Podcasts about decipher

Once Upon A Crime | True Crime

Play Episode Listen Later Mar 13, 2025

Corran, Batmouse, and special guest Scott make a single definitive list of the top 8 Information Brokers in Star Wars CCG. Featuring Dan on trivia with help from Greg..This item has files of the following types: Archive BitTorrent, Item Tile, Metadata, PNG, Spectrogram, VBR MP3

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True Crime Trailblazers - 3 Kickass Women Who Shaped True Crime

Play Episode Listen Later Mar 10, 2025 39:43

Women's History Month: Honoring True Crime Trailblazers March is Women's History Month, and we're spotlighting the female trailblazers who revolutionized true crime. These women—authors, investigators, prosecutors, researchers, and victims' advocates—played pivotal roles in shaping the genre, uncovering the criminal mind, aiding victims, and helping bring criminals to justice. In this episode, we explore the stories of three remarkable women whose work has left a lasting impact on true crime. Join me as we explore the stories of three extraordinary women who left an indelible mark on true crime. You won't want to miss this!

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Corey Feldman's Spooky Girlfriend - #854 Part 1

Jim and Them

Play Episode Listen Later Mar 3, 2025 112:52

Twitter Saga Continues: Corey once again performs on his Twitter seemingly for us to mock. How many 222s are left this century!? Haunted: Corey's spooky girlfriend Adrien Skye has a recent performance which leads us to find her previous EP, Haunted. On With Mario Lopez: Corey drops by Mario Lopez's drivel of a show which harkens back to the Every Show. Also Flogging Molly Perfect Strangers COREY FELDMAN!, SHOW STOPPER!, LET'S JUST TALK!, DON CHEADLE!, BOOGIE NIGHTS!, REAL ONES!, TIME TRAVEL!, PATREON!, COREY'S TWITTER!, WET OUR BEAKS!, APPETITE!, FIRST SUPER CHAT NAME!, CLETUS VAN DAMME!, JEAN CLAUDE!, FRANK MILITARY!, J PERRY!, GIVING US FODDER!, TOP 10 MOVIES STARRING PEOPLE FROM THE GOONIES!, DUKE GADD!, FENTANYL OVERDOSE!, GUTTURAL DARKNESS!, SCREENRANT!, INDIANA JONES AND THE TEMPLE OF DOOM!, FAIREST WE'VE EVER BEEN!, LUCKY FRITZ!, LICENSE TO KILL!, ROBERT DAVI!, THE MATRIX!, LORD OF THE RINGS TRILOGY!, AVENGERS!, 222 DAY!, DECIPHER!, CENTURY!, ADRIEN SKYE!, ADRIEN CRAIG!, HUNTED!, VAMPIRES BALLAD!, PERFORMANCE!, THE DESCENDANTS!, DISNEY!, CROONING!, LADY BLAHBLAH!, MARIO LOPEZ!, EVERY SHOW!, LASERS!, REGULAR RADIO!, BREAKS!, MARIA MENOUNOS!, ON WITH MARIO LOPEZ!, WILD MAN STEVE!, BIRTHDAYS!, VALENTINE'S DAY!, GUESS!, SIMON PEGG!, GENE HACKMAN!, DEATH!, CAUSE OF DEATH!, TRAIN TO HELL!, DRUGS!, AI!, KISSING!, FRED DURTS!, CAPTAIN AMERICA!, RED HULK!, COMMENT OF THE WEEK!, PERFECT STRANGERS THEME!, AI!, FLOGGING MOLLY!, IRISH PUNK! You can find the videos from this episode at our Discord RIGHT HERE!

The Untold Stories: North Korean Hacks, Exploited Vulnerabilities & Cybersecurity Legends

Stormâš¡ï¸Watch by GreyNoise Intelligence

Play Episode Listen Later Feb 18, 2025 65:47

Forecast: Expect increased malicious activity targeting enterprise network infrastructure and remote work platforms. ‍ In this episode of Storm⚡️Watch, the crew tackles some of the most pressing stories in cybersecurity and tech. First, we explore the case of Christian Marie Chapman, an Arizona woman who faces federal prison time for orchestrating a scheme that allowed North Korean IT workers to pose as U.S.-based employees. This operation, which generated over $17 million for North Korea, involved Chapman running a "laptop farm" that enabled remote access to U.S. company networks. The scheme not only compromised sensitive company data but also funneled money to North Korea's weapons programs. This story underscores the critical need for robust identity verification and background checks in hiring processes, especially in remote IT roles, to avoid inadvertently aiding malicious actors. Next, we discuss GreyNoise's findings on the active exploitation of a high-severity vulnerability in Palo Alto Networks PAN-OS (CVE-2025-0108). This authentication bypass flaw allows attackers to execute unauthorized PHP scripts, posing significant risks to unpatched systems. Organizations are urged to apply security patches immediately and restrict access to firewall management interfaces to mitigate potential breaches. GreyNoise's real-time intelligence highlights the importance of staying vigilant against evolving threats. In our featured segment, we sit down with Dennis Fisher, a celebrated journalist with over two decades of experience in cybersecurity reporting. Fisher shares insights from his career, including his work as co-founder of *Threatpost* and Editor-in-Chief at *Decipher*. Known for his analytical approach, Fisher has covered major cybersecurity events and delved into the motivations behind both attackers and defenders. His expertise offers a unique perspective on the complexities of information security. Finally, we touch on broader issues in vulnerability management and encryption policies. From GreyNoise's observations of exploitation surges in vulnerabilities like ThinkPHP and ownCloud to Censys' argument against weakening encryption standards, these discussions emphasize the need for proactive measures and smarter prioritization in cybersecurity strategies. Whether it's patching overlooked vulnerabilities or resisting calls to weaken encryption under the guise of security, staying informed is key to navigating today's threat landscape. Storm Watch Homepage >> Learn more about GreyNoise >>

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Venki Ramakrishnan - Discover What a Nobel Laureate Says About Anti-Aging Research

Cutting Edge Health: Preventing Cognitive Decline

Play Episode Listen Later Feb 17, 2025 39:57

Transcript with time code: https://cuttingedgehealth.com/wp-content/uploads/2025/02/Transcript-47-Dr-Venki-Ramakrishnan.pdf In this episode, Jane interviews Nobel Prize winner Venki Ramakrishnan, a molecular biologist who offers a balanced perspective on the anti-aging field. Ramakrishnan discusses various promising areas of anti-aging research, including caloric restriction drugs like rapamycin, senolytics to target senescent cells, and stem cell therapies. He emphasizes the importance of clinical trials and cautions against rushing into unproven treatments. The conversation covers lifestyle factors that can promote healthy aging, such as regular exercise, proper nutrition, and maintaining social connections. Ramakrishnan shares personal insights, including his father's experience of maintaining an active lifestyle until age 99. He also touches on his own career journey and winning the Nobel Prize. Throughout the interview, he stresses the need for a scientific approach to anti-aging research while acknowledging the urgency felt by many to combat aging. The podcast provides a thoughtful exploration of the current state of anti-aging science, balancing excitement for potential breakthroughs with the need for rigorous scientific validation. ***** Venki Ramakrishnan shared the 2009 Nobel Prize in Chemistry for uncovering the structure of the ribosome. A National Academy of Sciences member, Venki runs his research group at the MRC Laboratory of Molecular Biology in Cambridge, England. From 2015 to 2020, he served as president of the Royal Society, one of the world's oldest scientific organizations. He is the author of the frank scientific memoir Gene Machine: The Race to Decipher the Secrets of the Ribosome and Amazon bestselling book Why We Die: The New Science of Aging and the Quest for Immortality. ***** Cutting Edge Health podcast website: https://cuttingedgehealth.com/ Cutting Edge Health Social and YouTube: YouTube channel: youtube.com/@cuttingedgehealthpodcast Instagram - https://instagram.com/cuttingedgehealthpodcast Facebook - https://www.facebook.com/Cutting-Edge-Health-Podcast-with-Jane-Rogers-101036902255756 Please note that the information provided in this show is not medical advice, nor should it be taken or applied as a replacement for medical advice. The Cutting Edge Health podcast, its employees, guests and affiliates assume no liability for the application of the information discussed. Special thanks to Alan and Maria on the Cutting Edge Health team!

Sexual Decipher

Mojo In The Morning

Play Episode Listen Later Feb 3, 2025 11:32 Transcription Available

sexual decipher

Jillian Hastings Ward, Dr Karen Low and Lindsay Randall: How can parental insights transform care for rare genetic conditions?

