Podcasts about ciccarelli

Férias com Teologia https://wa.me/message/YCWR5HUZ2GZJK1 https://www.sezarcavalcante.com.br/musicalfm-feriascomteologia Programa: Debates Apresentação: Sezar Cavalcante @sezarcavalcante Convidados: Pastor Emerson Ciccarelli Igreja Cristã Ho Logos Instagram:@emerson.ciccarelli Pastor Vitor Couto Assembleia De Deus Santo Amaro Instagram: @vitorcouto_Oficial Tel. Da Faculdade- 11-97511-3385 Nome – Férias

Apresentação: Bispo Júlio Vertullo @juliovertullo Convidados: Pastor Ezequiel Gomes Igreja: Adventista do 7° dia – Jundiaí Pastor Emerson Ciccarelli Igreja:  cristã ho logos

Conduce Marzia Masiello

Moin! Es wird wieder wild! Wir verkosten das erste mal ein Bier des Einbecker Brauhaus und da muss es natürlich ein Bockbier sein, was denn sonst? Wir probieren ein Einbecker Mai-Ur-Bock. Außerdem hören wir 'Axiomatic 473' Exploration' von Alessandro Ciccarelli, Theo Jörgensmann und Lorenzo Santoro und 'Dark Rainbow' von Frank Carter & The Rattlesnakes. Und natürlich retten wir auch wieder die Welt mit Waffeln, Hundis, mit beidem oder vielleicht auch mit was ganz anderem. Und es stellt sich raus, dass Wahlplakate eher nicht die Welt retten.

A chat with New York Times bestselling YA author Kristen Cicarelli about Heartless Hunter, The Crimson Moth Book 1, a “dangerously romantic Scarlet Pimpernel-inspired fantasy.” Websitekristenciccarelli.com Facebook@AuthorKristenCiccarelli Instagram@kristenciccarelli Pinterest@kciccarelli Kristen Ciccarelli's Amazon Page Amazon Links for Heartless HunterAmazon.comAmazon.ca About the Book Enemies-to-lovers doesn't get more high stakes than a witch and a witch hunter falling … Continue reading "Episode 164: Kristen Ciccarelli – Heartless Hunter" Source

In this episode, we're chatting with author Kristen Ciccarelli about blood magic, witches, and witch hunters in Heartless Hunter, the YA fantasy romance inspired by the The Scarlet Pimpernel. Intro and outro music: "The Tavern" by Michael Ghelfi Visit the Tavern: ⁠⁠⁠⁠⁠Twitter⁠⁠⁠⁠⁠ | ⁠⁠⁠⁠⁠TikTok⁠⁠⁠⁠⁠ | ⁠⁠⁠⁠⁠Discord⁠⁠⁠⁠⁠ Access bonus content and support us on ⁠⁠⁠⁠⁠Patreon⁠⁠⁠ Find Kristen Ciccarelli at kristenciccarelli.com The Universal Fantasy Workbook by T. Taylor The Psychology of Fiction with Jennifer Lynn Barnes

Mikey has been skyrocketing to stardom over the past couple of years, and it's well-deserved. He's one of the most talented snowboarders I've seen transition from the contest world into backcountry filming. His bag of tricks runs DEEP, stemming from his early days in progressive contests. Now, he's taking on the Natural Selection Tour and sharing the screen with his heroes. Nicknamed "Psycho Mikey" for a reason. Get ready to be blown away! Tune in!

En este episodio hablamos de una práctica que se está volviendo cada vez más común entre menores de edad: el apostar, en juegos de cartas con amigos, en resultados de deportes, desde el celular o en lugares clandestinos. Vamos a aprender en qué consiste el juego de apuesta, cómo puede deformar nuestra cognición y llevarnos a apostar en forma problemática, sobre todo si se empieza en la etapa adolescente. Puede ser tu caso, o el caso de un ser querido o de un conocido. De cualquier forma, conocer los peligros de esta actividad y lo común que se está volviendo entre los adolescentes nos va a ayudar a educarnos y educar a nuestra comunidad para no caer en sus trampas. Referencias Derevensky J. Teen gambling: understanding a growing epidemic. New York: Rowman & Littlefield Publishing; 2012. www.jugarbien.es Rial, A., Mora-Salgueiro, J., Feijóo, S., Liñares, D., & Braña, T. (2023). El Juego de Azar Problemático en Menores de Edad: Con Quién, Dónde y Por Qué. Psicothema, 35(2). Cantero, F., & Bertolín, J. M. (2015). Influencia de las nuevas tecnologías en los problemas de juego y en las compras impulsivas en los jóvenes [Influence of new technologies on problem gambling and impulsive buying among young people]. Revista Española de Drogodependencias, 40(4), 34–47. Nigro, G., Matarazzo, O., Ciccarelli, M. et al. Positive Illusions: The Role of Cognitive Distortions Related to Gambling and Temporal Perspective in Chasing Behavior. J Gambl Stud 38, 889–904 (2022). https://doi.org/10.1007/s10899-021-10068-5 Livazović, G., Bojčić, K. Problem gambling in adolescents: what are the psychological, social and financial consequences?. BMC Psychiatry 19, 308 (2019). https://doi.org/10.1186/s12888-019-2293-2 Hardoon K, Gupta R, Derevensky JL. Psychosocial variables associated with adolescent gambling: a model for problem gambling. Psychol Addict Behav. 2004; https://doi.org/10.1037/0893-164X.18.2.170. Larocca, F. (2013). La neurociencia, la epigénesis y el entendimiento del ‘Sistema de Recompensa del Cerebro': sus aplicaciones en las adicciones y en los trastornos del comer.

Regular changes to and state-to-state variations in US data privacy laws often leave the public wondering who has access to their data and how it might be used. This is especially concerning when it comes to consumer health data, where misuse of personal information could negatively impact patients' care, treatment, and livelihood – concerns that have only been exacerbated with the overturning of Roe v. Wade. In this episode, Jen is joined by Vynamic's Jen Proietti-Fox and Courtney Ciccarelli, to discuss data privacy rules and their implications for patients, health tech companies, and the industry at large.Podcast Tags: healthcare, healthcare technology, health tech, digital health, data privacy, women's health, health equitySource Links:· The State of Consumer Data Privacy Laws in the US (And Why It Matters)· Patient perspectives around data privacy· State Laws Related to Digital Privacy· U.S. Data Privacy Protection Laws: A Comprehensive Guide· How period tracking apps and data privacy fit into a post-Roe v. Wade climate· Period tracker Flo launches anonymous mode amid post-Roe privacy concerns· These Period Tracker Apps Say They Put Privacy First. Here's What We Found.· SXSW 2023: Data privacy, healthcare websites new battlegrounds over reproductive rights· ‘Shut it off immediately': The health industry responds to data privacy crackdown· Examining the intersection of data privacy and civil rights· ACLU OF FLORIDA STATEMENT ON BILL THAT ALLOWS HEALTHCARE PROVIDERS AND PAYORS TO REFUSE HEALTHCARE TO FLORIDIANSFor additional discussion, please contact us at TrendingHealth.com or share a voicemail at 1-888-VYNAMIC.Jen Proietti-Fox, DirectorJen.Proietti-Fox@vynamic.comCourtney Ciccarelli, DirectorCourtney.Ciccarelli@vynamic.comJen Burke, DirectorJen.Burke@vynamic.com

