Podcasts about mdis

Video Version only on HCPLive!  In this episode of Diabetes Dialogue, hosts Diana Isaacs, PharmD, an endocrine clinical pharmacist, director of Education and Training in Diabetes Technology, and codirector of Endocrine Disorders in Pregnancy at the Cleveland Clinic, and Natalie Bellini, DNP, program director of Diabetes Technology at University Hospitals Diabetes and Metabolic Care Center explore the increasing focus on the connection between obesity and diabetes, including the latest advancements in glucagon-like peptide-1 (GLP-1) receptor agonist therapies, the use of inhaled insulin, and the recent addition of hypercortisolism to the “Ominous Octet”, creating the “Noxious Nine.” Although obesity rates in the US have been rising steadily globally, hosts pointed to a recent CDC report reporting a slight decrease in obesity rates. They suggest that this may be partially attributed to the impact of GLP-1 drugs, which have become increasingly popular in managing obesity and related metabolic disorders, including type 2 diabetes (T2D). With these drugs continuing to show promising results, the hosts express optimism about their potential to reduce obesity and improve long-term patient health outcomes. Their conversation shifted to a detailed discussion of the INHALE-1 trial, which evaluated the effectiveness of inhaled insulin in children with type 1 diabetes (T1D) and T2D. The trial, designed to evaluate the non-inferiority of inhaled insulin compared to traditional subcutaneous injections, found that inhaled insulin provided similar efficacy without significant differences in lung function or hypoglycemia occurrence. Isaacs and Bellini highlighted the implications of these findings, emphasizing that inhaled insulin could offer an alternative treatment option for pediatric patients, particularly those who struggle with needle phobia or the burden of multiple daily injections (MDIs). The episode concluded with a deep dive into the Catalyst study, which explored the use of mifepristone in patients with T2D complicated by hypercortisolism. The second phase of the Catalyst trial found a significant reduction in HbA1C levels, showing a 1.5% decrease in patients treated with mifepristone compared with the placebo group. Isaacs and Bellini discussed the potential clinical applications of these results, particularly for patients with difficult-to-control diabetes who may have an underlying hormonal issue contributing to their condition. Overall, hosts encouraged clinicians to consider hypercortisolism in their differential diagnosis for patients with challenging diabetes cases, noting the promise that mifepristone could offer as an adjunctive treatment. Relevant disclosures for Isaacs include Eli Lilly and Company, Novo Nordisk, Sanofi, Abbott Diabetes Care, Dexcom, Medtronic, and others. Relevant disclosures for Bellini include Abbott Diabetes Care, MannKind, Provention Bio, and others.

Today, I'm excited to speak with Brian Argrett, Chair of the Board Directors and President and CEO of Broadway Financial Corporation and its banking subsidiary City First Bank, the largest Black-led minority depository institution (MDI) in the nation. Impact investing is an increasingly important topic for enterprise families and family offices. Our conversation today focuses on a truly unique and attractive avenue for positive impact available to enterprise families and family offices, which is made possible thanks to the Advancing Communities Together Deposit Program, or ACT – an innovative program that provides an easy and fully insured way for family offices to invest their excess cash directly in the financial institutions dedicated to lifting up communities in need. Brian describes the greater goals of the ACT program, why it is needed, what the issues or challenges it is meant to address, and what opportunities it is designed to unlock. The ACT Deposit Program was launched in the summer of 2024 by the national trade associations representing Community Development Financial Institutions (CDFIs) and Minority Depository Institutions (MDIs). Brian explains how the ACT program works and defines the role of CDFIs and MDIs in delivering the intended impact and benefits of the program. He shares his views on why this program has strong appeal to family offices and enterprise families. Delving into the practical details of how the ACT program functions, Brian details the mechanics of the program, including some of the key elements family members and family office executives should be aware of, such as minimum deposits, interest rates earned, minimum maturity, etc. Brian also talks about what families and family office leaders can do to get involved with and take advantage of the ACT program. He offers an overview of existing resources and tools for them to get educated and ready to participate and contribute to the positive impact of this program. Enjoy this timely and informative conversation with a leading champion of the ACT program and long-time thought leader and practitioner in the impact banking space.

