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In this NBN episode, host Hollay Ghadery speaks with Conor Mc Donnell about his long poem, What We Know So Far Is...(Wolsak & Wynn, 2025). The Irish word for shadow, “scáth,” is also our word for shelter. In a powerful long poem that captures the disquiet of our age with cinematic language and imagery, Conor Mc Donnell's What We Know So Far Is … harkens back to the previous century in its daring. Drawing from his Irish heritage, his experience as a pediatrician and many other sources, Mc Donnell has created a work that echoes the scope of T.S. Eliot's The Waste Land and Hart Crane's The Bridge. Both ecstatic and challenging, the lines of the poem are filled with allusions and references, with biology shading into history into cultures both ancient and contemporary, where words are predators and “memes disseminate cultural-genes.” Through it all runs Mc Donnell's fascination with language, ever shifting, beguiling, mutating, virus-like. In these questioning, DNA-like lines, Mc Donnell shows us how to unmake and remake our understanding of the world. Dr. Conor Mc Donnell is a poet and physician at the Hospital for Sick Children, Toronto. He is the author of two collections of poems (most recently, This Insistent List) and three chapbooks. His poetry has appeared in various Canadian and international publications as well as noted medical journals such as JAMA and CMAJ. He is an associate professor at the University of Toronto and editor in chief of Case Repertory, a Narrative-Based Medicine Lab publication that seeks to engage and promote the voice of the patient in collaboration with their health-carers. He is a frequently invited international lecturer on pediatric perioperative care, error prevention and opioid stewardship, and he is current vice-president of the Canadian Pediatric Anesthesia Society. Learn more about your ad choices. Visit megaphone.fm/adchoices Support our show by becoming a premium member! https://newbooksnetwork.supportingcast.fm/new-books-network
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 March 7-13, 2026.
It's an era of breakthroughs in Alzheimer's research, yet for many clinicians, it's also a time of profound uncertainty. We are currently navigating competing definitions of the disease, multiple new biomarkers coming on market seemingly every week, and the clinical rollout of new amyloid antibodies. How do we translate this rapid-fire science into daily practice? On this week's GeriPal podcast, we sit down with dementia experts Halima Amjad, Barak Gaster, and Heather Whitson. We dive deep into: The evolving definitions of Alzheimer's disease. Does someone have Alzheimer's disease if you have only an abnormal biomarker as defined by the Alzheimer's Association, or is amyloid pathology necessary but not sufficient to define Alzheimer's as per the International Working Group (IWG) recommendations? Where do blood-based biomarkers for Alzheimer's fit into the diagnostic workup, and should they be used at all in primary care? FYI - here is my take on that question in a recent JAMA IM article titled "The Limited Role of Alzheimer's Disease Blood-Based Biomarkers in Primary Care." What's the role of amyloid antibodies in the care of individuals with Alzheimer's disease, including who to use them on? We covered a lot and discussed some of these resources that you can do a deeper dive on: Blood-based biomarker resources JAMA article on Blood-Based Biomarkers for Alzheimer's Disease: Preventing Unintended Consequences Alzheimer's Dementia article on Blood-based biomarkers for detecting Alzheimer's disease pathology in cognitively impaired individuals within specialized care settings: A systematic review and meta-analysis JAMA IM article on The Limited Role of Alzheimer Disease Blood-Based Biomarkers in Primary Care Appropriate use recommendations for amyloid antibodies Donanemab: Appropriate use recommendations Lecanemab: Appropriate Use Recommendations Primary Care Resources Cognition in Primary Care program A JAGS article on "Large Health System Quality Improvement Intervention Providing Training and Tools to Improve Detection of Cognitive Impairment in Primary Care" Other resources AGS's new online curriculum for Alzheimer's Disease By Eric Widera
Aux XVIIᵉ et XVIIIᵉ siècles, la vie des marins et des boucaniers est tout sauf romantique. Violence, maladies, tempêtes, batailles navales : l'espérance de vie est courte et l'avenir, profondément incertain. C'est dans ce monde brutal qu'apparaît une pratique aujourd'hui méconnue mais fascinante : le matelotage.Le matelotage est un contrat passé entre deux marins, très répandu dans les milieux de la piraterie et de la course, notamment dans les Caraïbes. Il lie deux hommes qui se promettent entraide, solidarité et protection mutuelle. Concrètement, cela signifie partager le butin, veiller l'un sur l'autre en cas de blessure ou de maladie, et surtout assurer une sécurité matérielle en cas de décès.Car le cœur du matelotage est juridique autant qu'humain. Si l'un des deux marins meurt, son matelot hérite de ses biens : argent, armes, parfois même parts de navire. À une époque où les marins sont souvent coupés de leur famille, parfois analphabètes, et sans accès à des institutions solides, ce type d'accord est une assurance vitale. Le matelot devient à la fois héritier, exécuteur moral et dernier proche.Cette pratique est particulièrement répandue chez les boucaniers installés dans des ports comme Port Royal, en Jamaïque, ou à l'île de la Tortue. Ces communautés sont presque exclusivement masculines. Les femmes y sont rares, les mariages traditionnels quasi impossibles. Le matelotage comble alors un vide social et affectif.Faut-il y voir une forme de mariage homosexuel avant l'heure ? La réponse est nuancée. Dans de nombreux cas, le matelotage est avant tout un pacte économique et de survie. Mais les sources indiquent clairement que certains de ces contrats s'accompagnaient d'une relation amoureuse ou sexuelle. Sans être systématique, cette dimension est suffisamment attestée pour montrer que le matelotage pouvait aussi être une union affective assumée, dans des sociétés marginales où les normes européennes perdaient leur force.Les autorités coloniales et religieuses regardaient ces pratiques avec méfiance, voire hostilité. Mais dans les faits, elles les toléraient souvent, faute de pouvoir contrôler ces communautés flottantes et armées.Le matelotage disparaît progressivement au XVIIIᵉ siècle, avec le déclin de la piraterie et la reprise en main des marins par les États et les marines nationales. Il laisse pourtant une trace singulière : celle d'un monde où, face à la mort omniprésente, la solidarité choisie pouvait prendre la forme d'un véritable engagement de vie.Une autre façon d'aimer, de survivre… et de faire famille, au bout du monde. Hébergé par Acast. Visitez acast.com/privacy pour plus d'informations.
Dr. Sunny Smith is a family physician, entrepreneur, and founder of Empowering Women Physicians (EWP), one of the fastest-growing companies in the U.S., as recognized by the Inc. 5000. A former Clinical Professor at UC San Diego School of Medicine, Dr. Smith has been honored for her excellence in teaching, humanism in medicine, and community leadership. She is a Fellow of the American Academy of Family Physicians and a dedicated advocate for physician wellness, as featured in Entrepreneur Magazine, Forbes, JAMA, and documentaries such as Struggling in Silence and Do No Harm. With her background in underserved medicine, patient advocacy, and medical education, Dr. Smith now empowers women physicians to enjoy the lives that they worked so hard to create through her innovative coaching programs.Some of the topics we discussed were:The evidence-based data showing that coaching has effective results, especially in physiciansFindings of a 2019 study where just 6 sessions of coaching decreased burnout and improved overall quality of lifeAnother study that focused on primary care doctors over the course of 6 monthsFindings of improvement in burnout that lasted beyond the course of the interventionNot only does the intervention group get better, but the control group, while waiting, gets worseJAMA study at 28 institutions with 1,000 female residents showing decreased burnout from just group coaching sessions2024 study where physicians trained in coaching trained physician peers at their institution and had those peers coach other people at their institutions Decreased burnout and increased professional fulfillment, the control group also got worse Significant effect sizes of these studiesFindings that after 8 weeks in Dr. Smith's program, 77% burned out decreased to 33% burned outHow you don't have to make huge external changes to really start feeling better and making change right where you areQualitative data showing how people's perceptions of their life change after coaching interventions Once you understand you can change your thoughts and feelings intentionally and change your perspective, you approach everything differentlyHow the ripple effect of people getting coached may extend to the people around them in their own lifeThere's no question of if coaching works, the only question is how it can be broadly implementedDr. Smith's Empowering Women Physicians coaching programDebunking the myth that a lot of physicians who train as coaches end up no longer practicing medicineUsing the Stanford Professional Fulfillment Inventory designed to detect changes in a small period of timeHow physicians' lived experiences make them uniquely qualified for coaching other physiciansWho better to coach a physician than a physician?How coaching looks at where you are and where you want to beAnd more!Interested in learning more about my telehealth direct specialty care practice? At my new practice, I help patients optimize weight and metabolic health, harmonize hormones in peri/menopause, and enhance wellness and vitality. Accepting new patients now: email amazvitamd@gmail.comLearn more about me or schedule a FREE coaching call:https://www.joyfulsuccessliving.com/ Join the Voices of Women Physicians Facebook Group:https://www.facebook.com/groups/190596326343825/ Connect with Dr. Smith: Website:https://empoweringwomenphysicians.com/Podcast:https://empoweringwomenphysicians.com/podcast/&a
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 痛風發作到底有多痛？ 03:21 減重有助緩解痛風，但為什麼有時反而會誘發發作？ 05:34 痛風不只傷害關節，也會影響心血管！慢性發炎與血管硬化的關係 07:40 積極服用降尿酸藥物，能降低中風與心血管疾病風險嗎？JAMA期刊怎麼說 12:07 尿酸降下來後，可以停藥嗎？ 15:26 重點整理 #痛風 #高尿酸 #關節痛 #減重 #緩解痛風 #尿酸 #健檢 #健檢數值 #多喝水 #吃太多海鮮 #喝太多啤酒 #痛風傷害關節 #痛風傷害血管 #痛風引發身體發炎 #JAMA期刊 #JAMA期刊研究 #降尿酸藥物---⟡ 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
Shirin Lafiya Jari ce a wannan makon ya mayar da hankali ne kan irin cututtuka da ke barazana ga lafiyar al'umma a lokacin azumin watan Ramadan, musamman ga masu azumi da ke fuskantar sauye-sauyen lafiyar jiki. Galibi a duk lokacin da aka faro azumi, mutane da dama musamman masu kwantattun cutuka kan taso musamman idan mutane basu ɗauka matakan da suka kamata ba. Ku latsa alamar sauti don sauraron cikakken shirin tare Azima Bashir Aminu.......
