Podcasts about fna

• FNA • 21 • The Worst Non-Spoiler review, EVER!! •Welcome to episode 21 of FnA Presents!! In this episode Fred and Adrienne really dive into the latest Marvel projects and movies that are upcoming, along with theories and conspiracies! Adrienne gives us her take on the newest game movie adaptation "Until Dawn" and YES there are spoilers! Fred and Adrienne both discuss the new season of The Last of Us and give us their thoughts and opinions on that as well. Spoilers for this as well!! To hear about all of this along with future shows, movies and other exciting topics....be sure to tune in! Be sure to check us out on our platforms below, as well as anything we discussed in this episode! So grab a drink, grab a snack and enjoy!!!**The Last of US S2E2 SPOILER Section Ends @ 1:27 [1hr 27min]LINKS to our Existence! |TWITCH||YouTube||Facebook Page||Twitter Page||Instagram Page||Apple Podcast||Spotify||Google Podcast||Amazon Podcast||Stitcher Podcast||Website|LINKS from the Episode•I KNOW WHAT YOU DID LAST SUMMER - Official Trailer (HD)•UNTIL DAWN – Official Movie Trailer (HD)•The Last of Us Season 2 | Official Trailer | Max•Thunderbolts* | Final Trailer | In Theaters May 2

Viu el món amb Viatges Magon és un espai en el que podem apropar-nos a l'oferta de viatges que han preparat des de l'agència de viatges. En el calendari del 2025 és fàcil trobar diferents ponts; el pont del 1 de març, el pont de Setmana Santa, el pont del dia primer de maig,... Segons si disposes de la possibilitat d'aprofitar aquests ponts, pots gaudir de petites vacances dins l'any, a preus increibles i amb la possibilitat de visitar indrets increíbles com Nàpols, Marrakesh o destins similars.  Si busques una destinació plena d'història, cultura i gastronomia, Nàpols i Marràqueix són opcions excepcionals. Cadascuna ofereix una experiència autèntica i inoblidable. Nàpols, la ciutat del caràcter mediterrani Nàpols, al sud d'Itàlia, és una ciutat vibrant amb un patrimoni històric impressionant. Els seus carrers plens de vida estan marcats per edificis barrocs, mercats bulliciosos i vistes espectaculars al Vesuvi. Destaca el seu centre històric, Patrimoni de la Humanitat per la UNESCO, amb joies com el Duomo, el Castel dell'Ovo i la Via San Gregorio Armeno, famosa pels seus artesans de pessebres. Gastronòmicament, Nàpols és el bressol de la pizza. No et pots perdre una autèntica "Margherita" en una pizzeria històrica. A més, la seva proximitat a Pompeia i la Costa Amalfitana la converteixen en una base ideal per explorar la regió. Marràqueix, la perla del sud del Marroc Marràqueix és una ciutat exòtica i fascinant, plena de colors, olors i sons que et transporten a un altre temps. La seva famosa Medina, amb el soc animat, ofereix artesania, espècies i tèxtils tradicionals. La Plaça Jemaa el-Fna es transforma cada vespre en un espectacle de cultura viva amb músics, encantadors de serps i parades de menjar. Els seus palaus, com el de Bahia, i els seus jardins, com els Majorelle, aporten un toc d'elegància. La gastronomia marroquina, amb el cuscús i el tajine, és un altre punt fort. Nàpols i Marràqueix ofereixen experiències autèntiques que et faran viure la seva essència al màxim.

Welcome to Friday Night Audit, the show that takes hotel industry networking, adds tequila, and lets the chaos unfold! This week, we're hosting our first-ever Friday Night Audit Awards, where we recognize the most questionable achievements in our show's history.

That's right, Sunny is for sale!! We are excited to find a good home for her and it could be with you! Click the link here to learn more: https://thevancamper.com/post/12049/renovated-1985-toyota-sunrader-w-warrantied-engine-for-sale Toronto Spring Camping Show: https://torontospringcampingrvshow.com/ Peace Love Vans Florida Event: https://www.peacelovevans.com/ get 50% off day pass tickets with code is: FNA-2025-DP50 Credit Card Referral: Here's my Amex referral link. Use it and we could both earn rewards if you are approved and get a Card. Check out offers and Card benefits. https://americanexpress.com/en-us/referral/cobrand/ALEXaMGCWL?xl=cp10a1 Hope to see you either in Toronto or in Florida in March!

FNA out of Florida builds some of the wildest custom bikes on the planet and makes some of the coolest parts line for your custom chopper. Now there's all this AND Morris magnetos, all under one roof. You can find the TCGP team online atwww.thecrazygentlemanpodcast.com, and on IG.Voiced by: @thecrazygentlemanProduced by: @WhiskyEyeToday's episode is brought to you by:Bare Knuckle Performancewww.bareknuckleperformance.com@bareknuckleperformanceSiembida Custom KnivesIG: @siembida_custom_knivesPhone (740) 270-9057The Huntsman OutdoorsEnter code word PATRIOT at checkout for 10% offwww.thehuntsmanoutdoors.com@huntsmanoutdoorsLexin Motowww.Lexin-Moto.comEnter code word CRAZY at checkout for 15% off @lexinmotoDirty Builds www.DIRTYBUILDS.com@DirtyBuildsArt by @the_junkersMusic by The Vandoliers

Get access to our clinical podcast series with our ⁠⁠30% off IVECCS Special.⁠⁠ A bit of a taster plate with some key takeaways from 3 of my favourite sessions today: 1. Bad wounds mean lots of work, and big bills, right? But how often are you faced with those serious wounds and a client with limited funding? ECC Specialist ⁠Dr Jenny Groover ⁠has your back with some highly practical 'plan B' treatment options that might just help you save some lives. 2. You know how you were taught never to aspirate a gallbladder? Along with adrenal glands, for most of us gallbladders are on the list of 'no 'stab' organs, but diagnostic imaging specialist Dr Marc Seitz brings us the evidence, and the experience, that will make you completely rethink some of the dogma around 'risky' ultrasound guided FNA's. 3. Did you know that you can 'patch' a hole in a popped lung with your patients own blood? Critical Care Specialist ⁠Dr Andrew Linklater⁠ gives us the when, why, and how of pleurodesis for pneumothorax in this conversation. Sign up for our ⁠⁠free weekly newsletter⁠⁠ to hear about my favourite 3 lessons I learnt in that week from making the podcasts. Get case support from our team at specialists in our ⁠⁠⁠Specialist Support Space⁠⁠⁠.

We're getting ready for an end of summer blast here on FNA and we're joined by Alex Coury, CEO and Founder at Coury Consulting, who's better at impersonating celebrities than Glenn is impersonating a podcaster.

FnA 14 - Where have you been? Deadpool & Wolverine, 3-Body Problem, X-Men 97', Late Night with the Devil, and much more including Games and Terrance Howard.TWITCHYouTubeFacebook PageTwitter PageInstagram PageApple PodcastSpotifyGoogle PodcastAmazon PodcastStitcher PodcastWebsite

The awesome Matt Hostetler, CDO with Red Roof, returns to learn a lesson about returning to FNA. Glenn, Craig and Producer Dave shake their heads in disbelief. Oh yeah, Glenn's in Vegas.... again!

Emily Cappiello is a PR specialist as well as a Food + Beverage Writer for major global publications. She joins the FNA gang to school them on how to really enjoy the worlds of hotel and travel.

FnA 011 - Groundhog Day SPECIAL - Spoilers and Triggers Rise and shine you wood chuck, chuckers..it's GROUNDHOG DAY!! That's right, in this episode Fred and Adrienne celebrate Punxsutawney Phil not seeing his shadow! Also, Fred and Adrienne start off this episode a little different...so be sure to tune in to see how they changed things up!Fred tells us about the latest Ghostbusters trailer as well as the newest Roadhouse remake that is premiering on Amazon next month starring Jake Gyllenhaal and Connor McGregor. We also hear Adrienne and Fred talk about Pauly Shore's latest project, The Court Jester, which is a short film on YouTube that focuses on Richard Simmons. I'm sure plenty of you remember him! The link to this short film is actually linked below, so check it out! Fred talks a little about the games he's been playing and streaming on twitch, so make sure you hop on twitch sometime to check him out!Adrienne shares 2 crime stories with us this week, and they are DEFINITELY A TRIGGER WARNING! These stories are dark and disturbing, but do end with justice!! The first disturbing story focuses on Shanda Vander Ark and the second, Baby Iris Rita Alfera. *We completely understand if these stories are too disturbing for you to hear*Fred ends the show with a tough question for us...it's definitely one that will make you think, so be sure to tune in to find out what it is!! So sit back, relax, grab a drink, grab a snack and we hope you enjoy the show!!! Links to what we discussed and also to our socials are below.Links:"Ghostbusters: Frozen Empire" - 2nd Trailer for the Sequel in the Sequel Series..."Road House" (2024) - Trailer for the Remake starring Jake Gyllenhaal & Conor McGregor"Road House" (1989) - Trailer for the Original film starring Patrick Swayze & Sam Elliott "The Court Jester" - Richard Simmons Short Biopic Starring Pauly Shore"The Wizard" (1989) - Trailer for one of the Greatest Films of All Time!!! Starring Fred Savage "It's so Bad" :)TWITCH - This is where I hang out now!!YouTube - Not so much Twitter Page - This is a good place to find us.Facebook Page - Sometimes here too!!Instagram Page Apple PodcastSpotifyGoogle Podcast

Tonight on FNA, Ted Torres of CREDE steps into the gaunlet to battle Glenn and Craig to see who can make it through an hour of half-assed jokes and drinks.

Join Yvonne Brandenburg, RVT, VTS SAIM and Jordan Porter RVT, VTS SAIM as we talk about: Yvonne's recent training with SonoPath on abdominal ultrasound. She spent four days in New Jersey at their training facility learning proper image acquisition of the abdomen using SDEP® and learning how to FNA pathology in the abdomen. Talk about Upping Your Tech Game and tech utilization! This course is great for both doctors and technicians wanting to learn how to efficiently do ultrasound. Less than 15 minutes of scanning time and all the organs are recorded including every adrenal every time!     Resources Mentioned in the Show  SonoPath https://sonopath.com/  Info about courses and on-site training: https://sonopath.com/education/what-is-sdep/  Use this link for a free online SonoPath education account: https://education.sonopath.com/share/XcLKbKgyKYV9fEAV?utm_source=manual  Don't forget to check out LoveHuvet.com and use our discount code IMFVT10 to receive 10% off your order! Thanks so much for tuning in. Join us again next week for another episode!  Want to earn some RACE approved CE credits for listening to the podcast? You can earn between 0.5-1.0  hour of RACE approved CE credit for each podcast episode you listen to.  Join the Internal Medicine For Vet Techs Membership to earn and keep track of your continuing education hours as you get your learn on!   Join now! http://internalmedicineforvettechsmembership.com/   Get Access to the Membership Site for your RACE approved CE certificates Sign up at https://internalmedicineforvettechsmembership.com  Get Access to the Technician Treasure Trove  Sign up at https://imfpp.org/treasuretrove    Thanks for listening!  – Yvonne and Jordan   

Welcome to Episode 10 of FnA Presents! In this episode, Fred and Adrienne change it up a bit! We hear their regular banter in the beginning of the episode to let us know what they've been up to and they also mention the cold front that the US recently has had!Fred fills us in on the latest Star Wars Theory news and what's been happening with the latest story. Also, we hear about some Marvel and a little DC news! Fred tells us what he's been playing lately, including: Dead Island 2, the latest Resident Evil 2, Mario, Eldin Ring and PalWorld! Adrienne gets to talk about one of her favorite entertainment genre's...Crime Stories! Yep! We get a story today about the wild and crazy case of Sherri Papini. This story took place originally in 2016 and this one is definitely a rollercoaster! Talk about twists and turns!! To find out about this curious case, you have to tune in to find out!Fred tells us about the latest conspiracy documentary that has been out...UFO Revolution which is presented by TMZ with Jeremy Corbell! This documentary talks about the recent Pentagon leaks and some whistle blowers...even some eye witness accounts! This is another one you definitely have to check out! This episode of FnA presents is one you really don't want to miss, so make sure you grab a drink, grab a snack and get comfortable!! We hope you enjoy the show!!! Check out our social platforms below!!The Sherri Papini interrogation link:https://youtu.be/T7idBeFkj84?si=_-J3ssTs3E9q9w6hTWITCHFacebook PageTwitter PageInstagram PageApple PodcastSpotifyGoogle PodcastAmazon PodcastStitcherPodcastWebsite