The G Word

Play Episode Listen Later Jan 15, 2025 29:26

The Genetic Rare Syndromes Observational Cohort (GenROC) study aims to improve our understanding of how rare genetic conditions affect the way children grow, their physical health and their development. Through actively involving parents as experts in their child's condition, the study seeks to gather valuable insights and ensure that family experiences shape future research and care strategies. You can find out more about the study and eligibility criteria via the Bristol University website. In this episode, Jillian Hastings Ward, patient advocate and former Chair of the Participant Panel at Genomics England, is joined by Dr Karen Low, a clinical geneticist leading the study at the University of Bristol, who shares insights into its objectives, the importance of a co-production approach with families, and the vital data being collected in the study to improve support for these children and their families. We'll also hear from Lindsay Randall, a parent who discusses the journey of receiving a rare diagnosis for her child, highlighting the critical need for more comprehensive information and community support. "If you join GenROC, that data will be used to develop a growth chart for your child essentially and their genetic condition, so I'm really excited about it because I feel like that's a very concrete definite given now for all the families in GenROC, which is just brilliant." You can download the transcript or read it below. Jillian: Welcome to Behind the Genes Lindsay: Historically, there's been a significant absence of patient voice in rare disease research and development, and knowing that's changing, I think that's really empowering for families and to know that professionals and industry are actually listening to our stories and unmet needs and really trying to understand, and that offers much greater impact on the care and treatments of patients in the future. Jillian: My name is Jillian Hastings-Ward. On today's episode I'm joined by Dr Karen Low, Consultant Clinical Geneticist and Chief Investigator for the General Cohort Study, and Lindsay Randall, Paediatric Practice Development Nurse and founder of Arthur's Quest, which is a UK registered, non-profit, raising awareness for the ultra-rare condition: SLC6A1, developmental and epileptic encephalopathy. Welcome to you both. Today we'll be discussing the GenROC study, which is aiming to understand more about the health, development and valuing the experiences of children with neurodevelopmental conditions. If you enjoy today's episode we'd love your support. Please like, share, and rate us on wherever you listen to your podcasts. Thank you both very much for joining us today, Karen and Lindsay. There's a lot we want to cover, but first of all it would be great just to put a little bit of context around the Gen-Roc study. Karen, can you tell us a bit about what the study is aiming to do, who is eligible and why do you want them? Karen: Thank you. And thank you so much for having me today, Jillian. So, the GenROC study, first to just explain to people what ‘GenROC' stands for. GenROC stands for the Genetic Rare Syndromes Observational Cohort Study. Just to give you some context about the study, I'm a clinical geneticist and most of my clinical work focuses on paediatrics, so I see children in my clinics and the sort of children I see generally are children with rare genetic syndromes. The last five to ten years we've got much better at diagnosing children with these rare conditions and that's because testing has got so much better. We can now do whole genome sequencing and we can do that on the NHS, which is amazing, children can get their tests as part of their clinical care, so it means that a lot more children are being diagnosed with rare conditions, about 2,000 per year in the UK. And the thing about that is, that I see these children in my clinics and I give their families that diagnosis. But the problem is for so many of these ultra-rare conditions, like Lindsay's family has, we sit there and we say to the family, “Well, your child has got ‘X' condition,” and we give them some information from maybe one or two publications and linked to a leaflet and a Facebook group. And then we say, “But really we don't know that much about this condition.” And they say, “But what is it going to mean for them when they are growing up or when they are adults? Will they be able to finish school? Will they be able to work? What is it going to mean?” And I have to shrug my shoulders and go, “I'm not really sure.” And as a geneticist and as a doctor and as a mother really, I just felt that wasn't good enough, and I found it really frustrating and I know that the families that I work with, that I look after, also find it frustrating and I wanted to do better. And I also found it frustrating that for many genes, researchers would publish two or maybe three publications about these conditions, and then they would move on to the next novel gene, and actually, the journals are a bit like that as well, they like novel things, they like new conditions, they like the next gene. And so, it means that actually data doesn't always carry on being gathered in these rare conditions, and there are a lot of them. That was another thing, I sort of felt that these conditions were being done a disservice and that we needed to do better, so that's where the whole idea of the GenROC study came from was my drive and desire to improve things for families and actually to work with families to improve that, and that's where so this is a very highly co-produced study and right from the outset I've involved parents in telling me what they wanted to know and I've got a very, very active PPI group, full of parents of children who have got rare genetic conditions, and also I'm really lucky to have a young adult who has a genetic neurodevelopmental disorder herself and they all tell me about essentially what I should do and what I shouldn't do. They tell me when I'm not doing enough or when I need to do something differently, so it's very highly co-produced, they're highly involved all along the way. So, children with a confirmed genetic diagnosis in a list of eligible genes which people can see on our website if they Google GenROC University of Bristol, we've got a very easy checker for eligible genes, but they are essentially the most frequently diagnosed genes in rare neurodevelopmental disorders. And if their child is under 16, has a confirmed diagnosis and doesn't have any other genetic diagnoses then they can go into the GenROC study, that's essentially the eligibility criteria. Jillian: That's really interesting. It's very helpful to hear the background and I think as a parent of a child with a very rare disorder hearing that the clinicians also recognise this gap and the sort of pause that happens once you have your initial diagnosis, is really helpful and really encouraging. Lindsay, can we turn to you next and can you unpack a little bit about what it meant for you to get a rare diagnosis for your child and what point on your family journey was that compared to where you are now? Lindsay: I think to get a rare diagnosis for us was difficult and challenging and I think the first kind of challenge that any family has is actually being well-informed by a paediatrician who is also well-informed, and that's not always the case. That can affect the way we acknowledge or accept a diagnosis and how we also access support and how we understand what more we can do to make more connections. We did have genetic counselling offered, but I think there are families out there who don't get genetic counselling offered to help them understand the child's diagnosis, and then there's a heavy reliance on the internet, and as you said, there's a lack of information out of there. A lot of conditions are newly diagnosed or they're very complicated genes to work with, or as Karen said, they've had a couple of papers and people have moved on. And I think that does cause an immense feeling of isolation. We were diagnosed in 2018, our son, our first child, and exactly as Karen said, it was a fairly quick appointment of, “We don't really know much about this condition at the moment, there's a couple of papers. We know of 34 children in the world at the moment with your condition. Here's a Facebook group,” which we did join. And it is overwhelming to be given a diagnosis that's delivered with such little hope I guess, finding sources of information that's valid and robust is challenging, not everyone knows how to do that or has a skillset to conduct searches of academic research and I think that clinicians could definitely do better in also signposting the kind of umbrella charities like Unique and Contact and Swan and patient organisations, because I know that would have been definitely helpful for us as a family to be able to have opportunities to connect with others. Jillian: Thank you. Our diagnostic journey has been a bit a similar in that we were diagnosed through the NHS, and that at the time my son was the first person diagnosed with his disorder in the whole of the UK so it was really a big question mark, it was a question of our geneticist saying, “Here's the three PDF articles that we know exist in the world about this condition. Can you read them and tell us whether you think that sounds like him in order for us to be confirming our diagnosis?” I very much hear what you're saying there about feeling lost in the wilderness. And we too joined a Facebook group quite shortly after we got our diagnosis, and at the time my son was among the older ones or certainly as time has gone by he has been among the older children, so it can be really hard to know what might happen next. I think that now as Karen was saying we're getting much better at diagnosing people thanks to all the extra testing that's happening, that happens much earlier in life than it has done in the past, but I think then it still leaves a gap in parents' understanding because you don't necessarily know what the next ten years might look like for example. And so, I think making connections with people who are in that age bracket can be really important, but it's very hard to do. So Lindsay, I'm conscious that your professional training as a nurse must have stood you in quite good stead when you were faced with a barrage of medical literature shortly after your diagnosis, but I think one thing that every parent shares is the desire to do the best for their child and especially in this world of rare disorders. There's a huge amount of energy that comes through the community I think, faced with the need to try and self-start and build these networks and connections for themselves. Is that something that you've seen in your community as your experience? Lindsay: Yes, definitely. I think we're a growing community and over the years of course more and more children and young adults have been diagnosed with a few older adults coming through. It is very much a global networking effort and parent/patient organisations have been set up in many countries now by parents of children with children with SLC6A1. I definitely think that drive to become an expert in your child's condition is a long journey and one of continual learning and actually a lot of families simply don't have a capacity to take that on, I think often the medical and scientific jargon is difficult to understand and that makes it challenging to access. And as you said, as a paediatric nurse, I at least have some existing skills to understand healthcare to read the research and speak with medical and scientific professionals with some confidence, but in some ways, that has increased the burden I've placed on myself to become an expert for my children and other children and families who are not in the same position as me. It does require a lot of dedication and time, and that does have implications on families because it's time away from our children and from home, and from the remnants of our lives that we desperately try to cling onto, to not lose all sense of ourselves. It's not often spoken about but I do see the strain it places on the families, as well where there's a lot of separation and divorce sadly in the rare disease communities, and often that's as a result of one parent's drive to be the expert, which seems to cause one parent to fulfil more burden of care and that fosters some level of resentment or sense of loneliness towards the other one. Jillian: There are some scary statistics out there around familial breakdown in this context, and it is something which there are so many factors at play, but it definitely seems to be quite widely recognised and definitely a problem. In terms of the time that people have to spend on liaisons with the research community and the clinical community, that could bring us quite nicely back into a question for you, Karen, about what kind of information the GenROC study is looking to collect from families, can you tell us a bit more about that, please? Karen: Yes, absolutely. As I said before, I've been very conscious of the sort of lives that our families are living, and listening to Lindsay, her story is very reminiscent of so many others and yours, Jillian. So I know families have about a gazillion hospital appointments, their children are often also very, very ill intermittently or a lot of the time, then they've got school stuff to deal with or they've got EHC plans to try and fight for. It's more than a fulltime job in itself just being a parent of a child with a rare disease and it's hard work, so me asking them to do anything else is asking a lot. Luckily, I find, with the families I work with, who are universally wonderful I should add, that they are actually just really enthusiastic anyway about research for their child's condition, and that's because there isn't enough information out there, so it's relevant and important to them. But because they have no time at all, and any time they do give is their own personal time when they could be finally putting their feet up and watching something on TV, I have to make it as low effort as possible. The questionnaire is all online, using a user-friendly and interface as we've been able to develop. It's very user-friendly, it takes 10-15 minutes to complete; they can come and go from the questionnaire as well. We only ask for one time point at the beginning, which is all the sort of stuff that most parents will be able to tell you off the top of their head as well, so they don't have to go looking for loads of information, apart from a height and a weight. Then later down the line we're going to ask for a second questionnaire, it's in the process of being finalised and again that will be the same amount of time, very easy to do, online, at their convenience. It was co-produced with the PPI group, they've tested it for me, I've had really good feedback and I've asked parents who are in the study as well for feedback. Everyone tells me it's not too difficult or burdensome for them to do. The secondary questionnaire has been very much informed by conversations with the parents that I had as part of a nest of qualitative interview study in GenROC, and that has driven that secondary questionnaire quite differently to what I thought it might be when we first set up the GenROC study. At the beginning I thought it might just be: have things changed for your child? Can you give us a bit more clinical data? But actually I realised that probably I will still gather that information, but they probably won't have changed that much within the timespan in the study because it will only be a year or two after they completed the first questionnaire, and actually I realised that it would be much more useful to look at the impact of the genetic diagnosis, look at how they're accessing services within the NHS, what sorts of services they are accessing, Impact on the family and also looking at priorities for families. So families have talked to me about what their priorities are in rare disease, both in service provision but also in research, and I really am a very strong believer that we need to be given the limited funding, we need to be doing the research that matters the most to the families, not to the researchers. What do families actually want us to look into? Actually, do they want us to be looking into behaviour and what strategies work best for example, rather than something else very medical – what matters the most? And so that's going to be a specific question in that secondary questionnaire, really trying to identify what matters to families the most and then how that can be translated into clinical research in the future. So I'm really interested to see what's going to come out of that. Lindsay: I think that sounds brilliant, Karen because I think historically there's been a significant kind of absence of patient voice in rare disease research and development, and knowing that that's changing, I think that's really empowering for families and to know that professionals and industry are actually listening to our stories and unmet needs, and really trying to understand, and that offers a much greater impact on the care and treatments for patients in the future and certainly it makes endpoints more relevant to families as well. Jillian: What kind of outputs are you going to be looking at? Karen: The height and weight, the reason I'm asking for that is really because we are trying to work on growth charts for children and that's because growth charts for children with rare conditions don't exist by enlarge, there are a very, very tiny number of rare syndromes or conditions that have their own growth chart. The problem is that most children with these sort of rare conditions that we're talking about are either quite small or quite big, and the problem is that the paediatricians look at their growth and they go, “Oh well, you're much bigger or much smaller than other children your own age, what shall we do about that?” and particularly the little tiny ones it causes lots and lots of concern, so quite often these sort of growth parameters mean that the paediatricians do lots and lots of tests or put feeding tubes down, or add lots of calories, so it can be quite invasive and interventional actually that sort of growth parameter. But actually, sometimes that's because of the genetic condition and no matter how much feeding you do it's not going to change anything. The difficulty is we don't know that for certain, and actually we need good growth charts where paediatricians can make that call, and conversely sometimes a child actually does need investigating and the paediatrician puts it all down to their genetic condition, and that's why we need these growth charts. So GenROC is aiming to gather growth data from all these children and then we're going to work closely with Decipher, which is a website that was developed through the DDD study, which already holds lots of data from that study, so we're building on the power of that study and we're going to be generating growth charts for all of these genes. We've developed a new method for producing growth charts for rare conditions where you've got small numbers of patients – that was never possible before, so we've already proven now for four conditions we can, so the next stage is using all the GenROC data, putting it into Decipher and coding it in. So, if you join GenROC, that data will be used to develop a growth chart for your child essentially and their genetic condition, so I'm really excited about it because I feel like that's a very concrete definite given now for all the families in GenROC, which is just brilliant. Jillian: And is that something which will be shared with the families individually? Karen: Really great question. I hadn't planned on sharing the growth charts individually with the families, but that's something I can also go back to my PPI group and discuss with them about whether that's something people would want, and also I have a newsletter which goes out every three months to the families, so I can certainly ask that question actually directly. It's going to be widely available, the growth charts, we're going to make sure that they're accessible to paediatricians and clinicians etc. but in terms of output to the study, definitely the growth charts, we're also hoping to have other clinically useful outcomes depending on the different genes that come into the study. We essentially have a cohort of children with rare conditions, everyone puts everything down to a specific genetic condition but we know that there must be other factors at play that influence how children do. And this is a really unique thing we're trying to do with GenROC actually, looking at aside from that genetic variant, that alteration, what other factors are influencing how children are doing? Because some of those might be modifiable, you know, or some of them there could be things that could be put in place to help improve outcomes. So I'm quite excited about that as well, because that's quite new and novel and not really been thought about in this context before, so that will be an output. And the other output is something that I'm working on with Unique, which is the rare disease charity who has worked with us on GenROC from the start, and they are involved in our PPI as well and that is going to be looking at a template, calling it a report at the moment, it's in very early days, but something that parents will be able to hold, it's going to have lots of drop-down boxes that can be tailored and modified for individual patients and children, which will be a bit of a guide that they can give to clinicians, professionals, education, telling them about their condition but also telling them on an individualised basis about what needs to be looked for in the future. Because parents tell me they are fed up of having to tell everybody about their child's condition constantly, all the time, over and over again. So what the point of this output would be is to try and ease that burden a little bit. This is very early stages but we're going to involved parents all along the way. Jillian: And is that something which builds on the hospital passport idea that we've seen emerging around the world over the last few years where parents can start off telling their child's story on their own behalf? Karen: So, it's come from my own lived personal experience of being a mother of a child with autism and I haven't really spoken about that publicly before, so it's something I'm saying for the first time. I have a child who has autism and I have had to navigate things like a DLA application form. Jillian: That's Disability Living Allowance. Karen: Yes, exactly, which is a horrendous form, it's the most horrible form to complete, probably apart from an EHCP plan form but it's a horrible form to complete, it's quite upsetting as a parent and it's also got millions of boxes that you have to fill in. But one of the things that really, really helped me when I was completing that was a charity who had come up with lots of drop-downs that you could select from that might be applicable to your child to help you complete this form. And so it made me really think, “Well, could we do something similar for our children with genetic conditions but come up with lots of dropdown options that might apply to their child in all sorts of different areas?” And that was the inspiration, it was that, and doing the qualitative study that I've already done with parents of children in GenROC who were telling me about how fed up they were of having to constantly tell everybody about their child's condition over and over again. Jillian: Yes, that's probably very helpful to empower families to use standard terminology across the different families because my own son has epilepsy as part of his condition but actually trying to describe what his seizures look like I'm not sure I'm using the right words to fit the right boxes to fit them into the right categories with the neurologist. So that level of standardisation is something that we definitely need embedded into the system in order for more people to be able to use this data more effectively, so that sounds very helpful. Lindsay, coming back to you, what are you hoping to get out of this study, or what are you hoping this study will do on your behalf for the world? What motivated you to take part? Lindsay: I think I would like to see all of the aims of the study realised and for the study data to be used to inform the development of standards of care for a wide range of conditions, those included in the study. I think it would be great if that information, as Karen said, is available not only to the participants but also to children diagnosed with those conditions in the future and also it's an opportunity to consider themes that are identified across the disease groups as that can also help inform future research and look at investigations into the mechanisms of disease and where actually therapeutics could treat maybe more than one disease at a time and increase potential for basket trials and early access programmes – thank you to Dr Karen Low and her team for conducting the project because it included a comprehensive list of rare diseases, it really does give parents and patients an opportunity to have a voice and to contribute, which is empowering, and it gives them a little bit of autonomy as well over their direction that science and research goes to. Jillian: Fantastic, thank you. Karen, can you tell us a little bit about the timeframe for the study? I realise that we haven't really touched on that so far. Karen: Yes absolutely, I'm aiming to recruit 500 children as a total. We're open at 22 sites across the UK. Coinciding with this podcast actually we've opened a second door for recruitment, so the way we've recruited so far has been through clinical genetic sites, which is the way we've done these sorts of studies in the past, like the DDD study. The problem is that that relies on clinicians identifying eligible patients and clinicians are very, very busy in the NHS. I have worked closely with Unique who have been doing a lot of publicity and the genetic alliance have done publicity as well for the study, so that's been one way of identifying eligible participants. And also just parent power through social media has been amazing. The second way we're going to recruit, and this is going to happen very soon, is through Genomics England. So, we are going to trial a completely novel way of recruiting to research through Genomics England and that is for Genomics England to identify eligible participants for GenROC and this would have been through the 100,000 genome study and then they're going to send them invite letters, inviting them to take part. So that's the next phase of recruitment, I think if we have more than 500 then that will be great too, we'll be able to include those comers too, so that's not a problem. But we don't know whether this will work or not in terms of a way of recruiting to research, this is completely new for Genomics England and I'm a bit of a guinea pig if you like through the GenROC study, but I was quite willing to be that guinea pig because I thought it might increase access. So there will be some parents who have not been told about GenROC who have not heard about it, and who would love to take part, so I feel like this is the way of really widening that net as wide as possible. Jillian: I think that is a challenge isn't it, especially in rare disease – there's no point doing a public broadcast about an initiative because you're going to hit so few of the people that you're interested in, so actually how you access the community is the first challenge and I'm really pleased that Genomics England will be able to help you there because I think that is a very useful route through. I think it will probably be quite reassuring to quite a lot of families who were on the 100,000 Genomes Project who have got a diagnosis of one of the conditions that you're interested in, and are now perhaps subsequently in the fallow period after you have a diagnosis, wondering what happens next, so I can imagine it might be quite good news for some of them at least that they are now being invited to do something further. And the reason that you're building forward and you don't want people who are currently in the deciphering developmental disorders study is because you're already using their data through another source, is that correct? Karen: Exactly. So absolutely, I don't want anyone to feel that I don't want them, that's really not the case. I do want them but we have their data already from Decipher, so we're building on the DDD data already, so they're already contributing which is just the beauty of it, because that's what we should be doing in rare disease, we should be building on previous research because you know, you don't want to be trying to reinvent the wheel. Jillian: Agreed. So if someone is listening to this and has a child with a rare developmental disorder and they are interested in finding out more, what are the steps they need to take? Karen: If they Google Bristol University, GenROC, they'll come straight to the webpage and everything is on there. There's a link that they can sign up, the patient information leaflet's there, the eligible gene list is there, all the information they need, including our email address. Jillian: And is there an upper age limit for recruitment? Karen: Yes, children have to be under 16 and that's because once they get to 16 many of these conditions have associated learning difficulties, and it's just very much more complex to try and recruit young adults, young people, with learning difficulties and given it was a cohort study we felt it was going to be too difficult at the moment. Saying that, I have a huge interest actually in how these conditions present in adulthood, and I'm actually conducting a much smaller study at the moment in KBG syndrome, looking at adults, and so I hope that my future research career will allow me both to follow-up the children in GenROC, so that would be my vision but also to be able to take this forward for other adults with rare conditions, that's my aim and goal in the medium to long-term, so watch this space for that. Jillian: That sounds very exciting, thank you. Lindsay: I think I would like to say to Karen that I really like the sound of the idea of following patients up into young adulthood and adulthood, as you said, that is definitely a kind of an unknown area in lots of the rare diseases, especially in our condition, SLC6A1, it was mutation and the disease was only really discovered in 2015, so it is fairly new and we have very, very few young people and adults coming through and being diagnosed and connecting with the rest of the community. So, being able to understand the trajectory of conditions better and especially conditions where actually the presentation it's quite a spectrum, and so the long-term outcomes for people with SLC6A1 can look quite different, so it's good to collate more information about that I think. Karen: I think it's really important, so that's definitely where I'm looking to for the future with GenROC and more widely, I think it's just something I'm really interested in and has huge relevance for parents and families. Jillian: Well, I think we need to wrap up there but thank you both very much Dr Karen Low and Lindsay Randall for joining me today as we've been discussing the GenROC study, and how the study aims to improve understanding of how rare genetic syndromes affect the way children grow, their physical health, their development, but also how the patient and parent communities can work more closely with researchers to end up delivering something which is of a huge benefit to everybody. If you would like to hear more about this, please subscribe to ‘Behind the Genes' on your favourite podcast app. Thank you for listening. I've been your host, Jillian Hastings Ward. This podcast was edited by Bill Griffin at Ventoux Digital and produced by Naimah Callachand.