Renato Ciccarelli: "Abilio sta rivoluzionando il settore immobiliare con un portale completo, QUIMMO, e una partnership strategica con COIMA".Il ceo di ABILIO SPA, Renato Ciccarelli è intervuto ai microfoni di Casa Italia Radio, nella rubrica Bricks and Music, condotta da Paolo Leccese ed il poliedrico Ing. Emiliano Cioffarelli.Nell'intervista Renato Ciccarelli, ha spiegato che ABILIO con QUIMMO ha portato onine un portale completo in cui gli utenti possono cercare, trovare, vedere, visionare, visitare e comprare case, differenziandosi così dai tradizionali portali immobiliari. Il portale ha finora registrato oltre 25 milioni di visite l'anno e gestisce circa 6000 immobili in tutto il territorio nazionale.L'unione strategica tra ABILIO e COIMA, lanciata in questi giorni, è una partnership che porta ad ampliare il mercato immobiliare unico, in cui tutti gli immobili sono in vendita allo stesso modo, anche se con diversi percorsi per raggiungerli. Si è sottolineato l'ingresso di COIMA come un'opportunità per l'intermediazione di immobili di prestigio e per aprire alle agenzie immobiliari.L'intervista è stata anche l'occasione per discutere della situazione dell'Emilia Romagna dopo la catastrofe naturale che ha colpito la regione, che porterà probabilmente a una svalutazione degli immobili in alcune zone. Ciccarelli ha sottolineato la necessità di un dialogo tra la collettività e le istituzioni per trovare soluzioni per coloro che sono stati colpiti dalla calamità.Infine il ringraziamento da parte dei conduttori e di Renato Ciccarelli, va a tutti gli ascoltatori di Casa Italia Radio per il sostegno alla campagna "Connessi per l'Emilia Romagna".

Mikey Ciccarelli is a professional snowboarder making a living from his riding for Burton and Rockstar Energy, living in Whistler BC. He currently competes in Travis Rice's Natural selection backcountry contest. Mikey grew up riding in Ontario at Mount St. Louis. He went on to the Canadian Olympic team after winning the Jr. Olympics in Slopestyle. Mikey has competed in X games and Dew tour and has won a World Cup event. Mikey has made the jump to riding in the backcountry filming full parts for Burton's movies. We discuss sponsorship, how Mark McMorris introduced him to Burton. We touch on training, fitness, accessing the flow state through breath work, being grateful for leading an extraordinary life and what it take to make a living as a Professional snowboarder.

In episode 46 of the Cheap Flights and Cornbread Podcast, we welcome on Vito Ciccarelli to talk about the 2023 Rockin' on the River Concert Series in Troy, NY, everything Radio Radio X and much more!

My guy Harold Laws of the OSS 980 Podcast comes in to chop it up about DMV Sports. Harold is a talented radio/podcast host and we have been collaborating for almost 10 years. It was great to see him.

This week, we skate back into the brain damage sports, with a Hall of Fame hockey player, who has definitely been done some terrible things, and has been accused of worse. The main problem appeared to be a desire, on his part, to not have his pants on, during times when his pants should most certainly be on. This leads to some angry neighbors, police surveillance, and an accusation of one of the worst things you could think of... in a limo... with 3 other players, and a 17 year old girl. Quite the wild life, and lack of personal responsibility!!Snap your leg in half, before you even get to the NHL, wear very strange outfits that absolutely don't cover what needs to covered, and have no accountability whatsoever with Dino Ciccarelli!!Check us out, every Tuesday!We will continue to bring you the biggest idiots in sports history!! Hosted by James Pietragallo & Jimmie Whisman Donate at... patreon.com/crimeinsports or with paypal.com using our email: crimeinsports@gmail.com Get all the CIS & STM merch at crimeinsports.threadless.com Go to shutupandgivememurder.com for all things CIS & STM!! Contact us on... twitter.com/crimeinsports crimeinsports@gmail.com facebook.com/Crimeinsports instagram.com/smalltownmurderSee Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

In this final part of the Song of Solomon series Pastor Filip shares some of the pitfalls and joys in early married life. Did you know that most divorces occur in the first few years of marriage? Solomon here gives some wise counsel on how to set yourself up for success in a really important phase of your lives. Then, as an added application, Pastor Kelly interviews Jon and Lisa Ciccarelli who speak on the real questions young adults at Praxis had about early married life.

This is a conversation with Katie Ciccarelli that will encourage your heart to follow God's call no matter where is leads or how unprepared you feel. God will blow our minds when we choose to walk in His will and leave the details to Him.Connect with usFacebook: https://www.facebook.com/encouragementfromwomenhttps://www.facebook.com/EncouragementFromWomenWhoveBeenThereInstagram: https://www.instagram.com/encouragementfromwomen.podcastEncouragement From Women Who've Been There:https://www.facebook.com/EncouragementFromWomenWhoveBeenThereHaley Shoemaker: https://www.facebook.com/haley.shoemaker.33/https://www.instagram.com/haleyshoe_/Katie Ciccarelli: https://www.facebook.com/katiejcichttps://www.instagram.com/ourchiclife/Resources:Bible Study- Encouraging Women of the Bible:https://www.amazon.com/Encouraging-Women-Bible-Week-Study/dp/B0BS8ZHMFFEncouragement For Little Women:https://www.amazon.com/Encouragement-Little-Women-Devotional-Girls-ebook/dp/B0BL2WVB9K/ref=sr_1_1?crid=1YMEK8I2E83KN&keywords=encouragement+for+little+women&qid=1667878622&sprefix=encouragement+for+little+women%2Caps%2C126&sr=8-1Encouragement For Women a 30 day Devotional: https://www.amazon.com/Encouragement-Women-Thirty-Day-Devotional/dp/B0941HJB83/ref=sr_1_3?crid=1RUBNXRJYWCM4&keywords=encouragement+from+women+whove+been+there&qid=1659315011&sprefix=encouragement+from+wo%2Caps%2C94&sr=8-3Encouragement for Your Identity: https://www.amazon.com/Encouragement-Your-Identity-Thirty-Devotional/dp/B09K1TWQY2/ref=sr_1_4?crid=1RUBNXRJYWCM4&keywords=encouragement+from+women+whove+been+there&qid=1659315011&sprefix=encouragement+from+wo%2Caps%2C94&sr=8-4Encouragement for Motherhood: https://www.amazon.com/Encouragement-Motherhood-Day-Devotional-Women/dp/B09WPVXSMB/ref=sr_1_2?crid=1RUBNXRJYWCM4&keywords=encouragement+from+women+whove+been+there&qid=1659315011&sprefix=encouragement+from+wo%2Caps%2C94&sr=8-2Website: https://www.encouragementfromwomen.com

The elusive practice of classroom differentiation has historically had lots of “shouldas” and “couldas” from experts, but it's always been difficult to do well at scale. Disruptions in formal schooling for all students and educators have only increased the need for good differentiation in the classroom, but there's no easy button. We discuss how differentiation works today — is it getting easier or harder? Are we making it too complicated, or not complicated enough? Our guests share successful practices they've learned from teachers around the country—teachers who walk that thin line between dull routine and total chaos to give kids the right level of voice and choice in their learning. We talk to Tatiana Ciccarelli, a math educator and model teacher from New York City, currently supporting educators around the country through professional learning, and Dr. Chase Nordengren, principal research scientist for effective instruction at NWEA.

Nicole DeLorenzo is a mother, nanny, writer, and spiritual guide. She discusses moving around a lot as a kid and what that was like switching schools so often. Nicole also talks about her parents getting a divorce the same year she found herself in a courtroom and on the news. She then discusses her journey with spirituality and how she found inner peace through inner work and katamine. Nicole then talks about becoming a mother and how her natural caregiving instincts have served her well, even prior to becoming a mother, in Hollywood and beyond. Looking for a fresh new sparkling water this spring? Get it from your favorite NA brewery! WellBeing brewing, the leader in NA craft beers, is now making a floral cirtus sparkling water that tastes like a botanical garden in your mouth, but in a good way! Grab some over at http://www.wellbeingbrewing.com/FRIENDREQUEST @FriendRequestPod on all socials JustinsFriendRequest@gmail.com

In questa nuova puntata del Podcast chiacchieriamo con Alessandro Ciccarelli, fotografo di Roma e curatore del festival di Funzilla, di fanzine fotografiche e di come dar vita al nostro primo prodotto cartaceo.++ LINK UTILI

Giose Ciccarelli, titolare e istruttore di Controvento ci parla del parapendio a motore!

