Podcasts about non hispanic

The APOE gene is recognized as a significant genetic risk factor for cognitive decline, with different alleles, like APOE e2, being seen as protective against decline and others, like APOE e4, indicating an increased risk for cognitive decline. However, new studies are looking at whether these trends are universal across different racial and ethnic groups. Dr. Cally Xiao joins the podcast to discuss her study, which focuses on how different APOE alleles affect risk for Alzheimer's disease within Hispanic populations compared to non-Hispanic populations. Guest: Cally Xiao, PhD, Project Specialist, Global Alzheimer's Association Interactive Network, Laboratory of Neuro Imaging, University of Southern California Show Notes Follow Dr. Xiao on Twitter.  Learn more about GAAIN on their website or on Twitter.  Read more about the study, “Comparison of genetic and health risk factors for mild cognitive impairment and Alzheimer's disease between Hispanic and non-Hispanic white participants,” online through the journal Alzheimer's and Dementia. Listen to Sarah Biber's episode, “The Future Of Sharing And Accessing Alzheimer's Disease Data,” on our website, Spotify, Apple Podcasts, Podbean, and all major podcast platforms. Connect with us Find transcripts and more at our website. Email Dementia Matters: dementiamatters@medicine.wisc.edu Follow us on Facebook and Twitter. Subscribe to the Wisconsin Alzheimer's Disease Research Center's e-newsletter.

Commentary by Dr. Valentin Fuster

Theme: Paediatrics. Participants: Dr Kerf Tan (emergency physician), Dr Karl Pobre (paediatric emergency physician and paediatrician), Yelise Foon, Mariez Gorgi, Shreyas Iyer, Harry Hong, and Samoda WilegodaDiscussion:Goyal, M., Chamberlain, J., Webb, M., Grundmeier, R., Johnson, T., & Lorch, S. et al. (2020). Racial and ethnic disparities in the delayed diagnosis of appendicitis among children. Academic Emergency Medicine, 28(9), 949-956. https://doi.org/10.1111/acem.14142.Presenter: Yelise Foon.Summary: Delay in the diagnosis of appendicitis is associated with perforation and significant subsequent morbidity.  Currently the pre-operative perforation rate for appendicitis is 30%.  Some known risk factors for a delayed diagnosis for appendicitis include a young age, female gender, African-American race, non-English speaking backgrounds and government insurance factors (predominantly in the US).  This was a multi-centre retrospective cohort study conducted over 3 years utilizing the PECARN registry, which aimed to compare the rate of appendiceal perforation, delayed diagnosis of appendicitis and diagnostic imaging use among different ethnicities. Of the 7298 children diagnosed with appendicitis where race/ethnicity data was collected, 34.9% of non-Hispanic white children had a perforated appendix, compared with 36.5% of non-Hispanic black children.  Non-Hispanic black children also had higher rates of delayed diagnosis (defined as having a relevant emergency visit in the week prior to diagnosis): at 4.7% compared with 2.0% for non-Hispanic white children.  Further non-Hispanic black children with a delayed diagnosis of appendicitis were less likely to undergo definite imaging (including MRI, ultrasound, or CT) compared with their non-Hispanic white counterparts (with 28.2% versus 46.2% undergoing imaging).  However, given that this study came out of the US, the generalisability of this study to Australian emergency departments is unclear.  Health literacy is likely to be a large contributor to delayed presentation of appendicitis and something to be carefully considered when treating any child (and their family).  There are tools such as the Paediatric Appendicitis Score (PAS) and the Alvarado Score which may assist in objectively quantifying the possibility of appendicitis (particularly for junior staff).   Take-Home Points:It is important for us to consider how we can minimise racial and ethnic disparities and make sure we are conscious of them. Credits:This episode is produced with help of HETI's Emergency Medicine Training Network 5.Music/Sound Effects Feel Me by LiQWYD | https://www.liqwydmusic.com, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. In The Eyes by Peyruis | https://soundcloud.com/peyruis, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. It's All Good by Roa Music | https://soundcloud.com/roa_music1031, Music promoted by https://www.free-stock-music.comCreative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Love Trip by Sarah Jansen Music | https://soundcloud.com/sarahjansenmusic, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Mamacita by Mike Leite | https://soundcloud.com/mikeleite, Music promoted by https://www.free-stock-music.comCreative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Slipz (audio logo) by tubebackr | https://soundcloud.com/tubebackr, Music promoted by https://www.free-stock-music.com. Sound effects from https://www.free-stock-music.com.  Thank you for listening!Please send us an email to let us know what you thought.You can contact us at westmeadedjournalclub@gmail.com.You can also follow us on Facebook, Instagram, and Twitter!See you next time,Caroline, Kit, Pramod, Samoda, and Shreyas.~

How do you discuss a disease with no history during Black History month? Surfing the NASH Tsunami asked, "What challenges exist for non-Hispanic Black Americans in the areas of NAFLD and NASH, given how low incidence is?" In this conversation, a corporate executive, not-for-profit patient champion and academic researcher discuss some of the reasons it is so important to identify and address these issues today.Yani Adere, NASH MSL at Novo Nordisk and the person who pitched the episode idea to Roger Green, kicks off this conversation by discussing issues that concern and motivate her, She notes that even with lower incidence than other racial groups, NASH is still the second leading cause of liver transplant in non-Hispanic blacks and that the course of the disease is similar in black and Caucasians. Next, Global Liver Institute Founder and CEO Donna Cryer notes that since NASH is a disease without much history, we can make Black History in realtime by introducing clinical trial protocols, treatment modalities and population screening programs that address specific challenges facing that community. Next, Dr. Zaki Sherif of Howard University notes that end-stage liver disease in non-Hispanic Black communities has two challenges: faster progression from cirrhosis to HCC than other groups and lower likelihood to receive a liver transplant. During the rest of this conversation, Dr. Ani Kardashian of the Keck School of Medicine at USC, Zaki and Donna comment on several addressable issues that explain why liver outcomes are lower for non-Hispanic Blacks than for other racial groups.

In recognition of Black History Month, SurfingNASH looks at how the impact of NASH on non-Hispanic Black Americans differs from other groups. The episode includes Key Opinion Leaders not only in Fatty Liver disease but also, more broadly, social determinants of health like food insufficiency and clinical trial participation.This episode was originally suggested by Dr. Yani Adere, a Medical Science Liaison at Novo Nordisk and long-time SurfingNASH listener. Yani set the stage for this conversation by noting that while incidence of NASH and NASH cirrhosis may be relatively low among non-Hispanic Black Americans, those who get the disease progress at the same rate as other ethnic groups and, in fact, Fatty Liver is the 2nd leading cause of cirrhosis in this population. She concludes by noting that Social Determinants of Health (SDOH) create undue burdens for Black Americans with liver disease as with other diseases.Donna Cryer, Founder and CEO of the Global Liver Institute followed Yani. First, she noted that since NASH has a limited history as a disease, it offers the chance to create history by building health equity into clinical trials and patient treatment as initial protocols and guidelines come into force, "instead of waiting 5-10 years" as with other diseases.Dr. Zaki Sherif of Howard University raised an important point about Liver Disease in this community: while non-Hispanic Black Americans progress from liver to cirrhosis slowly (as do other groups), the speed at which they progress from cirrhosis to HCC is faster...and Black Americans are less likely and slower to receive liver transplants.Dr. Ani Kardashian of USC, a transplant hepatologist and national leader on the issue of food insufficiency, began her comments by nothing that while Fatty Liver disease is not as common in Black Americans, outcomes are poorer. Ani raises the issue that some of the poorer outcomes might result from lower levels of patients in clinical trials, which is a challenge with many diseases.From here, the discussion heads off in several different directions, all of which confirm the point that the intersection of relatively low incidence, other diseases with higher prevalence and severe outcomes and the range of SDOH issue leads to a situation where patients receive less treatment and support than other sub-populations. The group discusses some of the major challenges and posits possible solutions.

