Podcasts about new england journal

Ime tedna je postal Tadej Avčin, predstojnik KO za alergologijo, revmatologijo in klinično imunologijo Pediatrične klinike UKC Ljubljana ter vodja klinične raziskave, v kateri so skupaj s sodelavci prvi klinično dokazali, da je mogoče avtoimunsko bolezen zdraviti z odstranjevanjem sprožilca bolezni namesto z neposrednim zaviranjem imunskega sistema. Gre za pomemben preboj pri razumevanju in zdravljenju avtoimunskih bolezni, rezultate raziskave pa je minuli teden objavila revija New England Journal of Medicine, ena najuglednejših medicinskih revij na svetu. Kandidata sta bila tudi: - Ivan Šprajc, predstojnik Inštituta za antropološke in prostorske študije ZRC SAZU, ki je z mednarodno ekipo sodelavcev na polotoku Jukatan v Mehiki odkril ostanke El Yesala, enega največjih majevskih mest v osrednjem nižavju Jukatana. Gre za zadnje v odkritje v trinajstih sezonah arheološkega rekognosciranja, ki ga je vodil v južnem in srednjem delu mehiške zvezne države Campeche. - Slavko Vinčić, sodnik, ki mu je mednarodna nogometna zveza zaupala sojenje finala svetovnega prvenstva v nogometu med Španijo in Argentino. Vinčić je prvi Slovenec, ki ga je doletela ta čast, v sodniški trojki sta bila tudi Tomaž Klančnik in Andraž Kovačič. Njihov izbor je zgodovinsko priznanje za slovenski nogomet.

John Gerardi is joined by Jonathan Keller of California Family Council to unpack the disturbing expansion of Canada's euthanasia program, from proposals to euthanize infants with disabilities to recommendations that minors consent to their own deaths without parental input. This week's mystery clip reveals just how far the MAID program has gone, with roughly half of 2024 recipients citing feeling like a burden rather than terminal illness. The guys then break down how activists quietly corrupt language, sliding from physician assisted suicide to medical assistance in dying to simply assisted death, and why that shift matters. Finally, they take on a New England Journal of Medicine article arguing to contextualize the dead donor rule, a euphemism for harvesting organs from euthanasia patients before death, and explain why the slippery slope keeps proving pro-lifers right.

Reference:  Denninghoff KR et al. Azithromycin for Preschoolers with Wheezing in the Emergency Department. New England Journal of Medicine. May 2026 Date: July 14, 2026 Guest Skeptic: Dr. Zara Ibrahim is a pediatric emergency medicine fellow at Children's National Hospital in Washington DC where she also completed medical school, pediatric residency. Her research interests include […] The post SGEM#515: Now the Azithromycin Don't Work for Preschool Wheeze first appeared on The Skeptics Guide to Emergency Medicine.

Like tens of millions of people, Stephen Dubner thought he had a penicillin allergy. Like the vast majority, he didn't. This misdiagnosis costs billions of dollars and causes serious health problems, so why hasn't it been fixed? We find out in this update of a 2025 episode.   SOURCES: Kimberly Blumenthal, allergist-immunologist and researcher at the Mayo Clinic. Theresa MacPhail, associate professor of science and technology studies at Stevens Institute of Technology. Thomas Platts-Mills, professor of medicine at the University of Virginia. Elena Resnick, allergist and immunologist at Mount Sinai Hospital.   RESOURCES: Allergic: Our Irritated Bodies in a Changing World, by Theresa MacPhail (2023). "Evaluation and Management of Penicillin Allergy: A Review," by Erica S. Shenoy, Eric Macy, and Theresa Rowe (JAMA, 2019). "The Allergy Epidemics: 1870–2010," by Thomas Platts-Mills (The Journal of Allergy and Clinical Immunology, 2016). "Randomized Trial of Peanut Consumption in Infants at Risk for Peanut Allergy," by George Du Toit, Graham Roberts, et al. (The New England Journal of Medicine, 2015).   EXTRAS: "The Freakonomics Radio Guide to Getting Better," series by Freakonomics Radio (2026). "Doctors Know They Prescribe Too Many Antibiotics. Why Don't They Stop?" by Freakonomics, M.D. (2022). Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

This article is for educational purposes only and is not a substitute for individualized medical advice. Always talk to your own healthcare provider before changing your diet, supplements, or medications.Unlocking the Secrets of Ferritin: What Your Iron Levels Are Telling YouYour “normal” bloodwork might be hiding the real reason you're exhausted, foggy, and losing hairTL;DR: * Ferritin is your iron savings account — and most labs only flag it as “abnormal” once it's nearly empty. * A level of 14 or 22 ng/mL might get a “you're fine” from your doctor, but optimal energy, mood, cognition, and hair growth usually need ferritin closer to 70–100 ng/mL. * Low ferritin can come from menstrual blood loss, poor absorption (celiac disease, low stomach acid, H. pylori), or inflammation-driven hepcidin blocking iron uptake.* If you're fatigued, foggy, cold, or shedding hair, ask for a full iron panel — not just a ferritin number — and talk through the results with your doctor.There's an old Japanese proverb: “When the body speaks, the wise person listens. When the body whispers, the fool waits for it to scream.” In health diagnostics, one of the quietest whispers is your ferritin level. It's often overlooked, yet it can be the missing link behind exhaustion, hair loss, brain fog, or the frustrating experience of bloodwork that comes back “normal” while you still feel terrible.What Is Ferritin?Ferritin is your body's iron storage protein. Think of your iron levels like a financial setup: hemoglobin is your checking account, drawn on daily. Ferritin is your savings account, tapped only when things get tight. Under stress, your body will drain the savings account long before it lets the checking account — hemoglobin — run low. That's why you can have “normal” hemoglobin and still be iron-depleted. A low ferritin level means your reserves are running out, and that shows up as fatigue, brain fog, mood changes, and thinning hair.Normal vs. OptimalMost labs flag ferritin as “normal” above roughly 10–20 ng/mL. That threshold mostly means you're not in immediate danger — not that you're thriving. Levels associated with feeling genuinely well tend to run from 70 to 100 ng/mL. So if you've been told your ferritin of 14 or 22 is fine, but you still feel wiped out, you're not imagining it — you're just being measured against a bar set for avoiding crisis, not for feeling good.Why Your Ferritin Might Be Low* Menstrual blood loss. For many women, the cumulative loss over months and years outpaces dietary iron intake, slowly draining reserves.* Absorption issues. Even a solid iron intake doesn't help if it isn't absorbed. Silent celiac disease, low stomach acid, or an H. pylori infection can quietly block uptake for years.* Inhibitors and hepcidin. Coffee, tea, and dairy consumed close to meals can inhibit iron absorption. Separately, inflammation can push your liver to produce hepcidin, a hormone that shuts down iron uptake even when you're eating enough.Symptoms to WatchPersistent fatigue, thinning hair, feeling cold more easily than others, and brain fog are the classic signs. If two or more of these sound familiar, it's worth getting your ferritin checked specifically — not just assumed to be fine because your CBC looked normal.The Bigger PictureIron does far more than carry oxygen. It's involved in thyroid hormone conversion, dopamine production, mitochondrial energy synthesis, and hair follicle health. That means low ferritin can produce symptoms that look a lot like depression or hypothyroidism — even when your thyroid panel and mood screening come back clean.Taking Action* Review your bloodwork. Look specifically at ferritin. Anything under 70 ng/mL is worth a conversation with your doctor.* Ask for a full iron panel. Ferritin alone isn't the whole story — request serum iron, total iron binding capacity (TIBC), transferrin saturation, and CRP (to rule out inflammation skewing the picture).* Adjust absorption habits. Space coffee and tea away from meals, lean into iron-rich foods, and avoid taking calcium and iron supplements together.* Choose the right supplement, if needed. Ferrous sulfate is harsh on the gut for many people. Iron bisglycinate is gentler and pairs well with vitamin C for better absorption — but check with your provider before starting, especially if high ferritin is a concern.* Loop in a professional. This is especially important before making changes if you suspect elevated ferritin, since iron overload carries its own risks.Listening to Your Body's WhisperYour body is constantly sending signals. Ignored long enough, whispers become screams. Taking ferritin seriously — not just as a checkbox on a lab report, but as a meaningful marker — is one concrete way to catch a problem while it's still easy to fix.Final ThoughtsMonitoring and optimizing ferritin can meaningfully change how you feel day to day. It starts with a simple ask: get the right test, read the number in context, and act on what it's telling you. If you want a more personalized look at your own levels and symptoms, consider scheduling a comprehensive health session.Stay informed, stay healthy, and listen closely to what your body is telling you. Until next time, take care.References* Camaschella, C. (2015). Iron-deficiency anemia. New England Journal of Medicine.* WHO guidance on serum ferritin concentrations for the assessment of iron status.* Clinical literature on ferritin thresholds and symptomatic iron deficiency without anemia.* Hepcidin and inflammation's role in iron regulation — recent reviews in Blood and Haematologica. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit tripleplaydoc.substack.com/subscribe

Could hepatitis B finally have a finite treatment option? Tatyana Kushner, MD, joins hosts Nancy Reau, MD, and Kimberly Brown, MD, to break down the phase 3 B-Well data for bepirovirsen, the first agent to hit functional cure as a primary endpoint in chronic hepatitis B.The conversation covers the phase 3 B-Well 1 and B-Well 2 results, published in the New England Journal of Medicine and presented at EASL 2026, and why quantitative HBsAg testing is becoming essential to patient selection ahead of a potential approval. Kushner, Reau, and Brown also work through what functional cure actually means for patients, how it compares to spontaneous HBsAg loss, and what dosing and monitoring are likely to look like given signals for ALT elevation and renal effects seen in the trials. They discuss which patients are unlikely to be candidates, including those with cirrhosis or decompensated liver disease, and close with a look at what an approval could mean for hepatitis B screening rates and referral patterns between primary care and specialty hepatology.Bepirovirsen is not yet FDA approved. The FDA has accepted the New Drug Application for priority review, with a PDUFA goal date of October 26, 2026.For more: https://www.hcplive.com/view/liver-lineup-bepirovirsen-and-the-push-toward-functional-cure-in-hepatitis-b

Cognitive Atrophy, Referral Incentives, Fragmented Care: Is Primary Care Inevitable or Fixable? Episode 519. Primary care physicians are leaving traditional practice for concierge medicine in visible numbers—and the question is whether that exodus is an unavoidable consequence of how the system is built, or something we've simply chosen not to fix. Stacey Richter talks with Dr. Lisa Rosenbaum, a cardiologist at Beth Israel Deaconess Medical Center (BIDMC) and national correspondent for the New England Journal of Medicine, who recently devoted an entire season of her NEJM podcast, Not Otherwise Specified, to the state of primary care. Together they test three forces reshaping the field—cognitive atrophy, referral incentives, and care fragmentation—against a single question: inevitable, or fixable? WHAT YOU'LL LEARN ✅ Why Dr. Lisa Rosenbaum calls the risk of "cognitive atrophy" among primary care physicians a generational threat rather than an individual one—and why she believes it is not inevitable ✅ How financial incentives that pay far more for a specialist visit than a primary care visit (roughly 5% of healthcare dollars for close to 35% of outpatient visits) structurally push referrals earlier and more often than necessary ✅ Why "relational expertise"—the judgment a doctor builds by knowing a patient over time—is, in Dr. Rosenbaum's view, primary care's real and undervalued skill set ✅ How care fragmentation, illustrated by Miriam Paramore's LinkedIn essay about her father's end-of-life care, leaves patients bouncing among specialists with no one taking ownership of the whole picture ✅ Why Dr. Rosenbaum argues that blaming everything on structural constraints "strip[s] ourselves of our own agency," and what she thinks physicians and healthcare buyers should each do about it WHY THIS MATTERS Roughly 70% of physicians are employed today, and about 5% of every healthcare dollar goes to primary care despite it covering close to 35% of all outpatient visits—numbers that, per Dr. Rosenbaum, reflect choices the system has made, not laws of nature. When primary care doctors lose the time and incentive to build relationships with patients, the system loses its quarterback, and patients end up fragmented across specialists with no one accountable for the whole picture. Dr. Rosenbaum's core argument is that none of this is inevitable, but fixing it requires both structural change and individual physicians and healthcare buyers reclaiming their own agency. MENTIONED IN THIS EPISODE EP504 with Ryan Jacobs: Apple Podcasts | Spotify | Other Apps EP473 with Kenny Cole, MD: Apple Podcasts | Spotify Other Apps EP391 with Scott Conard, MD: Apple Podcasts | Spotify | Other Apps Article: "Ordinary Rural Death: My Father's End-of-Life Journey" by Miriam Paramore EP409 with Larry Bauer, MSW, MEd: Apple Podcasts | Spotify | Other Apps === LINKS ===

In this special episode, Howie and Harlan revisit their conversation with trauma surgeon Selwyn Rogers, whose book Healing the Gun Violence Epidemic: Ending Violence, Rebuilding Communities, and a Trauma Surgeon's Vision for Restoring Hope was published on July 7. Show notes: Selwyn Rogers: Healing the Gun Violence Epidemic: Ending Violence, Rebuilding Communities, and a Trauma Surgeon's Vision for Restoring Hope Albert Ko "Selwyn Rogers named associate editor of prestigious New England Journal of Medicine" Selwyn Rogers: "Hope—Beyond Firearm Trauma" Selwyn Rogers: "Structural Racism and Firearm Injury: Operationalizing Health Equity in Trauma Care" Brain Death: What it is, Stages & Criteria New York Times Live Updates: Supreme Court Birthright Citizenship Case Annual Gun Violence Data 2023 In the Yale School of Management's MBA for Executives program, you'll get a full MBA education in 22 months while applying new skills to your organization in real time. Yale's Executive Master of Public Health offers a rigorous public health education for working professionals, with the flexibility of evening online classes alongside three on-campus trainings. Email Howie and Harlan comments or questions.

Clinical trial support companies are rapidly adopting AI, but sponsors have been more hesitant. Raj Indupuri, CEO of eClinical Solutions, gives the top three reasons behind the holdup in AI agent deployment. He explains the specific pattern of uptake for these agents, the required human-in-the-loop oversight, and how the agents can improve clinical trial velocity. Host Deborah Borfitz also gives the latest news on a highly acclaimed treatment for pancreatic cancer, filling evidence gaps in drug safety during pregnancy, guidelines for routinely collected health data for research purposes, an innovative portal aiding bidirectional communication with patients, and more. Show Notes News Roundup KRAS inhibitor therapy for pancreatic cancer Study in The New England Journal of Medicine  News on the Fred Hutch Cancer Center website  Target trial emulation in rural areas Perspective in the Medical Journal of Australia News on the Griffith University website   AI for improving drug safety during pregnancy Report from the Journal of Medical Internet Research Guidelines on the use of routinely collected data Article in The BMJ New regulatory framework in the U.K. Press release by the Medicines and Healthcare products Regulatory Agency  Participant Engagement Portal Article in JNCI Cancer Spectrum Press release from the Alliance for Clinical Trials in Oncology The Scope of Things podcast explores clinical research and its possibilities, promise, and pitfalls. Clinical Research News senior writer, Deborah Borfitz, welcomes guests who are visionaries closest to the topics, but who can still see past their piece of the puzzle. Focusing on game-changing trends and out-of-the-box operational approaches in the clinical research field, the Scope of Things podcast is your no-nonsense, insider's look at clinical research today.  

