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Episode 60: Variety of Topics.  Gabrielle Robinson (MS3) discusses with Dr Arreaza these topics: IsoPSA, 3HP for LTBI, shingles vaccine, and DELC.Introduction: You will hear a conversation between Gabrielle Robinson, a 3rd year medical student, and Hector Arreaza. They discussed 4 articles about topics that are relevant to current clinical practice in family medicine.This is Rio Bravo qWeek, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California. Our program is affiliated with UCLA, and it's sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home.Variety of Topics. By Gabrielle Robinson, MS3, Ross University School of Medicine, and Hector Arreaza, MD.  The IsoPSA testH: Cleveland Clinic published this article in July 2020[1]. G: According to that article, the IsoPSA test is a new clinically relevant screen for prostate cancer. The data suggests that ISoPSA can potentially decrease unnecessary prostate biopsies by 45%. The IsoPSA evaluates changes in the structure of PSA rather than measuring the concentration of PSA.  G: IsoPSA is meant to be used in patients who are over 50 years old with PSA > 4ng/mL that have not had a previous diagnosis for prostate cancer or are under surveillance.H: Is PSA a bad screening test?G: Measuring the concentration of PSA has proven to be a less sensitive screening tool because PSA is specific for tissues and nonspecific for cancer. This means that a high PSA does not necessarily mean cancer is present.  The PSA can be elevated due to a multitude of reasons including but not limited to prostatitis, benign prostatic hyperplasia, etc.  Unfortunately, this has led to the overdiagnosis of low-grade cancers that were in fact benign conditions. However, PSA is an effective tool for monitoring of recurrence of prostate cancer and it reduces the need for treatment of metastatic disease.H: As a reminder, screening for prostate cancer in asymptomatic individuals by using PSA is a grade D recommendation from the USPSTF. D means “Do not do it!” However, IsoPSA is not included in that recommendation. We'll see if evidence suggests IsoPSA as an alternative in the future.  3HP for latent TB infection treatmentH: This information was published by CDC on June 28, 2018. G: Previously, the treatment for latent TB included 3–9 months of DAILY Isoniazid (INH) or Rifampin (RIF), either alone or combined.  Now, new data according to CDC recommends that INH-RPT (isoniazid-rifaPENtine) treatment once a week for 12 weeks (AKA 3HP regimen) is adequate in controlling the reactivation of latent TB[2].H: RifaPEntine is not Rifampin.G: It is also worth mentioning that this treatment is also approved for patients 2-11 years of age as well as patients who have HIV/AIDS who are currently taking anti-retroviral.H: Currently, the regimens for LTBI treatment are: -Monotherapy with INH for 6-9 months-Monotherapy with Rifampin daily for 4 months-Combinations: INH-Rifampin daily for 3 months (3HR therapy), and INH-RifaPENTINE weekly for 3 months (3HP therapy). Shingles vaccine may reduce risk of strokeG: Why do we think having shingles increases risk of stroke in the first place? The mechanism is not well understood but there is a strong index of suspicion that the inflammation resulting from the outbreak plays a significant role.  H: So, you read a study, a chart review published by the American Heart Association, tell us about it.In this study, patients who received the shingles vaccine (live vaccine) were compared to patient who did NOT receive the vaccine. The results showed that getting the shingles vaccine decreased the risk of stroke by 16%.  The types of strokes that were decreased included hemorrhagic stroke which was decreased by 12% and ischemic stroke that was decreased by 18%.  The age range for which this was most effective is 66 to 79 years of age and is worth mentioning that patients under 80 years of age had a decreased risk in stoke by 20% while the patients over 80 years old were decreased by about 10%[3]. Diagonal Ear Lobe Crease: An Association with CADH: Last week we got this information from Dr Cobos, a Kern Medical hematologist. G: Diagonal Ear Lobe Crease (DELC) also known as Frank's sign, is a crease in the ear lobe that is associated with increased risk of coronary artery disease, peripheral vascular disease, and cerebrovascular disease. Although the pathophysiology of this sign is not yet understood, there has been a grading system set in place that is linked to the incidence of cardiovascular events based on length, depth, bilateralism, and inclination according to Stanford Medicine. The classifications are as follows:Unilateral incomplete – least severeUnilateral completeBilateral complete – Most severe Other classification (not associated with increased cardiovascular events):Grade 1 – wrinklingGrade 2a – Superficial crease (floor of sulcus visible)Grade 2b – crease greater than 50% across earlobeGrade 3 – deep cleft across whole earlobe (floor of sulcus not visible) H: As a curious fact, Steven Spielberg and Mel Gibson have the DELC.  Conclusion: Now we conclude our episode number 60 “Variety of Topics.” Future Dr Robinson presented a summary of four interesting articles she read. She explained that IsoPSA may be an alternative for screening for prostate cancer in the future, and she reminded us of the weekly treatment of latent tuberculosis infection with INH and rifaPENtine (also known as 3HP treatment for LTBI). There was a decrease in stroke risk in patients who received shingles vaccine, according to a study published by the American Heart Association in 2020, and the Diagonal Ear Lobe Crease sign was mentioned as a possible association with cardiovascular risk. Even without trying, every night you go to bed being a little wiser. Thanks for listening to Rio Bravo qWeek. If you have any feedback about this podcast, contact us by email RBresidency@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. This podcast was created with educational purposes only. Visit your primary care physician for additional medical advice. This week we thank Hector Arreaza and Gabrielle Robinson. Audio edition: Suraj Amrutia. See you next week! ____________________________References:  The IsoPSA Test Is Available, and It Could Change the Diagnostic Paradigm for Prostate Cancer, Consult QD, Cleveland Clinic, Jul 7, 2020, https://consultqd.clevelandclinic.org/the-isopsa-test-is-available-and-it-could-change-the-diagnostic-paradigm-for-prostate-cancer/ CDC Releases Updated Recommendations for Treatment of Latent TB Infection, Centers for Disease Control and Prevention, June 28, 2018, https://www.cdc.gov/nchhstp/newsroom/2018/treatment-of-latent-TB-infection.html Shingles vaccine may also reduce stroke risk, American Heart Association, February 12, 2020, https://newsroom.heart.org/news/shingles-vaccine-may-also-reduce-stroke-risk Frank's Sign - Diagonal earlobe crease (DELC), Stanford Medicine 25, July 2, 2015, https://stanfordmedicine25.stanford.edu/blog/archive/2015/what-is-the-name-of-this-sign.html 

