Central part of a church
Welcome to Twice 5 Miles Radio, a podcast sponsored by The Imaginative Storm Writing Project, www.imaginativestorm.com. I'm your host James Navé, www.jamesnave.com. Greetings, James Navé here. Today, I unpack ideas around writing, poetry, and identity on this solo show. I begin with Emily Dickinson's poem titled I'm Nobody. Do you think of your writing, poetry, and identity as evolving or fixed? Are you Somebody or Nobody? What does it mean to be a little somebody rather than a celebratory somebody? How can writing, poetry, and memorization add meaning to your identity? How do you deal with those self-important self-appointed somebodies you bump into now and then? Have you ever wondered why the spoken word movement enjoys so much attention today? How does memorization fit into writing, poetry, and identity? Thanks for listening. Enjoy the show.
First song from Nave Noblique's project Dark Waters --- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app --- Send in a voice message: https://anchor.fm/undrground/message Support this podcast: https://anchor.fm/undrground/support
In a clip from the Episode "The Moor You Know" Nave Talks how the Moor's role in bringing Europe out of the Dark Ages, and their presence in American history. --- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app --- Send in a voice message: https://anchor.fm/undrground/message Support this podcast: https://anchor.fm/undrground/support
Link to bioRxiv paper: http://biorxiv.org/cgi/content/short/2022.11.21.517320v1?rss=1 Authors: Arinrad, S., Depp, C., Siems, S. B., Sasmita, A. O., Eichel, M. A., Ronnenberg, A., Hammerschmidt, K., Lueders, K. A., Werner, H. B., Ehrenreich, H., Nave, K.-A. Abstract: A key feature of advanced brain aging includes structural defects of intracortical myelin that are associated with secondary neuroinflammation. A similar pathology is seen in specific myelin mutant mice that model 'advanced brain aging' and exhibit a range of behavioral abnormalities. However, the cognitive assessment of these mutants is problematic because myelin-dependent motor-sensory functions are required for quantitative behavioral readouts. To better understand the role of cortical myelin integrity for higher brain functions, we generated mice lacking Plp1, encoding the major integral myelin membrane protein, selectively in ventricular zone stem cells of the mouse forebrain. In contrast to conventional Plp1 null mutants, subtle myelin defects were restricted to the cortex, hippocampus and underlying callosal tracts. Moreover, forebrain-specific Plp1 mutants exhibited no defect of basic motor-sensory performance at any age tested. Surprisingly, several behavioral alterations reported for conventional Plp1 null mice (Gould et al., 2018) were absent and even social interactions appeared normal. However, with novel behavioral paradigms, we determined catatonia-like symptoms and isolated executive dysfunction in both genders. This suggests that loss of myelin integrity has an impact on cortical connectivity and underlies specific defects of executive function. These observations are likewise relevant for human neuropsychiatric conditions and other myelin-related diseases. Copy rights belong to original authors. Visit the link for more info Podcast created by Paper Player, LLC
In der heutigen Folge des Experten-Podcasts spricht Thomas Nave, leidenschaftlicher Unternehmer, darüber, wie Du über Fehlerfreudigkeit Kosten reduzierst und Gewinne steigerst. Du erfährst auch, welchen positiven Einfluss Fehler auf deine persönliche Entwicklung haben und wie Du jeden Fehler sofort in eine Chance verwandelst.Außerdem verrät Thomas Nave seine besten Strategien, um die Unternehmenskultur schnell und nachhaltig zu optimieren.Wenn auch Du wissen willst, wie Du Fehlerfreudigkeit leben kannst, dann solltest Du diese Folge des Experten-Podcasts nicht verpassen.Hat Dir der Experte des Tages gefallen, hast Du etwas für Dich mitnehmen können?Weitere Informationen bekommst Du unter https://thomas-nave.com/ oder https://de.linkedin.com/in/thomas-nave und https://www.instagram.com/thomasnave_official/. Hosted on Acast. See acast.com/privacy for more information.
#coches #renault #austral #dakar #toyotaprius #prius #navea122 #seatleon Desde los estudios centrales de ONDACERO Madrid Sur te acercamos las últimas noticias del motor, pruebas de los últimos modelos que llegan al mercado, consejos y recomendaciones y seguridad vial. Nos puedes escuchar en directo en ONDACERO Madrid Sur y ONDACERO Jaén. Analizamos las siguientes noticias: • El Renault Austral recibe 2.000 pedidos en un mes • Ya hemos probado el SEAT León más equilibrado, la nueva versión FR 130 CV gasolina • Día Mundial en Recuerdo de las Víctimas de Accidentes de Tráfico 2022 • Nuevo Toyota Prius • Renault 4, el mítico SUV del pueblo vuelve al mercado • El Toyota GR86 ya está a la venta en España • Ya ha sido presentado oficialmente el Porsche 911 Dakar 2023, deportividad para todos los terrenos. • Nuevo logotipo de Audi • Las nuevas Doblò y E-Doblò, los primeros Fiat “Made in Spain” • Hemos visitado la mítica Nave A122 de SEAT • El Porsche Taycan alcanza las 100.000 unidades fabricadas • Alpine A110 R, una versión que querrás tener en tu garaje para ir al circuito. • Competición con Javier Quilón: Historia Circuito Montmeló El equipo de gala que ha acompañado en este programa especial ha sido: Fernando Rivas, José Lagunar y Andrés Muñoz. Como invitados especiales: -Fernando Poveda, responsable de Comunicación de Renault-Alpine España. -Daniel Cuadrado, Director de Garage Days. En el espacio de TotalEnergies hablamos del AdBlue y la importancia que tiene este líquido en los motores diésel modernos. Puedes seguirnos en nuestra web: https://autofm.es/ y https://www.podcastmotor.es Twitter: @AutoFmRadio Instagram: https://www.instagram.com/autofmradio/ YouTube: https://www.youtube.com/channel/UC57czZy-ctfV02t_PeNXCAQ Contacto: firstname.lastname@example.org
Welcome to Twice 5 Miles Radio, a podcast sponsored by The Imaginative Storm Write What You Don't Know Project, www.imaginativestorm.com. I'm your host James Navé, www.jamesnave.com. This show is titled No War With My Father. Today, I'm going solo with a story about my Father, a war veteran, and an old-time Appalachian musician. Although he never talked about being in the war, he never stopped talking about how much he loved to play music. This narrative focuses on work, violence, booze, music, joy, and forgiveness. If you have conflicting opinions of your parents, this story will offer insights into how you can hold many opinions without remorse. Enjoy the show.
Hoy tenemos en el Podcast a una persona que me hace mucha ilusión traer. Otra ingeniera que acaba pivotando al diseño de productos digitales, cosa que hace en Telefónica como UX Design Lead. A la vez que forma a nuevas generaciones de diseñadores en La Nave Nodriza. En este episodio vamos a hablar sobre diseño, comunidad (iniciativas tan chulas como Ladies that UX), educación (en la Nave, nada más ni nada menos) y por supuesto un tema super importante. La salud mental y cómo gestionar el burnout.
