Podcasts about Jama

Chris Boyer and Reed Smith bring in two people who worked the problem from the inside. Chris Hemphill of Modular Feedback, who builds AI for a living, and Heather Nairn, a healthcare economist who reads this as an access problem first. The reflex across the industry is to point AI at the mess. Standardize the data, set some agents loose, let the model sort it out. Hemphill and Nairn tested that reflex against a plain deterministic workflow on exactly this job. The workflow won on accuracy, on speed and on cost. Their point is not that AI is useless here. It is that the most useful skill in this work is knowing when not to reach for it. The deeper problem is structural. Provider data is a commodity. Every payer and every health system chases the same handful of fields, guards its copy as proprietary, and rebuilds the same record in parallel. Every cycle spent on that is a cycle not spent on the access work that moves outcomes. Transportation, care coordination, the patient in crisis who just needs a number that connects. Mentions from the Show: U.S. Senate Finance Committee, Ghost Network Secret Shopper Study, May 2023: https://www.finance.senate.gov/imo/media/doc/050323%20Ghost%20Network%20Hearing%20-%20Secret%20Shopper%20Study%20Report.pdf HHS Office of Inspector General, behavioral health network issue brief, October 2025 (72% of listed clinicians non-participating) New York Attorney General, "Inaccurate and Inadequate: Health Plans' Mental Health Provider Directories" (EmblemHealth investigation) American Psychiatric Association class-action complaint against EmblemHealth, January 2026: https://psychiatryonline.org/doi/full/10.1176/appi.pn.2026.03.3.15 CMS Final Rule CMS-4208-F2, finalized September 2025 (MA directory data to Medicare Plan Finder by plan year 2027; 85% accuracy threshold) Ideon, CMS Provider Directory Requirements compliance guide, March 2026 (48.74% of MA provider locations carry at least one inaccuracy): https://ideonapi.com/resources/blog/cms-provider-directory-requirements-a-complete-compliance-guide-for-2026-2027/ JAMA, AI-assisted directory inconsistency study, University of Colorado researchers (81% of physicians show inconsistencies), via Healthcare Dive: https://www.healthcaredive.com/news/inconsistent-physician-directories-no-surprises-act/645307/ Modular Feedback (Chris Hemphill), deployment write-up: https://modularfeedback.com/blog Chris Hemphill on LinkedIn: https://www.linkedin.com/in/chrishemphill/ CONFIRM handle Heather Nairn on LinkedIn: CONFIRM URL Reed Smith on LinkedIn: https://www.linkedin.com/in/reedtsmith/ Chris Boyer on LinkedIn: https://www.linkedin.com/in/chrisboyer/ Chris Boyer website: http://www.christopherboyer.com/ Chris Boyer on BlueSky: https://bsky.app/profile/chrisboyer.bsky.social Reed Smith on BlueSky: https://bsky.app/profile/reedsmith.bsky.social Learn more about your ad choices. Visit megaphone.fm/adchoices

In this World Shared Practice Forum Podcast, first authors Drs. Frances Balamuth and Chanu Rhee describe the objectives and methodology for their study “National Estimates of Pediatric Sepsis in US Hospitals Using Clinical Data” published in the March 2026 edition of JAMA. They discuss the process of modifying the Phoenix Sepsis Criteria to an electronic health record-based Pediatric Sepsis Event (PSE) definition and the methods for validating this definition. The authors share salient findings from their study, noting the limitations, and share their hopes for the future direction of sepsis surveillance research. LEARNING OBJECTIVES - Understand the derivation for the Pediatric Sepsis Event definition for electronic health record-based pediatric sepsis surveillance - Review the validation process for the Pediatric Sepsis Event definition - Compare the Pediatric Sepsis Event definition to the Phoenix Sepsis Criteria - Discuss the results and limitations of the electronic health record-based study design - Express the goals for the future direction of pediatric sepsis surveillance research AUTHORS Frances Balamuth, MD, PhD, MSCE Professor of Pediatrics, Chief of Pediatric Emergency Medicine University of Pennsylvania Perelman School of Medicine Children's Hospital of Philadelphia Chanu Rhee, MD, MPH Associate Professor of Population Medicine Harvard Medical School and Harvard Pilgrim Health Care Institute Traci Wolbrink, MD, MPH‌ Senior Associate in Critical Care Medicine; Department of Anesthesiology, Critical Care and Pain Medicine Boston Children's Hospital Associate Professor of Anesthesia Harvard Medical School DATE Initial publication date: June 23, 2026. ARTICLES REFERENCED Rhee C, Balamuth F, Dysart K, et al. National Estimates of Pediatric Sepsis in US Hospitals Using Clinical Data. JAMA. 2026;335(15):1321-1331. https://pubmed.ncbi.nlm.nih.gov/41865411/ TRANSCRIPT https://cdn.bfldr.com/D6LGWP8S/as/swj4kvkgg686b6p9whmbht/20260622_WSP_Rhee_and_Balamuth_Transcript Please visit: www.openpediatrics.org OPENPediatrics™ is an interactive digital learning platform for healthcare clinicians sponsored by Boston Children's Hospital and in collaboration with the World Federation of Pediatric Intensive and Critical Care Societies. It is designed to promote the exchange of knowledge between healthcare providers around the world caring for critically ill children in all resource settings. The content includes internationally recognized experts teaching the full range of topics on the care of critically ill children. All content is peer-reviewed and open-access, thus at no expense to the user. For further information on how to enroll, please email: openpediatrics@childrens.harvard.edu CITATION Balamuth F, Rhee C, O'Hara JE, Wolbrink TA. National Estimates of Pediatric Sepsis. 06/2026. OPENPediatrics. Online Podcast. https://soundcloud.com/openpediatrics/new-national-estimates-of.

High performers are exceptional at supporting others. They are often much less exceptional at being supported themselves. In this episode, Dr Jo Braid unpacks why professional isolation is so common in healthcare — and what to actually do about it. You'll hear: Why medical culture trains us to see help-seeking as weakness - The neuroscience of social connection and what chronic isolation does to your decision-making - The difference between a mentor, a coach, and a peer — and why you need all three - The three-column support audit tool - The debrief walk and why movement + connection is a different thing to either alone Research referenced: - Dr Matthew Lieberman (UCLA) — the social brain and reward pathways - Dr Amy Edmondson (Harvard) — psychological safety and team performance - JAMA research — one trusted person and burnout outcomes in physicians Action step this week: Do the support audit. Three columns: Mentor / Coach / Peer. Five minutes. Honest answers. Pick the most depleted column and identify one name. This podcast is supported by MIGA: www.miga.com.au Connect with Jo:

CardioNerds (Amit and Dan), Billy Joe Mullinax, and Saahil Jumkhawala discuss the long term management of pulmonary embolism with Dr. Soophia Naydenov.  The episode focuses on the approach to patients who struggle with persistent symptoms like dyspnea and fatigue even after completing the acute phase of anticoagulation. This spectrum of disease, ranging from mild post-PE impairment to chronic thromboembolic pulmonary hypertension (CTEPH), requires a structured follow-up. The discussion covers the critical importance of identifying CTEPH early, the necessary timelines for follow-up, and the appropriate objective screening tools and invasive testing to guide patient care toward full functional recovery. Audio editing by CardioNerds academy intern, Grace Qiu. Dr. Dinu Balanescu and Dr. Billy-Joe Mullinax are Co-chairs for the CardioNerds PE Series, developed in collaboration with the PERT Consortium.   Enjoy this Circulation 2022 Paths to Discovery article to learn about the CardioNerds story, mission, and values. CardioNerds Pulmonary Embolism PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Acronyms PE: Pulmonary Embolism PERT: Pulmonary Embolism Response Team CTEPH: Chronic Thromboembolic Pulmonary Hypertension QL: Quality of Life VTE: Venous Thromboembolism DASH: D-dimer, Age, Sex, History of non-provoked PE (a risk score) CPET: Cardiopulmonary Exercise Testing PFTs: Pulmonary Function Tests VQ Scan: Ventilation-Perfusion Scan DOACs: Direct Oral Anticoagulants TPA: Tissue Plasminogen Activator (Thrombolytics) ECMO: Extracorporeal Membrane Oxygenation Pearls: Post-PE “Syndrome” is a Spectrum: It is more accurately a spectrum of disease (sequelae of PE) rather than a single syndrome, ranging from mild fatigue/dyspnea to the most severe form, CTEPH. Structured Follow-up is Mandatory: All PE survivors need a structured follow-up, typically with checkpoints at 3, 6, 12, and 16–24 months, with the primary goal being to detect CTEPH, the deadliest, yet potentially curable, disease on the spectrum. Screening Should Be Objective and Practical: When screening for persistent symptoms, use objective assessment tools like the Post-VTE Functional Status (PVFS) scale or the Modified Medical Research Council (MMR-C) scale, as highly comprehensive but cumbersome tools (like the PE Quality of Life questionnaire) may not be practical for routine clinical use. Recurrence Risk Scores Aid in Anticoagulation Duration: Simple scores like the DASH score or the HERDO2 score (for women) can provide guidance when considering the continuation versus discontinuation of anticoagulation after the initial treatment phase. Invasive Testing for Persistent Symptoms: If a patient remains symptomatic at the 6-month mark despite normal non-invasive testing (chest X-ray, ECG, PFTs, six-minute walk, echo, VQ scan, CPET), consider invasive testing such as Right Heart Catheterization (RHC) at rest or with exercise, or an invasive CPET. Notes: Notes drafted by Saahil Jumkhawala. 1. The Spectrum of Post-PE Disease The term “post-PE syndrome” should be used with caution, as it refers to a spectrum of disease rather than a single entity. This spectrum includes symptoms (sequelae) that exist in a patient’s life following an incidental PE event that they did not have before. On one extreme is Chronic Thromboembolic Pulmonary Hypertension (CTEPH): The definition is clear, but it is the most deadly type, though thankfully rare (2% to 4%). It involves a residual clot and pulmonary hypertension identifiable at rest. In the middle is Chronic Thromboembolic Disease (CTED): Patients may have residual defects seen on a VQ or CT scan, but they do not have pulmonary hypertension. On the other side is a milder disease, which can include fatigue, dyspnea, or a patient’s perceived impairment, where the definitions of CTEPH and CTED are not met, but the patient remains symptomatic. 2. Structured Follow-up and Screening for Post-PE Symptoms Structured follow-up is key for all PE survivors, though the structure may vary based on available resources (PCP, Cardiology, Pulmonary, or multidisciplinary clinic). Recommended Timeline for Follow-up: Data from studies like ELOPE and FOCUS suggest checkpoints at 3, 6, 12, and up to 16 to 24 months. This timeline is designed to identify patients who may develop CTEPH. 88% of patients who develop CTEPH will be identified within about a year. A structured follow-up can reduce the delay in CTEPH diagnosis from 10–12 months to 4–6 months. Personal Practice Note: A quick 2–3 week/30-day check-in is recommended for severely ill patients (e.g., those who had TPA, profound shock, or ECMO support) to ensure medication compliance, manage symptoms, and identify red flags. Screening Tools (Objective Assessment): The first step is an inventory of patient symptoms, leaning toward objective rather than subjective assessment. Recommended Simple Tools: Modified Medical Research Council (MMR-C) for dyspnea evaluation. Post-VTE Functional Status (PVFS) scale. The Pulmonary Embolism Quality of Life (QL) questionnaire is comprehensive but long, making it tedious and better suited for research. Future Utility: Technology (AI/electronic tools) may assist in administering these questionnaires before the clinic visit, presenting the information as a “dashboard” for the provider. 3. Management of Persistent Symptoms and Further Testing Initial Non-Invasive Tests (Often done at 3 months): Echocardiogram VQ Scan Full PFTs Six-minute walk CPET Further Evaluation for Persistent Symptoms (e.g., at 6 months): If non-invasive tests (Chest X-ray, ECG, CPET) are normal but symptoms persist, more invasive testing should be considered as the patient has not returned to baseline. Repeat VQ scan or echocardiogram if symptoms have changed. Right Heart Catheterization (RHC) at rest or with exercise. Invasive CPET. PA gram (Pulmonary Angiogram) to assess vasculature. 4. Recurrence Risk and Anticoagulation Duration The decision to continue or discontinue anticoagulation depends on the patient’s risk factors, the situation of the PE (provoked or unprovoked), presence of active cancer, and patient preference. Recurrence Risk Scores: Simple scores are preferred for practicality. DASH Score. HERDO2 Score (particularly for women). The Vienna Score can be considered if the question is whether to restart anticoagulation after a disruption. Role of D-dimer in Abbreviation: While D-dimer can be used to guide the decision to restart anticoagulation after a planned pause (if D-dimer is high, resume), patient symptoms are preferable to guide management decisions like early abbreviation. 5. Prevention of Post-PE Syndrome Currently, there is no clear tool known to prevent the post-PE syndrome/spectrum of disease. Best Current Advice for Prevention/Recovery: Anticoagulation compliance. Pulmonary rehabilitation, which aids in faster recovery. General precautions, such as smoking cessation and body weight management. Future Research: Ongoing trials are investigating whether acute management strategies (e.g., using thrombolytics in intermediate-risk PE) can prevent long-term sequelae. (The PYTHO trial did not show a reduced rate of CTEPH in intermediate-risk PE patients who received thrombolytics). References: Khan, F., Tritschler, T., Kahn, S. R., & Rodger, M. A. “Venous Thromboembolism.” The Lancet, vol. 398, no. 10294, 2021, pp. 64-77. doi:10.1016/S0140-6736(20)32658-1. Kearon, C., & Kahn, S. R. “Long-Term Treatment of Venous Thromboembolism.” Blood, vol. 135, no. 5, 2020, pp. 317-325. doi:10.1182/blood.2019002364. Kahn, S. R., & de Wit, K. “Pulmonary Embolism.” The New England Journal of Medicine, vol. 387, no. 1, 2022, pp. 45-57. doi:10.1056/NEJMcp2116489. Di Nisio, M., van Es, N., & Büller, H. R. “Deep Vein Thrombosis and Pulmonary Embolism.” The Lancet, vol. 388, no. 10063, 2016, pp. 3060-3073. doi:10.1016/S0140-6736(16)30514-1. Chopard, R., Albertsen, I. E., & Piazza, G. “Diagnosis and Treatment of Lower Extremity Venous Thromboembolism: A Review.” JAMA, vol. 324, no. 17, 2020, pp. 1765-1776. doi:10.1001/jama.2020.17272.

