Podcasts about kim j

We all know about the medical school curriculum. But what about the hidden curriculum, or how students learn about the unspoken culture of medicine through everyday, informal interactions? In this episode, Dr. Sandra Quezada and Dr. Sarah Dubbs explore the hidden curriculum with some examples, chat about whether the hidden curriculum can be positive or negative, and offer guidance on how students can best navigate the hidden curriculum and thrive within it.   References: Lawrence C, Mhlaba T, Stewart KA, et al. The Hidden Curricula of Medical Education: A Scoping Review. Acad Med. 2018 Apr;93(4):648-656. PMID: 29116981. Bandini J, Mitchell C, Epstein-Peterson ZD, et al. Student and Faculty Reflections of the Hidden Curriculum. Am J Hosp Palliat Care. 2017 Feb;34(1):57-63. Epub 2016 Jul 11. PMID: 26566929. Martimianakis MA, Michalec B, Lam J, et al. Humanism, the Hidden Curriculum, and Educational Reform: A Scoping Review and Thematic Analysis. Acad Med. 2015 Nov;90(11 Suppl):S5-S13. PMID: 26505101. Hopkins L, Saciragic L, Kim J, Posner G. The Hidden Curriculum: Exposing the Unintended Lessons of Medical Education. Cureus. 2016 Oct 25;8(10):e845. PMID: 27909633 Kalter L. Navigating the Hidden Curriculum in Medical School. AAMC News. Published July 13, 2019. Accessed December 10, 2024. Link.  Freedman D. The Hidden Curriculum. NYU Langone Health Hub. Accessed December 10, 2024. Link.   

The AOFAS OrthoPodcast committee discuss how to avoid and manage complications of Total Ankle Arthroplasty. References cited in this discussion include: Anastasio AT, Kim BI, Wixted CM, et al. Younger Patients Undergoing Total Ankle Arthroplasty Experience Higher Complication Rates and Worse Functional Outcomes. JBJS Am. 2024. Henry JK, Teehan E, Deland J, et al. Lessons From Revision Total Ankle Replacement: Tibias Fail Earlier, and Taluses Fail Later (and Fail Again). Foot Ankle Int. 2024. Palma J, Shaffrey I, Kim J, et al. Postoperative Medial Malleolar Fractures in Total Ankle Replacement Are Associated With Decreased Medial Malleolar Width and Varus Malalignment. Foot Ankle Int. 2024. For additional educational resources, visit AOFAS.org

Putin potřebuje vojáky. Tak si plácl s Kim Čong-unem. A ten pomohl. Severokorejci už jsou v Rusku. Otázka zní, proč fasují ruské uniformy? A co za to KLDR bude chtít? Téma pro Vlastislava Břízu, bezpečnostního analytika z katedry mezinárodních vztahů Fakulty sociálních věd Univerzity Karlovy. Ptá se Matěj Skalický.

Putin potřebuje vojáky. Tak si plácl s Kim Čong-unem. A ten pomohl. Severokorejci už jsou v Rusku. Otázka zní, proč fasují ruské uniformy? A co za to KLDR bude chtít? Téma pro Vlastislava Břízu, bezpečnostního analytika z katedry mezinárodních vztahů Fakulty sociálních věd Univerzity Karlovy. Ptá se Matěj Skalický.Všechny díly podcastu Vinohradská 12 můžete pohodlně poslouchat v mobilní aplikaci mujRozhlas pro Android a iOS nebo na webu mujRozhlas.cz.

Putin potřebuje vojáky. Tak si plácl s Kim Čong-unem. A ten pomohl. Severokorejci už jsou v Rusku. Otázka zní, proč fasují ruské uniformy? A co za to KLDR bude chtít? Téma pro Vlastislava Břízu, bezpečnostního analytika z katedry mezinárodních vztahů Fakulty sociálních věd Univerzity Karlovy. Ptá se Matěj Skalický.

In this Complex Care Journal Club podcast episode, Dr. Renee Turchi discusses an intervention study to improve emergency preparedness for families with children and youth with special health care needs. She describes the multiple community partners involved in intervention development, key insights gained while conducting the study, and next steps from this work. SPEAKER Renee M. Turchi, MD, MPH, FAAP Professor and Chair of Pediatrics, Pediatrician in Chief St. Christopher's Hospital for Children HOST Emily Goodwin, MD Clinical Associate Professor of Pediatrics, University of Missouri Kansas City School of Medicine Pediatrician, General Academic Pediatrics Beacon Program, Children's Mercy Kansas City DATE Initial publication date: October 7, 2024. JOURNAL ARTICLE Griffin JS, Hipper TJ, Chernak E, Berhane Z, Davis RK, Popek L, Kurapati P, Kim J, Turchi RM. A Virtual Home Preparedness Intervention Centered on Children and Youth With Special Health Care Needs. Acad Pediatr. 2024 Jun 10:S1876-2859(24)00167-0. doi: 10.1016/j.acap.2024.06.002. Epub ahead of print. PMID: 38866363. https://www.academicpedsjnl.net/article/S1876-2859(24)00167-0/fulltext OTHER REFERENCES Hipper TJ, Davis R, Massey PM, Turchi RM, Lubell KM, Pechta LE, Rose DA, Wolkin A, Briseño L, Franks JL, Chernak E. The Disaster Information Needs of Families of Children with Special Healthcare Needs: A Scoping Review. Health Secur. 2018 May/Jun;16(3):178-192. doi: 10.1089/hs.2018.0007. Epub 2018 Jun 8. PMID: 29883200; PMCID: PMC11015856. https://pubmed.ncbi.nlm.nih.gov/29883200/ TRANSCRIPT https://op-docebo-images.s3.amazonaws.com/Transcripts/Preparing+for+Emergencies+Planning+and+Partnerships+with+Families_Turchi_100824.pdf Please visit: http://www.openpediatrics.org OPENPediatrics™ is an interactive digital learning platform for healthcare clinicians sponsored by Boston Children's Hospital and in collaboration with the World Federation of Pediatric Intensive and Critical Care Societies. It is designed to promote the exchange of knowledge between healthcare providers around the world caring for critically ill children in all resource settings. The content includes internationally recognized experts teaching the full range of topics on the care of critically ill children. All content is peer-reviewed and open access-and thus at no expense to the user.For further information on how to enroll, please email: openpediatrics@childrens.harvard.edu CITATION Turchi RM, Goodwin EJ. Preparing for Emergencies: Planning and Partnerships with Families. 10/2024. OPENPediatrics. Online Podcast. https://soundcloud.com/openpediatrics/preparing-for-emergencies-planning-and-partnerships-with-families.

Send us a Text Message.My sis helped me do a thing…a podcast in a cafe. As the title suggests…we're doing a podcast at a cafe. Yes, there is a bit of background noise, but this show came together. She will unpack the importance of structures & systems and our favorite book (refer to show notes). She will truly help you grow in ways like never before. No pun intended, but you will value this digital product/content source. PassTheMessage #ThePassBTPodMusic for Intro & Outro:Tanya ChinaLinks:Bagby Referral CodeBrick App 10% Off (promo Code BRYANBRICK)Ono Affiliate link (code BryanTaylor)Bullet Journal Link (10% Off with code BRYANBUJO)Flow Page Link (All podcast platforms)10% Discount from AnkerBlue Yeti XPeachie Clean RVA988 Suicide & Crisis Line Bryan's NewsletterRely on BOT, LLCAmazon Affiliate LinkYouTube Playlist for thePass PodcastExternal Links:Itskimcousins InstagramDigital Marketing WebsitePersonal Instagram pageThe Four Agreements (Amazon)Libby App for booksFive AlbumsMaxwell-Urban Hang SuiteSade-Love is Stronger Than PrideDwele-SubjectKanye West-Good Music Cruel Summer Jill Scott-Who Is Jill Scott

Andrew Schultz aka Mr. Goody Two Shoes and Joseph Huggins aka OldManHuggie Discuss Mr. Goody's Continued Ascension To New Heights In Poker, Creepy Teachers, Boeing Being Completely Corrupt, NASA's Rover Finds A New Boulder On The Surface Of Mars, Putin's Trip To North Korea, Matt Gaetz Finally Facing The House Ethics Committee Over Sex and Drug Allegations, A Team of British Parkour Dweebs Damaging a Historic Building In Italy, and Of Course As Always They Start With Therapy Questions (Provided Below, With Show Notes and Links) Music Provided By Trapboy Freddy. Therapy Questions: If you had to pick a form of execution what would it be and why? What do you think the biggest threat to our future is (human race) and why? Do we have an issue with creepy teachers in the US school system? You are able to save a family from a burning building or stop a murder in progress. Which do you choose and why? Topics: Boeing is a bad company: https://apple.news/ApA_Vc3LPTSWMyuDaRtbepw NASA rover discovers mysterious light-toned boulder "never observed before" on Mars: https://apple.news/AQ-tPjmq2RDCOzK0zPQZcxA Putin and Kim embrace in North Korea, vow new multi-polar world: https://apple.news/AVLjQLprzSu6L9D1Rnh5vVA Matt Gaetz Faces House Ethics Committee Probe Over Sex, Drug Allegations: https://apple.news/AC1ove5--TwWMNOjF7ihnrw Parkour group damages historic Italian building in failed stunt: https://apple.news/AgKY_rlF_R3mo4xrS6mB-EA

Gratitude wasn't always my thing. In fact, I used to roll my eyes when yoga teachers talked about gratitude. But life's twists and turns led me through some of my darkest moments, including divorce, a battle with breast cancer, and my father's terminal illness. It was during these tough times that I discovered the power of gratitude. When life takes a difficult turn, it's easy to dwell on the negatives, which only amplifies our stress and anxiety. But by finding even one small thing to be grateful for, we can shift our mood and perspective. Gratitude isn't about ignoring life's hardships; it's a tool for resilience and positivity in the face of adversity. In this episode, I'm diving into the science of gratitude to explain exactly what happens in our brains when we intentionally shift our focus off negative thoughts toward more positive ones, even if you have to fake it until you make it. Research reveals that when we express and genuinely feel gratitude, our brains respond by releasing feel-good chemicals, including serotonin, dopamine, and oxytocin. This chemical cocktail enhances our mood, nurtures optimism, and elevates our overall well-being. I talk about neuroplasticity, where our brains form new neural connections through repetition and positive emotions. Through regular gratitude practice, we can train our brains to embrace positive emotions and thoughts, gradually shifting away from negativity, fear, and anxiety. You really can change yourself from the inside, helping you to better manage stress and cultivate a brighter outlook on life. Remember, gratitude isn't just a mental exercise—it's a potent tool for rewiring our brains towards positivity.Toward the end of the episode, I invite you to join me for a guided meditation to help you cultivate thoughts and feelings of gratitude in your own life. I encourage you that with regular practice, gratitude has the power to completely transform your way of being. LINKS:Curious about Yoga Alchemy? Join the waitlist here to save $500 off the next round References:Emmons, R. A., & McCullough, M. E. (2003). Counting blessings versus burdens: An experimental investigation of gratitude and subjective well-being in daily life. Journal of Personality and Social Psychology, 84(2), 377.Emmons, R. A., & Shelton, C. M. (2002). Gratitude and the science of positive psychology. Handbook of positive psychology, 18, 459–471.Fox, G. R., Kaplan, J., Damasio, H., & Damasio, A. (2015). Neural correlates of gratitude. Frontiers in Psychology, 6, 1491. https://doi.org/10.3389/fpsyg.2015.01491Kyeong S, Kim J, Kim DJ, Kim HE, Kim JJ. (2017) Effects of gratitude meditation on neural network functional connectivity and brain-heart coupling. Sci Rep. 2017 Jul 11;7(1):5058. doi: 10.1038/s41598-017-05520-9. PMID: 28698643; PMCID: PMC5506019.Website:https://cultivatecalmyoga.com.au/Instagram:https://www.instagram.com/cultivatecalmyogabrisbane/

Kim, alias Kim J Lewin sur les réseaux sociaux, est une jeune femme de 24 ans qui nous livre son parcours commençant par le divorce de ses parents puis le décès de sa grand mère lorsqu'elle avait 10 ans. En découle des troubles du comportement alimentaire, dépressions, plusieurs tentatives de suicide, phoebie scolaire, des souffrances physiques et psychologiques très intense. À 14 ans elle a dû se faire poser un bypass gastrique pour pouvoir perdre du poids rapidement car sa vie était en jeu.  Elle a été hospitalisé 9 fois dans des hopitaux psychiatriques, a été addict au canabis et à l'alcool.  Son parcours scolaire n'a pas été facile car elle a été diagnostiqué jeune ayant un TDAH (Troubles du Déficit de L'attention avec ou sans Hyperactivité). Elle nous explique comment son traitement, la Ritaline lui a été bénéfique mais aussi déstructeur à la fois. Aujourd'hui Kim est influenceuse et véhicule des messages d'acception de soi, de santé santale, d'espoir et de courage sur les réseaux sociaux.  Vous pouvez la retrouver sur instagram @kimjlewin et sur Tiktok Kimjlewinn.

This episode talks about the toxicity and life's obstacles that we were spared of. We talk about life, relationships, finances, religion, and have a great time. Tune in to catch up on life's segments between Lady Vasiliki and Kim J!

Aujourd'hui dans un nouvel épisode avec Kim J Lewin on parle d'un sujet souvent mis de côté : Les troubles du comportement alimentaire.En as-tu déjà entendu parler ? Peut-être qu'une personne de ton entourage en souffre sans que tu le saches.Ils existent différents troubles du comportement alimentaire ; tu les connais surement sous les noms anorexie, boulimie, et hyperphagie.Ils peuvent se manifester sous différentes formes, la cause peut être un traumatisme, ton rapport avec ton corps qui est difficile.Tu ne gères pas ton anxiété, ton stress et tu manges tes émotions.Saches que tu n'es pas seul, crois-moi nous sommes beaucoup à en souffrir.Avec Kim on te parle de notre expérience vis à vis de ce sujet et on te donne des conseils pour t'en sortir.N'aies pas peur de demander de l'aide.Nous sommes là, Kim J Lewin parle de santé mentale sur son Instragram fonce sur son compte si tu te sens pas bien ( @Kimjlewin )Bonne écoute, Lison.Musique : Sandro Enciso Hébergé par Acast. Visitez acast.com/privacy pour plus d'informations.

Kim's story begins with a dysfunctional family in which there was verbal and physical abuse. With a family history rife with alcoholism, Kim's childhood solution to the domestic chaos was to run away from home multiple times, only to be found and returned to the maelstrom . When she finally found alcohol, the solutions to her problems were quickly expunged by a can of beer or bottle of hard liquor. Toss in street drugs and the die was cast for a future of alcoholism and drug addiction. As all aspects of Kim's life became ruled by the disease and she considered herself an alcoholic from the start. After a difficult time in high school and an alcohol soaked college experience, she continued heavy drinking and dangerous relationships well into her twenties. With the tenacity of an active drug user, Kim managed to keep her various jobs and functioned well-enough to support herself. But the disease eventually damaged all aspects of Kim's life. Finally, beaten down and ravaged by her 28 years of emotional, physical, and spiritual damage of drug and alcohol abuse, Kim found the doors of Alcoholics Anonymous.  Though it took a while for her to embrace the Program, Kim finally allowed herself to be surrounded by fellow AA members who offered her friendship and support.  The rest of her story is both inspiring and informative, and spoken from seven years of hard-won experience. I believe you will enjoy Kim's words of wisdom and invite you to get comfortable while you enjoy today's episode of AA Recovery Interviews with my friend and AA sister, Kim J. If you've enjoyed my AA Recovery Interviews series and my Big Book podcast, have a listen to Lost Stories of the Big Book, 30 Original Stories Missing from the 3rd and 4th Editions of Alcoholics Anonymous. It's an engaging audiobook I narrated to bring these stories to life for AA members who've never seen them. These timeless testimonials were originally cut to make room for newer stories in the 3rd and 4th Editions. But their vitally important messages of hope are as meaningful today as when they were first published. Many listeners will hear these stories for the first time. Lost Stories of the Big Book is available on Audible, Amazon, and iTunes. It's also available as a Kindle book and in Paperback from Amazon if you'd like to read along with the audio. Check out my Big Book Podcast, the complete unabridged audio version of the First and Second Editions of Alcoholics Anonymous. The Big Book Podcast is an engaging cover-to-cover, word-for-word reading of all 11 chapters and Personal Stories, many of which were left out of the Third and Fourth Editions. Follow us on Apple Podcasts or wherever you get your podcasts. Or listen on https://bigbookpodcast.com [Disclaimer: AA Recovery Interviews podcast strictly adheres to AA's 12 Traditions and all General Service Office guidelines for safe-guarding anonymity on-line. I pay all podcast production costs and no one receives financial gain from the show. AA Recovery Interviews and my guests do not speak for or represent AA at-large. This podcast is simply my way of giving back to AA that which has been so freely given to me. -Howard L.]

In this episode the Endocrine Surgery team at BTK goes over two cases to review the American Association of Endocrine Surgeons Guidelines for Adrenalectomy.  Dr. Michael Yeh is a Professor of Surgery at UCLA and serves as Section Chief of the UCLA Endocrine Surgery program which he established.  Dr. Masha Livhits is an Assistant Professor of Surgery at UCLA and works in the Endocrine Surgery Department Dr. James Wu is an Assistant Professor of Surgery at UCLA and works in the Endocrine Surgery Department  Dr. Na Eun Kim is an Endocrine Surgery Fellow at UCLA in his first year of fellowship Dr. Rivfka Shenoy is a PGY-5 General Surgery Resident at UCLA who has completed two years of research  Dr. Max Schumm is a PGY-5 General Surgery Resident at UCLA who has completed two years of research. He is a future endocrine surgeon.  Important Papers  Yip L, Duh QY, Wachtel H, Jimenez C, Sturgeon C, Lee C, Velázquez-Fernández D, Berber E, Hammer GD, Bancos I, Lee JA, Marko J, Morris-Wiseman LF, Hughes MS, Livhits MJ, Han MA, Smith PW, Wilhelm S, Asa SL, Fahey TJ 3rd, McKenzie TJ, Strong VE, Perrier ND. American Association of Endocrine Surgeons Guidelines for Adrenalectomy: Executive Summary. JAMA Surg. 2022 Oct 1;157(10):870-877. doi: 10.1001/jamasurg.2022.3544. PMID: 35976622; PMCID: PMC9386598. Schumm M, Hu MY, Sant V, Kim J, Tseng CH, Sanz J, Raman S, Yu R, Livhits M. Automated extraction of incidental adrenal nodules from electronic health records. Surgery. 2023 Jan;173(1):52-58. doi: 10.1016/j.surg.2022.07.028. Epub 2022 Oct 4. PMID: 36207197. M. Conall Dennedy, Anand K. Annamalai, Olivia Prankerd-Smith, Natalie Freeman, Kuhan Vengopal, Johann Graggaber, Olympia Koulouri, Andrew S. Powlson, Ashley Shaw, David J. Halsall, Mark Gurnell, Low DHEAS: A Sensitive and Specific Test for the Detection of Subclinical Hypercortisolism in Adrenal Incidentalomas, The Journal of Clinical Endocrinology & Metabolism, Volume 102, Issue 3, 1 March 2017, Pages 786–792, https://doi.org/10.1210/jc.2016-2718 Amar, L., Pacak, K., Steichen, O. et al. International consensus on initial screening and follow-up of asymptomatic SDHx mutation carriers. Nat Rev Endocrinol 17, 435–444 (2021). https://doi.org/10.1038/s41574-021-00492-3 **Fellowship application link: https://forms.gle/PiKM2MMQpE5jSAeW7 Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.   If you liked this episode, check out other endocrine episodes here: https://behindtheknife.org/podcast-category/endocrine/

Torsdag samles hele EU-Kommissionen i den ukrainske hovedstad, og dagen efter holder unionens to øverste chefer topmøde med præsident Zelenskyj. Men hvad kan og vil Europa levere? I ugens podcast fra Bruxelles advarer Kim Jørgensen, generaldirektør i Den Europæiske Investeringsbank, om at genopbygningen af Ukraine bør begynde allerede nu.Vært: Thomas Lauritzen, Europa-analytiker.Gæst: Rikke Albrechtsen, EU-redaktør. Interview: Kim Jørgensen, generaldirektør i Den Europæiske Investeringsbank (EIB) med ansvar for kontakten til EU's institutioner. Producer: Magnus Ebsen Bøgelund Pedersen, podcastassistent. Hosted on Acast. See acast.com/privacy for more information.

