Podcasts about epas

In this episode, hosts Drs. Peter Lu and Jason Silverman talk to Dr. Cary Sauer about Competency-Based Medical Education (CBME) to break down this concept and all the related terminology that is part of this approach to medical training. If you're confused about CBME, EPAs, milestones and competencies, this episode is for you! Dr. Sauer is a Pediatric Gastroenterologist specializing in the care of children with IBD and Division Chief at Children's Healthcare of Atlanta and Emory University.Learning Objectives:Understand what Competency-Based Medical Education (CBME) means and how it differs from traditional time-based models of medical trainingUnderstand how milestones, competencies and EPAs relate to one another within the CBME frameworkRecognize the central role of entrustment and how that can is incorporated into workplace-based assessments of traineesLinks:Pediatric GI Milestones (v2.0)NASPGHAN EPA resourcesABP EPAs for subspecialtiesNorth American Society for Pediatric Gastroenterology,  Hepatology, and Nutrition Position Paper on Entrustable  Professional Activities: Development of Pediatric  Gastroenterology, Hepatology, and Nutrition Entrustable  Professional ActivitiesEducating pediatric gastroenterology fellows: milestones, EPAs, & their application within a new educational curriculumImplementing entrustable professional activities in pediatric fellowships: facilitating the processSupport the showThis episode may be eligible for CME credit! Once you have listened to the episode, click this link to claim your credit. Credit is available to NASPGHAN members (if you are not a member, you should probably sign up). And thank you to the NASPGHAN Professional Education Committee for their review!As always, the discussion, views, and recommendations in this podcast are the sole responsibility of the hosts and guests and are subject to change over time with advances in the field.Check out our merch website!Follow us on Bluesky, Twitter, Facebook and Instagram for all the latest news and upcoming episodes.Click here to support the show.

In 2002 a group of surgeons got together and radically changed surgical training forever. They just got together again... They call themselves the Blue Ribbon Committee. When they met in 2002 they addressed critical issues such as residency structure, specialization, work-life balance, and simulation-based training. Now, with rapid advancements in medicine and education, BRC II has revisited these topics and introduced new priorities to ensure that surgical education meets the demands of the modern era. In this episode, we are joined by Dr. Steven Stain, co-chair of BRC II and a leader in surgical education. Dr. Stain shares insights into the motivations behind the second committee, its key findings, and how competency-based education, entrustable professional activities (EPAs), and other innovations are shaping the future of surgical training. Join hosts Pooja Varman MD, Judith French PhD, and Jeremy Lipman MD, MHPE for an engaging discussion on what surgical educators, trainees, and institutions need to know about the new recommendations from BRC II and the future of surgical education. Learning Objectives By the end of this episode, listeners will be able to  1.     Under the origins and impact of the first Blue Ribbon Committee (BRC I) 2.     Explain the factors that led to the formation of the BRC II and its major recommendations 3.     Identify challenges and opportunities in modern surgical education 4.     Discuss the role of competency-based education and EPAs in training future surgeons 5.     Recognize how institutions and educators can adapt to BRC II recommendations References 1.     Recommendations on Surgical Education and Training in the United States: 2024. Ann Surg. 2024;280(4):535. doi:10.1097/SLA.0000000000006360 https://pubmed.ncbi.nlm.nih.gov/38814074/ 2.     Blue Ribbon Committee II Advises Sweeping Changes in Surgical Education. ACS. Accessed January 12, 2025. https://www.facs.org/for-medical-professionals/news-publications/news-and-articles/bulletin/2024/may-2024-volume-109-issue-5/blue-ribbon-committee-ii-advises-sweeping-changes-in-surgical-education/ ***Fellowship Application Link: https://forms.gle/PQgAvGjHrYUqAqTJ9 Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more. If you liked this episode, check out our recent episodes here: https://app.behindtheknife.org/listen

In this episode, we dive into the evolving use of Entrustable Professional Activities (EPAs) as a tool for assessing and supporting learner development in pharmacy experiential education. Dr. Abigail Elmes, Research Assistant Professor at the University of Illinois Chicago College of Pharmacy, shares her insights on implementing EPA-based assessments in Advanced Pharmacy Practice Experiences (APPEs). Whether you're new to EPAs or navigating their integration into your practice site, this episode offers practical strategies to promote student growth, improve feedback conversations, and overcome common barriers in EPA-based assessment.  HostKathy Schott, PhDVice President, Education & OperationsCEimpactGuestAbigail ElmesResearch Assistant ProfessorUniversity of Illinois Chicago College of PharmacyGet CE: CLICK HERE TO CPE CREDIT FOR THE COURSE!CPE Information Learning ObjectivesAt the end of this course, preceptors will be able to:1. Explain the purpose and structure of Entrustable Professional Activities (EPAs) in pharmacy education 2. Identify strategies to provide effective learner feedback using entrustment-supervision scales0.05 CEU/0.5 HrUAN: 0107-0000-25-147-H99-PInitial release date: 3/26/2025Expiration date: 3/26/2028Additional CPE details can be found here.The speakers have no relevant financial relationships with ineligible companies to disclose.This program has been:Approved by the Minnesota Board of Pharmacy as education for Minnesota pharmacy preceptors.Reviewed by the Texas Consortium on Experiential Programs and has been designated as preceptor education and training for Texas preceptors.Want more education on this or other topics?Check out this article authored by our guest, Dr. Abigail Elmes, and colleagues – Preceptor Perspectives Using Entrustable Professional Activity-Based Assessments During Advanced Pharmacy Practice Experiences.And here are links to a few great resources:ten Cate O. Nuts and bolts of entrustable professional activities. J Grad Med Educ. 2013;5(1):157-158. doi:10.4300/JGME-D-12-00380.1ten Cate O, Jarrett JB. Would I trust or will I trust? The gap between entrustment determinations and entrustment decisions for trainees in pharmacy and other health professions. Pharmacy. 2023;11(3):107. doi:10.3390/pharmacy11030107ten Cate O, Schwartz A, Chen HC. Assessing trainees and making entrustment decisions: on the nature and use of entrustment-supervision scales. Academic Medicine. 2020;Publish Ahead of Print. doi:10.1097/ACM.0000000000003427Persky AM, Fuller KA, Cate O ten. True entrustment decisions regarding entrustable professional activities happen in the workplace, not in the classroom setting. Am J Pharm Educ. 2021;85(5):8536. doi:10.5688/ajpe8536Check out the full library of Preceptor By DesignTM courses available for preceptors on the CEimpact website. Ask your experiential program director or residency program director if you are a member so that you can access it aFollow CEimpact on Social Media:LinkedInInstagram

We talk with SCCA Hall of Fame race car driver Randy Pobst. From his racing origins in a Mk1 VW Rabbit, to his 2 wins at the 24 Hours of Daytona, and his personal car collection – including his Smokey and the Bandit Trans Am and Flyin' Moose Volvo 740.  To start, we'll dive into Randy's racing experience: factory contracts with Porsche, Mazda, Volvo, and Toyota. Winning the 24 Hours of Daytona not once, but twice, and his 2015 induction into the SCCA Hall of Fame. We'll cover his exploits at Thunderhill, VIR, Road Atlanta, Laguna Seca, Daytona, Pikes Peak, Sonoma, Lime Rock, Willow Springs, and more!  From humble origins in a Mk1 VW Golf (no, not a GTI), to a factory-backed FX16 Toyota Corolla, to setting a Laguna Seca lap record in a McLaren Senna. Randy even worked on the set of 2 Fast 2 Furious as a driving instructor for the film's stars: Paul Walker, Tyrese Gibson, and Devon Aoki – to name a few.  Randy eventually met Jason while filming an uncooperative Cayman GT4 for Motor Trend, and, despite a rocky start when Jason unexpectedly flung a Range Rover off track while racing Randy in an Alfa Romeo 4C, the two teamed up again to film multiple Ultimate Drag Race, Lap Battle and ICONS episodes for Hagerty. The whole gang laments some of the most irritating modern car tech: excessively bright headlights, lights that are somehow off at night, ABS systems that fully shut down when traveling backwards, AEB overreach, and EPAS systems that completely ruin a car's limit handling by curtailing the driver's ability to quickly catch a slide (like the Shelby GT350 Randy repeatedly spun and Jason crinkled at Willow Springs – not to mention the Unplugged Performance Tesla Model 3 Randy famously wrecked at Pikes Peak).  Speaking of handling, Randy divulges his dislike of twitchy cars like the Jaguar F-Type R and XJ, the KTM X-Bow, and Ariel Atom. Jason on the other hand loves an ass-y car like the V12 Vantage S, but says the Lotus Exige V6 Cup was so tail-happy it was uncontrollable. The Porsche Carrera GT is somewhere in the middle with mixed reviews and experience all around. While on the topic of handling dynamics, Randy tells us his secret plan to invent a fix for the C8 Corvette's trailing throttle oversteer. He also gives praise to Porsche's Lars Kern for his work on the latest crop of RS products – which may or may not be Randy's favorite track cars of all time out of the box, alongside the 2014 Porsche 911 50th Anniversary Edition. All of which receive top marks on Randy's understeer spectrum, and are polar opposites of the likes of a 1960s Cadillac.  We'll touch on Randy's personal car collection as well, which includes a Volvo 740 sedan and wagon, his 1977 Pontiac Trans Am “Randit” (and its oil starvation woes), Toyota Tundra tow vehicle, VW Karmann Ghia and early Tesla Model S.  Plus, Derek invents a new phrase for “road rage”, Randy bitch slaps cars out of his way, and also beautifully sings Primus' Wynona's Big Brown Beaver. Learn more about your ad choices. Visit megaphone.fm/adchoices

Recursos emprendimiento, formación, intraemprendimiento, marketing online y lean startup: Club ágiles https://innokabi.com/club-agiles/ Libro "30 errores que matarán tu negocio" https://innokabi.com/libro-30-errores-que-mataran-tu-negocio/ Curso Lean Startup Innokabi https://cursoleanstartup.innokabi.com/ Suscripción Newsletter Innokabi https://innokabi.com/ ▬▬▬▬ INFO GENERAL ▬▬▬▬▬ ► DESCRIPCIÓN: Me alegro que hayas decidido acompañarnos una semana más en el podcast de Innokabi. Soy Alfonso Prim y quiero ayudarte a lanzar tu marca, producto o servicio con éxito empleando lean startup y las herramientas de marketing online más interesantes y experiencias de otros emprendedores que ya lo han conseguido. ▬▬▬▬▬ CONTENIDO ▬▬▬▬▬ ► DESCRIPCIÓN EPISODIO: En este episodio, nos acompaña Aitor Epas, guitarrista, creador de contenido en YouTube y emprendedor digital. Aitor ha logrado construir una sólida comunidad online gracias a su canal de guitarra y ha lanzado múltiples negocios, desde infoproductos educativos hasta una agencia digital. Además, comparte estrategias avanzadas para triunfar en YouTube, escalar negocios online y aplicar el lean startup para validar ideas. Aitor también hablará sobre cómo gestionar tiempo y recursos al combinar negocios online y offline, como su academia de guitarra y otros proyectos de éxito. ► MARCAS DE TIEMPO: 00:50 Introducción de Aitor Epas y su trayectoria como guitarrista. 02:30 Cómo empezó en YouTube y el éxito de su canal. 06:15 Validar ideas con lean startup y vender cursos. 10:45 Consejos para crecer en YouTube y captar audiencia. 15:30 Marketing digital: estrategias y lecciones aprendidas. 20:10 Gestionar negocios online y offline con éxito. 25:45 Cómo construir comunidad y fidelizar clientes. 30:20 Recomendaciones de Aitor para emprendedores. 35:50 Conclusiones y visión de futuro de Aitor. ▬▬▬▬ REFERENCIAS Y ENLACES ▬▬▬▬ Dónde encontrar a Aitor Epas: ► Web ► https://aitorepasguitar.com ► Youtube ► AitorEpasGuitar Recomendaciones de Aitor: ► Libro ► Bitcoin con rigor ► https://amzn.to/3CxZrcK ► Podcast ► Spicy Fortuna Si te gusta el Podcast de Innokabi por favor no olvides darle al ME GUSTA, dejarme un comentario en tu plataforma de podcasts favorita, y registrarte en la newsletter de Innokabi donde comparto experiencias, ideas de negocio y consejos sobre emprendimiento y marketing online: BLOG INNOKABI https://www.innokabi.com/blog/

In this episode, Adam is joined by two med ed heavyweights, Dr. Shiphra Ginsburg and Dr. David Taylor, who discuss their views on CBME in Canada in front of a live audience of medical educators. In Part 1 of this lively discussion, our guests discuss whether using EPAs as the unit of measurement in CBME makes sense as well as the challenge of differentiating signal from noise in an assessment environment with so much data.   Length of Episode: 40 minutes   Resources to check out :  Szulewski, A., Braund, H., Dagnone, D. J., McEwen, L., Dalgarno, N., Schultz, K. W., & Hall, A. K. (2023). The assessment burden in competency-based medical education: how programs are adapting. Academic Medicine, 98(11), 1261-1267.  Schumacher DJ, Cate OT, Damodaran A, Richardson D, Hamstra SJ, Ross S, Hodgson J, Touchie C, Molgaard L, Gofton W, Carraccio C; ICBME Collaborators. Clarifying essential terminology in entrustment. Med Teach. 2021 Jul;43(7):737-744. doi: 10.1080/0142159X.2021.1924365. Epub 2021 May 14. PMID: 33989100.  Contact us: keylime@royalcollege.ca   Follow: Dr. Adam Szulewski https://x.com/Adam_Szulewski  

*Corn basis is high for Texas cattle feeders.  *Texas peanut production is growing.  *The Texas Animal Health Commission is looking for areas of the state that have a veterinary shortage.*A very big annual ag event is about to take place in Amarillo.  *Nearly a dozen ag organizations are weighing in on the EPAs proposed rodenticide strategy.  *The meat industry is not happy with the new proposed dietary guidelines, which recommends eating less meat.  *The fall fair season impacts communities all over Texas.  *Storing hay properly can save time and money.  

Faculty in a Family Nurse Practitioner program integrated entrustable professional activities (EPAs) that aligned with the American Association of Colleges of Nursing Essentials and National Organization of Nurse Practitioner Faculties Core NP Competencies into their clinical assessment tool. Student performance expectations at different points in the program were outlined. Students documented each time they performed an EPA during clinical experiences. Drs. Angel Anthamatten and Courtney Pitts discuss this initiative and outcomes in the podcast. Read the full article (it is open access).  

*Texas Panhandle ranchers continue to rebuild fences destroyed by the spring wildfires.  *There is more corn and grain sorghum in storage in Texas this year.  *East Texas cattle producers are feeding hay early due to drought.*Texas High Plains corn farmers had an unexpected visitor in their fields this year. *The American Farm Bureau Federation is urging farmers, ranchers and applicators to pay attention to the EPAs new herbicide and insecticide strategies. *Fall is bringing dryer conditions to Texas as harvest wraps up.*Farmers in the Rolling Plains are focused on economic issues.*Ulcers are common in performance horses.  

- What could impress Texans fans?? - Washed, Watched, Wednesday! Aaron Rodgers is Washed! - Epas! What are they? What's good? What isn't? - Deshaun Watson worst quarterback for the Browns 2 years in a row.

