Findings should help company make any necessary changes; Meghan Markle wins a major legal battle with a UK newspaper. How high school basketball players tried to message a friend, but ended up talking to Tom Brady.
What challenges are you facing in Digital ministry? You're definitely facing challenges. We all are! What's fascinating to me, in this post-COVID culture we're moving into, is that one church's strength is another weakness, and vice-versa. Which really gets me to the heart of this podcast. Sprout Digital is in the midst of a five year Research Project, digging into the validity of Digital Church and Digital Discipleship. And with focuses like that, you can bet that THECHURCH.DIGITAL is excited about this conversation. So we're bringing in Jared & Ann Roth, Founders of Sprout Digital (and Co-Pastors at Evergreen Church), to excitedly discuss the trends that we're seeing in Digital Church post-COVID, and what it tells us about what's next… Complete Show Notes and Online Video Available at THECHURCH.DIGITAL --- Send in a voice message: https://anchor.fm/thechurchdigital/message
Study: Sustainable eating is cheaper and healthier Oxford University, November 11, 2021 Oxford University research has today revealed that, in countries such as the US, the UK, Australia and across Western Europe, adopting a vegan, vegetarian, or flexitarian diet could slash your food bill by up to one-third. The study, which compared the cost of seven sustainable diets to the current typical diet in 150 countries, using food prices from the World Bank's International Comparison Program, was published in The Lancet Planetary Health. (next) Meta-analysis concludes resveratrol beneficially modulates glycemic control in diabetics Zagazig University and Suez Canal University (Egypt), October 29 2021. Findings from a meta-analysis of clinical trials published in Medicina Clinica (Barcelona) revealed an association between supplementing with resveratrol and improvements in glycemic control. “This systematic review and meta-analysis is the first to consider resveratrol's efficacy on glycemic and cardiometabolic parameters in patients with Type 2 diabetes mellitus (T2DM).” (next) Exercise linked to better mental health Kaiser Permanente Research, November 11, 2021 Kaiser Permanente research published in Preventive Medicine showed people who exercised more during the initial lockdown period of the COVID-19 pandemic experienced less anxiety and depression than those who didn't exercise. It also showed that people who spent more time outdoors typically experienced lower levels of anxiety and depression than those who stayed inside. (next) Bedtime linked with heart health University of Exeter (UK), November 9, 2021 Going to sleep between 10:00 and 11:00 pm is associated with a lower risk of developing heart disease compared to earlier or later bedtimes, according to a study published today in European Heart Journal—Digital Health, a journal of the European Society of Cardiology (ESC). "While we cannot conclude causation from our study, the results suggest that early or late bedtimes may be more likely to disrupt the body clock, with adverse consequences for cardiovascular health." (NEXT) Garlic compounds may boost cardio health indirectly via gut microbiota National Taiwan University, November 6 2021 Allicin from garlic may prevent the metabolism of unabsorbed L-carnitine or choline into TMAO, a compound linked to an increased risk of cardiovascular diseases, says a new study. TMAO – or trimethylamine N-oxide – has been known to be generated from dietary carnitine through metabolism of gut microbiota, and was recently reported to be an “important gut microbiota-dependent metabolite to cause cardiovascular diseases.” New data indicated that carnitine-fed lab mice showed a “remarkable increase in plasma TMAO levels”, compared with lab mice fed a control (no carnitine). However, when allicin supplements were provided with the carnitine diet, TMAO levels were significantly reduced. (NEXT) Drug used to prevent miscarriage increases risk of cancer in offspring University of Texas Health Science Center, November 9, 2021 Exposure in utero to a drug used to prevent miscarriage can lead to an increased risk of developing cancer, according to researchers at The University of Texas Health Science Center at Houston The drug, 17α-hydroxyprogesterone caproate (17-OHPC), is a synthetic progestogen that was frequently used by women in the 1950s and 1960s, and is still prescribed to women today to help prevent preterm birth. (OTHER NEWS NEXT) 2,433 Dead Babies in VAERS as Another Study Shows mRNA Shots Not Safe for Pregnant Women by Brian Shilhavy Editor, Health Impact News, November 7, 2021 There have now been 2,433 fetal deaths recorded in VAERS (Vaccine Adverse Event Reporting System) from pregnant women who have been injected with one of the COVID-19 shots. The vast majority of these have been from the Pfizer shot (1,862 deaths) and the Moderna shot (656 deaths.) There have been more fetal deaths in the past 11 months following COVID-19 shots than there have been for the past 30+ years following ALL vaccines (2,198 – Source.) Last month (October, 2021) the New England Journal of Medicine admitted that the original study used to justify the CDC and the FDA in recommending the shots to pregnant women was flawed. (Source.) Since then, researchers in New Zealand have conducted a new study on the original data, and concluded: A re-analysis of these figures indicates a cumulative incidence of spontaneous abortion ranging from 82% (104/127) to 91% (104/114), 7–8 times higher than the original authors' results. (Source.) And yet, the CDC and FDA still continue to recommend the shots for pregnant women, even though a correct analysis on the original data shows that 82% to 91% of pregnant women will suffer miscarriages if their unborn child is less than 20 weeks old. (Source.) VAERS is a passive system that is severely under reported. The CDC and FDA have never conducted a study to determine what this under-reported factor is, but independent scientists have, and we have previously published the analysis conducted by Dr. Jessica Rose, who has determined that a conservative under-reported factor would be X41. See: STUDY: Government's Own Data Reveals that at Least 150,000 Probably DEAD in U.S. Following COVID-19 Vaccines This means that there have probably been at least 99,753 fetal deaths following COVID-19 injections so far. Here is a video report we made on this last month with some very unfortunate gruesome examples of what these shots are doing to unborn babies. 1,969 Fetal Deaths Recorded Following COVID-19 Shots but Criminal CDC Recommends Pregnant Women Get the Shot UPDATE – November 7, 2021 PM A couple of hours after publishing this article, a video that has been circulating on the Internet of an interview with a Funeral Director in the UK became known to me. He has been in practice for over 3 years and is identified as “Wesley,” and was interviewed by a group called “Resistance GB.” He claims that last fall was one the slowest periods of seeing deaths for all funeral directors, but when the COVID-19 shots were introduced, deaths started dramatically increasing. It started with the elderly, but then by April they were seeing large numbers of people in their 30s and 40s. Many of them were dying of myocarditis. Now, they are seeing unprecedented numbers of newborn babies, and they are piling up in hospital refrigerators. Some are full term, some are pre-term, he claims. The UK originally recommended that pregnant women and nursing mothers should NOT get the experimental COVID shots, but like the CDC in the U.S., they eventually changed their recommendation to encourage pregnant women to get the shots. (NEXT) An ethical analysis of vaccinating children against COVID-19: benefits, risks, and issues of global health equity Johns Hopkins University, Oxford-Johns Hopkins Global Infectious Disease Ethics Collaborative, Wageningen University - The Netherlands, University of Oxford, Abstract We argue that it is currently unclear whether routine COVID-19 vaccination of healthy children is ethically justified in most contexts, given the minimal direct benefit that COVID-19 vaccination provides to children, the potential for rare risks to outweigh these benefits and undermine vaccine confidence, and substantial evidence that COVID-19 vaccination confers adequate protection to risk groups, such as older adults, without the need to vaccinate children. We conclude that child COVID-19 vaccination in wealthy communities before adults in poor communities worldwide is ethically unacceptable and consider how policy deliberations might evolve in light of future developments. (NEXT) What's Driving Global Deforestation? Organized Crime, Beef, Soy, Palm Oil and Wood Products Jennifer Devine, Counterpunch, November 17, 2021 Every year the world loses an estimated 25 million acres (10 million hectares) of forest, an area larger than the state of Indiana. Nearly all of it is in the tropics. From my research on social and environmental issues in Latin America, I know that four consumer goods are responsible for the majority of global deforestation: beef, soy, palm oil, and wood pulp and paper products. Together these commodities are responsible for the loss of nearly 12 million acres (5 million hectares) annually. There's also a fifth, less publicized key driver: organized crime, including illegal drug trafficking. The dominant role of beef Among major products that promote deforestation, beef is in a class by itself. Beef production is now estimated to be the biggest driver of deforestation worldwide, accounting for 41% of global forest losses. In the Amazon alone, cattle ranching accounts for 80% of deforestation. From 2000 to 2011, beef production emitted nearly 200 times more greenhouse gases than soy, and 60 times more than oil palm in tropical countries with high deforestation rates. Soy and palm oil: Ubiquitous ingredients Together, soy and palm oil drive nearly 10% of deforestation annually – almost 2.5 million acres (1 million hectares). Clearing land for palm oil plantations fuels large-scale rainforest destruction in Indonesia and Malaysia, where most of the world's palm oil is produced. Palm oil is the most commonly produced, consumed and traded vegetable oil. Some 60% of the 66 million tons produced globally every year is used to produce energy in the form of biofuel, power and heat. About 40% is used for food, animal feed and chemical products. Palm oil is an ingredient in half of all products found at the supermarket, including margarine, shampoos, frozen pizza and detergents. Soy production has doubled globally in the past 20 years. Nearly 80% of global soy is fed to cows, chickens, pigs and farmed fish. This demand reflects the tripling of global meat production over the past 50 years. Wood products Wood products are responsible for about 5% of annual global deforestation, or about 1.2 million acres (500,000 hectares) yearly. Wood is widely used for home construction and furniture, and also as a pulp source for paper and fabric. And in low-income nations and rural areas, it's an important fuel source for heating and cooking. The three largest paper-producing countries are the U.S., Canada and China. Illegal deforestation and organized crime Another industry plays an important role, especially in tropical forests: organized crime. Large, lucrative industries offer opportunities to move and launder money; as a result, in many parts of the world, deforestation is driven by the drug trade. In South America and Central America, drug trafficking organizations are the vanguard of deforestation. Drug traffickers are illegally logging forests in the Amazon and hiding cocaine in timber shipments to Europe. In my research, I have analyzed how traffickers illegally log and raise cattle in protected areas in Central America to launder money and claim drug smuggling territory. Other scholars estimate that 30% to 60% of deforestation in the region is “narco-deforestation.” Forest Trends analysis, exports tied to illegal deforestation are worth US$61 billion annually and are responsible for 25% of total global tropical deforestation. (NEXT) ‘This Must Not Happen': If Unhalted, Permian Basin Fracking Will Unleash 40 Billion Tons of CO2 by 2050 As activists at the COP26 summit continue to denounce the “massive” gap between wealthy governments' lofty rhetoric and their woefully inadequate plans for addressing the climate emergency, a new analysis of projected extraction in the Permian Basin in the U.S. Southwest exposes the extent to which oil and gas executives' refusal to keep fossil fuels in the ground puts humanity's future in jeopardy. “While climate science tells us that we must consume 40% less oil in 2030, Permian producers plan to grow production more than 50%.” Released Tuesday by Oil Change International, Earthworks, and the Center for International Environmental Law, the second chapter of The Permian Basin Climate Bomb warns that if the drilling and fracking boom that has turned the Permian Basin into “the world's single most prolific oil and gas field” over the past decade is allowed to persist unabated for the next three decades, it will generate nearly 40 billion tons of carbon dioxide by mid-century. “With global markets flush with Permian oil and gas, it can only be harder to steer the world's economy toward clean energy.” “While climate science tells us that we must consume 40% less oil in 2030, Permian producers plan to grow production more than 50%” from 2021 to 2030, said Stockman. “This must not happen.” “If left unchecked,” the report notes, “the Permian could continue to produce huge amounts of oil, gas, and gas liquids for decades to come. With global markets flush with Permian oil and gas, it can only be harder to steer the world's economy toward clean energy.” (NEXT) Wall Street's Takeover of Nature Advances with Launch of New Asset Class By Whitney Webb A project of the multilateral development banking system, the Rockefeller Foundation and the New York Stock Exchange recently created a new asset class that will put, not just the natural world, but the processes underpinning all life, up for sale under the guise of promoting “sustainability.” Last month, the New York Stock Exchange (NYSE) announced it had developed a new asset class and accompanying listing vehicle meant “to preserve and restore the natural assets that ultimately underpin the ability for there to be life on Earth.” Called a natural asset company, or NAC, the vehicle will allow for the formation of specialized