Did you know that each year, around 200,000 non-traumatic amputations are performed due to peripheral artery disease (PAD)? Shockingly, Black Americans are up to 3 times more likely to face these surgeries than the national average. Dr. Foluso Fakorede, an expert in cardiovascular health, has made it his mission to change this statistic. Born in Nigeria, he immigrated to the United States and has become a leading advocate against preventable amputations. As the co-chair of the Association of Black Cardiologists' PAD initiative and a congressional testifier, he's dedicated to educating communities, enhancing healthcare access, and eliminating health disparities. Today, he joins Tavis to discuss his groundbreaking work and vision for a healthier future.
The story of Fatima is a long one with many twists and turns. There are genies, evil wizards, massive battles, and a world-wide trek to make sure evil pays for its crimes, but at the center is Fatima, a woman who won't back down no matter the opposition, and who always stands for what she knows is right. The creature is a hairy naked man (another one!) but you actually might want to make this one your friend. --- Disclaimer: https://www.mythpodcast.com/15951/334-arabian-folklore-part-2-the-enemy-of-my-enemy-is-my-enemy/ Sources The Tale of Princess Fatima, Warrior Woman The Warrior Women of Islam The Arabian Epic, Heroic and Oral Storytelling Volume 3 Rejected Princesses --- Sponsors: Bombas Bombas makes the season comfy with socks, tees, and underwear that feel good and do good: https://bombas.com/legends and use code: legends Audible Enjoy and discover audio entertainment in one app. New members can try Audible free for 30 days at https://Audible.com/legends or text the word legends to 500-500 --- Music: Tedukedo by Chad Crouch Pytarevubu by Chad Crouch Lead Shroud by Blue Dot Sessions Hills by Chad Crouch Wren Language by Blue Dot Sessions Dolly and Pad by Blue Dot Sessions Amaranthus by Chad Crouch
It's the annual Two Late Fee & Podcasting After Dark crossover month!Both shows will be extensively covering ROAD HOUSE (1989) starring Patrick Swayze, Kelly Lynch, and Sam Elliot. In this episode, the dudes reminisce on the bar busting classic along with celebrating the career of musician Jeff Healey (“Angel Eyes”, “When The Night Comes Falling From The Sky”).Next week, look for a scene by scene breakdown of ROAD HOUSE, PAD style! In two weeks Marshall Teague (who plays "Johnny Reno" in the movie) will be the featured interview of the month! Marshall will be back the following week for $2, 6 Questions. And the crossover will conclude with a Terry Funk celebration on Territory Marks!If you're not already subscribed to Two Dollar Late Fee, go check out their website for more info!— SUPPORT PODCASTING AFTER DARK —PATREON - Two extra shows a month including Wrap-Up After Dark and The Carpenter Factor, plus other exclusive content!MERCH STORE - We have a fully dedicated merch store at TeePublic with multiple designs and products!INSTAGRAM / FACEBOOK - Follow us on social media for updates and announcements!This podcast is part of the BFOP Network
The most vulnerable populations suffering from poor circulation, known as Peripheral Artery Disease Who are at-risk of amputation, are those living in Medical Deserts. A "medical desert" describes a community lacking access to medical necessities, resulting in increased morbidity and mortality. For the PAD patient, that medical necessity is a vascular specialist. One-third of hospitals across the U.S have postings for vascular surgeons, and because of that patients are progressing to a limb-threatening stage of the, known as critical limb ischemia, where the threat of amputation is real without timely, effective, limb-saving care. If only there was a way for vascular specialists in other areas to help physicians in medical deserts better care for these patients? That's the Idea behind Zivian Health. Co-Founder Dr.Rafid Fadul, an Intensive Care Pulmonologist, shares how Zivian Health is striving to improve collaboration amongst physicians across the globe. By connecting physicians across geographical boundaries and leveraging technology-driven solutions like telemedicine, Zivian Health aims to Bridge the gap between medical deserts and areas with greater access to specialized care.
Dr. Peter Schneider, Professor of Surgery in the Division of Vascular & Endovascular Surgery at the University of California San Francisco, and Dr. Justin Klein, AdvaMed board member and co-founder at Vensana Capital joined AdvaMed's Scott Whitaker to talk about a recent New York Times story about atherectomies and peripheral artery disease (PAD) and the impact the story could have on patients seeking treatment for this condition.
Jodorowsky's Dune (2013) synopsis: “The story of cult film director Alejandro Jodorowsky's ambitious but ultimately doomed film adaptation of the seminal science fiction novel.”Starring: Alejandro Jodorowsky, Brontis Jodorowsky, and H.R. GigerDirector: Frank PavichThis week on Podcasting After Dark, Zak and Corey review the 2013 documentary, Jodorowsky's Dune! This is the second, and final, review in the annual PAD docu-series. Like Corey's pick last year, Jodorowsky's Dune is a deep-dive into the creative process as told through the eyes of a true auteur. We hope that you enjoyed this little departure from our usual show format.Leave a comment on our Patreon page or social media and let the boys know what you think of Alejandro Jodorowsky and/or the Dune franchise in general!— SUPPORT PODCASTING AFTER DARK —PATREON - Two extra shows a month including Wrap-Up After Dark and The Carpenter Factor, plus other exclusive content!MERCH STORE - We have a fully dedicated merch store at TeePublic with multiple designs and products!INSTAGRAM / FACEBOOK - Follow us on social media for updates and announcements!This podcast is part of the BFOP Network
There are two main goals to focus on while caring for patients with peripheral arterial disease (PAD). Teresa Wu, MD, from the Section of Vascular Medicine at Cleveland Clinic talks about these two goals and insights into PAD management.
Peripheral Arterial Disease (PAD) is the narrowing or blockage of the vessels that carry blood from the heart to the legs. Natalie Salvatore, RN, talks with Dr. Teresa Wu from the Section of Vascular Medicine at Cleveland Clinic about PAD and what you need to know.
In this episode, host Dr. Ally Baheti interviews interventional radiologist Dr. Saher Sabri and vascular surgeon Dr. Frank Arko about their perspectives on a July 2023 New York Times article about the ethics of peripheral arterial disease (PAD) treatment in outpatient based labs (OBLs) and ambulatory surgery centers (ASCs). --- SHOW NOTES Dr. Arko emphasizes the importance of approaching articles as an unbiased reader. He acknowledges that sensationalism in the news is common, and while bad actors do exist, he personally knows talented OBL/ASC practitioners. He also notes that the article fails to mention that the majority of these practitioners follow society guidelines to provide appropriate and effective treatment for their patients, rather than prioritizing financial gain. He believes that most non-surgical specialists have the clinical insight to know when patients would be better candidates for open bypasses as opposed to endovascular interventions. Dr. Arko describes the split response to the article within vascular surgeons on social media, based on their personal philosophies of open versus endovascular interventions for PAD. Dr. Sabri believes that PAD and critical limb-threatening ischemia (CLTI) are not very well known by the general public, this article was a missed opportunity to bring attention to these conditions and disparities in treatments depending on patients' geographic locations and ethnicities. The article may have the effect of scaring patients away from seeking treatment for PAD and CLTI, as well as receiving care at OBLs, which were originally founded to make interventions more efficient and patient-friendly. Additionally, the article could foster divisiveness between vascular surgeons, interventional radiologists, and interventional cardiologists and as a result, increase barriers to collaboration. It is important to differentiate between PAD and CLTI and the stage at which patients present to medical care. Limb salvage rates and decisions to intervene and/or amputate are multifactorial and are not as straightforward as the article may imply. Both doctors agree that specialty societies share the responsibility of monitoring their members for overuse of interventions. In terms of rebates and volume discounts from device companies, the doctors discuss the ethics of cost savings that benefit a hospital system versus savings that benefit a physician-owned OBL. Dr. Arko recognizes that financing an OBL with device company partnerships can be a smart business decision if devices are used appropriately and only when indicated. He speaks about the need for societies to support more randomized control trials that compare the effectiveness of each atherectomy device. We also discuss implications for insurance coverage of PAD/CLTI interventions. Dr. Sabri believes that it is unfortunate when insurance companies become the decision-maker of patient treatments. --- RESOURCES “They Lost Their Legs. Doctors and Health Giants Profited” (NY Times, July 2023 article): https://www.nytimes.com/2023/07/15/health/atherectomy-peripheral-artery-disease.html BEST-CLI: https://www.bestcli.com/ “Blocked Artery in Your Leg? Here's What You Should Know” (ProPublica, June 2023 article) https://www.propublica.org/article/what-to-know-about-peripheral-artery-disease Outpatient Endovascular Interventional Society (OEIS): https://oeisweb.com/ Society of Vascular Surgery (SVS) Position Statement: https://vascular.org/news-advocacy/articles-press-releases/svs-response-new-york-times-article-overuse-interventions
UWAGA!!! W nagraniu poruszamy temat gwałtów i przemocy seksualnej. Jeśli jesteś słuchaczem wrażliwym na te treści to być może nie jest to audycja dla ciebie. OSTRZEGAMY!!! Kobiety Eksploatacji na dobre rozgościły się w latach 80. Dla nurtu rape and revenge to czas graniczny, swoisty moment zmian. Filmowcy podejmą próbę odświeżenia gatunku – porzucą oczywiste schematy na rzecz formalnych eksperymentów. Zabiorą głos w ważnej sprawie, zachowując indywidualny styl i przenosząc zagadnienie kobiecej krzywdy do głównego nurtu. Przed nami filmowy kalejdoskop dzieł docenianych, nagradzanych, podziwianych, zarówno przez widzów, jak i przez krytyków. W 1988 roku miał premierę film „Oskarżeni” w reżyserii Johnatana Kaplana. Film ważny, szeroko omawiany z docenioną rolą Jodie Foster. Gdy Sarah Tobias weszła do bary Mill jeszcze nie wiedziała, że przeżyje tam prawdziwy koszmar. Padła ofiarą zbiorowego gwałty, a świadkowie zdarzenia, zamiast jej pomóc lub zawiadomić policję dopingują krzywdzących ją mężczyzn. Sara zgłasza napaść i postanawia konsekwentnie walczyć o swoją sprawiedliwość. W tej nierównej batalii – z męskim środowiskiem i bezdusznym systemem – towarzyszyć jej będzie ambitna prokurator Kathryn Murphy. O kobiecym głosie sprzeciwu, piętnowaniu ofiary, społecznym przyzwoleniu, kulturze gwałtu. O tym, czy nieudzielenie pomocy to też przestępstwo. O osobistych doświadczeniach członków ekipy. Oraz o scenie, która przeszła do historii kina. Rozmawiają Marta i Bogusia. Polecamy!
Once a procedure is performed to improve blood flow in the legs for a circulation issue known as Peripheral Artery Disease (PAD), it starts the clock for the next one. PAD is a progressive disease in which the best treatment lay in patient compliance to appropriate medications and lifestyle modifications, including smoking cessation, diet, and diabetes management. That's why Interventional Cardiologists Dr. John Phillips and Dr. Ashish Gupta discuss the importance of ensuring all conservative options are exhausted prior to any attempt to restore blood flow manually using wires, balloons, and stents, or bypass. If conservative approaches aren't enough to relieve pain, cramping, or help heal a wound that has developed on the toe or foot, they say it's at that point guidelines indicate an intervention or bypass may be necessary. But it's important to have all risk factors mitigated prior to a procedure in order to extend its durability and time before another procedure may need to be performed again. This discussion comes on the heels of recent string of patients with moderate PAD presenting to patient advocacy organization The Way To My Heart with intervention and bypass surgery as frontline treatment prior to frontline treatment of medication and lifestyle modifications as per guidelines set forth by the Society for Vascular Surgery and American Heart Association.
A július eleji Árpád hídi baleset szomorú apropóján Karácsony Gergely közlekedéspolitikai kihagyott ziccerével indított Bánszegi Rebeka, Kerner Zsolt és Pető Péter a mai Háromharmadban. A színváltós ferencvárosi padon keresztül pedig egészen a vilniusi NATO-csúcsig jutottak. Minek egy főpolgármester ha nem csinál semmit? Miért nem érti az ellenzék a padon túli buborékot? És mit akart Magyarország elérni a svéd NATO csatlakozás akadályozásásval?
PILNO EPIZODO TEMOS: 00:00:00 Bideno kalba 00:09:47 Sukeltos perteklinės viltys 00:20:01 Ukrainai reikia ne tiek NATO, kiek ginklų 00:37:59 Padėtis fronte Remdami mus Patreon matysite PILNUS epizodus ir laidas, taip pat turėsite priėjimą prie labai didelio archyvo. Ačiū. Patreon: https://www.patreon.com/baciulisirramanauskas Mes būsime labai dėkingi jei pranešite miestui ir pasauliui apie mūsų Patreon: https://www.patreon.com/baciulisirramanauskas Mūsų Facebook: https://www.facebook.com/Ba%C4%8Diulis-ir-Ramanauskas-261379194566105/
Sign-up for Wynd and get a $10 discount: https://getpaidforyourpad.com/wynd (Use coupon code PAD)During a conversation with Mark Young and Dora Du, we discussed a product called Wynd Sentry, which is a smoke and noise monitoring device specifically designed for short-term rental properties. The device helps hosts maintain a safe and pleasant environment for guests and prevents potential damages caused by smoking and excessive noise.Dora explained that Wynd Sentry was developed by the company Wynd, initially focusing on air quality monitoring. However, they observed many hosts using their general air quality monitors to address smoking issues in their rental spaces. Recognizing this need, Wynd developed the Wynd Sentry, a specialized product to address smoke detection accurately.The device utilizes a proprietary technology called AirID, which classifies different particle types to identify specific smoke sources, such as cigarettes, marijuana, or vape. This enables hosts to receive real-time alerts and provides them with evidence to resolve any smoking-related issues with guests or with Airbnb. The reporting feature generates detailed reports, which can be submitted to insurance companies in case of damages caused by smoking.Furthermore, Wynd Sentry includes noise monitoring capabilities, helping hosts address noise complaints and maintain a peaceful environment for both guests and neighbors. The device measures decibels and provides hosts with the ability to address noise issues proactively, preventing potential disputes with guests.Dora emphasized that Wynd Sentry is designed to be tamper-proof. If a guest attempts to tamper with the device, an alert is triggered, ensuring the host is aware of any tampering and can take appropriate action.If you're interested in learning more about Wynd Sentry, you can visit the Wynd website at hellowynd.com. They are offering a discount of $10 off for listeners of the podcast using the code PAD. This device can be a valuable tool for hosts to maintain a smoke-free and peaceful rental environment. Hosted on Acast. See acast.com/privacy for more information.
