Podcasts about cnic

Descartan que la economía mexicana vaya a entrar en recesiónINE no tiene facultad para revisar requisitos de elegibilidad: Claudia Zavala Trump, aseguró que "las conversaciones con Rusia y Ucrania continúan"Más información en nuestro Podcast

Localizan restos humanos en la mina Pasta de ConchosCandidatos que han defendido a narcotraficantes deberían retirarse: Fernández NoroñaPor primera vez México mira más allá de EU: LulaMás información en nuestro Podcast

The Isotopes for Hope Podcast is a series that highlightsCanadian leaders in the country's isotope and cancer care sector who are contributing to Canada's leadership role in fighting cancer. While this podcast aims to frame the industry's future in this area, we also feature unique stories and perspectives about the importance of isotopes from current industry leaders. This episode features Lisa Stevens, Director of Programme of Action for Cancer Therapy (PACT) at the International Atomic Energy Agency (IAEA). Lisa joins James for a discussion about the important work that the IAEA leads, its Rays of Hope initiative, and the new partnership between the CNIC and the IAEA in support of the initiative. In 2022, the International Atomic Energy Agency (IAEA) launched Rays of Hope, an initiative aimed at addressing disparities in radiation medicine for cancer treatment in low- and middle-income countries. Through partnerships with governments, internationalfinancial institutions, and the private sector, Rays of Hope helps to save lives by increasing access to radiotherapy infrastructure and diagnostic imaging used in cancer care. 

Miquel Jarra, TIS de l'Institut Rocagrossa, explica quins són els aspectes més rellevants que tracten a les aules.

Mario Delgado presenta“Infancias sin muros. Por un mundo sin fronteras”Detienen a Bryan "N", operador de un grupo delictivo en Sinaloa Egipto y Jordania piden reconstrucción de Gaza para hacer frente al plan de Trump Más información en nuestro Podcast

El Centre d'Atenció Primària de Sitges té una agenda dedicada exclusivament a la prescripció social des de l'octubre de 2024 i en aquests mesos ja han passat per la consulta de Meli Moreno cent seixanta pacients dels quals el 60% han manifestat millores. Es tracta d'una eina de prevenció de benestar emocional que ofereix alternatives a la medicalització que passen per la recomanació o el convit a participar d'activitats socials del municipi com ara tallers, cursos, caminades, etc. i que parteix d'una atenció del professional sanitari amb més dedicació i temps. Parlem de prescripció social amb la tècnic en cures auxiliars d'infermeria, Amelia Moreno. L'entrada Els bons resultats de la prescripció social al CAP de Sitges amb Meli Moreno, tècnic d’infermera ha aparegut primer a Radio Maricel.

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#VallsEsports és un nou espai d'anàlisi de l'actualitat esportiva que fa la prèvia dels compromisos del cap de setmana que disputen els equips de casa nostra. Fem la prèvia del derbi de la Lliga Elit de futbol d'aquest diumenge entre la Unió Esportiva Valls i el CF Pobla de Mafumet. Conversa amb l'entrenador del conjunt […]

#VallsEsports és un nou espai d'anàlisi de l'actualitat esportiva que fa la prèvia dels compromisos del cap de setmana que disputen els equips de casa nostra. Fem la prèvia del derbi de la Lliga Elit de futbol d'aquest diumenge entre la Unió Esportiva Valls i el CF Pobla de Mafumet. Conversa amb l'entrenador del conjunt […]

Uno de los talleres más curiosos de la Semana de la Ciencia se llama: Descifrando el árbol genealógico de los Pokémon. Está organizado por el Centro Nacional de Investigaciones Cardiovasculares, para este viernes en la sede del CNIC de la calle Melchor Fernández Almagro, 3. Una iniciativa dirigida a niños de entre 8 y 14 años, en la que pueden reconstruir el árbol filogenético de los cinco pokémons más conocidos: Pikachu, Charizard, Blastoise, Delphox y Primarina. Fátima Sánchez Cabo, bioinformática en el CNIC y coordinadora de la actividad le ha contado a Ely del Valle, en Onda Madrid, los aspectos más destacados de este taller.

The Isotopes for Hope Podcast is a series that highlights Canadian leaders in the country's isotope and cancer care sector who are contributing to Canada's leadership role in fighting cancer. While this podcast aims to frame the industry's future in this area, we also feature unique stories and perspectives about the importance of isotopes from current industry leaders.  Rachel Sumner, CEO of Talent joins Chair of the CNIC, James Scongack for a discussion on workforce development for the Canadian medical isotope industry. It's the capability of people in our sector that makes all the difference. It's what gives Canada our competitive advantage and the confidence to know that we can continue to play a critical global role in the production, use, and deployment of medical isotopes for decades to come.

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L'entrevista, amb el director tècnic de l'Associació Wu Mu, Pere Perellón, sobre les sessions de Tai Chi i la formació en Defensa personal. podcast recorded with enacast.com

Josemi Rodríguez-Sieiro habla en 'Más de uno' sobre los pícnic, la cesta con la mantelería y los platos para ello que tenía su familia, pese a reconocer que nunca ha hecho uno, y cómo se preparan en eventos como la carrera de caballos en Longchamp.

Josemi Rodríguez-Sieiro habla en 'Más de uno' sobre los pícnic, la cesta con la mantelería y los platos para ello que tenía su familia, pese a reconocer que nunca ha hecho uno, y cómo se preparan en eventos como la carrera de caballos en Longchamp.