Cari Lettori,per le Anteprima 2023 oggi vi presento la chiacchierata con Andrea Ciccarelli Direttore Editoriale di Saldapress.Andrea dopo qualche minuto si sbottona parecchio e ci anticipa tutti i titoli in arrivo, voi cosa aspettate?Vi leggo nei commenti, Ciao Belli!!!Sommario:00:00 Inizio05:00 domanda 111:40 domanda 226:00 domanda 340:00 domanda 448:00 domanda 554:00 domanda 601:04:00 domanda 71. Partiamo dal 2022 un anno ricco di soddisfazioni per Saldapress, che in fiera diventa sempre più presente e ricercata.Avete lanciato nuove linee editoriali che vanno ad affiancare le consolidate anche per aiutare il pubblico a scegliere.Yaù per i giovani adulti, Ramenburger con prodotti che strizzano l'occhio al fumetto orientale (anche come formato e costi, anche come ristampe più accessibili), Rebel Rebel che unisce la qualità delle pubblicazioni e quella autoriale e Mangaka con la quale Saldapress entra nel mondo Manga e lo fa con la convinzione di poter dire la propria anche qua.Infine a Lucca avete presentato Spaisi! una linea di prodotti da degustazione (olii aromatizzati e vini), ma sopratutto uno spazio di convivialità.Com'è stato vivere questo 2022 dall'interno?2. Possiamo dire che il 2022 è stato un anno di profondi cambiamenti che hanno portato Saldapress a imporsi anche come casa editrice che produce fumetti, penso a Penelope di Dado e Savuland, a Underdogs ed in un certo senso anche a Distorted, dimentico qualcosa?3. Passiamo a questo 2023, cosa bolle in pentola? Lo scorso anno lo abbiamo iniziato in modo importante con il cartonato definitivo di Invincible, cosa bolle nella fucina dei saldatori? ah con un occhio anche al mangereccio.4. Il fumetto “italiano” avrà ancora spazio nelle proposte Saldapress? Come si deve approcciarti per proporti qualcosa?5. Come avete contrastato la crisi della carta? Lo dico in ogni video che i vostri volumi sono quelli più bilanciati tra pregio e costo6. Domanda doppia, un fumetto che volevi a tutti i costi per questo 2023? e poi ti chiedo di suggerire un'opera del vostro catalogo che tutti dovrebbero avere o leggere, ma che non ha avuto “un posto al sole”, che non è conosciutissima.7. Chiudiamo con una tua domanda ai Lettori che ci seguono e che risponderanno nei commenti.*** Iscriviti al Canale ➜ http://bit.ly/Lucadeejay ****** Qui trovi tutto: https://linktr.ee/ilucadeejay ***#lucadeejay #saldapress #manga #comics #fumetto #fumetti #booktok #comicbooktok

Renato Ciccarelli: "Acquistare un immobile da una vendita giudiziaria conviene sempre e non solo per il prezzo"Il ceo di Abilio Spa, Renato Ciccarelli, intervenuto ai microfoni di Casa Italia Radio, nella rubrica Bricks and Music, condotta da Paolo Leccese con Emiliano Cioffarelli, ha anticipato i temi della AbilioView odierna dal titolo "le aste come non te le ha mai spiegate nessuno!".

This week we're joined again by BJJMM team member and fan favorite Margot Ciccarelli!  They call her "The Nomadic Mars" for a reason: Margot has lived the nomadic lifestyle and has trained at gyms all around the world.  In this episode, Margot shares her tips for becoming a world-class athlete from anywhere in the world.Follow Margot on Instagram:https://www.instagram.com/margotciccarelli/Get coaching from Margot:https://margotciccarelli.com/Mental models discussed in this episode:Intentionhttps://bjjmentalmodels.com/intention/Idea Communismhttps://bjjmentalmodels.com/idea-communism/Feedback Loophttps://bjjmentalmodels.com/feedback-loop/Growth Mindsethttps://bjjmentalmodels.com/growth-mindset/Keep Your Identity Smallhttps://bjjmentalmodels.com/keep-your-identity-small/Scientific Methodhttps://bjjmentalmodels.com/scientific-method/Investing in Losshttps://bjjmentalmodels.com/investing-in-loss/Plus, Minus, Equalshttps://bjjmentalmodels.com/plus-minus-equals/Concepts Over Techniqueshttps://bjjmentalmodels.com/concepts-over-techniques/Raise the Level in the Roomhttps://bjjmentalmodels.com/raise-the-level-in-the-room/Don't forget to check out BJJ Mental Models Premium!If you love the podcast, you'll definitely love our premium membership offerings. The podcast is truly just the tip of the iceberg – the next steps on your journey are joining our community, downloading our strategy courseware, and working with us to optimize your game.  We do all this through memberships that come in at a fraction of the cost of a single private.Sign up here for a free trial:https://bjjmentalmodels.com/Need more BJJ Mental Models?Get tips, tricks, and breakthrough insights from our newsletter:https://bjjmentalmodels.com/newsletter/Get nitty-gritty details on our mental models from the full database:https://bjjmentalmodels.com/database/Follow us on social:https://facebook.com/bjjmentalmodels/https://instagram.com/bjjmentalmodels/Music by Enterprize:https://enterprize.bandcamp.com/

Scott sits down with local businessman Domenick Ciccarelli and breakdown everything from how he got started in architecture to the easy transition to the real estate and construction world. #architecture #statenisland #construction #custom #NYC #Design #designer #Realestate #toomanytopicspodcast Follow Dominick @dciccarellijr thinkdesignarch.com @thinkdesignarchitecture If you like what you hear give us a like and a review, even if you don't we would love to hear how to improve. Follow us www.toomanytopics.com https://www.facebook.com/toomanytopicspodcast/ https://www.instagram.com/toomanytopicspodcast/ https://www.youtube.com/channel/UCRtoxBvaN29LMD7HT82iw-Q https://www.tiktok.com/@2manytopicspodcast --- Send in a voice message: https://anchor.fm/toomanytopics/message

Renato Ciccarelli: "Gli immobili in asta dovrebbero essere proposti da operatori professionali che abbiano seguito specifici percorsi formativi"Il ceo di Abilio è intervenuto ai microfoni di Casa Italia Radio, nella rubrica Bricks and Music, condotta da Paolo Leccese con il poliedrico Ing. Emiliano Cioffarelli, per approfondire il tema delle vendite giudiziarie immobiliari e mobiliari a partire dall'esperienza di Abilio S.p.A., società del Gruppo illimity e player di riferimento nella vendita e acquisto di beni immobili e strumentali provenienti da procedure concorsuali ed esecutive, società di leasing e vendite volontarie. Abilio opera attraverso un ampio network di portali specializzati tra cui Quimmo, proptech innovativa con un modello unico sul mercato immobiliare che copre l'intera catena del valore e semplifica il processo di vendita e acquisto sia in ambito giudiziale che sul mercato libero.Abbiamo potuto ascoltare anche il ceo di Banca Illimity, Corrado Passera, che con estrema chiarezza ha spiegato l'esigenza di costruire player estremamente specializzati per rispondere alle nuove esigenze del mercato.

L'amministratore delegato di Abilio Spa, Renato Ciccarelli, è intervenuto ai microfoni di Casa Italia Radio, durante la Rubrica Bricks and Music, condotta da Paolo Leccese ed il poliedrico Ing. Emiliano Cioffarelli, per parlare del ruolo sempre più importante della tecnologia per un processo sempre più sicuro e trasparente nelle compravendite immobiliari e non solo.

