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This episode of Don't Miss a Beat, recorded at the American College of Cardiology (ACC) 2025 Annual Scientific Sessions, explores the evolving landscape of heart failure with preserved ejection fraction (HFpEF) treatment, focusing on the implementation of combination therapies. Hosts Steve Greene, MD, and Muthiah Vaduganathan, MD, MPH, discuss the transition from a previously limited treatment landscape to a new era with multiple proven therapeutic options. To open the episode, Greene argues in favor of rapid-sequence implementation of HFpEF therapies, drawing parallels to the established 4-pillar guideline-directed medical therapy (GDMT) for heart failure with reduced ejection fraction (HFrEF). He highlights 3 key classes of medications—SGLT2 inhibitors, non-steroidal mineralocorticoid receptor antagonists (MRAs), and incretin-based therapies—as the foundation of HFpEF treatment. He emphasizes the importance of early and aggressive therapy initiation to maximize clinical benefits and reduce the risk of delayed or missed treatment opportunities among this population. Vaduganathan acknowledges the strength of the data supporting combination therapy but suggests a more risk-based approach, considering the broad clinical variability among HFpEF patients. He advocates for prioritizing rapid implementation in high-risk patients, such as those recently hospitalized, while allowing a more measured approach for lower-risk individuals. The discussion also touches on the role of phenotyping in tailoring treatment decisions, with GLP-1 receptor agonists being particularly relevant for patients with obesity and ARNi potentially benefiting those with mildly reduced ejection fraction. Looking ahead, the hosts preview upcoming trials, including CONFIDENCE and CONFIRMATION, which will evaluate combination therapy strategies in chronic kidney disease and HFpEF populations. They also discuss the potential of fixed-dose combination therapies to simplify implementation and improve adherence. The episode closes with both experts agreeing on the need for a structured, evidence-based approach to HFpEF treatment while emphasizing the importance of translating trial data into real-world practice. Relevant disclosures for Vaduganathan include Amgen, AstraZeneca, Bayer AG, Boehringer Ingelheim Pharmaceuticals, Cytokinetics, Lexicon, and others. Relevant disclosures for Greene include Amgen, AstraZeneca, Bayer Healthcare Pharmaceuticals, Boehringer Ingelheim Pharmaceuticals, Cytokinetics, and others. Chapters 00:00-Intro 02:30-Argument for Rapid Sequencing 05:32-Argument Against Rapid Sequencing 10:00-Argument for Risk-Based Sequencing 14:25-Pillars of GDMT in HFpEF
Is low blood pressure hindering your heart failure treatment? How do you balance life-saving medications with hypotension? We explore the definitions, causes, and practical solutions to optimize patient care. Learn how to navigate ARNI, beta-blockers, SGLT2 inhibitors, and MRAs effectively.
In this episode, Dr. Valentin Fuster discusses a study on sodium zirconium cyclosilicate (SZC) for managing hyperkalemia in heart failure patients on mineralocorticoid receptor antagonists (MRAs) like spironolactone. While SZC effectively reduced hyperkalemia and allowed higher spironolactone doses, concerns over worsening heart failure events highlight the complex balance between treatment benefits and risks.
Our podcast show today features John Culhane and Mike Kilgarriff, partners in Ballard Spahr's Consumer Financial Services group. They discuss what supervision and enforcement will look like under a new acting director/director appointed by President Trump. This episode is a repurposing of the second half of a webinar that was produced on January 6. On January 23, we released the first half of the webinar, which consisted of Alan Kaplinsky's “fireside chat” with Kathy Kraninger, the former Director of the CFPB during Trump 1.0., linked here. With respect to supervision, we consider, among others, the following issues with respect to the CFPB's leadership under Trump 2.0: (a) Will it be business as usual or more relaxed? (b) Will it focus on compliance with the Federal consumer financial services laws and less on UDAAP? (c) Will there be reduced staffing and fewer exams? (d) Will there be fewer PAAR letters and more use of MRAS and MRIAs? With respect to enforcement, we consider, among others, the following issues with respect to the CFPB's leadership under Trump 2.0: (a) Will there be an exhaustive review of all existing investigations and lawsuits and a dismissal of those which involve “regulation by enforcement” or “pushing the envelope”? (b) Will they focus more on fraud and scams and less on UDAAP? (c) What position will they take on whether the CFPB has been unlawfully funded because the Federal Reserve Banks have had no combined earnings since September 2022? Alan Kaplinsky, Senior Counsel and former chair for 25 years of the Consumer Financial Services Group, hosts the discussion.
CME credits: 1.25 Valid until: 10-01-2026 Claim your CME credit at https://reachmd.com/programs/cme/elevating-hf-care-with-ns-mras-the-future-is-now/30065/ Discover the transformative potential of nonsteroidal mineralocorticoid receptor antagonists (ns-MRAs) in optimizing care for patients with the Cardiovascular-Kidney-Metabolic syndrome. Emerging data presented at EASD, HFSA, ASN and AHA, highlight their ability to improve cardiorenal outcomes in the spectrum of the Cardiovascular-Kidney-Metabolic syndrome. By integrating ns-MRAs into individualized treatment plans, healthcare professionals can offer their patients advanced care backed by cutting-edge research.
CME credits: 1.25 Valid until: 10-01-2026 Claim your CME credit at https://reachmd.com/programs/cme/ns-mras-and-biomarkers-the-nt-probnp-connection/30064/ Discover the transformative potential of nonsteroidal mineralocorticoid receptor antagonists (ns-MRAs) in optimizing care for patients with the Cardiovascular-Kidney-Metabolic syndrome. Emerging data presented at EASD, HFSA, ASN and AHA, highlight their ability to improve cardiorenal outcomes in the spectrum of the Cardiovascular-Kidney-Metabolic syndrome. By integrating ns-MRAs into individualized treatment plans, healthcare professionals can offer their patients advanced care backed by cutting-edge research.
The FiltrateJoel TopfSwapnil HiremathAC GomezJordy CohenNayan AroraSpecial Guest Brendon NuenEditing bySimon Topf and Nayan AroraShow NotesFINEARTS-HF in NEJM FINEARTS Kidney outcomes in JACCFINE-HEART pooled analysis of cardiovascular, kidney and mortality outcomes in Nature Medicine discussion in NephJC BARACH-D: Low-dose spironolactone and cardiovascular outcomes in moderate stage chronic kidney disease: a randomized controlled trial (Nature Medicine)Live Freely Filtered at KidneyWkSwapnil comes out as a SpiroStan post to NephJC TOPCATTOPCAT primary publication TOPCAT North American results TOPCAT funny business explained AHA/ACC/HFSA Heart Failure Guidelines (PDF)SGLT2i are 2aMRA are a 2bARBs are a 2bARNI are a 2bClinical Phenogroups in Heart Failure With Preserved Ejection Fraction: Detailed Phenotypes, Prognosis, and Response to SpironolactoneKansas city cardiomyopathy questionnaire in patients with CKD without a diagnosis of heart failure: https://pubmed.ncbi.nlm.nih.gov/21187260/GFR slope with steroidal MRAs in HF: https://onlinelibrary.wiley.com/doi/10.1002/ejhf.2635Why Has it Been Challenging to Modify Kidney Disease Progression in Patients With Heart Failure? (JACC)Tubular SecretionsSwap: Disclaimer on Apple TVAC: Duo Lingo Plushy (Amazon)Nayan: The Puzzle BoxJordy: Project Hail MaryBrendon has a podcast, The Kidney Compass with Shikha Wadhwani. And he recommends singer-songwriter, Maggie Rogers (YouTube)Joel: The Singularity Is Nearer: When We Merge with AI by Ray KurzweilClosing music, Tim Yau with The Kidney Connection
Welcome to Top of the Morning by Mint, your weekday newscast that brings you five major stories from the world of business. It's Monday, December 9, 2024. This is Nelson John, let's get started. Sanjay Malhotra, a seasoned bureaucrat from the Rajasthan cadre, is set to steer the RBI following his appointment as the new governor. His tenure starts just as Shaktikanta Das wraps up his six-year term. Malhotra, known for his balanced approach to policymaking and administration, has been instrumental in spearheading significant tax reforms as the revenue secretary since 2022. His efforts included simplifying income tax processes, reducing litigation, and combating fake GST registrations. His experience extends beyond finance as he has led initiatives in power, mining, and IT sectors. Notably, as CMD of REC Ltd, he navigated through a power crisis in 2021, showcasing his ability to manage challenging scenarios. Now, as he transitions to the RBI, Malhotra brings a deep understanding of fiscal matters and a track record of advocating for economic growth over mere revenue collection. This change comes at a critical time, with India facing persistent inflation challenges and global economic shifts. India is rolling out a new scheme called 'One Nation, One Subscription' (ONOS) to provide free access to over 13,000 international scientific journals to students and researchers across the country. This move, set to start next year, involves a substantial investment of about ₹6,000 crore over three years, making costly academic resources widely accessible without charge. Managed by the newly established Information and Library Network (INFLIBNET) under the UGC, the scheme will include top publishers like Wiley, Elsevier, and Springer Nature, covering subjects from health to materials science. This initiative not only aims to bridge the gap in academic resources, especially benefiting those in tier-2 and tier-3 cities, but also addresses the issue of academic piracy. Soumya Gupta explains the initiative in today's Primer. India is gearing up to boost its trade with BRICS countries by rolling out customs perks for trusted merchants through mutual recognition agreements, or MRAs. This move will streamline customs clearances, meaning quicker processes and fewer headaches for traders on both sides. Already set up with Russia, India's next stops include South Africa and Brazil, with China potentially in line too. These agreements are super handy for smoothing out trade bumps. They mean faster customs for approved businesses, less time spent on inspections, and quicker tax refunds. Gireesh Chandra Prasad reports on the changes, which are about making trading across borders as swift as possible, helping Indian goods become more competitive in these markets.The Delhi High Court recently addressed a trademark dispute between Mahindra Electric Automobile and Indigo's parent InterGlobe Aviation. Mahindra agreed not to use the "6E" trademark for its upcoming electric car, the BE 6, during the ongoing lawsuit filed by IndiGo, opting to rename it from BE 6E to BE 6. IndiGo has refrained from seeking an interim injunction against Mahindra in response to this undertaking. IndiGo alleges that the "6E" trademark is central to its brand identity. The airlines registered "6E" under various classes related to advertising, transportation, and promotional services. On the other hand, Mahindra, which had initially secured trademark approval for "BE 6E," argues that its mark is distinct given its classification in the motor vehicle category and that it does not conflict with IndiGo's airline services. Mahindra stresses that "BE" stands for its "Born Electric" series, and it plans to contest IndiGo's claims vigorously.Home decor startup Livspace, based in Bengaluru, has been grappling with some customer service challenges, with a number of customers voicing their dissatisfaction online. Despite this, the company reports that a majority of their customers still end up having a positive experience. Recognizing the issues, Livspace is actively working on improvements, particularly since quality concerns can significantly impact its reputation, especially when it comes to big-ticket investments like home interiors. The company last raised substantial funding in 2022, amounting to $180 million, which set high expectations given the company's valuation at the time. To better manage costs and control quality, Livspace has shifted its strategy. They've moved away from using outsourced designers, bringing nearly all design work in-house. This not only helps maintain quality but has also allowed them to cut down on heavy discounts they were offering previously.
