Podcasts about ESR

In this latest State of the Thunder, we're discussing the upcoming yearly ESR, 140.0, which is due out June 24, 2025. We explain our numbering convention and our different channels, which comes from Firefox, and the difference between ESR, Release, Beta, and Daily. Find out why we're encouraging to use the monthly Release channel, but how this won't take anything away from ESR. Learn more about what channel is right for you (especially if you use add-ons), how to help us with using Beta and Daily, and how to safely move between ESR and Release. And as always, we finish with a community shoutout! Resources: What Train is It Now: http://whattrainisitnow.comMonthly Release Channel Blog Post: https://blog.thunderbird.net/2025/03/thunderbird-release-channel-update/Choosing a Release Channel: https://support.mozilla.org/kb/choosing-thunderbird-release-channelTesting Beta Support Article: https://support.mozilla.org/kb/thunderbird-betaTesting Daily Support Article: https://support.mozilla.org/kb/thunderbird-dailyRelease Channel Support Article (with info on safely downgrading): https://support.mozilla.org/kb/thunderbird-releaseAdd-on Compatibility Add-on: https://addons.thunderbird.net/thunderbird/addon/addon-compatibility-check/tilorenz's Calendar grid patch: https://phabricator.services.mozilla.com/D251992 ★ Support this podcast ★

Episode 194: Acute low back pain.  Future Dr. Ibrahim presents a clinical case to explain the essential points in the evaluation of back pain.  Future Dr. Redden adds information about differentiating between a back strain and more serious diseases such as cancer, and Dr. Arreaza shares information about returning to work after back strain.Written by Michael Ibrahim, MSIV. Editing and comments by Jordan Redden, MSIV, and Hector Arreaza, MD.You are listening to Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California, a UCLA-affiliated program sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. This podcast was created for educational purposes only. Visit your primary care provider for additional medical advice.Dr. Arreaza:Welcome back, everyone. Today's topic is one that every primary care provider, emergency doctor, and even specialist sees routinely: low back pain. It's so common that studies estimate up to 80% of adults will experience it at some point in their lives. But despite how frequent it is, the challenge is to identify which cases are benign and which demand urgent attention.Jordan:Exactly. Low back pain is usually self-limiting and mechanical in nature, but we always need to keep an eye out for the rare but serious causes: things like infection, malignancy, or neurological compromise. That's why a good history and physical exam are our best tools right out of the gate.Michael:And to ground this in a real example, let me introduce a patient we saw recently. John is a 45-year-old warehouse worker who came in with two weeks of lower back pain that started after lifting a 50-lb box. He describes it as a dull, aching pain that radiates from his lower back down the posterior left thigh into the calf. He says it gets worse with bending or coughing, but he feels better when lying flat. He also mentioned some numbness in his left foot, but he denies any bowel or bladder issues. His vitals are completely normal. On exam, he had lumbar paraspinal tenderness, a positive straight leg-raise at 40 degrees on the left and decreased sensation in the L5 dermatome, though reflexes were still intact.Dr. Arreaza:That's a great case. Let's take a minute and talk about the straight leg raise test. This is a bedside tool we use to assess for lumbar nerve root irritation often caused by a herniated disc. ***Here's how it works: the patient lies supine, and you slowly raise their straight leg. If pain radiates below the knee between 30° and 70°, that suggests radiculopathy, especially involving the L5 or S1 nerve roots. Pain at higher angles is more likely due to hamstring tightness or mechanical strain.Michael:Right. So, stepping back: what do we mean by "low back pain"? Broadly, it's any pain localized to the lumbar spine, but it's often classified by type or cause:Mechanical (like muscle strain or degenerative disc disease), Radicular (nerve root involvement), Referred pain (like from pelvic or abdominal organs), Inflammatory (AS), and Systemic or serious causes like infection or malignancy. Jordan:In John's case, we're thinking radicular pain, most likely from a herniated disc compressing the L5 nerve root. That's supported by the dermatomal numbness, the leg pain, and that positive straight leg test.Dr. Arreaza:Good reasoning. Now, anytime we see back pain, our brains should run a checklist for red flags. These help us pick up more serious causes that require urgent attention. Let's run through the red flags.Michael:Sure. For fracture, we think about major trauma or even minor trauma in the elderly, especially those with osteoporosis or on chronic steroids. Also, anyone over 70 years old.Jordan:Then we have infections, which could include things like discitis, vertebral osteomyelitis, or epidural abscess. Red flags include fever, IV drug use, recent surgery, or immunosuppression.Michael:Malignancy is another critical one, especially if there's a history of breast, prostate, lung, kidney, or thyroid cancer. Clues include unexplained weight loss, night pain, or constant pain not relieved by rest.Jordan:And don't forget about inflammatory back pain, like ankylosing spondylitis, which is often seen in younger patients with morning stiffness that lasts more than 30 minutes and improves with activity.Dr. Arreaza:And of course, we always rule out cauda equina syndrome: a surgical emergency. That's urinary retention or incontinence, saddle anesthesia, bilateral leg weakness, or fecal incontinence. Missing this diagnosis can be catastrophic.Michael:Thankfully, in John's case, we don't see any red flags. His presentation is classic for uncomplicated lumbar radiculopathy. But we must stay vigilant, because sometimes patients don't offer up key symptoms unless we ask directly.Jordan:And that's where associated symptoms help guide us. For example:Radicular symptoms like numbness or weakness follow dermatomal patterns. Constitutional symptoms like fever or weight loss raise red flags. Bladder/bowel changes or saddle anesthesia raise alarms for cauda equina. Pain that wakes patients up at night might point to malignancy. Dr. Arreaza:So when do we order labs or imaging?Michael:Not right away. For most patients with acute low back pain, imaging is not needed unless they have red flags. If infection is suspected, we'd get CBC, ESR, and CRP. For cancer, maybe PSA or serum protein electrophoresis. And if inflammatory back disease is suspected, HLA-B27 can be helpful.Jordan:Yes, imaging should be delayed for at least six weeks unless red flags or significant neurologic deficits are present. When we do image, MRI is our go-to especially for suspected radiculopathy or cauda equina. X-rays can help if we're thinking about fractures, but they won't show soft tissue or nerve root issues.Michael:In the example from our case, since the patient doesn't have red flags, we'd go with conservative management: start NSAIDs and recommend activity modification. As this is the acute setting, physical therapy would not be recommended.Jordan:For the acute phase, research shows no serious difference between those with PT and those without in the long term. However, physical therapy is really the cornerstone of management for chronic back pain. It's not just movement: it's education, body mechanics, and teaching patients how to move safely. And PT can actually reduce opioid use, imaging, and injections down the line for patient struggling with long term back pain.Dr. Arreaza:Yes, and PT is not one-size-fits-all. PT might include McKenzie exercises, manual therapy, postural retraining, or even neuromuscular re-education. The goal is always to build core stability, promote healthy movement patterns, and reduce fear of motion.Jordan:Let's take a minute to talk about the McKenzie Method, a physical therapy approach used to treat lumbar disc herniation by identifying a specific movement, (often spinal extension) that reduces or centralizes pain. A common exercise is the prone press-up, (cobra pose for yoga fans) where the patient lies face down and pushes the upper body upward while keeping the hips on the floor to relieve pressure on the disc. These exercises should be done carefully, ideally under professional guidance, and discontinued if symptoms worsen.Michael:For our case patient, our working diagnosis is mechanical low back pain with L5 radiculopathy. No imaging needed now, no red flags. We'll treat conservatively and educate him about proper lifting, staying active, and recovery expectations.Jordan:We also emphasized to him that bed rest isn't helpful. In fact, bed rest can make things worse. Keeping active while avoiding heavy lifting for now is key.Dr. Arreaza:Return-to-work recommendations should be individualized. For example, an office worker, positioning while working, or work hours may be able to return to work promptly. However, those with physically demanding jobs may need light duty or be off work.Ice: no evidence of benefit. Heat: may reduce pain and disability in pain of less than 3 months, although the benefit was small and short.And we should always teach safe lifting techniques: bend at the knees, keep the load close, avoid twisting. It's basic knowledge, but it is very effective in preventing recurrence.Jordan:Now, if a patient fails to improve after 6 weeks of conservative therapy, or if they develop new neurologic deficits, that's when we think about referral to spine specialists or surgical consultation.Michael:And as previously mentioned: in cases where back pain becomes chronic (lasting more than 12 weeks) a multidisciplinary approach works best. That can include:Physical therapy, Cognitive behavioral therapy (CBT) And sometimes pain management interventions. Jordan:We can't forget the psychological toll either. Chronic back pain is associated with depression, anxiety, and opioid dependence. Increased risk factors include obesity, smoking, sedentary lifestyle, and previous back injuries.Dr. Arreaza:Well said. So, let's summarize. Michael?Michael:Sure! Low back pain is common, and most cases are benign. But we have to know the red flags that point to serious pathology. A focused history and physical exam are more powerful than many people realize. And the first step in treatment is almost always conservative, with a strong emphasis on maintaining physical activity.Jordan:And don't underestimate the value of patient education. Helping patients understand their pain, set realistic expectations, and stay active is often just as important as the medications or therapies we offer.Even without trying, every night you go to bed a little wiser. Thanks for listening to Rio Bravo qWeek Podcast. We want to hear from you, send us an email at RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. See you next week! _____________________References:Chou, R., Qaseem, A., Snow, V., Casey, D., Cross, J. T., Shekelle, P., & Owens, D. K. (2007). Diagnosis and treatment of low back pain: A joint clinical practice guideline from the American College of Physicians and the American Pain Society. Annals of Internal Medicine, 147(7), 478–491. https://doi.org/10.7326/0003-4819-147-7-200710020-00006Deyo, R. A., Mirza, S. K., Turner, J. A., & Martin, B. I. (2009). Overtreating chronic back pain: Time to back off? Journal of the American Board of Family Medicine, 22(1), 62–68. https://doi.org/10.3122/jabfm.2009.01.080102National Institute for Health and Care Excellence. (2020). Low back pain and sciatica in over 16s: Assessment and management (NICE Guideline No. NG59). https://www.nice.org.uk/guidance/ng59Qaseem, A., Wilt, T. J., McLean, R. M., & Forciea, M. A. (2017). Noninvasive treatments for acute, subacute, and chronic low back pain: A clinical practice guideline from the American College of Physicians. Annals of Internal Medicine, 166(7), 514–530. https://doi.org/10.7326/M16-2367UpToDate. (n.d.). Evaluation and treatment of low back pain in adults. Wolters Kluwer. https://www.uptodate.com (Access requires subscription)Theme song, Works All The Time by Dominik Schwarzer, YouTube ID: CUBDNERZU8HXUHBS, purchased from https://www.premiumbeat.com/. 

Join longevity experts Chris Burres and Lisa Tamati as they dive into cutting-edge biohacking strategies to optimise health and extend lifespan. In this engaging live session, they explore hydrogen inhalation for reducing oxidative stress, hyperbaric oxygen therapy (HBOT) for healing and neuroprotection, and the power of exogenous ketones in supporting brain health and cancer recovery. Lisa shares her inspiring journey of saving her mother's life through relentless research and a fighter's mindset, while Chris introduces innovative tools like nano oxygen therapy and ESR testing. Packed with actionable insights, this episode is a must-watch for anyone passionate about longevity, health optimization, and biohacking. Tune in monthly for more groundbreaking discussions!  Connect with Chris Burres:  Website: www.myvitalc.com YouTube: www.youtube.com/@myvitalc Instagram: @myvitalc

ESR data shows flu and COVID infections are on the rise, with a sharp jump in hospitalisations for severe respiratory infections across Auckland in a week. As Ruth Hill reports, GPs warn they're already under pressure.

Send us your feedback In this episode, of our special AI Impact series, Technology Partner Kate Cruickshank talks with Professor Albert Bifet, Director of the Artificial Intelligence Institute at the University of Waikato, about how AI is reshaping the environmental sector.[01:10] Kate and Albert discuss AI technologies already being used in the environmental sector, including deep learning models, computer vision, and real-time analytics and consider how these tools are boosting productivity, improving conservation efforts, and helping manage vast scientific datasets in this sector.[03:27] Albert highlights the growing impact of AI innovations in areas such as weather forecasting, species detection, and environmental surveillance. He notes that by tailoring these technologies to New Zealand's distinctive ecology and environmental conditions, they are transforming the way environmental monitoring is conducted. He also emphasises the value of scientific collaboration in AI, pointing to initiatives like the TAIAO Environmental Data Science Project and ESR's digital twin platform as key examples.[05:37] Kate asks about the main challenges in adopting AI in the environmental space, and Albert outlines key issues like data accessibility and privacy, Māori data sovereignty, and a lack of general AI understanding within the scientific community. He emphasises the need for better education and more integrated collaboration across sectors to create an integrated ecosystem.[07:45] Albert talks about how successful AI ecosystems abroad, particularly in Europe, have been built through joint investment from government, academia, and industry. He notes New Zealand's potential to do the same by leveraging its innovation culture and aligning national strategy with practical execution.[10:20] They discuss the future of AI in the environmental sector, with Albert highlighting the rise of agentic AI and robotics. He describes a near future where AI agents autonomously complete tasks and AI-driven robots work in the field, multiplying productivity and unlocking new capabilities.[13:14] Kate asks about the AI talent pipeline, and Albert explains the issue of brain drain in this area, stressing the importance of retaining skilled individuals in New Zealand and the need for a clear strategy and investment to combat this.Information in this episode is accurate as at the date of recording, 30 April 2025.Please contact Kate Cruickshank, Tom Maasland or our Technology team if you need legal advice and guidance on any of the topics discussed in the episode.Please get in touch to receive an episode transcript. Please don't forget to rate, review or follow MinterEllisonRuddWatts wherever you get your podcasts. You can also email us directly at techsuite@minterellison.co.nz and sign up to receive technology updates via your inbox here.  For show notes and additional resources visit minterellison.co.nz/podcasts