Please join author Khurram Nasir and Associate Editor Sandeep Das as they discuss the article "Social Vulnerability and Premature Cardiovascular Mortality Among US Counties, 2014-2018." Dr. Carolyn Lam: Welcome to Circulation on the Run your weekly podcast, summary, and backstage pass to the journal and its editors. We're your co-hosts, I'm Dr. Carolyn Lam, Associate Editor from the National Heart Center in Duke-National University of Singapore. Dr. Greg Hundley: And I'm Dr. Greg Hundley, Associate Editor, Director of the Poly Heart Center, VCU Health in Richmond, Virginia. Dr. Carolyn Lam: Greg, I'm really excited about today's feature discussion. It's really meaningful on so many levels. It discusses social vulnerability. In other words, social determinants of health and its association with premature cardiovascular mortality among US counties. Now, even as an ex-US person I learned a lot, so everyone is going to want to listen in. But now let's start with going through some exciting papers in today's issue, shall we? Dr. Greg Hundley: You bet Carolyn. So, I'm going to grab a cup of coffee and we'll get started with the first article. And really gets into the world of cardiovascular risk and prostate cancer management. Dr. Greg Hundley: So, Carolyn in the light of improved prostate cancer survivorship, and the competing risk of cardiovascular disease, there's an ongoing need for rigorous cardio oncology clinical trials. As you probably know, androgen deprivation therapy is a cornerstone of prostate cancer therapy. Through different pituitary gonadotropin releasing hormone receptor mediated mechanisms both GnRH agonists, as well as antagonists, either indirectly or directly inhibit luteinizing hormone secretion, consequently inhibiting testosterone production. These GnRH agonists are the most commonly prescribed form of androgen deprivation therapy with only 3 to 4% of patients receiving a GnRH antagonist. Dr. Greg Hundley: So, Carolyn the relative cardiovascular safety of gonadotropin releasing hormone antagonists compared with gonadotropin releasing hormone agonists in men with prostate cancer and known atherosclerotic cardiovascular disease remains somewhat controversial. And therefore these authors led by Dr. Renato Lopes from both Brazil, as well as the Duke University Medical Center in Durham, conducted an international multicenter, prospective randomized open label trial, and men with prostate cancer and concomitant atherosclerotic cardiovascular disease were randomized one to receive gonadotropin releasing hormone, antagonist degarelix or the gonadotropin releasing hormone, agonist leuprolide for 12 months and the primary outcome was time to first educate major adverse cardiovascular event that combined the endpoints of composite death MI and stroke over these 12 months. Dr. Carolyn Lam: Nice Greg, and what did they find? Dr. Greg Hundley: Right Carolyn, due to slower than projected enrollment and fewer than projected primary outcome events enrollment was stopped before the 900 plan participants were accrued from May 3rd, 2016 to April 2020, a total of 545 patients from 113 sites across 12 countries were randomized. Baseline characteristics were really balanced between the two study groups. Now Mace occurred in 5.5% of the patients assigned to degarelix and 4.1% assigned to leuprolide and so in summary, Carolyn, this pronounced study is the first international randomized clinical trial to prospectively compare the cardiovascular safety of a gonadotropin releasing hormone antagonist as well as agonist in patients with prostate cancer. And the study was terminated prematurely due to smaller than planned number of participants and events. And so no difference in mace at one year was noted between the two groups and this pronounced study really provides a model for interdisciplinary collaboration between urologists, oncologists and cardiologist with a sheer goal of evaluating the impact of cancer therapies on cardiovascular outcomes. Dr. Carolyn Lam: That's so cool, Greg. I heard the presentation of these results at the ESC by Dr. Renato Lopes and it's a really cool and important study, but a paper I want to present is an analysis from Emperor preserved on inpatient and outpatient heart failure events. Dr. Greg Hundley: Great. Carolyn, so remind us, what did the Emperor preserved trial show? Dr. Carolyn Lam: Emperor preserved showed that in patients with heart failure and preserved ejection fraction empagliflozin reduce the primary endpoint of cardiovascular death or hospitalization for heart failure, primarily related to a lower risk of hospitalizations for heart failure. Greg you're smiling, because you can see me beaming because we finally have a robustly positive outcomes trial in have pep in this trial. Nonetheless in the current analysis, Dr. Milton Packer from Baylor Heart and Vascular Institute and others used prospectively collected information on inpatient and outpatient events, reflecting worsening heart failure, and pre specified their analysis in individual and composite end points. Dr. Greg Hundley: I've been in suspense here. What did they find? Dr. Carolyn Lam: Empagliflozin reduced the risk of severe hospitalizations as reflected by admissions requiring the use of ionotropic or vasopressor drugs and the need for intensive care. Empagliflozin also reduce the risk of outpatient worsening heart failure events, including the need for urgent care visits, diuretic, intensification, and unfavorable changes in functional class. So, basically benefit across the spectrum. Furthermore, because there's controversy about the effect across the spectrum of ejection fraction. The benefit on total heart failure hospitalizations was found to be similar in patients with an ejection fraction of above 40, but less than 50% and between 50 to 60%, although it was attenuated at the higher ejection fractions and we'll hear a lot of discussions about this.   Dr. Greg Hundley: Wow, Carolyn. Just more information that keeps coming out about SGLT-2 inhibition. My next paper comes from the world of preclinical science and angiogenesis is a dynamic process, involves expansion of a preexisting vascular network that can incur in a number of physiologic and pathologic settings. But despite its importance, the origin of the new angiogenesis vasculature is really poorly defined in particular, the primary subtype of endothelial cells, whether they be capillary, Venus or arterial that might be driving, this process really remains undefined. These authors led by Dr. Michael Simmons at Yale University school of medicine, fate mapped endothelial cells using genetic markers specific to arterial, Venus and capillary cells. Dr. Carolyn Lam: What did they find Greg? Dr. Greg Hundley: This team study results found that Venus endothelial cells were the primary endothelial subtype responsible for the normal expansion of vascular networks, formation of arterial, venous malformation, and pathologic angiogenesis. And these observations highlight the central role of the Venus endothelium in normal development and disease pathogenesis. Dr. Carolyn Lam: Wow. That's really interesting. I don't think I've ever really paid attention to that bit. Venus endothelium. Thank you for that. Now what else is in today's issue? Well, there's an exchange of letters between Doctors Zhang and Liao regarding the article anti hypertrophic memory after regression of exercise induced physiologic, myocardial hypertrophy is mediated by the long noncoding RNA M heart 779, then ECG Challenge by Dr. Ahmed on challenges of interpreting smart watch and implantable loop recorder, tracings. There's cardiology news by Tracy Hampton and Highlights from the Circulation Family of journals by Sara O'Brien. These regular articles are just really worth a read. You learn so much from just these short lovely summaries. There's On My Mind paper by Dr. Meyer on a targeted treatment opportunity for taking advantage of diastolic tone. And there's also a Research Letter by Dr. Brozovich on a rat model of heart failure with preserved ejection fraction changes in contractile proteins, regulating calcium cycling and vascular reactivity. Dr. Greg Hundley: These journal issues, there's so much information. I'm in a close out with an in depth piece from professor entitled antithrombotic therapy in patients undergoing transcatheter interventions for structural heart disease. I really look forward to your feature discussion on the social vulnerability and premature cardiovascular mortality in US countries. Dr. Carolyn Lam: Thanks Greg. It's good. Dr. Carolyn Lam: Today's feature discussion focuses on an extremely important topic of social vulnerability and premature cardiovascular mortality. So pleased to have the corresponding author of the feature paper, Dr. Khurram Nasir from Houston Methodist and Dr. Alana Morris, who is the editorialist for this paper. And she's joining us from Emory University in Atlanta, Georgia. So thank you both of you for joining and Alana if you don't mind, I'm going to borrow some of the words from your really-excellent editorial to bring us into the discussion. You very nicely brought up that early race and ethnic disparities and a death toll from COVID 19 really, laid the foundation for us having Frank conversations about vulnerable populations and has really brought to light social determinant of health and social economic inequality as risk factors. Now that's, COVID 19. And frankly, if we put everything in a global view of what kills most of us, it's still cardiovascular disease, which is why this paper is just so important, but current recognizing I'm not from the US, lots of our audience are not from the US. Could you please walk us through what your paper looked at and what it means? Dr. Khurram Nasir: Sure. Klan, thank you so much for having us today and what a wonderful editorial by Dr. Morris on this. As you pointed out about the COVID challenges, we were all touched by the significant disparities, really in a one of the lifetime crisis, such as COVID. But the reality is that even in times of calm the benefits, for example, cardiovascular disease prevention access have not been shared equally among vulnerable groups. So I'm a preventive cardiologist, and it gives me immense pride that despite being the number one cause of morbidity mortality for so long as a cardiology community, we have made significant strides over the last three decades, cutting into our losses. And if you look at the trends it's appeared and I'm very hopeful that we'll soon be losing the number one killer tag in US. At the same time we are seeing that those cuts are being lost, especially in the young individuals. Dr. Khurram Nasir: And at one point while we celebrate these decline. But the thing that bothers many of us that unfortunately these gains have not been equal, especially for our more vulnerable patients. And apart from the well documented, I think racial disparities that we all know and are becoming more aware. I think health disparities also form across various fourth lines and I believe the deepest and more persistent divides is around income. And you can even go a step further in US, unfortunately for our international group is unfortunate fact that in US, your zip code may hold more sway than your genetic code. And an example was made famous in St. Louis, Missouri Del marble award, which is known as the Delmer divide, a title that was made famous by a four minute BBC documentary that showed, that a sharp dividing line between the poor predominantly African American neighborhoods in the north and more affluent, largely white neighborhood in the south with health falling across this divide. Dr. Khurram Nasir: And in our practice, we see this phenomenon clearly in our own backyard. So, inspired by this sterling. We wanted to determine that a mirror geographical measure, where we can get insights of conditions where people live, learn, work, play, grow, and age, and commonly now known as the social determinants of health. Can that explain some of these rising risks, especially in the premature cardiovascular disease. So to design this study, we reached out to the CDC social vulnerable, the index that has been created that ranks communities and zip codes based on 15 factors across food domains, socioeconomic status, household composition of disability, that in includes single parents, elderly or children, minority status and language and housing type and transportation, all of them are put together and for each census. And then eventually at the county level, you can classify what their social vulnerability is. And as you know, this was really developed in to identify places where in times of disaster and emergencies, you can focus a little bit more, but we thought about how do we connect this to, for example, our data on mortality from CDC wonder. Dr. Khurram Nasir: And once we did that, we found very interesting patterns that across the scale social vulnerability, there is a risk dose dependent fashion and the age adjusted mortality rates for premature cardiovascular disease, which we define as less than 65, went from the least vulnerable and became the worst across the most vulnerable. At the same time, we also found this double jeopardy issues where this association was varied by race, gender, and ruler. And what we found that specifically Non-Hispanic lack individuals were more likely for certain types of cardiovascular, premature, such as stroke and heart failure, mortality, as compared to the rest, even if you were from the least vulnerable to the most women also unfortunately had a twofold higher risk of CBD mortality. And what is becoming clearly this whole ruler urban that a two to five fold risk of CBD mortality was seen among the least vulnerable. So this is in just the motive of our study, what we did and what we found. Dr. Carolyn Lam: That is so wonderful. Thank you for setting the context and then just to reiterate, so this was all within the US. Alana, could you maybe help frame how important these findings are for us? Dr. Alana Morris: Yes. I think that this analysis is so important, particularly within the context of some of the things that we see happening politically in our country and our landscape right now. And I think we tried to touch on some of those issues in the editorial. Again, I think that the COVID 19 pandemic, if you want to put that against this landscape has really brought into the forefront of our minds, this issue of disparities. Of course, there are many of us who have been thinking about researching and writing about disparities for a long time, but the issue of disparities really, came into the public mindset with the COVID 19 pandemic. The question now is how do we address these as we go forward? And what we're seeing politically is this question of how do we address inequalities that have been present for really since the beginning of time and maybe are widening and perhaps threaten many of the advances that we've made in terms of cardiovascular disease, morbidity, and mortality. Dr. Alana Morris: I think we have to think about in the US, universal healthcare coverage, because we have to be able to prevent disease and treat disease. And as current addressed, there are neighborhood zip codes where people not only don't have access to healthcare, but they don't even have access to the ability to promote health. They don't have access to things like parks, where they can exercise. They don't have access to healthy foods or grocery stores and in a country like the United States where there's so much wealth, you need to think about the fact that certain individuals, don't have the ability to access a grocery store, to access healthy food. It's just really striking and mind boggling that we have this, the difference in rural versus urban locations where some of our US residents, unfortunately don't have access to primary care clinicians, certainly not specialty clinicians is really very mind boggling. And we've seen this play out with the pandemic, but hopefully once we get past the COVID 19 pandemic, we still have to come back to a place where again, we're taking care of not only preventives or services to prevent the onset of cardiovascular disease, but certainly once people are diagnosed with cardiovascular disease, we want to get them access to specialty care. So we have to think as a community, how do we prevent disease, but also treat disease once disease is diagnosed within our country.   Dr. Carolyn Lam: What you just said about the zip code being more powerful about, than the genetic code, that's like a quotable code. It's incredible. And for those of us coming outside of the US, we don't even realize how much that plays a role, even just within the US. But now let's get to exact point that Alana pointed out, which is what are the next steps. And could you maybe suggest Khurram, and Alana maybe come first, but what's the one thing you want to get out or the one next thing that should happen after this Dr. Alanna Morris: We put a figure in to the editorial that I think really gets to the heart of the matter, I think that those of us who are in healthcare or those of us who think about public health really would ask the question of, why in a country that has as much wealth as the United States, do we not have universal healthcare, most countries across the world that are in an economic position similar to the United States do have universal healthcare coverage for their residents. And you see much better statistics in terms of longevity for their residents as compared to what we have in the United States. And what you see when you look at the United States is that where there is the most vulnerable residents as per analysis identifies those states are the ones that actually don't have, Medicaid expansion. Dr. Alanna Morris: They don't have a safety net for their residents. And so there's really contrast and this disparity that just does not make sense. It does not make sense where there are residents in the United States, which need the most help and they just don't have it. They just are not able to get access to preventive services as well as diagnostic services. And it really just doesn't make sense what we're doing in the United States, in my humble opinion. And I think in the humble opinion of many of us who want to take care of patients, but just cannot, Kern and I both practice in states where this is an issue. And I think that's one big driver. But again, I think when we also think about the built environment in the US and how we think about promoting health and how we talk to patients, when we talk about individuals in the US, we try to give them advice about therapeutic lifestyle changes, how to exercise, how to eat healthy, to prevent disease. That's easier for certain individuals as compared to others, depending upon where you live, depending upon those five digits that make up your zip code. So if we really want our residents to be healthy, we have to create an environment that enables them to do that. Dr. Carolyn Lam: Wow, thank you very much. And as I let Khurram have the final words even about where you think mixed research should be. I just want to highlight that incredible figure from your editorial Alana. I mean, it is really started, there are three panels to it, everyone. The first one chose the social vulnerability index, the second, the premature cardiovascular disease mortality, and then the third, the status of Medicaid expansion. And you can see the colors are just vivid in, how it all makes sense and goes together. So pick up our journal and have a look, but then finally Khurram? Dr. Khurram Nasir: So, Alana, your figure was fantastic and so much add perspective to our findings. As you were saying, it took me back to 35 years back when, where we are before Medicare disparities, even in access to hospitals were dramatic. So where we practice in the south one third of the hospitals would not admit African Americans even for emergency. Now, this is where the policy comes in and suddenly in 1965 using the carrot of Medicare dollars, the federal government virtually ended the practice of racially segregating patients, doctors, and medical staffs, blood supplies so that is the direction that we need to go from the policy perspective and trying to affect the upstream determinants. Now moving forward, as I think more, and especially as a physician, I think while the census level measures are extremely useful to help refine these policy and focus programs in vulnerable areas. Dr. Khurram Nasir: I also think that there is a parallel need to start focusing on similar efforts at the individual level. The first thing is how do we even identify social determinants at this patient level? Are there three main categories, income, education, possibly healthcare, but I think that we need to broaden this. And in the past we have been challenged because we didn't have a set of consensus of the defined SDUH framework. But thankfully now in 2021, we have the healthy people, 2020. Actually for international community, the WHO there is a WHO framework of identifying SDOH at an individual level and in US a more comprehensive Kaiser family foundation. And not only that, we looked at superficially broadly, but we have to go deeper beyond these components of economic instability, education, housing, social context on healthcare beyond insurance, and even food. Dr. Khurram Nasir: For example, income and employment are predominant pillars of income stability, but it may not capture the full picture. For example, difficulty paying bills out of pocket cost and death related to medical care, same in education, where we captured the highest degree, but issues around health and digital literacy and language proficiency may be even more important. So not only we have to broaden the scope, but we have to go in depth. And thirdly, what I've realized from these kind of studies that we have to go a step further, that social disparities don't occur in silos. And we have to look at the aggregated information. And maybe it's time to potentially learn from advances in genetics, in what we have learned that manifestation of disease, especially cardio metabolic rather than being influenced by few major genes is manifested secondary to multiple interacting genes. So can we create similar to a poly genetic risk score, which is an aggregation of genetic smaller risk to a relevant something similar called poly social risk score. Dr. Khurram Nasir: Now, this is an area that our group has been extensively working. And over the last 12 months, we have tried to construct a comprehensive poly social risk score at an individual level based on almost about 50 sub components of the social determinants. And we have suddenly finding very interesting associations with premature CAD stroke. Almost one in two young individuals with stroke, have the worst poly social risk code at the individual level. I think so the next steps will be definitely validation of this tool, incorporation in practice, whether it's adoption and effective interventions can be tied. But the final thing, what I truly want to say is that I'm hopeful that these efforts, the census level at an individual level, at a societal level and the health system are waking up to the importance of social determinants that we can think outside the box and have strong community partnerships. Multi Pro strategies driven largely by social economic environmental factors. So we can all make a lead towards the mission of achieving social justice and equity that eventually cascades through the health system and beyond. So we had enough time to illuminate the issues and challenges. Now it's the time to act. Dr. Carolyn Lam: Thank you so much Kern for a beautiful paper. We are so proud to be publishing it in circulation. And thank you, Alana lovely, editor that we've said so many times. Thank you audience for joining us today. You've been listening to Circulation on the Run from Greg and I please tune in again. Next week, Dr. Greg Hundley: This program is copyright of the American heart association, 2021. The opinions expressed by speakers in this podcast are their own, and not necessarily those of the editors or of the American heart association for more visit ahajournals.org.

