Podcasts about CNS

In episode 466, Mary Ellen Valverde teaches us how to nourish our bodies and look after ourselves so that we can handle stress and avoid burnout. Mary Ellen Valverde MS, CNS, LDN is a Licensed Nutritionist & Holistic Nourishment Coach who guides women to feel clear and confident about what is uniquely nourishing to them. She works with busy women who are frustrated and confused about wellness and helps them reframe their beliefs around food and movement, their inner wisdom, and their full potential. By using a combination of scientific research, embodiment practices, and intuition, Mary Ellen helps equip her clients with the tools they need to deeply understand their own body's unique cues, needs, and desires so they can experience true self-care free from rules and restrictions. In this episode, you'll learn how to take care of yourself, including paying attention to your eating habits and stress levels, and how concepts like mindfulness and play can greatly benefit you while you're building a business. - If you're burnout, put everything aside and take time to work on yourself. - Don't underestimate the power of meditation. - No one's self-care can look exactly the same, but there are 5 similarities in how we can optimally nourish ourselves. - Focus on your nervous system first and make sure you get enough rest. - Aligned eating is less about what you eat but how you eat - are you taking time to sit down and have a meal? - How can you fit movement that you enjoy into your busy schedule? - Be conscious of what your body needs most and adjust your workouts and meals to your current needs. - Mindfulness is being fully present and aware of our surroundings. - Tune in to your senses when you're working in the kitchen. - Bring in creativity and play to feel happiness in your day and have fun. Connect with Mary Ellen Valverde Website | Instagram

Visit puritycoffee.com/empoweringneurologist for more information on Balance and use code PERLMUTTER for 30% off a one-time purchase of Balance. Applies to both 12oz bags and 5lb bags.  

#533. El doctor Guillermo Rodríguez Navarrete @nutrillermo es PhD, FACN, CNS, LDN pero sobretodo un experto del sentido común. Un recurso que junto con las metáforas usa para educar a las madres sobre hábitos ancestrales para poder hacer que sus hijos crezcan lo más salvajemente sanos que puedan. Esto incluye carne, sol y desintoxicación del entorno... y de medios. • Notas de este episodio: https://podcast.pau.ninja/533 • Comunidad + episodios exclusivos: https://sociedad.ninja/

#54 – With everything going on in the world right now, it's important now more than ever that our actions of healing in the world are connected to the space of inner being. And plants are so supportive for helping with this! How do plants support the path of intuitive healing? Join us for an amazing conversation with Intuitive Nourishment Guide Venessa Rodriguez on how working with plants helps us connect with ancestral medicine and integrate spiritual awakenings into the lived experience. In this episode, Venessa shares deep wisdom on Wild Rose medicine, the Akashic Records, and how plants can help usher us on our soul path. She also offers key insights into energetic hygiene practices and the importance of listening to the wisdom of the body so you can be a vessel for your medicine. Venessa Rodriguez, CNS is a mama, herbalist, intuitive nourishment guide, Akashic Soul Record channeler, and clinical nutritionist. Through her holistic healing & wellness education collective, Wildly Rooted, and her podcast Feed Your Wild, Venessa gets to the root of collective dis-ease & re-membering the soul back into medicine through radical nourishment of body, mind, & spirit. Venessa is also the founder of the Wildly Intuitive Practitioner Pathway and has worked in private practice since 2011 combining the science + spirituality of food & herbs. Wildly Intuitive Practitioner Pathway (WIPP) is a 9-month intuitive healing mentorship and practitioner mastermind. It's for wild-hearted practitioners & healers looking to develop a truly wholistic intuitive healing practice, step out of the “spiritual closet” and bridge the spiritual and mystical with the scientific and practical in client healing work. Learn more about the Wildly Intuitive Practitioner Pathway at: https://www.wildlyrooted.com/wipp-apply Listeners of the Plant Spirit Podcast also have a special invite to Venessa's workshop, Dare to Shine, Healer: Breakthrough Imposter Syndrome & Amplify Your Intuitive Gifts A Powerful Workshop for Practitioner & Healer's For Overcoming One ofthe Biggest Blocks Holding You Back From Your Soul Path & Medicine. If you've been struggling with imposter syndrome, fear of being seen, and/or procrastinating on utilizing your intuitive gifts in your healing work, this workshop is for you! Workshop Link: https://www.wildlyrooted.com/impostersyndrome  100% off coupon code: PLANTSPIRIT Website: https://www.wildlyrooted.com/   Mentorship: https://www.wildlyrooted.com/wipp-applyIG: https://www.instagram.com/wildlyrooted/ fb: https://www.facebook.com/wildlyrootedFor more info visit Sara's website at: https://www.multidimensionalnature.com/ IG: https://www.instagram.com/multidimensional.nature/facebook: https://www.facebook.com/saraartemisia.ms/facebook group: https://www.facebook.com/groups/plantspiritherbalismYoutube: https://www.youtube.com/@saraartemisiaLearn how to communicate with plant consciousness in the free workshop on How to Learn Plant Language: https://www.learnplantlanguage.com/

On this episode of the “Emotional Vitality” series, Jared shares a tool to add to your mental health toolbox. This tool is curiosity. You'll learn how to take control of your subconscious mind and change the trajectory of your thoughts to make a positive shift in your emotional and physical state. From Jared: “This is an incredible tool that anyone can use to get unstuck from unwanted patterns in life, things like addiction, anxiety, depression, etc. Once you learn and apply this, it can and will change your life!”Additional Information:Episode #264: Emotional Vitality: Jen's Story - From Addiction and Mental and Physical Illness to Vitality.Episode #345: Emotional Vitality: Limiting Beliefs and The Stories We Tell OurselvesEpisode #374: Emotional Vitality: From Anxiety to Vitality…What To Do When You Know Too MuchBook: Never Broken - Songs Are Only Half The Story by JewelJewel Interview on Joe RoganVisit the podcast website here: VitalityRadio.comYou can follow @vitalityradio and @vitalitynutritionbountiful on Instagram, or Vitality Radio and Vitality Nutrition on Facebook. Join us also in the Vitality Radio Podcast Listener Community on Facebook. Shop the products that Jared mentions at vitalitynutrition.com. Let us know your thoughts about this episode using the hashtag #vitalityradio and please rate and review us on Apple Podcasts. Thank you!Please also join us on the Dearly Discarded Podcast with Jared St. Clair.Just a reminder that this podcast is for educational purposes only. The FDA has not evaluated the podcast. The information is not intended to diagnose, treat, cure, or prevent any disease. The advice given is not intended to replace the advice of your medical professional.

De finanziellen Equiliber vun der CNS kënnt a gutt dräi Joer un d'Wackelen. Musse mir geschwënn all méi abezuelen, a kéint et zu Verschlechterunge bei de Leeschtunge kommen? Dat freet d¨Christiane Kleer de President vun der CNS.

An update on determination of death by neurological criteria, with Drs. Rachel Beekman and Jeremy Moeller.Note: This podcast is intended solely as an educational tool for learners, especially neurology residents. The contents should not be interpreted as medical advice.Further Reading:Greer DM, Kirschen MP, Lewis A, Gronseth GS, Rae-Grant A, Ashwal S, Babu MA, Bauer DF, Billinghurst L, Corey A, Partap S, Rubin MA, Shutter L, Takahashi C, Tasker RC, Varelas PN, Wijdicks E, Bennett A, Wessels SR, Halperin JJ. Pediatric and Adult Brain Death/Death by Neurologic Criteria Consensus Guideline: Report of the AAN Guidelines Subcommittee, AAP, CNS, and SCCM. Neurology. 2023 Oct 11:10.1212/WNL.0000000000207740. doi: 10.1212/WNL.0000000000207740. Kitlen E, Kim N, Rubenstein A, Keenan C, Garcia G, Khosla A, Johnson J, Miller PE, Wira C, Greer D, Gilmore EJ, Beekman R. Development and validation of a novel score to predict brain death after out-of-hospital cardiac arrest. Resuscitation. 2023 Nov;192:109955. doi: 10.1016/j.resuscitation.2023.109955. 

Matt Finch goes deep into the world of Highly Sensitive People and Empaths and why they can be highly prone to alcohol and drug addiction. In this episode, you'll learn about several interrelated topics, including the Highly Sensitive Person (HSP), the Empath, the Highly Sensitive Empath, and why these human biological innate traits can increase addiction vulnerability (especially to CNS depressants like alcohol, benzos, and opioids). Here are the main topics discussed in this episode: Topic: The Link Between Human Sensitivity and Addiction What is Sensitivity? What is a Highly Sensitive Person? What is an Empath? What are the differences and similarities between HSPs and Empaths? Can you be an HSP and an Empath or can you only be one? Why are sensitive humans prone to addiction? Are there substances and addictions sensitives get into more than others? Do sensitives need different approaches to addiction treatment? What are the key concepts a sensitive person with an addiction should know? What are the key concepts a sensitive person without an addiction should know? What are some helpful resources for highly sensitive people and empaths? Books, Podcasts, YouTube channels, Documentaries, Interviews, Free Online Assessments, Websites, Blogs, etc. Show Notes Page>>

No der Quadripartite vu gëschter schwätzt de Maurice Molitor mam President vun der Federatioun vun de Spideeler (FHL) iwwer d'Finanzsituatioun a -perspektive vun der CNS.

Die Themen in den Wissensnachrichten: +++ Mpox zirkuliert seit 2016 +++ Asteroid Dinkinesh ist Doppel-Asteroid +++ KI kann Tumor-Diagnose während OP stellen**********Weiterführende Quellen zu dieser Folge:Update ErdeAPOBEC3 deaminase editing in mpox virus as evidence for sustained human transmission since at least 2016, Science, 02.11.2023NASA's Lucy Spacecraft Discovers 2nd Asteroid During Dinkinesh Flyby, Nasa-Website, Zugriff: 02.11.2023Ultra-fast deep-learned CNS tumour classification during surgery, Nature, 11.10.2023Word differences in news media of lower and higher peace countries revealed by natural language processing and machine learning, Plos One, 01.11.2023Large-scale violence in Late Neolithic Western Europe based on expanded skeletal evidence from San Juan ante Portam Latinam, Scientific Reports, 2.11.2023Dopamine pathways mediating affective state transitions after sleep loss, Neuron, 02.11.2023**********Ihr könnt uns auch auf diesen Kanälen folgen: Tiktok und Instagram.

In this episode of "Pushing the Limits" I talk to Dr Rob Silverman, Chiropractor, clinical nutritionist, author, international speaker and functional medicine practitioner, founder of Westchester Integrated Health about the gut. Your microbiome is is the key to your immune system, over 80% of your immune system is in the gut.  We do a deep dive into: What is a healthy microbiome SIBO Leaky Gut and how to heal it Gall bladder health, pancreatic enzymes and the role of stomach acid. How the gut impacts your mental health How the gut impacts your neurotransmitter production. What short chain fatty acids are All about probiotics How to get rid of parasites, bacteria and viruses Foods to embrace and what to avoid We talk the latest on bioavailable peptides and  cutting edge longevity insights and much more. If you are having gut issues, autoimmune issues, mood and behavior issues, hormonal issues, bloating, IBS, IBD, Crohns disease, autism, alzheimers or neurodegeneration then this is the  episode for you! Dr Rob Silvermans new book "Immune Reboot" is now available for sale at https://www.immunereboot.com/ Find out more about Dr Rob at https://drrobertsilverman.com/ BIO Robert G. Silverman, DC, DACBN, DCBCN, MS, CCN, CNS, CSCS, CIISN, CKTP, CES, HKC, FAKTR Dr. Robert Silverman is a chiropractic doctor, clinical nutritionist, national/international speaker, author of Amazon's #1 bestseller  “Inside-Out Health,” founder and CEO of Westchester Integrative Health Ctr. He graduated magna cum laude from the University of Bridgeport College of Chiropractic and has a Master of Science in human nutrition. The ACA Sports Council named Dr. Silverman “Sports Chiropractor of the Year” in 2015. Dr. Silverman is on the advisory board for the Functional Medicine University and is a seasoned health and wellness expert on both the speaking circuits and the media. Dr. Silverman is a thought leader in his field and practice, a frequently published author in peer-reviewed  journals and other mainstream publications. Dr. Silverman was the principal investigator on two Level 1 laser FDA studies. His new book, Amazon's best seller, Immune Reboot, was released in December 2022. Instagram- @drrobertsilverman Facebook- @drrobertsilverman Linkedin- https://www.linkedin.com/in/drrobertsilverman/ Youtube- https://www.youtube.com/c/DrRobertSilverman   Health Optimisation and Life Coaching with Lisa Tamati Lisa offers solution focused coaching sessions to help you find the right answers to your challenges. Topics Lisa can help with:  Lisa is a Genetics Practitioner, Health Optimisation Coach, High Performance and Mindset Coach. She is a qualified Ph360 Epigenetics coach and a clinician with The DNA Company and has done years of research into brain rehabilitation, neurodegenerative diseases and biohacking. She has extensive knowledge on such therapies as hyperbaric oxygen,  intravenous vitamin C, sports performance, functional genomics, Thyroid, Hormones, Cancer and much more. She can assist with all functional medicine testing. Testing Options Comprehensive Thyroid testing DUTCH Hormone testing Adrenal Testing Organic Acid Testing Microbiome Testing Cell Blueprint Testing Epigenetics Testing DNA testing Basic Blood Test analysis Heavy Metals  Nutristat Omega 3 to 6 status and more  Lisa and her functional medicine colleagues in the practice can help you navigate the confusing world of health and medicine . She can also advise on the latest research and where to get help if mainstream medicine hasn't got the answers you are searching for whatever the  challenge you are facing from cancer to gut issues, from depression and anxiety, weight loss issues, from head injuries to burn out to hormone optimisation to the latest in longevity science. Book your consultation with Lisa    Join our Patron program and support the show Pushing the Limits' has been free to air for over 8 years. Providing leading edge information to anyone who needs it. But we need help on our mission.  Please join our patron community and get exclusive member benefits (more to roll out later this year) and support this educational platform for the price of a coffee or two You can join by going to  Lisa's Patron Community Or if you just want to support Lisa with a "coffee" go to  https://www.buymeacoffee.com/LisaT to donate $3   Lisa's Anti-Aging and Longevity Supplements  Lisa has spent years curating a very specialised range of exclusive longevity, health optimising supplements from leading scientists, researchers and companies all around the world.  This is an unprecedented collection. The stuff Lisa wanted for her mum but couldn't get in NZ.   Subscribe to our popular Youtube channel  with over 600 videos, millions of views, a number of full length documentaries, and much more. You don't want to miss out on all the great content on our Lisa's youtube channel. Youtube   Order Lisa's Books Lisa has published 5 books: Running Hot, Running to Extremes, Relentless, What your oncologist isn't telling you and her latest "Thriving on the Edge"  Check them all out at  https://shop.lisatamati.com/collections/books   Perfect Amino Supplement by Dr David Minkoff Introducing PerfectAmino PerfectAmino is an amino acid supplement that is 99% utilised by the body to make protein. PerfectAmino is 3-6x the protein of other sources with almost no calories. 100% vegan and non-GMO. The coated PerfectAmino tablets are a slightly different shape and have a natural, non-GMO, certified organic vegan coating on them so they will glide down your throat easily. Fully absorbed within 20-30 minutes! No other form of protein comes close to PerfectAminos Listen to the episode with Dr MInkoff here:  Ketone Products by HVMN The world's best  exogenous Ketone IQ Listen to the episode with Dr Latt Mansor Lisa's  ‘Fierce' Sports Jewellery Collection For Lisa's gorgeous and inspiring sports jewellery collection, 'Fierce', go to Jewellery   For Vielight Photobiomodulation devices Vielight brain photobiomodulation devices combine electrical engineering and neuroscience. To find out more about photobiomodulation, current studies underway and already completed and for the devices mentioned in this video go to www.vielight.com Use code "tamati" at checkout to get a 10% discount on any of their devices.   Enjoyed This Podcast? If you did, subscribe and share it with your friends! If you enjoyed tuning in, then leave us a review and share this with your family and friends. Have any questions? 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Go online to PeerView.com/HHW860 to view the activity, download slides and practice aids, and complete the post-test to earn credit. Despite all of the advances in cancer treatment, there is still a significant need for a fourth pillar of therapy that can help improve outcomes for patients across a spectrum of solid tumors, such as glioblastoma, lung cancer, and GI malignancies. In this PeerView activity, an expert faculty panel will review the latest cutting-edge data supporting the use of tumor treating fields (TTFields) and synergistic combination strategies in established and emerging solid tumor indications from CNS to thoracic malignancies and beyond. You'll gain strategies to maximize treatment adherence and quality of life, develop skills for evidence-based adverse event management, and discover life-prolonging clinical trial opportunities. Delve into the science behind the use of TTFields in the treatment of solid malignancies, the latest evidence on the efficacy and safety of this modality across approved and emerging indications, and radiation oncology–focused guidance for the safe and effective incorporation of TTFields therapy in the clinic. Upon completion of this activity, participants should be better able to: Describe the mechanistic rationale and evidence supporting the use of TTFields for the treatment of patients with CNS, thoracic, and other aggressive solid tumors; Integrate TTFields into multimodal management protocols for appropriately selected patients with CNS, thoracic, and other solid malignancies; and Devise team-based strategies designed to mitigate and manage adverse events associated with TTFields to improve outcomes in patients with difficult-to-treat cancers.