This episode is dedicated to one of our fallen shipmates, Jorden Burleson—Fair Winds and Following Seas.   Major shoutouts to our listeners—we missed y'all! Damo and Tisha catch up on date nights and cheering for your Sailors outside of the office. Damo opens up about his current command, while Tisha shares some details about her job. Damo reveals a medical issue he finally got some answers for. Shout out to Tricare for holding it down. All hail Simone Biles! We discuss her recent accomplishments and why her story is important for today's children. It's DEOCS season, so go ahead and knock those surveys out. The FY25 SELRES results are out, and the quotas have been released for active-duty CPO candidates. A past guest asks the show a question about the CPO Season. A Microsoft outage means so much more than just a “blue screen of death.” A SWO Department Head retention bonus has been announced. An economic hardship bonus has been announced for junior Sailors, but is it enough? CNIC has relaxed some restrictions on attire in shore-based galleys. Tish and Damo discuss politics for a bit. Before diving too deep into politics, let's make sure we review ALNAV 061/24, the guidance on political activities for all DoD personnel. Rest well to Sonya Massey. The Army arrests another military scammer. A $78 million project is underway at HII Newport News Shipyard to add and upgrade facilities that will improve the quality of life and work for Sailors in RCOH. An E4 in the Marines stands out for his mechanical expertise. Damo doesn't like being called “Sir.” Comments from listeners are read. Damo and Tisha share their “Do Betters,” and a listener's “Do Better” is also read.       Remember to follow the ‘Permission to Speak Freely' podcast on TikTok, Facebook, Discord, Instagram, and Twitter, and subscribe on YouTube. To have your “Do Better” reviewed on a future episode please get in touch with us at ptsfpodcast@gmail.com.       Keep up with the ‘Permission to Speak Freely' podcast on our social media and YouTube - https://linktr.ee/Ptsfpodcast       Links From This Episode: Command Climate Assessment https://www.mynavyhr.navy.mil/Portals/55/Messages/NAVADMIN/NAV2024/NAV24152.txt?ver=NOwKiP0GCRjkh0ye5WaEpA%3d%3d   SWO Dept head retention bonus https://www.mynavyhr.navy.mil/Career-Management/Detailing/Officer/Pers-41-SWO/Pay-Incentives/SWO-DH-Retention/   Heard about the Sailor who searched for the President's Medical Record? https://www.militarytimes.com/news/your-military/2024/07/09/sailor-searched-for-bidens-electronic-health-records-navy-says/   ALNAV 061/24 https://www.mynavyhr.navy.mil/Portals/55/Messages/ALNAV/ALN2024/ALN24061.txt?ver=arJyClji_Wrz_pXO0NBUpA%3d%3d   Rest Well to Sonya Massey https://www.cnn.com/2024/07/23/us/sonya-massey-police-shooting-what-went-wrong/index.html   Economic Hardship Bonuses https://www.military.com/daily-news/2024/07/19/economic-hardship-bonuses-are-finally-coming-troops-they-might-be-smaller-expected.html?amp   US Army worker who stole nearly $109 million to buy mansions and luxury cars is sentenced https://www.cnn.com/2024/07/24/us/us-army-worker-mello-sentenced/index.html   Carrier Refueling Overhaul Workcenter https://news.usni.org/2024/07/15/navy-issues-hii-78m-contract-mod-that-includes-quality-of-life-facility-at-newport-news   Sailors can wear regular clothes to the Galley on base https://www.navytimes.com/news/your-navy/2024/07/17/sailors-can-now-wear-regular-clothes-when-they-eat-in-shore-galleys/   Marine Corporal (E4) earns medal for finding flaws in tech manual https://www.marinecorpstimes.com/news/your-marine-corps/2024/05/16/marine-corporal-earns-prestigious-medal-for-saving-military-140m/       Damo's Book of the Week: Anchored In Resilience (Amaury Ponciano) https://www.amazon.com/Anchored-Resilience-Overcoming-Adversity-Awareness/dp/1662947216?dplnkId=a52fb6d3-d187-4886-8a73-7adda03742dc&nodl=1       Additional Credits: PTSF “Theme Music” - Produced by Lim0

DivulgaUIB, pòdcast de cultura científica, és una finestra radiofònica a la recerca i a la vida universitària. Aquest pòdcast s'ha fet des de la Unitat de Divulgació i Cultura Científica (UDCC-UIB) https://culturacientifica.uib.cat/ amb el suport de la Fundación Española para la Ciencia y la Tecnologia (FECYT).

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En un comunicat el FC Barcelona fa oficial la decisió del conjunt blaugrana

El restaurant Fragata va rebre el primer premi del jurat tècnic i el segon del popular amb el seu Fals caneló d’escamarlà i bolets de temporada i Pierre Sitges va rebre el primer del popular i el segon premi del jurat tècnic amb el seu Tartare à la parisienne. L’hotel Sabàtic va acollir l’entrega de guardons de la darrera edició del Tapa a Tapa amb una recaptació total de cent […] L'entrada Pierre Sitges i Fragata els restaurants guanyadors del jurat tècnic i popular del Tapa a Tapa ha aparegut primer a Radio Maricel.

El Dr. Borja Ibañez, cardiólogo y Director científico del CNIC e Iñaki Cano, periodista deportivo participa en las Jornadas Infosalud del Mes de Abril del año 2024, referidas a la “Vida Cardiosaludable”. Las enfermedades cardiovasculares son resultado de un largo periodo, que puede empezar a los 20 años y manifestarse de forma contundente décadas después. Así lo apuntó el Dr. Borja Ibañez, que en una entretenida charla con Iñaki Cano, víctima de un infarto de miocardio trataron de señalar algunos de los aspectos más destacados para la prevención de enfermedades relacionadas con el corazón. El publico asistente participó también en este encuentro exponiendo las numerosas preguntas que surgieron durante el encuentro, en en que se destacaron consejos para la prevención como no fumar, tomarse la tensión arterial, hacerse analíticas para controlar los parámetros correspondientes, ejercicio físico y sobre todo ser Feliz. Las jornadas de INFOsalud del mes de Abril se realizaron en colaboración con Recoletas Salud y Lidersport y en ellas participó también el Jefe de Cardiología del Hospital Recoletas, el Dr. José Luis Santos. INFOsalud es una iniciativa de la Fundación Caja Rural de León Valladolid Zamora y tiene como objetivo informar sobre aspectos relativos a la sanidad y promover hábitos saludables entre los ciudadanos. Todos los contenidos de la Fundación en: https://www.cajaruraldigital.com/

Prepara un pícnic esta Semana Santa en Querétaro, el micrófono de Manuel García nos platica las mejores opciones.

Aquesta vegada ens acostem fins a Premi

En esports, José López, primer tècnic de CF Ampolla ens parla de com ha estat el seu debut al capdavant de CF Ampolla, aquest cap de setmana. Diumenge, López i el seu equip s'enfrontaven a un Camarles que va sortir victoriós del partit amb un 3-1. Aquests resultats, però no han minvat la il·lusió del tècnic per treballar en què l'Ampolla surti de la zona de descens.

Ricard Torquemada analitza al "Torquelab" quin perfil hauria de tenir el nou t

Jeika, el tècnic

As the US (and the world) phases towards the electrification of everything, the opportunity to leverage electricity as a tradable commodity is immense. Join our hosts as they chat with Timothy Kramer, Founder and CEO at CNIC Funds on the first index created by them that tracks the broader US electricity market and more! Hosts: Chris Sass, Jeff McAulay Additional Reads: CNIC: https://www.cnicfunds.com/  CNIC Whitepaper on Electrification: https://www.cnicfunds.com/wp-content/uploads/2023/06/The-Electrification-of-America.pdf  

Amb David Porras, director esportiu de la Blanca Subur, conversem sobre una nova temporada que arrenca amb la disputa aquests dies del Torneig de Juvenils al Nou Pins Vens. Porras, que viu la seva tercera temporada en el càrrec, assegura que la Blanca es troba ara mateix en un procés d'anar introduint petits canvis o novetats per anar sentant les bases del futur. L'entrada La Blanca Subur estrena temporada amb el 40è Torneig de Juvenils. En parlem amb el seu director tècnic, David Porras ha aparegut primer a Radio Maricel.

Amb David Porras, director esportiu de la Blanca Subur, conversem sobre una nova temporada que arrenca amb la disputa aquests dies del Torneig de Juvenils al Nou Pins Vens. Porras, que viu la seva tercera temporada en el càrrec, assegura que la Blanca es troba ara mateix en un procés d'anar introduint petits canvis o novetats per anar sentant les bases del futur. L'entrada La Blanca Subur estrena temporada amb el 40è Torneig de Juvenils. En parlem amb el seu director tècnic, David Porras ha aparegut primer a Radio Maricel.

Chuck bought 100 shares of AMPD, the electricity ETF that's publicly traded on the NYSE. Having no idea what AMPD is or does, Chuck decided to have the creator explain it to him.  Turns out it's a pretty interesting, unique investment product that allows for a future bet on US carbon-neutral power prices.