NCUA Chairman Todd M. Harper's Written Testimony Before the House Financial Services CommitteeNCUA Chairman Todd M. Harper testifying before the House Financial Services Committee in 2023.Chairman McHenry, Ranking Member Waters, and members of the committee, thank you for inviting me to discuss the work of the National Credit Union Administration (NCUA).The NCUA insures deposits at federally insured credit unions, protects credit union members, and charters and regulates federal credit unions. The NCUA also protects the safety and soundness of the credit union system by identifying, monitoring, and managing risks to the National Credit Union Share Insurance Fund (Share Insurance Fund). In my testimony today, I will discuss the state of the credit union system, recent efforts by the agency to strengthen the system, and several legislative requests.State of the Credit Union SystemThe credit union system over the last year has remained largely stable in its performance and relatively resilient against economic disruptions. However, during the last few quarters, the NCUA has seen growing signs of financial strain on credit union balance sheets and in household budgets. Economists are also forecasting an economic slowdown as the lagged effects of elevated interest rates take hold. Each of these developments could affect credit union performance in the coming quarters.Over the same period, the NCUA has also seen growing stress within the system because of a rise in interest rate and liquidity risks. In fact, this financial stress is reflected in the increasing number of composite CAMELS code 3, 4, and 5 credit unions.1 Assets in composite CAMELS code 3 institutions increased sizably in the second quarter, especially among those complex credit unions with more than $500 million in assets. Such increases may well continue in future quarters. We have additionally seen more credit unions fall into the composite CAMELS code 4 and 5 ratings during the second quarter.Credit Union System PerformanceAs of June 30, 2023, the system's net worth ratio stood at 10.63 percent. There was continued year-over-year growth in assets and lending, with system assets surpassing $2.2 trillion and outstanding loans at more than $1.5 trillion. Although insured shares and deposits decreased slightly compared to the previous quarter, they stood almost 2 percent higher than one year earlier.Second quarter data also demonstrate some indications of growing consumer financial stress. The delinquency rate for loans rose slightly to 63 basis points, although it remains below historic averages. Credit cards and automobile loans, however, show increased delinquency levels at 154 and 67 basis points, respectively. Additionally, net charge-off levels have risen over the last year, returning to pre-pandemic averages.Additionally, funding costs for credit unions have increased significantly in the rising interest rate environment. Credit unions have increased their issuances of time deposits, leading to total interest expenses growing substantially over the year. However, the industry's return on average assets remains sound at 79 basis points. Together, these numbers show the credit union system continues to rest on a solid footing.External Factors Affecting the SystemThe NCUA is closely monitoring the financial markets and the economy as the current environment has created challenges for some consumers and credit unions. Inflation and interest rates are affecting household budgets, which could lead to an increase in credit risk in future quarters. In addition, the prevalence of hybrid work environments has placed pressure on commercial real estate lending. While the credit union system overall has modest exposure to this type of lending, the NCUA is closely monitoring individual credit unions with material exposure to commercial real estate.The rise in interest rates has also increased liquidity and interest rate risks in the credit union system, including at several of the 421 federally insured credit unions with more than $1 billion in assets. Accordingly, the NCUA has emphasized the importance of liquidity risk management and contingency planning in its industry communications and will continue to ensure credit unions conduct liquidity and asset-liability management planning to address current challenges and future uncertainties.With respect to all these risks and to protect the Share Insurance Fund against potential losses, the NCUA will continue to vigilantly monitor credit union performance through the examination process, offsite monitoring, and tailored supervision. The NCUA will also, when appropriate, take action to protect credit union members and their deposits.Share Insurance Fund PerformanceBacked by the full faith and credit of the United States, the Share Insurance Fund provides insurance coverage for individual accounts at federally insured credit unions up to $250,000.2 As of June 30, 2023, the Share Insurance Fund insured $1.7 trillion in deposits and shares. Notably, the Share Insurance Fund protects nearly 92 percent of total share deposits in the credit union system. In comparison, uninsured shares and deposits equaled approximately $160 billion in the second quarter or 8 percent of total share deposits.The Share Insurance Fund continues to perform well, with no premiums currently expected. As of June 30, 2023, the Share Insurance Fund reported a year-to-date net income of $79 million, a net position of $20.3 billion, and an equity ratio of 1.27 percent.3 The NCUA projects that the equity ratio of the Share Insurance Fund will end the year at 1.27 percent, which is sufficient but below the 1.33 percent normal operating level target set by the NCUA Board.Given the liquidity events in 2023, economic conditions, and the growing stress in the credit union system from liquidity and interest rate risks, the NCUA Board decided to build up the liquidity position of the Share Insurance Fund to a targeted amount of $4 billion. The Share Insurance Fund reached that target in September. The NCUA Board continues to monitor liquidity in the Share Insurance Fund.State of the Central Liquidity FacilityThe COVID-19 pandemic, inflationary pressures, interest rate volatility, and liquidity risk have all underscored the importance of the NCUA's Central Liquidity Facility (CLF).4 The CLF is an important tool and acts as a shock absorber when unexpected liquidity events occur.Under the NCUA's regulations, credit unions with assets more than $250 million must have access to a federal emergency liquidity source as part of their contingency funding plans. This federal emergency liquidity backstop can be the CLF, the Federal Reserve's Discount Window, or both. Credit unions with less than $250 million in assets are not required to have membership with a contingent federal liquidity source; however, they must identify external sources as part of their liquidity policy.5As of September 30, 2023, the CLF had 399 consumer credit union members, providing $19.8 billion in lending capacity. These credit unions range in asset size from less than $50 million to more than $10 billion. Their access to the CLF helps protect approximately $360 billion in credit union members' assets.The more members the CLF has, the more effective it is as a liquidity facility. As of December 2022, the CLF had a much greater total membership of 3,673 consumer credit unions with a combined $537 billion in member assets and a lending capacity of $27.5 billion. This rapid decline in membership assets followed the expiration of the temporary statutory enhancements that: Increased the CLF's maximum legal borrowing authority; Permitted access for corporate credit unions, as agent members, to borrow for their own needs; Provided greater flexibility and affordability to agent members to join the CLF to serve smaller groups of their covered institutions; and Gave the NCUA Board the clarity and flexibility about the loans it can approve by removing the phrase, “the Board shall not approve an application for credit the intent of which is to expand credit union portfolios.” Among other benefits, these statutory provisions facilitated agent membership of corporate credit unions. These enhancements, however, ended on January 1, 2023, resulting in 3,322 credit unions with less than $250 million in assets losing access to the CLF. Consequently, the CLF's borrowing capacity has decreased by almost $10 billion.To address this expiration and growing liquidity risks, the NCUA Board has unanimously requested that Congress allow corporate credit unions to purchase capital stock in the CLF to help smaller credit unions access to the facility. This change would make the CLF more affordable for corporate credit unions subscribing for a subset of their members. The Congressional Budget Office has scored the CLF reforms at no cost to taxpayers.6NCUA's Efforts to Protect and Strengthen the Credit Union SystemIn recent months, the NCUA has undertaken several actions to respond to cybersecurity risk; support minority depository institutions; enhance the credit union system's and the NCUA's diversity, equity, and inclusion efforts; and consider and adopt new rules to strengthen the system.Enhancing CybersecurityCybersecurity threats within the financial services industry are high and expected to remain so for the foreseeable future. To maintain vigilance against these threats, the NCUA is committed to ensuring consistency, transparency, and accountability in its cybersecurity examination program and related activities.Earlier this year, the NCUA deployed its updated, scalable, and risk-focused Information Security Examination (ISE) procedures. The ISE examination initiative offers flexibility for credit unions while providing examiners with standardized review steps to facilitate advanced data collection and analysis. Together with the agency's voluntary Automated Cybersecurity Evaluation Toolbox maturity assessment, the new ISE procedures will assist the NCUA in protecting the credit union system from cyberattacks.In addition, the NCUA's recently implemented cyber incident reporting rule has proven to be helpful to the agency and credit union industry.7 The final rule requires a federally insured credit union to report a substantial cyber incident to the NCUA as soon as possible but no later than 72 hours after the credit union reasonably believes a reportable cyber incident has occurred. In the first 30 days after the rule became effective, the NCUA received 146 incident reports, more than it had received in total in the previous year. More than 60 percent of these incident reports involve third-party service providers and credit union service organizations (CUSOs).The NCUA also actively communicates with credit unions about the increased likelihood of cyberattacks resulting from geopolitical and other cyber events. Credit unions of all sizes are a part of the U.S. critical infrastructure and should implement appropriate controls in the technology they use to deliver member services.Maintaining Consumer Financial ProtectionAn important part of the NCUA's mission is to examine credit unions with less than $10 billion in assets for compliance with consumer financial protection laws. The agency's consumer compliance efforts are integral to maintaining a safe-and-sound credit union system.In 2023, the agency's consumer financial protection supervisory priorities have included overdraft protection, fair lending, residential real estate appraisal bias, and Truth in Lending Act and Fair Credit Reporting Act compliance. The NCUA also prioritized examining credit union compliance with the Flood Disaster Protection Act, including disclosure requirements.In addition, the agency increased its review of overdraft programs and non-sufficient funds fee practices at credit unions to assess whether providing those services and charging the fees are potentially unfair practices. The NCUA's supervision of the services aims to create a more equitable system that supports financial stability for credit union members, improves transparency, and advances the statutory mission of credit unions to meet the credit and savings needs of their members, especially those of modest means.8Furthermore, the NCUA conducts targeted fair lending examinations and supervision at federal credit unions to assess compliance with federal fair lending laws and regulations. These reviews are critical to identifying discrimination and fostering financial inclusion. In August 2023, the NCUA encouraged the industry to review and comply with previously issued guidance addressing prohibited discriminatory practices in automated underwriting systems. Specifically, the agency encouraged credit unions to review system parameters to ensure compliance with the Equal Credit Opportunity Act and its implementing regulation.In addition to appraisal bias oversight examinations, the NCUA joined with the other Federal Financial Institution Examination Council agencies in June to issue proposed guidance for reconsideration of value for residential real estate valuations. The proposed guidance advises on policies that financial institutions may implement to allow consumers to provide information that may not have been considered during an appraisal or if deficiencies are identified in the original appraisal.As part of its consumer financial protection efforts, the NCUA's Consumer Assistance Center also resolves consumer complaints against federal credit unions with total assets up to $10 billion and, in certain instances, federally insured, state-chartered credit unions. In 2022, the Consumer Assistance Center responded to 10,589 written complaints, 1,842 inquiries, and 30,232 telephone calls from consumers and credit unions concerning consumer financial protection regulations.Finally, the NCUA regularly presents webinars promoting financial literacy and financial inclusion. Over the past year, the agency has hosted webinars on appraisal bias, elder financial abuse, and minority depository institutions. In addition, the agency participates in national financial literacy initiatives, including the interagency Financial Literacy and Education Commission.Supporting Minority Depository InstitutionsSupporting minority depository institution (MDI) credit unions is a longstanding priority for the NCUA. MDI credit unions represent approximately 10 percent of federally insured credit unions, and there are presently 498 such credit unions. These MDIs have more than five million members and exceed $66 billion in assets.In 2015, the NCUA established its MDI Preservation Program and has since sought new ways to assist MDI credit unions, their members, and the communities they serve. In 2022, the NCUA launched the Small Credit Union and MDI Support Program, allocating resources to assist MDIs in addressing operational challenges such as staff training, examinations, and improving earnings. In 2023, the NCUA allocated 10,000 staff hours across its three regional offices for the program.This year, the agency also issued customized guidance to examiners to provide insights into MDIs' unique business models and members' needs. The guidance assists examiners in understanding MDIs' distinct business model compared to other mainstream financial institutions by providing instruction on how to use MDI peer metrics instead of traditional peer metrics.Notably, while MDIs tend to be smaller institutions, they have relatively strong financial performance. As of the end of the second quarter of this year, MDIs averaged about $133 million in total assets, yet their return on average assets and net worth ratios were higher than federally insured credit unions overall and equal to credit unions with assets exceeding $1 billion. Meanwhile, their charge-off levels were consistent with the levels reported for both larger credit unions and credit unions overall.Congress recently authorized all MDIs to be eligible for Community Development Revolving Loan Fund grants and loans. Previously, MDIs required the low-income credit union designation to qualify. In the 2023 grant round, 42 MDIs received more than $1.4 million in technical assistance grants. The amount of funding MDIs received was a five-fold increase from the level of funding provided in 2022.Finally, the NCUA in October hosted an MDI Symposium that discussed how the agency can better serve these institutions. The MDI Symposium brought together MDI credit unions and industry stakeholders to learn about the challenges faced by MDIs. Sessions included case studies of successful MDI business models for replication. The NCUA plans to leverage this information to further support its MDI Preservation Program. And, as part of the NCUA's Diversity, Equity, and Inclusion Summit for credit unions in early November, the NCUA held a session that discussed MDI challenges and strategies for success.Advancing Diversity, Equity, and InclusionThe NCUA is fully committed to fostering diversity, equity, and inclusion (DEI) within the agency and the credit union system.The agency uses data from the Federal Employee Viewpoint Survey, including the Office of Personnel Management's Diversity, Equity, Inclusion, and Accessibility index, to inform its data-driven DEI strategies and activities.9 The agency's internal practices to promote DEI are also wide-ranging. For example, the NCUA's employee resource groups serve more than 30 percent of agency staff, surpassing the industry standard membership goal of 10 percent. Further, the NCUA's special emphasis program educates staff on cultural diversity and provides dedicated support for employees and managers with disabilities.In addition, the NCUA routinely recruits employees with diverse backgrounds and seeks to ensure broad applicant pools for vacancies. These diversity recruitment efforts are aimed at attracting and retaining highly qualified individuals from underrepresented groups, including Hispanics and candidates with disabilities. In 2023, the NCUA conducted a targeted barrier analysis to identify hiring and retention challenges for women and Hispanic employees. In addition, the agency has consistently exceeded the federal employment rate goals for employees with disabilities and targeted disabilities since 2017.10 Slightly more than 59 percent of the NCUA's managers are women.The NCUA has additionally built a diverse supplier network to obtain innovative solutions and the best value, particularly in technology and IT solutions. During 2022, the agency awarded $32.8 million of reportable contract dollars to minority and women-owned businesses. That figure represents 45 percent of the agency's contracting dollars, an increase of 8 percentage points from the prior year.Credit unions may also assess their DEI policies and programs through a voluntary credit union diversity self-assessment offered annually.11 Credit union submissions of their self-assessment have no bearing on their CAMELS rating, and examiners cannot access the data. The NCUA reports credit union diversity data only in the aggregate. The agency encourages credit unions to use this tool to support their DEI efforts.In 2022, 481, or 10 percent of all credit unions, submitted a self-assessment. The figure represents an all-time high for submissions to the NCUA. Of those submissions, 302 were federally chartered credit unions, 178 were federally insured and state-chartered, and one was a non-federally insured, state-chartered credit union. The number of CUDSA responses in 2022 is twice as much as the 240 self-assessments submitted in 2021.Finally, to support credit union accomplishments in DEI and provide further guidance, the NCUA hosted its fourth DEI Summit in Washington, D.C., in early November. This now annual event provided a forum for hundreds of credit union stakeholders to network, share best practices, and meet with thought leaders on ways to expand their DEI efforts. The event also highlighted the importance of allyship in helping to achieve the NCUA's and credit unions' DEI goals and improve the financial prospects and futures of families across the country.Rulemaking ActivitiesSince May, the NCUA Board has engaged in several rulemakings on topics like MDI preservation, member expulsion, financial innovation, fair hiring, and charitable donations. These rulemakings have aimed to implement laws required by Congress and strengthen the credit union system.In May, the NCUA Board approved a proposed rule that would add “war veterans' organizations” to the definition of a “qualified charity” that a federal credit union may contribute to using a charitable donation account. The NCUA Board approved the proposed rule noting the attributes of “veterans' organizations” as defined by section 501(c)(19) of the Internal Revenue Code are aligned with the purposes of the current charitable donation account rule. A “qualified charity” is a section 501(c)(3) entity defined by the Internal Revenue Code and must be both a non-profit and be organized for a charitable purpose. The final rule will be considered on November 16.In June, the NCUA Board approved proposed changes to the interpretive ruling and policy statement on the agency's Minority Depository Institution Preservation Program. The proposal would amend an existing interpretive ruling and policy statement to update the program's features, clarify the requirements for a credit union to receive and maintain an MDI designation, and reflect the transfer of the MDI Preservation Program administration from the agency's Office of Minority and Women Inclusion to its Office of Credit Union Resources and Expansion. Proposed amendments to the interpretive ruling and policy statement also include incorporating recent program initiatives, providing examples of technical assistance an MDI may receive, establishing a new standard for MDIs to assess their designation periodically, and updating how the NCUA will review an MDI's designation status, among other changes. This rule is pending.Additionally, the Board finalized a rule in July to implement requirements of the Credit Union Governance Modernization Act of 2022.12 This regulation streamlines procedures for credit unions to expel a member in cases of serious misconduct.In September, the NCUA Board approved a financial innovation final rule that provides flexibility for federally insured credit unions to utilize advanced technologies and opportunities offered by the financial technology sector. The final rule specifically provides credit unions with options to participate in loans acquired through indirect lending arrangements and financial technology. With the adoption of this final rule, the limits previously found in the NCUA's regulations are replaced with policy, due diligence, and risk-management requirements that can be tailored to match each credit union's risk levels and activities.Lastly, the NCUA Board in October approved a proposed rule that would incorporate the NCUA's Second Chance Interpretive Ruling and Policy Statement, and statutory prohibitions imposed by Section 205(d) of the Federal Credit Union Act into the agency's regulations. This proposed rule would allow people convicted of certain minor offenses to work in the credit union industry without applying for the NCUA Board's approval. It would also amend requirements governing the conditions under which newly chartered or troubled federally insured credit unions must notify the NCUA of proposed changes to their board of directors, committee members, or senior executive staff. The comment period closes on January 8, 2024.Legislative RequestsWhile the credit union system continues to perform well overall, several amendments to the Federal Credit Union Act would provide the NCUA with greater flexibility to effectively regulate the credit union system and protect the Share Insurance Fund in light of an evolving economic environment, a changing marketplace, and technological advancements.Central Liquidity Facility ReformsAs noted previously, the NCUA Board unanimously supports a statutory change to restore the ability of corporate credit unions to serve as CLF agents on behalf of a subset of their member credit unions. Such legislation would better allow the CLF to serve as a shock absorber for liquidity events within the credit union system.On February 28, 2023, lawmakers introduced bipartisan legislation that would allow corporate credit unions to purchase CLF capital stock on behalf of a subset of their members.13 This legislation would permit corporate credit unions to contribute capital to provide coverage for smaller members with less than $250 million in assets. Liquidity risks within the credit union system are rising, and timely consideration of this bill would better protect the credit union system from future liquidity events.Restoration of Third-Party Vendor AuthorityThe risks resulting from the NCUA's lack of vendor authority are real, expanding, and potentially dangerous for the nation's financial infrastructure. Other independent entities, including the Government Accountability Office, the Financial Stability Oversight Council, and the NCUA's Office of Inspector General, have identified this deficiency as inhibiting the NCUA from fulfilling its mission to safeguard credit union members and the financial system. And, it is the NCUA Board's continuing policy to seek third-party vendor authority from Congress.14The agency is working within its current authority to address this growing regulatory blind spot, but it is evident that additional authority is needed. There has also been a shift in credit union leaders' understanding of the value of the NCUA having the same vendor authority as the federal banking agencies. The benefits include credit union access to NCUA examination information when conducting due diligence of vendors, fewer requests from the NCUA to credit unions to intervene with vendors experiencing problems, and fewer losses to the Share Insurance Fund.The potential for such resulting losses to the Share Insurance Fund is real. The NCUA's Office of Inspector General stated that between 2008 and 2015, nine CUSOs contributed to material losses to the Share Insurance Fund. The report noted one of the CUSOs caused losses in 24 credit unions, some of which failed. According to NCUA staff calculations, at least 73 credit unions incurred losses between 2007 and 2020 as losses at CUSOs roll onto credit union ledgers and lead to liquidations.15The absence of third-party vendor examination authority limits the NCUA's ability to assess and mitigate potential risks associated with these vendors. Vendors typically decline these requests or refuse to implement recommended actions. This limitation exacerbates any exposure credit unions have to the operational, cybersecurity, and compliance risks that can arise from these relationships. Without the authority to enforce recommended corrective actions, the NCUA is unable to effectively protect credit unions and their members.Furthermore, the growing reliance on third-party services in the credit union industry poses a systemic risk to the credit union system. Five core banking processors, for example, handle more than 90 percent of the credit union system's assets. A failure of one of these critical third parties could cause hundreds of credit unions and potentially tens of millions of their members to lose access to their funds simultaneously. Such a vendor failure, in turn, may result in a loss of confidence in the financial sector. Ensuring proper oversight is imperative, as CUSOs and third-party vendors are poised to capitalize on financial institutions' growing appetite for artificial intelligence and real-time payment services.If granted third-party vendor authority, the NCUA would implement a risk-based examination program focusing on services that relate to safety and soundness, cybersecurity, Bank Secrecy Act and Anti-Money Laundering Act compliance, consumer financial protection, and areas posing significant financial risk for the Share Insurance Fund.Additional Flexibility for Administering the Share Insurance FundThe recent turmoil in the banking sector, growing liquidity risks within the credit union system, and rising interest rate risk all highlight the need for the NCUA to have additional flexibility for administering the Share Insurance Fund.Specifically, the NCUA requests amending the Federal Credit Union Act to remove the 1.50 percent ceiling for the Share Insurance Fund's equity ratio from the current statutory definition of “normal operating level,” which limits the ability of the Board to establish a higher normal operating level for the Share Insurance Fund. A statutory change should also remove the limitations on assessing Share Insurance Fund premiums when the equity ratio of the Share Insurance Fund is greater than 1.30 percent and if the premium charged exceeds the amount necessary to restore the equity ratio to 1.30 percent.16Together, these amendments would bring the NCUA's statutory authority over the Share Insurance Fund more in line with the FDIC's authority as it relates to administering the Deposit Insurance Fund. These amendments would also better enable the NCUA Board to proactively manage the Share Insurance Fund by building reserves during economic upturns so that sufficient money is available during economic downturns. This more counter-cyclical approach to managing the Share Insurance Fund would better ensure that credit unions will not need to impair their one percent contributed capital deposit or pay premiums during times of economic stress, when they can least afford it.ConclusionThe NCUA stands ready to address the impact of the evolving economic and business cycles within the credit union system. The NCUA will continue to monitor credit union performance and coordinate with other federal financial institution regulators, as appropriate, to ensure the overall resiliency and stability of our nation's financial services system and economy.Thank you again for the invitation to testify about the NCUA's programs and operations. 

