Podcasts about pccs

In this episode, we're joined by Police and Crime Commissioners Joy Allen (Durham) and Philip Seccombe (Warwickshire), two passionate leaders at the forefront of road safety reform. Together, they unpack the evolving role of PCCs in shaping both local and national road policing strategies. From relaunching partnerships and rolling out tech like ANPR and Operation Snap, to pushing for bold policy changes like lower drink-driving limits and graduated driver licensing, they aren't holding back. Both share hard-won insights, what they wish they'd known when they started, what needs to change, and how collaboration (across agencies and communities) is the real engine behind safer roads. We also hear about the powerful impact of victim advocacy, the importance of holding forces accountable, and how every traffic stop could disrupt wider criminal activity. This is a must-listen for anyone invested in road safety, policy innovation, and community protection.Find out more about Project EDWARD here.Welcome to the Project EDWARD Podcast, where we explore data-driven actions for safe mobility. Join the EDWARD team and our key partners as we facilitate events, symposiums, webinars, discussions, and podcast episodes. Our mission is to share evidence-led good practices that support the Safe System. Tune in to stay informed and inspired by the latest in road safety and mobility innovations.Follow us on:FacebookLinkedInInstagram

Prothrombin complex concentrates (PCCs) are frequently used off label for the management of factor Xa inhibitor-associated major bleeding. In 2018, accelerated approval was granted for andexanet alfa, a specific factor Xa inhibitor reversal agent, for reversal of apixaban and rivaroxaban in the setting of life-threatening or uncontrolled bleeding. Following accelerated approval, some clinical practice guidelines were updated to include recommendations for andexanet alfa preferentially over PCCs for reversal of life-threatening or uncontrolled bleeding due to rivaroxaban or apixaban. Other guidelines stated no preference of andexanet alfa over PCC. In 2020, Vizient convened an expert panel to critically appraise the literature and provide consensus-based, expert opinions on the utilization of pharmacological reversal agents for factor Xa-related major bleeding. Since then, the body of literature evaluating these agents has expanded to include a randomized controlled trial, ANNEXa-I, the results of which were submitted to the US Food and Drug Administration to convert the approval of andexanet alfa from accelerated to full approval. Dr. Lisa Baumann-Kreuziger, Associate Professor of Hematology and Oncology, Medical College of Wisconsin and medical director of the Antithrombotic Therapy Management Program at Froedtert Health discusses the current status of management of factor Xa inhibitor-associated major bleeding with Dr. Kerry Schwarz, Senior Clinical Manager of Evidence-Based Medicine and Outcomes with the Vizient Center for Pharmacy Practice Excellence, and your program host.   Guest speakers:  Liza Baumann-Kreuziger, MD, MS Investigator, Blood Research Institute, Versiti  Associate Professor of Hematology and Oncology, Medical College of Wisconsin Medical Director, Antithrombotic Therapy Management Program at Froedtert Health   Host:  Kerry Schwarz, Pharm.D, MPH Senior Clinical Manager of Evidence-Based Medicine and Outcomes  Vizient Center for Pharmacy Practice Excellence   Show Notes: [02:25-04:26] The current state of hemostatic management in the setting of factor Xa inhibitor-related major bleeding [04:27- 05:35] Limitations of available evidence making clinical practice and formulary decision making so challenging [05:35 – 10:52] Publication of the first randomized controlled trial, ANNEXa-I, comparing andexanet alfa to usual care [10:52-14:49] Meeting of the FDA advisory committee and subsequent complete response letter [14:50-16:45] How we can approach clinical management of patients and formulary decision-making in the current state   Subscribe Today! Apple Podcasts Amazon Podcasts Spotify Android RSS Feed

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Episode Summary In this episode of the Canadian Immigration Podcast, host Mark Holthe and co-host Alicia Backman-Beharry kick off the Express Entry Getting It Right series by tackling one of the most misunderstood aspects of Express Entry: Police Clearance Certificates (PCCs). Many applicants mistakenly assume they know when and how to submit police certificates—only to have their applications refused due to errors. Mark and Alicia break down the IRCC requirements, clarify common misconceptions, and provide essential tips to ensure you get it right the first time. With Express Entry becoming even more competitive and IRCC enforcing strict completeness checks, one mistake could cost you your ITA and delay your PR process. Key Topics Discussed Why Are Police Clearance Certificates Important? The role of PCCs in verifying admissibility under Canadian immigration law. Who needs to provide PCCs—principal applicants, spouses, and dependent children over 18. The risk of criminal inadmissibility and how it can impact your PR application. When and How to Obtain Your Police Clearance Certificate Understanding the 10-year rule—when police certificates are required. Why a PCC must be issued after your last stay in a country for 6+ months to be valid. Special cases: What to do if you currently live in the country requiring a PCC. How IRCC handles PCCs for certain high-risk countries (e.g., Mexico). Common Mistakes That Lead to Refusals Submitting a PCC issued before leaving the country—why this leads to rejection. Failing to provide PCCs for dependent children 18+. Assuming a PCC is valid if it has no expiry date—IRCC's rules differ from local laws. Misreporting time spent in a country—how incorrect address history can trigger a PCC request. Practical Tips to Avoid PCC Pitfalls Start early! Some PCCs take months to process. Follow country-specific IRCC guidelines carefully—common pitfalls with the UK, Australia, and South Africa. If a PCC isn't available before ITA deadline, provide proof of best efforts. Always submit in full colour—black-and-white scans can lead to refusal. Double-check official names of the PCC to avoid IRCC rejecting the wrong document. Key Takeaways - PCCs are mandatory for Express Entry applicants and must follow IRCC's strict timing rules.- Six-month rule: PCCs are needed for any country where you've stayed six months or more in a row in the last 10 years.- A PCC must be issued after your last departure from the country to be valid.- Mistakes = Refusal. IRCC will return your application as incomplete if PCCs are missing, incorrect, or outdated.- Start early! Delays in obtaining PCCs can derail your PR process. Quotes from the Episode Mark Holthe:"Submitting an Express Entry application without the correct police certificate is one of the most common mistakes we see—and IRCC has no mercy when it comes to refusing incomplete applications." Alicia Backman-Beharry:"The six-month rule is now in a row—not cumulative. Many people still get confused and risk losing their ITA because they misunderstand this critical requirement." Links and Resources Watch this episode on YouTube Canadian Immigration Podcast Book a consult with Mark Holthe Subscribe for MoreStay up-to-date with the latest in Canadian immigration by subscribing to the Canadian Immigration Podcast on iTunes, Spotify, or YouTube. Don't miss future episodes on policy changes, strategies, and practical advice for navigating Canada's immigration process. Disclaimer This episode provides general information about Canadian immigration and is not intended as legal advice. For personalized assistance, consult an immigration lawyer.

Chris and Bryan discuss training with rifles and PCCs in a home defense type scenario/stage.