Please visit answersincme.com/YTP860 to participate, download slides and supporting materials, complete the post test, and obtain credit. In this activity, experts in cardiology and nephrology discuss the latest evidence and guidance on the use of nonsteroidal mineralocorticoid receptor antagonist (MRA) for the treatment of cardio-renal-metabolic conditions. Upon completion of this activity, participants should be better able to: Identify patients with type 2 diabetes (T2D) who are at high risk for chronic kidney disease (CKD) progression and cardiovascular events; Outline the clinical implications of updated CKD guidelines regarding the use of nonsteroidal MRA therapy in patients with T2D and CKD; and Describe the latest evidence on the use of nonsteroidal MRA therapies in individuals with cardio-renal-metabolic conditions.
On today's Rantzerker Karen, Alison and Brian will be continuing to look at the latest from Jubilee which once again pits MRAs against feminists. Are women really oppressed? Does killing your unborn child equate to true freedom? Should men just cry more? Should we just tear down the concept of sex altogether? Join us at 4pm Eastern!
On today's Rantzerker Karen, Alison and Brian will be continuing to look at the latest from Jubilee which once again pits MRAs against feminists. Are women really oppressed? Does killing your unborn child equate to true freedom? Should men just cry more? Should we just tear down the concept of sex altogether? Join us at 12pm Eastern!
On today's Rantzerker Karen, Alison and Brian will be continuing to look at the latest from Jubilee which once again pits MRAs against feminists. Are women really oppressed? Does killing your unborn child equate to true freedom? Should men just cry more? Should we just tear down the concept of sex altogether? Join us at 12pm Eastern!
CME credits: 0.50 Valid until: 18-10-2025 Claim your CME credit at https://reachmd.com/programs/cme/new-horizons-unraveling-novel-therapies-for-enhanced-cardiovascular-outcomes-in-patients-with-heart-failure/26966/ There are limited therapeutic options for patients with heart failure with mid-range or preserved ejection fraction (HFmrEF/HFpEF). Recently, new data were released on the efficacy and safety of nonsteroidal mineralocorticoid receptor antagonists (MRAs) in patients with HFmrEF/HFpEF. What are the outcomes of the FINEARTS-HF trial with finerenone in this patient population, and what do these findings mean for clinical practice? Three cardiologists discuss the topic of novel therapies, with a focus on nonsteroidal MRAs, to improve cardiovascular outcomes in patients with HFmrEF/HFpEF. =
ESC TV Today brings you concise analysis from the world's leading experts, so you can stay on top of what's happening in your field quickly. This episode covers: Cardiology This Week: A concise summary of recent studies Which MRA to use in which heart failure patient Managing electrical storm Mythbusters: garlic protects from the heart Host: Perry Elliott Guests: Carlos Aguiar, Sana Al-Khatib, Rudolf de Boer Want to watch that episode? Go to: https://esc365.escardio.org/event/1792 Disclaimer ESC TV Today is supported by Bristol Myers Squibb. This scientific content and opinions expressed in the programme have not been influenced in any way by its sponsor. This programme is intended for health care professionals only and is to be used for educational purposes. The European Society of Cardiology (ESC) does not aim to promote medicinal products nor devices. Any views or opinions expressed are the presenters' own and do not reflect the views of the ESC. Declarations of interests Stephan Achenbach, Sana Al-Khatib and Nicolle Kraenkel have declared to have no potential conflicts of interest to report. Carlos Aguiar has declared to have potential conflicts of interest to report: personal fees for consultancy and/or speaker fees from Abbott, AbbVie, Alnylam, Amgen, AstraZeneca, Bayer, BiAL, Boehringer-Ingelheim, Daiichi-Sankyo, Ferrer, Gilead, GSK, Lilly, Novartis, Pfizer, Sanofi, Servier, Takeda, Tecnimede. Davide Capodanno has declared to have potential conflicts of interest to report: Sanofi Aventis, Novo Nordisk, Terumo. Rudolf de Boer has declared to have potential conflicts of interest to report: direct research funding from European Research Council (ERC), Netherlands Heart Foundation, Fondation leDucq, Netherlands Organization for Scientific Research. Research funding to department or institution: AstraZeneca, Abbott, Boehringer Ingelheim, Cardior Pharmaceuticals GmbH, NovoNordisk. Direct fees from Abbott, AstraZeneca, Cardior Pharmaceuticals GmbH, NovoNordisk, Roche Diagnostics. Fees to department or institution: NovoNordisk. Perry Elliott has declared to have potential conflicts of interest to report: consultancies for Pfizer, BMS, Cytokinetics, AstraZeneca, Forbion. Steffen Petersen has declared to have potential conflicts of interest to report: consultancy for Circle Cardiovascular Imaging Inc., Calgary, Alberta, Canada. Emma Svennberg has declared to have potential conflicts of interest to report: Abbott, Astra Zeneca, Bayer, Bristol-Myers, Squibb-Pfizer, Johnson & Johnson.
On today's Rantzerker Karen, Alison and Brian will be looking at the latest from Jubilee which once again pits MRAs against feminists. Are women really oppressed? Does killing your unborn child equate to true freedom? Should men just cry more? Should we just tear down the concept of sex altogether? Join us at 1pm Eastern!
MRAs in HF with renal dysfunction, coronary autoregulation, the hubris of US doctors, NSTEMI in older patients, survival after STEMI, and new leaders at JACC are discussed by John Mandrola, MD. This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I Listener Feedback Combined analysis (Matsumoto) II Coronary artery autoregulation with increasing stenosis NEJM Paper https://www.nejm.org/doi/full/10.1056/NEJMc2402216 III RECOVER IV Trial Gregg Stone, MD Tweet https://x.com/GreggWStone/status/1803583552354742416 DANGER-Shock Trial https://www.nejm.org/doi/full/10.1056/NEJMoa2312572 Impella Saves Lives in Cardiogenic Shock, but Patient Selection Key https://www.medscape.com/viewarticle/1000659 IV NSTEMI Elderly Main Paper Datamethods https://discourse.datamethods.org/t/random-vs-fixed-effects-meta-analysis/7361 O'Fee Paper https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2785560 V MI Survival Danish Paper https://doi.org/10.1016/j.jacc.2024.04.025 You may also like: The Bob Harrington Show with the Stephen and Suzanne Weiss Dean of Weill Cornell Medicine, Robert A. Harrington, MD. https://www.medscape.com/author/bob-harrington Questions or feedback, please contact news@medscape.net
Listener feedback, statin eligibility and Yogi Berra, evidence-based medicine and heterogenous treatment effects, and MRAs in HF are the topics John Mandrola, MD, discusses in this week's podcast. This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I. Listener Feedback ASPIRE AF https://classic.clinicaltrials.gov/ct2/show/NCT03968393 Butala paper: Stroke After TAVR With and Without EPD https://www.ahajournals.org/doi/abs/10.1161/CIRCINTERVENTIONS.123.013697 PROTECTED TAVR Heuts meta-analysis: EPD During TAVR https://heart.bmj.com/content/110/11/757 II. Statin Eligibility JAMA-IM: Data Analytic Choices and Predicting Vascular Events https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2819821 Zeraatker Specification Analysis Paper https://doi.org/10.1016/j.jclinepi.2024.111278 PCE https://www.mdcalc.com/calc/3398/ascvd-atherosclerotic-cardiovascular-disease-2013-risk-calculator-aha-acc III. Heterogenous Treatment Effect Weisberg and Dailey-Higgs DANISH IV. Heart Failure and MRAs RALES https://www.nejm.org/doi/full/10.1056/NEJM199909023411001 EMPHASIS https://www.nejm.org/doi/full/10.1056/NEJMoa1009492 Combined analysis (Matsumoto) You may also like: The Bob Harrington Show with the Stephen and Suzanne Weiss Dean of Weill Cornell Medicine, Robert A. Harrington, MD. https://www.medscape.com/author/bob-harrington Questions or feedback, please contact news@medscape.net
This is a free preview of a paid episode. To hear more, visit www.louiseperry.co.ukMy guest today is Cassie Jaye, a filmmaker best known for the hugely controversial 2016 documentary 'The Red Pill' which followed Cassie's journey from feminism to becoming (partially) persuaded by men's rights activism. We spoke about how she feels about the film – and about MRAs – eight years on.In the extended part of the episode, we also spoke about…
In the sequel to last week's episode, we are back with Dr. Jonathan Davis, Director of the Heart Failure program from San Francisco General. We continue our tour of GDMT for HF, by covering SGLT2-i, MRAs, as well as some AKI and outpatient considerations. This is part 1 of 2 parts which will cover an overview of GDMT medications, and dive into Beta-blockers and ARNIs. Part 2 to come out next week! | 00.33 - Previously on Booster Shots | | 01.31 - Chapter 3: SGLT2-i | The now famous EMPA-REG OUTCOME trial [NEJM 2015] Empagliflozin in HFpEF (not discussed in this episode [NEJM 2021] | 04.24 - Chapter 4: MRAs | RALES trial demonstrating benefit in Morbidity/Mortality [NEJM 1999] | 10.04 - Organizing follow up | | 11.51 - Issues with AKI | | 15.10 - Some fun questions about Fun questions | | 16.54 - Summary of All The Things! | [The appearance of external hyperlinks does not constitute endorsements by UCSF of the linked websites, or the information, products, or services contained therein. UCSF does not exercise any editorial control over the information found therein, nor does UCSF make any representation of their accuracy or completeness. All information contained in this episode are the opinions of the respective speakers and not necessarily the views their respective institutions or UCSF, and is only provided for information purposes, not to diagnose or treat.] Music by Amit Apte. Medical Heart Vectors by Vecteezy
A deep dive into the manosphere, with the scholar who knows it best, Louis Bachaud. The manosphere is a constellation of 5 loosely affiliated communities, including pick-up artists (PUAs), men's rights activists (MRAs), "Men Going Their Own Way" (MGTOW), incels (the "Black Pill" communiy), and the "Red Pill" community. Louis details the history of the manosphere, describes the current factions and their differences, and guides us through their use and misuse of science, especially evolutionary psychology. The episode opens with a systematic critique of the manosphere, and the interview starts around 34 minutes in. Enjoy. Recommended background, especially for critiques of the manosphere: - Bachaud, L., & Johns, S. E. (2023). The use and misuse of evolutionary psychology in online manosphere communities: The case of female mating strategies. Evolutionary Human Sciences, 5, e28. For the size and direction of sex differences, see: - Archer, J. (2019). The reality and evolutionary significance of human psychological sex differences. Biological Reviews, 94(4), 1381-1415. - Stewart-Williams, S., Butler, C. A., & Thomas, A. G. (2017). Sexual history and present attractiveness: People want a mate with a bit of a past, but not too much. The Journal of Sex Research, 54(9), 1097-1105. - Schmitt, D. P. (2005). Sociosexuality from Argentina to Zimbabwe: A 48-nation study of sex, culture, and strategies of human mating. Behavioral and Brain sciences, 28(2), 247-275. - Buss, D. M. (1989). Sex differences in human mate preferences: Evolutionary hypotheses tested in 37 cultures. Behavioral and brain sciences, 12(1), 1-14. For extra-pair paternity: - Wolf, M., Musch, J., Enczmann, J., & Fischer, J. (2012). Estimating the prevalence of nonpaternity in Germany. Human Nature, 23, 208-217. - Anderson, K. (2006). How well does paternity confidence match actual paternity? Evidence from worldwide nonpaternity rates. Current anthropology, 47(3), 513-520. - Bellis, M. A., Hughes, K., Hughes, S., & Ashton, J. R. (2005). Measuring paternal discrepancy and its public health consequences. Journal of Epidemiology & Community Health, 59(9), 749-754. For age gaps: - Conroy-Beam, D., & Buss, D. M. (2019). Why is age so important in human mating? Evolved age preferences and their influences on multiple mating behaviors. Evolutionary Behavioral Sciences, 13(2), 127. - Antfolk, J., Salo, B., Alanko, K., Bergen, E., Corander, J., Sandnabba, N. K., & Santtila, P. (2015). Women's and men's sexual preferences and activities with respect to the partner's age: Evidence for female choice. Evolution and Human Behavior, 36(1), 73-79. - Buunk, B. P., Dijkstra, P., Kenrick, D. T., & Warntjes, A. (2001). Age preferences for mates as related to gender, own age, and involvement level. Evolution and Human Behavior, 22(4), 241-250.