Link to bioRxiv paper: http://biorxiv.org/cgi/content/short/2022.11.08.515614v1?rss=1 Authors: Looser, Z. J., Ravotto, L., Jung, R. B., Werner, H. B., Ruhwedel, T., Moebius, W., Bergles, D. E., Barros, L. F., Nave, K.-A., Weber, B., Saab, A. S. Abstract: The integrity of myelinated axons relies on homeostatic support from oligodendrocytes (OLs), which is essential for brain function. However, the mechanisms by which OLs detect axonal spiking and rapidly control axon-OL metabolic coupling are largely unknown. Here, we combine optic nerve electrophysiology and two-photon imaging to study activity-dependent calcium (Ca2+) dynamics in OLs and metabolite fluxes in myelinated axons. Both high-frequency axonal firing and extracellular potassium (K+) elevations trigger a fast Ca2+ response in OLs that is facilitated by barium-sensitive, inwardly rectifying K+ channels. Using OL-specific Kir4.1 knockout mice (Kir4.1 cKO) we now demonstrate that, in addition to being crucial for K+ clearance, oligodendroglial Kir4.1 regulates axonal energy metabolism and long-term axonal integrity. Before the manifestation of axonal damage, we observed reduced glucose transporter GLUT1 and monocarboxylate transporter MCT1 expression in myelin of young Kir4.1 cKO mice, suggesting early deficits in metabolite supply to axons. Strikingly, we found lower resting lactate levels and activity-induced lactate surges in optic nerve axons of young Kir4.1 cKO mice. Moreover, both axonal glucose uptake and consumption were hampered in the absence of oligodendroglial Kir4.1, uncovering a new role of OLs in regulating axonal glucose metabolism. Our findings reveal a novel model of axon-OL signaling and metabolic coupling in which OLs detect high-frequency axonal activity through K+ signaling, which is critical in adjusting the axon-OL metabolic unit and in preserving long-term axonal health. Copy rights belong to original authors. Visit the link for more info Podcast created by Paper Player, LLC
Welcome to Between 2 Gamers! Our show is a weekly video game podcast where we discuss a wide variety of topics in the gaming industry. Every Wednesday we host our weekly topic where we discuss video game recaps and reviews, tier lists, and some whacky stuff in between! Every Friday we host our weekly video game news and rumors show called The Buzz Between to tell you what's going on in the industry. Both shows are on the same feed! We don't limit our discussion to one platform, so if you're a Nintendo, PlayStation, Xbox, or PC gamer, then we've got something for you! This week we team up with Gaming Together A Cooperative Podcast to discuss Among Us! We compare Frewy and Liv's launch day experiences with Phillip and Nave's recent experiences. Here is where you can find Between 2 Gamers, Frewy, and Liv's accounts: Between 2 Gamers: https://linktr.ee/Between2Gamers Frewy: https://linktr.ee/Frewy Liv: https://linktr.ee/obeyer10 Guest (Gaming Together A Cooperative Podcast): https://linktr.ee/gamingtogether Music by: https://twitter.com/lilkotobeats
Listen in as Sis. Kylee gives us Abraham's background and sets up this 2 part series. Check us out on social media: Facebook – https://www.facebook.com/theapcblm Instagram – https://www.instagram.com/the_apc Website – https://www.theapc.org Have a prayer request? We'd love to pray for you! https://apostolicpentecostalchurch.updates.church/# Subscribe to our channel and click the notification bell to get alerts on live or posted videos! www.youtube.com/c/ApostolicPentecostalChurch #pentecostal #upci #pentecostalteaching
A project centered around reflection, and navigating the at times troubled waters of life, while in search of something new --- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app --- Send in a voice message: https://anchor.fm/undrground/message Support this podcast: https://anchor.fm/undrground/support
Iker Jiménez dedica los diez minutos de su sección para hablar sobre algo que le preocupa bastante: las disculpas públicas que hacen los famosos y que la mayoría de las veces están condicionadas por terceras personas. El presentador defiende la libertad de opinión y asegura que le parece perfecto que, cuando un rostro conocido considere que se ha equivocado pida perdón en público, siempre y cuando lo sienta y lo piense, ya que todo el mundo tiene derecho a equivocarse. Sin embargo, el conductor de la Nave del Misterio se muestra muy crítico con aquellos que cambian su discurso para no ofender a marcas o por no perder seguidores en redes sociales: “Pedir perdón es muy sano para el que lo siente de verdad”, afirma. “¿Qué queremos? ¿Un mundo de asustados y ofendidos? Puede ser divertido, pero a mí me parece ridículo (..) Nadie quiere quedarse fuera del redil de lo aceptado”, dice Iker Jiménez, condenando a aquellos que no son fieles a sí mismos por mantener seguidores. “A mí se me han echado encima muchas veces y no he pedido disculpas porque lo pensaba. Me da igual quedarme sin seguidores, yo digo lo que pienso. ¿Cuál es el futuro dentro de dos o tres años, si cualquier famoso se asusta? ¿Qué tiene de auténtica la información que recibe?”. Escucha el episodio completo en la app de iVoox, o descubre todo el catálogo de iVoox Originals
Nave analyzes rapper Coolio's last interview where he reveals the truth about what's going on behind the scenes in the music industry --- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app --- Send in a voice message: https://anchor.fm/undrground/message Support this podcast: https://anchor.fm/undrground/support
Listen to a lesson on the life of Jacob. Check us out on social media: Facebook – https://www.facebook.com/theapcblm Instagram – https://www.instagram.com/the_apc Website – https://www.theapc.org Have a prayer request? We'd love to pray for you! https://apostolicpentecostalchurch.updates.church/# Subscribe to our channel and click the notification bell to get alerts on live or posted videos! www.youtube.com/c/ApostolicPentecostalChurch #pentecostal #upci #pentecostalteaching
Highschool Pastor Zach Nave stops bye for a great convo! He gives great advice for anyone who maybe unsure of what they are supposed to be doing in life. He and his wife are two people that obey God and love people so well in every single area. You won't regret listening to this episode!
Iker Jiménez dedica su cierre a hablar de la meditación y lo positivas que pueden llegar a ser algunas técnicas milenarias para nuestro cerebro. El presentador de ‘Cuarto Milenio’ comenzaba a divagar sobre este tema tras contar una anécdota que ocurrió en la intimidad de su hogar. Carmen Porter estaba dándose un baño en su casa, escuchando una meditación guiada, algo que llamó la atención del conductor de la Nave del Misterio. Pero él no es el único del entorno del presentador que emplea este tipo de técnicas para relajarse. Un amigo suyo, experto en artes marciales, considera importante la meditación para focalizar, ser una persona más metódica y, sobre todo, para resetear la mente: “La meditación provoca elementos positivos de sincronización de los hemisferios”, explicaba el presentador. “Cuando meditas, en el cerebro pasan cosas buenas”, decía Iker Jiménez, que se plantea pedirle al doctor Alonso que haga una sección especial para hablar de estas técnicas milenarias y sus beneficios para el cerebro. Escucha el episodio completo en la app de iVoox, o descubre todo el catálogo de iVoox Originals
FarmBits hosts Jose Cesario and Natasha Umezu welcome Jessica Korinek, President CEO of Nave Analytics, Inc., to this episode of the FarmBits podcast. Nave Analytics is a data coherence hub and delivery system powering versatile digital tools to support irrigation operations so growers and land managers can become more deliberate with their irrigation decisions. In this episode, Jessi discusses these challenges, the origin of Nave Analytics, how Nave Analytics navigates and operates irrigation, and her vision for the future of Nave Analytics. Tune in to this interesting episode to learn more about how Nave Analytics is supporting growers with their irrigation decisions. Jessica Korinek Contact Information: E-Mail: email@example.com Twitter: https://twitter.com/JessiKorinek LinkedIn: https://www.linkedin.com/in/jessica-korinek/ FarmBits Contact Information: E-Mail: firstname.lastname@example.org Twitter: https://twitter.com/NEDigitalAg Facebook: https://www.facebook.com/UNLFarmBits Jose's Twitter: https://twitter.com/josegcesario Jose's LinkedIn: https://www.linkedin.com/in/jose-guilherme-cesario-pereira-pinto Natasha'sTwitter: https://twitter.com/NatashaUmezu Natasha's LinkedIn: https://www.linkedin.com/in/natasha-hiromi-umezu-b84805136/ Opinions expressed by the hosts and guests on this podcast are solely their own, and do not reflect the views of Nebraska Extension or the University of Nebraska - Lincoln.
