Podcasts about EPUB

Contributor: Taylor Lynch, MD Educational Pearls: How do we risk-stratify chest-pain patients? One option is the HEART score This score predicts a patient's 6-week risk of a major adverse cardiac event. Ex. Cath procedure, CABG, PCI, death H stands for History Ask 1) Was the patient diaphoretic? 2) Did they have nausea and/or vomiting? 3) Did the pain radiate down the right or left arm? 4) Was it exertional? Yes to one = one point. Two or more = two points. E stands for EKG One point for left ventricular hypertrophy, t-wave inversions, new bundle-branch blocks. No points for first degree AV block, benign early repolarization, or QT-prolongation Two points for ST-depression A stands for Age >65 gets two points 45-64 gets one point R stands for Risk factors Hypertension, hyperlipidemia, diabetes, obesity, family history, smoking, previous MI, previous CABG, stroke, peripheral arterial disease 1-2 risk factors get 1 point More than two risk factors gets two points T stands for Troponin 1-3x upper limit of normal gets one point >3x upper limit of normal gets two points This gives you a score between zero and ten 0-3 points, patients have a ~2% chance of an adverse event These patients likely go home 4-6 points, patients have a ~20% chance of an adverse event These patients get admitted or expedited outpatient stress test/echo 7-10 points, patients have a ~60% chance of an adverse event Admit and call cardiology. These patients likely get catheterized References Backus BE, Six AJ, Kelder JC, Bosschaert MA, Mast EG, Mosterd A, Veldkamp RF, Wardeh AJ, Tio R, Braam R, Monnink SH, van Tooren R, Mast TP, van den Akker F, Cramer MJ, Poldervaart JM, Hoes AW, Doevendans PA. A prospective validation of the HEART score for chest pain patients at the emergency department. Int J Cardiol. 2013 Oct 3;168(3):2153-8. doi: 10.1016/j.ijcard.2013.01.255. Epub 2013 Mar 7. PMID: 23465250. Laureano-Phillips J, Robinson RD, Aryal S, Blair S, Wilson D, Boyd K, Schrader CD, Zenarosa NR, Wang H. HEART Score Risk Stratification of Low-Risk Chest Pain Patients in the Emergency Department: A Systematic Review and Meta-Analysis. Ann Emerg Med. 2019 Aug;74(2):187-203. doi: 10.1016/j.annemergmed.2018.12.010. Epub 2019 Feb 2. PMID: 30718010. https://www.mdcalc.com/calc/1752/heart-score-major-cardiac-events Summarized by Jeffrey Olson, MS4 | Edited by Jorge Chalit, OMS4 Donate: https://emergencymedicalminute.org/donate/

In this episode of the Saving Lives Podcast, we reviews a 2024 multicenter study on valproic acid for hyperactive delirium and agitation in ICU patients. The findings show that VPA may help reduce sedation needs, improve ventilator synchrony, and resolve delirium without major adverse effects. Tune in for practical insights into this emerging option for complex critical care cases.The Vasopressor & Inotrope HandbookI have written "The Vasopressor & Inotrope Handbook: A Practical Guide for Healthcare Professionals," a must-read for anyone caring for critically ill patients (check out the reviews)! You have several options to get a physical copy. Amazon: ⁠⁠⁠⁠⁠⁠⁠⁠https://amzn.to/47qJZe1⁠⁠⁠⁠⁠⁠⁠⁠ (Affiliate Link)My Store: ⁠⁠⁠⁠⁠⁠⁠⁠https://eddyjoemd.myshopify.com/products/the-vasopressor-inotrope-handbook⁠⁠⁠⁠⁠⁠⁠⁠ (Use "podcast" to save 10%)Citation: Nuti O, Merchan C, Ahuja T, Arnouk S, Papadopoulos J, Katz A. Valproic Acid for Hyperactive Delirium and Agitation in Critically Ill Patients. J Intensive Care Med. 2025 May;40(5):519-527. doi: 10.1177/08850666241302760. Epub 2024 Dec 8. PMID: 39648603.

You have a patient with complicated diverticulitis s/p IR drain with colo-cutaneous fistula and colo-vaginal fistula. They are scheduled for surgery. How will you do it? What is the role for hand assist? How can hand assist help? Tune in to find out! Join Drs. Peter Marcello, Jonathan Abelson, and Tess Aulet as they discuss high yield papers discussing hand assist laparoscopy in Colon and Rectal surgery.  Learning Objectives 1. Describe the technical considerations and how to do hand assist laparoscopic surgery (HALS) 2. Discuss the indications for use of HALS 3. Review literature supporting use of HALS   References: Marcello PW, Fleshman JW, Milsom JW, Read TE, Arnell TD, Birnbaum EH, Feingold DL, Lee SW, Mutch MG, Sonoda T, Yan Y, Whelan RL. Hand-assisted laparoscopic vs. laparoscopic colorectal surgery: a multicenter, prospective, randomized trial. Dis Colon Rectum. 2008 Jun;51(6):818-26; discussion 826-8. doi: 10.1007/s10350-008-9269-5. Epub 2008 Apr 17. PMID: 18418653. https://pubmed.ncbi.nlm.nih.gov/18418653/ Jacobs C, Read TE. "Peek port": avoiding conversion during laparoscopic colectomy-an update. Surg Endosc. 2020 Sep;34(9):3944-3948. doi: 10.1007/s00464-019-07165-3. Epub 2019 Oct 4. PMID: 31586252. https://pubmed.ncbi.nlm.nih.gov/31586252/ Heneghan HM, Martin ST, Kiran RP, Khoury W, Stocchi L, Remzi FH, Vogel JD. Laparoscopic colorectal surgery for obese patients: decreased conversions with the hand-assisted technique. J Gastrointest Surg. 2013 Mar;17(3):548-54. doi: 10.1007/s11605-012-2089-x. Epub 2012 Nov 27. PMID: 23188222. https://pubmed.ncbi.nlm.nih.gov/23188222/ 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, Professor Asim Surani, shares how his extensive research has significantly advanced the understanding of how the mammalian germline is specified, the mechanisms governing epigenetic reprogramming, and the critical conditions that maintain genomic integrity during early development. The discussion, led by Dr. Stefan Dillinger, provides an overview of Surani's journey into biology, the evolution of his research interests, and the pivotal discoveries that have shaped the field of epigenetics. Dr. Surani discusses the groundbreaking experiment he co-conducted in 1984 that led to the discovery of genomic imprinting. Initially a student involved in in vitro fertilization at Cambridge, he became intrigued by the implications of parthenogenesis in mammals. Challenging the prevailing cytoplasmic theory of development, Surani and his collaborators demonstrated that normal mammalian development requires contributions from both parental genomes, leading to the introduction of the concept of genomic imprinting—a term Surani defended to describe the phenomenon that he and his team observed. Surani's research then evolved toward understanding the mechanisms of genomic imprinting, particularly the role of DNA methylation. Throughout the interview, he details specific experiments that elucidated how genes could exhibit imprinted expression depending on the parental lineage, highlighting the importance of epigenetic factors in gene regulation. The revelation that DNA methylation marks were responsible for imprinting solidified the connection between genetic information and epigenetic influence in development. The conversation dives deeper into the mechanisms involved in germline specification and epigenetic reprogramming. Surani explains his transition into studying mammalian germline development and the intricacies of primordial germ cell specification. Working with his team, he utilized single-cell approaches to investigate gene expression profiles specific to germ cells, identifying critical factors like PRDM1 and PRDM14 that repress somatic gene programs while initiating germline-specific pathways. This work underscored the complex interplay of genetic and epigenetic factors that govern the development of germ cells. Another focus of the interview is the comparison of epigenetic resetting between mouse and human germlines. Surani addresses key differences in the timing and mechanisms of epigenetic reprogramming in humans, particularly the involvement of specific factors such as SOX17, which emerged as a crucial player in human germline specification, contrary to his earlier expectations. The discussion also highlights the technical challenges researchers face when studying human embryos due to ethical constraints, driving innovation in model systems such as stem cells to explore germline development.   References Surani MA, Barton SC, Norris ML. Development of reconstituted mouse eggs suggests imprinting of the genome during gametogenesis. Nature. 1984 Apr 5-11;308(5959):548-50. doi: 10.1038/308548a0. PMID: 6709062. Surani MA, Barton SC, Norris ML. Nuclear transplantation in the mouse: heritable differences between parental genomes after activation of the embryonic genome. Cell. 1986 Apr 11;45(1):127-36. doi: 10.1016/0092-8674(86)90544-1. PMID: 3955655. Ohinata Y, Payer B, O'Carroll D, Ancelin K, Ono Y, Sano M, Barton SC, Obukhanych T, Nussenzweig M, Tarakhovsky A, Saitou M, Surani MA. Blimp1 is a critical determinant of the germ cell lineage in mice. Nature. 2005 Jul 14;436(7048):207-13. doi: 10.1038/nature03813. Epub 2005 Jun 5. PMID: 15937476. Hajkova P, Ancelin K, Waldmann T, Lacoste N, Lange UC, Cesari F, Lee C, Almouzni G, Schneider R, Surani MA. Chromatin dynamics during epigenetic reprogramming in the mouse germ line. Nature. 2008 Apr 17;452(7189):877-81. doi: 10.1038/nature06714. Epub 2008 Mar 19. PMID: 18354397; PMCID: PMC3847605.   Related Episodes Epigenetic Reprogramming During Mammalian Development (Wolf Reik) Epigenetic and Metabolic Regulation of Early Development (Jan Żylicz) Epigenetic Mechanisms in Genome Regulation and Developmental Programming (James Hackett) Epigenetic Mechanisms of Mammalian Germ Cell Development (Mitinori Saitou) Exploring DNA Methylation and TET Enzymes in Early Development (Petra Hajkova)   Contact Epigenetics Podcast on Mastodon Epigenetics Podcast on Bluesky Dr. Stefan Dillinger on LinkedIn Active Motif on LinkedIn Active Motif on Bluesky Email: podcast@activemotif.com

Welcome to the podcast with Dr. Brendan McCarthy!   In this deeply personal episode, he shares why lab work—especially testing FSH (Follicle Stimulating Hormone)—is non-negotiable in hormone replacement therapy.   This is not about gatekeeping. It's about understanding. It's about caring. Dr. McCarthy recounts a formative memory of meeting a woman who underwent surgical menopause and was never told what would happen to her body afterward. That moment shaped his lifelong mission to treat women with comprehensive, individualized care—not cookie-cutter patches or “blind firing” estrogen without context. In this episode, he explains:

Dr hab. Magdalena Bainczyk rozmawia z prof. Mariuszem Załuckim, Sędzią Sądu Najwyższego, o instytucjonalnej sile niemieckiego sądownictwa i jego wpływie na rolę Niemiec w Unii Europejskiej.

En este episodio, nos lanzamos de lleno a comentar La Armada Invencible, una novela salvaje, irónica y entrañablemente absurda de Antonio Ortuño. Una historia donde los riffs de guitarra, los dinosaurios con chamarra de cuero y las derrotas personales se entrelazan con humor negro y crítica social.

This is a capstone presentation from Chief Resident of Mayo Clinic Emergency Medicine, Dr. Taylor Christian.   Teaser: Can we fulfill our oath to “do no harm” if we ignore the harm of racial injustice in medicine? Understanding the historical roots and persistent impact of medical racism isn't just informative; it is a call to action. This presentation is an opportunity to learn, reflect, and act to become better advocates.   CONTACTS X - @AlwaysOnEM; @VenkBellamkonda; @TayMChristian YouTube - @AlwaysOnEM; @VenkBellamkonda Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch; @drtaylormonet Email - AlwaysOnEM@gmail.com   REFERENCES & LINKS Meisel ZF, Shofer FS, Dolan AR, Goldberg E, Cannuscio CC, Rhodes KV, Perrone J, Hess EP, Rogers M, Bellamkonda V, Bell J, Zyla M, Becker L, McCollum S, Schapira M. Comparing Three Ways to Help Patients with Acute Pain Learn about Opioid Risks — The Life STORRIED Study [Internet]. Washington (DC): Patient-Centered Outcomes Research Institute (PCORI); 2021 Oct. PMID: 39383261. Engel-Rebitzer E, Dolan AR, Aronowitz SV, Shofer FS, Nguemeni Tiako MJ, Schapira MM, Perrone J, Hess EP, Rhodes KV, Bellamkonda VR, Cannuscio CC, Goldberg E, Bell J, Rodgers MA, Zyla M, Becker LB, McCollum S, Meisel ZF. Patient Preference and Risk Assessment in Opioid Prescribing Disparities: A Secondary Analysis of a Randomized Clinical Trial. JAMA Netw Open. 2021 Jul 1;4(7):e2118801. doi: 10.1001/jamanetworkopen.2021.18801. PMID: 34323984; PMCID: PMC8322998. Racic M, Roche-Miranda MI, Fatahi G. Twelve tips for implementing and teaching anti-racism curriculum in medical education. Med Teach. 2023 Aug;45(8):816-821. doi: 10.1080/0142159X.2023.2206534. Epub 2023 May 3. PMID: 37134226. Sahai A, Corley AMS, Lipps L, Lawton R, DeBlasio D, Klein M. A Locally-Focused Structural Racism Curriculum for Pediatric Primary Care Residents. Acad Pediatr. 2023 Nov-Dec;23(8):1510-1512. doi: 10.1016/j.acap.2023.06.012. Epub 2023 Jun 9. PMID: 37302703. Carrera D, Tejeda C, Kakani P, Napolitano J. Addressing Racism in Medical Education: A Longitudinal Antiracism Discussion Curriculum for Medical Students. Med Sci Educ. 2023 Apr 28;33(3):639-643. doi: 10.1007/s40670-023-01788-x. PMID: 37501797; PMCID: PMC10368613. Seegmiller Renner AM, Gross JR, Laughlin-Tommaso SK. Paving a Path to Inclusion, Diversity, Anti-Racism, and Equity: A Curriculum Roadmap. Mayo Clin Proc. 2023 Dec;98(12):1755-1762. doi: 10.1016/j.mayocp.2023.08.026. PMID: 38043992.

