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Send a textBen and Daphna review a randomized controlled trial published in The Journal of Pediatrics by Dr. Ariel Salas and colleagues at UAB. The study investigates whether early high-dose vitamin D supplementation (800 IU/day starting day 1) in extremely preterm infants reduces the incidence of Bronchopulmonary Dysplasia (BPD) compared to standard care (starting day 14). The hosts discuss the physiologic rationale linking vitamin D to lung development, the use of impulse oscillometry to measure lung mechanics, and the secondary findings regarding metabolic bone disease. They explore why the "physiologic rationale" doesn't always translate to clinical significance.----Early Vitamin D Supplementation in Infants Born Extremely Preterm and Fed Human Milk: A Randomized Controlled Trial. Salas AA, Argent T, Jeffcoat S, Tucker M, Ashraf AP, Travers CP.J Pediatr. 2025 Dec;287:114754. doi: 10.1016/j.jpeds.2025.114754. Epub 2025 Jul 24.PMID: 40714046 Clinical Trial.Support the showAs 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!

Depuis quand ça existe les TDAH ? Adhérez à cette chaîne pour obtenir des avantages : https://www.youtube.com/channel/UCN4TCCaX-gqBNkrUqXdgGRA/join ERRATUM à 6:21 lésion cérébrale mineure avec un e bien sûr! OUPS 00:00:00 - Introduction à l'histoire du diagnostic de TDAH 00:01:59 - Les premières tentatives 00:08:10 - Le début de la psychopharmacologie pour le TDAH 00:11:54 - L'impact de l'article du Washington Post 00:15:24 - La définition du TDAH par Russell Barkley 00:17:00 - Le diagnostic du TDAH au Québec   Pour soutenir la chaîne, au choix: 1. Cliquez sur le bouton « Adhérer » sous la vidéo. 2. Patreon: https://www.patreon.com/hndl Musique issue du site : epidemicsound.com Images provenant de https://www.storyblocks.com Abonnez-vous à la chaine: https://www.youtube.com/c/LHistoirenousledira Les vidéos sont utilisées à des fins éducatives selon l'article 107 du Copyright Act de 1976 sur le Fair-Use. Sources et pour aller plus loin: Marie-Christine Brault, Emma Degroote et Mieke Van Houtte, « Disparities in the prevalence of ADHD diagnoses, suspicion, and medication use between Flanders and Québec from the lens of the medicalization process », Health, 2023, vol. 27 (6), p. 958-979. Lange, K. W., Reichl, S., Lange, K. M., Tucha, L., & Tucha, O. (2010). The history of attention deficit hyperactivity disorder. Atten Defic Hyperact Disord . 2010 Dec;2(4):241-55. doi: 10.1007/s12402-010-0045-8. Epub 2010 Nov 30. Rothenberger A, Neumärker KJ. Wissenschaftsgeschichte der ADHS. Steinkopff, Darmstadt: Kramer-Pollnow im Spiegel der Zeit; 2005. https://neuronup.com/fr/actualites-de-la-stimulation-cognitive/troubles-neuro-developpementaux/tdah/bref-historique-du-tdah-et-de-son-impact-sur-le-fonctionnement-executif/ Barkley 2006a, Barkley RA (2006a) Attention-deficit hyperactivity disorder. A Hand- book for Diagnosis and Treatment, Guilford, New York, Barkley, R. (2002). Niños hiperactivos: cómo comprender y atender sus necesidades especiales. 3a. Ed. Barcelona: Paidós. Barkley, R. (2011). Executive functioning and self- regulation: Integration, extended phenotype, and clinical implications. The Guilford Press. « Early History of ADHD », Russell Barkley, PhD - Dedicated to ADHD Science+, 19 septembre 2023. https://youtu.be/jwrhLpSlMPY?si=-9vm5G3ho2wMg-M8 « Neurodiversity Video #16 A History of ADHD », Thomas Armstrong, 4 juillet 2025. https://youtu.be/KIFFeEFLti4?si=3fpd-bb7KqvBK0ZZ https://www.verywellmind.com/adhd-history-of-adhd-2633127#citation-12 https://www.neurodiverging.com/the-history-of-attention-deficit-disorder/ The Story of Fidgety Philip.” The Evolution of A Disorder. Edward M. Hallowell, M.D. and John J. Ratey, M.D. https://theconversation.com/ritalin-at-75-what-does-the-future-hold-121591 https://daily.jstor.org/adhd-the-history-of-a-diagnosis/ https://www.washingtonpost.com/archive/lifestyle/wellness/1996/03/05/attention-deficit-disorder/c3c72c65-bd93-472d-aa99-3622ad6f5d36/ Robert R. Erk, « The evolution of attention deficit disorders terminology », Elementary School Guidance & Counseling, Vol. 29, No. 4 (April 1995), pp. 243-248. Lawrence H. Diller, « The Run on Ritalin: Attention Deficit Disorder and Stimulant Treatment in the 1990s », The Hastings Center Report, Vol. 26, No. 2 (Mar. - Apr., 1996), pp. 12-18 Autres références disponibles sur demande. #histoire #documentaire #tdah #tda #adhd

Tus glúteos son el motor y la suspensión de tu zancada, pero la vida sentados y correr siempre en llano los deja medio dormidos. En este episodio te explico qué papel tienen en la técnica de carrera, por qué la famosa “amnesia glútea” está detrás de muchas rodillas y lumbares tocadas, cómo cambia su activación en trail frente a asfalto y qué ejercicios concretos puedes hacer para despertarlos y correr más rápido, con mejor postura y menos lesiones.Estudio citado:Beals C, Flanigan D. A Review of Treatments for Iliotibial Band Syndrome in the Athletic Population. J Sports Med (Hindawi Publ Corp). 2013;2013:367169. doi: 10.1155/2013/367169. Epub 2013 Oct 2. PMID: 26464876; PMCID: PMC4590904.

¿Se puede confiar en la memoria de un asesino? Hoy en Mentes Literales analizamos una de las obras más crudas y fascinantes de la literatura coreana contemporánea: ¿Quién sabe si mañana seguiremos aquí? de Kim Young-ha.☕ En el episodio de esta semana:Poniéndonos al día: Empezamos el episodio compartiendo un poco de lo que ha pasado en nuestras vidas últimamente.Reseña de Kim Young-ha: Analizamos el estilo del autor y la premisa de este thriller psicológico.El Debate (Con la película): Discutimos al final, la ambigüedad de la memoria del protagonista y qué es real y qué no en esta historia. También comentamos la diferencia que hay entre el libro y la película.

In this episode of the Pediatric and Developmental Pathology, our hosts Dr. Mike Arnold (@MArnold_PedPath) and Dr. Jason Wang speak with Dr. Aida Glembocki, a Pediatric Pathologist and Masters Degree candidate at the University of Toronto, and Dr. Robert Siddaway, an Oncology Investigator at The Hospital for Sick Children in Toronto.   Hear about how The Hospital for Sick Children applies RNA sequencing in pediatric cancer diagnosis to reduce costs and identify key information for diagnostic classification. We also hear about their article in Pediatric and Developmental Pathology: Fusion-Negative Rhabdomyosarcoma: Clinical Application of Targeted RNA Sequencing   Related article: Siddaway R, Glembocki AI, Arnoldo A, Staunton J, Liu APY, Yuki KE, Yu M, Cohen-Gogo S, Shlien A, Villani A, Whitlock JA, Hitzler J, Tabori U, Levine AB, Lafrenière A, Nagy A, Chen H, Ngan BY, Somers GR, Abdelhaleem M, Chami R, Hawkins C. Clinical utility of targeted RNA sequencing in cancer molecular diagnostics. Nat Med. 2025 Oct;31(10):3524-3533. doi: 10.1038/s41591-025-03848-8. Epub 2025 Jul 17. PMID: 40676318.   Featured public domain music: Summer Pride by Loyalty Freak

Robotic surgery has moved from novelty to norm, and in this episode of Behind the Knife, Drs. James Jung and Joey Lew sit down with urologic pioneer and Medtronic CMO Dr. Jim Porter to dissect how we got here, what the data really say about “the death of laparoscopy,” and where competing robotic platforms like Hugo may take the field next. From ergonomics and education to economics and global access, they tackle both the hype and the hard questions around robotics as the future of minimally invasive surgery.Hosts: ·      James Jung, MD, PhD, Assistant Professor of Surgery, Duke University·      Joey Lew, MD, MFA, Surgical resident PGY-3, Duke University, @lew__actuallyLearning Goals: By the end of this episode, listeners will be able to:·      Describe key clinical, ergonomic, and educational drivers behind the rapid adoption of robotic surgery in the United States and globally.·      Summarize current evidence comparing robotic and laparoscopic approaches for common procedures, including where outcomes are equivalent, inferior, or clearly superior.·      Explain how surgeon ergonomics, trainee experience, and video-based learning influence practice patterns and learning curves in minimally invasive surgery.·      Discuss the role of cost, reimbursement structures, and market competition (e.g., Medtronic Hugo vs da Vinci) in shaping robotic adoption across different health systems.·      Anticipate how next-generation, task- or organ-specific robotic platforms may further change standards of care in minimally invasive surgery.References:·      Violante T, Ferrari D, Novelli M, Larson DW. The Death of Laparoscopy - Volume 2: A Revised Prognosis. A retrospective study. Ann Surg. 2025 Jun 16. doi: 10.1097/SLA.0000000000006792. Epub ahead of print. PMID: 40518997. https://pubmed.ncbi.nlm.nih.gov/40518997/·      Yu Yoshida, Yoshiro Itatani, Takehito Yamamoto, Ryosuke Okamura, Koya Hida, Kazutaka Obama, Single-incision plus one robot-assisted surgery (SIPORS) using the Hugo robotic-assisted surgery (RAS) system for rectal cancer, Annals of Coloproctology, 10.3393/ac.2025.00787.0112, 41, 6, (586-591), (2025). https://pubmed.ncbi.nlm.nih.gov/41486916/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://behindtheknife.org/listenBehind the Knife Premium:General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-reviewTrauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlasDominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkshipDominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotationVascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-audio-reviewColorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-audio-reviewSurgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-audio-reviewCardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-audio-reviewDownload our App:Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