Cancer Caused by His Volunteer Work at a New York Attack: A 9/11 Volunteer's Fight Against Lung Cancer, Trauma, and Finding Hope. Those words summarize a journey that began with selfless service and evolved into a decades-long battle for survival. Twenty-five years after volunteering at Ground Zero following the September 11 terrorist attacks, Craig Sotkovsky continues fighting a different enemy, an aggressive form of lung cancer linked to toxic exposure at the World Trade Center. The Law Enforcement Talk Radio Show and Podcast social media like their Facebook , Instagram , LinkedIn , Medium and other social media platforms. His remarkable story is featured on the Law Enforcement Talk Radio Show and Podcast website, available on Apple Podcasts, Spotify, and shared across Facebook, Instagram, LinkedIn, X, and other major News and podcast platforms. The episode is available to listen to Free. The Podcast is available for free on the Law Enforcement Talk Radio Show and Podcast website, also on Apple Podcasts, Spotify, YouTube, iHeartradio and most major podcast platforms. #LawEnforcementTalk #Free #Podcast #Radio One Decision Changed Everything On September 11, 2001, Craig Sotkovsky watched history unfold from his home in Jersey City, New Jersey. Supporting articles about this and much more from Law Enforcement Talk Radio Show and Podcast in platforms like Medium , Blogspot and Linkedin. Like millions of Americans, he watched in disbelief as the Twin Towers collapsed after terrorists hijacked commercial airliners and carried out one of the deadliest attacks in U.S. history. But unlike most Americans, Craig didn't remain a spectator. A skilled carpenter and mason, he volunteered to help. He joined the bucket brigade at Ground Zero and spent two of the first five days working in the debris field following the collapse of the World Trade Center. Cancer Caused by His Volunteer Work at a New York Attack: A 9/11 Volunteer's Fight Against Lung Cancer, Trauma, and Finding Hope. The episode is available across major platforms including their website, Apple Podcasts, Spotify, YouTube, with highlights shared across their Facebook, Instagram, and LinkedIn profiles. At the time, he believed he was simply helping his country. He had no idea the toxic dust surrounding him would follow him for the rest of his life. "Twenty-five years ago, I answered a call for help." The Hidden Cost of Being a Volunteer Ground Zero contained a dangerous mixture of pulverized concrete, asbestos, glass fibers, lead, fuel residue, and countless other hazardous materials released when the towers collapsed. Available for free on the Law Enforcement Talk Radio Show and Podcast website, also on Apple Podcasts, Spotify, Youtube and most major Podcast networks. Years later, Craig received devastating news. He had developed a rare and aggressive lung cancer connected to his exposure at the World Trade Center. The diagnosis transformed every part of his life. He underwent multiple cancer surgeries. He endured physical pain, emotional trauma, and overwhelming financial hardship. The illness eventually cost him nearly everything. "Cancer changed everything." More Than a Medical Battle Craig explains that surviving cancer became more than simply recovering from surgery. It became a complete rebuilding of his identity. He describes losing financial security, emotional stability, and the life he once knew. The Podcast is available for free on the Law Enforcement Talk Radio Show and Podcast website, also on Apple Podcasts, Spotify, YouTube, iHeartradio and most major podcast platforms. Yet amid tremendous hardship, he discovered something unexpected. Purpose. "Growth can come from pain." That philosophy became the foundation for what Craig now calls "Gro-Win Through Pain," a message encouraging others to find strength through life's darkest moments. Cancer Caused by His Volunteer Work at a New York Attack: A 9/11 Volunteer's Fight Against Lung Cancer, Trauma, and Finding Hope. Trauma Doesn't Always End When the Crisis Is Over Many people associate September 11 with the horrific events of that single morning. Craig reminds listeners that for thousands of responders, recovery workers, and volunteers, the disaster never truly ended. For many, the effects emerged years later through chronic illness, cancer, respiratory disease, and lasting emotional trauma. The Law Enforcement Talk Radio Show and Podcast continues bringing listeners real conversations from the front lines of crime, policing, trauma, survival, and healing. His story highlights the reality that some of the greatest wounds are invisible for years. Research Continues to Show Elevated Cancer Risks Craig's experience reflects what researchers have documented for years. Studies examining World Trade Center responders have found elevated rates of several cancers among those exposed to Ground Zero dust. One study published in JAMA followed more than 12,000 World Trade Center responders. Researchers found that participants reporting heavier exposure experienced nearly three times the incidence of lung cancer compared with responders reporting minimal exposure, even after accounting for smoking history and other demographic factors. Cancer Caused by His Volunteer Work at a New York Attack: A 9/11 Volunteer's Fight Against Lung Cancer, Trauma, and Finding Hope. The complete interview is available as a Free Podcast on Facebook, Instagram, YouTube, Apple Podcasts, Spotify, LinkedIn, and major podcast platforms. While every individual's medical history is unique, Craig's diagnosis illustrates the very real health consequences many volunteers and first responders continue to face decades later. A Mission Across America As the 25th anniversary of September 11 approaches, Craig is preparing for another mission. He plans to travel across America in an RV to honor those who lost their lives, recognize responders and volunteers still living with the consequences of that day, and share stories of resilience, perseverance, and hope. His journey is no longer defined by cancer. It is defined by purpose. An Inspiring Conversation On the Law Enforcement Talk Radio Show and Podcast, Craig Sotkovsky shares the emotional details of witnessing the attacks, volunteering at Ground Zero, developing lung cancer, enduring repeated surgeries, and learning how to move forward despite overwhelming adversity. Cancer Caused by His Volunteer Work at a New York Attack: A 9/11 Volunteer's Fight Against Lung Cancer, Trauma, and Finding Hope. Listeners can hear the complete interview on Facebook, Instagram, YouTube, Apple Podcasts, Spotify, iHeartRadio, and other major Podcast, Radio, News, and Media platforms. His story serves as a reminder that true courage often continues long after the cameras disappear. Sometimes the greatest heroes are those who quietly keep fighting years after the world has moved on. Listen Free Today Hear Craig Sotkovsky's incredible story on the Law Enforcement Talk Radio Show and Podcast. The episode is available Free on the Law Enforcement Talk Radio Show and Podcast website, also on Apple Podcasts, Spotify, and is promoted across Facebook, Instagram, LinkedIn, X, and other major podcast and News platforms. Cancer Caused by His Volunteer Work at a New York Attack: A 9/11 Volunteer's Fight Against Lung Cancer, Trauma, and Finding Hope. This powerful conversation explores sacrifice, resilience, recovery, and the lasting impact of trauma from one of America's darkest days. The podcast is available on Facebook, Instagram, YouTube, Apple Podcasts, Spotify, LinkedIn, and other major podcast platforms. If Craig's story inspires you, please share this article so more people understand the sacrifices made not only on September 11, but for decades afterward. Listen to the full story on the Free Podcast, available on the Law Enforcement Talk Radio Show and Podcast Website, on Facebook, Instagram, YouTube, Apple, Spotify, and more. Be sure to follow us on X , Instagram , Facebook, Pinterest, Linkedin and other social media platforms for the latest episodes and news. Learn and get access to money saving tips and how to increase your net worth at www.LetSavings.com Listen to this powerful #Free Podcast episode featuring Marci Hopkins on Facebook, Instagram, Youtube, Apple Podcasts, Spotify, and major Podcast platforms nationwide. Download the Free Ebook about ways and tips to improve your health. You can get the ebook for free at www.LetHealthy.com Get the Free Clubhouse App, it is Drop In Social Audio. Think of it as your own talk radio show on your phone, and best of all it is free. Be sure to look for me and follow me, that's John J Wiley or @letradioshow  you can do all that here. The Law Enforcement Talk Radio Show and Podcast social media like their Facebook , Instagram , LinkedIn , Medium and other social media platforms. You can contact John J. “Jay” Wiley by email at Jay@letradio.com , or learn more about him on their website . Find a wide variety of great podcasts online at The Podcast Zone Facebook Page , look for the one with the bright green logo. Be sure to check out our website . Cancer Caused by His Volunteer Work at a New York Attack: A 9/11 Volunteer's Fight Against Lung Cancer, Trauma, and Finding Hope. Attributions Craig Sotovsky JAMA Wikipedia Facebook Facebook Group Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

Johnny Mac shares five good news stories: the USPS is reissuing the 2018 Mister Rogers Neighborhood stamp after it won an encore contest by over 40,000 votes, returning as a Forever stamp with souvenir sheets. In San Francisco Bay, an AI detection system called Whale Spotter uses thermal cameras to spot whales day and night and alert ships to slow down, addressing a rise in gray whale deaths, many from ship strikes. A JAMA study reports tofersen (Qalsody) slowed and sometimes reversed symptoms in a specific form of ALS, with over 20% showing improved strength and function after three years, including a patient who moved from wheelchair use to a cane. In Texas, volunteers set a world record by stacking 19,019 golf balls into a pyramid without adhesives. In Wisconsin, a driver ignored road-closed barricades and drove into wet concrete, prompting a safety reminder.00:00 Five Good News Intro00:10 Mister Rogers Stamp Returns01:28 Whale Spotter Saves Whales02:32 ALS Drug Breakthrough03:56 Golf Ball Pyramid Record04:25 Driver Sinks in Concrete 5 Good News Stories is a daily podcast with five positive, uplifting news stories to brighten your day. New episodes every day. Follow on Apple Podcasts, Spotify, or wherever you listen. Part of the Caloroga Shark Media networkJohn also hosts Daily Comedy NewsUnlock an ad-free podcast experience with Caloroga Shark Media!  For Apple users, hit the banner which says Uninterrupted Listening on your Apple podcasts app. Subscribe now for exclusive shows like 'Palace Intrigue,' and get bonus content from Deep Crown (our exclusive Palace Insider!) Or get 'Daily Comedy News,' and '5 Good News Stories' with no commercials! Plans start at $4.99 per month, or save 20% with a yearly plan at $49.99. Join today and help support the show!Get more info from Caloroga Shark Media and if you have any comments, suggestions, or just want to get in touch our email is info@caloroga.com