Meditando por un cambio es un espacio para que a través de la meditación, visualización y terapias energéticas, unamos fuerzas desde cualquier rincón del mundo y amplifiquemos la vibración de la paz y el amor incondicional a todos los rincones del planeta y a todos los corazones, empezamos por el tuyo mismo. Las meditaciones son canalizadas en vivo por Andrea Roa con la guía de arcángeles, maestros ascendidos y seres estelares de la más alta vibración. CURSOS, TALLERES, MEDITACIONES http://andrearoa.net/
Iker Jiménez dedica su cierre a una de sus grandes pasiones desde niño, el mundo de los ovni. El presentador de ‘Cuarto Milenio’ saca a la luz un objeto que tiene mucha importancia para él y reflexiona sobre los seres de otro mundo. El Santo Grial de Iker Jiménez El conductor de la Nave del Misterio sacaba a la luz un objeto de gran significado que encontró hace unos días en su casa. Se trata de la página del primer libro que escribió cuando tenía solo once años y que trataba de los ovni: “Esto es como mi Santo Grial”, decía. Además de ese dibujo, el presentador de ‘Cuarto Milenio’ sacaba a la luz dos libros que fueron muy importantes para él de niño y que le hicieron empezar a interesarse por el universo de la ufología. Sin embargo, parece que los años han hecho que Iker Jiménez empiece a replantearse cosas y que algunos de sus amigos empiecen a pensar que ha dejado de creer en ellos ovni. Sobre ese tema ha reflexionado el periodista en su sección. Escucha el episodio completo en la app de iVoox, o descubre todo el catálogo de iVoox Originals
Our special guest for this episode is Laurie Nave. She is a writer, musician, and instructional designer. She spent 16 years teaching general music and choir. She freelanced her way into a new career as an instructional designer, working the last decade at nonprofit organizations, NASA, and now The University of Alabama in Huntsville. Yes, NASA!She has published two suspense novels - Chosen by a Killer and Revenge al Dente - featuring Celia Brockwell as a “do anything for the story” journalist. The Bone Farm, Laurie's third installment, will be published in early 2023. She has also published a historical romance, Where Magnolias Lie, set in her hometown and New Orleans. On August 1, she will release an inspirational devotional entitled Run to the City: Abundant Living After the Well. In 2022, she also published two children's picture books based on rhyming stories she created as a music teacher.Laurie is currently working on a suspense novel set in Huntsville. In addition, she is working on her first speculative dystopian-style novel.Check out all Laurie's social media links:Website: https://www.laurienaveauthor.comTwitter: @lurioosiInstagram: @lyricallylaurieFacebook: Laurie Nave Author
Desempleo al alza en México durante agostoRusia reafirma amenazas de armas nuclearesEliminación del horario de verano avanza en la Cámara de DiputadosRenuncia Omar Gómez Trejo¿Misión Armageddon? Nave de la NASA impactó un asteroideMaca Carriedo y Javier Garza comentan las notas más destacadas de la jornada. Compártenos tus opiniones en Instagram: @expansion.dailyMás información en Expansión
This week in our return to the EIUPanthers Podcast series we sit down with Eastern Illinois Head Athletic Trainer Jim Nave. Nave has been in the athletic training business for more than 20 years and discusses what first got him into the profession and what things he has seen evolve over the past two decades. In addition he talks about how he has built his athletic training staff here at EIU and how his side hobbies of playing in a band and fishing give him a good balanced approach to his job. (Episode 88)
Unilever anunció que hará una nueva inversión en su planta trasladada de Cali a Palmira, Valle del Cauca, donde ya operan cuatro de las cinco unidades de negocio de la compañía a nivel global. Rodrigo Sotomayor, presidente de Unilever en Colombia, indicó que se trata de la operación de una “nave” de alimentos, que entrará a complementar el complejo productivo manufacturero. La nueva planta , que ya está construida, iniciará operaciones en 2023. En cinco años, Unilever ha invertido $210.000 millones.
La Fiscalía y el Congreso tras los pasos de «Lay Vásquez», el misterioso sobrino de Pedro Castillo. Además, Maricarmen Alva sigue siendo «Malcricarmen»; y la Nasa convierte la ciencia ficción en realidad. ¡Dale play!
Anoche, a las 20.15 hora de Uruguay, a 11 millones de kilómetros de la Tierra, se ejecutó una misión espacial de tintes hollywoodenses. Como en la película Armagedón, en la que Bruce Willis busca destruir un asteroide para que no impacte contra la Tierra, pero sin tanto show. Así podríamos caracterizar a la misión DART, cuya nave despegó en noviembre desde California, Estados Unidos, con el objetivo de desviar a un asteroide llamado Dimorphos. Si bien Dimorphos no es una amenaza para el planeta, la intención era practicar para estar preparados para ejecutar una operación de ese tipo cuando sea necesario actuar ante una amenaza real. Así celebraron ayer en la NASA el momento en que el vehículo impactó contra el asteroide: ¿Fue un éxito, entonces, la misión? ¿Qué información existe de lo que ocurrió anoche, además de lo que mostró la cámara hasta el instante del impacto? ¿Cómo sigue esta misión? Conversamos En Perspectiva con un uruguayo que es parte del equipo internacional de trabajo, el astrónomo y docente Gonzalo Tancredi.
Como en la película de Armaguedón, pero sin ficción cinematográfica, la NASA ha estrellado una nave contra un meteorito con la intención de desviarlo de su trayectoria. El impacto se ha logrado con éxito, pero queda por ver hasta qué punto se ha cambiado su trayectoria.