Go online to PeerView.com/HHW860 to view the activity, download slides and practice aids, and complete the post-test to earn credit. Despite all of the advances in cancer treatment, there is still a significant need for a fourth pillar of therapy that can help improve outcomes for patients across a spectrum of solid tumors, such as glioblastoma, lung cancer, and GI malignancies. In this PeerView activity, an expert faculty panel will review the latest cutting-edge data supporting the use of tumor treating fields (TTFields) and synergistic combination strategies in established and emerging solid tumor indications from CNS to thoracic malignancies and beyond. You'll gain strategies to maximize treatment adherence and quality of life, develop skills for evidence-based adverse event management, and discover life-prolonging clinical trial opportunities. Delve into the science behind the use of TTFields in the treatment of solid malignancies, the latest evidence on the efficacy and safety of this modality across approved and emerging indications, and radiation oncology–focused guidance for the safe and effective incorporation of TTFields therapy in the clinic. Upon completion of this activity, participants should be better able to: Describe the mechanistic rationale and evidence supporting the use of TTFields for the treatment of patients with CNS, thoracic, and other aggressive solid tumors; Integrate TTFields into multimodal management protocols for appropriately selected patients with CNS, thoracic, and other solid malignancies; and Devise team-based strategies designed to mitigate and manage adverse events associated with TTFields to improve outcomes in patients with difficult-to-treat cancers.

Do you ever wonder what the medical industry would be like if the practitioners incorporated Soul and all their soul gifts as healers, as seers, as mystics? Do you ever wonder what that would look like? Well, if you do, it would actually require of us to step out of the proverbial spiritual closet and start shining those gifts into the world and be brave and courageous. Today we're talking with Venessa Rodrigues who is an intuitive nourishment guide and creatrix and host of the Feed Your Wild podcast. Venessa's on a mission to guide ourselves to nourishment and remembrance so we can bring back soul into medicine. Watch or listen to explore your own soul gifts for yourself and/or for your community. You're invited! MORE ABOUT VENESSA RODRIGUEZVenessa Rodriguez, CNS is a mama, intuitive nourishment guide, Akashic Soul Record channeler, herbalist and clinical nutritionist. Through her holistic healing & wellness education collective, Wildly Rooted, and her podcast Feed Your Wild, Venessa's mission is to get to the root of our collective dis-ease & re-member the soul back into medicine through radical nourishment of body, mind, & spirit. Venessa has worked in private practice since 2011 combining the science + spirituality of food & herbs and is the founder of the Wildly Intuitive Practitioner Pathway, where she helps wild-hearted practitioners, healing artists, and change-makers step into their soul-driven mission, medicine & calling through intuitive-based healing work using their unique gifts.FREE GIFT: Dare To Shine Healer - Breakthrough Imposter Syndrome & Amplify Your Intuitive GiftsLink: https://www.wildlyrooted.com/imposter...Coupon code: SOULNECTARGO DEEPER: Wildly Intuitive Practitioner Pathway (WIPP)https://kerrihummingbird--wildlyroote...Wildly Intuitive Practitioner Pathway (WIPP) is a 9-month intuitive healing mentorship and practitioner mastermind. It's for wild-hearted practitioners & healers looking to develop a truly wholistic intuitive healing practice, step out of the “spiritual closet” and bridge the spiritual and mystical with the scientific and practical in client healing work.Connect with Venessa:Website: https://www.wildlyrooted.com/Podcast:

In the first part of two podcasts covering recent data presented at the European Society of Medical Oncology Congress 2023, host Dr. Stephen Liu summarizes the most compelling research on metastatic non small cell lung cancer from the meeting with Dr. Zosia Piotrowska and Dr. Noemi Reguart, discussing several impactful studies including MARIPOSA, MARIPOSA-2, LIBRETTO-431, TROPION-Lung01 and more as well as reviewing the importance of CNS efficacy and the evolving role of antibody drug conjugates (ADCs).

Neste episódio 47 do #PodcastADu, a entrevistada é Rosana Onoko Campos, docente na Faculdade de Ciências Médicas (FCM/Unicamp) e atual presidenta da Associação Brasileira de Saúde Coletiva (Abrasco). A professora Rosana fala sobre os impactos e riscos que a PEC 10/2022, conhecida como a PEC do Plasma, terá na sociedade brasileira caso seja aprovada. A PEC do Plasma poderá permitir que a iniciativa privada colete e processe o plasma do sangue humano. A PEC passou na Comissão de Constituição e Justiça (CCJ) do Senado, e foi aprovada por 15 votos a favor contra 11, no dia 04 de outubro, e agora o projeto será encaminhado para votação no plenário do Senado, que ainda não informou quando entrará na pauta. Várias instituições estão se posicionando radicalmente contrarias à emenda, entre elas a Fiocruz, o Conselho Nacional de Saúde (CNS) e a Associação Brasileira de Saúde Coletiva (Abrasco). NOVIDADE Estreamos neste episódio o novo formato do programa, agora gravado também em vídeo, e que pode ser assistido pelo canal oficial da ADunicamp Spotfy e no YouTube. Este foi o piloto e em breve teremos novidades!! O #PodcastADu está disponível também nas principais agregadoras do gênero: Apple Podcasts, Google Podcasts etc. CRÉDITOS Convidada: Professora Rosana Onocko Campos (FCM/Unicamp e ABRASCO) Roteiro e apresentação: Cristina Segatto e Paulo San Martin Edição de áudio: Paula Vianna e Magrão Edição de vídeo: Fernando Piva e MagrãoProdução e Coordenação: Fernando PivaRealização: ADunicampSIGA NOSSAS REDES www.adunicamp.org.br facebook.com/adunicamp twitter.com/adunicamp instagram.com/adunicamp youtube.com/adunicamp

Episode: October 2023 Host: Karl Steinberg, MD, HMDC, CMD Guest(s): Barbara Resnick, PhD, CRNP (editor); Daniel KY Chan, MBBS, MD, MHA In This Episode: In this episode, host Dr. Karl Steinberg, MD, CMD, and co-editor-in-chief Dr. Barb Resnick, PhD, CRNP, spotlight an article on telemedicine published in the JAMDA October issue. The author, Dr. Chan, MBBS, MD, MHA, will join the conversation. A non-inferiority study was conducted in 17 nursing homes, including 438 residents.  Face-to-face interventions involved on-site assessment by a geriatrician and aged care clinical nurse specialist (CNS). Telemedicine interventions involved on-site assessment by an aged care CNS with telemedicine input by a geriatrician. The study identified some pros and cons related to use of telemedicine in nursing home communities. Further, the findings provide interesting and useful conclusions to guide further work in this area.  In addition to Dr. Chan's paper, the following articles will be highlighted and reviewed: Challenges and Issues with Death Certificates After Voluntary Stopping of Eating and Drinking by Takeshi Uemura, MD, from the University of Maryland School of Medicine; Daytime Sleepiness Predicts Mortality in Nursing Home Residents: Findings from the Frailty in Residential Aged Care Sector Over Time (FIRST) Study by Ronaldo Piovezan, PhD, from the University of Adelaide, Australia; and Changes in Personality Before and During Cognitive Impairment by Antonio Terracciano, PhD, from Florida State University, Tallahassee, Florida. Articles Referenced: Telemedicine vs Face-to-face for Nursing Home Residents with Acute Presentations: A Non-Inferiority Study Corresponding  Challenges in Completing a Death Certificate after Voluntary Stopping of Eating and Drinking (VSED) Daytime Sleepiness Predicts Mortality in Nursing Home Residents: Findings from the Frailty in Residential Aged Care Sector Over Time (FIRST) Study Changes in Personality Before and During Cognitive Impairment Date Recorded: October 20, 2023 Available Credit: The American Board of Post-Acute and Long-Term Care Medicine (ABPLM) issues CMD credits for AMDA On-The-Go and affiliate podcast episodes as follows: Claim CMD Credit

Strategic empathy is the sincere effort to identify and assess patterns of behavior and the underlying drivers and constraints that shape those patterns.  In a CT Collaborative-funded research project, a team from the James Martin Center for Nonproliferation Studies at MIIS explored the utility of this concept for understanding the acquisition, threat, and use of strategic weapons. In this episode, we offer selections from a 2023 webinar describing the project's insights. Through case studies involving three US adversaries – Russia, North Korea, and Iran – the authors suggest that a more holistic, nuanced understanding of the adversary can inform effective policy responses. The CNS team included Sarah Bidgood, Robert Carlin, Siegfried Hecker, Jim Lamson, and Hanna Notte. You can read their full report at our website: https://www.middlebury.edu/conflict-transformation/supporting-faculty-research/spring-2022-grant-recipients  

Rabies is a vaccine-preventable, zoonotic, viral disease affecting the central nervous system. Once clinical symptoms appear, rabies is virtually 100% fatal, and treatment is typically supportive. It causes tens of thousands of deaths every year, mainly in Asia and Africa. Currently, there is no validated treatment in humans that prevents death following symptomatic rabies, however my guest today and his colleagues at the Uniformed Services University (USU) have made a significant breakthrough which may have changed that. Joining me today to discuss this rabies therapy is Brian Schaefer PhD, Dr Schaefer is a Professor in the Department of Microbiology and Immunology at the Uniformed Services University (USU) in Bethesda, MD. He also holds secondary appointments as Professor in the following USU graduate (Ph.D.) programs: Emerging Infectious Diseases; Molecular and Cell Biology; and Neuroscience. The study: mAb therapy controls CNS-resident lyssavirus infection via a CD4 T cell-dependent mechanism

A contracor del que molts socis i la pròpia junta del CNS han manifestat d'intentar fer el possible per salvar l'entitat. El regidor d'esports Jaume Monasterio, i el gerent municipal, Miquel Rodríguez, s'han encarregat d'explicar l'estat actual de la situació que, d'una banda, tal com marca la llei, requereix de la liquidació del Consorci que formen CNS i Ajuntament, i d'altra banda, segons el govern, impedeix la salvació del Club Natació Sitges i proposa la venda de les instal·lacions a través d'un concurs amb la garantia de mantenir l'oferta formativa, esportiva i federativa. Socis i assistents han apel·lat però al valor intangible i identitari de la marca CNS en tant que club gairebé centenari i han sorgit fins i tot propostes per tal de mantenir l'entitat, com la municipalització del servei o una quita de prop de cinquanta mil euros tal com proposa la junta actual del club. L'entrada L’Ajuntament exposa la difícil salvació del CNS i adquireix el compromís de salvar l’activitat esportiva ha aparegut primer a Radio Maricel.

Dr Michael Lange and Dr Richard Hall host todays show on what makes up a good protein. Dr Lange discusses a new fermented vegan protein that is as good as whey protein with a perfect PDCASS score of 1. He talks about the development of an all-vegan protein Fortifeye Vitamins has been testing using fermented pea, rice and or barley. They have been testing a variety of different forms of vegan protein that will be easily digestible, taste good, no chalky or grainy texture and be a complete protein. This new Fortifeye Vegan Super Protein will have a PDCASS score of 1 making it very similar to whey protein. Most vegan proteins are harsh on the digestive system due to the high amounts of lectins, phytic acid, gluten, fodmaps and other anti-nutrients that are in these types of vegan proteins. Fortifeye is working with a company that uses mushroom mycelia to ferment the pea and rice to make it much higher in amino acids and easier to digest. They are also working with an upcycled barley protein in their new vegan super protein and determining which form of vegan protein will work best. Dr Hall discusses the amount of time the team has spent in the lab doing taste and solubility testing for this new FOrtifeye Vegan Super Protein. Dr Hall does a discussion on how we can use nutritional support for sarcopenia and talks about the all new Fortifeye Fit Pro as having all of the ingredients to help with this muscle wasting condition. Fortifeye Fit Pro will hopefully be available for the Mr Olympia contest coming very soon. Dr Lange discusses natural support for glaucoma and mentions the all new Fortifeye eye pressure and Neuro Cognitive Support supplement coming very soon. This new supplement will combine Neumentix with Mirtogenol. This will be the first glaucoma vitamin on the market. This supplement will bring the latest in nutritional support to the optic nerve and brain via the retinal ganglion cell layer and retinal nerve fiber layer. Dr Hall is available for free nutritional consultations at the Lange Eye Institute and Dr Susan Summerton OD, CNS is available to see new patients at the Lange Eye Institute. Dr Lange goes over in detail how to pick a good protein powder and emphasizes grass fed, non-denatured whey protein. He promotes Fortifeye Grass Fed Whey Isolate as being one of the top whey proteins for a great price.Support the show: https://www.drmichaellange.com/category/ask-the-doctor/See omnystudio.com/listener for privacy information.