Professor Joseph Allen directs the Healthy Buildings Program at Harvard Chan School of Public Health. His expertise extends far beyond what makes buildings healthy. He has been a leading voice and advocate during the Covid pandemic for air quality and ventilation. He coined the term “Forever Chemicals” and has written extensively on this vital topic, no less other important exposures, which we covered In our wide-ranging conversation. You will see how remarkably articulate and passionate Prof Allen is about these issues, along with his optimism for solutions.A video snippet of our conversation: buildings as the 1st line of defense vs respiratory pathogens. Full videos of all Ground Truths podcasts can be seen on YouTube here. The audios are also available on Apple and Spotify.Transcript with External Links and Links to AudioEric Topol (00:00:06):Well, hello. It's Eric Topol from Ground Truths and I am just delighted to have with me, Joseph Allen from the Harvard School of Public Health, where he directs the Healthy Buildings Program that he founded and does a whole lot more that we're going to get into. So welcome, Joe.Joseph Allen (00:00:24):Thanks. It's great to be here. I appreciate the invitation.Joe Allen's Background As A DetectiveEric Topol (00:00:28):Well, you have been, as I've learned, rocking it for many years long before the pandemic. There's quite a background about you having been a son of a homicide detective, private eye agency, and then you were going to become an FBI agent. And the quote from that in the article that's the Air Investigator is truly a classic. Yeah, you have in there, “I guarantee I'm the only public health student ever to fail an FBI lie detector polygraph in the morning and start graduate school a few hours later.” That's amazing. That's amazing.Joseph Allen (00:01:29):All right. Well, you've done your deep research apparently. That's good. Yeah, my dad was a homicide detective and I was a private investigator. That's no longer my secret. It's out in the world. And I switched careers and it happened to be the day I took the polygraph at the FBI headquarters in Boston, was the same day I started graduate studies in public health.Sick vs Healthy Buildings (Pre-Covid)Eric Topol (00:01:53):Well, you're still a detective and now you're a detective of everything that can hurt us or help us environmentally and my goodness, how grateful we are that you change your career path. I don't know anyone who's had more impact on buildings, on air, and we're going to get into chemicals as well. So if we go back a bit here, you wrote a book before the pandemic, talk about being prescient. It's called Healthy Buildings: How Indoor Spaces Can Make You Sick - or Keep You Well with John Macomber, your co-author. What was it that gave you the insight to write a book before there was this thing called Covid?Joseph Allen (00:02:41):Yeah, well, thanks for making the connection too, my past career to current career. For many years, I thought there wasn't a connection, but I agree. There's actually a lot of similarities and I also am really appreciative. I am lucky I found the field of Public Health, it's clearly where I belong. I feel like I belong here. It's a place to make an impact that I want to make in my career. So yeah, the Healthy Buildings book, we started writing years before the pandemic and was largely motivated by, I think what you and others and other people in my field have known, is that buildings have an outsized impact on our health. Yet it's not something that comes to the forefront when you ask people about what matters for their health. Right, I often start presentations by asking people that, what constitutes healthy living? They'll say, I can't smoke, I have to eat well.(00:03:30):I have to exercise. Maybe they'll say, outdoor pollution's bad for you. Very few people, if any, will say, well, the air I breathe inside my building matters a lot. And over the years I had started my public health career doing forensic investigations of sick buildings. People really can get sick in buildings. It can be anything from headaches and not being able to concentrate all the way to cancer clusters and people dying because of the building. And I've seen this in my career, and it was quite frustrating because I knew, we all knew how to design and operate buildings in a way that can actually keep people healthy. But I was frustrated like many in my field that it wasn't advancing. In other words, the science was there, but the practice wasn't changing. We were still doing things the wrong way around ventilation, materials we put in our building, and I would lecture over and over and give presentations and I decided I want to try something new.(00:04:22):I do peer-reviewed science. That's great. I write pieces like you for the public, and I thought we'd try a longer form piece in a book, and it's published by Harvard Press. John Macomber for those who know is a professor at Harvard Business School who's an expert in real estate finance. So he'd been talking about the economic benefits of healthier buildings and some hand waving as he describes around public health. I've been talking about the public health benefits and trying to wave an economic argument. We teamed up to kind of use both of our strengths to, I hope make a compelling case that buildings are good for health and they're also just good business. In other words, try to break down as many barriers as we can to adoption. And then the book was published right as Covid hit.Indoor Air Quality and CognitionEric Topol (00:05:05):Yeah. I mean, it's amazing. I know that typically you have to have a book almost a year ahead to have it in print. So you were way, way ahead of this virus. Now, I'm going to come back to it later, but there were two things beyond the book that are pretty striking about your work. One is that you did all these studies to show with people wearing sensors to show that when the levels of CO2 were high by sensors that their cognition indoors was suffering. Maybe you could just tell us a little bit about these sensors and why aren't we all wearing sensors so that we don't lose whatever cognitive power that we have?Joseph Allen (00:05:56):Well, yeah. First I think we will start having these air quality sensors. As you know, they're starting to become a lot more popular. But yeah, when I first joined the faculty full-time at Harvard, one of the first studies I conducted with my team was to look at how indoor air quality influences cognitive function. And we performed a double-blind study where we took people, office workers and put them in a typical office setting. And unbeknownst to them, we started changing the air they were breathing in really subtle ways during the day, so they didn't know what we were doing. At the end of the day, we administered an hour and a half long cognitive function battery, and like all studies, we control for things like caffeine intake, baseline cognitive performance, all the other factors we want to account for. And after controlling for those factors in a double-blind study, we see that indoor air quality, minor improvements to indoor air quality led to dramatic increases in cognitive function test scores across domains that people recognize as important for everyday life.(00:06:59):How do you seek out and utilize information? How do you make strategic decisions? How do you handle yourself during a crisis and importantly recover after that crisis? I don't mean the world's ending crisis. I mean something happens at work that's stressful. How do you handle that and how do you respond? Well, it turns out that amongst all the factors that influence how we respond there, indoor air quality matters a lot. We call that study the COGfx Study for cognitive function. We replicated it across the US, we replicated it across the world with office workers around the world, and again, always showing these links, the subtle impact of indoor air quality on cognitive function performance. Now, that also then starts to be the basis for some of the economic analysis we perform with my colleague at Harvard Business School. We say, well, look, if you perform this much better related to air quality, what would happen if we implemented this at scale in a business?(00:07:51):And we estimate that there are just massive economic gains to be had. On a per person basis, we found and published on this, that's about $6,000 to $7,000 per person per year benefit across a company. It could lead to 10% gains to the bottom line performance of the company. And again, I'm a public health professor. My goal is to improve people's health, but we add a lens, mental health, brain health is part of health, and we add the economic lens to say, look, this is good for a worker of productivity and the costs are downright trivial when you compare it against the benefits, even just including the cognitive function benefits, not even including the respiratory health benefit.Eric Topol (00:08:33):And I mean, it's so striking that you did these studies in a time before sensors were, and they still are not widely accepted, and it really helped prove, and when we start to fall asleep in a group session indoors, it may not just be because we didn't have enough sleep the night before, right.Joseph Allen (00:08:56):It's funny you say that. I talk about that too. It's like, do we actually need the study to tell us to quantify what we've all experienced these bad conference rooms, you get tired, you can't concentrate, you get sleepy while you're driving your car. Yeah, a whole bunch of other factors. Maybe the speaker's boring, but a key factor is clearly indoor air quality and things like good ventilation, the chemical load in the space are all contributing.Eric Topol (00:09:20):Yeah. No, it's pretty darn striking. Now we're going to get into the pandemic, and this of course is when your work finally crystallized that you've been working on this for years, and then finally your collaboration with some of the aerosol experts. It was a transdisciplinary synergy that was truly extraordinary. And when you were on 60 Minutes last October, you said, “Think about the public health gains we've made over the past hundred years. We've made improvements to water quality, outdoor air pollution, our food safety, we've made improvements to sanitation: absolute basics of public health. Where has indoor air been in that conversation?” You brought it to us. I mean, you led the Lancet Commission on this. You've done a White House Summit keynote. You had a lot of influence. Why did it take us to finally wake up to this issue that you've been working on for years?Covid is Airborne, DenialJoseph Allen (00:10:31):Yeah. Well, I appreciate that, but I also liked what you started with. I mean, there's been a lot of us pulling on this, and I think one of the magical moments, if you could say that when the pandemic happened was that it forced these collaborations and forced a lot of us in our field to be a bit more vocal. And even that comment about the gains we made in public health, that comes from an article that we co-authored with 40 plus scientists around the world in science, trying to drive home the point that we've ignored one of the key factors that determines our health. We were all frustrated at the beginning of the pandemic. The first piece I wrote was January 2020, talking about healthy buildings as the first line of defense, airborne spread, ventilation, filtration. I could not get it published. I could not get it published.(00:11:20):So I moved it to an international paper. I wrote it in the Financial Times in early February, but it wasn't until mid-March that the Times took my piece on this airborne spread buildings ventilation. At the same time, we know people like Linsey Marr, Rich Corsi, many others, Shelly Miller out there publishing, doing the fundamental research, all trying to elevate, and I think we started to find each other and say, hey, someone's trying to hit the medical journals. We're not landing there. I'm trying to hit the Times, and we're not landing there. We're trying to get the reporters to pay attention. It's not landing there. Let's team up. Let's write these joint pieces. And I think what happened was you saw the benefit of the collective effort and interdisciplinary expertise, right? We could all start to come together, start instead of having these separate voices, a little bit of a unified voice despite important scientific minor disagreements, but start to say, hey, we started elevate each other and said, this is really important. It's the missing component of the messaging in the early days of the pandemic, and to know how to defend yourself.Eric Topol (00:12:20):Well, I think a lot of people think the big miss, and I know you agree, was the lack of recognition of aerosol transmission instead of just liquid droplets. But what you brought to this was really your priors on the buildings themselves and the ventilation systems and air quality that was highly, I mean, critical to it isn't just the aerosol, it's obviously how buildings are set up. Now, there's an amazing piece of course that appeared in the summer of 2021 called the Air Investigator, which profiled you, and in it brings up several things that finally are, we're starting to get our act together. I mean, ultimately there was in May 2023 years later, the CDC says, we're going to do something about this. Can you tell us what was this very distinct new path that the CDC was at least saying? And also couple that with whatever action if or not action has been taken.Joseph Allen (00:13:33):Yeah. So there really was a monumental shift that took, it was years in development, but we finally won the argument, collectively that airborne spread was the dominant mode of transmission. Okay, we got that. Then the question is, well, what changes? Do we actually get guidance here? And that took a little bit longer. I give Rochelle Walensky a lot of credit when she came into the CDC, we talked with her about this. That's when you start to first see ventilation starts showing up and the guidance, including guidance for schools. So I think that was a big win, but still no one was willing to set an official target or standard around higher ventilation rates. So that's important. Early in the pandemic, some people started to hear a message, yes, ventilation is important. What's the obvious next question, well, how much, what do I need? So in the summer of 2020, actually Shelly Miller and I collaborated on this.(00:14:23):We published some guidance on ventilation targets for schools. We said four to six air changes per hour (ACH) and target that. Well, it wasn't until 2023, spring of 2023 that you mentioned that CDC published target ventilation rates, and they went with five air changes per hour, which is right where we were talking about in summer 2020. It's what the Lancet of COVID-19 Commission adopted, but it's momentous in this way. It's the first time in CDCs history they've ever published a ventilation rate target for health. Now, I know this seems slow at the time, and it was, but if we think about some of the permanent gains that will come out of the pandemic. Pandemic changes society and science and policy and practice this, we are never going back. Now buildings will be a first line of defense for respiratory pathogens going forward that can no longer be ignored. And now we have the published target by CDC. That's a big deal because it's not just a recognition, but there's actually something to shoot for out there. It's a target I happen to like, I think there are differences between different scientists, but ultimately we've lifted the floor and said, look, we actually have to raise ventilation rates and we have something to shoot for. The public needed that kind of guidance a lot earlier, of course, but it was a big deal that it happened. It's just too bad it took until spring 2023.Eric Topol (00:15:46):Yeah, I certainly agree that it was momentous, but a year plus later, has there been any change as a result of this major proclamation, if you will?Joseph Allen (00:15:59):Well, I actually see a lot of change from a practitioner level, but I want to talk about it in two aspects. I see a lot of schools, universities, major companies that have made this shift. For example, in the 60 Minutes piece, I talk that I advised Amazon and globally they're measuring indoor air quality with real-time sensors in their buildings. I've worked with hundreds of school districts that have made improvements to indoor air quality. I know companies that have shifted their entire approach to how they design and operate their buildings. So it's happening. But what really needs to happen, Eric, if this movement is going to benefit everyone, is that these targets need to be codified. They need to go into building codes. It can't just be, oh, I've heard about this. So I made the decision. I have the resources and the money to make this improvement.(00:16:44):To create a healthy building or a healthy school, we need to be sure this gets built into our code. So it just becomes the way it's done. That is not happening. There are some efforts. There are some bills at the national level. Some states are trying to pass bills, and I have to say, this is why I'm optimistic. It feels very slow. I'm as frustrated as anybody. I wanted this done before the pandemic. As soon as the pandemic hit, we saw it. We knew what we needed to get done. It didn't happen. But if we think about the long arc here and the public health gains we're actually, it's remarkable to me that we actually have bills being introduced around indoor air quality that ASHRAE has set a new health focused target for the first time really in their history. CDC, first time. New buildings going up in New York City designed to these public health targets. That's really different. I've been in this field for 20 plus years. I've never seen anything like it. So the pace is still slow, but it really is happening. But it has to reach everybody, and the only way that's going to happen is really this gets into building codes and performance standards.The Old Efficient Energy BuildingsEric Topol (00:17:52):Yeah. Well, I like your optimistic perspective. I do want to go back for a second, back decades ago there was this big impetus to make these energy efficient buildings and to just change the way the buildings were constructed so that there was no leak and it kind of set up this problem or exacerbated, didn't it?Joseph Allen (00:18:19):Yeah. I mean, I've written about this a lot. I write in the book our ventilation standards, they've been a colossal mistake. They have cost the public in terms of its health because in the seventies, we started to really tighten up our building envelopes and lower the ventilation rates. The standards were no longer focused on providing people with a healthy indoor space. As I write in the book, they were targeted towards minimally acceptable indoor air quality, bare minimums. By the way that science is unequivocal, is not protective of health, not protective against respiratory pathogens, doesn't promote good cognitive function, not good for allergies. These levels led to more illness in schools, more absences for teachers and students, an absolute disaster from a public health standpoint. We've been in this, what I call the sick building era since then. Buildings that just don't bring in enough clean outdoor air. And now you take this, you have a building stock for 40 years tighter and tighter and tighter bumps up against a novel virus that spread nearly entirely indoors. Is it any wonder we had, the disaster we had with COVID-19, we built these bills. They were designed intentionally with low ventilation and poor filtration.Optimal Ventilation and FiltrationEric Topol (00:19:41):Yeah. Well, it's extraordinary because now we've got to get a reset and it's going to take a while to get this done. We'll talk a bit about cost of doing this or the investment, if you will, but let's just get some terms metrics straight because these are really important. You already mentioned ACH, the number of air changers per hour, where funny thing you recommended between four and six and the CDC came out with five. There's also the minimum efficiency reporting value (MERV). A lot of places, buildings have MERV 8, which is insufficient. We need MERV 13. Can you tell us about that?Joseph Allen (00:20:23):Yeah, sure. So I think when we think about how much, you have two ways to capture these respiratory particles, right? Or get rid of them. One is you dilute them out of the building or you capture them on filters. You can inactivate them through UV and otherwise. But let's just stay on the ventilation and filtration side of this. So the air changing per hour is talking about how often the air is change inside. It's an easy metric. There are some strengths to it, there's some weaknesses, but it's intuitive and I'll you some numbers so you can make sense of this. We recommended four to six air changes per hour. Typical home in the US has half an air change per hour. Typical school designed to three air changes per hour, but they operate usually at one and a half. So we tried to raise this up to four, five, or six or even higher. On the filtration side, you mentioned MERV, right? That's just a rating system for filters, and you can think about it this way. Most of the filters that are in a building are cheap MERV 8 filters, I tend to think of them as filters that protect the equipment. A MERV 13 filter may capture 80 or 90% of particles. That's a filter designed to protect people. The difference in price between a MERV 8 and a MERV 13 is a couple of bucks.(00:21:30):And a lot of the pushback we got early in the pandemic, some people said, well, look, there's a greater resistance from the better filter. My fan can't handle it. My HVAC system can't handle it. That was nonsense. You have low pressure drop MERV 13 filters. In other words, there really wasn't a barrier. It was a couple extra bucks for a filter that went from a MERV 8 might capture 20 or 30% to a filter, MERV 13 that captures 80 or 90% with very little, if any impact on energy or mechanical system performance. Absolute no-brainer. We should have been doing this for decades because it also protects against outdoor air pollution and other particles we generate indoors. So that was a no-brainer. So you combine both those ventilation filtration, some of these targets are out there in terms of air change per hour. You can combine the metric if we want to get technical to talk about it, but basically you're trying to create an overall amount of clean air. Either you bring in fresh outdoor air or you filter that air. It really is pretty straightforward, but we just didn't have some of these targets set and the standards we're calling for these minimum acceptable levels, which we're not protective of health.Eric Topol (00:22:37):So another way to get better air quality are these portable air cleaners, and you actually just wrote about that with your colleagues in the Royal Society of Chemistry, not a journal that I typically read, but this was an important article. Can you give us, these are not very expensive ways to augment air quality. Can you tell us about these PACs ?Joseph Allen (00:23:06):These portable air cleaners (PACs), so the same logic applies if people say, well, I can't upgrade my system. That's not a problem for very low cost, you could have, these devices are essentially a fan and a filter, and the amount of clean air you get depends on how strong the fan is and how good the filter is. Really pretty simple stuff here, and you can put one of these in a room if it's sized right. My Harvard team has built tools to help people size this. If you're not quite sure how to do it, we have a technical explainer. Really, if you size it right, you can get that four, five or six air changes per hour, very cheap and very quickly. So this was a tool I thought would be very valuable. Rich Corsi and I wrote about this all through the summer of 2020 to talk about, hey, a stop gap measure.(00:23:50):Let's throw out some of these portable air cleaners. You increase the air changes or clean air delivery pretty effectively for very low cost, and they work. And now the paper we just published in my team a couple of days ago starts to advance this more. We used a CFD model, so computational fluid dynamics. Essentially, you can look at the tracers and the airflow patterns in the room, and we learn a couple things that matter. Placement matters, so we like it in the center of the room if you can or as close as possible. And also the airflow matters. So the air cleaners are cleaning the air, but they're also moving the air, and that helps disperse these kind of clouds or plumes when an infected person is breathing or speaking. So you want to have good ventilation, good filtration. Also a lot of air movement in the space to help dilute and move around some of these respiratory particles so that they do get ventilated out or captured in a filter.Eric Topol (00:24:40):Yeah. So let me ask you, since we know outdoors are a lot safer. If you could do all these things indoors with filtration, air changing the quality, can you simulate the outdoors to get rid of the risk or markedly reduce the risk of respiratory viruses like SARS-CoV-2 and others?Joseph Allen (00:25:04):Yeah, you can't drop it to zero. There's no such thing as zero risk in any of these environments. But yeah, I think some of the estimates we've seen in my own team has produced in the 60-70% reduction range. I mean, if you do this right with really good ventilation filtration, you can drop that risk even further. Now, things like distancing matter, whether or not somebody's wearing a mask, these things are all going to play into it. But you can really dramatically drop the risk by handling just the basics of ventilation and filtration. And one way to think about it is this, distance to the infector still matters, right? So if you and I are speaking closely and I breathe on you, it's going to be hard to interrupt that flow. But you can reduce it through good ventilation filtration. But really what it's doing also is preventing super spreading events.(00:25:55):In other words, if I'm in the corner of a room and I'm infectious and you're on the other side, well if that room is sealed up pretty good, poor ventilation, no filtration, the respiratory aerosols are going to build up and your risk is going to increase and we're in there for an hour or two, like you would be in a room or office and you're exposed to infectious aerosol. With good ventilation filtration, those respiratory particles don't have a chance to reach you, or by the time they do, they're much further diluted. Linsey Marr I think was really great early in the pandemic by talking about this in terms of cigarette smoke. So a small room with no ventilation filtration, someone smoking in the corner, yeah, it's going to fill up over time with smoke you're breathing in that secondhand smoke. In a place with great ventilation filtration, that's going to be a lot further reduced, right? You're not going to get the buildup of the smoke and smoke particles are going to operate similarly to respiratory particles. So I think it's intuitive and it's logical. And if you follow public health guidance of harm reduction, risk reduction, if you drop exposure, you drop risk.(00:26:58):The goal is to reduce exposure. How do we do that? Well, we can modify the building which is going to play a key role in exposure reduction.Eric Topol (00:27:06):Now, to add to this, if I wear a sensor or have a sensor in the room for CO2, does that help to know that you're doing the right thing?Joseph Allen (00:27:17):Yeah, absolutely. So people who are not familiar with these air quality sensors. They're small portal air quality sensors. One of the things they commonly measure is carbon dioxide. We're the main source of CO2 inside. It's a really good indicator of ventilation rate and occupancy. And the idea is pretty simple. If the CO2 is low, you don't have a buildup of particles from the respiratory tract, right? And CO2 is a gas, but it's a good indicator of overall ventilation rate. This room I'm in right now at the Harvard School of Public Health has air quality sensors. We have this at Harvard Business School. We have it at the Harvard Health Clinics. Many other places are doing it, Boston Public schools have real-time air quality monitors. Here's the trick with CO2. So first I'll say we have some guidance on this at the Harvard Healthy Buildings page, if people want to go look it up, how to choose an air quality sensor, how to interpret CO2 levels.Carbon Dioxide Levels(00:28:04):But here's a way to think about it. We generally would like to see CO2 levels less than 800 parts per million. Historically, people in my field have said under 1,000 is okay. We like to see that low. If your CO2 is low, the risk is low. If your CO2 is high, it doesn't necessarily mean your risk is high because that's where filtration can come in. So let me say that a little bit better. If CO2 is low, you're diluting enough of the respiratory particles. If it's high, that means your ventilation is low, but you might have excellent filtration happening. Either those MERV 13 filters we talked about or the portable air cleaners. Those filters don't capture CO2. So high CO2 just means you better have a good filter game in place or the risk is going to be high. So if you CO2 is low, you're in good shape. If it's high, you don't quite know. But if you have bad filtration, then the risk is going to be much higher.Eric Topol (00:29:01):I like that 800 number because that's a little lower than some of the other thresholds. And why don't we do as good as we can? The other question about is a particulate matter. So we are worried about the less than 5 microns, less than 2.5 microns. Can you tell us about that and is there a way that you can monitor that directly?Joseph Allen (00:29:25):Sure. A lot of these same sensors that measure CO2 also measure PM 2.5 which stands for particular matter. 2.5 microns is smaller, one of the key components of outdoor air pollution and EPA just set new standards, right? WHO has a standard for 5 microgram per cubic meter. EPA just lowered our national outdoor limit from 12 to 9 microgram per cubic meter. So that's a really good indicator of how well your filters are working. Here again, in a place like this or where you are, you should see particle levels really under 5 microgram per cubic meter without any major source happening. What's really interesting about those like the room I'm in now, when the wildfire smoke came through the East coast last year, levels were extraordinary outside 100, 200, 300 microgram per cubic meter. But because we have upgraded our filters, so we use MERV 15 here at Harvard, the indoor levels of particles stayed very low.(00:30:16):So it shows you how the power of these filters can actually, they do a really good job of capturing particles, whether it be from our lungs or from some other source. So you can measure this, but I'll tell you what's something interesting, if you want to tie it into our discussion about standards. So we think about particles. We have a lot of standards for outdoor air pollution. So there's a national ambient air quality standard 9 microgram per cubic meter. We don't have standards for indoor air quality. The only legally enforceable standard for indoor particles is OSHA's standard, and it's 5,000 microgram per cubic meter 5,000.