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Send us a textThe Jams ‘N' Cocktails crew wraps up Season 9 with a finale that's equal parts hilarious and horrifying! Host Brad Brock, along with Captain Cocktail Derek Zugel and the ever-fearless Elly, dive headfirst into one of their messiest (and cringiest) food challenges yet. From scorpions and mealworms to Jurassic-level spicy jerky, this episode pulls no punches as the team faces off against bizarre snacks and serious heat—all while keeping the laughs rolling.Of course, it wouldn't be a JNC episode without a signature drink, and this week's star is the Dr Pepper Old-Fashioned—a playful twist on the classic cocktail that blends nostalgia with serious mixology chops. Plus, Brad shares behind-the-scenes stories, live music exclusives, and plenty of interactive fun with their vibrant live audience. Tune in for the finale sendoff and get a sneak peek at what's coming in Season 10!LinksJNC Officialhttps://www.jncpodcast.comSupport us on Patreonhttps://www.patreon.com/jncpodcast
The Jams ‘N' Cocktails crew wraps up Season 9 with a finale that's equal parts hilarious and horrifying! Host Brad Brock, along with Captain Cocktail Derek Zugel and the ever-fearless Elly, dive headfirst into one of their messiest (and cringiest) food challenges yet. From scorpions and mealworms to Jurassic-level spicy jerky, this episode pulls no punches as the team faces off against bizarre snacks and serious heat—all while keeping the laughs rolling.Of course, it wouldn't be a JNC episode without a signature drink, and this week's star is the Dr Pepper Old-Fashioned—a playful twist on the classic cocktail that blends nostalgia with serious mixology chops. Plus, Brad shares behind-the-scenes stories, live music exclusives, and plenty of interactive fun with their vibrant live audience. Tune in for the finale sendoff and get a sneak peek at what's coming in Season 10!LinksJNC Officialhttps://www.jncpodcast.comSupport us on Patreonhttps://www.patreon.com/jncpodcast
Send us a textIn this milestone episode of Jams ‘N' Cocktails, host Brad Brock and the infamous JNC Destruction Crew throw an epic party to celebrate reaching 1,000 YouTube subscribers! Broadcasting from the legendary JNC Lounge, Brad is joined by co-hosts Elly Brock, Derek “The Master of Disaster,” special guest Paul Robertson (host of Riffs ‘N' Rhythms), and the always-amazing Jordyn Taylor joining remotely. This lively crew reflects on the wild ride that brought them here, with laughter, music, cocktails, and chaos.Listeners can expect a nostalgic journey through old segments, a deep dive into how the show has evolved since its humble beginnings, and plenty of interactive fun—including a round of Shot Roulette, a boozy root beer float from Captain Cocktail, and a fiery rendition of The Jordy Files. The group also shares heartfelt moments and gratitude with fans who helped make this dream a reality. It's celebration, storytelling, and signature JNC shenanigans in one unforgettable episode.LinksJNC Officialhttps://www.jncpodcast.comSupport us on Patreonhttps://www.patreon.com/jncpodcast
In this milestone episode of Jams ‘N' Cocktails, host Brad Brock and the infamous JNC Destruction Crew throw an epic party to celebrate reaching 1,000 YouTube subscribers! Broadcasting from the legendary JNC Lounge, Brad is joined by co-hosts Elly Brock, Derek “The Master of Disaster,” special guest Paul Robertson (host of Riffs ‘N' Rhythms), and the always-amazing Jordyn Taylor joining remotely. This lively crew reflects on the wild ride that brought them here, with laughter, music, cocktails, and chaos.Listeners can expect a nostalgic journey through old segments, a deep dive into how the show has evolved since its humble beginnings, and plenty of interactive fun—including a round of Shot Roulette, a boozy root beer float from Captain Cocktail, and a fiery rendition of The Jordy Files. The group also shares heartfelt moments and gratitude with fans who helped make this dream a reality. It's celebration, storytelling, and signature JNC shenanigans in one unforgettable episode.LinksJNC Officialhttps://www.jncpodcast.comSupport us on Patreon!https://www.patreon.com/jncpodcast
The JNC crew was back in full force at the legendary JNC Lounge for a night that was equal parts hilarious, nostalgic, and just a little torturous. Host Brad Brock was joined by the ever-fabulous Jordyn Taylor and the one and only Derek Zugel for a raucous JNC Family Game Night — and yes, it was electrifying... literally.Armed with shock collars and a stack of trivia cards, the trio dove headfirst into the chaotic fun of Lyrically Correct — a throwback music trivia game that doesn't ask you to finish the lyrics, but to remember the clever details about them. A wrong answer? ZAP! The night also featured a “Shot of the Week” inspired by Snoop Dogg, a surprise mid-show acoustic concert from Brad, killer cocktail creations in JNC Bargatory, and the return of The Jordy Files for a fresh dose of entertainment news. This one's a wild ride from start to finish — buckle up!LinksJNC Officialhttps://www.jncpodcast.comSupport us on Patreonhttps://www.patreon.com/jncpodcast
The Pickleball Show with CurtisReese -Discuss the fast growing sport of Pickleball!
In this exciting episode of *The Pickleball Show*, host Curtis Reese welcomes the dynamic duo of Christine and Peter Burrows, founders of a corporate team-building company with a rich tennis background. The conversation delves into their unique journey of transitioning from tennis to pickleball, highlighting their experiences and insights gained along the way. Christine and Peter share how their love for tennis laid the foundation for their passion for pickleball, which they first discovered while living in Indiana. They recount their initial struggles and triumphs as they learned the nuances of the game, all while weaving in the importance of teamwork and communication—skills they emphasize in their corporate training programs. Curtis draws parallels between their experiences in corporate team-building and the collaborative spirit inherent in pickleball, emphasizing how both arenas foster connection and strategy. Listeners will gain valuable insights into the Burrows' approach to integrating pickleball into their corporate workshops, demonstrating how the sport can enhance teamwork and morale in the workplace. They also discuss the growing popularity of pickleball and its positive impact on community building. Join Curtis, Christine, and Peter for an inspiring conversation filled with laughter, lessons learned, and a shared love for the game that bridges generations. Whether you're a seasoned player or just curious about the sport, this episode is packed with motivation and tips to elevate your pickleball experience! Tune in to discover how the Burrows turned their passion into purpose and the incredible journey that brought them from the tennis courts to the pickleball courts of Wilmington.https://www.linkedin.com/posts/christine-burrows-pbpi_teambuilding-pickleball-leadership-activity-7105167353193144320-dBvb/https://pb-cb.com/the-story-of-pickleball-corporate-teambuilding-so-far/https://rss.com/podcasts/future-of-pickleball/1834555/https://connectcapefear.com/blog/christine-burrows-co-owner-of-pickleball-corporate-team-building-in-wilmington-nchttps://www.linkedin.com/posts/christine-burrows-pbpi_business-partnership-entrpreneurship-activity-7031272756386152450--JNc/https://youtu.be/QHWPZNNAZBU
Send us a textIn this spine-tingling episode of Jams 'N' Cocktails, host Brad Brock and the JNC crew kick off their two-night Halloween celebration with frightful fun, chaotic laughter, and creepy stories. The group dives deep into the world of horror in honor of National Horror Movie Day, discussing classic films, sharing their favorite fright flicks, and stirring up spooky nostalgia. As always, the night wouldn't be complete without games, giveaways, and unpredictable shenanigans from the JNC gang.The team tackles bizarre entertainment news, including some strange snacks and Halloween happenings, in a lively installment of The Jordy Files. The highlight of the night? A fierce (and hilarious) Scream Queen contest where each crew member competes to deliver the most terrifying scream. With mysterious drinks, outrageous banter, and audience participation, this is a Halloween bash you won't want to miss!LinksJNC Official https://www.jnclive.tvSupport us on Patreon!https://www.patreon.com/jncpodcast
In this spine-tingling episode of Jams 'N' Cocktails, host Brad Brock and the JNC crew kick off their two-night Halloween celebration with frightful fun, chaotic laughter, and creepy stories. The group dives deep into the world of horror in honor of National Horror Movie Day, discussing classic films, sharing their favorite fright flicks, and stirring up spooky nostalgia. As always, the night wouldn't be complete without games, giveaways, and unpredictable shenanigans from the JNC gang. The team tackles bizarre entertainment news, including some strange snacks and Halloween happenings, in a lively installment of The Jordy Files. The highlight of the night? A fierce (and hilarious) Scream Queen contest where each crew member competes to deliver the most terrifying scream. With mysterious drinks, outrageous banter, and audience participation, this is a Halloween bash you won't want to miss!LinksJNC Officialhttps://www.jnclive.tvSupport us on Patreon!https://www.patreon.com/jncpodcast
Send us a textIt's a special episode of Jams 'N' Cocktails! In this lively celebration, we're swapping cocktails for cold brews as we dive into the heart of Oktoberfest! Join us as we revel in the Bavarian tradition with our fourth annual Oktoberfest special. We've got pretzels, beers, and more as we chat about the history of Oktoberfest and dive into some hilarious games, including the infamous "Stein Holding" and "Das Boot" challenges. Of course, there are some fun surprises along the way, and we give a shoutout to our keg sponsor, Elly's Tarot Card Readings, perfect for the spooky season!Tune in to hear the laughs, learn a little about the rich tradition of Oktoberfest, and enjoy some friendly competition among the JNC crew. Prost!LinksJNC Officialhttps://www.jnclive.tvElly's Tarot Card Readingshttps://www.instagram.com/bad_bitchtarotSupport the show
It's a special episode of Jams 'N' Cocktails! In this lively celebration, we're swapping cocktails for cold brews as we dive into the heart of Oktoberfest! Join us as we revel in the Bavarian tradition with our fourth annual Oktoberfest special. We've got pretzels, beers, and more as we chat about the history of Oktoberfest and dive into some hilarious games, including the infamous "Stein Holding" and "Das Boot" challenges. Of course, there are some fun surprises along the way, and we give a shoutout to our keg sponsor, Elly's Tarot Card Readings, perfect for the spooky season! Tune in to hear the laughs, learn a little about the rich tradition of Oktoberfest, and enjoy some friendly competition among the JNC crew. Prost!LinksJNC Officialhttps://www.jnclive.tvElly's Tarot Card Readingshttps://www.instagram.com/bad_bitchtarot
Send us a textIn this lively episode of Jams 'N' Cocktails, host Brad Brock and the JNC crew—Jordyn, Derek, and Elly—pay tribute to the iconic city of New York. The team takes listeners on a virtual journey through the Big Apple's rich history, culture, and resilience, starting with a heartfelt reflection on the September 11th anniversary. They then lighten the mood with the cocktail of the week, the New York Sour, sharing some laughs along the way.From jazz and punk rock to hip hop, the crew explores NYC's deep musical roots, iconic venues, and vibrant art scene. Plus, they dive into the city's famous culinary delights, making this episode a must-listen for any lover of New York!LinksJNC Officialhttps://www.jnclive.tvJNC Patreonhttps://www.patreon.com/jncpodcastSupport the show
In this lively episode of Jams 'N' Cocktails, host Brad Brock and the JNC crew—Jordyn, Derek, and Elly—pay tribute to the iconic city of New York. The team takes listeners on a virtual journey through the Big Apple's rich history, culture, and resilience, starting with a heartfelt reflection on the September 11th anniversary. They then lighten the mood with the cocktail of the week, the New York Sour, sharing some laughs along the way. From jazz and punk rock to hip hop, the crew explores NYC's deep musical roots, iconic venues, and vibrant art scene. Plus, they dive into the city's famous culinary delights, making this episode a must-listen for any lover of New York!LinksJNC Officialhttps://www.jnclive.tvJNC Patreonhttps://www.patreon.com/jncpodcast
Hello, JNC Jammers! If you're looking for new episodes of Jams and Cocktails, we've got some exciting news! We've moved to the B3 Podcast Network – that's right, Bands Brands and Booze. So make sure to search for the B3 Podcast Network, hit that follow button, and join us over there for all the latest episodes, awesome guests, and, of course, the cocktails you love! Don't worry, though – all our previous episodes will remain here on this channel for posterity, so you can always come back and relive the memories. Thanks for being a part of the JNC family, and we can't wait to see you at B3! Cheers!
Welcome to Jams 'N' Cocktails, the Treasure Coast's premier live podcast, where music meets entertainment in a vibrant celebration of local culture! Hosted by the multi-talented musician and entertainer Brad Brock, this weekly show is your ticket to a night of fun, laughter, and all things music. Whether you're a local or tuning in from afar, Jams 'N' Cocktails offers a unique and lively experience that brings the best of the Treasure Coast's entertainment scene right to your screen. Each episode is a jam-packed event, featuring special guest appearances from local musicians, entertainers, and artists who are making waves in the community. You'll get to hear live performances, dive deep into engaging interviews, and discover the stories behind the songs that make the Treasure Coast's music scene so special. But it's not just about the music—Brad and his co-hosts keep the energy high with interactive games, social media trends, and discussions on pop culture and entertainment news, making every episode a full-fledged entertainment experience. Jams 'N' Cocktails is more than just a show—it's a community. Brad and the team are passionate about supporting local venues, bars, and businesses that keep the arts alive.Whether you're here for the music, the laughs, or the camaraderie, Jams and Cocktails promises a night of entertainment that you won't want to miss. So grab your favorite drink, sit back, and join the fun—because in the JNC world, there's always something to celebrate! Support the Show.Thanks for listening...Watch our show on YouTube & Subscribe!https://www.youtube.com/@JamsNCocktails
We're thrilled to have the incredibly talented DJ Patrick Coles join us. After a year of planning, we finally have him in the legendary JNC lounge. Tune in for a laid-back and lively episode as we dive into Patrick's musical journey and his latest tracks. We're gearing up for his big debut at the North Coast Music Festival in Chicago! Of course, it wouldn't be our show without our usual shenanigans – shots of the week, hilarious stories, and fun games. Join us as we explore Patrick's collaborations with artists like Summer Gill and Allegra Miles, and discover his passion for crafting tunes that perfectly capture those ultimate beach vibes. LinksJNC Officialhttps://www.jnclive.tvPatrick Coleshttps://www.instagram.com/patrickcolesmusicShark Shack Sweetshttps://www.facebook.com/SharkShackSweetsSupport the Show.Thanks for listening...Watch our show on YouTube & Subscribe!https://www.youtube.com/jamsncocktailspodcast
Prof. Brian Fitzpatrick of Vanderbilt Law School talks to Ryan and Curtis about how Tennessee successfully changed its judicial nominating process — and why Oklahoma should do the same. They discuss the dangers of a Bar-controlled court system and discuss what it would look like to allow the continuance of the Judicial Nominating Commission to be put to a state question.For more content on the truth and dangers of the JNC, listen to this popular episode with Ben Lepak; "Legislators In Black Robes With Ben Lepak."