In this episode, host Dr. Sabeen Dhand interviews vascular surgeon Dr. Rami Tadros about advantages and indications for radial access in PAD treatment and the current selection of radial access devices. --- CHECK OUT OUR SPONSOR Surmodics Sublime Radial Access Platform https://sublimeradial.com/ --- SHOW NOTES Dr. Rami Tadros is a vascular surgeon and Site Director of Endovascular Aortic Surgery at Mount Sinai Hospital. Dr. Tadros begins by discussing how often he uses radial access in his practice, how current wire and catheter technology limits the potential of radial access, and how evolution of these devices (such as increased length and improved sizing for transradial tools) is on the horizon. Dr. Tadros also discusses the indications and specific advantages for radial access. He describes his device preferences, workflow, and workarounds for radial access. The doctors then take a deeper dive into lengths and sizing of the tools that are currently on the market. They offer some insight on maximizing distance while still maintaining pushability and taking into account the variety of patient anatomy. There is also a brief discussion on pedal access, risks associated with it, and closure complications. Dr. Tadros covers specific clinical vignettes for treating PAD with radial access. There are limitations of the currently available devices, so it is important to plan for distal embolization and bailout stents. We conclude the episode with some guidance for radial access. We review the required tools, the importance of confirming patency of the palmar arch, and the Barbeau test to inform radial access. Dr. Tadros also highlights the use of verapamil, heparin, and nitroglycerin to minimize the risk of vessel spasm. --- RESOURCES Dr. Rami Tadros Twitter: https://twitter.com/VascMD
This recording features audio versions of July 2023 Journal of Vascular and Interventional Radiology (JVIR) abstracts:Short-Term Effects of Genicular Artery Embolization on Symptoms and Bone Marrow Abnormalities in Patients with Refractory Knee Osteoarthritis ReadReal-World Safety Analysis of Paclitaxel Devices Used for the Treatment of Peripheral Artery Disease ReadMedian Arcuate Ligament Compression Associated with Flow-Related Visceral Aneurysms ReadPregnancy Rate and Outcomes following Uterine Artery Embolization for Uterine Arteriovenous Malformations: A Systematic Review and Meta-Analysis ReadResolution of Pain after Percutaneous Image-Guided Cryoablation of Extraperitoneal Endometriosis ReadYttrium-90 Radiation Segmentectomy of Hepatocellular Carcinoma: A Comparative Study of the Effectiveness, Safety, and Dosimetry of Glass-Based versus Resin-Based Microspheres ReadJVIR and SIR thank all those who helped record this episode:Host and audio editor:Rommell Noche, Frank H. Netter MD School of Medicine at Quinnipiac University, ConnecticutAbstract readers:Jamie Lee, A.T. Still University School of Osteopathic Medicine, ArizonaManbir Sandhu, University of California Riverside School of MedicineAnna Hu, George Washington University School of Medicine and Health Sciences, D.C.Emily Barr, MBA, Burrell College of Osteopathic Medicine at New Mexico State UniversityIsabelle Barbosa, Frank H. Netter MD School of Medicine at Quinnipiac University, ConnecticutPriya Gupta, MD, Henry Ford Hospital, Michigan © Society of Interventional RadiologySupport the show
The mission to create Awake and Walking ICUs is not a brand new endeavor. Dr. Juli Barr, an early PAD and ICU liberation founder, shares with us the tools needed to master the ABCDEF bundle. www.daytonicuconsulting.com --- Support this podcast: https://podcasters.spotify.com/pod/show/walkinghomefromtheicu/support
Deion Sanders courageously shared his struggles with a circulation issue that puts him at-risk of losing his foot in a video posted on social media. It may have been left on the editing room floor, but critical information about this circulation issue and treatment options to prevent amputation were not shared in the video or across other media covering this story. In this episode, hosts Emmy Award-winning Journalist Kym McNicholas and Interventional Cardiologist Dr. John Phillips are joined by specialists trained in advanced treatment of this circulation known as peripheral artery disease (PAD) and its advanced stage critical limb ischemia CLI), a circulation issue characterized by narrowed or blocked arteries due to plaque such as blood clots and/or calcium, which can cause leg pain, leg cramps, non-healing wounds, and more.Interventional Cardiologist Dr. Jihad Mustapha, and Vascular Surgeons Dr. James Antezana and Dr. William Shutze talk about what you need to know about this circulation issue, which is one of the most debilitating diseases most have never heard of, yet impacts 3-in-5 heart attack sufferers, 1-in-5 over age 60, and 1-in-3diabetics (Type 1 and Type 2 diabetics) over the age of 50. Importantly, they'll share advances in treatment and amputation prevention as well as the standards of care patients should expect from their physicians treating it.
Are you ready to take control of your finances during life's most pivotal moments? In this episode, we dive into the complex world of financial decision-making during key life events. From the excitement of marriage and the joy of welcoming a new child to the challenges of divorce and the loss of a loved one, we'll provide practical tips and guidance to help you make informed decisions and maintain financial stability. Important Links Website: http://www.yourplanningpros.com Call: 844-707-7381 ----more---- Transcript Of Today's Show: Speaker 1: Welcome into this week's edition of the podcast folks. Thanks for tuning in to Plan With The Tax Man. Always glad to have you here as Tony and I talk investing, finance and retirement, and we're going to talk about some key financial decisions during major life events. So I've got several of these. We'll try to get to as many as we can, but it's always important to kind of try to keep a level head through major life events, and we know that's usually not possible in many cases. So that's where I think having an advisor in your corner, having a quality professional there can help you when dealing with some of these things. So we'll have Tony highlight some areas to think about from that financial standpoint during these. Tony, what's going on buddy? How are you? Tony Mauro: I'm doing well, thank you. Summers in full swing and trying to enjoy it. Weather's good. Speaker 1: Yeah, there you go. Exactly. I know that you've been doing this obviously a long time and you've seen lots of different scenarios and situations, so it'll work pretty well I think for you to kind of give us some things to think about, whether they're positives or negatives, right, some of these life events here, some are positives, some are negative, and just some financial highlights to make sure that we're thinking about should one of these things happen to us, because many of these on this list are going to happen to probably all of us along the way somewhere. And some of them hopefully will not, but it's possible. So let's go through and have you give us some highlights, shall we? Tony Mauro: Okay. Sounds good. Speaker 1: All right, let's jump in here. We'll start with me. I know you primarily are listening audiences, retirees, pre-retirees but you do have some younger clients as well, and so maybe it's a first marriage. Right. So let's start with marriage and just say there's definitely things you want to consider and think about when you're younger, even if you got married later in life. I was 33 before I got married, the first, well, I've only been married the one time, but started to say the first time, it's only been the one time, but I was 33. Right. So I was already fairly established. So there's things to think about whenever you're jumping into that. Tony Mauro: There is. And marriage for a lot of us is, it is eyeopening, like you said, in a lot of ways and some of this financial stuff, nobody really talks to you about. And so I'm glad we starting with this one because my own son got married last year at 26, Speaker 1: Okay. Tony Mauro: And so he's had to go through some of the stuff and we had kind of some of the same conversations because there isn't just some book out there, you could just go read and have it all down, and none of this really is necessarily black and white, right or wrong. It's just different ways to do things. But one of the biggest ones, and one of the first ones is, is now you've got generally, especially if you're younger, you've got two people working. So you've got two sources of income. So it's all about the finances and what are you going to do. Now you've got one set of bills, who's going to pay them? Are we combining our money and paying everything out and then we spend the rest, or that's what I get a lot. Others come to me and say, well, he's going to pay these bills, I'm going to pay these bills, and then the rest we'll decide what we want to do. So I think that's a big thing because that's hard for a lot of people whether you're going to, especially if you've, maybe you are a little older and you used to living on your own and just paying all your own bills. Speaker 1: Yeah. Yep. Tony Mauro: And do we have a joint account? Do we have two separate accounts? I think that's key. If you say, well, what's your opinion? If you asking me my opinion, Speaker 1: Right. Tony Mauro: I tend to lean towards the joint account because I think now you're one team, you're one. Right. And everybody needs to be involved. It's not like the old days where all the guys paid all the bills and the women stayed home and cooked type of thing. I mean, Speaker 1: Yeah. Tony Mauro: Both people are usually working. Speaker 1: Yeah. They definitely are. I think the modern era too, though, it's definitely, so my wife an I, Tony, we are completely separate on everything. Now, both of our names are on the house, but I pay the mortgage, but she pays all the utilities and she pays the insurance. So I think you can do the, and again, I was 33. Right. And she was already 30. Right. So we had been paying our own bills and having our own life. So I think it's either scenario, if you're a younger couple, maybe the joint thing is probably the way to go because you're definitely combining, probably not making as much and so on and so forth. But I think as long as you're honest and talk with each other, you can find a balance with either system, but make sure you do find the one that's right for you. Right. So because we all know marriage is the number one, or I mean, money is the number one fight in a marriage, right? Tony Mauro: It is. Speaker 1: Yeah. Tony Mauro: It is. And I'm not saying one's right or wrong. Speaker 1: No, no, not at all. Just point counterpoint. Yeah. Tony Mauro: Yeah. Yeah. And I think with either way you go after the bills are paid, however you're going to pay them, I still think it needs to be a team effort of sitting down saying, okay, hopefully you've got some left at the end of every month, Speaker 1: Right. Tony Mauro: You've got some positive cash flow. Speaker 1: Yeah, exactly. Tony Mauro: And then you both decide what to do with it rather than, and I've had a few couples fighting in my office through at tax time that don't do it that way. Speaker 1: Yeah. Yeah. Tony Mauro: That the guy makes a lot more than his wife and she wants stuff and he's saying, well, I already pay my share of the bills. That's your problem. Speaker 1: Yeah, that's a tougher, yeah, that's a tougher road. Yeah. Tony Mauro: Yeah. That's not the team approach. So, Speaker 1: No. Tony Mauro: Again, it takes some discussions, some maybe compromise and come up with something for you both because at the end of the day when we get back, because we've been talking a lot about retirement planning lately and decided to mix it up today. Speaker 1: Sure. Yeah. Tony Mauro: Hopefully you've got some money left. And so both can save for your goals I think. Speaker 1: Yeah, and I think even for our strategy, we had those conversations going into it ahead of time, and we both for a while she made more than me. And then in the last 15 years we've pretty much just been right there neck and neck. One will go up a little bit, the next one will go up a little bit. So I think that can certainly lend a hand to that lack of frustration as well. But as long as you have those conversations that are honest with each other ahead of time, then hopefully you can work your way through that. And actually we'll go right into the second one because it's remarriage. Okay. So a lot of our audience is older, maybe retirees or pre-retirees and gray divorces have been a huge thing. So maybe you're getting remarried at a later stage in life. Certainly more challenges here because you do have more things to try to combine. Tony Mauro: You do. There's a lot of big challenges here, unlike the first marriage with the younger people, so to speak. But just like you're saying, many of these people that are getting remarried have families, they have other concerns, especially the kids. And they've been through this before and now all of a sudden their needs are a little more, what I find with people coming in for remarriage is a little more self-focused, self-centered, if you will. It's like, well, my money's my money. We're getting remarried, but you have kids, maybe I have kids and I need to take care of these guys first and kind of then us. And so I think a lot of discussion needs to be made there about whose valuing what and how. And, Speaker 1: Yep, great point. Tony Mauro: Yeah. What kind of things you're bringing into the marriage too. A lot of people bring old tax debts into marriages, and so I think that needs to be discussed because obviously an innocent spouse may not want to be drug into a prior tax situation and have some of their money maybe taken for that. Speaker 1: Especially if you didn't disclose it. Right. Tony Mauro: If you didn't disclose it. Speaker 1: That's not good. Tony Mauro: That's not good. No. That's never a good recipe. Speaker 1: That's right. Tony Mauro: But there's things too, now you've got, again, second marriage, you definitely have to take a look at your own retirement plan. You might have two separate ones, beneficiaries, making sure those are updated, making sure insurance policies are updated properly. And then of course, the last thing is at the end with estate planning, which I've seen a lot of families get into huge fights about estates and whatnot. And potentially, for example, a gentleman that came in a couple years ago, he had remarried. His former wife died, remarried, but he was going to leave all his money to his new wife and the kids were just absolutely out of their minds with that. And, Speaker 1: Yeah, that's tough. Tony Mauro: Really caused a lot of animosity. Speaker 1: Oh, yeah. It'll fractures some things, that's for sure. Tony Mauro: Yes. Speaker 1: So. Tony Mauro: Yeah. Speaker 1: There's some definitely good things to consider. Maybe a prenup is something that's worth having a conversation on either situation of those. And again, it's all about having those chats before you go through these major life events. So since we're in this realm, let's just go ahead and go with divorce next. As I mentioned, gray divorces, especially for our demographic is higher and higher on the rise, which is just kind of mind-boggling to me. But people over 50 are getting divorces more. And so what's some things to think of here? You touched on a couple, but give us some things to think about from a financial standpoint. Tony Mauro: I think the one thing is, is in most states you're going to be dividing up your assets. And so that's a source of real contention in a lot of cases on how that's going to be done. And again, with divorce, I'd say with all of these, you should talk to some advisor. Divorce, obviously, Speaker 1: You need a lawyer as well. Tony Mauro: Yeah. You need an attorney, Speaker 1: Yeah. Tony Mauro: To protect your interests and then maybe your financial advisor. But in our realm on the financial side, Speaker 1: I was going to say Tony, that's a good point though with the financial side too. Right. People might think about a divorce and they think, well, I just need a lawyer, right? Well, no, especially if you're older because now you're talking about dividing possibly retirement accounts, a 401ks, the home. I mean, maybe there's rental property. I mean, there's lots of stuff to have to divide. Tony Mauro: There is. And on the finance area with us, a lot of people will say, well, since I'm getting the home, I had to give my now ex-spouse half of my retirement. Well, that comes back into our room a little bit. It's like, okay. Speaker 1: Sure. Tony Mauro: Well now you just half your retirement left. Yeah, you have a home, but you're going to have to live in that. That's not going to throw off any income. What are we going to do? How's our plan changed now going forward? And so you have to re kind of engineer the financial plan and maybe your goals need to be readjusted as well. Speaker 1: Indeed. Yeah, I mean, because you're going to have to reset this up, you're going to have to look at, okay, what's the shortfall now that you've lost maybe half or whatever the case is, especially if you're getting closer to retirement so. And you'll want to make sure, just kind of like with the other one, you want to make sure that you've updated any kind of documents and paperwork that you need to do as well. Not leaving off, removing the old spouse or updating all the documents, powers of attorney, all that stuff. Right. Tony Mauro: All that stuff. Yeah. Speaker 1: Okay. Tony Mauro: And again, a good attorney and your advisor's going to be able to help you a lot there. Speaker 1: Yeah, definitely. All right, so let's go to a job change. How about this for a major life event, right, especially if we're getting