One of the most pressing challenges faced by PCCs is managing incoming calls from potential customers who fall outside their service areas or require services they do not offer. In today's episode, Eric and Jake welcome Phil Kirkeiner, co-founder and CEO of Baton Leads. Phil shares his unique path from studying music to becoming an accountant, and eventually finding his way into the pest control industry through summer sales. His experiences led him to identify a significant gap in the market: the need for a better referral system for pest control leads.Topics include:Introduction (0:00)Baton referral network innovation (5:05)Building referral networks locally (6:44)Customer service and lead generation (10:37)Customer retention challenges in business (13:16)Value proposition in business (20:55)Pest control industry referrals (24:15)Grit and self-doubt in entrepreneurship (27:41)Supportive spouses in entrepreneurship (32:51)Expanding referral platforms (36:20)

Calum Semple is a respiratory and infectious disease professor in Liverpool. He has been part of the governmental advice team for pandemics since before COVID. We spoke to him in advance of his talk at the 2024 PCCS conference What is the frequency of pandemics? Is the 2018 Spanish Flu […]

In this episode, we highlight one of the features of the website, PrenatalDiagnosis.org, which allows site visitors to connect with a Parent Care Coordinator (PCC). PCCs provide a free service of practical guidance, information, and referrals to parents facing a … Continue reading →

Entrevistas exclusivas con el Presidente de la Asamblea, Henry Kronfle, la viceministra de Economía Ana Cristina Avilés y la ‘vice' del PCCS, Mishelle Calvache.

You will no doubt have heard that there was a nationwide election in Wales recently for us to elect our Police and Crime Commissioners for our four police forces. If you don't know who they are or what they do, you are not alone. Over 80% of registered voters declined to express a preference so, not for the first time, people are asking about the value, validity, and futures of these elected roles. We discuss the PCC elections, results, and future here as well as a round up of the English local elections, the latest about Senedd expansion and reform, and the travails of the Scottish Gov as John Swinney takes up the role of Scottish First Minister.To discuss, we are joined by:Lila Haines, independent researcher, author and Senedd Staffer in the first Assembly in 1999: https://twitter.com/LilaEilisCllr Joseph Carter, Welsh Liberal Democrat councillor for Pentwyn and Llanedeyrn in Cardiff: https://twitter.com/joseph_carterUK A reminder that you can buy Lila's excellent book here: https://www.amazon.co.uk/Radicals-Realists-Political-Parties-Ireland/dp/1860571514And listen to our conversation on the pod about it with her here: https://open.spotify.com/episode/62t9I2FursCq6gSzSXa5bz?si=MxzadEVKRYujOLdE3DttHw As always, you can find the latest from us @hiraethpod on most social media, including Twitter/X here: https://twitter.com/HiraethPod We hope you find this podcast interesting and useful. Please do send feedback, it's always great to hear what our audience thinks. Thank you for listening to the podcast. If you have enjoyed it, please leave us a nice rating or comment on your podcast app or on YouTube and, if you are able to do so, please consider supporting our work from just £3/month on Patreon: www.patreon.com/hiraethpod

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In this episode of the Talking Lead Podcast presented by Mission First Tactical: Lefty and Ton Jones (Firebird Targets) talk PCCs (pistol caliber carbines) and side charging AR-15s. Whether or not you love them or hate them they both have their uses and followings. Listen in to hear the guys' opinions on each and some […] The post TLP 528 – Pistol Caliber Carbines & Side Charging ARs, Hate ‘Em? Love ‘Em? appeared first on Firearms Radio Network.

The gang chat about the big announcements made this week and Tatton has some feelings about Police and Crime Commissioners… The Simple Politics book, "Two Years Indoors", is available for preorder NOW from spstuff.co.uk Who we are Simple Politics does things differently. We exist to help you have better conversations about the issues and the changes that matter. We do so by being clear, accurate and impartial. Also, light-hearted, engaging and occasionally (but not as often as we think) amusing. It's not just about understanding the facts and the topics themselves but also looking at why different people hold the opinions they do. Those with whom you disagree aren't monsters. Understanding and respect are at the core of everything we do. Our core offering will always be free. Unfortunately, giving things away for free isn't a great business model. We've never been business people. But. We do need to make this work. We do so through our amazing supporters, who keep us going by buying stuff in our shop and making monthly donations.  This podcast has been Produced by Stripped Media and edited by Laura Samulionyte. If you want to know more about this podcast and others produced by Stripped Media, please visit www.Stripped.media or email Producers@Stripped.Media to find out! Learn more about your ad choices. Visit megaphone.fm/adchoices

https://chtbl.com/track/118312/traffic.libsyn.com/secure/talkinglead/TLP_528_Ton_Talk.mp3 In this episode of the Talking Lead Podcast presented by Mission First Tactical: Lefty and Ton Jones (Firebird Targets) talk PCCs (pistol caliber carbines) and side charging AR-15s. Whether or not you love them or hate them they both have their uses and followings. Listen in to hear the guys' opinions on each and some different models that are available. Plus info on upcoming giveaways, NRA in Dallas, more discount codes and of course Jackwagons and Heroes!

In this episode, we review evidence-based guidelines for the emergency reversal of warfarin, dabigatran, and the oral Xa inhibitors (apixaban, edoxaban, and rivaroxaban). Key Concepts Reversal of anticoagulation is indicated in patients with major hemorrhage or when emergency surgery is necessary. Reversal of warfarin (Coumadin®) involves a fast-acting, short-term solution (usually prothrombin complex concentrates [PCC]) and a slower-acting, long-term solution (intravenous vitamin K). Idarucizumab (Praxbind®) is the preferred reversal strategy for dabigatran (Pradaxa®). Idarucizumab is a monoclonal antibody fragment specific that binds and inactivates dabigatran. If idarucizumab is unavailable, PCCs are recommended. Andexanet alfa (Andexxa®) is the preferred reversal strategy for oral Xa inhibitors and has FDA approval specific to apixaban and rivaroxaban. Andexanet alfa is a decoy factor Xa protein with higher binding affinity than human clotting factor Xa. There are several barriers to use with andexanet alfa that has led to low utilization in hospitals. If andexanet alfa is unavailable, PCCs are recommended. References Baugh CW, et al. Anticoagulant Reversal Strategies in the Emergency Department Setting: Recommendations of a Multidisciplinary Expert Panel. Ann Emerg Med. 2020;76(4):470-485. Cuker A, Burnett A, Triller D, et al. Reversal of direct oral anticoagulants: Guidance from the Anticoagulation Forum. Am J Hematol. 2019;94(6):697-709. doi:10.1002/ajh.25475 Tomaselli GF, et al. 2020 ACC Expert Consensus Decision Pathway on Management of Bleeding in Patients on Oral Anticoagulants: A Report of the American College of Cardiology Solution Set Oversight Committee. J Am Coll Cardiol. 2020;76(5):594-622.

PCCSは、eスポーツ施設運営サポート事業を展開しています。

Creating measurable marketing accountability is crucial for PCCs to track the performance of their marketing efforts and ensure that they are achieving their goals. In today's episode, Eric provides a step-by-step guide on how to create a high-level, high-accountability relationship with your marketing team.Topics include:Create measurable, accountable marketing relationships (1:54)Qualified lead ratio is important (5:31) Efficiency vs speed in marketing (10:44)Understand lead goals and phasing (18:04) Forecast lead performance using data (24:12)Measure performance for company success (28:30)

Israel, Vickers, Retro Rifle Builders, 9mm PCCs, Single Actions, Cap and Ball era, DB Cooper Handgun, 380 ACP dead, Gun sales?, 1800s Marksmanship, Single shot rifles?, Winchester 94 vs Krag carbine. 

