Podcasts about Lancet

Credits: 0.75 AMA PRA Category 1 Credit™   CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-500 Overview: To celebrate our 500th episode, each member of our team revisits a popular topic from the podcast's earlier installments—GLP-1s, cervical and breast cancer screening, diet and exercise, contraception, hypertension, and lipid management—to trace how the evidence and guidelines have changed since it was first covered. Whether you're catching up or reinforcing what you know, this milestone episode helps you bring the latest evidence into everyday patient care. Guest: Robert Baldor, MD, Alan Ehrlich, MD, Susan Feeney, DNP, FNP-BC; FAANP, Jillian Joseph, PA, Mariyan L. Montaque, DNP, FNP-BC, Jill Terrien PhD, ANP-BC, FAAN   Music Credit: Matthew Bugos Thoughts? Suggestions? Email us at FranklySpeaking@pri-med.com  Episode resource links:  Zhou H et al.  Evaluation and Comparison of the PREVENT and Pooled Cohort Equations for 10‐Year Atherosclerotic Cardiovascular Risk Prediction. Journal of the American Heart Association Volume 14, Number 4 Goff DC et al. 2013 ACC/AHA guideline on the assessment of cardiovascular risk: a report of the American College of Cardiology/American Heart Association task force on practice guidelines. Circulation. 2014;129:S49–S73. Circulation. 2018 Jul 24;138(4):345-355.  eClinicalMedicine 2025: 103741. Curry, J. (2018). Screening for cervical cancer: US Preventive Services Task Force Recommendation Statement. JAMA.320(7):674-686. doi:10.1001/jama.2018.10897 https://www.ncbi.nlm.nih.gov/pubmed/30140884  Perkins RB, Wolf AMD, Church TR, et al. Self-collected vaginal specimens for human papillomavirus testing and guidance on screening exit: An update to the American Cancer Society cervical cancer screening guideline. CA Cancer J Clin. 2026;e70041. doi:10.3322/caac.70041   Screening for Cervical Cancer (2026). Obstetrics & Gynecology, 148(1), e63-e67. https://doi.org/10.1097/AOG.0000000000006257  Jad Zeitouni, Nosayaba Osazuwa-Peters, Yusuf Dundar, Gregory Zimet, Mark A. Varvares. (2025). Two decades of the HPV vaccine: its promise, progress, prospects, projections, and posterity, The Lancet Regional Health - Americas, (51), https://doi.org/10.1016/j.lana.2025.101243 Diabetes, Obesity and Metabolism 28, no. 6 (2026): 5043–5057, https://doi.org/10.1111/dom.70698.  Relationship of early rapid weight loss to efficacy and safety of tirzepatide and semaglutide for obesity: SURMOUNT-5 post hoc analysis. Am J Med. 2026 Jul;139(7):913-921. doi: 10.1016/j.amjmed.2026.03.010 US Preventive Services Task Force; Nicholson WK, Silverstein M, Wong JB, et al. Screening for breast cancer: US Preventive Services Task Force recommendation statement. JAMA. 2024;331(22):1918–1930.  Trentham-Dietz A, Chapman CH, Jayasekera J, et al. Collaborative modeling to compare different breast cancer screening strategies: a decision analysis for the US Preventive Services Task Force. JAMA. 2024;331(22):1931–1946. Giaquinto AN, Sung H, Miller KD, et al. Breast cancer statistics, 2022. CA Cancer J Clin. 2022;72(6):524–541.  Qaseem A, Harrod CS, Balk EM, et al. Screening for breast cancer in asymptomatic, average-risk adult females: a guidance statement from the American College of Physicians (Version 2). Ann Intern Med. 2026.:  American Cancer Society. Breast Cancer Facts & Figures 2022–2024. Atlanta, GA: American Cancer Society, 2022.  Hu X, Chehal PK, Kaplan C, et al. Racial differences in patient-reported symptoms and adherence to adjuvant endocrine therapy among women with early-stage, hormone receptor-positive breast cancer. JAMA Netw Open. 2022;5(8):e2225485.  Torres JM, Sodipo MO, Hopkins MF, Chandler PD, Warner ET. Racial differences in breast cancer survival between Black and White women according to tumor subtype: a systematic review and meta-analysis. J Clin Oncol. 2024;42(35):4225–4234.  Bailey ZD, Krieger N, Agénor M, Graves J, Linos N, Bassett MT. Structural racism and health inequities in the USA: evidence and interventions. Lancet. 2017;389(10077):1453–1463. Hypertension. 2026;83:00–00. DOI: 10.1161/HYPERTENSIONAHA.125.25787 Allen RH, Bartz D. Opill: The Over-the-Counter Contraceptive Pill. Obstet Gynecol. 2024;143(2):184-188. doi:10.1097/AOG.0000000000005455  Cahill EP, Kaur S. Advances in contraception research and development. Curr Opin Obstet Gynecol. 2020;32(6):393-398. doi:10.1097/GCO.0000000000000666  Charles DN, Nagarsheth M, Oshman L. Pain Management for IUD Insertion in Primary Care. Am Fam Physician. 2025;111(4):299-301.  Chen, C., Strasser, J., Banawa, R., Luo, Q., Bodas, M., Castruccio-Prince, C., Das, K., & Pittman, P. (2022). Who is providing contraception care in the United States? An observational study of the contraception workforce. American journal of obstetrics and gynecology, 226(2), 232.e1–232.e11. https://doi.org/10.1016/j.ajog.2021.08.015  Diedrich,J., Klein, D. Peipert, J.(2017). Long-acting reversible contraception in adolescents: a systematic review and meta-analysis, Am J Ob Gyn, April 2017. http://dx.doi.org/10.1016/j.ajog.2016.12.024  Li RHW, Lo SST, Gemzell-Danielsson K, Fong CHY, Ho PC, Ng EHY. Oral emergency contraception with levonorgestrel plus piroxicam: a randomised double-blind placebo-controlled trial. Lancet. 2023;402(10405):851-858. doi:10.1016/S0140-6736(23)01240-0  Mørch LS, Meaidi A, Corn G, Hargreave M, Wessel Skovlund C. Breast Cancer in Users of Levonorgestrel-Releasing Intrauterine Systems. JAMA. 2024;332(18):1578–1580. doi:10.1001/jama.2024.18575  Nguyen AT, Curtis KM, Tepper NK, et al. U.S. Medical Eligibility Criteria for Contraceptive Use, 2024. MMWR Recomm Rep. 2024;73(4):1-126. Published 2024 Aug 8. doi:10.15585/mmwr.rr7304a1  Paradise SL, Landis CA, Klein DA. Evidence Based Contraception: Common Questions and Answers. American Family Physician. 2022. https://www.aafp.org/afp/2022/0900/contraception The views expressed in this podcast are those of Dr. Domino and his guests and do not necessarily reflect the views of Pri-Med.

Twenty-five years ago, sequencing the human genome seemed poised to usher in an era of personalized medicine. Dr. Euan Ashley helped turn that promise into an actual clinical experiment, leading one of the first efforts to interpret an entire human genome in the context of a real patient's health. The challenge quickly became apparent: medicine could suddenly generate billions of data points about one person, but making sense of them was painfully slow.That history feels newly relevant. Ashley recently gave an AI system his own 15-year-old genome data and watched it reproduce most of an analysis that had originally required months of work by a team, in about 30 minutes. Meanwhile, genomics is being joined by wearables, multi-omics, and other technologies capable of tracking far more of our biology over time.In this episode of NextLevel, we use the genome revolution as a case study for what happens when our ability to measure the body advances faster than our ability to interpret and use the information. The next leap in personalized medicine may depend less on collecting another mountain of data than on building the tools, reference datasets, and healthcare systems capable of turning that information into decisions.Free course: Improve your metabolic healthGet our free email course on how glucose, nutrition, exercise, sleep, and measurement can help you build habits that support better energy and long-term health: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://levels.link/wnl⁠

PCOS Is Now PMOS. What the New Name Changes About How You Get Treated For decades, the diagnosis pointed at your ovaries. Cysts. Fertility. Birth control to regulate the cycle, and a shrug for everything else. This year, that changed. Polycystic ovary syndrome was formally renamed polyendocrine metabolic ovarian syndrome, or PMOS, in a global consensus published in The Lancet. The point was not cosmetic. It was an admission that this was never really a gynecological problem. Dr. Terri sits down with Dr. Cassie Smith, MD, dual board-certified endocrinologist, founder of Modern Endocrine, and author of Fix Your Gut, Fix Your Hormones, recorded on location at the EVEXIAS provider training. Dr. Smith has been making this argument for years, long before the literature caught up: the insulin, the inflammation, and the gut come first. The hormones are downstream. And if you only treat the hormones, you never actually fix anything. The conversation runs from the patient who was thin, had no cysts, had one symptom, and whose insulin nobody ever checked, all the way to what is happening right now with GLP-1s, the telehealth prescribing free-for-all, and the muscle loss almost nobody is monitoring. If you have been told your cycles are irregular and handed a prescription, if you are thin but feel metabolically off, or if you are on a GLP-1 and wondering whether you are doing it right, this one is for you. What you'll discover: 00:00 PCOS is officially renamed PMOS, and why the shift moves the focus off the ovaries entirely 00:59 The six different presentations of PCOS, including lean patients with no cysts and normal testosterone 01:42 The thin patient with one symptom, an irregular cycle, and an insulin level nobody ever ordered 03:33 The metabolic dumpster fire: how gut dysfunction drives estrogen, progesterone, insulin, and cortisol out of balance 04:08 What actually happens when you come off birth control after years of symptom suppression 05:36 The lab panel Dr. Smith runs first, including Free T3, insulin, cortisol, and a gut study 06:28 The unsexy basics: sleep, real food, sunlight, walking, and getting off the phone at midnight 07:29 Delayed childbearing, coming off the pill at 33, and the fertility math nobody explains 09:29 Treating PMOS in perimenopause when fertility is no longer the goal 10:50 Low serum testosterone with high free testosterone, and what low SHBG is telling you 11:50 The estrobolome: the gut bacteria responsible for recycling your estrogen 13:39 Why endocrinology and gynecology both missed this for so long 15:32 Fat cells as a full endocrine organ, and the signals they send when they are overfull 17:29 Ten thousand smoke signals: how inflammatory cytokines confuse your immune system 19:51 Skinny fat explained, and how you can be thin with the metabolic profile of someone who isn't 22:09 GLP-1s: what they do well, and how they are being prescribed badly 22:53 There is no magic bullet, and why your health is rent, not something you own 24:34 Telehealth vial-and-titration prescribing, the gray market, and patients with no follow-up 26:52 Doing it correctly: body composition scans, protein, resistance training, realistic timelines 29:44 GLP-1s slow gut motility. What Dr. Smith does to protect the gut long term 30:05 Fiber, hydration, and the two steps that changed one patient's life before she lost a pound The rename was the easy part. Now somebody has to start treating the whole system. The Dr. Terri Show is presented by EVEXIAS Health Solutions. For more, visit: https://www.evexias.com Connect with Dr. Terri:

This hour we take a look at some of the stories making headlines before talking with Clare Ath of the Human Coalition, who gives us an update on where the fight for abortion funding stands and what Massachusetts did that is stunning the country. Then Wesley Smith will discuss why The Lancet declares wildfires the next health crisis and what just happened to a Kentucky organ procurement organization. Get ready to think critically and biblically.Become a Parshall Partner: http://moodyradio.org/donateto/inthemarket/partnersSee omnystudio.com/listener for privacy information.

Seu paciente treina pesado, tem exames "impecáveis" e quase nunca fala sobre uso de atalhos químicos.Até o dia em que chega ao pronto-socorro. Quanto você realmente sabe sobre o paciente que usa anabolizantes?Neste episódio, William Batah e Fernanda Justo recebem a Dra. Luciana Oliveira, endocrinologista pela UFPR, mestre pela UNIFESP e preceptora do ambulatório de endocrinologia do exercício, para destrinchar um tema que a cardiologia não pode mais ignorar. Luciana também lidera uma plataforma de notificação de complicações do uso indevido de hormônios e implantes no Brasil, o que dá ao episódio uma visão rara de quem lida com as consequências reais desse uso na prática.

Dr. Aaron S. Zelikovich discusses the phase 3 NIMBLE trial of cemdisiran, an siRNA targeting complement component 5, for the treatment of generalized myasthenia gravis.  Show citation:  Vu T, Habib AA, Jacob S, et al. Efficacy and safety of cemdisiran siRNA in myasthenia gravis (NIMBLE): a double-blind, randomised, placebo-controlled, phase 3 trial. Lancet. 2026;407(10540):1712-1725. doi:10.1016/S0140-6736(26)00690-2 