Donde se habla de la película "Lake Mungo" y "Pícnic en Hanging Rock", es decir, de misterios australianos y de sueños dentro de sueños.

En un format de converses entre membres de la formació Guanyem Sitges va presentar a l'Ateneu les línies bàsiques del seu programa electoral que passen per la reivindicació de drets com el de l'habitatge, la municipalització de serveis com les llars d'infants i la creació d'una regidoria de la infància, el suport a entitats i associacions de la vila amb la figura d'un tècnic municipal que assessori i acompanyi i reafirma el seu NO a macroprojectes com el de Vallcarca i l'autòdrom de Terramar en tant que afecten directament el medi ambient. L'entrada Guanyem Sitges reivindica el lema Sitges per viure-hi com a propi, diu no als macroprojectes de Vallcarca i Terramar i proposa la figura d’un tècnic que ajudi les entitats ha aparegut primer a Radio Maricel.

Commodity Indexes with Tim Kramer,  JC Kneale and Preston Peacock: Commodity indexes have grown in popularity among institutional and private investors, tracking the prices of a diversified basket of commodities to generate returns and hedge inflation, with current allocations totaling over $1.6 trillion in assets. Despite their acceptance, many investors are unsure of how these complex indexes are constructed, how returns are generated, and who ultimately determines the commodities they comprise. Furthermore, the future of these indexes remains a topic of discussion. To gain a deeper understanding of these indexes, Tim Kramer, founder and CEO of CNIC Funds LLC, is joined by Preston Peacock, Senior Director of ICE Data Indices, and J.C. Kneale, Head of North American Power and Gas Markets for ICE, to discuss the history, evolution, construction, uses, and potential future of commodity market indices, including their new power index designed for the energy transition age.Website: http://www.cnicfunds.com/Bloomberg Tickers:ICECNPIS = ICE US Carbon Neutral Power Spot Return Index (returns on underlying electricity + carbon only)ICECNPIE = ICE US Carbon Neutral Power Excess Return Index (returns on spot + roll yield)ICECNPIT = ICE US Carbon Neutral Power Total Return Index (spot + roll + collateral yield)

ULTRAESPORTS . Amb Manu Tajada, director tècnic de la Titan Desert, i Núria Picas.

Juan Carlos Pichardo, Ñonguito, Harold Diaz, Oscar Carrasquillo, Katherin Amesty, Begoña Guillen y Anier Barros

Juan Carlos Pichardo, Ñonguito, Harold Diaz, Oscar Carrasquillo, Katherin Amesty, Begoña Guillen y Anier Barros

El 2023 s’inicia un nou període de la Política Agrària Comuna, el que tots coneixem com la PAC. El pla estratègic de la nova PAC fomenta la sostenibilitat i la competitivitat i també redefinix els ajuts directes i estableix un nou marc de desenvolupament rural per al període 2023-2027. Ahir en una jornada a Arrossaires del delta de l’Ebre es va tractar l’encaix del cultiu de l’arròs en la nova PAC. D’este tema n’hem parlat amb Marc Ibeas, director tècnic de Prodelta.

Conversem amb Jaume Jordi Llopis. El tècnic sitgetà forma part, actualment, del cos tècnic de l'equip femení de la Reial Societat, que encapçala Natàlia Arroyo. La seva experiència a Donosti i unes quantes reflexions sobre l'actual moment que viu el futbol femení. L'entrada Un sitgetà a Donosti. Jaume Jordi Llopis i la seva experiència com a tècnic analista a l’equip femení de la Reial Societat ha aparegut primer a Radio Maricel.

The topics, stocks and shares mentioned/discussed include: The TwinPetesInvesting Challenge TwinPetes Menphys Charity Appeal please make a donation on the TwinPetes Investing Challenge 2023 Just Giving Page https://www.justgiving.com/fundraising/twinpeteschallenge23 FTSE / AIM Market momentum The importance of Dividends Return on Capital Employed Hvivo / HVO Ascential / ASCL Conduit Holdings / CRE Easyjet / EZJ JD Wetherspoon / JDW Hill & Smith / HILS Epwin / EPWN Lords / LORD RUA Life Sciences / RUA Tesla / TSLA Millicom / TIGO Darktrace / DARK City of London Investment Trust / CTY DividendHeroes Safestore / SAFE BT Group / BT. Vodafone / VOD Nokia / NOK Aviva / AV. Ergomed / ERGO Centralnic / CNIC Triad Group / TRD Cadence Minerals / KDNC Investing Trading & more. The Twin Petes Challenge 2023 / Charity fundraise for the MENPHYS Charity. Have you enjoyed one or more of these podcasts. Yes . Then please make a donation , every pound will help. JUST GIVING TWIN PETES FUNDRAISING FOR THE MENPHYS CHARITY https://www.justgiving.com/fundraising/twinpeteschallenge23?utm_source=copyLink&utm_medium=fundraising&utm_content=twinpeteschallenge23&utm_campaign=pfp-share&utm_term=28dcd233aed040659eb3f50a75bef3df Thank you. The Twin Petes Investing podcasts will be linked to and written about on the Conkers3 website and also on the WheelieDealer website . Thank you for reading this article and listening to this podcast, we hope you enjoyed it. Please share this article with others that you know will find it of interest. PLEASE SUBSCRIBE TO THE TWIN PETES INVESTING PLATFORM THAT YOU ARE LISTENING TO THIS PODCAST ON. THANK YOU.

Avui es complix el tercer aniversari del temporal Glòria. De la situació del delta de l’Ebre avui n’hem parlat amb Rafa Sánchez, director tècnic de la Taula de Consens del Delta