(00:30:59):And it's absurd, right? It's an absurdity. Here we are EPAs, should it be 12, should it be 9, or should it be 8? And for indoors, the legally enforceable limit for OSHA 5,000. So it points to the big problem here. We talked about earlier about the need for these standards to codify some of this. Yes, we have awareness from the public. We have sensors to measure this. We have CDC now saying what we were saying with the Lancet COVID-19 Commission and elsewhere. This is big movement, but the standards then need to come up behind it and get into code and new standards that are health focused and health based. And we have momentum, but we can't lose it right now because it's the first time in my career I felt like we're on the cusp of really getting this and we are so close. But of course it's always in danger of slipping through our fingers.Regulatory Oversight for AirEric Topol (00:31:45):Well, does this have anything to do with the fact that in the US there's no regulatory oversight over air as opposed to let's say Japan or other places?Joseph Allen (00:31:57):Yeah, I mean, we have regulatory oversight of outdoor air. That's EPA. There's a new bill that was introduced to give EPA more resources to deal with indoor air. EPA has got a great indoor air environments division, but it doesn't have the legally enforceable mandate or statute that we have for outdoor. So they'd give great guidance and have for a long time. I really like that group at EPA, but there's no teeth behind this. So what we have is worker health protections at OSHA to its own admission, says its standards are out of date. So we need an overhaul of how we think about the standards. I like the market driven approach. I think that's being effective, and I think we can do it from voluntary standards that can get adopted into code at the municipal level. I think that's a real path. I see it happening. I see the influence of all this work hitting legislators. So that's where I think the most promising path is for real change.The Risks of Outdoor Air Pollution Eric Topol (00:33:03):Yeah, I think sidestepping, governmental teeth, that probably is going to be a lot quicker. Now, before we get to the cost issue, I do want to mention, as you know very well, the issue of air pollution in Science a dedicated issue just a few weeks ago, it brought up, of course, that outdoor air pollution we've been talking about indoor is extraordinary risk for cancer, dementia, diabetes, I mean everything. Just everything. And there is an interaction between outdoor pollution and what goes on indoor. Can you explain basically reaffirm your concern about particulate matter outdoors, and then what about this interaction with what goes on indoors?Joseph Allen (00:33:59):Yeah, so it's a great point. I mean, outdoor pollution has been one of the most studied environmental pollutants we know. And there's all of these links, new links between Alzheimer's, dementia, Parkinson's disease, anxiety, depression, cardiovascular health, you named it, right? I've been talking about this and very vocal. It's in the book and elsewhere I called the dirty secret of outdoor air pollution. The reality is outdoor air pollution penetrates indoors, and the amount depends on the building structure, the type of filters you have. But let's take an infiltration value of say 50%. So you have a lot of outdoor air pollution, maybe half of that penetrates inside, so it's lower, the concentration is lower, but 90% of the breaths you take are indoor. And if you do the math on it, it's really straightforward. The majority of outdoor air pollution you breathe happens inside.(00:34:52):And people, I think when they hear that think, wait, that can't be right. But that's the reality that outdoor pollution comes inside and we're taking so many breaths inside. Your total daily dose of outdoor air pollution is greater from the time you spend inside. I talk about this all the time. You see any article about outdoor air pollution, what's the cover picture? It's someone outside, maybe they're wearing a mask you can't really see. It's smoky hazy. But actually one of the biggest threats is what's happening inside. The nice thing here, again, the solutions are pretty simple and cost-effective. So again, upgrade from MERV 8 to MERV 13, a portable air cleaner. We are just capturing particles on a filter basic step that can really reduce the threat of outdoor air pollution inside. But it's ignored all the time. When the wildfire smoke hit New York City. New York City's orange, I called colleagues who are in the news business.(00:35:48):We have to be talking about the indoor threat because the guidance was good, but incomplete. Talk about Mayor Adams in New York City. Go inside, okay, that's good advice. And go to a place that has good filtration or they should have been giving out these low cost air cleaners. So just going inside isn't going to protect your lungs unless you're actually filtering a lot more of that air coming in. So trying to drive home the point here that actually we talk about these in silos. Well, wildfire smoke and particles, Covid and respiratory particles, we're all talking about these different environmental issues that harm our health, but they're all happening through or mediated by the building performance. And if we just get the building performance right, some basics around good ventilation, good filtration, you start to address multiple threats simultaneously. Outdoor air pollution, wildfire smoke, allergens, COVID-19, influenza, RSV, better cognitive function performance, anxiety. You start addressing the root cause or one of the contributors and buildings we can then start to leverage as a true public health tool. We have not taken advantage of the power of buildings to be a true public health tool.Eric Topol (00:36:59):Oh, you say it so well, and in fact your Table on page 44 in Healthy Buildings , we'll link it because it shows quantitatively what you just described about outdoor and indoor cross fertilization if you will. Now before leaving air pollution outdoors, indoors, in order for us to affect this transformation that would markedly improve our health at the public health individual level, we're talking about a big investment. Can you put that in, you did already in some respects, but if we did this right in every school, I think in California, they're trying to mandate that in schools, in the White House, they're mandating federal buildings. This is just a little piece of what's needed. This would cost whatever trillions or hundreds of billions of dollars. What would it take to do this? Because obviously the health benefits would be so striking.What's It Gonna Cost?Joseph Allen (00:38:04):Well, I think one of the issues, so we can talk about the cost. A lot of the things I'm talking about are intentionally low cost, right? You look at the Lancet of COVID-19 Commission, our report we wrote a report on the first four healthy building strategies every building should pursue. Number one commission your building that's giving your building a tune-up. Well, guess what? That not only improves air quality, it saves energy and therefore saves money. It actually becomes cost neutral. If not provides an ROI after a couple of years. So that's simple. Increase the amount of outdoor air ventilation coming in that has an energy cost, we've written about this. Improved filtration, that's a couple bucks, really a couple bucks, this is small dollars or portable air cleaners, not that expensive. I think one of the big, and Lawrence Berkeley National Lab has written this famous paper people like to cite that shows there's $20 billion of benefits to the US economy if we do this.(00:38:59):And I think it points to one of the problems. And what I try to address in my book too, is that very often when we're having this conversation about what's it going to cost, we don't talk about the full cost benefit. In other words, we say, well, it's going to cost X amount. We can't do that. But we don't talk about what are the costs of sick buildings? What are the costs of kids being out of school for an entire year? What are the costs of hormonal disruption to an entire group of women in their reproductive years due to the material choices we make in our buildings? What are the costs to outdoor air pollution and cardiovascular disease, mental health? Because we don't have good filters in our buildings that cost a couple dollars. So in our book, we do this cost benefit analysis in the proforma in our book, we lay out what the costs are to a company. We calculate energy costs. We say these are the CapEx costs, capital costs for fixed costs and the OpEx costs for operating expenditures. That's a classic business analysis. But we factor in the public health benefits, productivity, reduced absenteeism. And you do that, and I don't care how you model it, you are going to get the same answer that the benefits far outweigh the cost by orders of magnitude.Eric Topol (00:40:16):Yeah, I want to emphasize orders of magnitude. Not ten hundred, whatever thousand X, right?Joseph Allen (00:40:23):What would be the benefit if we said we could reduce influenza transmission indoors in schools and offices by even a small percent because we improve ventilation and filtration? Think of the hospitalization costs, illness costs, out of work costs, out of school costs. The problem is we haven't always done that full analysis. So the conversation gets quickly to well, that's too much. We can't afford that. I always say healthy buildings are not expensive. Sick buildings are expensive. Totally leave human health out of that cost benefit equation. And then it warps this discussion until you bring human health benefits back in.Forever ChemicalsEric Topol (00:40:58):Well, I couldn't agree more with you and I wanted to frame this by giving this crazy numbers that people think it's going to cost to the reality. I mean, if there ever was an investment for good, this is the one that you've outlined so well. Alright, now I want to turn to this other topic that you have been working on for years long before it kind of came to the fore, and that is forever chemicals. Now, forever chemicals, I had no idea that back in 2018 you coined this term. You coined the term, which is now a forever on forever chemicals. And basically, this is a per- and polyfluoroalkyl substances (PFAS), but no one will remember that. They will remember forever chemicals. So can you tell us about this? Because this of course recently, as you know well in May in the New Yorker, there was an expose of 3M, perhaps the chief offender of these. They're everywhere, but especially they were in 3M products and continue to be in 3M products. Obviously they've been linked with all kinds of bad things. What's the story on forever chemicals?Joseph Allen (00:42:14):Yeah, they are a class of chemicals that have been used for decades since the forties. And as consumers, we like them, right? They're the things that make your raincoat repel rain. It makes your non-stick pan, your scrambled eggs don't stick to the pan. We put them on carpets for stain resistance, but they came with a real dark side. These per- and polyfluoroalkyl substances, as I say, a name only a chemist could love have been linked with things like testicular cancer, kidney cancer, interference with lipid metabolism, other hormonal disruption. And they are now a global pollutant. And one of the reasons I wrote the piece to brand them as forever chemicals was because I'm in the field of environmental health. We had been talking about these for a long time and I just didn't hear the public aware or didn't capture their attention. And part of it, I think is how we talk about some of these things.(00:43:14):I think a lot about this. Per- and polyfluoroalkyl substances, no one's going to, so the forever chemicals is actually a play on their defining feature. So these chemicals, these stain repellent chemicals are characterized by long chains of the carbon fluorine bond. And when we string these together that imparts this and you put them on top of a product that imparts the property of stain resistance, grease resistance, water resistance, but the carbon fluorine bond is the strongest in all of organic chemistry. And these chains of the carbon fluorine bond never fully break down in the environment. And when we talk in my field about persistent organic pollutants, we talk about chemicals that break down on the order of decades. Forever chemicals don't break down. They break down the order of millennia. That's why we're finding them everywhere. We know they're toxic at very low levels. So the idea of talking about forever chemicals, I wanted to talk about their foreverness.(00:44:13):This is permanent. What we're creating and the F and the C are the play on the carbon-fluorine bond and I wrote an article trying to raise awareness about this because some companies that have produced these have known about their toxicity for decades, and it's just starting the past couple of years, we're just starting to pay attention to the scale of environmental pollution. Tens of millions of Americans have forever chemicals in their drinking water above the safe limit, tens of millions. I worked as an expert in a big lawsuit for the plaintiffs that were drinking forever chemicals in their water that was dumped into the drinking water supply by a manufacturing company. I met young men with testicular cancer from drinking forever chemicals in their water. These really has escaped the public's consciousness, it wasn't really talked about. Now of course, we know every water body, we use these things in firefighting foams or every airport has water pollution.(00:45:17):Most airports do. Firefighters are really concerned about this, high rates of cancer in the firefighter population. So this is a major problem, and the cleanup is not straightforward or easy because they're now a global pollutant. They persist forever. They're hard to remediate and we're stuck with them. So that's the downside, I can talk about the positives. I try to remain an optimist or things we're doing to try to solve this problem, but that's ultimately the story. And my motivation was I just to have people have language to be able to talk about this that didn't require a degree in organic chemistry to understand what they were.Eric Topol (00:45:52):Yeah, I mean their pervasiveness is pretty scary. And I am pretty worried about the fact that we still don't know a lot of what they're doing in terms of clinical sequela. I mean, you mentioned a couple types of cancer, but I don't even know if there is a safe threshold.Joseph Allen (00:46:16):Eric, I'll tell you one that'll be really interesting for you. A colleague of mine did a famous study on forever chemicals many years ago now and found that kids with higher levels of forever chemicals had reduced vaccine effectiveness related to these chemicals. So your point is, right, a lot of times we're using these industrial chemicals. We know a couple endpoints for their affecting our bodies, but we don't know all of them. And what we know is certainly alarming enough that we know enough to know we shouldn't be using them.Eric Topol (00:46:51):And you wrote another masterful op-ed in the Washington Post, 6 forever chemical just 10,000 to go. Maybe you could just review what that was about.Joseph Allen (00:47:02):Yeah, I've been talking a lot about this issue I call chemical whack-a-mole. So forever chemical is the perfect example of it. So we finally got people's attention on forever chemicals. EPA just regulated 6 of them. Well, guess what? There are 10,000 if not many more than that. Different variants or what we call chemical cousins. Now that's important for this reason. If you think about how we approach these from a regulatory standpoint, each of the 10,000 plus forever chemicals are treated as different. So by the time EPA regulates 6, that's important. It does free up funding for cleanup and things like this. But already the market had shifted away from those 6. So in other words, in the many thousand products that still use forever chemicals, they're no longer using those 6 because scientists have told people these things are toxic years ago. So they switch one little thing in the chemical, it becomes a new chemical from a regulatory perspective.(00:47:57):But to our bodies, it's the same thing. This happens over and over. This has happened with pesticides. It happens with chemicals and nail polish. It happens in chemicals in e-cigarettes. It happens with flame retardant chemicals. I wrote a piece in the Post maybe six years ago talking about chemical whack-a-mole, and this problem that we keep addressing, these one-off, we hit one, it changes just slightly. Chemical cousin pops up, we hit that one. Five years later, scientists say, hey, the next one doesn't look good either. We're doing this for decades. It's really silly. It's ineffective, it's broken, and there are better ways to handle this going forward.Eric Topol (00:48:31):And you know what gets me, and it's like in the pharma industry that I've seen the people who run these companies like 3M that was involved in a multi-decade coverup, they're never held accountable. I mean, they know what they're doing and they just play these games that you outlined. They're still using 16,000 products, according to the New Yorker, the employee that exposed them, the whistleblower in the New Yorker article.Joseph Allen (00:48:58):That was an amazing article by Sharon Lerner talking to the people who had worked there and she uncovered that they knew the toxicity back in the seventies, and yes, they were still making these products. One of the things that I think has gotten attention of some companies is while the regulations have been behind, the lawsuits are piling up.Joseph Allen (00:49:21):The lawsuit I was a part of as an expert for that was about an $800 million settlement in favor of the plaintiffs. A couple months later is another one that was $750 million. So right there, $1.5 billion, there's been several billion dollars. This has caught the attention of companies. This has caught the attention of product manufacturers who are using the forever chemicals, starting to realize they need to reformulate. And so, in a good way now, that's not the way we should be dealing with this, but it has started to get companies to wake up that maybe they had been sleeping on it, that this is a major problem and actually the markets have responded to it.Eric Topol (00:50:02):Well, that's good.Joseph Allen (00:50:03):Because these are major liabilities on the books.Eric Topol (00:50:05):Yeah, I mean, I think what I've seen of course with being the tobacco industry and I was involved with Vioxx of course, is the companies just appeal and appeal and it sounds really good that they've had to pay $800 million, but they never wind up paying anything because they basically just use their muscle and their resources to appeal and put it off forever. So I mean, it's one way to deal with it is a litigation, but it seems like that's not going to be enough to really get this overhauled. I don't know. You may be more sanguine.Joseph Allen (00:50:44):No, no, I agree with you. It's the wrong way. I mean, we don't want to, the solution here is not to go after companies after people are sick. We need get in front of this and be proactive. I mentioned it only because I know it has made other companies pay attention how many billion does so-and-so sue for. So that's a good signal that other companies are starting to move away from forever chemicals. But I do want to talk about one of the positive approaches we're doing at Harvard, and we have a lot of other partners in the private sector doing this. We're trying to turn off the spigot of forever chemicals entering the market in the first place. As a faculty advisor to what we call the Harvard Healthier Building Materials Academy, we publish new standards. We no longer buy products that have forever chemicals in them for our spaces.(00:51:31):So we buy a chair or carpet. We demand no forever chemicals. What's really neat about this is we also say, we treat them as a whole class. We don't say we don't want PFOA. That's one of the regulated chemicals. We say we don't want any of the 10,000. We are not waiting for the studies to show us they act like the other ones. We've kind of been burned by this for decades. So we're actually telling the suppliers we don't want these chemicals and they're delivering products to us without these chemicals in them. We have 50 projects on our campus built with these new design standards without forever chemicals and other toxic chemicals. We've also done studies that a doctoral student done the study. When we do this, we find lower levels of these chemicals in air and dust, of course. So we're showing that it works.(00:52:19):Now, the goal is not to say, hey, we just want to make Harvard a healthier campus and the hell with everybody else. The goal is to show it can be done with no impact to cost, schedule or product performance. We get a healthier environment, products look great, they perform great. We've also now partnered with other big companies in the tech industry in particular to try and grow or influence the market by saying, look how many X amount of purchasing dollars each year? And it's a lot, and we're demanding that our carpets don't have this, that our chairs don't have it, and the supply chain is responding. The goal, of course, is to just make it be the case that we just have healthy materials in the supply chain for everybody. So if you or I, or anybody else goes to buy a chair, it just doesn't have toxic chemicals in it.Eric Topol (00:53:06):Right, but these days the public awareness still isn't there, nor are the retailers that are selling whether it's going to buy a rug or a chair or new pots and pans. You can't go in and say, does this have any forever chemicals? They don't even know, right?Joseph Allen (00:53:24):Impossible. I study this and it's hard for me when I go out to try and find and make better decisions for myself. This is one of the reasons why we're working, of course, trying to help with the regulatory side, but also trying to change the market. Say, look, you can produce the similar product without these chemicals, save yourself for future lawsuits. Also, there's a market for healthy materials, and we want everybody to be a part of that market and just fundamentally change the supply chain. It's not ideal, but it's what we can do to influence the market. And honestly, we're having a lot of impact. I've been to these manufacturing plants where they have phased out these toxic chemicals.Eric Topol (00:54:03):That's great to hear.Joseph Allen (00:54:06):And we see it working on our campus and other companies' campuses.Eric Topol (00:54:10):Well, nobody can ever accuse you of not taking on big projects, okay.Joseph Allen (00:54:15):You don't get into public health unless you want to tackle the big ones that are really going to influence.Micro(nano) PlasticsEric Topol (00:54:20):Well, that's true, Joe, but I don't know anybody who's spearheading things like you. So it's phenomenal. Now before we wrap up, there's another major environmental problem which has come to the fore, which are plastics, microplastics, nanoplastics. They're everywhere too, and they're incriminated with all the things that we've been talking about as well. What is your view about that?Joseph Allen (00:54:48):Well, I think it's one, well, you see the extent of the pollution. It's a global pollutant. These are petrochemicals. So it's building up, and these are fossil fuel derivatives. So you can link this not just to the direct human health impacts, the ecosystem impacts, but also ecosystem and health impacts through climate change. So we've seen our reliance on plastics grow exponentially over the past several decades, and now we're seeing the price we're paying for that, where we're seeing plastics, but also microplastics kind of everywhere, much like the forever chemicals. Everywhere we look, we find them and we're just starting to scratch a surface on what we know about the environmental impacts. I think there's a lot more that can be done here. Try to be optimistic again, at least if you find a problem, you got to try and point to some kind of solution or at least a pathway towards solutions.(00:55:41):But I like some of the stuff from others colleagues at Yale in particular on the principles of green chemistry. I write about them in my book a little bit, but it's this designing for non-permanence or biodegradable materials so that if we're using anything that we're not leaving these permanent and lasting impacts on our ecosystem that then build up and they build up in the environment, then they build up in all of us and in our food systems. So it seems to me that should be part of it. So think about forever chemicals. Should we be using chemicals that never break down in the environment that we know are toxic? How do we do that? As Harvard, one of the motivating things here for forever chemicals too, is how are we ignoring our own science? Everyone's producing this science, but how do we ignore even our own and we feel we have responsibility to the communities next to us and the communities around the world. We're taking action on climate change. How are we not taking action on these chemicals? I put plastics right in there in terms of the environmental pollutants that largely come from our built environment, food products and the products we purchase and use in our homes and in our bodies and in all the materials we use.Eric Topol (00:56:50):When you see the plastic show up in our arteries with a three, four-fold increase of heart attacks and strokes, when you see it in our testicles and every other organ in the body, you start to wonder, are we ever going to do something about this plastic crisis? Which is somewhat distinct from the forever chemicals. I mean, this is another dimension of the problem. And tying a lot of this together, you mentioned, we are not going to get into it today, but our climate crisis isn't being addressed fast enough and it's making all these things exacerbating.Joseph Allen (00:57:27):Yeah, let me touch on that because I think it is important. It gets to something I said earlier about a lot of these problems we treat as silos, but I think a lot of the problems run through our buildings, and that means buildings are part of the solution set. Buildings consume 40% of global energy.(00:57:42):Concrete and steel count for huge percentages of our global CO2 emissions. So if we're going to get climate solved, we're going to have to solve it through our buildings too. So when you start putting this all together, Eric, right, and this is why I talk about buildings as healthy buildings could potentially be one of the greatest public health interventions we have of this century. If we get it right, and I don't mean we get the Covid part, right. We get the forever chemicals part, right. Or the microplastics part, right. If you start getting this all right, good ventilation, better filtration, healthy materials across the board, energy efficient systems, so we're not drawing on the energy demand of our buildings that are contributing to the climate crisis. Buildings that also address climate adaptation and resilience. So they protect us from extreme heat, wildfire smoke, flooding that we know is coming and happening right now.(00:58:37):You put that all together and it shows the centrality of buildings on our collective health from our time spent indoors, but also their contribution to environmental health, which is ultimately our collective human health as well. And this is why I'm passionate about healthy buildings as a real good lens to put this all under. If we start getting these right, the decisions we make around our buildings, we can really improve the human condition across all of these dimensions we're talking about. And I actually don't think it's all that hard in all of these. I've seen solutions.Eric Topol (00:59:12):I'm with you. I mean, there's innovations that are happening to take the place of concrete, right?Joseph Allen (00:59:20):Sure. We have low emission concrete right now that's available. We have energy recovery ventilation available right now. We have real time sensors. We can do demand control ventilation right now. We have better filters right now. We have healthy materials right now.(00:59:33):We have this, we have it. And it's not expensive if we quantify the health benefits, the many, many multiple benefits. So it's all within our reach, and it's just about finding these different pathways. Some of its market driven, some of it's regulatory, some of it's at the local level, some of it's about raising awareness, giving people the language to talk about these things. So I do think it's the real beginning of the healthy buildings era. I really, truly believe it. I've never seen change like this in my field. I've been chasing sick buildings for a long time.Joseph Allen (01:00:11):And clearly there's pathways to do better.Eric Topol (01:00:13):You're a phenom. I mean, really, you not only have all the wisdom, but you articulate it so well. I mean, you're leading the charge on this, and we're really indebted to you. I'm really grateful for you taking an hour of your busy time to enlighten us on this. I think what you're doing is it's going to keep you busy for your whole career.Joseph Allen (01:00:44):Well, the goal here is for me to put myself out of business. We shouldn't have a healthy buildings program. It just should be the way it's done. So I'm looking forward to the time out of business, hopefully have a healthy building future, then I can retire, be happy, and we'll be onto the next big problem.Eric Topol (01:00:57):We'll all be following your writings, which are many, and fortunately not just for science publications, but also for the public though, they're so important because the awareness level as I can't emphasize enough, it's just not there yet. And I think this episode is going to help bring that to a higher level. So Joe, thank you so much for everything you're doing.Joseph Allen (01:01:20):Well, I appreciate it. Thanks for what you're doing too, and thanks for inviting me on. We can't get the word out unless we start sharing it across our different audiences, so I appreciate it. Thanks so much.Eric Topol (01:01:28):You bet.***********************************************A PollThanks for listening, reading or watching!The Ground Truths newsletters and podcasts are all free, open-access, without ads.Please share this post/podcast with your friends and network if you found it informative!Voluntary paid subscriptions all go to support Scripps Research. Many thanks for that—they greatly helped fund our summer internship programs for 2023 and 2024.Thanks to my producer Jessica Nguyen and Sinjun Balabanoff for audio and video support at Scripps Research.Note: you can select preferences to receive emails about newsletters, podcasts, or all I don't want to bother you with an email for content that you're not interested in. Get full access to Ground Truths at erictopol.substack.com/subscribe