Disclaimer: This episode and article are for educational purposes only and are not a substitute for individualized medical advice. Always consult your physician before making changes to your diet, exercise routine, or medications.TL;DR* The CDC's top 10 causes of death account for roughly 74% of all deaths in the US each year, and up to 80% of chronic disease is estimated to be driven by lifestyle factors — diet, movement, sleep, stress, and toxin exposure. * This episode goes cause by cause (heart disease, cancer, COVID/respiratory disease, accidents, stroke, Alzheimer's, diabetes, kidney disease, flu/pneumonia, and suicide) and lays out what the peer-reviewed research says about preventing, slowing, or reversing each one.* Ready to build your own plan? Book a free Metabolic Blueprint Session →The List, and the Number That Should Keep You Up at NightAccording to the CDC, ten conditions account for about 74% of all deaths in the United States every year:* Heart disease* Cancer* COVID-19 / chronic lower respiratory diseases* Accidents (unintentional injuries)* Stroke* Alzheimer's disease* Diabetes* Kidney disease* Influenza and pneumonia* SuicideHere's the part that doesn't get said enough: research estimates that up to 80% of chronic disease is driven by lifestyle factors — diet, movement, sleep, stress, and toxin exposure. Those aren't destinies. They're decisions, and decisions can change.A landmark paper in the Journal of the American Medical Association found that poor diet alone accounts for more deaths in the US than tobacco use. The fork may be more dangerous than the cigarette. And yet, most patients who end up on four to six medications were never once asked what they eat, how they sleep, or whether they move their bodies before those prescriptions were written. That's the difference between a sick care system and a healthcare system.Heart Disease and Stroke: The Most Reversible Disease We KnowHeart disease kills one American every 34 seconds and has held the #1 spot for over a century. But it's also one of the most reversible conditions in medicine.In 1990, Dr. Dean Ornish's landmark Lifestyle Heart Trial showed that intensive lifestyle changes — diet, exercise, stress management, and social support — could reverse coronary artery disease without drugs or surgery. Arterial plaques reduced. Blood flow improved. Chest pain decreased. A 2019 study in the Journal of the American College of Cardiology confirmed it: a plant-predominant diet, regular aerobic exercise, not smoking, and a healthy weight reduced cardiovascular risk by over 80%.What that looks like in practice:* A Mediterranean or whole-food, plant-based diet rich in omega-3s and antioxidants (this isn't the only diet that works — it's the broadest evidence-backed baseline)* Zone 2 cardio (low-intensity aerobic work, three to five times a week — a brisk walk counts)* Managing chronic inflammation, the real driver of arterial plaque formation* Reducing refined sugar and seed oils, which damage the endothelial lining of the arteries* Prioritizing sleep, since poor sleep spikes cortisol and directly harms the heartStroke follows the same playbook: control blood pressure through diet, exercise, and stress reduction. The DASH diet in particular has been shown in multiple studies to lower blood pressure as effectively as medication in many patients.Cancer: 30–50% Preventable, and Possibly More Metabolic Than GeneticTo be clear, this isn't a claim about curing cancer — it's about how much prevention research is available and underused. The World Health Organization estimates that 30–50% of cancers are preventable. The American Institute for Cancer Research has identified lifestyle factors that dramatically reduce risk across multiple cancer types:* Diet. A 2022 meta-analysis in The Lancet linked poor dietary patterns — low fiber, low fruit/vegetable intake, high processed meat — to one in five cancer deaths globally.* Obesity. Excess weight is now the second-leading risk factor for cancer after smoking, because fat tissue is metabolically active and produces hormones like estrogen and inflammatory cytokines that fuel cancer growth.* Exercise. A 2019 study of over 1.4 million people found higher physical activity was associated with lower risk across 13 cancer types, including breast, colon, and endometrial cancer.* Fasting and metabolic health. Emerging research on intermittent fasting and time-restricted eating shows it can lower insulin-like growth factor, a key promoter of cancer cell proliferation.* Toxin reduction. Chronic low-grade exposure to pesticides, plastics (BPA, phthalates), and environmental pollutants has been linked to increased cancer risk. Choosing organic where possible, filtering water and air, and reducing plastic in cookware and storage all matter.There's also a deeper shift happening in how researchers understand cancer itself. It's long been treated primarily as a genetic disease, but the evidence is increasingly pointing toward cancer as a metabolic disease. Dr. Thomas Seyfried at Boston College has done groundbreaking work showing that cancer cells overwhelmingly rely on glucose and glutamine fermentation for energy — which is why a ketogenic or low-glycemic approach may help starve cancer cells while protecting healthy ones. The research is still evolving, but it's compelling.Think of your body like a garden. You can water it, enrich the soil, and pull the weeds — or you can dump sugar and chemicals on it and wonder why nothing grows right. Disease doesn't happen to you. It grows in an environment you create, consciously or not. The good news: you can change that environment starting today.Alzheimer's: “Type 3 Diabetes”Alzheimer's is rising, and it's terrifying to watch someone go through it. But emerging science shows it has a strong lifestyle and metabolic component — researchers now sometimes call it “type 3 diabetes” because of the profound link between insulin resistance and neurodegeneration.Dr. Dale Bredesen's ReCODE Protocol, published in the Journal of Aging, showed that a multimodal lifestyle intervention — diet, exercise, sleep optimization, hormone balancing, and stress reduction — reversed early cognitive decline in the majority of patients treated. In his 2014 case series, 9 of 10 patients with early Alzheimer's or mild cognitive impairment showed measurable improvement, with several returning to work.Key strategies from the research:* Sleep is non-negotiable. The brain's glymphatic (waste clearance) system activates primarily during sleep, flushing out amyloid beta plaque. Poor sleep means plaque buildup.* Exercise. A 2020 study showed aerobic exercise increases BDNF (brain-derived neurotrophic factor) — essentially fertilizer for neurons — and reduces dementia risk by up to 35%.* Mediterranean-MIND diet. Shown to slow cognitive aging by an estimated 7.5 years in adherent individuals.* Blood sugar management. Insulin resistance in the brain disrupts its ability to use glucose for energy, effectively starving neurons.* Social connection. Harvard's 80-year longitudinal study found relationship quality was the single strongest predictor of cognitive health and longevity in old age.Type 2 Diabetes and Kidney Disease: One Disease Driving AnotherOver 37 million Americans have type 2 diabetes, and another 96 million are pre-diabetic. Here's the part that surprises people: type 2 diabetes is reversible in the majority of cases, and this isn't controversial — the science is overwhelming.The 2019 DiRECT trial, published in The Lancet, found that nearly half of type 2 diabetics achieved full remission through an intensive dietary intervention alone, with no medication. Other studies using low-carbohydrate and very-low-calorie diets have replicated these results consistently.Diabetic nephropathy — kidney damage from chronically high blood sugar — is the leading cause of kidney failure in the US. Control the upstream issue (blood sugar and metabolic dysfunction) and you protect the downstream organ.The diabetes reversal framework from the research:* Dramatically reduce refined carbohydrates and added sugars to blunt insulin spikes and reduce fat storage in the liver and pancreas* Practice time-restricted eating or intermittent fasting to improve insulin sensitivity* Add resistance training — muscle is your biggest glucose sink, so more muscle means better blood sugar control* Reduce visceral fat (the fat around and inside your organs), a key driver of insulin resistance and inflammationIf this list feels like a lot, that's fair. But it's not about blame — it's about empowerment. You have more control over your health outcomes than the medical system has typically told you.Respiratory Disease, Flu, and PneumoniaChronic lower respiratory diseases like COPD and emphysema are largely driven by smoking and air quality. Quitting smoking remains the single most impactful intervention here, full stop.For flu and pneumonia risk, immune resilience matters: vitamin D optimization, zinc and elderberry, and gut microbiome health (roughly 70% of your immune system lives in your gut). Even mild sleep deprivation has been shown to quadruple susceptibility to viral infection.Suicide and Mental HealthThis is the cause of death nobody wants to talk about, but it's in the top 10 — and it's the leading cause of death for men under 50, and the second-leading cause of death for people ages 10–34.While this is complex and deeply personal, research points to several lifestyle levers:* Exercise functions as an effective antidepressant, largely through endorphin release* The gut-brain axis matters more than most people realize — over 75% of the body's serotonin is produced in the gut, so gut health directly shapes brain chemistry* Social connection and purpose. Viktor Frankl's Man's Search for Meaning, written while he was in a Nazi concentration camp, captured this: meaning and connection to purpose are essential for survival, and perspective shapes both physiology and outcome* Reducing alcohol, a central nervous system depressant that worsens anxiety and depression despite short-term reliefIf you or someone you love is struggling, crisis hotlines are available 24/7. There's often a reason it's happening, and there's often a way through it.The Common ThreadAcross every single one of these conditions — heart disease, stroke, cancer, Alzheimer's, diabetes, kidney disease, respiratory disease, immune function, mental health — the same five levers keep showing up: diet, exercise, sleep, toxin reduction, and blood sugar balance.Your daily habits are either building disease or building resilience. Every meal, every walk, every night of good sleep compounds — just like interest in a bank account.This Week's Action Plan* Do a food audit. For the next three days, write down everything you eat. No judgment, just awareness — you can't change what you can't see.* Walk 30 minutes a day. It lowers blood pressure, improves insulin sensitivity, boosts BDNF, and reduces cortisol. Simple, not easy — do it anyway.* Optimize your sleep. Consistent bedtime, dark room, cool temperature, no screens.* Get your labs done. Know your fasting glucose, A1C, CRP, vitamin D, triglycerides, and LDL — these are your early warning systems.* Address one stress source this week. A conversation you need to have, a boundary you need to set, or ten minutes of breathwork. Chronic stress is silently killing you — take action on it.Ready for a Real Plan?If you're ready to take your health seriously and want a clear roadmap instead of guesswork, book a Metabolic Blueprint Session. In 30–45 minutes, we'll walk through your top three priority areas and how programs like the Metabolic Momentum Accelerator, the Cellular Reboot Accelerator, and the Total Health Restore Protocols can help.Schedule your complimentary consult →Know someone this could help? Share this episode with them — it might change or even save their life.If this episode was valuable, leaving a review on Spotify or Apple Podcasts helps this show reach more people.ReferencesStudies and sources cited in this episode:* CDC — Leading Causes of Death data* Journal of the American Medical Association (JAMA) — poor diet and US mortality* Ornish, D. et al. (1990) — The Lifestyle Heart Trial* Journal of the American College of Cardiology (2019) — plant-predominant diet, exercise, and cardiovascular risk reduction* DASH diet research on blood pressure control* World Health Organization (WHO) — cancer preventability estimates* American Institute for Cancer Research — lifestyle and cancer risk* The Lancet (2022 meta-analysis) — dietary patterns and cancer deaths* Physical activity and cancer risk study (2019, ~1.4 million participants)* Seyfried, T., Boston College — cancer as a metabolic disease* Bredesen, D., Journal of Aging — the ReCODE Protocol; 2014 case series* BDNF and exercise study (2020) — dementia risk reduction* Mediterranean-MIND diet and cognitive aging research* Harvard Study of Adult Development (80-year longitudinal study) — relationships and longevity* DiRECT Trial, The Lancet (2019) — type 2 diabetes remission through dietary intervention* Frankl, V. — Man's Search for MeaningThis article summarizes claims and studies as presented in the podcast episode. Listeners are encouraged to review primary sources directly and consult their own physician before making health decisions. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit tripleplaydoc.substack.com/subscribe

Welcome to the latest episode (August 2026) of DOC Updates, where every month Neil Skolnik, MD and John Russell, MD review the most important articles on diabetes, obesity, and cardiometabolic disease. This month on DOC Updates: Hirsh Elhence, Jennifer L. Dodge, Stephen Fuest, et al. National Prevalence of Clinical Obesity by BMI Class: A National Cross-Sectional Study. Ann Intern Med. [Epub 2 June 2026]. doi:10.7326/ANNALS-25-05287 Eva Johnsen, et al. Achieving at Least 15% Weight Loss Within 2 Years of Type 2 Diabetes Diagnosis Is Associated With Lower Risks of Macrovascular and Microvascular Complications: A U.K. Cohort Study. Diabetes Care 20 July 2026; 49 (8): 1480–1489. doi.org/10.2337/dc26-0937 Carel W. le Roux, et al. Survodutide Once Weekly for the Treatment of Adults with Obesity. The New England Journal of Medicine June 2026 DOI: 10.1056/NEJMoa2600751 Yu Wang, Shichao Tang, Xilin Zhou, Ping Zhang. National Trends in Out-of-Pocket Cost for Glucose-Lowering Drugs Among U.S. Adults With Diabetes, 2000–2022. Diabetes Care 20 July 2026; 49 (8): 1414–1419. https://doi.org/10.2337/dc25-2040 Jelle M. Beernink, et al. Effect of Finerenone on Albuminuria in Type 1 Diabetes by Baseline HbA1c Level and Diabetes Duration: An Exploratory Analysis of the FINE-ONE Trial. Diabetes Care 20 July 2026; 49 (8): 1434–1441. https://doi.org/10.2337/dc26-0882 Welch M, Forst T, Jia W et al. Orforglipron compared with dapagliflozin in adults with type 2 diabetes and inadequate glycaemic control with metformin (ACHIEVE-2): a multicentre, randomised, non-inferiority, open-label, phase 3 trial. The Lancet, 2026; 408, 125-140 DOI: 10.1016/S0140-6736(26)00800-7 Presented by: Neil Skolnik, MD, Professor of Family and Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University; Associate Director, Family Medicine Residency Program, Abington Jefferson Health John J. Russell, MD, Professor of Family and Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University; Chair-Department of Family Medicine, Abington Jefferson Health DOC Updates is a monthly podcast that presents and discusses the latest clinically relevant articles from the American Diabetes Association's three science and medical journals—Diabetes, Diabetes Care, and Diabetes, Obesity, and CardioMetabolic CARE. Intended for practicing physicians and health care professionals, DOC Updates discusses how the latest research is relevant in clinical practice. For information about the American Diabetes Association's scholarly journals, visit diabetesjournals.org. For more about this podcast, click here.

Today, we are taking a deep dive into an intervention that almost every labor and delivery unit in North America has adopted over the last decade: Quantitative Blood Loss, or QBL. ACOG first recommended quantitative blood loss assessment in Committee Opinion Number 794, published in December 2019. This opinion recommended that every birthing facility implement a standardized, quantitative method for measuring cumulative blood loss at all deliveries, replacing visual estimation as the default approach. This built on earlier ACOG efforts, including the 2015 reVITALize initiative, which standardized obstetric data definitions and defined postpartum hemorrhage using cumulative measured blood loss thresholds (≥1,000 mL regardless of delivery route, or blood loss accompanied by signs/symptoms of hypovolemia). We've all weighed sponges, measured calibrated drapes, and run the math. But here's the million-dollar question: Does measuring blood loss accurately, on its own, actually improve outcomes for patients? The answer is YES….and NO at the same time. Listen in for details as we discuss new data (July 2026 in AJOG) on this topic. 1. White A, Burns RN, Pruszynski JE, Ravindra D, Fin KX, Montgomery T, Jestes E, Ambia AM, Anyaehie B, Duryea EL. Establishing Normal Blood Loss Thresholds at the Time of Delivery Based on Quantitative Blood Loss. Am J Obstet Gynecol. 2026 Jul. DOI: 10.1016/j.ajog.2026.07.028. S0002-9378(26)00395-9. YMOB 16849.2. Quantitative Blood Loss in Obstetric Hemorrhage: ACOG COMMITTEE OPINION, Number 794.Obstetrics and Gynecology. 2019. Committee on Obstetric Practice3. Coomarasamy A, Devall AJ, Bell S, et al. Diagnosis and Treatment of Postpartum Haemorrhage: A Race Against Time. Lancet. 2026.

In the second edition of 'Quarterly catch-up', CMI Communications editors Emily McDonald and Erin McCreary round-up the biggest news in infectious diseases and review clinical microbiology and infectious diseases studies published in the second quarter of 2026 [1-4]. From Pneumocystis jirovecii pneumonia in solid-organ-transplant recipients to a double-blind randomised controlled trial reporting a new antibiotic for complicated urinary tract infections, Erin and Emily highlight four articles they found particularly noteworthy, and comment on whether the results can and should change clinical practice.  ReferencesAlanio A, et al. Pneumocystis jirovecii pneumonia in solid organ transplant recipients: a prospective observational cohort study, J Infect 2026. DOI: 10.1016/j.jinf.2026.106794Ramendra R, et al. Procalcitonin to guide 7 versus 14 days of antibiotics in bloodstream infections: a secondary analysis of the BALANCE trial, JAMA Netw Open 2026. DOI: 10.1001/jamanetworkopen.2026.20973Pai MP, et al. Challenging weight-tiered antibiotic prophylaxis in obese patients undergoing colorectal surgery using CT-derived body composition, CID 2026. DOI: 10.1093/cid/ciag383 Takahashi S, et al. Efficacy and safety of cefepime–nacubactam and aztreonam–nacubactam compared with imipenem–cilastatin for complicated urinary tract infection or acute uncomplicated pyelonephritis (Integral-1): a double-blind, randomised phase 3 trial. Lancet 2026. DOI: 10.1016/S0140-6736(26)00596-9 Further readingThe SNAP Trial Group. Cefazolin for Methicillin-Susceptible Staphylococcus aureus Bacteremia. NEJM 2026. DOI: 10.1056/NEJMoa2506905The SNAP Trial Group. Benzylpenicillin versus flucloxacillin or cloxacillin for the treatment of penicillin-susceptible Staphylococcus aureus bacteraemia (SNAP): an international, multicentre, open-label, non-inferiority randomised controlled trial. Lancet 2026. DOI: 10.1016/S0140-6736(26)00761-0McCreary EK, et al. Communicable episode 26: SNAP out of it – rethinking anti-staphylococcal penicillins for S. aureus bacteremia, the SNAP trial PSSA/MSSA results. Communicable Podcast 2025. https://share.transistor.fm/s/2a3c3bb4  Ilges D, et al. Anticalcitonin: limited utility of a context-dependent biomarker demonstrated in another real-world data set, CID 2026. DOI: https://doi.org/10.1093/cid/ciag396 Spellberg B. Procalcitonin–An enigmatic anxiolytic biomarker, JAMA Netw Open 2026. DOI: 10.1001/jamanetworkopen.2026.20978 

Reference:  Perry DC, et al. Surgical fixation versus non-surgical care for children with a displaced medial epicondyle fracture of the elbow (the SCIENCE study): a multicentre, randomised controlled, superiority trial and economic evaluation. The Lancet 2026 Date: July 14, 2026 Guest Skeptics: Dr. Megan Terle is an orthopedic surgeon and Assistant Professor for Pediatrics and […] The post SGEM#517 : I Will Try to Fix You. Surgery or Not for Pediatric Displaced Medial Epicondyle Elbow Fractures first appeared on The Skeptics Guide to Emergency Medicine.

