Podcasts about mri

Today we bring you the second half of Harry's conversation with Dave deBronkart, better known as E-Patient Dave for all the work he's done to help empower patients to be more involved in their own healthcare. If you missed Part 1 of our interview with Dave, we recommend that you check that out before listening to this one. In that part, we talked about how Dave's own brush with cancer in 2007 turned him from a regular patient into a kind of super-patient, doing the kind of research to find the medication that ultimately saved his life. And we heard from Dave how the healthcare system in the late 2000s was completely unprepared to help consumers like him who want to access and understand their own data.Today in Part 2, we'll talk about how all of that is gradually changing, and why new technologies and standards have the potential to open up a new era of participatory medicine – if, that is, patients are willing to do a little more work to understand their health data, if innovators can get better access to that data, and if doctors are willing to create a partnership with the patients over the process of diagnosis and treatment.Please rate and review The Harry Glorikian Show on Apple Podcasts! Here's how to do that from an iPhone, iPad, or iPod touch:1. Open the Podcasts app on your iPhone, iPad, or Mac. 2. Navigate to The Harry Glorikian Show podcast. You can find it by searching for it or selecting it from your library. Just note that you'll have to go to the series page which shows all the episodes, not just the page for a single episode.3. Scroll down to find the subhead titled "Ratings & Reviews."4. Under one of the highlighted reviews, select "Write a Review."5. Next, select a star rating at the top — you have the option of choosing between one and five stars. 6. Using the text box at the top, write a title for your review. Then, in the lower text box, write your review. Your review can be up to 300 words long.7. Once you've finished, select "Send" or "Save" in the top-right corner. 8. If you've never left a podcast review before, enter a nickname. Your nickname will be displayed next to any reviews you leave from here on out. 9. After selecting a nickname, tap OK. Your review may not be immediately visible.That's it! Thanks so much.Full TranscriptHarry Glorikian: Hello. I'm Harry Glorikian.Welcome to The Harry Glorikian Show, the interview podcast that explores how technology is changing everything we know about healthcare.Artificial intelligence.Big data.Predictive analytics.In fields like these, breakthroughs are happening much faster than most people realize. If you want to be proactive about your own healthcare and the healthcare of your loved ones, you'll need to some of these new tips and techniques of how medicine is changing and how you can take advantage of all the new options.Explaining this approaching world is the mission of the new book I have coming out soon, The Future You. And it's also our theme here on the show, where we'll bring you conversations with the innovators, caregivers, and patient advocates who are transforming the healthcare system and working to push it in positive directions.In the previous episode we met Dave deBronkart, better known as E-Patient Dave for all the work he's done to help empower patients to be more involved in their own healthcare. If you missed it, I'm gonna recommend that you listen to the first discussion, and then come back here.We talked about how Dave's own brush with cancer in 2007 turned him from a regular patient into a kind of super-patient, doing the kind of research to find the medication that ultimately saved his life. And we heard from Dave how the healthcare system in the late 2000s was completely unprepared to help consumers like him who want to access and understand their own data.Today in Part 2, we'll talk about how all of that is gradually changing, and why new technologies and standards have the potential to open up a new era of participatory medicine – if, that is, patients are willing to do a little more work to understand their health data, if innovators can get better access to that data, and if doctors are willing to create a partnership with the patients over the process of diagnosis and treatment.We'll pick up the conversation at a spot where we were talking about that control and the different forms it's taken over the years.Harry Glorikian: You've observed like that there's some that there's this kind of inversion going on right now where for centuries doctors had sole control over patient data and sole claims to knowledge and authority about how patients should be treated. But now patients may have more detailed, more relevant and more up to date data than your doctors does. Right. You've talked about this as a Kuhnian paradigm shift, if I remember correctly, where patients are the anomalies, helping to tear down an old paradigm, you know. Walk us through the history here. What was the old paradigm and what's the new paradigm and what are you some of your favorite examples of this paradigm shift?Dave deBronkart: Well, so I want to be clear here. I have the deepest admiration for doctors, for physicians and for licensed practitioners at all levels for the training that they went through. I don't blame any of this on any of them. I did a fair amount of study about what paradigms are Thomas Kuhn's epic book The Structure of Scientific Revolutions, like discovering that the Earth isn't the center of the solar system and things like that. The paradigm is an agreement in a scientific field about how things work. And it is the platform, the theoretical model on which all research and further study is done. And these anomalies arise when scientists operating in the field keep finding outcomes that disagree with what the paradigm says. So in the case of the planets circling the earth and the how the solar system works. They discovered that Mars and other planets all of a sudden would stop orbiting and when they would do a little loop de loop. I mean, that's what they observed. And they came up with more and more tortured explanations until finally, finally, somebody said, hey, guess what? We're all orbiting the sun. Now, the paradigm inn health care has been that the physician has important knowledge. Lord knows that's true. The physician has important knowledge and the patient doesn't and can't. Therefore, patient should do as they're told, so called compliance, and should not interfere with the doctors doing their work. Well, now along comes things like all of those things that I mentioned that the patient community told me at the beginning of my cancer. None of that is in the scientific literature. Even here, 15 years later, none of it's in the literature. What's going on here? Here's that first clunk in the paradigm. Right. And we have numerous cases of patients who assisted with the diagnosis. Patients who invented their own treatment. And the shift, the improvement in the paradigm that we have to, where just any scientific thinker -- and if you want to be a doctor and you don't want to be a scientific thinker, then please go away -- any scientific thinker has to accept is that it's now real and legitimate that the patient can be an active person in healthcare.Dave deBronkart: Yeah, I mean, you've said you don't have to be a scientist or a doctor anymore to create a better way to manage a condition. So, I mean, it's interesting, right? Because I always think that my doctor and I are partners in this together.Dave deBronkart: Good participatory medicine. Perfect.Harry Glorikian: You know, he has knowledge in certain places I definitely don't. But there are things where him and I, you know, do talk about things that were like, you know, we need to look into that further. Now, I'm lucky I've got a curious doctor. I found somebody that I can partner with and that I can think about my own health care in a sort of different way. But I mean, sometimes he doesn't have all the answers and we have to go search out something. You know, I was asking him some questions about HRV the other day that, you know, he's like, huh, let me let me ask a few cardiologists, you know, to get some input on this. So do you see that, I mean, I see that as the most desired outcome, where a patient can have their record. They're not expected to go and become a physician at that level of depth, but that the physicians who also have the record can work in a participatory way with the patient and get to a better outcome.Dave deBronkart: Exactly. And the other thing that's happened is and I've only recently in the last year come to realize we are at the end of a century that is unique in the history of humanity until science got to a certain point in the late 1800s, most doctors, as caring as they were, had no knowledge of what was going wrong in the body with different diseases. And then and that began a period of many decades where doctors really did know important things that patients had no access to. But that era has ended. All right, we now have more information coming out every day than anyone can be expected to keep up with. And we now are at a point also where we've seen stories for decades of patients who were kept alive. But at what cost? Right. Well, and we now we are now entering the point where the definition of best care cannot be made without involving the patient and their priorities. So this is the new world we're evolving into, like and Dr. Sands wears a button in clinic that says what matters to you?Harry Glorikian: So I mean, one of the other, based on where you're going with this, I think is you know, there are some movements that have been arising over the years. I don't know, maybe you could talk about one of them, which is OpenAPS. It's an unregulated, open source project to build an artificial pancreas to help people with type 1 diabetes. And I think it was Erich von Hippel's work on patient driven innovation. I talk in my book about, and I ask whether we should be training people to be better patients in the era of, say, A.I. and other technologies. What do you think could be done better to equip the average patient with to demand access to patient data, ask their doctors more important questions, get answers in plain English. You know, be more collaborative. What do you think is going to move us in that direction faster or more efficiently, let's say?Dave deBronkart: Well, I want to be careful about the word better, because I'm very clear that my preferences are not everyone's preferences. Really, you know, autonomy means every person gets to define their own priorities. And another thing is one of the big pushbacks from the hospital industry over the last 10 years as medical records, computers were shoved down their throats along with the mandate that they have to let patients see their data in the patient portal was a complaint that most patients aren't interested. Well, indeed, you know, I've got sorry news for you. You know, when I worked in the graphic arts industry, I worked in marketing, people don't change behavior or start doing something new until they've got a problem. If it's fun or sexy, you know, then they'll change, they'll start doing something new. What we need to do is make it available to people. And then when needs arise, that gets somebody's attention and they're like, holy crap, what's happening to my kid? Right. If they know that they can be involved, then they can start to take action. They can learn how to take action. It's having the infrastructure available, having the app ecosystem start to grow, and then just having plain old awareness. Who knows? Maybe someday there will be a big Hollywood movie where people where people learn about stories like that and. You know, from that I mean that I think nature will take its course.Harry Glorikian: Well, it's interesting because I recently interviewed a gentleman by the name of Matthew Might. He's a computer scientist who became a surrogate patient advocate for his son, Bertrand, who had a rare and undiagnosed genetic disorder that left him without an enzyme that breaks down junk protein in the cells. But he, you know, jumped in there. He did his own research found in over-the-counter drug, Prevacid of all drugs., that could help with Bertrand's deficiency. But, I mean, Dave, you know, Matt is a, he was a high-powered computer scientist who wasn't afraid to jump in and bathe in that, you know. Is that the type of person we need? Is that a cautionary tale, or an inspiring tale? How do you think about that?Dave deBronkart: Desperate people will bring whatever they have to the situation. And this is no different from, you know, there have been very ordinary people who had saved lives at a car crash because they got training about how to on how to stop bleeding as a Boy Scout. You know, it is a mental trap to say, "But you're different." Ok. Some people said, "Well, Dave, you're an MIT graduate, my patients aren't like you." And people say, well, yeah, but Matt Might is a brilliant PhD type guy. What you mentioned few minutes before gives the lie to all of that, the OpenAPS community. All right, now, these are people you need to know appreciate the open apps world. You need to realize that a person with type 1 diabetes can die in their sleep any particular night. You know, they can even have an alarm, even if they have a digital device connected with an alarm, their blood sugar can crash so bad that they can't even hear the alarm. And so and they got tired of waiting the industry. Year after year after year, another five years will have an artificial pancreas, another five years, and a hashtag started: #WeAreNotWaiting. Now, I am I don't know any of the individuals involved, but I'll bet that every single diabetes related executive involved in this thought something along the lines of, "What are they going to do, invent their own artificial pancreas?" Well, ha, ha, ha, folks. Because as I as I imagine, you know, the first thing that happened was this great woman, Dana Lewis, had a digital insulin pump and a CGM, continuous glucose meter, and her boyfriend, who's now her husband, watched her doing the calculation she had to do before eating a hamburger or whatever and said, "I bet I could write a program that would do that."Dave deBronkart: And so they did. And one thing led to another. His program, and she had some great slides about this, over the course of a year, got really good at predicting what her blood sugar was going to be an hour later. Right. And then they said, "Hmm, well, that's interesting. So why don't I put that in a little pocket computer, a little $35 pocket computer?" The point is, they eventually got to where they said, let's try connecting these devices. All right. And to make a long story short, they now have a system, as you said, not a product, they talked to the FDA, but it's not regulated because it's not a product. Right. But they're not saying the hell with the FDA. They're keeping them informed. What are the scientific credentials of Dana Lewis and her boyfriend, Scott? Dana is a PR professional, zero medical computer or scientific skills? Zero. The whole thing was her idea. Various other people got involved and contributed to the code. It is a trap to think that because the pioneering people had special traits, it's all bogus. Those people are lacking the vision to see what the future you is going to be. See, and the beautiful thing from a disruptive standpoint is that when the person who has the problem gains access to power to create tools, they can take it in whatever direction they want. That's one of the things that happened when typesetting was killed by desktop publishing.Harry Glorikian: Right.Dave deBronkart: In typesetting, they said "You people don't know what you're doing!" And the people said, whatever, dude, they invented Comic Sans, and they went off and did whatever they wanted and the world became more customer centered for them.Harry Glorikian: So. You know, this show is generally about, you know, data, Machine learning and trying to see where that's going to move the needle. I mean, do you see the artificial intelligence umbrella and everything that's under that playing a role to help patients do their own research and design their own treatments?Dave deBronkart: Maybe someday, maybe someday. But I've read enough -- I'm no expert on AI, but I've read enough to know that it's a field that is full of perils of just bad training data sets and also full of immense amounts of risk of the data being misused or misinterpreted. If you haven't yet encountered Cathy O'Neil, she's the author of this phenomenal book, Weapons of Math Destruction. And she said it's not just sloppy brain work. There is sloppy brain work in the mishandling of data in A.I., but there is malicious or ignorant, dangerously ignorant business conduct. For instance, when companies look at somebody who has a bad credit rating and therefore don't give them a chance to do this or this or this or this, and so and they actually cause harm, which is the opposite of what you would think intelligence would be used for.Harry Glorikian: So but then, on the opposite side, because I talk about some of these different applications and tools in in the book where, you know, something like Cardiogram is able to utilize analytics to identify, like it alerted me and said "You know, you might have sleep apnea." Right. And it can also detect an arrhythmia, just like the Apple Watch does, or what's the other one? Oh, it can also sort of alert you to potentially being prediabetic. Right. And so you are seeing, I am seeing discrete use cases where you're seeing a movement forward in the field based on the analytics that can be done on that set of data. So I think I don't want to paint the whole industry as bad, but I think it's in an evolutionary state.Dave deBronkart: Absolutely. Yes. We are at the dawn of this era, there's no question. We don't yet have much. We're just going to have to discover what pans out. Really, I. Were you referring to the Cardia, the Acor, the iPhone EKG device a moment ago?Harry Glorikian: No, there's there's actually an, I've got one here, which is the you know...Dave deBronkart: That's it. That's the mobile version. Exactly. Yeah. Now, I have a friend, a physician friend at Beth Israel Deaconess, who was I just rigidly absolutely firmly trust this guy's brain intelligence and not being pigheaded, he was at first very skeptical that anything attached to an iPhone could be clinically useful. But he's an E.R. doc and he now himself will use that in the E.R. Put the patient's fingers on those electrodes and and send it upstairs because the information, when they're admitting somebody in a crisis, the information gets up there quicker than if he puts it in the EMR.Harry Glorikian: Well, you know, I always try to tell people like these devices, you know, they always say it's not good enough, it's not good enough. And I'm like, it's not good enough today. But it's getting better tomorrow and the next day. And then they're going to improve the sensor. And, yep, you know, the speed of these changes is happening. It's not a 10 year shift. It's it's happening in days, weeks, months, maybe years. But, you know, this is a medical device on my arm as far as I'm concerned.Harry Glorikian: It's a device that does medical-related things. It certainly doesn't meet the FDA's definition of a medical device that requires certification and so on. Now, for all I know, maybe two thirds of the FDA's criteria are bogus. And we know that companies and lobbyists have gamed the system. It's an important book that I read maybe five years ago when it was new, was An American Sickness about the horrifying impacts of the money aspect of health care. And she talked about, when she was talking specifically about device certification, she talked about how some company superbly, and I don't know if they laughed over their three martini lunch or what, some company superbly got something approved by the FDA as saying, we don't need to test this because it's the same as something else.Harry Glorikian: Ok, equivalence.Dave deBronkart: And also got a patent on the same thing for being completely new. Right. Which is not possible. And yet they managed to win the argument in both cases. So but the this is not a medical device, but it is, gives me useful information. Maybe we should call it a health device.Harry Glorikian: Right. Yeah, I mean, there are certain applications that are, you know, cleared by the FDA right now, but, you know, I believe what it's done is it's allowing these companies to gather data and understand where how good the systems are and then apply for specific clearances based on when the system gets good enough, if that makes sense.Dave deBronkart: Yes. Now, one thing I do want to say, there's an important thing going on in the business world, those platforms. You know, companies like Airbnb, Uber, whatever, where they are, a big part of their business, the way they create value is to understand you better by looking at your behavior and not throwing so much irrelevant crap at you. Now, we all know this as it shows up. As you know, you buy something on Amazon and you immediately get flooded by ads on Facebook for the thing that you already bought, for heaven's sake. I mean, how stupid is that? But anyway, I think it's toxic and should be prohibited by law for people to collect health data from your apps and then monetize it. I think that should be completely unacceptable. My current day job is for this company called Pocket Health, where they collect a patient's radiology images for the patient so the patient can have 24/7 access in the cloud. And when I joined there, a friend said, oh, I gather they must make their money by selling the data. Right? And I asked one of the two founding brothers, and he was appalled. That's just not what they do. They have another part of the company. And anybody who gets any medical device, any device to track their health should make certain that the company agrees not to sell it.[musical interlude]Harry Glorikian: Let's pause the conversation for a minute to talk about one small but important thing you can do, to help keep the podcast going. And that's to make it easier for other listeners discover the show by leaving a rating and a review on Apple Podcasts.All you have to do is open the Apple Podcasts app on your smartphone, search for The Harry Glorikian Show, and scroll down to the Ratings & Reviews section. Tap the stars to rate the show, and then tap the link that says Write a Review to leave your comments. It'll only take a minute, but you'll be doing us a huge favor.And one more thing. If you like the interviews we do here on the show I know you'll   like my new book, The Future You: How Artificial Intelligence Can Help You Get Healthier, Stress Less, and Live Longer.It's a friendly and accessible tour of all the ways today's information technologies are helping us diagnose diseases faster, treat them more precisely, and create personalized diet and exercise programs to prevent them in the first place.The book is now available for pre-order. Just go to Amazon and search for The Future You, Harry Glorikian.Thanks. And now back to our show.[musical interlude]Harry Glorikian: You mentioned FHIR or, you know, if I had to spell it out for people, it's Fast Healthcare Interoperability Resource standard from, I think, it's the Health Level 7 organization. What is FHIR? Where did it come from and what does it really enable?Dave deBronkart: So I'll give you my impression, which I think is pretty good, but it may not be the textbook definition. So FHIR is a software standard, very analogous to HTTP and HTML for moving data around the same way those things move data around on the Web. And this is immensely, profoundly different from the clunky, even if possible, old way of moving data between, say, an Epic system, a Cerner system, a Meditech system nd so on. And the it's a standard that was designed and started five or six years ago by an Australian guy named Graham Grieve. A wonderful man. And as he developed it, he offered it to HL7, which is a very big international standards organization, as long as they would make it free forever to everyone. And the important thing about it is that, as required now by the final rule that we were discussing, every medical record system installed at a hospital that wants to get government money for doing health care for Medicare or Medicaid, has to have what's called a FHIR endpoint. And a FHIR endpoint is basically just a plug on it where you can, or an Internet address, the same way you can go to Adobe.com and get whatever Adobe sends you, you can go to the FHIR endpoint with your login credentials and say, give me this patient's health data. That's it. It works. It already works. That's what I use in that My Patient Link app that I mentioned earlier.Harry Glorikian: So just to make it clear to someone that say that's listening, what does the average health care consumer need to know about it, if anything, other than it's accessible? And what's the part that makes you most excited about it?Harry Glorikian: Well, well, well. What people need to know about it is it's a new way. Just like when your hospital got a website, it's a new way for apps to get your data out of the hospital. So when you want it, you know that it has to be available that way. Ironically, my hospital doesn't have a FHIR endpoint yet. Beth Israel Deaconess. But they're required to by the end of the year. What makes me excited about it is that... So really, the universal principle for everything we've discussed is that knowledge is power. More precisely, knowledge enables power. You can give me a ton of knowledge and I might not know what to do with it, but without the knowledge, I'm disempowered. There's no dispute about that. So it will become possible now for software developers to create useful tools for you and your family that would not have been possible 15 years ago or five years ago without FHIR. In fact, it's ironic because one of the earliest speeches I gave in Washington, I said to innovators, data is fuel. Right. We talked about Quicken and Mint. Quicken would have no value to anybody if they couldn't get at your bank information. Right. And that's that would have prevented. So we're going to see new tools get developed that will be possible because of FHIR and the fact that the federal regulations require it.Harry Glorikian: Yeah, my first one of my first bosses actually, like the most brilliant boss, I remember him telling me one at one time, he goes, "Remember something: Knowledge is power." I must have been 19 when he told me that. And I was, you know, it took me a little while to get up to speed on what he meant by that. But so do you believe FHIR is a better foundation for accessing health records than previous attempts like Google Health or Microsoft Health Vault?Dave deBronkart: Well, those are apples and oranges. FHIR is a way of moving the data around. Several years into my "Give me my damn data" campaign, I did a blog post that was titled I Want a Health Data Spigot. I want to be able to connect the garden hose to one place and get all my data flowing. Well, that's what FHIR is now. What's at the other end of the hose? You know, different buckets, drinking glasses, whatever. That's more analogous to Google Health and Health Vault. Google Health and Health Vault might have grown into something useful if they could get all the important information out there, which it turns out was not feasible back then anyway. But that's what's going to happen.Harry Glorikian: What is the evolution you'd like to see in the relationship between the patient and the U.S. health care systems? You know, you once said the key to be would get the money managers out of the room. You know, if you had to sort of think about what you'd want it to evolve to, what would it be?Dave deBronkart: Well, so. There are at least two different issues involved in this. First of all, in terms of the practice of medicine, the paradigm of patient that I mentioned, collaboration, you know, collaboration, including training doctors and nurses on the feasibility and methods of collaboration. How do you do this differently? That won't happen fast because the you know, the I mean, the curriculum in medical schools doesn't change fast. But we do have mid career education and we have people learning practical things. So there's a whole separate issue of the financial structure of the U.S. health system, which is the only one I know in the world that is composed of thousands of individual financially separate organizations, each of which has managers who are required by law to protect their own finances. And the missing ingredient is that as all these organizations manage their own finances, nobody anywhere is accountable for whether care is achieved. Nobody can be fired or fined or put out of business for failing to get the patient taken care of as somebody should have. And so those are those are two separate problems. My ideal world is, remember a third of the US health care spending is excess and somebody a couple of years ago...Guess what? A third of the US health care spending is the insurance companies. Now, maybe the insurance companies are all of the waste. I don't know. I'm not that well-informed. But my point is there is plenty of money there already being spent that would support doctors and nurses spending more time with you and me beyond the 12 or 15 minutes that they get paid for.Harry Glorikian: So it's interesting, right? I mean, the thing that I've sort of my bully pulpit for, for a long time has been, once you digitize everything, it doesn't mean you have to do everything the same way. Which opens up, care may not have to be given in the same place. The business model may now be completely open to shift, as we've seen with the digitization of just about every other business. And so I you know, I worry that the EMRs are holding back innovation and we're seeing a lot of innovation happen outside of the existing rubric, right, the existing ivory towers, when you're seeing drug development using A.I. and machine learning, where we're seeing imaging or pathology scans. I mean, all of those are happening by companies that are accessing this digitized data and then providing it in a different format. But it's not necessarily happening inside those big buildings that are almost held captive by the EMR. Because if you can't access the data, it's really hard to take it to that next level of analytics that you'd like to take it to.Dave deBronkart: Yes, absolutely.Harry Glorikian: I mean, just throwing that out there, I know we've been talking about the system in particular, but I feel that there's the edges of the system aren't as rigid as they used to be. And I think we have a whole ecosystem that's being created outside of it.Harry Glorikian: Absolutely. And the when information can flow you get an increasing number of parties who can potentially do something useful with it, create value with it. And I'm not just talking about financial value, but achieve a cure or something like that. You know, interestingly, when the industry noticed what the open apps people were doing, all of a sudden you could no longer buy a CGM that had the ability to export the data.Harry Glorikian: Right.Dave deBronkart: Hmm. So somebody is not so happy about that. When an increasing number of people can get out data and combine it with their other ideas and skills and try things, then the net number of new innovations will come along. Dana Lewis has a really important slide that she uses in some presentations, and it ties in exactly with Erich von Hippel's user driven innovation, which of course, shows up in health care as patient driven innovation. The traditional industrial model that von Hippel talks about is if you're going to make a car, if you're going to be a company going into the car business, you start by designing the chassis and doing the wheels and designing the engine and so on and so on. And you do all that investment and you eventually get to where you've got a car. All right. Meanwhile, Dana shows a kid on a skateboard who can get somewhere on the skateboard and then somebody comes up with the idea of putting a handle on it. And now you've scooter. Right. And so on. The user driven innovations at every moment are producing value for the person who has the need.Harry Glorikian: Right. And that's why I believe that, you know, now that we've gotten to sort of that next level of of datafication of health care, that these centers have gotten cheaper, easier, more accessible. You know, like I said, I've got a CGM on my arm. Data becomes much more accessible. FHIR has made it easier to gain access to my health record. And I can share it with an app that might make that data more interpretable to me. This is what I believe is really sort of moving the needle in health care, are people like Matthew Might doing his own work where it's it's changing that. And that's truly what I try to cover in the book, is how these data [that] are now being made accessible to patients gives them the opportunity to manage their own health in a better way or more accurately and get ahead of the warning light going on before the car breaks down. But one of the things I will say is, you know, I love my doctor, but, you know, having my doctor as a partner in this is makes it even even better than rather than just me trying to do anything on my own. Dave deBronkart: Of course, of course. Dr. Sands is fond of saying "I have the medical training or diagnosis and treatment and everything, but Dave's the one who's the expert on what's happening in his life." Right. And and I'm the expert on my own priorities.Harry Glorikian: Right. Which I can't expect. I mean, my doctor has enough people to worry about, let alone like, me being his sole, the only thing he needs to think about. So, Dave, this was great. It was great having you on the show. I hope this is one of many conversations that we can have going forward, because I'm sure there's going to be different topics that we could cover. So I appreciate you taking the time and being on the show.Dave deBronkart: Well, and same to you. The this has been a very stimulating I mean, and the you've got the vision of the arriving future that is informed by where we're coming from, but not constrained by the old way of thinking. And that really matters. The reality, the emerging reality, whether anybody knows it or not, is that people with a big problem are able to act now in ways that they weren't before. I mean, another amazing example is a guy in England named Tal Golesworthy has Marfan syndrome. And one problem that people with Marfan syndrome face is aortic dissection. The walls of the aorta split open and it can be pretty quickly fatal. And he describes himself in his TED talk as a boiler engineer. And he says when we have a weak pipe, we wrap it. So he came up with the idea of exporting his CAT scan data or the MRI data of his beating heart and custom printing a fabric mesh to wrap around his aorta. And it's become and medically accepted treatment now. Harry Glorikian: That's awesome, right.Dave deBronkart: This is the data in the hands of somebody with no medical training, just. But see, that's the point. That's the point. He enabled by the data, is able to create real value, and it's now an accepted treatment that's called PEARS and it's been done hundreds of times. And, you know, here's a beautiful, it's sort of like the Dana Lewis skateboard scooter progression, years later, a subsequent scan discovered something unexpected. The mesh fabric has migrated into the wall of his aorta. So he hadn't he now has a know what doctor, what hospital, what medical device company would have ever dreamed of trying to create that? That's the beauty of liberation when data gets into the hands of the innovators.Harry Glorikian: Well, that's something that everybody can take away from today is at least thinking about their data, how it can help them manage their health better or their life better. Obviously, I always say, in cahoots with your doctor, because they have very specific knowledge, but having the data and managing yourself is better than not having the data and not understanding how to manage yourself. So on that note, Dave, thank you so much for the time today. It was great.Dave deBronkart: Thank you very much. See you next time.Harry Glorikian:That's it for this week's episode. You can find past episodes of The Harry Glorikian Show and MoneyBall Medicine at my website, glorikian.com, under the tab Podcasts.Don't forget to go to Apple Podcasts to leave a rating and review for the show.You can find me on Twitter at hglorikian. And we always love it when listeners post about the show there, or on other social media. Thanks for listening, stay healthy, and be sure to tune in two weeks from now for our next interview.