Seran Glanfield, owner of Spring Three and host of The Pilates Business Podcast, joins me on the podcast this week!  We discuss the evolution of Seran's work in the past four years, highlighting her experience coaching Pilates studio owners and the growth of her podcast. Seran shares insights into her Thrive coaching program, which helps studio owners build profitable and fulfilling businesses tailored to their individual visions, including balancing work with personal life and family. The conversation also explores the current landscape of the Pilates industry, noting its significant growth, increased competition, and the importance of strong branding and strategic business development for success. Tune in!I want to hear from you! Share your thoughts and follow the podcast on Instagram and Facebook @pilatesteachersmanual. Full show notes, episode transcription, and chapter markers can be found on the podcast website here: http://bit.ly/pilatesteachersmanual. Be sure to subscribe to the podcast for updates, and rate and review wherever you listen!  Episodes now available on YouTube: *https://bit.ly/YouTubePTM*Email pilatesteachersmanual@oliviabioni.com with your feedback.  Show Notes:   Check out the Pilates Business Podcast with Seran here!Interested in the Thrive program for business owners? Check it out here!Support the podcast:   Get your copy of Pilates Teachers' Manual: The Book at https://book.oliviabioni.com/pilatesteachersmanual You can purchase the EPUB or PDF version of the book above and convert it to a Kindle friendly file here: https://amazon.com/sendtokindleVisit https://shop.oliviabioni.com for podcast merch! Visit https://links.oliviabioni.com/affiliates to take advantage of some sweet savings!Episode Music:Workout Dance Day EDM by Diamond_Tunes, in compliance with Pixabay's Content License (https://pixabay.com/service/license-summary/)Listen/download: https://pixabay.com/music/dance-workout-dance-day-edm-123377/Support the show

Below is the information on the fourth edition of this great resource copied from this Carroll Center website: https://carroll.org/product/the-windows-screen-reader-primer-all-the-basics-and-more-digital-copy/ The fourth edition of The Windows Screen Reader Primer: All the Basics and More is now out. We are making it available to you for free in Word and ePub formats. It is authored by David Kingsbury, an Assistive Technology Instructor at the Carroll Center for the Blind. The book is meant to help beginning and intermediate JAWS, NVDA, and Windows Narrator users work more effectively with the most important PC applications. These applications include the Windows operating system, the four primary Office Suite applications (Word, Outlook, Excel and PowerPoint), popular Google applications, and the three most commonly used web browsers (Google Chrome, Microsoft Edge, and Mozilla Firefox). Cloud-based file-sharing programs such as Dropbox, OneDrive, and Google Drive are also covered. So too is Adobe Acrobat Reader for accessing PDF files. And participating in, scheduling, and hosting Zoom meetings. New topics in this edition include coverage of FS Companion, the New Outlook, using advanced Excel functions, and A substantially revised chapter on artificial intelligence (AI) reflecting some of the major changes that have occurred over the past year. Presenter Contact Info Email: david.kingsbury@carroll.org

Phytoremediation. A fun word to say, but what does it mean? Turns out it's quite simple: using the superpower many plants naturally have to heal our wonderful Earth from terrible soil contaminants. Allan pulls us off the dark abyss edge that is our current world to deliver a wonderful tale of plants. Primary Sources: Gerhardt KE, Gerwing PD, Greenberg BM. Opinion: Taking phytoremediation from proven technology to accepted practice. Plant Sci. 2017 Mar;256:170-185. Epub 2016 Dec 5. PMID: 28167031. Lee, Jae. (2013). An overview of phytoremediation as a potentially promising technology for environmental pollution control. Biotechnology and Bioprocess Engineering. 18. +++ More of Our Work +++ Website Facebook TikTok Twitch Bluesky +++ Contact Us +++ Text/Call: (316)-512-8933 info@grasslandgroupies.org +++ Support Us +++ Bonfire Merch Store CashApp: $GrasslandGroupies Or... donate directly to our org.

　文学者と神秘主義は、必ずしも無縁ではありません。深層意識への探究は、狂気と隣り合わせです。そもそも、想像力が働くようにするには、どうすればいいのでしょうか。そういった問題を、脳波誘導という側面から探っていきます。　以下のリンクからダウンロードして下さい。Gojigen.epub　ePubはiOSのiPadやiPhoneなどで読むのに適した形式です。iBooksなどでご覧下さい。Windowsでは紀伊國屋書店のKinoppy（http://k-kinoppy.jp/for-w..

“¿Qué harías si toda tu vida descubrieras que no era realmente tuya? Hoy hablamos de un libro que nos sacudió por dentro: La extraña Sally Diamond de Liz Nugent. Una historia que va más allá del misterio, y que nos enfrenta al lado más oscuro de la infancia, la memoria… y la identidad.”⸻

In this Complex Care Journal Club podcast episode, Drs. Tamara Simon and Patrick Brady discuss the role of the journal Hospital Pediatrics in disseminating emerging evidence in complex care. They describe the evolution of complex care research throughout the journal's history, alignment with the journal's mission, and opportunities for clinicians to contribute to the literature in partnership with families. SPEAKERS Tamara Simon, MD, MSPH, FAAP Professor of Pediatrics (Clinical Scholar) University of Southern California Keck School of Medicine and Children's Hospital Los Angeles CHLA Site Principal Investigator and Director, Workforce Development, SC CTSI‌‌ Patrick Brady, MD, MSc Professor, Division Director, Division of Hospital Medicine Cincinnati Children's Hospital University of Cincinnati College of Medicine HOST Kristina Malik, MD Assistant Professor of Pediatrics, University of Colorado School of Medicine Medical Director, KidStreet Pediatrician, Special Care Clinic, Children's Hospital Colorado DATE Initial publication date: June 9, 2025. ARTICLE REFERENCED Simon TD; THE EDITORIAL BOARD OF HOSPITAL PEDIATRICS. Complex Care Has Arrived. Hosp Pediatr. 2020 Aug;10(8):631-632. doi: 10.1542/hpeds.2020-001057. Epub 2020 Jul 2. PMID: 32616601. TRANSCRIPT https://cdn.bfldr.com/D6LGWP8S/as/q4sxvz3kvrpbvk7wqw7vms5z/Simon_and_Brady_Final_Transcript_6-4-25‌‌ Clinicians across healthcare professions, advocates, researchers, and patients/families are all encouraged to engage and provide feedback! You can recommend an article for discussion using this form: https://forms.gle/Bdxb86Sw5qq1uFhW6. Please visit: www.openpediatrics.org OPENPediatrics™ is an interactive digital learning platform for healthcare clinicians sponsored by Boston Children's Hospital and in collaboration with the World Federation of Pediatric Intensive and Critical Care Societies. It is designed to promote the exchange of knowledge between healthcare providers around the world caring for critically ill children in all resource settings. The content includes internationally recognized experts teaching the full range of topics on the care of critically ill children. All content is peer-reviewed and open-access thus at no expense to the user. For further information on how to enroll, please email: openpediatrics@childrens.harvard.edu CITATION Simon T, Brady P, Malik K. Elevating the Evidence: Complex Care Research in the Journal Hospital Pediatrics. 6/2025. OPENPediatrics. Online Podcast. https://soundcloud.com/openpediatrics/elevating-the-evidence-complex-care-research-in-the-journal-hospital-pediatrics.

Send us a textConsensus Approach for Standardization of the Timing of Brain Magnetic Resonance Imaging and Classification of Brain Injury in Neonates With Neonatal Encephalopathy/Hypoxic-Ischemic Encephalopathy: A Canadian Perspective.Mohammad K, Reddy Gurram Venkata SK, Wintermark P, Farooqui M, Beltempo M, Hicks M, Zein H, Shah PS, Garfinkle J, Sandesh S, Cizmeci MN, Fajardo C, Guillot M, de Vries LS, Pinchefsky E, Shroff M, Scott JN; Newborn Brain Health Working Group of the Canadian Neonatal Network.Pediatr Neurol. 2025 May;166:16-31. doi: 10.1016/j.pediatrneurol.2025.01.021. Epub 2025 Feb 12.PMID: 40048833 Free article.As always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below. Enjoy!

Content warning:  arson, assault, fetal abduction, kidnapping, attempted murder, murder, substance use, and substance use disorder. As shared in part one, Angelique Robledo is an incredible mother and survivor living in Arizona. She was born in Southern California, but after a pivotal move nearly four hundred miles east in her middle school years, she found herself having trouble fitting in. Several years later, and not long after finding out she was pregnant, Angelique was introduced (by a mutual friend) to a Maricopa newcomer who she seemed to have a lot in common with. Over the next several months she would get to know the also-18-year-old via text and social media; they would discuss their pregnancies and build what Angelique considered a friendship. But everything changed on February 16, 2011, when their burgeoning relationship became nearly lethal. The Broken Cycle Media team is deeply honored and grateful that Angelique was willing to so rawly share about her experiences and all that came next for her after courageously surviving an alleged attempted fetal abduction and attempted arson. Angelique's Instagram: https://www.instagram.com/angelique.robledo92/ Angelique's TikTok: https://www.tiktok.com/@angeliquemonet0 Sources: Dr. Phil Fanatic. (2025, March 12). Dr. Phil - s11 e97: Baby Snatcher: Barely escaping a fetal abduction? [Video]. YouTube. https://www.youtube.com/watch?v=AbDdw19NLgI Welner M, Burgess A, O'Malley KY. Fetal abduction by maternal evisceration: A planned homicide. Forensic Sci Int. 2021 Dec;329:111057. doi: 10.1016/j.forsciint.2021.111057. Epub 2021 Oct 17. PMID: 34739916. https://pubmed.ncbi.nlm.nih.gov/34739916/ For a list of related resources and non-profit organizations that can help, please visit http://www.somethingwaswrong.com/resources

In this episode of the Epigenetics Podcast, we talked with Petra Hajkova from the MRC Laboratory of Medical Sciences about her work on epigenetics research on mammalian development, highlighting DNA methylation, histone modifications, and TET enzymes, along with her journey in molecular genetics and future research on epigenetic maintenance. Dr. Hajkova's early work focused on DNA methylation and resulted in innovative collaboration that allowed her to develop bisulfide sequencing techniques. We discuss her transition to the UK, where she began working in Azim Surani's lab at the University of Cambridge. Dr. Hajkova describes the excitement of researching chromatin dynamics in the mouse germline, leading to significant findings published in Nature. Her story highlights the intense yet rewarding nature of postdoctoral research as she navigated the complexities of working with embryos for the first time. As her research progressed, Dr. Hajkova established her own lab at the MRC London Institute of Medical Sciences, where she became a professor in 2017. We delve into her investigations on the differences between embryonic stem cells and embryonic germ cells regarding their distinct developmental origins. Dr. Hajkova outlines the challenges she faced in understanding the mechanisms behind global DNA demethylation in germline cells and the role of hydroxymethylation during early development. The discussion further covers her exciting findings regarding the specific functions of TET enzymes and their regulatory roles in maintaining epigenetic states. We explore her recent research published in Nature, which provides insights into the transition from primordial germ cells to gonocytes, emphasizing the significance of various epigenetic mechanisms in germline development.   References Hajkova P, Ancelin K, Waldmann T, Lacoste N, Lange UC, Cesari F, Lee C, Almouzni G, Schneider R, Surani MA. Chromatin dynamics during epigenetic reprogramming in the mouse germ line. Nature. 2008 Apr 17;452(7189):877-81. doi: 10.1038/nature06714. Epub 2008 Mar 19. PMID: 18354397; PMCID: PMC3847605. Hajkova P, Jeffries SJ, Lee C, Miller N, Jackson SP, Surani MA. Genome-wide reprogramming in the mouse germ line entails the base excision repair pathway. Science. 2010 Jul 2;329(5987):78-82. doi: 10.1126/science.1187945. PMID: 20595612; PMCID: PMC3863715. Hill PWS, Leitch HG, Requena CE, Sun Z, Amouroux R, Roman-Trufero M, Borkowska M, Terragni J, Vaisvila R, Linnett S, Bagci H, Dharmalingham G, Haberle V, Lenhard B, Zheng Y, Pradhan S, Hajkova P. Epigenetic reprogramming enables the transition from primordial germ cell to gonocyte. Nature. 2018 Mar 15;555(7696):392-396. doi: 10.1038/nature25964. Epub 2018 Mar 7. PMID: 29513657; PMCID: PMC5856367. Huang TC, Wang YF, Vazquez-Ferrer E, Theofel I, Requena CE, Hanna CW, Kelsey G, Hajkova P. Sex-specific chromatin remodelling safeguards transcription in germ cells. Nature. 2021 Dec;600(7890):737-742. doi: 10.1038/s41586-021-04208-5. Epub 2021 Dec 8. PMID: 34880491.   Related Episodes Epigenetic Mechanisms of Mammalian Germ Cell Development (Mitinori Saitou) Epigenetic Reprogramming During Mammalian Development (Wolf Reik) DNA Methylation and Mammalian Development (Déborah Bourc'his)   Contact Epigenetics Podcast on Mastodon Epigenetics Podcast on Bluesky Dr. Stefan Dillinger on LinkedIn Active Motif on LinkedIn Active Motif on Bluesky Email: podcast@activemotif.com

Welcome to the podcast with Dr. Brendan McCarthy!   Can you start hormone replacement therapy (HRT) or bioidentical hormones without lab testing? Technically—yes. But should you? In this episode, Dr. Brendan McCarthy, Chief Medical Officer of Protea Medical Center, shares his medical perspective on why skipping labs could put your health at risk. Responding to viral videos that suggest lab work is unnecessary, Dr. McCarthy walks you through: ✅ Why objective data matters—especially for hormone care ✅ The dangers of prescribing hormones without testing ✅ How HRT can be safely and affordably customized ✅ Real-life clinical scenarios that show the power of lab-guided treatment Whether you're navigating perimenopause, menopause, or curious about functional medicine, this episode aims to inform—not attack—and to elevate the standard of care all patients deserve.   Dr. Brendan McCarthy founded Protea Medical Center in 2002. While he's been the chief medical officer, Protea has grown and evolved into a dynamic medical center serving the Valley and Central Arizona. A nationally recognized as an expert in hormone replacement therapy, Dr McCarthy s the only instructor in the nation who teaches BioHRT on live patients. Physicians travel to Arizona to take his course and integrate it into their own practices. Besides hormone replacement therapy, Dr. McCarthy has spoken nationally and locally before physicians on topics such as weight loss, infertility, nutritional therapy and more.   Citations: - O'Connell, Mary Beth. "Pharmacokinetic and pharmacologic variation between different estrogen products." The Journal of Clinical Pharmacology 35.9S (1995): 18S-24S.. - Qureshi, Rehana, et al. "The major pre-and postmenopausal estrogens play opposing roles in obesity-driven mammary inflammation and breast cancer development." Cell metabolism 31.6 (2020): 1154-1172.. - Bagot CN, Marsh MS, Whitehead M, Sherwood R, Roberts L, Patel RK, Arya R. The effect of estrone on thrombin generation may explain the different thrombotic risk between oral and transdermal hormone replacement therapy. J Thromb Haemost. 2010 Aug;8(8):1736-44. doi: 10.1111/j.1538-7836.2010.03953.x. Epub 2010 Jun 14. PMID:   Thank you for tuning in and don't forget to hit that SUBSCRIBE button! Let us know in the COMMENTS if you have any questions or what you may want Dr. McCarthy to talk about next!   Check out Dr. Brendan McCarthy's Book! https://www.amazon.com/Jump-Off-Mood-...   -More Links- Instagram: www.instagram.com/drbrendanmccarthy TikTok: www.tiktok.com/drbrendanmccarthy Clinic Website: www.protealife.com

