Podcasts about Hg

This week on Bludging on the Blindside, Roy and HG discuss the Broncos and Reece Walsh's stunning performance at the NRL Grand Final, Teddy Swims visits the heritage listed toilets and the 'Year of healing' for Manly ended last weekend.

This week in the Speakeasy Studio, I'm joined by the remarkable Taylor Connery for a powerful and deeply personal conversation. Taylor opens up about her journey with Hyperemesis Gravidarum (HG) — a rare and severe pregnancy complication that affects fewer than 3% of women, yet can turn what's often portrayed as a “glowing” time into a fight for survival.Taylor courageously shares what it was like to face HG not once, but four times. She takes us through the physical challenges, the emotional toll, and the moments of strength that carried her through each pregnancy. With honesty and warmth, Taylor also talks about the support system that became her lifeline — and how those experiences inspired her to start a support group to help other women facing HG feel seen, understood, and less alone.This episode sheds light on a condition that's rarely talked about, while celebrating the power of resilience, community, and the voices of women turning their pain into purpose.Hyperemesis Gravidarum Supporthttps://www.facebook.com/share/g/1BVvhxEz2Q/Drink: ​⁠ Minutemaid LemonadeSponsorJacobson Real Estate Co.https://jacobsonrealestatecompany.comBrews & Cruise Podcasthttps://brewsandcruisepodcast.com

This week on Bludging on the Blindside, Roy and HG celebrate that the (Teddy) Swims is in to perform at the grand final, question if Reece Walsh should be the Face of rugby league, and ponder if the Broncos are stuck up.

Pumpkin spice season is here, and the HG crew is diving spoon-first into fall's most festive finds! In this episode, Lisa, Jamie, and Mikey taste-test a pumpkin-packed lineup that's equal parts cozy, crunchy, and surprising. From creamy Nutpods Pumpkin Spice Creamer that turned morning coffee into a fall dream, to Tate's Pumpkin Spice Cookies with their signature crispy crunch, to indulgent Clio Greek Yogurt Pumpkin Spice Bars that nearly stole the show, and even Lesser Evil Pumpkin Spice Popcorn that blended sweet with just the right amount of spice—this haul has something for every pumpkin lover. Tune in as Lisa dishes out her honest ratings, reveals which snacks are worth adding to your fall shopping list, and crowns a few new seasonal favorites. Whether you're a pumpkin fanatic or just pumpkin-curious, you won't want to miss this cozy, craveable episode. And don't forget to head on over to the Foodcast page for a list of all the finds mentioned in the episode!

 Senior Associate Pastor, Dr. Kyler SmithWednesday October 1, 2025

 Senior Pastor, Clint PressleyWednesday October 1, 2025

Welcome back to the Alt Goes Mainstream podcast.Today's episode provides a fascinating window into the world of private equity value creation and how AI can help transform both portfolio company and investment firm processes and operations to create value.We sat down in New York with Hg Partner and Head of Value Creation Chris Kindt to dive into how he spearheaded the growth of the firm's in-house value creation efforts and has built a high-performing team to meet the evolving needs of portfolio companies.Chris brings 15 years of experience in architecting and driving value creation to bear, with 11 years of experience at Hg and another 8 years as a consultant at BCG and Parthenon.Chris and his team are responsible for driving value across a portfolio of 55 companies that represents over $180B in enterprise value and would represent the second largest software company in Europe after SAP if it were a conglomerate.Chris and I had a thought-provoking discussion about value creation and the impact of AI on investing and operating companies. We discussed:How to build a high-performing value creation team.Where value creation has the biggest impact.How AI is transforming investment processes.How Hg has become an “AI-first” investment firm.Where AI will have the most impact in a company today and why agentic AI is transforming certain roles and processes within companies.How professionals can generate the most leverage from utilizing AI – without having cognitive decline.Why prompting and prompt engineering is so critical in the age of AI (and how you can use your weekends to perfect prompt engineering).How a management team can buy into AI and why the current time period represents an interesting opportunity for incumbents, particularly for those building mission-critical enterprise software.Thanks Chris for sharing your expertise and wisdom on company building and AI. We hope you enjoy.Note: this episode was filmed in August 2025.A word from AGM podcast sponsor, Ultimus Fund SolutionsThis episode of Alt Goes Mainstream is brought to you by Ultimus Fund Solutions, a leading full-service fund administrator for asset managers in private and public markets. As private markets continue to move into the mainstream, the industry requires infrastructure solutions that help funds and investors keep pace. In an increasingly sophisticated financial marketplace, investment managers must navigate a growing array of challenges: elaborate fund structures, specialized strategies, evolving compliance requirements, a growing need for sophisticated reporting, and intensifying demands for transparency.To assist with these challenging opportunities, more and more fund sponsors and asset managers are turning to Ultimus, a leading service provider that blends high tech and high touch in unique and customized fund administration and middle office solutions for a diverse and growing universe of over 450 clients and 1,800 funds, representing $500 billion assets under administration, all handled by a team of over 1,000 professionals. Ultimus offers a wide range of capabilities across registered funds, private funds and public plans, as well as outsourced middle office services. Delivering operational excellence, Ultimus helps firms manage the ever-changing regulatory environment while meeting the needs of their institutional and retail investors. Ultimus provides comprehensive operational support and fund governance services to help managers successfully launch retail alternative products.Visit www.ultimusfundsolutions.com to learn more about Ultimus' technology enhanced services and solutions or contact Ultimus Executive Vice President of Business Development Gary Harris on email at gharris@ultimusfundsolutions.com.We thank Ultimus for their support of alts going mainstream.Show Notes00:00 Message from our Sponsor, Ultimus01:18 Welcome to the Alt Goes Mainstream Podcast02:10 Guest Introduction: Chris Kindt03:58 Chris Kindt's Background and Journey05:43 Value Creation at Hg06:55 Pre-Investment and Diligence Process07:44 Management Team Dynamics08:40 Common Value Creation Interventions11:14 Building a Cross-Functional Team12:31 Scaling the Value Creation Team15:40 Measuring Value Creation Impact17:49 Investment Philosophy: Inch Wide, Mile Deep19:28 Partnerships with Management Teams20:03 Embedding AI in Value Creation20:24 Internal vs External AI Applications21:47 AI First Culture22:18 Effective AI Utilization24:04 Prompt Engineering and Whispering26:25 Choosing the Right AI Models26:50 AI Models: Strengths and Weaknesses27:42 Transformative Impact of AI28:21 Skills Needed in the AI Era28:26 AI's Role in Investment Firms28:55 Core Insights and Judgements29:04 The Core Skillset and Efficiency29:12 Philosophical Questions on AI and Talent Development30:18 Building Grit in the Age of AI31:12 Maintaining Discipline with AI32:08 AI as a Value Creation Lever32:35 Operational Efficiency and Copilots33:43 Emergence of Reasoning Models and Agentic Frameworks34:31 10x Efficiency in Engineering36:24 Challenges in Implementing AI37:16 AI Immersion Strategy Days39:52 Organizational Agility and AI42:15 AI's Impact on Investment Strategies43:26 AI in Mergers and Acquisitions45:29 The Importance of Proprietary Data47:12 AI Fatigue and Disillusionment48:07 Building AI Products and Agentic Products48:58 Hg's Internal AI Incubator49:59 The Next Wave of AI51:19 Voice and Multimodality in AI51:55 Globalization and Internationalization of AI53:35 Overestimating and Underestimating AI's Impact54:54 The Competitive Landscape of AI55:42 The Future of Value Creation with AI56:23 Conclusion and Final ThoughtsEditing and post-production work for this episode was provided by The Podcast Consultant.

Send us a textOn today's episode, we're sitting down with the incredible Kara Kushnir! Seriously, she is impressive. Kara is a perinatal mental health certified licensed clinical social worker who's impactful support of the perinatal population is not only felt through her extensive involvement with PSI, but also through the skilled support she provides for families in her local community of Bergen County, New Jersey. We'll chat all about HG, OCD, PTSD, seeking help without a diagnosis, dismantling misinformation, and having empowering conversations with kids about mental health - just to name a few. This entire episode was such a joy to record. So, without any further ado, please sit back, relax, and enjoy this episode with our friend, Kara!Mentioned on today's episode:PSI's Climb ProgramPodcast: The Birth Trauma Mama; Jess Press PlayTV: Arcane; The PittBook: What My Bones KnowKara's book: Mama's ThoughtsContact Kara: @takingkara.humans; @aworkofheart_counseling; A Work of Heart CounselingInterested in sharing your story?Fill out our podcast interest form here! Questions about the I AM ONE Podcast?Email Dani Giddens - dani@postpartum.net--------------------------------------------------------------------Connect by PSI - Download PSI's New App!Apple VersionAndroid Version Visit PSI's website: https://www.postpartum.netFind free resources & info on certification, training, and other incredible programs!Call or text 'HELP' to the PSI Helpline: 1-800-944-4773 Not feeling like yourself? Looking for some support? You never need a diagnosis to ask for help.National Maternal Mental Health Hotline (U.S. only): 1-833-852-6262Free and confidential Hotline for parents, providers & support people in English and Spanish.Suicide & Crisis Lifeline (U.S. & Canada): 988Free and confidential support for people in distress, prevention and crisis resources for you or your loved ones, and best practices for p...