In this special episode, Howie and Harlan revisit their conversation with trauma surgeon Selwyn Rogers, whose book Healing the Gun Violence Epidemic: Ending Violence, Rebuilding Communities, and a Trauma Surgeon's Vision for Restoring Hope was published on July 7. Show notes: Selwyn Rogers: Healing the Gun Violence Epidemic: Ending Violence, Rebuilding Communities, and a Trauma Surgeon's Vision for Restoring Hope Albert Ko "Selwyn Rogers named associate editor of prestigious New England Journal of Medicine" Selwyn Rogers: "Hope—Beyond Firearm Trauma" Selwyn Rogers: "Structural Racism and Firearm Injury: Operationalizing Health Equity in Trauma Care" Brain Death: What it is, Stages & Criteria New York Times Live Updates: Supreme Court Birthright Citizenship Case Annual Gun Violence Data 2023 In the Yale School of Management's MBA for Executives program, you'll get a full MBA education in 22 months while applying new skills to your organization in real time. Yale's Executive Master of Public Health offers a rigorous public health education for working professionals, with the flexibility of evening online classes alongside three on-campus trainings. Email Howie and Harlan comments or questions.

Weniger als vier von 100. So wenige gingen ein Jahr später noch ins Fitnessstudio. Und das lag nicht daran, dass sie nicht wollten.Fitness-Gewohnheiten – ob gesundes Essen, Supplement-Einnahme oder regelmäßiges Training – spielen neurobiologisch in einer eigenen Liga. Am Anfang arbeitet Dein Gehirn gegen Dich. Am Ende dieser Folge weißt Du, warum, und mit welchen drei Strategien Du trotzdem dranbleibst.Du erfährst:Warum sich die ersten Wochen wie ein Kampf anfühlen, und wann sich das drehtWarum die „21-Tage-Regel“ nicht funktioniert – und wie lange Du wirklich brauchst3 simple Strategien, die in Studien zu >50% häufigerem Training führen.Los geht's. Und dann: dranbleiben.____________*WERBUNG: Infos zum Werbepartner dieser Folge und allen weiteren Werbepartnern findest Du hier.

Get the 200+ Page Optimal Living Daily Workbook (PDF) — Free. Want to turn today's episode into an actionable plan? Join the Optimal Living Weekly newsletter and I'll send you our 200-page digital workbook immediately. It's packed with the best takeaways from the show, formatted for easy reading and implementation at home. Get your free PDF workbook here: ⁠https://oldpodcast.eo.page/join⁠ Discover all of the podcasts in our network, search for specific episodes and learn more at:⁠ OLDPodcast.com⁠. Episode 3453: Dr. Jenny Brockis explores the fine line between enjoying caffeine and becoming dependent on it, sharing her own experience of consuming too much tea and the surprising effects it had on her mood and anxiety levels. She also highlights the brain and longevity benefits associated with moderate caffeine intake, offering a balanced perspective on how to find the amount that works best for you. Read along with the original article(s) here: https://drjennybrockis.com/2014/2/3/could-you-be-addicted-to-caffeine/ Quotes to ponder: "It seems that caffeine can be good or bad for you depending on how much you consume on a daily basis. As Goldilocks discovered, it's about not having too much or too little, but just enough." "There are a number of health benefits to the brain that caffeine provides, but like most things, if we overdo it, we can run into trouble." "Certain plants (coffea and citrus) produce nectar that contains just a teensy bit of caffeine, but enough to enhance the honeybee's memory, making them more effective pollinators of those plants." Episode references: Nurses' Health Study: https://nurseshealthstudy.org/ The New England Journal of Medicine – Association of Coffee Drinking with Total and Cause-Specific Mortality: https://www.nejm.org/doi/full/10.1056/NEJMoa1112010 Learn more about your ad choices. Visit megaphone.fm/adchoices

Get the 200+ Page Optimal Living Daily Workbook (PDF) — Free. Want to turn today's episode into an actionable plan? Join the Optimal Living Weekly newsletter and I'll send you our 200-page digital workbook immediately. It's packed with the best takeaways from the show, formatted for easy reading and implementation at home. Get your free PDF workbook here: ⁠https://oldpodcast.eo.page/join⁠ Discover all of the podcasts in our network, search for specific episodes and learn more at:⁠ OLDPodcast.com⁠. Episode 3453: Dr. Jenny Brockis explores the fine line between enjoying caffeine and becoming dependent on it, sharing her own experience of consuming too much tea and the surprising effects it had on her mood and anxiety levels. She also highlights the brain and longevity benefits associated with moderate caffeine intake, offering a balanced perspective on how to find the amount that works best for you. Read along with the original article(s) here: https://drjennybrockis.com/2014/2/3/could-you-be-addicted-to-caffeine/ Quotes to ponder: "It seems that caffeine can be good or bad for you depending on how much you consume on a daily basis. As Goldilocks discovered, it's about not having too much or too little, but just enough." "There are a number of health benefits to the brain that caffeine provides, but like most things, if we overdo it, we can run into trouble." "Certain plants (coffea and citrus) produce nectar that contains just a teensy bit of caffeine, but enough to enhance the honeybee's memory, making them more effective pollinators of those plants." Episode references: Nurses' Health Study: https://nurseshealthstudy.org/ The New England Journal of Medicine – Association of Coffee Drinking with Total and Cause-Specific Mortality: https://www.nejm.org/doi/full/10.1056/NEJMoa1112010 Learn more about your ad choices. Visit megaphone.fm/adchoices

South Africa's clinical study, BEAT Tuberculosis, that began in a research unit in Gqeberha in the Eastern Cape, has transformed global treatment of drug-resistant tuberculosis. The primary aim of BEAT Tuberculosis was to evaluate the safety and effectiveness of a novel, shortened treatment regimen for DR-TB compared with the established standard of care. Last week, the study's findings were in the New England Journal of Medicine the highest-ranked medical journal in the world. The publication recognises that this research study has set the global standard for TB care. For more we Bongiwe Zwane spoke to Dr Francesca Conradie, principal investigator of BEAT Tuberculosis and a researcher at the Clinical Health Research Unit, University of the Witwatersrand

This piece is essential listening for anyone interested in modern academic publishing. Recorded at the Collaborative Clinical Trials Meeting in Prato, Italy, TopMedTalk hosts Kate Leslie and Mike Grocott speak with Eric Rubin (Editor-in-Chief, New England Journal of Medicine) and Jocalyn Clark (International Editor, BMJ) about medical publishing. The conversation covers, engaging with clinical researchers and seeing impactful work. How AI can help authors—especially non-native English speakers—while raising concerns about confidentiality, inaccurate or fabricated content, reviewer misuse, governance policies that struggle to keep pace, and AI-generated correspondence overwhelming journals. They explore how AI affects originality and idea generation, note an NEJM AI experiment using AI reviews, and consider how journals should communicate beyond clinicians to address misinformation and declining attention, while maintaining trust and collaborating more across publishing and science. -- The 2026 International Practicum on Cardiopulmonary Exercise Testing will be held at the Balmer Lawn Hotel in Brockenhurst, UK, from September 16th to 18th this year. It is organised by iPOETTS , the international perioperative testing and training society. Come and join us at this premier educational event designed for clinicians, scientists, and healthcare professionals interested in sport, exercise, and perioperative medicine. This is an International Perioperative Testing and Training Society accredited event so when you attend you can get your iPOETTS accreditation, showing that you are a practitioner who has reached a high, standardized level of competence in performing and interpreting Cardiopulmonary Exercise Testing (CPET) for patients preparing for major surgery. Go now to http://www.ebpom.org

SCOTUS votes 6-3 to uphold birthright citizenship, Kushner and Witkoff meet Qatari mediators in Doha for Iran talks, Keiko Fujimori wins Peru's presidency by a slim margin, South Korea's parliament confirms Han Seong-sook as prime minister, a Ukrainian businessman is among three people injured in a Monaco bomb attack, SCOTUS upholds state transgender sports bans, a Gallup poll shows that economic pessimism among Russians is at its highest in two decades, the U.K. considers blocking Paramount's takeover of Warner Bros Discovery, The New England Journal of Medicine retracts a Tavneos study over data concerns, and researchers find Antarctic sea creatures that may help treat melanoma. Sources: Verity.News

Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners.This episode covers the topic of grief with Dr. Cindy Grief, a Geriatric Psychiatrist at Baycrest Health Sciences in Toronto, where she is the Medical Director for Mental Health Services. She is also an Associate Professor at the University of Toronto and has played active roles in postgraduate and continuing education.The learning objectives for this episode are as followsExplain how acute grief becomes integrated over time, and how the dual process model helps us understand this adaptive process.Recognize the clinical features of Prolonged Grief Disorder, understand factors that may increase vulnerability, and distinguish it from trauma-related disorders and depression.Structure a bereavement-focused clinical history, differentiate the management of normative grief from Prolonged Grief Disorder, and approach suicide risk assessment in the context of grief.Guest: Dr. Cindy GriefHosts: Ahmad Khan (incoming PGY1), Dr. Angad Singh (PGY2), and Sara Abrahamson (MS3)Audio editing: Dr. Angad SinghResources:T⁠he Center for Prolonged Grief (https://prolongedgrief.columbia.edu/)Canadian Virtual Hospice  (MyGrief.ca)Association for Death Education and Counseling (https://adec.org)What's Your Grief (https://whatsyourgrief.com/)Podcasts: AllThere Is; Griefcast⁠⁠Books/Memoirs:Joan Didion, The Year of Magical ThinkingHelen Macdonald, H Is for HawkC.S. Lewis, A Grief ObservedChimamand Ngozi Adichie, Notes on GriefArticles:A.C. Shilton, “There Is No Vaccine for Grief,” New York Times, March 2, 2021M. Stroebe, “The Poetry of Grief: Beyond Scientific Portrayal,” OMEGA: Journal of Death and Dying, 2018, 78(1), 67–96References:Shear, K., Frank, E., Houck, P. R., & Reynolds, C. F., III. (2005). Treatment of complicated grief: A randomized controlled trial. Journal of the American Medical Association, 293(21), 2601–2608. https://doi.org/10.1001/jama.293.21.2601Simon, N. M., & Shear, M. K. (2024). Prolonged grief disorder. New England Journal of Medicine, 391(13), 1227–1236. https://doi.org/10.1056/NEJMcp2308707Zisook, S., & Shear, K. (2009). Grief and bereavement: What psychiatrists need to know. World Psychiatry, 8(2), 67–74. https://doi.org/10.1002/j.2051-5545.2009.tb00217.x

Contributor: Travis Barlock, MD Educational Pearls:   First-pass success is critical to limit complications from apnea, hypoxia, and airway trauma.  Complication rate for patients intubated on the first pass is 14% Complication rates increase to 47% after two attempts, 64% after three, and 71% after the fourth attempt   How to improve likelihood of first-pass success: Use Video laryngoscopy (VL). VL increases chance of first-pass success to 85% from 71% Use a bougie, especially in patients with anatomically difficult or otherwise obstructed airways. The BEAM study cites a success rate in these patients of 96% with a bougie, compared to 82% without Use a Checklist mnemonic (SOAPME) Suction – On, ready, and within reach Oxygen – Patient is preoxygenated Adjuncts – Oral/nasal adjuncts and BVM ready Positioning - Patient positioned properly; consider obesity, using semi-Fowler/head-up positioning Medications – Rapid sequence intubation (RSI), sedation, vasopressor, and other medications prepared as necessary Equipment – Laryngoscope (blade), tube, bougie/stylet, syringe, scalpel/cric kit, others ready as necessary References Sakles, J.C., Chiu, S., Mosier, J., Walker, C. and Stolz, U. (2013), The Importance of First Pass Success When Performing Orotracheal Intubation in the Emergency Department. Acad Emerg Med, 20: 71-78. https://doi.org/10.1111/acem.12055 Prekker ME, Driver BE, Trent SA, et al. Video versus Direct Laryngoscopy for Tracheal Intubation of Critically Ill Adults. New England Journal of Medicine. 2023;389(5). doi:https://doi.org/10.1056/nejmoa2301601 Driver BE, Prekker ME, Klein LR, et al. Effect of Use of a Bougie vs Endotracheal Tube and Stylet on First-Attempt Intubation Success Among Patients With Difficult Airways Undergoing Emergency Intubation: A Randomized Clinical Trial. JAMA. 2018;319(21):2179–2189. doi:10.1001/jama.2018.6496 ‌Turner JS, Bucca AW, Propst SL, et al. Association of Checklist Use in Endotracheal Intubation With Clinically Important Outcomes: A Systematic Review and Meta-analysis. JAMA Netw Open. 2020;3(7):e209278. doi:10.1001/jamanetworkopen.2020.9278 Turner, Joseph S et al. "Feasibility of  upright patient positioning and intubation success rates At two academic EDs." The American journal of emergency medicine vol. 35,7 (2017): 986-992. doi:10.1016/j.ajem.2017.02.011   Summarized by Sam Pahl | Edited by Sam Pahl & Ahmed Abdel-Hafiz, NREMT-P   Donate: https://emergencymedicalminute.org/donate/   Join our mailing list: http://eepurl.com/c9ouHf  

World-leading behaviour change expert Katy Milkman details how to change your habits.  --- Become an FSB member: https://get.fsb.org.uk/nudge/ Unlock the Nudge Vaults: https://www.nudgepodcast.com/vaults Katy's book: https://amzn.to/3RF63xA  Katy's podcast: https://www.schwab.com/learn/choiceology  Katy's newsletter: https://www.katymilkman.com/newsletter-milkman-delivers  Subscribe to my newsletter: https://www.nudgepodcast.com/mailing-list  Connect on LinkedIn: https://www.linkedin.com/in/phill-agnew/  --- Today's sources: Beshears, J.Beshears, J., Dai, H., Milkman, K. L., & Benartzi, S. (2021). Using fresh starts to nudge increased retirement savings. Organizational Behavior and Human Decision Processes, 167, 72–87. Dai, H., Milkman, K. L., & Riis, J. (2014). The fresh start effect: Temporal landmarks motivate aspirational behavior. Management Science, 60(10), 2563–2582. Eskreis-Winkler, L., Fishbach, A., & Duckworth, A. L. (2018). Dear Abby: Should I give advice or receive it? Psychological Science, 29(11), 1797–1806. Eskreis-Winkler, L., Milkman, K. L., Gromet, D. M., & Duckworth, A. L. (2019). A large-scale field experiment shows giving advice improves academic outcomes for the advisor. Proceedings of the National Academy of Sciences, 116(30), 14808–14810. Schroeder, S. A. (2007). We can do better — Improving the health of the American people. New England Journal of Medicine, 357(12), 1221–1228.