JCO PO author Dr. Amit Mahipal shares insights into his JCO PO article, “Tumor Mutational Burden in Real-world Patients with Pancreatic Cancer: Genomic Alterations and Predictive Value for Immune Checkpoint Inhibitor Effectiveness.” Host Dr. Rafeh Naqash and Dr Mahipal discuss real world evidence of immune checkpoint inhibitors in pancreatic ductal adenocarcinoma. TRANSCRIPT Dr. Rafeh Naqash: Welcome to JCO Precision Oncology Conversations, where we bring you engaging conversations with authors of clinically relevant and highly significant JCO PO articles. I'm your host, Dr. Rafeh Naqash, Social Media Editor for JCO Precision Oncology and Assistant Professor at the OU Health Stephenson Cancer Center, University of Oklahoma. Today we are joined by Dr. Amit Mahipal, Professor of Medicine and Director of GI Oncology at the Case Western Reserve University in Seidman Cancer Center. Dr. Mahipal is also the author of the JCO Precision Oncology article titled "Tumor Mutational Burden in Real World Patients with Pancreatic Cancer: Genomic Alterations and Predictive Value of Immune Checkpoint Inhibitor Effectiveness."  Our guest disclosures will be linked in the transcript. For the sake of this conversation, we will refer to each other using our first names. So Amit, welcome to our podcast and thank you for joining us today. Dr. Amit Mahipal: Thanks for having me here. Dr. Rafeh Naqash: Excellent. We came across your article in JCO Precision Oncology and it really aroused my interest because the topic and the audience that it caters to is very important in the current times. Because immunotherapy generally is considered- pancreas cancer the graveyard in immunotherapy in essence, based on what I have seen or what I have encountered. And now you're the expert here who sees people with pancreas cancer or has done a lot of work in pancreas cancer research side. So can you tell us the context of this work and why you wanted to look at immune checkpoint inhibitors in pancreas cancer? Dr. Amit Mahipal: Absolutely, Rafeh. As you mentioned, pancreatic cancer is considered a what we call "cold tumors." They don't typically respond to immunotherapy. And when we talk to our patients or patient advocates, as you know, patients are very excited about immunotherapy. Immunotherapy has transformed the treatment for a lot of different cancers and not only has increased survival, but the quality of life is so much different than with chemotherapy. This work came from based on the KEYNOTE-158 trial, which was a tumor-agnostic trial which accrued patients who had TMB high tumor. What that means is that tumor mutation had more than 10 mutations per megabase. And what happens is because of that trial, more than 200 patient trial, the FDA actually approved this immunotherapy or pembrolizumab as a single agent pembrolizumab for any patient with a solid tumor who has high TMB. Again, tumor mutation burden, more than 10 mut/Mb. This question comes in now. Does this apply to our pancreatic cancer patient groups? Especially as we know these are "cold tumors" that typically do not respond. There have been multiple trials looking at immunotherapy, single agent, dual immunotherapy agents, as well as combinations with chemotherapy, with somewhat very, very limited success. So that was kind of the basis. So we wanted to look at this retrospective kind of review of a big database to see how many patients we can find who have high TMB and see in that patient population is immunotherapy really active based on the FDA approval or is pancreatic cancer not a tumor where we should try immunotherapy unit as a selective group.    Dr. Rafeh Naqash: Thank you for that explanation. Taking a step back again, since you see these individuals with pancreatic cancer I imagine day in and day out in the space of drug development, what is the general current standard of care approach for individuals with pancreas cancer in your clinic? I'm talking about what are the most common approaches that you utilize that seem to be working or have FDA approvals in the pancreas cancer space. Dr. Amit Mahipal: As with any tumor, the first thing is obviously staging. So depending on whether we're dealing with early stage or advanced stage and what are the goals of treatment. At this point, the only thing that can cure pancreatic cancer patients that would be considered conventional therapy is surgical resection. So any patient who is a candidate for surgical resection is in a different bucket compared to advanced patients. For early stage patients, we try to do what we call neoadjuvant treatment or neoadjuvant chemotherapy. We shrink the tumor or at least maintain it, look at the biology of the disease, and then take them to surgery, which typically involves a Whipple procedure if it's a head of the pancreatic mass.   Moving on to advanced patients, that's where we know the goal of treatment is palliative to increase survival, but unfortunately, most of the times we cannot cure them. And there the standard of care options include systemic chemotherapy. We have two typical regimens that we use, one is called FOLFIRINOX, which is a three-drug regimen of 5-fluorouracil, leucovorin, oxaliplatin, and irinotecan. And another regimen is gemcitabine plus abraxane, which is a two-drug regimen of gemcitabine plus abraxane. These are considered the standard of care. Unfortunately, the median survival even with the best standard of care chemotherapy is only about a year, 12-13 months, depending on what trials we look at.  Dr. Rafeh Naqash: I still remember some of these regimens from my fellowship, where we had to decide which to give to each individual based on their performance status and clinical status, etc. But now I can see a lot of ongoing drug development in the space of pancreas cancer. I'm guessing that's why you wanted to assess both the molecular genomic landscape of pancreas cancer in this study and also look at the immune biomarker aspect. Could you tell us a little bit about the Foundation Medicine Clinical Genomic Database? How did you identify the patients, how many patients did you identify, what you narrowed down in the criteria, and the eventual sample size of what you were looking at?  Dr. Amit Mahipal: FoundationOne has a rich database. They have two or three things. One is a genomic database only. So in our clinical practice, I think it's some sort of next-generation sequencing or mutational testing for all patients with advanced solid tumors. All of these goes into their database. All of the samples that are sent to FoundationOne that goes into their database where they know the diagnosis of the patient and the know the sequencing results of these patients. In addition, they also have a clinical database called Flatiron. Basically, they collaborated with them. Flatiron has about 280 or so cancer clinics throughout the country, so a lot of community settings and some academic sites as well. They did not only have a genomic database, but they actually have a clinical database. They have demographics, clinical features, baseline clinical features, comorbidities, what kind of treatment they received, what would be the stage of the cancer, how many months of treatment they received, and their overall survival, and so on. So from that perspective, the FoundationOne has access to this partnership with Flatiron, clinical genomic database where they have both clinical data as well as genomic database for a lot of these patients.  In our study, we only focused on patients with advanced pancreatic cancer. We excluded a lot of patients who did not have sequencing results available, they cannot be performed due to lack of tissue. So the first we talked about the genomic database and we found about about 21,932 patients, so almost 22,000 patients and there we had the sequencing and we also had the data on TMB or tumor mutational burden. So here, we classified them into two groups: high TMB and low TMB. High TMB was seen in 1.3% of the patients, and about 98.3% of the patients had low TMB. Here we looked at the genomic alterations between the two groups. So these are like our genomic group, so to speak of about 22,000 patients. And among them, as mentioned, that the clinical data was available for about 3300 patients or 3279 patients to be exact.   After excluding some of those patients, we found about 51 patients who received immunotherapy. And when we say immunotherapy, it is single agent immuno checkpoint inhibitor like pembrolizumab or nivolumab. And then we classified them into high TMB versus low TMB and then we also looked at patients with high TMB and compared them to who received immunotherapy versus other therapies. Just to recap, we had about 22,000 patients where we have the genomic database and about 3300 or so patients who we have both genomic and clinical data for this patients. One of the key findings was that high TMB was present in only 1.3% of the patients, or about 293 patients out of 21,932.  Dr. Rafeh Naqash: Definitely an interesting sample size that you had utilizing this resource, which, of course, is more or less real-world. It is important to gather real-world outcomes that you did.   So, going to the TMB story of this paper, where you looked at immune checkpoint inhibitor use in these individuals, was there a reason why some of the individuals with low TMB were also given immune checkpoint inhibitors? From my understanding, I did see some checkpoint inhibitor use there. What could be the explanation for that? Dr. Amit Mahipal: So this data is from 2014 to 2022. So from the span of about eight or so years. And as you know, immune checkpoint inhibitors were approved in the last decade. And there were a lot of not only trials, but even in the non-trial setting, people had tried immune checkpoint inhibitors in, frankly, different tumor types because of the success in some of the common tumor types, like melanomas, lung cancer, and so on. So I agree, as of today, we probably would not use immune checkpoint inhibitors in patients with low TMB or MSS. But at that time, I think that information was not available. So people with low TMB and MSI-stable tumors also received immune checkpoint inhibitors. But those numbers are again low. So it's not very high numbers. Dr. Rafeh Naqash: Understandable. That makes it a little more clear.  Now, you looked at the TMB aspect. I'm guessing you also looked at the MSI aspect of PDAC. What is your understanding, or what was your understanding before this study, and how did it enhance your understanding of the MSI aspect of PDAC? And I'm again guessing, since TMB high individuals are on the lower side percentage, so MSI high is likely to be low as well. Did you see any interaction between those MSI highs and the TMB highs on the PDAC side?  Dr. Amit Mahipal: Yeah, absolutely. So we are very excited in general about MSI-high tumors for solid tumors because of their response to immunotherapy. Although I would do a caveat because we still don't know how MSI-high pancreatic cancer responds although there have been some real-world, very, very small series as well. In this study, one of the things is, is high TMB totally driven by MSI-high? That's a question that comes up, and TMB high may not matter. It's only the MSI-high that might matter. So definitely when we look at this patient population, we found that the patients who were 35-36% of patients who were TMB high also had MSI-high patients. So we do expect MSI-high patients to have a higher TMB compared to MSS patients. But there were about 66 or two-thirds of the patients who did not have MSI-high tumors and still had high TMB, as defined by, again, ten mutations per megabase. So we did see patients with MSI-stable tumors who had high TMB. And I think that was one of our biggest questions. I think MSI-high patients, we all tend to think that we would try immunotherapy even if it's in pancreatic cancer. I think what is not clear, at least from the real-world or any of the trial data, is if we were to give MSI-stable patients who have high TMB, if we give immunotherapy, are there any responses or any disease control that we see? And that was one of the reasons for this study.  Dr. Rafeh Naqash: Now, one of the things that comes to mind, and again, I think you based it on the FDA approval for TMB high, which is ten mutations per megabase, as you defined earlier. I do a lot of biomarker research, and oftentimes you come across this aspect of binary versus a linear biomarker, in this case being TMB, where about ten, less than ten. Do you think, in general, an approach where you maybe have tertiles or quartiles or a biomarker, or perhaps a better approach in trying to stratify individuals who may or may not benefit from immunotherapy? Dr. Amit Mahipal: That's a great point. I think when we use ten mutations per megabase as a biomarker, as a binary endpoint, do we apply it to all tumor types? I don't think that's a fair comparison, frankly speaking. We do know that high TMB, even in different tumor types, do tend to respond a little bit better to or do have better outcomes for patients treated with immune checkpoint inhibitors in different tumor types. But what that cutoff is not known in most of the tumor types. And also, one of the problems is how do you measure TMB and is it standard across different platforms? Like I'm just giving some names like FoundationOne, Tempus, Caris, and some obviously like MSKCC and some other university-owned panels as well. And frankly, I think if you look at different panels and if you send the same tumor tissue, you will get different measurements. So I think standardization is a problem as well.  In one of the studies involving cholangiocarcinoma, for example, we found that a TMB of 5 was enough to have an additive effect of immunotherapy, same with chemotherapy, so to speak. But again, this needs to be validated.  So you're absolutely correct. I don't know why we use the binary endpoint, but on the same token, the binary endpoint is easy to understand as a clinician. Like, “Hey, someone has this, do this, not this.” And when we look into a continuous range, I think the benefit obviously varies between high and low, different tertiles, and becomes somewhat challenging. How do you classify patients and what treatments to give? So I think in clinical decision-making, we like the cutoffs, but I think in reality, I don't know if the cutoff is a true representation. And maybe with the more use of AI or computing, we can just input some values, and then it can tell us what the best treatment option might be for the patient. But that's way in the future. Dr. Rafeh Naqash: That would definitely be the futuristic approach of incorporating AI, machine learning perhaps, or even digital pathology slides in these individuals to ascertain which individuals benefit.  Going back to your paper, could you highlight some of the most important results that you identified as far as which individual is better, whether it was immunotherapy, and you've also looked at some of the mutation co-mutation status. Could you highlight that for our listeners? Dr. Amit Mahipal: So the first thing we looked at was the genomic database of almost 22,000 patients, and then we classified them into high TMB and low TMB, with about 300 patients in the high TMB group and the rest in the low TMB group. And what we found was, talking about again in the genomic database, that patients who have high TMB actually have low KRAS mutation. So if we think about KRAS mutation, pancreatic cancer, almost 85% or so of patients have KRAS mutation who have pancreatic adenocarcinoma. So patients in this subgroup, so in the high TMB group, only about two-thirds of the patients had KRAS mutation, compared to 92% of the patients with low TMB who had KRAS mutation. So just giving that perspective. So KRAS mutation, which is the most common mutation in pancreatic cancer and is a driver mutation, their rates vary differ from the high TMB group versus the low TMB group.   And then in addition, in the high TMB group, we found higher rates of BRCA mutation, BRAF mutation, interestingly, and then obviously from the DNA damage repair genes like PALB2 mutation, MSH2 or MSH6, MLH1, and PMS2. So all these mismatch repair protein mutations were higher. As I mentioned before, one-third of the patients with high TMB also had MSI-high. So it's not a totally unexpected finding. I think the biggest finding was that we found more KRAS wild-type pancreatic adenocarcinoma in the high TMB group, almost a third. And those tend to have different targetable mutations like BRCA2, BRAF, and PALB2 mutations. So I think one of the interesting findings is that patients in the high TMB group actually tend to have KRAS wild-type or less KRAS mutations. So they're not necessarily KRAS-driven tumors, and they have a higher chance of having other targetable mutations like BRAF and so on, for which we have therapies for. So it's always something to keep in mind. Dr. Rafeh Naqash: Would you think that from a DDR perspective, the mutations that you did  identify that were more prevalent in individuals with high TMB, do you think that this is linked to perhaps more DNA damage, more replication stress, more neoantigens leaning toward more tumor mutation burden perhaps? Or is there a different explanation?  Dr. Amit Mahipal: For sure. As we said, MSI-high tumors have mutations in the DNA damage repair pathway and they definitely tend to have higher TMB. So I don't think that is very surprising that we found PALB2, or other MMR genes like MSH2, MSH6, MLH1, and PMS2 at much higher rates. I think the interesting finding is the fact that the KRAS wild-type and having BRAF alterations at least that's not suspected to definitely increase TMB. Although if we look at colorectal cancer, BRAF mutation and MSI are somewhat correlated to patients with BRAF mutations and to have high rates of MSI-high tumors. But that's not the case in pancreatic cancer. We also found an increase in BRCA2 mutations as well. So I agree that the DNA damage pathway repair gene alteration is not unexpected because they tend to increase TMB, but I think the other mutations were interesting. Dr. Rafeh Naqash: And I think one other aspect of this, which I'm pretty sure you would've thought about is the germline implications for some of these mutations where you could very well end up screening not only the individual patient, but also their family members and have measures in place that we're trying to enhance screening opportunities there. In your current practice, you are at an academic center but I'm talking about in general with your experience, how common is it to sequence broad sequencing panels in individuals with pancreas cancer? The reason I asked that is I do a lot with lung cancer and even now despite having all those targets in lung cancer which sort of paved the pathway for targeted therapy in many tumor types, we still don't see a full uptake for NGS Phase I drug development. And I get a lot of referrals from outside and I often see that it's a limited gene panel. So what is your experience with pancreatic cancer? Dr. Amit Mahipal: We kind of changed our practice. Similar to you, I'm involved in drug developments. I've been a big proponent of NGS for almost a decade now, when didn't even have targeted therapies but these companies first came in and they're like, “Okay. We're very very low chance.” But now obviously, we transformed the treatment for a lot of different cancers. Especially lung cancer, you don't sometimes even start treatment before you get an NGS panel like you said in situ. So what we're finding, at least for pancreatic cancer, as you know, the targetable mutations are there but they are somewhat not that common, I would say, in the 10-15% range. So many people would get dissuaded and then it's like, what's the point of doing it?   But I think for those 10% to 15% of the patients, firstly we can really change their treatment course and their prognosis. Secondly, if you don't do it and they cannot go in a different clinical trials, now we have trials targeting KRAS G12C, but not only that, KRAS G12D which is the most common mutation we see in pancreatic cancer and so on. So it's becoming very very important. One thing, at least with our practice we adopted last two or three years is sending liquid biopsies or liquid based NGS or blood-based NGS testing. Otherwise, what's happening I would send a solid tumor NGS from the tissue. And pancreatic cancer as you know has sometimes a very small amount of tissue obtained from FNA. And inevitably after four weeks, we'll get the result that there's not enough tumor to do NGS testing. And then the patient comes one or two months later and then we order the test, and that just delays everything.  So now we adopted a practice where we are trying to send both blood based NGS and solid tumor NGS at the same time the first time of diagnosis when we see the oncologist for the first time. And that has really increased the rate of NGS testing results for our patient population. And it's not 100%, even in blood-based NGS, sometimes they may not be able to find enough circulating tumor cells to do this blood-based NGS testing, but at least they're having these. But you're correct. I think we still see about one third of the patients who had not had NGS testing or referred for phase I clinical trial and have gone through more than two or three line of therapies which is unfortunate for our patients.  Dr. Rafeh Naqash: That's a very interesting perspective on how important it is to sequence these individuals. As you said, it may not be that all of them may benefit, but the ones that have those important alterations, especially BRCA, PALB, and KRAS could benefit from novel precision medicine-based approaches.  A question that came to my mind, I saw that you were trying to look at MYC and turmeric low tumors as well. So what is the role of MYC in the context of these individuals? Is there any drug development that's going on? Because I see small cell lung cancer. MYC is an important target there. These are two different tumors, but it looks like there was a hint of some correlation with respect to some of the findings that you showed. Is that something that you're currently looking at or planning to look at?  Dr. Amit Mahipal: I think that if we just talk about MYC in general, it is present at somewhat lower rate. I think we found MYC amplification in about 5% or so of TMB-low patients who had that and not really seen in the TMB-high patients. So right now, I am not aware of any trials targeting MYC in pancreatic cancer. But as you said, if it's successful in lung cancer, maybe that's when we can transform into the pancreatic cancer group. Dr. Rafeh Naqash: Of course we can all learn from each other's specialties.We learned a lot from melanoma with respect to therapy. Hopefully, other fields can also benefit from each other's experiences in the space of drug development.  Thank you so much for this interesting discussion. The last few questions are more or less about you as an individual researcher. So could you tell us briefly on your career trajectory and what led you into the space of GI oncology, pancreas cancer, even for that matter, drug development? And some of the advice that you may want to give to listeners who are trainees or early career individuals? Dr. Amit Mahipal: Sure. So I have gone through some different institutions. During my fellowship, that's when I really decided that I wanted to do GI oncology. Prior to that, I actually have a Masters in Public Health, where I learned about epidemiological research and how to design clinical trials, how to design cohort studies. My focus was on, actually there was somewhat a lot, but one of my mentors was working on colorectal cancer, and they had this huge database called the Iowa Women's Health Study Database of 100,000 patients. So that's where I started by clearly getting into colorectal cancer and GI cancer in general and how to learn from this database, how to mine these databases, how to do analyses, which seems easy but is actually quite complicated.  During my fellowship, I think the key to it is finding a good mentor during the fellowship. And I worked with one of the top GI oncologists in the country who's practicing. And I worked under her and learned a lot not only from the clinic side but also from the research perspective and how sometimes you'll come up with the ideas during the clinic itself.Like, “Hey, this patient had this and why aren't we looking into this.” And she would even do some of the therapies based on phase II trials and she was a part of a lot of these trials and learning from those experiences.  And following my fellowship, I joined Moffitt Cancer Center, where I led the phase I program there. So I was heavily involved in drug development programs, all training programs I've been to, NIH in Bethesda, an observership in the CTEP program, and also did the ASCO/AACR Vail workshop, where you really learned a lot in just like one week. So those are kind of opportunities present for fellows and even the early investigators and attendings as well in the first few years can go there, have your proposal. And really they are the world experts in trial design and they'll talk about how to design trials, how to add collaborators, improve your trial, and basically learn the whole protocol in a week so to speak.   And then I was at Moffitt Cancer Center for about five, six years. My home was GI so I did both GI oncology as well as phase I. And in terms of the GI oncology, my main focus was pancreatic cancer and liver tumors. Then I was at Mayo Clinic in Rochester for about seven or so years. I kind of did the same thing and solidified my career at GI oncology, looking at liver tumors, and pancreatic cancer and then being a part of the phase I division program. And now, most recently, about a year or so ago, I joined Case Western to lead the GI program here. Dr. Rafeh Naqash: Are the winters in Cleveland better than the winters in Minnesota? Dr. Amit Mahipal: For sure. I always say, you don't know cold until you go to Minnesota. It's a different kind of cold. I'm sure people in Dakota might say the same thing, but the cold in Minnesota is very brutal and different compared to any other place I've been to.  Dr. Rafeh Naqash: Well, it was great learning about you. Thank you so much for spending this time with us and for sharing your work with our journal. We hope you'll continue to do the same in the near future.  Thank you for listening to JCO Precision Oncology Conversations. Don't forget to give us a rating or review, and be sure to subscribe so you never miss an episode. You can find all ASCO shows at ascopubs.org/podcasts. Dr. Amit Mahipal: Thank you for having me here, Rafeh. Good luck. Take care. Dr. Rafeh Naqash: Thank you so much. The purpose of this podcast is to educate and inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions.   The guests on this podcast express their own opinions, experiences, and conclusions. Their statements do not necessarily express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.   Dr. Mahipal: Consulting or Advisory Role:QED TherapeuticsAstraZeneca/MedImmuneTaiho Oncology Speakers' Bureau:AstraZeneca Research Funding:Taiho Pharmaceutical"