In Episode 12, Dr. William Cushman, co-investigator of the 2015 SPRINT (Systolic Blood Pressure Intervention) Trial, joins us for a discussion all about hypertension trials, their long history, and what's ahead for research in this space. Too young to remember SPRINT or looking for a "CliffsNotes" of HTN trials? This episode's for you!Here's a Renal Fellow Network post from 2017 with a link to a cheat sheet of hypertension clinical trial.Nephrons: Matthew Sparks, Samira FaroukGuests: William Cushman, Medical Director & Professor, Department of Preventive Medicine, University of TennesseeLinks from the Show:00:41: Systolic Blood Pressure Intervention Trial (2015)02:17: VA Cooperative Study (1967)05:13: ACCORD Study (2010)06:30: SPRINT MIND (2019)08:40: Framingham Heart Study (Started 1948)11:27: Attended vs. unattended blood pressure – learnings beyond SPRINT (2021)14:03: Systolic Hypertension in the Elderly Program Study (1989)14:05: Hypertension Detection & Follow Up Program (1979)15:32: JNC 8 Guidelines (2014)16:01 AHA/ACC Guidelines (2017)17:54: Syst-Eur (Treatment of HTN in Patients > 60 y, 1998)17:54: HYVET (Treatment of HTN in Patients > 80 y, 2008)18:01: Syst-China (2000)22:18: AAFP HTN Guidelines (2022)22:40: KDIGO HTN Guidelines (2021)25:37: ALLHAT Study (2002)32:22: Secondary Prevention of Small Subcortical Strokes Trial (SPS3, 2013)
In this episode, we will be discussing anxiety triggers and the irrational thoughts that often accompany them. The JNC crew will share their own personal anxiety triggers, as well as address some that were submitted by our listeners. We will explore various methods to reduce anxiety and provide strategies to cope with its symptoms.Additionally, we have prepared an engaging game of Name That Tune to help you relax. Jordyn will also present the latest entertainment headlines in The Jordy Files, while Elly offers valuable tips to alleviate anxiety in her segment, Bad Bible Study.To conclude the show, we will participate in a thrilling scratch-off lottery game. Curious about the outcome? Stay tuned until the end to find out if we struck lucky!"LinksJNC Officialhttps://www.jnclive.tvAmazon Affiliate Linkhttps://amzn.to/3ElRViYSupport the showThanks for listening...Watch our show on YouTube & Subscribe!https://www.youtube.com/jamsncocktailspodcast
In this captivating episode, we take a thrilling journey back to the golden age of radio, where we proudly present an enthralling old-time murder mystery performance titled "A Sinister Serenade." Prepare to be transported to a bygone era as you join the talented JNC cast in the opulent estate of Lord Harrington. What was initially anticipated as an evening of delightful mingling and amusement swiftly descends into a chilling tale of murder!As the guests find themselves paralyzed with shock, the astute Inspector Lawrence takes charge of the investigation, determined to unveil the identity of the elusive killer lurking among them. Will he succeed in unraveling the web of deceit and betrayal that shrouds this perplexing case?But that's not all! This episode also offers a delightful game of "Name That Tune," where your musical knowledge will be put to the test. Stay tuned for "The Jordy Files," where you'll catch up on the latest entertainment headlines, and don't miss out on the enlightening segment of "Ellys Bad Bible Study," where you'll discover the art of seizing the day.To enhance your listening experience, we have the pleasure of featuring captivating musical performances from the talented Abby Owens and the mesmerizing Kevin McLoughlin Band. Their melodic tunes will transport you to a world of enchantment and add an extra layer of allure to this already captivating episode.So, sit back, relax, and allow yourself to be immersed in the captivating world of "A Sinister Serenade." Let the suspense grip you, the music enthrall you, and the intriguing segments entertain you. This episode promises to be an unforgettable experience that will leave you craving for more.LinksJNC Officialwww.jnclive.tvAbby Owenshttps://www.facebook.com/abbyowensmusicThe Kevin McLoughlin Bandwww.kvmcloughlinband.comRain Cat Recording Studiohttps://www.raincatrecordings.com/Support the showThanks for listening...Watch our show on YouTube & Subscribe!https://www.youtube.com/jamsncocktailspodcast
We're back and better than ever! It's our highly anticipated Season 6 Premiere, and we're kicking things off with a bang by celebrating Elly's 35th trip around the sun! You won't want to miss our special guest appearance by the one and only Mr. 772, Wishbull!Join the JNC crew as we dish about Jordyn and Brad's wedding, play a hilarious round of The Newlywed Game, and share some cringe-worthy embarrassing stories. But, fair warning, things get a little wild after we dive into the Fireball Party Bucket!Get ready to laugh, cringe, and have a blast with us as we dive headfirst into this exciting new season. So grab your favorite drink, sit back, and enjoy the ride!LinksJNC Officialwww.jnclive.tvSupport the showThanks for listening...Watch our show on YouTube & Subscribe!https://www.youtube.com/jamsncocktailspodcast
JNC Creative Branding shares who they are, what they do and how they can help your business excell. They share great tips as well as reason why it is important to hire help when it comes to branding, photography and website design. The JNC team are friends, partners and entrepreneurs who came together as JNC in 2021 because we fiercely believe in helping other business owners reach their dreams in business and in life. We know firsthand how challenging it is running a business and trying to grow your brand on social media and beyond. We have a strong passion for what we do: creating impactful and memorable content that makes your brand stand out from the competition. You have big goals to reach. Our mission is to help you get there sooner rather than later with elevated content that creates avid fans of your brand. We're excited to discuss how we want to change the dynamic of how women traditionally brand and market themselves and their business. We believe in getting creative and most importantly authentic with your story and your mission. I'm so excited to have the opportunity to talk with Jessica, Natalie and Candance of JNC Creative Branding on the Redefine Business Podcast! REDEFINE BUSINESS COMMUNITY: https://www.facebook.com/groups/redefineyourbiz INSTAGRAM: https://www.instagram.com/brittni.schroeder/ SHOWNOTES: https://brittnischroeder.com/podcast/client-boundaries
Brad gives his review of the John Mayer Sob Rock Tour concert in Sunrise, FL over the weekend. Derek reveals a new JNC challenge, Elly delivers a riveting Bad Bitch Bible Study, and Brad goes over this week's entertainment headlines while Jordyn is out for the evening.LinksLittle Nuggets Learninghttps://www.littlenuggetlearning.com/Jonathan Cummings Cancer Benefithttps://www.gofundme.com/f/help-jonathan-sing-againBrad Brock's One Man Bandhttps://www.bradbrock.comSupport the show
Tranise Goodlow is the founder and co-owner of Dr. G the NP, LLC. Dr. Goodlow, also known as Dr. G, is currently employed as a cardiology nurse practitioner and a graduate-level adjunct professor. Her passion is teaching patients and nurses to build understanding and achieve the best outcomes, as well as nurse and nurse practitioner advocacy. Dr. G obtained her Bachelor of Science in Nursing degree from Southern University and A&M College in 2010. She worked as a medical telemetry nurse for four years and also served as a charge nurse, preceptor, and mentor to her colleagues. During her time as a floor nurse, she discovered and developed an interest in cardiology. In 2014 Dr. G enrolled in the BSN-DNP, AGACNP program at the University of Arizona; she also worked as a nurse educator during her final year of graduate school. In 2017 Dr. G graduated from the University of Arizona with her DNP, AGACNP degree. Her doctoral research entitled “Provider Adherence to JNC 8 Pharmacological Guideline Recommendations in African American Adults Diagnosed with Hypertension” was awarded the Mary Opal Wolanin Outstanding Dissertation Award for Excellence in Nursing with Vulnerable Populations. Dr. G has the unique ability to simplify complex information which allows colleagues to build knowledge and confidence. Dr. G's teaching style is engaging and allows reflection while creating a safe and welcoming atmosphere for learners. Her ability to marry evidence-based practice and practical real-world situations allows learners to evolve within their practice. Dr. G the NP links: https://drgthenp.com/ https://linktr.ee/drgthenp Instagram: https://www.instagram.com/drgthenp Facebook: https://www.facebook.com/drgthenp Doctor Nurse Podcast Links: https://linktr.ee/DoctorNursePodcast Subscribe to our YouTube Channel: https://www.youtube.com/channel/UCYQYlS9d6m7HyMK7Z1BI5DA
Where the backbeats meet the spirits. Podcast #80 you may already know our guest and if not he's the songwriter of our opening tune, “Once Upon a Bottle of Rum”. Also a good friend to the show and podcast alumn. Brad Brock performs in a one-man band where he plays sings, plays guitar, and plays the drums with his feet. He's the host of the Jams ‘n' Cocktails podcast. We also celebrate National Hot Buttered Rum day as we taped this episode on January 17th.Check out the recipe we used from our friends at Instill Distilling. https://www.instagram.com/p/CVauD-Nr5Ip/This podcast is brought to you by Embroidery and Sew More, makers of Drums and Rums apparel----------------------------------------------------------------------The opening track is Once Upon a Bottle of Rum by Brad BrockCheck out Brad Brock's Jams ' N' Cocktails Podcast live every Wednesday at 8:pm EST----------------------------------------------------------------------Here are a few things you will hear in this episode.Where his podcast has come since he was the last one the podcast back on episode 15The evolution of his one man band showCohosting on the Johnny Ringo podcast He drops a few exclusives about the new season of his show and the new studioIn Four Sips or Less:Favorite curse wordLeast favorite tasteWhat's his favorite rumWhat guitarists and drummers he'd put on his Mt. RushmoreVisit Brad's and Jams 'N' Cocktails links:VISIT his website Brad Brock Music FOLLOW their JNC podcast on Instagram and FacebookFOLLOW Brad's One-man Band on Instagram and FacebookWATCH the weekly show and past episodes on YouTubeDon't forget to check out our site and linksDrums and Rums websiteFOLLOW us on Facebook, YouTube, Instagram.Support the show (https://www.patreon.com/drumsandrums)
In the episode, Mark Baratto sits down with Judge Edwin A. Scales, III to the Third District Court of Appeal, who also happens to be a DJ on local station 104.1. We talk about his love for music and how he never gave up on his dream, while still being a local District Court Judge. More on Ed Scales, III Ed's show—oddly named “The Ed Scales Show”—airs on US-1 Radio most Sundays from 11am-2pm. The show has aired on US-1 Radio for over two decades and continues the station's tradition of nontraditional radio, Florida Keys-style. No one (other than Bill Becker) has been on-the-air at US-1 Radio longer. Management of the station is as puzzled as everyone else as to why this is the case. No matter how often we change the locks to keep Ed out, Ed finds a way into the studio to do his show. Trust us, if it weren't for his impeccable musical taste, we'd call the cops! While it's hard to describe Ed's show with any particularity, suffice to say that he plays a wide variety of great rock and roll. Ed regularly sneaks down into the US-1 Radio music vault to play stuff you just don't hear every day, and he also mixes in the hits so that there's truly “something for everyone”. He even peppers the show with entertaining features like “Ed's Peeve of the Week” and “This Date in Rock and Roll History”. So, tune in on Sundays for “The Ed Scales Show”…..and give us a shout if you know a good locksmith. Now on to the Judge part... On October 18, 2013 Governor Rick Scott appointed Judge Edwin A. Scales, III to the Third District Court of Appeal, making him the first Monroe County attorney ever appointed to the Court. Before his appointment, Judge Scales was a sole practitioner in Key West, Florida. His practice concentrated in the areas of appellate litigation, commercial and real estate litigation, administrative law, and mediation. Additionally, through his “of-counsel” affiliation with the GrayRobinson law firm, Judge Scales served as the General Counsel to the Florida Citrus Commission. Prior to moving to Key West, Judge Scales was a shareholder in the Lakeland, Florida law firm of Lane, Trohn, Bertrand, & Vreeland, P.A. In 1998, Judge Scales became the General Counsel for Historic Tours of America, Inc., a national site-seeing company with headquarters in Key West, Florida. From 2011 thru 2013, Judge Scales served on the Florida Commission on Ethics and was its vice chairman. In 2005, Monroe County's attorneys elected Judge Scales to serve on the Florida Bar's Board of Governors, and he was re-elected to that position four times. He served on the Bar's Executive Committee for three years and chaired both the Bar's Legislation Committee and Citizen's Forum. In 2006, Judge Scales was appointed by Florida Governor Jeb Bush to the Board of Trustees of the Florida Keys Community College. He was reappointed to the Board by Governors Crist and Scott. He chaired the Board from 2007 to 2009, and again in 2011 and 2012. From 2000 to 2005, Judge Scales served on the Federal Judicial Nominating Commission for Florida's Southern District. In 2009, he was appointed by Governor Charlie Crist to the Judicial Nominating Commission for Florida's 16th Judicial Circuit, and was reappointed to the JNC by Gov. Rick Scott in 2012. In 2001, he was elected to serve a four-year term on the Key West City Commission, and in 2003 was appointed to the Florida Keys Tourist Development Council, where he served two years as Treasurer. Since 1999, Judge Scales has hosted the weekly "Ed Scales Show" heard on Keys radio station US-1 (104.1 FM - www.us1radio.com). He has an extensive background in both radio and television, hosting "The Legal Beagles" radio program in the Tampa Bay area from 1996 to 1998. Since joining the Court, Judge Scales has been appointed by the Florida Supreme Court to represent Florida's judiciary on the Florida Bar Foundation Board of Directors, where he chairs the Foundation's Audit Committee. Chief Justice Charles Canady appointed Judge Scales to serve on Florida's Judicial Management Council, the long-range planning committee for Florida's judicial branch of government. Judge Scales also served on the Board of Directors of the University of Florida Alumni Association, taught the complex civil litigation courses at Florida's College for Advanced Judicial Studies, has taught courses as part of the faculty of the National Judicial College, and regularly presents continuing legal education seminars to local bar associations. Judge Scales was born in Birmingham, Alabama, and was raised in Lakeland, Florida. He received his B.S. in Telecommunications with Honors from the University of Florida in 1988. While an undergraduate at the University of Florida, he was appointed by Governor Bob Martinez to serve on the Florida Board of Regents from 1987 to 1988, and was tapped into the Florida Blue Key leadership honorary. He also served as the "mike man" for the Florida Gators and is a 2-year UF Varsity Letterman. In 1988, he was named the University of Florida's outstanding male graduate and was named to the University of Florida Hall of Fame. In 1991 he received his J.D. from the University of Florida College of Law. While in law school, Judge Scales served as President of the University of Florida Student Body, he received the Bill Fleming Memorial Award for outstanding service to the University of Florida community, and he received the Book Award for Florida Administrative Law demonstrating academic excellence in that area. US1 Radio Show FL Courts.org