Un nouvel épisode du Pharmascope est disponible! Dans ce 173e épisode, Nicolas, Olivier et Amélie discutent de la prise en charge de l'hypothyroïdie dans divers contextes: hypothyroïdie subclinique, personnes âgées, grossesse, et plus encore! Les objectifs pour cet épisode sont les suivants: Discuter des évidences portant sur le traitement de l’hypothyroïdie subclinique Discuter de la prise en charge de l’hypothyroïdie chez la personne âgée Discuter du dépistage et de la prise en charge de l’hypothyroïdie subclinique et clinique durant la grossesse Ressources pertinentes en lien avec l'épisode Moon S, et coll. Subclinical Hypothyroidism and the Risk of Cardiovascular Disease and All-Cause Mortality: A Meta-Analysis of Prospective Cohort Studies. Thyroid. 2018 Sep;28(9):1101-1110. Stott DJ, et coll.; TRUST Study Group. Thyroid Hormone Therapy for Older Adults with Subclinical Hypothyroidism. N Engl J Med. 2017 Jun 29;376(26):2534-2544. Feller M, et coll. Association of Thyroid Hormone Therapy With Quality of Life and Thyroid-Related Symptoms in Patients With Subclinical Hypothyroidism: A Systematic Review and Meta-analysis. JAMA. 2018 Oct 2;320(13):1349-1359. Ringel MD, et coll. 2025 American Thyroid Association Management Guidelines for Adult Patients with Differentiated Thyroid Cancer. Thyroid. 2025 Aug;35(8):841-985 Thyroid Disease in Pregnancy: ACOG Practice Bulletin, Number 223. Obstet Gynecol. 2020 Jun;135(6):e261-e274. Sankoda A, et coll. Effects of Levothyroxine Treatment on Fertility and Pregnancy Outcomes in Subclinical Hypothyroidism: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Thyroid. 2024 Apr;34(4):519-530. Casey BM, et coll; Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal–Fetal Medicine Units Network. Treatment of Subclinical Hypothyroidism or Hypothyroxinemia in Pregnancy. N Engl J Med. 2017 Mar 2;376(9):815-825. Negro R, et coll. Universal screening versus case finding for detection and treatment of thyroid hormonal dysfunction during pregnancy. J Clin Endocrinol Metab. 2010 Apr;95(4):1699-707. Ringel MD, et coll. 2025 American Thyroid Association Management Guidelines for Adult Patients with Differentiated Thyroid Cancer. Thyroid. 2025 Aug;35(8):841-985.
AQEEDAH 01-07: Understanding the Aqeedah of Ahl al-Sunnah wal-Jama‘ah: Following the Qur'an, Authentic Sunnah, and the Path of the Sahabah | ZAD Academy Audio | Blogpost by Zayd HajiAssalamu Alaikum wa Rahmatullahi wa Barakatuh,I am Zayd Haji, a student at ZAD Academy. This blog post summarizes an important lesson from ZAD Academy discussing the Aqeedah (Islamic creed) of Ahl al-Sunnah wal-Jama‘ah, which emphasizes adherence to the Qur'an, the authentic Sunnah of the Prophet Muhammad ﷺ, and the understanding of the righteous predecessors.Islamic belief is built upon divine revelation. Muslims are required to follow the guidance revealed by Allah in the Qur'an and explained through the Sunnah of the Prophet ﷺ. This foundational principle forms the core of the creed of Ahl al-Sunnah wal-Jama‘ah.One of the central themes in the lecture is that Islam is a complete and perfected religion. Allah declares in the Qur'an:“Today I have perfected for you your religion and completed My favor upon you and have approved for you Islam as religion.” (Qur'an 5:3 – Quran.com)This verse was revealed during the Farewell Pilgrimage of the Prophet Muhammad ﷺ on the Day of ‘Arafah. It confirms that the religion of Islam is complete and does not require additions or innovations.Allah also states:“And We have revealed to you the Book as clarification for all things and as guidance and mercy and good tidings for the Muslims.” (Qur'an 16:89 – Quran.com)The Qur'an therefore serves as the primary source of guidance for humanity.The creed of Ahl al-Sunnah wal-Jama‘ah requires complete submission to the texts of revelation. Muslims must rely on the Qur'an and the authentic Sunnah for understanding Islam.Allah says:“O you who have believed, enter into Islam completely.” (Qur'an 2:208 – Quran.com)The Qur'an also warns believers not to speak about religious matters without knowledge:“And do not pursue that of which you have no knowledge. Indeed, the hearing, the sight and the heart – about all those one will be questioned.” (Qur'an 17:36 – Quran.com)The Sunnah complements the Qur'an and explains its meanings. Narrated Aisha: Allah's Messenger (ﷺ) said, "If somebody innovates something which is not in harmony with the principles of our religion, that thing is rejected."Sahih al-Bukhari 2697https://sunnah.com/bukhari:2697This hadith emphasizes the importance of avoiding innovations in religious practice.Allah says:“And whoever opposes the Messenger after guidance has become clear to him and follows other than the way of the believers – We will give him what he has taken and drive him into Hell.” (Qur'an 4:115 – Quran.com)The companions were the closest generation to the Prophet ﷺ and best understood the Qur'an and Sunnah.Narrated `Abdullah: The Prophet (ﷺ) said, "The best people are those living in my generation, and then those who will follow them, and then those who will follow the latter. Then there will come some people who will bear witness before taking oaths, and take oaths before bearing witness." (Ibrahim, a sub-narrator said, "They used to beat us for witnesses and covenants when we were still children.")Sahih al-Bukhari 3651https://sunnah.com/bukhari:3651The correct Islamic creed is based on the Qur'an and authentic Sunnah.Islam is a complete religion that does not require innovation.Muslims must avoid speaking about religion without knowledge.The understanding of the Sahabah and early scholars is essential in interpreting Islamic texts.Innovations (bid‘ah) in religion are rejected in Islam.The Aqeedah of Ahl al-Sunnah wal-Jama‘ah calls Muslims to adhere strictly to the Qur'an, the authentic Sunnah, and the understanding of the companions of the Prophet ﷺ. This methodology preserves the purity of Islamic belief and ensures that Muslims remain connected to the original teachings of Islam.
Teens aren't getting enough sleep! And a two-decade study suggests it's getting worse. Scientists found that the number of high schoolers getting insufficient sleep — less than seven hours a night — has increased from 69% to 77%. The throughline? There wasn't one. Teens had bad sleep habits across most demographics, including race, gender and grade level. The findings were published this week in the journal JAMA.Interested in more science behind recent headlines? Email us your question at shortwave@npr.org.For more about earthquake science – and the Cascadia Fault in particular – check out our recent episode on the Pacific Northwest's Big One.Listen to every episode of Short Wave sponsor-free and support our work at NPR by signing up for Short Wave+ at plus.npr.org/shortwave.To manage podcast ad preferences, review the links below:See pcm.adswizz.com for information about our collection and use of personal data for sponsorship and to manage your podcast sponsorship preferences.Learn more about sponsor message choices: podcastchoices.com/adchoicesNPR Privacy Policy
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 February 28-March 6, 2026.
Send a textWellness is a word we hear all the time—but what does it actually mean when life is complicated, busy, and sometimes overwhelming? In this milestone 200th episode, I explore the idea that living well isn't about perfection or rigid routines, but about the small choices we make every day that quietly shape our health, our relationships, and the direction of our lives. I invite you to reflect on the emotions you're choosing from, the responsibilities you're carrying, and the possibility that wellness might be closer than you think. If you've ever wondered how to care for yourself while managing a full and demanding life, this conversation might open a new perspective on what it truly means to live well.Quotes of the Week“Well-being is realized by small steps, but is truly no small thing.” — Zeno “The part can never be well unless the whole is well.” — Plato CitationsCohen, S., Janicki-Deverts, D., & Miller, G. E. (2012). Psychological stress and disease. JAMA.Lee, I. M., et al. (2019). Association of Step Volume and Intensity With All-Cause Mortality in Older Women. JAMA Internal Medicine.Waldinger, R., & Schulz, M. Harvard Study of Adult Development. Harvard Medical School.National Institutes of Health – Your Healthiest Self: Wellness Toolkits. Let's go, let's get it done. Get more information at: http://projectweightloss.org
There is enormous heterogeneity in clinical outcomes and severity of septic shock, with some patients needing only supportive care in the ICU and others progressing to multiorgan system failure and death. How can clinicians identify patients at higher risk of death? In this episode of the Society of Critical Care Medicine (SCCM) Podcast, host Marilyn Bulloch, PharmD, BCPS, FCCM, is joined by John A. Kellum, MD, FCCM, to discuss high endotoxin activity as a possible endotype for septic shock. Dr. Kellum's article, “Organ Failure, Endotoxin Activity, and Mortality in Septic Shock,” was published in the September 2025 compendium of Critical Care Explorations. Dr. Kellum is a professor and director of the Center for Critical Care Nephrology, as well as vice chair for the Department of Critical Care Medicine, at the University of Pittsburgh in Pittsburgh, Pennsylvania, USA. The study used a novel biomarker called the endotoxin activity assay (EAA) to detect endotoxin in the blood. While the EAA is not good at identifying patients who are at risk for sepsis, Dr. Kellum said that, when combined with organ failure, it identifies patients at high risk for endotoxic septic shock. In the study, these patients had a mortality rate of 60%. Neither the EAA nor the anti-endotoxin therapy is readily available. And, although endotoxic septic shock is rare, occurring in only a quarter of patients with septic shock, Dr. Kellum hopes that, through precision medicine, segmenting this population into treatable subgroups may allow better diagnostics and opportunities to develop or repurpose therapies in the future. This episode is sponsored by Prenosis. Resources referenced in this episode: Organ Failure, Endotoxin Activity, and Mortality in Septic Shock (Molinari L, et al. Crit Care Explor. 2025;7:e1308) Derivation, Validation, and Potential Treatment Implications of Novel Clinical Phenotypes for Sepsis (Seymour CW, et al. JAMA. 2019;321:2003-2017) Safety and Efficacy of Polymyxin B Hemoperfusion (PMX) for Endotoxemic Septic Shock in a Randomized, Open-Label Study (TIGRIS) (ClinicalTrials.gov. ID NCT03901807. Last update posted January 9, 2026)
Send a textDescription: An immersive reading of Offerings From My Patients and Their Families by Hanna M. Saltzman with reflection on offerings, gifts, complaints, and boundary crossings.Website:https://anauscultation.wordpress.comWork:https://jamanetwork.com/journals/jama/article-abstract/2839104 References:Saltzman HM. Offerings From My Patients and Their Families. JAMA. 2025;334(15):1399. doi:10.1001/jama.2025.12143https://jamanetwork.com/journals/jama/article-abstract/2839104 Hanna Saltzman: www.hannasaltzman.com Hyde, Lewis. The Gift: Imagination and the Erotic Life of Property. 25th anniversary ed., Vintage Books, 2007.Campo R. Making Lists in Medicine and Poetry. JAMA. 2025;334(15):1399. doi:10.1001/jama.2025.12103https://www.etymonline.com/word/offering
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 喝咖啡會致癌？喝咖啡會骨質疏鬆？ 02:16 全球最頂級的醫學期刊有哪些？可信度高嗎？ 03:23 JAMA研究重點解析：咖啡、茶與失智／認知功能 06:28 咖啡的劑量建議要喝多少？越多真的越好嗎？ 09:55 咖啡為什麼可能保護大腦？關鍵成分是什麼？ 13:11 喝咖啡的注意事項 #咖啡 #咖啡因 #茶 #儀式感 #昏沉 #想睡覺 #沒精神 #致癌 #骨質疏鬆 #JAMA研究 #喝茶 #茶葉 #無咖啡因 #Decaf #保護大腦 #預防失智 #失智症 #咖啡的劑量 #超商拿鐵 #超商咖啡 #咖啡因攝取 #抗氧化物 #綠原酸---⟡ 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
The following khatira is a short, focused Islamic reminder—meant to strengthen faith, sharpen priorities, and deliver a clear Qur'an-and-Sunnah-based takeaway you can apply right away. You'll hear a direct message that renews awareness of Allah... The post Khatira- Hold Tight to the Jama‘ah first appeared on Islampodcasts.