Your body has been talking to you your whole life. The question is whether anyone ever taught you to listen. In this episode, I want to widen the lens on how you read your own body. We have lost so much of the generational knowledge our mothers and grandmothers once passed down, and now we tend to wait until something hurts before we pay attention. But your body speaks in subtleties long before that. I share one of my great loves, Ayurveda, the 5,000-year-old healing system I studied for three years, and its practice of observation called the eightfold examination. What fascinates me most is how closely it aligns with modern functional nutrition's Nutrition Focused Physical Exam. We walk through what your tongue, skin, hair, nails, and eyes may be reflecting about your gut health, your nutrient status, your oxidative stress, and even your blood sugar, backed by research going back nearly 80 years. Here is what matters most. This is not about self-diagnosis. None of these signs are proof of anything on their own. They are invitations to pay attention, not verdicts to fear. My hope is that noticing your body builds confidence instead of anxiety, the quiet confidence of a woman in a loving conversation with her body rather than at war with it. If you take one small thing from this episode, try this. Tomorrow morning, look at your tongue and just notice. Do it for a week. That is the practice.   Resources Mentioned: Work with Laura: https://www.thebreastcancerrecoverycoach.com/health  Download for iPhone:  https://apps.apple.com/us/app/kajabi/id1485646310 Download for Android:  https://play.google.com/store/apps/details?id=kajabi.kajabiapp&hl=en_US Here is the link to the FREE Ayurveda Mini-Course that I talked about in this episode: https://www.thebreastcancerrecoverycoach.com/mybody   Here are the references: Foundational Asif T, Mohiuddin A, Hasan B, Pauly RR. Importance of Thorough Physical Examination: A Lost Art. Cureus. 2017;9(5):e1212. Newton C. The Functional Nutrition-Focused Physical Exam. IFNA Track 3 Module 2. Tongue Jeghers H. Nutrition: the appearance of the tongue as an index of nutritional deficiency. New England Journal of Medicine. 1942;227:221-8. Khayamzadeh M, Najafi S, Sadrolodabaei P, Vakili F, Kharrazi Fard MJ. Determining salivary and serum levels of iron, zinc and vitamin B12 in patients with geographic tongue. J Dent Res Dent Clin Dent Prospects. 2019;13(3):221-226. Chiang CP, Chang JY, Wang YP, Wu YH, Wu YC, Sun A. Atrophic glossitis: Etiology, serum autoantibodies, anemia, hematinic deficiencies, hyperhomocysteinemia, and management. J Formos Med Assoc. 2020;119(4):774-780. Skin Salem I, Ramser A, Isham N, Ghannoum MA. The Gut Microbiome as a Major Regulator of the Gut-Skin Axis. Front Microbiol. 2018;9:1459. Wang X, Li Y, Wu L, et al. Dysregulation of the gut-brain-skin axis and key overlapping inflammatory and immune mechanisms of psoriasis and depression. Biomed Pharmacother. 2021;137:111065. Jafferany M, Franca K. Psychodermatology: Basics Concepts. Acta Derm Venereol. 2016;96(217):35-7. Reunala T, Salmi TT, Hervonen K, Kaukinen K, Collin P. Dermatitis Herpetiformis: A Common Extraintestinal Manifestation of Coeliac Disease. Nutrients. 2018;10(5):602. Stefanadi EC, Dimitrakakis G, Antoniou CK, et al. Metabolic syndrome and the skin: a more than superficial association. Diabetol Metab Syndr. 2018;10:9. Hair O'Connor K, Goldberg LJ. Nutrition and hair. Clin Dermatol. 2021;39(5):809-818. Arck PC, Overall R, Spatz K, et al. Towards a "free radical theory of graying": melanocyte apoptosis in the aging human hair follicle is an indicator of oxidative stress induced tissue damage. FASEB J. 2006;20(9):1567-9. Zhang B, Ma S, Rachmin I, et al. Hyperactivation of sympathetic nerves drives depletion of melanocyte stem cells. Nature. 2020;577(7792):676-681. Poonia K, Bhalla M. Premature Graying of Hair: A Comprehensive Review and Recent Insights. Indian Dermatol Online J. 2024;15(5):721-731. Nails Singal A, Arora R. Nail as a window of systemic diseases. Indian Dermatol Online J. 2015;6(2):67-74. Cashman MW, Sloan SB. Nutrition and nail disease. Clin Dermatol. 2010;28(4):420-5. Eyes Knapp A. The Eye as a Guide to Latent Nutritional Deficiency Diseases. Bull N Y Acad Med. 1946. Wakamatsu TH, Dogru M, Tsubota K. Tearful relations: oxidative stress, inflammation and eye diseases. Arq Bras Oftalmol. 2008;71(6 Suppl):72-9. Seydou A, Arnould L, Gabrielle PH, et al. Plasma Fatty Acids Pattern and Dry Eye Disease in the Elderly: The Montrachet Population-Based Study. Nutrients. 2022;14(11):2290. Bu Y, Shih KC, Tong L. The ocular surface and diabetes, the other 21st Century epidemic. Exp Eye Res. 2022;220:109099. Rahman A, Yahya K, Ahmed T, Sharif-Ul-Hasan K. Diagnostic value of tear films tests in type 2 diabetes. J Pak Med Assoc. 2007;57(12):577-81. Seifart U, Strempel I. Trockenes Auge und Diabetes mellitus [The dry eye and diabetes mellitus]. Ophthalmologe. 1994;91(2):235-9. Campagnoli LIM, Varesi A, Barbieri A, Marchesi N, Pascale A. Targeting the Gut-Eye Axis: An Emerging Strategy to Face Ocular Diseases. Int J Mol Sci. 2023;24(17):13338. Let's Connect! If this episode helped you breathe a little easier, please share it with a friend or leave a review. Every share helps spread this message of hope, healing, and whole-person wellness.

────────────────────────────────────────[00:02:09]Trump Unilaterally Rewrites the MOU — Demands Iran Spend Frozen Funds Only on US Farm GoodsPoint 11 of the signed MOU says funds are released without conditions; Trump invented the escrow-for-American-corn clause after Kushner pressed him.────────────────────────────────────────[00:05:00]Senate Votes to Halt the Iran War — Resolution Has No Force of Law, White House Dismisses ItPassed 50-48; does not go to the president for signature or veto; four Republicans broke ranks including Rand Paul and Bill Cassidy.────────────────────────────────────────[00:10:18]Ben Gvir: All of Lebanon Must Be Our Playground — For Every Israeli Tear, a Thousand Lebanese Must WeepIsraeli finance minister refuses any restriction on Lebanese territory and demands it all burn; Netanyahu confirmed forces are not leaving.────────────────────────────────────────[00:46:01]Rand Paul's Wife Bought Gilead Stock During Remdesivir Push — Knight Says He Has No Credibility on FauciFauci declared remdesivir standard of care one day after a WHO trial showed it ineffective; Paul's wife held Gilead shares throughout.────────────────────────────────────────[00:47:41]Trump Orders Ford and GM to Make Bombs Instead of Cars — Same Defense Production Act Used for VentilatorsKnight: they don't want people to have independent transportation; commandeering auto production is the same playbook used in 2020.────────────────────────────────────────[00:56:37]VA Study Claims COVID Vaccine Lowers Cardiac Risk — Knight: They Caused the Heart Disease and Now Claim the CureSeven children confirmed dead from the jabs per FDA data; New England Journal of Medicine ex-editor said the journal lost all credibility.────────────────────────────────────────[01:29:16]Tulsi Gabbard's Entire Career Was Guided by a Hare Krishna Cult Leader Named Chris ButlerYear-long Washington Post investigation; former cult members handed over internal records showing Butler shaped her public decisions.────────────────────────────────────────[01:43:44]Ben Gvir Repeats: All of Lebanon Must Burn — No Distinction Between Hezbollah and Lebanese CiviliansSame doctrine applied in Gaza; Knesset member adds they want to drag Hamas leaders across Gaza in front of cameras before prison.────────────────────────────────────────[01:47:00]Jared Kushner Invented the Escrow-for-Farm-Goods Clause — JD Vance Selling It as a Trump DealMOU says nothing about escrow or American goods; Kushner and Qataris fabricated it after signing; Vance repeating the lie publicly.────────────────────────────────────────[01:51:28]Zionist Lobbyist Brags About Sanctioning UN Rapporteur Albanese, Freezing Her Bank Accounts, Demoting Her HusbandAfter boasting of controlling Albanese's finances and barring her from the US, lobbyist Hillel Neuer insists the Jewish lobby does not control America. ──────────────────────────────────────── Money should have intrinsic value AND transactional privacy: Go to https://davidknight.gold/ for great deals on physical gold/silver For 10% off Gerald Celente's prescient Trends Journal, go to https://trendsjournal.com/ and enter the code “KNIGHT” For high quality made in America products go to HomeSteadProducts.shop and use promo code “Knight” for 10% off your purchases Find out more about the show and where you can watch it at TheDavidKnightShow.com If you would like to support the show and our family please consider subscribing monthly here: SubscribeStar https://www.subscribestar.com/the-david-knight-show Or you can send a donation throughMail: David Knight POB 994 Kodak, TN 37764Zelle: @DavidKnightShow@protonmail.comCash App at: $davidknightshowBTC to: bc1qkuec29hkuye4xse9unh7nptvu3y9qmv24vanh7Become a supporter of this podcast: https://www.spreaker.com/podcast/the-david-knight-show--2653468/support.

────────────────────────────────────────[00:02:09]Trump Unilaterally Rewrites the MOU — Demands Iran Spend Frozen Funds Only on US Farm GoodsPoint 11 of the signed MOU says funds are released without conditions; Trump invented the escrow-for-American-corn clause after Kushner pressed him.────────────────────────────────────────[00:05:00]Senate Votes to Halt the Iran War — Resolution Has No Force of Law, White House Dismisses ItPassed 50-48; does not go to the president for signature or veto; four Republicans broke ranks including Rand Paul and Bill Cassidy.────────────────────────────────────────[00:10:18]Ben Gvir: All of Lebanon Must Be Our Playground — For Every Israeli Tear, a Thousand Lebanese Must WeepIsraeli finance minister refuses any restriction on Lebanese territory and demands it all burn; Netanyahu confirmed forces are not leaving.────────────────────────────────────────[00:46:01]Rand Paul's Wife Bought Gilead Stock During Remdesivir Push — Knight Says He Has No Credibility on FauciFauci declared remdesivir standard of care one day after a WHO trial showed it ineffective; Paul's wife held Gilead shares throughout.────────────────────────────────────────[00:47:41]Trump Orders Ford and GM to Make Bombs Instead of Cars — Same Defense Production Act Used for VentilatorsKnight: they don't want people to have independent transportation; commandeering auto production is the same playbook used in 2020.────────────────────────────────────────[00:56:37]VA Study Claims COVID Vaccine Lowers Cardiac Risk — Knight: They Caused the Heart Disease and Now Claim the CureSeven children confirmed dead from the jabs per FDA data; New England Journal of Medicine ex-editor said the journal lost all credibility.────────────────────────────────────────[01:29:16]Tulsi Gabbard's Entire Career Was Guided by a Hare Krishna Cult Leader Named Chris ButlerYear-long Washington Post investigation; former cult members handed over internal records showing Butler shaped her public decisions.────────────────────────────────────────[01:43:44]Ben Gvir Repeats: All of Lebanon Must Burn — No Distinction Between Hezbollah and Lebanese CiviliansSame doctrine applied in Gaza; Knesset member adds they want to drag Hamas leaders across Gaza in front of cameras before prison.────────────────────────────────────────[01:47:00]Jared Kushner Invented the Escrow-for-Farm-Goods Clause — JD Vance Selling It as a Trump DealMOU says nothing about escrow or American goods; Kushner and Qataris fabricated it after signing; Vance repeating the lie publicly.────────────────────────────────────────[01:51:28]Zionist Lobbyist Brags About Sanctioning UN Rapporteur Albanese, Freezing Her Bank Accounts, Demoting Her HusbandAfter boasting of controlling Albanese's finances and barring her from the US, lobbyist Hillel Neuer insists the Jewish lobby does not control America. ──────────────────────────────────────── Money should have intrinsic value AND transactional privacy: Go to https://davidknight.gold/ for great deals on physical gold/silver For 10% off Gerald Celente's prescient Trends Journal, go to https://trendsjournal.com/ and enter the code “KNIGHT” For high quality made in America products go to HomeSteadProducts.shop and use promo code “Knight” for 10% off your purchases Find out more about the show and where you can watch it at TheDavidKnightShow.com If you would like to support the show and our family please consider subscribing monthly here: SubscribeStar https://www.subscribestar.com/the-david-knight-show Or you can send a donation throughMail: David Knight POB 994 Kodak, TN 37764Zelle: @DavidKnightShow@protonmail.comCash App at: $davidknightshowBTC to: bc1qkuec29hkuye4xse9unh7nptvu3y9qmv24vanh7Become a supporter of this podcast: https://www.spreaker.com/podcast/the-real-david-knight-show--5282736/support.

Bio: Sean Duffy is the Co-founder and CEO of Omada Health, a between-visit care provider that addresses cardiometabolic conditions like diabetes, hypertension, prediabetes, and obesity, as well as musculoskeletal issues. He has dedicated his professional life to bridging technology, design, and care delivery to transform care experiences for patients. As a former MD/MBA candidate at Harvard, he also holds a BS in neuroscience from Columbia University. He has written extensively about digital health and the future of healthcare in The New England Journal of Medicine, The Wall Street Journal, Forbes, and TechCrunch, among other publications. Prior to Omada, Sean worked at both Google and IDEO.Company: Omada Health (Nasdaq: OMDA) is reverse engineering the way healthcare is delivered in America, putting the space between doctor visits–where health is won or lost–at the center of care. Today's healthcare system poorly serves chronic conditions that require ongoing support outside of the exam room, like obesity, diabetes, hypertension, cholesterol, and musculoskeletal conditions. Omada's virtual-first model combines human-led care teams, connected devices, and AI-enabled technology to deliver personalized care at scale, including support for GLP-1 therapy. Omada has served more than two million members since launch across 2,000+ employers, health plans, pharmacy benefit managers, and health systems. Learn more at omadahealth.com.

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

In today's episode, Dr. Lisa Oldson breaks down the science of microplastics and endocrine-disrupting chemicals, and why they may be quietly working against your weight loss efforts. From a landmark New England Journal of Medicine study linking microplastics in arterial plaque to a 4.5x higher risk of heart attack and stroke, to the growing evidence that BPA and phthalates disrupt fat cell formation, hormones, and gut health, Dr. Oldson explains what the research actually shows, and offers five practical, evidence-informed steps you can take starting today.Thanks for listening! If you'd like more support during your SMART weight loss & health focused journey, sign up for our FREE newsletter, or check out our program at: www.SmartWeightLossCoaching.com. We would love to help you reach your happy weight, and transform the way you talk to yourself about your body and the number on the scale. Negative thoughts about yourself don't have to take up so much brain space, and we'd be honored to help you reframe those thoughts. Also, we'd be grateful if you'd follow us and share our podcast with your friends & family. We're here to help you live longer, healthier, and lose weight the SMART way! This episode was produced by The Podcast Teacher: www.ThePodcastTeacher.com.The Smart Weight Loss Coaching Podcast is for informational purposes only and does not constitute medical advice. Always consult your physician or a qualified healthcare provider before starting, stopping, or changing any medication.

Doctor Mau Informa ®️ #drmauinforma Durante medio siglo, la endocrinología consideró al glucagón como el "villano" del metabolismo: la hormona responsable de subir el azúcar en la sangre. Sin embargo, ¿qué pasaría si pudiéramos domesticar a este villano para activar la quema extrema de grasa de forma segura. En este episodio de Doctor Mau Informa, analizamos la fascinante evolución científica que nos llevó desde tumores pancreáticos hasta el desarrollo del Retatrutide, un revolucionario fármaco "triple agonista". Descubre cómo la ciencia logró combinar tres señales hormonales (Glucagón, GLP-1 y GIP) en una sola inyección semanal para alcanzar resultados de pérdida de peso metabólica que antes solo le pertenecían al bisturí de la cirugía bariátrica. En este episodio aprenderás: → La balanza de la pérdida de peso: Por qué los medicamentos anteriores solo te quitaban el hambre, y cómo la nueva generación también acelera tu gasto energético. → El secreto del Glucagón: Cómo esta hormona del ayuno saca la grasa del hígado y eleva el metabolismo. → La evolución del GLP-1: El papel protector de la insulina natural para contrarrestar el azúcar y permitir una pérdida de peso segura. → Cirugía vs. Fármacos: Por qué los resultados de los nuevos tratamientos crónicos están cambiando el paradigma médico para siempre. → La realidad clínica: Efectos secundarios, la importancia de la titulación médica y por qué esto no es una "dieta milagro".