This week on Bludging on the Blindside, Roy and HG discuss Victor Radley's cancelled wedding, Roy's proposal for a tariff on imported cars, and the number of NRL players who will be "pantsed" without penalty.

Msgr. Roger J. Landry Leonine Forum NYC Chapter, IESE Business School Thursday of the 25th Week of Ordinary Time, Year I Votive Mass of the Holy Spirit September 25, 2025 Hg 1:1-8, Ps 149, Lk 9:7-9   To listen to an audio recording of this homily, please click here:  https://traffic.libsyn.com/secure/catholicpreaching/9.25.25_Homily_1.mp3   The following points were […] The post Building God’s Dwelling Place with Urgency, 25th Thursday (I), September 25, 2025 appeared first on Catholic Preaching.

 Adult Discipleship Pastor, Ric BlaziWednesday September 24, 2025

 Missions & Outreach Pastor, Kyle ScarlettWednesday September 24, 2025

PRESIDENT SNOW ORIGINS!! The Hunger Games: The Ballad of Songbirds & Snakes Full Movie Reaction Watch Along:   / thereelrejects   Visit https://huel.com/rejects to get 15% off your order Support The Channel By Getting Some REEL REJECTS Apparel! https://www.rejectnationshop.com/ The Hunger Games: Mockingjay Part 1 (2015) Movie Reaction:    • THE HUNGER GAMES: MOCKINGJAY PART 2 (2015)...   The Hunger Games: Mockingjay Part 1 (2014) Movie Reaction:    • THE HUNGER GAMES: MOCKINGJAY PART 1 (2014)...   The Hunger Games: Catching Fire (2013) Movie Reaction:    • THE HUNGER GAMES: CATCHING FIRE (2013) IS ...   The Hunger Games (2012) Movie Reaction:    • THE HUNGER GAMES (2012) IS A DYSTOPIAN EPI...   With The Hunger Games: Sunrise on the Reaping coming next year, Aaron & Andrew jump into the extended HG series, giving their The Hunger Games: The Ballad of Songbirds & Snakes Reaction, Recap, Analysis, & Spoiler Review! Aaron Alexander & Andrew Gordon sit down to review The Hunger Games: The Ballad of Songbirds & Snakes (2023), the prequel in Suzanne Collins' blockbuster YA dystopian saga. Directed by Francis Lawrence (Catching Fire, Mockingjay) and adapted by Michael Lesslie & Michael Arndt, the film takes us 64 years before Katniss Everdeen's time, exploring the origins of President Coriolanus Snow (Tom Blyth – Billy the Kid), when he's still a mentor in Panem and seeking to restore his family's lost prestige. Standout moments include Snow and Lucy Gray's performances in reaping ceremonies, the provocative “snake pit” element in the Games, and the tension-filled scenes that show Snow's moral decay—especially his final acts as he begins to embrace power at any cost. With lush cinematography, ethical dilemmas, and emotional character arcs, Songbirds & Snakes offers both spectacle and introspection, casting a dark light on how one young man transforms into the tyrant Panem would come to fear. Follow Aaron On Instagram: https://www.instagram.com/therealaaronalexander/?hl=en Follow Andrew Gordon on Socials:  YouTube: https://www.youtube.com/@MovieSource Instagram:  https://www.instagram.com/agor711/?hl=en Twitter:  https://twitter.com/Agor711 Intense Suspense by Audionautix is licensed under a Creative Commons Attribution 4.0 license. https://creativecommons.org/licenses/... Support The Channel By Getting Some REEL REJECTS Apparel! https://www.rejectnationshop.com/ Follow Us On Socials:  Instagram: https://www.instagram.com/reelrejects/  Tik-Tok: https://www.tiktok.com/@reelrejects?lang=en Twitter: https://x.com/reelrejects Facebook: https://www.facebook.com/TheReelRejects/ Music Used In Ad:  Hat the Jazz by Twin Musicom is licensed under a Creative Commons Attribution 4.0 license. https://creativecommons.org/licenses/by/4.0/ Happy Alley by Kevin MacLeod is licensed under a Creative Commons Attribution 4.0 license. https://creativecommons.org/licenses/... POWERED BY @GFUEL Visit https://gfuel.ly/3wD5Ygo and use code REJECTNATION for 20% off select tubs!! Head Editor: https://www.instagram.com/praperhq/?hl=en Co-Editor: Greg Alba Co-Editor: John Humphrey Music In Video: Airport Lounge - Disco Ultralounge by Kevin MacLeod is licensed under a Creative Commons Attribution 4.0 license. https://creativecommons.org/licenses/by/4.0/ Ask Us A QUESTION On CAMEO: https://www.cameo.com/thereelrejects Follow TheReelRejects On FACEBOOK, TWITTER, & INSTAGRAM:  FB:  https://www.facebook.com/TheReelRejects/ INSTAGRAM:  https://www.instagram.com/reelrejects/ TWITTER:  https://twitter.com/thereelrejects Follow GREG ON INSTAGRAM & TWITTER: INSTAGRAM:  https://www.instagram.com/thegregalba/ TWITTER:  https://twitter.com/thegregalba Learn more about your ad choices. Visit megaphone.fm/adchoices

This week on Bludging on the Blindside, Roy and HG discuss the return of the headbutt, the threat to the niggler and the use of the team bus as a weapon in the Rugby League.

 Harris Campus Worship Pastor, John StegemertenWednesday September 17, 2025

Meet Jes, holistic hyperemesis gravidarum expert and morning sickness coach. Jes shares her own HG story, multiple hospitalizations, prescriptions, and the moment she said “there has to be a better way”, and how she reverse-engineered her HG by targeting root causes instead of masking symptoms.In the episode, we dig into:HG vs “morning sickness” as a spectrum, and how feeling debilitated is a red flag.The uncomfortable truth about pregnancy meds like Diclectin/Zofran: when they're a necessary bridge, what they do (and don't) fix, and why informed consent matters.Jes's functional approach, how she weaned off meds and stopped vomiting within days.Why minerals are foundational and how depletion can show up later in mom and baby.The importance of preconception prep to prevent HG and build a resilient blueprint for baby.If you're in the thick of HG, planning another pregnancy, or you simply want a healthier baseline before conception, this episode is for you.--Get Jes's mineral guide: Connect with Jes: @the_wellness_element on instagram and The Wellness Element podcast.

Send us a textIf you've ever wondered whether your morning sickness is something more, this episode is for you. I'm joined by Dr Emily Rubinstein, women's health GP, for an honest conversation about morning sickness and hyperemesis gravidarum (HG) - a condition that can make pregnancy incredibly challenging.Together, we explore what HG really is, how it differs from typical morning sickness, and the treatment and support options available. My hope is that this episode helps you feel less alone and more empowered with knowledge to navigate pregnancy and seek the support you deserve.In this episode, we chat about:What hyperemesis gravidarum is and how it differs from morning sicknessPossible causes and risk factors that may increase your likelihood of experiencing HGWhen to seek help and how to advocate for yourself with healthcare providersMedical treatment options including vitamins, antihistamines, anti-emetics, and IV fluidsNon-medical approaches such as food and fluid strategies, supplements, and complementary therapiesThe link between HG, pelvic floor health, and mental wellbeingWhy a strong support system at home and in healthcare makes such a differenceHow to prepare for future pregnancies if you've experienced HG beforeConnect with Dr Emily RubinsteinInstagramWebsiteLINKS: Preparing for birth Pelvic health checklist Free 7 Day Trial Pregnancy Workouts Free 7 Day Trial Postnatal Workouts FitNest Mama Website Instagram @kathbaquie.physio 1:1 Consultation with Physio Kath at Hatched House ** This podcast has general information only. Always seek the guidance of your doctor or other qualified health professional with any questions or concerns you may have regarding your health or medical condition.

This week on Bludging on the Blindside, Roy and HG discuss which tennis superstars have a first class toss, delve into how Rugby League acts as a valve for peace, and ponder whether Andrew Abdo has become the NRL's new music critic.

