion ads at  the end of prolife videos on Youtube. Dan Churchwell discussed his article, "The screen is not your master" and Catherine Bauer shared about the mission of the Fairfield Carmelites. 

Holy Eucharist Rite II

Holy Eucharist Rite II

Holy Eucharist Rite II

Welcome to August on The B-Word!! I'm starting this month off with a bang bringing in two of my new besties to talk about "building an empire in high heels"...meaning how you really can have it all; family, career, business success and FUN while you're doing it! These are two powerhouse Real Boss Women; Linzee Ciprani with Ciprani Consulting & Amanda Churchwell from Hello Leverage. We dive into the highs, lows & most of all the 'how's' of starting & scaling a business without compromising any parts of yourself or other areas of your life that women need to be fulfilled  & thriving.This episode was actually inspired by Episode 42 of the B-Word  in June 2022 "Beach Hair Don't Care!"  Check it out as well. This highly engaging and candidly honest conversation about how they built their empires, the struggles they faced and the successes they saw is eye-opening for women CEOs. I hope you enjoy it, and if you do - to help even more  women find The B-Word please leave a review. Click here, scroll to the bottom, tap to rate with five stars, and select “Write a Review.”  Plus, I'd love to see you screen shot it and tag me on Instagram @realbosswomen.  There's a super big chance I'll respond and that an Amazon gift card thanks will follow! ;) Cheers,~JoanneMeet Amanda & Linzee:Amanda Churchwell founded Hello Leverage, formerly The Churchwell Group, in 2012 to assist Realtors with transaction coordination; adding a listing coordination division in 2014 and marketing services in 2017.  With many years of experience as a Realtor herself, she knows the intricate details involved in a Real Estate transaction. Her extensive background in customer service and sales drive her passion for connecting with other professionals and building a strong rapport quickly. Her experience includes not only selling real estate, but also broker compliance, training new agents and assisting with brokerage office management.Amanda created the company out of the desire to work from home to improve the quality of life for her family, and she quickly realized that she could share this same opportunity with other talented professionals – and this is what gets her up every day!   This drive is what earned her company the Entreleadership Momentum Award from Ramsey Solutions in 2019.Linzee Ciprani , Founder & CEO of Ciprani ConsultingLinzee has been in the real estate world since 2010. Her career path has taken her from an admin role for one of the country's top agents to leading her own $40M real estate team, and most recently merging her team with the Matt Fetick Team to create the #1 team in their area with both sides & volume. More importantly, Linzee is the Founder & CEO of Ciprani Consulting, the country's top real estate recruiting and training company. She and her husband Steve have hired and trained more real estate professionals than anyone else in the industry. Linzee is the systems guru, co-host of The Leader Equation podcast, a fierce business woman and a devoted wife and mother to two beautiful girls named Emerson aDoors have opened for the chic clique and I've got a seat reserved for YOU. Head on over to check it out and grab your key to the group. If you're a Realtor with less than 3 years in the business, or you're closing less than 8 transactions a year-this is a must-do for YOU. https://www.realbosswomen.com/chic-clique-mastermind

Yesterday's recording was just a preview. Here is the full interview.Linda Churchwell has quite a resume: Real Estate investor, Kingdom Entrepreneur, President of LJC Home Solutions, award-winning author, speaker, animal advocate and former drug dealer. In our interview, Linda bravely tells the story of how her former life dealing drugs brought her dangerously close to getting killed. Then, God stepped in...

Linda Churchwell is an award-winning author, speaker, animal advocate and former drug dealer. In our interview, Linda bravely tells the story of her former life dealing drugs, including how it almost cost her her life. And we learn the power of God when He stepped in, saved her and redeemed her. 

This week, please join author Fabian Eichelmann and Associate Editor Svati Shah as they discuss the article "Deep Lipidomics in Human Plasma: Cardiometabolic Disease Risk and Effect of Dietary Fat Modulation." Dr. Carolyn Lam: Welcome to Circulation on the Run, your weekly podcast, summary and backstage pass to the journal and its editors. We're your co-hosts. I'm Dr. Carolyn Lam, Associate Editor from the National Heart Center and Duke National University of Singapore. Dr. Greg Hundley: And I'm Dr. Greg Hundley, Associate Editor Director at the Pauley Heart Center at VCU Health in Richmond, Virginia. Well, Carolyn, this week's feature, we are going to get into the world of lipidomics and understand how some lipid metabolites may be more predictive of cardiovascular events above and beyond the conventional serum lipoproteins, like HDL and LDL. But before we get to that, how about we grab a cup of coffee and start with some of the other articles in the issue? Would you like to go first? Dr. Carolyn Lam: Sure thing. This first paper is about the basilar artery. Have you ever heard the analogy that the basilar artery is the neurologists' equivalent of our cardiologists' left main coronary artery? Well put, isn't it? Well, that's from the editorial that accompanies this paper, but basically, occlusion of either artery can be fatal without rapid re-perfusion. So that's why the basal artery is the neurologists' left main coronary artery. Re-perfusion therapies for acute basilar artery occlusion include thrombolysis or mechanical endovascular thrombectomy. Dr. Carolyn Lam: In today's issue, Professor Hu from University of Science and Technology of China, and Professor Nogueira from University of Pittsburgh School of Medicine in the US, these are the co-corresponding authors, and their colleagues, reported the outcome of the attention registry of more than 2000 patients with acute basilar artery occlusion who enrolled prospectively and consecutively at 48 sites in China from 2017 to 2021, and followed for the primary outcome of a favorable neurological functional outcome defined as a modified Rankin score of zero to three at 90 days. Dr. Greg Hundley: Wow, Carolyn, I love that analogy. So the basilar artery is kind of similar in the brain to the left main coronary artery in the heart. Whoa, what did they find here? Dr. Carolyn Lam: So, in this nationally representative observational study, the authors found a significant association between endovascular thrombectomy and better functional outcomes and survival at 90 days in patients with acute basilar artery occlusion, and this was compared to chemical thrombolysis. Now, notably, this relationship was modified by the baseline