Coming up in this episode * AI's Won't Take Over Yet * Is Rust Open Source? * and All Kinds of Feedback The Video Version https://youtu.be/LxMpNIfhFiA 0:00 Cold Open 3:56 Curl's "AI Slop" Problem 25:12 A Little Viral Licensing 42:12 So Much Feedback ❤️ 42:30 ukwan / Youtube 51:16 jliljj / Youtube 56:35 fredstech1 / Youtube 1:00:15 conan kudo / Youtube 1:02:06 amanita / Patreon 1:05:13 redvamp128 / Youtube 1:09:35 The Rules, Commands & Next Time 1:19:12 Stinger The Curl project pushes back on AI slop The Ars Technica article (https://arstechnica.com/gadgets/2025/05/open-source-project-curl-is-sick-of-users-submitting-ai-slop-vulnerabilities/) The Curl project on Hacker One (https://hackerone.com/curl?type=team)

We made it to episode 101! Thank you for listening! In this episode, I share my revamped daytime routine, emphasizing the importance of various practices which contribute to better sleep and overall wellness.New episodes of Welcome to Wellness every Friday!Not listening on Spotify? Show notes at:https://www.ashleydeeley.com/w2w/episode101Episode brought to you by: ⁠⁠⁠ApolloNeuro⁠⁠⁠Episode brought to you by:⁠⁠⁠⁠⁠⁠⁠⁠⁠ VieLight⁠⁠⁠ - ⁠⁠⁠⁠⁠⁠Code: DEELEY10Episode brought to you by:⁠⁠⁠⁠⁠⁠⁠⁠⁠Dry Farm Wines⁠⁠⁠⁠⁠⁠⁠⁠⁠2:21: Natural Cycles (non-hormonal birth control)3:21: Hormone testing for ovulation and perimenopause3:53: Sunlight for optimal health5:16: Why I avoid sunglasses6:00: Dr. Jack Cruz / Dr. Fritz Hollwich8:21: What I wish I knew when I was a Personal Trainer10:38: Women tear ACLs during the follicular phase 11:42: Quinton minerals12:41: Cancer and the New Biology of Water - Dr Thomas Cowan13:05: Why I quit coffee! Coffee alternatives: Chi Chaga & Kamana16:42: How to improve eyesight18:12: Why I take BHRT - bioidentical hormone replacement therapy19:10: Tallow from Amish farms for body lotion19:42: Better than Botox roller20:11: My favorite makeup brands21:56: Why I don't recommend the EWG22:36: Stored beauty products in myron glass!24:01: Avoid perfume and synthetic fragrances26:05: Tips for drinking out of plastic (1,2,4,5 are OK!)28:56: Why I don't use DoTerra30:22: Hateful eight oils to avoid35:30: My favorite blueblockers - VivaRays41:33: The reasonI I don't use Bluetooth43:00: Murray vs. Motorola 43:24: NuCalm can give you 2 hours of REM sleep results in 20 minutes48:11: Why I don't use air fresheners or any cleaning products which are scented50:06: Why I don't burn traditional candles53:18: Earthing can clinically reduce ESR - erythrocyte sedimentation rate54:35: Speed up wound healing time by Earthing56:00: Why I don't wear or recommend sunscreen 58:11: Community and friendships59:41: Social connection is the number one greatest predictor of your long-term happiness1:01:09: Shawn Achor: The happy secret to better work

If you are considering BHRT, this is for you. Even if you're currently on BHRT, you'll learn or confirm something here. If you've got daughters or DIL, in my case, there's something here for you on that front too. If you've wondered why does cholesterol go up for so many women or why do autoimmune numbers increase in midlife? There's a reason to be considering BHRT, and our guest explains why.    My Guest: Dr. Shilpa Sayana, MD is a Triple Board Certified in Internal, Obesity Medicine and Functional Medicine. She is recognized by her peers by receiving the “Most Humanistic Intern and Resident” award in all three years of her Internal Medicine Residency and celebrated by her patients by being presented the Best Doctors Women's Choice Award. She treats women in perimenopause and menopause, optimising their hormones, energy and weight, especially if they have been previously told that their labs are normal.   Questions We Answer in This Episode: [00:07:54] What are natural ways to improve your hormones above 45? [00:14:27] What tests do you recommend to a woman considering hormones? [00:22:30] Do you have a unique opinion on starting both progesterone and estrogen at the same time or layer in one?  [00:26:06] Do you advocate for women taking testosterone and what are the benefits and side effects of using TRT? [00:30:21] Why do autoimmune markers increase in perimenopause and menopause? and what to do about it? [00:32:04] What can help cholesterol and blood sugar levels?  #1 Longevity Hormone Panel  Purpose: To get a baseline of all key hormone levels Includes: Morning cortisol (before 10am) DHEAS (hormone that makes cortisol) TSH (thyroid) Free T4  Autoimmune Reverse  T4 (Hashimoto's) Reverse T3  Estrogen, Progesteron, Testosterone Total Testosterone Free Testosterone Sex Binding Hormone Globulin  ANA (antinuclear antibody or autoimmune antibody) ESR (erythrocyte sedimentation rate to check inflammation rate for autoimmune) CRP (C-reactive protein) Ferritin  Genetics Vitamin B12  Vitamin D   More Tests to Truly Know If You're Ready Before Considering BHRT   #2 Gut Test Purpose: To assess inflammation, microbiome health, and how well your body can process and eliminate hormones   #3 Toxin/Environmental Load Testing Purpose: To detect environmental toxins that may be disrupting hormone production or metabolism   Track Your Hormones Functional vs. Conventional medicine's approach to lab results: Functional Medicine Focuses on what's optimal, not just normal. Listens to the whole person (hormone networks), not just the labs. Conventional Medicine Labs are often labeled "normal" if they fall within the wide reference range. No action is taken unless results are severely out of range.   Connect with Shilpa: Website - Sayana Medical  Instagram - @sayanamedical YouTube - @SayanaMedical Other Episodes You Might Like: Previous Episode - Smart Movement for Aging Better with Lara Heimann Next Episode - Can We Just Stop the Self Sabotage to Feel Your Best Ever More Like This - Restore Hormones to Factory Settings? More Science for bHRT More Like This - How to Have and Still Thrive with Autoimmunity in Menopause Resources: Don't know where to start? Book your Discovery Call with Debra. Join the Flipping50 Insiders Facebook Group and connect with Debra and the community.  

Dr. Lauren Kim speaks with Dr. Andrea Rockall, Clinical Chair of Radiology at Imperial College London, about the growing movement toward sustainable practices in radiology. They explore global collaboration, innovative technologies, and the power of data in reducing the environmental impact of medical imaging. Sustainability in Radiology: Position Paper and Call to Actionfrom ACR, AOSR, ASR, CAR, CIR, ESR, ESRNM, ISR, IS3R,RANZCR, and RSNA. Rockall et al. Radiology 2025; 314(3):e250325. RSNA's online resources for environmental sustainability in imaging

Fulham demonstrates yet again that this Silva side is anything but predictable. A dire, shot-starved first-half was turned around by dynamic substitutions and a stoppage time header from Ryan Sess. ESR makes his return to the scoresheet with a deflected shot that tucked its way nicely behind Ramsdale.Elizabeth Barnard takes the reins for a joyous pod line-up of Dan Cooke, Yasmin Mills and Adam Farquharson as they look back on a sunny day on the south coast. They review the successes and failures of a surprising attacking formation from Marco Silva, comment on the hopes of heightened confidence in ESR and sing Sess' praises yet again. In part two, they answer some of your listener questions. Why can't Fulham keep clean sheets and can Palace ruin Fulham's Conference League dreams?--SHOW-LINKS:If you enjoy Fulhamish, please consider contributing a small amount monthly to help pay our costs. As a bonus, you receive access to our exclusive Telegram group chats where you can chat with fellow FFC fans and Fulhamish listeners ➼ https://levellr.com/communities/fulhamish--GUESTS:Elizabeth Barnard ➼ https://www.x.com/@ESBarnard_Yasmin Mills ➼ https://www.x.com/@yasmin_lmillsDan Cooke ➼ https://www.x.com/@DanSCooke97Adam Farquharson ➼ https://www.x.com/@AdamFarquharsonSee Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

Şeyh Galip, şiirlerinin Mevlana'nın Mesnevi'sinden çalıntı olduğuyla itham edildiğinde, o meşhur “Esrârını Mesnevî'den aldım / Çaldımsa da mîrî malı çaldım” beytini yazmıştı. Şair intihali itiraf etmekle birlikte çaldığının mîrî malı, yani, herkese ait, herkesin faydalanmasına açık bir eser olduğunu söylemek istemişti. Ne var ki, “mîrî” kelimesi aynı zamanda beytülmâl, yani devlet hazinesi anlamına da geliyordu ve büyük bir talihsizlikle Şeyh Galip'in bu güzel dizeleri 2 asır boyunca hırsızlığın bahanesi olarak kullanıldı. “Devlet malı deniz”, “su akarken küpünü dolduracaksın” ya da “çalıyor ama çalışıyor” gibi devletten çalmayı meşrulaştıran münasebetsiz ifadelerin yanına bir de Şeyh Galip'in bu dizesi eklendi.