At the 2023 PCCS conference in Edinburgh we chatted to Marie Spiers, Emergency Department consultant in Glasgow, about paediatric traumatic cardiac arrest. How does traumatic cardiac arrest differ to medical cardiac arrest? Is the treatment different? What should we be focusing on? What is the point in chest compressions, and […]

Kyle, Mo, and Adriel are joined by IPSC PCC National champion Taylor Reich to talk about the match, common PCCs, and how to get into the sport.Kyle shows off his unobtanium AR15, Adriel shows an “we have AK at home”, and Mo talks about how little he is doing in guns. Kelly's mom had to … Continue reading Episode 510 – IPSC PCC Nationals with Taylor → The post Episode 510 – IPSC PCC Nationals with Taylor appeared first on Slam Fire Radio.

In this episode, we discuss PCCs and what was the best Vietnam era rifle. The views and opinions expressed in this podcast are those of the individual guests and host and do not necessarily reflect the official policy or position of Ghost Tactical Productions. Some material may be for mature audiences and include language not suitable for young listeners. Listener Discretion is advised. Check out ALL of our podcasts, videos and swag https://ghosttactical.us/ Ghost Tactical Amazon Shop https://www.amazon.com/shop/GhostTact... Ghost Tactical Productions Credit: Trey Miller Contact: TheArmedCitizenPodcast@gmail.com  

This week I enjoyed chatting to Andrew Snowden, the current police and crime commissioner (PCC) for Lancashire. We had a wide-ranging chat about the work of PCCs, the controversy that surrounded their introduction under the Cameron/May government, political interference in policing, as well as hearing his thoughts on many of the current challenges faced by policing in the UK.

In this episode, we learn all about a network of local organizations that help connect the Postal Service with large and small business mailers. This network is called the Postal Customer Council® (PCC®). Join us as we learn more about what PCCs are and how they help extend the Postal Services' efforts into local communities with Lindsey Taylor, the Postal Services' Director of Industry Engagement & Outreach. We'll also dive into some of the great things PCCs have done and how they are essential to the Postal Services' success moving forward!

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In this GCP Short, produced in partnership with We Are Guernsey and the Guernsey International Insurance Association (GIIA), we reflect on 25 years of protected cell company legislation in the jurisdiction. The Protected Cell Companies Ordinance was legislated for in 1997 and at the end of 2021 there were 58 PCCs in the domicile, containing 294 cells excluding those used for insurance linked securities. PCCs are used for a wide variety of reasons and business cases and in this 20 minute episode we hear from three experts with different perspectives of working with these entities across the full spectrum of utilisation. Richard is joined by Paul Sykes, Managing Director of Aon Insurance Managers (Guernsey) Limited, Kate Storey, Partner at Walkers law firm, and regulator Caroline Bradley, Director of Authorisations and Innovation Division at the Guernsey Financial Services Commission. For more information on Guernsey as a captive domicile, visit their Friend of the Podcast page: https://www.globalcaptivepodcast.com/guernsey You can subscribe to the Global Captive Podcast on iTunes, Apple Podcasts, Spotify or any other podcast app. Contact Richard: richard@globalcaptivepodcast.com Visit the website: https://www.globalcaptivepodcast.com

Legalize Hunter Biden, Dangerous times, Civil War, Wokeism, WWSD debacle, Ruger 5.7 Carbine, PCCs?, Snub Noir revive Zoot Shooting?, Glock AR rile, Glock clones, Tokarev shotguns, SIG P210 carry, Walther P1 CCW?

Truss and Kwarteng's tax u-turn, Cross Question, plus Tory PCCs demand cannabis be upgraded to a Class A drug. Joining Iain Dale on Cross Question, live from the Conservative Party Conference in Birmingham, are Armed Forces Minister James Heappey, journalist and LBC presenter Rachel Johnson, Conservatives Against Racism for Equality co-founder Albie Amankona & National Farmers' Union President Minette Batters.

Veckans avsnitt sponsras av Westcoastmotorsport.se Forzapoddens besättning har knappt återhämtat sig från sitt livs första watchalong! Vi är fortfarande rätt möra efter en tre och halvtimmes sändning men vi gör vårt bästa för att sammanfatta vad som hände på riktigt i Singapore. Vi kommer lotta ut kepsarna som vår sponsor Westcoast Motorsport bjussat på. Blir en hel del snack F1 nyheter samt övrig motorsport från helgen, däribland PCCS, Rally VM, m.m. (03:00) F1 Singapores GP (33:56) Utlottning av F1 kepsar (1:03:00) Dietrich Mateschitz (1:09:06) Inför Japans GP (1:14:45) DEBATT: Varför har inte F1 blivit jämnare? (1:25:00) Ridderstolpes undersökning (1:27:45) IndyCar (1:31:47) Övrig Motorsport (PCCS och Rally VM) (1:40:15) Veckans Verstappen (1:47:04) Veckans Väder Beställ Regskyltar: https://forms.gle/cYBZySrq6kCHaPb78 Kom ihåg att ni kan stötta vår verksamhet på Patreon, Podstore och YouTube! Vår Patreon: https://www.patreon.com/forzapodden Forza Merchandise: https://www.podstore.se/podstore/forza-motorsport/ Vår YouTube: https://www.youtube.com/c/Forzapodden?sub_confirmation=1

Our second podcast linked to the 2022 PCCS Conference in Leicester, September 2022, with Mike Farquhar, sleep consultant at Evelina Children's Hospital, and Sapna Kudchadkar from Johns Hopkins. This podcast went live at the time of Mike's talk at the conference. Take a walk around a paediatric intensive care unit. […]

PCCs for PharmDs Part II Special Guest: Scott Dietrich, PharmD, BCCCP @PCC_PharmD   Reference List: https://pharmacytodose.files.wordpress.com/2022/08/pccs-for-pharmds-part-ii-references.pdf   04:45 – Fixed dose PCC; 11:58 – Time to administration; 15:00 – 3-factor v. 4-factor PCC; 19:12 – 4-factor PCC v. 4-factor aPCC; 30:36 – No anticoagulation reversal; 33:36 – PCC in surgery; 37:40 – PCC in trauma; 40:51 – PCC v. andexanet alfa; 54:10 – Guideline recommendations; 62:00 – Future studies; 69:10 – Take home points   PharmacyToDose.Com @PharmacyToDose on Twitter PharmacyToDose@Gmail.com

We turn the tables on PCC Superstar and Postal Biz-Buzz host Art Gerckensto hear his story on the enduring value of The Postal Service, PCCs,and their impact on his amazing life and career. 