Can low temperature-aged garlic enhance exercise performance? Korea Univesity & National Institute of Agricultural Sciences (South Korea), October 8, 2021 Scientists from South Korea's National Institute of Agricultural Sciences and Korea University looked at aged garlic to see whether it could help reduce fatigue. To do this, they conducted a study on mice fed with a special low-temperature-aged garlic (LTAG). Their findings were published in the Journal of Medicinal Food. Testing the fatigue-fighting effects of low temperature-aged garlic The researchers chose to use LTAG because it lacked the pungent odor and spicy flavor of regular garlic, making it easier to use for animal testing. To create the LTAG, the researchers stored garlic in a sealed container, aging at 60 C for 60 days. The resulting LTAG was then peeled and pulverized, before being added to 200 milliliters of 70 percent ethanol (EtOH), which was then subjected to ultrasonic extraction three times. This 70 percent EtOH and LTAG extract was then concentrated under a vacuum at 45 C and then lyophilized to create a dry LTAG residue. After the creation of the LTAG, the researchers then separated mice into six groups. The first group was given a low dose of LTAG extract; the second was fed a high dose of LTAG extract; the third was given a low dose of garlic extract; and the fourth was given a high dose of garlic extract. The fifth and sixth groups consisted of normal mice that were given phosphate-buffered saline (PBS) instead of garlic. One of these control groups was made to exercise while the other group was not. The mice in the five groups were forced to run on a treadmill for four weeks. With each passing week, the amount of exercise the mice would have to do on the treadmills would increase. This was done by increasing both the speed that the mice had to run, and the amount of time they had to spend running. (Related: How to alleviate fatigue with herbal medicine.) After 28 days of treatment, five mice from each group were subjected to a final, exhaustive treadmill test. This test increased the treadmill speed from 15 meters per minute (m/min) to 40 m/min every 3 minutes. During this test, the running time was monitored until each mouse failed to follow the increase in speed on three consecutive occasions and lag occurred. At this point, the mouse's total running time was recorded. The effect of the LTAG on the levels of glucose, lactate dehydrogenase (LDH), free fatty acid (FFA) and lactate in the mice's blood. Following the final exercise, the mice were killed and blood samples were collected from them. In addition, the mice's gastrocnemius muscles were also isolated and frozen in liquid nitrogen for testing. LTAG treated mice demonstrated less fatigue Following the exhaustive running tests, the researchers found that the mice treated with LTAG extract were able to run for much longer than the control mice. Meanwhile, looking at the blood tests, they noted that the mice treated with LTAG extract exhibited lower levels of glucose, LDH, FFA and lactate. More importantly, the LTAG treated mice had increased amounts of glycogen and creatine kinase (CK) in their muscles. Glycogen storage is an important source of energy during exercise. It serves a central role in maintaining the body's glucose homeostasis by supplementing blood glucose. Because of this, glycogen is seen as an accurate marker for fatigue, with increased glycogel levels closely associated with improved endurance and anti-fatigue effects. CK, on the other hand, is known to be an accurate indicator of muscle damage. During muscle degeneration, muscle cells are dissolved and their contents enter the bloodstream. As a result, when muscle damage occurs, muscle CK comes out into the blood. As such, fatigue tends to lead to lower muscle CK levels and higher blood CK levels. Higher levels of glycogen and muscle CK in the LTAG treated mice indicated that they experienced less fatigue than the other groups. Based on these findings, the researchers believe that LTAG has potential for use as an anti-fatigue agent.       Mindfulness meditation helps preterm-born adolescents University of Geneva (Switzerland), October 7, 2021 Adolescents born prematurely present a high risk of developing executive, behavioral and socio-emotional difficulties. Now, researchers from Geneva University Hospitals (HUG) and the University of Geneva (UNIGE) have revealed that practicing mindfulness may help improve these various skills. The study, published in the journal Scientific Reports, suggests using mindfulness as a means of clinical intervention with adolescents, whether prematurely born or not. Several studies have already shown that very preterm (VPT) children and adolescents are at higher risk of exhibiting cognitive and socio-emotional problems that may persist into adulthood. To help them overcome the difficulties they face, researchers from the HUG and UNIGE have set up an intervention based on mindfulness, a technique known to have beneficial effects in these areas. Mindfulness consists in training the mind to focus on the present moment, concentrating on physical sensations, on breathing, on the weight of one's body, and even on one's feelings and thoughts, completely judgment-free. The mindfulness-based interventions generally take place in a group with an instructor along with invitations to practice individually at home. To accurately assess the effects of mindfulness, a randomized controlled trial was performed with young adolescents aged 10 to 14, born before 32 weeks gestational weeks. Scientists quickly found that mindfulness improves the regulation of cognitive, social and emotional functions, in other worlds, our brain's ability to interact with our environment. Indeed, it increases the ability to focus on the present—on thoughts, emotions and physical sensations, with curiosity and non-judgment. Thanks to this practice, adolescents improve their executive functions, i.e. the mental processes that enable us to control our behavior to successfully achieve a goal. As a result, young people find it easier to focus, manage and regulate their behavior and emotions in everyday life. For eight weeks, the young teens spent an hour and a half each week with two mindfulness instructors. They were further encouraged to practice mindfulness daily at home. Parents were also involved in this study. They were asked to observe their child's executive functions, for example the ability to regulate their emotions and attentional control, their relationships with others and their behavior. The adolescents also underwent a series of computerized tasks to assess their reactions to events. A comparison of their test results with a control group that did not practice mindfulness shows a positive impact of the intervention on the adolescents' everyday life and on their ability to react to new events. "Each teenager is unique, with their own strenghts and difficulties. Through their involvement in this study, our volunteers have contributed to show that mindfulness can help many young people to feel better, to refocus and to face the world, whether they were born preterm born or not," agree Dr. Russia Hà-Vinh Leuchter, a consultant in the Division of Development and Growth, Department of Paediatrics, Gynaecology and Obstetrics at Geneva University Hospitals, and Dr. Vanessa Siffredi, a researcher at the Child Development Laboratory at the Department of Paediatrics, Gynaecology and Obstetrics at the UNIGE Faculty of Medicine, two of the authors of this work. "However, while the practice of meditation can be a useful resource, it is important to be accompanied by well-trained instructors", they specify. The adolescents who took part in the program are now between 14 and 18 years. Scientists are currently evaluating the long-term effects of mindfulness-based intervention on their daily attention and stress. Furthermore, to validate their clinical data with neurobiological measurements, researchers are currently studying the effects of mindfulness on the brain using magnetic resonance imaging (MRI).   Iron deficiency in middle age is linked with higher risk of developing heart disease University Heart and Vasculature Centre Hamburg (Germany) 6 October 2021 Approximately 10% of new coronary heart disease cases occurring within a decade of middle age could be avoided by preventing iron deficiency, suggests a study published today in ESC Heart Failure, a journal of the European Society of Cardiology (ESC).1 “This was an observational study and we cannot conclude that iron deficiency causes heart disease,” said study author Dr. Benedikt Schrage of the University Heart and Vasculature Centre Hamburg, Germany. “However, evidence is growing that there is a link and these findings provide the basis for further research to confirm the results.” Previous studies have shown that in patients with cardiovascular diseases such as heart failure, iron deficiency was linked to worse outcomes including hospitalisations and death. Treatment with intravenous iron improved symptoms, functional capacity, and quality of life in patients with heart failure and iron deficiency enrolled in the FAIR-HF trial.2 Based on these results, the FAIR-HF 2 trial is investigating the impact of intravenous iron supplementation on the risk of death in patients with heart failure. The current study aimed to examine whether the association between iron deficiency and outcomes was also observed in the general population. The study included 12,164 individuals from three European population-based cohorts. The median age was 59 years and 55% were women. During the baseline study visit, cardiovascular risk factors and comorbidities such as smoking, obesity, diabetes and cholesterol were assessed via a thorough clinical assessment including blood samples. Participants were classified as iron deficient or not according to two definitions: 1) absolute iron deficiency, which only includes stored iron (ferritin); and 2) functional iron deficiency, which includes iron in storage (ferritin) and iron in circulation for use by the body (transferrin). Dr. Schrage explained: “Absolute iron deficiency is the traditional way of assessing iron status but it misses circulating iron. The functional definition is more accurate as it includes both measures and picks up those with sufficient stores but not enough in circulation for the body to work properly.” Participants were followed up for incident coronary heart disease and stroke, death due to cardiovascular disease, and all-cause death. The researchers analysed the association between iron deficiency and incident coronary heart disease, stroke, cardiovascular mortality, and all-cause mortality after adjustments for age, sex, smoking, cholesterol, blood pressure, diabetes, body mass index, and inflammation. Participants with a history of coronary heart disease or stroke at baseline were excluded from the incident disease analyses. At baseline, 60% of participants had absolute iron deficiency and 64% had functional iron deficiency. During a median follow-up of 13.3 years there were 2,212 (18.2%) deaths. Of these, a total of 573 individuals (4.7%) died from a cardiovascular cause. Incidence coronary heart disease and stroke were diagnosed in 1,033 (8.5%) and 766 (6.3%) participants, respectively. Functional iron deficiency was associated with a 24% higher risk of coronary heart disease, 26% raised risk of cardiovascular mortality, and 12% increased risk of all-cause mortality compared with no functional iron deficiency. Absolute iron deficiency was associated with a 20% raised risk of coronary heart disease compared with no absolute iron deficiency, but was not linked with mortality. There were no associations between iron status and incident stroke. The researchers calculated the population attributable fraction, which estimates the proportion of events in 10 years that would have been avoided if all individuals had the risk of those without iron deficiency at baseline. The models were adjusted for age, sex, smoking, cholesterol, blood pressure, diabetes, body mass index, and inflammation. Within a 10-year period, 5.4% of all deaths, 11.7% of cardiovascular deaths, and 10.7% of new coronary heart disease diagnoses were attributable to functional iron deficiency. “This analysis suggests that if iron deficiency had been absent at baseline, about 5% of deaths, 12% of cardiovascular deaths, and 11% of new coronary heart disease diagnoses would not have occurred in the following decade,” said Dr. Schrage. “The study showed that iron deficiency was highly prevalent in this middle-aged population, with nearly two-thirds having functional iron deficiency,” said Dr. Schrage. “These individuals were more likely to develop heart disease and were also more likely to die during the next 13 years.” Dr. Schrage noted that future studies should examine these associations in younger and non-European cohorts. He said: “If the relationships are confirmed, the next step would be a randomised trial investigating the effect of treating iron deficiency in the general population.”     Consumption of a bioactive compound from Neem plant could significantly suppress development of prostate cancer National University of Singapore, September 29, 2021   Oral administration of nimbolide, over 12 weeks shows reduction of prostate tumor size by up to 70 per cent and decrease in tumor metastasis by up to 50 per cent   A team of international researchers led by Associate Professor Gautam Sethi from the Department of Pharmacology at the Yong Loo Lin School of Medicine at the National University of Singapore (NUS) has found that nimbolide, a bioactive terpenoid compound derived from Azadirachta indica or more commonly known as the neem plant, could reduce the size of prostate tumor by up to 70 per cent and suppress its spread or metastasis by half.   Prostate cancer is one of the most commonly diagnosed cancers worldwide. However, currently available therapies for metastatic prostate cancer are only marginally effective. Hence, there is a need for more novel treatment alternatives and options.   "Although the diverse anti-cancer effects of nimbolide have been reported in different cancer types, its potential effects on prostate cancer initiation and progression have not been demonstrated in scientific studies. In this research, we have demonstrated that nimbolide can inhibit tumor cell viability -- a cellular process that directly affects the ability of a cell to proliferate, grow, divide, or repair damaged cell components -- and induce programmed cell death in prostate cancer cells," said Assoc Prof Sethi.   Nimbolide: promising effects on prostate cancer   Cell invasion and migration are key steps during tumor metastasis. The NUS-led study revealed that nimbolide can significantly suppress cell invasion and migration of prostate cancer cells, suggesting its ability to reduce tumor metastasis. The researchers observed that upon the 12 weeks of administering nimbolide, the size of prostate cancer tumor was reduced by as much as 70 per cent and its metastasis decreased by about 50 per cent, without exhibiting any significant adverse effects.   "This is possible because a direct target of nimbolide in prostate cancer is glutathione reductase, an enzyme which is responsible for maintaining the antioxidant system that regulates the STAT3 gene in the body. The activation of the STAT3 gene has been reported to contribute to prostate tumor growth and metastasis," explained Assoc Prof Sethi. "We have found that nimbolide can substantially inhibit STAT3 activation and thereby abrogating the growth and metastasis of prostate tumor," he added.   The findings of the study were published in the April 2016 issue of the scientific journal Antioxidants & Redox Signaling. This work was carried out in collaboration with Professor Goh Boon Cher of Cancer Science Institute of Singapore at NUS, Professor Hui Kam Man of National Cancer Centre Singapore and Professor Ahn Kwang Seok of Kyung Hee University.   The neem plant belongs to the mahogany tree family that is originally native to India and the Indian sub-continent. It has been part of traditional Asian medicine for centuries and is typically used in Indian Ayurvedic medicine. Today, neem leaves and bark have been incorporated into many personal care products such as soaps, toothpaste, skincare and even dietary supplements.       Review looks at the efficacy of acupuncture in treating insulin resistance Guangzhou University of Chinese Medicine (China), October 8, 2021 In their report, researcherss from Guangzhou University of Chinese Medicine in China explored the role of acupuncture in treating insulin resistance. The study was published in the journal Complementary Therapies in Clinical Practice. Earlier studies have reported the effectiveness of acupuncture in treating insulin resistance and related conditions. The review looked at acupuncture and its effects on clinical outcomes. The researchers searched the following databases for randomized controlled trials involving insulin resistance patients treated with acupuncture: Cochrane Central Register of Controlled Trials Embase Medline (via OVID) China National Knowledge Infrastructure (CNKI) Wan Fang and China Science and Technology Journal Database (VIP) The studies show that homeostasis model assessment of insulin resistance significantly decreased with acupuncture treatment. Other significant decreases include fasting blood glucose, postprandial blood glucose and fasting insulin. Acupuncture increased insulin sensitivity with very few adverse effects. In sum, acupuncture is a safe and effective alternative treatment for insulin resistance.     Blueberries may improve attention in children following double-blind trial University of Reading (UK), October 10, 2021  Primary school children could show better attention by consuming flavonoid-rich blueberries, following a study conducted by the University of Reading. In a paper published in Food & Function, a group of 7-10 year olds who consumed a drink containing wild blueberries or a matched placebo and were tested on their speed and accuracy in completing an executive task function on a computer. The double blind trial found that the children who consumed the flavonoid-rich blueberry drink had 9% quicker reaction times on the test without any sacrifice of accuracy. In particular, the effect was more noticeable as the tests got harder. Professor Claire Williams, a neuroscience professor at the University of Reading said: "This is the first time that we have seen the positive impact that flavonoids can have on the executive function of children. We designed this double blind trial especially to test how flavonoids would impact on attention in young people as it's an area of cognitive performance that hasn't been measured before. "We used wild blueberries as they are rich in flavonoids, which are compounds found naturally in foods such as fruits and their juices, vegetables and tea. They have been associated with a range of health benefits including antioxidant and anti-inflammatory effects, and our latest findings continue to show that there is a beneficial cognitive effect of consuming fruit and vegetables, tea, coffee and even dark chocolate which all contain flavonoids." The children were then asked to pay attention to an array of arrows shown on a PC screen and press a key corresponding to the direction that the central arrow was facing. The task was repeated over a number of trials, where cognitive demand was manipulated by varying how quickly the arrows appeared, whether there were additional arrows appearing either side of the central arrow, and whether the flanking arrows were pointing in the same/different direction as the central arrow. Previous Reading research has shown that consuming wild blueberries can improve mood in children and young people, simple memory recall in primary school children, and that other flavonoid rich drinks such as orange juice, can also improve memory and concentration. The Wild Blueberry Association of North America provided a freeze-dried powder made from wild blueberries which was used in the study but did not provide any additional financial support and did not play a role in the design of the study. Wild blueberries are grown and harvested in North America, and are smaller than regular blueberries, and are higher in flavonoids compared to regular varieties. The double-blind trial used a flavonoid-rich wild blueberry drink, with a matched placebo contained 8.9g of fructose, 7.99g of glucose and 4 mg of vitamin C matching the levels of nutrients found in the blueberry drink. The amount of fructose is akin to levels found in a standard pear. This was an executive function task- requiring participants to pay attention to stimuli appearing on screen and responding correctly. The task was a simple one- responding to the direction of an arrow in the middle of a screen (by pressing left/right arrow key) but we then varied how quickly the stimuli appeared, whether there was additional arrows appearing either side of the stimuli and whether those flanking arrows were pointing in the same/different direction as they direction you had to respond. There are 6 main classes of flavonoids: Anthocyanins – found in berry fruits such as the blueberries used in this study and also in red wine. Flavonols - found in onions, leeks, and broccoli Flavones - found in parsley and celery, Isoflavones - found in soy and soy products, Flavanones - found in citrus fruit and tomatoes Flavanols—found in green tea, red wine, and chocolate     Nocebo effect: Does a drug's high price tag cause its own side effects? University Medical Center Hamburg (Germany), October 5, 2021  Pricey drugs may make people more vulnerable to perceiving side effects, a new study suggests—and the phenomenon is not just "in their heads." The study delved into the so-called "nocebo effect." It's the negative version of the well-known placebo effect, where people feel better after receiving a therapy because they expected good things. With the nocebo effect, patients' worries over treatment side effects make them feel sick. In this study, researchers found that people were more likely to report painful side effects from a fake drug when told it was expensive. But it wasn't just something people were "making up." Using brain imaging, the researchers traced the phenomenon to specific activity patterns in the brain and spine. "These findings are a strong argument against the perception of placebo and nocebo effects as being only 'fake' effects—created purely by imagination or delusions of the patient," said lead researcher Alexandra Tinnermann. She is with the University Medical Center Hamburg-Eppendorf, in Germany. Dr. Luana Colloca, a researcher at the University of Maryland in Baltimore, agreed. "This is not merely a reflection of people's biases," said Colloca, who wrote an editorial published with the study. "Expectations do modulate symptoms and patients' responses to treatment," she said. For the study, Tinnermann's team recruited 49 healthy volunteers and randomly assigned them to test one of two itch-relieving "medical creams." In reality, both creams were identical and contained no active ingredients. However, people in both groups were told that the products could have the side effect of making the skin more sensitive to pain. There was only one apparent difference between the two phony creams: One came in fancy packing with a high price tag; the other was cheap. After participants applied the creams to their forearms, the researchers had them undergo a standard test that measured their tolerance for heat-induced pain. It turned out that people who'd used the expensive cream were more sensitive to pain during the tests. On average, their pain rating hovered around a 15—within the "mild" pain range—whereas people using the cheap cream barely registered any discomfort. It's likely, Tinnermann said, that people expect a pricey medication to be potent—which could also make them expect more side effects. Colloca agreed. We are all "vulnerable" to such outside influences, she said, be it a drug's price or how it's given (by IV versus mouth, for instance). However, we are not just imagining those placebo or nocebo effects, both researchers noted. Using functional MRI brain scans, Tinnermann's team found specific patterns of nervous system activity in people who had a nocebo response to the pricey cream. That included a change in "communication" between certain brain structures and the spinal cord, Tinnermann said. According to Colloca, research like this can have practical uses. Doctors could, for instance, inform patients that drug prices or other factors can sway their expectations about a treatment's benefits and risks—and that, in turn, can influence whether they feel better or develop side effects. There is, however, no research into whether that kind of knowledge helps prevent patients from the nocebo effect, Tinnermann said. But, she added, health professionals can be aware that patients' expectations "play a huge role in medicine"—and be mindful of how they talk about a medication and its possible side effects. It's an important matter, Colloca said, because the nocebo effect can cause people to stop taking needed medications. Colloca pointed to the example of cholesterol-lowering statins. The potential for those medications to cause muscle pain has been widely reported. And one recent study found evidence that this knowledge can make statin users more likely to report muscle pain side effects. Other research, Colloca said, has shown that when people stop taking their statins, their risk of heart attack and stroke rises.

Dr. Pierre-Marie Robitaille is a world-class scientist and engineer responsible for doubling the power of the MRI medical imaging system. His insights from radio-imaging human bodies led to groundbreaking revelations about astronomical radio spectra, which ultimately led to him questioning the central dogma of solar science concerning the material nature of Earth's central star. This is the third of a four-part series with Dr. Robitaille. All are or will shortly become available at podcast locations worldwide. Support the podcast by becoming a Patron: ªº¬˚∆≤≥≤≥ https://www.patreon.com/demystifysci ≤≥≤≥∆˚¬ºª ªº¬˚∆≤≥≤≥ Join the mailing list https://bit.ly/3v3kz2S ≤≥≤≥∆˚¬ºª Check our YouTube channel, @DemystifyingScience for in depth-investigations. Dr. Robitaille's Channel: https://www.youtube.com/channel/UCL7QIOZteWPpBWBOl8i0e-g PODCAST INFO: Blog: http://demystifyingscience.com/blog Apple Podcasts: https://apple.co/3uhn7J1 Spotify: https://spoti.fi/39IDJBD RSS: https://anchor.fm/s/2be66934/podcast/rss Full episodes playlist: https://bit.ly/3sP1WgR Clips playlist: https://bit.ly/2OieYEG Donate: https://bit.ly/3wkPqaD Swag: https://bit.ly/2PXdC2y SOCIAL: - Twitter: https://twitter.com/demystifysci- Facebook: https://www.facebook.com/groups/demystifyingscience- Instagram: https://www.instagram.com/demystifysci/ --- Support this podcast: https://anchor.fm/demystifying-science/support

Credits: 0.25 AMA PRA Category 1 Credit™   CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-245   Overview: When your patient has an elevated screening PSA level, your first inclination may be to refer for a biopsy, but have you considered obtaining a pre-biopsy MRI? In this podcast, we will review the appropriate management for an elevated screening PSA. You'll want to hear about the new benefit of obtaining a pre-biopsy MRI to guide diagnostic procedures.   Episode resource links: NEJM July 9, 2021; DOI: 10.1056/NEJMoa2100852 Urology 2016 Apr;90:32-7. doi: 10.1016/j.urology.2015.11.046 Guest: Frank J. Domino, MD   Music Credit: Richard Onorato

Coming from a broken home with a single mom raising him and his brother, life was hard for his family and when he found fitness it became his escape. Training begins with body types, which of the 3 are you? Ectomorph, Mesomorph, Endomorph, focus on your body type to begin with. At 21 with the help of his wrestling coach, Dimitri was able to compete in his first show and he won. From there he worked in fitness clubs, good and bad ones, mostly bad ones, he saw where they could improve and how to improve. With the guidance of a mentor, Dimitri left the corporate life, and he took a chance and went on his own and built Pure Motivation Fitness, that was 15 years ago.Dimitri discusses customizing your fitness goals to your body type and truly understand why he is going to suggest eating habits, exercise techniques, weight training to suit your body. Dimitri wants to be your coach; everyone needs a coach to make sure you are held accountable to your health and fitness goals. 3 Key principles, Mindset, Training and Nutrition last.Dimitri isn't here to preach, he's here to help you change your life for the better, loosing body fat adds years of extra life. It's simply about taking bad habits and placing good habits in front of it, that is how you slowly change your day-to-day events, such as smoking. Accept, Acknowledge and Advance, 3 counts of accountability. Tim Lyons once taught Dimitri, “embrace the suck” Covid happened, and he had to embrace the suck to get over it.Dimitri shares some great insight into the medical industry and how to handle your doctor, your injuries, and avoiding pharmaceutical assistance. Here in Canada, we have the right to ask for a 2nd or 3rd and we have the right to ask for ultrasounds, x-rays and MRI's, we need to see what the problem is so we can figure out the best course of action because a pill may not always be best option for you. Dimitri pulls out the calculator and shows you how you can calculate the potential to have a heart attack or stroke based on your current state of resting heart rate, this will open you eyes wide. Dimitri has done an amazing job motivating, educating and empowering people and now it's time for Tradespeople to take back their lives.Shared and Discussed linkshttps://en.wikipedia.org/wiki/William_Herbert_Sheldonhttps://www.synviscone.ca/clinics/dr-anthony-(tony)-galea-ism-health-wellness-centre?i=17&culture=enhttps://www.poliquinstore.com/articleshttps://www.wimhofmethod.com/breathing-exercisesCheck out his app on Apple and AndroidWhat an amazing show full of truth, pain, fitness, health, exercises and more, I thank you so much Dimitri for sharing so much on your life for our construction lives, educating our listeners on everything to do with your body, mind and soul. Thank you. Find him on IG @puremotivationalfitness and @dimitrigiankonlas and contact him for your next exercise booking at dimitri@puremotivationfitness.com and his website is www.puremotivationalfitness.com and find his YouTube channel at Pure Motivational Fitness where he shows you key details to live a happy, healthy construction life.