Ohio Environmental Protection Agency (EPA) isn't like those other state EPAs, they're a cool state EPA. After all, they helped Ohio become a leader in water quality assessment! Mike and Elaine are joined by special guest Bill Zaweski, Ohio EPA environmental supervisor of the Division of Surface Water. Bill explains why water should have integrity and how the Gorge Dam compromises the Cuyahoga River's. Learn the Tale of Two Fish, find out which one of our cohosts ruffled Bill's feathers and why, and explore the negative ripple effects of keeping the dam in place — for fish, humans and everything in between. If you're curious about how Ohio became a water quality trailblazer, this episode is a must-listen!  For more, visit bit.ly/freethefalls  Follow Summit Metro Parks:  Facebook: summitmetroparks  Instagram: summitmetroparks  X: metro_parks 

*The U.S. cotton crop is feeling the heat.   *The Texas hog herd has grown over the past few months.   *The South Texas vegetable industry is suffering from a lack of water.*Prescribed burning could help avoid wildfires in the future.  *Some farmers and farm organizations have expressed concerns about the EPAs atrazine proposal.  *Dryland cotton on the southern plains of West Texas needs rain. *USDA's recent Land Values Report shows record high farmland prices. *Equine fat tissue is more than just fat.  

Šį savaitgalį Suvalkijoje vyksta IV kriminologijos festivalis „Demistify“, kuris šiais metais skiriamas konspiracijos teorijų temai.Tarpukariu šiaurinė Nidos dalis buvo vadinama Sibiru, o pietinė – Azija. Kodėl? Apie Nidos unikalumą, kultūros saleles, skaudulius, lėtąjį turizmą ir kur Neringoje galima sutikti briedį pasakoja geografė Aušra Feser.Japonijoje pristatyta kompozitorės Agnės Matulevičiūtės ir choreografo Pawelo Sakowicz garso instaliacija su choreografiniais elementais „Sayonakidori” (Lakštingala).Šilalės Vlado Satkevičiaus muziejuje vykusioje konferencijoje „Mūsų kraštotyros didieji“ pagerbti labiausiai Žemaitijai nusipelnę kraštotyrininkai. Kokius ryškiausius tyrimus atliko žymūs Žemaitijos kraštotyrininkai? Ir kuo atradimai naudingi šiais laikais?Rubrikoje „Be kaukių“ – pokalbis su architekte, viena iš studijos „Do Architects“ įkūrėjų Gilma Teodora Gylyte. Kalbamės apie sovietinių mokyklų konversijas Ukrainoje ir svarstome, ar Lietuvoje į architektūrinius, urbanistinius sprendimus priimame bendruomenės balsą?Ved. Urtė Karalaitė

“I think some of the biggest themes throughout (Project 2025) are a sort of reorganization or dismantling of some of our environment agencies. They literally use the word ‘dismantled' for what they would like to do to NOAA, the National Oceanic and Atmospheric Administration. The others are a little bit more subtle, but they talk about shifting senior career staffers out of the EPAs office of water. So, it's all sorts of, you know, reorganizing and rearranging these agencies and doing so in a way that might make them, or that is going to make them, less protective of the climate.” Rachel Frazin on Electric Ladies Podcast You may have heard about Project 2025, the 900-page far-right conservative blueprint for a potential Trump 2.0 administration developed by the Heritage Foundation and about 140 former Trump officials. But what's in it that could affect the country's ability to address climate change and how we power our economy?   Listen to Rachel Frazin, Energy and Environment Reporter at The Hill explain what specific provisions will affect climate and energy in this insightful discussion with Electric Ladies host Joan Michelson. You'll want to know this before you vote. You'll hear: What exactly is in Project 2025 related to water, air, weather management, and the environment. How Project 2025 proposes about our energy system and energy efficiency and what the impact would be on climate change, greenhouse gases and our air. Who Project 2025 prioritizes in the economy…and so much more. How candidate choice really matters this election – and how to do your research. Plus, insightful career advice, such as… “Being open-minded to new opportunities, I very much lucked into the energy environment and climate world…and I have fallen in love with it. So I think, you know, just being open to opportunities is huge. Generally, having a positive attitude, but also thinking critically, being skeptical, especially as a journalist. I like to be open-minded and believe that good ideas and good policies and can come from anyone and anywhere. But I also…don't take anything for granted… I encourage everybody to do their research.” Rachel Frazin on Electric Ladies Podcast Read Joan's Forbes articles here. You'll also like: Celinda Lake, CEO, Lake Research Partners, opinion research firm on women voters and climate. Anna Siefken, Deputy Director, Federal Energy Management Program, Dept. of Energy, on how the federal government reduces the energy use and carbon footprint of its 350,000 buildings. Rachel McCleery, Senior Advisor, Treasury Dept. Inflation Reduction Act Program, on how to leverage the IRA to save money reducing a building or business's energy use and carbon footprint. Vanessa Chan, Ph.D., Chief Commercialization Officer of the Department of Energy and Director of the Office of Technology Transitions, on the Inflation Reduction Act and the transition to clean energy. Lisa Jacobson of the Business Council for Sustainable Energy & Tara Narayanan, of Bloomberg NEF on their new Energy Factbook 2024, including the Inflation Reduction Act opportunities. Subscribe to our newsletter to receive our podcasts, blog, events and special coaching offers.. Thanks for subscribing on Apple Podcasts or iHeartRadio and leaving us a review! Follow us on Twitter @joanmichelson