NIH stroke scale. Specifically, patients with baseline NIH stroke scale of 10 or more had an increased rate of favorable outcome when treated with endovascular thrombectomy, whereas no significant beneficial effect was seen in patients with baseline NIH stroke scores of less than 10. Now, all this is discussed in a beautiful editorial by Dr. Hankey, entitled, "Endovascular therapy for acute basilar artery occlusion." Dr. Greg Hundley: Oh, beautifully stated, Carolyn. What a great article. But guess what, Carolyn? I've got a quiz for you. Dr. Carolyn Lam: Uh-oh. Dr. Greg Hundley: This one's open answer, so it's not multiple choice. Can you name a unique feature of zebra fish pertinent to the study of cardiovascular disease? Dr. Carolyn Lam: Okay. Watch me hedge there because, first of all, I'm a daughter of a zoologist. So my dad would have a heart attack if I couldn't say something about the zebra fish. So, what I do know is the zebra fish is an excellent animal model for genetic studies of heart generation, basically development. So, there must be something really cool there about how we can observe that. Dr. Greg Hundley: Excellent, Carolyn. So very well done. As you know, and your dad knows, certain non-mammalian species like zebra fish, have an elevated capacity for innate heart regeneration. Now, understanding how heart regeneration occurs in these contexts can help illuminate cellular molecular events that can be targets for heart failure prevention or treatment, your area of expertise. The epicardium, the mesothelial tissue layer that encompasses the heart, is a dynamic structure that is essential for cardiac regeneration in zebra fish, and these authors, led by Dr. Jinhu Wang from Emory University performed single cell RNA sequencing and identified seven epicardial cell clusters in adult zebra fish, three of which displayed enhanced cell numbers during regeneration. Dr. Carolyn Lam: Oh, interesting, Greg. So did these cell clusters provide some clues that could be applied clinically? Dr. Greg Hundley: Yes. Carolyn. So these authors identified that these subsets of epicardial cells emerge in post embryonic, zebra fish and sponsor regions of active cardio myogenesis during cardiac growth and regeneration. And as the heart achieves its mature structure, these cells facilitate extracellular matrix hyaluronic acid deposition to support formation of the compact muscle layer of the ventricle. These cells associate with the function of the hyaluron and proteoglycan link protein 1 or HAPLN1 paralogue in production and organization of hyaluronic acid containing matrix in cardiac injury sites and thereby enable normal cardiomyocyte proliferation and muscle generation. And so Carolyn, potentially in the future targeting hyaluronic acid regulation by manipulation of HAPLN1 in human epicardial cells could potentially modulate cardiac repair after myocardial infarction. Dr. Carolyn Lam: Well, thanks, Greg. That was awesome. Well, the next paper I want to tell you about is one in which a novel ECG based machine learning approach was used to determine and predict multiple structural heart conditions. So the authors led by Dr. Chen from Department of Translational Data Science and Informatics at the Geisinger Health System in Danville, Pennsylvania. So these colleagues hypothesized that a composite model would yield higher prevalence and positive predictive value to facilitate meaningful recommendations for echocardiography. Dr. Greg Hundley: Oh wow, Carolyn. Machine learning, it's just emerging everywhere these days. So don't we need a large data set to do this? Dr. Carolyn Lam: Absolutely, and listen to how large this is. So using more than 2.2 million ECGs linked to electronic health records and echocardiography reports from almost 500,000 adults between 1984 and 2021, the authors trained machine learning models to predict the presence or absence of any of seven echo confirmed diseases within a year, and the composite model and the composite label that they used included moderate or severe valve disease and reduced ejection fraction. So their composite recommend model where reco is E-C-H-O we used age, sex ECG traces, and had an area under the receive operating curve of 0.91 and a positive predictive value of 42% at 90% sensitivity with a composite label prevalence of 17.9%. Whereas the individual disease models had area under curve ranging from 0.86 to 0.93 and lower positive predictive values from about 1% to 31%. Dr. Carolyn Lam: So in summary, they showed that an ECG based machine learning model using a composite endpoint can identify a high risk population for having undiagnosed clinically significant structural heart disease while outperforming the single disease models and improving practical utility with higher positive predictive values. So this approach may facilitate targeted screening with echo to improve under diagnosis of structural heart disease. Dr. Greg Hundley: Wow, Carolyn, really great article from the world of machine learning. Well, how about we jump to some of the other articles in the issue and I can go first. There are two Research Letters. The first Research Letter comes from Professor Adlam entitled "Pregnancy and Spontaneous Coronary Artery Dissection Lessons from Survivors and Nonsurvivors." And our own Dr. Joe Hill, our Editor-in-Chief also has a Research Letter entitled “Impaired AMP Kinase Signaling in HFpEF Associated Atrial Fibrillation.” Dr. Carolyn Lam: Wow, what an issue filled with great stuff. There's an AHA update by Dr. Churchwell on promoting nutrition security through policies and programs. And there are highlights from the circulation family of journals by our own Molly Klemarczyk, now known as Molly Robbins. I'd love to tell you a little bit about it. The association of new onset AF with cardiovascular outcomes in patients hospitalized with COVID-19 are described in Circ Arrhythmia, and EP. Rates of cardiovascular and cerebral vascular disease mortality among Asian subgroups are presented in Circ CV, Quality and Outcomes. Blood pressure and glycemic control are presented in patients with heart failure in Circ Heart failure. The associations of atrial update with technetium 99 pyrophosphate scans for transthyretin amyloid cardiomyopathy with incident atrial fibrillation and possibly earlier diagnosis of amyloid is presented in Circ Cardiovascular Imaging. Dr. Carolyn Lam: And finally the outcomes associated with larger burdens of residual thrombus after aspiration thrombectomy for STEMI are presented in Circ CV Interventions. Isn't that cool? And finally, we've got an On My Mind paper by Dr. Arany on “It's Time to Offer Genetic Testing to Women with Peripartum Cardiopathy”. So that wraps it up, Greg. Let's go to our feature discussion, shall we? Dr. Greg Hundley: You bet. Dr. Greg Hundley: Welcome listeners to this feature discussion on July 5th, and we are very fortunate today. We have with us Dr. Fabian Eichelmann from the German Institute of Human Nutrition in Potsdam, Germany, and our