Podcasts about iii iv

This week, Pastor Rebecca shared some hard lessons she's learned about finances: sometimes, you don't know what you don't know until you find out. Preaching on scripture from the Book of Acts, her sermon explains that God is always trying to reveal to you, again and again, what more is possible.

Nonfat is sitting north of $2.25 on the CME spot market. But the bigger question is how long it can hold. In the latest episode of The Milk Check, the Jacoby team breaks down a dairy market that feels tight, fragile and increasingly dependent on timing. Here's what they're watching: Why nonfat prices surged, and what could break them How protein demand is pulling milk away from dryers Why MPC and MPI are outpacing nonfat What the inverted futures curve suggests for the second half of the year How depooling and Class III–IV dynamics are shifting milk flows Why butter feels weaker, even in the middle of flush Plus, the team talks through what happens if the nonfat market doesn't break soon. There's still a lot of milk moving. Just not where it used to go. Let the Jacoby team help you get up to speed on the new dairy market dynamics. Click below and listen to The Milk Check episode 98: A Market on Borrowed Time. Got questions? We'd love to hear them. Submit below, and we might answer it on the show. Ask The Milk Check Ted Jacoby III: Coming up on the Milk Check. Jacob Menge: if this doesn’t start falling soon, I think there’s gonna be people that are trying to make money on the short side of this thing because they didn’t make money on the long side. Ted Jacoby III: Welcome to the Milk Check from T.C. Jacoby & Co., Your complete guide to dairy markets, from the milking parlor to the supermarket shelf. I’m Ted Jacoby. Let’s dive in. Today is May 1st. It’s a couple of days after the ADPI and a couple of weeks after the Cheese Expo, and it’s usually after those two meetings a really good time to talk markets. So, we’ll go ahead and start with the market that everybody was talking about at the ADPI. Josh, Jake, Joe, what’s going on with our nonfat market? We’re at $2.26 today, I believe. Are we gonna stay up here for a while? Josh White: It’s a more challenging question than just the absolute price today. I think that if I were to summarize the show, there was a recognition across the entire dairy industry that there might be some legitimate reasons for nonfat to be tighter than they have been over the last several years. It feels like a lot of different things have resulted in the current spot price that we’ve seen today. Over the last five years, we globally have made more skim milk powder and nonfat. We’ve consumed more skim milk powder and nonfat, but the real story is in the fact that we’ve also made a whole lot more milk, and that milk doesn’t seem to have found its way to the dryer. Seems to have found its way to a variety of different products. And equally as important during the ADPI was the talk about the protein market, which I think we can likely get to later. But things like RDT products, beverages, protein consumption, cheese consumption, a lot of things have consumed incremental milk growth, particularly in the U.S., and that happened after many years where buyers had very little concerns over access to supply. And as a result, I think in the background we watched global inventories decline, and that all seems to have come to a head here in the early part of 2026. And now as we’re getting into the northern hemisphere flush, and particularly in middle America, yeah, then we have ADPI. And so, what’s interesting about your question is throughout most of the conference people were pretty convinced, “Yeah, we’re in a tighter nonfat market. We’re all buying into that.” Yet, the days following ADPI, we’ve seen futures sell off a bit and we’ve seen a little bit more volume traded at the CME spot call. What’s that mean going forward? Jacob Menge: The most interesting thing going forward is you don’t talk to single person that says these prices are gonna stick around for six months. And so it’s really a matter of timing, how long do we stay up here? I think we’re already up here longer than most anybody thought. And the other thing is, nobody got this market right. Some people got in at a buck 25. Those guys sold at a buck 40. They said, “I’m gonna take my 15, 20 cents and run.” And they felt like a genius for about three days before we were quickly at a buck 60. And we’ve got this really interesting dynamic of no market participant really happy with it being up here because nobody really made money on the way up. And everybody convinced that, okay it’s on the clock for when it comes off. And I’m not even gonna disagree with that, right? I don’t think anybody would argue that long-term we’re gonna have $2.50 nonfat in 2028 or whatever. But this really comes down to a question of timing, and I think that’s where you get mixed opinions. But in general, I think most people are of the opinion that it’s not gonna be that long before this thing does start to fall. I don’t have that strong of an opinion actually, but what I do have an opinion on is if this doesn’t start falling soon, I think there’s gonna be people that are trying to make money on the short side of this thing because they didn’t make money on the long side, that they’re gonna start feeling some pain. And as our curve has come up a bit over the past month, we’ve got this really interesting market conditions where, again, if we’re up at these levels even a month from now, two months from now sure, I’d make the argument, why couldn’t you have another squeeze higher? Because there’s still not that much product available right now today. We’re starting to see that change. We saw some really nice volume on the CME spot auction just this morning. But that’s what the eyes are on is how long does this thing take? And if it starts this week versus six weeks from now, I think those have very different implications for how the market reacts. Josh White: We’ve got three different reactions to the nonfat market right now. You’ve got the true nonfat participants that need product now, and that’s priced in the $2.25-plus type range right now on the countryside. And to your point, we’re seeing a few more loads available which is a decent sign. The market participants seem pretty convinced that we’re gonna see an easing from this price, but so are futures. And I think that’s another important thing to point out is that the futures curve is inverted and it’s quite a bit lower than the spot price today. So, you can have both situations. You can have a spot price drop while the futures price maybe doesn’t as much. Over the past few days, the futures curve has definitely traded lower, confirming what we heard there is that most people don’t believe in this market being as tight as it is currently into the future. And we have to remember, this is traditionally a globally traded product and our competitors across the pond are still quite a bit lower and making a whole lot of skim milk powder today. So, I think longer term, if the assumption is that we need to compete globally for at least some business, particularly in markets like Asia, we’re gonna have to be a little bit more aggressive to compete, but futures are saying we will be. Another important topic was now we’re starting to see an acceleration of the NDPSR price now that we’ve had several months of higher spot prices, and that’s starting to have an impact on markets other than just the powder market. And I think maybe, Gus, you would have a little bit more to say about how the market’s reacting to some of the component prices moving higher in the solids nonfat side of things. Gus Jacoby: The situation as we’ve talked about in the past is protein is being pulled in a lot of different directions and we don’t see that demand going away anytime soon. The one comment I would make though is your isolated protein, certainly UF milk in fluid form, are seeing some of the highest demand that we’ve seen in a very long time. So, if you’re cheese maker, if you wanna fortify, and certainly on higher butterfat milk, there’s plenty of folks that wanna fortify right now, there’s probably a little bit of a pull on all the skim solids at this moment in time. I don’t think that story has changed. We’ve beaten that up for a while. But that’s certainly gonna pull a fair amount of milk out of the dryer for nonfat. You look at where the capacity has been added, whether it be in the Southwest with all the large cheese plants that have been added there, and then Upstate New York where some dryers are also gonna sit idle as some new processing capacity comes on there. That’s two areas of the country that are gonna get a lot less milk into the nonfat dryers than previous. And certainly here we are now in the flush as these plants ramp up, it would typically be your highest powder production timeframe, and instead those solids are going elsewhere, and that will keep nonfat production down for the foreseeable future. Ted Jacoby III: Gus, are you seeing milk move towards Class IV plants instead of Class III plants this year? Gus Jacoby: We still see fortification solids during this flush finding its way into cheese plants. But that’s your surplus skim solids that might exist, and those are only available, I believe, because of the flush. Now, it’s not UF milk, right? UF milk tends to be going elsewhere whether it be going to some sort of IV or II-type arrangement, whether it be a high-protein beverage or a high-protein dry product. But you are still seeing a fair amount of condensed and other skim solids going to the cheese vat for fortification purposes. I think the way that will unfold likely is that those surplus skim solids that aren’t being turned into isolated protein products, they’re gonna probably get pulled out to a certain degree of the cheese plants, and then cheese plants will just not be able to utilize fortification as they are typically used to or would like as we move through the year. Ted Jacoby III: So, what you’re saying is if the price stays up here, the milk that is going into the dryers making nonfat will continue to do so longer than usual, and they won’t lose the flush-specific skim solids? Gus Jacoby: I don’t know if I’d agree with that, Ted. I think the flush, no matter where you’re at in the country, the surplus solids find its way to the dryer typically. And as we come out of the flush, certainly less solids everywhere will go toward the nonfat dryer, just as it always does during those seasonality changes and we come out of the spring. It’s just that the areas I talked about, Southwest and Northeast, they’re not getting near as much as they used to in the flush, and so overall that production is going to be missed upon the market. Ted Jacoby III: Do you sense any kind of competition right now between Class III and Class IV for the surplus milk, or is it just following its usual path? Gus Jacoby: There’s some surplus condensed solids going to cheese plants that if a better price could be had into a powder plant, it would go there. Ted Jacoby III: Okay. Gus Jacoby: And that’s happening predominantly in the upper Midwest, and maybe a little bit in other areas. But certainly if you’re gonna get a higher return going into cheese than you could going into powder, you’re gonna go after it right now. And that’s where the demand I would say is. But surplus is surplus, and you’re gonna sell it to the highest return you can. Ted Jacoby III: Okay. That sounds good. Joe, anything to add on the nonfat side? Joe Maixner: Any milk that is making it to dryers, they’re prioritizing the milk to try to get into the milk protein concentrate (MPC) sector or milk protein isolate (MPI) as opposed to nonfat because the return is better. Ted Jacoby III: Makes sense to me. Joe, Josh, are we seeing MPC prices rise faster than nonfat right now? Josh White: Yeah, no, it has to be faster than nonfat because basis is appreciating. You’ve got an MPC market that likes to trade on a multiple of nonfat, and that has appreciated. That has continued to increase. Now, again, I noted earlier we got an inverted forward curve, which means that basis can be going up and price could stay the same or even go down the second part of the year. So, that’s the dichotomy we’re dealing with right now, is that from a cost basis, it looks like it could be pretty okay the rest of the year. And if there’s dry time available, you would think you’re gonna maximize that MPC. And when compared to whey protein concentrate (WPC) prices, MPC 85 is a bargain. But again, not everyone can easily substitute between the two, and that takes some time for the market to figure out which market participants may be able to switch between WPCs and MPCs, may take a little time for them to make that switch. Ted Jacoby III: So, I just wanna clarify for the audience. There’s two different ways we can look at it. If we’re selling it forward into the second half of the year, from a market perspective, we may be selling it for a lower price because the futures curve is a lot lower than the cash price is today. But if we’re selling MPC or nonfat today, you’re telling me that the nonfat price has effectively doubled in the last three months, and the MPC price has more than doubled because not only has its basis doubled based on the nonfat market, but the overage above that has also gone up. Josh, you’re on mute. Josh White: I thought you said clarify for the audience, so I didn’t realize it was a question for me. Ted Jacoby III: Oh the answer is yes. That’s exactly what’s happening. Josh White: Yes. Nailed it. Ted Jacoby III: All right. So, basically what we’re saying is skim solids and protein are in high demand. That’s loud and clear. [Center commercial] Ted Jacoby III: Mike, what about from a federal order perspective, how this all feeds through the federal order? Obviously, since it’s a higher market right now, Class IV is what’s driving Class I prices. Obviously, it drives Class II prices. Is there anything else that kind of shifts around in a market like this? Mike Brown: There’s a couple things. First of all, a lot of your Class IV production is co-op owned. And what we’re seeing is depooling in Class IV, and to some degree Class II where it’s possible. So, rather than to go into the pool and get a blend price that’s below your class price, they’re electing to depool, just like we saw with cheese last fall when it was much higher than butter powder. We’re seeing some of that. But if you’re pooled, you’re ambivalent because you’re gonna pull the pool draw out anyway, and it’s not gonna make a lot of difference. It’s markets like the Southwest where a lot of that milk is never pooled or rarely pooled, and even in the eastern part of Kansas, changes in central order, you less have to pool it because the differential is so much wider now from Kansas City than it used to be. You may see more activity as you watch pool decisions being made since last June when the changes, people are getting a lot better at predicting whether or not they should be involved with the pool or not because it’s getting easier to predict because behavior is more what you’d expect. So, from my point of view, it has some effect, certainly, and if you’re trying to maximize a return to your owners and you have a plant with capacity and you get a higher value product, you’re gonna try to run the milk through that plant. Second part of that, of course, if you already have obligations, and some of these new cheese plants have supply obligations, they’re gonna get their milk regardless of the shift in price. So, it has less effect than you might think, but there is still effect, particularly if you’re having to pool your IV. There’s certainly a lot of IV being depooled right now. Production isn’t much lower. It’s just regionally shifted some, a lot more in the West Coast right now than in the Southwest. The orders kinda mute what would be the normal market decision to maximize return on milk for a producer because if you’re gonna blend it anyway, you don’t have the incentive that you do if you don’t. That said, right now, Class III guys, they’re pooled. The other part of this III-IV spread is, of course, what is the value of those solids into those cheese plants? I’m working on that today, Ted, trying to figure out how much does the high-WPC80 and WPI market bring to the value of buying outside Class IV solids to justify the price? Just on the price of cheese, I got some numbers here in front of me, you’re looking at on a per-pound cheese yield basis, if you buy powder in the powder market right now, it’s 25 to 40 cents more per pound cheese yield than it would be if you’re getting it from Class III. Mike Brown: You better either have a great margin or you’re really hitting up the whey market, and I’m gonna figure out exactly what that is. But that decision isn’t just a cheese decision, particularly with whey protein so high. There is a value of that nonfat dry milk whey protein that in the past didn’t matter as much as it does now. So, it may make that slightly more attractive or less unattractive than it would’ve in the past because your whey returns are so high on that protein compared to what they have been historically. So, it’s complicated, but it’s not just the value in cheese. It’s the value in cheese and in whatever your plant can make for whey. If you can make WPC80, you can pay more for those nonfat solids, obviously, than you can if you don’t. Ted Jacoby III: So to clarify, usually when you ship fluid into a Class III plant, you pay the Class III solids price. Mike Brown: That’s correct. Ted Jacoby III: If you use powder, you’re gonna have to pay whatever the prevailing nonfat price is. And most everybody running a cheese plant right now would really like their skim solids in fluid form so they can pay those Class III values instead of the Class IV values. Mike Brown: Oh, absolutely. But if they’ve got excess fat, and a lot of our American-style cheese plants now do have excess fat, what’s your market for that fat, and does it make sense to pay a little more for that protein from the Class IV side so that I can get a better price for that fat? Although we all know multiples this year aren’t near as horrible as they were a year ago. Yeah. So it’s a little better market. If you’re gonna get right down to dollars and cents, really you gotta look at your whole product mix out of your cheese plant and figure out what can you really afford to pay for those solids . And plus the opportunity of running your plant more full. What’s your fixed cost savings by running more product through your plant even if the cost is a little higher? Ted Jacoby III: Speaking of butterfat, Joe, this butter market just feels like it’s gone a lot lower than we expected it to go. Joe Maixner: Yeah, it’s weak. Cream’s not sloppy. It sure doesn’t seem like it’s super long in the market. But there’s still plenty of butter being made, and I think that this market’s also pricing in the fact that we’re anticipating that export reports are gonna decrease in the amount of butter that will get out monthly moving forward until this Middle East conflict gets resolved. And we’re basically peak flush through east of the Rockies, so this is the highest production point we’re gonna see through the rest of the year until we get past the holidays. Ted Jacoby III: Gus, are cream multiples poor right now as well? Gus Jacoby: We’re still on the flush, right? But they’re much, much tighter and higher than they were a year ago this time. It just goes to show that the additional churn capacity we’ve seen around the country and some better preparation by a lot of folks in dealing with excess butterfat has made this market a fair amount healthier when it comes to cream. Not near as sloppy as it was a year ago. Multiples have held at or better than even the year previous for flush times. So, I would imagine that what we’re gonna see here going forward is representative of this new marketplace. Ted Jacoby III: Josh, anything to say about the whey protein market? Josh White: Maybe some early signs of a market trying to figure out if it wants to continue on the trajectory it’s been on. WPC80, the general consensus out of ADPI is it remains tight. Seen a few extra spot loads trade this week though, so maybe some people were waiting for that information to let go of a little excess inventory or some incremental loads. WPI feels like it’s pretty stable. And the market came to the conclusion, I believe, during the ADPI conference, that, okay, it seems to be priced right. It doesn’t feel like WPI needs to go up at the moment. And we’ve definitely seen more offers since the show. Not ready to conclude that’s going lower because of where the WPC80 price is and how tight the WPC80 market is. So, those two have really converged at the moment, almost to a point that doesn’t make a lot of sense, the price spread between the two, so the market’s going to figure that out. So, yeah, that would be the only changes. Other than that, maybe just reiterating that we are constantly talking to new customers about new demand creation, and also outside of the traditional sports nutrition category, a lot of new CPG product launches and things like that are absolutely still in motion and consuming a lot of dry protein. Ted Jacoby III: Makes sense to me, and I would agree. And then, what I would say about cheese is it was easily the most boring market at the ADPI. I’d start by saying that. It feels like a market where a lot of people are complaining that the price isn’t low enough for them to get new sales on, but they also can’t find a ton of product out there. There is some spot product trading around, but there’s not massive quantities of it like you sometimes see in the height of the flush, which just makes me feel that right now the cheese market is in balance. In balance in a way that maybe we’re not getting a huge amount of additional export sales on the books, but we are continuing to export at a pretty high rate , especially considering there’s a lot of sales on the books that were put on the books earlier in the year that are gonna continue to ship. And it’s kept this market, this cheese market, I think, relatively well cleaned up considering we’re in the height of the flush. So, we don’t see a lot of movement going forward, at least in the next few months in cheese. You’re gonna trade in a 30 cent range, 20 cent range around where the current price is. That would be my take on the cheese market. All right. To all our listeners, I really appreciate you guys listening to us. I hope this information is helpful, and we look forward to talking to you soon. Take care. [Ending credits]