 Senior Pastor, Clint PressleyWednesday September 10, 2025

 Senior Associate Pastor, Dr. Kyler SmithWednesday September 10, 2025

This week on Bludging on the Blindside, Roy and HG discuss the legend of Aussie Joe Bugner, how strong was his feet? The Ref should never stop the game when a stink breaks out and the idea that poker machine profits should be reinvested directly into the local communities where they were generated.

A-lign founder and CEO Scott Price joins Tom Wallace and Saxon Baum to unpack the “all gas, no brakes” journey behind building a category leader in cybersecurity compliance. Scott traces his roots from Arthur Andersen and the Enron fallout to bootstrapping through 2009, landing the first clients, and evolving from SOC 2 mainstay to a broader, tech-enabled platform. He shares candid lessons from a re-traded 2017 deal, why outside capital served as market validation, and how partnering with FTV and later HG set the stage for scale enterprise expansion, European growth, and smart M&A. We dig into frameworks over tools for AI risk, the rise of CMMC and federal standards, and how Tampa's defense ecosystem fuels elite cybersecurity talent. Plus, leadership chemistry with a CFO, why second acts aren't automatically easier, and a lightning round on Bitcoin, AI's job impact, and the China tech challenge. A masterclass in grit, governance, and growth forward. Hosted on Acast. See acast.com/privacy for more information.

 Discipleship Pastor, Blake MaxwellWednesday September 3, 2025

Discipleship Pastor, Dr. Matt PhippsWednesday September 3, 2025 

It's time for another round of hope versus expectation. The WSL is back, Spurs Women are back, but has anything changed? Lauren, Rosa and HG cousin Caroline assess the squad and try to figure out just how big a job new boss Martin Ho has on his hands. There may be some ranting. But there are also culture picks! Hosted on Acast. See acast.com/privacy for more information.

This week on Bludging on the Blindside, Roy and HG discuss whether NRL teams should play their best players or face a term of imprisonment, does Bunnings Island need a minister of Rugby League first and is it Eric Abetz or Erica Betz? 

 Senior Associate Pastor, Dr. Kyler SmithWednesday August 27, 2025

 Executive Pastor, Steve AdamsWednesday August 27, 2025

Kencan Dengan Tuhan - Minggu, 24 Agustus 2025Bacaan: "Dan marilah kita saling memperhatikan supaya kita saling mendorong dalam kasih dan dalam pekerjaan baik." (Ibrani 10:29)Renungan: Menurut cerita, HG. Spafford seorang penulis lagu rohani "It Is Well With My Soul" menuliskan lagu ini ketika ia sedang melintasi lautan atlantik. Di laut itulah ketiga anaknya mati tenggelam ketika mereka sedang berlayar ke Eropa. Cobaan yang dialami Spafford memang luar biasa karena beberapa tahun kemudian anaknya yang lain meninggal karena sakit. Setelah peristiwa itu orang-orang di gereja mengucilkan mereka karena beranggapan bahwa keluarga ini berhubungan dengan kuasa iblis. Spafford masih sanggup berdiri ketika ketiga anaknya diambil dari padanya. Kemudian disusul dengan kematian anaknya yang lain. la tabah menerima semua itu. Tetapi apa yang terjadi ketika saudara-saudara seimannya mengucilkan dan memisahkan diri darinya? Ia tidak kuat lagi menahannya. Jiwanya hancur dan pada akhirnya ia menderita sakit jiwa. Kita harus mengakui bahwa kekuatan kita untuk menanggung segala sesuatunya sangat terbatas. Kita membutuhkan kekuatan dan kemampuan yang berasal dari luar diri kita sendiri. Kekuatan dari Tuhan itu sudah pasti. Tetapi dukungan dari orang-orang di sekeliling kita juga banyak diharapkan. Saudara-saudara seiman, anak, istri, suami, sahabat dan semua orang yang kita kasihi. Mereka inilah yang senantiasa mendoakan dan memberikan dukungan moril. Kita tidak bisa hidup sendiri karena tanpa keberadaan orang-orang di sekeliling kita mungkin kita tidak bisa berada dalam posisi seperti sekarang ini. Marilah kita mulai membina relasi yang baik dengan orang-orang di sekitar kita. Merekalah yang akan Tuhan pakai menjadi penopang di saat kita terjatuh. Kalau saat ini ada kenalan atau orang-orang yang terdekat dengan kita sedang mengalami pergumulan hidup yang berat, buka hati kita dan ulurkanlah tangan kita untuk membantunya, dan mulut kita untuk mendoakannya. Tuhan mau memakai kita untuk menjadi berkat bagi orang lain. Tuhan Yesus memberkati.Doa:Tuhan Yesus, kuasailah diriku sepenuhnya, agar kehadiranku dapat memberi ketenangan bagi orang-orang di sekitarku yang saat ini mengalami pergumulan hidup yang berat. Jangan biarkan kesibukanku membuat aku kehilangan berkat untuk menolong orang yang sedang kesusahan. Amin. (Dod).

This week on Bludging on the Blindside, Roy and HG discuss the Tszyu brothers - the Soul taker and the Butcher,The plight of the Dora Creek Swampies & the Northern Bullants, a Titans open day could save Des, Bait off - knock over a feral, do ex players make the best coaches? Believe in rugby league values, taming Snoop Dog (Mr Rude) for the granny and if you don't like your family... make them up.

VOV1 - Tiến sĩ khí tượng thuỷ văn Nguyễn Thị Minh Phương hơn 10 năm nay cùng cộng sự luôn nhặt rác xung quanh khu vực Hồ Gươm. Hoạt động này không chỉ gieo mầm ý thức giữ vệ sinh môi trường trong cộng đồng, mà còn là hành động thiết thực trong phong trào làm đẹp Thủ đô mừng 80 năm Quốc khánh.