own associate editor, Dr. Svati Shah from Duke University in Durham, North Carolina. Welcome to you both. Fabian, we're going to start with you. Can you describe for us some of the background information that went into the preparation of your study and what was the hypothesis that you wanted to address? Dr. Fabian Eichelmann : Yeah, sure. So first of all, thanks for the invitation to speak here. So this project was basically comes from a collaboration between us and a group in Redding, UK and we are part of a consortium called FAME, which is short for fatty acid metabolism. And there, we are interested in the health effects of fatty acid metabolism in general. And in this paper that we did, this was particularly cardiometabolic diseases. And I think this is no surprise that we look at lipid metabolism in this context, because there's so many really now also causal factors, lipoproteins, total triglycerides for specific cardiometabolic outcomes. So this is the reason why we wanted to look at it. And through this collaboration, we were also able to harness the potential from two different study designs that I probably will go into later, but which really gave us an opportunity to really generate I think, quite interesting insights. Dr. Greg Hundley: Very nice. And so what was that hypothesis? Dr. Fabian Eichelmann: So the hypothesis was that since the lipid metabolism has formally only been mostly in the clinic, at least been measured by lipoproteins and total triglycerides, for example, but the lipidome of plasma, for example, is really rich. It's really heterogeneous and it contains many different lipid classes and different fatty acids. And through novel technologies and in this case, lipidomics, you can really dive in really deeply and look at this in a specific manner. And then the idea was to really look at this and potentially identify lipids that would be associated or could surface as biomarkers for cardiometabolic diseases and at the same time, if those lipids were also sensitive to a dietary intervention that really tried to modulate the dietary intake of a fat. Dr. Greg Hundley: Very nice. And so how did you set this up? What was your study design and what was your study population? Dr. Fabian Eichelmann: So we had two different study populations for this. So the first one was the EPIC-Potsdam, which is a cohort study, a large scale cohort study here in Potsdam, which started in the nineties. And there, we basically associated baseline concentrations of these lipid measurements with later on occurring incident cardio metabolic outcomes. And in this case, this was type two diabetes and primary CVD and CVD in our case meant myocardial infarction and stroke. And we did that we checked which lipids would be statistically significantly associated after multiple testing with at least one of these outcomes. And then we took those lipids further into intervention trial, which is called the DIVAS trial in Redding, as I said, UK. And there, they had basically a dietary intervention trial that really wanted to assess if the change in the fatty acid proportions in the diet affects the lipids. So there we had the lipidomics measurements at baseline and after four months, and then we compared three different trials to each other. Dr. Greg Hundley: Very nice. And so how many patients did you include and who were these patients? Men and women? And did they have, for example, prior cardiovascular disease? Dr. Fabian Eichelmann: So in EPIC-Potsdam, that's a population based cohort study. All of the participants were drawn from the registries and invited. So these were apparently healthy people. And in those we did these association analyses and those we used the design, which is a case cohort design, which is a sub sample of the whole cohort, which is a really effective way and efficient way of analyzing biomarker projects. And there we had in total 1,262 control participants, and then later on additionally, a 775 type two diabetics and 551 CVD cases. In the DIVAS trial, that was a trial where participants also men and women, which was also the case in EPIC-Potsdam were invited, and they were at a higher risk of at the higher cardiovascular disease risk, which was measured by score, but they didn't have any prior cardiovascular diseases. And those were 113 participants that were randomized to one of these diets. Dr. Greg Hundley: Right. So it sounds like two studies. One, a large case control study and looking at different plasma lipid concentrations in two separate groups. And then the second was a randomized trial, a smaller trial of 113 individuals looking at a dietary intervention. So with that established, tell us your study results. Dr. Fabian Eichelmann: Yeah. So in the first step, as I said, where we associated lip concentrations to later occurring disease, we found from the 282 lipids that we looked at, 69 were really associated to at least one of these outcomes. And interesting here we saw that only eight were associated to both outcomes and 49 were specific to cardiovascular disease and 12 for specific to type two diabetes. And from those 69, we found 19 were also sensitive to the dietary intervention, and what was really striking here was that of these 19, 17 were perfectly in agreement with a suggested beneficial effect, meaning that those lipids that were associated in the EPIC-Potsdam studies on the cohort study with a higher disease risk were reduced by these diets or in the opposite direction, we saw those lipids that were associated with lower risk were increased by these diets. So this was quite a striking observation there. Dr. Greg Hundley: So it sounds like from the lipidomics analysis, there was a construct of certain blood lipid markers that were associated with cardiovascular events, and then in your randomized trial, you were able to modify those by different dietary interventions? Dr. Fabian Eichelmann: Exactly. Dr. Greg Hundley: So listeners, now we're going to turn to our own associate editor, Dr. Svati Shah. And Svati, you see many papers come across your desk. What attracted you to this particular paper and how do we put this study's results in the context with other studies that have been published in really the sphere of lipidomics research? Dr. Svati Shah: Yeah. Thank you, Greg. I just want to point out that this is a really elegant translational study. I think these papers can be very complicated to understand, and I think the authors did a fantastic job of really laying out how you can combine cutting edge what we call omics, using these cutting edge technologies, but applying them to human cohorts with a very strong clinical lens. So it's not just what do we learn about biology, but also what do we learn about biomarkers that might be relevant to how we take care of patients? And that's really one of the biggest things I loved about this study is sort of, you get to have your cake and eat it too. You get to learn about biology, but with a very strong clinical lens towards identifying clinically relevant