Podcasts about inr

Today, we are continuing our series, entitled Developer Chats - hearing from the large scale system builders themselves.In this episode, we are talking with Oleksandr Piekhota, Principal Software Engineer at Teaching Strategies. Oleksandr helps to show us at what point of scale platform approaches are required, when to run experiments and when to stop, and perhaps more importantly - engineering ownership beyond the code.QuestionsYou've moved from hands-on engineering into principal and technical leadership roles, working on architecture and platforms.At what point did you realize your work was no longer about individual features, but about the system as a wholeAcross several projects, growth didn't break functionality — it exposed architectural limits.Can you recall a moment when it became clear that shipping more features wouldn't solve the problem, and a platform approach was required?You've designed and supported APIs end-to-end, from architecture to real customers. How do you distinguish between an API that simply works and one that can truly support business scale?Internal systems like invoicing and HR workflows began as automation, but evolved into real products.What tells you that an internal tool is worth developing seriously rather than treating as a temporary workaround?In R&D, you explored CI/CD automation, server-less, and infrastructure experiments — not all reached production. How do you decide when an experiment should continue, and when it's no longer worth the engineering cost?You've hired teams, set standards, and shaped long-term technical direction. At what point does an engineer stop being a contributor and start owning business-level outcomes?You contributed to open-source tools that later became part of your company's infrastructure. Why do you see open source contributions as part of serious engineering work rather than a side activity?Looking across your projects, how do you now recognize a truly mature engineering system? Is it code quality, process, or how teams respond when things go wrong?If we look five to seven years into the future, which architectural assumptions we treat as “standard” today are most likely to turn out to be naive or limiting?SponsorsIncogniLinkshttps://www.linkedin.com/in/oleksandr-piekhota-b675ba53/https://teachingstrategies.com/Support this podcast at — https://redcircle.com/codestory/donationsAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Neurologic complications of hematologic disorders are frequently encountered in clinical practice and can involve both the central and peripheral nervous systems. Early recognition and appropriate management in collaboration with a hematologist are essential to reduce morbidity and mortality. In this episode, Kait Nevel, MD, speaks with Lauren Patrick, MD, and Mark Terrelonge, MD, MPH, authors of the article "Neurologic Complications of Hematologic Disorders" in the Continuum® February 2026 Neurology of Systemic Disease issue. Dr. Nevel is a Continuum® Audio interviewer and a neurologist and neuro-oncologist at Indiana University School of Medicine in Indianapolis, Indiana. Dr. Patrick is an assistant professor of neurology at the University of California, San Francisco, in San Francisco, California. Dr. Terrelonge is an associate professor of neurology at the University of California, San Francisco, in San Francisco, California. Additional Resources Read the article: Neurologic Complications of Hematologic Disorders Subscribe to Continuum®: shop.lww.com/Continuum Earn CME (available only to AAN members): continpub.com/AudioCME Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Host: @IUneurodocmom Full episode transcript available here Dr Nevel: Thick blood, thin blood. These are terms often used by patients and caregivers to describe some of the hematologic disorders that can lead to neurological diseases such as stroke. So, when should we consider a hematologic disorder as a potential cause for neurological conditions, such as stroke or neuropathy. Today I have the opportunity to interview Drs Lauren Patrick and Mark Terrelonge to learn more about neurologic complications of hematologic disorders in their recent article in Continuum. Dr Jones: This is Dr Lyell Jones, editor-in-chief of Continuum. Thank you for listening to Continuum Audio. Be sure to visit the links in the episode notes for information about earning CME, subscribing to the journal, and exclusive access to interviews not featured on the podcast. Dr Nevel: Hello, this is Dr Kate Nevel. Today I'm interviewing Drs Lauren Patrick and Mark Terrelonge about their article on neurologic complications of hematologic disorders. This article appears in the February 2026 Continuum issue on neurology of systemic disease. Welcome to the podcast, and please introduce yourself to the audience. Dr Patrick: Thank you for having us. We're both thrilled to be here. I'm Lauren Patrick, a vascular neurologist and assistant professor at the University of California, San Francisco, and program director for the Vascular Neurology Fellowship here. Dr Terrelonge: And I'm Mark Terrelonge, I'm an associate professor of neurology and neuromuscular medicine here at UCSF and one of the associate program directors for the adult neurology residency. Nice to meet you. Dr Nevel: Nice to meet you both. Really looking forward to getting into your article and learning more. So, to kind of kick us off, I always like to ask what do you think is the most important takeaway from your article for the practicing neurologist? And maybe since there are two of you and I suspect you covered slightly different aspects of this article, maybe you could give us two most important takeaways. Dr Patrick: Sure. I think the biggest takeaway is to keep hematologic disorders on the differential when evaluating patients with neurologic symptoms. Conditions like sickle cell disease, myeloproliferative neoplasms, or plasma cell dyscrasias and paraproteinemia can cause strokes or peripheral neuropathies, and many have specific and targetable treatments. The early recognition and collaboration with our hematology colleagues can truly change patient outcomes, whether that's by initiating cytoreductive therapy, managing thrombocytopenia, or optimizing antithrombotic therapy. Dr Nevel: Great. So, this is a really big and diverse topic. As always, I'm going to urge our listeners to read the article because there is a lot of really good stuff in your article that we just don't have time to get into during this interview today. But you cover a lot of different hematological disorders and how they can cause neurological complications. One of the major neurological complications of hematological disorders is cerebral vascular events. So, I'm hoping, Warren, that you can walk us through a little bit. When should we consider workup of potential hematologic disorder as a cause when we see a patient with ischemic stroke, because certainly not all patients with ischemic stroke should be getting a broad hematological disorder work up. So how can we kind of identify early on that there might be something else at play? Dr Patrick: Absolutely, great question. So, in many cases, the underlying hematologic disorder is already known, such as sickle cell disease or polycythemia vera. But sometimes stroke is the initial presentation or manifestation of the disease. So red flags can include young age, recurrent cryptogenic strokes or thrombosis, and unusual locations like the cerebral venous system. Laboratory clues such as unexplained erythrocytosis, thrombocytosis, thrombocytopenia, or hemolytic anemia should raise suspicion for an occult hematologic disorder. In the setting of acute illness, immune-mediated or heparin-induced thrombocytopenia or thrombotic microangiopathies should be suspected in patients that have hemorrhagic and or thrombotic complications, particularly when relevant lab disturbances are present. Acquired thrombophilia such as anti-phospholipid antibody syndrome should be considered in young patients with autoimmune disease, prior venous or arterial thrombotic complications, or pregnancy morbidity. Now, these are rare causes overall, but they're important to catch because the management can differ dramatically from our typical stroke care. Dr Nevel: Great. And what are some of the most common inherited or acquired thrombophilias and when should we be sending these labs? Dr Patrick: The hematologic causes really account for small minority of arterial strokes approximately one to two percent, but among those, sickle cell disease, anti-phospholipid antibody syndrome and the myeloproliferative neoplasms are the most common. Timing of testing is key. So, the genetic thrombophilia panels can be drawn at presentation, but lab values such as protein C, protein S, and antithrombin levels may be falsely low during acute thrombosis, so they're often repeated weeks later. Similarly, for anti-phospholipid antibody testing that should be done at presentation and when positive, confirmed at twelve weeks, since transient positivity can occur with affections or acute events. So, in patients that are already anticoagulated for anti-phospholipid antibody syndrome, testing becomes particularly tricky, especially with lupus anticoagulant assays. Some results need to be interpreted carefully or repeated when feasible. The main message is to collaborate early with our hematology colleagues to guide the timing and interpretation of these studies. Dr Nevel: Yeah, wonderful. Thank you. I'll ask some similar questions about neuropathy. So when should we consider an underlying hematologic disorder as being the cause for someone's neuropathy? Dr Terrelonge: So, luckily for a neurologist, then serum protein electrophoresis or an SPEP is already a part of the first pass evaluation for even the most common neuropathies we see, technically already considered every time we do an evaluation. However, we do know that most neuropathies progress very slowly and don't really lead to significant limitations in patient activities of daily living. And for those, the initial workup step, you may not need to do any additional search for any hematologic diseases after that first step. Within patients who start to have more unusual features with their neuropathy, including a rapid progression, early proximal weakness, significant and extremely painful neuropathies, significant ataxia, or new tremor or anything that's kind of outside of the garden variety neuropathy, then you should start to think about a hematologic cause. Additionally, if a patient already has a known hematologic malignancy or process before their neuropathy, there should be some form of assessment to see through exam or electrodiagnostically if the two are correlated. I do have to add one caveat, though, and that's just because someone has a hematologic malignancy or a paraprotein seen in their blood, their neuropathy and the neurologic syndrome don't necessarily have to be causally related. So, we have to do some additional testing to determine if the patient's presentation of the paraprotein are actually linked. Dr Nevel: Can you walk us through a little bit how we determine if they're associated or just coincidental? Dr Terrelonge: Yeah. So, for some of the proteins, there's a specific phenotype that will come with the specific protein. For example, an anti MAG proteinopathies or MAG standing for a myelin associated glycoprotein, it usually leads to a distal sensor and motor polyneuropathy where the most distal portions of nerves are affected. So, in that case, people might notice that they have numbness and weakness in their toes and their fingers, and it doesn't follow that typical length dependent pattern. So, in that case, if you have the anti mag neuropathy and the electrodiagnostic signature of an anti mag neuropathy along with the symptoms, you're more likely to think that the two are related then if not. Dr Nevel: Great. Thank you. And I was hoping you could speak a little bit more about amyloidosis just because I think that that's one that can be really tricky to diagnose. And I see patients, you know, have sometimes more drawn out evaluations or see multiple providers before a diagnosis is reached. So, can you speak a little bit more to how we diagnose amyloidosis in relationship to neuropathy or other neurological conditions and when we should push for more invasive testing like a nerve biopsy? Dr Terrelonge: So, amyloidosis certainly is a tricky diagnosis. I've been tricked by it and I think most of my neuromuscular colleagues have probably been tricked by it at least once. It's a hard diagnosis to make is it usually requires a pretty high index of suspicion, and also requires a tissue diagnosis to cinch. There're some patients who will come in with a prior history of amyloidosis and they're a little bit easier to figure out if the neuropathy is related. Maybe it's started in their heart or their kidney first and then you can just see if the type of amyloid they have usually deposits in nerve, and that may be enough. But if there's any diagnostic uncertainty, you could go forward with tissue biopsy. But it's patients in which the neuropathy is the first symptom that amyloidosis can be especially tricky to diagnose. It's a primarily light chain disease. So, if you do only an SPEP as a part of your initial neuropathy evaluation, you could miss it. But usually, the patients will have either a severely painful neuropathy, early autonomic dysfunction, or really prominent bilateral carpal tunnel syndrome. So, if they have any of those, usually we'll add in an amyloid workup as a part of that of the rest of the workup, which would include both light chain evaluations to see if there's any increase in Lambda or Kappa light chains and then also biopsy. Biopsy can be of the skin or fat pad first, which have reasonable sensitivity for picking up disease, but they're not necessarily a hundred percent. So if the suspicion remains high in those cases, a nerve biopsy should be considered. And the reason why this is important is that the chemotherapeutic agents that we have now can actually help arrest a lot of these diseases and stop further organ involvement. So, if you think about it, it is important to keep pushing and looking until you find it. Dr Nevel: Thank you so much for that. And a follow up question to that, once patients are started on appropriate therapy, the diagnosis is made, chemotherapy is started, what's the typical clinical course that you see in terms of their neuropathy? Do you ever see improvement or is it arrest of worsening? Dr Terrelonge: Usually for amyloid, there is an arrest of disease, but in some patients, they could have some improvement, not necessarily a dramatic improvement, but some patients could see some reversal of symptoms. That may not necessarily be because nerves injured nerves are regrowing, but because of reorganization of nerves to muscle, they could have some strength increases or at least less pain. Dr Nevel: Yeah, thank you. So, when should we involve a hematologist in aiding in the evaluation of patients we suspect may have an underlying hematological disorder? You guys really outlined very nicely in your article some of the laboratory workup or other workup like you just talked about with amyloidosis. But at what point in that workup should we reach out to our hematology colleagues? Dr Patrick: I would say almost always. So, these disorders are inherently multi-system and benefit from early co-management. In acute sickle cell stroke, for example, hematology helps direct emergent exchange transfusion. For myeloproliferative disorders they guide cyto reduction and long term antithrombotic strategy. And for antibody mediated or plasma cell disorders, hematology determines disease specific therapies. So, neurology may help with identifying the presentation, but the definitive management is almost always shared with our hematology colleagues. Dr Nevel: And as you both have mentioned that a lot of times in these cases, their hematologic disorder may be already known before they present with their neurological symptoms. So, I imagine obviously in those cases that a hematologist hopefully is already heavily involved in their care. What do you think is the most difficult aspect of identifying and diagnosing patients with neurologic illness as having an underlying hematological disorder? Dr Patrick: The hardest part is maintaining a high index of suspicion, especially since hematologic causes account for a very small minority of arterial strokes. Most strokes are from traditional vascular risk factors like you mentioned, or cardio embolism, so it's easy to stop diagnostic evaluation after standard studies have been performed. An example of a challenging case is a patient that's young, they've had recurrent cryptogenic stroke, and they could have antiphospholipid antibody syndrome, but it can be easy to miss if their antibody titers are borderline or if they're already anticoagulated, which would complicate retesting. So, it's about balancing the urge to over-test with recognizing the few cases where identifying A hematologic cause truly changes that management. Dr Terrelonge: And then on the neuropathy side, probably the hardest part is deciding what's causal and what's coincidence. Monoclonal gammopathy of unknown significance, or MGUS, is really common in older adults, so not every M-spike on an SPEP explains a neuropathy. And even sometimes there's times when the neurologic picture will develop a little bit faster than the hematologic one. So, it's hard to put the two together. Dr Nevel: Yeah. What's the most rewarding aspect of taking care of patients with complications from their hematologic disorders? Dr Patrick: It's deeply rewarding when a targeted diagnosis leads to a tangible improvement in that patient's care. For example, identifying A cryptogenic stroke is being due to myeloproliferative neoplasm or an inherited thrombophilia allows us to move from empiric treatment to possible disease specific strategy. It's really gratifying to give patients that clarity, to give them a diagnosis and in some cases prevent future events. Dr Terrelonge: Agreed. And even on the neuropathy side, almost all of the neuropathies that are hematologically related are treatable. So, it's so satisfying whenever you have a patient with say an anti-MAG neuropathy or Waldenström can start the patient on therapy, and you can see someone who's been having a progressive decline to stability and in those cases sometimes even significant recovery. Dr Nevel: Yeah, absolutely. Very rewarding when you can identify the problem and make it better. That's what it's all about. So, what are the future areas of research in this area? What do we still need to learn? Dr Patrick: There's still a lot to learn. I think we need better data on the safety of acute reperfusion therapy and antithrombotic agents, particularly in patients that are at dual risk for bleeding and thrombosis. Other examples, secondary prevention strategies and anti-phospholipid antibody syndrome. What's the best target INR? Do you add aspirin to warfarin or not? All of that is often left up to expert opinion. What's the best management for adults with sickle cell stroke? There are many open questions there. A lot of the protocols that we have in place for sickle cell patients that are adults as derived from pediatric literature and there's vast potential in terms of disease modifying therapies, especially in the fields of sickle cell disease and amyloidosis. And we'll need to reassess how those treatments may change neurologic outcomes. Dr Terrelonge: I think on the neuropathy side that having some form of new biomarkers to help us clearly know of the neuropathy and that hematologic illness are associated would be very helpful. On the treatment side, a lot of this is really being driven by the hematology space, but new therapies that treat hematologic plasma cell disorders, including some of the new BTK inhibitor, may be incorporated relatively soon into the algorithm for how we treat many of our patients. I'm excited to see what's to come from this. Dr Nevel: Wonderful. Thank you so much for sharing your knowledge with us today. I know I've certainly learned a lot by reading your article and through our discussion today. Highly encourage our listeners to read your wonderful article, which is a very thorough review of hematologic disorders and neurological complications. Again, today I've been interviewing Dr Lauren Patrick and Dr Mark Terrelonge on their article Neurologic Complications of Hematologic Disorders, which appears in the February 2026 Continuum issue on Neurology of Systemic Disease. Please be sure to check out Continuum Audio episodes from this and other issues. And as always, thank you so much to our listeners for joining today, and thank you so much to Lauren and Mark. Dr Terrelonge: Yeah, thank you so much for having us. Dr Patrick: Thank you so much for having us and for highlighting this topic. We hope the issue encourages clinicians to think broadly about hematologic causes of neurologic disease and to continue collaborating closely with our hematology colleagues. It's a complex but very fascinating intersection for both of our fields. Dr Monteith: This is Dr Teshamae Monteith, associate editor of Continuum Audio. If you've enjoyed this episode, you'll love the journal, which is full of in depth and clinically relevant information important for neurology practitioners. Use this link in the episode notes to learn more and subscribe. AAN members, you can get CME for listening to this interview by completing the evaluation at continpub.com/AudioCME. Thank you for listening to Continuum Audio.