Feminists like to accuse men in general, especially men in the men's rights movement, of basing their values and intentions on controlling & violent impulses & ideology. In the past, when MRAs have documented evidence of female behavior that constitutes a serious men's issue, feminists have accused those maintaining the documentation of stalking, harassment, and threatening women just for having that documentation. So what are they doing with the “Are we dating the same guy” website?
In evaluating Michael Flood's army of strawman arguments, we've run into a consistent problem with his answers. He seems to think Australia is representative of the world. This week, we're going to examine his arguments about filicides, and look at another data set for comparison. Let's see how Flood's claims hold up.
It came from the manosphere. . . In part 1 we learn about pickup artists, or PUAs — a group of men who've designed manipulative strategies in an attempt to attract women. In part 2, we explore the community of men's rights advocates, or MRAs — a group that feels men are the oppressed gender. The Sad Girls were not a fan of either. lolwtfbbq ig: @sadgap.podcast / @misandristmemes / @txgothgf / music producer @iamjonnibrooks.eth
You do NOT want to miss this powerful conversation with the amazing and unapologetic Michelle Mras. Unapologetically You with special guest - Michelle Mras on the Life At Full Blast Podcast Award-winning International TEDx Keynote Speaker, Executive Speaking Coach, co-host of the Denim & Pearls podcast, a 12X Bestselling Author and co-author of 27 books. Michelle is the Host of the MentalShift show on The New Channel (TNC), Philippines. She also has speaking parts in a few SyFy movies check the IMDB.com database for her and has a newly released music EP album, link is on MichelleMras.com Michelle is a survivor of multiple life challenges including a Traumatic Brain Injury and her current battle with Breast Cancer. She guides her clients to recognize the innate gifts within them, to stop apologizing for what they are not and to step into who they truly are. She accomplishes this through one-on-one and group coaching, Training events, Keynote talks, her books, Podcasts and MentalShift television show. Her background is in engineering, marketing management, banking, quality systems management, benefit-auctioneering, fundraising, political campaigning and a plethora of life experiences. She has lived and traveled around the world as a military child and spouse. Throughout her travels she has studied and incorporated the cultures into her life. Michelle's driving thought is that every day is a gift. Tomorrow is never promised. Every moment is an opportunity to be the best version of you… Unapologetically! Learn more about Michelle Mras and her work here - https://michellemras.com/ Learn more about Cindy and her work here - https://fullblastcoaching.com --- Send in a voice message: https://podcasters.spotify.com/pod/show/cindy-van-arnam/message
On social media, the term “fact check” has gotten a bad name due to its bad faith use by woke elitists who often imply that articles containing irrelevant or unrelated claims were written to correct factual information that is being passed around. As we began reading feminist spokesperson Michael Flood's page on “fact-checking MRAs,” it became apparent that he has taken a page from their book. So far, he's offered almost, but not quite, as much substance as one can see between bright objects in the cold vacuum of space. This week, we'll continue with our critique.This show is part of the Spreaker Prime Network, if you are interested in advertising on this podcast, contact us at https://www.spreaker.com/show/4148711/advertisement
ou know how much we just love male feminists here at HBR, especially the one who use the cult to make a career for themselves out of browbeating other men. We're looking at you, professor. No, I'm not capitalizing your choice to make a lot of claims about MRAs and our work, by going through and ripping them apart. Enjoy!This show is part of the Spreaker Prime Network, if you are interested in advertising on this podcast, contact us at https://www.spreaker.com/show/4148711/advertisement
Sponsor Link:- Red Pill Ring- https://www.redpillring.com/Transmaxxing - Why Are Incels Turning Themselves Into Girls? - https://unherd.com/thepost/why-are-in...Transmaxxers article 2: https://www.piratewires.com/p/transma...Mystery Link: https://www.youtube.com/shorts/V1aW4Q...Rumble: https://rumble.com/c/c-2039428Odysee.TV: https://odysee.com/@SandmanMGTOW:cBitchute Link: https://www.bitchute.com/channel/YIxe...SubscribeStar.com: https://www.subscribestar.com/sandmanPaypal / Email: Sandmanmgtow @ Gmail.comBitcoin Address: bc1qtkeru8ygglfq36eu544hxw6n9hsh22l7fkf8uvHi Everyone Sandman Here, This video is brought to you by a donation from Kim and he wants me to cover the Korean term Sampo Generation which means a generation that gives up on dating, marriage and having children. I had heard about the dishwashers in South Korea going their own way. But this term is new to me. Part of the wikipedia entry about the Sampo Generation says this and I quote: "Many of the young generation in South Korea have given up those three things because of social pressures and economic problems such as increasing cost-of-living, tuition payments, and affordable housing scarcity. There is also the opo sedae, or "five giving-up generation", which takes the same three and adds employment and home ownership. The chilpo sedae ("seven giving-up generation") further includes interpersonal relationships and hope, while the gupo sedae ("nine giving-up generation") extends to physical health and appearance. Finally, the sippo sedae ("ten giving-up generation") or wanpo sedae ("total giving-up generation") culminates in giving up life. The Sampo generation is similar to the Satori generation in Japan." unquote. This all kind of reminds me of the four or five levels of MGTOW. But that only goes as far as living as a reclusive self sufficient hermit in the woods. Not offing yourself. So I did a bit more research on this and discovered a mix race couple's YouTube channel called 2 heart 1 seoul spelled Seoul where the guy is Korean and his partner she's Canadian. They made a video about the Sampo generation and that's how I found them. They reminded me of all the mixed race couples with white whamen and Indian guys. Again he looks tall and looks like a Liu Kang instead an Incel no one wants to bang. Seems like western whamen are poaching the best men from foreign lands and geomaxxing too. In their video about the Sampo Generation they say the reason many guys are checking out is because it costs too much financially to get married and start a family. Also that it doesn't apply to people who actively choose to go their own way. Only those that have been sent their own way becauase they can't afford dating, marriage and children. Sure blame it on money when it's also a feminism and gynocentrism thing. Remember that Korea has the highest rates of feminism out of China, Japan and Korea and when you stop being a Christian it's not like you give up on your faith completely. You start falling for the feminist faith instead. It's easy to just blame money for the reason why guys are checking out in Korea. Remember that there are tons of MRAs in Korea fighting for men's rights. Guys are learning how to fight back against feminism in Korea better than any other country in the world and are going after companies that promote feminism and boycott them and as a result woke companies have to bend the knee instead of the other way around. I'll discuss more in a moment but let me first tell everyone about today's sponsor The Red Pill Ring:Support this podcast at — https://redcircle.com/mgtow/donationsAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy
The following question refers to Section 7.2 of the 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure. The question is asked by Cleveland Clinic internal medicine resident and CardioNerds Intern Akiva Rosenzveig, answered first by UPMC Harrisburg cardiology fellow and CardioNerds Academy House Faculty Leader Dr. Ahmed Ghoneem, and then by expert faculty Dr. Randall Starling. Dr. Starling is Professor of Medicine and an advanced heart failure and transplant cardiologist at the Cleveland Clinic where he was formerly the Section Head of Heart Failure, Vice Chairman of Cardiovascular Medicine, and member of the Cleveland Clinic Board of Governors. Dr. Starling is also Past President of the Heart Failure Society of America in 2018-2019. Dr. Staring was among the earliest CardioNerds faculty guests and has since been a valuable source of mentorship and inspiration. Dr. Starling's sponsorship and support was instrumental in the origins of the CardioNerds Clinical Trials Program. The Decipher the Guidelines: 2022 AHA / ACC / HFSA Guideline for The Management of Heart Failure series was developed by the CardioNerds and created in collaboration with the American Heart Association and the Heart Failure Society of America. It was created by 30 trainees spanning college through advanced fellowship under the leadership of CardioNerds Cofounders Dr. Amit Goyal and Dr. Dan Ambinder, with mentorship from Dr. Anu Lala, Dr. Robert Mentz, and Dr. Nancy Sweitzer. We thank Dr. Judy Bezanson and Dr. Elliott Antman for tremendous guidance. Enjoy this Circulation 2022 Paths to Discovery article to learn about the CardioNerds story, mission, and values. Question #27 Which of the following sentences regarding diuretics in the management of heart failure is correct? A In HF patients with minimal congestive symptoms, medical management with diuretics alone is sufficient to improve outcomes. B Prescribing a loop diuretic on discharge after a HF hospitalization may improve short term mortality and HF rehospitalization rates. C The combination of thiazide (or thiazide-like) diuretics with loop diuretics is preferred to higher doses of loop diuretics in patients with HF and congestive symptoms. D The maximum daily dose of furosemide is 300 mg. Answer #27 Explanation Choice B in correct. The guidelines give a Class 1 recommendation for diuretics in HF patients who have fluid retention to relieve congestion, improve symptoms, and prevent worsening heart failure. Recent data from the non-randomized OPTIMIZE-HF (Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure) registry revealed reduced 30-day all-cause mortality and hospitalizations for HF with diuretic use compared with no diuretic use after hospital discharge for HF. Choice A is incorrect. With the exception of mineralocorticoid receptor antagonists (MRAs), the effects of diuretics on morbidity and mortality are uncertain. As such, diuretics should not be used in isolation, but always combined with other GDMT for HF that reduce hospitalizations and prolong survival. Choice C is incorrect. The use of a thiazide or thiazide-like diuretic (e.g., metolazone) in combination with a loop diuretic inhibits compensatory distal tubular sodium reabsorption, leading to enhanced natriuresis. In a propensity-score matched analysis in patients with hospitalized HF, the addition of metolazone to loop diuretics was found to increase the risk for hypokalemia, hyponatremia, worsening renal function, and mortality, whereas use of higher doses of loop diuretics was not found to adversely affect survival. The guidelines recommend that the addition of a thiazide (e.g., metolazone) to treatment with a loop diuretic should be reserved for patients who do not respond to moderate- or high-dose loop diuretics to minimize electrolyte abnormalities (Class...