This is a hybrid heart disease risk factor post of a podcast with Prof Bruce Lanphear on lead and a piece I was asked to write for the Washington Post on risk factors for heart disease.First, the podcast. You may have thought the problem with lead exposure was circumscribed to children, but it's a much bigger issue than that. I'll concentrate on the exposure risk to adults in this interview, including the lead-estrogen hypothesis. Bruce has been working on the subject of lead exposure for more than 30 years. Let me emphasize that the problem is not going away, as highlighted in a recent New England Journal of Medicine piece on lead contamination in Milwaukee schools, “The Latest Episode in an Ongoing Toxic Pandemic.”Transcript with links to the audio and citationsEric Topol (00:05):Well, hello. This is Eric Topol with Ground Truths, and I'm very delighted to welcome Professor Bruce Lanphear from Simon Fraser University in British Columbia for a very interesting topic, and that's about lead exposure. We tend to think about lead poisoning with the Flint, Michigan, but there's a lot more to this story. So welcome, Bruce.Bruce Lanphear (00:32):Thank you, Eric. It's great to be here.Eric Topol (00:33):Yeah. So you had a New England Journal of Medicine (NEJM) Review in October last year, which was probably a wake up to me, and I'm sure to many others. We'll link to that, where you reviewed the whole topic, the title is called Lead Poisoning. But of course it's not just about a big dose, but rather chronic exposure. So maybe you could give us a bit of an overview of that review that you wrote for NEJM.Bruce Lanphear (01:05):Yeah, so we really focused on the things where we feel like there's a definitive link. Things like lead and diminished IQ in children, lead and coronary heart disease, lead and chronic renal disease. As you mentioned, we've typically thought of lead as sort of the overt lead poisoning where somebody becomes acutely ill. But over the past century what we've learned is that lead is one of those toxic chemicals where it's the chronic wear and tear on our bodies that catches up and it's at the root of many of these chronic diseases that are causing problems today.Eric Topol (01:43):Yeah, it's pretty striking. The one that grabbed me and kind of almost fell out of my chair was that in 2019 when I guess the most recent data there is 5.5 million cardiovascular deaths ascribed to relatively low levels, or I guess there is no safe level of lead exposure, that's really striking. That's a lot of people dying from something that cardiology and medical community is not really aware of. And there's a figure 3 [BELOW] that we will also show in the transcript, where you show the level where you start to see a takeoff. It starts very low and by 50 μg/liter, you're seeing a twofold risk and there's no threshold, it keeps going up. How many of us do you think are exposed to that type of level as adults, Bruce?Bruce Lanphear (02:39):Well, as adults, if we go back in time, all of us. If you go back to the 1970s when lead was still in gasoline, the median blood lead level of Americans was about 13 to 15 µg/dL. So we've all been exposed historically to those levels, and part of the reason we've begun to see a striking decline in coronary heart disease, which peaked in 1968. And by 1978, there was a 20% decline, 190,000 more people were alive than expected. So even in that first decade, there was this striking decline in coronary heart disease. And so, in addition to the prospective studies that have found this link between an increase in lead exposure and death from cardiovascular disease and more specifically coronary heart disease. We can look back in time and see how the decline in leaded gasoline led to a decline in heart disease and hypertension.Eric Topol (03:41):Yeah, but it looks like it's still a problem. And you have a phenomenal graph that's encouraging, where you see this 95% reduction in the lead exposure from the 1970s. And as you said, the factors that can be ascribed to like getting rid of lead from gasoline and others. But what is troubling is that we still have a lot of people that this could be a problem. Now, one of the things that was fascinating is that you get into that herbal supplements could be a risk factor. That we don't do screening, of course, should we do screening? And there's certain people that particularly that you consider at high risk that should get screened. So I wasn't aware, I mean the one type of supplements that you zoomed in on, how do you say it? Ayurvedic?Supplements With LeadBruce Lanphear (04:39):Oh yeah. So this is Ayurvedic medicine and in fact, I just was on a Zoom call three weeks ago with a husband and wife who live in India. The young woman had taken Ayurvedic medicine and because of that, her blood lead levels increased to 70 µg/dL, and several months later she was pregnant, and she was trying to figure out what to do with this. Ayurvedic medicine is not well regulated. And so, that's one of the most important sources when we think about India, for example. And I think you pointed out a really important thing is number one, we don't know that there's any safe level even though blood lead levels in the United States and Europe, for example, have come down by over 95%. The levels that we're exposed to and especially the levels in our bones are 10 to 100 times higher than our pre-industrial ancestors.Bruce Lanphear (05:36):So we haven't yet reached those levels that our ancestors were exposed to. Are there effects at even lower and lower levels? Everything would suggest, we should assume that there is, but we don't know down below, let's say one microgram per deciliter or that's the equivalent of 10 parts per billion of lead and blood. What we also know though is when leaded gasoline was restricted in the United States and Canada and elsewhere, the companies turned to the industrializing countries and started to market it there. And so, we saw first the epidemic of coronary heart disease in the United States, Canada, Europe. Then that's come down over the past 50 years. At the same time, it was rising in low to middle income countries. So today over 95% of the burden of disease from lead including heart disease is found in industrializing countries.Eric Topol (06:34):Right. Now, it's pretty striking, of course. Is it true that airlines fuel is still with lead today?Bruce Lanphear (06:45):Well, not commercial airlines. It's going to be a small single piston aircraft. So for example, when we did a study down around the Santa Clara County Airport, Reid-Hillview, and we can see that the children who live within a half mile of the airport had blood lead levels about 10% higher than children that live further away. And the children who live downwind, 25% higher still. Now, nobody's mapped out the health effects, but one of the things that's particularly troubling about emissions from small aircraft is that the particle size of lead is extraordinarily small, and we know how nanoparticles because they have larger surface area can be more problematic. They also can probably go straight up into the brain or across the pulmonary tissues, and so those small particles we should be particularly worried about. But it's been such a long journey to try to figure out how to get that out of aircraft. It's a problem. The EPA recognized it. They said it's an endangerment, but the industry is still pushing back.Eric Topol (07:55):Yeah, I mean, it's interesting that we still have these problems, and I am going to in a minute ask you what we can do to just eradicate lead as much as possible, but we're not there yet. But one study that seemed to be hard to believe that you cited in the review. A year after a ban leaded fuel in NASCAR races, mortality from coronary heart disease declined significantly in communities near racetracks. Can you talk about that one because it's a little bit like the one you just mentioned with the airports?Bruce Lanphear (08:30):Yeah. Now that study particularly, this was by Alex Hollingsworth, was particularly looking at people over 65. And we're working on a follow-up study that will look at people below 65, but it was quite striking. When NASCAR took lead out of their fuel, he compared the rates of coronary heart disease of people that live nearby compared to a control group populations that live further away. And he did see a pretty striking reduction. One of the things we also want to look at in our follow-up is how quickly does that risk begin to taper off? That's going to be really important in terms of trying to develop a strategy around preventing lead poisoning. How quickly do we expect to see it fall? I think it's probably going to be within 12 to 24 months that we'll see benefits.Eric Topol (09:20):That's interesting because as you show in a really nice graphic in adults, which are the people who would be listening to this podcast. Of course, they ought to be concerned too about children and all and reproductive health. But the point about the skeleton, 95% of the lead is there and the main organs, which we haven't mentioned the kidney and the kidney injury that occurs no less the cardiovascular, the blood pressure elevation. So these are really, and you mentioned not necessarily highlighted in that graphic, but potential cognitive hit as well. You also wrote about how people who have symptoms of abdominal pain, memory impairment, and high blood pressure that's unexplained, maybe they should get a blood level screening. I assume those are easy to get, right?Bruce Lanphear (10:17):Oh yeah, absolutely. You can get those in any hospital, any clinic across the country. We're still struggling with having those available where it's most needed in the industrializing countries, but certainly available here. Now, we don't expect that for most people who have those symptoms, lead poisoning is going to be the cause, right. It'd still be unusual unless you work in an industry, for example, smelting batteries to recycle them. We don't expect it to be real common, and we're not even sure, Eric, whether we should be doing widespread screening. If I looked at this as a population scientist, the real focus should be on identifying the sources. We mostly know where those are here and radically moving it down. Getting rid of the lead service lines, which was such a big part of what President Biden was doing, and it was perfect. For every dollar invested to reduce lead exposure from those lead service lines. Ronnie Levin at Harvard said there'd be a 35-fold return in cost, benefits really, and this has always been true, that reducing lead exposure throughout the past 40 years has always been shown to be amazingly cost beneficial. The problem is operating within a free market health system, even though there's tremendous social benefits, that benefit isn't going to be monetized or privatized. And so, who's going to make those decisions? We hope our government is, but that doesn't always play out.Eric Topol (11:52):Well. What's interesting is, as opposed to the problems we have today that are prominent such as the microplastic, nanoplastics, the air pollution, the forever chemicals, that just keep getting worse, I mean, they are just cumulative. This one, there was tremendous improvement, but it's still not enough. And I guess you're zooming in on the lead lines. That'd be the most important thing to work on today. Another thing that has come up, there's been trials, as you may I'm sure, because all over this field of chelation, there's a trial that was run by the NIH, supported by NH that looked at chelation to prevent coronary disease. Is there any evidence that people who have a problem with lead would benefit from chelation therapy?Bruce