Podcasts about kreb

In this episode, Dr. Adam Rinde sits down with integrative medicine specialist Dr. Carla Kuon from University of California San Francisco (UCSF) to explore the latest insights into long COVID, chronic fatigue syndrome, and post-viral illnesses. Dr. Kuon shares powerful breakthroughs from her clinical work and research—especially around mitochondrial health and how overlooked deficiencies in riboflavin (B2) and iron (ferritin) can disrupt the body's energy systems.You'll learn how chronic inflammation, nervous system dysregulation, and “bad programming” in the brain are key components of these conditions—and how holistic strategies like nutrient therapy, mindfulness, and vagus nerve stimulation are helping patients recover.Whether you're a patient, provider, or just curious about the future of functional medicine, this conversation is full of takeaways and hope.

This Real Science Exchange podcast episode was recorded during a webinar from Balchem's Real Science Lecture Series. You can find it at balchem.com/realscience.Dr. Baumgard begins with an overview of the structure and function of the gastrointestinal tract. More than 75% of an animal's immune system resides in the gut. The focus of this webinar is how heat stress initiates leaky gut, how that leaky gut then influences the immune and hormonal systems, and ultimately, how that reduces productivity. (0:22)Dr. Baumgard compares the metabolism of a cow 200 days in milk to a cow 10 days in milk. The 200-day cow is experiencing ad libitum intake and gaining weight. Her insulin levels would be high, and NEFAs would be low. On the other hand, the 10-day cow is experiencing suboptimal intake, and her insulin levels are the lowest they'll ever be during the production cycle. Body tissue is mobilized, and NEFAs will increase. Research shows it takes 72 grams of glucose to make one kilogram of milk. Any disruption to the gluconeogenic pathway has the potential to decrease milk yield. (6:38)Heat stress is estimated to cost the US dairy industry $1.7 billion each year. Regardless of climate change, heat stress will continue to be an issue because all economically important phenotypes in animal agriculture are heat-producing processes. Dr. Baumgard's lab has been investigating the biology of heat stress to implement more effective mitigation strategies. (9:09)How much of the reduction in feed intake during heat stress explains the reduction in milk yield? A pair-feeding experiment comparing thermoneutral to heat-stressed cows showed that about 50% of the reduction in milk yield during a heat wave is due to a reduction in feed intake. The thermoneutral cows lost weight in response to decreased intake, and their NEFAs increased. Heat-stressed cows did not have an increase in NEFA. Heat-stressed animals fail to mobilize adipose tissue despite their endocrine profile predicting that they should. However, insulin is high when we would expect it to be low, and that response to heat stress is highly conserved in all species. (10:43)Heat-stressed cows produced about 400 grams less lactose per day than their pair-fed thermoneutral controls. This is nearly a pound! Is the liver producing 400 fewer grams of glucose each day? Or is some other extramammary tissue using more glucose per day? Dr. Baumgard's work suggests that the immune system is where the 400 grams of glucose go in heat-stressed animals. During heat stress, vasodilation at the body surface occurs, with concomitant vasoconstriction in the gut. The gut epithelium is very sensitive to reduced oxygen delivery that would result from the vasoconstriction, and tight junction proteins do not function properly, resulting in a leaky gut. This results in an infiltration of antigens into the body, which causes an immune response.  (15:36)Dr. Baumgard details how insulin fits into these immune responses via the Warburg effect. An activated immune cell prefers glucose and needs it in high quantities. The activated cell switches from the Kreb's cycle to generate ATP to aerobic glycolysis. This requires high insulin. The immune system requires approximately one gram of glucose per kilogram of metabolic body weight per hour. (25:03)By far, the biggest impact a dairy producer can make to alleviate heat stress is to modify the environment physically: shade, fans, soakers, misters, etc. Investing in cooling cows improves production efficiency and profitability, summer fertility, animal welfare and health, and sustainability. Other important heat abatement considerations include adequate water availability, reducing walking distance to the parlor and time in the holding pen, and improving ventilation. Dry cows should also be part of any heat abatement strategy, as the benefits of cooling dry cows extends far into lactation. Dr. Baumgard also discusses different dietary management strategies for heat stress situations. (32:43)In summary, heat stress decreases almost every metric of productivity and costs everyone in the industry. Reduced feed intake is only part of the problem. Heat-induced leaky gut results in biological consequences incredibly similar to any other immune activation, such as mastitis or metritis. For dairy producers, heat stress abatement should by far be their biggest priority. Once those infrastructure improvements are in place, dietary interventions are another good strategy to minimize the negative consequences of heat stress. (47:43)Dr. Baumgard takes questions from the webinar audience. (49:22)Please subscribe and share with your industry friends to invite more people to join us at the Real Science Exchange virtual pub table.  If you want one of our Real Science Exchange t-shirts, screenshot your rating, review, or subscription, and email a picture to anh.marketing@balchem.com. Include your size and mailing address, and we'll mail you a shirt.

Mastering nonverbal communication can be an elusive task, but the fact remains: what's unsaid leaves a significant footprint in any interaction. Nowhere is this more palpable than in the medical exam room, where trust and connection between physicians and patients often hinge on subtle, nonverbal cues.So, how can one build trust through facial expressions and tone of voice alone?In this episode, we break down how to silently establish rapport, effective use of pauses, the curious role of your eyebrows, impact of end-of-sentence inflection, how to convey uncertainty with confidence, and why learning a patient's eye color can pay dividends.

Join Pacific Mammal Research (PacMam) scientists to learn about different marine mammals each episode! We discuss a little about the biology, behavior and fun facts about each species. Have fun and learn about marine mammals with PacMam! Donate today: https://donorbox.org/donatetopacmamwww.pacmam.org This week: Irrawaddy dolphin Presenters: Cindy Elliser, Katrina MacIver Music by Josh Burns Sources: https://www.marinebio.org/species/irrawaddy-dolphins/orcaella-brevirostris/#:~:text=Irrawaddy%20dolphins%2C%20Orcaella%20brevirostris%2C%20are,sub%2Dtropical%20Indo%2DPacific. https://www.riverdolphins.org/river-dolphins-worldwide/irrawaddy-dolphin/ New Research • Habitat modeling in Thailand Jackson Ricketts et al 2020 - https://repository.library.noaa.gov/view/noaa/28594 • Long term population and distribution dynamic in Inodonesia and effects of coastal development, Kreb et al. 2020 - https://www.frontiersin.org/journals/marine-science/articles/10.3389/fmars.2020.533197/full • ID habitat characteristics and crucial areas Peter et al. 2016 - https://link.springer.com/chapter/10.1007/978-3-319-26161-4_15 • Surviving ware and crowded world – in largest brackish water lagoon, Acharyya et al 2023 - https://link.springer.com/article/10.1007/s11852-023-00982-8 • Demographic collapse and low genetic diversity in Mekong river, Krutzen et al 2018- https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0189200

During Australia's duck season "circus," anti-hunters will flare your birds, paddle through your decoys and film your kids, reports Outdoor Life Executive Editor, Natalie Krebs. Having heard about the duck hunting battleground that is Australia, she went to see for herself. She was there during the most recent duck season opener. And while Kreb's first-hand accounts may seem otherworldly to us made-in-American duck hunters, she describes how it may not be nearly as far away as we'd like to think.   Related Links: During Australia's Duck Season ‘Circus' Anti-Hunting Activists Will Steal Your Birds, Paddle Through Your Decoys, and Film Your Kids (Outdoor Life, June 19, 2024) https://www.outdoorlife.com/hunting/australia-duck-season/     Visit MOJO's Duck Season Somewhere Podcast Sponsors:   MOJO Outdoors  Benelli Shotguns BOSS Shotshells Ducks Unlimited  Flash Back Decoys  HuntProof Premium Waterfowl App Inukshuk Professional Dog Food  Tetra Hearing Tom Beckbe Voormi GetDucks.com USHuntList.com     Please subscribe, rate and review Duck Season Somewhere podcast. Business inquiries and comments contact Ramsey Russell ramsey@getducks.com

Episode 31: Biochem of Sports Nutrition | Cauliflower Taco Meat Welcome to the Diet NPO Podcast! Your pod for RD Exam and nutrition questions. Come listen this week as we discuss Biochemistry of Sports Nutrition combined with practice questions and some Cauliflower Taco Meat! 1. If an athlete is training and develops a higher VO2 max, they would be relying more on which of the following processes? A. Anaerobic Glycolysis B. Lactic Acid Cycle  C. Creatine-Phosphate Pathway  D. Aerobic Glycolysis 2. Under anaerobic conditions, pyruvate can be converted into ______ through the Cori Cycle and can then be converted to ______ through gluconeogenesis. :  A. Lactate, Acetyl CoA B. Acetyl CoA, Glucose C. Lactate, Glucose D. Acetyl CoA, NADH 3. The pathway of aerobic metabolism that is producing the most amount of ATP through NADH and FADH intermediates, is known as the ________. A. Kreb's Cycle B. Citric Acid Cycle C. Aerobic Glycolysis D. Electron Transport Chain DM for your RD Exam tutoring needs! Instagram: @zak_snacks Threads: @zak_snacks Youtube: Zak Kaesberg MS, RDN

Dr. Bradley Block is an ENT physician (M.D.) who has a podcast to teach doctors "things they should have been learning while they were studying the Kreb's Cycle."  Dr. Block reached out to us to discuss what Osteopathic Medicine is and what the differences between "Allopathic" or M.D. degrees and "Osteopathic" or D.O. degrees were.  For those of you who are not already familiar with what the D.O. difference is. . . Dr. Block's interview with Dr. Storch's  will help answer many of your questions!

A New York Wiseguy and a Philly Punk walk into a Caddyshack with “ginned-up mobsters”… Frank sits down with the inimitable John Reilly, Director of Agronomy at The Resort at Longboat Key and discusses John's thinking on managing resort golf in an environmentally sensitive area and why he will sometimes discuss the Kreb's Cycle. John's pioneering work on the use of data and his interest in sharing and learning and failing and growing are a model for modern professionals in the golf turf industry. As always, this is a fun listen!

Happy New Year! Excited to kickstart 2024 with a focus on creating a sustainable clinical day by prioritizing life outside of medicine. In this special episode, we are replaying one of our top episodes of 2023, featuring Dr. Bradley Block who joins us to discuss how to engineer better office visits. Dr. Bradley Block, a private practice otolaryngologist who also hosts the “Physician's Guide to Doctoring” podcast. Dr. Block shared some amazing insights on how to engineer better office visits by exploring communication tools. Here are three key takeaways: 1️⃣ Identify the question behind the question: Dr. Block believes this is crucial for a more efficient and better patient experience. He shared that patients may not be aware of their actual question or may not ask it directly. Therefore, asking open-ended questions like “What about this worries you?” can help identify the real question. 2️⃣ Improve communication: Dr. Block emphasized the importance of patients liking and trusting their doctor to successfully treat them. Humour can also improve patient outcomes and make a practice more sustainable. 3️⃣ Personal values: Dr. Block discussed the importance of doctors finding a balance between serving patients and taking care of themselves. Personal values should align with the schedule and doctors should avoid burnout and becoming too selfish. Check out the full episode to learn more about Dr. Block's insights to better patient care and office visits. Dr. Bradley Block Bio: Bradley Block, MD, is a private practice otolaryngologist on Long Island, New York, where he lives with his wife and three young sons. He is a partner at ENT and Allergy Associates and creator of the Physician's Guide to Doctoring Podcast. He realized that rapport was the key to gaining trust, seeing patients efficiently, enjoying his practice, and building his reputation. He tried to find a podcast that would help him improve at doctor-patient communication, but there was none, so he created Physician's Guide to Doctoring! The topics quickly expanded to “everything we should have been learning while we were memorizing Kreb's Cycle,” and it is now a practical guide for practicing physicians, physicians-in-training and all allied health professionals. He is available as a keynote speaker on improving the patient experience, doctor-patient communication, and running office-hours efficiently. Website: https://www.physiciansguidetodoctoring.com Would you like to view a transcript of this episode? Click here -------------- **** Charting Champions is a premiere, lifetime access Physician only program that is helping Physicians get home with today's work done. All the proven tools, support and community you need to create time for your life outside of medicine. Learn more at https://www.chartingcoach.ca **** Enjoying this podcast? Please share it with someone who would benefit. Also, don't forget to hit “follow” so you get all the new episodes as soon as they are released. **** Come hang out with me on Facebook or Instagram. Follow me @chartingcoach to get more practical tools to help you create sustainable clinical medicine in your life. **** Questions? Comments? Want to share how this podcast has helped you? Shoot me an email at admin@reachcareercoaching.ca. I would love to hear from you.

The Neurophilia Podcast is back after a mid Season 2 hiatus! We are joined by the phenomenally brilliant and unbelievably kind, Dr. Joshua Budhu to discuss his journey to medicine, the subspecialty of neuro-oncology, and the intersection between health equity and cancer care. Listen to the full episode to figure out Dr. Budhu's favorite New York pizza spot and why he loves the Kreb's Cycle so much! Dr. Joshua Budhu is a neuro-oncologist and the inaugural Nichols Biondi Diversity Clinical Scientist Faculty Scholar at Memorial Sloan Kettering Cancer Center. He is a health equity scholar and develops interventions to improve access to care and mitigate health disparities. Dr. Budhu is also the Diversity, Equity, and Inclusion section editor for Neurology. Follow Dr. Joshua Budhu  on Twitter @joshuabudhuFollow the Neurophilia Podcast on Twitter and Instagram @NeurophiliaPodFollow Dr. Nupur Goel on Twitter @mdgoelsFollow Dr. Blake Buletko on Twitter @blakebuletkoSupport the show

This is an episode about optimization, opportunity, overwhelm, and discovering the why  for which we do the things that we do.It was such a pleasure to be joined for this episode by Dr. Bradley Block, a private practice otolaryngologist based in Long Island, NY, and the creator of the Physician's Guide to Doctoring Podcast. Shortly after starting his tenure at ENT and Allergy Associates, he realized that rapport was the key to gaining trust, seeing patients efficiently, enjoying his practice, and building his reputation. He tried to find a podcast that would help his improve at doctor-patient communication, but he came up blank, so he created Physician's Guide to Doctoring. His podcast focuses on topics that we, as physicians "should have been learning instead of memorizing the Kreb's Cycle," at it serves as a practical guide for physicians and other health professionals alike.In this episode, we talk about how his introduction to the concept of "social engineering" helped him to optimize his medical practice and planted the seeds for his podcast. We also get into the moments of "whelm" and "overwhelm" that he has experienced throughout his career as a result of the seemingly endless sea of opportunities that cross the paths of physician entrepreneurs. And we round the episode out by talking about how he has learned (or is still learning) to manage the overwhelm while staying true to what is important to him.For more information about Dr. Block's work, be sure to check out any of the links below:ENT and Allergy AssociatesPhysicians Guide to Doctoring WebsiteInstagramFacebookLinkedInYouTube Support the showTo learn more about my coaching practice and group offerings, head over to www.healthierforgood.com. I help Physicians and Allied Health Professional women to let go of toxic perfectionist and people-pleasing habits that leave them frustrated and exhausted. If you are ready to learn skills that help you set boundaries and prioritize yourself, without becoming a cynical a-hole, come work with me.

I've selected 2 key metabolic ingredients, Acetyl CoA and Citrate, to explain nutrition metabolism in further detail. I've also selected a different storyline, the mitochondrial amusement park and the Kreb's merry-go-round, to help you visualize some of the most fundamental steps of metabolism. In this episode we cover: Acetyl CoA's role as a key metabolic conductor The metabolic merry-go-round used to explain Kreb's cycle The importance of the Citrate sensor in switching between anabolism and catabolism How these concepts are tied to the root cause for weight gain and insulin resistance A critique of B-vitamin supplements as "energy producers"

In this episode of the Sustainable Clinical Medicine Podcast, we had the pleasure of hosting Dr. Bradley Block, a private practice otolaryngologist who also hosts the “Physician's Guide to Doctoring” podcast. Dr. Block shared some amazing insights on how to engineer better office visits by exploring communication tools. Here are three key takeaways: 1️⃣ Identify the question behind the question: Dr. Block believes this is crucial for a more efficient and better patient experience. He shared that patients may not be aware of their actual question or may not ask it directly. Therefore, asking open-ended questions like “What about this worries you?” can help identify the real question. 2️⃣ Improve communication: Dr. Block emphasized the importance of patients liking and trusting their doctor to successfully treat them. Humor can also improve patient outcomes and make a practice more sustainable. 3️⃣ Personal values: Dr. Block discussed the importance of doctors finding a balance between serving patients and taking care of themselves. Personal values should align with the schedule and doctors should avoid burnout and becoming too selfish. Check out the full episode to learn more about Dr. Block's insights to better patient care and office visits. Meet Dr. Bradley Block Bradley Block, MD, is a private practice otolaryngologist on Long Island, New York, where he lives with his wife and three young sons. He is a partner at ENT and Allergy Associates and creator of the Physician's Guide to Doctoring Podcast. He realized that rapport was the key to gaining trust, seeing patients efficiently, enjoying his practice, and building his reputation. He tried to find a podcast that would help him improve at doctor-patient communication, but there was none, so he created Physician's Guide to Doctoring! The topics quickly expanded to “everything we should have been learning while we were memorizing Kreb's Cycle,” and it is now a practical guide for practicing physicians, physicians-in-training and all allied health professionals. He is available as a keynote speaker on improving the patient experience, doctor-patient communication, and running office-hours efficiently Website: https://www.physiciansguidetodoctoring.com Would you like to view a transcript of this episode? Click here -------------- **** Charting Champions is a premiere, lifetime access Physician only program that is helping Physicians get home with today's work done. All the proven tools, support and community you need to create time for your life outside of medicine. Learn more at https://www.chartingcoach.ca **** Enjoying this podcast? Please share it with someone who would benefit. Also, don't forget to hit “follow” so you get all the new episodes as soon as they are released. **** Come hang out with me on Facebook or Instagram. Follow me @chartingcoach to get more practical tools to help you create sustainable clinical medicine in your life. **** Questions? Comments? Want to share how this podcast has helped you? Shoot me an email at admin@reachcareercoaching.ca. I would love to hear from you.

Now, let's break down the Krebs cycle into its key stages and highlight the main reactions that take place: Acetyl-CoA Formation: The cycle begins when a two-carbon molecule called acetyl-CoA combines with a four-carbon molecule called oxaloacetate, forming a six-carbon molecule known as citrate. This step is catalyzed by the enzyme citrate synthase. Citrate Isomerization: The citrate molecule then undergoes a series of rearrangements, resulting in its isomerization into isocitrate. This conversion is facilitated by the enzyme aconitase. Listen to learn more! --- Support this podcast: https://podcasters.spotify.com/pod/show/healthfacts/support

Tune in on Monday, 5/1/23, for a brand new episode of The Doctor Whisperer Show featuring Otolaryngologist and host of the Physician's Guide to Doctoring Podcast, Dr. Bradley Block. ▪︎ ▪︎ ▪︎ ︎ A︎BOUT OUR GUEST: Bradley Block, MD, is a private practice otolaryngologist on Long Island, New York, where he lives with his wife and three young sons. He is a partner at ENT and Allergy Associates and creator of the Physician's Guide to Doctoring Podcast. He realized that rapport was the key to gaining trust, seeing patients efficiently, enjoying his practice, and building his reputation. He tried to find a podcast that would help him improve at doctor-patient communication, but there was none, so he created Physician's Guide to Doctoring! The topics quickly expanded to “everything we should have been learning while we were memorizing Kreb's Cycle,” and it is now a practical guide for practicing physicians, physicians-in-training and all allied health professionals. He is available as a keynote speaker on improving the patient experience, doctor-patient communication, and running office-hours efficiently. @physiciansguide on Instagram and Twitter https://www.linkedin.com/in/bradley-block-md-1712a6127/ Podcast website: PhysiciansGuidetoDoctoring.com ▪︎ ▪︎ ▪︎ Please join us in welcoming our new show sponsor, SRA 831b Admin! This agency strengthens businesses with an 831(b) Plan and helps doctors navigate tax deferrals today to address tomorrow's risks. Collectively, we want to help the professionals that ultimately risk so much to save our lives and offer some peace of mind. If you are a physician that is seeking financial stability within your practice, please check out SRA 831(b) Admin... you won't regret it. Learn more: http://831b.com --- Send in a voice message: https://podcasters.spotify.com/pod/show/thedoctorwhisperer/message