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Corran On The Horn 35 Andrew Moss And Karl Koenig(audio Version)

Play Episode Listen Later Jan 14, 2025

The audio version of my livestreamed interview with Andrew Moss and Karl Koenig where we spoil some cards from set 24..This item has files of the following types: Archive BitTorrent, Item Tile, Metadata, PNG, Spectrogram, VBR MP3

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Corran On The Horn - 36 - Jarad Konsker

Open Loops with Greg Bornstein: Conversations That Bend

Play Episode Listen Later Jan 14, 2025

I interview long time player, volunteer, and Sequel Trilogy apologist also known as Jar Jar Drinks..This item has files of the following types: Archive BitTorrent, Item Tile, Metadata, PNG, Spectrogram, VBR MP3

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We Don't Talk About New Drones, No, No, No: Our Ancestral Lineage in the Stars with Ki'Shara Ninki, Author and Genetic Historian

Play Episode Listen Later Jan 2, 2025 136:34

Welcome to 2025.Remember all the buzz last month about ET disclosure? Those strange ...things....hovering in the skies of New Jersey—lights blinking, colors shifting, orbs appearing and vanishing in plain sight. Large machines, unlike anything we've seen before, flying over military bases.But here's the kicker: the news, social media, and those in charge? They're silent. They claim they don't know what they are.And just like that, the stories vanish. Poof.You'd expect the Open Loops podcast to jump into December's UAP/UFO hype… but we never, ever talk about that… Shhhhhh…So, what do we talk about when we're not talking about...ya know....those.... things...(Shhhhh.....we don't EVER talk about -)We talk about your New Year's resolutions, of course! You know the usual—lose weight, get a promotion, find someone special—but we've got something a little more… out there this year.This year, do you resolve to:-Uncover the lost city of Atlantis—and prove it's still hiding in plain sight, under the waves, with clues embedded in ancient Egyptian architecture?- Track down the 15,000-year-old trident that could rewrite history and prove the existence of an ancient civilization that predates everything we've been taught?- Decipher the forgotten messages of the Anunnaki—and figure out how their genetic engineering of early humans may have shaped your very DNA?-Unlock the mysteries of the 12,000-year-old pyramids and their hidden power, revealing how they might be the secret to humanity's next leap forward?-Solve the riddle of the ancient giants—where did their bones vanish to, and what ancient force was responsible for their disappearance?-Dive into the Sumerian tablets to expose the truth behind their gods and understand what they were really doing when they created mankind?-Investigate the untold stories of the secret space program—is it possible someone has already visited Mars? And what if you could uncover their untold journey?-Reveal the dark truth about humanity's spiritual suppression and uncover how an ancient, suppressed knowledge has been hidden from us to maintain control?-Discover the “sacred secret” buried in the Lost Book of Thoth—a secret so powerful, it could change the course of human evolution and unlock the true potential of your mind?Forgot to add those to the list, didn't you? No worries, Ki'Shara Ninki (Author, Researcher, Hydrid Phenomena Expert and Atlantean Genealogist) has you covered!She returns to enlighten you in this evidence-backed deep dive into our cosmic origins.All your resolutions - resolved. In one podcast episode.And while Greg and Ki'Shara might not talk about these things, unlike the people voted into office in the United States, you might actually hear something of substance...Chapters:(00:00) - Alien Lineage and Psychic Phenomenon(17:18) - Ancient Civilization and Global Connections(31:31) - Collective Religious Storytelling Through History(39:34) - Alien Influence and Human Perspective(41:15) - Gods, Goddesses, and Political Endorsements(50:42) - Anunnaki Heritage and Genetic Manipulation(01:08:30) - Dragons and Genetic Origins(01:13:09) - Dragon Genealogy and Cosmic Ramifications(01:19:37) - Mysterious Mars Trip and Genetic Hybrids(01:32:59) - Exploring Psychic Abilities and Vibrational Frequencies(01:51:45) - Secrets of Earth's Hidden History(02:03:37) - Species and Genetic Evolution(02:12:52) - Celestial Beings and Ancient EnergiesKi'Shara's Links: https://www.afsresearch.org/ Let Greg know how you like the show. Write your review, soliloquy, Haiku or whatever twisted thoughts you want to share at https://ratethispodcast.com/openloops

2024 Year End Zoom Orphan Special

Play Episode Listen Later Dec 23, 2024

A quick and dirty collection of segments that were recorded on my portable Zoom recorder..This item has files of the following types: Archive BitTorrent, Item Tile, Metadata, PNG, Spectrogram, VBR MP3

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Manhunt: World-Renowned Profilers Decipher New Clues in the Search for Brian Thompson's Killer

search killers fbi surviving survivors true crime defend investigators clues manhunt world renowned brian thompson decipher

Play Episode Listen Later Dec 6, 2024 93:09

#STSNation! Welcome to the podcast that promises to bring you the very #BestGuests in all of #TrueCrime. In this special episode of Surviving the Survivor, we delve into the shocking developments in the manhunt for the assassin of CEO Brian Thompson. Investigators have uncovered eerie etchings on bullets and casings, along with disturbing photos of the alleged killer smiling. Deny. Defend. Depose. Joining us tonight are two world-renowned profilers and a retired FBI agent help decode the mindset of this smiling sicko and provide insight into the motives behind the etchings and the attack. #BestGuests: Legendary Profiler Dr. Ann Burgess, Retired FBI Profiler and Agent Gregg McCrary and Retired FBI Agent and Private Investigator Tom Simon (Simon Investigations)Support the show:Patreon: https://www.patreon.com/SurvivingTheSurvivorYouTube: Surviving The Survivor: #BestGuests in True Crime - YouTubeJoel's Book: Https://www.amazon.com/shop/surviving...Website: https://survivingthesurvivor.com#TrueCrime #TrueCrimeCommunity #Manhunt #BrianThompson #CEOMurder #UnitedHealthcare #SmilingSicko #CriminalProfiling #ForensicPsychology #MurderInvestigation #CrimeAnalysis #SurvivingTheSurvivor #truecrimecommunity #truecrimepodcast #truestory #criminaljustice #crimestory #crimenews #criminal #crime_news #newsupdate #breakingnews #nyc #murdernews #murdermystery #wanted #investigations #crime_news

Why Teaching Students to Decipher Fake News is Crucial

Class Dismissed

Play Episode Listen Later Nov 25, 2024 29:12

In an age where information is constantly at our fingertips, distinguishing credible news from misleading or false information is more critical than ever. Fake news can distort perspectives, influence decision-making, and undermine trust in legitimate sources. Teaching students how to identify and analyze the credibility of news prepares them to navigate the digital world responsibly and fosters informed citizenship. How We Can Teach Students to Spot Fake News Encourage Critical Thinking Teach students to question the origin of the information, its intent, and its potential biases. Asking "Who wrote this?" and "Why was it written?" helps develop a skeptical mindset. Introduce Fact-Checking Tools You can familiarize students with tools like Snopes, FactCheck.org, or basic search techniques to cross-check information from multiple reputable sources. Spot Emotional Language Teach students to recognize when an article uses overly emotional or sensational language, which can indicate bias or an intent to mislead. Evaluate Sources Help students learn to identify credible sources, including checking the publication's history, credentials, and editorial standards. Practice With Real-Life Scenarios Provide students with examples of true and false stories and work through identifying characteristics that distinguish one another. Our guest in Episode 274 of Class Dismissed is David Cutler, a Massachusetts high school history and journalism teacher. Cutler recognizes the importance of teaching to distinguish between legitimate news sources and news sites designed strictly for political or monetary gain. Cutler authored a column featured on PBS Newshour titled “How I use George Washington to make kids care about fake news.” He detailed his methods in Episode 274. Listen to this latest episode on your favorite podcast app or Apple Podcast