Both interviews in this episode are with presenters at the 2023 ASCO Gastrointestinal Cancers symposium. Dr. Myriam Chalabi (Netherlands Cancer Institute) discusses the TARZAN trial, which found that, in patients with rectal cancer, neoadjuvant radiotherapy followed by atezolizumab and bevacizumab resulted in an encouraging complete response rate. The findings of this phase 1 study demonstrate that total mesorectal excision may be prevented in a significant proportion of patients, increasing the chance for organ preservation and reducing the risk for long-term morbidity related to surgery. It is a small but very exciting study!But first, Dr. Laura Dawson (Princess Margaret Cancer Centre, Toronto, Canada) reviews her phase 3 study of single-dose radiotherapy to manage pain from hepatocellular carcinoma and liver metastases. The results of this trial delivered encouragingly good results, beyond even the palliative endpoint.  Enjoy listening!Additional reading:1.    Dawson LA, et al. Canadian Cancer Trials Group HE.1: A phase III study of palliative radiotherapy for symptomatic hepatocellular carcinoma and liver metastases. LBA492, Rapid Abstract Session B: Cancers of the Pancreas, Small Bowel, and Hepatobiliary Tract, ASCO-GI 2023, San Francisco, CA, USA, 19-21 January.2.    Soliman H, Ringash J, Jiang H, Singh K, Kim J, Dinniwell R, Brade A, Wong R, Brierley J, Cummings B, Zimmermann C, Dawson LA. Phase II trial of palliative radiotherapy for hepatocellular carcinoma and liver metastases. J Clin Oncol. 2013 Nov 1;31(31):3980-6.3.    Verschoor YL, et al. Radiotherapy, atezolizumab, and bevacizumab in rectal cancers with the aim of organ preservation: The TARZAN study. Poster Session C: Cancers of the Colon, Rectum, and Anus, Abstract 158, 2023 ASCO GI Cancers Symposium, San Francisco, CA, USA, 19-21 January.4.      Chalabi M. Defying all odds in MMR-deficient rectal cancers. Cancer Cell. 2022 Sep 12;40(9):914-916. Let us know what you thought of this week's episode on Twitter: @physicianswkly Want to share your medical expertise, research, or unique experience in medicine on the PW podcast? Email us at editorial@physweekly.com! Thanks for listening!

Kim J's (CA) 01 14 23 lead at MAWPM's "Saturday Night Live" meeting Learn more about Marijuana Anonymous MA Meetings by Phone Search for a MA Meeting Marijuana Anonymous Preamble Marijuana Anonymous is a fellowship of people who share our experience, strength, and hope with each other that we may solve our common problem and help others to recover from marijuana addiction. The only requirement for membership is a desire to stop using marijuana. There are no dues or fees for membership. We are self-supporting through our own contributions. MA is not affiliated with any religious or secular institution or organization and has no opinion on any outside controversies or causes. Our primary purpose is to stay free of marijuana and to help the marijuana addict who still suffers achieve the same freedom. We can do this by practicing our suggested Twelve Steps of recovery and by being guided as a group by our Twelve Traditions. Marijuana Anonymous uses the basic 12 Steps of Recovery founded by Alcoholics Anonymous, because it has been proven that the 12 Step Recovery program works! Who is a Marijuana Addict? We who are marijuana addicts know the answer to this question. Marijuana controls our lives! We lose interest in all else; our dreams go up in smoke. Ours is a progressive illness often leading us to addictions to other drugs, including alcohol. Our lives, our thinking, and our desires center around marijuana—scoring it, dealing it, and finding ways to stay high." Why Marijuana Anonymous? • Stop Smoking Weed • Quit Smoking Pot • Cannabis/THC Addiction For a copy of our basic text and 12 Step Workbook: Life with Hope

To barske nordlendinger med underhudsfettet i behold, snakker om ting de ikke turde å snakke om på bygda. I denne, så langt, siste bonusepisoden fra Tromsø, har Per fått besøk av selveste Kim Jøran Olsen. Harstads svar på Kjerstads Per Kjerstad. Kim har hatt et meget anstrengt og komplisert forhold til sin egen kropp. I denne episoden deler han modig, ærlig og åpent om sine erfaringer og utfordringer angående egen mentale og fysiske helse, hvordan det kanskje henger sammen, og hvor langt det gikk før han oppdaget det. Velkommen! Hosted on Acast. See acast.com/privacy for more information.

October is Sudden Infant Death Syndrome awareness month. Dr. Richard Goldstein, director of the Robert's Program on Sudden Unexplained Death in Pediatrics, provides an overview of Sudden Infant Death Syndrome (SIDS), including historical perspectives, definitions, current understanding of potential etiologies, and emerging research. Additionally, Dr. Goldstein offers practical tips for speaking with caregivers about SIDS. After this podcast, listeners will be able to: -Learn the historical background of Sudden Infant Death Syndrome (SIDS) -Describe key terminology regarding SIDS and Sudden Unexplained Death in Pediatrics -Identify some of the proposed mechanisms related to SIDS -Present practical advice for speaking with families and caregivers Publication date: October 21, 2022. Articles referenced: • Goldstein RD, Kinney HC, Guttmacher AE. Only Halfway There with Sudden Infant Death Syndrome. N Engl J Med. 2022;386(20):1873-1875. (0:44) • MacDorman MF, Rosenberg HM. Trends in infant mortality by cause of death and other characteristics, 1960-88. Vital Health Stat 20. 1993;(20):1-57. (2:40) • Mitchell EA, Thach BT, Thompson JMD, Williams S, for the New Zealand Cot Death Study. Changing Infants' Sleep Position Increases Risk of Sudden Infant Death Syndrome. Arch Pediatr Adolesc Med. 1999;153(11):1136–1141. (2:48) • Haynes RL, Frelinger AL 3rd, Giles EK, et al. High serum serotonin in sudden infant death syndrome. Proc Natl Acad Sci U S A. 2017;114(29):7695-7700. (17:20) • Kinney HC, Haynes RL, Armstrong DD, et. al. Abnormalities of the Hippocampus in Sudden and Unexpected Death in Early Life. In: Duncan JR, Byard RW, eds. SIDS Sudden Infant and Early Childhood Death: The Past, the Present and the Future. University of Adelaide Press; 2018. (19:09) • Koh HY, Haghighi A, Keywan C, et al. Genetic Determinants of Sudden Unexpected Death in Pediatrics. Genet Med. 2022;24(4):839-850. (22:50) • Miller MB, Huang AY, Kim J, et al. Somatic genomic changes in single Alzheimer's disease neurons. Nature. 2022;604(7907):714-722. (30:45) • Warland J, O'Leary J, McCutcheon H, Williamson V. Parenting paradox: parenting after infant loss. Midwifery. 2011;27(5):e163-e169. (36:10) • Kinney HC, Richerson GB, Dymecki SM, Darnall RA, Nattie EE. The brainstem and serotonin in the sudden infant death syndrome. Annu Rev Pathol. 2009;4:517-550. (42:01) Additional references: • Back to Sleep campaign: https://safetosleep.nichd.nih.gov/act... • https://www.childrenshospital.org/pro... • https://undiagnosed.hms.harvard.edu/ • https://www.broadinstitute.org/ • https://medicine.uiowa.edu/humangenet... • https://www.genomeweb.com/informatics... • https://med.nyu.edu/departments-insti... • https://www.australiangenomics.org.au.... • https://ojrd.biomedcentral.com/articles/10.1186/s13023-021-02089-5 Citation: Goldstein R, Daniel D, Wolbrink T. Sudden Infant Death Syndrome. 10/22. Online Podcast. OPENPediatrics. https://youtu.be/pu-gnSCHDhw. Please visit: www.openpediatrics.org OPENPediatrics™ is an interactive digital learning platform for healthcare clinicians sponsored by Boston Children's Hospital and in collaboration with the World Federation of Pediatric Intensive and Critical Care Societies. It is designed to promote the exchange of knowledge between healthcare providers around the world caring for critically ill children in all resource settings. The content includes internationally recognized experts teaching the full range of topics on the care of critically ill children. All content is peer-reviewed and open access-and thus at no expense to the user. For further information on how to enroll, please email: openpediatrics@childrens.harvard.edu

Dans ce 25ème épisode, Léa et Mathilde accueillent au micro du podcast Kim, @kimjlewin sur les réseaux sociaux. D'une adolescence compliquée à une acceptation de soi, Kim nous fait part de son parcours de vie. Bonne écoute !

In dieser Folge haben wir Kim als unseren Special Guest eingeladen. Sie war von 2018-2019 als Au Pair in Maryland und berichtet heute von ihrer genialen Zeit in den USA! Schnappt euch euren Kaffee und los gehts. Folgt uns auf Instagram unter @aupair.coffee Ihr möchtet 50€ auf die Programmgebühr bei AuPairCare sparen?

*The opinions are our own, and do not reflect the opinions of BSCOS, their working groups, committees or members.* Please follow BSCOS on twitter: @BSCOS_UK Hosts @AnishPSangh @AlpsKothari @Pranai_B Special Guest: Steve Cooke aka Captain CPIPS (@CPIP_uk @stevecookeortho) References Wagner P, Hägglund G. Hip development after surgery to prevent hip dislocation in cerebral palsy: a longitudinal register study of 252 children. Acta Orthop. 2022 Jan 3;93:45-50. PMID: 34662250 Minaie A, Gordon JE, Schoenecker P, Hosseinzadeh P. Failure of Hip Reconstruction in Children With Cerebral Palsy: What Are the Risk Factors? J Pediatr Orthop. 2022 Jan 1;42(1):e78-e82. PMID: 34657091. Laron D, Kelley J, Chidambaran V, McCarthy J. Fascia Iliaca Pain Block Results in Lower Overall Opioid Usage and Shorter Hospital Stays than Epidural Anesthesia After Hip Reconstruction in Children With Cerebral Palsy. J Pediatr Orthop. 2022 Feb 1;42(2):96-99. PMID: 34882587. Dala-Ali B, Donnan L, Masterton G, Briggs L, Kauiers C, O'Sullivan M, Calder P, Eastwood DM. Osteofibrous dysplasia of the tibia : the importance of deformity in surveillance. Bone Joint J. 2022 Feb;104-B(2):302-308. PMID: 35094574. Abdelazeem AH, Khedr AM, Scarlat MM. Orthopaedic training during COVID-19 pandemic: should action be taken? Int Orthop. 2022 Feb;46(2):159-164. PMID: 35031819 Coleman E, Arundel C, Clark L, Doherty L, Gillies K, Hewitt C, Innes K, Parker A, Torgerson D, Treweek S. Bah humbug! Association between sending Christmas cards to trial participants and trial retention: randomised study within a trial conducted simultaneously across eight host trials. BMJ. 2021 Dec 14;375:e067742. PMID: 34906985. Nickel AJ, Bretscher BS, Truong WH, Laine JC, Kharbanda AB. Novel Uses of Traditional Algorithms for Septic Arthritis. J Pediatr Orthop. 2022 Feb 1;42(2):e212-e217. PMID: 34995263. Gaulrapp H, Nührenbörger C. The Osgood-Schlatter disease: a large clinical series with evaluation of risk factors, natural course, and outcomes. Int Orthop. 2022 Feb;46(2):197-204. PMID: 34427770. Badawy MY, Afifi A, Shaker ES, Elbarbary H, Hegazy M, Mohamed MT, Arafa A. Is capsulorrhaphy a necessary step during open reduction of developmental dysplasia of the hip? A randomized controlled trial. Int Orthop. 2022 Mar;46(3):589-596. PMID: 34817631. Huhnstock S, Wiig O, Merckoll E, Svenningsen S, Terjesen T. The modified Stulberg classification is a strong predictor of the radiological outcome 20 years after the diagnosis of Perthes' disease. Bone Joint J. 2021 Dec;103-B(12):1815-1820. PMID: 34847712. Kim J, Kim K, Kwon M, Cho J, Seilern Und Aspang J. The association between foot alignment and the development of ingrown toenails: A case-control study in a young adult military population. Foot Ankle Surg. 2022 Jan;28(1):119-125. PMID: 33676822. BSCOS Podcast TEAM Host: Anish Sanghrajka, NNUH @AnishPSangh Co-Host: Alpesh Kothari, Oxford @AlpsKothari Producer: Pranai Buddhdev, Broomfield @Pranai_B Special Guest: Steve Cooke, Coventry @stevecookeortho

Global demand for micro-chips has exploded. Today a worldwide shortage of semi-conductors is disrupting supply-chains of everything from cars to smartphones to the gaming consoles that normally see a peak in sales this time of year. This comes at a time when Europe's share across the semi-conductor value chain has shrunk, leaving the EU dependent on chips from Asia. In addition, the havoc wreaked by COVID-19 on supply chains suggests that being dependent is being vulnerable, especially in a global environment characterised by trade wars and geopolitical power games. It is against this backdrop that European Commission president von der Leyen in September announced a European Chips Act to promote European chips production. Proponents say this will give Europe its security of supply. Opponents say it will fail to guarantee supply, whilst making us poorer and less productive in the process. This event features a panel of expert speakers to discuss these issues, including: Kim Jørgensen, Head of Cabinet of European Commission Vice-President for a Europe Fit for the Digital Age, Margrethe Vestager; Thomas Bustrup, Deputy Director General of the Confederation of Danish Industry; and Greg Slater, Director of Global Regulatory Affairs at Intel. Think Tank EUROPA in Denmark and the Institute of International and European Affairs (IIEA) in Ireland look forward to welcoming you to this event. This event is part of a project entitled Europe's Digital Future, which is exploring the topic of digital sovereignty in Europe. The project is coordinated by the IIEA and is supported by Google. About the Speakers: Kim Jørgensen, Head of Cabinet of European Commission vice-president for a Europe Fit for the Digital Age, Margrethe Vestager Thomas Bustrup, Deputy Director General of the Confederation of Danish Industry Greg Slater, Director of Global Regulatory Affairs at Intel  This expert panel will be moderated by Catharina Sørensen, Deputy Director of Think Tank EUROPA.

Kim Jøran Olsen er skuespiller og du kjenner han kanskje fra filmen «Den 12. mann».Verden raste sammen dagen han fikk en kommentar på brystene sine i svømmehallen. Hvorfor hadde han bryster? Det skulle jo ikke gutter ha?Kampen mot kroppen og brystene var i gang, og spiseforstyrrelsen fulgte han i årevis.Helt frem til en lege oppdaget noe som ingen andre leger tidligere hadde gjort.

Dr. Chris Coetzee leads an engaging discussion with Dr. Selene Parekh and Dr. Bryan Den Hartog about Total Ankle Replacement: the history, clinical experiences, and evolution to next generation devices featuring the Salto Talaris and Cadence Total Ankle Systems. Thanks to Smith and Nephew for sponsoring this episode. For more information visit: https://www.smith-nephew.com/professional For additional educational resources visit https://www.aofas.org/ Disclaimer: This presentation and the information contained herein was prepared by the presenter. The views and opinions expressed in this presentation are those of the presenter and do not reflect the position, opinion, or guidelines for clinical care of any other person, institution, scientific association, or product manufacturer. Smith & Nephew does not provide medical advice and is not responsible for the content or information provided through this presentation. It is the treating health care provider's responsibility to determine the best course of treatment for their patient based upon his professional medical judgment. This information may not be appropriate for all countries and/or jurisdictions. Smith+Nephew products may not be available or authorized for distribution in all markets. Please contact your Smith+Nephew representative if you have questions about the availability of Smith+Nephew products in your area. The presenters are paid consultants of Smith + Nephew. ◊Trademark of Smith & Nephew. All trademarks acknowledged ©2021 Smith & Nephew, Inc. 31543 V1 References: 1. Day J, Kim J, O'Malley MJ, et al. Radiographic and Clinical Outcomes of the Salto Talaris Total Ankle Arthroplasty. Foot & Ankle International. 2020;41(12):1519-1528 2. Nunley JA, Adams SB, Easley ME, DeOrio JK. Prospective Randomized Trial Comparing Mobile-Bearing and Fixed-Bearing Total Ankle Replacement. Foot & Ankle International. 2019;40(11):1239-1248. 3. Stewart MG, Green CL, Adams SB Jr, DeOrio JK, Easley ME, Nunley JA 2nd. Midterm Results of the Salto Talaris Total Ankle Arthroplasty. Foot Ankle Int. 2017 Nov;38(11):1215-1221. 4. Hofmann, Kurt J. MD1,a; Shabin, Zabrina M. MD2; Ferkel, Eric MD3; Jockel, Jeffrey MD4; Slovenkai, Mark P. MD1 Salto Talaris Total Ankle Arthroplasty, The Journal of Bone and Joint Surgery: December 21, 2016 - Volume 98 - Issue 24 - p 2036-2046

How do our fingerprint ridges optimize grip?  In this episode, I feature a paper by Yum and colleagues who demonstrated that optimizing grip requires managing the moisture levels in our finger pads. This is the mechanism through which we are able to perform many of our day-to-day activities like playing sports and even eating.   Full citation: Yum SM, Baek IK, Hong D, Kim J, Jung K, Kim S, Eom K, Jang J, Kim S, Sattorov M, Lee MG. Fingerprint ridges allow primates to regulate grip. Proceedings of the National Academy of Sciences. 2020 Dec 15;117(50):31665-73.