corporations “that hold the rights to the ecosystem services produced on a given chunk of land, services like carbon sequestration or clean water.” These NACs will then maintain, manage and grow the natural assets they commodify, with the end of goal of maximizing the aspects of that natural asset that are deemed by the company to be profitable. Though described as acting like “any other entity” on the NYSE, it is alleged that NACs “will use the funds to help preserve a rain forest or undertake other conservation efforts, like changing a farm's conventional agricultural production practices.” Yet, as explained towards the end of this article, even the creators of NACs admit that the ultimate goal is to extract near-infinite profits from the natural processes they seek to quantify and then monetize. NYSE COO Michael Blaugrund alluded to this when he said the following regarding the launch of NACs: “Our hope is that owning a natural asset company is going to be a way that an increasingly broad range of investors have the ability to invest in something that's intrinsically valuable, but, up to this point, was really excluded from the financial markets.” Framed with the lofty talk of “sustainability” and “conservation”, media reports on the move in outlets like Fortune couldn't avoid noting that NACs open the doors to “a new form of sustainable investment” which “has enthralled the likes of BlackRock CEO Larry Fink over the past several years even though there remain big, unanswered questions about it.” Fink, one of the world's most powerful financial oligarchs, is and has long been a corporate raider, not an environmentalist, and his excitement about NACs should give even its most enthusiastic proponents pause if this endeavor was really about advancing conservation, as is being claimed. How to Create a NAC The creation and launch of NACs has been two years in the making and saw the NYSE team up with the Intrinsic Exchange Group (IEG), in which the NYSE itself holds a minority stake. IEG's three investors are the Inter-American Development Bank, the Latin America-focused branch of the multilateral development banking system that imposes neoliberal and neo-colonalist agendas through debt entrapment; the Rockefeller Foundation, the foundation of the American oligarch dynasty whose activities have long been tightly enmeshed with Wall Street; and Aberdare Ventures, a venture capital firm chiefly focused on the digital healthcare space. Notably, the IADB and the Rockefeller Foundation are closely tied to the related pushes for Central Bank Digital Currencies (CBDCs) and biometric Digital IDs. The IEG's mission focuses on “pioneering a new asset class based on natural assets and the mechanism to convert them to financial capital.” “These assets,” IEG states, make “life on Earth possible and enjoyable…They include biological systems that provide clean air, water, foods, medicines, a stable climate, human health and societal potential.” Put differently, NACs will not only allow ecosystems to become financial assets, but the rights to “ecosystem services”, or the benefits people receive from nature as well. These include food production, tourism, clean water, biodiversity, pollination, carbon sequestration and much more. IEG is currently partnering with Costa Rica's government to pilot its NAC efforts within that country. Costa Rica's Minister of Environment and Energy, Andrea Meza Murillo, has claimed that the pilot project with IEG “will deepen the economic analysis of giving nature its economic value, as well as to continue mobilizing financial flows to conservation.” With NACs, the NYSE and IEG are now putting the totality of nature up for sale. While they assert that doing so will “transform our economy to one that is more equitable, resilient and sustainable”, it's clear that the coming “owners” of nature and natural processes will be the only real beneficiaries. Per the IEG, NACs first begin with the identification of a natural asset, such as a forest or lake, which is then quantified using specific protocols. Such protocols have already been developed by related groups like the Capitals Coalition, which is partnered with several of IEG's partners as well as the World Economic Forum and various coalitions of multinational corporations. Then, a NAC is created and the structure of the company decides who has the rights to that natural asset's productivity as well as the rights to decide how that natural asset is managed and governed. Lastly, a NAC is “converted” into financial capital by launching an initial public offering on a stock exchange, like the NYSE. This last stage “generates capital to manage the natural asset” and the fluctuation of its price on the stock exchange “signals the value of its natural capital.” However, the NAC and its employees, directors and owners are not necessarily the owners of the natural asset itself following this final step. Instead, as IEG notes, the NAC is merely the issuer while the potential buyers of the natural asset the NAC represents can include: institutional investors, private investors, individuals and institutions, corporations, sovereign wealth funds and multilateral development banks. Thus, asset management firms that essentially already own much of the world, like Blackrock, could thus become owners of soon-to-be monetized natural processes, natural resources and the very foundations of natural life itself. Both the NYSE and IEG have marketed this new investment vehicle as being aimed at generating funds that will go back to conservation or sustainability efforts. However, on the IEG's website, it notes that the goal is really endless profit from natural processes and ecosystems that were previously deemed to be part of “the commons”, i.e. the cultural and natural resources accessible to all members of a society, including natural materials such as air, water, and a habitable earth. Per the IEG, “as the natural asset prospers, providing a steady or increasing flow of ecosystem services, the company's equity should appreciate accordingly providing investment returns. Shareholders and investors in the company through secondary offers, can take profit by selling shares. These sales can be gauged to reflect the increase in capital value of the stock, roughly in-line with its profitability, creating cashflow based on the health of the company and its assets.” Researcher and journalist Cory Morningstar has strongly disagreed with the approach being taken by NYSE/IEG and views NACs as a system that will only exacerbate the corporate predation of nature, despite claims to the contrary. Morningstar has described NACs as “Rockefeller et al. letting the markets dictate what in nature has value – and what does not. Yet, it's not for capitalist institutions and global finance to decide what life has value. Ecosystems are not ‘assets.' Biological communities exist for their own purposes, not ours.” A New Way to Loot The ultimate goal of NACs is not sustainability or conservation – it is the financialization of nature, i.e. turning nature into a commodity that can be used to keep the current, corrupt Wall Street economy booming under the guise of protecting the environment and preventing its further degradation. Indeed, IEG makes this clear when they note that “the opportunity” of NACs lies not in their potential to improve environmental well-being or sustainability, but in the size of this new asset class, which they term “Nature's Economy.” Indeed, while the asset classes of the current economy are value at approximately $512 trillion, the asset classes unlocked by NACs are significantly larger at $4,000 trillion (i.e. $4 quadrillion). Thus, NACs open up a new feeding ground for predatory Wall Street banks and financial institutions that will allow them to not just dominate the human economy, but the entire natural world. In the world currently being constructed by these and related entities, where even freedom is being re-framed not as a right but “a service,” the natural processes on which life depends are similarly being re-framed as assets, which will have owners. Those “owners” will ultimately have the right, in this system, to dictate who gets access to clean water, to clean air, to nature itself and at what cost. According to Cory Morningstar, one of the other aims of creating “Nature's Economy” and neatly packaging it for Wall Street via NACs is to drastically advance massive land grab efforts made by Wall Street and the oligarch class in recent years. This includes the recent land grabs made by Wall Street firms as well as billionaire “philanthropists” like Bill Gates during the COVID crisis. However, the land grabs facilitated through the development of NACs will largely target indigenous communities in the developing world. As Morningstar notes: “The public launch of NACs strategically preceded the fifteenth meeting of the Conference of the Parties to the Convention on Biological Diversity, the biggest biodiversity conference in a decade. Under the pretext of turning 30% of the globe into “protected areas”, the largest global land grab in history is underway. Built on a foundation of white supremacy, this proposal will displace hundreds of millions, furthering the ongoing genocide of Indigenous peoples. The tragic irony is this: while Indigenous peoples represent less than 5% of the global population, they support approximately 80% of all biodiversity.“ IEG, in discussing NACs, tellingly notes that proceeds from a NAC's IPO can be used for the acquisition of more land by its controlling entities or used to boost the budgets or funds of those who receive the capital from the IPO. This is a far cry from the NYSE/IEG sales pitch that NACs are “different” because their IPOs will be used to “preserve and protect” natural areas. The climate change panic that is now rising to the take the place of COVID-19 panic will surely be used to savvily market NACs and similar tactics as necessary to save the planet, but – rest assured – NACs are not a move to save the planet, but a move to enable the same interests responsible for the current environmental crises to usher in a new era where their predatory exploitation reaches new heights that were previously unimaginable.
Episode 75: Multisystem Inflammatory Syndrome in Children (MIS-C). Dr Schlaerth explains the signs, symptoms, and basic management of MIS-C. Lam explain the role of anti-obesity medications in weight management. Introduction: The Role of Drugs in Weight Loss Management By Lam Chau, MS3, Ross University School of Medicine Today about 70% of adult Americans are overweight or obese. Obesity is associated with increased risk of heart disease, stroke, and diabetes, among many other diseases. Studies have shown losing 5-10% of your body weight can substantially reduce your risk of cardiovascular disease. Traditional belief is that weight loss can only be attributed to diet and exercise. While there are certainly elements of truth to that statement, medication is a safe and proven method for weight management that is often overlooked. The fact of the matter is that weight loss is an ongoing field of study with constant new research and innovations. In June of this year, a medication named Wegovy was approved for weight loss management by the FDA. This drug is indicated for chronic weight management in patients with a BMI of 27 or greater with an accompanying weight-related ailment or in a patient with a BMI of 30 or greater. Rachel Batterham, PhD, of the Centre for Obesity Research at University College London, shared: "The findings of this study represent a major breakthrough for improving the health of people with obesity. No other drug has come close to producing this level of weight loss — this really is a game changer.” Despite breakthroughs like these, the use of medication for weight loss is still relatively low. Dr. Erin Bohula, a cardiologist and assistant professor at Harvard Medical School, believes “there are probably a few reasons for this, including cost, if not covered by insurance, and a perception these agents are not safe in light of the history with weight loss agents.” A study from 2019 examined the medical records from eight geographically dispersed healthcare organizations. They found that out of 2.2 million patients who were eligible for weight loss medication, only 1.3% filled at least 1 prescription. Weight loss is a dynamic process with many different variables. While it may not necessarily be for everyone, medication can help tremendously and is an option you should consider if you are interested in weight loss[1,2]. This is Rio Bravo qWeek, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California. Our program is affiliated with UCLA, and it's sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. ___________________________Multisystem Inflammatory Syndrome in Children (MIS-C). By Katherine Schlaerth, MD, and Hector Arreaza, MD. History and epidemiologyMost children who get COVID-19 have either no symptoms or very mild symptoms. However, about 18 months ago, a new pediatric complication of COVID-19, possibly postinfectious, was described. The eight children who were initially described had a clinical presentation which was similar to either Kawasaki Disease or perhaps toxic shock syndrome, and since these children had signs of a hyperinflammatory state coupled with shock, the new syndrome was named Multisystem Inflammatory Syndrome in Children, or MIS-C for short. By midsummer of 2021, the United States had about two thousand cases and 30 deaths in children under 21. Other name for this condition is Pediatric Hyperinflammatory Shock. DiagnosisWhat are the criteria for a diagnosis of Multisystem Inflammatory Syndrome? They include:Age below 21Fever above 100.4 degrees Fahrenheit or 38 degrees centigrade for 24 hours (a subjective fever for more than 24 hours counts too). Laboratory evidence of inflammation which should include at least two of the following tests: elevated CRP, elevated ESR, elevated fibrinogen level, procalcitonin, D-dimer, ferritin, lactic acid dehydrogenase (LDH), interleukin-6, and neutrophil counts, low lymphocyte count and low albumin.Severe disease necessitating hospitalization with multisystem organs affected. The systems affected include cardiac, renal, respiratory, hematologic, gastrointestinal, dermatologic, and neurologic (at least three systems need to be involved). No creditable other diagnosis. Other symptoms include:GI complaints (diarrhea, vomiting, abdominal pain)Skin rashConjunctivitisHeadacheLethargyConfusionRespiratory distressSore throatMyalgiasSwollen