On this episode, my guest is Leslie Kern, PhD, the author of three books about cities, including Gentrification Is Inevitable And Other Lies and Feminist City: Claiming Space in a Man-Made World. Her work provokes new ways of thinking about and creating cities that are more just, equitable, caring, and sustainable. Leslie was an associate professor of geography and environment and women's and gender studies at Mount Allison University from 2009-2024. Today, she is a public speaker, writer, and career coach for authors and academics.Show Notes* Gentrification and touristification* Naturalization of gentrification* The new colonialism* Intersectionality* Who's to blame: renter or landlord?* The hipster and the safety net* The invisible face behind gentrification and touristifcation* Transactionality or hospitality? The case of Airbnb* Commercial gentrification* The right to stay putHomeworkLeslie Kern - Website - InstagramGentrification Is Inevitable and Other Lies - USA - Canada Feminist City: Claiming Space in a Man-Made World - USA - CanadaHigher Expectations: How to Survive Academia, Make it Better for Others, and Transform the UniversityThe Tenant Class by Ricardo TranjanTranscriptChris: [00:00:00] Welcome, Leslie, to the End of Tourism Podcast. Thank you for taking time out of your day, to speak with me. Thank you. To begin, I'm wondering if you'd be willing to tell us where you find yourself today and what the world looks like there, for you.Leslie: Sure. I find myself in Cambridge, Ontario.It's a city of about 130,000 people. If I looked out my window right now, I would see a lot of blowing snow. It's about minus 27 Celsius with the windchill, or something hideous like that today, so taking the time to talk to you this morning means I don't have to go out and shovel anything just yet. So.Chris: Well, thank you. Thank you for joining us. it's a great honour and I'm really looking forward to this conversation that bears a great deal of complexity. So, I had invited you on the pod in part to explore your book, Gentrification is Inevitable and Other Lies. And [00:01:00] in it, Leslie, you write that“Gentrification has come to be used as a metaphor for processes of mainstreaming, commodification, appropriation, and upscaling that are not necessarily or directly connected to cities. In this story about gentrification, gentrification stands in for any sort of change that pulls a thing or a practice out of its original context and increases its popularity, priciness, and profit-making potential.”Given that some of our listeners might not have heard of the term “gentrification” before, although I doubt it, but given that those who have heard it might understand it also to be what you and others refer to as a “chaotic concept,” I'm wondering if you'd be willing to take a stab at defining it for us today?Leslie: Yeah, absolutely. If we [00:02:00] look to, I guess, a kind of typical scholarly definition of gentrification, it would be describing an urban process in which middle or upper class, or in some other way, privileged households start to move into a neighbourhood or area of the city that has historically been more working class, or perhaps an immigrant neighbourhood, perhaps more industrial, and begin to remake that neighbourhood, kind of in their own image, thus driving up housing prices both in the rental and ownership markets, driving up the cost of living in the area, and critically, as part of the definition, resulting in some level of displacement of the older inhabitants of that neighbourhood. “Displacement” meaning they've been kind of priced out or otherwise pushed directly or indirectly to leave and [00:03:00] move to some other neighbourhood.So, typically with gentrification, the definition is centred around it being a class-based process, but in more recent decades, many scholars, myself included, have wanted to broaden that and to acknowledge that other axes of power and privilege, for example, race, gender, ability, age, sexuality, and so on, also play a role in contributing to the kinds of forces that propel gentrification. And we can maybe get into some of that later.So for myself, in the book, I talk about gentrification as “any kind of process of taking over claiming space and remaking it in the image and for the interests and benefit of a more powerful group of people, or perhaps even corporations, to some extent.” So, [00:04:00] gentrification is really the process of taking and claiming space. And I also do include displacement as part of that process, although I also acknowledge that sometimes people can be kind of psychologically displaced, even if they aren't necessarily physically pushed out of their neighbourhoods.Chris: Mean it's something that I was noticing in Toronto before I left and moved and migrated here to Oaxaca. It's something that I think in the last five or ten years has become an unfortunate mainstay of city life in the vast majority of places, of urban places in the world.And this is also something that I've seen quite a bit here in Oaxaca, Mexico in a somewhat prolific tourist destination. And so, in places that have [00:05:00] been deemed “destinations” in this way, there's often a kind of reductionism, here anyways, and in other tourist destinations in which gentrification and what's sometimes called touristification is confused.And so one definition of “touristification” is simply “the process of transformation of a place into a tourist space and its associated effects.” So a kind of very vague and broad definition. But we also understand that gentrification can happen in places that aren't necessarily tourist destinations.And so, we've also discussed in the pod the possibility that a place doesn't necessarily need tourists in it to have touristic qualities or context what we might say. [00:06:00] And so I'm curious for you, do you think it's important to distinguish the two concepts, gentrification and touristification? And if so, why?Leslie: Yeah, great question. I think a distinction, to some extent, is important in that, yeah, there may be elements of touristification, for example, that are somewhat unique to that process, especially in terms of the kind of impact that it might have on local inhabitants who may not necessarily be displaced, but who may see their everyday lives kind of radically altered by the touristification of an area.And as you say, gentrification happens in all kinds of areas, many of which are not geared to tourism, although sometimes that is a kind of later effect of gentrification, is that tourists might be drawn to certain neighbourhoods or places that they would not have otherwise gone to in the past.As [00:07:00] you mentioned in your earlier question, there's been some concern in the gentrification literature that it's a bit of a chaotic concept, by which it is meant that it's maybe too broad of an umbrella [term], and so many different kinds of processes are kind of lumped together under that umbrella. I think it's a useful umbrella, but under that umbrella, we can try to be clear about what we're talking about when we look at particular locations, and try to articulate the impacts that these processes are having on the local community, economy, environment, and so on.Chris: Thank you, Leslie. Thank you for that. So your book is broken up into chapters that reveal the deeper realities behind the tropes or lies sometimes spouted about gentrification. And there are often many. And so I'm curious if after having done the research and writing for this book, and it was published in [00:08:00] 2022, so perhaps there's been some deeper reflection in that regard, I'm curious what you feel might be the most important lie about gentrification that requires our attention and why?Leslie: Ooh, really putting me on the hook to like pick a favorite child there. No, I'm joking. Ultimately, I mean, I guess the most straightforward answer would be the first one that I discuss in the book, which is right there in the book's title, which is the idea that gentrification is inevitable. And we can kind of unpack that a little bit further, as I do in the kind of first main chapter of the book, which is to say that in some accounts of gentrification, it's presented as a sort of natural process, right? As something that is just akin to evolution, for example. So there's this idea that if you kind of start with, for example, a working class or immigrant [00:09:00] neighbourhood, lower income community, with some other kinds of attributes that might not make it seem wealthy or desirable, that over time, just through, I don't know, a kind of mystical series of properties, the way that species evolve or human beings develop from fetus and baby to an adult through this series of difficult to trace impacts, that somehow it just happens. Right. And of course, the problem with that, again, is that if we think it's natural, then we don't really think there's any way to stop it.And also when we describe something as “natural,” we often imbue it with positive qualities. Well, if it's “natural,” it's just meant to happen. It's just the way things are. And why would we want to stand in the way of that process? From a kind of political standpoint, it becomes very problematic, because it means that there's not really a [00:10:00] willingness perhaps on the part of those who have some power and influence to slow down gentrification, to pause it, to use whatever tools they might have in their kind of legislative toolbox to create guardrails around the process happening or to try to prevent it altogether. And from a kind of community response standpoint, it can be very disempowering to believe that gentrification is inevitable, unstoppable, that once you see those first, white, middle-class families move into your neighbourhood, “boom, you're done. It's over. The clock is counting down to the time when it's not your neighbourhood anymore and you'll just have to leave, so why bother to do anything about it?”And as I also try to show in the book, you know, it's hard to fight gentrification, but there are examples around the world of communities that have pushed back and kind of “pumped the brakes on gentrification,” as one [00:11:00] activist described it to me. So, we, I think, don't want to fall into this trap of believing that communities themselves are powerless, or that our politicians and policy-makers have absolutely no tools that they can use to change this.So I would say that is probably the most important kind of first line myth or lie that we need to challenge. And then we can kind of go down the line and pick apart some of the other ones, which is how I've structured the book as you point out. Yeah.Chris: Thank you, Leslie. Yeah, I mean, that was a really jarring chapter for me, in part because of this notion that not only is quote gentrification inevitable or natural, but that the city is, according to different philosophers and thinkers, imbued with this kind of biological life and [00:12:00] and that it follows as you were mentioning certain processes that are “ natural” as far as evolution is concerned.And imediately, this brought me back to my research on what's often referred to as 19th century social evolutionist thought, these notions that were often created or maintained by kind of, elite, wealthy, white men in the 19th century, not all of whom were academics, some of them were bankers, for example, among other things, but essentially promoting this notion that certain races or genders or types of people had evolved along the natural processes of evolution either faster than others or got ahead in certain ways, and that, of course, this was a way for those people, not only the non-academics, but those in academia [00:13:00] to employ hypotheses theories as a way of justifying colonial histories and the ongoing conquests of different people around the world. And so, in that context, I'm curious if you imagine or think that gentrification understood or described as “natural” in this way is a kind of extension, a historical extension of that kind of colonial power play of the 19th century.Leslie: Yeah, I absolutely do. And there are many ways in which the power dynamics and even the language or the vocabulary around gentrification mirrors that around colonialism with all of the problematic tropes there of neighbourhoods or areas of the city being taken over where “there's really nothing there,” right?[It's the] same kind of justification for colonialism. “There's nothing there. [00:14:00] There's nobody there that we need to care about,” so European colonizers are entitled to this land. Similarly, with the way that many developers, for example, I think, rationalize or justify the kind of projects they engage in.“Oh, there's nothing really happening in that part of the city. There's not really a community there. It's just a space of problems or deviation from the norm or disorder. And so we, as developers, as city planners, we're going to bring order and light and civilization, quite frankly, to these neighbourhoods.”So I'm sure you're hearing in this, all those echoes around colonialism. And this point around the social evolution part of it, I think that is the kind of darker, maybe less acknowledged side of gentrification, is that when we start to talk about neighbourhoods as “nothing's happening there, there's nobody there.” [00:15:00] Who's “nobody,” right? Who falls into that category of “nobody,” right? It's poor people. It might be unhoused people, working-class people, people of colour, queer people, disabled people, sex workers, right?“All people who we don't really think of as kind of counting as citizens, people who we don't think have a legitimate voice in the city, people who we don't think have a right to the city or a claim on the city.” And they're just seen as disposable, as easily displaceable, as not really contributing anything to the community or to the city at large. So I think there's definitely a sense of kind of hierarchy in terms of, “who are the seemingly new people who are coming in, right?” And they're viewed as “bringing all of these kind of gifts and benefits to the neighbourhood, and in some ways, perhaps even uplifting the poor [00:16:00] or downtrodden inhabitants of the ghetto or the barrio or whatever. And the locals should somehow be grateful to receive gentrification similarly to the way that people were, say, ‘oh, you should be grateful to receive an education if you're from the lower-classes or working-classes.'”So, yeah, I think there's definitely echoes and traces of that same kind of logic, right? It's a logic of superiority, a logic of dominance, a logic of control that resonates, whether it's colonialism or social evolutionism. Um, yeah.Chris: Wow. Fascinating. Fascinating stuff. I mean, this is, I think, to a large degree culture or what we call culture or what culture might be is made on the tongue, and that the, the kind of unacknowledged ways in which we speak the world into being [00:17:00] is something that's been direly overlooked in our time. So thank you for speaking to that in that way. And I think it's something that we would properly kind of continue to wonder about as we speak and as we think, and perhaps before we speak as well.You know, you mentioned in there the different types of people that are often displaced as a result of gentrification. And this shows up quite a bit in your book. So I wanted to ask you about what you refer to as “intersectionality,” an intersectional approach to gentrification.Some of the conventional critiques that you mentioned in the book, including the economic critique (kind of follow the money), the aesthetic critique (the kind of clean lines and fancy bakeries that show up), as well as the class critique, which you mentioned kind of upward mobility, among others.That said, you focus a good portion of the book, I think, on this neglected importance of intersectionality. And so I'm curious, why do you think an intersectional approach has been ignored in the [00:18:00] past, and why might it be crucial for a cohesive or integral analysis of gentrification?Leslie: Hmm. I think an intersectional approach has been kind of sidelined, if you will, in part because most of the key kind of prominent gentrification scholars of the late 20th century and into the 21st century have been, honestly, white men probably themselves from middle-class backgrounds, or obviously university educated scholars and they've been, like neo-Marxist, or Marxist. That's their theoretical perspective. That's their training. They come from a kind of Marxist, political economy, background. That's the lens of analysis that they bring to whatever kind of problem they're looking at in the world, including gentrification.And they've done brilliant work, right, and created a lot of really foundational [00:19:00] concepts, gone and done really important empirical work so that we can actually see what the impacts of these processes are. And there's nothing I want to take away from that being a key voice within the field of gentrification studies, but I think too often either there's been kind of minimal lip service paid or kind of outright pushing to the side of feminist perspectives, anti-racist perspective, anti-colonial perspectives and more, because it's sort of seemed like, well, “class is the main driver and anything that maybe disproportionately impacts women or people of colour, or queer folks or elderly people, that's like a side effect, right? Like the main driver is class and those people are simply impacted because they also happen to fall into lower income brackets.”So it's a pretty neat and tidy [00:20:00] story and you can kind of see why it has some appeal. So I think, you know, those political economy, neo-Marxist scholars is not that they don't care about race or gender or other factors. They're just like, “well, it's all really rolled up under the umbrella of ‘class.' And if we just figure out the ‘class' piece, then those other things will kind of fall into place.” But for feminist scholars, critical race scholars, anti-colonial scholars and so on, they've wanted to point out that assuming that class is the primary driver behind things is maybe an assumption that we've held onto for too long without questioning it. And instead of seeing racial impacts and so on as something that's just happening off to the side through a class process, maybe we want to also look, especially in something like an American context, but in other places as well, at the deeply foundational layer of race to the development of cities, to the development of the [00:21:00] nation, and we can't kind of sideline the impacts of racial discrimination and the kind of hierarchy of race that has developed over many centuries in these locations and say, “oh, well it's a secondary factor.”For myself, I'm a feminist scholar. My background is in women's and gender studies before I kind of accidentally stumbled into being an urban geographer. And to me it was always kind of obvious, but I think I've had to argue this point so often that processes like gentrification, neoliberalism, urban revitalization, as it's called, doesn't just kind of impact women as a tangential side effect, but that gender inequality or assumptions about gender roles and so on are like part of what drives the process. And so I try to bring that out in the book by looking at different kinds of examples of the ways in which different sorts of [00:22:00] communities or people are impacted to hopefully show, to hopefully make a case for this idea that taking an intersectional perspective doesn't deny the class factor at all, but that it allows us to look at gentrification through a more nuanced lens and one that respects the fact that class is not the only, and not always the most salient marker of hierarchy and status in our societies.Chris: Hmm, hmm. Yeah, I did go to university a long time ago, and it seemed that what was offered up on the proverbial, kind of conceptual, bill, politically speaking was, here are your five major theories or perspectives and kind of like choose one and decide what you like the best and then argue for it or against it.But it does seem that the more apertures that we have onto the world, without necessarily needing [00:23:00] to collapse our considerations into a single one can broaden our understanding of the world deeply, right? Deeply, deeply. And it's something that I see anyways less and less of.I think there's more and more possibilities for experiencing that in our time, but I think there's a lot of processes that are happening in which there's less and less of it that's actually occurring - a kind of collapse of maybe ontological diversity or philosophical diversity.I don't know what to call it, but seems prevalent and at least from this little aperture. So.Leslie: Yeah, I would agree with that, as someone who, just in my own little brief lifetime here on this earth has been peddling my little feminist arguments for 30-plus years. And then we add on to that, the 30 years before that and 30 years before all of the previous generations. It seems like we are, [00:24:00] not just from a feminist perspective, but we are kind of constantly having to make these arguments for that ontological diversity, as you put it, or even just the idea that, oh, you can view things through different lenses and learn different things about whatever kind of process or force or issue that you're interested in.Chris: Hmm. Well, thank you for that. I'd like to, if I can, Leslie, there was something I've been wrestling with for a while and it was very much front and centre, this kind of inner wrestling when I was reading your book.And so, I'd like to share that with you at the moment if I can, and we'll see where it takes us. So part of the reason that I left Toronto a decade ago was that the housing crises, that perhaps for some wasn't yet a crisis in Toronto, has of course ballooned. But in the past five years I've watched that same housing crisis play out here in Oaxaca.[00:25:00] And what arose almost immediately in the, we'll say media sphere, the online world and certainly on the streets as well, was a kind of xenophobic campaign or campaigns blaming tourists, digital nomads, and “expats” for the rising cost of rentals and housing. Now, while not entirely misguided, the percentage of such people is insignificant in comparison to the total population of renters and homeowners here.And then I ask myself, well, “why isn't anyone questioning the role of homeowners and landlords, those who actually decide the price of rental units, those who decide to turn long-term rentals into Airbnbs, and those who are, some of them anyways, more often than not, part and parcel of the political ruling class in many places?” Why not blame them?And so, if you think about this enough, you can [00:26:00] begin to imagine that the willingness to blame specific people, types, classes, races, et cetera, can ignore the cultural, economic and structural elements of society that allow and encourage such dynamics to emerge. And it seems to me that you speak to this, to some degree, in your book writing, how“it is not helpful in a critique of gentrification to get overly stuck on the styles and preferences of a group, when, for many decades now, gentrification has been propelled by much stronger forces than aesthetic trends.”And in another part of the book, you write that “cultural factors cannot be hastily dismissed, not when their power is easily co-opted by capital. Trends in denim and facial hair are not responsible for gentrification, but when large groups of people are redefined as a class based on their tastes, occupations, and aesthetics, they become a market and a justification for urban [00:27:00] interventions.”And so my question has to do with what I might call, I don't know if this is something that shows up in your work or in your research, but a kind of “ecological analysis,” one that doesn't necessarily separate people into essentialist categories, but contends with how maybe the rules of the game produce the player's behaviour and beliefs.And so I'm wondering, you know, in your research, is that something that is tended to, a way of, “okay so, we're not going to only blame or ask the tourists to take responsibility or the digital nomads, et cetera, and we're not only gonna blame or ask the landlords to take responsibility, but understand that they live and inhabit a kind of web of relations that has, for a long time, created the context that allows them or even [00:28:00] encourages them to proceed in a particular way?Leslie: Yes, a hundred percent. I really love the way that you put that there and giving it that kind of label of like an ecological perspective there. I think it's so important to do in the book. You know, the first quote that you read there, I think has to do with this idea that, “oh, you know, hipsters were causing gentrification” kind of thing.And I wanted to kind of, not defend the hipster per se, but to just say, well, in a city like New York, for example, the takeover of midtown Manhattan and the absolute sort of pricing out of regular people, well, from Manhattan as a whole in many cases is not to do with artists and yoga teachers moving into those neighborhoods. It has to do with massive multinational corporations buying up housing, developing condos, like all of these other things that [00:29:00] are going on. And as you say, I mean, I think it is useful to question and critique landlordism for example, and even home ownership itself, but there's a reason why people engage in these practices and as you say, it's because of these all sorts of other like prior sort of conditions and causes this kind of web of possibilities that so much of our... the policy, the legislative world, our national context shapes for us.Like in Canada for example, home ownership is, as you well know, sort of seen as the ultimate goal in the housing market. Renting is seen as very much a kind of transitional stage for people. And the idea is to eventually, sooner rather than later, own your own home.And of course there's all kinds of cultural myths around that, of homeowners being like responsible people and better citizens and all this kind of stuff that is, maybe like [00:30:00] largely nonsense. But why, in this context, do people become homeowners? Well, this is the way that we've been told “you secure your retirement in the absence of a truly kind of robust old age security net.” Yes, we have some. We have pension, old age pension, but for many people, the home is ultimately their social safety net, and government policy has very much been set up to encourage us to treat our homes in that way and to rely on paying off a mortgage and having that home to be the basis of survival into our old age.Right. And there are many other things. That's just one example. So I think, as you say, it's really important to kind of look at that whole ecosystem. And that doesn't mean that we don't say, “well, okay, what are homeowners doing that might be potentially problematic and contributing to the problem?”Well, that could include things like turning units into Airbnbs or acting in NIMBY-ish (Not In My Backyard), kind of ways that limit, for example, the amount of affordable housing that might go up in their neighbourhood and other things. Of course, all of those dynamics have to be critiqued, challenged, pushed back against. But, keeping, at the same time that kind of zoomed out perspective of like what's going on on a larger scale, in the kind of corporate and investment world and the government policy-making world, I think at least helps us to understand why these different groups are kind of positioned in the way that they do and the kind of range of possibilities that they see for themselves within that web.Chris: Mm mm Yeah. Yeah. That reminds me of a moment that I had here in Oaxaca, maybe three or four years ago. There was a student group that had come down from a Canadian university, and they were here for a couple weeks, and I was having dinner with them. Not all of them, but there was maybe four of the women from the student group that I was having dinner with.And one of them was probably in her, I would say [00:32:00] mid-fifties, an indigenous woman from Ontario. And the other three were much younger, probably in their early twenties. And they were suddenly talking about the sudden or at least recent kind of housing crisis in their university town, we'll call it, maybe a small city, but big town. And how in previous years they could afford the rent, but suddenly, and of course this was 2021-2022, when a lot of these dynamics started changing extremely rapidly. And I was kind of moderating the conversation at first. And then it turned out, she wasn't so quick to out herself as a landlord. But the indigenous woman, the 55-year-old kind of alluded to it and then said, “well, you know, for a lot of people, it's a pension plan. “It's my retirement plan, essentially.” And it was this really interesting dynamic about how these four women, who had come to this place and were in the same program, studying the [00:33:00] same thing, that one of them had to perhaps, unbeknownst to her, undermine the economic life and possibilities of those younger women by virtue of requiring a retirement plan.Right. And I think at least in Canada, in countries that are very much still welfare states, that it speaks to a, the incredible degree in which the care that's offered, especially to the elderly, is almost entirely top-down. There's so little, if any, community care.And, you know, of course this is a very kind of small example, a very kind of minute example. I think maybe a common one. But of course you also have other examples of, as you mentioned before, corporations... is it BlackRock this massive mutual fund that I know in, in Europe and places like Barcelona and the major cities there end up buying entire apartment buildings or blocks even, and evicting [00:34:00] the residents and then setting up Airbnb buildings, essentially. So, I mean, there's this incredible kind of degree of difference and diversity in terms of how, as you mentioned landlordism and rent is affecting people.But I just wanted to mention that. It was a really kind of interesting moment for me to see this dynamic and the young women kind of complaining about, you know, I guess the future, the present and the future of their economic lives. And then, this older woman also not necessarily complaining, but very much concerned about her ability to live as well, economically and to thrive economically into her older age.Leslie: Yeah. And there's these kind of ironic situations popping up all over the place where so for example, someone might have a public pension. And as you point out, many public pensions are deeply invested in real estate income trusts. This is like a huge piece for example, in Ontario, of [00:35:00] Ontario public workers' pensions, but around the world as well, and I don't have the details, but a story that was in the news several years ago about a man somewhere in Europe who was being evicted from his apartment because that one of these real estate investment corporations was taking it over and was gonna redevelop it in some way. But his public pension was invested in that very same company. Right?So many people are kind of caught in these loops where it's like, we would very much like to not be like, displacing ourselves or our neighbours or community members, but we don't necessarily have control over how our pension funds are invested, right? Like you might have a choice like, “oh, I'd like to divest from fossil fuels, for example, or from tobacco or military, like arms deals.” Like, sometimes, you can opt out of those things in your pension funds, but there's not really a way to like opt out of real estate investment.My substack is a reader-supported publication. To receive new posts and support my work, consider becoming a free or paid subscriber.It's such a huge part of those things now. So I think that's an area where there's increasing kind of research and critical perspectives on that in gentrification scholarship and so on that I think is really important to look at, because it's also very hidden, right? This is another aspect I think of contemporary kind of gentrification touristification even, is that there's no face to it, right? There's no face to this process. And maybe that's why it's tempting to take, as you put it a minute ago, that kind of like xenophobic perspective or to blame “expats” in the case of Oaxaca and touristification or in cities to be like, “oh, it's these urban hipsters, maybe these like trust fund kids” or whatever label people might want to put on someone, because there's a face, right? There you can look and be like, “that's the problem.” But the reality is there is no face, right? There's no individual or even group of individuals that's easy to identify. And people doing [00:37:00] research into some of this pension fund stuff that I'm talking about, they hit very opaque walls, even just trying to get the information about how these companies work, the kinds of decisions they make, what their rubrics are around what they call “socially responsible investing.”So it's very deliberately mystified and hidden from us, and I think that is part of the challenge now is like, how do you fight this monster that you can't see, that you can barely name?So yeah, that is I think one of the kind of frightening things, if you will, about, whether we call it “gentrification,” or we think about it in this broader sense of the housing crisis, who's the face of that, the cause of that crisis? Very hard to say in many cases.Chris: Wow. Yeah, I know that these mutual fund companies that end up buying, you know, whole city blocks or buildings, apartment buildings, and then tending to renovictions or whatever they [00:38:00] might use in order to get people out. Once the buildings are “ renovated” as Airbnbs, what happens is those corporations end up outsourcing all of the operational and cleaning duties to companies that they're not involved with at all. So, again, you could have this person who's in front of you, who might be a cleaner or who comes ou in and out of the building or who might run the reservation books or something like that, but they've never met anyone from that mutual fund company. Right. They just get a paycheck.Leslie: Yeah. And it's happening on this kind of global level. The people behind the company that's investing in that building in Oaxaca, like they may have never set foot there, and they may never set foot there. Right? So it's happening from around the world, from thousands of kilometers away from behind these kind of screens of, as you said, these kind of shell companies and these subcontracted, property management companies.I mean the story you were just telling about the woman who's a landlord, like on that small scale, not that [00:39:00] there's nothing problematic about it, but it is also like, you know, she's probably met her tenants, right? She probably occasionally sets foot in the property that she owns and that she rents out, and there's like some aspect of a relationship there. It's still, you know, a problematic power dynamic and all of that, but it's on a very different scale than the investor from London who's has a stake in a condo in Oaxaca. Like, it's a very different web of of relations that goes into that.Chris: Yeah. And even if someone like that, and I've had many, many landlords over the years and I've been blessed to have a number of them who are really incredible people and really incredible in terms of showing up when they're needed in that regard. But it's something, I discussed on a previous episode regarding the Airbnb-ization of the world, a couple years ago. And one of the themes that came up was around hospitality, right? [00:40:00] And even if you have people who are kind of really engaged and really excited and responsible about having a tenant in their home or in a particular building, the kind of transactional nature of that rent almost (and then of course the history of it) precludes, almost by default, the possibility of there being a kind of host-guest relationship, right? Instead of that we are “clients” and and, and “salespeople,” businesspeople to some degree.Right. So another layer of it is this question of like, “well, is it even possible within the dynamic or structure that renting implies and incurs, is it even possible to create a dynamic wherein a person can be understood as a guest in another person's home, and another person can be understood as a host to people who are coming to live in their home? Right? That that same [00:41:00] woman, the 55-year-old landlord said that she had tenants who refused to leave for, I dunno, a year and a half or two years, and once they finally did, left her with a $40,000 damage bill. So, I think there's just layers and layers that are extremely difficult to kind of get into, I shouldn't say in terms of dialogue, in terms of investigation, but in terms of the possibility of creating different dynamics that would maybe represent or produce the kinds of dynamics and worlds that, I think, a lot of people would want to live in.Leslie: Yeah, I totally agree. I mean, I think in a lot of cases, and you honestly don't have to dig very deep, you can open up CBC News and see some poor, sad landlord story most days of the week or listen to kind of corporate or larger scale landlords talk and they often see tenants as a nuisance.“The tenants themselves are a problem,” and if they could invest in real estate and still make [00:42:00] these returns without actually having tenants, that would probably be ideal. And I think that is also part of the push to an Airbnb is that with a temporary guest, you know, a week, a weekend or whatever, you don't have the same responsibility to them as you do to someone with a year lease or perhaps the right to stay there for a longer period of time. So, all you have to do is kind of provide this very basic amenity of the space. You can even impose all these rules on them that you maybe otherwise wouldn't be able to do if it was a longer-term rental.You know, the people who check-in have many fewer rights than actual tenants do. And so in some ways it makes that relationship even more transactional and even more hands off in many cases. And of course there's the quicker profit motive is really the main driving force behind that. But I think there's also this piece of it where it's like, “well, how can I maximize the profit potential of this space with as little actually dealing with other human beings and their needs [00:43:00] as human beings as possible.And yeah, I think that is really, again, from my kind of feminist perspective, that is also interested in thinking about how do we create systems of care in our cities, and what does “care” mean, and what are our responsibilities to one another that, when we look at something like Airbnbification and the touristification and gentrification more generally, those things, in many cases kind of act against the possibility of creating more caring and careful spaces.Chris: Hmm, hmm. Yeah. Thank you for that, Leslie. I have a couple more questions for you, if that's all right?Leslie: Yes, go ahead. Yeah.Chris: All right. Wonderful. So this next question maybe requires a bit of imagination, which I think you have a good amount of, and it has to do with rent.And so one of the lies that you highlight in your book is the belief that gentrification is natural and hence forth inevitable. [00:44:00] And of course, as we've been discussing, nothing is natural nor inevitable and you make an excellent case for that throughout the book. And I feel that there is an equally and perhaps more subtle incarnation of this myth, of this inevitability, in regards to rent, that we as urban people or modern people who grow up in contemporary societies often reinforce and even naturalize a kind of rent slavery that most people rarely see, that most people rarely see their lives as indentured to their landlords.And so, when we talk about gentrification, does this show up at all? Should it? You know, this notion that, “well, if we can come to gentrification and understand that it's in fact not natural and it's not inevitable, can we do the same thing for rent? Because, maybe I haven't read much of the research, but it doesn't seem to be something that [00:45:00] people are so quick to aim their arrows at, we'll say.Leslie: Yeah. I love that question. And I think A, you're right that there hasn't been enough conversation about that. There has not been nearly enough attempts to kind of denaturalize this and B, that that perspective is emerging and growing. If I could recommend a book called The Tenant Class by Ricardo Tranjan. It's also a Toronto-based author, and he does an amazing job in this very short book of basically laying out the case against landlordism, and it totally, as you say, kind of denaturalizing and pushes back on this idea that it's inevitable that there are a class of people that own property and a class of people that rent property, and that this is not inherently a deeply problematic relation. You know, this idea that it's not in some way akin to some kind of indentureship. And he really asks us to look deeply again at this [00:46:00] idea that, if you're a landlord, “well, I have a mortgage to pay, so it's somehow natural that this other person will pay my mortgage for me,” which, when you start to think about it, like it's really messed up in a way. And once you see it, you can't unsee it. So yeah, I think looking more closely at some of these ideas, these kind of statements that come out, and again, you can see it in news articles, these kind of horror stories, and not to diminish, I'm sure, what are very real, like economic and psychological impacts of the so-called kind of nightmare tenant and all of those kinds of things.But you'll hear those kinds of statements: “you know, I have a mortgage to pay.”Well, why is this other person paying your mortgage, then?And then we could probably take a step back and be like, “why do we have mortgages to pay?” But that's maybe another conversation.But yeah, so I definitely recommend that book, The Tenant Class, as a really quick, easy to read, and kind of unforgettable primer on this question. And [00:47:00] I really appreciate you asking it, and I hope your listeners will be like, “oh, yeah, I gotta dig into that a bit more too.”Chris: Yeah.Yeah. I mean, you know, in part because, as prices have risen in most western countries in the last four or five years, there's of course, of course, protests and backlash among people, and “oh, this bakery raised their prices” or “ my rent's going up,” and all these things. But specifically in terms of products and services, you know, people complain or they just accept the fact that prices have risen to a degree that's pricing a lot of people out of their lives, really. But, you know, in the conversations I've had with people and in the literature that I've read, there's no consideration, I think, that the businesses who are raising their prices have had their rents raised, that so much of a business' costs include rent, right? And that very few businesses actually [00:48:00] own the building that they're working out of.Leslie: Yeah, commercial rent is a whole other story because, you know, the protections on residential rent are not what they could be in most places around the world, but there's no protections on commercial rent, like no limitations there. So it's entirely possible that local bakery, their rent could go up by, like double. It could go up from $20,000 a year to $60,000 a year. There's no restrictions on that. There's nowhere to appeal that. There's nothing. So, they are, in some ways, even those small businesses, especially, independent businesses and so on, are very at risk of this. And there's a whole branch of kind of retail gentrification studies as well that kind of looks at the impacts on the local economic landscape of things like this as well. Yeah.Chris: Hmm. Wow. Thank you for unveiling that for us. I mean, uh, so much.So my last question, Leslie, has to do [00:49:00] with what is mentioned in your book, what you refer to as “the right to stay put.”And so,“the right to stay put is a common rallying cry in response to the dangers of displacement. Drawing inspiration from the broader notion of the right to the city, the right to stay put insists that communities are entitled to remain in the places they have contributed to. Furthermore, the right to dwell extends beyond simply having a home in an area, encompassing the right to continue using commercial, community, and public spaces and institutions, as well as the dignity of defending such rights. Importantly, it recognizes that agency is a critical factor. People do not want to be forced to move, nor do they want to be forced to stay in place. Rather, people value choice, the ability to participate in [00:50:00] decisions that affect their communities and the right to resist when they need to.”And so I'm curious what you think it would take for people, say, in urban environments to achieve or enshrine the right to stay put or the right to dwell in their places.Leslie: Yeah, I think we could talk about kind of two main avenues. One would be more of the top-down approach, which is to work to enshrine anti-displacement measures in neighborhoods, which can include everything from rent control or rent stabilization, to the right to return when there are redevelopment projects going on, to deeply affordable housing in new developments, to communities themselves taking on the role of becoming developers, but creating housing within the community for the [00:51:00] community. Not to draw in new residents or not to primarily draw new residents. Again, we're not trying to like, build a fortress around communities or anything, but rather to say, “this is housing that we're earmarking for people from the local community who are struggling with their rent or struggling to find housing, or who need perhaps entry-level home ownership opportunities and to kind of provide that.So there's the kind of top-down approach, really pushing our local governments to have things like community benefit ordinances when new developments are happening that force developers to actually pay attention to what the community needs and to provide those benefits and such.And then, from the kind of ground-up or more grassroots piece, the right to stay put is the the willingness, the ability to organize and come together in some of the places that I mentioned throughout the book. You know, it really [00:52:00] is community-level organization where people have really rallied to make it deeply difficult for planners or developers to kind of roll in and roll out their vision without any pushbacks, to the extent that their neighbourhoods become less of a target for gentrification, because it's like, “oh yeah, we wanna build something there. Oh, that's gonna be a real pain in the butt. The community is not gonna let us get away with what we wanna do.” And that means really making it possible for people to come out to meetings, organizing protests, that kind of right to resist. Sometimes taking... You know, we have long histories in many cities of squatters movements and perhaps we need to revitalize some of that old energy, as well. A kind of refusal to leave. And to find ways, you know, perhaps they don't always have to be kind of in-your-face protest ways, but what are ways to mobilize things like mutual aid to help make sure that our [00:53:00] neighbors are supported, for example, if they have to go before a landlord-tenant board, how can we use community resources and knowledge to actually support one another to stay in place?And that can be everything from addressing food insecurity to having a local rent bank, to partnering with nonprofits, churches, other religious institutions that may have an interest in building social and nonprofit housing to create some of those options.So I think it's about looking at the kind of wide range of alternative forms of housing and housing provision, looking at community mobilizing, community resources, and also tackling the local policy agenda to make staying put as possible, or to enshrine it as a right at a kind of higher level, as well.Chris: Hmm, hmm. Yeah, you go into [00:54:00] great detail about this in the book, and I'm very grateful for that. And the right to stay put kind of jumped out, the text jumped out of the page at me, because living here in Oaxaca, I came to know about this declaration that was created in 2009 by people in a number of communities here in the Mixteca region of Oaxaca who were meeting with their migrant kin who had gone to work in California and the people who had stayed in the community.And the declaration is literally translated as “the right to not migrate.” The way it was translated in English by the author of the book of the same name, was “The Right to Stay Home.” And so while there's a lot of differences between these contexts in terms of rural, indigenous communities here in Mexico and modern urban communities in the global north, there is this sense, [00:55:00] this kind of perhaps shared context wherein the ability to to stay in a place in order so that community can be conjured and maintained and of course enjoyed and lived in, seems to thread its way through these different social movements from the global north into the global south.So, I'm really grateful to see that and to know that there's similar understandings, of course not the same, but similar understandings that are even somewhat unorthodox and unexpected given the political context that sometimes challenge them or preclude something like that from coming up.So that's a little way of saying thank you for your time today, Leslie. On behalf of our listeners, I'd like to thank you for your willingness to join me and to speak to these often complex issues. And on behalf of them, I'd also like to ask you how they might find out more about [00:56:00] your work and your books: Gentrification Is Inevitable And Other Lies, Feminist City: Claiming Space In A Manmade World, and finally Higher Expectations: How To Survive Academia, Make It Better For Others, And Transform The University.Leslie: Yeah, thank you so much for this conversation. People can find out about me and my work at my website, which is just lesliekern.ca.If you just google my name, it will come up easily enough. Feminist City and Gentrification Is Inevitable And Other Lies. For an international audience, you can find those books through Verso books in the US and UK. There's also many translations of both of those books, so you may have the opportunity to read it in your local language if you want to do that as well.The more recent book, Higher Expectations is available from my Canadian publisher Between the Lines Books and in the US [00:57:00] from AK Books, as well. And there's also Epub versions and for the first two books, audiobook versions as well. And I've written lots of articles on these topics as well, in the Guardian and other places.So you can get a little snippet of my thoughts if you, again, Google my name and all of these things will come up in short order. So thank you for letting me share that as well.Chris: Yeah, of course. I'll make sure that the links to all those pages that you mentioned are available on the End of Tourism website and the Substack when the episode launches.And once again, Leslie, a really beautifully revealing conversation today. I think it's something that will not just provoke generally, but provoke a willingness in our listeners to reconsider some of the assumptions that they've had about gentrification.So, once again, thank you for your time today.Leslie: Thank you for having me. I really enjoyed the conversation. Appreciate it. Get full access to Chris Christou at chrischristou.substack.com/subscribe