This year's RVA Environmental Film Festival runs from 2/21 to 3/7 in venues all over town. Today's show features 2 locally made docs. CATCHING PINECONES tells the story of Jan and Herb Conn, who were pioneering rock climbers, cavers and nature preservationists. Director Chad Heddleston discusses: – The 10-year journey to get this made – Inspiration from the lives of the Conns – The meaning of the title – Using jaunty jump cuts instead of pan and zoom – Jan's music in the soundtrack ALL FORWARD profiles an intensive training program for river rafting guides in Richmond, which has the nation’s only class III/IV urban whitewater. Director Justin Black returns to talk about his new short: – An update on “Headwaters Down” – Being a raft guide – Using a GoPro in his mouth – Things that went wrong LINKS RVA Environmental Film Festival Catching Pinecones website Chad's Mockumentary “Almost Alpine” Headwaters Down website Podcast with Justin Black about “Headwaters Down” The Richmond Film Network (upcoming meeting) My podcast with the creator of the SONG SUNG BLUE documentary

Herodotos från Halikarnassos lade under 400-talet f.Kr. grunden till historieämnet genom sin metodiska skildring av krig, kulturer och makt i den antika världen. Han var den förste som försökte förklara historiska skeenden genom systematiska undersökningar.Herodotos huvudsakliga fokus var de grekisk-persiska krigen, men hans omättliga nyfikenhet omfattade även folk, seder, landskap, myter och maktförhållanden. Hans verk är ett försök att förstå världen i sin helhet. Det är en hissnande resa där vi får möta grymma kungar, kloka rådgivare, etnografiska skildringar av begravningsriter – och guldsökande myror stora som hundar.I detta avsnitt av Historia Nu Premium samtalar programledaren Urban Lindstedt med antikvetaren Allan Klynne om Herodotos och hans betydelse för historieskrivningens framväxt. Är du en vanlig prenumerant får du bara lyssna på tio minuter. Vill du höra hela avsnittet blir du premium-medlem via historia.nu/premium. Genom att bli premiummedlem hjälper du oss att stå fria från annonsmarknadens svängningar och säkrar att Historia Nu kan fortsätta berätta historien – år efter år.I sitt stora verk Historia lade Herodotos grunden till västerländsk historieskrivning. Han reste sannolikt till Egypten, och kanske så långt som till Babylon. Han samlade in berättelser från Libyen, Indien och länder bortom Svarta havet.Herodotos föddes omkring 484 f.Kr. i Halikarnassos (nuvarande Bodrum i Turkiet), en grekisk stad under persiskt styre. Han tillhörde en välbärgad familj med både grekiska och kariska rötter. Redan i unga år började han resa och samla in berättelser. Under sina färder besökte han bland annat Egypten, Libyen, Babylonien, Skytien och flera delar av det persiska riket – platser han beskrev med imponerande detaljrikedom.Senare bosatte han sig i Aten, där han uttryckte beundran för den atenska demokratin och dess öppna politiska klimat. Mot slutet av sitt liv flyttade han till kolonin Thurii i södra Italien. Där färdigställde han troligen sitt livsverk Historiae och avled omkring 424 f.Kr.Herodotos skrev Historia mellan cirka 430 och 424 f.Kr. Verket består av nio böcker – en uppdelning som gjordes av senare redaktörer och namngetts efter de nio muserna.Berättelsen inleds med kung Krösus i Lydien och kulminerar i de grekisk-persiska krigen under 400-talets första hälft, särskilt Xerxes I:s invasion av Grekland. Böckerna I–V skildrar förspelet till konflikterna: det persiska rikets uppkomst, öst-västliga relationer och interna händelser i Grekland. Böckerna VI–IX behandlar själva kriget, inklusive de avgörande slagen vid Salamis, Plataiai och Mykale (480–479 f.Kr.).Men Herodotos nöjde sig inte med att beskriva strider. I stället erbjuder han ett tvärsnitt av sin samtida värld. I Bok II presenterar han en omfattande skildring av Egypten: dess geografi, historia, religion och samhällsstruktur. Böckerna III–IV behandlar det persiska imperiets förvaltning, kung Kambyses fälttåg och Dareios I:s politiska reformer.Bildtext: Porträttbyst av Herodotos, romersk marmorskulptur från 100-talet e.Kr. Denna byst föreställer den grekiske historikern Herodotos, ofta kallad "historieskrivningens fader", och är ett romerskt verk som sannolikt återger ett äldre grekiskt original. Herodotos är mest känd för sitt verk Historiae, där han skildrar de grekisk-persiska krigen och försöker förstå världens orsaker genom berättelser och undersökningar. Källa: Metropolitan Museum of Art via Wikimedia Commons. Bilden är public domain.Musik: The Sands Of Ancient Ruins av LIVINGFORCE, Storyblock Audio.Klippare: Emanuel Lehtonen Hosted on Acast. See acast.com/privacy for more information.