最近韓國綜藝節目像是Running man、我獨自生活，都狂拍「個人色彩」的主題。 原來穿錯顏色，會顯老又暗沈？個人色彩一旦測試之後，是不是就不會變呢？ 韓國彩妝產業，又怎麼運用個人色彩的風潮，來行銷產品？ 來分享我做了個人色彩的分析的流程，還有跟個人色彩有關的韓國行銷案例。 一起來聽聽Fion焢韓集第46集《韓國女生為什麼要花兩千元做色彩測試？個人色彩檢測風潮》 喜歡我的podcast的話，也可以請我喝杯咖啡

Coming this September: a proper face to face conference IS BACK! The 2022 Paediatric Critical Care Society Conference, held in Leicester on the 14-16th September 2022, will be packed full of mind-expanding workshops, cross cutting plenary topics, and focussed sessions on a breadth of PCC issues for all members of […]

http://www.mofpodcast.com/https://prepperbroadcasting.com/https://www.facebook.com/matteroffactspodcast/https://www.facebook.com/groups/mofpodcastgroup/www.youtube.com/user/philrabhttps://www.instagram.com/mofpodcastSupport the showShop at Amazon: http://amzn.to/2ora9riPatreon: https://www.patreon.com/mofpodcastPurchase American Insurgent by Phil Rabalais: https://amzn.to/2FvSLMLShop at MantisX: http://www.mantisx.com/ref?id=173*The views and opinions of guests do not reflect the opinions of Phil Rabalais, Andrew Bobo, or the Matter of Facts Podcast*The boys sit down to talk about anti-gun states not embracing SCOTUS's decision, Phil's “Murse” project (look to IG later on for more info), and the boys debate the case for a 9mm PCC vs. a short AR Carbine.Intro and Outro Music by Phil RabalaisAll rights reserved, no commercial or non-commercial use without permission of creator

For the June Paediatric Critical Care Society Hot Topics Webinar series, we have interviewed one of the the speakers Barney Scholefield from Birmingham, an expert in the field of Post Cardiac Arrest care. First of all: what is cardiac arrest? How do we define it, and how do we classify […]

Severe TBI is a difficult, frustrating condition to treat. The secondary injury process occurs despite our best efforts: and our monitoring tools are incredibly blunt. Physiological parameters change when it's too late: ICP is a localised and at times unreliable measure. CPP is two steps away from cerebral blood flow. […]

We were invited to chair a session at the 2022 Paediatric Critical Care Society Study Group meeting at St Mary's Hospital in London. This is a national meeting of research interested PIC clinicians. Two excellent speakers contributed. Chris Gale is a neonatologist who has led the WHEAT trial, in to […]

Angstadt Arms was born in an incredible time during the firearms industry as ARs and 9mm AR-style PCCs and pistols started to become extremely popular. Since then, Angstadt Arms has grown quickly and rapidly to meet consumer demand and along the way they've continued to innovate and provide firearms owners with quality, American Made guns with a price to match that quality. Please welcome Founder of Angstadt Arms Rich Angstadt to the show once again! About Angstadt Arms: Rich Angstadt started Angstadt Arms in 2014, the company was born from his passion for shooting sports and a desire to continue the dynasty of Angstadt master gun makers. Comprised of 10 skilled craftsmen, the Angstadt family of gun makers handcrafted long rifles for over 100 years during the 1700 and 1800 hundreds. These guns were a perfect blend of form and function – a work of art that could be used to gather food or defend your family. The modern Angstadt rifle is no different. Aided by the latest in design and manufacturing technologies, each firearm we build is machined from the best materials and equipment and hand-finished by skilled men and women (many of whom are veterans). The end result is a beautifully crafted firearm that will hold up to continued hard use and perform when you need it the most.

Hey guys here we are talking about NVGS again, we talk about how much i HATE 9mm PCCs and why you should just get a rifle. I talk about NVG accessories and how to mount them to your helmet. Go visit Linktree: https://linktr.ee/Hoodlums_Gun_Bench ———————————————————————— ⬇️⬇️⬇️ go visit my friend @lineonegear Use code: HOODLUM to save 10% https://www.lineonegear.com/ Also now available are slings! He has ear pro wraps, Ammo bags, Belts all 100% US made and made by him. He is making great gear at a fantastic price. Go give him a shout! Links for others in the comments. Content not for child

So we talk about a lot on this one, and it will be continued next week. Mike was able to join us for a bit, so you guys know we didn't kill him. We talk about PCCs and why someone decided to create this thing, and we talk about Night Vision!!! We will soon be taking a deeper dive into this stuff. So thank you guys for being awesome! Click the links below! _. Go visit Linktree: https://linktr.ee/Hoodlums_Gun_Bench ———————————————————————— ⬇️⬇️⬇️ go visit my friend @lineonegear Use code: HOODLUM to save 10% https://www.lineonegear.com/ Also now available are slings! He has ear pro wraps, Ammo bags, Belts all 100% US made and made by him. He is making great gear at a fantastic price. Go give him a shout! Links for others in the comments. Content not for children.

Join hosts Josiah and Kalinn to hear about what's going on at PCCS this week!   Purchase tickets for Beauty and the Beast here - showings this Thursday, Friday, and Saturday.

Join hosts Gabriella and Blake to hear about the happenings at PCCS! This week, we sit down with Mrs. Thayer to learn more about the grammar spelling bee. Then, we're joined by some of the ladies of the junior class to hear some top-tips for secondary finals. And finally, we get a very special message about the spring musical, Beauty and the Beast. 

We are pleased to announce that in the coming weeks the UK Paediatric Critical Care Society (https://pccsociety.uk/, @PICSociety, soon to be @PCCSociety) is going to be joining up its educational resources run by its members. In this short podcast we explain the strategy. First we have Akash Deep, chair of […]

A sua dose semanal de sanidade mental está no ar! Já ouviu falar do Plano de Cargos, Carreiras e Salários? O PCCS ou plano de cargos, carreiras e salários, é o alicerce de toda organização, porque ele analisa, atualiza e equaliza a estrutura dos cargos e funções dentro de uma organização. Além de definir regras de administração salarial e definir parâmetros justos e técnicos. O objetivo do PCCS é organizar e padronizar os cargos internos e garantir a competitividade salarial dentro do mercado de trabalho. Caso você não tenha o investimento necessário para contratar uma consultoria para fazer o seu PCCS, nós do Mentes em Foco, conversamos com o Ivan Jacomassi, Head de Operações da Perfix, ele acumula em seu currículo mais de 50 projetos e no episódio de hoje, traz seu conhecimento técnico e passa 5 passos para você conseguir implantar o Plano de Cargos, Carreira e Salários! E no final desse episódio tem um bônus especial para você que quer fazer o seu PCCS! Host: Joseane Freitas (@joseane_freitas) Co-Host: Ivan Jacomassi Equipe: Fabio Oliveira Edição: Cellos Mídia Não esqueça de seguir a gente aqui no Spotify Siga também no Instagram: https://www.instagram.com/mentes.em.foco/ E inscreva-se no nosso canal do Youtube: https://www.youtube.com/channel/UCwJKl5zyWN3uklzO64Hz_VA Link da Mentoria mencionada: https://www.perfixconsultoria.com.br/nova-lp/ --- Support this podcast: https://anchor.fm/mentesemfoco/support

Today we look at another question sent to us by one of you guys. Ben wanted to know our thoughts and opinions on PCCs or pistol caliber Carbines in Airsoft. We look at mags and the inner barrel lengths as well as how to reload in the field and how to justify some of the cost for them vs a regular carbine length rifle. --- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app Support this podcast: https://anchor.fm/cross-tactical-airsoft/support

A Assembleia Legislativa do Rio (Alerj) aprovou nesta terça-feira, em discussão única, o projeto de lei 4.601/21, de autoria da Defensoria Pública do Estado do Rio. A proposta reestrutura o quadro permanente de funcionários da Defensoria, instituindo o Plano de Cargos, Carreiras e Salários (PCCS) dos servidores do órgão.