Host: Alpha Mike Intro: Host Alpha Mike welcomes the Nation to episode #237. How to contact us RaiderCop.Com and RaiderCopNation.com. Join us on, our social media accounts, you can find us @RaiderCop @RaiderCopNation or @RaiderCopPodcast. Additionally you can hear Raider-Cop Podcast wherever you get your podcast, just look us up. Alpha reminds the Nation about joining the USCCA, pennies on the dollar when you need it. Just text, “Raider” to 87222 to become a member today. Want to upgrade your old gun, well I got the guy for you. Pistol Pete The Gunsmith (8277 NW 64th Street Miami, Florida 33166/ p 786-294-0756), see below for details. Need gun training in the Jersey / Philly area, contact Kilo Sierra www.sepulveda.com and you can contact me, Alpha Mike (raidercopnation@gmail.com) if you are in Florida for gun training. Please consider supporting Tunnel to Towers Foundation Living in the Bolshevik States of Woke: 1. Democrats oppose ending house arrest. 2. Media continues to fawn over Joe Biden after 6 months. 3. Kamala routine checkup at Walter Reed on a Sunday night Joke: How do you fix a broken gorilla? with a monkey wrench Word of the Week: Now May the God of hope fill you with all joy and peace in believing, that you may abound in hope by the power of the holy spirit. Romans 15:13 Main Topic: The Downfall of Portland Portland Population Next to Vancouver, Canada Demographics 2010: White 76.1%, Non Hispanic 72%, Black 6.3%, Latino 9.4%, Asian 7.1 Historically has a significant connection to the LGBT community only behind San Francisco 54% Democratic, 11.1% Republican, 26.2 Unaffiliated, 8.7% other De-funding the Police cause 1,900% murder increase The rise of ANTIFA, left wing thugs majority with communist / socialist principles National murder percentage rates Up Next: #238 July 25, 2021; Tactical Shooting Rifle with Kilo Sierra & #239 July 28, 2021; Freedom Instagram @milo_raider_cop  & @raidercoppodcast Co-host of Raider-Cop Tube coming in 2021 Spotify   Stitcher  PodBean Join the Raider-Cop Nation Pistol Pete the Gunsmith                                                                                  Kilo Sierra's Firearms Training or Investigation: Sepulveda inc MeWe, WimKin, Rumble.ApplePodcast GooglePodcast Pandora Frank the voice of free speech Parler: @RaiderCop  CloutHub: @RaiderCopWimkin: @Martinino and Raider Cop PodcastMeWe: Raider-Cop Podcast & Alpha MikeGab: @RaiderCopPodcastFacebook @RaiderCopNationGun Owners Of America GOA joinUnited States Concealed Carry Association USCCA JOIN#JailsLASD #CACorrections #MDCR #NYPD #LAPD #LASD #MDPD #MPD #NYSP #NJSP #LVPD #Security #HCSO #PBSO #BSO #OCSO #PCSO #SFPD #DPD #HPD #SAPD #LCSO #FMPD #CCSO #NYC #NYCDOC #NJDOC #PPD #SLPD #CPD #TestEverything @RaiderCopNation #RaiderCopNation #TrainUp #o9TG #WiseGuySeries #TrainUpSeries #RollCallSeries #ThinkOuttaDaBox #SideBarSeries #TheWord #Buccaneer #OfficerDeanJoseph #RaiderCopPodcast #BeLikeJack #Corrections #RaiderCop #EmpanadaLadiesOfGeorgia Stepping Across The Line, a skid row cop's storyYoutube Free Music: Triumph by Yung Logos, Rodeo Show by The Green Orbs, Minor Blues for Booker E's Jammy Jams, Happy Birthday Mambo, by E's Jammy James. The Awakening Patrick jazz Space, The Current Blues, Blue Infusion, Front Porch Blues, Crazy Blues, Midnight Special, Super Blues, Bright Eyed Blues, Bleeker Street Blues, Olde Salooner Blues, Miles Beyond, D.J. Freedem, Causmic, Verified Picasso, Coyote Hearing, Diamond Ortiz, Nico Staf Brooklyn & The Bridge, 2 Hearts Patrick Patikios, A Ghost Town Quinoas Moreira, Tacklebox Blues Mini Vandals. Road Tripzzz of shane 1 & Like That Anno Domini Beats, Seration from the sun Rage.PatrikiosMusic: I'm Back by Eye of the beholder. #SOSCUBA