Questa volta a consigliarvi (e sconsigliarvi) c'è un ospite d'eccezione: Andrea G. Ciccarelli, direttore editoriale di Saldapress.Abbiamo parlato di qualsiasi cosa: la crisi della carte (#occhioallacarta), coscine di pollo, mondi bizzarri e moschettieri di ferro.EVVIVA!-Acquista Underdogs, la mia nuova serie a fumetti ‣‣‣ https://rebrand.ly/Underdogs-L'amazon shop di FREKT dove ti consiglio fumetti e libri belli ‣‣‣ https://www.amazon.it/shop/iosonofrekt-Acquista i biglietti di VEGETA E' morto (e l'ho ucciso io) ‣‣‣ https://linktr.ee/vegetaemorto-Unisciti al gruppo telegram dei Frektiani ‣‣‣ https://rebrand.ly/TelegramFrekt-Le opere di cui abbiamo parlato in questo episodio:‣Coscine di pollo (libro) ‣‣‣ https://amzn.to/3UKb0Bm‣Waterworld (film disponibile su Netflix e Now Tv) ‣‣‣ https://amzn.to/3E2owtk‣Doomsday clock (fumetto) ‣‣‣ https://amzn.to/3WR3LJQ‣Watchmen (serie disponibile per l'acquisto su Chili)‣Building stories (fumetto opera artistica) ‣‣‣ https://amzn.to/3tkedvE‣Storie n.13 - Il moschettiere di ferro (fumetto) ‣‣‣ https://amzn.to/3EneJzq‣Asterios Polyp (fumetto) ‣‣‣ https://amzn.to/3toBAVc‣Unastoria (fumetto) ‣‣‣ https://amzn.to/3fXtj7r‣LMVDM. La mia vita disegnata male. (fumetto) ‣‣‣ https://amzn.to/3UvPNeG‣Barbarone sul pianeta delle scimmie erotomani (fumetto in uscita il 15/11/2022) ‣‣‣ https://amzn.to/3WU2ly7 ‣Dylan Dog n.435: due minuti a mezzanotte (fumetto in edicola dal 30/11/2022)‣Il regista di film brutti che vinse il festival di Cannes (fumetto) ‣‣‣ https://amzn.to/3En6Ytb-Contatti di Frekt-‣ Instagram: https://www.instagram.com/iosonofrekt‣ Twitch: https://rebrand.ly/twitchFrekt ‣ Pagina Facebook: https://www.facebook.com/thefrekt-Altre cose di Frekt ‣‣‣ https://linktr.ee/iosonofrekt--Prova Amazon Prime Video gratis per 30 giorni ‣‣‣ https://www.primevideo.com/?&tag=frekt-21--La voce della sigla è di Gianluca Iacono https://www.instagram.com/gianlucaiacono_official/ la sigla è stata prodotta da Silvio Benvenuto https://www.instagram.com/earthquake51d/

On Episode 404 of Spittin' Chiclets, the guys are joined by Dino Ciccarelli. The Hall of Famer joined (14:37) to discuss his career, to tell some Federov stories from his time in Detroit, some old school prank stories, and tons more. Rear Admiral also breaks down the rest of his trip to Newfoundland and talks all things House of Dragons.

Siamo tutti social media manager. Ovviamente è una provocazione per dire che c'è molta confusione attorno a una professione, ormai consolidata, che lascia spazio alle interpretazioni.Oggi ospite di News per Freelance è Paola Ciccarelli, amica e professionista attenta appassionata di social network e comunicazione.Ho conosciuto Paola sui social, ci siamo frequentate on line e abbracciate in un'edizione del Premio Gamma Donna quando facevamo parte del Social Team, appunto.In questo racconto Paola ci svela come si è reinventata e come aggiornarsi per svolgere uan professione ancora poco compresa da che potrebbe farne un uso migliore per comunicare il proprio prodotto e coltivare la relazione con il proprio pubblico.Ringrazio Paola di questa chiacchierata e vi invito ad ascoltarci fino alla fine per non perdervi i consigli per migliorare la nostra presenza sui social come freelance.Buon ascolto!

✋ Intervista a Renato Ciccarelli, ceo di Abilio Spa e Responsabile del progetto Quimmo

Joe rogan the clearing YuSkool youskool youschool yuschool podcast fun laugh friends garage Simpsons fox Disney Howard stern barstool sports ripon Modesto central valley escalon salida merced Patterson Manteca Livingston Turlock fantasy football guru sports football basketball baseball ncaa mlb nfl wwf wwe gronkowski call her daddy armchair full circle usmc air force united states marine corps marines devil dog navy army talk talking California usa USA America merica ‘merica san francisco Seattle new york Los Angeles LA Iowa dordt san diego beach surf surfboard republican trump conservative serial this American life radio lab radiolab reply all stuff you should know my favorite murder criminal jre planet money how I built this with Marc mason mark maron dirty John comedy serious listen how do I how to mount Hermon mt Hermon ca California christian God Disciple raiders patriots niners bay area Oakland san jose listen do you funny guys Diaz nick Diaz Nate Diaz brothers have a good long day Hollywood vegas traveling travel drive road trip driving van dwellers vacation vacationing entertain entertainment life fixer upper fixxer upper Stockton morada Lodi tracy acampo macaroni salad potato salad girls wives cheri Machado Emily Lori call her daddy who's your daddy George Weston tik tok tiktok  Jammed Up, Meatloaf Touchdown Knights, PSL Pumpkin Spice Latte, Sanuks Vest Chapstick Quarterback club Mine His & Ours Side hustle Mow Blow & Go shower bench Vince Gill Eagles Amy Grant Steven Curtis Chapman 6 fingers 6 toes Chiggers Karaoke Have a nice long day Mar Val Titos vodka chaka chakas Waterloo bbq Lathrop Costco bulls eye sweet baby rays bbq sauce garlic salt pepper chicken dill pickles jerky beef ripon inn main street inn arborists oak tree bike riders bicycle riders bicyclist toe nail update aerials Cher dolly parton gap teeth tooth hydro flask map hitch hiker invasion Manteca hikers halloween millennials sweat pants sweat suit Mike Tyson socks underwear work target lucky peak reservoir cabin twain hart cold springs long barn snow Tahoe lake tahoe Yosemite Sonora Jamestown snuggle pants Santa Joe Pesci Johnny cash cameo celebrity montell Jordan thanksgiving lucky peak reservoir  Idaho Ohio Montana mcrd camp pendleton Trump Christmas is here songs movies song movie elf national lampoons fox cinema santa claus clause special presents present elf on the shelf base  Nintendo gameboy game boy big Johnson give away oh boy haters gonna hate uncle Jemima snl Saturday night live tracy Morgan nacho libra oak ridge boys the body guard led zeppelin count down 12 days of Christmas Charlie Brown in and out in n out episode 36 wine potato tequila scotch gin fernet Portugal Portuguese toenail talk sex with sue Johansen love line Adam corolla dr drew beach body bodies diet sizzler sizzlers white claw new years ace hardware the chive escalon kaepernick chic fill a crab boerenjongens Groningen netherlands wes Kennedy gleek iphone ollie bollen golf tournament almond blossom la contenta parade carnies carnival massage gumby getting gumbied camping poop knife living amongst bigfoot instagram space daddy festival Kristin Smart Cal Poly golf tournament diaper derby brats and drinks corona virus covid 19 covid-19  your own backyard san luis Obispo corona virus pandemic social distancing best podcast to listen to while driving to work going on vacation glamour shots national anthem Michael bolton Cuba gooding sr Roseanne Matt's birthday party tongue and groove mell's your own backyard Paul Flores over my dead body tiger king bear brook Joe exotic carol baskins carolle the chameleon Terry peder Rasmussen ed Edwards the clearing Kristin smart cake walk family fun night boyfriend  girlfriend first kiss bill gates tom hanks asymptomatic burrito review cover conspiracy oj Simpson Isaac kappy bfbr Bigfoot blue mountain Bigfoot research bfro Bigfoot research scot Scott viollette violet violet viollete Oregon Washington freeman film Harley Hoffman Hofman Patterson gimlin dana mclendon mc Lendon hot crazy matrix go zone fun zone dough boy pool surfer surf Santa Cruz Henry cowell state park karen chad brad marty hat burrito golf cart candle cowells light house 41st street Ciccarelli jewelers als Al's Furniture perks cafe gary shriver monster trucks Turlock auto plaza mike tyson knee boarding volcom kpig 107.5 oink Steve Burton blue Daimond almond Norway Norwegian Indiana jones Arizona barkstone vasectomy bananas rules urinals salsa cumin golf pumpkin spice fall bugs apple cat dog golf cart teacher wenis bucks fortnite ps4 playstation game gamer Nintendo Daniel de Graaf dan vice mayor elect re elect jewel of the valley marines usmc devil dog america usa marine Bert backarack Daniel regnart chad van Rys covid covid-19 covid 19 tuna mako blue shark James Postma ed Tilma Anthony ratto Pendleton whisky whiskey uti Arizona college Dave Portnoy Barstool Fund Britney Spears pit and peak barstool fund home town Buffett golden corral twisted tea cranberry juice pink floyd wizard of oz caffeine and kilos Danny Lehr crossfit cross fit excel 2021 dodge ridge powder pig ski snowboard snowboarders snowboarder snow pine crest pinecrest  chicken sandwich whopper burger king chicken chickens super bowl valentines day sweater puppies kidney bunny ranch fire light farts on fire Greenfield Stockton insane asylum sushi JRE experience 9/11 September 11 go no go Hume lake anamaniacs chip and dale rescue rangers dark wing duck duck tales gummy bears fuller house free reign tailspin tale spin blue lysol best to watch Costco pizza gold dust pizza plus rusty ranks beers rusty featherstone roller king Tom Friday beers tin foil hat wear a mask Gavin newsmen delete facebook catfish scammers scam scammer cancel culture duck duck go hecka hella hellsa scooter goth storming Norman norm 20 thousand hoisting heavies heavy lumber prices co lab blue Daimond vaccine cdc who Kathy Strain Cathy Strain Bigfoot researcher Stanislaus National Forest mi wok miwuk mi wuk cliff barackman James Fay shiba inu bit coin crypto currency we bull Ian Buzzsaw Barnes buzz saw Seattle Todd snider yellow stone Yellowstone chick fil a chicken sandwich mcdonalds Mac Donalds  Popeyes Louisiana kitchen Farmer Boys chicken barn