In this episode of the RCP Medicine Podcast, transplant hepatologist Dr Mhairi Donnelly joins gastroenterology trainee Dr Jennifer Tham to explore the high‑stakes world of acute liver failure.Through a detailed case of a young woman presenting with severe transaminitis and paracetamol toxicity, Mhairi and Jennifer guide listeners through the crucial steps in recognising acute liver injury, identifying early markers of deterioration, and escalating care at the right time.The discussion covers the most common causes of acute liver failure in the UK, how to interpret markedly raised transaminases, the role of NAC beyond confirmed paracetamol toxicity, the importance of monitoring lactate and INR trends, management of hepatic encephalopathy in acute liver failure, and how psychiatric assessment influences transplant suitability. A must‑listen for anyone managing acutely unwell medical patients or seeking to deepen their understanding of this life‑threatening condition.RCP Links Education Events Membership Improving care Policy and campaigns RCP Social Media Instagram LinkedIn Facebook X Bluesky Music: Episode 50 onward - Bensound.com Episodes 1 - 49 'Impressive Deals' - Nicolai Heidlas

Bomo Slovenke in Slovenci spremenili varčevalne navade in prihrankov ne bomo kopičili le v bankah, ampak tudi na donosnejših finančnih trgih? Država nam z letošnjim marcem za ta namen ponuja individualne naložbene račune. Namenjeni bodo samo fizičnim osebam in bodo davčno prijaznejši od obstoječih trgovalnih računov. Kakšne so prednosti odprtja tako imenovanega INR, kolikšni bodo stroški, povezani s tem, zakaj ne bo mogoče nanje prenesti že pridobljenih vrednostnih papirjev? O vsem tem pa tudi o pomembnosti razvitega kapitalskega trga v tokratnem Studiu ob 17.00. Gostje: Nikolina Prah, državna sekretarka na finančnem ministrstvu; dr. Aljoša Valentinčič, Ekonomska fakulteta Univerze v Ljubljani; Mitja Tomažinčič, direktor investicijskega bančništva v NLB; Daniel Medved, direktor oddelka investicijskega bančništva v OTP.

Heidi setzt ihre Predigt von letzter Woche fort und stellt uns die Frage, wofür Jesus uns befreit hat.In Römer 7 lesen wir von Gesetz und Gnade.Rap by Marios Santoskiu-altona.de

#realconversations #ForeignService #Vietnam #Iran#SaudiArabia #SouthAmerica #Panama #Venezuela #Quebec #China CONVERSATIONS WITH CALVIN — WE THE SPECIESMeet RALPH MILTON BUCK: “Watch this. Introducing RalphMilton Buck. I felt like an eight-year-old walking down the steps on Christmasmorning to get that first glimpse of gifts wrapped by the tree and stockings.Anticipation. Thrill. Wonderment. That's a perfect description. Ralph justpublished ‘An American Diplomat: How it Happened.' The State Department clearedthis book for publication. He worked for nine different bureaus of the U.S.Department of State. A Foreign Service Officer for 33 years. Served in eightcountries and two wars and survived at least one revolution. THIS interview. Ralph was honest, brilliant, positive,eloquent, and thorough. During the pandemic, I watched Ken Burns' documentary‘The Vietnam War' three times. I lived in those days. Ralph began his servicein Vietnam in 1967, where he reviewed intelligence reports on the TetOffensive. Get the idea of thefascination of this interview?? More words about this interview. To induceviewing. Just words. Canada. Quebec Liberation Front. Paris Peace Agreement.Grenada. President Reagan. American Embassy in Iran, 1979. Saudi Arabia.Communist China in 1980. Panama and Canal Treaties. Bolivia. Columbia. Brazil.NAFTA. Venezuela in 2000. I said to Ralph. These places are current eventstoday, even this morning, as the President met with Colombia's President. Thewords above aptly capture my emotions during this interview with Ralph.Christmas morning again. What a gift. Ralph is a gift. Our time together is agift.” Calvin Hosted by Calvin Schwartz

Seit einem Jahr gibt es die elektronische Patientenakte (ePa). Seit etwa vier Monaten müssen Ärztinnen und Ärzte sie nutzen und sie mit den entsprechenden Daten befüllen. Allerdings gibt es viel Kritik daran, denn es gibt offenbar keine Ordnung oder eine Struktur innerhalb der e-Akte. Die Vorsitzende des rheinland-pfälzischen Hausärzteverbands, Barbara Römer, sagt im Gespräch mit SWR Aktuell-Moderator Andreas Böhnisch, dass die ePa eher ein digitaler Aktenschrank sei, in den alle Akten ohne Ordnung eingefügt würden. Der Zugang für Patientinnen und Patienten sei außerdem schwierig, was sich auch im Nutzungsverhalten zeige. In Römers Arztpraxis in Saulheim (im Landkreis Alzey-Worms) läge der Anteil der Patienten, die die ePa tatsächlich nutzen, im unteren einstelligen Prozentbereich. Die meisten wüssten nicht einmal, wie sie auf ihre e-Akte zugreifen könnten.

The global ship recycling market saw another shift in Week 7 of 2026 as key fundamentals moved in different directions across the sub-continent. The Baltic Dry Index declined by 0.6 percent, mainly due to weaker Capesize and Panamax performance, while Supramax rates improved. Oil prices held near USD 62.8 per barrel as markets continued to monitor U.S. and Iran tensions. In this week's episode, Ingrid and Henning discuss how the U.S. Dollar strengthened against most recycling nation currencies, with India being the exception as the Rupee improved to around INR 90.6. Steel plate prices reversed course in India, falling nearly USD 10 per ton, while Pakistan maintained the strongest fundamentals in the region with plate prices holding near USD 594 per ton. Bangladesh reached a political milestone as the BNP secured a more than two-thirds majority in the general elections. The result is expected to support long-delayed infrastructure projects and could improve domestic steel demand in the months ahead. The country also adopted the International Ready for Recycling Certificate framework, aligning with regional compliance requirements under the Hong Kong Convention. Steel plate prices in Bangladesh remained flat near USD 494 per ton, while the Taka weakened slightly. Pakistan continued to lead pricing tables, supported by firm steel levels, stable currency performance near PKR 279.6, and rising anchorage activity totaling nearly 30,000 LDT across multiple bulk carriers. India's anchorage activity also remained active with more than 47,000 LDT present, despite softer steel prices. Turkey remained quiet, with limited activity in Aliaga and the Lira weakening toward TRY 44. This episode covers demolition pricing direction, steel and currency movements, port activity in Alang, Chattogram, and Gadani, and the ongoing shortage of recycling candidates. The discussion is intended for shipowners, cash buyers, recyclers, brokers, and maritime professionals following developments in the global demolition market

Anticoagulation therapy can feel complex, but nurses play a vital role in keeping patients safe. In this episode, we break down the key differences between warfarin and direct oral anticoagulants (DOACs), including how they work, when they're used, and what makes each unique. You'll review important monitoring parameters like INR for warfarin, renal function considerations for DOACs, major drug and food interactions, and bleeding risk assessment. We'll also cover reversal strategies and practical patient education pearls. Whether you're preparing for exams or managing patients on anticoagulation, this episode will simplify the essentials and strengthen your confidence in safely caring for patients on warfarin and DOAC therapy. Your support helps me provide more free resources like this! Consider supporting and getting more amazing pharmacology content! Head on over to meded101.com/nurse

Please support this podcast by pressing the follow button and support Chinmaya Mission Mumbai projects taken up by Swami Swatmananda, through generous donations. Contribution by Indians in INR can be made online using this link: https://bit.ly/gdswatmanDonors outside India who would like to offer any Gurudakshina/donation can send an email to enquiry@chinmayamissionmumbai.com with a cc to sswatmananda@gmail.com to get further details.These podcasts @ChinmayaShivam are also available on Spotify, Apple iTunes, Apple Podcasts, Podomatic, Amazon music and Google PodcastFB page: https://www.facebook.com/ChinmayaShivampageInsta: https://instagram.com/chinmayashivam?igshid=1twbki0v3vomtTwitter: https://twitter.com/chinmayashivamBlog: https://notesnmusings.blogspot.comLinkedIN: www.linkedin.com/in/swatmananda