Dr. Kevin Mailo welcomes Dr. Bradley Block, otolaryngologist and host of the podcast ‘Physician's Guide to Doctoring' to the show for a discussion on using humour and setting boundaries in private practice. Dr. Block has a wealth of insight that he happily shares.Dr. Block shares a rule he received from Scott Dikkers, founder of The Onion, on not punching down in using humour. The role of humour is to “comfort the afflicted and afflict the comfortable” and he shares examples of what that looks like in practice as a physician. Humour is a great way to increase rapport with patients and get them into a more relaxed state.In this episode, Kevin Mailo and guest Brad Block talk about humour and how best to use it with patients, the flip side of how to carefully deliver bad news, why body language and non-verbal cues matter when interacting with patients, and how to draw important boundaries in private practice. While the instinct is to give everything to patients, a firm boundary for yourself and your self-care is vital to maintaining positive engagement with patients. This episode is both entertaining and enlightening.About Dr. Bradley Block:Bradley Block, MD, is a private practice otolaryngologist on Long Island, New York, where he lives with his wife and three young sons. He is a partner at ENT and Allergy Associates and creator of the Physician's Guide to Doctoring Podcast.He realized that rapport was the key to gaining trust, seeing patients efficiently, enjoying his practice, and building his reputation. He tried to find a podcast that would help him improve at doctor-patient communication, but there was none, so he created Physician's Guide to Doctoring! The topics quickly expanded to “everything we should have been learning while we were memorizing Kreb's Cycle,” and it is now a practical guide for practicing physicians, physicians-in-training and all allied health professionals. He is available as a keynote speaker on improving the patient experience, doctor-patient communication, and running office-hours efficiently.Brad, or Dr. Block as his parents call him, went to med school at SUNY Buffalo and graduated with research honors. He then went on to his ENT residency at Georgetown. He enjoys spending time with his family, surfing (yes, there is surfing on Long Island), skiing (there is no skiing on Long Island), smoking meat, exercising, and finding any excuse to quote an 80s movie. “I'm not saying I'd build a summer home here, but the trees are actually quite lovely.”Resources Discussed in this Episode:Scott Dikkers, The Onion—Physician Empowerment: website | facebook | linkedinBradley Block, MD - Private Practice Otolaryngologist / ‘Physician's Guide to Doctoring' Host: website | podcast | linkedin__TranscriptDr. Kevin Mailo: [00:00:00] Hi, I'm Dr. Kevin Mailo and you're listening to the Physician Empowerment Podcast. At Physician Empowerment, we're focused on transforming the lives of Canadian physicians through education in finance, practice transformation, wellness and leadership. After you've listened to today's episode, I encourage you to visit us at PhysEmpowerment.ca - that's P H Y S Empowerment dot ca - To learn more about the many resources we have to help you make that change in your own life, practice and personal finances. Now on to today's episode. Dr. Kevin Mailo: [00:00:34] Hi, I'm Dr. Kevin Mailo, the co founder and co host of the Physician Empowerment Podcast. And today I am very excited to be joined by Dr. Bradley Block, community based ENT physician down in New York and the founder of the Physicians Guide to Doctoring. And Brad, why don't you tell us a little bit about your practice background and what you're going to talk about today. Dr. Bradley Block: [00:00:58] So I'm a general ENT and not realizing that going into general practice, private practice ENT would be mostly office hours. So, you know, in residency we're doing like four days a week in the operating room, half a day, maybe a full day of office hours, you know, and then lecture and the rest. In private practice, general ENT, we spend maybe four and a half days a week in the office and then another half day in the operating room, maybe a little more in the O.R. than that for some, but very, very office hours. And we see a lot of patients. And so what we're going to be talking about today is how I make sure that the patient experience is as positive as possible. Right? And so the reason that I founded my podcast, The Physician's Guide to Doctoring, is I noticed that there were a lot of experts out there that were helping people interact with other human beings, right? The interactions between salespeople and their customers, the interactions between people trying to date successfully or leaders and executives. But there weren't, there were these people with that expertise, but they weren't really focused on physicians. So I thought, you know what? I would love to hear what they had to say about specifically the physician-patient interaction. How do I get an audience with them? Well, start a podcast and then I can give them a call. And the physicians got to doctor and kind of sprouted from that because it became, really answers any questions that physicians might have that help us be better at physicianing. You know, it is either going to be the Physician's Guide to Doctoring or the Doctor's Guide to Physicianing. So better physicianing, whether it's in the office or interacting with our staff or being better community members, community leaders, public health issues, anything, anything that could help us be better doctors that we're not typically taught in our training. Dr. Kevin Mailo: [00:02:55] Perfect. I love that. It is so true. I mean, this is the thing that we talk about at length here on the podcast. But in reality, during those training years, med school residency and those early practice years, we don't get a lot of training on that, right? And then the realities, as you alluded to, Brad, of going into practice and realizing that you don't have an hour for every single patient, right? So your patients need to feel valued, they need to feel heard, they need to feel that their concerns are important. And yet at the same time, you are running a practice where things have to move along, right? Because there are financial considerations to this. You know, you have to, you are a limited resource as a physician. We all are. And so how do we serve our community? How do we serve our patients as a whole? By being efficient, yet at the same time maintain that human connection, which I think is so, so important. So take us through. Take us through your approach. What have you learned? Maybe even share some failures or struggles. Tell us a little bit of wisdom, Brad. Dr. Bradley Block: [00:03:58] So one of my favorite guests was Scott Dikkers, who founded The Onion. And I had him on on How to Be Funny. And he wrote a book called How to Be Funny, How to Be Funnier, and the finale to the trilogy, How to Be Funniest. And so he had a great rule for physicians and really for anybody, essentially don't punch down. But what it comes down to is the role of humor is to comfort the afflicted and afflict the comfortable. And so when you're deciding whether or not you want to make a joke, because if you joke around with your patients in the office, that is a great way to connect with them further, right? It's a great way to establish more rapport, to establish trust. People learn better when they're in a more relaxed state. And so you're going to decrease that cortisol that's coursing through their blood vessels when they're in the visit. So it helps them retain what you've what you're talking to them about and understand better. So there's a lot of roles for humor in the in the exam room. And so you always have to make sure you're using it to afflict the comfortable and comfort the afflicted. And so the afflicted in this case is your patient, right? And so you never want to make fun of the patient at all by any means. And then so who can you make fun of? Really, anyone. As long as you're punching up. Like you can make fun of the disease, you can make fun of the electronic medical record, you can make fun of yourself, although you have to be careful because you don't want to use humor that makes you look less competent at what you're doing. So you don't want to look like you're using like slapstick humor to look like you're bumbling. You can make fun of the institution. So there are lots of things that you can make fun of. And you said, look, one of my failures. So how do you recover from a failed joke? That's easy. You can use the same joke every time because even though it's the same thing to you, each encounter is a different patient. So you could always say, Oh, all right, I got it. That wasn't funny. I'll stick to doctoring. I won't, I won't make my foray into stand up anytime soon. So, you know, it's a quick and easy way to recover from a joke, but just identify that you made a bad joke because that can really sour the relationship. Dr. Kevin Mailo: [00:06:09] Excellent. Talk to us about not using humor. Talk to us about bad news. Dr. Bradley Block: [00:06:16] Bad news. Okay. So. So a great way... so you have to have a system when you're breaking bad news. You can't go in there without having a plan, just like when you're doing a surgery. You have a plan going into the operating room, right? If you're doing a procedure. When you're breaking bad news, you need to think first about how you're going to break the bad news. And a lot of times what you can do is you go through the steps with the patient of what's gotten you to this point. And what that helps them do is that helps kind of soften the blow as you're getting the bad news, as they're getting the bad news, because they can tell what's going on. So do you remember you came to me with that bump on your neck, right? And we weren't sure what it was. You'd already treated it with antibiotics. It wasn't going down. And so we decided to image it with an ultrasound. And that ultrasound, it really didn't come back with anything specific. So we decided to do a needle biopsy. Right? And what were we, you know, we were worried about that needle biopsy with was the possibility of cancer. Well, we got the results back, and unfortunately, that is the result, that it was cancer. And it's always important to use those words. Right? You don't want to say tumor, you don't want to say mass, you don't want to say malignancy, like use the C-word. Use the, you want to be frank about it. So you can kind of ease them into it that way. And once they have the news, you have to give them a chance to process it, right? So just let them, give them some time to sit with it. You can even give them some time to talk to someone. Would you like to call a family member right now? Would you like to... Listen, you have as much time as you need. Call one of your family members. Talk to them about it. I'll be back in a few minutes. And when you guys come up with some questions, we'll go over them. And then another thing they're going to need is they're going to need a clear delineation of next steps. And oftentimes, we don't have all of the steps, but they need to know what's happening next and it needs to be given to them with a good amount of confidence. Now we're talking about confidence. This is where we get into non-verbal communication. And so non-verbal communication can really be broken down into two different types, right? You want to convey interest and authority. Dr. Bradley Block: [00:08:45] So when you're conveying interest, that's more like facial expressions and body language. I really love the term body language, but helps people to understand what's being said. So you convey interest, you know, keep eye contact, make sure you're actually emoting with your face. Right? Some of us get kind of stone faced, so you're emoting with your face and then the cadence and the volume of your voice can convey that authority. So when you're conveying that information, you want to convey it with that authority. So you're giving the bad news. You're emoting with the patient, right? And you are demonstrating that you have authority over what's going on with them. Like you're demonstrating your expertise. So. And then you need, that's when you come up with the plan. You don't want to go too many steps ahead as much as they will want you to. But what you do is you give them a clear follow up. So the next step, we're going to order this imaging. In m field, it would probably be okay, we're going to get a CAT scan to the head and neck with contrast, we're going to get a PET scan, and then you're going to follow up with me two weeks later. I want you to write down all of the questions that come up. I'm not going to have many answers now, but I'll answer what I can. But as you're processing this, you're going to come up with a lot of questions. Make sure you write them down, because each visit is going to be a lot more information than the last one. You might forget the questions that you have, so make sure you write them down and make sure you come with somebody. You don't want to come by yourself to these visits because of the volume and the complexity of the information that you're going to be getting. The reason I'm using cancer is the example just because in my field, that's usually what ends up being the bad news, and it's common in other fields as well. So those are a few bits of advice for how you break the bad news and how you kind of walk them through what's going to be happening next because they're going to feel like they've been cast out into space with no gravitational pull to bring them back and they don't know what's going, what side's up and what's down. So you give them some touch points to hold on to, and then you go from there. Dr. Kevin Mailo: [00:11:01] So, many of our listeners are family physicians in private practice. And again, one of the big things that we feel is that time pressure and one of the commonest things - you probably don't get it as much as the specialist, but we get it all the time in family medicine - is that And what about this? And what about this? Right? And as patients struggle to access primary care, they often will come in with a laundry list of complaints or issues that they want worked out in that 50 minute appointment. And I completely sympathize with those patients. I do the same thing when I go see my own family doctor. So what do you do when you're having one of those days and you are running behind and not like 5 minutes, you're an hour behind because maybe it was a couple of difficult conversations around cancer. Maybe there's a whole bunch of loose ends. Maybe something blew up at the hospital or the O.R. and you're late getting into clinic, whatever. How do you navigate that data? How do you keep your composure? How do you make your patients feel valued? How do you speak to them honestly about what's going on, when, you know, for many patients, it's not easy, right? People got child care to coordinate. They got careers. You know, some people take a bus to get to the other side of town and see you. Tell me what that looks like. Dr. Bradley Block: [00:12:13] So as an otolaryngologist, this happens as well. Dr. Kevin Mailo: [00:12:15] Okay. Dr. Bradley Block: [00:12:16] You know, I've got a patient that comes in with an active nosebleed and they also want to talk about their CPAP machine. Oh, and also they've been having some dizziness lately, probably because they've lost a bunch of blood from the nosebleed. But, you know, they assume that it's something from their inner ear. Everyone assumes it's coming from the inner ear. I can't tell you how many people I see when it's like, Oh, yeah, it's my earwax that's causing my dizziness. Okay, so just for the audience, earwax doesn't cause dizziness, okay? It's a skin issue. Can cause  hearing loss. But okay, so it's important to create boundaries. Now, I recognize that you said some of these patients are coming, they took three busses to get there, but you still have to create those boundaries. And I've gotten better at it as I've gotten along in my practice. Like I used to have patients, like they come in and they can't hear anything. Why? Because they have bilateral middle ear effusions. I could do a myringotomy at the time, but like you said, I've already got four patients waiting. So you know what? That procedure is going to have to wait. They're going to have to reschedule, make an appointment, and we can do bilateral myringotomy, maybe with tubes, we'll see. So I've gotten, I've gotten better about that. But yeah, that happens to me. I would make, when they come in, right, if they come in with that list at the get go, give them the choice of what they want to talk about. Okay. You get to pick two things and I get to pick one thing, but we're only going to talk about three things today. Or vice versa. I get to pick one. I get to pick two. You get to pick one. So whatever you feel comfortable doing as the physician. But they don't get an infinite list of things to discuss. And if you're already out the door and they say, Oh, wait a second, I also want to talk about this, Great, I'd love to talk to you about that. Unfortunately, we've run out of time. I do have three other patients waiting. We've covered a lot today. We talked about X, we talked about Y, we talked about Z. But we don't have time to talk about that too. So just schedule your follow up. It sounds like an issue that you should probably discuss within 3 to 4 weeks or whatever timeline you decide. But it's important to draw those boundaries. And as physicians, we're not trained to. We're trained to give up everything. Stay late, like miss your kid's birthday. I got a patient they wanted to be squeezed in today. It was my kid's birthday today, right? I'm already in the, you know, I'm already getting home late enough. Dr. Kevin Mailo: [00:14:29] Exactly. Dr. Bradley Block: [00:14:30] Like, no, no. Like, you can see one of my partners, or I can see you within the next couple of days. But no, I'm sorry. I just. So you have to get better at drawing boundaries. And you do that by keeping the patients to just a couple of issues. Dr. Kevin Mailo: [00:14:44] You know, one of the things that I found helpful in the emergency department in my own practice is very often I'll take, I'll sit down with patients and I'm later then I said I would because inevitably I get called away to an emergency, something more urgent in the department, I get interrupted to deal with a result or something like that. I come back, I sit down with my patient, I apologize that I'm late, but I say this is important for me that I give you time and it's important for you that you get time. So now I've created time for you because I'm now towards the end of my shift. Let's say if it's something serious or complex, like a geriatric patient, there are a whole bunch of issues. I want to sit down and make sure that I am not rushing that. And as you alluded to earlier, Brad, that body language is everything. I make every effort to sit at eye level or lower than my patients and be near with them and never look like I'm in a rush when the department is busy. I really try to create that space in that time. And that's even about setting boundaries with other patients or residents or whoever wants your time. Right? And just saying, I have to go in here for a couple of minutes and sit down and talk to a patient, really convey or go over the issues. So I think that thing about boundaries is so important. And in terms of our self care, we do a better job when we're  caring for ourselves, right? If you were running late today for your child's birthday, seeing that patient, I mean, how good is that patient interaction going to be? Right? Because there's probably going to be some degree of frustration or angst or worry that carries in your voice as you interact with your patient versus any other day, Brad, when you could have sat down and created that space for them. So I think it was such a powerful observation that you made in terms of setting those boundaries. Dr. Bradley Block: [00:16:30] Yeah, the non-verbal cues, they can pick up on that, they can pick up when they know that you're rushed. But it's also important that you convey those non-verbal cues. So sometimes, as I said earlier, we're a little stone faced, myself in particular, and they have trouble reading that we're interested. So it's, you can't fake it, but you can make sure that you're conveying it. And that helps those visits to actually go, those other visits to go faster. And when they feel like they're being heard, they feel like they're being understood, that you're more likely to move through the visit faster than if they're getting frustrated because they don't feel like they have your full attention. And that's often why they need to repeat themselves over and over. Another reason why they end up repeating themselves is because there's something that they're not saying that you need to get them to say. And sometimes it's important to really pull that out of them. And like, and I find it a good way to do that is say, What's bothering you about this? Like, right, people come to see me with with globus, right? They feel like they've got something stuck in ther, there's nothing actually stuck in their throat. What are you, what bothers you about this? Do you, do you think you might have cancer? Dr. Kevin Mailo: [00:17:41] Right? Dr. Bradley Block: [00:17:42] Yes, I do. Well I'm going to do this exam. And by putting this camera down your throat, I'm going to be able to see whether or not there's cancer. And if I can't see anything like it's extraordinarily unlikely that there's anything there. Right? So getting them to verbalize what's bothering them about their particular symptom can often get you over that hump where it seems like you're just going in circles, you're saying the same thing, they're saying the same thing. So a good question like that can move things along nicely and then everyone leaves the visit feeling more satisfied. Dr. Kevin Mailo: [00:18:12] Yeah. Boy, I love that. So, Brad, this was absolutely outstanding. I don't want, I mean, I think we can go on and on and on. But give us give us your wisdom. Give us your insights. We have a lot of young listeners who are here. And I think even for for those of us that have been practiced for years, this is the one part of the job that we continue to evolve on. I continue to be humbled throughout my career by the things that patients have shared with me that were unexpected, that if I just took time and listened, I really came to appreciate the patient's perspective. So share share that wisdom with us, share your insights on how we can keep that humanity in medicine that's so important not only for our patients, but for ourselves as well. Because medicine is not a business. Medicine is not a technical skill or a set of knowledge. It really is a human, a human career. Dr. Bradley Block: [00:19:05] Really, it goes back to what you said, right, about making sure you're taking care of yourself. Because if you are hating life, you're going to resent your patients for it, right? If you're burning out, you're going to resent your patients, and that's going to put up those boundaries, it's going to take away from their care. And it's not their fault that you've made these decisions or the system has put these these things upon you so that you can't take care of yourself. So you really, it's really important for that self care. And it's not just lip service, right? Like we've all been in that, I've been in that place where I've resented, I've resented it, I've resented the patients because I've burned myself out. And that's where the boundaries come in, wherever you decide to put them, wherever you decide it works for you that you can really enjoy. And I'm in that place again. I'm in that place again where I'm really enjoying what I'm doing. I mean, I do plan on retiring at some point. I'm not going to do this for, I'm not going to, you know, I'm not going to be those people that's like, oh, it's my passion. I enjoy it, right? But I definitely enjoy it. It's, I'm not in that bad place anymore because I figured out how to make those boundaries. So self care boundaries, all that, all that stuff, wellness stuff that we say, it really does make sense. It's just every person has a different way they need to go about doing it. You got to figure out what works for you and that might evolve as you practice. But yeah, you've got to look out for number one first. Dr. Kevin Mailo: [00:20:33] Well, I absolutely love that. So again, for our listeners, I'd encourage you to track down Brad's podcast, The Physician's Guide to Doctoring, and he has got so much great material, so many great episodes with amazing guest speakers. So I'm very honored to have had you today, Brad, joining us on the Physician Empowerment Podcast. And for anyone listening, if you want to be a guest, we're always looking to hear from members of our profession and hear their perspectives and hear what they've got to share. So again, thank you, Brad. Absolutely loved it. Dr. Bradley Block: [00:21:06] Thank you, Kevin. It's been a lot of fun. Dr. Kevin Mailo: [00:21:09] Thank you so much for listening to the Physician Empowerment Podcast. If you're ready to take those next steps in transforming your practice, finances or personal well-being, then come and join us at PhysEmpowerment.ca - P H Y S Empowerment dot ca - to learn more about how we can help. If today's episode resonated with you, I'd really appreciate it if you would share our podcast with a colleague or friend and head over to Apple Podcasts to give us a five star rating and review. If you've got feedback, questions, or suggestions for future episode topics, we'd love to hear from you. If you want to join us and be interviewed and share some of your story, we'd absolutely love that as well. Please send me an email at KMailo@PhysEmpowerment.ca. Thank you again for listening. Bye. 

In diesem Video erfährst Du, was eine Polyneuropathie ist, wie Du diese erkennen kannst und was Du vorbeugend und unterstützend tun kannst. Anna-Lena Becker ist Apothekerin mit dem Schwerpunkt Integrative Onkologie. In ihren individuellen Beratungen legt sie besonderen Wert auf die ganzheitliche Unterstützung bei Beschwerden während der Krebstherapie und gibt Tipps zur Vorbereitung auf die Behandlung. Beratungen können hier gebucht werden: https://www.mediosapotheke.de/onkologie/ Weitere Videos zur Unterstützung bei Krebs findest Du hier: https://www.youtube.com/playlist?list=PLmQ0zX_vlIWFNxf5Vbfow-Jh6VOwgRGra Erwähnte Links: https://www.mediosapotheke.de/onkovision-magazin/ https://www.staerkergegenkrebs.de/ https://netzwerk-onkoaktiv.de/ https://www.daegfa.de/Themen/Patienteninfo/Akupunkturaerzte#/ Quellen: https://www.leitlinienprogramm-onkologie.de/leitlinien/supportive-therapie/ https://www.leitlinienprogramm-onkologie.de/leitlinien/komplementaermedizin/ https://pubmed.ncbi.nlm.nih.gov/33489425/