hands/feetLymphadenopathyCardiac signs and symptoms include troponin/BNP elevation and arrhythmia. Findings on ECHO may include depressed LVEF, coronary artery abnormalities, including dilation or aneurysm, mitral regurgitation, and pericardial effusion. There also must be a positive test for SARS-CoV-2 and this test can be either a reverse transcriptase polymerase chain reaction (RT-PCR), serologic, or antigen testing. Exposure to someone who has had or is suspected of having had COVID-19 within the last 4 weeks also counts. Patients with MIS-C may have predominately gastrointestinal symptoms, mucocutaneous findings, and may be hypotensive or “shocky” on presentation. Up to 80% require ICU admission. Thrombocytopenia and /or elevated transaminase levels can also be seen. MIS-C vs Kawasaki DiseaseThe big issue in diagnosing MIS-C is the overlap with Kawasaki's disease and with toxic shock syndrome. Patients with Kawasaki Disease in their second week of illness often will have thrombosis, not thrombocytopenia. Whereas MIS-C usually affects school age children or adolescents, Kawasaki Disease is more commonly a problem in younger children, who have an average age of 2 years. Kawasaki Disease is also more common in Asian children and MIS-C disproportionately seems to affect Black and Hispanic children. Obesity seems to be another risk factor for MIS-C. Kawasaki's Disease also has different cardiac manifestations from MIS-C. Coronary artery dilatation is common in Kawasaki's disease and left ventricular dysfunction in MIS-C, although sometimes coronary artery dilatation and rarely aneurisms can be noted on echocardiogram in putative MIS-C, which is why differentiation from Kawasaki's Disease is an issue. PathophysiologyThe cause of MIS-C is probably postinfectious immune dysregulation. Only a minority of MIS-C patients are identified as having COVID-19 by RT-PCR, but most have positive tests for immunoglobulin G. Statistically, there is a lag of 4-6 weeks between peak community cases of COVID-19 and the time at which children present with MIS-C. Although research is being done on MIS-C, and theories abound about etiology, there is no clear-cut answer to why some children get MIS-C and the vast majority do not. In a review of the literature on MIS-C using literature from December 2019 through May 2020, gastrointestinal symptoms such as diarrhea, and abdominal pain were 4-5 times more common than cough and respiratory distress. There was a slight preponderance of male patients and mean age was 8 ½ years. ICU admission was common and 2/3 required inotropic support, over ¼ needed respiratory help with extracorporeal membrane oxygenation warranted in 31 children. The death rate was 1.5 % of these very sick children treated in hospital. In another smaller study, 80% had mild, but 44% had moderate to severe EKG abnormalities including coronary involvement. The good news was that coronary arteries were normal in all children after a month, and at 4-9 months, only 2-4% had mild heart abnormalities. Unfortunately, mechanisms of MIS-C as well as universal treatment is still being worked out. Published articles may be delayed due to time constraints in publishing. Other immunologic interventions do not have sufficient data. TreatmentWhat about the treatment of children diagnosed with MIS-C?Usually, a variety of specialists become involved initially. These can include pediatric rheumatology, infectious disease, cardiology, and hematology. If children with MIS-C meet criteria for complete or incomplete Kawasaki disease as well, regardless of COVID-19 testing results, IVIG and aspirin are reasonable. Corticosteroid use must be individualized, and if used it may require a taper. An echocardiogram can be done initially looking for coronary aneurisms and repeated in a week. In severe cases, shock may be a presenting factor needing urgent attention. Generally, the treatments used are decided by the aforementioned consults and may consist of immunomodulating therapy, including possibly IVIG (2g/kg), and/or corticosteroids methylprednisolone (30mg/kg). AntiviralsThe role of antiviral therapy is unclear and remdesivir should be reserved for children with acute COVID-19. COVID-19 vaccination-associated myocarditisAnother entity which needs further evaluation is COVID-19 vaccination-associated myocarditis in adolescents. This problem is more common in young males and may occur after the administration of mRNA based COVID-19 vaccines. The presentation occurs within 2 weeks of COVID-19 vaccination, and clinical presentation can include chest pressure, abnormal biomarkers (elevated troponins), and cardiac imaging findings. It is unknown if subclinical cases occur. COVID-19 infection in children, while usually benign, has the potential to become serious, and the association between some mRNA vaccines and the occurrence of myocarditis has yet to be thoroughly studied. We look forward to more and better data to guide the care of children and young adults in these spheres. The risk of having myocarditis is still higher with the actual COVID-19 than the COVID-19 vaccine. The incidence of myocarditis after BioNtech/Pfizer vaccine was 2.13 cases per 100,000 persons in a large study done in a large health care organization in Israel where more than 2 million people were vaccinated (that represents 0.00213%). Another US study showed that there were 77 cases per million doses of vaccines in young male, in contrast, there were 450 cases of myocarditis per million COVID-19 cases in the same age group.____________________________Conclusion: Now we conclude our episode number 74 “Multisystem Inflammatory Syndrome in Children.” Dr. Schlaerth explained that MIS-C is a work in progress in terms of pathophysiology, diagnosis, treatment, and prognosis. MIS-C and Kawasaki Disease are very similar, but, for example, GI symptoms, cardiac dysfunction, shock and multisystem dysfunction are more prominent in MIS-C than Kawasaki Disease. Whereas coronary artery aneurysms are more common in Kawasaki disease than MIS-C. Even without trying, every night you go to bed being a little wiser.Thanks for listening to Rio Bravo qWeek. If you have any feedback about this podcast, contact us by email RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. This podcast was created with educational purposes only. Visit your primary care physician for additional medical advice. This week we thank Hector Arreaza, Katherine Schlaerth, and Lam Chau. Audio edition: Suraj Amrutia. See you next week! _____________________References:FDA Approves New Drug Treatment for Chronic Weight Management, First Since 2014, June 04, 2021, U.S. Food and Drug Administration (FDA), https://www.fda.gov/news-events/press-announcements/fda-approves-new-drug-treatment-chronic-weight-management-first-2014. Saxon DR, Iwamoto SJ, Mettenbrink CJ, et al. Antiobesity Medication Use in 2.2 Million Adults Across Eight Large Health Care Organizations: 2009-2015. Obesity (Silver Spring). 2019;27(12):1975-1981. doi:10.1002/oby.22581. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6868321/. Carroll, Linda, Weight-loss pills can help. So why don't more people use them? NBC News Health Care, September 2, 2018. https://www.nbcnews.com/health/health-care/weight-loss-pills-can-help-so-why-don-t-more-n905211 World Health Organization, WHO recommends groundbreaking malaria vaccine for children at risk, October 6, 2021. https://www.who.int/news/item/06-10-2021-who-recommends-groundbreaking-malaria-vaccine-for-children-at-risk Lee, Min-Sheng et. al, Similarities and Differences Between COVID-19-Related Multisystem Inflammatory Syndrome in Children and Kawasaki Disease, Front. Pediatr., 18 June 2021, https://doi.org/10.3389/fped.2021.640118. Gail F. Shust, Vijaya L. Soma, Philip Kahn and Adam J. Ratner, Pediatrics in Review July 2021, 42 (7) 399-401; DOI: https://doi.org/10.1542/pir.2020-004770. Jain SS, Steele JM, Fonseca B, et al. COVID-19 vaccination-associated myocarditis in adolescents. Pediatrics. 2021; doi:10.1542/peds.2021-053427. https://pediatrics.aappublications.org/content/pediatrics/early/2021/08/12/peds.2021-053427.full.pdf. Wilson, Clare, Myocarditis is more common after covid-19 infection than vaccination, New Scientist, 4 August 2021, https://www.newscientist.com/article/mg25133462-800-myocarditis-is-more-common-after-covid-19-infection-than-vaccination/#ixzz79JPn2E47. Son, Mary Beth F, MD, and Kevin Friedman, MD, COVID-19: Multisystem inflammatory syndrome in children (MIS-C) clinical features, evaluation, and diagnosis, Up to Date, September 2021, https://www.uptodate.com/contents/covid-19-multisystem-inflammatory-syndrome-in-children-mis-c-clinical-features-evaluation-and-diagnosis?search=kawasaki%20vs%20misc&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1
Videos for Today: 1. DR Peter C. Gøtzsche Comments – 3 mins 2. PARENTS IN NY TAKE TO THE STREETS TO WARN IGNORANT PARENTS INJECTING THEIR CHILDREN WITH PFIZER SHOT 3, DANIEL NAGASE – EFFECTS OF CV VX ON THE IMMUNE SYSTEM DEVELOPMENT IN CHILDREN 4.The Great Narrative: A call to action speaker Freeke Heijman (start 3 min mark) 5. COMMERCIAL PILOT CODY FLINT: “I DON'T KNOW IF I WILL EVER BE ABLE TO FLY A PLANE AGAIN.” 6. Study, Experts: Vaccinated Are Spreading COVID-19 start 23 seconds in 7. RFK CLIP Start 50 seconds in Everyone missed this one… vaccinated people are up to 9X more likely to be hospitalized than unvaccinated people Australian War Propaganda Keeps Getting Crazier Are we seeing some new form of Covid-19 Vaccine induced Acquired Immunodeficiency Syndrome? – Official Government data suggests the Fully Vaccinated are on the precipice of disaster as their Immune Systems are being decimated $285 Billion Tax Cut for the Rich Is Now 2nd Most Expensive Piece of Build Back Better Wall Street's Takeover of Nature Advances with Launch of New Asset Class Court Deals New Blow to ‘Fatally Flawed' Biden Vaccine Mandates, But What Does That Mean? Study: Sustainable eating is cheaper and healthier Oxford University, November 11, 2021 Oxford University research has today revealed that, in countries such as the US, the UK, Australia and across Western Europe, adopting a vegan, vegetarian, or flexitarian diet could slash your food bill by up to one-third. The study, which compared the cost of seven sustainable diets to the current typical diet in 150 countries, using food prices from the World Bank's International Comparison Program, was published in The Lancet Planetary Health. It found that in high-income countries: Vegan diets were the most affordable and reduced food costs by up to one third. Vegetarian diets were a close second. Flexitarian diets with low amounts of meat and dairy reduced costs by 14%. By contrast, pescatarian diets increased costs by up to 2%. “We think the fact that vegan, vegetarian and flexitarian diets can save you a lot of money is going to surprise people,” says Dr. Marco Springmann, researcher on the Oxford Martin Programme on the Future of Food. “When scientists like me advocate for healthy and environmentally-friendly eating, it's often said we're sitting in our ivory towers promoting something financially out of reach for most people. This study shows it's quite the opposite. These diets could be better for your bank balance as well as for your health and…the planet.” Miguel Barclay, author of the bestselling “One Pound Meals” series of cookbooks, says, “I definitely agree that cutting down your meat, or cutting it out completely, will save you money. I've written seven budget cookbooks and have costed up hundreds of recipes, and without doubt vegan and vegetarian meals consistently come in at a much lower price than recipes with meat.” The study focused on whole foods and did not include highly-processed meat replacements or eating at restaurants or takeaways. The study also found that in lower income countries, such as on the Indian subcontinent and in sub-Saharan Africa, eating a healthy and sustainable diet would be up to a quarter cheaper than a typical Western diet, but at least a third more expensive than current diets. To analyze what options could improve affordability and reduce diet costs, the study looked at several policy options. It found that making healthy and sustainable diets affordable everywhere is possible within the next 10 years when economic development, especially in lower income countries, is paired with reductions in food waste and a climate and health-friendly pricing of foods. “Affording to eat a healthy and sustainable diet is possible everywhere, but requires political will,” according to Dr. Springmann. “Current low-income diets tend to contain large amounts of starchy foods and not enough of the foods we know are healthy. And the western-style diets, often seen as aspirational, are not only unhealthy, but also vastly unsustainable and unaffordable in low-income countries. Any of the healthy and sustainable dietary patterns we looked at are a better option for health, the environment, and financially, but development support and progressive food policies are needed to make them both affordable and desirable everywhere.” The study, “The global and regional costs of healthy and sustainable dietary patterns: a modeling study,” is published in The Lancet Planetary Health on 10 November 2021. Country-level results are available here. Green One Pound Meals by Miguel Barclay is published on 30 December. It features planet-friendly recipes and includes tips and ideas for shopping smart and avoiding food waste. Meta-analysis concludes resveratrol beneficially modulates glycemic control in diabetics Zagazig University and Suez Canal University (Egypt), October 29 2021. Findings from a meta-analysis of clinical trials published on October 16, 2021 in Medicina Clinica (Barcelona) revealed an association between supplementing with resveratrol and improvements in glycemic control. “Type 2 diabetes mellitus (T2DM) is a progressive meta-inflammatory disorder, which induces micro and macrovascular complications,” Ibrahim A. Abdelhaleem and colleagues wrote. “Resveratrol is a nutraceutical known to have antioxidant and anti-inflammatory properties.” “This systematic review and meta-analysis is the first to consider resveratrol's efficacy on glycemic and cardiometabolic parameters in patients with T2DM.” Sixteen randomized trials that included a total of 871 diabetic men and women were selected for the meta-analysis. The trials compared resveratrol to a placebo with or without concurrent antidiabetic medications or other drug treatment. Resveratrol doses of 500 milligrams or more were associated with lower fasting blood glucose, fasting