Paul Krauss MA LPC and Joshua Nave MS LMSW discuss power, abuse, control, and gaslighting within relationships (domestic violence), but also within cultural entities, organizations, and society as a whole. The pair define power, abuse, gaslighting and control tactics used by abusers, some of the ways that they use them to keep control in a relationship, and how often times the abusers view them themselves as "victims" to rationalize their behavior. Of course, depending on one's culture of origin and background, there are many considerations and ways of "framing" these topics--and Joshua and Paul discuss this from a viewpoint that seeks cultural competency and understanding. Later on Joshua Nave and Paul Krauss discuss how to reclaim one's voice if you have been abused, controlled, or "gaslit" by a person or an entity that was attempting to keep power over you. If you believe you are in a domestic violence relationship with a person or a larger group, get help now by calling or chatting online: 800.799.SAFE (7233) or https://www.thehotline.org/ Joshua Nave, LMSW is a therapist in Grand Rapids, Michigan who provides EMDR and trauma-informed talk therapy to people who are struggling with anxiety. For more than five years, Joshua has been providing specialized trauma and anxiety therapies to a wide range of people. He aspires to provide healing to everyone. In order to effectively treat the full person, his counseling technique focuses on incorporating his client's beliefs, cultural background, personal history, and life experiences. In order to effectively treat the full person, his counseling technique focuses on incorporating his client's beliefs, cultural background, personal history, and life experiences. Joshua is interested in assisting anyone, regardless of race or background, in getting the life they want by helping them overcome their own trauma, accessory trauma, or just general anxiousness. If you live in Michigan you can work with Joshua online or in person. Check out his therapy page here: https://healthforlifegr.com/experts/joshua-nave/ Preview On-Demand Online Video Course for the Parents of Young Adults by Paul Krauss MA LPC Want to get trained in EMDR Therapy? Looking for some great advanced EMDR therapy trainings? Check out EMDR Training Solutions and Register Today! Use the code INTENTIONAL at checkout, and get $100 Dollars OFF at Checkout! Remember, from my research, EMDR Training Solutions is the most affordable independent training on the market! EMDR Training Solutions: for all of your EMDR training needs. Paul Krauss MA LPC is the Clinical Director of Health for Life Counseling Grand Rapids, home of The Trauma-Informed Counseling Center of Grand Rapids. Paul is also a Private Practice Psychotherapist, an Approved EMDRIA Consultant , host of the Intentional Clinician podcast, Behavioral Health Consultant, Clinical Trainer, and Counseling Supervisor. Paul is now offering consulting for a few individuals and organizations. Paul is the creator of the National Violence Prevention Hotline (in progress) as well as the Intentional Clinician Training Program for Counselors. Paul has been quoted in the Washington Post, NBC News, and Wired Magazine. Questions? Call the office at 616-200-4433. If you are looking for EMDRIA consulting groups, Paul Krauss MA LPC is now hosting weekly online and in-person groups. For details, click here. For general behavioral and mental health consulting for you or your organization. Follow Health for Life Grand Rapids: Instagram | Facebook | Youtube Original Music: ”Shades of Currency" [Instrumental] from Archetypes by PAWL (Spotify) "A Further Look at Loss" from Parallel Light by Andrew Wasylyk (Spotify)
Y tras un largo periodo vacacional vuelve el Club de los Curiosos y lo hace para reescribir el mundo de la ufología con nuevos estudios y testigos de lo imposible. Lo hacemos con público, nuestra gente y desde la Nave 22. Desde el barrio de Ciudad Jardín en Málaga, lugar habitual de avistamientos recibimos a un valiente llamado Fernando, un tipo que trae imágenes que analizada por expertos siguen sin explicación a día de hoy. Tras su testimonio, recibimos a Isidro, quizás uno de los pocos españoles que pueden afirmar haber sobrevivido a un intento de abducción. El niño de las estrellas Javier Ramos, analiza el caso paranormal de la subvención de los extraterrestres te quieren violar y la siempre polémica ecuación de Drake. Con Elena Gómez sentimos el autentico terror, nos trae el Caso Anolaima, cuando los extraterrestres matan. El maestro Manolo del Pryca saca del cuaderno de campo un caso internacional, John Mooner. Un aficionado que miró de frente a un ser de otro planeta, se enfrentó y quedó registrado en Google Maps. El amigo Jaime Noguera nos trae expedientes desclasificados donde queda patente que un mal día lo tiene hasta ET, atentos a la guía de naves extraterrestres estrelladas en nuestro planeta. ¿Carlos Jesús y el Penumbra realmente son unos frikis a manos de personas sin escrúpulos como Javier Cárdenas?, Marnofle nos cuenta toda la verdad. ¿Qué hacer ante un encuentro en la tercera fase?, toma nota que Virginia nos da todas las respuestas. Claudio Martino, experto en el manejo del cuchillo, analiza los últimos casos de animales mutilados por extraterrestres en su Argentina natal. Además, tras la conclusión del programa con público vuelven las Rimas de Martino y la lectura de comentarios por parte del Glan Lidel en la soledad de la noche. Tráiler de Solteronas, del amigo Manuel Jiménez, poned cosas bonitas gente: https://vimeo.com/user17011142/solt Apoya el tratamiento de nuestra curiosa Elena Gómez, firma en Change.org: https://www.change.org/p/ministerio-de-sanidad-si-me-quitas-el-tratamiento-para-la-ame-qu%C3%A9-futuro-tengo Hazte #Mecenas del Club para apoyar la lucha de los anormales por el mundo o bien haz una donación por #Bizum indicando tu nombre y la palabra anormal al 688 323 552 Merchandising del Club de los Curiosos: https://www.creandacosas.com/categoria-producto/curiosos/ Web del Glan Lidel: www.albertoenriquepons.es Compra el Libro Oficial del Club “Historias para Anormales”: https://www.amazon.es/dp/8409315343?fbclid=IwAR189XyUIcGvMjQg1C8M_cEgQMMMq-PIe9pOGtIpw-hX8w4Ob0PDfLpY5tQ También en EBook: https://www.amazon.es/dp/B09B2TXRZ8 Libro de Mark Knopfler Málaga 360: https://360malaga.es Libro de Elena Gómez “Eros y Thanatos”: https://www.amazon.es/EROS-THANATOS-13-ENTRE-L%C3%8DNEAS/dp/841204357X No dejes de dejar comentarios, todos serán leídos y respondidos en el próximo programa, se os quiere. Estamos en Twitch, Instagram, TikTok, Youtube, Facebook y Twitter. Nuestro Mail de Contacto: email@example.com Twitch del Club de los Curiosos: https://www.twitch.tv/el_club_de_los_curiosos Youtube del Club de los Curiosos: https://www.youtube.com/channel/UC6KgIO7QIVyYNY8LDbVvErA Facebook del Club de los Curiosos: https://www.facebook.com/elclubdeloscuriosos Instagram del Club de los Curiosos: https://www.instagram.com/elclubdeloscuriosos/?hl=es Tema Cierre: Lastre Tema Cabecera: Makuki No dejes de visitar el Canal de Youtube de nuestra Cristina Marley:https://youtube.com/c/CristinaMarley Ivoox de Narraciones de un Burro: https://www.ivoox.com/podcast-narraciones-burro_sq_f1507763_1.html Youtube de Bendito Caótico: https://www.youtube.com/channel/UCWWabzn2yB-XVmPN9QnPeIQ Instagram Marta González Vallovera: https://www.instagram.com/artealday/?hl=es.Javier Si te gustan los animales visita www.airedelatoscana.com
In this episode, Tim Nave talks about being the Governor of Appalachia, whether or not being "southern" is positive or negative, having a chip on your shoulder, the connection between the "Bitter as Hell" songs, and strategies for releasing physical copy. Plus, not being understandable at a McDonalds due to accent, building an audience, making a living playing music, and other bands named Takat. You can check out Tim Nave at the following locations: https://www.theartistknownastim.com/ https://www.facebook.com/The-artist-known-as-Tim-685181168581739/ https://www.youtube.com/channel/UCeZaXLYi_P88QKAb6233M5g https://www.instagram.com/artist_timnave Paul works a day job and puts out vinyl and puts on shows via Katzulhu Productions https://www.facebook.com/paul.neil.12 https://www.facebook.com/katzulhu https://www.facebook.com/Dont-Quit-Your-Day-Job-podcast-107924851339602
If you're working class, and you're wondering if the political class has done anything for you lately, tune in to this week's Heartland Labor Forum where Rep. Sharice Davids and the Kansas AFL-CIO's John Nave will explain what's in it for you in recent bills passed by Congress. We'll talk infrastructure, the cost of drugs, […] The post Rep. Sharice Davids and KS AFL-CIO’s John Nave on What Has Congress Done for Us Lately appeared first on KKFI.
Il traffico di navi in partenza dall'Ucraina sembra andare verso una normalizzazione: sei navi cariche di prodotti agricoli ucraini sono partite nelle prime ore del mattino dai porti del Paese sul Mar Nero. Interessante anche il calo del costo dei noli, misurato dal Baltic Dry Index, che da maggio è sceso da circa 3400 punti a 1133. Ne parliamo con Augusto Cosulich, agente marittimo genovese, presidente e amministratore delegato della "Fratelli Cosulich". Al via il piano del governo: riscaldamenti a 19 gradi e 15 giorni in meno Arriva il piano italiano per limitare gli effetti del caro energia. Il Mite ha infatti pubblicato il Regolamento per "realizzare da subito risparmi utili a livello europeo a prepararsi a eventuali interruzioni delle forniture di gas dalla Russia". Le stime dell impatto di tutte le misure di contenimento indicate dal Regolamento "portano ad un potenziale di circa 5,3 miliardi di metri cubi di gas". Facciamo il punto con Celestina Dominelli, del Sole 24 Ore. Caro energia. Nel cuneese una cartiera ferma la produzione La Cartiera Pineroli di Roccavione in provincia di Cuneo ha fermato la produzione e ha messo in cassa integrazione i dipendenti. Il caro bollette si è abbattuto anche su questa azienda: se l'anno scorso pagavano di bollette 400mila euro e al mese a luglio hanno pagato 3,2 milioni di euro. Ospite Silviano Carletto, presidente della Pirinoli.