biomarkers. I think another really important strength of this study, which differentiates it is this sort of use of really cutting edge lipidomics. Dr. Svati Shah: So this is a subset of omics where we're really looking at these granular lipid classes. And some of the clinicians might say, well, we measure cholesterol, why is this different? And you know, Greg, really what lipidomics allows us is a much more granular snapshot of these complex lipid species that are only grossly captured by the cholesterol levels that we would measure normally if we were seeing a patient in clinic. So to be able to get this really granular snapshot of what is happening to lipid biology and how it might relate to cardiovascular events, diabetes, I think is really important. And finally, I think the coolest part about this study is, in other studies we always have a little bit of a hard time with what we call confounders. And what does that mean? That means there may be other things for why you're seeing these biomarkers associated with your disease and those might be uncaptured things, things that you didn't measure in this study. And we call that residual confounding. Dr. Svati Shah: And I think the authors in this study, not only statistically adjusted for those potential confounders, but also importantly, the DIVAS study, where they took the biomarkers that they found from EPIC-Potsdam and said, do they change with the dietary intervention? And in fact, they did find that many of these lipid, these granular lipid species improved, meaning they went in the proper direction in terms of your health with a diet that was higher in unsaturated fats. So really proving not only the potential biology of the benefit of diets enriched in unsaturated fats, but also that these particular biomarkers are modifiable, so they're able to be changed even in this case within 16 weeks with just a dietary intervention. So to me that really was just a beautifully laid out study that highlights really what translational omics and these biomarker studies can do as we think about the clinical care of patients. Dr. Greg Hundley: Very nice. And so it sounds like listeners, moving beyond the lipoproteins, LDL, maybe total cholesterol and these granular lipid species cholesterol esters, free fatty acids, fingo-lipids, glycerophospholipid, et cetera, that's what we were studying in this particular manuscript. So, well, let's turn back to Fabian. And Fabian, what do you see is the next study to really be performed in this sphere of research? Dr. Fabian Eichelmann: I think what would be really interesting and what would really kind of prove what we saw is if you could find a way that an intervention, be it like a drug intervention and not diet because we looked at dietary intervention, that kind of shows the same as we saw, but also that really specifically only alters these lipids and how obviously not really feasible, but if that would be going on for a long enough period, if you also saw these effects that we now saw after four months would also affect the health outcomes instead of just only these proxies. Dr. Greg Hundley: Very nice. And Svati, how about you? What do you see as the next study that might be informative in this sphere of research? Dr. Svati Shah: Yeah. Great question, Greg. I mean, to me, I really think about this gap that we have in actually translating these findings in how we take care of patients. So again, really provocative results here. We have really significant P values, strong effect sizes, biomarkers that are modifiable, but in the paper they show that it adds on top of a clinical model, so what we might use as clinicians in the clinic that these biomarkers may help on top of what we already know about patients. But we really need to implement these findings and study that implementation for how this might in a real world setting actually change outcomes in patients and how we can actually help explain to clinicians how these results might be beneficial for clinical care. Dr. Svati Shah: So on top of what Fabian already said, I think really implementation science is a huge gap in how we take these translational omics discoveries and use them in support of improving patient care. We have lots to learn about these lipid biomarkers and lots more discovery science that can be done. As Fabian said, can we find drugs that might beneficially modified these lipid subspecies? But again, I think this gap in implementation science is really important. Dr. Greg Hundley: Very nice. Well listeners, we want to thank Dr. Fabian Eichelmann from the German Institute of Human Nutrition in Potsdam, Germany, and our own associate editor, Dr. Svati Shah from Duke University in Durham, North Carolina for bringing us these really provocative results, highlighting the identification of several lipids and their association with cardiometabolic disease risk. And then also nested within the same paper, a subset of individuals undergoing a randomized clinical trial demonstrating benefit by a dietary fat intervention, and there possibly supporting the substitution of dietary saturated fatty acids with unsaturated fatty acids perhaps as a potential tool for primary disease prevention. Dr. Greg Hundley: Well, on behalf of Carolyn and myself, we want to wish you a great week and we will catch you next week on the run. Dr. Greg Hundley: 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, please visit ahajournals.org.

CHANGING THE GAME Through Real Estate EP:28 #housingcrash2022 #commercialrealestate #ccim #howtogetintocommercialFEATURING: Timothy Churchwell ( https://www.linkedin.com/in/tim-churchwell-ccim-5108a98/ ) Podcast Host:Tyler Wynn ( https://linktr.ee/Wynningteam757 )Rob Sembiante Alexis Terry This Week on the podcast we had the opportunity to talk to Timothy Churchwell president of CCIM Mid Atlantic, Director of Exit Commercial Department. In this episode Tim talked about the federal reserve and how high interest rates will go, what is the best investment in real estate that NOONE is talking about. He broke down in detail the process for a commercial property and how it differs against residential properties. If you looking to get into commercial real estate and DO NOT KNOW WHERE TO START THIS IS THE EPISODE FOR YOU!!*****DISCLAIMER****I AM NOT A CPA, ATTORNEY, INSURANCE, CONTRACTOR, LENDER, OR FINANCIAL ADVISOR. THE CONTENT IN THESE  VIDEOS SHALL NOT BE CONSTRUED AS TAX, LEGAL,INSURANCE, CONSTRUCTION, ENGINEERING, HEALTH OR SAFETY, ELECTRICAL, FINANCIAL ADVICE, OR OTHER AND MAY BE OUTDATED OR INACCURATE; IT IS YOUR RESPONSIBILITY TO VERIFY ALL INFORMATION YOURSELF. THIS IS A PODCAST AND YOUTUBE VIDEO FOR ENTERTAINMENT PURPOSES ONLYFEATURING: King Reynard (@kingreynard11) FEATURING King Reynard

As CEO of Boston Children's Hospital, Kevin Churchwell spends his days planning the next evolution of care. In this episode, Kevin describes his journey from physician to CEO, his commitment to diversity and inclusion, and his process for staying calm and positive in a crisis.