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Stars And Wars - 5 - The Naked Lieutenant

Play Episode Listen Later Nov 23, 2024

The season finale of the first actual play podcast on the network. Our heroes are summoned to the bridge of the Motti's Legacy and some crazy stuff happens. Intro and outro music are The Prisoner by Stumfol as performed by Kendall Halman.This item has files of the following types: Archive BitTorrent, Item Tile, Metadata, PNG, Spectrogram, VBR MP3

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402. Guidelines: 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure – Question #39 with Dr. Robert Mentz

Play Episode Listen Later Nov 13, 2024 8:00

The following question refers to Sections 7.3.3 and 7.3.6 of the 2022 ACC/AHA/HFSA Guideline for the Management of Heart Failure.The question is asked by Palisades Medical Center medicine resident & CardioNerds Academy Fellow Dr. Maryam Barkhordarian, answered first by UTSW AHFT Cardiologist & CardioNerds FIT Ambassador Dr. Natalie Tapaskar, and then by expert faculty Dr. Robert Mentz.Dr. Mentz is associate professor of medicine and section chief for Heart Failure at Duke University, a clinical researcher at the Duke Clinical Research Institute, and editor-in-chief of the Journal of Cardiac Failure. Dr. Mentz has been a mentor for the CardioNerds Clinical Trials Network as lead principal investigator for PARAGLIDE-HF and is a series mentor for this very Decipher the Guidelines Series. For these reasons and many more, he was awarded the Master CardioNerd Award during ACC22.The Decipher the Guidelines: 2022 AHA / ACC / HFSA Guideline for The Management of Heart Failure series was developed by the CardioNerds and created in collaboration with the American Heart Association and the Heart Failure Society of America. It was created by 30 trainees spanning college through advanced fellowship under the leadership of CardioNerds Cofounders Dr. Amit Goyal and Dr. Dan Ambinder, with mentorship from Dr. Anu Lala, Dr. Robert Mentz, and Dr. Nancy Sweitzer. We thank Dr. Judy Bezanson and Dr. Elliott Antman for tremendous guidance.Enjoy this Circulation 2022 Paths to Discovery article to learn about the CardioNerds story, mission, and values. American Heart Association's Scientific Sessions 2024As heard in this episode, the American Heart Association's Scientific Sessions 2024 is coming up November 16-18 in Chicago, Illinois at McCormick Place Convention Center. Come a day early for Pre-Sessions Symposia, Early Career content, QCOR programming and the International Symposium on November 15. It's a special year you won't want to miss for the premier event for advancements in cardiovascular science and medicine as AHA celebrates its 100th birthday. Registration is now open, secure your spot here!When registering, use code NERDS and if you're among the first 20 to sign up, you'll receive a free 1-year AHA Professional Membership! Question #39 Ms. Kay Lotsa is a 48-year-old woman with a history of CKD stage 2 (baseline creatinine ~1.2 mg/dL) & type 2 diabetes mellitus. She has recently noticed progressively reduced exercise tolerance, leg swelling, and trouble lying flat. This prompted a hospital admission with a new diagnosis of decompensated heart failure. A transthoracic echocardiogram reveals LVEF of 35%. Ms. Lotsa is diuresed to euvolemia, and she is started on carvedilol 25mg BID, sacubitril/valsartan 49-51mg BID, and empagliflozin 10mg daily, which she tolerates well. Her eGFR is at her baseline of 55 mL/min/1.73 m2 and serum potassium concentration is 3.9 mEq/L. Your team is anticipating she will be discharged home in the next one to two days and wants to start spironolactone. Which of the following is most important regarding her treatment with mineralocorticoid antagonists?ASpironolactone is contraindicated based on her level of renal impairment and should not be startedBSerum potassium levels and kidney function should be assessed within 1-2 weeks of starting spironolactoneCEplerenone confers a higher risk of gynecomastia than does spironolactoneDThe patient will likely not benefit from initiation of spironolactone if her cardiomyopathy is ischemic in origin Answer #39 ExplanationThe correct answer is B – after starting a mineralocorticoid receptor antagonist (MRA), it is important to closely monitor renal function and serum potassium levels.MRA (also known as aldosterone antagonists or anti-mineralocorticoids) show consistent improvements in all-cause mortality, HF hospitalizations, and SCD across a wide range of patients with HFrEF.

401. Guidelines: 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure – Question #38 with Dr. Randall Starling

Play Episode Listen Later Nov 11, 2024 12:33

The following question refers to Sections 7.4 and 7.5 of the 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure.The question is asked by the Director of the CardioNerds Internship Dr. Akiva Rosenzveig, answered first by Vanderbilt AHFT cardiology fellow Dr. Jenna Skowronski, and then by expert faculty Dr. Randall Starling.Dr. Starling is Professor of Medicine and an advanced heart failure and transplant cardiologist at the Cleveland Clinic where he was formerly the Section Head of Heart Failure, Vice Chairman of Cardiovascular Medicine, and member of the Cleveland Clinic Board of Governors. Dr. Starling is also Past President of the Heart Failure Society of America in 2018-2019. Dr. Staring was among the earliest CardioNerds faculty guests and has since been a valuable source of mentorship and inspiration. Dr. Starling's sponsorship and support was instrumental in the origins of the CardioNerds Clinical Trials Program.The Decipher the Guidelines: 2022 AHA / ACC / HFSA Guideline for The Management of Heart Failure series was developed by the CardioNerds and created in collaboration with the American Heart Association and the Heart Failure Society of America. It was created by 30 trainees spanning college through advanced fellowship under the leadership of CardioNerds Cofounders Dr. Amit Goyal and Dr. Dan Ambinder, with mentorship from Dr. Anu Lala, Dr. Robert Mentz, and Dr. Nancy Sweitzer. We thank Dr. Judy Bezanson and Dr. Elliott Antman for tremendous guidance.Enjoy this Circulation 2022 Paths to Discovery article to learn about the CardioNerds story, mission, and values. American Heart Association's Scientific Sessions 2024As heard in this episode, the American Heart Association's Scientific Sessions 2024 is coming up November 16-18 in Chicago, Illinois at McCormick Place Convention Center. Come a day early for Pre-Sessions Symposia, Early Career content, QCOR programming and the International Symposium on November 15. It's a special year you won't want to miss for the premier event for advancements in cardiovascular science and medicine as AHA celebrates its 100th birthday. Registration is now open, secure your spot here!When registering, use code NERDS and if you're among the first 20 to sign up, you'll receive a free 1-year AHA Professional Membership! Question #38 Mrs. M is a 65-year-old woman with non-ischemic dilated cardiomyopathy (LVEF 40%) and moderate to severe mitral regurgitation (MR) presenting for outpatient follow-up. Despite improvement overall, she continues to experience dyspnea on exertion with two flights of stairs and occasional PND. She reports adherence with her medication regimen of sacubitril-valsartan 97-103mg twice daily, metoprolol succinate 200mg daily, spironolactone 25mg daily, empagliflozin 10mg daily, and furosemide 80mg daily. A transthoracic echocardiogram today shows an LVEF of 35%, an LVESD of 60 mm, severe MR with a regurgitant fraction of 60%, and an estimated right ventricular systolic pressure of 40 mmHg. Her EKG shows normal sinus rhythm at 65 bpm and a QRS complex width of 100 ms. What is the most appropriate recommendation for management of her heart failure?AContinue maximally tolerated GDMT; no other changesBRefer for cardiac resynchronization therapy (CRT)CRefer for transcatheter mitral valve intervention Answer #38 ExplanationChoice C is correct. The 2020 ACC/AHA Guidelines for the management of patients with valvular heart disease outline specific recommendations.In patients with chronic severe secondary MR related to LV systolic dysfunction (LVEF

Stars And Wars 4 Seven Food Spare Clothes

Play Episode Listen Later Nov 11, 2024

Our heroes gear up for the big finale.This item has files of the following types: Archive BitTorrent, Item Tile, Metadata, PNG, Spectrogram, VBR MP3

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Stars And Wars 3 Prince Xizor, Like The Salad

Play Episode Listen Later Nov 11, 2024

Our heroes meet a falleen scientist.This item has files of the following types: Archive BitTorrent, Item Tile, Metadata, PNG, Spectrogram, VBR MP3

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David Kelts - From Idemia to Decipher Identity and the Evolution of Mobile IDs

The Future of Identity

Play Episode Listen Later Nov 6, 2024 42:55

In this episode of The Future of Identity Podcast, I'm joined by David Kelts, a leader in digital identity and mobile ID initiatives, with a career that spans significant contributions across multiple companies and initiatives worldwide. David's insights shed light on the journey of mobile driver's licenses (mDLs), the evolution of identity verification, and his current role at Decipher Identity, where he's tackling adoption challenges and working with businesses to expand use cases for digital identity.We explore:- David's early work at Idemia, including pioneering efforts in connecting driver's licenses to online identity proofing.- The origin and adoption challenges of mobile driver's licenses (mDLs) and why adoption has lagged behind expectations.- Privacy concerns surrounding digital IDs and the misconception of "phone home" tracking in mobile identity, along with how privacy regulations are influencing this space.- The role of standards organizations and government agencies, like AMVA and TSA, in fostering privacy and security in digital credentials.- The future vision for digital identity, including the potential for digital-native identity credentials, cross-border use cases, and the value of user choice in secure digital wallets.David also shares stories from working directly with states like Utah and California on mDL projects and reflects on what's needed for broader adoption. This episode is a deep dive into the evolving landscape of digital identity and is perfect for anyone interested in the future of authentication, privacy, and user-centric identity solutions.You can learn more about Decipher Identity at decipher.id.Subscribe to our weekly newsletter for more announcements related to the future of identity at trinsic.id/podcastReach out to Riley (@rileyphughes) and Trinsic (@trinsic_id) on Twitter. We'd love to hear from you.

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399. Guidelines: 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure – Question #37 with Dr. Clyde Yancy

Play Episode Listen Later Nov 5, 2024 8:40

The following question refers to Section 7.4 of the 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure.The question is asked by the Director of the CardioNerds Internship Dr. Akiva Rosenzveig, answered first by Vanderbilt AHFT cardiology fellow Dr. Jenna Skowronski, and then by expert faculty Dr. Clyde Yancy.Dr. Yancy is Professor of Medicine and Medical Social Sciences, Chief of Cardiology, and Vice Dean for Diversity and Inclusion at Northwestern University, and a member of the ACC/AHA Joint Committee on Clinical Practice Guidelines.The Decipher the Guidelines: 2022 AHA / ACC / HFSA Guideline for The Management of Heart Failure series was developed by the CardioNerds and created in collaboration with the American Heart Association and the Heart Failure Society of America. It was created by 30 trainees spanning college through advanced fellowship under the leadership of CardioNerds Cofounders Dr. Amit Goyal and Dr. Dan Ambinder, with mentorship from Dr. Anu Lala, Dr. Robert Mentz, and Dr. Nancy Sweitzer. We thank Dr. Judy Bezanson and Dr. Elliott Antman for tremendous guidance.Enjoy this Circulation 2022 Paths to Discovery article to learn about the CardioNerds story, mission, and values. American Heart Association's Scientific Sessions 2024As heard in this episode, the American Heart Association's Scientific Sessions 2024 is coming up November 16-18 in Chicago, Illinois at McCormick Place Convention Center. Come a day early for Pre-Sessions Symposia, Early Career content, QCOR programming and the International Symposium on November 15. It's a special year you won't want to miss for the premier event for advancements in cardiovascular science and medicine as AHA celebrates its 100th birthday. Registration is now open, secure your spot here!When registering, use code NERDS and if you're among the first 20 to sign up, you'll receive a free 1-year AHA Professional Membership! Question #37 Mr. S is an 80-year-old man with a history of hypertension, type II diabetes mellitus, and hypothyroidism who had an anterior myocardial infarction (MI) treated with a drug-eluting stent to the left anterior descending artery (LAD) 45 days ago. His course was complicated by a new LVEF reduction to 30%, and left bundle branch block (LBBB) with QRS duration of 152 ms in normal sinus rhythm. He reports he is feeling well and is able to enjoy gardening without symptoms, though he experiences dyspnea while walking to his bedroom on the second floor of his house. Repeat TTE shows persistent LVEF of 30% despite initiation of goal-directed medical therapy (GDMT). What is the best next step in his management?AMonitor for LVEF improvement for a total of 60 days prior to further interventionBImplantation of a dual-chamber ICDCImplantation of a CRT-DDContinue current management as device implantation is contraindicated given his advanced age Answer #37 Explanation Choice C is correct. Implantation of a CRT-D is the best next step. In patients with nonischemic DCM or ischemic heart disease at least 40 days post-MI with LVEF ≤35% and NYHA class II or III symptoms on chronic GDMT, who have reasonable expectation of meaningful survival for >1 year,ICD therapy is recommended for primary prevention of SCD to reduce total mortality (Class 1, LOE A). A transvenous ICD provides high economic value in this setting, particularly when a patient's risk of death from ventricular arrhythmia is deemed high and the risk of nonarrhythmic death is deemed low. In addition, for patients who have LVEF ≤35%, sinus rhythm, left bundle branch block (LBBB) with a QRS duration ≥150 ms, and NYHA class II, III, orambulatory IV symptoms on GDMT, cardiac resynchronization therapy (CRT) is indicated to reduce total mortality, reduce hospitalizations, and improve symptoms and QOL. Cardiac resynchronization provides high economic value in this setting. Mr.