Our friend Sarah Dandashy has amnesia. No other explanation as to why she's returning to FNA to celebrate the end of the week by having some drinks and laughs with Glenn, Craig andf Producer Dave.

Making the FNA Count Author: Jeffery Rinker The hospital at Sanford Bemidji Medical Center has 119 beds and performs an average of 150 FNAs each year. Our histologists do both histology and cytology, with FNAs comprising the majority of our cytology. Since 2020, our non-diagnostic rates on FNA samples have fluctuated. In 2022, our rate was as high as 28%. Compared to the non-diagnostic rate of 10% outlined in The Bethesda System for Reporting Thyroid Cytopathology, our results were over two times the accepted rate. To bring non-diagnostic rates down at our facility, a look at processing from beginning to end.  Radiology was the first place to start an overview of the process. During observation, we discovered that multiple passes of the needle contributed the bloodier samples, which affected the specimens processed later. To counter this, we reduced the number of smears and increased the amount of specimen deposited into CytoLyt (ThinPrep). Next, the cytology department process was examined. During this examination, it was discovered the CytoLyt (Thinprep) specimen was not being processed because of lack of specimen. When it was processed the slides were being dried to long leading to artifact on the slide. By increasing the sample size in radiology and using a slide dryer to regulate the drying, the lab was able to produce a more consistent result.  Following these changes, the lab projected to meet or exceed the goal of less than 10% non-diagnostic slide results by the end of 2023.

Welcome to Episode 6 of FnA Presents!!In this episode, Fred and Adrienne dive into a variety of subjects from television shows they have been watching, the latest court drama and more! There will be SPOILERS in this episode, so you have been warned!Fred and Adrienne start off this episode with their fun and crazy banter they do! Fred discusses an incident with his cell phone that we all can definitely relate to! Plus…some Disney news has dropped recently that you want to check out for sure!Adrienne fills us in on the latest with the Jonathan Majors trial and the major bomb shell that dropped this past Friday which included text messages that doesn't bode well for Majors!Fred and Adrienne dive into the shows that they have been watching on Apple TV such as Monarch: Legacy of Monsters and For All Mankind. Fred also got Adrienne to check out the first episode of an AMAZING show on Apple TV, Severance!! She gives us her thoughts and opinions on it and lets just say…she's hooked after the first episode!! Fred gives us a little treat with Monarch by letting us know some Easter eggs and fun facts about the monsters in the show and he and Adrienne discuss the last 2 episodes and what's been happening!Adrienne starts us off with the latest episode of For All Mankind and gives us the latest dilemma's of the show! They both share their thoughts and where they think the show is headed!! This show is definitely packed with drama and exciting, shocking things so you definitely want to hear the latest about this streaming show! We can't have an episode of FnA presents without a little gaming news or topics! Fred shares with us the latest theories and Easter eggs for GTA 6! This episode is one you definitely want to check out! So grab a drink, grab a snack, grab whatever ya want and tune in! We hope you Enjoy the show!! Please let us know what you think and your thoughts/reviews on our socials below:YouTubeTWITCHTwitter PageFacebook PageSpotifyInstagram PageApple PodcastGoogle PodcastAmazon PodcastStitcher PodcastWebsite

SLP  – this podcast may help you meet your continuing education requirements. Access Relias Academy to review course certificate information.    Do you want to implement the standardized IDDSI diets at your facility but are unsure how to start? Would you like to know about online resources that are available to help you and your team? In this podcast, Faerella Boczko, MS, CCC-SLP, BCS-S, and Mary Casper, MA, CCC-SLP, ASHA Fellow, FNA, will give you that information and more with a discussion about how the diets were successfully implemented in skilled nursing facilities.  How are we doing? Click here to give us feedback  (03:32) IDDSI Implementation in the U.S. (11:11) First Steps in Facility Implementation (15:46) Implementation Team and Timeline (22:27) Staff Education (26:12) Converting Labels to New Consistencies (29:32) Testing and Tasting (35:26) Additional Unexpected Steps (39:35) Keeping Momentum During Lengthy Implementation  (44:58) Value of IDDSI  (46:59) Converting from Pre-Admission Diet to IDDSI Diet  (50:04) Approach to Bread  (52:23) Interprofessional Collaboration (54:30) Recommended First Steps (57:35) Summary  The content for this course was created by Faerella Boczko, MS, CCC-SLP, BCS-S.    The content for this course was created by Mary Lee Casper, MA, CCC-SLP, ASHA Fellow, FNAP.  The content for this course was created by Susan Almon-Matangos, MS/CCC-SLP. Here is how Relias can help you earn continuing education credits:  Access your Relias Library offered by your employer to see course certificate information and exam;   or   Access the continuing education library for clinicians at Relias Academy. Review the course certificate information, and if eligible, you can purchase the course to access the course exam and receive your certificate.  Learn more about Relias at www.relias.com.    Legal Disclaimer: The content of Stretch: Relias Rehab Therapy Education is provided only for educational and training purposes for healthcare professionals. The educational material provided in this podcast should not be used as medical advice to treat any medical condition in either yourself or others.  Resources  International Dysphagia Diet Standardisation Initiative (IDDSI) website with framework, testing methods, and resources: https://iddsi.org/  IDDSI resources for U.S. implementation: https://iddsi.org/United-States  Please see other Relias courses related to IDDSI for more information. 

Get Thrifty Traveler Premium deal/award alerts sent straight to your inbox. Use promo code “AT101” for $10 off your first year. Head to ThriftyTraveler.com for more details and check out their Google Flights guide. Recent finds include:Business class to Paris for 40KBusiness class to New Zealand for 63KBusiness class to India and Middle East for 68KYou can find these at ThriftyTraveler.com/Premium.Post/s of the weekChelsea ElizabethNewsSouthwest bookable through Chase travel portalLifelock at 95% RakutenBlack Friday Huge Qatar award dumpCondor and Emirates partnerAlaska changesTrip updatesAngieMontana tripP2 doesn't want to safari.Australia??JoeBreeze credits/pointsHyatt VIP Suite for P2 & meShort-notice meetupToys for Tots drive on Monday, December 4, 2023 from 6 to 9 p.m. Joe will be joining. To get your free tickets.What bonuses did we get?AngieBusiness GoldAnother InkJoeTargeted Business Platinum + checking offerHighlight feature: LingoFeel like you are learning a new language? We often get folks saying “please spell out these acronyms” but when it's the same word over and over again, you need shorthand. Some examples include 5/24, CSR, SUB, and P2.Airline codesCheck out our world-famous Award Travel 101 Transfer Partner Matrix.Airport codesIt's necessary when for searching for award flights that you know where you're going. Class of Service codesFor simplicity these are boiled down to 3 major:F - FirstJ - BusinessY - EconomyGeneral termsThere are so many more, and you can find those on this FlyerTalk message board post.Tip of the weekUse Award Wallet. Once you have a bunch of cards it's hard to keep track of all the credits and benefits! Angie received an email from AwardWallet that she hasn't used the $75 credit on the WN Priority card! Keeping track of how you used a FNA can add value.Where To Find the Award Travel 101 Community For questions, you can join us in the free 100,000+ member Award Travel 101 Community. For more intermediate and advanced strategies, join Award Travel 201 community To book time with our team, check out Award Travel 1-on-1. You can also email us at contactawardtravel@gmail.com. Our next meetup is located in San Antonio, TX on April 26–28, 2024, and it's SOLD-OUT. You can get on our wait-list, but to learn more visit Taco 'Bout A Fiesta! Support the AT101 Podcast/Community

Dr. Shin describes continued movement from FNA to FNB for solid pancreas lesions to aid in more informed treatment algorithms.   (7) Carrara S, Soldà G, Di Leo M, Rahal D, Peano C, Giunta M, Lamonaca L, Auriemma F, Anderloni A, Fugazza A, Maselli R, Malesci A, Laghi L, Repici A. Side-by-side comparison of next-generation sequencing, cytology, and histology in diagnosing locally advanced pancreatic adenocarcinoma. Gastrointest Endosc. 2021 Mar;93(3):597-604.e5. doi: 10.1016/j.gie.2020.06.069. Epub 2020 Jul 5. PMID: 32640200. Starkey M, Daboul J, Lang J, Hart B, Ekwenna O. Trends in female representation in gastroenterology fellowships in the United States. Ann Gastroenterol. 2022 Nov-Dec;35(6):577-583. doi: 10.20524/aog.2022.0747. Epub 2022 Oct 3. PMID: 36406975; PMCID: PMC9648528.   ENDO-1663703-AA

It's really important you know that they're on your side. Games we played this week include: Lies of P (16:00) Solar Ash (17:35) F-Zero 99 (20:20) Nun Massacre (27:10) No One Lives Under the Lighthouse (27:35) Blood Wash (31:40) Trombone Champ (39:55) Gloomhaven (42:05) MythForce (47:05) --- News things talked about in this episode: Microsoft leaks everything, like, everything, on FTC website (52:42) https://www.theverge.com/2023/9/19/23880165/xbox-leak-ftc-documents-new-xbox-series-x-controller-next-gen Ubisoft Montreal workers get screwed by sudden “return-to-office” demands (1:13:15) https://news.xbox.com/en-us/2023/09/11/xbox-mastercard/ Unity makes a crap “apology” for runtime fees, but has not reversed course yet (1:37:30) https://www.eurogamer.net/unity-apologises-for-confusion-and-angst-over-fee-changes Terraria developer Re-Logic donated $200k to alternative game engines Godot and FNA (1:25:35) https://www.gamesindustry.biz/re-logic-donating-100000-to-godot-and-fna-in-response-to-unity-backlash Bobby Kotick might be only person outside of Nintendo to play a Switch 2 https://www.theverge.com/2023/9/18/23878412/nintendo-switch-2-activision-briefing-next-gen-switch --- Buy official Jimquisition merchandise at thejimporium.com Find Laura at LauraKBuzz on Twitter, Twitch, YouTube, and Patreon. All her content goes on LauraKBuzz.com, and you can catch Access-Ability on YouTube every Friday. Follow Conrad at ConradZimmerman on Twitter/Instagram/BlueSky and check out his Patreon (patreon.com/fistshark). You can also peruse his anti-capitalist propaganda at mercenarycreative.com.

The 8bA Podcast is a podcast bringing you the latest and greatest geeky news of the past week.NEWS ITEMSBluey. IGN reports that a Bluey game is in development from Outright Games and BBC Studios. The game will feature all four of the show's main characters and include an original story, but also feature familiar activities. The game will have 4-player coop, and seamlessly matches the cartoon's art style. Bluey: The Video Game will release on Switch, PS5, PS4, Xbox Series X/S, Xbox One, and PC on November 17.Cult of the Lamb. Polygon reports that Massive Monster will not, in fact, take the game offline on January 1st, but will experience delays on new projects as dev teams switch to new engines.Dungeons & Dragons. Phandelver and Below: The Shattered Obelisk released today. The updated starter adventure will include new material up to 12th level and feature a longer, sinister plot involving mind flayers and other aberrant denizens of the Underdark.Embracer. Game Developer reports that the Embracer-owned studios Beamdog and Crystal Dynamics have laid off employees as part of Embracer's restructuring efforts. 26 employees were let go from Beamdog, which include producers, artists, and QA staff. Affected departments at Crystal Dynamics include project management, PR, editing, and 2D art.Final Fantasy XIV. SiliconEra reports that Square-Enix has announced a new TTRPG based on the popular MMORPG. The starter set will release May 2024 for $59.99, and will include a Player Book, GM book, premade character sheets (Warrior, White Mage, Dragoon, and Black Mage), a set of dice (6d20 and 10d6), a rules summary, strategy guide, encounter map, character tokens, and ability markers. The recommended party size is 3-5, including a GM.Re-Logic. GamesRadar reports that the Terraria developer plans to donate $100k each to two open source engines (Godot and FNA), with $1,000 monthly donations to both moving forward. In Re-Logic's statement, they, “unequivocally condemn and reject the recent TOS/fee changes proposed by Unity and the underhanded way they were rolled out. The flippant manner with which years of trust cultivated by Unity were cast aside for yet another way to squeeze publishers, studios, and gamers is the saddest part. That this move was wholly unnecessary pushes things into the tragedy category - a cautionary tale the industry will not soon forget.”Unity. Bloomberg (Jason Schreier) reports that Unity might consider limiting total fees to 4% of a game's revenue, and suggests this limit would apply to customers making over $1M. The fees would also rely on developers self-reporting installation numbers.LINKSWebsite: https://8-bitadventures.comPatreon: https://patreon.com/8bitAdventuresMerch: https://8-bitadventures.com/shopJoin the Discord: https://discord.gg/FAPKjjQ“1-UP” is by Professor Shyguy. You can find his work at https://professorshyguy.bandcamp.com Hosted on Acast. See acast.com/privacy for more information.