The ability to chronically anticoagulate a patient has prevented significant morbidity and mortality from thromboembolic events. Over time, our anticoagulation choices for oral use have evolved, but the need for reversal agents still persist. Two Vizient pharmaceutical experts weigh in on the clinical implications and latest standings of reversal agents.    Guest speaker: Stacy Lauderdale, PharmD, BCPS Senior Director, Drug Information Vizient   David Reardon, PharmD, BCPS Senior Director, Pharmacy Networks Northeast Purchasing Coalition (NPC) Pharmacy Member Services Vizient   Moderator: Gretchen Brummel, PharmD, BCPS Pharmacy Executive Director Vizient Center for Pharmacy Practice Excellence   Show Notes: [01:15] Warfarin has been the cornerstone of oral anticoagulant therapy since the 1950s but has many limitations including causing bleeding and thrombosis if not managed properly. [01:45] In 2011, a new class of oral factor 10a inhibitors was approved which drastically changed the oral anticoagulant landscape.   [01:45] Most common:  apixaban and rivaroxaban.  They have fewer drug-drug interactions and fewer drug-food interactions than Warfarin.   [02:26] In May 2018, FDA approved andexanet alfa. It has an accelerated biologic license conditional approval based on some surrogate markers in the trials. Clinical trials are underway. [03:41] In January 2021, Vizient published a consensus-based document regarding the expert task force's findings on how to manage the pharmacological reversal agents for factor 10a inhibitor-related bleeding.  [05:27] What the literature says regarding the factor 10a inhibitors [06:53] Task force compared the clinical effectiveness of andexanet versus pro-hemostatic agents using the ICER Evidence rating Matrix tool.   [08:37] Task force recommends that institutions have an anticoagulation reversal policy.  The Joint Commission National Patient Safety Goal for anticoagulation therapy provides guidance for that organizations should have on hand. [09:06] Policy should address standard of care, radiographical and laboratory studies, as well as appropriate pharmacological interventions. Anticoagulation reversal agents will not correct hemodynamic instability, so you'll need to start other therapies. [09:35] Pharmacists can drive the protocols and adoption of prothrombin complex concentrates [10:43] Expert panel is in consensus that use of pro-hemostatic agents for reversal of a factor 10a inhibitor-related bleed is ethically and legally justified, despite the fact that andexanet is FDA approved for it. [12:42] Budgetary considerations with the two agents, the prothrombin complex concentrates or PCCs and andexanet alfa   Links | Resources: Consensus statement on use of reversal agents for factor Xa inhibitor – related bleeding, December 2020, Vizient Click here   Subscribe Today! Apple Podcasts Google Podcasts Spotify Stitcher Android RSS Feed

Stories are proven to hold attention, and one reasons why is the constant need to make predictions about what happens next. This is a super important survival skill, and 'story' is the purest form of training because, in a well-told story, everything that happens matters. There's no noise in a well-told story, it's ALL signal. Yesterday, I was typing into my phone and smiling as the Autocomplete got it wrong, that humans are just like that. We have Autocomplete that's 'on' all the time, and sometimes we get things wrong. This is why it's so important to tell great stories, because without a well-structured narrative we risk our PCCs (prospects/customers/clients) getting the wrong idea, and leaving us behind. When we tell a good story, their autocomplete is right on the money. When we don't, they'll get us wrong and leave. -- Show notes at: https://StoriesMeanBusiness.com/podcast/692-Humans-have-Autocomplete

The foolish prince, ATF "ghost" guns. Truck guns, Serbu 50 cal rifle, SLAP rounds, need or evolution, AutoMag 44, WWSD rifles, PCCs a fad, Wildcat cartridges, AR action as a template for cartridge design.

Projeto de lei aprovado pela Assembleia Legislativa do Rio altera o Plano de Cargos, Carreiras e Salários (PCCS) dos funcionários da Secretaria de Estado de Saúde (SES) e do Instituto de Assistência dos Servidores do Estado (Iaserj). O objetivo é facilitar a implementação da norma pelo Governo do Estado, uma vez que adequa os valores a realidade fiscal atual.

In this GCP Short, produced in collaboration with Friends of the Podcast Swiss Re Corporate Solutions, Richard and guests debate the similarities and differences between virtual captives and protected cell companies (PCCs). Thomas Keist, Global Captive Solutions Leader at Swiss Re Corporate Solutions, and Fabrice Frere, Managing Director within Aon Global Risk Consulting in Luxembourg, discuss the two structures, addressing areas such as fronting and reinsurance partners, domicile considerations and consolidated and unconsolidated balance sheets. For more information on Swiss Re Corporate Solutions and their captive services, visit their GCP page: https://www.globalcaptivepodcast.com/swissre You can subscribe to the Global Captive Podcast on iTunes, Apple Podcasts, Spotify or any other podcast app. Read the second edition of GCP Insights here: www.globalcaptivepodcast.com/gcp-insights Contact Richard: richard@globalcaptivepodcast.com Visit the website: www.globalcaptivepodcast.com Follow us on LinkedIn: www.linkedin.com/company/global-captive-podcast/

Halbautomaten in Pistolenkalibern sorgen oft für verdutzte Gesichter. Hier erklären wir den Sinn von sogenannten "PCCs" für Jäger und Sportschützen. Für das Hintergrundwissen beleuchten wir auch die Bedeutung deren "Ahnen" der Maschinenpistolen. Wie immer erheben wir keinen Anspruch auf Vollständigkeit und Richtigkeit. Dennoch versuchen wir die Qualität so hoch wie möglich zu halten.

Host: Dr. Sarah Tabbutt (UCSF Benioff Children's Hospital). Editor/Producer: Dr. David Werho (UC San Diego). Peter Rimensberger from Geneva, Switzerland and Stacey Bedford from London, UK discuss the varied practices for noninvasive and invasive mechanical ventilation in Europe. This was recorded at our last international meeting in London as a collaboration between PCICS, PICS-UK (now PCCS), and EPNCIC. Please register for our 2020 PCICS virtual meeting now for more great content! PCICS does not endorse specific devices or care practices.

Host/Editor: Dr. Raj Sahulee (NYU Langone – Hassenfeld Children's Hospital). Producer: Dr. David Werho (UC San Diego). A multidisciplinary team from the Hospital for Sick Kids in Toronto discusses the story of a remarkable young girl's resilience during her prolonged hospitalizations as well as the development of their Care By Parent protocol to allow VAD patients off the cardiac unit. This was recorded at our last international meeting in London as a collaboration between PCICS, PICS-UK (now PCCS), and EPNCIC. Please register for our 2020 PCICS virtual meeting now for more great content! Off-label use discussed – PCICS does not endorse specific devices or care practices.