Stay in touch and sign up for Paco's weekly email newsletter, The Nerdletter. If you'd like to contact us about the show or ask Paco a question about finances, call our hotline at 1-833-ASK-PACO, email us at weirdfinancepod (at) gmail.com or submit your questions here. We'd also love your listener feedback about the show; here's a short survey.   In this episode of Weird Finance, Paco talks to Robert E. James II and Stephen H. Gordon about the role banks play in closing the racial wealth gap, the importance of minority depository institutions (MDIs) in underprivileged communities, the need for increased financial education and skills in underserved communities, the value of diversity and inclusion in the banking industry, and the historical context and impact of the racial wealth gap in the United States.   Robert E. James II Since October 2020, Robert James has served as Chairman of the National Bankers Association, the leading advocacy group for the nation's minority banks. Robert leverages his experiences in banking, law, real estate development, and consulting to lead America's only Black-owned multibank holding company, Carver Financial Corporation, and its operating subsidiaries, Carver State Bank in Savannah, GA and Alamerica Bank in Birmingham, AL, which was acquired in 2021. Robert, who was named to his current role with the holding company in 2021, has led the 95-year-old institution to several accomplishments over his fifteen-year tenure. Robert graduated from Harvard Law School in 1995 and from Howard University in 1992. He is father of one teenage daughter, a member of the Alpha Lambda Boulé of Sigma Pi Phi Fraternity and Omega Psi Phi Fraternity, and enjoys cooking and travel.   Stephen H. Gordon Stephen H. Gordon is the Founding Chairman and Chief Executive Officer of Genesis Bank, a member of the National Bankers Association. Mr. Gordon has nearly 40 years of financial industry experience, including serving as Founding Chairman, Chief Executive Officer, and President of Opus Bank; Founding Chairman and CEO of Commercial Capital Bank and its holding company, Commercial Capital Bancorp, Inc; as well as Chairman and CEO of Fremont Investment and Loan and its holding company, Fremont General Corporation. Additionally, Mr. Gordon served as a Partner at Sandler O'Neill + Partners, L.P., a New York based investment banking firm, now Piper Sandler, and joined the firm at its founding in 1988. Genesis Bank is a California state chartered commercial bank, organized by Mr. Gordon. The Bank focuses on serving the financial needs of small to mid-sized businesses and owners, and investors in income-producing multifamily and commercial real estate located primarily in the diverse majority minority markets of Los Angeles and Orange counties, California, as well as the western portions of the Inland Empire (Riverside and San Bernardino counties). Genesis Bank is designated by the FDIC as a Minority Depository Institution (MDI), and is only the second diverse, multi-racial MDI in the U.S. The Bank's products, services, and solutions primarily include traditional commercial business, Small Business Administration (SBA), income property, and owner-occupied commercial real estate loan and deposit products, as well as treasury management services and solutions. Genesis Bank is headquartered in Orange County California. This episode also features a segment called Stock Watch with Amanda Holden (@dumpster.doggy). In this segment, we'll follow a stock-picking competition between a dog named Henry, a cat named Hugo, and a human baby. If you'd like to learn more about investing from Amanda, sign up for her online course, Invested Development. Thank you to Jess Rona and Ramsey Yount for lending your voice for our special PSA. A special thanks to the talented and generous Ramsey Yount for producing, editing, and sound designing this episode. The theme music was written and performed by Andrew Parker, Jenna Parker, and Paco de Leon.See omnystudio.com/listener for privacy information.