Send us Fan MailHormone therapy is used across a wide range of clinical settings—from contraception and menopause management to pregnancy care and gender-affirming therapy. But how do these treatments influence thrombosis risk, and how should clinicians approach these decisions in practice?In this episode of CLOT Conversations, hosts Dr. Jameel Abdulrehman and Dr. Maha Othman speak with Dr. Leslie Skeith and Dr. Shannon Bates about their recent New England Journal of Medicine review on sex hormone influences on venous thrombotic and cardiovascular risk.The discussion explores the thrombotic effects of estrogen, progestogens, and testosterone; differences between hormone formulations; management considerations for patients with prior thrombosis; gender-affirming hormone therapy; and practical approaches to perioperative care.Whether you care for patients receiving contraception, hormone replacement therapy, or gender-affirming care, this episode provides evidence-based guidance to support informed clinical decision-making.For the full publication: https://www.nejm.org/doi/abs/10.1056/NEJMra2202438Support the showhttps://thrombosiscanada.caRegister today for our upcoming conference on November 7, 2026 in Montreal at https://thrombosiscanada.ca/2026ConferenceTake a look at our healthcare professional and patient resources, videos and publications on thrombosis from the expert members of Thrombosis Canada

Many mothers go to the doctor because they feel exhausted, overwhelmed, and they aren't sleeping - and leave with a depression diagnosis and a prescription. The message is: your brain isn't working right, and medication will help you cope. But what if the problem isn't your brain at all? In this episode, I talk with journalist Bob Whitaker, who has spent decades investigating psychiatric treatment in the U.S. We look at how women's distress has been medicalized instead of taken seriously as a response to impossible circumstances. We look at how antidepressants work, which is quite different from what the drug companies have been telling us for years.  He also shares the results of a New Zealand study on postpartum depression that should have changed how we support new mothers - but didn't. Questions this episode will answer Is it burnout or depression? Burnout and depression share a lot of the same symptoms - exhaustion, low mood, difficulty functioning - but they have different roots. Burnout is a response to sustained, unmanageable circumstances. Depression, as it's currently diagnosed and treated, is framed as a brain malfunction. This episode looks at why this difference matters, and why so many mothers get a depression diagnosis when they're experiencing burnout. Why are mothers more likely to be diagnosed with depression? Mothers in the US are frequently carrying an unequal share of household work, childcare, and mental load - often while also working full time - with little support. When that situation becomes unsustainable, the distress it causes is then treated as an individual brain problem rather than a response to a broken system. What prevents postpartum depression? A study out of New Zealand found that consistent, practical support - help with the actual work of running a household - significantly reduced postpartum depression. But even though the findings were significant, more support has not become the standard of care. Should I take antidepressants? Antidepressants may reduce symptoms for some people, but research shows they are far less effective than we've been told - and for mothers whose distress is rooted in unsustainable circumstances, medication addresses the symptom rather than the source. If antidepressants are helping you, that's OK (and do keep taking them!). But antidepressants should be used to help create space for other interventions to work, rather than used long-term. How does society affect women's mental health? When we treat women's distress as a potentially life-long medical problem rather than a signal about unsustainable circumstances, we direct attention away from the structural changes that would actually help. This episode traces how that pattern developed - and what a different approach might look like. What you'll learn in this episode Why the mental load of motherhood is a structural problem, not a brain problem that medication should fixHow psychiatry functions as social control when it diagnoses individuals instead of the broken systems they're living inWhat the New Zealand postpartum depression study found - and why its results were largely ignoredHow drug advertising has shaped what we believe about women's distress - from Valium in the 1960s to antidepressants todayHow to shift from asking "what's wrong with my brain" to "what would actually need to change in my situation" If you want to learn more about Bob's work and the research on depression and antidepressants, go to https://madinamerica.com/. Want to go deeper? The full one-hour conversation with Bob is available to Parenting Membership members. In it, Bob traces exactly how depression came to be understood as a chemical imbalance - not because research proved it, but because psychiatry in the U.S. wanted to rebrand itself as a legitimate medical discipline in the 1980s.  He walks us through how pharmaceutical companies funneled money to academic psychiatrists to become "thought leaders," how Prozac was marketed as making people "feel better than well," and how the industry captured the entire profession so thoroughly that by 1998, the New England Journal of Medicine couldn't find a single academic expert on depression in the US who wasn't taking money from pharmaceutical companies. We went deep on the STAR*D trial - the largest antidepressant study ever conducted. The public was told 70% of patients got better. The actual stay-well rate at one year, once a researcher used a Freedom of Information request to get the raw data: 3%. Bob walks through exactly how that number was inflated - the protocol violations, the patients who were already in remission when they enrolled, the switched measurement scales - and why he calls it a straight-out public betrayal. The whole episode is available to you in your private podcast feed immediately after joining the Parenting Membership.  Inside the membership, you'll find research-based modules on the specific challenges that make family life hard - from navigating parenting as a team to raising siblings who get along. Monthly group coaching calls give you a chance to talk through your specific situation directly with me. And you'll find a community of parents who share your values and are working through parenting challenges together, and with my support. If you've been told the problem is your brain, and something in this episode made you wonder whether that's the whole story - the membership is where you get help to figure out what's right for you and your family. Click the banner to learn more Jump to highlights: 01:50 Introduction to today's episode and guest 05:04 Just remember what the disease model does. It focuses on the problems in the head of the individual, not in the social way we arrange our society. 06:25 From hysteria and electroshock therapy (mostly given to women) in the 1800s, to marketing benzodiazepines to wives in the 1960s, the pattern of pathologizing women's distress has been consistent. 08:32 When benzodiazepines were recognized as addictive in the late 1970s, psychiatry reframed anxiety as a type of depression and switched women to antidepressants, another numbing drug that keeps women quiet and functioning in an impossible situation. 13:31 In the New Zealand study, it says that when women got daily help with housework for six months, postpartum depression was prevented. Yet this support became standard care nowhere, because the system still believes the problem is in people's brains, not in their circumstances. 14:17 Wrapping up today's topic

Myoscience GlyNAC (20% off, exclusive to this community): https://bit.ly/4auv3xW  Pre-order Keto Flex Revised and get free bonuses at: https://bit.ly/4wKG1sM    A 2026 randomized controlled trial called the PERTH trial found that people reduced plastic-related chemicals in their bodies by up to 60% in just seven days by swapping their food, kitchenware, and personal care products. The research behind this is not fringe. A study in the New England Journal of Medicine found microplastics embedded in arterial plaque in over half of 257 surgical patients. Those patients had a 4.5 times higher risk of heart attack, stroke, or death. A 2025 Nature Medicine study found the average human brain now holds roughly a spoonful of microplastic particles, up 50% in just eight years. In dementia brains, the concentration was ten times higher. In this episode, Ben walks through exactly where exposure comes from, what these plastics are doing to your hormones, your metabolism, your inflammation, and your brain, and the simple five-step protocol you can start today. Key takeaways: A single liter of bottled water contains around 240,000 microplastic particles on average One plastic teabag releases 11.6 billion plastic particles into a single cup of hot water BPA mimics estrogen at receptor sites, disrupting testosterone in men and fertility in women Your body stores these chemicals in fat cells through a pathway called PPAR gamma, creating new fat cells if it runs out of room Glutathione is the master molecule your liver uses to neutralize and eliminate these toxins, and modern life depletes it constantly NAC supplies the cysteine your liver needs to produce glutathione internally The five-step protocol: stop heating plastic, filter your water, eat real food, sweat daily, prioritize fiber and hydration Find All The Ben Azadi Show Sponsorship Deals ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.ketokamp.com/sponsorship-deals Learn more about your ad choices. Visit megaphone.fm/adchoices

Scroll down for a transcription of this episode.Intention to Treat: The Race Equation is a new series from the New England Journal of Medicine, investigates how race-specific diagnostic tools harm Black patients and contribute to growing health inequities.Transcription: https://tinyurl.com/36bne7hd

A University of Kentucky epidemiologist convinced 678 Catholic nuns to donate their brains and their entire life records to science, and the autopsies he performed quietly rewrote everything modern medicine thought it knew about Alzheimer’s disease. The findings have been published in JAMA and the New England Journal of Medicine. Almost nobody outside the field… Continue reading The Power of Gratitude

A 25-year-old pregnant woman presents with a 1-day history of progressive pain and swelling. The foot is cold, pulseless and neurologic function is deteriorating by the hour. Imaging shows a massive iliofemoral DVT. Now both the limb and the pregnancy are threatened. Do you anticoagulate, thrombolyse or operate? Join us as we break down the management and decision making behind this rare but devastating case.Hosts:·      Christian Hadeed -PGY 4 General Surgery, Brookdale Hospital Medical Center·      Paul Haser -Division Chief, Vascular Surgery, Brookdale Hospital Medical Center·      Andrew Harrington, Vascular surgery, Brookdale Hospital Medical Center·      Lucio Flores, Vascular surgery, Brookdale Hospital Medical CenterLearning objectives:-       Recognize the clinical presentation and pathophysiology of phlegmasia cerulea dolens-       Describe how pregnancy affects decision making in patients with phlegmasia and venous thromboembolic disease-       Discuss the goals of treatment for patients with DVT's and identify when operative intervention is indicated-       Describe the sequelae of DVT's and how this relates to post thrombotic syndrome-       Review the indications, risks, and limitations of anticoagulation, catheter-directed thrombolysis, thrombectomy, and fasciotomy in the management of DVT and phlegmasia.-       Explain the role of IVUS in managing venous thromboembolic disease and May Thurner syndromeReferences:-       Vedantham, S., Goldhaber, S. Z., Julian, J. A., Kahn, S. R., Jaff, M. R., Cohen, D. J., Magnuson, E., Razavi, M. K., Comerota, A. J., Gornik, H. L., Murphy, T. P., Lewis, L., Duncan, J. R., Nieters, P., Derfler, M. C., Filion, M., Gu, C.-S., Kee, S., Schneider, J., … Kearon, C. (2017). Pharmacomechanical catheter-directed thrombolysis for deep-vein thrombosis. New England Journal of Medicine, 377(23), 2240–2252. https://doi.org/10.1056/NEJMoa1615066-       Gomes, M. S., Guimarães, M., & Montenegro, N. (2019). Thrombolysis in pregnancy: A literature review. Journal of Maternal-Fetal & Neonatal Medicine, 32(14), 2418–2428. https://doi.org/10.1080/14767058.2018.1438402-       Mangla, A., & Hamad, H. (2023). May-Thurner syndrome. In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK554377/-       Bates, S. M., Rajasekhar, A., Middeldorp, S., McLintock, C., Rodger, M. A., James, A. H., et al. (2018). American Society of Hematology 2018 guidelines for management of venous thromboembolism: Venous thromboembolism in the context of pregnancy. Blood Advances, 2(22), 3317–3359. https://doi.org/10.1182/bloodadvances.2018024802-       Kahn, S. R., Comerota, A. J., Cushman, M., Evans, N. S., Ginsberg, J. S., Goldenberg, N. A., et al. (2014). The postthrombotic syndrome: Evidence-based prevention, diagnosis, and treatment strategies. Circulation, 130(18), 1636–1661. https://doi.org/10.1161/CIR.0000000000000130 https://pubmed.ncbi.nlm.nih.gov/25246013/Sponsor URL: https://www.goremedical.com/If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listenBehind the Knife Premium: https://behindtheknife.org/premiumOral Board Review: https://behindtheknife.org/oral-boardOral Board Simulator: https://behindtheknife.org/oral-board/simulatorGeneral Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-reviewTrauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlasDominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkshipDominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotationVascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-reviewColorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-reviewSurgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-reviewCardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-reviewDownload our App:Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

Microplastics and Stroke Risk: What a Landmark 2024 Study Found Inside Human Arteries In 2024, a team of Italian researchers published a study in the New England Journal of Medicine that stopped the cardiovascular science community in its tracks. They found microplastics, tiny synthetic fragments embedded inside the carotid artery plaque of more than half the patients they examined. And the patients who had them faced more than four and a half times the risk of a serious cardiovascular event compared to those who didn’t. This isn’t a distant, theoretical risk. These are living people who had already been identified as having carotid artery disease, and plastics were found inside their arterial walls. For stroke survivors and those at elevated risk of stroke, this study raises important questions that the medical system has not yet caught up with. What the Research Found The study by Marfella et al., published in the New England Journal of Medicine (2024), enrolled 304 patients who were undergoing carotid endarterectomy, a surgical procedure to remove plaque from the carotid arteries. Researchers analysed the excised plaque for the presence of microplastics and nanoplastics. Their findings: 58% of patients had detectable levels of polyethylene, polyvinyl chloride (PVC), or polystyrene in their arterial plaque. This was not contamination from the surgical procedure; it was already there. Over a 34-month follow-up period, patients with microplastics in their plaque had a 4.53 times higher risk of a combined endpoint: non-fatal myocardial infarction, non-fatal stroke, or death from any cause. Inflammatory markers were significantly elevated in the microplastics-positive group. IL-18 and TNF-alpha proteins associated with systemic vascular inflammation were markedly higher in plaque samples that contained plastics. This suggests the mechanism is not simply physical obstruction, but an inflammatory cascade triggered by the presence of synthetic material in arterial tissue. What This Means for Stroke Survivors The carotid arteries are the primary conduits supplying oxygenated blood to the brain. Plaque accumulation in these vessels is one of the leading causes of ischaemic stroke, and carotid artery disease is a condition many stroke survivors are already living with. “The patients with microplastics in their plaque had a 4.53 times higher risk of stroke, heart attack, or death over the 34-month follow-up. That’s not a marginal finding. That’s a signal the research community needed to take seriously.” The NEJM study doesn’t yet tell us whether removing microplastic exposure after the fact reduces risk. It doesn’t confirm that healthy individuals with no existing carotid disease are accumulating plastics at the same rate. And it cannot tell us which plastic sources are most responsible because we’re exposed to microplastics through drinking water, food packaging, air, and a dozen other vectors simultaneously. But what it does tell us clearly and with high statistical significance is that microplastics in arterial plaque are associated with dramatically worse cardiovascular outcomes. What the Research Does Not Yet Tell Us Science at the frontier moves in one direction at a time. This study establishes association, not causation. It cannot yet answer: Whether people without existing carotid disease are accumulating microplastics at comparable rates. Whether reducing exposure actively reverses or slows plaque-associated risk. Which types of microplastics are most biologically harmful? Whether there will be a clinical screening tool for this in the near future. These are the questions the next generation of research will need to answer. In the meantime, it’s reasonable to act on what we do know. Practical Steps to Reduce Exposure No clinical screening currently exists for microplastics in arterial plaque. There is no blood test, no imaging, no biomarker that your GP can order today. What you can do is reduce your ongoing exposure, particularly through food and water contact with plastics. Evidence-informed steps worth discussing with your treating team: Use glass, stainless steel, or ceramic containers rather than plastic for food and drink storage. Avoid microwaving food in plastic containers; heat accelerates the leaching of plastic particles. Filter your drinking water; some filters (carbon block and reverse osmosis) reduce microplastic levels significantly. Reduce consumption of highly processed foods in plastic packaging. Bring this study to your vascular neurologist, cardiologist, or GP and ask whether it’s relevant to your personal risk profile. This is not a recommendation to take a supplement or start a treatment. It’s an invitation to have an informed conversation with the people responsible for your care using the best available evidence. If you found this useful, my book walks through the science of stroke recovery in the same evidence-first, no-hype way. Find it at recoveryafterstroke.com/book. Want to go deeper and support the channel? Join the community at patreon.com/recoveryafterstroke. The post Plastics in Your Arteries: The Stroke Risk Study You Must Know appeared first on Recovery After Stroke.