Quais foram os principais destaques científicos, alertas globais e resoluções regulatórias que marcaram a medicina nos últimos dias? Nesta edição de resumo semanal do Afya News, analisamos o maior registro de casos de sarampo em três décadas nos EUA e a resolução do Cremesp que limita o tempo de cirurgias plásticas estéticas a seis horas em São Paulo. Discutimos também as novas diretrizes da OMS e o estudo latino-americano no The Lancet para prevenção do declínio cognitivo, os achados da Sociedade Brasileira de Cardiologia sobre os benefícios cardiovasculares da amamentação para as mães, a ampliação do teleatendimento do SUS para dependência em apostas digitais e a gravidade do surto de Ebola no Congo. O Afya News apresenta notícias da medicina com informação confiável e atualizada no seu tempo. Criado pela Afya, o maior hub de educação e soluções para a prática médica do Brasil, nosso propósito é transformar a saúde junto com quem tem a medicina como vocação.Fontes do episódio aqui:⁠https://portal.afya.com.br/podcasts/afya-news/08-08-2026

Our kidneys do an incredible job filtering our blood every hour of every day. Most of us have two kidneys, and each one has about a million microscopic filters called glomeruli. Unlike the filters in our HVAC system, though, these filters cannot be replaced. But they do their work so well and unobtrusively that most of us don't even think about our kidney function. Although 37 million Americans have kidney trouble, the majority are unaware of their situation. Two tests could reveal how well the kidneys are working. What are they, and how often should you ask about them? At The People's Pharmacy, we strive to bring you up‑to‑date, rigorously researched insights and conversations about health, medicine, wellness and health policies and health systems. While these conversations intend to offer insight and perspective, the content is provided solely for informational and educational purposes. Please consult your healthcare provider before making any changes to your medical care or treatment. How You Can Listen You could listen through your local public radio station or get the live stream at 7 am EST on Saturday, August 8, 2026, through your computer or smart phone (wunc.org). Here is a link so you can find which stations carry our broadcast. If you can't listen to the broadcast, you may wish to hear the podcast later. You can subscribe through your favorite podcast provider, download the mp3 using the link at the bottom of the page, or listen to the stream on this post starting on August 10, 2026. What Are the Two Tests That Reveal Kidney Trouble? Chronic conditions like high blood pressure and diabetes put a strain on the kidneys. They are very common problems that signal the need for kidney function monitoring. Our guest expert, Dr. Samir Parikh, suggests that all of us should know our numbers. One is derived from the level of creatinine in the blood. This is normally part of a basic metabolic panel. Usually, the panel results will include a number for the estimated glomerular filtration rate (EGFR) calculated from the value for blood creatinine. The other crucial test is a urine test for protein. Keeping Kidneys Healthy by Staying Properly Hydrated One of the simplest tactics to keep kidneys healthy is to provide them with enough liquid. We get some fluid from the food we eat, which may be one reason eating fruits and vegetables seems to be good for us. They are full of water! We also need to drink fluid, and plain water is probably the best choice. It would be smart to use thirst as a guideline and make sure to drink when thirsty. We do avoid overdoing water consumption, though, as overloading the kidneys with more fluid than they can handle is dangerous as well. Medicines That Are Hard on the Kidneys We mentioned to Dr. Parikh the experience of an older friend, a devoted runner, who discovered that taking ibuprofen after a run reduced the likelihood of having to get up overnight to urinate. He reminded us and our listeners that nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, naproxen, celecoxib or meloxicam can be hard on the kidneys. That doesn't mean we shouldn't ever take such pain relievers, but perhaps we should try not to make it a habit. When we asked about other medicines that might be tough on the kidneys, he mentioned PPIs. Proton pump inhibitors such as omeprazole (Prilosec) or esomeprazole (Nexium) are often used to treat heartburn or other digestive symptoms. Regular use can put a strain on the kidneys, although the gastroenterologist recommending the medicine might not warn you of that side effect. We asked about environmental toxins and learned that heavy metals such as lead or arsenic can harm the kidneys along with other organs. We should make sure that the food we eat and the water we drink are not contaminated with such compounds. The Possible Benefits of Vitamin B Dr. Parikh has been studying how the kidneys respond to the B vitamin nicotinamide. The preliminary work he and his colleagues have done so far is promising. However, they have not conducted clinical trials to find out whether the vitamin could help people with early kidney disease. Because kidneys work so hard, they need a lot of energy to be produced by the mitochondria in their cells. Those mitochondria need NAD+ (nicotinamide adenine dinucleotide) to function at their best. Providing additional nicotinamide appears to help (Nature Reviews. Nephrology, Feb. 2020).  One to three grams a day appears to be safe and may be beneficial. Medications That Can Promote Kidney Health Some medicines initially developed for other conditions are proving to be helpful in treating kidney disease. In particular, these include diabetes drugs known as SGLT2 inhibitors like dapagliflozin (Farxiga) or empagliflozin (Jardiance). They help slow the decline of kidney function (New England Journal of Medicine, Nov. 4, 2022). GLP-1 agonists may also be familiar because they too are used to treat diabetes. Medications such as semaglutide (Ozempic, Rybelsus, Wegovy) and tirzepatide (Mounjaro, Zepbound) have made headlines as weight loss and diabetes meds, but they also can reduce the risk of kidney failure and other bad outcomes (Lancet. Diabetes & Endocrinology, Jan. 2025). The benefits of these types of drugs should give us hope that we can go from slowing the progression of kidney disease to stopping it in its tracks Taking Care of Your Kidneys We asked Dr. Parikh what we should be doing to care for our kidneys and keep them healthy. He urged us once again to know our numbers: most importantly, the numbers from the two tests we discussed, blood creatinine and urine protein. Other numbers that are important for kidney are our blood pressure and, for those with diabetes, HbA1c. In addition to paying attention to all those numbers, we need to embrace a lifestyle that will help keep them where they belong. That means following a heart-healthy diet, staying physically active and getting adequate sleep. This Week’s Guest Samir M. Parikh, M.D., FASN, is Professor of Internal Medicine and Pharmacology and Chair of Internal Medicine at the University of Texas Southwestern. He holds the Donald W. Seldin Distinguished Chair in Internal Medicine and the Ruth W. and Milton P. Levy, Sr., Chair in Molecular Nephrology. Dr. Samir Parikh, University of Texas Southwestern Listen to the Podcast The podcast of this program will be available Monday, August 10, 2026, after broadcast on Aug. 8. This week's podcast has additional information on a possible role for sodium bicarbonate (baking soda) for kidney function. We also discussed medical silos, and how that leads to gastroenterologists overlooking the kidney risks from PPIs. Also, what should prospective kidney donors consider? You can stream the show from this site and download the podcast for free. Download the mp3, or listen to the podcast on Apple Podcasts or Spotify.

No Way But Forward: Remembering Families in the Gaza Strip   Join Michelle Villegas, host of Friends With The World, for a powerful and heartfelt conversation with psychologist and researcher Brian Barber PhD, author of No Way But Forward. For more than 25 years, Brian has studied and lived alongside Palestinian families, listening to their stories and witnessing their resilience, generosity, forgiveness, and deep commitment to one another. In this episode, Dr. Barber shares insights from his decades of research in the Gaza Strip, offering a deeper understanding of the lives, hopes, struggles, and humanity of families who often feel forgotten by the world. Together, Michelle and Brian explore the beauty of the human spirit, the importance of being seen and heard, and remembered. Bio: BRIAN K. BARBER, PhD, is a non-resident senior scholar at the Middle East Policy Council, a senior fellow at the Institute for Palestine Studies, and professor emeritus at the University of Tennessee. He currently lives in Washington, DC. Barber's work has addressed how context—from parenting to political systems—impacts individual and social development.Barber is the editor of Adolescents and War: How Youth Deal with Political Conflict (Oxford University Press, 2008), among other books. For the past thirty years, he has researched more than ten thousand Palestinian families in the West Bank, East Jerusalem, and the Gaza Strip. His published articles have appeared in The Lancet, Social Science & Medicine, Global Public Health, PLOS ONE, Child Development, the Journal of Adolescent Research, and other journals. Barber's commentaries have appeared in Haaretz, CNN.com, Informed Comment, Counterpunch, and Middle East Policy. His most recent book is No Way but Forward: Life Stories of Three Families in the Gaza Strip. Learn more about Michelle here  https://dreamvisions7radio.com/friends-with-the-world/ Website: friendswiththeworld.com

In the first episode of this special three-part series, Neil Skolnik speaks with Dr. Minesh Rajpal. Together, they provide an overview, discussing the assessment and management of high blood pressure. This special episode is sponsored with support from AstraZeneca. Presented by: Neil Skolnik, MD, Professor of Family and Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University; Associate Director, Family Medicine Residency Program, Abington Jefferson Health Minesh Rajpal, MD, Attending Nephrologist and Hypertension Specialist at the Southwest Kidney Institute References: 2025 AHA/ACC/AANP/AAPA/ABC/ACCP/ACPM/AGS/AMA/ASPC/NMA/PCNA/SGIM Guideline for the Prevention, Detection, Evaluation and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Joint Committee. Hypertension 2025; 82(10) Blood pressure lowering for prevention of cardiovascular disease and death: a systematic review and meta-analysis. Lancet 2016;387:957

Como os debates sobre a precisão diagnóstica em mastologia, as novas ferramentas de teleatendimento e as evidências científicas em neurologia impactam o consultório? Neste episódio do Afya News, analisamos a reportagem da BBC Health sobre as possíveis falhas nos métodos atuais de rastreamento do câncer de mama para mulheres jovens em maior risco, reforçando a necessidade de reavaliar protocolos de vigilância. Discutimos também a incorporação do canal de apoio psicológico ao Meu SUS Digital com triagem por inteligência artificial para jovens. Por fim, apresentamos no Radar o estudo inédito do The Lancet na América Latina sobre intervenções multidomínio para a prevenção da demência. O Afya News apresenta notícias da medicina com informação confiável e atualizada no seu tempo. Criado pela Afya, o maior hub de educação e soluções para a prática médica do Brasil, nosso propósito é transformar a saúde junto com quem tem a medicina como vocação.Fontes do episódio aqui:⁠https://portal.afya.com.br/podcasts/afya-news/05-08-2026

For decades, migraine was explained to patients as a blood vessel problem: swelling, throbbing, treat it by shrinking things back down. That explanation is mostly a myth, and it may be part of why so many older treatments never worked.Dr. Fred Cohen is medical director of Headache Intervention and an assistant professor of medicine and neurology at the Icahn School of Medicine at Mount Sinai. He's one of the few headache specialists in the country trained in both internal medicine and headache medicine, has over 40 publications in journals including The Lancet and Cephalalgia, and has lived with migraine himself since his teens.In this conversation, you'll explore:Why migraine is a neuroinflammatory condition, not a vascular one, and why some medical schools still teach the outdated versionThe "broken thermostat" phenomenon of chronic sensitization, and how untreated migraine can convince your brain that constant pain is normalWhy only about 30% of people with migraine ever experience aura, and the surprising range of ways it can actually show upThe current treatment landscape, from triptans to CGRP therapies, Botox, neuromodulation devices, and what's coming nextWhy Dr. Cohen calls this the golden age of headache medicine, and what that means if you gave up on treatment years agoIf migraine has ever made you feel like your body was working against you, or like you'd already tried everything, this conversation will change how you see both.You can find Fred at: Website | Instagram | Episode TranscriptNext week, we're sitting down with Marisa Renee Lee to talk about why the tidy stories we tell ourselves about grief and resilience tend to fall apart, and what it actually looks like to build a life around pain instead of waiting to get past it. Be sure to follow Good Life Project wherever you get your podcasts so you don't miss any upcoming episodes!Check out our sponsors and resources: Visit Our Sponsor Page Hosted on Acast. See acast.com/privacy for more information.

Mudanças no estilo de vida podem proteger o cérebro contra as demências e o declínio cognitivo _ ou seja, a dificuldade de memória, atenção, raciocínio. Essa foi a conclusão de um estudo que acompanhou 1.065 participantes entre 60 e 77 anos durante dois anos em 11 países da América Latina, incluindo o Brasil. O resultado comprovou que a adoção de um programa de hábitos saudáveis melhorou em 55% o desempenho cognitivo de pessoas idosas que tinham alto risco de desenvolver problemas de cognição e demência. No episódio de hoje, a gente vai conhecer a fundo esse estudo e entender de que forma é possível evitar esse que é um dos maiores temores associados ao envelhecimento. Nosso entrevistado é Dr. Paulo Caramelli, neurologista e um dos pesquisadores do programa LatAm Fingers, recém-publicado na revistas científica The Lancet, uma das mais importantes do mundo.

287 million people live with viral hepatitis worldwide. But vaccination and treatment offer new hope that elimination is possible. Lancet editor Niall Boyce discusses progress and challenges with Dr John Ward, Director of the Coalition for Global Hepatitis Elimination at the Task Force for Global Health. Visit https://www.taskforce.org/viral-hepatitis/ and https://www.worldhepatitisday.org/ to find out more. The Lancet Voice is part of the Lancet Group podcast offering.  Editorial team: Niall Boyce, Miriam Sabin, Jessamy Bagenal, Richard Horton, and Gavin Cleaver Podcast editing: Matteo Simonetti Visit https://www.thelancet.com/multimedia to learn more about our multimedia offering.  Find the best science for better lives at thelancet.com Follow us today at... https://thelancet.bsky.social/ https://instagram.com/thelancetgroup https://facebook.com/thelancetmedicaljournal https://linkedIn.com/company/the-lancet https://youtube.com/thelancettv

Guest Host Joe DeMare talks about the City of Bowling Green eliminating its penalty on rooftop solar after a seven year battle. Next he interviews Cathy Cowan-Becker about SB 219 a law which makes it easier for oil and gas companies to frack Ohio's state parks and other lands. Rebecca Wood tells us more than we want to know about hookworm. Ecological News includes The Lancet publishing a letter which blows the case for nuclear power out of the water, the Pentagon blocking wind power in the US, and the OEPA deciding NOT to issue a blanket water permit for data centers after all.  