What if one of the most important health crises affecting men today wasn't being caused by aging, but by the environment we live in? In this eye-opening solo episode, Darin Olien investigates the alarming decline in testosterone levels, fertility, and reproductive health among men worldwide. Drawing on decades of research, epidemiological studies, environmental science, endocrinology, and public health data, Darin examines the growing evidence connecting endocrine-disrupting chemicals, microplastics, sleep deprivation, chronic stress, poor lifestyle habits, and environmental toxins to declining testosterone levels across generations. From BPA, phthalates, atrazine, PFAS, and microplastics to sleep quality, circadian rhythms, cholesterol metabolism, cortisol regulation, and natural testosterone-supporting strategies, this episode explores what may be one of the most underreported public health issues of our time—and what men can do to take control of their health today.     What You'll Learn Why testosterone levels have been declining for decades The startling research on global sperm count decline How endocrine-disrupting chemicals interfere with hormone production Why BPA and phthalates may disrupt testosterone synthesis The role of atrazine, PFAS, and environmental toxins How chronic stress diverts resources away from testosterone production Why sleep may be the most important testosterone intervention The connection between cholesterol and hormone production How microplastics are being found throughout the human body The surprising relationship between statins and testosterone levels Natural lifestyle strategies that support healthy hormone production Practical steps to reduce environmental exposure and improve health     Chapters 00:00:00 – Welcome to SuperLife 00:00:33 – Sponsor: Fatty15 and cellular health 00:04:17 – The testosterone collapse explained 00:04:51 – Testosterone levels have been declining for decades 00:06:03 – Global sperm count decline and accelerating trends 00:07:02 – Why treating symptoms misses the root cause 00:07:27 – The hidden public health crisis 00:08:03 – Why low testosterone isn't just about aging 00:09:12 – Why hormone health affects longevity 00:09:53 – Low testosterone and increased mortality risk 00:10:35 – Testosterone's role in metabolism and cardiovascular health 00:11:27 – Endocrine-disrupting chemicals and hormone disruption 00:12:44 – BPA and its effects on testosterone production 00:13:59 – Phthalates and their impact on hormone pathways 00:16:00 – Glyphosate, atrazine, and pesticide exposure 00:17:07 – PFAS and reproductive health concerns 00:17:55 – Environmental toxins and population-wide effects 00:18:11 – Sponsor: Shakeology 00:20:02 – Cholesterol and hormone production 00:20:53 – Chronic stress and cortisol dominance 00:21:45 – Actionable solutions begin 00:21:56 – Why sleep is essential for testosterone production 00:23:07 – How sleep deprivation rapidly lowers testosterone 00:23:21 – Light pollution and circadian disruption 00:23:41 – Foods and nutrients needed for hormone health 00:24:23 – Microplastics and testicular tissue 00:24:53 – Statins and unintended hormonal consequences 00:25:39 – A practical testosterone sovereignty protocol 00:25:48 – Water filtration and reducing toxic exposure 00:26:13 – Eliminating plastics and fragrance chemicals 00:26:35 – Why organic food matters 00:26:45 – Sunlight and vitamin D 00:27:05 – Magnesium, omega-3s, and iodine 00:27:26 – Pine pollen and natural androgen support 00:28:01 – Tongkat Ali and ashwagandha 00:28:48 – Strength training and lifestyle interventions 00:29:10 – Habits that naturally support testosterone 00:29:27 – Darin's approach to healthy aging 00:29:37 – Plants, herbs, and common sense 00:29:51 – Reclaiming your health and sovereignty 00:30:00 – Final thoughts and closing message     Thank You to Our Sponsors Fatty15: Get an additional 15% off their 90-day subscription Starter Kit by going to fatty15.com/DARIN and using code DARIN at checkout. Shakeology: Get 15% off with code DARINO1BODI at Shakeology.com.     Join the SuperLife Patreon: This is where Darin now shares the deeper work: - weekly voice notes - ingredient trackers - wellness challenges - extended conversations - community accountability - sovereignty practices Join now for only $7.49/month at https://patreon.com/darinolien     Find More from Darin Olien: Website: darinolien.com Instagram: @darinolien Book: Fatal Conveniences Platform & Products: superlife.com New Show: Roadmap to Happiness     Key Takeaway "The testosterone crisis may be about far more than aging. It may be a reflection of the modern environment itself—one increasingly saturated with endocrine-disrupting chemicals, chronic stress, poor sleep, circadian disruption, and toxic exposures. While many of these forces feel outside our control, the encouraging reality is that many of the most powerful interventions remain accessible: improving sleep, reducing toxic load, eating whole foods, getting sunlight, managing stress, exercising regularly, and reclaiming responsibility for our health. The goal isn't fear. The goal is awareness—and action."     Bibliography/Sources: The Decline — Primary Research Levine, H., Jørgensen, N., Martino-Andrade, A., et al. (2022). Temporal trends in sperm count: A systematic review and meta-regression analysis of samples collected globally in the 20th and 21st centuries. Human Reproduction Update, 29(2), 157–176. https://doi.org/10.1093/humupd/dmac035 Lokeshwar, S. D., Patel, P., Fantus, R. J., et al. (2021). Decline in testosterone levels in men aged 15–40: Results from the National Health and Nutrition Examination Survey (NHANES), 1999–2016. World Journal of Urology, 39(2), 447–452. https://doi.org/10.1007/s00345-020-03227-1 Spital Clinic. (2026, March). Declining testosterone levels by generation. https://www.spitalclinic.com Travison, T. G., Araujo, A. B., O'Donnell, A. B., Kupelian, V., & McKinlay, J. B. (2007). A population-level decline in serum testosterone levels in American men. The Journal of Clinical Endocrinology & Metabolism, 92(1), 196–202. https://doi.org/10.1210/jc.2006-1375 Low Testosterone — Mortality & Disease Risk Muraleedharan, V., Marsh, H., Kapoor, D., Channer, K. S., & Jones, T. H. (2013). Testosterone deficiency is associated with increased risk of mortality and testosterone replacement improves survival in men with type 2 diabetes. European Journal of Endocrinology, 169(6), 725–733. https://doi.org/10.1530/EJE-13-0321 Shores, M. M., et al. (2006). Low testosterone associated with increased all-cause and cardiovascular mortality. Archives of Internal Medicine, 166(15), 1660–1665. https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/410754 Yeap, B. B., Marriott, R. J., Dwivedi, G., et al. (2024). Associations of testosterone and related hormones with all-cause and cardiovascular mortality and incident cardiovascular disease in men. Annals of Internal Medicine. https://doi.org/10.7326/M23-2781 Endocrine Disrupting Chemicals Associations between endocrine-disrupting chemical exposure and fertility outcomes: A decade of human epidemiological evidence. (2024). PubMed Central (PMC12299029). https://pmc.ncbi.nlm.nih.gov/articles/PMC12299029/ Hayes, T. B., Haston, K., Tsui, M., et al. (2002). Herbicides: Feminization of male frogs in the wild. Nature, 419, 895–896. https://doi.org/10.1038/419895a Mechanisms of testicular disruption from exposure to BPA and phthalates. (2020). Journal of Clinical Medicine, 9(2), 471. https://pmc.ncbi.nlm.nih.gov/articles/PMC7074154/ Meeker, J. D., Calafat, A. M., & Hauser, R. (2014). Urinary phthalate metabolites and their biotransformation products: Predictors and temporal variability among men and women. Journal of Exposure Science & Environmental Epidemiology. https://www.sciencedaily.com/releases/2014/08/140814124330.htm Zhao, Q., et al. (2023). Male reproductive toxicity of microplastics: Head and tail of the sperm. Science of the Total Environment, 872, 162181. https://doi.org/10.1016/j.scitotenv.2023.162181 Zhong, B., et al. (2024). Mixed EDC exposure associated with reductions in testosterone and free androgen index. Scientific Reports. https://doi.org/10.1038/s41598-024-76972-z Cortisol, Stress & the HPG Axis Bielohuby, M., et al. (2012). Swiss military cadets prolonged stress study. Psychoneuroendocrinology. Preprints.org. (2025). Sleep deprivation: A modifiable cause. https://doi.org/10.20944/preprints202505.0580.v1 SiPhox Health. (n.d.). Summary of Journal of Clinical Endocrinology & Metabolism data. https://www.siphoxhealth.com Viau, V. (2002). Functional cross-talk between the hypothalamic-pituitary-gonadal and -adrenal axes. Journal of Neuroendocrinology, 14(6), 506–513. https://doi.org/10.1046/j.1365-2826.2002.00798.x Sleep & Testosterone Leproult, R., & Van Cauter, E. (2011). Effect of 1 week of sleep restriction on testosterone levels in young healthy men. JAMA, 305(21), 2173–2174. https://jamanetwork.com/journals/jama/fullarticle/1029127 Reiter, R. J., et al. (2021). Melatonin and male reproductive health: Relationship to oxidative stress, mitochondrial function, and Leydig cell protection. Endocrine. Tan, D. X., Hardeland, R., Manchester, L. C., et al. (2023). Melatonin as a pleiotropic antioxidant hormone. Journal of Pineal Research. Nutrition — Zinc, Vitamin D, Cholesterol Corona, G., et al. (2010). Statin therapy and testosterone levels in men: A systematic review. The Journal of Sexual Medicine. Daniell, H. W. (2002). Hypogonadism in men consuming sustained-action oral opioids. The Journal of Pain, 3(5), 377–384. https://doi.org/10.1054/jpai.2002.126790 Pilz, S., Frisch, S., Koertke, H., et al. (2011). Effect of vitamin D supplementation on testosterone levels in men. Hormone and Metabolic Research, 43(3), 223–225. https://doi.org/10.1055/s-0030-1269854 Prasad, A. S., Mantzoros, C. S., Beck, F. W., Hess, J. W., & Brewer, G. J. (1996). Zinc status and serum testosterone levels of healthy adults. Nutrition, 12(5), 344–348. https://doi.org/10.1016/S0899-9007(96)80058-X Natural Testosterone Support — Botanical Evidence Pine pollen impacts testosterone-related symptoms in men. (2024). ACMCR Case Reports, 14(5), 1–9. Chinnappan, S. M., George, A., et al. (2021). Effect of Eurycoma longifolia standardised extract Physta on testosterone levels in ageing males: A randomised, double-blind, placebo-controlled multicentre study. Food & Nutrition Research, 65. https://doi.org/10.29219/fnr.v65.5647 Lazarev, A., & Bezuglov, E. (2021). Testosterone boosters intake in athletes: Current evidence and further directions. Endocrines, 2(2), 109–120. https://doi.org/10.3390/endocrines2020011 Leisegang, K., et al. (2022). Eurycoma longifolia (Tongkat Ali) improves serum total testosterone in men. Food & Nutrition Research. https://pubmed.ncbi.nlm.nih.gov/36013514/ Leitão, A. E., et al. (2021). 6-month double-blind RCT: Eurycoma longifolia 200mg + concurrent training. Maturitas. https://doi.org/10.1016/j.maturitas.2020.10.005 Lopresti, A. L., Smith, S. J., et al. (2019). An investigation into the stress-relieving and pharmacological actions of an ashwagandha extract. Medicine, 98(37), e17186. https://doi.org/10.1097/MD.0000000000017186 Pandit, S., Biswas, S., Jana, U., De, R. K., Mukhopadhyay, S. C., & Biswas, T. K. (2016). Clinical evaluation of purified shilajit on testosterone levels in healthy volunteers. Andrologia, 48(5), 570–575. https://doi.org/10.1111/and.12482 Saden-Krehula, M., Tajic, M., & Kolbah, D. (1971). Testosterone, epitestosterone and androstenedione in the pollen of Scotch pine Pinus sylvestris L. Experientia, 27(1), 108–109. https://doi.org/10.1007/BF02137731 Wankhede, S., Langade, D., Joshi, K., et al. (2015). Examining the effect of Withania somnifera supplementation on muscle strength and recovery: A randomized controlled trial. Journal of the International Society of Sports Nutrition, 12, 43. https://doi.org/10.1186/s12970-015-0104-9

In this episode of Keeping Abreast, Dr. Jenn Simmons responds to Peter Attia's breast cancer screening episode (#396). Attia asks the right question: why are 42,000 women still dying of breast cancer every year? But his answer, more mammograms and MRI on top, is exactly wrong. Dr. Jenn breaks down, study by study, why that 40-year approach has never moved the death toll.Forty-two thousand women a year. That number has not moved since mammography went mainstream in the 1980s. Detection rates are up, diagnoses are up, and the death toll has not changed. We have been finding more cancer, calling more women patients, and watching the same number of them die. If you have ever scheduled your annual mammogram believing it was the most protective thing you could do, this episode will reframe everything you thought you knew.What You'll LearnWhy the breast cancer death toll has not moved in 40 years, and why more screening is the reasonWhy DCIS is not cancer, why mammography invented it, and what happens to a woman the moment it gets labeled "stage zero"Why an aggressive tumor is aggressive from the day it forms, and why finding it earlier on a mammogram does not change what it does nextWhy mammography catches the cancers least likely to kill you, and routinely misses the ones that willWhat happened when researchers followed 89,835 women for 25 years and compared annual mammography to doing nothing, and why you have never heard about itWhat the Cochrane review found after analyzing every randomized mammography trial ever run, and why Peter Attia addressed it in one sentenceWhy the WISDOM trial, the most significant recent evidence in this space and the one study Attia never mentions, is an indictment of everything he arguedWhy there is no standard radiation dose for a mammogram, and why the woman next to you in the waiting room may have received ten times less than you didWhat the FDA has formally documented about gadolinium staying in the brain and bones for years, and why the women being told to get it every six months are the last women who shouldWhy insulin resistance, chronic inflammation, and toxic burden are among the most powerful drivers of breast cancer risk, and why Attia's episode contained zero mention of any of themResources MentionedPeter Attia, Episode 396 on breast cancer screening: peterattiamd.com/breastcancerscreeningDr. Robin Berzin, founder of Parsley HealthMiller AB, et al. Twenty five year follow-up of the Canadian National Breast Screening Study. BMJ. 2014;348:g366.Gøtzsche PC, Jørgensen KJ. Screening for breast cancer with mammography. Cochrane Database Syst Rev. 2013;(6):CD001877.Zahl PH, et al. Results of the Two-County trial are not compatible with official Swedish breast cancer statistics. Danish Medical Bulletin. 2006;53(4):438–440.Nyström L, et al. Long-term effects of mammography screening: updated overview of the Swedish randomised trials. Lancet. 2002;359:909–19.Esserman LJ, et al. Risk-Based vs Annual Breast Cancer Screening: The WISDOM Randomized Clinical Trial. JAMA. 2026;335(9):763–774.FDA gadolinium-based contrast agent safety communications (2015, 2017, 2018), summarized in Fotenos A, FDA Pediatric Advisory Committee, Sept 2018.Kanda T, et al. High signal intensity in the dentate nucleus and globus pallidus and cumulative gadolinium dose. Radiology. 2014;270(3):834–841.Veenhuizen SGA, et al. Supplemental breast MRI for women with extremely dense breasts: DENSE trial. Radiology. 2021;299(2):278–286.Tabar L, et al. Reduction in mortality from breast cancer after mass screening with mammography. Lancet. 1985;325:829–32.To talk to a member of Dr. Jenn's team and learn more about working privately with Dr. Jenn visit: https://calendly.com/stephanie-1031/clarity-callTo get your copy of Dr. Jenn's book, The Smart Woman's Guide to Breast Cancer, visit: https://tinyurl.com/SmartWomansBreastCancerGuideTo purchase the auria breast cancer screening test go here https://auria.care/ and use the code DRJENN20 for 20% Off.Connect with Dr. Jenn:Website: https://www.jennsimmonsmd.com/Facebook: https://www.facebook.com/DrJennSimmonsInstagram: https://www.instagram.com/drjennsimmons/YouTube: https://www.youtube.com/@dr.jennsimmons

At Euroanaesthesia in Rotterdam, TopMedTalk hosts Andy Cumpsty and Kate Leslie speak with Denise Veelo Professor of Anesthesiology at the Amsterdam University Medical Center and Bernd Saugel Professor of Anesthesiology and Vice Chair of the Department of Anesthesiology in the Center of Anesthesiology and Intensive Care Medicine at the University Medical Center Hamburg-Eppendorf, about two JAMA blood-pressure trials published on the same day. Veelo describes a 3,500-patient, two-center randomized trial comparing usual care (MAP 65) with more intensive, risk-stratified higher MAP thresholds (70/80/90) using a functional recovery primary outcome, stopped early for futility. Saugel outlines the 1,300-patient IMPROVE trial in 15 German centers, individualizing the lower intervention threshold to each patient's preoperative nighttime MAP versus routine MAP 65, with a 7-day composite outcome; no significant difference was found and event rates were ~30%. They conclude routine targeting substantially above MAP 65 is not supported for broad populations, note special circumstances may differ, and they discuss limitations, vasopressor-heavy practice, and future research including the ASPIRE 85 delirium-focused trial and work on autoregulation and physiology. -- The 2026 International Practicum on Cardiopulmonary Exercise Testing will be held at the Balmer Lawn Hotel in Brockenhurst, UK, from September 16th to 18th this year. It is organised by iPOETTS , the international perioperative testing and training society. Come and join us at this premier educational event designed for clinicians, scientists, and healthcare professionals interested in sport, exercise, and perioperative medicine. This is an International Perioperative Testing and Training Society accredited event so when you attend you can get your iPOETTS accreditation, showing that you are a practitioner who has reached a high, standardized level of competence in performing and interpreting Cardiopulmonary Exercise Testing (CPET) for patients preparing for major surgery. Go now to http://www.ebpom.org

Editor's Summary by Kirsten Bibbins-Domingo, PhD, MD, MAS, Editor in Chief, and Preeti Malani, MD, MSJ, Deputy Editor of JAMA, the Journal of the American Medical Association, for articles published from June 13-18, 2026.