In this episode, Lyell K. Jones Jr, MD, FAAN, speaks with Cheryl Bushnell, MD, MHS, who served as the guest editor of the June 2026 Cerebrovascular Disease issue. They provide a preview of the issue, which publishes on June 3, 2026. Dr. Jones is the editor-in-chief of Continuum: Lifelong Learning in Neurology® and is a professor of neurology at Mayo Clinic in Rochester, Minnesota. Dr. Bushnell is a Professor of Neurology and Director of the Center for Transformative Stroke Care at Wake Forest University School of Medicine in Winston-Salem, North Carolina. Additional Resources Read the issue: continuum.aan.com Subscribe to Continuum®: shop.lww.com/Continuum Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Host: @LyellJ Guest: @CBushnellMD  Full episode transcript available here Dr Jones: One of the core tenets of our field is that we learn neurology one stroke at a time. But what do we have to learn about preventing them altogether? The science of stroke prevention, acute treatment, and recovery are evolving rapidly, and it's hard to keep up. Today, we're speaking with Dr. Cheryl Bushnell, guest editor of our latest Continuum issue on Cerebrovascular Disease, to discuss these topics and much more.  Dr Jones: This is Dr. Lyell Jones, editor-in-chief of Continuum. Thank you for listening to Continuum Audio. Be sure to visit the links in the episode notes for information about subscribing to the journal, listening to verbatim recordings of the articles, and exclusive access to interviews not featured on the podcast.  Dr Jones: This is Dr. Lyell Jones, editor-in-chief of Continuum: Lifelong Learning in Neurology. Today, I'm interviewing Dr. Cheryl Bushnell, who is Continuum's guest editor for our latest issue on Cerebrovascular Disease. Dr. Bushnell is a professor of neurology and the director of the Center for Transformative Stroke Care at the Wake Forest University School of Medicine in Winston-Salem, North Carolina, where she specializes in the care of stroke patients and their social and functional determinants of recovery and health, and is an internationally recognized expert on those topics. Dr. Bushnell, welcome. Thank you for joining us today. Why don't you introduce yourself to our listeners?  Dr Bushnell: Absolutely. Thank you for the invitation. It's really an honor to be here. So, as you mentioned, I am the director of the Center for Transformative Stroke Care at Wake Forest. It's a really fun transition for me to be involved with different care models for stroke, and I think a lot of the Continuum topics are directly relevant to some of the things that I'm doing now as an administrator and sort of a facilitator of new research. So, thanks again for having me.  Dr Jones: Yeah, and, and you have a wonderful perspective, and we're gonna pull that out today in our interview questions, and I'm looking forward to sharing that with our listeners. But before we get to the questions, we're gonna start off today's podcast with another Continuum Audio trivia question for our listeners. Anticoagulation has played a critical role in secondary ischemic stroke prevention for a long time now. While direct oral anticoagulants have taken on a greater role in the treatment of prevention of stroke, there are still some use cases for vitamin K antagonists like warfarin. The trivia question for our listeners is this: How was warfarin discovered, and how did it get its name? Stick around and we'll share the answer to that question toward the end of our interview today. So, Dr. Bushnell, let's get right to it. You alluded to your various roles, and your leadership in the field has been exemplary. The interventions for acute ischemic stroke have really exploded over the last decade or so, and they get a lot of attention and discussion, but prevention and recovery are just as important in the care of these patients. Tell us a little more about how you approached this issue, about the article topics you chose, etc.  Dr Bushnell: Well, once I was chosen to lead the guest editorship, I wanted to come up with a group of topics that were maybe a little bit different from previous issues. So, I kind of looked at the previous issues and saw, as you said, an emphasis on acute stroke, and that's really important because it has been evolving. But my thought was, how about what happens to patients after they get the intervention and they're discharged home? And because a lot of trainees may not get to see these patients ever again, or it's months before they might see them, or if they're readmitted, which is what we don't want to see, but that certainly is a lot of the exposure is in the inpatient setting. So, I thought I would kind of transport the education into the outpatient and transitional setting, as well as prevention, not only secondary, but primary prevention, with an emphasis on brain health. Some of the populations that may not get as much attention. So, sex differences, stroke in women, pregnancy, the transitions of care, and also the emphasis on holistic view of patients and their challenges, which includes the non-medical factors that drive health, otherwise known as social determinants of health.  Dr Jones: I appreciate that perspective, and obviously th-this is an area of your deep expertise, and it's great to have an issue that really digs into some of those topics a little more deeply. As an educator, I'm really glad you mentioned that about the trainee's perspective. You know, especially junior neurology trainees that are in the hospital all the time. They're seeing patients in the middle of a cerebrovascular catastrophe. But there's a long tail of recovery, right? And they'll get to see that in continuity clinic, but it's a good message to share from an evidence and, um, experiential perspective in the issue. So, appreciate that perspective. You've just read all these articles and edited them. Was there anything that you ran across that was a surprise to you?  Dr Bushnell: Well, I personally chose a lot of the authors based on my knowledge of their work. So, I wouldn't say that it was completely surprising, but I do think that I was just genuinely impressed with the quality of the writing and the synthesis of information. I just was incredibly proud of the work that these co-authors have put together. I'd say that that was-- it wasn't surprising so much as just a sense of pride that I had with the product that's coming out. But of course, there have been some new trials that had to be incorporated at the last minute, some of which were presented at the International Stroke Conference just a few weeks ago.  Dr Jones: Yeah. We try to be as up-to-date as we can, and I will completely agree with you. We have some really good writers in our field, and it's really just a pleasure when you read an article that's by an expert, and it's a joy to read. I can tell you it's one of the best parts of this job, and you get to learn a lot. I think one of the more challenging scenarios that I hear about from colleagues in recent years has been optimal management of patients with asymptomatic extracranial atherosclerosis. The pivotal trials that inform how we manage those patients were from a long time ago, decades ago, predating a lot of the more intensive medical management tools that we have today. In that scenario, Dr. Bushnell, what's the latest on that, and what should our listeners know?  Dr Bushnell: Well, obviously, the CREST 2 trial has been long awaited. It's been going on for over ten years, I believe. Of course, it's, uh, two different trials all in one, the carotid stenting and angioplasty versus intensive medical management. And of course, each of the carotid vascularization arms of the trial also had intensive medical management. And then the other trial is the carotid endarterectomy as the form of revascularization. And it interestingly did not show any benefit of carotid endarterectomy compared to intensive medical management. But of course, the somewhat surprising result was that carotid angioplasty and stenting truly was superior, although it was a small number of events in the trial overall. But that stenting plus intensive medical management was somewhat better than intensive medical management alone. And I think stenting has come a long way in terms of safety, and so I think that's been part of the evolution of the field. I do wanna say that I'm a huge fan of the intensive medical management, and I think that what the protocol does in terms of blood pressure management, cholesterol management is very much above and beyond what's done in private practice even. And the health coaching for all the other things related to diabetes and weight loss and smoking cessation and physical activity, that is what we need to be doing to actually decrease the risk of stroke, and I think that it's very effective. I can't say enough about the design of the study for that reason, that everyone gets the intensive medical management, and then you just layer on the type of revascularization on top of it. So, I wouldn't have been surprised if this was a completely negative trial overall. They just happened to have some better outcomes in the stenting arm.  Dr Jones: I recall a few years ago when the series of endovascular therapy trials for acute stroke came out, and I think there was a, a period of time where the field had to adapt to that. I wonder what you think about with the CREST 2 findings on stenting. I mean, is that gonna be a big change? Because obviously atherosclerosis is highly prevalent. Is that gonna be a big change? Is the field ready for that? How much adjustment do we have in store?  Dr Bushnell: I'm not sure it's gonna be a really big change. If you read the editorial that accompanied the trial in the New England Journal, just a few patients in either direction would have changed the outcome. I kind of look at it as an absolute difference that's relatively small. So, I'm not sure that it will have a huge impact on the field. I do think that the specialists who insert the stents may have some differences of opinion of who should be stented and who shouldn't. Because I think, you know, all of the specialists who do procedures were involved with the trial. But I would say there's a larger percentage of vascular surgeons who were involved, and so I'd say they may have a change of their practice. And neurologists may not even get involved at all.  Dr Jones: Right.  Dr Bushnell: That was one of the challenges for getting patients in the trial is that, you know, not all of us see the asymptomatic carotid stenosis, that they tend to get referred to vascular surgery. So, I think maybe in a corner of the practices of vascular surgeons is where you might see the differences.  Dr Jones: Your point about the way the trial was designed or the trials were designed, that intensive medical management is really important, and we have huge gaps in that. In our specialty, it's, you know, we have probably an opportunity in primary care even to address that. And that leads me to my next question. You know, given your perspective and your expertise, what do you think is the biggest practice gap in the care of patients with stroke or with cerebrovascular disease of any kind?  Dr Bushnell: I think by far the biggest gap is transitions of care and access to follow-up in a specialty clinic after discharge and continuous secondary prevention. We only call it secondary prevention because it happened to come after a stroke, but I really feel like we should just focus on prevention and call it that. There are a lot of people who are trying to kind of, get us away from primary versus secondary prevention. And, and Mitch Elkind is phenomenal and had a beautiful chapter weaving in prevention and brain health. So, I highly recommend that people, if they don't read any other chapters of the Continuum to read his, because I think that it's getting to your point about where the gaps are, and I think prevention is the biggest one. I think we could do so much more in models of care to ensure that there is a pathway once patients are discharged. We have no quality metrics. We have no measurement of how well people are doing after they're discharged. We have all of these fancy things and sophisticated acute treatments, but all of those are for naught if somebody goes home and they fall and they have a severe head injury or hip fracture because they weren't properly supervised or they didn't have the help that they needed at home. So, you got me on my soapbox here for a second, but that is definitely what I see as the gap.  Dr Jones: That's an important soapbox, an important gap, and obviously, if it was a simple problem, we could solve it. But it's obviously something that education is a valuable tool for that, and that's part of why we are including so much content in this issue of Continuum. So, if we put that aside as a gap that we would love to close, when you look into the near future or distant future, Dr. Bushnell, and what's the next big thing on the horizon? New interventions, new prevention tools, or something else entirely? What do you think?  Dr Bushnell: There are two things that I would mention. One is sort of the new category of anticoagulants, antithrombotics, the factor XIa inhibitors. We had an amazing presentation of the oceanic stroke trial at the International Stroke Conference, and this is probably going to be a game changer for the arsenal of antithrombotic therapies that we can offer to patients that do not have a reason for anticoagulation. So, they, they don't have atrial fibrillation, for example, or something else that requires anticoagulation. And so, the factor XI, asundexian, is the drug that they used in that trial. The safety profile is pretty amazing. There was very little bleeding complications and a great benefit in those patients with some degree of atherosclerosis, but, you know, of course, not enough to require carotid revascularization, but then also, um, small vessel disease and cryptogenic stroke. I think those are the three categories of patients, and that's a lot of the strokes that we see all benefited from this new drug. So, I think that's gonna be exciting. There, of course, it has to go through the FDA approval process, and so it might take a little bit of time before that's on the market, and we don't know how much it's gonna cost, but I think it is a, a major breakthrough. And of course, there are other similar medications in that category that are coming. And then I think the other thing is the emphasis on brain health and lifestyle factors and the things that we can do to prevent stroke and dementia because they are the same, essentially. Those are really important. And when we have someone in the hospital with a stroke or a TIA in particular, it's a great teaching opportunity for those patients to say, "Hey, here's what you can do to protect your brain." These are things that we always tell people to prevent a stroke, but just think about it as protecting your brain and keeping your brain as healthy as possible.  Dr Jones: That's a great message, and one that you get to share with patients directly. You're joining us today for this interview. You're on stroke service, so you're actively involved in caring for patients with stroke. What in your practice is the most rewarding aspect of caring for these patients? What is it that you find most rewarding?  Dr Bushnell: I've been involved in a clinical trial that has focused on managing blood pressure and also coaching and other aspects of stroke recovery. I think that has probably been the most rewarding aspect of my career. Until I was involved with this trial, I didn't necessarily do intensive blood pressure monitoring, but I'm seeing the benefits of having data from home, what those blood pressures are over a span of time. I see the immediate or intermediate effects of the blood pressure medication changes that I've made, and I see how the patients respond. So, I have to say that this is not part of usual practice, but I think it should be. And I think it's been incredible from the perspective of a neurologist who is really intensively trying to make the patients' lives better. And it's not just what I do, it's what the health coaches do as part of this intervention. And again, very similar to intensive medical management. So, I, I feel like I've been living it in a slightly different setting than in the CREST 2 trials. But there are other trials that have used the intensive medical management as approach as well. But I would say that's the most rewarding. I've seen people who've lost weight, who are physically fit, who are able to get off of blood pressure medications practically by the end of six months, and that's amazing. And then they continue doing it because they see the benefits.  Dr Jones: You've had a front row seat to a lot of that. That's really got to feel rewarding.  Dr Bushnell: It is, absolutely.  Dr Jones: You know, when you put it that way, it makes me want to go home and check my blood pressure, which I haven't done in a while. But I think that's a message to all of our listeners that we do have plenty of opportunity for risk factor optimization and following the evidence that has been generated and is being generated. Huge opportunity, not only at the population level, but I think the, um, individual patient level too. Okay, so now we're back to our Continuum Audio trivia question, and I'll repeat it for our listeners. How was warfarin discovered, and how did it get its name? Dr. Bushnell and I were talking about this earlier, so I'll just go ahead and share the answer. So, in the early 20th century in the U.S. Midwest, there were epidemics of a hemorrhagic disease in cattle, of all places, and this was eventually traced to moldy cattle feed that was made from sweet clover. And in 1940, researchers at the University of Wisconsin discovered that the anticoagulant in the sweet clover was a compound that was later synthesized for therapeutic use in 1954 as warfarin. And the name came from, uh, the support for the research. The research support came from the Wisconsin Alumni Research Foundation, or WARF, and the end of the word came from the underlying compound, which was coumarin. So that was a little bit of trivia that I had never heard. It's not in the issue, everyone, so you're getting something extra here on the podcast. But been using the drug forever. It still has its uses, even though it's become less advantageous than some of the newer agents. But-- And of course, Dr. Bushnell already knew that when I brought it up, but I just thought that was an interesting bit of history. Well, Dr. Bushnell, thank you for joining us. Thank you for such a great conversation about the latest in cerebrovascular disease. I learned a lot today. I learned a lot in reading these wonderful articles. I hope our listeners learned a lot today as well. I'm really grateful for your hard work on the issue, which I think will come in handy for junior readers and subscribers, as well as our more experienced neurologists as well. Sometimes it's hard to keep up with a rapidly changing subspecialty of our field. So, thank you for joining us today.  Dr Bushnell: Thank you for having me. It's been my pleasure.  Dr Jones: Again, today we've been speaking with Dr. Cheryl Bushnell, guest editor of Continuum's most recent issue on cerebrovascular disease. Please check it out, and thank you to our listeners for joining today.  Dr Monteith: This is Dr. Teshamae Monteith, Associate Editor of Continuum Audio. If you've enjoyed this episode, you'll love the journal, which is full of in-depth and clinically relevant information important for neurology practitioners. Use the link in the episode notes to learn more and subscribe. Thank you for listening to Continuum Audio.