En 2018, l'obésité touchait près de 25 % des adultes québécois. Dans certains cas, la chirurgie bariatrique est une option de traitement indiquée, mais cette procédure n'est pas sans impact sur la pharmacocinétique des médicaments et l'absorption de certaines molécules. Pour répondre aux questions qu'un pharmacien pourrait se poser dans le suivi d'un patient ayant subi ce type de chirurgie, Trait pharmacien reçoit Isabelle Giroux, pharmacienne à l'Institut universitaire de cardiologie et de pneumologie de Québec. Références : 1. Application Bariatrique Québec (Android) : https://play.google.com/store/apps/details?id=ca.qc.iucpq.bariatrique_mobile&hl=en_US&gl=US 2. Application Bariatrique Québec (iOS) : https://apps.apple.com/ca/app/bariatrique-qu%C3%A9bec/id1531824809 3. Sjöström L, Narbro K, Sjöström CD, Karason K, Larsson B, Wedel H, et al. Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med. 2007 Aug 23;357(8):741-52. 4. Mechanick JI, Apovian C, Brethauer S, Garvey WT, Joffe AM, Kim J, et al. Clinical practice guidelines for the perioperative nutrition, metabolic, and nonsurgical support of patients undergoing bariatric procedures - 2019 update: cosponsored by American Association of Clinical Endocrinologists/American College of Endocrinology, The Obesity Society, American Society for Metabolic & Bariatric Surgery, Obesity Medicine Association, and American Society of Anesthesiologists. Surg Obes Relat Dis. 2020 Feb;16(2):175-247. 5. Parrott J, Frank L, Rabena R, Craggs-Dino L, Isom KA, Greiman L. American Society for Metabolic and Bariatric Surgery Integrated Health Nutritional Guidelines for the Surgical Weight Loss Patient 2016 Update: Micronutrients. Surg Obes Relat Dis. 2017 May;13(5):727-41.

”Implicit i diskussionerne om recovery ligger også en diskussion om definitioner af psykisk lidelse, ikke kun om disse er kroniske eller ej, men hvad de består af, og hvorvidt de bør forstås ud fra en psykiatrisk deficit-og sygdoms-model” (s.79, Recovery-orienteret praksisser) Recovery handler om at opbygge et meningsfuldt og tilfredsstillende liv, defineret af den pågældende person selv. Recovery repræsenterer en bevægelse bort fra patologi, sygdom og symptomer, i retning af sundhed, styrker og velbefindende s.213, Reovery-orierenteret praksisser) I denne her taler vi med forsker og redaktør på bogen, Recovery-orienterede praksisser, Kim Jørgensen om RECOVERY. VI taler endda om at recover begrebet recovery, da det også er et politiseret begreb. Recovery handler grundlæggende om at blive accepteret som en “hel person”, med både vanskeligheder og ressourcer Vi taler om: - Hvad det vil sige at komme sig - Hvordan Recovery begrebet udfordrer sundhedsprofessionelles traditionelle magtposition og definitionsret - Borger/patient autonomi til trods for skemabundne ufleksible indsatser - Dilemmaet i begrebet "sygdomsindsigt" - Hjælp der støtter personens aktive kontrol over sit liv - Selvstigmatisering - At gå fra perfekte løsninger til et mere realistisk håb for fremtiden - Når den der lider og den der hjælper begge har ret -i forskellige opfattelser - Opgør med paternalisme - Opgør med at man ikke må gøre sig afhængig af en professionel person - Forskellige situationer kræver forskellig hjælp, fx akut eller mere fremadskridende - Snævre mulighedsrum fx på sygehuset versus samtaler der ikke taler ind i den medicinske forståelse af problemet   TEASER her: https://youtu.be/JrhHO9ysSZ0   Mød Kim Jørgensen i denne oplysende og spændende samtale og find bogen her: https://samfundslitteratur.dk/bog/recovery-orienterede-praksisser Min hjemmeside her: https://www.mannahguldager.com/ Kh Mannah   

Kim nous parle de son combat contre l'obésité, sa dépression et son cheminement vers l'amour de soi.

Dr. Degenholtz interviewed Dr. Suzanne Meeks, Editor-in-Chief of The Gerontologist, about the recently published special collection of The Gerontologist, Gerontology in a Time of Pandemic (Part I in February 2021; and Part II in March 2021), that brings together fascinating papers on the COVID-19 pandemic.  The three articles published in Part I, which were highlighted in this episode, were: "National Profiles of Coronavirus Disease 2019 Mortality Risks by Age Structure and Preexisting Health Conditions" by A. M. Verdery, L. Newmyer, Wagner, and R. Margolis "'It's Pure Panic': The Portrayal of Residential Care in American Newspapers During COVID-19" by L. D. Allen and L. Ayalon "Social Isolation and Psychological Distress During the COVID-1 Pandemic: A Cross-National Analysis" by H. H. Kim & J. H. Jung In the final part of their conversation, the editors brief discussed Part II of the special collection. Check out the previous episode, COVID-19 and the Aging Prison Population with Dr. Stephanie Prost, which discusses the paper, "Prisons and COVID-19: A Desperate Call for Gerontological Expertise in Correctional Health Care", published in Part I of this special collection.

Welcome to this week's episode of Beauty News where we discuss new release and pre-release makeup and beauty products. Products mentioned listed below. This episode of Beauty News is sponsored by Panasonic & Function of Beauty. The Panasonic NA67 nanoe™ hair dryer is available now at Amazon: https://www.amazon.com/Panasonic-Oscillating-Quick-Dry-Attachment-EH-NA67-W/dp/B08RK2LHR6 Function of Beauty is a custom hair cleansing system. Visit http://www.functionofbeauty.com/beauty for 20% off your first order. This episode of Beauty News is dedicated to Kim J! Thank you for supporting Beauty News! Products mentioned (affiliate links marked *) Too Faced Teddy Bare collection https://go.magik.ly/ml/160wn/ * BH Cosmetics Flower Power collection https://go.magik.ly/ml/160wg/ * Buxom Plump Shot Lip Gloss https://go.magik.ly/ml/160wl/ * Chanel Coco Rouge Flash Lipsticks https://www.chanel.com/ * Charlotte Tilbury Kissing Lipstick in Nude Romance https://go.magik.ly/ml/160wk/ * Colourpop x Lizzie McGuire collection https://go.magik.ly/ml/160wp/ * Dior Rouge Dior Forever Liquid Lipsticks https://www.dior.com/  Dominique Cosmetics Now or Never collection https://dominiquecosmetics.com/  Holo Taco For Art's Sake collection https://www.holotaco.com/  Laneige Lip Treatment Balm https://go.magik.ly/ml/160wo/ * Lanolips 101 Ointment Watermelon https://lanolips.com/  MAC Love Me Liquid Lipstick https://www.maccosmetics.com/  Morphe x Avani collection https://www.morphe.com/  Nars Summer Solstice collection https://go.magik.ly/ml/160wr/ * Pat McGrath Sublime Perfection Under Eye Powder in Yellow https://go.magik.ly/ml/160wq/* Sol De Janeiro Bom Dia Bright https://soldejaneiro.com/  Trixi Cosmetics Back To The Fuchsia collection trixiecosmetics.com  Wayne Goss Radiance Boosting Face Palettes https://go.magik.ly/ml/160wt/ * Winky Lux PH Gloss https://go.magik.ly/ml/160wv/ * Jeffree Star Cosmetics Mascarahttps://jeffreestarcosmetics.com/  Learn more about your ad choices. Visit megaphone.fm/adchoices

We're back for Episode 48 In this episode Cody and Eric catch up on the news and discuss "6 Good "Christmas" Games".  We are doing news for the first monthly episode and then "catching up" later in the month.   Episode Guide --------------- Quick Questions 4:30 Patreon 14:33 News 29:42 Eric's Take - Memories! 1:35:25 Tea Time With Tim - Christmas 1986 - 1:53:37 6 Good Games - "Christmas!'"  2:15:38 News -    (Eric) Capcom releasing Mini-arcade system – Packed with Megaman and Street Fighter games - https://www.nintendolife.com/news/2020/11/capcoms_releasing_a_mini-arcade_system_packed_with_mega_man_and_street_fighter_games  (Cody) Evercade Worms Announced  (Cody) Cotton Reboot $100  https://www.nintendolife.com/news/2020/11/the_cotton_reboot_for_switch_sure_is_shaping_up_nicely  (Tim) Commodore 64 Mega Holiday Season bundle on itch.io. Hosted by the amazing folks at Badger Punch games who created Showdown, have collected together an amazing collection of games, some holiday related some just excellent games. They have also included a Holiday reskined version of Showdown called “Snowdown” along with Santon from Sarah Jane Avory, Grid Pix and Vegetables Deluxe, full list on the itch.io page. All this for $5 or more!  https://itch.io/b/699/c64-xmas-bundle  (Cody) Metal Slug 6 on Dreamcast https://www.retrorgb.com/metal-slug-6-first-atomiswave-arcade-native-port-to-dreamcast.html  (Eric) ZX Spectrum alternate Arcade Game Designer ROM - https://hackaday.io/project/176017-zx-spectrum-rom-arcade-game-designer  (Cody) Stern Star Wars Comic for “The Home”  (Eric) Scourge of the Underkind (Amiga) - Exclusive video tease of this fantastic Chaos Engine inspired shooter! - http://www.indieretronews.com/2020/12/scourge-of-underkind-amiga-exclusive.html  (Cody) NES Space Station Tracker – and Fujinet Weather App ? (Eric) Mention Fujinet Voting App  https://www.nintendolife.com/news/2020/09/random_someones_made_a_nes_game_that_can_track_the_international_space_station  (Tim) New from The Future Was 8 Bit – A version of the Kung Fu Flash Commodore 64 cartridge expansion created by Kim Jørgensen. Nic from TFW8B has taken the base Open Source GIT and refined the usual TFW8B way. This amazing device not only allows you to load PRG and single disk image files through the cartridge slot via a Micro SD Slot, it also allows you to mount Cartridge images (CRT files). So you can run games and also cartridge images like the Easy Flash, Action Replay and Epyx Fastload. Priced at a mere £45. More details on The Future Was 8 Bit Website  https://www.thefuturewas8bit.com/kung-fu-flash.html  (Cody) Arcade 1up Infinity Game Table https://arcade1up.com/products/infinity-game-table  (Tim) Ultiamte 64 new firmware update available. V1.37 Now with exFAT support, Restructure Menu on F5 key, Addition of Alalog modes PAL64 and NTSC50 to name but a few, full list and firmware download on Gideons site at:  https://ultimate64.com/firmware  (Cody) R-Type Final 2 release on Switch  (Cody) Another Mini? Capcoms newest release.  https://www.nintendolife.com/news/2020/11/capcoms_releasing_a_mini-arcade_system_packed_with_mega_man_and_street_fighter_games  (Tim) - Cheesy Trials by Hewco for the expanded VIC20. Amazing new game from Hewco. Save Echo the mouse and guide him through 36 fiendishly designed rooms, puzzle platformer with high res graphics and great sound on the VIC20. Hewco pushing the VIC20 again to the max. This is their entry in to the Winter THEC64/VIC20 competition so it runs on the “THEC64 Maxi and VIC20” remake by Retro Games Ltd. Also on a real VIC20!  https://twitter.com/Hewco64/status/1337565187059101697?s=20  (Cody) v6 Megaman 8-bit DeathMatch https://cutstuff.net/mm8bdm/  (Tim) Soul Force – Now ready for pre-order on the Protovision website   https://www.protovision.games/shop/product_info.php?products_id=302  (Cody) BOTW DLC allows you to see where you have been on the map.  (Tim) Protopad – Also from Protovision an new 8 button Joypad friendly to 8bit and 16bit systems, also talk of paddles and a new Joystick, all based on Donations to fund the project.  https://www.protovision.games/shop/protopad/protopad.php?language=en  (Cody) Warrior 64 https://retrododo.com/warrior-64/  (Tim) M0DE from Terraonion – Gets new Firmware (1.04 R2) and will now support Playstation 1 with the PSX accessory kit, orders before the end of December for a M0DE will get the kit free.  (Cody) Game Gear Micro Started to ship......hoooray.  (Cody) DragonBourne GB game pre orders available  https://www.nintendolife.com/news/2020/10/2020_isnt_all_bad_because_the_game_boy_is_getting_a_brand-new_rpg_called_dragonborne  (Cody) And a new GBC RPG as well - Coria and the Sunken City – wonder boy and y’s inspired https://www.nintendolife.com/news/2020/11/the_game_boy_is_getting_a_new_wonder_boy_and_ys-inspired_adventure  (Eric) New Nintendo Switch Firmware 11.0.0  https://t.co/A894RCMh9y?amp=1   (Cody) Super nintendo World officially to open in Japan Feb 4 2021.  https://www.theverge.com/2020/11/30/21726093/super-nintendo-world-osaka-japan-opening-date-announced  (Cody) Perfct Dark Announced  https://www.eurogamer.net/articles/2020-12-11-perfect-dark-reboot-announced  (C0dy) New switch Ghosts and Goblins https://www.nintendolife.com/news/2020/12/capcom_reveals_ghost_ln_goblins_resurrection_launches_on_nintendo_switch_in_february_2021  (Dustin Newel ) Nov 22, 2005 Xbox 360 released  (Cody) Retro Gaming Bygones – Gal “eh” ga  Mix between Flacks Storytelling and Us.  Please give us a review on Apple Podcasts! Thanks for listening! You can always reach us at podcast@pixelgaiden.com. Send us an email if we missed anything in the show notes you need. You can now support us on Patreon.  Thank you to Tim Drew, Henrik Ladefoged, Jim Tessier, Roy Fielding, Garry Heather, Matthew Ackerman, Josh Malone, Daniel James, 10MARC, Eric Sandgren, David Motowylak, Team Gray All The Way, Maciej Sosnowski, Paradroyd, RAM OK ROM OK, Mitsoyama, and Dustin Newell for making this show possible through their generous donation to the show.

FDA 批准颈动脉窦压力反射刺激疗法治疗心衰Lancet 血ACE2水平与心血管疾病及死亡的关系Science子刊 一种具有几何适应性的人工心脏瓣膜BAROSTIM NEO系统BAROSTIM NEO系统包括一个植入式脉冲发生器（IPG）、一个颈动脉窦含铅套件和一个程序。医生将BAROSTIM NEO脉冲发生器植入晚期心力衰竭患者的左或右锁骨下方，并在患者的左或右颈动脉窦处放置颈动脉窦导线，然后将脉冲发生器连接到颈动脉窦导线上。医生根据病人的个人需求制定脉冲发生器程序，然后向颈动脉的压力感受器传递电脉冲。压力反射激活（BAT）疗法的目的是激活颈动脉壁的压力感受器，刺激自主神经系统的传入和传出神经，大脑接收到神经信号作出相应反应：松弛血管、降低心率、并通过改善肾功能来减少液体储留。2019年8月，FDA批准BAROSTIM NEO系统用于药物治疗无效的、不符合心脏再同步化治疗适应症的、难治性心力衰竭患者。《BeAT-HF研究：这项研究证明了压力反射刺激疗法（BAT）对射血分数降低的心力衰竭患者的安全性和有效性》Journal of American College of Cardiology，2020年7月 (1) BeAT-HF研究是一项多中心、前瞻性、随机对照研究，纳入408名射血分数降低的心力衰竭（HFrEF）患者中，入组要求：纽约心功能分级II-III级、射血分数≤35%、药物治疗方案稳定≥4周、不符合心脏再同步化治疗的I类指征。这篇报告重点汇报了D队列中、NT-proBNP

FDA 批准颈动脉窦压力反射刺激疗法治疗心衰Lancet 血ACE2水平与心血管疾病及死亡的关系Science子刊 一种具有几何适应性的人工心脏瓣膜BAROSTIM NEO系统BAROSTIM NEO系统包括一个植入式脉冲发生器（IPG）、一个颈动脉窦含铅套件和一个程序。医生将BAROSTIM NEO脉冲发生器植入晚期心力衰竭患者的左或右锁骨下方，并在患者的左或右颈动脉窦处放置颈动脉窦导线，然后将脉冲发生器连接到颈动脉窦导线上。医生根据病人的个人需求制定脉冲发生器程序，然后向颈动脉的压力感受器传递电脉冲。压力反射激活（BAT）疗法的目的是激活颈动脉壁的压力感受器，刺激自主神经系统的传入和传出神经，大脑接收到神经信号作出相应反应：松弛血管、降低心率、并通过改善肾功能来减少液体储留。2019年8月，FDA批准BAROSTIM NEO系统用于药物治疗无效的、不符合心脏再同步化治疗适应症的、难治性心力衰竭患者。《BeAT-HF研究：这项研究证明了压力反射刺激疗法（BAT）对射血分数降低的心力衰竭患者的安全性和有效性》Journal of American College of Cardiology，2020年7月 (1) BeAT-HF研究是一项多中心、前瞻性、随机对照研究，纳入408名射血分数降低的心力衰竭（HFrEF）患者中，入组要求：纽约心功能分级II-III级、射血分数≤35%、药物治疗方案稳定≥4周、不符合心脏再同步化治疗的I类指征。这篇报告重点汇报了D队列中、NT-proBNP

FDA 塞帕替尼治疗RET基因突变的甲状腺癌的新药JAMA 成人减肥手术的好处和风险Science Advance 可测定皮质醇的隐形眼镜塞帕替尼（selpercatinib）第22期，呼吸科星期二介绍了RET选择性抑制剂塞帕替尼（selpercatinib）被批准用于治疗RET融合阳性非小细胞肺癌的最新研究。甲状腺髓样癌中，约有70%存在RET突变，2020年5月，塞帕替尼（selpercatinib）同时被FDA批准用于治疗RET驱动的甲状腺癌。《LIBRETTO-001研究：塞帕替尼对RET驱动的甲状腺癌的疗效的1/2期临床研究》New England Journal of Medicine，2020年8月 (1)研究纳入了RET突变型甲状腺髓性癌患者，接受塞帕替尼治疗，其中一部分患者曾接受过凡德他尼（vandetanib）或卡博替尼（cabozantinib）治疗的。在RET突变型甲状腺髓样癌患者中，曾接受凡德他尼和/或卡博替尼治疗的55名参与者中，缓解率为69%，1年无进展率为82%。未接受过凡德他尼和/或卡博替尼治疗的88名参与者中，缓解率73%，1年无进展率为92%。最常见的严重不良事件是高血压、转氨酶升高、低钠血症和腹泻。结论：在RET基因突变的甲状腺癌髓性患者中，塞帕替尼表现出持久的疗效。肥胖肥胖是一种疾病，会显著增加死亡率和诸多健康风险，包括2型糖尿病、高血压、血脂异常和冠心病，肥胖者应减重。25kg/m2≤BMI