Testosteron fylder mere end nogensinde på sociale medier – men hvad siger evidensen?Anne Møller og Anne Holm er praktiserende læger og seniorforskere. De har gennemgået forskningen og giver dig et overblik. Du får blandt andet svar på, hvornår testosteron bør måles, hvem der kan have gavn af behandling, hvor godt behandlingen virker – og lidt om hvad vi ved om testosteron til kvinder.ReferencerLee et al. Testosterone replacement in men with sexual dysfunction. Cochrane, 2024.Snyder et al. Effects of Testosterone Treatment in Older Men. NEJM, 2016.Lincoff et al. Cardiovascular Safety of Testosterone-Replacement Therapy. NEJM, 2023.Resnick et al. Testosterone Treatment and Cognitive Function in Older Men With Low Testosterone and Age-Associated Memory Impairment. JAMA, 2017.Qaseem et al. Testosterone Treatment in Adult Men With Age-Related Low Testosterone. Ann Intern Med, 2020.Somboonporn et al. Testosterone for Peri- and Postmenopausal Women. Cochrane, 2005.Dansk Endokrinologisk Selskab. Testosteronmangel hos mænd. NBV, 2024.Dansk Selskab for Obstetrik og Gynækologi. Menopausal Hormon Terapi (MHT). DSOG Guideline, 2026Rojas-Zambrano et al. Effects of Testosterone Hormone on the Sexual Aspect of Postmenopausal Women: A Systematic Review. Cureus, 2024.  

In deze podcast spreekt prof. dr. ir. Koos van der Hoeven met oncologisch chirurg prof. dr. Kees Verhoef en internist-oncoloog prof. dr. Henk Verheul beiden van het Erasmus MC te Rotterdam, over de ORCHESTRA-studie bij patiënten met gemetastaseerd colorectaal carcinoom. Aan bod komen onder andere de aanleiding om deze studie op te zetten, het ontwerp van de studie en de resultaten die recentelijk in JAMA gepubliceerd werden.1 Daarnaast bespreken zij de implicaties van de resultaten voor de dagelijkse praktijk.Referentie 1. Gootjes EC, et al. JAMA 2026;335:1311-20.

Dr. Spencer Nadolsky and Karl bring on Dr. Austin Baraki and Dr. Jordan Feigenbaum from the Barbell Medicine crew for a conversation that cuts through one of the most hyped and least understood topics in the health and fitness space right now: the research peptides that millions of people are injecting into themselves based on anecdotes, social media marketing, and the logic that short chain amino acids are natural so they must be fine. In this episode they cover what peptides actually are from a basic biochemistry standpoint and why calling something a short chain amino acids does not make it a food or a supplement it makes it a drug with all the same questions around safety efficacy dosing and long-term effects that any other drug requires, why the explosion of GLP-1 popularity essentially normalized both injectable medications and the idea that if semaglutide works this well what else is out there leading directly to the current peptide boom, why BPC-157 has no randomized controlled trial data in humans and the three human trials that were started were all terminated early with results never published which is a red flag that would make people furious if it were a vaccine but barely registers in the peptide space, why TB-500 has wound healing data when applied topically but nothing when injected despite being universally marketed as a muscle and tendon healer, why MOTS-C has never been tested in humans at all and yet enormous numbers of people are currently injecting it, why the argument that big pharma would sell these if they worked is actually the correct argument and why most of these compounds were abandoned precisely because they failed in trials or showed harm signals, why biological plausibility is a dangerous standard to rely on given that suppressing arrhythmias seemed biologically obvious until the CAST trial showed it killed people and beta blockers for heart failure seemed obviously wrong until trials showed they were life saving, what a randomized controlled trial actually does that anecdote cannot and why thousands of positive experiences are not equivalent to controlled data, why a JAMA study on SARMs sold as research chemicals found that only 18 of 44 products actually contained what was on the label meaning people may not even be getting the compound they think they are getting, why the doctors on this podcast could have made millions of dollars branding and selling their own peptide lines and have specifically chosen not to, and what standard of evidence they believe should be the minimum before recommending any compound to another human being. The Docs Who Lift podcast distills and simplifies the complexities of exercise, medicine, and weight loss. Subscribe so you never miss an episode. Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

近期，一项发表在《JAMA》上的研究引发了广泛关注。数据显示，孕期每日久坐超过10小时，不良妊娠结局的风险将增加122%，几乎翻倍。对于许多因工作、身体疲劳或传统观念而习惯长时间静坐的准妈妈来说，这一数据无疑敲响了警钟。但是，安胎并不意味着要刻意进行高强度的健身运动。研究表明，通过调整日常生活中的微小习惯，即可显著降低风险。

Today we have another Pulm PEEPs Pearls episode about a core critical care topic. Furf and Monty will be giving a high level overview of the use of steroids in sepsis including a review of the relevant literature and recent guidelines, and pragmatic bedside points. Contributors This episode was prepared with research by Pulm PEEPs Associate Editor George Doumat. Dustin Latimer, another Pulm PEEPs Associate Editor, assisted with audio and video editing. Key Learning Points Why Steroids in Sepsis? Steroids do not treat the infection — antimicrobials are always first and remain the cornerstone. The goal is addressing critical illness–related corticosteroid insufficiency (CIRCI), where cortisol production cannot keep up with the overwhelming inflammatory demand of septic shock. Hydrocortisone helps in two main ways: Blunts the dysregulated inflammatory response — tempers the excessive vasodilation and febrile response that drive harm beyond the infection itself. Restores vascular sensitivity to catecholamines — sepsis downregulates adrenergic receptors; steroids turn that responsiveness back on. Clinical takeaway: The first thing you notice is vasopressor weaning (or a bend in the escalation curve) — not a rapid improvement in fever or white count. Caveat: These trials predate modern sepsis phenotyping. None distinguish hyperinflammatory vs. hypoinflammatory responders — they treat all comers. The Evidence: Four Landmark Trials Every IM resident and critical care fellow will eventually journal-club these four. The most consistent signal across all of them is faster shock reversal and reduced vasopressor use; the mortality question remains unsettled. Trial (Year)NRegimenKey FindingAnnane (2002)~300Hydrocortisone + fludrocortisoneMortality benefit in ACTH non-responders; criticized methodology and messy cortisol-response testing; not cleanly replicated.CORTICUS (2008)~500Hydrocortisone aloneFaster shock reversal but no mortality benefit, regardless of cortisol responsiveness. Raised (later allayed) superinfection concern. Cornerstone for abandoning routine cort-stim testing.ADRENAL (2018)~3,800Hydrocortisone aloneFaster vasopressor weaning; no 90-day mortality benefit.APROCCHSS (2018)~1,200Hydrocortisone + fludrocortisoneMortality benefit at 90 days. Bottom line: Faster shock reversal is consistent. Mortality benefit appears in 2 of 4 trials (both used fludrocortisone) but not the others. A 2026 meta-analysis showed benefit for hydrocortisone + fludrocortisone vs. placebo, but not for hydrocortisone + fludrocortisone vs. hydrocortisone alone — suggesting hydrocortisone drives the main effect. Who Gets Steroids, and When? 2021 Surviving Sepsis: Consider steroids for norepinephrine or epinephrine ≥ 0.25 mcg/kg/min for ≥ 4 hours despite adequate resuscitation — a reasonable bedside trigger. Early 2026 update: Moved away from a specific numeric trigger — consider steroids when a septic patient is not responding well to vasopressors or has escalating requirements. Make a clinical decision. (Quality of evidence: low to moderate.) Go faster than the threshold when: Known/suspected adrenal insufficiency or home steroids, or florid pressor-requiring shock on arrival. A practical escalation sequence: escalating norepinephrine → add vasopressin (per VASST) → then add steroids if requirements keep climbing. Do NOT wait for an ACTH stimulation test. It does not reliably predict who responds and only delays treatment. Sepsis is an elevated-cortisol state but can dissociate ACTH and cortisol, and cortisol-binding globulin is depleted — the test is too messy to guide care. What to Give: The Regimen Standard dose: Hydrocortisone 200 mg/day, typically 50 mg IV Q6H. (Original trials often used continuous infusions, rarely used in the U.S.) Some start with a 100 mg bolus to gain control. Higher dose: If chronically on steroids / adrenally insufficient, consider ~300 mg/day (e.g., 100 mg Q8H). Fludrocortisone: Unsettled. The two mortality-benefit trials added it (50 mcg PO/NG/OG daily), but hydrocortisone already has mineralocorticoid activity and meta-analyses don't show added benefit over hydrocortisone alone. Most clinicians omit it — adding it is reasonable and safe, just be honest about the uncertainty. Duration & Tapering Typical course: ~7 days is most common. Trial practices varied (ADRENAL ~7 days; VANISH used a taper after 6 days; some continue until pressors are off). No taper needed. You do not need to taper for adrenal insufficiency after a short course — just stop. If pressors dramatically rebound, you can restart, but most patients have gained the benefit they'll get by day 7. Pitfalls & Safety Hyperglycemia: Expected and must be managed (monitor closely; insulin drip if needed). No signal for major DKA / severe complications in the trials. Superinfection / fungal infection: The most-quoted concern, but the overall literature does not show a convincing, statistically significant increase. Be disciplined about stopping on schedule. Muscle weakness: Steroids can worsen critical illness myopathy; a short 7-day course likely has limited effect, but be aware. Other: GI bleeding (follow general PPI prophylaxis guidance) and sodium disturbances (watch for hyper-/hyponatremia). Two things we know: (1) steroids shorten duration of vasopressor support, and (2) they are relatively safe in sepsis. Whether they improve mortality — and in whom — remains open. The Five Pulm PEEPs Pearls Mechanism: Steroids restore catecholamine vascular sensitivity and blunt dysregulated inflammation. The clinical target is vasopressor weaning, not infection treatment. Evidence: Faster shock reversal is the most consistent finding. Mortality benefit is seen in 2 of 4 trials but not the others — still controversial. Some patients likely benefit; we don't yet know who. Trigger: A practical 2021 threshold is levo/epi ≥ 0.25 mcg/kg/min for ≥ 4 hours. Newer guidance drops the strict number — make a clinical decision based on poor pressor response or escalation. Dose: Hydrocortisone 200 mg/day (e.g., 50 mg Q6H). Adding fludrocortisone mirrors two trials, but meta-analyses find no benefit over hydrocortisone alone. Safety: Steroids appear safe in sepsis. Monitor and treat hyperglycemia; no marked increase in superinfection. References and Further Reading Annane, Djillali et al. “Effect of treatment with low doses of hydrocortisone and fludrocortisone on mortality in patients with septic shock.” JAMA vol. 288,7 (2002): 862-71. doi:10.1001/jama.288.7.862 Sprung, Charles L et al. “Hydrocortisone therapy for patients with septic shock.” The New England journal of medicine vol. 358,2 (2008): 111-24. doi:10.1056/NEJMoa071366 Venkatesh, Balasubramanian et al. “Adjunctive Glucocorticoid Therapy in Patients with Septic Shock.” The New England journal of medicine vol. 378,9 (2018): 797-808. doi:10.1056/NEJMoa1705835 Annane, Djillali et al. “Hydrocortisone plus Fludrocortisone for Adults with Septic Shock.” The New England journal of medicine vol. 378,9 (2018): 809-818. doi:10.1056/NEJMoa1705716 Sun, Alin et al. “Correction: Hydrocortisone combined with fludrocortisone for treatment of adults with septic shock: an updated meta-analysis and systematic review.” Frontiers in medicine vol. 13 1811616. 2 Mar. 2026, doi:10.3389/fmed.2026.1811616 Prescott, Hallie C et al. “Executive Summary: Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2026.” Critical care medicine vol. 54,4 (2026): 715-724. doi:10.1097/CCM.0000000000007089

Are you a dermatologist curious about clinical research — or a seasoned trialist looking to reignite your passion? In this episode of the Science of Skin Podcast, Dr. Ted Lane (Austin, TX) sits down with Dr. Jason Hawkes, Chief Scientific Officer at Oregon Medical Research Center, to pull back the curtain on what it really means to build a career in dermatology clinical trials. From navigating the growing complexity of modern trial protocols to reframing the pharma-physician relationship, Ted and Jason share candid insights that only experienced clinical trialists can offer. They discuss how running trials makes you a sharper diagnostician, why medical dermatology remains one of the most rewarding specialties, and how industry partnerships open unexpected academic and commercial doors. You'll also hear their honest takes on mentorship — including the must-read JAMA article Mentorship Malpractice — and why thinking of your career as a lattice, not a ladder may be the most liberating shift you can make. Whether you're five years into practice or just starting out, this episode is packed with hard-won wisdom on building a meaningful, intellectually stimulating career in dermatology.

Patient safety is often associated with what happens inside the exam room, operating room, or hospital bedside. But what if one of the greatest threats to patient safety occurs long before a patient ever receives care?In this thought-provoking episode of All-Access Pass, Elizabeth Woodcock sits down with Dr. Victor Hassid, Associate Vice President of Access Services and Professor of Plastic Surgery at UT MD Anderson Cancer Center, to discuss his groundbreaking JAMA article, Patient Safety Begins with Access. Together, they explore the powerful argument that delays, barriers, and failures in patient access should be viewed not simply as operational challenges, but as patient safety events. Dr. Hassid shares how fragmented referral processes, scheduling barriers, authorization delays, and care coordination failures can directly impact diagnosis, treatment, and patient outcomes. The conversation also examines the concepts of visibility, accountability, high reliability organizations, and the critical role of data in identifying and preventing access-related harm.Tune in to hear discussions on patient safety, access-related harm, high reliability principles, referral and scheduling barriers, access performance metrics, patient advocacy, health equity, and the future of treating access as a core component of quality and safety in healthcare.

Editor's Summary by Kirsten Bibbins-Domingo, PhD, MD, MAS, Editor in Chief, Linda Brubaker, MD, Deputy Editor, and Christopher W. Seymour, MD, MSc, Associate Editor of JAMA, the Journal of the American Medical Association, for articles published from June 6-12, 2026. Related Content: Audio Highlights

Interview with Amal Isaiah, MD, PhD, MBA, author of Deep Learning in Otolaryngology: A Narrative Review, and Matthew A. Shew, MD, MSCI, author of Shifting the AI Questions in Otolaryngology From “Can We Build a Model?” to “Will It Improve Patient Care?” Hosted by Paul C. Bryson, MD, MBA. Related Content: Deep Learning in Otolaryngology Shifting the AI Questions in Otolaryngology From “Can We Build a Model?” to “Will It Improve Patient Care?”