This month on Episode 38 of Discover CircRes, host Cynthia St. Hilaire highlights original research articles featured in the Jue 24th, July 8th and July 22nd issues of the journal. This episode also features an interview with the 2022 BCBS Outstanding Early Career Investigator Award finalists, Dr Hisayuki Hashimoto, Dr Matthew DeBerge and Dr Anja Karlstadt.   Article highlights:   Nguyen, et al. miR-223 in Atherosclerosis.   Choi, et al. Mechanism for Piezo1-Mediated Lymphatic Sprouting   Kamtchum-Tatuene, et al.  Plasma Interleukin-6 and High-Risk Carotid Plaques   Li, et al. 3-MST Modulates BCAA Catabolism in HFrEF   Cindy St. Hilaire:        Hi, and welcome to Discover CircRes, the podcast of the American Heart Association's journal, Circulation Research. I'm your host, Dr Cindy St. Hilaire, from the Vascular Medicine Institute at the University of Pittsburgh. And today I'm going to be highlighting articles from our June 24th, July 8th and July 22nd issues of Circulation Research. I'm also going to have a chat with the finalists for the 2022 BCBS Outstanding Early Career Investigator Award, Dr Hisayuki Hashimoto, Dr Matthew DeBerge and Dr Anja Karlstadt.   Cindy St. Hilaire:        The first article I want to share is from our June 24th issue and is titled, miR-223 Exerts Translational Control of Proatherogenic Genes in Macrophages. The first authors are My-Anh Nguyen and Huy-Dung Hoang, and the corresponding author is Katey Rayner and they're from the University of Ottawa. A combination of cholesterol accumulation in the blood vessels and subsequent chronic inflammation that's derived from this accumulation drive the progression of atherosclerosis. Unfortunately, current standard medications tackle just one of these factors, the cholesterol. And this might explain why many patients on such drugs still have vascular plaques. In considering treatments that work on both aspects of the disease, meaning lipid accumulation and inflammation, this group investigated the micro RNA 223 or miR-223, which is a small regulatory RNA that has been shown to suppress expression of genes involved in both cholesterol uptake and inflammatory pathways in both liver and immune cells.   Cindy St. Hilaire:        The team showed that mouse macrophages deficient in miR-223, exhibited increased expression of pro-inflammatory cytokines and reduced cholesterol efflux compared with control cells. Overexpression of miR-223 had the opposite effects. Furthermore, atherosclerosis prone mice, whose hematopoietic cells lacked miR-223, had worse atherosclerosis with larger plaques and higher levels of pro-inflammatory cytokines than to control animals with normal levels of miR-223. These findings highlight miR-223's dual prompt, antiatherogenic action, which could be leveraged for future therapies.   Cindy St. Hilaire:        The second article I want to share is from our July 8th issue of Circulation Research and is titled, Piezo1-Regulated Mechanotransduction Controls Flow-Activated Lymph Expansion. The first author is Dongwon Choi and the corresponding author is Young-Kwon Hong, and they're from UCLA.   As well as being super highways for immune cells, lymph vessels are drainage channels that help maintain fluid homeostasis in the tissues. This network of branching tubes grows as fluids begin to flow in the developing embryo. This fluid flow induces calcium influx into the lymphatic endothelial cells, which in turn promotes proliferation and migration of these cells, leading to the sprouting of lymph tubules. But how do LECs, the lymphatic endothelial cells, detect fluid flow in the first place? Piezo1 is a flow and mechanosensing protein known for its role in blood vessel development and certain mutations in Piezo1 cause abnormal lymphatic growth in humans.   Cindy St. Hilaire:        This script found that Piezo1 is expressed in the embryonic mouse LECs and that the suppression of Piezo1 inhibits both flow activated calcium entry via the channel ORAI1, as well as downstream target gene activation. Overexpression of Piezo1, by contrast, induced the target genes. The team went on to show that mice lacking either Piezo1 or ORAI1 had lymphatic sprouting defects and that pharmacological activation of Piezo1 in mice enhanced lymphogenesis and prevented edema after tail surgery. Together, the results confirmed Piezo1's role in flow dependent lymphatic growth and suggest it might be a target for treating lymphedema.   Cindy St. Hilaire:        The third article I want to share is also from our July 8th issue and is titled, Interleukin-6 Predicts Carotid Plaque Severity, Vulnerability and Progression. The first and corresponding author of this study is Joseph Kamtchum-Tatuene from University of Alberta.   Excessive plasma cholesterol and systemic inflammation are contributing factors in atherosclerosis. While traditional remedies have been aimed at lowering patient's lipid levels, drugs that tackle inflammation are now under investigation, including those that suppress Interleukin-6, which is an inflammatory cytokine implicated in the disease. Focusing on carotid artery disease, this group conducted a prospective study to determine whether IL-6 levels correlated with disease severity. 4,334 individuals were enrolled in the cardiovascular health study cohort. They had their blood drawn and ultrasounds taken at the start of the study and five years later. This group found IL-6 was robustly correlated with and predicted plaque severity independent of other cardiovascular risk factors. This study also determined that an IL-6 blood plasma level of 2.0 picograms/mls, identified individuals with the highest likelihood of plaque, vulnerability and progression. This threshold value could be used to select patients who might benefit from novel IL-6 lowering medications.   Cindy St. Hilaire:        The last article I want to share is from our July 22nd issue of Circulation Research and is titled, Mitochondrial H2S Regulates BCAA Catabolism in Heart Failure. The first author is Zhen Li, and the corresponding author is David Lefer from Louisiana State University. Hydrogen sulfide, or H2S, is a compound that exerts mitochondrial specific actions that include the preservation of oxidative phosphorylation, mitochondrial biogenesis and ATP synthesis, as well as inhibiting cell death. 3-mercaptopyruvate sulfurtransferase, or 3-MST, is a mitochondrial H2S producing enzyme, whose functions in cardiovascular disease are not fully understood.   Cindy St. Hilaire:        This group investigated the global effects of 3-MST deficiency in the setting of pressure overload induced heart failure. They found that 3-MST was significantly reduced in the myocardium of patients with heart failure, compared with non failing controls. 3-MST knockout mice exhibited increased accumulation of branch chain amino acids in the myocardium, which was associated with reduced myocardial respiration and ATP synthesis, exacerbated cardiac and vascular dysfunction, and worsened exercise performance, following transverse aortic constriction. Restoring myocardial branched-chain amino acid catabolism, or administration of a potent H2S donor, ameliorated the detrimental effects of 3-MST deficiency and heart failure with reduced injection fraction. These data suggest that 3-MST derived mitochondrial H2S, may play a regulatory role in branch chain amino acid catabolism, and mediate critical cardiovascular protection in heart failure.   Cindy St. Hilaire:        Today, I'm really excited to have our guests, who are the finalists for the BCVS Outstanding Early Career Investigator Awards. Welcome everyone.   Hisayuki Hashimoto:   Thank you.   Anja Karlstaedt:          Hi.   Hisayuki Hashimoto:   Hi.   Matthew DeBerge:      Hello. Thank you.   Cindy St. Hilaire:        So the finalists who are with me today are Dr Hisayuki Hashimoto from Keio University School of Medicine in Tokyo, Japan, Dr Matthew Deberge from Northwestern University in Chicago and Dr Anja Karlstaedt from Cedar Sinai Medical Center in LA. Thank you again. Congratulations. And I'm really excited to talk about your science.   Hisayuki Hashimoto:   Thank you. Yes. Thanks, first of all for this opportunity to join this really exciting group and to talk about myself and ourselves. I am Hisayuki Hashimoto, I'm from Tokyo, Japan. I actually learned my English... I went to an American school in a country called Zaire in Africa and also Paris, France because my father was a diplomat and I learned English there. After coming back to Japan, I went to medical school. During my first year of rotation, I was really interested in cardiology, so I decided to take a specialized course for cardiology. Then I got interested in basic science, so I took a PhD course, and that's what brought me to this cardiology cardiovascular research field.   Matthew DeBerge:      So I'm currently a research assistant professor at Northwestern University. I'm actually from the Chicagoland area, so I'm really excited to welcome you all to my hometown for the BCVS meeting.   Cindy St. Hilaire:        Oh, that's right. And AHA is also there too this year. So you'll see a lot of everybody.   Matthew DeBerge:      I guess I get the home field advantage, so to speak. So, I grew up here, I did my undergrad here, and then went out in the east coast, Dartmouth College in New Hampshire for my PhD training. And actually, I was a viral immunologist by training, so I did T cells. When I was looking for a postdoctoral position, I was looking for a little bit of something different and came across Dr Edward Thorpe's lab at Northwestern university, where the interest and the focus is macrophages in tissue repair after MI. So, got into the macrophages in the heart and have really enjoyed the studies here and have arisen as a research assistant professor now within the Thorpe lab. Now we're looking to transition my own independent trajectory. Kind of now looking beyond just the heart and focusing how cardiovascular disease affects other organs, including the brain. That's kind of where I'm starting to go now. Next is looking at the cardiovascular crosstalk with brain and how this influences neuroinflammation.   Anja Karlstaedt:          I am like Hisayuki, I'm also a medical doctor. I did my medical training and my PhD in Berlin at the Charité University Medicine in Berlin, which is a medical faculty from Humboldt University and Freie University. II got really interested in mathematical modeling of complex biological systems. And so I started doing my PhD around cardiac metabolism and that was a purely core and computationally based PhD. And while I was doing this, I got really hooked into metabolism. I wanted to do my own experiments to further advance the model, but also to study more in crosstalk cardiac metabolism. I joined Dr Heinrich Taegteyer lab at the University of Texas in the Texas Medical Center, and stayed there for a couple of years. And while I was discovering some of the very first interactions between leukemia cells and the heart, I decided I cannot stop. I cannot go back just after a year. I need to continue this project and need to get funding. And so after an AHA fellowship and NIHK99, I am now here at Cedars Sinai, an assistant professor in cardiology and also with a cross appointment at the cancer center and basically living the dream of doing translational research and working in cardio-oncology.   Cindy St. Hilaire:        Great. So, Dr Hashimoto, the title of your submission is, Cardiac Reprogramming Inducer ZNF281 is Indispensable for Heart Development by Interacting with Key Cardiac Transcriptional Factors. This is obviously focused on reprogramming, but why do we care about cardiac reprogramming and what exactly did you find about this inducer ZNF281?   Hisayuki Hashimoto:   Thank you for the question. So, I mean, as I said, I'm a cardiologist and I was always interested in working heart regeneration. At first, I was working with pluripotent stem cells derived cardiomyocyte, but then I changed my field during my postdoc into directly programming by making cardiomyocyte-like cells from fiberblast. But after working in that field, I kind of found that it was a very interesting field that we do artificially make a cardiomyocyte-like cell. But when I dissected the enhanced landscape, epigenetic analysis showed that there are very strong commonalities between cardiac reprogramming and heart development. So I thought that, hey, maybe we can use this as a tool to discover new networks of heart development. And the strength is that cardiac reprogramming in vitro assay hardly opens in vivo assay, so it's really time consuming. But using dark programming, we can save a lot of time and money to study the cardiac transitional networks. And we found this DNF281 from an unbiased screen, out of 1000 human open reading frames. And we found that this gene was a very strong cardiac reprogramming inducer, but there was no study reporting about any functioning heart development. We decided to study this gene in heart development, and we found out that it is an essential gene in heart development and we were kind of able to discover a new network in heart development.   Cindy St. Hilaire:        And you actually used, I think it was three different CRE drivers? Was that correct to study?   Hisayuki Hashimoto:   Ah, yes. Yeah.   Cindy St. Hilaire:        How did you pick those different drivers and what, I guess, cell population or progenitor cell population did those drivers target?   Hisayuki Hashimoto:   So I decided to use a mesodermal Cre-driver, which is a Mesp1Cre and a cardiac precursor Cre-driver, which is the Nkx2-5 Cre and the cardiomyocyte Cre, which is the Myh6-Cre. So three differentiation stages during heart development, and we found out that actually, DNF281 is an essential factor during mesodermal to cardiac precursor differentiation state. We're still trying to dig into the molecular mechanism, but at that stage, if the DNF281 is not there, we are not able to make up the heart.   Cindy St. Hilaire:        That is so interesting. Did you look at any of the strains that survived anyway? Did you look at any phenotypes that might present in adulthood? Is there anything where the various strains might have survived, but then there's a kind of longer-term disease implicating phenotype that's observed.   Hisayuki Hashimoto:   Well, thank you for the question. Actually, the mesodermal Cre-driver knocking out the DNF281 in that stage is embryonic lethal, and it does make different congenital heart disease. And they cannot survive until after embryonic day 14.5. The later stage Nkx2-5 Cre and Myh6-Cre, interestingly, they do survive after birth. And then in adult stage, I did also look into the tissues, but the heart is functioning normally. I haven't stressed them, but they develop and they're alive after one year. It looks like there's really no like phenotype at like the homeostatic status.   Cindy St. Hilaire:        Interesting. So it's kind of like, once they get over that developmental hump, they're okay.   Hisayuki Hashimoto:   Exactly. That might also give us an answer. What kind of network is important for cardiac reprogramming?   Cindy St. Hilaire:        So what are you going to do next?   Hisayuki Hashimoto:   Thank you. I'm actually trying to dig into the transitional network of what kind of cardiac transitional network the ZNF281 is interacting with, so that maybe I can find a new answer to any etiology of congenital heart disease, because even from a single gene, different mutation, different variants arise different phenotypes in congenital heart disease. Maybe if I find a new interaction with any key cardiac transitional factors, maybe I could find a new etiology of congenital heart disease phenotype.   Cindy St. Hilaire:        That would be wonderful. Well, best of luck with that. Congratulations on an excellent study. Hisayuki Hashimoto:   Thank you.   Cindy St. Hilaire:        Dr DeBerge, your study was titled, Unbiased Discovery of Allograft Inflammatory Factor-1 as a New and Critical Immuno Metabolic Regulatory Node During Cardiac Injury. Congrats on this very cool study. You were really kind of focused on macrophages in myocardial infarction. And macrophages, they're a Jeckel Hyde kind of cell, right? They're good. They're bad. They can be both, almost at the same time, sometimes it seems like. So why were you interested in macrophages particularly in myocardial infarction, and what did you discover about this allograft inflammatory factor-1, or AIF1 protein?   Matthew DeBerge:      Thank you. That's the great question. You really kind of alluded to why we're interested in macrophages in the heart after tissue repair. I mean, they really are the central mediators at both pro-inflammatory and anti-inflammatory responses after myocardial infarction. Decades of research before this have shown that inflammation has increased acutely after MI and has also increased in heart failure patients, which really has led to the development of clinical efforts to target inflammatory mediators after MI. Now, unfortunately, the results to target inflammation after MI, thus far, have been modest or disappointing, I guess, at worst, in the respect that broadly targeting macrophage function, again, hasn't achieved results. Again, because these cells have both pro and anti-inflammatory functions and targeting specific mediators has been somewhat effective, but really hasn't achieved the results we want to see.   Matthew DeBerge:      I think what we've learned is that the key, I guess, the targeting macrophage after MI, is really to target their specific function. And this led us to sort of pursue novel proteins that are mediating macrophage factor function after MI. To accomplish this, we similarly performed an unbiased screen collecting peri-infarct tissue from a patient that was undergoing heart transplantation for end stage heart failure and had suffered an MI years previously. And this led to the discovery of allograft inflammatory factor-1, or AIF1, specifically within cardiac macrophages compared to other cardiac cell clusters from our specimen. And following up with this with post-mortem specimens after acute MI to show that AIF1 was specifically increased in macrophages after MI and then subsequently then testing causality with both murine model of permanent inclusion MI, as well as in vitro studies using bone marrow drive macrophages to dig deeper mechanistically, we found that AIF1 was crucial in regulating inflammatory programing macrophages, which ultimately culminated in worse in cardiac repair after MI.   Cindy St. Hilaire:        That's really interesting. And I love how you start with the human and then figure out what the heck it's doing in the human. And one of the things you ended up doing in the mouse was knocking out this protein AIF1, specifically in macrophage cells or cells that make the macrophage lineage. But is this factor in other cells? I was reading, it can be intracellular, it can be secreted. Are there perhaps other things that are also going on outside of the macrophage?   Matthew DeBerge:      It's a great question. First, I guess in terms of specificity, within the hematopoietic compartment, previous studies, as well as publicly available databases, have shown that AIF1 is really predominantly expressed within macrophages. We were able to leverage bone marrow chimera mice to isolate this defect to the deficiency to macrophages. But you do bring up a great point that other studies have shown that AIF1 may be expressed in other radio-resistant cell populations. I mean, such as cardiomyocytes or other treatable cells within the heart. We can't completely rule out a role for AIF1 and other cell populations. I can tell you that we did do the whole body knockout complementary to our bone marrow hematopoetic deficient knockouts, and saw that deficiency of AIF1 within the whole animal, recapitulate the effects we saw within the AIF1 deficiency within hematopoietic department.   Matthew DeBerge:      It was encouraging to us that, again, the overall role of AIF1 is pro-inflammatory after MI.   Cindy St. Hilaire:        I mean, I know it's early days, but is there a hint of any translational potential of these findings or of this protein?   Matthew DeBerge:      Yeah, I think so. To answer your question, we were fortunate enough to be able to partner with Ionis that develops these anti-sensible nucleotides so that we could specifically target AIF1 after the acute phase during MI. We saw that utilizing these anti-sensible nucleotides to deplete AIF1, again, within the whole mouse, that we were able to reduce inflammation, reduce in heart size and preserve stock function. I think there really is, hopefully a therapeutic opportunity here. And again, with it being, perhaps macrophage specific is, even much more important as we think about targeting the specific function of these cells within the heart.   Cindy St. Hilaire:        Very cool stuff. Dr Karlstaedt, the title of your submission is, ATP Dependent Citrate Lyase Drives Metabolic Remodeling in the Heart During Cancer. So this I found was really interesting because you were talking about, the two major killers in the world, right? Cardiovascular disease and cancer, and you're just going to tackle both of them, which I love. So obviously this is built on a lot of prior observations about the effects of cancer on cardiac metabolic remodeling. Can you maybe just tell us a little bit about what is that link that was there and what was known before you started?   Anja Karlstaedt:          Yeah. Happy to take that question. I think it's a very important one and I'm not sure if I will have a comprehensive answer to this, because like I mentioned at the beginning, cardio-oncology is a very new field. And the reason why we are starting to be more aware of cancer patients and their specific cardiovascular problems is because the cancer field has done such a great job of developing all these new therapeutics. And we have far more options of treating patients with various different types of cancers in particular, also leukemias, but also solid tumors. And what has that led to is an understanding that patients survive the tumors, but then 10, 20 years later, are dying of cardiovascular diseases. Those are particular cardiomyopathies and congestive heart failure patients. What we are trying, or what my lab is trying to do, is understanding what is driving this remodeling. And is there a way that we can develop therapies that can basically, at the beginning of the therapy, protect the heart so that this remodeling does not happen, or it is not as severe.   Anja Karlstaedt:          Also, identifying patients that are at risk, because not every tumor is created equally and tumors are very heterogeneous, even within the same group. To get to your question, what we found is, in collaboration actually with a group at Baylor College of Medicine, Peggy Goodell's group, who is primarily working on myeloid malignancies, is that certain types of leukemias are associated with cardiomyopathies. And so when they were focusing on the understanding drivers of leukemia, they noticed that the hearts of these animals in their murine models are enlarged on and actually developing cardiomyopathies. And I joined this project just very early on during my postdoc, which was very fortunate and I feel very lucky of having met them. What my lab is now studying here at Cedars is how basically those physiological stress and mutations coming from the tumors are leading to metabolic dysregulation in the heart and then eventually disease.   Anja Karlstaedt:          And we really think that metabolism is at the center of those disease progressions and also, because it's at the center, it should be part of the solution. We can use it as a way to identify patients that are at risk, but also potentially develop new therapies. And what was really striking for us is that when we knock down ACLY that in a willdtype heart where the mouse doesn't have any tumor disease, ACLY actually is critically important for energy substrate metabolism, which seems counterintuitive, because it's far away from the mitochondria, it's not part of directly ADP provision. It's not part of the Kreb cycle. But what we found is that when we knock it out using a CRISPR-Cas9 model, it leads to cardiomyopathy and critically disrupts energy substrate metabolism. And that is not necessarily the case when the mouse has leukemia or has a colorectal cancer, which upregulated in the beginning, this enzyme expression. And so we have now developed models that show us that this could be potentially also therapeutic target to disrupt the adverse remodeling by the tumor.   Cindy St. Hilaire:        That is so interesting. So one of the things I was thinking about too is we know that, I mean, your study is showing that, the tumor itself is causing cardiac remodeling, but we also know therapies, right? Radiation, chemotherapy, probably some immune modulatory compounds. Those probably do similar, maybe not exactly similar, but they also cause, adverse cardiac remodeling. Do you have any insights as to what is same and what is different between tumor driven and therapy driven adverse remodeling?   Anja Karlstaedt:          So we do not know a lot yet. It's still an open question about all the different types of chemotherapeutics, how they are leading to cardio toxicities. But what we know, at least from the classic anti-cyclic treatments, is right now at the core, the knowledge is that this is primarily disrupting cardiac mitochondrial function. And through that again, impairing energy provision and the interaction, again, with the immune system is fairly unknown, but we know through studies from Kathryn Moore and some very interesting work by Rimson is that myocardial infarction itself can lead to an increase in risk for tumor progression. And what they have shown as independent of each other, is that the activation of the immune system in itself can lead to an acceleration of both diseases, both the cardiac remodeling, and then also the tumor disease. We don't fully understand which drivers are involved, but we do know that a lot of the cardiomyopathies on cardiotoxicities that are chemotherapeutically driven, all have also metabolic component.   Cindy St. Hilaire:        Nice. Thank you. When I prepare for these interviews, I obviously read the abstracts for the papers, but I found myself also Googling other things after I read each of your abstracts. It was a rabbit hole of science, which was really exciting.                               I now want to transition to kind of a career angle. You all are obviously quite successful, scientifically, at the bench, right? But now you are pivoting to a kind of completely opposite slash new job, right? That of, independent researcher. I would love to hear from each of you, if there was any interesting challenge that you kind of overcame that you grew from, or if there was any bit of advice that you wish you knew ahead of time or anything like that, that some of our trainee listeners and actually frankly, faculty who can pass that information onto their trainees, can benefit from.   Anja Karlstaedt:          I think the biggest challenge for me in transitioning was actually the pandemic. Because I don't know how it was for Hisa and Matt, but trying to establish a lab, but also applying for faculty position during a major global pandemic, is challenging is not quite something that I expected that would happen. And so I think saying that and looking more conceptually and philosophically at this as, you can prepare as much as you want, but then when life just kicks in and things happen, they do happen. And I think the best is to prepare as much as you can. And then simply go with the flow. Sometimes one of my mentors, Dave Nikon, mentioned that to me when I was applying for faculty positions, it's sometimes good to just go with the flow. And as a metabolism person, I absolutely agree. And there are some things that you can do as a junior investigator.   Anja Karlstaedt:          We need to have a good network. So just very important to have good mentors. I was blessed with have those mentors, Peggy Goodell's one of them, Heinrich Taegtmeyer was another. And now with this study that we are publishing, Jim Martin and Dave Nikon were incredible. Without them, this study wouldn't have been possible and I would not be here at Cedars.   Anja Karlstaedt:          You need to reach out to other people because those mentors have the experience. They have been through some of this before. Even if they have never had a major event, like COVID-19 in their life before, because none of us had before, they had other experiences and you can rely on them and they set you then up for overcoming these challenges. And the other thing I would say, is put yourself out there, go and talk to as many people as possible or set conferences, present a poster, not only talks. Don't be disappointed if you don't get a talk, posters are really great to build this network and find other people that you probably wouldn't have encountered and apply for funding. Just again, put yourself out there and try to get the funding for your research. Even if it's small foundations, it builds up over time and it is a good practice to then write those more competitive grants.     Cindy St. Hilaire:        Dr Hashimoto, would you like to go next?   Hisayuki Hashimoto:   Just my advice is that, could be like a culture of difference, but in east Asia, like in Japan, we were taught to, do not disturb people, don't interrupt people and help people. But I realized that I wasn't really good at asking for help. After I am still not like fully independent, but I do have my own group and I have to do grant writing. I still work at the bench and then have to teach grad students, doing everything myself. I just realized it's just impossible. I didn't have time. I need like 48 hours a day. Otherwise, you won't finish it. I just realized that I wasn't really good at asking for help. So my advice would be, don't hesitate to ask for help. It's not a shame. You can't do everything by just yourself. I think, even from the postdoc, even from grad school, I think, ask for help and then get used to that. And then of course, help others. And that is the way I think to probably not get overwhelmed and not stress yourself. Science should be something fun. And if you don't ask for help and if you don't help someone, I think you are losing the chance of getting some fun part from the science.   Cindy St. Hilaire:        That's great advice. I really like that, especially because I find at least, I started my lab seven years ago now. And I remember the first couple months/year, it was extremely hard to let go, right? Like I taught my new people how to do the primary cell culture we needed, but I was terrified of them doing it wrong or wasting money or making too many mistakes. But you realize, you got to learn to trust people. Like you said, you got to learn to ask for help. And sometimes that help is letting them do it. And you doing, you're being paid now to write grants and papers. That's a big brain, you're not paid to do the smaller things. That's really great advice. I like that. Thank you. Dr DeBerge, how about you?   Matthew DeBerge:      So I guess towards a bit of life advice, I think two obvious things is one, be kind, science is hard enough as it is. So I think we should try to lift each other up and not knock each other down. And along those lines as the others have alluded to as well, one of the mantras we sort of adapted on the lab, is a rising tide raises all ships, this idea that we can work together to elevate each other's science and really, again, collaborate.   Towards the career side of things I'll just touch on, because I guess one thing I'll add, there's more than one path, I guess, to achieving your goals. I've been fortunate enough to have an NIH post-doctoral fellowship and had an AHA career development award, but I'm not a K99 recipient. Oftentimes, I think this is the golden ticket to getting the faculty job, so I'm trying to, I guess, buck trend, I just submitted an RO1. So fingers crossed that leads to some opportunity.   Even beyond academia, I'm not certain how much everyone here is involved in science Twitter, it's really become a thing over the last couple years, but I think, kind of the elephant in the room is that academia, it's really hard on the trainees nowadays to have a living wage, to go through this. I mean, I'm really excited to see my, fellow finalists here are starting their own groups and stuff, but for many, that's not the reality for many, it's just not financially feasible. So I think, kind of keeping in mind that there's many, many alternative careers, whether it's industry, whether it's consulting, science writing, etcetera, going back to what Dr Hash says, find what you love and really pursue that with passion.   Cindy St. Hilaire:        I think it's something only, I don't know, five to 10% of people go into or rather stay in academia. And that means, 90 to 95% of our trainees, we need to prepare them for other opportunities, which I think is exciting, because it means it can expand our network for those of us in academia.   Anja Karlstaedt:          I think right now it's even worse because it's about 2% of old postdocs that are actually staying and becoming independent researchers, independent or tenure track or research track. And I think I second, as what Matt said, because I play cello. I do music as a hobby and people always ask me if I'm a musician. And at the beginning I felt like, no, of course not. I'm not like Yoyo Ma. I'm just playing, it's a hobby. And then I, that got me thinking. I was like, no, of course you are because there's so many different types. And what we need to understand is that scientists, like you are always a scientist. It doesn't matter if you are working at Pfizer or if you are working at a small undergrad institution and you're teaching those next generation scientists, you are still scientist and we all need those different types of scientists because otherwise, if everybody is just a soloist, you are never going to listen to symphony. You need those different people and what we need to normalize beyond having those different career paths, is also that people are staying in academia and becoming those really incredible resources for the institutions and labs, quite frankly, of being able to retain those technologies and techniques within an institution. And I think that's something to also look forward to, that even if you're not the PI necessarily, you're the one who is driving those projects. And I hope to pass this on at some point also to my trainees that they can be a scientist, even if they're not running a lab and they become an Institute director and that's also critically important.   Cindy St. Hilaire:        There's lots of ways to do science. Thank you all so much for joining me today. Either waking up at 5:00 AM or staying up past midnight, I think it is now in Japan or close to it. So Matt and I kind of made it out okay. It's like 8:00 or 9:00 AM.   Matthew DeBerge:      Thank you.   Hisayuki Hashimoto:   My apologies for this time zone difference.   Cindy St. Hilaire:        I'm very glad to make it work. Congratulations to all of you, your presentations. I forget which day of the week they are on at BCVS, but we are looking forward to the oral presentations of these and congratulations to all of you. You are amazing scientists and I know I'm really looking forward to seeing your future work so best of luck.   Matthew DeBerge:      Thank you.   Hisayuki Hashimoto:   Thank you.   Anja Karlstaedt:          Thank you so much.   Cindy St. Hilaire:        That's it for the highlights from the June 24th, July 8th and July 22nd issues of Circulation Research. Thank you for listening. Please check out the CircRes Facebook page and follow us on Twitter and Instagram with the handle at CircRes and hashtag Discover CircRes. Thank you to our guests. The BCVS Outstanding Early Career Investigator Award Finalists, Dr Hisayuki Hashimoto, Dr Matthew DeBerge and Dr Anja Karlstaedt. This podcast is produced by Ashara Ratnayaka, edited by Melissa Stoner and supported by the editorial team of Circulation Research. Some of the copy text for the highlighted articles is provided by Ruth Williams. I'm your host, Dr Cindy St. Hilaire. And this is Discover CircRes, you're on the go source for the most exciting discoveries in basic cardiovascular research. This program is copyright of the American Heart Association, 2022. The opinions expressed by speakers in this podcast are their own and not necessarily those of the editors or of the American Heart Association. For more information visit ahajournals.org.  