NAD is a supplement. Similar to testosterone, if we are not producing enough, we want to supplement it. Well, NAD enhances the ability of Vitamin B3 to support cellular healing in the body. This is a naturally occurring element in the body in which production can decrease for several reasons. Substance abuse or any abuse the body suffers could potentially erode the production of this in our body, as well as aging. I am talking with Mike Godfrey and Stephanie Rose who are working together on a research project entitled “Perceptions of Mental Health and Recovery after Receiving NAD Treatment: A different Approach for Recovery and Withdrawal.” Although I do not support an abstinent-only approach, NAD seems to be a route for those that want abstinence. Withdrawal is painful no matter how you slice it, and when it comes to stimulants there has previously been no help, or harm-reductive approach, to detoxing. NAD is not only being used to detox people from stimulants but for those who are ready to leave their MAT (suboxone/methadone) behind, as well as alcohol. Not everyone is going to want to move into abstinence but for those that are interested in that route, NAD seems to get people to a place where they can step into sobriety with a mind that is thinking clearer than otherwise would be possible. Since doing this interview I have been taking NAD, I have not experienced any noticeable shift in my thinking or behaving. However, it should be noted that I didn't take any tests to see the level of NAD I was producing, so it very well may have been a wash. I do have an MRI coming up in Dec for my MS, if I have significant shrinking in my legions or if it aids in any way I can detect, I will definitely let you know. The center doing the research is Incura in North Little Rock Arkansas. https://incura.life/ @incura.life on Instagram Dr. Stephanie Rose bio https://uca.edu/healthsci/facultystaff/rose/ Questions: Would you try NAD if you were in a position to face detoxing? Where do you see NAD treatment, taking the information you have heard here, being able to offer benefit. Is NAD offered in your treatment facility? The Recover Yourself approach is a path to your total wellness: Physical, Emotional, and Spiritual (however you define that). If you have pain or a major diagnosis, spiritual misgivings, or are easily emotionally disrupted, you are not whole. We give up on ourselves so easily. As children, we lived under the influence of our parents and that, for many, continues from one relationship to another. There is a you that you will be, which you have never known, that you can Recover To. Contact me when you are ready to step into that. o Patreon https://www.patreon.com/RecoverYourself o Instagram https://www.instagram.com/martinjon/ o Facebook https://www.facebook.com/MartinJonRecoveryMentor o LinkedIn https://www.linkedin.com/in/martinjonarts/ o Link Tree https://linktr.ee/martinjon o Venmo: MartinJon_Garcia --- Send in a voice message: https://anchor.fm/martinjon/message Support this podcast: https://anchor.fm/martinjon/support

When we last spoke to Skye Moench we had no idea that later this year she would race The Collin's Cup, finish 6th at 7.0 World Champs and then crush IM Chattanooga by more than 25 minutes.  Skye Moench's dominating win at IRONMAN Chattanooga with a greater than 25-minute lead just a week after St George.    Show Sponsor: VENGA CBD Thanks very much to Venga CBD for helping make the show possible. Venga CBD is not like most CBD companies who just post a bunch of products and hope you figure it out. Venga was started in Colorado by athletes like you who wanted a better way to use CBD to help fight pain, train longer, race harder and recover faster. That's why they created a SYSTEM of CBD products for athletes and only have 4 products that cover 100% of your CBD needs. I use it every day in one form or another! Each product is specifically made to support an area of your endurance life from training to racing to recovery. Combined together the Venga CBD system is designed to make you unstoppable! Save a whopping 30% off & get free shipping when you buy the Venga Endurance System versus buying the products separately  - seriously, this is the best deal on the market. Just go to https://vengaendurance.com/303podcast to order yours today. First-time order is 30% off with code (303PODCAST).  We've also added 50% off your first month's subscription with code (303SUBSCRIPTION).   In Today's Show Feature interview with Skye Moench (IM Chattanooga winner) Endurance News No, Running Doesn't Wear Down Your Cartilage. It Strengthens Your Joints. What's new in the 303 Small Town America at the Heart of Gravel Racing? The Rad Dirt in Trinidad Shows Us Why Video of the Week Ironman Chattanooga Highlights   Interview Sponsor: UCAN Take your performance to the next level with UCAN Energy and Bars made with SuperStarch®  UCAN uses SuperStarch instead of simple sugars to fuel serious athletes.  UCAN keeps blood sugar steady compared to the energy spikes and crashes of sugar-based products.  Steady energy equals sustained performance! You put in the training, so don't let nutrition limit your performance.  Use UCAN in your training and racing to fuel the healthy way, finish stronger and recover more quickly!  Use the code 303UCAN for 20% off at ucan.co/discount/303UCAN/ or ucan.co Use the code 303UCAN for 20% off at ucan.co/discount/303UCAN/ or ucan.co,    Interview with Skye Moench A little over two years ago Skye won the 2019 Ironman European Championship Frankfurt. In April of this year we interviewed Skye.  At this point in the season she was fresh off a 6th at Challenge Daytona and 5th at Challenge Miami.  Skye had already made an amazing comeback from her bike crash the kept her from racing at Kona back in 2019.  We came away from that interview with a headline of "Skye's Comeback".  We had no idea at that time that later this year she would be on the final list for The Collin's Cup, finish 6th at 7.0 World Champs and then crush IM Chattanooga by more than 25 minutes. Was that part of the plan?  Did that win gap come as a surprise? How cool is that new purple Trek bike?   All those questions and more coming up right now with Skye Moench! Results (ironman.com)   Post interview: Skye adding another voice to the pros who thinks that The Collins Cup is a "must do" race and opportunity to connect with other pros and make new friends. Focus on the long distance and Kona.  It sounded to me that she raced St George, but goal was Kona Ironman Florida vs Ironman Cozumel     Our News is sponsored by Buddy Insurance. It's big time training and racing season.  Buddy Insurance is the kind of peace of mind so you can enjoy your training and racing to their fullest.  Buddy's mission is simple, to help people fearlessly enjoy an active and outdoor lifestyle.  You can now get on-demand accident insurance to make sure you get cash for bills fast and fill any gaps between your current coverage.  Go to buddyinsurance.com and create an account.  There's no commitment or charge to create one.  Once you have an account created, it's a snap to open your phone and in a couple clicks have coverage for the day.  Check it out!   Endurance News: No, Running Doesn't Wear Down Your Cartilage. It Strengthens Your Joints. Numerous studies have shown that, contrary to what your sedentary friends may sometimes argue, running does not cause arthritis. New research shows, in fact, that running may actually help strengthen your joints against future wear and tear, says Jean-Francois Esculier, leader of research and development for The Running Clinic (headquartered near Montreal, Canada) and a medical professor at the University of British Columbia.   In a Sept. 3 paper in Sports Medicine, Esculier's team examined 43 studies that had used MRI to measure the effect of running on cartilage. One major finding of these studies, he says, was that the impact from running squeezes water out of cartilage and into the underlying bone. That means that an MRI taken immediately after running will show a decrease in cartilage thickness. So, Esculier says, “If you want to say running is bad, you can show a study that shows it reduces the thickness of the cartilage.” But the effect is transient and harmless, he says, because the moment you finish your run, the cartilage begins to reabsorb water and expand back to normal. “It only takes an hour,” he says. In fact, he says, running may actually be beneficial. Historically, Esculier says, doctors, researchers, and runners were taught that cartilage simply is what it is, and won't respond to training. “But we now know that cartilage can adapt,” he says. “Even with novice runners, after only 10 weeks, you see changes in cartilage so that it can actually tolerate more load.” What's happening, he says, is a side-effect of having fluid squeezed out of the cartilage into the underlying bone. When it comes back, he says, it brings with it nutrients that feed the cartilage and make it stronger. “So not only is running not bad for your joints, it's actually good for your joints,” he says. It isn't just beginners whose joints can strengthen with use. Studies of more experienced runners, he says, suggest that they have developed cartilage that is more resistant to the type of impacts seen in running than that of non-runners. One of the more dramatic studies looked at competitors in the TransEurope FootRace, a 4,486-kilometer mountain run (2,787 miles) that went from Sicily to northern Scandinavia in 64 days. A team of scientists followed the runners, using a portable MRI to assess them every 900 kilometers or so. Amazingly, Esculier says, they found not only that the competitors didn't have cartilage damage, but that their cartilage adapted during the race. About Bill's friend London Marathon - Raphael Pacheco Deb Connelly - Monday Running   What's New in the 303: Small Town America at the Heart of Gravel Racing? The Rad Dirt in Trinidad Shows Us Why Posted on October 5, 2021 By Becky Furuta If the heart of gravel racing is the wild west of cycling – where the rules are few and weirdness is welcomed instead of scrutinized – small town America is its soul. The lure of gravel racing is in the long, off-road adventure. It's tricky trails and hellacious hills and mud so thick it's like riding through peanut butter and rolling roads with expansive views. It's dust and limestone chunks and pea gravel that bury your tires like quicksand. Due in part to its grassroots heritage, gravel remains the antidote to the technology-driven, aggressive and often super-competitive mentality of road cycling. Most of today's gravel grinders began as small-scale events, and often with no entry fees. Despite their growth, they're dripping with the same low-key attitude that attracted participants in the first place. Small towns and gravel are perfectly paired. A convergence of factors have fueled gravel's popularity, but all speak to quiet country roads with little traffic and natural scenery. The character of these towns shape the events and the way they unfold. Trinidad, Colorado is no exception. And the quirky town on the New Mexico border may well become one of gravel's new hotspots. The small city of 9000 residents was founded in 1862 after rich coal seams were discovered in the region. By 1910, Trinidad was a company town. Colorado Fuel and Iron operated the largest steel mills in the West, and dozens of mines, coke ovens and transportation lines cropped up to support local industry. CF&I created small communities for the workers they recruited to come from Europe, believing they were less likely to try and organize. To the contrary, this led to one of the darkest chapters in American labor history. Just a few miles north of Trinidad in the Spring of 1914, Union organizer Louis Tikas and 20 others were killed in a violent company crackdown known as the Ludlow Massacre. It was a bloody insurrection that occurred in protest of brutal working conditions. Three of the victims – a woman and her two children – suffocated in the dirt pit where they were hiding. By the 1920s, the coal industry was fading but Trinidad found a new, strange prosperity when mobster Al Capone and his family took the town during prohibition. They were able to easily blend in with local Italian families who continued to call the city home. Lavish hotels, a Carnegie library, an Opera House and the oldest synagogue in the state of Colorado cropped up in what would be called “the Victorian jewel of Southern Colorado.” Just having dirt alone isn't enough to make Trinidad a gravel success story. Part of an event's draw is the community itself, and how well they embrace the cyclists who come to visit. It's about the community and the culture, the adventure and the Instagram images of rolling hills and farmland. It's about getting people to drive hours in search of something different. Trinidad seems to understand all of that. City Council members greeted riders at the start and the finish. Restaurants enthusiastically marketed to gravel tourists. (Just ask me about the singing waiters at Rino Italian Restaurant downtown.) The route featured unique terrain you won't find at other gravel events. Only time will tell if Trinidad's next identity is built around bikes and outdoor tourism, but judging by the reactions of participants in The Rad Dirt Fest, it's right on track. Trinidad, like so many other rural communities, may well become a town transformed by bikes.     Video Of The Week: Ironman Chattanooga 2021 Highlights   Closing: Thanks again for listening in this week.  Please be sure to follow us @303endurance and of course go to iTunes and give us a rating and a comment.  We'd really appreciate it! Stay tuned, train informed, and enjoy the endurance journey!

Ever wondered if you truly NEED knee surgery? Because let's be real, how accurate are one of those MRI machines and is it truly getting the WHOLE picture? These are questions anyone who has experienced knee pain, or been told they need surgery has thought at least once. Curious what research has to say about this? Be sure to tune in...you won't want to miss out on this one. Show Notes: Website: www.motusrx.com Knee E-Guide: bit.ly/5stepstorelievekneepain Sick of your knee pain and want to find out what is going on? Schedule your Complimentary Visit at www.motusrx.com/free-discovery-visit

Today on the show I am talking about one of the possible root causes of your endo belly – coeliac disease. Now, before you turn this podcast off because you think you don't react to gluten, I am literally begging you to listen.  I have noticed a trend in my clients to dismiss coeliac disease as a possibility, because they don't have immediate reactions after gluten. But – here's the thing, the reactions from gluten are not always obvious and they don't always happen straight away.  So, if you're bloated all the time, tired all the time, maybe you have diarrhoea regularly or gas, or constipation, or maybe you don't have any gut symptoms at all – but you have brain fog, fatigue and achy joints, then it may be down to coeliac disease.  And these symptoms don't just have to occur after straight after gluten. In fact, according to the Food Allergy Research and Resource Program at the University of Nebraska-Lincoln, coeliac disease is a “delayed hypersensitivity reaction where symptoms develop 48-72 hours after ingestion” of gluten.(1) Now yes, some people with coeliac disease will experience symptoms soon after eating gluten, but for others, it's a couple of hours or even longer, as demonstrated here. So just because your symptoms do not show up straight after gluten, that doesn't mean you do not have coeliac disease and in fact, if you tend to eat gluten daily, and you tend to feel unwell daily – maybe you have chronic fatigue, for example - then this could be the result of that delayed reaction, just blurring into the next, because there's little time between each serving.  Additionally, the NHS states that symptoms can actually be mild and can come and go, so the signs of coeliac disease may be inconsistent(2). Your reactions to gluten do not have to be severe for you to have coeliac disease, for example, my brother was hospitalised with severe abdominal cramping and vomiting when he was diagnosed, whereas my sister literally said she was just “fed up of feeling nauseas”. And here's why it's important to get checked.  In the UK, only 30% of people with coeliac disease have been diagnosed(3), and it is estimated that 500,000 people are walking around with undiagnosed coeliac disease.(4)  In America, 83% of people with coeliac disease are undiagnosed.(5) And it's not rare either. In the UK, 1 in 100 people have coeliac disease (3) and in the USA, 1 in 133 people have coeliac disease.(5) And as you can see from these stats, the majority of them don't know they have it. And if you have endometriosis, the chances of having coeliac disease is higher. Research has identified a strong  association between endometriosis and coeliac disease. Coeliac disease patients were found to be almost twice as likely to develop endo in research(6) and studies have found that people with endometriosis are significantly more likely to develop coeliac disease.(7) To add to that, coeliac disease is a co-condition of small intestine bacterial overgrowth(8), which is a condition where normal bacteria which should be found in the large intestine, are growing in the small intestine. And SIBO is at present, estimated to affect up to 80% of people with endometriosis(9) and is a root cause of the endo belly, because the signature SIBO symptom is bloating. So, if you have endometriosis and SIBO, this is a really strong indicator that you should get tested. Additionally, in a study of over 200 women with endo, 75% experienced a reduction in symptoms after eliminating gluten for 12 months.(10) That doesn't mean you have to be as strict as someone with coeliac disease if you don't have it, as people with coeliac disease have to avoid cross-contamination, so literally they have to have separate food prep areas, chopping boards, etc. But not eating gluten containing foods may make a significant difference to life with endo.  Now, clearly, this isn't for everyone. For some people in this study, it didn't help, and we have to be careful when we talk about eliminating foods, as it can be triggering and cause issues with disordered eating, so I am not saying to just go and cut out gluten today. In fact, I actually advise against that – at least until you've been tested for coeliac disease! Then if you don't have it, I advise you work with someone to identify if gluten is a problem for your endo personally or take one of my courses where I teach you how to do that yourself, and as you guys know, The Endo Belly Course is currently open for enrolment now. So now you know the prevalence rates of coeliac disease, I thought I'd take you through some of the signs. Now, gut symptoms are often common symptoms, but  some people don't have these at all and in fact, they have other symptoms that may be seemingly random or connected to endometriosis, so they dismiss the possibility of it being coeliac disease. So today, I want to take you through some surprising signs of coeliac disease to look out for: 1) Rashes. Number one is rashes and specifically, a rash called dermatitis herpetiformis. My brother developed this, but my sister didn't, and the rash turned up probably a year or more before his gut issues arrived and it's actually common for people who have the rash, to not have the gut symptoms (though this isn't always the case). The rash looks like blisters on the skin, and is itchy, red, and tends to occur on the elbows (which is where my brother had it), knees and glutes. It is only a rash that appears in coeliac disease patients and is caused by gluten, it is not a rash anyone could get and is not caused by herpes, however, it does look like the herpes virus! Of course, if you have a rash like this and you have some of the other symptoms of coeliac disease, it's worth testing for it, but you can also get a biopsy to confirm whether this is dermatitis herpetiformis.(11) 2) Number two is dental problems. Now this tends to occur if the coeliac disease developed as a child (and just be mindful that coeliac disease can develop at any age!) due to the body being unable to absorb enough nutrients due to the damage in the intestines and from my understand, also as a result of the immune reactions. Dental problems can occur as issues with the enamel and can look like discolouration, patches on the teeth, translucent areas, grooves on the teeth and potentially increased cavities. Additionally, the growth of adult teeth can be delayed too.(12) 3) Number three is mouth ulcers(13), and these would be on the side of the mouth, on the cheeks and tongue, not on the lips – so we're not talking about cold sores. These won't occur in everyone, but if they do, they'll usually be recurring and you may have a few at one time. Again, this is thought to be a result of the nutrient deficiencies and immune response to the gluten.  4) Number four is anaemia, either b12 or iron deficiency induced anaemia or both(14). And this is tricky, because this is also a sign of SIBO!(15) So again, it's easy to dismiss coeliac disease here. B12 and iron deficiency anaemia will cause symptoms like tiredness, dizziness, shortness of breath, heart palpitations, numbness in the hands and feet, mouth ulcers, brain fog and irritability to name a few.(16,17) I've linked to the NHS page for symptoms in the show notes.  You can fairly easily get tested for these through your GP or online testing sites like Thriva in the UK, and I've linked to a few of them(18). If your levels are low but not deficient, it's still worth ruling out coeliac disease, because they have to get low to get deficient and if you've only just recently developed coeliac disease, it may take some time for your levels to drop. And on top of that, if you have the presence of gut problems, endo belly or any of the other symptoms I've listed, and you have low levels of iron and B12, it's safer just to rule it out. 5) Number five is infertility or reoccurring miscarriages, and I think this is an important one to raise because we often dismiss fertility problems as a symptom of endometriosis.  Now if coeliac disease is diagnosed and treated (as in, a person sticks to a strictly gluten free diet, which is the only form of treatment there is) then fertility rates return to normal and are equal to someone without coeliac disease. The problem is when it's left undiagnosed, and in fact, the guidance in the UK is that people who have recurring miscarriages or fertility struggles should be tested. I mean I think they should be tested as soon as the difficulty begins, to save people all that heartache, but I guess it costs the NHS less this way. There are numerous reasons why coeliac disease will affect fertility, from disrupting hormones, causing inflammation in the body, nutrient deficiencies and so on. But the bottom line is, the only way to treat it would be with a diagnosis and an adherence to a gluten free diet.(19)  6) Number six is brain fog(20). Coeliac disease patients often report brain fog and fatigue and research confirming these reports, with MRI scans showing brain changes and damage in people with coeliac disease. This brain fog may be accompanied by memory loss, headaches, and even balance or speech problems.  One small study found a significant improvement in patients with CD and cognitive impairment after a year on a strict gluten free diet(21), so there is definitely hope if this is a symptom you have and you're diagnosed!  And I thought I'd raise this one because so many of us report brain fog with endometriosis, and whilst there are many root causes behind this (in fact, I have a whole episode on them) often we just dismiss it as something we have to live with. So those are a few symptoms that you may not suspect would be behind coeliac disease – and these can all occur with or without gut problems and the endo belly. Some other signs to look out for include the development of autoimmune conditions like hashimoto's thyroiditis, type 1 diabetes (which my brother developed) and osteoporosis(22). So now let's move onto testing. To accurately test for coeliac disease, you must be eating gluten daily, at least twice a day, for six weeks(23). This is because the immune system will create antibodies against gluten and that's what's being measured. If you're not eating gluten at all or not regularly, you'll get a false negative test, even if you have the disease. So, if my brother tested today, he would come up as negative, because he hasn't eaten gluten for several years.  Once you've done the blood test, you'll then also be sent for a biopsy.  If you're still not sure whether it's worth getting tested, I've linked to an online assessment in the show notes, which will literally create a letter to take to the doctor, if it advises you to get tested, based on your symptoms.(24)  So that's it! If you have the endo belly, full stop, I advise you to get tested. And if any of these other symptoms sound familiar, I advise you to get tested too! Left undiagnosed, coeliac disease can cause serious health problems and increase your risk of multiple conditions and chronic diseases(24), and we've never lived in a better time to be gluten free, so even though it might be a hassle to get tested, it'll be worth it in the long run.  I've also linked to some gluten free courses and cookbooks in the show notes.(25) Listen and subscribe on your favourite player or listen directly/download MP3 here or just listen below! Let's get social! Come say hello on Instagram or sign up to my newsletter. Sign up to my free workshop: Creating a Roadmap to Endo Belly Healing Sign up to the wait list for my course, Live and Thrive with Endo here. My cookbook This EndoLife, It Starts with Breakfast is out now! Get 28 anti-inflammatory, hormone friendly recipes for living and thriving with endometriosis. Order your copy here. If you feel like you need more support with managing endometriosis, you can join Your EndoLife Coaching Programme. A 1-to-1 three month health and life coaching programme to help you thrive with endometriosis. To find out more about the programme and to discuss whether it could be right for you, email me at hello@thisendolife.com or visit my website. This episode is sponsored by The Pod Farm. Learn all about how to start your own podcast with the complete course from The Pod Farm. Aimed at beginners, this course takes a simple and straightforward approach to planning, equipment buying, setting up, recording, editing and hosting your own podcast. With hours of audio and video materials, and downloadable guides and useful links, this multimedia approach aims to have something for every kind of learner. From now until April 15, newsletter subscribers get 20% off the course price. Visit www.thepodfarm.com to enroll or find out more This episode is sponsored by BeYou. Soothe period cramps the natural way with these 100% natural and discreet menthol and eucalyptus oil stick on patches and CBD range. Click here to find out more and to shop: https://beyouonline.co.uk  Show Notes 1.      https://farrp.unl.edu/resources/gi-fas/celiac-disease 2.     https://www.nhs.uk/conditions/coeliac-disease/symptoms/ 3.    https://www.coeliac.org.uk/information-and-support/coeliac-disease/coeliac-disease-faqs/ 4.      https://www.coeliac.org.uk/information-and-support/coeliac-disease/about-coeliac-disease/myths-about-coeliac-disease/?&&type=rfst&set=true#cookie-widget 5.      https://www.beyondceliac.org/fast-facts-about-celiac-disease-infographic/ 6.     https://pubmed.ncbi.nlm.nih.gov/21840904/ 7.     https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6601386/ 8.    https://www.siboinfo.com/associated-diseases.html 9.    https://pubmed.ncbi.nlm.nih.gov/9660426/ 10.  https://pubmed.ncbi.nlm.nih.gov/23334113/ 11.    https://celiac.org/about-celiac-disease/related-conditions/dermatitis-herpetiformis/ 12.   https://celiac.org/about-celiac-disease/related-conditions/oral-health/, https://jcda.ca/article/b39 13.  https://www.coeliac.org.uk/information-and-support/coeliac-disease/about-coeliac-disease/what-are-coeliac-disease-symptoms/ 14.   https://www.coeliac.org.uk/information-and-support/coeliac-disease/about-coeliac-disease/what-are-coeliac-disease-symptoms/ 15.   https://www.siboinfo.com/overview1.html 16.  https://www.nhs.uk/conditions/vitamin-b12-or-folate-deficiency-anaemia/symptoms/ 17.   https://www.nhs.uk/conditions/iron-deficiency-anaemia/ 18.  https://thriva.co, https://valahealth.com, https://www.letsgetchecked.com 19.  https://www.coeliac.org.uk/information-and-support/coeliac-disease/conditions-linked-to-coeliac-disease/infertility-and-coeliac-disease/ 20. https://www.coeliac.org.uk/information-and-support/coeliac-disease/conditions-linked-to-coeliac-disease/neurological-conditions/ 21.   https://celiac.org/about-the-foundation/featured-news/2014/07/brainfog/ 22.  https://www.coeliac.org.uk/information-and-support/coeliac-disease/conditions-linked-to-coeliac-disease/ 23.  https://www.coeliac.org.uk/information-and-support/coeliac-disease/getting-diagnosed/#glutenthroughout 24.  https://www.nhs.uk/conditions/coeliac-disease/complications/ 25.  https://www.penguinrandomhouse.com/books/665647/cannelle-et-vanille-bakes-simple-by-aran-goyoaga/, https://www.arangoyoaga.com/on-demand-videos,https://www.learningwithexperts.com/foodanddrink/courses/river-cottage-gluten-free?ref=naomidevlin, https://gluten-free-baking-school.thinkific.com/courses/gluten-free-sourdough-bread, https://gluten-free-baking-school.thinkific.com/courses/enriched-dough, https://gluten-free-baking-school.thinkific.com/courses/everyday-gluten-free, https://gluten-free-baking-school.thinkific.com/courses/bao-noodles-and-dumplings, https://sweetlaurel.com

Welcome to the NeurologyLive Mind Moments podcast. Tune in to hear leaders in neurology sound off on topics that impact your clinical practice. In this episode, we spoke with Gregory W. Albers, MD, director, Stanford Stroke Center, Coyote Foundation Professor of Neurology and Neurological Sciences, Stanford Medical Center; and founder, RapidAI. He shared his insight into the development and clinical use of RapidAI, a platform that leverages artificial intelligence to create enhanced, high-quality images from noncontrast CT, CT angiography, CT perfusion, and MRI diffusion and perfusion data, aiming to expedient diagnoses, treatment, and transfer decisions Episode Breakdown: 1:15 – Background on RapidAI and its development 3:30 – Findings from the pivotal DIFFUSE clinical program of the system 9:15 – Immediate future plans for RapidAI's capabilities and use 15:55 – Neurology News Minute 18:50 – RapidAI as a complement to the physician in diagnosis 22:00 – Integrating the RapidAI system across the United States 24:50 – The future use of AI in stroke and neuroimaging 28:00 – Closing thoughts The stories featured in this week's Neurology News Minute, which will give you quick updates on the following developments in neurology, are further detailed here: Lecanemab Rolling Submission for Alzheimer Disease Initiated by Eisai, Biogen Fenfluramine sNDA Submitted for Lennox-Gastaut Syndrome Atogepant Approved for Episodic Migraine Prevention Thanks for listening to the NeurologyLive Mind Moments podcast. To support the show, be sure to rate, review, and subscribe wherever you listen to podcasts. For more neurology news and expert-driven content, visit neurologylive.com.

CF 198: MRI's and Clinic Presentation & Surgery vs. Conservative Care For Discs Today we're going to talk about surgery vs. conservative treatment for discs and we'll talk about MRI findings and clinical pain.  But first, here's that sweet sweet bumper music     Purchase Dr. Williams's book, a perfect educational tool and chiropractic research... The post MRI's and Clinic Presentation & Surgery vs. Conservative Care For Discs appeared first on Chiropractic Forward.

Cooper Hodges, PhD earned a Bachelor of Science in psychology from Andrews University in 2016 and a doctorate in cognitive and behavioral neuroscience from Brigham Young University in 2020. He is currently a Postdoctoral Fellow at Virginia Commonwealth University in the Department of Physical Medicine and Rehabilitation. Cooper's research interests primarily involve the use of imaging techniques like MRI to investigate traumatic brain injury in military Veterans and how injuries may affect brain structure and psychological functioning.https://twitter.com/cooper__hodgesWe discuss:traumatic brain injurytrue source of depressionwhat to say when someone is suicidalhow to challenge your thoughtsvr exposure therapyimpostor syndrome solutionsintimate partner violenceIf you want go from feeling hopeless to hopeful, lonely to connected and like a burden to a blessing, then go to 1-on-1 coaching, go to www.thrivewithleo.com. Let's get to tomorrow, together. National Suicide Prevention Lifeline800-273-TALK [800-273-8255]1-800-SUICIDE [800-784-2433]Teen Line (Los Angeles)800-852-8336The Trevor Project (LGBTQ Youth Hotline)866-488-7386National Domestic Violence Hotline800-799-SAFE [800-799-7233]Crisis Text LineText "Connect" to 741741 in the USALifeline Chathttps://suicidepreventionlifeline.org/chat/International Suicide Hotlines: http://www.suicide.org/international-suicide-hotlines.htmlhttps://www.nowmattersnow.org/skillshttps://sobermeditations.libsyn.com/ www.suicidesafetyplan.com https://scaa.club/

Zone3podcast is lucky to be joined by returning guest Kristan Harrington, MBA, RT(R)(MR) to discuss Breast MRIBreast imaging is one of Kristan's passions. Her interest started with her experience in research at Emory University. Kristan provides the audience with a run-down of today's Breast Cancer statistics and how MRI is becoming the leading preferred imaging modality because of its success with specificity and sensitivity. This consequently, could be linked to the reason the breast cancer mortality rate has dropped 40% in the past 25 years. 322,000 women's lives saved! Kristan discusses Breast cancer's many contributing factors that are considered established risks. She also touches on some interesting things that are considered emerging risks, as well. Kristan is an advocate of abbreviated breast imaging.  Allowing the exam to be available to more patients is key. Technological Advancements in MRI have greatly increased image quality, resulting in an increase in diagnostic integrity.About our Guest:Kristan has been an educator specializing in MRI since 1998. She worked as an educator with Philips Healthcare for almost 12 years. She held a full-time faculty appointment at Emory University School of Medicine leading the MRI Bachelor's Degree Program. Kristan is the Senior Associate with William Faulkner & Associates providing both MRI educational and consulting services. She speaks at conferences nationally for many vendors including, MTMI, NWIF, Siemens, Philips, Bracco, and Medtronic. Kristan is also developing bachelor's degree programs in MRI for universities that are moving in that direction. Kristan earned her Associate's degree in Radiology Technology in 1996 and her Bachelor's Degree in Medical Science Education, with honors from Emory University in 1997. She then received her Master's in Business Administration in 2010.Breastcancer.orgAbout our Sponsor:  Aegys is an innovative leader in the MRI safety industry.Aegys is committed to providing innovative product and process solutions that enhance overall magnet safety and improve efficiency.  Their TechGate Auto is a Zone 4 Barrier System that keeps patients and MRI technologists safe.  TechGate Auto allows technologists to focus on the care of patients and efficient room turnaround rather than worrying about anyone entering the MRI room behind them. Easy to use and designed for the MRI environment, TechGate Auto is deployed whenever the technologist enters or leaves the MR room or via push-button remote control, providing an immediate physical restriction of access to all unauthorized individuals.The use of a “caution” barrier at the entrance to the MR room is now a recommendation of the American College of Radiology MR Safety Committee.Thanks for Joining us in Zone 3!