Optic neuropathies encompass all congenital or acquired conditions affecting the optic nerve and are often a harbinger of systemic and central nervous system disorders. A systematic approach to identifying the clinical manifestations of specific optic neuropathies is imperative for directing diagnostic assessments, formulating tailored treatment regimens, and identifying broader central nervous system and systemic disorders. In this episode, Gordon Smith, MD, FAAN speaks with Lindsey De Lott, MD, MS, author of the article “Optic Neuropathies” in the Continuum® April 2025 Neuro-ophthalmology issue. Dr. Smith is a Continuum® Audio interviewer and a professor and chair of neurology at Kenneth and Dianne Wright Distinguished Chair in Clinical and Translational Research at Virginia Commonwealth University in Richmond, Virginia. Dr. De Lott is an assistant professor of neurology and ophthalmology at the University of Michigan in Ann Arbor, Michigan. Additional Resources Read the article: Optic Neuropathies Subscribe to Continuum®: shop.lww.com/Continuum Earn CME (available only to AAN members): continpub.com/AudioCME Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Host: @gordonsmithMD Guest: @lindseydelott Full episode transcript available here Dr Jones: This is Dr Lyell Jones, Editor-in-Chief of Continuum. Thank you for listening to Continuum Audio. Be sure to visit the links in the episode notes for information about earning CME, subscribing to the journal, and exclusive access to interviews not featured on the podcast. Dr Smith: Hello, this is Dr Gordon Smith. Today I'm interviewing Dr Lindsey De Lott about her article on optic neuropathies, which appears in the April 2025 Continuum issue on neuro-ophthalmology. Lindsey, welcome to the podcast, and perhaps you can introduce yourself to our audience. Dr De Lott: Thank you, Dr Smith. My name is Lindsey De Lott and I am a neurologist and a neuro-ophthalmologist at the University of Michigan. I also serve as the section lead for the Division of Neuro-Ophthalmology, which is actually part of the ophthalmology department rather than the neurology department. And I spend a good portion of my time as a researcher in health services research, and that's now about 60% of my practice or so. Dr Smith: I'm super excited to spend some time talking with you. One, I'm a Michigan person. As we were chatting before this, I trained with Wayne Cornblath and John Trobe, and it's great to have you. I wonder if we maybe can begin- and by the way, your article is outstanding. It is such a huge topic and it was actually really fun to read, so I encourage our listeners to check it out. But you begin by talking about misdiagnosis as being a common problem in this patient population. I wonder if you can talk through why that is and if you have any pearls or pitfalls in avoiding it? Dr De Lott: Yeah, I think there's been a lot of great research looking at misdiagnosis in specific types of optic neuropathies; in particular, compressive optic neuropathies and optic neuritis. A lot of that work has come out of the group at Emory and the group at Washington University. But a lot of neuro-ophthalmologists across the country really contributed to those data. And one of the statistics that always strikes me is that, you know, for example, in patients with optic nerve sheath meningiomas, something like 70% of them are actually misdiagnosed. And a lot of those errors in diagnosis, whether it's for compressive optic neuropathy or some other type of optic neuropathy, really comes down to the way that physicians are really incorporating elements of the history in the physical. For example, in optic neuritis, we know that physicians tend to anchor pretty heavily on pain in general. And that often tends to lead them astray when optic neuritis was never the diagnosis to begin with. So, it's really overindexing on certain things and not paying attention to other features of the physical exam; for example, say presence of an afferent pupillary defect. So, I think it just really highlights the need to have a really relatively structured approach to patients that you think have an optic neuropathy when you're trying to sort of plan your diagnostic testing and your treatment. Dr Smith: I do maybe five or six weeks on our hospital service each year, and I don't know if it's just a Richmond thing, but there's always at least two people in my week who come in with an optic neuropathy or acute vision loss. How common is this in medical practice? Or neurologic practice, I should say? Dr De Lott: Optic neuropathies themselves… if you look across, unfortunately we don't have any great data that puts together all optic neuropathies and gives us an actual sort of prevalence estimate or an incidence estimate from year to year. We do have some of those data for specific types of optic neuropathies like optic neuritis and NAION, and you're probably looking around five-ish per one hundred thousand. So, these aren't that common, but at the same time they do get funneled to- often to emergency rooms and to neurologists from our ophthalmology colleagues and optometry colleagues in particular. Dr Smith: So, one other question I had before kind of diving into the topic at hand is how facile neurologists need to be in recognizing other causes of acute visual loss. I mean, we see acute visual loss as neurologists, we think optic neuropathy, right? Optic neuritis is sort of the go-to in a younger patient, and NAION in someone older. But what do neurologists need to know about other ophthalmologic causes? So, glaucoma or acute retinal disorders, for instance? Dr De Lott: Yeah, I think it's really important that neurologists are able to distinguish optic neuropathies from other causes of vision loss. And so, I would really encourage the listeners to take a look at the excellent article by Nancy Newman about vision loss in this issue where she really kind of breaks it down into vision loss that is acute and chronic and how you really think through distinguishing optic neuropathies from other causes of vision loss. But it is really important. For example, a patient with a central retinal artery occlusion may potentially be eligible for treatments. And that's very different from a patient with optic neuritis and acute vision loss. So, we want to be able to distinguish these things.  Dr Smith: So maybe we can pivot to that a little bit. Just for our listeners, our focus today is going to be on- not so much on optic neuritis, although obviously we need to talk a little bit about how we differentiate optic neuritis from non-neuritis optic neuropathies. It seems like the two most common situations we encounter are ischemic optic neuropathies and optic neuritis. Maybe you can talk a little bit about how you distinguish these two? I mean, some of it's age, some of it's risk factors, some of it's exam. What's the framework, of let's say, a fifty-year-old person comes into the emergency room with acute vision loss and you're worried about an optic neuropathy? Dr De Lott: The first step whenever you are considering an optic neuropathy is just making sure that the features are present. I think, really going back to your earlier question, making sure that the patient has the features of an optic neuropathy that we expect. So, it's not only vision loss, but it's also the presence of an apparent pupillary defect in a patient with a unilateral optic neuropathy. In a person who has a bilateral optic neuropathy, that apparent pupillary defect may not be present because it is relative. So, you really would have to have asymmetric vision loss between the two eyes. They should also have impairment of their color vision, and they're probably going to have some kind of visual field defect, whether that's central scotoma or an arcuate scotoma or an altitudinal defect that really respects the horizontal meridian. So, you want to make sure that, first and foremost, you've got a patient that really meets most of those- most of those features. And then from there, we're looking at the other features on their history. How acute is the onset of the vision loss? What is the progression over time? Is there pain associated or not associated with the vision loss? What other medical issues does the patient have? And you know, one of the things you already brought up, for example, is, what's the age of the patient? So, I'm going to be much more hesitant to make a diagnosis of optic neuritis in a much older patient or a diagnosis on the other side, of ischemic optic neuropathy, in a much younger patient, unless they have really clear features that push me in that direction. Dr Smith: I wonder if maybe you could talk a little bit about features that would push you away from optic neuritis, because, I mean, people who are over fifty do get optic neuritis- Dr De Lott: They do. Dr Smith: -and people who get ischemic optic neuropathies who are younger. So, what features would push you away from optic neuritis and towards… let's be broad, just a different type of optic neuropathy? Dr De Lott: Sure. We know that most patients with optic neuritis do have pain, but that pain is accompanied---within a few days, typically---with vision loss. So, pain alone going on for a number of days without any visual symptoms or any of those other things I listed, like the afferent papillary defect, the visual field defect, would push me away from optic neuritis. But in general, yes, most optic neuritis is indeed painful. So, the presence of optic disc edema is unfortunately one of those things that an optic neuritis may be present, may not be present, but in somebody with ischemia that is anterior---and that's the most common type of ischemic optic neuropathy, would be anterior ischemic optic neuropathy---they have to have optic disc edema for us to be able to make that diagnosis, and that is a diagnosis of NAION, or nonarteritic ischemic optic neuropathy. An APD in this case, again, that's just a feature of an optic neuropathy. It doesn't really help you to distinguish, individual field defects are going to be relatively similar between them. So then in patients, I'm also looking, like I said, at their history. So, in a patient where I'm entertaining a diagnosis of ischemic optic neuropathy, I want to make sure that they have vascular risk factors or that I'm actually doing things like measuring their blood pressure in the office if they haven't seen a physician recently or checking a lipid panel, hemoglobin A1c, those kinds of things, to look for vascular risk factors. One of the other features on exam that might push me more- again, in a patient with ischemic optic neuropathy, where it might suggest ischemia over optic neuritis, would be some other features on exam like a crowded optic disc that we sometimes will see in patients with ischemic optic neuropathy. I feel like that was a bit of a convoluted answer. Dr Smith: I thought that was a great answer. And when you say crowded optic disc, that's the- is that the “disc at risk”? Dr De Lott: That is the “disk at risk,” yes. So, crowded optic disk is really a disk that is smaller than what we see in the average population, and the average cup to disk ratio is 0.3. So, I think that's where 30% of the disk should be. So, this extra wiggle room, as I sometimes will explain to my patients. Dr Smith: And then, I wonder if you could talk a little bit about more- just more about exam, right? You raised the importance of recognizing optic disc edema. Are there aspects of that disc edema that really steer you away from optic neuritis and towards ischemia-like hemorrhages or whatnot? And then a similar question about the importance of careful visual field testing? Dr De Lott: So, on the whole, optic disc edema is optic disc edema. And you can have very severe optic neuritis with hemorrhages, cotton wool spots, which is essentially just an infarction of the retinal nerve fiber layer either overlying the disc or other parts of the retina. And ischemia, you can have some of the same features. In patients who have giant cell arteritis, which is just one form of anterior ischemic optic neuropathy, patients can have a pallid optic disc edema where the optic disc is swollen and white-looking. But on the whole, swelling is swelling. So, I would caution anyone against using the features of the optic nerve swelling to make any type of, sort of, definitive kind of diagnosis. It's worth keeping in mind, but I just- I would caution against using specific features, optic nerve swelling. And then for visual field testing, there are certain patterns that sometimes can be helpful. I think as I mentioned earlier, in patients with ischemic optic neuropathy, we'll often see an altitudinal defect where either the top half or, more commonly, the bottom half of the vision is lost. And that vision loss in the field corresponds to the area of swelling on the disk, which is really rewarding when you're actually able to see sectoral swelling of the disk. So, say the top half of the disk is swollen and you see a really dense inferior defect. And other types of optic neuropathy such as hereditary optic neuropathies, toxic and nutritional optic neuropathies, they often cause more central field loss. And in patients who have optic neuropathies from elevated intracranial pressure, so papilladema, those folks often have more subtle visual field loss in an arcuate pattern. And it's only once the optic nerves have sustained a pretty significant injury that you start to see other patterns of field loss and actual decline in visual acuity in those patients. I do think a detailed visual field assessment can often be pretty helpful as an adjunct to the rest of the exam. Dr Smith: So, we haven't talked a lot about neuroimaging, and obviously, neuroimaging is really important in patients who have optic neuritis. But how about an older patient in whom you suspect ischemic optic neuropathy? Do those patients all need a MRI scan? And if so, is it orbits and brain? How do you- how do you protocol it? Dr De Lott: You're asking such a good question, totally controversial in in some ways. And so, in patients with ischemic optic neuropathy, if you are confident in your diagnosis: the patient is over the age of fifty, they have all the vascular, you know, they have vascular risk factors. And those vascular risk factors are things like diabetes, hypertension, high blood pressure, hyperlipidemia, obstructive sleep apnea. They have a “disc at risk” in the fellow eye. They don't have pain, they don't have a cancer history. Then doing an MRI of the orbits is probably not necessary to rule out another cause. But if you aren't confident that you have all of those features, then you should absolutely do an MRI of the orbit. The MRI of the brain probably doesn't provide you with much additional information. However, if you are trying to distinguish between an ischemic optic neuropathy and, say, maybe an optic neuritis, in those patients we do recommend MRI orbits and brain imaging because the brain does provide additional information about other CNS demyelinating disorders that might be actually the cause of a patient's optic neuritis. Dr Smith: I wonder if you could talk a little bit about posterior ischemic optic neuropathy. That's much less common, and you mentioned earlier that those patients don't have optic disk edema. So, if there's a patient who has vision loss that- in a similar sort of clinical scenario that you talked about, how do you approach that and under what circumstances do we see patients who have posterior ischemic optic neuropathy? Dr De Lott: So, you're going to most often see patients with posterior ischemic optic neuropathy who, for example, have undergone a recent surgery. These are often associated with things like spinal surgeries, cardiac surgeries. And there are a number of risk factors that are associated with it. Things like blood pressure, drain surgery, the amount of blood loss, positioning of patient. And this is something that the surgeons and anesthesiologists are very sensitive to at this point in time, and many patients are often- this can be part of the normal informed consent process at this point in time since this is something that is well-recognized for specific surgeries. In those patients, though… again, unless you're really certain, for example, maybe the inpatient neurology attending and you've been asked to consult on a patient and it's very clear that they went into surgery normal, they came out of surgery with vision loss, and all the rest of the features really seem to be present. I would recommend that in those cases you think about orbital imaging, making sure you're not missing anything else. Again, unless all of the features really are present- and I think that's one of the themes, definitely, throughout this article, is really the importance of neuroimaging in helping us to distinguish between different types of optic neuropathy. Dr Smith: Yeah, I think one of the things that Eric Eggenberger talks about in his article is the need to use precise nomenclature too, which I plan on talking to him about. But I think having this very structured approach- and your article does it very well, I'll tell our listeners who haven't seen it there's a series of really great tables in the article that outline a lot of these. I wonder, Lindsey, if we can switch to talk about arteritic optic neuropathy. Is that okay? Dr De Lott: Sure. Yeah, absolutely. Dr Smith: How do you sort that out in an older patient who comes in with an ischemic optic neuropathy? Dr De Lott: Yeah. In patients who are over the age of fifty with an ischemic optic neuropathy, we always need to be thinking about giant cell arteritis. It is really a diagnosis we cannot afford to miss. If we do miss it, unfortunately, patients are likely to lose vision in their fellow eye about 1/3 to 1/2 the time. So, it is really one of those emergencies in neuro-ophthalmology and neurology. And so you want to do a thorough review systems for giant cell arteritis symptoms, things like headache, jaw claudication, myalgias, unintentional weight loss, fevers, things of that nature. You also want to check their inflammatory markers to look for evidence of an elevated ESR, elevated C-reactive protein. And then on exam, what you're going to find is that it can cause an anterior ischemic optic neuropathy, as I mentioned earlier. It can cause palette optic disc swelling. But giant cell arteritis can also cause posterior ischemic optic neuropathy. And so, it can be present without any swelling of the optic disc. And in fact, you know, you mentioned one of my mentors, John Trobe, who used to say that in a patient where you're entertaining the idea of posterior ischemic optic neuropathy, who is over the age of fifty with no optic disc swelling, you should be thinking about number one, giant cell arteritis; number two, giant cell arteritis; number three, giant cell arteritis. And so, I think that is a real take-home point is making sure that you're thinking of this diagnosis often in our patients who are over the age of fifty, have to rule it out. Dr Smith: I'll ask maybe a simple question. And presumably just about everyone who you see with a presumed ischemic optic neuropathy, even if they don't have clinical features, you at least check a sed rate. Is that true? Dr De Lott: I do. So, I do routinely check sedimentation rate and C-reactive protein. So, you need to check both. And the reason is that there are some patients who have a positive C-reactive protein but a normal sedimentation rate, so. And vice versa, although that is less common. And so both need to be checked. One other lab that sometimes can be helpful is looking at their CBC. You'll often find these patients with giant cell arteritis have elevated platelet counts. And if you can trend them over time, if you happen to have a patient that's had multiple, you'll see it sort of increasing over time. Dr Smith: I'm just thinking about how you sort things out in the middle, right? I mean, so that not all patients with GCF, sky-high sed rate and CRP…. And I'm just thinking of Dr Trobe's wisdom. So, when you're in an uncertain situation, presumably you go ahead and treat with steroids and move to biopsy. Maybe you can talk a bit about that pathway? Dr De Lott: Yeah, sure. Dr Smith: What's the definitive diagnostic process? Do you- for instance, the sed rate is sky-high, do you still get a biopsy? Dr De Lott: Yes. So, biopsy is still our gold-standard diagnosis here in the United States. I will say that is not the case in all parts of the world. In fact, many parts of Europe are moving toward using other ancillary tests in combination with labs and exam, the history, to make a definitive diagnosis of giant cell arteritis. And those tests are things like temporal artery ultrasound. We also, even though we call it temporal artery ultrasound, we actually need to image not only the temporal arteries but also the axillary arteries. The sensitivity and specificity is actually greater in those cases. And then there's high-resolution imaging of the vessels and the- both the intracranial and extracranial distributions. And both of those have shown some promise in their predictive values of patients actually having giant cell arteritis. One caution I would give to our listeners, though, is that, you know, currently in the US, temporal artery biopsy is still the gold standard. And reading the ultrasounds and the MRIs takes a really experienced radiologist. So, unless you really know the diagnostic accuracy at your institution, again, temporal artery biopsy remains the gold standard here. So, when you are considering giant cell arteritis, start the patient on steroids and- that's high dose, high dose steroids. In patients with vision loss, we use high dose intravenous methylprednisolone and then go ahead and get the biopsy. Dr Smith: Super helpful. And are there other treatments, other than steroids? Maybe how long do you keep people on steroids? And let's say you've got a patient who's, you know, diabetic or has other factors that make you want to avoid the course of steroids. Are there other options available? Dr De Lott: So, in the acute phase steroids are the only option. There is no other option. However, long term, yes, we do pretty quickly put patients on tocilizumab, which is really our first-line treatment. And I do that in conjunction with our rheumatology colleagues, who are incredibly helpful in managing and monitoring the tocilizumab for our patients. But when you're seeing the patients, you know, whether it's in the emergency room or in the hospital, those patients need steroids immediately. There are other steroid-sparing agents that have been tried, but the efficacy is not as good as tocilizumab. So, the American College of Rheumatology is really recommending tocilizumab as our first line steroid-sparing agent at this point. Dr Smith: Outstanding. So again, I will refer our listeners to your article. It's just chock-full of great stuff. This has been a great conversation. Thank you so much for joining me today. Dr De Lott: Thank you, Dr Smith. I really appreciate it.  Dr Smith: The pleasure has been all mine, and I know our listeners will be enjoying this as well. Again, today I've been interviewing Dr Lindsey De Lott about her article on optic neuropathies, which appears in the most recent issue of Continuum on neuro-ophthalmology. Be sure to check out Continuum Audio episodes from this and other issues. I already mentioned Dr Eggenberger and I will be talking about optic neuritis, which will be a great companion to this discussion. Listeners, thank you for joining us today. Dr Monteith: This is Dr Teshamae Monteith, Associate Editor of Continuum Audio. If you've enjoyed this episode, you'll love the journal, which is full of in-depth and clinically relevant information important for neurology practitioners. Use the link in the episode notes to learn more and subscribe. AAN members, you can get CME for listening to this interview by completing the evaluation at continpub.com/audioCME. Thank you for listening to Continuum Audio.