Paul J. Wang: Welcome to the monthly podcast On the Beat for circulation, arrhythmia, and electrophysiology. I'm Dr. Paul Wang, Editor In Chief, with some of the key highlights from this month's issue.   Elizabeth Wang and Associates examined the relationship between acute precipitants of atrial fibrillation and long-term recurrence of atrial fibrillation, AF, from a multi-institutional, longitudinal electronic medical record database. Among 10,723 patients with newly diagnosed Afib, age 67.9 years, 41% women, the authors found that 19% had an acute AF precipitant, the most common of which were cardiac surgery in 22%, pneumonia in 20% and non-cardiothoracic surgery in 15%. The cumulative incidence of AF recurrence at five years was 41% among individuals with a precipitant, compared to 52% in those without a precipitant. Adjusted hazard ratio 0.75 P < 0.001. The lowest risk of recurrence among those with precipitants with postoperative atrial fibrillation, five-year incidence 32% in cardiac surgery and 39% in non-cardiothoracic surgery. Regardless of the initial precipitant, recurrent atrial fibrillation was associated with an increased adjusted risk of heart failure, hazard ratio of 2.74 P < 0.001, Stroke, hazard ratio 1.57 P < 0.001 and mortality, hazard ratio 2.96 P < 0.001. Thus, the authors found that atrial fibrillation after acute precipitant frequently recurs and the recurrence is associated with substantial long-term morbidity and mortality.   In the next paper, Jacob Koruth and associates examine the effect of pulse field ablation on the esophagus in a novel in-vivo porcine esophageal injury model. The authors studied 10 animals under general anesthesia while the lower esophagus was deflected towards the inferior vena cava using an esophageal deviation balloon and ablation was formed from within the inferior vena cava at areas of esophageal contact. Six animals received eight pulse field ablation applications per site and four animals received six clusters of irrigated radio frequency ablation applications at 30 Watts for 30 seconds. All animals survived to 25 days, sacrificed, and the esophagus was submitted for a pathological examination including 10 discreet histological sections of the esophagus. The authors found that zero out of six pulse field ablation animals demonstrated esophageal lesions while esophageal injury occurred in all four radio frequency ablation animals, P = 0.005. A mean of 1.5 mucosal lesions per animal, length 21.8 millimeters with 4.9 millimeters were observed, including one esophageal pulmonary fistula, and deep esophageal ulcers in the other animals. Histological examination demonstrated tissue necrosis surrounded by an acute and chronic inflammation and fibrosis. The necrotic radio frequency ablation lesions involved multiple esophageal tissue layers with evidence of arteriolar medial thickening and fibrosis of peri-esophageal nerves, abscess formation and full thickness esophageal wall disruption were seen in the areas of perforation or fistula.   In our next paper, Peter Noseworthy and associates examine whether the ability of deep learning algorithms to detect low left ventricular ejection fraction using the 12 lead electrocardiogram varies by race or ethnicity. The authors used a retrospective cohort analysis and included 97,829 patients with paired electrocardiograms and echocardiograms and used a convolutional neural network to identify patients with a left ventricular ejection fraction less than or equal to 35% from the 12 lead electrocardiogram. The convolutional neural network was previously derived in a homogeneous population, 96.2% non Hispanic white, N = 44,959 which demonstrated consistent performance to detect low left ventricular ejection fraction across a range of racial ethnic subgroups in a separate cohort of 52,870 patients (Non-Hispanic white 44,524 patients with an AUC of 0.93; Asian 557 with an AUC of 0.96; Black/African American N = 651 with an AUC of 0.937; in Hispanic/Latino N = 331 AUC of 0.937; in Native American/Alaskan N = 223 AUC of 0.938). In secondary analysis, a separate neural network was able to discern racial subgroup category, Black/African American AUC 0.84 and white non-Hispanic AUC 0.75 in a five-class classifier. In a network trained only in non-Hispanic whites, from the original derivation cohort, performed similarly well across a range of racial ethnic subgroups in the testing cohort with at least an AUC of 0.93 in all racial ethnic subgroups. The authors concluded that while ECG characteristics vary by race, this did not impact the ability of a convolutional neural network to predict low left ventricular ejection fraction from the ECGs. They recommend reporting of performance against diverse ethnic, racial, age, and gender groups for all new artificial intelligent tools.   In our next paper, Benjamin Shoemaker and associates examine the association between atrial fibrillation or AF genetic susceptibility and recurrence after de novo AF ablation, using a comprehensive polygenic risk score for AF in the 10 centers from the AF genetics consortium. AF genetic susceptibility was measured using a previously described a polygenic risk score, N = 929 snips. The overall arrhythmia recurrence rate between 3 and 12 months was 44% in 3,259 patients. Patients with a higher AF genetic susceptibility were younger and have fewer clinical risk factors for atrial fibrillation. Persistent atrial fibrillation has a ratio of 1.39, left atrial size has a ratio of 1.32, and left ventricular ejection fraction per 10% has a ratio of 0.88, were associated with increased risk of occurrence. In unit varied analysis, the authors found that AF genetic susceptibility had a hazard ratio of 1.08 P = 0.07 and in multivariate analysis hazard ratio 1.06 with a P value 0.13.   In our next paper, Mohit Turagam and associates reported the outcomes of the first inhuman value trial, which uses low intensity collimated ultrasound or LICU guided anatomical mapping in robotic ablation to isolate the pulmonary veins for atrial fibrillation ablation. In 52 paroxysmal atrial fibrillation patients, ultrasound M-mode based left atrial anatomies were successfully created and ablation was performed under robotic control along an operated defined lesion path. The operatives found that acute pulmonary vein isolation was achieved in 98% of pulmonary veins using LICU only in 77% of pulmonary veins and requiring touch-up with a standard radio frequency ablation catheter in 23% of the pulmonary veins. The touch up rate decreased to 5.8% in patients undergoing LICU ablation with an enhanced software. Freedom from atrial relational recurrence was 79.6% at 12 months or 92.3%, 12 out of 13 patients with the enhanced software. Major adverse events occurred in three patients or 5.8%. One had transient diaphragmatic paralysis, one vascular access complication and one had transient ST segment elevation from air-embolism without sequelae.   In our next paper, Miguel Rodrigo and associates mapped electrical patterns of disorganization and reasons of reentrant activity in atrial fibrillation, or AF, from the body surface using electrocardiographic imaging. The author examined the bi-atrial intracardiac electrograms of 47 patients at ablation (30 persistent, 29 males, age 63 years) obtained using 64-pole basket catheters while simultaneously recording 57-lead body surface electrocardiogram. The authors found the body surface mapping showed greater atrial fibrillation organization near intracardiac detected drivers and elsewhere, both in phase singularity density in numbers of drivers, they found that complexity defined as a number of stable AF reentrant sites was concordant between the noninvasive and invasive methods. The subset receiving targeted ablation, AF complexity, showed lower values in those in whom AF terminated than in those in whom AF did not terminate, P < 0.01. The authors concluded that AF complexity, assessed noninvasively, correlates well with organized, disorganized regions detected by intracardiac mapping.   In our next paper, Krystien Lieve and Veronica Dusi and associates examined whether heart rate reduction immediately after exercise is regulated by autonomic reflexes, particularly vagal tone and may be associated with symptoms and ventricular arrhythmias in patients with catecholaminergic polymorphic ventricular tachycardia, CPVT. In a retrospective observational study, the authors studied 187 patients mean age 36 years, 68 or 36% symptomatic before diagnosis, pre-exercise stress test heart rate and maximal heart rate were equal amongst symptomatic and asymptomatic patients. Patients that were symptomatic prior to diagnosis had a greater delta HRR one prime after a maximum exercise, 43 versus 25, P < 0.001. Corrected for age, gender, and relatedness, patients in the upper tertile for Delta HRR one prime had an odd ratio of 3.4 of being symptomatic before diagnosis, P < 0.001. In addition, Delta HRR one prime was higher in patients with complex ventricular arrhythmias at exercise stress test, off antiarrhythmic drugs. After diagnosis, patients with a Delta HRR one prime in the upper tertile of its distribution, had significantly more rhythmic events as compared to patients and other tertiles, P=0.045. The authors concluded that CPVT patients with a larger heart rate reduction following exercise are more likely to be symptomatic and have complex ventricular arrhythmias during first exercise stress test off antiarrhythmic drugs.   In our next paper, Balvinder Handa and associates examined whether low spatial resolution, sequentially acquired data can be used to examine the global fibrillation organization, characterizing dominant propagating patterns and identifying rotational drivers. The authors employed ranger causality analysis, an econometric tool for quantifying causal relationships between complex time series, which was developed as a novel fibrillation mapping tool and adapted to low spatial resolution sequentially acquired data. Ventricular fibrillation, or VF, optical mapping was performed and Langendorff-perfused Sprague Dawley rat hearts, N = 18. And novel algorithms were developed using Granger causality analysis to quantify causal dependence of neighboring signals and plot Granger causality analysis vectors, quantify global organization using causality pairing index, a measure of neighboring causal signal pairs, and localize rotational drivers by quantifying the circular interdependence of neighboring signals with the circular interdependence value. Granger causality analysis based mapping tools were optimized for low spatial resolution by down sampled optical mapping data validated against high resolution phase mapping analysis and further tested in previous VF optical mapping recordings of coronary perfused donor heart LV wedge preparations, N = 12, and adaptive for sequentially acquired intracardiac electric Grande during human persistent atrial relation mapping, N=16. The authors found that global VF organization quantified by causality pairing index showed a negative correlation at progressively lower resolutions in organized VF with high causality pairing index values. Ranger causality analysis vector mapping characterize dominant propagating patterns and localized stable rotational drivers with the circular interdependence value showing a significant difference in driver versus non driver regions, P = 0.0002. These findings were further confirmed in human VF in persistent atrial fibrillation, a positive correlation was found between causality peri-index and presence of stable rotational drivers. 50% of patients had rotational drivers with a low incidence of 0.9 rotational drivers per patient. In a special report, Piotr Futyma and associates report on the use of bipolar radiofrequency ablation of ventricular arrhythmias originating in the vicinity of the His bundle. Bryce Alexander and associates report in a research letter the patient acceptance of cybersecurity upgrade in ICDs.   That's it for this month. We hope that you'll find the journal to be the go to place for everyone interested in the field. See you next time.   This program is copyright American Heart Association 2020.