Episode 151: Martian Medicine 102Future Dr. Collins discussed with Dr. Arreaza two common complications of astronauts in a hypothetical travel to Mars: Spaceflight-Associated Neuro-ocular Syndrome and mental illness.  Written by Wendy Collins, MSIV, Ross University School of Medicine. Comments by Hector Arreaza, MD.You are listening to Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California, a UCLA-affiliated program sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. This podcast was created for educational purposes only. Visit your primary care provider for additional medical advice.Arreaza: We are back for another episode of Martian Medicine! A couple months ago we published the episode Martian Medicine 101. We talked about radiation and its health risks for astronauts going beyond Low Earth Orbit such as a crew going to Mars. Today, we are going to be covering Martian Medicine 102, where we discuss some more risks from the article “Red risks for a journey to the red planet”. So, let's just jump into it! The next risk we are going to talk about is Spaceflight-Associated Neuro-ocular Syndrome or SANS.  Wendy: Yes, so this used to be called Vision Impairment Intracranial Pressure because the syndrome affects astronauts' eyes and vision and can appear like idiopathic intracranial hypertension. But the name changed to SANS because is not associated with the classic symptoms of increased intracranial pressure in idiopathic intracranial hypertension such as severe headaches, transient vision obscurations, double vision, and pulsatile tinnitus. Also, it has never induced vision changes that meet the definiti on of vision impairment, as defined by the National Eye Institute. Its name change also reflects that the syndrome can affect the CNS well beyond the retina and optic nerve. Arreaza: Let's talk about SANS some more. SANS presents with an array of signs including edema of the optic disc and retinal nerve fiber, and what else?Wendy: Edema of chorioretinal folds, globe flattening, and refractive error shifts. Flight duration is thought to play a role in the pathogenesis of SANS, as nearly all cases have been diagnosed during or immediately after long-duration spaceflight such as missions of 30 days duration or longer. But signs have been discovered as early as mission day 10. SANS has been studied in ISS crewmembers who are tested with optical coherence tomography (OCT), retinal imaging, visual acuity, a vision symptom questionnaire, Amsler grid, and ocular ultrasound.Arreaza: About 69% of the US crewmembers on the ISS experience an increase in retinal thickness in at least one eye, indicating the presence of optic disc edema. This can cause an astronaut to experience blind spots and reduced visual function. Fortunately, to date, blind spots are uncommon and have not had an impact on mission performance.Wendy: And chorioretinal folds if severe enough and located near the fovea, an astronaut can experience visual distortions or reduced visual acuity that cannot be corrected with glasses or contact lenses. Fortunately, and despite a prevalence of 15–20% in long-duration crewmembers, chorioretinal folds have not yet impacted astronauts' visual performance during or after a mission.  Arreaza: A change in your glasses prescription is due to a change in the distance between the cornea and the fovea, and it occurs in about 16% of crewmembers during long-duration spaceflight. This risk is reduced by giving crewmembers with several pairs of “Space Anticipation Glasses” (or contact lenses). The crewmember can then select the appropriate lenses to correct visual acuity. Wendy: From a longer-term perspective, SANS presents two main risks to crewmembers: optic disc edema and chorioretinal folds. It is unknown if a multi-year spaceflight like that to Mars will be associated with a higher prevalence, duration, and/or severity of optic disc edema compared to what has been experienced onboard the ISS. Since the retina and optic nerve are part of the CNS, if optic disc edema is severe enough, the crewmember risks a permanent loss of optic nerve and retinal nerve fiber tissue and thus, a permanent loss of visual function. But again, no astronaut has experienced SANS-related permanent vision loss and choroidal folds usually improved post-flight in affected crewmembers. Arreaza: It is important to understand the pathogenesis of SANS. In microgravity, fluid can distribute uniformly. The fluid that normally pools in your legs due to gravity can now move to your head and cause congestion of the cerebral veins. The pathophysiology of SANS is that CSF outflow can be blocked, which increases intracranial pressure. Wendy: There can be confounding variables such as exercise, high-sodium dietary intake, and high carbon dioxide levels. It is difficult to know much about SANS because there are not many crewmembers who have completed long-duration spaceflight. There is now enough evidence to state that SANS is not a male-only syndrome. Optical Coherence Tomography (OCT) has been used on the ISS since 2013, and it has allowed NASA to build a database of retinal and optic nerve images to understand SANS better. Research from this has shown that most long-duration astronauts present with some level of optic disc edema.Arreaza: Now all NASA crewmembers receive pre- and post-flight MRIs of the brain. There is evidence that brain changes structure with longer space flights. For example, the ventricles of the brain enlarge with 2–3 mL of CSF in astronauts. Luckily, there has been no cognitive problems with this. Like with most space health concerns, more research is needed. Wendy: In summary, SANS is a red risk and top priority to NASA and the human research program. The main concern with SANS is optic disc edema because it could lead to permanent vision impairment. And choroidal folds are also concerning for both short- and long-term flights. But for now, loss of visual acuity is successfully combatted with glasses. Certainly, the more astronauts and flights we take, the more we will learn about SANS.Wendy: Sorry we took so long on SANS, it's probably one of my favorites of all the red risk. Now let's move onto the red risk that includes behavioral health and performance. Future long duration mission in which you are in an isolated and confined space such as a space craft surrounded by an inhospitable environment which humans are not meant to survive could be a problem for the crew's behavioral and mental health. Arreaza: This could affect the astronauts and their ability to complete their mission. Typically, astronauts enjoy space and report it is a positive experience. But psychological changes from being in space for a long time will likely be even more challenging. Wendy: In the past, astronauts have reported ‘hostile' and ‘irritable' crew and symptoms of depression. Arreaza: Stressors to the ISS include long work hours and high workload, and the discomfort of space motion sickness. No one likes vomiting.  Wendy: Being on the ISS, you are close to Earth, and it is easy to communicate with family and friends when needed. Going to Mars there will be communication delay and will make support more difficult. Astronauts on the ISS also have routinely received care packages, which will also not be available to boost morale. Crew members can also change by swapping out astronauts over a certain period, but the crew to Mars will also not have this ability to work with new people.  Arreaza: There are simulation projects to test human resilience. NASA does these kinds of testing at the Johnson Space Center. There is also research in Antarctica that has shown decreased mood and increased stress for scientists in extreme environments. There is also the Mars 500 mission.  Wendy: Yes, the Mars 500 mission was where a crew of 6 went into isolation in Moscow for 520 days to simulate a trip to Mars. The astronauts had to complete behavioral questionnaires weekly. One of the six reported depressive symptoms based on the Beck Depression Inventory. Two crew members who had the highest ratings of stress and exhaustion, also reported conflicts and sleep difficulties. Two crew members reported no adverse behavioral symptoms during the mission.Wendy: So, I believe we're done. We've covered Radiation, SANS, and behavioral health. I know this topic is probably unique for qWeek, but a lot of what we learn medically from our time in space does have applications to us on Earth. As a medical student advice, I have gotten from others in the field is pursue what you're passionate about. Aerospace medicine is a growing field for clinicians from all specialties, so there's no golden path to take. If you are interested more in this field, I highly recommend joining relevant associations specifically AsMA and AMRSO. And if you ever want to discuss aerospace medicine further, feel free to reach out to me at my Ross email!______________________Conclusion: Now we conclude episode number 151, “Martian Medicine 102.” Future Dr. Collins explained that ocular issues are a potential problem when astronauts go to Mars, including Spaceflight-Associated Neuro-ocular Syndrome and vision impairments that would require changes in glass prescription, so, don't forget to take extra pairs of glasses when you go to the red planet. Dr. Arreaza also joined the conversation by talking about the mental health challenges that many astronauts may face as they embark on a long trip to Mars in a secluded spacecraft. We look forward to more information on Martian Medicine as primary care on Mars may look surprisingly similar to primary care on Earth.This week we thank Hector Arreaza and Wendy Collins. Audio editing by Adrianne Silva.Even without trying, every night you go to bed a little wiser. Thanks for listening to Rio Bravo qWeek Podcast. We want to hear from you, send us an email at RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. See you next week! _____________________References:Patel, Z.S., Brunstetter, T.J., Tarver, W.J. et al. Red risks for a journey to the red planet: The highest priority human health risks for a mission to Mars. npj Microgravity 6, 33 (2020). https://doi.org/10.1038/s41526-020-00124-6Royalty-free music used for this episode: Space Orbit by Scott Holmes, downloaded on July 20, 2022, from https://freemusicarchive.org/music/Scott_Holmes/. 

On episode #38 of the Infectious Disease Puscast, Daniel reviews the infectious disease literature for the weeks of 9/14 – 9/27/23. Host: Daniel Griffin and Sara Dong Subscribe (free): Apple Podcasts, Google Podcasts, RSS, email Become a patron of Puscast! Links for this episode Features of Long COVID identified through immune profiling (Nature) Severity of influenza-associated hospitalizations by influenza type (The Lancet) Cefazolin for the treatment of CNS infections (CID) Rifampin based therapy for patients with Staphylococcus aureus native vertebral Osteomyelitis (CID) State of the management of infections caused by multidrug-resistant organisms (CID) Are contact precautions “essential” for the prevention of healthcare-associated methicillin-resistant Staphylococcus aureus? (CID) Impact of the sequential implementation of a pharmacy-driven methicillin-resistant Staphylococcus aureus (MRSA) nasal-swab ordering policy and vancomycin 72-hour restriction protocol on standardized antibiotic administration ratio (ICHE) Update on outbreak of fungal meningitis among US residents who received epidural anesthesia at two clinics in Mexico (CID) Paratracheal abscess by plant fungus Chondrostereum purpureum (MMCR) Canadian Blood Services traceback investigation of a suspected case of transfusion-transmitted malaria (Transfusion) Strongyloides infection screening in transplant candidates (TID) The world of microbial odors (JID) Music is by Ronald Jenkees

Shoulder pain can be related to various neurological factors and connections within the central nervous system. The central nervous system (CNS) includes the brain and spinal cord, and it plays a crucial role in transmitting and processing pain signals. Here are a few ways in which shoulder pain and the central nervous system are connected:1. Nerve Impingement:Brachial Plexus: The brachial plexus is a network of nerves that control the shoulder, arm, and hand muscles. Compression or impingement of these nerves due to conditions like thoracic outlet syndrome or cervical radiculopathy can cause shoulder pain.2. Referred Pain:Visceral Referred Pain: Problems in internal organs like the heart, liver, or gallbladder can cause shoulder pain. This phenomenon, known as referred pain, occurs because the nerves that supply the internal organs and the shoulder converge at the same levels in the spinal cord, leading to the brain interpreting the pain as coming from the shoulder.4. Neuropathic Pain:Neuropathy: Damage to peripheral nerves (nerves outside the brain and spinal cord) can cause neuropathic pain. Conditions like diabetic neuropathy or nerve injuries near the shoulder can result in chronic shoulder pain due to faulty signaling to the brain.5. Inflammatory Responses:Cytokines and Neurotransmitters: Inflammation in the shoulder joint can lead to the release of cytokines and neurotransmitters that sensitize nearby nerves, making them more responsive to pain signals. These signals are transmitted to the CNS, leading to the perception of pain.In summary, the connection between shoulder pain and the central nervous system is multifaceted, involving a complex interplay of peripheral nerve signals, CNS processing, psychological factors, and inflammatory responses. Understanding these connections is crucial for diagnosing and effectively managing shoulder pain in clinical settings. If you have any questions call Dr.McKay 203-656-3636 our clinic is a chiropractic holistic practice specializing in pain relief.Core Health Darien-Dr.Brian Mc Kay 551 Post RoadDarien CT 06820203-656-363641.0833695 -73.46652073GMP+87 Darien, Connecticuthttps://youtu.be/WThis podcast welcomes your feedback here are several ways to reach out to me. If you have a topic you would like to hear about send me a message. I appreciate your listening. Dr. Brian Mc Kayhttps://twitter.com/DarienChiro/https://www.facebook.com/ChiropractorBrianMckayhttps://chiropractor-darien-dr-brian-mckay.business.sitehttps://podcasts.apple.com/us/podcast/not-just-chiropractor-for-stamford-darien-norwalk-new/id1503674397?uo=4Core Health Darien-Dr.Brian Mc Kay 551 Post RoadDarien CT 06820203-656-363641.0833695 -73.46652073GMP+87 Darien, Connecticuthttps://youtu.be/WpA__dDF0O041.0834196 -73.46423349999999https://darienchiropractor.comhttps://darienchiropractor.com/darien/darien-ct-understanding-pain/Find us on Social Mediahttps://chiropractor-darien-dr-brian-mckay.business.site https://www.youtube.com/channel/UCNHc0Hn85Iiet56oGUpX8rwhttps://docs.google.com/spreadsheets/d/1nJ9wlvg2Tne8257paDkkIBEyIz-oZZYy/edit#gid=517721981https://goo.gl/maps/js6hGWvcwHKBGCZ88https://www.youtube.com/my_videos?o=Uhttps://www.linkedin.com/in/darienchiropractorhttps://www.facebook.com/ChiropractorBrianMckayhttps://sites.google.com/view/corehealthdarien/https://sites.google.com/view/corehealthdarien/home

I love talking with Amy Berger as she keeps what we should eat real and simple! Amy Berger, MS, CNS, is a U.S. Air Force veteran and Certified Nutrition Specialist who helps people do “Keto Without the Crazy.”™ She writes about a wide range of health and nutrition-related topics, such as insulin, weight loss, diabetes, Alzheimer's disease, thyroid function, and more. She has presented internationally on these issues and is the author of The Alzheimer's Antidote, The Stall Slayer, and co-author of End Your Carb Confusion, written with Eric Westman, MD. She is the Lead Nutritionist for Adapt Your Life Academy, where she helps create course content and coaches people through implementing low-carb keto diets safely and effectively. She helped create the American Nutrition Association's Ketogenic Nutrition Training Program curriculum and is on the BCNS exam review committee, which writes the credentialing board exam for Certified Nutrition Specialists. Check out her recent recording on talk on thyroid from Low Carb Denver:    • Amy Berger, MS, CNS presentation: Opt...   We talk about... Why be in nutritional ketosis … how long or flex in/out? Why do so many people struggle with low thyroid and hormones? Is keto carnivore the answer for everyone? Are all “carbs evil”? How to make aging gracefully- aging athlete and female athletes Watch our video here Are you an aging athlete and on a mission as myself to improve the aging process?  Are you an ambitious, driven, high charging athlete who is struggling to get the desired results even when doing all the "right" things? Do you prioritize protein and lifting weights to build/maintain muscle as you age? Are you living life as a race instead of a journey? CHRONIC Stress will impact all efforts... check out the elements of what I call "The WHOLESTIC Method" to transform the WHOLE you from the inside out to burn fat, improve performance and longevity.  Connect and Follow Coach Debbie: Life is Not a Race...It is a Journey: Learn how to pace the WHOLE you with The WHOLESTIC Method https://www.amazon.com/dp/1540572005 WEB: http://debbiepotts.net/ 

Yvonne C. Lee, MD, of Northwestern Medicine Rheumatology, explores pain mechanisms in rheumatoid arthritis (RA). Dr. Lee is an expert on the effects of central nervous system (CNS) modulation of pain in rheumatoid arthritis. She has contributed novel insights into the role of CNS modulation of pain using novel techniques, such as quantitative sensory testing and neuroimaging. She shares her recent findings on sex differences in pain, and quantitative sensory testing in patients with RA and their clinical implications.