Is your doctor this fly? We had the pleasure of chatting with the Dapper Doc himself, Dr. André Churchwell. He is a LEGEND in the game and one of the wisest doctors out there. Dr. Churchwell serves as the vice chancellor for equity, diversity and inclusion and chief diversity officer at Vanderbilt University Medical Center. Interestingly enough, his two brothers are also physicians. As always, Dr. Churchwell has a MESSAGE full of wisdom for the listener. IMPORTANT LINKS!!!!!! If you're a clinician with a great journey to share, we'd love to have you on the podcast. Email us at Podcast@BlackMenInWhiteCoats.org Stay updated by getting on our mailing list at www.BlackMenInWhiteCoats.org Become a mentor or get a mentor at www.DiverseMedicine.com WE'RE PAYING FOR MCAT EXAMS: https://www.BlackMenInWhiteCoats.org/MCAT CLOTHING AND SWAG https://www.bmwc.store/ Check out Dr. Dale's episode on NBC's The Today Show https://www.today.com/video/black-men-in-white-coats-founder-aims-to-shape-next-generation-of-doctors-62785093586 BOOKS BY DR. DALE: How to Raise a Doctor https://www.amazon.com/How-Raise-Doctor-Wisdom-Parents-ebook/dp/B07F62JMCP A Doctor's Guide to Self-Publishing https://book.authorandexpert.com/ Black Men in White Coats: 100 Rules for Success https://www.amazon.com/Black-Men-White-Coats-Success/dp/1674109253 PreMed Mondays https://www.amazon.com/PreMed-Mondays-Letters-Mentorship-Future/dp/167570077X/ Doc 2 Doc (Heart) https://www.amazon.com/Doc-Tony-Learn-About-Heart/dp/1693229765 Doc 2 Doc (Lungs) https://www.amazon.com/Doc-Tony-Learn-About-Lungs/dp/1706830637 Doc 2 Doc (Bones) https://www.amazon.com/Doc-Tony-Learn-About-Bones/dp/B086B9TT3P Doc 2 Doc (Viruses) https://www.amazon.com/Doc-Tony-Learn-About-Viruses-ebook/dp/B088BP9S76 Doc 2 Doc (Compilation) https://www.amazon.com/Doc-Books-Dale-Okorodudu-ebook/dp/B08XP4L7R3 Theme Song: White Coats by XVI The post How I Became the President Part 1 – Dr. Wayne J. Riley appeared first on Black Men in White Coats. --------------------- RECENT EPISODES Wish My Dad Could See Me Now (pt 1 and 2) - Dr. Wayne J. Riley From The Prison Cell to The PhD – Dr. Stanley Andrisse My Brother's Keeper – Student Doctors Kyle & Kendall Lewis Staying Authentic In Medicine – Future Dr. Noah Thomas Why Not Do It All? – Dr. Wendy Goodall McDonald Steppin Out The Mud – Dr. Kristopher Stepps

“Coming back to work is partially about surveillance and micromanagement,” Keisha, a podcasting executive, says. “Everybody feels it, but people of color feel it in a different way.” For workers who have been remote for the better part of two years, returning to the office is undeniably complicated. For some Black workers who didn't feel at ease in majority-white offices to begin with, the complications are even greater. Racial microaggressions abound, and, for some, the stress of excessive visibility that comes with being a minority never goes away. “I would love to be ‘feet on the couch relaxed,' like some of my colleagues in the past,” Keisha says, but “I don't know if I could allow myself that.” As an entrepreneur named James put it, “Black folks aren't really allowed to have bad days.”    The Radio Hour's KalaLea talks with four Black professionals and compares their experience to that of Robert Churchwell, a Black reporter hired by the Nashville Banner in 1950. Churchwell was excluded from the white newsroom and worked from home for five years.     Audio from an interview with Robert Churchwell comes from the Civil Rights Oral History Project, Special Collections, Nashville Public Library.

This week, join author Tristram Bahnson and Associate Editor Changsheng Ma as they discuss the article "Association Between Age and Outcomes of Catheter Ablation Versus Medical Therapy for Atrial Fibrillation: Results from the CABANA Trial." Dr. Carolyn Lam: Welcome to Circulation On The Run, your weekly podcast summary and backstage pass to the journal and its editors. We're your co-hosts. I'm Dr. Carolyn Lam, Associate Editor from the National Heart Center and Duke National University of Singapore. Dr. Greg Hundley: And I'm Dr. Greg Hundley, Associate Editor, Director of the Poly Heart Center at VCU Health in Richmond, Virginia. Dr. Carolyn Lam: Guess what, Greg? For today's feature paper, we are going to be looking at a very interesting analysis from the CABANA trial, this time, looking at the association between age and outcomes of catheter ablation versus medical therapy for atrial fibrillation. Cool, huh? Okay, but first, let's go through some other important papers in today's issue. Why don't I let you go first? Dr. Greg Hundley: Well, Carolyn, my first paper pertains to the cost effectiveness of coronary artery bypass surgery, and it comes to us from the STICH trial. Dr. Carolyn Lam: Ah, very important question, but please remind us what the STICH trial is again. Dr. Greg Hundley: Right, Carolyn. So the Surgical Treatment for Ischemic Heart Failure trial, or STICH demonstrated that coronary artery bypass grafting reduced all-cause mortality rates out to 10 years compared with medical therapy alone in patients with ischemic cardiomyopathy and reduced left ventricular function, defined as an ejection fraction of less than or equal to 35%. Now in this study, the authors led by Dr. Derek Chew at University of Calgary examined the economic implications of these results using a decision-analytic patient-level simulation model to estimate the lifetime costs and benefits of CABG versus medical therapy alone, using patient-level resource use and clinical data collected from the STICH trial. Dr. Carolyn Lam: Again, really important study. And what did they find? Dr. Greg Hundley: Right, Carolyn. So first, using their patient-level simulation model incorporating resource use and clinical data collected from the STICH trial, they found that coronary artery bypass grafting was estimated to cost $63,989 per quality-adjusted life year gain compared to medical therapy alone. Second, in STICH eligible patients with left ventricular ejection fraction of less than 35% in coronary artery disease amenable to CABG, routine use of CABG increased the quality-adjusted life expectancy compared to medical therapy alone for an increased cost within current benchmarks for good value in healthcare within the United States. Then finally, Carolyn, together with the improved clinical outcomes seen in the 10 year extended follow-up of STICH, the findings in this study provide additional economic support for the use of coronary artery bypass grafting in patients with ischemic cardiomyopathy eligible for STICH. Dr. Carolyn Lam: Wow, thanks Greg. Well, this next study contributes to the understanding of the effect of lifestyle and genetic risk on the lifetime risk of coronary