In this episode, Sharona and Bosley sit down with Dr. Asao Inoue, the opening keynote speaker of the 2025 Grading Conference, to discuss his use of Labor-Based Grading in the teaching of writing. Exploring everything from negotiating a grading contract with students to intentionally discussing creating a culture of compassion in the classroom, this fascinating conversation is a great opportunity to think about our classrooms in new ways.LinksBooks from the WAC Clearinghouse are free to access in PDF and ePUB formats.Labor-Based Grading Contracts: Building Equity and Inclusion in the Compassionate Writing Classroom, 2nd Edition (from the WAC Clearinghouse)Cripping Labor-Based Grading for More Equity in Literacy Courses (from the WAC Clearinghouse)Above The Well: An Antiracist Argument From a Boy of Color (from the WAC Clearinghouse)Antiracist Writing Assessment Ecologies: Teaching and Assessing Writing for a Socially Just Future (from the WAC Clearinghouse)On Compassion and Brave Space, Asao InoueThe Greater Good WebsiteThe Science of CompassionResourcesThe Center for Grading Reform - seeking to advance education in the United States by supporting effective grading reform at all levels through conferences, educational workshops, professional development, research and scholarship, influencing public policy, and community building.The Grading Conference - an annual, online conference exploring Alternative Grading in Higher Education & K-12.Some great resources to educate yourself about Alternative Grading:The Grading for Growth BlogThe Grading ConferenceThe Intentional Academia BlogRecommended Books on Alternative Grading:Grading for Growth, by Robert Talbert and David Clark

En este episodio hablamos de una historia muy distinta a las novelas de misterio a las que nos tiene acostumbrados Joël Dicker. Esta vez nos sorprende con un cuento lleno de humor, animales alborotados y una niña protagonista que se enfrenta a una visita al zoológico que se sale completamente de control.Una jirafa despistada, un tigre curioso, pingüinos organizados y monos juguetones… ¿qué puede salir mal?⸻

Jody responds to the American College of Physicians' Annals On Call Podcast episode released on May 19th, 2025.Links:Advanced Practice Clinicians Cannot Replace Primary Care Physicians. Annals On Call Podcast, 5-29-25Physician Assistant and Former PA-Turned-Physician Discuss the State of the Profession. Patients At Risk Podcast, 7-25-21 (Spotify)New Workforce Model Suggests Continued Physician Shortages In Nonprimary Care Specialties (AAMC Article)Christin Giordano McAuliffe. There Is No Substitute for Primary Care Physicians: A Response to the Association of American Medical Colleges' Workforce Model. Ann Intern Med.2025;178:590-591. [Epub 4 March 2025]. doi:10.7326/ANNALS-24-03806University of South Alabama Dual Role NP CurriculumRazavi, Moaven PhD*; O'Reilly-Jacob, Monica RN, PhD, FNP-BC†; Perloff, Jennifer PhD*; Buerhaus, Peter RN, PhD, FAAN, FAANP(h)‡. Drivers of Cost Differences Between Nurse Practitioner and Physician Attributed Medicare Beneficiaries. Medical Care 59(2):p 177-184, February 2021. | DOI: 10.1097/MLR.0000000000001477 McMenamin A, Turi E, Schlak A, Poghosyan L. A Systematic Review of Outcomes Related to Nurse Practitioner-Delivered Primary Care for Multiple Chronic Conditions. Medical Care Research and Review. 2023;80(6):563-581. doi:10.1177/10775587231186720Kippenbrock T, Emory J, Lee P, Odell E, Buron B, Morrison B. A national survey of nurse practitioners' patient satisfaction outcomes. Nurs Outlook. 2019 Nov-Dec;67(6):707-712. doi: 10.1016/j.outlook.2019.04.010. Epub 2019 May 4. PMID: 31607371.Haas, D., Pozehl, B., Alonso, W. W., & Diederich, T. (2023). Patient Satisfaction With a Nurse Practitioner–Led Heart Failure Clinic. Journal for Nurse Practitioners, 19(4), Article 104496. https://doi.org/10.1016/j.nurpra.2022.11.006https://www.techtarget.com/patientengagement/news/366584669/Nurse-Practitioners-Boost-Patient-Satisfaction-Quality-Outcomeshttps://www.aanp.org/advocacy/advocacy-resource/position-statements/quality-of-nurse-practitioner-practicehttps://www.aacnnursing.org/news-data/all-news/rounds-with-leadership-focusing-on-the-outcomes-of-np-practiceStanik-Hutt, J., Newhouse, R. P., White, K. M., Johantgen, M., Bass, E. B., Zangaro, G., Wilson, R., Fountain, L., Steinwachs, D. M., Heindel, L., & Weiner, J. P. (2013). The quality and effectiveness of care provided by nurse practitioners. Journal for Nurse Practitioners, 9(8), 492-500.e13. https://doi.org/10.1016/j.nurpra.2013.07.004Savard I, Al Hakim G, Kilpatrick K. The added value of the nurse practitioner: An evolutionary concept analysis. Nurs Open. 2023 Apr;10(4):2540-2551. doi: 10.1002/nop2.1512. Epub 2022 Dec 17. PMID: 36527435; PMCID: PMC10006655.

We covered a paper in episode 81 that suggested treating atrial fibrillation with rapid ventricular response in the field could lower mortality. But it also drops BP a bit. Could pretreating these patients with calcium lower the risk of hypotension? Dr Jarvis puts on his nerd hat and uses Bayesian analysis to assess a new randomized, placebo-controlled study that looked at just this thing. Why is he going off on this Bayes thing? Because he's been reading a couple of book on it and wanted to take it for a spin.  Tables:  Charts: Bayesian Distributions: Citation: 1.     Az A, Sogut O, Dogan Y, Akdemir T, Ergenc H, Umit TB, Celik AF, Armagan BN, Bilici E, Cakmak S: Reducing diltiazem-related hypotension in atrial fibrillation: Role of pretreatment intravenous calcium. The American Journal of Emergency Medicine. 2025;February;88:23–8.2.     Fornage LB, O'Neil C, Dowker SR, Wanta ER, Lewis RS, Brown LH: Prehospital Intervention Improves Outcomes for Patients Presenting in Atrial Fibrillation with Rapid Ventricular Response. Prehospital Emergency Care. doi: 10.1080/10903127.2023.2283885 (Epub ahead of print).3.     Kolkebeck T, Abbrescia K, Pfaff J, Glynn T, Ward JA: Calcium chloride before i.v. diltiazem in the management of atrial fibrillation. The Journal of Emergency Medicine. 2004;May 1;26(4):395–400.4.     Chivers T: Everything Is Predictable: How Bayes' Remarkable Theorem Explains the World. Weidenfeld & Nicolson, 2024.5.     McGrayne SB: The Theory That Would Not Die. how Bayes' Rule Cracked The Enigma Code, Hunted Down Russian Submarines & Emerged Triumphant From Two Centuries of Controversy. New Haven, CT, Yale University Press, 2011. FAST25 | May 19-21, 2025 | Lexington, KY

This is the second part of a crossover episode with Mara Sievers of Pilates Encyclopedia discussing Olivia's Pilates journey, how she's grown as an instructor,  and all about writing Pilates Teachers' Manual: The Book! Check out the first part here: https://youtu.be/E3CZIxyaQyQI want to hear from you! Share your thoughts and follow the podcast on Instagram and Facebook @pilatesteachersmanual. Full show notes, episode transcription, and chapter markers can be found on the podcast website here: http://bit.ly/pilatesteachersmanual. Be sure to subscribe to the podcast for updates, and rate and review wherever you listen!  Episodes now available on YouTube: *https://bit.ly/YouTubePTM*Email pilatesteachersmanual@oliviabioni.com with your feedback.  Show Notes:   You can purchase the EPUB or PDF version of the book here and convert to a Kindle friendly file here: https://amazon.com/sendtokindleSupport the podcast:   Get your copy of Pilates Teachers' Manual: The Book at https://book.oliviabioni.com/pilatesteachersmanualVisit https://shop.oliviabioni.com for podcast merch! Visit https://links.oliviabioni.com/affiliates to take advantage of some sweet savings!Episode Music:Workout Dance Day EDM by Diamond_Tunes, in compliance with Pixabay's Content License (https://pixabay.com/service/license-summary/)Listen/download: https://pixabay.com/music/dance-workout-dance-day-edm-123377/Support the show

Mood swings, brain fog, and burnout? It might not just be stress—it could be perimenopause. In this episode, Dr. Stephanie Hack, MD, MPH explores the connection between hormonal changes and depression during the menopausal transition. Backed by clinical evidence and national research studies, she breaks down why this critical phase is so often misunderstood, how to recognize real warning signs, and what steps you can take to protect your mental health. Because yes—healthcare is self-care, and knowledge is power.References:1.       Kessler RC, McGonagle KA, Zhao S et al. Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Arch Gen Psychiatry 1994;51:8–19. [DOI] [PubMed] [Google Scholar]2.   Freeman EW, Sammel MD, Liu L, Gracia CR, Nelson DB, Hollander L. Hormones and menopausal status as predictors of depression in women in transition to menopause. Arch Gen Psychiatry 2004;61:62–70. [DOI] [PubMed] [Google Scholar]3.   Bromberger JT, Epperson CN. Depression During and After the Perimenopause: Impact of Hormones, Genetics, and Environmental Determinants of Disease. Obstet Gynecol Clin North Am. 2018 Dec;45(4):663-678. doi: 10.1016/j.ogc.2018.07.007. Epub 2018 Oct 25. PMID: 30401549; PMCID: PMC6226029. (https://pmc.ncbi.nlm.nih.gov/articles/PMC6226029/#R4)4.   Behrman S, Crockett C. Severe mental illness and the perimenopause. BJPsych Bull. 2023 Nov 13;48(6):1-7. doi: 10.1192/bjb.2023.89. Epub ahead of print. PMID: 37955045; PMCID: PMC11669460. https://pmc.ncbi.nlm.nih.gov/articles/PMC11669460/#:~:text=Fluctuations%20of%20hormone%20levels%20and,episodes%20of%20mental%20illness%2C%20including5.   https://www.health.harvard.edu/womens-health/perimenopause-rocky-road-to-menopause6.   https://www.swanstudy.org/womens-health-info/depression-menopause/7.   https://www.swanstudy.org/wps/wp-content/uploads/2023/04/SWAN-Fact-Sheets-Depression.pdf8.   Santoro N, Epperson CN, Mathews SB. Menopausal Symptoms and Their Management. Endocrinol Metab Clin North Am. 2015 Sep;44(3):497-515. doi: 10.1016/j.ecl.2015.05.001. PMID: 26316239; PMCID: PMC4890704. (https://pmc.ncbi.nlm.nih.gov/articles/PMC4890704/)9.   Kravitz HM, Colvin AB, Avis NE, Joffe H, Chen Y, Bromberger JT. Risk of high depressive symptoms after the final menstrual period: the Study of Women's Health Across the Nation (SWAN). Menopause. 2022 Jul 1;29(7):805-815. doi: 10.1097/GME.0000000000001988. PMID: 35796553; PMCID: PMC9268212. { https://pubmed.ncbi.nlm.nih.gov/35796553/ )10. Gibbs Z, Lee S, Kulkarni J. What factors determine whether a woman becomes depressed during the perimenopause? Arch Womens Ment Health 2012;15:323–332.