397. Guidelines: 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure – Question #36 with Dr. Shelley Zieroth

Play Episode Listen Later Oct 23, 2024 5:43

The following question refers to Sections 2.1 and 4.2 of the 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure.The question is asked by CardioNerds Academy Intern Dr. Adriana Mares, answered first by CardioNerds FIT Trialist Dr. Christabel Nyange, and then by expert faculty Dr. Shelley Zieroth. Dr. Zieroth is an advanced heart failure and transplant cardiologist, Head of the Medical Heart Failure Program, the Winnipeg Regional Health Authority Cardiac Sciences Program, and an Associate Professor in the Section of Cardiology at the University of Manitoba. Dr. Zieroth is a past president of the Canadian Heart Failure Society. She has been a PI Mentor for the CardioNerds Clinical Trials Program. The Decipher the Guidelines: 2022 AHA / ACC / HFSA Guideline for The Management of Heart Failure series was developed by the CardioNerds and created in collaboration with the American Heart Association and the Heart Failure Society of America. It was created by 30 trainees spanning college through advanced fellowship under the leadership of CardioNerds Cofounders Dr. Amit Goyal and Dr. Dan Ambinder, with mentorship from Dr. Anu Lala, Dr. Robert Mentz, and Dr. Nancy Sweitzer. We thank Dr. Judy Bezanson and Dr. Elliott Antman for tremendous guidance. Enjoy this Circulation 2022 Paths to Discovery article to learn about the CardioNerds story, mission, and values. American Heart Association's Scientific Sessions 2024As heard in this episode, the American Heart Association's Scientific Sessions 2024 is coming up November 16-18 in Chicago, Illinois at McCormick Place Convention Center. Come a day early for Pre-Sessions Symposia, Early Career content, QCOR programming and the International Symposium on November 15. It's a special year you won't want to miss for the premier event for advancements in cardiovascular science and medicine as AHA celebrates its 100th birthday. Registration is now open, secure your spot here!When registering, use code NERDS and if you're among the first 20 to sign up, you'll receive a free 1-year AHA Professional Membership! Question #36 A 50-year-old woman presents to establish care. Her medical history includes COPD, prediabetes, and hypertension. She is being treated with chlorthalidone, amlodipine, lisinopril, and a tiotropium inhaler. She denies chest pain, dyspnea on exertion, or lower extremity edema. On physical exam, blood pressure is 154/88 mmHg, heart rate is 90 beats/min, and respiration rate is 22 breaths/min with an oxygen saturation of 94% breathing ambient room air. BMI is 36 kg/m2. Jugular venous pulsations are difficult to assess due to her body habitus. Breath sounds are distant, with occasional end-expiratory wheezing. Heart sounds are distant, and extra sounds or murmurs are not detected. Extremities are warm and without peripheral edema. B-type natriuretic peptide level is 28 pg/mL (28 ng/L). A chest radiograph shows increased radiolucency of the lungs, flattened diaphragms, and a narrow heart shadow consistent with COPD. An electrocardiogram shows evidence of left ventricular hypertrophy. The echocardiogram showed normal LV and RV function with no significant valvular abnormalities. In which stage of HF would this patient be classified?AStage A: At Risk for HFBStage B: Pre-HFCStage C: Symptomatic HFDStage D: Advanced HF Answer #36 Explanation The correct answer is A – Stage A or at risk for HF. This asymptomatic patient with no evidence of structural heart disease or positive cardiac biomarkers for stretch or injury would be classified as Stage A or “at risk” for HF. The ACC/AHA stages of HF emphasize the development and progression of disease with specific therapeutic interventions at each stage. Advanced stages and disease progression are associated with reduced survival. The stages were revised in this edition of guidelines to emphasize new terminologies of “at risk” for Stage A and “pre...

Should the Menendez Brothers Walk Free? Legendary Dr. Burgess Testified in Trial & Weighs in

JCO Precision Oncology Conversations

Play Episode Listen Later Oct 17, 2024 75:32

#STSNation, Welcome to Surviving The Survivor the podcast that brings you the best guests in true crime. Lyle and Erik Menendez were convicted of the grisly 1989 shotgun murders of their parents, Jose and Mary Louise "Kitty" Menendez, at the family's sprawling Beverly Hills mansion. They've been in prison ever since. But, do they have a new shot at freedom? A major press conference is set for Wednesday October 16th about resentencing the brothers. #BestGuests: Dr. Ann Burgess is an internationally recognized pioneer in the assessment and treatment of victims of trauma and abuse, and author of A Killer by Design: Murderers, Mindhunters, and My Quest to Decipher the Criminal Mind. Among her many awards and accolades, in 2016 she was named a Living Legend by the American Academy of Nursing She has also worked with FBI Academy special agents to study serial offenders, and the links between child abuse, juvenile delinquency, and subsequent perpetration. Erlinda Ocampo Johnson Erlinda Ocampo Johnson, University of New Mexico School of Law graduate ('95), was appointed the special prosecutor in the Alec Baldwin case. She's a highly experienced and successful Criminal Defense and Personal Injury Attorney that has represented hundreds of clients facing Federal and State Criminal Charges R. Timothy Jansen has handled complex Civil, Administrative and Criminal Litigation s, first as Chief Trial Counsel for the Secretary of State of Florida, Tallahassee, handling both complex Civil and Criminal matters. Afterwards, he worked as a Senior Fraud Prosecutor for the United States Attorney in Tampa, handling exclusively complex White Collar Crimes, including Health Care Fraud Litigation. He was also the Chairmain of the Health Care Fraud Task Force and a member of the Attorney General's Health Care Fraud Task Force in Washington, D.C. Mr. Jansen also practices in the areas of Constitutional (First Amendment) Support the show:Patreon: https://www.patreon.com/SurvivingTheSurvivorYouTube: Surviving The Survivor: #BestGuests in True Crime - YouTubeJoel's Book: Https://www.amazon.com/shop/surviving...Website: https://survivingthesurvivor.comAll Things STS: https://linktr.ee/stspodcast #MenendezBrothers #TrueCrime #LyleMenendez #ErikMenendez #Menudo #BoyBand #PrisonLife #TrueCrimeCommunity #DomesticViolence #LosAngeles #GeorgeGascon #DistrictAttorney #truecrimecommunity #truecrimepodcast #truestory #justice #criminaljustice #crimestory #breakingnews #newsupdate