Giant Cell Arteritis (GCA) is one of the most dreaded diagnoses in ophthalmology; not only can it cause vision loss, but it can also be life threatening.  So what is the threshold for going down the 'GCA diagnostic path'? When should one order an ESR and CRP?  When is the concern high enough to warrant a temporal artery biopsy, and when should steroids be started?  How is temporal artery biopsy changing our diagnostic alogirthm.  Dr. Andrew Lee joins the podcast. This episode of the podcast is sponsored by Thea Pharma Canada - https://www.theapharma.caBecome a supporter of this podcast: https://www.spreaker.com/podcast/blind-spot-the-eye-doctor-s-podcast--5819306/support.

"With a quarter million miles under her belt and counting, North Carolina native Emily Scott Robinson travels the dusty highways of America's wild country, capturing the stories of the people she meets and expertly crafting them into songs. Robinson received critical acclaim for her debut album Traveling Mercies-- Rolling Stone named it one of the “40 Best Country and Americana Albums of 2019.” In 2021, Robinson signed with Oh Boy Records, the label founded by the legendary John Prine, and released her follow-up album "American Siren." It made numerous “Best of 2021” lists including NPR, Rolling Stone, American Songwriter, and No Depression." (emilyscottrobinson.com) I've been wanting to have ESR on the show for a while, and when I learned she was playing a show with a couple of my friends at the end of 2024, I made them ask her for me! She said yes, and here we are. Robinson currently resides in Ouray, CO, and tours the US and UK consistently. Recently, she supported Ron Pope for a run in the UK. During our conversation, we chat about traveling logistics out of a small town (tisk tisk Southwest!!), her life changing experience at Song School at Rocky Mountain Folks Fest in Lyons, CO, and her decision to buy an RV and travel as a full time musician in her 20s. If you enjoy the podcast, please let others know, subscribe, or write a review! IF YOU'D LIKE TO SUPPORT THE PODCAST IN A MONETARY WAY, I'M NOW ON PATREON! Please note: new Patreon members get to pick a cover song for me to record especially for them! www.patreon.com/andysydow Guest Links: https://www.emilyscottrobinson.com Episode Music: Original music by Andy Sydow Contact me: middleclassrockstar@gmail.com (or) andysydowmusic@gmail.com

Join Michelle Martin on her tour of markets! Asia-Pacific markets trade higher following Wall Street's rally overnight. Hosted by Michelle Martin who speaks with Ryan Huang, this episode unpacks DFI Retail’s $125M supermarket exit to Macrovalue, BYD’s EV surge past Tesla, and Xiaomi’s $5.5B fundraise. They also explore CK Hutchison’s strategic moves, 23andMe’s bankruptcy, and the latest from REITs like Keppel DC and ESR. Plus, a check-in on the STI, Disney’s controversial Snow White remake, and more market movers.See omnystudio.com/listener for privacy information.

Nicole Rincon https://www.nicolerincon.comNicole's X https://x.com/NicoleRinconPARossignol Clinic https://rossignolmedicalcenter.comTACA Info: https://tacanow.org/wp-content/uploads/2019/10/F-H-2-Nicole-Rincon-Beginning-Biomed.pdfTACA Talks: https://www.nicolerincon.com/videosPublications https://rossignolmedicalcenter.com/articles-publications/#published-2024-2-articlesNicole Episode 1 https://www.youtube.com/watch?v=BBkdgwVfcZINicole Episode 2 https://www.youtube.com/watch?v=auLReV0DHkQDaylight Computer Company https://daylightcomputer.comuse "autism" in the discount code for $25 coupon.This is the future of tech.Chroma Light Therapy https://getchroma.couse "autism" for a 10% discount,***THIS IS NOT MEDICAL ADVICE***0:00 Nicole Rincon1:10 Daylight Computer Company; DC-15:33 Pre-pregnancy checks; Vitamin D8:37 MTHFR, Folate; Mitochondria; CPR, ESR, Inflammation11:12 GI; CSA; Bacteria, Fungus, Parasites, Calprotectin; Zonalin; MS & Proteus Mirabilis13:06 Organic Acid Test (OAT); Clostridia15:24 MTHFR; C677, 1298; Folinic Acid19:02 Folate's role in pregnancy and development; Critical info about types and duration22:35 Cholesterol; Maternal & Child; Speech & Communication25:06 Telepathy; Autism Rates26:40 Dysbiosis; PCOS29:30 Cholesterol ranges & symptoms; mood, irritability, cognition, aggression; Cortisol & Hormones37:02 Dysbiosis symptoms; Self-Injurious, Posturing41:08 Identifying symptoms in Non-Verbal; Self-Injurious45:08 Importance of Gut Health & Checks; Vitamin D, Electrical Efficiency & Biological Energy48:17 Autistics and pale skin; too many are pale; supplementing Vitamin D, K2; Brands51:00 Proprietary blends warning; abbreviated doses; Fungal overgrowth, Yeast55:49 "Binders;" Magnesium61:00 Fungal Overgrowth & Autism; OAT, Clostridia, C. diff, aggression, self-injurious; Antibiotics & Probiotics1:05:42 Telepathy Tapes, Autism, Water (Cytochrome C Oxidase), Coherence; Luc Montagier NOT Emilio Del Giudice; Distal Connections via Water and NOT axons; OutroX: https://x.com/rps47586Hopp: https://www.hopp.bio/fromthespectrumYT: https://www.youtube.com/channel/UCGxEzLKXkjppo3nqmpXpzuAemail: info.fromthespectrum@gmail.com

Une sélection des actualités du jour qui ont un impact direct ou indirect sur vos finances personnelles. Avec : Étienne Bracq, journaliste BFM Business, Laurent Grassin, directeur médias chez Boursorama Banque, et François-Xavier Soeur, gestionnaire de patrimoine chez Terrae Patrimoine.

George Cooper is joined by Dan, AF and Avais as they indulge in a brilliant win against Nottingham Forest who have had a remarkable season so far in the Premier League. These three points have shown that Fulham's season is far from petering out. With goals from Emile Smith Rowe and Calvin Bassey, Fulham are on track to return to peak Vibes FC form. They reflect on how Fulham set-up to fell a flying Forest side, ESR's second PL headed goal and how his performances continue to improve, and the cheery atmosphere in the dressing room that saw Fulham win the Snapchat Derby. In part two, they answer your listener questions. Should Lukic be Fulham's player of the season? Is this the best Fulham squad we've ever seen? And simply, how are Fulham so good? --SHOW-LINKS:If you enjoy Fulhamish, please consider contributing a small amount monthly to help pay our costs. As a bonus, you receive access to our exclusive Telegram group chats where you can chat with fellow FFC fans and Fulhamish listeners ➼ https://levellr.com/communities/fulhamish--GUESTS:George Cooper ➼ https://www.x.com/@GeorgeCoopsDan Cooke ➼ https://www.x.com/@DanSCooke97Avais Malik ➼ https://www.x.com/@Here4TheFulhamAdam Farquharson ➼ https://www.x.com/@AdamFarquharsonSee Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

Precio: https://amzn.to/3EpW4pm El protector de pantalla magnético ESR con sensación de papel para el iPad Pro de 13 pulgadas (M4) está diseñado para ofrecer una experiencia de escritura y dibujo similar a la del papel. Su superficie especialmente tratada proporciona una textura que simula el papel, mejorando la precisión y el control al usar el Apple Pencil. Los bordes magnéticos permiten una fácil colocación y remoción, facilitando su uso cuando se necesita y su almacenamiento cuando no. Además, incluye un sobre protector para transportarlo de manera segura

ETHAN STOWELL We're diving into the story of Ethan Stowell—a name that's become synonymous with the culinary world in Seattle. He comes from a family of artists, specifically ballet dancers. He's not just a chef; he's an innovator who's left an indelible mark on his community. Ethan started with a vision back in 2003 when he opened Union, his first restaurant in downtown Seattle, praised for its simplicity and its elegance right out of the gate. From there, Ethan Stowell Restaurants, or ESR, grew into something truly remarkable. We're talking about Tavolàta, with its pasta-inspired focus, and How to Cook a Wolf, which brings this delicate, almost artful approach to dining, among others. Oh, and there's Ballard Pizza Company—it's like, the perfect neighborhood pizza spot. He makes high-quality food feel accessible and welcoming. What's even more impressive is how ESR has expanded, now covering over a dozen concepts and over twenty locations, including in Idaho and New York City—and it doesn't stop there. Ethan's team has partnered with iconic brands like the Seattle Mariners. And even with all that growth, there's this real effort to stay anchored in the community. Back in 2008, he was named one of *Food Wine*'s Best New Chefs, and in 2020, he was a semifinalist for a James Beard Award in the Outstanding Restaurateur category. Those aren't just titles—they're windows into the kind of impact he's had, both regionally and nationally. It's stories like Ethan's that remind us how passion, vision, and a commitment to community can truly shape industries and, honestly, create experiences people cherish. ETHAN RELATED LINKS Ethan Stowell Restaurants Wikipedia  Holland America Partnership Seattle City Makers (Video via Downtown Seattle Association) GENERAL INFO| TOP OF THE GAME: Official website: https://topofthegame-thepod.com/ RSS Feed: https://feed.podbean.com/topofthegame-thepod/feed.xml Hosting service show website: https://topofthegame-thepod.podbean.com/ Javier's LinkTree: https://linktr.ee/javiersaade  SUPPORT & CONNECT: LinkedIn: https://www.linkedin.com/showcase/96934564 Facebook: https://www.facebook.com/profile.php?id=61551086203755 Twitter: https://twitter.com/TOPOFGAMEpod Subscribe on Podbean: https://www.podbean.com/site/podcatcher/index/blog/vLKLE1SKjf6G Email us: info@topofthegame-thepod.com   THANK YOU FOR LISTENING – AVAILABLE ON ALL MAJOR PLATFORMS  

Two second-half goals from Emile Smith Rowe and Adama Traore sealed Fulham's three points against Leicester who have had seven losses out of eight, a pretty dismal showing. A toxic atmosphere at the King Power suggested that Van Nistelrooy's lifetime with the Foxes might be short. Leicester's poor performance does not take away from the comfortable, stylish display from Marco Silva's Fulham side. Sander Berge returned to the starting line-up as George, with Avais, George Rossiter and Yasmin, reflect on what was a stellar performance from him in the midfield. A calm and assured presence consistently broke up any essence of Leicester threat and helped Fulham fans' shoulders relax a little more. We react to ESR's redeeming diving header that put Fulham in front just after half-time which will hopefully boost his confidence going forward to an exciting Manchester United fixture. Rossiter and Avais tell the tales of what was an eventful away day, including a Network Rail heist and a masterclass in drumming. We answer some of your listener questions in part two, having some theoretical fun with our striker position.

In this episode, we present the second part of our conversation with the authors of the scouting reports for the teams in the T'd Up T-cells region of RheumMadness 2025: the Innovation Invitational.  Plus, we highlight Q&As from theMednet.org about the T'd Up T-Cells teams AND record an interview with Dr. Bill St. Clair, the first author of the phase 2 dazodalibep study.  It's a long episode because there's so much content!Links to the Q&As from theMednet.org discussed in this episode:What is your approach to managing sicca symptoms in patients not responding or not tolerating conservative measures, pilocarpine, and cevimeline?What is your approach to immunomodulatory treatment in patients with Sjogren's syndrome who have active serologies (i.e. elevated ESR, hypergammaglobulinemia, hypocomplementemia) but minimal symptoms?What is your approach to monitoring patients referred for high titer +RF and +CCP but without active symptoms of inflammatory arthritis?What factors drive you to prioritize T vs B cell inhibition when choosing therapies for patients with refractory SLE?To learn more about RheumMadness:https://sites.duke.edu/rheummadness/Subscribe to our newsletter:https://lists.duke.edu/sympa/subscribe/rheummadnessFind us on social media:Bluesky: @rheummadness.bsky.socialInstagram: https://www.instagram.com/rheummadness/X: Follow #RheumMadnessIntro/outro music: Cheery Monday by Kevin MacLeodLink: https://incompetech.filmmusic.io/song/3495-cheery-mondayLicense: http://creativecommons.org/licenses/by/4.0/

Klimat- och miljöministern om att Sveriges utsläpp ökar snabbare än beräknat, samtidigt som kolinlagringen i skog och mark minskar kraftigt. Och om slopat förbud mot uranbrytning i Sverige. Lyssna på alla avsnitt i Sveriges Radio Play. I år väntas svenska klimatutsläpp öka kraftigt. Under det första halvåret ökade utsläppen från svensk ekonomi med sex procent enligt SCB:s statistik från det första och andra kvartalet. Enligt Eurostat är Sverige det EU-land där utsläppen ökade mest under det andra kvartalet. Under det första kvartalet har Malta och Litauen större utsläppsökning.Att utsläppen skulle öka i år var väntat eftersom regeringen kraftigt sänkte reduktionsplikten i januari, men nu visar statistik över bränsleleveranser under årets tre första kvartal att ökningen blir ännu större än regeringen beräknat. ”Det vi märker här är att det diffar lite. Vår bedömning var att det skulle öka förra året men det minskade. Och nu märker vi att det ökar mer än vi hade bedömt. Och skälen är att den höga inflationen är dämpad, svenska hushåll har mer pengar i plånböckerna, och att reduktionsplikten har sänkts temporärt.”, säger Romina Pourmokhtari (L).Klimatministern säger att även om Sveriges utsläpp skulle öka något mer än beräknat i år så kommer Sverige klara EU-målet för utsläpp från inrikes transporter, ESR-målet, eftersom det finns marginaler i regeringens prognoser. Den slutliga klimatstatistiken från Naturvårdsverket publiceras först i slutet av nästa år. I veckan publicerades 2023 års statistik som visar att utsläppen då minskade med knappt två procent. Förväntningarna var att utsläppen skulle öka något i fjol, men den ekonomiska lågkonjunkturen drog ner utsläppen, framför allt från industrin.Kraftigt minskad kolsänkaVäxande skog fungerar som en kolsänka som lagrar koldioxid som motverkar klimatförändringar. Enligt EU:s LULUCF-förordning behöver inlagringen av kol i svensk skog och mark öka med fyra miljoner ton till 2030 för att vi ska klara det klimatmålet. Men just nu går utvecklingen snabbt i motsatt riktning, mellan 2022 och 2023 minskade kolinlagringen i svensk skog och mark med hela sju procent.”Det är väldigt allvarligt. Vi har ju gjort upp en plan under många år i EU. Där utgår man ju från en viss nivå av tillväxt i skogen, en viss nivå av lagring i marken, och nu upptäcker vi att planeten och skogarna inte lagrar så mycket som vi bedömde.”, säger Romina Pourmokhtari (L).Slopat uranförbudI februari tillsatte regeringen en snabbutredning om att tillåta uranbrytning i Sverige. Nu är utredningen klar och regeringen går vidare med förslaget att ta bort det förbud mot uranbrytning som den förra regeringen införde 2018.Men klimat- och miljöministern kan inte ge besked om ifall det kommunala vetot ska vara kvar eller ej, hon säger att regeringen nu tittar på flera olika lagändringar och att det exempelvis är oklart hur man ska klassa uran som utvinns som biprodukt i gruvor där huvudsakligen andra metaller och mineraler utvinns.”Om man nu hittar uran när man har annan gruvnäring, då måste man idag hantera det som avfall och de är ju ett enormt resursslöseri, att om vi har gruvor i Sverige som bryter uran, då måste de hantera de som avfall och jag tycker inte att vi ska gör avfall av resurser som vi kan använda och det är därför också vi plockar bort den här lagen”, säger Romina Pourmokhtari.Gäst: Romina Pourmokhtari (L), klimat- och miljöminister Programledare: Katarina von ArndtKommentar: Daniel VärjöTekniker: Susanne MartinssonProducent: Maja LagercrantzIntervjun spelades in torsdagen den 19 december.