For those who need neither the entire play nor the discrete Acts of Accursed Philoctetes, here are Parts I & II. Part I addresses events which lead to the abadonment of Philoctetes on Lemnos. Part II the fraught return of the Greeks to retrieve Philoctetes and the bow. Enjoy these iterations of Accursed Philoctetes.

Please visit answersincme.com/CAY860 to participate, download slides and supporting materials, complete the post test, and obtain credit. In this activity, an expert in melanoma discusses how to optimize the use of neoadjuvant, adjuvant, or perioperative immunotherapy approaches for patients with resectable high-risk melanoma. Upon completion of this activity, participants should be better able to: Recognize recurrence patterns in patients with resected high-risk melanoma and the importance of timely referral to improve recurrence-free survival; Evaluate the risk-benefit profiles of neoadjuvant, adjuvant, or perioperative immunotherapy in patients with resectable stage IIB/C and stage III/IV melanoma; and Outline strategies to individualize the selection of neoadjuvant, adjuvant, or perioperative immunotherapy approaches for patients with resectable stage IIB/C and stage III/IV melanoma.

Please visit answersincme.com/CAY860 to participate, download slides and supporting materials, complete the post test, and obtain credit. In this activity, an expert in melanoma discusses how to optimize the use of neoadjuvant, adjuvant, or perioperative immunotherapy approaches for patients with resectable high-risk melanoma. Upon completion of this activity, participants should be better able to: Recognize recurrence patterns in patients with resected high-risk melanoma and the importance of timely referral to improve recurrence-free survival; Evaluate the risk-benefit profiles of neoadjuvant, adjuvant, or perioperative immunotherapy in patients with resectable stage IIB/C and stage III/IV melanoma; and Outline strategies to individualize the selection of neoadjuvant, adjuvant, or perioperative immunotherapy approaches for patients with resectable stage IIB/C and stage III/IV melanoma.

hour one: "I want to talk about you" (live excerpt - penn state on jan 19, 1963) john coltrane "dream city" basic "changes, changing" basic "log 15" church of the annihilation "babies and gentlemen" guided by voices "she walks alone" rational cut "a lovers theory of value" (freak heat waves remix) ruth mascelli & mary hanson scott "fool's convention" (official visualiser) nicky "inner extremities suite part 1 of 3" eugene chadbourne & jair-rohm parker wells "new auspicious" basic hour two: "a love supreme" (live) chris forsyth "interlude 3 (goblins)" [excerpt] tim holehouse "nublu jam, part 2" (live) chris forsyth, dave harrington, ryan jewell, spencer zahn "dreaming in the non-dream" chris forsyth with garcia peoples hour three: "tomorrow might as well be today" chris forsyth "circumambulations" butler "the ballad of freer hollow" chris forsyth & the solar motel band "high castle rock" chris forsyth & the solar motel band "island girl" (robo bass hifi's defending rights & justice remix) ari up featuring lee scratch perry "solar motel, parts III-IV" chris forsyth

How did we deal with Miriam's revelations? Can you be a good teacher and a bad person, and visa versa? And what do we want for soup season? All that and more in this Afterparty!We're playing Masks for this campaign! You can access a running list of all the NPCs from Campaign 4 here.Sponsors- Uncommon Goods, where you can get 15% off at uncommongoods.com/jointhepartyFind Us Online- website: https://jointhepartypod.com- patreon: https://patreon.com/jointhepartypod- instagram: https://instagram.com/jointhepartypod- twitter: https://twitter.com/jointhepartypod- tumblr: https://jointhepartypod.tumblr.com- facebook: https://facebook.com/jointhepartypod- merch & music: http://jointhepartypod.com/merchCast & Crew- Game Master, Co-Producer: Eric Silver- Co-Host, Co-Producer, Sound Designer, Composer (Connor Lyons): Brandon Grugle- Co-Host, Co-Producer, Editor (Shelley Craft): Julia Schifini- Co-Host, Co-Producer (Rowan Rosen): Amanda McLoughlin- Artwork: Allyson Wakeman- Multitude: https://multitude.productionsAbout UsJoin the Party is an actual play podcast with tangible worlds, genre-pushing storytelling, and collaborators who make each other laugh each week. We welcome everyone to the table, from longtime players to folks who've never touched a roleplaying game before. Hop into our current campaign: the drama and excitement of a superhero high school! Or marathon our completed stories: Campaign 3 for a pirate story set in a world of plant- and bug-folk, the Camp-Paign for a MOTW game set in a weird summer camp, Campaign 2 for a modern superhero game, and Campaign 1 for a high fantasy story. And once a month we release the Afterparty, where we answer your questions about the show and how we play the game. New episodes every Tuesday.See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

Europos Sąjunga akcentuoja daugiakalbystės svarbą. Tačiau Lietuvos mokyklose šis siekinys yra dažniau deklaracija, o ne realybė. Mat daugybė mokinių ne tik negali dėl Europos kalbų pasiūlos nebuvimo pasirinkti mokytis norimos antrosios užsienio kalbos, o ir pamokų, reikalingų antrosioms užsienio kalboms išmokti, skaičius nepakankamas.Kaip rodo oficialioji švietimo statistika, 2024–2025 mokslo metais 311 tūkst. mokinių pasirinko anglų kalbą kaip pirmąją užsienio kalbą – tai beveik visi Lietuvos moksleiviai (prieš penkerius metus 291 tūkst.). Vokiečių kalbą pirmąja užsienio kalba pasirinko tik 800 (prieš penkerius metus – 1300), prancūzų kalbą rinkosi – mažiau nei 250 moksleivių (prieš penkerius metus – apie 500).Antrosios užsienio kalbos, pradedamos mokyti nuo 6 klasės, populiarumas toliau disonuoja su Europos kalbų mokymosi skatinimu. Rusų kalbą kaip antrąją 2024-2025 m. m. rinkosi 89,5 tūkst. mokinių (prieš penkerius metus – 108 tūkst.), vokiečių – beveik 36 tūkst. (prieš penkerius metus – 24,7 tūkst.), prancūzų – 14,4 tūkst. (prieš penkerius metus – 9 tūkst.), o ispanų – 6,4 tūkst. (prieš penkerius metus – 649). Italų ir lenkų kalbos lieka užribyje – atitinkamai tik 41 ir 112 besimokiusiųjų.Tačiau realybė stabdo tikrą daugiakalbystę: pasiekti B1/B2 vokiečių, prancūzų ar ispanų kalbos lygį, kaip rodo JAV Valstybės departamento kalbų instituto atlikti tyrimai, reikia maždaug 600–900 valandų. Bet Lietuvos moksleiviai nuo 6 iki 10 klasės antrosios užsienio kalbos mokosi tik apie 400–500 valandų. O ir po 10 klasės dauguma mokinių antrosios užsienio kalbos atsisako. Mat, pagal Švietimo, mokslo ir sporto ministerijos Bendrąjį ugdymo planą, gimnazijos III–IV klasėse leidžiamas maksimalus individualus pamokų krūvis – 35 valandos per savaitę. Tad dažnas mokslus jaunuolis, rinkdamasis, ko atsisakyti, dažniausiai atsisako antrosios užsienio kalbos. Kitaip negalės pasirinkti tiek dalykų, kiek reikalinga stojant į aukštąsias mokyklas.Rugsėjo 26 d. minima Europos kalbų diena primena: norint, kad jaunimas iš tiesų taptų daugiakalbis, reikia ne tik gražių žodžių, bet ir realių sprendimų – daugiau pamokų, lankstesnio krūvio ir galimybių mokytis įvairių kalbų.LRT radijo švietimo laidoje dalyvauja Goethe's instituto Lietuvoje vadovo pavaduotoja, Kalbos skyriaus vadovė Nijolia Buinovskaja ir Lietuvos prancūzų kalbos mokytojų ir dėstytojų asociacijos prezidentė Danutė Stankaitienė.Ved. Jonė Kučinskaitė.

Baptism III-IVThirdHow can water do such great things?Certainly not just water, but the word of God in and with the water does these things, along with the faith which trusts this word of God in the water. For without God's word the water is plain water and no Baptism. But with the word of God it is a Baptism, that is, a life-giving water, rich in grace, and a washing of the new birth in the Holy Spirit, as St. Paul says in Titus, chapter three: "He saved us through the washing of rebirth and renewal by the Holy Spirit, whom He poured out on us generously through Jesus Christ our Savior, so that, having been justified by His grace, we might become heirs having the hope of eternal life. This is a trustworthy saying" (Titus 3:5ó8).FourthWhat does such baptizing with water indicate?It indicates that the Old Adam in us should by daily contrition and repentance be drowned and die with all sins and evil desires, and that a new man should daily emerge and arise to live before God in righteousness and purity forever.Where is this written?St. Paul writes in Romans chapter six: "We were therefore buried with Him through baptism into death in order that, just as Christ was raised from the dead through the glory of the Father, we too may live a new life" (Romans 6:4).Luke 18:15-17Now they were bringing even infants to him that he might touch them. And when the disciples saw it, they rebuked them. But Jesus called them to him, saying, “Let the children come to me, and do not hinder them, for to such belongs the kingdom of God. Truly, I say to you, whoever does not receive the kingdom of God like a child shall not enter it.”