In this sermon, Pastor Dave Capoccia completes examination of Solomon’s surprising teaching in Ecclesiastes 7:23-29. Solomon warns against vainly pursuing deep knowledge and instead urges you to understand and apply three basic life truths. In part 2, Pastor Dave explains the second and third basic truths from Solomon. Introduction: You cannot know the fundamental scheme… The post Wisdom’s Low-Hanging Fruit, Part 2 appeared first on Calvary Community Church.

Introduction You know that moment when you realize that something is off? It's when everyone's attention is on You, like when you present a report at school, or when you‘re getting together with friends. Right in the middle of an important moment you think that maybe you never brushed your hair today.…

In this sermon, Pastor Dave Capoccia begins examining Solomon’s surprising teaching in Ecclesiastes 7:23-29. Solomon warns against vainly pursuing deep knowledge and instead urges you to understand and apply three basic life truths. In part 1, Pastor Dave examines the introduction and first basic truth. Introduction: You cannot know the fundamental scheme of the world… The post Wisdom’s Low-Hanging Fruit, Part 1 appeared first on Calvary Community Church.

https://astralcodexten.substack.com/p/the-rise-and-fall-of-online-culture [Followup to: New Atheism: The Godlessness That Failed] I. Introduction You've probably seen these graphs before: They tell a familiar story: America is becoming increasingly obsessed with racism and sexism. Identity issues are dominating our politics more and more with no end in sight. But what does Google Trends have to say? I chose these as especially obvious terms. But other gender-related terms

Introduction “You shall not bear false witness against your neighbor. “You shall not covet your neighbor's house; you shall not covet your neighbor's wife, nor his male servant, nor his female servant, nor his ox, nor his donkey, nor anything that is your neighbor's.” A Day of HONESTY And you shall know…

Introduction “You shall not make for yourself a carved image—any likeness of anything that is in heaven above, or that is in the earth beneath, or that is in the water under the earth; you shall not bow down to them nor serve them. For I, the Lord your God, am a jealous God, visiting the iniquity of…