In this episode of The Brave Enough Show, Dr. Sasha Shillcutt and Dr. Sunny Smith discuss: Being lonely in a room full of people How to tear down the walls we build Not believing everything we think "We are meant to live in community with others. When we are vulnerable, authentic, and truthful, we open ourselves up for real connection." -Dr. Sunny Smith Dr. Sunny Smith is the Founder and CEO of Empowering Women Physicians, the most effective physician coaching program documented to date. Dr Smith brings her background as an awarded Medical Educator, Clinical Professor of Family Medicine and Public Health, and long history of being an advocate for medical student and physician wellness into the coaching space. She leads a comprehensive and collaborative coaching program, podcast, retreats, and Facebook group that seek to change the culture of medicine. Dr. Smith is the recipient of multiple teaching awards, including Humanism in Medicine, Excellence in Teaching, and Outstanding Community Leader award. Her work has been published in many peer-reviewed journals, including JAMA. She has been in the top 1-2% of female entrepreneurs in the US for the past 6 years and has been featured in Forbes, Inc 5000, and Entrepreneur Magazine. Brave Balance is about transforming your professional and personal life in a safe, small group setting. You will grow deep in self-awareness, set clear boundaries, and develop strong time management skills to create the work-life balance you desperately need (and deserve). Change your mindset to let unhealthy behaviors go, and create long-lasting work-life control so you can live well on YOUR terms. Brave Enough 2026 CME Conference For ten years, women have gathered at the Brave Enough Conference to step away from the demands of medicine and into a space of renewal. This anniversary year, we celebrate a decade of empowerment and sisterhood—ten years of lifting each other up, reigniting purpose, and remembering that none of us has to do this alone. Join us September 24-27, 2026 at the Omni Scottsdale Resort and Spa. Follow Brave Enough: WEBSITE | INSTAGRAM | FACEBOOK | TWITTER | LINKEDIN Join The Table, Brave Enough's community. The ONLY professional membership group that meets both the professional and personal needs of high-achieving women.
CardioNerds (Dr. Jenna Skowronski [Heart Failure Council Chair], Dr. Shazli Khan, and Dr. Josh Longinow) are joined by renowned leaders in the field of AHFTC (Advanced Heart Failure and Transplant Cardiology) and mechanical circulatory support, Dr. Jeff Teuteberg and Dr. Mani Daneshmand to continue the discussion of advanced heart failure therapies by taking a deep dive into the world of durable LVADs (Left Ventricular Assist Devices). In this episode, we will review the history of ventricular assist devices, the basics of LVAD function, selection criteria for LVAD therapy, and surgical nuances of LVAD implantation. Audio Editing by CardioNerds intern, Joshua Khorsandi. Enjoy this Circulation 2022 Paths to Discovery article to learn about the CardioNerds story, mission, and values. CardioNerds Heart Success Series PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Pearls There have been significant advances in the field of MCS/LVAD therapy since the first implanted LVAD in the 1960s, to the first FDA approved device in the early 2000's, to now the HM3 LVAD, with the most important change being a centrifugal flow/magnetically levitated design that led to minimized hemocompatibility-related adverse events (HRAE's) (MOMENTUM 3 trial comparing HM2 and HM3). The REMATCH trial in 2001 was a pivotal trial for LVAD therapy, demonstrating that in a population of patients with advanced HF (70% IV inotrope dependent), LVAD therapy significantly improved survival at both 1 and 2 years as compared to medical therapy alone. MOMENTUM 3 trial was a landmark trial for the HM3 device, showing that in a population of end stage HF patients (86% inotrope dependent, 32% INTERMACS 1-2, and 60% DT strategy), 5-year survival with HM3 was 58% and HM3 had lower HRAE's compared with HM2. There are both patient-specific factors and surgical considerations when it comes to candidacy for LVAD therapy. RV function prior to LVAD is a key determinant for success post-LVAD Many patients being considered for LVAD may not have robust RV function, however, predicting RV failure after LVAD is exceedingly difficult. In general, it doesn’t matter how bad the RV may look on imaging; we care more about the pre-LVAD hemodynamics (look at the PAPi and RA/wedge ratio). What happens in the OR may be the most important determinant of how the RV will do with the LVAD! Notes Notes drafted by Dr. Josh Longinow. 1. Historical background of heart pumps and LVADs LVAD Evolution FDA approval year 2001 2008 2012 2017 Pump HeartMate XVE HeartMate II Heartware HVAD HeartMate III Flow/Design Features Pulsatile Technology Continuous flow Axial design Continuous flow Centrifugal design Continuous flow Full MagLev + Centrifugal design The 1960's ushered in the first ‘LVADs', when the first air-powered ‘LVAD' was implanted. It kept the patient alive for four days before the patient expired. The first generation of LVADs were pulsatile pumps The first nationally recognized, FDA approved LVAD was the HeartMate XVE (late 1990s to early 2000s, REMATCH trial). The XVE pump used compressed air (pneumatically driven) to power the pump. Prior to the XVE, OHT was the standard of care for patients with advanced, end-stage heart failure. The second and third generations of LVADs were non-pulsatile, continuous flow devices and included the HVAD, HM2, and HM3 devices. MOMENTUM 3 was a landmark trial for the HM3 device, showing that in a population of sick patients with end stage HF (86% inotrope dependent, 32% INTERMACS 1-2, and 60% DT strategy), 5-year survival with HM3 was 58% and HM3 had lower HRAE's compared with HM2. The only pump that is currently FDA approved for implant is the HM3, although other pumps are in clinical trials (BrioVAD system, INNOVATE Trial). 2. What are LVADs, and how do they work? In simplest terms, the LVAD is a heart pump comprised of several key mechanistic components: Inflow cannula Mechanical pump Outflow cannula Driveline Controller/Power source The HM3 differs from its predecessors (HM2 and HVAD) in several key ways; HM3 is placed intrapericardial whereas the HM2 was placed pre-peritoneal. Perhaps most importantly, the HM3 is a fully magnetically levitated, centrifugal flow pump, whereas the HM2 is an axial flow device. Axial flow pumps are not magnetically levitated, leading to more friction produced between the ruby bearing's contact with the pump rotors, and higher rates of hemocompatibility related adverse events (HRAEs, i.e. pump thrombosis) and the HM2 was ultimately discontinued in favor of the HM3 (MOMENTUM 3 trial). 3. What do the terms ‘Destination Therapy' (DT) or ‘Bridge to Transplant' (BTT) mean when it comes to LVADs? When LVADs first came on the stage, EVERYONE was a BTT; these early pumps weren't designed for long term use (I.e. REMATCH Trial, Heartmate XVE) Destination therapy means the LVAD was placed in leu of transplant because there are contraindications to transplant REMATCH trial brought about the concept of “Destination therapy”, comparing outcomes in patients (with contraindications for transplant) who received an LVAD vs optimal medical therapy Bridge to transplant means we are placing the LVAD in a patient who may not be a transplant candidate at this moment in time (is too sick, or conversely, not sick enough), but may be down the line Bridge to recovery is another term used when the LVAD is being placed for a patient we think may have a recoverable cardiomyopathy 4. What are some factors we should consider when assessing a patient’s candidacy for LVAD, in general, and from a surgical perspective? Patient factors Older age might push us towards thinking LVAD rather than transplant In general, age > 70 is the cutoff for transplant, but this is not a hard cut off and varies institution to institution In general, think about things that help predict recovery after a major surgery; Frailty and Nutritional status are important, we try to optimize these prior to LVAD implant Right ventricular function remains the Achilles heel of LV support We know that needing temporary RV support post LVAD puts you on a different survival curve than patients who don’t need RVAD support Studies have not been able to successfully predict who will develop RV failure after LVAD implantation What happens in the time between when the patient goes to the OR and when they get back to the ICU is an important determinant who might develop RV failure post LVAD Surgical techniques such as implanting the HM3 in the intra-thoracic cavity, rather than intra-pericardial may help maintain LV/RV geometry to help optimize the RV post LVAD Surgical considerations for LVAD candidacy Small, hypertrophied LV: HM3 inflow cannula is small, but small hypertrophied ventricles tend towards chamber collapse during systole causing suction, needing to run slower with lower flow rates Chest size/diameter: pumps have gotten so small now, that for adults, these have become less of a consideration BMI: low BMI used to be more of a concern with the older pumps due to where they were placed, and the relative size of the pump itself, not so much now with the smaller HM 3 pumps Calcified LV apex: would increase risk of stroke, bleeding Driveline tunneling becomes a concern in the super obese population, higher risk for driveline infections (might tunnel these driveline's shorter, and to a less fatty region of the abdomen, could even tunnel out the thoracic cavity in the super obese to limit skin motion) 5. Is there a role for MCS (i.e. temporary LVAD such as Impella) in pre-habilitation of patients prior to LVAD surgery? The theory of being able to improve systemic perfusion, decongest the organs, and make the patient feel better prior to surgery makes sense, but becomes problematic due to the lack of a hard end point/time for prehabilitation which might risk delays in surgery More likely that it can lead to delay in the surgery, with less-than-optimal benefit; you don't want to prolong the wait for surgery and increase the risk for complications prior to surgery An Impella 5.5 is currently FDA approved for 2 weeks of support, not 2 months so timing is important to keep in mind It’s unlikely that you will take a patient and convert them from a malnourished, cachectic person in 2 weeks’ time 6. Is there a role for LVAD therapy in the younger patient population? Should we be thinking of LVAD up front for these patients, with the goal of transplanting down the line? Recovery may be more likely in certain populations, particularly younger females with smaller LV's; in those populations, perhaps bridge to recovery should be the focus, optimizing them on GDMT etc. The replacement of transplant, with MCS (LVAD) in young patients has become a topic of discussion, because these pumps have become better and better, with the thinking that an LVAD could bridge a patient for 10 years or so, and they could get a transplant later It is still a big unknown, but several concerns exist Patients who get LVADs might end up with complications that become contraindication to transplant down the line (stroke, sensitization etc) Patients and providers are more hesitant because of the more recent iteration for the UNOS criteria for OHT listing which no longer gives patients with an uncomplicated LVAD higher priority, and therefore they could end up waiting a longer time for a heart after undergoing LVAD References Rose EA, Gelijns AC, Moskowitz AJ, et al. Long-term use of a left ventricular assist device for end-stage heart failure. N Engl J Med. 2001;345(20):1435-1443. doi:10.1056/NEJMoa012175 Mehra MR, Uriel N, Naka Y, et al. A Fully Magnetically Levitated Left Ventricular Assist Device – Final Report. N Engl J Med. 2019;380(17):1618-1627. doi:10.1056/NEJMoa1900486 Mancini D, Colombo PC. Left Ventricular Assist Devices: A Rapidly Evolving Alternative to Transplant. J Am Coll Cardiol. 