closer to retirement and whether we are asked to step away, whether the job change is not our doing or it is our doing, give us some big things to think about here. And obviously a lot of this is going to come back to possibly being laid off or downsizing. This is the kind of thing that you guys typically see as financial professionals is in that scenario where someone's on that cusp of retirement and they're maybe looking at being laid off. And now they got to figure out, well, okay, should I just go into retirement early or do I need to find another job? Tony Mauro: Right. And today, so many people don't stay like the old days, 30, 40 years at the same position. Everybody's moving around and the bigger companies consolidate so much that it's not uncommon. You're here one day and the next day ask you to leave just through cutting or whatever they're doing. But I think that on the financial side, a couple of things. One is if you're departing and getting a severance or some other large sum of money, how is that going to play out for taxes, number one. And then how is your financial plan going to be affected by that? In other words, if you're out of work for a long time, do you have the necessarily emergency fund or you're going to have to use the severance for that? A lot of times people, and I've just had this with a friend of mine who he was actually asked to leave after many years and they gave him a huge severance, like $800,000, but he is mid 50s and he's scratching his head saying, well, I don't really want to retire, but I don't think I can go make the money I was making in my 50s. Speaker 1: Right. Yeah. Tony Mauro: And so he's kind of, well, what am I going to do with myself and what am I going to do for new opportunities type of thing. And so he's struggling a little bit with that and what he wants to do there. And then really too, the next one really is now you've got retirement accounts potentially at the old employer. What are you going to do with those? You're going to leave them. Maybe they'll force you to take them elsewhere. Talk to your advisor about that because you definitely want to explore that. And then I think that the toughest one, and I get this all the time as well, like you were saying earlier, I'll think I'll just call it quits now. Speaker 1: Right. Tony Mauro: I just had one of my business owners in last week and he's young, he's 51 and he thinks he can retire. And I said, well, let's look at the numbers because I said, I frankly, I don't think you can. I said, I do your finances. Unless you're thinking of maybe really cutting back, I think you're going to run out of money probably by the age of 75. And I don't think I've convinced him yet. Speaker 1: Well, but that's a great point though, Tony. And that's what an advisor brings to the table. Right. So this is the guy's wish, this is his wants, he's on this cusp here, and it's your job to be that sounding board to go, okay, let's run these numbers and see. And I'm not going to sugar sugarcoat it. I don't think you're going to make it. So let's look at, we got to make some tweaks. Tony Mauro: I got to make some tweaks. And I told him, you're going to have make some tweaks to your spending. And he is conservative, so I said, you probably can do it, but you've got to understand what you're going to have to cut and know that you may run out of money, which it doesn't seem to bother him. I like, well, I'll just go do some work. Okay, I'll run out of, if I do I do. Speaker 1: That's a tough one though. Right. Because it's like, okay, I'm going to cut some things to make these numbers work to get into retirement early, and are you really going to be, like that feels like a shortsighted goal, right? Tony Mauro: It does, yes. Speaker 1: The first five years you might be totally like yes, I made the right decision, this is great, but as your quality of life stays diminished or you're not able to do some of the things you want to do, then now you've regretted this decision and you aren't, look like it or not, ageism happens out there in the workforce. Right. It's not supposed to, but it does. And it's going to be harder to get back in and maybe do the same exact thing or whatever. And I think you said he's self-employed. So maybe there's a difference there, but still. Tony Mauro: Well, I think in his case, because he's self-employed the conversation I had with him is, if you have to go back to work, what are you going to be skilled enough to do at that point? Speaker 1: Yeah. Unless it's the exact same thing he's doing now, right. Tony Mauro: Yeah. Which I don't think he could do. And I just said, you got to think about these things. Speaker 1: That's true. Tony Mauro: And understand what you're getting yourself into. Speaker 1: Well, and then medical. I'm 51 as well. I'm with him. I'd like, okay, cool. Let's do it. Tony Mauro: You would like to retire, right? Speaker 1: Yeah. But I mean, I've gotten some medical issues and that's 14 years before I can, is that right? 14 years before I can turn on social or, Tony Mauro: Yeah, or Medicare. Speaker 1: Medicare. Yeah. Right. So that's a big chunk of change too. Now maybe he's got a spouse that's going to have him covered, which this is my scenario as well. I'm covered by my wife's because I'm self-employed also, but still, that's something to consider. Right. How are you shoring up that gap medically? Tony Mauro: Yep. Yep. Speaker 1: Yeah. Tony Mauro: I'm trying to talk to him a little bit about just maybe doing something, even if it's just for some mad money and doing something part-time and he's entertaining that. Speaker 1: Pad the stats, so to speak. Yeah. Tony Mauro: Yeah. Yeah. Speaker 1: Well actually, speaking of medical, let's go to our next one then with that, Tony. And that's maybe a major life event, unfortunately, like a big medical issue or a disability. Right. So I had open heart surgery at 41. I mean, that could have gone a different way and I may have not been able to work ever again. Now luckily I've been able to. Right. But you just never know. Something could come back around or you never know what could happen, right? And so what are some things to think about if you get hit with a big medical issue or even a disability? Tony Mauro: Well, on the financial side, it's one of the hugest issues, is really making sure that you've got to have your situation and enough control I guess I should say that if something major medical happens, number one, how's it going to impact your financial situation and what's your insurance going to pay, what's it not. If it's going to be something long term, how's it going to impact your daily life? Even your life expectancy could be cut well short if, depending on what it is. And you've got to have some plans in case that happens, and even some contingency plans in there in case you start going down a little bit more. Speaker 1: Right. Tony Mauro: And then on top of that, you've got the mental side and the fact you've got to update policies and documents. And I think sometimes when people get hit with this, they seem real rushed. And I think there should be some urgency, Speaker 1: Sure. Yeah. Tony Mauro: To get some of this done. But make sure that you're methodically going through it. Make sure you get some advice from your advisor and then your significant other or others to come up with the best plan to make your life as good as possible for while you're here. Speaker 1: Yeah, definitely. Tony Mauro: Which is hell, what we all want to do, right? I mean, medical issues or no medical issues. Speaker 1: Right. And we got to definitely plan for this because like you said, there's lots of things. There's deterioration of the condition, there's updating the documents, there's even taking the time to see what kind of benefits or programs or assistance is out there to possibly help you. So lots of points to think about there, should you be going through a major life event is that. And let's do our last one, Tony. We'll wrap it up with just plain old retirement. It's like people sometimes I think forget and depending on how they're viewing it, we're so busy accumulating money to get to retirement. We forget that retirement in and of itself is a major life event. It's a total change. Tony Mauro: It is. And my sister-in-law's going through it right now, we're helping her. And her last day of teaching was last Friday. And so all of a sudden she's entering this new phase, and when I saw her a couple weeks ago, she happened to say, I'm not going to have any money in June. And I said, you have a lot of money, you just don't have any money coming in from work. So you got to change your mindset a little bit. So she's coming in. We're developing an income plan for her so that she's got to develop this mindset of here's how much income I've got, just like a W2, but it's just coming from different places. Speaker 1: Right. Tony Mauro: And we've got to change her strategies a little bit. So it's much more income oriented. And then work with her budget. She's conservative as well. So she knows exactly how much she's spending on everything, but you've got to understand what your monthly bills are so you can make sure you have enough for them. And then she's got some health issues too. She's got lupus fairly badly and her life expectancy probably isn't all that long. And she knows that and she understands that. She wants to make sure everything is taken care of. And we just kind of talked about that in case her health goes bad, but it is a big mental change along with the financial change. Speaker 1: Yeah. For sure. Yeah, I mean, there's. Tony Mauro: So I think you got to think about it. Speaker 1: Yeah, you definitely have to check all those things because it's a big gear shift. Right. So there's tons of stuff that you've got to go through when there's a major life event involved, and that's why having a qualified professional in your corner can certainly help you. So if you have not considered doing so, reach out to Tony and have a conversation about some things and get some stuff, some planning processes going with Your Planning Pros. You can find them online at yourplanningpros.com. It's yourplanningpros.com. Don't forget to subscribe to the podcast, Plan With The Tax Man. It's on Apple, Google, Spotify, all that good stuff. So you can simply type that into the search box of those apps, or again, find it at Tony's website, yourplanningpros.com. All right, my friend, thanks for breaking this down for me this week. I appreciate it. As always, have yourself a great week, and I'll see you soon. Tony Mauro: All right, see you soon. Thanks. Speaker 1: Thanks folks for listening. We appreciate your time here on the podcast. We'll catch you next time here on Plan With The Tax Man with Tony Mauro. Disclaimer: Securities offered through Avantax Investment ServicesSM. Member FINRA, S.I.P.C. Investment advisory services offered through Avantax Advisory Services. Insurance services offered through an Avantax affiliated insurance agency.
On a recent episode of City Cast Philly, host Trenae Nuri talked with Citizen editor Christina Griffith about Police Assisted Diversion (PAD) which refers people to social services instead of jail. This program was started in Kensington in 2017 and boasts impressive statistics. Only 8.5% of participants commit another crime. PAD is set to expand to the entire city this summer. Nuri chatted with Griffith about who qualifies for the program and if Philly is ready for a city-wide expansion.
Every year, the Medicare Physician Fee Schedule (PFS) is updated to determine the reimbursement rates for physicians. The powers that be decide which areas require more funding and which areas need to see a decrease in reimbursement to maintain budget neutrality. However, the latest reimbursement cuts have hit the "limb savers" hard, including vascular surgeons, interventional cardiologists, and interventional radiologists, who provide amputation prevention services for patients, with a circulation issue known asperipheral artery disease (PAD), in community-based clinics known as office-based labs (OBLS). P.A.D. is a circulation issue that left untreated can lead to amputation. To prevent further amputations and disruptions in patient access to care, new bipartisan legislation has been introduced to stop ongoing cuts to office-based specialists for the next two years. The Cardiovascular Coalition's Dr. Paul Gagne and Dr. Daniel Nathanson, both vascular surgeons, talk about why this new legislation is critical to save life and limb.
A Philadelphia Police Department pilot program, that refers people to social services instead of jail, is set to expand to the entire city this summer. The Police Assisted Diversion (PAD) started in Kensington in 2017 and has been successful, with only 8.5% of people who get into the program committing another crime after going through it. Host Trenae Nuri talks with Christina Griffith, contributing editor for the Philadelphia Citizen, about who qualifies for this program and if the city is ready for the expansion of PAD. Read Christina's full story here. Here's a list of Neighborhood Energy Centers. Center City District SIPS kicks off tonight. Want some more Philly news? Then make sure to sign up for our morning newsletter. We're also on Twitter and Instagram! Follow us @citycastphilly. Have a question or just want to share some thoughts with the team? Leave us a voicemail or send us a text at 215-259-8170. Interested in advertising with City Cast? Find more info here. Learn more about your ad choices. Visit megaphone.fm/adchoices
On this edition of the ODPH, the panel sits down to discuss: - Across The Spider-Verse and what Ken thought of it! Yes, Pad still hasn't seen it yet... To skip the spoilers, jump to: 37:46 - What we thought of Episode 11 "Complications" of Superman & Lois on The CW! - The FIRST trailer for The Expendables 4! And much more! For more #ODPH Content, check out our website! For #ODPH Social Media, here's our directory! Sign up for the ODPH Patreon! THANK YOU TO OUR AMAZING PATRONS! Check out the ODPH Merch Store at TeePublic! ODPH Entertainment Edition Intro Music provided by Shout At the Robots Contact NERD INITIATIVE Shop Comics Online: Shop Cheers To Comics & Use the promo code “ODPH” for 10% off your order!
Thomas loves working with people and his job as a casino supervisor kept him on his feet his entire eight hour shift. But peripheral artery disease, which is plaque buildup in mainly the leg arteries, was slowing him down and putting his job in jeopardy. So, he trusted his vascular surgeons to perform whatever procedure was needed to keep him on his feet. But he didn't know the advances in treatment for PAD and that minimally invasive options were available until complications occurred following an invasive bypass procedure. He reached out to a PAD advocacy organization called, The Way To My Heart, and they informed him of innovative, minimally invasive options. But it was too late for those as the complication at that point from the previous invasive bypass procedure led to an infection of the bypass graft and incision site. His incision site blossomed like a flower and needed immediate care. Dr. David Allie, a cardio thoracic surgeon,who specializes in advanced PAD care, and has advanced wound care experience with his involvement with various breaking studies, offered new options to save his leg from amputation. Dr. Allie and Thomas share this incredible journey to get him back on his feet for good.Thomas loves working with people and his job as a casino supervisor kept him on his feet his entire eight hour shift. But peripheral artery disease, which is plaque buildup in mainly the leg arteries, was slowing him down and putting his job in jeopardy. So, he trusted his vascular surgeons to perform whatever procedure was needed to keep him on his feet. But he didn't know the advances in treatment for PAD and that minimally invasive options were available until complications occurred following an invasive bypass procedure. He reached out to a PAD advocacy organization called, The Way To My Heart, and they informed him of innovative, minimally invasive options. But it was too late for those as the complication at that point from the previous invasive bypass procedure led to an infection of the bypass graft and incision site. His incision site blossomed like a flower and needed immediate care. Dr. David Allie, a cardio thoracic surgeon,who specializes in advanced PAD care, and has advanced wound care experience with his involvement with various breaking studies, offered new options to save his leg from amputation. Dr. Allie and Thomas share this incredible journey to get him back on his feet for good.
Many individuals who suffer from vascular diseases such as Peripheral Artery Disease and Chronic Venous Insufficiency are plagued with chronic pain. This ongoing pain can cause a sense of helplessness and frustration, as those affected struggle to regain control over their lives. Take Helen, for example, who finds herself buried under medical bills and unsure of where to turn for relief. She doesn't want to burden her family, but the prospect of managing her chronic pain seems overwhelming. In this episode, Helen shares her story about how she ended up determining that jail was her only option for medical care and pain relief.Kathryn Walker, Psychiatric Nurse Practitioner and CEO of Rivitalist, a wellness healthcare chain, helps Helen walk us through her story and what was going through her mind when she was arrested as she pretended to attempt to steal items from a Georgia Walmart. Christopher Stout, a vascular surgeon,contributes to the conversation by highlighting the challenges faced by patients with PAD and CVI, such as delayed care, insurance obstacles, and gaps between diagnosis and treatment. These issues can result in chronic pain that can significantly impact patients' daily lives and mental well-being.