The show moves on to a new console, but we're still staying with Nintendo for just a little while longer as I finally get to talk about my time with the Game Boy! And I can't begin it any other way than starting here with Kirby's Dream Land! The first game in a franchise can always be a toss up, but when it's made specifically for the limitations of the hardware it was made for, well sometimes limitation breeds creativity. Let's find out how the franchise started.... Check out Nave and Gaming Together HERE! Support the show further and DRIP HARD @ the Redbubble store! Follow the show on Instagram Write in to the show! Mainquestpod@gmail.com
Na segunda temporada do PIXEL REDONDO, conversamos com executivos das principais empresas de tecnologia do planeta para entender seus planos, novidades e como elas prestam atenção nos consumidores! Nesse episódio, conversamos com Roger Melo, Gerente Geral da divisão Gaming da NAVE, para falar sobre o mercado gamer, estratégias de produto e marca e marketing! Gostou do episódio? Mande um comentário em áudio pelo WhatsApp +55 11 98765-6950. Seu comentário poderá aparecer no podcast Serviço de Atendimento à Cavalaria (SAC). Saiba mais em www.redegeek.com.br
Laurie and I had such a fun chat today! We talk about research for books, why words have power, and what happens when we dislike books vs dislike movies. You can find Laurie on Twitter, Instagram, Facebook, and her author page on Amazon. Until next time, friends! --- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app Support this podcast: https://anchor.fm/pickybookworm/support
In this episode, Brian chats about American politics with author Laurie Nave. Follow Laurie on Twitter @lurioosi and check out her books on Amazon! --- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app Support this podcast: https://anchor.fm/searchingforpoliticaliden/support
On Episode 19 of the Stroke Alert Podcast, host Dr. Negar Asdaghi highlights two articles from the August 2022 issue of Stroke: “Direct to Angiosuite Versus Conventional Imaging in Suspected Large Vessel Occlusion” and “Recurrent Ischemic Stroke and Bleeding in Patients With AF Who Suffered an Acute Stroke While on Treatment With NOACs.” She also interviews Dr. Alexander Nave about “Combined Oral Triglyceride and Glucose Tolerance Test After Acute Ischemic Stroke to Predict Recurrent Vascular Events.” Dr. Negar Asdaghi: Let's start with a few questions. 1) How much time do we actually save if we were to transfer all patients with suspected target vessel occlusion directly to the angiosuite and practically bypassing our current conventional imaging model? 2) What is the impact of an impaired metabolic state as measured by abnormal glucose and triglyceride tolerance tests on the risk of stroke recurrence in patients with ischemic stroke? 3) And finally, should we or should we not change the anticoagulant therapy of a patient with atrial fibrillation who suffered an ischemic stroke despite appropriate treatment with anticoagulation? We have the answers to these questions and much more in today's podcast because this is the best in Stroke. Stay with us. Dr. Negar Asdaghi: Welcome back to another issue of the Stroke Alert Podcast. My name is Negar Asdaghi. I'm an Associate Professor of Neurology at the University of Miami Miller School of Medicine and your host for the monthly Stroke Alert Podcast. The August 2022 issue of Stroke contains a range of really stimulating articles. We have an interesting study titled "Individual and Joint Effects of Influenza-Like Illness and Vaccinations on Stroke in the Young," led by Dr. Amelia Boehme and colleagues from Columbia University, with its accompanying editorial on how influenza-like illness is associated with increased risk of stroke in the young and middle-aged population while vaccinations of any type is protective of this risk. In a different paper, as part of a population-based study out of Scotland, Dr. Rustam Al-Shahi Salman from University of Edinburgh and colleagues report on a positive association between the use of beta-blockers, especially propranolol, and a lower risk of cerebral cavernous malformation, or CCM, associated intracranial hemorrhage. This study's findings are very interesting and quite important, and I encourage you to review the growing literature to suggest how beta-blockers may, in fact, reduce the risk of CCM-related hemorrhages through their anti-angiogenic properties. Dr. Negar Asdaghi: Later in the podcast, I have the great pleasure of interviewing Dr. Alexander Nave from Charité University Hospital in Berlin to discuss the relationship between having an impaired metabolic state in the setting of acute stroke and the risk of ischemic stroke recurrence, as we'll review the long-awaited results of the Berlin "Cream&Sugar" study, a very catchy title. But first, with these two articles. Dr. Negar Asdaghi: Time to successful endovascular reperfusion is an important predictor of clinical outcomes in patients with acute ischemic stroke related to a large vessel occlusion. And for years, we've known that the faster we're able to open the affected artery, the better the ischemic stroke outcomes are. Correspondingly, systems of care have adapted to various requirements of this so-called rapid workflow to ensure that all necessary pre-reperfusion steps are completed as fast as possible, preferably most in parallel to one another. And if any steps are unnecessary, they're bypassed altogether. Dr. Negar Asdaghi: Despite all these modifications to date, time from conventional imaging to angiosuite arrival remains both the longest and the most variable interval in the intra-hospital workflow prior to endovascular therapy. So, it's not surprising that many recent studies have evaluated whether the current model of hospital arrival, then transfer to the scanner for imaging, then transfer to the angiosuite for endovascular therapy, can be replaced by a simpler model where, based on clinical assessment, a patient with high likelihood of having a target vessel occlusion can directly be transferred to the angiosuite, where fast stroke imaging, including CT, CT angiogram, and CT perfusion, are completed on the angiotable using the flat panel imaging technology. Dr. Negar Asdaghi: If the patient is then found to be eligible to receive reperfusion therapies, including intravenous thrombolytics, they can receive the treatments and then proceed to endovascular thrombectomy without any further delays. So, in this issue of the journal, in the study titled "Direct to Angiosuite Versus Conventional Imaging in Suspected Large Vessel Occlusion," Dr. Raul Nogueira from Department of Neurology at Emory University and colleagues performed a systematic review and meta-analysis of published articles on this topic. So, they included seven articles for this analysis after pulling over 4000 articles using the common search engines for this meta-analysis. These articles included two single-centered European randomized controlled trials, one conducted in Germany, and the other one conducted in Spain, and five observational studies for a total of 1971 patients. The primary outcome was the odds of achieving favorable neurological recovery as defined by a modified Rankin Scale of zero to two at 90 days. Dr. Negar Asdaghi: Now, a few things to note: All studies reported door-to-puncture times, but not all reported door-to-reperfusion times or rate of successful reperfusion, and we know that these metrics are important in predicting the odds of safety and efficacy outcomes of endovascular therapy. And also it's important to note that not all details of the safety and efficacy outcome measures were reported in all of those seven studies. So, with that, here are the main findings of the meta-analysis. First off, amongst patients who were directly transferred to the angiosuite across these seven studies, the overall rate of false activation was 28%, meaning that after imaging assessment, 28% of those who were directly taken to the angiotable were not found to have a target occlusion, and as such, there was no need to further proceed to endovascular thrombectomy. And this is a practical finding of this meta-analysis as we deal with resource allocation and concerns of potentially overwhelming the neurointerventional teams. Dr. Negar Asdaghi: Now, moving on to the next finding of the study, the direct angio approach significantly reduced door-to-puncture times by a median of 30 minutes, and door-to-reperfusion times, when these metrics were available, by a median of 33 minutes as compared to the conventional imaging approach. So, bypassing conventional CT does translate into faster time metrics. These were, of course, expected findings of this meta-analysis, but nonetheless, important to quantify. But these faster time metrics did not improve the endovascular procedural outcomes, meaning that the direct to angio approach did not increase the odds of achieving a TICI 2b or better reperfusion, which is how successful reperfusion is defined, or the odds of achieving full reperfusion, meaning modified TICI 2c or greater reperfusion. Dr. Negar Asdaghi: So, it's great to get to the angiosuite fast, but that does not impact the procedural outcomes of endovascular therapy. Despite the