FDA 塞帕替尼治疗RET基因突变的甲状腺癌的新药JAMA 成人减肥手术的好处和风险Science Advance 可测定皮质醇的隐形眼镜塞帕替尼（selpercatinib）第22期，呼吸科星期二介绍了RET选择性抑制剂塞帕替尼（selpercatinib）被批准用于治疗RET融合阳性非小细胞肺癌的最新研究。甲状腺髓样癌中，约有70%存在RET突变，2020年5月，塞帕替尼（selpercatinib）同时被FDA批准用于治疗RET驱动的甲状腺癌。《LIBRETTO-001研究：塞帕替尼对RET驱动的甲状腺癌的疗效的1/2期临床研究》New England Journal of Medicine，2020年8月 (1)研究纳入了RET突变型甲状腺髓性癌患者，接受塞帕替尼治疗，其中一部分患者曾接受过凡德他尼（vandetanib）或卡博替尼（cabozantinib）治疗的。在RET突变型甲状腺髓样癌患者中，曾接受凡德他尼和/或卡博替尼治疗的55名参与者中，缓解率为69%，1年无进展率为82%。未接受过凡德他尼和/或卡博替尼治疗的88名参与者中，缓解率73%，1年无进展率为92%。最常见的严重不良事件是高血压、转氨酶升高、低钠血症和腹泻。结论：在RET基因突变的甲状腺癌髓性患者中，塞帕替尼表现出持久的疗效。肥胖肥胖是一种疾病，会显著增加死亡率和诸多健康风险，包括2型糖尿病、高血压、血脂异常和冠心病，肥胖者应减重。25kg/m2≤BMI

Lady Vasiliki and Kim J. go into a conversation about things that they would reset to make up a better them! Whether it may be companionship, finances, friends, presidents, and even age! No worries, because they fill you in on the why's.. stay tuned

This episode includes:-Rheuminders from the previous episode on IgG4-RD classification criteria-Primer on relapsing polychondritis-Discussion of a new paper (see below) describing 3 clinical subtypes of relapsing polychondritisReference: Ferrada M, Rimland CA, Quinn K, Sikora K, Kim J, Allen C, Sirajuddin A, Goodspeed W, Chen M, Grayson PC. Defining Clinical Subgroups in Relapsing Polychondritis: A Prospective Observational Cohort Study. Arthritis Rheumatol. 2020 Apr 6. doi: 10.1002/art.41270. Epub ahead of print. PMID: 32249511.Intro and Outro music: Cheery Monday by Kevin MacLeodLink: https://incompetech.filmmusic.io/song/3495-cheery-mondayLicense: http://creativecommons.org/licenses/by/4.0/

References 1. Ota Y, Connolly M, Srinivasan A, Kim J, Capizzano AA, Moritani T. Mechanisms and Origins of Spinal Pain: from Molecules to Anatomy, with Diagnostic Clues and Imaging Findings. Radiographics. 2020;40(4):1163-81.2. Lotz JC, Haughton V, Boden SD, An HS, Kang JD, Masuda K, et al. New treatments and imaging strategies in degenerative disease of the intervertebral disks. Radiology. 2012;264(1):6-19.3. Theodorou DJ, Theodorou SJ, Kakitsubata S, Nabeshima K, Kakitsubata Y. Abnormal Conditions of the Diskovertebral Segment: MRI With Anatomic-Pathologic Correlation. AJR Am J Roentgenol. 2020;214(4):853-61.4. HS K. Lumbar Degenerative Disease Part 1: Anatomy and Pathophysiology of Intervertebral Discogenic Pain and Radiofrequency Ablation of Basivertebral and Sinuvertebral Nerve Treatment for Chronic Discogenic Back Pain: A Prospective Case Series and Review of Literature. Int J Mol Sci. 2020;21:1483.5. Hughes RJ, Saifuddin A. Numbering of lumbosacral transitional vertebrae on MRI: role of the iliolumbar ligaments. AJR Am J Roentgenol. 2006;187(1):W59-65.6. K C. A Concise Introduction to the Imaging of the Lumbar Spine2016.7. Fardon DF, Williams AL, Dohring EJ, Murtagh FR, Gabriel Rothman SL, Sze GK. Lumbar disc nomenclature: version 2.0: Recommendations of the combined task forces of the North American Spine Society, the American Society of Spine Radiology and the American Society of Neuroradiology. Spine J. 2014;14(11):2525-45.8. Kushchayev SV, Glushko T, Jarraya M, Schuleri KH, Preul MC, Brooks ML, et al. ABCs of the degenerative spine. Insights Imaging. 2018;9(2):253-74.9. Pfirrmann CW, Metzdorf A, Zanetti M, Hodler J, Boos N. Magnetic resonance classification of lumbar intervertebral disc degeneration. Spine (Phila Pa 1976). 2001;26(17):1873-8.10. M B. MRI Degenerative Disease of the Lumbar Spine. J Am Osteopath Coll Radiol. 2018.11. Yu LP, Qian WW, Yin GY, Ren YX, Hu ZY. MRI assessment of lumbar intervertebral disc degeneration with lumbar degenerative disease using the Pfirrmann grading systems. PLoS One. 2012;7(12):e48074.12. KS T. Imaging of Spinal Stenosis. Applied Radiology. 2017.13. Carlson BB, Albert TJ. Lumbar disc herniation: what has the Spine Patient Outcomes Research Trial taught us? Int Orthop. 2019;43(4):853-9.14. Pfirrmann CW, Dora C, Schmid MR, Zanetti M, Hodler J, Boos N. MR image-based grading of lumbar nerve root compromise due to disk herniation: reliability study with surgical correlation. Radiology. 2004;230(2):583-8.15. Gallucci M, Puglielli E, Splendiani A, Pistoia F, Spacca G. Degenerative disorders of the spine. Eur Radiol. 2005;15(3):591-8.16. Mamisch N, Brumann M, Hodler J, Held U, Brunner F, Steurer J, et al. Radiologic criteria for the diagnosis of spinal stenosis: results of a Delphi survey. Radiology. 2012;264(1):174-9.17. N H. The "ABCDE" Approach to the Systematic Assessment of Lumbar Spine MR Examination. CDR. 2020.18. Zileli M, Crostelli M, Grimaldi M, Mazza O, Anania C, Fornari M, et al. Natural Course and Diagnosis of Lumbar Spinal Stenosis: WFNS Spine Committee Recommendations. World Neurosurg X. 2020;7:100073.19. Cho IY, Park SY, Park JH, Suh SW, Lee SH. MRI findings of lumbar spine instability in degenerative spondylolisthesis. J Orthop Surg (Hong Kong). 2017;25(2):2309499017718907.20. Semaan H, Curnutte B, Cooper M, Obri J, Elsamaloty M, Obri T, et al. Overreporting of the disc herniation in lumbar spine MRI scans performed for patients with spondylolisthesis. Acta Radiol. 2020:284185120925483.21. GC G. Lumbar Spine Imaging: MRI. 2017.

References 1. Ota Y, Connolly M, Srinivasan A, Kim J, Capizzano AA, Moritani T. Mechanisms and Origins of Spinal Pain: from Molecules to Anatomy, with Diagnostic Clues and Imaging Findings. Radiographics. 2020;40(4):1163-81.2. Lotz JC, Haughton V, Boden SD, An HS, Kang JD, Masuda K, et al. New treatments and imaging strategies in degenerative disease of the intervertebral disks. Radiology. 2012;264(1):6-19.3. Theodorou DJ, Theodorou SJ, Kakitsubata S, Nabeshima K, Kakitsubata Y. Abnormal Conditions of the Diskovertebral Segment: MRI With Anatomic-Pathologic Correlation. AJR Am J Roentgenol. 2020;214(4):853-61.4. HS K. Lumbar Degenerative Disease Part 1: Anatomy and Pathophysiology of Intervertebral Discogenic Pain and Radiofrequency Ablation of Basivertebral and Sinuvertebral Nerve Treatment for Chronic Discogenic Back Pain: A Prospective Case Series and Review of Literature. Int J Mol Sci. 2020;21:1483.5. Hughes RJ, Saifuddin A. Numbering of lumbosacral transitional vertebrae on MRI: role of the iliolumbar ligaments. AJR Am J Roentgenol. 2006;187(1):W59-65.6. K C. A Concise Introduction to the Imaging of the Lumbar Spine2016.7. Fardon DF, Williams AL, Dohring EJ, Murtagh FR, Gabriel Rothman SL, Sze GK. Lumbar disc nomenclature: version 2.0: Recommendations of the combined task forces of the North American Spine Society, the American Society of Spine Radiology and the American Society of Neuroradiology. Spine J. 2014;14(11):2525-45.8. Kushchayev SV, Glushko T, Jarraya M, Schuleri KH, Preul MC, Brooks ML, et al. ABCs of the degenerative spine. Insights Imaging. 2018;9(2):253-74.9. Pfirrmann CW, Metzdorf A, Zanetti M, Hodler J, Boos N. Magnetic resonance classification of lumbar intervertebral disc degeneration. Spine (Phila Pa 1976). 2001;26(17):1873-8.10. M B. MRI Degenerative Disease of the Lumbar Spine. J Am Osteopath Coll Radiol. 2018.11. Yu LP, Qian WW, Yin GY, Ren YX, Hu ZY. MRI assessment of lumbar intervertebral disc degeneration with lumbar degenerative disease using the Pfirrmann grading systems. PLoS One. 2012;7(12):e48074.12. KS T. Imaging of Spinal Stenosis. Applied Radiology. 2017.13. Carlson BB, Albert TJ. Lumbar disc herniation: what has the Spine Patient Outcomes Research Trial taught us? Int Orthop. 2019;43(4):853-9.14. Pfirrmann CW, Dora C, Schmid MR, Zanetti M, Hodler J, Boos N. MR image-based grading of lumbar nerve root compromise due to disk herniation: reliability study with surgical correlation. Radiology. 2004;230(2):583-8.15. Gallucci M, Puglielli E, Splendiani A, Pistoia F, Spacca G. Degenerative disorders of the spine. Eur Radiol. 2005;15(3):591-8.16. Mamisch N, Brumann M, Hodler J, Held U, Brunner F, Steurer J, et al. Radiologic criteria for the diagnosis of spinal stenosis: results of a Delphi survey. Radiology. 2012;264(1):174-9.17. N H. The "ABCDE" Approach to the Systematic Assessment of Lumbar Spine MR Examination. CDR. 2020.18. Zileli M, Crostelli M, Grimaldi M, Mazza O, Anania C, Fornari M, et al. Natural Course and Diagnosis of Lumbar Spinal Stenosis: WFNS Spine Committee Recommendations. World Neurosurg X. 2020;7:100073.19. Cho IY, Park SY, Park JH, Suh SW, Lee SH. MRI findings of lumbar spine instability in degenerative spondylolisthesis. J Orthop Surg (Hong Kong). 2017;25(2):2309499017718907.20. Semaan H, Curnutte B, Cooper M, Obri J, Elsamaloty M, Obri T, et al. Overreporting of the disc herniation in lumbar spine MRI scans performed for patients with spondylolisthesis. Acta Radiol. 2020:284185120925483.21. GC G. Lumbar Spine Imaging: MRI. 2017.

References 1. Ota Y, Connolly M, Srinivasan A, Kim J, Capizzano AA, Moritani T. Mechanisms and Origins of Spinal Pain: from Molecules to Anatomy, with Diagnostic Clues and Imaging Findings. Radiographics. 2020;40(4):1163-81.2. Lotz JC, Haughton V, Boden SD, An HS, Kang JD, Masuda K, et al. New treatments and imaging strategies in degenerative disease of the intervertebral disks. Radiology. 2012;264(1):6-19.3. Theodorou DJ, Theodorou SJ, Kakitsubata S, Nabeshima K, Kakitsubata Y. Abnormal Conditions of the Diskovertebral Segment: MRI With Anatomic-Pathologic Correlation. AJR Am J Roentgenol. 2020;214(4):853-61.4. HS K. Lumbar Degenerative Disease Part 1: Anatomy and Pathophysiology of Intervertebral Discogenic Pain and Radiofrequency Ablation of Basivertebral and Sinuvertebral Nerve Treatment for Chronic Discogenic Back Pain: A Prospective Case Series and Review of Literature. Int J Mol Sci. 2020;21:1483.5. Hughes RJ, Saifuddin A. Numbering of lumbosacral transitional vertebrae on MRI: role of the iliolumbar ligaments. AJR Am J Roentgenol. 2006;187(1):W59-65.6. K C. A Concise Introduction to the Imaging of the Lumbar Spine2016.7. Fardon DF, Williams AL, Dohring EJ, Murtagh FR, Gabriel Rothman SL, Sze GK. Lumbar disc nomenclature: version 2.0: Recommendations of the combined task forces of the North American Spine Society, the American Society of Spine Radiology and the American Society of Neuroradiology. Spine J. 2014;14(11):2525-45.8. Kushchayev SV, Glushko T, Jarraya M, Schuleri KH, Preul MC, Brooks ML, et al. ABCs of the degenerative spine. Insights Imaging. 2018;9(2):253-74.9. Pfirrmann CW, Metzdorf A, Zanetti M, Hodler J, Boos N. Magnetic resonance classification of lumbar intervertebral disc degeneration. Spine (Phila Pa 1976). 2001;26(17):1873-8.10. M B. MRI Degenerative Disease of the Lumbar Spine. J Am Osteopath Coll Radiol. 2018.11. Yu LP, Qian WW, Yin GY, Ren YX, Hu ZY. MRI assessment of lumbar intervertebral disc degeneration with lumbar degenerative disease using the Pfirrmann grading systems. PLoS One. 2012;7(12):e48074.12. KS T. Imaging of Spinal Stenosis. Applied Radiology. 2017.13. Carlson BB, Albert TJ. Lumbar disc herniation: what has the Spine Patient Outcomes Research Trial taught us? Int Orthop. 2019;43(4):853-9.14. Pfirrmann CW, Dora C, Schmid MR, Zanetti M, Hodler J, Boos N. MR image-based grading of lumbar nerve root compromise due to disk herniation: reliability study with surgical correlation. Radiology. 2004;230(2):583-8.15. Gallucci M, Puglielli E, Splendiani A, Pistoia F, Spacca G. Degenerative disorders of the spine. Eur Radiol. 2005;15(3):591-8.16. Mamisch N, Brumann M, Hodler J, Held U, Brunner F, Steurer J, et al. Radiologic criteria for the diagnosis of spinal stenosis: results of a Delphi survey. Radiology. 2012;264(1):174-9.17. N H. The "ABCDE" Approach to the Systematic Assessment of Lumbar Spine MR Examination. CDR. 2020.18. Zileli M, Crostelli M, Grimaldi M, Mazza O, Anania C, Fornari M, et al. Natural Course and Diagnosis of Lumbar Spinal Stenosis: WFNS Spine Committee Recommendations. World Neurosurg X. 2020;7:100073.19. Cho IY, Park SY, Park JH, Suh SW, Lee SH. MRI findings of lumbar spine instability in degenerative spondylolisthesis. J Orthop Surg (Hong Kong). 2017;25(2):2309499017718907.20. Semaan H, Curnutte B, Cooper M, Obri J, Elsamaloty M, Obri T, et al. Overreporting of the disc herniation in lumbar spine MRI scans performed for patients with spondylolisthesis. Acta Radiol. 2020:284185120925483.21. GC G. Lumbar Spine Imaging: MRI. 2017.

References 1. Ota Y, Connolly M, Srinivasan A, Kim J, Capizzano AA, Moritani T. Mechanisms and Origins of Spinal Pain: from Molecules to Anatomy, with Diagnostic Clues and Imaging Findings. Radiographics. 2020;40(4):1163-81.2. Lotz JC, Haughton V, Boden SD, An HS, Kang JD, Masuda K, et al. New treatments and imaging strategies in degenerative disease of the intervertebral disks. Radiology. 2012;264(1):6-19.3. Theodorou DJ, Theodorou SJ, Kakitsubata S, Nabeshima K, Kakitsubata Y. Abnormal Conditions of the Diskovertebral Segment: MRI With Anatomic-Pathologic Correlation. AJR Am J Roentgenol. 2020;214(4):853-61.4. HS K. Lumbar Degenerative Disease Part 1: Anatomy and Pathophysiology of Intervertebral Discogenic Pain and Radiofrequency Ablation of Basivertebral and Sinuvertebral Nerve Treatment for Chronic Discogenic Back Pain: A Prospective Case Series and Review of Literature. Int J Mol Sci. 2020;21:1483.5. Hughes RJ, Saifuddin A. Numbering of lumbosacral transitional vertebrae on MRI: role of the iliolumbar ligaments. AJR Am J Roentgenol. 2006;187(1):W59-65.6. K C. A Concise Introduction to the Imaging of the Lumbar Spine2016.7. Fardon DF, Williams AL, Dohring EJ, Murtagh FR, Gabriel Rothman SL, Sze GK. Lumbar disc nomenclature: version 2.0: Recommendations of the combined task forces of the North American Spine Society, the American Society of Spine Radiology and the American Society of Neuroradiology. Spine J. 2014;14(11):2525-45.8. Kushchayev SV, Glushko T, Jarraya M, Schuleri KH, Preul MC, Brooks ML, et al. ABCs of the degenerative spine. Insights Imaging. 2018;9(2):253-74.9. Pfirrmann CW, Metzdorf A, Zanetti M, Hodler J, Boos N. Magnetic resonance classification of lumbar intervertebral disc degeneration. Spine (Phila Pa 1976). 2001;26(17):1873-8.10. M B. MRI Degenerative Disease of the Lumbar Spine. J Am Osteopath Coll Radiol. 2018.11. Yu LP, Qian WW, Yin GY, Ren YX, Hu ZY. MRI assessment of lumbar intervertebral disc degeneration with lumbar degenerative disease using the Pfirrmann grading systems. PLoS One. 2012;7(12):e48074.12. KS T. Imaging of Spinal Stenosis. Applied Radiology. 2017.13. Carlson BB, Albert TJ. Lumbar disc herniation: what has the Spine Patient Outcomes Research Trial taught us? Int Orthop. 2019;43(4):853-9.14. Pfirrmann CW, Dora C, Schmid MR, Zanetti M, Hodler J, Boos N. MR image-based grading of lumbar nerve root compromise due to disk herniation: reliability study with surgical correlation. Radiology. 2004;230(2):583-8.15. Gallucci M, Puglielli E, Splendiani A, Pistoia F, Spacca G. Degenerative disorders of the spine. Eur Radiol. 2005;15(3):591-8.16. Mamisch N, Brumann M, Hodler J, Held U, Brunner F, Steurer J, et al. Radiologic criteria for the diagnosis of spinal stenosis: results of a Delphi survey. Radiology. 2012;264(1):174-9.17. N H. The "ABCDE" Approach to the Systematic Assessment of Lumbar Spine MR Examination. CDR. 2020.18. Zileli M, Crostelli M, Grimaldi M, Mazza O, Anania C, Fornari M, et al. Natural Course and Diagnosis of Lumbar Spinal Stenosis: WFNS Spine Committee Recommendations. World Neurosurg X. 2020;7:100073.19. Cho IY, Park SY, Park JH, Suh SW, Lee SH. MRI findings of lumbar spine instability in degenerative spondylolisthesis. J Orthop Surg (Hong Kong). 2017;25(2):2309499017718907.20. Semaan H, Curnutte B, Cooper M, Obri J, Elsamaloty M, Obri T, et al. Overreporting of the disc herniation in lumbar spine MRI scans performed for patients with spondylolisthesis. Acta Radiol. 2020:284185120925483.21. GC G. Lumbar Spine Imaging: MRI. 2017.