Individualni naložbeni računi (INR) prinašajo davčne ugodnosti za dolgoročne vlagatelje. Komu so namenjeni, kakšne so omejitve vplačil in kako deluje 15-letni davčni cikel? Pred mikrofonom: Nikolina Prah, državna sekretarka na ministrstvu za finance ______________________ Bootcamp za mlade Vse, kar mora vaš otrok vedeti o upravljanju denarja Termini: Ljubljana - 19. februar 2026 med 10.00 Info: https://money-how.si/dogodki/ ____________________________ KNJIGA: Mami, oči, ali smo mi bogati? Od žepnine do investiranja. Vodnik za starše, ki želijo razumeti upravljanje denarja in to znanje samozavestno prenesti na otroke. Tiskana knjiga https://money-how.si/knjiga/mami-oci-ali-smo-mi-bogati/ E-knjiga + bootcamp https://money-how.si/knjiga/mami-oci-ali-smo-mi-bogati-2/ ____________________________ Money-How Premium: https://money-how.si/narocnine/ vključuje: - Modri AI - Finančni asistent, ki pomaga pri raznih finančnih dilemah https://money-how.si/modri-ai/ - Taxistent - Davčni asistent, ki pomaga pri oddaji davčne napovedi https://money-how.si/taxistent/ (deluje za IBKR; Revolut, Trade Republic... in kombinacijo vseh) - poglobljene članke ____________________________ Bootcamp v živo: Investiranje – kako sploh začeti Že dolgo razmišljaš o vlaganju in ne veš, kje in kako začeti? Nimaš energije, da bi raziskoval vse podrobnosti. Skrbijo te davki? Presekaj in se nam pridruži v živo, kjer bomo skupaj naredili prvi korak v svet investiranja! Termini: Ljubljana - 19. marec 2026 med 17.00 in 20.30 Info: www.money-how.si/dogodki/ ______________________ Finančna delavnica je lahko čudovito darilo. Več preveri https://money-how.si/izobrazevanja ______________________ (delavnica) Investiranje v delnice: Kaj moram vedeti, ko se odločam za investiranje v delnice Prijava: https://money-how.si/izobrazevanja ______________________ (delavnica) Investiranje za začetnike. Praktično o osnovah investiranja. Prijava: https://money-how.si/izobrazevanja _________________________________ DISCORD skupnost: V finančnih zagatah nismo sami, pridružite se nam na Discord Money-How / discord ______________________________ Več o Money-How na https://money-how.si/

Please support this podcast by pressing the follow button and support Chinmaya Mission Mumbai projects taken up by Swami Swatmananda, through generous donations. Contribution by Indians in INR can be made online using this link: https://bit.ly/gdswatmanDonors outside India who would like to offer any Gurudakshina/donation can send an email to enquiry@chinmayamissionmumbai.com with a cc to sswatmananda@gmail.com to get further details.These podcasts @ChinmayaShivam are also available on Spotify, Apple iTunes, Apple Podcasts, Podomatic, Amazon music and Google PodcastFB page: https://www.facebook.com/ChinmayaShivampageInsta: https://instagram.com/chinmayashivam?igshid=1twbki0v3vomtTwitter: https://twitter.com/chinmayashivamBlog: https://notesnmusings.blogspot.comLinkedIN: www.linkedin.com/in/swatmananda

Please support this podcast by pressing the follow button and support Chinmaya Mission Mumbai projects taken up by Swami Swatmananda, through generous donations. Contribution by Indians in INR can be made online using this link: https://bit.ly/gdswatmanDonors outside India who would like to offer any Gurudakshina/donation can send an email to enquiry@chinmayamissionmumbai.com with a cc to sswatmananda@gmail.com to get further details.These podcasts @ChinmayaShivam are also available on Spotify, Apple iTunes, Apple Podcasts, Podomatic, Amazon music and Google PodcastFB page: https://www.facebook.com/ChinmayaShivampageInsta: https://instagram.com/chinmayashivam?igshid=1twbki0v3vomtTwitter: https://twitter.com/chinmayashivamBlog: https://notesnmusings.blogspot.comLinkedIN: www.linkedin.com/in/swatmananda

In "R is for Repentance," TJ and Tory go on an adventure to learn the difference between confession and repentance. They discover that true repentance is more than saying sorry—it means turning around, going the other way, and walking toward God in obedience.Follow along as TJ and Tory learn about the God's unchanging character week after week with the ABCs of Theology! Season 5 and 6 follow this best-selling card set, and we just know your kids are going to love them. Shop all discipleship tools for kids ages 2 to 12 at tinytheologians.shop, and join our email list to be among the first to know about sales, new releases, and get all the podcast updates right in your inbox!Resources: The ABCs of TheologyFollow Us:Instagram | Website | NewsletterEditing and support by The Good Podcast Co. Editing and support by The Good Podcast Co. Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

"Im Swimmingpool des einstigen Stummfilmstars Norma Desmond wird die Leiche des Drehbuchautors Joe Gillis gefunden. In Rückblenden erzählt Joe vom Jenseits aus die dramatischen Geschehnisse - von dem Tag an, als er sich auf der Flucht vor seinen Gläubigern auf das verfallende Anwesen der vergessenen Diva verirrte. Aufgrund seiner Geldsorgen nimmt er ihr Angebot an, ein von ihr geschriebenes Drehbuch zu bearbeiten, von dem sie sich ein großartiges Leinwand-Comeback erhofft."