JCO PO author Dr. Jens Rueter Chief Medical Officer at The Jackson Laboratory and Medical Director of the Maine Cancer Genomics Initiative, shares insights into his JCO PO article, “The Maine Cancer Genomics Initiative: Implementing a Community Cancer Genomics Program Across an Entire Rural State.” Host Dr. Rafeh Naqash and Dr. Rueter discuss this successful initiative for patients and its implementation for access to precision oncology in rural settings.  TRANSCRIPT Dr. Rafeh Naqash: Hello and welcome to JCO Precision Oncology Conversations, where we bring you engaging conversations with authors of clinically relevant and highly significant JCO PO articles. I'm your host, Dr. Rafeh Naqash, Social Media Editor for JCO Precision Oncology, and Assistant Professor at the OU Stephenson Cancer Center. Today we are joined by Dr. Jens Rueter, Chief Medical Officer at The Jackson Laboratory and Medical Director at the Maine Cancer Genomics Initiative. Dr. Rueter is also the Associate Director for Regional Translational Partnerships at the Jackson Cancer Center and the lead author of the JCO Precision Oncology article titled “The Maine Cancer Genomics Initiative: Implementing a Community Cancer Genomics Program Across an Entire Rural State.”  Full disclosures for our guest will be linked in the transcript and can be found on the article's publication page.  Welcome to our podcast and thank you for joining us today, Dr. Rueter.  Dr. Jens Rueter: Well, thanks for having me. It's a pleasure to be here. Dr. Rafeh Naqash: For the sake of this podcast, we'll refer to each other using our first name if that's okay with you. Dr. Jens Rueter: That's great. Dr. Rafeh Naqash: So this article that your group published in JCO Precision Oncology has significant implications. It has broad outreach. It incorporates an aspect of Precision Oncology that is very important for not only academia but also from a community outreach perspective, which is one of the reasons why I chose this as one of our podcast highlights. So to start off, I would really be interested to know what are the current barriers to the implementation of Precision Oncology, especially in rural settings versus urban settings, that can impact cancer mortality. Dr. Jens Rueter: Yeah, that's a great question. Let me just go back a little bit in time here. When we first started with the Maine Cancer Genomics Initiative back in 2016, the problems were actually even more significant than they are today. Back in those days, I would say even access to testing was a problem in rural areas. And I think that is still the first thing to consider when thinking about barriers. Back in 2016, there were only a handful of testing companies. There were issues with reimbursement or patient out-of-pocket costs. So I think that's the first barrier. I would say that that has significantly changed in the last six years. There are more testing companies available. It appears that the out-of-pocket expenses for patients have dramatically decreased or the systems programs have improved. There are still some barriers, but I think it's a much smaller part of the population.  The second barrier to implementation, though, which remains to this day, and in fact, I would argue has actually become more complicated, is a quick and comprehensive, yet fast and deliverable interpretation of the test reports. The test reports contain a lot of information. It's often 20 to 30 pages long, multiple sections, and really understanding how to utilize that information for clinical care is a very significant issue for clinicians to this day. So that's the second barrier.  And I think then the third barrier that is still ongoing and I think, especially in rural areas, is the access to treatments through either a clinical trial or even through off-label prescriptions, that both of those require a lot of infrastructure, and that still remains a significant issue to this day. Dr. Rafeh Naqash: You touched up on some very important aspects and one being understanding of genomic reports and this has been something that I talk to fellows all the know. I finished fellowship a few years back. At that time, NGS testing was becoming more and more prevalent, even though, as you mentioned in your paper, CMS coverage for this didn't start until 2018, 2019 approximately. And from a phase one trial standpoint, which is what I do, I have probably a little more exposure to genomics and precision medicine than perhaps some of our community colleagues. But it does come up often when we get referrals from outside sites. We're trying to look through the report and see something that stands out, whether it's a varying allele frequency that's high enough to warrant testing, germline testing, or some other targets that were identified a few years back but probably were not acted upon.   So you had this very interesting approach, a three-pronged approach is what I understood, of how you tried to tackle this within your main precision oncology program. Before we go there, could you tell us what was the idea behind establishing something like this? Because I imagine bringing it to fruition is something much more complicated, but the idea is where it starts. So I imagine, like, you probably had a conversation with some of your colleagues or somebody else noticed this as a barrier in the clinic and came up with this sort of an approach. Could you touch upon that for the sake of our listeners? Dr. Jens Rueter: Yes. So back in 2016, or actually in 2015, when we started conceptualizing the Maine Cancer Genomics Initiative, the idea was to look at Maine as a state, as a very rural state. The Jackson Laboratory is an NCI-designated basic science cancer center in the state, the only NCI-designated cancer center in the state. And we feel like there is an obligation, if you will, to the state to do good for all of Maine. So it's a community approach that we felt was important. And we realized then at the time that, again, that testing genomic tumor testing, or NGS testing while available, was not being used effectively in the community. So I think those two ideas essentially made us think and believe that we should take the lead in starting such a program.  We felt that we had actually one significant advantage in that we are a non-patient care organization. So the Jackson Laboratory, even though we have an NCI-designated cancer center, we don't see patients at Jax. So we were not a competitor, if you will, for patients in the state. So we were an honest broker. We were sort of a neutral Switzerland, if you will, in Maine, and were able to convene the entire community around this concept. Even though Maine is a small state, there are a number of healthcare systems that are actually competing with each other for patients in certain areas. And when we sort of started this program, we said, look, we want to work with everyone, and it's important for us to work with everyone, and we want to include even the smaller, truly rural critical access hospitals that have small, very small oncology practices. They're just as important to us as the larger centers. So I think that was sort of the community idea behind this and this is what really started it all. And then also, again, the fact that testing was such an issue, it also happened that at the time, Jax had just started we had just started our own clinical laboratory, our own CLIA certified laboratory. So we felt like we actually had the expertise to bring a test to the community that would then engage them to utilize the technology more effectively. And that's how we proceeded with this.  Dr. Rafeh Naqash: Excellent. And I totally agree that this inclusive stakeholder approach that you had was probably one of the elements for success in this kind of an approach and led to a significant impact in the lives of patients. You mentioned three things that you targeted or three things that you identified and tried to implement as part of this Precision Oncology program. Could you tell us about those briefly, what they were, and why they were important to be included in this approach? Dr. Jens Rueter: Yes, absolutely. So the first and most important one and most impactful one was that we developed a genomic tumor board program through this initiative, which again we had a centralized yet hub-and-spoke type approach where we said, “Okay, we are going to organize these for all of the practices, for all of the studies. The patients that are enrolled in our study protocol, we will organize these and basically create an environment where we call on national experts from around the country and, in fact, around the world at this point, that call in and provide input on the different cases that the physicians had enrolled.” We left it up to the physicians to decide which cases they wanted to present because they had some patients that they enrolled where they felt like they didn't necessarily have to present the case. So there was a lot of buy-in for these genomic tumor boards because we really discussed cases that were probably the most challenging ones and the most relevant ones.  So I think the genomic tumor board program was really the most significant development and the most significant infrastructure that we built. And in fact, the work that we did in Maine actually enabled us to design a cluster randomized study that we're now running through the SWOG Cancer Research Network. I'm leading that effort with a collaborator from Columbia in New York, actually, Meghna Trivedi. And so that was really a great success, and we will hopefully in a few years know if this approach actually leads to changes in some patient outcomes. We have some indication that it does from our own work, but we will see that in a more rigorous fashion.  The second pillar, if you will, the second part of the approach was that we have a dedicated clinical education group at JAX. So JAX Laboratories, as I said, a basic science cancer center,  but we also have essentially an entire group dedicated to genomic education. And part of that group is focused on clinical genomics education. So we have a modular online program that clinicians can access, not just the physicians, but also the nurses and other people, other members of the patient care team. And in fact, in addition to the online program, we ran a few virtual educational sessions specifically for nurses, which we actually found was, nurses and clinical research coordinators were really one of the most important keys to success as well, that we get them on board and enable them to better understand the complexities of testing.  And then the third aspect, of course, was that we did provide the testing as well as part of this initiative, which we saw as kind of a method to really engage clinicians and take the pressure off the clinicians. “What if I order this testing? Are patients going to come back with significant out-of-pocket expenses?” Again, that was particularly relevant back in 2016, 2017, before the CMS coverage decision. So those three aspects were really what drove this program. Dr. Rafeh Naqash: Excellent. Now what I gather is for something like this to come to a full functional state, you need a team and you need funding. So how did you define or identify the core group of people that were most important for this initiative? And what was the funding source? Because these days, nothing gets done without the appropriate level of funding. So I wanted to ask you and see how you manage some of those logistical issues.  Dr. Jens Rueter: Great question. So this whole program was really enabled by a large philanthropic grant, or donation, if you will, from a foundation called the Harold Alfond Foundation. It's a very large philanthropic organization in New England, and they're very Maine-focused. They have historical or family ties actually to Maine, and it's very important to them to bring Maine sort of to the forefront, sort of out of the rural disadvantage, and turn that into an advantage, which is why they agreed to provide funding for this program. And I agree with you that that is a critical step. This program was always in between a traditional research program that could be funded by an NIH grant, for example. I think that initially you need some startup funding first to get this going, and then later on, as you can develop more concise research questions, I think you can also apply for NIH funding for something like this. But certainly, philanthropy goes a long way here. So that was sort of the funding source, and, I think, very important.  Now, in terms of the team, that's actually a great question. You need a few different functions represented here. So I think, first of all, having some clinical expertise is important. So I was actually specifically hired to JAX for this program. I'm a medical oncologist. I actually still have a small practice in Maine as well, but I was in full practice before I joined JAX. And I was hired specifically for this purpose so I could engage with the community and sort of understand my colleagues over the state. You need a very good and rigorous program manager, someone who can really– It's a complex project that there are many aspects you need to consider and you really need someone that kind of keeps track of all the different activities and makes sure that things are moving in the right direction.  Since we are a research organization, we decided to roll this out on a study protocol. So we hired a clinical research manager that would basically disseminate and enable the study protocol and make sure that it's actually done correctly. Even though it was a low-risk observational study, we still wanted to make sure that we collect good data on the patients and the number of publications that we've been able to produce from this initiative, I think, speak to the quality of the data. And then as the program has evolved, we have actually added on a couple of other key functions within the program, and actually one of them pertains specifically to the genomic tumor boards, which again, I think are really critical to this. So you really need one dedicated person to organize these and coordinate these. It's a lot of scheduling. There's a lot of, as you know, from your own clinical practice, clinicians have very specific schedules, and if you really want to make this successful, you really need to make sure that everyone's schedules are accounted for.  And then we also recently added another function to our program, another individual who is a genomic navigator. Actually, we call it the genomic navigator. And I think that this individual, her job is if there are additional questions, for example, after genomic tumor board, or if there are just some very specific about a test report from the entire- it could be from anyone on the team, the physicians, the nurses, the research coordinators, she can help identify some additional answers to some additional questions. She can also help clinicians if they're interested in finding a clinical trial for the patient or find some supporting evidence for off-label drugs, for example, she can provide them with additional references. We have crafted documents that basically summarize the available evidence that exists for using a specific drug in association with a genomic marker. So I think genomic navigators are also very important, and I think there are some other individuals on my team now, but I think those are the core functions that you really should consider. Dr. Rafeh Naqash: Thank you for giving us a detailed explanation of the team that I'm pretty sure has expanded over the last few years as you've tried to expand this program concurrently.  Now, going from the team to the platform, I was kind of interested to know a little more about the sequencing platform generally, as from my clinic, I do FoundationOne, or ERUS testing, or Tempus testing, etc., and I'm not very well versed with some of the platforms used. Could you tell us a little bit more about what these platforms are? How big the panels are from a DNA standpoint? And I see you did test for some RNA fusions as well. So could you tell us how that came about? Dr. Jens Rueter: So when we first started the initiative, we started with a single assay that we ran through the Jackson Laboratory, and it was at the time a fairly contemporary test. It looked at both SNVs, insertions, deletions, and so forth on the DNA level and on copy number variants as well. And it was 212, at the time, 212 cancer-related genes. It was a homegrown panel if you will. This was back in 2017, 2018, and we also had a fusion assay that looked at RNA already at the time. So we were already kind of ahead of the curve at that point because, at the time, many assays were still just looking at DNA for fusion. So we already figured that it would be better to look at the RNA level. And then we sort of grew the panel from there.  The last panel that we used specifically for this first phase of the initiative had grown to 501 genes. It was already done on a specific platform. I think it was one of the Illumina platforms at the time. So we figured the off-the-shelf solutions weren't necessarily the right approach. We also added in tumor mutational burden. We added in MSI. We did not yet have at the time LOH or HRD assessment, but we certainly offered TMB and MSI. And we had the usual sort of commodity testing for PDL-1, which we actually sent out because it wasn't necessarily what we do in-house. So that was during the program as it is described in the manuscript. I will say we continue this program. We're continuing the genomic tumor boards now. We've never stopped. We just continued after the study was over. We offer it essentially as a service now to the community, as an educational service if you will, and we now actually work with any test reports that the physicians provide. Again, I think the landscape has shifted dramatically and the testing itself doesn't seem to be as much of a barrier anymore. So we look at a lot of Tempus reports, KRAS foundation, every now and then we'll have something that's a little bit more unique, I would say.  There are obviously many other sequencing companies out there and we've actually found that this is– For our genomic tumor boards, we actually developed a template that is non-branded, that is just trying to put every test into the same table, front table, which I think has actually been very helpful for the clinicians because, again, sometimes you just can't find all of the relevant information on the front page. And we comb through every report and try to find every addendum that may have been generated and all kind of collate it in one single slide if you will, so that the clinicians have it right there and then we kind of talk it through as well. So that's essentially the evolution of the testing over the last six, seven years. Dr. Rafeh Naqash: So this more or less sounds like a very state-of-the-art, contemporary approach that was available more or less to other clinicians at that time. 200 gene panel seems pretty extensive for 2018, 2019 and, as you probably know, things have gone to whole exome at this point, but I think you seem to be doing what was most appropriate at that time.  Now, going to the results between 2017 to 2020, your precision oncology program enrolled around 1600 people. The results were simple but very impactful, is how I describe it. Could you tell us some of the highlights from the results, what you identified, both from an implementation standpoint, participation standpoint, and from an impact at an individual patient's level?  Dr. Jens Rueter: Yeah, I'm happy to do that. So, I think the most important for us, the most important metric was that we were able to, over time, engage all practices and engage all– When we finished with the initiative, at that point, every physician, every oncologist in the state had actually been enrolled in our program as a study participant, which was actually one of the unique features, by the way, of our program: we said we were going to study both the physicians and the clinicians. So we had enrolled on our study 100% of the oncologists. It took us about 18 months to get to all the practices, which I think is an important metric for anyone who wants to pursue something similar. You have to always keep in mind that, even if you come in with a fairly solid proposal and something that is clearly of benefit to patients, every institution that you work with, it's going to take a while before you can get all the agreements signed and the IRB issues settled.   So it took us about 18 months, which I think is still fairly quick actually. And we listed the enrollment as well, the enrollment curve of patients in the paper. And it certainly did take some ramp-up in the very beginning, but then we really very quickly sort of ramped up to a steady state after about a year or so. We discussed about a little bit less than, about a third of the cases actually, at our genomic tumor boards. Almost three-quarters of the physicians actually participated in the genomic tumor boards as well. We ran around 200 GTBs throughout the initiative, and we're currently looking at the clinical outcomes of these patients. It's currently under review what the clinical outcomes were, but I can already say that we are sort of, I would argue, in about the same place in terms of patients that actually went on a genome-match therapy as many other publications in that venue. And it is actually, as you can probably imagine, rather complicated to define what a genome-match therapy actually is. And that will be coming out soon, hopefully soon.  So the other findings are also quite interesting and they have been published in other publications over the last few years. So at baseline, for example, we actually asked the patients, “What are your expectations? What are you expecting from this enrollment, from the tumor testing?” And we actually identified that the patient expectations were very high, which I think is important, an important finding -  can be explained partially by precision oncology, it's a buzzword right now, and patients have certainly picked up on this and there are a lot of very high expectations in that it's going to change your outcomes. And physicians also at baseline felt quite confident, actually. There was a fairly good spread, but most of them felt quite confident that they would be able to utilize the information and actually explain it to their patients. They felt mch less confident, very on-point, in my opinion, that they would be able to put the patients on a targeted therapy or that their practice would have the infrastructure to support putting patients on therapy. So those are some of the other findings that we've identified over the last few years overall. Dr. Rafeh Naqash: Thank you. And just on a side note, I was looking at Figure 4, which shows the number of cases per physician, and one physician particularly stands out with 120+ cases. Dr. Jens Rueter: Yes. Dr. Rafeh Naqash: Did that individual physician get any kudos after doing this excellent job? Dr. Jens Rueter: Yes, actually this physician did. That's actually a really good point that you're bringing up. That's another important finding that I found quite fascinating, actually, that everyone is kind of the same at baseline. We offer the same thing to everyone. And you can see in Figure 4 in the paper that there is a significant spread in terms of how many patients each physician enrolled and also how many they presented at a genomic tumor board. And certainly that one physician is a very engaged member. We have a steering committee that we implemented very early on. That physician is also on our steering committee. And this really has contributed a lot of insights into what has worked well and maybe what hasn't worked so well. So it is a rather fascinating statistic, I agree. Dr. Rafeh Naqash: One of the things I also noticed from your summary was that the uptake of the genomic testing and being part of this initiative was more for rural areas than for urban areas. And I was trying to understand why perhaps one of the reasons could be that it does help the community physicians in that setting. Was that what you saw, or was there another side to it that perhaps may not necessarily be explained in this manuscript? Dr. Jens Rueter: Yeah. So, first of all, just to be very clear that the highest enrollment in rural areas was per capita so that's an important distinction in my opinion. So, it obviously goes that the more rural areas are more densely populated. And what's actually behind this is that the physicians that were working in those rural areas also just happen to be really engaged in the program and find a lot of value, especially, in the genomic tumor boards. So it was really very much a personable motivation. I would say, though, that the larger issue behind this, or the larger interpretation of these findings is that, especially at that time, I would argue that the– In Maine, you can always see that everything kind of moves from the south all the way to the north. It takes a little bit of time and it's the same in pretty much anything, but in medicine as well. And so, I think at that time, the NGS testing just wasn't really used all that much in the more rural areas. So I think the fact that we provided it– And again, there's also less infrastructure at these smaller hospitals or smaller practices. So running through the hoops of getting prior authorizations and still managing potential out-of-pocket expenses just aren't there and these were things back in the day for sure that were barriers. So I think us coming in and saying, “Look, all you have to do is you mention to your patients that there is this program called the Maine Cancer Genomics Initiative, and if you're interested, someone will contact you from the Jackson Lab and talk to you more about the study and see if you want to participate.” That's all they needed to do. And then everything else kind of went from there. I think that is really probably one of the reasons why we had such a significant accrual in those more rural areas. Dr. Rafeh Naqash: Amazing. And one of the things that I am very dreadful of is ‘tissue being the issue' where, despite the biopsy, despite everything you do, the pathologist comes back. Or you send the tissue to the sequencing company, they come back saying, not enough tumor cells. What were some of the things that you did or your group did to help the people involved in this process understand why tissue matters? Because that can add to further delays in treatment. So I'm very curious to know what some of those things were that you tried to help everybody understand from an educational perspective. Dr. Jens Rueter: We noticed that very much in the beginning, especially, of the program, so after about two or three months, we realized that there were a significant number of tissue failures and we realized we needed to address that. And we did that both by internal as well as external processes. So we actually looked back at our assay and said, "Look, maybe our requirements for DNA input are just too high. We need to rethink that and maybe there's a way to improve the laboratory processing so that we can actually work with less DNA." So I think that's a very important lesson.   And interestingly enough, I think this is still an issue to this day in a certain way with any of the testing laboratories, and we can get back to that in just a second. But I think the other aspect that was important here was, again, getting on the phone or on a Zoom call or whatever it was at the time, and really talk to the pathologist, talk to the clinicians, talk about, when you order a test, for example, think about beforehand as you're identifying the right specimen. Is this actually potentially enough tissue? If it's an FNA, maybe it's not enough. But if it's a good core biopsy, that's probably the better specimen. So that's certainly on the ordering physician side, but then also on the pathologist side, it was actually quite interesting. And one of the larger pathology practices in the state actually implemented something very smart, I think, as they sign out cases, and I think they do this universally on any case, as a pathologist signs out the case, he will actually indicate on the report which block should be used for sequencing. And they will actually indicate a tumor cell percentage, which I think is an excellent small step, but very impactful because it will reduce frustration on the side of the clinician, if a block is sent with not enough tissue, it will facilitate the workflow between the place where the tissue is stored, for example, and where it's cut, and it makes everything a lot simpler. And I think those are the kinds of things that you really have to think about. I think in the contemporary times now where it's become quite common for testing companies to weed out samples that have 20% or 30% neoplastic content. What's interesting there, though, is that I feel like sometimes they're almost a little bit optimistic. They're always very clear on the disclosures in the report. They will say that there was a low tumor cell purity and some of the results should be interpreted with caution. But again, I'm not sure that clinicians are actually reading the fine print. So the example has kind of flipped a little bit that nowadays you're getting a lot more information than you did six, seven years ago. But you have to understand better as to how the information was derived. Dr. Rafeh Naqash: I couldn't agree with you more as far as noting down in the pathology specimen which specimen is the most appropriate for NGS. It's a small thing to do, but I think it makes a huge impact when the research team or the nurses are actually trying to identify what specimen to send.  So now, Jens, coming to the last portion, I'd really like you to summarize in 30 seconds what are the future directions from this program? Where does it stand right now? And what are some of the things that you're trying to add on to the current format? Dr. Jens Rueter: Where we stand is we're continuing to run our genomic tumor boards in the state of Maine. And as I mentioned earlier, we're also running a national study where we're running an additional GTB per week just to really see how impactful it is on patient outcomes. In the future, we need to improve the processes. We need to streamline the processes with genomic tumor boards, involve more technology to scale it, essentially, and make it more broadly available. And lastly, what's really important is we also need to think more closely about treatment options and enabling rural areas to have more access to clinical trials. And I hope that with the current post-pandemic thinking, that we can actually enable that with technologies, with virtual visits, with virtual consent, and so forth. And then, one other point, we also need to educate patients so that they know what to ask for when they're meeting with the oncologist.  Dr. Rafeh Naqash: Thank you so much.  Now the last portion, a minute or two is going to be dedicated to you specifically. So, Jens, tell us a little bit about your career trajectory. Where did you start? You mentioned earlier that you did or currently do practice clinical oncology. And how did you get into the field of precision medicine that culminated into developing such an impactful program? Dr. Jens Rueter: We moved to Maine in 2010 after I completed my Hem/Onc Fellowship at the University of Pennsylvania, where I'd actually done quite a lot of translational and bench research. We came to practice. We moved to Bangor, and practiced here. And the Jackson Laboratory is really just on the road from where we are. We're at Mount Desert Island, right next to Acadia National Park, and I started collaborating with some of the scientists. Actually, early on, we built a tissue bank at the Northern Light Hospital here to facilitate translational research. And then when the funding became available, I received a call from the then CEO of Jackson Laboratory, and h, Ed Liu, and he said, "Jens, we're thinking about running this program and would you be interested?" And so that's how I joined JAX. And that's really when I started. I saw at the time already this gap that was widening and I saw how complicated it is to practice rural oncology. And I really saw this as a great opportunity to bring the field forward, to bring Maine forward, and to really address one of the major disparities that still exist to this day.  Prior to that, I spent quite a bit of time doing, as I said, bench research at the University of Pennsylvania. I also did my internal medicine residency at Tulane, and I always thought I was going to be a traditional physician-scientist. I actually feel great about this opportunity because I think it's addressing one of the major issues in contemporary oncology. So that's sort of how I got here. I'm originally from Germany, I went to medical school in Germany, did some research there, and then came to the United States about 20 years ago now for my postgraduate training, and I've stayed here ever since.  Dr. Rafeh Naqash: Excellent. Sounds like you're the right person for this job, with both a clinical translational bench kind of experience and having worked in different settings.  So thank you once again, Jens, for being a part of this conversation. I think at least I learned a lot. Hopefully, our listeners will find it equally interesting, intriguing, and perhaps implement some of the things that you have accomplished as part of this initiative.  Thank you for listening to JCO Precision Oncology Conversations. Don't forget to give us a rating or review and be sure to subscribe so you never miss an episode. You can find all ASCO shows at asco.org/podcast.  The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions.   Guests on this podcast express their own opinions, experiences, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement. Guest Bio: Jens Rueter, M.D. is the Chief Medical Officer of The Jackson Laboratory and Medical Director for the Maine Cancer Genomics Initiative.  Guest COIs: No Disclosures