Host/Editor: Saidie Rodriguez, MD (Children's Healthcare of Atlanta). Producer: David Werho, MD (UC San Diego). Eduardo da Cruz, MD from Children's Hospital Colorado discusses the roles of innovation, collaboration, and new technologies in the future of pediatric cardiac critical care both locally and globally. This was recorded at our last international meeting in London as a collaboration between PCICS, PICS-UK (now PCCS), and EPNCIC.

In this episode I talk to Margaret Pritchard Houston about her new book 'Beyond the Children's Corner', I loved the book and the conversation with Margaret, the whole conversation really resonated with much of my own experience as a Mum of young children and teenagers in church! Enjoy... Beyond the Children's Corner is a practical handbook to help churches become more welcoming to children and families in worship. It encourages PCCs and ministry teams to reflect on the spiritual needs of children, the pastoral needs of families, and how to remove barriers and manage change effectively. Based on multiple training sessions and extensive casework, informed by research by the Church of England's Life Events team and the Methodist Church, it explores: * The changing needs of modern families; * What tells you it's time for change; * 'Quick wins' to make the worship space more welcoming and spiritually imaginative; * Engaging children in spiritually nourishing worship; * Children and contemplative worship - what to do about noise; * Building and sustaining relationships with families and children. Many books on All-Age Worship focus the service itself. Beyond the Children's Corner explores how children and adults can be truly integrated as the church community, covering parents' perspectives, the church building and the challenge of change as well as what happens in worship. Margaret Pritchard Houston is the Children's Mission Enabler for the Diocese of St Albans, and a former parish Children's and Families Worker. She has written for the Church Times, Premier Youth and Childrenswork, and elsewhere, and is the author of "There is a Season: celebrating the church year with children" and "Beyond the Children's Corner: creating a culture of welcome for all ages." When not working, she can be found doing amateur dramatics (outside of pandemic times), trapped under cats, or over on Twitter at @HoustonMargaret You can find me, Jenni on Facebook @Jennitalks, Instagram @jenni.osborn and new Twitter account @jenni_talks You can also email me if you'd like to be on the podcast: JenniTalks@gmail.com

Principais Notícias 13 de agosto de 2020. Varejo tem alta de 8% / Queda curva de contágio em Resende / Justiça ordena cumprimento de PCCS em Volta Redonda

Get early access to our latest psychology lectures: bit.ly/new-lectures An existential crisis is a situation in which our entire existence and everything we used to take for granted is in the balance, so that we feel insecure and threatened. This affects all dimensions of life, at the physical, social, personal and spiritual levels. It means that our bodies are challenged, our relationships are changed, our sense of our self is altered, and our beliefs and values are shaken up. For most people this is a very difficult experience to encompass as it leads to a total revolution of our established patterns, routines and habits. It always involves a lot of loss and therefore leads to feelings of bereavement and sorrow as well as to experiences of confusion, fear, anger, doubt and panic. In this presentation we shall consider how existential philosophers and therapists are able to make sense of such situations, be they caused by politics, society, personal choices or natural catastrophes. We shall explore the relationship between the shattering of our most reliable connections to the world and the loss of meaning. Then we shall consider how we can rise to such limit situations and personal challenges, finding ways to thrive instead of being destroyed by radical change, transforming and transcending our previous existence. Emmy van Deurzen is a philosopher, counselling psychologist and existential psychotherapist. She has founded and directed a number of training organizations and continues to be the Principal of the New School of Psychotherapy and Counselling at the Existential Academy in London. She is a visiting professor with Middlesex University. Amongst her 17 books are the bestsellers Existential Psychotherapy and Counselling in Practice (3d edition 2012), Psychotherapy and the Quest for Happiness (Sage, 2009) and Everyday Mysteries (2nd edition Routledge, 2010). She is currently completing her eighteenth book, entitled Rising from Existential Crisis for PCCS books. Follow Emmy on Twitter @emmyzen. Links: - Get our latest psychology lectures emailed to your inbox: http://bit.ly/new-lectures - Check out our next event: http://theweekenduniversity.com/events/ - Support this channel on Patreon: https://www.patreon.com/theweekenduniversity - Emmy's website: http://emmyvandeurzen.com - Emmy's books: https://amzn.to/3aEAqsz

Topic: Fun Pistol Caliber Carbines Are they good for self defense?  Should you get one?  What do we use ours for?  Which ones do we own? Bob and I love pistol caliber carbines.  They are just a blast.  I’ve been competing mine for the last month and starting to win […] The post MHG 13 Fun with PCCs appeared first on Modern Handgunners.

Su Blanch PCC thainks out loud talking about using coaching with groups in the church. Some principles: Coaching with groups involves working with a collection of individuals rather than a team. The principles of coaching remain the same when working with groups. Contracting is important when starting a conversation with a group. The structure of the conversation provides a container for the discussion. It is valuable to have a good structure for a conversation with a group. The subject of the conversation is what we are here to talk about. Consider the time available for the conversation Reflect on the desired outcome of the discussion Understand the role of the facilitator Challenge assumptions and explore different perspectives Be aware of power dynamics and the impact on the environment The facilitator's role is to enable participants to think and contribute Keywords coaching, groups, church, PCCs,  conversations, colleagues, apply, contexts, time, outcome, facilitator, assumptions, power dynamics, environment, facilitator, group meetings, enabling participants, clarity, purpose, contribution, responsibility, engagement, productive meeting, facilitator, container, listening, exploration, moving, world, static, comfortable, awareness, process, outcomes, facilitator, boundaries, conversation, group, internal conflict, direction, thinking, sides, back of the room, noticing, time, reflection, accountability, challenge thinking, desired outcome, time management, productive landing, process questions, reflection, discussion, meetings, facilitators, coaches, meaningful conversations, ownership, learning, resources  

Prothrombin Complex Concentrates (PCCs) for PharmDsSpecial Guest: Scott Dietrich, PharmD, BCCCPShow Notes: https://pharmacytodose.files.wordpress.com/2019/12/pccs-for-pharmds-show-notes.pdfShow References: https://pharmacytodose.files.wordpress.com/2019/12/pccs-for-pharmds-references.pdf3:05 – Anticoagulation reversal pre-PCC5:18 – Brief history of PCC6:45 – Current role for 3-factor PCC7:56 – When should we be using PCC?10:00 – Role of PCC for non-reversal indications13:20 – Weight-based v. Fixed-dose Kcentra15:39 – Why fixed-dose Kcentra?17:33 – When to re-dose Kcentra?18:50 – Kcentra when INR < 220:20 – Guideline-recommended anticoagulation reversal22:30 – How does Kcentra differ from FEIBA?23:48 – FEIBA dosing strategy24:15 – Kcentra for DOAC reversal28:22 – FEIBA for DOAC reversal30:02 – FEIBA v. Kcentra for DOAC reversal30:25 – FEIBA v. KCentra for warfarin reversal33:32 – Should we have Kcentra and FEIBA on formulary?34:26 – Weight-based v. Fixed-dose FEIBA for DOAC reversal35:20 – Pros/Cons of Andexxa37:14 – PCC v. Andexxa37:45 – Andexxa’s cost40:10 – How would Scott reverse his AC?43:20 – Pharmacist’s role45:54 – PCC take home points PharmacyToDose.Com@PharmacyToDose on Twitter/InstagramPharmacyToDose@Gmail.com