ASCO: You're listening to a podcast from Cancer.Net. This cancer information website is produced by the American Society of Clinical Oncology, known as ASCO, the voice of the world's oncology professionals. The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guests' statements on this podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement. Cancer research discussed in this podcast is ongoing, so data described here may change as research progresses. The theme of the 2023 ASCO Annual Meeting was “Partnering With Patients: The Cornerstone of Cancer Care and Research.” From June 2 to 6 in Chicago, Illinois, and online, cancer researchers and clinicians from around the world gathered to discuss the latest cancer research and how to ensure that all people receive the cancer care they need. In the Research Round Up series, members of the Cancer.Net Editorial Board discuss the most exciting and practice-changing research in their field presented at the meeting and explain what it means for people with cancer. In today's episode, our guests will discuss new research advances in treating non-small cell lung cancer, small cell lung cancer, and mesothelioma.  Dr. Charu Aggarwal is the Leslye Heisler Associate Professor of Medicine in the Hematology-Oncology Division at the University of Pennsylvania's Perelman School of Medicine in Philadelphia, Pennsylvania. She is also the 2023 Cancer.Net Associate Editor for Lung Cancer. Dr. Melina Marmarelis is an assistant professor at the University of Pennsylvania, the Medical Director of the Penn Medicine Mesothelioma Program, and the co-director of the Molecular Tumor Board at the University of Pennsylvania. She is also the 2023 Cancer.Net Specialty Editor for Mesothelioma. Dr. Kristin Higgins is a radiation oncologist, Professor and Vice Chair in Clinical Research in the Department of Radiation Oncology at Emory University School of Medicine and medical director of radiation oncology of The Emory Clinic at Winship Cancer Institute's Clifton campus location. She is also a 2023 Cancer.Net Advisory Panelist for Lung Cancer. You can view disclosures for Dr. Aggarwal, Dr. Marmarelis, and Dr. Higgins at Cancer.Net. Dr. Aggarwal: Hello and welcome to this Cancer.Net Research Round Up podcast. Today, we will be talking about the latest research from the Annual Meeting of the American Society of Clinical Oncology from June 2023, and I'm joined today by 2 experts in the field of lung cancer. Before I introduce them, I'd like to introduce myself. I'm Dr. Charu Aggarwal. I'm an associate professor for lung cancer excellence at the University of Pennsylvania's Abramson Cancer Center. I'd now like to introduce Dr. Melina Marmarelis. Dr. Marmarelis: Hi, so happy to be here. I'm Melina Marmarelis. I'm an assistant professor at the University of Pennsylvania and the medical director of the Penn mesothelioma program. Dr. Aggarwal: And Dr. Kristin Higgins. Dr. Higgins: Hi, everyone. I'm Kristin Higgins. I am a thoracic radiation oncologist at Winship Cancer Institute of Emory University. I'm a professor and vice chair for clinical research for radiation oncology. Dr. Aggarwal: Fantastic. So today, we'll talk about relevant research as it applies to practical implications in the clinic for practitioners, but most importantly, patients with lung cancer. I'd like to start off by discussing 2 key studies, and I would love for perspectives from our faculty here. The first study I want to highlight is the ADAURA trial. This is a trial that has already sort of changed practice in most recent years when the study was presented at the Annual Meeting of the American Society of Clinical Oncology in 2020, but we have new updates on this study as of 2023. So, in brief, this was a study that looked at the value of administering an oral pill called osimertinib that is a tyrosine kinase inhibitor against the EGFR, or the epidermal growth factor receptor, in patients with non-small cell lung cancer. We know that non-small cell lung cancer is quite a heterogeneous disease with some subsets of patients having mutations that may render them increasingly sensitive to the effects of these tyrosine kinase inhibitors. In fact, these pills have been used in the metastatic setting for several years based on an improvement in overall survival. What the ADAURA study tried to do was ask the question if this pill would add an incremental advantage after receiving curative-intent surgical resection in those with early-stage lung cancer. So this study enrolled patients with stage IB to IIIA non-small cell lung cancer after surgical resection and focused only on those patients that had sensitizing EGFR mutations with EGFR exon 19 deletion or L858R mutations. Patients could receive chemotherapy after having the surgery and then were basically randomized into 2 groups, one of whom received osimertinib at a dose of 80 milligrams once daily for a total of 3 years. Patients were followed up for recurrence. We already know from the earlier results that patients who received osimertinib had a better chance of delaying the recurrence of disease. However, what we found at the Annual Meeting this year is that the administration of this osimertinib also improved overall survival, which is really what we all look for in the oncology world. If you're administering a therapy, especially for a long duration, we want to be able to see a survival benefit, and that's what we saw. In fact, in patients who received osimertinib, there was a 49% less likelihood of dying from lung cancer compared to those who did not receive osimertinib. This, I think, is practice-affirming. It may not be practice-changing because some of the practitioners started using osimertinib after its FDA approval in December of 2020, but I think it just confirms our practice as it delivers an overall survival advantage in these patients. One thing that's increasingly important is to identify patients who have this mutation, so now we have efforts underway locally as well as nationally to perform molecular genotyping on all patients with lung cancer so that we can adequately and appropriately treat those with early-stage lung cancer following curative resection or following surgery. Melina and Kristin, what are your thoughts? Dr. Marmarelis: Well, I think these results are really important because it did, as you say, affirm kind of what we're already doing, but I think the most convincing part of this for me is the prevention of spread of disease to the brain. This is not comparing osimertinib after surgery versus osimertinib ever, which I think is a difficult part about interpreting this trial. But I think the fact that it prevented disease from going to the brain is really meaningful to everyone, to patients, to the physicians that are caring for them, so I think that's a really important endpoint. Dr. Higgins: I agree with Melina. I think this is really exciting for our patients. It's exciting to have more treatment options for early-stage lung cancer. I think patients that are diagnosed with early-stage lung cancer are highly motivated to do everything they can to improve their likelihood of being cured. So I tend to have a lot of conversations about side effects and toxicities with patients that have questions and are sort of wondering how it will affect their quality of life, and of course, that is an important piece of it because patients that do have curable lung cancer are probably starting off with a better overall quality of life, but I think generally speaking, our patients have tolerated it well. I'm also kind of excited from a radiation oncology point of view. We treat patients with stereotactic body radiation therapy [SBRT] that are medically inoperable. And we have another trial with a cohort looking at osimertinib for those patients that have EGFR mutations, too, and that's ongoing, again, applying the same concept of trying to really use these SBRTs that work really well in the advanced setting, moving them into earlier stages of disease to help us care for more patients. So overall, I think it's really exciting, and I think it's a huge win for the clinical research community. Dr. Aggarwal: Well, that's wonderful. And I think this certainly advances the field as this is the first targeted therapy approved for patients with early-stage non-small cell lung cancer. I should add that AstraZeneca, the company that makes this drug, has provided institutional research funding to my institution, and I also serve as an advisor to them, but I was not involved personally in the research of this clinical trial. I'd like to move on but stay within the field of early-stage lung cancer and talk about another study called the KEYNOTE-671 study, and this is important because it really applies the idea of using immunotherapy before and after surgical resection in patients with early-stage lung cancer. Just to give a little bit of background to our listeners, we now have 3 approvals for the use of immunotherapy in patients with early-stage lung cancer. Two of those are in the adjuvant setting, meaning that if a patient undergoes surgical resection or surgery for early-stage lung cancer, they can receive either atezolizumab or pembrolizumab following that surgery, and that has been shown to improve outcomes in terms of reducing the chances of recurrence. We also have another approval, which is the third approval in early-stage lung cancer, where 3 cycles of chemotherapy and immunotherapy are administered prior to surgery, also called as the neoadjuvant chemo-immunotherapy approach. This drug that has been approved in combination with chemotherapy is nivolumab, and this approval came from a clinical trial called CheckMate 816 that showed both that patients who received this neoadjuvant chemo-immunotherapy approach had a higher proportion of patients who had complete response or pathologic complete response in their tumors at the time of surgery and also showed that the chances of the disease coming back after surgical resection was much lower amongst those that had received this intervention. The current study, the KEYNOTE-671 study, builds upon this concept and adds both a before-surgery intervention as well as an after-surgery intervention. So what this study did was it enrolled patients with early-stage, stage II to IIIB non-small cell lung cancer, and patients in the intervention arm received 4 cycles of chemotherapy in combination with pembrolizumab, underwent surgery, and then received immunotherapy with pembrolizumab for up to 13 cycles. Patients in the control arm received only chemotherapy prior to surgery and then placebo for up to 13 cycles after. This was a large study with about 786 patients randomized, and what we found was that those patients that received the intervention had a much higher likelihood of remaining disease-free or event-free following surgical resection as well as in the early analysis, an improvement in overall survival with about a 27% reduction in the risk of death. So I do think that this is the first study that shows us that use of both neoadjuvant as well as adjuvant. So sort of this perioperative approach of using immunotherapy before and after surgical resection can actually lead to improved outcomes. This is ultimately what we want for our patients, improvement in overall survival, improvement in cure rates, etc. The study has been silent on the use of radiation therapy, although it has gone into details in terms of the kinds of surgery that was done. Kristin, what are your views about this? Dr. Higgins: I think postoperative radiation after resection for non-small cell lung cancer has sort of started to fall out of favor because of the Lung ART trial that was published in Europe, a randomized phase III trial that showed no differences in disease-free survival or overall survival. And that's not to say that there aren't more study questions on ways to give it safer and ways to incorporate radiation in with the chemo-IO approach, and there are some novel ways to do that, and we're going to see some data presented at the World Lung Cancer Conference looking at some of those novel approaches. But standardly, when patients receive neoadjuvant chemo-immunotherapy followed by surgery, we typically would not offer radiation. There are instances, though, when patients have positive margins, for example, and in that situation, it's sort of a discussion on a case-by-case basis. But ideally, we're hoping that most of these patients that go to surgery are able to get a complete resection, and that's really the key component of the decision-making for deciding if patients are eligible for this approach. Dr. Aggarwal: I agree. Melina, any additional thoughts on this trial? Dr. Marmarelis: I think it's an exciting trial for the reasons that you mentioned. I think it does bring up a number of questions about whether both neoadjuvant and adjuvant immunotherapy are needed. I tend to like the idea of having immunotherapy present when the tumor is present before surgery, so I like kind of having that on board, but I think we still don't know which is more important. Dr. Aggarwal: So it certainly raises many more questions, which hopefully will be answered in the future. KEYNOTE-671 trial was conducted by Merck that produces the drug Keytruda, or pembrolizumab. We have received institutional research funding for other trials. I was not personally involved in this clinical trial. I do serve as an advisor for Merck. I think we'll bring you more research from the ASCO Annual Meeting. And I'll turn it over to Dr. Marmarelis to discuss some more exciting research. Dr. Marmarelis: Thanks, Charu. So perhaps it's not surprising that one of the exciting things I picked from ASCO has to do with mesothelioma. And I just want to put into context a little bit about why this trial was important. This is IND227. It was a cooperative group trial done across Canada, France, and Italy, and this was chemotherapy plus or minus pembrolizumab in patients with pleural mesothelioma that did not undergo surgery. So this was their first treatment, and they were not undergoing surgery. And the reason this trial was important is that in the last few years, we had results from CheckMate 743, which was looking at IPI/NIVO, so a combination of immunotherapies versus chemotherapy. And there was an improvement in survival for those that received double immunotherapy, and that improvement was most pronounced in the non-epithelioid population, which is actually a smaller subset of pleural mesotheliomas. And so as we've seen in the lung when we look at immunotherapy versus chemo, it raises the question of whether combination immunotherapy plus chemotherapy would actually be better for all and, in particular, for all histologies in pleural mesothelioma. So this was looking at that concept. It took the standard chemotherapy, carboplatin-pemetrexed or cisplatin-pemetrexed, and then combined it with one immunotherapy, so slightly less than the combo immunotherapy seen in CheckMate 743, and that was pembrolizumab. And what they saw was that there was a small overall survival improvement in the group that got pembrolizumab. Again, that was most pronounced in patients in the non-epithelioid group, so those with sarcomatoid or biphasic histology. And this is really a prelude to several other trials that are coming out in mesothelioma, namely the DREAM3R trial, which is looking at chemotherapy plus or minus durvalumab. That control arm also includes IPI/NIVO, so that will be really important to be able to compare those, and then also the BEAT-meso trial, which is looking at chemotherapy-immunotherapy but also with an anti-VEGF agent, bevacizumab. So I think this was an important trial. It's a little bit of proof of concept, but there's still a lot that we're looking forward to. It's not quite practice-changing in the clinic, although I think it's certainly an option that people are using, but I'm looking for more data going forward. Dr. Aggarwal: It's incredible to see how far we've come in mesothelioma within the last decade. We are introducing immunotherapy. We're introducing novel agents in the first-line setting. Dr. Marmarelis: The other trial that I was interested in was KEYNOTE-789, which is looking also at patients with EGFR mutations and those that had the original osimertinib as their first-line treatment or another tyrosine kinase inhibitor and then had disease progression on that TKI. And this is an area of huge need. We have patients that do really well on targeted therapies, and then they have disease progression, and we're looking for additional targeted options, but we're also looking for effective chemotherapy options. And one of the questions that has risen from this is whether there's a role for immunotherapy. We know that immunotherapy alone in patients with EGFR mutations is not very effective when you look at a broad population, but in combination with chemotherapy, it's possible that it can add some benefit. So this trial looked at those that had EGFR mutations, had disease progression after a targeted therapy, and then it randomized them to chemotherapy plus or minus pembrolizumab, so chemotherapy plus or minus immunotherapy, and interestingly, it had no difference in the progression-free survival or the overall survival. So the 2 arms were really similar in terms of outcomes. There was also no difference in the overall response rates of the amount that the drug actually shrinks the tumor. So it really doesn't look like immunotherapy is adding much to chemotherapy for these patients. I think we still need to look a little bit closer because there are probably some patients with EGFR mutations that could benefit from immunotherapy, but we're really not very good at identifying those. One of the questions that comes up in this space is whether to add anti-VEGF treatment in addition to chemotherapy and immunotherapy. So there are some upcoming trials looking at that. Dr. Aggarwal: I think this was a trial that was actually very important and again, practice-affirming that this idea of continuing chemotherapy without adding immunotherapy, patients are not losing much. In fact, they're not gaining anything by adding immunotherapy as shown in this clinical trial. I think continuing immunotherapy, so continuing osimertinib, may be important in this setting also because we know that osimertinib can cross the blood-brain barrier. It can provide that CNS [central nervous system] protection. Dr. Marmarelis: Yeah, I think that's a great point that the comparison here is not chemotherapy plus osimertinib. It's chemotherapy alone. So I agree that the control arm is not quite what some of us do. I agree. I do the same as you do. I also just want to mention that the KEYNOTE trial and the previous trial about mesothelioma used pembrolizumab, which is made by Merck. We have received institutional funding, and I've served as an advisor as well as received honorarium from Merck.   Dr. Aggarwal: Melina, those were 2 very important studies and certainly, I think, answer some very relevant questions in clinic in the management of patients with EGFR-mutant lung cancer, for example. And then I think we look forward to more practice-changing data in mesothelioma. Kristin, I would love to hear research from ASCO from you. What caught your interest? Dr. Higgins: So I have a special interest in small cell lung cancer. And I think there was one important small cell lung cancer trial that I wanted to review with everyone. It was SWOG S1929. And SWOG is the Southwest Oncology Group, and it's a cooperative group that conducts clinical trials in cancer funded by the National Cancer Institute. And this is a randomized phase II trial of atezolizumab and chemotherapy followed by randomization to continuing the maintenance of atezolizumab with a PARP inhibitor. Now, we know from prior data that PARP inhibition is attractive for small cell lung cancer because PARP is expressed frequently in small cell lung cancer, and there is a biomarker called Schlafen-11 that preclinical data and prior data has shown can predict response to PARP inhibition. And this trial was sort of a proof-of-concept trial, a small, randomized phase II trial testing whether or not that Schlafen-11 biomarker could be used to direct therapy. Now, in this trial, there were 309 patients that were registered. They then had to have their tumor samples sent for central testing for the Schlafen-11 expression. One thing that I think is important to bring up is that in small cell lung cancer, there's this belief that it's really hard to get tissue samples from small cell lung cancer and it's a difficult thing logistically because it's just a lot harder to access these tumors. But interestingly, in this trial, 80% of patients had tumors that were evaluable for the biomarker, and the median time to the test result was only 7 days. So patients were able to get their tumor tested, get it sent out, get results in a rapid manner, and then be randomized based on these results. The primary endpoint for this trial was progression-free survival, and the primary endpoint was met. Progression-free survival was 4.2 months versus 2.8 months. Now, I think many people will say the magnitude of benefit here is not very much, but it's small cell lung cancer, and we don't have a lot of positive trials in this space, and we also don't have many trials that have used a biomarker to direct therapy. So I think for those reasons, it's really exciting to see these results. It was also conducted within a cooperative group with multiple different sites across the United States, and the fact of the matter is that we can do trials like this in small cell lung cancer patients, and I think it will sort of serve as a precedent for future trial design. Now, the overall survival for the trial is still premature. It didn't look that much different with the PARP inhibitor, but that doesn't mean that, again, things could change with more follow-up. And I really like the approach of this trial design, and I'm excited to see biomarker-driven trials in small cell lung cancer. Charu and Melina, what do you guys think about this study? And what do you think about our small cell lung cancer patients and our ability to conduct future trials like this? Dr. Aggarwal: I think this is certainly an advance. As you pointed out, Kristin, it shows us that we can conduct trials in the space. I think it offers a lens into the potential of personalized therapy in small cell lung cancer, which has eluded us for a very long time. The standard of small cell lung cancer has not changed significantly for a very long time, so I think this is very exciting and can't wait to see more things come in the future. Dr. Marmarelis: Yeah, I agree. I think we've always been asking for additional biomarkers, especially in such a difficult disease like small cell. And so this is really exciting to see potential biomarkers and that it was feasible to actually pose that question and study it. So that part's really exciting. Dr. Higgins: Great. And I should also say I was not involved in the study, and I'm not associated with any of the pharmaceutical companies that were involved in the study for S1929. And the final study that we wanted to talk about was the phase III LUNAR study, and this is sort of a different type of trial in the setting of advanced non-small cell lung cancer. It was studying tumor treatment fields with standard of care in metastatic non-small cell lung cancer after progression with platinum-based therapies. And first, I just want to step back and explain what tumor treating fields are. Tumor treating fields are applied to a patient with a transducer that's placed on the skin, and what it does is it applies an electrical field, and that disrupts mitosis when the cancer cells are trying to divide. And the mechanism of cell death is a little bit unclear. There are sort of many mechanisms that are postulated, one of which is immunogenic cell death, but we don't really know, I think, what's happening. But there have been studies that show improved results with tumor treating fields and other diseases. For example, particularly in glioblastoma multiforme, tumor treating fields are used in combination with surgery, radiation, and temozolomide (Temodar). So it's something that's being used in other disease sites, and this is some of the early data that we've seen in metastatic non-small cell lung cancer. And so in this trial, 276 patients were randomized to tumor treating fields plus standard of care or standard of care alone. Now, I should mention that this trial began enrolling patients in 2016, and so the standard of care was very different. After platinum-based therapies, the standard was considered docetaxel. Of course, platinum-based therapy alone for frontline treatment of advanced non-small cell lung cancer is also not the standard of care anymore. And so I think with that in the background, it does make interpretation of these results somewhat difficult, and that's probably the major caveat to this study. But nonetheless, patients were randomized, 276 patients. The primary endpoint of the study was overall survival. They were looking at progression-free survival and overall response rates as secondary endpoints as well as overall survival in patients that received immunotherapy versus just chemotherapy alone. And the trial was positive. Overall survival was improved. The median overall survival was 13.2 months for patients that received tumor treating fields with standard of care versus 9.9 months for standard of care alone. If you look at 3-year survival, it was 18% versus 7%. I think this is a new type of therapy for our patients with non-small cell lung cancer. It is somewhat of a difficult thing to wear the transducer, and you have to wear it for many, many hours. So that is one thing that I think can be difficult for patients that are using this treatment, but nonetheless, it is something new for advanced non-small cell lung cancer. I do know that the technology of tumor treating fields is being studied in other settings for non-small cell lung cancer, for stage III non-small cell lung cancer, for example, and also in the frontline setting. I think this trial kind of speaks to the fact that the landscape of advanced non-small cell lung cancer is changing so rapidly, and when we're studying something novel, we have to make sure that we make these trials feasible for enrollment so that we can get them completed rapidly, and we can get a readout and it doesn't become obsolete based on this shift in the standard of care. So I think it just really kind of drives home that we need to make sure that we're taking that into account with trial design. It's not standard of care changing right now, but it'll be interesting to see how the data evolves over time. Melina, I'm interested to hear your point of view because I know that these can be used in mesothelioma, maybe not that frequently. What is your experience with tumor treating fields, if any? Dr. Marmarelis: Tumor treating fields are approved as a device in pleural mesothelioma in the first-line setting in combination with chemotherapy. They have been used off-label in other settings, but that's the device approval. The trial that looked at tumor treating fields in mesothelioma was a single-arm trial, so there was no control arm, and it was really actually just looking at the safety of the device. So I have not used it personally in mesothelioma, although I know of patients and I know of real-world studies looking at its use, and I think it's potentially an interesting modality of treatment, especially in combination with immunotherapy, given that it really doesn't have a lot of additive toxicity. But I think the question is really, which patients are benefiting from it, and which patients are able to actually wear the vest in the case of mesothelioma? Dr. Higgins: Yeah. Any thoughts, Charu? Dr. Aggarwal: I agree, and I think this is going to be largely driven by patient experience. I think this is going to be quite onerous to wear this, carry the suitcase, so I would be very interested in patient reported outcomes as well as patient experiences and stories, which will really drive our use here. Dr. Higgins: Yeah, that's a great point. I should say that this trial was sponsored by Novocure. My institution does have other Novocure studies underway, and we receive research funding, but I was not involved in the study, and I did not personally receive any research funding. Dr. Aggarwal: Thank you, Kristin. This has been a wonderful review of practice-changing and some promising research that came out of the ASCO Annual Meeting. I hope our listeners enjoyed it, and we'll be sure to update you with the next annual research conference. Thank you, everyone. ASCO: Thank you, Dr. Aggarwal, Dr. Marmarelis, and Dr. Higgins. You can find more research from recent scientific meetings at www.cancer.net. Cancer.Net Podcasts feature trusted, timely, and compassionate information for people with cancer, survivors, and their families and loved ones. Subscribe wherever you listen to podcasts for expert information and tips on coping with cancer, recaps of the latest research advances, and thoughtful discussions on cancer care. And check out other ASCO Podcasts to hear the latest interviews and insights from thought leaders, innovators, experts, and pioneers in oncology. Cancer.Net is supported by Conquer Cancer, the ASCO Foundation, which funds lifesaving research for every type of cancer, helping people with cancer everywhere. To help fund Cancer.Net and programs like it, donate at CONQUER.ORG/Donate.