Our guest today is Dr. Caree Cotwright, director of Nutrition Security and Health Equity at the Food and Nutrition Service at the US Department of Agriculture. Dr. Cotwright is leading a USDA-wide approach to advancing food and nutrition security in the United States. Part of her responsibility includes the charge from Secretary of Agriculture Tom Vilsack to make MyPlate a household name. MyPlate is the official visual reminder of the US government to make healthy food choices from each of the five food groups. Now, this turns out to be a tall but important order. About a quarter of US adults have heard of MyPlate, according to a recent survey. Interview Summary You came to USDA while on leave from the University of Georgia (UGA) where, by the way, you were the first Black woman in the Department of Nutritional Sciences to earn tenure. Congratulations for this, and please know how much I appreciate the important role that you've played in our field. So, let's start with discussing what drew you to food policy and what makes you excited about your role in public service at USDA? I am really excited about this role because it's just a privilege. When I think about the fact that USDA has the title or has a position for the director of Nutrition Security and Health Equity, I get excited about that. It's been a privilege to work on advancing all of the things that have come about because of the White House Conference. I came to nutrition policy really in a kind of a roundabout way. I was working on my master's at UGA and I was doing an internship at the Center for Science and the Public Interest (CSPI). At that time, I was wanting to write on the Nutrition Action Health letter, but they had someone who was mentoring in nutrition policy and that someone was Margo Wootan. She kind of took me under her wing and helped me to learn about what nutrition policy was.  After completing my master's and my PhD, I did my postdoc, and then did a RISE fellowship at the CDC. I was working on disseminating policy around early care and education obesity prevention policies and just really to understand the keen role that policy plays in the advancement of nutrition and policies in general. That was really eye-opening for me. I knew that during my role at University of Georgia as a faculty member that I would focus on both policy and intervention. I've had such a wonderful experience of being able to use different creative approaches, but also using policy. Some of those approaches have earned me the opportunity to talk to a variety of communities in different ways, including having a TED Talk. It's just been a joy to do this work. You've had so many interesting experiences and I could see how you'd be passionate about food policy after spending time at CSPI, especially with Margo Wootan. There aren't many people that know food policy like she does. But one thing I wanted to ask you about is one of the highly novel part of your work and your approach to nutrition has been to incorporate the creative arts, including storytelling. Tell us about this if you would. Storytelling has always been near and dear to my heart. When people ask me about that question, I've been doing it since I was about five years old when I was asked to come and give the commencement speech for my nursery school. I wasn't afraid, it was fun for me, and I just said, "Wow, this is really something that I can do." I enjoyed connecting and engaging with others. As I think about my work, I know that telling stories and using creative approaches to meet people where they are helps us to promote a variety of topics. Of course, it's kind of entertainment education, but using these approaches is a catalyst to get people interested in what we're doing. We know we're competing with so many things that pull people's attention now.  Some of the things that I've done are I have a play about nutrition for young children, I have a hip hop song. I tell stories even in my speeches because I know that when I can connect, people will remember that story. And that's so important. Through my work, I promoted the Child and Adult Care Food program. I worked on the SNAP-Ed program at University of Georgia. We've done creative things like having skits and have enough care to call Healthy Bear that the children relate to. Even in some of our work that I've been blessed to have and had the privilege to work with Robert Wood Johnson Healthy Research to have social media and to use all of these approaches, but to use it to promote health and use it to promote healthy messages and messages specifically about nutrition. That creativity and those approaches are things that I bring to my current position in thinking about how do we engage the public, especially as we continue forward with advancing nutrition security and health equity, as well as making MyPlate a household brand? I love that creativity. I think back on memorable speeches I've heard or talks I've listened to and things, very often, it's the stories that you remember. The fact that you're recognizing that, appreciating that, and perfecting it, I think is really impressive. I'm glad to learn a little bit more about that. Let's talk now about your federal service at the CDC. This was another experience that I know helped shape your interest and your passions and your desire to return to public service at USDA. That's a wonderful question. It was such a wonderful opportunity to come to CDC at a time we were on the cusp of really thinking about how do we develop and disseminate policy related to obesity prevention for our youngest children, age zero to five. I had just finished a postdoc in community-based participatory research at Morgan State University working with Head Start children. At the time when I got to CDC, we had former First Lady Michelle Obama working on Let's Move! One of the key initiatives was Let's Move! Child Care. We modeled the initiative and the work we were doing related to policy on the work of an outstanding researcher. Her name is Dr. Dianne Ward. Not only was she an outstanding researcher, she became a mentor, colleague, and friend of mine. I just have so much admiration for the work that Dianne Ward did and the trailblazing efforts that she did to advance policy in the early care and education setting related to obesity prevention, but also in equity.  So we were working on these things and my task was to go around to stakeholders all across the country and make sure that they understood what we were saying. So again, bringing in that community engagement and the training that I had, I said, "We can't just put this on a website and say, 'Hey everybody, you should go out and do this.' We have to go in and teach people and train people and explain it." Fortunately, my mentor there, Dr. Reynolds and Heidi Blanck, they agreed. I was able to go out and help to disseminate the policy, and again, it gave me such a strong and firm understanding of how to really relate.  I'll tell you just a quick story. At the time, I didn't have kids, Kelly, and we were talking about these obesity prevention policies and we said, "Okay, no screen time for children under two," and those things. It wasn't until I had kids and I thought, "Well, how do you do that?" Because it has to be realistic and you have to think about how these policies work on the ground. As I talk to childcare providers, as I talk to stakeholders, as I talk to people working at the state level across the country, we help gain an understanding for just how these policies will go into place and gain support for policy implementation because we can't do the work without the people who are working on the ground level. Two things I want to make note of that you just said. First is if it's easy to to talk about how children should be fed and learn about food until you have them, and then all of a sudden, it gets a lot more complicated, I know. But the other thing I'm grateful that you did was to pay tribute to Dianne Ward. Many of our listeners may know she was a professor at the University of North Carolina at Chapel Hill and recently passed away. There are people all over the country in the world who were just broken hearted by this because she was such a dear friend and colleague to many of us, and just a completely inspired researcher who wanted to make a difference in the world and really did. It's not surprising that she touched you and your professional career in such positive ways and that's true of a lot of us. I'm really happy that we were able to talk about her for a moment. So thank you. Thank you. Thank you for allowing me the opportunity. Let's talk more about your current position at USDA now. Can you tell us what your primary responsibilities are and what your vision is for your work ahead? Yes. My primary responsibilities are to advance the work of food and nutrition security and health equity. I know that's a part of my title, but we really are working to make sure that people are able to get access to the food they need. Our definition is that nutrition security means that everyone has equitable access and consistent access to healthy, safe, and affordable food that is optimal for their wellbeing. We do this at USDA through four pillars. We think about having meaningful support for nutrition and nutrition education, making sure that people have access to that healthy, safe, and affordable food, making sure that we work through collaborative action through partnerships, and then making sure that we prioritize equity every step of the way.  When you think about USDA and the programs that FNS has and the programs that we are working on in our mission area, we have lots of opportunities to advance nutrition security because our work is just so closely related. I work very closely with our programs and I work a lot with our stakeholders, both internally and externally, to make sure that people are aware of the work that we're doing. But not only that, that we are leveraging things like the historic White House Conference, making sure that we have lots of commitments from people all over. We've had over $8 billion of commitments. But making sure that with our stakeholders and our partners, that we lean into new creative approaches that will help us to reach our goals. We have some really big goals to end hunger, to improve nutrition, physical activity, and to reduce diet-related diseases and disparities. We are holding ourselves accountable and making sure that we're getting the word out and making sure that we're partnering in very meaningful ways.  A part of my larger vision is a part of the secretary's vision, which is to make MyPlate a household brand. We think about what does that mean? We want to make sure, you said early on that about 25% of Americans are aware of this tool, but we want to make sure that not only are they aware, but they use the wonderful resources that are attached to MyPlate because it is our federal symbol for healthy eating. It's heartening to hear about your vision and to understand the kind of progress that's being made to advance food and nutrition security, and also to specifically leverage some of the commitments that were made at the White House Conference. In addition to what the federal government can do, are there things that individuals can do like our listeners, for example, or the ways they can help? Yes, and I'm so glad you brought up your listeners because that's so important. So every voice matters. And so all of our actions add up collectively. I've heard up from some wonderful, wonderful people in West Virginia and Oklahoma, just all across the country. When I go out and speak and I tell people, "You have to help me with this mission of making MyPlate of household brand." They sent me back things that they're doing. Creative things like setting up kids farmers' markets, popup markets in places like hardware stores that don't traditionally do that. But they will set it up and let a farmer come in and set up a popup shop, and then they provide the tokens through some of our wonderful programs like SNAP-Ed and FNA. When we think about these creative solutions where there are already existing things, but we're solving a problem, we're solving that access problem. Just thinking about that and making sure that we are all collectively working together, we want to hear from you. We want to hear from you. I always give out my email. It's caree.cartwright@usda.gov. We want to hear from your ideas. We also have our pillar pages on our website. If you just look at nutrition security at USDA, we have our pillar pages so you can learn more. But we also have a very short video where we're talking about the work that we're doing and highlighting that work, and a blog that is attached to that. So again, if you're wanting to promote efforts that we're doing, that's a very quick synopsis and a short way to get it out there to people to spread the word and increase awareness about all of the wonderful things that we're doing to advance food and nutrition security. I never thought of my hardware store as a place to learn about nutrition, but why the heck not? Let's talk about MyPlate a little bit more. What's your role and how are you going to go about trying to make MyPlate a household name? It's a very multi-pronged approach. My role is to bring those creative approaches. One of the things I love about this position is that it's a culmination of so many of the things that I've already been doing. Using my creativity, thinking about the equity focus, and working with our Center for Nutrition Policy and Promotion. They're a wonderful team. They've already been doing wonderful things on MyPlate but helping to amplify that work and helping to get it out there so we make it a household brand. We have a multi-pronged approach where we'll be using social media. I told you I was able to use that in my research. Not only that but doing things where we're celebrating the great work that people are doing around MyPlate. Like for example, I know in Oklahoma, they had a wonderful day at the capitol and the lieutenant governor was working with students to put food in the right MyPlate categories and making sure that people are aware of them. There are artists making songs about MyPlate. And so, making sure that we are making the public aware of what we're doing. With this multi-pronged approach, we'll be doing listening sessions. We're hearing from people about what can we do better? What do you really like? Are here things that we can change? Really hearing from the community on that level. Then, also thinking about industry and how can industry partner to promote MyPlate and promote those food categories so that people have an understanding of MyPlate and the branding of the icon. Making sure that people recognize MyPlate and the icon and are knowledgeable about the resources that we have. I'm really excited about doing partnerships because this is a one USDA approach. We're going across all levels to make sure that we get the word out about MyPlate. And we do have a MyPlate national strategic partnership with partner organizations all over the country that are already helping us to do this work. We want to attract new partners, to have new partners to come in, and lean in to help us to amplify MyPlate and all the wonderful resources for the public. I'm assuming it's pretty easy to find out about MyPlate online, is that right? It is. It's myplate.gov. It is very simple. All of our materials are branded with that, but it's very simple. You can remember MyPlate, you can remember our website. So it's myplate.gov. You can go directly there and find all of our wonderful resources, and we'll be having more, as I said, on social media. I don't want to forget this point too as well, Kelly. There are cultural adaptations. When I'm out in the field, people ask me about, what about for my culture? What about for the things that I eat? How is MyPlate relevant to that? What I love about MyPlate is that it's so adaptable. During our listening sessions and the work that CNPP is doing, we are working to address that as well. Again, meeting people where they are, having them understand that your cultural foods are healthy foods too, and how do we use MyPlate to guide our healthy choices when we're making our meal choices. Again, you look at the plate, half the plate is fruits and vegetables and that can be from a variety of sources and a variety of cultures and preparations and lots of different foods. And so we want to make sure that people are understanding that and that we get the word out there. Bio Dr. Caree Jackson Cotwright serves as the Director of Nutrition Security and Heath Equity for the Food and Nutrition Service at the United States Department of Agriculture (USDA). In this role, Dr. Cotwright leads a whole-of-Department approach to advancing food and nutrition security. She also serves as one of two Departmental representatives on accelerating action on the White House Conference on Hunger, Nutrition, and Health goals to end hunger, improve nutrition and physical activity, and reduce diet-related diseases and disparities and implementing the corresponding National Strategy. Her work includes building public awareness of USDA's actions to advance food and nutrition security, as well as collaborating and building partnerships with key stakeholders to maximize our reach and impact. Dr. Cotwright is on leave as an Associate Professor of Nutritional Sciences in the University of Georgia's College of Family and Consumer Sciences' Department of Nutritional Sciences. Her research centers on promoting healthy eating among infants through age five-years-old with a particular focus on accelerating health equity among historically underserved populations via community-based participatory research and focusing on developing, implementing, evaluating, and sustaining best practices and policies in the early child education setting. She has developed a variety of innovative interventions, which use theater, media, and other arts-based approaches. She is the author of numerous peer-reviewed publications and secured over $1M in grants focused on obesity prevention and health equity from Healthy Eating Research, a national program of the Robert Wood Johnson Foundation, and the USDA. From 2010-2013, she worked as an ORISE Research Fellow at the Centers for Disease Control and Prevention Division of Nutrition, Physical Activity, and Obesity, where she was highly engaged in the early care education elements of the First Lady Michelle Obama's Let's Move! initiative dedicated to helping kids and families lead healthier lives. Dr. Cotwright holds a PhD in Foods and Nutrition and Community Nutrition and MS in Foods and Nutrition both from the University of Georgia and a bachelor's degree in Biology from Howard University and is a Registered Dietitian Nutritionist. She lives in Athens, GA with her loving husband and adorable three daughters.  