Do you know the #1 killer of people in the US that kills more people than all cancers combined? Join Dr. Jeffrey Gladden, Steve Reiter, and Rhonda Rhyne in this episode of the Gladden Longevity Podcast. Rhonda Rhyne is a highly accomplished healthcare executive with a Bachelor of Pharmacy and an MBA. Most of her career has been spent in cardiovascular medicine and industry, primarily in medical devices. With experience in General Electric Medical Systems and Cardiodynamics, she became fascinated by the biomarker world, particularly non-invasive cardiac output and single biomarkers such as BNP. Rhonda then became the CEO of Prevencio, leading the company towards developing multi-analyte or multi-protein tests after seeing the potential of these combinations. In this episode, they discuss current diagnostic testing modalities, including exercise/echo/nuclear stress tests, coronary artery calcium scores, cholesterol, single protein blood tests, and genetic scores that have lower accuracy as compared to AI-driven multiprotein blood tests. As the podcast progresses, they look at how Prevencio's HART blood tests were developed through the use of AI to select and combine multiple proteins and optionally clinical parameters in an algorithm and scoring system that has almost 90% accuracy for detecting whether you have heart disease and are at imminent risk of heart attack (HART CADhs), or one year risk of heart attack, stroke or cardiac death (HART CVE). They discuss the negative effects of alcohol on sleep and exercise routines, as well as how the enzyme alcohol dehydrogenase can contribute to aging. Rhonda shares their experience conducting cardiopulmonary exercise tests and strategies for protecting kidneys during contrast dye exposure. We dive into the importance of identifying insulin resistance and understanding genetic expression in predisposition to cardiovascular disease. Finally, we look at a new algorithm combining six parameters for a more accurate diagnosis of coronary artery disease. Do you know you can use the HART tests as a baseline to track and trend your hopeful improvement or deterioration of your heart? Listen to this episode to learn about making 100 the new 30 and living young for a lifetime! Dr. Gladden welcomes everyone to the show and shares how he met Rhonda (2:15) Rhonda shares how she got into what she presently does and her background. (3:15) Through proteins, we see how a genetic expression is. (5:33) Dr. Gladden highlights that high-sensitivity troponins and other proteins are being identified as potential markers for heart disease. (7:03) Dr. Gladden observes troponin levels rise in people who exercise but not exercising may show normal ranges. (9:55) Dr. Gladden shares how adiponectin protects arteries from oxidative stress. (12:22) Rhonda reveals that they fed machine learning all the proteins they could get. (14:30) Heart health comes down to a lot of things, not just one. (16:25) Rhonda says they are in the process of collecting data and doing case studies. (18:52) Gene expression can be modulated to achieve balance in the body's complex ecosystem using custom peptides. (21:42) Dr. Gladden says, in his practice, one of the issues he faced was taking care of people's kidneys. (23:28) Rhonda gives information about a test that is not commercialized yet but is just in the process. (26:56) Steve asks about the long-term effects of what Dr. Gladden mentioned. (27:40) Rhonda says the PAD will soon be available. (29:40) Rhonda discloses that, in August, she will have been with the company for ten years. (31:11) Dr. Gladden insinuates that there is a lot more to insulin levels than people realize. (33:23) There are no side effects in getting a simple blood test. (35:26) Rhonda talks about the accuracy of their tests compared to traditional ones. (38:02) Rhonda thanks Steve and Dr. Gladden for the podcast. (38:50) Visit our website, www.gladdenlongevitypodcast.com, for more information on this episode and other episodes as well. Click on the link to let us know what you'd like us to talk about on the podcast too! Follow us on social media! Instagram: @gladdenlongevity Twitter: @gladdenlongevit Facebook: @GladdenLongevity LinkedIn: @GladdenLongevity For more information on our practice or how to become a client, visit: www.gladdenlongevity.com Call us: 972-310-8916 Or email us: firstname.lastname@example.org To learn more about Rhonda Rhyne and/or Prevencio, check out the following: Website: https://prevenciomed.com/ Phone Number: (425) 576-1200 Linked: https://www.linkedin.com/company/prevencio-inc./ (@PrevencioInc) Facebook: https://www.facebook.com/Prevencioinc/ (@PrevencioInc) Youtube: https://www.youtube.com/channel/UCurfuy5rBjtc-ShYs_Aetpg Twitter: https://twitter.com/RhondaRhyne DISCOUNT: Podcast10 (10% off your purchase at the Gladden Longevity Supplement shop (https://gladdenlongevityshop.com/) Get the supplements mentioned in this episode! CoQ10: https://gladdenlongevityshop.com/products/super-ubiquinol-coq10-100mg-60-softgels?_pos=1&_psq=coq&_ss=e&_v=1.0 Berberine: https://gladdenlongevityshop.com/products/berberine-60-count?_pos=1&_psq=berberine&_ss=e&_v=1.0 Bergamot: https://gladdenlongevityshop.com/products/bergamot-bpf-60ct?_pos=1&_psq=berga&_ss=e&_v=1.0
5/19/23 - Host Doug Stephan and Dr. Ken Kronhaus of Lake Cardiology (352-735-1400) cover a number of topics, including: how napping can help boost your creativity, cranberries can help fight recurring urinary tract infections, sadly deaths during pregnancy are on the rise, the use of Marijuana increases your risk for PAD by 3 times, Dr. Ken and Doug salute Nurses and Nursing, an update on Jamie Fox and how strokes affect us, gastro intmestional Cancer is now linked to Obesity, a new drug being tested on mice may hold the key to killing Cancerous breast tumor and finally, Dr. Ken offers a warning on adopting AI in medicine too quickly.This show is part of the Spreaker Prime Network, if you are interested in advertising on this podcast, contact us at https://www.spreaker.com/show/3010085/advertisement
Ep 083: Lately with our show, we've been going into a lot of purpose driven topics and naturally, our goal is to be tying money and purpose as part of our Practice, but also as a podcast theme here on The Retirement Success in Maine Podcast. Sometimes, we think that we need to lean back into the financial end on this show, and that's exactly what we are going to do on this episode! In this episode, you'll hear from Austin, Ben, and Curtis, from Guidance Point Advisors, directly as they are going to share with you some of the top financial tips that they are providing in their financial planning and advisory sessions each day. Chapters: Take a hard look at your cash accounts. [2:22] Take a look at your debts. [7:42] Pad your emergency fund. [10:04] Fight Inflation. [13:43] Re-think your stock to bond mix. [26:45] Be greedy when others are fearful. [28:00] Consider a ROTH Conversion. [31:40] Check your pandemic subscriptions. [33:24] Be careful of what you hear/see online. [36:45]
Electromagnetic therapy has been in use by physicians with Tesla coils in the 1930's stemming from early more rudimentary electric charged needles used for treating slow healing fractures in the mid 1800's. More scholarly research for fractures and bone healing was conducted in the 1960's that led to eventual FDA approval for those indications. A 2003 study conducted by NASA concluded that time varying fields increased the growth rate of neural progenitor cells in culture mediums by 2.5- 4 times. PEMF use has now exploded for health and wellness by consumers particularly after the development of low PEMF mats. There is confusion by physicians as well as the lay public about what devices and strengths are needed for health benefits and healing. Ben Pearl, D.P.M. is exploring and developing a number of new protocols that he has implanted in his practice to treat patients with fractures, arthritis, acute trauma, gout, tendonitis, neuropathy, vascular problems such as Raynaud's, PAD venous insufficiency and neuropathy. He continues to be at the forefront of looking for more effective ways to help patients in the clinic and home setting.
Falo sobre a decisão unânime do TSE que considerou inelegível, e, logo, cassou o mandato, do Deputado Deltan Dallagnol. Explico os fundamentos da decisão que se deu com base na Lei das Inelegibilidades (LC. 64/90), que foi alterada pela "Lei da Ficha Limpa".Para quem quiser ler a decisão, ela está disponível aqui: https://www.tse.jus.br/comunicacao/noticias/2023/Maio/por-unanimidade-tse-cassa-registro-do-deputado-federal-deltan-dallagnol-podeGostou do conteúdo? Curta, Compartilhe e Assine o Canal!
To continue our Jewish American Heritage Month celebrations, guest host Laura Shaw Frank, AJC's director of William Petschek Contemporary Jewish Life, speaks with Chanie Apfelbaum, author of the popular food blog Busy in Brooklyn. Chanie joins us to discuss her new cookbook, "Totally Kosher," the intersection of Jewish culture and food, and the future of kosher cuisine. She also shares how the murder of her brother, Ari Halberstam, who was killed in a 1994 terrorist attack on the Brooklyn Bridge, has inspired her career. *The views and opinions expressed by guests do not necessarily reflect the views or position of AJC. ____ Episode Lineup: (0:40) Chanie Apfelbaum ____ Show Notes: Take our quiz: Jewish American Heritage Month Quiz: Test your knowledge of the rich culture and heritage of the Jewish people and their many contributions to our nation! Start now. Read: What is Jewish American Heritage Month? Jewish American Heritage Month Resources Faces of American Jewry Amazing Jewish Americans Listen: 8 of the Best Jewish Podcasts Right Now AJC CEO Ted Deutch on the Importance of Jewish American Heritage Month From Israel: AJC's Avital Leibovich Breaks Down Latest Gaza Escalation Follow People of the Pod on your favorite podcast app, and learn more at AJC.org/PeopleofthePod You can reach us at: email@example.com If you've enjoyed this episode, please be sure to tell your friends, tag us on social media with #PeopleofthePod, and hop onto Apple Podcasts to rate us and write a review, to help more listeners find us. __ Transcript of Interview with Chanie Apfelbaum Manya Brachear Pashman: People of the Pod is celebrating Jewish American Heritage Month by devoting all our May episodes to what makes us Jewish and proud -- food, music, and our mission to repair the world. Last week you heard from AJC CEO Ted Deutch about why we should set aside a month to celebrate. This week nods to our obsession with food. And for that, I'll turn it over to my guest co-host, Laura Shaw Frank, AJC's Director of Contemporary Jewish Life. Laura, the mic is yours. Laura Shaw Frank: Thanks, Manya. Happy Jewish American Heritage Month! As we celebrate Jewish American culture and history this month, it feels like we would be quite remiss if we didn't spend some time talking about Jewish food. Food plays an enormous role in Jewish tradition and culture. Jews have foods linked to particular Jewish holidays and of course Shabbat, ethnic foods linked to particular places where Jews lived, and of course, lots of Jews, myself included, keep kosher, follow the laws of Kashrut, which deeply influences the way we cook and eat. I think I'd be pretty safe in saying that Jewish food is really important in Jewish life. Not surprisingly, statistics bear this out. In the Pew Survey of Jewish Americans in 2020 over 70% of American Jews, young and old alike, reported cooking or eating traditional Jewish foods. Which is why I'm so excited to be joined by today's guest, Chanie Apfelbaum. Chanie is a food writer and photographer whose blog “Busy in Brooklyn” is chock full of delectable recipes and beautiful pictures of amazing Jewish foods. Her newest cookbook, Totally Kosher, hit bookstores in March 2023. Chanie, welcome to People of the Pod. Chanie Apfelbaum: Thanks so much for having me. Laura Shaw Frank: I'm thrilled to have you and really thrilled to talk to you about your new cookbook. So before we get into that, though, let's take a step backward. How did you get into kosher cooking? Chanie Apfelbaum: Well, I was born Jewish. That's the first step, always. I always say– learning your way around the kitchen is just a rite of passage when you get married. And being a Jewish housewife, obviously, we have, you know, Shabbat dinner every week, and so many holidays, and Jews are always just celebrating around food. I actually never stepped foot in the kitchen before I got married, never really helped my mom, my older sister used to help with cooking. It just looked like a chore to me. I am a very creative soul, very artistic. And it just seemed like a whole lot of rules. And I just wasn't interested. And then I got married. And I would call my mother every Friday and like, how do I make gefilte fish and potato kugel, and chicken soup. And I started hosting a lot. And people started asking me for my recipes. And I realized that I kind of had a knack for presentation. Because I've always been artistic. And you know, like composition and things like that. And my food always was presented nicely and looked beautiful. So it kind of got me you know, a little bit interested, piqued my interest. And I realized that it could be a way for me to explore my creative side. So I I started watching The Food Network a lot. And I subscribed to Bon Appetit Magazine, and started looking at cookbooks. And then when I had my third child, I didn't want to really work outside the house anymore. So I was like, What should I do with myself, I'm not the type of person that could just be a stay at home mom, I would lose my mind. So I was like, Okay, I'm gonna start a blog. And there really weren't any food blogs and no kosher food blogs. This is back in 2011. There was Smitten Kitchen, there was Pioneer Woman, those are both pioneers in the blogging world, in general. And there definitely weren't any kosher blogs. And I just, you know, I started my blog. And like I said, I wasn't cooking, you know, the traditional Jewish, heimish Ashkenazi food that I grew up with. Talking a little about being a mom. I had my crochet projects on there. And it was just like my place to get creative and have an outlet. And then feedback really started pouring in, everything I was posting, people were so interested. It didn't exist in the kosher world. And despite not being a big foodie, I just continued to just do my thing and taking terrible pictures in the yellow light of my kitchen island, on automatic, with my terrible camera. And over time, just my food started to evolve, my photography started to evolve. And fast-forward a couple of years, I went to a kosher culinary school, which really helped me kind of opened my mind to new flavors, which I was I think stuck a little bit in the Ashkenazi palate of paprika and garlic powder, as I like to say, and just tried all these Indian food and Thai food and all these flavors that I literally never ever experienced. And it just blew my mind open in so many ways. Being creative, a few of my friends kind of started blogs around the same time. And every time a holiday would come around, it was like who's going to come up with the coolest latke or the coolest humentasch, or the most creative donut. So it really pushed my competitive side and also my creative side. And I just started really thinking outside the box and doing a lot of these cool twists on tradition and fusion recipes and caught a lot of attention in mainstream media and everything went from there, I guess. Laura Shaw Frank: That's amazing. I want to pick up on one thing that you said. You said when you started blogging that so many people got in touch with you. And you were obviously bringing them content that they hadn't seen before. What do you think was missing from the conversations around kosher food before you entered the space? I mean, I'll just you know, tell you when I got married, everyone got the Spice and Spirit cookbook from Lubavitch. I still use it, by the way. It's a fantastic cookbook. It's a more traditional cookbook. And so tell us a little bit about what did you bring that was different to kosher cooking? Chanie Apfelbaum: You know what, there's one story that sticks out in my mind that really, because I've always been this person that picks up hobbies along the way, like every creative thing. I'm knitting, I'm crocheting. I'm scrapbooking, kind of all these type of things. I pick up a hobby, I do it for a couple of months and then I kind of let it go. So I always asked myself, like, what was it about food blogging that really stuck for me, and I think that I realized the power of it. One year, I made this recipe for the nine days when we don't eat meat, you know, between before Tisha B'Av, some people have accustomed not to eat any meat recipes, because it's a time of mourning, it's a serious time before the anniversary of the destruction of the Holy Temple. So wine and meat are more celebratory things that