Lanphear (12:44):Well, there's two major studies that have been done, and Tony Lamas was in charge of both of them. The first one Trial to Assess Chelation Therapy (TACT) study, it was a randomized controlled trial, not intended specifically to focus on lead, but rather it was to look at sort of this alternative therapy. They found significant benefits about an 18% reduction in subsequent cardiac events. That led to a second study that was just published last year, and it was focused on people who had diabetes. They saw some benefit, but it wasn't significant. So whether that's because there wasn't enough variability and exposure, it's not entirely clear, but we've seen this with lead in IQ deficits in kids where we can show that we can reduce blood lead levels. But ultimately what tends to happen is once you've taken lead out of the blood, some of it's released again from the bone, but you still have all that lead in the bone that's there. You get some of it out, but you're not going to get the bulk of it out.The Lead-Estrogen HypothesisEric Topol (13:47):Right. It's a reservoir that's hard to reckon with. Yeah. Now another thing, you have a Substack that is called Plagues, Pollution & Poverty, and you wrote a really provocative piece in that earlier and April called How Estrogen Keeps Lead - and Heart Attacks - in Check, and basically you got into the lead estrogen hypothesis.Eric Topol (14:10):Can you enlighten us about that?Bruce Lanphear (14:12):Yeah. A lot of the seminal work in this area was done by Ellen Silbergeld, who's a brilliant and somewhat peculiar toxicologist and Ellen for years, I focused on childhood lead exposure, and for years Ellen would tell me, almost demolish me for not studying adults. And because she had found back in 1988 that as women go into menopause, their blood lead levels spike increased by about 30%, and that's where most of our lead is stored is in our bone. And so, as I was thinking about this, it all became clear because blood lead levels in boys and girls is about the same. It's comparable up until menarche, and then girls young women's blood leads fall by about 20%. And they stay 20% lower throughout the reproductive years until menopause. And especially during those first few years around menopause, perimenopause, you see fairly striking increases in the weakening of the bone and blood lead levels.Bruce Lanphear (15:19):So that might very well help to explain why estrogen is protected, because what happens is throughout the reproductive life, women are losing a little bit of lead every month. And estrogen is at its lowest during that time, and that's going to be when blood lead is at its highest because estrogen pushes lead into the bone. Not only that, women lose lead into the developing fetus when they're pregnant. So what Ellen found is that there was less of a spike around menopause for the women that had three or four pregnancies because they had offloaded that into their babies. So all of this, if you put it together, and this is of course in a very short note of it, you can see that lead increases dyslipidemia, it leads to tears in the endothelium of the arterial wall, it's going to increase thrombosis. All of these things that we think of as the classic atherosclerosis. Well, what estrogen does is the opposite of those. It decreases dyslipidemia, it repairs the arterial endothelial wall. So how much of it is that estrogen is protective, and how much is it that it's moving lead out of the system, making it less biologically available?Eric Topol (16:46):Yeah, I know. It's really interesting. Quite provocative. Should be followed up on, for sure. Just getting to you, you're a physician and epidemiologist, MD MPH, and you have spent your career on this sort of thing, right? I mean, is your middle name lead or what do you work on all the time?Bruce Lanphear (17:09):Yeah, I've been doing this for about 30 years, and one of my mentors, Herb Needleman spent 40 years of his career on it. And in some ways, Eric, it seems to me particularly in these very difficult entrenched problems like lead, we don't have any pharmaceutical company reaching out to us to promote what we do. We've got industry trying to squash what we do.Bruce Lanphear (17:35):It really does take a career to really make a dent in this stuff. And in a way, you can look at my trajectory and it is really following up on what Herb Needleman did and what Clare Patterson did, and that was finding the effects at lower and lower levels. Because what we do with lead and most other toxic chemicals, the ones that don't cause cancer, is we assume that there's a safe level or threshold until we prove otherwise. And yet when you look at the evidence, whether it's about asbestos and mesothelioma, air pollution and cardiovascular mortality, lead and cardiovascular mortality, benzene and leukemia, none of those exhibit a threshold. In some cases, the risks are steepest proportionately at the lowest measurable levels, and that really raises some tremendous challenges, right? Because how are we going to bring air pollution or lead down to zero? But at the same time, it also provides these tremendous opportunities because we know that they're causing disease. We know what the sources are. If we could only bring about the political will to address them, we could prevent a lot of death, disease, and disability. I mean, about 20% of deaths around the world every year are from air pollution, lead, and other toxic chemicals, and yet the amount of money we invest in them is just paltry compared to what we invest in other things. Which is not to pit one against the other, but it's to say we haven't invested enough in these.Eric Topol (19:14):No, absolutely. I think your point, just to make sure that it's clear, is that even at low levels, this is of course where most of the population exposure would be, and that's why that's so incriminating. Now, one of the things I just want to end up with is that we know that these are tiny, tiny particles of lead, and then the question is how they can synergize and find particulate matter of air pollution in the nanoplastic, microplastic story and binding to forever chemicals, PFAS. How do you process all that? Because it's not just a single hit here, it's also the fact that there's ability to have binding to the other environmental toxins that are not going away.Bruce Lanphear (20:10):That's right. And in a way, when we talk about lead playing this tremendous role in the rise and decline of coronary heart disease, we can't entirely separate it out, for example, from air pollution or cigarette smoke for that matter, nor plastic. So for example, with air pollution, if we look at air pollution over the past century, up until the 1980s, even into the 1990s, it was leaded, right? So you couldn't separate them. If you look at cigarette smoke, cigarette tobacco in the 1940s and 1950s was grown in fields where they used lead arsenic as an insecticide. So smokers even today have blood lead levels that are 20% higher than non-smokers, and people who are not smokers but exposed to secondhand smoke have blood lead levels 20% higher than non-smokers who aren't exposed to secondhand smoke. So in a way, we should try to tease apart these differences, but it's going to be really challenging. In a way we can almost think about them as a spectrum of exposures. Now with plastics, you can really think of plastics as a form of pollution because it's not just one thing. There's all these additives, whether it's the PFAS chemicals or lead, which is used as a stabilizer. And so, all of them really are kind of integrated into each other, which again, maybe there's some opportunity there if we really were ready to tackle.Eric Topol (21:40):And interestingly, just yesterday, it was announced by the current administration that they're stopping all the prior efforts on the forever chemicals that were initiated in the water supply. And I mean, if there's one takeaway from our discussion, it's that we have to get all over this and we're not paying enough attention to our environmental exposures. You've really highlighted spotlighted the lead story. And obviously there are others that are, instead of getting somewhat better, they're actually going in the opposite direction. And they're all tied together that's what is so striking here, and they all do many bad things to our bodies. So I don't know how, I'm obviously really interested in promoting healthy aging, and unless we get on this, we're chasing our tails, right?Bruce Lanphear (22:31):Well, I think that's right, Eric. And I was reading the tips that you'd written about in preparation for your book release, and you focused understandably on what each of us can do, how we can modify our own lifestyles. We almost need six tips about what our government should do in order to make it harder for us to become sick, or to encourage those healthy behaviors that you talked about. That's a big part of it as well. One of the things we're celebrating the hundredth anniversary. This is not really something to celebrate, but we are. The hundredth anniversary of the addition of tetraethyl lead to gasoline. And one of the key things about that addition, there was this debate because when it was being manufactured, 80% of the workers at a plant in New Jersey suffered from severe lead poisoning, and five died, and it was enough that New York City, Philadelphia and New Jersey banned tetraethyl lead.Bruce Lanphear (23:31):Then there was this convening by the US Surgeon General to determine whether it was safe to add tetraethyl lead to gasoline. One scientist, Yandell Henderson said, absolutely not. You're going to create a scourge worse than tuberculosis with slow lead poisoning and hardening of your arteries. Robert Kehoe, who represented the industry said, we know lead is toxic, but until you've shown that it's toxic when added to gasoline, you have no right to prohibit us from using it. So that is now known as the Kehoe rule, and it's relevant not only for lead, but for PFAS, for air pollution, for all these other things, because what it set as a precedent, until you've shown that these chemicals or pollution is toxic when used in commerce, you have no right to prohibit industry from using it. And that's the fix we're in.Eric Topol (24:27):Well, it sounds too much like the tobacco story and so many other things that were missed opportunities to promote public health. Now, is Canada doing any better than us on this stuff?Bruce Lanphear (24:40):In some ways, but not in others. And one of the interesting thing is we don't have standards, we have guidelines. And amazingly, the cities generally try to conform to those guidance levels. With water lead, we're down to five parts per billion. The US is sticking around with ten parts per billion, but it's not even really very, it's not enforced very well. So we are doing better in some ways, not so good in other ways. The European Union, generally speaking, is doing much better than North America.Eric Topol (25:15):Yeah, well, it doesn't look very encouraging at the moment, but hopefully someday we'll get there. Bruce, this has been a really fascinating discussion. I think we all should be thankful to you for dedicating your career to a topic that a lot of us are not up on, and you hopefully are getting us all into a state of awareness. And congratulations on that review, which was masterful and keep up the great work. Thank you.Bruce Lanphear (25:42):Thank you, Eric. I appreciate it.