Acting Comptroller Mike Hsu talks about banking policy and minority and community banks after the collapse of Silicon valley Bank. Learn more about your ad choices. Visit megaphone.fm/adchoices

FDIC Vice Chair Travis Hill talks about banking policy and minority and community banks after the collapse of Silicon valley Bank. Learn more about your ad choices. Visit megaphone.fm/adchoices

THis episode discusses the statements made by NCUA about the safety and soundness of credit unions, board actions, and Silicon Valley Bank new. NCUA issues this Board Action Bulletin on the Subordinated Debt Rule:ALEXANDRIA, Va. (March 16, 2023) – The National Credit Union Administration Board held its third open meeting of 2023 and approved a final rule on subordinated debt.In a prepared statement, Chairman Todd M. Harper said, “I support this rule because it facilitates the access of eligible credit unions to the U.S. Department of the Treasury's Emergency Capital Investment Program. Congress created ECIP to support the communities of color and low-income households hit hardest by the COVID-19 pandemic's financial and economic disruptions. With rising interest rates, lingering inflation, and continuing economic uncertainty, under-resourced families and communities face many challenges. ECIP funding is a much-needed boost to these communities, allowing them to address short-term needs and achieve long-term financial stability.”The final rule makes two changes to the current subordinated debt rule that was finalized in 2020. Specifically, this final rule replaces the maximum permissible maturity of subordinated debt notes with a requirement that any credit union seeking to issue subordinated debt notes with maturities longer than 20 years demonstrate how such instruments would continue to be considered “debt.”The rule also extends the regulatory capital treatment of grandfathered secondary capital to the later of 30 years from the date of issuance or January 1, 2052. This extension will align the treatment of grandfathered secondary capital with the maximum permissible maturity for any secondary capital issued by low-income credit unions under the U.S. Department of the Treasury's Emergency Capital Investment Program or other programs administered by the U.S. government.In addition, the NCUA Board approved four minor modifications to other sections of the current subordinated debt rule to make it more user-friendly and flexible.“This final rule ensures eligible credit unions participating in the ECIP or other government-sponsored initiatives providing needed capital can fully benefit from those initiatives,” Chairman Harper said in his prepared statement. “The 30-year, low-cost, patient capital provided through ECIP will be a game changer in under-resourced communities nationwide. And, with this rule change, credit unions that are either MDIs or CDFIs will be well-positioned to advance economic equity and fulfill their statutory mission of meeting the credit and savings needs of their members, especially those of modest means.”The final rule is effective 30 days after publication in the Federal Register.

The banking industry is increasingly leveraging innovations in alternative data to underwrite loans for both consumers and small businesses. This can make a huge impact in communities that Minority Depository Institutions and Community Development Financial Institutions serve.In this episode, Michael Pugh, CEO of Carver Federal Savings Bank, discusses how to support small businesses better and serve communities by developing programs based on improved data analysis.Join us as Jeff and Michael discuss:Roles of MDIs and CDFIs in helping communities grow businessesThe importance of capital access for underserved business ownersUnderstanding the voice and perspective of members who have difficulty accessing capital Want to learn more about how Upstart partners with credit unions? Check out this case study mentioned in the episode.

Note: This episode Plant Power Unleashed: How To Get Enough Protein On A Plant-Based Diet | Dr. Patricia Mills, MDis a segment from THRIVE Thursday with Dr. Patricia Mills, which airs live every Thursday at 12:00 pm PDT / 3:00 pm EST in her facebook group ‘Wild Wisdom With Dr. Patricia Mills, MD'. Join this private free FB group for the opportunity to attend live, ask your questions, get weekly health tips, and so much more!    Are you thinking about going plant-based, want to eat a more plant-focused diet, or are currently vegetarian or vegan? Dr Patricia shares essential information for those looking to live optimally on a plant-based diet. She shares her insights on plant protein vs animal protein and the CRITICAL errors people make when trying to increase their protein intake. Dr Patricia will also share some not so common techniques on preparing your food your great-grandmother knew as common sense. The way you prepare or the lack of preparation of some foods can actually be sabotaging your intentions to thrive on a plant-based diet. This audio IS worth your time. If you have decided or are thinking about going plant-based this is a must listen.  