Kiera is joined by the tooth-healer himself, Jason Dent! Jason has an extensive background in pharmacy, and shares with Kiera where his pharmaceutical experience has bled over into dentistry. This includes the difference between anti-quag and anti-platelet and which medications are probably safe, what to do to shorten the drag time in the pharmacy, how to write prescriptions most efficiently, and more. Episode resources: Subscribe to The Dental A-Team podcast Schedule a Practice Assessment Leave us a review Transcript: The Dental A Team (00:00) Hello, Dental A Team listeners. This is Kiera and today is a really awesome and unique day. It is, think the second time I've had somebody in the podcast studio with me live for a podcast and it's the one and only Jason Dent. Jason, how are you? I'm doing well. Good morning. Thanks for having me. It is crazy. I I watch Instagram real like this all the time where people are like in the podcast and they're hanging out on two chairs and couches and now look at us. We're doing it. Cheers. Cheers.   That was a mic cheer for those of you who are only listening, but yeah, Jace, how does this feel to be on the podcast? It's weird. Like I was not nervous at all talking about it. I got really nervous as soon as you hit play. So if I stumble over my words, please forgive me ahead of time. Well, Jason, I appreciate you being on the podcast because marketing had asked me to do a topic about teledentistry and I was like, oh shoot, that's like not my forte at all. so   You and I were actually chatting in the hot tub. call it Think Tank session and you and I, we have a lot of good ideas that come from that Think Tank. A lot of business. no phones. That's why. We do leave our phones out. But I was talking to Jason and this is actually a podcast we had talked about quite a while ago. Jason has a lot of information on pharmacy. And if you don't know, Jason isn't really, we were going through all of it last night. It's kind of a mock in the tub. And I think it's going to be great because I feel like this is an area, I'm working at Midwestern and   knowing about how dentists, pharmacology was surely not your favorite one. Jason actually helps a lot of dentists with their clearances. And so we were talking about it and I like it will just be a really awesome podcast for you guys to brush up on pharmacology, different things from a pharmacist's side. So Jason, welcome. Thank you. Yeah, no, we were talking about it and here's like, what should I talk about on the podcast next? I have all these different topics and she's like, what do you know? And the only real interaction I have with dentists is doing clearances for procedures. We get them all the time, which makes sense.   Lots of people are on blood thinner, I've always told Kiera, like, hey, I could talk about that. Like, that's kind of a passion of mine. I'm not a dentist. Or my name is Jason Dent. So in Hebrew, Jason means tooth. No, no, no, sorry. Nerves are getting to me. Jason means healer and Dent means tooth. So my name means tooth healer. So, here's a little set. Hold on, on, hold Can we just talk about? I brought that up before you could talk about it more. So.   My name means tooth healer but I did not become a dentist. I know you wanted me to become a dentist. did. I don't know why. I enjoy medicine. I know what you're going to get to already. The things you're going to ask me. There's been years of this. But nevertheless, that's my name. We'll get that out of the way. But you did give me a great last name. So I mean, it's OK. You're All is fair and love here. SEO's up for that. But yeah, Jason, I'm going to get you right into the show. And I'm going to be the host. And we're going to welcome to the podcast show. Jace, how are you?   Good, good, good. Good, good, good. So by getting into clearances, right? This is what you're kinda talking about with you know, before we get to clearances, I actually wanted Jason, for the listeners who don't know you, who haven't talked to you, who don't know, let's kinda just give them like, how did you go from, Kiera wanted you to be a dentist, to now Jason, you are on the podcast talking as our expert on pharmacy. fantastic. I've always really loved medicine, a ton. As a kid getting headaches and taking Excedrin, like you just feel like a miserable pile of crap.   and then you take two pills and all of a sudden you feel better. Like that's amazing, like how does that happen? Also getting ear aches as a kid, just being in so much pain and then taking some medicine and you start feeling a lot better. I always had a lot of appreciation for that. I've always been mechanically inclined. I went to, started doing my undergrad and took biology and learned about ATP synthase, which is a spinning enzyme that's inside the mitochondria, like a turbine engine. I used to work on small engines on my dirt bike and thought that is so cool. So I really got wrapped up into chemistry.   All the mechanics of chemistry really pulled me in. I'm not getting goosebumps. checking. I usually get goosebumps when I think about chemistry. But it's so cool. You think an engine's awesome, like pistons and camshafts and pressures, the cell is the same thing. It's not as loud, so it's not as cool. But it's fascinating. that's why we're like. ⁓   chemistry and really got into coagulation. So I did my residency after pharmacy school. we went to Arizona for three years. ⁓ You did and your main focus, you were never wanting to be the guy behind the counter. No, I haven't done that. Yeah. No, I love them though. I've always really want to go clinical. ⁓ But I love my retail ⁓ pharmacists. They're amazing resources. And ⁓ I use the retail pharmacist every day still to this day, but I went more the clinical route, really love the chemistry aspect of it.   did my doctorate degree and then I did my residency in Reno. Reno's kind That's how we got here everybody. Welcome to Reno. Strategically placed because I was really interested in critical medicine and where we're located we cover a huge area. So we pull in to almost clear, we go clear to Utah, clear to California, all of Northern Nevada. We get cases from all over. So we actually are kind like the first hub of care for lot of areas. So we really get an eclectic mixture of patients that come in that need-   all kinds of different cases that are coming to them. So it's what I really wanted. So I did my residency in critical care there. And then for the next 10 years, I worked in vascular medicine with my final five years being the supervisor of the clinic. Ran all the ins and outs of that. So my providers, two doctors were on our view. So when we talk about dentistry, talk about production, those kinds of things, totally get it. My doctors were the exact same way, my vascular providers. ⁓   There's some pains there, right? You wanna be seeing patients as much as possible, being able to help as many people, keeping the billing up. And had other nurse practitioners, four practitioners, a fleet of MAs, eight pharmacists. We also had that one location we had, going off the top of my head, I think we had eight locations running as well. And we took care of all the different kinds of vascular cases that came to us. Most common was blood clots, ⁓ which is just a...   which is an easier way of saying VTE. There's so many different ways to say a blood clot. Like you might hear patients say, I've had a PE or a DVT or a venous thromboembolism or a clot in my leg, right? They're all clots, but in different locations. Same with an MI, and MI can be a clot as well. ⁓ there's a lot of, everybody's kind of saying the same thing, but sometimes the nomenclature can make it sound hard, but it really is actually pretty simple.   No. And Jason, I love that you went through, you've been in like, and even in your, ⁓ when you were getting your doctorate, you were in the ER. You also worked in retail pharmacy. remember you having a little sticker on your hand. And retail pharmacy, I have a lot of respect for those guys. They have a lot of pressure on them. and then you also, ⁓ what was that test that you had to take that? I don't know. You were like studying forever for it. ⁓ board certification for, ⁓ NABP. Yeah. So I did that board certification as well.   And now you've moved out of the hospital side onto another section in your career. Now in the insurance, right? So it's really, really interesting. So now I'm on the other side reading notes and evaluating clinical appropriateness and trying to help patients with getting coverage and making those kinds of determinations. So yeah, I've really jumped all over. Really love my clinical days. I know. don't I don't I do miss them. But yeah, kind of had a good exposure to a lot of.   pharmacy a lot a lot of dentists actually with all the places that come through which Jason I really appreciate that and honestly I know you are my spouse and so it's fun to have you on but when I go into conversations like this I don't know any of this information and so finding experts and Jason I think here's me talk more about dentistry and my business than I do hear about him on pharmacy so as we were chatting about this I really realized you are a wealth of knowledge because you've been on the clinical side so you've done a lot of patient care and you've seen how   medications interact and I know you've had a few scares in your career and ⁓ you've known some physicians that have had a few scares and ⁓ you've seen plenty of patients pass away working in the ER and gosh in Arizona drownings were such a big deal. I remember when you were in the ER on your rotations I'd be like who died today? Like tell me the stories and you've really seen and now going on to the insurance side I felt like you could just be such a good wealth of knowledge because I know dentists are sometimes so   I would say like maybe just a little more anxious when it comes to medications. I know that dental students from Midwestern were like here was like four months and we had to like pass it, learn it. And Jason, you've done four years plus clinical residency, plus you've been in it. And something I really love about Nevada Medicine is they've been so collaborative with you.   like your heart, your cardiologist, they diagnose and then they send to you to treat with medicine and... Yeah, I've been really lucky being here in Reno too. The cardiology team has been amazing to work with. We started a CHF program, sorry, congestive heart failure program for patients. So we would collaborate with cardiologists. They'd see the cardiologists and then they send them to the pharmacist to really manage all the medications. So there's pillars of therapy ⁓ called guideline directed medical therapy and the pharmacist would take care of all that. So that's gonna be your...   your beta blockers, your ACEs, your ARBs, your Entresto, which would be a little bit better, spironolactone. So just making sure that all these things are dosed appropriately, really monitoring the heart, and make sure that patients are getting better. we've had real positive outcomes when the, sorry, this is totally off topic. do, talk about that study. When we looked at when patients were coming to see our pharmacists in our clinic that we started up, the patients were half as likely to be readmitted. And this was in 2018, and our pharmacists,   We're thinking about all the medications. We're usually adjusting diabetes medications too at the same time. Just kind of naturally just taking care of all the medications because we kind of got a go ahead from the providers, a collaborative practice agreement that we could make adjustments to certain medications within certain parameters. So we weren't going rogue or maverick, but we were definitely trying to optimize our medications as much as possible. And then years later, some studies came out with, I'm sure you've seen Jardins and Farseegh. not trying to, I'm not.   I don't get any kickback from them. I have no conflicts to share. But because our pharmacists were really optimizing that medication, those medications were later shown to reduce hospitalizations and heart failure, even though they're diabetes medications. Fascinating. So it wasn't really the pharmacists. It was just the pharmacists doing as much as they can with all the tools that were in front of them. And then we found out that the patients were going back to the hospital.   half as much as regular patients. So, yeah, being here, it's been so amazing to work with providers here. the providers here want help, want to help patients, don't have an ego. I mean, I just, it's awesome. I love it. I do love how much I think Jason sees me geek out about dentistry and I watching Jay's geek about his pharmacy and how much he loves helping patients. And ⁓ really that was the whole idea of, all right.   Dentistry has pharmacy as a part of it. And I know a lot of dentists are sending in clearances and I know working in a chair side, it would be like, oh no, if they're on warfarin or on their own blood clot, you guys, honestly don't even know half of what I'm talking about because this is not my jam, which is why Jason's here. But I do know that there was always like, well, we got to talk with their provider. And so having Jason come in and just kind of explain being the pharmacist that is approving or denying or saying yes or no to take them off the blood thinners in different parts, because you have seen several dental   I don't know what they're called. What is it? Clarence's? that what comes to you? don't even know. All day my mind, it's like, here is the piece of paper that gets mailed to you to the pharmacist and then you mail it back. So whatever that is. But Chase, let's talk about it because I think you can give the dentist a lot of confidence coming from a pharmacist. What you guys see on that side. When do you actually need to approve or disapprove? Let's kind of dig into that. Yeah. Well, first of all, I think I'm not a replacement for any kind of clinical judgment whatsoever. Every patient's different. But the American Diabetes Association, you   I work with diabetes a lot. American Dental Association has some really great guidelines on blood thinners and I would always reference them. I actually looked at their website today. Make sure I'm up to speed before I get back on this again. They have resources all around making decisions for blood thinners. And I think the one real important thing in putting myself in the shoes of a dentist or any kind of staff that's around a patient that's in a chair, if they say I'm on a blood thinner, right, a flag goes up. At least in my mind, that's what goes up.   Like, okay, how do we get across this bridge? And I think the important thing to really distinct right then when they say they're on a blood thinner is that is kind of a slang word for a lot of different medications, right? Like it's the overarching word that everybody pulls up saying, I'm on a blood thinner. It's like, okay, but I don't know what say. It's like, I have a car. You're like, okay, do you have a Mazda? Do you have?   Toyota, Honda, what do you have? or even worse it'd be like saying I have a vehicle, right? So when somebody says they're on a blood thinner, it opens up a whole box of possibilities of what they're Blood thinners are also, doesn't, when they're taking these types of medications that are quote unquote a blood thinner, it doesn't actually thin the blood, like adding water to the blood, if that makes sense, or like thinning paint, or like thinning out a gravy, right? It doesn't do the same thing. Blood thinners, really what they're doing is they're working on the blood, which.   which is really cool, try not to tangent on that. ⁓ When they're working on the blood, it's not thinning it per se, but it's making it so that the proteins or platelets that are in it can't stick together and make a cloth quite as easy. So whenever somebody's on a blood thinner, I usually ask, what's the name of the blood thinner that you're on? It's not bad that they use that slang, that's okay, on the same page, but it's really broken into two different classes. There's anticoagulant and antiplatelet.   And a way to kind of remember which is which, when residents would come through our clinics, the way that I teach them is a clot is like a brick wall. You know, it's not always a brick wall. Usually the blood is a liquid going through. But once they receive some kind of chemical message, it starts making a brick wall with the mortar, which is the concrete between the and the bricks, the two parts. When it's an anti-quagent, it's working on that mortar part. When it's an anti-platelet, it's working on the bricks part, right? You need both to make a strong clot or strong brick wall.   But if you can make one of them not work, obviously like if your mortar is just water, it's not working, right? You're not gonna make a strong brick wall. So that's kind of the two deviants right there. So that's what I do in my mind real quickly to find out because antiplatelets are usually, so that's gonna be like your Plavix, Ticagrelor, Brilinta. And hold on, antiplatelets are bricks? Good job, bricks. They're the bricks. And so the reason I was thinking you could remember this because I'm, antiplatelets, it's a plate and a plate is more like a brick.   And anti coagulant, I don't know why quag feels like mortar to me, like quag, like, know, it's like slushy in the blood, like it's coagulating. It's a little bit of that, like, honestly, I'm just thinking like coagulated blood is a little bit more mortar-ish. And so platelet is your plate, like a brick, and anti-quag is like.   the gilly between the bricks. Okay, okay, I got it. Yeah, so there's an exception to every rule, but when they're on that Don't worry, this is Kiera, just like very basic. You guys are way smarter listening to this, and that's why Jason's here. No, no, you helped me pass pharmacy school. When we were doing all the top 200, you helped me memorize all know what flexorill is, all right? That's a muscle relaxant. Cyclo? I don't know that part. It's a cyclo, because you guys are cycling and flexing. I don't actually know. just know it's a muscle relaxant, so that's about as far as I got. When we're looking at antitick platelets, so that's the brick part, so that's going to be your, you know,   Hecagrelor, Breitlingta, Clopidogrel is the most common one. It's the cheapest one, so probably see that one the most. Those, I mean, there's an exception to every rule, but that's generally being used after like a stent's placed in the heart. It can be used for VTE, there's some out there, but that's pretty rare. But also for some valves that are placed in the hearts, it can be used for that as well. So antiplatelet, really thinking more like a cardiac event, right? Like I said, there's always an exception to every rule, but that's kind of where my mind goes real quickly, because we're gathering information from the patient.   They're on anticoagulant. Those are like going to be the new ones that you see commercials for all the time. So Xeralto, Alequis, those are the two big ones right now. They're replacing the older one. And also we were supposed to do a disclaimer of this is current as of today because the ADA guidelines do change. this will be current as of today. And Jason, as a pharmacist, is always looking up on that. I had no clue that you are that up to speed on dental knowledge. so just throwing it out there that if you happen to catch his podcast,   a few years back that obviously check those guidelines for sure. But the new ones are the Xarelto and Eloquist. They're replacing the older ones of warfarin. Warfarin's been around for a really long time. We've seen that one. Those are anti-coagulants. So when you're looking, when a patient says that, generally they're on that medication because they've possibly had a clot in the past or they have a heart condition called atrial fibrillation. Those are kind of the two big ones. Like I said, there's always caveats to it, but that's kind of where my mind goes real quickly. And then,   as far as getting patients cleared, the American Dental Association has really good resources on their website. You can look at those and they're always refreshing that up. They even say in their own words that there's limited data around studying patients in the dental chair and with anticoagulants or anti-platelets. It's pretty limited. There's a few studies, some from 2015, some from 2018. There's one as recent as 2021, which is nice. But really, all of those studies come together and it's really more of an expert consensus.   And with that expert consensus, they have kind of simplified things for dentistry, which is really nice. ⁓ comparing that to, we have more data for like total hip replacement, total knee replacement. We have a lot of data and we know really what we should be doing around then. But going back to dentistry, we don't have as much information, so they always say use clinical judgment, but they do give some really great expert guidance on that. So if a patient's on an anticoagulant, ⁓   they generally recommend that it doesn't need to be stopped unless there's a high bleeding risk for a patient. as a provider or as a clinician in the practice, you can be looking at high bleeding risk. Some things that make an oral procedure a little bit lower risk is one, it's in the compressible site, right? Like we can actually put pressure on that site. That's the number one way to stop bleeding is adding pressure. It's not like it's in the abdominal cavity where we can't get in and can't apply pressure. So number one, that kind of reduces the bleeding risk.   is number one. Two, we can add topical hemostatic agents. Dentists would know that better than me. There's a lot of topical ways to do that. So not only pressure, but there's those things as well. And also, but there are some procedures that are a little bit more likely to bleed. And that's where you and dentists would come in hand in What's the word in APO? Oh, the APOectomy. I got it right. Good job. like, didn't you tell me last night that the ADA guideline was like what?   three or four or more teeth? great question. So you can extract one to three teeth is what their expert consensus One to three teeth without. Without really managing or stopping anticoagulation or doing anything like that. I think that's some good guidance from them. I'm gonna add a Jasonism on that though. So with warfarin, I do see why dentists would be a little bit more conservative or worried about stopping the warfarin because warfarin isn't as stable as these newer agents. Warfarin, the levels.   quote unquote levels can go really high, they can go really low. And if the warfarin levels are high, they're more likely to bleed. So I do think it makes sense to have a really recent INR. That's how we measure what the warfarin's doing. I think that makes a lot of sense, but the ADA guidelines really go into the simplification version of all these blood thinners. Generally, it's recommended to not stop them because the risk of stopping them outweighs the benefit of stopping them in almost every case. Almost every case.   ⁓ So when you're with that patient, right, they say I'm on a blood thinner, finding out which kind of blood thinner that they're on, you find out that they're on Xeralto, right? How long have you been on Xeralto for? I've been on it for years. You don't know exactly why, but if they haven't had any recent bleeding, you're only gonna remove one tooth. ⁓ You can do what's called a HasBlood score. That kind of looks at the bleeding risk that they'd have. That'd be kind of going a notch above, but in my mind, removing one tooth isn't a real serious bleeding risk. I'd love to hear from my dentist friends if they...   disagree, right, but ADA says one to three tooth removals, extractions, that's the fancy word. Extractions, yeah, for extracting teeth out. Is not really that invasive. Sure. It's not that high risk, so it's usually perfectly fine. So if a patient was on Xarelto, ⁓ no other, this is in a vacuum, right? I'm not looking at any other factors, which you should be looking at other factors. I would be perfectly fine to just remove one to two.   And when those clearances come in, because dentists do send them, talk about what happens. You guys were working in the hospital and you guys would get these clearances all the time. do. We get them so often. I mean, we get like four or five a day. We'd love to give it to our students, student pharmacists, and ask them what to do. And they would usually look up the American Dental Association guidelines and come up with something. We're like, yep, that's what we say too. In fact, we say it so many times a day that we have a smart phrase.   which just blows in the information real quickly and faxes it right back to the So it's like a copy paste real quick. So what I wanted to point out when Jason told me this is dentists like hearing this and learning this, this can actually save you guys a ton of time to be able to be more confident, to not need to send those clearances on. And we were actually talking last night about how I think this might be a CYA for dentists. like, as we were talking, I think Jason, you seeing so many other aspects of medicine, like you've literally seen patients die, you've seen other areas.   And so coming from that clinical vantage point, we were realizing that dentists, we are so blessed to live in an injury. I enjoy dentistry because possibly there's someone dying, not super high, luckily in dentistry. The only time that I have actually had a doctor have a patient pass away, and it was only when they were completely sedated and doing ⁓ some other things, but that was under the care of an anesthesiologist. And so that's really our high, high risk. And so hearing this, Jason,   That was one of the reasons I wanted him to come on is to give you doctors more confidence of do we have to always send to a pharmacist? I mean, hearing that on the pharmacy side, they're just sending these back and not to say to not see why a to not cover this because you might be questioning like, well, do I really need to? But you also were talking about some other ways of so number one, you guys are just going to copy back the 88 guidelines. So so 88 guidelines. Yeah. And I think that that gives a lot of confidence to a provider or a dentist is that you can go to the 88 guidelines and read them, right? Like you're listening to some   nasally monotone pharmacist on a podcast. Rumor has it, people love him at the hospital. were like, you're the voice, he's been told he has a good radio So for the clinic, I was the voice. Like, yeah, you've reached the vascular clinic, right? And they're like, oh my gosh, you're the voice. But sorry, you me distracted. That'll be your next career, Jace. You're going to be a radio host. OK. I would love that. I love music. But you're hearing from a nasally guy, but you can actually read the ADA guidelines. You just go right to the ADA, click on Resources, and under Resources, it has the   around anticoagulants, I think that's the best way to get a lot of confidence about it because they have dentists who are the experts making calls on these. I'm just reiterating what they say, but I think it makes a lot of sense to help providers. And the reason why my heart goes out to you as well is having the providers that used to work underneath me, they're always looking for our views, which is a fancy way of making sure that they're drilling and filling. Can I say that? Yeah, can say drilling and filling. They're being productive, right? They're being productive, right?   They're always looking to make sure if a patient's canceling, like get somebody in here. Like I need to be helping people all day long. That's how I, we keep the lights on. That's how I help as many people. And so if you have a patient coming in the chair and it has an issue, they say I'm on Xeralto. Well, you can ask real quickly, why are you on Xeralto? I had a clot 10 years ago. my gosh. Well, yeah, we're pretty good to go. Then I'm not worried. We're only removing one tooth or we're just doing a cavity or a cleaning. Something like that. Shouldn't be an issue whatsoever because there's experts in the dental. ⁓   in the dental society, the ADA guidelines that recommend three teeth or less, minimally invasive. They really recommend if it's gonna be really high bleeding risk. And clinically, that's where you would come in, ⁓ or yourself. know, apioectomy is one that's like on the fence line. I don't know where implants set. though, and like we were talking, implants aren't usually like a date of procedure. Most people aren't popping in, having tooth pain, and we're like, let's do an implant. Now sometimes that can be the case, but typically that one's gonna have   a few other pieces involved. And so that is where you can get a clearance if you want to. ⁓ But we were really looking at this of like so many dentists that I know that you've seen will just send in these clearances because they are. And I think maybe a way to help dentists have more confidence is because you know, I love routines. I love to not have to remember things. So why don't we throw it in, have the team member set it up where every quarter we just double check the ADA guidelines. Are there any updates? Are there any other things that we need to do on that? That way you can just see like   getting into the language of this, of what do I need to do? Because honestly, you guys, know pharmacy was not a big portion for it, so, recommending different parts, but I think this is such a space where you can have confidence, and there's a few other things I wanna get to, and I you- I some pearls too. Okay, go. I'm so when she get me into talking about drugs, I'm not gonna stop. So, some other things around that too is these newer blood thinners like Xarelto Eloquist, they now have reversal agents, so a lot of providers in the past were really worried about bleeding because we can't turn it off. We can turn those off. Warfarin has reversal as well, right?   So I'm looking at these patients. It's really low risk. It's in the mouth, generally speaking. Very rarely are they a high bleeding risk. Now if you're doing maxillofacial surgery, this does not apply, right? This does not apply whatsoever. you're like general dentist, you're pediatric dentist. Yeah, yeah, and it's kind of on the fly. So just trying to really help you to be able to take care of those patients on the moment, have that confidence, look at the ADA guidelines, have that in front of you. I don't think it's a bad thing to ever...   check with their provider if you need to. If you're thinking, I feel like I should just check with the provider, I would never take that away from you. But I just want to kind of steer towards those guidelines that I have to help. But what did you want to share? No, yeah, I love that. And I think there were just a few other nuggets that we were chatting about last night that can help dentists just kind of get things passed a little bit easier. So you were mentioning that if they were named to their cardiologist, what was it? was like, who is the last? Great question. Yeah, when a patient's on a blood thinner,   It could be prescribed by the cardiologist. It could be prescribed by the family provider or could have been punted to like a vascular clinic like where I was working. It can go to any of those. And when you send that fax, right, if it goes to the cardiologist and it's supposed to go to the family care provider, like it just kind of goes, goes nowhere, right, from there. So I think it's a really good idea to find out who prescribed it last. If the patient doesn't know who prescribed their blood thinner last, you can call their pharmacy. I call pharmacies all day long.   I have noticed in the last year, they are way easier to get a hold of, which has made my job a lot easier, working on the insurance portion. So reaching out to the pharmacy, finding out who that provider is and sending it to them, because they should be able to help with that. I thought that was a good shift in verbiage that you had of asking instead of like the cardiologist, because that's who you would assume was the one. But you said like so many times you guys would take care of them, and then they go back to family practitioner, and you guys would get the clearances, but you couldn't clear because you weren't overseeing. So just asking the patient.   who prescribed their medication for them last time. That way you can send the clearance to the correct provider. then- And they might not know. You know patients, right? They're like, I don't know, my mom's or else, I don't know who gave it to me. Somebody told me I need to be on this. But at least that could be another quick thing. And then also we were talking last night about-   ⁓ What are some other things that dentists can do when like writing scripts to help them get what I think like overarching theme of everything we discussed is one how to help dentists have less I think drag through pharmacy. ⁓ Because pharmacy can take a little while and so perfect we now know the difference between anti-quag and anti-platelet. We know which medications are probably safe. We know we can check the ADA guidelines so that we were not having to do as many clearances. We also know if they're on a medication to find out and we do need a clearance.   who we can go to for the fastest, easiest result. And now, in talking about prescriptions, you had some really interesting tips that you could share with them. Yeah, so with writing prescriptions, right, pharmacies are pharmacies. So I'm not gonna say good thing or bad thing. There are challenges working with pharmacies. I'm not gonna play that down at all. ⁓ If you're writing prescriptions and having issues and kickbacks from pharmacies, there's some interesting laws around ⁓ writing prescriptions. Say that you're trying to ⁓ prescribe   augmentin, you know, 875 BID, and you tell the patient, hey, I want you to take this twice a day for seven days, and then you put quantity of seven, because you're moving fast, right? You want it for seven days, quantity of seven. Quantity would actually be 14, right? It's not that big of a deal. Anybody with common sense would say if you're taking a pill for twice a day for seven days, you need 14 tablets. But LAHA doesn't allow pharmacists to make that kind of a change, unfortunately. They have to follow what you're saying there. So you're going to get a...   An annoying callback that says, you wrote for seven tablets. I know you need 14. Is that OK? Just delays things, right? So ⁓ I really like the two letters QS. That's Q isn't queen. S isn't Sam. Yeah. It stands for quantity sufficient. So you don't have to calculate the amount of any medication that you're doing. So for me, as a pharmacist, when I was taking care of patients, I hated calculating the amount of insulin they would need for an entire month. So I would say.   Mrs. Jones needs 15, I'd say 15 units ⁓ QD daily. ⁓ And then I say QS, quantity sufficient, ⁓ 90 day supply through refills. So the pharmacy can then go calculate how much insulin that they need. I don't have to even do that. So anytime you're prescribing anything, I like that QS personally. So that lets the pharmacy use ⁓ common sense, as I like to call it, instead of giving you a call. I think that's super helpful. I also thought of one thing too.   going back to blood thinners is when it's kind of like a real quick, like they're not gonna have you stop the blood thinner at all. like you're seeing if you can stop the blood thinner for a patient, there's some instances it's just not gonna happen. And that's whenever they've been, they've had a clot or a stroke or a heart attack within the last three months. Three months. Yeah, that's kind of like the.   Because so many people are like, they had a heart thing like six years ago. And so I think a lot of my dentists that I worked with were like, we got to stop the blood thinners. But it sounds like it's within three months. Yeah, well, I'm just the time. Like this is general broad strokes. What I'm just trying to say is when you want to expect a no real quick. Got it. Right. So because benefits of stopping a blood thinner within those first three months of an event is very, very risky versus the, you know, the benefit of reducing a little bit of blood coming out of the mouth. Right. Like that's not that bad.   when somebody's had a stroke or a heart attack or pulmonary embolism, a clot in the lung, like we can't replace the lung, heart or brain very easily. We can replace blood a lot better. We've got buckets of it at most hospitals have buckets of it, right? So I'm always kind of leaning towards I'd rather replace blood than tissue at all times. So that's kind of a quick no. If they've had one those events in the last three months, we are really, really gonna watch their brain instead of getting.   root canal, right? Like really worried about them. So you'll just say no. And they could the dentist still proceed with the procedure or would you recommend like a three month wait? Or is it provider specific way the pros and cons because sometimes you need to get that tooth out. Great question. think then it's going to come into clinical. That's that's when you send in the clearance, right? Like, and it's great to reach out to the provider who's managing it for you. But I think it's kind of good to know exactly when you get a quick no quick no is going to be less than three months.   ⁓ Or when it's going to be like a kind of a typical, yeah, no problem. If it's been no greater than six months, they're on the typical anticoagulants or alto eloquence. Nothing crazy is going on for them. You're only removing two teeth. This is very, very low risk. But again, I'd urge everybody to read the ADA guidelines. That way you feel more comfortable with it. I'm not as eloquent as they do. They do a real good job. So I don't want to take any of their credit. I think they do a real good job of simplifying that and making you feel confident with providing.   more timely care for patients. Which is amazing. And Jayce, one last thing. I don't remember what it was. You were talking about the DEA and like six month rule. yeah. Let's just quickly talk about that and then we'll wrap this because this is such a fascinating thing for me last night. Yeah. So when comes to prescribing controlled substances, most providers have to have a DEA license. OK. First of all, though, what's your take on dentist prescribing controlled substances? ⁓ I don't think, you know, I worked on the insurance side of things. Right. And I look at the requirements for the   as the authorizations, what a patient, the criteria a patient needs to hit in order to qualify for certain medications. A lot of times for those controlled substances, they have pretty significant issues going on, like fibromyalgia or cancer-related pain or end-of-life care versus we don't, in all my scanning thread, I don't have a ⁓ perfect picture memory. Sure. But I don't usually see oral.   pain in there. There is some post-operative pain that can be covered for those kind of medications but I really recommend to keep those lower and in fact in a lot of our criteria it recommends you know have they tried Tylenol first, they tried, have they filled NSAIDs or are they contraindicated with the patient. So really they should be last line for patients in my two cents but there's always going to be a caveat to the rule right? Of course. comes through that has oral cancer and you're taking   like that would make sense to me. Got it, so then back to the DEA. Yeah, okay. Okay, ready. So as a provider, you should be checking the, if you're doing controlled substances, you should be checking the prescription drug monitoring program, or sometimes called the PDMP, looking to see if patients are getting ⁓ controlled substances from another provider. So it's really just a check and balance to make sure that they're not going from provider to provider to getting too many narcotics and causing self harm or harm to others.   And so with checking that PDMP before prescribing, I think a lot of providers do that. A lot of softwares that I'm aware of, EMRs, electronic medical records, sometimes have links so that you can do that more quickly. However, I don't think it's as intuitive that they need to be checking that every six months in some states. And like here in Nevada, you're supposed to be checking it every six months, not for a patient, but for your actual DEA registration to see if anybody else is prescribing underneath you. Because if you don't check that every six months, you could get in some serious trouble with...   not only DEA, but even more the Board of Pharmacy and your state. Now, I don't know all 50 states, so I check with your state to see if you need to be checking that every six months, but set an alarm just to check that real quickly, keep your nose clean. ⁓ I've had providers, I've had to remind to do that. And if somebody was using your account, prescribing narcotics, you'd never know unless you went and checked that PDMP.   Yeah, I remember last night you were like, and if that was you, I would not want to be you. The Board of Pharmacy is going to be real excited to find you. So that was something where I was like, got it. So, and we all know I'm big on let's make it easy. And Jason, I love that you love this so much and you just brought so much value today. And like also for me, it's just fun to podcast. fun. Yeah. But I got a nerd out on my world a little bit. Bring it into yours. I work with dentists or at least you know, when I was working in Vascular Clinic all day long. Great questions that would come through. Yeah.   So I think for all of us, as a recap on this is number one, I think setting yourself ⁓ some cadences. So maybe every quarter we check our ADA guidelines and we check our, what is it, PDMP. PDMP. so each state, so they call it Prescription Drug Monitoring Program. We need that. Yeah, but there are different acronyms in different states, though. That's just what it's called in Nevada. I forget what it is in California, but you can check your state's prescription monitoring program, make sure that opioids aren't being prescribed under your name. Got it. So we just set that as a cadence.   We know one to three teeth most likely if they're on a blood thinner is According to the 88 as of today is good to go You know things that are going to get a quick know are going to be within the last three months of the stroke the heart attack or the Clot I'm thinking like the pulmonary embolus. Yeah, that's what we're trying to prevent   Those are gonna be quick knows and then if we're prescribing, let's do QS. We've got quantity is sufficient so that we're not getting phone calls back on those medications that we are. And then on narcotics, just being a bit more cautious. Of course, this is provider specific and in no way, or form did Jason come on here to tell you you are the clinical expert.   Jason's the clinical expert on medications. And if you guys ever have questions, I know Jason, you geek out and you want to talk to people so that anyone wants to chat shop. Be sure to reach out and we'll be able to connect you in. we've even talked about possibly, so let me know listeners. You can email in Hello@TheDentalATeam.com of ask a pharmacist anything. I talked to Jason. I was like,   We'll just have them like send in questions and maybe get you back on the podcast or we do a webinar. But any last thoughts, Jace, you've got of pharmacy and dentistry as we as we wrap up today? No, I think that's pretty much it. So check the ADA guidelines. I think it's really good to have cross communication between professions. Right. If you're working with the pharmacy, CVS, Walgreens or something like that or Walmart, I know that it can be challenging. Right. They're under different pressures. You're under different pressure. So I think ⁓ just coming in with an understanding, not being angry at each other.   you know what mean, is super beneficial and working together. When it comes to it, every dentist that I've talked to is actually worried about their patient. Every pharmacist that I've worked with is really worried about the patient as well. So we're trying to accomplish the same thing, but we have different rules and our hands are bound in different ways that annoy each other, right? Like I know Dr. Jones, want 14 tablets, but you said seven. And I know Common Sense says I should give them 14, but I've got to make that change.   knowing that their hands are tied by the law. They can't use as much common sense, which is aggravating. I mean, that's why I love what I gotta do here. I gotta just kind of help a lot more and use common sense and improve patient care. But those kinds of things I think are really beneficial as you work together and then not being so afraid of blood thinners, right? So I think those guidelines do a great job of giving you confidence and not worrying about the side effects. And there's a lot of things that you can do locally for bleeding.   You have a lot of control over that. I think that's pretty cool, the tools they have. Yeah. And at the end of the day, yes, you are the clinician. You are the one who is responsible for this. so obviously, chat, but I think collaborating, talking to other pharmacists, talking to them in your state, finding out what are the state laws, things like that I think can be really beneficial just to give you peace of mind and confidence. And again, dentistry, are maybe a bit more risk adverse because luckily we don't have patients dying That's great thing. Yeah, that's fantastic. I want my dentists to be risk adverse. I think so too. But Jason, I appreciate you being on the podcast today.   And for all of you listening, ⁓ more confidence, more clarity, more streamline to be able to serve and help our patients better. if we can help you in any way or you've got more questions, reach out Hello@TheDentalATeam.com. And as always, thanks for listening. I'll catch you next time on the Dental A Team podcast.  