serum insulin, insulin resistance, total cholesterol, LDL cholesterol and diastolic blood pressure in comparison with a placebo. Resveratrol was associated with a greater reduction in hemoglobin A1c (a marker of long-term glucose control) compared to a placebo in trials of three months duration. When HDL cholesterol levels were analyzed, resveratrol was superior to a placebo in trials of less than two months duration. Resveratrol was also associated with a reduction in systolic blood pressure compared to measurements obtained in the placebo group. Furthermore, triglycerides were lower in association with resveratrol in trials that lasted six to twelve months. “We concluded that resveratrol appropriately improved insulin sensitivity by decreasing insulin resistance, fasting blood glucose, fasting serum insulin, and hemoglobin A1c,” the authors concluded. “In addition, it improved other cardiometabolic parameters, including triglycerides, total cholesterol, LDL cholesterol, and systolic and diastolic blood pressure. The most appropriate glycemic control effect was fulfilled when consumed for at least one month with doses of 500 mg or more.” Exercise linked to better mental health Kaiser Permanente Research, November 11, 2021 Kaiser Permanente research published on November 11 in Preventive Medicine showed people who exercised more during the initial lockdown period of the COVID-19 pandemic experienced less anxiety and depression than those who didn't exercise. It also showed that people who spent more time outdoors typically experienced lower levels of anxiety and depression than those who stayed inside. More than 20,000 people participated in the survey-based study from 6 regions served by Kaiser Permanente across the United States, which included Hawaii, Colorado, Georgia, and the mid-Atlantic states, as well as Southern and Northern California. “What these study findings tell us is that even during an active pandemic or other public health crisis, people should be encouraged to be physically active to help maintain their physical and mental health,” said the study's lead author Deborah Rohm Young, PhD, the director of the Division of Behavioral Research for the Kaiser Permanente Southern California Department of Research & Evaluation. “Parks and other nature areas should remain open during public health emergencies to encourage outdoor physical activity.” In March 2020, COVID-19 developed into a worldwide pandemic. With no known treatment, public health officials attempted to reduce its spread by limiting human interactions through stay-at-home policies. Businesses temporarily closed or changed their practices to prevent the spread of the virus, affecting the economy and many people's jobs. These stressful factors, along with fewer opportunities to socialize with friends and family, increased symptoms of depression and anxiety for many people. Since it is known that physical activity and time spent in nature are associated with improved mental health, researchers at Kaiser Permanente in Southern California sought to determine how exercise and time outdoors was associated with people's mental health during the height of the pandemic. In April 2020, researchers sent a series of COVID-19 surveys to more than 250,000 participants in the Kaiser Permanente Research Bank — a collection of lifestyle surveys, electronic health record data, and biospecimens, which Kaiser Permanente members volunteered. People who reported COVID-19 symptoms were not included in this analysis, resulting in 20,012 respondents. They each completed at least 4 surveys between April and July 2020. White women older than 50 accounted for a high proportion of the respondents. Most respondents said they were retired and generally adhered to the “safer-at-home” orders during the period of the survey. The study found that: Reports of anxiety and depression decreased over time Anxiety and depression scores were higher for females and younger people, and lower for Asian and Black people compared with white respondents Participants who reported no physical activity reported the highest depression and anxiety compared to people who had exercised Spending less time outdoors was associated with higher depression and anxiety scores People who had increased their time outdoors the most reported the highest anxiety scores, but the research could not explain the finding “What we learned from these findings is that during future emergencies it will be important to carefully weigh the decisions to close parks and outdoor areas against the negative impact those closures may have on people's mental health,” said Dr. Young. Bedtime linked with heart health University of Exeter (UK), November 9, 2021 Going to sleep between 10:00 and 11:00 pm is associated with a lower risk of developing heart disease compared to earlier or later bedtimes, according to a study published today in European Heart Journal—Digital Health, a journal of the European Society of Cardiology (ESC). “The body has a 24-hour internal clock, called circadian rhythm, that helps regulate physical and mental functioning,” said study author Dr. David Plans of the University of Exeter, UK. “While we cannot conclude causation from our study, the results suggest that early or late bedtimes may be more likely to disrupt the body clock, with adverse consequences for cardiovascular health.” While numerous analyses have investigated the link between sleep duration and cardiovascular disease, the relationship between sleep timing and heart disease is underexplored. This study examined the association between objectively measured, rather than self-reported, sleep onset in a large sample of adults. The study included 88,026 individuals in the UK Biobank recruited between 2006 and 2010. The average age was 61 years (range 43 to 79 years) and 58% were women. Data on sleep onset and waking up time were collected over seven days using a wrist-worn accelerometer. Participants completed demographic, lifestyle, health and physical assessments and questionnaires. They were then followed up for a new diagnosis of cardiovascular disease, which was defined as a heart attack, heart failure, chronic ischaemic heart disease, stroke, and transient ischaemic attack. During an average follow-up of 5.7 years, 3,172 participants (3.6%) developed cardiovascular disease. Incidence was highest in those with sleep times at midnight or later and lowest in those with sleep onset from 10:00 to 10:59 pm. The researchers analyzed the association between sleep onset and cardiovascular events after adjusting for age, sex, sleep duration, sleep irregularity (defined as varied times of going to sleep and waking up), self-reported chronotype (early bird or night owl), smoking status, body mass index, diabetes, blood pressure, blood cholesterol and socioeconomic status. Compared to sleep onset from 10:00 to 10:59 pm, there was a 25% higher risk of cardiovascular disease with a sleep onset at midnight or later, a 12% greater risk for 11:00 to 11:59 pm, and a 24% raised risk for falling asleep before 10:00 pm. In a further analysis by sex, the association with increased cardiovascular risk was stronger in women, with only sleep onset before 10:00 pm remaining significant for men. Dr. Plans said: “Our study indicates that the optimum time to go to sleep is at a specific point in the body's 24-hour cycle and deviations may be detrimental to health. The riskiest time was after midnight, potentially because it may reduce the likelihood of seeing morning light, which resets the body clock.” Dr. Plans noted that the reasons for the observed stronger association between sleep onset and cardiovascular disease in women is unclear. He said: “It may be that there is a sex difference in how the endocrine system responds to a disruption in circadian rhythm. Alternatively, the older age of study participants could be a confounding factor since women's cardiovascular risk increases post-menopause—meaning there may be no difference in the strength of the association between women and men.” He concluded: “While the findings do not show causality, sleep timing has emerged as a potential cardiac risk factor—independent of other risk factors and sleep characteristics. If our findings are confirmed in other studies, sleep timing and basic sleep hygiene could be a low-cost public health target for lowering risk of heart disease.” Garlic compounds may boost cardio health indirectly via gut microbiota National Taiwan University, November 6 2021 Allicin from garlic may prevent the metabolism of unabsorbed L-carnitine or choline into TMAO, a compound linked to an increased risk of cardiovascular diseases, says a new study from the National Taiwan University. TMAO – or trimethylamine N-oxide – has been known to be generated from dietary carnitine through metabolism of gut microbiota, and was recently reported to be an “important gut microbiota-dependent metabolite to cause cardiovascular diseases,” explained Taiwanese researchers in the Journal of Functional Foods . While antibiotics have been found to inhibit TMAO production, concerns over side effects and resistance have limited their use. This has led researchers to examine the potential of natural alternatives. New data indicated that carnitine-fed lab mice showed a “remarkable increase in plasma TMAO levels”, compared with lab mice fed a control (no carnitine). However, when allicin supplements were provided with the carnitine diet, TMAO levels were significantly reduced. “Surprisingly, the plasma TMAO levels in the mice of ‘carnitine diet + allicin' treatment group were as low as that of chow diet [control] group,” wrote the researchers. “This result indicated that the metabolic capacity of mice gut microbiota to produce TMAO was completely inhibited by allicin supplement even though provided with carnitine-rich environment in the gut. “It means the functional alteration of gut microbiota induced by carnitine diet can be prevented by addition of another substance with antimicrobial potential derived from food, such as allicin.” Garlic and heart health The study adds to the body of scientific literature supporting the potential heart health benefits of garlic and the compounds it contains. Consumer awareness of the health benefits of garlic, mostly in terms of cardiovascular and immune system health, has benefited the supplements industry, particularly since consumers seek the benefits of garlic without the odors that accompany the fresh bulb. The benefits have been linked to the compound allicin, which is not found in fresh garlic: It is only formed when garlic is crushed, which breaks down a compound called diallyl sulphide. Study details “This may offer an opportunity to take advantage of plants' delicately designed defense system against microorganisms, to protect ourselves by modulating gut microbiota to a healthier status,” wrote the researchers The Taiwanese researchers divided male C57BL/6(B6) mice into four groups: One group received only the control chow diet; the second group received the carnitine diet (carnitine added to drinking water at a level of 0.02%); the third group received the carnitine diet with supplemental allicin; and the final group received the control diet plus the allicin supplement for six weeks. Results showed that the second group (carnitine diet) had TMAO levels 4–22 times greater than those observed in the control group. However, these increases were attenuated in the carnitine + allicin group, said the researchers. “Our study suggests that antimicrobial phytochemicals such as allicin effectively neutralize the metabolic ability of TMAO production of gut microbiota induced by daily intake of L-carnitine,” wrote the researchers. “It may offer an opportunity for us to take advantage of plants' delicately designed defense system against microorganisms, to protect ourselves by modulating gut microbiota to a healthier status. “Our research also suggested that allicin and dietary fresh garlic containing allicin might be used as functional foods for the prevention of atherosclerosis,” they concluded. Drug used to prevent miscarriage increases risk of cancer in offspring University of Texas Health Science Center, November 9, 2021 Exposure in utero to a drug used to prevent miscarriage can lead to an increased risk of developing cancer, according to researchers at The University of Texas Health Science Center at Houston (UTHealth Houston). The study was published today in the American Journal of Obstetrics and Gynecology. The drug, 17α-hydroxyprogesterone caproate (17-OHPC), is a synthetic progestogen that was frequently used by women in the 1950s and 1960s, and is still prescribed to women today to help prevent preterm birth. Progesterone helps the womb grow during pregnancy and prevents a woman from having early contractions that may lead to miscarriage. “Children who were born to women who received the drug during pregnancy have double the rate of cancer across their lifetime compared to children born to women who did not take this drug,” said Caitlin C. Murphy, PhD, MPH, lead author on the study and associate professor in the Department of Health Promotion and Behavioral Sciences at UTHealth School of Public Health in Houston. “We have seen cancers like colorectal cancer, pancreatic cancer, thyroid cancer, and many others increasing in people born in and after the 1960s, and no one really knows why.” Researchers reviewed data from the Kaiser Foundation Health Plan on women who received prenatal care between June 1959 and June 1967, and the California Cancer Registry, which traced cancer in offspring through 2019. Out of more than 18,751 live births, researchers discovered 1,008 cancer diagnoses were made in offspring ages 0 to 58 years. Additionally, a total of 234 offspring were exposed to 17-OHPC during pregnancy. Offspring exposed in the womb had cancer detected in adulthood more than twice as often as offspring not exposed to the drug – 65% of cancers occurred in adults younger than 50. “Our findings suggest taking this drug during pregnancy can disrupt early development, which may increase risk of cancer decades later,” Murphy said “With this drug, we are seeing the effects of a synthetic hormone. Things that happened to us in the womb, or exposures in utero, are important risk factors for developing cancer many decades after we're born.” A new randomized trial shows there is no benefit of taking 17-OHPC, and that it does not reduce the risk of preterm birth, according to Murphy. The U.S. Food and Drug Administration proposed in October 2020 that this particular drug be withdrawn from the market.