Join Sheikh Sammar Ahmad and Raheel Ahmad for Thursday's show where we will be discussing: Space Wars / Youth day Space Wars Should billionaires be spending their wealth on getting into space? What is the value of space exploration? Could space help us solve our problems on Earth or make them worse? These are some of the questions we would like to explore as we review the current race to the stars by Branson, Bezos and Musk. Join us as we discuss man's role in outer space. Youth day: Do young Muslims matter? This #youthday we ask if young people matter are given their deserved value and regard? They are our future and society needs to be there to help them overcome the mental and social challenges of today. Guests include: Ethan R. Siegal PhD (Author of Beyond the Galaxy and Founder of Starts with a Bang) Dr Tony Milligan (Senior Researcher on the Cosmological Visionaries Project at King's College, London) Abbee McLatchie (Director of Youth Work for the National Youth Agency in England, JNC-qualified youth and community worker) Fateen Yasir (National Secretary of Education for Atfalul Ahmadiyya) Produced by: Nabeela Shah and Naveeda Gondal
In this episode, we give you a little preview of the new JNC Season 2 format and focus. We tackle several headlines including the passing of ZZ Top bassist Dusty Hill & rapper Biz Markie, the Britney Spears conservatorship, R. Kelly's new allegations, Eric Clapton's line in the sand, Billie Eilish's new record setting album, Bennifer, and more. We also talk about mental health in the Olympics with special guest panelist Elly Brock. Later in the show we take on the Chubby Bunny Marshmallow Challenge. You'll get your Mid-Week Motivation, a new episode of JNC's National Day, and our Shameless Plugs!Subscribe on YouTube: https://www.youtube.com/jamsncocktailspodcastFollow on Facebook: https://www.facebook.com/jncpodcastVisit us on the web: https://www.jncpodcast.comListen to JNC Radio: https://player.live365.com/a09222Support the show (https://www.patreon.com/jncpodcast)
On this episode, podcast alumni Vern Daysel return to the legendary JNC lounge with his band, Switch N' Whisky! We talk to Vern, Eric, Hatchet, and Coby about their new single 'Keep It In The Red', music, life , and more. We play games and get some sweet acoustic jams! Become our Patron on Patreon: www.patreon.com/jncpodcast - Check out the shows LIVE every Wednesday at 8pm ET on Facebook LIVE & YouTube. keyword: Jams N Cocktails Podcast - LIKE our Facebook Page https://www.facebook.com/jncpodcast - SUBSCRIBE on YouTube https://www.youtube.com/channel/UCVs-g46bC034QOlUB5TPrnA?sub_confirmation=1 **Episode Links** https://switchnwhisky.com/
On this episode we debut our shock collars gifted to us by Paul from the Drums & Rums Podcast and incorporate them into our Truth Hurts game... they didn't disappoint. We get some live jams from singer/songwriter Brad Brock, The Jordy Files, JNC's National Day episode, Mid-Week Motivation, and more! - Become our Patron on Patreon: www.patreon.com/jncpodcast - Check out the shows LIVE every Wednesday at 8pm ET on Facebook LIVE & YouTube. keyword: Jams N Cocktails Podcast - LIKE our Facebook Page https://www.facebook.com/jncpodcast - SUBSCRIBE on YouTube https://www.youtube.com/channel/UCVs-g46bC034QOlUB5TPrnA?sub_confirmation=1
On this episode we're joined via Skype by our friend, singer/songwriter Bob Green! We talk about his brand new singles and his upcoming record Back To Neverland. We reminisce about some old times and get a few jams! We also debut the first episode of our new comedy series JNC's National Days! Check it out... - Become our Patron on Patreon: www.patreon.com/jncpodcast - Check out the shows LIVE every Wednesday at 8pm ET on Facebook LIVE & YouTube. keyword: Jams N Cocktails Podcast - LIKE our Facebook Page https://www.facebook.com/jncpodcast - SUBSCRIBE on YouTube https://www.youtube.com/channel/UCVs-g46bC034QOlUB5TPrnA?sub_confirmation=1 **Episode Links** Back To Neverland album Kickstarter Campaign: http://kck.st/3fgmKbK Bob Green: https://www.reverbnation.com/bobgreen
This week, your hosts Steve Lowry and Yvonne Godfrey interview Rich Newsome of Newsome Melton Law Firm (https://www.newsomelaw.com/). Remember to rate and review GTP in iTunes: Click Here To Rate and Review Episode Details: Orlando trial lawyer Rich Newsome of Newsome Melton Law Firm shares how he successfully advocated for the parents of deceased University of Florida student Abigail Dougherty after she was struck and killed by a Waste Corporation of America (WCA) garbage truck while riding her bicycle. On October 28, 2016, Abigail was riding her bike in the dedicated bicycle lane near 17th Street and University Avenue in Gainesville, Florida, when a 15-year veteran WCA driver made a right turn, striking the rear tire of Abigail's bike in the crosswalk. Abigail and her bicycle were pulled under the truck, dragged and crushed by the right rear tires of the 2,000-ton vehicle. Despite the defense's attempts to blame Abigail for this tragic collision, Rich convinced the jury that WCA was responsible due to its driver's negligent actions, including not checking the right-side mirrors and making a sharp turn at a high speed. In October 2018, an Alachua County, Florida jury assigned 80% of the blame for Abigail's death to WCA and awarded a sum of $12,500,000 in damages to each of Abigail's parents, Pat Dougherty and Anita Forester, resulting in a major $25 million verdict. Click Here to Read/Download the Complete Trial Documents Guest Bios: Rich Newsome Rich Newsome is the senior partner of the Newsome Melton law firm and represents people and families in complex civil litigation. After graduating from the University of Florida College of Law in 1989, Rich worked as a federal prosecutor for the U.S. Attorney's Office in the Northern and Middle Districts of Florida. Rich left the U.S. Attorney's Office in 1993 and went to work for a large product liability defense firm in Orlando, Florida where he represented manufacturers. After defending a manufacturer in a case brought by a family who lost a child, Rich felt compelled to leave the defense practice and began representing only families and individuals. Since then, for more than 25 years, Rich's practice has focused on representing people who have suffered catastrophic or fatal injuries. In 2001, Rich was appointed by the Florida Governor to the Fifth District Court of Appeals Judicial Nominating Commission and served as the JNC's Chairman during his term. He is a Past-President of the Orlando Federal Bar Association, Past-President of the Florida Justice Association, Past-Member of the Board of Governors of the American Association for Justice, Past-President of the Central Florida Trial Lawyers Association, and is a member of the American Board of Trial Advocacy. Rich is a graduate of the Gerry Spence Trial Lawyer's College and was invited to serve as a member of the College Faculty. Rich is a member of the Florida, Texas, New Mexico, and Oregon Bar Associations. In 2016, Rich was selected as the “Orlando Personal Injury Lawyer of the Year” by Best Lawyers, a peer-review publication. In 2015, Rich received the Steven C. Sharpe Public Service Award from the American Association for Justice, in recognition of his representation of Corey Burdick who was severely injured by a defective Takata airbag. The Steven C. Sharpe Award is awarded annually to one attorney and their client. In 2017, Rich was appointed to the Constitution Revision Commission by Richard Corcoran, the Speaker of Florida's House of Representatives. The 37 member Commission drafted and submitted 32 amendments to the Florida Constitution which were placed on the ballot and approved by Florida voters to be part of the Florida Constitution in November 2018. In 2019, Rich was recognized by the National Law Journal as having won two of the Nation's 100 largest verdicts in 2018. Rich is a member of the Summit Council, a national group of America's best plaintiff trial lawyers. Membership is limited to less than thirty trial lawyers from across the country, is by invitation only, and is extended to lawyers who have a proven record of large jury verdicts and are recognized as leaders of the national plaintiffs bar. Rich is a founding faculty member of Trial School, Inc., a not-for-profit organization that seeks to foster collaboration between lawyers on today's best trial advocacy methods and to provide free education and practice for trial lawyers who exclusively represent people and families. Read Full Bio Show Sponsors: Legal Technology Services -LegalTechService.com Digital Law Marketing - DigitalLawMarketing.com Harris, Lowry, and Manton - hlmlawfirm.com Free Resources: Stages Of A Jury Trial - Part 1 Stages Of A Jury Trial - Part 2
In this episode, we honor our Veterans on Veterans Day! We're joined by our good friend and Air Force Veteran, Jo Neeson. She shares some amazing stories and we have a great conversation. We play a patriotic round of Name That Tune, Tony gets into character for his Veterans Day edition of Mid-Week Motivation, we put Jo on the hot seat Inside The Lipton Tea, we feature an amazing video performance from Jams 'N' Cocktails alumni Jamie Floyd, and I come out of JNC performance "retirement" and play a couple tunes live. - Check out the shows LIVE every Wednesday at 8pm ET on Facebook LIVE & YouTube. keyword: Jams N Cocktails Podcast - LIKE our Facebook Page https://www.facebook.com/jncpodcast - SUBSCRIBE on YouTube https://www.youtube.com/channel/UCVs-g46bC034QOlUB5TPrnA?sub_confirmation=1 *Episode Links* https://www.operationsong.org http://op300.org/
Treasure Coast indie band Sandman Sleeps joins us in the lounge to talk about their upcoming album, debut their new single "Opaque", and talk about their first live stream performance from Respectable Street Cafe. Mike Bamonte from the Hit Box Studio is in the house to talk about working with the band, and various other topics! It's producer Derek's golden JNC birthday, turning 37 or our 37th episode! Jordyn rejoins us in the lounge for The Jordy Files!
Hey! So another awesome JnC broadcast with The Doctor on September 12, and this is my recording. I opted to do a Metrik vs. Darren Styles only set because some people said their music is similiar in structure and even in sound, and I think this recording proves them right! Your tracklist: 01. Metrik - Hi! - Hospital Records 02. Camo & Krooked feat. Ayah Marar - Cross The Line (Metrik Remix) - Hospital Records 03. Sub Focus - X-Ray (Metrik Remix) - RAM 04. Darren Styles - Satellite (2014 Update) - Junkbox Recordings 05. Darren Styles & Re-Con - Sober - Futureworld Recordings 06. Metrik - Automata - Hospital Records 07. Metrik - Hackers - Hospital Records 08. Darren Styles - Screwface - Junkbox Recordings 09. Darren Styles, Mark Breeze, Petruccio & Modulate - Rock The Club - Futureworld Recordings 10. Metrik feat. Kathy Brown - I See You - Hospital Records 11. Metrik feat. Elisabeth Troy - Chasing Sunrise - Hospital Records 12. Darren Styles feat. Andrea Britton - Show Me The Sunshine - Junkbox Recordings 13. Darren Styles & Gammer - You & I - Junkbox Recordings 14. Metrik & Grafix - Parallel - Hospital Records 15. Metrik - Closer - Hospital Records 16. John B feat. Code 64 - The Journey (Metrik Remix) - Beta Recordings 17. Darren Styles - Getting Better - Raver Baby 18. Darren Styles feat. Whizzkid - Girlfriend - Junkbox Recordings 19. Metrik - Shadows - Hospital Records 20. Metrik - We Are The Energy - Hospital Records 21. Darren Styles feat. Molly - Never Forget You - Junkbox Recordings 22. Darren Styles feat. Francis Hill - Come Running - Junkbox Recordings 23. Metrik - Ex Machina - Hospital Records 24. Metrik - Fatso (VIP) - Hospital Records 25. Metrik - Thunderblade - Hospital Records 26. Force & Styles feat. MC Junior - Pacific Sun - UK Dance Enjoy guys, thanks for your support and let me know what you think!
Kartoittaja, ratamestari, tapahtumanjärjestäjä, valmentaja ja huippusuunnistaja. Todellinen suunnistuksen monitoimimies. JNC, Lummukka Games, yläkoululeirit, näistä herra ainakin tunnetaan. Lukuisia karttoja Helsingin yhdinkeskustasta Jyväskylän vaaroille. Vieraana suunnistusmaailman yksi positiivisimmista hahmoista, Arttu Syrjäläinen.