Dr. Pierre-Marie Robitaille is a world-class scientist and engineer responsible for doubling the power of the MRI medical imaging system. His insights from radio-imaging human bodies led to groundbreaking revelations about astronomical radio spectra, which ultimately led to him questioning the central dogma of solar science concerning the material nature of Earth's central star. This is the second of a four-part series with Dr. Robitaille. All are or will shortly become available at podcast locations worldwide. Support the podcast by becoming a Patron: ªº¬˚∆≤≥≤≥ https://www.patreon.com/demystifysci ≤≥≤≥∆˚¬ºª ªº¬˚∆≤≥≤≥ Join the mailing list http://eepurl.com/gRUCZL​ ≤≥≤≥∆˚¬ºª Check our main channel, @DemystifyingScience for in depth-investigations. Dr. Robitaille's Channel: https://www.youtube.com/channel/UCL7QIOZteWPpBWBOl8i0e-g PODCAST INFO: Blog: http://demystifyingscience.com/blog Apple Podcasts: https://apple.co/3uhn7J1Spotify: https://spoti.fi/39IDJBDRSS: https://anchor.fm/s/2be66934/podcast/rssFull episodes playlist: https://bit.ly/3sP1WgRClips playlist: https://bit.ly/2OieYEGDonate: https://bit.ly/3wkPqaDSwag: https://bit.ly/2PXdC2y SOCIAL: - Twitter: https://twitter.com/demystifysci- Facebook: https://www.facebook.com/groups/demystifyingscience- Instagram: https://www.instagram.com/demystifysci/ See the YouTube version for all of Pierre-Marie's references & citations: https://youtu.be/0fB9M4vjHXY --- Support this podcast: https://anchor.fm/demystifying-science/support

Elizabeth Jameson is an artist and writer who explores what it means to live in an imperfect body as part of the universal human experience. Before her diagnosis of multiple sclerosis, she served as a public interest lawyer representing incarcerated children; she later represented children living with chronic illnesses and disabilities in their attempts to receive medically necessary care. As her disease progressed, she began using her MRI's to create art as a way of reclaiming agency of her own medical data. She transformed the unsettling, clinical images into work that invites people to open up conversations about what it means to have an illness or disability. Her work is part of permanent collections both nationally and internationally, including the National Institutes of Health, major universities, and medical schools. She now writes personal essays and speaks across the country sharing her experiences living with illness and disability. Her essays have been published by The New York Times, British Medical Journal, WIRED magazine, and MIT's Leonardo Journal "Intimate Visions: Representations of the Imperfect Body in the Age of Digital Medicine". Her essay, “Losing Touch, Finding Intimacy,” was included in the New York Times book, About Us, released in September 2019 by Norton Publishing. She published a second article in the New York Times titled "To Feed Me Is to Know Me". Many of her lectures at medical schools and symposiums have been recorded and shared, including her Stanford TedX talk, “Learning to Celebrate and Embrace Our Imperfect Bodies.”

Heather Isch is CEO and President at LKF Marketing, a B2B-focused full-service marketing communications company that specializes in working with manufacturers with complex, often highly technical products and complicated sales channels; governmental agencies working on regional economic development; and local community-focused arts organizations and nonprofits (the agency's give-back “passion” projects). Heather describes the process of getting to know LKF clients as a “deep dive” – into understanding all of the different industries they work in, the “customer levels” within each of those industries, who clients are trying to reach (which may vary by product application), what clients are trying to sell, and how they are trying to solve their customers' problems – and compiling that information into “customer maps.” In addition to questioning clients, the agency gets industry information through accessing existing research, consulting with trade partners, following industry trade journals, through trade shows (when possible), or by, when something is completely new and needs to be “explored,” commissioning paid research. “We spend a lot of time with engineers,” Heather says.  Another piece of the “deep dive” is market research: finding and figuring out how to effectively reach target audiences – where these people are, how they make decisions, their internal “cultures” and inter-relationships, and the right media mix to support client messages. LKF started in 1989 with two partners, graphic designer Charlie King and strategist Brad Lawton – and soon added media buyer Carol Fricke. After a number of years, Carol bought out her partners and invited Heather on board. In 2015, after Heather had served in the role of vice president for about 8 years, Carol retired and Heather took over as owner. Heather says that this transition was “always part of the plan” and that “when you plan for . . . transitions, they go a lot smoother.” Even now, Heather is working with her team so that when it is time for her to go, her current team of leaders will have everything they need to make the transition seamless.  In this interview, Heather talks about how her team of 17, each of whom has a specific “area of expertise,” has maintained relevance through the years. She explains that the agency's culture supports “keeping ahead of trends” and not fearing trying new things or failure. The agency actively promotes continued training, attending seminars, and trying out and leveraging new client-appropriate tools and technology . . . all with a focus on delivering results for LKF's clients. A recent example: LKF developed a trademarked Content Management System, McConimore, to facilitate rapid/ agile Web development and overcome some of what Heather describes as WordPress's “intrinsic flaws.” Heather takes a very holistic view of her organization. She explains that LKF's passion statement, “Assisting the people in our family to thrive,” applies to the agency's clients as well as the agency's internal work family, employees' families, and the community the agency serves. Heather can be reached on her agency's website at: lkfmarketing.com and on Facebook, LinkedIn, and Twitter. Transcript Follows: ROB: Welcome to the Marketing Agency Leadership Podcast. I'm your host, Rob Kischuk, and I'm excited to be joined today by Heather Isch. She is the CEO and President at LKF Marketing based in Kalamazoo, Michigan. Welcome to the podcast, Heather. HEATHER: Thanks. I'm glad to be here. ROB: Super great to have you here. Why don't you kick us off by telling us what LKF Marketing excels in? What's your specialty?  HEATHER: We are a full-service marketing communications company. We primarily serve B2B. We like really technical, confusing kinds of clients, so we have a lot of clients in the manufacturing space. We also have a lot of digital skills, so a lot of web development, that kind of thing. So helping clients with complicated sales channels, complicated products, that kind of thing. ROB: Got it. When you say “technical and confusing,” let's pull on that thread for a minute. What would something technical and confusing sound like? Even though once you describe it, it may not sound so technical and confusing. HEATHER: A lot of our clients serve highly technical clients. They might be working with highly engineered products that might be sold into packaging or beverage or wastewater treatment. Sometimes in the medical industry, like for MRI equipment. So a lot of our clients have technical products that you really have to dig in and understand, spend a lot of time with engineers so that you understand what you're talking about, first of all. But then those clients typically have very complicated sales channels, and it's understanding how to get to and share their messaging in a variety of different industries to a variety of different levels, whether they're influencers or the buyers. In other markets that we serve, we work in economic development, so we have a lot of development clients working with, in our case, the state of Michigan working to understand brownfields and redevelopment credits and all kinds of crazy stuff. And then we have some of our more fun clients that might be a little bit more – those are our passion projects, more in the community that we live in. We like to give back, so we'll be working with people in our arts community or some of our nonprofits. But we're not typically the consumer products group, if that makes any sense. ROB: It certainly does to an extent, although I'm now also contemplating who a wastewater influencer is. [HEATHER laughs] When we get into the particulars of it, take us down a layer on that. The complexity affects who you're targeting, it affects your marketing channels. How do you take a problem like wastewater treatment – I imagine the client is very helpful in informing you of what they know, but they also might not know, and the knowledge may not transfer over the same way as if you're in a core B2B context. HEATHER: Right. With a client like that, it could be a wastewater treatment plant, it could be – here's one for you. We've started working with some of the people that are trying to do extraction in the cannabis market. That's really been more of an exploration. Who is making these decisions? Same thing in wastewater treatment plant. It may be the facilities manager that we need to get to; it could be an operations person in a specific area, but then you may also need to be speaking with the director of public services, depending on the different cities and states. A lot of times it's doing a deep dive with our clients to really understand all of the different industries that they're working in, who they're trying to connect with, what we're trying to sell them, or how we're trying to solve their problems, and then really going to work and putting together all of those customer maps. Sometimes there's research that exists; a lot of times we rely heavily on some of our trade partners. We've spent a lot of time with engineers. And in some cases, there might be actual research that we commission because we're really in exploratory mode. If the client's trying to launch something new, then we have to go down that paid research path. ROB: It seems like some of these prospects for these products – they're almost going to be pleasantly surprised if you can reach them with a convincing message directly. But how do you think about reaching such a specific customer? This certainly doesn't sound like billboard and TV ad territory. HEATHER: Not typically billboards, no. Usually there's heavy emphasis in the different – there's trade journals for everything under the sun. We work with a client that makes products for linemen to keep them safe when they're up on utility poles. You would be amazed at how many trade journals there are for that industry and for very specific titles. So for that particular group, we might be doing a combination of traditional print mixed with some social media, heavy web presence. Honestly, it's trying to do the deep dive by industry, figuring out where these folks are, and doing the right media mix. Sometimes it's tradeshows thrown in there, although COVID has not done us any favors in that department, so we've had to get a little more creative with how to reach our customers. ROB: That's wild, because I'm also thinking that linemen are probably not on LinkedIn very much. Maybe less than other industries, if you will. HEATHER: Right. ROB: I can't imagine all the trade journals you get at your office. That must be a heck of a picture on its own. HEATHER: Yeah, we have a lot of trade journals that come here. Also, I think one of the things that has been fascinating is the connection that linemen have with each other. There's a very tight, almost like a brotherhood. There are a lot of ways to reach this group, but they're also very connected and become very attached to their brands, and we are lucky enough that our client is very, very well-known, and linemen ask for it by name. That's been an interesting little twist in their industry. And we find that across the board. Every industry is very different, so you really have to figure out what's going to get the best result based on the market. You learn to talk. You learn to figure out where these people are and how they make decisions. ROB: It's interesting, especially with the linemen. When someone's going to get up near high-energy power, downed lines, all that stuff, when they ask for safety equipment, I feel like you listen to them. [laughs] But I don't know. Also, you're talking about getting deep into an industry. It seems to me there could be some big opportunities – if somebody's been marketing with a firm that doesn't take the time to get in deep, there could be huge uncovered opportunities that are maybe even pretty low-hanging in the content and search world. Have you found examples of keywords that are lying out in the wide open for the taking, but weren't claimed by the industry? HEATHER: Absolutely. ROB: What's that look like? HEATHER: I think that's probably one of our key strengths. We are hell-bent on getting results for our clients, and the way you do that is really digging in deep and understanding their business and what they're making, what they're creating, what that end game is. We have search engine optimization talent on staff as well as usability experts, and a lot of this is really just years of learning to understand, I guess as best as anyone can, Google. They change everything every day. That's a full-time job. But I feel like we're pretty gifted in that department. ROB: Heather, let's rewind the clock a little bit on this. What is the origin story of LKF? Where did this business come from? HEATHER: This business was actually created in 1989, and there were two partners, Charlie King and Brad Lawton, the ‘L' and the ‘K' in LKF. Charlie was a graphic designer and Brad was a strategy guy. Then they met up with Carol Fricke, and she was a media buyer. She came to Kalamazoo after a long stint in Atlanta, Georgia, and she teamed up with this group. They formed the trio, Lawton, King, Fricke, and operated for quite a few years together. During that time, I was actually a kid fresh out of college and I met Carol while I was selling ad space for one of the papers. I continued to have that relationship with her for many years. I left publishing and became a marketing manager for a manufacturing company, which is where I probably learned to really love all of those nerdy technical things. She and I stayed in touch, and actually LKF did a lot of design work for the manufacturing company that I worked with. During one of our lunches one day, she told me she wondered what was happening with me. I said I was negotiating hopefully what I thought would be “the job” with a local agency, and she said, “I don't think so. I don't want you to go work for another agency. I just bought my partners out, so I think you should come and work for me.” So I did. I worked with her for many, many years, and in 2015 she was ready to retire, and I took over as owner. ROB: Congratulations. It's a good long story, and some of the best stories are those long stories. I find that every change of control of an agency is a little bit the same and a little bit different. What do the mechanics of assuming ownership, as it were, of an agency – I mean, you don't have to get into particulars and percentages, but how does that even work? These are often somebody's baby, but they also don't want to care for it anymore. So what does that look like? HEATHER: I think one of the things that was really beautiful about our transition is Carol and I had talked about that early on. That was always kind of the game plan. Neither one of us really had an end date, but we worked towards that, and I worked as the vice president for about eight years before taking over as owner. I think your point about the same yet different – there are so many things that make LKF who we are today, and we have always been uber-focused on delivering results for the client. That's just embedded in who we are. I think the culture piece also. We've always had this – it's overused, but “work hard, play hard” focus. We always enjoyed each other's company. Carol made it possible for me to be a vice president, help run the company, but also raise two small children. I had a very flexible schedule throughout that time. I think when I took over, I wanted to put a bigger light on that, taking that to the next level, really looking at giving our team the ability to take care of their own families but be wildly successful here at the agency. I think we've been doing flex schedules – it was fashionable before COVID made it fashionable. [laughs] So we're very blessed in that department. Our passion statement is “Assisting the people in our family to thrive,” and in the LKF bunch, we describe our family as our clients as well as our internal work family, their families, and the community that we serve. I feel like that has just gotten bigger, I think, in that transition. But it was planned for, and I think when you plan for those transitions, they go a lot smoother. ROB: How does that inform where you sit now? I'm sure someday you are planning to not run the agency anymore. How are you thinking about even the next generation? And really, you're talking about handling a 50-year-old agency before too long, 40 even sooner. HEATHER: That's my goal. I would say my vision is that my current team of leaders are getting everything that they need so that the day that it's time for me to go, it's really seamless. I think good leadership is not about the who or the personality cult of what's at the top; it's what has made us who we are. Is everybody trained and schooled in all things LKF Marketing, the LKF way? How do we push that down in the organization so that there's a seamless transition when the time comes? ROB: Nobody's surprised, right? HEATHER: Nobody's surprised. ROB: It makes logical sense to everybody involved. HEATHER: Yep. ROB: That is quite a journey, and congratulations on everything so far. In the time that you have been there, when you track back to 1989, in terms of skills of the team members, some things are still very valid and helpful. There are still media buying elements there. But how media is bought and the other marketing channels that are involved have shifted entirely. How has the team over time been able to continue to stay relevant? You mentioned even getting up into social, and then there's stuff beyond that. There are so many places where an agency can get stuck in media, in SEO, in PPC, and others keep going past that. How do you think about these practice areas, which ones are ready to adopt for the agency, and how to either upskill or add skills to the team to get there? HEATHER: I think that's always the question. How do you keep yourself relevant? One of the things that we've always been very good at is not being afraid to fail and not being afraid to try things. Having experts – our team is very small. There's 17 of us. But every person on the team has an area of expertise, and they're really charged with keeping ahead of trends. We put significant emphasis on training and making sure that we're attending seminars, that we're trying out tools, that we're figuring out which tools make sense for our client base and how to apply them so that they're getting the best results and we're leveraging the right technology, and we're not becoming irrelevant. I think that's also something that has happened during the past 18-20 months, this explosion of digital tools, technology. And that's what we're excited about: how are we going to harness some of this new technology and really apply it to our client base? One of the things we had started working on pre-COVID was a new web development platform. We in the past have had a proprietary development platform, and over the years we've realized that's just not a thing anymore. But we've also seen the need for some tools to allow rapid or agile development. WordPress is always the thing that people are all about, but we've always felt like it had some intrinsic flaws. [laughs] So we went to work and have come up with our own product in that category. It's been trademarked. We're really excited about using that, alongside many other tools. But I think that's a testament to how we're staying relevant. We're constantly saying, “This is good. We tried this; it didn't work. That's okay.” And honestly, every client, because of the industries that they're in, they're pushing us to try things that might work for them but don't work for one of our other clients. So I think that also helps us to stay relevant and on top of what's out there. ROB: Very, very interesting. Very tricky, of course. You're saying you've built a new CMS up from scratch? Is that my understanding, or did I miss a detail there? HEATHER: Say that again? ROB: You have a new CMS that you've put together? HEATHER: Yes. ROB: Wow. What's it called? HEATHER: It is called McConimore and we don't widely – it's really only available to our customers. ROB: Pretty interesting. There's always room for new ideas there. That's a category where everybody's always trying to dominate it and nobody ever does. It's sort of the tale as old as time. WordPress is always there, but you've got your GoDaddys, your Webflows – all of the things. But nothing ever dominates. It's pretty interesting. Heather, as you look at your tenure, as you look at your time in LKF and overall, what are some key lessons that you've learned as you've been leading that you might want to go back and tell yourself if you could rewind a little bit? HEATHER: I think for me personally, I am a thinker, a big picture person. I love data. But once I have enough data, I'm definitely ready to move, and I think my younger self could get talked out of moving as quick as she would like to go. [laughs] There has to be calculated risk. There has to be data, all of those things. But I think that is part of, in our industry, staying ahead of everybody else. Failure or trying things on, that's all part of the learning journey, and I hope that's one thing that we instill in our teams: to never be afraid to try something and see if it works. I think that's probably it. ROB: Very good. As you're looking forward at the future of LKF, the future of marketing in general, what are some things you are looking forward to? What's next? HEATHER: I think really taking our team to the next level. We are training up newer teams, and I'm looking forward to being able to serve more clients. We're ready. I also think harnessing all of these different technologies and leveraging them for our clients. There's been a really big shift over the last 20 months, and I think as people get back online, helping them to really innovate and think about how to solve some of their challenges – that's been a topic of discussion for us because I think we've been so focused over the past 18 months on tomorrow and next month. We've got to get people asking different questions, thinking about how we're going to do it differently, how we're going to tackle this problem in a different way. Some of the previous solutions just don't work. So I'm excited about what's next for our clients and how we might go to market and start looking at things from a different perspective. ROB: Absolutely. I always enjoy thinking through the individual contexts of where people are. It sounds like you are very aligned to your local community, to the art community. If someone has not been to visit you in the place that you call home in Kalamazoo, what should somebody go see? What are some of the highlight reels of your home? HEATHER: We have a beautiful downtown that is very vibrant with lots of fun little boutiques and breweries. Wonderful little shops. We also, on the outside edges of Kalamazoo, have a wonderful Air Zoo, which is a great museum to take your families to. We also are home to Western Michigan University, Kalamazoo College, Kalamazoo Valley Community College. We are a town that is very focused on education and keeping our talent here in Kalamazoo. We are also home to The Promise, if you've ever heard of that. The Kalamazoo Promise has been talked about all over the United States. We have a very philanthropic community. So lots of good reasons to come and visit. ROB: It sounds wonderful. I always like to dig in and honor – my team is around the country, and I just like to have us all think about what makes each other's homes special. So thank you for sharing that. I know we always see Western Michigan jumping up and biting some other team in college football that wasn't expecting to get beaten that week. They're one of those upstarts that likes to surprise people, but it sounds like the people there are not surprised. HEATHER: Kalamazoo is a great place to live. ROB: Heather, when people want to get in touch with you and with LKF, where should they go to find you? HEATHER: You can find us at lkfmarketing.com. You can also find us on Facebook, LinkedIn, and Twitter. ROB: Fantastic. Heather, thank you so much for your time, for sharing your journey, for sharing that unique depth of understanding that you get into with clients to sell things that I think are hard to sell by a formula. That is very much to your credit, so congratulations. HEATHER: Thank you. ROB: Be well, and we'll look for more great things from LKF. HEATHER: Thanks, Rob. It was great talking to you. ROB: Thanks, Heather. Take care. Bye. HEATHER: Bye. ROB: Thank you for listening. The Marketing Agency Leadership Podcast is presented by Converge. Converge helps digital marketing agencies and brands automate their reporting so they can be more profitable, accurate, and responsive. To learn more about how Converge can automate your marketing reporting, email info@convergehq.com, or visit us on the web at convergehq.com.

Suarez has Mexican ancestry. She started wrestling before her fourth birthday, as all of her older brothers wrestled and she insisted that her mother let her wrestle too. She graduated from Northview High School before attending Lindenwood University. She is a two-time bronze medalist in the world championships of freestyle wrestling. In 2011, she was ranked the number one freestyle wrestler in the US at 55 kg (121 lb). While training for the 2012 Summer Olympics in London, Suarez suffered a neck injury, which derailed her Olympic aspirations. An MRI and CAT scan not only revealed a bothersome disc in her neck, but a cancerous growth on her thyroid. Suarez underwent radiation therapy and had her thyroid and several lymph nodes removed. After successful treatment, her thyroid cancer was gone and she eventually began to train again. Suarez started practicing Brazilian jiu-jitsu, which led her to discovering mixed martial arts. Thanks to our main sponsors:   Go Check this months feature sponsor:   http://advancewarriorsolutions.com https://inforce-mil.com​ https://www.watchwpsn.com​ code: “BARTOLO” https://www.pulsarnv.com/ https://www.gallowtech.com​​​​ https://rhinosafe.com​​​​​ https://www.galcogunleather.com/​​​​​ https://blackwaterammunition.com​​​​​ https://ritonoptics.com​​​​ www.JohnBartoloShow.com Visit our Friends: Kenzies Optics https://www.kenziesoptics.com Visit Microtech Knives https://microtechknives.com/​​​​​ #johnbartoloshow #johnbartolo

Entrepreneurs solve problems for customers. There are few problems bigger than the horribly perverse medical care system under which patients suffer in the US. The system has evolved over time, with the stimulus of bad decisions, bad actors, and bad incentives. Entrepreneurship can solve the system problem with specific actions at the component level, each of which are practical and do-able, and can interact to create a new outcome at the system level. Murray Sabrin has studied both the system and the component solutions, and he joins the Economics For Business podcast to enumerate his proposed actions. Key Takeaways and Actionable Insights Healthcare is a consumer good, and a consumer responsibility. Medical care is a provider proposition. Consumer sovereignty is a cornerstone concept in Austrian economic theory. Consumers determine what is produced as a result of their buying or not buying. Does this principle apply in healthcare? To answer requires us to differentiate between healthcare and medical care. Healthcare is an individual choice and a personal responsibility: we do everything we can to maintain a healthy lifestyle of eating and drinking, exercise and sound physical and mental health practices. In the internet age, there is plenty of knowledge available to help us in our decision-making. Medical care is what we turn to when sound healthcare proves to be insufficient to keep us off medication and out of hospital. How do consumers realize value from medical care providers? To do so is very challenging due to (among other barriers) price fixing, price opacity, price inflation, monopolistic and duopolistic market structures, the misuse of insurance, bureaucratic management, perverse incentives, government intervention, and barriers to entrepreneurial entry. Are there potential solutions in the face of this systemic dysfunction? Yes: solutions that come from the best countervailing source — entrepreneurship. Entrepreneurial Solution #1: Direct Primary Care — Restoring the doctor-patient relationship. Murray Sabrin recalled the $5 doctor visit of the past, characterized by a personal relationship with no bureaucracy or insurance forms. Entrepreneurs are now re-establishing that relationship via Direct Primary Care. DPC is retainer fee-based access to unlimited doctor visits, including office-based testing and additional services, with no insurance forms. DPC doctors have fewer patients in their practice and can consequently provide more time and attention. Stronger relationships are built, which is the essence of entrepreneurial value-generation. Entrepreneurial Solution #2: Transparent versus distorted pricing. Pricing is one of the most important bulwarks of free markets. In medical care, pricing is opaque to the point of invisibility, distorted, and inflated. It is unresponsive to the normal choice-based supply-demand mechanisms, and not indicative of value. Some entrepreneurs are acting to change these pricing conditions via what is termed fee-for-service: transparent pricing for specific services. An often-cited example is Surgery Center of Oklahoma, where specific prices for specific surgical services are openly posted on their website. Other members of the Free Market Medical Association provide similar price transparency. One of the results is revelatory price comparison: Murray told the story of a DPC practice patient who identified a 75% price reduction at Surgery Center of Oklahoma compared to a local South Florida hospital. Entrepreneurial Solution # 3: One stop shopping at local non-profit clinics. Murray described the launch and success of several non-profit local and regional clinics, including one for which he was the founding trustee. These are philanthropically established and funded local clinics with volunteer staff, providing a range of services. Equipment and pharmaceuticals may be fully or partially donated by the manufacturing companies. The combination of direct primary care doctors and specialists can make these clinics one-stop shopping solutions for patients seeking quality medical care. With a little philanthropic assistance, they could eliminate the need for Medicaid. Entrepreneurial Solution #4: Direct Contracting. Insurance companies purposefully inflate medical care prices to fund their business model. Murray told the story of a large (4-500 employees) company that contracted directly with a service that brought a vehicle with an MRI machine to the employers location, and charged $400 per MRI to the employees. The same vehicle was utilized by a nearby hospital that charged $6,000 for the same MRI. Direct contracting saved $5400 per unit cost, or 90%. Direct contracting has the potential to significantly reduce costs in the Medical Care system, while opening access and increasing convenience. Entrepreneurial Solution #5: The 3-tier household medical care budget system. Murray has a well-constructed and eminently practical household medical care budget system. There's a version for families with at least on member in employment and an alternative for those on Medicare today. There are three elements: Direct Primary Care for a monthly fee, covering unlimited office visits and routine tests.A Health Savings Account to cover costs of specialists, prescription drugs, medical equipment, major tests and brief hospitalizations.Catastrophic insurance coverage for major operations and hospitalizations and long term care. Greater detail is provided in Murray's book, Universal Medical Care From Conception To End Of Life. Download our corresponding PDF, which features an adapted table from Murray's book: Mises.org/E4B_137_PDF In a system of personal responsibility, we would all manage our household medical care budgets with these kinds of tools. Entrepreneurial Solution #6: Voluntarism And Mutualism. Voluntarism has a long tradition in America. Mutual aid societies were prevalent before the New Deal. Ethnic, religious and trade groups joined together for mutual support. The Federal Government co-opted these functions and now people look to Washington DC to solve their problems. But young people today are more interested in voluntarism and non-political social activism. 30 years ago in the Wall Street Journal, Peter Drucker argued for the non-profit sector to replace the welfare state. Creative and innovative people find ways to surmount institutionally-erected barriers in all phases of life, and medical care is certainly one of those. There's a liberating and energizing sense of acting as the custodian of one's own life and helping others who need it. It's the entrepreneurial ethic. Entrepreneurial Solution #7: Distributed Knowledge. There is so much available knowledge today about healthy life habits and about the symptoms and characteristics of various medical conditions, and about options for treatment. We as individuals are free to explore, and responsible for gathering our own store of knowledge. The outcome of the research may not be definitive, and we may find ourselves making a choice between alternatives. But doctors and hospital administrators make choices too, and they are not infallible. It may be possible for an individual to gather more knowledge about their own specific condition from the internet than any single doctor can know, simply as a consequence of concentrated effort. Each of us can take responsibility for our own life. Summing up: Murray Sabrin's prescription: Eliminate employer-based insurance.Make a single exception for the case in which the employer pays the direct primary care fee for the patient.The resultant employer savings are deposited in employees' health savings accounts.Employees determine their best medical care options.Phase out Medicare and Medicaid.Let young people create super health savings accounts so that they don't need Medicare in the future.Hospitals price at realistic market pricing, not insurance-inflated prices.All prices are transparent.Get the government out of medical care — it's none of their business.Free up resources from the medical-pharmaceutical-insurance complex and redirect them to savings, investment and philanthropy. Additional Resources Read Murray's book, Universal Medical Care from Conception to End of Life: The Case for A Single-Payer System: Mises.org/E4B_137_Book It's self-published and all proceeds go to charity and non-profits. "Individual Single-Payer Alternative For Employer-Based Insurance" (PDF): Mises.org/E4B_137_PDF Surgery Center Of Oklahoma: surgerycenterok.com Forward: goforward.com Direct Primary Care Coalition: dpcare.org Volunteers in America: vimamerica.org