The venerable SF Examiner is under new ownership and management. Editor in Chief Carly Schwartz, after stints at The Huffington Post and Google has a 5 prong strategy to reorganize the paper: Findings, Fixes, Faces, Forum and Fanfare. And it will be a crusading force against some of the City's chronic problems. A new broom sweeps clean ! --- Send in a voice message: https://anchor.fm/james-herlihy/message
Pediatric pain management is fraught with reasons that make it feel like we are operating blindfolded. Many treatments are used without clear indications or evidence specifically in this population. What if you had a way to study what you do in pediatric pain management, while you do it, would you embrace it? In this episode, Dr. Drake Ross, a specialty pediatrician at Starship Children's Health in Auckland, New Zealand with training in pediatric pain and palliative care, shares with us the features, goals and outcomes of their Rapid pharmacovigilance program, a multi institutional collaborative clinical research endeavor. This program provides real-time evaluation of net clinical benefit of what we do in our day to day clinical practice, while we do it! Takeaways In This Episode What got Dr. Drake's to transition from general pediatrics into palliative care and pediatric pain medicine How he get interested in pharmacovigilance and how he initiated that for pediatric pain medicine as the RAPID multi-institutional, international endeavor What Rapid is? Findings of their research thus far and what's on the horizon How you can participate in this research endeavor while carrying out your daily clinical work and the benefits it offers as collaborators How they determine their protocol numbers and demographics What Dr. Drake hopes for Rapid to achieve Unique benefits of this collaborative research compared with other databases based research (Hint: the ability of foresight and hindsight simultaneously!) The biggest takeaways and his message to the audience Links Ross Drake, MB ChB, FRACP, FAChPM, FFPMANZCA Rapid Program Get involved with Rapid program Alternate Contact Attend the International Symposium on Pediatric Pain 2022 Clinicians' Pain Evaluation Toolkit Proactive Pain Solutions About the Guest: Ross Drake, MB ChB, FRACP, FAChPM, FFPMANZCA Dr. Drake is a Pediatrician who specializes in Pain Medicine and Palliative Care for children having gained fellowships in Paediatrics, Palliative Medicine and Pain Medicine after he completed specialist training at Great Ormond Street Hospital in London and The Children's Hospital at Westmead in Sydney. Ross is Clinical Lead of the Paediatric Palliative Care and Complex Pain Services at Starship Children's Hospital; both being the only specialist services of their type in New Zealand. Amongst his clinical duties he strives to improve the recognition and support of children/tamariki & young adults/rangitahi and their families/whānau requiring palliative care and the management of chronic pain. He remains very involved in developing a national approach to both disciplines and works to improve resourcing to enable equitable access and service delivery for all New Zealand children in need. Dr Drake also regularly presents and teaches on various topics in children's pain medicine and palliative care. More recently, he has been involved with establishing an international pharmacovigilance research collaborative (The RAPID Program) looking at the effectiveness and adverse effects of medications and other interventions commonly used in palliative care and pain management.
Much of what is thought about hormone replacement therapy is outdated and untrue. We do a deep dive into what is HRT, what are the benefits, and who should and should not be taking it. What happens during a women's hormone journey from childhood to post-menopausal? How are hormones and a woman's brain connected? What happens in a women's body during menopause? What is hormone replacement therapy? Does HRT increase the risk of breast cancer? What is the relation between hormones and the cardiovascular system? How does menopause impact sleep? Dr. Rebecca Dunsmoor-Su is the Medical Director of Menopause services at the Women's Wellness and Gyn Specialties Clinic at Swedish Medical Center. She is also the Chief Medical Officer at Gennev. Dr. Dunsmoor-Su joins us on the SuperAge podcast for an information-dense episode all about menopause. She explains what happens leading up to and during menopause, some of the symptoms like weight gain, trouble sleeping, brain fog, and how they are addressed, how we can use hormone replacement therapy to improve symptoms and longevity for women post-menopause, and much more. What you will learn in this episode:What a woman's body goes through in terms of hormones from childhood all the way through post-menopause The impact of menopause on the brainEverything we need to know about hormone replacement therapy and some of the myths around itHow menopause impacts sleep and what can help How menopause impacts brain health and the cardiovascular system “Estrogen replacement does not cause breast cancer. And I like to shout that from the rooftops. We have many studies that tell us that estrogen replacement does not cause breast cancer.” “Women who start hormone replacement therapy within 5 years of their last period actually reduce their cardiovascular risk. They also slightly reduce their risk of colon cancer and they reduce their all cause mortality overtime.” “When women are transitioning through menopause, we're talking about 5-10 years of disrupted sleep. That's a lot of impact to the brain.” “Menopause is fine and functional if you're going to live to be 65. You've got 10 years to survive menopause, you're going to be okay. We live to 95, 100, 105! That's a long time, that's almost half your life without the hormones that sort of keep things going. So I think that we need to adjust.” Listen to the SuperAge podcast wherever you get your pods. Connect with Dr. Rebecca Dunsmoor-Su: https://swedishfoundation.org/frontline-Dunsmoor-Su LinkedIn: https://www.linkedin.com/in/rebecca-dunsmoor-su-92a4997b/ Check out the app, CBT-i Coach, that Dr. Dunsmoor-Su recommends for at home Cognitive Behavioral Therapy for insomnia: https://apps.apple.com/us/app/cbt-i-coach/id655918660
First Watch is a breakfast and lunch restaurant franchise serving made-to-order breakfast, brunch and lunch using fresh ingredients. First Watch offers traditional favorites, such as omelets, pancakes, sandwiches and salads, and unique specialty items like quinoa power bowls, and avocado toast. First Watch also sells alcoholic beverages. You can learn more here: https://www.vettedbiz.com/first-watch-franchise/ If you are looking for more information, you can connect with us through our networks: https://www.vettedbiz.com/ https://www.linkedin.com/company/vettedbiz/ https://www.facebook.com/vettedbiz
Welcome to the NeurologyLive Mind Moments podcast. Tune in to hear leaders in neurology sound off on topics that impact your clinical practice. In this episode, we spoke with Victor Sung, MD, director, UAB Huntington's Disease Clinic, codirector, UAB School of Medicine Neuroscience Module, and director, Birmingham VAMC Deep Brain Stimulation Program. Sung detailed data on the cost of genetic testing in HD that he and colleagues presented earlier this year at the International Parkinson and Movement Disorders Society Congress (MDS 2021), and the current utilization of testing in clinical practice. Episode Breakdown: 1:45 – Background on the genetic testing process 3:50 – Findings of the study presented at MDS 2021 7:30 – Future plans to evaluate genetic testing costs 11:30 – Current utilization of genetic testing for HD 14:10 – Neurology News Minute 18:05 – Raising awareness for genetic testing 21:25 – Biggest step forward in Huntington disease 25:10 – Takeaways from MDS 2021 The stories featured in this week's Neurology News Minute, which will give you quick updates on the following developments in neurology, are further detailed here: Cerezen Device Gets Breakthrough Designation in Alzheimer Disease, MCI Eli Lilly Initiates Rolling Submission for Donanemab in Early Alzheimer Disease Amylyx Submits New Drug Application for ALS Treatment AMX0035 Thanks for listening to the NeurologyLive Mind Moments podcast. To support the show, be sure to rate, review, and subscribe wherever you listen to podcasts. For more neurology news and expert-driven content, visit neurologylive.com. REFERENCE Massey M, Orem T, Sung V. Cost of Predictive Genetic Testing for Huntington's Disease at Centers of Excellence in the US. Presented at: MDS Congress 2021; September 17-22; Virtual. Poster 240.
While Lunchbox was napping at the diamond mine in Arkansas, Abby did some digging of her own. She took her findings to get checked out and shared with us what she found. We Spin the Wheel and the loser must drink a bottle of turkey flavored soda. Amy is taking her daughter to see Garth Brooks but she's never listened to his music before. Bobby shares his Top 5 Garth Brooks songs for her to enjoy while at the show! Learn more about your ad-choices at https://www.iheartpodcastnetwork.com
Recap your news day with the Grand Forks Herald Minute Podcast. Join us daily for the latest headlines from news, weather and sports in the northern Red River Valley area. The Grand Forks Herald Minute can be found on Spotify, Apple and Google Podcasts as well as the Herald website.
It sounds reasonable to say that investing in the most popular companies would produce the best returns, but this is just not how asset pricing works. Today on the show, we unpack the ‘good company is a good investment' fallacy. Before diving into the main topic, we kick off our discussion on the subject of index funds with Robert Wigglesworth's Trillions. From there, we share some updates about custom indexing and home buying in Canada, along with the immense valuation of Tesla as well as Elon Musk's net worth. This acts as a great segue into the focus of today's show: a so-called good company has high historical returns, strong earnings growth, strong forecasted earnings growth, and high prices. But just because the good companies have done well historically, this does not mean they will continue to be a good investment. In fact, there is a premium that says that higher-priced stocks earn lower returns than lower-priced stocks and value stocks. We unpack several papers that explore the concept that it is the lesser-known companies that tend to have better returns. We also get into how growth extrapolation, the skewness effect, and the big market delusion plays into the good company is a good investment fallacy. Our discussion concludes with the idea that investors are better off paying attention to expected returns rather than falling victim to extrapolation errors. Tune in today! Key Points From This Episode: Introductory comments: modifications to the show, listener feedback, and more. [0:00:30.2] Book review of the week: Trillions by Robert Wigglesworth. [0:08:28.3] News updates: custom indexing, Tesla valuation, homebuyer gifts, and more. [0:12:23.2] Introducing today's topic: the ‘good company is a good investment' fallacy. [0:19:30:9] Investing in good companies is irrational because of how asset pricing works. [0:20:44.7] The threat that crypto and decentralized applications pose to good companies. [0:21:50.5] Higher-priced stocks earn lower returns than lower-priced and value stocks. [0:24:40.3] Findings from papers exploring glamorous stocks and investor bias. [0:27:21.2] The problem of extrapolating growth too far into the future. [0:34:07.1] Behaviour patterns of lottery-like stocks with high expected skewness. [0:37:17.4] Declining prices and the big market delusion. [0:39:51.1] The high prices and low expected returns of the NIFTY 50 companies. [0:44:05.2] What the Fama French Five-Factor Model has to say about how assets are priced. [0:45:30.2] Talking Cents: Questions about the price we pay for riches. [0:46:50.2]
Supplementation with vitamins C and E associated with decreased risk of cognitive impairment, dementia CHU de Québec Research Center, November 1, 2021. An article that appeared in the Annals of Pharmacotherapy reports an association between the intake of vitamin C and E supplements and a lower risk of developing cognitive decline among men and women aged 65 years and older. The current investigation included 5,269 men and women who were free of dementia upon enrollment in the Canadian Study of Health and Aging from 1991 to 1992. Follow-up examinations conducted during 1996-1997 and 2001-2002 provided post-enrollment diagnoses of dementia or cognitive impairment without dementia. Information concerning current use of prescription drugs and vitamins was ascertained from interview or questionnaire responses at the beginning of the study. Approximately 10% of the subjects reported using vitamin C or E. Over up to 11 years of follow up, 821 cases of all-cause dementia (including 560 Alzheimer's disease cases) were diagnosed and 882 cases of cognitive impairment without dementia developed. In comparison with those who did not report supplementing with either vitamin, the use of vitamin C and/or vitamin E was associated with a 38% lower adjusted risk of all-cause dementia and a 40% lower risk of Alzheimer's disease. For cognitive impairment without dementia, the risk was 23% lower among those who used either or both vitamins. Evaluation of the effects of using either vitamin alone resulted in associations with similar risk reductions. “This study supports a protective role of vitamin E and C supplements in the risk for Alzheimer's disease and all-cause dementia,” authors Luta L. Basambombo, MSc, of CHU de Québec Research Center and colleagues conclude. “In addition, these supplements may contribute to a reduced risk of CIND [cognitive impairment, not dementia]. Overall, these findings indicate additional support for the use of antioxidants as a preventive strategy against cognitive decline.” Research suggests calorie restriction may be better than keto for cancer patients Massachusetts Institute of Technology, October 22 2021. Findings reported in Nature revealed that restricting the intake of calories, including fats, rather than adopting a regimen of restricted carbohydrates and increased fats as characterized by a ketogenic diet, was associated with slower tumor growth in mice. Evan Lien, PhD, and associates evaluated the effects of calorie restricted, ketogenic or normal diets in mice with pancreatic tumors. While both glucose and plasma and tumor lipid levels declined in calorie-restricted animals, ketogenic diet-fed mice had lower glucose levels, but an increase in lipids. In comparison with mice given ketogenic diets, slower tumor growth occurred in the calorie-restricted mice. The finding can be explained by the animals' reduced levels of lipids, which are needed by cancer cells for membrane production. Diet-induced lipid depletion decreases cellular levels of polyunsaturated fatty acids because they can't be manufactured by the body and must be obtained from food. When these lipids aren't available, cells make their own in a process that requires the enzyme SCD, which converts saturated fatty acids into unsaturated fatty acids. Since both diets lowered SCD activity, mice that received calorie restricted diets couldn't obtain enough fatty acids from their diet or produce their own, whereas animals on the ketogenic diet had abundant lipids. “Not only does caloric restriction starve tumors of lipids, it also impairs the process that allows them to adapt to it,” Dr Lien explained. “That combination is really contributing to the inhibition of tumor growth.” “The purpose of these studies isn't necessarily to recommend a diet, but it's to really understand the underlying biology,” Dr Lien stated. “They provide some sense of the mechanisms of how these diets work, and that can lead to rational ideas on how we might mimic those situations for cancer therapy.” Widespread fast-food