Kim J. Plyler is the CEO and president of SahlComm Inc., a public relations and creative communications firm based in Pennsylvania. Kim is a public speaker, PR strategist, Certified Optimize Coach, and author of Master Your Story, It Matters! She has written speeches for admirals in the US navy, has an education in theatre with a Bachelor of Arts degree from DeSales University, and attended The Defense Information School for Journalism, Public Affairs, and Media Relations. Kim has traveled the world, inspiring her to become a storyteller at heart. Kim joins me today to discuss how to master your brand story. She shares why authenticity in your narrative is a vital part of connecting with your audience. She discusses the importance of looking inward to find out who you are and why failures are powerful lessons that will point you in the right direction to move your business forward. She shares tips for refreshing your brand and highlights why it is vital to discover people's perception of you and your business. Kim also shares her favorite marketing tips, business apps, and podcasts. “The best place to learn is when you fail because that's when you start to look internally and you start to see, really, what you are.” - Kim J. Plyler This week on the SmallBizChat Podcast: Resources Mentioned: Connect with Kim J. Plyler: Fix Your Business! Are you ready to run your business with intention? Ready to create a business that allows you to live your dream life and take those dream vacations you deserve? Then you need a copy of my latest book: Fix Your Business: A 90-Day Plan to Get Back Your Life and Remove Chaos From Your Business. Fix Your Business gives you concrete advice on the problem areas many small business owners face as well as the step-by-step process to find solutions so you can live the life of your dreams. It's time to take back control of your business and change how your business is run. Order your copy of Fix Your Business and design your business - and life - with intention. Let's End Small Business Failure - Together! Thanks for tuning into this week's episode of the SmallBizChat Podcast - the show on a mission to improve small business success. If you enjoyed this episode, head over to Apple Podcasts, subscribe to the show, and leave us a rating and review. Help us spread the word and end small business failure by sharing your favorite episodes with your friends and colleagues on social media. Visit our website or follow us on Facebook, Twitter, LinkedIn, Instagram, or YouTube for more great content, tips, and strategies to improve your small business.See omnystudio.com/listener for privacy information.

In this episode, Melinda Emerson talks with Kim J. Plyler, CEO of Shawcom Inc., about the importance of a clear company narrative. They cover handling businesses without a brand story, using failure as part of your story, and current communication trends. The discussion includes tips on refreshing your brand story and marketing advice for start-ups, concluded with Plyler's favorite business tools.

It is rumored that the North Korean leader is in a coma and his sister is prepared to exert absolute power. In studio today, we have our very own Kim J. Anthony Brown Un and he reminds us of the real truth. Learn more about your ad-choices at https://news.iheart.com/podcast-advertisers

Talking to my co-host Kim J. on the phone I thought immediately to take our convo. onto podcast. This is just an everyday shoot the breeze type of talk between me and my girl!! And our talks, encouragements, and great laughter can and will go in forever.. Stay tuned

What is COVID myocarditis and how strong is the data to create a link between COVID and potential arrhythmias? Was COVID myocarditis the leading factor in the recent decisions of some American athletic conferences to shut-down the fall sports season? What are the criteria to start participation again?On this episode of the AMSSM Sports Medcast, host Devin McFadden, MD is joined by sports medicine physicians and internationally renowned experts on Sports Cardiology Jonathan Drezner, MD, FAMSSM and Michael Ackerman, MD, who have both been influential in the debate on whether a Collegiate Athletic season can safely occur in the midst of the ongoing COVID-19 Pandemic.Dr. Jonathan Drezner is a Professor from the Department of Family Medicine and Director of the University of Washington Center for Sports Cardiology, past president of the AMSSM, team physician for the Seattle Seahawks, UW Huskies, and OL Reign and deputy editor of the BJSM. Dr. Michael Ackerman is a Professor of Medicine, Pediatrics, and Pharmacology at the Mayo Clinic College of Medicine and Science. He is the Director of the Windland Smith Rice Genetic Heart Rhythm Clinic and Windland Smith Rice Sudden Death Genomics Laboratory, as well as the president of the Sudden Arrhythmia Death Syndromes (SADS) Foundation.In this 40 minute conversation Drs. Drezner and Ackerman addressed the following topics:What is COVID myocarditis and why is it so concerning?How strong is the link between COVID-19 and was this a driving factor in the cancelling of the FALL sports season by some collegiate conferences?What metrics need to be satisfied in order to safely return to play, and will that occur this year?Health and Well Being Considerations for PAC-12 Institutions: Guidance for Local Planning for Return to Sporting Activity https://xs.pac-12.com/2020-08/Pac-12%20Covid-19%20Return%20to%20Play%20Considerations%2008.10.2020.pdf Puntmann VO, Carerj ML, Weiters I. Outcomes of Cardiovascular Magnetic Resonance Imaging in Patients Recently Recovered From Coronavirus Disease 2019 (COVID-19) https://jamanetwork.com/journals/jamacardiology/fullarticle/2768916 Baggish A, Drezner JA, Kim J, et al. Resurgence of sport in the wake of COVID-19: cardiac considerations in competitive athletes https://bjsm.bmj.com/content/early/2020/06/18/bjsports-2020-102516 Maron BJ, Zipes DP, Kovacs RJ, et al. Eligibility and disqualification recommendations for competitive athletes with cardiovascular abnormalities: a scientific statement from the American Heart Association and the American College of Cardiology. Copublished in Circulation and the Journal of the American College of Cardiology 2015. https://www.acc.org/~/media/fb92803045d249ae91b715650dd0ebe4.pdf Pelliccia A, Solberg EE, Papadakis M, et al. Recommendations for participation in competitive and leisure time sport in athletes with cardiomyopathies, myocarditis, and pericarditis: position statement of the Sport Cardiology Section of the European Association of Preventive Cardiology (EAPC). European Heart Journal 2019;40:19.https://academic.oup.com/eurheartj/article/40/1/19/5248228

Y'all president is crazy, Kim J is doing a pooch round up, and Kim K wanna save my round C Murder. --- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app --- Send in a voice message: https://anchor.fm/thechopshop/message Support this podcast: https://anchor.fm/thechopshop/support

What is COVID myocarditis and how strong is the data to create a link between COVID and potential arrhythmias? Was COVID myocarditis the leading factor in the recent decisions of some American athletic conferences to shut-down the fall sports season? What are the criteria to start participation again? On this episode of the AMSSM Sports Medcast (T: @TheAMSSM) host Dr. Devin McFadden, MD is joined by sports medicine physicians and internationally renowned experts on Sports Cardiology Dr. Jonathan Drezner and Dr. Michael Ackerman, who have both been influential in the debate on whether a Collegiate Athletic season can safely occur in the midst of the ongoing COVID-19 Pandemic. Dr. Jonathan Drezner is a Professor from the Department of Family Medicine and Director of the University of Washington Center for Sports Cardiology, past president of the AMSSM, team physician for the Seattle Seahawks, UW Huskies, and OL Reign and deputy editor of the BJSM. Dr. Michael Ackerman is a Professor of Medicine, Pediatrics, and Pharmacology at the Mayo Clinic College of Medicine and Science. He is the Director of the Windland Smith Rice Genetic Heart Rhythm Clinic and Windland Smith Rice Sudden Death Genomics Laboratory, as well as the president of the Sudden Arrhythmia Death Syndromes (SADS) Foundation. In this 40 minute conversation Drs. Drezner and Ackerman addressed the following topics: What is COVID myocarditis and why is it so concerning? How strong is the link between COVID-19 and was this a driving factor in the cancelling of the FALL sports season by some collegiate conferences? What metrics need to be satisfied in order to safely return to play, and will that occur this year. Health and Well Being Considerations for PAC-12 Institutions: Guidance for Local Planning for Return to Sporting Activity https://xs.pac-12.com/2020-08/Pac-12%20Covid-19%20Return%20to%20Play%20Considerations%2008.10.2020.pdf Puntmann VO, Carerj ML, Weiters I. Outcomes of Cardiovascular Magnetic Resonance Imaging in Patients Recently Recovered From Coronavirus Disease 2019 (COVID-19) https://jamanetwork.com/journals/jamacardiology/fullarticle/2768916 Baggish A, Drezner JA, Kim J, et al. Resurgence of sport in the wake of COVID-19: cardiac considerations in competitive athletes https://bjsm.bmj.com/content/early/2020/06/18/bjsports-2020-102516 Maron BJ, Zipes DP, Kovacs RJ, et al. Eligibility and disqualification recommendations for competitive athletes with cardiovascular abnormalities: a scientific statement from the American Heart Association and the American College of Cardiology. Copublished in Circulation and the Journal of the American College of Cardiology 2015. https://www.acc.org/~/media/fb92803045d249ae91b715650dd0ebe4.pdf Pelliccia A, Solberg EE, Papadakis M, et al. Recommendations for participation in competitive and leisure time sport in athletes with cardiomyopathies, myocarditis, and pericarditis: position statement of the Sport Cardiology Section of the European Association of Preventive Cardiology (EAPC). European Heart Journal 2019;40:19. https://academic.oup.com/eurheartj/article/40/1/19/5248228

Zapraszam na pierwszy odcinek miniserii o walce duchowej. W tym podcaście usłyszysz o: istocie walki duchowej; podstawowej wiedzy o nieprzyjacielu ludzkiej natury; dwóch skrajnościach w pojmowaniu walki duchowej; powodach z jakich toczy się walka duchowa; Jezus Chrystus a walka duchowa. Kolejny odcinek o taktykach nieprzyjaciela.

Bom dia, boa tarde, boa noite! Esse é mais um podcast do Medicina do Conhecimento. Ciência e informação a qualquer momento, em todo lugar. Eu sou Pablo Gusman, o Anestesiador. E como compartilhar é multiplicar segue uma pílula, dica rápida para aumentar seu conhecimento. Antes eu gostaria de avisar que você usuário de smartphones androides pode baixar o app Medicina do Conhecimento na sua loja Google Play para ouvir a nossa rádio web e interagir conosco no seu momento. Basta procurar por medicinadoconhecimento. Digite todas as palavras juntas! Vamos lá aumentando nosso mundo do conhecimento. A clonidina tem sido usada como droga adjuvante de anestésicos locais em várias técnicas regionais para prolongar a duração dos bloqueios moter e sensitivo. Uma revisão sistemática de Elia e colaboradores no jornal Regional Anesthesia Pain Medicine mostrou que a duração do bloqueio motor e sensitivo foi prolongada por 47 minutos em média quando a clonidina foi adicionada a anestésicos locais intratecais. Contudo, o estudo não divulgou uma dose ideal e incluiu uma faixa de dosagem ampla de 15 a 150 μg. Na publicação de Rhee no Acta Anaesthesiologica Scandinavica, uma dose de 3 μg/kg de clonidina endovenosa administrada imediatamente após o bloqueio espinhal mostrou o prolongamento do bloqueio por aproximadamente 60 minutos sem efeitos colaterais adversos perceptíveis. Além disso, deve-se notar que, embora conheçamos o mecanismo de ação da clonidina na técnica neuroaxial, não há um mecanismo de ação estabelecido da clonidina no bloqueio de nervo periférico. Um ensaio clínico randomizado duplo-cego de Duma no British Journal of Anaesthesia investigou os efeitos da clonidina no prolongamento da duração do bloqueio do plexo braquial e axilar e mostrou que não houve diferença na duração do bloqueio com ou sem clonidina. Baixe os arquivos no nosso canal do Telegram Medicina do Conhecimento! O link é t.me/medconhecimento ou abra seu telegram e busque por Medicina do Conhecimento. A qualquer momento e em todo lugar, escute a rádioweb no www.medicinaconhecimento.com.br Escolha sua plataforma e ouça mais podcasts. Siga pelo Spotify, Deezer, Itunes, Google Podcasts, Soundcloud, Youtube e mais uma dezena de agregadores de podcast. Na medicina do conhecimento, você escolhe o player da sua preferência. É muito importante seu feedback. Compartilhe nas suas redes e deixe seu like. Isso aumenta a divulgação do projeto. Além disso, você pode entrar em contato conosco e sugerir o próximo tema! Fique ligado nas redes sociais Twitter, Facebook e Instagram Medicina do Conhecimento, afinal compartilhar é multiplicar! Murphy DB, McCartney CJ, Chan VW. Novel analgesic adjuncts for brachial plexus block: a systematic review. Anesthes Analg. 2000;90(5):1122-1128. Elia N, Culebras X, Mazza C, Schiffer E, Tramer MR. Clonidine as an adjuvant to intrathecal local anesthetics for surgery: systematic review of randomized trials. Reg Anesth Pain Med. 2008;33(2):159-167. Rhee K, Kang K, Kim J, Jeon Y. Intravenous clonidine prolongs bupivacaine spinal anesthesia. Acta Anaesthesiol Scand. 2003;47(8):1001-1005. Duma A, Urbanek B, Sitzwohl C, Kreiger A, Zimpfer M, Kapral S. Clonidine as an adjuvant to local anesthetic axillary brachial plexus block: a randomized, controlled study. Br J Anaesth. 2005;94(1):112-116.

Junior doctor and Wiradjuri woman Dr Claudia Paul is passionate about Indigenous health and opportunities for Indigenous medical students and junior doctors. Dr Paul is only the third Australian Aboriginal woman to be awarded a Rhodes Scholarship. With welcome the support from Foundation of Surgery, she's currently studying a PhD at Oxford University. In this episode, she says would like to see surgical care more equitable to all Australians, including better accessibility and health care outcomes to Indigenous Australians. If you would like to learn more about the studies mentioned, we’ve included a list of references below: Secombe P, Brown A, McAnulty G, Pilcher D. Aboriginal and Torres Strait Islander patients requiring critical care: characteristics, resource use, and outcomes. Crit Care Resusc. 2019. http://www.scopus.com/inward/record.url?scp=85071617883&partnerID=8YFLogxK Bureau of Health Information. Patient Perspectives – Hospital care for Aboriginal people. Sydney (NSW); BHI; 2016.  Peiris D, Brown A, Howard M et al. Building better systems of care for Aboriginal and Torres Strait Islander people: findings from the Kanyini health systems assessment. BMC Health Serv Res. 2012. https://doi.org/10.1186/1472-6963-12-369 Australian Government. National Aboriginal and Torres Strait Islander Health Plan 2013 – 2023, Australian Government, Canberra. 2013.https://www1.health.gov.au/internet/main/publishing.nsf/content/B92E980680486C3BCA257BF0001BAF01/$File/health-plan.pdf Azzopardi P S, Sawyer S M, Carlin J B et al. Health and wellbeing of Indigenous adolescents in Australia: a systematic synthesis of population data. The Lancet. 2018. http://doi.org/10.1016/ S0140-6736(17)32141-4. Thong DW, Kim J, Dobson B et al. Variation in anti- microbial prescription and complications post emergency appendicectomy in Australia: do we follow recommended guidelines? ANZ J. Surg. 2019. https://doi.org/10.1111/ans.15099. Henman K, Gordon C, Gardiner T et al. Surgical site infections following caesarean section at Royal Darwin Hospital, Northern Territory. Healthcare Infection. 2012. http://dx.doi.org/10.1071/HI11027 De Jager E, Gunnarsson R, Ho, Y. Measuring the quality of surgical care provision to Aboriginal and Torres Strait Islander patients. ANZ J. Surg. 2019. https://doi.org/10.1111/ans.15535. Commons R J, Robinson C H, Gawler D et al. High burden of diabetic foot infections in the top end of Australia: An emerging health crises (DEFINE study). Diabetes Res Clin Pract. 2015.https://doi.org/10.1016/j.diabres.2015.09.016 West M, Chuter V, Munteanu S, Hawke F. Defining the gap: a systematic review of the difference in rates of diabetes-related foot complications in Aboriginal and Torres Strait Islander Australians and non-Indigenous Australians. Journal of Foot and Ankle Research. 2017. https://doi.org/10.1186/s13047-017-0230-5  

Patreon and Masterclass:  https://www.patreon.com/thegaitguys join us at the 40$ level,   VIMEO on demand (pssst, the 40$ patreon level is a better deal  !) https://vimeo.com/ondemand/thegaitmasterclass   *The Masterclass in Gait, with the Gait Guys join us monthly at: https://www.patreon.com/thegaitguys for the monthly Masterclass installment hour. Formal presentations, slides, videos, demos, deep dives on topics you will not hear anywhere but here ! We hit gait, biomechanics, neurology and orthopedics of all of the gait topics we present. This is not for the weak and timid, this is the deep dive you have been waiting for. Join us while we turn our normal 50 minute presentations into 3.5 hours on a regular basis ! The 40$ Patreon level will give you the best deal on the Masterclass and also get you the $20, $10, and 5$ Patreon level content. What a deal ! It will not be here forever so lock in now ! Note, the 40$ Patreon level gets you more Masterclass content than the $40 VIMEO purchases. Links to find the podcast: Look for us on Apple Podcasts, Google Play, Podbean, PlayerFM, RADIO and more. Just Google "the gait guys podcast". _______________________________________________________________________________ Our Websites: www.thegaitguys.com Find Exclusive content at: https://www.patreon.com/thegaitguys doctorallen.co summitchiroandrehab.com shawnallen.net Our website is all you need to remember. Everything you want, need and wish for is right there on the site. Interested in our stuff ? Want to buy some of our lectures or our National Shoe Fit program? Click here (thegaitguys.com or thegaitguys.tumblr.com) and you will come to our websites. In the tabs, you will find tabs for STORE, SEMINARS, BOOK etc. We also lecture every 3rd Wednesday of the month on onlineCE.com. We have an extensive catalogued library of our courses there, you can take them any time for a nominal fee (~$20). Our podcast is on iTunes and just about every other podcast harbor site, just google "the gait guys podcast", you will find us. Where to find us, the podcast Links: Apple podcasts: https://itunes.apple.com/us/podcast/the-gait-guys-podcast/id559864138?mt=2 Google Play: https://play.google.com/music/m/Icdfyphojzy3drj2tsxaxuadiue?t=The_Gait_Guys_Podcast Links to today's show:   Gait Posture. 2020 Feb 20;78:54-59. doi: 10.1016/j.gaitpost.2020.02.014. [Epub ahead of print]   Muscle capacity to accelerate the body during gait varies with foot position in cerebral palsy. Hegarty AK1, Kurz MJ2, Stuberg W2, Silverman AK3. J Sport Rehabil. 2020 Mar 31:1-9. doi: 10.1123/jsr.2019-0211. [Epub ahead of print] Effects of a 4-Week Short-Foot Exercise Program on Gait Characteristics in Patients With Stage II Posterior Tibial Tendon Dysfunction. Kim J, Lee SC, Chun Y, Jun HP, Seegmiller JG, Kim KM, Lee SY. Hum Mov Sci. 2020 Apr;70:102584. doi: 10.1016/j.humov.2020.102584. Epub 2020 Feb 8. Gait control in children with attention-deficit/hyperactivity disorder. Simmons RW1, Taggart TC2, Thomas JD3, Mattson SN3, Riley EP3. Gait Posture. 2020 Mar 17;78:30-34. doi: 10.1016/j.gaitpost.2020.03.009. [Epub ahead of print] Navicular drop is negatively associated with flexor hallucis brevis thickness in community-dwelling older adults. Fukumoto Y1, Asai T2, Ichikawa M3, Kusumi H3, Kubo H4, Oka T5, Kasuya A6. Front Pediatr. 2020 Feb 28;8:75. doi: 10.3389/fped.2020.00075. eCollection 2020. Effects of Selective Dorsal Rhizotomy on Ankle Joint Function in Patients With Cerebral Palsy. Ates F1, Brandenburg JE2,3,4, Kaufman KR1. Gait Posture. 2020 Mar 4;78:26-29. doi: 10.1016/j.gaitpost.2020.03.003. [Epub ahead of print] Higher visual reliance during single-leg balance bilaterally occurring following acute lateral ankle sprain: A potential central mechanism of bilateral sensorimotor deficits. Kim KM1.