we eat. So those are restricted for nine days before Tisha B'av. So I made this recipe for Chili Pie in Jars. And it was a vegetarian chili, a layer of cheddar cheese, and cornbread, and you bake it in a mason jar in the oven. So each person has basically their own pie. So I made this recipe and I put it in on my blog, and this is before Instagram, can't DM somebody a picture, it's before smartphones, you can't just take a picture on your smartphone. So somebody took out their digital camera, took a picture of their families sitting around the table, everyone's holding their own mason jar, and like, took the SD card out, put it in their laptop and sent me an email. This is early days of my blog. I get this picture. I see a whole family sitting around the table eating my recipe and I'm like, oh my god, how powerful is this, that I have the opportunity to bring families around the table, it is so special. And I think that that's something that really stuck with me through all my years of blogging and really at the core, for me, what keeps me going because I realize the power of food. Especially, as a proud Jew, to celebrate our traditions through food, because, thank God through my platform, I get messages from people–someone sent me a message from literally Zimbabwe making Challah for the first time. It's just so special to me. So, obviously, as a mom of five, I'm always cooking dinner, and it can feel like a chore. I get cooking fatigue like everybody else. And cooking Shabbat dinner every week. I always say in the main world, they make this big deal about Thanksgiving, you know, you have to plan your menu from Sunday, and then your shopping list from Tuesday and all that but like we literally have Thanksgiving every Friday night. It's a three course or four course meal sometimes. So yeah, I get the cooking fatigue. And for me, I want to show people how to bring the love back in the kitchen. You know, how food can be more than just a way of sustaining ourselves, it could be a way of celebrating our Jewishness, it could be a way of bringing our family around the table, it could be a way of getting pleasure out of life. Food can be so delicious, and it can open your eyes and experience global cuisine. That's so cool and amazing. So I had that aha moment for myself, and I want other people to have it too. Laura Shaw Frank: That's amazing. I love that. So what you're really saying is that food and culture are really intertwined with one another. And you gave this example of the nine days before the Jewish fast day of Tisha B'Av, which takes place in the summertime, when it's traditional among religious Jews to not eat meat and wine and talking about sort of adjusting recipes. Could you give us a couple of other examples of ways that you see sort of Jewish history, Jewish culture, Jewish tradition embedded in food? Chanie Apfelbaum: Look at the holidays, right, Rosh Hashanah, we have a lot of symbolic foods. Most people know of apple and honey, but there are actually a whole range of symbolic foods that we eat. The actual names and Hebrew of those foods, point to different things that we want for our year,like we eat a fish head because we want to be like a head and not a tail. For me that really helped me kind of zone in on what is my niche here, right? I am a kosher food blogger, but how do I define my skill or who I am because every blogger kind of has their thing. And for me a lot of it is centered around the holidays because first of all for me like I have so many beautiful memories growing up. My mother is very much a traditional Ashkenazi cook, making kugel and gefilte fish and cholent and matza ball soup. She doesn't veer away from that. Those are the dishes that I grew up on and they're so nostalgic for me and there's a place for that. Our home was always open, we had so many guests. I actually grew up in Crown Heights. So I really zone in a lot on holiday foods, but putting my own spin on it, because I feel like people want something fresh and new and exciting. And I definitely think there's a place for the traditional foods. You want to mix it up and have a little bit something fresh and new and something old, that's great. We're lucky that we have that core of our heritage and our traditions throughout the year with so many Jewish holidays that allow us to get together, with family, with friends, and celebrate our Jewishness. Laura Shaw Frank: So, my husband and my three sons are all vegan. Chanie Apfelbaum: Oh, wow. Laura Shaw Frank: My daughter and I are not – but my husband and my three sons are vegan. As I was thinking about interviewing you, I was thinking about how kosher cooking is always intertwined with the places that it's located in and the time in which it's occurring. Do you feel like your cooking has been influenced by the recent trends toward vegetarian and vegan and more plant based eating? Chanie Apfelbaum: I definitely, just as someone who grew up eating a lot of heavy Ashkenazi food. Being in the food world, seeing what's out there. Besides for the fact that it's trendy. I feel like after Shabbat, I want to break from meat and animal protein. I mean, we're eating fish, we're usually having three courses. We're having fish, we're having chicken soup or having some kind of meat or chicken. Sunday we're usually having leftovers because there's just so much food from Shabbat. So come Monday we do in my house–in my first cookbook, Millennial Kosher, which came out in 2018. I had a Meatless Meals chapter. And that was really new for any kosher cookbook. You don't find it, you find definitely very heavy meat chapters. But it was important to me because I instituted that in my house many years ago. And I have it in this book as well. And I got so much amazing feedback because there's a lot of people out there who don't eat meat. There's a lot of vegetarians. There's a lot of vegans. And they were so happy that I was bringing that to the kosher world, and of course wanted to bring it again. And also my kids love it. Like come Monday they know it's Meatless Monday in my house. God forbid I didn't have time to think of something and I bring chicken they're like, What, what's going on here? Ma, it's Meatless Monday. It's like a rule. So I include this in the book where I talk about the way I structure my week because it really helped me kind of take the guesswork out of what am I making for dinner. I have a loose framework, while still allowing me the possibility to be creative because I love you know, playing Chopped with my kids, with whatever's in my fridge or my pantry. I want the possibility to be creative but I still need a little bit of framework. So Sunday's we'll have leftovers if there's no leftovers, we'll do a barbecue or sometimes a restaurant if we're out for the day. But Monday's Meatless, Tuesdays is beef. Wednesdays is chicken, Thursdays is dairy. Shabbos is Friday night, it's always a little bit different. And then, Saturday night is eggs. And it gives me the base protein, I know what I'm working off of and then from that I can kind of play around. And I think that really helps people that are like so overwhelmed with the idea of what am I making for dinner? You wake up on a Tuesday morning, you know, it's meat day, okay, I got to take out some kind of meat from the freezer. I'll figure out what I'm doing for later. Maybe I'll make tacos. Maybe I'll make spaghetti Bolognese maybe, you know, maybe I'll make burgers, but you took the meat out, you know. But going back to your question. So you know, Mondays is meatless in my house and we're a big bean family. My kids love beans. One of their favorite dinners are my refried bean tacos that are my first book. I have these amazing smashed falafel burgers in this book. Like I said, we love beans, I do curries I do, Falafel I do. Once in a while I'll try and play around with tofu. My kids don't love it too much. Tempe is something - I have tempe shawarma in the book which is really amazing. Let's not forget to mention plant based beef which I think totally revolutionized the kosher experience because when can we ever make you know, meat and dairy together because that's one of the basic rules within the kosher kitchen. You can't mix meat and dairy together in the same dish. My kids love when I make smash burgers for dinner. And I always said like, I don't love vegan dairy products if you just don't get that cheese pull, but like with the vegan meat products, with the new plant based impossible beef, it's really close to the real thing. It really is. Laura Shaw Frank: We love impossible burgers in our house and I want to try that tempe shawarma. Chanie Apfelbaum: Oh, it's really good. Laura Shaw Frank: What recipe would you say was kind of the biggest surprise for you? I mean, it seems to me like you often work from traditional Jewish recipes, but seems like you also are constantly innovating and making up your own recipes. So is there a recipe that just kind of surprised yourself and couldn't believe how it turned out? Chanie Apfelbaum: My favorite recipe in the book is my Pad Chai. And it's kind of a Middle Eastern spin on Pad Thai, where I use harissa and silan and lime and tamarind in the sauce. It almost feels like pad thai with just that little hint of Middle Eastern flavor. Pad thai is always finished with crushed peanuts, and I put crushed bamba over the top. And it's just so fun and playful. And I also love fun names. So I love just the name of it, but it's really a reflection of, first of all my favorite flavors, like I love middle eastern food, I love Thai food, marrying them together. And it's colorful and beautiful and so flavorful. Everything I love about food, and was really inspired by the pad thai made in culinary school. And it was one of the dishes that really, really transformed my palate completely. So it's kind of an ode to that. Laura Shaw Frank: You're getting me very excited to go home and make dinner for the next few nights. Chanie Apfelbaum: You see right there. Laura Shaw Frank: So your latest cookbook, Totally Kosher, is being published by Random House. And that's a really interesting thing for a kosher kind of a niche cookbook to be published by a very mainstream publisher. So I was wondering if you could tell us a little bit about how it came about that you got, first of all, that you got Random House to publish your cookbook, which is amazing. Second of all, why you left the more Jewish the more orthodox publishing world. Chanie Apfelbaum: I'm with Clarkson Potter, one of the imprints of Penguin Random House, that's an imprint. They haven't written a kosher book in many, many, many years. Thank God, I've been in this industry for 12 years. And I already wrote a very successful book. So my name is really out there. People know me as being the kosher cook. So they did approach me to write the book, which was really an honor. I had a very good experience the first time around working with Artscroll. Artscroll is like the main Jewish distributor of and publisher of Jewish books. My book was beautiful, and their distribution is really unmatched, but it's really only in the Jewish world. they'll get your book and every Judaica shop in the world, but not in Barnes and Nobles, and not in you know, in mainstream, indie booksellers. I really wanted to reach a larger demographic of Jews. As a blogger, people have come to know me and my family. I wanted to put more lifestyle photos in and most Jewish publishers don't actually publish photos of women in their books, which is something that I definitely want to see change. And I put beautiful pictures of my family, me and my daughters lighting Shabbos candles which is something that like, the moment of my week that I look forward to and a special time for me that I really feel like I connect with my Jewishness. And you know, my book is dedicated and memory of my Bubbie and to my mother and to my daughters and for me, it's really about the Jewish family and Jewish pride–not just about food, but really about family and I wanted to be able to portray that through the photos in the book. So that was another of my reasons for moving mainstream. Laura Shaw Frank: I think it's just amazing. And I just think it's so wonderful that you are illustrating your cookbook, with pictures that are not just about Jewish pride, but also about the special pride of Jewish women and the special…you know, of course, not only women cook, you know, men cook too, I have to say, my husband cooks dinner a lot more than than I do. And kids cook and lots of different people find a lot of wonderful fulfillment in the kitchen. But, of course, we do have this very long tradition of women cooking for their families, even as we change it up today. And I just think it's beautiful that you actually intentionally use pictures of women, of your family, in your cookbook. Chanie Apfelbaum: And my sons are there too. Laura Shaw Frank: Excellent. Let's make it a family experience. Chanie Apfelbaum: Exactly, exactly. Laura Shaw Frank: Speaking about family experience, you've written about why it's so important to you to encourage family meals with everyone sitting around the table together, whether it's on Shabbat or holidays or even just a weekday dinner. Could you share with us why that's so important to you? Chanie Apfelbaum: Well, I grew up in a very open home. My mom always had guests for shabbat or holidays. I grew up on the block of 770 Eastern Parkway, Chabad Lubavitch headquarters, and our house was just always open to guests. It's something of value that was instilled in me from early on. And I don't know if you know this, but my brother Ari Halbersham was actually killed in a terrorist attack on the Brooklyn Bridge in 1994. That's something that I feel like, I don't think people realize, when you lose a family member in that way, it's not like, OK, you just lost your brother. But it affects the whole family, really for generations. And I think that one of the things that I lost was having those experiences around the table. And especially so many memories with my brother at the table as well. So for me, I find so much healing–first of all healing, but also just, I see the greatness and the power to bring families around the table. To create family memories. So many that I draw great comfort from, I want other people to be able to experience that. It's important for me to do that, also as a way to remember him and celebrate what he lived for and what he died for. Laura Shaw Frank: Ok, that's incredible. And it's an incredible message to all of us to be in the moment and treasure those moments around the table. So the last thing I want to ask you is, so you have this cookbook that's being published by a mainstream publisher. And we know that not a lot of Jews keep kosher. The percentages are not that high. Do you think your cookbook appeals beyond just a kosher audience? Chanie Apfelbaum: Well, I'll tell you that I have a lot of–forget about non- kosher keeping. I have a lot of non-Jewish followers on Instagram that buy my book, because they just like my style of cooking. I know it's called Totally Kosher. And obviously, it's a celebration of kosher and celebration of our Jewish heritage, and our customs and traditions, but at the same time, it's just good food, it's just good food, despite it being kosher, and really, I really want to break that stigma that there is about kosher food - that kosher food is brown, and it is brown. You know, like I can't take it away. Matzah ball soup is beige, and gefilte fish is beige, and potato kugel's beige, and brisket's brown. And you know, there's a reason for the stereotype. Laura Shaw Frank: Cholent's brown too. Chanie Apfelbaum: It is. And if you look through my book, one thing that will pop out at you is how colorful the food is, and how beautiful the food is. And like I said earlier, I came to food by means of artistry. They say people eat with their eyes first. And it has changed and I think in the mainstream world, they haven't quite realized how kosher has evolved. I mean, there's so many different restaurants, kosher restaurants now, that celebrate different global cuisines. There's a Peruvian Japanese restaurant in the city, there's a Georgian restaurant in Queens. It's not just your Bubbie's stuffed cabbage anymore. And I want, like I said, the stigma to change and make waves in the mainstream world to see kosher a little bit differently. Laura Shaw Frank: Well, I'm for one very excited to start making some recipes from Totally Kosher. And I just want to thank you, Chanie, so much for coming to join us on People of the Pod. I think that you are bringing such a fresh take. And such a warmth, such a deep sense of Jewish culture and peoplehood, and family, and love to your work. And it's really more than just about kosher cooking. It's really about something much bigger. And I just want to thank you for that. So thanks so much for joining us today and I know we're gonna have a lot of listeners going to buy your cookbook. Chanie Apfelbaum: Thank you for having me.