Interview with Joachim Hübner, MD, SJD, and Alexander Katalinic, MD, authors of Population Skin Cancer Screening and Melanoma Mortality Rates. Hosted by Adewole S. Adamson, MD, MPP. Related Content: Population Skin Cancer Screening and Melanoma Mortality Rates

A University of Kentucky epidemiologist convinced 678 Catholic nuns to donate their brains and their entire life records to science, and the autopsies he performed quietly rewrote everything modern medicine thought it knew about Alzheimer’s disease. The findings have been published in JAMA and the New England Journal of Medicine. Almost nobody outside the field… Continue reading The Power of Gratitude

Cyanotic congenital heart diseases occur in approximately 0.2% of live births in the US, but survival to adulthood is common with current surgical interventions. JAMA Associate Editor David Simel, MD, MHS, speaks with author Michael Landzberg, MD, who coauthored a recent review in JAMA on this topic. Related Content: Survivors of Cyanotic Congenital Heart Disease

Comment se rendre réellement compte de ce qu'ont vécu pendant la traite négrière les personnes transformées en esclaves et transportées à travers l'Atlantique pour être vendues à des planteurs ? Un livre d'histoire qui vient d'être traduit en français nous plonge dans la brutalité du quotidien des esclaves. Cet ouvrage est intitulé Le Zorg, du nom d'un navire négrier à bord duquel s'est déroulé un épisode d'une rare cruauté à la fin du 18e siècle. Une tragédie qui, une fois connue, a joué un rôle déterminant dans le combat des abolitionnistes. Pour en parler, nous recevons l'auteur du livre Siddharth Kara, universitaire à Harvard et à Nottingham. RFI : Que s'est-il passé à bord du Zorg à la fin de l'année 1781 ? Siddharth Kara : Le navire s'est égaré. Il a été détourné par des tempêtes et, au cours de son voyage vers la Jamaïque, il a semblé manquer d'eau. L'équipage a dû prendre une décision… et pour réduire la consommation d'eau, cette décision a été de jeter par-dessus bord plus de 130 esclaves africains. Ils ont commencé, par les femmes et les enfants qu'ils ont jetés directement à la mer, il y avait un bébé. Ensuite, ils ont sélectionné les hommes les plus malades, un par un, deux par deux, enchaînés, entravés. Après de longs mois passés dans l'enfer de la cale de ce navire négrier, ils ont été jetés à la mer. L'équipage a agi ainsi parce qu'il craignait de manquer d'eau et de ne pas atteindre la Jamaïque à temps. Cette histoire a été révélée au public parce que les armateurs ont demandé une indemnisation pour ce qu'ils ont décrit, dans un déni total d'humanité, comme une « cargaison perdue ». Pouvez-vous nous expliquer ce qui s'est passé ensuite ? Le marchand d'esclaves, le propriétaire du navire, était cupide, il était attaché à son argent. Plus de la moitié des esclaves du Zorg étaient morts, alors que le taux de mortalité habituel sur un navire négrier britannique était d'environ 15%... Il n'a pas pu accepter cette perte. Or, à l'époque, les navires et leur cargaison étaient assurés pour la traversée de l'Atlantique. Il a donc déposé une demande d'indemnisation, en réclamant une compensation pour la perte de plus de 130 esclaves. L'assureur a refusé, parce qu'il était surpris par ce taux de mortalité aussi élevé. Le marchand aurait pu en rester là, mais la cupidité l'a poussé à engager un procès. Il a gagné : il a été décidé que l'assurance devait indemniser la perte des esclaves assassinés. Mais quelqu'un assistait à l'audience ce jour-là et s'est demandé pourquoi on parlait d'assurance plutôt que de meurtre. Il a écrit une lettre anonyme posant cette question, publiée le lendemain dans les journaux londoniens. Cette lettre a été remarquée par un groupe naissant d'abolitionnistes en Angleterre, qui y ont vu la preuve des horreurs de la traite. Ils se sont réunis, sous la direction de Granville Sharp, une figure fondatrice de l'abolitionnisme anglais, et ont convaincu les assureurs de demander un nouveau procès. Lors de ce second procès, une question fondamentale a été débattue : ces Africains étaient-ils des biens ou des personnes ? Des animaux ou des êtres humains ? Ce débat, porté devant le Lord Chief Justice de l'Empire britannique, a contribué à lancer le premier mouvement abolitionniste. L'une des forces de votre travail réside dans la précision avec laquelle vous décrivez l'expérience vécue par les personnes capturées et vendues comme esclaves. L'horreur de l'esclavage est démultipliée par des violences constantes : les coups de fouet, les viols, la vie dans la puanteur des excréments, l'enfermement dans les cales. Pouvez-vous donner quelques exemples tirés de votre livre ? Nous savons ce qu'est l'esclavage, nous en connaissons l'existence, mais nous ne plongeons jamais dans l'horreur brute de la traversée forcée des Africains à travers l'Atlantique. À bord des navires, de nombreux instruments de torture étaient utilisés pour maintenir le contrôle. Les violences sexuelles contre les femmes et les enfants étaient constantes. Un ancien capitaine négrier devenu abolitionniste, John Newton, racontait qu'il voyait ses marins assouvir leurs pulsions sur des fillettes de neuf ou dix ans. Dans les cales, les captifs étaient enchaînés, contraints de vivre dans leurs excréments et leur urine, avec à peine quelques seaux inaccessibles. Tous contractaient la dysenterie. Imaginez le mal de mer, les vomissements continus, sans même pouvoir s'asseoir. Ils étaient entassés comme des livres sur une étagère, dans la chaleur, la putréfaction et les immondices. Voilà pourquoi les taux de mortalité étaient si élevés. La puissance des intérêts financiers liés à la traite apparaît clairement dans votre livre. On a l'impression que la traite occupait une place majeure dans l'économie britannique à la fin du 18e siècle. Absolument. Prenons un indicateur : en 1775, juste avant la guerre d'indépendance américaine, les exportations de sucre de la Jamaïque vers l'Angleterre étaient cinq fois supérieures à l'ensemble des exportations des treize colonies américaines réunies. Le sucre était la ressource stratégique de l'époque, produite grâce au travail forcé des esclaves. Comment évaluez-vous la manière dont le monde traite aujourd'hui la mémoire de l'esclavage ? Existe-t-il une conscience globale de ce que cela a représenté, ou observe-t-on encore des formes de déni ? Nous restons encore à la surface de notre reconnaissance de ce qui s'est passé durant ces 350 années, cette tâche sur la conscience humaine. Il existe encore un certain déni quant à l'ampleur et à la gravité des faits. J'espère que l'histoire du Zorg contribuera à une compréhension plus complète, car on ne peut envisager de réparer cette période sans en mesurer pleinement la violence et l'ampleur. Et nous n'y sommes pas encore. Le 25 mars dernier, le Ghana a conduit l'Assemblée générale de l'ONU à qualifier la traite négrière de crime le plus grave contre l'humanité. Cette qualification vous paraît-elle justifiée et utile ? Absolument. Elle est justifiée. Césaire a déclaré que l'Europe se tient devant la communauté mondiale, responsable du plus grand amas de cadavres de l'histoire humaine. Et il parlait de la traite négrière. Des millions de personnes ont été torturées, violentées et tuées, et des millions d'autres condamnées à une vie de travail forcé. La culture du sucre était l'une des formes de travail les plus dures et violentes. C'est l'un des crimes les plus graves en raison de son ampleur, de sa durée — plus de trois siècles et demi — et de ses conséquences encore visibles aujourd'hui en Afrique. Il doit y avoir une forme de réparation entre les pays du Nord et les pays africains. Le Zorg, de Siddharth Kara, un ouvrage publié aux éditions Paulsen, 304 pages, 2026. À écouter aussiDes rives de la Méditerranée au Sahara : vérités et tabous des esclavages dans le monde musulman À lire aussiL'odyssée des Tinchant, de l'esclavage à la résistance: une histoire-monde

Helen Pearson, PhD, is an award-winning biomedical journalist at Nature, named European Science Journalist of the Year in 2025. She teaches science writing at University College London. BEYOND BELIEF is her second, just published book. THE LIFE PROJECT was her first. The points we covered include:—The evolution of evidence over 8 decades, moving from rationalism, expert opinion, hunches (eminence-based) to empiricism, evidence-based—The enormous devastating adverse impact of Dr. Spock's Baby and Child Care book from a single sentence change, leading to an epidemic of sudden infant death syndrome. And how it ultimately got corrected. —The term evidence-based medicine was coined in 1991 at McMaster University—Iain Chalmers, Archie Cochrane and the Cochrane Collaboration“The scandalous failure of science to cumulate evidence scientifically”—Iain Chalmers—Systematic reviews—Natural experiments (such as with Shingles)—Resistance to change“Challenging a doctor's conventional way of practice is like hitting him in the intellectual testicles”—Drummond Rennie, past JAMA editor —Evidence-based practice (and not) in the Covid pandemic—Recent examples of challenging dogma (kindly stones, thymus involution)—AI and misinformation, false evidenceThank you Harshi Peiris, Ph.D., Ageless Mind Project, Anthony Higgins, E West, MagnaAnimus, and many others for tuning into my live video with Helen Pearson! Join me for my next live video in the app.A big thanks to Ground Truths subscribers from every US state and 212 countries. Your subscription to these free essays and podcasts makes my work in putting them together worthwhile. If you're not a subscriber, please join!If you found this interesting PLEASE share it!Paid subscriptions are voluntary and all proceeds from them go to support Scripps Research. They do allow for posting comments and questions, which I do my best to respond to. Please don't hesitate to post comments and give me feedback. Let me know topics that you would like to see covered.Many thanks to those who have contributed—they have greatly helped fund our summer internship programs for the past two years. It enabled us to accept and support a record number of 51 summer interns coming in 2026! These are high school, college and medical students selected from thousands of applicants. We couldn't do this expanded program without the funds coming in throughGround Truths. Get full access to Ground Truths at erictopol.substack.com/subscribe

Group A Streptococcal infections remain a global challenge, spanning common conditions like pharyngitis to severe invasive disease. Dr. Shiranee Sriskandan, Dr. Josh Osowicki, and Dr. Tom Parks join host Dr. Erin McCreary to explore the evolving landscape of Group A Strep. From unpacking vaccine development challenges and the ongoing burden of rheumatic fever, to rethinking durations of therapy for strep throat and the role of adjunctive treatments, we have you covered! Join us as we break down key controversies, share expert insights, and highlight practical pearls you can apply in your own practice. References: 1. https://www.lancefieldsociety.org/ 2. Osowicki J, Lamagni TL. Invasive Group A Streptococcal Disease in the US. JAMA. 2025;333(17):1493-1494. doi:10.1001/jama.2025.3257 3. Davis K, Abo YN, Steer AC, Osowicki J. Chains of misery: surging invasive group A streptococcal disease. Curr Opin Infect Dis. 2024;37(6):485-493. doi:10.1097/QCO.0000000000001064 4. Osowicki J, Azzopardi KI, Fabri L, et al. A controlled human infection model of Streptococcus pyogenes pharyngitis (CHIVAS-M75): an observational, dose-finding study. Lancet Microbe. 2021;2(7):e291-e299. doi:10.1016/S2666-5247(20)30240-8 5. Hla TK, Osowicki J, Marsh JA, et al. Establishing the lowest penicillin concentration to prevent pharyngitis due to Streptococcus pyogenes using a human challenge model (CHIPS): a randomised, double-blind, placebo-controlled trial. Lancet Microbe. 2025;6(5):101038. doi:10.1016/j.lanmic.2024.101038 Learn more about the Society of Infectious Diseases Pharmacists: https://sidp.org/About Instagram: @SIDPharm (https://www.instagram.com/sidpharm/) or @breakpointspodcast_sidp (https://www.instagram.com/breakpointspodcast_sidp/)https://www.instagram.com/breakpointspodcast_sidp/?hl=en Facebook: https://www.facebook.com/sidprx LinkedIn: https://www.linkedin.com/company/sidp/ SIDP welcomes pharmacists and non-pharmacist members with an interest in infectious diseases, learn how to join here: https://sidp.org/Become-a-Member Listen to Breakpoints on iTunes, Overcast, Spotify, Listen Notes, Player FM, Pocket Casts, Stitcher, Google Play, TuneIn, Blubrry, RadioPublic, or by using our RSS feed: https://sidp.pinecast.co/

Editor's Summary by Linda Brubaker, MD, and Preeti Malani, MD, MSJ, Deputy Editors of JAMA, the Journal of the American Medical Association, for articles published from May 30-June 5, 2026.

Fontes do episódio aqui:⁠https://portal.afya.com.br/podcasts/afya-news/05-06-2026Nesta sexta-feira, analisamos atualizações em endocrinologia reprodutiva, uma revolução na terapia celular oncológica e o papel dos jogos sérios no julgamento clínico. Abordamos as diretrizes atualizadas da American Thyroid Association, que estabelecem valores de referência por trimestre para TSH e T4, priorizando o rastreamento direcionado. Detalhamos os dados promissores da nova terapia CAR-T in vivo da Legend Biotech para linfoma não-Hodgkin, que gera as células de defesa diretamente dentro do corpo do paciente. Por fim, discutimos no Radar um estudo do JAMA que comprova como o jogo eletrônico Night Shift reduziu erros médicos e a subestimativa de traumas em idosos na emergência. Afya News. Informação médica confiável e atualizada no seu tempo.