+ Evangelio de nuestro Señor Jesucristo según san Mateo 1, 1-17 Genealogía de Jesucristo, hijo de David, hijo de Abraham: Abraham fue padre de Isaac; Isaac, padre de Jacob; Jacob, padre de Judá y de sus hermanos. Judá fue padre de Fares y de Zará, y la madre de estos fue Tamar. Fares fue padre de Esrón; Esrón, padre de Arám; Arám, padre de Aminadab; Aminadab, padre de Naasón; Naasón, padre de Salmón. Salmón fue padre de Booz, y la madre de este fue Rahab. Booz fue padre de Obed, y la madre de este fue Rut. Obed fue padre de Jesé; Jesé, padre del rey David. David fue padre de Salomón, y la madre de este fue la que había sido mujer de Urías. Salomón fue padre de Roboám; Roboám, padre de Abías; Abías, padre de Asá; Asá, padre de Josafat; Josafat, padre de Jorám; Jorám, padre de Ozías. Ozías fue padre de Joatám; Joatám, padre de Acaz; Acaz, padre de Ezequías; Ezequías, padre de Manasés. Manasés fue padre de Amón; Amón, padre de Josías; Josías, padre de Jeconías y de sus hermanos, durante el destierro en Babilonia. Después del destierro en Babilonia: Jeconías fue padre de Salatiel; Salatiel, padre de Zorobabel; Zorobabel, padre de Abiud; Abiud, padre de Eliacím; Eliacím, padre de Azor. Azor fue padre de Sadoc; Sadoc, padre de Aquím; Aquím, padre de Eliud; Eliud, padre de Eleazar; Eleazar, padre de Matán; Matán, padre de Jacob. Jacob fue padre de José, el esposo de María, de la cual nació Jesús, que es llamado Cristo. El total de las generaciones es, por lo tanto: desde Abraham hasta David, catorce generaciones; desde David hasta el destierro en Babilonia, catorce generaciones; desde el destierro en Babilonia hasta Cristo, catorce generaciones. Palabra del Señor

Mt 1,1-17.Genealogía de Jesucristo, hijo de David, hijo de Abraham:Abraham fue padre de Isaac; Isaac, padre de Jacob; Jacob, padre de Judá y de sus hermanos.Judá fue padre de Fares y de Zará, y la madre de estos fue Tamar. Fares fue padre de Esrón;Esrón, padre de Arám; Arám, padre de Aminadab; Aminadab, padre de Naasón; Naasón, padre de Salmón.Salmón fue padre de Booz, y la madre de este fue Rahab. Booz fue padre de Obed, y la madre de este fue Rut. Obed fue padre de Jesé;Jesé, padre del rey David. David fue padre de Salomón, y la madre de este fue la que había sido mujer de Urías.Salomón fue padre de Roboám; Roboám, padre de Abías; Abías, padre de Asá;Asá, padre de Josafat; Josafat, padre de Jorám; Jorám, padre de Ozías.Ozías fue padre de Joatám; Joatám, padre de Acaz; Acaz, padre de Ezequías;Ezequías, padre de Manasés. Manasés fue padre de Amón; Amón, padre de Josías;Josías, padre de Jeconías y de sus hermanos, durante el destierro en Babilonia.Después del destierro en Babilonia: Jeconías fue padre de Salatiel; Salatiel, padre de Zorobabel;Zorobabel, padre de Abiud; Abiud, padre de Eliacím; Eliacím, padre de Azor.Azor fue padre de Sadoc; Sadoc, padre de Aquím; Aquím, padre de Eliud;Eliud, padre de Eleazar; Eleazar, padre de Matán; Matán, padre de Jacob.Jacob fue padre de José, el esposo de María, de la cual nació Jesús, que es llamado Cristo.El total de las generaciones es, por lo tanto: desde Abraham hasta David, catorce generaciones; desde David hasta el destierro en Babilonia, catorce generaciones; desde el destierro en Babilonia hasta Cristo, catorce generaciones.

Genealogía de Jesucristo, hijo de David, hijo de Abraham:Abraham fue padre de Isaac; Isaac, padre de Jacob; Jacob, padre de Judá y de sus hermanos.Judá fue padre de Fares y de Zará, y la madre de estos fue Tamar. Fares fue padre de Esrón;Esrón, padre de Arám; Arám, padre de Aminadab; Aminadab, padre de Naasón; Naasón, padre de Salmón.Salmón fue padre de Booz, y la madre de este fue Rahab. Booz fue padre de Obed, y la madre de este fue Rut. Obed fue padre de Jesé;Jesé, padre del rey David. David fue padre de Salomón, y la madre de este fue la que había sido mujer de Urías.Salomón fue padre de Roboám; Roboám, padre de Abías; Abías, padre de Asá;Asá, padre de Josafat; Josafat, padre de Jorám; Jorám, padre de Ozías.Ozías fue padre de Joatám; Joatám, padre de Acaz; Acaz, padre de Ezequías;Ezequías, padre de Manasés. Manasés fue padre de Amón; Amón, padre de Josías;Josías, padre de Jeconías y de sus hermanos, durante el destierro en Babilonia.Después del destierro en Babilonia: Jeconías fue padre de Salatiel; Salatiel, padre de Zorobabel;Zorobabel, padre de Abiud; Abiud, padre de Eliacím; Eliacím, padre de Azor.Azor fue padre de Sadoc; Sadoc, padre de Aquím; Aquím, padre de Eliud;Eliud, padre de Eleazar; Eleazar, padre de Matán; Matán, padre de Jacob.Jacob fue padre de José, el esposo de María, de la cual nació Jesús, que es llamado Cristo.El total de las generaciones es, por lo tanto: desde Abraham hasta David, catorce generaciones; desde David hasta el destierro en Babilonia, catorce generaciones; desde el destierro en Babilonia hasta Cristo, catorce generaciones.

Evangelio de hoy, 17 de diciembre de 2024 | Para un nuevo inicio San Mateo 1, 1 – 17 "Genealogía de Jesucristo, hijo de David, hijo de Abraham: Abraham fue padre de Isaac; Isaac, padre de Jacob; Jacob, padre de Judá y de sus hermanos. Judá fue padre de Fares y de Zará, y la madre de estos fue Tamar. Fares fue padre de Esrón; Esrón, padre de Arám; Arám, padre de Aminadab; Aminadab, padre de Naasón; Naasón, padre de Salmón. Salmón fue padre de Booz, y la madre de este fue Rahab. Booz fue padre de Obed, y la madre de este fue Rut. Obed fue padre de Jesé; Jesé, padre del rey David. David fue padre de Salomón, y la madre de este fue la que había sido mujer de Urías. Salomón fue padre de Roboám; Roboám, padre de Abías; Abías, padre de Asá; Asá, padre de Josafat; Josafat, padre de Jorám; Jorám, padre de Ozías. Ozías fue padre de Joatám; Joatám, padre de Acaz; Acaz, padre de Ezequías; Ezequías, padre de Manasés. Manasés fue padre de Amón; Amón, padre de Josías; Josías, padre de Jeconías y de sus hermanos, durante el destierro en Babilonia. Después del destierro en Babilonia: Jeconías fue padre de Salatiel; Salatiel, padre de Zorobabel; Zorobabel, padre de Abiud; Abiud, padre de Eliacím; Eliacím, padre de Azor. Azor fue padre de Sadoc; Sadoc, padre de Aquím; Aquím, padre de Eliud; Eliud, padre de Eleazar; Eleazar, padre de Matán; Matán, padre de Jacob. Jacob fue padre de José, el esposo de María, de la cual nació Jesús, que es llamado Cristo. El total de las generaciones es, por lo tanto: desde Abraham hasta David, catorce generaciones; desde David hasta el destierro en Babilonia, catorce generaciones; desde el destierro en Babilonia hasta Cristo, catorce generaciones." ……………. Spotify: https://open.spotify.com/show/2M0Ubx3Jh55B6W3b20c3GO Apple podcast: https://podcasts.apple.com/us/podcast/evangelio-del-d%C3%ADa/id1590423907 Para más información puede consultar nuestro sitio: https://www.vozcatolica.com o escríbanos a info@vozcatolica.com . Si quiere colaborar con este Apostolado lo puede hacer dirigiéndose a: https://vozcatolica.com/ayudanos . Desde ya muchas gracias

Adquiere el "LIBRO DE ORACIÓN. Mi día a día con Jesús" en https://sercreyente.com/libros. Con más de 400 páginas, más de 500 oraciones y decenas de ilustraciones. Ve el vídeo en https://youtu.be/_9Z40IqjHj8 ________________ Martes, 17 de diciembre de 2024 Evangelio del día y reflexión... ¡Deja que la Palabra del Señor transforme tu vida! [Mateo 1, 1-17] Libro del origen de Jesucristo, hijo de David, hijo de Abrahán. Abrahán engendró a Isaac, Isaac engendró a Jacob, Jacob engendró a Judá y a sus hermanos. Judá engendró, de Tamar, a Fares y a Zará, Fares engendró a Esrón, Esrón engendró a Arán, Arán engendró a Aminadab, Aminadab engendró a Naasón, Naasón engendró a Salmón, Salmón engendró, de Rajab, a Booz; Booz engendró, de Rut, a Obed; Obed engendró a Jesé, Jesé engendró a David, el rey. David, de la mujer de Urías, engendró a Salomón, Salomón engendró a Roboán, Roboán engendró a Abías, Abías engendró a Asaf, Asaf engendró a Josafat, Josafat engendró a Jorán, Jorán engendró a Ozías, Ozías engendró a Joatán, Joatán engendró a Acaz, Acaz engendró a Ezequías, Ezequías engendró a Manasés, Manasés engendró a Amós, Amós engendró a Josías; Josías engendró a Jeconías y a sus hermanos, cuando el destierro de Babilonia. Después del destierro de Babilonia, Jeconías engendró a Salatiel, Salatiel engendró a Zorobabel, Zorobabel engendró a Abiud, Abiud engendró a Eliaquín, Eliaquín engendró a Azor, Azor engendró a Sadoc, Sadoc engendró a Aquín, Aquín engendró a Eliud, Eliud engendró a Eleazar, Eleazar engendró a Matán, Matán engendró a Jacob; y Jacob engendró a José, el esposo de María, de la cual nació Jesús, llamado Cristo. Así, las generaciones desde Abrahán a David fueron en total catorce; desde David hasta la deportación a Babilonia, catorce; y desde la deportación a Babilonia hasta el Cristo, catorce. ________________ Descárgate la app de SerCreyente en https://sercreyente.com/app/ ¿Conoces nuestra Oración Online? Más información en: https://sercreyente.com/oracion ¿Quieres recibir cada día el Evangelio en tu whatsapp? Alta en: www.sercreyente.com/whatsapp También puedes hacer tu donativo en https://sercreyente.com/ayudanos/ Contacto: info@sercreyente.com

A murder investigation was launched into the death of 60-year-old Invercargill woman Karen Gaylene White last month. Police returned to the murder scene this week, examining it with scientists from ESR. Reporter Tess Brunton spoke to Lisa Owen. 

Whooping Cough A national epidemic has just been declared in New Zealand. Reported 260+ cases diagnosed in past four weeks. Whooping cough is potentially a fatal disease especially in younger children and babies less than one year. Three babies died last year in New Zealand from whooping cough when we didn't have an epidemic! What is whooping cough? Caused by a bacteria called pertussis. Damages lining of throat and lungs causing cough. Cough can go on for weeks or months – called ‘100' day cough. Very easy to catch – spreads through the air – cough/sneezing - one person can on average spread to 12 others. What are the signs? Depends on age - Younger the child more at risk of becoming very unwell. Starts with runny nose, temp and sneezing 1-2 weeks Cough develops, very irritating, bouts of coughing with gasping for air between coughs, may last minutes and may vomit after cough. Older children typically whoop as they gasp for breath. Younger infants less than 6 months: go blue with cough spasms, stop breathing, not able to feed, get exhausted – may need hospital. Gradually over weeks, up to 3 months cough gets better. In older adults and children – symptoms less severe. Who is at risk? Partially immunized children. Babies too young for their first immunization at 6 weeks. Children with heart or lung conditions. How is it treated? Antibiotics may reduce the severity if given early and can reduce spread. However, there is no treatment for the cough once it starts. Babies: The cough may make the baby difficult to breath and unable to feed. Sometimes will need to go to hospital for oxygen treatment and feeding through a nasal tube. How do you prevent it and when to see your doctor? Immunization is the only protection. In particular pregnant mums after 16 weeks should be immunized as gives protection to baby in first6 weeks of life. Partially immunized children at risk. See your doctor if your child has difficulty breathing or looks unwell. Call ambulance if child or baby goes blue coughing, stops breathing or seizure. Current outbreak The latest ESR data, which covers the four weeks up to 8 November, showed rates were highest among infants less than a year old, those most vulnerable to severe disease, and with a high proportion requiring hospitalisation. It also identified hotspots in in Wairarapa, Southern, Whanganui and Capital and Coast health districts. Wairarapa had 13 cases, which was by far the highest rate at 25.4 cases per 100,000 people. That was followed by Southern at 11.6 (42 cases), Whanganui at 11.4 (8 cases) and Capital and Coast at 10.4 (34 cases).See omnystudio.com/listener for privacy information.