In this new book from my Bringers of the Light series we meet twins Pinky & Meggy. The girls with a little fairy blood inside live in the etheric town of Oakwood on the West Coast of the USA. Pinky & Meggy both think they know what love is. Until two love interests enter their life. Harry Winterbottom and Count Mashar both magical men on their own rights. Harry a hot wizard with a big Instagram following and an even bigger sex drive and Dark Matters agent Count Mashar with a sordid past and a closed heart. Will Pinky & Meggy find the love of their lives with these two paramours? Only time and a little magic will tell. ⭐️

We've all seen it: the patient whose chart is “flagged” with a penicillin allergy, but when you dig into the history, the story doesn’t quite add up. Maybe it was a stomach ache in the 90s, or maybe they're just carrying a “inherited” allergy from a parent. In this episode of EM Pulse, we sit down with ED Clinical Pharmacist Haley Burhans to discuss why these labels are more than just a nuisance—they're a clinical liability—and how a simple tool can empower you to fix them on the fly. The Hidden Danger of the “Safe” Choice Choosing a non-beta-lactam antibiotic because of a questionable allergy label feels like the path of least resistance, but the data tells a different story. We explore how “playing it safe” can actually lead to: Worse Outcomes: Why second line antibiotics often mean higher treatment failure rates. The “Superbug” Factor: The surprising link between penicillin allergy labels and the rise of MRSA and VRE in our communities. The C. diff Connection: Why alternative choices might be setting your patient up for a much more difficult recovery. The Solution: The PEN-FAST Score How do you move from “I think this might not be a true allergy” to “I am confident this antibiotic is safe”? Haley introduces the PEN-FAST score, a validated scoring tool designed to risk-stratify patients based on a few key historical questions. The Mnemonic: We break down the PEN-FAST acronym so you know exactly which three questions to ask to risk-stratify your patient in seconds. IgE vs. The Rest: Learn to distinguish between the “true” dangerous hypersensitivity and the delayed reactions that shouldn’t stop you from using the best drug for the job. The “Amoxicillin Rash”: We dive into this common pediatric “gotcha.”, why many kids end up with a lifelong allergy label after a routine ear infection, and why it often has nothing to do with the drug itself. The Bottom Line: Patients with low PEN-FAST scores are considered low risk, making an oral challenge under observation in the ED a reasonable option. Higher scores may require shared decision-making or referral. Why the ED is the Perfect Place for a “Challenge” Delabeling isn’t just for the allergist’s office. We argue that the Emergency Department is actually the ideal setting to challenge these allergies. The “Oral Challenge”: Learn the practical steps for performing a trial dose in the department. Safety First: Why your environment and expertise make you uniquely qualified to handle the “what-ifs” better than anyone else. Key Takeaways Question the Label: The vast majority of reported penicillin allergies are inaccurate due to patients outgrowing the allergy or misinterpreting common side effects as allergic reactions. History is Everything: Dig deeper than just “rash.” Ask about the timing relative to the dose, specific appearance (hives vs. flat rash), and what treatment was required (epinephrine vs. antihistamines). Use PEN-FAST: Utilize this tool to objectify the risk. Document Tolerance: Even if you don’t fully delete the allergy label, if you successfully treat the patient with another beta-lactam (like ceftriaxone), document that tolerance clearly to aid future clinicians. Cephalosporins are likely safe: Later-generation cephalosporins generally have very low cross-reactivity and are usually safe options even in truly allergic patients How do you handle documented penicillin allergies? Do you use the PEN-FAST tool? Share your experience with us on social media @empulsepodcast or at ucdavisem.com Hosts: Dr. Julia Magaña, Professor of Pediatric Emergency Medicine at UC Davis Dr. Sarah Medeiros, Professor of Emergency Medicine at UC Davis Guests: Haley Burhans, PharmD, Emergency Medicine Clinical Pharmacist at UC Davis Resources: PEN-FAST Score on MDCalc Penicillin Allergy Evaluation Should Be Performed Proactively in Patients with a Penicillin Allergy Label – A Position Statement of the American Academy of Allergy, Asthma & Immunology Staicu ML, Vyles D, Shenoy ES, Stone CA, Banks T, Alvarez KS, Blumenthal KG. Penicillin Allergy Delabeling: A Multidisciplinary Opportunity. J Allergy Clin Immunol Pract. 2020 Oct;8(9):2858-2868.e16. doi: 10.1016/j.jaip.2020.04.059. PMID: 33039010; PMCID: PMC8019188. Yang C, Graham JK, Vyles D, Leonard J, Agbim C, Mistry RD. Parental perspective on penicillin allergy delabeling in a pediatric emergency department. Ann Allergy Asthma Immunol. 2023 Jul;131(1):82-88. doi: 10.1016/j.anai.2023.03.023. Epub 2023 Mar 27. PMID: 36990206. *** Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Productions for audio production services.  