This week, we kick off a new series focusing on diffuse large B-cell lymphoma. In this first episode, we discuss the basics that everyone needs to understand before diving into the management of this disease. We highly recommend listening to our hemepath series before proceeding with this DLBCL series: https://www.thefellowoncall.com/rotationguide-intro-to-hematopathologyContent: - Approach to workup for a patient with suspected lymphoma- FNA vs. Core vs. Excisional biopsy for diagnosis- Use of PET/CT for staging- How to risk-stratify patients - "Double hit" vs. "double expressor"**This episode is sponsored by HemOnc.org** Want to review the show notes for this episode and others? Check out our website: https://www.thefellowoncall.com/our-episodesLove what you hear? Tell a friend and leave a review on our podcast streaming platforms!Twitter: @TheFellowOnCallInstagram: @TheFellowOnCallListen in on: Apple Podcast, Spotify, and Google Podcast

 Mike joins Joe to discuss his newest cards, news, and their most recent trip to educate members on how to ramp up their Award Travel game. Plus is there a Fiesta in-store? Post of the weekThis comes from our Daniel Mark Adsit who shared how he put an entire 27-day trip to South America utilizing rewards. Check it out and let us know in the comments what your longest rewards trip was.NewsTime sensitive stuff that ended the day before this episode released, but that's why you should be following along in the Award Travel 101 communityChase to British Airways, Iberia, Aer Lingus 30%Is my AA account being hackedWhat bonuses did we get?Mike -Hilton Business. 130k + FNA. Immediately redeemed it for Niagara Falls.Ink Business Preferred. 50% through min spend. Also got two referral bonuses for a total of 80kJoe - almost done with Chase Ink Preferred Minimum Spend RequirementHighlight feature: MSP Meetup RecapWe brought almost 100 Award Travel community members to Minneapolis for "Let's Go Crazy with AT in the TC," to party like it's 1999.Arrival - flight disruptions caused some havocTram - how was itReception at Graze Rooftop - this is where the rubber hits the roadElite Breakfast - Was one better than the other?Presentations - presentations kicked off Free time - Prince Museum, Fair, Socials - what did each of us do?Brits Pub - Party Like It's 1999After party (Loud dance club) - how Joe helped a member use a tool he'd just learned about from JT's presentationHell's Kitchen - did we do the unthinkable and skip free Elite breakfast?Airport lounge hopping First Class Home (Free WiFi!) - Joe booked economy with just 8.5K Virgin points, so how did he get First Class?Next meetup in SAT - Taco 'Bout A Fiesta! Limited amount of tickets left (and an even smaller amount of discounted tickets using code: SAT20 to save 20%).Tip of the weekOur Tip of the Week comes from Mike, who's been updating the Award Travel 101 website. For some of the tools we've produced to answer common questions of group members, checkout:Transfer Partner Matrix - simple view of which card points transfer to which travel partnersCard Earning Charts - quick view of potential earningsCents Per Point Calculator - how to value point returnsTransferWhere To Find the Award Travel 101 Community For questions, you can join us in the free 100,000+ member Award Travel 101 Community. For more intermediate and advanced strategies, join Award Travel 201 community To book time with our team, check out Award Travel 1-on-1. You can also email us at contactawardtravel@gmail.com. Our next meetup is located in San Antonio, TX on April 26–28, 2024, and it's SOLD-OUT. You can get on our wait-list, but to learn more visit Taco 'Bout A Fiesta! Support the AT101 Podcast/Community

On this week's FNA we have Morgan Brodey, President of JACLO. As an amazing pro, she has the skill to put Glenn in his place. Join them, Craig Sullivan and Producer David Mignano, CRME for some laughs and cocktails!   #hospitality #happyhour #cocktails #hotelpodcast #podcast

Benedetti seguirá siendo embajador de Colombia ¿Se caerá la paz total? Encuesta Opinómetro… Cecilia López revela las razones de su salidaExpresidente del FNA se defiende en silencioLos cultivos de coca crecen y las incautaciones caen 19 de julio marcha de la reserva activa¿Petro perdido por un día en Francia?Petro con todos sus Ministros en la Guajira

This show is totally paint by numbers. No, literally. But yes, it'll probably suck too. Grab a cocktail and join Glenn, Craig and Producer Dave as they paint the FNA logo under the tutelage of the Amazing Amy Montgomery.

El abogado Julio César Ortiz se refirió en La W al presunto manejo irregular del FNA por parte de su presidente, Gilberto Rondón.

It is time to have your questions answered about Van Life. Alex and I will use our 3 and a half years of experience of life on the road to answer the question you have for us. We want you to feel comfortable to just in a van and start living your dream life. All the questions we were ask where from our Instagram community, if you are interested in getting your questions answered follow us and keep an eye out for our story with a question box. Become part of the FnA Community, Join our Patron today: ⁠https://www.patreon.com/fnavanlife⁠ It's time to hit the road for all your FnA summer road trips and vacations and full time travels!! We're breaking down our favorite summer destinations all over North and Central America. After 3 years on the road, we've been to a lot of different destinations, all have their pros and cons and there's something for everyone. But we're sharing our tips for the best summer ever. Pick up your copy of the Van Life Book: ⁠https://www.amzn.to/2MAN2uL⁠ Join Sekr for FREE and start exploring: ⁠https://sekr.com/auth?ref=qL1u4cr80yY5NJTd6B1ZXdtFNO72&email=true&type=sign-up⁠ Our YouTube Channel: ⁠https://www.youtube.com/fnavanlife⁠ #vanlife #fnavanlife #vanlifers #travel Don't forget to leave a review to get featured in next week's episode! To pick up any of the products we talked about in today's video, check out our Amazon Store: ⁠https://www.amazon.com/shop/fnavanlife⁠ all links are affiliates so we get a small kickback from Amazon but your price stays the same. --- Support this podcast: https://podcasters.spotify.com/pod/show/fnavanlife/support

Become part of the FnA Community, Join our Patron today: ⁠https://www.patreon.com/fnavanlife⁠ It's time to hit the road for all your FnA summer road trips and vacations and full time travels!! We're breaking down our favorite summer destinations all over North and Central America. After 3 years on the road, we've been to a lot of different destinations, all have their pros and cons and there's something for everyone. But we're sharing our tips for the best summer ever. Pick up your copy of the Van Life Book: ⁠https://www.amzn.to/2MAN2uL⁠ Join Sekr for FREE and start exploring: ⁠https://sekr.com/auth?ref=qL1u4cr80yY5NJTd6B1ZXdtFNO72&email=true&type=sign-up⁠ Our YouTube Channel: ⁠https://www.youtube.com/fnavanlife⁠ #vanlife #fnavanlife #vanlifers #travel Don't forget to leave a review to get featured in next week's episode! To pick up any of the products we talked about in today's video, check out our Amazon Store: ⁠https://www.amazon.com/shop/fnavanlife⁠ all links are affiliates so we get a small kickback from Amazon but your price stays the same. --- Support this podcast: https://podcasters.spotify.com/pod/show/fnavanlife/support

Fear the 'Fro is here previewing the Cavs vs. Knicks, recapping a fun week in the NBA that saw Evan Mobley and Donovan Mitchell with incredible awards showings.  Bob discusses what he's looking forward to with Cavs and Knicks, and then is joined by Kevin Figgers, of the FnA podcast, to discuss All-NBA awards, the logical inconsistencies of voters, and some playoff predictions.  Bring on the New York Knicks.