Mark Fuccio, Wally Cherwinski, and host Chuck Joiner finish off the second part of MacVoices 2024 Holiday Gift Guide with small picks, big picks, iPhone picks, audio picks, and more. (Part 2)  Today's MacVoices is supported by 1Password and their new 1Password Extended Access Management. Security for the way we work today, Learn about the problems it solves at 1Password.com/macvoices. Show Notes: Links: Mark Fuccio's Picks: Victorinox Swiss Army Multi-Tool, Tinker Pocket Knife https://amzn.to/3AWTqG0 The Deep View https://www.thedeepview.co/ Wally Cherwinski's Picks: Yatchen Emily in Paris Phone Case for iPhone 16 Pro Max Cute 3D Vintage Camera Phone Case with Lanyard Adjustable Shoulder Strap https://amzn.to/3V9diMX elago iPhone cases https://amzn.to/4g3T1jU Ringke Hand Strap [Phone Wrist Strap] Designed for Camera Strap and Phone Strap https://amzn.to/4i51GV3 Chuck Joiner's Picks: JBL Flip 6 - Portable Bluetooth Speaker, powerful sound and deep bass, IPX7 waterproof, 12 hours of playtime, JBL PartyBoost for multiple speaker pairing https://amzn.to/413msP4 XANAD Hard Case Compatible with JBL FLIP 6 or FLIP 5 or FLIP 4 or FLIP Essential or Sono Roam 2/1 https://amzn.to/3AVFzzP ESR for MagSafe Car Mount Charger (HaloLock), 15W Magnetic Wireless Car Charger, for MagSafe Car Charger, Air Vent Phone Holder for iPhone https://amzn.to/4g1atWu Guests: Support:      Become a MacVoices Patron on Patreon      http://patreon.com/macvoices      Enjoy this episode? Make a one-time donation with PayPal Connect:      Web:      http://macvoices.com      Twitter:      http://www.twitter.com/chuckjoiner      http://www.twitter.com/macvoices      Mastodon:      https://mastodon.cloud/@chuckjoiner      Facebook:      http://www.facebook.com/chuck.joiner      MacVoices Page on Facebook:      http://www.facebook.com/macvoices/      MacVoices Group on Facebook:      http://www.facebook.com/groups/macvoice      LinkedIn:      https://www.linkedin.com/in/chuckjoiner/      Instagram:      https://www.instagram.com/chuckjoiner/ Subscribe:      Audio in iTunes      Video in iTunes      Subscribe manually via iTunes or any podcatcher:      Audio: http://www.macvoices.com/rss/macvoicesrss      Video: http://www.macvoices.com/rss/macvoicesvideorss

Health authorities have declared a national whooping cough epidemic. Cases have been rising and ESR reports there've been 263 cases in the past four weeks. The disease is infectious and can be particularly dangerous and even deadly for elderly people and newborns especially. Ministry of Health Director of Public Health Dr Nicholas Jones told Heather du Plessis-Allan we're at the beginning of a serious epidemic. “It can go on for about 18 months. The last time we had about 4700 cases reported over that time period, and judging by what we're seeing overseas, we'd be expecting higher numbers in that again.” LISTEN ABOVESee omnystudio.com/listener for privacy information.

Episode 180: Pediatric Hip PainFuture Dr. Pena-Brockett explains the differential diagnosis in a 14-year-old patient who has a new onset of left hip pain. Dr. Arreaza adds comments and explains toxic synovitis.  Written by Natalie Pena-Brockett, MSIV, California Health Sciences University. Comments by Hector Arreaza, MD.You are listening to Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California, a UCLA-affiliated program sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. This podcast was created for educational purposes only. Visit your primary care provider for additional medical advice.Having a limping kid can be terrifying. Many questions may cross your mind: Is this a permanent damage? What is going on here? Where is the pain located? Do I need to send this child to the hospital? Today, hopefully, we can help you ease some of your fears. Case: This is a 14-year-old boy with no past medical history, no trauma, presents to the family medicine clinic with a complaint of left-sided hip pain. Mom notes that her son has been limping for the last week and complaining of pain in his left hip and knee when he walks. He has never experienced this pain before this week. He does not take any medications. Physical exam: He is afebrile and all of his vitals are within normal limits. On exam, you note that his BMI is at the 90th percentile (overweight), and has an antalgic gait where he is favoring the right side and has tenderness on his left groin. His left foot is turned outward while standing up straight. His left knee has negative findings on specialized tests, but he has restricted movement of the left hip. Discussion: This is a common topic that you will see on board exams or limping into your office. Although pediatric hip pain may seem like a benign musculoskeletal concern, taking the time to take a complete history and perform a thorough physical exam is critical to assess the severity of the patient's concern.Physical Exam for Pediatric Hip Pain.Observation: Every physical exam begins the moment you first see the patient. This allows you to gauge the patient's comfort level, the natural stature, length, and positioning of the patient's extremities, skin changes, gait, and ability to bear weight. Palpation: In medicine, our hands are one of our greatest tools for evaluating patients, especially those with musculoskeletal concerns. This is the time to palpate the area for any tenderness or gross deformities of the pelvis, hip, knee, or leg. Special Tests: In the world of MSK, we have all sorts of tests to evaluate the range of movement of our joints and tendons. When specifically evaluating the hip, the most common are the FABER(flexion, abduction, external rotation),test to assess the sacroiliac joint, Ober's Test to assess the iliotibial band, and Straight Leg Raise to assess for lumbar radiculopathy.Legg-Calve Perthes Disease-Legg-Calve Perthes disease is an idiopathic avascular necrosis of the femoral head. -It is most commonly observed in patients between the ages of 2-12 years and in a higher ratio of males to females 1. -It often manifests as an atraumatic limp with limited movement in abduction and internal rotation. -X-ray imaging may demonstrate a widening of the joint space and sclerosis of the femur, and MRI will confirm osteonecrosis of the femoral head. -Early diagnosis is key to minimizing the risk of developing osteoarthritis of the hip. -The goal of treatment is to maintain the shape of the femoral head and the range of motion of the hip. -The first-line treatment includes managing pain with NSAIDs, limiting weight-bearing activity, and physical therapy for range of motion.-If the disease progresses, bracing and casting can be used to retain the femoral head within the acetabulum to keep the shape and integrity of the femoral head. In more serious cases, a surgical osteotomy may be done to cut and realign the bones. Developmental Dysplasia of the Hip (DDH)-Developmental Dysplasia of the Hip (DDH) is a pediatric condition that results in unilateral or bilateral instability of the hip due to the abnormal development of the acetabulum or femur. -This is most commonly seen in newborns, especially those which develop in a breech position. -These patients often present with a shortened leg or asymmetric gluteal creases and a Trendelenburg gait when walking. -The Trendelenburg gait is an abnormal gait caused by weak hip abductor muscles. The person's trunk shifts over the affected hip during the stance phase of walking and away from it during the swing phase, making it look like the person is missing steps or limping. -On physical exam, hip joint laxity can be evaluated with the Ortolani and Barlow maneuvers to apply pressure to the proximal femur to assess dislocatability of the hip joints. These maneuvers would both be considered positive if a “clunk” is felt over the hip as this means that the hip is dislocated with pressure. Due to the patient's age usually being under 6 months old, ultrasound is the most common imaging modality to confirm the diagnosis, otherwise, an X-ray can be used. -The treatment in patients under 18 months old, a Pavlik Harness is often used to treat patients to maintain the placement of the hip within the acetabulum. -Patients between the ages of 18 months and 9 years old, are most often treated with open or closed reduction of the hip. -There is generally less success in reduction treatment of children older than 9 years old as they have likely developed femoral head deformities and are at greater risk of osteonecrosis. -Children with DDH should continue to be monitored with regular imaging to evaluate for complications. These patients should also be made aware that they are also at increased risk of requiring a hip replacement, especially if their treatment included a reduction. 2Slipped Capital Femoral Epiphysis (SCFE)-Slipped Capital Femoral Epiphysis (SCFE) is one of the most common pediatric hip pathologies in which the capital femoral epiphysis is anterolaterally displaced from the femoral neck. -Although slightly more common in males than females between the ages of 10 to 16, the greatest risk factor for an SCFE is childhood obesity 3. -Common symptoms include an insidious onset of unilateral hip pain and a change in gait due to the displacement of the hip from the acetabulum. In some instances of chronic SCFE, some patients will experience ipsilateral knee pain due to compensation. -A SCFE can be evaluated with an AP radiograph which will demonstrate a widened physis in the early stages or the classic “slipped ice cream cone sign” which is the posterior displacement of the femoral epiphysis. -Management of a SCFE includes limiting weight-bearing activities as well as screw fixation by an orthopedic surgeon to stabilize the hip.Patients should consider pinning the contralateral hip due to increased risk of developing a future SCFE. Early diagnosis is critical as untreated SCFE can lead to osteonecrosis.Osgood-Schlatter-Osgood-Schlatter is a repetitive-use pediatric condition as a result of traction to the growth plate of the tibial tubercle. -This pathology is most common in male children between the ages of 9 to 14 years old 4. -Active athletes or children with rapid growth spurts are at greater risk of developing Osgood-Schlatter than non-active children.-These children often present with an achy knee pain that can lead to a unilateral limping gait.  On physical exam, these patients often have a bony prominence over the tubercle that is tender to palpation with greater tenderness over the patellar tendon. -The knee will have full range of motion and stability, but will likely have a warmth and erythema over the knee.  Imaging of the knees can have nonspecific findings and diagnosis is made clinically. -For management, it is recommended that children continue their regular activities and rest with NSAIDs for pain management as needed 5. Physical therapy can be prescribed to prevent deconditioning as this can result in recurrence or additional injuries.Arreaza: It seems like the pain is more localized to the knee, but it can be referred to the hip. If you have tenderness on the tibial tubercle, you got the diagnosis. Juvenile Idiopathic Arthritis (JIA)-Juvenile Idiopathic Arthritis (JIA) is a systemic rheumatologic condition in children that often presents as a polyarticular pain. The onset of disease is often bimodal with peaks between 2 to 5 years old and 10 to 14 years old. 6-Patients will often complain of minor symmetric joint pain and stiffness until an infection causes an inflammatory reaction that exacerbates the joint pain or can increase joint involvement. Small joints are the most likely to be involved, but hips and knees can also be affected. -Lab evaluation will demonstrate inflammation with an elevated ESR, low hemoglobin, and a positive ANA. -Disease management starts with NSAIDS for pain control and can escalate to immunosuppressive measures for moderate disease7.Toxic Synovitis-Toxic synovitis, also known as transient synovitis, is the leading cause of acute hip pain and limping in children aged 2–12, more commonly affecting boys. -This self-limited inflammatory condition, often confused by its name as "toxic," has no relation to a toxic state. It typically arises after an upper respiratory or other viral infection (e.g., rubella or coxsackie virus).-Children with toxic synovitis may show mild to moderate hip pain, limp, and keep their hip in abduction and external rotation. Movement is usually possible within a limited range, and weight-bearing is often maintained.-Evaluation: A thorough history and physical exam are key, as laboratory tests like CBC, ESR, and CRP are often normal, mainly used to rule out other conditions like septic arthritis. X-rays typically show no abnormalities, although small changes may appear. Ultrasound can help detect joint effusion and rule out septic arthritis if no effusion is present.Arreaza: DDX: DDH, SCFE, Osgood Schlatter, and toxic synovitis.Osteopathic Manipulative Treatment in Pediatric Hip PathologiesSacroiliac Articulatory Technique- this is a technique in which you move the joint into an out of its barrier to reduce restriction and improve movementCounterstrain of Tender points (psoas, piriformis, hip adductors)- in this technique we shorten the muscle to decrease tension.  This allows the muscle to increase blood lymphatic flow to reduce nociceptive and proprioceptive activity of the muscleBalanced Ligamentous Tension of the Innominate- with this technique, we manipulate the joint in a way that moves the ligaments into neutral position so that there is balance in all planes of motion.  The goal is to again release tension within the muscles and the jointClinical Decision Making Now that we have covered the most common differential diagnoses for pediatric hip pain, let's revisit our patient presentation and identify the key characteristics to determine which diagnosis he most likely has.The patient is 14 years old.  This makes DDH and Legg-Calve Perthe less likely, and SCFE more likely.He has been complaining of symptoms for 1 week, which indicates that is not likely a chronic condition. This makes DDH and Osgood-Schlatter less likely.The patient has never experienced joint pain like this before.  This makes JIA, DDH, and Osgood-Schlatter less likely.The patient is overweight. This makes SCFE more likely.The unilateral hip tenderness and no knee pain.      This makes Osgood-Schlatter and JIA less likely.The patient has antalgic gait and limited internal rotation of the foot. This makes Legg-Calve Perthes and SCFE more likely. Now when we take the epidemiological factors, the history of the present illness, and the physical exam findings into account, this patient's presentation best aligns with a SCFE. We would order a bilateral AP and Frog-leg views of the hips. If either imaging shows a widened physis or the classic “ice cream cone sign”, this is when we would start the referral process for an orthopedic surgery consultation for internal fixation. As family medicine physicians, we would give instructions for strict non-weight bearing activities and analgesics or anti-inflammatories for pain management.Keep in mind some of the DDX: Calve Legg-Perthes disease, Developmental Dysplasia of the Hip (DDH), Juvenile Idiopathic Arthritis (JIA), Osgood Schlatter, toxic synovitis, and Slipped Capital Femoral Epiphysis (SCFE). Hopefully, the next time you have a pediatric patient present with a complaint of hip pain, you'll feel more comfortable evaluating and working up the case._________________________This week we thank Hector Arreaza and Natalie Pena-Brockett. Audio editing by Adrianne Silva.Even without trying, every night you go to bed a little wiser. Thanks for listening to Rio Bravo qWeek Podcast. We want to hear from you, send us an email at RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. See you next week! _____________________References:Osteonecrosis of the femoral head / Legg-Calvé-Perthes disease | Time of Care. Accessed October 27, 2024. https://www.timeofcare.com/osteonecrosis-of-the-femoral-head-legg-calve-perthes-disease/Scott EJ, Dolan LA, Weinstein SL. Closed Vs. Open Reduction/Salter Innominate Osteotomy for Developmental Hip Dislocation After Age 18 Months: Comparative Survival at 45-Year Follow-up. J Bone Joint Surg Am. 2020;102(15):1351-1357. doi:10.2106/JBJS.19.01278. https://europepmc.org/article/med/32769602Perry DC, Metcalfe D, Costa ML, Van Staa T. A nationwide cohort study of slipped capital femoral epiphysis. Arch Dis Child. 2017;102(12):1132-1136. doi:10.1136/archdischild-2016-312328. https://pubmed.ncbi.nlm.nih.gov/28663349/Haines M, Pirlo L, Bowles K-A, Williams CM. Describing Frequencies of Lower-Limb Apophyseal Injuries in Children and Adolescents: A Systematic Review. Clin J Sport Med. 2022;32(4):433-439. doi:10.1097/JSM.0000000000000925. https://pubmed.ncbi.nlm.nih.gov/34009802/Wall EJ. Osgood-Schlatter disease: practical treatment for a self-limiting condition. Phys Sportsmed. 1998;26(3):29-34. doi:10.3810/psm.1998.03.802. https://pubmed.ncbi.nlm.nih.gov/20086789/Oberle EJ, Harris JG, Verbsky JW. Polyarticular juvenile idiopathic arthritis - epidemiology and management approaches. Clin Epidemiol. 2014;6:379-393. doi:10.2147/CLEP.S53168. https://pubmed.ncbi.nlm.nih.gov/25368531/Beukelman T, Patkar NM, Saag KG, et al. 2011 American College of Rheumatology recommendations for the treatment of juvenile idiopathic arthritis: initiation and safety monitoring of therapeutic agents for the treatment of arthritis and systemic features. Arthritis Care Res (Hoboken). 2011;63(4):465-482. doi:10.1002/acr.20460. https://pubmed.ncbi.nlm.nih.gov/21452260/Theme song, Works All The Time by Dominik Schwarzer, YouTube ID: CUBDNERZU8HXUHBS, purchased from https://www.premiumbeat.com/.