For the past seven years, All the Best has collaborated with the University of Melbourne's Centre for Advancing Journalism and the Science Gallery to mentor students in my Audio Journalism class and to provide audio editorial training. These produced narrative podcasts that have been used in the Science Gallery's shows and broadcast on All the Best. This collaboration has allowed students to produce work for broadcast for a public audience for the first time. This year's theme is 'Dark Matter' and All The Best mentors are currently working with students on a brand new batch of stories to fit this theme. You can keep an eye out for those in June, but in the meantime here are some of our favourites from previous years. You'll hear the stories as they were first aired, so get keen to hear voices from hosts of All the Bests' past! Grandpa Delivers The Eulogy At His Funeral by Julia Bergin 2017 Three years prior to his death, Grandpa and father began formal discussions for his funeral. Whilst they disagreed over size and music, there was consensus that Grandpa should speak on the day of his departure. In March this year, the funeral planning committee's recommendations took effect; Grandpa addressed the congregation from his casket, delivering the eulogy at his own funeral. Supervising producer: Jordan Fennell. More Than a Pad by Wing Kuang, Chang He and Inderpreet Kaur 2019 Australians are pretty used to disposable menstrual products. But for Indepreet, growing up in India, cloth pads have always been the norm. Supervising producer: Eugenia Zoubtchenko. Brown and Happy by Dilpreet Kaur 2018 “You have dark skin and a fat nose,” said the 60-year-old neighbour to a 12 year-old girl. A whole decade later, this girl is still fighting the stereotype of being a woman of color and the lack of privilege of not being white. Does she give in? Supervising Producer: Jordan Fennell. All The Best credits: Production Manager: Phoebe Adler-Ryan Editorial Manager: Mell Chun Episode Mix and Compile: Phoebe Adler-Ryan Host: Madhuraa PrakashSee omnystudio.com/listener for privacy information.
Lindholt JS, Søgaard R, Rasmussen LM, et al. Five-year outcomes of the Danish cardiovascular screening (DANCAVAS) trial. N Engl J Med 2022;387(15):1385-1394. Study design: Randomized controlled trial (nonblinded) Looking to see if intensive screening protocol for cardiovascular disease reduce cardiovascular events or mortality in older men? Danish study, 46,611 men aged 65 to 74 years were randomly assigned to receive an invitation to screening or usual careThe screening program included non-contrast electrocardiographically gated CT to measure coronary artery calcium, look for aneurysms, and detect atrial fibrillation; ankle-brachial index measurements for peripheral arterial disease (PAD) and hypertension; and blood tests for diabetes and hyperlipidemiaThose who accepted screening were more educated, more likely to be employed, and had a somewhat lower rate of hospitalization for cardiovascular events in the previous 5 years. (the rich white gullible ceo male)The screened group was more likely to be given lipid-lowering drugs and antithrombotics, and they were more likely to have repair of an aortic aneurysm.In the entire population, stroke was less likely (HR 0.93; 0.86 - 0.99) but there were no significant differences in myocardial infarction, aortic dissection, or aortic rupture. The authors estimated that 97.4% of men who received preventive therapy of some kind as a result of screening experienced no mortality benefit after almost 6 yrs of follow up. This is basically a really small absolute benefit which we could also see in just placing a pt on a statin. We don't need vip medicine we need pcp that have time to calculate risk and place pt on statin when indicated. Goldberg RB, Orchard TJ, Crandall JP, et al, for the Diabetes Prevention Program Research Group. Effects of long-term metformin and lifestyle interventions on cardiovascular events in the diabetes prevention program and its outcome study. Circulation 2022;145(22):1632-1641. Study design: Randomized controlled trial (nonblinded) What is the long-term impact of treating prediabetes on mortality and cardiovascular outcomes? Go way back original Diabetes Prevention Program study randomized 3234 overweight or obese adults with impaired glucose tolerance ("prediabetes") to receive metformin 850 mg twice daily, an intensive exercise program, or placebo and followed them for 3 years Patients were invited to participate in a long-term open-label follow-up study This article reports long-term cardiovascular and mortality outcomes for each group. Patients in the intervention groups were less likely to have been given a diagnosis of T2DM (55% for metformin and 53% for lifestyle vs 60% for placebo; P = .001; number needed to treat [NNT] = 17) There was no difference between either intervention group and placebo with regard to the risk of cardiovascular death, nonfatal stroke, or nonfatal myocardial infarction. There was also no significant difference in the composite of all 3 outcomes for the original metformin group versus the placebo group (hazard ratio [HR] 1.03; 95% CI 0.78 - 1.37) or for those in the original lifestyle group versus the placebo group (HR 1.14; 0.87 - 1.50). More is less or rather more meds is less diagnosis but no difference in things we actually care about Skjerven HO, Lie A, Vettukattil R, et al. Early food intervention and skin emollients to prevent food allergy in young children (PreventADALL): a factorial, multicentre, cluster-randomised trial. Lancet 2022;399(10344):2398-2411. Study design: Randomized controlled trial (single-blinded) Does the early introduction of allergenic foods prevent the development of food allergy? investigators randomized healthy newborns, singletons or twins, with at least 35 weeks' gestational age (concealed allocation) to receive no intervention (n = 597), a skin intervention (n = 575), a food intervention (n = 642), or a combined intervention (n = 583). The skin intervention consisted of 5- to 10-minute baths with added petrolatum-based emulsified oil followed by topical cetirizine cream applied to the face. This intervention was to occur at least 4 days per week from age 2 weeks to 8 months, The food allergy intervention consisted of sequentially adding allergenic foods (peanuts, cow's milk, wheat, then eggs) to the infants' regular diet at weekly intervals starting at age 3 months. Overall, 95% of the infants in each group were breastfed at 3 months The researchers had final data on 99.9% of the participants! based on structured parental interviews, skin testing, and oral challenges The researchers classified the development of food allergy at 36 months as probable, none, or unclear. There was no significant difference, however, between the infants who were exposed to skin interventions and those who were not exposed (2.1% vs 1.6%). BUT BUT BUT Food allergy occurred in 1.1% of infants in the interventions using food (food intervention and combination intervention) compared with 2.6% in not using food (no intervention and skin intervention; number needed to treat = 63; 95% CI 37-196). Lewis E, Merghani K, Robertson I, et al. The effectiveness of leucocyte-poor platelet-rich plasma injections on symptomatic early osteoarthritis of the knee: the PEAK randomized controlled trial. Bone Joint J 2022;104-B(6):663-671. Study design: Randomized controlled trial (double-blinded) Allocation: Concealed recruited adults with at least 4 months of knee pain (with or without swelling) who had mild degeneration on their x-rays (if plain x-rays found no signs of degeneration, they used magnetic resonance imaging to confirm the diagnosis). The participants were randomized to receive 3 weekly saline injections (n = 28), or a single PRP injection followed by 2 weekly saline injections (n = 47), or 3 weekly PRP injections (n = 27). . The clinician performing the injections was unmasked but had no other involvement in the study procedures. the participants were evaluated at 6 weeks, 12 weeks, 6 months, and 12 months after enrollment Using intention-to-treat analysis looking at pain, function, and quality of life, at no point in the study were PRP injections, singly or serially, superior to saline injections.
In this episode, host Dr. Chris Beck interviews Dr. Alexander Ushinsky about his standard workup and treatment when performing arterial thrombectomy in acute limb ischemia (ALI). --- CHECK OUT OUR SPONSOR AngioDynamics Auryon System https://www.auryon-system.com/ --- SHOW NOTES In the past three years, Dr. Ushinksy has focused on building up peripheral vasculature service lines at the Mallinckrodt Institute of Radiology at Washington University in St. Louis. He has acquired skills not only in treatment of ALI, but also in building referral bases and collaborating with vascular surgeons and cardiologists. To begin, we review important aspects of a focused history and physical exam. It is crucial to assess whether the patient has underlying peripheral arterial disease (PAD), other thromboembolic diseases, or underlying coagulopathies. Different etiologies of thrombus could require additional consultation with hematologists and cardiologists. Additionally, timing of symptom onset is important to consider when planning interventions in an on-call setting. Dr. Ushinsky relies on extremity pulse exams using bedside doppler and the Rutherford Classification System for ALI to ascertain whether intervention can be helpful. In cases of Rutherford class 1-2a, intervention is usually warranted. Cases that fall into class 2b may or may not require intervention, and cases in class 3 and beyond usually do not gain benefit from intervention since lower extremity paralysis and clot burden is so severe. With regards to types of interventions, Dr. Ushinsky highlights two common IR procedures– lysis catheter placement and endovascular thrombectomy. In the past, lysis catheters were the only available endovascular treatment. We walk through catheter placement, noting that in order to gain maximum benefit, the catheter should be placed across the entirety of the thrombus, with holes proximal and distal to the lesion, so that tPA can be infused throughout the clot and have appropriate inflow and outflow tracts. Good candidates for lysis catheter placement include patients who have extensive clot burden in small vessels and those who have underlying CLI that can be definitively addressed in a later procedure. A major difference between lytic catheter placement and thrombectomy is that patients receiving lytic therapy require admission to the ICU for close monitoring and frequent neurovascular checks. Next, we pivot to discussion about newer thrombectomy devices. Dr. Ushinsky describes pros and cons of common devices that are used in his practice and types of cases that would benefit from each one. Thrombectomy is useful if there is a low clot burden that can be addressed in a single session. Additionally, this procedure is more appropriate than lysis catheter placement if the patient is elderly, has had recent surgery, or is otherwise a poor candidate for systemic tPA. Dr. Ushinsky always performs a diagnostic angiogram at the beginning of the case and a completion angiogram to confirm that the lesion has been fully treated. Overall, he believes that the best intervention for a patient is the one that the practitioner feels the most adept at and can safely perform. --- RESOURCES Rutherford Acute Limb Ischemia Classification System: https://www.jvascsurg.org/article/S0741-5214(97)70045-4/fulltext#secd69653256e1488 Boston Scientific AngioJet Thrombectomy System: https://www.bostonscientific.com/en-US/products/thrombectomy-systems/angiojet-thrombectomy-system.html Penumbra Indigo Thrombectomy System: https://www.penumbrainc.com/peripheral-device/indigo-system/ AngioDynamics Auryon Thrombectomy System: https://www.angiodynamics.com/product/auryon/ Rotarex Excisional Atherectomy System: https://www.bd.com/en-us/products-and-solutions/products/product-families/rotarex-rotational-excisional-atherectomy-system Pounce Thrombectomy System: https://pouncesystem.com/ Find this episode on BackTable.com to see the full list of resources.
Episode 18April 24-30 | John 7-10 | “I Am the Good Shepherd”AfricaNo AbuseHealing is possible#NewTestament #ComeFollowMe #ComeFollowMe2023 #TalkofHim #FindHimJoin hosts Ganel-Lyn Condie and John Fossum on this New Testament episode of Talk of Him as we explore these important themes, topics, and questions from John 7-10:Everyone wants to know their Heavenly ParentsJesus's life manifested the character and nature of our Heavenly ParentsHow merciful and kind are our Heavenly Parents?Pad the fall with loveTalk of Christ, preach of Christ so our children what source they can turn to when they mess up—Invitation: How does it make you feel when someone treats you with love and kindness in moments when you are not your best self? Look for opportunities this week to be like Jesus by being loving and kind toward someone who is making poor, self-destructive choices. — Quotes & Links: Link to FIND HIM New Testament Study Guide:https://www.seagullbook.com/find-him-new-testament-come-follow-me-guidebook.html “As President of the Church, I affirm the teachings of the Lord Jesus Christ on this issue. Let me be perfectly clear: any kind of abuse of women, children, or anyone is an abomination to the Lord. He grieves and I grieve whenever anyone is harmed. He mourns and we all mourn for each person who has fallen victim to abuse of any kind.” (2022–O:29, Russell M. Nelson, What Is True?)“The Savior offers the gift of healing to you. With courage, patience, and faithful focus on Him, before too long you can come to fully accept this gift. You can let go of your pain and leave it at His feet. Your gentle Savior declared, “The thief cometh not, but for to steal, and to kill, and to destroy: I am come that [you] might have life, and that [you] might have it more abundantly.” You are a survivor, you can heal, and you can trust that with the power and grace of Jesus Christ, you will overcome and conquer. Jesus specializes in the seemingly impossible. He came here to make the impossible possible, the irredeemable redeemable, to heal the unhealable, to right the unrightable, to promise the unpromisable. And He's really good at it. In fact, He's perfect at it.” (2022–A:37, Patrick Kearon, He Is Risen with Healing in His Wings: We Can Be More Than Conquerors)—Talk of Him is presented by Seagull Book and hosted by Ganel-Lyn Condie and John Fossum.
Host/Editor: Dr. Alla Turshudzhyan, Chief Medical Resident at UCONN. Majority of peripheral disease (PAD) cases are asymptomatic with only about 25% of patients presenting with claudication, rest pain, gangrene, and limb ulcerations. Ankle-brachial index (ABI) is a first-line diagnostic test. ABI of less than 0.9 is consistent with PAD. ABI greater than 1.3 is a sign of noncompressible calcified vessels. If patient's story and exam are highly concerning for PAD, but ABI is normal, consider post-exercise ABI or a toe-brachial index. Use duplex US to help you identify location and severity of PAD. More advanced imaging may be warranted if non-invasive modalities are non-diagnostic or if patient needs an intervention. For symptomatic PAD patients, it is reasonable to consider clopidogrel over aspirin or low-dose rivaroxaban plus aspirin (while keeping in mind that rivaroxaban + ASA carries an increased risk of bleeding when compared to ASA alone). Antiplatelet therapy use in asymptomatic PAD is not routinely recommended. Treat claudication with supervised exercise program, followed by cilostazol or naftidrofuryl. If your patient progressed to the point that their symptoms are constant, disabling, and no longer responsive to lifestyle modification and pharmacotherapy, revascularization may be indicated. There are two options for revascularization – percutaneous and surgical. Most cases can be done percutaneously. Surgery is reserved for patient with long segment stenosis, multifocal stenosis, eccentric, calcified stenosis, or long segment occlusions. We hope you enjoy this episode! Thank you for listening.