2015;65(23):2542-2555. doi:10.1016/j.jacc.2015.04.039 Mehra MR, Goldstein DJ, Cleveland JC, et al. Five-Year Outcomes in Patients With Fully Magnetically Levitated vs Axial-Flow Left Ventricular Assist Devices in the MOMENTUM 3 Randomized Trial. JAMA. 2022;328(12):1233-1242. doi:10.1001/jama.2022.16197 Rose EA, Moskowitz AJ, Packer M, et al. The REMATCH trial: rationale, design, and end points. Randomized Evaluation of Mechanical Assistance for the Treatment of Congestive Heart Failure. Ann Thorac Surg. 1999;67(3):723-730. doi:10.1016/s0003-4975(99)00042-9 Kittleson MM, Shah P, Lala A, et al. INTERMACS profiles and outcomes of ambulatory advanced heart failure patients: A report from the REVIVAL Registry. J Heart Lung Transplant. 2020;39(1):16-26. doi:10.1016/j.healun.2019.08.017 Mehra MR, Netuka I, Uriel N, et al. Aspirin and Hemocompatibility Events With a Left Ventricular Assist Device in Advanced Heart Failure: The ARIES-HM3 Randomized Clinical Trial. JAMA. 2023;330(22):2171-2181. doi:10.1001/jama.2023.23204 Mehra MR, Nayak A, Morris AA, et al. Prediction of Survival After Implantation of a Fully Magnetically Levitated Left Ventricular Assist Device. JACC Heart Fail. 2022;10(12):948-959. doi:10.1016/j.jchf.2022.08.002 Bhardwaj A, Salas de Armas IA, Bergeron A, et al. Prehabilitation Maximizing Functional Mobility in Patients With Cardiogenic Shock Supported on Axillary Impella. ASAIO J. 2024;70(8):661-666. doi:10.1097/MAT.0000000000002170
New AHA/ACC guidelines overhaul pulmonary embolism management with a five-tier risk classification, endorsing ED discharge for low-risk patients and DOACs as first-line therapy. A JAMA trial confirms IV acetaminophen adds modest but real pain relief when combined with morphine. A large cohort study shows SGLT2 inhibitors dramatically reduce kidney, cardiovascular, and liver complications in diabetic cirrhosis patients.
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 February 21-27, 2026.
The editor-in-chief of the Journal of the American Medical Association (JAMA), Professor Kirsten Bibbins-Domingo, explains how she reports on the science of health care without inflicting too much political noise on her readers — mostly clinicians.
Radiation. Regions. Responsibility.
As if we didn't have enough to worry about, a new piece in JAMA says states need to act now to prevent online sports betting from becoming a big problem. David W. Johnson and Julie Murchinson break it down on, “The Odds of Online Sports Betting Becoming a Public Health Crisis,” the new episode of the 4sight Health Roundup podcast, moderated by David Burda.
The Match. Two words that define the trajectory of every physician's career in the United States. But how does the algorithm actually work, and who is looking out for the applicants navigating this high-stakes process? In this episode, we sit down with Dr. Donna Lamb, President and CEO of the National Resident Matching Program (NRMP), to pull back the curtain on one of medicine's most consequential systems. Dr. Lamb unpacks the strengths and limitations of the match algorithm and shares her candid advice on overapplication, post-interview communication, and dual applying. She also addresses the growing financial burden on applicants, challenges facing international medical graduates amid shifting visa restrictions, and recent congressional scrutiny into the match algorithm's antitrust exemption. Join hosts Pooja Varman, MD, Judith French, PhD, and Jeremy Lipman, MD, MHPE for this conversation about the system that shapes the future of medicine—and the people working to make it more equitable, transparent, and efficient.Learning ObjectivesBy the end of this episode, listeners will be able to 1. Explain how the NRMP match algorithm work and describe both its strengths and potential areas for reform.2. Identify key match policies and best practices for applicants and programs.3. Discuss the challenges applicants face in the match and the NRMP's role in supporting equitable access. References1. Roth AE. The Origins, History, and Design of the Resident Match. JAMA. 2003;289(7):909-912. doi:10.1001/jama.289.7.9092. Lamb D. Letter to the Medical Education Community. Published online December 8, 2025. Accessed January 7, 2026. https://www.nrmp.org/wp-content/uploads/2025/12/Dec8_Letter-to-Community_JudiciarySubcommittee-FINAL-PDF.pdf***Fellowship Application Link: https://forms.gle/QSUrR2GWHDZ1MmWC6Please 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:General 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
16 years ago a chain of Chinese restaurants wanted to increase sales without changing the price. They didn't change the product. The service. The chef. The food. Instead, they changed two words on their menu and increased sales by 18%. The restaurants used the advice of today's guest on Nudge, Robert Cialdini. Today, Cialdini explains the social proof principle, sharing how changing just two words could increase your sales. --- Unlock the Nudge Vaults: https://www.nudgepodcast.com/vaults Read Cialdini's bestseller Influence: https://amzn.to/4prHb7Y Read the new and expanded Influence: https://amzn.to/43TY0jI Read Pre-Suasion: https://amzn.to/48hA6Qr Read Yes! (Containing 60 Psyc-Marketing Tips): https://amzn.to/48ddNNf Join 10,428 readers of my newsletter: https://www.nudgepodcast.com/mailing-list Connect on LinkedIn: https://www.linkedin.com/in/phill-agnew/ --- Today's sources: Aune, R. K., & Basil, M. D. (1994). A relational-obligations approach to fund-raising: The effects of guilt and credibility appeals on compliance. Communication Research, 21(4), 486–498. Binning, K. R., Kaufmann, N., McGreevy, E. M., Fotuhi, O., Chen, S., Marshman, E., Kalender, Z. Y., Limeri, L. B., Betancur, L., & Singh, C. (2020). Changing social contexts to foster equity in college science courses: An ecological-belonging intervention. Psychological Science, 31(9), 1059–1070. Boh, W. F., & Wong, S.-S. (2015). Managers versus co-workers as referents: Comparing social influence effects on within- and outside-subsidiary knowledge sharing. Organizational Behavior and Human Decision Processes, 126, 1–17. Borman, G. D., Rozek, C. S., Hanselman, P., & Destin, M. (2019). Reappraising academic and social adversity improves middle school students' academic achievement, behavior, and well-being. Proceedings of the National Academy of Sciences of the United States of America, 116(33), 16286–16291. Cai, H., Chen, Y., & Fang, H. (2009). Observational learning: Evidence from a randomized natural field experiment. American Economic Review, 99(3), 864–882. Frank, R. H. (2020). Under the influence: Putting peer pressure to work. Princeton University Press. Goldstein, N. J., Cialdini, R. B., & Griskevicius, V. (2008). A room with a viewpoint: Using social norms to motivate environmental conservation in hotels. Journal of Consumer Research, 35(3), 472–482. Hallsworth, M., List, J. A., Metcalfe, R. D., & Vlaev, I. (2017). The behavioralist as tax collector: Using natural field experiments to enhance tax compliance. Journal of Public Economics, 148, 14–31. Jung, J., Busching, R., & Krahé, B. (2019). Catching aggression from one's peers: A longitudinal and multilevel analysis. Social and Personality Psychology Compass, 13(4), e12440. Linder, J. A., Meeker, D., Fox, C. R., Friedberg, M. W., Persell, S. D., Goldstein, N. J., Knight, T. K., Hay, J. W., & Doctor, J. N. (2017). Durability of benefits of behavioral interventions on inappropriate antibiotic prescribing in primary care: Follow-up from a cluster randomized clinical trial. JAMA, 318(14), 1391–1392. Meeker, D., Linder, J. A., Fox, C. R., Friedberg, M. W., Persell, S. D., Goldstein, N. J., Knight, T. K., Hay, J. W., & Doctor, J. N. (2016). Effect of behavioral interventions on inappropriate antibiotic prescribing among primary care practices: A randomized clinical trial. JAMA, 315(6), 562–570. Murrar, S., Campbell, M. R., & Brauer, M. (2020). Exposure to peers' pro-diversity attitudes increases inclusion and reduces the achievement gap. Nature Human Behaviour, 4(9), 889–897. Nolan, J. M. (2021). Social norm interventions as a tool for pro-climate change. Current Opinion in Psychology, 42, 120–125. Peterson, R. A., Kim, Y., & Jeong, J. (2020). Out-of-stock, sold out, or unavailable? Framing a product outage in online retailing. Psychology & Marketing, 37(4), 535–547.
Ecoutez Le Cave' réveil avec Philippe Caverivière du 23 février 2026.Hébergé par Audiomeans. Visitez audiomeans.fr/politique-de-confidentialite pour plus d'informations.
Ecoutez Le Cave' réveil avec Philippe Caverivière du 23 février 2026.Hébergé par Audiomeans. Visitez audiomeans.fr/politique-de-confidentialite pour plus d'informations.
Listeners may recall I interviewed Ms. Smith early last March because the Trump administration immediately abandoned a decades old policy that forbade immigration enforcement at “protected [or sensitive] areas” that include healthcare facilities. Now a year later, ICE contingents have been sent to over 15 cities including of course Minneapolis. Beyond ICE arrest operations resulting in gunshot wounds, blunt force and psychological trauma and a constellation of subsequent health harms via arrest and detention, ICE agents have been appearing moreover in community health center and hospital ED waiting rooms, accessing facility medical examination rooms and pursuing Medicaid and other patient record resources. As a result, patients are effectively being “ICE-d Out of healthcare.” A recent Kaiser survey found, e.g., 14% of lawfully present immigrants, 8% of naturalized citizens and 48% of undocumented immigrant adults said they or a family member have avoided seeking medical care this year. In turn, healthcare providers are in sum left to determine how they can meet their professional responsibilities to effectively render timely care while managing or deescalating intimidation and avoiding possible obstruction charges. The recently published JAMA article, “Patients Are Getting ICE-d Out of Health Care” is at: https://jamanetwork.com/journals/jama/fullarticle/2845182. The recently published Stateline article, “Health care workers want ICE Out of Hospitals, and Blue States Are Responding,” is at: https://stateline.org/2026/02/09/health-care-workers-want-ice-out-of-hospitals-and-blue-states-are-responding/. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com
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 February 14-20, 2026.