In this episode, we dive into the rapidly evolving world of ambient listening AI in healthcare. From outpatient clinics to inpatient wards and operating rooms, this technology is reshaping how care is delivered, documented, and experienced. We explore how ambient listening AI is improving clinic flow by streamlining documentation and reducing interruptions, allowing clinicians to stay more present with their patients. The technology is increasingly adaptive to individual provider styles, learning preferences and workflows to deliver more personalized support. Plus, we share practical tips for new users to get the most out of their ambient listening AI systems from day one. Join us as we hear from experts on the front lines and debate the future of ambient listening AI in medicine—where the walls really do have ears, but for all the right reasons. Host:  - Nicole Petcka, MD – General Surgery Resident, Emory University, @npetcka2022 Guests:  - Samuel R. Torres Landa Fernández, MD – Minimally Invasive Surgery Fellow, Emory University  - Anastasios Nikolaos (Nick​) Panagopoulos, MD – Internal Medicine Resident, Emory University  - Joe Sharma, MD - McGarity Chair in Endocrine Surgery and Professor of Surgery, Vice-chair for Patient Safety, Quality and Innovation, Emory University  Resources:  Enhancing Accuracy of Operative Reports with Automated Artificial Intelligence Analysis of Surgical Video Khanna A, Wolf T, Frank I, Krueger A, Shah P, Sharma V, Gettman MT, Boorjian SA, Asselmann D, Tollefson MK. Enhancing Accuracy of Operative Reports with Automated Artificial Intelligence Analysis of Surgical Video. J Am Coll Surg. 2025 May 1;240(5):739-746. doi: 10.1097/XCS.0000000000001352. Epub 2025 Apr 16. PMID: 39918224. https://pubmed.ncbi.nlm.nih.gov/39918224/ 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

Contributor: Aaron Lessen, MD Educational Pearls: How do we take care of kids in severe pain? There are many non-pharmacologic options for pain (i.e. ice, elevation) as well as more conventional medication options (i.e. acetaminophen, NSAIDS) but in severe pain stronger medications might be indicated. These stronger medications include options such as IV morphine, a subdissociative dose of ketamine, as well as intranasal fentanyl. Intranasal fentanyl has many advantages: Studies have shown it might be more effective early on in controlling pain, as in the first 15-20 minutes after administration, and then becomes equivalent to other pain control options Total adverse effects were also lower with IN fentanyl, including low rates of nausea and vomiting To administer, use the IV formulation with an atomizer and spray into the nose; therefore, you do not need an IV line Dose is 1-2 micrograms per kilogram, can be redosed once at 10 minutes.  Don't forget about gabapentinoids for neuropathic pain, muscle relaxants for muscle spasms, and nerve blocks when appropriate. (Disclaimer: muscle relaxers have not been well studied in children) References Alsabri M, Hafez AH, Singer E, Elhady MM, Waqar M, Gill P. Efficacy and Safety of Intranasal Fentanyl in Pediatric Emergencies: A Systematic Review and Meta-analysis. Pediatr Emerg Care. 2024 Oct 1;40(10):748-752. doi: 10.1097/PEC.0000000000003187. Epub 2024 Apr 11. PMID: 38713846. Bailey B, Trottier ED. Managing Pediatric Pain in the Emergency Department. Paediatr Drugs. 2016 Aug;18(4):287-301. doi: 10.1007/s40272-016-0181-5. PMID: 27260499. Hadland SE, Agarwal R, Raman SR, Smith MJ, Bryl A, Michel J, Kelley-Quon LI, Raval MV, Renny MH, Larson-Steckler B, Wexelblatt S, Wilder RT, Flinn SK. Opioid Prescribing for Acute Pain Management in Children and Adolescents in Outpatient Settings: Clinical Practice Guideline. Pediatrics. 2024 Sep 30:e2024068752. doi: 10.1542/peds.2024-068752. Epub ahead of print. PMID: 39344439. Summarized by Jeffrey Olson, MS4 | Edited by Jorge Chalit, OMS4 Donate: https://emergencymedicalminute.org/donate/

En este episodio, nos adentramos en el fascinante y a veces olvidado mundo vegetal con dos libros que nos volaron la cabeza (sí, como semillas al viento

D&D and RPG news and commentary by Mike Shea of https://slyflourish.com Contents 00:00 Show Start 00:33 Sly Flourish News: New Articles, Updated Obsidian Notes, COA Shipping in Europe, Lazy DM's Companion in EPUB and Markdown 08:04 D&D & RPG News: Old School Essentials Bundle of Holding 11:14 Kickstarter Spotlight: Blades in the Dark Deep Cuts 13:52 D&D & RPG News: Daggerheart Released 27:42 DM Tip: Mashing Up the Eight Steps 48:04 Commentary: Too Much Linking In Markdown Notes 49:57 Patreon Question: Rolling 3d6 For Ability Scores 53:34 Patreon Question: Low Level Characters with Powerful Legacy Magic Items 57:11 Patreon Question: Building Rich Tactical Battles in Old School Adventures Links Subscribe to the Sly Flourish Newsletter Support Sly Flourish on Patreon Buy Sly Flourish Books: Your Criteria for Selecting Great Published Adventures Leave Blanks Old School Essentials Bundle of Holding Blades in the Dark Deep Cuts Backerkit Campaign Dice Exploder Interview with Jonathan Harper on Blades in the Dark Deep Cuts Daggerheart on Critical Role Store Daggerheart SRD Daggerheart Community License Daggerheart Quickstart PDF Evaluating an adventure — Patchwork Paladin

Send us a textTrajectory of Postnatal Oxygen Requirement in Extremely Preterm Infants.Groves AM, Bennett MM, Loyd J, Clark RH, Tolia VN.J Pediatr. 2025 Feb;277:114414. doi: 10.1016/j.jpeds.2024.114414. Epub 2024 Nov 20.PMID: 39577761As always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below. Enjoy!

Send us a textThe new normal: parental use of online health communities in the NICU.Adams SY, Tucker R, Lechner BE.Pediatr Res. 2022 Jun;91(7):1827-1833. doi: 10.1038/s41390-021-01684-3. Epub 2021 Aug 17.PMID: 34404928As always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below. Enjoy!

In this episode of "PICU Doc on Call," pediatric intensivists Dr. Rahul Damania, Dr. Pradip Kamat, and Dr. Monica Gray discuss a critical case involving a 16-year-old male who experienced severe carbon monoxide poisoning after being found unresponsive in a garage. They chat about the pathophysiology, clinical manifestations, diagnostic workup, and management of carbon monoxide toxicity. Furthermore, they cover the importance of early oxygen administration, recognizing potential delayed neurological sequelae, and keeping an eye out for cardiac complications. Tune in and hear more about a comprehensive approach to treatment and the significance of multidisciplinary support for achieving the best patient outcomes.Show Highlights:Case presentation of a 16-year-old male with severe carbon monoxide poisoningPathophysiology of carbon monoxide toxicity and its effects on hemoglobinClinical manifestations and symptoms associated with carbon monoxide poisoningDiagnostic workup for suspected carbon monoxide exposureManagement principles for treating carbon monoxide poisoning in pediatric patientsSources and scenarios leading to carbon monoxide poisoningComplications arising from carbon monoxide exposure including neurological injuriesImportance of early oxygen administration and monitoring in treatmentDiscussion of hyperbaric oxygen therapy and its indicationsKey takeaways for clinicians regarding the management and follow-up of carbon monoxide poisoning casesWe welcome you to share your feedback, subscribe & place a review on our podcast! Please visit our website picudoconcall.org.References:Tapking, C., et al. (2021). Burn and inhalation injury. In J. J. Zimmerman & A. T. Rotta (Eds.), Fuhrman and Zimmerman's Pediatric Critical Care (6th ed., pp. 1347–1362). Elsevier.Nañagas KA, Penfound SJ, Kao LW. Carbon Monoxide Toxicity. Emerg Med Clin North Am. 2022 May;40(2):283-312. doi: 10.1016/j.emc.2022.01.005. Epub 2022 Apr 5. PMID: 35461624.Smollin C, Olson K. Carbon monoxide poisoning (acute). BMJ Clin Evid. 2010 Oct 12;2010:2103. PMID: 21418677; PMCID: PMC3217756.Palmeri R, Gupta V. Carboxyhemoglobin Toxicity. [Updated 2023 Apr 17]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan.

Drs. Amy Crockett (@amyhcrockett), Ben Ereshefsky (@brainofbpharm), and Pamela Bailey (@pamipenem) join Dr. Julie Ann Justo (@julie_justo) to discuss new treatment strategies for management of intraamniotic infections, also known as chorioamnionitis. They discuss whether it is time to move away from the combination of ampicillin, gentamicin, and/or clindamycin, alternative antibiotic regimens to consider, and stewardship strategies to approach this practice change at a local level. References: Basic stats/epi on chorioamnionitis: Romero R, et al. Clinical chorioamnionitis at term I: microbiology of the amniotic cavity using cultivation and molecular techniques. J Perinat Med. 2015 Jan;43(1):19-36. doi: 10.1515/jpm-2014-0249. PMID: 25720095. ACOG 2017 Guideline for IAI: Committee Opinion No. 712: Intrapartum Management of Intraamniotic Infection. Obstet Gynecol. 2017 Aug;130(2):e95-e101. doi: 10.1097/AOG.0000000000002236. PMID: 28742677. ACOG 2024 Update on clinical criteria for IAI: ACOG Clinical Practice Update: Update on Criteria for Suspected Diagnosis of Intraamniotic Infection. Obstetrics & Gynecology 144(1):p e17-e19, July 2024. doi: 10.1097/AOG.0000000000005593 Helpful review with more recent microorganisms : Jung E, et al. Clinical chorioamnionitis at term: definition, pathogenesis, microbiology, diagnosis, and treatment. Am J Obstet Gynecol. 2024 Mar;230(3S):S807-S840. doi: 10.1016/j.ajog.2023.02.002. PMID: 38233317. Cochrane Review: Chapman E, et al. Antibiotic regimens for management of intra-amniotic infection. Cochrane Database Syst Rev. 2014 Dec 19;2014(12):CD010976. doi: 10.1002/14651858.CD010976.pub2. PMID: 25526426. Helpful recent review on intrapartum infections: Bailey, P, et al_._ Out with the Old, In with the New: A Review of the Treatment of Intrapartum Infections. Curr Infect Dis Rep. 2024;26:107–113 doi: 10.1007/s11908-024-00838-8. Role of genital mycoplasmas in IAI: Romero R, et al. Evidence that intra-amniotic infections are often the result of an ascending invasion - a molecular microbiological study. J Perinat Med. 2019 Nov 26;47(9):915-931. doi: 10.1515/jpm-2019-0297. PMID: 31693497. Regimens without enterococcal coverage with similar clinical outcomes: Blanco JD, et al. Randomized comparison of ceftazidime versus clindamycin-tobramycin in the treatment of obstetrical and gynecological infections. Antimicrob Agents Chemother. 1983 Oct;24(4):500-4. doi: 10.1128/AAC.24.4.500. PMID: 6360038. Bookstaver PB, et al. A review of antibiotic use in pregnancy. Pharmacotherapy. 2015 Nov;35(11):1052-62. doi: 10.1002/phar.1649. PMID: 26598097. Updated review in pregnancy, includes data on frequency of antibiotic use in pregnancy: Nguyen J, et al. A review of antibiotic safety in pregnancy-2025 update. Pharmacotherapy. 2025 Apr;45(4):227-237. doi: 10.1002/phar.70010. Epub 2025 Mar 19. PMID: 40105039. Locksmith GJ, et al. High compared with standard gentamicin dosing for chorioamnionitis: a comparison of maternal and fetal serum drug levels. Obstet Gynecol. 2005 Mar;105(3):473-9. doi: 10.1097/01.AOG.0000151106.87930.1a. PMID: 15738010. Clindamycin CDI Risk: Miller AC, et al. Comparison of Different Antibiotics and the Risk for Community-Associated Clostridioides difficile Infection: A Case-Control Study. Open Forum Infect Dis. 2023 Aug 5;10(8):ofad413. doi: 10.1093/ofid/ofad413. PMID: 37622034. Impact of penicillin allergy on clindamycin use & cites 47% clindamycin resistance per CDC among GBS: Snider JB, et al. Antibiotic choice for Group B Streptococcus prophylaxis in mothers with reported penicillin allergy and associated newborn outcomes. BMC Pregnancy Childbirth. 2023 May 30;23(1):400. doi: 10.1186/s12884-023-05697-0. PMID: 37254067. Clindamycin anaerobic coverage data: Hastey CJ, et al. Changes in the antibiotic susceptibility of anaerobic bacteria from 2007-2009 to 2010-2012 based on the CLSI methodology. Anaerobe. 2016 Dec;42:27-30. doi: 10.1016/j.anaerobe.2016.07.003. PMID: 27427465. Older PK study of ampicillin & gentamicin for chorioamnionitis: Gilstrap LC 3rd, Bawdon RE, Burris J. Antibiotic concentration in maternal blood, cord blood, and placental membranes in chorioamnionitis. Obstet Gynecol. 1988 Jul;72(1):124-5. PMID: 3380500. Paper putting out the call for modernization of OB/Gyn antibiotic regimens: Pek Z, Heil E, Wilson E. Getting With the Times: A Review of Peripartum Infections and Proposed Modernized Treatment Regimens. Open Forum Infect Dis. 2022 Sep 5;9(9):ofac460. doi: 10.1093/ofid/ofac460. PMID: 36168554. Vanderbilt University Medical Center experience with modernizing OB/Gyn infection regimens: Smiley C, et al. Implementing Updated Intraamniotic Infection Guidelines at a Large Academic Medical Center. Open Forum Infect Dis. 2024 Sep 5;11(9):ofae475. doi: 10.1093/ofid/ofae475. PMID: 39252868. Prisma Health/University of South Carolina experience with modernizing OB/Gyn infection regimens: Bailey P, et al. Cefoxitin for Intra-amniotic Infections and Endometritis: A Retrospective Comparison to Traditional Antimicrobial Therapy Regimens Within a Healthcare System. Clin Infect Dis. 2024 Jul 19;79(1):247-254. doi: 10.1093/cid/ciae042. PMID: 38297884.

This week's episode looks at the various ways we can offer corrections to our clients during group classes. We explore the importance of consent, the purpose of a hands on correction, and how you may be able to achieve the same outcome with a hands off correction. Tune in!I want to hear from you! Share your thoughts and follow the podcast on Instagram and Facebook @pilatesteachersmanual. Full show notes, episode transcription, and chapter markers can be found on the podcast website here: http://bit.ly/pilatesteachersmanual. Be sure to subscribe to the podcast for updates, and rate and review wherever you listen!  Episodes now available on YouTube: *https://bit.ly/YouTubePTM*Email pilatesteachersmanual@oliviabioni.com with your feedback.  Show Notes:   You can purchase the EPUB or PDF version of the book here and convert to a Kindle friendly file here: https://amazon.com/sendtokindleSupport the podcast:   Get your copy of Pilates Teachers' Manual: The Book at https://book.oliviabioni.com/pilatesteachersmanualVisit https://shop.oliviabioni.com for podcast merch! Visit https://links.oliviabioni.com/affiliates to take advantage of some sweet savings!Episode Music:Workout Dance Day EDM by Diamond_Tunes, in compliance with Pixabay's Content License (https://pixabay.com/service/license-summary/)Listen/download: https://pixabay.com/music/dance-workout-dance-day-edm-123377/Support the show