Uluslararası Hipertansiyon Derneği tarafından Haziran ayında yayımlanan global hipertansiyon uygulama kılavuzları ışığında hipertansiyonun tanımı, hipertansif acillerin yönetimi ve kullanılan ilaçların yer aldığı bir derleme yapmak istedim.1 2 Keyifli okumalar. Kan basıncı yüksekliği, yılda 10,4 milyon ölüme yol açarak dünya genelinde önde gelen morbidite ve mortalite nedenlerinden biri olmaya devam etmektedir. Dünya çapında rakamlar incelendiğinde, 2010 yılında tahminen 1,39 milyar insanın hipertansiyon tanısı almış olduğu ve hasta dağılımının gelişmiş ülkelerden düşük gelirli ve gelişmekte olan bölgelere kaydığı görülmektedir. JNC 8 uyarınca kan basıncı sınıflaması tablodaki gibidir: EvreSistolik Kan Basıncı (mmHg)Diyastolik kan Basıncı (mmHg)Normal< 120< 80Pre hipertansiyon120-13980-89Evre 1140-15990-99Evre 2> 160> 100HİPERTANSİYON SINIFLAMASI (JNC 8) Kan basıncının ideal ölçümü için 3-5 dakikalık dinlenme sonrası, sessiz bir odada, 30 dakika boyunca sigara ve kahve içmemiş, egzersiz yapmamış olmak gerekir. 1 dakikalık aralıklarla 3 ölçüm yapılmalı ve son 2 ölçümün ortalaması kabul edilen değer olarak alınmalıdır. Uygun manşon seçimi yapılmalı, kolun orta bölümü kalp düzeyinde olmalı ve manşon kolun orta 1/3’üne yerleştirilmelidir. Primer hipertansiyon tanılı hastalar genellikle asemptomatiktir, bulgu veren hipertansiyon sekonder bir nedene ya da hipertansiyona bağlı komplikasyona bağlı olabilir. Anamnezde aile öyküsü ve hastanın medikal geçmişi iyi sorgulanmalıdır. Hipertansiyona eşlik eden ve acil yaklaşım gerektiren göğüs ağrısı, sırt ağrısı, nefes darlığı, çarpıntı, kladikasyo, periferik ödem, baş ağrısı, bulanık görme, bilinç değişikliği, idrar çıkışında azalma, hematüri, baş dönmesi açısından hasta dikkatli değerlendirilmelidir. Anamnez Hipertansiyonun süresi, önceki kan basıncı seviyeleri, varsa mevcut antihipertansif ilaçlar, kan basıncını etkileyebilecek diğer ilaçlar, antihipertansif tedaviye uyum. Risk faktörleri: kardiyovasküler hastalık öyküsü, inme, geçici iskemik atak, diyabet, dislipidemi, kronik böbrek hastalığı, sigara kullanımı, sodyumdan zengin diyet, alkol alımı. Fizik Bakı Kalp hızı/ritmi, juguler venöz dolgunluk, apeks vurusu, ekstra kalp sesleri, periferik ödem, üfürüm varlığı (karotis, renal, femoral), palpabl tiroid, artmış vücut kitle indeksi. Laboratuvar Kan testleri: sodyum, potasyum, serum kreatinin ve glomerüler filtrasyon hızı. Mümkünse, lipid profili ve açlık glikozu. İdrar testi: proteinüri, albümin/kreatinin oranı 12 derivasyonlu EKG Hipertansiyon İlişkili Organ Hasarı Hipertansiyon ilişkili organ hasarı, yüksek kan basıncı nedeniyle organlarda meydana gelen yapısal veya fonksiyonel değişiklikler olarak tanımlanır. End organlar arasında beyin, kalp, böbrekler, merkezi ve periferik arterler ve göz bulunur. Genel kardiyovasküler riskin değerlendirilmesi yanında hipertansiyon ilişkili organ hasarının belirlenmesi iki konu nedeniyle önemlidir: Hafif-orta dereceli tansiyon yükseklikleri olan hastalarda organ etkilenmesi olması nedeniyle yeniden sınıflandırma yapılmasını sağlar. 2) Spesifik etkiye dayalı ilaç tedavilerinin seçimi konusunda önemli terapötik rehberlik sağlar. Beyin: Geçici iskemik atak veya inme yüksek kan basıncının sık bulgularındandır. Erken subklinik değişiklikler (beyaz cevher lezyonları, sessiz mikroinfarktlar ve mikrokanamalar) en hassas şekilde kranial MRI ile saptanabilir ancak rutin uygulamada yeri yoktur. Bilinç değişikliği, nörolojik bozukluğu ve amnezisi olan hastalarda düşünülmelidir. Kalp: Hipertansiyon nedeniyle periferik vaskuler direncin uzun süreli artışına bağlı gelişen sol ventrikül hipertrofisi (LVH), 12 derivasyonlu EKG’de saptanabilse de (Sokolow-Lyon kriteri: SV1 + RV5 ≥ 35 mm, Cornell kriteri: SV3 + RaVL erkekler için > 28mm veya kadınlar için > 20mm ve Cornell voltajı süresi: > 2440mm-ms) sol ön fasiküler bloğu olanlarda ya da genç hastalarda bu kriterlerin duyarlılığı azalacağı iç...
The dramatic return of **Jack N Coke!!** Roman and I started this project to a) be able to play together, and b) kinda see how well we could crossbreed drum and bass & UK Hardcore. The results have been good. This set is a lot of dnb but some awesome hardcore tunes weaved in, about what you'd expect from a live JnC set. Hope you enjoy it! Your tracklist: 01. Sub Focus & Wilkinson - Just Hold On (Sub Focus & Wilkinsom vs. Pola & Bryson Remix) - Virgin 02. Camelphat & Au/Ra - Panic Room (S9 Bootleg) - Unreleased 03. DJ Brockie & Ed Solo - Represent 2020 - Undiluted 04. Dub Elements - Shit - DEM Recordings 05. Dougal & Gammer - 3000 Cycles - Essential Platinum 06. IMANU - Lucifer - Vision Recordings 07. Major Lazer - Get Free (Andy C Remix) - Mad Decent 08. InsideInfo & Mefjus - Mythos - Virus Recordings 09. Ham - Love You Tonight - Blatant Beats 10. Machinedrum & Holly - Berry Patch (IMANU Remix) - Vision Recordings 11. Mampi Swift - Gangster - Charge 12. Koffee - Toast (Clipz Bootleg) - Unreleased 13. Prisoners Of Technology - Trick Of Technology (Time To Work Mix) - Fresh Kutt 14. RAM Trilogy - Beastman (Ed Rush & Optical Remix) - RAM 15. Prolix & DC Breaks - Beat Down - Blackout Music 16. State Of Mind - Psychopath - Blackout Music 17. Twenty One Pilots - Heathens (Audio Remix) - Unreleased 18. Shimon & Andy C - Quest (Bladerunner VIP) - RAM 19. Oops! 20. Shimon & Andy C - Quest (Bladerunner VIP) - RAM 21. Summa Jae feat. KYRK - Find Me - OneSeventy 22. Bad Company UK - Planet Dust - Prototype 23. Break & DLR - City Slickers (Skeptical Remix) - Symmetry 24. Dillinja - Hard Noize (Break Remix) - Valve 25. Al Storm feat. Amy - Surrender (Clubland Mix) - 24/7 Hardcore
The dramatic return of **Jack N Coke!!** Roman and I started this project to a) be able to play together, and b) kinda see how well we could crossbreed drum and bass & UK Hardcore. The results have been good. This set is a lot of dnb but some awesome hardcore tunes weaved in, about what you'd expect from a live JnC set. Hope you enjoy it! Your tracklist: 01. Sub Focus & Wilkinson - Just Hold On (Sub Focus & Wilkinsom vs. Pola & Bryson Remix) - Virgin 02. Camelphat & Au/Ra - Panic Room (S9 Bootleg) - Unreleased 03. DJ Brockie & Ed Solo - Represent 2020 - Undiluted 04. Dub Elements - Shit - DEM Recordings 05. Dougal & Gammer - 3000 Cycles - Essential Platinum 06. IMANU - Lucifer - Vision Recordings 07. Major Lazer - Get Free (Andy C Remix) - Mad Decent 08. InsideInfo & Mefjus - Mythos - Virus Recordings 09. Ham - Love You Tonight - Blatant Beats 10. Machinedrum & Holly - Berry Patch (IMANU Remix) - Vision Recordings 11. Mampi Swift - Gangster - Charge 12. Koffee - Toast (Clipz Bootleg) - Unreleased 13. Prisoners Of Technology - Trick Of Technology (Time To Work Mix) - Fresh Kutt 14. RAM Trilogy - Beastman (Ed Rush & Optical Remix) - RAM 15. Prolix & DC Breaks - Beat Down - Blackout Music 16. State Of Mind - Psychopath - Blackout Music 17. Twenty One Pilots - Heathens (Audio Remix) - Unreleased 18. Shimon & Andy C - Quest (Bladerunner VIP) - RAM 19. Oops! 20. Shimon & Andy C - Quest (Bladerunner VIP) - RAM 21. Summa Jae feat. KYRK - Find Me - OneSeventy 22. Bad Company UK - Planet Dust - Prototype 23. Break & DLR - City Slickers (Skeptical Remix) - Symmetry 24. Dillinja - Hard Noize (Break Remix) - Valve 25. Al Storm feat. Amy - Surrender (Clubland Mix) - 24/7 Hardcore
JNC turns 21... episodes old! We celebrate our little milestone by reflecting on our humble beginnings and hearing from some of our JNC alumni and friends wishing us a happy 21st! We toast with birthday cake shots, play some games, unveil our news segment called The Jordy Files, and get our Mid-Week Motivation with Tony Espinosa. Elly Brock & Kat McCabe join us on the guest panel and fun ensues! - Check out the shows LIVE every Wednesday at 8pm ET on Facebook. - Join the Jams 'N' Cocktails Facebook Group https://www.facebook.com/groups/jamsncocktails/
Apologies! I recorded this from home, lots of popping and poor mic quality! Bear with me for this and the next episode please! Today we attack hypertension management and JNC 8 recommendations.
Entrevistem a Ferran Mascarell, actual regidor de JxCAT a l'Ajuntament de Barcelona i ex-conseller de Cultura. També tindrem a Santiago Espot de la plataforma política Força Catalunya. Taula de debat amb: -Pau Ferran, NNGG PPC -Nil López, JSC, -Laia Garrido, Joves C's -Maurici sabater, La Forja -Alvaro Clapés, JNC
Singer/Musician/Composer Tony Solomon joins me to chat about music, life, and charity. We talk about his influences and his work to help homelessness through the Tent City Helpers. We introduce Jordyn Taylor in her first official producing role joining the show and debut our new broadcasting space, GaRo Studios! We get some mid-week motivation from Tony Espinosa and a jam session! SUBSCRIBE for more videos: https://www.youtube.com/channel/UCVs-g46bC034QOlUB5TPrnA?sub_confirmation=1 Want to know what's going on with Brad Brock & JNC in the future? Follow us on Twitter: https://twitter.com/bradbrockmusic On Facebook: https://www.facebook.com/bradbrockmusic/ On Instagram: https://www.instagram.com/bradbrockmusic/ For more great content from Brad Brock & the JNC Podcast visit our official website: https://www.bradbrock.com Check out the JAMS 'N' COCKTAILS LIVE PODCAST Wednesdays at 8pm EST https://www.facebook.com/groups/jamsncocktails
Entrevistem a Fernando Carrera, secretari d'organització de BCN pel canvi, i taula de debat amb: -Dani Sosa, Confluència Jove -Laia Garrido, Joves Cs -Tomás Güell, Joves Units x Avançar -Pau Ferran, NNGG PPC -Gerard Rosell, JNC
Diumenge d'eleccions i per aquest motiu a Cooltura Política fem un especial de dos debats. Primera taula amb: -Manu Rodríguez, diputat de C's al Parlament -Ot García, regidor del PSC a l'Ajuntament de Cornellà -Ignacio Rigau, candidat del PP al Congrés -Jordi Coronas, regidor d'ERC a Barcelona -Laura Oliva, candidata d'En Comú Podem al Congrés -Joel Reguant, JuntsxCatalunya I una segona taula de debat amb: -Joan Mangues, Jovent Republicà -Pau Ferran, NNGG Catalunya -Cinta González, Joves Esquerra Verda -Nil López, JSC -Laia Garrido, Joves C's -David Mas, JNC
It was an honour to be invited to Birmingham to speak to the amazing academic and community leader Craig Pinkney. With the ongoing increase of youth violence within our inner cities i decided it was time to find and speak to someone who is well read academically and also has the street credibility to help me understand the violence amongst our youth. In this episode we covered many of the issues facing young men in todays society such as poverty, fatherless homes, misconceptions of masculinity, drill music and its impact on the youth and many more. Craig Pinkney is a Criminologist, Urban Youth Specialist, Lecturer at the University College Birmingham and is one of the UK's leading thinkers/doers in responding to Gangs and Serious Youth Violence. He is an JNC qualified Youth Worker with over 15 year’s experience as an Outreach Worker, Transformational Speaker, Gang Exit Strategist, Mediator, Mentor and Filmmaker. Craig delivers interactive workshops for young people and bespoke training for professionals in Criminal Justice, Education, Community, Health, Social Services, Family Support and Faith Based Organisations. Most of Craig’s workshops and bespoke training is delivered locally and nationally, however he has spoken and trained professionals at a numerous international conferences and events across Europe, the Caribbean and in the United States. Craig is the UK Lead for the EUGANGS Project, which is a collaborative research project focusing on serious youth violence, in conjunction with universities and private sector organisations across seven European countries. Additionally, Craig is an advisor for the Ministry of Justice in Jamaica, an advisor for the Home Office (UK) and an advisor for the Crime Commission (West Midlands). Due to his expertise, Craig is often asked to comment for local and national news, radio and has featured in a number of documentaries. Contact Craig: https://craigpinkney.com/ https://twitter.com/RealActionUK https://www.linkedin.com/in/craig-pinkney-18830a44/ https://www.youtube.com/user/nejashispeaks #LetsDoHumans #YouthViolence #StayBlessed Follow us: Castbox- https://castbox.fm/channel/LetsDoHuma... Instagram- https://www.instagram.com/letsdohumans/ iTunes- https://itunes.apple.com/gb/podcast/l... Facebook- https://www.facebook.com/LetsDoHumans/ Spotify- https://open.spotify.com/show/119kKxj... Twitter- https://twitter.com/letsdohumans Host: https://www.instagram.com/mrtudark/ (Francis Gyamera) Want to feature on Lets Do Humans or have any ideas and suggestion? Please tell us: letsdohumans@gmail.com
HH IZ DEAD #29 Dans ce HH iz Dead #29, nous avons sélectionné des sorties de rap US de cet hiver ( de janvier et février ), c’était la récolte de ces « Winter Flakes » , une sélection à la couleur de la saison , des flocons d’hiver pour mieux nous préparer au printemps qui arrive … HH iz Dead #29 : 1) Nas ft. Divine, Naezy, Ranveer Singh : NY Se Mumbai 2) Domo Genesis : Could this be 3) Westide Gunn : Karl 4) Drop by Yelawolf 5) Yelawolf : Billy Goat Freestyle 6) Mc Ren : King Vilain 7) Smif-N-Wessun ft. Rick Ross : Let me Tell Ya 8) Sean Price & Small Professor ft. AG Da Coroner, Guilty Simpson & Your Old Droog : John Gotti 9) Tory Lanez : Free 21 Freesstyle 10) Meyhem Lauren & The Alchemist : Still playing Celo 11) Streetlife & Method Man ft. Havoc : Squad Up 12) Fat Joe ft. Remy Ma & Reef Hustle : Fire 13) Jim Jones & The Heatmakers : Cristal Occasions 14) Dj Kay Slay ft. Raekwon, Cee-Lo Green, Grandmaster caz & melle Mel : Hip Hop Frontline 15) Erick Sermon ft. Big K.R.I.T & Ricco Barrino : That Girl 16) Big Boi ft. Sleepy Brown : Doin it 17) Riff Raff ft.YG : Make It Drop 18) Diplo ft. Octavian : New Shapes 19) Outro
HH IZ DEAD #29Dans ce HH iz Dead #29, nous avons sélectionné des sorties de rap US de cet hiver ( de janvier et février ), c'était la récolte de ces « Winter Flakes » , une sélection à la couleur de la saison , des flocons d'hiver pour mieux nous préparer au printemps qui arrive …HH iz Dead #29 :1) Nas ft. Divine, Naezy, Ranveer Singh : NY Se Mumbai2) Domo Genesis : Could this be3) Westide Gunn : Karl4) Drop by Yelawolf5) Yelawolf : Billy Goat Freestyle6) Mc Ren : King Vilain7) Smif-N-Wessun ft. Rick Ross : Let me Tell Ya8) Sean Price & Small Professor ft. AG Da Coroner, Guilty Simpson & Your Old Droog : John Gotti9) Tory Lanez : Free 21 Freesstyle10) Meyhem Lauren & The Alchemist : Still playing Celo11) Streetlife & Method Man ft. Havoc : Squad Up12) Fat Joe ft. Remy Ma & Reef Hustle : Fire13) Jim Jones & The Heatmakers : Cristal Occasions 14) Dj Kay Slay ft. Raekwon, Cee-Lo Green, Grandmaster caz & melle Mel : Hip Hop Frontline15) Erick Sermon ft. Big K.R.I.T & Ricco Barrino : That Girl16) Big Boi ft. Sleepy Brown : Doin it17) Riff Raff ft.YG : Make It Drop18) Diplo ft. Octavian : New Shapes19) Outro