Really? Who's got all their shit together all the time? Simple. Nobody does.NOTE: Mental health is a topic that hits home with all three of us on the Shit Show, so this is gonna get personal.Let's get real. Mental health is a real and significant issue. We convince ourselves of the lie, nobody cares and you're alone. This is bullshit. People do care and you are NOT alone! Some facts:• 19.1% of U.S. adults experienced mental illness in 2018 (47.6 million people). This represents 1 in 5 adults.• 4.6% of U.S. adults experienced serious mental illness in 2018 (11.4 million people). This represents 1 in 25 adults.• 16.5% of U.S. youth aged 6-17 experienced a mental health disorder in 2016 (7.7 million people)• 3.7% of U.S. adults experienced a co-occurring substance use disorder and mental illness in 2018 (9.2 million people)It's not a race or sexual-preference thing. The annual prevalence of mental illness among U.S. adults, by demographic group:• Non-Hispanic Asian: 14.7%• Non-Hispanic white: 20.4%• Non-Hispanic black or African-American: 16.2%• Non-Hispanic American Indian or Alaska Native: 22.1%• Non-Hispanic mixed/multiracial: 26.8%• Hispanic or Latino: 16.9%• Lesbian, Gay or Bisexual: 37.4%:It's a fucking human thing! Sadly, too many of us believe the lie and don't get help. We must fight the stigma and make help more accessible to those who need it.• 11.3% of U.S. adults with mental illness had no insurance coverage in 2018• 13.4% of U.S. adults with serious mental illness had no insurance coverage in 2018• 60% of U.S. counties do not have a single practicing psychiatristIt's OK to talk about mental health issues openly and it's OK to face our mental challenges head on. It's NOT OK to keep this shit under wraps and it's NOT OK to face your mental challenges alone. The ultimate end for some who are suffering is suicide.• Suicide is the 2nd leading cause of death among people aged 10-34 in the U.S.• Suicide is the 10th leading cause of death in the U.S.• The overall suicide rate in the U.S. has increased by 31% since 2001• 46% of people who die by suicide had a diagnosed mental health condition• 90% of people who die by suicide had shown symptoms of a mental health condition, according to interviews with family, friends and medical professionals (also known as psychological autopsy)• Lesbian, gay and bisexual youth are 4x more likely to attempt suicide than straight youth• 75% of people who die by suicide are male• Transgender adults are nearly 12x more likely to attempt suicide than the general population• Annual prevalence of serious thoughts of suicide, by U.S. demographic group:o 4.3% of all adultso 11.0% of young adults aged 18-25o 17.2% of high school studentso 47.7% of lesbian, gay, and bisexual high school studentsSadly, these numbers are likely worse now. All these statistics are pre-2020, pre-COVID, pre-riots, etc. Take these facts, sprinkle in the stress of working in our (information security) industry (marginalized, understaffed, misunderstood, etc.), and we have a potential recipe for disaster, at least for some of us.This might not be an uplifting topic to discuss on the Shit Show, but it's one we won't back down from. We give a shit about people and we give a shit about you, so we'll openly discuss all this tonight!Be sure to tune in tonight (8/13) at 10pm CDT for our live show. If can't catch us live, go watch the recording afterwards.