above, the faster approach resulted in a significantly better functional independence outcome as measured by mRS Scale at 90 days, again emphasizing how important time is when it comes to endovascular outcomes. Now, the authors also performed a number of subgroup analysis in this meta-analysis, which I'd like to highlight some of them. We know that the impact of time on endovascular outcomes is more robust in the early time window. So, not surprisingly, when restricting the primary outcomes to those presenting within six hours from symptom onset, the favorable effect of direct to angio approach persisted in the early time window as well. Dr. Negar Asdaghi: Another important subgroup analysis was when restricting data to those patients who were transferred from a primary hospital to an endovascularly-capable center, the direct angio method didn't really have a significant impact on improving the primary outcome. Why is that? Let me repeat. So, when they restricted the analysis to those patients who were transferred from one hospital to an endovascularly-capable center, they did not find the same significant positive impact on endovascular outcomes in the direct to angio approach. I think the way we can explain this from a pathophysiological standpoint is that transferred patients are more likely to be slow progressors and, therefore, less likely to be impacted by delays in the workflow process as compared to the fast progressors. Dr. Negar Asdaghi: Take-home message: We've got to be fast in the fast progressors, and it's safe to assume that those who are within the first six hours after presentation are more likely to be fast progressors, and these workflow modifications are, therefore, much more robust and much more impactful in patients who present early on after their symptoms onset. And finally, in terms of safety outcomes, there were no significant differences in the rate of symptomatic intracerebral hemorrhage rate or the 90-day mortality rates either for the whole study population or when the analysis was restricted to those treated in the early time window. Dr. Negar Asdaghi: So, in summary, what we learned from this large meta-analysis is that as compared to the current conventional imaging model, the direct transfer to angio model is not only plausible and unlikely to overwhelm the interventional teams, as only less than 30% of patients in a direct method were not eligible for endovascular thrombectomy, but also this method is safe and results in significant improvements in workflow time metrics and functional outcomes. So, as the saying goes, select faster, select less, and treat more will likely be the future of endovascular therapy, particularly in the early time window. Dr. Negar Asdaghi: We know that oral anticoagulants reduce the risk of ischemic events in patients with atrial fibrillation. Nonvitamin K antagonist oral anticoagulants, or NOACs, also known as direct oral anticoagulants, or DOACs, are currently the standard of care for treatment of patients with non-valvular atrial fibrillation. Now, we have to keep in mind that although NOACs reduce the risk of ischemic stroke and systemic embolism in atrial fibrillation, they don't completely abolish the risk. So, they're not curative treatments for AFib, and patients can still experience embolic events despite appropriate treatment with these agents. In a meta-analysis of randomized trials, the residual risk of ischemic events in patients treated with NOACs was estimated at 1.4% per year, but this number is a lot lower than what is reported by real-life observational studies. Dr. Negar Asdaghi: In the large multicenter RENO study, which was published in this journal in 2019, we learned that in the setting of atrial fibrillation treated with a NOAC, a number of factors, including atrial enlargement, dyslipidemia, scoring high on the CHA2DS2-VASc score, and the use of low dose of NOACs, especially off-label low dose use of these medications, are significantly associated with increased risk of recurrent ischemic events despite treatment. But there's still a number of important questions that we routinely encounter in practice, most important of which is how to manage these patients with these so-called breakthrough ischemic events moving forward? Do we switch them to a different NOAC or go back to a vitamin K antagonist? Should we add an antiplatelet treatment to the regimen? And importantly, how do we counsel these patients and their families on their future risk of recurrent ischemic or hemorrhagic events? Dr. Negar Asdaghi: So, in the current issue of the journal, the RENO investigators, led by Dr. Maurizio Paciaroni and Valeria Caso, set out to answer some of these important questions as part of the RENO-EXTEND study, which basically followed the patients in the RENO cohort for at least 12 months, evaluating them for either recurrent ischemic or hemorrhagic events, whether occurring intra or extracranially. So, a bit about this cohort. The RENO study was a multicenter observational cohort across 43 centers in Europe and the United States, including consecutive patients with atrial fibrillation who presented to the hospital with an acute ischemic stroke despite being on a NOAC therapy. Patients were enrolled in the study only if they were compliant with their NOAC treatment and they had not missed their treatment for any reasons for greater than 24 hours prior to their index event. Dr. Negar Asdaghi: The patients were followed in the cohort and the choice of whether or not to start and timing, very importantly, for resumption of anticoagulation therapies were left to the discretion of the treating physicians. For the current paper, they analyzed 1240 patients. After the index event, 39.5%, so close to 40%, had their NOACs changed to another NOAC, mostly to a different class of NOAC. 42.5% continued with the same NOAC at the same dose. 6.7% continued with the same NOAC, but the dose was increased, and a small percentage were shifted to warfarin, that was only 4.7% of the patients. And 6.6% were shifted to low molecular weight heparin or were never prescribed oral anticoagulations after that index event for a variety of reasons, such as earlier ischemic recurrence, early hemorrhagic transformation, or early death or severe index stroke. And the overall median follow up in the study was 15 months. Dr. Negar Asdaghi: So, with that, here are the main study findings. The annual rate of the primary outcome of recurrent ischemic or hemorrhagic events, again, a reminder that these could have been intra or extracranial events, was 13.4%. The majority of these events were ischemic stroke, followed by major extracranial bleeding, then intracranial bleeding and systemic embolism. We have to note that this overall primary outcome rate is a lot higher than what was observed as part of the randomized trials of NOACs, as we noted earlier, which is an important finding of these real-life studies. Now, with regards to the factors predicting the primary outcome, having a higher CHA2DS2-VASc score and persistent hypertension were both predictive of recurrent ischemic events, whether ischemic stroke or systemic embolism. Next, the predictive factors for hemorrhagic events, either intracranial or major extracranial bleeding, included age, for each year increase in age, the odds increased by 1.1; history of major bleeding in the past; and, very importantly, a scenario that not uncommonly happens in routine practice, which is the addition of antiplatelet to a NOAC after the so-called NOAC failure. Dr. Negar Asdaghi: And finally, it turns out that changing that failed NOAC to a different agent didn't really seem to make a difference at all. As we mentioned earlier, close to 40% of patients were changed from one NOAC to another agent after the index ischemic event, and when they looked at the primary outcome, there was no difference in the rate of combined ischemic and hemorrhagic events, or the ischemic events alone, or bleeding outcomes alone, amongst patients who changed their NOAC to a different agent as compared to those who did not. The authors performed a number of subanalyses to see whether a particular strategy, for example, a switch from a particular class of NOACs to another class, or change in dosage, or NOAC to warfarin change, may be more or less beneficial in reducing the primary outcome, and there was really no difference between any of these strategies with the exception of one group. Dr. Negar Asdaghi: It turns out that the cumulative risk of ischemic and hemorrhagic events were a lot higher in those 6.6% of patients in whom NOAC treatment was changed to low molecular weight heparin injection. But I think one should consider this observation as hypothesis generating. First off, it was just a very small percentage of patients in this study that actually did go through this switch. And also we should note that in practice, we reserve a switch to low molecular weight heparin injection in only special cases. Some examples would be patients in whom there's a consideration of a hypercoagulable state, whether cancer related or not. But regardless, I think what we learned from this finding is that the patients in whom low molecular weight heparin injection is considered after a NOAC or an