  We are continuing our miniseries where we pay tribute to one of my favorite podcasts, Revisionist History, hosted by the well-known author Malcolm Gladwell. Gladwell describes Revisionist History as a podcast about things overlooked and misunderstood. There are many injuries or problems we see in the office or on the sidelines that patients, parents, coaches, and even health care professionals give a generic label or diagnosis. In some situations, it may be correct, but often things get lumped into a simple category which may lead to things not being treated or managed most effectively. This is episode 9 of this series I am affectionately calling “Revisionist Sports Medicine”, a series about things in Pediatric Sports Medicine overlooked or misunderstood.   Connect with The Host! Subscribe to This Podcast Now!     The ultimate success for every podcaster – is FEEDBACK! Be sure to take just a few minutes to tell the hosts of this podcast what YOU think over at Apple Podcasts! It takes only a few minutes but helps the hosts of this program pave the way to future greatness! Not an Apple Podcasts user? No problem! Be sure to check out any of the other many growing podcast directories online to find this and many other podcasts via The Podcaster Matrix!     Housekeeping -- Get the whole story about Dr. Mark and his launch into this program, by listing to his "101" episode that'll get you educated, caught up and in tune with the Doctor that's in the podcast house! Listen Now! -- Interested in being a Guest on The Pediatric Sports Medicine Podcast? Connect with Mark today!     Links from this Episode: -- Dr. Mark Halstead: On the Web -- On X -- Dr. Sarah Kinsella: https://providers.mhealthfairview.org/provider/sarah-kinsella/2239919 -- Stiell IG, Greenberg GH, McKnight RD, Nair RC, McDowell I, Reardon M, Stewart JP, Maloney J. Decision rules for the use of radiography in acute ankle injuries. Refinement and prospective validation. JAMA. 1993 Mar 3;269(9):1127-32. doi: 10.1001/jama.269.9.1127. PMID: 8433468. https://pubmed.ncbi.nlm.nih.gov/8433468/ -- Dowling S, Spooner CH, Liang Y, Dryden DM, Friesen C, Klassen TP, Wright RB. Accuracy of Ottawa Ankle Rules to exclude fractures of the ankle and midfoot in children: a meta-analysis. Acad Emerg Med. 2009 Apr;16(4):277-87. doi: 10.1111/j.1553-2712.2008.00333.x. Epub 2009 Feb 2. PMID: 19187397. https://pubmed.ncbi.nlm.nih.gov/19187397/ -- McGuine TA, Hetzel S, Wilson J, Brooks A. The effect of lace-up ankle braces on injury rates in high school football players. Am J Sports Med. 2012 Jan;40(1):49-57. doi: 10.1177/0363546511422332. Epub 2011 Sep 16. PMID: 21926383; PMCID: PMC3729027.https://pubmed.ncbi.nlm.nih.gov/21926383/ -- McGuine TA, Brooks A, Hetzel S. The effect of lace-up ankle braces on injury rates in high school basketball players. Am J Sports Med. 2011 Sep;39(9):1840-8. doi: 10.1177/0363546511406242. Epub 2011 Jul 27. PMID: 21795671; PMCID: PMC3213051. https://pubmed.ncbi.nlm.nih.gov/21795671/       Calls to the Audience Inside this Episode: -- Be sure to interact with the host, send detailed feedback via our customized form and connect via ALL of our social media platforms! Do that over here now! -- Interested in being a guest inside The Pediatric Sports Medicine Podcast with Dr. Mark? Tell us now! -- Ready to share your business, organization or efforts message with Dr. Mark's focused audience? Let's have a chat! -- Do you have feedback you'd like to share with Dr. Mark from this episode? Share YOUR perspective!   Be an Advertiser/Sponsor for This Program!   Tell Us What You Think! Feedback is the cornerstone and engine of all great podcast. Be sure to chime in with your thoughts, perspective sand more.  Share your insight and experiences with Dr. Mark by clicking here!   The Host of this Program: Mark Halstead:  Dr. Mark Halstead received his medical degree from the University of Wisconsin Medical School. He stayed at the University of Wisconsin for his pediatric residency, followed by a year as the chief resident. Following residency, he completed a pediatric and adult sports medicine fellowship at Vanderbilt University. He has been an elected member to the American Academy of Pediatrics (AAP) Council on Sports Medicine and Fitness and the Board of Directors of the American Medical Society for Sports Medicine (AMSSM). He has served as a team physician or medical consultant to numerous high schools, Vanderbilt University, Belmont University, Washington University, St. Louis Cardinals, St. Louis Blues, St. Louis Athletica, and St. Louis Rams. He serves and has served on many local, regional and national committees as an advisor for sports medicine and concussions. Dr. Halstead is a national recognized expert in sport-related concussions and pediatric sports medicine. — Dr. Mark Halstead on Facebook — Dr. Mark Halstead on LinkedIn — Dr. Mark Halstead on X — Learn Why The Pediatric Sports Medicine Podcast Exists...     Sarah Kinsella:  Dr. Sarah Kinsella is a sports medicine physician at M Health Fairview Orthopedics in both Blaine and Wyoming, Minnesota. She is an Adjunct Assistant Professor in the Department of Pediatrics at the University of Minnesota. She is the co-chair of the Minnesota State High School League Sports Medicine Advisory Committee and also serves nationally on the Executive Committee of the American Academy of Pediatrics Council on Sports Medicine and Fitness. Connect with Dr. Sarah Kinsella: https://providers.mhealthfairview.org/provider/sarah-kinsella/2239919      

Well, even though low dose aspirin has been recommended for the reduction of preeclampsia risk for many years, 2 controversies persist: 1. who should get it, and 2. the dose we should use. While the current US recommendation still focuses on 81 mg low dose aspirin, initiated after 12 weeks of gestation (based on risk factors), there's increased movement and growing data supporting both universal adoption and the higher dose of 162 mg. In this episode, we will briefly summarize brand new data out of UT Southwestern which was just published at the SMFM Annual Pregnancy meeting in Las Vegas. Listen in for details.1. https://www.smfm.org/news/new-studyroutine-aspirin-therapypreventsseverepreeclampsiainat-risk-populations2. ACOG CO 7433. The Effect of Aspirin on the Risk of Preeclampsia Based on the Fetal Medicine Foundation First Trimester Risk.4. Bujold E, Rolnik DL, Poon L, Syngelaki A, Wright D, Nicolaides KH. The effect of aspirin on the risk of preeclampsia based on the Fetal Medicine Foundation first-trimester risk. Am J Obstet Gynecol. 2025 Oct 31:S0002-9378(25)00808-7. doi: 10.1016/j.ajog.2025.10.032. Epub ahead of print. PMID: 41177290.

Send a textIn this episode of Journal Club, Ben and Daphna review a prospective cohort study from the Journal of Perinatology that examines the care of neonates following in-utero growth restriction. The hosts unpack the critical distinction between Fetal Growth Restriction (FGR) and Small for Gestational Age (SGA), highlighting how the "decay of information" in the NICU can lead clinicians to overlook early risk factors as babies grow. They discuss the study's alarming findings regarding the six-fold increased risk of Necrotizing Enterocolitis (NEC) in SGA infants and the importance of maintaining a comprehensive medical history throughout a patient's stay.----Care of neonates following in-utero growth restriction: A prospective cohort study exploring neonatal morbidity. Alda MG, Wood AG, MacDonald T, Charlton JK.J Perinatol. 2025 Sep;45(9):1219-1225. doi: 10.1038/s41372-025-02397-9. Epub 2025 Aug 21.PMID: 40841433 Free PMC article.Support the showAs 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 new book from my Bringers of the Light series we meet twins Pinky & Meggy. The girls with a little fairy blood inside live in the etheric town of Oakwood on the West Coast of the USA. Pinky & Meggy both think they know what love is. Until two love interests enter their life. Harry Winterbottom and Count Mashar both magical men on their own rights. Harry a hot wizard with a big Instagram following and an even bigger sex drive and Dark Matters agent Count Mashar with a sordid past and a closed heart. Will Pinky & Meggy find the love of their lives with these two paramours? Only time and a little magic will tell. ⭐️

There has been a shift in cervical cancer screening from primary cytology based to HPV based. Even HPV screening has had its evolution from physician collected samples to patient self-collection, either in a clinical setting or at home with an approved collection system. In May 2025, the FDA cleared the first at-home self-collection kit for HPV screening, specifically the Teal Wand by Teal Health. Now, we are seeing the advent of POSSIBLY another avenue for cervical HPV testing- although it is a bit awkward: the use of menstrual blood as an HPV screening test. In this episode we will review a new cross-sectional, population-based study from China which compared testing menstrual blood for human papillomavirus during cervical cancer screening to clinician-collected cervical samples for human papillomavirus (HPV). This concept, and these results, are not new at all! And there are important limitations to consider at this time. Listen in for details.1. Testing menstrual blood for human papillomavirus during cervical cancer screening in China: cross sectional population based study. BMJ 2026; 392 doi: https://doi.org/10.1136/bmj-2025-084831 (Published 04 February 2026)BMJ 2026;392:e084831https://www.bmj.com/content/392/bmj-2025-0848312. Naseri S, Young S, Cruz G, Blumenthal PD. Screening for High-Risk Human Papillomavirus Using Passive, Self-Collected Menstrual Blood. Obstet Gynecol. 2022 Sep 1;140(3):470-476. doi: 10.1097/AOG.0000000000004904. Epub 2022 Aug 3. PMID: 35926207; PMCID: PMC9377370.3. Fokom Domgue J, Chandra M, Oladoyin O, Desai M, Yu R, Shete S. Women's Preferences for Home-Based Self-Sampling or Clinic-Based Testing for Cervical Cancer Screening. JAMA Netw Open. 2026;9(2):e2558841. doi:10.1001/jamanetworkopen.2025.58841

In this research review, we are highlighting what Greg Nuckols has put together around the impact of sleep (or lack of it) on strength. The two studies below look at how sleep impacts strength and the findings weren't quite as big as you might have thought. We discuss what this means, how it applies and how you still want to focus on sleep to make sure it is a priority but also that you can still get work done if you fall short on any given night.1. Craven J, McCartney D, Desbrow B, Sabapathy S, Bellinger P, Roberts L, Irwin C. Effects of Acute Sleep Loss on Physical Performance: A Systematic and Meta-Analytical Review. Sports Med. 2022 Jun 16. doi: 10.1007/s40279-022-01706-y. Epub ahead of print. PMID: 35708888.2. Knowles OE, Drinkwater EJ, Urwin CS, Lamon S, Aisbett B. Inadequate sleep and muscle strength: Implications for resistance training. J Sci Med Sport. 2018 Sep;21(9):959-968. doi: 10.1016/j.jsams.2018.01.012. Epub 2018 Feb 2. PMID: 29422383. #complicatedsimple #progressive #openminded #PBE #EBP #noagenda #performance #training #nutrition #health #wellness #athlete #athletictraining #science #chiropractic #rehab #prevention #clinicallypressed #phd

In this episode, we simplify things. We break blood sugar control down into five simple strategies that actually make a difference — without extremes. We share:• Why meal timing matters as much as food quality• How to balance carbohydrates without cutting them out• The difference between glycemic index and glycemic load, and why it matters• Why eating enough is essential for blood sugar control in PCOS• How movement, sleep, nervous system and social factors shape blood sugar every day If you're tired of conflicting advice and feel like you're “doing everything right” but not seeing results, this episode is for you. These are the same foundations we teach inside our 12-week PCOS Recovery Program where we help you turn these principles into real-life habits with education, tools, and bi-weekly coaching support. Our next cohort starts February 18th! Enjoyed the episode? We'd love to hear it! Leave a rating, review and share with a loved one. ReferencesAli M, Reutrakul S, Petersen G, Knutson KL. Associations between Timing and Duration of Eating and Glucose Metabolism: A Nationally Representative Study in the U.S. Nutrients. 2023 Feb 1;15(3):729. doi: 10.3390/nu15030729. PMID: 36771435; PMCID: PMC9919634. Darraj A. The Link Between Sleeping and Type 2 Diabetes: A Systematic Review. Cureus. 2023 Nov 3;15(11):e48228. doi: 10.7759/cureus.48228. PMID: 38050514; PMCID: PMC10693913. Gómez-Ruiz RP, Cabello-Hernández AI, Gómez-Pérez FJ, Gómez-Sámano MÁ. Meal frequency strategies for the management of type 2 diabetes subjects: A systematic review. PLoS One. 2024 Feb 29;19(2):e0298531. doi: 10.1371/journal.pone.0298531. PMID: 38421977; PMCID: PMC10903815. Leung GKW, Huggins CE, Bonham MP. Effect of meal timing on postprandial glucose responses to a low glycemic index meal: A crossover trial in healthy volunteers. Clin Nutr. 2019 Feb;38(1):465-471. doi: 10.1016/j.clnu.2017.11.010. Epub 2017 Nov 22. PMID: 29248250. Tsereteli N, Vallat R, Fernandez-Tajes J, Delahanty LM, Ordovas JM, Drew DA, Valdes AM, Segata N, Chan AT, Wolf J, Berry SE, Walker MP, Spector TD, Franks PW. Impact of insufficient sleep on dysregulated blood glucose control under standardised meal conditions. Diabetologia. 2022 Feb;65(2):356-365. doi: 10.1007/s00125-021-05608-y. Epub 2021 Nov 30. PMID: 34845532; PMCID: PMC8741723.

Contributor: Alec Coston, MD Educational Pearls: Disclaimer: this has nothing to do with the ER but is too cool to not talk about. Condition: Carbamoyl phosphate synthetase 1 (CPS1) deficiency Rare inborn error of metabolism Inability to properly break down ammonia Leads to severe hyperammonemia and hepatic encephalopathy Natural history: Without treatment, typically fatal within the first few weeks of life Even with current standard treatments, life expectancy is often limited to ~5–6 years Breakthrough treatment: A team of researchers at the Children's Hospital of Philadelphia and the Perelman School of Medicine at the University of Pennsylvania developed the CRISPR-based targeted gene therapy for this patient. First-of-its-kind precision approach tailored to the patient's specific mutation Key components of the therapy: Whole-genome sequencing to identify the exact CPS1 mutation Creation of a custom base-editing enzyme designed to correct that specific mutation Design of a guide RNA to direct the base editor to the precise genomic location Delivery method: Lipid nanoparticles used to deliver the gene-editing machinery Nanoparticles can be targeted to specific tissues Why the liver works well: CPS1 is primarily expressed in hepatocytes The liver is relatively easy to target with lipid nanoparticles Hepatocytes divide frequently, allowing edited genes to be passed on as cells replicate Long-term impact: Once edited, cells continue producing functional CPS1 enzyme Potential for durable, possibly lifelong correction from a single treatment References https://www.nih.gov/news-events/news-releases/infant-rare-incurable-disease-first-successfully-receive-personalized-gene-therapy-treatment Choi Y, Oh A, Lee Y, Kim GH, Choi JH, Yoo HW, Lee BH. Unfavorable clinical outcomes in patients with carbamoyl phosphate synthetase 1 deficiency. Clin Chim Acta. 2022 Feb 1;526:55-61. doi: 10.1016/j.cca.2021.11.029. Epub 2021 Dec 29. PMID: 34973183. Bharti N, Modi U, Bhatia D, Solanki R. Engineering delivery platforms for CRISPR-Cas and their applications in healthcare, agriculture and beyond. Nanoscale Adv. 2026 Jan 5. doi: 10.1039/d5na00535c. Epub ahead of print. PMID: 41640466; PMCID: PMC12865601. Summarized and edited by Jeffrey Olson MS4 Donate: https://emergencymedicalminute.org/donate/ Join our mailing list: http://eepurl.com/c9ouHf

In this episode host, Erin Gallardo, PT, DPT, NCS speaks with Chris McElderry, PT, DPT, NCS about how dry needling can be used in neuro rehab, particularly for people post-stroke. Chris explains why he pursued dry needling, how using it in PT differs from acupuncture, and walks through what a typical session looks like, including safety, side effects, and billing considerations. He shares clinical examples of using dry needling to address spasticity, hypertonicity, pain, and range of motion limitations, and discusses current research on short-term effects for spasticity and pain reduction. Erin and Chris also clarify the differences between spasticity and hypertonicity, touch on contracture management, and highlight where dry needling can be a useful adjunct—not a standalone cure—in helping neuro clients move and feel better. Follow Chris McElderry, PT, DPT, NCS @theneuroguy_dpt  Ebrahimzadeh M, Nakhostin Ansari N, Abdollahi I, Akhbari B, Dommerholt J. Changes in Corticospinal Tract Consistency after Dry Needling in a Stroke Patient. Case Rep Neurol Med. 2024 Sep 14;2024:5115313. doi: 10.1155/2024/5115313. PMID: 39309410; PMCID: PMC11416164. Fakhari Z, Ansari NN, Naghdi S, Mansouri K, Radinmehr H. A single group, pretest-posttest clinical trial for the effects of dry needling on wrist flexors spasticity after stroke. NeuroRehabilitation. 2017;40(3):325-336. doi: 10.3233/NRE-161420. PMID: 28222554. Fernández-de-Las-Peñas C, Pérez-Bellmunt A, Llurda-Almuzara L, Plaza-Manzano G, De-la-Llave-Rincón AI, Navarro-Santana MJ. Is Dry Needling Effective for the Management of Spasticity, Pain, and Motor Function in Post-Stroke Patients? A Systematic Review and Meta-Analysis. Pain Med. 2021 Feb 4;22(1):131-141. doi: 10.1093/pm/pnaa392. PMID: 33338222. Núñez-Cortés R, Cruz-Montecinos C, Vásquez-Rosales P, et al. Effectiveness of dry needling in the treatment of spasticity in stroke patients: A systematic review. J Body Mov Ther. 2020;24(3):113-122. Suputtitada A, et al. Emerging theory of sensitization in post-stroke muscle spasticity: Implications for dry needling and other interventions. Front Rehabil Sci. 2023;4:1169087. Valencia-Chulián R, Heredia-Rizo AM, Moral-Munoz JA, Lucena-Anton D, Luque-Moreno C. Dry needling for the management of spasticity, pain, and range of movement in adults after stroke: A systematic review. Complement Ther Med. 2020 Aug;52:102515. doi: 10.1016/j.ctim.2020.102515. Epub 2020 Jul 16. PMID: 32951759.