Do you think your hospital should allow unilateral DNR orders? Under what circumstances? Through what process? Do you think that when you obtain the assent of a family to not code their loved one, that assent DNR should be counted as a unilateral DNR order? Should we document unilateral DNR and the rationale? Why for DNR, when we don't document unilateral dialysis not offered, or unilateral no ECMO offered? Is the assent of a family member to a statement that we will not code their loved one a nudge, and is the assent approach ethical? Reasonable people will disagree, as we do on this podcast. Our guests today are Gina Piscitello, Erin DeMartino, and Will Parker, authors of a terrific viewpoint in JAMA about the need to address inadequate documentation of unilateral DNR orders. You might recall Gina was a guest on our lively podcast about slow codes, and we pick up where that podcast left off. We highlight the many clinical, practical, and ethical issues at stake, including Gina's finding that during Covid, 3% of critically ill patients receiving pressors had a DNR order. Black patients and those who spoke Spanish had higher rates of unilateral DNR. That variation should trouble those in favor of unilateral DNR orders. We talk about variation Gina found at the state and health system level, and what exactly is concerning, the variation itself, or the lack of thought and care that went into some of these policies. Are you a heartbreaker? Dream Maker? Love taker? Don't you mess around with me. (song hint) -Alex
Colorectal cancer is now the leading cause of cancer deaths for Americans under the age of 50, according to a paper published last month in JAMA. This research backs up a trend that doctors have been seeing for a while now: Colon cancer isn’t just a disease that affects older people. Just last week, James Van Der Beek, who played Dawson on “Dawson’s Creek” died of colorectal cancer. He was 48 years old. In the past few years, more health organizations have followed the American Cancer Society in lowering the recommended age for colon cancer screenings from 50 to 45 years old. And more recently, there’s been a trend online that encourages people to start “fibermaxxing”... which is just a fancy way of telling them to eat more fiber. We talk to a doctor about this trend and the symptoms to look out for when it comes to colon cancer. Guests: Dr. Rachel Issaka, director of the colorectal cancer screening program for the Fred Hutchinson Cancer Center and UW Medicine Related links: Leading Cancer Deaths in People Younger Than 50 Years | Breast Cancer | JAMA | JAMA Network Colorectal Cancer Is Now the Top Cause of Cancer Death in Younger People - WSJ Thank you to the supporters of KUOW, you help make this show possible! If you want to help out, go to kuow.org/donate/soundsidenotes Soundside is a production of KUOW in Seattle, a proud member of the NPR Network.See omnystudio.com/listener for privacy information.
Interview with Maria L. Wei, MD, PhD, author of Sunscreen Costs in Association With Sun Protective Behaviors. Hosted by Adewole S. Adamson, MD, MPP. Related Content: Sunscreen Costs in Association With Sun Protective Behaviors
640 - Carl Carlton - She's a Bad Mama Jama (She's Built, She's Stacked): Chris, Nick, and Andy are joined by Tommy Lombardozzi from the Jacked Kirby podcast to break down "She's a Bad Mama Jama (She's Built, She's Stacked)" from the self titled 1981 album by Carl Carlton.
On this, our 314th Evolutionary Lens livestream, we discuss love, coffee, and AI. For Valentine's Day, Bret shares his thoughts on myths, love, and soulmates, and we discuss how relationships form—both in the abstract and in our case—and how relationships cannot be antagonistic or about short time horizons. Then: new research finds that drinking moderate amounts of coffee or tea—but not if decaffeinated—slows cognitive decline. And: is AI coming for us, and if so, how soon? How fast are LLM's evolving, whose work will they disappear, and is concern or hope the more constructive response? We can see some of how AI will change our world; what can we not yet see? Finally: could menial, repetitive work (“drudgery”) have more to recommend it than we know?*****Our sponsors:Caraway: Non-toxic, highly functional & beautiful cookware and bakeware. Save with Caraway's cookware set, and visit http://Carawayhome.com/DH10 to for an additional 10% off your next purchase.ARMRA Colostrum is an ancient bioactive whole food that can strengthen your immune system. Go to http://www.tryarmra.com/DARKHORSE to get 30% off your first order.CrowdHealth: Pay for healthcare with crowdfunding instead of insurance. It's way better. Use code DarkHorse at http://JoinCrowdHealth.com to get 1st 3 months for $99/month.*****Join us on Locals! Get access to our Discord server, exclusive live streams, live chats for all streams, and early access to many podcasts: https://darkhorse.locals.comHeather's newsletter, Natural Selections (subscribe to get free weekly essays in your inbox): https://naturalselections.substack.comOur book, A Hunter-Gatherer's Guide to the 21st Century, is available everywhere books are sold, including from Amazon: https://amzn.to/3AGANGg (commission earned)Check out our store! Epic tabby, digital book burning, saddle up the dire wolves, and more: https://darkhorsestore.org*****Mentioned in this episode:Zhang et al 2026. Coffee and Tea Intake, Dementia Risk, and Cognitive Function. JAMA published online 2-9-26: https://jamanetwork.com/journals/jama/article-abstract/2844764Something big is happening: https://x.com/mattshumer_/status/2021256989876109403It was never about AI (we are not our tools): https://x.com/EricMarkowitz/status/2022005480240120229AI isn't coming for your future. Fear is: https://x.com/cboyack/status/2021647373571862952Support the show
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 February 7-13, 2026.
Mark Cuban, entrepreneur, investor, and cofounder of the Mark Cuban Cost Plus Drug Company, joins JAMA Editor in Chief Kirsten Bibbins-Domingo, PhD, MD, MAS, to discuss the role of pharmacy benefit managers, insurance formularies, and opaque pricing practices that shape how most Americans access prescription drugs. Hear why he thinks doctors are the good guys in a broken system. Related Content: Pharmaceutical Pricing—JAMA Talks With Mark Cuban
HEALTH NEWS A Simple Diet Change Could Slow Liver Cancer Brief, intensive exercise helps patients with panic disorder more than standard care Lucid dreaming could be used for mental health therapy, new study says US cancer institute studying ivermectin's ‘ability to kill cancer cells Too many saturated fats may be more harmful than too many refined carbohydrates. Clips Andrew Bridgen - https://x.com/ABridgen/status/2020573528571977993?s=20 MAHA Alliance Mike Tyson Super Bowl Commercial - https://www.youtube.com/watch?v=jg1SjFt1a_U KETO DIET RISKS The rationale for Keto Diet by its advocates Restricting carbohydrates, suppressing insulin and ketosis will lead to better metabolic heath, increase weight loss, reduce inflammation, and protect from chronic diseases. Keto Claim: Carbohydrates raise insulin leading to fat storage – keto lowers insulin and burns body fat better Debunking: Ketosis is a metabolic state and not a health outcome. For example ketones can be elevated by very long fasting, starvation, different illnesses and uncontrolled diabetes. Keto Claim: By minimizing carbs keto stabilizes blood sugar, reduce insulin spikes, and improve insulin sensitivity that benefits those with type 2 diabetes Debunked: This claim contradicts the evidence of induced hepatic insulin resistance and glucose intolerance in longer-term studies. In animal models, keto diets impair blood sugar regulation within several days, which shows harm for metabolic health. Keto Claim: Ketones are seen as “clean” fuel that advocates claim are anti inflammatory and neuroprotective. Believe that this along with ketosis lowers triglycerides, raises HDL cholesterol, and improves lipid profiles. They argue that the increase in LDL cholesterol is benign. Claim saturated fats are harmless if carbs are low Debunked: This claim is undermined by the increased LDL cholesterol, triglycerides, and cardiovascular risks from saturated fats in animal products. Meta-analyses show no long-term lipid improvements from keto diets. Rather this is the risk in elevated low-density lipoprotein and very-low-density lipoproteins that increase cardiovascular disease Also, insulin reduction does not override the quality of fat. LDL cholesterol and ApoB, as well as atherosclerosis, increase significantly on an animal based diet. Saturated fat still remains a causal factor for cardiovascular disease. Keto Claim: High protein and fat increases satiety and therefore reduces hunger Debunking: Weight loss is primarily from reduced intake due to satiety, not fat-burning efficiency. Long-term keto adherence often leads to weight regain with no significant sustained benefits for visceral fat or appetite control. hort term weight loss is not same as long term benefits. A study shows that weight loss at 3-6 months on a keto diet disappears by 12 months Keto Claim: It enhances brain function and energy that then improves mental clarity and mood. Argue that animal products like eggs and organ meats provides choline and other nutrients for brain health. Debunked: There is no strong evidence for this claim. In fact keto's nutrient deficiencies and lack of fiber in the long term can lead to fatigue, constipation and in women neural tubal defects. Keto's claims are only based on short term trials. Keto Claim: Use the evolutionary argument that humans evolved eating meat and fat – same argument the paleo folks used. Therefore, they believe keto diets align with human biology Debunked: A big study in Science in 2025 analyzed tooth enamel from skeletons of some of our oldest human ancestors, 3.5 million years ago, and found they ate predominately a plant based diet with no substantial sigh of mammalian meat. The isotopes matched herbivores (fruits, leaves and grasses, tubers, nuts, other vegetation) not carnivores. Keto Diet Risks It is worth noting, according to the Northwestern University Health site, there is a sizable drop out rate of participants in keto trials. Although, there are studies that show keto does what it claims in the short term, there are no long-term human data to support their claims that an animal-based diet does this efficiently. Important, research leans in the direction to indicate that keto's benefits – especially weight loss and glucose reduction, are transient and may not be directly related to animal food consumption itself but rather to calorie reduction and limiting glycogen. Long term prospective studies and systematic meta analysis evaluations consistently show high red meat consumption, full-fat dairy and animal fats are associated with the following medical conditions. This is true even when carbohydrate intake is low A good thorough study in JAMA shows that unprocessed red meat mildly increases all cause mortality – about 3-5% per 100 grams meat per day High red and processed meat consumption increases carcinogenic N-nitroso compounds and heterocyclic amines that raise cancer risks by up to 18% per 50-100 grams/day – from meta analysis in the European Journal of Epidemiology Dairy increases IGF-1 levels thereby too much calcium also suppressing Vitamin D and elevating prostate cancer risks by 79% per 400 gram dairy per day. Worse for processed meats that inreases risk by 21% per 20 grams/day – American Journal of Epidemiology Red meat is linked to hormonal disruptions and carcinogens contributing breast cancer – European Journal of Cancer Total unprocessed