"House Speaker Nancy Pelosi compared President Donald Trump to a despotic tyrant in a press conference Thursday and announced she has asked House Judiciary Chairman Jerry Nadler to prepare articles of impeachment," Common Dreams reported. "'The facts are uncontested,' said Pelosi, a California Democrat. 'The president abused his power for his own personal political benefit at the expense of our national security.'""The proposed Trump administration changes to the Supplemental Nutritional Assistance Program (SNAP) could strip 3.7 million low-income Americans of their food stamps and slash benefits for millions of others," Business Insider reported Tuesday, citing a November study by the Urban Institute. The institute said of the proposed changes: "Sixteen percent of households with no children, no adults age 60 or older, and no one with a disability would lose eligibility under the proposed changes to the ABAWD [able-bodied adults without disabilities] regulations. Nearly 12 percent of households with an adult age 60 or older would lose eligibility under the proposed changes to broad-based categorical eligibility (BBCE). Households that include someone age 60 or older or someone with a disability are most likely to be affected by the proposed changes to the SUAs [standard utility allowances], although a larger absolute number of households with children would be affected than for either of these groups. Non-Hispanic white and Asian households would be somewhat more likely than other racial and ethnic groups to lose eligibility or benefits under the proposed changes to BBCE and SUAs. The estimated likelihood of eligibility loss from the proposed ABAWD changes differs little among racial and ethnic groups."According to a Friday Washington Post report on November numbers from the US Bureau of Labor Statistics, “The jobs data offers the latest snapshot into an economy that appears to have lost some steam from 2018 but continues to grow. Heading into President Trump's fourth year in office, the labor market remains one of the economy's biggest engines, and Trump regularly touts the low unemployment rate as one of his top achievements.” Julia Pollak, an economist at ZipRecruiter, "said it was remarkable that so much uncertainty wasn't depressing job growth. And while it's difficult to predict whether the numbers would have come in higher without Trump's trade war, she said the impact seems to have been 'relatively muted.' ... Manufacturing appears to have regained its footing a bit after several months of extreme pressure. Data showed that within manufacturing, jobs in motor vehicles and parts were up by 41,000 in November," the report noted.Trump was in London this week extolling the virtues of NATO and taking French President Emmanuel Macron to task for saying in an interview with the Economist on November 7 that NATO is becoming brain dead; Trump said that was insulting and a “very, very nasty statement.” Then there was a hot-mic video that captured other world leaders making fun of Trump. In January, it was widely reported that Trump was threatening to pull the US out of NATO, and many on his staff were concerned that he would. Macron and Trump had some nice things to say about Russia at the NATO meetings. The French president's argument was that the real threat to Western Europe these days does not come from Moscow in the east, but from terrorists to the south. For example, Thierry de Montbrial, executive chairman of the French Institute of International Relations says, "We are in a totally different world. The shadow of the Soviet Union is no longer a risk of the same nature ... the principal risk is not an invasion into Baltic countries by Russia, it's terrorism, it's the danger we have on our southern flank for which NATO has no response." Macron also questioned whether Article 5, one of NATO's cornerstones – the mutual defense principle that an attack on one ally is an attack on all – was fit for its purpose."Bloomberg News Editor-in-Chief John Micklethwait said in a note to editorial staff Sunday morning that the company will extend its policy of not investigating its owner, Michael Bloomberg, to all Democrats running for president in 2020," Axios reported on November 24. This development comes as Bloomberg surpasses Senator Kamala Harris (D-CA) in the polls, and Harris said Tuesday that she will get out of the race. Let's unpack this knapsack. "The company has struggled in recent weeks to determine how it would cover the race and Bloomberg as a candidate, given that its company policies prohibit the newsroom from covering Bloomberg's wealth or personal life, or stories about the company itself," Axios noted. This is problematic for me. Is Bloomberg News really an independent news organization that displays journalistic integrity or not?"Mike Bloomberg claimed today that he only recently apologized for New York police's 'stop and frisk' policy because he wasn't asked about it before he started running for president," the Washington Post reported Friday. "The former New York mayor, in an interview with CBS News, was pressed by anchor Gayle King about the timing of his apology for the controversial policy that allowed city police officers to detain and search people believed to be involved in a crime, resulting in a disproportionate number of people of color being stopped. 'Well, the mark of an intelligent, competent person is when they make a mistake, they have the guts to stand up and say: I made a mistake, I'm sorry,' Bloomberg said. King said she wasn't questioning whether he believed he'd made a mistake, 'but the timing that you realized you made the mistake.' 'Well, nobody asked me about it until I started running for president, so come on,' Bloomberg said." What is it with these folks? Talk about tone deaf. It's as though they forget that news agencies have archives.GUESTS:Caleb Maupin — Journalist and political analyst who focuses his coverage on US foreign policy and the global system of monopoly capitalism and imperialism. Jim Kavanagh — Political analyst and commentator and editor of The Polemicist.Daniel Lazare — Journalist and author of three books: "The Frozen Republic," "The Velvet Coup" and "America's Undeclared War."Dr. Linwood Tauheed — Associate professor of economics at the University of Missouri-Kansas City.