________________________________________________My Recommendations for Preventing Heart Disease (Markedly Truncated from Text and Graphics Provided in SUPER AGERS)Recently the Washington Post asked me for a listicle of 10 ways to prevent heart disease. I generally avoid making such lists but many people have de-subscribed to this newspaper, never subscribed, or missed the post, so here it is with links to citations:Guest column by Eric Topol, MDThe buildup of cholesterol and other substances in the wall of our arteries, known as atherosclerosis, is common. It can lead to severe plaques that narrow the artery and limit blood flow, or to a crack in the artery wall that can trigger blood clot formation, resulting in a heart attack.While we've seen some major advances in treating heart disease, it remains the leading killer in the United States, even though about 80 percent of cases are considered preventable. There are evidence-based steps you can take to stave it off. As a cardiologist, here's what I recommend to my patients.1. Do both aerobic and resistance exerciseThis is considered the single most effective medical intervention to protect against atherosclerosis and promote healthy aging. Physical activity lowers inflammation in the body. Evidence has shown that both aerobic and strength training forms of exercise are important. But only 1 in 4 Americans meet the two activity guidelines from the American Heart Association: aerobic exercise of 150 minutes per week of at least moderate physical activity, such as walking, bicycling on level ground, dancing or gardening, and strength training for at least two sessions per week, which typically translates to 60 minutes weekly.The protective benefit of exercise is seen with even relatively low levels of activity, such as around 2,500 steps per day (via sustained physical activity, not starting and stopping), and generally increases proportionately with more activity. It used to be thought that people who exercise only on the weekend — known as “weekend warriors” — put themselves in danger, but recent data shows the benefits of exercise can be derived from weekend-only workouts, too.2. Follow an anti-inflammatory dietA predominantly plant-based diet — high in fiber and rich in vegetables, fruits and whole grains, as seen with the Mediterranean diet — has considerable evidence from large-scale observational and randomized trials for reducing body-wide inflammation and improving cardiovascular outcomes.Foods rich in omega-3 fatty acids, such as salmon, also form part of a diet that suppresses inflammation. On the other hand, red meat and ultra-processed foods are pro-inflammatory, and you should limit your consumption. High protein intake of more than 1.4 grams per kilogram of body weight per day — around 95 grams for someone who is 150 pounds — has also been linked to promoting inflammation and to atherosclerosis in experimental models. That is particularly related to animal-based proteins and the role of leucine, an essential amino acid that is obtained only by diet.3. Maintain a healthy weightBeing overweight or obese indicates an excess of white adipose tissue. This kind of tissue can increase the risk of heart disease because it stores fat cells, known as adipocytes, which release substances that contribute to inflammation.In studies, we've seen that glucagon-like peptide (GLP-1) drugs can reduce inflammation with weight loss, and a significant reduction of heart attacks and strokes among high-risk patients treated for obesity. Lean body weight also helps protect against atrial fibrillation, the most common heart rhythm abnormality.4. Know and avoid metabolic syndrome and prediabetesTied into obesity, in part, is the problem of insulin resistance and metabolic syndrome. Two out of three people with obesity have this syndrome, which is defined as having three out of five features: high fasting blood glucose, high fasting triglycerides, high blood pressure, low high-density lipoprotein (HDL) and central adiposity (waist circumference of more than 40 inches in men, 35 inches in women).Metabolic syndrome is also present in a high proportion of people without obesity, about 50 million Americans. Prediabetes often overlaps with it. Prediabetes is defined as a hemoglobin A1c (a measure of how much glucose is stuck to your red blood cells) between 5.7 and 6.4 percent, or a fasting glucose between 100 and 125 milligrams per deciliter.Both metabolic syndrome and prediabetes carry an increased risk of heart disease and can be prevented — and countered — by weight loss, exercise and an optimal diet.As the glucagon-like peptide drug family moves to pills and less expense in the future, these medications may prove helpful for reducing risk in people with metabolic syndrome and prediabetes. For those with Type 2 diabetes, the goal is optimizing glucose management and maximal attention to lifestyle factors.5. Keep your blood pressure in a healthy rangeHypertension is an important risk factor for heart disease and is exceptionally common as we age. The optimal blood pressure is 120/80 mm Hg or lower. But with aging, there is often an elevation of systolic blood pressure to about 130 mm Hg, related to stiffening of arteries. While common, it is still considered elevated.Ideally, everyone should monitor their blood pressure with a home device to make sure they haven't developed hypertension. A mild abnormality of blood pressure will typically improve with lifestyle changes, but more substantial elevations will probably require medications.6. Find out your genetic riskWe now have the means of determining your genetic risk of coronary artery disease with what is known as a polygenic risk score, derived from a gene chip. The term polygenic refers to hundreds of DNA variants in the genome that are linked to risk of heart disease. This is very different from a family history, because we're a product of both our mother's and father's genomes, and the way the DNA variants come together in each of us can vary considerably for combinations of variants.That means you could have high or low risk for heart disease that is different from your familial pattern. People with a high polygenic risk score benefit the most from medications to lower cholesterol, such as statins. A polygenic risk score can be obtained from a number of commercial companies, though it isn't typically covered by insurance.I don't recommend getting a calcium score of your coronary arteries via a computed tomography (CT) scan. This test is overused and often induces overwhelming anxiety in patients with a high calcium score but without symptoms or bona fide risk. If you have symptoms suggestive of coronary artery disease, such as chest discomfort with exercise, then a CT angiogram may be helpful to map the coronary arteries. It is much more informative than a calcium score.7. Check your blood lipidsThe main lipid abnormality that requires attention is low-density cholesterol (LDL), which is often high and for people with increased risk of heart disease should certainly be addressed. While lifestyle improvements can help, significant elevation typically requires medications such as a statin; ezetimibe; bempedoic acid; or injectables such as evolocumab (Repatha), alirocumab (Praluent) or inclisiran (Leqvio). The higher the risk, the more aggressive LDL lowering may be considered.It should be noted that the use of potent statins, such as rosuvastatin or atorvastatin, especially at high doses, is linked to inducing glucose intolerance and risk of Type 2 diabetes. While this is not a common side effect, it requires attention since it is often missed from lack of awareness.A low high-density lipoprotein (HDL) cholesterol often responds to weight loss and exercise. We used to think that high HDL was indicative of “good cholesterol,” but more recent evidence suggests that is not the case and it may reflect increased risk when very high.To get a comprehensive assessment of risk via your blood lipids, it's important to get the apolipoprotein B (apoB) test at least once because about 20 percent of people have normal LDL and a high apoB.Like low HDL, high fasting triglycerides may indicate insulin resistance as part of the metabolic syndrome and will often respond to lifestyle factors.The lipoprotein known as Lp(a) should also be assessed at least once because it indicates risk when elevated. The good news is scientists are on the cusp of finally having medications to lower it, with five different drugs in late-stage clinical trials.8. Reduce exposure to environmental pollutantsIn recent years, we've learned a lot about the substantial pro-inflammatory effects of air pollution, microplastics and forever chemicals, all of which have been linked to a higher risk of heart disease. In one study, microplastics or nanoplastics in the artery wall were found in about 60 percent of more than 300 people. Researchers found a vicious inflammatory response around the plastics, and a four- to fivefold risk of heart attacks or strokes during three years of follow-up.While we need policy changes to address these toxic substances in the environment, risk can be reduced by paying attention to air and water quality using filtration or purification devices, less use of plastic water bottles and plastic storage, and, in general, being much more aware and wary of our pervasive use of plastics.9. Don't smoke This point, it should be well known that cigarette smoking is a potent risk factor for coronary artery disease and should be completely avoided.10. Get Good SleepAlthough we tend to connect sleep health with brain and cognitive function, there's evidence that sleep regularity and quality are associated with less risk of heart disease. Regularity means adhering to a routine schedule as much as possible, and its benefit may be due to our body's preference for maintaining its circadian rhythm. Sleep quality — meaning with fewer interruptions — and maximal deep sleep can be tracked with smartwatches, fitness bands, rings or mattress sensors.Sleep apnea, when breathing stops and starts during sleep, is fairly common and often unsuspected. So if you're having trouble sleeping or you snore loudly, talk to your doctor about ruling out the condition. Testing for sleep apnea can involve checking for good oxygen saturation throughout one's sleep. That can be done through a sleep study or at home using rings or smartwatches that include oxygen saturation in their sensors and body movement algorithms that pick up disturbed breathing.Eric Topol, MD, is a cardiologist, professor and executive vice president of Scripps Research in San Diego. He is the author of “Super Agers: An Evidence-Based Approach to Longevity” and the author of Ground Truths on Substack.*********************°°°°°°°°°°°°°°°°°°°°Thanks to many of you Ground Truths subscribers who helped put SUPER AGERS on the NYT bestseller list for 4 weeks.Here are 2 recent, informative, and fun conversations I had on the topicMichael Shermer, The SkepticRuss Roberts, EconTalk I'm also very appreciative for your reading and subscribing to Ground Truths.If you found this interesting PLEASE share it!That makes the work involved in putting these together especially worthwhile.All content on Ground Truths—its newsletters, analyses, and podcasts, are free, open-access.Paid subscriptions are voluntary and all proceeds from them go to support Scripps Research. They do allow for posting comments and questions, which I do my best to respond to. Please don't hesitate to post comments and give me feedback. Let me know topics that you would like to see covered.Many thanks to those who have contributed—they have greatly helped fund our summer internship programs for the past three years. Just a week ago we just had nearly 50 interns (high school, college and medical students) present posters of the work they did over the summer and it was exhilarating! Some photos below Get full access to Ground Truths at erictopol.substack.com/subscribe