Matthew 2:1-12 Introduction You may think that Christmas is over but it is not. As the song says, there are twelve days of Christmas, starting on December 25 and ending on January 6. So Merry Christmas! When I think of Christmas, I often think of nativity sets. Each of us might be drawn to different… Read more

INTRODUCTION You ever have someone mistake you for someone else ? They swear your are the spitting image of someone else? I had no idea what a doppelganger was until I watched the television series “The Flash” Kathryn and I got into it. Every night we would look at each other and say, “Flash?”. Later…

Acts 4:13-22 Introduction You may or may not know that I took a number of years off pastoral ministry between my previous churches and coming to Queen Street Baptist Church. But of course we still needed to eat and so that meant I needed to get a job.  At that point, I had been a… Read more

Class 10 of the series: "“They tell of the glory of your kingdom and speak of your might” (Psalm 145:11) Introduction - You have chosen your text - You have explored it - You have mined other resources - You have found the point - You have chosen a structure - You have planned how to start your lesson - You have planned how to end your lesson - You have added your illustrations - You have planned your congregational involvement - Now it’s time to prepare yourself - Today: How to prepare yourself 1. You are enough - Don't become somebody different - Strength in weakness - Fear and insecurity are no barriers to God’s effectiveness through you 2. Live it to give it - Apply text to yourself - **James 3.1** - Preparation in advance critical to this 3. Prayer - For courage: When Hugh Latimer was preaching one day in the presence of King Henry VIII, he reports that he said to himself, “Latimer! Latimer! Remember that the king is here; be careful what you say.” Then he said to himself, “Latimer! Latimer! Remember that the King of kings is here; be careful what you do not say.” For such unflinching faithfulness Latimer was eventually burned at the stake. But He feared failing God more than he feared offending men. - For wisdom: What to cut out; attentiveness to the Spirit - For peace: God’s Word is more powerful than your mistakes - At start of message? 4.Routine - Some people find routines helpful - My Sunday morning routine:     - Bruckner Symphony No. 7 - **play loudly in the background**     - Read text     - Review sermon     - Make notes on things to be adjusted     - Check slides et cetera     - Go out to pray     - Return, edit and leave it alone     - Gap between final edit and preaching helpful 5. Random practicals - Bible, notes ready? - Energy?     - Too little: Run up some stairs….     - Too much: Breathe - Voice: room temperature water - Nervous: Good! Pray they will help you fly.     - Tuesday Teaching Tips: "[Nervous? Good! (https://youtu.be/FjFmiT11Dj0) ]"     - Tuesday Teaching Tips, Episode 127: ["How to make nerves your friend" (https://youtu.be/q2nAVvtcbIs) ] Part 1     - Tuesday Teaching Tips 146, ["What to do when your nerves get the upper hand" (https://youtu.be/tLbj-8bVlIo) ] Closing - Question: “How do you know you are prepared?” - Next time: Summary class - Need questions for the concluding summary class - “One generation commends your works to another; they tell of your mighty acts.” (Psalm 145:4 NIV11) Please add your comments on this week’s topic. We learn best when we learn in community.  Do you have a question about teaching the Bible? Is it theological, technical, practical? Send me your questions or suggestions. Here’s the email: malcolm@malcolmcox.org. If you’d like a copy of my free eBook on spiritual disciplines, “How God grows His people”, sign up at my website: http://www.malcolmcox.org. Please pass the link on, subscribe, leave a review. “Worship the LORD with gladness; come before him with joyful songs.” (Psalms 100:2 NIV11) God bless, Malcolm PS: You might also be interested in my book: "An elephant's swimming pool", a devotional look at the Gospel of John