Living longer with HIV is one of medicine's greatest success stories, but longevity brings new challenges. By 2040, more than half of all people living with HIV are expected to be over the age of 50, and their health pathways during ageing are very heterogeneous. What does that mean for patients, clinicians, and health systems worldwide? Are our health systems ready for this shift in the HIV ageing demographics? In this episode, Amy Justice and Keri Althoff discuss The Lancet HIV Commission on Ageing and HIV: A global perspective, exploring why the future of HIV care must shift beyond viral suppression toward healthy ageing, integrated care, and what matters most to people living with HIV. Click here to read the full commission and related material:  www.thelancet.com/commissions-do/ageing-and-hiv If you want to discover more you can download the related infographic at: www.thelancet.com/infographics-do/ageing-with-HIV-26 And a video form the authors of the commission at: https://www.youtube.com/watch?v=WHhBYh1zKMI

A new Lancet study on IVF add-ons made headlines, and acupuncture was one of the treatments under review.  Dr. Lee Hullender Rubin joins Dr. Susan Fox to discuss what the study actually found, what it got right, and what it missed.  Dr. Lee explains that studies using one or two sessions on transfer day was an insufficient dose.research was done on fresh embryo transfers, but almost nobody does fresh anymore.“sham acupuncture” isn't placebo..This episode is for you if:you saw the headlines and want the full pictureyou're planning IVF and considering acupuncture you're thinking acupuncture on embryo transfer day will helpyou want to understand what "sham" acupuncture is and why it mattersSupport your fertility journey with Preconception Plan at Health Youniversity. Learn more here: https://healthyouniversity.co/programs Want to know more about the latest IVF acupuncture study? Read the full article here: https://www.rosefinchhealth.com/blog/acupuncture-ivf-major-new-study-fuller-story Website: https://www.rosefinchhealth.com/ 

Dr. Jimenez cites a 2024 Lancet study reporting a 79% rise in cancer among young adults globally between 1990 and 2019, with a 28% increase in deaths, across 17 cancer types. He attributes this to environmental toxins, obesity, diet, and early-life exposures, and names three top toxicities he targets in treatment: aluminum, glyphosate, and EMF radiation. He walks through daily detox practices (coffee enemas, shilajit, hydrogen water) and practical EMF-reduction steps (Wi-Fi off at night, phone away from the bed, grounding sheets). He explains when Hope4Cancer still uses chemo, radiation, or surgery — low-dose IPT chemo for tumor debulking, targeted "spot radiation" for pain control, and stents for obstructions — despite the clinic's non-toxic-first philosophy. He then details the clinic's "seven key principles," spending the most time on emotional/spiritual health (his upcoming book, Emotions and Cancer, out March 2025) and introduces Davida, a new five-part bioimmunotherapy meant to upregulate the immune system without targeting specific cancer-cell receptors (unlike checkpoint inhibitors such as Opdivo/Keytruda). Host Jim, a stage IV melanoma survivor, shares his own remission story, and Dr. Jimenez recommends he ask his oncologist about the Signatera circulating-tumor-cell test for ongoing monitoring.HealingStrong's mission is to educate, equip and empower our group leaders and group participants through their journey with cancer or other chronic illnesses, and know there is HOPE. We bring this hope through educational materials, webinars, guest speakers, conferences, community small group support and more.Please take advantage of our FREE resources below to help you along your health and healing journey:Support Group DirectoryHolistic Curriculum - Participant GuideSupport Our Mission - DonateAdditional Health ResourcesListen to Previous EpisodesWebsite: healingstrong.org

Open vs partial nephrectomy, and open vs robotic prostatectomy - two large randomised trials that did not change surgical practice! Just as important to examine these in GU Cast Journal Club as to examine pivotal trials that did change practice. Today we discuss the EORTC Today we discuss the EORTC 30904 RCT looking at kidney cancer surgery (Eur Urol 2011), and the Brisbane randomised trial of open vs robotic prostatectomy conducted (Lancet 2016). We are delighted to welcome back our GU Cast Journal Club Editors, Dr Carlos Delgado (Mexico City, MEX), and Dr Elena Berg (Munich, GER), along with main GU Cast Hosts, Renu Eapen and Declan Murphy. AN emotional one as Carlos is heading home to Mexico soon! Links to papers below:1. A prospective, randomised EORTC intergroup phase 3 study comparing the oncologic outcome of elective nephron-sparing surgery and radical nephrectomy for low-stage renal cell carcinoma Eur Urol 2011 2. Robot-assisted laparoscopic prostatectomy versus open radical retropubic prostatectomy: early outcomes from a randomised controlled phase 3 study Lancet 2016Even better on our YouTube channelAbout GU Cast Journal Club:Each month, two papers are discussed, each of which are of importance to the GU Oncology community. These may be recent papers, or occasionally we will chose a classic landmark paper in GU Oncology. The objective is to draw attention to important papers in GU Oncology, and critique these in a robust manner. The key target audience is trainees working in Urology, Medical Oncology, Radiation Oncology, Nuclear Medicine, and diagnostic specialties such as Radiology and Pathology. But any of our regular audience are likely to enjoy this Journal Club series.

What if some of the most powerful ways to improve your health didn't require expensive gadgets, complicated routines, or the latest supplement trend? In this rapid-fire solo episode, Darin shares 15 unusual, science-backed habits that can dramatically improve longevity, mobility, brain function, nervous system regulation, digestion, and overall vitality. From dead hangs and deep squats to humming, sunlight, boredom, and chewing your food more thoroughly, each practice is grounded in published research, not internet biohacking hype. These are simple, practical habits you can start today that may have an outsized impact on your health over time. If you're looking for evidence-based ways to optimize your body without spending a fortune, this episode is packed with actionable takeaways. What You'll Learn Why grip strength may be one of the strongest predictors of longevity How deep squats improve mobility and joint health The surprising connection between balance and lifespan Why humming boosts nitric oxide production The science behind mouth taping and nasal breathing How cold water can instantly calm your nervous system Why boredom fuels creativity and brain function The health benefits of intentional silence How awe can reduce inflammation Why soil microbes strengthen your immune system The importance of chewing for nutrient absorption Why sunlight is one of the most powerful daily health tools Chapters 00:00:00 – Welcome to SuperLife 00:00:32 – Sponsor: Tru Niagen 00:02:35 – 15 science-backed health habits you probably aren't doing 00:04:18 – #1 Grip strength and longevity 00:06:40 – #2 The deep squat rest 00:08:16 – #3 Single-leg balance 00:09:36 – #4 Why humming boosts nitric oxide 00:11:01 – #5 Mouth taping and nasal breathing 00:12:41 – #6 Cold water face immersion 00:14:05 – #7 Ice on the back of your neck 00:14:59 – Sponsor: Manna Vitality 00:16:55 – #8 Getting bored on purpose 00:18:34 – #9 Scheduling daily silence 00:20:01 – #10 Chasing awe instead of scrolling 00:21:20 – #11 Why getting your hands dirty boosts immunity 00:23:00 – #12 Chewing your food more thoroughly 00:24:20 – #13 Squatting while using the bathroom 00:25:41 – #14 Get sunlight before your phone 00:26:59 – #15 Sunlight on your skin 00:28:28 – The complete 15-step daily protocol 00:29:05 – Start with one habit today 00:29:26 – Final thoughts and closing message Thank You to Our Sponsors Tru Niagen: Boost NAD+ levels for cellular health and longevity. Get 20% off with code DARINOLIEN20 at truniagen.com. Manna Vitality: Go to mannavitality.com/ and use code DARIN for 20% off your order. Join the SuperLife Community Get Darin's deeper wellness breakdowns — beyond social media restrictions: Weekly voice notes Ingredient deep dives Wellness challenges Energy + consciousness tools Community accountability Extended episodes Join for $7.49/month → https://patreon.com/darinolien Connect with Darin Olien: Website: darinolien.com Instagram: @darinolien Book: Fatal Conveniences Platform & Products: superlife.com New Show: Roadmap to Happiness Key Takeaway "Better health doesn't always come from doing more—it often comes from returning to the simple things humans have done for thousands of years. Move your body naturally. Breathe through your nose. Spend time in silence. Get into the sun. Touch the earth. Challenge your balance. Strengthen your grip. These aren't expensive biohacks—they're timeless biological signals that remind your body how to thrive. Small daily actions, repeated consistently, can create extraordinary long-term health." Bibliography/Sources Physical Function & Biomechanics Araujo, C. G., et al. (2022). Successful 10-second one-legged stance performance predicts survival in middle-aged and older individuals. British Journal of Sports Medicine https://www.frontiersin.org/journals/sports-and-active-living/articles/10.3389/fspor.2022.1066913/full Deep squat / ankle dorsiflexion as clinical mobility assessment. (n.d.). PubMed Central. https://pmc.ncbi.nlm.nih.gov/articles/PMC7276781/ https://pmc.ncbi.nlm.nih.gov/articles/PMC12358486/ Leong, D. P., et al. (2015). Prognostic value of grip strength: Findings from the Prospective Urban Rural Epidemiology (PURE) study. The Lancet, 386(9990), 266–273. https://doi.org/10.1016/S0140-6736(14)62000-6 Sikirov, D. (2003). Comparison of straining during defecation in three positions: Results and implications for human health. Digestive Diseases and Sciences, 48(7), 1201–1205. https://doi.org/10.1023/A:1024180319005 Respiratory & Nervous System Effects of cold stimulation on cardiac-vagal activation in healthy participants: A randomized controlled trial. (n.d.). PubMed Central. https://pmc.ncbi.nlm.nih.gov/articles/PMC6334714/ Systematic review of mouth taping for sleep-disordered breathing. (2024). PLOS One. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0323643 Trigeminocardiac / mammalian dive reflex response to cold facial immersion. (2023). PubMed Central. https://pmc.ncbi.nlm.nih.gov/articles/PMC10295257/ Weitzberg, E., & Lundberg, J. O. N. (2002). Humming greatly increases nasal nitric oxide. American Journal of Respiratory and Critical Care Medicine, 166(2), 144–145. https://pubmed.ncbi.nlm.nih.gov/12119224/ Brain, Silence & Emotion Bartoli, E., et al. (2024). Default mode network electrical stimulation effects on creativity. Brain, 147(10), 3409+. Bernardi, L., Porta, C., & Sleight, P. (2006). Cardiovascular, cerebrovascular, and respiratory changes induced by different types of music in musicians and non-musicians: The importance of silence. Heart, 92, 445–452. https://pubmed.ncbi.nlm.nih.gov/16199412/ Mann, S., & Cadman, R. (2014). Does being bored make us more creative? Creativity Research Journal, 26(2), 165–173. https://doi.org/10.1080/10400419.2014.901073 Münzel, T., et al. (2024). Noise causes cardiovascular disease: It's time to act. Journal of Exposure Science & Environmental Epidemiology. https://pmc.ncbi.nlm.nih.gov/articles/PMC11876066/ Stellar, J. E., John-Henderson, N., Anderson, C. L., Gordon, A. M., McNeil, G. D., & Keltner, D. (2015). Positive affect and markers of inflammation: Discrete positive emotions predict lower levels of inflammatory cytokines. Emotion, 15(2), 129–133. Immune, Digestion & Environmental Light Cassady, B. A., Hollis, J. H., Fulford, A. D., Considine, R. V., & Mattes, R. D. (2009). Mastication of almonds: Effects of lipid bioaccessibility, appetite, and hormone response. The American Journal of Clinical Nutrition, 89(3), 794–800. https://pubmed.ncbi.nlm.nih.gov/19144727/ Liu, D., Fernandez, B. O., Hamilton, A., et al. (2014). Isolated UVA irradiation of human skin generates dermal nitric oxide and lowers blood pressure independent of vitamin D. Journal of Investigative Dermatology, 134(7), 1839–1846. https://pubmed.ncbi.nlm.nih.gov/24445737/ Morning light exposure and circadian phase-shifting / dim-light melatonin onset. (n.d.). PubMed Central. https://pmc.ncbi.nlm.nih.gov/articles/PMC10594521/ Rook, G. A. W., et al. (2023). The old friends hypothesis: Evolution, immunoregulation and essential microbial inputs. Frontiers in Allergy. https://pmc.ncbi.nlm.nih.gov/articles/PMC10524266/ Strachan, D. P. (1989). Hay fever, hygiene, and household size. BMJ, 299(6710), 1259–1260. https://doi.org/10.1136/bmj.299.6710.1259