Overcoming the challenges of end of life care. How can the church support families suffering the loss of loved ones? Why is spiritual support at the end of life important for patients and families?

Multiple time World and European champion Margot Ciccarelli joins us take us through travelling and training at different gyms while competing at the highest level, how to feel invincible on the mats, tempo changes, transitioning through different guards, and learning faster vs staying in your comfort zone. Follow Margot on Instagram @thenomadicmars And check out my latest instructional, Omoplata 2.0. It's your step-by-step system for adding the most versatile submission in jiu-jitsu to your game! Cheers, Stephan Kesting

IN THIS EPISODE, WE COVER: [2:14] – Intro to Jacob [3:35] – Documenting your sales journey [8:07] – Embracing rejection [11:39] – Taking on more responsibility [14:23] – The greatest impact on Jacob's career [16:38] - Identifying a mentor [18:14] – Learning from the best MORE ON JACOB:Jacob serves as the Vice President of Sales for Whip Around. A true SaaS and scaleup, Whip Around (whiparound.com) aims to keep the world's fleets moving with their fleet inspection and maintenance app. With almost 10 years of sales and leadership experience, Jacob is passionate about helping those around him become the best version of themselves and offers sales leadership consulting as a John Maxwell Team Certified Coach, Speaker, and Trainer. Outside of work, you'll find him spending time with his wife Kayla and 4 children - Gianna, Jude, Luca, and Leo! You can find him on LinkedIn at https://www.linkedin.com/in/jacobciccarelli.MORE ON RAMPED: Check us out at www.rampedcareers.com Interested in becoming a Ramped Professional? Sign up here: https://rampedcareers.com/candidate-form/ Interested in becoming a Ramped Corporate Partner? Email us at sales@rampedcareers.com

Here is what happened in Sports Jersey History on February 3: A blockbuster deal for Carew goes down, The Iceman Cometh in the All-Star game, and a dramatic 600th goal milestone is reached on the ice. Our Sports Jersey Take of the Day is from Mark Morthier of Yesterday Sports on Thurman Munson. Listen in to learn more about sports history along with me from the uniforms and jerseys the players wore. Come join us at the https://jerseydispatch.com/ (Sports Jersey Dispatch website) or the https://pigskindispatch.com/ (Pigskin Dispatch website) to see even more Positive football news! Sign up to get daily football history headlines in your email inbox @ https://pigskindispatch.com/home/Email-subscriber (Email-subscriber) Go to https://my.captivate.fm/SportsHistoryNetwork.com/Row1 (SportsHistoryNetwork.com/Row1 )for access to the full Row One catalog for gallery prints and gift items. Plus, get a 15% discount on all prints on the Row One Pictorem Gallery with coupon code SHN15. Get a free one-week subscription to Newspapers.com by visiting http://sportshistorynetwork.com/newspapers (SportsHistoryNetwork.com/newspapers). And with a paid subscription, you'll also be helping to support the production of this and other Sports History Network shows. 

Join us for coffee as we interview one of our SPELLIFE founders: Jill Ciccarelli Rapps. Jill is a certified financial advisor CFP, Partner at Ciccarelli Advisory Services, an IPEC certified coach and is the co-founder of A Euphoric Living Foundation and the SpelLIFE Women's Wellness Summit. In our conversation, we discuss how our “unconscious mind” has an impact on our money and our financial behavior. Experiences and intrinsic traits contribute to our money management techniques, which can influence our ability to take or avoid monetary risks. We all have different money personalities that influence how we spend and save money. We uncover techniques to recognize these filters and limitations to attain “money harmony” within our relationships and unlock our full financial potential. Resources: Book by Olivia Mellan: Money Harmony: A Roadmap for Individuals and Couples (Timestamp 10:48) Olivia Mellan Moneyharmony Quiz: moneyharmony.com (Timestamp 25:00)

Mikey Ciccarelli is an Ontario transplant living in Whistler. He started competing in halfpipe at 8 years old. He started competing in slopestyle and won the Junior Olympics and a World Cup Slopestyle contest when he turned 18 ( the year his father passed). Mikey went on to compete in X-Games before deciding to film in the Whistler backcountry with some of the world's best. After scoring a couple of shots in Burton's One World movie he decided to go full time filming with Kingsnow which led to an IF3 Backcountry part of the year award. Mikey joined me at Boardroom's Whistler chalet for this interview about his life in snowboarding.Support the show (https://paypal.me/fnradfoundation)

Never take no for an answer. Unpack that to see if it's really a 'no means no' or perhaps it's a 'no not now.' on the Daily Grind, your weekly goal-driven podcast. This episode features Kelly Johnson and special guest David Ciccarelli. Ciccarelli is the Co-Founder and CEO of Voices.com - the largest marketplace for voice talent. Voices.com has over 1 million members, and has received $20M+ funding to date.The unique blending of his audio-engineering background with self-taught business savvy and website development afforded Ciccarelli the creative freedom to pursue his passion for innovation during the first dot com boom, the result of which catapulted him onto the scene as a pioneer in his field in the early 2000s. S3 Episode 23: 11/02/2021 Featuring Kelly Johnson with Special Guest David Ciccarelli Audio Credit Intro: Draw The Line Mastered by Connor Christian Follow Our Podcast: Instagram: @dailygrindpod Twitter: @dailygrindpod Podcast Website: http://www.kjfwi.org/the-daily-grind Shop Our Merch: https://kelly-johnson-foundation.square.site Follow Our Special Guests: Voices Instagram: @voices Voices Website: https://www.voices.com/ --- Support this podcast: https://anchor.fm/dailygrindpod/support