restaurants linked to higher rates of type 2 diabetes New York University, November 1, 2021 An increasing number of studies suggest a link between a neighborhood's built environment and the likelihood that its residents will develop chronic diseases such as heart disease, type 2 diabetes (T2D) and certain types of cancers. A new nationwide study led by researchers from NYU Grossman School of Medicine published online today in JAMA Network Open suggests that living in neighborhoods with higher availability of fast-food outlets across all regions of the United States is associated with higher subsequent risk of developing type 2 diabetes. Findings also indicated that the availability of more supermarkets could be protective against developing T2D, particularly in suburban and rural neighborhoods. The study—notable for its large geographic breadth—uses data from a cohort of more than 4 million veterans living in 98 percent of U.S. census tracts across the country. It counted fast-food restaurants and supermarkets relative to other food outlets, and is the first, according to the researchers, to examine this relationship in four distinct types of neighborhoods (high-density urban, low-density urban, suburban, and rural) at the hyperlocal level nationwide. "Most studies that examine the built food environment and its relationship to chronic diseases have been much smaller or conducted in localized areas," said Rania Kanchi, MPH, a researcher in the Department of Population Health at NYU Langone and lead author of the study. "Our study design is national in scope and allowed us to identify the types of communities that people are living in, characterize their food environment, and observe what happens to them over time. The size of our cohort allows for geographic generalizability in a way that other studies do not." How the study was conducted The research team used data from the U.S. Veterans Health Administration (the largest single-payer healthcare system in the country) that captures more than 9 million veterans seen at more than 1,200 health facilities around the country. Using this data, the researchers then constructed a national cohort of more than 4 million veterans without diabetes from the VA electronic health records (EHR) between 2008 and 2016. Each veteran's health status was followed through 2018 or until the individual either developed diabetes, died, or had no appointments for more than two years. Within each of four distinct neighborhood types, the proportion of restaurants that were fast food, and the proportion of food outlets that were supermarkets were tabulated within a one-mile walk in high- density urban neighborhoods, a two-mile drive in low-density urban neighborhoods, a six-mile drive in suburban communities, and a 10-mile drive in rural communities. Veterans were followed for a median of five and a half years. During that time, 13.2 percent of the cohort were newly diagnosed with T2D. Males developed T2D more frequently than females (13.6 versus 8.2 percent). Non-Hispanic Black adults had the highest incidence (16.9 percent), compared to non-Hispanic Whites (12.9 percent), non-White Asian and Hispanics (12.8 percent), Native Hawaiian and Pacific Islanders (15 percent), and Native American and Alaskan Indians (14.2 percent). When stratifying by community types, 14.3 percent of veterans living in high density urban communities developed T2D, while the lowest incidence was among those living in suburban and small town communities (12.6 percent). Overall, the team concluded that the effect of the food environment on T2D incidence varied by how urban the community was, but did not vary further by region of the country. "The more we learn about the relationship between the food environment and chronic diseases like type 2 diabetes, the more policymakers can act by improving the mix of healthy food options sold in restaurants and food outlets, or by creating better zoning laws that promote optimal food options for residents," said Lorna Thorpe, Ph.D., MPH, professor in the Department of Population Health at NYU Langone and senior author of the study. One limitation of the study, according to the authors, is that the study may not be fully generalizable to non-veteran populations, as U.S. veterans tend to be predominantly male and have substantially greater health burdens and financial instability than the civilian population. They are also at greater risk of disability, obesity, and other chronic conditions. The next phase of the research, say Thorpe and Kanchi, will be to better understand the impacts of the built environment on diabetes risk by subgroups. They plan to examine whether or not the relationships between fast-food restaurants, supermarkets and community types vary by gender, race/ethnicity, and socioeconomic status. Researchers have discovered neurons needed for acupuncture's anti-inflammatory response Harvard Medical School, October November 1, 2021 Acupuncture is a traditional Chinese technique that has been used for millennia to treat chronic pain and other health problems associated with inflammation, yet the scientific basis of the technique remains poorly understood. Now, a team of researchers led by neuroscientists at Harvard Medical School has elucidated the underlying neuroanatomy of acupuncture that activates a specific signaling pathway. In a study conducted in mice and published Oct. 13 in Nature, the team identified a subset of neurons that must be present for acupuncture to trigger an anti-inflammatory response via this signaling pathway. The scientists determined that these neurons occur only in a specific area of the hindlimb region—thus explaining why acupuncture in the hindlimb works, while acupuncture in the abdomen does not. "This study touches on one of the most fundamental questions in the acupuncture field: What is the neuroanatomical basis for body region, or acupoint, selectivity?" said lead investigator Qiufu Ma, HMS professor of neurobiology at Dana-Farber Cancer Institute. One area of particular interest to the research team is the so-called cytokine storm—the rapid release of large quantities of cytokines that frequently drives severe, systemic inflammation, and can be triggered by many things, including COVID-19, cancer treatment, or sepsis. "This exuberant immune response is a major medical problem with a very high fatality rate of 15 percent to 30 percent," Ma said. Even so, drugs to treat cytokine storm are lacking. Adapting an ancient technique to treat aberrant inflammation In recent decades, acupuncture has been increasingly embraced in Western medicine as a potential treatment for inflammation. In this technique, acupoints on the body's surface are mechanically stimulated, triggering nerve signaling that affects the function of other parts of the body, including organs. In a 2014 study, researchers reported that electroacupuncture, a modern version of traditional acupuncture that uses electrical stimulation, could reduce cytokine storm in mice by activating the vagal-adrenal axis—a pathway wherein the vagus nervesignals the adrenal glands to release dopamine. In a study published in 2020, Ma and his team discovered that this electroacupuncture effect was region-specific: It was effective when given in the hindlimb region, but did not have an effect when administered in the abdominal region. The team hypothesized that there may be sensory neurons unique to the hindlimb region responsible for this difference in response. In their new study, the researchers conducted a series of experiments in mice to investigate this hypothesis. First, they identified a small subset of sensory neurons marked by expression of the PROKR2Cre receptor. They determined that these neurons were three to four times more numerous in the deep fascia tissue of the hindlimb than in the fascia of the abdomen. Then the team created mice that were missing these sensory neurons. They found that electroacupuncture in the hindlimb did not activate the vagal-adrenal axis in these mice. In another experiment, the team used light-based stimulation to directly target these sensory neurons in the deep fascia of the hindlimb. This stimulation activated the vagal-adrenal axis in a manner similar to electroacupuncture. "Basically, the activation of these neurons is both necessary and sufficient to activate this vagal-adrenal axis," Ma said. In a final experiment, the scientists explored the distribution of the neurons in the hindlimb. They discovered that there are considerably more neurons in the anterior muscles of the hindlimb than in the posterior muscles, resulting in a stronger response to electroacupuncture in the anterior region. "Based on this nerve fiber distribution, we can almost precisely predict where electrical stimulation will be effective and where it will not be effective," Ma explained. Together, these results provide "the first concrete, neuroanatomic explanation for acupoint selectivity and specificity," Ma added. "They tell us the acupuncture parameters, so where to go, how deep to go, how strong the intensity should be." He noted that while the study was done in mice, the basic organization of neurons is likely evolutionarily conserved across mammals, including humans. However, an important next step will be clinical testing of electroacupuncture in humans with inflammation caused by real-world infections such as COVID-19. Ma is also interested in exploring other signaling pathways that could be stimulated by acupuncture to treat conditions that cause excessive inflammation. "We have a lot of tough chronic diseases that still need better treatments," he said, such as inflammatory bowel syndrome and arthritis. Another area of need, he added, is excessive immune reactions that can be a side effect of cancer immunotherapy. Ma hopes that his research will ultimately advance scientific understanding of acupuncture and provide practical information that can be used to improve and refine the technique. Happy childhood memories linked to better health later in life Michigan State University, November 5, 2018 People who have fond memories of childhood, specifically their relationships with their parents, tend to have better health, less depression and fewer chronic illnesses as older adults, according to research published by the American Psychological Association. "We know that memory plays a huge part in how we make sense of the world—how we organize our past experiences and how we judge how we should act in the future. As a result, there are a lot of different ways that our memories of the past can guide us," said William J. Chopik, Ph.D., from Michigan State University and lead author of the study. "We found that good memories seem to have a positive effect on health and well-being, possibly through the ways that they reduce stress or help us maintain healthy choices in life." The findings were published in the journal Health Psychology. Previous research has shown a positive relationship between good memories and good health in young adults, including higher quality of work and personal relationships, lower substance use, lower depression and fewer health problems, according to Chopik. He and his co-author, Robin Edelstein, Ph.D., from the University of Michigan, Ann Arbor, wanted to see how this would apply to older adults. Also, much of the existing research focused on mothers and rarely examined the role of fathers in child development. Chopik and Edelstein sought to expand on the existing studies to include participants' reflections of their relationships with both parents. The researchers used data from two nationally representative samples, the National Survey of Midlife Development in the United States and the Health and Retirement Study, with a total of more than 22,000 participants. The first study followed adults in their mid-40s for 18 years and the second followed adults 50 and over for six years. The surveys included questions about perceptions of parental affection, overall health, chronic conditions and depressive symptoms. Participants in both groups who reported remembering higher levels of affection from their mothers in early childhood experienced better physical health and fewer depressive symptoms later in life. Those who reported memories with more support from their fathers also experienced fewer depressive symptoms, according to Chopik. "The most surprising finding was that we thought the effects would fade over time because participants were trying to recall things that happened sometimes over 50 years ago. One might expect childhood memories to matter less and less over time, but these memories still predicted better physical and mental health when people were in middle age and older adulthood," said Chopik. There was a stronger association in people who reported a more loving relationship with their mothers, noted Chopik, but that might change. "These results may reflect the broader cultural circumstances of the time when the participants were raised because mothers were most likely the primary caregivers," said Edelstein. "With shifting cultural norms about the role of fathers in caregiving, it is possible that results from future studies of people born in more recent years will focus more on relationships with their fathers." Chopik and Edelstein found that participants with positive childhood memories also had fewer chronic conditions in the first study of 7,100 people, but not in the second study of 15,200, making the results less straightforward Researchers outline the connection between inflammation and depression Emory University, October 28, 2021 In a paper published recently in Pharmacological Reviews, Emory University School of Medicine researchers outlined the impact of inflammation on motivation as it relates to depression. The researchers propose that low grade inflammation affects brain chemicals and brain circuits that regulate motivation, ultimately leading to motivational deficits and a loss of interest or willingness to engage in usually pleasurable activities including work and play. These motivational deficits are reflected as anhedonia, a core and likely the most disabling symptom of depression, as well as other psychiatric disorders. The paper also outlines how these effects of inflammation on the brain are an adaptation to the energy demands of inflammation that require conservation of energy resources, and thus the shutting down of behavior. Low grade inflammation can be caused by lifestyle changes such as poor diet and sedentary behavior. "A vicious cycle can occur where poor lifestyle habits lead to increased inflammation that in turn reduce the wherewithal or motivation to change those habits. Such a vicious cycle may be especially relevant during pandemic life when even greater energy resources are required to sustain healthy eating and physical activity," says Andrew H. Miller, MD, William P. Timmie Professor of Psychiatry and Behavioral Sciences, Emory University School of Medicine. Miller co-authored the paper, along with his colleagues in the Department of Psychology and the Emory Behavioral Immunology Program, where he serves as director. Miller says novel treatment strategies to break this vicious cycle are currently under development. He and his colleagues raise the possibility of developing treatments specifically for the motivational deficits caused by inflammation, thus moving to a much more targeted approach to therapeutic development in psychiatry, as now seen in the oncology field, versus the current use of outdated and non-specific diagnostic categories of psychiatric disease such as "depression." "We believe more therapies targeted to specific pathophysiologic pathways and symptoms will lead to better outcomes and more precision care. Non-specific therapies as represented by conventional antidepressants, which are still embraced by regulatory agencies, do not instill the confidence that a more personalized approach does. There is widespread interest in moving in this direction internationally," says Miller.