En este episodio exploramos la novela Sin decir adiós de Harlan Coben y Reese Whiterspoon una historia cargada de suspenso, secretos familiares y giros inesperados. Hablamos sobre los personajes principales, sus motivaciones y cómo la narrativa mantiene al lector al filo del asiento. Especialmente la protagonista quien tiene que realizar un trabajo especial en otro pais, con un personaje enigmatico. Reese Witherspoon debuta como autora, aportando su voz única a la historia y guiándote a través de los acontecimientos que se desarrollan en la novela. Por otro lado, esta la colaboración de Harlan Coben, un escritor de renombre conocido por sus exitosas adaptaciones de novelas, que te mantiene enganchado hasta el final con su estilo de escritura.  Te dejamos el enlace para mas informacion de esta novela,  Sin Decir AdiósSi gustas escucharnos en nuestro contenido de Patreon no dudes en acompañarnos por esos rumbos lectores.Recuerda que si gustas apoyarnos en nuestras lecturas y reseñas, lo puedes realizar mediante: ☕️ Paypal o a través de nuestras redes sociales o correo electrónico.También te agradeceríamos

Well podcast family, we are back with another installment of our “You ask, We answer” edition. We've got 2 fascinating and real-world clinical conundrums in this episode, both suggested by two separate podcast family members. The first has to do with RH IG maternal administration. Here's the question: If a patient receives routine, prophylactic RH IG at 28 weeks but then has maternal trauma say 1 or 2 weeks after, does she still require an additional dose of RH IG? That's a good question because it's not as intuitive as you would think. We will explain in this episode and there is a bit of a contradiction in the guidance. The second question has to do with finding an asymptomatic uterine rupture at cesarean section. Is there such a thing as a “partial” (silent) uterine rupture? There's recent data from 2025 about this. Listen in for details.1. ACOG PB 181; 2017. 2. Baek S, Froese V, Morgenstern B. Risk Profiles and Outcomes of Uterine Rupture: A Retrospective and Comparative Single-Center Study of Complete and Partial Ruptures. J Clin Med. 2025 Jul 15;14(14):4987. doi: 10.3390/jcm14144987. PMID: 40725680; PMCID: PMC12295210.3. Vandenberghe G, Bloemenkamp K, Berlage S, Colmorn L, Deneux-Tharaux C, Gissler M, Knight M, Langhoff-Roos J, Lindqvist PG, Oberaigner W, Van Roosmalen J, Zwart J, Roelens K; INOSS (the International Network of Obstetric Survey Systems). The International Network of Obstetric Survey Systems study of uterine rupture: a descriptive multi-country population-based study. BJOG. 2019 Feb;126(3):370-381. doi: 10.1111/1471-0528.15271. Epub 2018 Jun 12. PMID: 29727918.

In this episode of "PICU Doc on Call," Drs. Pradip Kamat and Rahul Damania dive into a pediatric ICU case involving a 4-year-old girl who presents with severe anemia and bleeding, ultimately diagnosed with von Willebrand disease (VWD). They chat about the causes and different types of VWD, walk through the key clinical features, and break down how to diagnose and manage this condition. Drs. Kamat and Damania highlight the important roles of desmopressin and factor concentrates in treatment. Throughout the episode, they stress the need to recognize VWD in kids who have mucosal bleeding and offer practical tips for intensivists on lab evaluation and treatment strategies for this common inherited bleeding disorder.Show Nighlights: Clinical case discussion of a 4-year-old girl with severe anemia and bleeding symptomsDiagnosis of von Willebrand disease (VWD) and its significance in pediatric critical careEtiology and pathogenesis of von Willebrand diseaseClassification of von Willebrand disease into types (Type 1, Type 2 with subtypes, Type 3)Clinical manifestations and symptoms associated with VWDDiagnostic approach for identifying von Willebrand disease, including laboratory testsManagement strategies for VWD, including desmopressin and von Willebrand factor concentratesRole of adjunctive therapies such as antifibrinolytics and hormonal treatmentsImportance of multidisciplinary collaboration in managing complex bleeding disordersOverview of the pathophysiology of von Willebrand factor and its role in hemostasisReferences:Fuhrman & Zimmerman - Textbook of Pediatric Critical Care Chapter ***.Reference 1: Leebeek FW, Eikenboom JC. Von Willebrand's Disease. N Engl J Med. 2016 Nov 24;375(21):2067-2080.Reference 2: Ng C, Motto DG, Di Paola J. Diagnostic approach to von Willebrand disease. Blood. 2015 Mar 26;125(13):2029-37.Platton S, Baker P, Bowyer A, et al. Guideline for laboratory diagnosis and monitoring of von Willebrand disease: A joint guideline from the United Kingdom Haemophilia Centre Doctors' Organisation and the British Society for Hematology. Br J Haematol 2024 May;204(5):1714-1731.Mohinani A, Patel S, Tan V, Kartika T, Olson S, DeLoughery TG, Shatzel J. Desmopressin as a hemostatic and blood-sparing agent in bleeding disorders. Eur J Haematol. 2023 May;110(5):470-479. doi: 10.1111/ejh.13930. Epub 2023 Feb 12. PMID: 36656570; PMCID: PMC10073345.

Nurses are the backbone of patient care, but their role in antibiotic and diagnostic stewardship is still underrecognized. In this episode of The SHEA Podcast, host Dr. Marisa Holubar is joined by Dr. Eileen Carter and Dr. David Ha to explore why nurses are essential to stewardship success. Together, they discuss the evidence behind nursing engagement, persistent barriers to involvement, and real-world examples where nurse-led initiatives have reduced antibiotic use, infections, and waste. From IV-to-PO transitions to penicillin allergy assessment and diagnostic stewardship, this conversation offers practical strategies for engaging nurses, leveraging shared governance, and building stronger, more effective stewardship programs across care settings. References: Thurman Johnson C, Ridge LJ, Hessels AJ. Nurse Engagement in Antibiotic Stewardship Programs: A Scoping Review of the Literature. J Healthc Qual. 2023 Mar-Apr 01;45(2):69-82. doi: 10.1097/JHQ.0000000000000372. Epub 2022 Dec 12. PMID: 36729679; PMCID: PMC9991980. Shenoy ES, Macy E, Rowe T, Blumenthal KG. Evaluation and Management of Penicillin Allergy: A Review. JAMA. 2019 Jan 15;321(2):188-199. doi: 10.1001/jama.2018.19283. PMID: 30644987. Carter EJ, Schramm C, Baron K, Zolla MM, Zavez K, Banach DB. Perceived usefulness of a mnemonic to improve nurses' evaluation of reported penicillin allergies. Antimicrob Steward Healthc Epidemiol. 2023 Jul 11;3(1):e124. doi: 10.1017/ash.2023.177. PMID: 37502243; PMCID: PMC10369439. Carter EJ, Zavez K, Schramm C, Zolla MM, Baron K, Banach DB. Multifaceted implementation strategy to improve the evaluation of penicillin allergies in perioperative patients: a pre-post feasibility implementation study. Infect Control Hosp Epidemiol. 2024 Oct 30;45(12):1-7. doi: 10.1017/ice.2024.119. Epub ahead of print. PMID: 39473231; PMCID: PMC11663472. Resources: ANCC Magnet Recognition Program: https://www.nursingworld.org/organizational-programs/magnet/ Breakpoints, The SIDP Podcast: https://breakpoints-sidp.org/18-waking-the-sleeping-giant-engaging-nurses-in-antimicrobial-stewardship/

How are hospitals using AI and HPC to assist them in helping save lives? This week, Technology Now is joined by Keith Perry, Senior Vice President and Chief Information Officer at St. Jude Children's Research Hospital to explore how St Jude uses the latest technologies to help treat and prevent illness and catastrophic disease, giving patients and families more time, and more hope, when it comes to diagnosis.This is Technology Now, a weekly show from Hewlett Packard Enterprise. Every week, hosts Michael Bird and Sam Jarrell look at a story that's been making headlines, take a look at the technology behind it, and explain why it matters to organizations.About Keith:https://www.linkedin.com/in/keith-perry-8562347/Sources:Hernigou P. Ambroise Paré III: Paré's contributions to surgical instruments and surgical instruments at the time of Ambroise Paré. Int Orthop. 2013 May;37(5):975-80. doi: 10.1007/s00264-013-1872-y. Epub 2013 Apr 12. PMID: 23580029; PMCID: PMC3631503.https://www.surgicalholdings.co.uk/history-of-surgical-instruments.htmlSmith-Bindman R, Kwan ML, Marlow EC, et al. Trends in Use of Medical Imaging in US Health Care Systems and in Ontario, Canada, 2000-2016. JAMA. 2019;322(9):843–856. doi:10.1001/jama.2019.11456https://caferoentgen.com/2023/10/07/a-tale-of-two-hands-the-story-behind-the-two-famous-radiographs-captured-by-wilhelm-roentgen/https://www.orau.org/health-physics-museum/collection/shoe-fitting-fluoroscope/index.html

This week, Marianna sits down with Chris Bositis and Cara McAnaney from the National Clinician Consultation Center (NCCC) to talk all about lower-barrier substance use and HIV prevention and treatment. Tune in to learn how direct-to-inject ties into that and why it matters for you as an HIV care provider. -- Resources: Waters RC, Hoog J, Bell C, Toland P, Valley J, Hurtado L, Kallsen MA, Johnson T, Gerard A, Fockele CE, Klein JW. Injectable-Only Overlapping Buprenorphine Starting Protocol in a Low-Threshold Setting. JAMA Netw Open. 2025 Aug 1;8(8):e2527016. doi: 10.1001/jamanetworkopen.2025.27016. PMID: 40815514; PMCID: PMC12357186.Rosenwohl-Mack S, Suen LW, Logan AA, Peterson D, Snyder HR. Outpatient Initiation of 7-Day Injectable Buprenorphine: A Direct-to-Inject Case Series. Subst Use Addctn J. 2025 Oct;46(4):1064-1069. doi: 10.1177/29767342251330412. Epub 2025 Apr 4. PMID: 40183345; PMCID: PMC12353995.D'Onofrio G, Herring AA, Perrone J, Hawk K, Samuels EA, Cowan E, Anderson E, McCormack R, Huntley K, Owens P, Martel S, Schactman M, Lofwall MR, Walsh SL, Dziura J, Fiellin DA. Extended-Release 7-Day Injectable Buprenorphine for Patients With Minimal to Mild Opioid Withdrawal. JAMA Netw Open. 2024 Jul 1;7(7):e2420702. doi: 10.1001/jamanetworkopen.2024.20702. PMID: 38976265; PMCID: PMC11231806. Help us track the number of listeners our episode gets by filling out this brief form! (https://www.e2NECA.org/?r=AQX7941)--Want to chat? Email us at podcast@necaaetc.org with comments or ideas for new episodes. --Check out our free online courses: www.necaaetc.org/rise-courses--Download our HIV mobile apps:Google Play Store: https://play.google.com/store/apps/developer?id=John+Faragon&hl=en_US&gl=USApple App Store: https://apps.apple.com/us/developer/virologyed-consultants-llc/id1216837691

This episode of EM Pulse dives into one of the most stressful scenarios in the ED: the febrile infant in the first month of life. Traditionally, a fever in this age group has meant an automatic “full septic workup,” including the dreaded lumbar puncture (LP). But times are changing. We sit down with experts Dr. Nate Kuppermann and Dr. Brett Burstein to discuss a landmark JAMA study that suggests we might finally be able to safely skip the LP in many of our tiniest patients. The Study: A Game Changer for Neonates Our discussion centers on a massive international pooled study evaluating the PECARN Febrile Infant Rule specifically in infants aged 0–28 days. While previous guidelines were conservative due to a lack of data for this specific age bracket, this study provides the evidence we've been waiting for. The Cohort: A large pool of infants across multiple countries. The Findings: The PECARN rule demonstrated an exceptionally high negative predictive value for invasive bacterial infections. The Big Win: The rule missed zero cases of bacterial meningitis. Defining the Danger: SBI vs. IBI The experts break down why we are shifting our terminology and our clinical focus. Serious Bacterial Infection (SBI)  Historically, this was a “catch-all” term including Urinary Tract Infections (UTIs), bacteremia, and meningitis. However, UTIs are generally more common, easily identified via urinalysis, and typically less life-threatening than the other two. Invasive Bacterial Infection (IBI)  This term refers specifically to bacteremia and bacterial meningitis. These are the “high-stakes” infections the PECARN rule is designed to rule out. Dr. Kuppermann notes that we should ideally view bacteremia and meningitis as distinct entities, as the clinical implications of a missed meningitis case are far more severe. The HSV Elephant in the Room One of the primary reasons clinicians hesitate to skip an LP in a neonate is the fear of missing Herpes Simplex Virus (HSV) infection. Low Baseline Risk: While the overall risk of HSV in a febrile infant is low, the risk of “isolated” HSV (meningitis without other signs or symptoms) is even rarer. Screening Tools: Most infants with HSV appear clinically ill. Clinicians can also use ALT (liver function) testing as a secondary screen – transaminase elevation is a common marker for systemic HSV. Clinical Judgment: If the baby is well-appearing, has no maternal history of HSV, no vesicles, and no seizures, the risk of missing HSV by skipping the LP is exceptionally low. Practical Application: Shared Decision-Making This isn’t just about the numbers—it’s about the parents. “Families don’t mind their babies being admitted… They do not want the lumbar puncture. It is the single most anxiety-provoking aspect of care.” — Dr. Brett Burstein The PECARN “Low-Risk” Criteria:  (Remember, this rule applies only to infants who are not ill-appearing.) Urinalysis: Negative Absolute Neutrophil Count (ANC): ≤ 4,000/mm³ Procalcitonin (PCT): ≤ 0.5 ng/mL The Bottom Line: If an infant is well-appearing and meets these criteria, physicians can have a nuanced conversation with parents about the risks and benefits of forgoing the LP, while still admitting the child for observation (often without empiric antibiotics) while cultures brew. Key Takeaways The “Well-Appearing” Filter: If an infant looks ill, the rule does not apply. These patients require a full workup, including an LP, regardless of lab results. Meticulous Physical Exam: Assess for a strong suck, normal muscle tone, brisk capillary refill, and any rashes or vesicles. History is Key: Always ask about maternal GBS/HSV status, pregnancy or birth complications, prematurity, sick contacts, and any changes in feeding, stooling or activity. Procalcitonin: PCT is the superior inflammatory marker for this rule. If your facility only offers traditional markers like CRP, the PECARN negative predictive value cannot be strictly applied. In the words of Dr. Kuppermann: “If you don’t have it, for God’s sakes, just get it! ALT to Screen for HSV: While not part of the official PECARN rule, our experts suggest that significantly elevated liver enzymes should raise suspicion for systemic HSV. Observe, Don’t Discharge: Being “low risk” does not mean the infant goes home. All infants ≤ 28 days still require admission for 24-hour observation and blood/urine cultures. We want to hear from you! Does this change how you approach febrile neonates in the ED? How do you handle shared decision-making with parents? Connect with us on social media @empulsepodcast or on our website ucdavisem.com. Hosts: Dr. Julia Magaña, Professor of Pediatric Emergency Medicine at UC Davis Dr. Sarah Medeiros, Professor of Emergency Medicine at UC Davis Guests: Dr. Nate Kuppermann, Executive Vice President and Chief Academic Officer; Director, Children’s National Research Institute; Department Chair, Pediatrics, George Washington University School of Medicine and Health Sciences Dr. Brett Burstein, Clinician-Scientist and Pediatric Emergency Medicine Physician at Montreal Children’s Hospital, McGill University Resources: Burstein B, Waterfield T, Umana E, Xie J, Kuppermann N. Prediction of Bacteremia and Bacterial Meningitis Among Febrile Infants Aged 28 Days or Younger. JAMA. 2026 Feb 3;335(5):425-433. doi: 10.1001/jama.2025.21454. PMID: 41359314; PMCID: PMC12687207“Hot” Off the Press: Infant Fever Rule “Hot” Off the Press: Infant Fever Rule Do I really need to LP a febrile infant with a UTI? PECARN Infant Fever Update: 61-90 Days Kuppermann N, Dayan PS, Levine DA, Vitale M, Tzimenatos L, Tunik MG, Saunders M, Ruddy RM, Roosevelt G, Rogers AJ, Powell EC, Nigrovic LE, Muenzer J, Linakis JG, Grisanti K, Jaffe DM, Hoyle JD Jr, Greenberg R, Gattu R, Cruz AT, Crain EF, Cohen DM, Brayer A, Borgialli D, Bonsu B, Browne L, Blumberg S, Bennett JE, Atabaki SM, Anders J, Alpern ER, Miller B, Casper TC, Dean JM, Ramilo O, Mahajan P; Febrile Infant Working Group of the Pediatric Emergency Care Applied Research Network (PECARN). A Clinical Prediction Rule to Identify Febrile Infants 60 Days and Younger at Low Risk for Serious Bacterial Infections. JAMA Pediatr. 2019 Apr 1;173(4):342-351. doi: 10.1001/jamapediatrics.2018.5501. PMID: 30776077; PMCID: PMC6450281. Pantell RH, Roberts KB, Adams WG, Dreyer BP, Kuppermann N, O’Leary ST, Okechukwu K, Woods CR Jr; SUBCOMMITTEE ON FEBRILE INFANTS. Evaluation and Management of Well-Appearing Febrile Infants 8 to 60 Days Old. Pediatrics. 2021 Aug;148(2):e2021052228. doi: 10.1542/peds.2021-052228. Epub 2021 Jul 19. Erratum in: Pediatrics. 2021 Nov;148(5):e2021054063. doi: 10.1542/peds.2021-054063. PMID: 34281996. ****Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Productions for audio production services.  