In recent years there has been more reporting and recognition of the racial wealth gap- the large, and growing, gap in the percentage of family wealth in black households, as compared to white households. Banks like Carver State have been operating within the mission to serve the African American community since 1927 and are now leveraging partners to maximize their reach and accessibility. Our guest today, Robert James, Chief Executive Officer at Carver State Bank, gives our listeners a look at the unique service they provide and how they have been addressing the racial wealth gap in Georgia for several decades. Join us as we discuss: Carver State's role as both a minority depository institution (MDI) and community development financial institution (CDFI) Unlocking credit access and opportunity Leveraging fintech partnerships to find the balance between high tech and high touch How the National Bankers Association (NBA) ensures the needs of MDIs across the country are met      Want to learn more about how Upstart partners with banks? Check out this case study mentioned in the episode.

Deputy Treasury Secretary Wally Adeyamo on Twenty-one corporations and 3 foundations' public and private investments in community development financial institutions (CDFIs), minority depository institutions (MDIs), and other local financial institutions; supporting entrepreneurship and minority-owned businesses; expanding inclusive and equitable access to credit and other financial services facilitating financial health; and making infrastructure investments that create more community wealth by preserving and expanding affordable rental housing and homeownership in underserved neighborhoods.Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

My guests today are Nicole Elam, CEO of the National Bankers Association, and Robert James II, who chairs the NBA's board of directors and is also president of Carver Financial Corporation in Savannah, Georgia.   The NBA is the trade association for Minority Depository Institutions, or MDIs. It was founded nearly a century ago, in 1927, to build on the work being done by a group of Black-owned banks that were chartered shortly after the US Civil War, because white-owned banks were not serving the needs of Black communities.

Physicians working in hospitals see the mountains of medical waste generated each day. Meanwhile, the climate crisis challenges the medical system to reduce its contribution to greenhouse gas emissions. Globally, healthcare systems contribute as much carbon dioxide as the airline industry. In Canada, healthcare accounts for 4.6% of our total emissions. The problem is urgent, but potential solutions are both easier and more complex than many might think. Guests on this episode are advocates in the climate and health space. Dr. Samantha Green is the co-author of the CMAJ article, Five Things to Know About Metered Dose Inhalers and their Impact on Climate Change. She's a family physician at Unity Health Toronto and the climate and health lead at the University of Toronto's Department of Family and Community Medicine.In the article, she and her co-authors point out that pressurized metered-dose inhalers (pMDIs) are an important contributor to greenhouse gas emissions.  Dr. Green says measurements done in the United Kingdom by the National Health Service found that MDIs contribute 3.1% of the entire health system's carbon emissions. One MDI contributes the equivalent of driving 290km by car.Meanwhile, dry powdered inhalers (DPIs) and soft mist inhalers (SMIs) are effective available alternatives with lower environmental impact. Dr. Green encourages physicians to make the switch for eligible patients and explains how her clinic has created resources to facilitate the prescribing change.Addressing such low-hanging fruit of climate action in the healthcare system is important but, according to Dr. Andrea MacNeill, reducing waste, changing prescriptions, and recycling are the tip of the iceberg. What's really needed is profound systemic change. Dr. MacNeill argues that emissions are driven by a system focused on providing the most complex and carbon-intensive care. “New healthcare funding seems to go into very complex resource-intensive treatments that modify very advanced disease processes. And I would suggest that we need to shift that focus upstream and start to think, okay, could we have prevented this from ever happening? And in many cases, the answer to that is yes,” says Dr. MacNeill.Along with a focus on prevention, Dr. MacNeill argues healthcare systems need to put pressure on the supply chain, which accounts for the bulk of emissions. In England, the NHS is demanding that vendors match the NHS's climate target to decarbonize by 2030. Links to resources discussed on the episode:Inhaler Toolkit for PhysiciansCascadesPlanetary Health Lab

Episode 66 – Acute Asthma Exacerbations – An Interview with Dr. Steven Hochman and Dr. Brandon SomwaruEMplify – February 2022Emergency Department Management of Acute Asthma ExacerbationsInterview with the authors: Steven M. Hochman, MD, and Brandon Somwaru, DO Episode Outline:EpidemiologyRisk factors for death from asthma (Table 1)Triggers for asthma attacksVariants of asthma (Table 2)Differential diagnosis (Table 3)Can PE be a trigger for an acute asthma attack? Prehospital careED care: history (what should we ask?)ED care: physical exam (what are we looking for?)Classifying mild/moderate/severe asthma Lab studiesPOCUS (Table 5 and Figure 3)Peak expiratory flowETCO2 capnography and capnometryChest x-rayTreatment (Table 6)MedicationsOxygenSABA vs LABAWhat about MDIs?Continuous nebs?AnticholinergicsSteroids (IV, oral, inhaled; prednisone vs dexamethasone)Magnesium sulfateEpinephrineTerbutalineKetamineNIPPVIntubation pearls and pitfalls (Table 8)Special populationsPediatrics PregnancyCOVID-19 Controversies and cutting edgeBiologicsFractional exhaled nitric oxideHeliox High flow nasal cannulaDelayed sequence intubationECMODisposition

Episode 66 – Acute Asthma Exacerbations – An Interview with Dr. Steven Hochman and Dr. Brandon SomwaruEMplify – February 2022Emergency Department Management of Acute Asthma ExacerbationsInterview with the authors: Steven M. Hochman, MD, and Brandon Somwaru, DO Episode Outline:EpidemiologyRisk factors for death from asthma (Table 1)Triggers for asthma attacksVariants of asthma (Table 2)Differential diagnosis (Table 3)Can PE be a trigger for an acute asthma attack? Prehospital careED care: history (what should we ask?)ED care: physical exam (what are we looking for?)Classifying mild/moderate/severe asthma Lab studiesPOCUS (Table 5 and Figure 3)Peak expiratory flowETCO2 capnography and capnometryChest x-rayTreatment (Table 6)MedicationsOxygenSABA vs LABAWhat about MDIs?Continuous nebs?AnticholinergicsSteroids (IV, oral, inhaled; prednisone vs dexamethasone)Magnesium sulfateEpinephrineTerbutalineKetamineNIPPVIntubation pearls and pitfalls (Table 8)Special populationsPediatrics PregnancyCOVID-19 Controversies and cutting edgeBiologicsFractional exhaled nitric oxideHeliox High flow nasal cannulaDelayed sequence intubationECMODisposition

Chaque jeudi sur euradio, le Think tank Sport et Citoyenneté propose un regard sur l'impact social du sport en Europe : handicap, gouvernance, égalité des genres, sédentarité, inclusion sociale… c'est aussi du sport !

JPMorgan Chase presenta avances en inclusión financiera de latinos El mayor banco de Estados Unidos, JPMorgan Chase, presentó el miércoles balance del primer año de su compromiso de 30,000 millones de dólares para ofrecer un acceso igualitario a instrumentos de financiación y asesoramiento a hispanos y afroamericanos. La firma informó hoy, a un año del compromiso que continuará hasta el 2025, que logró ayudar a 16,000 hogares adicionales (de los 20,000 más que tienen como meta) a ahorrar dinero a través del refinanciamiento de hipotecas. Asimismo, incrementó la cantidad que tenía destinada de 50 millones a más de 100 millones de dólares para apoyar a 14 instituciones financieras de propietarios hispanos y afroamericanos (MDIs, por su sigla en inglés), y abrió sucursales para extender el acceso a servicios bancarios a comunidades desatendidas. Tanto los emprendedores como las familias hispanas y afroamericanas buscan salida a la crisis económica a la que les ha empujado el Covid 19 con un acceso igualitario a instrumentos de financiación y asesoramiento, una asignatura pendiente de la banca tradicional. Según datos de la Reserva Federal, solo el 70 % de los hispanos y el 60 % de los afroamericanos dispone de una cuenta corriente y de servicios bancarios, frente al 81 % de media general en los hogares estadounidenses y el casi 90 % de los blancos. Esto los expone a pagar cientos de dólares en servicios no tradicionales para canjear cheques por efectivo o hacer transferencias bancarias, por ejemplo. A nivel empresarial, un estudio publicado este mes por la Universidad de Nueva York, junto con el National Bureau of Economic Research, mostró que las pequeñas empresas latinas y afroamericanas han preferido acudir a entidades digitales intermedias o ‘fintech' antes que a bancos tradicionales para acceder a los programas públicos de recuperación frente a la covid 19. “Nuestro propósito es ayudar a que más personas en nuestras comunidades puedan alcanzar un mayor poder económico y por eso nos concentramos en apoyar a más personas a ser dueñas de vivienda, crecer sus negocios y tener una mejor salud financiera que son maneras claves de construir seguridad financiera,” dijo Alice Rodríguez, líder del grupo de impacto comunitario en JPMorgan Chase. Mediante su compromiso de 30.000 millones que busca cerrar la brecha existente y ayudar a crear equidad, JPMorgan Chase otorga préstamos hipotecarios para la compra de vivienda, o hipotecas, a 40.000 hogares adicionales y unos 2.000 millones de dólares adicionales en préstamos para pequeños negocios de latinos y afroamericanos, entre otros objetivos claves para promover el alcance de metas financieras. La compañía bancaria manifestó que con este proyecto pretende derribar “barreras estructurales en los Estados Unidos que han creado profundas inequidades raciales que han empeorado durante la pandemia. “Nuestro objetivo es ayudar a nuestras comunidades a prosperar, a través de la inclusión económica, promoviendo que más personas puedan ser dueños de casa y contar con viviendas asequibles, apoyando el crecimiento de los negocios y reforzando la salud financiera” añadió Rodríguez.