In this conversation, Awab Abdel-Jalil discusses the evolution and significance of the constructional approach in behavior analysis. Awab Abdel-Jalil is the Associate Vice President of Applied Research at Upstate Caring Partners in Utica, NY, and a doctoral candidate at Endicott College under the mentorship of Dr. Joe Layng. He emphasizes the importance of understanding historical context, the role of ascent in learning, and the scrutiny faced by ABA, which can lead to positive changes. Awab shares his personal journey into the field, the influence of mentorship, and the legacy of Israel Gold Diamond. He also addresses common misunderstandings of nonlinear contingency analysis and highlights the growing resources available for practitioners. The conversation concludes with insights into future directions in constructional therapy and the importance of harnessing negative reinforcers in practice. Continuing Education Credits (https://www.cbiconsultants.com/shop) BACB: 1.5 Learning IBAO:  1.5 ABA Topics QABA: 1.5 General CBA/CPD:    1.5 Learning   Follow us! Instagram: https://www.instagram.com/behaviourspeak/ LinkedIn:  https://www.linkedin.com/in/behaviourspeak/ Contact LinkedIn: https://www.linkedin.com/in/awab-abdel-jalil-64541a196/ Upstate Caring Partners: https://www.upstatecp.org/ The Institute for Applied Behavior Science at Endicott College https://www.endicott.edu/academics/schools/institute-for-applied-behavioral-science   Links: The Constructional Approach Website https://theconstructionalapproach.com/ The Constructional Approach Facebook Group https://www.facebook.com/groups/700952357829957 Claire St. Peter on The Behavioral Observations Podcast https://open.spotify.com/episode/5NLz4wfAT9paQfzvut11K1 Articles and Books Discussed Abdel-Jalil, A., Linnehan, A. M., Yeich, R., Hetzel, K., Amey, J., & Klick, S. (2023). Can there be compassion without assent? A nonlinear constructional approach. Behavior Analysis in Practice, 1-12. https://doi.org/10.1007/s40617-023-00850-9  Goldiamond, I. (2002). Toward a constructional approach to social problems: Ethical and constitutional issues raised by Applied Behavior Analysis. Behavior and Social Issues, 11(2), 108-197. https://doi.org/10.5210/bsi.v11i2.92 (Original work published in 1974). Goldiamond, I. (1984). Training parents and ethicists in nonlinear behavior analysis. In R. F. Dangel & R. A. Polster (Eds.), Parent training: Foundations of research and practice (pp. 504–546). Guilford.   Layng, T. V. J., & Abdel-Jalil, A. (2022). Toward a constructional exposure therapy. Advances in Cognitive Therapy, Fall, 8–11. https://www.researchgate.net/publication/373767631_TOWARD_A_CONSTRUCTIONAL_EXPOSURE_THERAPY Layng, T. V. J., Andronis, P. T., Codd III, R. T., & Abdel-Jalil, A. (2022). Nonlinear contingency analysis: Going beyond cognition and behavior in clinical practice. Routledge.  Liden, T. A., & Rosales-Ruiz, J. (2024a). Constructional parent coaching: A collaborative approach to improve the lives of parents of children with autism. Behavior Analysis in Practice. https://doi.org/10.1007/s40617-024-00944-y Linnehan, A. M., Abdel-Jalil, A., Klick, S., Amey, J., Yeich, R., & Hetzel, K. (2023). Foundations of preemptive compassion: A behavioral concept analysis of compulsion, consent, and assent. Behavior Analysis in Practice. https://doi.org/10.1007/s40617-023-00890-1  Scallan, C. M., & Rosales-Ruiz, J. (2023). The constructional approach: A compassionate approach to behavior change. Behavior Analysis in Practice. https://doi.org/10.1007/s40617-023-00811-2   Wilder, D. A., Ingram, G., & Hodges, A. C. (2021). Evaluation of shoe inserts to reduce toe walking in young children with autism. Behavioral Interventions, 37(3), 754–765. https://doi.org/10.1002/bin.1860   Books coming this summer:  Nonlinear Contingency Analysis: Going Beyond Cognition and Behavior in Clinical Practice. Second Edition.  Layng, T. V. J., Andronis, P. T., Codd III, R. T., & Abdel-Jalil, A. Applications in Nonlinear Contingency Analysis.  Abdel-Jalil, A., & Linnehan, A. (Editors)  