How do we feel about Emily Slaughter? What are field day events like at a superhero high school? And how many card games can we come up with over the course of the podcast?We're playing Masks for this campaign! You can access a running list of all the NPCs from Campaign 4 here.Sponsors- The Sprouting, an eldritch horror actual play podcast.Find Us Online- website: https://jointhepartypod.com- patreon: https://patreon.com/jointhepartypod- instagram: https://instagram.com/jointhepartypod- twitter: https://twitter.com/jointhepartypod- tumblr: https://jointhepartypod.tumblr.com- facebook: https://facebook.com/jointhepartypod- merch & music: http://jointhepartypod.com/merchCast & Crew- Game Master, Co-Producer: Eric Silver- Co-Host, Co-Producer, Sound Designer, Composer (Connor Lyons): Brandon Grugle- Co-Host, Co-Producer, Editor (Shelley Craft): Julia Schifini- Co-Host, Co-Producer (Rowan Rosen): Amanda McLoughlin- Artwork: Allyson Wakeman- Multitude: https://multitude.productionsAbout UsJoin the Party is an actual play podcast with tangible worlds, genre-pushing storytelling, and collaborators who make each other laugh each week. We welcome everyone to the table, from longtime players to folks who've never touched a roleplaying game before. Hop into our current campaign: the drama and excitement of a superhero high school! Or marathon our completed stories: Campaign 3 for a pirate story set in a world of plant- and bug-folk, the Camp-Paign for a MOTW game set in a weird summer camp, Campaign 2 for a modern superhero game, and Campaign 1 for a high fantasy story. And once a month we release the Afterparty, where we answer your questions about the show and how we play the game. New episodes every Tuesday.See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

CME credits: 1.00 Valid until: 31-07-2026 Claim your CME credit at https://reachmd.com/programs/cme/efficacy-and-safety-outcomes-for-adjuvant-immunotherapy-driving-guideline-recommendations-for-stage-iiiiv-melanoma/36325/ This online CME activity, presented in collaboration with the National Comprehensive Cancer Network (NCCN®), focuses on translating oncology clinical practice guidelines into practical strategies for treating melanoma. Participants will learn how to integrate clinical trial data into guideline-concordant treatment plans in the neoadjuvant, adjuvant, and metastatic settings. The program highlights the importance of evidence-based approaches and the use of immunotherapy for the treatment of melanoma. Attendees will also explore emerging data that could influence future treatment guidelines, patient case examples, and insights from international faculty to develop region-specific therapeutic tactics aligned with NCCN Guideline® recommendations. *This program was published on July 31st, 2025 and the information therein was up-to-date when created.

CME credits: 1.00 Valid until: 31-07-2026 Claim your CME credit at https://reachmd.com/programs/cme/efficacy-and-safety-outcomes-for-adjuvant-immunotherapy-driving-guideline-recommendations-for-stage-iiiiv-melanoma/36325/ This online CME activity, presented in collaboration with the National Comprehensive Cancer Network (NCCN®), focuses on translating oncology clinical practice guidelines into practical strategies for treating melanoma. Participants will learn how to integrate clinical trial data into guideline-concordant treatment plans in the neoadjuvant, adjuvant, and metastatic settings. The program highlights the importance of evidence-based approaches and the use of immunotherapy for the treatment of melanoma. Attendees will also explore emerging data that could influence future treatment guidelines, patient case examples, and insights from international faculty to develop region-specific therapeutic tactics aligned with NCCN Guideline® recommendations. *This program was published on July 31st, 2025 and the information therein was up-to-date when created.

“We should start back” sono le primissime parole de “Le Cronache del Ghiaccio e del Fuoco” di George R.R. Martin e noi abbiamo pensato di fare esattamente così.Alla fine del loro viaggio in lettiga, Illyrio lascia Tyrion in compagnia di Haldon Halfmaester e Ser Rolly Duckfield, conosciuto anche solo come Duck. Dopo vari aggiornamenti sul ragazzo, Young Griff, e delle recenti informazioni sui khalasar che infestano la zona dalle Velvet Hill fino a Qohor, i tre si mettono in cammino verso la meta: Ghoyan Drohe, un'antica città rhoynar sulla sponda sud della Piccola Rhoyne, un affluente della grande Madre Rhoyne dove troveranno la Shy Maid e tutti gli altri loro compagni. Durante il viaggio a cavallo, Haldon e Tyrion si stuzzicano a vicenda poiché Haldon ha probabilmente capito (??) chi è il piccolo Hugor Hill, in arte Yollo, ma in realtà l'unico a raccontare davvero la sua storia è Duck, originario di Bitterbridge e scappato dalla casa dei Casswell per aver picchiato l'erede.Sulla Shy Maid li accolgono i due Griff, il vecchio e il giovane, entrambi dai capelli blu e dal passato oscuro e misterioso. Sarà compito di Tyrion scoprire le loro vere origini. È con il Griff adulto che Tyrion si confronta per primo; Illyrio infatti ha scritto per lui una lettera spiegando la vera identità di Tyrion e la sua potenziale utilità nella missione. Tyrion non manca di notare che Griff mente, e anche male.Le giornate sulla Shy Maid procedono lente e monotone, tra un allenamento alle armi e una lezione di storia e geografia. Tyrion è curioso e osserva soprattutto i nuovi compagni: i coniugi Yandry e Ysilla, septa Lemore, la più bella e intrigante e Griff, sempre taciturno e pieno di rabbia e dolore.Inesorabilmente si avvicinano alla vera corrente della Rhoyne e con essa Tyrion inizia a sentire l'influenza delle mille leggende e storie che circondano questa nuova parte di mondo che sta visitando: dalle guerre contro l'antica Valyria ai semidei che popolano le acque del grande fiume, come il Signore del Sudario o il Vecchio Uomo del Fiume. La loro meta è Volantis, ma per raggiungerla dovranno passare per Ny Sar, la città di Nymeria, e Chroyane, nel Sorrows, la parte più larga e misteriosa della Rhoyne.In tutto questo, Tyrion partecipa all'educazione del Giovane Griff scrivendo su carta tutta la sua conoscenza sui draghi e, mentre si sforza di ricordare, impara a giocare bene a cyvasse tanto che sfida Haldon a duello.Tyrion quel duello lo vince e così facendo ottiene la verità su un re, un certo Lord Perduto e la loro missione verso la Madre dei Draghi.Ovviamente condividete su tutte le piattaforme, spargete la voce e mettete like al video. Potete trovarci su tutti gli altri social tramite i link qua sotto:Facebook: https://www.facebook.com/tronodispadepod/Twitter: https://twitter.com/tronodispadepodInstagram: https://www.instagram.com/tronodispadepod/Spotify: https://open.spotify.com/show/4mdslx4Nd8vunpc7nP3B45Google Podcast: https://www.google.com/podcasts?feed=aHR0cHM6Ly9hbmNob3uZm0vcy81MDk3ZTk4OC9wb2RjYXN0L3Jzcw==Patreon: https://www.patreon.com/ilpodcastdelghiaccioedelfuocoKo-fi: https://ko-fi.com/ilpodcastdelghiaccioedelfuocoLinkt.ree: https://linktr.ee/ilpodcastdelghiaccioedelfuoco

Dr. John Sweetenham shares highlights from Day 5 of the 2025 ASCO Annual Meeting, including data from large trials in advanced malignant melanoma and mCSPC plus a new approach to first-line treatment for patients with multiple myeloma who are not transplant eligible. Transcript Hello, I'm Dr. John Sweetenham, the host of the ASCO Daily News Podcast, with my takeaways on selected abstracts from Day 5 of the 2025 ASCO Annual Meeting. My disclosures are available in the transcript of this episode. The selected abstracts from this final day of ASCO25 include important new data from large, randomized trials in patients with advanced malignant melanoma and patients with metastatic castration-sensitive prostate cancer, as well as a new approach to the first-line treatment of patients with multiple myeloma who are not transplant eligible.  Starting with LBA9500, this study was conducted in patients with completely resected stage III or IV malignant melanoma and compared the combination of relatlimab plus nivolumab versus nivolumab alone in this population. The study, named the RELATIVITY-098 trial, was presented by Dr. Georgina Long from the University of Sydney, Australia. In her introduction to the study, Dr. Long explained that the current standard of care for adjuvant therapy of resected stage III/IV melanoma is with PD-1 monotherapy with nivolumab, but that about 50% of patients will suffer from a subsequent relapse. In the first-line setting in patients with advanced or unresectable melanoma, the combination of nivolumab with the LAG-3 inhibitor, relatlimab, has been previously shown to improve progression-free survival in the RELATIVITY-047 trial. The current study evaluated this same combination in the adjuvant setting. More than 1,000 patients from 24 countries were randomized to receive either nivolumab alone (546 patients) or the combination of nivolumab with relatlimab (547 patients). Both treatments were given for a maximum of 1 year or until progression of disease, unacceptable toxicity, withdrawal, or death. Various biomarker studies were also undertaken including LAG-3 and PD-1 expression on CD8-positive T cells. The primary endpoint of the study was relapse-free survival, and Dr. Long reported that this was the same in both arms of the study. For example, at 24 months, the relapse-free survival was 64% in the monotherapy arm compared with 62% in the combination arm. The hazard ratio was 1.01 and the P value was 0.928. Metastasis-free survival was also identical in both arms. No benefit was observed for the combination in any of the prespecified subgroups. No new toxicity signals emerged compared with the RELATIVITY-047 trial. Interestingly, the baseline surface expression of LAG-3 and co-expression of LAG-3 and PD-1 on CD8 T cells in the 098 adjuvant trial were lower than in the 047 advanced disease trial, perhaps explaining why the combination did not confer benefit over nivo alone in the adjuvant setting. This is an important result, demonstrating that results from one clinical setting cannot always be extrapolated to another. Although the combination has gained some use in the adjuvant setting, this study clearly demonstrates that more drug in this situation is no better and that monotherapy remains the current standard of care. Results from the AMPLITUDE trial for patients with metastatic castration-sensitive prostate cancer with alterations in homologous recombination repair (HRR) genes, in LBA5006, were presented today by Dr. Gerhardt Attard from University College London, UK. This international, multicenter study evaluated the combination of the selective PARP inhibitor, niraparib, in combination with abiraterone acetate and prednisone. The same combination has been previously shown to improve outcomes in castration-resistant metastatic prostate cancer harboring BRCA mutations in the MAGNITUDE study. The current trial included patients with castration-sensitive disease with HRR mutations including BRCA1/2. Six hundred and ninety-six patients were randomized between niraparib, abiraterone, and prednisone plus androgen deprivation therapy, or the same combination with placebo instead of niraparib. Permitted prior therapies included no more than 6 months of prior androgen deprivation therapy and the use of docetaxel, or prior palliative radiation therapy. The primary endpoint of the study was radiographic relapse-free survival. Dr. Attard reported that the risk for radiographic progression-free survival in the whole population was significantly reduced by 37% with niraparib and abiraterone acetate plus prednisone compared with the placebo arm. The radiographic progression-free survival risk reduction with niraparib in the prespecified BRCA1/2 subgroup was 48% and reached statistical significance compared with the placebo arm. The secondary endpoint of time to symptomatic progression was also improved with niraparib in the HRR population and the BRCA1/2 subgroup. There was a trend for overall survival favoring the niraparib combination. However, the overall survival data were immature at this first interim analysis and did not yet reach statistical significance. No new safety concerns emerged with the toxicity data consistent with the MAGNITUDE study. Less than 5% more of the patients on the experimental arm discontinued treatment in comparison to the control arm. The authors conclude that the AMPLITUDE study results support the use of niraparib, abiraterone, and prednisone as a new treatment option for patients with metastatic castration- sensitive prostate cancer and BRCA and homologous recombination repair gene alterations. The results certainly support this conclusion and are potentially practice-changing. Turning to hematologic malignancies, my final selection from today's presentations is Abstract 7504, presented by Dr. Hang Quach from St Vincent's Hospital, Melbourne, Australia, and describes a novel combination of elranatamab, daratumumab, and lenalidomide in patients with newly diagnosed multiple myeloma who are not transplant-eligible – the so-called MagnetisMM-6 trial part 1. Elranatamab is a novel bispecific T-cell engaging antibody directed against BCMA and CD3, which has previously been approved for certain patients with relapsed and refractory multiple myeloma. In the present study, this was combined with lenalidomide and daratumumab in newly diagnosed patients. The report today describes the dose-finding phase of this study, which was part 1, specifically addressing so-called dose level ‘G', comprising elranatamab 76mg subcutaneously every 4 weeks plus daratumumab 1800mg subcutaneously and lenalidomide 25mg given orally. Thirty-seven patients were entered at this dose level, of whom 32 were on treatment at the time of analysis. Early response data show an overall response rate of 97.3%. With median follow up of 7.9 months, the current CR rate is 27% with a VGPR rate of almost 68%. The most frequent toxicities were hematologic, with neutropenia observed in 75%. Some cytokine release syndrome was observed in about 60% of patients, but none was greater than grade 2. The authors conclude that this combination is active in untreated multiple myeloma, with manageable toxicity and evidence of responses which appear to deepen over time. The dose-finding component of this trial is continuing and will subsequently progress into a phase 3 trial based on the data from the current study. This will compare daratumumab plus lenalidomide with the same combination plus elranatamab in previously untreated patients. That concludes our special coverage from the 2025 ASCO Annual Meeting. Thanks for listening and we hope you have enjoyed listening to our top takeaways from ASCO25. If you value the insights that you hear on the ASCO Daily News Podcast, please remember to rate, review, and subscribe wherever you get your podcasts. Disclaimer:  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, experience, 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.  Find out more about today's speaker:    Dr. John Sweetenham    Follow ASCO on social media:     @ASCO on Twitter    @ASCO on Bluesky    ASCO on Facebook    ASCO on LinkedIn     Disclosures:   Dr. John Sweetenham:    No relationships to disclose