This week, please join author Judith Hochman, Editorialist Steven Bradley, and Guest Host Mercedes Carnethon as they discuss the article " Survival After Invasive or Conservative Management of Stable Coronary Disease" and editorial “If the Fates Allow: The Zero-Sum Game of ISCHEMIA-EXTEND.” Dr. Greg Hundley: Welcome everyone to our new year 2023, and we are here on this January 3rd edition of Circulation on the Run. I'm Dr. Greg Hundley, Associate Editor, Director of the Pauley Heart Center at VCU Health in Richmond, Virginia. Dr. Peder Myhre: I am Dr. Peder Myhre, Social Media Editor and doctor at the Akershus University Hospital and University of Oslo. Dr. Greg Hundley: Very nice. Well, welcome listeners and this week's feature, ah, very interesting. You know many times patients with stable coronary artery disease, we're seeing a lot in the literature about an invasive strategy versus a conservative strategy. But what happens long term for these patients? What's their prognosis? Well, more to come in the feature discussion. But first, how about we grab a cup of coffee and we discuss some of the other issues in this session. Peder, would you like to go first? Dr. Peder Myhre: Yes, Greg I would love to and the first paper today is very interesting and relates to one of the most important challenges globally, namely climate changes and extreme temperatures. And in this paper, which comes to us from corresponding author, Barrak Alahmad from Harvard Chan School of Public Health in the United States, together with a large international group of authors, investigated the associations between extreme temperatures and cardiovascular cause-specific mortality in 567 cities in 27 countries from 1979 to 2019. Dr. Greg Hundley: Wow Peder, that is a really large comprehensive study. So, how did they perform this analysis? What did they find? Dr. Peder Myhre: So Greg, the investigators collected city-specific daily ambient temperatures from weather stations and analyzed cause-specific cardiovascular mortality and excess deaths in association with extreme hot and extreme cold temperatures. And in total, the analysis included more than 32 million deaths from any cardiovascular cause, which were subdivided into deaths from ischemic heart disease, stroke, heart failure and arrhythmia and at extreme temperature percentiles. And that is defined as heat above the 99th percentile and as cold below the first percentile were associated with a high risk of dying from any cardiovascular cause, ischemic heart disease, stroke and heart failure as compared to the minimum mortality temperature, which is the temperature associated with least mortality. And Greg, across a range of extreme temperatures, hot days above the 97.5 percentile and cold days below the 2.5 percentile accounted for more than two and more than nine excess deaths for every thousand cardiovascular death respectively. And heart failure was associated with the highest excess death proportions from extreme hot and cold days. So Greg, it seems like extreme temperatures really impact the cardiovascular mortality across the globe. Dr. Greg Hundley: Yeah, beautiful description Peder. And I think what was really exciting about that particular article is you had results from 27 countries. Wow, so really quite a global study and very informative. Dr. Peder Myhre: Yes, indeed very impressive. Dr. Greg Hundley: Well, Peder my next study comes to us from the world of preclinical science. And Peder, these investigators led by Professor Jose Luis de la Pompa from CNIC, evaluated two structural cardiac diseases, left ventricular non-compaction and bicuspid aortic valve. And they wanted to determine if those two conditions were caused by a set of inherited heterozygous gene mutations affecting the notch ligand regulator, Mind bomb-1 and co-segregating genes. Dr. Peder Myhre: Okay Greg, so we are looking at mechanisms for non-compaction and bicuspid aortic valve. What did they find? Dr. Greg Hundley: Right Peder, so whole exome sequencing of the left ventricular non-compaction families identified heterozygous missense mutations in five genes co-segregating with E3 ubiquitin protein ligase-1 Mib-1 as well as left ventricular non-compaction. And corresponding mouse models showed that left ventricular non-compaction or bicuspid aortic valve in a notch-sensitized genetic background. Now, also gene profiling showed that increased cardiomyocyte proliferation and defective morphological and metabolic maturation in mouse hearts and human pluripotent stem cell cardiomyopathy. Biochemistry suggested a direct interaction between notch and some of the identified gene products. And so, these data Peder support a shared genetic basis for left ventricular non-compaction and bicuspid aortic valve with Mib-1 notch playing a crucial role. And thus, identification of heterozygous mutations leading to left ventricular non-compaction or bicuspid aortic valve may allow us to expand the genetic testing panel repertoire for better diagnosis and or risk stratification of both of these conditions, left ventricular non-compaction and bicuspid aortic valve. Dr. Peder Myhre: All right, that is really great and novel linking left ventricular non-compaction to bicuspid aortic valve, really great. And now Greg, we're going to go back to clinical science and we're going to talk about lipoprotein(a) or Lp(a). And as you know, elevated Lp(a) is a common risk factor for cardiovascular disease outcomes with unknown mechanisms. And the authors of this next paper coming to us from corresponding author Olli Raitakari from University of Turku in Finland, examined Lp(a)'s potential role in identifying youths who are at increased risk of developing adult atherosclerotic cardiovascular disease, ASCVD. And they did this by measuring Lp(a) in youths nine to 24 years old and linking that to a diagnosis of ASCVD as adults and also linking it to carotid intermediate thickness in the Young Finns Study. And in addition, these results were validated in the Bogalusa Heart Study. Dr. Greg Hundley: Oh, very nice Peder. So, what did they find? Dr. Peder Myhre: So Greg, those who have been exposed to high Lp(a) levels in youth and that was defined as greater than or equal to 30 milligrams per deciliter, had about two times greater risk of developing adult ASCVD compared to non-exposed individuals. In fact, all the following youth risk factors were independently associated with a higher risk. Lp(a), LD, cholesterol, body mass index and smoking all independently associated with ASCVD. And similar findings were made in the validation cohort who were participants with a high Lp(a) had 2.5 times greater risk of developing adult ASCVD compared to non-exposed individuals. And this also persisted in adjusted models. Now, what about the carotid intermediate thickness? In that analysis, there were no associations detected to youth Lp(a) levels in either of the cohorts. Dr. Greg Hundley: Very nice, Peder. So, great description of the utility of lipoprotein(a) measurements in the youth and for predicting future major cardiovascular events. Well, the next paper goes back to the world of preclinical science. And Peder, cardiac hypertrophy increases demands on protein folding, which causes an accumulation of misfolded proteins in the endoplasmic reticulum. Now, these misfolded proteins can be removed via the adaptive retro-translocation, poly-ubiquitylation and a proteasome mediated degradation process. The endoplasmic reticulum-associated degradation, ERAD, which altogether as a biological process and rate has not been studied in vivo. So, these investigators led by Dr. Christopher Glembotski from University of Arizona College of Medicine, investigated the role of ERAD in a pathophysiological model and they examined the function of the functional initiator of ERAD, VCP-interacting membrane protein and positing that the VCP-interacting membrane protein would be adaptive in pathological cardiac hypertrophy in mice. Dr. Peder Myhre: Thanks Greg. So, we're talking about degradation of the endoplasmatic reticulum and the association to hypertrophy. So, what did these investigators find, Greg? Dr. Greg Hundley: Right, Peder. So, this was really the first study to demonstrate that endoplasmic reticulum-associated protein degradation or ERAD is responsible for degrading and thus, regulating the levels of a cytosolic non-endoplasmic reticular protein. The results reported here describe a new mechanism mediating the pathological growth of the heart, such that in the healthy heart SGK-1 levels are low due to ERAD-mediated degradation. While in the setting of pathology, ERAD-mediated degradation of SGK-1 is disrupted, allowing the pro-growth kinase to accumulate and contribute to pathological cardiac hypertrophy. And so Peder, the clinical relevance of these findings is that the investigators found that a variety of proteins that constitute the ERAD machinery were decreased in both mouse and human heart failure samples while SGK-1 was increased, supporting the possibility that SGK-1 is a contributor to the disease phenotype. And this is notable and that these studies could lead to the development of new therapeutic approaches for managing pathological cardiac hypertrophy and heart failure that target the ERAD to restore efficient SGK-1 degradation. Dr. Peder Myhre: That was an excellent explanation of a very difficult topic. Thank you, Greg. Dr. Greg Hundley: Well, Peder how about we take a look and see what else is in the issue? And now I'll go first. Well, first there's an In Depth by Professor Ntsekhe entitled, "Cardiovascular Disease Among Persons Living with HIV: New Insights into Pathogenesis and Clinical Manifestations within the Global Context." And then, there's a Research Letter by Professor Verma entitled, "Empagliflozin in Black Patients Versus White Patients With Heart Failure: Analysis of EMPEROR results-Pooled." Dr. Peder Myhre: Great Greg and there is an On My Mind by Gabriel Steg entitled, "Do We Need Ischemia Testing to Monitor Asymptomatic Patients With Chronic Coronary Syndromes?" Very timely and interesting. And finally, there is an AHA Update from Michelle Albert, the President of the AHA entitled, "Tackling Adversity and Cardiovascular Health: It is About Time." Dr. Greg Hundley: All right. Well Peder, how about we get onto that feature discussion looking at survival after invasive or conservative management in stable coronary heart disease? Dr. Mercedes Carnethon: Thank you so much for joining us for this episode of Circulation on the Run. I'm Mercedes Carnethon, Professor and Vice Chair of Preventive Medicine at the Northwestern University, Feinberg School of Medicine. And I'm very excited today to have as a guest, Dr. Judith Hochman, who is going to be discussing the long-awaited findings from the ISCHEMIA-EXTEND trial that are looking at survival after invasive or conservative management of stable coronary disease. Really pleased to have you with us today, Judy to hear about these findings. Dr. Judith Hochman: It's a pleasure to be here. Dr. Mercedes Carnethon: Thank you. So, just to start off, can you tell us about this study? What motivated this long-term follow-up of this particular trial? Dr. Judith Hochman: Yeah, so as I think the viewers or the listeners will recall, we built on a wealth of data from COURAGE and BARI 2D, some of the landmark trials that looked at revascularization versus optimal medical therapy or guideline-directed medical therapy alone. We tested an invasive strategy versus