Entrepreneurs solve problems for customers. There are few problems bigger than the horribly perverse medical care system under which patients suffer in the US. The system has evolved over time, with the stimulus of bad decisions, bad actors, and bad incentives. Entrepreneurship can solve the system problem with specific actions at the component level, each of which are practical and do-able, and can interact to create a new outcome at the system level. Murray Sabrin has studied both the system and the component solutions, and he joins the Economics For Business podcast to enumerate his proposed actions. Key Takeaways and Actionable Insights Healthcare is a consumer good, and a consumer responsibility. Medical care is a provider proposition. Consumer sovereignty is a cornerstone concept in Austrian economic theory. Consumers determine what is produced as a result of their buying or not buying. Does this principle apply in healthcare? To answer requires us to differentiate between healthcare and medical care. Healthcare is an individual choice and a personal responsibility: we do everything we can to maintain a healthy lifestyle of eating and drinking, exercise and sound physical and mental health practices. In the internet age, there is plenty of knowledge available to help us in our decision-making. Medical care is what we turn to when sound healthcare proves to be insufficient to keep us off medication and out of hospital. How do consumers realize value from medical care providers? To do so is very challenging due to (among other barriers) price fixing, price opacity, price inflation, monopolistic and duopolistic market structures, the misuse of insurance, bureaucratic management, perverse incentives, government intervention, and barriers to entrepreneurial entry. Are there potential solutions in the face of this systemic dysfunction? Yes: solutions that come from the best countervailing source — entrepreneurship. Entrepreneurial Solution #1: Direct Primary Care — Restoring the doctor-patient relationship. Murray Sabrin recalled the $5 doctor visit of the past, characterized by a personal relationship with no bureaucracy or insurance forms. Entrepreneurs are now re-establishing that relationship via Direct Primary Care. DPC is retainer fee-based access to unlimited doctor visits, including office-based testing and additional services, with no insurance forms. DPC doctors have fewer patients in their practice and can consequently provide more time and attention. Stronger relationships are built, which is the essence of entrepreneurial value-generation. Entrepreneurial Solution #2: Transparent versus distorted pricing. Pricing is one of the most important bulwarks of free markets. In medical care, pricing is opaque to the point of invisibility, distorted, and inflated. It is unresponsive to the normal choice-based supply-demand mechanisms, and not indicative of value. Some entrepreneurs are acting to change these pricing conditions via what is termed fee-for-service: transparent pricing for specific services. An often-cited example is Surgery Center of Oklahoma, where specific prices for specific surgical services are openly posted on their website. Other members of the Free Market Medical Association provide similar price transparency. One of the results is revelatory price comparison: Murray told the story of a DPC practice patient who identified a 75% price reduction at Surgery Center of Oklahoma compared to a local South Florida hospital. Entrepreneurial Solution # 3: One stop shopping at local non-profit clinics. Murray described the launch and success of several non-profit local and regional clinics, including one for which he was the founding trustee. These are philanthropically established and funded local clinics with volunteer staff, providing a range of services. Equipment and pharmaceuticals may be fully or partially donated by the manufacturing companies. The combination of direct primary care doctors and specialists can make these clinics one-stop shopping solutions for patients seeking quality medical care. With a little philanthropic assistance, they could eliminate the need for Medicaid. Entrepreneurial Solution #4: Direct Contracting. Insurance companies purposefully inflate medical care prices to fund their business model. Murray told the story of a large (4-500 employees) company that contracted directly with a service that brought a vehicle with an MRI machine to the employers location, and charged $400 per MRI to the employees. The same vehicle was utilized by a nearby hospital that charged $6,000 for the same MRI. Direct contracting saved $5400 per unit cost, or 90%. Direct contracting has the potential to significantly reduce costs in the Medical Care system, while opening access and increasing convenience. Entrepreneurial Solution #5: The 3-tier household medical care budget system. Murray has a well-constructed and eminently practical household medical care budget system. There's a version for families with at least on member in employment and an alternative for those on Medicare today. There are three elements: Direct Primary Care for a monthly fee, covering unlimited office visits and routine tests.A Health Savings Account to cover costs of specialists, prescription drugs, medical equipment, major tests and brief hospitalizations.Catastrophic insurance coverage for major operations and hospitalizations and long term care. Greater detail is provided in Murray's book, Universal Medical Care From Conception To End Of Life. Download our corresponding PDF, which features an adapted table from Murray's book: Mises.org/E4B_137_PDF In a system of personal responsibility, we would all manage our household medical care budgets with these kinds of tools. Entrepreneurial Solution #6: Voluntarism And Mutualism. Voluntarism has a long tradition in America. Mutual aid societies were prevalent before the New Deal. Ethnic, religious and trade groups joined together for mutual support. The Federal Government co-opted these functions and now people look to Washington DC to solve their problems. But young people today are more interested in voluntarism and non-political social activism. 30 years ago in the Wall Street Journal, Peter Drucker argued for the non-profit sector to replace the welfare state. Creative and innovative people find ways to surmount institutionally-erected barriers in all phases of life, and medical care is certainly one of those. There's a liberating and energizing sense of acting as the custodian of one's own life and helping others who need it. It's the entrepreneurial ethic. Entrepreneurial Solution #7: Distributed Knowledge. There is so much available knowledge today about healthy life habits and about the symptoms and characteristics of various medical conditions, and about options for treatment. We as individuals are free to explore, and responsible for gathering our own store of knowledge. The outcome of the research may not be definitive, and we may find ourselves making a choice between alternatives. But doctors and hospital administrators make choices too, and they are not infallible. It may be possible for an individual to gather more knowledge about their own specific condition from the internet than any single doctor can know, simply as a consequence of concentrated effort. Each of us can take responsibility for our own life. Summing up: Murray Sabrin's prescription: Eliminate employer-based insurance.Make a single exception for the case in which the employer pays the direct primary care fee for the patient.The resultant employer savings are deposited in employees' health savings accounts.Employees determine their best medical care options.Phase out Medicare and Medicaid.Let young people create super health savings accounts so that they don't need Medicare in the future.Hospitals price at realistic market pricing, not insurance-inflated prices.All prices are transparent.Get the government out of medical care — it's none of their business.Free up resources from the medical-pharmaceutical-insurance complex and redirect them to savings, investment and philanthropy. Additional Resources Read Murray's book, Universal Medical Care from Conception to End of Life: The Case for A Single-Payer System: Mises.org/E4B_137_Book It's self-published and all proceeds go to charity and non-profits. "Individual Single-Payer Alternative For Employer-Based Insurance" (PDF): Mises.org/E4B_137_PDF Surgery Center Of Oklahoma: surgerycenterok.com Forward: goforward.com Direct Primary Care Coalition: dpcare.org Volunteers in America: vimamerica.org

Dr. Pierre-Marie Robitaille is a world-class scientist and engineer responsible for doubling the power of the MRI medical imaging system. His insights from radio-imaging human bodies led to groundbreaking revelations about astronomical radio spectra, which ultimately led to him questioning the central dogma of solar science concerning the material nature of Earth's central star. This is the first of a four-part series with Dr. Robitaille. Stay tuned! Support the podcast by becoming a Patron: ªº¬˚∆≤≥≤≥ https://www.patreon.com/demystifysci ≤≥≤≥∆˚¬ºª ªº¬˚ ∆≤≥≤≥ Join the mailing list http://eepurl.com/gRUCZL ≤≥≤≥∆˚¬ºª Check our main channel, @DemystifyingScience for in depth-investigations. PODCAST INFO: Blog: http://demystifyingscience.com/blog Apple Podcasts: https://apple.co/3uhn7J1 Spotify: https://spoti.fi/39IDJBD RSS: https://anchor.fm/s/2be66934/podcast/rss Full episodes playlist: https://bit.ly/3sP1WgR Swag: https://bit.ly/2PXdC2y SOCIAL: - Twitter: https://twitter.com/demystifysci - Facebook: https://www.facebook.com/groups/demystifyingscience - Instagram: https://www.instagram.com/demystifysci/ --- Support this podcast: https://anchor.fm/demystifying-science/support

Tuesday 9-21-21 Show #658: Ken and Myke talk about getting too old for the road trip, comedy condos, health insurance and Myke gets an MRI.

Dr. Al Danenberg or “Dr. Al” as he's known by his friends, patients and community, consults with patients all over the world (virtually via Zoom or Skype) regarding animal-based nutrition, lifestyle, oral & overall health, and the importance of a healthy gut and immune system. After a terminal cancer diagnosis, Dr. Al developed a plan that evolved into his Unconventional Cancer Protocols, combing in-depth research of ancestral nutrition & lifestyle changes with his knowledge from 44 years of as a periodontist. Now, he focuses on helping others like you regain control of their health.  Visit his website! - https://drdanenberg.com Join us! - https://freelynetwork.com/ Subscribe for tomorrow's newsletter! - http://Sapien.org   SHOW NOTES: [6:45] His background [12:50] An MRI revealed that he had terminal cancer [17:50] Why he went into a hospice ready to die. [20:10] How he landed on the carnivore diet [24:00] The paleolithic ketogenic diet [27:35] Male Dentists & Multiple Myeloma [30:50] The FDA's stance on mercury dental fillings [33:50] Toxins and our metabolism [37:50] Metabolic flexibility & the immune system [38:50] Our diet includes the water we drink [41:35] What kind of water does Dr. Al drink? [45:20] Is SOLE water better than filtered water? [50:40] All disease starts in the gut. [54:20] What causes gum disease and tooth decay? [58:50] Why spore-based probiotics are ancestral. [1:00:50] Dental health starts in the gut [1:03:50] How dental plaque protects our teeth [1:08:50] Gut problems manifest in the mouth [1:10:40] Ancestral diets for dental health [1:13:35] Stress can lead to dental problems [1:15:50] How to clean your mouth properly [1:19:25] Manuka honey works as toothpaste [1:21:50] How to get rid of bacteria on the tongue [1:25:00] How to solve bad breath. [1:26:00] Why we should be in ketosis sometimes [1:31:40] Why metabolic flexibility is important right now   GET THE MEAT! http://NosetoTail.org GET THE FREE SAPIEN FOOD GUIDE! http://Sapien.org   Follow along: http://twitter.com/FoodLiesOrg http://instagram.com/food.lies http://facebook.com/FoodLiesOrg    

What the recent recall election in California tells us about the current political climate in America. Then, the latest developments in treating food allergies. And, the gray wolf may be back on the decline not long after being removed from the endangered species list. Also, on today's show: making the MRI machine mobile; fuzzy puppets may be useful in therapy for children with autism; the story behind the first all-black high school rowing team in the country. (AP Photo/Rich Pedroncelli)

Today's episode actually comes from a podcast listener who had a question:  "I got an MRI just to give me the green light to resume training and it showed a grade three stress reaction of the left tibia. Do you think I can run?"  Deciding whether or not you can run with a stress fracture really depends on understanding how bad it was when it started, and how bad it is right now.  How bad is a grade three stress fracture? Well, that's what we're talking about today on the Doc on the Run podcast. 

Monday Night Football: With media surrounding both teams entering last nights matchup, the Packers came out of Lambeau Field with their first win of the 2021 campaign against the Lions. Florio and Simms discuss what went wrong and what went right for both teams during their match. Press releases from Aaron Rodgers on his first win of the season, along with an emotional Aaron Jones and what last night's game meant to him and his late great father. QB Injury Updates: We look around the league to the teams who currently have injuries in the QB position. Tyrod Taylor may be out for a couple weeks, Derek Carr got an MRI done, and Carson Wentz is injured yet again.Chicago Bears: Matt Nagy discusses the QB situation in Chicago. With veteran QB Andy Dalton dealing with some nagging injuries, does that leave the much anticipated rookie phenom Justin Fields a starting shot at QB? See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

This week's episode features author Benjamin Levine and Guest Editor Walter Paulus as they discuss the article "One-Year Committed Exercise Training Reverses Abnormal Left Ventricular Myocardial Stiffness in Patients with Stage-B HFpEF." Dr. Greg Hundley: Well, welcome listeners. This is the September 21st podcast for Circulation on the Run. Sadly, I'm without Carolyn today, but I am your host today, Dr. Greg Hundley, associate editor and director of the Pauley Heart Center at VCU Health in Richmond, Virginia. Dr. Greg Hundley: Our feature discussion today is really interesting. It's from Dr. Ben Levine, and he's evaluating the utility of exercise training and actually trying to reverse abnormal left ventricular myocardial stiffness in individuals that have stage B, it's a very early heart failure and preserved ejection fraction. But before we get to that, let's grab a cup of coffee and we're going to work through some of the other articles in this issue. Dr. Greg Hundley: So the first one comes to us from Göran Bergström from University of Gothenburg in Sweden. He and his team used coronary computed tomography angiography or CCTA to determine the prevalence, severity and characteristics of coronary atherosclerosis and its association to coronary artery calcification scores in a general population of greater than 25,000 individuals all aged 50 to 64 years and without known coronary heart disease. It really comes to us from the Swedish CArdioPulmonary BioImage Study or SCAPIS. Well, Carolyn would ask me that is a really large study, and what did they find? Well, let's get to the results. Dr. Greg Hundley: So using CCTA to detect silent coronary atherosclerosis, the investigators showed that any coronary atherosclerosis was actually quite common, 42% of individuals and significant stenosis of greater than 50% was less common, only 5% of individuals. More severe forms were rarely found, only 1.9% in this very large, random sample of middle-aged individuals. Dr. Greg Hundley: Now disease onset was delayed by 10 years in women and a higher prevalence of coronary atherosclerosis was observed with higher age and accumulation of risk factors. Interestingly, CCTA detected atherosclerosis increased with an increasing coronary artery calcium score. All those with a high CAC score of greater than 400 had atherosclerosis and 45% had significant stenosis. 5.5% of those with no coronary artery calcification had atherosclerosis and 0.4% had significant stenosis. So although there was a strong association with high coronary artery calcium scores and significant stenosis, atherosclerosis was not excluded in those with zero coronary artery calcification especially in those with high baseline risk. Dr. Greg Hundley: Well, our second article comes to us from the world of preclinical science and it's from Dr. Nathan Palpant from the University of Queensland. So the article pertains to ischemia reperfusion injury, and it's one of the major risk factors implicated in morbidity and mortality associated with cardiovascular disease. Now during cardiac ischemia, the buildup of acidic metabolites results in decreased intracellular and extracellular pH that can reach as low as 6 to 6.5, and the resulting tissue acidosis exacerbates ischemia injury and significantly impacts cardiac function. Dr. Greg Hundley: So the authors today use genetic and pharmacologic methods to investigate the role of acid-sensing ion channel 1a or ASIC1a, we'll call it from now, in cardiac ischemia reperfusion injury at the cellular and whole organ level. Human induced pluripotent stem cell-derived cardiomyocytes as well as ex vivo and in vivo models of ischemia reperfusion injury were used to test the efficacy of ASIC1a inhibitors as pre-imposed conditioning therapeutic agents. Dr. Greg Hundley: So what did the authors find in this study? Well, they demonstrated for the first time that acid-sensing ion channel 1a or that ASIC1a mediates cardiac ischemia reperfusion injury. The authors identify that ASIC1a inhibition is a novel therapeutic strategy for preventing acute injury response to myocardial ischemia reperfusion injury. Dr. Greg Hundley: So what are the clinical implications of this research? Well, first there are currently no drugs in clinical use that prevent acute injury response to myocardial ischemia, despite many promising candidates identified over decades of research, all of which ultimately failed in subsequent clinical trials. Second, the identification of new therapeutic targets for preventing the injury response to myocardial ischemia reperfusion injury would therefore have profound implications in cardiovascular medicine. Therefore, the results of this study reveal that ASIC1a inhibiting drugs, they're safe and they have potential applications in heart transplant and myocardial infarction with potential use in other clinical scenarios where myocardial ischemia reperfusion injury is a risk such as those that undergo cardiac surgery. Dr. Greg Hundley: Well, our next article comes from Robin Choudhury from the University of Oxford. Have you ever wondered why cardiovascular risk and diabetes remains elevated despite glucose-lowering therapies? Well, these authors hypothesized that trained immunity in response to elevated glucose accounts for diabetic hyperglycemic "memory", we'll call it, in relation to atherosclerosis. So accordingly, the author sought to determine if hyperglycemia-induced disease relevant changes in monocyte and macrophage function and whether these changes persisted after restoration of normal glucose, thereby implying fundamental reprogramming. So the team combined studies of cellular function, metabolomics, transcriptomics and epigenomics to define how hyperglycemia altered metabolism to modulate long-term activation through epigenetic modifications. Dr. Greg Hundley: Well, what did they find? First, hyperglycemia induced a trained immunity in bone marrow progenitor cells by inducing persistent epigenetic modifications. Second, hyperglycemia-induced trained immunity persisted after differentiation into those macrophages. Finally, hematopoetic stem cells transplanted from mice with diabetes to euglycemic mice promoted exaggerated atherosclerosis. So therefore, the findings of this study may explain the resistance of macrovascular complications of diabetes to conventional glucose-lowering treatments. Dr. Greg Hundley: Well, in the mailbag this week, there are some other articles. Professor Huang has a Research Letter entitled, “Adrenergic-Thyroid Hormone Interactions Drive Postnatal Thermogenesis and Loss of Mammalian Heart Regenerative Capacity.” Dr. De Caterina has an In Depth article on coronary artery anomalies. Finally, Professor Merid has a Perspective piece entitled, “Digital Redlining and Cardiovascular Innovation.” Dr. Greg Hundley: Well, listeners, what a great group of articles, and now we're going to turn to that feature discussion with Dr. Ben Levine. Dr. Greg Hundley: Welcome listeners to our feature discussion today and we're very fortunate. We have with us, Dr. Ben Levine from UT Southwestern in Dallas, Texas and also Dr. Walter Paulus from Amsterdam. Welcome gentlemen. Dr. Greg Hundley: Ben, we'd like to start with you. Could you describe for us a little bit of the background related to your study and what was the hypothesis that you wanted to test? Professor Benjamin Levine: Sure. Oh, nice to talk with you, Greg. As you know, our lab has been very interested in the effects of both aging and physical activity on cardiac mechanics. To cut a very long story short, what we know is that sedentary aging leads to stiffening of the heart. We also know that HFpEF, heart failure with preserved ejection fraction, is a disorder predominantly of the aged. I don't know about you, Walter, but I've never seen any lead masters athlete HFpEF. Professor Benjamin Levine: What we've shown is that if you regularly exercise over a lifetime that the heart can preserve its youthful compliance and flexibility. But if you wait until somebody is older, meaning over 65, 70, regardless of how hard or intense we train, the heart seems to lose its plasticity. It can't actually get that much better. But if we start in late middle age, it turns out that you can actually reverse some of the adverse effects of sedentary aging. So we said, "Okay, we know what the dose is, how much exercise you need to do. We know what the sweet spot in time. Now how do we find those people who are most likely to go on to develop HFpEF in whom getting them on a regular exercise program might help forestall this very challenging syndrome." Professor Benjamin Levine: So as part of an AHA-funded strategically focused research network and prevention, we identified a group of patients who had left ventricular hypertrophy, but evidence that they were on the wrong path. Their biomarkers were elevated. They have an elevated NT-BNP or a high sensitivity troponin. We did a right heart catheterization and we looked at their cardiac stiffness using a technique that we've done now for the past 25 years or so, and showed that indeed those patients' hearts are clearly stiffer than healthy, but otherwise sedentary middle-aged individuals. Professor Benjamin Levine: So our key question was what happens if we put them on a long sustained high intensity exercise program? Can we reverse the effects of sedentary aging superimposed with hypertension, left ventricle hypertrophy and elevated biomarkers? Dr. Greg Hundley: Really interesting, Ben. So describe your study design for us. How are you going to set up? It sounds like a very elaborate experimental setup here. Then also, maybe just define for us your study population. Did you have men and women or- Professor Benjamin Levine: Yeah, we started by going to the Dallas Heart Study. We're blessed here in Dallas by having this room access to our remarkable population where we know a lot about them. So we picked people in late middle age of all races, both sexes, and we reached out to the members of the Dallas Heart Study if they had left ventricular hypertrophy by echo or MRI and were of the right age range. We enriched that database by going to an EKG database and looking at the Ecolab database, trying to find people who did not have heart disease already. That was important. They couldn't have had a heart attack. They couldn't have had heart failure. They couldn't have had infiltrative disease. They had to be generally healthy except had left ventricular hypertrophy. Professor Benjamin Levine: We screened a lot of patients to get there, I have to acknowledge that, almost 4,000 of them or so to get the small number who were interested in doing a one-year exercise training program. But as we eventually got a good solid number that because we use such high resolution techniques, we were able to define the key outcome variable, which is cardiac stiffness. Professor Benjamin Levine: Briefly in our lab, we put a right heart catheter in to measure wedge pressure. We use 3D-echo to measure volume and then we use something called lower body negative pressure to unload the heart. It's almost like standing up progressively or tilting upright and then we give them a rapid saline infusion, 200 mls a minute. So a lot of saline, 15 and 30 mls/kg. We can get the left atrial pressure from about three or four up until about 18 to 20 and define the entire physiologic range of left ventricular filling. We look not just at the wedge pressure of course, but the transmural pressure. Professor Benjamin Levine: John Tyberg and his colleagues in Canada have shown clearly that the pericardial pressure is pretty close to right atrial pressure. So transmural pressure, which is the distending pressure of the heart, is left atrial minus right atrial pressure. We use that as the input into a pressure volume relationship. Dr. Greg Hundley: Very nice, and then what did you find? Professor Benjamin Levine: Well, what we found is after demonstrating that these patients with LVH and elevated biomarkers have increased stiffness, what we found quite remarkably actually was that we were able to reverse that by a year of training. Professor Benjamin Levine: Now when I say training, I mean, we do use the optimal approach to training that we've demonstrated in our lab. We didn't just pick one thing, get on a bike, do that for 30 minutes three times a week, right? These were sedentary people so we built them up slowly over about seven months. We added frequency, we added duration, we added intensity. Professor Benjamin Levine: I am enamored by the four by four in old Norwegian ski team workout, which is four minutes at 95% of max followed by three minutes of recovery repeated four times. We added interval training and long slow distance battle lasting about an hour on the weekends and a little bit of strength training, too. Professor Benjamin Levine: So what we consider the ideal prescription for life, four to five days a week, one long session, one high intensity session, two or three moderate intensity sessions and a little bit of strength. We did it for a year. It took a lot of effort. We had dedicated trainers. We gave them all heart rate monitors. Each person had a trainer to follow them. Professor Benjamin Levine: We did have a control group. We randomly assign them to a group that did stretching and yoga and mindfulness and a little bit of strength training, which makes people feel better. But we know from experience, it doesn't make them fitter and doesn't change their cardiac compliance. Dr. Greg Hundley: What happened with the treatment group? Professor Benjamin Levine: Oh, they got much more compliant. They got as compliant as if they had been training most of their lives. It was quite remarkable, actually, frankly, better than we expected it to be. We check the data multiple times by multiple people to make sure that this was a real finding. We really reversed much of the effects of the adverse effects of sedentary aging plus LVH. We hope that if that would be sustained over more than a year, years of long training study, there are very few training studies that go that long. But it's not a lifetime and at least we've set the stage for the concept that if this were to be sustained over a lifetime that we think it could forestall HFpEF. Dr. Greg Hundley: Very nice. Well, Walter, I know serving as a guest editor for us at Circulation and we're most appreciative for you doing that task. What struck you about this particular article and really enticed you to want to help us move it toward publication? Professor Walter Paulus: Well, I felt that the article was very visionary. Of course, as it comes from Ben, I didn't expect anything else. But what struck me were two points. Professor Walter Paulus: First of all, he looks at patients which we would label type B HFpEF. Most of our efforts have always been focusing on sick people, stage C HFpEF, stage D HFpEF. Now Ben was so clever to go to an early stage, and I believe that many of the so-called neutral outcomes in therapy for HFpEF are related to the fact that we actually address patients population who is quite far out on its natural history. So I think this was the first point to me. He, Ben, was addressing a population at the early stages of HFpEF. Professor Walter Paulus: The second point that struck me was that the variable he was looking at is in my opinion the key variable in HFpEF. It's the main reason I appreciated that this is the disease of myocardial compliance of left ventricle stiffness, and then very nicely addressed the stiffness of the heart as its primary outcome. This is something what we miss in all the pharmacological trials. I have always been curious when are we going to see the pharmacological trial whereby somebody is going to evaluate a compound in terms of its effects on left ventricular stiffness on myocardial compliance. Professor Walter Paulus: So these were for me two very salient features and very visionary in terms of treatment of a HFpEF population. Also, a couple of things that need to be clarified for me and I did. The patient's entry criteria were very demanding, has been also already said. I have the feeling that if you have LVH and then you will try NT-proBNP to be elevated and all your required troponins to be elevated, it's probably be very hard to get such a patient population and that may be then the only remark that could come up toward an extent in such a patient population still reflective of everyday health. Dr. Greg Hundley: Very good. Well, Ben, coming back to you, what's your next study? Professor Benjamin Levine: Well, we have a large program project grant, Greg, funded by the NIH, looking at the mechanisms of dyspnea and HFpEF. We're now just entered our third year. We're looking at a strategy to try to lower cardiac filling pressures acutely to see if that improves exercise tolerance and reduce dyspnea. We're looking at peripheral mechanisms of oxygen uptake and utilization and vascular control. We're looking at autonomic function, sympathetic nerve recordings, regulation of the sympathetic nervous system. We have a group focused on pulmonary mechanics, particularly on the effects of obesity. Professor Benjamin Levine: Our team with Tom Sarma is our recruitment core expert and one of the Circulation editors and is really the lifeblood of our study and leads our effort. We have Paul Fidel from UT Arlington who's leading our peripheral function studies, Qi Fu from UT Southwestern leading our autonomic group, and Tony Babb also from Southwestern in the pulmonary division leading our pulmonary mechanics. Professor Benjamin Levine: So we're entering this phase where we're trying to say, "Are there other components?" We know myocardial stiffness is a key factor, but what else in patients with the already manifest HFpEF is causing them to be so short of breath and can we change that? Professor Benjamin Levine: So that's what we're doing next, Greg. I think that if you ask what is the next step from this study, I think it has to be population-based and pushing the concept that exercise is medicine. When you find patients who have hypertension in general, and most of these had hypertension or diabetes, I mean, Walter has led this field and in emphasizing these comorbidities and what they do to the heart and the vasculature and the rest of the body, we have to catch people early. We can't wait until they have full-blown manifest HFpEF. We have to get them to include exercise as part of their personal hygiene. Professor Benjamin Levine: I know that that's a major effort from the American Heart Association. But I think that for the long-term health of our population and preventing this disease that is so difficult to treat when it's firmly established, we have to as cardiologists and as a healthcare system, we have to start by including incentives for reducing healthcare costs to get people to use exercise as part of their personal hygiene and daily life. Dr. Greg Hundley: Very nice. Walter, from your perspective, what do you see are the next studies that need to be performed in this sphere of research? Professor Walter Paulus: Well, I will be very curious to see how many patients would actually go on to develop HFpEF in their life. It should be as if Ben's hypothesis holds, then the control group probably would have an access development of HFpEF compared to his exercise training group. I think that would really extend to study from above, from a mechanical observation to a clinically, epidemiologically more relevant endpoint. So I think that to me would be the first question, how many patients will evolve to clinical HFpEF. Professor Walter Paulus: Second point I would be very intrigued in is, are there SIP groups in the patients who have a positive response to exercise? For instance, what happens with the different ejection fractions? Because we are very intrigued at present in HFpEF that at high ejection fractions nothing seems to work. Sacubitril was notable at high ejection fractions. Empagliflozin was also neutral to ejection fractions. What would happen with exercise? Do the patients who present with the 70% ejection fraction at the angio study, do they still have a positive response? This would be a game change because this would then be the only intervention that is able to cure the HFpEF with high ejection fraction. These are some future projects that come into my mind. Professor Benjamin Levine: Let me just add that we have studied and put patients with HFpEF on a yearlong exercise program with not as much effect as we would like. I think that's one of the things that pushed us to getting earlier into the course of HFpEF, as Walter said earlier. Professor Benjamin Levine: Ambarish Pandey and Jarett Berry, also from UT Southwestern, of course are very interested in this effect of fitness at different points in the lifespan, our fitness test, for example, measured in mid-life and what means for heart failure later. I think it's hard to do the kind of studies that we do and follow patients for 20 years to see if they're going to develop heart failure, and that's where I think being creative and looking at the studies that incorporate an assessment of fitness and that follow people over time will be very informative. I hope with me, Walter's hope and hypothesis that these patients are less likely to develop HFpEF. We've got to get in there early. Dr. Greg Hundley: Very good. Well, listeners, we want to thank Professor Benjamin Levine from UT Southwestern in Dallas and also Dr. Walter Paulus from Amsterdam for bringing us this really interesting study, indicating that in patients with LVH and elevated cardiac biomarkers, sort of the stage B HFpEF that one year of exercise training reduces left ventricular myocardial stiffness. Dr. Greg Hundley: Well, on behalf of Carolyn and myself, I want to wish you a great week and we will catch you next week on the run. This program is copyright of the American Heart Association, 2021. The opinions expressed by speakers in this podcast are their own and not necessarily those of the editors or of the American Heart Association. For more, visit ahajournals.org.  