This week's mid-week BustUp looked at the upcoming Google+ closure due on 2nd April, and look a possibly one of the reasons it failed as a social platform, also looking at Instagram and its rise in popularity while also other such as Facebook, Twitter and Pintrest. ## Video Information Correction ## Please note that Instagram's top user bases is US, but within this demographic it's highest user base is as follows: 43% of Instagram users are Black, Non-Hispanic, 38% are Hispanic, and 32% are White, Non-Hispanic and out of all of those 64% are 18- to 29-year-old's. Although 88% of user are from outside the US (120 mil): 1) India (75 mil) 2) Brazil (69 mil) 3 Indonesia (62 mil) 4) Turkey (38 mil) 5) Japan (27 mil) Live channel every Sunday and midweek for BustUps to your week... And now available to watch us directly on our own website https://gigaxon.com/live Brought to you by James and Rich. The Co founders of an online business dedicated to helping YouTube viewers to understand the different online opportunities available for everyone. During which they will cover different topics each SHow on the basis of entrepreneurship and online business, where the floor is opened up to viewer questions relating to the Live SHow's streamed topic. Also our duo often invite special guests whom together, provide viewers with real-time insights from their own personal perspectives respectively. So sit back, relax and watch out for the open floor signs during each Live SHow, for your chance to ask our experts any burning questions you have on topic of the day. https://twitter.com/gigaxon https://www.facebook.com/gigaxon https://www.instagram.com/gig_xon https://www.pinterest.co.uk/gig_xon https://www.linkedin.com/company/gigaxon ## SUBSCRIBE to get instant notifications to your device of choice, as we'll always notify you 15 minutes prior to a live SHow production stream starting ## ##### Support the stream: https://streamlabs.com/gigaxon ####

There’s been a lot of talk about the coming of majority-minority America — the point, projected for roughly 2045, when there will no longer be any racial or ethnic group that makes up a majority of the United States. But there are plenty of places in America where this has already happened. Los Angeles is one of them. LA has about 4 million people, making it more populous than 23 states, and a demography in rapid flux. Non-Hispanic whites make up about 30 percent of the population, while Hispanics and Latinos make up 47 percent, and African Americans make up 10 percent. Eric Garcetti is the mayor of LA. He’s its first Jewish mayor and its second Mexican-American mayor. He was reelected in 2017 with a stunning 81 percent of the vote. And he’s openly considering a run for president in 2020. If Garcetti does jump into the race, he’ll likely do so based on two core ideas: that there’s a better way to talk about and govern amid diversity than either Donald Trump or the Democrats have shown, and that Americans are primed for a manager who makes running the government their core objective, rather than fighting the culture wars. In this conversation, Garcetti and I talk about what he’s learned governing a majority-minority polity, why he thinks national identity is crucial amid rising diversity, his political vison’s central tenant of “belonging,” the roots of LA’s homelessness crisis, whether paving streets is sexy, and much more. Garcetti offers a different vision of where the Democratic Party should go next — one based much more on the lessons of California than backlash to Trump. It’s worth hearing. Recommended books: Stone, Paper, Knife by Marge Piercy Ficciones by Jorge Luis Borges What It Takes by Richard Ben Cramer Learn more about your ad choices. Visit megaphone.fm/adchoices

Today Dr. Michele is sharing facts and figures about diabetes, how it is affecting millions of Americans each year, and her clinical experience in treating thousands of diabetics over the past 22 years as a diabetic specialist. Prevalence of diabetes Total: 30.3 million people (9.4% of the U.S. population has diabetes.) Diagnosed: 23.1 million people Undiagnosed: 7.2 million people Prevalence of diabetes among different age groups Age 18-44 years: 4.6 million  Age 45-64 years: 14.3 million Age 65 years or older: 12.0 milion  Men:  15.3 million Women: 14.9 million *This total included: 132,000 children and adolescents younger than age 18 years (0.18% of the total U.S. population younger than age 18 years). 193,000 children and adolescents younger than age 20 years (0.24% of the total U.S. population younger than age 20 years). About 5% of people with diabetes are estimated to have type 1 diabetes.  Prevalence of diabetes by race/ethnicity among people 20 years or older The prevalence was higher among Native Americans/Alaska Natives (15.1%), non-Hispanic blacks (12.7%), and people of Hispanic ethnicity (12.1%) than among non-Hispanic whites (7.4%) and Asians (8.0%) Among people of Hispanic ethnicity, Mexicans had the highest prevalence (13.8%), followed by Puerto Ricans (12.0%), Cubans (9.0%), and Central/South Americans (8.5%) Among Asians, Asian Indians had the highest prevalence (11.2%), followed by Filipinos (8.9%), and Chinese (4.3%). Other Asian groups had a prevalence of 8.5% Prevalence varied significantly by education level, which is an indicator of socioeconomic status. Specifically, 12.6% of adults with less than a high school education had diagnosed diabetes versus 9.5% of those with a high school education and 7.2% of those with more than a high school education Prevalence of Prediabetes An estimated 33.9% of U.S. adults aged 18 years or older (84.1 million people) have prediabetes, based on their fasting glucose or A1C level. Nearly half (48.3%) of adults aged 65 years or older had prediabetes. Among adults with prediabetes, 11.6% reported being told by a health professional that they had this condition. Age-adjusted data indicated that more men (36.6%) than women (29.3%) had prediabetes. Prevalence of prediabetes was similar among racial and ethnic groups. Risk Factors for Complications Smoking: 15.9% of adults are current smokers, and 34.5% had quit smoking but had a history of smoking at least 100 cigarettes in their lifetime. Overweight and Obesity: 87.5% of adults were overweight or obese, defined as a body mass index (BMI) of 25 kg/m2 or higher. Physical Inactivity: 40.8% of adults were physically inactive, defined as getting less than 10 minutes a week of moderate or vigorous activity in each of the physical activity categories of work, leisure time, and transportation. High Blood Pressure: 73.6% of adults had systolic blood pressure of 140 mm Hg or higher or diastolic blood pressure of 90 mm Hg or higher, or they were on prescription medication for high blood pressure. High Cholesterol (Hyperlipidemia): 58.2% of adults aged 21 years or older with no self-reported cardiovascular disease but who were eligible for statin therapy were on a lipid-lowering medication. 66.9% of adults aged 21 years or older with self-reported cardiovascular disease who were thus eligible for statin therapy were on a lipid-lowering medication. High Blood Glucose (Hyperglycemia): • 15.6% of adults had an A1C value higher than 9%. Complications of Diabetes:  Amputations More than 60 percent of non-traumatic lower-limb amputations in the United States occur among people with diabetes. Nearly 82,000 non-traumatic lower-limb amputations are performed among people with diabetes each year. Non-Hispanic blacks are 2.7 times as likely to suffer from lower-limb amputations as non-Hispanic whites. Kidney Disease Among U.S. adults aged 20 years or older with diagnosed diabetes, the estimated crude prevalence of chronic kidney disease (stages 1–4) was 36.5%. Among those with diabetes and moderate to severe kidney disease (stage 3 or 4), 19.4% were aware of their kidney disease. Approximately 53,000 people develop end-stage renal disease with diabetes as the primary cause each year. Preventing Diabetes Complications A podiatric physician, a doctor focusing on the treatment of diabetic foot and ankle conditions, plays an integral role in a diabetes management team. Diabetes can affect many parts of the body and can lead to serious complications such as blindness, kidney damage, and lower-limb amputations. Working together, people with diabetes and their health care providers, such as a podiatric physician, can reduce the occurrence of these and other diabetes complications. Comprehensive foot care programs can reduce amputation rates by 45 percent to 85 percent. Research in the United States and abroad has found that lifestyle changes can prevent or delay the onset of type II diabetes among high-risk adults.  Lifestyle interventions included diet and moderate-intensity physical activity, such as walking for 2.5 hours each week.  My Clinical Experience As you many know by now, I’ve been practicing medicine for over 20 years, and in that time I have seen thousands of diabetic patients. My practice is specialized to focus on diabetic care and to prevent diabetic limb loss and amputations. I have discovered that most of my patients are not educated much about how to prevent complications of diabetes or how to reverse diabetes by their primary care physicians. I spend much of my time educating my patients about diabetes, what they should and should not be eating (and it’s not just about table sugar), how they can start to lose the stubborn weight and bloated belly by making a few simple changes in their daily routines, and how to save their eyes, kidneys, and feet from the damage that diabetes can do. My passion is to help pre-diabetics, borderline diabetics, women who have been diagnosed with prenatal diabetes (research has found this to be a precursor to type II diabetes), and people who have been diagnosed with metabolic syndrome or insulin resistance, reverse their diagnosis and prevent full blown type II diabetes from taking over their lives. If you have any of these conditions or type II diabetes and would like to discuss how we can work together to prevent or reverse diabetes, schedule a free consultation with me so we can dive deeper to find out what is going on and come up with a plan of action for you: drmichele.com/schedule P.S. Make sure to read my blog post #1 and blog post #2 for more information on reversing diabetes. Dr. Michele Summers Colon, DPM, MS, RYT-500 3503 Lexington Ave. El Monte, CA 91731 *Information for this blog post has been compiled using the latest statistics from the American Diabetes Association and Centers for Disease Control and Prevention, 2017 Report.