This week, please join authors Marc Sabatine and Prakriti Gaba, as well as Associate Editor Amit Khera, as they discuss the article "Association Between Achieved Low-Density Lipoprotein Cholesterol Levels and Long-Term Cardiovascular and Safety Outcomes: An Analysis of FOURIER-OLE." Dr Greg Hundley: Welcome listeners, to this April 18th issue of Circulation on the Run and I am Dr. Greg Hundley, Associate Editor, Director of the Pauley Heart Center at VCU Health in Richmond, Virginia. Dr Peder Myhre: And I'm Dr. Peder Myhre, Social Media Editor from Akershus University Hospital and University of Oslo. Dr Greg Hundley: Peder, today's feature discussion, very interesting. We're going to evaluate the association between what's achieved with LDL cholesterol lowering, and then also long-term cardiovascular and safety outcomes. But before we get to that, how about we grab a cup of coffee and discuss some of the other articles in the issue? Would you like to go first? Dr Peder Myhre: Yes, Greg. I would love to. And the first paper is from the World of Preclinical Science and it comes to us from corresponding author, Jan Magnus Aronsen from University of Oslo in Norway. And perhaps, as you know, Greg, cardiomyocyte contraction and relaxation depend on the activity of the sarcoplasmic reticulum CA+2 ATPase 2, abbreviated SERCA2, and lowered levels or reduced activity of SERCA2, as seen in chronic heart failure, weakens contractile force and delays relaxation and no available therapy involves direct manipulation of the SERCA2 activity. And Greg, phosphodiesterase 3A is proposed to be present in the SERCA2 interactome limit SERCA2 activity and disruption of phosphodiesterase 3A from SERCA2 might thus be a strategy to develop SERCA2 activators. And in this study, the authors investigated and mapped SERCA2 and phosphodiesterase 3A and assessed this in experiments assessing the binding between these two in cardiomyocytes and in vesicles. Dr Greg Hundley: Wow Peder, sounds very interesting. So what did they find and how about the clinical implications of the findings? Dr Peder Myhre: So Greg phosphodiesterase 3A bounded directly to SERCA2 in the cardiomyocyte. So that's the first finding. Second, they demonstrated that SERCA2 phosphodiesterase 3A disruption increased SERCA2 activity independently of the catalytic activity of phosphodiesterase 3A in both normal and failing cardiomyocytes. And third, SERCA2 activity by the optimized SERCA2 phosphodiesterase 3A disruptor peptide OPT F reduced mortality and improved contractility after aortic binding in mice. So the clinical implication is that direct targeting of phosphodiesterase 3A binding to SERCA2 could be a novel approach to increase SERCA2 activity and thus cardiac contractility in patients with heart failure. Dr Greg Hundley: Very nice Peder. What a great new finding in the world of preclinical science. Well my paper is going to delve into the world of clinical science and involves patients with stroke. So Peder in this study led by corresponding author, Dr. Dileep Yavagal from University of Miami Miller School of Medicine performed a survey in 75 countries through the Mission Thrombectomy 2020+ Global Network between November of 2020 and February of 2021 to determine the availability of mechanical thrombectomy for large vessel occlusion in patients with stroke. Now Peder, the primary endpoints were the current annual mechanical thrombectomy availability, the mechanical thrombectomy operator availability and the mechanical thrombectomy center availability. All of these availabilities were defined as the proportion of estimated large vessel occlusion for patients receiving mechanical thrombectomy in a given region annually. Dr Peder Myhre: Okay, Greg, so this is really an access question. So in essence, what is the availability of mechanical thrombectomy worldwide? So what did they find? Dr Greg Hundley: Right, great Peder. So what they found, the authors received 887 responses from 67 countries and low-income countries had 88% lower mechanical thrombectomy availability compared to high-income countries. The global mechanical thrombectomy operator availability was 16.5% of optimal, and the mechanical thrombectomy center availability was only 20.8% optimal. And with these results, the authors indicate that global cooperation and targeted region-specific public health interventions, including all stakeholders involved in stroke care delivery, are really needed to rapidly increase access to this brain-saving and disability-sparing treatment with mechanical thrombectomy really worldwide. Dr Peder Myhre: Oh wow. What a beautiful summary, Greg. Thank you so much. And we also have some other interesting papers in the mailbag today. We have an exchange of letters between Dr. Yang and Dr. O'Donoghue regarding the article “Long Term evolocumab in Patients with Established Atherosclerotic Cardiovascular Disease.” Dr Greg Hundley: Great Peder, and also Professor Perera has a Frontiers article entitled “Unloading the Left Ventricle in Venoarterial ECMO in Who, When and How?” and then finally there's a Research Letter from Professor Verma entitled “Prevalence of Diabetes and Cardiovascular Risk in the Middle East and Africa: The Primary results of the PACT-MEA Study.” Well Peder, how about we jump to that feature discussion? Dr Peder Myhre: Can't wait. Dr Greg Hundley: Welcome listeners to this feature discussion on April 18th and we have with us today Prakriti Gaba and Marc Sabatine from Brigham and Women's Hospital and our own associate editor, Dr. Amit Khera. Welcome everyone. Well Marc, we'll start with you. Can you describe for us some of the background information that really helps constitute the preparation of your study and what was the hypothesis that you wanted to address? Dr. Marc Sabatine: Yeah, thanks Greg and thanks for having us. So we've seen in a variety of epidemiologic cohorts the association between LDL cholesterol and the risk of adverse cardiovascular events like in Framingham Heart Study and UK Biobank. But in those cohorts, in these industrial societies, we don't have the benefit of lots of data in individuals with very low levels of LDL cholesterol and so we had the opportunity with the FOURIER study that was the randomized comparison of evolocumab PCSK9 inhibitor versus placebo to get patients down to extremely low levels of LDL cholesterol and evolocumab. We were able to get individuals down to about 30 mg/dL. And so in addition to all the studies we've done showing the comparison of evolocumab to placebo, we also then had the chance to use FOURIER, and as you'll hear from PK, FOURIER-OLE, the open-label extension, as a cohort to then examine patients' new baseline, if you will, their new achieved LDL cholesterol and then it's association not only with cardiovascular events but safety events. And so the hypothesis is that there would be a relationship with the lower the LDL cholesterol, the lower the risk of cardiovascular events and we wanted to explore how far down that went. And then the second one for safety would be that there wouldn't be any association between low levels of LDL cholesterol and a variety of safety outcomes that rightly or wrongly people have ascribed to low levels of LDL cholesterol. Dr Greg Hundley: Thanks so much, Marc. Well listeners, now we're going to turn to PK, the first author, on this very interesting paper and PK, Marc mentioned to us the FOURIER-OLE study. Maybe describe for us here your study design and then what specifically was your study population? Dr. Prakriti Gaba (PK): Yeah, definitely. Thanks so much for the introduction. So the study population included 27,564 patients with stable atherosclerotic cardiovascular disease and LDL cholesterol levels that were greater than or equal to 70 mg/dL or non-HDL cholesterol greater than or equal to a 100 mg/dL on statin therapy. The patients who then went on to the FOURIER-OLE or the open-label extension part of the trial consisted of about 6,635 patients. And so in this study we essentially evaluated the combination of those populations in 2 separate analyses. We then categorized patients according to 6 pre-specified bins based on their achieved LDL cholesterol levels at designated time points and those ranged from LDL levels of less than 20 mg/dL all the way up to 100 mg/dL. And then we looked at their baseline characteristics and evaluated the cardiovascular and safety outcomes that Dr. Sabatine mentioned earlier. Dr Greg Hundley: Very nice PK. Well we've got a great listening audience today and they're anxious to hear your study results, so can you share those with us please? Dr. Prakriti Gaba (PK): Definitely. So over the course of more than 77,000 patient years of follow-up, we found that there was a monotonic relationship between achieving lower LDL cholesterol levels down to very low levels of less than 20 mg/dL and a lower annualized risk of the primary efficacy endpoint, which was a composite of 5 individual endpoints. We also found that there was a similar relationship observed between lower LDL achieved, LDL cholesterol levels and a lower annualized risk of the secondary efficacy endpoint, and then when we looked at safety, there were actually no clear monotonic trends between lower achieved LDL levels and the risk of any of the 8 adverse events and these included things like serious adverse events, hemorrhagic stroke or muscle related events. Dr Greg Hundley: Very nice PK and I'm sure our listeners are wanting to know, did you find any discrepancy in your results based on either age or gender? Dr. Prakriti Gaba (PK): That's an excellent question, and we did look at age and gender throughout. I think across the board the results were pretty consistent, but additional subanalyses will further address this question. Dr Greg Hundley: Very good. Well listeners now we're going to turn to one of our associate editors, Dr. Amit Khera, who has helped move this article through the process of evaluation with the editorial team. Amit, you have many papers come across your desk, what attracted you to this paper and then how do we put this study's results really in the context of other studies that have sought to dramatically lower LDL cholesterol? Dr. Amit Khera: Well first thanks a lot Greg for allowing me to participate today. I want to congratulate Drs. Gaba and Sabatine on a fantastic paper and the minute I saw it, and you know can tell when you've done this for a while what's a great paper, and this one certainly is and we work closely with them to try to make it better and enhance the analyses and as a group, I think we achieved that. I was fortunate to write an accompanying editorial that you'll see. So I got to take a pretty deep dive in this paper and I want to just talk about sort of what's important here, why is this important, and I think as Dr. Gaba mentioned, there's two sides to this. There's the efficacy side where you talk about LDL lowering and getting to very low levels. Now mind you, they got to, what I call, ultra low levels, even explored for a down to a median of 7 mg/dL, so really, really low. And first I think what our listeners need to know when we look at guidelines, these numbers of 70 or 55, these are completely arbitrary and they're based on what was observed in clinical trials, what was achieved in high intensity versus moderate intensity statins in IMPROVE-IT. There's no biology behind that, and I think what this study does is reminds us there is no biology behind how low we need to go. This group previously published their shorter-term data approximately 2 years with this construct of lower is better and I think that's fine, but people worry, particularly on the safety side about extension, and we'll get to that in a minute, so where this fits is it gives us even more reassurance that lower is better, reminds us there's no biologic basis of that even down to very low levels. And so what does that mean? I think that comes back to guidelines. We have some discrepancy between European, ACC, Multisociety Guidelines that are around 55 and so from a guideline perspective, I think we'll see a little bit more enthusiasm about lower cut points or lower thresholds. And from a clinical standpoint, as a clinician it reminds me that when I see someone that's very high risk, there's no magic to achieving a number that if the risk is high, we need to be quite intensive and get their LDL down as low as possible and as safely as possible. I do want to also acknowledge, there's not, to your point about context, the IMPROVE-IT study also showed very low levels show additional efficacy and there's also a lot of other data, genetics and ecologic data supporting this. So this is... we look at Bayesian analysis that this is consistent that we're seeing across different platforms. I do want to talk about safety too, Greg. That's really important because honestly this is when it comes to patient level, the safety part of it. We as clinicians may have comfort with very low levels, but the safety is important. I also want to, just from a steady design, this is post-hoc, so those that achieve very low levels are different. You can see that in their table 1, but these investigators did lots of things. They did pretty extensive multi-variable analysis, they looked at time-dependent LDLs, they looked at it multiple different ways, but as mentioned, there really did not seem to be a safety signal. And this is where time matters. Safety in two years, interesting, but safety 5 to 8 years really offers us much more reassurance. So I think that's where this really comes in about that safety piece with the extended analysis. So again, I think from a guideline perspective, from a clinical perspective, there's so many implications from this paper and I really hope people take the time to take a deep dive and also put it in context, like you said, to the other literature where this is not standalone, but it's corroborating what we're seeing. Dr Greg Hundley: Very nice, amit. Marc, I want to come back to you, just two quick questions thinking about the preparation of your study. One, did you sample cognition? One thing we hear about frequently in dramatic lowering of LDL cholesterol are questions around cognition, particularly in the elderly? Dr. Marc Sabatine: Yeah, it's a great question Greg. So first of all, in the FOURIER study itself, there was an embedded study called EBBINGHAUS that Bob Giugliano from our group led that actually did formal neurocognitive testing in individuals using basically a iPad-like test. We also collected the usual neurocognitive adverse events as part of safety collecting. So 2 ways, the general asking about any adverse events and then the specific neurocognitive testing. We had previously reported out the results of EBBINGHAUS that there wasn't any relationship between evolocumab and the low LDL cholesterol and the risk of any neurocognitive AEs. We just were able to recently do this OLE analysis over time for the major adverse cardiovascular events and for the general safety events including cognition, so all that looked good. As PK indicated, we're now digging into the EBBINGHAUS formal neurocognitive testing, which was also extended out. So stay tuned for those results. Dr Greg Hundley: Very nice. And then eligibility, maybe just walk us through that really quickly. Patients that are going to be randomized to this form of therapy, were they already on high-dose statins? Who exactly did we randomize in this trial? Dr. Marc Sabatine: Yeah, so at the get-go, as PK indicated, these are patients with atherosclerotic cardiovascular disease, so they had a prior MI, prior stroke, symptomatic PAD. They were to be on an optimized lipid-lowering regimen, optimized statin therapy, so for close to 70%, that was a high-intensity statin. We had a small percentage on ezetimibe, but that's because we hadn't yet published the results of the IMPROVE-IT trial that Amit mentioned when we were enrolling in FOURIER, but it was a well-treated population on statin therapy. So these results would apply to your typical patient with ASCVD who's on a good statin regimen. Dr Greg Hundley: Very nice. Well, listeners now we're going to go back to both of our authors and investigators, as well as Dr. Khera. PK we'll start with you. What do you see as the next study to really be performed in this sphere of research? Dr. Prakriti Gaba (PK): I think that's an excellent question. I think with the data presented here now we know that the lower the LDL, the lower the risk of adverse cardiovascular events and that having a low LDL is safe in the long term. I think moving forward, as Dr. Khera mentioned, there needs to be a shift of these recommendations into the guidelines. So I think additional studies confirming these findings is what we need, but we do have the evidence available. Dr Greg Hundley: Very nice. And Marc? Dr. Marc Sabatine: Yeah, and I agree with PK of course. I think there's a couple things that we want to look at. We had looked in the parent FOURIER trial and found some groups who were higher risk, who seemed to have a bigger benefit early on, and those by and large were people who had a lot of athero. But as Amit indicated that the parent FOURIER trial was relatively short at about in two and a quarter years median follow up, and so now we have the benefit of an additional half decade of follow up in a subset of people and so now we're starting to look through and see the subgroups where we saw some differential benefit and this was a paper we published in circulation soon after we published the primary results of FOURIER. Now we have the ability to go through and look at those same subgroups and see what happens now with an additional 5 years. And so that'll be quite interesting, I think, to see how those groups play out now over time. I think as Amit indicated, time is critical. We know the benefit of lipid lowering really tends to grow with time. We saw that in FOURIER, we saw that in FOURIER-OLE and then as Amit indicated, I think for safety also it's now very reassuring, being able to go out to not two and a half years, but 5, 6, 7, 8 years of safety follow up. Dr Greg Hundley: Very nice. Well, listeners we're next going to turn to Dr. Khera. I'm going to put him on the spot a little bit. I don't know if many of you know he's a cardiologist with expertise in primary prevention. So here we've really focused today, I think, on a very unique set of results in secondary prevention. Amit, as you think about studies to be performed in the future, is there a role for really lowering LDL cholesterol as a primary prevention target? Dr. Amit Khera: The short answer is absolutely. I think, to be fair, you can't necessarily directly extrapolate these results 'cause it's a secondary prevention population, but I think if we step back for a second, is there any reason I think this wouldn't work in primary prevention, there's not, and I think there's tons of genetic data, tons of other long-term data that suggests that lower is better than primary prevention. I think the challenge, as you know, is just from primary prevention is it's just about the number that you need to treat and primary prevention is pretty profound in terms of to lower events. So this is where the trade-off comes. I think even in their study, we do have to appreciate while lower is better, when you have very low levels and you're going to even lower, let's say when you go from in secondary prevention from 50 to 40, as much as that sounds valuable, that delta's pretty small and then the absolute risk reduction is still going to be pretty small for those individuals and that's only magnified in primary prevention. So the short answer is I have no reason to believe that lower is better is not applicable in primary prevention, but I do know that the cost and what entails to get there, you don't get as much return on investment. I do want to say one last thing though. We're talking about lower is better, and I know these investigators know this well, but it's not only just how low but how long and I think that's where primary prevention about to go to clinic and I play the long game for primary prevention that we know we've magnified these benefits over the long term and even a little bit early in life can pay off long dividends. So that's how I look at it. Dr Greg Hundley: Very nice. Well, listeners we want to thank Dr. Prakriti Gaba, Dr. Marc Sabatine, both from Brigham and Women's Hospital and also our own associate editor, Dr. Amit Khera from University of Texas Southwestern Medical Center for bringing us this study involving patients with arteriosclerotic cardiovascular disease indicating that long-term achievement of lower LDL cholesterol levels down to values less than 20 mg/dL was associated with a lower risk of cardiovascular outcomes and not and not an increase in the risk of significant safety related events. Well, on behalf of Peder, Carolyn and myself, we want to wish you a great week and we will catch you next week on the run. Dr. Greg Hundley: This program is copyright of the American Heart Association 2023. 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, please visit ahajournals.org.