(12/4/19) Another in-between week, so it's time for another off the cuff gun talk. We'll talk SMGs vs PDWs vs PCCs, the real history of the NRA, who knows? Let's see! Live video - https://www.facebook.com/andrew.gouff/videos/10162613189040150/ Inked Anarchist YT - https://www.youtube.com/channel/UCYuYw7aFnaJBc8F6NCn-CKg/videos Dyreka's book - https://www.amazon.com/Think-Yourself-Critical-Thinking-Beginners/dp/1791936172/ref=sr_1_fkmrnull_1 Anarchy Among Friends FB - https://www.facebook.com/AAFRTD Spotify - https://open.spotify.com/show/0pqbeHBmWPN1sG0e6L28Uv Apple Podcasts - https://podcasts.apple.com/us/podcast/anarchy-among-friends/id1459037636?ign-mpt=uo%3D4 Stitcher - https://www.stitcher.com/podcast/anchor-podcasts/anarchy-among-friends GooglePodcasts - https://podcasts.google.com/?feed=aHR0cHM6Ly9hbmNob3IuZm0vcy9hNGZmNzQwL3BvZGNhc3QvcnNz Breaker - https://www.breaker.audio/anarchy-among-friends Overcast - https://overcast.fm/itunes1459037636/anarchy-among-friends PocketCasts - https://pca.st/CDH3 RadioPublic - https://radiopublic.com/anarchy-among-friends-Wkzzjl THIS PODCAST IS COVERED BY A BipCot NoGov LICENSE. USE AND RE-USE BY ANYONE EXCEPT GOVERNMENTS OR THEIR AGENTS IS OK. MORE INFO: https://bipcot.org/

Credits: 0.25 AMA PRA Category 1 Credits™ Claim CME/CE credit: https://www.pri-med.com/online-education/basal-insulin-type-2-diabetes-pt-3 Overview: Primary care clinicians (PCCs) are ideally suited to educate and advise people with type 2 diabetes about basal insulin. This program will inform PCCs about current recommendations and advances in the safe and effective use of basal insulin, so they can provide individualized, appropriate care for their patients.

Credits: 0.25 AMA PRA Category 1 Credits™ Claim CME/CE credit: https://www.pri-med.com/online-education/basal-insulin-type-2-diabetes-pt-2 Overview: Primary care clinicians (PCCs) are ideally suited to educate and advise people with type 2 diabetes about basal insulin. This program will inform PCCs about current recommendations and advances in the safe and effective use of basal insulin, so they can provide individualized, appropriate care for their patients. 

Credits: 0.25 AMA PRA Category 1 Credits™ Claim CME/CE credit: https://www.pri-med.com/online-education/basal-insulin-type-2-diabetes-pt-1 Overview: Primary care clinicians (PCCs) are ideally suited to educate and advise people with type 2 diabetes about basal insulin. This program will inform PCCs about current recommendations and advances in the safe and effective use of basal insulin, so they can provide individualized, appropriate care for their patients. 

On this week's episode – Gallen, the new Squire, some Random guy named Dave, Adriel, Trevor and Kelly have a chance to chat about Summer Slam and how the pre-shoot went. We talk – PCCs, squibs and out of battery detonations as well as injuries. It was a rough day for some and not so … Continue reading Episode 314 – Summer Slam Pre-Match Shoot → The post Episode 314 – Summer Slam Pre-Match Shoot appeared first on Slam Fire Radio.

On this week’s episode – Gallen, the new Squire, some Random guy named Dave, Adriel, Trevor and Kelly have a chance to chat about Summer Slam and how the pre-shoot went. We talk – PCCs, squibs and out of battery detonations as well as injuries. It was a rough day for some and not so … Continue reading Episode 314 – Summer Slam Pre-Match Shoot → The post Episode 314 – Summer Slam Pre-Match Shoot appeared first on Slam Fire Radio.

Since 2012, Revolving Doors has been working with the Police and Crime Commissioners across the country to improve the experience of young adults and those in the revolving door of personal crisis and crime. We’ll be hearing from five PCCs from across the country who are demonstrating what can be achieved when agencies and individuals with relevant skills work together.

On the show today we have some great feedback. I also talk about some ongoing projects and some follow up on my PCC build. Please feel free to send in feedback for the show on any topics that you like. Voice Mail 206 745-2731 Email: Firearmscafe@protonmail.com Intro Music: ARTIST: Screenatorium ALBUM: Take Off For Naive […]

It’s time to reimagine therapy and what it means to be a therapist. We are human beings who can now present ourselves as whole people, with authenticity, purpose, and connection. Especially now, when therapists must develop a personal brand to market their practices. To support you as a whole person and a therapist, your hosts, Curt Widhalm and Katie Vernoy talk about how to approach the role of therapist in the modern age. Interview with Benjamin E. Caldwell, Psy.D. Dr. Benjamin Caldwell is the author of five books, including Basics of California Law for LMFTs, LPCCs, and LCSWs, which is now on its fourth edition, and Saving Psychotherapy, which has been the focus of several invited conference presentations. He serves as adjunct faculty for California State University Northridge and The Wright Institute in Berkeley, CA. In his role as Chair of the Legislative and Advocacy Committee for the California Division of AAMFT, he has been directly involved in California's first-in-the-nation ban on reparative therapy for minors, and he drove the change in title from "intern" to "associate" for prelicensed MFTs and PCCs. For his advocacy work, he was awarded the AAMFT Division Contribution Award in 2013. He is a California licensed marriage and family therapist (#42723) and maintains a private practice in Los Angeles, specializing in working with couples. In this episode we talk about: Why psychotherapy needs to be saved, looking at the huge financial barriers to entering the profession and the diminishing amount of money spent on treatment. The advocacy needed to address training requirements, outdated laws and ethical codes, etc. The importance of being clear in communicating what we do, how we’re different from each other, and why we do what we do Why people don’t like or trust therapists How Evidence Based Practices are impacting the field Why we’ve not become more effective as a profession The need to improve therapists, not treatment protocols The “way of being” of a therapist is more important than the clinical interventions used Deliberate Practice How to improve workplaces to take better care of therapists How to advocate at each stage of your career Resources mentioned: We’ve pulled together any resources mentioned in this episode and put together some handy-dandy links. Curt’s almost weekly mention of Scott Miller and his work (and Ben chimes in a lot this time) The Evolution of Psychotherapy Conference Saving Psychotherapy by Benjamin E. Caldwell Basics of California Law for LMFTs, LPCCs, and LCSWs by Benjamin E. Caldwell Ben Caldwell Labs Psychotherapy Notes Our events: The Brand Called “You”: Legal and Ethical Issues in Developing Your Personal Brand The Therapy Reimagined Conference in Los Angeles in October 2018!! Who we are: Curt Widhalm is a Licensed Marriage & Family Therapist in private practice in the Los Angeles area. He is a Board Member at Large for the California Association of Marriage and Family Therapists, a Subject Matter Expert for the California Board of Behavioral Sciences, Adjunct Faculty at Pepperdine University, and a loving husband and father. He is 1/2 great person, 1/2 provocateur, and 1/2 geek, in that order. He dabbles in the dark art of making "dad jokes" and usually has a half-empty cup of coffee somewhere nearby. Learn more about Curt at www.curtwidhalm.com. Katie Vernoy is a Licensed Marriage and Family Therapist, coach, and consultant. As a helping professional for two decades, she’s navigated the ups and downs of our unique line of work. She’s run her own solo therapy practice, designed innovative clinical programs, built and managed large, thriving teams of service providers, and consulted hundreds of helping professionals on how to build meaningful AND sustainable practices. In her spare time, Katie is secretly siphoning off Curt's youthful energy, so that she can take over the world. Learn more about Katie at www.katievernoy.com. A Quick Note: Our opinions are our own. We are only speaking for ourselves – except when we speak for each other, or over each other. We’re working on it. Our guests are also only speaking for themselves and have their own opinions. We aren’t trying to take their voice, and no one speaks for us either. Mostly because they don’t want to, but hey. Stay in Touch: www.mtsgpodcast.com https://www.facebook.com/therapyreimagined/ https://twitter.com/therapymovement https://www.instagram.com/therapyreimagined/ Credits: Voice Over by DW McCann https://www.facebook.com/McCannDW/ Music by Crystal Grooms Mangano http://www.crystalmangano.com/