SAN LUIS OBISPO| In 1998/1999, an Ex-Convict & Rapist, kidnaps and murders two young female college students.   SOURCES   SLO County Appeal Confirmation https://www.slocounty.ca.gov/Departments/District-Attorney/Latest-News/2020/January/Supreme-Court-Affirms-Rex-Allan-Krebs-Conviction-a.aspx   Supreme Court Appeal document: Justia https://law.justia.com/cases/california/supreme-court/2019/s099439.html   Timeline of Kreb's life and crimes http://maamodt.asp.radford.edu/Psyc%20405/serial%20killers/Krebs,%20Rex%20Allen%20-%202005.pdf   The Mercury News https://www.mercurynews.com/2020/02/07/what-happened-to-the-two-san-luis-obispo-students-who-disappeared-after-kristin-smart/   Murderpedia http://www.murderpedia.org/male.K/k/krebs-rex-allan.htm     CREDITSTheme Song: Dark Swag by Tiny … Murder in San Luis Obispo Read More »

Detox Pathways and Protocols (Youtube)Free 15-min phone consult!Website and Supplement Store So - yup, toxins are a big problem. We are exposed to tons of them, and if our bodies aren't detoxifying properly, they can accumulate or cause damage to our cells, organs, and systems and wreak havoc on our lives. So how do you make sure you aren't overflowing your bucket? Here are 10 Important Concepts:Bucket Theory explains everything - keep this in mind if things are NOT getting better. SOMETHING is still filling the bucket from somewhere if you are actively trying to detoxify and leading a non-toxic life and you aren't improving. You have to empty the bucket faster than you are filling - you either aren't emptying it well, or you are still exposed somewhere.Breathing - There are only a few "exits" for things to get out of the body, breath is one of them. Think about a roadside alcohol test - you breathe out toxins to get rid of them.Peeing - this one is more obvious that you are "getting rid of waste", but the kidneys filter toxins and toxic metabolites, and you pee them out, so that system has to be working well too. Pooping - This one is the most obvious - - waste is bad so you want to get it out of you!! Your poop is how you get rid of MANY MANY toxins, and if your gut is not moving well, everything else backs up. Sweating - You are slightly limited on how much you can speed up your breathing, peeing, and pooping, but you can always open the other exit - sweat. Many toxins have been found excreted in the sweat - mycotoxins, BPA, parabens, metals, etc, so sweating is crucial for detoxification.Liver/Bile Flow - The liver filters toxins (through many processes - phase I and II, cytochrome P450 enzymes, glutathione, conjugation, glucuronidation, methylation, etc). These toxins are then put into bile, which is stored and released by the gallbladder. You have to have good liver function to filter the toxins, and then you have to have good gallbladder function and bile flow for the toxins to get into the gut, then you have to be pooping for them to get out.Lymph Drainage - The lymphatic system is one way that toxins and waste products are transported around the body to be excreted, and your lymphatic system has to be moving, it can't be stagnant. Cell Membranes - Toxins damage your cell membranes (including mitochondrial membrane), causing lipid peroxidation, stiffening, and poor membrane fluidity. Then toxins can also STORE in the cell membranes, so you need good healthy cell membrane support - this can be really important for detoxification.Mitochondria - THEY DO IT ALL!!!! Toxins store in the mitochondria, they damage the mitochondria, they affect fatty acid beta oxidation, Kreb's Cycle, Oxidative Phosphorylation, all the things - and mitochondria power detoxification in the liver, organs, cells, etc. It's all mitochondrial!Relevant Genes - There are a lot of relevant genes in detoxification, and it's super important. Many of them relate to "methylation", like MTHFR, COMT, PEMT, HNMT, but there are many others that regulate processes like glutathione recycling, cytochrome P450 activity, and many many more. 

Dr. Aaron Fritts is a co-founder of BackTable and a practicing Interventional Radiologist in Dallas, Texas. Early in his practice, Dr. Fritts realized the need for centralized, in-depth procedure and device information that his peers could access on the fly. Not long after, BackTable was born. Backtable is a podcasting brand for physician education, which started as interventional radiology and now also includes ENT, urology and their newest podcast, innovation, for physician entrepreneurs. We talk about the origin of the backtable, where he sees it evolving, what will happen if he starts including specialties that don't have backtables and most importantly how to build a team. I have chosen to outsource everything, whereas he has slowly built his team, so this was good information for me. But, one big takeaway for me was JoinHandshake.com, so I'm eventually going to hire a premed to help me. It'll be a good experience for them, something interesting for the resume and will take some tasks off my plate. He tries to convince me to join him for the next podcast convention. I think he just wants to hang out since I come across as so much fun.  Backtable.com JoinHandshake.com   This is a podcast that answers the question, “what should we have been learning while we were memorizing Kreb's cycle?” This is a practical guide for practicing physicians and other healthcare practitioners looking to improve in any and all aspects of our lives and practices. For more Physician's Guide to Doctoring, visit: PhysiciansGuideToDoctoring.com

This week, please join author Zdenka Pausova and Associate Editor Svati Shah as they discuss the article "Circulating Metabolome and White Matter Hyperintensities in Women and Men." Dr. Carolyn Lam: Welcome to Circulation on the Run, your weekly podcast summary and backstage pass to the journal and its editors. We're your cohosts. I'm Dr. Carolyn Lam, Associate Editor from the National Heart Center and Duke National University of Singapore. Dr. Greg Hundley: And I'm Dr. Greg Hundley, Associate Editor, Director of the Pauley Heart Center at VCU Health in Richmond, Virginia. Dr. Carolyn Lam: Greg, have you ever wondered what white matter hyperintensities in a brain are made of? Well, guess what? The feature discussion is going to give us a little clue. Believe it or not from the circulating metabolome, interesting, huh? Well, I'm going to keep you in suspense, as we first discuss other papers in the issue. And I want to go first, may I? Dr. Greg Hundley: Absolutely, but let's all grab a cup of coffee. Dr. Carolyn Lam: All right. You got yours. And here goes. This first paper reviews the results of endovascular aneurysm repair in patients from the Japanese Committee for Stent Graft Management registry, to determine the significance of persistent type II endoleak and the risk of late adverse events, including aneurysm sac enlargement. Dr. Greg Hundley: Ah, Carolyn, a very clinically relevant question. So what did this study show? Dr. Carolyn Lam: Of more than 17,000 patients who underwent endovascular aneurysm repair for abdominal aortic aneurysm from 2006 to 2015, 29% had persistent type II endoleak. The cumulative incidence rates of abdominal aortic aneurysm related mortality, rupture, sac enlargement, and reintervention were higher in patients with persistent type II endoleak. Specifically, the cumulative incidence rates of rupture and abdominal aortic aneurysm related mortality increased to 2% at 10 year follow up, which is dissimilar to the previously reported frequency of only about 1%. Cox regression analysis revealed older age, female sex, proximal neck diameter, and chronic kidney disease as independent, positive correlates of sac enlargement. Dr. Carolyn Lam: So these wonderful results are from Dr. Hitoshi Matsuda and colleagues from the National Cerebral and Cardiovascular Center in Osaka Japan, and really suggests that persistent type II endoleaks are not always benign. Dr. Greg Hundley: Beautiful summary, Carolyn. Well, my paper comes from the world of pre-clinical science. And Carolyn, in most eukaryotic cells, the mitochondrial DNA is uniparenterally transmitted and present in multiple copies derived from the clonal expansion of maternally inherited mitochondrial DNA. All copies are therefore, nearly identical or, as we would call homoplasmic. Dr. Greg Hundley: Now Carolyn, the presence of more than one mitochondrial DNA variant in the same cytoplasm can arise naturally or as a result from new medical technologies aimed at preventing mitochondrial genetic diseases and improving fertility. The latter is called divergent non-pathological mitochondrial DNA heteroplasmy, or DNPH. Dr. Greg Hundley: Now Carolyn, these investigators led by Professor Jose Enriquez from the Centro Nacional de Investigaciones Cardiovasculares hypothesized that DNPH is maladaptive and usually prevented by the cell. Dr. Carolyn Lam: Wow, that's really interesting, investigations from the world of preclinical science. What did the investigators find? Dr. Greg Hundley: Right, Carolyn. So, the investigative team engineered and characterized divergent non-pathological mitochondrial DNA heteroplasmy, or DNPH, as we've talked about before, mice throughout their lifespan. The authors found that DNPH impair mitochondrial function with profound consequences in critical tissues that did not resolve heteroplasmy, particularly within cardiac and skeletal muscle. Progressive metabolic stress in these tissues led to severe pathology results, including pulmonary hypertension and heart failure, skeletal muscle wasting, frailty, and premature death. And finally, Carolyn, symptom severity was strongly modulated by the nuclear context. Dr. Greg Hundley: So in conclusion, Carolyn, these findings suggest that medical interventions that could generate divergent non-pathological mitochondrial DNA heteroplasmy, or DNPH, so to address potential incompatibility between donor and recipient mitochondrial DNA. Dr. Carolyn Lam: Oh wow. That is fascinating. Well guess what? My next paper is also about mitochondria, but this time looking at the role of the mitochondrial calcium uniporter. So we know that calcium is a key regulator of energy metabolism and impaired calcium homostasis damages mitochondria, resulting in cardiomyocyte death, pathological hypertrophy, and heart failure. Dr. Carolyn Lam: This study by Dr. Wang from University of Washington and colleagues investigated the regulation and the role of the mitochondrial calcium uniporter in chronic stress induced pathological cardiac remodeling. In a series of elegant experiments in the mitochondrial calcium uniporter knockout or transgenic mice infused with isoproteronol, the authors found that the mitochondrial calcium uniporter is up regulated in the stressed heart to orchestrate mitochondria sarcoplasmic reticulum, and cytosolic calcium handling, preventing cytosolic calcium overload induced cardiomyocyte death. Dr. Carolyn Lam: Lack of mitochondrial calcium uniporter mediated mitochondrial calcium uptake is detrimental. Whereas, transgenic over expression is beneficial to the heart during chronic beta adrenergic stimulation. The nuclear translocation of calcium/ calmodulin kinase II delta beta via calcineurin mediated dephosphorylation of serine 332 activates CAMP response element binding protein to promote mitochondrial calcium uniporter gene expression in adult cardiomyocytes. Dr. Greg Hundley: Well, Carolyn, what's the take home here? What are the clinical implications? Dr. Carolyn Lam: Ah, thought you might ask. Well, this study indicates that enhancing mitochondrial calcium uptake could be a new approach to prevent chronic beta adrenergic stimulation induced heart remodeling. Targeting this cam kinase two delta beta KREB mitochondrial calcium uniporter pathway could be a therapeutic option for pathologic cardiac remodeling associated with chronic adrenergic stress. Dr. Greg Hundley: Excellent description, Carolyn, and thank you for walking us through that wonderful paper. Well, we've got some other papers in the issue and from the mail bag, Professor Lusis has a Research Letter entitled Identification of DNA Damage Repair Enzyme, ASK II as Causal for Heart Failure with Preserved Ejection Fraction. And Carolyn there's a cardiovascular case series from Professor Barrett entitled, “The Unrepairable Infant Mitral Valve, an Unexpected Case of Decompensated Heart Failure.” Dr. Carolyn Lam: Interesting. There's an exchange of letters between Doctors Matrougui and Wang regarding the article, “Integrated Stress Response Couples Mitochondrial Protein Translation with Oxidative Stress Control” and a Perspective piece by Dr. Fatkin on “Fishing for Links between Omega-3 Fatty Acids and Atrial Fibrillation.” Wow. Super cool. Greg, let's go on now to a feature discussion, shall we? Dr. Greg Hundley: You bet. Dr. Carolyn Lam: For our feature discussion today, we are talking about white matter hyperintensities. Now that's the most common brain imaging marker of small vessel disease. That may be known, but there's a lot more to it. For example, what are they made of? Well, you're going to so enjoy today's feature paper, and I'm so proud to have the corresponding author with us, Dr. Zdenka Pausova from Hospital for Sick Kids in Toronto, Canada, as well as our associate editor, Dr. Svati Shah from Duke University. So welcome ladies. And Zdenka, if I could start with, could you explain the rationale for your study and what you did?   Dr. Zdenka Pausova: Yeah. Thank you. Thank you for having me. Well, we were thinking that it is important to know what the metabolic variables that associate with white matter hyperintensities might be, simply because we know that there are other studies that have shown that whatever circulates in blood is in some way related to brain health. For example, different lipids associated with Alzheimer Disease, cognitive functioning and with structural properties of the brain. So we were wondering what the metabolics that are associated with white matter hyperintensities might be, simply because we would like to know a little bit more about the pathogenesis of the disease, because that's what metabolomic profiling can provide. And also if one can identify biomarkers that potentially could be used in the clinical setting. Dr. Carolyn Lam: Wow. Thank you. And Zdenka, this may be a very basic question, but we hear a lot about the metabolome and sometimes it's not very clear what metabolome profiling actually is. And could you just say a little bit about the technique and your study population and then your findings? Thanks. Dr. Zdenka Pausova: Yes. Sure. So we actually studied over 9,000 individuals from eight different population based studies and all of those individuals had metabolomic assays done with two main platforms. It's mass spectrometry and nuclear magnetic spectroscopy. Mostly these platforms are actually commercially available and altogether across all platforms, there were over 2,200 different metabolites. And from those we could study about 1200 that we had at least in two populations. And what the metabolites are, these are different metabolites of lipids, sugar, proteins, amino acids that people put on those platforms or that designers put on the platforms, in order to test some of their hypotheses, that they were actually these metabolites of interest for different sorts of diseases, including cardiovascular and cerebrovascular disease. Dr. Carolyn Lam: Wow. So this is really large scale, massive, big data, if I may, and if I'm not wrong, it's the first large scale study to identify circulating metabolomic measures associated with white matter hyperintensities. So could you please summarize the main findings? Dr. Zdenka Pausova: Well, overall we actually found that there were 416 metabolites that were nominally associated with white matter hyperintensities, but as it is in epidemiology, you have to correct for multiple comparisons. So when we did DR correction, there were only 30 variables associated with white matter hyperintensities. And when we wanted to check whether those associations are independent of the risk factors for white matter hyperintensities, such as hypertension, type two diabetes, smoking, obesity, we actually ended up with seven markers, seven metabolites that were significantly associated in the fully adjust model. Dr. Zdenka Pausova: And the main one was actually a derivative of amino acid hydroxyphenol that probably is a marker of ischemia in the brain. And what actually I am coming to is, and one of the main findings was, that many of those metabolites were associated with white matter hyperintensities in a sex specific manner. That is that they were detected in the pool sample, but essentially the signal came from only one of the sexes. And so this one that was the most significant was detected only in males essentially, and not really in females. Dr. Zdenka Pausova: And that I think is an interesting, one of the most interesting findings that we can expect that there are really sex specific pathways, biochemical pathways, that accompany white matter hyperintensities. Dr. Carolyn Lam: Wow. Zdenka, thank you so much. I have to bring Svati in right now to share some perspective, Svati, especially to put these findings into context, please. Dr. Svati Shah: Yes. Dr. Pausova, really wonderful paper. This is an incredible study, if you think about it. The largest scale study that really is trying to understand metabolic by biomarkers, but the biomarkers actually tell us about the potential biology of what's going on with these white matter hyperintensities. We know that these hyperintensities in the brain are associated with increased risk of stroke, increased risk of cognitive decline, but we don't really understand stand what the risk factors are. There's been some studies suggesting that there's genetic risk factors, but this is really the first large scale study to say, "Hey, what's in the blood that we can measure?" And just to be clear, these technologies are measuring these biomarkers that are very, very, very low levels in the blood, really granular snapshot of what's going on with the human being. Dr. Svati Shah: And by looking at these blood markers that the authors were able to find biomarkers that are associated with these brain abnormalities, but really highlighting some of the important biology as Dr. Pausova started to talk about. So I think what it gets us to is we get to have our cake and eat it too. We get to learn about biomarkers that might have clinical utility, but we also have discovered, they've discovered new biology that could lead to new therapies, for example, and a better understanding of the mechanisms of why some people develop these hyperintensities as they age. And some people do not. Dr. Carolyn Lam: Wow, Svati, you put that so eloquently and just to put it out there for everyone, that significant metabolite hydroxyphenol pyruvate explain 14% of the variants of white matter hyperintensity volumes in males. Whereas, the proportion of variants explained by hypertension is only 1% or type two diabetes is only 1 to 3%, or smoking is even less than 0.1%. So this is, as you said, Svati, it's a significant discovery as well. Zdenka, though, how do we apply this clinically? Dr. Zdenka Pausova: Well, it could be a marker that is measured in circulation and it is a marker that can be measured in blood and can indicate early stages of white matter hyperintensities. But I think before we get there, it would be of high value to actually carry out some longitudinal studies, because it would be really interesting to know if it is an early marker before the white matter hyperintensities extent is enlarged. And so that would one thing. But other than that, I think if that would be the case, we can just measure it in blood and see how predictable it is. Dr. Carolyn Lam: Can I ask what about the women? Did anything predict it in women? Dr. Zdenka Pausova: That's a good question. There was only actually one variable. To our surprise, only one variable that was significantly associated with white matter hyperintensities in women. And it is really surprising because the sample size was the same. The extent, the volume of white matter hyperintensities was quite similar. They were of similar age, similar adiposity. So there were no huge differences, yet we could not actually detect too many metabolized associated with white matter hyperintensities in women. Really surprising. And I don't have a good answer for it now. Dr. Carolyn Lam: Wow. Thank you. Svati, did you have further thoughts on the clinical applications and implications of these tremendous data? Dr. Svati Shah: Yeah. I think the ability to have a biomarker as Dr. Pausova nicely articulated that would potentially prevent people from having to get an MRI. And we would be able to identify people hopefully at an earlier stage in the process. In this lovely study, they were looking at biomarkers in people who already had the hyperintensities. I think the next step as Dr. Pausova outlined to be able to identify whether these predict high risk people who will develop them in the future and then try to target therapies. A potential advance in precision medicine in the neurologic space, that we could use this biomarker to say, "You need this particular medication." Dr. Svati Shah: Some of the biomarkers that Dr. Pausova's group discovered were actually just cholesterol measures. So maybe we need to be instituting more aggressive cholesterol therapies in these patients who are at high risk. I'm not saying we can do that yet, but these provocative results suggest that this could lead to a more personalized approach to high risk individuals who may have consequences and develop these white matter hyperintensities. Dr. Carolyn Lam: And Zdenka, did you have anything to add to that? Dr. Zdenka Pausova: Perhaps one interesting aspect of the study that I actually was nicely surprised at the end of the study that the markers, one could the different lipids or the different derivatives of amino acids, the literature provided actually a possible pathways, how those could be involved in the development of white matter hyperintensities. Some of them actually, we could possibly link to impairment of myelination of a neuronal axons, or actually the axons themselves could be the metabolized could reflect damage of those axons.     Dr. Zdenka Pausova: And also, one suspicious pathway or one pathway that is suspected to be big part of the development of white matter hyperintensities is the disruption of blood brain barrier and some of the markers could be actually linked to that vascular dysfunction. Dr. Carolyn Lam: Aw, that's wonderful. Thank you so much, Zdenka, for publishing this beautiful work with us in Circulation. And thank you, Svati, for taking this paper through and inviting this beautiful editorial. In fact, it quite summarizes our discussion. It's entitled, What Turns White Matter White? Metabolic Clues to the Origin of Age-Related White Matter Hyperintensities and it's by Dr. Eric Smith from University of Calgary and I invite everyone to read this. Dr. Carolyn Lam: So thank you once again for joining us today on Circulation on the Run. From Greg and I, it's been wonderful having you. Don't forget to join us again next week. Dr. Greg Hundley: This program is copyright of the American Heart Association 2022. The opinions expressed by speakers in this podcast are their own and not necessarily those of the editors or of the American Heart Association. For more, please visit ahajournals.org.