Grifty Pod Episode 8: Boys Don't Cry Boy's don't cry, and that is precisely the problem. On this episode of Grifty, all the gang is back in town for our back-to-school episode of exploring the Manosphere – an interconnected echo chamber of men and boys where the themes of toxic masculinity, misogyny, and homophobia are platformed and normalized in online forums, podcasts, and articles all over the web. A large part of the appeal of the manosphere is that it acknowledge the increasing rates of depression, suicide, and incarceration among men. However, they take this sliver of truth and leverage it into a fear-mongering grift where they make the false link that these issues plaguing our boys and men are the result of some global conspiracy. Find us on all social media platforms @griftypod Learn more www.grifty.org IN THIS EPISODE On the History of the Manosphere: “The Evolution of the Manosphere Across the Web,” Proceedings of the Fifteenth International AAAI Conference on Web and Social Media (ICWSM 2021) The Evolution of the Manosphere across the Web “To Learn About the Far Right, Start With the ‘Manosphere',” The Atlantic https://www.theatlantic.com/international/archive/2019/08/anti-feminism-gateway-far-right/595642/ On the Ideology and Content of the Manosphere: “Glitz, Glam & Violent Misogyny: The Toxic Ideology of the Manosphere,” International Socialist Alternative https://internationalsocialist.net/en/2023/05/socialist-feminism “Jordan Peterson and the Return of the Men's Rights Movement,” The Washington Post https://www.washingtonpost.com/news/made-by-history/wp/2018/07/24/before-jordan-peterson-there-were-mens-rights-activists/ “The Liver King and the Problematic rise of Primal Manhood,” Huck Magazine https://www.huckmag.com/article/liver-king-and-the-problematic-rise-of-primal-manhood On the Radicalization of men and boys caused by the Manosphere: “The “Manosphere” Is Getting More Toxic As Angry Men Join the Incels,” MIT Technology Review https://www.technologyreview.com/2020/02/07/349052/the-manosphere-is-getting-more-toxic-as-angry-men-join-the-incels/ “The Misogynist Incel Movement is Spreading. Should it be Classified as a Terror Threat?,” The Guardian https://www.theguardian.com/lifeandstyle/2021/mar/03/incel-movement-terror-threat-canada “ Mass Violence and Terrorism since Santa Barbara,” New America https://www.newamerica.org/political-reform/reports/misogynist-incels-and-male-supremacism/mass-violence-and-terrorism-since-santa-barbara “Elliot Rodger: How misogynist killer became 'incel hero',” BBC.com https://www.bbc.com/news/world-us-canada-43892189 “Plymouth Shooter Fascinated By Serial Killers and ‘Incel' Culture, Inquest Hears,” The Guardian https://www.theguardian.com/uk-news/2023/jan/18/plymouth-shooter-jake-davison-fascinated-by-mass-shootings-and-incel-culture-inquest-hears On the grifts, scams, and charlatans of the Manosphere: “Andrew Tate Wants Everyone To Get In On the Grift,” Jacobin https://jacobin.com/2023/03/andrew-tate-capitalism-scam-misogyny-alienation-hustle “Generation Tate: How can we stop losing vulnerable men to the ‘manosphere'?,” The Independent https://www.independent.co.uk/life-style/andrew-tate-manosphere-influencers-b2261515.html?utm_source=flipboard&utm_content=Independent%2Fmagazine%2FLife+%26+Style The manosphere consists of 5 main groups: Men's rights activists (MRAs) advocate political changes that will benefit men. However, much of their activism consists of harassment and abuse towards feminists and other female public figures. (example: Jordan Peterson, Joe Rogan) Men going their own way (MGTOW) argue that women are so toxic that men should avoid them altogether. Some MGTOW will date women but avoid anything serious like getting married, while others won't even be friends with women. (example: youtube channels like Hooman TV and Fresh & Fit Clips that aim to portray woman as selfish gold diggers that ‘use' men for their wealth) Pick-up artists (PUAs) teach men seduction strategies so that they can be more successful in attracting women. Many of these techniques involve mistreating women, such as insulting them (“negging”) or disregarding consent. (example: Andrew Tate and his ‘hustler university' scam) Involuntary celibates (incels) believe they are entitled to a relationship with a woman, but are incapable of finding a partner. Multiple acts of extreme violence and even murder have been attributed to this group. (example: Elliot Rodger 2014 Isla Vista shooting, Jake Davidson Plymouth Shooter 2021) Primal Manhood Alphas These masculinity influencers champion a hyper-masculine version of self actualization that seeks to revert to an ‘ancestral' lifestyle with their diet and workouts as well as reverting to a time when women were confined to the home and subservient to men. (example: Liver King) The history of the manosphere dates back to the Men's Liberation movement that began in the 1960s and went on through the 80s. Existed within the context of the Vietnam war and it was essentially a critique of traditional male gender roles. These were the hippies that were raised by their WW2 veteran fathers and homemaker mothers who pushed a very traditional binary for gender roles which these men within the liberation movement saw as toxic. They rejected the notion that the main role for men is to produce money and this essentially anti-capitalist view was tied together with second-wave feminism. Pretty reasonable in those early years. but this honeymoon if you will ended by the mid 70s. As inflation and gas prices went up and employment and faith in politicians went down, a new group branched off from the Men's Liberation movement called Men's Rights advocates. They placed blame the problems of the time on feminism and women's liberation. They focused on what they felt were men's issues like divorce and custody issues, health problems, etc. They went from a sympathetic tone of this whole system is fucked up and we support the empowerment of both women and men. But then capitalism stops working and with less money and opportunities they're like “umm actually we think giving women rights and power is actually the problem so we'd like to take that back, please” But some would say that even before the 1960s, the seed was planted for the manosphere by pop culture trends that broke away from traditional male gender roles. The launch of Playboy Magazine in the early 1950s created this window into an aspirational world for men who sought a life more liberating than the college-job-wife-suburbs-kids pipeline. Playboy provided young men of the post war era an alternative view of masculinity. You can be a complete person without having a family and being the bread winner. This is a good thing. But what was suggested to essentially fill that spot was stuff – a nice place full of cool furniture, a stocked bar to bring over the ladies that you also treat like an object. He essentially invented and popularized the concept of the bachelor pad. Ironically, this alternative vision was still a fully capitalistic one, just changing the rewards from a family in the suburbs to the bachelor pad in the city 1950s culture was toxic so it's not that unreasonable to want to break from it; but as we all know Hugh took this to an extreme that became even more toxic than the culture it was critiquing. He took the same tactic that we are seeing today with the manosphere – instead of saying hey we don't have to live up to these toxic gender roles that are making you feel detached and frustrated. No, instead he blames women for those troubles. The very first issue of Playboy included an article warning men on “money hungry, gold-digging women” and went on to talk about the magazine's love for “long legged big breasted women” and their hate for wives
Join experts Drs Matthew Sparks and James Matthew Luther as they discuss how and why they're using mineralocorticoid receptor antagonists to treat patients with diabetic kidney disease in their practice. Relevant disclosures can be found with the episode show notes on Medscape (https://www.medscape.com/viewarticle/991189). The topics and discussions are planned, produced, and reviewed independently of advertisers. This podcast is intended only for US healthcare professionals. Resources Chronic Kidney Disease (CKD) https://emedicine.medscape.com/article/238798-overview Physiology, Aldosterone https://www.ncbi.nlm.nih.gov/books/NBK470339/ Angiotensin II https://www.ncbi.nlm.nih.gov/books/NBK499912/ Primary Aldosteronism https://emedicine.medscape.com/article/127080-overview Epithelial Sodium Channel (ENaC) and the Control of Blood Pressure https://pubmed.ncbi.nlm.nih.gov/24721652/ Hypertension Treatment & Management https://emedicine.medscape.com/article/241381-treatment Hypertension Medication https://emedicine.medscape.com/article/241381-medication#2 Mineralocorticoid Receptor Antagonists in Diabetic Kidney Disease - Mechanistic and Therapeutic Effects https://pubmed.ncbi.nlm.nih.gov/34675379/ Malignant Hypertension https://emedicine.medscape.com/article/241640-overview Androgenetic Alopecia https://emedicine.medscape.com/article/1070167-overview Effect of Finerenone on Chronic Kidney Disease Outcomes in Type 2 Diabetes https://pubmed.ncbi.nlm.nih.gov/33264825/ Cardiovascular Events With Finerenone in Kidney Disease and Type 2 Diabetes https://pubmed.ncbi.nlm.nih.gov/34449181/ Regression to the Mean https://www.britannica.com/topic/regression-to-the-mean Sodium-glucose Transport Protein 2 (SGLT2) Inhibitors https://www.ncbi.nlm.nih.gov/books/NBK576405/ Potassium Binders for Chronic Hyperkalaemia in People With Chronic Kidney Disease https://pubmed.ncbi.nlm.nih.gov/32588430/