Joined once again by @fromoldharlem, The Third Member and certified Stan of A Tribe Called Quest, Moulz & Mel review The Love Movement, essentially ATCQ's breakup album. ------------- Intro (0:00) -- The Rating System, Explained (6:24 - 9:07) -- The Rap Rankings Game (38:17) -- RAB Express: Young Thug, Beautiful Thugger Girls (2:03:27) -- This Week In Moulz & Mel (2:37:06) -- The Love Movement Info (2:55:07) -- Track 1: "Start It Up" (3:53:32) -- Track 2: "Find A Way" (4:09:48) -- Track 3: "Da Booty" (4:39:27) -- Track 4: "Steppin' It Up" (4:57:37) -- Track 5: "Like It Like That" (5:09:59) -- Track 6: "Common Ground (Get It Goin' On)" (5:17:59) -- Track 7: "4 Moms" (5:28:33) -- Track 8: "His Name Is Mutty Ranks" (5:57:13) -- Track 9: "Give Me" (6:02:29) -- Track 10: "Pad & Pen" (6:19:14) -- Track 11: "Busta's Lament" (6:36:25) -- Track 12: "Hot 4 U" (6:46:15) -- Track 13: "Against The World" (6:52:54) -- Track 14: "The Love" (7:02:36) -- Track 15: "Rock Rock Y'all" (7:16:23) -- Ranking The Love Movement (7:28:10) -- Outro (7:40:32)
Peripheral Artery Disease (PAD) is a chronic circulatory condition, which if not treated, can lead to limb amputations. PAD affects nearly 20 million Americans. An estimated 200,000 people, disproportionately from minority communities, suffer avoidable amputations every year. Dr. Scott Cameron, Section Head for Vascular Medicine at Cleveland Clinic, hosts a 2-part, multidisciplinary panel discussion. Drs. Luke Laffin, Teresa Wu, Aravinda Nanjundappa, and Jon Quatromoni share their thoughts as experts in their fields. Part 2 highlights medications, interventions and the benefits of these various specialties collaborating to ensure patients receive the best possible care.
Vigilante (1982) synopsis: “After his wife and son got brutalized by a street gang, and a corrupt criminal justice system puts the perpetrators back on the street, a NYC factory worker teams up with a vigilante group to find some measure of bloody justice.”Starring: Robert Forster, Fred Williamson, Richard Bright, and Joe SpinellDirector: William LustigThis week on Podcasting After Dark, Zak and Corey breakdown and review Vigilante! Not only is this Zak's favorite exploitation film from the 80s, it might just be the best one the boys have covered on PAD to date! With great casting, fantastic pacing, and some wild surprises, Vigilante is a must-see for every listener of the show. If you haven't watched this one yet, please check it out before listening to our review. You won't regret it!Leave a comment on our social media pages or Patreon and let us know what you think of this episode or the movie itself. We always love hearing from our listeners!— SUPPORT PODCASTING AFTER DARK —PATREON - Two extra shows a month including Wrap-Up After Dark and The Carpenter Factor, plus other exclusive content!MERCH STORE - We have a fully dedicated merch store at TeePublic with multiple designs and products!REDDIT - Join our growing Subreddit community!INSTAGRAM / FACEBOOK - Follow us on social media for updates and announcements!Purchase 7 WINTERS ALONE on Amazon: HARDCOVER / PAPERBACK / KINDLEThis podcast is part of the BFOP Network
Have you ever wondered how to maximize your short-term rental revenue by making strategic pricing adjustments to your Airbnb booking funnel?Today, Jeff Brown, co-founder of Loma Homes and Founder of IntelliHost, joins me on "Get Paid for Your Pad" to discuss a new tool to help property managers optimize their booking funnels and increase their revenue.IntelliHost, the platform built by Airbnb hosts for Airbnb hosts, empowers short-term rental hosts to make data-driven decisions and optimize their listings to earn more revenue. IntelliHost provides real-time data on the impact of listing changes on search metrics.In this episode, Jeff shares the factors that impact search visibility, how to activate Professional Host Tools on Airbnb to gain access to deeper metrics and insights, and what to focus on to maximize bookings, plus he explains how to identify gaps in booking periods and provides tips on how to fill them proactively.Listen in as Jeff shares how IntelliHost's dashboard can help property managers visualize their sales funnel, determine how much traffic they are getting, and make pricing adjustments to maximize their revenue.Are you ready to optimize your booking funnel and increase your short-term rental revenue? Sign up for a 30-day free trial of IntelliHost and use the offer code "PAD" to get 20% off your subscription. Just click here: Intellihost.co/pad.Topics CoveredUnderstanding the four key factors that influence booking rates: impressions, first impressions, clicks, and bookingsThe importance of optimizing an Airbnb listing for search visibility and bookingsThe factors that impact search visibility (listing title, description, amenities, reviews, and photosThe role of the cover photo and additional photos in capturing potential guests' attention (and conveying the value of the listing)How to activate Professional Host Tools on Airbnb to gain access to deeper metrics and insightsThe importance of comparing your listing the metrics of your listing to similar listings to gauge your competitivenessHow to use Airbnb Insights to track listing performance and make data-driven decisionsHow IntelliHost can help property managers visualize, track, and analyze their booking funnel to identify areas for improvementHow IntelliHost's pricing tool can help property managers make data-driven pricing decisions, including tracking future traffic to proactively fill gaps in their booking calendarConnect with Jeff BrownJeff BrownIntelliHostLoma HomesResourcesSign up for a 30-day free trial of IntelliHost with an exclusive 20% off subscription using the offer code "pad"Stand out on Airbnb with Extremely Themed Units (Ep480)Sponsor Rising Stars Mastermind Hosted on Acast. See acast.com/privacy for more information.
Hi and welcome to Physiotutors podcast episode 51 with Henrik Riel. Henrik is a physiotherapist from Denmark and has obtained his PhD in the management of plantar heel pain. He is doing a post-doc fellowship at the university of Aalborg and he is an assistant professor at the physio department of the university of northern Denmark. In this episode we will talk about plantar heel pain etiology, the risk factors associated with it, Henrik's approach to examination, imaging, and treatment. We will answer the question if there are prognostic factors for the condition, what mode of strength training is recommended and discuss the efficacy of adjunct treatment modalities for plantar fasciopathy. So make sure to listen to the entire episode. Content 00:00 Intro 00:45 Plantar fasciitis, Plantar Fasciotpathy or Plantar heel pain? 02:41 Is it a tendinopathy? 03:33 The typical patient 04:40 Risk factors 07:13 Signs & Symptoms 09:05 Differential Diagnoses 10:10 Examination/Imaging & Testing 13:00 What about Heel spurs? 14:10 Prognosis 19:28 Isometrics for Plantar Heel Pain 22:04 Treatment Options 26:35 Load Management 28:15 Plyometrics/SSC Exercises 30:54 Henrik's Closing Thoughts 32:00 Outro Bonus Material To view and download the bonus content such as transcripts of this episode become a Physiotutors Member. All episodes and bonus content can be found here Follow our Podcast on: Spotify | Apple Podcasts
The LEAST talented rock star - revealed! ■ How wannabe stars fuel the EBAY economy ■ How APPLE stole the MP3 player ■ Why most podcasts should be called PAD-casts ■ Howard Stern joins The VIEW! ■ How idiot copycats are ruining the podcast genre
FULL SHOW NOTES https://podcast.nz365guy.com/441 Goloknath Mishra shares his experience in Singapore, where he enjoys exploring different places, particularly Little India for its vegetarian food options. Tune in for an engaging conversation with Goloknath about technology and learn the vital aspect of career growth and success. Goloknath shares his experience of building solutions on the Power Platform and how the platform has evolved over the years. Goloknath talks about the Singapore community around Dynamics 365 and his involvement with it over the years. The importance of having a clear vision and mission for your business, and how to define your ideal customer and target market. Goloknath talks about the various line of business applications he has seen built using Dynamics and the Power Platform. Goloknath explains that his area of expertise is in Dynamics CRM, but he has also delved into the Power Platform, which he finds to be an interesting and low-cost platform for building a line of business applications. A discussion about the future of the Power Platform and how it can be used to create even more innovative solutions for businesses. Goloknath encourages listeners to explore the platform and see what it can do for their organizations. OTHER RESOURCES: Microsoft MVP YouTube Series - How to Become a Microsoft MVP 90-Day Mentoring Challenge - https://ako.nz365guy.com/ PAD in Udemy - https://www.udemy.com/course/introduction-to-power-automate-desktop/ AgileXRM AgileXRm - The integrated BPM for Microsoft Power PlatformSupport the showIf you want to get in touch with me, you can message me here on Linkedin.Thanks for listening
There is a lot to learn in the short-term rental industry. The environment is constantly changing; new tools, tips, markets to look for, and best practices to incorporate into your short-term rental (or your upcoming purchase). Too much to learn in fact that there is no way for me to process it all myself. So to change things up a bit, I've decided to bring on a few other experts in the space in the coming weeks. And if I had to name one of the industry's most well known experts… a man that literally wrote the book on Airbnb..ing, that would be Jasper Ribbers. Jasper is the host of one of the industry's top podcasts; “Get Paid for your Pad” and also wrote the book Get Paid for Your Pad years ago before many even knew what Airbnb was! In fact, I read Jasper's book years ago before I got started with my first Airbnb. This week's interview is packed full of EXPERT tips. Everything from why you should have an “ammo box” in your rental to how you can have a long lasting, successful partnership. Join us as I discuss with a friend and fellow short term rental expert more on: Maximizing your experience at in-person conferences Why being a “digital nomad” has changed Midterm stay rental platforms and their potential evolution Tips for working with a partner Tips for someone getting started today! Future outlook of the STR industry Having an “ammo box” in all of your rentals What living a “RICH” life really means Make sure to catch Jasper on his popular podcast: “Get Paid for Your Pad.” If you want to listen to the episode where Jasper interviewed Tim over two years ago you can listen in here from December 2020 episode #363. The crazy thing is… even though it's been years since the interview, the content we discussed is still relevant! Like predicting higher interest rates for example… You can also find out how to work with Jasper and his partner Eric by going to https://www.overnightsuccess.io/ . There you will have more info on their excellent coaching programs, resources, and much more. Are you enjoying the podcast? Please subscribe, leave a rating and a review, and share it! This helps us reach others that may find the info helpful as well. Get a copy of my 12 proven house rules to protect your property from almost every negative situation (highly recommended) You can find all of our links here including our website, recommended resources, upcoming live events, short-term rental playbook, Instagram, and more!
Ali Gilmore vanished from her home in Tallahassee, FL in the middle of the night on February 2, 2006. She's not been seen or heard from since… Tickets for PAD's 5-year PODiversary Party: Click HereJoin our Patreon and enjoy early and ad-free episodes, bonus content, discounts on our merchandise and more! www.patreon.com/palmahawkmediaVisit our website paradiseafterdark.com for links to our store, Patreon, tip jar and more! Facebook.com/palmahawkmediaInstagram @palmahawkmedia Twitter @paradisedark239TikTok @palmahawkmedia If you see something say something!!Music by Captain Fathands @ captainfathands.com
Lindsay Clancy, a 32-year-old labor and delivery nurse killed her three children and attempted to kill herself on Tuesday, January 24, 2023. How can this happen??Tickets for PAD's 5-year PODiversary Party: Click HereJoin our Patreon and enjoy early and ad-free episodes, bonus content, discounts on our merchandise and more! www.patreon.com/palmahawkmediaVisit our website paradiseafterdark.com for links to our store, Patreon, tip jar and more! Facebook.com/palmahawkmediaInstagram @palmahawkmedia Twitter @paradisedark239TikTok @palmahawkmedia If you see something say something!!Music by Captain Fathands @ captainfathands.com
On May 26, 1990, 40-year-old Marlene Warren opened the door of her home in Wellington, FL, and was shot in the face by a person dressed as a clownTickets for PAD's 5-year PODiversary Party: Click HereJoin our Patreon and enjoy early and ad-free episodes, bonus content, discounts on our merchandise and more! www.patreon.com/palmahawkmediaVisit our website paradiseafterdark.com for links to our store, Patreon, tip jar and more! Facebook.com/palmahawkmediaInstagram @palmahawkmedia Twitter @paradisedark239TikTok @palmahawkmedia If you see something say something!!Music by Captain Fathands @ captainfathands.com