In this new book from my Bringers of the Light series we meet twins Pinky & Meggy. The girls with a little fairy blood inside live in the etheric town of Oakwood on the West Coast of the USA. Pinky & Meggy both think they know what love is. Until two love interests enter their life. Harry Winterbottom and Count Mashar both magical men on their own rights. Harry a hot wizard with a big Instagram following and an even bigger sex drive and Dark Matters agent Count Mashar with a sordid past and a closed heart. Will Pinky & Meggy find the love of their lives with these two paramours? Only time and a little magic will tell. ⭐️

Contributor: Alec Coston, MD Educational Pearls: BiPAP is often effective in severe asthma, but many patients struggle with mask tolerance due to intense air hunger–driven anxiety, often compounded by hypoxia. Benzodiazepines are commonly used for anxiety, but they can depress respiratory drive, making clinical improvement difficult to interpret (a lower RR may reflect sedation rather than true physiologic improvement). Low-dose fentanyl is a useful alternative when patients cannot tolerate BiPAP despite coaching. Opioids blunt the perception of dyspnea and are well established for treating air hunger. When carefully titrated, fentanyl provides anxiolysis without significant respiratory suppression. It is rapidly titratable (e.g., 25 mcg IV every 5 minutes). Evidence primarily comes from palliative and oncology literature, but growing clinical experience supports its use in severe asthma to improve BiPAP tolerance. Failure of fentanyl should prompt escalation to ketamine, often signaling impending need for intubation. References Pang GS, Qu LM, Tan YY, Yee AC. Intravenous Fentanyl for Dyspnea at the End of Life: Lessons for Future Research in Dyspnea. Am J Hosp Palliat Care. 2016 Apr;33(3):222-7. doi: 10.1177/1049909114559769. Epub 2014 Nov 25. PMID: 25425740. Summarized and edited by Meg Joyce, MS2 Donate: https://emergencymedicalminute.org/donate/ Join our mailing list: http://eepurl.com/c9ouHf

En este episodio contamos con una recomendación de un libro polémico, una novela que puede ser del gusto de algunos lectores o simplemente una decepción.Alice Gould llega a un sanatorio mental. Ella afirma que está ahí por un motivo muy específico (y estratégico), pero el entorno —doctores, expedientes, reglas internas y miradas— pone en duda su relato. A partir de ahí, la novela juega a dos bandas: investigación y supervivencia emocional dentro de un lugar donde cada palabra puede ser prueba… o síntoma.Consigue el libro digital por aquíSi gustas escucharnos en nuestro contenido de Patreon no dudes en acompañarnos por esos rumbos lectores.Recuerda que si gustas apoyarnos en nuestras lecturas y reseñas, lo puedes realizar mediante: ☕️ Paypal o a través de nuestras redes sociales o correo electrónico.También te agradeceríamos

Drs. Ted Morton and Christine Lockowitz join Dr. Ryan Moenster to discuss all things amoxicillin, particularly in our pediatric patients. Our guests answer common questions, such as, what formulations should be used for certain infectious conditions and/or organisms and how to dose amoxicillin to maximize PK/PD optimization without inducing potential adverse events. It is a must-listen for all! This episode also qualifies for 1 hour of BCIDP credit! How to Obtain BCIDP Recertification Credit for this Episode: Visit sidp.org/BCIDP for more information. References: Bradley JS, Garonzik SM, Forrest A, Bhavnani SM. Pharmacokinetics, pharmacodynamics, and Monte Carlo simulation: selecting the best antimicrobial dose to treat an infection. Pediatr Infect Dis J. 2010 Nov;29(11):1043-6. doi: 10.1097/INF.0b013e3181f42a53. PMID: 20975453. Craig WA. Pharmacokinetic/pharmacodynamic parameters: rationale for antibacterial dosing of mice and men. Clin Infect Dis. 1998 Jan;26(1):1-10; quiz 11-2. doi: 10.1086/516284. PMID: 9455502. Hakenbeck R, Grebe T, Zähner D, Stock JB. beta-lactam resistance in Streptococcus pneumoniae: penicillin-binding proteins and non-penicillin-binding proteins. Mol Microbiol. 1999 Aug;33(4):673-8. doi: 10.1046/j.1365-2958.1999.01521.x. PMID: 10447877. Bax R. Development of a twice daily dosing regimen of amoxicillin/clavulanate. Int J Antimicrob Agents. 2007 Dec;30 Suppl 2:S118-21. doi: 10.1016/j.ijantimicag.2007.09.002. Epub 2007 Nov 5. PMID: 17983732. Bielicki JA, Stöhr W, Barratt S, Dunn D, Naufal N, Roland D, Sturgeon K, Finn A, Rodriguez-Ruiz JP, Malhotra-Kumar S, Powell C, Faust SN, Alcock AE, Hall D, Robinson G, Hawcutt DB, Lyttle MD, Gibb DM, Sharland M; PERUKI, GAPRUKI, and the CAP-IT Trial Group. Effect of Amoxicillin Dose and Treatment Duration on the Need for Antibiotic Re-treatment in Children With Community-Acquired Pneumonia: The CAP-IT Randomized Clinical Trial. JAMA. 2021 Nov 2;326(17):1713-1724. doi: 10.1001/jama.2021.17843. Erratum in: JAMA. 2021 Dec 7;326(21):2208. doi: 10.1001/jama.2021.20219. PMID: 34726708; PMCID: PMC8564579.

We have covered the subject of whether to include the decidual (innermost) layer when closing the uterine incision during cesarean section (CS) on at least 2 episodes. The most recent was in September 2025, when we focused on a published (September 2025) systematic review and meta-analysis from the Green Journal. Back then, we compared those new findings to our prior episode from 2023 on the same matter. Well, we are back at it again with the same subject as there is a new EXPERT REVIEW from the AJOG on hysterotomy closure technique which just came out January 2026. What did these authors conclude? There are also some controversial suggestions made by the authors. Listen in for details. 1. Antoine C, Meyer JA, Silverstein J, Buldo-Licciardi J, Lyu C, Timor-Tritsch IE. Endometrium-Free Closure Technique During Cesarean Delivery for Reducing the Risk of Niche Formation and Placenta Accreta Spectrum Disorders. Obstet Gynecol. 2025 Jun 1;145(6):674-682. doi: 10.1097/AOG.0000000000005813. Epub 2025 Jan 9. PMID: 39787602. 2. Gialdini, Celina et al.Evidence-based surgical procedures to optimize caesarean outcomes: an overview of systematic reviews. eClinicalMedicine- Lancet (June 2024), Volume 72, 102632 3. Dahlke, Joshua D. MD; Mendez-Figueroa, Hector MD; Maggio, Lindsay MD, MPH; Sperling, Jeffrey D. MD, MS; Chauhan, Suneet P. MD, Hon DSc; Rouse, Dwight J. MD. The Case for Standardizing Cesarean Delivery Technique: Seeing the Forest for the Trees. Obstetrics & Gynecology 136(5):p 972-980, November 2020. | DOI: 10.1097/AOG.0000000000004120 4. Antoine C, Timor-Tritsch IE, Bujold E, Young BK, Reece EA. Endometrium-free closure technique for hysterotomy incision at cesarean delivery. Am J Obstet Gynecol. 2026 Jan;233(6S):S103-S114. doi: 10.1016/j.ajog.2025.07.009. PMID: 41485813.

On this week’s episode, we’re continuing our Guidelines Series exploring the 2022 ESC/ERS Guidelines for the diagnosis and treatment of Pulmonary Hypertension. If you missed our first episode in the series, give it a listen to hear about the most recent recommendations regarding Pulmonary Hypertension definitions, screening, and diagnostics. Today, we’re talking about the next steps after diagnosis. Specifically, we’ll be discussing risk stratification, establishing treatment goals, and metrics for re-evaluation. We’ll additionally introduce the mainstays of pharmacologic therapy for Pulmonary Hypertension. Meet Our Co-Hosts Rupali Sood  grew up in Las Vegas, Nevada and made her way over to Baltimore for medical school at Johns Hopkins. She then completed her internal medicine residency training at Massachusetts General Hospital before returning back to Johns Hopkins, where she is currently a pulmonary and critical care medicine fellow. Rupali’s interests include interstitial lung disease, particularly as related to oncologic drugs, and bedside medical education. Tom Di Vitantonio  is originally from New Jersey and attended medical school at Rutgers, New Jersey Medical School in Newark. He then completed his internal medicine residency at Weill Cornell, where he also served as a chief resident. He currently is a pulmonary and critical care medicine fellow at Johns Hopkins, and he’s passionate about caring for critically ill patients, how we approach the management of pulmonary embolism, and also about medical education of trainees to help them be more confident and patient centered. Key Learning Points 1) Episode Roadmap How to set treatment goals, assess symptom burden, and risk-stratify patients with suspected/confirmed pulmonary arterial hypertension (PAH). What tools to use to re-evaluate patients on treatment Intro to major PAH medication classes and how they map to pathways. 2) Case-based diagnostic reasoning Patient: 37-year-old woman with exertional dyspnea, mild edema, abnormal echo, telangiectasias + epistaxis → raises suspicion for HHT (hereditary hemorrhagic telangiectasia) and/or early connective tissue disease. Key reasoning move: start broad (Groups 2–5) and narrow using history/exam/testing. In a young patient without obvious left heart or lung disease, think more about Group 1 PAH (idiopathic/heritable/associated). HHT teaching point: HHT can cause PH in more than one way: More common: high-output PH from AVMs (often hepatic/pulmonary) Rare (1–2% mentioned): true PAH phenotype (vascular remodeling; associated with ALK1 in some patients), behaving like Group 1 PAH. 3) Functional class assessment WHO Functional Class: Class I: no symptoms with ordinary activity, only with exertion Class II: symptoms with ordinary activity Class III: symptoms with less-than-ordinary activity (can't do usual chores/shopping without dyspnea) Class IV: symptoms at rest Practical bedside tip they give: Ask if the patient can walk at their own pace or keep up with a similar-age peer/partner. If not, think Class II (or worse). 4) Risk stratification at diagnosis: why, how, and which tools Big principle: treatment choices are driven by risk, and the goal is to move patients to low-risk quickly. ESC/ERS approach at diagnosis (as described): Use a 3-strata model predicting 1-year mortality: Low: 20% ESC/ERS risk assessment variables (10 domains discussed): Clinical progression, signs of right heart failure, syncope WHO FC Biomarkers (NT-proBNP) Exercise capacity (6MWD) Hemodynamics Imaging (echo; sometimes cardiac MRI) CPET (peak VO₂; VE/VCO₂ slope) They note: even if you don't have everything, the calculator can still be useful with ≥3 variables. REVEAL 2.0: Builds on similar core variables but adds further patient context (demographics, renal function, BP, DLCO, etc.) Case result: both tools put her in intermediate risk (ESC/ERS ~1.6; REVEAL 2.0 score 8), underscoring that mild symptoms can still equal meaningful mortality risk. 5) Treatment goals and follow-up philosophy What they explicitly prioritize: Help patients feel better, live longer, and stay out of the hospital Use risk tools to communicate prognosis and to track improvement Reassess frequently (they mention ~every 3 months early on) until low risk is achieved “Time-to-low-risk” is an important treatment goal Also emphasized: The diagnosis is psychologically heavy; patients need clear counseling, reassurance about the plan, and connection to support groups. 6) Medication classes for the treatment of PAH Nitric oxide–cGMP pathway PDE5 inhibitors: sildenafil, tadalafil Soluble guanylate cyclase stimulator: riociguat Important safety point: don't combine PDE5 inhibitors with riociguat (risk of significant hypotension/hemodynamic effects) Endothelin receptor antagonists (ERAs) “-sentan” drugs: bosentan (less used due to side effects/interactions), ambrisentan, macitentan Teratogenicity emphasized Hepatotoxicity that requires LFT monitoring Can cause fluid retention and peripheral edema Prostacyclin pathway Prostacyclin analogs/agonists: Epoprostenol (potent; short half-life; IV administration) Treprostinil (IV/SubQ/oral/inhaled options) Selexipag (oral prostacyclin receptor agonist) 7) Sotatercept (post-guidelines) They note sotatercept wasn't in 2022 ESC/ERS but is now “a game changer” in practice: Mechanism: ligand trap affecting TGF-β signaling / remodeling biology Positioned as potentially more disease-modifying than pure vasodilators Still evolving: where to place it earlier vs later in regimens is an active question in the field 8) How risk category maps to initial treatment intensity General approach they outline: High risk at diagnosis: parenteral prostacyclin (IV/SubQ) strongly favored, often aggressive early Intermediate risk: at least dual oral therapy (typically PDE5i + ERA); escalate if not achieving low risk Low risk: at least one oral agent; many still use dual oral depending on etiology/trajectory For the case: intermediate-risk → start dual oral therapy (they mention tadalafil + ambrisentan as a typical choice), reassess in ~3 months; add a third agent (e.g., selexipag/prostacyclin pathway) if not low risk.  References and Further Reading Humbert M, Kovacs G, Hoeper MM, Badagliacca R, Berger RMF, Brida M, Carlsen J, Coats AJS, Escribano-Subias P, Ferrari P, Ferreira DS, Ghofrani HA, Giannakoulas G, Kiely DG, Mayer E, Meszaros G, Nagavci B, Olsson KM, Pepke-Zaba J, Quint JK, Rådegran G, Simonneau G, Sitbon O, Tonia T, Toshner M, Vachiery JL, Vonk Noordegraaf A, Delcroix M, Rosenkranz S; ESC/ERS Scientific Document Group. 2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension. Eur Heart J. 2022 Oct 11;43(38):3618-3731. doi: 10.1093/eurheartj/ehac237. Erratum in: Eur Heart J. 2023 Apr 17;44(15):1312. doi: 10.1093/eurheartj/ehad005. PMID: 36017548. Condon DF, Nickel NP, Anderson R, Mirza S, de Jesus Perez VA. The 6th World Symposium on Pulmonary Hypertension: what’s old is new. F1000Res. 2019 Jun 19;8:F1000 Faculty Rev-888. doi: 10.12688/f1000research.18811.1. PMID: 31249672; PMCID: PMC6584967. Maron BA. Revised Definition of Pulmonary Hypertension and Approach to Management: A Clinical Primer. J Am Heart Assoc. 2023 Apr 18;12(8):e029024. doi: 10.1161/JAHA.122.029024. Epub 2023 Apr 7. PMID: 37026538; PMCID: PMC10227272. Hoeper MM, Badesch DB, Ghofrani HA, Gibbs JSR, Gomberg-Maitland M, McLaughlin VV, Preston IR, Souza R, Waxman AB, Grünig E, Kopeć G, Meyer G, Olsson KM, Rosenkranz S, Xu Y, Miller B, Fowler M, Butler J, Koglin J, de Oliveira Pena J, Humbert M; STELLAR Trial Investigators. Phase 3 Trial of Sotatercept for Treatment of Pulmonary Arterial Hypertension. N Engl J Med. 2023 Apr 20;388(16):1478-1490. doi: 10.1056/NEJMoa2213558. Epub 2023 Mar 6. PMID: 36877098. Ruopp NF, Cockrill BA. Diagnosis and Treatment of Pulmonary Arterial Hypertension: A Review. JAMA. 2022 Apr 12;327(14):1379-1391. doi: 10.1001/jama.2022.4402. Erratum in: JAMA. 2022 Sep 6;328(9):892. doi: 10.1001/jama.2022.13696. PMID: 35412560.

As OB healthcare providers, we have several pieces of guidance regarding determination of amniotic fluid volume antepartum. The SMFM has Consult Series #46 (2018), which describes the management of polyhydramnios. We'll touch on that in this episode. However, while we have clear understanding of the increased risks of oligohydramnios, where an MVP is preferred for diagnosis over AFI, we have less information about polyhydramnios. But a new study published in BJOG (January 2026) provides more insights on this. While MVP is preferred for oligo diagnosis, can the same be said for polyhydramnios? Is there an increased risk in perinatal morbidity with polyhydramnios, and is that better detected by MVP or AFI? This new study findings left the authors unsatisfied although it CONFIRMED what we have covered in past episodes. Listen in for details.1. Dashe, Jodi S. et al. SMFM Consult Series #46: Evaluation and management of polyhydramnios. American Journal of Obstetrics & Gynecology, Volume 219, Issue 4, B2 - B8 (2018)2. ACOG PB 229: Antepartum Fetal Surveillance (2021)3. Petrecca A, Chauhan SP, Tersigni C, Ghi T, Berghella V. Amniotic Fluid Index Versus Maximum Vertical Pocket Versus Both for Polyhydramnios. BJOG. 2026 Jan 7. doi: 10.1111/1471-0528.70139. Epub ahead of print. PMID: 41502220.

En este episodio, nos propusimos la tarea de realizar una lectura en conjunto, Any le recomendó este libro a Mix y se decidió comentarlo en un futuro cercano. Nos agrada hacer este tipo de ejercicio para poder hacer un mejor episodio y dar nuestras propias opiniones.Este libro aborda un tema delicado y presenta una investigación exhaustiva para encontrar a una niña desaparecida en un pequeño pueblo.  Erik, un personaje del libro, adquiere una librería cercana al pueblo, huyendo de su pasado intenta socializar con personas del lugar.  Además, un grupo de vecinos guardan secretos que poco a poco se irán descubriendo.