Forget muscle repair. The reason sleep actually transforms your health is happening inside your skull every night — and it's not what Matthew Walker's TED Talk made famous. In this episode of Health Longevity Secrets, Robert Lufkin MD breaks down the real science of sleep: the glymphatic system that flushes beta-amyloid from your brain, the hippocampal "sharp wave ripples" that lock in memories, the slow-wave growth hormone pulse you can't make up, and the testosterone and insulin damage that happens in a single week of short sleep. He closes with the single most evidence-based intervention you can do tonight — and it's not melatonin. CHAPTERS: 00:00 — Why The "Sleep For Muscle Repair" Story Is Wrong 01:00 — Part 1: The Muscle Repair Myth (mTOR, Protein Synthesis, 24–48hr Window) 02:00 — Part 2: The Molecular Truth — The Glymphatic System 02:35 — The 60% Brain Cleaning Cycle (Xie 2013, Beta-Amyloid Clearance) 03:30 — Sharp Wave Ripples and Memory Consolidation in Deep Sleep 03:55 — How Sleep Onset Drives 70% of Your Nightly Growth Hormone 04:30 — Sleep Restriction Drops Testosterone 10–15% in One Week 05:00 — Part 3: The Hormonal Layer — Insulin, Cortisol, Ghrelin 05:15 — 4 Nights, 4 Hours: Prediabetes In Healthy Young Men (Spiegel 1999) 06:30 — Ghrelin, Leptin, and Why You Wake Up Hungrier 07:00 — Part 4: The Practical Tactic — Thermal Regulation 07:30 — The 2–3°F Core Temperature Drop That Triggers Sleep 08:00 — Why a Hot Shower 90 Minutes Before Bed Beats Melatonin 08:45 — The 65–68°F Bedroom Rule 09:15 — Part 5: The Reframe — Sleep Is Neurological, Not Muscular KEY TAKEAWAYS: • Muscle protein synthesis runs 24–48 hours post-workout and does not require sleep architecture — it requires amino acids, energy, and time. • During sleep, your brain's interstitial space expands ~60% to flush metabolic waste, including the beta-amyloid and tau proteins implicated in Alzheimer's. • ~70% of your daily growth hormone is released in the first slow-wave cycle — disrupt the first 90 minutes and you blunt the whole night. • Four nights of 4-hour sleep produced prediabetes-level insulin resistance in healthy young men (Spiegel et al., Lancet 1999). • A hot bath or shower 60–90 minutes before bed shortens sleep latency more reliably than melatonin (Haghayegh et al., Sleep Medicine Reviews 2019). Pair with a 65–68°F bedroom. STUDIES & SOURCES MENTIONED: • Xie L, et al., Science 2013 — Sleep drives beta-amyloid clearance via the glymphatic system — https://pubmed.ncbi.nlm.nih.gov/24136970/ • Spiegel K, Leproult R, Van Cauter E, Lancet 1999 — Sleep debt and metabolic/endocrine function (4-night 4-hour sleep restriction trial) — https://pubmed.ncbi.nlm.nih.gov/10543671/ • Leproult R, Van Cauter E, JAMA 2011 — 1 week of sleep restriction drops testosterone 10–15% in healthy young men — https://pubmed.ncbi.nlm.nih.gov/21632481/ • Haghayegh S, et al., Sleep Medicine Reviews 2019 — Warm shower/bath 1–2h before bed shortens sleep onset latency (meta-analysis of 13 trials) — https://pubmed.ncbi.nlm.nih.gov/31102877/ • Pontzer H, et al., Current Biology 2016 — Constrained total energy expenditure model — https://pubmed.ncbi.nlm.nih.gov/26832439/ • Walker M, "Why We Sleep" (book) — https://en.wikipedia.org/wiki/Why_We_Sleep ─────────────────────────────────

Interview with Luc Thomas, MD, PhD, author of Limits of Artificial Intelligence Models for Skin Cancer Diagnosis in Realistic Settings. Hosted by Adewole S. Adamson, MD, MPP. Related Content: Limits of Artificial Intelligence Models for Skin Cancer Diagnosis in Realistic Settings

Send us a Text Message (please include your email so we can respond!)Episode 93! In this episode we go over TOWAR or "Prehospital Resuscitation with Type O Whole Blood for Trauma and Hemorrhage" by Sperry et all published in NEJM and "Remote Multicomponent Rehabilitation in Intensive Care Unit Survivors" published by O'Neill et al in JAMA both in May 2026 and presented at the ATS International Conference! Then we talk a little bit about some current events with Hantavirus and sepsis that has hit the news cyclesTOWAR (NEJM): https://www.nejm.org/doi/full/10.1056/NEJMoa2602167iRehab (JAMA): https://jamanetwork.com/journals/jama/fullarticle/2849320If you enjoy the show be sure to like and subscribe, leave that 5 star review! Be sure to follow us on the social @icucast for the associated figures, comments, and other content not available in the audio format! Email us at icuedandtoddcast@gmail.com with any questions or suggestions! Thank you Mike Gannon for the intro and exit music! 

Welcome to the latest episode (June 2026) of Diabetes Core Update, where every month Neil Skolnik, MD and John Russell, MD review the most important articles on diabetes, obesity, and cardiometabolic disease. This month on DOC Update: Shah S, et al. "Food Coloring Additives and Incidence of Type 2 Diabetes in the NutriNet-Santé Prospective Cohort Diabetes Care. 2026;49(6):1067–1077. doi.org/10.2337/dc25-2727 Hespanhol L, et al. "Automated Insulin Delivery Systems in Type 2 Diabetes Mellitus: A Systematic Review and Meta-analysis." Diabetes Care. 2026;49(6):1134–1143. doi.org/10.2337/dc25-2435 Tatum K, et al. "Survival and Recurrence With GLP-1 Receptor Agonists in Breast Cancer." JAMA. Published Online: May 11, 2026 2026;9;(5):e2612133. doi:10.1001/jamanetworkopen.2026.12133 Winkler C, et al. "Screening Children for Early-Stage Type 1 Diabetes." JAMA. Published Online: May 21, 2026 doi:10.1001/jama.2026.6085 Würtz Yazdanfard P, Kosjerina V, Wood-Kurland H et al. "Effectiveness and Safety of Semaglutide in Type 1 Diabetes: A Danish Nationwide Cohort Study (2018–2024)" Lancet. Volume 66, 101716, July 2026. doi:10.1016/j.lanepe.2026.101716 Horn D, Aronne L, Wharton S et al. "Tirzepatide for maintenance of bodyweight reduction in people with obesity in the USA (SURMOUNT-MAINTAIN): a multicentre, double-blind, randomised, placebo-controlled trial." Lancet. Published online May 12, 2026. doi:10.1016/S0140-6736(26)00656-2 Presented by: Neil Skolnik, M.D., Professor of Family and Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University; Associate Director, Family Medicine Residency Program, Abington Jefferson Health John J. Russell, M.D., Professor of Family and Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University; Chair-Department of Family Medicine, Abington Jefferson Health For information about the American Diabetes Association's scholarly journals, visit diabetesjournals.org. For more about this podcast, click here.

Send us Fan MailOpioid withdrawal dosing, intranasal breast milk, human milk fortification in Japan, neonatal dysphagia, and vaccine policy. A full week on the Incubator Journal Club.Ben opens with the Optimized NOW trial in JAMA: symptom-based dosing reduced time to medical readiness for discharge by nearly two and a half days in NOWS infants managed with Eat Sleep Console, and allowed 65% of pharmacologically treated infants to avoid scheduled opioids entirely.Daphna reviews a small RCT out of Turkey showing improved cerebral oxygenation and favorable vital sign trends after intranasal breast milk administration in preterm infants, adding to the growing tolerability data for this intervention.Ben then covers the JASMINE trial, a Phase 3 RCT in Japan showing significantly better weight gain velocity with an exclusive human milk diet in very low birth weight infants.Daphna closes with a retrospective cohort study on FEES-confirmed dysphagia in preterm infants. Of those who met criteria for evaluation, every single one had laryngeal penetration and 57% were aspirating.Ben and Eli close the week on the quiet dismantling of vaccine infrastructure in the US and what it means for the populations in your NICU.Support the showAs always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below.Enjoy!

Coffee Helpful or Harmful + Soy & Alcohol and the Truth About Breast Cancer with guest expert Dr. William Li #62What if the habits you already have — your morning coffee, your soy latte, your occasional glass of wine — are actually working for you, not against you? In this episode, Samantha sits down once again with William Li, MD, internationally renowned physician, scientist, and New York Times bestselling author of Eat to Beat Disease and Eat to Beat Your Diet, to cut through decades of nutritional myths and replace fear with facts.From the cancer-fighting compound hiding in your espresso, to the truth about soy and breast cancer risk that 14 published studies now confirm, to what your "healthy" stevia packet may secretly contain — Dr. Li delivers the kind of science-backed clarity that changes how you shop, eat, and think about food as medicine every single day. This is one of those episodes you'll want to share with every woman you love.What You'll LearnThe chlorogenic acid triple-threat: How the natural compound in coffee simultaneously lowers inflammation, activates brown fat to burn visceral fat, AND cuts off the blood supply to cancer cells.Organic coffee is more potent: Why pesticide-free farming causes the coffee plant to produce more chlorogenic acid — meaning organic beans are literally more medicinal.The dairy-in-coffee trap: How dairy fat forms "soap bubbles" around chlorogenic acid, blocking up to 20–30% of its absorption in your gut.Cellular aging and telomeres: How chlorogenic acid has been shown to slow the shortening of telomeres — the protective caps on your DNA — keeping your tissues and organs more vital, longer.The 1–4 cup sweet spot: What the clinical and epidemiological research says about optimal daily coffee intake and how not to get paralyzed by the math.The stevia label scandal: Why a "pure stevia" label can be deceiving — and how the filler erythritol, often hidden inside, has been linked by cardiologists to increased heart attack risk.Soy is nature's tamoxifen: How soy's phytoestrogen (genistein) has a completely different molecular structure than human estrogen — and actually blocks estrogen receptors the same way the breast cancer drug tamoxifen does.14 JAMA-level studies, one conclusion: Every single study examining soy consumption in women at high breast cancer risk found improved survival rates and lower recurrence — with no study showing increased mortality.The 10-gram soy protein target: How one tall glass of soy milk or a small portion of tofu delivers the daily amount studied in clinical trials for breast protection.Emulsifiers and your gut microbiome: Why additives like carrageenan, guar gum, and polysorbate in commercial coffee drinks and plant milks silently alter the healthy bacteria in your gut, raising systemic inflammation.About Our GuestDr. William Li is an internationally renowned physician, scientist, researcher, and author whose work has impacted over 70 diseases, including cancer, diabetes, and cardiovascular disease. He is the founder and president of the Angiogenesis Foundation and is best known for his groundbreaking TED Talk, Can We Eat to Starve Cancer?, which has been viewed by millions worldwide. He is the New York Times bestselling author of Eat to Beat Disease and Eat to Beat Your Diet.

Drop us a line or two . . .This week, TT survives a heroic (if bruising) escape from a dream assailant via an impressive mid-sleep dismount, and Queenie's sister quits her toxic job with no safety net and full support from the hosts. The two dig into a JAMA study on why older adults are cannabis's fastest-growing demographic — and have thoughts about whether "I just like the way I feel" counts as a valid medical reason. Plus: Conan O'Brien's edible anxiety, Gas Pops, a commitment ceremony, and a very spirited TT's Choice about microdosing before job interviews. Welcome to the Closet Disco Queen Pot-Cast, a #1 ranked Women in Cannabis (Feedspot, Million Pods; 2025) comedy podcast with music and pop culture references that keeps you laughing and engaged. Join our hosts, Queenie & TT as they share humorous anecdotes about daily life, offering women's perspectives on lifestyle and wellness. We dive into funny cannabis conversations and stories, creating an entertaining space where nothing is off-limits. Each episode features entertaining discussions on pop culture trends, as we discuss music, culture, and cannabis in a light-hearted and inclusive manner. Tune in for a delightful blend of humor, insight, and relatable stories that celebrate life's quirks and pleasures. Our Closet Disco Queen Pot-Cast deals with legal adult cannabis use and is intended for entertainment purposes only for those 21 and olderVisit our Closet Disco Queen Pot-Cast merch store!Find us on Facebook and Green Coast RadioSound from Zapsplat.com,  https://quicksounds.com, 101soundboards.com #ToneTransfer