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Scripture For Today: Psalm 66:20“Praise be to God, who has not rejected my prayer or withheld His Love from me!”Prayer and Miracles pt 2Yesterday, we introduced the subject of “Prayer and Miracles.” We outlined the fact that a miracle is simply God imposing His will and actions in such a way that it overrides the natural order of things. Such as healing a broken arm in six seconds instead of six weeks. But when x-ray or an MRI is done, it looks just like an arm that had undergone the entire healing process.  That was just one example. Amen! But we also discussed that it is not a good way to live if you are dependent on miracles coming your way on a daily basis – especially if it is a result of you messing things up in the natural!  Ok…Like I said, I believe in miracles…I believe in signs and wonders….I walk and believe according to Mark 16:15-21….but, we also need to look at Ephesians 6:16-18 and take OUR SHIELD OF FAITH and OUR SWORD OF THE SPIRIT and we should always be praying with all different kinds of prayer…all different manners of prayer. We will be studying them…in Matthew we will see that the Prayer of Binding and Loosing is first, followed by the Prayer of Agreement….but, for clarity purposes…I want to start with the Prayer of Agreement…because I believe it will help you to grasp the rest…amen! Ok, we are wearing God's armor…praying always…every waking moment…I want you to remember our three basic points we started this series with:   We do not try to get God's attention with our prayers… We do not try to change God with our prayers… We DO communicate with God with our prayers so we can receive from Him what He has already said belongs to us. Your prayer life should be your most consistent thing you do each and every day – all day long…because JESUS IS IN YOU!  He said that “he and the father will come and make their abode” in each and every believer….are you a believer?  If so, then GOD Himself and Jesus – is in you right now…everywhere you go, they go…everything you do – you are making them do….stop and think about the club you went to last night and who you went home with last night….if you are a believer…….hmmm…I'll leave that alone for right now…but I want you to see this…that is why I said that decisions we make affect our lives….and if we stay in a constant state of communication with God through Prayer…we avoid a lot of things that have brought strife into our hearts…some people have gone to clubs and had bad things happen to them….diseases…rapes…murders…the list goes on and on…if they would have only NOT gone to the club…these things would not have happened.  I'm not saying these things to be mean…I just, again, want to bring to your attention that the decisions we make have ramifications that can last for years….  Thanks bet to God for the Blood of Jesus which cleanses us from ALL our sins…AMEN!  We are not under condemnation…we are under GRACE!  Amen!  If what I just said convicted you of your sin…REPENT!  Ask Jesus to forgive and to help you….amen!  I don't know what you have gone through….I don't need to know  and I don't want to know…it is between you and God through Jesus….amen!!!  It is NOBODY else's business either….just you and Jesus – Jesus washes it away…and leads you to the father….and the father sees nothing but Righteousness when He sees you…amen!!! Well, I'm already over time for today, so let's stop right here. We will take it up again tomorrow.  Let's Pray!  Please subscribe to this podcast, leave us a quick 5 star review on Apple Podcasts to help us grow and be sure to visit our website for more information on our ministry: https://podcastersforchrist.com/ (https://podcastersforchrist.com). And while you are at the website, download the free resource I have for you… it is free and is called, “How to Start a Christian...

In this interview we asked @themyochiro, Simi, about the scope of practice for chiropractors, differences between the chiropractic medicine and athletic training professions, and common misconceptions about chiropractors. Timestamps 11:53- What is the scope of practice for chiropractors High velocity low amplitude manipulations Order labs/imaging (X-ray, MRI, etc.) 17:41- Chiropractic medicine curriculum 20:46- Common misconceptions about chiropractors 28:32- Coolest opportunity as a chiropractic student Building network 31:08- What can you do as a chiropractor that you can't do as an AT 35:09- When should an AT refer to a chiropractor 38:23- How should chiropractors utilize ATs 40:02- Action Item: What the AT community should know about chiropractors Join our AT Corner Facebook Group to comment on this episode and join the conversation with other listeners of the show! https://www.facebook.com/groups/atcornerpodcast Listen on Spotify, Apple Podcasts, or your favorite podcast directory! Linktr.ee/atcornerpodcast Instagram, Website, YouTube, and other links: atcornerds.wixsite.com/home/links Medbridge: Use code ATCORNER to get $175 off your subscription Precision AT: Use code ATCORNER for 15% off all home study courses Email us your stories, questions to answer on the show, topics you would like to hear, or just say hi! atcornerds@gmail.com Music: Jahzzar (betterwithmusic.com) CC BY-SA -Sandy & Randy

Today's episode comes from a podcast listener with a stress fracture and wants to get back to running. Jennifer says, "I went to see my doctor again today for my MRI results. He told me that I still have a stress fracture.  I was a bit confused, because after 10 weeks without running I thought there would have been more signs of healing.  So I asked if he could see a fracture line and he said, 'Yes and that I should stop running immediately!' (I guess my doctor forgot that I had stopped a long time ago).  I want to get back to running and I don't believe my doctor is truly getting me there. Prior to this appointment, I was feeling confident  that I could continue with my walk/jog routine as long as there was no pain.  However, now I am feeling scared because he could still see the fracture." In short, it sounds like Jennoifer is saying, "I don't trust my doctor." Well, that's what we're talking about today on the Doc On The Run podcast.

In this episode Toby sits down with Travis McCoy, vocalist of Gym Class Heroes. They talk about float tanks, MRI's, pandemic, Naked & Afraid, Geneva NY, Daryl Hall, getting into punk, art, tattoo apprenticing at 15, origins of the band, opioid issues, playing shows under the influence, working with Bruno Mars, hip hop and rap battles, making amends and recording new music. Please remember to rate, review and subscribe and visit our youtube channel https://www.youtube.com/tobymorseonelifeonechance

What if your orthopedic surgeon suggested you skip the MRI? Or if she suggested that knee scope probably isn't worth pursuing? Or pointed out your arthritis is not due to your activity? Would you look back at the sign on the door to make sure you were actually in a surgeon's office?Welcome to the latest episode of the Catalyst Health, Wellness & Performance Coaching podcast – one of our classic Hidden Gem episodes! I'm your host, Dr. Bradford Cooper and thanks to the magic of twitter, I discovered Dr. Howard Lucks, a respected orthopedic surgeon who didn't sound like most orthopedic surgeons I'd met during my 30 years as a physical therapist and endurance athlete. The more I read, the more intrigued I became, and the more obvious you'd want to hear from him too.Dr. Lucks is a Board-certified orthopedic surgeon specializing in sports medicine for almost 25 years. He is an Associate Professor of Orthopedic Surgery at New York Medical College and is the Chief of Sports Medicine and Arthroscopy at WMC Health, a branch of Westchester Medical Center. He's also a trail runner, amateur cyclists and father to 3 children. He also – like most of you here – believes in the pursuit of better.  For more information about the Catalyst Community, earning your health & wellness coaching certification, the annual Rocky Mountain Coaching Retreat & Symposium and much more, please see https://www.catalystcoachinginstitute.com/ or reach out to us Results@CatalystCoachingInstitute.com If you'd like to share the Be A Catalyst! message in your world with a cool hoodie, t-shirt, water bottle stickers and more (100% of ALL profits go to charity), please visit https://teespring.com/stores/be-a-catalyst If you are a current or future health & wellness coach, please check out our Health & Wellness Coaching Forum Group on Facebook: https://www.facebook.com/groups/278207545599218.  This is an awesome group if you are looking for encouragement, ideas, resources and more! Finally, if you enjoy the Catalyst Podcast, you might also enjoy the YouTube Coaching Channel, which provides a full library of freely available videos covering health, wellness & performance: https://www.youtube.com/c/CoachingChannel

Today's guest is Dr. Lisa Miller, whose doing some of the most valuable work on the science behind spirituality in the world right now. That's not to say this is a cold, sterile conversation about the topic. It is anything but that, and Lisa is one of my favorite guests we've ever had. Do yourself a favor and don't miss this essential 40 minutes.Dr. Lisa Miller is the New York Times bestselling author of The Spiritual Child and a professor in the clinical psychology program at Teachers College, Columbia University. She is the founder and director of the Spirituality Mind Body Institute, the first Ivy League graduate program in spirituality and psychology, and has held over a decade of joint appointments in the department of psychiatry at Columbia medical school.Her innovative research has been published in more than one hundred empirical, peer-reviewed articles in leading journals, including Cerebral Cortex, The American Journal of Psychiatry, and the Journal of the American Academy of Child and Adolescent Psychiatry.Her new book is The Awakened Brain, a brilliant work from a brilliant mind.Listen as we discuss:How do scientists define spirituality?MRI studies have allowed us to characterize the neurological seat of awareness.We are not alone. What does that mean?The poison of radical materialism.The dangers of "I gotta..." mindset and MRI proof that it's part of the addicted brain.We're designed to only see glimpses of the plane of truth.Take your intuition and wisdom as hard data.The best experiences of our lives are the ones that happen off the plan.People that are awakened are more likely to have depression.We all have the capacity for awakened awareness.Life is playing at a particularly frequency in one big symphony.Reprogramming ourselves from "achieving awareness" to "awakened awareness."Honor your knowing!Instagram: @mo_gawdatFacebook: @mo.gawdat.officialTwitter: @mgawdatLinkedIn: /in/mogawdatWebsite: mogawdat.comConnect with Dr. Lisa Miller on Twitter @lisamillerphd and on her website, lisamillerphd.comSome big news. I'm hosting my first sweepstakes. My new book, Scary Smart, is releasing September 30th. Pre-order your copy here, send a screenshot of your proof of pre-order to win@mogawdat.com, and win a signed copy, dinner with me, or access to an exclusive online talk. Hope to meet you all soon enough!Don't forget to subscribe to Slo Mo for new episodes every Sunday. Only with your help can we reach One Billion Happy #onebillionhappy.

The adventurous jazz punk percussionist and vibraphonist with Rickie Lee Jones, Ani DiFranco, Les Claypool, and Critters Buggin’, as well as his own groups including Punkadelick, Nolatet, and Billy Goat, is one of the most dynamic performers you’ll find anywhere. His terrific trilogy of Quarantine-era albums has raised the bar for everyone else. Mike comes clean about his triumphs and regrets over a stellar 30-year career that’s stronger than ever and as wild as it gets. Topics include a maiden episode, a road trip, an MRI, RIP Don (and Phil) Everly and Charlie Watts, a dead squirrel text, Texas roots, the Bad Brains, the DIY ethic, fIREHOSE, Ten Hands, Deep Ellum, prog rock, Fishbone, Zappa damage, the New Bohemians, Matt Chamberlin, a psychedelic epiphany, a dope habit, getting signed to Hollywood Records, Bob Cavallo, getting clean, Skerik, a genius quote, jam bands, “Shoot the Moon,” “Suitcase Man,” Elliott Smith, Alex McMurray, depression, Bob Wills, “1918,” a musical palette, Tito Puente, high jumps, and much more. Support the podcast here. Join the Patreon page here. Shop for Troubled Men’s Wear here. Subscribe, review, and rate (5 stars) on Apple Podcasts, Spotify, or any podcast source. Follow on social media, share with friends, and spread the Troubled Word. Intro music: Styler/Coman Break music: “Pelagic” from “1918” by Mike Dillon Outro music: “Shoot the Moon” by Mike Dillon and Punkadelick Troubled Men Podcast Facebook Troubled Men Podacst Instagram Mike Dillon Homepage Mike Dillon Facebook

Lymphoma is a cancer of the lymphatic system, which is part of the body's germ-fighting network. The lymphatic system includes the lymph nodes or glands, the spleen, the thymus gland, and bone marrow. While many types of lymphoma exist, the main subtypes are Hodgkin's lymphoma and non-Hodgkin's lymphoma.Knowing exactly which type of lymphoma you have is key to developing an effective treatment plan."The main problem with lymphoma is accurate diagnosis," says Dr. Jose Villasboas Bisneto, Mayo Clinic hematologist. "It is a rare cancer in proportion to the other cancers, so most cancer doctors will not see many lymphoma patients in any given month, or even a given year."Tests used to diagnose lymphoma include imaging tests, such as PET, CT or MRI scans, as well as biopsies of the lymph nodes and bone marrow.What treatment is best for a patient depends on the lymphoma type and its severity.On the Mayo Clinic Q&A podcast, Dr. Villasboas Bisneto discusses the various types of lymphoma and how they are treated.

This week we take a fan recommendation and dive into Helen Fisher's TedTalk "Why we love, why we cheat." We unpack the MRI studies of human brains when individuals are in love and when individuals are experiencing heartbreak. Erica and Molly also discuss the biology behind love and attachment, the three brain systems of romantic love, and much more. 20% off your order at Sunset Lake CBD with PROMO CODE: SGS20 at SunsetLakeCBD.com Get extra exclusive episodes & discounts by joining the Patreon: https://www.patreon.com/Shootersgottashoot Check out our new blog posting every Sunday! **LEAVE US A RATING AND REVIEW ON APPLE PODCASTS** Follow us on Instagram Erica Spera: instagram.com/spericaa // Molly DeMellier: instagram.com/theguaca_molly Email us your questions & DM stories at: shootersgottashootpod@gmail.com or DM us: instagram.com/shootersgottashootpod If you'd like to join Erica's NYC based Herpes Support group: https://www.meetup.com/NYC-Herpes-Support-Meetup/ or email: herpesgroupnyc@gmail.com www.shootersgottashoot.com --- Support this podcast: https://anchor.fm/shootersgottashoot/support

Science FINALLY Catches Up with Spirituality with Dr. Lisa Miller   “Life is like the winds or the river, life is moving. It is full of waves. Life is very much alive, very dynamic.”   “We are knowers in many forms and we need empiricists AND scientists… the magician, the intuitive, the mystic. We need to ask the questions in our head, and get answers in our hearts… This is how the big decisions need to be made - decisions on the board room, decisions with foreign policy. If we use just a tiny little splintered part of our brain, we will not make the best decisions.”   “The outward stuff falls in place when we follow the truth.”   “Are we pushing the wave or are we surfing the wave? If I try to push the wave, I get drowned under, but if I surf the wave and my goal is to ride with the flow of nature, then I go places I didn't know I was going to go... It opens up in the realm of miracles and unforeseen opportunities and magnificent surprises.”   “We're living the same life. We are the family of life. We are one human family and we are one living being.”   Lisa Miller       Episode Summary:   Have you ever had an overwhelming feeling of inner-knowing pops up inexplicitly?  Can current science validate that your gut feeling is real?   In this episode, we talk with Dr. Lisa Miller, Columbia University professor of Clinical Psychology, and New York Times bestselling author of “The Spiritual Child”.   Talk about credentials!  A graduate of Yale and the University of Pennsylvania, she's the founder and director of the Spiritual Mind Body Institute, the first Ivy league graduate program and research institute in spirituality and psychology, and has held over a decade of joint appointments in the Department of Psychiatry at Columbia University Medical School. Her innovative research has been published in more than 100 peer reviewed articles in leading journals including: Cerebral Cortex, American Journal of Psychiatry, and The Journal of American Academy of Child and Adolescent Psychiatry. Dr. Miller is the editor of the Oxford University press Handbook of Psychology and Spirituality, founding co-editor-in-chief of the APA journal, Spirituality and Clinical Practice, and an elected fellow of the American Psychological Association and two time president of the APA Society for Psychology and Spirituality. WHOA!   Her latest book, “The Awakened Brain”, is amazing. Dr. Miller describes it as “the culmination of 25 years of research. And equally importantly, interwoven with those 25 years of research, 25 years of life.” Listen in to understand Dr. Lisa Miller validate the science of spirituality, intuition, synchronicity.       Topics We Discuss: Most women know to use awakened awareness, will make an important decision out of a deep inner hunch, their instincts, a transcendent dream, some sort of inescapable synchronicity. They will count on that form of mystical awareness far and above the sort of linear, lists of pros and cons and statistics. The hard-nosed empirical scientific materialism validates our spirituality as our birthright.  MRI studies, genotyping studies, long-term clinical course studies all say that this deep form of awareness, our awakened awareness, the neuro docking station of transcendent spiritual experience -- A is real, B is our birthright, and C it is the foundation for greater health, greater recovery and renewal in times of suffering. How spirituality mitigates depression and addiction, suicidal deaths. Learning to trust that intuitive, inner-knowing as legitimate, right and true. Authenticity, synchronicity. Schumann Resonance – a high amplitude alpha wavelength within all of nature from the earth crust up one mile. The spiritually engaged brain vibrates at the wavelength of all creation of all nature of all life, the consciousness of the life, the loving felt substance of existence, the essence of existence, the family of life. “Spiritual bypassing” – the attempt to self-label as spiritual, without actually being spiritual.  Dr. Lisa Miller assures we are all spiritual, and we can all count on our awakened brain.     Follow Dr. Lisa Miller:   You can learn more about “The Awakened Brain”, purchase your copy and find out more about Dr. Lisa Miller at her website.   Support Life, Death and the Space Between:   If you're enjoying the podcast and finding value in guest interviews, ghost stories, and the content I share, please consider supporting the show by becoming a Patreon member for as little as $5 a month at Patreon.com/DrAmyRobbins   As a member you'll get more say in the content we cover and exclusive access to behind-the-scenes goodness!     Stay Connected: Facebook Instagram YouTube Fireside

Dietary propolis supplementation reduced proinflammatory cytokines associated with air pollution exposure, without impacting on immune cell infiltration or lung function New Zealand Institute for Plant and Food Research, September 10, 2021 Air pollution is estimated to cause 7 million annual deaths globally. Our aim was to determine if dietary propolis consumption could prevent the immune and functional damage in a mouse model of acute urban dust exposure. Female C57BL/6J mice were challenged three times with intranasal urban dust over seven days which significantly increased proinflammatory cytokines and immune cells in the lung 24 h post final challenge. Dietary New Zealand propolis (2%) with gamma cyclodextrin supplementation reduced urban dust-induced lung TNFα, IL-4, and IL-6 cytokine production; but did not alter immune cell infiltration into the lung, or lung function outcomes. This suggests that daily consumption of 8% propolis with gamma cyclodextrin supplemented food was sufficient to reduce urban dust pollution-induced proinflammatory cytokine production but was not sufficient to prevent immune cell recruitment into the lung or lung function decline in a murine model of lung inflammation. In this study we found that daily consumption of a New Zealand propolis reduced proinflammatory cytokines within the lung in response to acute urban dust exposure but this inhibition was not sufficient to reduce immune cell infiltration or prevent increased airways tissue constriction. These results suggest that dietary supplementation of 8% propolis with gamma cyclodextrin (equivalent to 2% propolis resin) does not result in sufficient bioavailable concentrations of the bioactive polyphenolics to fully overcome urban dust pollution-induced acute immune cell infiltration into the lung. Other studies have shown that acute gavage consumption or intraperitoneal injection of specific propolis bioactive components can protect against a number of different immune challenges within the lung. These effects appear to be both concentration and administration route dependent, and may not be achievable using unenriched propolis as a dietary intervention.   20-Week Study of Clinical Outcomes of Over-the-Counter COVID-19 Prophylaxis and Treatment Comprehensive Pain Management Institute (Ohio), August 6, 2021 New research published in the Journal of Evidence-Based Integrative Medicine shows that early intervention against a Wuhan coronavirus (Covid-19) infection using natural, over-the-counter remedies is a safe and effective way to avoid complications. Researchers from Ohio looked at modalities that are readily available for the Chinese Virus, including zinc, zinc ionophores, vitamins C, D3, and E, and l-lysine. These items were categorized in the study as “preventive measures” and “early-stage treatments” that can help to avoid the need for more “advanced” anti-covid measures such as pharmaceutical drugs and vaccines. Each of these tested remedies is natural, by the way, and the results of what they can do are impressive. Once again, nature wins out as our most abundant medicine cabinet, far exceeding anything cooked up in a lab. The clinical study found that this “multi-component OTC (over-the-counter) ‘core formulation' regimen” successfully protected test subjects against getting sick from the Chinese Virus, even as others got sick. “While both groups were moderate in size, the difference between them in outcomes over the 20-week study period was large and stark: Just under 4% of the compliant test group presented flu-like symptoms, but none of the test group was COVID-positive,” the paper reveals. “[W]hereas 20% of the non-compliant control group presented flu-like symptoms, three-quarters of whom (15% overall of the control group) were COVID-positive.” For 20 weeks, test subjects took these natural supplements. Adjustments were made for those with pre-existing health conditions and other health factors that may have influenced the outcome. Since all of the remedies utilized fall into the “low cost” category, anyone can access them. They are all dubbed as “anti-viral” as well, meaning they are safe and effective for use against viruses. By taking advantage of these remedies early, the paper explains, people can help to protect themselves against the types of adverse events that are causing some people to have to be hospitalized and put on a ventilator. “From early March through the end of July 2020, one of us (LM) monitored approximately 600 patients in Columbus and Cleveland, Ohio cities heavily affected by the COVID-19 pandemic, and did consultations with several colleagues (including JL) in the New York City metropolitan area, also heavily hit,” the paper explains. “Over that 5-month period, we dealt with dozens of clinical and/or test-confirmed cases of COVID-19. Much of the monitoring was performed via telemedicine; approximately 20% was performed in-office. It is from in-office monitored patients and staff that the study groups emerged.” We have been covering some of these same remedies along with others that have been scientifically shown to help protect against spike protein-induced illness. Hydroxychloroquine (HCQ), as one example, is a zinc ionophore that helps to deliver more zinc into cells for improved immune function. Epigallocatechin gallate (EGCG), a polyphenol component of green tea, is a natural zinc ionophore that improves zinc absorption. For this latest study, the research team used quina (cinchona) plant bark extract and quercetin as zinc ionophores, as these, too, help to deliver more healing nutrients like zinc to the cells. “The core supplementation formulation components have been demonstrated … to have beneficial effects both outside of and within clinical settings in the prevention of viral infections and also in the treatment of early stages of such diseases,” the study reveals. “Zinc ionophores can … be utilized to gain the anti-viral benefit of enhanced intracellular Zn+2 concentrations while limiting tolerance / side-effect / toxicity issues associated with elevated serum levels of zinc supplementation.” You can review the full paper at this link.     Neuroprotective effect of L-carnitine against glyceraldehyde-induced metabolic impairment University Politecnica delle Marche (Italy), September 7, 2021 According to news reporting originating from Ancona, Italy, research stated, “Alzheimer's disease (AD) is a neurodegenerative disorder characterized by progressive cognitive regression and memory loss. Dysfunctions of both glucose metabolism and mitochondrial dynamics have been recognized as the main upstream events of the degenerative processes leading to AD.” Our news editors obtained a quote from the research from the School of Medicine, “It has been recently found that correcting cell metabolism by providing alternative substrates can prevent neuronal injury by retaining mitochondrial function and reducing AD marker levels. Here, we induced an AD-like phenotype by using the glycolysis inhibitor glyceraldehyde (GA) and explored whether L-carnitine (4-N-trimethylamino-3-hydroxybutyric acid, LC) could mitigate neuronal damage, both in SH-SY5Y neuroblastoma cells and in rat primary cortical neurons. We have already reported that GA significantly modified AD marker levels; here we demonstrated that GA dramatically compromised cellular bioenergetic status, as revealed by glycolysis and oxygen consumption rate (OCR) evaluation. We found that LC ameliorated cell survival, improved OCR and ATP synthesis, prevented the loss of the mitochondrial membrane potential (Dps) and reduced the formation of reactive oxygen species (ROS). Of note, the beneficial effect of LC did not rely on the glycolytic pathway rescue. Finally, we noticed that LC significantly reduced the increase in pTau levels induced by GA. Overall, these findings suggest that the use of LC can promote cell survival in the setting of the metabolic impairments commonly observed in AD.” According to the news editors, the research concluded: “Our data suggest that LC may act by maintaining mitochondrial function and by reducing the pTau level.”     Hyperbaric oxygen study shows reversal of biologic hallmarks responsible for development of Alzheimer disease Tel Aviv University  & Shamir Medical Center (Israel), September 10, 2021 A new study, published today in peer-review medical journal Aging, marks the first time non-pharmaceutical clinical exploration proves efficacy in reversing the main activators of Alzheimer's disease.    Using a specific protocol of hyperbaric oxygen therapy (HBOT), cerebral blood flow (CBF) improved/increased in elderly patients by 16-23%, alleviating vascular dysfunction and amyloid burden. The study, part of a comprehensive research program directed toward aging and accompanying ailments as a reversible disease, holds promise for a new strategic approach to the prevention of Alzheimer's by addressing not only the symptoms or targeting biomarkers, but rather the core pathology and biology responsible for the advancement of the disease.  Vascular dysfunction is a crucial element in the development of Alzheimer's and cognitive decline: Amyloid beta deposits in the brain blood vessel walls are the most common vascular pathology in Alzheimer's.  Reduced blood flow to the brain and its related decrease in oxygen supply (hypoxia) can precede the clinical onset of dementia and correlates with the degree of cognitive impairment in Alzheimer's. The comprehensive research, conducted at the Sagol School of Neuroscience at Tel Aviv University and the Sagol Center for Hyperbaric Medicine and Research at Shamir Medical Center, was led by study co-authors, Professor Shai Efrati, M.D.; Professor Uri Ashery, Ph.D.; Ronit Shapira, Ph.D.; Pablo Blinder, Ph.D.; Amir Hadanny, M.D. Using combined data from an animal model of Alzheimer's, where effects were evaluated directly on brain tissue (Sagol School of Neuroscience at Tel Aviv University); humans, assessed with the use of high-resolution MRI and computerized cognitive test (Sagol Center for Hyperbaric Medicine and Research at Shamir Medical Center); correlating results displayed beneficial effects of HBOT on patients suffering from mild cognitive impairment (MCI), the stage before dementia. Each patient received 60 HBOT sessions over a 90-day period, showcasing substantial improvement in cognitive functions – with memory, attention and information processing speed exhibiting the strongest results.  "After dedicating our HBOT research to exploring its impact on the areas of brain functionality and age-related cognitive decline, we have discovered for the first time HBOT induces degradation and clearance of pre-existing amyloid plaques – treatment, and the appearance of newly formed plaques- prevention," explains Professor Uri Ashery. "Elderly patients suffering from significant memory loss at baseline revealed an increase in brain blood flow and improvement in cognitive performance, demonstrating HBOT potency to reverse core elements responsible for the development of Alzheimer's disease." "By treating vascular dysfunction, we're mapping out the path toward Alzheimer's prevention. More research is underway to further demonstrate how HBOT can improve cognitive function and become an influential tool in the imperative fight against the disease," affirms Professor Efrati, research group leader and medical advisor to Aviv Scientific.  Aviv has developed a unique medical treatment protocol that includes HBOT, cognitive and physical training, and nutritional coaching, to enhance brain and body performance of aging adults at Aviv Clinics, currently available in Central Florida and Dubai.  HBOT is already used in patients with other pathologies and is known to be a relatively safe treatment modality, illustrating its potential to be easily implanted in clinical practice. In recent years, there is growing scientific evidence that certain protocols of HBOT can improve brain oxygen supply, induce proliferation of neuronal stem cells and induce generation of new blood vessels and neurons in the brain.       Increased flatulence from eating plant-based diet found to indicate healthier gut microbiome Center for Biomedical Research Network for Liver and Digestive Diseases (Spain), September 10, 2021 A team of researchers affiliated with a host of institutions across Spain has found that the increase in flatulence experienced by people switching to a plant-based diet is an indication of a healthier gut microbiome. In their paper published in the journal Nutrients, the group describes experiments they conducted with healthy, male volunteers regarding diet, fecal sample size and flatulence. It is widely known that switching from a fat or carbohydrate-based diet to one that features more vegetables results in more flatulence—particularly if the switch is to cruciferous vegetables. But as the researchers with this new effort have noted, little research has been done to learn more about the association between diet and flatulence. To learn more about the impact of switching to a plant-based diet on digestion and the gut biome, the researchers enlisted the assistance of 18 healthy, adult male volunteers. Each was asked to eat a western-style diet and then to switch to the plant-based Mediterranean diet for two weeks. Over the study period, the volunteers were asked to count the number of times they defecated each day and to capture and weigh each stool sample. Each of the volunteers was also asked to count the number of times they passed gas. The volunteers were also asked to submit to randomized testing that involved measuring the amount of gas that was emitted during episodes of flatulence, using balloons. The researchers found that the change in diet did not change the number of times the volunteers defecated each day—but it did change the amount of material discharged. The researchers found the plant-based diet doubled the stool size on average. The researchers note this was due to a huge increase in the mass of bacterial growth and excretion. The data also showed that the number of flatulence episodes increased by seven times per day on the plant-based diet—and each discharge had approximately 50% more gas. The researchers note this was due to fermenting of plant material in the gut. The researchers suggest their experiments show that a plant-based diet promotes more healthy types of gut bacteria which leads to better overall gut health.   Physical exercise can relieve tumor-associated anemia University of Basel (Switzerland), September 10, 2021 Many cancer patients suffer from anemia leaving them fatigued, weak, and an impaired ability to perform physical activity. Drugs only rarely alleviate this type of anemia. Researchers at the University of Basel have now been able to show what causes the anemia, and that physical exercise can improve this condition. The two major symptoms of cancer are loss of muscle mass and a reduced hemoglobin level, leading to weight loss, fatigue, lethargy and reduced physical performance. Moreover, both symptoms—atrophy and anemia—prompt many patients to schedule a doctor's appointment, then resulting in the diagnosis of a tumor. Why cancer causes muscle atrophy and anemia is not yet understood, and treatment is currently difficult. The fact that anemia leads to a decline of the overall state of health and can negatively affect the course of cancer therapy highlights the urgency to obtain insights into causes and potential remedies. In collaboration with the Department of Biomedicine at the University of Basel, the research group of Professor Christoph Handschin at the Biozentrum has now been able to show in a mouse model that cancer not only triggers a systemic inflammatory reaction, but also massively changes the handling of lipids and other metabolites in the body. The body's fight is unsuccessful These changes result in a tumor-related enhanced destruction of red blood cells. The study published in Science Advances shows that exercise normalizes these metabolic abnormalities and thereby reduces the anemia caused by cancer. The body tries to counteract the degradation by increasing red blood cell productionin the bone marrow and the spleen—without success. However, the increased production of blood cells is insufficient to prevent tumor-associated anemia. "We have now been able to clarify how cancer causes the degradation of red blood cells," says Christoph Handschin. "Cancer massively alters the metabolism of lipids and other compounds. This alters not only the red blood cells but also the macrophages, causing a sharp increase in red blood cells destruction by the macrophages." Macrophages are a type of white blood cells and part of the immune system. Exercise normalizes metabolism and alleviates anemia The research group attempted to normalize the metabolism by pharmacological means. However, none of the drugs could significantly improve the anemia. In contrast, however, the metabolism was regulated to such an extent by exercise that the anemia also decreased. Even the abnormal increase in red blood cell production could be reduced to a lower level. "Training was able to restore tumor-induced metabolic remodeling and inflammation sufficiently to blunt the excessive blood cell formation and destruction," explained Handschin. This study provides novel insights into the development of tumor-associated anemia. The findings suggest that exercise is a useful therapy for cancer patients, in order to counteract anemia and associated fatigue and lethargy and in turn to improve their general well-being and quality of life. This also leads to improved tolerance of radio- and chemotherapy, as has previously been established.   Mango could help maintain gut bacteria at risk from high-fat diets Oklahoma State University, September 13, 2021 Mango consumption could help prevent the loss of beneficial gut bacteria caused by a high fat diet, according to research on mice. The findings, published in the Journal of Nutrition , appears to reveal for the first time the positive impact of mango on gut microbiota. In the study, 60 male mice were assigned to one of four dietary treatment groups for 12 weeks - control (with 10% of calories from fat), high fat (with 60% calories from fat), or high fat with 1% or 10% mango. All high-fat diets had similar macronutrient, calcium, phosphorus, and fiber content. “We investigated the effects of freeze-dried mango pulp combined with an high-fat diet on the cecal microbial population and its relation to body composition, lipids, glucose parameters, short-chain fatty acid (SCFA) production, and gut inflammatory markers in a mouse model of diet-induced obesity,” the study reports. The high-fat dietary treatment with 10% mango (equivalent to 1½ cups of fresh mango pieces) was found to be the most effective in preventing the loss of beneficial bacteria from a high-fat diet without decreasing body weight or fat accumulation. Specifically, mango supplementation regulated gut bacteria in favor of Bifidobacteria and Akkermansia and enhanced short-chain fatty acid (SFCA) production. SCFAs have been shown to possess a wide range of beneficial effects, such as anti-inflammatory properties. Fibre benefits In previous studies, Bifidobacteria, for example, has been found to be lower in both obese individuals and those with type-2 diabetes. Similar results have been observed withAkkermansia in animal studies. High-fat diets, meanwhile, have been linked to gut dysbiosis, or bacterial imbalances within the intestinal tract. "Fibre and other bioactive compounds in plant-based foods are suggested to prevent gut dysbiosis caused by a high-fat diet," said Edralin A. Lucas, professor of nutritional sciences at Oklahoma State University and lead researcher of the study. "Mango is a good source of fibre and has been reported in previous studies to have anti-obesogenic, hypoglycemic and immunomodulatory properties. The results of this animal study showed that adding mango to the diet may help maintain and regulate gut health and levels of beneficial bacteria levels.” India, China, Indonesia and Thailand are the top four Mango growing countries, accounting for well over half the total global production. Although more research is needed on the effects of mango on human health, this study suggests that mango consumption may be important in improving gut health particularly for those consuming a high-fat diet, the researchers concluded.