Michelle Mras is an award-winning, internationally recognized inspirational speaker, published #1 Best Selling Author, intuitive leader, wife, and mother who has been stirring audiences and individuals to action through her compelling message of self-leadership, resilience, and living a life of intention. Michelle's infectious presentations and coaching inspire her clients to rise above negative self-talk to reclaim their inner grit. Michelle encourages you to be your best version every day and live unapologetically. Her fiery spirit and passion drive her to candidly share the key moments that transformed her into the irresistible force she is today. This episode is titled “Be The Best You… Unapologetically!” because Michelle empowers people to be your best version every day and to always live unapologetically. Jr and Michelle take a deep dive into how to be the best version of yourself by identifying your true gifts and deep desires. If all business leaders truly served others by leading with their true gifts, the world can become a better place. Michelle encourages you to be you and to never apologize for who you truly are! In this episode, business strategist and consultant, JR Spear, will teach you how to become the best version of yourself by being your most authentic and true self. Pull up a seat because this is a conversation you do not want to miss! Learn more about Michelle and her writing at www.MichelleMras.com. Connect with Business Leaders Network www.businessleadersnetworking.com grow@businessleadersnetworking.com
Sponsor Link: Chris Whalen CPAhttp://www.chriswhalencpa.comhttps://www.amazon.com/dp/0979352266‘Manosphere': Where men who hate women come together for supporthttps://bit.ly/3NzITCLMystery Link: https://www.youtube.com/watch?v=wMiK7...Odysee.TV: https://odysee.com/@SandmanMGTOW:cBitchute Link: https://www.bitchute.com/channel/YIxe...SubscribeStar.com: https://www.subscribestar.com/sandmanPaypal / Email: Sandmanmgtow @ Gmail.comBitcoin Address: bc1qtkeru8ygglfq36eu544hxw6n9hsh22l7fkf8uvHi Everyone Sandman Here,This video isn't brought to you by any donation because I didn't get any. If you want to request a topic you can do so at the Paypal or subscribestar links found in the description. I thought I'd take a chance and cover an article called Manosphere: Where men who hate women come together for support by PATRICIA GOSÁLVEZ and here's what parts of her article have to say and I quote: In the jungle of the manosphere, there are different subcultures: MRAs, MTGOW, incels... This caste system is explained endlessly on websites and forums with the meticulous detail of someone describing a Tolkien universe or a deck of Pokémon. There are the “men's rights activists” (MRA). Their causes are mistreated men, especially in terms of parental custody, and they want to change the laws. Then there are the pick-up artists), who have “professionalized” their activity, converting it into a business. Ther are also anti-feminist women, who have “high symbolic value.” Then there are the MGTOWs, or men going their own way, whose misogyny has no monetary or social relevance. They do not want to transform anything, but live on the sidelines: they are done with relationships, and their rhetoric is more cynical. “In Spain, there are very few of them, but they are still more numero Ultimately, the men of all these subcultures are united by the feeling of being “victims of the discrimination that living in a society they consider gynocentric means. They are seeking a group identity, their search is not so much for information as for consolation.”" The manosphere is an internet universe of online forums, websites, blogs, YouTube channels and social media profiles marked by the defense of a masculinity that is loaded with misogyny, where users feel threatened by the system, women and, above all, feminism. “Parallel to the arrival of feminism in institutions, there has been an anti-feminist retreat that considers itself countercultural,” says Elisa García-Mingo, a sociologist from Spain who spent a year between February 2021 and 2022 diving into online spaces. She and fellow researcher Silvia Díaz Fernández shared their findings in a report called Young people in the manosphere: Influence of digital misogyny on their perception of sexual violence. García-Mingo says hat authorities are closely monitoring the radicalization of what they describe as “incel terrorism.” What worries her the most, she says, is “how easily and subtly kids come across this content and how they internalize it, turning it into something emotional that you can no longer refute with arguments or data.” For example: a boy who starts dating girls and Googles “flirt” will soon fall into a spiral of hostile, misogynistic and even self-destructive content.Support this podcast at — https://redcircle.com/mgtow/donationsAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy
http://ExpertTalk.fm ~ Expert Talk with TGo is not your average talk show. It's been chosen as one of the exclusive Talk Shows to be featured on Amazon Prime for the first 2 seasons, with over 400 episodes and counting featuring over 70 millionaires and 3 billionaires, this show is the ultimate connector to experts from all over the world through more than 50 social video and audio platforms, including iHeart Radio, as well as OTT streaming apps like ROKU, Amazon Fire TV, and Apple TV. And if that's not enough, Expert Talk with TGo has reached millions of TV viewers across the US through YurView and COX Communications. This Episode features Chris Naugle. Chris is the founder and CEO of The Money School. The Money School teaches you to Be Your Own Bank - which helps you solve your money problem, by putting you back in control of your money. Michelle Mras is an award winning, internationally recognized inspirational speaker, published #1 Best Selling Author, intuitive leader, who has been stirring audiences and individuals to action through her compelling message of self-discovery and living a life of intention. Peggy McColl is a world-renowned wealth, business and manifestation expert as well as the New York Times Best Selling Author of "Your Destiny Switch: Master Your Key Emotions and Attract the Life of Your Dreams”. #ExpertTalkWithTGo #ExpertTalkXtra #TalkShow #PodcastToBroadcast #TheresaGoss #ExpertTalkFM #Roku #Pandora #iHeartRADIO #PodNationTV #talkshowtv #talkshowonline #talkshowhost #podcast #motivation #broadcast #listennow #entrepreneur #marketing #TGoTV #9at9 #FastFunInformative #LightsCamerasTakeAction #YurView #Cox
For more information regarding this CME/CE activity and to complete the CME/CE requirements and claim credit for this activity, visit:https://www.mycme.com/courses/the-role-of-non-steroidal-mras-in-chronic-kidney-disease-8866Featuring faculty Robert D. Toto, MD, moderated by Gregg Sherman, MD.SummaryChronic kidney disease (CKD) is estimated to affect 20%–40% of patients with diabetes mellitus. In renal disease, increased production of aldosterone and other mediators leads to overactivation of the mineralocorticoid receptor (MR). In turn, overactivation of the MR can drive progression of renal disease. Through these mechanisms, increased aldosterone production and MR overactivation contribute to adverse renal, cardiac, and vascular effects. Traditional steroidal MR antagonists (MRAs) are beneficial but are associated with hyperkalemia. However, a newer nonsteroidal MRA is available that targets MR overactivation without the risk of hyperkalemia.In this second of two podcast episodes, Dr. Robert Toto and Dr. Gregg Sherman discuss identifying appropriate candidates for nonsteroidal MRAs, as well as incorporating these therapies into the management of CKD of T2D.This podcast was recorded and is being used with permission of the presenters.Learning ObjectiveUpon completion of this activity, learners should be able to:Identify patients with CKD and T2D who are appropriate candidates for non-steroidal MRAs to manage residual riskThis activity is accredited for CME/CE Credit.The National Association for Continuing Education is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.The National Association for Continuing Education designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.National Association for Continuing Education is accredited by the American Association of Nurse Practitioners as an approved provider of nurse practitioner continuing education. Provider number: 121222. This activity is approved for 0.25 contact hours (which includes 0.25 hours of pharmacology).Summary of Individual DisclosuresRobert Toto has disclosed the following financial relationships:Consultant: Amgen (Anemia in CKD), AstraZeneca (CKD), Akebia (Anemia in CKD), Bayer (CKD), Boehringer Ingelheim (CKD), Medscape (CKD anemia and hyperkalemia), Novartis (CKD), Novo Nordisk (Diabetic Kidney Disease), Otsuka (Anemia in CKD), Vifor (CKD), CinCor (CKD)Advisor – Unicycive (hyperphosphatemia in CKD)Angela Golden has disclosed the following financial relationships:Consultant: SetPoint (Obesity), WW (Obesity)Advisor: Currax (Obesity), Genesis (Obesity), Lilly (Obesity), Novo Nordisk (Obesity), (Obesity), Acela (Hypothyroidism)Speaker: Currax, Novo Nordisk (Obesity)Receipt of Royalty: Amazon (fiction books), Springer (obesity book)Faculty, planners, guest patient(s) (if applicable), and moderators for this educational activity not listed in the Summary of Individual Disclosures above have no relevant financial relationship(s) to disclose with ineligible companies whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.Disclosure of Commercial SupportThis activity has been supported by an educational grant from Bayer HealthCare Pharmaceuticals Inc.Please visit http://naceonline.com to engage in more live and on demand CME/CE content.