heart disease. Interesting? Well, listen up. This is from Dr. deVries from UT Health Science Center at Houston and colleagues who aimed to quantify remaining lifetime risk and years free of coronary heart disease according to polygenic risk and the AHA's Life's Simple 7 guidelines in the population base cohort of ARIC. As a reminder, the Life's Simple 7 by the AHA consists of smoking status, body weight, total cholesterol, blood glucose, blood pressure, physical activity, and diet. Dr. Greg Hundley: Ah, Carolyn. So genes versus lifestyle. So what did they find? Dr. Carolyn Lam: Participants with high polygenic risk may offset their lifetime risk of coronary heart disease by up to 50% through managing their health according to the Life's Simple 7's recommendations, depending on ancestry. Individuals with high polygenic risk scores and ideal Life's Simple 7 scores had 4.5 to 20 more coronary heart disease free years than individuals with high polygenic risk scores, but low Life's Simple 7 scores and again, depending on ancestry. Appropriate management of lifestyle and clinical risk factors of coronary heart disease play larger roles in the overall lifetime risk of coronary heart disease than presently available genetic information. Thus, communicating the effects of Life's Simple 7 measures and polygenic risk on coronary heart disease in terms of absolute risk may have important implications for education, policy, and environmental changes, which can benefit not only high risk individuals, but the whole population. Dr. Greg Hundley: Wow, Carolyn, really informative study and so nicely summarized. So Carolyn, my next paper comes to us from the world of preclinical science and it's from Professor Yan from Shanghai, Ruijin University School of Medicine. So Carolyn, previous studies have suggested that mitochondrial dysfunction plays critical roles in the progression of heart failure. However, the underlying mechanisms often remain unclear. Now since kinases have been reported to modulate mitochondrial function team investigated the effects of dual specificity tyrosine regulate kinase one B on mitochondrial, bio energetics, cardiac hypertrophy, and heart failure. Dr. Carolyn Lam: Wow. Okay. So what did they find Greg? Dr. Greg Hundley: Right, Carolyn. So this team found that Dual Specificity Tyrosine-Regulated Kinase 1B, our DYRK1B expression was clearly up regulated in failing human myocardium as well as in hypertrophic mirroring hearts and cardiac specific DYRK1B over expression resulted in cardiac dysfunction, accompanied by a decline in the left ventricular ejection fraction, as well as the fraction shortening. And it increased left ventricular myocardial fibrosis. Carolyn in striking contrast to DYRK1B over expression, the deletion of DYRK1B mitigated tack-induced cardiac hypertrophy and heart failure. In addition, the authors found that DYRK1B was positively associated with impaired mitochondrial bio-energetics by directly binding with stat three to increase its phosphorylation and nuclear accumulation. Thereby ultimately contributing toward the down regulation of PG C one alpha. Now, furthermore, the inhibition of DYRK1B or stat three activity using specific inhibitors was able to restore cardiac performance by rejuvenating mitochondrial bio-energetics. Dr. Carolyn Lam: Cool, Greg. So could you give us a take home? Dr. Greg Hundley: Right. So in summary then, Carolyn, taken together, the findings of this study provide new insights into the previously unrecognized role of DYRK1 beta in mitochondrial bio-energetics and the progression of cardiac hypertrophy in heart failure. Dr. Carolyn Lam: Fantastic. Thanks, Greg. Well, other papers in today's issue include an exchange of letters between Doctors Nie and Wollert on the article myeloid derived growth factor protects against pressure overload induced heart failure by preserving sarcoplasmic reticulum calcium, ATPase expression in cardiomyocytes. There's an AHA update [AHA Advocacy Page] paper by Dr. Churchwell on improving heart health through value-based payment. An ECG Challenge by Dr. Murphy on a “Curious ECG Morphology of a Cardiac Device.” An On My Mind paper by Dr. Figtree on “Sublingual Nitrates for Patients as a Default in the Post ACS Discharge Pack. Is the Time for a Rethink?” Dr. Greg Hundley: Right? Carolyn. Boy, this issue is really packed with great articles. There's a Perspective piece from Professor Stewart entitled “Myocardial Edema Provides A Link Between Pulmonary Arterial Hypertension and Pericardial Effusion.” There's a wonderful Frontiers in medicine piece from Professor Kandzari entitled “A Clinical Trial Design Principles and Outcomes Definitions for Device-Based Therapies for Hypertension: A Consensus Document from the Hypertension Academic Research Consortium.” And then finally, Carolyn, there's a Research Letter from Professor Wold entitled “E-Cigarette Aerosol Reduces Left Ventricular Function in Adolescent Mice. Well, Carolyn, how about we get onto those results from the CABANA trial?” Dr. Carolyn Lam: Let's go, Greg. Dr. Greg Hundley: Well, listeners, we are now here for our feature discussion and we have with us today, Dr. Tristram Bahnson from Duke University and one of our own Associate Editors, Dr. Changsheng Ma from Beijing. Welcome gentlemen. Tristram, we will start with you first. Could you describe for us some of the background pertaining to this particular research study and what was the hypothesis that you wanted to address? Dr. Tristram Bahnson: Sure. Being an active electrophysiologist, a challenge we've had over the years is to try to figure out for whom catheter ablation would be a preferred therapy. I've had the privilege of being part of the CABANA study team over the last several years. As listeners might recall, the CABANA trial was a very large trial looking specifically at hard endpoints, including mortality, to try to determine whether or not catheter ablation provides significant benefits to patient. Apart from what we already knew over the years, which is the catheter ablation was more effective than drug therapy to reduce AFib recurrences. That study, the CABANA proper study was published in 2019. Dr. Tristram Bahnson: In the course of that study, pre-specified subgroup analyses were done initially reporting unadjusted outcomes for important clinically relevant subgroups. We found in that initial study that patients with heart failure, minorities, and patients of young age in particular appeared to do better with catheter ablation than with drug therapy. So with that as background, the CABANA study team embarked to focus on each of those subgroups and the heart failure paper was published in 2021, the minorities paper also in 2021 and the subject of