HH IZ DEAD #28Dans ce HH iz Dead #28 , retour sur 2 ateliers menés à la prison de Mons et à la prison de Lantin. Une partie des détenu(e)s avec lesquels j'ai travaillé en ateliers propose leur sélection Hip Hop et commente leurs choix. Merci encore à Youssef, Marie-Hélène, Rachid, Farid, Mouss, Rustem, Michael, Saadia, Jy, Aurélien, Yacine, Omer, Gaetan, Fouad et tous ceux que j'oublie …HH iz Dead Label FB : https://www.facebook.com/hhizdeadlabel/HH iz Dead Archives : https://www.mixcloud.com/KingleeTracklisting HH IZ DEAD #28 :1) Talk with Youssef2) IAM : Demain c'est loin3) Talk with Youssef4) LIM: Tous illicites5) Mister You : La rue et la prison6) Michael, Mouss, Marie-Hélène, Saadia, Jy, Farid et Aurélien : Mons Churchill 247) Talk with Marie-Hélène8) BigFlo et Oli : Dommage9) Fonky Family: Art de Rue10) Talk with Rachid 11) Rohff: Embrouille12) Talk with Farid & Mouss 13) Jul: Tout seul14) Yacine & Youssef : Evasion15) Alonzo: Binta16) Lifers Group : Short Life of a Gangsta17) Talk with Rustem 18) Kery James : Mouhammad Alix19) Youssoupha : Clashes20) Talk with Rachid21) Rohff : Parfois, des fois22) Talk with Rustem23) King Lee : All The Way ( inédit )24) outro
HH IZ DEAD #28 Dans ce HH iz Dead #28 , retour sur 2 ateliers menés à la prison de Mons et à la prison de Lantin. Une partie des détenu(e)s avec lesquels j’ai travaillé en ateliers propose leur sélection Hip Hop et commente leurs choix. Merci encore à Youssef, Marie-Hélène, Rachid, Farid, Mouss, Rustem, Michael, Saadia, Jy, Aurélien, Yacine, Omer, Gaetan, Fouad et tous ceux que j’oublie … HH iz Dead Label FB : https://www.facebook.com/hhizdeadlabel/ HH iz Dead Archives : https://www.mixcloud.com/Kinglee Tracklisting HH IZ DEAD #28 : 1) Talk with Youssef 2) IAM : Demain c’est loin 3) Talk with Youssef 4) LIM: Tous illicites 5) Mister You : La rue et la prison 6) Michael, Mouss, Marie-Hélène, Saadia, Jy, Farid et Aurélien : Mons Churchill 24 7) Talk with Marie-Hélène 8) BigFlo et Oli : Dommage 9) Fonky Family: Art de Rue 10) Talk with Rachid 11) Rohff: Embrouille 12) Talk with Farid & Mouss 13) Jul: Tout seul 14) Yacine & Youssef : Evasion 15) Alonzo: Binta 16) Lifers Group : Short Life of a Gangsta 17) Talk with Rustem 18) Kery James : Mouhammad Alix 19) Youssoupha : Clashes 20) Talk with Rachid 21) Rohff : Parfois, des fois 22) Talk with Rustem 23) King Lee : All The Way ( inédit ) 24) outro
HH IZ DEAD #27Dans ce HH iz Dead #27 , nous avons sélectionné des sorties de rap US de cet automne , c'était la récolte des ces « Autumn Nutz » , une sélection à la couleur de la saison , des noix musicales d'automne …Tracklisting HH IZ DEAD #27 :1) Kanye West ft Lil Pump & Adèle Livens : I love it !2) Family Business : Bars from the Sunken Place3) Boogie : Fado4) French Montana : Nervous5) Ghostface Killah: Done it again6) Little Simz : Boss7) Method Man: Grand Prix8) Wu Tang ft. Sean Price( RIP): Pearl Harbor9) Redman : Tear it up10) The Alchemist ft. Conway & Westside Gunn : 94 Ghost11) Dj Muggs X Roc Marciano : White Dirt12) The Cool Kidz : Black Mags 213) Roc Marciano : 1000 Deaths14) Yung Lean : Happy Feet15) Styles P : Never fight an African16) Smif N Wessun : Let it go 17) Travis Scott ft. Drake : Sicko Mode18) Outro
HH IZ DEAD #27 Dans ce HH iz Dead #27 , nous avons sélectionné des sorties de rap US de cet automne , c’était la récolte des ces « Autumn Nutz » , une sélection à la couleur de la saison , des noix musicales d’automne … Tracklisting HH IZ DEAD #27 : 1) Kanye West ft Lil Pump & Adèle Livens : I love it ! 2) Family Business : Bars from the Sunken Place 3) Boogie : Fado 4) French Montana : Nervous 5) Ghostface Killah: Done it again 6) Little Simz : Boss 7) Method Man: Grand Prix 8) Wu Tang ft. Sean Price( RIP): Pearl Harbor 9) Redman : Tear it up 10) The Alchemist ft. Conway & Westside Gunn : 94 Ghost 11) Dj Muggs X Roc Marciano : White Dirt 12) The Cool Kidz : Black Mags 2 13) Roc Marciano : 1000 Deaths 14) Yung Lean : Happy Feet 15) Styles P : Never fight an African 16) Smif N Wessun : Let it go 17) Travis Scott ft. Drake : Sicko Mode 18) Outro
Today's Rapid Response Friday takes us back to a well-worn trope here at OA that we can't emphasize enough in late October: elections have consequences! Specifically, we take a look at the importance of past and future elections in the pivotal swing state of Florida. We begin, however, with a quick statement on the Trump administration's apparently-leaked policy regarding trans people and some new developments. After that, it's time for the ever-popular Andrew Was Wrong segment, with two things that.. well, Andrew got wrong: Whitewater and Paul Manafort (!) Then it's time for a deep dive into the Florida Judicial Nominating Commission and various constitutional amendments that are on the ballot this November, including one that takes a swipe at our favorite doctrine. But that's not all! We move on to discuss 202 Democratic Presidential Candidate Michael Avenatti. It's not pretty. Finally, we end with an all new Thomas Takes The Bar Exam #99 regarding criminal procedures. After getting it wrong last week, Thomas needs to go 2-for-2 to get to the coveted "60% at the half" -- can he do it?!?? You'll have to listen and find out! And, of course, if you'd like to play along with us, just retweet our episode on Twitter or share it on Facebook along with your guess and the #TTTBE hashtag. We'll release the answer on next Tuesday's episode along with our favorite entry! Appearances None! If you'd like to have either of us as a guest on your show, drop us an email at openarguments@gmail.com. Show Notes & Links For more on the history of jury sentencing at the state level, check out this 2011 law review article by Melissa Carrington that's well worth a read. Click here to read the Tampa Bay Times article suggesting that the next court nominee is going to be a conservative regardless of the election; here for the official Florida government website describing how the JNC is selected; and here for an in-depth discussion of the history of the changes to that process. This is Detzner v. Anstead, the Florida Supreme Court decision we discussed regarding bundled amendments, and you can click here to read the text of the proposed Florida amendments. Click here to read the Grassley referral of Avenatti and Sweatnick to the DOJ. And we broke down the Avenatti-Frank lawsuit first in OA Episode 181. Support us on Patreon at: patreon.com/law Follow us on Twitter: @Openargs Facebook: https://www.facebook.com/openargs/ Don't forget the OA Facebook Community! For show-related questions, check out the Opening Arguments Wiki And email us at openarguments@gmail.com
HH IZ DEAD #26Dans ce HH iz Dead #26 , nous avons rencontré Phil Plastic , graphiste, chanteur de 2 Star Hotel et de Tache à l'occasion de l'exposition « Primitive Belgian Skateborading 1978 » qu'il proposera avec Marc Laguna à la Galerie Central du 12 au 14 octobre 2018Nous avons donc discuté de la scène musicale et nous lui avons demandé sa sélection Hip Hop.Primitive Skateboarding Belgium 1978 Trailer : https://youtu.be/K191YsLrmBkHH iz Dead Label FB : https://www.facebook.com/hhizdeadlabel/HH iz Dead Archives : https://www.mixcloud.com/KingleeTracklisting HH IZ DEAD #26 :1) Two Star Hotel : Knifeedge2) Two Star Hotel : Walkin in Line3) Talk with Phil Plastic4) Grand Master Flash : The Message5) The Clash : The Magnificient Seven6) Talk with Phil Plastic7) Public Enemy : Public Enemy #18) Beastie Boys : She's on it9) Talk with Phil Plastic10) Drop by Rae Sremmurd11) Sleaford Mods : My Jampandy12) Stupeflip : Je fume plus de shit 13) Talk with Phil Plastic14) PIL : Double Trouble15 ) Meyhem Lauren : 41mm16) Ho99o9 : DeathKult Disciples17) Talk with Phil Plastic 18) La Muerte : Evil Land ( live ) 19) Outro
HH IZ DEAD #26 Dans ce HH iz Dead #26 , nous avons rencontré Phil Plastic , graphiste, chanteur de 2 Star Hotel et de Tache à l’occasion de l’exposition « Primitive Belgian Skateborading 1978 » qu’il proposera avec Marc Laguna à la Galerie Central du 12 au 14 octobre 2018 Nous avons donc discuté de la scène musicale et nous lui avons demandé sa sélection Hip Hop. Primitive Skateboarding Belgium 1978 Trailer : https://youtu.be/K191YsLrmBk HH iz Dead Label FB : https://www.facebook.com/hhizdeadlabel/ HH iz Dead Archives : https://www.mixcloud.com/Kinglee Tracklisting HH IZ DEAD #26 : 1) Two Star Hotel : Knifeedge 2) Two Star Hotel : Walkin in Line 3) Talk with Phil Plastic 4) Grand Master Flash : The Message 5) The Clash : The Magnificient Seven 6) Talk with Phil Plastic 7) Public Enemy : Public Enemy #1 8) Beastie Boys : She’s on it 9) Talk with Phil Plastic 10) Drop by Rae Sremmurd 11) Sleaford Mods : My Jampandy 12) Stupeflip : Je fume plus de shit 13) Talk with Phil Plastic 14) PIL : Double Trouble 15 ) Meyhem Lauren : 41mm 16) Ho99o9 : DeathKult Disciples 17) Talk with Phil Plastic 18) La Muerte : Evil Land ( live ) 19) Outro
Dr. Carolyn Lam: Welcome to "Circulation on the Run," your weekly podcast summary and backstage pass to the journal and its editors. I'm Dr. Carolyn Lam, Associate Editor from the National Heart Center and Duke‐National University of Singapore. Our featured discussion this week focuses on the new 2017 ACC/AHA high blood pressure guidelines, and the potential impact of these guidelines on the U.S. population. A must listen, coming right up after these summaries. The first original paper this week provides insights into how extracellular matrix remodeling contributes to in‐stent restenosis and thrombosis. First author, Dr. Suna, corresponding author, Dr. Mayr, and colleagues from King's College London, implanted bare metal and drug‐eluting stents in pig coronary arteries with an overstretch and then harvested the stented segments up to 28 days poststenting for proteomics analysis of the media and neointima. The authors found significant differences by proteomics in the extracellular matrix of coronary arteries after stent implantation. Most notably, an upregulation of aggrecan, a major extracellular matrix component of cartilaginous tissues that confers resistance to compression. In fact, this study provided the first evidence implicating aggrecan and aggrecanases in the vascular injury response after stenting. This opens a door to consideration of aggrecanase activity as new drug targets that may alter extracellular matrix remodeling in the vasculature. The next paper tells us that empagliflozin could address a significant unmet need in patients with chronic kidney disease. First and corresponding author, Dr. Wanner, from Wurzburg University Clinic in Germany investigated the effects of empagliflozin on clinical outcomes in patients with chronic kidney disease in the EMPA‐REG OUTCOME trial, where patients with type 2 diabetes, established cardiovascular disease, and an eGFR above 30 at screening were randomized to receive empagliflozin or placebo, in addition to standard of care. In the current study, prevalent kidney disease was defined as an eGFR of less than 60 or urine albumin/creatinine ratio of more than 300 at baseline. In these patients, empagliflozin reduced the risk of cardiovascular death by 29% compared with placebo, reduced the risk of all‐cause mortality by 24%, and reduced the risk of hospitalization for heart failure by 39%, and the risk of allcause hospitalization by 19%. The effects of empagliflozin on these outcomes were independent of renal function or albuminuria status at baseline. Furthermore, the adverse event profile of empagliflozin was similar across subgroups by renal function at baseline. Adverse events of particular concern in this population, such as urinary tract infection, acute renal failure, hypokalemia or fractures, lower limb amputations or hypoglycemia were not increased with empagliflozin compared to placebo. The next study provides mechanistic insights into exercise intolerance in heart failure with preserved ejection fraction or HFpEF. First author, Dr. Houstis, corresponding author, Dr. Lewis and colleagues from Massachusetts General Hospital, investigated the mechanism of exercise intolerance in 79 patients with HFpEF and 55 controls referred for cardiopulmonary exercise testing who were also studied with invasive monitoring to measure hemodynamics, blood gases and gas exchange during exercise. These measurements were used to quantify six steps of oxygen transport and utilization in each HFpEF patients, identifying the defective steps that impaired each one's exercise capacity. The authors then quantified the functional significance of each pathway defect by calculating the improvement in exercise capacity that a patient could expect from correcting the defect. The authors found that the vast majority of HFpEF patients harbored defects at multiple steps of the pathway, the identity and magnitude of which varied widely. Two of these steps, namely, cardiac output and skeletal muscle oxygen diffusion were impaired relative to controls by an average of 27% and 36% respectively. Due to interactions between a given patient's defects, the predicted benefit of correcting any single defect was often minor. At the individual level, the impact of any given pathway defect on a patient's exercise capacity was strongly influenced by comorbid defects. The authors concluded that a personalized pathway analysis could identify patients most likely to benefit from treating a specific defect. However, the system properties of oxygen transport favor treating multiple defects at once, such as, with exercise training. What are the potential benefits or risks of intensive systolic blood pressure lowering in individuals with a low diastolic blood pressure? Well, the final paper today tells us. In this study by first and corresponding author, Dr. Beddhu, and colleagues from Salt Lake City in Utah, a post hoc analysis of the SPRINT trial was performed. Remember that the SPRINT trial was a randomized control trial that compared the effects of intensive versus standard systolic blood pressure control in older adults with high blood pressure at increased risk of cardiovascular disease. The current post hoc analysis examined whether the effects of the systolic blood pressure intervention differed by baseline diastolic blood pressure. The authors found that there were