Upon reading the beginning of this homily, one clearly gets the sense that Saint Isaac the Syrian wants our understanding of the spiritual life, who we are as human beings, and a relationship with God (who has created us in His image and likeness), to be set on a foundation that is unshakable. One must love Isaac for the effort! He is giving us eyes to see.  He began by presenting us with an image of a soul who truly abides in her nature, and so comes to penetrate into and understand the wisdom of God. Knowing nothing of the impediment of the passions, the soul is lifted up toward God and is astonished and struck with wonder. This is Isaac's starting point for a reason. He wants us to regain what over the course of time has been lost; that is, our perception the beauty and wonder of how God has created us and our natural capacity for love and virtue. Furthermore, it is not just about perception but the experience of being God bearers and temples of the Holy Spirit. It is about our deification.  What has distorted or understanding is the emergence of the passions and how we have come to view them. Isaac tells us categorically that the soul by nature is passionless. We are created in God‘s image and likeness and it is only the emergence of sin that has darken that which was created to be filled with light. Thus, when a soul is moved in a passionate way, she is outside her nature. The passions have the ability to move the soul after the fall. There's a radical communion between body and soul and with sin our experience of the world through the senses and in our desires and appetites become distorted. The break of communion with God leads to an internal break within us as human beings; a fragmentation on the deepest level of our existence. What is the nature of a soul created for communion when it pursues autonomy from the one who created her in love? Is it not only the loss of unity with God but within ourselves and our capacity to experience and reflect our true dignity?  Saint Isaac makes us work in these paragraphs and grapple to understand what he's saying. Yet, it is a labor of love; for it is upon the foundation of this understanding of our nature that we will once again be able to see the wonder and beauty of how God has created us and experience the healing necessary to reflect this wondrous reality to the world. --- Text of chat during the group: 00:17:20 Bob Čihák, AZ: P. 127, paragraph 1 00:31:07 Lindsey Funair: When I hear the memories of the soul grow old, it reminds me that the soul knows not ego or attachment, it remembers only what is worthy of taking to Paradise, only that that is in Love. That is all there is once the world and self-love and other things that are not Love, is filtered from our memory. 00:31:13 Anthony: It's important to say that Isaac was born into a time and geography of turmoil and he wasn't living in comfort locked away from the outside. 00:31:43 Maureen Cunningham: Washington Carfer 00:31:52 Maureen Cunningham: Carver 00:33:02 Troyce Garrett Quimpo: This sections reminds me of St John of the Cross's Purgative Way. 00:36:11 Anthony: George Washington Carver 00:36:20 Vanessa: famous Black inventer 00:40:08 Maureen Cunningham: Yes George Washington Carver thank you , a little book I read . A Man who talked to flowers. 00:40:34 Anthony: I think when Isaac refers to philosophers he might have in mind the humors that dominate a man or the astrologers who Forcast about a person. 00:42:08 Lindsey Funair: it helps me to think of passions in this sense of Maslow's entire hierarchy, those things which are necessary to life and living and connecting with others and doing good, but when focused on directly become a distraction from the humility and obedience which place us "in" our soul and in relative connection to God 00:42:08 Manuel: How this idea that the soul is passionless by nature fit in with the opening of the Philokalia “There is among the passions an anger of the intellect, and this anger is in accordance with nature. Without anger a man cannot attain purity”? 00:44:25 Vanessa: When I went to university, I always thought the academics disciplines were centered around "explaining the world without God." 00:44:51 Anthony: I wrote it 00:44:56 Kathy Locher: What in our nature would have made us susceptible to temptation. Especially, given that we were living in Eden in God's company? 00:45:31 Ryan N: Father what would your response be to those who emphasize the importance of the body because it is equally made in the image and likeness of God ( not just the soul) 00:46:35 Myles Davidson: Reacted to "What in our nature w..." with

In this episode of the Epigenetics Podcast, we talked with Ani Deshpande from Sanford Burnham Prebys about his work on epigenetic regulation and developing small molecules through high throughput screens for AML. Throughout our discussion, we delve into Dr. Despande's journey into the field of biology and science, tracing his evolution from a literature enthusiast in Mumbai to a dedicated cancer researcher. He reflects on his formative experiences during his PhD at Ludwig Maximilian University in Munich, where she developed murine models for refractory acute myeloid leukemia (AML). We examine these models' contributions to therapeutic discovery and understanding the intricate mechanisms underscoring AML's complexities. Transitioning to his postdoctoral work at Scott Armstrong's lab in Boston, Dr. Despande shares his insights on the importance of epigenetic regulators, such as DOT1L, in leukemias, and how they can serve as strategic therapeutic targets. His ambitious pursuit of translational research is further highlighted through his efforts in developing a conditional knockout mouse model and his collaborative work utilizing CRISPR technology to refine our understanding of epigenetic regulation in cancer pathogenesis. Moreover, we engage in a conversation about the challenges and opportunities that arise when establishing his lab at Sanford Burnham Prebys. Dr. Despande candidly discusses the delicate balance between pursuing topics of genuine interest versus adhering to grant fundability, underlining the tension researchers face in the current scientific landscape. His emphasis on the critical need for innovation within lab settings serves as a motivational call for emerging scientists to venture beyond the established templates that often inhibit groundbreaking discoveries. We conclude our dialogue with an exploration of his recent projects, which involve targeting specific epigenetic modifiers and how his lab's findings can contribute to greater understanding and potential treatments for not only AML but also other pediatric cancers driven by gene fusions. Dr. Despande's insights into the integration of modern technologies, such as CRISPR libraries, exemplify his commitment to pushing the boundaries of cancer research. In addition to discussing his scientific contributions, we touch upon Dr. Despande's foray into podcasting (The Discovery Dialogues), shedding light on his motivation to bridge the communication gap between scientists and the broader public. He articulates his desire to demystify scientific discoveries and promote awareness about the intricate journey of research that lays the groundwork for medical advancements. This multidimensional discussion not only highlights his scientific achievements but also emphasizes the importance of effective science communication in fostering public understanding and appreciation of research.   References Deshpande AJ, Cusan M, Rawat VP, Reuter H, Krause A, Pott C, Quintanilla-Martinez L, Kakadia P, Kuchenbauer F, Ahmed F, Delabesse E, Hahn M, Lichter P, Kneba M, Hiddemann W, Macintyre E, Mecucci C, Ludwig WD, Humphries RK, Bohlander SK, Feuring-Buske M, Buske C. Acute myeloid leukemia is propagated by a leukemic stem cell with lymphoid characteristics in a mouse model of CALM/AF10-positive leukemia. Cancer Cell. 2006 Nov;10(5):363-74. doi: 10.1016/j.ccr.2006.08.023. PMID: 17097559. Deshpande AJ, Deshpande A, Sinha AU, Chen L, Chang J, Cihan A, Fazio M, Chen CW, Zhu N, Koche R, Dzhekieva L, Ibáñez G, Dias S, Banka D, Krivtsov A, Luo M, Roeder RG, Bradner JE, Bernt KM, Armstrong SA. AF10 regulates progressive H3K79 methylation and HOX gene expression in diverse AML subtypes. Cancer Cell. 2014 Dec 8;26(6):896-908. doi: 10.1016/j.ccell.2014.10.009. Epub 2014 Nov 20. PMID: 25464900; PMCID: PMC4291116. Sinha S, Barbosa K, Cheng K, Leiserson MDM, Jain P, Deshpande A, Wilson DM 3rd, Ryan BM, Luo J, Ronai ZA, Lee JS, Deshpande AJ, Ruppin E. A systematic genome-wide mapping of oncogenic mutation selection during CRISPR-Cas9 genome editing. Nat Commun. 2021 Nov 11;12(1):6512. doi: 10.1038/s41467-021-26788-6. Erratum in: Nat Commun. 2022 May 16;13(1):2828. doi: 10.1038/s41467-022-30475-5. PMID: 34764240; PMCID: PMC8586238.   Related Episodes Targeting COMPASS to Cure Childhood Leukemia (Ali Shilatifard) The Menin-MLL Complex and Small Molecule Inhibitors (Yadira Soto-Feliciano) MLL Proteins in Mixed-Lineage Leukemia (Yali Dou)   Contact Epigenetics Podcast on Mastodon Epigenetics Podcast on Bluesky Dr. Stefan Dillinger on LinkedIn Active Motif on LinkedIn Active Motif on Bluesky Email: podcast@activemotif.com

Contributor: Travis Barlock, MD Educational Pearls: Wheezing is classically heard in asthma and COPD, but it can be the result of a wide range of processes that cause airflow limitation Narrowed bronchioles lead to turbulent airflow → creates the wheezing Crackles (rales) suggest pulmonary edema which is often due to heart failure Approximately 35% of heart failure patients have bronchial edema, which can also produce wheezing COPD and heart failure can coexist in a patient, and both of these diseases can cause wheezing It's vital to differentiate whether the wheezing is due to the patient's COPD or their heart failure because the treatment differs Diagnosing wheezing due to heart failure (cardiac asthma): Symptoms: orthopnea, paroxysmal nocturnal dyspnea Diagnostic tools: bedside ultrasound Treatment: diuresis and BiPAP for respiratory support Not all wheezing is asthma Consider heart failure in the differential and tailor treatment accordingly References 1. Buckner K. Cardiac asthma. Immunol Allergy Clin North Am. 2013 Feb;33(1):35-44. doi: 10.1016/j.iac.2012.10.012. Epub 2012 Dec 23. PMID: 23337063. 2. Hollingsworth HM. Wheezing and stridor. Clin Chest Med. 1987 Jun;8(2):231-40. PMID: 3304813. Summarized by Meg Joyce, MS1 | Edited by Meg Joyce & Jorge Chalit, OMS3 Donate: https://emergencymedicalminute.org/donate/  

En este episodio de Mentesliterales, te llevamos a un viaje literario lleno de misterio y nostalgia. Hablamos de Tranvías del autor Hans Olav Lahlum, una novela de suspense ambientada en Noruega que combina un crimen intrigante con un retrato fascinante de la sociedad de la época. Comentamos la trama, los personajes y la particular forma en que Lahlum nos sumerge en su atmósfera única.Además, como ya es costumbre, compartimos algunas anécdotas curiosas y divertidas que nos sucedieron en la semana. Desde accidentes extraños hasta pequeños momentos que nos sacaron una sonrisa, este episodio mezcla la pasión por los libros con nuestra dosis de vida cotidiana.

Even if you don't have hot flashes, stay with me on this because this episode is on exercise and hot flashes. We're going to dissect the science and eradicate “science says” as a cry for validity by influencers.  Hot flashes are one of the most common symptoms of menopause. I'll talk about the relationship between exercise and hot flashes along with other menopause symptoms like muscle loss or fat increase.   In previous podcast episodes and books, I've shared researcher comments about whether exercise could mitigate menopause symptoms. The answer, “Yes, provided it's intense enough.”    The Science A 2024 study on 72 pre, peri and postmenopausal women, published in the Menopause Journal of The Menopause Society, looked at the impact of minutes spent in 3 exercise intensities and body composition on total menopause symptoms (TMS).  More symptoms were associated with higher body fat. Intense physical exercise improves % body composition and may reduce TMS, beneficial for perimenopausal women.  An article published by the American College of Sports Medicine, looked at protein turnover changes, muscle size, quality and strength during menopause. All seemed to decline.    What we don't know [Dr Stuart Phillips' response to Mary Claire Haver's Instagram post regarding estrogen's impact on muscle] is the cause for these changes.   Is there evidence for causation between decline of estrogen and decrease in muscle mass, which some women experience:  Insomnia  Poor mood, depression or anxiety Lack of motivation (serotonin receptors) A time crunch in midlife  Comfort or emotional eating  Repeatedly, women will say, “I haven't changed a thing, but my results have changed.” That would be true if you didn't change what it was you were doing. If your hormones have changed, we have to change the exercise.   Another 2024 study in Menopause Journal showed both moderate intensity and resistance training exercise will decrease hot flash occurrence in some women, especially in women with depression.  High Intensity - more impact on body composition and positive impact on hot flashes Moderate Intensity - decreased hot flash occurrence   Exercise and Hot Flashes, Estrogen and Muscle Whether we're talking about exercise and hot flashes or estrogen and muscle loss, so many variables could be at play, even if the science is a randomized double-blind study with a large enough subject pool. If hormones have changed, we have to change the exercise (including nutrition and sleep habits) or it's not going to work.  If medications become important, then we have to look at micronutrients because they're depleted by each prescription or OTC med. If you don't absorb micronutrients you don't have optimal muscle or strength building blocks.    Social Media The type of studies that influencers share matters. Whether they've shared a review of literature, a double-blind randomized control study, or a narrative or know what that means What is the interpretation that helps you make decisions on changes you may want to consider or that reinforces what you are doing? The only real thing an influencer is sharing unless they share the science with you is, “what works for me” and you're left to guess… is that really what happens behind the scenes?    But before I share that, I think we know this:  Both are on a worthy mission… To improve the knowledge we have about muscle, bone and aging and the impact on them of daily and weekly habits  To acknowledge menopause has historically impacted women's health.   What can you do with the information? Make the best choices on exercise prescription, dietary choices, lifestyle habits to offset what is impacted by hormonal changes Make the best choices with their time and energy for women with hormonal changes to get the optimal health habits. Provide clarity about the exercise prescription that is most advantageous and then customize it for women based on their fitness status, health history, and stage of menopause  Train an army of Menopause Fitness Specialist® in every fitness club, health center, university and behind every online program.    Become a Coach on Exercise and Hot Flashes for Women in Midlife If you are interested in becoming a Flipping 50 Menopause Fitness Specialist® and tired of guessing for yourself, your clients and watching a lot of bro science applied to women without ever considering…  We've never asked questions about pelvic floor health in intake forms in the fitness industry. We've never considered from ovulation to luteal phase, a change in nutrition and exercise might serve a woman in reducing injury and getting better results. We've never suggested a woman test her muscle mass at 25 and bone at 30 when she's peaking to compare later.   Do you want to know how to create a comprehensive exercise prescription that supports, not worsens:  Insomnia Pre-diabetes and insulin resistance Low libido  Low bone mass  Body and (specifically) belly fat Exercise  Hot flashes/night sweats   More than 7 other key changes in exercise prescription that help a woman arrive at menopause, thrive through menopause, and enhance her longevity – reach out to me right now. We're opening the enrollment for the Flipping50 Menopause Specialist®. This is an amazing opportunity to join the program. Not only get the knowledge you need, but the business growth coaching so you aren't a wise broke trainer or coach like so many of your peers.  The number of trainers increased from 250,000 to 750,000 in the last decade. The number of health coaches has grown from zero to thousands in a few short years.  Yet, few of those are making a profit, let alone a living.  They're building websites, apps, social media…  they are failing. But you don't have to.  If you start from the beginning, skip the guessing with the copycat Chatgpt copy. You don't have to have a MBA in marketing or sales but you need to have a formula and blueprint to follow to build a business that starts successfully and is sustainable.    References on Exercise and Hot Flashes:  Moore SR, Cabre HE, Smith-Ryan AE. Body composition, physical activity, and menopause symptoms: how do they relate? Menopause. 2024 Apr 1;31(4):336-341. doi: 10.1097/GME.0000000000002334. Epub 2024 Mar 5. PMID: 38442308. Witkowski S, Evard R, Rickson JJ, White Q, Sievert LL. Physical activity and exercise for hot flashes: trigger or treatment? Menopause. 2023 Feb 1;30(2):218-224. doi: 10.1097/GME.0000000000002107. Epub 2022 Nov 7. PMID: 36696647; PMCID: PMC9886316.   Other Episodes You Might Like: Previous Episode - How and Why to Consider Meditation in Menopause Next Episode - How to Bounce Back Boldly After You Blew Your Diet More Like This - Caffeine, Hot Flashes, and Fat Burning During Menopause   Resources:  Join Flipping 50 Menopause Fitness Specialist® to become a coach! Book a Discovery Call with Debra to talk about your own menopause or becoming a coach.