This Physician World Shared Practice Forum Podcast explores two multicenter studies on extubation outcomes in neonates and children following congenital cardiac surgery. These studies incorporate integration of machine learning and risk analytics for extubation decision-making, and examine extubation readiness and extubation failure outcomes. LEARNING OBJECTIVES - Understand the key factors influencing extubation outcomes following congenital cardiac surgery - Examine the use of machine learning and risk analytics in neonatal and pediatric extubation decisions - Discuss how machine learning can improve clinical decision-making and patient safety AUTHORS Daniel Hames, MD, MPH Assistant Professor of Pediatrics, Cardiac Care Unit Director of Quality and Safety University of Nebraska Medical Center Children's Nebraska Jeffrey Burns, MD, MPH Emeritus Chief Division of Critical Care Medicine Department of Anesthesiology, Critical Care and Pain Medicine Boston Children's Hospital Professor of Anesthesia Harvard Medical School DATE Initial publication date: January 27, 2026. ARTICLES REFERENCED - Hames DL, Abbas Q, Asfari A, Borasino S, Diddle JW, Gazit AZ, Lipsitz S, Marshall A, Reise K, Guerineau LR, Wolovits JS, Salvin JW. Extubation Failure in Neonates Following Congenital Cardiac Surgery: Multicenter Retrospective Cohort, 2017-2020. Pediatr Crit Care Med. 2025 May 1;26(5):e590-e599. doi: 10.1097/PCC.0000000000003703. Epub 2025 Feb 10. PMID: 39927824. - Hames DL, Abbas Q, Asfari A, et al. Clinical and Risk Analytics Associations With Extubation Failure in Children Following Congenital Cardiac Surgery: A Multicenter Retrospective Cohort Study, 2017-2020. Pediatr Crit Care Med. 2025;26(9):e1105-e1114. doi:10.1097/PCC.0000000000003793. TRANSCRIPT https://cdn.bfldr.com/D6LGWP8S/as/w7qqc97g6m9g5n5vrq5vkx6x/202601_WSP_Hames_Transcript. Please visit: http://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 Hames DL, Burns JP. Integrating Risk Analytics in Post-Cardiac Surgery Extubation Readiness. 01/2026. OPENPediatrics. Online Podcast.

In this episode of Science of Slink, Dr. Rosy Boa shares vital lessons she wishes she had learned earlier in her 14-year pole dancing journey. Covering exercise science fundamentals, recognizing when a space isn't right for you, and the perils of diet culture and disordered eating, Dr. Boa offers practical advice and reflections aimed at helping fellow pole dancers avoid common pitfalls. Additionally, she emphasizes the importance of a healthy relationship with food and the benefits of understanding exercise science principles. Dr. Boa encourages listeners to contribute their own lessons and insights while promoting her online pole studio for further learning and community support.Are you a pole nerd interested in trying out online pole classes with Slink Through Strength? We'd love to have you! Use the code “podcast” for 10% off the Intro Pack and try out all of our unique online pole classes: https://app.acuityscheduling.com/catalog/25a67bd1/?productId=1828315&clearCart=true Citation for perfectionism & orthorexia: Oberle CD, Samaghabadi RO, Hughes EM. Orthorexia nervosa: Assessment and correlates with gender, BMI, and personality. Appetite. 2017 Jan 1;108:303-310. doi: 10.1016/j.appet.2016.10.021. Epub 2016 Oct 15. PMID: 27756637.Timestamps00:00 Welcome to Science of Slink00:57 My Pole Dancing Journey Begins02:06 Discovering Exercise Science05:29 Finding the Right Space for You08:57 Understanding Diet Culture and Disordered Eating13:31 Final Thoughts and Advice

Ursodiol (ursodeoxycholic acid) is a prescription bile acid medication used to dissolve cholesterol gallstones, prevent gallstones during rapid weight loss, and treat liver diseases like primary biliary cholangitis (PBC) by reducing toxic bile acids and cholesterol production. It works by changing bile composition, making it less saturated with cholesterol, and is available as oral medication. Of course, it is also the foundational medication for treatment of diagnosed Intrahepatic Cholestasis of Pregnancy (ICP). Does this medication reduce adverse perinatal outcomes? In this episode, we will review a new study from the Green Journal, which will be out in February 2026, examining the recurrence risk for ICP using data from NY. In a patient with prior history of ICP, is there any guidance on monitoring of serum bile acids in the subsequent pregnancy before symptoms develop? We will explain. PLUS we will review the data on whether Ursodiol may hold promise in recurrence prevention or in reduction of adverse outcomes once the condition is diagnosed. Listen in for details. 1. 2019: Chappell LC, Bell JL, Smith A, Linsell L, Juszczak E, Dixon PH, Chambers J, Hunter R, Dorling J, Williamson C, Thornton JG; PITCHES study group. Ursodeoxycholic acid versus placebo in women with intrahepatic cholestasis of pregnancy (PITCHES): a randomised controlled trial. Lancet. 2019 Sep 7;394(10201):849-860. doi: 10.1016/S0140-6736(19)31270-X. Epub 2019 Aug 1. PMID: 31378395; PMCID: PMC6739598. https://pubmed.ncbi.nlm.nih.gov/31378395/2. February 08, 2025: Rahim, Mussarat N et al. Pregnancy and the liver. The Lancet. 2021; Volume 405, Issue 10477, 498 – 513 https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)02351-1/fulltext3. SMFM CS 53; 20214. Rosenberg, Henri M. MD; Sarker, Minhazur R. MD; Ramos, Gladys A. MD; Bianco, Angela MD; Ferrara, Lauren MD; DeBolt, Chelsea A. MD. Intrahepatic Cholestasis of Pregnancy Recurrence in a Subsequent Pregnancy. Obstetrics & Gynecology 147(2):p 239-241, February 2026. | DOI: 10.1097/AOG.0000000000006033 https://journals.lww.com/greenjournal/fulltext/2026/02000/intrahepatic_cholestasis_of_pregnancy_recurrence.13.aspx5. Ovadia C, Sajous J, Seed PT et al. Ursodeoxycholic acid in intrahepatic cholestasis of pregnancy: a systematic review and individual participant data meta-analysis. Lancet Gastroenterol Hepatol. 2021 Jul;6(7):547-558. doi: 10.1016/S2468-1253(21)00074-1. Epub 2021 Apr 27. PMID: 33915090; PMCID: PMC8192305.6. EASL Clinical Practice Guidelines on the management of liver diseases in pregnancy. European Association for the Study of the Liver; 2023

🧭 REBEL Rundown 📌 Key Points 🎯Partnership Focus: New collaboration with Arena Labs aimed at enhancing healthcare worker wellness.🏃🏽‍️‍➡️Personalized Coaching: Tools and coaching programs designed for stress management and performance improvement.📊Data-Driven Insights: Utilizing wearable sensor data to tackle burnout effectively.🌄Broad Impact: Offers a unique opportunity to contribute to large-scale healthcare improvements. Click here for Direct Download of the Podcast. 📝 Introduction Welcome back to REBEL MIND, where MIND stands for Mastering Internal Negativity during Difficulty. Here we sharpen the person behind the practitioner by focusing on things that improve our performance, optimizing team dynamics and the human behavior that embodies the hidden curriculum of medicine. In this episode, hosted by Drs. Mark Ramzy and Marco Propersi, we’re excited to introduce a collaboration with Arena Labs. Arena Labs is helping us measure healthcare performance through innovative programs designed to combat burnout and enhance personal wellness using data-driven strategies.  Cognitive Question What would it look like in emergency medicine and critical care to be set up with the same tools as elite teams and professional athletes when it comes to measuring performance and recovery? How would our patients benefit? 💭 Why This is Important Burnout among healthcare workers is a growing concern, especially in such high-pressure environments as emergency and intensive care units. The collaboration with Arena Labs brings forth a vital focus on using data and coaching to build resilience among medical professionals. 🌟Be Brilliant at the Basics Ask yourself — “What is it on your time off that gives you a deep sense of fulfillment?”On your time off are you doing things that fill your bucket and add to your recovery? What is Allostasis and Allostatic Load Allostasis: Our body’s ability to adapt over time to stress. It’s relevant to the phase you are in during this particular season in your life. Ex. You are a first year medical student freaking out about your very first exam. Over time as you do more exams, they are still stressful, but by now you have developed modified study habits to succeed and get used to the frequent examsIn the context of emergency medicine, you may be nervous or stressed about your first shift at a new hospital but overtime you learn the staff, the location of equipment, the acuity of that particular site, the patient population so over time you get used to the stress of a shift at that new hospitalAllostatic Load: The wear and tear on the body from chronic stress due to maladaptation or poor recovery methods.This refers to the cumulative burden of chronic stress and life events. It involves the interaction of different physiological systems at varying degrees of activity.Ex. You are an emergency medicine physician at a very busy, high acuity center and have never prioritized taking care of yourself on/during a shift. As a result, external factors add to not being able to fully recover when you get home or are off shift (ie. Admin work, teaching obligations, family/friends) and so you never fully recover before you have to go back on shift to the same stressors you just exposed yourself to. So the cycle continuesFigure 1: Long term effects of Chronic Stress (Source: Andrew Hogue from NeuroFit) 🏥How This Applies to the Emergency Department or ICU? Healthcare workers in emergency departments (ED) and intensive care units (ICU) are often under enormous stress due to the nature of their work. Arena Labs’ program offers tailored solutions, helping ED and ICU staff manage their unique challenges through effective recovery techniques and performance tools. This approach caters specifically to the demanding schedules and the unpredictability inherent in these environments. 👀 Where to Learn More Intrigued by the possibilities this partnership offers? You can explore more by visiting Arena Labs’ website here. Also, check out the comprehensive coaching program available, designed specifically for healthcare providers looking to enhance their well-being and performance. 🚨 Clinical Bottom Line In an era where burnout is pervasive, our collaboration with Arena Labs offers a beacon of hope for healthcare workers. By leveraging cutting-edge data insights and practical coaching, this partnership aims to redefine healthcare wellness, fostering a sustainable, resilient workforce that’s equipped to navigate the pressures of modern medicine. Join us in this journey towards enhanced well-being and workforce empowerment, ensuring that those who care for us are also cared for. 📚References Guidi J, et al.Allostatic Load and Its Impact on Health: A Systematic Review. Psychother Psychosom. 2021; Epub 2020 Aug 14. PMID: 32799204Frueh BC, et al.“Operator syndrome”: A unique constellation of medical and behavioral health-care needs of military special operation forces. Int J Psychiatry Med. Epub 2020 Feb 13. PMID: 32052666 Meet the Authors Mark Ramzy, DO Co-Editor-in-Chief Cardiothoracic Intensivist and EM Attending RWJBH / Rutgers Health, Newark, NJ Marco Propersi Co-Editor-in-Chief Chair of Emergency Medicine at Vassar Brothers Medical Center, Poughkeepsie, NY Brain Ferguson Founder and CEO Arena Labs The post REBEL MIND: Performance Under Pressure – What Medicine Can Learn from Elite Teams appeared first on REBEL EM - Emergency Medicine Blog.

Contributor: Aaron Lessen, MD Educational Pearls BRASH Syndrome: Bradycardia Renal Failure AV Nodal Blockade Shock Hyperkalemia  Clinical Features: Profound bradycardia and shock in patients on AV nodal blockers: Commonly, Beta Blockers or Calcium Channel Blockers Etiology:  Caused by an inciting kidney injury: Common triggers include precipitating illness, dehydration, or medications  Results in hyperkalemia The enhanced effect of the combination of AV nodal blockade and hyperkalemia leads to a more profound presentation of shock. Treatment:  IV Fluids, unless volume overloaded Epinephrine for bradycardia Lasix for volume overload, only if the patient is still making urine Low threshold to dialyze for hyperkalemia Focus on treating early and more aggressively.  References: Farkas JD, Long B, Koyfman A, Menson K. BRASH Syndrome: Bradycardia, Renal Failure, AV Blockade, Shock, and Hyperkalemia. J Emerg Med. 2020 Aug;59(2):216-223. doi: 10.1016/j.jemermed.2020.05.001. Epub 2020 Jun 18. PMID: 32565167.   Summarized by Ashley Lyons OMS3 Editting by Ashley Lyons OMS3 and Jeffrey Olson MS4   Donate: https://emergencymedicalminute.org/donate/ Join our mailing list: http://eepurl.com/c9ouHf

Credits: 0.25 AMA PRA Category 1 Credit™   CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-468 Overview: We first discussed aspirin use for primary prevention of cardiovascular disease in 2022 when the USPSTF recommended against it. In this follow-up episode, we review new trial data reinforcing that guidance and help you translate the evidence into safer prevention strategies. Build confidence in supporting patients with evidence-based approaches to reduce cardiovascular risk. Episode resource links: Aspirin, cardiovascular events, and major bleeding in older adults: extended follow-up of the ASPREE trial. Eur Heart J. 2025 Aug 12:ehaf514. doi: 10.1093/eurheartj/ehaf514. Epub ahead of print. PMID: 40796244. Guest: Robert A. Baldor MD, FAAFP   Music Credit: Matthew Bugos Thoughts? Suggestions? Email us at FranklySpeaking@pri-med.com The views expressed in this podcast are those of Dr. Domino and his guests and do not necessarily reflect the views of Pri-Med.

En este episodio hablamos de Mi adorada esposa, un thriller que desde las primeras páginas deja claro que aquí nada es normal, aunque todo intente parecerlo. Conocemos a una pareja “perfecta”: matrimonio estable, hijos, rutina… y un pacto tan oscuro como inquietante que se convierte en el verdadero motor de la historia.Any revela su oscuro secreto, mientras Mix comparte sus actividades nocturnas. 

Credits: 0.25 AMA PRA Category 1 Credit™   CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-468 Overview: We first discussed aspirin use for primary prevention of cardiovascular disease in 2022 when the USPSTF recommended against it. In this follow-up episode, we review new trial data reinforcing that guidance and help you translate the evidence into safer prevention strategies. Build confidence in supporting patients with evidence-based approaches to reduce cardiovascular risk. Episode resource links: Aspirin, cardiovascular events, and major bleeding in older adults: extended follow-up of the ASPREE trial. Eur Heart J. 2025 Aug 12:ehaf514. doi: 10.1093/eurheartj/ehaf514. Epub ahead of print. PMID: 40796244. Guest: Robert A. Baldor MD, FAAFP   Music Credit: Matthew Bugos Thoughts? Suggestions? Email us at FranklySpeaking@pri-med.com The views expressed in this podcast are those of Dr. Domino and his guests and do not necessarily reflect the views of Pri-Med.

This week we're traveling back to first-century Jerusalem with The Book of Clarence! Join us as we learn about Mary Magdalene, Barabbas, Biblical sick burns, and more! Sources: Martínez-Cruz, B., Mendizabal, I., Harmant, C. et al. Origins, admixture and founder lineages in European Roma. Eur J Hum Genet 24, 937–943 (2016). https://doi.org/10.1038/ejhg.2015.201 Gresham D, Morar B, Underhill PA, Passarino G, Lin AA, Wise C, Angelicheva D, Calafell F, Oefner PJ, Shen P, Tournev I, de Pablo R, Kuĉinskas V, Perez-Lezaun A, Marushiakova E, Popov V, Kalaydjieva L. Origins and divergence of the Roma (gypsies). Am J Hum Genet. 2001 Dec;69(6):1314-31. doi: 10.1086/324681. Epub 2001 Nov 9. PMID: 11704928; PMCID: PMC1235543. James Carroll, "Who Was Mary Magdalene?" Smithsonian Magazine https://www.smithsonianmag.com/history/who-was-mary-magdalene-119565482/   Cornelis Bennema, "Mary Magdalene: Recognizing the Shepherd's Voice," Encountering Jesus (2014). https://www.jstor.org/stable/j.ctt9m0t70.27  Meggan Watterson, Mary Magdalene Revealed: The First Apostle, Her Feminist Gospel & the Christianity We Haven't Tried Yet (audiobook).  Y'all Translation Bible, https://www.bible.com/bible/4108/JHN.20.YALL  NIV Study Bible Rotten Tomatoes: https://www.rottentomatoes.com/m/the_book_of_clarence_2024  Robert Daniels, https://www.rogerebert.com/reviews/the-book-of-clarence-film-review-2024  Alissa Wilkinson, https://www.nytimes.com/2024/01/11/movies/the-book-of-clarence-review.html  https://www.hollywoodreporter.com/movies/movie-reviews/the-book-of-clarence-review-lakeith-stanfield-1235780399/ 

Send us a textIn this episode of Journal Club, Ben and Daphna review a retrospective cohort study from the Journal of Perinatology examining the association between NICU capacity strain and neonatal outcomes. We discuss how high census and acuity on admission day correlate with increased mortality and morbidity when adjusted for hospital and patient factors. Join us as we explore why being "slammed with admissions" is more than just a badge of honor—it's a critical safety metric for our patients.----The association of NICU capacity strain with neonatal mortality and morbidity. Salazar EG, Passarella M, Formanowski B, Rogowski J, Edwards EM, Halpern SD, Phibbs C, Lorch SA.J Perinatol. 2025 Dec;45(12):1801-1808. doi: 10.1038/s41372-025-02449-0. Epub 2025 Oct 20.PMID: 41116036 Free PMC article.Support the showAs 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!