U‐shaped relationships of baseline diastolic blood pressure with the primary cardiovascular disease outcome and all‐cause death. However, the beneficial effects of intensive systolic blood pressure lowering on the primary cardiovascular disease outcome in all‐cause death were not modified by baseline level of diastolic blood pressure. Increased risk of kidney events and serious adverse effects of the intervention were consistent across baseline diastolic blood pressure quintals. Therefore, there was no evidence that the benefit of intensive systolic blood pressure lowering differed by baseline diastolic blood pressure levels. These findings suggest that the reason for the observed associations of worse outcomes with lower diastolic blood pressure was due to underlying processes, such as increased arterial stiffness that lead to a decline in diastolic blood pressure, rather than the level of diastolic blood pressure per se. Furthermore, lower levels of diastolic blood pressure within the ranges examined in SPRINT, should not be an impediment to intensive treatment of hypertension, at least in those without diabetes or stroke. Well, that wraps it up for our summaries. Now for our feature discussion. The ACC/AHA guidelines for the management of hypertension in adults has really been a hot topic. Just published this year, and it really updates the seventh JNC report, which was published in 2003. Well, today's feature paper deals directly with a comparison of these two guidelines and how it may impact our practice. I'm so pleased to have with us today the first and corresponding author of this paper, Dr. Paul Muntner, from University of Alabama at Birmingham and a very familiar wonderful voice, Dr. Wanpen Vongpatanasin, associate editor from UT Southwestern. Welcome! Dr. Paul Muntner: Hi. Thank you for having me. Dr. Wanpen Vongpatanasin: Hi, Carolyn. Dr. Carolyn Lam: Paul, could I ask for you to start by painting the differences between the 2017 ACC/AHA guidelines and the JNC 7? We understand you were part of writing the guidelines, so who better than to draw our attention to the main differences. Dr. Paul Muntner: I think that the new guideline, the ACC/AHA guideline, it was fairly comprehensive included 15 chapters, so there's a lot of new information in the guideline, everything from a dedicated section on the measurement of blood pressure to aspects of patient care. The manuscripts featured in "Circulation" in this issue is focused on, in the past, there's different blood pressure thresholds in the guideline for defining hypertension, as well as recommendations for antihypertensive medication treatments, as well as blood pressure goals. As everyone probably knows form JNC 7, hypertension was defined as a systolic blood pressure greater than or equal to 140 mmHg and/or a diastolic blood pressure greater than or equal to 90 mmHg, versus in the 2017 ACC/AHA guideline, these were lowered to 130/80. In terms of treatment recommendations, there's really a fundamental shift with the new guideline, where the new guideline focuses not just on blood pressure levels, but also on overall cardiovascular disease risk. So going to the new guideline, people are recommended treatment if their blood pressure is above 140/90 but also there's a group with a blood pressure in the 130 to 139 range for systolic blood pressure, of 80 to 89 mmHg for diastolic blood pressure, who are recommended treatment if they have a high cardiovascular disease risk. Finally, I'll just finish with this last note is that blood pressure control for people taking antihypertensive medication is now 130/80 so a goal blood pressure for people taking antihypertensive medication is systolic blood pressure less than 130 mmHg, and a diastolic blood pressure less than 80 mmHg. Dr. Carolyn Lam: That was beautifully explained. Paul, I just really loved table 1 of your paper, and I want to refer our audience to it. It so nicely summarizes the differences between the 2017 guidelines and JNC 7. At risk of oversimplifying, when you compare the two in this approach, it's sort of comparing using a cardiovascular risk in conjunction with blood pressure‐type approach with a blood pressureonly number approach, isn't it? Dr. Paul Muntner: Right. I think that's a key important piece of the new guideline and really CVD risk is used in conjunction with blood pressure levels to guide the recommendation to initiate antihypertensive medication. This decision was based on a wide variety of data from randomized trials, observational studies, as well as simulation or economic analyses that consistently showed the benefits of considering an individual's overall cardiovascular disease risk and providing effective and efficient treatment for lowering blood pressure. Dr. Carolyn Lam: Right. And you analyzed the impact of this in the NHANES data in today's paper. Could you tell us a bit more about that? Dr. Paul Muntner: The U.S. National Health and Nutrition Examination Survey, or NHANES, provides an opportunity to generate national representative point estimates on the prevalence of hypertension and treatment recommendations. So we're able to use data on about 9500 U.S. adults. Each person came in for a clinic examination where they had their blood pressure measured three times, and they were asked about their use of antihypertensive medication. What we found was the prevalence of hypertension, or the percentage of U.S. adults with hypertension according to the new guideline, is about 46%, which compares to 32% according to the JNC 7 guideline, so really a big increase in the prevalence of hypertension of about 14%. However, by using the combination of risk and blood pressure, we're not recommending treatment for everyone with hypertension but rather people with hypertension with very high blood pressure as well as those at high cardiovascular disease risk. So antihypertensive treatment, pharmacological antihypertensive treatment, is now being recommended for about 36% of U.S. adults compared to 34% of U.S. adults according to JNC 7. The rest of the people with hypertension are recommended nonpharmacological therapies; exercise, diet, alcohol reduction, weight loss for people who are overweight and obese. Really, it's an opportunity to treat people with pharmacological therapy if they're high risk. Then for people who aren't high risk, there's an opportunity for nonpharmacological therapies, so they can, hopefully, prevent the need for further treatment. Overall, this equates to about 103 million U.S. adults with hypertension, so it's a very large number. However, only about 82 million of these individuals are recommended pharmacological antihypertensive treatment, so there's a big portion of the U.S. population who have hypertension, have high blood pressure, yet we think would benefit from nonpharmacological therapy. Dr. Carolyn Lam: Wanpen, could I get you to chime in on what you think of the clinical implications of today's paper? Dr. Wanpen Vongpatanasin: I think that this paper gives us at least reassurance that although we have 30 million more people with hypertension now, not all of them have to be started on medication right away. But it also put an emphasis on cardiovascular risk assessment, which we as the cardiologist are already doing this on a regular basis. It is a major step forward to incorporate cardiovascular risks as another way to gauge how people should be treated intensively, which we like that aspect of it. Dr. Carolyn Lam: I agree. I think it's reassuring because most people think, "Oh, my goodness. We have got so much more hypertensives to manage." But then it tells us that a restratified approach really keeps it manageable, I suppose. But Wanpen, did you have some specific concerns or questions? Dr. Wanpen Vongpatanasin: We look at the people who by JNC 7 calls prehypertension, which it's now some of them turn out to be a stage 1 hypertension. The question I have for Paul is that even though guidelines call for nonpharmacologic treatment first, the guidelines said give a try from three to six months, but what happens after that if they're still not reaching the goal? Would people on the guidelines propose drug treatment eventually because, as you know, nonpharmacology treatment is easier said than done. Even though you might be able to tackle some aspect of it, but I doubt you can tackle everything; exercise, diet, sodium, weight loss all at the same time in a three to six month period. Dr. Paul Muntner: It's a great question and it's something that the guidelines really spent a lot of time considering and reviewing the evidence. First, what the recommendation is that we recommend nonpharmacological intervention as you mentioned and the re‐evaluation. If the person's blood pressure remains in the stage 1 hypertension range and they're not a high cardiovascular disease risk, then they are recommended to continue attempts at the nonpharmacological interventions. I've been asked several times since the guideline has been published, "What, are we supposed to just wait until people become high risk?" And my viewpoint on this is, it's hard enough to get people to adhere to their medications currently, let's be judicious about this, focus on the high‐risk people, and maybe if we can communicate with people that have high‐risk for cardiovascular disease, we can work with patients to improve medication adherence and really focus on the low‐risk people in preventing the need for lifelong therapy. Dr. Wanpen Vongpatanasin: That's great, I think that's really helpful in clarifying this point. Because even if you say that 30 million doesn't need to be started on the drug right away, that eventually have to be started on drug in six months, I think that doesn't really give us a reassurance but, obviously, we still have to continue to work on these patients who are on the fence of needing pharmacology intervention. Dr. Paul Muntner: Right. I think what's interesting here is a lot of people since the guideline has been published have said to me, "Now this is done." I said, "No. Now we're really just starting. Now is the most important part of the guideline, which is implementation." And how are we going to implement the guideline, which, as we were just discussing, isn't just about initiating pharmacological therapy, but it's also about the nonpharmacological therapies as well as medication adherence and all these other issues that are in the guideline, proper measurement of blood pressure, etc. I think that now is going to be the most important time to really have a big impact on our patients' lives by really using the evidence and now that it's in the guideline, we're using the evidence to direct treatment appropriately. Dr. Carolyn Lam: Indeed, Paul. Just one thing. Along the lines of implementation, how about the issue of the lower target BP, to treat to? What did your study from NHANES show about that, numbers reaching targets, and do you see that as an issue? Dr. Paul Muntner: It's an interesting question because the findings from our study found that it's currently over half of U.S. adults according to the new guideline, over half of U.S. adults on antihypertensive medication, have blood pressure above the goal in the new guideline. So in our study, 53% of U.S. adults taking antihypertensive medication had a blood pressure above 130/80. This represents an increase from the JNC 7 guideline of people with blood pressure above 140/90, of course, of about 14.4%. According to our estimates, there are about 8 million U.S. adults who are going to be recommended more intensive antihypertensive medication. The blood pressure of less than 130/80 is a uniform goal for all people taking antihypertensive medication. This comes from several meta‐analyses that have consistently shown the cardiovascular and mortality risk reduction associated with achieving a blood pressure of less than 130/80. I think there's very firm evidence to stand on. One interesting thing from the guidelines, it's in one of the tables, and I think it's a very important point to make, is that a lot of people who have above goal blood pressure, according to the new guideline, they're only taking one or two classes of antihypertensive medication. The vast majority of them are not taking multiple classes of antihypertensive medication, so we feel that these therapies can be optimized and we're not going to be pushing people into antihypertensive polypharmacy but rather they can receive substantial risk reductions without really giving them too many additional pills. Dr. Carolyn Lam: Wow. Really about implementation. Wanpen, did you have any other comments before we close? Dr. Wanpen Vongpatanasin: Yes, I think that is really interesting to see also with these guidelines how is this going to be embraced to the rest of the world. Actually, prior to this guideline, at least hypertension control rate in the U.S. is better than most countries, European countries, as well as in Asia. But now even lowering the bar, we use the same criteria for the rest of the world, that would be a lot worse control rate than now. I think it will be challenging, not only in this country but throughout the world. Dr. Paul Muntner: That's a great point. Obviously, these guidelines are U.S. guidelines, however, new European guidelines should be coming out in 2018, is what I've heard. I think that even though these guidelines were developed by the American College of Cardiology and the American Heart Association, the data that we're using really comes from worldwide evidence. The evidence didn't stop at the borders. A lot of the evidence that was used in choosing the blood pressure levels to define hypertension, the blood pressure levels to recommend pharmacological interventions, as well as the blood pressure goals do come from other countries. A lot of data from Asia, Europe, Australia, so I think that the data used in these guidelines should be generalized when it's out of the United States. I think there may be challenges with implementing these guidelines in different settings, and, obviously, a lot of things will have to be tailored to where they will be implemented. However, the overall goal is to reduce the burden of cardiovascular disease and renal disease related to hypertension and, hopefully, that can be a worldwide goal. Dr. Carolyn Lam: What a great reminder. It is worldwide data, worldwide evidence for a worldwide problem. Well, listeners, you heard it right here on "Circulation on the Run." Thank you so much for joining us today and don't forget to tune in again next week.