Bradley Block, MD, is an otolaryngologist-head and neck surgeon on Long Island, New York, where he lives with his wife and three young sons. He is a partner at ENT and Allergy Associates and he created the Physician's Guide to Doctoring Podcast. It is a scintillating and engaging podcast, where he interviews physician and non-physician experts to help teach us what we should have been learning while we were busy memorizing Kreb's Cycle. It is a practical guide for practicing physicians, physicians-in-training, and all allied health professionals. Topics range from personal finance to politics to improve interactions with patients to what every doctor should know about different specialties.He went to med school at SUNY Buffalo and graduated with research honors and went on to residency at Georgetown. He enjoys surfing (yes, there is surfing on Long Island), skiing (there is no skiing on Long Island), smoking meat, exercising, throwing his sons across the pool, and finding any excuse to quote an 80s movie.In this episode, Dr. Bradley also discussed...1:15 Who is Bradley Block?2:58 Pressures in the life of Dr. Bradley4:05 Don't force yourself to something 9:05 What's a great physician father to you?10:38 Putting your kids first, but not putting yourself last11:57 Setting a good example13:29 Physician's guides to doctoring14:26 How can we communicate effectively and efficiently?16:28 Being a good listener18:15 Bradley's great advice for doctors and physicians when talking to patients 20:38 Importance of paying attention to your kids 22:56 Comforting your kids in their hard times 23:35 Be a role model to your children 25:37 Imperfections of being a dad 27: 32 Controlling patience 28:47 Practice apologizing to your kids when you make mistakes 30:14 Bradley shares a movie 32:36 Purpose of Dads Before Doctors Podcast 33:28 Parting Words Listen and be inspired. It will be worth it all!Connect with Bradley BlockWebsite: physiciansguidetodoctoring.comFacebook: facebook.com/physiciansguidetodoctoringInstagram: @physiciansguideLinkedIn: https://www.linkedin.com/in/bradley-block-md-1712a6127/Get In Touch With Dads Before Doctors!Website: www.dadsbeforedoctors.comFacebook: www.facebook.com/dadsbeforedoctorsFacebook Group: https://www.facebook.com/groups/dadsbeforedoctorsInstagram: www.instagram.com/dadsbeforedoctorsIf you like the podcast, please leave us a rating or review. That way, we'll be able to reach even more dads like you.Apple Podcast: https://podcasts.apple.com/us/podcast/dads-before-doctors-podcast/id1572464956Spotify: https://open.spotify.com/show/4JrRJgdX8FwueuwJFROir8Be our next guest: https://dadsbeforedoctors.com/podcast

Dr Alessandro Bitto is a researcher at the University of Washington who studies biological aging, mitochondrial function and metabolic disease. He walks us through the history, current thinking and some of the experimental data of cellular senescence, including the role of DNA damage and telomeres, some of the senolytic drugs (quercetin, Dasatinib and others), and how different cells effect senescence differently, like epithelial cells vs neurons vs immune cells. He talks about the root of cancer being cells that escape cellular instructions. From this foundation, Dr Bitto layers in the role of mitochondria with deep explanations of metabolism as the summary of actions that cover the cycles of catabolism and anabolism- the breaking down of our food, water and oxygen intake into their individual constituents and then the process of building membranes, organelles, cells, tissues, organs, etc. He discusses the actions with the mitochondria which govern oxidative phosphorylation including the Kreb's cycle (aka Citric Acid Cycle) and the electron transport chain and the importance of membranes to govern the passage and connection of these elements to do the work. We discuss macronutrients (fats, carbohydrates and proteins) as well as the vitamins and minerals that act as co-factors. Next, Dr Bitto links mitochondrial activity with aging. Dr Bitto then shares the research he's been personally working on, which revolves around the impact on aging (in mice) by rapamycin, acarbose and butryrate. Of note, acarbose and butryrate are active in the gut and suddenly, here we see the direct link between the gut, the mitochondria, and biological aging- wow! Listen in for a ride through the science and research of metabolism, mitochondria and aging.

If you missed the last episode, go back and listen to it, but the takeaway was that your MITOCHONDRIA ARE REALLY, REALLY,  IMPORTANT for autoimmunity, or anything else. Like - the most important thing for your health. These little cellular batteries power your brain, your heart, your muscles, everything. When they become dysfunctional, it leads to symptoms like fatigue, weight gain/inability to lose weight, brain fog, malaise, and eventually disease processes like autoimmunity, dementia, and metabolic diseases like heart disease and diabetes. HOW DO MITOCHONDRIA MALFUNCTION? To understand how mitochondria MALfunction, you have to understand some basics about how they are SUPPOSED TO FUNCTION PROPERLY (and how to test that!) so that you can support your mitochondria appropriately with strategies I will discuss in the next episode. In this podcast I describe 4 main aspects of mitochondrial function that you need to understand in order to understand your personal metabolism:1. Glycolysis - this is a sugar-fermenting pathway that actually occurs outside the mitochondria, but dysfunctional cells can get "stuck" in glycolysis, which ferments sugar to produce energy less efficiently than "respiration". YOU DON'T WANT THAT! Viruses induce a glycolytic shift, it helps them survive. Toxins induce a glycolytic shift. But most of all, a high sugar diet and a sedentary lifestyle will encourage your cells to get "stuck" in this glycolytic shift, which is a hallmark of many cancer and Alzheimer's cells. 2. Kreb's Cycle and Oxidative Phosphorylation - sounds fancy, don't get PTSD from high school bio, but this is the BIG MOTOR that we want our cells to use, and glycolysis is the TROLLING MOTOR (listen to episode 30 if that doesn't make sense!). We WANT the body to use the Kreb's Cycle and then the Electron Transport Chain to produce ATP (energy) because it produces the most energy with the least exhaust!3. Electron Transport Chain - your food gets broken down and goes through the Kreb's Cycle and those electrons get put into something called the Electron Transport Chain (ETC), which is a "chain" of 5 proteins that pass electrons from one to the other, this drives the pumping of protons and like quantum cellular magic, out spits ATP, or ENERGY. YOU WANT THAT!!!Poisons like cyanide and carbon monoxide shut this down immediately and you die. Popular supplements like CoQ10 help this. You want electrons passing through this chain at the highest rate possible!4. Beta-Oxidation - this process shuttles fat into the mitochondria to be burned for fuel, and many people have broken or "less-than-optimal" beta-oxidation function (think: "I can't burn this last 20 lbs even though I'm exercising!")If you have metabolic issues, it's really important to know what's wrong with YOUR mitochondria - you could have issues in #1, #2, #3, #4, or in ALL FOUR!!Many basic lab tests actually give you an idea of your mitochondrial function (iron, thyroid, blood sugar, inflammation....almost all labs because mitochondria power all functions). These labs are obviously very important for any case or condition, but my favorite testing for mitochondrial function is Urinary Organic Acids testing that actually shows specific markers for Glycolysis, markers of Kreb's Cycle dysfunction, Beta-Oxidation dysfunction, and much more, and gives us more detailed answers on how the mitochondria are malfunctioning so that we can support them properly!

“...and physicians, we're not good at doing this for ourselves, you have to give yourself some grace. Right? Like, ‘You're being hard on yourself. You're a good person, you're working hard, you deserve the best.'” -Dr. Bradley Block In today's episode, Jen has a conversation with the host of the Physician's Guide to Doctoring Podcast, Dr. Bradley Block, to talk about the ins and outs of physician podcasting. Have you ever thought about starting your own podcast or just wondered about the inner workings? In this episode, Jen asks Brad about his start at podcasting, what motivated him to do that, and the guest who most inspired him. They discuss whether podcasting is a viable side gig. If you're a healthcare provider thinking about joining the podcast world, this is the episode for you!    Bradley Block, MD, is an otolaryngologist – head and neck surgeon on Long Island, New York, where he lives with his wife and three young sons. He is a partner at ENT and Allergy Associates and he created the Physician's Guide to Doctoring Podcast. It is a scintillating and engaging podcast, where he interviews physician and non-physician experts to help teach us what we should have been learning while we were busy memorizing the Kreb's Cycle. It is a practical guide for practicing physicians, physicians-in-training and all allied health professionals. Topics range from personal finance to politics to improving interactions with patients to what every doctor should know about different specialties. You can find him at PhysiciansGuidetoDoctoring.com and on Twitter and rarely on Instagram @physiciansguide. You can't find him on TikTok, Snapchat, Etsy or on Pinterest and you probably never will.    Dr. Block attended medical school at SUNY Buffalo, graduating with research honors, and went on to ENT residency at Georgetown University Medical Center. He enjoys surfing (yes, there is surfing on Long Island), skiing (there is no skiing on Long Island), smoking meat, exercising, throwing his sons across the pool and finding any excuse to quote an 80s movie.   EmpathIQ can help you build more positive reviews online AND by doing so, bring more fulfillment to you about your important work!  click here Claim the DocWorking discount and learn more  Find full transcripts of episodes on the DocWorking Blog  Our New DocWorking THRIVE  Membership is here!! You'll get ongoing Small Group Coaching with our Experienced Team, Ongoing Coaching Support in a Private Community that Fosters Peer Support and Mentorship, and superb virtual courses to include ‘STAT: Quick Wins to Get Your Life Back' with Gabriella Dennery MD and Master Certified Coach Jill Farmer, ‘A New Era of Leadership' and ‘Communication for the Win' with Lisa Kuzman, and so much more!    Join our community by clicking here.   At DocWorking, our specialty is Coaching Physicians. We bring an exceptional experienced team to Coach Physicians to achieve the Best in Life and Medicine.    Doctors devote their lives to caring for others. But does that mean they must sacrifice their own health and wellbeing? Absolutely not!   At DocWorking, we have developed a unique way to embrace it all.   The caring for others that you do so selflessly AND the caring for YOURSELF AND YOUR FAMILY that you crave in order to bring it all into the perfect balance specific to YOU.   What if we told you that you CAN have it all? The career you dreamed of when you decided to become a doctor AND the life outside of medicine that you desire?   DocWorking empowers physicians to get back on the path to achieving their dreams.   Ace the Boards and Max Your CME Preparing for your board exam or looking for a quick and convenient way to earn CME? Study for your board exam and fulfill your CME requirements with BoardVitals. 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Outsourcing allows you to delegate tasks to virtual assistants so you can free up your time and finally do whatever it is you've been wanting to do.   Become a Medical Legal Consultant We at DocWorking are excited to collaborate with Dr. Armin Feldman to bring you this opportunity to develop a side income or even a full time income while using your clinical skills!   Achieve Financial Independence with a Financial Planner/Advisor Change your trajectory: build financial independence and strength by working with our trusted resources. Working with a trusted financial planner and/or financial advisor can help you to create a specific plan that works for you. The right advisor can help you stay on track to reach your financial independence goal and your next vision.   Protect Yourself and Your Family with the Right Insurance Doctors and their families need many types of insurance–and inadequate coverage can cost you dearly. Connecting with trusted insurance professionals in your area is recommended to be sure you're appropriately covered.   Are you a physician who would like to tell your story? Please email Amanda, our producer, at Amanda@docworking.com to be considered. And if you like our podcast and would like to subscribe and leave us a 5 star review, we would be extremely grateful! We're everywhere you like to get your podcasts! Apple iTunes, Spotify, iHeart Radio, Google, Pandora, PlayerFM, ListenNotes, Amazon, YouTube, Podbean You can also find us on Instagram, Facebook, LinkedIn and Twitter.    Some links in our blogs and show notes are affiliate links, and purchases made via those links may result in payments to DocWorking. These help toward our production costs. Thank you for supporting DocWorking: The Whole Physician Podcast! Occasionally, we discuss financial and legal topics. We are not financial or legal professionals. Please consult a licensed professional for financial or legal advice regarding your specific situation.   Podcast produced by: Amanda Taran

Aging-US published a Special Collection on Eye Disease which included "Loss of NAMPT in aging retinal pigment epithelium reduces NAD+ availability and promotes cellular senescence" which reported that retinal pigment epithelium performs numerous functions critical to retinal health and visual function. Here, the authors evaluated the temporal expression of key nicotinamide adenine dinucleotide -biosynthetic genes and associated levels of NAD+, a principal regulator of energy metabolism and cellular fate, in mouse RPE. They simulated in vitro the age-dependent decline in NAD+ and the related increase in RPE senescence in human and mouse primary RPE using the NAMPT inhibitor FK866 and demonstrated the positive impact of NAD+-enhancing therapies on RPE cell viability. This was confirmed in vivo in the RPE of mice injected sub-retinally with FK866 in the presence or absence of nicotinamide mononucleotide. Dr. Pamela M. Martin and Dr. Ravirajsinh N. Jadeja said, "The retinal pigment epithelium (RPE) performs numerous functions essential to normal retinal health and function." RPE serves as a physiologic barrier between the photoreceptor cells and the choroidal blood supply and in doing so, plays an essential role in protecting the retina from systemic insults by regulating immune responses and thereby limiting the entry of infectious or otherwise detrimental agents into retina. This is the premise of a number of recent studies including the present investigation in which we focused on nicotinamide adenine dinucleotide and factors governing its bioavailability in relation to the overall impact on RPE viability. NAD+, a central metabolic cofactor, plays a critical role in regulating cellular metabolism and energy homeostasis. The ratio of NAD+ to NADH regulates the activity of various enzymes essential to metabolic pathways including glycolysis, the Kreb's cycle, and fatty acid oxidation. There is a wealth of clinical and experimental data stemming from studies of other primary diseases of aging demonstrating clearly a generalized decline in the availability of NAD+ in association with increased age and the related reduction in the activity of a number of downstream metabolic pathways that contribute to the development and progression of degenerative processes. Members of the sirtuin family, poly ADP-ribose polymerases and the efficacy of therapies capable of impacting them have been evaluated in the context of aging retina and RPE. However, little attention has been given to upstream factors that regulate NAD+ biosynthesis, particularly in RPE. Given the importance of RPE to retinal health and function, in the present investigation we focused on evaluating the impact of NAD+ and factors that regulate its availability on RPE viability both in vivo and in vitro. This finding is highly relevant to the clinical management of AMD but perhaps also broadly to the management of other degenerative retinal diseases in which RPE is prominently affected. The Martin/Jadeja Research Team concluded in their Aging-US Research Output that these present data demonstrating an age-dependent decline in NAMPT expression and in turn, NAD+ generation in RPE which ultimately promotes RPE senescence supports strongly the rationale for enhancing NAMPT expression and associated NAD+ generation therapeutically. Based upon the present experimental observations, future preclinical studies evaluating NMN or other therapies that have a direct impact on NAMPT expression and NAD+ metabolism in the context of aging and age-related retinal disease development and progression are highly warranted. Full Text - https://www.aging-us.com/article/101469/text Correspondence to: Pamela M. Martin email: pmmartin@augusta.edu and Ravirajsinh N. Jadeja email: rjadeja@augusta.edu Keywords: retinal pigment epithelium (RPE), aging, age-related macular degeneration, NAD+, NAMPT, senescence, SIRT1

Sébastien Kreb reçoit Benjamin Lavernhe, comédien. Il est à l'affiche du film "Le Discours", réalisé par Laurent Tirard, qui sortira ce mercredi dans les salles.

Eden Robins and Dr. Craig McClain join me on today's episode to talk about why they started a podcast to make boring science things not so boring with their new podcast. It's funny, it's witty, it's actually quite informative as it dives into science to make things like lichens and the Kreb's Cycle exciting.  Follow the podcast here: Apple Podcasts: https://podcasts.apple.com/ca/podcast/no-such-thing-as-boring/id1566049669Spotify: https://open.spotify.com/show/1WxUiisgFOX9awi8ns4DCs?si=46WLZzoKTmKQm0pAmWX_Iw Want To Talk Oceans? Join the Speak Up For Blue Facebook Group: http://www.speakupforblue.com/group. Speak Up For Blue Instagram: https://www.instagram.com/speakupforblue/ Speak Up For Blue Twitter: https://twitter.com/SpeakUpforBlue  

On this weeks episode of The Beats with Kelly Kennedy, we it down with Melatonin Master - Dr. John Lieurance. In this conversation Dr. John shares his story, the almost 15 year journey that he went through in order to regain his health. In doing so he acquired knowledge and insight about what the body needs to function optimally. His wealth of knowledge on mitochondria, melatonin and NAD+ is extremely impressive and we are so excited to get his message out to the world. Dr. John attended St Luke's Medical School & Parker College of Chiropractic, and has a BA in Anatomy from New York State College. He has been involved in an integrated practice for over 25 years, practicing with MD's, DO's, AP's, PT's & DPM's in an integrated setting. With the successful integration of Neurology, Chiropractic, Naturopathy, LumoMed and Nutrition, he sees excellent clinical results! He has successfully treated himself for Chronic Lyme disease & CIRS. He uses some of the most cutting edge treatments to treat others with many chronic conditions. a few of these treatments are: CVAC, 10 pass hyperbaric ozone, silver IV, IV laser (LumoStem), hyperbaric oxygen, the shoemaker protocol and other natural means. These treatments have been proven very successful for treating many chronic neurological and chronic infection conditions. Dr. Lieurance believes that toxins and infections are at the root of many conditions including Autoimmune, Parkinson's, Alzheimer's, Inner Ear Conditions, and most Degenerative Neurologic Conditions. He is the chief scientific officer of MitoZen a cutting-edge health care technology company which has a focus on powerful delivery systems such as nasal sprays, suppositories, and liposomal preparations. Many of the products created are designed to be used for support for alternative practitioners to apply to chronic conditions such as mold toxicity (CIRS), heavy metal toxicity, autoimmune conditions, neurological diseases, and chronic inflammation. Also, many “BioHackers” find them helpful to enhance cognition and physical performance. He is also the director of the Functional Cranial Release Research Institute (FCRRI), whose purpose is to study the neurologic mechanisms behind specific endo-nasal balloon inflations. His main clinical interest is in cranial morphology, as well as cranial rhythm and its influence in brain function. He developed the “Ultimate Guide to EWOT” a DVD (with manual), that describes setting up EWOT out of your home or office. John Lieurance founded UltimateCellularReset.com, a web based educational portal, which sends out weekly videos on health and wellness tools for overcoming disease, longevity and vitality. He has been featured in many podcasts and documentaries, including Ben Greenfield Fitness and Pain Revealed. 0:00 | Introduction 3:08 | Dr John's Story 7:17 | How did Dr. John resolve his Lyme disease? 10: 40 | why didn't Dr. John give up on his trying healing journey? 14:00 | The Melatonin, why you need it! 17:30 | We need to be challenged, the importance of stress 20 :40 | Let's understand the Kreb's cycle ...it's really important! 26:30| Do we need more then 5-6 hours of sleep? 30:00 | How can we get into a parasympathetic healing more 32:00 | What is Heart Rate Variability really telling us? 36:30 | Achieving vitality 38:35 | What is NAD+? 39:36| What effects NAD+? 41:00 | What is NADH? 41:20 | How do we get naturally occurring NAD+ 45:00 | Ways to get NAD+ into the body 51:40 | What is Dr. John's message to the world? Resources discussed|| Parascelusus Clinic Melatonin Amazing Benefits of the Miracle Molecule By: Dr John Lieurance Sandman Dr. Peter Martone and necknest.com Dr. John's Mitofast Connect with Dr. John! Melatonin Amazing Benefits of the Miracle Molecule By Dr. John Lieurance Visit Dr. John in Sarasota, FL Advanced Rejuvenation MitoZen.com Ultracellular Reset Education Program

Bradley Block, MD, is an otolaryngologist – head and neck surgeon on Long Island, New York, where he lives with his wife and three young sons. He is a partner at ENT and Allergy Associates and he created the Physician’s Guide to Doctoring Podcast. It is a scintillating and engaging podcast, where he interviews physician and non-physician experts to help teach us what we should have been learning while we were busy memorizing Kreb’s Cycle. It is a practical guide for practicing physicians, physicians-in-training and all allied health professionals. Topics range from personal finance to politics to improving interactions with patients to what every doctor should know about different specialties. You can find him at PhysiciansGuidetoDoctoring.com and on Twitter @physiciansguide Unlock Bonus content and get the shows early on our Patreon Subscribe: Apple Podcasts | Google Podcasts | Stitcher | Amazon  | Spotify   Michael L. Relvas, is a CFP professional and insurance agent committed to helping physicians nationwide with their term life and disability insurance needs. He provides an objective, transparent and education-focused process that aims to help physicians make prudent decisions and avoid over-complicating things. He exclusively offers Own-Occupation disability insurance policies for residents, fellows, and attending physicians. We really like Michael and know he’s got your best interest at heart when it comes to disability insurance. We know he’d be happy to help you with whatever your needs are. You can find Michael at doctorpodcastnetwork.com/mrinsurance or contact him at 800-817-4522. Show notes at https://rxforsuccesspodcast.com/45 Report-out with comments or feedback at https://rxforsuccesspodcast.com/report