Den danske EU-repræsentation skal have ny chef, nu da Kim Jørgensen forlader ambassadørposten for at lede kabinettet for EU-Kommissionens danske næstformand. Hør Jørgensens tanker om skiftet i denne uges podcast, hvor Altinget også taler om bl.a. Brexit-tomrum, EU's fremtidsbudget og handelsaftaler med Sydamerika See acast.com/privacy for privacy and opt-out information.

Dawn Channell Interviews Author Kim J as they discuss mental wellness. Co-Host Dawn Chanell and Akiana talk plenty of smack as usual about the latest happenings and current events

Tea is spilled...skinny tea. Bella B and Meara choose sides in the epic Kim J vs Jameela J battle. Meara in Motown? Bella B was in WHAT PLAY?! See acast.com/privacy for privacy and opt-out information.

I dette afsnit får vi en snak med en af de helt store profiler indenfor det digitale landskab. Kim J. Andersen er director i EY’s Digital Advisory afdeling, samt formand for Danish Digital Awards. Kim taler om hvorfor digitaliseringen burde anses mere som en fundamental organisatorisk disciplin, samt hvordan man som virksomhed skal gribe, og kapitalisere, på den store mængde af data der kan indsamles i vores digitale samfund. Vi håber I vil lytte med! God fornøjelse!Kontakt:Gustavanholm@gmail.comtlf: 21 63 89 75

Endelig er det klart for en episode om fellefangst på mår, røyskatt, mink og kråkefugler. For å lære oss mer om dette temaet har vi fått med oss Kim Jønsson som i mange år har vært profesjonell jeger og fangstmann. Kim forteller om hvordan man kan komme i gang med fellefangst, og deler sine beste tips til hvordan du kan lykkes.Support the show (https://www.patreon.com/jegerpodden) See acast.com/privacy for privacy and opt-out information.

No episódio de hoje vamos discutir no artigo principal um novo mecanismo pelo qual tumores metastáticos suprimem o sistema imune e favorecem o seu crescimento através da liberação de microvesículas contendo uma potente molécula imunomoduladora e como isso pode ser usado como indicador de prognostico de tumores metastáticos, aqueles tumores que tem a capacidade de se espalhar para outros órgãos além do inicial. No Microlitros de Notícias falamos sobre o aumento na resistência a álcool em bactérias que causam infecções hospitalares; sobre uma nova classe de antibióticos, os nano antibióticos; e também trazemos notícias da China sobre um novo composto capaz de impedir a metástase de alguns tumores. Na Filogenia da Ciência falaremos sobre Rosalind Franklin, a cientista que fotografou o DNA   Tópicos comentados nesse episódio Tumor Cancêr Metástase Imunossupressão Vesículas Microvesículas PD-L1 Prognóstico de cancêr Keytruda Bactérias resistentes a álcool Enterococcus faecium Nano-antibióticos Ginesteína Anti-metástase Rosalind Franklin XXIV Semana de Microbiologia e Imunologia da UFRJ Inscrições para o II Workshop on Inflammation, clique aqui   Referências desse episódio 2018. Chen G, Huang AC, Zhang W, Zhang G, Wu M, Xu W, Yu Z, Yang J, Wang B, Sun H, Xia H, Man Q, Zhong W, Antelo LF, Wu B, Xiong X, Liu X, Guan L, Li T, Liu S, Yang R, Lu Y, Dong L, McGettigan S, Somasundaram R, Radhakrishnan R, Mills G, Lu Y, Kim J, Chen YH, Dong H, Zhao Y, Karakousis GC, Mitchell TC, Schuchter LM, Herlyn M, Wherry EJ, Xu X, Guo W. Exosomal PD-L1 contributes to immunosuppression and is associated with anti-PD-1 response. Nature, 560:382-386. 2012. Peinado H, Alečković M, Lavotshkin S, Matei I, Costa-Silva B, Moreno-Bueno G, Hergueta-Redondo M, Williams C, García-Santos G, Ghajar C, Nitadori-Hoshino A, Hoffman C, Badal K, Garcia BA, Callahan MK, Yuan J, Martins VR, Skog J, Kaplan RN, Brady MS, Wolchok JD, Chapman PB, Kang Y, Bromberg J, Lyden D. Melanoma exosomes educate bone marrow progenitor cells toward a pro-metastatic phenotype through MET. Nat Med, 18:883-891. Portal ANVISA. Anvisa aprova indicação inédita para câncer de pulmão. 2018. PIDOT, Sacha J. et al. Increasing tolerance of hospital Enterococcus faecium to handwash alcohols. Science Translational Medicine, v. 10, n. 452. 2017. de Oliveira, J. F. A., Saito, Â., Bido, A. T., Kobarg, J., Stassen, H. K., e Cardoso, M. B. Defeating bacterial resistance and preventing mammalian cells toxicity through rational design of antibiotic-functionalized nanoparticles. Scientific Reports, 7(1), 1326. 2018. Li Xu, Ryan Gordon, Rebecca Farmer, Abhinandan Pattanayak, Andrew Binkowski, Xiaoke Huang, Michael Avram, Sankar Krishna, Eric Voll, Janet Pavese, Juan Chavez, James Bruce, Andrew Mazar, Antoinette Nibbs, Wayne Anderson, Lin Li, Borko Jovanovic, Sean Pruell, Matias Valsecchi, Giulio Francia, Rick Betori, Karl Scheidt & Raymond Bergan. Precision therapeutic targeting of human cancer cell motility. Nature.   Sobre o Podcast Microbiando A ideia do Microbiando é discutir artigos científicos de ponta em todas as áreas da microbiologia e imunologia. Vamos utilizar uma linguagem bem acessível para destrinchar esses artigos para vocês, mas sem perder o rigor científico e analítico necessário para essa tarefa. Além de discutir artigos nós teremos o quadro Microlitros de Notícias, onde nossos microbiologistas e imunologistas de plantão irão abordar pequenas reportagens e trazer novidades para vocês. No quadro filogenia da Ciência vamos contar um pouco sobre a vida de grandes personalidades que revolucionaram a Microbiologia e Imunologia com suas descobertas. Você pode nos ouvir no Spotify, Google Podcast, Player FM, Podcast Addict, CastBox, Blubrry Podcasting, iTunes e outros agregadores de podcasts.   Contatos E-mail: microbiando@micro.ufrj.br Twitter Facebook Instagram   Expediente

Anthony Kennedy- Supreme court justice has announced his retirement. BIG implications for the US in the next lots of year...  VLaddy P is jelous of Kim J 2 and looking for some attention from Donald.  Hope Solo hit her boyfriend a few years ago as well.  News for the week! News! News!

Author: Dylan Luyten, MD Educational Pearls:   Most important questions to answer with low potassium are 1. What are their symptoms? 2. Can they take potassium by mouth? Oral repletion is faster, cheaper, and more effective than IV repletion. Give IV potassium when patients have K < 2.5 mmol/L or present with arrhythmias and/or characteristic EKG changes (flattened T waves). Most patients who are hypokalemic are hypomagnesemic and require magnesium supplementation.  Checking a level is unnecessary.   References Ashurst J, Sergent SR, Wagner BJ, Kim J. Evidence-based management of potassium disorders in the emergency department. Emerg Med Pract. 2016 Nov 22;18(Suppl Points & Pearls):S1-S2   Whang R, Flink EB, Dyckner T, et al. Magnesium depletion as a cause of refractory potassium repletion. Arch Intern Med 1985; 145:1686.

Here's what we're talking about...    Sports gambling is now legalISH in the united states, we bring on a special guest Prof. of Sports Gambling Mike Conti. There was another shooting and some girl that just graduated from Kent State thinks its a good time to take her senior pictures on a school campus featurin her AR-10. The MET gala happened, its' like the Royal wedding (which also happened) with no vows, flower girls or drunk uncles... (maybe a few drunk uncles). Net neutrality is maybe back? until than, hopefully I paid off my internet thingy so this episode is coming in loud and clear. the greatest love story ever told: Kim J 2 and Donlad Drunk - they've been getting close on Tinder, time for a first D8?? Segment: QuickBait

Lars Seier Christensen og Nanna Gotfredsen tager i andet afsnit af "På samfundets bund" til Aarhus, hvor de taler med nogen af byens stofbrugere om de forhold, som brugerne fixer under i byen. I København besøger de Fixelancen og hører om nogle af de problemer, som stofbrugere oplever at have i forbindelse med en række regler, der er forbundet med lægeordineret stof. Medvirkende: Lars Seier Christensen (milliardær og stifter af Saxo-bank), Nanna Gotfredsen (stifter af Gadejuristen), Anja Plesner Bloch, formand for Brugernes Akademi, Jørgen Kjær, formand for Brugerforeningen for aktive stofbrugere, Christina Strauss, formand, Morten Damgaard og Kim Jørgensen. Tilrettelægger: Jette Damgaard. Redaktør: Karen Albertsen. Produceret til DR for Munck København.

Mælkeproducent Kim Jørgensen fra Rødding i Sønderjylland er lidt af en nørd, når det kommer til beholdninger. Han ved præcist, hvor meget foder han har liggende, hvor meget han bruger, og hvad det koster. Hør, hvordan han gør, og hvorfor han har fokus på beholdninger.Indlægget Traktorøkonomi : Beholdninger blev først udgivet på SEGES Podcast.

  It's time again to wrap up our impressions and thoughts on season 34, Survivor Game Changers. The finale and the season as a whole is getting mixed reviews. Most were happy with the winner and viewed her as deserving, but almost everyone wished it had been Cirie. All in all though, we had fun together and found lots to enjoy and discuss each week. We will be on hiatus till the fall when we return for the season 35 JABBIC episodes. We want to thank and acknowledge everyone who contributed to another great LF show. This week we heard from: Pete, Ian, Shea, IronDave, Crystal, Mikeybear, Victoria, Shelley, Jody, Rashmi, Parker, Jack, Ronda, Sophie, Marla-n-Sarah, Ed, Drew-Charlie-n-Adelaide, BrandonB, Kenny, Shannon, BrandonA, Josh, Nicola, Nina, Samantha, Jill, James, Jeremiah, Kim, Jen, and Paul. We've got several ways you can reach us. You can call and leave a voicemail at 206-350-1547 or toll-free at 844-643-8737. You can record an audio comment and attach it or just type up a quick text message and send it to us via email at joannandstacyshow@gmail.com. 00:00 Date 00:04 Ancient Voices Dedication to Russ Landau mix by Aaron 00:39 Introductions 02:36 Pete from Boston, Massachusetts 08:11 Ian from Woodland Hills, California 12:03 Shea from Arkansas 14:58 IronDave from SoCal 16:10 Crystal from Georgia 20:03 Mikeybear from Hackensack, New Jersey 20:57 Victoria from Maryland 24:19 Shelley from Australia 28:08 Jody from Brisbane, Australia 31:38 Rashmi from Perth, Australia 34:00 Parker from Illinois 37:14 Jack from California 39:29 Ronda from Portland, Oregon 42:36 Sophie from Texas 43:22 Marla-n-Sarah from Illinois 44:42 Ed from Milwaukee, Wisconsin 47:58 Drew, Charlie, and Adelaide from Utah 51:36 BrandonB from Brooklyn, New York 54:06 Kenny from Dallas, Texas 58:54 Shannon from Charleston, South Carolina 60:09 BrandonA from Cleveland, Ohio 62:34 Josh the Plush Moose from Massachusetts 65:47 Nicola from Lexington, Kentucky 67:12 Nina from Chicago, Illinois 68:53 Samantha from Texas 71:52 Jill from the Outback 74:30 James from Charleston, South Carolina 78:37 Jeremiah from SoCal 81:56 Kim J. from Nashville, Tennessee 84:54 Jen from California 88:48 Paul from Louisiana 92:09 Wrap Up 96:19 Ancient Voices Dedication to Russ Landau mix by Aaron Links for Today's Show Paul's Visual Roster Survivor Fans Podcast Fans group on Facebook JSFL SFP on Twitter Contact Info: Voicemail: 206-350-1547 Toll Free Voicemail: 844-643-8737 Email: joannandstacyshow@gmail.com Survivor Fans Podcast P.O. Box 2811 Orangevale, CA 95662 Enjoy, Jo Ann and Stacy

This Saturday morning, Joseph and Chris watched GRAVEDALE HIGH, from 1990! This cartoon was chosen by Kim J.! Thanks, Kim! EPISODES WATCHED: 1. First Episode: Long Day’s Gurney Into Night (S1E01) 2. Highest Rated: Save Our School (S1E10) 3. Random/Listener Pick: Night of the Living Dad (S1E11) – Chosen by Joseph IMDB SYNOPSIS: Schneider is […]