Schriftlezing: Johannes 3 (vers 1 - 16) & DL artikel III/IV art 11 en 12 | Voorganger: G. M. Bijkerk | Datum: 25 mei 2025 | Tune: Gerben Budding

May 18, 2025

Chuck Quinn III and Chuck Quinn IV, a father and son duo, are performing together in Deerfield Theater's upcoming production of Our Town. They share their unique experiences of working together on stage, the deep bond it forms, and how their real-life relationship influences their portrayal of their characters in the play, and vice versa. They reflect on the significance of the play's themes of cherishing everyday moments, especially poignant after the pandemic. Both Chucks describe their journey in theater and offer insights into how performing arts have impacted their lives. They encourage audiences to see Our Town, highlighting its timeless message and the joy of live theater.Theater D Presents: Our TownPerformances at Caruso Auditorium, 1801 Montgomery Rd., Deerfield on:* Fridays, March 28, 4, and 11 at 7:30pm* Saturdays, March 29, April 5 and 12 at 7:30pm* Sundays, March 30, April 6 and 13 at 2:00pmDeerfield TheaterPurchase Tickets This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit deerfieldtheater.substack.com

Donate to support GG Podcast: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://ko-fi.com/jside⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Join the GG Discord! : ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://discord.gg/gsHTFJWewe⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Genshin Guys Twitter - @GenshinGuysPod  JSide Twitch - ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠http://twitch.tv/jside⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ JSide Twitter - @jsidegaming  Kahi Twitter & Youtube - @Kahiyao Episode 089 - In this episode, we can talk about our impressions of Natlan so far as well as the next two acts of the Archon Quest~! New community question:  Who did you bring to the fight? Send us your answer to the community question through either Discord or in the Spotify comments! BGM by 3AMAudio from Pixabay Original music by Yu-peng Chen and HoYo Mix. Voicelines by Hoyoverse.

This podcast is the audio version of the Gear Garage Live Show, where we answer submitted questions and talk all things whitewater. Topics and links that Zach talked about this episode River Hardware Answer Questions Some of the Questions that Zach covered in the Q&A section of this episode Topic: Illinois IK How low has the Illinois been run to your knowledge? I know Cronin and friends run it in the summer time but would like to get an idea of the CFS they/others have paddled. Is it still considered a 4+ river when the water is super low? Also, have you ever done the Deer Creek to Illinois section? Looks interesting. Thanks love the show. Topic: Boat Decals Rando question. What material do you guys use for the letters on your boat names to get them to stick so well? I wanted to add a name to our site raft and the best I could think of is a vinyl cut letters but don't know how well they will stay on. Thank you for the info Topic: PFD Help Hi - I'm hoping you can help me choose a life jacket. I do mostly class III-IV rivers, and occasionally a IV+ or V rapid. Because I'm not a great swimmer and because I have Parkinson's, I'd like a life jacket better than what guides typically provide. Should I buy a Type 1, Type 5, or something else?

* Psalm 86 * Proverbs 20:1–25 * John 17:1–26 * Augsburg Confession, III–IV

In this episode of the IJGC podcast, Editor-in-Chief Dr. Pedro Ramirez is joined by Dr. Domenica Lorusso to discuss the survival analysis of the PAOLA1 trial. Dr. Domenica Lorusso, MD, PhD, directs the Gynaecological Oncology Unit at Humanitas Hospital, Milan, and holds a Full Professorship in Obstetrics and Gynaecology at Humanitas University, Rozzano, Milan. She has led/participated in approximately 250 phase I-IV clinical trials. Currently overseeing more than 60 studies as Principal Investigator, Dr. Lorusso also chairs the Clinical Trials Committee of the MITO Group. She serves on the Board of Directors of the GCIG and is an active member of ENGOT, where she chairs the Gynecological Cancer Academy. Additionally, she sits on the Board of Directors of the ESGO. With around 300 international oncology publications and contributions to national and international treatment guidelines, her primary objectives are to ensure optimal patient care, foster clinical research, and advance international collaborations and education in the field.   Highlights: Bevacizumab plus olaparib has reported to increase PFS and OS in advanced stage III-IV, newly diagnosed, high grade serous and endometrioid HRD positive ovarian cancer in the maintenance setting  Exploratory analysis suggest that the advantage is particularly high in low risk patients (stage III withour residual tumor at primary surgery) where  a 5-year OS more  than 90% has been reported suggesting some of these patients may be cured In the HRp population the combination of olaparib-bevacizumab did non increase PFS and OS in comparison to bevacizumab alone The toxicity profile of the combination is in line with what expected with the single drugs

5-5-24 PM "Sovereignty in Salvation: Redemption Applied Pt. 2" Scripture Reading: John 3:1-2, Canons of Dort, III/IV.11, Forms & Prayers, 273 I. The Means of Regeneration A. The External Proclamation of the Gospel B. The Internal Operation of the Spirit II. The Effect of Regeneration A. Within the Soul B. Upon the Person III. The Result of Regeneration A. The Exercise of Faith B. The Attitude of Humility Rev. Greg Lubbers

4-28-24 PM "Sovereignty in Salvation: Redemption Applied Pt. 1" Sermon Text: Canons of Dort, III/IV.3 I. The Universal Corruption of Humanity A. The Object of the Universal Corruption B. The Cause of the Universal Corruption II. The Condemned Corruption of Humanity A. The Explanation of the Condemned Corruption B. The Reason for the Condemned Corruption III. The Paralyzing Corruption of Humanity A. The Description of the Paralyzing Condition B. The Remedy for the Paralyzing Condition Rev. Greg Lubbers

CME credits: 0.75 Valid until: 26-04-2025 Claim your CME credit at https://reachmd.com/programs/cme/what-dermatologists-surgeons-need-to-know-adjuvant-treatment-for-resectable-stage-iiiiv-melanoma/24380/ This educational initiative will enhance dermatologists' and surgeons' knowledge, clinical skills, and confidence in recognizing patients who may benefit from adjuvant systemic therapy and selecting individualized, appropriate agents to improve outcomes for patients with stage IIB-IV resectable melanoma.

Want access to more wisdom in time? Get access to over 1,500 +1's (just like this!) and 650+ Philosopher's Notes (distilling life-changing big ideas from the best self-development books ever written) and a LOT more with our Heroic Premium membership. Learn more and get 30 days free at https://heroic.us

Hoy continuamos con la carrera hacia el olimpo de los boxeadores con Rocky Balboa. En esta ocasión continuamos con las 3 secuelas que continuaron esta estelar saga, con sus altibajos. Para hablar de todo esto y mucho mas estamos por aqui Miguel Angel, Guillermo, David, Fer y el mamado. Esperamos que disfrutéis como siempre. Porque venimos de las estrellas!!! Mas enlaces de la guarida https://bio.link/laguaridadelsith

Francis's favorite nephews continue down the literary journey by reading some more of Mario Puzo's Godfather source material; books 2, 3 and 4 of the eponymous novel. Find out just what Johnny Fontaine was up to after Jack Woltz found a horse head in his bedsheets as well as life with Sonny as the Don.