In the first episode of our Workforce Resiliency season, Just Science sat down with Dr. Jennifer Rineer, a program manager and research psychologist in RTI International's Center for Policing Research and Investigative Science, and Kelly Keyes, a research forensic scientist in RTI's Center for Forensic Sciences, to discuss workforce resiliency among medicolegal death investigators. Medicolegal death investigators face consistent exposure to stress and traumatic events on the job, yet there is limited research on the daily pressures these professionals experience. An NIJ study led by Dr. Rineer surveyed 900 medicolegal death investigators to gain more information on the driving sources of stress among these practitioners, with the goal of developing better interventions to mitigate these stressors. Listen along as these experts discuss the responsibilities of medicolegal death investigators and the difficulty of retaining good staff, as well as their findings on work-related stress within the profession in this episode of Just Science. This season is funded by the National Institute of Justice's Forensic Technology Center of Excellence.

Community development financial institutions (CDFIs) and minority depository institutions (MDIs) serve as major sources of consumer and commercial loans for low-income individuals and minority groups; however, a lack of automation continues to plague some of these financial institutions and hinder the delivery of loans.  CDFIs deliver at least 60% of their total lending, services and other activities in low-income communities, according to the FDIC. MDIs originate a greater share of mortgages to borrowers in low- and moderate-income areas and with larger shares of minority populations than non-MDIs.  In today's episode of “The Buzz,” hear Bryan DeShasier, managing director of product and process at digital mortgage platform Promontory MortgagePath, discusses this lack to automation at these particular types of financial institutions. Promontory's solution provides comprehensive fulfillment services and compliance support for them.  When technology is used at CDFIs and MDIs, it is often older, meaning that the lending process is fraught with lengthy manual processes and extended turn times for loans. Better automation means the lenders can scale up operations quickly, although many have few loan officers in place.  In this Bank Automation News podcast, DeShasier and Carrie Mumma, director, manager of client relationships at Promontory MortgagePath, address the opportunities and challenges of rolling out the fintech's new initiative for CDFIs and MDIs and the value proposition automation offers.  While automation does speed loan closures, there remain hurdles to implementation that are similar among all banks. Changing the culture and habits of the employees of any financial institution can be difficult and does take time, said Mumma.   

Episode 60: In this two-part episode, we welcome guest speaker Kae Hana, fashion educator at MDIS Singapore. She shares with us the organic materials she and her students have been experimenting with to make "fabric", including nettle and banana peel. Tune in to view delicious, mesmerising examples of kombucha scoby leather and (almost) edible bioplastics.

Episode 60: In this two-part episode, we welcome guest speaker Kae Hana, fashion educator at MDIS Singapore. She shares with us the organic materials she and her students have been experimenting with to make "fabric", including nettle and banana peel. Tune in to view delicious, mesmerising examples of kombucha scoby leather and (almost) edible bioplastics.

Theme: Paediatrics. Participants: Dr Surbhi Rikhi, Dr Kerf Tan, Dr Pramod Chandru, Johann De Alwis (PEM trainee) Omal Fernando (PEM trainee), Min Park (EM trainee), Shreyas Iyer, Kit Rowe, Caroline Tyers and Samoda Wilegoda Mudalige.Discussion 1:Kuppermann, N., Dayan, P., Levine, D., Vitale, M., Tzimenatos, L., & Tunik, M. et al. (2019). A Clinical Prediction Rule to Identify Febrile Infants 60 Days and Younger at Low Risk for Serious Bacterial Infections. JAMA Pediatrics, 173(4), 342. https://doi.org/10.1001/jamapediatrics.2018.5501. Presenter - Johann De Alwis.Summary: Serious bacterial infections (SBIs); which include UTI, meningitis, and bacteraemia, lead to dangerous complications in infants. This was a prospective observational study between 2011 and 2013, looking at previously healthy febrile infants aged 60 days or younger, who were evaluated for SBIs. The clinical rule considered the urinalysis, absolute neutrophil count (ANC), and serum procalcitonin, and had a sensitivity of 97.7%, with a specificity of 60%, and a negative predictive value of 99.6%. One infant with bacteraemia and two with UTI who were misclassified.  This tool decreased the number of lumbar punctures performed, antibiotics administered, and infants admitted to the hospital.  Take-Home Points: Remember that these infants are the most at-risk population; do more rather than less. Safety net: no matter what you do or what investigations reveal, always have a safety net!  Discussion 2:Pan, P. (2020). Validation of the Testicular Workup for Ischemia and Suspected Torsion (TWIST) Score in the Diagnosis of Testicular Torsion in Children With Acute Scrotum. Indian Pediatrics, 57(10), 926-928. https://doi.org/10.1007/s13312-020-1992-6.Presenter - Omal Fernando.Summary: The TWIST score includes - testicular swelling (2), hard testicle (2), absent cremasteric reflex (1), nausea or vomiting (1), a high-riding testicle (1).  Low risk was a score of 0-2, intermediate risk was a score of 3-4 and high risk was a score 5-7. Of those with testicular torsion, the mean TWIST score was 5.7 (none in low-risk category, 13 in intermediate-risk group, and 55 in high-risk group).  Of those without testicular torsion, the mean TWIST score was 1.46 (21 in low-risk group, 7 in the intermediate-risk group, and 0 in the high-risk group). All patients with a high-riding testis or absent cremasteric reflex were found to have testicular torsion. Take-Home Points: This score reminds us what we should be looking for when assessing a patient with acute testicular pain and thus help to build clinical gestalt, however, there is not enough evidence at present to rely on this tool alone (although this may change in the years to come).  It is important to involve the urologist/general surgeon if there is any suspicion of torsion. Given the time-critical nature of this presentation, patients should be taken to the theatre (rather than further investigated with ultrasound) if testicular torsion is suspected. Discussion 3:Iramain, R., Castro‐Rodriguez, J., Jara, A., Cardozo, L., Bogado, N., Morinigo, R., & De Jesús, R. (2019). Salbutamol and ipratropium by inhaler is superior to nebulizer in children with severe acute asthma exacerbation: Randomized clinical trial. Pediatric Pulmonology, 54(4), 372-377. https://doi.org/10.1002/ppul.24244.Presenter - Min Park. Take-Home Points: 103 children between the age of 2 and 14 years with severe asthma exacerbations (pulmonary score 7) were randomly allocated to a nebulizer or metred dose inhaler (MDI) and spacer with nasal prong oxygen. The primary outcome was the rate of hospitalization with the secondary outcome being oxygen saturations at 60 and 90 minutes. Children in the MDI group had significantly improved oxygen saturation from 60 minutes compared with the nebulizer group, with significantly lower rates of admission to hospital (5.8% vs. 27.5%).  Summary: MDIs may be at least equally effective if not more effective than nebulizers. MDIs are also cheaper and provide an opportunity to educate patients regarding their use. It is important to re-assess your patients following initial treatment. There may be variability in the way you approach each patient to meet their individual needs.  Always refer to your local guidelines.  Interlude Segment 1:Presenter - Dr Surbhi Rikhi.Interlude Segment 2:Presenter - Dr Kerf Tan.Resources (to support doctor well-being) -  Applications: Shift (Black Dog Institute app for healthcare workers), Calm, Headspace, Feeling Good, Smiling Minds, Insight Timer.   JMO support line (NSW): 1300 566 321. Access EAP (free confidential service for all NSW Health employees). Doctors for doctors: www.drs4drs.com.au. Beyond Blue: 1300 224 636. Lifeline: 13 11 14.  Suicide call-back service: 1300 659 467.  Other References:“Step by step” approach to the febrile infant -  Mintegi, S., Bressan, S., Gomez, B., Da Dalt, L., Blázquez, D., & Olaciregui, I. et al. (2013). Accuracy of a sequential approach to identify young febrile infants at low risk for invasive bacterial infection. Emergency Medicine Journal, 31(e1), e19-e24. https://doi.org/10.1136/emermed-2013-202449.Original study validating the TWIST score - Barbosa, J., Tiseo, B., Barayan, G., Rosman, B., Torricelli, F., & Passerotti, C. et al. (2013). Development and Initial Validation of a Scoring System to Diagnose Testicular Torsion in Children. Journal Of Urology, 189(5), 1859-1864. https://doi.org/10.1016/j.juro.2012.10.056.Starship Hospital (NZ) study examining nebuliser vs. MDI delivery for asthma - Klassen, T. (2001). Spacers were better and less expensive than nebulisers for giving albuterol to children with moderate to severe acute asthma. Evidence-Based Medicine, 6(1), 31-31. https://doi.org/10.1136/ebm.6.1.31.Further evidence regarding female ACS presentations (as covered in our previous episode) -van Oosterhout, R., de Boer, A., Maas, A., Rutten, F., Bots, M., & Peters, S. (2020). Sex Differences in Symptom Presentation in Acute Coronary Syndromes: A Systematic Review and Meta‐analysis. Journal Of The American Heart Association, 9(9). https://doi.org/10.1161/jaha.119.014733.Sederholm Lawesson, S., Isaksson, R., Thylén, I., Ericsson, M., Ängerud, K., & Swahn, E. (2018). Gender differences in symptom presentation of ST-elevation myocardial infarction – An observational multicenter survey study. International Journal Of Cardiology, 264, 7-11. https://doi.org/10.1016/j.ijcard.2018.03.084.Credits:The discussions were mediated by PEM consultant Dr Surbhi Rikhi, ED consultant Dr Kerf Tan and, ED consultant Dr Pramod Chandru. This episode was produced by the ­­­­Emergency Medicine Training Network 5 with the assistance of Dr Kavita Varshney, Deepa Dasgupta, Cynthia De Macedo Franco, and Paul Scott.Music/Sound Effects Fable by Free Music | https://soundcloud.com/fm_freemusic, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US.  Medical Examination by MaxKoMusic | https://maxkomusic.com/, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution-ShareAlike 3.0 Unported, https://creativecommons.org/licenses/by-sa/3.0/deed.en_US.  Moments by Sarah Jansen Music | https://soundcloud.com/sarahjansenmusic, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US.  New Days by Roa Music | https://soundcloud.com/roa_music1031, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US.  Nightswim by Scandinavianz | https://soundcloud.com/scandinavianz, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Sound effects from https://www.free-stock-music.com. Sunset Beach by Scandinavianz | https://soundcloud.com/scandinavianz, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US.   Warm Duck Shuffle by arnebhus | https://soundcloud.com/arnebhus, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. ~Thank you for listening!Please send us an email to let us know what you thought.You can contact us at westmeadedjournalclub@gmail.com.You can also follow us on Facebook, Instagram, and Twitter!See you next time,Caroline, Kit, Pramod, Samoda, and Shreyas.