CardioNerds (Drs. Apoorva Gangavelli, Jenna Skowronski, and Hannah Every) discuss the continuum of prevention and heart failure with Drs. Anu Lala and Martha Gulati. Grounded in a clinical case of a 55-year-old woman with uncontrolled hypertension, type 2 diabetes, and obesity who is on the trajectory toward heart failure, this episode unpacks a paradigm-shifting framework from a joint HFSA/ASPC Scientific Statement. The discussion explores how prevention should not be siloed from heart failure management but rather integrated across a patient’s lifespan—from primary prevention in at-risk individuals, to secondary prevention in those with established heart failure, to tertiary prevention in patients with advanced therapies such as LVADs and heart transplantation. The experts highlight the importance of aggressive risk factor management, biomarker-guided screening, the AHA’s Life’s Essential 8, and the need for multidisciplinary collaboration and systems-level change to shift heart failure care from reactive to proactive. Audio editing for this episode was performed by CardioNerds Intern, Dr. Julia Marques Fernandes. Enjoy this Circulation 2022 Paths to Discovery article to learn about the CardioNerds story, mission, and values. US Cardiology Review is now the official journal of CardioNerds! Submit your manuscript here. CardioNerds Prevention PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Pearls Systemic inflammatory diseases are associated with an elevated CVD risk that has significant implications for early detection, risk Heart failure prevention is a continuum, not a checkpoint. Prevention applies at every stage—from at-risk (Stage A) through advanced/post-transplant care—and every clinical encounter is an opportunity to intervene. The AHA’s Life’s Essential 8 (diet, physical activity, nicotine exposure, sleep, BMI, blood lipids, blood glucose, blood pressure) forms the foundation at every stage. Hypertension carries the highest population-attributable risk for heart failure of any modifiable risk factor. In the Framingham Heart Study, 91% of patients with newly diagnosed HF had pre-existing hypertension. The SPRINT trial demonstrated a 38% reduction in HF incidence with intensive blood pressure targets (30 ng/L or NT-proBNP >125 ng/L) identify individuals at heightened risk for progression to symptomatic HF. The ACC/AHA/HFSA guidelines give a Class IIa recommendation for natriuretic peptide screening in at-risk patients. Urine albumin-to-creatinine ratio (UACR) is an underutilized screening tool that provides additional insight into CKM risk. The heart failure label does not close the prevention window—it accentuates it. Secondary prevention through GDMT optimization (quadruple therapy in HFrEF) and continued risk factor management remains critical. Tertiary prevention extends to post-LVAD and post-transplant patients, where hypertension, diabetes, obesity, and CKD management remain essential to long-term outcomes. Show notes For a comprehensive review, please review the full HFSA/ASPC Joint Scientific Statement: Lala A, Beavers C, Blumer V, et al. The Continuum of Prevention and Heart Failure in Cardiovascular Medicine. J Card Fail. 2026;32:75-105. doi:10.1016/j.cardfail.2025.06.013 1. What is the “continuum of prevention” framework, and how does it differ from traditional approaches to heart failure prevention? Historically, prevention and heart failure management have been treated as separate disciplines—primary prevention handled by preventive cardiologists and treatment managed by heart failure specialists. This joint HFSA/ASPC Scientific Statement reframes prevention as a dynamic, continuous process that spans a patient’s entire lifespan, regardless of HF stage or ejection fraction. The framework maps onto the ACC/AHA HF staging system: Primary prevention targets Stage A (“at risk”) and Stage B (“pre-HF”) patients to reduce the burden of incident HF. Secondary prevention targets Stage C (symptomatic) and Stage D (advanced) patients to reduce the impact of established HF through GDMT optimization and ongoing risk factor management. Tertiary prevention encompasses risk factor management in patients with LVADs or heart transplants—populations where hypertension, diabetes, and obesity still drive outcomes. The Central Figure of the statement illustrates that Life’s Essential 8 (blood pressure and lipid control, diabetes management, exercise, sleep, smoking cessation, weight management, and diet/nutrition counseling) forms the foundation at every stage, with pharmacologic and device-based therapies layered on top as disease progresses (Figure) 2. How do traditional risk factors drive heart failure, and what should clinicians prioritize? Hypertension carries the greatest population-attributable risk for HF. In the Framingham Heart Study (N=5,143), HTN was associated with a 2- to 3-fold increased risk of HF, with a population-attributable risk of 39% in men and 59% in women. The SPRINT trial showed a 38% reduction in HF incidence and 25% reduction in the primary composite outcome with intensive BP targets (30 ng/L or NT-proBNP >125 ng/L) are associated with heightened risk for progression to symptomatic HF. In the ARIC study, incorporating NT-proBNP reclassified 20% of older adults without HF into Stage B. Factors that affect interpretation include age, sex, obesity (lower values), and CKD (higher values). High-sensitivity cardiac troponin (hs-cTn): Concentrations above the 99th percentile are now included in the definition of Stage B HF. Troponin testing may complement natriuretic peptides, particularly when BNP/NT-proBNP values are ambiguous. Risk scores: The PCP-HF equation predicts 10-year HF risk using traditional risk factors plus QRS duration. The AHA PREVENT score incorporates HF risk calculation and includes markers of kidney function (albuminuria, eGFR), though it may underestimate risk in men and Black adults. The CKM syndrome staging framework (Stages 0–4) provides a holistic approach to assessing systemic cardiovascular-kidney-metabolic risk. 4. What are the key nontraditional risk factors and cross-cutting themes in heart failure prevention? Genetics: Pathogenic cardiomyopathy variants exist in ~1 in 200 individuals in the general population. The HFSA and ACMG recommend cascade testing to identify at-risk family members. Polygenic risk scores for dilated cardiomyopathy show a 3.8-fold risk for DCM in the top 10th percentile compared with the median. Sex-specific considerations: Women have 2.8 times the odds of developing HFpEF, while men have similarly increased odds of HFrEF. A complete obstetric/gynecologic history is essential—preeclampsia is associated with a 4-fold increased risk of HF. Peripartum cardiomyopathy requires intentional screening in high-risk populations. Cardiotoxic exposures: Clinicians should be aware of medications that cause direct myocardial toxicity (e.g., anthracyclines, trastuzumab, tyrosine kinase inhibitors). A team-based approach with pharmacists can help optimize medication selection and risk factor modification. Social determinants of health: Environmental exposures (air pollution, arsenic, lead, cadmium), food insecurity, financial instability, and limited healthcare access contribute to HF risk and progression. Equity-focused, risk-based prevention strategies are needed. Psychological health: Depression is common in HF and independently associated with worse outcomes. Screening with brief questionnaires (e.g., PHQ-2) is recommended. Meditation, spirituality, and holistic wellness approaches remain underutilized. 5. What systems-level and policy changes are needed to move the needle on heart failure prevention? Multidisciplinary HF prevention clinics that bring together preventive cardiologists, HF specialists, endocrinologists, nephrologists, dietitians, pharmacists, exercise physiologists, and genetic counselors are advocated by the statement. EHR-embedded risk stratification could proactively flag patients on a trajectory toward HF—analogous to sepsis alerts or fall risk flags—enabling earlier intervention, particularly for patients who may not reach a cardiologist. Cardiac rehabilitation remains underutilized, particularly in HFrEF (Class 2b recommendation) and HFpEF (not yet covered by Medicare). The HF-ACTION trial showed quality-of-life benefits, and the REHAB-HF trial showed particular benefit in older patients with HFpEF. Policy priorities include expanding insurance coverage for preventive screening and novel therapies (SGLT2i, GLP-1 RAs, nsMRAs), reducing clinical inertia through team-based care models with closer follow-up intervals, and ensuring equitable access to evidence-based therapies across diverse populations. Digital health and AI hold promise for personalized risk prediction, remote monitoring (e.g., wearable devices, implantable PA pressure monitors), and virtual cardiac rehabilitation to overcome access barriers. Figure  Lala A, Beavers C, Blumer V, et al. The continuum of prevention and heart failure in cardiovascular medicine: a joint scientific statement from the Heart Failure Society of America and the American Society for Preventive Cardiology. J Card Fail. 2026;32(1):75-105. doi:10.1016/j.cardfail.2025.06.013) References Key references are bolded. Lala A, Beavers C, Blumer V, et al. The continuum of prevention and heart failure in cardiovascular medicine: a joint scientific statement from the Heart Failure Society of America and the American Society for Preventive Cardiology. J Card Fail. 2026;32(1):75-105. doi:10.1016/j.cardfail.2025.06.013 Heidenreich PA, Bozkurt B, Aguilar D, et al. 2022 AHA/ACC/HFSA guideline for the management of heart failure: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2022;145(18):e895-e1032. doi:10.1161/CIR.0000000000001063 Lloyd-Jones DM, Allen NB, Anderson CAM, et al. Life’s Essential 8: updating and enhancing the American Heart Association’s construct of cardiovascular health: a presidential advisory from the American Heart Association. Circulation. 2022;146(5):e18-e43. doi:10.1161/CIR.0000000000001078 SPRINT Research Group, Wright JT Jr, Williamson JD, et al. A randomized trial of intensive versus standard blood-pressure control. N Engl J Med. 2015;373(22):2103-2116. doi:10.1056/NEJMoa1511939 Levy D, Larson MG, Vasan RS, Kannel WB, Ho KK. The progression from hypertension to congestive heart failure. JAMA. 1996;275(20):1557-1562. doi:10.1001/jama.1996.03530440037034 Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic: the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). JAMA. 2002;288(23):2981-2997. doi:10.1001/jama.288.23.2981 Yusuf S, Sleight P, Pogue J, et al. Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. N Engl J Med. 2000;342(3):145-153. doi:10.1056/NEJM200001203420301 Zinman B, Wanner C, Lachin JM, et al. Empagliflozin, cardiovascular outcomes, and mortality in type 2 diabetes. N Engl J Med. 2015;373(22):2117-2128. doi:10.1056/NEJMoa1504720 Anker SD, Butler J, Filippatos G, et al. Empagliflozin in heart failure with a preserved ejection fraction. N Engl J Med. 2021;385(16):1451-1461. doi:10.1056/NEJMoa2107038 Solomon SD, McMurray JJV, Claggett B, et al. Dapagliflozin in heart failure with mildly reduced or preserved ejection fraction. N Engl J Med. 2022;387(12):1089-1098. doi:10.1056/NEJMoa2206286 Filippatos G, Anker SD, Agarwal R, et al. Finerenone reduces risk of incident heart failure in patients with chronic kidney disease and type 2 diabetes: analyses from the FIGARO-DKD trial. Circulation. 2022;145(6):437-447. doi:10.1161/CIRCULATIONAHA.121.057983 Solomon SD, McMurray JJV, Vaduganathan M, et al. Finerenone in heart failure with mildly reduced or preserved ejection fraction. N Engl J Med. 2024;391(16):1475-1485. doi:10.1056/NEJMoa2407107 Lincoff AM, Brown-Frandsen K, Colhoun HM, et al. Semaglutide and cardiovascular outcomes in obesity without diabetes. N Engl J Med. 2023;389(24):2221-2232. doi:10.1056/NEJMoa2307563 Deanfield J, Verma S, Scirica BM, et al. Semaglutide and cardiovascular outcomes in patients with obesity and prevalent heart failure: a prespecified analysis of the SELECT trial. Lancet. 2024;404(10454):773-786. doi:10.1016/S0140-6736(24)01498-3  Kosiborod MN, Abildstrøm SZ, Borlaug BA, et al. Semaglutide in patients with heart failure with preserved ejection fraction and obesity. N Engl J Med. 2023;389(12):1069-1084. doi:10.1056/NEJMoa2306963 Ndumele CE, Neeland IJ, Tuttle KR, et al. A synopsis of the evidence for the science and clinical management of cardiovascular-kidney-metabolic (CKM) syndrome: a scientific statement from the American Heart Association. Circulation. 2023;148(20):1636-1664. doi:10.1161/CIR.0000000000001175 Khan SS, Matsushita K, Sang Y, et al. Development and validation of the American Heart Association’s PREVENT equations. Circulation. 2024;149(6):430-449. doi:10.1161/CIRCULATIONAHA.123.067626 Khan SS, Ning H, Shah SJ, et al. 10-year risk equations for incident heart failure in the general population. J Am Coll Cardiol. 2019;73(19):2388-2397. doi:10.1016/j.jacc.2019.02.057 Bozkurt B, Fonarow GC, Goldberg LR, et al. Cardiac rehabilitation for patients with heart failure: JACC expert panel. J Am Coll Cardiol. 2021;77(11):1454-1469. doi:10.1016/j.jacc.2021.01.030 Packer M. Leptin-aldosterone-neprilysin axis: identification of its distinctive role in the pathogenesis of the three phenotypes of heart failure in people with obesity. Circulation. 2018;137(15):1614-1631. doi:10.1161/CIRCULATIONAHA.117.032474 Lala A, Tayal U, Hamo CE, et al. Sex differences in heart failure. J Card Fail. 2022;28(3):477-498. doi:10.1016/j.cardfail.2021.10.006 Bozkurt B, Coats AJS, Tsutsui H, et al. Universal definition and classification of heart failure. Eur J Heart Fail. 2021;23(3):352-380. doi:10.1002/ejhf.2115 Hershberger RE, Givertz MM, Ho CY, et al. Genetic evaluation of cardiomyopathy—a Heart Failure Society of America practice guideline. J Card Fail. 2018;24(5):281-302. doi:10.1016/j.cardfail.2018.03.004 Levine GN, Cohen BE, Commodore-Mensah Y, et al. Psychological health, well-being, and the mind-heart-body connection: a scientific statement from the American Heart Association. Circulation. 2021;143(10):e763-e783. doi:10.1161/CIR.0000000000000947 Ezekowitz JA, Colin-Ramirez E, Ross H, et al. Reduction of dietary sodium to less than 100 mmol in heart failure (SODIUM-HF): an international, open-label, randomised, controlled trial. Lancet. 2022;399(10333):1391-1400. doi:10.1016/S0140-6736(22)00369-5

¿Has escuchado maravillas sobre medicamentos como Ozempic, Wegovy o Mounjaro, pero nadie te habla de las constantes náuseas y el malestar estomacal? La realidad clínica es que una gran parte de los pacientes abandonan estos tratamientos para la obesidad simplemente porque los efectos secundarios arruinan su calidad de vida. Pero la ciencia médica está a punto de dar un salto monumental. En este episodio, descubriremos a la AMILINA, una hormona producida por tu páncreas que está demostrando resultados asombrosos en ensayos clínicos: pérdida de peso significativa sin los severos vómitos ni malestares intestinales de los fármacos actuales. En este episodio aprenderás: → Cómo tu páncreas libera dos hormonas cada vez que comes. → Cómo la amilina bloquea el freno metabólico que hace que recuperes el peso perdido. → Cómo dos equipos de investigadores resolvieron el mismo problema químico de formas distintas. → Cómo la combinación CagriSema alcanza una reducción significativa del peso corporal. → Por qué la amilina resensibiliza tu cerebro a la leptina, algo que la semaglutida no logra.   Mi nombre es Dr. Mauricio González, médico internista y especialista en endocrinología en formación. Aquí comparto información basada en evidencia para que tomes decisiones de salud sin mitos ni marketing engañoso. Suscríbete a mi boletín informativo en: www.drmauriciogonzalez.com/   ⚠️ Este podcast tiene fines exclusivamente educativos e informativos y no constituye asesoramiento médico, diagnóstico ni tratamiento personalizado. Los medicamentos que se discuten en este episodio se encuentran en fase de investigación y no cuentan con aprobación de la FDA. Consulta siempre a tu médico o a un profesional de la salud calificado antes de cambiar tu régimen de tratamiento.   ¡Sigamos la conversación en redes sociales! Instagram

At the EBPOM World Congress in London; TopMedTalk's Andy Cumpsty sits down for an exclusive interview with Amy Slogrove, editor-in-chief of the new journal, The Lancet Surgery and Anaesthesiology, ahead of its public launch on 20 July and a planned first issue in early 2027. Dr Slogrove, a South Africa–based pediatrician and epidemiologist, explains the journal's aim - to bring surgery and anaesthesiology together across the perioperative space, emphasizing research integrity, rigor, and ethics, supported by clinical peer review. She outlines the editorial team, submission route via thelancet.com/surgery, expected decision timelines, and peer-review approach. The journal will be a monthly, small-format, hybrid subscription model, with priorities including equity, patient-centered care, sustainability, resilience of perioperative systems, and global inclusivity. -- The 2026 International Practicum on Cardiopulmonary Exercise Testing will be held at the Balmer Lawn Hotel in Brockenhurst, UK, from September 16th to 18th this year. It is organised by iPOETTS , the international perioperative testing and training society. Come and join us at this premier educational event designed for clinicians, scientists, and healthcare professionals interested in sport, exercise, and perioperative medicine. This is an International Perioperative Testing and Training Society accredited event so when you attend you can get your iPOETTS accreditation, showing that you are a practitioner who has reached a high, standardized level of competence in performing and interpreting Cardiopulmonary Exercise Testing (CPET) for patients preparing for major surgery. Go now to http://www.ebpom.org

Trump wants $95 billion more for his Iran war while oil giants cash in — and DNI pick Jay Clayton confesses to victimizing Epstein's victims. In this episode: • Hegseth testifies war money runs dry by August 1 — demands $87 to $95 billion more on top of a nearly $1 trillion budget • Hegseth admits $37.7 billion already spent, then warns we're low on ammo on camera • US bombing hits civilian desalination systems — 10,000 Iranians without drinking water • Oil near $90 a barrel, gas near $4 — Chevron, Exxon, ConocoPhillips feast while Hormuz stays shut • Jay Clayton clears committee 9–8 for Director of National Intelligence after he spilled Epstein victims' names, addresses, and photos • Clayton won't say Biden won 2020 — and shrugs at Tulsi helping seize Fulton County ballots • Tillis and Cornyn freeze Todd Blanche's Attorney General path after Epstein survivor meeting left victims more traumatized • Cornyn holds Kari Lake and Mastriano ambassadorships hostage over PEPFAR AIDS funding — Lancet warns 14 million dead if cuts stand, one third children • Ed Martin's pardon office ignores nearly 6,000 pleas for clemency so he can free Trump donors and Clean Air Act polluters • Sunny Hostin's Harvard grad son handcuffed jogging in New Rochelle Key figures covered: Donald Trump, Pete Hegseth, Jay Clayton, Todd Blanche, Thom Tillis, Jon Cornyn, Kari Lake, Ed Martin, Kash Patel, Chelsi "Sunny" Hostin Subscribe for live shows Sunday, Tuesday, and Thursday at 6:05 PM Eastern. Recorded live on the David Feldman Show July 21, 2026 #IranWar #EpsteinFiles #ToddBlanche #PeteHegseth #Trump #JayClayton #PEPFAR #WarSupplemental #OilPrices #DavidFeldmanShow