Episode 191: Diagnosis of ADHDFuture Dr. Granat explains how to diagnose Attention Deficit Hyperactivity Disorder. She explained the influence of social media in increasing awareness of ADHD. Dr. Arreaza added input about the validated tools for ADHD diagnosis and highlighted the importance of expert evaluation for the diagnosis of this disorder.  Written by Yen Stephanie Granat, MSIV. Ross University School of Medicine. Comments and editing by Hector Arreaza, MD.You are listening to Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California, a UCLA-affiliated program sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. This podcast was created for educational purposes only. Visit your primary care provider for additional medical advice.Steph: I love podcasts—many of us do—and if you, like me, spend any amount of your leisure time listening to podcasts, perusing the news, or scrolling social media; you've likely noticed an alarming trend in the number of discussions we seem to be having about ADHD. It has grown into a very hot topic over the past couple of years, and for some of us, it seems to have even begun sneaking into our “recommended videos” and across our news feeds! Naturally, for the average person this can spur questions like:“Do I have ADHD? Do we all have it? How can I be certain either way, and what do I do if I find myself relating to most of the symptoms that I'm seeing discussed?”Granted that there is a whirlpool of information circulating around this hot topic, I was hoping to spend a bit of time clearly outlining the disorder for anyone finding themselves curious. I believe that can best be achieved through outlining a clear, concise, and easy-to-understand definition of what ADHD is; outlining what it is not; and helping people sift through the fact and the fiction. As with many important things we see discussed on the internet, we're seeing is that there is much more fiction than fact. Arreaza: I'm so glad you chose this topic! I think it is challenging to find reliable information about complex topics like ADHD. Tik Tok, Instagram and Facebook are great social media platforms, but we have to admit that fake news have spread like a fire in recent years. So, if you, listener, are looking for reliable information about ADHD, you are in the right place. With ADHD, there aren't any obvious indicators, or rapid tests someone can take at home to give themselves a reliable “yes” or “no” test result. People's concerns with ADHD are valid, and important to address, so we will discuss the steps to identify some of signs and symptoms they are seeing on TikTok or their favorite podcaster. Steph: Healthcare anxiety is a vital factor to consider when it comes to large cultural conversations around our minds and bodies; so, I hope to sweep away some of the misconceptions and misinformation floating around about ADHD. In doing so, I want to help alleviate any stress or confusion for anyone finding themselves wondering if ADHD is impacting their lives! We might even be able to more accurately navigate these kinds of “viral topics” (for lack of a better term) next time we see them popping up on our news feeds.Arreaza: The first thing I want to say about ADHD is “the crumpled paper sign.”Steph: What is that?Arreaza: It is an undescribed sign of ADHD, I have noticed it, and it is anecdotal, not evidence based. When I walk into a room to see a pediatric patient, I have noticed that when the paper that covers the examination table is crumpled, most of the times it is because the pediatric patient is very active. Then I proceed to ask questions about ADHD and I have been right many times about the diagnosis. So, just an anecdote, remember the crumpled paper sign.  Steph: When you have patients coming to you asking for stimulants because they think they have ADHD, hopefully, after today, you can be better prepared to help those patients. So, for the average person—anyone wanting to be sure if this diagnosis applies to them—how can we really know?”Arreaza: So, let's talk about diagnosis.Steph: Yes, the clearest information we have is the DSM-5, which defines these disorders, as well as outlines the specific criteria (or “checkpoints”) one needs to meet to be able to have a formal diagnosis. However, this manual is best utilized by a trained professional—in this case, a physician—who can properly assess your signs and symptoms and give you a clear answer. Steph: ADHD stands for Attention Deficit Hyperactivity Disorder. It is among the most common neurodevelopmental disorders of childhood. That is not to say it does not affect adult—it does—and because it can be easy to miss, it's very possible for someone to have ADHD without knowing. Arreaza: I recently learned that ADD is an outdated term. Some people with ADHD do not have hyperactivity but the term still applies to them. Steph: Yes, there are multiple types that I will explain in just a bit. But overall the disorder is most simply characterized by a significant degree of difficulty in paying attention, controlling impulsive behaviors, or in being overly active in a way that the individual finds very difficult to control. (CDC)Arreaza: How common is ADHD?Steph: The most recently published data from The CDC estimates that 7 million (11.4%) of U.S. children between the ages of 3 and 17 have been diagnosed with ADHD. For adults, it is estimated that there are 15.5 million (6%) individuals in the U.S. who currently have ADHD. Arreaza: I suspected it would be more than that. [Anecdote about Boy Scout camp]. Steph: I totally agree. With short videos on TikTok, or paying high subscription fees to skip ads, it feels like as a society we all have a shorter attention span. Arreaza: Even churches are adapting to the new generation of believers: Shorter sermons and shorter lessons.Steph: When it comes to better understanding these numbers, it's also important to know that there are three distinct presentations of ADHD recognized by The CDC and The World Health Organization. Arreaza: The DSM-5 TR no longer uses the word “subtypes” for ADHD. Instead, it uses the word "presentation" to describe the different ways that ADHD may manifest in a person. That reminded me to update my old DSM-5 manual and I ordered it while reading today about ADHD. This means people with ADHD are no longer diagnosed as having a “subtype”. Instead, they are diagnosed with ADHD and a certain “presentation” of symptoms.Steph: These presentations are:Inattentive TypePeople often have difficulty planning or completing tasksThey find themselves easily distracted (especially when it comes to longer, focus-oriented tasks)They can often forget details and specifics, even with things that are part of their daily routineThis used to be referred to as “ADD” (you'll notice the absence of an “H”, segue).Hyperactive-Impulsive TypePeople often have a sense of intense “restlessness”, noticeable even in calm environments.They tend to be noticeably more talkative, and might often be seen interrupting others, or finishing their sentences.They find significant difficulty in being still for extended periods. Because of this, they are often unable to sit through a movie or class time, without fidgeting or getting up and moving around.With this category of ADHD, we often see an impulsiveness that unwittingly leads to risky behavior. Because of this, accidents and bodily injury are more common in individuals with this type of ADHD.Combined TypeThese are individuals who exhibit symptoms from both “Inattentive” and “Hyperactive-Impulsive” ADHD equally.Some listeners might have noticed that the categories are quite different, meaning that ADHD presents in different ways depending on the person! Two people who have ADHD can be in the same room and have vastly different presentations, whilst still having many of the same types of challenges. You also might have noticed what makes the discussion so interesting to the general public, which is also the thing that makes speaking to a professional to get formally tested so important:The diagnostic criteria rely heavily on patterns of behavior, or external variables; rather than on how a person might feel, or certain measurements taken from lab tests.Arreaza: Diagnosing ADHD requires evaluation by a professional who is properly trained for this. Fortunately, we have tools to assist with the diagnosis. The attention deficit must be noted in more than one major setting (e.g., social, academic, or occupational), that's why the information should be gathered from multiple sources, including parents, teachers, and other caregivers, using validated tools, such as:The Neuropsychiatric EEG-Based ADHD Assessment Aid (NEBA), recommended by the American Academy of NeurologyThe Vanderbilt ADHD Diagnostic Parent Rating Scale (VADPRS) and the Vanderbilt ADHD Diagnostic Teacher Rating Scale (VADTRS), recommended by the Society for Developmental and Behavioral Pediatrics.For adults: The validated rating scales include the Adult ADHD Self-Report Scale (ASRS) and the Conners Adult ADHD Rating Scales (CAARS).Steph: This is important because nearly everyone alive has experienced several, if not most, of these behavioral patterns at least once. Whether or not an individual has ADHD, I'm certain we could all think of moments we've had great difficulty focusing or sitting still. Perhaps some of us are incredibly forgetful, or act more impulsively than the average person might find typical. Getting a professional diagnosis is important because it is in skillfully assessing “the bigger picture” of a person's life, or their patterns of behavior, that a skilled physician, who understands the nuances and complexities in these disorders, can properly tell each of us whether we have ADHD, or not.Essentially, most of us could stand to use a bit more focus these days, but far fewer of us would meaningfully benefit from the kinds of treatments and therapies needed by individuals with ADHD to live healthier, more happy and regulated lives.Arreaza: I had a mother who came to discuss the results of the Vanderbilt Questionnaire. I think she left a little disappointed when she heard that, based on the responses from her and the teacher, her son did not have ADHD. Some kids may have behaviors such as being distracted during a meeting, forgetting about homework or having a lot of energy, but that does NOT mean necessarily that they have ADHD, right?Steph: Absolutely! The important thing to remember here is that these patterns of behavior outlined in the DSM-5 are merely an external gauge for a neurological reality. What the science is showing us is that the brains of people with ADHD are wired differently than that of the more “neurotypical” brain. Much like a check engine light would serve as a signal to a driver that something under the hood needs attention; these patterns of behavior, when they begin impeding our day to day lives, might tell us that it's time to see a professional (whether it be an auto mechanic or a trained physician). I think we all know someone who drives with their check engine light and not a care in the world. Arreaza: How serious/urgent is ADHD? Why should we care to make the diagnosis?Steph: Although we've yet to see anyone incur harm solely from having ADHD, it does lead to quite a range of more serious issues, some of which might prove more urgent. In the cases of ADHD, specifically, what we know is that there is a notable degree of dysregulation in some key neurotransmitters, like dopamine and norepinephrine. More plainly, what we are seeing in the brains of people with ADHD is a disruption, or alteration, of some of the brain's key chemicals.These neurotransmitters are largely responsible for much-needed processes like Motivation, Satisfaction, Focus, Impulse control, even things like energy and feelings of happiness. Many of these things serve as “fuel” for our day-to-day lives; things we'd call our “executive function”.  These are also what prove dysfunctional in those struggling with ADHD. It is in this sense that we might be able to bridge a meaningful gap between ADHD as being seen through patterns of behaviorthat signal a real, neurological reality.Steph: We often hear of the brain referenced as a kind of supercomputer. A more accurate assessment might be that the brain is more of a network of interconnected computers that run different processes and require continual communication with one another for our brain to function properly and seamlessly. What we're seeing in members of the population with this diagnosis, is a significant disruption in these lines of communication. Although this is a very broad oversimplification, for the purposes of our metaphor is to think of it like our brain chemicals getting caught in a traffic jam, or parts of our brain attempting to communicate to one another with poor cell signal. Arreaza: Making the diagnosis is critical to start treatment because having that level of dysfunction sounds like having a very difficult life.Steph: Yeah! I think that's why this conversation matters so much. There's a sense of urgency there, because much of life is, in fact, boring. Things like paying bills, exercising and eating well, work and school—these are all things that are vital to health and wellbeing in day-to-day life; and for the more neurotypical brain, these things might prove occasionally challenging. Yet, they are still doable. For those with ADHD however, this goes far beyond mere boredom or “laziness” (which proves to be a trigger term for many—more on that in just a bit).For folks listening, I wanted to offer some statistics that show why this is such a big concern for the public, whether one has a formal ADHD diagnosis or not. The facts are figures are:Children with ADHD are more than five times as likely as the child without ADHD to have major depression.A significant increase in the prevalence of anxiety is seen in ADHD patients, ranging from 15% to 35%, when accounting for overlap in symptoms.There are significant correlations in youth diagnosed with ADHD, and those diagnosed with what are known as “externalizing disorders”. These are things like Conduct Disorder, Disruptive Mood Dysregulation Disorder, and Oppositional Defiant Disorder.We are seeing a much higher rate of academic problems in kids who have ADHD, like reading disorder, impaired verbal skills, and visual motor integration.We're finding that many, if not most, of these connections are being made after diagnosis. In the case of the “internalized disorders”, like depression and anxiety, we're often seeing years between ADHD diagnoses and the diagnoses of major depressive disorder or anxiety disorders. Given this framework, much of the data is theorized to point towards what we call “negative environmental circumstances”, otherwise known as “ADHD-related demoralization”.For children, this often looks like struggling with sitting still during class, failing to get homework done (because they forgot, or couldn't focus on the tasks at hand), and struggling to focus their attention on what their teacher is saying during lecture. These things often lead to bad grades, discipline or forced time sitting still in detention. This can be seen in more problems at home, with children being disciplined often for behavior that they struggle immensely to control.For adults, this can mean forgetting to pay your bills, missing work meetings, having trouble making appointments, or having difficulty with day-to-day tasks, really anything that requires sustained attention. We often see adults with ADHD who are chasing normalcy with caffeine addictions or even struggling with substance use. Arreaza: Substance use disorder actually can be a way for some people living with ADHD to self-treat their symptoms. Steph: These differences between the individual's experience and the world around them can lead to really powerful feelings of failure or inadequacy. They can affect your social life, your sense of community, and even further limit your capacity to seek help.Literacy in these things is so important—not just for the individual who feels that they may have ADHD, but also for those who are likely to encounter people with ADHD in their own lives. Understanding why some of these patterns pop up, even those who might not have a formal diagnosis, can go a long way to properly approaching these behaviors with success and with empathy.Arreaza: Learning about ADHD is fundamental for primary care doctors. We talked about the high prevalence and the influence of the media in increasing awareness and sometimes increasing public panic. So, we have to be prepared to diagnose or undiagnosed ADHD. Steph: Whether we're the physicians in the room, or the patient in the chair, I think it's important to have a clear understanding of what ADHD is and how it can affect lives. Thanks for listening, I hope we were able to teach you a little more about ADHD. ______________Even without trying, every night you go to bed a little wiser. Thanks for listening to Rio Bravo qWeek Podcast. We want to hear from you, send us an email at RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. See you next week! _______________References:NICHQ-Vanderbilt-Assessment-Scales PDF: https://nichq.org/wp-content/uploads/2024/09/NICHQ-Vanderbilt-Assessment-Scales.pdfADHD: The facts. ADDA - Attention Deficit Disorder Association. (2023, January 11). https://add.org/adhd-facts/American Psychiatric Association, DSM-5 Task Force. (2013). Diagnostic and statistical manual of mental disorders: DSM-5™ (5th ed.). American Psychiatric Publishing, Inc. https://doi.org/10.1176/appi.books.9780890425596.Gnanavel S, Sharma P, Kaushal P, Hussain S. Attention deficit hyperactivity disorder and comorbidity: A review of literature. World J Clin Cases. 2019 Sep 6;7(17):2420-2426. doi: 10.12998/wjcc.v7.i17.2420. PMID: 31559278; PMCID: PMC6745333.Staley BS, Robinson LR, Claussen AH, et al. Attention-Deficit/Hyperactivity Disorder Diagnosis, Treatment and Telehealth Use in Adults — National Center for Health Statistics Rapid Surveys System, United States, October – November 2023. CDC.Gov, MMWR Morb Mortal Wkly Rep 2024;73:890-895.Danielson ML, Claussen AH, Arifkhanova A, Gonzalez MG, Surman C. Who Provides Outpatient Clinical Care for Adults With ADHD? Analysis of Healthcare Claims by Types of Providers Among Private Insurance and Medicaid Enrollees, 2021. J Atten Disord. 2024 Jun;28(8):1225-1235. doi: 10.1177/10870547241238899. Epub 2024 Mar 18. PMID: 38500256; PMCID: PMC11108736. https://pubmed.ncbi.nlm.nih.gov/38500256/Mattingly G, Childress A. Clinical implications of attention-deficit/hyperactivity disorder in adults: what new data on diagnostic trends, treatment barriers, and telehealth utilization tell us. J Clin Psychiatry. 2024;85(4):24com15592. https://www.psychiatrist.com/jcp/implications-adult-adhd-diagnostic-trends-treatment-barriers-telehealth/Didier J. My four kids and I all have ADHD. We need telehealth options. STAT News. Published October 10, 2024. Accessed October 10, 2024. https://www.statnews.com/2024/10/10/adhd-medication-shortage-telehealth-dea-congress/.Hong J, Mattingly GW, Carbray JA, Cooper TV, Findling RL, Gignac M, Glaser PE, Lopez FA, Maletic V, McIntyre RS, Robb AS, Singh MK, Stein MA, Stahl SM. Expert consensus statement for telepsychiatry and attention-deficit hyperactivity disorder. CNS Spectr. 2024 May 20:1-12. doi: 10.1017/S1092852924000208. Epub ahead of print. PMID: 38764385. https://pubmed.ncbi.nlm.nih.gov/38764385/Gabor Maté: The Myth of Normal: Trauma, Illness, and Healing in a Toxic Culture. (2022). Youtube. Retrieved April 27, 2025, from https://www.youtube.com/watch?v=ttu21ViNiC0. Theme song, Works All The Time by Dominik Schwarzer, YouTube ID: CUBDNERZU8HXUHBS, purchased from https://www.premiumbeat.com/.