Transcriptomic Profiling of Non-Localized Prostate Cancer

Play Episode Listen Later Oct 16, 2024 27:07

JCO PO author Dr. Amar U. Kishan, Professor, Executive Vice Chair, and Chief of Genitourinary Oncology Service in the Department of Radiation Oncology at the University of California, Los Angeles, shares insights into his JCO PO article, “Transcriptomic Profiling of Primary Prostate Cancers and Nonlocalized Disease on Prostate-Specific Membrane Antigen Positron Emission Tomography/Computed Tomography: A Multicenter Retrospective Study.” Host Dr. Rafeh Naqash and Dr. Kishan discuss the relationship between Decipher genomic classifier scores and prostate-specific membrane antigen (PSMA) PET/CT-based metastatic spread. TRANSCRIPT Dr. Rafeh Naqash: Hello and welcome to JCO Precision Oncology Conversations, where we bring you engaging conversations with authors of clinically relevant and highly significant JCO articles. I'm your host, Dr. Rafeh Naqash, Assistant Professor at the OU Health Stephenson Cancer Center at the University of Oklahoma. Today we are joined by Dr. Amar Kishan, Executive Vice Chair of the Department of Radiation Oncology at the David Geffen School of Medicine at UCLA and UCLA Jonsson Comprehensive Cancer Center, and also the corresponding and senior author of the JCO Precision Oncology article entitled, “Transcriptomic Profiling of Primary Prostate Cancers and Non Localized Disease on Prostate-Specific Membrane Antigen (PSMA) Positron Emission Tomography/Computed Tomography: A Multicenter Retrospective Study.” Dr. Kishan, welcome to our podcast and thank you for joining us today. Dr. Amar Kishan: Thank you so much for that kind introduction and the invitation to be here today. Dr. Rafeh Naqash: Well, it seems to me that there's a theme that people in the GU space, investigators in the GU space, are very interested in trying to understand risk predictors for prostate cancer. We had somebody, I believe from Huntsman Cancer Center a few months back on a previous podcast, where they were trying to do risk prediction modeling as well. Could you tell us why that's something that the GU community is very interested in? What's the background? Is it because there's no risk prediction approaches currently? And would this somehow influence management in the near future? Dr. Amar Kishan: Yeah, that's a great question. So, I think this goes back to the point that we're in the era of precision medicine now, and many cancers have these molecular stratification scores and all that. Prostate cancer has lagged a little bit behind in that regard, despite the fact that it's such a common cancer that affects so many people across the country and across the world. So, we do have risk stratification schemes for prostate cancer. These are based off clinical and pathologic variables, like the level of PSA, the size of the tumor on digital rectal examination, now, we're incorporating MRI imaging as well, and then what the cancer looks like under the microscope, the Gleason score. And now there have been revisions to the Gleason score, but it's really kind of the architecture, what the biopsy looks like. And this was kind of developed many, many years ago by Donald Gleason, a pathologist at the VA. What we're not necessarily taking into account routinely is kind of the biology of the cancer per se. You know, what are the molecular drivers? How could that influence ultimate outcome? And that's very important because we have these risk groups, low risk, very low risk, favorable intermediate risk, unfavorable intermediate risk, high risk, very high risk. But within each of those groups, based on the clinical kind of pathological characteristics, there's a huge heterogeneity in outpatients too, and our treatments are effective, but they can be morbid. Putting someone on hormone therapy for an extended period of time has a lot of side effects. Dose escalating radiotherapy or doing surgery and then radiation afterwards, these are big things that have a big impact on the patient, and I think we really need better risk stratification tools to understand who needs intensification and who we can de-escalate treatment for. Dr. Rafeh Naqash: I think those are absolutely valid points, perhaps not just for prostate cancer, more so for all cancers that we currently treat, especially in the current day and age, where we have a tendency to add more and more therapies, combination therapies for patients, and as you mentioned, risk stratification to help identify high risk versus low risk, where you can de intensify treatment, is of high value from a patient standpoint as well as from a financial toxicity standpoint. So then, going to this next part of the approach that you used, and from what I understand in this paper, you had the radiological aspect, which is the PSMA PET, which we'll talk about. Then you had the genomic aspect, where you did some genomic risk-based stratification. Then you had the transcriptomic score based on the Decipher score. So, could you go into some of the details, first, for the PSMA PET, when is it used? What is the utilization? What is it based on, the science behind the PSMA PET? And then we can talk about some of the other genomic transcriptomic predictors that you use in this study. Dr. Amar Kishan: Sure. Absolutely. So, a PSMA PET is an advanced molecular imaging tool. PSMA stands for prostate specific membrane antigen. It's a membrane protein that is expressed on the surface of prostate cancer cells. It is expressed elsewhere in the body as well. The utilization of this for imaging has been a revolution in the staging of prostate cancer, both upfront and in the recurrent setting. We basically had fairly recent approval for PSMA PET being used more routinely in upfront staging and recurrent staging in 2022. Essentially, what this is it gives us an ability to detect whether prostate cancer has spread at a time of diagnosis or try to localize the recurrence. Now, no imaging test is perfect, of course, and a PET has a resolution of about 3 mm. There are questions about the sensitivity of the PET. You get it on a patient with high-risk disease, the PET is negative; you do surgery, there are positive lymph nodes. That can happen, but it's far superior to the tools that we have had before. For instance, beforehand, all we would have is a contrast enhanced CT, bone scan, and MRI. And the sensitivity of those is far below that of a PSMA PET. And that has actually been shown in a randomized trial called the ProPSMA trial out of Australia, where they compared conventional upfront imaging versus PSMA upfront imaging with a crossover design, and there was better detection of disease with the PSMA PET. So that's been a revolution in how we stage prostate cancer. But I'm sure many of your listeners and others are aware of the concerns. When you get a new test and you're detecting disease that's extra prostatic, for instance, are you seeing truly significant new disease that we do need to change our management for, or are we just seeing stuff that wasn't there before that actually wouldn't impact anything? And what I mean by that is, let's say you're seeing things that would never have made a difference to the patient, but now you're saying they have metastatic disease. You're changing their entire treatment paradigm, all kinds of things like that. There's implications to this that hasn't been fully fleshed out. But very recently, like we're talking in July of 2024, essentially, there was a Lancet Oncology paper that looked at the long-term prognosis of patients who had extra prostatic disease on PSMA PET, judged by something called a PROMISE score, kind of gives a quantification on the volume of disease, the brightness of disease, and they correlated that with long term outcomes. And that was really the first time that we have long term follow up data that this extra prostatic disease on PSMA PET actually is prognostically important. So, we're getting there. I mean, now that it's approved and, in some sense, the cat is out of the bag, patients are coming in asking for a PSMA PET, etc. I'm sure everyone has experienced that, but I think we now do have good evidence that it actually is prognostically important as well. Dr. Rafeh Naqash: Thank you for that explanation. And again, to put this into context for things that I've seen and that might also help the listeners in other tumors, so, for example, melanoma surveillance tends to be or while on treatment, patients tend to have more PET scans than what you see, maybe in individuals with lung cancer, where you get a baseline PET and then you have follow up CT scan based imaging is that something that you guys have shifted from in the prostate cancer space with the approval for PSMA PET, where follow up imaging, whether patient is on treatment or surveillance imaging, is PSMA PET based? Dr. Amar Kishan: Yeah, that's a good question. I think there's actually less robust data to support it as a means of treatment response. But in terms of evaluating a recurrence, then, yes, that has become kind of a standard tool. It's very complicated because all of the metrics that we have for, say, a treatment failing are based on conventionally detected metastases or something that shows up on a CT or bone scan. So, again, that question arises if someone is on systemic therapy and then you see something on a PSMA PET, are you going to abandon the therapy that you're on? It technically would be earlier than you would otherwise have done that, or what are you going to do? So, that hasn't been fully fleshed out, but it is used in that circumstance. So, I'd say less for treatment monitoring and more for evaluation of suspected recurrence. Dr. Rafeh Naqash: Understood. And I'm guessing, as a futuristic approach, somebody out there may perhaps do a trial using PSMA PET based imaging to decide whether treatment change needs to be made or does not need to be made. Dr. Amar Kishan: Yeah. It is being incorporated into trials as we speak, I think. Dr. Rafeh Naqash: Now, going to the second part of this paper is the Decipher score. Could you explain what the score is, what its components are, how it's calculated? Is it DNA, is it RNA, is it both combined? Is it tissue based; is it blood based? Dr. Amar Kishan: Yeah. So, the Decipher is also an approved test now, was approved in 2018. What it is, essentially, and how it's derived is based on the idea originally that patients might have a recurrence after surgery for prostate cancer. And it's just a PSA recurrence. It's this way. It's literally what we call a biochemical recurrence. That patient might not have any problems, whereas other patients with a recurrence might go on to develop metastatic disease. And we didn't have a good way of determining which patient is which. Get back to that prognostic problem that we have. So, some investigators, they looked at men that had radical prostatectomy from 1987 to 2001 at the Mayo Clinic that had archived tissue. They looked at FFPE, or basically paraffin embedded tissue. They extracted the RNA and then did a microarray analysis and looked at transcriptomic signatures and wanted to see, could this discern the patients who had mets, who had clinically significant recurrences from those that didn't? And out of that exercise came the Decipher Genomic Classifier, which basically is based on 22 genes. These are involved with cell proliferation, etc., but it's an RNA-based, tissue-based assay. So, if you wanted to order a Decipher on somebody, you would need to use a biopsy or prostatectomy specimen to do so. Essentially, that the samples, they would take the highest grade, highest Gleason grade specimen, send it to their lab. Their main lab is in California. The company is called Veracyte. And then they will do this RNA express analysis with a microarray and then return a score. The score is 0 to 1. Basically, 0 is the lowest, one is the highest, and it is a way of prognosticating the risk of metastasis. Originally, when you get a Decipher report, it actually will tell you the 5 and 10-year risks of distant metastasis, and we'll quantify that. Dr. Rafeh Naqash: And you said this is approved or has been approved in 2018. So, is this insurance reimbursable at this point? Dr. Amar Kishan: Most insurances do, not all, and the criteria for getting it can vary, so we can talk about it, but it was initially developed in this post-op setting. On the basis of a significant amount of validation studies, it has been moved to being used in the upfront setting as well. So, if you look at some of the ongoing NRG trials, for instance, they are stratifying patients based off the upfront Decipher score. And this is based off of validation studies that have been conducted looking at past RTOG trials and other trials. That said, sometimes it is not approved by commercial insurances in the upfront setting, because that wasn't where it was initially validated and derived. But honestly, here in 2024, that's very uncommon. It's much more common that it's approved. Dr. Rafeh Naqash: Understood. And in your practice, or the medical oncologist practice at your institution or other institutions, is this something that is commonly used for some sort of treatment decision making that you've seen? Dr. Amar Kishan: Yeah. So, as a radiation oncologist, I do think it's a useful test, because my approach is, if we're talking about adding hormone therapy, for instance, which is oftentimes dominating the conversation, we know that it offers a relative benefit to a lot of patients. We've published on this; others have published on it. Let's say it reduces the chance of metastasis by about 40%. 10-year risk of metastasis has a ratio of 0.6. So, 40% reduction. But if your risk of metastasis is 2%, that benefit is not that much in absolute terms. And we don't historically have a great way of saying, what is your absolute risk of metastasis? And I think Decipher is one tool that does tell us that - it literally gives it on the report. Now, is that a holy grail? Is it 100% accurate? Nothing is 100% accurate. But it does give us some quantification. Then I can go back to the patient and say, yes, you will get a benefit from adding hormone therapy, but you're talking about going from 2% to 1%, and so they can decide if that's worth it to them. Conversely, it could be a situation where they really don't want hormone therapy, but it comes back that their risk of metastasis is 20%, and then there's actually a big absolute benefit. So that's how I use it as a radiation oncologist, and we would use it upfront. Now surgeons, and if I was consulting on a post operative patient, maybe it plays more of a role. And do we need to do post operative radiotherapy on this patient, or do we need to add hormone therapy in the postoperative situation? From the medical oncology perspective, there are emerging data that may be useful in the choice of systemic therapy for metastatic disease, but that is a little bit earlier in the investigational stage, I would say. So, when I'm working with medical oncologists, it's often still in this localized setting, and typically, do we add hormone therapy or not, and that type of thing. Dr. Rafeh Naqash: Understood. And from a reporting standpoint, so the Decipher score, I'm guessing it's some sort of a report that comes back to the ordering physician and you basically see the score, it gives you a potential recurrence free survival percentage or a metastasis percentage of what is your risk for having metastasis in the next five years - is that how they generally do it? Because I've personally never seen one, so I'm just curious. Dr. Amar Kishan: Yeah, essentially, it comes back with a score, a numerical score, again, from 0 to 1, and it will basically give you the five-year risk of distant metastasis. The ten-year risk of distant metastasis. You can request an extended report that provides additional, not as well supported signatures that are out there, like ADT response signature, etc. But those maybe may have been published, but are not clinically validated as much, but the actual Decipher report, which goes to patients too, just has this kind of 5,10-year risk of distant metastasis. They have some estimations on prostate cancer specific mortality as well. Dr. Rafeh Naqash: Sure. Now, the third part of this project, and correct me if I'm wrong, the grid database of the 265 genomic signature score. From what I understood, this is a different component than the Decipher score. Is that a fair statement? Dr. Amar Kishan: Yeah. No, that's exactly correct. And that was an exploratory part of this analysis, to be honest. Basically, I think our main focus in the paper was those advances that we've talked about PSMA and Decipher, those happened concurrently. People started developing PSMA PET, people started developing Decipher. And so, what we wanted to understand was, if you have a patient that has extra prosthetic disease on PSMA PET, are those biologically more aggressive cancers, is their Decipher score going to be higher? What can we learn about the biology of this? And we were the first, to my knowledge, where we actually had a large data set of patients that actually received PSMA PETs and Decipher. And that's kind of the gist of the paper. We have patients in the upfront setting, patients in the post radical prostatectomy setting, and we're essentially showing that there is this correlation. In the upfront setting, the odds of extra prosthetic disease are higher for higher Decipher scores, which is kind of maybe validating that this biology is capturing something that's akin to this ability to spread. And in the post-op setting, because we have time to failure, technically, we can calculate a hazard ratio rather than odds ratio. So, we have a hazard ratio that's significantly associated with an increased risk of spread for patients with higher Decipher. The grid portion, which is the genomic resource information database, was more of an exploratory part where I mentioned the Decipher score is based off this microarray, they're looking at 1.4 million transcripts. Only 22 are part of the Decipher, but you can request the rest of the signature data as well. And so, we wanted to look at other pathways, other signatures that have been published, like looking at DNA repair, neuroendocrine pathway, just to see if we could see any correlations there that's not necessarily as clinically actionable. These are more exploratory. But again, we were trying to just look at whether patients who had non localized disease on their PSMA PET, whether their primary had more aggressive biology. We did see that. So that's kind of loosely speaking things like PTEN loss, androgen receptor, DNA repair, metabolism, neuroendocrine signaling, which are thought to be portenders of aggressive disease. Those pathways were upregulated at the RNA level in patients who had non-localized disease. And that's kind of the take home from that. But I wouldn't say any of that is clinically actionable at this point. It's more kind of defining biology. Dr. Rafeh Naqash: Some of the interesting correlations that you make here, at least in the figures that we see, you're looking at different local occurrences, nodal metastases, M1A and M1B disease. And one thing that I'm a little curious about is the Decipher score seems to be lower in pelvic nodal metastasis, that is, PSMA PET positive versus local recurrence, which has a slightly higher Decipher score. Is that just because of a sample size difference, or is there a biologically different explanation for that? Dr. Amar Kishan: Yeah, that's a good point. I would assume that's probably because of a sample size in this case, and it's a little bit complicated. It wasn't statistically different. And it was 0.76 on average for patients with local recurrence and 0.7 for patients with a pelvic nodal metastasis. Well, what I think is interesting is we can maybe think that in this post-op setting the time to failure could have been long in some of these cases. So, it is conceivable that an isolated nodal recurrence 10 years after the surgery, for instance, is not as aggressive a cancer as a local recurrence in a short time after the surgery. And that's not taken into account when you're just looking at median scores like we are in this fox and whiskers plot. But overall, I think what it's suggesting is that there are patients who have more indolent disease. That's actually pretty widespread there. There are pretty indolent cases that have these nodal metastases. So just because you have a nodal metastasis doesn't mean it's an incredibly aggressive cancer, biologically. Dr. Rafeh Naqash: Now, the exploratory component, as you mentioned, is the grid part where you do look at TP53, which is a cell cycle gene, and higher TP53 associated with worse recurrences, from what I understand. Do you see that just from a cell cycle standpoint? Because from what I, again, see in the paper, there's a couple of other cell cycle related signatures that you're using. Is that just a surrogate for potential Gleason score? Have you guys done any correlations where higher Gleason score is associated with maybe higher cell cycle checkpoint, pathway related alterations and replication stress and DNA damage and perhaps more aggressive cancers? Dr. Amar Kishan: Yeah, that's a great question. We haven't done that in this paper, but it has been published before that there is this correlation loosely between grade and some of these parameters - so repair, metabolism, androgen receptor signaling. However, it's a very great point that you bring up, which is that it's pretty heterogeneous and that's why we need something like this as opposed to Gleason score. So, you can have Gleason 10 cancer. I mean, that would be pretty uncommon. But within the Gleason 9, at least, which we have published on and looked at, there's a heterogeneity. There are some that are biologically not that aggressive. And the converse Gleason 7, you can have some that are actually biologically aggressive. That's why it may be useful to move away from just the pathological architecture and get a little bit more into some of these pathways. Dr. Rafeh Naqash: What's the next step here? I know this perhaps isn't ready for primetime. How would you try to emphasize the message in a way that makes it interesting and clinically applicable for your colleagues in the GU community? Dr. Amar Kishan: Yeah. I think for me, what I would try to emphasize here and what I think is the main takeaway is this is kind of a validation that having extra prostatic disease on PSMA PET is likely suggestive of a more aggressive disease biology. And I think what this stresses to me is the importance of getting a PSMA PET, particularly in patients with high-risk prostate cancer. This isn't always happening. And I think if we see things on a PSMA PET, we really need to consider systemic therapy intensification. And what do I mean by that as a practical point? You have a high-risk prostate cancer patient. You get a PSMA PET, you see an isolated pelvic lymph node. If we believe the results of the study, that's a more aggressive biology likely. Whether we have the Decipher or whether we have genomic signatures, which we may or may not have, maybe that patient should get treated with something like an androgen receptor signaling inhibitor in addition to ADT, more akin to a clinically node positive case. So, intensify the systemic therapy, more aggressive disease. That's how I would incorporate it practically into my practice, that really what we're seeing on the PSMA PET is real. It's a reflection of biology that's aggressive. It's not just some Will Rogers effect where you're upstaging stuff needlessly. I think this is telling us some true biology. So that's kind of what my takeaway would be. I think future areas of investigation would be, honestly, to try to have a better idea of what's going on in these metastases. So, if you could design a study potentially, where your biopsy some of these and actually do sequencing and understand a little bit more of that. And so, we're looking into stuff like that. But my takeaway for like the everyday clinician would be to try to get a PSMA PET, if you can, and to intensify therapy on the basis of that, or at least consider it, discuss it in a multidisciplinary setting. Dr. Rafeh Naqash: And I'm guessing somebody out there, perhaps even you, are thinking or planning on doing a ctDNA MRD based correlation here, since that's up and coming in this space. Dr. Amar Kishan: That is up and coming, I think one of the challenges in prostate cancer is the amount of ctDNA can be low. But yes, you're right, that's certainly things that a lot of us are looking at, too. Dr. Rafeh Naqash: Excellent. Well, thank you for the science discussion, Dr. Kishan, could you tell us a little bit about yourself, your career trajectory, where you started, what you're doing, and perhaps some advice for early career junior investigators, trainees, things that might have worked for you, that could also work for them as they are progressing in their careers. Dr. Amar Kishan: Sure. So, yeah, I'm a radiation oncologist at UCLA. I run the prostate cancer radiation program. Clinically. I'm also heavily involved in our research enterprise, so I kind of oversee the clinical and translational research aspect. That's what I do currently. So, I did my residency in radiation oncology at UCLA. Just on a personal note, my wife is from LA, her parents live in LA. We really wanted to stay in LA, so I was fortunate to be able to join the faculty here. I always liked GU oncology, so that was kind of a natural thing for me to kind of go into this position here and try to build the GU program. I've been very fortunate to have great collaborators. My message to students and trainees is to try to reach outside your department for mentorship as well. It's important to have people inside your department who can mentor you. But as a radiation oncologist, I work so closely with urology, so closely with medical oncology that I'm very fortunate to have individuals in those departments who have a vested interest in me and my success as well. I like working with them. It's important to be a team player. If they need help, you help them. If you need help, you ask for help from them. So, I think that's the single biggest thing that I would say to any trainee is don't be intimidated. Please reach outside of your department. Lots of people are willing to help and provide mentorship, and it's helpful to have that perspective. We are in a very multidisciplinary environment and era of practicing medicine. Dr. Rafeh Naqash: Well, thank you again for those personal insights and especially for submitting your work to JCO PO. And we hope to see more of this work perhaps in the subsequent sessions for JCO PO, and maybe we'll bring you back again. And at that point, the Decipher and the PSMA PET scan will have more data, more implementation in the clinically relevant real-world setting. Dr. Amar Kishan: Thank you very much. And if I could just give one quick shout out. The first author of this work, which I presented, was Dr. John Nikitas, who is a trainee that works with me here at UCLA a PGY5 resident. So, I do want to give credit to him as well. Dr. Rafeh Naqash: And John, if you're listening to this hopefully, it's always great to get a shout out from your mentor. Thank you both again for putting in the work and effort to submit this manuscript. Thank you for listening to JCO Precision Oncology Conversations. Don't forget to give us a rating or review and be sure to subscribe so you never miss an episode. You can find all ASCO shows at asco.org/podcasts. 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. Disclosures Dr. Kishan Honoraria Company: Varian Medical Systems, Boston Scientific, Janssen Oncology Consulting or Advisory Role Company: Janssen, Boston Scientific, Lantheus Research Funding Company: Janssen , Point Biopharma