our discussion now, the relationship between age and outcome in the CABANA study cohort is a subject of study today. Dr. Greg Hundley: Describe just quickly Tristram the hypothesis you wanted to test here and then in order to test that hypothesis, what was the study population that you included and what was your study design? Dr. Tristram Bahnson: So the focus was on the relationship between age and outcome in CABANA, and this was pre-specified substudy of the CABANA population. So it's probably worthwhile going over who got into the CABANA trial and to remind folks the CABANA trial enrolled 2,204 patients across 126 sites at 10 countries and randomized them one to one to a treatment strategy of either catheter ablation or drug therapy for simple traumatic atrial fibrillation that in the judgment of the treating physicians warranted therapy, patients had to have had at least two episodes of PAF or one episode of persistent AFib documented by ECG or ambulatory recordings within the six months prior to enrollment and they hadn't have failed more than one anuric drug. In other words, they would have to have been reasonable candidates for drug therapy, should they be so randomized. Dr. Tristram Bahnson: In addition, patients that were less than 65 years of age, had to have some additional factors that would increase the likelihood that outcome events would occur. They had to have a CHADSVASC score greater than one. That was not required of the older subjects follow up was 48 and a half months for the population at large, with the interportal range of follow up between 30 and 62 months. The patients had regular follow up every three months for the first year and then six months thereafter. In addition, 1,240 patients received a recording device that allowed them to provide either prescribed episodic recordings or recordings for when they were symptomatic and they also provided 96 hour holters every six months throughout the duration of the trial. Dr. Tristram Bahnson: So that's the population that we were working with. The study design, as I said, focused on trying to tease out the relationship between age and outcomes and the primary outcomes of the CABANA trial included the primary outcome, which was a composite. It included all cause mortality, disabling, stroke, serious bleeding or cardiac arrest, and the key secondary endpoints that were looked at included mortality and cardiovascular hospitalization and AF recurrence. Dr. Greg Hundley: Very nice. Describe for us your results. Dr. Tristram Bahnson: So we actually took a deeper dive into the subgroup of age, and we did a couple things that we thought would be valuable. One was to consider age as a continuous variable because after all, it's pretty arbitrary to bin people into age groups. I think the initial analysis did so with the CABANA proper publication in 2019 to correspond with the break points that we use for CHADSVASC scoring, but we elected to consider age as a continuous variable and we also elected to do adjusted Cox proportional hazard models to account for the various clinical factors that of course varied with age, such as their CHADSVASC score, the occurrence of structural heart disease, like valvular heart disease or coronary disease, the proportion of women, which typically increases with age and did so in this population. The key endpoints that we examined were the CABANA endpoints, including the primary composite endpoint of total mortality, mortality, or CB hospitalization and AF recurrence. Dr. Tristram Bahnson: So at the end of the day, we had 766 patients who were less than 65, 1,130 that were between 65 and 74 and 308 that were greater than 75. Mind you, CABANA admitted patients with any kind of AFib. As a matter of fact, more than half of the study population had persistent or longstanding persistent atrial fibrillation, which is not typical of many studies that have been published, looking at the relative benefits of catheter ablation. We had an unexpected finding that was hinted at, at the initial CABANA study and that was the benefit of catheter ablation was greatest in the younger patients and the benefits of catheter ablation relative to drug therapy seemed to decrease with advancing age at enrollment, which was the age criterion that we based the analysis this on and that this effect was primarily driven by changes in mortality. Dr. Tristram Bahnson: For the composite endpoint in CABANA, which was total mortality, serious stroke, serious bleeding and cardiac arrest, we saw that the adjusted hazard ratio increased average of 27% for every decade in advancing age, where the age was defined as that at enrollment, and for the total mortality endpoint, the adjusted hazard ratio increased an average of 46% for every 10 year increment in age at enrollment. For all age groups, catheter ablation was superior to drug therapy, a relative to a reduction in AFib consistent with many other studies. The benefit was a reduction in the adjusted hazard ratio of about 50%. So catheter ablation was agnostic to age in terms of the benefit of reducing AFib, but was not agnostic to age with result to these mortality inclusive endpoints. We did notice that there was a trend towards a relative benefit of drug therapy for the oldest age group, but we interpreted that result with caution for a variety of reasons. The oldest age group was least well represented and comprised less than 10% of the CABANA population and less than half of the next best well represented age group, which was the less than 65's. Dr. Tristram Bahnson: In looking carefully at the data, we could find no plausible explanation for why the older age group might do better with drug therapy. Again, it was not significant by an intention to treat analysis, but there was a trend towards drug therapy getting better with the oldest age group. We noticed that there was no excess mortality in the old age group within six months of treatment, so it didn't seem like it was related to some adverse procedural effect. We saw no evidence of more advanced forms of AFib in the oldest age group, because they had as good AFib suppression as others, and had the same distribution of paroxysmal versus persistent forms of AFib as the other age groups. There was no difference in crossover after all, if more patients in the old age group crossed over from drug to ablation therapy, who might expect that to be a confounder. Dr. Tristram Bahnson: We did see something that was very unusual and unexpected, which is that the mortality of the oldest age group treated with drugs was actually less than their mortality in catheter ablation, which is the issue at hand, but also less than the other age groups, which was unexpected and even less than all but the