Today my guest is Dr. Bronwyn Bryant, a pathologist and pathology educator. Dr. Bryant has been involved in the National EPA Working Group, focused on implementing Entrustable Professional Activities (EPAs) in pathology residency programs. The group conducted a pilot study on EPAs and is now working on developing an electronic tool to facilitate the completion of EPAs in real-time. Dr. Bryant is passionate about using EPAs to provide more specific and actionable feedback to residents, ultimately improving the learning and assessment experiences. She is also interested in studying the impact of EPAs on resident training. Dr. Bryant emphasizes the importance of faculty development in using EPAs effectively and believes that this method can lead to a culture shift in pathology education. Links for this episode: Health Podcast Network  LabVine Learning Dress A Med scrubs Digital Pathology Club   National pilot of entrustable professional activities in pathology residency training Leveraging faculty development to support validation of entrustable professional activities assessment tools in anatomic and clinical pathology training   People of Pathology Podcast: Twitter Instagram

„Skrieja kamuolys“: Čepas = Žibėnas? Švediškas saulėlydis ir numeriai virš 30 15min tinklalaidėje apie futbolą „Skrieja kamuolys“ lyg nujausdami atsisveikinome su Glennu Stahliu, diskutavome apie Mindaugo Čepo darbus, apverkėme „Liverpool“ jaunuolių klaidas bei dar kartą špagavome „Bayern“. Komanda – 15min sporto žurnalistai Marius Bagdonas, Mantas Krasnickas, Aurimas Tamulionis bei tinklaraščio „Vienuolika“ bendraautorius ir „Go3” komentatorius Karolis Dudėnas. 00:00 Intro. Serialai, dokumentikos ir sporto turinys 09:41 Nenusipelnęs „Džiugas“ ir Skerlos pastaba 12:23 Rimtas alytiškių ir gargždiškių mūšis 18:28 Komentatorių pozicijos A lygoje, „Sūduvos“ pergalė ir kuriamas puslapis? 30:58 „Šiaulių“ pralaimėjimas, šaunus „Žalgiris“ 39:50 Čepas – A lygos Žibėnas? 58:16 Čia dar nežinojome, kad Glenną išspyrė 1:13:51 Filosofo Gritėno klausimas 1:22:08 Paskandintas delfinas Ekvadore 1:24:30 „Premier“ lyga. Kosminis vakaras ketvirtadienį ir vyrukai, kurių numeriai virš 30 1:55:28 „Bayern“ parodija, „Bayer“ planuoja vakarėlį 1:58:55 Karolio vėlyvas krytis lovon dėl ispanų taurės

The Technical Review Workgroup (TRW) Bioavailability Committee recently published the "Guidance for Sample Collection for In Vitro Bioaccessibility Assay for Arsenic and Lead in Soil and Applications of Relative Bioavailability Data in Human Health Risk Assessment." This is an update to the 2015 Guidance for Sample Collection for In Vitro Bioaccessibility Assay for Lead (Pb) in Soil. The update is intended to help EPA risk assessors, remedial project managers, and on-scene coordinators develop and use bioavailability data at their sites. It incorporates sample planning and data analysis recommendations from EPA's Guidance on Systematic Planning Using the Data Quality Objectives Process that are pertinent to sampling for In Vitro Bioaccessibility (IVBA) and Relative Bioavailability (RBA). It also clarifies the application of IVBA and RBA data to human health risk assessment, the development of risk-based goals at CERCLA remedial and removal sites and includes arsenic (As) which was recently added to the In Vitro Bioaccessibility Assay. The TRW has developed a series of trainings based on the updated guidance. This session will focus on a discussion of soil sample planning and data evaluation to assess confidence in site assessment and remediation decisions at soil arsenic & lead contaminated sites. EPAs new bioavailability sampling guidance tool will also be presented.  This training will target a general audience of regional staff working in risk assessment, remediation, emergency response, technical support, and quality assurance. The training will be an approximately one and half hours long and will include time for general discussion. Members of the Bioavailability Committee and a Regional representative will be present to answer questions in real time. To view this archive online or download the slides associated with this seminar, please visit http://www.clu-in.org/conf/tio/IVBA-3_031824/

The Technical Review Workgroup (TRW) Bioavailability Committee recently published the "Guidance for Sample Collection for In Vitro Bioaccessibility Assay for Arsenic and Lead in Soil and Applications of Relative Bioavailability Data in Human Health Risk Assessment." This is an update to the 2015 Guidance for Sample Collection for In Vitro Bioaccessibility Assay for Lead (Pb) in Soil. The update is intended to help EPA risk assessors, remedial project managers, and on-scene coordinators develop and use bioavailability data at their sites. It incorporates sample planning and data analysis recommendations from EPA's Guidance on Systematic Planning Using the Data Quality Objectives Process that are pertinent to sampling for In Vitro Bioaccessibility (IVBA) and Relative Bioavailability (RBA). It also clarifies the application of IVBA and RBA data to human health risk assessment, the development of risk-based goals at CERCLA remedial and removal sites and includes arsenic (As) which was recently added to the In Vitro Bioaccessibility Assay. The TRW has developed a series of trainings based on the updated guidance. This session will focus on a discussion of soil sample planning and data evaluation to assess confidence in site assessment and remediation decisions at soil arsenic & lead contaminated sites. EPAs new bioavailability sampling guidance tool will also be presented.  This training will target a general audience of regional staff working in risk assessment, remediation, emergency response, technical support, and quality assurance. The training will be an approximately one and half hours long and will include time for general discussion. Members of the Bioavailability Committee and a Regional representative will be present to answer questions in real time. To view this archive online or download the slides associated with this seminar, please visit http://www.clu-in.org/conf/tio/IVBA-3_031824/

EPAs ... Erfolgsproduzierende Aktivitäten sind letztlich das Wichtigste, wenn es darum geht, in dem, was du machst, erfolgreich zu sein. Wie du damit umgehst, damit du dein Ergebnis optimierst, erfährst du in der aktuellen Folge!

Today is an expose about one of America's dirty secrets - we're talking about the nation wide biosolids program. Supposedly its a great way to beneficially cycle a "renewable resource" to help fertilize crop fields, protect water sheds and keep people healthy. In reality, its anything but - and we know from first hand knowledge because we lived with it right across the street from us for months.  For any would-be homesteader looking to re-locate to the country, be aware of the potential for biosolids in your watershed and potentially right across the fence (as in our case). This is a huge problem, one that has resulted from a society and civil infrastructure built around the assumptions of a perpetual and never-ending supply of cheap energy. Now those chickens are coming home to roost, and its on us to fix it. First things first we have to learn just how extensive the problem of dealing with our own shit is so we can wrap our heads around what will be required to retrofit existing systems to make them work for a lower energy future. Show Resources Actual EPA Laws & Regs: https://www.epa.gov/biosolids/biosolids-laws-and-regulations Plain English version (its 175 pages long - don't get too excited): https://www.epa.gov/sites/default/files/2018-12/documents/plain-english-guide-part503-biosolids-rule.pdf EPA Propaganda Page for National Biosolids Initiative: https://www.epa.gov/biosolids PFAS Guide Doc: https://www.epa.gov/system/files/documents/2023-07/Joint-Principles-Preventing-Managing-PFAS.pdf The EPAs sheet on PFAS: https://www.epa.gov/pfas/pfas-explained EWG PFAS Factsheet: https://static.ewg.org/ewg-tip-sheets/EWG-AvoidingPFCs.pdf https://thesovereignhomestead.com/soil-fertility-for-homesteads-vermicompost/ Home Bio Gas Toilet - turn your sewage and food waste into methane gas for cooking and valuable and SAFE fertilizer for your garden: https://www.homebiogas.com/   ____________________________________________________________________________ WHAT I DO: Design: On-Site Consultation Online Site/Project Consultation Holistic Ecosystem Design   Implementation: Water Harvesting Earthworks High-function, Low-Maintenance Access Living Systems Spring Development   Courses: Minimum Holistic Goal   Media: The Sovereign Homestead Podcast YouTube Instagram          

Qui peut plonger ? A partir de quel âge ? Où faut il aller pour voir les requins ?Retrouvez dans cet épisode de Beau Voyage un condensé des meilleurs tips et des choses à savoir sur la plongée grâce à Cyrielle. Cette amoureuse de l'océan, qui se bat aujourd'hui pour la survie des requins, a multiplié les plongées à l'autre bout du monde, malgré sa prothèse cardiaque. Dans cet épisode elle nous dit tout sur la plongée sous marine. On lui a demandé : A partir de quel âge est ce que l'on peut plonger ? En combien de temps est ce qu'on passe son brevet de plongée ?  Ca coute combien de passer son brevet de plongée ?Une fois passé il est valable partout dans le monde ? Ma première plongée je la fais où ?Ca dure combien de temps une plongée classique ? Quelles sont les contre indications pour la plongée ?Est ce qu'une fois que j'ai mon brevet je peux plonger tout seul ?C'est vrai que tu n'as pas le droit de prendre l'avion après?Les plus beaux spots où plonger ? On peut plonger jusqu'à combien de mètres lorsque l'on est un plongeur aguerri ? Le plus dangereux en plongée c'est quoi ?Si on veut plonger en France on va où ?Si t'avais un voyage-plongée à recommander ce serait lequel ?3 endroits fabuleux ou plonger avec des requins ?Les essentiels a savoir lorsque l'on plonge avec un requin ?Apnée ou plongée, je choisis quoi ? C'est quoi la narcose ?Si j'ai envie de vomir, je fais comment ?A noter dans sa check list

Entrustable Professional Activities, or EPAs, is a term you may have heard…or maybe not.  EPAs represent a tectonic shift in surgical training and how residents will be evaluated. So, what are EPAs?  How will they affect you?  And what do you need to know? We sat down with Dr. George Sarosi, previous member of the ABS EPA Advisory Council and current General Surgery Residency Program Director at the University of Florida, to answer all of our questions now that EPAs are here.  Guests: George Sarosi, MD- Professor of Surgery and General Surgery Residency Program Director- University of Florida Patrick Georgoff, MD- Trauma Surgery and Surgical Critical Care- WakeMed Hospital; Co-director and Host of Behind the Knife Jessica Millar, MD- General Surgery Resident- University of Michigan; Education Fellow- Behind the Knife Daniel Scheese, MD- General Surgery Resident- Virginia Commonwealth University; Education Fellow- Behind the Knife Helpful Websites:  Resources Page - ABS EPA resources page for Programs and Trainees: https://www.absurgery.org/default.jsp?eparesources - FAQs about EPAs and the ABS EPA Project (continuously updated so be sure to check back periodically): https://www.absurgery.org/xfer/epaprogfaqs.pdf - ABS EPA Program Timeline for program engagement (includes webinars, suggestions for activities for programs to consider, and an expected timeframe for the distribution of additional implementation resources): https://www.absurgery.org/xfer/absepaprogtimeline.pdf - Checklists for Program directors/Residency administrators/Faculty (https://www.absurgery.org/xfer/epaimplementationchecklist_programs.pdf) and for Residents (https://www.absurgery.org/xfer/epaimplementationchecklist_residents.pdf) to guide and sequence implementation priorities and timing   If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listen/

Entrustable Professional Activities, or EPAs, is a term you may have heard…or maybe not.  EPAs represent a tectonic shift in surgical training and how residents will be evaluated. So, what are EPAs?  How will they affect you?  And what do you need to know? We sat down with Dr. George Sarosi, previous member of the ABS EPA Advisory Council and current General Surgery Residency Program Director at the University of Florida, to answer all of our questions now that EPAs are here.  Guests: George Sarosi, MD- Professor of Surgery and General Surgery Residency Program Director- University of Florida Patrick Georgoff, MD- Trauma Surgery and Surgical Critical Care- WakeMed Hospital; Co-director and Host of Behind the Knife Jessica Millar, MD- General Surgery Resident- University of Michigan; Education Fellow- Behind the Knife Daniel Scheese, MD- General Surgery Resident- Virginia Commonwealth University; Education Fellow- Behind the Knife Helpful Websites:  Resources Page - ABS EPA resources page for Programs and Trainees: https://www.absurgery.org/default.jsp?eparesources - FAQs about EPAs and the ABS EPA Project (continuously updated so be sure to check back periodically): https://www.absurgery.org/xfer/epaprogfaqs.pdf - ABS EPA Program Timeline for program engagement (includes webinars, suggestions for activities for programs to consider, and an expected timeframe for the distribution of additional implementation resources): https://www.absurgery.org/xfer/absepaprogtimeline.pdf - Checklists for Program directors/Residency administrators/Faculty (https://www.absurgery.org/xfer/epaimplementationchecklist_programs.pdf) and for Residents (https://www.absurgery.org/xfer/epaimplementationchecklist_residents.pdf) to guide and sequence implementation priorities and timing   Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.   If you liked this episode, check out other recent episode here: https://behindtheknife.org/listen/

Description: RINS reporter, Matthew Cope, returns on the driving discussions series with Jason Metko, to discuss the recent EPA announcement regarding finalized biofuel blending volumes for the future, learning about HOBO and BOHO, and how the market is shaping up the for the rest of 2023.