anticoagulant failure are likely very high risk patients for recurrent thromboembolic and hemorrhagic events. Dr. Negar Asdaghi: So, in summary, we learned a number of important lessons from RENO-EXTEND study. Number one, patients with atrial fibrillation presenting with a breakthrough ischemic stroke, despite treatment with NOAC, represent a high-risk group of patients who continue to be at a substantial risk for recurrent events, mostly ischemic, but also hemorrhagic. And this substantial risk was actually over 10% in the current study. Number two, we also learned that various strategies of changing the dose or class of anticoagulants don't seem to have much, if any, benefit in reducing the recurrent event outcomes. And finally, the addition of antiplatelet to oral anticoagulant therapies in this situation is not a good idea. This strategy gets us more in trouble and can increase the risk of bleeding and confers practically no benefits. Finally, these are the types of patients in whom we may have to consider other treatment options, such as left atrial appendage closure, and I'm sure we'll hear more on this in the future. Dr. Negar Asdaghi: Having an abnormal lipid profile has long been recognized as a risk factor for development of vascular disorders, particularly leading to atherosclerosis, but this association varies for the different components of the lipid panel and is most robust for elevated low density lipoprotein cholesterol levels, or LDL, causing various vascular disorders. Amongst patients with ischemic stroke and TIA, randomized trials have also shown that lowering LDL can reduce the risk of major cardiovascular events, including the risk of ischemic stroke, but the connection between elevated triglyceride levels and the risk of recurrent ischemic stroke is less clear. Moving from lipids to sugar, the presence of uncontrolled diabetes increases the risk of stroke by two to five folds, depending on the patient population studied and coexistence of other risk factors. In contrast, impaired glucose tolerance, which is an intermediate metabolic state between normal glucose tolerance and diabetes, has also been found to be associated with an increased risk of stroke in patients with coronary artery disease, but this association is less clear amongst patients with ischemic stroke. Dr. Negar Asdaghi: In clinical practice, fasting blood glucose and lipid profiles are routinely measured post-stroke, but we put a greater emphasis on the elevated LDL and hemoglobin A1C levels, and, in general, pay less attention, if any, to other metabolic derangements, including the impaired glucose tolerance state or even abnormal triglyceride levels. So, the question is, what is the impact of these metabolic derangements on the risk of stroke recurrence amongst patients presenting with ischemic stroke? In the current issue of the journal, in the study titled "A Combined Oral Triglyceride and Glucose Tolerance Test After Acute Ischemic Stroke to Predict Recurrent Vascular Events: The Berlin 'Cream&Sugar' Study," we learn about these important associations. Joining me now is the first author of this paper, Dr. Alexander Nave. Dr. Nave is a neurologist and clinician scientist at Charité University Hospital in Berlin. He leads a junior research group as part of the Center of Stroke Research in Berlin and has a special interest in stroke rehabilitation and cardioembolic risk factors of stroke. Good morning, Alex, from Miami. Good afternoon to you in Berlin. Thank you for joining us. Welcome to our podcast. Dr. Alexander Nave: Hi, thank you very much. I'm very happy to be with you. Dr. Negar Asdaghi: All right. Let's go over the background of what we knew on the association between elevated triglyceride levels and the risk of recurrent stroke. Dr. Alexander Nave: Sure. So, as you pointed out earlier, diabetes and hypercholesterolemia are well established risk factors for first and recurrent ischemic stroke. However, for triglyceride levels, this association is less well understood and somewhat inconclusive. So, prior large epidemiological studies of the healthy population from the U.S. and from Denmark have shown an independent association of triglyceride levels in the risk of vascular events, including ischemic stroke. This association was actually stronger for non-fasting triglycerides levels compared to fasting triglycerides levels. In the ischemic stroke population, however, there were only a few investigations with conflicting results. So, the SPARCL trial, for example, which was a large secondary prevention stroke trial with more than 3000 stroke patients, showed that triglyceride levels were associated with major cardiovascular events, but not with recurrent ischemic stroke. So, therefore, we designed the Berlin “Cream&Sugar” study to investigate the association of postprandial triglyceride levels following an oral triglyceride tolerance test with recurrent vascular risk. Dr. Negar Asdaghi: So, let me just summarize. From SPARCL, actually, we knew that an increased level of triglycerides were associated with increased risk of development of cardiovascular events, so things such as coronary artery events and so on, but not an increased risk of stroke. And that's where you come in with the new study, the Berlin “Cream&Sugar” study. Now, before we talk about the study, can you tell us a little bit about the tests that were done, the oral triglyceride and glucose tolerance tests? Dr. Alexander Nave: Absolutely. So, both tests eventually help us to evaluate the glucose and lipid metabolism of a patient. So, the OGTT, the oral glucose tolerance test, as most of the listeners probably know, is a test that helps us to assess the ability of the patient to metabolize glucose after receiving a drink with a standard dose of 75 grams of glucose. The blood glucose levels after one hour and two hours then help us to diagnose diabetes or pre-diabetic state of the patient. So, we're not only evaluating the fasting state, but we can also quantify the body's response to a glucose challenge. And as an equivalent, the OTTT, the oral triglyceride tolerance test, will test the ability of a patient to metabolize triglycerides after oral ingestion of a lipid challenge, which is usually a certain amount of fat. However, this test is less well studied and without any standardized diagnostic criteria so far. And in contrast to the OGTT, the OTTT has not been tested in the stroke population so far. Dr. Negar Asdaghi: So, we're not just looking at those metrics of fasting sugar or fasting lipids and triglycerides specifically, we're looking at the patient's ability to metabolize glucose or triglyceride levels. So, now, with that understanding, can you tell us a little bit about the methodology of the study? Dr. Alexander Nave: Yes, of course. So the Berlin “Cream&Sugar” study was a prospective observational study recruiting acute stroke patients between 2009 and 2017 at the Charité University Hospital in Berlin. And we included first-ever ischemic stroke patients within three days to seven days after onset of stroke, and all patients received a sequential OTTT OGTT. So, all recruited patients received fasting blood sampling in the morning before taking the OTTT with 250 cc of cream, which corresponds to 30% of fat intake. So, all patients without known diabetes mellitus additionally had the OGTT with 75 grams of glucose starting three hours after the OTTT. Dr. Alexander Nave: And all patients received consecutive blood tests at three hours, four hours, and five hours after start of the OTTT to determine the course of glucose and triglyceride levels in the blood. And after one year, we performed follow up of all patients. The primary outcome was recurrent fatal or non-fatal ischemic stroke, and secondary outcome was a composite endpoint of recurrent vascular events, including ischemic stroke, TIA, myocardial infarction, and coronary revascularization, as well as cardiovascular death. And we compared patients with high versus low fasting and nonfasting triglyceride and glucose levels, respectively, using Cox regression analysis. Dr. Negar Asdaghi: Okay. 250 cc of cream and 75 grams of sugar right after a stroke. Was it challenging to recruit patients? Dr. Alexander Nave: Yes, that was a task. And we did experience some difficulties during the course of the study. It was not easy to ask a patient to drink a glass of cream during the first week after suffering from a stroke, obviously. In fact, a substantial number of patients eventually did not participate or did not complete the OTTT. However, in our study, we showed that performing a sequential OGTT OTTT within seven days after stroke was feasible. Approximately 10% of patients reported only minor adverse events such as nausea, diarrhea, and bloating. But with regards to the study population, overall, we enrolled 755 patients, 523 have completed the challenge and entered follow up. So, considering the fact that we had some difficulties in recruitment, was not surprising that we predominantly ended up with minor ischemic stroke patients, considering that we did not include patients with dysphagia or patients that were not able to give informed consent in the early phase after stroke. The median NIHSS was one with an interquartile range