N.B.: This month's show notes are a departure from the usual summary.  Below is a reprint (with permission) of a soon-to-be released chapter, Horeczko T. "Acute Pain in Children". In Management of Pain and Procedural Sedation in Acute Care. Strayer R, Motov S, Nelson L (eds). 2017.  Rather than the customary blog post summary, the full chapter (with links) is provided as a virtual reference. INTRODUCTION Pain is multifactorial: it is comprised of physical, psychological, emotional, cultural, and contextual features.  In children often the predominant feature may not be initially apparent.  Although clinicians may focus on the physical component of pain, much time, energy, and suffering can be saved through a holistic approach.  What is the age and developmental stage of the child?  How is the child reacting to his condition?  What are the circumstances?  What is the family or caregiver dynamic? We rely much on how patients and families interact with us to gauge pain.  Assessing and managing children’s pain can be challenging, because they may not exhibit typically recognized signs and symptoms (Srouji 2010).  Further, children participate in and absorb their family’s culture and specific personality from a very young age (Finley 2009).  Knowing the context of the episode may help.  For example, a very anxious caregiver can easily transmit his or her anxiety to the child, which may either inhibit or amplify presentation of symptoms (Bearden 2012). The guiding principles in pediatric pain assessment and management are: know the child; know the family; and know the physiology.  Children have long suffered from an under-treatment of their pain, due both to our incomplete acknowledgement of their pain and our fear of treatment (Howard 2003).  As the pendulum on pain management swings one way or the other, do not let your pediatric patient get knocked by the wayside.  Take a thoughtful approach: know the signs and symptoms, and aggressively treat and reassess. ASSESSMENT Each stage of development offers a unique framework to the child’s signs and symptoms of pain.  In pre-verbal children, use your observational skills in addition to the parent’s report of behavior.  Verbal children can self-report; younger children require pictorial descriptions, while older children and adolescents may use standard adult scales.  In all ages, ask open-ended questions and allow the child to report and speak for himself whenever possible. Neonates Neonates are a unique group in pain assessment.  The neonate (birth to one month of age) has not yet acquired social expression of pain, and his nascent nervous system is only now learning to process it.  Do not expect typical pain behaviors in neonates.  Facial grimacing is a weak indicator of pain in neonates (Liebelt 2000).  When this behavior is present, look for a furrowed brow, eyes squeezed shut, and a vertically open mouth.  Tachycardia, tachypnea, and a change in behavior can be indicators not only to the presence of pain, but possibly to its etiology as well. Neonatal observational scales have been validated in the intensive care and post-operative settings; ED-specific quantitative scales are lacking.  CRIES is a 10-point scale, using a physiologic basis similar to APGAR: Crying; Requires increased oxygen administration (distress and breath-holding); Increased vital signs; Expression; and Sleeplessness (Krechel 1995).  CRIES (Table 1) was validated for post-operative patients; to adapt its use for the ED, the most conservative approach is to substitute “preoperative baseline” with normal range for age.  Although the numerical values of CRIES have not been validated to date in the ED, the clinician may find the domains included in CRIES to be a useful cognitive construct in assessing neonatal pain. Neonatal pain pathways are particularly plastic; prompt assessment of and increased alertness to neonatal pain may help to mitigate long-lived pain sensitivity and hyperalgesia (Taddio 2002).  In other words, treat the neonate’s pain seriously, as you may save him long-term pain sequelae in the future. Infants and Toddlers This group will begin to exhibit more reproducible, reliable signs and symptoms of pain. For infants of less than one year of age, the Neonatal Infant Pain Scale (NIPS) uses observational and physiologic parameters to detect pain (Table 2).  A score of 0-2 indicates no pain present.  A score of 3-4 indicates mild to moderate pain; non-pharmacologic techniques may be tried first.  A score of 5 or greater indicates severe pain; some pharmacologic intervention is indicated (Lawrence 1993). For children greater than one year who are preverbal, a well performing scale is the FLACC score: Face, Legs, Activity, Cry, Consolability (Table 3). Contextual and caregiver features predominate in this group.  Frequent reassessments are helpful, as the initial trepidation and fright in triage may not accurately reflect the child’s overall pain status. Preschool and School-age children Increasing language development offers the hope of more information to the clinician, but be careful not to ask leading questions.  Do not jump directly to “does this hurt?”.  Preschoolers will say ‘yes’ to anything, in an attempt to please you.  School-age children may passively affirm your “statement”, if only to validate their human need for care or attention.  Start with some ice-breaking banter, lay down the foundations for rapport, and then ask open-ended questions.  Be careful not to allow the caregiver to “instruct” the child to tell you where it hurts, how much, how often, etc.  Rather, engage the parents by asking them what behavior they have noticed.  Eliciting history from both the child and the parent will go a long way in constructing a richer picture of the etiology and severity of the pain, and will help to build rapport and trust. The Baker-Wong FACES Pain Rating scale (Figure 1) was developed with feedback from children and has been validated for use in those 3 years of age and older (Keck 1996, Tomlinson 2010). Adolescents Adolescents vary in their development, maturity, and coping mechanisms.  You may see a mixture of childhood and adult behaviors in the same patient; e.g. he may be initially stoic or evades questioning, then later exhibits pseudo-inconsolability.  Do what you can to see the visit from the adolescent’s perspective, and actively transmit your concern and intention to help – many will respond to a warm, open, non-judgemental, and helpful attitude.  The overly “tough” adolescent is likely secretly fearful, and the “dramatic” adolescent may simply be very anxious.  Take a moment to gauge the background behind the presentation. You may use the typical adult scale of 0 (no pain) to 10 (worst pain), or the Faces Pain Scale–Revised (FPS-R).  The FPS-R uses more neutral and realistic faces and, unlike the Wong Baker scale, does not use smiling or crying faces to anchor the extremes of pain (Tsze 2013). PAIN PHYSIOLOGY Pain includes two major components: generation and perception.  Generation of pain involves the actual propagation of painful stimuli, either through nociceptive pain or neuropathic pain.  Nociceptive pain arises from free nerve endings responding to tissue damage or inflammation. Nociceptive pain follows a specific sequence: transduction (an action potential triggered by chemical mediators in the tissue, such as prostaglandins, histamine, bradykinin, and substance P); transmission (the movement of the action potential signal along the nerve fibers to the spinal cord); perception (the impulse travels up the spinothalamic tract to the thalamus and midbrain, where input is splayed out to the limbic system, somatosensory cortex, and parietal and frontal lobes); and modulation (the midbrain enlists endorphins, enkephalins, dynorphin, and serotonin to mitigate pain) (Pasero 2011).  As clinicians we can target specific “stations” along the pain route to target the signal more effectively. Simple actions such as ice, elevation, local anesthetics, or splinting help in pain transduction.  Various standard oral, intranasal, or IV analgesics may help with pain’s transmission. Non-pharmacologic techniques such as distraction, re-framing, and others can help with pain perception.  The sum of these efforts encourage pain modulation. A phenomenon separate from nociceptive pain is neuropathic pain, the abnormal processing of pain stimuli.  It is a dysregulated, chaotic process that is difficult to manage in any setting.  Separating nociceptive from neuropathic symptoms may help to select specific pain treatments and to clarify treatment goals and expectations. Neonates Neonates are exquisitely sensitive to many analgesics.  Hepatic enzymes are immature and exhibit decreased clearance and prolonged circulating levels of the drug administered.  Once the pain is controlled, less frequent administration of medications, with frequent reassessments, are indicated. The neonate’s vital organs (brain, heart, viscera) make up a larger proportion of his body mass than do muscle and fat.  That is to say, the volume of distribution is unique in a neonate.  Water-soluble drugs (e.g. morphine) reach these highly perfused vital organs quickly; relatively small overdosing will have rapid and exaggerated central nervous system and cardiac effects.  The neonate’s small fat stores and muscle mass limit the volume of distribution of lipophilic medications (e.g. fentanyl, meperidine), also making them more available to the central nervous system, and therefore more potent.  Other factors that predispose neonates to accidental analgesic overdose are their decreased concentrations of albumin and other plasma proteins, causing a higher proportion of unbound drug.  Renal clearance is also decreased in the first few months of life. Clinical note: in the ED, neonates often require analgesia for procedures more than for injury.  Non-pharmacologic techniques predominate (see below).  Make liberal use of local anesthetics such as eutectic mixture of local anesthetics (EMLA; for intact skin, e.g. IV access, lumbar puncture) and lidocaine-epinephrine-tetracaine gel (LET; for superficial open skin and soft tissue application).  Oral sucrose (30%) solutions (administered either with a small-volume syringe or pacifier frequently dipped in solution) are effective for minor procedures (Harrison 2010, Stevens 2013) via the release of dopamine and through distraction by mechanical means.  Neonates with severe pain may be managed with parenteral analgesics, on a monitor, and with caution. Infants and Toddlers With increasing body mass comprised of fat stores in conjunction with an increase in metabolism, this group will require a different approach than the neonate.  For many medications, these children will have a greater weight-normalized clearance than adults (Berde 2002).  They will often require more frequent dosing.  Infants and toddlers have a larger functioning liver mass per kilogram of body weight, with implications for medications cleared by cytochrome p-450. Clinical note: some drugs, such as benzodiazepines, will have both a per-kilogram dosing as well as an age-specific modification.  When giving analgesics or anxiolytics to young children, always consult a reference for proper dosing and frequency. School-age children and Adolescents This group retains some hyper-metabolic features of younger children, but the dose-effect relationship is more linear and transparent.  Physiologic clearance is improved, and from a physical standpoint, these are typically lower-risk children.  From a psychological standpoint, this group may need more non-pharmacologic consideration and support to modulate pain optimally. NON-PHARMACOLOGIC TREATMENT The first line of treatment in all pain management is non-pharmacopeia (Horeczko 2016).  Not only is this the safest of all techniques, but often the most effective.  Some are simple comfort measures such as splinting (fracture or sprain), applying cold (acute soft tissue injury) or heat (non-traumatic, non-specific pain), or other targeted non-pharmacology. Many a pain control regimen is sabotaged without consideration of non-pharmacologic techniques, which may augment, or at times replace, analgesics.  Think of non-pharmacopoeia as your “base coat” or “primer” before applying additional coats of analgesic treatment.  With the right base coat foundation, you have a better chance of painting a patient’s symptoms a more tolerable and long-lasting new color. A tailored approach based on age will allow the practitioner to employ a child’s developmental strengths and avoid the frustration that results in asking the child to do what he is not capable of doing.  A brief review of Piaget’s stages of development will help to meet the child at his developmental stage for best effect (Piaget 1928, Sheppard 1977) during acute painful presentations and minor procedures. Sensorimotor stage (from birth to age 2): Children use the five senses and movement to explore the world.  They are egocentric: they cannot see the world from another’s viewpoint.   At 6 to 9 months, object permanence is established: understanding that objects (or people) exist even without seeing them. Preoperational stage (from ages 2 to 7):  Children learn to use language.  Magical thinking predominates. They do not understand rational or logical thinking. Concrete operational stage (from age 7 to early adolescence): Children can use logic, but in a very straightforward, concrete manner (they do well with simple examples).  By this stage, they move from egocentrism to understanding another point of view.  N.B. Some children (and adults) never completely clear this stage. Formal operational stage (early adolescence to adult): children are capable of abstract thinking, rationalizing, and logical thinking. It is important to assess the child’s general level of development when preparing and guiding him through the minor procedure or distracting him until his pain is controlled.  It is not uncommon for acutely ill or injured to regress temporarily in their behavior (not their development) as a coping mechanism. Neonate and Infant (0-12 months) Involve the parent, and have the parent visible to the child at all times if possible.  Make advances slowly, in a non-threatening manner; limit the number of staff in the room.  Use soothing sensory measures: speak softly, offer a pacifier, and stroke the skin softly.  Swaddle the infant and encourage the parent to comfort him during and after the procedure.  Engage their developing sensorimotor skills to distract them. Toddler to Preschooler (1-5 years) Use the same techniques as for the infant, and add descriptions of what he will see, hear, and feel; you can use a doll or toy to demonstrate the procedure.  Use simple, direct language, and give calm, firm directions, one at a time.  Explain what you are doing just before doing it (do not allow too much time for fear or anxiety to take root).  Offer choices when appropriate; ignore temper tantrums.  Distraction techniques include storytelling, bright and flashy toys, blowing bubbles, pinwheels, or having another staff member play peek-a-boo across the room.  The ubiquitous smart phone with videos or games can be mesmerizing at this age. School age (6-12 years) Explain procedures using simple language and (briefly) the reason (understanding of bodily functions is vague in this age group).  Allow the child to ask questions, and involve him when possible or appropriate.  Distraction techniques may include electronic games, videos, guided imagery, and participation in the minor procedure as appropriate. Adolescent (13 and up) Use the same techniques for the school age child, but can add detail.  Encourage questioning.  Impose as few restrictions as possible – be flexible.  Expect more regression to childish coping mechanisms in this age group.  Distraction techniques include electronic games, video, guided imagery, muscle relaxation-meditation, and music (especially the adolescent’s own music, if available). APPLIED PHARMACOLOGY No amount of knowledge of the above physiology, pharmacology, or developmental theory will help your little patient in pain without a well constructed and enacted plan.  Aggressively search out and treat your pediatric patient’s presence and source of pain.  Frequent reassessments are important to ensure that breakthrough pain treatment is achieved, when re-administration is indicated, or when a change of plan is necessary.  This is the time to involve the parents or caregivers to let them know what the next steps are, and what to expect. Start with the least invasive modality and progress as needed.  After non-pharmacologic treatments such as splinting, ice, elevation, distraction, and guided imagery, have an escalation of care in mind (Figure 2). From a pharmacologic perspective, various options are available.  Your pain management plan will differ depending on whether a painful procedure is performed in the ED (Table 4).  Once pain is addressed, create a plan to keep it managed.  Consider the trajectory of illness and the expected time frame of the painful episode.  Include practicalities such as how well the pain may be controlled as an outpatient.  Poorly controlled pediatric pain is more often managed as an inpatient than the same condition in an adult.  Speak frankly with the parents about what drug is indicated for what type of pain and that treatment goals typically do not include absence of all pain, but function in face of the pain, in anticipation for clinical improvement. A special note on codeine: Tylenol with codeine (“T3”) has never been a very effective pain medication, as up to 10% of patients lack enzymatic activity to metabolize it into morphine, its active form (Crews 2014).  New evidence is emerging on the erratic and unpredictable individual metabolism of codeine.  Some children are ultra-rapid-metabolizers of codeine to morphine, causing a rapid “bolus” of the available drug, with respiratory depression and death in some cases (Ciszkowski 2009, Racoosin 2013).  Author’s advice: take codeine off your formulary. COMMON SCENARIOS Head and neck pain Most common non-traumatic head and neck complaints can be managed non-pharmacologically (e.g. headache: improved hydration, sleep, stress, nutrition) or with PO medications, such as NSAIDs.  The anti-inflammatory nature of ibuprofen (10 mg/kg PO q 4-6 h prn, up to adult dose) for example, will treat the cause as well as the symptoms of ear pain, sore throat, and muscular pain.  Ibuprofen may be more effective than acetaminophen (paracetamol) for odontogenic pain (Bailey 2013).  For most applications, acetaminophen may be as effective; however, the combination of both NSAIDs is not likely to be more effective than either agent individually (Merry 2013). True migraine headache may be treated with all of the above, and rescue therapy may include prochlorperamide (0.15 mg/kg IV, up to 10 mg ) (Brousseau 2004), often given with diphenhydramine (1 mg/kg PO or IV, up to 50 mg) and IV fluids.  Ketoralac (0.5 mg/kg IV, up to 10 mg) may be substituted for ibuprofen (Paniyot 2016).  Other specific therapies may be considered, although evidence for them varies. Chest pain After ruling out important pulmonary (e.g. the under-recognized spontaneous pneumothorax) and cardiac (e.g. pericarditis, myocarditis) etiologies, many chest complaints are amenable to NSAIDs.  There is often a large component of anxiety in the child and/or parents in chest pain; no amount of medication will assuage them without addressing their concerns as well. Abdominal pain Abdominal pain in children is challenging, as it is common, often benign, but may be disastrous if the etiology is missed.  For mild pain, consider acetaminophen as indicated (15 mg/kg/dose q 4-6 h prn, up to 650 mg).  The oral route is preferred, but intravenous acetaminophen is an option for patients unable to tolerate PO, or for those in whom the per rectum (PR) route is contraindicated (e.g. neutropenia) (Babl 2011, Dokko 2014).  For children with moderate to severe abdominal pain in whom a nil per os (NPO) status is ideal, consider rehydration/volume repletion, and small, frequent aliquots of a narcotic agent.  Surgical pain is not “erased” by opioids (Thomas 2003, Poonai 2014); treating pain improves specificity to certain surgical emergencies with retained diagnostic accuracy (Manterola 2007).  If there is inter-departmental concern about prolonged effects, sedation, limitation in the physical exam, or there is a need to “see if the pain will come back”, you may opt to use fentanyl initially for its shorter half-life.  More frequent re-assessments may help the surgical team in its deliberations.  Transition quickly to a longer-acting opioid as soon as possible. Long-bone injuries Fracture pain should be addressed immediately with splinting and analgesia.  Oral, intranasal, and intravenous routes are all acceptable, depending on the severity of the injury and symptoms. Intranasal (IN) medications offer the advantage of a fast onset for moderate-to-severe pain (Graudins 2015), either as monotherapy or as a bridge to parenteral treatment (Table 4).  The ideal volume of IN medication is 0.25 mL/naris, with a maximum of 1 mL/naris.  Common concentrations of fentanyl limit its mg/kg use to the school-aged child; intranasal ketamine may be used for pain (i.e. sub-dissociative dose) up to adult weight. Long-bone injuries are a good opportunity to employ a speedy modality that requires little technical skill in administration: nebulized fentanyl.  Clinically significant improvement in pain scales are achieved with 3 mcg/kg/dose of fentanyl administered via standard nebulizer in children 3 years of age or older (Miner 2007, Furyk 2009).  Nebulized fentanyl is a rapid, non-invasive alternative to the IN route for older children, adolescents, or adults, in whom the volume of IN medication would exceed the recommended per naris volume (Deaton 2015). Consider an aggressive, multi-modal approach to control symptom up front.  For example, for a simple forearm fracture, you may opt to give an oral opioid, perform a hematoma block, and offer inhaled nitrous oxide for reduction, rather than a formal intravenous procedural sedation (Luhmann 2006). Ultrasound-guided peripheral nerve blocks are a good pain control adjunct, after initial treatment, and in communication with referring consultants (Ganesh 2009, Suresh 2014). Skin and Soft tissue Skin and soft tissue injuries or abscesses often require solid non-pharmacopoeia in addition to local anesthetics.  For IV cannulation, consider EMLA if the patient is stable and a minor delay is acceptable. Topical ethyl chloride vapo-coolant offers transient pain relief due to rapid cooling and may be used just prior to an IV start (Farion 2008).  Try this: engage your young child’s imagination to distract him and say, “have you ever held a snow ball? You are in luck – it’s just like that – here, do you feel it?”. Vibratory adjuncts such as the “BUZZY” bee can be placed near the IV cannulation site to provide mechanical and cognitive distraction (Moadad 2016). Needleless lidocaine injectors may facilitate IV placement without obscuring the target vein (Spanos 2008, Lunoe 2015).  The medication is propelled into the dermis by a CO2 cartridge that makes a loud popping sound; try this to alleviate anxiety, just before using it: “your skin looks thirsty – it needs a drink – there you are!”. As with any minor procedure, when you tell the child what you are doing, be sure to do it right away.  Do not delay or build suspense. Lidocaine-epinephrine-tetracaine gel (LET) is used for open or mucosal wounds.  Apply as soon as possible in the visit.  The goal of LET is to pretreat the wound to allow for a painless administration of injectable anesthetic.  A common practice to apply LET two or three times at 15-minute intervals for deeper anesthesia, in an attempt to avoid injection altogether.  Researchers are currently working to offer an evidence base to this anecdotal practice. Pediatric burns should be assessed carefully and treated aggressively.  Submersion of the affected extremity in room-temperature water (if possible) or applying room-temperature saline-soaked gauze will both thwart ongoing thermal damage, soothe the wound, and provide foundational first-aid.  Minor burns can be treated topically and with oral medications.  Major burns require IN, IM, or IV analgesics with morphine.  Treatment may escalate to ketamine (Gandhi 2010), in analgesic or dissociative dosing, depending on the context.  Post-traumatic disorders are common in burns; effective pain management is ever-more important in these cases. SPECIFIC SCENARIOS The child with chronic medical problems Children with acute exacerbations of their chronic pain or episodic painful crises require special attention.  Some examples of children with recurring pain are those suffering from sickle cell disease, juvenile idiopathic arthritis, complex regional pain syndrome, and cancer.  Find out whether these symptoms and circumstances are typical for them, and what regimen has helped in the past.  Previous unpleasant experiences may prime these children with amplified anxiety and perception of pain (Cornelissen 2014).  Target the disease process and do your best to show the patient and his family you understand his condition and needs. An equally challenging scenario is the child with chronic pain.  Treat the entire patient with a multimodal approach.  Limit opioids as possible.  As an opioid-sparing strategy or as rescue therapy, consider sub-dissociative ketamine, especially for conditions such as sickle cell crisis, complex regional pain syndrome, autoimmune disorders, or chronic pain due to sub-acute trauma (Sheehy 2015). Intranasal ketamine may be used for sub-dissociative pain control at 0.5 – 1 mg/kg (Andolfatto 2013, Yeaman 2013).  Intravenous infusions of ketamine at 0.1 – 0.3 mg/kg/h may be initiated in the ED and continued 4 – 8 h/d, up to a maximum of 16 h total in 3 consecutive days (Sheehy 2015).  In vaso-occlusive episodes, dexmedetomidine has been shown to be an effective adjunct for severe pain poorly responsive to opioids and/or ketamine (Sheehy 2015b). The child with cognitive impairment Children with cognitive impairment such as those with various genetic or metabolic syndromes, or primary neurologic conditions such as some with cerebral palsy are a challenge to assess and treat properly.  These children not only cannot explain their symptoms, but they also have atypical expressions of pain.  Pain responses in severely intellectually disabled children include a full-blown smile (which may or may not accompany inappropriate laughter), stiffening, and non-cooperation (Hadden 2002).  Other observed behaviors include the freezing phenomenon, in which the child acutely feels the pain, and he abruptly pauses without moving his face for several seconds.  Look also for episodes of unexplained pallor, diaphoresis, breath-holding, and shrill vocalizations. The FLACC has been revised (r-FLACC) for children with cognitive impairment and appears to be reliable for acute care (Malviya 2006). The most distressing and perplexing presentation is the parent who brings his or her child with cognitive impairment for “fussiness”, “irritability”, or “I think he’s in pain”.  Often, this is after significant investigations have been performed, sometimes repeatedly.  Poorly controlled spasticity is an often under-appreciated cause of unexplained pain; treat not with opioids, but with GABA-receptor agonists, such as baclofen or benzodiazepines. Take special precautions in the administration of opioids or benzodiazepines in children with metabolic disorders (e.g. mitochondrial disease) or various syndromes (e.g. Trisomy 21).  They may have a disproportionate reaction to the medication.  Start with a low dose in these children and reassess frequently, titrating in small aliquots as needed. After careful, meticulous investigation in the ED to rule out occult infection, trauma, electrolyte imbalance, or surgical causes, the child with cognitive impairment who continues to be symptomatic despite ED treatment may be admitted for observation.  However, in some cases, the addition of gabapentin to the typical regimen has been shown to manage unexplained irritability in these children (Hauer 2007) by treating visceral hyperalgesia. Multi-trauma The child with multi-trauma is in need of meticulous critical care.  Frequent assessments of pain analgesic response (typically via the intravenous route) are necessary to gauge the child’s trajectory.  Unexplained tachycardia may be the early signs of shock.  Without controlling the child’s pain, it is difficult to distinguish the extreme tachycardia from pain or from blood loss.  If intubated, control the pain first with a fentanyl drip, then use a sedative in addition as needed to keep him comfortable. The child under palliative care Children undergoing palliative care require a multidisciplinary approach.  This includes engaging the patient’s car team as well as “treating” members of the patient’s family.  Examples include the natural course of devastating chromosomal, neurologic, and other congenital conditions; terminal cancer; and trauma, among others (Michelson 2007).  Family dynamics and family members’ needs are often overlooked; the family as a whole must be considered.  Focus on the productive and beneficial treatments that can be offered.  Treat pain promptly, but speak with the parents about end-of-life goals as early as possible, as any analgesic or sedative may have an untoward effect.  You do not want to be caught in the position of potentially precipitously providing cardiopulmonary resuscitation in a child undergoing palliative care, because of a lack of understanding of how increasingly large doses of pain medications can affect breathing and circulation (AAP 2000). Children with ongoing opioid requirements may present not so much with an exacerbation of their chronic pain, but a complication of its treatment.  Identify, assess and aggressively treat constipation, nausea and vomiting, pruritus, and urinary retention (Friedrichsdorf 2007); treating side-effects of pain management may be just as important for quality of life as treating the pain itself. PEARLS AND PITFALLS IN PEDIATRIC PAIN Allow the child to speak for himself whenever possible.  After acknowledging the parent’s input, perhaps try “I want to make sure I understand how the pain is for you.  Tell me more.” Engage parents and communicate the plan to them.  Elicit their expectations, and give them of preview of what to expect in the ED. Opioids are meant for pain caused by acute tissue injury, for the briefest period of time feasible.  Older school-aged children and adolescents are increasingly at risk for opioid dependence and addiction. Premature infants present a challenge in pain control.  Their pain is under-recognized, as they often display atypical responses to painful stimuli.  Treatment is equally difficult, as they are particularly sensitive to analgesia-sedation.  This is important, as this group is even more likely to undergo painful procedures due to their higher-risk status. Give detailed advice on how to manage pain at home.  Set expectations.  Let them know you understand and will help them through your good advice that will carry them through this difficult time.  Patients and families often just need a plan.  Map it out clearly. SUMMARY In pediatric acute pain, know the child; know the family; and know the physiology. Use your observational skills enhanced with collateral information to assess and reassess for pain in children. Treat pediatric pain well and often. Failure to address the child’s pain has long-lasting consequences. Non-pharmacologic treatments for all, pharmacologic treatments for many. A multi-modal approach is the most effective. Neonates, infants and toddlers, and school-aged children and adolescents exhibit specific physiology in expression of pain and in response to treatment. Tailor your regimen to your young patient’s physiologic pitfalls and needs. References American Academy of Pediatrics. Committee on Bioethics and Committee on Hospital Care. Palliative care for children. Pediatrics. 2000 Aug;106(2 Pt 1):351-7. Andolfatto G, Willman E, Joo D, Miller P, Wong WB, Koehn M, Dobson R, Angus E, Moadebi S. Intranasal ketamine for analgesia in the emergency department: a prospective observational series. Acad Emerg Med. 2013 Oct;20(10):1050-4. Babl FE, Theophilos T, Palmer GM. Is there a role for intravenous acetaminophen in pediatric emergency departments? Pediatr Emerg Care. 2011 Jun;27(6):496-9. Bailey E, Worthington HV, van Wijk A, Yates JM, Coulthard P, Afzal Z. Ibuprofen and/or paracetamol (acetaminophen) for pain relief after surgical removal of lower wisdom teeth.Cochrane Database Syst Rev. 2013 Dec 12;(12):CD004624. Bearden DJ, Feinstein A, Cohen LL. The influence of parent preprocedural anxiety on child procedural pain: mediation by child procedural anxiety. J Pediatr Psychol. 2012 Jul;37(6):680-6. Berde CB, Sethna NF. Analgesics for the treatment of pain in children. N Engl J Med. 2002 Oct 3;347(14):1094-103. Brousseau DC, Duffy SJ, Anderson AC, Linakis JG. Treatment of pediatric migraine headaches: a randomized, double-blind trial of prochlorperazine versus ketorolac. Ann Emerg Med. 2004 Feb;43(2):256-62. Ciszkowski C, Madadi P, Phillips MS, Lauwers AE, Koren G. Codeine, ultrarapid-metabolism genotype, and postoperative death. N Engl J Med. 2009 Aug 20;361(8):827-8. Cornelissen L, Donado C, Kim J, Chiel L, Zurakowski D, Logan DE, Meier P, Sethna NF, Blankenburg M, Zernikow B, Sundel RP, Berde CB. Pain hypersensitivity in juvenile idiopathic arthritis: a quantitative sensory testing study. Pediatr Rheumatol Online J. 2014 Sep 6;12:39. Crews KR, Gaedigk A, Dunnenberger HM, Leeder JS, Klein TE, Caudle KE, Haidar CE, Shen DD, Callaghan JT, Sadhasivam S, Prows CA, Kharasch ED, Skaar TC; Clinical Pharmacogenetics Implementation Consortium. Clinical Pharmacogenetics Implementation Consortium guidelines for cytochrome P450 2D6 genotype and codeine therapy: 2014 update. Clin Pharmacol Ther. 2014 Apr;95(4):376-82. Deaton T, Auten JD, Darracq MA. Nebulized fentanyl vs intravenous morphine for ED patients with acute abdominal pain: a randomized double-blinded, placebo-controlled clinical trial. Am J Emerg Med. 2015 Jun;33(6):791-5. Dokko D. Best practice for fever management with intravenous acetaminophen in pediatric oncology. J Pediatr Oncol Nurs. 2015 Mar-Apr;32(2):120-5. Farion KJ, Splinter KL, Newhook K, Gaboury I, Splinter WM. The effect of vapocoolant spray on pain due to intravenous cannulation in children: a randomized controlled trial. CMAJ. 2008 Jul 1;179(1):31-6. Finley GA, Kristjánsdóttir O, Forgeron PA. Cultural influences on the assessment of children's pain. Pain Res Manag. 2009 Jan-Feb;14(1):33-7. Friedrichsdorf SJ, Kang TI. The management of pain in children with life-limiting illnesses. Pediatr Clin North Am. 2007 Oct;54(5):645-72. Furyk JS, Grabowski WJ, Black LH. Nebulized fentanyl versus intravenous morphine in children with suspected limb fractures in the emergency department: a randomized controlled trial. Emerg Med Australas. 2009 Jun;21(3):203-9. Gandhi M, Thomson C, Lord D, Enoch S.  Management of Pain in Children with Burns. Int J Pediatr. 2010; 2010: 825657. Ganesh A, Gurnaney HG. Ultrasound guidance for pediatric peripheral nerve blockade. Anesthesiol Clin. 2009 Jun;27(2):197-212. Graudins A, Meek R, Egerton-Warburton D, Oakley E, Seith R. The PICHFORK (Pain in Children Fentanyl or Ketamine) trial: a randomized controlled trial comparing intranasal ketamine and fentanyl for the relief of moderate to severe pain in children with limb injuries. Ann Emerg Med. 2015 Mar;65(3):248-254.e1. Hadden KL, von Baeyer CL. Pain in children with cerebral palsy: common triggers and expressive behaviors. Pain. 2002 Sep;99(1-2):281-8. Harrison D, Bueno M, Yamada J, Adams-Webber T, Stevens B. Analgesic effects of sweet-tasting solutions for infants: current state of equipoise. Pediatrics. 2010 Nov;126(5):894-902. Hauer JM, Wical BS, Charnas L. Gabapentin successfully manages chronic unexplained irritability in children with severe neurologic impairment. Pediatrics. 2007 Feb;119(2):e519-22. Horeczko T, Mahmoud MA. The sedation mindset: philosophy, science, and practice. Curr Opin Anaesthesiol. 2016 Feb;29 Suppl 1:S48-55. Howard RF. Current status of pain management in children. JAMA. 2003 Nov 12;290(18):2464-9. Keck JF, Gerkensmeyer JE, Joyce BA, Schade JG. Reliability and validity of the Faces and Word Descriptor Scales to measure procedural pain. J Pediatr Nurs. 1996 Dec;11(6):368-74. Krechel SW, Bildner J. CRIES: a new neonatal postoperative pain measurement score. Initial testing of validity and reliability. Paediatr Anaesth. 1995;5(1):53. Lawrence J, Alcock D, McGrath P, Kay J, MacMurray SB, Dulberg C. The development of a tool to assess neonatal pain. Neonatal Netw. 1993;12(6):59–66. Liebelt EL. Assessing children's pain in the emergency department. Clin Pediatr Emerg Med. 2000; 1(4):260-269. Luhmann JD, Schootman M, Luhmann SJ, Kennedy RM. A randomized comparison of nitrous oxide plus hematoma block versus ketamine plus midazolam for emergency department forearm fracture reduction in children. Pediatrics. 2006 Oct;118(4):e1078-86. Lunoe MM, Drendel AL, Levas MN, Weisman SJ, Dasgupta M, Hoffmann RG, Brousseau DC. A Randomized Clinical Trial of Jet-Injected Lidocaine to Reduce Venipuncture Pain for Young Children. Ann Emerg Med. 2015 Nov;66(5):466-74. Malviya S, Voepel-Lewis T, Burke C, Merkel S, Tait AR. The revised FLACC observational pain tool: improved reliability and validity for pain assessment in children with cognitive impairment. Paediatr Anaesth. 2006 Mar;16(3):258-65. Manterola C, Astudillo P, Losada H, Pineda V, Sanhueza A, Vial M. Analgesia in patients with acute abdominal pain. Cochrane Database Syst Rev. 2007 Jul 18;(3):CD005660. Maxwell LG, Malavolta CP, Fraga MV. Assessment of pain in the neonate. Clin Perinatol. 2013 Sep;40(3):457-69. Merry AF, Edwards KE, Ahmad Z, Barber C, Mahadevan M, Frampton C. Randomized comparison between the combination of acetaminophen and ibuprofen and each constituent alone for analgesia following tonsillectomy in children. Can J Anaesth. 2013 Dec;60(12):1180-9. Michelson KN, Steinhorn DM. Pediatric End-of-Life Issues and Palliative Care. Clin Pediatr Emerg Med. 2007 Sep; 8(3): 212–219. Miner JR, Kletti C, Herold M, Hubbard D, Biros MH. Randomized clinical trial of nebulized fentanyl citrate versus i.v. fentanyl citrate in children presenting to the emergency department with acute pain. Acad Emerg Med. 2007 Oct;14(10):895-8. Moadad N, Kozman K1, Shahine R, Ohanian S, Badr LK. Distraction Using the BUZZY for Children During an IV Insertion. J Pediatr Nurs. 2016 Jan-Feb;31(1):64-72. Patniyot IR, Gelfand AA. Acute Treatment Therapies for Pediatric Migraine: A Qualitative Systematic Review. Headache. 2016 Jan;56(1):49-70. Pasero C, McCaffery M. Pain Assessment and Pharmacologic Management. St. Louis, Mo: Mosby; 2011. Piaget J. Judgment and reasoning in the child. Harcourt & Brace. Oxford, England. 1928. Poonai N, Paskar D, Konrad SL, Rieder M, Joubert G, Lim R, Golozar A, Uledi S, Worster A, Ali S. Opioid analgesia for acute abdominal pain in children: A systematic review and meta-analysis. Acad Emerg Med. 2014 Nov;21(11):1183-92. Racoosin JA, Roberson DW, Pacanowski MA, Nielsen DR. New evidence about an old drug--risk with codeine after adenotonsillectomy. N Engl J Med. 2013 Jun 6;368(23):2155-7. Sheehy KA, Muller EA, Lippold C, Nouraie M, Finkel JC, Quezado ZM. Subanesthetic ketamine infusions for the treatment of children and adolescents with chronic pain: a longitudinal study. BMC Pediatr. 2015 Dec 1;15:198. Sheehy KA, Finkel JC, Darbari DS, Guerrera MF, Quezado ZM. Dexmedetomidine as an Adjuvant to Analgesic Strategy During Vaso-Occlusive Episodes in Adolescents with Sickle-Cell Disease. Pain Pract. 2015 Nov;15(8):E90-7. Sheppard JL. The application of Piaget's theory to physiotherapy. Aust J Physiother. 1977 Dec;23(4):133-40. Spanos S, Booth R, Koenig H, Sikes K, Gracely E, Kim IK. Jet Injection of 1% buffered lidocaine versus topical ELA-Max for anesthesia before peripheral intravenous catheterization in children: a randomized controlled trial. Pediatr Emerg Care. 2008 Aug;24(8):511-5. Srouji R, Ratnapalan S, Schneeweiss S. Pain in children: assessment and nonpharmacological management. Int J Pediatr. 2010;2010. Stevens B, Yamada J, Lee GY, Ohlsson A. Sucrose for analgesia in newborn infants undergoing painful procedures. Cochrane Database of Systematic Reviews 2013, Issue 1. Art. No.: CD001069. Suresh S, Sawardekar A, Shah R. Ultrasound for regional anesthesia in children. Anesthesiol Clin. 2014 Mar;32(1):263-79. Taddio A, Shah V, Gilbert-MacLeod C, Katz J. Conditioning and hyperalgesia in newborns exposed to repeated heel lances. JAMA. 2002;288(7):857. Thomas SH, Silen W. Effect on diagnostic efficiency of analgesia for undifferentiated abdominal pain. Br J Surg. 2003 Jan;90(1):5-9. Tomlinson D, von Baeyer CL, Stinson JN, Sung L. A systematic review of faces scales for the self-report of pain intensity in children. Pediatrics. 2010 Nov;126(5):e1168-98. Tsze DS, von Baeyer CL, Bulloch B, Dayan PS. Validation of Self-Report Pain Scales in Children. Pediatrics. 2013 Oct; 132(4): e971–e979. Voepel-Lewis T, Merkel S, Tait AR, Trzcinka A, Malviya S. The reliability and validity of the Face, Legs, Activity, Cry, Consolability observational tool as a measure of pain in children with cognitive impairment. Anesth Analg. 2002 Nov;95(5):1224-9. Yeaman F, Oakley E, Meek R, Graudins A. Sub-dissociative dose intranasal ketamine for limb injury pain in children in the emergency department: a pilot study. Emerg Med Australas. 2013 Apr;25(2):161-7   This post and podcast are dedicated to Sergey M. Motov, MD, FAAEM, for his integrity, hard-won expertise, humility, and innovation.  Thank you for making us better doctors, Sergey, and for getting us ever closer to a pain-free ED. Pediatric Pain Powered by #FOAMed -- Tim Horeczko, MD, MSCR, FACEP, FAAP