In discussion with Dr. Stephen Liu, covering the World Conference on Lung Cancer Highlights from Community Oncology perspective. We covered 4 important practice informing studies with Dr. Liu: - FLAURA2 - studying the importance of Osimertinib + chemo vs. Osimertinib in EGFRm patients, PFS benefit in the combination arm, though pending OS and most benefit derived in patients with CNS mets - CHRYSALIS-2 - post progression on EGFR therapy, there is ORR benefit from adding Amivantamab in combination with Lazertinib plus chemo - MARS2 - when compared surgery followed by chemo vs chemo alone, chemo alone had better outcomes in patients with resectable mesothelioma - EVOKE-02 - Sacituzumab approved bladder and breast cancer, was tested here along with Pembrolizumab in 1st line mNSCLC setting, with more data to come to confirm its arrival in this space #WCLC #IASLC #LungCancer #2023 #cancer #oncology #oncbrothers Website: http://www.oncbrothers.com/ Twitter: https://twitter.com/oncbrothers Contact us at info@oncbrothers.com

Good morning from Pharma and Biotech Daily: the podcast that gives you only what's important to hear in the Pharma and Biotech world. Novartis has terminated its partnership with Beigene after the European Union approved Beigene's cancer drug, leaving Novartis without a PD-1 inhibitor. Histogen plans to wind down operations after failing to find a partner, resulting in the majority of employees being laid off. Kinnate is also laying off 70% of its staff and reorganizing its pipeline. The rollout of new RSV vaccines is posing a challenge as public health officials and drugmakers try to raise awareness among older adults at risk and convince them to get an additional respiratory shot alongside those for COVID-19 and flu.Boston Scientific has announced its plans to acquire Relievant Medsystems, a company that manufactures a treatment for chronic back pain, for $850 million. Johnson & Johnson (J&J) has begun a trial of its pulsed field ablation catheter with mapping feedback. GE Healthcare has received a $44 million grant from the Gates Foundation to develop AI tools for ultrasound technology. The FDA has released draft guidance for studying weight loss devices. MedTech Europe has called for "structural reform" of the new regulatory system established by the Medical Device Regulation (MDR) and In Vitro Diagnostic Regulation (IVDR). The FDA has finalized changes to its breakthrough device program in order to target health inequities.A new analysis by the Kaiser Family Foundation (KFF) has found that over 80% of nursing homes in the US fall short of the proposed staffing thresholds set by CMS. Ochsner Health has launched a pilot program that uses generative AI to draft messages to patients. The Bill and Melinda Gates Foundation has granted GE Healthcare $44 million to develop AI tools for ultrasound technology. Former employees of Tennessee Blue Cross Blue Shield (BCBS) have filed a lawsuit against the nonprofit health plan over its COVID-19 vaccine mandate. These developments highlight ongoing challenges in the healthcare industry, including staffing shortages in nursing homes and legal issues surrounding COVID-19 vaccine mandates.Novartis is returning the anti-PD-1 antibody, tislelizumab, to Beigene after facing regulatory roadblocks. Sanofi has sold 11 CNS assets to Pharmanovia. These developments in the pharmaceutical industry highlight the complexities and challenges faced by companies in drug development and commercialization.Voyager, a cloud-based scan comparison software developed by Lumafield, aims to revolutionize non-destructive testing in medical device product development. Rayzebio and Neumora have successfully priced some of the largest IPOs in the biotech sector this year. UK biotech company Alveogene has launched with plans to develop an inhaled gene therapy. Generate has raised $273 million in funding as its first drugs move into clinical testing. Precision medicine startup Actio has launched with $55 million in funding. AIRNA has emerged from stealth mode with plans to develop RNA editing therapies for rare diseases.Oracle is set to launch generative AI tools integrated with EHR that will automate notetaking and suggest next steps. A secret shopper survey found that hospitals often share different medical prices online compared to over the phone. Former employees have sued Tennessee BCBS over its COVID-19 vaccine mandate. Ascension has posted a net loss of $2.7 billion in fiscal year 2023. Public health officials and drugmakers are working on raising awareness about RSV among at-risk older adults. The CMMI has announced plans to launch new behavioral and maternal health models this year.The pharmaceutical industry has the potential to move towards animal-free research and development (R&D). Efforts are being made to spare horseshoe crabs from blood collection and alternative technologies are emerging that could replace the need for animal testing.Anthos Therapeutics has halted its phase II atrial fi

The David Alliance   mingle mate marry .com   Change = repent Repent is less of an emotional response and actually more of a practical response by what we see in scripture.  Acts 3:19 Repent, then, and turn to God, so that your sins may be wiped out, that times of refreshing may come from the Lord,   to change one's mind or purpose/behavior with abhorrence to ones past.    So its not just a spiritual response, its not just an emotional response… it is actually changing ones mind and behavior… But what is the best way to change ones behavior? Well Repentance is first… crying out to God asking for forgiveness… but now what. What are some practical ways?  I will give you 7 quick ways to think and work on.    1 Pick one behavior that will change more than just your behavior… Lose weight or work out… this changes many things and not just the one behavior itself. Healthier, feel better, boost self esteem, look better, more energy, it might help you better find that special person, builds self discipline for other areas… One behavior with many blessings.    2 Next… pick just one behavior you want to change. My clients who I train want me to train them, give them a routine for the other days they are home, give them a diet etc… I say NO. Lets just work out 2 or 3 days a week and make that a normal behavior. your CNS can only handle on major change at a time… so don't make it harder than it should be.    3 make it measurable… Now again make the measuring stick easy to manage. if you are going to work out… don't build into the behavior, work out, lose 30 pounds, fit into that little black dress. Just make the behavior work out 3 times a week. One simple measurable goal… if you measure to many things or make it to complicated you will feel overwhelmed and give up.    4 Envision it before it ever happens… yes this is called faith. But envision you pushing through the days you want to give up, envision the way you will feel when it happens, envision the stories you will tell… envision teaching others how you did it… as Victor Frankl said “find your why”. live the whole experience before it ever happens.  Wether it is getting out of debt, saving for a house, rebuilding a relationship, reading your bible every day… see it, feel it, taste it.    5 Expect and plan for interruptions. It is called planning for chaos… its normal, its expected, it's life. So why would you not expect it?  You know why most people fail? They don't plan for failure!    6 Activate mental peer pressure Outward peer pressure is good… but inner mental peer pressure is even better. It is the peer pressure that has not yet happened. Let me explain… I will never have an affair… why? I have deep seated mental peer pressure…  Pro.6:32He who commits adultery lacks judgment; whoever does so destroys himself. 33Wounds and dishonor will befall him, and his reproach will never be wiped away. There are people in my life and network who have messed up greatly with adultery, pornography etc… and they are now “that guy”. I don't like these people, I love them…but I don't like them. I do not want to be looked at like the people I don't like. I don't want to carry reproach that will never be wiped away… I never want to always be that guy?   7 Get a mentor Best way to change your behavior is to hang around those who are already practicing that behavior. 