For more information regarding this CME/CE activity and to complete the CME/CE requirements and claim credit for this activity, visit:https://www.mycme.com/courses/residual-risk-in-chronic-kidney-disease-8865Featuring faculty Robert D. Toto, MD, moderated by Gregg Sherman, MD.SummaryChronic kidney disease (CKD) is estimated to affect 20%–40% of patients with diabetes mellitus. All-cause mortality in patients with diabetic kidney disease (DKD) is 30-fold higher than in individuals who have diabetes without CKD, and many of these deaths are due to cardiovascular disease (CVD). Traditional steroidal MR antagonists (MRAs) are beneficial but are associated with hyperkalemia. In this first of two podcast episodes, Dr. Robert Toto and Dr. Gregg Sherman discuss the impact of MR overactivation on cardiovascular risk and CKD progression in patients with diabetes, as well as the mechanism of action and recent data regarding newer non-steroidal MRA and emerging treatment options for CKD of T2D. This podcast was recorded and is being used with permission of the presenters.Learning ObjectivesRecognize the impact of mineralocorticoid receptor (MR) overactivation on cardiovascular risk and chronic kidney disease (CKD) progression in patients with diabetesSummarize the mechanism of action, efficacy, and safety of non-steroidal MR antagonists (MRAs) and other emerging treatment options for CKD of T2DThis activity is accredited for CME/CE Credit.The National Association for Continuing Education is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. The National Association for Continuing Education designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. National Association for Continuing Education is accredited by the American Association of Nurse Practitioners as an approved provider of nurse practitioner continuing education. Provider number: 121222. This activity is approved for 0.25 contact hours (which includes 0.25 hours of pharmacology).Summary of Individual DisclosuresRobert Toto has disclosed the following financial relationships:Consultant: Amgen (Anemia in CKD), AstraZeneca (CKD), Akebia (Anemia in CKD), Bayer (CKD), Boehringer Ingelheim (CKD), Medscape (CKD anemia and hyperkalemia), Novartis (CKD), Novo Nordisk (Diabetic Kidney Disease), Otsuka (Anemia in CKD), Vifor (CKD), CinCor (CKD)Advisor – Unicycive (hyperphosphatemia in CKD)Angela Golden has disclosed the following financial relationships:Consultant: SetPoint (Obesity), WW (Obesity)Advisor: Currax (Obesity), Genesis (Obesity), Lilly (Obesity), Novo Nordisk (Obesity), (Obesity), Acela (Hypothyroidism)Speaker: Currax, Novo Nordisk (Obesity)Receipt of Royalty: Amazon (fiction books), Springer (obesity book)Faculty, planners, guest patient(s) (if applicable), and moderators for this educational activity not listed in the Summary of Individual Disclosures above have no relevant financial relationship(s) to disclose with ineligible companies whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.Disclosure of Commercial SupportThis activity has been supported by an educational grant from Bayer HealthCare Pharmaceuticals Inc.Please visit http://naceonline.com to engage in more live and on demand CME/CE content.
Amy is joined by Dr. Srimati Basu to discuss her book The Trouble With Marriage: Feminists Confront Law and Violence in India and explore the complicated gender politics behind divorce.Srimati Basu is a Professor of Gender and Women's Studies and Anthropology, and a member of the Committee on Social Theory. She serves as the President of the Association for Feminist Anthropology, 2021-2023. Srimati has an Interdisciplinary Ph.D. from Ohio State University in Cultural Studies/ Anthropology/ Women's Studies, and her teaching, research and community work interests include Global Feminisms, Law, Gender-Based Violence, Social Movements, Feminist Methodologies, and Masculinities. At present, she is writing a monograph on anti-feminist men's rights groups, following a 2013-14 Fulbright Fellowship to conduct fieldwork with MRAs across Indian cities. She has recently begun a research project on Indian women private detectives with fellowships from National Endowment for Humanities/ American Institute of Indian Studies and from Sisters in Crime.
George L. Bakris, MD, MA - Step-by-Step: Setting a Course for Managing CKD and T2DM With Nonsteroidal MRAs
Michelle Mras is an award-winning, internationally recognized speaker. She is a number one bestselling author, an intuitive leader, a wife and mother who has been stirring audiences into action through a compelling message of self-leadership, resilience and living a life of intention. Listen in as we discuss embracing the toddler mindset, rising up after a fall, and how Michelle is known for creating clarity for others as the conductor of clarity. Please enjoy, subscribe, and share. https://buildcs.net brianb@buildcs.net https://michellemras.com
We demystify primary aldosteronism, MRAs (mineralocorticoid receptor antagonists), non-steroidal MRAs, and how to recognize and treat renovascular hypertension with nephrologist/hypertension expert, Dr. Matt Luther (@DrJMLuther) as part of the NephMadness PodCrawl 2023. Fill out a bracket for NephMadness and check out all eight NephMadness PodCrawl participants at NephMadness.com/podcrawl (list below) and the MRA region write-up by Micah Schub (@AcidBassMD). The Curbsiders gets the skinny on mineralocorticoid receptor antagonists Core IM will be covering Kidney Transplant in their classic Five Pearl format The CardioNerds will be covering the effect of Heart Failure Devices on Kidney Health Freely Filtered will try to understand thrombotic microangiopathy ISN Global Kidney Care goes deep on IgA nephropathy The Cribsiders look at transitions, first the Pediatrics to Adult nephrology transition and then from living to death with palliative nephrology Fellow on Call will be covering Onconephrology And finally, The Nephron Segment looks at Transgender Health and CKD Claim free CME for this episode at curbsiders.vcuhealth.org! Episodes | Subscribe | Spotify | YouTube | Mailing List | Contact | Swag | CME Show Segments Intro Diagnosis and Management of Primary Aldosteronism (PA) MRAs vs non-steroidal MRAs (mineralocorticoid receptor antagonists) NephMadness MRA region picks Renovascular Hypertension Outro Credits Writer and Producer: Matthew Watto MD Show Notes: Matthew Watto MD Cover Art & Infographic: Matthew Watto MD Hosts: Matthew Watto MD, FACP; Paul Williams MD, FACP Reviewer: Leah Witt MD Showrunners: Matthew Watto MD, FACP; Paul Williams MD, FACP Technical Production: PodPaste Guest: J. Matthew Luther MD Sponsor: Locumstory Get a comprehensive view of locums, and decide if it;s right for you, at locumstory.com Sponsor: indeed Visit indeed.com/internalmedicine to start hiring now.
Sponsor Link: Chris Whalen CPAhttp://www.chriswhalencpa.comhttps://www.amazon.com/dp/0979352266Feminist Logichttps://www.reddit.com/r/MensRights/c...Mystery Link: https://www.youtube.com/watch?v=nByBE...Odysee.TV: https://odysee.com/@SandmanMGTOW:cBitchute Link: https://www.bitchute.com/channel/YIxe...SubscribeStar.com: https://www.subscribestar.com/sandmanPaypal / Email: Sandmanmgtow @ Gmail.comBitcoin Address: bc1qtkeru8ygglfq36eu544hxw6n9hsh22l7fkf8uvHi Everyone Sandman Here, This video is brought to you by a donation from James. He didn't give me a topic so I wanted to read and cover a reddit post I found on the men's rights Reddit called Feminist Logic. Which has to be the biggest oxymoron in the world. The irony is not lost on me. You don't reach whamen with logic and reason. You reach them by tickling their emotions regardless of if what you say is factually right or wrong. It's all about the oppressor ie the man and the oppressed ie the whamen. It's all about cultural marxism. Instead of the business owner oppressing the worker. Now we have the man oppressing the woman. Anywho the MRAs just don't get it. Here's what the Reddit post says and I quote: According to women “500 years ago, men discriminated against women. You are a man too, so you must be a misogynist!” What kind of logic is this and how am I supposed to be accountable for something that happened centuries ago JUST BECAUSE IM THE SAME GENDER? Women say “We can't walk out at night so women have it harder” It is not our problem you are too paranoid to walk from your house. Women also say "We are expected to do EVERYTHING like shopping, cleaning etc.” So you want to do no work while the man works his butt off all day, and then you spend all his money on dumb things? Women also say “I can hit you all I want, but if you dare hit me, you're an abuser!” I don't even know what to say to this. This is a double standard that clearly has men as the bad ones, and women try to act like THEY are the victims here? They also say “Men hit and abuse women” Think who really is in the power here, a woman can easily lie, and ruin a man's life. If any of you understand this reference, life for men is like Minecraft's new chat reporting system, even a false accusation gets you permanently banned." unquote. I'll discuss more in a moment but let me first tell everyone about today's sponsor Chris Whalen:Support this podcast at — https://redcircle.com/mgtow/donationsAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy
The following question refers to Section 7.3.1 of the 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure. The question is asked by Palisades Medical Center medicine resident & CardioNerds Intern Dr. Maryam Barkhordarian, answered first by MedStar Washington Hospital Center cardiology hospitalist & CardioNerds Academy Graduate Dr. Luis Calderon, and then by expert faculty Dr. Robert Mentz. Dr. Mentz is associate professor of medicine and section chief for Heart Failure at Duke University, a clinical researcher at the Duke Clinical Research Institute, and editor-in-chief of the Journal of Cardiac Failure. Dr. Mentz is a mentor for the CardioNerds Clinical Trials Network as lead principal investigator for PARAGLIDE-HF and is a series mentor for this very 2022 heart failure Decipher the Guidelines Series. For these reasons and many more, he was awarded the Master CardioNerd Award during ACC22. Welcome Dr. Mentz! The Decipher the Guidelines: 2022 AHA / ACC / HFSA Guideline for The Management of Heart Failure series was developed by the CardioNerds and created in collaboration with the American Heart Association and the Heart Failure Society of America. It was created by 30 trainees spanning college through advanced fellowship under the leadership of CardioNerds Cofounders Dr. Amit Goyal and Dr. Dan Ambinder, with mentorship from Dr. Anu Lala, Dr. Robert Mentz, and Dr. Nancy Sweitzer. We thank Dr. Judy Bezanson and Dr. Elliott Antman for tremendous guidance. Enjoy this Circulation 2022 Paths to Discovery article to learn about the CardioNerds story, mission, and values. Question #7 Ms. Valarie Sartan is a 55-year-old woman with a history of HFrEF (EF 35%) and well controlled, non-insulin dependent diabetes mellitus who presents to heart failure clinic for routine follow up. She is currently being treated with metoprolol succinate 200mg daily, lisinopril 10mg daily, empagliflozin 10mg daily, and spironolactone 50mg daily. She notes stable dyspnea with moderate exertion, making it difficult to do her yardwork. On exam she is well appearing, and blood pressure is 115/70 mmHg with normal jugular venous pulsations and trace bilateral lower extremity edema. On labs, her potassium is 4.0 mmol/L and creatinine is 0.7 mg/dL with an eGFR > 60 mL/min/1.73m2. Which of the following options would be the most appropriate next step in heart failure therapy? A Increase lisinopril to 40mg daily B Increase spironolactone to 100mg daily C Add sacubitril-valsartan to her regimen D Discontinue lisinopril and start sacubitril-valsartan in 36 hours E No change Answer #7 Explanation The correct answer is D – transitioning from an ACEi to an ARNi is the most appropriate next step in management. The renin-angiotensin aldosterone system (RAAS) is upregulated in patients with chronic heart failure with reduced ejection fraction (HFrEF). Blockade of the RAAS system with ACE inhibitors (ACEi), angiotensin receptor blockers (ARB), or angiotensin receptor neprilysin inhibitors (ARNi) have proven mortality benefit in these patients. The PARADIGM-HF trial compared sacubitril-valsartan (an ARNi) with enalapril in symptomatic patients with HFrEF. Patients receiving ARNi incurred a 20% relative risk reduction in the composite primary endpoint of cardiovascular death or heart failure hospitalization. Based on these results, the 2022 heart failure guidelines recommend replacing an ACEi or ARB for an ARNi in patients with chronic symptomatic HFrEF with NYHA class II or III symptoms to further reduce morbidity and mortality (Option D). This is a class I recommendation with level of evidence of B-R and is also of high economic value. Making no changes at this time would be inappropriate (Option E). While it would be reasonable to increase the dose of lisinopril to 40mg (Option A), this should be pursued only if ARNi therapy is not tolerated. Mineralocorticoid receptor antagonists (MRAs) have a class I (LOE A...