VOV1 - Trích Ghi nhanh không khí mừng chiến thắng tại Hồ Gươm chiều ngày 30-4-1975, do nhóm phóng viên Thời sự thực hiện.

This week on Bludging on the Blindside, Roy and HG discuss a disproportionate responses to a slight, Snoop Dog at the AFL granny, Trainers love the lime light, willynillyism, Names for the PNG team, a great grub is a slippery grub, betting on school raised racing dogs and down-in-the-dumpism.

Tối 13/8, tại Nhà hát Hồ Gươm (Hà Nội), Bộ Công an phối hợp với Hội Nhà báo Việt Nam tổ chức Lễ trao giải Báo chí toàn quốc “Vì An ninh Tổ quốc và bình yên cuộc sống” giai đoạn 2023-2025.

We know he is one of the all time great goal umpires - but Darkie Collins could send down a cricket ball as well, Mason 8 days sober and on fire, the boys look into the radio broadcast stoush from Wangaratta, a tribute from Roy and HG to our groundsman and the Indian cricket coach gets a double whammy ! 

Send us a text—This is an encore presentation of an episode previously published June 30—On this episode of the CMAJ Podcast, hosts Dr. Mojola Omole and Dr. Blair Bigham speak with two authors of the latest “Hypertension Canada guideline for the diagnosis and treatment of hypertension in adults in primary care”The discussion reflects a shared urgency: despite past successes, Canada's hypertension control rates are declining. The new guidelines aim to reverse this trend by simplifying diagnosis and treatment for frontline clinicians.Dr. Rémi Goupil, a nephrologist and clinician researcher at Sacré-Cœur Hospital in Montreal, and Dr. Greg Hundemer, a nephrologist and clinician scientist at The Ottawa Hospital, explain that the updated guideline is deliberately designed for primary care providers. They highlight key shifts: lowering the diagnostic threshold for hypertension to  ≥ 130/80 mm Hg, simplifying blood pressure targets, and emphasizing accurate, standardized measurement techniques both in clinic and at home. The guidelines were created with input from a majority-primary care committee—including family physicians, nurses, pharmacists, and patient partners—to ensure clinical applicability.Together, the panel outlines a streamlined nine-step treatment algorithm, emphasizing combination therapy as first-line pharmacologic management. They explain the evidence supporting ARB–thiazide combinations, discuss cost considerations for drug selection, and address adherence challenges. They also explore red flags for secondary hypertension and how the algorithm supports—but does not replace—clinical judgment.For physicians, this guideline offers a clear and practical roadmap: measure blood pressure correctly, aim for systolic pressure below 130 mm Hg, and use the simplified treatment sequence to improve adherence and outcomes. Designed to be easy to implement, the new approach aims to empower primary care providers to act with confidence.Join us as we explore medical solutions that address the urgent need to change healthcare. Reach out to us about this or any episode you hear. Or tell us about something you'd like to hear on the leading Canadian medical podcast.You can find Blair and Mojola on X @BlairBigham and @DrmojolaomoleX (in English): @CMAJ X (en français): @JAMC FacebookInstagram: @CMAJ.ca The CMAJ Podcast is produced by PodCraft Productions

This week on Bludging on the Blindside, Roy and HG discuss the rugby league runners - are they legit? Plan your life around rugby league, Alice Springs centre of excellence, the try celebration approval process, Runner agents - Is this something to consider? Billy Coleman the strongman of Lithgow, Horse racing base camp and where are the boxing TAFE courses?

A mix of rumours circling and the recently reviewed FiftyOne Sika road bike have Ronan and Dave pondering whether the UCI frame sticker is relevant to many of us. Spoiler, it's not.The episode was recorded a few days before we know for sure, but the social media profiles of athletes strongly point toward some interesting drop-bar-converted mountain bikes for the Leadville 100 race ahead.Ronan and Dave discuss a PSA for themselves, and of course, members of Escape Collective get access to the Ask a Wrench segment with Brad Copeland, where this week a handful of drivetrain-related questions are answered, including one about measuring for lateral chain wear.Enjoy!Time stamps:2:20 - The UCI approval sticker overrated16:50 - Wild bikes expected at Leadville31:30 - PSA for those with an air compressor40:00 - Standert's new Keiswerk44:00 - Ask a Wrench with Brad Copeland (Members Only)45:30 - Chasing noises that only occur under high load54:00 - Upgrading an old MTB drivetrain that's locked to an HG freehub1:03:00 - All about lateral chain wear

Welcome back to the Alt Goes Mainstream podcast.Today's episode is about mining for investment success in enterprise software by going “an inch wide and a mile deep” with someone who is one of the industry's most prolific private equity technology investors.We sat down with Nic Humphries in Hg's London office. Nic is the Senior Partner and Executive Chairman of Hg and Head of the firm's Saturn fund.Hg, one of the top 10 largest PE firms globally based on the PEI300 ranking, has built an impressive investment engine focused on mission-critical enterprise software. The firm has built a portfolio that is a “transatlantic ecosystem of software and services businesses” — representing over $180B in collective enterprise value across its 55 portfolio companies.Nic is responsible for Hg's strategy, management, and governance. On the investing side, Nic focuses on larger software investments that provide daily-use mission critical applications for accountants, tax / compliance professionals, and designers / engineers / scientists. He has brought his electrical engineering background to bear to go a “mile deep” into a category where Hg has become an unquestioned market leader.Nic balances being both a detail-oriented specialist with a vision for both the enterprise software industry and Hg as a firm. We had a fascinating discussion about enterprise software investing, how to create European software giants, applying AI to make companies more efficient, and much more.We covered:The origin story of Hg.How Hg grew into one of the industry's leading software focused private equity firms.How an engineering mindset has helped Nic become a leading investor.Why Hg focuses on mission-critical enterprise software and why it's a compelling investment thesis.Why enterprise software investing can be considered a low volatility investment strategy and how Hg has delivered consistent returns to investors.How to effectively manage exits and DPI.Why Europe, why now?How AI could impact technology and services businesses.Thanks Nic for coming on the show to share your wisdom and expertise about enterprise software and private markets.A word from AGM podcast sponsor, Juniper SquareWhen was the last time things were easy for GPs?Fundraising remains challenging, providing liquidity to investors is even harder—and broadly speaking, most GPs are underwater operationally.It's not about to get easier, either. Especially for managers vying for capital from the wealth channel. Sure, there's increased demand from HNW and UNHW investors to gain private markets exposure…but managing their expectations for the investing experience is a whole different ballgame.Reams of paper and a new KYC process every single time they subscribe to a fund? Brutal.But what if committing capital to private equity, venture, and real estate funds was digital and seamless for investors — and scalable to manage for GPs?Meet Juniper Square, the fund operations partner to over 2,000 private markets GPs worldwide.Juniper Square gives GPs the connected software, data, and fund administration services needed for modern private markets. No matter how ambitious your next raise is, how many investors you manage, and how complex your investment vehicles are, Juniper Square empowers GPs to raise capital faster, reduce operational risk, and deliver a world-class investor experience.And with JunieAI, Juniper Square's enterprise-grade AI built for private markets, GPs can truly and finally unlock the power of AI to work smarter, move faster, and focus on relationships and returns.Scale your business, not your operational burdens and costs. Visit junipersquare.com/agm today to learn more.Show Notes00:00 Introduction to our Sponsor, Juniper Square01:40 Introducing Nic Humphries01:56 Hg's Investment Strategy04:03 Nic's Background and Career Journey04:46 Engineering Mindset in Investing05:14 Long-Term Business Thinking05:58 Hg's Focus on Accounting Software06:45 Growth Drivers in SMB Market09:05 Impact of AI on Enterprise Software09:34 Platform Shifts in Technology11:10 Adapting to AI in Business12:15 Mission Critical Software14:02 Challenges of AI Integration14:58 Embedding Products and Services17:13 Organic Growth vs. Acquisitions20:51 Geographical Expansion Strategies21:59 European vs. North American Markets23:30 Management Teams and Expansion24:32 Jurisdictional Challenges in Europe25:05 Hg's Investment Philosophy25:50 Mission Critical Software in Europe36:22 Hg's Consistent Investment Returns38:00 Conclusion and Final Thoughts40:13 Understanding Recurring Revenues40:59 The Importance of Discipline in Investing41:48 Learning from Past Experiences43:30 Maintaining Excitement and Focus45:26 The Role of Realization Committees46:44 Continuous Improvement Culture47:42 The Importance of Cash Returns48:51 Exit Strategies and Realization Committees50:32 Re-underwriting Investments52:40 AI's Impact on Software Development54:17 The Rule of 40 and AI54:38 Investing in AI: Startups vs. Established Businesses55:59 Hg's Growth Strategy58:56 Specialization in B2B Back Office Software01:01:35 Fund Structure and Management01:03:27 Expanding into the Wealth Channel01:03:48 Hg Capital Trust and Fusion Fund01:05:27 Communicating with a Broader Audience01:06:39 The Importance of Brand in Wealth Management01:07:32 Connecting Private Markets to Everyday Life01:09:36 The Prevalence of Private Companies01:11:09 Aligning Interests with Investors01:12:19 Investment Decisions and Long-term Growth01:14:21 Future Growth Opportunities for Hg01:16:38 The Role of AI in Future Investments Editing and post-production work for this episode was provided by The Podcast Consultant.DisclaimerThe views and opinions expressed in this episode are those of the speaker and do not necessarily reflect the official policy or position of any affiliated organization.Any references to past performance, including IRR or MOIC figures, are presented on a gross basis and do not reflect the deduction of fees, expenses, or carried interest. These figures are illustrative and not necessarily indicative of future results. Statements regarding industry rankings, success rates, or performance consistency are based on internal analysis and may not be indepe...