This week, I am excited to have Joelle Ciccarelli on the podcast! Joelle is an anti-diet, weight inclusive dietitian at  The Balanced Practice. In this episode, we talked about her story becoming a dietitian and we dive deeper on dancers, disordered eating and body image.  Joelle is a BIG part of The Balanced Practice and I feel honoured to get to work with her! Her clients love her empathy, kindness and down to earth personality.   Want to work with Joelle? Book a time with her here (thebalancedpractice.janeapp.com)   I hope you enjoyed this episode!! If so, don't forget to leave us a review wherever you listen to podcasts ;)   ARE YOU READY TO STOP OBSESSING ABOUT FOOD AND FEEL GOOD IN YOUR BODY? Join me for a FREE class where I cover the biggest mistakes folks make when healing AND give you my step-by-step approach!   Connect with me on IG: @the.balanced.dietitian

Episode 107 of Open GuardCast is an interview with Margot Ciccarelli. Margot is a black belt under Murilo Santana and recently earned a silver medal at the 2021 IBJJF Pans, her first major tournament as a black belt. Topics discussed in this episode include: Margot's experience in other martial arts disciplines Optimal training intensity Gaining skill while living a nomadic lifestyle Her first major tournament as a black belt And much more... Be sure to follow Margot on Instagram at @thenomadicmars!

I have been wanting to read The Last Namsara, the first in the Iskari series by Kristen Ciccarelli, for a long time. It has been one of my highest anticipated reads, so I am so glad that it lived up to my expectations! If you are a fan of the enemies to lovers trope, dragons, and high fantasy, then this one's for you! Make sure you check out Cait's Books, the blogger whose review convinced me to read this novel: https://caitsbooks.com/ --- // Content warning: PTSD, murder, blood, death, domestic abuse, emotional abuse, slavery, insinuations of sexual assault // --- Read my review of The Last Namsara: https://mayagreviews.wordpress.com/2021/09/01/the-last-namsara-iskari-1-by-kristen-ciccarelli/ Visit Kristen Ciccarelli's website: https://www.kristenciccarelli.com/ Goodreads: https://www.goodreads.com/book/show/32667458-the-last-namsara?ac=1&from_search=true&qid=CpidXZP5yq&rank=1 Amazon: https://www.goodreads.com/buy_buttons/12/follow?book_id=32667458&page_type=book&page_type_id=32667458&ref=x_gr_w_bb_glide_sin&sub_page_type=show&tag=x_gr_w_bb_glide_sin-20 --- View all of my links: https://beacons.ai/mayareviews You can find me @mayathebookworm on Twitter, TikTok, BookBub, and BookSirens; and @mayareviews on Tumblr. --- Send in a voice message: https://podcasters.spotify.com/pod/show/maya-reviews/message

Annie asks Patrice some questions about her life and how she ended up where she is today. email: Ihaveafewquestionspodcast@gmail.com https://www.instagram.com/ihaveafewquestionspodcast/ Take the Thinking Styles Assessment Visit Annie's website Visit Patrice's website --- Support this podcast: https://podcasters.spotify.com/pod/show/annie-middlemist4/support

In this episode Karl and Filip have a conversation with Jon Ciccarelli about how we can get in the habit of responding with forgiveness rather than reacting with self-defence or retaliation. The post Ep 7. How to Respond with Forgiveness with Jon Ciccarelli appeared first on The Overflow Podcast.

The three most important letters in the alphabet right now are PPE. The personal protective equipment shortage is a major problem. The tragedy of the COVID-19 pandemic will be multiplied, exponentially, if doctors and nurses can't get the necessary masks, gloves, and gowns to shield themselves as they treat patients. What's needed is a fast and effective response—and this requires both innovation and cooperation. These two elements can be found in the GENTL Mask project, EPAM Continuum's open source PPE effort. In this episode of *Silo Busting,* we're proud to tell the story of the GENTL Mask. Jit Agarwal, VP of Enterprise Products for EPAM, speaks with Rich Ciccarelli,, Senior Director of our Made Real Lab™, and Duncan Freake, Senior Mechanical Engineer, two leaders of the GENTL Mask initiative. It's a tale of speed, skill, and scale. “Good Enough, Not Too Late [GENTL] has been the guiding principle of a lot of our decisions here,” says Freake, explaining both the project's ethos and name. “We set out to design something that would really provide meaningful protection and not take months to develop or be based on equipment that would not be set up until June.” Listen and learn how the GENTL Mask was briskly prototyped in our Made Real Lab, the role partnerships play here, and the open source nature of the project. We hope it will inform and inspire you. Host: Macy Donaway Editor: Kip Pilalas Producer: Ken Gordon

“ most people think its bullshit. The more you speak it the more you begin to fuel your actions” Mitch Ciccarelli ( @sargeamerica ) was like most teens in highschool, ambitious with a dream but no real plan to get there. It was around this time he was asked an important question by his step dad about his ambition of being a broadcast journalist, “ how are you going to get there? “ It was after this conversation that he decides to talk to a recruiter about joining the Airforce. It started off as a way to satisfy his parents but after failing the entrance exam it turned into more of a mission to see what he could do. His competitive nature served him because his results improved so much after a month they thought he cheated and had to retake it a 3rd time. After 9 years in the Air Force he has grown to love the life and culture. He now in a ROTC program grooming the next line of officers where he finds great joy and fulfillment working with young adults and helping them develop. One of the remarkable things we noticed during the interview is Mitch's ability to keep it light and not take life so seriously. He a huge Mets fan and stays in the know with happening in sports. So much so he's given thought to starting back up his own college career and moving towards that sports psychology degree while he climbs the ranks of the military, hopefully landing in the rare Chief Master Sergeant role. To follow and keep tabs on the REAL Mitch Ciccarelli follow the links below https://www.instagram.com/sargeamerica/ Connect with us https://www.instagram.com/theunitedpromotion/ https://linktr.ee/TheUp

NASCAR Gander Outdoors Truck Series owner-driver and dirt modified racer Ray Ciccarelli shares his story of fighting Crohn's disease and coping with an ostomy pouch to live out a dream in his late 40s. He also talks about his modest upbringing, a near-death on-track incident, the business model for a low budget NASCAR team, the future of NASCAR, the highly-debated 2021 schedule, and how he wants to become a developmental program for up-and-coming drivers. The two -- Ciccarelli and host Kyle McFadden -- also talk about the Truck Series, dirt racing, chippy moments on the racetrack, and Kyle Busch.

In this episode, we're honored to speak with Paul Ciccarelli, Assistant Superintendent of The Dunes Club in New Buffalo, Michigan and the owner of Aim Better Golf, a craft shop that makes golf specific products by hand from reclaimed and recycled wood -- including NewClub's official bag tag.