Here is the link to the article "Why I Reject Vitamin B12 Supplementation" by Akin Olokun, which discusses the alternative perspective on B12 touched on in the video:https://akinolokun.com/b12/ Brain Health Breakthrough Coaching Programhttps://rawfoodmealplanner.clickfunnels.com/webinar-replay-brain-health-breakthrough-coaching-programJoin January 2027 RawFoodMealPlanner's 21-Day Challengehttps://rawfoodhealthempowermentsummit.com/the-rawfoodmealplanner-s-21-day-new-year-meal-prep-challenge Boost Your Wellness Journey:The Brain Reboot Plan: 5 Simple Daily Shifts for More Focus, Energy & Peacehttps://rawfoodmealplanner.com/brain-reboot-plan/Revitalize Your Brain: A Lifestyle Approach for Women Over 50https://rawfoodmealplanner.clickfunnels.com/webinar-replay-brain-health-breakthrough-coaching-programRESET: 3 Metabolic Mistakes Women 30+ Make And How to Fix Themhttps://rawfoodmealplanner.com/reset-3-metabolic-mistakes-women-30-make-and-how-to-fix-them/The Lancet published a study here https://www.thelancet.com/journals/lanhl/article/PIIS2666-7568(24)00191-0/fulltext emphasizing that young adults (ages 18–39) are a neglected but crucial window for dementia prevention. Most dementia research focuses on mid-to-late life, yet many modifiable risk factors that affect long-term brain health emerge or peak in young adulthood.Key Modifiable Risk FactorsEducation: Low levels reduce cognitive reserve and increase the risk of dementia.Hearing loss: One billion young adults globally are at risk due to unsafe listening practices.Traumatic brain injury (TBI): High rates from sports, motor accidents, and intimate partner violence.Hypertension: One in 12 young adults is affected; rates higher among Black Americans and in LMICs.Alcohol use: Peaks in early 20s, linked to long-term brain changes.Obesity & physical inactivity: Both rising rapidly; linked to inflammation and cardiovascular risk.Smoking/vaping: 90% of daily smokers start before 26.Depression & social isolation: Peak in early 20s, linked to later ADRD (Alzheimer's disease and related dementias) risk.Diabetes: 4% prevalence in young adults; prediabetes affects 1 in 4.Environmental factors: Air pollution, vision loss, high LDL cholesterol, and even emerging risks like sleep disruption, stress, spirituality, and microplastics.Join the Conversation:Subscribe and share this episode with anyone on their own path of health and transformation. // HOST Samantha Salmon, NBC-HWC Nationally Board Certified Health & Wellness Coach Brain Health Licensed Trainer | Integrative Nutrition Coach | Intuitive Nutrition Coach for Brain & Metabolic HealthThe information provided in this broadcast is for educational purposes only and is not intended as medical advice. These statements have not been evaluated by the Food and Drug Administration or the equivalent in your country. Any products/services mentioned are not intended to diagnose, treat, cure, or prevent disease. RawFoodMealPlanner.com © 2026

There is a narrative circulating loudly in certain corners of social media and conventional medicine that what I do is not evidence-based. That functional medicine is supplement selling. That the testing is not validated. That providers like me are operating outside the bounds of legitimate medicine.I want to address that directly. Not because I am interested in a fight. But because the women listening to this deserve to feel certain about the care they are choosing. They deserve not to be destabilized by a confident-sounding voice that has not done the research.This episode is for you. And I am coming with receipts.Inside this episode, we cover:What evidence-based medicine actually means by definition, and why most people using it as a weapon are working with an incomplete version of itWhy the randomized controlled trial is the right tool for certain questions and the wrong tool for others, and what that distinction actually means for root cause medicineWhere the peer-reviewed research supporting functional medicine actually lives: the New England Journal of Medicine, Nature, The Lancet, Frontiers in EndocrinologyThe documented blind spots in conventional medical training: four hours or less of nutritional education across an entire medical school curriculumWhy the Women's Health Initiative may be the single greatest tragedy in women's healthcare, and what has changed in the decades sinceThe supplement accusation: what is true, what is misleading, and what the foundation of functional medicine is actually built onWhy the tests I use are not invented by functional medicine, and what the science actually says about cortisol curves, fasting insulin, comprehensive stool analysis, and full thyroid panelsThe story of a patient who came to me skeptical, and what the data said six months laterWhy the patient getting better is evidence, and why dismissing reproducible clinical outcomes as anecdote is a rhetorical position, not a scientific oneConventional medicine saves lives. Functional medicine restores them. Both of these things are true. And the women who need the second one deserve to pursue it without apology.You are not required to defend your healthcare choices to people who have not examined the research, have not sat with the patients, and have not followed the outcomes. The evidence exists. The research is in the journals. And the medicine that is actually restoring function in women who spent years being managed without being healed deserves to be chosen with confidence.Share this episode with one woman who has been made to second-guess the care that is actually working for her. She deserves the language to stand in it.Your next steps are below:✨ Free Guide: 9 Hidden Signs Your Metabolism Is Stuck in Survival Mode www.drkaceywallace.com/hiddenmetabolicmess✨ Adrenal Optimization Test (see your cortisol rhythm + DHEA clearly) www.drkaceywallace.com/innercalm✨ Hair Tissue Mineral Analysis www.drkaceywallace.com/htma✨ The Anchored Journey (application) www.drkaceywallace.com✨ Get the book: You Are Not Fine www.youarenotfine.com✨ Get our weekly newsletter: Dr. Kacey's Cornerwww.drkaceywallace.com/newslettersignupSupport the show

In this informative episode Dr. Tom Frieden former CDC director for eight years for President Obama shares his journey in public health. Tom discusses his 'See, Believe, Create' formula for better health, and insights on how individuals can contribute to global health improvements. Kimberly and Tom disscus practical tips for longevity, the importance of trust in public health, and stories from his global experiences, including Ebola and COVID-19 responses. Tom speaks about his new book; The Formula for Better Health: How to Save Millions of Lives and Your Own. Chapters00:00 Introduction to Dr. Tom Frieden's Journey02:56 The Philosophy of Service and Health05:47 Understanding the Formula: See, Believe, Create09:04 Navigating Misinformation in Public Health11:55 Experiences in Global Health: Ebola and Beyond14:51 Reflections on COVID-19 and Lessons Learned17:10 The Importance of Belief in Public Health19:59 The Legacy of Smallpox Eradication21:17 Preventable Health Issues Today23:19 Key Factors for a Healthy Life26:36 The Power of Physical Activity27:54 Nutrition and Its Impact on Health29:21 Environmental Toxins and Health Risks30:57 Fertility Challenges in Modern Society33:21 Creating a Healthier Future37:37 The Call to Action for Global HealthEpisode Sponsor: ANIMA MUNDI OFFER: Anima Mundi is giving Feel Good Podcast listeners their largest discount of the year. It's a great opportunity to treat yourself or a friend to some soothing self-care by going to AnimaMundiHerbals.com and use the code: SOLLUNA20 for 20% off your purchase. USE LINK: AnimaMundiHerbals.com Code: SOLLUNA20 for 20% off your purchase.Dr. Tom Frieden Resources: Book: The Formula for Better Health: How to Save Millions of Lives—Including Your OwnWebsite: resolvetosavelives.orgSocial: X @drtomfriedenBio: Dr. Tom Frieden is a physician specializing in internal medicine, infectious diseases, public health, and epidemiology. He led New York City's control of multidrug-resistant tuberculosis and other health threats, directed the CDC during the Ebola epidemic, and helped start Mayor Michael Bloomberg's global health philanthropy, particularly the Bloomberg Initiative to Reduce Tobacco Use, which has helped countries implement measures that will prevent more than 35 million deaths. His work has appeared in medical journals including The New EnglandJournal of Medicine, JAMA, and The Lancet as well as media outlets including the New York Times, Washington Post, and The Wall Street Journal. Dr. Frieden is the founder and CEO of Resolve to Save Lives, a global health organization that accelerates action against the world's deadliest health threats. The organization has partnered with countries around the world to support implementation of programs that will prevent more than 9 million deaths.Dr. Frieden's forthcoming book, The Formula for Better Health: How to Save Millions of Lives—Including Your Own (MIT Press, September 2025), distills four decades of public health leadership into a clear, actionable framework to extend healthy lives. Drawing from real-world successes and failures, the book bridges the lethal gap between scientific knowledge and life-saving action.See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

Can an algorithm decide who sees a doctor first — and what happens when it gets the call wrong? The NHS is rolling out AI triage tools and ambient scribes across general practice, promising to shorten waiting lists and free up clinician time. In this episode of The Lancet Voice, host Niall Boyce and Chloe Wilson, senior editor at The Lancet, cast a questioning eye over the initiative. Chloe raises concerns about AI triage — including the risk of downgrading seemingly innocuous but important symptoms — and questions whether AI in health care is adding efficiency, or simply cutting costs. The hosts also examine ambient scribes in the consulting room, discussing how AI scribes may change clinical practice, or even deskill physicians. The issue isn't whether AI can help the NHS — it's whether we're asking it to do the right things, and if we are implementing it in the right way. Let us know your thoughts in the comments! The Lancet Voice is part of the Lancet Group podcast offering.  Editorial team: Niall Boyce, Miriam Sabin, Jessamy Bagenal, Richard Horton, and Gavin Cleaver Podcast editing: Matteo Simonetti Visit https://www.thelancet.com/multimedia to learn more about our multimedia offering.  Find the best science for better lives at thelancet.com Follow us today at... https://thelancet.bsky.social/ https://instagram.com/thelancetgroup https://facebook.com/thelancetmedicaljournal https://linkedIn.com/company/the-lancet https://youtube.com/thelancettv

No episódio de hoje do Radar Médico, Juliane B. Braziliano, endocrinologista e editora médica de Endocrinologia do Portal Afya, explica a recente mudança de nomenclatura da Síndrome dos Ovários Policísticos (SOP), que passa a se chamar Síndrome Ovariana Metabólica Poliendócrina (SOMP).A atualização resulta de um consenso global publicado pelo The Lancet e busca refletir melhor o caráter multissistêmico da doença, destacando seus aspectos metabólicos, endocrinológicos, reprodutivos e psicológicos. O episódio revisa os critérios diagnósticos, os motivos para a mudança e como será a implementação da nova terminologia na prática clínica e na pesquisa. Tópicos abordados:Por que a SOP passou a se chamar SOMPCritérios diagnósticos em adultas e adolescentesManifestações metabólicas, reprodutivas e endocrinológicas da síndromeComo ocorreu o consenso global para a mudança de nomeEstratégia de implementação da nova nomenclaturaImpactos da mudança para a prática clínica, pesquisa e educação médicaDê o play e atualize sua prática clínica.

In this episode I look at the effects of climate change and also the recent hot weather from the level of the individual to the state of the planet.Links: Understanding climate change and its impacts: https://pmc.ncbi.nlm.nih.gov/articles/PMC11998295/Climate anxiety: https://mentalhealth-uk.org/news-and-insights/what-is-climate-anxiety-and-what-can-we-do-about-it/Lancet study on climate anxiety: https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3918955Hope in the climate crisis: https://www.youtube.com/watch?v=XZQMVYSD9EMThirst and dehydration: https://www.nhs.uk/conditions/dehydration/Mosquitoes: https://www.cdc.gov/mosquitoes/about/where-mosquitoes-live_1.htmlClimate summits: https://www.un.org/en/climatechange/un-climate-conferencesSave your life in slow motion and those of others by subscribing now and sharing. Thank you for listening and for your support. It means a lot to me. Hosted on Acast. See acast.com/privacy for more information.

Brain Health Breakthrough Coaching Programhttps://rawfoodmealplanner.clickfunnels.com/webinar-replay-brain-health-breakthrough-coaching-programJoin January 2027 RawFoodMealPlanner's 21-Day Challengehttps://rawfoodhealthempowermentsummit.com/the-rawfoodmealplanner-s-21-day-new-year-meal-prep-challenge Boost Your Wellness Journey:The Brain Reboot Plan: 5 Simple Daily Shifts for More Focus, Energy & Peacehttps://rawfoodmealplanner.com/brain-reboot-plan/Revitalize Your Brain: A Lifestyle Approach for Women Over 50https://rawfoodmealplanner.clickfunnels.com/webinar-replay-brain-health-breakthrough-coaching-programRESET: 3 Metabolic Mistakes Women 30+ Make And How to Fix Themhttps://rawfoodmealplanner.com/reset-3-metabolic-mistakes-women-30-make-and-how-to-fix-them/The Lancet published a study here https://www.thelancet.com/journals/lanhl/article/PIIS2666-7568(24)00191-0/fulltext emphasizing that young adults (ages 18–39) are a neglected but crucial window for dementia prevention. Most dementia research focuses on mid-to-late life, yet many modifiable risk factors that affect long-term brain health emerge or peak in young adulthood.Key Modifiable Risk FactorsEducation: Low levels reduce cognitive reserve and increase the risk of dementia.Hearing loss: One billion young adults globally are at risk due to unsafe listening practices.Traumatic brain injury (TBI): High rates from sports, motor accidents, and intimate partner violence.Hypertension: One in 12 young adults is affected; rates higher among Black Americans and in LMICs.Alcohol use: Peaks in early 20s, linked to long-term brain changes.Obesity & physical inactivity: Both rising rapidly; linked to inflammation and cardiovascular risk.Smoking/vaping: 90% of daily smokers start before 26.Depression & social isolation: Peak in early 20s, linked to later ADRD (Alzheimer's disease and related dementias) risk.Diabetes: 4% prevalence in young adults; prediabetes affects 1 in 4.Environmental factors: Air pollution, vision loss, high LDL cholesterol, and even emerging risks like sleep disruption, stress, spirituality, and microplastics.Join the Conversation:Subscribe and share this episode with anyone on their own path of health and transformation. // HOST Samantha Salmon, NBC-HWC Nationally Board Certified Health & Wellness Coach Brain Health Licensed Trainer | Integrative Nutrition Coach | Intuitive Nutrition Coach for Brain & Metabolic HealthThe information provided in this broadcast is for educational purposes only and is not intended as medical advice. These statements have not been evaluated by the Food and Drug Administration or the equivalent in your country. Any products/services mentioned are not intended to diagnose, treat, cure, or prevent disease. RawFoodMealPlanner.com © 2026