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Kelly Hooker - October's Real Time Reading

Thoughts from a Page Podcast

Play Episode Listen Later Oct 14, 2024 53:43

Kelly Hooker joins me for the October's Real Time Reading episode where we highlight our current, past and upcoming reads. Kelly's Selections: Last: Broken Country by Clare Leslie Hall Famous Last Words by Gillian McAllister Now: Jane and Dan at the End of the World by Colleen Oakley The Small and the Mighty by Sharon McMahon Next: The Family Inside by Katie Garner One Good Thing by Georgia Hunter DNFs or Didn't Like: Isola by Allagra Goodman Clever Little Thing by Helena Eschlin Book Mail Highlights: The Trouble Up North by Travis Mulhauser The Snowbirds by Christina Clancey Cindy's Selections: Last: We Solve Murders by Richard Osman Rental House by Weike Wang Now: Eden Undone by Abbott Kahler The Oligarch's Daughter by Joseph Finder Next: Everyone This Christmas Has a Secret by Benjamin Stevenson Kills Well with Others by Deanna Raybourn DNFs or Didn't Like: The Way by Cary Groner The Mesmerist by Caroline Wood Book Mail Highlights: Jane and Dan at the End of the World by Colleen Oakley The Mesopotamian Riddle: An Archaeologist, a Soldier, a Clergyman, and the Race to Decipher the World's Oldest Writing by Joshua Hammer Literary Lookbook information: Want to know which new titles are publishing in May - October of 2024? Check out our second Literary Lookbook which contains a comprehensive but not exhaustive list all in one place so you can plan ahead. Our third Literary Lookbook will be out at the end of October. Join my Patreon group to support the podcast. Other ways to support the podcast can be found here. Connect with Kelly Hooker on Instagram. Connect with me on Instagram, Facebook, YouTube, and Threads. Learn more about your ad choices. Visit megaphone.fm/adchoices

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Targeted Diagnosis in Prostate Cancer with Dr. Todd Morgan

The Dr. Geo Podcast

Play Episode Listen Later Oct 12, 2024 53:07

In this episode, Dr. Geo sits down with Dr. Todd Morgan, a leading urological surgeon from Michigan Medicine, to explore cutting-edge tools like biomarkers, MRI, and genomic testing in diagnosing prostate cancer. They dive into the benefits of active surveillance, the importance of the MUSIC trial, and how advanced diagnostics shape treatment decisions.Key Points:Importance of biomarkers and MRI in reducing unnecessary biopsies.Active surveillance for low-risk prostate cancer and the impact of the MUSIC trial.Use of genomic testing (Decipher, Prolaris) to inform treatment decisions.Debate around active surveillance for higher-risk Gleason 7 cancers.Role of AI and precision-based treatments in prostate cancer care.----------------We are excited to introduce our October Sponsors:XY Wellness: XY Wellness provides a high-value roadmap to health and wellness for men with prostate cancer. Co-founded by our Chief Medical Officer, they aim to help men thrive post-diagnosis. [Learn more about XY Wellness here [https://bit.ly/3uJPC7Z].AG1 (Athletic Greens): AG1 contains 75 high-quality vitamins, minerals, whole-food sourced ingredients, probiotics, and adaptogens to help you start your day right. This special blend of ingredients supports your gut health, nervous system, immune system, energy, recovery, focus, and aging. All the things. Enjoy AG2 (Athletic Greens) [https://bit.ly/3mA2tVV] here----------------Thanks for listening to this week's episode. Subscribe to The Dr. Geo YouTube Channel to get more content like this and learn how you can live better with age.You can also listen to this episode and future episodes of the Dr. Geo Podcast by clicking HERE.----------------Follow Dr. Geo on social media. Facebook, Instagram Click here to become a member of Dr. Geo's Health Community.Improve your urological health with Dr. Geo's formulated supplement lines:XY Wellness for Prostate cancer lifestyle and nutrition: Mr. Happy Nutraceutical Supplements for prostate health and male optimal living.You can also check out Dr. Geo's online dispensary for other supplement recommendations Dr. Geo's Supplement Store____________________________________DISCLAIMER: This audio is educational and does not constitute medical advice. This audio's content is my opinion and not that of my employer(s) or any affiliated company.Use of this information is at your own risk. Geovanni Espinosa, N.D., will not assume any liability for any direct or indirect losses or damages that may result from the use of the information contained in this video, including but not limited to economic loss, injury, illness, or death.

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Sean “Diddy” Combs Profiled By Legendary Mindhunter Dr. Ann Burgess & Renowned Psychologist

Play Episode Listen Later Oct 9, 2024 100:06

#STSNation, Welcome to another episode of Surviving The Survivor, the podcast that brings you the #BestGuests in all of True Crime… Among 120 civil lawsuits expected to be filed against Sean 'P. Diddy' Combs is one involving a nine-year-old, according to a Texas lawyer who is overseeing the reported cases. Attorney Tony Buzbee alleged during a press conference: "This, individual who was nine years old at the time, was taken to an audition in New York City with Bad Boy Records. Other boys were there to audition as well. All of them were trying to land a record deal. All of them were minors. This individual was sexually abused, allegedly, by Sean Combs, and several other people at the studio in the promise to both his parents and to him himself of getting a record deal." #BestGuests: Dr. Ann Burgess is an internationally recognized pioneer in the assessment and treatment of victims of trauma and abuse, and author of A Killer by Design: Murderers, Mindhunters, and My Quest to Decipher the Criminal Mind. Among her many awards and accolades, in 2016 she was named a Living Legend by the American Academy of Nursing She has also worked with FBI Academy special agents to study serial offenders, and the links between child abuse, juvenile delinquency, and subsequent perpetration. Dr. Anna Salter is an American psychologist, an internationally recognized expert on sexual predators, and a mystery novelist. Dr. Salter earned her MA from Tufts University and PhD from Harvard University. She has been a teaching fellow at both Tufts University and Harvard University. She is the author of several non-fiction books including Predators: Pedophiles, Rapists, and Other Sex Offenders: Who They Are, How They Operate, and How We Can Protect Our Children (2003), and Treating Child Sex Offenders and Victims (1988) Robert Prentky has practiced as a forensic psychologist for the past 35+ years, and in that capacity assessed or supervised the assessment of 2,000+ offenders in 30-40 prisons around the country. He's been conducting research on sexual offenders for the past 38 years, with support from 20 state and federal research grants. Support the show:Patreon: https://www.patreon.com/SurvivingTheSurvivorYouTube: Surviving The Survivor: #BestGuests in True Crime - YouTubeJoel's Book: Https://www.amazon.com/shop/surviving...Website: https://survivingthesurvivor.comAll Things STS: https://linktr.ee/stspodcast #Diddy #FreakOff #SeanCombs #Cassie #TrueCrime #Rap #RapGame #CassieVentura #TrueCrime #TrueCrimeCommunity #Rapper #ThugLife

Stars And Wars 2 The Rise Of The Skywalkers

Play Episode Listen Later Oct 7, 2024

Levi and BM unite with Fopp and learn to work together as a team to deal with "The Skywalkers" Main theme is "The Prisoner" by Stomfel performed by Kendall.This item has files of the following types: Archive BitTorrent, Item Tile, Metadata, PNG, Spectrogram, VBR MP3

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Stars And Wars 1 The Cafeteria Catastrophe

Play Episode Listen Later Sep 30, 2024

In the KendallCast Network's first foray into the world of Actual Play Podcasting, we meet BM(Anthony "Batmouse" Howard), Levi(Jordan Sam), and Lt. Fop(Matt "BrenDerlin" Thorton), two inmates and an officer on a prison space station thingy when something goes wrong during dinner.This item has files of the following types: Archive BitTorrent, Item Tile, Metadata, PNG, Spectrogram, VBR MP3

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391. Guidelines: 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure – Question #35 with Dr. Mark Drazner

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Play Episode Listen Later Sep 19, 2024 6:03