Durch einen Anruf seiner Mutter erfährt der Regisseur Salvatore, dass sein Freund der alte Filmvorführer Alfredo gestorben ist. In Rückblenden erzählt der Film aus der Kindheit und Jugend Salvatores, Toto genannt. Toto wächst in einem einfachen sizilianischen Fischerdorf auf. Dessen großer Anziehungspunkt ist das Kino Cinema Paradiso, in dem sich Toto als Kind mit dem Filmvorführer Alfredo anfreundet und sehr zum Leidwesen seiner Mutter jede freie Minute verbringt. Er sammelt die Filmrollenteile mit Küssen und Nacktszenen, die Alfredo auf Zuruf des Dorfpfarrers aus den öffentlich gezeigten Filmen herausschneiden muss. Er lernt bei Alfredo das Handwerk der Filmvorführung und übernimmt schließlich dessen Job, nachdem dieser bei einem Kinobrand sein Augenlicht verloren hat. Wir sehen, wie das Kino die Menschen in dem kleinen Dorf bewegt, wie es sie zusammenbringt und ihnen ein Stück Welt vermittelt. Toto wird vom Kind zum Jugendlichen, er verliebt sich, sein Herz wird gebrochen, er wird erwachsen. Und schließlich muss er sich die Frage stellen, ob er mehr will, als Filmvorführer in seiner Heimat zu bleiben. Cinema Paradiso aus dem Jahr 1988: Eine Liebeserklärung an das Medium Film und den magischen Ort Kino. Aber auch eine Auseinandersetzung mit dem, worum es im Leben geht, und welchen Platz Nostalgie darin einnimmt. Ein Film, der mich auch heute noch zum, Lachen, Schwelgen und auch Weinen bringt. Johannes, hast du geweint?

Ein Wort ist nie nur ein Wort. Und eine Zahl nie nur eine Zahl. In (R&Z)³ geht es diesmal um Übersetzungen, die Geschichte geprägt haben – nicht durch simple Fehler, sondern durch Bedeutungsverschiebungen, falsche Einheiten und unterschiedliche Verständnisse von Sprache, Macht und Wissen. Wir sprechen über Texte, Begriffe und Zahlen, die beim Übergang zwischen Kulturen ihre Bedeutung verändert haben – mit realen historischen Folgen. Keine Mythen, keine vereinfachten Erzählungen, sondern ein genauer Blick darauf, warum Übersetzen nie neutral ist. Eine Folge über Sprache als Risiko. Und darüber, wie leicht Bedeutung kippen kann.

Tudi v novem letu nadaljujemo z malo šolo finančne pismenosti. Tokrat nas je finančni strokovnjak Simon Meglič spomnil na pomen načrtovanja in beleženja, glavno pozornost pa smo posvetili zavedanju vzorcev, ki nas lahko vlečejo nazaj, in odprtosti za spremembe. Izvedeli smo, kaj stoji za kratico INR in kako razumeti pričakovanja analitikov, da iz njih res potegnemo korist.

Imbiss-Check: Wer gibt gesunkene Mehrwertsteuer weiter? In Rüsselsheim wird das voraussichtlich kaum ein Gastwirt tun. In den Michelstädter Stadtteilen, besonders in Rehbach, ist die Verkehrsbelastung deutlich gestiegen. Die Stadt hat im vergangenen Jahr gemessen: Innerhalb von zwei Wochen hat sich die Zahl der Fahrzeuge im Ortsteil sogar vervierfacht. Von rund 2.000 auf etwa 8.500 Autos täglich. Deshalb hat die Stadt jetzt neue Straßenübergänge eingerichtet: eine Ampelanlage an der B47 und ein gut beleuchteter Fußgängerüberweg in Rehbach. Schon jetzt ist das S-Bahnfahren auf der Strecke zwischen Kelsterbach und Wiesbaden nur eingeschränkt möglich, ab heute Abend geht dort gar nichts mehr - ganze zwei Wochen fallen die S8 und die S9 auf dieser Teilstrecke komplett aus. Die Bahn modernisiert in dieser Zeit die Bahninfrastruktur rund um Mainz, etwa die Gleise, Weichen und Oberleitungen. Das Winter-Trainingslager des SV Darmstadt 98 endet mit vielen offenen Fragen. Viele verletzte oder angeschlagene Spieler trüben dann auch die Bilanz von Trainer Florian Kohfeldt vor dem Rückrundenstart in Bochum.

Please support this podcast by pressing the follow button and support Chinmaya Mission Mumbai projects taken up by Swami Swatmananda, through generous donations. Contribution by Indians in INR can be made online using this link: https://bit.ly/gdswatmanDonors outside India who would like to offer any Gurudakshina/donation can send an email to enquiry@chinmayamissionmumbai.com with a cc to sswatmananda@gmail.com to get further details.These podcasts @ChinmayaShivam are also available on Spotify, Apple iTunes, Apple Podcasts, Podomatic, Amazon music and Google PodcastFB page: https://www.facebook.com/ChinmayaShivampageInsta: https://instagram.com/chinmayashivam?igshid=1twbki0v3vomtTwitter: https://twitter.com/chinmayashivamBlog: https://notesnmusings.blogspot.comLinkedIN: www.linkedin.com/in/swatmananda

Get ready for a massive week in the world of cricket! In this episode, we dive deep into the upcoming 3rd Ashes Test at the Adelaide Oval, exploring the crucial matchups and who needs to step up to keep the series alive. With Australia currently leading the Ashes 2025/26 series, the pressure is mounting on England's key players. Our experts break down the pitch conditions, team changes, and provide their bold predictions for the decisive day/night Test match. The action isn't just Down Under; it's also about to explode at the IPL auction! The podcast shifts gears to preview the highly anticipated IPL 2026 mini-auction in Abu Dhabi. Is Australian all-rounder Cameron Green really set to break all previous auction records and surpass Rishabh Pant's massive INR 27 crore bid? We analyze which franchises have the biggest war chests, the key players available for bidding, and predict where the biggest surprises might land. Tune in for expert analysis on the Ashes, IPL news, and all the T20 buzz you need! Want to create live streams like this? Check out StreamYard: https://streamyard.com/pal/d/6313687373840384 Learn more about your ad choices. Visit podcastchoices.com/adchoices

In this Week 50 edition of the GMS Weekly Podcast, Grace and Ryan break down the latest ship recycling / demolition market developments across Bangladesh, India, Pakistan, and Turkey. Week 50 delivers “December Downers” as sentiment weakens into year-end: the Baltic Dry Index (BDI) slips nearly 4% (with Capes down 5.6%), and oil retreats over 3% to around $57.61/bbl. A strong U.S. Dollar, softer local steel plate prices, and limited tonnage continue to pressure bids—pushing many sub-continent indications toward $400/LDT and below. Bangladesh remains top-ranked but faces declining fundamentals—local plate prices drop about $9/ton into the high-$490s, and political risk rises with elections confirmed for Feb 12, 2026. India (Alang) stays the weakest as steel levels ease to roughly $377/ton, and the INR hits around 90.50 to the Dollar. Pakistan (Gadani) remains quiet despite ongoing Hong Kong Convention (HKC) progress; inflation sits near 6.1%, plate levels around $575/ton, and the PKR near 280.35. Turkey (Aliaga) is stable but slow, with the TRY near 42.70. Indicative price levels this week (USD/LDT): Bangladesh 410 / 430 / 440 (Bulker / Tanker / Container) Pakistan 400 / 420 / 430 India 380 / 400 / 410 Turkey 270 / 280 / 290 For the full report, rankings, and port positions, download the GMS Weekly via the GMS App or our website. Follow GMS on LinkedIn and social media for daily ship recycling market updates.