Dr Carolyn Lam:                Welcome to Circulation on the Run, your weekly podcast summary and backstage pass to the journal and its editors. I'm Dr. Carolyn Lam, Associate Editor from the National Heart Center and Duke National University of Singapore.                                                 Today's feature paper is about statins, and it's the first population-based study to show a dose-dependent benefit on amputation and survival in peripheral artery disease. Very important data and a very important discussion coming right up after these summaries.                                                 The first original paper this week indicates for the first time that the natural history of coronary stenosis is better predicted by physiologic information by FFR, or fractional flow reserve, than by anatomic information from angiography. First author, Dr. Ciccarelli, corresponding author, Dr. DeBruyne, from OLV Hospital in Belgium compared the values of angiographic diameter stenosis and of fractional flow reserve in predicting the natural history among 607 patients from the FAME 2 trial who had documented stable coronary disease and in whom no revascularization was performed. The primary end point was defined as vessel oriented clinical end point at two years, and this was a composite of prospectively adjudicated cardiac death, vessel-related myocardial infarction, vessel-related urgent and non-urgent revascularization.                                                 The overall results showed that FFR predicted the natural history better than diameter stenosis. In addition, among the stenosis with mismatch between diameter stenosis and FFR, more than half had a low FFR in the presence of an angiographically mild stenosis and the rate of primary outcome was higher in those with reduced FFR regardless of whether diameter stenosis was significant or not. The take-home message is, therefore, that measurements of FFR should be considered not only an angiographically intermediate stenosis but also perhaps a mild or severe stenosis by visual evaluation.                                                 The next study provides population-based data on cardiovascular outcomes and risks after initiation of a sodium glucose cotransporter-2 inhibitor, or SGLT2 inhibitor. First and corresponding author, Dr. Udell, from University of Toronto, and his colleagues, performed population-based cohort study among type 2 diabetes patient with established cardiovascular disease and newly initiated on antihyperglycemic agents within the US Department of Defense Military Health System between 2013 and 2016. After propensity matching, more than 25,250 patients were followed for a median of 1.6 years. Initiation of SGLT2 inhibitors was associated with a lower all-cause mortality, lower hospitalization for heart failure events, lower major adverse cardiovascular events, but higher below-knee amputation risk. Findings underscore the potential benefits and risks to be aware of when initiating SGLT2 inhibitors. Importantly, it remains unclear whether the risk of below-knee amputation extends across a class of medications as the study was not powered to make comparisons among individual treatments.                                                 The next paper reports results of the redefined trial, which is the first trial to study the effects of renin-angiotensin-aldosterone system inhibitors in adults with tetrology of Fallot and mild right ventricular dysfunction in the absence of severe valvular lesions. First author, Dr. Bokma, and corresponding author, Dr. Bouma from Academic Medical Center Amsterdam, and their colleagues, studied 95 patients in the redefined trial and found that 150 mg of losartan daily did not significantly improve the primary outcome of right ventricular ejection fraction change compared to placebo. There were no significant treatment effects on secondary outcomes of left ventricular ejection fraction, peak aerobic exercise capacity or NT-proBNP. However, in a post hoc analysis, losartan was associated with improved right ventricular ejection fraction in a subgroup of 30 patients with nonrestrictive right ventricles and incomplete remodeling. The conclusion is, therefore, that losartan had no significant effect on right ventricular dysfunction or secondary outcome parameters in repaired tetralogy of Fallot. Future larger studies may determine whether there might be a role for losartan in specific vulnerable subgroups.                                                 The final study reinforces that vesicle trafficking plays an essential role in the signal regulation of pathologic hypertrophy and identifies a novel potential target in this process. This novel target is the transmembrane BAX inhibitor motif containing 1, or TMBIM1. First author, Dr. Deng, corresponding author, Dr. Li, from Wuhan University in China, and their colleagues, found that TMBIM1 expression levels were substantially decreased in both clinical and experimental hypertrophic hearts. Mechanistically, TMBIM1 interacted directly with tumor susceptibility gene 101 and accelerated the formation of multivesicular bodies to degrade activated toll-like receptor 4. Toll-like receptor 4 degradation in turn was essentially for the progression of cardiac hypertrophy. Importantly, expressing TMBIM1 in monkeys via lentivirus protected their hearts from aortic banding induced cardiac hypertrophy. In summary, these findings shed light on the role of vesicle trafficking in signal regulation during cardiac hypertrophy and provide a novel therapeutic target for treating hypertrophy.                                                 That wraps it up for our summaries. Now for our feature discussion.                                                 Peripheral artery disease, a disease that affects more than 200 million individuals worldwide and associated with a high risk of cardiovascular events and death and, of course, the much feared amputations. Yes, statin guidelines for peripheral artery disease are largely based on coronary artery disease or stroke data. Well, today's feature paper really addresses an important knowledge gap between statins, doses, amputation survival in peripheral artery disease. I'm delighted to have the first and corresponding author, Dr. Shipra Arya from Stanford University School of Medicine and, of course, our favorite, Dr. Josh Beckman, Associated Editor from Vanderbilt University.                                                 Now, Josh. I understand there's a bit of a back story of how this paper came to circulation. Want to share? Dr Josh Beckman:            Oh, absolutely. First of all, I have to say that one of the jobs of an associated editor is someone who kind of goes antiquing in every single store. Every place I am where people are presenting really good science, I'm kind of scoping it out. I'm interested. I want to see what's going on. I like to talk to the people who are doing the work to see how they're thinking about it, and I was lucky enough to see Dr. Arya's presentation. I think it was at an ATVB meeting, wasn't it? Dr Shipra Arya:                  That's right. Dr Josh Beckman:            I thought that this is an incredibly cool piece of work, and I basically hoped, I prayed, I asked. I said, "You know, maybe you should send this to us because we would really like to see the full manuscript," because inside I hoped that it would be just as impressive when it was written out as a full manuscript as it was when she was discussing it at the meeting. And, lo and behold, we were lucky enough that she submitted it to us and you can see the results online right now. Dr Carolyn Lam:                Indeed! Well put. Shipra, with that kind of lineup, please, tell us about your study and what you found. Dr Shipra Arya:                  Thank you for that invitation to submit to Circulation because initially I wasn't sure if Circulation would be interested in my work, so it was really great to hear when Josh said that this is something that it would certainly consider. The basic premise was to try and find out whether high-intensity statins as defined by the 2013 lipid guidelines, they would also have limb protective effects for PAD along with reduction mortality. As you said in the introduction, most of the data comes from either coronary data or comes from small groups of PAD patients, but never from such a large population.                                                 We identified about 150,000 veterans in the National VA database from 2003 to 2014 and excluded people who didn't have a diagnosis of PAD before 2003, and why this was such a labor of love was also to figure out how to identify the certainty that people had PAD and then getting into their pharmacy files and trying to parse out whether they were on high-intensity, low, moderate, or no statin. Initially, I had done the analysis of no statin, but then after review and discussion, it became clear that we needed a control group, which was people who were also on some guideline-directed therapy and not just no statin because they could be patients who were the noncompliant patients and who don't show up to the doctor's visits, and that's why they do poorly.                                                 That's why we chose a control group which were on antiplatelet therapy, at least aspirin or Plavix, any other antiplatelet agent. Even in that comparison, we find that after risk adjustment, patients who are on high-intensity statin had a more than 30% risk reduction of amputation as well as about a 24, 25% risk reduction of mortality compared to people who did not take a statin but at least took an aspirin. Low to moderate intensity statins were also effective, about 20%. Risk reduction in both amputation and mortality, but high-intensity statins when directly compared to the low to moderate intensity statins outperformed them.                                                 