“Beyond the Digest” episodes are bonus content to DermSurgery Digest, including reviews and commentary of interesting and relevant articles in dermatologic surgery literature. Articles featured in this episode include: McEvoy, A. M., Hippe, D. S., Lachance, K., Park, S., Cahill, K., Redman, M. W., Gooley, T., Kattan, M. W., & Nghiem, P. Merkel cell carcinoma recurrence risk estimation is improved by integrating factors beyond cancer stage: a multivariable model and web-based calculator. Journal of the American Academy of Dermatology 2023; 90(1), 208-210. https://doi.org/10.1016/j.jaad.2023.11.020 Alexander, N. A., Schaub, S. K., Goff, P. H., Hippe, D. S., Park, S. Y., Lachance, K., Bierma, M., Liao, J. J., Apisarnthanarax, S., Bhatia, S., Tseng, Y. D., Nghiem, P., & Parvathaneni, U. Increased risk of recurrence and disease-specific death following delayed postoperative radiation for Merkel cell carcinoma. Journal of the American Academy of Dermatology 2023; 90(2), 261–268. https://doi.org/10.1016/j.jaad.2023.07.1047 Lin, S. K., Deitermann, A., Haynes, D., Ricciardelli, K., Etzkorn, J. R., Miller, C. J., Higgins, H. W., Giordano, C. N., McMurray, S. L., Walker, J., Zhang, J., Nguyen, H. P., & Sobanko, J. F. Impact of time to surgical treatment in Merkel cell carcinoma: Surveillance, Epidemiology, and End Results–based population study. Journal of the American Academy of Dermatology 2023; 90(1), 208–210. https://doi.org/10.1016/j.jaad.2023.09.058 Massey, P. R., Wang, D. M., Murad, F., Mulvaney, P. M., Moore, K., Okhovat, J., Russell‐Goldman, E., Lin, W. M., Piris, A., Huilgol, S. C., Ruiz, E. S., & Schmults, C. D. Extensive Perineural Invasion vs Nerve Caliber to Assess Cutaneous Squamous Cell Carcinoma Prognosis. JAMA Dermatology 2023; 159(12), 1332. https://doi.org/10.1001/jamadermatol.2023.3703 Granger, E., Kim, E., Karn, E., Groover, M., Silk, A. W., Margalit, D. N., Tishler, R. B., Schoenfeld, J. D., & Ruiz, E. S. Definitive radiation therapy for inoperable stage III/IV cutaneous squamous cell carcinoma: A single-institution retrospective cohort study. Journal of the American Academy of Dermatology 2023; 90(1), 187–189. https://doi.org/10.1016/j.jaad.2023.09.030 Ahmady, S., Nelemans, P. J., Kelleners‐Smeets, N. W., Arits, A., De Rooij, M., Kessels, J. P. H. M., Essers, B. A., & Mosterd, K. Surgical excision versus topical 5% 5-fluorouracil and photodynamic therapy in treatment of Bowen's disease: A multicenter randomized controlled trial. Journal of the American Academy of Dermatology 2023; 90(1), 58–65. https://doi.org/10.1016/j.jaad.2023.08.076 Paver, E., Ahmed, T., Burke, H., Saw, R. P., Stretch, J. R., Spillane, A. J., Shannon, K. F., Vergara, I. A., Elder, D. E., Lo, S., Thompson, J. F., & Scolyer, R. A. Prognostic significance of incipient ulceration in primary cutaneous melanoma. JAMA Dermatology 2023; 159(12), 1359. https://doi.org/10.1001/jamadermatol.2023.4193 Kwapnoski, Z., Doost, M. S., Vy, M., & Eisen, D. B. Aesthetic outcome of intermediate closure versus intermediate closure followed by 2-octyl cyanoacrylate: A randomized evaluator-blinded split-wound comparative effectiveness trial. Journal of the American Academy of Dermatology 2023. https://doi.org/10.1016/j.jaad.2023.10.028 Groover, M., Gupta, N., Granger, E., Forrester, V. J., Anstadt, E. J., Su, W., Heusinkveld, L. E., Chen, A., Lukens, J. N., Silk, A. W., Vidimos, A. T., Schoenfeld, J. D., Koyfman, S. A., & Ruiz, E. S. A multicenter real-world analysis of risk factors, therapeutics, and outcomes of patients with metastatic basal cell carcinoma. Journal of the American Academy of Dermatology 2024; 90(3), 545–551. https://doi.org/10.1016/j.jaad.2023.10.060 “Beyond the Digest” contributors include Dermatologic Surgery Digital Content Editor Naomi Lawrence, MD; “Beyond the Digest” co-host Yesul Kim, MD; Ami Greene, MD; Tara Jennings, MD; Sydney Proffer, MD; Devina Mehta, MD; and Catherine Motosko, MD. Please contact communicationstaff@asds.net.

Daniel Gonzalez joins the Star Wars Historians as they cover episodes three and four entitled "Time to Fly" & "Fallen Jedi!" Make sure to share the podcast with your friends and leave us a review!

Continuing with our Saw marathon, we get unhinged while talking about the next three films. It's crazy they really made ten of these. Support the show***Patreon: https://www.patreon.com/IMNerdSend listener letters to: imnerdpodcast@gmail.comLinktree: https://linktr.ee/IMNerdPodcastThanks for listening!

Editor’s Choice Paper: Overall survival and patient-reported outcome results from the placebo-controlled randomized phase III IMagyn050/GOG 3015/ENGOT-OV39 trial of atezolizumab for newly diagnosed stage III/IV ovarian cancer Hosted by:Ursula Matulonis, MD, Associate Editor of Gynecologic OncologyFeaturing:Kathleen N. Moore, MD, GOG-F and Stephenson Cancer Center at the University of Oklahoma Health Sciences Center

How many door knobs are too many door knobs? How do you bring mixed successes into D&D? And are the players not concerned that they stumbled into an international incident? All that and more on the Afterparty!   Check out the Conversation Pit channel on our Patreon discord and keep sending in questions!   Dive into our ship combat mechanics, classes from Mage Hand Press, the countries of Verda Stello, and other changes we've made for C3 HERE!   Sponsors - Betterhelp, where you can get 10% off your first month at betterhelp.com/jointheparty - Ravensburger CreArt, a new paint-by-numbers experience! Shop on Amazon, their website, or your local art supply store. - Bodoni Designs, where you can use code jointheparty for 10% off your purchase at BodoniDesigns.Etsy.com   Find Us Online - website: jointhepartypod.com - patreon: patreon.com/jointhepartypod - twitter: twitter.com/jointhepartypod - facebook: facebook.com/jointhepartypod - instagram: instagram.com/jointhepartypod - tumblr: jointhepartypod.tumblr.com - merch & music: jointhepartypod.com/merch   Cast & Crew - Game Master, Co-Producer: Eric Silver - Co-Host (Umbi), Co-Producer, Sound Designer, Composer: Brandon Grugle - Co-Host (Chamomile Cassis), Co-Producer: Julia Schifini - Co-Host (Troy Riptide), Co-Producer: Amanda McLoughlin - Theme Song: Lyrics by Eric Silver, music by Brandon Grugle. Vocals by Brandon Grugle, Lauren Shippen, Julia Schifini, Roux Bedrosian, Eric Silver, Tyler Silver, and Amanda McLoughlin. Available for purchase here. - Artwork: Allyson Wakeman - Multitude: multitude.productions   About Us Join the Party is an actual play podcast with tangible worlds, genre-pushing storytelling, and collaborators who make each other laugh each week. We welcome everyone to the table, from longtime players to folks who've never touched a roleplaying game before. Hop into our current campaign, a pirate story set in a world of plant- and bug-folk, or marathon our completed stories with the Camp-Paign, a MOTW game set in a weird summer camp, Campaign 2 for a modern superhero game, and Campaign 1 for a high fantasy story. And once a month we release the Afterparty, where we answer your questions about the show and how we play the game. New episodes every Tuesday.

DISCLAIMER: This episode was recorded during the 2023 WGA and SAG-AFTRA strikes. Without the labor of the writers and actors currently on strike, the series being discussed here wouldn't exist. If you're willing and able, please consider supporting the writers and actors currently on strike through Entertainment Community Fund at: ⁠⁠⁠⁠https://secure2.convio.net/afa/site/Donation2?df_id=8117&8117.donation=form1&mfc_pref=T⁠⁠⁠⁠. For more information on the strike please consult either the WGA or SAG-AFTRA FAQs at ⁠⁠⁠⁠https://t.co/c0FbeUqghK⁠⁠⁠⁠ or ⁠⁠⁠⁠https://t.co/baYKIOtqkZ⁠⁠⁠⁠. • • • Welcome to Triad of the Force's AHSOKA Reviews! Join Nani, and Gus on their limited series, covering all things Ahsoka (and Rebels, and Clone Wars!). Today, ⁠⁠⁠⁠⁠⁠⁠the gang reviews and analyzes the first two episodes of Season 1 of AHSOKA: Parts III, IV, & V | Time to Fly, Fallen Jedi, and Shadow Warrior. • • • Triad of the Force is a channel which was featured on the Podcast Stage at Star Wars Celebration 2022 and 2023, featuring Nani and Gus, lifelong Puerto Rican friends who after years of discussing the media they love, came together and created their show. Triad of the Force focuses their discussions on Star Wars, but their love for media spans everything from sci-fi, fantasy, CBMs, and beyond. From films to TV, from books to comic books, Triad of the Force looks at all media critically, from a Latine/x perspective. Joins us! Follow Triad Of The Force at: Twitter: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://twitter.com/TriadOfTheForce⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Instagram: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.instagram.com/triadoftheforce/⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ YouTube: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.youtube.com/c/TriadoftheForce/⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ If you like us, get some merch and help the channel: TeePublic: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.teepublic.com/user/triad-of-the-force⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ • • • Acknowledgement: The Intro and Outro music is the Triad of the Force Theme, composed and performed by Grushkov with full permission for use by Grushkov (⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://linktr.ee/Grushkov⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠). • • • This channel is not affiliated in any way with Lucasfilm Ltd. LLC, The Walt Disney Company, or any of their affiliates or subsidiaries.

Wir kehren zur Prom Night Reihe zurück und besprechen für euch die Teil 3 bis 4. Während wir es im dritten Teil mit sehr viel Humor und wieder mit Mary Lou zu tun bekommen, lehrt uns in Deliver us from evil ein fieser Pastor das Fürchten. Ob die unterschiedlichen Rezepturen funktionieren? Findet es gemeinsam mit uns heraus!