Dr. Margarita Fedorova discusses the effectiveness of shunting for idiopathic normal pressure hydrocephalus.  Show citation:  Luciano MG, Williams MA, Hamilton MG, et al. A Randomized Trial of Shunting for Idiopathic Normal-Pressure Hydrocephalus. N Engl J Med. 2025;393(22):2198-2209. doi:10.1056/NEJMoa2503109   Show transcript:  Dr. Margarita Fedorova: Welcome to Neurology Minute. My name is Margarita Fedorova and I'm a neurology resident at the Cleveland Clinic. Today we're reviewing a randomized trial that provides high quality evidence for treatment we've been using for decades, shunting for idiopathic normal pressure hydrocephalus. The PENS trial, a placebo controlled effectiveness and iNPH shunting trial was published in the New England Journal of Medicine in December 2025 by Luciano and colleagues. This international multicenter study enrolled 99 patients across the United States candidate in Sweden. While idiopathic normal pressure hydrocephalus or iNPH is characterized by triad of gait impairment, cognitive decline in urinary continence, these findings can be non-specific and we mass factor in radiological findings too. Furthermore, while CSF shunting has long been the standard treatment, its effectiveness has never been rigorously confirmed in a large well-powered randomized trial. In this trial, patients with a clinical improvement in gait velocity after temporary CSF drainage were deemed eligible for shunting and randomizing the trial. What makes this trial particularly elegant is its blending strategy. All 99 participants underwent the same surgical procedure with the same commercially available programmable shunt valve. After surgery, the valve was set either to an open functioning position or to a high resistance placebo setting. Neither patients nor assessors knew who had a working shunt. This is about as close to a true double-blind design as neurosurgery can get. The primary outcome was changing gait velocity at three months. The open shunt group improved by 0.23 meters per second on average, while the placebo group showed essentially no change in 0.03 meters per second. That's a treatment difference of 0.21 meters per second, both statistically significant and clinically meaningful. To put that in perspective, a change of 0.10 meters per second is considered the threshold for substantial meaningful change in the elderly. 80% of the open shunt group exceeded that threshold compared to only 24% of the placebo group.  The Tenet scale, which measures gait imbalance, also showed significant improvement in the open shunt group. However, screening measures for good condition using the MoCA scale and bladder symptoms did not reach significance at three months, though tertiary outcomes for cognitive testing, quality of life and functional independence tended in favor of shunting. Importantly, falls were more common in the placebo group at 46% compared to 25% in the open shunt group. This is a meaningful safety signal given how dangerous falls are in older adults. There were also real risks with active shunting. Subdural hematomas occurred in 12% of the open shunt group versus 2% of placebo and three even required surgical intervention. Positional headaches from low CSF pressure were more common in the open shunt group at 59% versus 28%. The good news is that the adjustable valve allowed non-invasive management of many of these complications. While this trial gives us reasons to be cautiously optimistic about shunting for appropriately selected iNPH patients, it's worth noting that we only have evidence for improvement in gait and follow-up is only three months.  Longer-term data is still being collected so we don't know yet how durable these benefits are. If you want to read more, please find the paper by Mark G. Luciano, et al. It's titled A Randomized Trial of Shunting for Idiopathic Normal Pressure Hydrocephalus published in the New England Journal of Medicine in December 2025. That's your neurology menu for today. Keep exploring and we'll see you next time. 

We bring you an episode of "Intention to Treat: The Race Equation." It's a new series from the New England Journal of Medicine that investigates how race-specific diagnostic tools harm Black patients and contribute to growing health inequities.

Dr. Casandra MacLeod discusses central retinal artery occlusions, recent trials, and those anticipated in the future.  Show citation:  Préterre C, Gaultier A, Obadia M, et al. Intravenous alteplase versus oral aspirin for acute central retinal artery occlusion within 4·5 h of severe vision loss (THEIA): a multicentre, double-dummy, patient-blinded and assessor-blinded, randomised, controlled, phase 3 trial. Lancet Neurol. 2025;24(11):909-919. doi:10.1016/S1474-4422(25)00308-4  Poli S, Grohmann C, Wenzel DA, et al. Early REperfusion therapy with intravenous alteplase for recovery of VISION in acute central retinal artery occlusion (REVISION): Study protocol of a phase III trial. Int J Stroke. 2024;19(7):823-829. doi:10.1177/17474930241248516  Ryan SJ, Jørstad ØK, Skjelland M, et al. A Randomized Trial of Tenecteplase in Acute Central Retinal Artery Occlusion. N Engl J Med. 2026;394(5):442-450. doi:10.1056/NEJMoa2508515 Show transcript:  Dr. Casandra MacLeod Hello, this is Casandra MacLeod, a neurology resident at Cleveland Clinic with today's Neurology Minute. Today we will be discussing central retinal artery occlusions, or CRAOs, and the recent trials that have come out and even those further on the horizon. The 2026 American Heart Association and American Stroke Association guidelines for the early management of patients with acute ischemic stroke were recently published and in them highlight the uncertainty around the treatment of acute CRAOs with intravenous thrombolysis, even when the patient presents within four and a half hours and is otherwise eligible. These guidelines come after two recent trials, which we will further discuss. The thrombolysis in patients with acute central retinal artery occlusion, or the THEIA trial, was published in the November issue of Lancet Neurology. This multicenter trial out of France randomized 70 patients with acute CRAOs presented within four and a half hours of time from last known well to either receive IV alteplase and oral placebo or IV placebo and oral aspirin. While safety measures showed no symptomatic hemorrhage event, although they did have one asymptomatic intracerebral hemorrhage occur, the primary outcomes, which included visual acuity improvement at one month, showed some evidence for a trend of improved acuity in the IV thrombolytic group at 66% compared to 48 in the aspirin group, it did not reach significant. And now more recently, the Tenecteplase in central retinal artery occlusion study, or TenCRAOs, was published in the January 2026 issue of The New England Journal of Medicine. TenCRAOs was a six European country multicenter trial that randomized 78 patients with CRAOs all presenting within four and a half hours of time from last known well to either receive IV Tenecteplase or aspirin, both with placebo-matching as in THEIA. The primary outcomes of TenCRAOs also included visual acuity at one month, but unfortunately this trial also did not show [inaudible 00:02:07]. They showed 20% in the IV TNK group compared to 24% in aspirin. And additionally, there was one fatal intracerebral hemorrhage in the TNK group that should be considered. Overall, the AHA and ASA guidelines state the usefulness of treatment with intravenous thrombolysis is uncertain. And this is based largely on these studies as neither trial showed improved visual recovery. Although both of these trials are underpowered, leading many to believe that the jury is still out on the use of IV thrombolytics in CRAOs. But importantly, stay on the lookout for one last trial. The early reperfusion therapy with intravenous alteplase for recovery of vision and acute central retinal artery occlusion, or the Revision trial, is actively recruiting. Revision is similar in design as THEIA, but with a goal of up to 422 total patients for a goal of a well-powered study to guide decision making. 

Equip Foods Protein (grass-fed beef isolate, no seed oils, third-party tested) Code: BENAZADI - https://bit.ly/49xXaMq  Keto Flex Revised by Ben Azadi (pre-order now, releases July 21st, includes exclusive bonus chapters as a downloadable PDF): https://bit.ly/4wKG1sM    In this episode, Ben Azadi reveals the five foods he eliminated that ended his chronic cravings and led to losing 19 pounds in 30 days. The root issue is not willpower. It's hormones and inflammation. A 2019 NIH study by Kevin Hall had participants eating ultra-processed vs. whole foods at matched calories. On the ultra-processed diet, they ate 500 extra calories per day without realizing it. The food was driving the overconsumption, not a lack of discipline. The five foods to remove: Liquid sugar. Sodas, juices, sports drinks, and flavored coffee drinks don't register as fullness. The Harvard Nurses' Health Study found adding one sugary drink per day led to 358 extra calories consumed daily. Swap for black coffee, plain tea, or sparkling water. Ultra-processed breads and tortillas. Stripped of nutrition and engineered for shelf life, modern bread spikes blood sugar as much as a Snickers bar according to Dr. William Davis. Opt for fermented sourdough or sprouted grain, or remove bread entirely for 30 days. Boxed pastas and processed comfort foods. Hyper-palatable combinations of salt, sugar, fat, and starch that overstimulate the brain's reward centers while leaving the body nutritionally depleted. A follow-up to Hall's study found people eating these foods consumed up to 1,000 extra calories per day. Seed oil-laden dressings, sauces, and condiments. Soybean, canola, corn, sunflower, and related oils produce carcinogenic aldehydes during processing and are in roughly 80% of the food supply. Replace with avocado oil, extra virgin olive oil, grass-fed butter, ghee, coconut oil, beef tallow, or duck fat. Look for seed oil-free brands like Primal Kitchen and Chosen Foods. Alcohol. A 1992 New England Journal of Medicine study found moderate alcohol consumption drops fat oxidation by 70% for hours. The liver prioritizes clearing alcohol above all else, including fat burning, while simultaneously increasing appetite and lowering the brain's stop-eating signals. Find All The Ben Azadi Show Sponsorship Deals ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.ketokamp.com/sponsorship-deals Learn more about your ad choices. Visit megaphone.fm/adchoices

Welcome back, everyone. Today we're diving into one of the most hotly debated topics in obstetrics- should we be treating preeclampsia without severe features with antihypertensive medications during expectant management? Now, if you've been following the literature- and our show, you know that the landmark CHAP trial changed the game for chronic hypertension in pregnancy. It showed us that targeting a blood pressure below 140 over 90 reduces serious maternal complications, without harming the baby. That was a big deal. But here's the thing, CHAP studied chronic hypertension. Then there was the CHIP trial- that also found that tight control of gestational hypertension and nonproteinuric chronic hypertension was also beneficial. These did not address preeclampsia without severe features, and yet, the ripple effects of that trial have sparked a global conversation about whether we should be extending those same treatment principles to women with preeclampsia who don't yet have severe features. And this is where it gets really interesting, because the guidelines don't agree. In the United States, ACOG and the Society for Maternal-Fetal Medicine still say: hold off on antihypertensives unless blood pressures hit the severe range at 160/110. But step outside the US, and you'll find the World Health Organization, the International Society for the Study of Hypertension in Pregnancy, FIGO, NICE, and Hypertension Canada all recommending treatment at 140 over 90, regardless of whether the diagnosis is chronic hypertension, gestational hypertension, or preeclampsia. So who's right? And more importantly what does this mean for the patient sitting in front of you right now, at 34 weeks, with a blood pressure of 150 over 95, some proteinuria, but no severe features? Today, we're going to break this down. We'll review the controversy, walk through the divergent guidelines, and most importantly talk about the real, practical implications that favor treating these patients during expectant management. Because when you're watching someone with preeclampsia, waiting for the right time to deliver, there's a strong argument that controlling their blood pressure isn't just reasonable…may be protective. So grab your coffee, settle in, and let's get into it.1. Society for Maternal-Fetal Medicine Statement: Antihypertensive Therapy For mild chronic Hypertension in Pregnancy-The Chronic Hypertension And Pregnancy Trial. American Journal of Obstetrics and Gynecology. 2022. Society for Maternal-Fetal Medicine; Publications Committee. 2. Preeclampsia. The New England Journal of Medicine. 2022. Magee LA, Nicolaides KH, von Dadelszen P.3. Antihypertensive Drug Therapy for Mild to Moderate Hypertension During Pregnancy.The Cochrane Database of Systematic Reviews. 2018. Abalos E, Duley L, Steyn DW, C.4. Prevention and Treatment of Maternal Stroke in Pregnancy and Postpartum: A Scientific Statement From the American Heart Association. Stroke. 2026. Miller EC, Bello NA, Chen PR, et al.5.Hypertension in Pregnancy: Diagnosis, Blood Pressure Goals, and Pharmacotherapy: A Scientific Statement From the American Heart Association. Hypertension. 2022. Garovic VD, Dechend R, Easterling T, et al.

Hosts: Jake Lancaster MD, Chief Medical Information Officer and Amanda Comer DNP, System Director, Advanced Practice ProvidersDr. Stephen Threlkeld, Baptist Memorial Health Care's medical director of infectious diseases, contributed to a case study published on Thursday, Jan. 8, 2026, in the prestigious New England Journal of Medicine titled “Case 1-2026: A 50-Year-Old Woman With Fever and Abdominal Pain.”The case study, published in Vol. 394, No. 2 of the journal, is part of a century-old series called “Case Records of the Massachusetts General Hospital.” It explores clinical cases that challenge physicians.CME Credit Info:Link to complete brief survey and claim CME credit: https://www.surveymonkey.com/r/C55LKSYCME credit is available for up to 3 years after the stated release dateContact CEOD@bmhcc.org if you have any questions about claiming credit.

Headlines warned us about microplastics in our brains. A chemist says the study may have been measuring brain fat instead. In 2025, a study claiming microplastics accumulate in human brain tissue dominated our feeds. We covered it. Then Dr. Michelle Wong, a chemical scientist and science communicator, flagged a problem with the methodology. So we went to the primary literature, read the critique, and brought in one of the first scientists to publicly challenge the findings: Dr. Oliver Jones, Professor of Analytical Chemistry at RMIT University in Melbourne. In this episode, we unpack what went wrong with the measurement method, what it means for the broader microplastics conversation, and why being willing to say "I was wrong" is so vital for good science. In this episode: How pyrolysis GC-MS works and why it can confuse plastic breakdown products with brain fat Why potassium hydroxide digestion creates soap, which also mimics plastic signatures The contamination problem: body bags, centrifuge tubes, plastic storage containers, and lab air Why 7 grams of microplastic per brain is more than what researchers find in raw sewage The Marfella study in The New England Journal of Medicine: microplastics in arterial plaques and why it also lacked blank controls How microplastics could enter the body: skin absorption, ingestion, and inhalation Why PM2.5 monitoring already captures the most relevant airborne microplastic exposure What the WHO, FDA, and European Food Safety Authority have concluded about microplastic harm What better microplastics research would actually look like Why the real lesson is about how we evaluate headlines, not just microplastics Dr. Oliver Jones is Professor of Analytical Chemistry and Associate Dean of Biosciences and Food Technology at RMIT University in Melbourne. A Fellow of the Royal Society of Chemistry (FRSC) and the Royal Australian Chemical Institute (FRACI), he holds degrees from Imperial College London and Cambridge. He is one of only 118 scientists worldwide named to the IUPAC Periodic Table of Outstanding Younger Chemists. His research focuses on developing methods to measure environmental contaminants, including microplastics, and he was among the first scientists to publicly challenge the methodology of the viral "microplastics in the brain" study. Follow Dr. Jones: @dr_oli_jones RMIT faculty page: rmit.edu.au/oliver-jones Dr. Michelle Wong (Lab Muffin Beauty Science) first flagged the methodological concerns to us. Hosted by Drs. Ayesha & Dean Sherzai Subscribe to The Synapse (free weekly newsletter): https://thebraindocs.com/newsletter  Follow @TheBrainDocs on Instagram

Sleep is one of the most common struggles in the CPTSD community, and one of the least understood. If you've tried the routines, the supplements, the magnesium, the blue light glasses, and you're still lying awake at midnight or waking up at 3am feeling like something is wrong, this episode is for you.Today I break down why sleep is uniquely hard when you have complex trauma, what's actually happening in your nervous system at night, and what might actually help. In this episode:Why sleep requires felt safety and why that's so hard with CPTSDThe two ends of the sleep struggle spectrum: can't fall asleep vs. sleeps but never feels restedHypervigilance at night and why the quiet, dark room can become the triggerNightmares as attempted processing and what's actually getting in the wayThe IFS lens: the protectors, managers, and exiles running the show at nightWhy parts work is nervous system workSleep hygiene that actually makes sense for a dysregulated nervous systemSomatic tools to try before bed and when you wake up at 3amReferences:Dana, D. (2018). The Polyvagal Theory in Therapy: Engaging the Rhythm of Regulation. Norton.Balban, M. Y., Neri, E., Kogon, M. M., Weed, L., Nourski, B., Picard, M., ... & Huberman, A. D. (2023). Brief structured respiration practices enhance mood and reduce physiological arousal. Cell Reports Medicine, 4(1).Southwick, S. M., Bremner, J. D., Rasmusson, A., Morgan, C. A., Arnsten, A., & Charney, D. S. (1999). Role of norepinephrine in the pathophysiology and treatment of posttraumatic stress disorder. Biological Psychiatry, 46(9), 1192–1204.Yehuda, R. (2002). Post-traumatic stress disorder. New England Journal of Medicine, 346(2), 108–114.Thanks for listening to The Complex Trauma Podcast!Be sure to follow, share and give us a review on your favorite podcast platform.Follow on Instagram: @sarahherstichlcsw Follow on TikTok: @sarahherstichlcswLearn more about EMDR & trauma therapy in Pennsylvania with Reclaim TherapyThis podcast is for educational and informational purposes only. It is not intended as a substitute for professional medical, psychological, or nutritional advice, diagnosis, or treatment.Remember, I'm a therapist, but I'm not your therapist. Nothing in this podcast is meant to replace actual therapy or treatment. If you're in crisis or things feel really unsafe right now, please reach out to someone. You can call 988 for the Suicide and Crisis Lifeline, text them, or head to your nearest ER.The views expressed by the host and guests are their own and do not represent the opinions of any organizations or institutions. Reliance on any information provided by this podcast is solely at your own risk.