On February 3rd, a train carrying 20 cars with poisonous, flammable chemicals derailed in East Palestine, OH. In this episode, we're going to get some answers. Using testimony from four Congressional hearings, community meeting footage, National Transportation Safety Board preliminary reports, and lots of articles from local and mainstream press, you will learn what Congress is being told as they write the Rail Safety Act, which both parts of Congress are working on in response to the East Palestine train derailment. Please Support Congressional Dish – Quick Links Contribute monthly or a lump sum via PayPal Support Congressional Dish via Patreon (donations per episode) Send Zelle payments to: Donation@congressionaldish.com Send Venmo payments to: @Jennifer-Briney Send Cash App payments to: $CongressionalDish or Donation@congressionaldish.com Use your bank's online bill pay function to mail contributions to: 5753 Hwy 85 North, Number 4576, Crestview, FL 32536. Please make checks payable to Congressional Dish Thank you for supporting truly independent media! View the show notes on our website at https://congressionaldish.com/cd274-norfolk-southern-train-derailment-in-east-palestine Background Sources Recommended Congressional Dish Episodes CD247: BIF: The Growth of US Railroads East Palestine Derailment Overview “It's been more than a month since a freight train carrying hazardous chemicals derailed in Ohio. Here's what's happened since.” Alisha Ebrahimji and Holly Yan. Mar 23, 2023. CNN. “Residents can return home after crews burned chemicals in derailed tanker cars.” Associated Press. Feb 8, 2023. NPR. “WATCH: Smoke billows over East Palestine after controlled burn at train derailment site.” Feb 8, 2023. Cleveland 19 News. Vinyl Chloride and Dioxins “East Palestine Train Derailment: What is vinyl chloride and what happens when it burns?” Associated Press. Feb 8, 2023. CBS News Pittsburgh. “Dioxins and their effects on human health.” Oct 4, 2016. World Health Organization. “Medical Management Guidelines for Vinyl Chloride.” Last reviewed Oct 21, 2014. Centers for Disease Control Agency for Toxic Substances and Disease Registry. National Transportation Safety Board Findings “Norfolk Southern Railway Train Derailment with Subsequent Hazardous Material Release and Fires: Investigation Details.” Last updated Mar 21, 2023. National Transportation Safety Board. “What appears to be an overheated wheel bearing seen moments before East Palestine train derailment, NTSB says.” Ian Cross. Feb 14, 2023. ABC News 5 Cleveland. “Vent and Burn” Decision “Ex-EPA Administrator Doubts Agency's East Palestine Claims: 'Hard to Believe They Were Silent' Before Norfolk Southern Detonated Toxic Vinyl Chloride Cars.” Jordan Chariton. May 25, 2023. Status Coup News. “East Palestine emails reveal insight into decision to vent and burn toxic rail cars.” Tara Morgan. May 15, 2023. ABC News 5 Cleveland. “EXCLUSIVE: 'I truly feel defeated and useless.' Emails and texts reveal anguish of East Palestine fire chief over lack of adequate health advice after he was told to treat chemical disaster 'like a normal house fire.'” Daniel Bates. May 15, 2023. The Daily Mail. EPA failures “East Palestine Bombshell: EPA Official Admits It May Be Missing Toxic Chemicals in Air Testing, Admits Some of Its Decision Making Has Been to Prevent Lawsuits.” Louis DeAngelis. Mar 29, 2023. Status Coup News. East Palestine Resident Health Problems “No one has accepted real responsibility for the East Palestine disaster.” Zsuzsa Gyenes. May 16, 2023. The Guardian. “East Palestine survey reveals residents experienced headaches and anxiety after train derailment.” Nicki Brown, Artemis Moshtaghian and Travis Caldwell. Mar 4, 2023. CNN. “People in East Palestine showing breakdown product of vinyl chloride in urine tests.” Tara Morgan. Apr 28, 2023. ABC News 5 Cleveland. Norfolk Southern “Making it Right.” Norfolk Southern. “Norfolk Southern unveils compensation plans for homeowners near derailment site.” Andrea Cambron, Jason Carroll and Chris Isidore. May 11, 2023. CNN Business. “‘32 Nasty:' Rail Workers Say They Knew the Train That Derailed in East Palestine Was Dangerous.” Aaron Gordon. Feb 15, 2023. Vice. “Wall Street says Norfolk Southern profits won't suffer from derailment.” Rachel Premack. Feb 14, 2023. Freight Waves. “US rail industry defends safety record amid staffing cuts.” Josh Funk. May 16, 2021. AP News. Lobbying Against Regulations “Rail Companies Blocked Safety Rules Before Ohio Derailment.” David Sirota et al. Feb 8, 2023. The Lever. ECP Brake Deregulation “USDOT repeals ECP brake rule.” William C. Vantuono. Dec 5, 2017. Railway Age. Railway Safety Act “Railway Safety Act passes committee, moves to Senate floor for full vote.” Abigail Bottar. May 10, 2023. Ideastream Public Media. Staffing Cuts “Railroads are slashing workers, cheered on by Wall Street to stay profitable amid Trump's trade war.” Heather Long. Jan 3, 2020. The Washington Post. Long Trains “The True Dangers of Long Trains.” Dan Schwartz and Topher Sanders. Apr 3, 2023. Propublica. Bills S.576: Railway Safety Act of 2023 Audio Sources Senate Executive Session May 10, 2023 Senate Committee on Commerce, Science and Transportation Clips 36:30 Sen. JD Vance (R-OH): This bill has changed a lot from what I introduced just a few short months ago. We've made a number of concessions to industry; a number of concessions to the rail industry, a number of concessions to various interest groups, which is why we have so much bipartisan support in this body but also why we have a lot of support from industry. East Palestine Community Meeting March 28, 2023 Status Coup News Government Response to East Palestine: Ensuring Safety and Transparency for the Community March 28, 2023 House Energy and Commerce Subcommittee on Environment, Manufacturing, & Critical Materials Watch on YouTube Witnesses: Debra Shore, Regional Administrator, U.S Environmental Protection Agency, Region 5 Wesley Vins, Health Commissioner, Columbiana County General Health District Anne M. Vogel, Director, Ohio Environmental Protection Agency Clips 30:40 Debra Shore: Since the derailment, EPA has been leading robust, multi-layered air quality testing, using state of the art technology in and around East Palestine, and that extensive monitoring has continued daily at 23 stations throughout the community. Since the fire was extinguished on February 8, EPA monitors have not detected any volatile organic compounds above established levels of health concerns. EPA has also been assisting with indoor air screenings in homes through a voluntary program to keep residents informed. As of March 21, more than 600 homes have been screened, and no sustained or elevated detections of chemicals have been identified. 33:00 Debra Shore: Here's how EPA is holding Norfolk Southern accountable. On February 21, EPA issued a Unilateral Administrative Order to Norfolk Southern, including a number of directives to identify and clean up contaminated soil and water resources, to attend and participate in public meetings at EPA's request, and to post information online, and ordering the company to pay EPA's costs for work performed under the order. All Norfolk Southern work plans must be reviewed and approved by EPA. It must outline all steps necessary to address the environmental damage caused by the derailment. If the company fails to complete any of the EPAs ordered actions, the agency will immediately step in, conduct the necessary work, and then seek punitive damages at up to three times the cost. 46:30 Rep. Bill Johnson (R-OH): In one case, trucks were actually turned around at the gate of a proper, certified disposal facility and sent back to East Palestine to sit practically in my constituents backyard. Why did the EPA believe that it needed to send those letters? Debra Shore: Chairman Johnson, the instance you cite occurred before EPA assumed responsibility under the Unilateral Administrative Order for the cleanup. We don't know who told those trucks to turn around, whether it was the disposal facility itself or someone else. 48:50 Rep. Bill Johnson (R-OH): Why were they turned around? Debra Shore: This occurred during the transition period between Ohio EPA and US EPA assuming the lead for the emergency response. As such, under the Unilateral Administrative Order, all disposal facilities are required to be on the CERCLA (Comprehensive Environmental Response, Compensation, and Liability Act) approved off-site disposal list. So, we needed a few days to review what had occurred and ensure that those facilities that Norfolk Southern had contracts with were on that approved list. Once we determined which ones were on the approved list, it's up to Norfolk Southern to ship waste off the site. 1:03:30 Rep. Diana DeGette (D-CO): Is the EPA intending to use the Unilateral Administrative Order to ensure that Norfolk Southern establishes a health and environmental screening program beyond this initial cleanup period? Debra Shore: Right now, the focus of the Unilateral Order and our work with Norfolk Southern is to make sure the site is cleaned up. I think the responsibility for that longer term health effort, I support what Dr. Vins recommended, and that may have to be negotiat[ed] with Norfolk Southern going forward. Rep. Diana DeGette (D-CO): Obviously, that hasn't started yet. Debra Shore: Not to my knowledge. 1:09:05 Rep. Buddy Carter (R-GA): What will take place in the remediation phase, what happens then? Debra Shore: Then there'll be restoration of stream banks and the places where the soil was removed from along the railroad sites and I think a larger vision for the community that they're already beginning to work on, such as parks and streetscapes. Rep. Buddy Carter (R-GA): Right. Any idea of what kind of timeframe we're talking about here? I mean, are we talking like in my district, decades? Debra Shore: No. We believe the core of the removal of the contaminated site and the restoration of the tracks will be several months. 1:11:35 Rep. Frank Pallone (D-NJ): When did clean up responsibility shift from EPA to Norfolk Southern, and what protections were put in place to ensure the health and safety of the community during that shift? Debra Shore: Thank you, Congressman Pallone. The transition from the State agency, which has the delegated authority in every state, has an emergency response capability, and so Ohio was on the ground working with the local firemen and other agencies as EPA arrived shortly after the derailment. It is typical in these kinds of emergency responses for the state agency to take the lead in the early days and Norfolk Southern was complying with the directives from the state. They continued to comply, but we've found over time that it's important to have all the authority to hold the principal responsible party in this case Norfolk Southern accountable, which is why on February 21, several weeks after the derailment, EPA issued its Unilateral Administrative Order. 1:19:55 Debra Shore: In the subsequent soil sampling that's been conducted, we looked at the information about the direction of the plume from the vent and burn event and focused that primarily where there might have been aerial deposition of soot or particulate matter, and that those soil samples have been collected in Pennsylvania. Rep. John Joyce (R-PA): And today, what soil, air, and water tests are continuing to occur in Pennsylvania? Debra Shore: Additional soil samples will be collected in collaboration, principally, with the Pennsylvania Department of Agriculture, the local Farm Bureau, and the Pennsylvania Department of Environmental Protection. 1:28:36 Anne M. Vogel: The reason that we have been able to say that the municipal drinking water is safe is based on an Ohio EPA map that pre-exists the derailment. This is the source water protection map. So the municipal wellfield is right here, if folks can see that, that big well in the blue. So the derailment happened way over here, a mile and a half away from the wellfield. And we know how the water flows, down this way, down this way, down the creeks. So the derailment would not have affected the municipal water source and we knew that very quickly after the derailment. 1:49:05 Debra Shore: Norfolk Southern has encountered some difficulties in finding and establishing contracts with sites to accept both liquid and solid waste. And I think we could accelerate the cleanup if they were able to fulfill that obligation more expeditiously. 1:51:20 Rep. Raul Ruiz (D-CA): What are some of the long term health concerns that residents and your providers have? Wesley Vins: We've heard a whole wide range of concerns long term. Certainly, cancer is first and foremost, because of much of the information that the residents see online and here, as well as reproductive concerns, growth concerns, hormonal concerns Rep. Raul Ruiz (D-CA): Do you think there's a potential with the carcinogens or any of the toxins that it could lead to ailments for five years from now? Wesley Vins: Yeah, I understand your question. So the some of the constituents that we have related to this response, obviously are carcinogenic, however, we're seeing low levels, is really the initial response. So I think the long question is, we don't know. Rep. Raul Ruiz (D-CA): We don't know. 2:04:50 Rep. Nanette Barragán (D-CA): Administrator Shore, one concern my office has heard is that relocation costs are not being covered by Norfolk Southern for everyone in East Palestine. How is it determined whether a resident is eligible to have their relocation costs paid for? Debra Shore: I'm sorry to hear that. My understanding was that Norfolk Southern was covering temporary relocation costs for any resident who sought that, and I would direct you to Norfolk Southern to ask why they are being turned down. Rep. Nanette Barragán (D-CA): Can the EPA require that Norfolk Southern cover relocation costs for anyone in East Palestine? Debra Shore: I'll find out. 2:11:45 Rep. Mariannette Miller-Meeks (R-IA): I guess my concern is, if the EPA is website says that the sampling data hasn't been quality assured, how did the EPA make the determination that the air is safe to breathe when it appears that the sampling data has not been quality assured? Debra Shore: Congresswoman, I'm going to ask our staff to get back to you with an answer for that. Executive Session and Improving Rail Safety in Response to the East Palestine Derailment March 22, 2023 Senate Committee on Commerce, Science, & Transportation View on Senate website Introduction Panel: U.S. Senator Sherrod Brown U.S. Senator J.D. Vance Mike DeWine, Governor of Ohio Misti Allison, Resident of East Palestine Witnesses: Jennifer Homendy, Chair, National Transportation Safety Board David Comstock, Chief, Ohio Western Reserve Joint Fire District Clyde Whitaker, Legislative Director, Ohio State SMART-TD Alan Shaw, CEO, Norfolk Southern Ian Jefferies, CEO, Association of American Railroads Clips 1:35:00 Sen. Ted Cruz (R-TX): Is there any relief being offered now to say, if you make the decision to move your home and move your family somewhere else, there is an avenue for you to sell your home and get a fair market price for it? Misti Allison: The short answer is, as of today, no. There is not a clear cut explanation or parameters of how you would do that. We've heard time and time again from Norfolk Southern that they're going to make it right and that they're looking into some long term health care monitoring and assistance and home value protection, but details of that plan have not been disclosed to residents as of today. 1:42:05 Jennifer Homendy: This derailment, as all accidents we investigate, was 100% preventable. 1:43:20 Jennifer Homendy: First, the definition of high hazard flammable train should be expanded to a broader array of hazmats and the definition's threshold of 20 loaded tank cars in a continuous block or 35 tank cars dispersed throughout a train should be eliminated. Second, DOT 111 should be phased out of all hazmat service. They're not as protected as DOT 117 tank cars. Third, people deserve to know what chemicals are moving through their communities and how to stay safe in an emergency. That includes responders who risk their lives for each of us every single day. They deserve to be prepared. That means access to real time information, obtaining the right training and gear, and having the right communications and planning tools. Fourth, light cockpit voice recorders in the aviation, audio and video recorders in the locomotive cab are essential for helping investigators determine the cause of an accident and make more precise safety recommendations. Recorders also help operators proactively improve their safety policies and practices. In the East Palestine derailment, the locomotive was equipped with an inward facing camera. However, since the locomotive was put immediately back into service following the accident, the data was overwritten. That means the recorder only provided about 15 minutes of data before the derailment, and five minutes after. The FAST Act, following terrible tragedies in Chatsworth and in Philadelphia, required Amtrak and commuter railroads to maintain crash and fire hardened inward and outward facing image recorders in all controlling locomotives that have a minimum of a 12 hour continuous recording capability. This was extremely helpful in our DuPont Washington investigation. Now is the time to expand that requirement to audio, and include the Class One freight railroads in that mandate. In fact, now is the time to address all of the NTSB's open rail safety recommendations, many of which are on our most wanted list. Fifth and finally, as the committee works on enhancing rail safety, I trust that you'll consider the resources that we desperately need to carry out our critical safety mission. Investments in the NTSB are investments in safety across all modes of transportation. 1:52:05 Clyde Whitaker: This derailment did not have to happen. And it makes it so much more frustrating for us to know that it was very predictable. And yet our warnings and cries for help over the last seven years have fallen on deaf ears and the outcome was exactly as we feared. Now the result is a town that doesn't feel safe in their own homes, businesses failing to survive and a railroad that prioritized its own movement of trains, before the people in the community, as well as its workers. It truly is a shame that operational changes in place prior to that incident are still in place today and the possibility for a similar disaster is just as possible. My entire railroad career I've listened to the railroads portray a message and image of safety first, but I have never witnessed or experienced that truth, one single day on the property. For years I've handled complaint after complaint regarding unsafe practices and unsafe environments, and for almost every single one I've been fought every step of the way. The truth is, ask any railroad worker and they will tell you, that their carriers are masters of checking the boxes and saying the right things, without ever doing anything meaningful toward improving safety. They're only focus is on the operating ratios and bottom lines, which is evidenced by the fact that their bonus structures are set up to reward timely movements of freight rather than reaching destinations safely, as they once were. Actions do speak louder than words. And I assure you that what you have heard, and will hear, from the railroads today are nothing more than words. Their actions are what's experienced by men and women I represent as well as what the people of East Palestine have been through. This is the reality of what happens when railroads are primarily left to govern and regulate themselves. 1:54:05 Clyde Whitaker: On July 11, 2022, I filed a complaint with the FRA (Freight Railroad Administration) regarding an unsafe practice that was occurring on Norfolk Southern (NS), despite existing operating rules to the contrary. NS was giving instructions to crews to disregard wayside detector failures and to keep the trains moving. This meant the trains were not being inspected as intended, and that the crews were not able to ascertain the integrity of such trains. This practice remained in place even after East Palestine. 1:54:40 Clyde Whitaker: It is a virus that has plagued the industry for some time, with the exception of precision scheduled railroading. Across America, inspections and maintenance is being deferred to expedite the movement of trains. No longer is identifying defects and unsafe conditions the goal of inspections, but rather minimiz[ing] the time it takes to perform them, or the elimination of them all together. 2:17:40 Sen. Ted Cruz (R-TX): Why did Norfolk Southern not stop the train then and examine the bearing to make sure that it didn't melt the axle and that you didn't have a derailment? If you'd stop then it would have prevented the derailment. So my question is, why did the second hotbox reading not trigger action? Alan Shaw: Senator, my understanding is that that second reading was still below our alarm threshold, which is amongst the lowest in the industry. In response to this, the industry has agreed to work together to share best practices with respect to hotbox detectors, trending technology, and thresholds. Sen. Ted Cruz (R-TX): So when you and I visited my office yesterday, you said your threshold is now 170 degrees above ambient temperature. As I understand it, at the time of the derailment, your threshold was 200 degrees above ambient temperature. 2:20:15 Clyde Whitaker: Make note that trending defect detector technology from being in the cab of a locomotive, when we pass a defect detector, it trends to an office like Norfolk Southern in Atlanta, Georgia. It doesn't convey to the railroad crews, which is a problem in this incident as well as many others that still continue to this day. What we need as a train crew -- which they say they listen, they haven't been listening for quite a while -- we need to be notified whenever these trending detectors are seeing this car trend hotter. That way we can keep a better eye on it. 2:22:35 Clyde Whitaker: It is feasible. The technology is there. Several days after East Palestine, we almost had a similar incident in the Cleveland area on Norfolk Southern. The defect detector said no defects to the crew. The train dispatcher came on and said, "Hey, we have a report of a trending defect detector on the train. We need you to stop and inspect it." Immediately after that the chief dispatcher, which is the person that controls the whole railroad, told them to keep going. If it were not for an eastbound train passing them and instructing them, "Hey, your train is on fire, stop your train." And we set that car out. They had to walking speed this car five miles. So the technology is there. They're just raising and lowering their thresholds to move freight. 2:25:15 Sen. Ed Markey (D-MA): His testimony is loud and clear: it would have been worse if there was only one person as a crew on that train. Do you disagree with him? Alan Shaw: Senator, I believe that we have operations infrastructure on the ground to respond to derailments. Sen. Ed Markey (D-MA): I think you're not answering the question, okay? It's almost like the last hearing all over again. Because I think the evidence is very clear that these trains can be absolutely safer, but that technology is no replacement for human beings. For example, it can't provide the cognitive functions of a conductor and can't collect visual cues during an emergency. Two-person crews make our trains safer and I wish that you would commit to that today, because I think it's pretty obvious that is the correct answer. I just get sick of industry executives talking about supporting the principles of regulation, while they lobby against common sense regulations like this one behind the scenes. 2:38:50 Sen. Peter Welch (D-VT): I understand that the business plan of Norfolk Southern includes a $7.5 billion stock buyback that is ongoing. Do you believe it would be appropriate to suspend that buyback program until all of the assurances that you are making to this committee and also to the people of East Palestine, about "making this right," that that stock back buyback program should be suspended until you have accomplished what you've assured us and what you've assured that people of East Palestine that you would do? Alan Shaw: Senator, we think about safety every day. We spend a billion dollars a year in capital on safety. And we have ongoing expenses of about a billion dollars a year in safety and as a result over time, derailments are down, hazardous material releases are down and injuries are down. We can always get better. Sen. Peter Welch (D-VT): Right, so you won't answer my question about suspending the buyback program. Alan Shaw: Senator, stock buybacks never come at the expense of safety Sen. Peter Welch (D-VT): I take that is that you will continue with your plan on the buyback. 2:51:30 Sen. Shelley Moore Capito (R-WV): I know that high hazardous flammable trains have more safety regulations. Why would this not have been characterized as a high hazard flammable train if it had th ese hazardous materials on it as part of the 149 car train? Alan Shaw: Senator, thank you for your question. I'm not familiar with the entire makeup of the train. I know that a highly hazardous train is defined by a certain number of highly hazardous cars in it or a certain number of cars in a block. Sen. Shelley Moore Capito (R-WV): Miss Homendy, maybe you can help me with that question. Jennifer Homendy: Yes, the definition of a high hazard flammable train involves class three flammable liquids only, 20 car loads in a continuous block, which would be a unit train, or 35 car loads of class three flammable liquids in a mixed freight train. That was not what was on this train. There were some that were class three defined flammable liquids, but this train was not a high hazard flammable train. Sen. Shelley Moore Capito (R-WV): Right. It wasn't a high hazard train, but it had high hazardous materials that are very flammable that just lit up the sky. So is that something that you would consider that should be looked at as a safety improvement? Jennifer Homendy: Yes, Senator. We think that the thresholds of the 20 and 35 should be eliminated and we think a broader array of hazmat should be in the definition of high hazard flammable train. Protecting Public Health and the Environment in the Wake of the Norfolk Southern Train Derailment and Chemical Release in East Palestine, Ohio March 9, 2023 Senate Committee on Environment & Public Works View on Senate website Witnesses: Sen. Sherrod Brown (D-OH) Sen. JD Vance (R-OH) Sen. Bob Casey (D-PA) Alan Shaw, President and CEO, Norfolk Southern Corporation Debra Shore, Regional Administrator, U.S. Environmental Protection Agency, Region V Anne Vogel, Director, Ohio Environmental Protection Agency Richard Harrison, Executive Director and Chief Engineer, Ohio River Valley Water Sanitation Commission Eric Brewer, Director and Chief of Hazardous Materials Response, Beaver County Department of Emergency Services Clips 26:50 Sen. Sherrod Brown (D-OH): The company followed the Wall Street business model: boost profits by cutting costs at all costs, the consequences for places like East Palestine be damned. In 10 years, Norfolk Southern eliminated 38% of its workforce. Think of that. In a decade they cut more than a third of their jobs. We see what the company did with their massive profits. Norfolk Southern spent $3.4 billion on stock buybacks last year and were planning to do even more this year. That's money that could have gone to hiring inspectors, to putting more hotbox detectors along its rail lines, to having more workers available to repair cars and repair tracks. Norfolk Southern's profits have gone up and up and up and look what happened. 33:35 Sen. JD Vance (R-OH): It is ridiculous that firefighters and local officials don't know that hazardous chemicals are in their community, coming through their community. In East Palestine you had a community of largely volunteer firefighters responding to a terrible crisis, toxic burning chemicals, without knowing what was on them. 34:50 Sen. JD Vance (R-OH): I've talked to a number of my Republican colleagues and nearly everybody has dealt in complete good faith, whether they like the bill or have some concerns about it, and these comments are not directed at them. Who they are directed at is a particular slice of people who seem to think that any public safety enhancements for the rail industry is somehow a violation of the free market. Well, if you look at this industry and what's happened in the last 30 years, that argument is a farce. This is an industry that enjoys special subsidies that almost no industry enjoys. This is an industry that is enjoys special legal carve outs that almost no industry enjoys. This is an industry that just three months ago had the federal government come in and save them from a labor dispute. It was effectively a bailout. And now they're claiming before the Senate and the House that our reasonable legislation is somehow a violation of the free market. Well, pot, meet the kettle, because that doesn't make an ounce of sense. You cannot claim special government privileges, you cannot ask the government to bail you out, and then resist basic public safety. 40:10 Alan Shaw: Air and water monitoring have been in place continuously since the accident and to date it consistently indicated that the air is safe to breathe and the water is safe to drink. 47:20 Debra Shore: Since the fire was extinguished on February 8, EPA monitors have not detected any volatile organic compounds above levels of health concerns. 47:45 Debra Shore: EPA has been assisting with indoor air screenings for homes through a voluntary program offered to residents to provide them with information and help restore their peace of mind. As of March 4, approximately 600 homes had been screened through this program and no detections of vinyl chloride or hydrogen chloride have been identified. 48:40 Debra Shore: On February 21, we issued a unilateral administrative order to Norfolk Southern which includes a number of directives to identify and clean up contaminated soil and water resources, to attend and participate in public meetings at EPA's request, and to post information online, to pay for EPA's costs for work performed under this order. EPA is overseeing Norfolk Southern's cleanup work to ensure it's done to EPA specifications. The work plans will outline all steps necessary to clean up the environmental damage caused by the derailment. And most importantly, if the company fails to complete any of the EPA ordered actions, the agency will immediately step in, conduct the necessary work, and then force Norfolk Southern to pay triple the cost. 1:04:30 Eric Brewer: Norfolk Southern hazmat personnel and contractors arrived on scene shortly after 11pm. At around midnight, after research of the contents, it was decided to shut down fire operations and move firefighters out of the immediate area and to let the tank cars burn. This is not an unusual decision. This decision was made primarily by Norfolk Southern's hazmat coordinator, as well as their contractor. 1:05:15 Eric Brewer: There was a possibility of explosion and we should consider a one mile evacuation. Ohio officials notified us that the one mile radius would now be from the leaked oil address. This would add additional residents from Beaver County in the one mile evacuation zone. Donington township officials went door to door, as well as using a mass notification system to advise the residents of the one mile recommended evacuation. It was stressed that this was a recommendation as we cannot force residents from their homes. Social media posts began to circulate stating that arrest would be made if people refused to leave during the evacuation. Let me be clear that was not the case in Pennsylvania, as this was not a mandatory evacuation. Monday morning, we assembled at the Emergency Operations Center in East Palestine. We learned Norfolk Southern wanted to do a controlled detonation of the tank car in question. We were assured this was the safest way to mitigate the problem. During one of those planning meetings, we learned from Norfolk Southern that they now wanted to do the controlled detonation on five of the tank cars rather than just the one. This changed the entire plan, as it would now impact a much larger area. 1:21:25 Sen. Shelley Moore Capito (R-WV): Why did you wait a month before you started to order the dioxin testing when the community was asking for this? Was that a decision that you made early on that it wasn't critical? Or how was this decision made? Debra Shore: Senator Capito, our air monitoring was searching for primary indicators, such as phosgene and hydrogen chloride, immediately during and after the burn. We detected very low levels which very quickly went even down to non detectable. Without those primary indicators, it was a very low probability that dioxins would have been created. They are secondary byproducts of the burning of vinyl chloride. 1:25:40 Alan Shaw: As you saw just this week, a six point safety plan that included a number of issues which we're implementing immediately to improve safety, including installing more wayside detectors. The first one was installed yesterday outside of East Palestine. 1:30:20 Sen. Markwayne Mullin (R-OK): Mr. Shaw, when the vent and burn process was being made, who who made those decisions? And what was other considerations other than just burning it and letting the material burn off? Alan Shaw: Thank you for that question. The only consideration, Senator, was the safety and health of the community. And that decision was made by Unified Command under the direction of the Incident Commander? Sen. Markwayne Mullin (R-OK): Who's that? Alan Shaw: The Incident Commander was Fire Chief Drabick. Norfolk Southern was a part of Unified Command. 2:07:25 Alan Shaw: Senator, the NTSB report indicated that all of the hotbox detectors were working as designed. And earlier this week, we announced that we are adding approximately 200 hotbox detectors to our network. We already have amongst the lowest spacing between hotbox detectors in the industry. And we already have amongst the lowest thresholds. 2:15:35 Sen. Ed Markey (D-MA): Will you commit to compensating affected homeowners for their diminished property values? Alan Shaw: Senator, I'm committing to do what's right. Sen. Ed Markey (D-MA): Well, what's right is a family that had a home worth $100,000 that is now worth $50,000 will probably never be able to sell that home for 100,000 again. Will you compensate that family for that loss? Alan Shaw: Senator, I'm committed to do what's right. Sen. Ed Markey (D-MA): That is the right thing to do. These are the people who are innocent victims, Mr. Shaw. These people were just there at home and all of a sudden their small businesses, their homes are forever going to have been diminished in value. Norfolk Southern owes these people. It's an accident that is basically under the responsibility of Norfolk Southern, not these families. When you say do the right thing, will you again, compensate these families for their diminished lost property value for homes and small businesses? Alan Shaw: Senator, we've already committed $21 million and that's a downpayment Sen. Ed Markey (D-MA): That is a down payment. Will you commit to ensuring that these families, these innocent families, do not lose their life savings in their homes and small businesses? The right thing to do is to say, "Yes, we will." Alan Shaw: Senator, I'm committed to doing what's right for the community and we're going to be there as long -- Sen. Ed Markey (D-MA): What's right for the community will then be balanced -- which is what we can see from your stock buybacks -- by what's right for Norfolk Southern. C-SPAN: Washington Post Live March 6, 2023 Speakers: Heather Long, Columnist and Editorial Writer, Washington Post Jennifer Homendy, Chair, National Transportation Safety Board Clips 5:14 Jennifer Homendy: Hazardous materials are transported on all modes of transportation. Our aviation system is the safest, but they're limited in what they can transport for dangerous materials. Pipelines can also be safe as well. They have a generally good safety record until one big rupture occurs. But then our railroads also have a good safety record. Train accidents in general, per million trains miles, are going up. So it's trending upwards, accidents. With that said, going on our nation's roads with these materials is not something we want to see. You know, we have 43,000 people that are dying on our nation's roads annually. We have a public health crisis on our roads. Millions of crashes are occurring, so transporting hazmat on our roads would be more dangerous than on our railways. 6:50 Jennifer Homendy: The numbers are trending upward on accidents overall and also for Norfolk Southern 8:20 Jennifer Homendy: That is a role that's very important for the NTSB and why we are independent of the Department of Transportation. We are not part of the Department of Transportation because we do conduct federal oversight to see if DoT's oversight of the freight railroads is adequate or inadequate and we may make recommendations on that. 10:20 Jennifer Homendy: Once it hit well over 250 degrees, it was time for the train crew to stop to inspect the axle, to inspect the wheel bearing and to possibly, in this case, set out the car. But it was too late because as they were slowing and stopping, the train derailed, the wheel bearing failed. And so there might need to be more conservative temperature thresholdss o that started earlier. Also, something the Transportation Safety Board of Canada has looked at is real time monitoring of temperatures and data trending from the control center so that they can see the temperatures increase over a period of time. In this derailment, or what we saw of this train and its operations, is the temperature of that wheel bearing was going up pretty significantly over the course of the three different wayside detectors, but you know, the crew doesn't see that. So that real time monitoring and data trending so that there's some communication with the crew to stop the train and take immediate action is definitely needed. We'll look at that as part of our investigation as well. 12:30 Jennifer Homendy: One thing I will mention is that these decisions about the placement of these hot bearing detectors and the thresholds really vary railroad by railroad and so there needs to be good decision making, some policies and practices put in place. 18:00 Jennifer Homendy: Electronically controlled pneumatic (ECP) brakes don't prevent a derailment. It could lessen damage. So let me explain that. So in this one, car 23 still would have derailed because a wheel bearing failed. So car 23 still would have derailed. Still would have been a derailment, still would have been a fire, and the responders, and Norfolk Southern, and the state and locals would have had to still make a decision on whether to vent and burn the five vinyl chloride tank cars. There could have been a possibility of less damage, meaning a few cars could have remained on the track later in the train. But as for most of the damage, that still would have occurred whether we had ECP brakes on this train or not. 19:50 Heather Long: There's a lot fewer people working on rail, especially freight rail. Does the number of people make any difference here? Jennifer Homendy: Well for this one, as you said, we had two crew members and a trainee. They all stay, as with every train, in the cab of the head locomotive. So I do not see where that would have made a difference in this particular train and this derailment. One thing we are going to look at is whether any changes in staffing lead to any differences in how these cars are maintained or how they're inspected. That is something we will look at. 21:05 Jennifer Homendy: Yeah, so the fire chief, upon arrival at the command center following the derailment, had electronic access to the train consist, which is the list of cars and the materials or liquids that the train is carrying, but none of the responders had the Ask Rail app. You could look up a UN number for a particular car and get the whole consist of the train. It's in an app that the railroads developed for helping emergency responders to get information following an accident. 25:05 Jennifer Homendy: And we have over 250 recommendations that we've issued on rail safety generally that have not been acted upon yet. Music Tired of Being Lied To by David Ippolito (found on Music Alley by mevio) Editing Pro Podcast Solutions Production Assistance Clare Kuntz Balcer