This podcast, Dr. Peter Eckman, a cardiologist and heart failure specialist, with Minneapolis Heart Institute, discusses heart failure and why it is an extensive medical issue. Enjoy the podcast. Objectives:Upon completion of this podcast, participants should be able to: Recognize heart failure as a problematic clinical disease and its morbidity and mortality that leads to comprehensive medical management. Identify and describe optimal contemporary medical therapy for heart failure. Describe novel options for heart failure. CME credit is only offered to Ridgeview Providers & Allied Health staff for this podcast activity. After listening to the podcast, complete and submit the online evaluation form. Upon successful completion of the evaluation, you will be e-mailed a certificate of completion within approximately 2 weeks. You may contact the accredited provider with questions regarding this program at Education@ridgeviewmedical.org. Click the link below, to complete the activity's evaluation. CME Evaluation (**If you are listening to the podcasts through iTunes on your laptop or desktop, it is not possible to link directly with the CME Evaluation for unclear reasons. We are trying to remedy this. You can, however, link to the survey through the Podcasts app on your Apple and other smart devices, as well as through Spotify, Stitcher and other podcast directory apps and on your computer browser at these websites. We apologize for the inconvenience.) DISCLOSURE ANNOUNCEMENT The information provided through this and all Ridgeview podcasts as well as any and all accompanying files, images, videos and documents is/are for CME/CE and other institutional learning and communication purposes only and is/are not meant to substitute for the independent medical judgment of a physician, healthcare provider or other healthcare personnel relative to diagnostic and treatment options of a specific patient's medical condition; and are property/rights of Ridgeview Medical Center & Clinics. Any re-reproduction of any of the materials presented would be infringement of copyright laws. It is Ridgeview's intent that any potential conflict should be identified openly so that the listeners may form their own judgments about the presentation with the full disclosure of the facts. It is not assumed any potential conflicts will have an adverse impact on these presentations. It remains for the audience to determine whether the speaker's outside interest may reflect a possible bias, either the exposition or the conclusions presented. Ridgeview's CME planning committee members and presenter(s) have disclosed they have no significant financial relationship with a pharmaceutical company and have disclosed that no conflict of interest exists with the presentation/educational event. Thank-you for listening to the podcast. SHOW NOTES: *See the attachment for additional information. Heart Failure (HF)- Can occur without congestion or fluid retention - Characterized by fatigue, fluid retention, SOB, PND, orthopnea - We should consider the same urgency for heart failure as patients with CAD and CA. Heart Failure Preserved/Reduced Ejection Fraction (HFpEF/HFrEF)- HFpEF is a Preserved Ejcetion Fraction over about 50% - HFpEF - congestive phenotype more of a fluid retention - an exercise intolerant phenotupe where the patient becomes intolerant of exercise induced dyspnea. - Pulm HTN phenotype - Increased pressure in the heart that gets transmitted to the lungs - HRrEF is Reduced EF is usually below 40% Medications- 4 classes of medications (MRAs, BB, SGLT2, ARNIs) - Treatment with mineralocorticoid receptor antagonists (MRAs) has been demonstrated to improve clinical outcomes in patients with HFrEF with mild to severe symptoms and also in patients with left ventricular dysfunciton after myocardial infarction. - SGLT2 inhibitors reduced the risk of cardiovascular death and hospitalizations for heart failure in a broad range of patients with heart failure, supporting their role as a foundational therapy for heart failure, irrespective of ejection fraction or care setting. - ARNI (angiotensin receptor/neprilysin inhibitor) medication is a newer treatment for heart failure. The combination of sacubitril and valsartan has helped people live longer and have a better quality of life. - Comprehensive EF therapy involves BB, ARNI, MRAs, angiotensin receptor/neprilysin inhibitors. Spironolactone, SGLT2 inhibitors. Treatment- Traditional therapy usually involves a BB and ACE inhibitor. - Currently we should be looking at comprehensive therapy when it comes to HF treatment. - STOP USING LISINOPRIL.- SGLT2 inhibitors contraindicated ketoacidosis, amputation UTI, weight loss - (SGLT2 inhibitors) DAPA-HF trial showed that dapagliflozin was superior to placebo at preventing cardiovascular deaths and heart failure events among patients with heart failure. (Source: https://www.nejm.org/doi/full/10.1056/NEJMoa1911303#article_citing_articles ) - Catheterization - a vast majority of HF patients will need a right heart catheterization. - Cardiac pulmonary pressure monitoring Cardio MEMS - same day outpatient surgery which helps with medication adjustments and hospitalization in half. Works regardless of EF. - CardioVere laser spectroscopy which uses different wavelengths to detect light characteristics to determine the level of edema/fluid present wihin someone's tissues. Currently in development. - Casana is a toilet seat with certain sensors that detect and monitor impedance that check levels between different tissues, monitors HR and weight. - Cardiac contractility modulation causing electrical stumulation during a particular contraction of the myocyets it will augment potential (like a pacemeaker). -CORCHINCH - HF trial catheter based device that cinches up the heart, thereby making it smaller. It works more efficiently. (Source: Clinical Evaluation of the AccuCinch® Ventricular Restoration System in Patients Who Present With Symptomatic Heart Failure With Reduced Ejection Fraction (HFrEF): The CORCINCH-HF Study) Novel Treatments- Atrial shunting procedure is investigational trials. Potentially impactful in exercise capacity and pressures but stay tuned as the verdict is not out. HfPEF exercise induced intolerance may be the best candidate. - SVC trial feasibility trial more durable effects of cardiac output. Stay tuned. - LVAD for advanced therapies. Sometimes a bridge for candidacy as well as recovery. - Biventricular pacing has shown promise. *Heart failure is a problematic clinical disease entity with significant morbidity and mortality often leading to comprehensive medical management. It is often beneficial to enlist the help of our heart failure colleagues for these complicated patients. Thanks to Dr. Peter Eckman - MHI heart failure specialist for his knowledge and contribution to this podcast. Please check out the additonal show notes for additional information/resources.
Trump is Truth squealing over the Jan. 6th Committee's criminal referral. Shitler minion Hope Hicks said man-baby was never worried about harming his legacy with the insurrection. Mother's Husband, aka Mike Pence, blathered the DOJ shouldn't bring charges against his former boss. Tech-load Elon Musk put out a poll on Twitter asking users if he should step down as CEO. Pillow Czar Mike Lindell passed out "prayer pillows" to a stadium full of MAGATS. King of all MRAs and antisemitic dumpster Nick Fuentes is fed up with people dissing Hitler. Crappy Senator Kyrsten Sinema is selling used shoes on Facebook Marketplace. Christian hate pastor Jonathan Shelley was kicked out of his church by his landlord yet again. According to a study people prefer a 4-day work week to a 5-day work week.