If you enjoy this episode, we're sure you will enjoy more content like this on The Occult Rejects.  In fact, we have curated playlists on occult topics like grimoires, esoteric concepts and phenomena, occult history, analyzing true crime and cults with an occult lens, Para politics, and occultism in music. Whether you enjoy consuming your content visually or via audio, we've got you covered - and it will always be provided free of charge.  So, if you enjoy what we do and want to support our work of providing accessible, free content on various platforms, please consider making a donation to the links provided below.  Thank you and enjoy the episode!Links For The Occult Rejectshttps://linktr.ee/theoccultrejectsOccult Research Institutehttps://www.occultresearchinstitute.org/Cash Apphttps://cash.app/$theoccultrejectsVenmo@TheOccultRejectsBuy Me A Coffeebuymeacoffee.com/TheOccultRejectsPatreonhttps://www.patreon.com/TheOccultRejectsBibliographyThe Mechanics of Magick: Singing Bowls and the Ritual Physics of ResonanceCore Singing Bowl ResearchStanhope, Jessica, and Philip Weinstein. “The Human Health Effects of Singing Bowls: A Systematic Review.” Complementary Therapies in Medicine 51 (2020): 102412. Use for the honesty frame: promising findings around mental health and cardiovascular measures, but limited evidence and need for stronger study design.Cai, Yiqing, Guo-Yan Yang, Yibo Liu, Xiang-yun Zou, Heng Yin, Xinyan Jin, Xue-han Liu, Chenlu Wang, Nicola Robinson, and Jian-Ping Liu. “Therapeutic Effects of Singing Bowls: A Systematic Review of Clinical Studies.” Integrative Medicine Research 14, no. 2 (2025): 101144. Use for the newer clinical overview. Important correction: this appears as 101144, not 101176. Good for anxiety, depression, sleep quality, cognition, autistic behavior, and EEG-related outcomes while still keeping the evidence cautious.Lin, F. W., et al. “Effects of Tibetan Singing Bowl Intervention on Psychological and Physiological Health in Adults: A Systematic Review.” 2025. Useful as another recent review angle, especially for psychological health, physiological measures, HRV, and brainwave-related discussion. Keep it secondary behind Stanhope and Cai.Landry, Jayan Marie. “Physiological and Psychological Effects of a Himalayan Singing Bowl in Meditation Practice: A Quantitative Analysis.” American Journal of Health Promotion 28, no. 5 (2014): 306–309. Use for the controlled relaxation study: 51 participants, randomized crossover design, singing bowl exposure or silence before directed relaxation.Goldsby, Tamara L., Michael E. Goldsby, Mary McWalters, and Paul J. Mills. “Effects of Singing Bowl Sound Meditation on Mood, Tension, and Well-Being: An Observational Study.” Journal of Evidence-Based Complementary & Alternative Medicine 22, no. 3 (2017): 401–406. Use for reductions in tension, anger, fatigue, depressed mood, anxiety, and stress after singing bowl meditation. Good, but frame as observational, not definitive.Rio-Alamos, Cristina, et al. “Acute Relaxation Response Induced by Tibetan Singing Bowl Sounds: A Randomized Controlled Trial.” European Journal of Investigation in Health, Psychology and Education 13, no. 2 (2023): 317–328. Use for Tibetan singing bowl treatment compared with progressive muscle relaxation and a waiting-list control in anxious nonclinical adults.Walter, Nina, et al. “Neurophysiological Effects of a Singing Bowl Massage.” Medicina 58, no. 5 (2022): 594. Use for EEG, ECG, and respiration during singing bowl massage; the authors interpret the results as a shift toward a more mindful or meditative state.Goldsby, Tamara L., et al. “Mood, Emotional, and Spiritual Well-Being Interrelationships.” Religions 13, no. 2 (2022). Useful follow-up for spiritual well-being, emotional interpretation, and how people understand sound-healing experiences.Sound, Anxiety, HRV, and Brainwave CautionMallik, Adiel, and Frank A. Russo. “The Effects of Music & Auditory Beat Stimulation on Anxiety: A Randomized Clinical Trial.” PLOS ONE 17, no. 3 (2022): e0259312. Use this carefully for the broader point that sound-based treatments can reduce somatic and cognitive state anxiety. Do not use it as proof that singing bowls automatically entrain brainwaves.Ingendoh, Ruth Maria, Ella S. Posny, and Angela Heine. “Binaural Beats to Entrain the Brain? A Systematic Review of the Effects of Binaural Beat Stimulation on Brain Oscillatory Activity, and the Implications for Psychological Research and Intervention.” PLOS ONE 18, no. 5 (2023): e0286023. Very useful caution source. Use it when warning against overclaiming “brainwave entrainment” and frequency-healing claims.Vilímek, et al. 2022. Low-frequency sound / HRV / vibroacoustic-related research. Use cautiously if you want to discuss low-frequency vibration, body sensation, and autonomic response. I'd keep this as a secondary source unless you want a dedicated paragraph on vibroacoustics.Physics, Resonance, and CymaticsTerwagne, Denis, and John W. M. Bush. “Tibetan Singing Bowls.” Nonlinearity 24, no. 8 (2011): R51–R66. Use for the physics section: wall vibrations, water-surface waves, Faraday-wave effects, droplet motion, and the visible demonstration of resonance.Jenny, Hans. Cymatics: A Study of Wave Phenomena and Vibration. Newmarket, NH: MACROmedia, 2001. Use carefully for visual sound-pattern history. Good for imagery and occult imagination, but don't overuse it as clinical proof.Rossing, Thomas D. The Science of Sound. 3rd ed. San Francisco: Addison Wesley, 2002. Useful general acoustics source for resonance, overtones, vibration, sound waves, and instrument physics.Sound Baths, Wellness Culture, and Modern RitualSobo, Elisa J. “Sound Baths, Trauma Talk, and the Wellness Paradox in the USA.” Medical Anthropology 43, no. 5 (2024): 367–382. Excellent for the modern sound-bath/wellness-culture angle, especially trauma language, nervous-system talk, ritual performance, and how providers frame sound baths.Sobo, Elisa J. “A Beginner's Guide to Sound Baths — What They Are, How to Choose a Good One and What the Research Shows.” The Conversation (2024). Useful for accessible show-note language and ethical/practical framing.Sobo, Elisa J. “Healing Vibrations.” Anthropology News 64, no. 5 (2023): 28–32, 49. Good anthropology/public-facing source for sound healing and wellness culture.Tibetan Singing Bowls, History, and Cultural CommodificationGrimes, Samuel. “Where Did ‘Tibetan' Singing Bowls Really Come From?” Tricycle (2020). Use for the contested-history section. Strong source for questioning popular origin stories around “Tibetan” singing bowls.Joffe, Ben. “Anthropology and Tibetan Buddhism / Cultural Commodification / Tibetan Mystique.” 2015. Use for the larger argument about how Tibetan/Himalayan aura gets packaged in Western spiritual markets. Good support for the “Tibet as imagined storehouse of hidden wisdom” point.Scheidegger, Daniel A. “Tibetan Ritual Music.” Use for actual Tibetan Buddhist ritual sound: bells, cymbals, long horns, drums, chant, and liturgical soundscape. This helps separate real Tibetan ritual sound from overblown modern singing-bowl mythology.Lopez, Donald S. Prisoners of Shangri-La: Tibetan Buddhism and the West. Chicago: University of Chicago Press, 1998. Excellent support for Western romanticization of Tibet.Bishop, Peter. The Myth of Shangri-La: Tibet, Travel Writing, and the Western Creation of Sacred Landscape. Berkeley: University of California Press, 1989. Very useful for the “Tibet as fantasy geography” angle.Ritual, Sound, and Religious ExperienceEliade, Mircea. Shamanism: Archaic Techniques of Ecstasy. Princeton: Princeton University Press, 1964. Use carefully. Good for altered-state technologies and ritual sound/trance, but don't treat it as the final word on shamanism.Rouget, Gilbert. Music and Trance: A Theory of the Relations Between Music and Possession. Chicago: University of Chicago Press, 1985. Excellent for sound, music, trance, possession, rhythm, and ritual performance.Becker, Judith. Deep Listeners: Music, Emotion, and Trancing. Bloomington: Indiana University Press, 2004. Strong source for deep listening, music, emotion, trance, and the body.Husserl, Edmund. On the Phenomenology of the Consciousness of Internal Time. Useful if you want to get philosophical about tone, decay, waiting, and how sound reveals time.Ihde, Don. Listening and Voice: Phenomenologies of Sound. Albany: SUNY Press, 2007. Good for sound as experience, listening, voice, and embodied perception.Placebo, Meaning Response, and Healing RitualMoerman, Daniel E. Meaning, Medicine and the “Placebo Effect.” Cambridge: Cambridge University Press, 2002. Use for “meaning response” instead of treating placebo as “fake.”Benedetti, Fabrizio. Placebo Effects: Understanding the Mechanisms in Health and Disease. Oxford: Oxford University Press, 2009. Useful for placebo mechanisms, expectation, physiology, and therapeutic context.Kaptchuk, Ted J., and Franklin G. Miller. “Placebo Effects in Medicine.” New England Journal of Medicine 373 (2015): 8–9. Good short medical source for placebo effects as real psychobiological phenomena.Csordas, Thomas J. The Sacred Self: A Cultural Phenomenology of Charismatic Healing. Berkeley: University of California Press, 1994. Useful for healing, embodiment, ritual, and religious experience.Embodied Cognition, Extended Mind, and Ritual ToolsClAlso want to remind people about the website, if you're into reading we have tons of information by multiple contributors, and we got t-shirts up on the site if you're interested. Fun fact, the art is all based on the eyeball. A

Dr. Irwin Goldstein didn't set out to become a pioneer of sexual medicine. He was a biomedical engineer turned urology resident who, as he tells it, asked one stupid question during a 1976 surgery: "Could you explain the physiology of erection to me?" The surgeon shrugged. Irwin spent the next decade figuring it out. Along the way, he co-discovered that nitric oxide, the elephant of our air, is what makes erections possible. He published the first paper on it in 1991. Seven years later, he became the first author on the New England Journal of Medicine paper that introduced Viagra to the world. But that's only half the story. The other half is Sue Goldstein, Irwin's college sweetheart turned partner in life, parenting, and eventually the practice itself. Sue spent decades raising their family while quietly absorbing the science her husband brought home. She is now an AASECT-certified educator, a published researcher, and one of the most outspoken patient advocates in the field. Together, they run San Diego Sexual Medicine, a clinic where every patient gets a three-hour visit, full education, and an entire team practicing what they call true bio-psycho social care. In this first half of our two-part conversation, Dr. Jenni Skyler and Daniel Lebowitz sit with the Goldsteins and explore how a field gets built, and how it still leaves so many patients behind. They cover prostate cancer and the silent erectile crisis that follows it. The buccal grafting innovation that's helping women with severe vestibular pain finally get answers. Why women, on average, see ten or twelve doctors before they get a real diagnosis. And Sue's pet peeve, medical gaslighting and what to do when a doctor says "there's nothing that can be done." This is a conversation for anyone who has ever felt unheard by a clinician, dismissed by their own body, or convinced they were the problem. The Goldsteins want you to know — you're not. You just haven't been to the right office yet. Irwin Goldstein, MD, IF (he/him/his)Director, San Diego Sexual Medicine5555 Reservoir Drive, Suite 300, San Diego, CA 92120Director, Sexual Medicine, UC San Diego Health East Campus, San Diego, CAClinical Professor of Urology, University of California at San DiegoVoluntary Clinical Professor of Obstetrics, Gynecology and Reproductive ServicesPast President, International Society for the Study of Women’s Sexual HealthPast President, Sexual Medicine Society of North AmericaEditor Emeritus, Sexual Medicine Reviews, The Journal of Sexual Medicine, International Journal of Impotence Researchphone: 619 265-8865fax: 619 265-7696mobile: 619 987-7432dr.irwingoldstein@gmail.comhttp://www.sandiegosexualmedicine.comLike us on Facebook: https://www.facebook.com/SDSexMedtwitter.com/SDSexualMedSee omnystudio.com/listener for privacy information.

In Episode 289 of the Fit Father Project Podcast, Dr. Anthony Balduzzi takes a deep dive into one of the most urgent and underappreciated health threats of our time: microplastics and nanoplastics.While most people know to avoid drinking from single-use plastic bottles, this episode goes far beyond the obvious.Dr. A explains the critical difference between microplastics and nanoplastics, breaks down the five mechanisms by which plastic damages the body, and exposes the hidden sources of plastic exposure most people never think about, including tea bags, table salt, cookware, clothing, seafood, and grocery store receipts.He also covers what the latest research says about how plastic is showing up in human blood, brain tissue, arterial plaques, and even reproductive organs, and what you can realistically do about it.If you're serious about protecting your hormones, your heart, your gut, and your long-term vitality, this episode gives you the research-backed knowledge and practical steps to start reducing your plastic burden today.It is also a must-share episode for parents and grandparents who want to protect the next generation from a growing and largely invisible threat.Rate & Review – If this episode helped you understand the real dangers of microplastics and gave you practical tools to reduce your exposure, please take a minute to rate and review the Fit Father Project Podcast. Your review helps more men and women discover the show and get the information they need to live stronger, healthier, and longer.Join the Fit Father Community – Want support from others who are serious about their health after 40? Join the Fit Father brotherhood and surround yourself with people who are committed to living with more strength, energy, and purpose.Key TakeawaysMicroplastics vs. nanoplastics: size determines where they go in the body and how much damage they causeNanoplastics are 70 times smaller than the width of a human hair and can cross the intestinal wall, enter the bloodstream, and reach the heart, brain, and reproductive tissueA Columbia University study found that 90% of plastic particles in bottled water are nanoplastics, the most dangerous kindThe five mechanisms of plastic harm: endocrine disruption, oxidative stress, chronic inflammation, gut microbiome disruption, and cellular senescenceBPA and phthalates act as xenoestrogens, blocking natural hormones, lowering testosterone in men, worsening perimenopausal symptoms in women, and suppressing thyroid function in both sexesA 2024 New England Journal of Medicine study found that patients with microplastics in their arterial plaques had a 4.5 times higher risk of heart attack, stroke, and deathHidden sources most people miss: plastic-mesh tea bags, table salt, polyester clothing, nonstick cookware, larger fish, and BPA-coated thermal receiptsHimalayan pink salt tested with the highest microplastic load of any salt in a 2023 Australian study; Redmond Real Salt from Utah is currently the cleanest known optionThe body can eliminate microplastics through fiber-rich stool and excrete plasticizer chemicals like BPA and phthalates through sweat and saunaThere is currently no proven method to remove embedded nanoplastics from tissues; reducing total lifetime exposure is the single most important strategyWant To Change Your Life? Check Out Foundations!Foundations is a simple, sustainable, and specific weight loss program designed especially for busy men over 40. With short metabolic training workouts, an easy-to-follow meal plan, and an accountability team there for you every step of the way, Foundations can help you lose weight, regain energy and vitality, and live life to the fullest. Fit Father / Fit Mother LIVE 2026!Come experience the energy of Fit Father / Fit Mother Live in person this August 7–9 in Phoenix. You'll enjoy transformational teaching, nourishing meals, and the kind of real community that leaves you feeling recharged, inspired, and deeply connected. Reserve your spot now and join us for an unforgettable weekend. We look forward to meeting you!