Welcome to the May Pedo Teeth Talk! This month's podcast focuses on resident education and assessments.Delivering safe and effective patient care begins with education, especially during residency. Joining us today on the podcast is Dr. Jennifer Cully, a board-certified pediatric dentist, talks about a new strategy for resident assessments. Introducing the topic of EntrustableProfessional Activities (EPAs), Dr. Cully explains how trust, competencies, and defining the core tasks of pediatric dentistry can be integrated into EPAs to make sure graduating pediatric dental residents are ready to provide unsupervised care.   References for this podcast and for more information on EPAs:   Cully JL, Schwartz SB. Pediatric dentistry residency program directors' assessment techniques. Pediatr Dent. 2022; 44(1): 38-44. Cully JL, Schwartz SB, Quinonez R, Martini A, Klein M, Schumacher DJ. Development of Entrustable Professional Activities for Post-Doctorate Pediatric Dentistry. J Dent Educ. 2023; 87: 6 - 17. tenCate O. Nuts and bolts of entrustable professional activities. J Graduate Med Educ. 2013:157-158. Bio: Name: Jennifer Cully, DMD MEd Education: B.S., The College of William & Mary D.M.D., New Jersey Dental School Certificate in Pediatric Dentistry, Children's National Hospital M.Ed., University of Cincinnati Current practice: Full-time faculty Areas of interest: Education, curriculum development and assessment; interprofessional collaboration; prevention; hospital dentistry; dental trauma Fun fact: Played Division 1 Lacrosse 

Learning from the lessons of the Obama Administration's failed Clean Power Plan, the Biden EPA is set to launch a new set of rules governing carbon emissions from fossil fueled power plants this week. What's in these rules? What effect are they likely to have on greenhouse gas emissions? And, frankly, what likelihood do they have to stand up against a conservative Supreme Court?Paul dives into the EPA's latest carbon regulations in this latest episode.Follow Paul on LinkedIn.

We're getting back into the groove. Accusations fly. Offense is taken. No apologies are offered. That's just the way we are.Our Mission Statement: Helping the world word better.Our Catchphrase: Words mean things Wednesdays are not Saturdays Jeff's calendar head goes to H-E-Double hockey sticks in a handbasket with cascading R.U.D.sGratefully he doesn't use up the whole episode ranting about it. Duck Season! Rabbit Season! Duck Season! Rabbit Season! Rabbit Season! Duck Season! Jeff is, was, and always will be bananers - emphasis added Jeff rants about the BoSux and poor announcing and... This leads us to the headlines... Tragic stories need to be treated with the gravitas they deserve Jeff will have a custom-tailored I Love Me jacket whether he wants one or not. The Federal and State-level EPAs suck at their jobs..."Yakety Sax!" (this actually demeans the song) Car rides and fish filets Peter M. Lenkov, Robert Renee, and Daniel Waters were right! A new bit is proposed: all of the headlines starting with "how" will now be a guessing game How did she get 69 cars? Because Science! Physics is all made up...intentionally!Scientists vs. Journalists who think they know science Chocolate sprinkles for everybody! Yea! Creators & Guests Jeff Feightner - Host Chris Dubbelde - Host If you're ready to make a podcast, make your podcast better or collaborate in another way, contact us at makemypod@fytepro.com

1610: Biden/EPA “rules” will make cars more expensive! Our roads suck after winter, but sorry ADOT, they were bad to begin with!   More flooding in NAZ (3:00) and now in Flagstaff.    Radical, rabid leftists, in their unrelenting cult like climate alarmist frenzy want you to pay triple for a car! (7:00) Jeff discusses the EPAs new rules that may force Americans to switch to EV's by as early as 2027!   ADOT addresses potholes (15:00) but blaming winter alone is conveniently forgetting the sorry state of our roads prior to NAZ record snowfall.    More home runs due to climate change??? (21:00)…”come on man”!   Glenn Leest discusses today's “lower inflation number” (24:00) but we're still at 5%, 10% if you do it the old way plus what's to come with energy costs once again rising.    Angela joins Jeff to discuss end of Covid “emergency (46:00)    Republican Liz Harris gets expelled (48:00) from the Arizona Legislature. + Jeff's fuzzy math!   Katie Hobbs celebrates 100 days in office (49:00) but there's not much to be happy about. Jeff breaks down all the good bills she's vetoed.    Jeff's shares a homebuyers event with Kim Dawson (64:00)...see flier at bottom of page. Plus Angela remembers their first house.   Jeff and Angela discuss candidates who've announced (75:00) for US Senate in AZ.

Den Oscar für den momentan begehrtesten Politiker bekäme wohl Christian Lindner, denn alle Ministerinnen und Minister wollen ihn. Oder besser, alle wollen etwas VON ihm: Geld für ihr Ressort. Und zwar fast 70 Milliarden mehr, als er bereit ist rauszurücken. Zum Glück lässt sich ja jeder Euro doppelt ausgeben, wie ein Finanzexperte Moderator Stephan Fritzsche vorrechnet. Wenn es mit den Handwerkern doch auch so einfach wäre, aber von denen gibt es nach wie vor viel zu wenige. Und wenn Sie einen finden, dann hat der mit viel zu viel Bürokratie zu kämpfen. Zum Glück soll die Sache mit den Anträgen und Genehmigungsverfahren vereinfacht werden, hat der Kanzler versprochen. Wichtig, denn über die Bürokratie-Hürden im Handwerk ließen sich gleich mehrere Oscar-reife Filme drehen. Apropos „einfach“: Hoffentlich wird es auch einfach mit der Einrichtung der EPA - der elektronischen Patientenakte. Die Ärzte haben da noch ein paar Fragen. Im NDR Satire-Magazin Intensiv-Station beantwortet Gesundheitsminister Karl Lauterbach diese auch. Wenn die Sache mit dem Klimaschutz nicht mal bald klappt, dann werden sich die EPAs dramatisch füllen. Aber zum Glück hat Jean Pütz noch ein paar Tipps parat, wie sich ganz emissionsfrei Energie erzeugen lässt. Sie brauchen dazu nur einen Nachbarn. Wie das genau gehen soll? Hören Sie selbst.