Session 47 Dr. Westley Ohman is an academic Vascular Surgeon in the St. Louis area. We discuss why he chose academics, what makes a good vascular surgeon and more. Good news to all premeds out there! We have a new podcast called Ask Dr. Gray Premed Q&A. Or if you know someone who's a premed, point them to the podcast as well as all our shows on MedEd Media. [01:54] Interest in Vascular Surgery Westley had exposure to vascular surgery from an engineering standpoint as an undergrad. But it wasn't until late in his third year and going into his fourth year with his sub-I's that he had world-class mentors from the cardiac and vascular side of things. He was fortunate enough to be guided in his decision making. They supported him going into vascular seeing that's where his interest and his skill set lie more than on the cardiac side. He likes the interventional approach where you can treat aneurysm in one room with two small needle pokes in the femoral arteries and then patients go home the next day. Then in the next room, you can be doing an open aneurysm and the patients can stay for a week. You're deciding which patient benefits from which and really try to master both open and endovascular surgery. Westley is fortunate enough to where his mentors would let him manipulate the wires when it was safe to do so even as a medical student. So his appetite only went from there. Other specialties in the running as he was going through his sub-I's were cardiac surgery and cardiac interventions which he found interesting. But he can't explain but the technical aspects of doing a fenestrated aneurysm appealed more to how he approaches problems and think about things. He also thought about neurosurgery more on the endometrial neurosurgery as opposed to true neurosurgery. [04:50] Traits that Lead to Becoming a Great Vascular Surgeon Westley sees spatial reasoning more so than any other surgical discipline. They do open surgery anywhere in the body. So you have to understand not just where the blood vessel runs but where's the nearest muscle insertion or origin. Understand how you're going to be able to tunnel your bypass graft or how you're going to get exposure to that artery. And in the belly, understand where the important organs live as well as be able to manipulate the space in terms of where you're going to run your bypass. "I really demand for technical precision. Vascular surgery has a way of humbling you." In short, you have to know every inch of the body to be able to successfully operate on somebody. He even jokes in medical school that he's a practical radiologist. They know the anatomy from looking at pictures, but this is his practice on a daily basis. [07:00] Types of Patients and His Decision to Stay in the Academic Setting A big portion of the patients they're treating are the end stage renal patients. They do access creation or maintaining functional access through dialysis or revisions. They also treat peripheral arterial disease that comes along with the disease brought about by end stage renal disease. Your average VA patient encapsulates a lot of vascular surgery from a general standpoint. They're the smokers, the diabetics, the ones that don't necessarily take the best care of their body. So they get peripheral arterial disease or aneurysm. But from an academic standpoint, he also gets a lot of the referrals for infected endografts, aneurysms, in and of themselves. As to his thought process behind choosing academic versus community setting, he looked at jobs for both academic and community settings. One of the things that made him stay in the academics was a job available for him. When you're going through looking for a job, the academic jobs are always posted about 4-5 months after the private practice jobs. "No one truly knows when an academic job is going to pop up because of the difference in funding cycles." The complex endo interventions entail pushing the limits of what they can do from an interventional approach or minimally invasive approach while still doing right to a patient. It's very easy to do something to a patient but determining if it's the right way to do it. They also have to consider limiting the physiologic stress on aortic surgery patients. And this is what kept him in the academics. Moreover, he has always wanted to be a big aortic surgeon having found the disease processes in terms of aneurysm and dissections fascinating. And a lot of the smaller hospitals and mid-sized hospitals just don't have the resources to support the very sick and very challenging patient population. Westley clarifies it's not the fault of the hospital. It's just not their mission or their buildup. And it takes a very specific type of place to do it which he always saw himself doing as a surgeon. [11:10] Percentage of Patients, Typical Day, and Taking Calls Westley says two-thirds of his patients come in already diagnosed with a caveat. If he'd do thoracic outlet syndrome, they have one of the biggest, if not the biggest, thoracic outlet syndrome referrals in the country. Nearly 100% of those patients come in with a diagnosis in the ballpark. But for the remainder of his patients, he will get referrals from the hematologists or the rheumatologists. Once you get outside of the pure simple cases, you see patients in end stage renal disease and they need access or they've been smoking and they have peripheral arterial disease. So there are a lot of esoteric diagnoses they made in an interdisciplinary process. "There are days in my clinic where the diagnosis is made for the patient before they get there." This said, 25%-33% of his patients are usually an interplay between himself and another consulting physician where they bounce ideas off each other. But a lot of his diagnosis are not made from subtle physical exam findings. They're important but they're a more imaging-driven specialty. Westley can't say there is a typical day for him, which has been a selling point for him. But if he's on call at a major center, he could get a ruptured and aortic aneurysm and go do that. While he could also deal with a gunshot wound to an extreme median having to figure out how to reconstruct or what conduit to use. But it's very easy to start your day with one procedure and then going to a different procedure. And then you bounce back upstairs to either do bypass or belly revascularization. Outside of clinic days, he doesn't really know what comes his way. Because even if he's not on call, if they happen to get swamped and being pulled into other cases. So being able to be flexible and offer the full toolkit really allows his day to be as variable as the hospital needs him to be or as he wants it to be. He takes one and a half days of clinic per week so he basically spends more time in the OR or the cath lab or the interventional suite. Westley describes being one of those rare groups with ten partners, nine of which will take call. So it ends up being a one in eight or so calls. He'd be on call a weekday, usually every other week. Then he'd have a weekend call every other month. For him, this is better than it was when he was in training. Outside of those large groups, it's easy to be in a Q3, Q4 call. That said, he's in a major referral center so although it's an infrequent call, it's still a very busy call. Half of his calls, he's operating most of the night, if not all of it, and still running the full day the next day. And the other half, he's interacting with the referral line or fielding inpatient consults that don't necessarily need to go to the operating room. But students should expect that there are going to be emergencies going into vascular surgery. Not a lot of their cases is that when something goes wrong can be sit on until the next morning. "Going into vascular surgery, there should be the expectation that there are going to be emergencies." [16:52] Work-Life Balance Westley still finds having life outside of the hospital. He's married to a fourth year general surgery resident. They have a toddler and two dogs. It's tough. But since he's finished training, their life has gotten significantly better. Regardless of what his wife is doing, he has time for what he wants to do in terms of family and career. It's about finding that right balance and for them, that right balance is a wonderful nanny who helps them out. This allows them to stay in the hospital late on a rare night that you need to. [18:03] The Training Path to Vascular Surgery Westley explains that there are two routes. One is the traditional two-year fellowship after a five-year general surgery program, known as the 5+2. There's also the 0+5, which is 5 years of some amount of general surgery and a lot more vascular surgery. His program did it half and half for the first three years and the last two were only vascular, This allows you board certification only in vascular surgery. From this, you can go on to do fellowships in cardiology or critical care to augment what you can offer. Westley comes from a 0+5 program where he could whatever he wanted anywhere in the body that he needed to be. I don't think either pathway is the right way. I don't think there's a wrong way to go. He noticed that his co-fellow who came from general surgery training when he started his fourth year, was more comfortable in the belly. But by the end of it, they were roughly equivalent. And he felt he had stronger interventional or endovascular skills. That because he didn't learn laparoscopy whereas he did. "It really takes some soul searching from the student as to which pathway they think is best for them." According to Westley, all of his friends who have done general surgery and the vascular don't touch a laparoscope. And in fact, he's more likely to touch one than they are just by accident. Regardless of the setting, Westley stresses the importance of the quality of the training program. There are 5+2 programs that will prepare you for a very successful private practice. And there are some 0+5 that will prepare you for a very successful academic, doing the big cases and vice versa. He thinks that each program has its own individual strengths. When he sat down six years ago to make his rank list, his first three were integrated programs and his fourth was general surgery. He would recommend students to figure out what you want from there and what you want your life to look like. They may not know that and think 5+2 is the way to go since they have their general surgery to fall back on. It's not a bad decision. But it's a mindset that a lot of vascular surgery is moving more towards 95%-100% vascular surgery. This is because of what they can do and how they can do it expanding every year. In terms of competitiveness, Westley describes it as fairly competitive. He thinks there are slightly more applicants than there are spots. And in terms of the 0+5, when he applied, it was more competitive than dermatology. They still have 80 programs per one spot per year and they interview about 20-25 of them. And for the fellowship, the numbers are a little smaller. A big debate going on is that a lot of the 0+5 programs were born out of the big academic centers. Michigan was the first to have it as well as Pitt and Dartmouth, which are big names in vascular surgery. At WashU, they keep both pathways open. They're committed to matching one for each pathway per year. Part of that is having complementary learning that makes for a better learning environment. Then there's always the big academic centers that don't have the 0+5. And the biggest leaders in vascular surgery right now say they will hopefully never have a 0+5 at their program. So even though it's been out for almost a decade now, it's still a very polarizing topic for some of the very senior people in the discipline. [23:50] Advice to Students to Become Competitive Just like for everything else, Westley says it comes down to having a reasonable Step 1 score. It's going to be a very easy, quick, and dirty screening outlet. Another thing is that vascular surgery being a small field, doing a sub-I is absolutely critical. This allows you to get your name in the door in different places. And if you can, you get letters and phone calls fro not only your home institution, but other institutions as well. So this goes a long way towards building a competitive application. Especially at 0+5 level, it shows exploration and an interest. There are also people falling out of the pathway and having an empty spot for the next x number of years where you're supposed to be training. Being able to show you know what you're getting into goes a long way. This is something they look for when they're interviewing applicants. "Vascular surgery is a very small field and I think more so than general surgery...doing a sub-I is absolutely critical." [25:30] Bias Against DOs and Subspecialty Opportunities Westley doesn't see any overt bias against DOs. They've interviewed some DOs in the last couple of years. It's just that a lot of the big programs for vascular surgery aren't associated with an osteopathic school. This is an extra hurdle the student has to go through. They have to show they're investigated and they have the commitment. And if they can show that, then they could go further than the allopathic student who comes from a program that might have a great reputation for vascular surgery but didn't necessarily show as much interest or build a competitive application packet. In term subspecialty opportunities within vascular surgery, there are several ways to make your niche. There isn't any formal ACGME fellowships. But as he said, what comes into anyone's mind is there is advance aortic endografting fellowships. Cleveland Clinic has one as the Mayo Clinic, which they've rolled out as a complex aortic reconstruction fellowship. UT Houston also has it, which is where he went to medical school. These are big aortic referral centers so they attract the aortic "super" fellows to learn those techniques. Moreover, Westley says it's very easy to build a very heavy thoracic outlet syndrome practice if that's where you want to make your mark. Because if you can do it well and show consistent outcomes, those are patients that will come to you. And the referrals will come to you as well fairly easily. A lot of people in the community end up either specializing or treatments for venous reflux. Those are disease process that he thinks they've undersold as a society or medical profession. There's always one guy in town who's that carotid surgeon just like the thyroid surgeon that get good outcomes with your carotid procedures. Referrals will also continue to come as well. But in terms of established training pathways, there aren't any besides the aortic surgery. "Beyond the general training, it's just kind of how you want to market yourself." [28:50] Working with Primary Care and Other Specialties Westley wishes to thank primary care physicians which he considers as his very best friends.A lot of the medical management of vascular patients is driven by the primary care physician. Whether in terms of following the JNC guidelines and the AHA guidelines in terms of the best medical management. About a third of his clinic patients, he ends up getting or giving a phone call to the primary care physician to pick their brain about it. He thinks it's underrecognized. In a large portion of society, everyone thinks about carotid disease and stroke but lower extremity and peripheral arterial disease and critical limb ischemia are fairly quick to pick up in terms of simple questions. These are quick and easy things that can prompt a referral to him and really impact the patient’s overall lifespan. "A lot more medical management happens in vascular surgery than a lot of the other specialties." Other specialties he works the closest with include the cardiac surgeons, nephrologists, hematologists, trauma team, radiology, and primary care. He is fortunate where the turf war was fought by a generation before him so he no longer has to fight them. But they do interact a lot with the interventional radiology colleagues in a congenial relationship and not antagonistically. The same think with interventional neuroradiologists that have made a name for themselves in the intracranial work. They do most of the extra cranial carotid disease. If those issues had not been settled, Westley admits it would have been different. As far as limiting their scope of practice in the future, Westley doesn't really see this coming. He thinks a lot of the blame for the vascular being open for other specialties is they've done a poor job defining what's the best treatment option for this disease process. And the interventional cardiologist or interventional radiologist has the skill set to treat those patients as equivalently as he does in terms of cutting a wire across the lesion. Or whether it could be putting a balloon or a stent. Westley believes a way for vascular surgeons to really sell themselves is that mindset of having multiple skill sets. But also think whether they're burning any bridges. If they can define who benefits from what procedure, and also market themselves as being the one-stop shop for lower extremity work. Either they protect their patient population or start to grow it. He won't sit and tell that there aren't interventional radiologists that can do phenomenal work in the peripherals. Or that the cardiologist can't do a good work in the renal segment for instance. So he thinks it as not only someone who can put a hole in an artery or fix a remote artery, he can also make an incision and provide a definitive fix to that problem. [35:49] Opportunities Outside of Clinical Medicine The first thing that always comes to mind is a lot of early advances in the industry. The first stent was developed by a physician (not a vascular surgeon). And a lot of the newer stent grafting was pushed by a vascular surgeon or helped developed by a vascular surgeon. Where he's at, they have a very large industry presence and they’re very active on clinical trials. The IP world for vascular surgery or devices in general has changed. Before, they'll just run with it and sit back and collect royalties. But those easy-picking days are gone because they really want to see an idea almost brought to the market. This could be in terms of the background studies, safety and efficacy studies. Some of his partners are working on small drug molecules and working with industry from that standpoint. One of his former partners who moved on from the University of Michigan was big in "nanotherapeutics." They're pushing the envelope of how they can augment devices with small drug molecules to bridge the device industry and the pharmaceutical aspect of it. "From the policy standpoint, vascular surgery hits on a lot of different disease processes that unify different body areas." Moreover, he knows other vascular surgeons who have tried to move into more of a healthcare policy standpoint. They don't only look at the cardiovascular system but also the cardiology or nephrology world. Westley believes there has to be a healthy relationship with industry right now in terms of devices, balloons, grafts, and stents. [39:15] What He Wished He Knew and What He Likes the Most and Least When he was in training, he would curse the middle of the night and thought he should have gone to a place that's not a major level 1 trauma center. He really doesn't like operating that much in the middle of the night. "Looking back on it, I really see that the trauma situations were really the ones where I grew the most as a surgeon." And in that moment, he was tempted to curse and throw an instrument. And as he looks back, he thought that was actually an opportunity to learn how to approach new problems. He thinks it really made him a better surgeon. Would he pick vascular surgery all over again? Westley is absolutely sure, but just with a caveat that there are going to be a lot of nights and late days if you're going to do the big cases. If you want to design your practice to where you are treating venous reflux all day, then you're not going to have any inpatients. And you're going to live a very comfortable life. So it depends on what you want. What he likes the most about being a vascular surgeon is being able to treat any disease process outside of the head and the heart. Because it always keeps his days different. And he really enjoys interacting with not only other surgical disciplines but also other medical disciplines. And in terms of approaching and managing those problems. Not every patient that comes across him needs an operation. But almost uniformly, he'll be interacting with either the primary care physician or some sort of medicine subspecialist to help provide some input on the disease process. He would still be treating patients even without a scalpel or without a needle. What he likes the least is not operating at night. He often jokes with his trainees but there really is nothing more humbling than vascular surgery. He finds it very demanding from a technical aspect. Sometimes, he finds himself losing more sleep now as an attending than he did as a trainee. He's worried about whether it's okay enough to where he can leave the operating room or does he need to work on the problem. He likes the challenge but it's starting to wear on him. So he's starting to explore with his senior problems as to how to deal with it. Not to wear him down but to motivate him to either do better in that moment or do better for the next patient. [43:05] Major Changes in Vascular Surgery in the Future Westley explains that there's always going to be turf wars and he thinks that should be a call to better ourselves and better define ourselves. There's always going to be pushing the envelope. Fifteen to twenty ears ago, the only way to treat aneurysm was a big belly incision. Then they got to a groin cut downs and rudimentary endovascular devices. Today, he can do a complex paravisceral aneurysm through a procedure that at the one month follow up, you can't even tell they had an operation from the outside. That said, the explosion of minimally invasive techniques is going to allow more and more people who say they have the skills with wires and catheters to come into their "turf." It's going to be up to the next generation to show that they can do it a lot better and here's how. Eventually, all hardware fails. It's just a matter of whether or not the patient lives long enough for the device to get fatigued. Westley adds that as all hardware fails, it's only a matter of time until the device can get fatigued. In which case, they'll require an open conversion and you do want them to be at a major aortic referral center. It's not just about putting in the equipment but being able to manage all the complications that come from it. This is where vascular surgeons are going to help be able to define themselves. "It's not just putting in the equipment, it's also being able to manage all of the complications that come from it." [45:30] Final Words of Wisdom Westley says vascular surgery is one of the more dynamic and rapidly changing surgical disciplines not only in terms of who they can treat and how. But also, pushing the envelope of what may be inoperable now. Ten years from now, you may already have a very simple device or very simple fix that you may very well be a part of developing. It's not for everyone. But people who will love this are those who welcome the technically demanding challenge or the opportunities of the spatial challenges that come along with vascular surgery. If you're good at it and you have inclination towards it, you're going to love it. Especially for the general surgery resident who may only do it as an intern or a second year, not to see as a full breath and just be taking care of the patients. It's so much more than that once you get into the operating room. If you have the opportunity to rotate as a senior, by all means you should. It is night and day from just managing them post-operatively or sewing a simple fistula. And he was quick to discover there's no such thing as simple fistula, which he thought it was as a second year resident. When you're doing the more challenging cases either technically or intellectually, it's incredibly rewarding even though the patients may be challenging at times. "When you're doing the more challenging cases either technically or intellectually, it's incredibly rewarding." Links: Ask Dr. Gray Premed Q&A MedEd Media
In this podcast episode, we will talk about how systolic hypertension effects outcomes, put into context a recent JACC systematic review paper on the topic and JNC 8 and discuss NNT and NNH.