Exercise is a big part of staying in shape, but you'd be surprised how many people at the ages of 50 & up aren't. FOX's Alex Hein has this week's "Housecall for Health": This is Housecall for Health. A new study from the CDC suggests about one in four Americans ages 50 and older don't regularly exercise, leaving them at a greater risk of heart disease, diabetes and cancer. The research, featured in the CDC's morbidity and mortality weekly report, found that 31 million Americans ages 50 and older, or 28 percent, are not active beyond basic movements common in daily life. The CDC analyzed 2014 survey data that examined inactivity differences among the age group by race, sex, geographical region and more. Survey recipients were from all 50 U.S. states and the district of Columbia. They found about 30 percent of women were inactive compared to about 26 percent of men. Non Hispanic blacks were the least active followed by Hispanics, other groups and non-Hispanic whites. Inactivity appeared to slightly increase with age. For more on this story, check FOXNewsHealth.com. Housecall for Health, I'm Alex Hein, FOX News. Follow Alex Hein on Twitter: @Ahlex3889

Kristen is in Cleveland! Calling in from radio row. Margie is in the soundbooth, eager to hear the gossip.    Poll of the week: Elvis is in the building. There comes a time in every person's life when you must decide between an office dog and virtual reality glasses.  PSB/Dell Poll   2016: Well, this is going well.  Cleveland is like Glastonbury. Except in all the ways it's not. Gallup:Pence's Effect on Trump Victory in November CBS Poll finds most voters are unfamiliar with Pence Real Clear Politics: How favorable is Pence? Aggregators' predictions FiveThirtyEight election forecast NY Times: Clinton has 76% chance of winning   Race to the bottom? Margie is turned off by some of the RNC rhetoric. What does Kristen think? Monmouth poll: Black Lives Matter has worsened racial tensions 74% think race relations are bad in US Voters favor Clinton on issues of race relations Americans are less optimistic about blacks' opportunities Non-Hispanic whites are only group to favor Trump's immigration policies   Learn more about your ad choices. Visit megaphone.fm/adchoices

Here is part 2 of our discussion on business and social media! For more, make sure to listen to episode 19. Instagram 28% of online adults use Instagram. 55% of users are young adults between the age of 18 - 29. This is followed by the age group of 30-49 at 28% The largest group of users are Black, Non-Hispanic, at 47% followed by Hispanic and then White, Non-Hispanic. Like Pinterest, the largest group to use this have some college with the 2nd largest group being college graduates. Between gender, Women tend to use Instagram more, though not by too much more then Men. Overall benefits: - instantly see what visually engages your audience by seeing the images they share. - Instagram makes it incredibly easy to discover new photos, new people and new businesses - able to gain trust faster visually than through what you type up. Instagram has 10 times more user engagement than Facebook and Twitter. - Instagram can easily be used to create free advertisements, whether it is a professional photo or a 15 sec professional video while using the right hashtags in the description. Linking up on LinkedIn: Surprisingly, only a quarter of online adults use LinkedIn. In the Pew Center Research, LinkedIn was actually one of the lowest used social media platforms. (Between Facebook, Instagram, Twitter, Pinterest, and LinkedIn.) LinkedIn is the only major social media platform for which usage rates are higher among 30-49 years old than among 18-29-year-olds. With the largest user base having a college education. Also, LinkedIn is primarily used by those that are employed (or at least listed as employed). *not employed included those who are retired, not employed for pay, disabled or students. As for gender, it is pretty closely split between men and women. Overall benefits: - assists in finding potential new hires for your company - can check in on your competitors and those employed by your competitors - can be easier to spot industry trends - another location to build online reviews Put a Bird on it - on Twitter! 23% of all online adults use Twitter. The bulk of those users are in Urban areas with the popularity being among younger adults of 18-29 and 30-49 following closely behind. The bulk of users are tied between Hispanics and Black, Non-Hispanics and White, Non-Hispanic following behind them. The largest group of users are college graduates being followed by those who attended some college and then closely trailing behind that is those who attended High School. Overall benefits: - given multiple ways of expressing personality of the brand - can easily research trends based on what is being shared out and what hashtags or topics are popular - can see what competitors are doing - can quickly and easily respond to customer queries For more information: www.WaverleyKnobs.com Lets get social! Facebook - www.facebook.com/waverleyknobs Twitter - www.twitter.com/waverleyknobs Instagram - www.instagram.com/waverleyknobs Resources: www.pewinternet.org/2015/08/19/the-…al-media-users/ www.onlinecollege.org/2012/03/26/11-…-social-media/

We all hear the importance of social media and the term, “social selling”. Social media is a great way to share your messaging, engage your target market and assist in the relationship creation process. The biggest keys for a company to understand though are what social media platforms they should be utilizing and how to successfully utilize it to experience those benefits There is a large assortment to study-up on and understand such as: Facebook Instagram Pinterest Twitter LinkedIn YouTube / Vimeo Snapchat And honestly, there are still even more social media platforms (including industry specific social media platforms) that we could mention. During this episode of Branch-Out, we are going to breakdown a few of these major platforms, what industries should be utilizing them and how! Concerning Social Media, overall, it can have a multitude of benefits ranging from: ability to promote your business build customer relationships listen and get feedback manage your reputation online But you want to make sure you are picking the right platform(s). Lets start off with Facebook: Who is using this? Well as of August of 2015, the Pew Research Center came up with these numbers: 72% of online American adults use Facebook. The largest age group was 18-29, while not far behind are those ages 30-49. More women are using Facebook. The largest demographic is hispanic followed by White, Non-Hispanic and then Black, Non-Hispanic What about Pinterest? 31% of online adults use Pinterest with women dominating usage. 44% of online women use the site. Hispanic and White, Non-Hispanic seemed to be the heaviest users primarily around the age of 18 -29 with the second largest age group being from 30-49. The largest amount of users have attended some college while the 2nd largest group completed college. Just with this information already, we can see that there could be a great marketing opportunity for universities. We already know from past research that more women are going through higher education. Pinterest could be a great market for Universities/Colleges/Trade Schools. They could promote people getting back to school and taking the classes they want and need for success. While platforms like Facebook tend to pull in more of a Urban population, Pinterest pulls in a Suburban market with Rural following close behind. For more information: http://www.WaverleyKnobs.com Lets get social! Facebook - http://www.facebook.com/waverleyknobs Twitter - http://www.twitter.com/waverleyknobs Instagram - http://www.instagram.com/waverleyknobs Resources: http://www.pewinternet.org/2015/08/19/the-demographics-of-social-media-users/ http://www.onlinecollege.org/2012/03/26/11-industries-that-benefit-the-most-from-social-media/

Share Us!Hotch Potch English - The Mega-Minute Podcast - No.50Listen to the Mega Minute Podcast, read the text, and try to understand as much as possible.Don't worry if you don't understand everything - just listening to real English is a FANTASTIC way to improve..!Practise as you listen:do a dictation: write down everything and check belowlisten and repeat: speak until your English accent is perfect!learn by heart: remember everything and impress your friends!Fun FREE English Lesson:CLICK HERE for comprehension questions for THIS podcast and much more!AC_VHost_Embed(2011527,300,200,'',1,1, 2253272, 0,1,0,'24d13793d9ce78a0bbcc617163cd8c32',9);Podcast Script:(Click HERE to listen)_____________________________________________Hello, and welcome to the...Hotch Potch English ~ Mega Minute Podcast No.50!Today's Quote'Take some more tea,' the March Hare said to Alice, very earnestly. 'I've had nothing yet,' Alice replied in an offended tone, 'so I can't take more.' 'You mean you can't take less,' said the Hatter: 'it's very easy to take more than nothing.'   ~ Lewis Carroll, Alice's Adventures in WonderlandToday's FactsIn the United States...People with less than a high school degree have the highest obesity rate (32.9%)Non-Hispanic black people have the highest obesity rate of 36.8%.Non-Hispanic white people have an obesity rate of 25.2%. Other races (i.e. Asians) have the lowest obesity rate of 16.7%.Approximately 72.5 million American adults are obese.Today's (bad) JokeSo I said to the miserable employee, 'Hey, I thought McDonalds was supposed to have fast and friendly service.' And she says, 'That's at participating McDonald's, and we ain't participating.'That's all for today!Tell your friends. Read the words on the blog atstudents.hotchpotchenglish.comAnd see you next time!_____________________________________________________________________________Subscribe to this Podcast in iTunes_____________________________Podcast 50 {Quote~Fact~Fun} ~ "Food Fest"Created & written by Sab WillCopyright 2012 Sab Will / Hotch Potch English___________________________________________________Visit Hotch Potch English ~ The Unique English Teaching Website http://www.hotchpotchenglish.com/