This week's episode features special Guest Host Mercedes Carnethon, as she interviews author Miriam Cortese-Krott and Associate Editor Charles Lowenstein as they discuss the article "Red Blood Cell and Endothelial eNOS Independently Regulate Circulating Nitric Oxide Metabolites and Blood Pressure." Dr. Carolyn Lam: Welcome to Circulation on the Run, your weekly podcast, summary, and backstage pass to the journal and its editors. We're your co-host I'm Dr. Carolyn Lam, associate editor from The National Heart Center in Duke National University of Singapore. Dr. Greg Hundley: And I'm Dr. Greg Hundley, associate editor, director of the Pauley Heart Center at VCU Health in Richmond, Virginia. Dr. Carolyn Lam: Greg, today's feature paper is one of those really, really landmark papers that really advance our understanding of Nitric oxide signaling. And it's about red blood cell and Endothelial eNOS, and how they independently regulate circulating nitric oxide, metabolites, and blood pressure. A real, real must, but let's go on and look at the other papers in this issue first. Greg, you want to go first? Dr. Greg Hundley: You bet, Carolyn. Better grab a cup of coffee. And my first paper is from professor Nathan Mewton from Hôpital Louis Pradel Hospices Civils de Lyon. Carolyn, these authors hypothesized that Colchicine a potent anti-inflammatory agent may reduce infarct size in left ventricular remodeling at the acute phase of STEMI. And so to address this hypothesis, they performed a double-blind multi-center trial and randomly assigned patients admitted for a first episode of STEMI referred for primary PTCA to receive oral Colchicine two-milligram loading dose followed by 0.5 milligrams twice a day, or matching placebo from admission to day five and the primary efficacy outcome was infarct size determined by cardiovascular magnetic resonance imaging at five days. And the relative left ventricular end-diastolic volume change at three months and infarct size at three months was also assessed by cardiac MRI. And these were secondary outcomes. Dr. Carolyn Lam: Nice. Okay. So what were the results? Dr. Greg Hundley: Right, Carolyn. So 192 patients were enrolled. 101 in the Colchicine group and 91 in the controls. And as a result of this trial, the oral administration of high dose Colchicine at the time of Reperfusion. And for five days thereafter did not reduce infarct size assessed by cardiac MRI. And so Carolyn, the clinical implications of these results suggest that other studies exploring the timing, pharma kinetics, and dose-response of Colchicine, as well as other anti-inflammatory agents are needed to identify an effective method to reduce infarct size and limit remodeling in this group of patients. Dr. Carolyn Lam: Wow, it's just such a rich field done with all this about Colchicine. Well, our next paper is a pre-specified sub-analysis of the randomized EAST-AFNET 4 Trial and the sub-analysis assess the effect of systematic early rhythm control therapy that is using Antiarrhythmic drugs or catheter ablation compared to usual care, which means allowing rhythm control therapy to improve symptoms in patients with heart failure. And this was defined in the sub-analysis as the presence of heart failure symptoms of New York Heart Association status two to three or a left ventricular ejection fraction of less than 50%. Dr. Carolyn Lam: Now, the authors led by Dr. Kirchhof at University Heart and Vascular Center UKE in Hamburg, Germany included 798 patients in this sub-analysis of whom 442 had HFpEF, 211 had heart failure with mid-range ejection fraction and 132 had HF-rEF over a median of 5.1 years of follow-up the composite primary outcome of cardiovascular death stroke or hospitalization for worsening heart failure, or for acute coronary syndrome occurred less often in patients randomized to early rhythm control therapy compared with patients randomized to usual care. And this was not altered by heart failure status with an interaction P-value of 0.6. Left ventricular function, symptoms, and quality of life improved equally in both treatment strategies. Dr. Greg Hundley: Wow, Carolyn, a lot of information here. So what can we take away from this? Dr. Carolyn Lam: Well, let's remember that this is a sub-analysis, albeit pre-specified of that randomized trial of the EAST-AFNET 4 Trial, but nonetheless, the data supports a treatment strategy of rhythm control therapy with Antiarrhythmic drugs or ablation within a year of diagnosing atrial fibrillation in patients with signs and symptoms of heart failure to reduce cardiovascular outcomes. Dr. Greg Hundley: Very nice, Carolyn. So, Carolyn, my next paper pertains to Alarmin Interleukin-1 Alpha, and it comes to us from Dr. Thimoteus Speer at Saarland University. So, Carolyn, Alarmin Interleukin-1 Alpha is expressed in a variety of cell types, promoting sterile systemic inflammation. And the aim of the present study was to examine the role of Alarmin Interleukin-1 Alpha in mediating inflammation in the setting of acute myocardial infarction and chronic kidney disease. Dr. Carolyn Lam: Wow, sterile inflammation. It's a really hot topic now. So what did these authors find? Dr. Greg Hundley: Right, Carolyn. So we're going to call Alarmin Interleukin-1 Alpha. Let's just call it IL-1 Alpha and so increased IL-1 Alpha surface expression on monocytes from patients with acute myocardial infarction in patients with chronic kidney disease was found to be associated with cardiovascular events. Next, IL-1 Alphas itself served as an adhesion molecule, mediating leukocyte-endothelial adhesion, and finally, abrogation of IL-1 alpha prevented inflammation after myocardial infarction and ameliorated chronic kidney disease in Vivo. Dr. Carolyn Lam: Wow. So what does this mean clinically? Dr. Greg Hundley: Right, Carolyn, so perhaps targeted therapeutic inhibition of IL-1 Alpha might represent a novel anti-inflammatory treatment strategy in patients with myocardial infarction and in patients with chronic kidney disease. Dr. Carolyn Lam: Amazing. Thanks, Greg. Well, in today's issue, there's also an exchange of letters between doctors Lother and Filippatos on Finerenone and risk of hyperkalemia in CKD and type two diabetes. There's an On My Mind paper by Dr. Sattler on the single-cell immunology and cardiovascular METs in, do we know yet what we don't know? Dr. Greg Hundley: And then Carolyn, from the mailbag, a Research Letter from Professor Wehrens entitled “Atrial Specific LK Beta One Knockdown Represents a Novel Mouse Model of Atrial Cardiomyopathy with Spontaneous Atrial Fibrillation.” Well, Carolyn, how about we turn our attention to those red blood cells and endothelial nitric oxide synthase. Dr. Carolyn Lam: Yeah. Can't wait. Dr. Mercedes Carnethon: Well, welcome to this episode of Circulation on the Run. Our podcasts, where we have an opportunity to speak with authors of important papers that are appearing in the journal of circulation. I'm pleased to introduce myself. My name is Mercedes Carnethon, professor and vice-chair of preventive medicine at the Northwestern University Feinberg School of Medicine. And I'm pleased today to invite our guest author, Miriam Cortese-Krott, who is the faculty of the University of Duesseldorf, and a guest professor at the Karolinska Institute in Stockholm. And we have with us as well the other associate editor who handled the piece for circulation, Dr. Charlie Lowenstein from Johns Hopkins University. So welcome to each of you this morning. Miriam Cortese-krott: Thank you. Dr. Charles Lowenstein : Thanks for having me. Dr. Mercedes Carnethon: Well, thank you. I'm really excited to jump right into this piece, Miriam, can you tell me a little bit about the rationale for carrying out the study, why you pursued it? Professor Miriam Cortese-Krott: The reason is because when I was working as a post-doc, I had to isolate an enzyme from red blood cells, which is a very, very difficult. And if you know, this enzyme is endothelial nitric oxide synthase, which produce nitric oxide, and actually, the red blood cell is full of the worst enemy of nitric oxide, which is hemoglobin. So actually, when I was talking about my project, everybody was asking, "Why are you doing that?" And I was actually able to isolate the enzyme and look at activity and be sure that the enzyme was fine, but the function of this enzyme was absolutely unknown. Professor Miriam Cortese-Krott: And the only way to study proteins in red blood cells is to make modification in the bone marrow of the mice. So in the Erythroid cells, because you can not, of course, if there are cells without nucleus you don't have any chance to modify them in culture, something like that. So the only way was to generate mice with modification specifically in the red blood cells. And I had the chance to create, to generate red cell-specific eNOS knockout mice. And of course, as a control endothelial-specific eNOS knockout mice by using the Cre-loxP technology. And with this technology, I could really understand what's happening to the physiology of the mouse if you remove this protein from the red blood cells. And so this was the whole idea. Dr. Mercedes Carnethon: Thank you so much. It was really exciting for me to read this piece. We are on opposite ends of the scientific inquiry spread as I'm an epidemiologist who does things at the population level, and you're identifying things at the basic science level. I thought the paper was extremely well-written and that encouraged people to dig in, even if you're unfamiliar, and in part that's because you provided such a great explanation of how your findings are used and how they're relevant to the process. Do you mind sharing a little bit about your findings and how you expect that they will be used by our scientific community? Professor Miriam Cortese-Krott: I think the main finding of this paper is that if you remove eNOS from the red blood cells if the mice are hypertensive, have hypertension, and this is completely something that you actually will not expect, as I told you that indeed red cells are full of the enemy of nitric oxide that remove it immediately. So you can ask yourself how it is possible. But I think the key finding here in this paper was that I also generated the opposite model. So I created the model a conditional eNOS Knockout model where you can decide in which tissue you want to have your enzyme. And of course, I applied for red blood cells. And what you see in this model is that you start from a global knockout mouse with hypertension, you reintroduce the eNOS just in the red blood cells, you have normal tension. So this means, this is the main finding. You have a switch in the red blood cells, which is the enzyme eNOS, which it's behaving in a completely different way clearly as compared to the vessel wall eNOS and still regulating blood pressure. Dr. Mercedes Carnethon: Well, thank you so much. I think this is the point at which I like to turn to the associate editor who handled the piece. Charlie, you and I don't get to talk as often given the diversity of work that we each pursue, but Charlie, tell me a little bit about what excited you about this piece? Dr. Charles Lowenstein: Thanks, Mercedes. So I love this piece. I thought Miriam, your article is so great. So a couple of thoughts. One is nitric oxide and nitric oxide synthase are so important in biology and medicine, nitric oxide regulates blood pressure. It regulates neurotransmission. It regulates inflammation. And this is true, not only in the lab, looking at cells in mice, but also in the human. So genetic variance in the endothelial nitric oxide synthase gene or NOS3 are associated with risks for diseases like coronary artery disease. So eNOS is just so important in biology and medicine. And now some ancient history. When I was a cardiology fellow, about a hundred years ago, I worked in the lab that first purified nitric oxide synthase proteins, and we cloned two of the nitric oxide synthase genes that was in the lab of Dr. Solomon Snyder at Johns Hopkins back in the 1700s. Dr. Charles Lowenstein: So when we cloned the nitric oxide synthase genes, when we and others did, we made a huge mistake. We chose the names for these isoforms from the tissue where they were first isolated. So we called the brain nitric oxide synthase nNOS, because it's a neurons, macrophages MCnos we called it MCnos and in endothelial cells, we called it the nitric oxide synthase eNOS or endothelial NOS. But in the last 20 years, lots of investigators have found these isoforms are in other cells, not just the original cells at discovery. And so Miriam's question is just so important, which cells make endothelial NOS also called NOS3. That's the history. Now what Miriam has discovered is just so important. I was so fascinated by her work because as she just said, she made two amazing discoveries. One, red blood cells make endothelial nitric oxide synthase. Dr. Charles Lowenstein: And that's been a controversy for a long time. Some people have said, "Yes." Some, "No." And Miriam made the definitive answer. Yes, red blood cells make eNOS, and secondly, she has discovered so much about the physiology of ENO coming from red blood cells, the nitric oxide that's made inside red blood cells regulates blood pressure. What a magical, interesting, and important finding. That's a little bit about the history. Nitric oxide and NOS are important in medicine. The people who originally cloned and purified the nitric oxide synthase isoforms named them after the tissue in which they discovered. And Miriam has made a major discovery that it's not only endothelial cells that make nitric oxide but also red blood cells. Dr. Mercedes Carnethon: Thank you so much for that summary. And I guess, I would have thought perhaps this was something of an Elixir of youth because if you've been working in this area for 200 plus years and Miriam, you started working on this as part of your dissertation work, you both have a lot of insight and background on where we've been and what the advances are. Miriam, can you tell me a little bit about how you'd like to see these findings used by the scientific community? Professor Miriam Cortese-Krott: I think I would like that the scientific community would use my mice first because I think, as Charles has said, it's not only red cells that express eNOS and it's not only endothelial cells. There are other cells producing eNOS and the function in the other cells is not known even in leukocytes, even when they have iNOS of course, but also have eNOS. So you can use my mice since it's a flux model. You can choose whatever you want, what cell you want, and then knock it in and knock it out. So this is one thing that I think the community could really do. I cannot do everything. So I'm happy to give my mice away. Professor Miriam Cortese-Krott: And the second thing is I would like too that in particular, the clinical community would see this link between Emathology and cardiovascular disease. This is something that was started, of course, there are studies looking at anemia and cardiovascular disease, but these studies have sometimes some issues I of course cannot speak as a basic scientist. I cannot speak about huge clinical trials, but I think this link exists and exists at the molecular level and it can be a target for pharmacological therapy. So I think this is what I would like to transport with this study to the clinical community and the basic science community. Dr. Mercedes Carnethon: Yeah. I think this is the point at which Charlie, I turn it to you because you really stand at the intersection of both of those communities. What questions do you have for Miriam going forward, as you think about spreading the word on this important work? Dr. Charles Lowenstein: So Miriam's discovery is just so important and she now has the tools to help answer really, really important questions. How is nitric oxide made in red blood cells? How is it stored in red blood cells? How is it transported throughout the body in red blood cells? What is the chemistry of nitric oxide, when it is stored, when it combines with oxygen when it forms nitrite and nitrate, how is it released from red blood cells? How is it targeted from a red blood cell to the vasculature? So there're these great basic science questions that Miriam and her colleagues are now poised to answer. So there's the science part of it. Then there's the medicine part of it because Miriam's mice and her great discovery have really huge implications for medicine. And so the question is, how can we use ENO? How can we deliver it? How can we target ENO to human tissues? Dr. Charles Lowenstein: How can we turn on erythrocyte, nitric oxide synthase? How can we turn it off? Because there are all these medical diseases where too much nitric oxide is bad, like in sepsis or inadequate amounts, don't protect the vasculature like atherosclerosis. Then there are all these other interesting questions. When we transfuse red blood cells, sometimes if you transfuse aged red blood cells, it's not good. You can harm people. Maybe we can load up or activate eNOS in stored red blood cells and then help deliver more ENO to patients who need red blood cells. So there are all these fascinating medical questions that we can look at based on Miriam's really important discovery. Dr. Mercedes Carnethon: Well, thank you so much. We're coming to the end of this wonderful and informative podcast. And I guess, I'd just ask Miriam, do you have anything else you'd like our listeners to know about your work and about the findings from this study? Professor Miriam Cortese-Krott: I would like people know that hard work help a lot, and that you have to believe in what you are doing and the quality of your science at the end would bring their true discoveries. So I think it's important specifically, for the young women in science that having this message too. So the science per se must be excellent and to proceed, you need a lot of work, but then the work goes to a good end. Dr. Mercedes Carnethon: Miriam, thank you so much for that inspirational note. The hard work that scientists need, the persistence across one's career and building from earlier discoveries, and bringing those forward through one's career are always critically important. And so I hope everyone has really enjoyed this episode and this opportunity to hear from Dr. Cortese-Krott. Miriam, you've done such wonderful work, and thank you as well, Charlie, for your insights about the intersection of this work with clinical care and basic science. Professor Miriam Cortese-Krott: Thank you. Dr. Charles Lowenstein: Thank you. Dr. Mercedes Carnethon: Thank you all very much for joining us today in this episode of Circulation on the Run. Dr. Greg Hundley: This program is copyright of the American Heart Association, 2021. The opinions expressed by speakers in this podcast are their own and not necessarily those of the editors or of the American Heart Association. For more, visit ahajournals.org.  

Dr. Eoin Flanagan discusses MRI lesion evolution in different CNS demyelinating disorders.

After skin cancer, prostate cancer is the most common type of cancer in men. One in 8 men will be diagnosed with prostate cancer in his lifetime, according to the National Cancer Institute.While some types of prostate cancer grow slowly, and may need minimal or even no treatment, other types are aggressive and can spread quickly.So if you've been diagnosed with prostate cancer. Now what?"It's very important to know the extent or stage of the cancer," says Dr. R. Jeffrey Karnes, a Mayo Clinic urologist and chair of the Division of Community Urology at Mayo Clinic in Rochester, Minnesota.Diagnosis and staging are done using tests, including ultrasound, MRI and biopsy.Prostate cancer that's detected early — when it's still confined to the prostate gland — has the best chance for successful treatment. Prostate cancer treatment options depend on several factors, such as how fast the cancer is growing, whether it has spread, as well as the potential benefits or side effects of the treatment.On the Mayo Clinic Q&A podcast, Dr. Karnes discusses treatment options for prostate cancer and the latest in clinical trials and research.

About Sam Visnic: Sam Visnic has spent his life studying the fundamental aspects of human health with a focus on movement and clinical massage therapy.  In a world of specialists, surgical procedures, drugs, and quick-fix remedies, he's committed to finding and developing strategies that help people stuck at the “gap.” Sam has studied dozens of systems and methodologies for uncovering the root cause of aches and pains, along with postural and movement issues.  Pain science, the art and science of hands-on soft tissue massage techniques, myofascial release, and coaching movement are essential in his practice.  Integrating different methods but above all deciphering WHEN to use different techniques with different people and situations, along with the integration of movements that people want to be able to do again is the key to long-term success with Sam's incredible track record with his personal clients. Understanding the various elements that contribute to conditions and the power of communication and education makes his Release Muscle Therapy program unique from other hands-on therapeutic approaches. What We Discuss in This Episode: Sam's passion has evolved over the last 20 years. He loves to help his clients learn how to be proactive and prevent injury. We know much more now about pain and the physiology of pain, and Sam shares how he's been able to integrate this into his practice with movement specifically targeted for what the individual is dealing with. Sam tells us why this time and age has brought more chronic pain into today's lifestyle. He goes back to when these types of things could have begun and our responses to the persistent pain in our lives. He believes we over x-ray and over MRI a person's issues bringing them to surgical prevention or medication intervention. Sam works to bring about a better response to pain so that we can actually live without this vicious cycle of pain. He explains the process of why we still might feel pain even after tissue has healed in our bodies. Sam teaches people about chronic pain and sensitivity in our nervous system and digs into what other factors might be involved when it comes to chronic pain. The more we understand the nervous system, the easier it is to navigate this process to bring our system back into homeostasis.  It's not just a mechanical fix for us but it also involves other factors influencing our response to certain therapies. He gives some examples of how this works for us and how we can get beyond the fear or apprehension of engaging in therapeutic intervention from past responses so that we can engage in these therapies and activities to help bring about healing. He shares some tips on how we can get beyond chronic pain and all that comes along with it so that we can truly get beyond this point and live in hope and healing.   Free Resources from Sam Visnic: Free copy of his digital book + other resources found at bottom of homepage: https://releasemuscletherapy.com Connect with Sam Visnic:  Website: https://releasemuscletherapy.com Facebook: https://facebook.com/releasemuscletherapy Instagram: https://instagram.com/releasemuscletherapy YouTube: https://youtube.com/samvisnic   Connect with Lynne: If you are looking for a community of like-minded women on a journey - just like you are - to improved health and wellness, overall balance, and increased confidence, check out Lynne's private community in The Energized & Healthy Women's Club. It's a supportive and collaborative community where the women in this group share tips and solutions for a healthy and holistic lifestyle. (Discussions include things like weight management, eliminating belly bloat, wrangling sugar gremlins, and overcoming fatigue, recipes, strategies, and much more so women can feel energized, healthy, confident, and joyful each day. Website:  https://holistic-healthandwellness.com Facebook: https://www.facebook.com/holistichealthandwellnessllc The Energized Healthy Women's Club:  https://www.facebook.com/groups/energized.healthy.women Instagram: https://www.instagram.com/lynnewadsworth   Free Resource: Hot flashes? Low Energy? Difficulty with weight management? If MID-LIFE & MENOPAUSE are taking their toll then I've got a solution for you! I've taken all my very best strategies and solutions to help you feel energized, vibrant, lighter & healthy, and compiled them into this FREE resource! Thrive in midlife and beyond - download my guide here: https://holistic-healthandwellness.com/thrive-through-menopause/   Did You Enjoy The Podcast? If you enjoyed this episode please let us know! 5-star reviews for the Living Life Naturally podcast on Apple Podcasts, Spotify, Pandora, or Stitcher are greatly appreciated. This helps us reach more women struggling to live through midlife and beyond. Thank you. Together, we make a difference!