Ya estamos de vuelta en esa otra galaxia que nos encanta, para disfrutar de las 4 ultimas películas de la tripulación original. Una despedida, llena de nostalgia y mucho fanservice, con algunas tramas muy divertidas y otras muy interesantes, pero para nada despreciables y que enriquecen la historia de la ciencia ficción. Para todo esto estamos hoy aqui Fran Prados, Guillem y Asier Huarte, aunque por estos lares se me conoce como El Mamado Lidel y desde mi puente de mando os advierto que vamos a despegar... Porque venimos de las estrellas!!! Mas enlaces de la guarida https://bio.link/laguaridadelsith

We pick back up with new best friends Gilgamesh and Endiku as they head out to best the best of the Cedar Forrest. Andrea, Brandon, and Matt discuss more connections to the Bible and other ancient mythology.Join the discussion on CIRCE Circle: https://circe.circle.so/c/overdue-classics/Send questions or comments to podcasts@circeinstitute.orgFind the books here: https://bookshop.org/lists/overdue-classics Hosted on Acast. See acast.com/privacy for more information.

Church of Jesus Christ Study Session seeks to generate reflection about areas in the Restored Gospel. Whether it's Come Follow Me, a General Conference talk or a recent Gospel Topic, hopefully you'll find something to keep the Spirit of Christ in your life. Twitter - @mattsroberts90 ldsstudysession@gmail.com You can also join the discussion in the Facebook Group 'Church of Jesus Christ Study Session with Come Follow Me'. You can purchase my book, From Father to Child: Raising a Child to Spiritual Strength in Generation Alpha at the link here: https://www.amazon.co.uk/Father-Child-Spiritual-Strength-Generation-ebook/dp/B08DRLWWZD/ref=mp_s_a_1_3?dchild=1&keywords=from+father+to+child&qid=1596387393&sr=8-3

Cornelius Boots is a woodwinding pioneer, composer and root philosopher. He is a nanotheist and elemental-nature lover. After a 30-year career of high-caliber jazz, classical, rock and experimental music activities (on multiple woodwinds with a focus on the bass clarinet), Boots has now positioned himself at the crossroads of personal expression and divine revelation, exclusively playing bamboo shakuhachi (jinashi/hotchiku) and its baritone brother, Taimu. He is the founder of Black Earth Shakuhachi School, and composes music for The Heavy Roots Shakuhachi Ensemble, the world's first bass shakuhachi group. (For bass clarinet and Edmund Welles-related information, go here.) In 2018, he was a World Shakuhachi Competition finalist and featured at Sony PlayStation's E3 (LA). Also in 2018, he performed at the World Bamboo Congress (Xalapa, Mexico) and the World Shakuhachi Festival (London). In 2019, Boots founded the Heavy Roots Shakuhachi Ensemble, debuting at SF Music Day. In 2020, the Boots received a Musical Grant Program Award from InterMusic SF to compose four movements of Wood Prophecy, a woodwind chamber saga for the Heavy Roots. The music video for his composition “Green Swampy Water” won Best Music Video in the Tokyo International Short Film Festival in January 2021. Cornelius is a sought-after composer, performer, and teacher. He is reshaping the landscape of modern shakuhachi performance and teaching through introducing a robust body of new compositions and a set of expressive signature techniques. Music from Today's episode by Cornelius Boots “Black Earth” from Sacred Root: Kung Fu Flute & Buddhist Blues (Shakuhachi Unleashed Vol. III) “IV. Dark Hallow” and “V. Wood Prophecy” from Wood Prophecy

Go online to PeerView.com/NHA860 to view the activity, download slides and practice aids, and complete the post-test to earn credit. Immunotherapy is now a highly efficacious management tool for melanoma, including in resectable stage III/IV disease, where its use is supported by phase 3 evidence and current practice guidelines. This “Clinical Consults” activity, taken from a recent surgical oncology live event, features expert-led case discussions that illustrate how to deliver effective care with established and emerging immune-based modalities in surgical settings. Linked mini lecture segments cover topics such as adjuvant immunotherapy in stage II/III melanoma; efficacy, safety, and dosing information on neoadjuvant immunotherapy; and emerging immune-based treatments in resectable melanoma (eg, PD-1/LAG-3 combinations). Watch today to learn how to identify optimal candidates for immunotherapy, address treatment selection and dosing considerations, and effectively manage immune-related events. Upon completion of this activity, participants should be better able to: State current evidence and guideline recommendations surrounding the use of adjuvant and neoadjuvant immunotherapy for resectable or potentially resectable melanoma, including stage II, III, and IV disease; Develop a treatment plan that includes adjuvant and neoadjuvant immunotherapeutic options for patients with resectable melanoma, including those with and without BRAF-mutant disease; and Implement strategies to mitigate immune-related adverse events in patients with melanoma who are receiving immunotherapy in conjunction with surgery.

Church of Jesus Christ Study Session seeks to generate reflection about areas in the Restored Gospel. Whether it's Come Follow Me, a General Conference talk or a recent Gospel Topic, hopefully you'll find something to keep the Spirit of Christ in your life. Twitter - @mattsroberts90 ldsstudysession@gmail.com You can also join the discussion in the Facebook Group 'Church of Jesus Christ Study Session with Come Follow Me'. You can purchase my book, From Father to Child: Raising a Child to Spiritual Strength in Generation Alpha at the link here: https://www.amazon.co.uk/Father-Child-Spiritual-Strength-Generation-ebook/dp/B08DRLWWZD/ref=mp_s_a_1_3?dchild=1&keywords=from+father+to+child&qid=1596387393&sr=8-3

To unlock the full episode, join the Frightday Society at http://thefrightdaysociety.org for access to this, and much, much more.   Folks...we've arrived. Another typical, mid-April end to a bracket-style competition. The best PG-13 horror film has been determined (with the help of a surprise tie-breaking guest), and all that's left...is to listen and find out.   Do you agree with our thoughts? What's the next bracket we should do?

In this episode of the IJGC podcast, Editor-in-Chief, Dr. Pedro Ramirez, is joined by Dr. David M. Gershenson to discuss updates on germ cell tumors. Dr. Gershenson is Professor and former Chair of the Department of Gynecologic Oncology and Reproductive Medicine at The University of Texas MD Anderson Cancer Center. His major focus is on the clinical and translational research or rare ovarian cancers. Highlights: - The treatment of malignant ovarian germ cell tumor has evolved over the last 5 decades to represent one of our most remarkable success stories, with cure in 95+% of patients with stage I/II and approximately 75% of patients with stage III/IV. - AGCT1531 is a very important trial, which, if positive, will reduce toxicity by extending surveillance to patients with stage IA or IB malignant ovarian germ cell tumors, including grade 2 and 3 immature teratomas, yolk sac tumors, and non-gestational choriocarcinomas and will result in the substitution of carboplatin for cisplatin in the regimen for treatment of stage IC-III. - Fertility-sparing surgery is possible in the majority of young patients with malignant ovarian germ cell tumor, related to the following: a) 95% are confined to one ovary ; b) approximately 2/3s are stage I; and c) most patients are in their teenage years, 20s, and 30s and have not completed childbearing. - Major controversies differentiating the treatment of children and adults by pediatric oncologists/pediatric surgeons and gynecologic oncologists, respectively, include the extent of surgical staging and the role of postoperative chemotherapy in patients with pure immature teratoma. - For patients with malignant ovarian germ cell tumors who recur following primary therapy, BEP is recommended for those who have been treated with surgery alone. For those who have previously received BEP, standard management generally includes high-dose chemotherapy with stem cell rescue. - Aspects of management of malignant ovarian germ cell tumors that require further study include the role of neoadjuvant chemotherapy and the role of secondary cytoreductive surgery.

Church of Jesus Christ Study Session seeks to generate reflection about areas in the Restored Gospel. Whether it's Come Follow Me, a General Conference talk or a recent Gospel Topic, hopefully you'll find something to keep the Spirit of Christ in your life. Twitter - @mattsroberts90 ldsstudysession@gmail.com You can also join the discussion in the Facebook Group 'Church of Jesus Christ Study Session with Come Follow Me'. You can purchase my book, From Father to Child: Raising a Child to Spiritual Strength in Generation Alpha at the link here: https://www.amazon.co.uk/Father-Child-Spiritual-Strength-Generation-ebook/dp/B08DRLWWZD/ref=mp_s_a_1_3?dchild=1&keywords=from+father+to+child&qid=1596387393&sr=8-3

Church of Jesus Christ Study Session seeks to generate reflection about areas in the Restored Gospel. Whether it's Come Follow Me, a General Conference talk or a recent Gospel Topic, hopefully you'll find something to keep the Spirit of Christ in your life. Twitter - @mattsroberts90 ldsstudysession@gmail.com You can also join the discussion in the Facebook Group 'Church of Jesus Christ Study Session with Come Follow Me'. You can purchase my book, From Father to Child: Raising a Child to Spiritual Strength in Generation Alpha at the link here: https://www.amazon.co.uk/Father-Child-Spiritual-Strength-Generation-ebook/dp/B08DRLWWZD/ref=mp_s_a_1_3?dchild=1&keywords=from+father+to+child&qid=1596387393&sr=8-3