In this episode of The Moss Report, Ben Moss speaks with Dr. Ralph Moss about a little-known natural compound that may have big implications: Modified Citrus Pectin (MCP). A recent clinical trial in Israel found that MCP helped slow PSA doubling time in men with recurrent prostate cancer—suggesting it may offer real, measurable support for patients after treatment. Ben and Ralph trace the story from its origins in the 1990s through modern-day research, digging into how MCP works by targeting Galectin-3, a molecule tied to inflammation and cancer spread. Along the way, they highlight the researchers who kept this idea alive, including Dr. Kenneth Pienta and Dr. Isaac Eliaz, and ask why this research isn't more widely known. It's an honest, science-based conversation about where evidence and action meet—and how natural approaches might still be flying under the radar. Link to the full article with transcript, slide presentation, links and cited studies. https://www.themossreport.com/mcp-podcast/ Products mentioned in this podcast: Pectasol-C – https://econugenics.com/?a_aid=TMR Mycolife – The Moss Method Mushroom Formula – https://mycolife.us/product/the-moss-method-mushroom-formula/ Links and Resources:

We all know about the medical school curriculum. But what about the hidden curriculum, or how students learn about the unspoken culture of medicine through everyday, informal interactions? In this episode, Dr. Sandra Quezada and Dr. Sarah Dubbs explore the hidden curriculum with some examples, chat about whether the hidden curriculum can be positive or negative, and offer guidance on how students can best navigate the hidden curriculum and thrive within it.   References: Lawrence C, Mhlaba T, Stewart KA, et al. The Hidden Curricula of Medical Education: A Scoping Review. Acad Med. 2018 Apr;93(4):648-656. PMID: 29116981. Bandini J, Mitchell C, Epstein-Peterson ZD, et al. Student and Faculty Reflections of the Hidden Curriculum. Am J Hosp Palliat Care. 2017 Feb;34(1):57-63. Epub 2016 Jul 11. PMID: 26566929. Martimianakis MA, Michalec B, Lam J, et al. Humanism, the Hidden Curriculum, and Educational Reform: A Scoping Review and Thematic Analysis. Acad Med. 2015 Nov;90(11 Suppl):S5-S13. PMID: 26505101. Hopkins L, Saciragic L, Kim J, Posner G. The Hidden Curriculum: Exposing the Unintended Lessons of Medical Education. Cureus. 2016 Oct 25;8(10):e845. PMID: 27909633 Kalter L. Navigating the Hidden Curriculum in Medical School. AAMC News. Published July 13, 2019. Accessed December 10, 2024. Link.  Freedman D. The Hidden Curriculum. NYU Langone Health Hub. Accessed December 10, 2024. Link.   

About our Guest: Dr. Omar Alibrahim is a professor of pediatrics at Duke University and a pediatric intensivist at Duke Children's Hospital. He completed his Pediatric Residency and Chief Residency at St. Joseph's Children's Hospital, followed by Pediatric Critical Care Fellowship at the University of Buffalo. He served as the Pediatric Critical Care Division chief, the PICU Medical Director, and the PCCM fellowship Director in Buffalo, NY, for more than 8 years, during which he worked with the pulmonology and respiratory therapy divisions to develop a negative pressure ventilation program for acute respiratory failure. In 2021 Dr. Alibrahim was recruited to Duke Children's Hospital and now serves as the PICU Medical Director and the program director for the Pediatric Critical Care Fellowship. Learning Objectives: By the end of this podcast series, listeners should be able to: Critique the physiologic rationale for negative pressure ventilation (NPV) in acute respiratory failure.Understand the experience of introducing a novel form of respiratory support in a PICU.Describe the stepwise escalation of NPV settings often used in acute respiratory failure.References:Derusso, M., Miller, A. G., Caccamise, M., & Alibrahim, O. (2024). Negative-Pressure Ventilation in the Pediatric ICU. Respiratory Care, 69(3), 354–365. https://doi.org/10.4187/RESPCARE.11193Hassinger AB, Breuer RK, Nutty K, Ma CX, Al Ibrahim OS. Negative-Pressure Ventilation in Pediatric Acute Respiratory Failure. Respir Care. 2017 Dec;62(12):1540-1549. doi: 10.4187/respcare.05531. Epub 2017 Aug 31. PMID: 28860332.Deshpande SR, Maher KO. Long term negative pressure ventilation: Rescue for the failing fontan? World J Cardiol. 2014 Aug 26;6(8):861-4. doi: 10.4330/wjc.v6.i8.861. PMID: 25228965; PMCID: PMC4163715.Questions, comments or feedback? Please send us a message at this link (leave email address if you would like us to relpy) Thanks! -Alice & ZacSupport the showHow to support PedsCrit:Please complete our Listener Feedback SurveyPlease rate and review on Spotify and Apple Podcasts!Donations are appreciated @PedsCrit on Venmo , you can also support us by becoming a patron on Patreon. 100% of funds go to supporting the show. Thank you for listening to this episode of PedsCrit. Please remember that all content during this episode is intended for educational and entertainment purposes only. It should not be used as medical advice. The views expressed during this episode by hosts and our guests are their own and do not reflect the official position of their institutions. If you have any comments, suggestions, or feedback-you can email us at pedscritpodcast@gmail.com. Check out http://www.pedscrit.com for detailed show notes. And visit @critpeds on twitter and @pedscrit on instagram for real time show updates.

Send us a textEffect of kangaroo mother care in low birth weight infants on human milk intake: a randomized controlled trial.Sinha B, Mazumder S, Thakur A, Devi S, More D, Ashorn P, Sommerfelt H, Kurpad A, Bhandari N.Am J Clin Nutr. 2025 May;121(5):1109-1116. doi: 10.1016/j.ajcnut.2025.02.006. Epub 2025 Feb 11.PMID: 39947481 Free article. Clinical Trial.As always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below. Enjoy!

En este episodio nos sumergimos en las turbias aguas del thriller psicológico con Yo soy el abismo, una novela inquietante del maestro italiano del suspense, Donato Carrisi. Acompáñanos a descubrir la historia del Hombre del Lago, un limpiador de residuos con un oscuro secreto y una vida marcada por la soledad… hasta que aparece la Chica del Lazo Lila. Hablamos de la atmósfera opresiva, la construcción de personajes y cómo Carrisi teje un relato que atrapa y perturba a partes iguales.Si eres amante de las novelas que te mantienen en vilo hasta la última página, este episodio es para ti.

Let's unpack something most midlife women are totally missing – protein for Menopause Hormone Support. Are you feeling moody, low-energy, or constantly craving carbs in midlife? It might not just be your hormones—it could be your protein intake… and its effect on your hormones.  In today's episode, know how protein connects hormones and why your daily meals might be the hormonal tune-up you didn't know you needed. Cortisol & Protein: The Stress-Balance Dance Cortisol levels increase in response to low blood sugar or stress, which are common when meals are high-carb and low-protein. A high-protein diet blunts cortisol spikes post-meal and improves the body's stress response.   Insulin: Protein's Role in Glucose Control Protein stimulates insulin—but in a modulated way that helps with blood sugar stability, not spikes. In midlife and beyond, protein helps preserve insulin sensitivity, especially when combined with resistance training.   Ghrelin & Leptin: Protein vs. Cravings Ghrelin = your hunger hormone. Protein is the most effective macronutrient at suppressing ghrelin. Leptin = satiety hormone. Protein helps regulate leptin sensitivity over time. The Protein theory goes that if the body doesn't get enough protein it will message you it wants more. The problem is the message is not clear. It's just a hunger signal. You're left to figure it out or deal with the tempting cookies, cakes, and chocolate hidden in the icebox.    Estrogen: From Muscle Protector to MIA Estrogen is an anabolic hormone—it supports muscle maintenance, insulin sensitivity, and metabolic efficiency. As estrogen declines in perimenopause and menopause, its natural support of muscle protein synthesis (MPS) disappears. With estrogen no longer stimulating MPS, women must now rely on two primary tools to stimulate it: Resistance training Adequate high-quality protein (especially leucine-rich) “Estrogen enhances the anabolic response of skeletal muscle to both feeding and resistance exercise, and its loss results in anabolic resistance.”   More Truths About Protein for Menopause Hormone Support Muscle Protein Synthesis declines with age—and even more so without estrogen.  This is why RDA-level protein (0.8g/kg) is not sufficient in midlife - a statement agreed on by Registered Dietitians, longevity and geriatric experts alike.  Experts (ISSN) recommend ≥1.6–2.2g/kg of body weight for active women in midlife to maintain muscle, metabolism, and hormonal resilience.   The Anabolic vs. Catabolic Hormone Framework Anabolic Hormones = Build & Repair These are hormones that stimulate tissue growth and regeneration: Testosterone – promotes muscle growth, strength, libido Growth Hormone (GH) – supports repair, recovery, and fat metabolism Estrogen – helps preserve lean mass, regulates insulin sensitivity Insulin – can be anabolic by shuttling nutrients into cells, especially post-exercise Protein intake supports all of these by providing the amino acid building blocks needed for anabolic activity. Catabolic Hormones = Break DownThese are hormones that promote the breakdown of muscle, tissue, and energy stores: Cortisol – breaks down muscle for glucose during stress Epinephrine/Norepinephrine – mobilize energy in fight-or-flight Chronically elevated catabolic hormones + low protein = muscle loss, cravings, fatigue. Fat Storage Insulin isn't actually a catabolic hormone but it does increase fat storage. You can't be burning fat if insulin is high, as is true for many women. Focusing on boosting the anabolic hormones is the game-changer.    Other Episodes You Might Like: Previous Episode - Can We Just Stop the Self Sabotage to Feel Your Best Ever  Next Episode - How and Why to Consider Meditation in Menopause More Like This - Where Protein Recommendations for Women Come From?   Resources:  This episode is brought to you by Flipping 50 Longevity Pro Protein & Fiber, the simplest ingredient, cleanest, third-party-tested protein powder formulated specifically for midlife metabolism. No bloat, no fillers, just functional fuel. Use code PODCAST10 for 10% off at checkout.   References:  Lemmens SG, Born JM, Martens EA, Martens MJ, Westerterp-Plantenga MS. PLoS One. 2011 Feb 3;6(2):e16826. doi: 10.1371/journal.pone.0016826. PMID: 21304815; PMCID: PMC3033415. Layman et al., 2008 reported that diets with higher protein and lower carbs improved insulin sensitivity in adults. DOI: 10.1093/jn/138.3.514 Leidy HJ, Ortinau LC, Douglas SM, Hoertel HA. Am J Clin Nutr. 2013 Apr;97(4):677-88. doi: 10.3945/ajcn.112.053116. Epub 2013 Feb 27. PMID: 23446906; PMCID: PMC3718776. Tang JE, Moore DR, Kujbida GW, Tarnopolsky MA, Phillips SM. J Appl Physiol (1985). 2009 Sep;107(3):987-92. doi: 10.1152/japplphysiol.00076.2009. Epub 2009 Jul 9. PMID: 19589961.  