Brain Health Breakthrough Coaching Programhttps://rawfoodmealplanner.clickfunnels.com/webinar-replay-brain-health-breakthrough-coaching-programJoin January 2027 RawFoodMealPlanner's 21-Day Challengehttps://rawfoodhealthempowermentsummit.com/the-rawfoodmealplanner-s-21-day-new-year-meal-prep-challenge Boost Your Wellness Journey:The Brain Reboot Plan: 5 Simple Daily Shifts for More Focus, Energy & Peacehttps://rawfoodmealplanner.com/brain-reboot-plan/Revitalize Your Brain: A Lifestyle Approach for Women Over 50https://rawfoodmealplanner.clickfunnels.com/webinar-replay-brain-health-breakthrough-coaching-programRESET: 3 Metabolic Mistakes Women 30+ Make And How to Fix Themhttps://rawfoodmealplanner.com/reset-3-metabolic-mistakes-women-30-make-and-how-to-fix-them/The Lancet published a study here https://www.thelancet.com/journals/lanhl/article/PIIS2666-7568(24)00191-0/fulltext emphasizing that young adults (ages 18–39) are a neglected but crucial window for dementia prevention. Most dementia research focuses on mid-to-late life, yet many modifiable risk factors that affect long-term brain health emerge or peak in young adulthood.Key Modifiable Risk FactorsEducation: Low levels reduce cognitive reserve and increase the risk of dementia.Hearing loss: One billion young adults globally are at risk due to unsafe listening practices.Traumatic brain injury (TBI): High rates from sports, motor accidents, and intimate partner violence.Hypertension: One in 12 young adults is affected; rates higher among Black Americans and in LMICs.Alcohol use: Peaks in early 20s, linked to long-term brain changes.Obesity & physical inactivity: Both rising rapidly; linked to inflammation and cardiovascular risk.Smoking/vaping: 90% of daily smokers start before 26.Depression & social isolation: Peak in early 20s, linked to later ADRD (Alzheimer's disease and related dementias) risk.Diabetes: 4% prevalence in young adults; prediabetes affects 1 in 4.Environmental factors: Air pollution, vision loss, high LDL cholesterol, and even emerging risks like sleep disruption, stress, spirituality, and microplastics.Join the Conversation:Subscribe and share this episode with anyone on their own path of health and transformation. // HOST Samantha Salmon, NBC-HWC Nationally Board Certified Health & Wellness Coach Brain Health Licensed Trainer | Integrative Nutrition Coach | Intuitive Nutrition Coach for Brain & Metabolic HealthThe information provided in this broadcast is for educational purposes only and is not intended as medical advice. These statements have not been evaluated by the Food and Drug Administration or the equivalent in your country. Any products/services mentioned are not intended to diagnose, treat, cure, or prevent disease. RawFoodMealPlanner.com © 2026

Links For The Occult Rejectshttps://linktr.ee/theoccultrejectsOccult Research Institutehttps://www.occultresearchinstitute.org/Substackhttps://substack.com/@theoccultrejects?r=7auau0&utm_campaign=profile&utm_medium=profile-pageCash Apphttps://cash.app/$theoccultrejectsVenmo@TheOccultRejectsBuy Me A Coffeebuymeacoffee.com/TheOccultRejectsPatreonhttps://www.patreon.com/TheOccultRejectsAssmann, Jan. Death and Salvation in Ancient Egypt. Translated by David Lorton. Cornell University Press, 2005.Ariès, Philippe. The Hour of Our Death. Translated by Helen Weaver. Knopf, 1981.Beard, Mary, John North, and Simon Price. Religions of Rome. 2 vols. Cambridge University Press, 1998.Blackmore, Susan. Dying to Live: Near-Death Experiences. Prometheus Books, 1993.Boyce, Mary. Zoroastrians: Their Religious Beliefs and Practices. Routledge, 1979.Bremmer, Jan N. The Rise and Fall of the Afterlife: The 1995 Read-Tuckwell Lectures at the University of Bristol. Routledge, 2002.Chalmers, David J. “Facing Up to the Problem of Consciousness.” Journal of Consciousness Studies 2, no. 3 (1995): 200–219.Fenwick, Peter, and Elizabeth Fenwick. The Art of Dying: A Journey to Elsewhere. Continuum, 2008.Graf, Fritz, and Sarah Iles Johnston. Ritual Texts for the Afterlife: Orpheus and the Bacchic Gold Tablets. 2nd ed. Routledge, 2013.Greyson, Bruce. After: A Doctor Explores What Near-Death Experiences Reveal about Life and Beyond. St. Martin's Essentials, 2021.Greyson, Bruce. “The Near-Death Experience Scale: Construction, Reliability, and Validity.” Journal of Nervous and Mental Disease 171, no. 6 (1983): 369–375.Griffiths, Roland R., William A. Richards, Una McCann, and Robert Jesse. “Psilocybin Can Occasion Mystical-Type Experiences Having Substantial and Sustained Personal Meaning and Spiritual Significance.” Psychopharmacology 187, no. 3 (2006): 268–283.Hornung, Erik. The Ancient Egyptian Books of the Afterlife. Translated by David Lorton. Cornell University Press, 1999.Johnston, Sarah Iles. Restless Dead: Encounters between the Living and the Dead in Ancient Greece. University of California Press, 1999.Kerr, Christopher W., et al. “End-of-Life Dreams and Visions: A Longitudinal Study of Hospice Patients' Experiences.” Journal of Palliative Medicine 17, no. 3 (2014): 296–303.Le Goff, Jacques. The Birth of Purgatory. Translated by Arthur Goldhammer. University of Chicago Press, 1984.Moody, Raymond A. Life After Life. Mockingbird Books, 1975.Nahm, Michael, Bruce Greyson, Emily Williams Kelly, and Erlendur Haraldsson. “Terminal Lucidity: A Review and a Case Collection.” Archives of Gerontology and Geriatrics 55, no. 1 (2012): 138–142.Nelson, Kevin R., Michelle Mattingly, Sherman A. Lee, and Frederick A. Schmitt. “Does the Arousal System Contribute to Near Death Experience?” Neurology 66, no. 7 (2006): 1003–1009.Obayashi, Hiroshi, ed. Death and Afterlife: Perspectives of World Religions. Greenwood Press, 1992.Osis, Karlis, and Erlendur Haraldsson. At the Hour of Death. Avon, 1977.Parnia, Sam, et al. “AWAreness during REsuscitation—II: A Multi-Center Study of Consciousness and Awareness in Cardiac Arrest.” Resuscitation 191 (2023).Plato. Phaedo. In Plato: Complete Works. Edited by John M. Cooper. Hackett, 1997.Segal, Alan F. Life After Death: A History of the Afterlife in Western Religion. Doubleday, 2004.Stevenson, Ian. Children Who Remember Previous Lives: A Question of Reincarnation. Rev. ed. McFarland, 2001.Taylor, John H., ed. Journey through the Afterlife: Ancient Egyptian Book of the Dead. Harvard University Press / British Museum Press, 2010.Tucker, Jim B. Life Before Life: A Scientific Investigation of Children's Memories of Previous Lives. St. Martin's Press, 2005.van Gennep, Arnold. The Rites of Passage. Translated by Monika B. Vizedom and Gabrielle L. Caffee. University of Chicago Press, 1960.van Lommel, Pim, Ruud van Wees, Vincent Meyers, and Ingrid Elfferich. “Near-Death Experience in Survivors of Cardiac Arrest: A Prospective Study in the Netherlands.” The Lancet 358, no. 9298 (2001): 2039–2045.Xu, Gang, et al. “Surge of Neurophysiological Coupling and Connectivity of Gamma Oscillations in the Dying Human Brain.” Proceedings of the National Academy of Sciences 120, no. 19 (2023).Also want to remind people about the website, if you're into reading we have tons of information by multiple contributors, and we got t-shirts up on the site if you're interested. Fun fact, the art is all based on the eyeball. 

Rethinking preventionThe funding crisis reshaping global health has hit HIV prevention particularly hard. At the same time, science is handing us some of the most powerful HIV prevention tools we have ever had – long-acting injectables like lenacapavir and cabotegravir, and a monthly oral pill on the horizon. But science alone does not deliver prevention. That takes systems, policy, funding and a trained healthcare workforce. It takes communities leading in planning, implementation and holding the HIV response to account. This episode of HIV unmuted is a curtain raiser for AIDS 2026, the 26th International AIDS Conference, taking place in Rio de Janeiro, Brazil, and virtually. The theme of the conference, Rethink. Rebuild. Rise., is also the spirit of this episode. We look at what rethinking prevention means in people's lives, what it will take to rebuild the systems and political will to deliver innovation at scale, and how the global HIV response can rise to this moment. Meet our guests:Axel Bautista, Community Mobilization Coordinator at MPACT Global Action for Gay Men's Health and Rights, shares what rethinking prevention really means on the ground, in communities and in people's lives. Nomathemba Chandiwana, Chief Scientific Officer at the Desmond Tutu Health Foundation in Cape Town and a clinician-scientist at the forefront of HIV prevention, unpacks the systems and science needed to rebuild prevention and make innovation accessible to all. Beatriz Grinsztejn, President of the International AIDS Society and infectious disease physician-researcher at Fiocruz in Rio de Janeiro, asks how the global HIV response can rise at AIDS 2026. Meet our host:Ibanomonde Ngema is a South African HIV advocate for young people living with and affected by HIV. She has spoken at major global platforms, including IAS conferences and the United Nations General Assembly. She serves as South Africa's Her Voice Fund Ambassador and UNFPA's Regional Youth Advocate for East and Southern Africa and has authored a paper in The Lancet. 

We follow the footnotes on a common gyn rule, then use that same evidence-first lens to question popular fertility add-ons and persistent pregnancy myths. Along the way, we talk pretest probability, counseling tradeoffs, and why simple cutoffs often replace better clinical reasoning. • tracing the “biopsy Bartholin cysts after 40” claim back to weak citations • using pretest probability and exam features to decide on selective biopsy • weighing hysteropexy versus hysterectomy for prolapse with long-term cancer risk in mind • breaking down a Lancet review of IVF add-ons and what actually shows benefit • spotting how marketing and online forums amplify unproven fertility interventions • reviewing data on sedentary time in pregnancy and why activity restriction persists • debunking “walking progresses labor” with randomized trial evidence • clarifying early diabetes testing as screening for preexisting diabetes and when A1C makes more sense than early glucose tolerance tests Be sure to check out thinkingaboutobgyn.com for more information and be sure to follow us on Instagram.0:00 Welcome And What's Ahead0:23 Bartholin Cyst Biopsy Age Rule14:17 Prolapse Repair With Uterus Preservation21:45 IVF Add-Ons And The Lancet Review37:35 Pregnancy Activity Myths And New Data50:53 Early Diabetes Testing And A1CFollow us on Instagram @thinkingaboutobgyn.

After earning her first-class degree in chemistry from Oxford, Dorothy embarked on an impressive career in the new field of X-ray crystallography. She would ultimately earn many, many accolades for her work. Research: "Dorothy Crowfoot Hodgkin." Encyclopedia of World Biography Online, Gale, 1998. Gale In Context: Opposing Viewpoints, Biophysical Society. “Profiles in Biophysics: Dorothy Hodgkin.” 2016. https://www.biophysics.org/profiles/dorothy-hodgkin Boon, Rachel. “Curator Rachel Boon celebrates the work of Dorothy Hodgkin.” Science Museum. 12/10/2014. https://blog.sciencemuseum.org.uk/celebrating-dorothy-hodgkin-britains-first-female-winner-of-a-nobel-science-prize/ Bragg, Sir William. “Concerning The Nature Of Things.” London. Bell & Sons. 1932. https://archive.org/details/in.ernet.dli.2015.222386/ Bud, Robert. "Discoverers and developers of penicillin (act. 1928–1950)." Oxford Dictionary of National Biography. May 21, 2009. Oxford University Press. Date of access 22 Jun. 2026, https://www.oxforddnb.com/view/10.1093/ref:odnb/9780198614128.001.0001/odnb-9780198614128-e-97279 Dodson, Guy. “Dorothy Mary Crowfoot Hodgkin, O.M. 12 May 1910--29 July 1994.” Biographical Memoirs of Fellows of the Royal Society , Dec., 2002, Vol. 48 (Dec., 2002). Via JSTOR. https://www.jstor.org/stable/3650256 DOROTHY CROWFOOT HODGKIN. NobelPrize.org. Nobel Prize Outreach 2026. Wed. 24 Jun 2026. https://www.nobelprize.org/stories/women-who-changed-science/dorothy-hodgkin/ Ferry, Georgina. "Dorothy Hodgkin". Encyclopedia Britannica, 8 May. 2026, https://www.britannica.com/biography/Dorothy-Hodgkin. Accessed 24 June 2026. Ferry, Georgina. "Hodgkin, Dorothy Mary Crowfoot (1910–1994), chemist and crystallographer." Oxford Dictionary of National Biography. May 21, 2009. Oxford University Press. Date of access 22 Jun. 2026, https://www.oxforddnb.com/view/10.1093/ref:odnb/9780198614128.001.0001/odnb-9780198614128-e-55028 Ferry, Georgina. “Dorothy Hodgkin: A Life.” Bloomsbury. 1998, 2014. Ferry, Georgina. “Dorothy Hodgkin: on proteins and patterns.” The Lancet, 384, 1496-1497. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)61912-7/fulltext Ferry, Georgina. “The making of an exceptional scientist.” Nature. Vol. 464. April 29, 2010. Gamble, Jessa. “When Hodgkin met Thatcher.” Nature. Vol. 514. October 16, 2014. Hodgkin, Dorothy Crowfoot. “The X-ray analysis of complicated molecules.” Nobel Lecture, December 11, 1964. https://www.nobelprize.org/uploads/2018/06/hodgkin-lecture-1.pdf Hodgkin, Dorothy. “The Pugwash Movement.” India International Centre Quarterly. Vol. 13, No. 2. June 1986. Via JSTOR. https://www.jstor.org/stable/23001474 Howard, Judith A.K. “Dorothy Hodgkin and her contributions to biochemistry.” Nature Reviews. Vol. 4. November 2003. gale.com/apps/doc/K1631003072/GPS?u=mlin_n_melpub&sid=bookmark-GPS&xid=8d7c4045. Accessed 23 June 2026. Pearce, JMS. “Dorothy Crowfoot Hodgkin OM, FRS (1910-1994).” Hektoen International. https://hekint.org/2020/11/04/dorothy-crowfoot-hodgkin-om-frs-1910-1994/ Perutz, Max. “Dorothy Crowfoot ” The Independent. Via The Crystallographic Community. https://www.iucr.org/people/crystallographers/dorothy-crowfoot-hodgkin-by-m.f.-perutz Pietzsch, Jochim. “Perspectives: Enhancing X-ray vision.” Nobel Prize. https://www.nobelprize.org/prizes/chemistry/1964/perspectives/ Ramaseshan, S. “Dorothy Hodgkin and the Indian Connection.” Notes and Records of the Royal Society of London , Jan., 1996. http://www.jstor.com/stable/531845 Root-Bernstein, Robert. “Dorothy Crowfoot Hodgkin: Structure as Art.” Leonardo , 2007, Vol. 40, No. 3 (2007). Via JSTOR. https://www.jstor.org/stable/20206415 Science History Institute Museum and Library. “Dorothy Crowfoot Hodgkin.” https://www.sciencehistory.org/education/scientific-biographies/dorothy-crowfoot-hodgkin/ The Royal Society. “Dorothy Hodgkin FRS.” https://royalsociety.org/about-us/who-we-are/diversity-inclusion/case-studies/scientists-with-disabilities/dorothy-hodgkin/ “Science for peace Building cultures of cooperation and non-violence through scientific collaboration.” 2025. Via JSTOR. https://www.jstor.org/stable/resrep73183.6 University of Oxford History of Science Museum. “Modelling the Structure of Penicillin.” https://www.mhs.ox.ac.uk/backfromthedead/exhibition/the-structure-of-penicillin/index.html Vijayan, M. “An outstanding scientist and great humanist: An obituary of Dorothy Crowfoot Hodgkin.” Current Science, 10 August 1994, Vol. 67, No. 3 (10 August 1994). Via JSTOR. https://www.jstor.org/stable/24095820 Wallace, Rob. “Dorothy Crowfoot Hodgkin: Captured by Crystals.” National World War II 3/16/2022. https://www.nationalww2museum.org/war/articles/dorothy-hodgkin-penicillin-insulin See omnystudio.com/listener for privacy information.