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Dr. Joseph Weiner is an Associate Professor of Clinical Psychiatry, Medicine and Science Education at the Zucker School of Medicine at Hofstra/Northwell, where he co-directs the four-year curriculum in Physician-Patient Communication and Interpersonal Skills. Thinking and writing about how patients and clinicians communicate with each other has been a major interest in his career. He teaches us today about something I’ve been wanting to learn about for a long time. The tagline of this show is “everything we should have been learning while we were memorizing Kreb’s cycle.” This doesn’t hold true for this episode because Dr. Weiner teaches motivational interviewing to medical students; it just wasn’t being taught when I was there. We go over the basics of motivational interviewing, its origins, the spirit of it, how to go about it and then we discuss how it can be used to have a productive conversation about the SARS-CoV-2 vaccine. I haven’t had training in it, but I’ve used it already and it WORKS! You can’t use it to get someone to do something they don’t already want to do, but it helps them clarify their thoughts and hesitations and, using BJ Fogg’s language, either get closer to or over the action line. Dr. Weiner received his M.D. and his Ph.D. in Physiology and Biophysics from New York University. He did residency training in psychiatry at NYU/Bellevue and a fellowship in public psychiatry at Columbia College of Physicians and Surgeons. In addition, he pursued advanced psychotherapy training at the American Institute of Psychoanalysis. Dr. Weiner has received national and regional awards for his work as a clinician and educator. One he is particularly proud of was the 2015 Teacher of the Year Award from the Zucker School of Medicine at Hofstra/Northwell for the first 100 weeks of medical school. Dr. Weiner’s career interest in communication has expanded to the written medical narrative. He is writing a book about lessons learned from his late wife’s battle with cancer and is currently an MFA student in Creative Writing and Literature at Stony Brook Southampton. Find this and all episodes on your favorite #podcastplatform at PhysiciansGuidetoDoctoring.com Please SHARE and SHARE and SHARE!!! #DoctorPod #DocPod #PhysicianPodcast #PhysicianPod #DoctorPodcast #DoctorPodcastNetwork #PhysicianPodcaster #DoctorPodcaster #HealthcarePodcast #MedicalPodcast #MedicinePodcast #PhysiciansGuide #GuidetoDoctoring #MedPod #HealthPod #MedCast #HealthCast

When should med students trust their school…and when should they push back? This episode is sponsored by Panacea Financial, a division of Sonabank, member FDIC. Panacea is banking for medical students, built by doctors. Med students sometimes find it difficult to trust their school will get them through this ordeal of learning medicine.  Sometimes you're taught things that seem less than useful.  Sometimes your professors or administrators don't seem to understand what's at stake for you.  Sometimes the rules and procedures are puzzling.  When should you trust the system, and when should you push back?  To help him with this topic Dave talks to M1s Rick Gardner, AJ Chowdhury, and Eric Boeshart;  and M4 Holly Conger. They discuss times when trust was warranted (turns out the Kreb's cycle really does have clinical applications), and when to push back if something needs fixing. Plus, Dave and the crew visit the saddest place on the Internet to practice answering real medical questions: Yahoo! Answers. We Want to Hear From You How'd we do on this week's show? Did we miss anything in our conversation? Did we anger you? Did we make you smile? Call us at 347-SHORTCT anytime  or email theshortcoats@gmail.com.  It's always a pleasure to hear from you!…

Welcome back to episode 437 of the Whole View. (0:27) Stacy welcomes new listeners and takes a quick moment to introduce herself. Stacy had a 20-year career in Federal Regulation and Law. She jokes about how she tries not to talk about it because it's such a boring topic. Discovering how what she put in and her body affected her health was a life-changing experience for her. Now she works as her own boss. Stacy leads a large team (mostly women) focused on getting safer, non-toxic products into consumers' hands. She also does weekly podcasts with her co-host, Dr. Sarah Ballantyne. Sarah also introduces herself to any new listeners. She has a medical research background and a Ph.D. in Medical Biophysics. Sarah also had a similar translational type experience as Stacy. While navigating her academic research career and struggling with over a dozen different health conditions, Sarah discovered just how much the food we eat impacts the way our bodies work. Looking at her lifestyle choices and their impact on her life opened a new pathway for her. Now Sarah is an author, blogger, health educator, and thinks of herself as a "science translator." Her goal is to dig deep into the literature and act as a bridge to the academic research community she used to bring that information to everyday people who can benefit from it. The Mission Of Nutrivore Stacy tells listeners that one of the best things they've done to help bridge that gap looks at the specific nutrients within different forms of food and how they affect our bodies. She adds that they've gotten so deep in the weeds, they want to look more big picture as to what being a "nutrivore" means from a whole health perspective. Stacy also hopes that doing this will provide more context for the science of past and future shows. Sarah tells the audience that she and Stacy have been throwing the word "nutrivore" around a lot lately. She thinks that it would be helpful to ground ourselves in understanding what the ultimate goal is. That means getting away from diet jargon. Sarah also shares that this is a fantastic episode to share with friends and family overwhelmed with diets. There are so many "fad diets" approaches out there that can be next to impossible to separate out what is an influencer making commissions off of selling a supplement line versus something rooted in science that may be misinterpreted. Sarah and Stacy try to stay as close to science as they possibly can. They use science to guide recommended health principles. The vast majority of scientific studies tell us that focusing on a nutrient-rich fuel source, as well as other lifestyle factors, are the things that support health. Diets vs. Health and Wellness Stacy shares a huge mental shift of focusing on the outcome being health helped her navigate. (6:18) "Diet" is a word used to sell you a weight loss product that actually depletes your body of nutrients. Or it could be referring to how you eat. And so, instead of using a term used that way, it's easier for Stacy to think of nutrient-density as a way to achieve the ultimate goal: health. Stacy tells listeners that the justification for all the things we do are all around this idea of health and wellness. As so, as confusing as that is, one of the things that people get askew is the idea of nutrients. She attributes this to macro and micronutrients. And they are entirely different. Stacy suggests they start with the very basics and go over what they mean by "nutrient." She also reminds listeners that the goal of every one of these shows is never to cause shame or guilt, whether for past choices or future ones. Stacy adds one is perfect, and no one ever will be perfect. But we can make choices if we know what health looks like, and the more choices we make toward that goal, the better off we'll be. What Are Nutrients? Sarah dives into what the different nutrients are. (8:53) She explains that Macronutrients are protein, carbohydrates, and fats, and they amount to energy. So what they do is supply our body with the energy required for chemical reactions to occur.  Micronutrients are amino acids, fatty acids, vitamins, and vitamin-like compounds, minerals, and phytonutrients.  These are the building blocks for cellular structures and resources needed for all those chemical reactions to happen. Sarah explains that they're called "macro" and "micro" due to the amount of each that we need to consume. So we need larger amounts of energy to drive all these chemical reactions. And then we need smaller amounts of building blocks and resources. Sarah explains that our body breaks it down into individual amino acids when we digest a protein before it's absorbed. The protein itself is a macronutrient, while the amino acid is a micronutrient. However, the body needs both equally. Without either nutrient, our cells stop being able to do the things they need to do their jobs. Sarah believes it would be helpful to talk about a few examples of a biological system. And how it uses nutrients to sustain itself or drive its function in some way. When you understand that we use these nutrients are up in chemical reactions, it becomes a lot easier to see why we need to replenish them by consuming those nutrients constantly. Essential and Nonessential Stacy shares how it's been helpful for her to think about things in terms of essential and nonessential things. Sarah agrees, saying that the classification of essential and nonessential nutrients is very interesting. Anything labeled essential has two things in common: We know that our bodies can't make it at all or anywhere near enough of what we need, so we need to get it from outside sources There is an identified disease that occurs from deficiency of that nutrient Vitamin C and Iron are both classified as essential because Scurvy or Anemia comes from insufficient quantities. With nonessential nutrients, we can make them ourselves in a dire situation, or there's never been a deficiency-disease identified from not getting enough. Fiber would be an example of a nonessential nutrient. Sarah explains that this is a misnomer because we do actually need both to function properly. She adds that with nonessential, it means that you won't die without them. And that it's very different from saying you'll be healthy without them. What It All Means Stacy shares how mind-blowing it is to think about how her body and make something automatically when it needs to. Sarah talks a little bit about Vitamin A and how some people are genetically unable to make their own. And how this relates to how we need to think about consuming active forms of vitamins that we can get from food. Stacy agrees, sharing how we much rather get the nutrients her body needs from food, and not supplements, whenever she can. Sarah also takes a minute to emphasize there is a lot of science showing that nutrients in a multivitamin are very poorly absorbed. They tend to go straight through you, and part of that has to do without the nutrients are put into the tablet or capsules. Sarah explains the steps folic acid goes through as an example and what can impact our ability to absorb it into our bodies. She also reiterates that it's best to get as much as we can from our food because it's so much easier for us to get the nutrients we can use from there. How Are Nutrients Used in Our Body? Sarah wants to use this next example mostly just to show how complex these processes are. (23:22) There are about twelve biological systems, and they are things like the muscular and skeletal systems. Central Nervous System She will be talking about the central nervous system in this example. She also explains that the central nervous system controls much more than just your brain, but also your heart, lungs, etc. Biologically speaking, without your brain controlling your central nervous system, your body can't do anything. It turns out brains are really necessary for health! For example, B-vitamins are used by the mitochondria in our cells in the chemical reactions (together called the Kreb's cycle or citric acid cycle) to make the cellular energy molecule (called ATP) from sugars and fat we eat, as well as glycogen at fat we store. The nervous system (brain, spinal cord and nerves) needs: Vitamin B1: neurotransmitter production Vitamin B6:  neurotransmitter production Choline:  neurotransmitter production Vitamin B12: myelin sheath Copper:  myelin sheath B vitamins in general: ATP production / mitochondrial function Vitamin D: gene expression, biorhythms Calcium: nerve impulses Potassium: nerve impulses Sulfur: cell regeneration, oxygen use Omega-3 Fats: nerve signaling and cellular health, maintains blood-brain barrier Tryptophan:  serotonin, melatonin Phenylalanine: dopamine Glutamate, glutamic acid: GABA Polyphenols: promote neuronal signaling, increase production of antioxidant and anti-inflammatory agents Our brains are very unique because it has this special barrier. Not everything in the blood can get into the brain, which's different from other tissues. This barrier protects the brain from pathogens and toxins that might be in the blood, and without sufficient Omega-3 fats, we can't maintain that barrier's integrity. Sarah adds that this is a very generalized list of nutrients the central nervous system needs to function. Check out this study for more information on how dietary factors influence the central nervous system! The Immune System She adds that she often talks about the immune system as a "nutrient hog" because it's the most greedy system in terms of nutrients it requires to function optimally. When it's not working properly, it tends to turn on inflammation and not be able to turn it off. This is often called "systemic inflammation" and contributes to every chronic illness, such as autoimmune disease, cardiovascular disease, asthma, diabetes, kidney disease, etc. Sarah sums up that an immune system that cannot regulate itself is a very bad thing. The immune system needs: Vitamin A:  immune regulator, differentiation Vitamin D: immune regulator, Treg cells Vitamin E: antioxidant Vitamin K2: antioxidant Vitamin B12: cell production, methylation Vitamin C: antioxidant Zinc: T-cell development and activation, cytokines Selenium: antioxidant, cell function and activation Iodine: phagocyte health Iron: antioxidant enzymes Magnesium: thymus gland Copper: cytokine production, cell proliferation Flavonoids: antioxidants Omega 3 fats: phagocytes It turns out that nutrient insufficiencies (which is different from deficiencies because we're getting some, just not enough) pretty dramatically impact how the immune system is functioning. Sarah says that specifically Vitamins A and D are really important for immune regulation, which reigns in the system, so you don't get that system-wide inflammation. Our immune system also identifies cells that may be up to some cancer-like shenanigans and kill them off before becoming cancerous. So part of the process of cancer development is the immune system failing to identify those cells.   Deficiency vs. Insufficiency Sarah explains that just between these two systems, nearly every essential and nonessential nutrient is represented.   (33:55) Stacy takes a moment say how interesting she finds insufficiencies versus deficiencies. She adds that due to the high levels of deficiencies there are, the levels of insufficiencies much be way higher. Sarah defines insufficiencies as not consuming the recommended daily allowance of a specific nutrient. The "recommended" numbers are set based on a body of scientific literature for which 97.5% of the population will not show a deficiency. Sarah also explains that that recommended number should be seen as a minimus and not a goal. And there's still a percentage of the population that that won't be enough for. She defines a deficiency as, if doctors measured it in your blood, you wouldn't have the amount considered in the normal range, or you have some sort of symptom associated with not having enough of that nutrient. Sarah explains that deficiency in a single nutrient can impact the function of multiple biological systems. If a biological system is missing a nutrient required for optimal function, the body can not be optimally healthy. In fact, nutrient deficiencies are linked to every chronic illness! How Prevalent are Nutrient Deficiencies? Stacy asks about how prevalent nutrient deficiencies are. (39:10) Sarah explains that one of the main ways deficiencies are studied is through food journals. Scientists have people send in their meals, and they study them that way. The following chart includes food and supplements like multivitamins: Sarah repeats how each of the nutrients is important to every system of the body. They all use them. And when you're deficient in something, a system that needs it to function isn't functioning to its highest capacity. Sarah adds that when you take supplements out of the equation, these numbers get even worse: For example, the immune system not operating at full capacity can't heal a cut, fight off an illness, or even turn itself off as best as it should. Sarah also includes examples from the liver and brain not functioning optimally. She also explains that our genetics play a big role in how susceptible we are to nutritional deficiencies. And it's not always predictable how long our bodies can go "running on fumes." Top 10 Nutrients We’re Deficient In Stacy asks about which nutrients are the most common for deficiencies and where we might find a solution. (43:54) Sarah says that an estimated 90% of Americans are deficient in at least 1 essential nutrient! She also explains there are ten nutrients out there that over half of us are said to be deficient in. Vitamin A Sarah tells the audience that roughly 56% of us are diffident in Vitamin A and recaps how Vitamin A is very often found in animal food sources. Vitamin A is important for our bones, eyes, immune health, maintenance and normal regeneration of all our barriers (like the gut and blood-brain barriers), and more. Sarah drops that the top food source for gaining Vitamin A is the liver and pauses for dramatic effect. Stacy adds that organ meat is a high-optimized source for almost all of the deficiencies on this list. But before Sarah gets too deep into that, Stacy reminds listeners not to worry- you can take a pull for that. Stacy also wants listeners to understand that she and Sarah go so deep into where you can find all of these things in foods because taking a multivitamin isn't always as readily absorbed or as high in quality as something you can get from a food source. Stacy shares that she's not actively putting organ meat on her family's table, and so for her, the best way to get it is in supplement form. She adds that it is not an extraction; it is a whole food that is dehydrated and powdered. Sarah lists red meat, organ meat, pork, poultry, fish, and shellfish are all good sources of Vitamin A. Vegetable sources must be converted into an active form, which is very inefficient (as low as 3%). How It Effects Us Stacy adds it takes a few years for these deficiencies to catch up with us, and we won't notice how being deficient is affecting us right away. She recognizes that not everyone eats meat, and that's okay. Fish and eggs also get you very far if you're able to prioritize them. Stacy shares that in her youth, being a vegetarian did affect her health negatively long-term because she wasn't eating the correct kinds of foods to supplement what she wasn't getting from animal sources. Vitamin B6 Sarah explains that approximately 54% of us are deficient in Vitamin B6. (51:02) Vitamin B6 is essential for cellular energy, metabolism of amino acids and lipids, required for gluconeogenesis, synthesis of neurotransmitters, and hemoglobin, supporting the methylation cycle. Sarah takes a minute to explain to listeners how the methylation cycle works for turning proteins on and off. Peppers, onion family, pistachios, liver, fish, meat (poultry and red meat), sunflower seeds, garlic, and dark leafy greens are all great sources of Vitamin B6. Stacy asks about other forms of B Vitamins and if they're found in similar food sources. Sarah answers that it's a good general rule. Vitamin B9 Sarah tells the audience that 75% of us are deficient in this B Vitamin. She explains that it's essential to metabolize nucleic acids and amino acids, cell division, and production of red blood cells, supporting the methylation cycle. Food sources for B9 are organ meat, green veggies, leafy greens, legumes, beets, asparagus, avocados, papayas, strawberries, and seaweed. Vitamin D 75% of us are deficient in Vitamin D. Stacy tells viewers that the best source of vitamin D is from the sun! Sarah adds that where this vitamin comes from is due to our cholesterol's response to that UV radiation. Stacy and Sarah went further into detail in Episode 354! This nutrient controls the expression of over 200 genes. Vitamin D is critical for the function of mineral metabolism, bone mineralization and growth, biosynthesis of neurotrophic factors, hormone regulation, cell survival and division, circadian rhythms, barrier tissue health, and immune system health. Sarah tells the audience that it's very important to get their vitamin D levels tested. And if they're low, look at supplementation. The dose sufficient to bring you up to the level you need to be at varies wildly from person to person. And that is controlled by how your body regulates vitamin D and your environmental factors. Too Much Is A Thing? Sarah also explains that it's very hard to get enough from food on its own if you're already deficient. She also adds that there's a happy medium range and such a thing as too much Vitamin D. She does say it's usually cured by supplements and very hard to do with just food alone. Top food sources include fish, grass-fed dairy, oysters, pastured eggs, grass-fed meat, pasture-raised meat, shrimp, other shellfish, mushroom (D2), and tofu (D2). Stacy loves the idea of animals living a happy life outside in the sun and that the best animal products for our health come full circle. Sarah says this goes as far as plants grown in depleted soil as well. So how our food is raised is very important to our health as well. She also reminds listeners that eating snout to tail means nothing is going to waste. Vitamin E Sarah explains that around 60% of people are deficient in Vitamin E. She adds that it functions as an antioxidant throughout the body, which is quite important for immune function. It's also very important for anti-aging of cells. Top food sources for Vitamin E are nuts, seeds, leafy greens, avocado, olives, organ meat, shellfish, unrefined plant oil, fatty fish, and winter squash. Sarah also explains that high-fat plant products are the best producers of this vitamin. Calcium Approximately 65% of us are deficient in calcium. Both calcium and magnesium are electrolytes. Sarah explains that calcium is a large component of bones and teeth, is a cofactor for many enzymes, cell signaling (metabolism, cell division, gene expression), blood clotting, neurotransmitter release and nerve conductance, and muscle contraction. Sarah explains what being a cofactor is and how it works. Top food sources for calcium are grass-fed dairy, tofu, sesame seeds, chives, chia seeds, radishes, seaweed, beef, dark leafy greens, and sardines. Stacy points out that there's more than just dairy on the list. Sarah agrees and points out how the body more easily absorbs the calcium in dark leafy greens than the calcium in dairy. In fact, studies on dairy are pretty mixed in terms of osteoporosis. Stacy adds that stress is big for depleting calcium. Magnesium  Around 68% of people are magnesium deficient. Sarah and Stacy covered magnesium in detail in Episode 409! Sarah explains that three hundred different enzymes use magnesium. It's also key for ATP synthesis, DNA and RNA synthesis, a constituent of bones and teeth, neuromuscular contractions, production of testosterone and progesterone, metabolism of phosphorus, calcium, potassium, sodium, B vitamins, and vitamins C and E, cofactor in methylation, and the immune system. Top food sources for magnesium are seaweed, dark leafy greens, chives, pumpkin seeds, fish, soy, Brazil nuts, sunflower seeds, other nuts and seeds, and avocados. Sarah tells listeners that the "superstar" foods for this nutrient are leafy greens. She also explains that it's one of the harder nutrients to get adequate amounts of from food sources alone. Sarah explains why she loves food journals from the point of view of piecing together the puzzle of what we're getting, what we need, and where we need to get it from. Which is exactly the idea behind nutrivore! Zinc Around 73% of people are zinc deficient. Sarah tells the audience that zinc is everywhere and kind of a do-it-all nutrient. Sarah explains the diverse functions of zinc include the activity of approximately three hundred different enzymes, DNA and RNA transcription, regulates apoptosis, absorption and activity of B vitamins, muscle contraction, connective tissue formation, insulin production, and testosterone, a component of vitamin D receptor, and immune system. Stacy says that without looking, she can name the number one source of zinc: oysters! If they are in season and on the menu, she orders them. Sarah claims that you will have met your zinc quota for the week if you eat oysters once a week. Sarah adds liver, crab, wild game (red meat), loser, farmed red meat, clams, organ meat, mushrooms, and seaweed are all great food sources for zinc. She reiterates that so many of us are deficient and so much of our body relies on zinc, that there's never been a better reason to try organ meat and shellfish. DHA & EPA Around 70% of people are DHA & EPA deficient. These are also known as Omega fats. Sarah tells listeners DHA & EPA are used by the body for anti-inflammatory, immune health, vascular health, neural/brain health, vision health, fetal development, supports healthy microbiome, and cellular health in general. Fish, shellfish, grass-fed meat, organ meat, grass-fed dairy, and seaweed are great food sources for DHA and EPA. Sarah adds that nuts and seeds can be very high in ALA (especially flax, chia, walnuts), which can be converted into DHA and EPA. Although this is usually inefficiently done- again 3%. Fiber Stacy says you can never talk about fiber enough. In fact, if she's eating carbohydrates, she wants to be eating fiber as well. Sarah says about 90% of us are deficient in fiber! Sarah explains we need fiber because it feeds the gut microbiome, helps eliminate toxins, helps regulate hormones, regulates gut motility, fermentation produces SCFA, and promotes better sleep. Plus, it helps you poop! Sarah explains what happens in our intensities if we don't have enough fiber to bind our waste eliminated by the body. Some stuff we want to get rid of can actually be reabsorbed into the body if we don't have enough fiber to aid in getting rid of. Fruits, veggies, mushrooms, and legumes are all great food sources of fiber. Sarah also reminds listeners that we want diversity in our fibers for the sake of our gut microbiome. Nutrivore: Frequent Flyer Nutrient-Dense Foods Sarah and Stacy have done several different shows on the importance of vegetables and vegetable diversity for any listeners interested in checking them out. (1:19:15) Stacy also recaps a previous show about needing 30 different types of fruits and veggies a week. And how it is not as scary as it sounds. Sarah shares that certain foods, like liver and other organ meat, vegetables, and seafood, come up repeatedly as the best sources of these nutrients. Stacy shares how mushrooms and seaweed were on several lists and found that very interesting. Sarah explains the term "nutrient density" refers to micronutrients' concentration (mainly vitamins and minerals) per calorie of food.  She also knows that organ meat is a "big ask" for people. There is a big market out there for encapsulating these foods, so don't run away! Sarah also explains that nutrient-dense foods supply a wide range of vitamins and minerals relative to the calories they contain.  Low nutrient density foods supply lots of energy without much in the way of additional nutrition.  Sarah tells listeners that a nutrivorous, or nutrient-sufficient, diet is practically achieved by consuming more nutrient-dense foods, in ratios that provide synergistic quantities of every nutrient. More Episodes: A nutrient-sufficient diet must focus on the most nutrient-dense foods available: Offal (how to eat nose to tail EP 347) Seafood (fish, shellfish, sea vegetables) (seafood safety concerns EP 366) Vegetables (8+ servings daily!!!!)  (most recent is 30 a week, EP 424) 373, 335, 304, 286, 152, plus a ton more, talk about different aspects of high veggie consumption, why, what counts, and what that looks like Edible fungi (EP 392, 307) Fruit (3-5 servings per day) (Case for more carbs, 305) Other nutrient-dense foods: High-quality meat and dairy (Ep 317 Budget vs Quality) Healthy fats (EVOO EP 326) (Best fats for gut health EP 414) Nuts and seeds (EP 413) Herbs and spices Fermented foods (EP 155) Eggs Properly-prepared legumes Sarah tells the audience that she recognizes that we are all human and that change is hard. She wants to be sure to permit listeners not to have to go "all-in" immediately if that's not the best way for you to make a long-lasting, positive change in your life. Sarah also reminds listeners to aim for 30 different fruits and veggies a week! Nutrivore: The Whole Diet Stacy loves the idea of taking this all into account when looking at a nutrivore diet. This is because the focus is on eating what we need to feel like our best selves. A nutrivorous diet is one in which the goal is to fully meet the body’s physiologic needs for both essential and nonessential nutrients from the foods we eat.  This is also called a nutrient-sufficient diet. Stacy tells listeners that a nutrivore diet is about the overall quality of the whole diet. And not about a list of yes-foods and no-foods.   Stacy shared that, as a person with many food intolerances, she learned the hard way that if you continue to eat a food your body is intolerant to, you're keeping your body from absorbing more of everything else. That means you then need to consume more of everything because your body still hasn't absorbed everything it needs to function because something like gluten or nightshades are gumming up the works. Be Nice To Yourself Sarah explains that though eliminating empty calorie foods helps to achieve nutrient sufficiency, no food is strictly forbidden. There are no "yes" food and "no" foods. You can "buy" yourself wiggle room with your favorite "junk foods" by eating more nutrient-dense superfoods. Also, food sensitivities and other dietary priorities can be layered on top of this approach. Sarah suggests thinking of nutrivore as a diet modifier: you can do nutrivore Mediterranean, nutrivore vegetarian, nutrivore Paleo, etc. Don't Be Afraid Of Going Nutrivore! Stacy shares that her body had been able to handle more stress in life because her body is less involved with dealing with inflammatory foods. (1:37:14) Sarah shares that this might be a great time to emphasize that it only takes a few weeks for our taste buds to adapt to big shifts in our diets.  Studies looking at taste adaptation to one of a low-sugar, low-salt, or low-fat diet have shown that participants develop a preference for the healthier foods they've been eating over a few weeks.  This is attributable to our taste buds becoming more sensitive.  Sarah explains that familiarity and flavor association with positive experiences is another key driver of food preference.  Studies show that with repeated exposure to foods that we innately dislike, we can lose our aversions to those foods and actually develop a preference for them.  In fact, we can learn to like new flavors after trying them as few as four or five times.  What does this mean? If you aren't enjoying the new healthy foods you're adding to your diet, don't give up. The more of these healthy foods you eat, the more you'll enjoy them! Final Thoughts on Nutrivore Stacy shares that her favorite thing she used to tell her kids is your tongue sheds tastebuds like a snake sheds its skin. And you just have to wait until the next round to see if you like whatever it is then. Stacy also said it's not so much as figuring out to like a certain food but finding a way to prepare. She invites listeners to stay open-minded, ready, and willing to get there. Thanks so much for listening!