red meat consumption shows a modest 5% risk in pancreatic cancer per 100 grams/day. – From journal Clinical Nutrition Many meta-analyses on meats have a relationship to stomach/gastric cancer, but processed meats are worse than unprocessed red meat. From study in Nutrients – 24 studies showed unprocessed red meat associated with gastric cancer by about 25% increase risk for every 100 grams/day. Unprocessed red meat is linked to an 11% higher risk in overall cardiovascular disease risk due to inflammation and endothelial dysfunction. – from European Heart Journal Saturated fats in meats increases non-HDL cholesterol and blood pressure and raises the risks of ischemic heart disease by 119% per 100 grams/day red meat – from American J Clinical Nutrition Red meat diets reduce LDL Cholesterol much less than plant proteins and thereby increase atherosclerosis risks – from the journal Circulation Red meats (an processed meats also in this study) contributes to insulin resistance via heme iron and raises Type 2 diabetes risks by up to 51% per 50 grams/day – International Journal Environmental Research in Public Health Saturated fats in unprocessed red meat has a modest positive 12% increase with stroke risk – From European Heart Journal Unprocessed poultry consumption shows a modest 4% increase in incident cardiovascular events per 100 grams/day. This is believed to be due to arachidonic acid poultry – in JAMA Red meat contributes to sodium and saturated fat intact raising hypertension conditions by 14% per 50-100 gram/day – from journal Advanced Nutrition Saturated fats from animal products cause lipotoxicity and insulin resistance, that promotes hepatic fat accumulation leading to non-alcoholic fatty liver disease – from Cardiovascular Development and Disease High animal protein increases urinary calcium and acid overload leading to the formation of kidney stones – from the journal Nutrient Animal-heavy diets have low fiber and micronutrient intake that contribute to nutrient deficiencies. Also causes constipation that can lead to immune system issues. – from the journal Nutrients Red meat, dairy, and eggs disrupts the gut metabolism of carnitine and choline. This promotes TMAO plaque formation and inflammation that leads to atherosclerosis. – from Journal of Cardiovascular Development. Although unprocessed meat consumption has not been adequately associated with dementia and Alzheimer's – yes, processed meats do – there are studies showing red meat is associated with “subjective cognitive decline” (SCD) which is related to precursors to dementia and Alzheimer's. A study in journal Neurology links unprocessed red meat eaten at 1 or more servings per day to 16% higher risk in SCD. High caloric density from saturated animal fats displaces fiber that contributes to weight gain obesity. From Neal Barnard in the American Journal of Clinical Nutrition Animal products transmit prions that are associated with neurodegenerative disorders. Proinflammatory compounds like TMAO are linked to neurological risks. – in International Journal of Molecular Science
Authorities in Arizona said they detained a "subject" in connection to the Nancy Guthrie investigation. Hours later, a man who identified himself as Carlos said he was that person and that authorities searched his car and a van before releasing him. Police have not confirmed that Carlos was that subject. Video shows a raid at a horse racing event in Idaho last October where nearly 500 people, the vast majority U.S. citizens or legal residents, were detained. A 14-year-old girl describes the moment she was confronted by authorities and zip-tied. Matt Gutman reports. U.S. figure skater Maxim Naumov competed Tuesday at the 2026 Winter Games – fulfilling a dream he had shared with his parents who were killed last year in the D.C. midair collision. Kelly O'Grady has more. Millions of Americans are turning to AI for emotional therapy. A report in JAMA found about 13% of young people use AI chatbots for mental health advice. Dr. Sue Varma, a board-certified psychiatrist, explains what to know about safety, privacy and ethical standard concerns. Officials are looking to identify a person who was caught on video wearing a mask and gloves outside Nancy Guthrie's home the night she went missing. On Tuesday, a person was detained in connection to the case and a man who identified himself as Carlos said he was that person and was released. Lance Leising, a retired supervisory special agent with the FBI, joins "CBS Mornings" to break down the latest developments in the case. Republican Sen. Rand Paul of Kentucky talks with "CBS Mornings" about the brief El Paso airspace closure and immigration crackdowns in U.S. cities, adding "I think there's a loss of public trust" in ICE" following the deadly shootings in Minneapolis. On Thursday, top officials from three federal immigration agencies will testify before a Senate committee. (Update: The FAA lifted the closure at El Paso Airport hours after it said it was halting all flights in and out of the airport for 10 days) To learn more about listener data and our privacy practices visit: https://www.audacyinc.com/privacy-policy Learn more about your ad choices. Visit https://podcastchoices.com/adchoices
Send us a Text Message (please include your email so we can respond!)Episode 85! In this episode we go over LIBERATE-D or "A Conservative Dialysis Strategy and Kidney Function Recovery in Dialysis-Requiring Acute Kidney Injury" by Liu et al in JAMA 2026. We have the second author, Eddie Siew, on with us to discuss!LIBERATE-D (pubmed): https://pubmed.ncbi.nlm.nih.gov/41201895/LIBERATE-D (JAMA): https://jamanetwork.com/journals/jama/article-abstract/2841171If 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!
This week’s Pulm PEEPs Pearls episode is all about spontaneous breathing trials (SBTs). SBTs are a standard part of the daily practice in the intensive care unit, but the exact methods vary across ICUs and institutions. Listen in to hear about the most common methods of SBTs, the physiology of each method, and what the evidence says. 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 What an SBT is really testing An SBT is a stress test for post-extubation work of breathing, not just a ventilator check. The goal is to balance sensitivity and specificity: Too hard → unnecessary failures and delayed extubation Too easy → false positives and higher risk of reintubation Common SBT modalities and how they compare T-piece No inspiratory support and no PEEP Highest work of breathing Most “physiologic” but often too strict Pressure support (PS) + PEEP (e.g., 5/5 or 8/5) Offsets ETT resistance and provides modest assistance Easier to pass than T-piece CPAP (0/5) No inspiratory help, but provides PEEP to counter ETT resistance Sits between PS and T-piece in difficulty Evidence favors pressure-supported SBTs for most patients Large meta-analysis (~6,000 patients, >40 RCTs): Pressure-supported SBTs increase successful extubation (~7% absolute benefit) No increase in reintubation rates Trials (e.g., FAST trial): Patients pass SBTs earlier Leads to earlier extubation and fewer ventilator-associated risks Bottom line: A 30-minute PS 5/5 SBT is evidence-based and appropriate for most stable ICU patients When a T-piece still makes sense T-piece SBTs are useful when: Cost of reintubation is high Difficult airway Prior failed extubation Pretest probability of success is low Prolonged or difficult weaning Tracheostomy vs extubation decisions Need to mimic physiology without positive pressure In LV dysfunction or pulmonary edema even small amounts PEEP may significantly improve physiology Some centers use a hybrid approach: PS SBT → short confirmatory T-piece before extubation CPAP as a middle ground Rationale: Allows full patient effort while compensating for ETT resistance Evidence: Fewer and smaller trials Possible modest improvement in extubation success No clear mortality or LOS benefit Reasonable option based on patient physiology, institutional protocols, and clinician comfort No single “perfect” SBT mode Across PS, T-piece, CPAP, and newer methods (e.g., high-flow via ETT) there are no consistent differences in mortality or length of stay What matters most: Daily protocolized screening Thoughtful bedside clinical judgment Matching SBT difficulty to patient-specific risk Institutional variation is normal—and acceptable Examples: PS 10/5 in postoperative surgical ICU patients PS 5/0 as an intermediate difficulty option Key question clinicians should ask: What does passing or failing this specific SBT tell me about this patient's likelihood of post-extubation success? Take-home pearls SBTs are stress tests of post-extubation physiology. PS 5/5 for 30 minutes is a strong default for most ICU patients. T-piece trials are valuable when false positives are costly or physiology demands it. CPAP is reasonable but supported by less robust data. Consistency, daily screening, and judgment matter more than the exact mode. References and Further Reading Burns KEA, Khan J, Phoophiboon V, Trivedi V, Gomez-Builes JC, Giammarioli B, Lewis K, Chaudhuri D, Desai K, Friedrich JO. Spontaneous Breathing Trial Techniques for Extubating Adults and Children Who Are Critically Ill: A Systematic Review and Meta-Analysis. JAMA Netw Open. 2024 Feb 5;7(2):e2356794. doi: 10.1001/jamanetworkopen.2023.56794. PMID: 38393729; PMCID: PMC10891471. Burns KEA, Sadeghirad B, Ghadimi M, Khan J, Phoophiboon V, Trivedi V, Gomez Builes C, Giammarioli B, Lewis K, Chaudhuri D, Desai K, Friedrich JO. Comparative effectiveness of alternative spontaneous breathing trial techniques: a systematic review and network meta-analysis of randomized trials. Crit Care. 2024 Jun 8;28(1):194. doi: 10.1186/s13054-024-04958-4. PMID: 38849936; PMCID: PMC11162018. Subirà C, Hernández G, Vázquez A, Rodríguez-García R, González-Castro A, García C, Rubio O, Ventura L, López A, de la Torre MC, Keough E, Arauzo V, Hermosa C, Sánchez C, Tizón A, Tenza E, Laborda C, Cabañes S, Lacueva V, Del Mar Fernández M, Arnau A, Fernández R. Effect of Pressure Support vs T-Piece Ventilation Strategies During Spontaneous Breathing Trials on Successful Extubation Among Patients Receiving Mechanical Ventilation: A Randomized Clinical Trial. JAMA. 2019 Jun 11;321(22):2175-2182. doi: 10.1001/jama.2019.7234. Erratum in: JAMA. 2019 Aug 20;322(7):696. doi: 10.1001/jama.2019.11119. PMID: 31184740; PMCID: PMC6563557. Burns KEA, Wong J, Rizvi L, Lafreniere-Roula M, Thorpe K, Devlin JW, Cook DJ, Seely A, Dodek PM, Tanios M, Piraino T, Gouskos A, Kiedrowski KC, Kay P, Mitchell S, Merner GW, Mayette M, D’Aragon F, Lamontagne F, Rochwerg B, Turgeon A, Sia YT, Charbonney E, Aslanian P, Criner GJ, Hyzy RC, Beitler JR, Kassis EB, Kutsogiannis DJ, Meade MO, Liebler J, Iyer-Kumar S, Tsang J, Cirone R, Shanholtz C, Hill NS; Canadian Critical Care Trials Group. Frequency of Screening and Spontaneous Breathing Trial Techniques: A Randomized Clinical Trial. JAMA. 2024 Dec 3;332(21):1808-1821. doi: 10.1001/jama.2024.20631. PMID: 39382222; PMCID: PMC11581551. Mahul M, Jung B, Galia F, Molinari N, de Jong A, Coisel Y, Vaschetto R, Matecki S, Chanques G, Brochard L, Jaber S. Spontaneous breathing trial and post-extubation work of breathing in morbidly obese critically ill patients. Crit Care. 2016 Oct 27;20(1):346. doi: 10.1186/s13054-016-1457-4. PMID: 27784322; PMCID: PMC5081985. Yi LJ, Tian X, Chen M, Lei JM, Xiao N, Jiménez-Herrera MF. Comparative Efficacy and Safety of Four Different Spontaneous Breathing Trials for Weaning From Mechanical Ventilation: A Systematic Review and Network Meta-Analysis. Front Med (Lausanne). 2021 Nov 22;8:731196. doi: 10.3389/fmed.2021.731196. PMID: 34881255; PMCID: PMC8647911.