Please support this podcast by pressing the follow button and support Chinmaya Mission Mumbai projects taken up by Swami Swatmananda, through generous donations. Contribution by Indians in INR can be made online using this link: https://bit.ly/gdswatmanDonors outside India who would like to offer any Gurudakshina/donation can send an email to enquiry@chinmayamissionmumbai.com with a cc to sswatmananda@gmail.com to get further details.These podcasts @ChinmayaShivam are also available on Spotify, Apple iTunes, Apple Podcasts, Podomatic, Amazon music and Google PodcastFB page: https://www.facebook.com/ChinmayaShivampageInsta: https://instagram.com/chinmayashivam?igshid=1twbki0v3vomtTwitter: https://twitter.com/chinmayashivamBlog: https://notesnmusings.blogspot.comLinkedIN: www.linkedin.com/in/swatmananda

La Mesa - Jueves 04.12.2025 - Negro compareció en Diputados por atentados a Fiscal Ferrero e INR by En Perspectiva

V epizodi se pogovarjamo o stanju slovenskega trga, prihajajočih individualnih naložbenih računih (INR) in o tem, zakaj 25 milijard evrov na bančnih računih predstavlja tveganje, ne varnosti. Bombač razloži, zakaj meni, da bi moral vsak vlagatelj marca prihodnje leto opraviti prvo vplačilo v INR, ter izpostavi, da bodo znotraj računa vsi donosi neobdavčeni do dviga. Dotakneva se stroškov in pasti neobrokerjev, vloge pokojninskih skladov, možnosti slovenskega trga za preboj v višjo kategorijo ter njegove osebne naložbene strategije – kot pravi, je "hodler", ki stavi na disciplino in razpršitev, ne na dnevno trgovanje. Epizoda je bila posneta konec avgusta 2025. Objavljena je tudi na Youtube. V tokratni epizodi boste slišali: 00:00 Intro 03:00 – Se napihuje balon 05:10 – Koncentracija v SBITOP-u in vloga "svete trojice" 07:30 – Ali Slovenija lahko dočaka nove velike IPO-je? 10:00 – Individualni naložbeni računi: zakaj marca 2026 ne smeš zamuditi prvega vplačila 14:30 – Psihologija malih vlagateljev in lekcije iz krize 2007–2009 17:00 – Koliko slovenskih delnic naj ima vlagatelj v portfelju? 19:30 – Likvidnost Ljubljanske borze: miti in realnost 22:00 – Neobrokerji: zakaj "ničelna provizija" ni vedno najcenejša 25:00 – Zakaj hrvaški pokojninski skladi bolj verjamejo v slovenske delnice kot slovenski 28:00 – Preveč denarja na bankah: izguba tretjine vrednosti v 20 letih 31:00 – Vizija LJSE do 2028 in pot do trgov v razvoju 35:00 – Ljudske obveznice in prihod novih finančnih instrumentov 38:00 – Osebni portfelj in "hodler mindset" 42:00 – Pogled na FIRE: zakaj ga ne zanima zgodnja upokojitev 45:00 – Zaključek epizode *ustavrjeno s pomočjo umetne inteligence ____________________________ Money-How Premium: https://money-how.si/narocnine/ vključuje: - Modri AI - Finančni asistent, ki pomaga pri raznih finančnih dilemah https://money-how.si/modri-ai/ - Taxistent - Davčni asistent, ki pomaga pri oddaji davčne napovedi https://money-how.si/taxistent/ - poglobljene članke ____________________________ Bootcamp v živo: Investiranje – kako sploh začeti (omejeno število) Že dolgo razmišljaš o vlaganju in ne veš, kje in kako začeti? Nimaš energije, da bi raziskoval vse podrobnosti. Skrbijo te davki? Ne veš, kako investiranje vpliva na socialne transferje, kot so otroški dodatki? Presekaj in se nam pridruži v živo, kjer bomo skupaj naredili prvi korak v svet investiranja! Termin: 27. november 2025 med 17.00 in 20.30 Info: www.money-how.si/dogodki ______________________ Finančna delavnica je lahko čudovito darilo. Več preveri https://money-how.si/izobrazevanja ______________________ (delavnica) Investiranje v delnice: Kaj moram vedeti, ko se odločam za investiranje v delnice Prijava: https://money-how.si/izobrazevanja ______________________ (delavnica) Investiranje za začetnike. Praktično o osnovah investiranja. Prijava: https://money-how.si/izobrazevanja _________________________________ DISCORD skupnost: V finančnih zagatah nismo sami, pridružite se nam na Discord Money-How / discord ______________________________ Več o Money-How na https://money-how.si/

La Mesa - 17.11.2025 - Dispararon contra la sede del INR y dejaron una carta con una amenaza para su directora by En Perspectiva

In this Week 45 edition of the GMS Weekly Podcast, global ship recycling markets remain subdued as weak fundamentals, falling steel prices, and currency volatility continue to pressure recyclers across South Asia. From Bangladesh and India to Pakistan and Turkey, sentiment stays fragile while inflation, sanctions, and lack of supply define the tone. Global Market Overview Markets limped through early November as macro pressures persisted. The Baltic Dry Index gained about 7% for the week, with Capes up 3.1%, Panamaxes 0.9%, and smaller segments rising 0.5%. Oil slipped again, closing just above USD 60 per barrel, while renewed U.S. sanctions and weaker global demand continue to cloud forecasts. Inflation in key recycling nations remained uneven: Pakistan saw renewed price pressure, Turkey and Bangladesh stayed unstable, and India's figures remain pending. Bangladesh Chattogram stayed on top in name but not in action, with no viable tonnage arrivals and local buyers offering above-market rates just to keep yards active. The Taka depreciated further to BDT 121.93 per USD, and domestic steel plate prices collapsed, ending the week with no trading reported. Inflation hovered at 8.17%, while political and economic uncertainty weigh heavily heading into 2026. India Alang continues to show resilience despite ongoing price weakness. Steel plate levels fell to USD 388.95 per ton, while the INR slipped to 88.67 per USD. Despite those declines, two mini-VLCCs arrived this week, showing India's growing dominance as an HKC-compliant recycling destination. Pakistan Gadani's market remains under heavy strain, with offers below USD 400 per LDT as cheap Iranian steel imports flood the market. Local steel prices held around USD 614 per ton, but the PKR weakened to 282.5 per USD, and inflation jumped to 6.2%. Still no HKC-approved yards, leaving Gadani struggling for competitiveness. Turkey Aliaga stayed mostly silent this week. The Lira plunged nearly 40 basis points to TRY 42.23 per USD, while local recyclers tried to lift prices slightly to attract tonnage, with little success so far. Market Sentiment With global inflation, currency devaluation, low supply, and soft steel fundamentals, the world's ship recycling sector continues to drift through uncharted waters. Optimism now shifts to 2026 as recyclers await a long-overdue "Trading Day."   For full details, vessel rankings, and port positions, download the GMS Weekly on our website or mobile app. Follow GMS on LinkedIn, Facebook, Instagram, and Twitter for daily updates.

(Seminarhaus Engl) Der mittlere Weg vermittelt zwischen Extremen. Dadurch entstehen Räumen, in denen wir uns bewegen können, flexibel reagieren können. Das Gleiche gilt für die Übung der Brahmavihara durch die wir unser Herz weit für alle Wesen öffnen. Achtsamkeit öffnet Raum indem sie allen Erfahrungen gleichermaßen ohne Werten begegnet und sein lässt. Weisheit kann dann unheilsames aus den Raum heraustragen und heilsames hineinbringen. In Räumen können wir uns entwickeln, verändern, wie können sie gestalten. Räume ermöglichen, dass wir uns weiten können, atmen können, frei fühlen können, wohin die Fesseln des Anhaftens uns limitieren und beschränken. In diesen Räumen können sich Freude, Kreativität, Spontanität entfalten.

(Seminarhaus Engl) Der mittlere Weg vermittelt zwischen Extremen. Dadurch entstehen Räumen, in denen wir uns bewegen können, flexibel reagieren können. Das Gleiche gilt für die Übung der Brahmavihara durch die wir unser Herz weit für alle Wesen öffnen. Achtsamkeit öffnet Raum indem sie allen Erfahrungen gleichermaßen ohne Werten begegnet und sein lässt. Weisheit kann dann unheilsames aus den Raum heraustragen und heilsames hineinbringen. In Räumen können wir uns entwickeln, verändern, wie können sie gestalten. Räume ermöglichen, dass wir uns weiten können, atmen können, frei fühlen können, wohin die Fesseln des Anhaftens uns limitieren und beschränken. In diesen Räumen können sich Freude, Kreativität, Spontanität entfalten.

Please support this podcast by pressing the follow button and support Chinmaya Mission Mumbai projects taken up by Swami Swatmananda, through generous donations. Contribution by Indians in INR can be made online using this link: https://bit.ly/gdswatmanDonors outside India who would like to offer any Gurudakshina/donation can send an email to enquiry@chinmayamissionmumbai.com with a cc to sswatmananda@gmail.com to get further details.These podcasts @ChinmayaShivam are also available on Spotify, Apple iTunes, Apple Podcasts, Podomatic, Amazon music and Google PodcastFB page: https://www.facebook.com/ChinmayaShivampageInsta: https://instagram.com/chinmayashivam?igshid=1twbki0v3vomtTwitter: https://twitter.com/chinmayashivamBlog: https://notesnmusings.blogspot.comLinkedIN: www.linkedin.com/in/swatmananda

Please support this podcast by pressing the follow button and support Chinmaya Mission Mumbai projects taken up by Swami Swatmananda, through generous donations. Contribution by Indians in INR can be made online using this link: https://bit.ly/gdswatmanDonors outside India who would like to offer any Gurudakshina/donation can send an email to enquiry@chinmayamissionmumbai.com with a cc to sswatmananda@gmail.com to get further details.These podcasts @ChinmayaShivam are also available on Spotify, Apple iTunes, Apple Podcasts, Podomatic, Amazon music and Google PodcastFB page: https://www.facebook.com/ChinmayaShivampageInsta: https://instagram.com/chinmayashivam?igshid=1twbki0v3vomtTwitter: https://twitter.com/chinmayashivamBlog: https://notesnmusings.blogspot.comLinkedIN: www.linkedin.com/in/swatmananda

Please support this podcast by pressing the follow button and support Chinmaya Mission Mumbai projects taken up by Swami Swatmananda, through generous donations. Contribution by Indians in INR can be made online using this link: https://bit.ly/gdswatmanDonors outside India who would like to offer any Gurudakshina/donation can send an email to enquiry@chinmayamissionmumbai.com with a cc to sswatmananda@gmail.com to get further details.These podcasts @ChinmayaShivam are also available on Spotify, Apple iTunes, Apple Podcasts, Podomatic, Amazon music and Google PodcastFB page: https://www.facebook.com/ChinmayaShivampageInsta: https://instagram.com/chinmayashivam?igshid=1twbki0v3vomtTwitter: https://twitter.com/chinmayashivamBlog: https://notesnmusings.blogspot.comLinkedIN: www.linkedin.com/in/swatmananda