The [DS]/[CB] are moving their agenda forward with the reset, they are preparing the world for what they want. Trump is preparing the transition away from the [CB]/[DS]. Trump has the upper-hand, he will use their weapons against them. The patriots are in control, the elections are going exactly how they planned it, it must be shown to the people. If it was presented outright the public would not accept, the people must see the fraud. The [DS]/[CB] are preparing for their loss and so are the patriots. Trump just terminated Kreb who handled CISA. Chris Miller and Ezra Cohen Watnik took back control of special operations. All the pieces are almost in place.

This is Frank Gaffney with the Secure Freedom Minute. Christopher Krebs was responsible for the federal Cybersecurity and Infrastructure Security Agency in the course of the 2020 election, which he characterized as the most secure in the country’s history. President Trump fired him yesterday, prompting a fresh torrent of claims from his media and other admirers that there’s “no evidence” of fraud and decrying Kreb’s termination. In fact, voting irregularities and misconduct, to say nothing of simple human errors, did happen this year. As always. What remains to be determined – and proven – is whether such defrauding affects the outcome of the presidential race. Christopher Krebs should have been removed long before now, however, for not acting on warnings his office received before the election that electronic voting systems used by 28 states were materially compromised. That failure may well have enabled massive fraud that has compromised the 2020 election, as well.  This is Frank Gaffney.

Purple’s not the dm for once as Kreb takes control, of you can cal it that.

Welcome to podcast 344. On this podcast, we've got quite a bit for you. We've got news notes of varying kind. I demo and talk about something I recently learn on the iphone thanks to Michael in Indiana. I talk about Kreb's article about moving money and how one can get duped. Krebs on Security: When in Doubt: Hang Up, Look Up, & Call Back which is also talked about on the tech blog. Getting forms in a different language than you speak? We got two applications at MENVI which we are now not going to process based on advise given to us. I hope to have another podcast really soon. Thanks for listening to this one, and make it a great day

Register here to find out when our webinar is going live. Tuesdays and Thursdays 1pm PST –https://greenmoustache.easywebinar.live/registration-16..... Find out more about and support our 22 Million Campaign - https://nicolettericher.com/ Want to improve your health… Click here to access our FREE resources so you can live your best life! https://nicolettericher.com/free-stuff Today Dr. Terry Wahls, the MS conqueror, is back! We discuss her new book - based on the Wahls Protocol - and dive deeper into the tools and resources to reverse your multiple sclerosis and a host of other chronic diseases. The Wahls Protocol is very similar to the Gerson Therapy and our Eat Real to Heal protocol in that it's all about rebuilding your body's cellular mechanisms to kickstart your body to self heal. Dr. Wahls got the lasting results herself after suffering from debilitating MS for years and being in a wheelchair. Join us and discover how to use your kitchen as your local farmacy to reverse your disease once and for all. Find Terry Wahls on Website - www.terrywahls.com/research Instagram @drterrywahls Facebook/Twitter at @TerryWahls.   NEW BOOK - The Wahls Protocol: A Radical New Way to Treat All Chronic Autoimmune Conditions Using Paleo Principles - https://terrywahls.com/the-wahls-protocol/ Other Book - The Wahls Protocol Cooking for Life: The Revolutionary Modern Paleo Plan to Treat All Chronic Autoimmune Conditions - https://www.amazon.ca/Wahls-Protocol-Cooking-Life-Revolutionary/dp/0399184775/ref=tmm_pap_swatch_0?_encoding=UTF8&qid=&sr= Learn more about her MS clinical trials by reaching out to her team: MSDietStudy@healthcare.uiowa.edu. TED Talk - Minding your mitochondria Pick up a one-page handout for the Wahls™ Diet at www.terrywahls.com/diet Copies of our  research papers https://terrywahls.com/researchpapers/ Discussed on the PODCAST: Kreb cycle - https://en.wikipedia.org/wiki/Citric_acid_cycle Last podcast with Dr Terry Wahls - https://podcasts.apple.com/us/podcast/ep-44-dr-terry-wahls-talks-about-her-ms-how-she-reversed/id1442998357?i=1000462606049 Tommy Douglas - https://en.wikipedia.org/wiki/Tommy_Douglas Book – The brain that changes itself by Norman Doidge - https://www.amazon.ca/Brain-That-Changes-Itself-Frontiers/dp/0143113100 Book – Food fix by Mark Hyman,MD - https://www.amazon.ca/Food-Fix-Economy-Communities-Planet-One/dp/031645317X Health practitioner training program – physicians, health coaches, nutrition professionals and other health professions learn about the wahls protocal – https://terrywahls.com/certification/ Wahls protocol seminar – https://terrywahls.com/seminar/ Find out about our Richer at Work program - https://nicolettericher.com/richer-at-work Find out ways you can work with Nicolette to improve your health here: https://nicolettericher.com/work-with-me Find out more about our non-profit society Sea to Sky Thrivers - https://seatoskythrivers.com/ Want to know more about Nicolette’s Green Moustache Café’s https://www.greenmoustache.com/ Sign up for the Eat Real to Heal Online Course - https://nicolettericher.com/eat-real-to-heal Buy the Eat Real to Heal Book here: https://www.amazon.ca/Eat-Real-Heal-Medicine-Arthritis/dp/163353782X/ref=tmm_pap_swatch_0?_encoding=UTF8&qid=1567629190&sr=8-1

Talk to a Dr. Berg Keto Consultant today and get the help you need on your journey (free consultation). Call 1-540-299-1557 with your questions about Keto, Intermittent Fasting or the use of Dr. Berg products. Consultants are available Monday through Friday from 8:30am to 9 pm EST. Saturday & Sunday 9 am to 5 pm EST. USA Only. Join my FREE 30-Day Low-Carb, No-Cheat Challenge Here! http://bit.ly/30-DayKetoChallenge Take the Free Keto Mini-Course: https://bit.ly/2Cpb03l Download Keto Essentials https://m.me/drericberg?ref=w2128577 Take Dr. Berg's Advanced Evaluation Quiz: http://bit.ly/EvalQuiz Do you feel like you just can't sit still? Here's what to do. For more info on health-related topics, go here: http://bit.ly/2ZE1PXR Today, we're going to talk about restless leg syndrome. What is restless leg syndrome? Restless leg syndrome is very uncomfortable and keeps you from sleeping. You have an impulse to fidget, and you feel like you can't be still. What causes restless leg syndrome? • A deficiency of vitamin B1 (thiamine) What can influence this condition: 1. KREB cycle (ATP production) 2. Pentose phosphate pathway (nerve atrophy) 3. Acetylcholine 4. Low dopamine Dr. Eric Berg DC Bio: Dr. Berg, 51 years of age is a chiropractor who specializes in weight loss through nutritional & natural methods. His private practice is located in Alexandria, Virginia. His clients include senior officials in the U.S. government & the Justice Department, ambassadors, medical doctors, high-level executives of prominent corporations, scientists, engineers, professors, and other clients from all walks of life. He is the author of The 7 Principles of Fat Burning. FACEBOOK: fb.me/DrEricBerg?utm_source=Podcast&utm_medium=Anchor TWITTER: http://twitter.com/DrBergDC?utm_source=Podcast&utm_medium=Post&utm_campaign=Daily%20Post YOUTUBE: http://www.youtube.com/user/drericberg123?utm_source=Podcast&utm_medium=Anchor DR. BERG'S SHOP: https://shop.drberg.com/?utm_source=Podcast&utm_medium=Anchor MESSENGER: https://www.messenger.com/t/drericberg?utm_source=Podcast&utm_medium=Anchor DR. BERG'S VIDEO BLOG: https://www.drberg.com/blog?utm_source=Podcast&utm_medium=Anchor

Once you've made the decision to hold a crisis management exercise, how should the exercise team and participants begin planning for the exercise? There's a lot to do in order to ensure that the goals of the exercise are achieved! In this episode of the Managing Uncertainty Podcast, Bryghtpath Principal & CEO Bryan Strawser along with Consultant Bray Wheeler discuss their experiences in crafting and preparing exercise material - but also how to coach participants through preparing for the exercise that you are developing. Related Posts & Podcast Episodes: Crisis Exercises: Why are they important? Managing Uncertainty Podcast - Episode #19: Exercises are Boring How to evaluate plan effectiveness after active shooter exercises Why social media and communications should be part of any crisis exercise //static.leadpages.net/leadboxes/current/embed.js Episode Transcript Bryan Strawser: Hello and welcome to the Managing Uncertainty Podcast. This is Bryan Strawser, principal and CEO at Bryghtpath. Bray Wheeler: This is Bray Wheeler, a consultant at Bryghtpath. Bryan Strawser: We've decided that 90 days from now, we're going to have a crisis exercise. We've scheduled it. We've sent out the invites. We've secured the room. Then it hits us. We have to prepare for this exercise. We just thought it was a good idea to have one. What are we going to do here? What do we do, Bray? Bray Wheeler: Where to begin? Where to begin? Well, I think a couple of assumptions. We've identified the scenario. We've laid out our run of play, or our outline, for the exercise. We feel pretty confident in that. I think what we're trying to drive at is- Bryan Strawser: We know who's participating and observing and evaluating and controlling, which might all be the same person. Bray Wheeler: Right. All the finer points of the nature of the exercise and what we're trying to accomplish has been laid out. But we have to get ready for it. I think there's a couple of different pockets of things, activities, that have to be done. One is as players and one is as facilitators from that exercise. From just a pure participant player standpoint, there's quite a bit that people can do that's probably fairly obvious, but not everybody does it. We do surveys a lot with a lot of our companies, and it's amazing to see that people, "Well, I brought the plan." And that's all they did. Bryan Strawser: Bringing the plan is good. It's good to have the plan with you. Bray Wheeler: Right. It's a good start, but they often don't necessarily review that plan upfront. They're not meeting as individual workstreams or things like that. There's a lot that can be done. I think we've talked quite a bit about reviewing that plan is important, but it's really looking at it from a, "I understand the general flow of how things go, that I could easily communicate that to somebody who doesn't know." Maybe that's your participants, your members of your crisis group, whatever that is, should be able to walk up to a random employee in the company and be able to succinctly explain what the general process is for that and have that person understand what they're talking about, because that means that participant gets it. Bryan Strawser: Yeah. They understand what's going on. They can speak to the context of the exercise. I think our standard practice has been, as you get closer to the exercise, seven to ten days out or maybe a little bit earlier, we're having somebody, sometimes it's us, sometimes the client's main program person is sending out an email to participants. In the email, we always include a couple of things, like, "Here's the goals or objectives for the exercise. More importantly, how you should think about preparing for the exercise." To your point, it is to review the plan, talk about the plan with others. We have them look at previous after-action reports, to look at what worked well and what recommendations work. Sometimes those recommendations are about the participants, or about the interaction from the participants or knowledge from the plan, that kind of thing. Bray Wheeler: Or a process, like accounting for- Bryan Strawser: Or a process. Bray Wheeler: ... employees, or how to engage an HR partner or something like that, that having those workstreams, whether it's communications or HR or security or something like that, get together and meet up in advance and just say, "Hey, we get into a situation where this exercise is coming up. Let's talk through our roles and responsibilities, our process. Who's going to have the ball? When do I need to pick the ball up? When are you going to pass me the ball, or when can I expect that the ball's coming my way without knowing in advance?" That, I think, speaks to just being comfortable, just generally, not only with the process but just that roles and responsibilities and understanding what other people are doing when you walk into that room. You're not breaking down, "Why to do this?" or "Don't you do this?" That you're pretty comfortable, and it's deeper questions that you're going to ask during the exercise to clarify a certain piece, rather than knowledge seek. Bryan Strawser: I think it behooves people who have been involved in a previous exercise, and they find themselves going into another exercise. Same company, same rough role, and responsibilities. I think it is important to reflect on what went well and what didn't go well in that previous exercise, and look at the formal after-action report if you have access to it, because at least the way we ponder constructing exercises, and I know our clients believe in this too, we're looking at what didn't go well last time that we said we were going to fix? Now we're going to test it again to see if it's fixed. You brought up accountability for employees. We've done a couple of exercises earlier this year with clients where that was a factor. One company had a process for that. It went into the exercise world and went well. One had never thought about it, and went, "Wow, we should figure out how to do that." Obviously, this fall when we go back there and do an exercise, we're going to be asking that. "Okay, so ..." Bray Wheeler: You've had time. Bryan Strawser: "You've had time. We're going to test it." Bray Wheeler: Do you know where your employees are? Bryan Strawser: Yeah, "Do you know where your employees are? How are you going to account for the employees in this building?" The 1100 employees [inaudible 00:05:58], and I have confidence in this particular case the HR leader will be like, "Yes, we're going to initiate our new process." Bray Wheeler: Done. Bryan Strawser: Like magic, it happens. But it behooves you to go back and look at that list of opportunities and make sure that you've addressed them before the next exercise. Bray Wheeler: Or I think to your point, in preparing for the next exercise, and even thinking about how you're going to follow up out of that exercise is that after action and those opportunities, those things that didn't go well, to your point, is it's really based on what do we want to change? How do we want to fix it? Making it actionable, those opportunities, rather than, "Well, that didn't go well. We don't have a process for that." Great. You need to take that opportunity and say, "Okay, we didn't have this and we need to put that into place and that needs to be ready for the next exercise or next event or time limit, or whatever you want to set to it." But make it actionable. Bryan Strawser: Another area, I think, in preparing for an exercise, and you mentioned this, I think you talked about it as workstreams and I agree with that context. You think about the elements of a crisis team or a data incident response team, you have people there who are representing different functions or are a particular subject matter expert. They're bringing that silo with them. But think about a client-facing business where you have multiple clients in different sizes that your organization provides services or products to, and then just think about the concept of communication in that world. You've got external comms going out to the public, like PR, you got social media. You got the investment community for publicly traded. You've got your employees, so now you got internal communications, and then you got communications for your clients. Bray Wheeler: You even have regulatory. Bryan Strawser: Good point. I left that out. You've also got communication regulators. Now you're in a crisis and you have to communicate what's going on. That is probably not just your comms team. It's probably multiple stakeholders in various workstreams to make that happen. If you go upstream of preparing for the exercise, then it might be a good idea to get your workstream together and walk through this, particularly if it's been a while since your last exercise. Do you have the inputs and outputs and the decision points nailed down? Do you need to practice this outside of the crisis environment before you get to the exercise? In some cases, yes. We have clients that should probably practice that. Bray Wheeler: Well, and especially if there have been organizational changes if there are new leaders in those positions covering those areas. Communications is a good example because it's probably one of the more complex pieces of running a crisis, because of everything we've laid out. Who's in charge of drafting the messaging? Who has that responsibility? Who's approving it? Who needs to see it first? Bryan Strawser: Where's the base factual narrative that we're all working off of? Bray Wheeler: Right. How is it being delivered, and who's delivering it? How? There's through social media. There's through, hey, we have people calling into our customer service line who may not be a customer. They may just be journalists or a general person off the street asking a question. Employees calling up. We've seen that before, where employees will call the customer service line looking for information. It's having all those different components, to your point, laid out ahead of time and knowing who's running what. Bray Wheeler: The second bucket we have been talking about ... we have the player, participants, members of the crisis team, and then there's the facilitators or the operators of the exercise [crosstalk 00:10:06]- Bryan Strawser: Controllers and exercise director, depends on what terminology you're using. Bray Wheeler: Evaluator. All those things. Bryan Strawser: Servers. Bray Wheeler: I think as we were talking earlier, there's really two ways as you're thinking about the exercise. You're running an exercise probably for two reasons. One is it's a newer function or a newer plan or generally just a new team, and really it's a- Bryan Strawser: It's a confidence builder. Bray Wheeler: Yeah. You're building confidence. You're getting them comfortable with the plan and the process and the players and each other, in a lot of cases. The second one is it's a more mature function. This one is we're going to challenge you. As you indicated earlier, introducing fog into it. Bryan Strawser: Fog of war. Bray Wheeler: Stress. Bryan Strawser: We're going to introduce noise in order to distract you from managing your scenario. Bray Wheeler: Yeah. How are you able to discern what's important, what's not important, what decisions do you need to make, all those different things. Really, as a facilitator or controller ... we'll use facilitator for conversation purposes, really with that new function, you're really guiding them. You're shepherding them through the exercise. You're a source for answers to questions. You're mediating different conversations. You're really just allowing them to talk it out and play it out to get comfortable with it. When you get into that mature scenario, your role changes. You're less the source of truth. You're a nudger. You're just poking them and prodding them along to keep the exercise moving so that they don't stall out, but really you're not giving them the answers anymore. Bray Wheeler: You need to be able to distinguish between what role you're playing in preparing for that exercise and make sure that you're clear on that, so that you're not giving too much information in a mature situation, but you're also not so abstract with the new. Bryan Strawser: Yeah. I think those are all great points. As the exercise staff, so to speak, we're really looking at are we clear upfront what everyone's roles are going to be? Are we clear on how we're going to interact? The way our approach has been, even if we're sitting next to each other during the exercise, is we use a particular channel on our internal slack to keep everybody in sync, because often when we're doing exercises, there might be two or three of us in the room, and one or two of us are mulling, who are calling in, or some other nefarious way of injecting information. We've done some strange things. But the interaction ... we're very clear that we're going to execute a move 14 now. Bryan Strawser: When I'm directing the exercise, I'll then say, based on their reaction to move 14, we'll execute move 17 or move 19. Those moves are basically the reward or the consequence of what they're doing in the move that we just called. Sometimes we have moves that we inject that we don't even bring up because the situation has superseded that. Part of what I think we do in the preparation for this is we do a pretty good job, I think, of thinking about the multiple branches that the exercise may take, and then crafting injects that are realistic that make sense in the moment that they do these things. Even if they seem far fetched at the time, we're creating them. Sometimes we're creating these in order to jump ahead in time or force an action because they haven't chosen to do something earlier. Bryan Strawser: For example, one of our internal traditions on information security, cyber security-focused exercise, is to have someone inject themselves into the scenario and pretend to be Journalist Brian Krebs, because famously, Kreb gets ignored by people sometimes and that's really not a wise move. There's always a consequence in our exercise if you respond to Krebs, then he will work with you in the exercise on the story. If you ignore Krebs, then the story's going to break a lot faster than you think it's going to, because now he's mad. Exercise Krebs is mad. Bray Wheeler: And often with a surprising level of accuracy of- Bryan Strawser: Of what actually happened. Bray Wheeler: ... what's going on to force that, because he's known for that. Bryan Strawser: But this is what you want to create, I think, in the exercise, is to play out what we were just talking about. One of the bigger decisions that you're going to make in a cybersecurity exercise when you get to the point of confirming a breach, and the breach involved regulated data, PCI, PHI, trade seeker data, you pick your issue, some of these have mandatory reporting periods attached to them. You may be in the exercise thinking, "I've got 72 hours to craft my messaging to understand the various vehicles I've got to send stuff out to my different audiences, and I've got time to figure this out." What you don't know is that phone they rang over at the comms table in the exercise was exercise Bryan Krebs, and your comms team blew him off. Bryan Strawser: To them, they're just ... At least the first time. They learn the lesson quick. The first time they do that... They're like, "Okay, well I've saved the situation because no journalist knows." The problem is, 15 minutes later in the exercise, you get the ... a new story lands in everyone's mailbox, and when they click it, it's an audio link that they've recorded by an actor blowing your story wide open by Bryan Krebs. And now you don't have 72 hours. Bray Wheeler: You do not. Bryan Strawser: You're out of time. Bray Wheeler: You're out of time. Bryan Strawser: You got to go now, and actually you're too late because the story's already out. It's not your story. Bray Wheeler: Now you're playing catch up to ... Bryan Strawser: Now you're playing catch up. Bray Wheeler: ... what's going on. Bryan Strawser: In fact, we always craft it in a way that you're going to have to correct the story. The story's right, you've had a data breach. It might be that what you know is 600,000 records, the story is 4 million, so it sounds worse than what it really is and now you got to correct it. That's going to be really hard. Bray Wheeler: Really to that point, in thinking about the different branches, you also have to be able to go into this prepared for situations where they take a different turn, or they explore a different branch than what was considered. Often, you can lay some of these out as ... some of them are more binary choices. It's a yes, no. It's a go, don't go, pay, don't pay, type of situation. Sometimes there are more branches that we think through and have prepared. But I think as the facilitator, what you really want to be able to do is be comfortable with that exercise in a fashion that if they go a different route or they don't take action on something that you assume they were going to take action on that they had done previously, that they were good at, that you assume there's no way they're possibly going to pass this up. Bryan Strawser: And they do. Bray Wheeler: They do, or it gets stalled out in a different conversation and nobody's aware that this other conversation's going on. You have to be prepared to add another inject, or on the fly put additional pressure out there so that you're forcing some of these injects you've already put into play to be played. You have to be able to improvise and adapt, even if you've done a really good job of laying out the different things. I think to that end, too, as the facilitator, you can bind yourself up in knots if you get too detailed and you get too rigid to the plan that you're trying to play out that, "Well, there's only one of two choices. If they don't pick these two choices, I don't know what to do. This exercise is a failure." It's not a failure. Bray Wheeler: You have to be able to lay it out in a way that you're allowing them to organically react to things and just prepare for them to start taking paths, but then be prepared as that facilitator or evaluator to say, "You know what? They actually went a different route and it was really effective. We didn't have to play two more injects," or "We had to add two more injects in on the fly to move the conversation or explore a different piece of the objectives that they want to accomplish with the exercise." I think that's the other piece of a facilitator, too, is to keep those objectives that you've laid out for the exercise top of mind, that really what you're trying to do is if communications is a thing, you're really playing up that communications piece of it. You're not letting that slide because the conversation went a different way. You're trying to drive them back to some of those objectives if you can. Bryan Strawser: I think you bring a really important point. Part of it is that whole idea of thinking through the storyline for the exercise, and crafting your injects to support that in branches that you've foreseen. But you're exactly right, Bray, in that there will be situations that you just didn't foresee. It doesn't mean that they're wrong, the team just chose to go a different route. As the facilitator, exercise director, you either got to decide that the path they're on is right and that's the right path for what they've decided and you're going to have to rearrange on the fly to deal with that, or you're going to have to take some actions to get them back onto your main storyline. It's hard to tell until you're in the moment and you see the direction that they're going to wind up going. Bray Wheeler: Well, and sometimes they just get hung up on a point and they just feel like, "I don't have all the-" Bryan Strawser: The wrong point? Bray Wheeler: The wrong point. Or, "I don't have enough information to make a decision. I don't know what to do. I'm making an assumption here. I don't know. I don't know." You have to be able to, as the facilitator or that exercise staff, be able to step in and just say, "This is what we know. This is the only information you have. Assume this to be true," in order to get them unhooked or unstuck off of a point that they've rallied around that says, "No. Just assume this to be true. Move on." To get them to keep moving. It's that nimbleness. It's that improvisation, that as that facilitation staff when you're preparing for it, you need to know the nuts and bolts of logistics of what's going on. But really, you just need to be comfortable in a way walking in there that you can push them and make them work through it. Whatever the goal is for that exercise, your focus is just on making sure that that happens. Bray Wheeler: Regardless of what tangent or how slow the exercise may move because they're really exploring good content, those aren't failures, if you can't get to your last inject. You crafted ten injects and you only get to eight. It's not a failure. Bryan Strawser: In the end, the number of injects doesn't matter. Bray Wheeler: No. Bryan Strawser: Do you reach the goals the director just laid out in the exercise? Bray Wheeler: Exactly. Bryan Strawser: When you're finalizing your exercise plan and you lay out, "Here's where we're going to stop. We're stopping at 3:00, or when we reach this point in the exercise, this decision has been made, or this conclusion has been reached and this is where we're going to cut it." Bray Wheeler: Call it. Bryan Strawser: Call it. Maybe you don't really have a hard time in some cases. It depends on your exercise and your company that you're doing. I think ours usually has a ... There's a point where we got to end, but we're trying to get them there in advance of that by getting them to the final decision that they need to make before this thing wraps up, or... Bray Wheeler: Or identifying the decision points you need to be able to- Bryan Strawser: Exactly. Bray Wheeler: ... walk into the execs. Bryan Strawser: Or you achieve the result. It's like your Oregon Trail game ends because you died of dysentery, or you died fording the Mississippi. Bray Wheeler: Right, your wagon axle broke. Bryan Strawser: Your wagon axle broke. Bray Wheeler: You all starved. Bryan Strawser: Whatever those events were in Oregon Trail on the exercises, we're the same way. That's it for this edition of the Managing Uncertainty Podcast. We wish you well in preparing and planning for your next exercise. We've got 90 days till ours, so we've got some work to do. Thanks for tuning in. Hope you'll listen next week.