The Cannon Stats podcast is back talking about the Chelsea match:* Overall performance* Blow by blow view* Mikel Merino* Does a draw mean it is over* The infamous Deserve to Win-O-MeterThe second half of the show focuses on the summer business:* Did Arsenal allocate their resources wrong?* Was there better choices to make?* Should Arsenal have kept ESR or Nelson?Some of the links talked about in the show:Merino Film Study:Gyokeres film study:The vibes: This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit www.cannonstats.com/subscribe

récezöld iPhone 16, Apple TV élmények, képernyő kímélő, AppleOne, új iPad mini 7.gen, ma jött új mini okt 23.tól kapható https://www.apple.com/ipad-mini, még a kamera is nettó ugyanaz, proci más és kap AI-t ennyi, kijelző ugyanaz, Wifi 6 helyett 6E hát ezt pont leszarod. Pencil Pro, ugyanannyi mm minden oldal és ugyanannyi g a súlya, BT 5 helyett 5.3 nabumm és kivették a SIM tálcát, XaB iPad mini 5th gen https://en.wikipedia.org/wiki/IPad_Mini, ESR brifkó https://www.esrgear.com/categories/magsafe-wallets/, DJI Avata 2 https://x.com/xab83/status/1845105223964004652?s=46, NEO laktanyás FPV teszt https://youtu.be/FGEBYW6nFsY?si=oO17iX7qB6itta5J, DJI AIR 3S megjelenés, DJI ökoszisztéma (Pocket3, MIC2, Avata2, NEO), Nintendo Alarmo https://www.nintendo.com/de-de/Hardware/Nintendo-Sound-Clock-Alarmo/Nintendo-Sound-Clock-Alarmo-2670177.html, https://www.youtube.com/watch?v=o9cyIRgT9hw, iOS LightCut https://www.dji.com/hu/lightcut, pénzügyek csoport a telegramon,cliffhanger: hover pro 8K, BB Tenerife, Alarmo tartós tesztYT: https://www.youtube.com/xabesbarataiKözösség: t.me/xabesbarataiBB: twitter.com/myrtlewoodsterSanko: twitter.com/NagySnd35898231XaB: https://twitter.com/xab83email: xab@me.com

Cost cutting means New Zealand is ill prepared for an outbreak of a new covid variant, despite the virus still being the number one infectious disease killer, according to well known Otago University epidemiologist Doctor Michael Baker. ESR confirmed the highly transmissable Covid-19 sub-variant, XEC is here. This strain is a mix of two previous Omicron subvariants, it's already in about 30 other countries too and spreading rapidly. Epidemiologist Professor Michael Baker spoke to Lisa Owen.

The highly transmissable Covid-19 sub-variant, XEC has arrived in New Zealand, with one epidemologist concerned people will die if there's an outbreak of the new strain. This strain is a mix of two previous Omicron subvariants. A recombinant variant is created when a person is infected with two strains of a virus that then reproduce, resulting in a different strain. ESR has detected a number of cases of the new strain in clinical samples. Epidemiologist Professor Michael Baker said a clear strategy is needed to reduce the impact of XEC. It's been reported in about 30 other countries, including Australia, infectious disease expert, Professor Paul Griffin from the University of Queensland spoke to Lisa Owen.

Send us a textShow Notes:In this eye-opening episode of Inflamed in the Brain, host Krissy tackles a topic that resonates with many—how to know if your inflammation is improving without relying on lab tests or weight loss. As a registered dietitian who has personal experience managing inflammation from MS, Krissy dives into practical ways to recognize progress beyond the numbers.Introduction to the Episode:Krissy kicks off by acknowledging the overwhelming pressure to lose weight or rely on expensive lab work to gauge inflammation. She highlights that weight isn't the root cause of inflammation and debunks the idea that weight loss alone will make it disappear. By addressing visceral fat and inflammation, Krissy shows the complexity of the body's relationship with fat, emphasizing that not all fat is harmful and that inflammation impacts everyone differently.Weight and Inflammation:Krissy offers listeners a compassionate reminder that hyper-focusing on visceral fat can increase stress—and stress, as she explains, is another inflammatory trigger. She shares insights into body acceptance, the nuanced role of fat in inflammation, and why focusing on bigger-picture lifestyle changes is more effective than obsessing over weight loss.She warns against extreme diets and low-calorie eating patterns that leave you feeling hungry and deprived, noting that these approaches can worsen inflammation by increasing stress hormones and dysregulating hunger cues.Why Lab Work Isn't Always the Answer:Although there are lab tests like CRP, ESR, and organic acid tests to measure inflammation, Krissy reminds listeners that these are expensive, not always accessible, and don't paint the full picture. Lab numbers can fluctuate due to various factors, including genetics and lifestyle. She even shares her personal story of navigating lab results during her first MS flare-up—highlighting that, despite normal CRP levels, she still experienced symptoms.Krissy's focus today is on empowering her audience to tune into their body's own cues, offering ways to recognize improvement that aren't dependent on weight or labs.Main Points Covered in the Episode:Improved Symptoms: Krissy emphasizes that improvement in the symptoms that first led you to the doctor is a clear indicator that your inflammation is improving. Whether it's chronic fatigue, joint pain, or digestive issues, reduced severity or frequency of these symptoms is a key sign that your efforts are paying off. Krissy shares her experience with MS symptoms, reminding listeners to reflect on their progress, even if it's gradual.Boosted Energy Levels: Chronic inflammation often causes fatigue. When your energy starts improving, it's a sure sign that your inflammation is decreasing. Krissy explains how a reduction in chronic inflammation allows the body to redirect energy away from fighting inflammation and towards daily tasks, leading to fewer naps, better motivation, and more consistency in life.Better Digestion: Improved digestion—fewer instances of bloating, constipation, and diarrhea—is a huge sign that inflammation in the gut is decreasing. Krissy talks about the connection between gut health, dysbiosis, and systemic inflammation, explaining how inflammation in the gut can lead to a wide range of issues. As your gut heals, these digestive issues often resolve, showing your body is healing from the inside out.Reduced Joint Pain and Stiffness: Joint pain isn't just an issue for the elderly. Krissy dives into how inflammation impacts joints and how rFollow along: https://betterwithcarbo.com/ Instagram

Today's guest SallyAnn Harbison has been working in the field for over 30 years. She's the Director of Auckland Universities' Forensic science programme, and leads the forensic biology team at ESR. Have you ever wondered if it's really possible to use DNA to track bank notes? Or maybe your more interested in whether the mud on your shoe gives away your movements? Jesse puts that to SallyAnn and the listener questions.

Unfortunately, there simply isn't a one-size-fits-all treatment protocol for patients infected with Lyme disease and/or co-infections. This is why it's critical for physicians treating Lyme disease to invest time with patients, thoroughly understand their medical history, and closely monitor symptoms and treatment response. With that in mind, there are currently two different treatment approaches for Lyme disease. The Infectious Disease Society of America (IDSA) and the International Lyme and Associated Diseases Society (ILADS) have each published their own set of evidence-based treatment guidelines. IDSA guidelines recommend a short course of antibiotics, typically 14 to 30 days. IDSA argues that the Borrelia burgdorferi bacteria do not persist in a patient beyond this timeframe and that lingering symptoms are the result of an ongoing immune response and not an active infection. It also cites scientific evidence claiming treatments beyond 30 days are ineffective, unnecessary, and even dangerous. IDSA physicians will stop treatment after 30 days, even if symptoms remain. They advise an additional 30 days of treatment recommended for patients with Lyme arthritis.  On the contrary, ILADS offers its own scientific data to show that a additional treatment with antibiotics is required to eradicate the bacteria. ILADS recognizes that a month of treatment may be sufficient for patients in the acute stage of Lyme disease, but in cases where the spirochete has disseminated and the disease has advanced, a 30-day treatment regimen is inadequate. ILADS guidelines recommend additional antibiotics until a patient's symptoms have been resolved. Treating Lyme disease in its advanced stage can be complicated based on the complexity of the organism itself, differences in each patient's immune system, the length of time infected, and the possible presence of other co-infections transmitted by the same tick. There are several choices in treating Lyme disease, which include oral, intravenous, and intramuscular antibiotic options. Other options may include sequential antibiotic therapy, higher doses of antibiotics, taking antibiotics for a longer period of time, a combination of antibiotics, retreatment, as well as diagnosing and treating co-infections. Some specific antibiotics used in treating Lyme disease are doxycycline, minocycline, amoxicillin, cefuroxime, azithromycin, and clarithromycin. Other tests include measures of blood counts, chemistries, liver function tests, ANA, dsDNA, RF, TSH, free T3, free T4, ESR may be helpful at ruling out other conditions.  Referral to specialist might help to rule out other conditions.  I find shared decision with my patient helpful. I also find follow-up helpful to assess my patient's response to treatment to rule out other conditions. There are additional protocols that may also aid in treating Lyme disease, such as avoiding alcohol, simple and processed sugars, exercising as tolerated, counseling for a Jarisch-Herxheimer reaction, managing symptoms, monitoring and reducing the risk of an adverse event, and reducing stress. However, there is a chance of side effects such as Clostridium difficile-associated diarrhea (CDAD). Probiotic have been prescribed with the hope of reducing the risk of developing CDAD.   