Introduction- -You may remember that we said, way back in chapter 5, that from the 5th chapter to the 8th chapter the major theme being expounded by the apostle Paul is the security of salvation. -It is the freeness of salvation that assures the finality of salvation. -He is emphasizing both. -He is teaching the truth of justification by faith, and as a result, why future glorification is a certainty.-ESV Romans 5-1 Therefore, since we have been justified by faith, we have peace with God through our Lord Jesus Christ. 2 Through him we have also obtained access by faith into this grace in which we stand, and we rejoice in hope of the glory of God. 3 Not only that, but we rejoice in our sufferings, knowing that suffering produces endurance, 4 and endurance produces character, and character produces hope, 5 and hope does not put us to shame, because God's love has been poured into our hearts through the Holy Spirit who has been given to us.-Everything that we have been studying in the book of Romans from that point forward is just an extended explanation of truths contained in that opening statement.-Salvation is accomplished by Jesus Christ, found in Jesus Christ, and received by faith.-The result is a new standing before God, one that is both now and forever.-That salvation imparts a hope.-That hope holds despite all of life's troubles. It will not disappoint.-That hope is so certain, and so full of purpose, that the troubles of life prove to be productive. The God who saved us is the same God at work in all our circumstances producing in us that which He has destined for us.-And all of this has been sealed to us by the Holy Spirit's presence in our lives. His presence is

Text:Psalm 16:11 and  Psalm 25:1-5 Introduction: You would not have believed me if I told you that these protests, riots, and looting has been planned for decades.  It is what is called an “Organic Revolution” but it is not so organic.  It is a well thought out plan to destroy the Judeo-Christian culture we still… Read more

Text:1 Timothy 1:5  and 2 Corinthians 4:1-2 Introduction: “You cannot give away what you don’t possess!”    To manifest Truth to others we must discern good and evil and then we must consistently choose good and refuse evil.  In so doing we touch the hearts, mind, and conscience in others.  Point 1: What is a Good… Read more

Introduction: You have heard the saying, ‘I can’t see the forest for the trees.’ Some of you may feel this way as we come to the end of the book of Romans, it is the longest of all Paul’s letters, and the most theological. If I had to ask you to give me a quick rundown of Romans could you do it? Are you familiar with its content and the development of its argument or is it a maze? Romans is a long development of the theological twists and turns of the gospel of God. So it is my job today to take you to 30 000 feet and give you the top view that you can see the forest again.   Source

Introduction: You might think now that we have finished the doctrinal part of the letter to the Romans the last chapter and a half are unimportant and will be a let-down. You could not be more wrong. This last section of Romans gives us a tremendous window into the nature of Paul’s ministry helping us to think about our own ministry as a church. As well as a window into the life of the early church. In this closing section of the letter Paul reverts to personal comments as he did in the introduction of this letter. And just as Romans has the longest introduction to any of Paul’s letters so it also has the longest conclusion in all his letters. Paul has never met the Roman church yet he is wanting to include them in his plans as he goes to preach in places where Christ has not yet been preached. So Paul includes in this final part a deeper look into his ministry so the Romans would be willing partners with him. Paul describes himself as a minister to the Gentiles, as an apostle, as a church planter, as a missionary, as a church ambassador and a persecuted Christian in v14-33. All of this information is because Paul wants to make a stop in Rome to be helped on his way by them, v24. ‘I myself am satisfied about you, my brothers, that you yourselves are full of goodness, filled with all knowledge and able to instruct one another.15 But on some points I have written to you very boldly by way of reminder, because of the grace given me by God16 to be a minister of Christ Jesus to the Gentiles in the priestly service of the gospel of God, so that the offering of the Gentiles... Read More Source