Dr. Arreaza: Hello, everyone, my name is Dr. Hector Arreaza, I am a family physician and an associate program director in the Clinica Sierra Vista – Rio Bravo Family Medicine Residency Program.  Today we're discussing one of the most powerful predictors of health that many people rarely think about: geography. Where someone lives can influence everything from access to physicians and emergency care to chronic disease outcomes and life expectancy. Joining us today is Peyton, who will be taking a deeper look into the matter. Peyton, thank you for being here — can you start by introducing yourself, please? Peyton: Hello, thank you for having me. My name is Peyton, I am a 4th year medical student with Western Atlantic University, and I am from a very small town in South Dakota.  Dr. Arreaza: Peyton, you are on your last few days in your FM rotation, when are you graduation?  Peyton, you prepared this topic and it is great. When people hear the phrase “your ZIP code can determine your health,” what does that actually mean? Peyton: It basically means that where someone lives can significantly influence their health outcomes and even life expectancy. A person's ZIP code can affect access to physicians, hospitals, transportation, emergency services, and preventative care. Arreaza: Talking about prevention. The American Heart Association agrees with you because Zip code is not part of the cardiovascular risk calculator called PREVENT. I invite everyone to take a look at this new calculator. I think a lot of people assume healthcare is equal as long as hospitals or clinics exist nearby, right? Peyton: Yes, patients may still struggle with overcrowded healthcare systems, which can lead to long wait times. In fact, a national physician appointment survey found that average wait times for new patient primary care appointments in major cities can exceed three weeks, with some cities reporting significantly longer delays depending on specialty access and provider availability. Dr. Arreaza: And when patients experience those kinds of delays, they may frequently switch between providers, which becomes much harder to establish consistent long-term care. Peyton: One of the biggest issues many patients face is continuity of care — having consistent follow-up with the same provider over time. Dr. Arreaza: And that continuity really matters in medicine, especially family medicine, it is one of our keywords: continuity of care. Peyton: Exactly. Preventative care and chronic disease management work best when patients have long-term relationships with healthcare providers. But in many underserved communities, patients may wait months for appointments, frequently change providers, or rely on emergency rooms instead of primary care clinics. Dr. Arreaza: And urgent care too. When care becomes fragmented, conditions like hypertension, diabetes, and chronic illnesses can become much harder to manage. Peyton: Exactly. Delayed screenings, missed follow-up appointments, and lack of preventative care often lead to patients presenting later with more advanced disease that could have been treated earlier. Dr. Arreaza: And urban communities may face some of the same challenges, but rural communities are at a different level of barriers to health care. Peyton: Absolutely. Rural communities often experience significant physician shortages. According to the Health Resources and Services Administration, over 100 million Americans live in primary care shortage areas, and nearly 65% of those shortage areas are located in rural regions. Peyton: I think one of the biggest solutions starts with strengthening primary care and investing more heavily in underserved communities, especially rural areas. Dr. Arreaza: And that includes increasing the number of physicians going into family medicine and primary care specialties.  Peyton: Here is an interesting fact: According to the Graham Center, Northeastern states receive high graduate medical education (GME) funding but produce relatively fewer primary care physicians. Northwestern states receive low GME funding but perform relatively better, producing slightly above the U.S. average (70.8 vs 69.8 primary care physicians per 100,000 people). However, even this remains far below Canada's average of 119 primary care physicians per 100,000 people.  Right now, the United States is facing a growing physician shortage. According to the Association of American Medical Colleges, the country could face a shortage of up to 86,000 physicians by 2036, with primary care being one of the most affected areas. Arreaza: Another group that may help address the physician shortage is International Medical Graduates. We'll cover this in more detail in a future episode, but it's worth mentioning briefly here. We have highly trained physicians, including neurosurgeons, driving Uber. There is nothing wrong with that work, but their medical skills could be used to help more people. I'll leave our listeners with that thought: IMGs can help. So, Peyton, are you interested in rural medicine? Peyton: I am very interested in Rural medicine, in fact my next few rotations will be back in South Dakota on the Pine Ridge Indian Reservation. Actually, the Pine Ridge Reservation is the poorest Indian Reservation in the country.  Peyton: The measure of any healthcare system is not how well it serves those closest to its centers of power, but how far its reach extends to those who need it most. If we are serious about health equity, the road forward must run through every small town, every county clinic, and every community that has been told to wait its turn. Their turn is now. References Association of American Medical Colleges (AAMC). The Complexities of Physician Supply and Demand: Projections From 2021 to 2036. https://www.aamc.org/workforce American Academy of Family Physicians (AAFP). Rural Practice and Physician Recruitment.https://www.aafp.org Centers for Disease Control and Prevention (CDC). Rural Americans at Higher Risk of Death from Five Leading Causes.https://www.cdc.gov/media/releases/2017/p0112-rural-death-risk.html Cecil G. Sheps Center for Health Services Research. Rural Hospital Closures.https://www.shepscenter.unc.edu/programs-projects/rural-health/rural-hospital-closures/ Chetty R, Stepner M, Abraham S, et al. The Association Between Income and Life Expectancy in the United States, 2001–2014. JAMA. 2016;315(16):1750–1766. https://jamanetwork.com/journals/jama/fullarticle/2513561 Health Resources & Services Administration (HRSA). Health Professional Shortage Areas (HPSAs).https://data.hrsa.gov/topics/health-workforce/shortage-areas Rural Health Information Hub. Healthcare Access in Rural Communities.https://www.ruralhealthinfo.org/topics/healthcare-access Rural Health Information Hub. Transportation to Support Rural Healthcare.https://www.ruralhealthinfo.org/topics/transportation Rural Health Information Hub. Rural Residency Planning and Development. https://www.ruralhealthinfo.org/topics/rural-residency-programs Centers for Disease Control and Prevention (CDC). Health and Access to Care in Rural America.https://www.cdc.gov/ruralhealth/index.html Measure of America. A Portrait of Los Angeles County 2026. Social Science Research Council.https://ssrc-static.s3.amazonaws.com/moa/APortraitofLosAngelesCounty2026.pdf Merritt Hawkins. Survey of Physician Appointment Wait Times and Medicare and Medicaid Acceptance Rates.https://www.merritthawkins.com/news-and-insights/thought-leadership/survey/survey-of-physician-appointment-wait-times/ Fenster, T. L., MD, Park, J., PhD, Huffstetler, A. N., MD, & Topmiller, M., PhD (2026). Graduate Medical Education Funding Does Not Flow to Primary Care Physician Production. American family physician, 113(4), 321–322. https://pubmed.ncbi.nlm.nih.gov/42101593/ Theme song, Works All The Time by Dominik Schwarzer, YouTube ID: CUBDNERZU8HXUHBS, purchased from https://www.premiumbeat.com/. Even without trying, every night you go to bed a little wiser. Thanks for listening to Rio Bravo qWeek Podcast. We want to hear from you, send us an email at RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. See you next week!

Editor's Summary by Linda Brubaker, MD, and Preeti Malani, MD, MSJ, Deputy Editors of JAMA, the Journal of the American Medical Association, for articles published from May 23-29, 2026.

What does it take for a single idea to travel from a research lab in New Haven to war zones in Uganda, refugee camps in Malaysia, and clinics across 30 countries and six continents? In this episode, we sit down with Dr. Myrna Weissman, one of the most consequential figures in modern psychiatry, to find out.Dr. Weissman co-developed Interpersonal Psychotherapy (IPT) alongside her late husband, Dr. Gerald Klerman, on a simple premise: that human suffering is deeply tied to human connection. Grief. Conflict. Loneliness. Life upended. These are not niche clinical categories, but rather a universal language of distress. And IPT was built to respond to it.In this conversation, Dr. Weissman reflects on five decades of research, the pandemic-era project that became a sweeping global volume (now available free via open access), and what it means to build something that outlives its origins. *This episode briefly mentions suicide.(Re-post: This is one of our most beloved episodes, brought back by popular demand. If you've heard it before, we hope it moves you just as much the second time.)What Is Interpersonal Therapy (IPT) and Why Does It Work?IPT links the emergence of psychiatric symptoms to what is happening in a person's current life. It focuses on four core problem areas:1. Grief — the loss of a loved one2. Disputes — conflict with someone important to you3. Transitions — life changes, even positive ones, that disrupt relationships4. Loneliness/Isolation — chronic or newly developed lack of attachmentThese four areas have proven to resonate across vastly different cultures because they reflect fundamental aspects of the human condition. Dr. Weissman emphasizes that IPT is not the only evidence-based psychotherapy — it is “one tool in the toolbox, not a religion.”IPT for AdolescentsAdolescence is a prime time for IPT's problem areas, especially disputes, transitions, and loneliness. Key takeaways for parents:• Try to understand the specific stressors behind an adolescent's symptoms rather than reacting to global, dramatic statements.• Always be alert to the possibility of suicidal ideation.• Communication barriers between teens and parents are common; a trusted third party (grandparent, therapist, family friend) can sometimes serve as a valuable bridge.The New Book: IPT Around the WorldThis book is now available open access for readers everywhere!The COVID-19 pandemic gave Dr. Weissman the unexpected opportunity to connect with IPT practitioners worldwide. What began as a routine update to the standard IPT manual grew into a sweeping collaborative volume covering more than 30 countries across Africa, Asia, Europe, and the Americas. Contributors were asked: What are you doing? What works? What doesn't? What adaptations did you need to make?Notable chapters include:• Uganda — IPT was introduced around 2003 amid civil war and a mental health crisis. A landmark clinical trial published in JAMA confirmed its effectiveness. Sean Mabry, a former WHO worker, went on to treat hundreds of thousands of people using IPT, even by telephone during the pandemic, and has now established a low-cost program in New Jersey.• China — After government engagement and training by Columbia experts, IPT became what practitioners called a “rapidly growing practice,” with books, training programs, and internet-based delivery.• Malaysia — IPT has been applied with refugees, using the “transitions” framework to help people process displacement and profound loss.• Africa (Ethiopia, Kenya, Mozambique, Senegal, Zambia, Uganda) — Adaptations have been made for cultural context, including how disputes are communicated and resolved within different family and community structures.• Japan and Hong Kong — Initial resistance to psychotherapy has given way to growing acceptance and translated materials.• United States special populations — Chapters cover Alaska Natives, people who are incarcerated, sexual and gender minorities, pre-adolescents, adolescents, and older adults.Cultural AdaptationsDr. Weissman shares a vivid example from Uganda: women in marital disputes are often encouraged not to confront their husbands directly, but to work through an elder who mediates. The underlying IPT principle, that the dispute is driving the symptoms, remains intact; only the implementation changes.Resources Mentioned• International Society of Interpersonal Psychotherapy (ISIPT) — volunteer-run, affordable membership, biannual international conference (10th meeting held in the UK, March 2024)• Dr. Weissman's new book on IPT across international sites — published Open Access, freely available to practitioners and researchers worldwide• Oxford University Press — publisher of the standard IPT manualAbout the GuestDr. Myrna Weissman is the Diana Goldman Kemper Family Professor of Epidemiology and Psychiatry at Columbia University's Vagelos College of Physicians and Surgeons and Mailman School of Public Health, and Chief of the Division of Translational Epidemiology at the New York State Psychiatric Institute. Alongside her late husband, Dr. Gerald Klerman, she co-developed Interpersonal Psychotherapy (IPT), now backed by over 140 clinical trials, translated into numerous languages, and recommended by the World Health Organization.

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Zamzam Jama, for that is indeed her name, has been convicted in connection with the "Feeding Our Future" scheme.  Visit the Howie Carr Radio Network website to access columns, podcasts, and other exclusive content.

Send us Fan MailOne infant is diagnosed with neonatal opioid withdrawal syndrome every 27 minutes, and rates are rising. In this episode of Journal Club, Ben and Daphna review the Optimized NOW randomized clinical trial, a landmark multicenter study published in JAMA. The trial compared symptom-based dosing,  a single opioid dose given when a withdrawal threshold is met against the traditional scheduled opioid taper in infants managed with Eat Sleep Console. The results are striking: symptom-based dosing reduced time to medical readiness for discharge by nearly two and a half days, and 65% of pharmacologically treated infants avoided scheduled opioid dosing entirely. Could this be the evidence-based approach that finally reshapes how we treat NOWS pharmacologically?----Symptom-Based Dosing for Neonatal Opioid Withdrawal: The OPTimize NOW Randomized Clinical Trial. Devlin LA et al HEAL Evaluation of Limited Pharmacotherapies for Neonatal Opioid Withdrawal Syndrome (HELP for NOWS) Consortium.JAMA. 2026 Apr 25:e265782. doi: 10.1001/jama.2026.5782. Online ahead of print. PMID: 42033722Support the showAs always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below.Enjoy!

Frank & Mere sit down with their good friend, Endurance Expert, and Chattanooga Echelon Instructor- Jama Oliver. Exciting Tour de Echelon news, basement concerts, and working on finding balance in life are just some of the hot topics discussed. Mere managed to mess up the intro, but thankfully Gerard Way still got his shout out. IYKYK.You can get more regular doses of Jama by taking her classes and following her her on IG @jamaoliverfitness, FB Jama Oliver Fitness, and her FB fanpage Jama's Groupies. Enjoy!

In Mali, separatist group, Azawad Liberation Front have renewed attacks in the northern part of the country with the aim of creating an independent Tuareg state. We hear from a Sahel security expert on the origins of the group, and their recent alliance with Jama'at Nusrat al-Islam wal-Muslimin (JNIM) - al-Qaeda's armed affiliate in West Africa and the Sahel.And, some lawmakers in Ghana are considering a bill to introduce compulsory DNA testing to combat the increase in paternity fraud cases in the country.Presenter: Nkechi Ogbonna Producers: Keikantse Shumba, Bella Twine, Blessing Aderogba and Godwin Asediba Technical Producer: David Kinyanjui Senior Producer: Charles Gitonga Editors: Priya Sippy and Maryam Abdalla

Send Zorba a message!Zorba looks at new research from JAMA showing that the HPV vaccine can reduce cancer risk by half in men. He helps out a caller with questions about nagging sinus pressure; and helps listeners with throat clearing, and a question about E-bikes. We learn about "Brain Honey" and Karl's mom shares one her mom jokes.Support the showProduction, edit, and music by Karl ChristensonSend your question to Dr. Zorba (he loves to help!):Phone: 608-492-9292 (call anytime)Email: askdoctorzorba@gmail.comWeb: www.doctorzorba.orgStay well!

Send us a Text Message (please include your email so we can respond!)Episode 92! In this episode we talk about "Restrictive vs Liberal Physical Restraint Strategies in Critically Ill Patients" published in JAMA by Sonneville et al April 2026!R2D2 (pubmed): https://pubmed.ncbi.nlm.nih.gov/41841304/R2D2 (JAMA): https://jamanetwork.com/journals/jama/article-abstract/2846726If you enjoy the show be sure to like and subscribe, leave that 5 star review! Be sure to follow us on the social @icucast for the associated figures, comments, and other content not available in the audio format! Email us at icuedandtoddcast@gmail.com with any questions or suggestions! Thank you Mike Gannon for the intro and exit music! 

蒼藍鴿使用的保健品牌「藥師健生活」:輸入優惠碼「bluepig」享全品項95折優惠!點我購買▶ https://www.phargoods.com/⟡ 支持蒼藍鴿產出Podcast ➤ https://open.firstory.me/join/bluepigeon0810⟡ 信箱 ➤ bluepigeonn@gmail.com【各段重點】00:00 寶寶睡過夜的心得分享 02:24 寶寶被傳染感冒後的照顧經驗 04:22 鼠患恐引發漢他病毒！JAMA 醫學期刊統整解析 08:48 漢他病毒的潛伏期與常見症狀 13:30 漢他病毒與流感的比較16:18 大掃除時，如何安全清理老鼠屎？#鼠患 #漢他病毒 #傳染病 #鼠屍 #老鼠糞便 #台北鼠患 #漢他病毒潛伏期 #漢他病毒症狀 #漢他病毒出血熱 #HFRS #結膜充血 #發燒 #急性腎衰竭 #腎衰竭 #老鼠屎 #老鼠汙染 #大掃除 #打掃家裡 #寶寶睡過夜 #睡眠倒退期 #寶寶睡眠周期 #寶寶感冒⟡ 更多醫學知識：蒼藍鴿著作 ➤ https://reurl.cc/WA7lpLInstagram ➤ https://reurl.cc/ygvba8Youtube ➤ https://reurl.cc/gm6bb7 Powered by Firstory Hosting

Allergies have tripled - with hay fever, seasonal allergies, eczema and food intolerances now affecting millions of people. But why are allergy symptoms getting worse, and what does gut health have to do with it? In this episode, Adam Fox, a world-leading allergy Professor at King's College London, explains why allergies may be rising so fast, why many beliefs about allergies are wrong, and what new science reveals about your immune system, skin and gut. Professor Fox explores why some foods are more likely to trigger reactions, and why modern allergy science is increasingly focused on gut health. Adam also discusses why 90% of people told they are allergic to certain things may not actually be allergic, the difference between allergies and intolerances, and why some antihistamines may be doing you more harm than you realise. By the end of this episode, you will have some practical ways to manage hay fever and seasonal allergies, including which antihistamines experts now recommend avoiding, simple ways to reduce pollen exposure at home, and when allergy testing or desensitisation treatment may help. Adam explains how newer treatments are starting to retrain the immune system rather than simply suppress symptoms. If allergies barely existed a few hundred years ago, what changed? And could your gut now be shaping the way your immune system reacts to the world around you?