I had an opportunity to catch Helen Cutteridge at the Gathering to talk about Young People and Mental Health. This is a growing issue in todays society, especially amongst young people. Please have a listen and share with whoeveryou think would benefit from listening to this episode. Helen Cutterdige has been doing Youth Work for the last 10years, qualifying with a degree and JNC in Youth and Community Work with CYM. She’s worked for local churches, local councils and for the last year has been working for Youthscape as their Emotional Wellbeing (Self Harm) Lead for the local team, most of Helen’s time is spent supporting young people 1:1 or in group settings in school. She also delivers training for SelfharmUK, writes blogs and talks at other events. Enjoy!
Summary: On this episode we’ll teach you to dominate hypertensive urgency and severe hypertension (HTN) in the clinic, the ER, or on the hospital wards. The Curbsiders offer you this delicious serving of knowledge food so you can manage high blood pressure (BP) without making the same egregious errors that we made during our more formative years. Of note, The Curbsiders are guestless for this episode. Guestless? Is that a word? Our guest for this episode was supposed to be Dr. Wallace Johnson, a Cardiologist, and expert on HTN from the University of Maryland. He did a fantastic job, but, unfortunately, technical difficulties caused us to lose any useable audio. Our sincerest gratitude and deepest apologies to Dr. Johnson. Nevertheless, we pressed on and used one of our own, the illustrious Dr. Paul Williams, as our expert guest. Clinical Pearls: Hypertensive crisis is divided into hypertensive emergency and hypertensive urgency. “Emergency” needs IV therapy NOW “Urgency” needs increased oral therapy over next 24-72 hours History, physical exam, and familiarity with the patient are key for triage (e.g. verify BP readings, assess compliance, etc.) Severe HTN and hypertensive urgency can often be treated in the outpatient setting IV agents are not indicated outside of true hypertensive emergency (i.e. objective end organ damage) We recommend increasing dose or frequency of existing BP meds as 1st line (better long-term solution) Intermittent dosing of oral labetalol, clonidine, and captopril can be considered as 2nd line (short-term solution) Rule out uncontrolled pain, volume overload, alcohol withdrawal, illicit drug, and missed medications as cause of severe HTN Evidence from observational studies suggests that headaches are NOT caused by HTN Untreated severe HTN was historically fatal in months to years prior to development of antihypertensives Goal: Listeners will become proficient in the appraisal of severe hypertension/ hypertensive urgency and employ safe and practical management strategies. Learning objectives: By the end of this podcast listeners will: Confidently triage patients with severe hypertension and provide appropriate disposition in a variety of settings Employ a safe and common sense approach to the treatment of severe hypertension in the clinic, the ER, or on the wards Be familiar with pharmacologic management of severe hypertension in a variety of settings Recognize the common causes of severe blood pressure elevation in the inpatient setting Counsel patients on the relationship of severe hypertension and headache Recall the natural history of untreated severe hypertension Disclosures: The Curbsiders report no relevant financial disclosures, but hope to become successful enough to display an absurd list of disclosures in the future. Time Stamps 0:00 Hook 0:26 Intro 1:38 Rapid fire questions 03:45 Triage of patient with severe HTN 05:05 Case example HTN in office 07:05 Does HTN cause a headache? 08:30 Workup of severe HTN in the office 10:20 Stuart discusses HTN and headaches 11:30 In office treatment of blood pressure 14:28 Recap 15:50 Stuart discuss HTN emergency at normal BP 17:00 Acute treatment of HTN in ER 18:10 Approach to the inpatient with HTN 20:50 Choice of agent for inpatient HTN 23:23 Italian study of HTN crisis in the ER 24:20 Outcomes in asymptomatic patients with severe HTN 26:15 Sleep apnea and HTN 27:10 Natural history of untreated severe HTN 29:10 Take home points 30:50 Outro Links from the show: Blood Meridian by Cormack McCarthy Horton Hears a Who by Dr. Seuss ASCVD risk calculator http://tools.acc.org/ASCVD-Risk-Estimator/ Epocrates. Download it here Dr. Johnson’s excellent review article on hypertensive crisis https://www.ncbi.nlm.nih.gov/pubmed/23102030 Another great review with tables on oral drug therapy and dosing for hypertensive crisis https://www.ncbi.nlm.nih.gov/pubmed/18710665 Fascinating article from 1928 on The Syndrome of Malignant Hypertension* http://archinte.jamanetwork.com/article.aspx?articleid=535650 Observational study from Italy characterizing symptoms and outcomes in hypertensive crisis https://www.ncbi.nlm.nih.gov/pubmed/8591878 JNC 7 recommendations for hypertensive crisis: See page 54 of this PDF for details http://www.nhlbi.nih.gov/files/docs/guidelines/express.pdf Most recent review we could find on hypertensive crisis https://www.ncbi.nlm.nih.gov/pubmed/25575271 Migraine and subsequent risk of stroke in the Physicians' Health Study. https://www.ncbi.nlm.nih.gov/pubmed/7848119 Blood pressure as a risk factor for headache and migraine: a prospective population-based study. https://www.ncbi.nlm.nih.gov/pubmed/25155744 Blood pressure and risk of headache: a prospective study of 22,685 adults in Norway. https://www.ncbi.nlm.nih.gov/pubmed/11909904
HH IZ DEAD #12 Dans ce HH iz Dead #12 , nous fêterons comme il se doit les 25 ans des JNCKingz , nous avons demandé à une série de membres des JNC ce que cet acronyme représentait pour eux mais aussi ce que ça leur faisait ce 25ème anniversaire et enfin leur sélection musicale qui incarne le mieux pour chacun le crew.Dans la deuxième partie de l’émission Aurélie Portois revient en détails sur le programme complet de ce mois d’anniversaire….Enjoy ! JNCKingz FB : https://www.facebook.com/JNCKINGZ HH iz Dead Archives : https://www.mixcloud.com/Kinglee Tracklisting HH IZ DEAD #12 : 1) Intro Style Wars 2) Drop by Henry Chalfant 3) The Warriors Theme 4) Drop by by Yelawolf Dj 5) Drop by Yelawolf 6) Black Star : Respiration 7) Intvw de Spyk 8) Beastie Boys : The New Style 9) Intvw de Lick 10) LL Cool J : Shot Ya 11) Zapp: So Ruff , so Tuff 12) Drop by Bouli 13) Intvw de Kaer 14) Intvw de Roger Mopar 15) Intvw de Jaba 16) Eric B. & Rakim : Follow The leader 17) Intvw de Miles 18) Kool Keith : Sex Style 19) Drop by Jazz Cartier 20) Intvw de 2 Shy 21) Lunatic : Le crime paie 22) Drop by Nathy 23) Intvw de Mon Colonel et Rai 24) King Crimson : Larks tongues in aspic 25) Mobb Deep : Shook Ones 26) The Subs vs Partyharders : Pope of Dope 27) Intvw de Mikos 28) Starflam : Mic Smokin 29) Intvw de Ben 30) Drop by Stromae 31) Shurik’n : les miens 32) Intvw de Them 33) Onyx : I’ll murder You 34) Drop by Sylvestre Defontaine 35) Intvw de Beurk 36) Jean-Pierre Mader : Macumba 37) Drop by Jean Jass & Dj Eskondo 38) Intvw d’Aurélie Portois 39) Drop by Dirty Cock 40) Drop by Goldo 41) Drop by Scred Connexion 42) Drop by Demi Portion 43) Drop by Dj Rolex 44) Outro
HH IZ DEAD #12Dans ce HH iz Dead #12 , nous fêterons comme il se doit les 25 ans des JNCKingz , nous avons demandé à une série de membres des JNC ce que cet acronyme représentait pour eux mais aussi ce que ça leur faisait ce 25ème anniversaire et enfin leur sélection musicale qui incarne le mieux pour chacun le crew.Dans la deuxième partie de l'émission Aurélie Portois revient en détails sur le programme complet de ce mois d'anniversaire….Enjoy !JNCKingz FB : https://www.facebook.com/JNCKINGZHH iz Dead Archives : https://www.mixcloud.com/KingleeTracklisting HH IZ DEAD #12 :1) Intro Style Wars2) Drop by Henry Chalfant3) The Warriors Theme4) Drop by by Yelawolf Dj5) Drop by Yelawolf6) Black Star : Respiration7) Intvw de Spyk8) Beastie Boys : The New Style9) Intvw de Lick10) LL Cool J : Shot Ya11) Zapp: So Ruff , so Tuff12) Drop by Bouli13) Intvw de Kaer14) Intvw de Roger Mopar15) Intvw de Jaba16) Eric B. & Rakim : Follow The leader17) Intvw de Miles18) Kool Keith : Sex Style 19) Drop by Jazz Cartier20) Intvw de 2 Shy21) Lunatic : Le crime paie22) Drop by Nathy23) Intvw de Mon Colonel et Rai24) King Crimson : Larks tongues in aspic25) Mobb Deep : Shook Ones26) The Subs vs Partyharders : Pope of Dope27) Intvw de Mikos28) Starflam : Mic Smokin29) Intvw de Ben30) Drop by Stromae31) Shurik'n : les miens32) Intvw de Them33) Onyx : I'll murder You34) Drop by Sylvestre Defontaine35) Intvw de Beurk36) Jean-Pierre Mader : Macumba37) Drop by Jean Jass & Dj Eskondo38) Intvw d'Aurélie Portois39) Drop by Dirty Cock40) Drop by Goldo41) Drop by Scred Connexion42) Drop by Demi Portion43) Drop by Dj Rolex44) Outro
Japanese Nostalgic Car’s Touge was born when JNC’s co-founder and editor-in-chief Ben Hsu was drinking some beers with rally-master Patrick Strong. They wondered why, with all the classic car rallys, there wasn’t one dedicated to classic Japanese steel.
The American Medical Association has issued new blood pressure guidelines through it’s Joint National Committee (JNC). The eighth edition (JNC 8) has important information for African-Americans since over forty percent of African Americans have high blood pressure according to Centers for Disease Control and Prevention (CDC). Learn more at https://jay-harold.com/african-american-high-blood-pressure-guidelines-2013/
HelixTalk - Rosalind Franklin University's College of Pharmacy Podcast
In this episode, we discuss the new JNC 8 guidelines and how these guidelines differ from other hypertension guidelines released in 2013-2014.
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