Welcome to The Times of Israel's Daily Briefing, your 20-minute audio update on what's happening in Israel, the Middle East and the Jewish world. Military correspondent Emanuel Fabian joins host Amanda Borschel-Dan for today's episode. The Israel Defense Forces captured a “senior” member of the al-Jama’a al-Islamiyya (Islamic Group) terror organization during an overnight raid in southern Lebanon. We hear how, according to the IDF, the operative was nabbed late Sunday from a building in the Mount Dov area near the border by a special forces unit operating with troops of the 210th “Bashan” Regional Division. We then turn to a tour of Israel's borders and learn where are the hot spots and where things are (smuggling) business as usual. In light of Hamas's continued refusal to lay down its arms, the IDF is preparing plans for a larger ground operation. Fabian fills us in. And to close out the program, we learn about a new, all-female combat intelligence unit and how the IDF is happy for all the woman-power it can get. Check out The Times of Israel's ongoing liveblog for more updates. For further reading: IDF nabs top terror group figure from Lebanon, targets Hezbollah operative IDF says it hit Hamas arms depot after issuing evacuation warning for Gaza City building Hamas terrorist who murdered IDF surveillance soldier Noa Marciano killed in strike Subscribe to The Times of Israel Daily Briefing on Apple Podcasts, Spotify, YouTube, or wherever you get your podcasts. This episode was produced by Ari Schlacht. IMAGE: Hezbollah supporters raise their group's flags during a protest condemning recent Israeli military actions in Lebanon in Beirut, Lebanon, February 4, 2026. (AP Photo/Bilal Hussein)See omnystudio.com/listener for privacy information.
Send us a textIn this episode of The Incubator, Ben and Daphna return from the Delphi Conference to dive back into Journal Club. They review the highly anticipated TORPIDO 30/60 trial published in JAMA, comparing initial oxygen concentrations of 30% versus 60% for preterm resuscitation. The hosts discuss the primary outcomes of survival and brain injury, while highlighting intriguing secondary findings regarding chest compressions and epinephrine use in the delivery room. They also share exciting updates on the Vermont Oxford Network collaboration and a new family study from the GFCNI.----Targeted Oxygen for Initial Resuscitation of Preterm Infants: The TORPIDO 30/60 Randomized Clinical Trial. Oei JL, Kirby A, Travadi J, Davis P, Wright I, Ghadge A, Yeung C, Cruz M, Keech A, Hague W, Lui K, Vento M, Gordon A, De Waal K, Chaudhari T, Hong TSL, Morris S, Kushnir A, Bonney D, Tracy M, Kumar K, Chhnia AS, Baral VR, Muniyappa P, Cheah FC, Sarnadgouda P, Rajadurai VS, Balakrishnan U, Oleti TP, Aldecoa-Bilbao V, Couce ML, Collados CT, Fernández RE, Moliner E, Ruiz Gonzalez MD, Singhal M, Agrawal G, Singh J, Pal S, Nayya S, Arora R, Amboiram P, Simes J, Tarnow-Mordi W; TORPIDO30/60 Collaborative Group.JAMA. 2025 Dec 10:e2523327. doi: 10.1001/jama.2025.23327. Online ahead of print.PMID: 41369162Support 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!
Nurses are the backbone of patient care, but their role in antibiotic and diagnostic stewardship is still underrecognized. In this episode of The SHEA Podcast, host Dr. Marisa Holubar is joined by Dr. Eileen Carter and Dr. David Ha to explore why nurses are essential to stewardship success. Together, they discuss the evidence behind nursing engagement, persistent barriers to involvement, and real-world examples where nurse-led initiatives have reduced antibiotic use, infections, and waste. From IV-to-PO transitions to penicillin allergy assessment and diagnostic stewardship, this conversation offers practical strategies for engaging nurses, leveraging shared governance, and building stronger, more effective stewardship programs across care settings. References: Thurman Johnson C, Ridge LJ, Hessels AJ. Nurse Engagement in Antibiotic Stewardship Programs: A Scoping Review of the Literature. J Healthc Qual. 2023 Mar-Apr 01;45(2):69-82. doi: 10.1097/JHQ.0000000000000372. Epub 2022 Dec 12. PMID: 36729679; PMCID: PMC9991980. Shenoy ES, Macy E, Rowe T, Blumenthal KG. Evaluation and Management of Penicillin Allergy: A Review. JAMA. 2019 Jan 15;321(2):188-199. doi: 10.1001/jama.2018.19283. PMID: 30644987. Carter EJ, Schramm C, Baron K, Zolla MM, Zavez K, Banach DB. Perceived usefulness of a mnemonic to improve nurses' evaluation of reported penicillin allergies. Antimicrob Steward Healthc Epidemiol. 2023 Jul 11;3(1):e124. doi: 10.1017/ash.2023.177. PMID: 37502243; PMCID: PMC10369439. Carter EJ, Zavez K, Schramm C, Zolla MM, Baron K, Banach DB. Multifaceted implementation strategy to improve the evaluation of penicillin allergies in perioperative patients: a pre-post feasibility implementation study. Infect Control Hosp Epidemiol. 2024 Oct 30;45(12):1-7. doi: 10.1017/ice.2024.119. Epub ahead of print. PMID: 39473231; PMCID: PMC11663472. Resources: ANCC Magnet Recognition Program: https://www.nursingworld.org/organizational-programs/magnet/ Breakpoints, The SIDP Podcast: https://breakpoints-sidp.org/18-waking-the-sleeping-giant-engaging-nurses-in-antimicrobial-stewardship/
🧭 REBEL Rundown 📌 Key Points 💨 HFNC met criteria for non-inferiority to BPAP for preventing intubation or death within 7 days in four of the five ARF subgroups.🧪 Bayesian dynamic borrowing increased power across subgroups but created variable certainty, especially in smaller groups such as COPD.🫁 The immunocompromised hypoxemia subgroup did not meet non-inferiority, leading to early trial stopping for futility.️ Rescue BPAP use, subgroup-specific exclusion criteria, and non-standardized BPAP delivery are important contextual factors that influence how subgroup results should be interpreted. Click here for Direct Download of the Podcast. 📝 Introduction Bilevel Positive Airway Pressure (BPAP) has long been a foundational modality in the management of acute respiratory failure (ARF), particularly in COPD exacerbations and cardiogenic pulmonary edema, where it can rapidly reduce work of breathing and improve gas exchange. It remains a core tool in our respiratory support arsenal.High-flow nasal cannula (HFNC), however, has expanded what we can offer patients by delivering many of the same physiologic benefits through a far more comfortable interface. With high flows, modest PEEP, and effective dead-space washout, HFNC can improve oxygenation and decrease work of breathing while preserving the ability to talk, cough, eat, and interact with staff and family. This combination of physiologic support and tolerability makes HFNC especially attractive in patients where comfort, anxiety, or cardiovascular stability are key considerations, and in settings where prolonged noninvasive support may be needed. Rather than competing with BPAP, HFNC broadens our options in ARF and allows us to better match the modality to the patient and their underlying disease process.The RENOVATE trial set out to answer a high-impact question across five distinct etiologic groups: Is HFNC non-inferior to BPAP (NIV) for preventing intubation or death in acute respiratory failure? 🧾 Paper Azoulay É, et al. High-Flow Nasal Oxygen vs Noninvasive Ventilation in Patients With Acute Respiratory Failure: The RENOVATE Randomized Clinical Trial. JAMA. 2025 PMID: 39657981 🔙Previously Covered On REBEL: HFNC: Part 1 – How It WorksHFNC: Part 2 – Adult and Pediatric IndicationsFLORALI and AVOID TrialFLORALI-2: NIV vs HFNC as Pre-Oxygenation Prior to IntubationThe Pre-AeRATE Trial – HFNC vs NC for RSI ️ What They Did CLINICAL QUESTION Is HFNC non-inferior to BPAP for rate of endotracheal intubation or death at 7 days in patients with acute respiratory failure due to a variety of causes? STUDY DESIGN Multicenter, randomized non-inferiority trial33 Brazilian hospitalsNov 2019 – Nov 2023Adaptive Bayesian hierarchical modeling with dynamic borrowingOpen label, outcome adjudicators blindedPatients were classified into 5 subgroups SUBGROUPS 1. Non-immunocompromised hypoxemiaSpO₂ < 90% on room air orPaO₂ < 60 mm Hg on room air plusIncreased respiratory effort (accessory muscle use, paradoxical breathing, thoracoabdominal asynchrony) orRespiratory rate > 25 breaths/min2. Immunocompromised hypoxemiaDefined as:Use of immunosuppressive drugs for >3 monthsOR high-dose steroids >0.5 mg/kg/dayOR solid organ transplantOR solid tumors or hematologic malignancies (past 5 years)OR HIV with AIDS / primary immunodeficiency3. COPD exacerbation with acidosisHigh clinical suspicion of COPD as primary diagnosisRR >25 with accessory muscle use, paradoxical breathing, and/or thoracoabdominal asynchronyABG: pH 454. Acute cardiogenic pulmonary edema (ACPE)Sudden onset dyspnea and rales± S3 heart soundNo evidence of aspiration, infection, or pulmonary fibrosisCXR consistent with pulmonary edema5. Hypoxemic COVID-19 (added June 2023)Added due to deviations between expected and observed outcome proportionsAny patient across the other 4 groups with PCR-confirmed SARS-CoV-2 infection in any of the above groups POPULATION Inclusion Criteria:≥18 yrs with ARF* in one of 5 pre-defined subgroups excluding COPD was defined by the following:Hypoxemia with SpO₂
In 1930, the King of Thailand gifted a tree to the University of Hawaii in Manoa for developing a treatment for leprosy. For decades, the tree has stood as a symbol of the groundbreaking scientific achievement. However, the woman who created the solution was missing from the story.Read Alice Ball's Master's Thesis on the Kava Plant, and Dr. Hollman's JAMA article crediting Alice Ball. And check out The Ball Method Film.We always want to hear from you! If you have a question or story for us, give us a call at at 315-992-7902 and leave a message, or send an email to hello@atlasobscura.com Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.