For decades, a tight carotid stenosis felt like a ticking time bomb — a plaque waiting to throw an embolus and cause the next stroke. We were taught that severe narrowing meant surgery, and trials like ACAS and ACST-1 seemed to prove it. But medicine has changed. Statins, antiplatelets, tighter blood pressure control, even PCSK9 and GLP-1 therapies have quietly slashed stroke risk, and now newer data from CREST-2 suggest that for many asymptomatic patients, the knife — or the stent — may not add much at all. So if modern medical therapy works better than ever… who actually benefits from intervention anymore? Today, we unpack the evidence, the controversies, and how to counsel the patient who feels perfectly fine but has high-grade stenosis.Hosts: Carolyn Judge, Andrew Huang, Luciano Delbono, Frank Davis, Robert BeaulieuInstitution: University of Michigan, Department of Surgery, Section of Vascular SurgeryLearning objectives: Describe how modern intensive medical therapy has transformed the natural history of asymptomatic carotid stenosis and explain why contemporary patients experience substantially lower annual stroke risk than those in earlier eras. Interpret and compare the results of landmark trials—including ACAS, ACST-1, and CREST-2—to assess the relative benefits of medical therapy, endarterectomy, and stenting. Apply current evidence and guideline recommendations to patient care by selecting which asymptomatic patients are most likely to benefit from carotid revascularization versus optimized medical therapy alone. References:SVS Guidelines:Brook, R. D., et al. (2022). Society for Vascular Surgery clinical practice guidelines for management of extracranial carotid artery disease. Journal of Vascular Surgery, 75(1), e1–e67. https://doi.org/10.1016/j.jvs.2021.09.031CREST (1)Brott, T. G., Hobson, R. W., Howard, G., et al. (2010). Stenting versus endarterectomy for treatment of carotid-artery stenosis. New England Journal of Medicine, 363(1), 11–23. https://doi.org/10.1056/NEJMoa0912321CREST-2Brott, T. G., Howard, G., Fong, P., et al. (2024). Randomized trial of carotid artery stenting or carotid endarterectomy vs best medical therapy for asymptomatic carotid stenosis: CREST-2 results. [Manuscript in preparation]. ClinicalTrials.gov Identifier: NCT02089217. Retrieved from https://clinicaltrials.gov/ct2/show/NCT02089217ACST-1Halliday, A., Mansfield, A., Marro, J., et al. (2004). Randomised trial of carotid artery surgery for asymptomatic stenosis. Lancet, 363(9420), 1491–1502. https://doi.org/10.1016/S0140-6736(04)16153-1ACST-2Halliday, A., Bulbulia, R., Bonati, L. H., et al. (2021). Carotid artery stenting versus carotid endarterectomy in patients with asymptomatic carotid stenosis (ACST-2): A randomised trial. Lancet, 398(10291), 1065–1073. https://doi.org/10.1016/S0140-6736(21)01980-1ACASExecutive Committee for the Asymptomatic Carotid Atherosclerosis Study. (1995). Endarterectomy for asymptomatic carotid stenosis. JAMA, 273(18), 1421–1428. https://doi.org/10.1001/jama.1995.03520420033036Sponsor URL: https://www.goremedical.com/Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listenBehind the Knife Premium: https://behindtheknife.org/premiumOral Board Review: https://behindtheknife.org/oral-boardOral Board Simulator: https://behindtheknife.org/oral-board/simulatorGeneral Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-reviewTrauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlasDominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkshipDominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotationVascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-audio-reviewColorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-audio-reviewSurgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-audio-reviewCardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-audio-reviewDownload our App:Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

What if loneliness isn't just an emotion… but one of the most dangerous biological threats to your health? In this deeply personal and scientifically explosive solo episode, Darin opens up about something he recently realized in his own life: despite being surrounded by people, he was lonely. But what began as an emotional realization quickly became a deep dive into some of the most shocking research he's ever uncovered, showing that chronic loneliness may increase the risk of heart disease, dementia, cancer, autoimmune dysfunction, accelerated aging, and early death. From inflammatory gene expression and cortisol dysregulation to oxytocin, vulnerability, and the collapse of real human connection in the digital age, this episode reveals why loneliness may be the most overlooked "fatal convenience" of modern life, and how vulnerability may be the medicine. What You'll Learn Why loneliness is a biological crisis, not just an emotional feeling The shocking link between loneliness and heart disease, dementia, and early death Why the quality of your relationships is the #1 predictor of long-term health How loneliness activates inflammatory genes inside your body The role of cortisol, sleep disruption, and chronic stress in social isolation Why social media and "surface-level connection" are replacing real intimacy The connection between loneliness and Alzheimer's disease How oxytocin and genuine connection reduce inflammation Why vulnerability is the gateway to meaningful relationships Practical ways to create deeper connection starting today Chapters 00:00:33 – Sponsor: the truth about the exploding NAD supplement market 00:01:04 – Why supplement verification and transparency matter 00:02:17 – Opening: Darin admits something deeply personal 00:02:30 – "I realized recently… I'm lonely" 00:02:37 – The difference between being surrounded by people vs being truly known 00:03:06 – Loneliness as a biological experience, not just an emotional one 00:03:27 – The hidden risks: heart disease, dementia, cancer, early death 00:03:45 – Why this is not fringe science 00:04:13 – The most important predictor of long-term health 00:04:34 – Why relationship QUALITY matters more than quantity 00:05:06 – The global loneliness epidemic 00:05:11 – U.S. Surgeon General advisory on loneliness 00:05:39 – Loneliness declared a public health crisis 00:06:02 – 50% of Americans report measurable loneliness 00:06:22 – "A generational collapse of connection" 00:06:30 – 29% of adults have no close friends 00:06:40 – Face-to-face interactions dramatically declining 00:07:01 – The UK, Japan, and Australia loneliness crisis initiatives 00:07:32 – The paradox: hyperconnected but deeply isolated 00:08:04 – Loneliness as a biological alarm signal 00:08:31 – What loneliness actually looks like in modern life 00:08:42 – The lonely CEO, the unseen mother, the isolated social media addict 00:09:31 – "Perceived social isolation" and why the brain can't tell the difference 00:10:21 – Meta-analysis of 3.4 million people 00:10:55 – Loneliness vs obesity and smoking risk comparisons 00:11:18 – The biology of loneliness begins 00:11:50 – NF-kB: inflammatory gene activation explained 00:12:33 – How loneliness changes gene expression 00:13:02 – Chronic inflammation and disease pathways 00:13:21 – Cortisol, sleep disruption, and immune dysfunction 00:14:00 – How loneliness affects brain repair and amyloid plaque clearing 00:14:21 – Sponsor: Fatty15 and cellular health 00:18:02 – The Alzheimer's and dementia connection 00:18:25 – Loneliness as a major modifiable dementia risk factor 00:18:57 – Cortisol, neuroinflammation, and brain degeneration 00:19:16 – The hippocampus physically shrinking in lonely people 00:19:27 – Social media as a "fatal convenience" 00:19:57 – The oxytocin economy: connection as medicine 00:20:15 – Oxytocin as one of the body's strongest anti-inflammatory molecules 00:20:30 – HeartMath research: emotional synchronization between people 00:20:48 – "You regulate each other's biology" 00:21:07 – The real barrier: vulnerability 00:21:32 – Darin's recent experiences with radical vulnerability 00:21:54 – Conversations with family, ex-partners, and loved ones 00:22:35 – Brené Brown's research on connection and worthiness 00:23:14 – The "depth audit" exercise 00:23:42 – Reaching out, expressing appreciation, and owning your emotions 00:24:01 – Sacred hours: spending time without phones 00:24:13 – Questions that create real intimacy 00:24:30 – Darin's emotional conversation with his brother 00:25:03 – Protecting yourself from social media disconnection 00:25:20 – Becoming a source of joy and connection in everyday life 00:25:25 – Darin reflects on seven years of subtle loneliness 00:25:48 – The shift from surface conversations to meaningful connection 00:26:01 – "If you want love, give love" 00:26:19 – Final message: generate the connection you want to receive 00:26:22 – Closing thoughts and outro Thank You to Our Sponsors Truniagen: Go to www.truniagen.com and use code DARIN20 at checkout for 20% off Fatty15: Get an additional 15% off their 90-day subscription Starter Kit by going to fatty15.com/DARIN and using code DARIN at checkout. Join the SuperLife Community Get Darin's deeper wellness breakdowns — beyond social media restrictions: Weekly voice notes Ingredient deep dives Wellness challenges Energy + consciousness tools Community accountability Extended episodes Join for $7.49/month → https://patreon.com/darinolien Connect with Darin Olien: Website: darinolien.com Instagram: @darinolien Book: Fatal Conveniences Platform & Products: superlife.com New Show: Roadmap to Happiness Key Takeaway "Loneliness isn't weakness. It isn't failure. It's a biological signal telling you that something essential is missing. And in a world addicted to surface-level connection, the real medicine may simply be this: vulnerability, presence, eye contact, honesty, and the courage to let yourself truly be seen." Bibliography/Sources The Loneliness Epidemic & Public Health Data Bureau of Labor Statistics. (2023). American time use survey. U.S. Department of Labor. https://www.bls.gov/tus/ Cigna. (2023). Cigna U.S. loneliness index. Evernorth Health Services. https://newsroom.cigna.com/loneliness-epidemic-continues-to-rise-cigna-study Murthy, V. H. (2023). Our epidemic of loneliness and isolation: The U.S. Surgeon General's advisory on the healing effects of social connection and community. U.S. Department of Health and Human Services. https://www.hhs.gov/sites/default/files/surgeon-general-social-connection-advisory.pdf Survey Center on American Life. (2021). The state of American friendship: Change, challenges, and loss. American Enterprise Institute. https://www.americansurveycenter.org/research/the-state-of-american-friendship-change-challenges-and-loss/ Mortality & Systemic Health Risk Cohen, S., Doyle, W. J., Skoner, D. P., Rabin, B. S., & Gwaltney, J. M. (1997). Social ties and susceptibility to the common cold. JAMA, 277(24), 1940–1944. https://pubmed.ncbi.nlm.nih.gov/9200634/ Hawkley, L. C., & Cacioppo, J. T. (2010). Loneliness matters: A theoretical and empirical review of consequences and mechanisms. Annals of Behavioral Medicine, 40(2), 218–227. https://pubmed.ncbi.nlm.nih.gov/20396846/ Holt-Lunstad, J., Smith, T. B., Baker, M., Harris, T., & Stephenson, D. (2015). Loneliness and social isolation as risk factors for mortality: A meta-analytic review. Perspectives on Psychological Science, 10(2), 227–237. https://doi.org/10.1177/1745691614568352 Valtorta, N. K., Kanaan, M., Gilbody, S., Ronzi, S., & Hanratty, B. (2016). Loneliness and social isolation as risk factors for coronary heart disease and stroke. Heart, 102(13), 1009–1016. https://heart.bmj.com/content/102/13/1009 Genetics, Inflammation & The Immune System Cole, S. W. (2013). Social regulation of human gene expression: Mechanisms and implications for public health. American Journal of Public Health, 103(S1), S84–S92. https://pmc.ncbi.nlm.nih.gov/articles/PMC3786756/ Cole, S. W., Hawkley, L. C., Arevalo, J. M. G., Sung, C. Y., Rose, R. M., & Cacioppo, J. T. (2007). Social regulation of gene expression in human leukocytes. Genome Biology, 8(9), Article R189. https://pmc.ncbi.nlm.nih.gov/articles/PMC2375027/ Sleep & Cognitive Decline Cacioppo, J. T., Hawkley, L. C., Berntson, G. G., Ernst, J. M., Gibbs, A. C., Stickgold, R., & Hobson, J. A. (2002). Do lonely days invade the nights? Potential social modulation of sleep efficiency. Psychological Science, 13(4), 384–387. https://pubmed.ncbi.nlm.nih.gov/12137144/ Holwerda, T. J., Deeg, D. J. H., Beekman, A. T. F., et al. (2014). Feelings of loneliness, but not social isolation, predict dementia onset. Journal of Neurology, Neurosurgery & Psychiatry, 85(2), 135–142. https://jnnp.bmj.com/content/85/2/135 Oxytocin & The Biology of Connection Szeto, A., Sun-Suslow, N., Mendez, A. J., Hernandez, R. I., Wagner, K. V., & McCabe, P. M. (2017). Regulation of the macrophage oxytocin receptor in response to inflammation. American Journal of Physiology—Endocrinology and Metabolism, 312(2), E183–E189. https://journals.physiology.org/doi/full/10.1152/ajpendo.00424.2016 Uvnas-Moberg, K. (2003). The oxytocin factor: Tapping the hormone of calm, love, and healing. Da Capo Press. https://books.google.com/books?id=b-aKjQoB_nQC Psychology, Vulnerability & Relationship Science Aron, A., Melinat, E., Aron, E. N., Vallone, R. D., & Bator, R. J. (1997). The experimental generation of interpersonal closeness. Personality and Social Psychology Bulletin, 23(4), 363–377. https://doi.org/10.1177/0146167297234003 Brown, B. (2010). The gifts of imperfection: Let go of who you think you're supposed to be and embrace who you are. Hazelden Publishing. https://brenebrown.com/book/the-gifts-of-imperfection/ Cacioppo, J. T., & Patrick, W. (2008). Loneliness: Human nature and the need for social connection. W. W. Norton & Company. https://wwnorton.com/books/9780393335286 Dunbar, R. I. M. (2012). 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