A new editorial paper was published in Oncotarget's Volume 14 on July 7, 2023, entitled, “Systemic treatment for brain metastasis in HER2- positive advanced breast cancer: what have we learned so far?” In their new editorial, researchers Marta Vaz Batista, José Perez-Gracia, Inês Eiriz, Maria Gion, Antonio Llombart, Sofia Braga, and Javier Cortés from Medica Scientia Innovation Research (MEDSIR) and Hospital Professor Doutor Fernando Fonseca discuss new drugs available for breast cancer (BC) patients with brain metastasis (BM). The better survival of Human Epidermal growth factor receptor-type 2 positive (HER2+) BC patients unmasked the biological predilection of this BC subtype for development of BM. Indeed, central nervous system (CNS) is a frequent metastatic site for HER2+ advanced BC patients. Over the last years, new therapeutic strategies targeting the HER2 protein have been introduced for systemic treatment of HER2+ BC - either tyrosine kinase inhibitors, monoclonal antibodies, or antibody-drug conjugates. Patients with BMs have a poorer outcome, compared with patients without BMs, but their prognosis is also improving with the introduction of new anti HER2+ - targeted therapies. “Our group has been working in the DEBBRAH trial, using trastuzumab deruxtecan for different settings of CNS involvement: stable or progressing BM and/or leptomeningeal carcinomatosis.” The team included patients with HER2+ and HER2-low BC. Activity of trastuzumab-deruxtecan in patients with HER2+ BC and untreated or progressing after local therapy BMs also has been shown in another phase II trial. “The final results are yet to be reported, but so far, we observed intracranial responses in HER2+ BC patients [7].” Read the full editorial: DOI: https://doi.org/10.18632/oncotarget.28435 Correspondence to: Marta Vaz Batista - marta.vaz@hff.min-saude.pt Sign up for free Altmetric alerts about this article - https://oncotarget.altmetric.com/details/email_updates?id=10.18632%2Foncotarget.28435 Subscribe for free publication alerts from Oncotarget - https://www.oncotarget.com/subscribe/ Keywords - cancer, brain metastasis, HER2+ breast cancer About Oncotarget Oncotarget (a primarily oncology-focused, peer-reviewed, open access journal) aims to maximize research impact through insightful peer-review; eliminate borders between specialties by linking different fields of oncology, cancer research and biomedical sciences; and foster application of basic and clinical science. To learn more about Oncotarget, please visit https://www.oncotarget.com and connect with us: SoundCloud - https://soundcloud.com/oncotarget Facebook - https://www.facebook.com/Oncotarget/ X - https://twitter.com/oncotarget Instagram - https://www.instagram.com/oncotargetjrnl/ YouTube - https://www.youtube.com/@OncotargetJournal LinkedIn - https://www.linkedin.com/company/oncotarget Pinterest - https://www.pinterest.com/oncotarget/ Reddit - https://www.reddit.com/user/Oncotarget/ Media Contact MEDIA@IMPACTJOURNALS.COM 18009220957

Audio roundup of selected biopharma industry content from Scrip over the past business week. In this episode: the rise of Novo Nordisk; senior level changes at Novartis; Moderna's progress against BA.2.86; major new CNS drugs coming; and Boehringer Ingelheim's head of innovation on R&D priorities. https://scrip.citeline.com/SC149038/Quick-Listen-Scrips-Five-MustKnow-Things

Deanna Minich, MS, PhD, CNS, Certified Functional Medicine Practitioner (IFMCP), is a nutrition scientist, international lecturer, educator, and author, with over twenty years of experience in academia and in the food and dietary supplement industries, currently serving as Chief Science Officer at Symphony Natural Health. She has been active as a functional medicine clinician in clinical trials and in her own practice (Food & Spirit™). She is the author of six consumer books on wellness topics, four book chapters, and over fifty scientific publications. Her academic background is in nutrition science, including a Master of Science (M.S.) degree in Human Nutrition and Dietetics from the University of Illinois at Chicago (1995) and a Doctorate (Ph.D.) in Medical Sciences from the University of Groningen in the Netherlands (1999). She has served on the Nutrition Advisory Board for The Institute of Functional Medicine and on the Board of Directors for the American Nutrition Association. Currently, she teaches for the Institute for Functional Medicine, University of Western States, Institute for Integrative Nutrition, and Institute for Brain Potential. Through her talks, workshops, groups, and in-person retreats, she helps people to practically and artfully transform their lives through nutrition and lifestyle. Visit her at: www.deannaminich.com   Website & Social media links (Facebook, instagram, twitter) FB: https://www.facebook.com/deanna.minich/ IG: https://www.instagram.com/deannaminich/   For more information about Michelle, visit www.michelleoravitz.com The Wholesome Fertility facebook group is where you can find free resources and support: https://www.facebook.com/groups/2149554308396504/ Instagram: @thewholesomelotusfertility Facebook: https://www.facebook.com/thewholesomelotus/

  Have you ever considered the wondrous role of cerebrospinal fluid (CSF) in your body? The CSF is a clear fluid that bathes our central nervous (CNS) system. Our CNS is entirely buoyant in this fluid. The CSF has many important functions in nervous system development and the adult human to promote growth and help maintain homeostasis. Research has shown that activating the parasympathetic nervous system helps drive the CSF into the nervous system tissue. If the CSF has evolved as a fluid system transmitting information, whether through mechanical means, vibrations, or light, could the CSF be responsible for transmitting source energy through our nervous system and body? Join me for a fascinating conversation with Dr. Zappaterra as we discuss: The evolution of CSF as a light-infused information conduitThe potential memory-holding power of CSF's watery essenceBridging the gap between metaphysical and physical through CSFExploring the idea of CSF as a luminous consciousness batteryEmbracing conscious breathwork to amplify your inner lightAnd so much more! Check out Dr. Zappaterra's website at HoldingSpace.com, along with his amazing children's books like "I Am," "All One," and "All Love," as well as the imaginative "Close Your Eyes, What Do You See?" co-authored with his insightful 7-year-old son.

Dr. Shannon Westin and her guest, Dr. Helena Yu discuss the paper "HERTHENA-Lung01, a Phase 2 Trial of Patritumab Deruxtecan (HER3-DXd) in EGFR-Mutated NSCLC Following EGFR TKI Therapy and Platinum-Based Chemotherapy" published in the JCO during the World Conference on Lung Cancer in Singapore.  TRANSCRIPT The guest on this podcast episode has no disclosures to declare.  Dr. Shannon Westin: Hello, everyone, and welcome to another episode of JCO After Hours, the podcast where we get in-depth on manuscripts that are published in the Journal of Clinical Oncology. I am your host, Dr. Shannon Westin, GYN Oncologist and Social Media Editor of the JCO. And as always, it's my pleasure to review an incredibly exciting manuscript.  Today, we're going to be talking about “HERTHENA-Lung01: A Phase II Trial of Patritumab Deruxtecan (HER3-DXd) in EGFR-mutated NSCLC Following EGFR TKI Therapy and Platinum-based Chemotherapy.” And this is exciting. This is a simultaneous publication in the JCO on September 10th, 2023 at the same time it's being presented at the World Conference on Lung Cancer in Singapore.  I am joined today by the first author and overall outstanding physician, Helena Yu. She's an Associate Attending Physician, Thoracic Oncologist, and Early Drug Development Specialist at Memorial Sloan Kettering Cancer Center in New York, New York.  Welcome, Dr. Yu.  Dr. Helena Yu: Thank you. I'm glad to be here, and thanks for having me.  Dr. Shannon Westin: So we're so excited to have you, and we love doing these simultaneous podcasts because I think not everyone can go to Singapore and be with you today. So it's awesome that we'll be able to give people the data that they want to see as soon as possible.  So first, let's just level set. Coming from the GYN Oncology standpoint, I always like to get down to the basics of the cancer. So, can you speak just a little bit about the incidence and mortality of lung cancer overall and what have been some recent trends in the treatment of this disease?  Dr. Helena Yu: Everyone knows somebody that has been touched by lung cancer. It's the second most common cancer that is diagnosed in men and women in the US today. It is the leading cause of cancer-related deaths, with 25% of cancer deaths really being attributable to lung cancer. Historically, prognosis with lung cancer has been poor, with five-year survivals around 10%. What's really interesting is over the last couple of years, there have been some improvements in survival with lung cancer. And I think that that can largely be attributed to the advent of immunotherapies as standard of care, as well as targeted therapies for driver mutation-positive lung cancer.  Dr. Shannon Westin: So that leads right into the next question: What is the role of the EGFR pathway in lung cancer? How common are these aberrations and how successful have prior treatments targeting this pathway been?  Dr. Helena Yu: Yes. So we, in lung cancer, have this mutation pie, which really describes the different oncogenes that we see in lung cancer. And probably now two-thirds of patients actually have a detectable driver mutation when their tumors undergo next generation sequencing. EGFR is probably one of the first mutations that was identified. About 15% to 20% of patients diagnosed with lung cancer in the US have mutations in EGFR. It is both activating and sensitizing. So, obviously mutations in EGFR cause cancer and they are sensitizing to different EGFR targeted therapies we have.   Right now, the standard of care for first-line treatment for EGFR mutant lung cancer are EGFR tyrosine kinase inhibitors. And those are oral therapies that actually are very successful at managing EGFR mutant lung cancer. They're not curative, but they do kind of control disease for a long period of time. But unfortunately for all patients, at some point their cancer does progress on these targeted therapies. And the most common one we use today is one called osimertinib, which is a third-generation EGFR TKI. And we do not have any approved targeted therapies after osimertinib. And so that kind of is the setting for this new drug, patritumab-deruxtecan.  Dr. Shannon Westin: So tell us a little bit about HER3-DXd and why you prioritize targeting this particular part of the EGFR pathway in this population.  Dr. Helena Yu: Yes. So HER3 is actually part of the HER EGFR family, and it is a protein that, when expressed, really portends a poor prognosis. It kind of tells us cancers that are more likely to recur and cancers where overall survival is shorter. So HER3-DXd is an antibody drug conjugate. There are a slew of new medicines in lung cancer that are ADCs. Historically, we looked at HER3 monoclonal antibodies in EGFR mutant lung cancer and they actually were not successful, not efficacious. And so it's really interesting that using these antibodies as part of an ADC construct has led to better efficacy.  The HER3-DXd has that HER3 monoclonal antibody, there is a linker and then there is a chemotherapy payload. So for the deruxtecan family of which there are a few ADCs has a topoisomerase 1 chemotherapy, and in part, we know that HER3 is sort of more significantly expressed in these EGFR mutant lung cancers. And because HER3 is part of the EGFR family and heterodimerizes with EGFR, it was sort of a natural initial population to study this drug.  Dr. Shannon Westin: Why don't you briefly highlight the design of the trial and your key eligibility for our listeners? Dr. Helena Yu: So this phase II study came off the heels of an initial phase I study that helped us identify the appropriate dose of HER3-DXd for patients with EGFR mutant lung cancer. And so this study enrolled patients with metastatic EGFR mutant lung cancer. All patients had to have received EGFR TKI, most of them received osimertinib and that's first line standard of care globally. And then also patients had to receive platinum doublet chemotherapy, which is really our second line standard of care treatment. The initial study randomized patients to two cohorts. One, which was all patients received 5.6 milligrams per kilogram every three weeks intravenous. The other cohort was an uptitration cohort, where they actually started with lower doses and then kind of sequentially over cycles increased the dose to see if that mitigated toxicity based on emerging phase I data that really showed that the 5.6 milligram per kilogram had the better efficacy as well as better toxicity profile. Pretty soon after the study started, all patients received that 5.6 mg per kilogram.  And I think the other important thing to say is that patients with asymptomatic brain metastases were allowed. Lung cancer, in general, has a very high incidence or frequency of brain metastases. But in EGFR mutant lung cancer that number is north of 50%. So having a therapy that is effective in the CNS is especially important for this population. Dr. Shannon Westin: So let's talk a little bit more about this population. The group that you enrolled and treated, is it representative of the general population that we might see in the community?  Dr. Helena Yu: Yes, I think so. I think that one thing to highlight are these patients were pretty heavily pretreated. The median prior lines of therapy were three lines prior to study enrollment, but I think that went up to eleven for certain patients. And so that is one thing that I think is unique about this population, where they're able to sort of receive several sequential therapies. I think it was unique in allowing those asymptomatic brain metastases and then EGFR mutant lung cancer has certain demographic tendencies. And so we see women, Asian, never smokers, which may not kind of represent the typical demographic for lung cancer, but certainly is the typical demographic for EGFR mutant lung cancer. Dr. Shannon Westin: Got it. And let's hear about your primary results. What did you discover? Dr. Helena Yu: To set the stage, this is really an unmet need where post EGFR TKI and post chemotherapy, we really don't have exciting efficacious therapies. When you look at real world studies, the response rate to third line and beyond treatments are less than 10% PFS less than three months. And so really searching for something in this treatment landscape. And so for the study, the primary endpoint was confirmed overall response which was 30% for this patient population. Duration of response was 7.4 months and the median progression free survival was 5.5 months. Looking at sort of prespecified subgroups, there really did not seem to be a particular subgroup that had enhanced benefit.  Dr. Shannon Westin: So that is a really impressive improvement in the expected standard of care results. So I congratulate you and I'm so excited.  I was also really excited to see that you included patients with the asymptomatic brain meds for the recent ASCO-Friends guidelines. Can you speak a little bit about the efficacy in this population specifically? Dr. Helena Yu: Absolutely. As I mentioned before, for these novel targeted therapies, we really do need to look specifically at CNS efficacy because that is absolutely an area where we often see disease progression. And so having studies that allow those patients really is more representative, of course, of the clinical practice that we actually treat. And so when you look at the subgroup that had a history of brain metastases, which in this group was actually, I believe, 51%, so the majority of patients, the response rate was really similar to the patients that did not have brain metastases. I believe it was 29% response rate for patients with brain metastases and 30% for patients without.  And I think what is especially useful that we did was we had specific neuroradiologist look for measurable target lesions within the CNS that had not received prior radiation or prior local therapy to look at intracranial response rate. And so there were a subgroup of patients, 30 patients that had measurable target lesions within the CNS and the confirmed intracranial response rate was 33.3% in those patients with measurable target lesions in the CNS and disease control rate was 77%. So, I think, it's really exciting to see that the response rate in the CNS was really comparable to what we see with systemic disease. Dr. Shannon Westin: That is awesome. I don't think I've ever seen anything quite like that. So really, you and your co-authors are to be congratulated for including this really important population.  I guess the next natural question is, how was HER3 expression? Did you look at that? How was it associated with response to therapy? And did you find any other intriguing genomic alterations associated with benefit from the HER3-DXd?  Dr. Helena Yu: That is a super interesting topic because I think in lung cancer we are well familiar with these driver mutations that really are the biomarker for targeted therapy. It is less clear what the appropriate biomarkers are for some of these antibody drug conjugates. We absolutely looked at HER3 expression, pretreatment tissue was required for this point specifically. And actually within EGFR mutant lung cancer, almost all patients have some degree of HER3 expression. And so we're already looking at a population that is enriched for potential response.  But we actually looked at H-scores, looking at membrane HER3 expression and really did not find differences in the degree of HER3 expression when you compare patients with response versus stable disease versus progressive disease. So I don't think the degree of HER3 expression really is an appropriate biomarker. And I think we're still figuring out with ADCs, I think you actually might need very little of the surface protein for these ADCs to be internalized and be effective. So, right now, the disease population of interest is EGFR mutant lung cancer, where we think there's reasonable efficacy. Dr. Shannon Westin: And that makes sense. And with this particular drug, is there a bit of bystander effect as well, like we've seen with some of the other ADCs?  Dr. Helena Yu: There absolutely is a little bit. And I think what is interesting for this drug too is there are a few ADCs that are in development. So there is trastuzumab-deruxtecan, which is already approved for HER2 positive lung cancer; and then there is also datopotamab-deruxtecan, which is a TROP2 ADC. And so I think there really will be a wave of these different ADCs which are studied in slightly different populations. But I think understanding what the biomarker is for these and then, will there be cross resistance because of the similar chemo backbone, is something that we will need to find out in the future.  Dr. Shannon Westin: Yeah, these are definitely unmet needs in this space.   I guess one other question just around safety signals, anything unique for this particular agent? Kind of take us through the dose interruptions and dose reductions?  Dr. Helena Yu: Absolutely. So I think that it is important to remember, and I do remind all of my patients that have consented to this study, that ADCs are a hybrid chemotherapy agent. So they will have some of the typical chemotherapy adverse events like cytopenias. We did see a little bit of alopecia with this as well. So I think there's thrombocytopenia and neutropenia that actually is more front-loaded and actually weren't necessarily associated with significant clinical sequelae like bleeding or neutropenic fever.  The rate of treatment discontinuation from adverse events was actually pretty low at 7%; but about 20% of patients did require a dose reduction, and many of the side effects do appear to be dose-dependent. So I think those dose reductions are helpful. And then a really important side effect of this class of drugs is ILD or interstitial lung disease or pneumonitis. And we've seen kind of varying ranges of pneumonitis with these drugs. So far it really looks to be the highest with trastuzumab-deruxtecan with an ILD rate north of 15%; but with this drug, the independently adjudicated rate of ILD was 5%. So present, but maybe not as high as some of the other drugs in this class.   Dr. Shannon Westin: Well, that's great news. Well, congratulations on these exciting results and your presentation and your paper.  The last question I have for you is what's next for this agent? What do you see? Where do you see it going? Dr. Helena Yu: Absolutely. So I hope that with these promising results in an area of unmet need, that we will get approval for this drug so that we can get access to our patients. The other interesting thing that we are looking at is combining HER3-DXd with osimertinib, which is the standard of care EGFR inhibitor. So the idea of combining this novel therapy with the standard targeted therapy for this type of cancer, I think, is really interesting to see if we'll get even sort of greater efficacy and in particular greater CNS efficacy by combining two CNS active agents. So those are results that I'm looking forward to seeing, too. Dr. Shannon Westin: That's great. Well, thank you so much for being here, Dr. Yu. And congratulations again on these incredible results and your incredible success in the lung cancer space.   And thank you all of you for listening in to JCO After Hours, again, discussing the “HERTHENA-Lung01: Phase II Trial of of HER3-DXd in EGFR Mutated Non-Squamous Cell Lung Cancer.” We are always excited to have you. Please check out our other podcasts, reach out and let us know how we did. And until then, we'll see you next time.   The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions.  Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.      