Caterpillar (CAT) reported a revenue beat in its 2Q earnings figures, but fell shy of EPS top line expectations. Ben Watson examines the chart patterns formulating after the report. He uses the MACD study on a 5-day, 5-minute timeframe that shows near-term support around $421 and a slight reversal from initial weakness. On a 1-year timeframe, he points to the correlation to Copper futures (/HG) as something to watch.======== Schwab Network ========Empowering every investor and trader, every market day.Subscribe to the Market Minute newsletter - https://schwabnetwork.com/subscribeDownload the iOS app - https://apps.apple.com/us/app/schwab-network/id1460719185Download the Amazon Fire Tv App - https://www.amazon.com/TD-Ameritrade-Network/dp/B07KRD76C7Watch on Sling - https://watch.sling.com/1/asset/191928615bd8d47686f94682aefaa007/watchWatch on Vizio - https://www.vizio.com/en/watchfreeplus-exploreWatch on DistroTV - https://www.distro.tv/live/schwab-network/Follow us on X – / schwabnetwork Follow us on Facebook – / schwabnetwork Follow us on LinkedIn - / schwab-network About Schwab Network - https://schwabnetwork.com/about

This week on Bludging on the Blindside, Roy and HG discuss Adam Reynolds' a front rower in a halfback's body, Reed Mahoney - Niggler or grub? Can the NRL handle Trump's 1700% tariff? Todd Payten can fire the grub button, is Andrew Leigh MP the rugby league candidate? Nothing like a family pig baiting, Baiting - a practical entry point and the fight hole at LIV golf.

This week on Bludging on the Blindside, Roy and HG discuss, are the Phins the new entertainers? English imports to rugby league, try celebration approvals, Tinkler comeback, dirty worded team songs, SBW vs Gallen wrap up - Haymakers in our undies and Kevvie's in the car park.

The JournalFeed podcast for the week of July 14-18, 2025.These are summaries from just 2 of the 5 articles we cover every week! For access to more, please visit JournalFeed.org for details about becoming a member.Monday Spoon Feed:A single high-quality CT scan is highly accurate at detecting serious cervical spine injuries in children after trauma and may be enough to clear the spine without further imaging safely in majority of patients.Thursday Spoon Feed:For patients with ROSC after OHCA who required vasopressors transported by Finnish helicopter EMS (HEMS), normotension (100-140 mm Hg) was associated with improved 30-day mortality compared to hypo and hypertension.Friday Spoon Feed:This study of a trauma database found patients intubated in the emergency department (ED) who required hemorrhage control surgery had worse outcomes than those who were intubated in the operating room (OR). However, a study published just two months ago, from the same database of patients, found no difference in patients based on intubation location. What gives?

This week on Bludging on the Blindside, Roy and HG discuss Queensland's origin win, Roy doesn't mind a backyard incinerator, comfortable jockey vests, sailor's language on the origin coverage, the blues don't need champs - they need a champion team, some Sea eagle fans hate Manly too, take the kids holiday pigg'in and they also have a finger on the line.

David Aspell says the market will care more about tariff threats if they're made against bigger trading partners. He thinks copper tariffs of 50% are “much higher” than the market expected, and its price surge has already had rippling consequences. He is bullish on copper (/HG) overall. “The [countries] we import copper from are generally friendly” to us, he adds, “The speed in which it's being implemented is quite surprising.”======== Schwab Network ========Empowering every investor and trader, every market day. Subscribe to the Market Minute newsletter - https://schwabnetwork.com/subscribeDownload the iOS app - https://apps.apple.com/us/app/schwab-...Download the Amazon Fire Tv App - https://www.amazon.com/TD-Ameritrade-...Watch on Sling - https://watch.sling.com/1/asset/19192...Watch on Vizio - https://www.vizio.com/en/watchfreeplu...Watch on DistroTV - https://www.distro.tv/live/schwab-net...Follow us on X – / schwabnetwork Follow us on Facebook – / schwabnetwork Follow us on LinkedIn - / schwab-network About Schwab Network - https://schwabnetwork.com/about

This week on Bludging on the Blindside, Roy and HG discuss the British Lions bash everyone, LIV Golf - watch it, vomit, party and go home, when's Cam going to get his own gameshow? Manly fans hate you too, BYD Tasmanian stadium, buying panther semen online, ground staff appreciation day.

N Engl J Med 2004;351:2049-2057Background: Endothelial dysfunction, reduced nitric oxide availability, and increased oxidative stress occur in patients with heart failure and contribute to cardiac remodeling. In the V-HeFT I trial, combining isosorbide dinitrate (a nitric oxide donor) with hydralazine (an antioxidant) improved outcomes in patients with systolic heart failure. However, its long-term effectiveness in patients already receiving neurohormonal blockade was unclear.Cardiology Trial's Substack is a reader-supported publication. To receive new posts and support our work, consider becoming a free or paid subscriber.Racial differences exist in heart failure prevalence, mechanisms, and outcomes. Patients who identify as Black may have a less active renin–angiotensin system and lower nitric oxide availability. Prior analyses suggested that Black patients respond well to isosorbide dinitrate + hydralazine and respond less to Angiotensin Converting Enzyme Inhibitors (ACEi). For example, in a subgroup analysis of the V-HeFT I trial, isosorbide dinitrate + hydralazine reduced mortality in Black but not White patients.The African-American Heart Failure Trial (A-HeFT) sought to assess the efficacy of isosorbide dinitrate + hydralazine in Black patients with systolic heart failure.Patients: Patients were eligible if they self-identified as Black (defined as African decent), and had NYHA class III or IV heart failure for at least 3 months. The left ventricular ejection fraction had to be 35% or less or less than 45% if the ventricle was dilated. In addition, patients had to be on guideline medical therapy for at least 3 months.Patients were excluded if they had acute coronary syndrome or stroke within 3 months, cardiac surgery or percutaneous coronary intervention within 3 months, significant valvular disease, hypertrophic or restrictive cardiomyopathy plus many others.Baseline characteristics: Patients were recruited from 161 centers in the United States. The trial randomized 1,050 patients – 518 randomized to receive isosorbide dinitrate + hydralazine and 532 to receive placebo.The average age of patients was 57 years and 60% were men. The average left ventricular ejection fraction was 24% and the average left ventricular internal diastolic diameter was 6.5 cm. The cause of cardiomyopathy was ischemic in 23% of the patients, hypertensive in 39%, idiopathic in 26%, and other causes constituted the rest. The NYHA class was III in 96% of the patients. The average systolic blood pressure was 126 mm Hg.Approximately 40% had diabetes, 17% had chronic kidney disease and 17% had atrial fibrillation.At the time of enrollment, 90% were taking a diuretic, 69% were taking an ACEi, 17% were taking an angiotensin receptor blocker, 74% were taking a beta-blocker, 39% were taking spironolactone and 60% were taking digoxin.Procedures: The trial was double-blinded. Patients were randomized in a 1:1 ratio to receive fixed-dose combination of isosorbide dinitrate + hydralazine or to receive placebo. The initial dose was one tablet taken three times daily, containing either placebo or a combination of 37.5 mg of hydralazine and 20 mg of isosorbide dinitrate. If no side effects, the dose was increased to two tablets three times a day.Patients had follow up by phone every month and clinic visits every 3 months.Endpoints: The primary endpoint was a composite of weighted values of all-cause mortality, first hospitalization for heart failure within 18 months, and change in quality of life at 6 months. Quality of life was assessed using the Minnesota Living with Heart Failure Questionnaire, a 21-question self-administered questionnaire in which scores range from 0 to 5, with higher scores reflecting worse quality of life.The table below summarizes how the weighted score for the primary outcome was calculated.Analysis was performed based on the intention to treat principle. The main manuscript did not mention the estimated number of events for sample size calculation but did mention that 1,100 patients would provide sufficient power with a p

Severe nausea and vomiting in pregnancy/hyperemesis gravidarum (HG) takes a toll on patient, and the healthcare system. According to a June 2024 ACOG Clinical Expert Series on the subject, GFD15 and IGFBP7 both play important roles in placentation, appetite, and cachexia that are linked to hyperemesis gravidarum. Specifically, LOW pre-pregnancy GFD15 is associated with increased frequency of HG as GFD15 levels spike post pregnancy in an otherwise "naive" system. Since metformin increases GFD15, can this be a pre-pregnancy, chemoprophylactic option in high risk women? New data just released (June 2025; AJOG) provides some eye-opening insights. Listen in for details.