a conservative strategy dating back already to 2012 is when we started. And we had a five component primary outcome, which included cardiovascular death, myocardial infarction or hospitalization for unstable angina, heart failure or resuscitated cardiac arrest. And at the end of 3.2 median years of follow-up, we saw no difference in the primary outcome in that the curves crossed with some excess risk upfront due to periprocedural MI and decreased risk of spontaneous MI long-term. But the net overall timeframe spent free of event was similar between the groups. So, we did observe improved quality of life for the invasive strategy, but in terms of clinical outcomes there was no difference. So, cardiovascular death at the end of that time period was no different between the groups, all-cause mortality was no different, non-cardiovascular death, there was actually an increase in the invasive group, which was somewhat of a mystery. We can get into that a little bit later because I think that becomes important. But 3.2 years meeting and follow-up is relatively short. So, everyone was very interested in what would the long-term outcomes be. So, we had another grant from the National Heart, Lung and Blood Institute to follow these patients long-term. And this is an interim report with seven years of follow-up, a median of 5.7 years. And the bottom line is that all-cause mortality was the same at seven years but for the first time, an invasive strategy resulted in lower cardiovascular mortality, which was very interesting and very exciting except that it was offset, exactly offset by the continued excess that we had previously observed in non-cardiovascular mortality. And that's basically the upshot of what we just reported and why we continue to follow patients and why we're going to continue to follow patients and have a final report in 2026. Dr. Mercedes Carnethon: This is really fantastic work. As you point out, the initial follow-up was fairly short and the findings were so critically important demonstrating that there were subtle differences between the two approaches but that overall, things appeared relatively similar. Did it surprise you? Oh, please correct me. Dr. Judith Hochman: I should point out that because there were less spontaneous MIs during follow-up and spontaneous MIs are associated with a heightened risk of subsequent death more so than the periprocedural MIs, we did hypothesize and we're very interested in longer term cardiovascular and all-cause mortality thinking that those reduced spontaneous MIs in the invasive group would be associated with reduced cardiovascular death and perhaps reduced mortality. As I did indicate, cardiovascular death mortality was reduced but all-cause mortality was the same with a hazard ratio of 1.0. Dr. Mercedes Carnethon: Well, nothing seems more clear than a hazard ratio of 1.0 with those very tight confidence limits so thank you so much. I'm really pleased that our editorialist, Dr. Steve Bradley was also able to join us today because to hear his thoughts about where this fits in the context of what we know can be really insightful. So, I'd really love to turn to you, Dr. Bradley. In your opinion, why was this study question so important and tell us a little bit about how you think the clinical field should use these findings. Dr. Steven Bradley: Absolutely and thanks for having me. I think there were some indication that perhaps the farther we follow the patients out from the original ISCHEMIA trial that we might start to see some evidence of benefit for revascularization. I think Dr. Hochman spoke about the evidence of more of these spontaneous myocardial infarctions that were happening in the non-revascularization arm of the study and an association with worse cardiovascular outcomes in patients that experience spontaneous events. And so, the thoughts might be that over time we would see the benefit of that. And certainly if you parse out cardiovascular versus non- cardiovascular outcomes, we do, we see lower rates of cardiovascular death in the patients who undergo revascularization but it's balanced out by non-cardiovascular death. And so, it becomes a zero sum game for a patient. They want to be alive, it doesn't matter by what mechanism. So, if we have a therapy that doesn't actually prolong their life but it leads to different mechanisms by which they have an outcome, that's important for us to understand. This adds to an already robust evidence-based that ISCHEMIA really did inform and it gives us that long-term trajectory to help us understand for patients what the implications are. I will note that and we've commented in the editorial and this is something that was shown in the original ISCHEMIA trial, that it's not just about mortality for patients, it's important that we help them live better as well. And certainly we know that revascularization is associated with quality of life improvement so that's an important part of the conversation with patients. But again, continuing to refine our understanding of what the implications of revascularization are for mortality is where this study leads us now. Dr. Mercedes Carnethon: Thank you so much. One of the things that I find so impressive about clinical trials of this scale are that you incorporate such a broad audience. I note that 36 countries contributed data to this particular trial. I wonder whether, did you have an opportunity to investigate whether these findings were similar in low and middle income countries as compared with higher income countries? And how would you expect clinicians in low and middle income countries to use this information? Dr. Judith Hochman: That's a great question and yes, the treatment effect was similar across regions, didn't really have any very low income regions but we did have India was in the study and a number of South American countries. And I think it's incredibly important for those countries where there are very limited resources to reassure them, the practitioners and their patients that just because they can't afford an expensive invasive procedure, stenting or bypass, does not mean it's going to cut their life shorter, it's not going to make them survive for a shorter amount of time. Therefore, they can limit the use of scarce resources to the most severely impaired in terms of quality of life, the patients with the most frequent angina. It also became extremely relevant during COVID. Dr. Mercedes Carnethon: Tell me more. Dr. Judith Hochman: Well, elective procedures were shut down during COVID and more publications that cited the ISCHEMIA trial to say that they felt comfortable not being able to do elective stenting in patients with stable ischemic heart disease that would've met the ISCHEMIA trial criteria, which by the way we should add was preserved ejection fraction, we excluded ejection fraction less than 35, patients had to be stable. They could not have had two coronary syndrome within the last few months. They could not have had angina refractory to medical therapy and they could not have had left main disease. So, those are key. There are other exclusion criteria but those are the key exclusion criteria. Dr. Mercedes Carnethon: Thank you for that. And I can really see a corollary and I appreciate the messaging around similar outcomes and preserving resources. And I think certainly even within our own country where we see vast differences in access to intensive medical therapies or tertiary care medical centers who do these procedures on a higher volume, at least we can feel reassured that outcomes may be quite similar as far as mortality. What do you- Dr. Judith Hochman: If they take their guideline-directed medical therapy. Dr. Mercedes Carnethon: Thank you for pointing that out. Dr. Judith Hochman: It's incredibly important. John Curtis' group looked at adherent patients by the modified Morisky score versus non-adherent patients. Non-adherent patients don't have as good a health status as adherent patients. So, just that also adds to a wealth of literature that you have much better outcomes if you actually take your medications. Dr. Mercedes Carnethon: No, I think that's a very good point. What are your thoughts, Steve on what the next steps might be? Dr. Steven Bradley: Well, I know that as was pointed out earlier, there's going to be the opportunity to see additional longer term follow-up beyond this interim analysis. So, it'll be interesting to see what that continues to show us in terms of understanding applications on mortality. I'll pose a question that we posed within our editorial around trying to identify non-fatal outcomes to see if there are any opportunity to capture those non-fatal outcomes to give us an understanding of potential mechanisms for why there is this cardiovascular versus non- cardiovascular mortality difference by treatment arm? Certainly, that may be helpful. Dr. Judith Hochman: Sorry. We're very, very interested in the excess in non-cardiovascular death. So, we are as a result of this interim analysis, revising our case report form, which was very lean, pragmatic because the funding is relatively limited to include especially collection of data around malignancy. Because as we reported before, the non-cardiovascular deaths were largely malignancy and to some extent infection. And what was driving the difference, the excess in non-cardiovascular death as we published in American Heart Journal in the invasive group was excess malignancy. Dr. Mercedes Carnethon: That's really interesting. Dr. Judith Hochman: To our deep surprise and shock, it appeared that the only variable associated with that excess risk was the number of tests or procedures you had that involve radiation. And of course, we're talking about medical doses of radiation. And this short timeframe, three and a half to seven years, which is when the curve started to diverge to three and a half, we filed to seven years is not thought to ... it's thought to be too short a timeframe for exposure to radiation to lead to excess malignancy. So, we have partnered with some radiation experts, we are adding much more details to our case report form, not only in terms of death from malignancy but just the occurrence of malignancy. Did you get malignancy during the course of follow-up? And that's really critically important. We are not adding information about additional myocardial infarctions. We think that the key, if we're going to focus on site burden and how much they can actually collect, is to look at the mechanisms of death and the occurrence of malignancy, whether that leads to death or not, those are our top priorities at this point. Dr. Mercedes Carnethon: I could go on and on, I'm learning so much speaking with the two of you. And again, that really is the primary goal of our podcast to really have an opportunity to extend beyond what's written in the paper and really hear directly from the authors who led the study to hear your thoughts as well as those of the editorialists on where this is going. I really want to thank you both for the time you've spent today to share with our audience of the Circulation on the Run podcast. Dr. Judith Hochman: You're very welcome. Dr. Steven Bradley: My pleasure. Dr. Mercedes Carnethon: I just want to thank all of our listeners for joining us on this really stimulating discussion today on this episode of Circulation on the Run. Please tune in next week where we will have more exciting discussions like this one. Thank you. 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.