In this episode of the Ask Nurse Alice podcast, host Alice Benjamin welcomes Dr. Mitzi Saunders, the president of the National Association of Clinical Nurse Specialists. Dr. Saunders, who has 34 years of nursing experience and is a professor and graduate nursing coordinator, discusses the role of the clinical nurse specialist and its importance in healthcare. The conversation highlights the need to educate people about the CNS role and emphasizes its significance in providing specialized care. Tune in to learn more about the valuable contributions of clinical nurse specialists in the field of nursing.Jump ahead to listen:[00:01:56] What is a clinical nurse specialist (CNS)? [00:09:24] Impacting the population. [00:14:27] The problem with CNS title. [00:18:43] Harmony in leadership teams. [00:21:46] Demonstrating value in healthcare. [00:24:30] Nurse retention and shortages. [00:28:23] Career satisfaction during COVID. [00:31:13] CNS role and education.

In this enlightening episode, I had the distinct honor of speaking with Dominic D'Agostino, Ph.D., an esteemed Associate Professor at the University of South Florida. He is also a Research Scientist at the Institute for Human and Machine Cognition (IHMC), dedicating his vast expertise towards optimizing the health and resilience of both warfighters and astronauts. His remarkable background, which spans from neuropharmacology to physiology and from neuroscience to medical biochemistry, offers a unique perspective that makes him a thought leader in his fields.Our in-depth discussion delved into the intricate details of metabolic health, with particular emphasis on the ketogenic diet and its impact on various conditions including epilepsy, cancer, and even Alzheimer's. Dr. D'Agostino shared invaluable insights into how the body's metabolism is intimately connected to overall health and well-being, including how ketone supplementation can play a pivotal role in brain health. The conversation didn't stop there. We further ventured into the intriguing realm of CNS oxygen toxicity, discussing its profound implications on the brain, and the potential therapeutic avenues that might mitigate its effects. I am confident that our listeners, whether familiar with these topics or just diving into the world of metabolic health, will find immense value in Dr. D'Agostino's insights. So, grab your headphones, find a cozy spot, and tune into this episode.Dr. Dominic P. D'Agostino, affiliated with Audacious Nutrition, co-founded KETOSTART® to address the market's long-standing need for a trusted exogenous ketone supplement, delivering all the benefits of beta-hydroxybutyrate without the pitfalls of rushed and poorly researched product development. Their singular goal was to do it right, making KETOSTART stand out among the myriad of exogenous ketone supplements available. Key Points From This Episode:Understanding ketosis' impact on the central nervous system [00:05:30]Exploring CNS oxygen toxicity  [00:11:20]Diving into dietary protocols  [00:15:45]Importance of self-monitoring and physiological baselines [00:20:40]Dominic's emphasis on journaling for health and training [00:24:50]Ketone esters require caution [00:34:40]Ketones have neuroprotective effects [00:38:48] Exogenous ketones can cause harm [00:45:20]Ketones may enhance mental performance [00:55:04]Discussing the metabolic health summit  [01:23:42]Links Mentioned in Today's Episode:Click HERE to save on BiOptimizers MagnesiumAudacious NutritionPeter AttiaDr Richard VeechKeto NutritionThe Metabolic Link Metabolic Health SummitDr Dominic on TwitterDr Dominic  on InstagramDr Dominic  on LinkedinSupport the show

In this episode of The Nurse Practitioner Podcast, Julia Rogers, DNP, APRN, CNS, FNP-BC, FAANP discusses pulmonary fibrosis: Presentation, manifestations, and treatment. linktr.ee/TheNursePractitionerJournal Podcast Sponsored By: Dakins Wound Cleanser When it comes to treating persistent, hard-to-heal, or complex wounds, you need a solution you can trust. Dakin's Wound Cleanser is an FDA approved device for wound cleansing and management. It's powerful, cost effective, and easy to order. Studies have shown this formulation to be effective in killing 99.99999% of MRSA, VRE and biofilm-forming bacteria within 30 seconds! (Barsoumian et. al) Visit http://shop.getdakins.com/affiliates/default.aspx?Affiliate=4&Target=Home to request a sample today!