Stanford Professor of Global Health, Infectious Diseases, and Pediatrics, Dr. Yvonne Maldonado, joins Dr. Marc Siegel and offers insight into the clinical trials she's led looking at the safety and efficacy of COVID vaccines for children. And, she explains how vaccinating pregnant women benefits their babies.
Alina Allen and Ian Rowe lead the Surfers in considering biopathological shortcomings in fibrosis as a solitary endpoint. Their comments stem from Alina's presentation of the recent Mayo Clinic paper, "MRE for Prediction of Long-Term Progression and Outcome in Chronic Liver Disease: A Retrospective Study." In this conversation, Alina summarizes the paper, after which Stephen Harrison asks questions about availability of subgroup analysis.This conversation focuses on flaws in biopsy as a measurement device and also in fibrosis as a solitary endpoint.In the rest of the discussion, the group discusses challenges in proving that NITs can accurate measure and differentiate between different drugs in terms of therapeutic efficacy. One challenge is with the current metrics. We speak frequently about the challenges with biopsy and with fibrosis being an ordinal variable, but as Alina notes, being too tied for fibrosis means we focus solely on one measure of improvement and downplay others, such as steatosis.The conversation is too rich and nuanced to be captured in a paragraph or two. This episode is worth two or three listens to capture all its points.
Chris & Josh discuss the report released this week relating to sexual abuse charges levied against a former Assistant Coach at the Blackhawks along with the fall out being felt across the hockey world.Its then onto a standings run through along with picks of the week.Please follow, rate and review. Also check us out at atpsports.nethttps://linktr.ee/atpsports#atpsportsnetwork #nhl #hockey #flames #letsgooilers #gohabsgo #gosensgo #leafsforever #canucks #gojetsgo #nhlbruins #letsgobuffalo #njdevils #isles #nyr #anytimeanywhere #letsgopens #allcaps #flytogether #yotes #goavsgo #gokingsgo #mnwild #sjsharks #stlblues #vegasborn #letsgocanes #blackhawks #cbj #gostars #lgrw #flapanthers #preds #gobolts #seakraken
Welcome back NAKE'd listeners! If you're reading this, you are awesome! Did you know that we have a live stream of this show on Mondays? You should check out the OM Linktree links down below. This week, we discuss: Alec Baldwin fires a Hot Gun on Set of “Rust” N.I.H report regarding bat findings in Wuhan Nintendo Subscription Backlash Check out our website www.officialmillennials.com, and tag us @OG_TheNAKEdPod on Twitter. If you have anything to talk to us about, email email@example.com Social Links: NJ - https://linktr.ee/NoThisIsNJ Alan – https://linktr.ee/peach_zee Kielyn – https://linktr.ee/puzzldscarlett Ethan – https://bio.fm/crazyebie Official Millennial - https://linktr.ee/OfficialMillennials Music by Joseph McDade, GameChops (www.gamechops.com), & Purple Planet Music (www.purple-planet.com) #OGNAKEdPod --- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app --- Send in a voice message: https://anchor.fm/officialmillennials/message
The possibility of microbial treatments for autism has inspired a burst of research and nascent clinical trials, but new research suggests these efforts rest on shaky scientific ground. The post Despite flurry of findings, doubts dog gut microbes' role in autism appeared first on Spectrum | Autism Research News.
There's a mental health crisis in America, people are not always getting the help they need, and then the world got plunged into a global pandemic. So how bad is the problem right now? Which states are doing better to get resources out to people? And what can we do as individuals and across our society to address a problem that really affects everyone? Mental Health America recently released their State of Mental Health in America report and we dug into it with Mental Health America President and CEO Schroeder Stribling. Read the report here: https://mhanational.org/issues/state-mental-health-america Learn more about your ad choices. Visit podcastchoices.com/adchoices
These are simply my findings. From someone who didn't see the point, to someone who was anti, to someone who simply went and got it. I share my reasons in the episode. I felt a sense of responsibility to share my findings, as this may help someone listening to find some ease and let go of some fear. If this serves you, please share it. I am writing this a few hours after my first jab, and I'm feeling sweet. I'm not pro or anti vax, I'm for humans. Thus, my shares are unbiased. Below are the links to the studies and articles I touched on in this episode. I did my best to find studies that weren't government funded so we could ensure unbiasedness... however, a couple naturally were still govt funded, as studies focused on these areas are still limited. I am not a doctor, and this is not medical advise. Please do your own research, and make the decision that you feel is best for you. References COVID-19 vaccines and decreased transmission of SARS-CoV-2 https://link.springer.com/article/10.1007/s10787-021-00847-2 Delta coronavirus variant: scientists brace for impact https://www.nature.com/articles/d41586-021-01696-3 Interim recommendations for use of the Pfizer–BioNTech COVID-19 vaccine, BNT162b2, under Emergency Use Listing https://apps.who.int/iris/bitstream/handle/10665/341786/WHO-2019-nCoV-vaccines-SAGE-recommendation-BNT162b2-2021.2-eng.pdf?sequence=1 First Month of COVID-19 Vaccine Safety Monitoring — United States, December 14, 2020–January 13, 2021 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8344985/ Quantifying the relationship between SARS-CoV-2 viral load and infectiousness https://elifesciences.org/articles/69302 Lowering SARS-CoV-2 viral load might affect transmission but not disease severity in secondary cases – Authors' reply https://doi.org/10.1016/S1473-3099(21)00210-3 How long to mRNA and spike proteins last in the body https://www.nebraskamed.com/COVID/where-mrna-vaccines-and-spike-proteins-go Allergic Reactions Including Anaphylaxis After Receipt of the First Dose of Pfizer-BioNTech COVID-19 Vaccine https://jamanetwork.com/journals/jama/article-abstract/2775646 Warnings regarding the potential coronavirus disease 2019 (COVID-19) transmission risk: Vaccination is not enough https://www.cambridge.org/core/journals/infection-control-and-hospital-epidemiology/article/warnings-to-the-potential-covid19-transmission-risk-vaccine-is-not-enough/46D4F976C2928BC19267B5FEBAE29D13 With love, Kez. --- Send in a voice message: https://anchor.fm/pocketcoach/message
Find out how many witnesses went before U.S. Coast Guard's Board of Inquiry and testified. Learn what formidable conclusion was best reached by board regarding Bradley's status the night she sank. Find out if more vessels were already anchored to becoming anchored around time Bradley herself went down night of November 18. Learn if Deceased Bradley Captain Roland Bryan was held liable for any personal actions. Find out what new recommendations were suggested by U.S. Coast Guard regarding the future of Great Lakes Vessels. Learn how shock & sadness got replaced by other forms of personal feelings, which impacted Elmer Fleming & Frank Mays. Discover what new realities lie at stake for Michigan Limestone & Bradley Transportation Officials. Getting an understanding of how Bradley's sinking alone greatly altered relations amongst Rogers City's People. --- Send in a voice message: https://anchor.fm/kirk-monroe/message Support this podcast: https://anchor.fm/kirk-monroe/support
Wednesday's episode of Locked On Blackhawks begins with a FULL recap of the findings from the Blackhawks' independent investigation. Then, host Jack Bushman talks about how those findings are going to affect Joel Quenneville (FLA Panthers HC), Kevin Cheveldayoff (WGP Jets GM), and Blackhawks head coach Jeremy Colliton. The episode concludes with a quick preview of tonight's matchup with the Toronto Maple Leafs. All that and more on Locked On Blackhawks. Part of the Locked On Podcast Network. Your Team. Every Day. Lawsuit Recap (2:00) Quenneville & Cheveldayoff (15:30) Colliton's Status (18:45) Preview vs. Leafs (24:55) There is only 1 place that has you covered and 1 place we trust. Betonline.ag! Sign up today for a free account at betonline.ag and use that promocode: LOCKEDON for your 50% welcome bonus. Built Bar is a protein bar that tastes like a candy bar. Go to builtbar.com and use promo code “LOCKED15,” and you'll get 15% off your next order. Learn more about your ad choices. Visit podcastchoices.com/adchoices
Mike Mulligan and David Haugh were joined by Dan Bernstein and Leila Rahimi for transition, where they discussed the findings of the investigation into how the Blackhawks handled sexual assault allegations against video coach Bradley Aldrich in 2010. See omnystudio.com/listener for privacy information.
WARNING: The content of this episode may be upsetting to listeners. There are graphic descriptions of sexual abuse and quotes of homophobic slurs used in the episode. Please be advised. In this episode of the Madhouse Chicago Hockey Podcast, James Neveau and Jay Zawaski react to the release of the Blackhawks internal investigation of the Brad Aldrich abuse scandal and Stan Bowman's resignation. Learn more about your ad choices. Visit podcastchoices.com/adchoices
WARNING: If there are any little ears around, make sure to listen to this while they are away. Today we will be discussing the result of the Investigation made on the Chicago Blackhawks organization and what it means for Coach Quenneville. In segment number 3, we preview tonight's game against the Boston Bruins. Support Us By Supporting Our Sponsors! BetOnline AG There is only 1 place that has you covered and 1 place we trust. Betonline.ag! Sign up today for a free account at betonline.ag and use that promocode: LOCKEDON for your 50% welcome bonus. Built Bar Built Bar is a protein bar that tastes like a candy bar. Go to builtbar.com and use promo code “LOCKED15,” and you'll get 15% off your next order. Rock Auto Amazing selection. Reliably low prices. All the parts your car will ever need. Visit RockAuto.com and tell them Locked On sent you. Learn more about your ad choices. Visit podcastchoices.com/adchoices
Mark Lazerus and Scott Powers discuss the announced findings of the independent investigation into the Blackhawks, Stan Bowman out as GM and more. Save on an annual subscription to The Athletic: theathletic.com/lazandpowers Learn more about your ad choices. Visit megaphone.fm/adchoices
In other stories tonight: the news that federal regulators are one step closer to approving the use of Pfizer's COVID-19 vaccine for children age five to eleven is bringing a response from Chicago's public health commissioner; we're now getting a clearer picture of what's caused the water delivery issues that have affected homes and businesses in suburban Dixmoor for more than a week; the Naperville Police Department says a New York City teen is responsible for making a threat to Naperville North High School earlier this month; and much more. See omnystudio.com/listener for privacy information.