Please support this podcast by pressing the follow button and support Chinmaya Mission Mumbai projects taken up by Swami Swatmananda, through generous donations. Contribution by Indians in INR can be made online using this link: https://bit.ly/gdswatmanDonors outside India who would like to offer any Gurudakshina/donation can send an email to enquiry@chinmayamissionmumbai.com with a cc to sswatmananda@gmail.com to get further details.These podcasts @ChinmayaShivam are also available on Spotify, Apple iTunes, Apple Podcasts, Podomatic, Amazon music and Google PodcastFB page: https://www.facebook.com/ChinmayaShivampageInsta: https://instagram.com/chinmayashivam?igshid=1twbki0v3vomtTwitter: https://twitter.com/chinmayashivamBlog: https://notesnmusings.blogspot.comLinkedIN: www.linkedin.com/in/swatmananda10 - तत्त्वबोध हिन्दी | अद्वैत जागरण युवा शिविर | सत्संग 10 | सितम्बर 2025Youtube Link : https://youtu.be/bd1zITcK18sPodomatic Link : https://www.podomatic.com/podcasts/swatmananda/episodes/2025-10-28T05_46_24-07_00

Please support this podcast by pressing the follow button and support Chinmaya Mission Mumbai projects taken up by Swami Swatmananda, through generous donations. Contribution by Indians in INR can be made online using this link: https://bit.ly/gdswatmanDonors outside India who would like to offer any Gurudakshina/donation can send an email to enquiry@chinmayamissionmumbai.com with a cc to sswatmananda@gmail.com to get further details.These podcasts @ChinmayaShivam are also available on Spotify, Apple iTunes, Apple Podcasts, Podomatic, Amazon music and Google PodcastFB page: https://www.facebook.com/ChinmayaShivampageInsta: https://instagram.com/chinmayashivam?igshid=1twbki0v3vomtTwitter: https://twitter.com/chinmayashivamBlog: https://notesnmusings.blogspot.comLinkedIN: www.linkedin.com/in/swatmananda

Please support this podcast by pressing the follow button and support Chinmaya Mission Mumbai projects taken up by Swami Swatmananda, through generous donations. Contribution by Indians in INR can be made online using this link: https://bit.ly/gdswatmanDonors outside India who would like to offer any Gurudakshina/donation can send an email to enquiry@chinmayamissionmumbai.com with a cc to sswatmananda@gmail.com to get further details.These podcasts @ChinmayaShivam are also available on Spotify, Apple iTunes, Apple Podcasts, Podomatic, Amazon music and Google PodcastFB page: https://www.facebook.com/ChinmayaShivampageInsta: https://instagram.com/chinmayashivam?igshid=1twbki0v3vomtTwitter: https://twitter.com/chinmayashivamBlog: https://notesnmusings.blogspot.comLinkedIN: www.linkedin.com/in/swatmananda

Please support this podcast by pressing the follow button and support Chinmaya Mission Mumbai projects taken up by Swami Swatmananda, through generous donations. Contribution by Indians in INR can be made online using this link: https://bit.ly/gdswatmanDonors outside India who would like to offer any Gurudakshina/donation can send an email to enquiry@chinmayamissionmumbai.com with a cc to sswatmananda@gmail.com to get further details.These podcasts @ChinmayaShivam are also available on Spotify, Apple iTunes, Apple Podcasts, Podomatic, Amazon music and Google PodcastFB page: https://www.facebook.com/ChinmayaShivampageInsta: https://instagram.com/chinmayashivam?igshid=1twbki0v3vomtTwitter: https://twitter.com/chinmayashivamBlog: https://notesnmusings.blogspot.comLinkedIN: www.linkedin.com/in/swatmananda

Please support this podcast by pressing the follow button and support Chinmaya Mission Mumbai projects taken up by Swami Swatmananda, through generous donations. Contribution by Indians in INR can be made online using this link: https://bit.ly/gdswatmanDonors outside India who would like to offer any Gurudakshina/donation can send an email to enquiry@chinmayamissionmumbai.com with a cc to sswatmananda@gmail.com to get further details.These podcasts @ChinmayaShivam are also available on Spotify, Apple iTunes, Apple Podcasts, Podomatic, Amazon music and Google PodcastFB page: https://www.facebook.com/ChinmayaShivampageInsta: https://instagram.com/chinmayashivam?igshid=1twbki0v3vomtTwitter: https://twitter.com/chinmayashivamBlog: https://notesnmusings.blogspot.comLinkedIN: www.linkedin.com/in/swatmananda

Please support this podcast by pressing the follow button and support Chinmaya Mission Mumbai projects taken up by Swami Swatmananda, through generous donations. Contribution by Indians in INR can be made online using this link: https://bit.ly/gdswatmanDonors outside India who would like to offer any Gurudakshina/donation can send an email to enquiry@chinmayamissionmumbai.com with a cc to sswatmananda@gmail.com to get further details.These podcasts @ChinmayaShivam are also available on Spotify, Apple iTunes, Apple Podcasts, Podomatic, Amazon music and Google PodcastFB page: https://www.facebook.com/ChinmayaShivampageInsta: https://instagram.com/chinmayashivam?igshid=1twbki0v3vomtTwitter: https://twitter.com/chinmayashivamBlog: https://notesnmusings.blogspot.comLinkedIN: www.linkedin.com/in/swatmananda

Please support this podcast by pressing the follow button and support Chinmaya Mission Mumbai projects taken up by Swami Swatmananda, through generous donations. Contribution by Indians in INR can be made online using this link: https://bit.ly/gdswatmanDonors outside India who would like to offer any Gurudakshina/donation can send an email to enquiry@chinmayamissionmumbai.com with a cc to sswatmananda@gmail.com to get further details.These podcasts @ChinmayaShivam are also available on Spotify, Apple iTunes, Apple Podcasts, Podomatic, Amazon music and Google PodcastFB page: https://www.facebook.com/ChinmayaShivampageInsta: https://instagram.com/chinmayashivam?igshid=1twbki0v3vomtTwitter: https://twitter.com/chinmayashivamBlog: https://notesnmusings.blogspot.comLinkedIN: www.linkedin.com/in/swatmananda

There is something inside Ira. It's growing. It's alive. And it is not a baby.Listen to EP 01 HereEpisode 2 of Rakt Lekha is a descent into pure, unfiltered body horror. The secret of the Sehajeevi is about to be born, and the revelation is a grotesque nightmare. This is the Hindi horror story everyone is talking about, a terrifying kahani that takes the classic Monkey's Paw legend and injects it with a horrifying, biological twist.Prepare yourself for a darawni kahani that doesn't hold back. This is a monster story unlike any other, where the greatest horror is the one that grows within.[Hindi Horror Story, Horror Story, Kahani, The Monkey's Paw, Rakt Lekha, Indian Horror Story, SciFi Horror, Body Horror, Darawni Kahani, Bhutiya Kahani, Cursed Wish, Supernatural Thriller, Audio Story, Horror Podcast, Hindi Kahani, Rahasyamayi Kahani, Monster Story, Alien Story, Sehajeevi]Join this channel to get access to exclusive perks @just 59 INR a month!! Follow me on YouTubeFacebookInstagram

Please support this podcast by pressing the follow button and support Chinmaya Mission Mumbai projects taken up by Swami Swatmananda, through generous donations. Contribution by Indians in INR can be made online using this link: https://bit.ly/gdswatmanDonors outside India who would like to offer any Gurudakshina/donation can send an email to enquiry@chinmayamissionmumbai.com with a cc to sswatmananda@gmail.com to get further details.These podcasts @ChinmayaShivam are also available on Spotify, Apple iTunes, Apple Podcasts, Podomatic, Amazon music and Google PodcastFB page: https://www.facebook.com/ChinmayaShivampageInsta: https://instagram.com/chinmayashivam?igshid=1twbki0v3vomtTwitter: https://twitter.com/chinmayashivamBlog: https://notesnmusings.blogspot.comLinkedIN: www.linkedin.com/in/swatmananda

Please support this podcast by pressing the follow button and support Chinmaya Mission Mumbai projects taken up by Swami Swatmananda, through generous donations. Contribution by Indians in INR can be made online using this link: https://bit.ly/gdswatmanDonors outside India who would like to offer any Gurudakshina/donation can send an email to enquiry@chinmayamissionmumbai.com with a cc to sswatmananda@gmail.com to get further details.These podcasts @ChinmayaShivam are also available on Spotify, Apple iTunes, Apple Podcasts, Podomatic, Amazon music and Google PodcastFB page: https://www.facebook.com/ChinmayaShivampageInsta: https://instagram.com/chinmayashivam?igshid=1twbki0v3vomtTwitter: https://twitter.com/chinmayashivamBlog: https://notesnmusings.blogspot.comLinkedIN: www.linkedin.com/in/swatmananda

Please support this podcast by pressing the follow button and support Chinmaya Mission Mumbai projects taken up by Swami Swatmananda, through generous donations. Contribution by Indians in INR can be made online using this link: https://bit.ly/gdswatmanDonors outside India who would like to offer any Gurudakshina/donation can send an email to enquiry@chinmayamissionmumbai.com with a cc to sswatmananda@gmail.com to get further details.These podcasts @ChinmayaShivam are also available on Spotify, Apple iTunes, Apple Podcasts, Podomatic, Amazon music and Google PodcastFB page: https://www.facebook.com/ChinmayaShivampageInsta: https://instagram.com/chinmayashivam?igshid=1twbki0v3vomtTwitter: https://twitter.com/chinmayashivamBlog: https://notesnmusings.blogspot.comLinkedIN: www.linkedin.com/in/swatmananda

Please support this podcast by pressing the follow button and support Chinmaya Mission Mumbai projects taken up by Swami Swatmananda, through generous donations. Contribution by Indians in INR can be made online using this link: https://bit.ly/gdswatmanDonors outside India who would like to offer any Gurudakshina/donation can send an email to enquiry@chinmayamissionmumbai.com with a cc to sswatmananda@gmail.com to get further details.These podcasts @ChinmayaShivam are also available on Spotify, Apple iTunes, Apple Podcasts, Podomatic, Amazon music and Google PodcastFB page: https://www.facebook.com/ChinmayaShivampageInsta: https://instagram.com/chinmayashivam?igshid=1twbki0v3vomtTwitter: https://twitter.com/chinmayashivamBlog: https://notesnmusings.blogspot.comLinkedIN: www.linkedin.com/in/swatmananda

Contributors: Travis Barlock MD, Jeffrey Olson MS4 Feel free to use the cases below for your own practice. All of the scenarios are completely made up and designed to hit several teaching points. Case 1 25 M, presents to the ED with chest pain. Stabbing, started a few hours ago, substernal. Thinks it is GERD. After 2-3 minutes, pain worsens and radiates to the back. VS: BP 125/50 (Right arm 190/110). HR 120. RR of 18. Sat 98% on RA. Additional VS: Temp of 37.2, height of 6'5”, BMI of 18. PMH: None, doesn't see a doctor. Meds: None FH: Weird heart thing (Mitral Valve Prolapse), weird lung thing (spontaneous pneumothorax), tall family members with long fingers and toes Physical Exam: Cards: Diastolic decrescendo at the RUSB, diminished S2. UE pulses are asymmetric, LE pulses are asymmetric, carotid pulses are asymmetric, BP is asymmetric MSK: Knees, elbows, and wrists are hypermobile. Imaging: CXR #1 normal, #2 widened mediastinum (no read yet but shows widened mediastinum), POCUS shows small effusion CTA/MRA doesn't come back until after the case.  ECG: Sinus Tach Labs: NT-proBNP 500 pg/mL D-Dimer: 7000 ng/L CBC: Hemoglobin: 13.5 g/dL, WBC: 20,000/µL, Platelets: 250,000/µL Chem 7: Na 138, K, 5.7, Cl 102, Bicarb 17, BUN 45, Creatinine: 3.5 mg/dL, Glucose: 180 LFTs: Albumin 2.4, Total protein 5.5, ALP: 140, AST: 3500, ALT: 2800, TBili: 3.2, DirectBili: 2.4, Ca: 7.8 LDH: 2200 PT: 20.5, INR: 2.2, Fibrinogen: 170 5th gen High-Sensitivity Troponin:

We are all aware that mental/emotional well-being is essential to maintain on a surface level. But on a deeper level, research shows us over & over that emotional skills are thee foundation to human happiness & success. There is no such thing as a solely logical person. Emotions are what make us human, and we must learn how to interact with them, not because we're whiny or soft, but because emotions drive humanity. Emotions are at the root of everything humans do, and whether or not we will survive.(Please excuse my runny nose in this one

*****To sign up and get started with GlintPay, go to glintpay.com and make sure to use the code SNIDER.*****The dollar is surging again. And while it's primary the euro taking the other side, just as importantly, if not more importantly, currencies like the rupee are tanking worse. INR hit another record low and that along with the euro's sharp reverse is a canary singing in the eurodollar coalmine...perhaps gasping. Eurodollar University's Money & Macro Analysishttps://www.eurodollar.universityTwitter: https://twitter.com/JeffSnider_EDU