Dr. Lindsey Hughey // #ClinicalTuesday // www.ptonice.com  In today's episode of the PT on ICE Daily Show, Extremity Division Leader Lindsey Hughey discusses how encouragement and support are crucial factors in helping patients overcome challenges and develop resilience. This episode emphasizes the significance of being there for patients and showing them that a healthier and stronger version of themselves is achievable, despite the short-term suffering they may experience. Lindsey acknowledges that this aspect of patient care cannot be measured on standardized scales or assessments, but it plays a vital role in the patient's journey towards better health. Additionally, the episode highlights the importance of providing encouragement to patients when they face setbacks or failures. It is essential to support them and let them know that it is okay to struggle. By reframing these setbacks as part of the process and emphasizing that it is better than not taking any action at all, healthcare providers can help patients maintain their motivation and continue working towards their goals. Furthermore, the episode emphasizes that patients should not be defined by their diagnosis or label. It is crucial to help patients understand that they have the power to make choices that can improve their well-being. Healthcare providers should assist patients in reframing their experiences and show them a different way to approach suffering. This involves forging connections, offering hope, and helping patients gain a new perspective on their situation. In addition to encouragement and support, the episode also mentions the importance of accountability. Patients may need someone to hold them accountable for their actions and help them stay on track with their goals. This can be achieved through forming new connections, such as involving family members or enlisting the support of a healthcare provider. By creating a sense of accountability, patients can stay motivated and make positive changes in their lives. Overall, the episode emphasizes that encouragement, support, and accountability are essential components of helping patients overcome challenges and build resilience. By providing these elements of care, healthcare providers can help patients navigate their journey towards better health and well-being. Lindsey emphasizes that simply modulating pain symptoms is not enough. They want to open up opportunities for patients to maximize their fitness, both physically and psychologically. Take a listen or check out the episode transcription below. If you're looking to learn more about our Extremity Management course or our online physical therapy courses, check our entire list of continuing education courses for physical therapy including our physical therapy certifications by checking out our website. Don't forget about all of our FREE eBooks, prebuilt workshops, free CEUs, and other physical therapy continuing education on our Resources tab. EPISODE TRANSCRIPTION 00:00 LINDSEY HUGHEY Good morning, PT on ICE Daily Show. How's it going? I am Dr. Lindsay Hughey, one of our lead faculty for extremity management, along with Dr. Mark Gallant and Cody Gingrich. It's nice to see you all this morning. I am coming to you from Manitou Springs, Colorado. There are some mountains peeking in the background. This Clinical Tuesday, I am going to be chatting with you all about the stimulus of suffering and how in our folks in particular with knee and HIPAA can transform their current suffering to a strength. But I'll tell you it's not by giving up suffering, it's by transforming it. So we will take on this challenging subject today and consider how the suffering stimulus produces growth and satisfaction. But before we do, I would love to tell you about some upcoming courses that Mark and Cody and I have in the extremity division because there's only a handful of courses to catch us in 2023. So coming up is we are in Amarillo, Texas, September 9th and 10th. Mark will be there, so there are still spots left. Join him. And then September 16th, 17th, we'll also be in Cincinnati, Ohio. Moving into the fall, in October, October 7th and 8th, Cody will be in Rochester, Minnesota. So that'll be his first lead course. Join him. He is going to crush that. He has been on the extremity management team and ice team for so long. He brings such a wealth of knowledge. So that is going to be a blast of a course if you are nearby. And then Ridgefield, Connecticut, I added that course about three to four months ago. I'll be there with Melissa Reed. It's a really rad CrossFit gym, CrossFit 203. Lots of spots there, so join us. And then just a couple more opportunities in November and December. So check us out on ptlonice.com. But to the topic at hand. So I've come on here the last few months really chatting a lot about Hip OA and Knee OA and kind of that underlying systemic struggle that they have. And so in particular, we're going to talk about the mental physical struggle that they go through. So those folks with Hip OA and Knee OA, they often start to really identify with that bone on bone label, right? Osteoarthritis becomes who they are. It's how they plan their day. They plan their outings, their weekends, their shopping trips. It's all planned around how long a distance to walk, their energy level, the amount of steps that might be on board, wherever they're headed, how much pain they might be in, how much medicine they might have to take to get through that, or how much they'll pay for it later. So they are considering all of these factors. And it all comes back to like that label that diagnosis of, Oh, I have osteoarthritis. And this starts to really dictate their whole life. And it starts to creating quite a bit of disability limiting their interaction socially. It monopolizes their mental and emotional capacity a bit. And they're struggling. They are suffering. And this is on top of their pain, right in their knee or hip joints and in other areas in their body, because they're walking with the intelligent gait patterns. It's not just the physical impairments, right? Range of motion and strength. They are suffering physically and psychosocially. And we have to recognize this if we want to make an impact. And what's strange is that this suffering becomes a sort of comfort for them, because it's familiar, right? This is now their identity. 04:42 WHEN SUFFERING BECOMES COMFORT We often associate comfort in our society with happiness and well-being. But there's really this intriguing paradox that you start to become comfortable in your current suffering because it is familiar. And this happens to our folks with hip and knee OA in particular, their suffering becomes their comfort. It's what they rely on to dictate their life. Their whole identity is around the suffering. So the reason they don't go to the grocery store anymore, that they have their cousin do their shopping for them, the reason they ride the motorized car and don't walk through the store, the reason they don't take that flight to see their daughter because they can't help bear the thought of walking to that plane and the pain that will cause, or maybe the embarrassment of being pushed in a wheelchair, they're missing their bingo nights, birthday parties of family members, their church Bible studies. They're not able to mow the lawn anymore. They need their nephew or their grandson to do it. They're not doing their exercises because they hurt. They don't want to do them. They'd rather watch their shows. They're not going outside and enjoying the weather. This is suffering and it becomes this holding pattern of inactivity and excuse, which leads to what? It leads to more suffering. The familiarity of that routine to stay home, to not exercise, to eat out, maybe because it's convenient, because they no longer can stand to make a whole meal. This becomes comfortable. Folks are suffering though in another way with these choices, right? They're missing out on socializing. Their joints become more immobile the less they move. They become more painful with less activity and then plus that sequelae of untangible systemic inflammatory changes that are happening when you stop moving, right? Physically and then we can't even put a, you know, a tangible thing on the mental emotional changes that are happening internally and possibly affecting their ecosystems. They will not only stay in these patterns, think about your patients with HIP and NEOA or really anyone really suffering in any diagnosis. Folks tend to find solace in it. We are creatures of habit humans, right? And we stay in these holding patterns of suffering. Our job, we need to create a novel suffering stimulus for these folks. We have to help them see there's this opportunity challenge before them and guess what? They're going to continue to suffer, right? But in a different more productive way, right? And what I mean by that, it's doing your exercises regularly, getting 30 to 60 minutes of physical activity regularly, these things, planning a meal so you don't eat out or having someone come over, help you prepare that meal, things that are outside of comfort zone. Our job is we have to show them the dividends of adapting and learning and evolving lifestyle behaviors. They can change their activity level little by little. They can change their diet and nutrition, their fueling. They can change their hydration. This will all be hard. It will cause some suffering shifts, right? Because of the planning and the change associated with changing those behaviors, like waking up early to do exercises, right? If there's someone that works full time and they just say, I don't have any time to do my exercises for my hip and knee. It might be helping them develop a routine to take their vitamins or hydrate. It might just be asking for help, right? To have an exercise buddy in the morning to walk with. But these all take effort and it takes getting out of that comfortable routine of sitting, right? And doing less. It will definitely take failing, right? Patients, it's hard when you make lifestyle changes. Think about yourself, right? It's hard to make diet and lifestyle changes and nutrition, like eating more protein, drinking half your body weight in ounces. But if you're there, encouraging them, they'll continue to go back at it despite these failures. All of this causes some amount of suffering, right? This change out of normal routine to shift to more healthy lifestyle behaviors. It's one that involves sacrifice, but they have to be novel. It has to be something different, not their comfortable suffering. 09:17 PATIENT AUTONOMY & RESILIENCE We have to try to challenge and force adaption and learning and evolution surrounding their ecosystem, not just in their home program. And this ultimately leads to the patient's autonomy, right? Showing them that a healthier, stronger version of themselves is more resilient despite some short-term suffering. If you can be there to encourage them, right? When they do fail, this helps produce fortitude and resilience. And this can't be measured on an MPRS or KOS. I can't tell you an MCID of encouraging someone and the dividends associated with this. But if we can be there, right, to help them get back up on the saddle, maybe they take off doing their, they're doing great for a week with their physical activity and then they hit three days in a row where they don't, and they just don't feel like it. We have to be there to encourage them. When you fail, right, patients, this causes mental suffering. So as they shift behaviors, lifestyle behaviors, and maybe fail at them, we have to let them know that that's okay and that that's normal and that you're going to be with them. But this is better than sitting on the couch, not going out with your friends, planning your life around your osteoarthritis diagnosis. Our patients are not their diagnosis. They are not their label and they have to believe that. We have to help reframe that and I've talked about that in previous episodes you can check out. But the patients, they are, the some are their choices and we have to let them know that. We have to make them make better suffering choices. It is not okay if they miss doing their exercises, right, those three days. I'm not going to tell Nancy or Marilyn, it's okay. I'm going to say we need to get back at it, Marilyn. We need to get back up on that saddle. They need someone to tell them it's not okay. Along the way to the suffering and accountability, there's healthy byproducts, right, like forming new connection as your PT, right, as their healthcare provider. Maybe it's a family member that they're eliciting to help them be accountable to eat a little bit healthier diet or to drink that extra glass of water. We all need help and accountability to get through hard things and so help them realize that this is also an opportunity for connection to change their outlook and how they even connect with others around them. 12:21 THE SUFFERING STIMULUS The suffering stimulus creates change. Your values of the patient priority start to shift. I keep saying suffering stimulus and that's because in our course we talk a lot about dosage stimulus. In particular, we talk about it in the physical realm, right, like when we talk about strength, we say this is for functional confidence and competence or performance dominance. We work at this at five reps, five sets, greater than 80% one rep max intensity. We're working some sets, greater than 80% one rep max intensity. We're working so hard we need a three-minute rest break. We are doing this three to four days a week. In the rehab dose, it's eight to 20 reps, three to four sets, 30 to 80% intensity. This is for dysfunctional tissue issue, local issues, right, we might rest 60 to 90 seconds and then powers three reps, 10 sets, right, requiring a three-minute rest break because we're taxing the CNS to use strength quickly, right, power is force times velocity, right, these all have standard definitions and reps and set schemes and frequency. The suffering stimulus is a little bit different, right, this is an intangible dose but this is a dose that pushes a human outside of their mental and emotional comfort zone. It shifts their values and their priorities in their time choices, their nutrition choices, their exercise choices, lifestyle choices, even your friend choices. Some friends have to go, right, if they're the ones you're drinking with on the regular and that tell you to eat that extra piece of cake and those cheese fries, right, we might need to change our circle and that might even involve some family ties, right, our activity choices will change and there is a certain amount of suffering associated with that. The suffering stimulus frequency, it's a daily commitment, it's reps and sets, they are boundless but this yields in unmeasurable dividends of hope, resilience, confidence, and maybe a dash of fun if we do our job well to elicit and show them the power of doing exercise and how that changes life and how lifestyle behaviors enhances that even more. The suffering stimulus, it's a life-altering dose that we don't talk about enough. It's our job to show our patient that they can do this and support them in this journey and we do have to be honest that some folks are not going to really lean in to suffering, right, they find finding comfort in suffering. It really is a deeply personal journey, right. I want you to know this isn't about glorifying pain. I hate the saying no pain no gain, we don't say that but this is about recognizing that resilience and growth emerge from life's difficulties, from one's sufferings. We have to reframe that experience for the patient, show them a different way to suffer. It is a delicate balance. We have the privilege of serving humans on the regular, right, in their most vulnerable moments when they're in pain and they're hurting and they are suffering but let's forge connection, hope, and perspective change. Let's help them redirect to control the controllables. Let's help them find their why, paint that picture of what is most important to them, right, playing with grandkids, picking up their kids, running, it's always usually family, right, being able to keep running with their kiddos. Maybe it's running a marathon, maybe it's doing chores without restriction or mowing the lawn again, going to bingo. Let's give them the resources that hold them accountable to achieving these goals like gym access, community classes, connecting them with others with the same struggles. We know this if you've been to an ICE course and you've been part of our tribe for a while but we don't just want to change your hip or knee, shoulder pain, back pain, pelvic pain, right, we want to change your life. We want to modulate your pain symptoms to open the opportunity to maximize fitness but not just physically and not just through fitness-forward lifestyle behavior. We want to build and challenge your psychological fitness. We have to help our humans break their routine suffering for a novel suffering stimulus that challenges them not only physically but mentally to lean into hard-think mindset, lifestyle shifting behavior that yields a more healthy human. 15:47 PRODUCTIVE SUFFERING I want you to not only think about humoring suffering with hip and knee OA patients but even consider yourself, is there some comfortable suffering that you're currently taking part in that you maybe need to shift in to more productive suffering? Maybe it's tracking your food, maybe it's getting in zone two work more, maybe it's actually taking a rest day if you're a work outaholic, right, and allowing yourself dessert once a week. Consider how you can shift your patient to a suffering stimulus that changes their life and think about in your own life as well. Thank you for joining me this clinical Tuesday and if you feel so inclined share with me some ways that you have helped invoke the suffering stimulus personally or in your patients. The suffering stimulus is always a catalyst for change if you let it be. Happy Tuesday folks. 16:20 OUTRO Hey thanks for tuning in to the PT on Ice Daily Show. If you enjoyed this content head on over to iTunes and leave us a review and be sure to check us out on Facebook and Instagram at the Institute of Clinical Excellence. If you're interested in getting plugged into more ICE content on a weekly basis while earning CU's from home, check out our virtual ICE online mentorship program at ptonice.com. While you're there sign up for our hump day hustling newsletter for a free email every Wednesday morning with our top five research articles and social media posts that we think are worth reading. Head over to ptonice.com and scroll to the bottom of the page to sign up.  

Contributor: Aaron Lessen MD Educational Pearls: What is Carbamazepine (Tegretol)? Carbamazepine is an anti-epileptic drug with mood-stabilizing properties that is used to treat bipolar disorder, epilepsy, and neuropathic pain. It functions primarily by blocking sodium channels which can prevent repetitive action potential firing. What are the symptoms of an overdose? Common initial signs include diminished conscious state, nystagmus, ataxia, hyperreflexia, CNS depression, dystonia, and tachycardia Severe toxicity can cause seizures, respiratory depression, decreased myocardial contractility, pulmonary edema, hypotension, and dysrhythmias. How is an overdose treated? An overdose is treated with large doses of activated charcoal and correction of electrolyte disturbances. Be ready to intubate given the potential for respiratory depression. Carbamazepine is moderately dialyzable and dialysis is recommended in severe overdoses. Additional educational pearl: Individuals in correctional facilities can occasionally self-administer medications which means that medication overdose should still be on the differential for any of these individuals. References Epilepsies in children, Young People and adults: NICE guideline [NG217]. National Institute for Health and Care Excellence. (2022, April 27). https://www.nice.org.uk/guidance/ng217  Ghannoum M, Yates C, Galvao TF, Sowinski KM, Vo TH, Coogan A, Gosselin S, Lavergne V, Nolin TD, Hoffman RS; EXTRIP workgroup. Extracorporeal treatment for carbamazepine poisoning: systematic review and recommendations from the EXTRIP workgroup. Clin Toxicol (Phila). 2014 Dec;52(10):993-1004. doi: 10.3109/15563650.2014.973572. Epub 2014 Oct 30. PMID: 25355482; PMCID: PMC4782683. Seymour JF. Carbamazepine overdose. Features of 33 cases. Drug Saf. 1993 Jan;8(1):81-8. doi: 10.2165/00002018-199308010-00010. PMID: 8471190. Spiller HA. Management of carbamazepine overdose. Pediatr Emerg Care. 2001 Dec;17(6):452-6. doi: 10.1097/00006565-200112000-00015. PMID: 11753195. Tran NT, Pralong D, Secrétan AD, Renaud A, Mary G, Nicholas A, Mouton E, Rubio C, Dubost C, Meach F, Bréchet-Bachmann AC, Wolff H. Access to treatment in prison: an inventory of medication preparation and distribution approaches. F1000Res. 2020 May 13;9:357. doi: 10.12688/f1000research.23640.3. PMID: 33123347; PMCID: PMC7570324. Summarized by Jeffrey Olson, MS2 | Edited by Meg Joyce & Jorge Chalit, OMSII  

Dr. Gail Clayton, DCN, CNS, MS, RPh, is a Clinical Pharmacist and a Certified Nutrition Specialist. She has experience in many fields of Pharmacy including retail, HMO, hospital, home infusion and compounding and has since retired from working as a Pharmacist and opened her own private nutrition practice as the next creative step in her journey to help alleviate the suffering of others coping with devastating health conditions.

This week on The Less Stressed Life Podcast, I have my dear friend Jen Fugo on for a friendly debate on the integrative process. We talk about what research says versus what we have experienced in our practices. Jen and I also talk about how our practices have evolved. I think the biggest takeaway here is, whether you are a client or a practitioner, there is multiple ways of doing things. Jen adds, "everyone's journey is going to look different and that's ok."More episodes with Jen:#58 Why you shouldn't use coconut oil on your skin#191 Are Skin Rashes Related to Parasites?KEY TAKEAWAYS:What is evidence based medicine?What is the integrative process?Practice: how did we start vs where we are now?Practice versus researchHow are clients changing?ABOUT GUEST:Jennifer Fugo, MS, LDN, CNS is a clinical nutritionist empowering adults who've been failed by conventional medicine to beat chronic skin + unending gut challenges. She has experience working with conditions such as eczema, psoriasis, rosacea, dandruff + hives — with clientele ranging from regular folks to celebrities + professional athletes.Jennifer also founded her own line of skincare + supplements available at www.QuellShop.com specifically for people struggling with these chronic skin issues. She holds a Master's degree in Human Nutrition from the University of Bridgeport and is a Licensed Dietitian-Nutritionist and Certified Nutrition Specialist. Jennifer is the host of the Healthy Skin Show podcast with over 1 MILLION downloads.WHERE TO FIND:URL: https://www.skinterrupt.com + https://www.jenniferfugo.com Healthy Skin Show Podcast: https://skinterrupt.com/listen Quell Shop: https://www.quellshop.com Facebook: https://www.facebook.com/GlutenFreeSchoolPinterest: http://www.pinterest.com/gfreeschoolInstagram: http://www.instagram.com/jenniferfugoTwitter: https://twitter.com/jenniferfugo Tiktok: https://www.tiktok.com/@jenniferfugo Youtube: https://www.youtube.com/jenfugo LinkedIn: https://www.linkedin.com/in/jenniferfugo/ WHERE TO FIND CHRISTA:Website: https://www.christabiegler.com/Instagram: @anti.inflammatory.nutritionistPodcast Instagram: @lessstressedlifeLeave a review, submit a questions for the podcast or take one of my quizzes here: https://www.christabiegler.com/linksWORK WITH CHRISTA:Food Sensitivity & Fatigue Freedom Enrollment Is Now Open! This is the last opportunity to work with me in 2023!