youngest age group treated with catheter ablation. So we can't explain this finding. It was not statistically significant. At the end of the day, we don't believe that elderly patients who have drug refractory AFib that is symptomatic should be denied ablation. Dr. Greg Hundley: Well, thank you so much, Tristram, for these very intriguing results. Changsheng, you have many papers that come across your desk. What drew you to this particular paper? Dr. Changsheng Ma: Yes. Dr. Bunch and colleagues should be commanded for the understand and taking important subgroup analysis of CABANA study. There has also been interest in whether the risk and the benefit of ablation may be modulated by patient age. The current analysis suggests that the related benefit of ablation was characterized for those less than 65 years of age are a tiny bit by the increasing age. It is important to emphasize that the current analysis result should not be interpreted to suggest that the cancer ablation has less value in idly patients. As a casual ablation must treated before recurrence across all age groups. Dr. Changsheng Ma: The current analysis is assuming we should know age related increase in safety constant in patients and taking ablation therapy. So we must be cautious not to over incorporate the result of the sub-group analysis, especially in the context of CABANA trial, treating in the permanent effect of ITT analysis. So I think it can be a possible that reach age related gradings in the relatively treatment benefits of the ablation is finding a challenge. Secondly, the CABANA trial was not a oral subgroup analysis. So the variation of treatment effect across the different age group were in the further resource. That's my opinion. Dr. Greg Hundley: Thank you very much. Well, gentlemen, what do you see is the next study that needs to be performed in this sphere of research and Tristram, we'll start with you. Dr. Tristram Bahnson: Well, clearly the clinical task at hand, for those of us who treat patients is to advise patients about relative benefits of therapy when there are choices at hand. And in the case of atrial fibrillation, the fundamental choice obviously is whether or not to pursue catheter ablation or to pursue medical therapy, either for rhythm or rate control. An important part of that decision making is to understand which patients would derive the most benefit from one versus the other therapy. And that need is perhaps the genesis of why we embarked on these subgroup analysis, which admittedly need to be interpreted with caution are not powered to give definitive results, but can certainly help guide future research. So we have noted in the CABANA trial that heart failure patients might do better and that's consistent with other studies looking specifically at heart failure with reduced ejection fraction. So we're contemplating additional studies to help tease that population out since in CABANA, in particular, our heart failure population was mostly those with a preserved ejection fraction and clinical heart failure. Dr. Tristram Bahnson: With regard to age, I think it'll be important to do studies to try to understand what factors resulted in the young patients apparently doing better with ablation. Again, this is hypothesis generating in terms of our result with this paper. So it'd be very interesting to find out whether there are some subsets of patients with younger ages or patients who have the relevant characteristics of the young age patients who would derive particular benefit from catheter ablation. This would obviously require a variety of approaches, including prospective randomized studies and carefully done population studies. So this issue about which patients really derive a significant mortality benefit it from catheter ablation is an important one that has not yet been teased out completely. Dr. Greg Hundley: Thank you. And Changsheng, do you have anything to add? Dr. Changsheng Ma: Yes. I think two streams say it's a very important topic for, you know, who have more and more, the older patients. So we need to answer the question, how about the real influence of age on the outcomes of the atrial fibrillation patients with ablation. So in future, we should consider randomized trial, but I think it's very difficult. So maybe we have to wait more and more, you know, other study to have a trend, how about the outcome for all the patients. It becomes too difficult for a new randomizedtrial. Dr. Greg Hundley: Very nice. Well listeners, we want to thank Dr. Tristram Bahnson from Duke University and Dr. Changsheng Ma from Beijing for bringing us the results from this substudy of the CABANA trial indicating that the mortality related benefits of catheter ablation for atrial fibrillation appeared to decrease for every 10 year increment in age, above the age of 65 years. Well, on behalf of Carolyn and myself, we want to wish you a great week and we will catch you next week on the run. Dr. Greg Hundley: 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 please visit ahajournals.org.

Whatever you do, you don't miss this podcast with Lou's special quest, Dr. Kevin B. Churchwell, MD, the President and Chief Executive Officer of Boston Children's Hospital. Dr. Churchwell provides leadership, vision, and oversight for a team that's dedicated to improving and advancing child health through their life-changing work in clinical care, research and innovation, medical education, and community engagement.Since joining Boston Children's as its Executive Vice President of Health Affairs Chief Operating Officer in 2013, Dr. Churchwell has been instrumental in leading the hospital's work to become a High Reliability Organization, one where zero avoidable harm impacts any patient, family member, or employee. He has brought to Boston the same passion for enhancing the patient family experience that defined his tenure as CEO of both Nemours/Alfred I. duPont Hospital for Children in Wilmington, DE, and Monroe Carell Jr. Children's Hospital, part of the Vanderbilt University Medical Center in Nashville, TN.Dr. Churchwell oversaw an instituted Patient and family efforts well before it's popularity. His vision, foresight and human compassion is self-evident.An advocate for equity, diversity and inclusivity, Dr. Churchwell is responsible for establishing three of the 11 Offices of Health Equity and Inclusion at hospitals across the U.S. and Canada, including the Office at Boston Children's, which he founded in 2016. With the publication of Boston Children's own Declaration for Equity, Diversity and Inclusivity in 2020, Dr. Churchwell has committed to the work required to make Boston Children's a community that's made stronger by our differences, and a leader in equity for all.