When financial advisors collaborate with fellow professionals (EPAs, CPAs, other advisors, etc.), it helps them improve their client service and simultaneously accelerate their own growth. This is the rationale behind Centura Wealth Advisory's Elite Advisor Collaboration Program (EACP), where radically transparency is the cornerstone. In this episode, Jonathan Freeman and Derek Myron explain what EACP … Continue reading Bringing Exponential Value to Clients With the Elite Advisor Collaboration Program (Ep. 71) →

After the EPAs' "control burn" of toxic vinyl chloride in Ohio, Amanda Breshears said the smell caused her eyes to water. She believes it could be the reason why her chickens are now dead.

The December WASDE dropped Friday, December 9th, largely meeting market expectations with a few key updates around demand and global crop levels. And yet, as the 2022 draws to a close, a few key riddles remain in the market– leaving many scratching their heads about what USDA, and traders, might be missing. DTN's Todd Hultman joins us to dig into the relevant changes in the corn export and ethanol demand pictures, as well as to walk us through the inexplicable current state of the global wheat market. We'll dive into farmer outlooks on the year's harvest, unpack how EPAs announcements on the renewable fuel standard are (and aren't) affecting soybean crush expectations, and check in on the record high basis figures that are lingering across the country. Then we'll look ahead to the January WASDE, potential market moving news in 2023, and the hot and dry conditions in Argentina.

For two decades, the EU has sought to modernise its preferential trade relationship with the sub-Saharan African, Caribbean and Pacific (ACP) countries and establish free trade areas with regional groupings under so-called economic partnership agreements (EPAs). These are free trade agreements that allow ACP countries to continue exporting their products to the EU duty free and quota free, while ensuring full compliance with World Trade Organization (WTO) rules. EU goods should also benefit gradually from full liberalisation, though with numerous exceptions related to goods ACP countries wish to protect from external competition, particularly agricultural products. - Original publication on the EP Think Tank website - Subscription to our RSS feed in case your have your own RSS reader - Podcast available on Deezer, iTunes, TuneIn, Stitcher, YouTubeSource: © European Union - EP

Elonas Muskas PAGALIAU nuspirko Twitter. Daugiau nei pusę metų besitęsianti istorija, nuo pradžios iki šios dienos: kaip Muskas sugalvojo pirkti socialinį tinklą, kaip vėliau persigalvojo, bet galiausiai buvo priverstas užbaigti sandorį ir gerokai permokėti. Muskas nieko nelaukia ir jau dabar vykdo daugybę pakeitimų bei mėtosi idėjomis į kairę ir (radikalią?) dešinę. Taip pat, ES uždraus pardavinėti naujus sprogstančių dinozaurų kuro automobilius.

Welcome to the Summer of 2022 KeyLIME “re run” series! Over the summer months, we will be re-releasing some of our earliest episodes: Give some old favorites a listen or discover some episodes from our archive you may not have heard yet! This week, in summer re run #16...  Episode 271: Good Tech + Good Design = Great #MedEd. Jon presents a study that identifies key enablers and barriers to engagement mobile apps that utilize the framework of entrustable professional activities (EPAs) to capture and deliver feedback. Young et. al., A mobile app to capture EPA assessment data: Utilizing the consolidated framework for implementation research to identify enablers and barriers to engagement. Perspect Med Educ. 2020;9(4):210-219. View the episode abstract here. Follow our co-hosts on Twitter! Jason R. Frank: @drjfrank  Jonathan Sherbino: @sherbino  Linda Snell: @LindaSMedEd  Lara Varpio: @LaraVarpio Lara Varpio's Disclaimer: The views expressed in this manuscript are solely those of the authors and do not necessarily reflect those of the Uniformed Services University of the Unites States Department of Defense.  Want to learn more about KeyLIME? Click here!

On June 30th, 2022, the Supreme Court decided West Virginia v. Environmental Protection Agency (EPA), limiting the EPAs ability to regulate greenhouse gas emissions. Beyond its direct impact on climate policy, the case significantly impacts administrative power by supercharging a new legal regime - the “major questions doctrine.” Environmental law and administrative law expert, Professor Lisa Heinzerling (Georgetown Law Center) unpacks the Court's decision in WV v. EPA and explains the broad powers of the judicial doctrine.Prof. Heinzerling goes on to explain how major questions may prove to be the death knell for a prior test known as “Chevron deference.” Where Chevron assured judicial restraint toward federal policy, major questions now threatens to stymie agency action on some of the most critical and contentious issues of the moment, from climate change policy and far beyond.

On June 30th, 2022, the Supreme Court decided West Virginia v. Environmental Protection Agency (EPA), limiting the EPAs ability to regulate greenhouse gas emissions. Beyond its direct impact on climate policy, the case significantly impacts administrative power by supercharging a new legal regime - the “major questions doctrine.” Environmental law and administrative law expert, Professor Lisa Heinzerling (Georgetown Law Center) unpacks the Court's decision in WV v. EPA and explains the broad powers of the judicial doctrine.Prof. Heinzerling goes on to explain how major questions may prove to be the death knell for a prior test known as “Chevron deference.” Where Chevron assured judicial restraint toward federal policy, major questions now threatens to stymie agency action on some of the most critical and contentious issues of the moment, from climate change policy and far beyond.

In Episode #46, I talk with John Hindman of RSM as we discuss EPA's - known as Economic Price Adjustments (EPAs).   Recently, this has surfaced has a hot topic in the federal government contracting community as inflationary pressure has increased prices for energy and supplies creating situations where costs of finished goods have skyrocketed.  The government is keenly aware of the challenges to contractors in controlling prices while still delivering under the contract terms. Some contracts have had a EPA clause in the contract while others have not.  John discusses the key elements of EPAs including the difference between EPA and an Equitable Price Adjustment.   

Entrustable Professional Activities, or EPAs, are a concept that was developed by Olle ten Cate in 2005 as a way to operationalize and assess competency-based medical education.  EPAs are observable, routine activities that a general pediatrician or subspecialist should be able to perform safely and effectively to meet the needs of their patients. The American Board of Pediatrics, or ABP, collaborated with the education community several years ago to develop  17 core EPAs that are essential activities needed for practice in general pediatrics and that can be used as a framework for curriculum and assessment.  The ABP also worked with the subspecialty community to develop EPAs that define what patients need from our subspecialty physicians. However, the original pediatric EPA framework developed by the ABP in conjunction with the general pediatrics and subspecialty communities did not adequately address structural racism, discrimination, and social determinants of health and their contribution to inequities. Today, we are going to hear about the development and content of a revised EPA entitled: Use of Population Health Strategies and Quality Improvement Methods to Promote Health and Address Racism, Discrimination, and Other Contributors to Inequities Among Pediatric Populations. Today, I am happy to be speaking with Dr. Ndidi Unaka and Dr. David Turner.  Ndidi is a pediatric hospitalist who is involved in Cincinnati Children's Community Health initiatives, medical director of QI and data analytics for Cincinnati Children's ACO called HealthVine and until recently was the associate program director of the pediatric residency program at Cincinnati Children's.  David is the Vice President of Competency-Based Medical Education at the American Board of Pediatrics.

Morse code transcription: vvv vvv Supreme Court limits EPAs authority to regulate power plants greenhouse gas emissions Judge says Floridas 15 week abortion law is unconstitutional Supreme Court limits Bidens power to cut emissions Supreme Court tells lower courts to reconsider disputes on abortion and guns after blockbuster decisions Liz Cheney looks forward to day she can disagree with Democrats Snake Island Why Russia couldnt hold on to strategic Black Sea outcrop Missing homing pigeon Bob found 4,000 miles away in Alabama Ketanji Brown Jackson sworn in as first black woman on US top court Ketanji Brown Jackson joins US Supreme Court as first Black woman on the bench Controversial Florida abortion ban blocked by court Biden Supports Exception to Filibuster to Codify Roe v. Wade Into Law Jan 6 hearings live Adam Kinzinger hails true patriot Cassidy Hutchinson as Trump calls testimony crazy Missing Cryptoqueen FBI adds Ruja Ignatova to top ten most wanted Xi Jinping in Hong Kong to mark 25 years of handover Russia abandons Black Sea outpost of Snake Island in victory for Ukraine Smuggling a big business along US Mexico border, says trucker Remain In Mexico Biden can end Trump era policy, court rules Supreme Court to Hear Case on State Legislatures Power Over Elections Texas tractor trailer driver smiles for Border Patrol checkpoint cameras hours before migrants found dead Sri Lanka fuel crisis Waiting for days to get fuel

Morse code transcription: vvv vvv Liz Cheney looks forward to day she can disagree with Democrats Supreme Court tells lower courts to reconsider disputes on abortion and guns after blockbuster decisions Supreme Court to Hear Case on State Legislatures Power Over Elections Ketanji Brown Jackson joins US Supreme Court as first Black woman on the bench Remain In Mexico Biden can end Trump era policy, court rules Smuggling a big business along US Mexico border, says trucker Russia abandons Black Sea outpost of Snake Island in victory for Ukraine Judge says Floridas 15 week abortion law is unconstitutional Missing homing pigeon Bob found 4,000 miles away in Alabama Missing Cryptoqueen FBI adds Ruja Ignatova to top ten most wanted Texas tractor trailer driver smiles for Border Patrol checkpoint cameras hours before migrants found dead Xi Jinping in Hong Kong to mark 25 years of handover Biden Supports Exception to Filibuster to Codify Roe v. Wade Into Law Ketanji Brown Jackson sworn in as first black woman on US top court Supreme Court limits EPAs authority to regulate power plants greenhouse gas emissions Supreme Court limits Bidens power to cut emissions Controversial Florida abortion ban blocked by court Sri Lanka fuel crisis Waiting for days to get fuel Jan 6 hearings live Adam Kinzinger hails true patriot Cassidy Hutchinson as Trump calls testimony crazy Snake Island Why Russia couldnt hold on to strategic Black Sea outcrop

Morse code transcription: vvv vvv Jan 6 hearings live Adam Kinzinger hails true patriot Cassidy Hutchinson as Trump calls testimony crazy Xi Jinping in Hong Kong to mark 25 years of handover Snake Island Why Russia couldnt hold on to strategic Black Sea outcrop Smuggling a big business along US Mexico border, says trucker Russia abandons Black Sea outpost of Snake Island in victory for Ukraine Liz Cheney looks forward to day she can disagree with Democrats Remain In Mexico Biden can end Trump era policy, court rules Supreme Court limits EPAs authority to regulate power plants greenhouse gas emissions Texas tractor trailer driver smiles for Border Patrol checkpoint cameras hours before migrants found dead Ketanji Brown Jackson joins US Supreme Court as first Black woman on the bench Controversial Florida abortion ban blocked by court Judge says Floridas 15 week abortion law is unconstitutional Biden Supports Exception to Filibuster to Codify Roe v. Wade Into Law Missing Cryptoqueen FBI adds Ruja Ignatova to top ten most wanted Missing homing pigeon Bob found 4,000 miles away in Alabama Ketanji Brown Jackson sworn in as first black woman on US top court Supreme Court limits Bidens power to cut emissions Sri Lanka fuel crisis Waiting for days to get fuel Supreme Court tells lower courts to reconsider disputes on abortion and guns after blockbuster decisions Supreme Court to Hear Case on State Legislatures Power Over Elections

It's an industry worth billions of pounds, and it's one that leads the way when it comes to technology and forward thinking - so why is the gaming industry so behind the times when it comes to apprenticeships?According to a recent report by Into Games, there are only 35 active apprenticeships in the UK gaming sector - and more than half of those in the industry say they had no idea how an apprenticeship scheme could even work.In this episode business journalist Georgie Frost speaks to Susi Bauer and Declan Cassidy from Into Games, a non-profit that supports people on their journey in developing the skills & confidence they need to thrive in the gaming sector.Into Games is organising a National Strategy Group and is open for organisations to join and help create new standards or adjust existing ones. To join, email susi@intogames.org or apprenticeships@intogames.org. The group already has members from studios like Epic Games, nDreams, Sumo Group, Ubisoft and more, training providers like HOST Salford, NextGen Skills, ScreenSkills, The Game Assembly and EPAs in there, as well as institutions like UKIE, BAFTA, the DCMS, Apprenticeship Hubs (Hampshire), BFI and IfATE. If you're interested in finding out more about careers in the gaming industry, you can find information at intogames.org/careers.And don't forget to check out @national_careers_service or head to Amazing Apprenticeships or UCAS for up to date information on current apprenticeship vacancies. You can also find out more about how the HomeServe Foundation could help you find an apprenticeship.

It's common for financial advisors to collaborate with estate planning attorneys (EPAs). Partner with the right EPA, and you'll get more referrals, enhance your value proposition, and provide a better client experience!

It's common for financial advisors to collaborate with estate planning attorneys (EPAs). Partner with the right EPA, and you'll get more referrals, enhance your value proposition, and provide a better client experience!

EPAs are coming in 2023. This isn't about your carbon emissions, but it will dramatically impact surgery training programs. Join Drs. Karen Brasel, Jeremy Lipman, Judith French, and Amy Han as they discuss Entrustable Professional Activities (EPAs) and how they will change the way we assess trainees. Learning Objectives 1.     Listeners will be able to define entrustable professional activities (EPAs) within the context of competency-based education during General Surgery residency training 2.     Listeners will be able to understand the impetus behind adopting EPA assessments for surgical trainees.  3.     Listeners will be able to interpret and apply EPA assessment data based on the discussion of the example scenarios. References: Brasel KJ, Klingensmith ME, Englander R, Grambau M, Buyske J, Sarosi G, Minter R. Entrustable professional activities in general surgery: development and implementation. Journal of surgical education. 2019 Sep 1;76(5):1174-86. Lindeman B, Brasel K, Minter RM, Buyske J, Grambau M, Sarosi G. A Phased Approach: The General Surgery Experience Adopting Entrustable Professional Activities in the United States. Acad Med. 2021;96(7S):S9-S13. Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

回想 2003 年臺灣歷經 SARS 之後，醫學教育面臨了重大改革。過度重視專科化的醫學訓練方針，讓當時的臺灣一時之間沒有足夠的人力對大規模的疫病給予基礎照護。也在SARS 之後，臺灣醫學教育向美國取經，導入了PGY制度，推動EBM(實證醫學)、PBL(以問題為導向的學習)、OSCE(技能測試)等制度。 2020 年，這一次的疫情又更加嚴重且席捲全球。又要再次翻轉醫學教育中的各種觀念。為了讓下一個世代的醫師能夠獨當一面，推動核心能力導向醫學教育(CBME)是近年來醫學教育改革趨勢。比起傳統醫學訓練，CBME 更強調訓練後的結果，而非單注重過程面評估。也能依照學生核心能力的分級、運用學習里程碑，發展可信任專業活動EPAs。 本集邀請北醫教學部主任陳建宇醫師將帶來他在各國參訪醫學教育的經驗，帶您深入討論下個世代的醫學教育。台灣在未來如何從住院醫師訓練、臨床工作負擔上進行改變，讓台灣醫療有更靈活彈性的量能。 一起來聽本集 #矽谷為什麼。 討論大綱: ✅ 疫情之後，下個世代的醫學教育 ✅ 住院醫師制度的變化 ✅ 個人化醫療與遠端醫療導入 來賓介紹： 陳建宇醫師目前擔任臺北醫學大學附設醫院教學部主任與麻醉學科副教授。2020 年陳醫師前往美國加州史丹佛大學史丹佛醫學院擔任客座副教授。陳建宇醫師對於醫學倫理教育和能力導向醫學教育(CBME)有高度興趣，擅長帶領跨領域臨床人文反思、進行醫學倫理/法律臨床案例討論與初階臨床體驗。 ========================================== 歡迎與我們討論 「矽谷為什麼」 FB粉絲頁 bit.ly/39xLlDR 「台矽交流平台」社團 https://bit.ly/3oBAFvM ========================================== 在這邊也能收聽到我們的最新節目唷！ Youtube→ meetstartup.pse.is/3e6f38 Firstory→ meetstartup.pse.is/3fzp96 Apple Podcast→ meetstartup.pse.is/QEX8Y SoundCloud→ meetstartup.pse.is/R5AQ4 Spotify→ meetstartup.pse.is/RFBKL Castbox→ meetstartup.pse.is/QHQL6 SoundOn→ meetstartup.pse.is/QQX2G ========================================== 感謝 #國發會 Startup Island TAIWAN 和 #數位時代 #創業小聚 Meet Startup 獨家贊助本節目！ Powered by Firstory Hosting