Award Winning Global TEDx Speaker, Executive Speaker Coach, Leadership Trainer, 7x Best Selling Author and multi-platform Media Host. Internationally acclaimed Author of Eat, Drink and Be Mary: A Glimpse Into a Life Well Lived and It's Not Luck: Overcoming You. Co-Author of the best selling book series: 13 Steps to Riches, Lead Author of HOLD MY CROWN - Women of grit share stories of resilience. Co-Creator of Amplifluence: 3 pillars to speak, publish and convert your message. Michelle is the co-Host of the Amplifluence podcast and Host of MentalShift on The New Channel (TNC), Philippines. She amplifies your presence and guides you through the professional speaker process of core message development and signature talks. Michelle's bonus service is to orchestrate the delivery and framework of your multi-faceted presentation. Michelle is a survivor of multiple life challenges to include a Traumatic Brain Injury and Breast Cancer. She guides others to recognize their innate gifts, stop apologizing for what they aren't and step into who they truly are… Unapologetically. Connect with Michelle : www.MichelleMras.com Facebook: https://www.facebook.com/profile.php?id=1342939359 LinkedIn: https://www.linkedin.com/in/michellemras Instagram: @michellemras Link tree: https://linktr.ee/MichelleMras Let's Connect: https://www.instagram.com/jr.spear/ Facebook: https://www.facebook.com/jr.spear.3 CREED CONSULTING : https://www.facebook.com/groups/1750459338428570 Please subscribe, like, and share. I appreciate the support and look forward to serving you further in the future. Semper Fi
Join us as Dr. Michelle Mras shares her journey to becoming a speaker coach, and why she decided to take that route. Also learn about some of the amazing opportunities that she has coming up, and projects that she's working on. --- Send in a voice message: https://podcasters.spotify.com/pod/show/ontheissuepodcast/message Support this podcast: https://podcasters.spotify.com/pod/show/ontheissuepodcast/support
Your story is too big to play small, and everyone's story can help heal not only yourself but other people.Dr. Michelle Mras is a very impactful executive coach and a speaking coach, an author of 16 books, a host of two podcasts, and a powerful icon helping people formulate their stories and walk through healing by telling their stories. On This Episode:Dr. Michelle shares her experiences in life and how she overcomes her traumatic journey.Dr. Michelle discusses how she went from pain to purpose or tragedy to triumph from her upbringing.Learn how Dr. Michelle's coaching as an executive coach and as helping people formulate their stories.Dr. Michelle shares what happened after her brain injury and her mindset through that journey.Hear how forgiving yourself can help you lead and work in the world.Joseph and Dr. Michelle discuss the trauma and tragedies they had in life and how they used that as a tool for their healing journey.Dr. Michelle shares her book, Hold My Crown: Women of Grit Share Stories of Resilience. The stories of women and the miracle of life happen in their stories. Key takeaways:1. Be able to forgive because you do need forgiveness for yourself.2. Your inner critic isn't holding you back. Your inner critic challenges you to provehow badly you truly want something.3. When you walk in faith and trust the opportunities that are open to you, when you listen to that voice in your soul, there's nothing you can do wrong.4. Remember that when someone's holding you back, they're not holding you back, they're afraid of losing you.5. Eat dessert first. The small things in life are the things that you will regret more than anything when you miss them.6. Remember, when you're not protected and alone, God's protecting you another way. He's enabling you to encompass that learning experience, that you can utilize it somehow in another lifetime or at another time. But remember that you're never alone.Tweetable Quotes:"Life's too short to play small. Life is too short for taking little or petty things and making them big.""The difference between a rut and a grave are the dimensions." -Ellen Glasgow."Your power is the power in your brain that can either make or break you, and it's your choice.""The best thing that's going to happen is another door of opportunity to where you want. It's going to be there, so stop being the adult."Connect With Dr. Michelle Mras:Website: https://michellemras.com/Linkedin: https://www.linkedin.com/in/michellemras/Youtube: https://www.youtube.com/MichelleMrasConnect with Joseph James:Facebook: https://www.facebook.com/meetjoejamesInstagram: https://www.instagram.com/meetjosephjames/
Here are the things to expect in the episode:Why is it important to be resilient in life?How can you be the best version of yourself?How can you develop self-leadership skills?Why is decision-making a vital part of your life?And much more! About Michelle:Award Winning Global TEDx Speaker, Executive Speaker Coach, Leadership Trainer, 7x Best Selling Author, and multi-platform Media Host. Connect with Michelle Mras!Website: https://michellemras.com/Facebook: https://www.facebook.com/MrasMichelle/Twitter: https://twitter.com/MrasMichelleLinkedIn: https://www.linkedin.com/in/michellemras/Podcast: https://anchor.fm/MentalShiftYouTube: https://www.youtube.com/channel/UCQ36Z_Q3BViC5VsIiglLAQA Connect with Kamie Lehmann!Website: https://www.kamielehmann.com/Facebook: https://www.facebook.com/kamie.lehmann.1LinkedIn: https://www.linkedin.com/in/kamie-lehmann-04683473Learn more about how to minimize the emotional side effects of cancer: https://adventurefound.org/
The following question refers to Section 6.2 of the 2021 ESC CV Prevention Guidelines. The question is asked by Dr. Christian Faaborg-Andersen, answered first by Houston Methodist medicine resident Dr. Najah Khan, and then by expert faculty Dr. Jaideep Patel. Dr. Patel recently graduated from Virginia Commonwealth University cardiology fellowship and is now a preventive cardiologist at the Johns Hopkins Hospital. The CardioNerds Decipher The Guidelines Series for the 2021 ESC CV Prevention Guidelines represents a collaboration with the ACC Prevention of CVD Section, the National Lipid Association, and Preventive Cardiovascular Nurses Association. Question #18 A 60-year-old Black woman with a history of hypertension and heart failure with reduced ejection fraction (EF 40%) presents to clinic for follow-up. She is currently doing well with NYHA class II symptoms. She is taking carvedilol 25 mg BID, sacubitril/valsartan 97/103 mg BID, and spironolactone 25 mg daily, all of which have been well tolerated. In clinic, her BP is 125/80 mmHg, and her HR is 55 bpm. Routine labs are within normal limits including Cr of 1.0, K of 4.0, and HbA1c of 6.0. What is the most appropriate next step in her management? A. No change in management B. Reduce beta blocker C. Add an SGLT2 inhibitor (dapagliflozin or empagliflozin) D. Add vericiguat E. Add hydralazine/isosorbide dinitrate Answer #18 The correct answer is C – Add an SGLT2 inhibitor (dapagliflozin or empagliflozin) For patients with symptomatic HFrEF, neurohormonal antagonists (ACEi, ARB, ARNI; BB; MRA) improve survival and reduce the risk of HF hospitalization. This patient is already on these agents. The addition of an SGLT2 inhibitor on top of neurohormonal blockade reduces the risk of CV death and worsening HF in patients with symptomatic HFrEF and is the next best step for this patient (Class I, LOE A). Vericiguat may be considered in patients with symptomatic HFrEF with HF worsening despite already being on maximally tolerated neurohormonal blockade (Class IIb, LOE B), but first-line therapies should be started first. Hydralazine/Isosorbide dinitrate should be considered in self-identified Black patients or people who have EF ≤ 35% or
The following question refers to Section 6.2 of the 2021 ESC CV Prevention Guidelines. The question is asked by Dr. Christian Faaborg-Andersen, answered first by Houston Methodist medicine resident Dr. Najah Khan, and then by expert faculty Dr. Jaideep Patel. Dr. Patel recently graduated from Virginia Commonwealth University cardiology fellowship and is now a preventive cardiologist at the Johns Hopkins Hospital. The CardioNerds Decipher The Guidelines Series for the 2021 ESC CV Prevention Guidelines represents a collaboration with the ACC Prevention of CVD Section, the National Lipid Association, and Preventive Cardiovascular Nurses Association. Question #18 A 60-year-old Black woman with a history of hypertension and heart failure with reduced ejection fraction (EF 40%) presents to clinic for follow-up. She is currently doing well with NYHA class II symptoms. She is taking carvedilol 25 mg BID, sacubitril/valsartan 97/103 mg BID, and spironolactone 25 mg daily, all of which have been well tolerated. In clinic, her BP is 125/80 mmHg, and her HR is 55 bpm. Routine labs are within normal limits including Cr of 1.0, K of 4.0, and HbA1c of 6.0. What is the most appropriate next step in her management? A. No change in management B. Reduce beta blocker C. Add an SGLT2 inhibitor (dapagliflozin or empagliflozin) D. Add vericiguat E. Add hydralazine/isosorbide dinitrate Answer #18 The correct answer is C – Add an SGLT2 inhibitor (dapagliflozin or empagliflozin) For patients with symptomatic HFrEF, neurohormonal antagonists (ACEi, ARB, ARNI; BB; MRA) improve survival and reduce the risk of HF hospitalization. This patient is already on these agents. The addition of an SGLT2 inhibitor on top of neurohormonal blockade reduces the risk of CV death and worsening HF in patients with symptomatic HFrEF and is the next best step for this patient (Class I, LOE A). Vericiguat may be considered in patients with symptomatic HFrEF with HF worsening despite already being on maximally tolerated neurohormonal blockade (Class IIb, LOE B), but first-line therapies should be started first. Hydralazine/Isosorbide dinitrate should be considered in self-identified Black patients or people who have EF ≤ 35% or
THE THESIS: Americans below the age of 50 have had the truth about the Country stolen from them. If they actually knew the facts, they would be as pro-liberty as the most constitutionally minded of us. THE SCRIPTURE & SCRIPTURAL RESOURCES: The Parable of the Ten Virgins Matthew 25: 31-46 - The Sheep and the Goats 31 “When the Son of Man comes in his glory, and all the angels with him, he will sit on his glorious throne. 32 All the nations will be gathered before him, and he will separate the people one from another as a shepherd separates the sheep from the goats. 33 He will put the sheep on his right and the goats on his left. 34 “Then the King will say to those on his right, ‘Come, you who are blessed by my Father; take your inheritance, the kingdom prepared for you since the creation of the world. 35 For I was hungry and you gave me something to eat, I was thirsty and you gave me something to drink, I was a stranger and you invited me in, 36 I needed clothes and you clothed me, I was sick and you looked after me, I was in prison and you came to visit me.' 37 “Then the righteous will answer him, ‘Lord, when did we see you hungry and feed you, or thirsty and give you something to drink? 38 When did we see you a stranger and invite you in, or needing clothes and clothe you? 39 When did we see you sick or in prison and go to visit you?' 40 “The King will reply, ‘Truly I tell you, whatever you did for one of the least of these brothers and sisters of mine, you did for me.' 41 “Then he will say to those on his left, ‘Depart from me, you who are cursed, into the eternal fire prepared for the devil and his angels. 42 For I was hungry and you gave me nothing to eat, I was thirsty and you gave me nothing to drink, 43 I was a stranger and you did not invite me in, I needed clothes and you did not clothe me, I was sick and in prison and you did not look after me.' 44 “They also will answer, ‘Lord, when did we see you hungry or thirsty or a stranger or needing clothes or sick or in prison, and did not help you?' 45 “He will reply, ‘Truly I tell you, whatever you did not do for one of the least of these, you did not do for me.' 46 “Then they will go away to eternal punishment, but the righteous to eternal life.” THE NEWS & COMMENT: Scoop: GOP heavyweights launch “anti-woke” lobbying group American Free Enterprise Chamber of Commerce Pelosi is opening a liquor store in the House where Members can buy alcohol with their taxpayer-funded MRAs. All while Americans are struggling to pay for food? Outrageous. MUSIC REVIEW: [AUDIO] - Hank Williams, Jr. - "A Country Boy Can Survive" See omnystudio.com/listener for privacy information.
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