What causes r-rolling difficulties otherwise known as rhotacism? Also, why do we have to stay still in an MRI scanner, why is calcium a metal, what makes water hard and how does a water softener work, what is the impact of a caesarian birth on health and why, what's the reason dementia affects short but not long term memory, and how does gravity work? Join Lester and Dr Chris for the answers to this week's crop of questions... Like this podcast? Please help us by supporting the Naked Scientists

Just this weekend, I got a call from somebody who said that she was out on a run, she felt a pop in the back of her heel, she went to the emergency room and she was told that she has a partial tear in her Achilles tendon. I'm not really sure if they did x-rays or an MRI or an ultrasound or anything to confirm that, but the doctor seemed very confident that she had torn her Achilles tendon. And so, she said that all they did really was they gave her some crutches and they told her to see a specialist, which is why she called me. She asked me “I just found out that I tore my Achilles tendon. The emergency room physician gave me crutches. What should I do?” Well, that's what we're talking about today on the Doc On The Run Podcast.

Dave Woodward is making his comeback to ClickFunnels Radio! A lot has happened since we heard from him last, and though he typically prefers not to share the private details of his life, Dave feels he needs to make an exception here. In an episode that departs from the norm, Dave relates to Myles how an MRI at the end of July unexpectedly resulted in emergency brain surgery less than a week later - catapulting him and his family into a world of crushing uncertainty. Though this past month has been harrowingly difficult, Dave candidly shares what this emotional journey has taught him about the importance of God, friends and family amid the trials of life. Having that support and connection, he says, is irreplaceable. Don't forget to grab your ticket to Funnel Hacking Live! (In-person and virtual options available!) Join our Messenger Tribe! https://m.me/clickfunnels?ref=cfpodcast-join-CF-tribe

Our bodies are scanned, probed, imaged, sampled, and transformed into data by clinicians and technologists. In Giving Bodies Back to Data: Image Makers, Bricolage, and Reinvention in Magnetic Resonance Technology (MIT Press, 2021), Silvia Casini reveals the affective relations and materiality that turn data into image–and in so doing, gives bodies back to data. Opening the black box of MRI technology, Casini examines the bodily, situated aspects of visualization practices around the development of this technology. Reframing existing narratives of biomedical innovation, she emphasizes the important but often overlooked roles played by aesthetics, affectivity, and craft practice in medical visualization. Combining history, theory, laboratory ethnography, archival research, and collaborative art-science, Casini retrieves the multiple presences and agencies of bodies in data visualization, mapping the traces of scientists' body work and embodied imagination. She presents an in-depth ethnographic study of MRI development at the University of Aberdeen's biomedical physics laboratory, from the construction of the first whole-body scanner for clinical purposes through the evolution of the FFC-MRI. Going beyond her original focus on MRI, she analyzes a selection of neuroscience- or biomedicine-inspired interventions by artists in media ranging from sculpture to virtual reality. Finally, she presents a methodology for designing and carrying out small-scale art-science projects, describing a collaboration that she herself arranged, highlighting the relational and aesthetic-laden character of data that are the product of craftsmanship and affective labor at the laboratory bench. Galina Limorenko is a doctoral candidate in Neuroscience with a focus on biochemistry and molecular biology of neurodegenerative diseases at EPFL in Switzerland. To discuss and propose the book for an interview you can reach her at galina.limorenko@epfl.ch. Learn more about your ad choices. Visit megaphone.fm/adchoices Support our show by becoming a premium member! https://newbooksnetwork.supportingcast.fm/new-books-network

Death is a part of life and, coincidentally, this week's episode! Hayley teaches us about the Capuchin Catacombs of Palermo which attracts hoards of tourists thanks to its 8,000+ mummified corpses. The most famous of them being 2 year-old, Rosalia Lombardo, the blinking mummy. And we have the MRI scan to prove she's real! As real as Kim K's you-know-what. Next, Kat answers all of our burning questions about American squirrels like, "The American government used propaganda to persuade school children to do WHAT to squirrels?!" We had walkathons, these children had homicide... It was a different time.    https://linktr.ee/NightClassy Produced by Parasaur Studios © 2021

Nikka brags about how she watches movies and talks about the psychological disorder behind the movie "Swallow," and Taylor explains how an MRI works and how one machine led to a man's tragic demise. Learn more about your ad-choices at https://www.iheartpodcastnetwork.com

Pomegranate peel has protective effects against enteropathogenic bacteria US Department of Agriculture, August 31, 2021 A recent study by the U.S. Department of Agriculture revealed that pomegranate peel extract contains bioactive compounds that have potential antibacterial activity. The study's findings were published in the journal Nutrition Research. Pomegranate fruit peel is considered an agricultural waste product. However, it is a rich source of polyphenols like punicalins, punicalagins and ellagic acids. Earlier studies have shown that products derived from pomegranates have health benefits, including antibacterial activity, in vitro. There is limited evidence, however, of their antibacterial activity in vivo. For this study, researchers sought to determine the antibacterial properties of pomegranate peel extract in vivo. In particular, they focused on the punicalin, punicalagin and ellagic acid present in the peel extract. The researchers infected C3H/He mice with the bacterial pathogen Citrobacter rodentium, a bacterium that mimics the enteropathogenic bacterium, Escherichia coli. Prior to infection, the mice were orally treated with water or pomegranate peel extract. Twelve days after infection, the researchers examined C. rodentium colonization of the colon and spleen, as well as changes in tissue and gene expression. Fecal excretions were also analyzed for C. rodentium. The results revealed that the pomegranate peel extract reduced weight loss and mortality induced by C. rodentium infection. The extract also reduced C. rodentium colonization of the spleen. Additionally, pomegranate peel extract decreased the extent of damage in the colon caused by C. rodentium infection. In sum, pomegranate fruit peel extract contains bioactive compounds that can help reduce the severity of C. rodentium infection in vivo.   Vitamin D may protect against young-onset colorectal cancer Dana-Farber Cancer Institute and Harvard  School of Public Health, September 1, 2021 Consuming higher amounts of Vitamin D - mainly from dietary sources - may help protect against developing young-onset colorectal cancer or precancerous colon polyps, according to the first study to show such an association. The study, recently published online in the journal Gastroenterology, by scientists from Dana-Farber Cancer Institute, the Harvard T.H. Chan School of Public Health, and other institutions, could potentially lead to recommendations for higher vitamin D intake as an inexpensive complement to screening tests as a colorectal cancer prevention strategy for adults younger than age 50. While the overall incidence of colorectal cancer has been declining, cases have been increasing in younger adults - a worrisome trend that has yet to be explained. The authors of the study, including senior co-authors Kimmie Ng, MD, MPH, of Dana-Farber, and Edward Giovannucci, MD, DSc., of the T.H. Chan School, noted that vitamin D intake from food sources such as fish, mushrooms, eggs, and milk has decreased in the past several decades. There is growing evidence of an association between vitamin D and risk of colorectal cancer mortality. However, prior to the current study, no research has examined whether total vitamin D intake is associated with the risk of young-onset colorectal cancer. “Vitamin D has known activity against colorectal cancer in laboratory studies. Because vitamin D deficiency has been steadily increasing over the past few years, we wondered whether this could be contributing to the rising rates of colorectal cancer in young individuals,” said Ng, director of the Young-Onset Colorectal Cancer Center at Dana-Farber. “We found that total vitamin D intake of 300 IU per day or more - roughly equivalent to three 8-oz. glasses of milk - was associated with an approximately 50% lower risk of developing young-onset colorectal cancer.” The results of the study were obtained by calculating the total vitamin D intake - both from dietary sources and supplements - of 94,205 women participating in the Nurses' Health Study II (NHS II). This study is a prospective cohort study of nurses aged 25 to 42 years that began in 1989. The women are followed every two years by questionnaires on demographics, diet and lifestyle factors, and medical and other health-related information. The researchers focused on a primary endpoint - young-onset colorectal cancer, diagnosed before 50 years of age. They also asked on a follow-up questionnaire whether they had had a colonoscopy or sigmoidoscopy where colorectal polyps (which may be precursors to colorectal cancer) were found. During the period from 1991 to 2015 the researchers documented 111 cases of young-onset colorectal cancer and 3,317 colorectal polyps. Analysis showed that higher total vitamin D intake was associated with a significantly reduced risk of early-onset colorectal cancer. The same link was found between higher vitamin D intake and risk of colon polyps detected before age 50. The association was stronger for dietary vitamin D - principally from dairy products - than from vitamin D supplements. The study authors said that finding could be due to chance or to unknown factors that are not yet understood. Interestingly, the researchers didn't find a significant association between total vitamin D intake and risk of colorectal cancer diagnosed after age 50. The findings were not able to explain this inconsistency, and the scientists said further research in a larger sample is necessary to determine if the protective effect of vitamin D is actually stronger in young-onset colorectal cancer. In any case, the investigators concluded that higher total vitamin D intake is associated with decreased risks of young-onset colorectal cancer and precursors (polyps). “Our results further support that vitamin D may be important in younger adults for health and possibly colorectal cancer prevention,” said Ng. “It is critical to understand the risk factors that are associated with young-onset colorectal cancer so that we can make informed recommendations about diet and lifestyle, as well as identify high risk individuals to target for earlier screening.”     Choosing personal exercise goals, then tackling them immediately is key to sustaining change University of Pennsylvania, September 1, 2021 When people set their own exercise goals – and then pursue them immediately – it's more likely to result in lasting positive changes, according to a new study at the Perelman School of Medicine at the University of Pennsylvania. The results of this research are especially important because they were found among an underserved population that is at particularly high risk of having or developing heart conditions. The study was published in JAMA Cardiology. “Most behavior change programs involve goal-setting, but the best way to design that process is unknown,” said lead author Mitesh Patel, MD, MBA, an associate professor of Medicine at Penn and vice president for Clinical Transformation at Ascension. “Our clinical trial demonstrated that physical activity increased the most when patients chose their goals rather than being assigned them, and when the goals started immediately rather than starting lower and gradually increasing over time. These findings are particularly important because the patients were from lower-income neighborhoods and may face a number of challenges in achieving health goals.” This study consisted of 500 patients from low-income neighborhoods, mainly in West Philadelphia but also elsewhere in and outside of the city. Participants either had a cardiovascular disease or were assessed to have a near-10 percent risk of developing one within a decade. These high-risk patients stood to greatly gain from increased physical activity. Patel's previous work at the Penn Medicine Nudge Unit often focused on the use of gamification, a concept used to create behavioral change by turning it into a game. The work usually tested whether playing a game attached to physical activity goals could make significant increases against not playing a game, or between different versions of a game. As with past studies, every participant was given a wearable step tracker that recorded their daily step counts through Penn's Way to Health platform. But what set this study apart from many of its predecessors was that the main outcomes of the research were less about participation in the games themselves and more about how goals were established, as well as when participants were encouraged to pursue them. Once every participant got their wearable step counter, they were given a week or two to get used to it. This time period also functioned as a baseline-setting period for everyone's pre-intervention daily step count. After that, participants were randomly assigned to the control group, which didn't have step goals or games attached, or one of the gaming groups with goals. Those in the gamified group also went through two other sets of random assignments. One determined whether they'd have input on their step goal, or whether they'd just be assigned a standard one. The second decided whether each participant would immediately start working toward their goals (for the entire 16-week intervention), or whether they'd ramp up to it, with minor increases in goals, until the full goals kicked in at week nine. After analyzing the results, the researchers saw that the only group of participants who achieved significant increases in activity were those who chose their own goals and started immediately. They had the highest average increase in their steps compared to the group with no goals, roughly 1,384 steps per day. And, in addition to raw step counts, the study also measured periods of sustained, high activity, amounting to an average increase of 4.1 minutes daily. Comparatively, those who were assigned their goals or had full goals delayed for half the intervention only increased their daily steps above the control group's average by between 500 and 600 steps. “Individuals who select their own goals are more likely to be intrinsically motivated to follow through on them,” said Kevin Volpp, MD, PhD, director of the Center for Health Incentives and Behavioral Economics. “They feel like the goal is theirs and this likely enables greater engagement.” The study didn't end when the researchers turned the games off. Participants kept their activity trackers, and in the eight weeks following the intervention, the group that chose their goals and started immediately kept up their progress. In fact, they achieved almost the exact same average in steps – just three less than during the active games. “It is exciting to see that the group that increased their activity levels by the most steps maintained those levels during follow-up,” Patel said. “This indicates that gamification with self-chosen and immediate goals helped these patients form a new habit.” Many programs, whether offered through work or by health insurance companies, offer incentives for boosts in physical activity. But these goals are often fairly static and assigned based on round numbers. Patel, Volpp, and colleagues believe this research suggests that adjusting goal setting in these programs can have a significant impact. And if these adjustments lead to gains among people with lower incomes, whom cardiovascular disease kill at 76 percent higher rates, that could be particularly important.           “Goal-setting is a fundamental element of almost every physical activity program, whether through a smartphone app or in a workplace wellness program,” Volpp said. “Our findings reveal a simple approach that could be used to improve the impact of these programs and the health of their patients.”   Comparing seniors who relocate long-distance shows that where you live affects your longevity Massachusetts Institute of Technology, September 1, 2021 Would you like to live longer? It turns out that where you live, not just how you live, can make a big difference. That's the finding of an innovative study co-authored by an MIT economist, which examines senior citizens across the U.S. and concludes that some locations enhance longevity more than others, potentially for multiple reasons. The results show that when a 65-year-old moves from a metro area in the 10th percentile, in terms of how much those areas enhance longevity, to a metro area the 90th percentile, it increases that person's life expectancy by 1.1 years. That is a notable boost, given that mean life expectancy for 65-year-olds in the U.S. is 83.3 years. "There's a substantively important causal effect of where you live as an elderly adult on mortality and life expectancy across the United States," says Amy Finkelstein, a professor in MIT's Department of Economics and co-author of a newly published paper detailing the findings. Researchers have long observed significant regional variation in life expectancy in the U.S., and often attributed it to "health capital"—tendencies toward obesity, smoking, and related behavioral factors in the regional populations. But by analyzing the impact of moving, the current study can isolate and quantify the effect that the location itself has on residents. As such, the research delivers important new information about large-scale drivers of U.S. health outcomes—and raises the question of what it is about different places that affects the elderly's life expectancy. One clear possibility is the nature of available medical care. Other possible drivers of longevity include climate, pollution, crime, traffic safety, and more. "We wanted to separate out the role of people's prior experiences and behaviors—or health capital—from the role of place or environment," Finkelstein says. The paper, "Place-Based Drivers of Mortality: Evidence of Migration," is published in the August issue of the American Economic Review. The co-authors are Finkelstein, the John and Jennie S. MacDonald Professor of Economics at MIT, and Matthew Gentzkow and Heidi Williams, who are both professors of economics at Stanford University. To conduct the study, Finkelstein, Gentzkow, and Williams analyzed Medicare records from 1999 to 2014, focusing on U.S. residents between the ages of 65 and 99. Ultimately the research team studied 6.3 million Medicare beneficiaries. About 2 million of those moved from one U.S. "commuting zone" to another, and the rest were a random 10 percent sample of people who had not moved over the 15-year study period. (The U.S. Census Bureau defines about 700 commuting zones nationally.) A central element of the study involves seeing how different people who were originally from the same locations fared when moving to different destinations. In effect, says Finkelstein, "The idea is to take two elderly people from a given origin, say, Boston. One moves to low-mortality Minneapolis, one moves to high-mortality Houston. We then compare thow long each lives after they move." Different people have different health profiles before they move, of course. But Medicare records include detailed claims data, so the researchers applied records of 27 different illnesses and conditions—ranging from lung cancer and diabetes to depression—to a standard mortality risk model, to categorize the overall health of seniors when they move. Using these "very, very rich pre-move measures of their health," Finkelstein notes, the researchers tried to account for pre-existing health levels of seniors from the same location who moved to different places. Still, even assessing people by 27 measures does not completely describe their health, so Finkelstein, Gentzkow, and Williams also estimated what fraction of people's health conditions they had not observed—essentially by calibrating the observed health of seniors against health capital levels in places they were moving from. They then consider how observed health varies across individuals from the same location moving to different destinations and, assuming that differences in unobserved health—such as physical mobility—vary in the same way as observed differences in health, they adjust their estimates accordingly. All told, the study found that many urban areas on the East and West Coasts—including New York City, San Francisco, and Miami—have positive effects on longevity for seniors moving there. Some Midwestern metro areas, including Chicago, also score well. By contrast, a large swath of the deep South has negative effects on longevity for seniors moving there, including much of Alabama, Arkansas, Louisiana, and northern Florida. Much of the Southwest, including parts of Texas, Oklahoma, New Mexico, and Arizona, fares similarly poorly. The scholars also estimate that health capital accounts for about 70 percent of the difference in longevity across areas of the U.S., and that location effects account for about 15 percent of the variation. "Yes, health capital is important, but yes, place effects also matter," Finkelstein says. Other leading experts in health economics say they are impressed by the study. Jonathan Skinner, the James O. Freeman Presidential Professor of Economics, Emeritus, at Dartmouth College, says the scholars "have provided a critical insight" into the question of place effects "by considering older people who move from one place to another, thus allowing the researchers to cleanly identify the pure effect of the new location on individual health—an effect that is often different from the health of long-term residents. This is an important study that will surely be cited and will influence health policy in coming years." The Charlotte Effect: What makes a difference? Indeed, the significance of place effects on life expectancy is also evident in another pattern the study found. Some locations—such as Charlotte, North Carolina—have a positive effect on longevity but still have low overall life expectancy, while other places—such as Santa Fe New Mexico—have high overall life expectancy, but a below-average effect on the longevity of seniors who move there. Again, the life expectancy of an area's population is not the same thing as that location's effect on longevity. In places where, say, smoking is highly prevalent, population-wide longevity might be subpar, but other factors might make it a place where people of average health will live longer. The question is why. "Our [hard] evidence is about the role of place," Finkelstein says, while noting that the next logical step in this vein of research is to look for the specific factors at work. "We know something about Charlotte, North Carolina, makes a difference, but we don't yet know what." With that in mind, Finkelstein, Gentzkow, and Williams, along with other colleagues, are working on a pair of new studies about health care practices to see what impact place-based differences may have; one study focuses on doctors, and the other looks at the prescription opioid epidemic. In the background of this research is a high-profile academic and policy discussion about the impact of health care utilization. One perspective, associated with the Dartmouth Atlas of Health Care project, suggests that the large regional differences in health care use it has documented have little impact on mortality. But the current study, by quantifying the variable impact of place, suggest there may be, in turn, a bigger differential impact in health care utilization yet to be identified. For her part, Finkelstein says she would welcome further studies digging into health care use or any other factor that might explain why different places have different effects on life expectancy; the key is uncovering more hard evidence, wherever it leads. "Differences in health care across places are large and potentially important," Finkelstein says. "But there are also differences in pollution, weather, [and] other aspects. … What we need to do now is get inside the black box of 'the place' and figure out what it is about them that matters for longevity."   Gut bacteria influence brain development Researchers discover biomarkers that indicate early brain injury in extreme premature infants University of Vienna (Austria), September 3, 2021 The early development of the gut, the brain and the immune system are closely interrelated. Researchers refer to this as the gut-immune-brain axis. Bacteria in the gut cooperate with the immune system, which in turn monitors gut microbes and develops appropriate responses to them. In addition, the gut is in contact with the brain via the vagus nerve as well as via the immune system. "We investigated the role this axis plays in the brain development of extreme preterm infants," says the first author of the study, David Seki. "The microorganisms of the gut microbiome - which is a vital collection of hundreds of species of bacteria, fungi, viruses and other microbes - are in equilibrium in healthy people. However, especially in premature babies, whose immune system and microbiome have not been able to develop fully, shifts are quite likely to occur. These shifts may result in negative effects on the brain," explains the microbiologist and immunologist. Patterns in the microbiome provide clues to brain damage "In fact, we have been able to identify certain patterns in the microbiome and immune response that are clearly linked to the progression and severity of brain injury," adds David Berry, microbiologist and head of the research group at the Centre for Microbiology and Environmental Systems Science (CMESS) at the University of Vienna as well as Operational Director of the Joint Microbiome Facility of the Medical University of Vienna and University of Vienna. "Crucially, such patterns often show up prior to changes in the brain. This suggests a critical time window during which brain damage of extremely premature infants may be prevented from worsening or even avoided." Comprehensive study of the development of extremely premature infants Starting points for the development of appropriate therapies are provided by the biomarkers that the interdisciplinary team was able to identify. "Our data show that excessive growth of the bacterium Klebsiella and the associated elevated γδ-T-cell levels can apparently exacerbate brain damage," explains Lukas Wisgrill, Neonatologist from the Division of Neonatology, Pediatric Intensive Care Medicine and Neuropediatrics at the Department of Pediatric and Adolescent Medicine at the Medical University of Vienna. "We were able to track down these patterns because, for a very specific group of newborns, for the first time we explored in detail how the gut microbiome, the immune system and the brain develop and how they interact in this process," he adds. The study monitored a total of 60 premature infants, born before 28 weeks gestation and weighing less than 1 kilogram, for several weeks or even months. Using state-of-the-art methods - the team examined the microbiome using 16S rRNA gene sequencing, among other methods - the researchers analysed blood and stool samples, brain wave recordings (e.g. aEEG) and MRI images of the infants' brains. Research continues with two studies The study, which is an inter-university clusterproject under the joint leadership by Angelika Berger (Medical University of Vienna) and David Berry (University of Vienna), is the starting point for a research project that will investigate the microbiome and its significance for the neurological development of prematurely born children even more thoroughly. In addition, the researchers will continue to follow the children of the initial study. "How the children's motoric and cognitive skills develop only becomes apparent over several years," explains Angelika Berger. "We aim to understand how this very early development of the gut-immune-brain axis plays out in the long term. " The most important cooperation partners for the project are already on board: "The children's parents have supported us in the study with great interest and openness," says David Seki. "Ultimately, this is the only reason we were able to gain these important insights. We are very grateful for that."     Amino acid supplements may boost vascular endothelial function in older adults: Study University of Alabama, August 28, 2021 A combination of HMB (a metabolite of leucine), glutamine and arginine may improve vascular function and blood flow in older people, says a new study. Scientists from the University of Alabama report that a supplement containing HMB (beta-hydroxy-beta-methylbutyrate), glutamine and arginine (Juven by Abbott Nutrition) increased flow-mediated dilation (FMD - a measure of blood flow and vascular health) by 27%, whereas no changes were observed in the placebo group. However, the researchers did not observe any changes to markers of inflammation, including high-sensitivity C-reactive protein (hsCRP) and tumor necrosis factor-alpha (TNF-alpha) “Our results indicate that 6 months of dietary supplementation with HMB, glutamine and arginine had a positive impact on vascular endothelial function in older adults,” wrote the researchers, led by Dr Amy Ellis in the European Journal of Clinical Nutrition . “These results are clinically relevant because reduced endothelial-dependent vasodilation is a known risk factor for cardiovascular diseases. “Further investigation is warranted to elucidate mechanisms and confirm benefits of foods rich in these amino acids on cardiovascular outcomes.” The study supported financially by the National Center for Complementary and Alternative Medicine. Study details Dr Ellis and her co-workers recrtuited 31 community-dwelling men and women aged between 65 and 87 to participate in their randomized, placebo-controlled trial. The participants were randomly assigned to one of two groups: The first group received the active supplements providing 3 g HMB, 14 g glutamine and 14 g arginine per day; while the second group received a placebo. After six months of intervention, the researchers found that FMD increased in the HMB + glutamine + arginine group, but no such increases were observed in the placebo group. While no changes in CRP or TNF-alpha levels were observed in the active supplement group, a trend towards an increase in CRP levels was observed in the placebo group, but this did not reach statistical significance, they noted. “Although no previous studies have examined this combination of amino acids on vascular function, we hypothesized that the active ingredients of the supplement would act synergistically to improve endothelial function by reducing oxidative stress and inflammation,” wrote the researchers. “However, although we observed a trend for increasing hsCRP among the placebo group (P=0.059), no significant changes in hsCRP or TNF-alpha were observed for either group. “Possibly, the effects of the supplement on reducing oxidative stress and inflammation were subclinical, or the high variability in these biomarkers, particularly hsCRP, among our small sample could have precluded visible differences.” The researchers also noted that an alternate mechanism may also be responsible, adding that arginine is a precursor of the potent vasodilator nitric oxide “Although investigation of this mechanism was beyond the scope of this study, it is feasible that the arginine in the supplement improved endothelial-dependent vasodilation by providing additional substrate for nitric oxide synthesis,” they added.     Moderate coffee drinking associated with lower risk of mortality during 11-year median follow-up Semmelweis University (Bulgaria), September 1 2021.  Research presented at ESC (European Society of Cardiology) Congress 2021 revealed a lower risk of dying from any cause during an 11-year median period among light to moderate coffee drinkers in comparison with men and women who had no intake. The study included 468,629 UK Biobank participants of an average age of 56.2 years who had no indications of heart disease upon enrollment. Coffee intake was classified as none, light to moderate at 0.5 to 3 cups per day or high at over 3 cups per day. A subgroup of participants underwent magnetic resonance imaging (MRI) of the heart to assess cardiac structure and function.  Light to moderate coffee intake during the follow-up period was associated with a 12% decrease in the risk of dying from any cause, a 17% lower risk of cardiovascular mortality and a 21% reduction in the incidence of stroke in comparison with the risks associated with not drinking coffee.  “The imaging analysis indicated that, compared with participants who did not drink coffee regularly, daily consumers had healthier sized and better functioning hearts,” reported study author Judit Simon, of Semmelweis University in Budapest. “This was consistent with reversing the detrimental effects of aging on the heart.” “To our knowledge, this is the largest study to systematically assess the cardiovascular effects of regular coffee consumption in a population without diagnosed heart disease,” she announced. “Our results suggest that regular coffee consumption is safe, as even high daily intake was not associated with adverse cardiovascular outcomes and all-cause mortality after a follow-up of 10 to 15 years. Moreover, 0.5 to 3 cups of coffee per day was independently associated with lower risks of stroke, death from cardiovascular disease, and death from any cause.”

As always we appreciate you all being so patient when life gets in the way. Please have a listen to an oldie but goodie while we get well. Thank you  This Sofa King Podcast takes a look at the phenomenon of alien implants. As we've discussed in earlier episodes, a percentage of the population believes they have been abducted by extraterrestrial beings. Of these people, another statistical subset claims to have implants placed in their bodies. At their craziest, they believe the implants alter people's behavior and give psychic powers. We don't talk about that because, well, give me a break. However, we do look at some of the most famous and more credible examples of alien implants and the doctors who deal with them. We start with a look at the earliest case of implanted technology, allegedly from a woman in 1938 who claims devices were implanted behind her ears to control her with sound (this was discussed by Ufologist John Robinson in 1957). Since then, the cases have obviously grown. Perhaps the most famous is the case of Betty Andreason—she claims to have gone through what is now thought of as the textbook abduction by gray aliens back in 1967. Her story was explored heavily by the most legitimate UFO investigator, J. Allen Hynek in 1977. From there, we look at the famous case of Whitley Strieber (author of Communion) and his claims that an MRI shows abnormal things in his temporal lobe and that things were placed in his ear by a Man (and a Woman) in Black. What did he discover after a biopsy? Good question. Give us a listen. Finally, we talk about Doctor Roger Leir, a surgeon who has allegedly removed 16 alien implants from various patients. One of them proved to stump the teams at Los Alamos National Laboratory, New Mexico Tech, and US San Diego's metallurgical teams. What did they all say the implant was made of? Is Leir a quack, or is there some merit to his beliefs? What do the Sofa Kings think about the implants at the end of the day? And lastly, does Dave have an implant in his ankle? Listen, laugh, learn.