Dorothy Hodgkin's career in X-ray crystallography impacted a lot of science in the 20th century. Part one of her story covers her early life and formative experiences that led her to her field of research. Research: "Dorothy Crowfoot Hodgkin." Encyclopedia of World Biography Online, Gale, 1998. Gale In Context: Opposing Viewpoints, Biophysical Society. “Profiles in Biophysics: Dorothy Hodgkin.” 2016. https://www.biophysics.org/profiles/dorothy-hodgkin Boon, Rachel. “Curator Rachel Boon celebrates the work of Dorothy Hodgkin.” Science Museum. 12/10/2014. https://blog.sciencemuseum.org.uk/celebrating-dorothy-hodgkin-britains-first-female-winner-of-a-nobel-science-prize/ Bragg, Sir William. “Concerning The Nature Of Things.” London. Bell & Sons. 1932. https://archive.org/details/in.ernet.dli.2015.222386/ Bud, Robert. "Discoverers and developers of penicillin (act. 1928–1950)." Oxford Dictionary of National Biography. May 21, 2009. Oxford University Press. Date of access 22 Jun. 2026, https://www.oxforddnb.com/view/10.1093/ref:odnb/9780198614128.001.0001/odnb-9780198614128-e-97279 Dodson, Guy. “Dorothy Mary Crowfoot Hodgkin, O.M. 12 May 1910--29 July 1994.” Biographical Memoirs of Fellows of the Royal Society , Dec., 2002, Vol. 48 (Dec., 2002). Via JSTOR. https://www.jstor.org/stable/3650256 DOROTHY CROWFOOT HODGKIN. NobelPrize.org. Nobel Prize Outreach 2026. Wed. 24 Jun 2026. https://www.nobelprize.org/stories/women-who-changed-science/dorothy-hodgkin/ Ferry, Georgina. "Dorothy Hodgkin". Encyclopedia Britannica, 8 May. 2026, https://www.britannica.com/biography/Dorothy-Hodgkin. Accessed 24 June 2026. Ferry, Georgina. "Hodgkin, Dorothy Mary Crowfoot (1910–1994), chemist and crystallographer." Oxford Dictionary of National Biography. May 21, 2009. Oxford University Press. Date of access 22 Jun. 2026, https://www.oxforddnb.com/view/10.1093/ref:odnb/9780198614128.001.0001/odnb-9780198614128-e-55028 Ferry, Georgina. “Dorothy Hodgkin: A Life.” Bloomsbury. 1998, 2014. Ferry, Georgina. “Dorothy Hodgkin: on proteins and patterns.” The Lancet, 384, 1496-1497. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)61912-7/fulltext Ferry, Georgina. “The making of an exceptional scientist.” Nature. Vol. 464. April 29, 2010. Gamble, Jessa. “When Hodgkin met Thatcher.” Nature. Vol. 514. October 16, 2014. Hodgkin, Dorothy Crowfoot. “The X-ray analysis of complicated molecules.” Nobel Lecture, December 11, 1964. https://www.nobelprize.org/uploads/2018/06/hodgkin-lecture-1.pdf Hodgkin, Dorothy. “The Pugwash Movement.” India International Centre Quarterly. Vol. 13, No. 2. June 1986. Via JSTOR. https://www.jstor.org/stable/23001474 Howard, Judith A.K. “Dorothy Hodgkin and her contributions to biochemistry.” Nature Reviews. Vol. 4. November 2003. gale.com/apps/doc/K1631003072/GPS?u=mlin_n_melpub&sid=bookmark-GPS&xid=8d7c4045. Accessed 23 June 2026. Pearce, JMS. “Dorothy Crowfoot Hodgkin OM, FRS (1910-1994).” Hektoen International. https://hekint.org/2020/11/04/dorothy-crowfoot-hodgkin-om-frs-1910-1994/ Perutz, Max. “Dorothy Crowfoot ” The Independent. Via The Crystallographic Community. https://www.iucr.org/people/crystallographers/dorothy-crowfoot-hodgkin-by-m.f.-perutz Pietzsch, Jochim. “Perspectives: Enhancing X-ray vision.” Nobel Prize. https://www.nobelprize.org/prizes/chemistry/1964/perspectives/ Ramaseshan, S. “Dorothy Hodgkin and the Indian Connection.” Notes and Records of the Royal Society of London , Jan., 1996. http://www.jstor.com/stable/531845 Root-Bernstein, Robert. “Dorothy Crowfoot Hodgkin: Structure as Art.” Leonardo , 2007, Vol. 40, No. 3 (2007). Via JSTOR. https://www.jstor.org/stable/20206415 Science History Institute Museum and Library. “Dorothy Crowfoot Hodgkin.” https://www.sciencehistory.org/education/scientific-biographies/dorothy-crowfoot-hodgkin/ The Royal Society. “Dorothy Hodgkin FRS.” https://royalsociety.org/about-us/who-we-are/diversity-inclusion/case-studies/scientists-with-disabilities/dorothy-hodgkin/ “Science for peace Building cultures of cooperation and non-violence through scientific collaboration.” 2025. Via JSTOR. https://www.jstor.org/stable/resrep73183.6 University of Oxford History of Science Museum. “Modelling the Structure of Penicillin.” https://www.mhs.ox.ac.uk/backfromthedead/exhibition/the-structure-of-penicillin/index.html Vijayan, M. “An outstanding scientist and great humanist: An obituary of Dorothy Crowfoot Hodgkin.” Current Science, 10 August 1994, Vol. 67, No. 3 (10 August 1994). Via JSTOR. https://www.jstor.org/stable/24095820 Wallace, Rob. “Dorothy Crowfoot Hodgkin: Captured by Crystals.” National World War II 3/16/2022. https://www.nationalww2museum.org/war/articles/dorothy-hodgkin-penicillin-insulin See omnystudio.com/listener for privacy information.

Can food improve brain health, memory and mood?  In this episode, Prof Felice Jacka and Prof Tim Spector explore how diet, the gut microbiome and fermented foods may affect your mood, brain function and dementia risk. Drawing on clinical trials and research involving more than 10 million people, they explain why what you eat could have a much bigger impact on your brain than most people realise, and what the latest science suggests you can do about it. Felice, who helped create the field of nutritional psychiatry, explains how food influences the brain through the gut microbiome and inflammation. She and Tim explore why some foods change brain function, which support brain health, what the evidence says about ultra-processed foods, and why diet is becoming an increasingly important part of research on brain and mental health. Learn which foods to eat more often, which foods to reduce, and simple, affordable ways to build meals that support your gut, mood and long-term brain health. From whole grains and legumes to fermented foods and everyday supermarket and grocery store choices, by the end of the episode, you'll have realistic advice that's easy to put into practice today. If the food you eat today helps shape your brain tomorrow, what small change could make the biggest difference over the next year?

Second, NBC News correspondent Ryan Nobles corners Republican Senator Roger Marshall on Meet the Press over voter fraud claims, with Hawk noting that Republicans won the House, the Senate, the presidency, and effectively control the Supreme Court in 2024, making the left-rigs-elections argument impossible to sustain. Third, an Ohio pastor from the Springfield area shares a firsthand account of what Haitian immigrants have contributed to his community, and what the TPS ruling means for families who have been there for over a decade. Hawk also covers the current conditions in Haiti that made Temporary Protected Status necessary in the first place. Fourth, Steve Schmidt and Jim Acosta discuss Megyn Kelly's racist commentary about Haitian immigrants, with Hawk responding to her record and her history with Trump going back to the 2016 debate. Fifth, Fox News broadcasts live from Trump's America 250 celebration, which is scheduled for 16 days. The footage behind the reporter shows almost no one in attendance, prompting widespread mockery including from Ron Filipkowski, Hemant Mehta, and others. SUPPORT & CONNECT WITH HAWK- Support on Patreon: https://www.patreon.com/mdg650hawk - Hawk's Merch Store: https://hawkmerchstore.com - Connect on TikTok: https://www.tiktok.com/@mdg650hawk7thacct - Connect on TikTok: https://www.tiktok.com/@hawkeyewhackamole - Connect on BlueSky: https://bsky.app/profile/mdg650hawk.bsky.social - Connect on Substack: https://mdg650hawk.substack.com - Connect on Facebook: https://www.facebook.com/hawkpodcasts - Connect on Instagram: https://www.instagram.com/mdg650hawk - Connect on Twitch: https://www.twitch.tv/mdg650hawk ALL HAWK PODCASTS INFO- Additional Content Available Here: https://www.hawkpodcasts.comhttps://www.youtube.com/@hawkpodcasts- Listen to Hawk Podcasts On Your Favorite Platform:Spotify: https://spoti.fi/3RWeJfyApple Podcasts: https://apple.co/422GDuLYouTube: https://youtube.com/@hawkpodcastsiHeartRadio: https://ihr.fm/47vVBdPPandora: https://bit.ly/48COaTB

For years on True Birth and in their OB/GYN practice, Dr. Abdelhak & Kristin Mallon have made an unpopular argument: when a baby is measuring big, the safest move is usually to induce, not to wait. The conventional literature did not back them up, and plenty of academics pushed back with the same line every time, that induction does not lower the risk of a cesarean or a shoulder dystocia. In this episode they walk through two pieces of high level evidence that land squarely on their side, and they explain why this was common sense all along. They start with the bigger cultural point. We do not have natural pregnancies anymore, so it is unrealistic to expect a uniformly natural birth. Electricity, processed food, far fewer daily steps, and later maternal age all push birth weights up, which means more babies are simply too big to deliver without help. Kristin brings the midwife lens to this, including a frank look at the Ina May Gaskin farm numbers and what they actually showed. From there they get into the data, share a real shoulder dystocia save from the floor, and detour into the things that genuinely scare them in delivery, like postpartum hemorrhage, plus Dr. Abdelic's running theory that growth problems are usually about the cord, not the placenta. The take home is blunt. If your provider tells you the baby is measuring large, the right question is not whether to induce. It is when. What we cover Why "natural birth" is a moving target in a non natural world The Ina May Gaskin farm numbers and what they really tell us The landmark randomized trial on inducing large for date babies The brand new 2026 meta analysis on induction at 38 weeks How estimated fetal weight, the 90th and 95th percentiles, and hospital induction rules actually play out in practice A real time shoulder dystocia at the bedside, handled without the fanfare Why hemorrhage, not shoulder dystocia, is the emergency that worries them most "It is all about the cord," and why placental insufficiency is the wrong framing The difference between cervical insufficiency and true preterm labor How to filter real clinical advice from social media noise The research referenced The randomized controlled trial (the Lancet study): Boulvain M, Senat MV, Perrotin F, et al. Induction of labour versus expectant management for large for date fetuses: a randomised controlled trial. Lancet. 2015;385(9987):2600 to 2605. A pragmatic trial across 19 centers in France, Switzerland, and Belgium. Women with singleton fetuses above the 95th percentile were randomized to induction between 37 0/7 and 38 6/7 weeks or to expectant management. Induction significantly reduced the composite of shoulder dystocia and associated morbidity, relative risk 0.32, 95% CI 0.15 to 0.71, p equals 0.004, without raising the cesarean rate and with more spontaneous vaginal deliveries. The 2026 meta analysis (the AJOG MFM study): Paladino, et al. Induction at 38 weeks for large for gestational age or macrosomic fetuses decreases the incidence of cesarean delivery: meta analysis of randomized controlled trials. Am J Obstet Gynecol MFM. 2026. Five randomized trials, 4,083 pregnant individuals, most induced at 38 0/7 to 38 4/7 weeks for an estimated weight above the 90th percentile. Induction lowered the cesarean rate and cut macrosomia (relative risk 0.53 for 4,000 grams or more, and 0.22 for 4,500 grams or more). Shoulder dystocia and fetal fracture both trended down but did not reach significance, which is expected for outcomes this rare. Roughly 25 inductions in this window prevent one cesarean. Key takeaways A big baby is the single biggest risk factor for shoulder dystocia, and a baby does not get smaller between 38 and 40 weeks. The evidence now shows that inducing for a large for date baby reduces shoulder dystocia and cesarean delivery and increases the odds of a vaginal birth. If you are told your baby is measuring large, come prepared to ask for induction rather than waiting to be offered it. And take advice from clinicians who have actually cared for patients with your condition recently, not from a single viral story. Connect New episodes drop weekly. If you have a question or a topic you want covered, reach out, and please subscribe and leave a review wherever you listen. More at www.trubirthpodcast.com.

In “Dharma & Empire,” Mary Thanissara and Vince Fakhoury Horn trace how the structures of Empire occupy not just land but the psyche—moving from their own Irish, Palestinian, and colonial family histories to Gaza, climate, and class—and ask what a more revolutionary Dharma might require of practitioners right now.

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

Welcome back to the show, everybody! Today, we are diving deep into the intersection of maternal-fetal medicine and cardiology. We're tackling a condition that keeps every OB/GYN, MFM, and cardiologist up at night: Peripartum Cardiomyopathy, or PPCM. And to keep our clinical gears turning, we are framing this discussion squarely through the lens of Society for Maternal-Fetal Medicine (SMFM) Consult Series #73, which focuses on right and left heart failure in pregnancy, alongside the foundational data from ACOG Practice Bulletin #212. PPCM presents fundamentally as acute left heart failure with reduced ejection fraction. Think of the left ventricle as the primary engine pump of the systemic circulation. When it stalls, everything upstream gets backed up. While this was traditionally called IDIOPATHIC, newer data says otherwise. We are going to cover presentation, eval, care and prognosis. So, get your palpitations in check- here we go. 16% OFF TONA ACTIVE WEAR PROMO: https://tonaactive.com/discount/CHAPANOSPINOBG1. SMFM CS 73; 20252. ACOG PB 212; 20193. Arany Z. Peripartum Cardiomyopathy. The NEJM. 2024. 4. Sliwa K, Hilfiker-Kleiner D, Damasceno A, Al Farhan H, Goland S, Johnson MR, Bauersachs J. Peripartum cardiomyopathy. Lancet. 2025 Nov 22;406(10518):2483-2493. doi: 10.1016/S0140-6736(25)01451-5. Epub 2025 Oct 28. PMID: 41173010.