Kim J. Schofield, a health advocate and lobbyist, global speaker with the Lupus Foundation of America, Georgia Chapter and founder of lupus patient network known as LACES.  As a person living with lupus, Kim advocate for people, friends and caregivers impacted by lupus. She strives to bring lupus to the forefront in the legislative, medical and research communities. Her passion helps us take lupus from a “Whisper to a Shout.” She holds a federal appointment to the Health IT Policy Committee and works to make recommendations to the National Coordinator for Health IT. With 15 years in coaching, teaching, workshops and seminars facilitation, her professional career spans across healthcare, financial and non-profit agencies. . Kim holds a Bachelors and Masters in Theology and Organizational Leadership.  In 2017, she will hold her doctorate from Oral Roberts University. She has written several articles and has been a reoccurring guest on several television, radio and internet stations.I’m the founder of Lost Creek Chiropractic and Chriro Team Training. The goal of Chiro Team Training is to present a relevant training system that a Chiropractic Office – or any medical office – can implement without hassles with a tremendous amount of benefit to the profitability of the office. I’m also a John Maxwell certified coach, speaker and trainer and have partnered with many entrepreneurs, companies, individuals, and office teams to create wind on their backs as they journey toward greater and greater successes. Visit me at: http://www.docrump.com

Kim J. Schofield, a health advocate and lobbyist, global speaker with the Lupus Foundation of America, Georgia Chapter and founder of lupus patient network known as LACES.  As a person living with lupus, Kim advocate for people, friends and caregivers impacted by lupus. She strives to bring lupus to the forefront in the legislative, medical and research communities. Her passion helps us take lupus from a “Whisper to a Shout.” She holds a federal appointment to the Health IT Policy Committee and works to make recommendations to the National Coordinator for Health IT. With 15 years in coaching, teaching, workshops and seminars facilitation, her professional career spans across healthcare, financial and non-profit agencies. . Kim holds a Bachelors and Masters in Theology and Organizational Leadership.  In 2017, she will hold her doctorate from Oral Roberts University. She has written several articles and has been a reoccurring guest on several television, radio and internet stations.I’m the founder of Lost Creek Chiropractic and Chriro Team Training. The goal of Chiro Team Training is to present a relevant training system that a Chiropractic Office – or any medical office – can implement without hassles with a tremendous amount of benefit to the profitability of the office. I’m also a John Maxwell certified coach, speaker and trainer and have partnered with many entrepreneurs, companies, individuals, and office teams to create wind on their backs as they journey toward greater and greater successes. Visit me at: http://www.docrump.com