In this episode Dr. Raffaele Teperino shares insights from his ongoing research focused on developmental programming, particularly how paternal health before conception influences not only offspring health but also maternal health outcomes. As we trace his academic journey from studying biotechnology and pharmacology to leading his own lab, Dr. Teperino reflects on his early fascination with medicine, the pivotal experiences that shaped his career, and the integration of epigenetics into understanding metabolic diseases. We discuss the nuances of epigenetics—going beyond simple chromatin biology to examine its wider implications on phenotypic variation. Dr. Teperino emphasizes his approach of modeling relevant physiological phenomena in the lab to better understand the underlying mechanisms driving conditions like obesity and metabolic disruption. A particular focus is placed on his experiences during his postdoctoral years, where he investigated the developmental pathways of hedgehog signaling and its metabolic implications in adipogenesis. Our talk shifts towards the practical implications of his research, highlighting recent investigations into how circadian rhythms and paternal lifestyles influence offspring health. Dr. Teperino reveals his findings on how disturbances in circadian rhythms can lead to intergenerational health issues, showcasing the surprising effects observed in offspring of fathers experiencing circadian misalignment. We delve into the significance of seminal fluid as a potential medium for intergenerational transfer of stress responses, examining the role of stress hormones and their impacts on fetal development. As we explore a fascinating recent study highlighting the impact of paternal diets on future generations, Dr. Teperino underscores the importance of understanding the shorter exposure periods sufficient to trigger these health changes. He presents data that links paternal obesity and preconception health to an increased risk of obesity and insulin resistance in children, challenging traditional narratives around maternal responsibility for offspring health.   References Darr J, Tomar A, Lassi M, Gerlini R, Berti L, Hering A, Scheid F, Hrabě de Angelis M, Witting M, Teperino R. iTAG-RNA Isolates Cell-Specific Transcriptional Responses to Environmental Stimuli and Identifies an RNA-Based Endocrine Axis. Cell Rep. 2020 Mar 3;30(9):3183-3194.e4. doi: 10.1016/j.celrep.2020.02.020. PMID: 32130917. Lassi M, Tomar A, Comas-Armangué G, Vogtmann R, Dijkstra DJ, Corujo D, Gerlini R, Darr J, Scheid F, Rozman J, Aguilar-Pimentel A, Koren O, Buschbeck M, Fuchs H, Marschall S, Gailus-Durner V, Hrabe de Angelis M, Plösch T, Gellhaus A, Teperino R. Disruption of paternal circadian rhythm affects metabolic health in male offspring via nongerm cell factors. Sci Adv. 2021 May 26;7(22):eabg6424. doi: 10.1126/sciadv.abg6424. PMID: 34039610; PMCID: PMC8153725. Tomar A, Gomez-Velazquez M, Gerlini R, Comas-Armangué G, Makharadze L, Kolbe T, Boersma A, Dahlhoff M, Burgstaller JP, Lassi M, Darr J, Toppari J, Virtanen H, Kühnapfel A, Scholz M, Landgraf K, Kiess W, Vogel M, Gailus-Durner V, Fuchs H, Marschall S, Hrabě de Angelis M, Kotaja N, Körner A, Teperino R. Epigenetic inheritance of diet-induced and sperm-borne mitochondrial RNAs. Nature. 2024 Jun;630(8017):720-727. doi: 10.1038/s41586-024-07472-3. Epub 2024 Jun 5. PMID: 38839949; PMCID: PMC11186758.   Related Episodes The Impact of Paternal Diet on Offspring Metabolism (Upasna Sharma) Transgenerational Inheritance and Evolution of Epimutations (Peter Sarkies) The Role of Small RNAs in Transgenerational Inheritance in C. elegans (Oded Rechavi)   Contact Epigenetics Podcast on Mastodon Epigenetics Podcast on Bluesky Dr. Stefan Dillinger on LinkedIn Active Motif on LinkedIn Active Motif on Bluesky Email: podcast@activemotif.com

In this Mini Series episode, I dive into a nuanced conversation around gratitude practices for perinatal trauma survivors. While gratitude can be a powerful tool for healing, it often becomes complicated when paired with the experiences of trauma, grief, and loss.Whether you've felt pressure to “just be grateful” or are searching for ways to reconnect with yourself and your story, this episode offers validation and actionable insight.

In our recent episode on global burn surgery with Dr. Barclay Stewart and Dr. Manish Yadav, we discussed several cases at Kirtipur Hospital in Nepal to illustrate the global burden of burns and similarities and differences in treating burns at Harborview Medical Center, a level 1 trauma and ABA verified burn center in Seattle, WA and Kirtipur Hospital (Nepal Cleft and Burn Center) in Kathmandu, Nepal. In this episode Dr. Stewart and Dr. Yadav return for an interview by UW Surgery Resident, Paul Herman, sharing insights on how to get involved in global surgery with an emphasis on sustainable participation. Hosts:  Manish Yadav, Kirtipur Hospital, Nepal Barclay Stewart, UW/Harborview Medical Center Paul Herman, UW/Harborview General Surgery Resident, @paul_herm  Tam Pham, UW/Harborview Medical Center (Editor) Learning Objectives 1.     Approaches to global surgery  a.     Describe historical perspectives on global health and global surgery reviewing biases global surgery inherits from global health due to the history of colonialism, neo-colonialism and systemic inequalities b.     Review a recently published framework and evaluation metrics for sustainable global surgery partnerships (GSPs) as described by Binda et al., in Annals of Surgery in March 2024. c.      Provide examples of this framework from a successful global surgery partnership d.     Define vertical, horizontal and diagonal global surgery approaches e.     Share tips for initial engagement for individuals interested in getting involved in global surgery References 1.     Gosselin, R., Charles, A., Joshipura, M., Mkandawire, N., Mock, C. N. , et. al. 2015. “Surgery and Trauma Care”. In: Disease Control Priorities (third edition): Volume 1, Essential Surgery, edited by H. Debas, P. Donkor, A. Gawande, D. T. Jamison, M. Kruk, C. N. Mock. Washington, DC: World Bank. 2.     Qin R, Alayande B, Okolo I, Khanyola J, Jumbam DT, Koea J, Boatin AA, Lugobe HM, Bump J. Colonisation and its aftermath: reimagining global surgery. BMJ Glob Health. 2024 Jan 4;9(1):e014173. doi: 10.1136/bmjgh-2023-014173. PMID: 38176746; PMCID: PMC10773343. https://pubmed.ncbi.nlm.nih.gov/38176746/ 3.     Binda CJ, Adams J, Livergant R, Lam S, Panchendrabose K, Joharifard S, Haji F, Joos E. Defining a Framework and Evaluation Metrics for Sustainable Global Surgical Partnerships: A Modified Delphi Study. Ann Surg. 2024 Mar 1;279(3):549-553. doi: 10.1097/SLA.0000000000006058. Epub 2023 Aug 4. PMID: 37539584; PMCID: PMC10829902.  https://pubmed.ncbi.nlm.nih.gov/37539584/ 4.     Jedrzejko N, Margolick J, Nguyen JH, Ding M, Kisa P, Ball-Banting E, Hameed M, Joos E. A systematic review of global surgery partnerships and a proposed framework for sustainability. Can J Surg. 2021 Apr 28;64(3):E280-E288. doi: 10.1503/cjs.010719. PMID: 33908733; PMCID: PMC8327986. https://pubmed.ncbi.nlm.nih.gov/33908733/ 5.     Frenk J, Gómez-Dantés O, Knaul FM: The health systems agenda: prospects for the diagonal approach. The handbook of global health policy. 2014 Apr 24; pp. 425–439 6.     Davé DR, Nagarjan N, Canner JK, Kushner AL, Stewart BT; SOSAS4 Research Group. Rethinking burns for low & middle-income countries: Differing patterns of burn epidemiology, care seeking behavior, and outcomes across four countries. Burns. 2018 Aug;44(5):1228-1234. doi: 10.1016/j.burns.2018.01.015. Epub 2018 Feb 21. PMID: 29475744. https://pubmed.ncbi.nlm.nih.gov/29475744/ 7.     Strain, S., Adjei, E., Edelman, D. et al. The current landscape of global international surgical rotations for general surgery residents in the United States: a survey by the Association for Program Directors in Surgery's (APDS) global surgery taskforce. Global Surg Educ 3, 77 (2024). https://doi.org/10.1007/s44186-024-00273-2 8.     Francalancia S, Mehta K, Shrestha R, Phuyal D, Bikash D, Yadav M, Nakarmi K, Rai S, Sharar S, Stewart BT, Fudem G. Consumer focus group testing with stakeholders to generate an enteral resuscitation training flipbook for primary health center and first-level hospital providers in Nepal. Burns. 2024 Jun;50(5):1160-1173. doi: 10.1016/j.burns.2024.02.008. Epub 2024 Feb 15. PMID: 38472005; PMCID: PMC11116054. https://pubmed.ncbi.nlm.nih.gov/38472005/ 9.     Shrestha R, Mehta K, Mesic A, Dahanayake D, Yadav M, Rai S, Nakarmi K, Bista P, Pham T, Stewart BT. Barriers and facilitators to implementing enteral resuscitation for major burn injuries: Reflections from Nepalese care providers. Burns. 2024 Oct 28;51(1):107302. doi: 10.1016/j.burns.2024.107302. Epub ahead of print. PMID: 39577105. https://pubmed.ncbi.nlm.nih.gov/39577105/ 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

Contributor: Aaron Lessen, MD Educational Pearls: What is a Rescue Inhaler? A rescue inhaler is a medication for people with asthma to quickly reverse the symptoms of an asthma attack. Historically albuterol (Short Acting Beta Agonist (SABA)) monotherapy has been the mainstay rescue inhaler. This is because albuterol works fast and is relatively cheap. What are Combination Rescue Inhalers? Combination rescue inhalers contain a fast-acting bronchodilator as well as an inhaled corticosteroid (ICS) The steroid helps to reduce some of the chronic airway inflammation that is worsening the asthma attack and can help to prevent future attacks Examples include budesonide-formoterol and albuterol-budesonide Global Initiative for Asthma (GINA), states that combination therapy is now the preferred reliever for adults and adolescents with mild asthma What are the drawbacks of Combination Rescue Inhalers? These inhalers are generally more expensive than just using a SABA inhaler which can be a barrier for some people Improper use can also lead to conditions like thrush due to the addition of the steroid References Krings JG, Beasley R. The Role of ICS-Containing Rescue Therapy Versus SABA Alone in Asthma Management Today. J Allergy Clin Immunol Pract. 2024 Apr;12(4):870-879. doi: 10.1016/j.jaip.2024.01.011. Epub 2024 Jan 17. PMID: 38237858; PMCID: PMC10999356. Papi A, Chipps BE, Beasley R, Panettieri RA Jr, Israel E, Cooper M, Dunsire L, Jeynes-Ellis A, Johnsson E, Rees R, Cappelletti C, Albers FC. Albuterol-Budesonide Fixed-Dose Combination Rescue Inhaler for Asthma. N Engl J Med. 2022 Jun 2;386(22):2071-2083. doi: 10.1056/NEJMoa2203163. Epub 2022 May 15. PMID: 35569035. Summarized by Jeffrey Olson, MS3 | Edited by Jorge Chalit, OMS3 Donate: https://emergencymedicalminute.org/donate/  

Listen as we discuss the highly-awaited ESOPEC trial, which examines treatment regimens for esophageal and EGJ adenocarcinoma. Wildly impress your thoracic attendings or peers with your nuanced knowledge! FLOT who? You'll know. Pull out the paper and listen along! Learning Objectives: -Discuss the patient population in the ESOPEC trial -Discuss the main differences between the ESOPEC trial and the CROSS trial -Describe the main drawbacks between FLOT and the CROSS regimen. Hosts: Chloe Hanson MD, Brian Louie MD, and Peter White MD   Referenced Material https://www.nejm.org/doi/full/10.1056/NEJMoa2409408 Hoeppner J, Brunner T, Schmoor C, Bronsert P, Kulemann B, Claus R, Utzolino S, Izbicki JR, Gockel I, Gerdes B, Ghadimi M, Reichert B, Lock JF, Bruns C, Reitsamer E, Schmeding M, Benedix F, Keck T, Folprecht G, Thuss-Patience P, Neumann UP, Pascher A, Imhof D, Daum S, Strieder T, Krautz C, Zimmermann S, Werner J, Mahlberg R, Illerhaus G, Grimminger P, Lordick F. Perioperative Chemotherapy or Preoperative Chemoradiotherapy in Esophageal Cancer. N Engl J Med. 2025 Jan 23;392(4):323-335. doi: 10.1056/NEJMoa2409408. PMID: 39842010. https://www.nejm.org/doi/full/10.1056/NEJMoa1112088 van Hagen P, Hulshof MC, van Lanschot JJ, Steyerberg EW, van Berge Henegouwen MI, Wijnhoven BP, Richel DJ, Nieuwenhuijzen GA, Hospers GA, Bonenkamp JJ, Cuesta MA, Blaisse RJ, Busch OR, ten Kate FJ, Creemers GJ, Punt CJ, Plukker JT, Verheul HM, Spillenaar Bilgen EJ, van Dekken H, van der Sangen MJ, Rozema T, Biermann K, Beukema JC, Piet AH, van Rij CM, Reinders JG, Tilanus HW, van der Gaast A; CROSS Group. Preoperative chemoradiotherapy for esophageal or junctional cancer. N Engl J Med. 2012 May 31;366(22):2074-84. doi: 10.1056/NEJMoa1112088. PMID: 22646630. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)32557-1/abstract Al-Batran SE, Homann N, Pauligk C, Goetze TO, Meiler J, Kasper S, Kopp HG, Mayer F, Haag GM, Luley K, Lindig U, Schmiegel W, Pohl M, Stoehlmacher J, Folprecht G, Probst S, Prasnikar N, Fischbach W, Mahlberg R, Trojan J, Koenigsmann M, Martens UM, Thuss-Patience P, Egger M, Block A, Heinemann V, Illerhaus G, Moehler M, Schenk M, Kullmann F, Behringer DM, Heike M, Pink D, Teschendorf C, Löhr C, Bernhard H, Schuch G, Rethwisch V, von Weikersthal LF, Hartmann JT, Kneba M, Daum S, Schulmann K, Weniger J, Belle S, Gaiser T, Oduncu FS, Güntner M, Hozaeel W, Reichart A, Jäger E, Kraus T, Mönig S, Bechstein WO, Schuler M, Schmalenberg H, Hofheinz RD; FLOT4-AIO Investigators. Perioperative chemotherapy with fluorouracil plus leucovorin, oxaliplatin, and docetaxel versus fluorouracil or capecitabine plus cisplatin and epirubicin for locally advanced, resectable gastric or gastro-oesophageal junction adenocarcinoma (FLOT4): a randomised, phase 2/3 trial. Lancet. 2019 May 11;393(10184):1948-1957. doi: 10.1016/S0140-6736(18)32557-1. Epub 2019 Apr 11. PMID: 30982686. ***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