One of the highlights of a visit to Morocco is getting a henna art design, something as authentically Moroccan as tagines and desert camping. More than just a decorative activity, henna has deep cultural roots in Morocco, particularly for women.Siham Essahiri is an expert henna artist, offering design experiences to travellers from around the world out of her home studio in Marrakech. Many listeners and guests on the podcast have had this experience themselves.But few of us have known her remarkable true life story, until now. Born in a mountain village in the High Atlas mountains, Siham was put into an arranged marriage in the mid-2000's, and became pregnant at the age of 19. Despite being worldly and well-educated, she was facing a bleak future in a society of pre-determined roles and customs.In today's episode, Siham shares how she took control of her and her daughter's lives, making bold choices and becoming self sufficient. Key to this achievement was her ability as an artist, which opened doors and opportunities in tourism and beyond.Azdean and Siham talk about the power and strength of women in Morocco, the many barriers that still exist, yet the inspiring examples of Siham and others like her.We learn about the history of henna, and the many occasions where it is used. Siham explains how henna parties are a part of a bride's wedding preparation: more than just an art session, it's a major event!And being so popular an activity, scams to hook tourists in will inevitably abound, at the Jamma el Fna square in Marrakech in particular. There are numerous reasons to avoid these and other scams, and Siham shares some horror stories of "tattoos" gone wrong and exorbitant fees charged.If and when you're in Marrakech, go for the real deal: an all-natural, custom-designed henna experience from an authentic artist. Siham is a wonderful artist, host, cook, guide and more, and will welcome you into her home with open arms.You're about to learn:What exactly is henna, the plant.How henna differs around the world, and the Moroccan interpretation of it.How henna paste is made, and when it should be made.Why authentic, hand-mixed henna paste is not just better quality but will last much longer than what you find in the square, where it is chemical and cheap.Can you buy the hand-mixed paste and do it yourself?What tool Siham uses to create her designs.This Episode is sponsored by:Travel Anywhere - One stop for all your travel needs.https://www.travelanywhere.travel/Follow, Share and Participate:Learn more about the show on our Podcast WebsiteFind beautiful pictures on our Instagram!Help people find us: Leave a Review in Apple PodcastsHelp us grow: Rate us on SpotifyBecome a Guest on the Show!Visit Destination Morocco Travel Agency

Laura Wittner nació en Buenos Aires en 1967. Es traductora, narradora y poeta. Con su talento y conocimiento tradujo al español a autores como Leonar Cohen, Katherine Mansfield, Anne Tayler y David Markson, entre otros. Recientemente tradujo el libro Bocetos de natación, de Leanne Shapton, un inesperado tesoro para lectores sensibles que publicó Blatt y Ríos. Entre sus libros de poesía se encuentran Lugares donde una no está y Traducción de la ruta. Es autora de libros para chicos como Dime cómo vuelas, Los entusiasmos, Justo antes de dormir, vecinos bichos, Animal entendido y Cual para tal, estos dos últimos en coautoría con Juan Nadalini. Su libro Se vive y se traduce, publicado por Entropía, se convirtió el año pasado en un boca a boca para todos aquellos que buscan saber qué hay detrás de ese trabajo muchas veces invisibilizado y siempre fundamental: el de traductor. Se trata de un libro compuesto por notas, fragmentos, y citas de otros traductores que en conjunto componen un libro delicado y potente que habla de la tarea de aquellos que tienen que trabajar con la palabra de los otros y cuyo trabajo no concluye una vez que se cierra la computadora. La lengua, las lenguas, siguen reverberando. Traducir un texto es traducir a una persona, intentar alcanzar aquello que quiso decir y dar a entender y es, también, traducir una cultura. De todo esto habla el agudo y hermoso libro de Laura. En la sección El Extranjero, Hinde habló del libro “Love me Tender”, de Constance Debré y en Libros que sí recomendó “Un trabajo para toda la vida”, de Rachel Cusk (Libros del Asteroide) y “Médicos, maleantes y maricas”, de Jorge Salessi (Planeta). En la sección Mesita de luz, la escritora y pintora Ana Montes nos contó que libros está leyendo. Ana es autora de Poco frecuente en 2021 ganó la Beca de Creación del FNA para terminar de escribir su segundo libro, Meditación Madre, publicado por Concreto Editorial en 2022.  

Cytopathology Program Director Toolkit: Rapid On-Site Evaluation  Dr. Vanda Torous, Chair of the ASC Cytopathology Program Directors Committee, interviews Dr. Kamal Khurana and Dr. Cecilia Gimenez on their experiences incorporating ROSE into their training programs including telecytology in this episode of our series Cytopathology Program Director Toolkit.   Dr. Gimenez is an anatomic and clinical pathologist at the Donald and Barbara Zucker School of Medicine at Northwell Health. Since 2017, she has been their cytopathology fellowship director. Her areas of interest include medical education, cytopathology and ultrasound-guided FNA training. She was on the ASC Program Director Committee for 2 years and is currently on the Diversity, Equity, and Inclusion Committee.  Dr. Khurana is a professor of pathology and medicine and Director of Cytopathology at Upstate University Hospital in Syracuse NY. His interests and areas of focus include interventional cytopathology and gynecologic pathology. He was on the ASC Program Director Committee for multiple terms, about 8 years in total.  Sponsored by the ASC Cytopathology Program Directors Committee.  

Become part of the FnA Community, Join our Patron today: https://www.patreon.com/fnavanlife Jeff Wagg is the amazing host of Built to Go! a van life podcast you can and should check out here: https://open.spotify.com/show/7LVDUu68iZ1wGRSoy86HeE Today Jeff is interviewing us about how we got on the road and what our plans are for the future. Big things are coming to FnA!! Sign up for Nomadic Health Insurance here: https://safetywing.com/nomad-insurance/?referenceID=fnavanlife&utm_source=fnavanlife&utm_medium=Ambassador Pick up your copy of the Van Life Book: https://www.amzn.to/2MAN2uL Join Sekr for FREE and start exploring: https://sekr.com/auth?ref=qL1u4cr80yY5NJTd6B1ZXdtFNO72&email=true&type=sign-up Our YouTube Channel: https://www.youtube.com/fnavanlife #vanlife #fnavanlife #vanlifers #travel Don't forget to leave a review to get featured in next week's episode! To pick up any of the products we talked about in today's video, check out our Amazon Store: https://www.amazon.com/shop/fnavanlife all links are affiliates so we get a small kickback from Amazon but your price stays the same. --- Support this podcast: https://anchor.fm/fnavanlife/support

Ron Balassanian is a Professor of Pathology at the University of California San Francisco (UCSF) with an appointment in UCSF Helen Diller Family Comprehensive Cancer Center. His clinical and research work focuses on fine needle aspiration (FNA) biopsy and general breast pathology, as well as patient communication and global health. Ron has led workshops on training pathologists to perform and interpret ultrasound guided FNA for the College of American Pathologists, the American Society of Cytopathology and the United States and Canadian Academy of Pathology. In collaboration with PATH, a Seattle based NGO, he helped develop the Community Program for Breast Health in Trujillo Peru, using FNA as a cost-effective tool for diagnosis and triage. Through the UCSF Global Cancer Program, he helped develop an US-FNA course in Dar es Salaam Tanzania as part of an ongoing educational collaboration between Muhimbili University and the UCSF Global Cancer Program. At UCSF he developed a patient education program called “Ask Your Pathologist” inviting patients to review their breast cancer slides with a Pathologist to better understand their pathology report. In his clinical service and research work, Ron is passionate about patient centered pathology and bridging the gap between the patient and the pathologist.  Twitter:  @BalassanianRon

Ryan Huntsman returns to FNA to make up for his 2022 appearance where he introduced us to an amazingly horrid drink. Find out what's in store this year as we celebrate Happy Hour with Craig, Dave and myself. This is bar none the best show of 2023 so far!

小額贊助支持本節目： https://open.firstory.me/user/ck4fgb04n698h0804wzdkaycj 簡介： 腎上腺腫瘤最常見於狗，多半在腎上腺依賴性腎上腺皮質機能亢進症、高血壓或是針對非特異性臨床症狀（如虛弱、厭食和嘔吐）進行腹部超音波檢查期間發現的。 雖然超音波檢查是一個相對簡易的腎上腺檢查方法，但腎上腺輕微腫大的臨床意義有時很難解釋。 腎上腺寬度在縱向平面上大於 1公分認為是腫大的。腎上腺切除術所需的技術，根據是否有血管侵犯和侵犯的程度而不同，而血管侵犯及程度又常與腫瘤的大小和類型相關。 重點整理：大於 2.0 cm 的腎上腺腫塊，有很大的機會是惡性的。使用 電腦斷層血管攝影(CT angiography, CTA)或超音波造影(contrast ultrasound) 的高階成像、FNA細胞學檢查或尿液生化檢測等，可以提供額外的訊息，以識別小於2.0 cm的惡性腫瘤，並區分皮質腫瘤和嗜鉻細胞瘤；然而，沒有任何測試工具有 100%的準確性，並且也已經有報告指出，同時分泌皮質醇(cortisol)和兒茶酚胺(catecholamines)的混合性內分泌腫瘤的存在。術前用phenoxybenzamine預先治療嗜鉻細胞瘤(pheochromocytoma)，可降低35%的死亡風險。只要適當選擇合適的病例，執行腹腔鏡腎上腺切除手術是相當安全的。成功切除有實質被侵犯的腎上腺腫塊，是高度可行的；然而，成功與否，取決於與手術和麻醉團隊的良好協調和溝通、術前整體計劃和手術經驗等。 留言告訴我你對這一集的想法： https://open.firstory.me/user/ck4fgb04n698h0804wzdkaycj/comments Powered by Firstory Hosting

Rodrigo Duarte nació en Uruguay, vivió en Buenos Aires y en la actualidad reside en Ciudad de México. Es periodista, fue editor de la sección Opinión en Infobae y también de la sección LGBT+ del mismo sitio y es un gran lector y un servero crítico de cine y música. Una curiosidad para la cofradía de los oyentes: Rodrigo es quien me hizo escuchar el tema Fortuna, de Antonio Zambujo, que tenemos como cortina desde el comienzo de Vidas Prestadas, en el año 2019. Editorial Aguilar, del grupo Penguin Random House, acaba de publicar su primer libro: Klemm, la extraordinaria vida del ícono pop argentino contada por amigos, amantes, artistas y adversarios. Se trata de una biografía coral de Federico Klemm, un personaje excéntrico y bastante central de la vida social porteña de los 90, quien nació en 1942 en República Checa y murió en Buenos Aires, en el año 2002. Klemm fue artista visual, cantante de ópera amateur, mecenas, galerista y gran divulgador del arte en medios masivos y para este retrato completísimo de su vida y su obra, Rodrigo trabajó durante varios años -pandemia y distancia mediante- y entrevistó a más de 120 personas. Entre ellos, hay grandes celebridades y otras figuras menos conocidas pero muy cercanas a Klemm, muchos de ellos lo quisieron y lo valoraron, otros no y también están aquellos que comenzaron a valorarlo recientemente. En la sección Voz alta, Silvia Arazi leyó el inicio de la nouvelle “La nieta del señor Lihn” de Philippe Claudel. Silvia nació estudió Historia del Arte y canto lírico en el Instituto Superior del Teatro Colón. Es poeta, narradora y cantante y acaba de publicar “La voz de la madre” una novela íntima y bella sobre el final de la vida de una madre ante los ojos de su hija y sobre el vacío lacerante de esa ausencia. En Te regalo un libro Damián Huergo habló de “Mentirosos enamorados” de Richard Yates. Damián Huergo nació en Longchamps en 1983. Estudió sociología en la Universidad de Buenos Aires. Es autor de los libros de cuentos Ida y Biografía y Ficción (Primer Premio del Fondo Nacional de las Artes, 2017), y de la novela Un verano (2015). Publicó crónicas y ficción en antologías y en medios como Radar Libros, Anfibia, Gatopardo, y Coolt, entre otros. En 2017 obtuvo una beca del FNA para escribir La ley primera, su novela de reciente aparición En la sección Bienvenidos, Hinde habló de “Maestras del engaño”, de Tori Telfer (Impedimenta) y “Libro blanco de la conversación”, de Patricia Nigro y Marcela Farré como compiladoras. (Biblos) Y en Libros que sí recomendó “Debimos ser felices”, de Rafaela Lahore (Montacerdos), “El trabajo ya no es lo que fue”, de Alain Supiot (Siglo XXI) y “Escritos sobre la mesa”, compilación de Mariano García y Mariana Dimópulos (Adriana Hidalgo).