This episode of EM Pulse dives into one of the most stressful scenarios in the ED: the febrile infant in the first month of life. Traditionally, a fever in this age group has meant an automatic “full septic workup,” including the dreaded lumbar puncture (LP). But times are changing. We sit down with experts Dr. Nate Kuppermann and Dr. Brett Burstein to discuss a landmark JAMA study that suggests we might finally be able to safely skip the LP in many of our tiniest patients. The Study: A Game Changer for Neonates Our discussion centers on a massive international pooled study evaluating the PECARN Febrile Infant Rule specifically in infants aged 0–28 days. While previous guidelines were conservative due to a lack of data for this specific age bracket, this study provides the evidence we've been waiting for. The Cohort: A large pool of infants across multiple countries. The Findings: The PECARN rule demonstrated an exceptionally high negative predictive value for invasive bacterial infections. The Big Win: The rule missed zero cases of bacterial meningitis. Defining the Danger: SBI vs. IBI The experts break down why we are shifting our terminology and our clinical focus. Serious Bacterial Infection (SBI) Historically, this was a “catch-all” term including Urinary Tract Infections (UTIs), bacteremia, and meningitis. However, UTIs are generally more common, easily identified via urinalysis, and typically less life-threatening than the other two. Invasive Bacterial Infection (IBI) This term refers specifically to bacteremia and bacterial meningitis. These are the “high-stakes” infections the PECARN rule is designed to rule out. Dr. Kuppermann notes that we should ideally view bacteremia and meningitis as distinct entities, as the clinical implications of a missed meningitis case are far more severe. The HSV Elephant in the Room One of the primary reasons clinicians hesitate to skip an LP in a neonate is the fear of missing Herpes Simplex Virus (HSV) infection. Low Baseline Risk: While the overall risk of HSV in a febrile infant is low, the risk of “isolated” HSV (meningitis without other signs or symptoms) is even rarer. Screening Tools: Most infants with HSV appear clinically ill. Clinicians can also use ALT (liver function) testing as a secondary screen – transaminase elevation is a common marker for systemic HSV. Clinical Judgment: If the baby is well-appearing, has no maternal history of HSV, no vesicles, and no seizures, the risk of missing HSV by skipping the LP is exceptionally low. Practical Application: Shared Decision-Making This isn’t just about the numbers—it’s about the parents. “Families don’t mind their babies being admitted… They do not want the lumbar puncture. It is the single most anxiety-provoking aspect of care.” — Dr. Brett Burstein The PECARN “Low-Risk” Criteria: (Remember, this rule applies only to infants who are not ill-appearing.) Urinalysis: Negative Absolute Neutrophil Count (ANC): ≤ 4,000/mm³ Procalcitonin (PCT): ≤ 0.5 ng/mL The Bottom Line: If an infant is well-appearing and meets these criteria, physicians can have a nuanced conversation with parents about the risks and benefits of forgoing the LP, while still admitting the child for observation (often without empiric antibiotics) while cultures brew. Key Takeaways The “Well-Appearing” Filter: If an infant looks ill, the rule does not apply. These patients require a full workup, including an LP, regardless of lab results. Meticulous Physical Exam: Assess for a strong suck, normal muscle tone, brisk capillary refill, and any rashes or vesicles. History is Key: Always ask about maternal GBS/HSV status, pregnancy or birth complications, prematurity, sick contacts, and any changes in feeding, stooling or activity. Procalcitonin: PCT is the superior inflammatory marker for this rule. If your facility only offers traditional markers like CRP, the PECARN negative predictive value cannot be strictly applied. In the words of Dr. Kuppermann: “If you don’t have it, for God’s sakes, just get it! ALT to Screen for HSV: While not part of the official PECARN rule, our experts suggest that significantly elevated liver enzymes should raise suspicion for systemic HSV. Observe, Don’t Discharge: Being “low risk” does not mean the infant goes home. All infants ≤ 28 days still require admission for 24-hour observation and blood/urine cultures. We want to hear from you! Does this change how you approach febrile neonates in the ED? How do you handle shared decision-making with parents? Connect with us on social media @empulsepodcast or on our website ucdavisem.com. Hosts: Dr. Julia Magaña, Professor of Pediatric Emergency Medicine at UC Davis Dr. Sarah Medeiros, Professor of Emergency Medicine at UC Davis Guests: Dr. Nate Kuppermann, Executive Vice President and Chief Academic Officer; Director, Children’s National Research Institute; Department Chair, Pediatrics, George Washington University School of Medicine and Health Sciences Dr. Brett Burstein, Clinician-Scientist and Pediatric Emergency Medicine Physician at Montreal Children’s Hospital, McGill University Resources: Burstein B, Waterfield T, Umana E, Xie J, Kuppermann N. Prediction of Bacteremia and Bacterial Meningitis Among Febrile Infants Aged 28 Days or Younger. JAMA. 2026 Feb 3;335(5):425-433. doi: 10.1001/jama.2025.21454. PMID: 41359314; PMCID: PMC12687207“Hot” Off the Press: Infant Fever Rule “Hot” Off the Press: Infant Fever Rule Do I really need to LP a febrile infant with a UTI? PECARN Infant Fever Update: 61-90 Days Kuppermann N, Dayan PS, Levine DA, Vitale M, Tzimenatos L, Tunik MG, Saunders M, Ruddy RM, Roosevelt G, Rogers AJ, Powell EC, Nigrovic LE, Muenzer J, Linakis JG, Grisanti K, Jaffe DM, Hoyle JD Jr, Greenberg R, Gattu R, Cruz AT, Crain EF, Cohen DM, Brayer A, Borgialli D, Bonsu B, Browne L, Blumberg S, Bennett JE, Atabaki SM, Anders J, Alpern ER, Miller B, Casper TC, Dean JM, Ramilo O, Mahajan P; Febrile Infant Working Group of the Pediatric Emergency Care Applied Research Network (PECARN). A Clinical Prediction Rule to Identify Febrile Infants 60 Days and Younger at Low Risk for Serious Bacterial Infections. JAMA Pediatr. 2019 Apr 1;173(4):342-351. doi: 10.1001/jamapediatrics.2018.5501. PMID: 30776077; PMCID: PMC6450281. Pantell RH, Roberts KB, Adams WG, Dreyer BP, Kuppermann N, O’Leary ST, Okechukwu K, Woods CR Jr; SUBCOMMITTEE ON FEBRILE INFANTS. Evaluation and Management of Well-Appearing Febrile Infants 8 to 60 Days Old. Pediatrics. 2021 Aug;148(2):e2021052228. doi: 10.1542/peds.2021-052228. Epub 2021 Jul 19. Erratum in: Pediatrics. 2021 Nov;148(5):e2021054063. doi: 10.1542/peds.2021-054063. PMID: 34281996. ****Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Productions for audio production services.
Physicians face higher rates of depression, anxiety, and suicide risk than the general population, yet most never seek mental health care. In this episode, Dr. Jesse Ehrenfeld, professor of anesthesiology at the Medical College of Wisconsin and Global Chief Medical Officer for AIDOC, discusses new JAMA research examining why. The conversation looks at how medical culture, stigma, time constraints and concerns about confidentiality or professional consequences can keep physicians from getting help, even when effective treatment exists. Hosted on Acast. See acast.com/privacy for more information.
The Derm on RheumNow podcast is a collection of Citations and Content curated for dermatologists – addressing Psoriasis, PsA, CLE, vasculitis, HS, other CTD skin disorders. dermatology drugs, biiologics, JAKs - their use, efficacy and side effects. Features Dr. Jack Cush, Editor at RheumNow.com. SHOW NOTES Lupus Accelerating Breakthroughs Consortium commissioned a stakeholders group (including the FDA) to assess drug development in Cutaneous lupus CLE), and they have endorsed CLASI (CLE Dz Area & Severity Index) as the outcome measure for CLE clinical trials. https://t.co/q7If97AHBa PAPA Syndrome: When Sterile Inflammation Mimics Infection (Pyogenic Arthritis, Pyoderma gangrenosum, Acne) •A rare monogenic autoinflammatory disease •Caused by gain-of-function mutations in PSTPIP1
Recent randomized controlled trials have shown that routine perioperative palliative care does not improve outcomes for patients undergoing curative-intent cancer surgery. No, that wasn't a typo. Regardless of how the data were analyzed, the findings remained consistent: perioperative palliative care DID NOT improve outcomes in the only two randomized controlled trials conducted in this area—the SCOPE and PERIOP-PC trials. Null trials like these often receive less attention in academic and clinical settings, but they can be profoundly practice-changing. Consider the Shannon Carson study on palliative care for chronically critically ill patients. While some have argued it "wasn't a palliative care study," I've always regarded it as one of the most significant studies for understanding not what works—but what doesn't—for palliative care in specific patient populations. The same holds true for the SCOPE and PERIOP-PC trials. Both were null, but their findings are deeply relevant to clinical practice. That's why we invited the lead authors, Rebecca Aslakson (PERIOP-PC) and Myrick "Ricky" Shinall (SCOPE), to share insights into what they did in their studies and why they think they got the results that they did. One key takeaway for me from this discussion was the idea that patients undergoing curative-intent surgery might simply be too early in their cancer trajectory to derive meaningful benefits from palliative care, and maybe the focus should be more on geriatrics. I especially appreciated the closing discussion about the future of research in this area: if routine perioperative palliative care doesn't improve outcomes, what should the next generation of studies focus on? Eric Widera Studies we talk about during the podcast Aslakson et al. Effect of Perioperative Palliative Care on Health-Related Quality of Life Among Patients Undergoing Surgery for Cancer: A Randomized Clinical Trial. JAMA Netw Open. 2023 Shinall et al. Effects of Specialist Palliative Care for Patients Undergoing Major Abdominal Surgery for Cancer: A Randomized Clinical Trial. JAMA Surg. 2023 Carson et al. Effect of Palliative Care–Led Meetings for Families of Patients With Chronic Critical Illness: A Randomized Clinical Trial. JAMA. 2016 Holdsworth et al. Patient Experiences of Specialty Palliative Care in the Perioperative Period for Cancer Surgery. JPSM. 2024 Williams et al. Patient Perceptions of Specialist Palliative Care Intervention in Surgical Oncology Care. Am J Hosp Palliat Care. 2025 Yefimova et al. Palliative Care and End-of-Life Outcomes Following High-risk Surgery. JAMA Surg. 2020
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