Tuesday's episode of Locked On Blackhawks opens up with Blackhawks' latest additions to COVID-19 protocol during Monday & Tuesday's practices. Then, host Jack Bushman provides a couple of updates from ESPN's Emily Kaplan on Jeremy Colliton's current job status. The episode concludes with the Blackhawks publicly releasing the findings of the independent investigation conducted by Jenner & Block LLP. All that and more on Locked On Blackhawks. Part of the Locked On Podcast Network. Your Team. Every Day. Toews & Borgstrom Added To COVID Protocol (3:25) Blackhawks Practicing Hard (5:25) Colliton Updates (12:30) Blackhawks Lawsuit Findings (20:15) Amazing selection. Reliably low prices. All the parts your car will ever need. Visit RockAuto.com and tell them Locked On sent you. There is only 1 place that has you covered and 1 place we trust. Betonline.ag! Sign up today for a free account at betonline.ag and use that promocode: LOCKEDON for your 50% welcome bonus. Learn more about your ad choices. Visit podcastchoices.com/adchoices
"As the next wave of the pandemic unfolds, the rise in cases is once again straining health care systems. But that's not the only reason hospitals and health systems could experience an influx of emergency or critical care visits. Findings from the National Poll on Healthy Aging based at the University of Michigan Institute for Healthcare Policy and Innovation revealed that nearly one in three Americans between the ages of 50 and 80 put off an in-person appointment for medical care in 2020 because they were worried about potential COVID-19 exposure, and with the emergence of new variants, that trend could continue. There is a growing concern that patients will either see a relapse in their illness or will experience new complications as a result of waiting too long to visit the doctor. Put simply, there could essentially be two health crises crowding the system: those who have tested positive for the coronavirus, and those who delayed routine preventative and ongoing care for ailments such as chronic disease or mental health." Matt Dickson is a health care executive. He shares his story and discusses his KevinMD article, "Why now is the time to get patients back to in-person routine care." (https://www.kevinmd.com/blog/2021/08/why-now-is-the-time-to-get-patients-back-to-in-person-routine-care.html)
Does your diet allow you to go to happy hour?! What about enjoying your kid's birthday party? Or weekend getaways with friends? Today we are on a search for science and sustainability in popular diet trends. A lot of the time, food is more than just fuel, it is a way to connect with friends, family, and yourself! It's important to take these things into consideration when establishing your own relationship with food. In this episode I am covering a framework that you can use to evaluate whatever diet it is that's trending to decide if it's something you actually want to do. I break down keto, intermittent fasting, detox and cleanses, and the vegan diet to see where they all fall on the sustainability spectrum. I also go over what actually happens to the body when we fall into yoyo dieting and how it may be more harmful to our health than carrying a few extra pounds. Lots of science and fun nutrition facts coming your way! For more in intermittent fasting be sure to check out this episode! References: (1) Golden, N. H., Schneider, M., & Wood, C. (2016). Preventing Obesity and Eating Disorders in Adolescents. Pediatrics, 138(3). doi:10.1542/peds.2016-1649 (2) The National Center on Addiction and Substance Abuse (CASA) at Columbia University. Food for Thought: Substance Abuse and Eating Disorders. The National Center on Addiction and Substance Abuse (CASA) Columbia University; New York: 2003 (3) Neumark-Sztainer, D. (2005). I'm, Like, SO Fat!. New York: Guilford (4) Golden, N. H., Schneider, M., & Wood, C. (2016). Preventing Obesity and Eating Disorders in Adolescents. Pediatrics, 138(3). doi:10.1542/peds.2016-1649 (5) Grodstein, F., Levine, R., Spencer, T., Colditz, G. A., &Stampfer, M. J. (1996). Three-year follow-up of participants in a commercial weight loss program: Can you keep it off? Archives of Internal Medicine 156(12), 1302. (6) Neumark-Sztainer D., Haines, J., Wall, M., & Eisenberg, M. ( 2007). Why does dieting predict weight gain in adolescents? Findings from project EAT-II: a 5-year longitudinal study. Journal of the American Dietetic Associatio, 107(3), 448-55 (7)Harvey K.L., Holcomb L. E., Kolwicz S. C. (2019). Ketogenic Diets and Exercise Performance. Nutrients. (11)2296. (8) Mattson M.P., Longo V.D., Harvie M. Impact of intermittent fasting on health and disease process. Aging ResRev. 2017 10 (39) 46-58. (9) Cho et al., 2016 (10) Sainsbury et al., 2018 (11) Rynders CA et al, 2019 (12) Dr. Stacy Sims “Roar: How to Match Food and Fitness to You Female Physiology for Optimum Performance, Great Health, and a Strong, Lean Body For Life.” (2016). (13) Tantamango-Bartley Y, Jaceldo-Siegl K, Fan J, Fraser G. Vegetarian diets and the incidence of cancer in a low-risk population. Cancer Epidemiol Biomarkers Prev. 2013;22(2):286-294. (14) Key TJ, Appleby PN, Crowe FL, Bradbury KE, Schmidt JA, Travis RC. Cancer in British vegetarians: updated analyses of 4998 incident cancers in a cohort of 32,491 meat eaters, 8612 fish eaters, 18,298 vegetarians, and 2246 vegans. Am J Clin Nutr. 2014;100(Supplement 1):378S-385S. (15) Hokin BD, Butler T. Cyanocobalamin (vitamin B-12) status in Seventh-day Adventist ministers in Australia. Am J Clin Nutr. 1999;70(3 Suppl):576S-578S. (16) Bardone-Cone AM, Fitzsimmons-Craft EE, Harney MB, et al. The inter-relationships between vegetarianism and eating disorders among females. J Acad Nutr Diet. 2012;112(8):1247–1252. (17) Fuhrman J., Ferreri DM. Fueling the Vegetarian (Vegan) Athlete. Curr. Sports Med. Rep., Vol. 9, No. 4, pp. 233Y241 (18) “Detoxes” and “Cleanses” : What You Need to Know. (n.d.) Retrieved June 26, 2020 from https://www.nccih.nih.gov/health/detoxes-and-cleanses-what-you-need-to-know (19) CPR Monthly: Examining Popular Detix Diets- Today's Dietitians. (n.d.). Retrieved June 26, 2020, from https://www.todaysdietitian.com/newarchives/1016p52.shtml (20) Publishing, H (n.d.) The dubious practice of detox. Retrieved June 26, 2020, from https://www.health.harvard.edu/staying-healthy/the-dubious-practice-of-detox (21) Makkapati, S., D'Agati, V. D., & Balsam, L. (2018). "Green Smoothie Cleanse" Causing Acute Oxalate Nephropathy. American journal of kidney diseases : the official journal of the National Kidney Foundation, 71(2), 281–286. https://doi.org/10.1053/j.ajkd.2017.08.002 (22) Jane E. Getting, PA-C., James R. Gregoire, MD (2018). Oxalate Nephropathy Due to ‘juicing': case report and review. The American Journal of Medicine. (23) Seidelmann SB., Claggett B., Cheng S., Henglin M., Shah A., Steffen LM., Folsom AR., Rimm EB,. Willett WC., Solomon SD. Dietary carbohydrate intake and mortality: a prospective cohort study and meta- analysis. Lancet Pub Health. 2018; 3(9):e419-e428.
Jesse and Brittany discuss reminders for Thanksgiving, flu shots, a listener voicemail related to vaccine mandates and staffing shortages in hospitals, Joe Rogan’s episode with Dr. Sanjay Gupta and his praise of Tucker Carlson, Pat Robertson’s resignation and contributions to society, the failure of the media and politicians to educate the American people on the... The post #753 – “Thanksgiving, Flu Shots, Pat Robertson’s Resignation, Reconciliation Bill & Findings on Expanding the Court, and Takin’ Care of Biz featuring Jake Tapper.” appeared first on I Doubt It Podcast.
This is the audio from RQM+ Live! #41, originally recorded 14 October, 2021. Your post-market surveillance (PMS) system complying to the EU MDR was put into place in May 2021. How is it going? Now months later, there are an abundance of issues and questions! This panel discussion provides a unique opportunity to learn from the experiences of seasoned experts as they share PMCF successes and failures they've seen across the industry so far. While there have been and will continue to be plenty of implementation challenges, our esteemed panel has worked through comprehensive solutions and is anxious to share. Discussion will include: Best practices for optimizing PMCF as it relates to the EU MDR implementation Typical NB findings and variations in interpretation Strategies to overcome audit findings and gaps in your evidence The panel will include: Amie Smirthwaite, BEng, PhD - Global Vice President, Intelligence & Innovation Nancy J. Morrison, RAC - Executive Director, Regulatory & Quality Consulting Services Jonathan Gimbel, PhD - Executive Director, Technical Leadership, Clinical & Post-Market Practice Celeste Ann Maksim, PhD - Chief of Staff, Clinical & Post-Market Practice Andreas Tarnaris, M.D. MD (Res) FRCS (NeuroSur) - Medical Director - About RQM+ RQM+ is the leading international provider of regulatory, quality and compliance consulting services for medical device and diagnostics manufacturers. The company delivers transformative solutions by providing unrivaled collective expertise fueled by passion for client success. The experts at RQM+ are collaborative, laser-focused on client needs and committed to delivering high-value solutions that exceed expectations. For more information, please visit RQMplus.com. --- Send in a voice message: https://anchor.fm/deviceadvice/message
Mehdi Kordi, PhD, is a track cycling coach (sprinting in particular) working with the Royal Dutch Cycling Federation. In Tokyo, the Dutch track sprinters brought home multiple golds and medals, and Mehdi joins us to discuss how these athletes train to be the fastest on the planet. Also we discuss the physiology of W' and how it relates to neuromuscular function, and other bits and pieces from Mehdi's research. IN THIS EPISODE YOU'LL LEARN ABOUT: -Mehdi's take on the Olympics in Tokyo and how his team performed -How do track sprint cyclists train? -The relationship between neuromuscular function and W' (anaerobic work capacity) -The importance of muscle size (rather than neural functions, fiber type etc.) and maximum force capacity on W' -What sort of strength training might be used to improve W'? -Reliability and sensitivity of the Notio Konect aero sensor SHOWNOTES: https://scientifictriathlon.com/tts307/ SCIENTIFIC TRIATHLON AND THAT TRIATHLON SHOW WEBPAGE: www.scientifictriathlon.com/podcast/ SPONSORS: ROKA - Exceptional quality triathlon wetsuits, trisuits, swimskins, goggles, performance sunglasses as well as prescription eyeglasses and sunglasses. Online vision test for prescription updates and home try-on options available for eyeglasses. Ships from the US, UK and EU. Trusted by world-leading athletes such as Lucy Charles-Barclay, Javier Gómez Noya, Flora Duffy, Morgan Pearson, Summer Rappaport and others in triathlon, cycling, speed skating, and many more. Visit roka.com/tts for 20% off your order. ZEN8 - The ZEN8 Indoor Swim Trainer is a tool for time-crunched triathletes looking to improve swim specific strength and technique. The swim trainer is a perfect complement to your training in the pool. On days when you don't have time to go to the pool, you can now do a short but effective home-based workout on the trainer. It is inflatable, so doesn't take up much space, and best of all, it is very affordable. Get 20% off your order at zen8swimtrainer.com/tts. LINKS AND RESOURCES: Mehdi's Twitter and Research Gate profiles The Relationship Between Neuromuscular Function and the W′ in Elite Cyclists - Kordi et al. 2021 Reliability and Sensitivity of the Notio Konect to quantify Coefficient of Drag Area in Elite Track Cyclists - Kordi et al. 2021 Training talk and Tokyo 2020 with Nate Wilson | EP#303 Olympic gold medal training and preparation with Arild Tveiten | EP#304 Aerodynamic testing in the field with Michael Liberzon | EP#294 RATE AND REVIEW: If you enjoy the show, please help me out by subscribing, rating and reviewing: www.scientifictriathlon.com/rate/ CONTACT: Want to send feedback, questions or just chat? Email me at firstname.lastname@example.org or connect on Instagram, Facebook, or Twitter.
The news to know for Monday, September 27th, 2021! We'll tell you about an Amtrak passenger train that went off the tracks and how locals rushed in to help out. Also, what to know about the candidate Germans elected to be their new leader, and what a Republican-led audit found about the last presidential election here in the U.S. Plus, the impact of a record backlog of cargo ships off the U.S. coasts, a new law in China that could shake the cryptocurrency market, and how an NFL kicker made history over the weekend. Those stories and more in around 10 minutes! Head to www.theNewsWorthy.com/shownotes for sources and to read more about any of the stories mentioned today. This episode is brought to you by Noom.com/newsworthy and BetterHelp.com/newsworthy Thanks to The NewsWorthy INSIDERS for your support! Become one here: www.theNewsWorthy.com/insider