Amie and Hussain discuss a case with a very unexpected cause. Amie revisits the Kreb's cycle. Hussain remains baffled.

Zoraida handles the situation, Nightmare catches up, and Aelar returns home(little does he know) and it’s not quite the same.

dr. sc. Marko Škreb je ponekad kontroverzni ekonomist, bivši guverner Hrvatske narodne banke i svojedobni predsjednički savjetnik za gospodarstvo. Za vrijeme guvernerstva HNB-a je bio proglašen za najboljeg guvernera u Srednjoj Europi te najboljim bankarom u Istočnoj Europi, što su veliki uspjesi s obzirom da su se za njegovog mandata dogodile velike krize i problemi sa prevarama u ranim novim hrvatskim bankama. Karijeru je nastavio kao suradnik Međunarodnog monetarnog fonda i Svjetske Banke, na tim poslovima je proputovao puno svijeta, te je neko vrijeme živio u Africi. S Markom smo razgovarali otvoreno o tome kako funkcionira svijet bankarstva, koje su neke od najzanimljivijih situacija koje je doživio u svojoj dugoj karijeri, što su MMF i Svjetska banka, što misli o Bitcoinu, te koji su njegovi pogledi na globalne teme i osobne financije. Uskoro ćemo objaviti popis tema. PREPORUKE ZA LAKŠE I UGODNIJE SLUŠANJE PODCASTA Tri načina kako slušati podcast Kako slušati podcast u autu koji nema Mp3 player Top lista najslušanijih epizoda *Epizoda podcasta snimljena je na radiju 808. Majstor zvuka: Gordan Antić

What is something that is tough to learn and every doctor should know it better than they do?  Aside from Kreb’s Cycle.  Billing and coding!  Dr. Charlotte Akor is a nationally recognized speaker and physician coach on billing and coding.  In this interview, we discuss the necessary history, physical and medical decision making in order to bill and code appropriately and then get into the weeds about proper coding of medical decision making.  She uses examples to help explain medical decision making with diagnoses of varying complexity.   We then get into the time-based codes and how to appropriately document for this.  We end with the common modifiers and some newer codes that are frequently missed in the primary care setting.  Dr. Akor completed her undergraduate education at Yale, attended medical school at West Virginia University, and completed her ophthalmology residency at SUNY Buffalo.  She then completed TWO fellowships, one in ophthalmologic pathology at Emory and one in pediatric ophthalmology at Children’s Health Care of Atlanta Hospital.  She is the former head of the Pediatric Ophthalmology on the faculty of The University of Texas at Houston Health Sciences Center and is now in a hospital-based practice in Abilene, Texas.  She is the Amazon best-selling author of Medical Coding Decoded and can be found at CharlotteAkorMD.com.   Find this and all episodes on your favorite podcast platform at PhysiciansGuidetoDoctoring.com Please be sure to leave a five star review, a nice comment and SHARE!!!

Make sure to follow Coach JV on Instagram @jvimpacts_ and Warrior JV on Instagram @jvwarrior444! Also make sure to give us a 5 star rating on Apple Podcasts! Check out today's reference: https://www.quora.com/Why-are-fats-called-an-energy-store-in-the-body  The majority of energy in your body is stored as triglycerides in adipose tissue (fat). Triglycerides are a very efficient energy store because they are energy-rich and can be used by many of the tissues in the body to generate energy during fasting and exercise by the biochemical pathways of fatty acid oxidation and the Kreb’s cycle. One very clear advantage of storage of energy as fat is that it is very hydrophobic (does not associate with water) and therefore weighs a lots less than stored carbohydrate (glycogen) does. Listen Now! Learn more about your ad choices. Visit megaphone.fm/adchoices

We take a trip to the ends of the earth and hear some stories of tech support in Antarctica, cover a surprisingly reasonable new suggested standard for responsible disclosure & discuss Kreb's latest adventures in the world of deep-insert credit card skimmers. And of course your feedback, a fantastic round-up & so much more!

We take a trip to the ends of the earth and hear some stories of tech support in Antarctica, cover a surprisingly reasonable new suggested standard for responsible disclosure & discuss Kreb's latest adventures in the world of deep-insert credit card skimmers. And of course your feedback, a fantastic round-up & so much more!

We take a trip to the ends of the earth and hear some stories of tech support in Antarctica, cover a surprisingly reasonable new suggested standard for responsible disclosure & discuss Kreb's latest adventures in the world of deep-insert credit card skimmers. And of course your feedback, a fantastic round-up & so much more!

Dr. Tim Jackson - Mitochondrial dysfunction, mold and MTHFR solutions - Podcast #124 Get Show Updates Here: http://www.beyondwellnessradio.com/newsletter You-tube Podcast Subscribe: http://www.youtube.com/subscription_center?add_user=justinhealth Show Transcription: See https://justinhealth.com/dr-tim-jackson-mitochondrial-dysfunction-mold-and-mthfr-solutions-podcast-124/ Dr. Justin Marchegiani and Dr. Tim Jackson dive into a stimulating discussion about mitochondria, the enzyme MTHFR, genetic testing, and mycotoxin. Join them and pick up some valuable information as Dr. Tim Jackson shares his knowledge and expertise on gene SNPs, factors that affect them, the supplements he recommends, as well as the approach he implements to create a positive impact on someone's health. Learn about the mitochondria's function and discover its connection to the Kreb's cycle and electron transport chain, both of which are naturally occurring chemical reactions in our bodies. Know and understand the different mitochondria-related issues like infections, low iron and low B vitamins. Get valuable insight on how these issues are tested, including the diet, nutrients and supplements to support the mitochondria. And lastly, gain helpful information about mycotoxin and find out different ways to prevent and get rid of them. In this episode, we cover: 4:11 Mitochondria 15:20 Bacterial infections 21:50 Iron and B12 issues 27:10 Glutathione 35:41 Gene SNPs (MTHFR, APO, TON1) 49:13 Mycotoxins Subscribe on I-Tunes: http://www.beyondwellnessradio.com/itunes Review us at: http://www.beyondwellnessradio.com/itunes Visit us at: http://www.beyondwellnessradio.com Have a question: http://www.beyondwellnessradio.com/question

The top 5 supplements to enhance your work out - Podcast #83 The Blood Test Road Map: http://justinhealth.com/blood-test-road-map Paleo Blood Work: http://www.justinhealth.com/paleo-labs Get Show Updates Here: http://www.beyondwellnessradio.com/newsletter You-tube Podcast Subscribe: http://www.youtube.com/subscription_center?add_user=justinhealth Show Transcription: http://justinhealth.com/using-lab-work-common-health-markers-help-transition-healthy-diet-podcast-82/ Dr. Justin Marchegiani and Evan Brand talk about workout supplements including workout timing then they really dig into what they themselves use specifically pre and post workout. Find out more about these supplements that you can use to improve your workouts. Basically you have to remember to get diet and sleep dialed in before adding in any workout supplements. supplements_for_work_outsDiscover the different types of protein powders, collagen, and creatine that can be used for energy performance. Learn about the various adaptogens you can also use before, during, and after your workouts as well as what they can do for your body. Get to know more about branched chain amino acids and mitochondrial support or Kreb cycle nutrients when you listen to this podcast. In this episode, topics include: 2:06 Supplements to improve workouts 3:20 Protein powders, collagen and creatine 7:53 Adaptogens 12:07 Branched chain amino acids 15:05 What to do for people with adrenal issues 17:31 Why do you exercise? 20:10 Mitochondrial support Kreb cycle nutrients Subscribe on I-Tunes: http://www.beyondwellnessradio.com/itunes Review us at: http://www.beyondwellnessradio.com/itunes Visit us at: http://www.beyondwellnessradio.com Have a question: http://www.beyondwellnessradio.com/question

Improve your energy by boosting your mitochondria – Podcast #67 Get Show Updates Here: http://www.beyondwellnessradio.com/newsletter Show transcriptions: http://justinhealth.com/improve-your-energy-by-boosting-your-mitochondria-podcast-67/ Learn more about the various nutrients needed to boost energy when you listen to this interview. If you're in the mood to geek out, here's your chance to get a concise overview on how the citric acid/Kreb cycle works. Also find out what is the best test to take to look at how compounds are being produced and the nutrients needed to produce them. In this episode, topics include: 00:41 about the mitochondria and energy 2:46 citric acid/Kreb cycle 09:52 electron transport chain 11:24 supplement for energy production 21:54 action steps Write us a review: http://www.beyondwellnessradio.com/itunes Visit us at: http://www.beyondwellnessradio.com Have a question: http://www.beyondwellnessradio.com/question

In this adventure Little Pete is desperate to meet the person who he considers his guardian angel. Inspector 34. The person at the Kreb of the Loom factory that always makes his underpants to perfection. Inspector 34 answers his letters … Continue reading → The post WBA S02E06: Inspector 34 | Adventures of Pete & Pete appeared first on Welcome Back, Artie..

Everything dinosaur is discussed. 60 seconds science focuses on specific fan favorite dinosaurs like brontosaurus, triceratops, and tyrannosaurus rex. The Basic Biology of dinosaurs, such as cold-blooded versus warm-blooded is included. The story of the mass extinction event that may or may not have involved the KT asteroid impact is told. The velociraptor and the tyrannosaurus rex have various myths replaced with truth such as the fact that they had feathers and attacked with their feet. Are you curious about if dinosaurs tickled each other? The relationship between birds and dinosaurs is highlighted. The discussion is the controversy of resurrecting dinosaurs Jurassic Park style and the scientific ethics is part of a round table.

KREB Radio presents its first episode focusing out beyond the world of scientists into how science affects people in the real world. Featured are social work, music education, city administration, and a guest appearance by some wise and sage grandparents who discuss the changes in technology over time. The episode is hosted by Alex alone due to recording limitations. Topics include learning, treating mental disability, civil engineering, telephones, and the spread of electricity. Career options in science are also presented. E-mail krebradio@gmail.com to comment.

Brains, Psychics, Artificial Intelligence, and How To Win at Rock, Paper, Scissors is the fourth episode. We talk about how the brain influences behavior, how you can trick your memory into remembering better, we debate nature versus nurture, and I tell you how to be a veritable psychic and win at rock, paper, scissors. Ken Jennings, jeopardy, and Waston are discussed at length. Sixty second sciences include seasonal affective disorder, implanting false memories, music and the brain, chronic traumatic brain injury in professional sports and its relation to Alzheimer's and Parkinson's, and Cerebral Palsy. Commercials include Sing-Along Study Songs for Science, a certain point of view, the animal helmet, and more.

This week's episode of KREB Radio focuses in on microbes and viruses. We start with a discussion of nanobots and medicine. We also take about the influenza virus, including the H1N1 pandemic, pigs, and the avian flu. We highlight the human microbiome project, or the bacteria that normally exist on your skin and take up a biological niche. We also explore the nature of gene therapy and its promise in curing genetic diseases like Huntington's Disease and cancer. Zombies will also make an appearance, with references including Young Frankenstein, 28 Days Later, Warm Bodies, The Walking Dead, and other common fiction to verify or vilify the possibility of the undead hordes. Complete with commercials encompassing the noire of Officer Marcrophage, Die Hard: Bubonic Plague with A Vengeance, and the new immune system evasion game Forbidden Host, it is KREB Radio Episode 3.

A collection of all kinds of music fill this random episode of the podcast for those who like it spooky. Monstermatt Patterson is home sick, but we’ve got a doctor making a house call: Dr. Gangrene! With music from The Coffin Wheels, Tribal Gothic, The Brimstones, Kreb and more! www.6ftplus.com www.gravediggerslocal.com www.hahahorror.com www.twistedcentral.com www.hahahorror.com www.chillercinema.com... The post Episode 95: Glen Goes Sale Shopping for Skulls appeared first on Six Foot Plus.

A collection of all kinds of music fill this random episode of the podcast for those who like it spooky. Monstermatt Patterson is home sick, but we’ve got a doctor making a house call: Dr. Gangrene! With music from The Coffin Wheels, Tribal Gothic, The Brimstones, Kreb and more! www.6ftplus.com www.gravediggerslocal.com www.hahahorror.com www.twistedcentral.com www.hahahorror.com www.chillercinema.com... The post Episode 95: Glen Goes Sale Shopping for Skulls appeared first on Six Foot Plus.

KREB Radio is meant to be a fun light-hearted take on very complex scientific issues. In this episode we focus on the inheritance of the X-gene in X-Men, the oddities of androgen insensitivity and what determines if someone is male or female for Olympic competitions, hormones, genetically-modified organisms, with molecular biology, biochemistry, wonderfully entertaining commercials, and small tidbits of 60 second science with Alex Generous.

Episode 0x28 -- For Reals... it's here. I SAID it's a weekly podcast Life gets in the way of art. There's five of us, we are operating from 3 time zones and several of us have a whole lot more than just one job, and then parenting duties as well. This negatively contributes to the possibility of getting all of us together at the same time for a recording. We're trying to figure out what to do about it. It may be that we go for more frequent recordings of whomever is available and stuff together the rest of us when we can. Sigh. Or something. Upcoming this week... Lots of News Breaches SCADA / Cyber, cyber... etc. finishing it off with DERPs/Mailbag and There will be a DEEP DIVE But there are weekly Briefs - no arguing or discussion allowed And if you've got commentary, please sent it to mailbag@liquidmatrix.org for us to check out. DISCLAIMER: It's not that explicit, but you may want to use headphones if you're at work. ADDITIONAL DISCLAIMER: In case it is unclear, this is the story of 5 opinionated infosec pros who have sufficient opinions of their own they don't need to speak for anyone except themselves. Ok? Good. In this episode: News and Commentary Stonesoft bought by McAfee/Intel How I got here: Hoff Thotcon / BSidesChicago - Jericho says I did a good job Is the U.S. Government Recording and Saving All Domestic Telephone Calls? Systems manager arrested for hacking former employer's network Breaches Study: Utah Health Breach Could Approach $406M The Onion Hacked by Syrians and the Onion responds 1 million dollars (Kreb's said "cyberheist" drink!) SCADA / Cyber, cyber... etc Many MANY sources: Your inability to understand Google Earth is entertaining DERP This time, the DERP is on us. With five schedules spread across 3 time zones and about 12 different jobs (not including parenting)... the Liquidmatrix Crew takes the DERP of the week. We promise we will attempt to get back on ye olde horse. Although it may be in the form of us no longer trying to have all hands on deck. What say you dear listener? Hide a bitcoin miner in your code vendor just called me, offered "a great solution for cyber defense by securing end points using DoD standards" #salesFail Mailbag / Bizarro Land Hey, I'm stupid busy at work. Can't keep up. People know where I sit. The email. The phone calls. I'm trying to use the damn bathroom now. Please help? SRSLYBizzay Secpro DEEP DIVING - Productivity In The Security Hotseat Interupt driven lifestyle for the win? Rage Quit Plan to be interupted - get in earlier or stay later than most of your co-workers Use a trick to determine how much productive time you have (Carmack and his CD player) Arrange a "cover" for the day Emergent Time Planner & Task Order Up kanban Trello (free) Lean Kit (not Free) Atlassian (jira) Greenhopper ($) Time Management for System Administrators Trusted Systems "Heroes are Zeroes" - Identify and Manage Failure to document makes you a team liability Briefly - NO ARGUING OR DISCUSSION ALLOWED Notch says practice your typing skills Cyber Observable Expression from MITRE OpenBSD 5.3 Released. Teacher 'powerless' to stop ex-girlfriend's cyberstalking Liquidmatrix Staff Projects The Liquidmatrix Vegas Party- You've asked when and where - that'd be "We don't know yet" and "The week of Blackhat/BSides/DEFCON". You can beg your way onto the list by sending an email to vegas2013party@liquidmatrix.org. The BSidesLV Ticket Give-away- Three tickets up for grabs: best original piece of artwork incorporating a security rock star; bonus points for using a unicorn best rap song about a major breach best poem describing a vendor DERP Judging will be done by The Liquidmatrix Intern. Mocking will be done by us. I'd suggest you start buying a vote early. Email your submission to bsideslv2013@liquidmatrix.org The Security Conference Library  Contribute to the Strategic Defense Execution Standard (#SDES) and you'll be Doing Infosec Right in no time. If you're interested in helping out with openCERT.ca, drop a line to info@openCERT.ca Upcoming Appearances: James Training (with Rich Mogull) at BHUSA. Dave will be at Black Hat, DEF CON (AMFYOYO), Secure Asia. Matt and Wil will be at Blackhat/DEF CON and James, Ben and Dave will be joined by Mike Rothman for SecTor 2013's return of the (canadian) fail panel. In Closing Movie Review Terminator 2: All your PINs belong in my Atari handheld HSM everyday is CTF! go set up a team Signing up for a SANS course? Be sure to use the code "Liquidmatrix_150" and save $150 off the course fee! And Liquidmatrix_5 for 5% off a course Seacrest Says: She sells sea shells on the sea shore. Creative Commons license: BY-NC-SA