Alfons Pérez, investigador i activista de l'Observatori del deute en la Globalització, explica que les fuites als gasoductes Nord Stream 1 i 2 són "un fet sense massa precedents amb gasoductes marins".

Fa uns dies els parlàvem al programa de la preocupació existent entre el sector de l’arròs del delta de l’Ebre davant la proposta de la Comissió Europea de modificar el reglament que regula l’ús de productes fitosanitaris i que té com a objectiu reduir un 50% l’ús d’aquests productes abans del 2030. En el cas del delta de l’Ebre l’aplicació d’esta nova normativa implicaria la prohibició d’ús de qualsevol producte fitosanitari, ja sigui químic o biològic. Per aprofundir més en esta qüestió avui hem entrevistat Marc Ibeas, director tècnic de Prodelta, organisme que agrupa les dos cooperatives arrosseres del Delta, les dos comunitats de regants i també l’ADV de Pals.

Un any més, a l’agost se celebra la baldana d’arròs: una jornada gastronòmica dedicada a un dels productes més típics de les Terres de l’Ebre. Els restaurants del municipi preparen diversos plats elaborats amb aquest ingredient. També s’organitzen altres activitats complementàries per a tota la família. Avui, Joaquim Mauri, tècnic a l'Ajuntament de Camarles, ens explica les novetats d'enguany!

Una gran parte de las enfermedades cardiovasculares pueden prevenirse si se actúa sobre los factores de riesgo. Pequeños cambios saludables en nuestro comportamiento, sostenidos en el tiempo, pueden ayudarnos a preservar nuestra salud cardiovascular. Lo ha demostrado un estudio realizado en el Centro Nacional de Investigaciones Cardiovasculares (CNIC), publicado en la revista European Heart Journal. Lo cuenta en Ágora Inés García, cardióloga del CNIC.

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Luri Sorroche no ha pogut acabar la temporada a la banqueta d’Aiguadolç (foto twitter Luri Sorroche) Hauria estat a final de temporada però la UE Sitges no ha volgut esperar i ha decidit destituir Luri Sorroche com a entrenadora del primer equip, quan tot just falta un mes per acabar la competició. El club li va comunicar ahir la decisió de prescindir dels seus serveis després de la derrota que l’equip va patir diumenge passat a Aiguadolç davant el Sant Quirze. La derrota ha estat, en definitiva, el detonant i el club, tal i com ha manifestat . . . → Llegir més: La UE Sitges destitueix Luri Sorroche a manca de quatre jornades per acabar el campionat. Toni Salido, tècnic del B, confirmat com a nou entrenador del primer equip pel que resta i per la temporada vinent

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La epidemia del s. XXI: sobrepeso y obesidad Puedes ver el programa entero a la carta en este enlace http://www.telemadrid.es/programas/la-otra-ciencia/OtraCiencia-Obesidad-2-2060814003--20181023105300.html 1.900 millones de personas tienen sobrepeso, de los cuales 650 millones padecen obesidad. Este problema tiene consecuencias muy graves: Según la OMS cada año fallecen 2,8 millones de personas como consecuencia del sobrepeso o la obesidad. El exceso de azúcares, la comida rápida y un estilo de vida cada vez más sedentario favorecen una tendencia que ha adquirido la categoría de epidemia global.En este programa visitamos el Centro Nacional de Investigaciones Cardiovasculares donde podremos comprobar los efectos del sobrepeso en nuestras arterias, descubriremos que no toda la grasa nos engorda y el papel de la educación en la salud de por vida junto a especialistas en cardiología, genética, microbiología, y más. El plato fuerte será la entrevista con uno de los cardiólogos más reputados e influyentes del mundo, director del CNIC y director médico del Hospital Monte Sinaí de Nueva York, el Dr. Valentín Fuster. Estamos de enhorabuena por el Premio Ondas 2018 al mejor podcast recibido por Las Tres Muertes de mi Padre, Pablo Romero y Cuonda —> https://cuonda.com/las-tres-muertes-de-mi-padre Este contenido es gratis y sólo te pido que, si te ha gustado, entretenido, iluminado de algún modo, lo compartas en tus redes y nos valores en tu plataforma de pódcast favorita. Gracias ;)