The following question refers to Section 2.2 of the 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure.The question is asked by University of Colorado internal medicine resident Dr. Hirsh Elhence, answered first by University of Chicago advanced heart failure cardiologist and Co-Chair for the CardioNerds Critical Care Cardiology Series Dr. Mark Belkin, and then by expert faculty Dr. Mark Drazner.Dr. Drazner is an advanced heart failure and transplant cardiologist, Professor of Medicine, and Clinical Chief of Cardiology at UT Southwestern. He is the President of the Heart Failure Society of America.The Decipher the Guidelines: 2022 AHA / ACC / HFSA Guideline for The Management of Heart Failure series was developed by the CardioNerds and created in collaboration with the American Heart Association and the Heart Failure Society of America. It was created by 30 trainees spanning college through advanced fellowship under the leadership of CardioNerds Cofounders Dr. Amit Goyal and Dr. Dan Ambinder, with mentorship from Dr. Anu Lala, Dr. Robert Mentz, and Dr. Nancy Sweitzer. We thank Dr. Judy Bezanson and Dr. Elliott Antman for tremendous guidance.Enjoy this Circulation 2022 Paths to Discovery article to learn about the CardioNerds story, mission, and values. Question #35 A 50-year-old woman with a history of congestive heart failure, hypertension, type 2 diabetes mellitus, and obstructive sleep apnea presents to the outpatient clinic to follow up on her heart failure management. One year prior, echocardiogram showed an ejection fraction of 30% with an elevated BNP, for which she was started on appropriate GDMT. Repeat echocardiogram today showed an EF of 50%. Which of the following best describes her heart failure status? A HFrEF (HF with reduced EF) B HFimpEF (HF with improved EF) C HFmrEF (HF with mildly reduced EF) D HFpEF (HF with preserved EF) Answer #35 Explanation The correct answer is B – HFimpEF, or heart failure with improved ejection fraction, best describes her current heart failure status. Left ventricular ejection fraction is an important factor in classifying heart failure given differences in prognosis, response to treatment, and use in clinical trial enrollment criteria. The classification of heart failure by EF (adopted from the Universal Definition of HF): – HFrEF (HF with reduced EF): LVEF ≤40% – HFimpEF (HF with improved EF): previous LVEF ≤40%, a ≥10% increase from baseline LVEF, and a second measurement of LVEF >40%. – HFmrEF (HF with mildly reduced EF): LVEF 41%–49%, andevidence of spontaneous or provokable increased LV filling pressures (e.g., elevated natriuretic peptide, noninvasive and invasive hemodynamic measurement) – HFpEF (HF with preserved EF): LVEF ≥50%, and evidence of spontaneous or provokable increased LV filling pressures (e.g., elevated natriuretic peptide, noninvasive and invasive hemodynamic measurement) Patients with HFmrEF are usually in a dynamic state of improving from HFrEF or deteriorating towards HFrEF. Therefore, patients with HFmrEF may benefit from follow-up evaluation of systolic function and etiology of sub-normal EF. Improvements in EF are associated with better outcomes but do not indicate full myocardial recovery or normalization of LV function. Indeed, structural and functional abnormalities such as LV dilation and systolic or diastolic dysfunction often persist. Moreover, EF may remain dynamic with fluctuations in either direction depending on factors such as GDMT adherence and re-exposure to cardiotoxic agents. As such, the term heart failure with “improved EF” was deliberately chosen over “recovered EF” and “preserved EF”. Importantly, in patients with HFimpEF while on GDMT, the EF may decrease after withdrawal of GDMT. Main Takeaway

Michael Ellenhorn & Julie Henson | Grow Your Law Firm Through Strategic Lateral Hiring

The Lawyer's Edge

Play Episode Listen Later Aug 13, 2024 43:14

Michael Ellenhorn founded Decipher Investigative Intelligence to help clients create safer, more productive, and more profitable workplaces through reliable investigative intelligence. He counsels clients on mitigating risks associated with the hiring process and is a frequent speaker on the topic of lateral hiring, integration, and talent acquisition strategy. Under his leadership, Decipher has been recognized by St. Louis Business Journal's “Best Places to Work” and honored for his innovation in corporate philanthropy. As Chief Growth Officer at Decipher, Julie Henson empowers law firms to make strategic growth decisions. Whether it's lateral hiring, exploring new markets, or seizing M&A opportunities, she helps firms elevate client service, mitigate risk, boost revenue, and foster vibrant cultures. With more than 20 years of legal industry experience, including in business development strategy and as a Chief Client Officer at an AmLaw 100 firm, she offers unparalleled insights into fostering growth and maximizing potential for law firms and other legal organizations. WHAT'S COVERED IN THIS EPISODE ABOUT STRATEGIC LATERAL HIRING Did you know that 50% of lateral partner hires fail within a few years? Most law firms are focused on growth, whether it's through increased head count or better approaches to profitability, but law firms often make decisions based on what feels right. Growth requires a strategic approach, not one based on gut feeling or limited information. Collecting and analyzing data through investigative intelligence helps you make accurate decisions in talent acquisition that also align with your company's culture. In this episode of The Lawyer's Edge podcast, Elise Holtzman sits down with the CEO and Chief Growth Officer of Decipher Investigative Intelligence, Michael Ellenhorn and Julie Henson, to talk about the importance of using investigative intelligence in decision-making for growing and sustaining law firms. You'll learn about various growth strategies, the challenges of integrating lateral partners, avoiding cultural mismatches, and much more! 1:59 - What investigative intelligence is and two ways you can use it to gather the information you need 8:07 - How to define growth and success for your law firm 12:09 - How to start determining the best path for growing through mergers and acquisitions 14:35 - Examples of how cultural divides within a merged organization can create problems 16:52 - Other common mistakes made with lateral hires, mergers, and acquisitions 23:06 - The challenge of finding game-changing lateral partners to fill certain needs in your law firm 25:20 - One way to drastically get ahead of your competition when hiring and how Decipher utilizes information to help 29:11 - Dos and don'ts for successful lateral hiring and integration in your law firm 39:53 - The importance of kindness in your interactions and paying attention to red flags in the hiring process MENTIONED IN GROW YOUR LAW FIRM THROUGH STRATEGIC LATERAL Decipher Investigative Intelligence Michael Ellenhorn on LinkedIn Julie Henson on LinkedIn Get Connected with The Coaching Team at hello@thelawyersedge.com The Lawyer's Edge SPONSOR FOR THIS EPISODE… Today's episode is brought to you by the coaching team at The Lawyer's Edge, a training and coaching firm which has been focused exclusively on lawyers and law firms since 2008. Each member of The Lawyer's Edge coaching team is a trained, certified, and experienced professional coach AND either a former practicing attorney or a former law firm marketing and business development professional. Whatever your professional objectives, our coaches can help you achieve your goals more quickly, more easily, and with significantly less stress. To get connected with YOUR coach, just email the team at hello@thelawyersedge.com.

How to decipher fear from intuition, managing anxiety + life updates

ReCharge the Soul

Play Episode Listen Later Aug 13, 2024 48:01

In this episode we dive into how to decipher fear vs. intuition, tips on managing anxiety, how to follow your astrological transits to maximise opportunities in your life and life updates. We hope you enjoy! Find us: Website: rechargethesoul.com Facebook: Recharge the Soul retreats Instagram: _rechargethesoul Book an astrology session with Bailee via baileecode@yahoo.com. Book a intuitive reading with Lorri Ann via lorriann@bodybycode.com

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Try to Decipher My Funny Fad Lingo Ringo You're A Daisy If You Do

Heroes of Humility

Play Episode Listen Later Aug 12, 2024 54:58

Unrelenting, in their objective to unravel social behavioral mysteries with a desire for truth and humor, real pals and oxymorons Heroes of Humility commence episode 49. HoHs discuss hipster idioms and ways of engaging in communication that actually impede meaning. They cover aspects of overusing exclamation points, LoL, emojis, acronyms, over simplified brevity, and unspoken rules of electronic messaging behavior. Somehow the HoHs even sprinkle in a totally germane discussion about one of the greatest movies of all time, Tombstone. Subscribe for updates and look for Heroes of Humility on Facebook, Instagram, and YouTube for some unbelievably trite yet profound adventures. Send us a message on social media if you have an idea you would like us to tackle anonymously or feel free to request that we mention you by name if we address your topic on the show. www.heroesofhumility.com

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383. Guidelines: 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure – Question #33 with Dr. Biykem Bozkurt

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Play Episode Listen Later Jul 30, 2024 5:55 Transcription Available

The following question refers to Section 5.1 of the 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure.The question is asked by University of Colorado internal medicine resident Dr. Hirsh Elhence, answered first by advanced heart failure faculty at the University of Chicago and Co-Chair for the CardioNerds Critical Care Cardiology Series Dr. Mark Belkin, and then by expert faculty Dr. Biykem Bozkurt.Dr. Bozkurt is the Mary and Gordon Cain Chair, Professor of Medicine, Director of the Winters Center for Heart Failure Research, and an advanced heart failure and transplant cardiologist at Baylor College of Medicine in Houston, TX. She is former President of HFSA, former senior associate editor for Circulation, and current Editor-In-Chief of JACC Heart Failure. Dr. Bozkurt was the Vice Chair of the writing committee for the 2022 Heart Failure Guidelines.The Decipher the Guidelines: 2022 AHA / ACC / HFSA Guideline for The Management of Heart Failure series was developed by the CardioNerds and created in collaboration with the American Heart Association and the Heart Failure Society of America. It was created by 30 trainees spanning college through advanced fellowship under the leadership of CardioNerds Cofounders Dr. Amit Goyal and Dr. Dan Ambinder, with mentorship from Dr. Anu Lala, Dr. Robert Mentz, and Dr. Nancy Sweitzer. We thank Dr. Judy Bezanson and Dr. Elliott Antman for tremendous guidance.Enjoy this Circulation 2022 Paths to Discovery article to learn about the CardioNerds story, mission, and values. /*! elementor - v3.23.0 - 25-07-2024 */ .elementor-toggle{text-align:start}.elementor-toggle .elementor-tab-title{font-weight:700;line-height:1;margin:0;padding:15px;border-bottom:1px solid #d5d8dc;cursor:pointer;outline:none}.elementor-toggle .elementor-tab-title .elementor-toggle-icon{display:inline-block;width:1em}.elementor-toggle .elementor-tab-title .elementor-toggle-icon svg{margin-inline-start:-5px;width:1em;height:1em}.elementor-toggle .elementor-tab-title .elementor-toggle-icon.elementor-toggle-icon-right{float:right;text-align:right}.elementor-toggle .elementor-tab-title .elementor-toggle-icon.elementor-toggle-icon-left{float:left;text-align:left}.elementor-toggle .elementor-tab-title .elementor-toggle-icon .elementor-toggle-icon-closed{display:block}.elementor-toggle .elementor-tab-title .elementor-toggle-icon .elementor-toggle-icon-opened{display:none}.elementor-toggle .elementor-tab-title.elementor-active{border-bottom:none}.elementor-toggle .elementor-tab-title.elementor-active .elementor-toggle-icon-closed{display:none}.elementor-toggle .elementor-tab-title.elementor-active .elementor-toggle-icon-opened{display:block}.elementor-toggle .elementor-tab-content{padding:15px;border-bottom:1px solid #d5d8dc;display:none}@media (max-width:767px){.elementor-toggle .elementor-tab-title{padding:12px}.elementor-toggle .elementor-tab-content{padding:12px 10px}}.e-con-inner>.elementor-widget-toggle,.e-con>.elementor-widget-toggle{width:var(--container-widget-width);--flex-grow:var(--container-widget-flex-grow)} Question #33 A 63-year-old man with a past medical history of hypertension and type 2 diabetes mellitus presents for routine follow-up. He reports feeling in general good health and enjoys 2-mile walks daily. A review of systems is negative for any symptoms. Which of the following laboratory studies may be beneficial for screening?ANT-proBNPBCK-MBCTroponinDC-reactive proteinENone of the above Answer #33 ExplanationThe correct answer is A – NT-proBNP.This patient is at risk for HF (Stage A) given the presence of risk factors (hypertension and type 2 diabetes mellitus) but the absence of signs or symptoms of heart failure.Patients at risk for HF screened with BNP or NT-proBNP followed by collaborative care, diagnostic evaluation, and treatment in those with elevated levels can reduce combined rates of LV systolic ...

#310 - The relationship between testosterone and prostate cancer, testosterone replacement therapy, and tools for predicting cancer aggressiveness and guiding therapy | Ted Schaeffer, M.D., Ph.D.

The Peter Attia Drive

Play Episode Listen Later Jul 22, 2024 47:53

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter's Weekly Newsletter Ted Schaeffer is an internationally recognized urologist specializing in prostate cancer and a returning guest on The Drive. In this episode, Ted provides insights into the role testosterone plays, or doesn't play, in the initiation and progression of prostate cancer. He unpacks the findings and limitations of the recent TRAVERSE trial, exploring the complex relationship between testosterone and prostate cancer. Ted delves into the molecular nature of prostate cancer, explaining the androgen receptor saturation theory and the potential impact of testosterone on cancer growth. He also discusses the use of the Decipher test to predict cancer aggressiveness and guide targeted treatment. Furthermore, Ted shares how he counsels patients regarding testosterone replacement therapy (TRT), including its safe administration in patients with low-grade prostate cancer. Additionally, he highlights advancements in prostate cancer therapies and biomarkers that help develop precise treatment strategies while minimizing the need for broad androgen deprivation therapy. We discuss: Background on the TRAVERSE trial: insights into exogenous testosterone and prostate cancer risk [3:00]; The androgen receptor saturation theory: how different organs respond to varying levels of testosterone [10:30]; The relationship between testosterone levels and prostate cancer aggressiveness: how aggressive prostate tumors have lower androgen receptor activity and rely on different growth mechanisms [16:15]; Using the Decipher score to assess prostate cancer aggressiveness and guide personalized treatment strategies [23:45]; Considerations for testosterone replacement therapy: how Ted counsels patients, how TRT can be safely administered in patients with low-grade prostate cancer, and more [31:15]; Advancements in prostate cancer therapies and PSA as a biomarker for precise treatment decisions, minimizing the need for broad androgen deprivation therapy [38:30]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

“Masterminds'” Dr. Ann Burgess Profiles Assassins as Trump Prepares to Speak at RNC