Join Kayo Founder and host, Lindsay Burton, and featured trailblazers Effie Dennison, Texas Capital Bank and Kim Saunders, National Bankers Association, as they discuss where MDIs exist today and how the national banks benefit. The Weekly Knockout is now featured on Feedspot as one of the Top 35 Women in Business Podcasts, and one of […]

Contributor: Aaron Lessen, MD Educational Pearls: Contrary to many assumptions, meter-dose inhalers (MDIs) are as effective as nebulizers in pediatric and adult patients Nebulizers are associated with higher rates of tremor, tachycardia; they cost more and are associated with longer ED stays Though it may take some convincing, in a patient that is physically able, using an MDI with spacer appears to be the better option - and that was even before COVID. References Snider MA, Wan JY, Jacobs J, Kink R, Gilmore B, Arnold SR. A Randomized Trial Comparing Metered Dose Inhalers and Breath Actuated Nebulizers. J Emerg Med. 2018 Jul;55(1):7-14. doi: 10.1016/j.jemermed.2018.03.002. Epub 2018 Apr 30. PMID: 29716819. Brocklebank D, Ram F, Wright J, Barry P, Cates C, Davies L, Douglas G, Muers M, Smith D, White J. Comparison of the effectiveness of inhaler devices in asthma and chronic obstructive airways disease: a systematic review of the literature. Health Technol Assess. 2001;5(26):1-149. doi: 10.3310/hta5260. PMID: 11701099. Dhuper S, Chandra A, Ahmed A, Bista S, Moghekar A, Verma R, Chong C, Shim C, Cohen H, Choksi S. Efficacy and cost comparisons of bronchodilatator administration between metered dose inhalers with disposable spacers and nebulizers for acute asthma treatment. J Emerg Med. 2011 Mar;40(3):247-55. doi: 10.1016/j.jemermed.2008.06.029. Epub 2008 Dec 11. PMID: 19081697.   Summarized by Jackson Roos, MS4 | Edited by Erik Verzemnieks, MD   The Emergency Medical Minute is excited to announce that we are now offering AMA PRA Category 1 credits™ via online course modules. To access these and for more information, visit our website at www.emergencymedicalminute.com/cme-courses/ and create an account.

Tackling all of the pros and cons of using insulin pumps or MDIs. --- Support this podcast: https://anchor.fm/t1talks/support

In this episode of the podcast, Lori Bruce, Director of Communications for MBA, interviews Deron Burr, President & CEO of People's Bank of Senenca. People's Bank of Seneca is the only minority owned depository institution in the state, and as a result, Deron served on the FDIC Subcommittee for MDIs. In the interview, Lori talks with Deron about his career in banking, what makes community banks so unique and important and what the goals are for the FDIC subcommittee.

  Rapid Therapeutic Science Laboratories, Inc. (OTC: RTSL) manufactures and markets FDA-listed pressurized metered dose inhalers (pMDIs) that enable users to conveniently and safely self-administer CBD. RTSL's MDIs deliver a 98% bioavailable dose of CBD each & every time and could very well replace vape pens, tanks and mods and have a major impact on a $9 Billion market.  

  Rapid Therapeutic Science Laboratories, Inc. (OTC: RTSL) manufactures and markets FDA-listed pressurized metered dose inhalers (pMDIs) that enable users to conveniently and safely self-administer CBD. RTSL's MDIs deliver a 98% bioavailable dose of CBD each & every time and could very well replace vape pens, tanks and mods and have a major impact on a $9 Billion market.  

First Independence Bank was founded 50 years ago to help rebuild Detroit’s economy in the wake of damaging urban violence. Today, in a new era of economic hardship due to the coronavirus pandemic, and protests and unrest in response to incidents of racial injustice, minority depository institutions continue to have a unique role in serving distressed communities. On the latest episode of the ABA Banking Journal Podcast — sponsored by Jack Henry — First Independence Chairman and CEO Kenneth Kelly tells the First Independence story and discusses: the historical struggles of and current environment for MDIs; talent development in the MDI sector; and the ongoing role of minority banks in promoting financial inclusion and helping minority communities build wealth. As chairman of the National Bankers Association, Kelly also discusses the NBA’s recent strategic partnership with the American Bankers Association and how ABA member banks can get involved to support the MDI sector.

Show notes at pharmacyjoe.com/episode494. In this episode, I’ll discuss what to use for acute asthma exacerbation if you run out of MDIs and can’t use nebulizers. The post 494: What to use for acute asthma exacerbation if you run out of MDIs? appeared first on Pharmacy Joe.