Today's episode is the audio version of the introduction to the Independent Adjuster's Playbook. Just got this back from the editor and we'll probably redo the take for the final audiobook but I was so excited I had to share it with you the listener. You can pre-order your free copy of the Independent Adjuster's Playbook at IAPlaybook.com Enjoy! Introduction You (yes, you!) can become an independent auto adjuster if you are able to apply the principles and strategies included inside of this book.  My life completely changed after I became an independent auto adjuster, and I am certain it will change your life as well.  For over a decade, being an adjuster has empowered a life that my wife and I had previously only dreamed about. We thought that we needed stacks of cash and would have to wait until retirement to achieve the things we wanted, but we were wrong. Travel, adventure, purpose, and a secure career have all become the norm for our young family, and we have not had to sacrifice who we are in the process. Looking back, I remember how I was NO ONE and how I had NO SKILLS that you would think an auto adjuster would need. I had never worked on a car, never changed my own oil, and my stellar warehouse career (of throwing boxes for a living) was completely unrelated to being an adjuster. Truly, if I have found and achieved a successful career in this fascinating industry, anyone can. I've handled claims locally in my state, traveled across the country chasing hail storms, shown up in the aftermath of catastrophes (like hurricane Sandy) and have been able to connect to people whose lives have been shaken by nature's awesome and terrible power. I have seen the tremendous damage a storm can cause and have heard the stories from people…… REAL PEOPLE, about how their lives were shattered, and I even got to enjoy playing a small part in their life's restoration. In short, it is an exciting career that pays well while still giving you freedom. However, this is only true if you are able to unlock the many doors that stand between you and the life you have always wanted. A typical scenario for many new adjusters attempting to enter into the industry is finding themselves overwhelmed, confused, misled, and walking for months or years in circles still trying to find a solid way into the industry.  Sadly, because of this difficulty and confusion, many new adjusters give up. I am here to tell you that the code is cracked inside of this book. This book is about my own experiences and the experiences of dozens of others that I have either interviewed on my podcast (The Independent Adjusters Podcast) or have worked closely with inside the adjusting world. Having heard their stories of how they successfully navigated the industry, I found the correlations between all of our success stories and have created a roadmap for you to follow that will exponentially increase your chances of success in this industry while removing the guesswork from your new career. There are three main parts to this book. The first section is called “The Decision”. Inside this first section, we will cover what exactly an adjuster is and will correctly set your expectations about the career, allowing you to make an educated decision on whether to pursue insurance adjusting as a career. Part two of the book is “The Strategy”. Here, I will show why the typical way (that is spouted on the Internet) of thinking about becoming an adjuster is highly flawed. I will also discuss the overall strategy that you will need to employ for your new career and why it is important to your success. The final part of the book is “The Roadmap”. The Roadmap is a list of the steps that you will need to take along with the instructions to accomplish each step. Rather than leaving you to try and figure this process out on your own, I knew I needed to create this step by step guide for you to follow. The Roadmap is the playbook that other successful adjusters, including myself, have followed to find success and a fulfilling career in insurance adjusting. This book is not just an interesting or fun explanation of a job, it is a call to action. Either to embrace your dreams of becoming an adjuster or to abandon them.  See, as independent adjusters and appraisers, we can't hide behind corporate logos, processes, and profits. We are spending our own money and putting our reputation on the line. We have to figure out how to get work, assignments, and of course, more income. All of this needs to be accomplished without wasting time or money. These are the questions and issues at hand, and this book will guide you to the answers. My name is Chris Stanley, and this is the Independent Adjuster's Playbook. Join myself and other independents on our path to non-corporate success in the insurance industry…… WE ARE IA's!

2 Timothy 4:1-5 Introduction You may or may not know that I’m involved in the area of apologetics. If you are not familiar with apologetics, it is about providing reasons for holding to the Christian faith. It often includes a defence against attacks on the faith. To some, that might seem like a distraction from… Read more

In this inaugural episode, Darrell White, MD, gives the background of how he came to be Healio.com/OSN’s first podcaster, starting out from blogging, to The Dry Eye columnist to podcaster. While becoming known as Healio.com/OSN’s dry eye disease expert, he delves into his background as an anterior segment ophthalmologist with a cross-interest in business and the ongoing arc of his career. Disclaimer :09 Introduction: “You have been reading my blog posts, haven’t you?” 1:00 It’s great you’re a dry eye expert, but do you still operate? 2:22 Who am I and why should you care what I think? 2:51 The arc of an ophthalmology career 3:23 Starting out in private practice 3:57 How did I get into ophthalmology? 4:45 Thinking about the intersection between health care and commerce 9:10 Finding your voice by taking care of patients 10:40 Lessons learned starting a private practice during an economic recession 11:59 Demographics are on the side of the ophthalmologist 13:25 Making the connection between industry and patient care 14:34 Let’s have a conversation about ideas 14:38

You may know how the urban dictionary defines “friends with benefits” but true friendship brings the greatest benefit. Your spouse was designed to be your truest and most intimate friend with signifiant benefits. “This is my lover, this my friend…” (Song 5:16 NIV)   Introduction You may know how the urban dictionary defines “friends with […]