Contributor: Aaron Lessen, MD Educational Pearls: There has long been many questions about which IV fluid is best for ED resuscitation Multiple adult studies have shown no clear benefit of balanced fluid vs normal saline A large pediatric randomized clinical trial published in April compared balanced fluid vs normal saline in children with septic shock  The study included about 9,000 patients from 47 emergency departments in five countries Patients with septic shock were randomized to receive either balanced fluid or normal saline The primary outcome was adverse kidney event (death, dialysis, or persistent kidney dysfunction) at 30 days or hospital discharge Results showed no difference in any safety outcomes and no adverse events occurred The key takeaway is that early fluid resuscitation matters more than which crystalloid you choose   References Balamuth F, Weiss SL, Long E, et al. Balanced Fluid or 0.9% Saline in Children Treated for Septic Shock. New England Journal of Medicine. Published online April 23, 2026. doi:https://doi.org/10.1056/nejmoa2601969   Summarized by Meg Joyce, MS3 | Edited by Meg Joyce & Ahmed Abdel-Hafiz, NREMT-P Donate: https://emergencymedicalminute.org/donate/  

For decades, a tight carotid stenosis felt like a ticking time bomb — a plaque waiting to throw an embolus and cause the next stroke. We were taught that severe narrowing meant surgery, and trials like ACAS and ACST-1 seemed to prove it. But medicine has changed. Statins, antiplatelets, tighter blood pressure control, even PCSK9 and GLP-1 therapies have quietly slashed stroke risk, and now newer data from CREST-2 suggest that for many asymptomatic patients, the knife — or the stent — may not add much at all. So if modern medical therapy works better than ever… who actually benefits from intervention anymore? Today, we unpack the evidence, the controversies, and how to counsel the patient who feels perfectly fine but has high-grade stenosis.Hosts: Carolyn Judge, Andrew Huang, Luciano Delbono, Frank Davis, Robert BeaulieuInstitution: University of Michigan, Department of Surgery, Section of Vascular SurgeryLearning objectives: Describe how modern intensive medical therapy has transformed the natural history of asymptomatic carotid stenosis and explain why contemporary patients experience substantially lower annual stroke risk than those in earlier eras. Interpret and compare the results of landmark trials—including ACAS, ACST-1, and CREST-2—to assess the relative benefits of medical therapy, endarterectomy, and stenting. Apply current evidence and guideline recommendations to patient care by selecting which asymptomatic patients are most likely to benefit from carotid revascularization versus optimized medical therapy alone. References:SVS Guidelines:Brook, R. D., et al. (2022). Society for Vascular Surgery clinical practice guidelines for management of extracranial carotid artery disease. Journal of Vascular Surgery, 75(1), e1–e67. https://doi.org/10.1016/j.jvs.2021.09.031CREST (1)Brott, T. G., Hobson, R. W., Howard, G., et al. (2010). Stenting versus endarterectomy for treatment of carotid-artery stenosis. New England Journal of Medicine, 363(1), 11–23. https://doi.org/10.1056/NEJMoa0912321CREST-2Brott, T. G., Howard, G., Fong, P., et al. (2024). Randomized trial of carotid artery stenting or carotid endarterectomy vs best medical therapy for asymptomatic carotid stenosis: CREST-2 results. [Manuscript in preparation]. ClinicalTrials.gov Identifier: NCT02089217. Retrieved from https://clinicaltrials.gov/ct2/show/NCT02089217ACST-1Halliday, A., Mansfield, A., Marro, J., et al. (2004). Randomised trial of carotid artery surgery for asymptomatic stenosis. Lancet, 363(9420), 1491–1502. https://doi.org/10.1016/S0140-6736(04)16153-1ACST-2Halliday, A., Bulbulia, R., Bonati, L. H., et al. (2021). Carotid artery stenting versus carotid endarterectomy in patients with asymptomatic carotid stenosis (ACST-2): A randomised trial. Lancet, 398(10291), 1065–1073. https://doi.org/10.1016/S0140-6736(21)01980-1ACASExecutive Committee for the Asymptomatic Carotid Atherosclerosis Study. (1995). Endarterectomy for asymptomatic carotid stenosis. JAMA, 273(18), 1421–1428. https://doi.org/10.1001/jama.1995.03520420033036Sponsor URL: https://www.goremedical.com/Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listenBehind the Knife Premium: https://behindtheknife.org/premiumOral Board Review: https://behindtheknife.org/oral-boardOral Board Simulator: https://behindtheknife.org/oral-board/simulatorGeneral Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-reviewTrauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlasDominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkshipDominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotationVascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-audio-reviewColorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-audio-reviewSurgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-audio-reviewCardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-audio-reviewDownload our App:Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

GLP-1 drugs like Ozempic and Mounjaro are now everywhere. But what do they actually do beyond weight loss? And what do you need to know before starting them? In this episode, we're joined by Dr Ania Jastreboff, a world-leading researcher at the forefront of GLP-1 treatments and writer of the New York Times bestselling book Enough: Your Health, Your Weight, and What It's Like To Be Free, co-authored with Oprah Winfrey. Dr Jastreboff explains everything you need to know about Ozempic, Mounjaro, Wegovy and other GLP-1 medications for 2026. You'll learn how GLP-1s may reduce the risk of heart disease, improve blood sugar control, and support conditions like sleep apnoea. We also explore why weight often returns after stopping, and what you need to know about Ozempic side effects and long-term use. If these drugs can change how your brain controls hunger, what does that mean for willpower, weight gain, and how we treat obesity long term?

What if the clothes you're putting on your body, or your child's body, every single day… were quietly poisoning you? In this explosive solo episode, Darin exposes a shocking and largely ignored reality: fast fashion clothing, especially brightly colored, cheap garments, may be loaded with toxic heavy metals like lead. Backed by a 2026 study from the American Chemical Society, this conversation reveals how these chemicals don't just sit on fabric, they leach into your skin, enter your bloodstream, and accumulate over time. From the hidden chemistry behind synthetic dyes to the devastating neurological effects of lead exposure in children, this episode pulls back the curtain on one of the most overlooked "fatal conveniences" in modern life—and gives you the tools to make safer, smarter choices starting today.     What You'll Learn The shocking discovery: children's clothing exceeding federal lead limits Why bright, cheap fast fashion items are the most toxic How heavy metals like lead are used to fix dyes into fabrics Why your skin is not a barrier, but a direct absorption pathway The connection between clothing, sweat, and chemical absorption The devastating effects of lead exposure on children's brains and development Why there is no safe level of lead exposure The hidden chemical load in fast fashion: PFAS, phthalates, formaldehyde How the fast fashion industry cuts costs at the expense of health Practical steps to protect yourself and your family     Chapters 00:00:00 – Opening: introducing the fast fashion heavy metal crisis 00:00:17 – The "cheap t-shirt" scenario and hidden danger 00:00:46 – Speaking directly to parents and caregivers 00:01:30 – The shocking claim: clothing may contain neurotoxins 00:02:45 – 2026 study: children's clothing tested for lead 00:03:14 – Every sample exceeded federal safety limits 00:04:20 – Lead exposure happening through daily wear 00:05:33 – Fast fashion industry scale: $150B+ and growing 00:06:20 – 1,000 new styles per day: the system behind overproduction 00:07:09 – How cheap clothing is actually manufactured 00:07:49 – Chemical dyes and fixatives explained 00:08:20 – Why lead is used in fabric dyeing 00:08:49 – Study details: methodology and testing process 00:09:21 – Research team and origin of investigation 00:10:52 – Advanced testing: spectroscopy and EPA protocols 00:11:40 – Results: every shirt failed safety standards 00:12:10 – Bright colors = higher toxicity 00:13:05 – Secondary experiment: ingestion and mouthing behavior 00:14:00 – Children chewing clothing: real-world exposure 00:14:49 – Skin is not a barrier—it's a delivery system 00:15:30 – Sweat and heat increase chemical absorption 00:16:28 – Microplastics and chemical leaching through skin 00:17:13 – Exercise increases toxin absorption 00:18:00 – Flame retardants and systemic circulation 00:18:50 – Long-term exposure: accumulation over time 00:19:36 – No safe level of lead exposure—global consensus 00:20:15 – Effects on children: brain damage and development issues 00:21:14 – Behavioral, cognitive, and neurological consequences 00:22:00 – Broader chemical exposure: 8,000+ compounds in clothing 00:23:01 – Solutions begin: awareness and behavior change 00:23:40 – Immediate action: always wash new clothes 00:24:10 – Choosing safer fabrics: organic and natural materials 00:24:50 – Avoiding synthetic blends and bright dyes 00:25:20 – Buy less, buy better philosophy 00:26:01 – Supporting ethical and non-toxic brands 00:26:40 – Using your consumer voice to create change 00:27:10 – Educating others and spreading awareness 00:27:40 – Final message: protecting your body and your children 00:28:00 – Closing: reclaiming control and living a SuperLife     Thank You to Our Sponsors: Our Place – Non-toxic cookware that keeps harmful chemicals out of your food. Get 10% off at fromourplace.com with code DARIN. Tru Niagen – Boost NAD+ levels for cellular health and longevity. Get 20% off with code DARIN20 at truniagen.com.     Find More From Darin: Website: darinolien.com Instagram: @darinolien Book: Fatal Conveniences     Key Takeaway "Your skin is not a shield—it's a gateway. And when you start to realize that the things you wear every day can carry toxic chemicals directly into your body, everything changes. Because this isn't about fear—it's about awareness. And once you're aware, you have the power to choose differently, protect your family, and stop participating in a system that was never designed with your health in mind."     Bibliography/Sources The Primary Study American Chemical Society. (2026, March 23). Initial tests find lead in children's fast-fashion clothing [Press release]. https://www.acs.org/pressroom/presspacs/2026/march/initial-tests-find-lead-in-childrens-fast-fashion-clothing.html Deavers, K., Avello, C., & Espinoza, P. (2026, March 22–26). Lead contamination in fast fashion children's clothing [Paper presentation]. ACS Spring 2026 Meeting, Atlanta, GA, United States. HealthDay. (2026, March 24). Cheap children's clothing tainted with lead, study says. U.S. News & World Report. https://www.usnews.com/news/health-news/articles/2026-03-24/cheap-childrens-clothing-tainted-with-lead-study-says Marian University. (2026, March 23). Marian University students warn of lead in children's fast-fashion clothing. Marian University Newsroom. https://www.marian.edu/newsroom/2026/03/marian-university-students-warn-of-lead-in-childrens-fast-fashion-clothing ScienceDaily. (2026, April 2). Initial tests find lead in children's fast-fashion clothing. https://www.sciencedaily.com/releases/2026/04/260402042737.htm Texfash. (n.d.). Lead found in fast-fashion children's clothing as preliminary tests exceed federal safety limits. Texfash Update. https://texfash.com/update/lead-found-in-fast-fashion-children-s-clothing-as-preliminary-tests-exceed-federal-safety-limits Lead Toxicity & Children's Health Agency for Toxic Substances and Disease Registry. (n.d.). Lead toxicity: What are possible health effects from lead exposure? Centers for Disease Control and Prevention. https://archive.cdc.gov/www_atsdr_cdc_gov/csem/leadtoxicity/physiological_effects.html American Academy of Child & Adolescent Psychiatry. (n.d.). Lead exposure in children affects brain and behavior. https://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/FFF-Guide/Lead-Exposure-In-Children-Affects-Brain-And-Behavior-045.aspx Brain Injury Association of America. (2021). Chronic lead exposure: A non-traumatic brain injury. https://biausa.org/public-affairs/public-awareness/news/chronic-lead-exposure-a-non-traumatic-brain-injury Canfield, R. L., et al. (2004). Intellectual impairment in children with blood lead concentrations below 10 μg per deciliter. New England Journal of Medicine, 348, 1517–1526. Centers for Disease Control and Prevention. (2025). Risk factors and children. Childhood Lead Poisoning Prevention. https://www.cdc.gov/lead-prevention/risk-factors/children.html Hubbs-Tait, L., et al. (2005). Neurotoxicants, micronutrients, and social environments: Individual and combined effects on children's development. Psychological Science in the Public Interest, 6(3), 57–121. Lanphear, B. P., et al. (2005). Environmental lead exposure and children's cognitive function. Environmental Health Perspectives. https://pmc.ncbi.nlm.nih.gov/articles/PMC4675165/ Liu, J., et al. (2013). A clinical study of the effects of lead poisoning on the intelligence and neurobehavioral abilities of children. BMC Pediatrics. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3598508/ Needleman, H. L., & Bellinger, D. (2001). Recent developments in low-level lead exposure and intellectual impairment in children. Environmental Health Perspectives. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1247191/ Skin Absorption & Transdermal Chemical Exposure Abafe, O., et al. (2024). Flame retardants leach from microplastics into human sweat; absorption through skin demonstrated. Environment International. Corinti, D., et al. (2018). Chemicals from textiles to skin: An in vitro permeation study of benzothiazole. PubMed Central. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6133113/ EveryRep. (2025). Non-toxic activewear: The BPA, PFAS and polyester risk. https://everyrep.com/synthetic-toxins-endocrine-safety/ University of Birmingham. (2024, April). Toxic chemicals from microplastics can be absorbed through skin. https://www.birmingham.ac.uk/news/2024/toxic-chemicals-from-microplastics-can-be-absorbed-through-skin Fast Fashion: Industry Scale, Chemicals & Health Impacts Cobbing, M., Wohlgemuth, A., & Panhuber, T. (2022). Greenpeace investigation: Hazardous chemicals in SHEIN garments. Greenpeace International. Earth Day Network. (n.d.). Hazardous hems: How fashion wreaks havoc on health. https://www.earthday.org/hazardous-hems-how-fashion-wreaks-havoc-on-health/ Earth Day Network. (n.d.). Toxic textiles: The chemicals in our clothing. https://www.earthday.org/toxic-textiles-the-chemicals-in-our-clothing/ Enhesa. (2026). Toxic chemicals in fast fashion supply chains: Risks, impacts, and regulation. https://www.enhesa.com/resources/article/toxic-chemicals-in-fast-fashion-supply-chains-risks-impacts-and-regulation/ Giró-Palau, A., et al. (2025). The health impact of fast fashion: Exploring toxic chemicals in clothing and textiles. MDPI Encyclopedia, 5(2), 84. https://www.mdpi.com/2673-8392/5/2/84 Green America. (n.d.). Unpacking toxic textiles. https://greenamerica.org/unraveling-fashion-industry/unpacking-toxic-textiles Million Marker. (2024). Fast fashion: A toxic trend and the path to sustainable change. https://millionmarker.com/blogs/blog/fast-fashion-is-toxic OsloMet Clothing Research. (2025). From clothes to skin: Chemical safety in ultra-fast fashion and luxury brands' clothes. https://clothingresearch.oslomet.no/2025/06/03/from-clothes-to-skin-chemical-safety-in-ultra-fast-fashion-and-luxury-brands-clothes/ Fast Fashion Industry Statistics & Environmental Scope Center for Biological Diversity. (n.d.). At what cost? Unravelling the harms of the fast fashion industry. https://www.biologicaldiversity.org/programs/population_and_sustainability/sustainability/fast_fashion Earth.org. (2026). Fast fashion and its environmental impact. https://earth.org/fast-fashions-detrimental-effect-on-the-environment/ Niinimäki, K., et al. (2020). The environmental price of fast fashion. Nature Reviews Earth & Environment. https://www.nature.com/articles/s43017-020-0039-9 The Sustainable Agency. (2026). Environmental & human impact of fast fashion: 2026 facts. https://thesustainableagency.com/blog/impact-of-fast-fashion-stats-and-facts/ Uniform Market. (2025). Environmental impact of fast fashion statistics. https://www.uniformmarket.com/statistics/fast-fashion-statistics Certifications & Resources for Cleaner Clothing bluesign. (n.d.). bluesign standard. https://www.bluesign.com Global Organic Textile Standard. (n.d.). GOTS. https://global-standard.org Oeko-Tex. (n.d.). Oeko-Tex Standard 100. https://www.oeko-tex.com/en/our-standards/oeko-tex-standard-100 Zero Discharge of Hazardous Chemicals. (n.d.). Roadmap to zero. https://www.roadmaptozero.com