Deep Dive in DDH is a three-part limited series where experts in the field of DDH have been invited to discuss the controversies in the management of hip dysplasia. Episode 1 was published in August and discussed management of DDH in infants under 6 months of age. In Episode 2, we are joined by Eduardo Novais at Nemour Children's Health in Jacksonville and Salil Upasani of Rady Children's Hospital and discuss the controversies in the management of developmental hip dislocations in the operating room including the process to decide between closed and open reduction, the use of concomitant osteotomies, adjunctive imaging, and casting protocols. Hosted by Will Morris (Scottish Rite for Children). Music by A. A. Aalto. Referenced Publications: Novais EN, Hill MK, Carry PM, Heyn PC. Is Age or Surgical Approach Associated With Osteonecrosis in Patients With Developmental Dysplasia of the Hip? A Meta-analysis. Clin Orthop Relat Res. 2016 May;474(5):1166-77. doi: 10.1007/s11999-015-4590-5. PMID: 26472583; PMCID: PMC4814411. Schmaranzer F, Justo P, Kallini JR, Ferrer MG, Miller P, Bixby SD, Novais EN. Hip Morphology on Post-Reduction MRI Predicts Residual Dysplasia 10 Years After Open or Closed Reduction. J Bone Joint Surg Am. 2024 Jan 17;106(2):110-119. doi: 10.2106/JBJS.23.00333. Epub 2023 Nov 22. PMID: 37992184; PMCID: PMC12205695. Morris WZ, Chilakapati S, Hinds SA, Herring JA, Kim HKW. The Clinical Significance of Infolded Limbus on Postreduction Arthrogram in Developmental Dysplasia of the Hip. J Pediatr Orthop. 2022 Apr 1;42(4):e309-e314. doi: 10.1097/BPO.0000000000002070. PMID: 35132011. Morris WZ, Hinds S, Worrall H, Jo CH, Kim HKW. Secondary Surgery and Residual Dysplasia Following Late Closed or Open Reduction of Developmental Dysplasia of the Hip. J Bone Joint Surg Am. 2021 Feb 3;103(3):235-242. doi: 10.2106/JBJS.20.00562. PMID: 33252590. Gans I, Sankar WN. The medial dye pool revisited: correlation between arthrography and MRI In closed reductions for DDH. J Pediatr Orthop. 2014 Dec;34(8):787-90. doi: 10.1097/BPO.0000000000000187. PMID: 24787303. Novais EN, Hollnagel KF, Bixby SD, Ferrer MG, Williams DN, Kim YJ, Schmaranzer F. Predictive value of post-reduction gadolinium-enhanced magnetic resonance imaging in detecting avascular necrosis after closed and open reduction for developmental dysplasia: A minimum 5-year follow-up study. J Child Orthop. 2025 Jul 6;19(4):329-338. doi: 10.1177/18632521251350524. PMID: 40630930; PMCID: PMC12230044. Paez C, Badrinath R, Holt J, Bomar JD, Mubarak SJ, Upasani VV, Wenger DR. Ligamentum Teres Transfer During Medial Open Reduction in Patients with Developmental Dysplasia of the Hip. Iowa Orthop J. 2021;41(1):47-53. PMID: 34552403; PMCID: PMC8259203.

It's a controversial topic: the impact of uterine incision (hysterectomy) on the neonate delivery interval (also called the U-D interval). Does it matter? Just to be clear, we're talking about time from uterine entry to fetal extraction, not skin incision to fetal extraction. Past publications have produced conflicting results, often limited by small sample sizes, heterogeneous indications for delivery, and reliance on surrogate markers (like apgar scores) rather than clinical morbidity. But a new study published in the Gray journal at the end of 2025 (December 30, 2025) gives some new insights. In this episode, we will review this retrospective study and play the “Devil's advocate” as we summarize the rebuttal data. As the reports are conflicting, we will end the podcast with a real-world interpretation and application of this data. Listen in for details. 1. Bart, Yossi et al. Uterine Incision-to-Delivery Interval and Neonatal Outcomes among Non-urgent, Term, Cesarean Deliveries. American Journal of Obstetrics & Gynecology, Volume 0, Issue 0. https://www.ajog.org/article/S0002-9378(25)00980-9/fulltext?rss=yes2. Maayan-Metzger A, Schushan-Eisen I, Todris L, Etchin A, Kuint J. The effect of time intervals on neonatal outcome in elective cesarean delivery at term under regional anesthesia. Int J Gynaecol Obstet. 2010 Dec;111(3):224-8. doi: 10.1016/j.ijgo.2010.07.022. Epub 2010 Sep 19. PMID: 20855070. https://pubmed.ncbi.nlm.nih.gov/20855070/3. Spain JE, Tuuli M, Stout MJ, Roehl KA, Odibo AO, Macones GA, Cahill AG. Time from uterine incision to delivery and hypoxic neonatal outcomes. Am J Perinatol. 2015 Apr;32(5):497-502. doi: 10.1055/s-0034-1396696. Epub 2014 Dec 24. PMID: 25539409.4. Bader AM, Datta S, Arthur GR, Benvenuti E, Courtney M, Hauch M. Maternal and fetal catecholamines and uterine incision-to-delivery interval during elective cesarean. Obstet Gynecol. 1990 Apr;75(4):600-3. PMID: 2107478.5. Tekin, E., Inal, H.A. & Isenlik, B.S. A Comparison of the Effect of Time from Uterine Incision to Delivery on Neonatal Outcomes in Women with One Previous and Repeat (Two or More) Cesarean Sections. SN Compr. Clin. Med. 5, 80 (2023). https://doi.org/10.1007/s42399-023-01427-x

Luke Hedrick, Dave Furfaro, and recurrent RFJC guest Robert Wharton are joined again today by Nicole Ng to discuss the FIBRONEER-IPF trial investigating Nerandomilast in patients with IPF. This trial was published in NEJM in 2025 and looked at Neradomilast vs placebo for treating patients with IPF, on or off background anti-fibrotic therapy. This agents is now FDA approved for pulmonary fibrosis, and understanding the trial results is essential for any pulmonary physician treating patients with IPF or progressive pulmonary fibrosis. Article and Reference Today’s episode discusses the FIBRONEER-IPF trial published in NEJM in 2025. Richeldi L, Azuma A, Cottin V, Kreuter M, Maher TM, Martinez FJ, Oldham JM, Valenzuela C, Clerisme-Beaty E, Gordat M, Wachtlin D, Liu Y, Schlecker C, Stowasser S, Zoz DF, Wijsenbeek MS; FIBRONEER-IPF Trial Investigators. Nerandomilast in Patients with Idiopathic Pulmonary Fibrosis. N Engl J Med. 2025 Jun 12;392(22):2193-2202. doi: 10.1056/NEJMoa2414108. Epub 2025 May 18. PMID: 40387033. https://www.nejm.org/doi/abs/10.1056/NEJMoa2414108 Meet Our Guests Luke Hedrick is an Associate Editor at Pulm PEEPs and runs the Rapid Fire Journal Club Series. He is a senior PCCM fellow at Emory, and will be starting as a pulmonary attending at Duke University next year. Robert Wharton is a recurring guest on Pulm PEEPs as a part of our Rapid Fire Journal Club Series. He completed his internal medicine residency at Mt. Sinai in New York City, and is currently a pulmonary and critical care fellow at Johns Hopkins. Dr. Nicole Ng is an Assistant Profess of Medicine at Mount Sinai Hospital, and is the Associate Director of the Interstitial Lung Disease Program for the Mount Sinai National Jewish Health Respiratory Institute. Infographic Key Learning Points Why this trial mattered IPF therapies remain limited: nintedanib and pirfenidone slow (but do not stop) decline and often cause GI side effects. Nerandomilast is a newer agent (a preferential PDE4B inhibitor) with antifibrotic + immunomodulatory effects. Phase 2 data (NEJM 2022) looked very promising (suggesting near-“halt” of FVC decline), so this phase 3 trial was a big test of that signal. Trial design essentials Industry-sponsored, randomized, double-blind, placebo-controlled, large multinational study (332 sites, 36 countries). Population: IPF diagnosed via guideline-aligned criteria with central imaging review and multidisciplinary diagnostic confirmation. Intervention: nerandomilast 18 mg BID, 9 mg BID, or placebo; stratified by background antifibrotic use. Primary endpoint: change in FVC at 52 weeks, analyzed with a mixed model for repeated measures. Key secondary endpoint: time to first acute exacerbation, respiratory hospitalization, or death (composite). Who was enrolled Typical IPF trial demographics: ~80% male, mean age ~70, many former smokers. Many were already on background therapy (~45% nintedanib, ~30–33% pirfenidone). Notable exclusions included significant liver disease, advanced CKD, recent major cardiovascular events, and psychiatric risk (suicidality/severe depression), reflecting class concerns seen with other PDE4 inhibitors. Efficacy: what the primary endpoint showed Nerandomilast produced a statistically significant but modest reduction in annual FVC decline vs placebo (roughly 60–70 mL difference). Importantly, it did not halt FVC decline the way the phase 2 data suggested; patients still progressed. Important nuance: interaction with pirfenidone Patients on pirfenidone had ~50% lower nerandomilast trough levels. Clinically: 9 mg BID looked ineffective with pirfenidone, so 18 mg BID is needed if used together. In those not on background therapy or on nintedanib, 9 mg and 18 mg looked similar—suggesting the apparent “dose-response” might be partly driven by the pirfenidone drug interaction Secondary and patient-centered outcomes were neutral No demonstrated benefit in the composite outcome (exacerbation/resp hospitalization/death) or its components. Quality of life measures were neutral and declined in all groups, emphasizing that slowing FVC alone may not translate into felt improvement without a disease-reversing therapy. The discussants noted this may reflect limited power/duration for these outcomes and mentioned signals from other datasets/pooling that might suggest mortality benefit—but in this specific trial, the key secondary endpoint was not positive. Safety and tolerability Diarrhea was the main adverse event: Higher overall with the 18 mg dose, and highest when combined with nintedanib (up to ~62%). Mostly mild/manageable; discontinuation due to diarrhea was relatively uncommon (but higher in those on nintedanib). Reassuringly, there was no signal for increased depression/suicidality/vasculitis despite psychiatric exclusions and theoretical class risk. How to interpret “modest FVC benefit” clinically The group framed nerandomilast as another tool that adds incremental slowing of progression. They emphasized that comparing absolute FVC differences across trials (ASCEND/INPULSIS vs this trial) is tricky because populations and “natural history” in placebo arms have changed over time (earlier diagnosis, improved supportive care, etc.). They highlighted channeling bias: patients already on antifibrotics may be sicker (longer disease duration, lower PFTs, more oxygen), complicating subgroup comparisons. Practical takeaways for real-world use All three antifibrotics are “fair game”; choice should be shared decision-making based on goals, tolerability, dosing preferences, and logistics. Reasons they favored nerandomilast in practice: No routine lab monitoring (major convenience advantage vs traditional antifibrotics). Generally better GI tolerability than nintedanib. BID dosing (vs pirfenidone TID). Approach to combination therapy: They generally favor add-on rather than immediate combination to reduce confusion about side effects—while acknowledging it may slow reaching “maximal therapy.” Dosing guidance emphasized: Start 18 mg BID for IPF, especially if combined with pirfenidone (since dose reduction may make it ineffective). 9 mg BID may be considered if dose reduction is needed and the patient is not on pirfenidone (e.g., monotherapy or with nintedanib).

Uterine rupture or dehiscence associated with TOLAC results in the most significant increase in the likelihood of additional maternal and neonatal morbidity. It should be noted that the terms “uterine rupture” and “uterine dehiscence” are not consistently distinguished from each other in the literature and often are used interchangeably. Furthermore, the reported incidence of uterine rupture varies in part because some studies have grouped true, catastrophic uterine rupture together with asymptomatic scar dehiscence. In January 2026, a new meta-analysis examines the relationship between oxytocin use with TOLAC and uterine rupture. In this episode, we will summarize the key findings in that study and review the data on the use of internal monitors during TOLAC. Do internal monitors (FSE, IUPC) offer a safer TOLAC compared with external monitors? Listen in for details.1. Nicolì, Pierpaolo et al.Oxytocin dosing during trial of labor after cesarean to minimize the risk of uterine rupture: a systematic review and meta-analysisAmerican Journal of Obstetrics & Gynecology MFM, Volume 8, Issue 1, 1018462. Practice Bulletin No. 184: Vaginal Birth After Cesarean Delivery. Obstetrics & Gynecology 130(5):p e217-e233, November 2017. | DOI: 10.1097/AOG.00000000000023983. ACOG Clinical Practice Guideline No. 10:Intrapartum Fetal Heart Rate Monitoring: Interpretation and Management. Obstetrics & Gynecology 146(4):p 583-599, October 2025. | DOI: 10.1097/AOG.00000000000060494. Bruno AM, Allshouse AA, Metz TD. Maximum Oxytocin Dose and Uterine Rupture During Trial of Labor After Cesarean. Obstet Gynecol. 2025 Dec 1;146(6):843-850. doi: 10.1097/AOG.0000000000006106. Epub 2025 Oct 30. PMID: 41325062.

Currently, as of today's date, neither the ACOG nor SMFM currently support routine early induction of labor for suspected fetal macrosomia, instead recommending individualized counseling and reserving elective cesarean for extreme estimated fetal weights. However, a 2025 multicenter, open-label, randomized controlled trial was published in the Lancet comparing induction of labor versus standard care in pregnant women with fetuses suspected to be large for gestational age. The study used a parallel-group design with 1:1 randomization, enrolling women from 106 NHS hospitals across England, Scotland, and Wales. The per-protocol analysis demonstrated a significant reduction (40%) in shoulder dystocia with induction of labor at 38- 38 weeks and 4 days. Is this in conflict with the ACOG current guidance? In this episode, we will review the “Big Baby study” from the Lancet and provide 3 main limitations of this very large study, review the importance of PP vs ITT results, and explain why more data is still needed. Listen in for details. 1. ACOG PB 178; 2017 (reaffirmed 2024)2. Gardosi J, Ewington LJ, Booth K, Bick D, Bouliotis G, Butler E, Deshpande S, Ellson H, Fisher J, Gornall A, Lall R, Mistry H, Naghdi S, Petrou S, Slowther AM, Wood S, Underwood M, Quenby S. Induction of labour versus standard care to prevent shoulder dystocia in fetuses suspected to be large for gestational age in the UK (the Big Baby trial): a multicentre, open-label, randomised controlled trial. Lancet. 2025 May 17;405(10491):1743-1756. doi: 10.1016/S0140-6736(25)00162-X. Epub 2025 May 1. PMID: 40319899.3. Blaauwgeers, Anne N et al. Rethinking induction of labour for LGA fetuses: the Big Baby trial. The Lancet, Volume 406, Issue 10512, 1562

Endocrine Surgery emergencies are rare. However, they can be clinically significant and understanding how to navigate them as a surgeon in timely fashion is critical. Hosts:  Dr. Rebecca Sippel is an endowed professor of surgery and Division Chief of Endocrine Surgery at University of Wisconsin (UW) - Madison, and she is the most recent past president of the American Association of Endocrine Surgeons (AAES).  She is an internationally recognized leader in the field of endocrine surgery with over 250 publications. She was the principal investigator for a hallmark randomized controlled trial which studied the need for prophylactic central neck dissections in thyroid cancer.   Dr. Amanda Doubleday is a fellowship trained endocrine surgeon in private practice with an affiliation to UW Health. Her primary practice is with Waukesha Surgical Specialists in Waukesha WI. Her clinical interests are in robotic adrenalectomy, benign and malignant thyroid cancer and hyperparathyroidism. Dr. Simon Holoubek is a fellowship trained endocrine surgeon affiliated with UW Health. His primary practice is with UW Health with privileges at UW Madison and UW Northern Illinois. His clinical interests are aggressive variants of thyroid cancer, parathyroid autofluorescence, and nerve monitoring.  Learning Objectives: 1) Learn about thyroid storm in hyperthyroidism and treatment options. 2) Understand how to treat hypercalcemic crisis due to uncontrolled primary hyperparathyroidism. 3) Describe the modified surgical techniques required for thyroidectomy in patients with Graves' disease to prevent recurrent laryngeal nerve traction injury. 4) Identify clinical and intraoperative indicators of parathyroid carcinoma and explain the necessity of en bloc resection to prevent parathyromatosis. References: 1 Palit TK, Miller CC 3rd, Miltenburg DM. The efficacy of thyroidectomy for Graves' disease: A meta-analysis. J Surg Res. 2000 May 15;90(2):161-5. doi: 10.1006/jsre.2000.5875. PMID: 10792958. https://pubmed.ncbi.nlm.nih.gov/10792958/ 2 Yoshimura Noh J, Inoue K, Suzuki N, Yoshihara A, Fukushita M, Matsumoto M, Imai H, Hiruma S, Ichikawa M, Koshibu M, Sankoda A, Hirose R, Watanabe N, Sugino K, Ito K. Dose-dependent incidence of agranulocytosis in patients treated with methimazole and propylthiouracil. Endocr J. 2024 Jul 12;71(7):695-703. doi: 10.1507/endocrj.EJ24-0135. Epub 2024 May 3. PMID: 38710619. https://pubmed.ncbi.nlm.nih.gov/38710619/ 3 Christopher L, Mellman M, Buicko JL. Management of Hypercalcemic Crisis due to Primary Hyperparathyroidism During Pregnancy. Am Surg. 2023 Aug;89(8):3638-3640. doi: 10.1177/00031348231162704. Epub 2023 Apr 27. PMID: 37102502. https://pubmed.ncbi.nlm.nih.gov/37102502/ Sponsor Disclaimer: Visit goremedical.com/btkpod to learn more about GORE® SYNECOR Biomaterial, including supporting references and disclaimers for the presented content. Refer to Instructions for Use at eifu.goremedical.com for a complete description of all applicable indications, warnings, precautions and contraindications for the markets where this product is available. Rx only 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://behindtheknife.org/listen Behind the Knife Premium: General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-review Trauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlas Dominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkship Dominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotation Vascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-audio-review Colorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-audio-review Surgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-audio-review Cardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-audio-review Download our App: Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049 Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US