Listen as the pioneers of the COVID pandemic share their experiences taking care of some of the first COVID patients in the US. Our guests have a broad range of expertise and experiences. This episode features hospitalist Dr. Francisco Alvarez (University of California at San Francisco, @fnalvarez), Infectious Disease fellow Dr. Karolina Maciag (University of Washington, @KMaciag), Critical Care and Pulmonology Fellow Dr. David Furfaro (Columbia University, @david_furfaro) and intensivist and founder of onepagericu.com, Dr. Nick Mark (Seattle, WA).   Show Notes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | thecurbsiders@gmail.com    Credits Written and Produced: Justin Berk MD MPH MBA Cover Art: Kate Grant MBChB DipGUMed Hosts: Justin Berk MD MPH MBA; Matthew Watto MD, FACP; Paul Williams MD, FACP    Editor: Matthew Watto MD (written materials); Clair Morgan of nodderly.com Guest: Dr. Francisco Alvarez, Dr. Karolina Maciag, Dr. Dave Furfaro, Dr. Nick Mark   Sponsor Primary Care Internal Medicine of Ithaca Join a well established practice in beautiful upstate New York near the finger lakes and wine country! You'll have flexible hours and the ability to take the time you need with patients! Contact Dr. Ann Costello arcostello@gmail.com to find out more about this incredible opportunity to join the team at Primary Care Internal Medicine of Ithaca https://www.primarycareinternalmedicineofithaca.com/.   Time Stamps 00:00 Sponsor - https://www.primarycareinternalmedicineofithaca.com/. 00:20 Intro, disclaimer, guest bios and a bad pun 04:28 Francisco: Process leading up to first case 07:42 Karolina: The perspective of the consultant- calm in the storm 11:40 (Karolina) Seattle Flu Study as early warning 16:00 Dave: ICU patients 20:30 Nick: making decisions with a moving target     25:05 Sponsor - https://www.primarycareinternalmedicineofithaca.com/. 25:53 Francisco: data available on Twitter 28:00 Francisco: the role of generalist during the COVID pandemic 31:15 Karolina: on vulnerable populations during pandemic 38:26 Dave/Nick: how generalists should be preparing themselves 45:16 Avoiding aerosolized procedures / nebulizers 47:46 What was the big surprises 54:20 How do you address the anxiety 60:12 Plugs64:20 Outro   Links* The Seattle Flu Study research team helped identify first patterns of COVID in the US A New York Times article highlighted the story of the Seattle Flu Study  was one of the first  A published case series of the first 12 US COVID patients (Dr. Alvarez is a co-author) The CDC offers a very comprehensive video for donning and doffing A previous “Things We Do For No ReasonTM” article suggests MDIs are non-inferior to nebulizer treatments COVID Communications Guide CardioNerds: Episode #20: COVID-19 in the ICU UW COVID Resource Site OnePagerICU.com   Goal Listeners will recall the perspectives of the first providers taking care of COVID patients and will be able to apply some of their insights to when the epidemic hits their region.   Learning objectives After listening to this episode listeners will…   Be familiar with the ICU and hospitalist challenges in taking care of COVID patients. Describe how to learn new information and connect with others in the COVID community. Recognize the social challenges associated with the epidemic for patients and providers.   Disclosures Drs. Maciag, Mark, Alvarez, and Furfaro report no relevant financial disclosures. The Curbsiders report no relevant financial disclosures.    Citation Alvarez, F, Maciag K, Furfaro D, Mark N, Berk, JB, Williams PN, Watto MF. “#201: COVID Narratives: Stories from Physicians at the Front Lines”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list. March 26, 2020.

Metered Dose Inhalers (MDIs) & COVID-19We need your input! Are these podcasts working for you? Do you have an idea for a podcast episode? Know someone that would make an awesome guest? Please take a moment to fill out our Medic Minutes Survey HostsGord Minaker - PCP-IV, UBC Medical StudentKaela Richardson - Respiratory Therapist, UBC Medical Student Date of Episode Release:March 23, 2020 Episode Description & SummaryIn this episode, Gord & Kaela review best practices for the use of Metered Dose Inhalers (MDIs) in the prehospital setting. They discuss the benefit of MDIs over nebulizer medications in the context of the COVID-19 pandemic.Please refer to the BCEHS Handbook for the latest guidelines: https://handbook.bcehs.ca Contacts: Clinical Questions - clinicalpractice@bcehs.caPodcast feedback & suggestions - podcast@bcehs.ca  

Metered Dose Inhalers (MDIs) & COVID-19 We need your input! Are these podcasts working for you? Do you have an idea for a podcast episode? Know someone that would make an awesome guest? Please take a moment to fill out our Medic Minutes Survey   Hosts Gord Minaker - PCP-IV, UBC Medical Student Kaela Richardson - Respiratory Therapist, UBC Medical Student   Date of Episode Release: March 23, 2020   Episode Description & Summary In this episode, Gord & Kaela review best practices for the use of Metered Dose Inhalers (MDIs) in the prehospital setting. They discuss the benefit of MDIs over nebulizer medications in the context of the COVID-19 pandemic. Link to BCEHS Education Video on MDIs: (coming soon!) Please refer to the BCEHS Handbook for latest guidelines: https://handbook.bcehs.ca   Contacts: Clinical Questions - clinicalpractice@bcehs.ca Podcast feedback & suggestions - podcast@bcehs.ca    

Buenos días a todos, nuevamente soy Roberto Chalela médico neumólogo. Hoy les traigo mi segundo episodio que es especialmente útil y estoy convencido que les gustará mucho. Sobretodo la idea es hacer una pequeña guía para solucionar las dudas que puedan surgir al momento de iniciar un inhalador. En la actualidad hay fácilmente más de 25 dispositivos distintos y más de 50 marcas de productos por vía inhalada. Por eso empezaré este episodio dejando conceptos claros de esta terapia tan utilizada en todo el mundo y resumiré las diferencias entre el tratamiento con cartuchos presurizados (MDIs), dispositivos en polvo seco y nebulizadores. Es imposible avanzar sin revisar conceptos básicos del depósito pulmonar y los mecanismos por los cuales actúa la terapia inhalada, luego haré una revisión de los tipos de medicamentos que podemos encontrar en dispositivos para inhalar (broncodilatadores, glucocorticoides, antibióticos, vasodilatadores pulmonares, etc…). Esperamos que os haya resultado útil, muchas gracias por acompañarnos en esta aventura y ¡nos escuchamos la semana que viene! Ya sabéis que apreciamos vuestro feedback, así que para cualquier comentario, duda o sugerencia, o si queréis proponer un tema para el podcast, podéis contactar con nosotros en doctortopic.com/contacto. ¡Gracias por vuestros comentarios positivos, likes y valoraciones de 5 estrellas ya sea en Itunes, Ivoox o spotify, y por compartir el podcast con vuestros compañeros! Créditos: Música entrada“Hotshot”. Inspiring & Upbeat Music by Scott Holmes licensed under a Attribution-NonCommercial License

Metered Dose Inhalers with a spacer (or MDIs with a spacer) are very easy and practical to use, you don’t need to carry any extra pieces and you can use it whenever and wherever you need it. https://www.respiratorycarestore.com

MDIS Secretary-General R Theyvendran reveals his secret to success: visualise your goal and his replicable formula for turning companies fortunes around.

In this EM Cases episode on Pediatric Asthma we discuss risk stratification (including the PASS and PRAM scores), indications for CXR, the value of blood gases, MDIs with spacer vs nebulizers for salbutamol and ipatropium bromide, the best way to give corticosteroids, the value of inhaled steroids, the importance of early administration of magnesium sulphate in the sickest kids, and the controversies around the use of ketamine, heliox, high flow nasal cannuala oxygen, NIPPV, epinephrine and IV salbutamol in severe asthma exacerbations. So, with the multinational and extensive experience of Dr. Dennis Scolnik, the clinical fellowship Program Director at The Hospital for Sick Children in Toronto and Dr. Sanjay Mehta, multiple award winning educator who you might remember from his fantastic work on our Pediatric Orthopedics episode, we'll help you become more comfortable the next time you are faced with a child with asthma who is crashing in your ED... The post Episode 79 – Management of Acute Pediatric Asthma Exacerbations appeared first on Emergency Medicine Cases.

In this EM Cases episode on Pediatric Asthma we discuss risk stratification (including the PASS and PRAM scores), indications for CXR, the value of blood gases, MDIs with spacer vs nebulizers for salbutamol and ipatropium bromide, the best way to give corticosteroids, the value of inhaled steroids, the importance of early administration of magnesium sulphate in the sickest kids, and the controversies around the use of ketamine, heliox, high flow nasal cannuala oxygen, NIPPV, epinephrine and IV salbutamol in severe asthma exacerbations. So, with the multinational and extensive experience of Dr. Dennis Scolnik, the clinical fellowship Program Director at The Hospital for Sick Children in Toronto and Dr. Sanjay Mehta, multiple award winning educator who you might remember from his fantastic work on our Pediatric Orthopedics episode, we'll help you become more comfortable the next time you are faced with a child with asthma who is crashing in your ED... The post Episode 79 – Management of Acute Pediatric Asthma Exacerbations appeared first on Emergency Medicine Cases.

This week’s guest on Point of Inquiry, Paul A. Offit, MDis best known as a co-inventor of the rotavirus vaccine and a staunch, public supporter of vaccination and opponent of pseudoscientific alternative medicine. His most recent book, Do you Believe in Magic?: The Sense and Nonsense of Alternative Medicine points a critical eye at the alt-med industry, one than takes in 34 billion dollars a year with little to no regulation. Are patients being harmed, and is it any worse or better than so-called “Big Pharma”? Dr. Offit talks with our host, Lindsay Beyerstein, about all of this and much more on this week’s Point of Inquiry. Dr. Offit has published over 130 scholarly articles on the rotavirus vaccine  and vaccine safety and efficacy in general.  He has also authored or co-authored many books on pediatric medicine, childhood vaccination and opposing pseudoscience in Medicine. He is also the Maurice R. Hilleman Professor of Vaccinology, Professor of Pediatrics at the University of Pennsylvania, Chief of the Division of Infectious Diseases, and the Director of the Vaccine Education Center at The Children's Hospital of Philadelphia as well as a member of the Centers for Disease Control (CDC) Advisory Committee on Immunization Practices. Offit is also a Founding Board Member of the Autism Science Foundation (ASF).