The first win of the season is always a sweet one, especially when it comes from the first home outing. Craven Cottage was alive with optimism on Saturday, after goals from new signing Emile Smith Rowe and Alex Iwobi got us over the line against the Foxes. Fulham were the better team throughout the game. This, paired with a "feel good factor" around the club, a brilliant manager, and exciting new signings yet to be fully bedded in, and there are many reasons to be cheerful this week. In part 1 we discuss the game; what ESR is capable of within this Fulham side, the manner in which we conceded, and the midfield conundrum. In part 2 we answer some of your questions. If you enjoy Fulhamish, please consider contributing a small amount monthly to help pay our costs. As a bonus, you receive access to our exclusive Telegram group chats where you can chat with fellow FFC fans and Fulhamish listeners ➼ https://levellr.com/communities/fulhamish GUESTS: George Cooper ➼ https://www.x.com/@GeorgeCoops Avais Malik ➼ https://www.x.com/@Here4TheFulham Cam Ramsey ➼ https://www.x.com/@94CAMRAM Jack Kelly ➼ https://www.x.com/@JackellyFFC Learn more about your ad choices. Visit megaphone.fm/adchoices

"We dreamed of Ream, oh what a guy..." It's a sad day in SW6 as the club parts ways with our very own Captain America, the Cottage Colossus of Tim Ream, whose move to Charlotte was confirmed on Wednesday. There's a little bit of time to pay our tributes to a man who has served Fulham Football Club with distinction over the past nine years, as well as a moment to relive one of the best ever This'll Catch On's in his honour. Before we get to that emotional farewell though, there's a bit of pre-season to discuss too, so Jack and Sammy are joined by Jack Kelly, who has been covering the games in the Algarve, to get his thoughts on the camp as a whole, the two performances against Sevilla and Benfica, and where Fulham are in our preparations for the season beginning in 8 (!!!) days. There's also some transfer talk, including the latest on the André saga, with news coming out of Brazil that Fluminense's willingness to put their star midfielder on the market is growing again, as well as some thoughts on where the squad needs augmenting before the window closes at the end of August. -- 00:00 - Pre-season discussion 14:43 - ESR's best role 36:02 - New away kit 40:38 - Farewell Tim Ream 54:08 - Listener questions -- If you enjoy Fulhamish, please consider contributing a small amount monthly to help pay our costs. As a bonus, you receive access to our exclusive Telegram group chats where you can chat with fellow FFC fans and Fulhamish listeners ➼ https://levellr.com/communities/fulhamish -- GUESTS: Sammy James ➼ https://www.x.com/@MrSammyJames Jack Collins ➼ https://www.x.com/@jackjcollins Jack Kelly ➼ https://www.x.com/@Jackellyffc Learn more about your ad choices. Visit megaphone.fm/adchoices

On today's episode of TCOAG, Harry Symeou discusses all the latest Arsenal news. We'll bring you an update on Marseille's pursuit of Eddie Nketiah, Emile Smith Rowe's goodbye, the latest reports linking us with Victor Osimhen and whether in our view, there's anything in them. Support the podcast & access benefits by joining our Patreon page: https://patreon.com/thechroniclesofagooner?utm_medium=unknown&utm_source=join_link&utm_campaign=creatorshare_creator&utm_content=copyLink Watch my Scouting Report on Riccardo Calafiori here: https://youtu.be/5whNabuLRS8 Watch my Scouting Report on Mikel Merino here: https://www.youtube.com/live/ic4eEaEwFI4?si=rM5K7N-V9QDGI0X- Follow Harry Symeou: https://www.instagram.com/harry_symeou/ https://twitter.com/HarrySymeou https://www.tiktok.com/@harrysymeou/ 0:00 - Podcast opener 4:06 - Smith Rowe's goodbye 10:18 - The details of the ESR deal 10:59 - Nketiah deal in danger of collapse 23:10 - Osimhen links reliable? Learn more about your ad choices. Visit megaphone.fm/adchoices

• Summing up the tour• An exercise in exercise• Did we learn anything at all?• ESR departs• Rotation Imagination Hosted on Acast. See acast.com/privacy for more information.

Arsenal make their first MEGA signing of the summer and Pedro, Aash, and Matt chat about it. We discuss: Mikel Arteta's big hug and his secret slides Beating off Madrid and Bayern - are we massive? Signing players that are already sold on Arsenal Arsenal - can we concede less than 21 goals? Eddie, Reiss, and ESR - will all three move? Let us know what you think! Learn more about your ad choices. Visit podcastchoices.com/adchoices

On this edition of TCOAG, Harry Symeou discusses the reports from Spain claiming Mikel Merino is 'close' to joining Mikel Arteta at Arsenal. We'll also discuss Nketiah, Smith Rowe, Kiwior, Zinchenko, Tierney and take some of your questions from the live chat. Support the podcast & access benefits by joining our Patreon page: https://patreon.com/thechroniclesofagooner?utm_medium=unknown&utm_source=join_link&utm_campaign=creatorshare_creator&utm_content=copyLink Watch my Scouting Report on Riccardo Calafiori here: https://youtu.be/5whNabuLRS8 Watch my Scouting Report on Mikel Merino here: https://www.youtube.com/live/ic4eEaEwFI4?si=rM5K7N-V9QDGI0X- Follow Harry Symeou: https://www.instagram.com/harry_symeou/ https://twitter.com/HarrySymeou https://www.tiktok.com/@harrysymeou/ 0:00 - Podcast opener 6:32 - Marseille progress in Nketiah pursuit 15:04 - ESR update 18:22 - Arsenal to listen to offers for defenders 21:05 - Comments from the live chat 25:56 - Mikel Merino 'close' to Arsenal move 32:48 - Q&A Learn more about your ad choices. Visit megaphone.fm/adchoices

On today's episode of TCOAG, Harry Symeou talks Mikel Merino, is he on his way to the Arsenal? We discuss Fulham's bid for Emile Smith Rowe, Edu's plans for the window, two departures, when we can expect some key players to return and Gareth Southgate's resignation from his post as England boss. Support the podcast & access benefits by joining our Patreon page: https://patreon.com/thechroniclesofagooner?utm_medium=unknown&utm_source=join_link&utm_campaign=creatorshare_creator&utm_content=copyLink Watch my latest Scouting Report on Riccardo Calafiori here: https://youtu.be/5whNabuLRS8 Follow Harry Symeou: https://www.instagram.com/harry_symeou/ https://twitter.com/HarrySymeou https://www.tiktok.com/@harrysymeou/ 0:00 - Podcast intro 3:21 - Gareth Southgate resigns as England boss 8:40 - International stars to begin returning 10:50 - Saliba honoured 12:40 - Lokonga & Tavares departures confirmed 13:44 - More Jorginho's & Trossard's 16:15 - Arsenal's interest in Merino 21:13 - Fulham fail with ESR bid 22:30 - Q&A Learn more about your ad choices. Visit megaphone.fm/adchoices

John Haskell, CIO at Atla Capital Management, joins the podcast to share his thoughts on international real estate investing, emerging markets and ESR Group Limited ($1821.HK). For more information about Atla Capital Management, please visit: https://www.atlacap.com/ Chapters: [0:00] Introduction + Episode sponsor: Fundamental Edge [2:22] International public real estate investing [11:00] Taxation on global REITs / emerging markets [17:54] John's most interesting market(s) right now / Vietnam overview [21:58] ESR Group Limited thesis overview and why interesting to John [27:12] Why has the stock not worked (since it's high in 2021) / how did John get comfortable with owning ESR [36:06] Starwood investment / potential ESR buyout / how does John think ESR take out plays out [45:54] ESR valuation [55:54] Related party transactions and how do you have faith that they are done in fair value / final thoughts Today's episode is sponsored by: Fundamental Edge One of a kind, world-class training created for your team, your culture, your way. Fundamental Edge was founded with a mission to train the next generation of investors and a vision to create a platform that serves the learning and development needs of investment professionals throughout their careers. Through structured lessons and proven frameworks, Fundamental Edge aims to condense years of “learning via osmosis” into a masterclass for the equity research process. Funds looking to strengthen their internal training programs can visit fundamentedge.com/corporate-training to learn more.

video: https://youtu.be/bfXXS5Z1JMc Forum Discussion Thread (https://forum.tuxdigital.com/t/271-fedora-metrics-wayland-zed-ide-gnome-finally-revamping-extensions-site-more-linux-news/6334) This week in Linux, Fedora announced some plans for future releases that may be controversial. There's a new IDE available for Linux that might turn some heads. GNOME's Extensions Website is getting a redesign but is it any good? All of this and more on This Week in Linux, the weekly news show that keeps you up to date with what's going on in the Linux and Open Source world. Now let's jump right into Your Source for Linux GNews! Download as MP3 (https://aphid.fireside.fm/d/1437767933/2389be04-5c79-485e-b1ca-3a5b2cebb006/c1fc47ca-d7d4-496e-ad49-befaaa8b7686.mp3) Support the Show Become a Patron = tuxdigital.com/membership (https://tuxdigital.com/membership) Store = tuxdigital.com/store (https://tuxdigital.com/store) Chapters: 00:00 Intro 00:33 Ubuntu App Center Can Now Install DEBs 02:10 Fedora Workstation: Opt-In Metrics & Wayland Only 07:41 Mozilla Firefox 128 ESR & Thunderbird 128 ESR 13:58 Zed IDE is now available for Linux 17:22 GNOME Extensions Website Redesign Coming 20:26 DXVK 2.4 Released 22:30 15 Years of GamingOnLinux.com 24:26 Outro Links: Ubuntu App Center Can Now Install DEBs https://www.omgubuntu.co.uk/2024/07/app-center-update-adds-deb-install-support (https://www.omgubuntu.co.uk/2024/07/app-center-update-adds-deb-install-support) Fedora Workstation: Opt-In Metrics & Wayland Only Opt-In Metrics https://discussion.fedoraproject.org/t/f42-change-proposal-opt-in-metrics-for-fedora-workstation-system-wide/124325 (https://discussion.fedoraproject.org/t/f42-change-proposal-opt-in-metrics-for-fedora-workstation-system-wide/124325) https://lists.fedoraproject.org/archives/list/devel@lists.fedoraproject.org/thread/RENZQGQTUPVNNVNN6GI6EC4K632S6SOU/ (https://lists.fedoraproject.org/archives/list/devel@lists.fedoraproject.org/thread/RENZQGQTUPVNNVNN6GI6EC4K632S6SOU/) https://fedoraproject.org/wiki/Changes/Metrics (https://fedoraproject.org/wiki/Changes/Metrics) Wayland only https://fedoraproject.org/wiki/Changes/WaylandOnlyGNOMEWorkstationMedia (https://fedoraproject.org/wiki/Changes/WaylandOnlyGNOMEWorkstationMedia) Mozilla Firefox 128 ESR & Thunderbird 128 ESR Firefox https://www.mozilla.org/en-US/firefox/128.0/releasenotes/ (https://www.mozilla.org/en-US/firefox/128.0/releasenotes/) https://9to5linux.com/mozilla-firefox-128-is-now-available-for-download-heres-whats-new (https://9to5linux.com/mozilla-firefox-128-is-now-available-for-download-heres-whats-new) https://www.omgubuntu.co.uk/2024/07/mozilla-firefox-128-released-this-is-mostly-whats-new (https://www.omgubuntu.co.uk/2024/07/mozilla-firefox-128-released-this-is-mostly-whats-new) Thunderbird https://www.thunderbird.net/en-US/thunderbird/128.0esr/releasenotes/ (https://www.thunderbird.net/en-US/thunderbird/128.0esr/releasenotes/) https://9to5linux.com/mozilla-thunderbird-128-esr-is-now-available-for-download-heres-whats-new (https://9to5linux.com/mozilla-thunderbird-128-esr-is-now-available-for-download-heres-whats-new) https://www.omgubuntu.co.uk/2024/07/thunderbird-128-released-with-major-changes (https://www.omgubuntu.co.uk/2024/07/thunderbird-128-released-with-major-changes) Zed IDE is now available for Linux https://zed.dev/ (https://zed.dev/) https://zed.dev/blog/zed-on-linux (https://zed.dev/blog/zed-on-linux) https://www.omgubuntu.co.uk/2024/07/zed-editor-linux-released (https://www.omgubuntu.co.uk/2024/07/zed-editor-linux-released) https://www.gamingonlinux.com/2024/07/popular-multiplayer-code-editor-zed-gets-a-linux-release/ (https://www.gamingonlinux.com/2024/07/popular-multiplayer-code-editor-zed-gets-a-linux-release/) https://www.phoronix.com/news/Zed-Native-Linux-Builds (https://www.phoronix.com/news/Zed-Native-Linux-Builds) GNOME Extensions Website Redesign Coming https://www.omgubuntu.co.uk/2024/07/gnome-extensions-website-redesign-2024 (https://www.omgubuntu.co.uk/2024/07/gnome-extensions-website-redesign-2024) DXVK 2.4 Released https://github.com/doitsujin/dxvk/releases/tag/v2.4 (https://github.com/doitsujin/dxvk/releases/tag/v2.4) https://9to5linux.com/dxvk-2-4-released-with-non-native-refresh-rate-emulation-direct3d-8-support (https://9to5linux.com/dxvk-2-4-released-with-non-native-refresh-rate-emulation-direct3d-8-support) https://www.gamingonlinux.com/2024/07/dxvk-24-brings-d8vk-for-direct3d-8-support-frame-rate-limiter-adjustments-lots-of-game-fixes/ (https://www.gamingonlinux.com/2024/07/dxvk-24-brings-d8vk-for-direct3d-8-support-frame-rate-limiter-adjustments-lots-of-game-fixes/) https://www.phoronix.com/news/DXVK-2.4-Released (https://www.phoronix.com/news/DXVK-2.4-Released) Happy 15th Anniversary to GamingOnLinux https://www.gamingonlinux.com/2024/07/happy-birthday-to-gamingonlinux-15-years-old-today/ (https://www.gamingonlinux.com/2024/07/happy-birthday-to-gamingonlinux-15-years-old-today/)

How do you know if your hives are chronic spontaneous urticaria?  Join Kortney and Dr. Payel Gupta in the second episode of this chronic spontaneous urticaria (CSU) series as they delve into the diagnostic journey of CSU.  Have you wondered if the path to a chronic spontaneous urticaria diagnosis is long? CSU can feel like a very complex disease to diagnose due to the lack of identifiable triggers, but this episode breaks down the steps healthcare professionals take to diagnose CSU.  Dr. G clarifies how allergists' and dermatologists' roles differ in diagnosing CSU. The episode emphasizes the importance of a detailed medical history and the tests involved in ruling out other conditions. It also describes the journey of determining CSU from other skin and allergic reactions through meticulous evaluation and specific testing methods. What we cover in our episode about diagnosing Chronic Spontaneous Urticaria: Introduction to CSU Diagnosis: CSU has no identifiable triggers, making diagnosis a process of elimination. Role of Specialists: Patients often start their diagnosis journey at urgent care, after which they consult allergists and dermatologists depending on the severity and symptoms of hives. Detailed Medical History: Essential questions cover medications, infections, travel history, and other health changes to rule out underlying causes. Physical Examination: Doctors check if hives are “blanchable” to differentiate from other conditions like vasculitis. Ruling out other Conditions: This involves evaluating other conditions in which hives are a symptom, such as mast cell disease or various autoimmune diseases.  Necessary Tests: Doctor's apprehension about doing a food allergy test unless necessary. Other tests include looking at blood count (CBC with differential) and inflammation (ESR or CRP).  More resources about chronic spontaneous urticaria:  Chronic Urticaria Management, Resources & Glossary of Terms: https://allergyasthmanetwork.org/health-a-z/chronic-urticaria/management-and-resources/ What is Chronic Urticaria: https://allergyasthmanetwork.org/health-a-z/chronic-urticari This episode is produced in partnership with Allergy & Asthma Network. We want to thank Novartis for sponsoring this episode. Disclaimer: This podcast is for informational purposes only and does not substitute professional medical advice. Always consult with your healthcare provider for any medical concerns.