An interview with Dr. William Tew from Memorial Sloan Kettering Cancer Center in New York, NY, lead author on "Poly(ADP-Ribose) Polymerase Inhibitors in the Management of Ovarian Cancer: ASCO Guideline Rapid Recommendation Update." Dr. Tew reviews changes to the recommendations for PARPi therapy for patients with epithelial ovarian cancer, and the outstanding questions in the field. For more information, visit www.asco.org/gynecologic-cancer-guidelines. TRANSCRIPT Brittany Harvey: Hello, and welcome to the ASCO Guidelines Podcast series, brought to you by the ASCO Podcast Network, a collection of nine programs covering a range of educational and scientific content, and offering enriching insight into the world of cancer care. You can find all the shows, including this one, at asco.org/podcasts.  My name is Brittany Harvey, and today, I'm interviewing Dr. William Tew from Memorial Sloan Kettering Cancer Center in New York, New York; lead author on “PARP Inhibitors in the Management of Ovarian Cancer, ASCO Guideline Rapid Recommendation Update.” Thank you for being here, Dr. Tew.  Dr. William Tew: Thank you, Brittany. Glad to be here.  Brittany Harvey: Great. Then first, I'd like to note that ASCO takes great care in the development of its guidelines and ensuring that the ASCO conflict of interest policy is followed for each guideline.  The full conflict of interest information for this guideline panel is available online with the publication of the guideline in the Journal of Clinical Oncology.  Dr. Tew, do you have any relevant disclosures that are directly related to this guideline topic?  Dr. William Tew: I do not.  Brittany Harvey: Thank you. Then let's get into the content of this rapid update. So, what prompted this rapid update to the ASCO Guideline on PARP inhibitor therapy in the management of ovarian cancer, which was previously published in 2020?  Dr. William Tew: Yeah, there's been rapid change in the use of PARP inhibitors over the last five years. We have seen marked improvements and patient outcomes with the use of PARP inhibitors in the maintenance setting and treatment settings.  And new data has developed specifically in the last three months that we felt it was really important to help our patients and their providers, give them the best and safest treatments with PARP inhibitors.  Brittany Harvey: Understood. So, then based off this new data that you mentioned, what are the updated recommendations from the expert panel?  Dr. William Tew: Well, there's a few. First, at ASCO 2022 in June, there was the ATHENA-MONO phase III randomized control trial that was presented and published looking at rucaparib monotherapy in patients with stage III-IV epithelial ovarian cancer who were in complete or partial response to platinum-based therapy and in remission. And then studies showed a significant improvement in progression-free survival.  And that's what first prompted the update of the guideline. We felt it was an important note that now, there are three PARP inhibitors that are approved and showing significant benefit in patients in the first remission setting. And those are olaparib, niraparib, and rucaparib.  And then as we were working on the guideline, there has been several updates provided primarily through Dear Doctor letters directed through the U.S. FDA, as well as different labeling changes that were made to different PARP inhibitors.  However, the changes that were made are in the settings outside of the first line setting. So, we are talking about patients who had recurrence of their ovarian cancer and where PARPs are being used either as treatment or as a maintenance strategy after completion of another round of platinum-based treatment.  Brittany Harvey: Understood. So, these sound like important updates to the recommendations. So, then what should clinicians know as they implement these updated recommendations?  Dr. William Tew: Well, I think first and foremost, PARP inhibitors are a really critical treatment strategy for our patients. And patients that benefit the most from PARP inhibitors are women with a germline or somatic mutation in the BRCA gene. These are the patients that are going to benefit the most.  And then I think where the confusion lies is how best to use PARP inhibitors in patients that don't have a BRCA mutation. These groups of patients kind of fall into different categories.  One, a group of patients that have what's called homologous repair deficiency, or those patients that don't have a BRCA gene or have a BRCA gene mutation, or have this HRD positive status.  The emerging data that has been presented is really focused on mostly these patients, this non-BRCA patient population. And again, I want to just be cautious here because this is all evolving data and I suspect further data is going to emerge over the coming months and years.  And we wanted to give some flexibility as far as how patients and their providers use PARP inhibitors, but we felt given that this new emerging data specifically with signals affecting survival, was important to outline to our community.  Brittany Harvey: Excellent. And then you've just touched on those who respond best to PARP inhibitor therapy, but how does this rapid update impact patients with epithelial ovarian cancer?  Dr. William Tew: Yeah, I think what we described and outlined in this updated guideline is that, one, as a general rule, PARP inhibitors are not particularly recommended in patients as a treatment.  That is, if patients have recurrence of their ovarian cancer, using PARP inhibitors as a treatment rather than a maintenance strategy does not offer significant benefit and may have some survival decrements. At least, this is the data that we are following.  And so, as a general recommendation, we're expressing caution in the use of PARP inhibitors in patients that have platinum sensitive recurrence as a treatment. And we are continuing to recommend (this was in the initial 2020 guideline) that PARP inhibitor monotherapy is not recommended for patients with platinum-resistant recurrent ovarian cancer or BRCA wild-type.  The other broad category is PARP inhibitor maintenance, and where we've made some adjustments in the guideline is as far as the strength and the overall recommendations of the use of PARP inhibitors after completion of platinum-based therapy in the recurrent setting.  And specifically, we're expressing caution and the use of PARP inhibitors, particularly for those that have BRCA wild-type, meaning they don't have a germline or somatic BRCA mutation, and expressing some caution in patients that are just homologous repair deficient score positive.  Brittany Harvey: Well, I appreciate you reviewing the updated data that the panel reviewed and what those new recommendations that you all made.  So, you just mentioned that further data may emerge over the coming days and years. So, what are the outstanding questions regarding PARPi therapy in the management of ovarian cancer?  Dr. William Tew: Well, I think a few things. One, the way PARP inhibitors have been developed was first in the recurrent setting as a treatment, then in the recurrent setting as a maintenance, and most recently, in the frontline treatment as maintenance therapy.  And what we're seeing as this data evolves is that PARP inhibitor has remain a very important treatment strategy in the first line maintenance group. And patients with BRCA mutations continue to have significant improvements and outcomes.  But what I think the data that we're following closely, is what about those patients that have recurrent ovarian cancer and where PARPs now are being used as treatment and maintenance — we're seeing that as a treatment, there may be harm, although, again, cautioned because of the data that is used. There's faults with how we look at this data.  But really, these subgroups of patients, specifically those patients without a positive HRD score or those patients without a BRCA mutation, is the benefit going to still outweigh the risk in the PARP inhibitor maintenance setting, particularly in the recurrent setting.  Brittany Harvey: Yes, those are important questions and I'm sure the panel will keep their eye on those to update the guideline further as needed.  So, I want to thank you so much for your work on this rapid update, and thank you for your time today, Dr. Tew.  Dr. William Tew: You're welcome.  Brittany: And thank you to all of our listeners for tuning into the ASCO Guidelines Podcast series. To read the full guideline, go to www.asco.org/gynecologic-cancer-guidelines.   You can also find many of our guidelines and interactive resources in the free ASCO Guidelines app available in iTunes or the Google Play Store.  If you have enjoyed what you've heard today, please rate and review the podcast, and be sure to subscribe so you never miss an episode.  Voiceover: 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, experience, 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.     

The following question refers to Section 6.2 of the 2021 ESC CV Prevention Guidelines. The question is asked by Dr. Christian Faaborg-Andersen, answered first by Houston Methodist medicine resident Dr. Najah Khan, and then by expert faculty Dr. Jaideep Patel. Dr. Patel recently graduated from Virginia Commonwealth University cardiology fellowship and is now a preventive cardiologist at the Johns Hopkins Hospital. The CardioNerds Decipher The Guidelines Series for the 2021 ESC CV Prevention Guidelines represents a collaboration with the ACC Prevention of CVD Section, the National Lipid Association, and Preventive Cardiovascular Nurses Association. Question #18 A 60-year-old Black woman with a history of hypertension and heart failure with reduced ejection fraction (EF 40%) presents to clinic for follow-up. She is currently doing well with NYHA class II symptoms. She is taking carvedilol 25 mg BID, sacubitril/valsartan 97/103 mg BID, and spironolactone 25 mg daily, all of which have been well tolerated. In clinic, her BP is 125/80 mmHg, and her HR is 55 bpm. Routine labs are within normal limits including Cr of 1.0, K of 4.0, and HbA1c of 6.0. What is the most appropriate next step in her management? A. No change in management B. Reduce beta blocker C. Add an SGLT2 inhibitor (dapagliflozin or empagliflozin) D. Add vericiguat E. Add hydralazine/isosorbide dinitrate Answer #18 The correct answer is C – Add an SGLT2 inhibitor (dapagliflozin or empagliflozin) For patients with symptomatic HFrEF, neurohormonal antagonists (ACEi, ARB, ARNI; BB; MRA) improve survival and reduce the risk of HF hospitalization. This patient is already on these agents. The addition of an SGLT2 inhibitor on top of neurohormonal blockade reduces the risk of CV death and worsening HF in patients with symptomatic HFrEF and is the next best step for this patient (Class I, LOE A). Vericiguat may be considered in patients with symptomatic HFrEF with HF worsening despite already being on maximally tolerated neurohormonal blockade (Class IIb, LOE B), but first-line therapies should be started first. Hydralazine/Isosorbide dinitrate should be considered in self-identified Black patients or people who have EF ≤ 35% or

The following question refers to Section 6.2 of the 2021 ESC CV Prevention Guidelines. The question is asked by Dr. Christian Faaborg-Andersen, answered first by Houston Methodist medicine resident Dr. Najah Khan, and then by expert faculty Dr. Jaideep Patel. Dr. Patel recently graduated from Virginia Commonwealth University cardiology fellowship and is now a preventive cardiologist at the Johns Hopkins Hospital. The CardioNerds Decipher The Guidelines Series for the 2021 ESC CV Prevention Guidelines represents a collaboration with the ACC Prevention of CVD Section, the National Lipid Association, and Preventive Cardiovascular Nurses Association. Question #18 A 60-year-old Black woman with a history of hypertension and heart failure with reduced ejection fraction (EF 40%) presents to clinic for follow-up. She is currently doing well with NYHA class II symptoms. She is taking carvedilol 25 mg BID, sacubitril/valsartan 97/103 mg BID, and spironolactone 25 mg daily, all of which have been well tolerated. In clinic, her BP is 125/80 mmHg, and her HR is 55 bpm. Routine labs are within normal limits including Cr of 1.0, K of 4.0, and HbA1c of 6.0. What is the most appropriate next step in her management? A. No change in management B. Reduce beta blocker C. Add an SGLT2 inhibitor (dapagliflozin or empagliflozin) D. Add vericiguat E. Add hydralazine/isosorbide dinitrate Answer #18 The correct answer is C – Add an SGLT2 inhibitor (dapagliflozin or empagliflozin) For patients with symptomatic HFrEF, neurohormonal antagonists (ACEi, ARB, ARNI; BB; MRA) improve survival and reduce the risk of HF hospitalization. This patient is already on these agents. The addition of an SGLT2 inhibitor on top of neurohormonal blockade reduces the risk of CV death and worsening HF in patients with symptomatic HFrEF and is the next best step for this patient (Class I, LOE A). Vericiguat may be considered in patients with symptomatic HFrEF with HF worsening despite already being on maximally tolerated neurohormonal blockade (Class IIb, LOE B), but first-line therapies should be started first. Hydralazine/Isosorbide dinitrate should be considered in self-identified Black patients or people who have EF ≤ 35% or

This time we read the final story from the first volume of the Grimms' fairy tales: The Fox and the Geese. A tale in which our trusty cunning fox may have taken on more than he bargained for... After the story things get mega foxy as we hear two other stories - that's right, two! - where things don't turn up entirely roses for Reynard: "The Hare And The Fox" by Ludwig Bechstein, and "Beasts In A Pit" collected by Alexander Afanasyev. And that's not all! We also take the time to reintroduce Reynard the Fox (the archetypal trickster fox of Medieval epics), including his incredible connection Disney's Robin Hood. And finally we unveil a new section of the show, "Fox News", where we hear some shocking Kitsune news fresh out of Japan.  Twitter Facebook Instagram Patreon   grimmreadingpodcast@gmail.com Theme music: Bicycle Waltz by Goodbye Kumiko Other Music: Robert Schumann's Scenes from Childhood, Op. 15 - III. Blind Man's Buff // Chopin's Cello Sonata in G Minor, Op. 65 - II. Scherzo // Beethoven's Piano Sonata No.28 in A Major, Op.101 - III & IV.