of zero to three. And, as I mentioned previously, this was because patients with impaired swallowing could not be included into the study. Dr. Negar Asdaghi: Okay. So, 750 patients within a week after their stroke, majority of them, as you mentioned, had mild ischemic events, were enrolled, and then they underwent sequential OTTT and OGTT tests. And then they were followed for a year for the primary outcomes. Now I think we're ready to hear the primary results. Dr. Alexander Nave: Sure. So, overall, 54 patients, 10% of the total population, reached a study endpoint within one year follow up. 31 patients experienced recurrent ischemic stroke within one year. So, when we compared the highest quartiles of triglyceride levels to the lowest quartiles, neither fasting nor postprandial triglyceride levels were associated with recurrent stroke. Similarly, fasting triglyceride levels were not associated with major cardiovascular events one year after stroke. Surprisingly though, higher postprandial triglycerides, measured at five hours after OTTT, were significantly associated with a lower risk for recurrent vascular events. The hazard ratio was 0.42, and the confidence interval 0.18 to 0.95. So, regarding glucose levels, on the other hand, we found no associations between glucose levels and recurrent vascular risk at all. Dr. Negar Asdaghi: Interesting. So, before I ask you what your takeaway is from all of this, the first question is the 10% rate of primary outcome. Were you at all surprised by this? This seems quite high for the recurrent rate of vascular events after the first year after ischemic stroke and TIA. Dr. Alexander Nave: Well, actually, when the “Cream&Sugar” study was designed, we expected the recurrent event rate to be even higher, approximately 10% of recurrent stroke events within one year and not 10% recurrent vascular events as a composite outcome. But as we know from previous registries, such as the TIA registry, the recurrent risk of vascular events after TIA and minor stroke is much lower now. So, I think with the reported 7% of recurrent stroke events, we're actually quite in line with the reports of the TIA registry, considering the fact also that we had no TIA patients enrolled in our study and had quite a high proportion of patients with large artery atherosclerosis as well as atrial fibrillation. Dr. Negar Asdaghi: So, thank you. This is a grim reminder that ischemic stroke patients remain at high risk of having recurrent vascular events. Alex, what should be our top two takeaway messages from your study? Dr. Alexander Nave: So, first, I think a sequential OTTT OGTT probably does not contribute a lot to future vascular risk stratification in ischemic stroke patients. So, I think all patients and carers can be relieved. There's no need to implement an OTTT into routine clinical care. However, based on our results, I think further studies are necessary and needed to better understand the importance of glucose and lipid metabolism in patients after acute ischemic stroke. And eventually we might figure out some nice information how we can improve risk prediction. Dr. Negar Asdaghi: So, it's good to know that we don't have to ask patients to drink a lot of cream after stroke. Can you tell us a little bit about the future of the Berlin “Cream&Sugar” study group? What are the next steps for the authors and the study group? Dr. Alexander Nave: Absolutely. Well, since there's no urgent need to start another large study soon, I think it would be reasonable to get our data and merge it with datas from other groups who also investigated the role of an OTTT in cardiovascular risk cohorts, also to increase power and detect some other signals. And we want to have a more detailed look at the variability of triglycerides and glucose levels following sequential OTTT OGTT. So, not only go into the absolute levels that you can measure at certain time points, but also how much these parameters fluctuate over time. Dr. Negar Asdaghi: To Alexander Nave, it's been a pleasure interviewing you on the podcast today. We look forward to covering more of your work in the future. Dr. Alexander Nave: Thank you very much. It was a pleasure to talk to you. Dr. Negar Asdaghi: And this concludes our podcast for the August 2022 issue of Stroke. Please be sure to check out this month's table of contents for the full list of publications, including three topical reviews, from “Strategies for Maintaining Brain Health: The Role of Stroke Risk Factors Unique to Elderly Women” to “Ethical Considerations in Surgical Decompression for Stroke.” These articles summarize a large body of evidence, which I encourage you to review. And before we end our August podcast, I'd like to take a moment to recognize the incredible dedication and hard work of our medical students and fellows, especially the young doctors who are just starting their training this year. Dr. Negar Asdaghi: And if you happen to be one of those young doctors who is listening to our podcast in one of those sleepless on-call nights, I want to recount the story of Dr. Carl David Anderson, who won the Nobel Prize in physics for his discovery of the first particle of antimatter known as positron on August 2, 1932. A positron is actually the identical twin of the well-known negative electron, and its discovery in the 1930s truly changed our understanding of the origin of the universe, and it's practically impacted all aspects of science, not to mention it's impacted medicine and medical imaging. But the moral of the story lies in the fact that on August 2, when Anderson announced his discovery, he was a post-doctoral fellow himself, hadn't even graduated yet. So, if you are such a trainee, I hope you know that your hard work, combined with that incredible scientific inquisition, has the potential to change our understanding of the universe. And what better way to do this? You guessed it, than staying alert with Stroke Alert. Dr. Negar Asdaghi: This program is copyright of the American Heart Association, 2022. The opinions expressed by speakers in this podcast are their own and not necessarily those of the editors or of the American Heart Association. For more, visit AHAjournals.org.
Welcome to episode 23 of the Unlockables and this week's exciting guest is none other than Nave from Gaming Together! Nave stops by the show to share the origins of Gaming Together as well as talk about some of his favorite games! You won't want to miss this discussion. Gaming Together Podcast Gaming Together Twitter Gaming Together Instagram Eric's Twitter Podcast Twitter Podcast Instagram Thanks to Hyper Potions for letting us use of their incredible songs for part of the intro! Be sure to check them out by clicking on the links and give them all the support!
Nave of the Gaming Together Podcast returns to the show to break down trophy hunting and completionism in the gaming community. We have some major news updates as well! Video game sales are on the decline, Activision-Blizzard seems to be performing well(?) and the KOTOR Remake seems to be dead in the water. Who do we think has the better trophy system? Xbox or Playstation? Will the trophy lists make or break our favorite games?! Time to find out all that and more. This is our first episode breaking the 2hr mark and wow is this incredible! I hope you enjoy every minute as much as we did!(00:24) - Intro(02:43) - Patreon Question(07:55) - What are we playing?!(28:56) - US Video Game Sales in Q2 are Down(33:10) - Activision/Blizzard beats Revenue Expectations(40:37) - KOTOR get Cancelled?!(49:09) - Trophy Hunting & Completionism(01:04:36) - Nave was a COD Master in High School(01:05:47) - 7 Day Survivor in Dead Rising(01:14:33) - Totally Normal Elden Ring Transition(01:23:36) - Most Memorable Experiences with Trophies(01:57:22) - Twitter Community Responses(02:01:23) - OutroGaming Together Podcast - https://twitter.com/GameTogetherPodSpotify: https://t.co/yNn5Mb2499Apple Podcasts: https://t.co/phauMNNOMHIf you want to reach out to Nick and Will personally if you have any questions or just wanna chat about the show, follow us on any link here:https://linktr.ee/FridayNightGamecastMusic by: https://twitter.com/lilkotobeatsSupport the show
In October 2020 an emergency call was received from a ship in British waters. After a full-scale commando raid, seven Nigerians were taken off in handcuffs – but no one was ever charged. What really happened on board?. Help support our independent journalism at theguardian.com/longreadpod
https://www.linkedin.com/in/derrick-nave/Can automation improve your sustainability? What kind of stretch wrap are you using? Could you use less plastic stretch film? https://ororapackagingsolutions.com/Looking to improve the sustainability of your packaging today? Check out: https://www.landsberg.com/The views and opinions expressed on the "Sustainable Packaging with Cory Connors" podcast are solely those of the author and guests and should not be attributed to any other individual or entity. https://specright.com/ This podcast is an independent production and the podcast production is an original work of the author. All rights of ownership and reproduction are retained—copyright 2022. https://www.amazon.com/dp/1329820053/ref=as_sl_pc_qf_sp_asin_til?tag=corygat