Just to be sure of our findings, we did it so many different ways. We did the Cox modeling. Then we did propensity matching that which person is more likely to receive the statin versus the other. Then we did subgroup analyses where we put people in different subgroups that people who had coronary artery disease as an indication, maybe that's why they were on these statins. But, people without coronary artery disease also same association [stack 00:11:12]. We were pretty confident in our findings, and that's why we sent it to Circulation. Dr Carolyn Lam:                Wow. You know, Josh, you are the best at putting papers like this into context and really expounding on the significant. Tell us, why did this catch your attention so much? Dr Josh Beckman:            Every time I think that statins have become just a standard part of therapy for patients with atherosclerosis, the first thing I noticed in this paper was that there were so many people who were still not on any statins or people who were on homeopathic doses of statins, and I can't understand how that happens. I think the mortality data was nice and consistent, but the amputation data is what really made a big difference. I'll ask Dr. Arya, but in my impression, the literature has been sort of back and forth as to whether or not statins really reduced limb outcomes. Your paper, I think, was clearly the largest sample that had taken a look at that question. Can you sort of separate out your papers from some of the previous work in that area? Dr Shipra Arya:                  Sure. I would add that a lot of work about amputations has been coming out from vascular surgery data, and a lot of that work just focuses on short term outcome for limb loss. They look at 30 days. Maybe they'll go look up to six months to a year, but actually patency of bypasses, patency of vessels is a long-term phenomenon. Much like mortality that can happen years later, your amputation risk can happen years later, too. I think what separates us is the lifetime followup for these patients, and we are looking in a cohort of patients who are in this veterans' healthcare system so the data is automatically getting captured even if they get their care outside. Records do make it back and diagnoses do make it back. It's the VA [inaudible 00:13:03], and we did some sensitivity analysis to show that, yes, most of the veterans we have in [inaudible 00:13:09] actually get their care and have data being added continuously into the corporate data warehouse.                                                 That was something I think that lent to the power of making the [sure 00:13:20] conclusion and that's where previous studies have not been able to show a significant association with amputation. The studies, if they are single center or they are focused from electronic medical records or perspective followup, either the patients get lost to followup or go see other doctors or other healthcare systems, and that information doesn't get back to the researchers, while mortality data you can get from Social Security Death Index or other sources. I think that's what makes the study different than other studies in this similar field in terms of followup. Dr Josh Beckman:            I don't think you're giving yourself enough credit. There's a whole bunch of things that make the study unique. One of the things that I was most taken with right upfront was the way that you defined peripheral artery disease for this population. There has been, as far as I know, at least seven or eight different definitions that people have used with administrative data to try and ferret out who has PAD, and in contrast to coronary disease and stroke, it's a much more complicated endeavor to do that. So, when I saw the way that you did it ... I'm going to say this in a way that I know is going to sound funny, but you made the complicated look really simple. Your definition is not something that required 3,000 lines of ICD-9 codes within inclusion and exclusion criteria and speaks, in my opinion, to the power of the large sample because, basically, they needed one ICD-9 code and either two ABIs, a visit to a vascular surgeon or procedural code. Now, I know that this definition comes from some of your work, so can you tell us how you derive this and then let's talk about what that means. Dr Shipra Arya:                  Absolutely. We looked at practice patterns for patients with vascular disease across the VA, and most patients who undergo procedures for PAD, we can confidently say that they do have PAD. When we look at the specificity of just that occurrence, it's pretty high, like [90% 00:15:23]. Then what we did was we did some random sampling in the VA data, about 300 patients, and used different codes to see if patients came back to the vascular surgeon within ... We used 14 months because it's usually one year followup that most people prescribe, so whether they went two months before or after because the appointment hours. We found that that was again a high specificity of about 80%. Then, when you look at patients who come back with ABI followup. So, we looked at CPT codes for ABI. We found out it's like a 99% specificity. If you have ABI followup within a year, and we relaxed it to 14 months, you could be 99% confident that this patient does have PAD.                                                 We just combined all those three together, and this is ... If Circulation is interested, I can send you this, too. We are working on this manuscript where we are giving researchers different algorithms that they could use to identify PAD because I wanted a more specific sample because I was looking at PAD outcomes. I wanted the PAD definition to be tight. Our specificity is greater than 80% combining all these three together, about 84%. We are fairly confident in this that, yes, these patients truly have PAD, so when we follow them up for outcomes, we can be confident in our results. If researchers wanted a more relaxed definition of PAD, they could use other algorithms that we are putting in that paper where they could say, "We will only use one ABI measurement, or we would use a combination of these." Dr Josh Beckman:            That brings up two points. You talk about this brings up the power of large data and the ability to tone down on people who really, truly, absolutely have PAD without any question. So, number one, are you worried that you're missing people that probably do have PAD and would benefit from therapy, and number two, do you worry that you're basically concentrating on the sickest right end of the curve of the group of PAD patients? Dr Shipra Arya:                  Right. That's a great point, and I discussed that with my coauthors and mentors and we wanted to be sure about our outcomes and not want to include people who did not have PAD, and then we are kind of including the effect size of what we may find, but yes, these are truly what we are calling a symptomatic PAD, and I think I mentioned that in the manuscript somewhere, that we probably would be missing people who are asymptomatic and not really being followed up. If we extended this analysis to people who are not regularly being followed or being under surveillance for their PAD, the results could be different. So, yes, it does not generalize the whole of that population. If we had gone that route and relaxed our inclusion, my worry was that we would get ... Because of large data setting up, as you say, if we include a bunch of people who are truly not PAD, we would be a [threading 00:18:17] risk in non-PAD patients. Dr Carolyn Lam:                Josh and Shipra, I loved the paper, but after this discussion I'm even more in love with the paper and impressed, so I think I just have a question for both of you. Is there any excuse not to give statins now? Do we actually think a trial is going to come on this topic? Is this the best data that we have? Is it going to enter guidelines? What do you think? Dr Josh Beckman:            I can give you my opinion first, if you want, because you're the person who actually has control of all the data. I would say this. I think it's been well known that statins should be used in all the patients with PAD for their cardiac outcome. My guess is that there are two things that are going to happen that are going to make people consider statins for limb outcomes.                                                 One, data like this and there's never going to be a trial, a prospective randomized trial at this point, I mean unless you disagree, but there's no way people will randomize to not statin. I think the second reason is the recent data on the PCSK9 inhibitor, evolocumab, which showed that on top of statins in PAD patients, there was a further reduction in limb events. I think we're heading towards getting the LDL to zero. It may take a couple more steps, but that's basically what's going to happen. Dr Shipra Arya:                  I agree. I think there has been time and time again data that shows, especially those already data supporting the mortality benefit for larger cohorts of patients with cardiovascular disease including PAD. I think this study really nails down the limb protector effects of statins, and doing a trial of this magnitude would be very difficult to do because to get that would be effect size that you have. You would need a huge cohort of patients, and you probably won't find statin-naïve patients because you have already half the patients with PAD have coronary artery disease, as well. So, not every study needs a trial. Not every question needs a trial, in my opinion. I think that's the power of large data sets. I think the evidence is overwhelming, and I would agree with Josh. Dr Josh Beckman:            I have always had a hard time explaining to people who came to see me for legs problems that they have to take a drug for their heart. It's sort of a weird two-step that people have a hard time accommodating. Do you think by telling them that this drug will also save their leg that they're going to be more likely to take the medicine by the end of the year? Dr Shipra Arya:                  Yes, absolutely. That's what I tell my patients who come and see me, that this medication works on arterial plaques, and it stabilizes them. It's not just the same plaque that you have in your heart is the one you have in your leg. Maybe a little different, but to oversimplify, yes. This is not just a heart medication, and this is not just a cholesterol medication. This is a medication for your plaques, for your blockages. That's how I explain it to them, and I think the uptake would be more if we explain to them that, yes, this will help you keep your leg, stay ambulatory and stay at home and not end up in assisted living or nursing home. Dr Josh Beckman:            Carolyn, this is so much fun, especially when we get to talk to the people that do so much hard work to put stuff in circulation, so I just want to say thanks again to Shipra and her coauthors. Dr Shipra Arya:                  Thank you so much, and thank you for giving us the opportunity. I think the comments from Circulation really made our paper better, so thank you for doing that. Dr Carolyn Lam:                I wish that we could just keep going on and on because I just know that Josh has even more great questions up his sleeve. See, Shipra, I told you, he's amazing. But, there you go. You're amazing, too. Your paper is amazing. Thank you so much for joining us today.