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 issue features striking results from the ASSERT 2 trial of the prevalence of subclinical atrial fibrillation detected with implantable monitors in a group of high-risk older individuals. Much more soon, right after these summaries.                                                 The first original paper in this weeks' journal shows for the first time that myocardial edema, in the week after STEMI in humans, is a bimodal phenomenon. First off, there is Dr. Fernandez Jimenez and Barreiro-Perez, corresponding author Dr. Ibañez, and colleagues from CNIC in Madrid, Spain, evaluate that the time course of edema reaction in 16 patients with anterior STEMIs successfully treated by primary angioplasty compared to 16 matched controls using cardiac magnetic resonance and assessing its implications for myocardium at risk quantification. The STEMI patients were scanned serially within the first three hours after reperfusion and at, one, four, seven and 40 days, while controls were scanned once. Furthermore, they performed an experimental study of 20 pigs undergoing 40 minute ischemia reperfusion, followed by serial cardiac magnetic residence exams at 120 minutes, one, four and seven days after reperfusion.                                                 The authors found that am initial wave of edema appeared abruptly at reperfusion, but it was significantly attenuated by 24 hours. The initial wave of edema was followed by a second or differed healing related wave of edema several days after reperfusion, reaching a plateau around four to seven days after myocardial infarction. Of note, cardiac magnetic resonance myocardium at risk quantification at 24 hours post-reperfusion severely underestimated the infarct size.                                                 In summary, post-MI edema in patients follows a bimodal pattern, which affects cardiac magnetic resonance in estimates of myocardium at risk. The dynamic changes in post-STEMI edema, highlight the need for standardization of cardiac magnetic resonance timing to retrospectively delineate myocardium at risk and quantify myocardial salvage. According to the present clinical and experimental data, a time window between day four and seven, post-MI, seems a good compromise for standardization. However, further studies are needed to study the effect of other factors on these variables.                                                 The next paper sheds light on molecular mechanisms underline the progression of atherosclerosis, involving multiple inflammatory events, as well as the counteraction by inflammatory responses in cells such as the endothelium, circulating monocytes and resident macrophages in the arterial wall.                                                 Co-first authors, Dr. Li and Martin, corresponding author Dr. Shyy from Xi'an Jiaotong University Health Science Center and University Health Science Center and University of California, San Diego and colleagues, analyzed RNA seek data to identify cholesterol oxidation and e-flux genes regulated by Kruppel-like factor 4, which is a key anti-inflammatory transcription factor. They found that Kruppel-like factor 4 upregulates cholesterol 25 hydroxylase and liver X receptor in vascular endothelial cells and macrophages. In further in vitro and in vivo experiments, they show that access enhanced reverse cholesterol transport from the vascular wall, mitigated inflammation through suppression of sterile regulatory binding protein two and NOD-like receptor family hiring pyrin domain containing protein three inflammasome in endothelial cells and also promoted cholesterol e-flux in M1 to M2 transition in macrophages.                                                 In summary, Kruppel-like factor 4 trans-activates cholesterol 25 hydroxylase and liver X receptor, promoting the synergistic effects between individual cells and macrophages to protect against atherosclerosis susceptibility, and this may therefore be a therapeutic target for cardiovascular disease.                                                 The next study provides data on the safety and efficacy of a novel cobalt alloy-based coronary stent eluting the antiproliferative agent, ridaforolimus, for treatment of patients with coronary artery disease.                                                 Dr. Kandzari from Piedmont Heart Institute in Atlanta, Georgia and colleagues, reported the primary results of the bionics trial, which was a prospective international, one-to-one randomized trial conducted to evaluate in a noninferiority design, the relative safety and efficacy of ridaforolimus-eluting stents compared to slow release zotarolimus-eluting stents among 1,919 patients at 76 centers undergoing PCI. At 12 months, the primary endpoint of target lesion failure was 5.4% for both devices, thus meeting the prespecified criteria of noninferiority of ridaforolimus stent compared to the zotarolimus stent.                                                 Angiographic and intravascular ultrasound measures of restenosis, late lumen loss and nepintimal hyperplasia measured at 13 months, were similar in both devices. Treatment with the ridaforolimus-eluting stent resulted in low rates of myocardial infarction, repeat revascularization and stent thrombosis, and results were consistent in predefined patients and lesion groups. The authors therefore concluded that these results support the safety and efficacy of ridaforolimus-eluting stents in patients representative of every day clinical practice.                                                 Well, that wraps it up for your summaries. Now, for our future discussion.                                                 Today for our future discussion, we are going to talk about a true global public health problem. It's a condition that affects 33 million people worldwide, a number that is expected to double by 2050, and what we're talking about is atrial fibrillation. Those are the numbers of just what we know of detected atrial fibrillation, but today's paper deals with silent subclinical atrial fibrillation and the results of the ASSERT 2 trial. I'm so pleased I have the first and corresponding author with us today, Dr. Jeff Healey from Population Health Research Institute at McMaster University in Hamilton, Ontario. Welcome, Jeff. Dr. Jeff Healey:                 Good morning. Dr. Carolyn Lam:               Also on the show today is Dr. Sami Viskin, associate editor from Tel Aviv Medical Center. Hi, Sami. Dr. Sami Viskin:                 Hi. Hello, everybody. Dr. Carolyn Lam:               Jeff, from ASSERT to ASSERT 2, could you give us a bit of the picture of what made you do ASSERT 2 and what have we learned? Dr. Jeff Healey:                 The ASSERT trial was a large 2,500 patient trial in patients in with pacemakers and also implantable defibrillators and it was really an easy first place to study this entity of sub-clinical atrial fibrillation because, of course all of these patient had implanted devices with electrodes in their atrial where they could report all of the internal activity continuously for many years at a time. This was done with really no incremental costs or inconvenience to the patient, the data were already being collected, so in ASSERT we asked the question, how common is atrial fibrillation as it is not detected clinically and is it associated with stroke? What we found was that over time, somewhere between 30% and 40% of patients with an implemented device developed atrial fibrillation, which we termed subclinical atrial fibrillation, because this was not detected by the usual clinical mean. Great results, very interesting, but begged the question, is this a unique entity that we see only in pacemaker patients or if you just took older individuals in the more general population, would you see subclinical atrial fibrillation as well? That was really the impetus for doing that ASSERT 2 trial in patients who are over the age of 65, had cardiovascular condition, placed them at increased risk or stroke in atrial fibrillation, but did not have implanted devices. Dr. Carolyn Lam:               Indeed, Jeff. That's a beautiful set up. The ASSERT was really quite a landmark study suggesting that what we know as clinical may be just the tip of the iceberg, isn't it? Now you've extended it, and I think it'd be really important for the audience to understand that ASSERT 2 was really a high risk cohort. Could you maybe tell us a little bit more of what you did and what more we learned? Dr. Jeff Healey:                 Sure. These were typical patients who might be attending a cardiology clinic, an outpatient general medicine clinic who did not have pacemakers and did not have any history of atrial arrhythmias, but you're right, they were high-risk. These were patients over 65 who have had clinical risk factors, things like hypertension, or diabetes, but also some other marker of increased risk such as a BNP that was elevated or left atrial enlargement. Dr. Carolyn Lam:               Yeah and your findings were so striking. Tell us. Dr. Jeff Healey:                 What was quite was surprising was, indeed, we found that in the non-pacemaker, non-defibrillator population from ASSERT 2, we also found high prevalence of subclinical atrial fibrillation. This was really quite surprising. In fact, it was many times higher than we had predicted. We found that over time, the annual risk of developing atrial fibrillation in this cohort was 34.4% per year, which is truly astounding number of patients who developed atrial fibrillation. Dr. Carolyn Lam:               That's like one in three of such patients experiencing at least one of these episodes lasting at least five minutes? That's really impressive. Dr. Jeff Healey:                 It was high.  