What is a soft tissue sarcoma? Soft tissue sarcomas are a broad category of tumors including those that arise from the connective, muscle, or nervous tissues in dogs and cats. These tumors are the result of abnormal production of these cell types in an uncontrolled manner. Connective, muscle, and nervous tissues are present throughout the entire body; therefore, these tumors can develop over the chest, back, side, legs, and facial tissues of your pet. Soft tissue sarcomas make up about 15% of cancers of the skin affecting dogs and about 7% of those affecting cats. Fibrosarcomas are common in dogs and are a type of soft tissue sarcoma (see handout "Fibrosarcoma in Dogs" for more information). "Soft tissue sarcomas make up about 15% of cancers of the skin affecting dogs and about 7% of those affecting cats." Even though soft tissue tumors arise from many different types of cells, they all behave in a similar manner and their treatment is typically the same. What causes soft tissue sarcomas? The reason why a particular pet may develop this, or any tumor or cancer, is not straightforward. Very few tumors and cancers have a single known cause. Most seem to be caused by a complex mix of risk factors, some environmental and some genetic or hereditary. For most cases of soft tissue sarcomas, no direct cause has been determined for their development. Sarcomas at injection sites occur in cats but are rare in dogs (see handout “Post-Vaccination Sarcoma in Cats” for further information on this type of sarcoma). In cats exposed to a form of the feline leukemia virus (called feline sarcoma virus), the development of sarcomas on the head and neck sometimes occurs. What are the clinical signs of soft tissue sarcomas? The clinical signs depend on where the tumor is located and the tissues that are affected. Often, pets have a noticeable mass that is growing in size. Signs associated with soft tissue sarcomas include the following: Pets that have tumors arising from muscle tissue may show signs of pain in the affected region and may have a distinct firm and growing mass (tumor). Tumors that are located on the limbs may cause changes in your pet's ability to walk and the limbs may have obvious swelling. Pets that have tumors arising from nervous tissue may be unable to use the affected limb or may show other neurological signs. Pets with intestinal tumors may have signs of an intestinal blockage, such as vomiting, diarrhea, lack of appetite, weight loss, and abdominal pain. Pets with soft tissue sarcomas in the mouth often have halitosis (bad breath), difficulty eating, loss of appetite, bleeding in the mouth, or obvious tumors in the mouth. Signs of a soft tissue sarcoma affecting the reproductive system depend on the location of the tumor. For example, if the prostate is affected, difficulty with urinating or defecating may be observed. How are soft tissue sarcomas diagnosed? In some cases, a fine needle aspiration (FNA) may be performed. FNA involves taking a small needle with a syringe to suction a sample of cells directly from the tumor and placing them on a microscope slide. A veterinary pathologist then examines the slide under a microscope. If a diagnosis is not confirmed by this method, a biopsy may be needed. A biopsy is a surgical excision of a piece of the tumor. Pieces of the tumor are then examined under the microscope. This is called histopathology. A biopsy is beneficial because it gives an indication as to how aggressive the tumor is and how its treatment should be approached. Staging (searching for potential spread to other locations in the body) may be recommended. This may include blood work, urinalysis, radiographs (X-rays) of the lungs, and possibly an abdominal ultrasound. If any lymph nodes are enlarged or feel abnormal, further sampling may be pursued to determine if any spread is present. "If any lymph nodes are enlarged or feel abnormal, further sampling may be pursued to determine if any spread is present." How do these tumors typically progress? This is entirely dependent on the location and grade of the tumor. Typically, the higher the grade (these tumors are graded from I to III) the more likely that spread is possible. However, one of the biggest concerns with soft tissue sarcomas is their ability to invade the local surrounding tissues. They can almost be described as an 'octopus', where the bulk of the tumor is the head and the microscopic cells that invade the surrounding tissue are like small tentacles. These ‘tentacles' become challenging to treat when managing your pet's tumor, either by surgery or radiation therapy. "...one of the biggest concerns with soft tissue sarcomas is their ability to invade the local surrounding tissues." What are the treatments for these types of tumors? The most commonly pursued treatment for all soft tissue sarcomas is surgery. Because these tumors typically produce ‘tentacles' of abnormal cells, wide margins (the amount of tissue that needs to be removed) must be obtained for the best control of the tumor. If microscopic cells are left behind after surgery, recurrence of the tumor is much more likely. If cells are left behind (determined through histopathology), either a second surgery or a combination of surgery and radiation therapy may be pursued. Chemotherapy is not usually pursued as a primary treatment unless surgery or radiation are not options for your pet based on the tumor size or location. Chemotherapy may be an option after surgery. Metronomic chemotherapy (daily administration of lower doses of chemotherapy rather than traditional schedules) may be recommended. These therapies will be discussed with you if they are relevant to your pet's particular type of sarcoma.

From Dublin, Ireland, embalmer and educator, Glyn Tallon sits down at the FNA roundtable.  Have a story and want to be on the show? Connect with Undertaking: The Podcast here: On The Net Facebook Twitter Instagram Today's sponsors: The Wilbert Group Indiana Donor Network

Executive Summary This episode is part of our Subject Matter Expert Interviews. It will be one in a series over time, keeping up with the development of the central banks and their digital currency. This episode is just the start! We talk to Kimmo, a regtech entrepreneur, who formerly worked at central banks of Finland, Norway, Bank of England, ECB, and the Fed in New York City. This episode is a starting point for us, from which we will dive deeper, keeping up with the developments on CBDC. At the Federal Reserve in New York I siumlated attacks on critical infrastructure on the back of the 9/11 attacks.Kimmo Soramäki, Founder and CEO of FNA Subscribe Here We are always sharing new resources with you. Find all of our options below. We want to make sure that we provide what's best for your growing team, so please take a look at these additional ways in which can help! https://linktr.ee/startupradio We work with a lof of clients with three letter acronyms. So we decided to name our company financial network analytics, FNA.Kimmo Soramäki, Founder and CEO of FNA The Expert This episode is part of our Subject Matter Expert Interviews. It will be one in a series over time, keeping up with the development of the central banks and their digital currency. We talk to Kimmo, a regtech entrepreneur, who founded with FNA a company that helps banks, central banks and financial institutions. He has already advisde the central banks of Finland and Norway, been a visiting researcher at the Bank of England and expert at ECB. He also spents a year as research economist at the Fed in New York City. His first software simulated for finish banks the impact of joining the euro zone. When the financial crisis 2008 came, we realized that we don't need an outside attack on the symstem to destabilize it. Kimmo Soramäki, Founder and CEO of FNA Our Sponsor Startupraven A startup's journey can be a tough one, but it doesn't have ́to feel like you're alone on your quest! Invest in others' success with us by joining our community of entrepreneurs who are building amazing things every day - no matter how big or small their ideas may seem at first glance. The best way to find investors and cooperation partners for early-stage startups. Sign up here: https://startupraven.com/ Blog Post Find all links and show notes here: https://medium.com/@startuprad_io/fintech-opportunities-in-cental-bank-digital-currency-part-1-839a35c2a1be

Executive Summary This episode is part of our Subject Matter Expert Interviews. It will be one in a series over time, keeping up with the development of the central banks and their digital currency. This episode is just the start! We talk to Kimmo, a regtech entrepreneur, who formerly worked at central banks of Finland, Norway, Bank of England, ECB, and the Fed in New York City. This episode is a starting point for us, from which we will dive deeper, keeping up with the developments on CBDC. At the Federal Reserve in New York I siumlated attacks on critical infrastructure on the back of the 9/11 attacks.Kimmo Soramäki, Founder and CEO of FNA Subscribe Here We are always sharing new resources with you. Find all of our options below. We want to make sure that we provide what's best for your growing team, so please take a look at these additional ways in which can help! https://linktr.ee/startupradio We work with a lof of clients with three letter acronyms. So we decided to name our company financial network analytics, FNA.Kimmo Soramäki, Founder and CEO of FNA The Expert This episode is part of our Subject Matter Expert Interviews. It will be one in a series over time, keeping up with the development of the central banks and their digital currency. We talk to Kimmo, a regtech entrepreneur, who founded with FNA a company that helps banks, central banks and financial institutions. He has already advisde the central banks of Finland and Norway, been a visiting researcher at the Bank of England and expert at ECB. He also spents a year as research economist at the Fed in New York City. His first software simulated for finish banks the impact of joining the euro zone. When the financial crisis 2008 came, we realized that we don't need an outside attack on the symstem to destabilize it. Kimmo Soramäki, Founder and CEO of FNA Our Sponsor Startupraven A startup's journey can be a tough one, but it doesn't have ́to feel like you're alone on your quest! Invest in others' success with us by joining our community of entrepreneurs who are building amazing things every day - no matter how big or small their ideas may seem at first glance. The best way to find investors and cooperation partners for early-stage startups. Sign up here: https://startupraven.com/ Blog Post Find all links and show notes here: https://medium.com/@startuprad_io/fintech-opportunities-in-cental-bank-digital-currency-part-1-839a35c2a1be

If you've been considering joining the next round of the Funk'tional Nutrition Academy in September, but want to know what the experience of being in the school is all about, listen up! Hear directly from current FNA student Lori Fish Bard, MS, CNS, LDN as she shares why she joined and her experience thus far. Also…Extended Financing for FNA Now Available! Check our full show notes with the link below for more details! FOR OUR FULL LIST OF LINKS + RESOURCES, HEAD TO: https://www.thefunktionalnutritionist.com/podcast/218-hear-from-an-fna-student

When navigating healing from food sensitivities and food allergies, the first action step is to remove the trigger. In the case of Celiac disease, that trigger is gluten and gluten-containing grains. However, while removing gluten from the diet is a crucial first step, it doesn't necessarily heal intestinal permeability, reduce gut inflammation, restore a damaged gut lining, and stop the autoimmune response. Today on the show Lori Fish Bard, MS, CNS, LDN sits down with Erin to explain why this is the case. Lori is a licensed clinical nutritionist and board-certified integrative health counselor who works with men, women, children, and families, many of whom have Celiac and/or gluten sensitivity, give up gluten, but still feel crappy. She describes her experience working with her clients, plus her own experience navigating Celiac disease with her daughter and self, an experience that prompted her to dive into the research and even go back to school to receive her masters in Clinical Nutrition. Lori is so committed to a root cause approach to healing that she also enrolled in FNA—stay til the end to hear about her experience! If you suffer from gluten sensitivity, Celiac disease, suspect you may be sensitive to gluten, or have tried going gluten-free but still don't feel better, this will be an insightful episode to hear! In this episode: -Why Celiac disease is hard to diagnose [5:01] -Where a lot of folks get stuck in their healing after Celiac disease [9:41] -Unexpected indications you could be dealing with Celiac disease [11:57] -How Celiac disease contributes to malabsorption (& why healing requires a nuanced approach) [13:42] -Testing options for tracking healing progress [15:45] -Other foods that could potentially be problematic for those with Celiac [18:28] -Molecular mimicry & why this is important for Celiacs to know [19:59] -The empowerment and control from knowing your genetics [23:06] -Eating out safely & confidently after learning you have Celiac [31:02] -Gut healing strategies beyond removing gluten [37:13] -Why Lori chose FNA for deep functional nutrition education [41:34] FOR OUR FULL LIST OF LINKS + RESOURCES, HEAD TO: https://www.thefunktionalnutritionist.com/podcast/217-going-beyond-gluten-celiac-disease

Time to learn about fine needle aspiration and cytopathology with Dr Celina Nadelman. She has a private practice and that is a rate situation. Get inspired and enjoy her episode. Dr. Celine Nadelman, MD talks to Dr. Justin Trosclair, DC on A Doctor's Perspective Podcast How does one go from psychology (neuroscience), art and then switch it up and go into medicine? Dr. Nadelman even spent multiple years in Italy developing her artist vibes but ultimately the practice of medicine is an art as well as a science so the two melded nicely. Some people know they want to not only do medicine but which specialty from high school age, but she was a bit unsure and had to try out a few things to figure out that Fine Needle Aspiration (FNA) pathology was her best fit. When she was in the process of residency, the big push was primary care but through a series of events and personal contact she found that pathology was her path. She was also a talented surgeon but with her desire to have a family and balance family with the surgery responsibilities, Dr. Celina decided that wasn't her path. Fine Needle Aspiration Biopsy Smallest needle possible, getting a smear of tissue, looking at in the microscope and determining what it is you have. It's the smallest amount of tissue needed to make a diagnosis. Pathologist is the Doctor's Doctor A lot of anatomical pathology is pattern recognition. You know what it is supposed to look like and in what location and then you start to recognize what's wrong and what patterns wrong have. Her specialty is cytology aka thyroids and head and neck tumors. She has her own private clinic doing FNA biopsy but it's a pretty rare thing and Dr. Nadelman is hoping a platform like A Doctor's Perspective Podcast will help others to do the same thing. It is a little hard to be private because you compete against the hospital pathologists. A problem is that any MD can do a fine needle aspiration but many many times they don't get enough readable material, or it's full of blood (bad) and both make it difficult to make a correct and confident diagnosis. Having to get more than one biopsy is not a pleasant experience for the patient and in her private practice, she can get the sample, smear it on a slide immediately and put it in under the microscope she has in the room to make sure it's readable. (Rapid On Site Evaluation). She gives a great story around minute 18 about a case that she did that required a second FNA because what she saq bedside would require extra tissue for further testing. This also saved the patient from having to come back to the office and from another pathologist reading it as, need more tissue for evaulation. Especially in this case it could have been a 1 year terminal diagnosis or not. Diagnosing normal and cancer is easy she says. The tough stuff are the tissues that are irregular and make you need to send out the sample to molecular specialist and beyond. Who is a good referral source for a private practice pathologist? Would it surprise you that she has to meet face to face with doctors, just like you do, so they refer to her instead of the hospital? Dr. Nadelman has been married for 24 years and this was during both of their professional school years and have 3 kids. Listen at the end for her marriage tips. A top tip is to not be in cruise control on your marriage. You have to engage each other in partnership. Also, don't be afraid to go to a counselor. www.drnadelman.com IG:drcanceranswerShow notes and the transcript can be found at https://adoctorsperspective.net/184 Dr. Celine Nadelman, MD talks to Dr. Justin Trosclair, DC on A Doctor's Perspective Podcast Full Transcript of the Interview (it will have grammatical errors and mistakes). Just Click to expand. Thanks descript! Episode 184 cytopathologist and FNA specialist. I'm your host, Dr. Justin TRS, Claire. And today we're Dr. Selena Nadel man's perspective.

“Our deepest fear is not that we are inadequate. Our deepest fear is that we are powerful beyond measure.” We SAY we want success / financial freedom / bigger audience / more clients / private practice / fill in with your own personal goals… but deep down there is some part of our subconscious that is TERRIFIED of this. (Ain't that a kick in the head?) In order to achieve our goals, hopes and dreams, we have to first acknowledge any mental blocks, limiting beliefs and/or fears that are standing in the way. You MUST have practices in place to clear them, to move beyond them, to recognize them as untruths. (Because PS It's not that you have LESS limiting beliefs and fears as you grow, it's that you get better at NOT believing they are true.) Because of this, we do A LOT of belief work in the Funk'tional Nutrition Academy. As Erin says, FNA is a container for growth. We won't let you sleep on your come up. In today's episode Erin discusses one place where your limiting beliefs may come from, and how to recognize if this is holding you back. Enrollment for the Funk'tional Nutrition Academy is officially OPEN TODAY!!!! Click here to fill out our application form: https://www.funktionalnutritionacademy.com/ From a current FNA student: I just wanted to reach out and express my deepest gratitude for Erin and the FNA program. I'm about halfway through the program and can confidently say that enrolling in FNA was by far one of the best decisions I've ever made, on both a personal and professional level. Not only have I learned so much about functional medicine (like seriously, SO much), but I've also learned a lot about myself along the way. Participating in this program has helped me to gain the confidence and clarity that I needed to leave a comfortable, yet unfulfilling, 8-5 job and move forward with my dream of opening a functional nutrition private practice. If it weren't for this program, I'm not sure if I ever would have built up the courage to make this leap, no matter how many functional nutrition trainings & certification programs I completed. Happy International Women's Day, Erin! Thank you for all you do to build up other women in this field. Your work is making a difference! From a recent FNA grad: I have been over the moon with my experience in this program!! I highly recommend FNA to my fellow practitioners looking to expand on their functional nutrition knowledge, education and application; as well as those looking to embark into the realm of private practice. You have everything to gain, and this program will not disappoint. This program was everything I needed and more - it helped me organize the knowledge I already had while further expanding my understanding of the content and enhancing my ability to utilize this knowledge in practice. Thank you, @the.funktional.nutritionist , and happy international women's day!! View on our website at https://www.thefunktionalnutritionist.com/podcast/196-confidence-clarity-courage-for-practitioners