You could look into that study and find groups where the risk was even higher, so we chose to cut off left atrial volume of 58 millimeters and not correspondent with the median volume of the population series of Olmstead County for people over the age of 65 who came in for an echocardiogram, and that was the minimum left atrial size to get into the trial. If you then looked at within the ASSERT 2 trial and looked at the volumes within the trial, somewhere around 72 1/2 milliliters, if you looked at the patients who had the top of atrial size, that risk was as high 50% per year, so one in two. Dr. Carolyn Lam:               Another thing I noticed though about your results is that the frequency of these episodes, it's not that frequent, and so what we would do typically in a 24-hour monitoring or even a seven-day monitoring would have captured only a small proportion of these. Isn't that the case, Jeff? Could you give us some numbers there? Dr. Jeff Healey:                 Yes, of course. The episodes that qualified were at last five minutes in duration, we then do longer episodes in course, but these were much less frequent in the single digit percent risk, and what we found was there were, as you say, quite infrequent. So with the standard 24-hour halter monitor, for example, you would have had a very low pickup. It really goes to show that the longer you monitor, the more you will find. I think that's the key message out of this study and other studies like it.                                                 I think conversely, you also have to realize that the more you look, or the harder you look, you may be uncovering atrial fibrillation that behaves differently than atrial fibrillation you find, for example, in the single 12 lead ECG. We have found, and others have found, that the risk of stroke we find when we would have short episode picked up only with long term continuous monitoring is real but it's much lower than we see with atrial fibrillation that was picked up by ECB where patients are presenting in emergency rooms stroke with symptoms. Dr. Carolyn Lam:               That's such relevant points, and it really brings up the unanswered questions perhaps, exactly what is the correlation with stroke risk? What should we do about it? Sami, I'm sure you have other questions when you handle this paper and we had so many discussions among the editor, would you like to just start the ball rolling in some of these considerations? Dr. Sami Viskin:                 Well, actually, we understood from the beginning of the study was not powered to show any difference in outcome by intervention, by treating any of these patients that had discovered atrial fibrillation with anticoagulation, so we took this paper as what it is, a paper that shows the unexpectedly high privileges of atrial fibrillation in patients who have neither symptoms nor electrocardiographic documentation of atrial fibrillation when they undergo implantation of our recording device. So we took this paper for what it is, a very interesting finding that opens the door for new studies, testing perhaps the value of intervention with anticoagulation at an earlier stage. Dr. Carolyn Lam:               Yeah, I agree. I'd love to hear Jeff's thoughts on what those next steps may be, but just to point out to the audience, I mean, at the moment, our decisions on whether to anti-coagulate, like the CHADSVASC score and so on, doesn't really take into account the type of atrial fibrillation or the duration of atrial fibrillation? Does it? What do we do now? What do we do in the context of the fact that results, like the COMPASS trial, that maybe just based on the presence of vascular disease, we should anti-coagulate, right? Jeff, how about your thoughts? What are the next steps? Dr. Jeff Healey:                 You're right. I mean, is there a value for empirically anticoagulating individuals. That's really going to boil down to the individuals with an absolute risk of stroke and how well they do on anticoagulants. Good question.                                                 In the post-stroke world or post-cryptogenic stroke, which we now report to as [inaudible 00:16:48], these individuals are being evaluated with two large clinical trials, looking at this idea of just empiric anticoagulation with low dose, NOAC in comparison to aspirin.  These trials are ongoing, and they expect to report findings by the end of 2018.                                                 In the general population, no such large scale trial is ongoing at the present time. You mentioned COMPASS and the big COMPASS results were clearly a big result at the European Society meeting, but it must be clarified that the dose of NOAC or rivaroxaban used in COMPASS was not the typical dose that we would use in the treatment of patients with atrial fibrillation, so much lower. I think we have to be careful when we're talking about doses that may be different 5 to 10 fold and what is then coagulating a patient and what is not. I think, certainly, I would not consider the COMPASS tests right now to be an effective atrial fibrillation dose, but as we've discussed, subclinical atrial fibrillation is different and we may have further data in the future.                                                 Now, how do we get there? I think many people are aware of two ongoing trials, the ARTESIA trial, which is run by our group, the NOAH-AF Trial run by Kirchof and the group from Birmingham and the AF-NET organization, and these two ongoing trials have taken this question back again, so the pacemaker population that we are enrolling thousands of patients with pacemakers and defibrillators who have these short episodes, and they're being randomized treatment with a full dose new oral anticoagulant vs aspirin. These trials are ongoing, and I think these trials and the pacemaker population will actually give us the answer to what is the risk benefit for treating, so interesting course of event. We started in the pacemaker population to show there was risk for these short episodes, that this was hotly debated 10 - 15 years ago, and now we take ASSERT 2 and other trials into the non-pacemaker population to show that this is actually a problem for older individuals in general, and now the third step, go back into the pacemaker clinic again and to do trials to study the effectiveness in therapy. Dr. Carolyn Lam:               Great point and great takeaways. How about, Sami? What do you think would be the take-home message for clinicians at this moment based on what we know now and based on this new data? Dr. Sami Viskin:                 Well, the message is clear, the message is that atrial fibrillation is far more prevalent than what we think it is, the message is that for every event of atrial fibrillation that we feel we probably have many events that we don't feel we should be distrustful about judging the decision to anti-coagulate or not based on symptoms, and I'm referring now to patients who already have one event documented of atrial fibrillation and are waiting until they feel the next one, before they start taking anti-coagulations. This is another warning about how we should be careful about trusting symptoms when deciding to treat and when not to treat. I just said this opens a new door for a new line of studies, looking at how early to intervene with anticoagulation, what dosage should be used for these patients who probably have lower burden of atrial fibrillation. If you can see that the patients who have atrial fibrillation documented on the electric cardiogram, as patients who simply have a higher burden and therefore they are more likely to come up with documentation on a regular ACG, so perhaps those only have subclinical atrial fibrillation have a lower burden, perhaps they can benefit from lower doses of anticoagulation, but these are all fit, that need to be proven by trials. Dr. Jeff Healey:                 It is not only an issue for implanted devices but with the implantable cardiac monitors, this is now relevant for many other patients who have these devices implanted for things like syncope, but also there's been a lot of progress in the last 5 to 10 years on surface-attached based monitors or other types of monitors that can be with patients for days, weeks and even months, and we're all grappling with this in clinical medicine, what to do with a person with 25 beats of an atrial tachycardia or 37 seconds on a 30-day monitor? It's all an issue of the density, the burden of arrhythmia, and we do believe there is some gradience in the risk of stroke ... You're right, the treatment is not obvious, but we should take our treatment for patients who are in atrial fibrillation a lot or all the time, and simply apply it upstream like, that we may have very different treatment or approaches that are more tailored to individual patient risk. Dr. Carolyn Lam:               Thanks, Jeff, and thank you so much, Sami. Congratulations, Jeff. We discussed a lot of other questions that need to be answered, but you've really opened the door to look at some of these questions with your paper today and we're really very proud to be publishing your paper in this week's journal.                                                 Thank you very much, listeners for joining us this week. Don't forget to tune in again next week.