A 5-year-old boy was playing with his older brother in front of their home when he was struck by a car. He sustained a femur fracture, splenic laceration, and blunt head trauma – the so-called Waddell’s triad. On arrival, he was in compensated shock, with tachycardia. He decompensates and needs blood. How do we manage his hemodynamics and when do we perform massive transfusion? Pediatric Massive Transfusion 40 mL/kg of blood products given at any time within the first 24 hours. Adolescents and Adult Massive Transfusion 6-8 units of packed red blood cells (PRBCs) Adults have about 5 L of circulating blood. Not including plasma, one could replace all circulating erythrocytes with about 10 units of PRBCS The best ratio of PRBCs:Plasma:Platelets is unknown, but consensus is 1:1:1. 1 unit of PRBCS is typically 300 mL of volume. The typical initial transfusion of PRBCs in children is 10 mL/kg. Massive transfusion in children is defined as 40 mL/kg of any blood product. Once you start to give a child with major trauma the second 10 mL/kg dose of PRBCs – start thinking about other blood components, and ask yourself whether you should initiate your massive transfusion protocol. The goal is to have the products ready to use in the case of the dynamic trauma patient. The Thromboelastogram (TEG) Direct measures the four components of clot formation. When there is endolethial damage and bleeding, the sequence that your body takes to address it is as follows:  Platelets migrate and form a plug Clotting factors aggregate and reinforce the platelets Fibrin arrives an acts like glue Other cells migrate and support the clot. R time – reaction time – the initial line in the tracing that shows time to beginning of clot formation. Treated with platelets K factor – kinetics of the clot –how much the clot allows the pin to move, or the amplitude. Treated with cryoprecipitate Alpha angle – the slope between the R and K measurements – reflects how quickly the fibrin glue is working. Treated with cryoprecipitate Ma – maximum amplitude – reflects the overall strength of the clot. Treated with platelets LY30 – the clot lysis at 30 min – is the decrease in strength of the clot’s amplitude at 30 min. Treated with an antifibrinolytics (tranexamic acid) Shape Recognition Red wine glass: a normal tracing with a normal reaction time and a normal amplitude. That patient just needs support and monitoring. Champagne glass: a coagulopathic TEG tracing – thinned out, with less amplitude. This patient needs specific blood products. Puffer fish or blob: a hyperfibrinolytic tracing. That patient will needs clot-stablizer. TEG – like the FAST – can be repeated as the clinical picture changes. The Trauma Death Spiral Lethal triad of hypothermia, acidosis, and coagulopathy. Keep the patient perfused and warm. Each unit of PRBCs contains 3 g citrate, which binds ionized calcium, causing hypotension. In massive transfusion, give 20 mg/kg of calcium chloride, up to 2 g, over 15 minutes. Calcium chloride is preferred, as it is ionically readily available – just use a larger-bore IV and watch for infiltration. Calcium gluconate could be used, but it requires metabolism into a bioavailable source of calcium. Prothrombin complex concentrate (PCC) Prothrombin complex concentrate (PCC) is derived from pooled human plasma and contains 25-30 times the concentration of clotting factors as FFP. Four-factor PCCs contain factors II, VII, IX and X, while 3-factor PCCs contain little or no factor VII. The typical dose of PCC is 20-50 units/kg In the severely hemorrhaging patient – you don’t have time to wait for the other blood products to thaw – PCC is a powder that is reconstituted instantly at the bedside. Tranexamic acid (TXA) Tranexamic acid (TXA), is an anti-fibrinolytic agent that functions by stopping the activation of plasminogen to plasmin, and the degradation of fibrin. The Clinical Randomisation of an Antifibrinolytic in Significant Hemorrhage (CRASH-2) investigators revealed a significant decrease in death secondary to bleeding when TXA was administered early following trauma. Based on the adult literature, one guideline is to give 15 mg/kg loading dose of TXA with a max 1 g over 10 minutes followed by 2 mg/kg/h for at least 8 h or until bleeding stops. Resuscitative Pearls Our goal here is damage control. Apply pressure whenever possible. Otherwise, resuscitate, identify the bleeding source, and slow or stop the bleeding with blood products or surgery. How Children are Different in Trauma In adults, we speak of “permissive hypotension” (also called “balanced resuscitation” or “damage control resuscitation”). The idea is that if we bring the adult patient’s blood pressure up to normal, we may be promoting clot rupture. To avoid this, we target a MAP of 65 and look for clinical signs of sufficient perfusion. Adults tolerate hypotension relatively well, and is sufficient until we send them to the OR or interventional radiology suite. In children, this is simply not the case. Hypotension in children is a sign of pre-arrest. Remember, they compensate with an increased systemic vascular resistance and tachycardia to maintain blood pressure. We should not allow children to become hypotensive – severe tachycardia alone should prompt us to resuscitate. In other words, permissive hypotension is not permissible for children. FAST is not sensitive enough to rule-out abdominal trauma. Fox et al in Academic Emergency Medicine found a sensitivity of 52%; with a 95% confidence interval [CI] = 31% to 73%. Often children even with high-grade splenic and liver lacerations can be managed non-operatively. If they are supported adequately, they are observed in the ICU and can avoid surgery in many cases. Unfortunately, a negative FAST cannot help with detecting or grading the laceration for non-operative management. In other words, feel free to use ultrasound – especially for things that we in the ED will react to and intervene on – but CT may help to manage the traumatized child non-operatively. General Guideline for Imaging in Pediatric Trauma CT Head and Neck, non-contrast: in concerning mechanisms of injury, patients that are difficult to assess (especially those under 3 months), those with a GCS of 13 or lower. CT Chest, IV contrast: for suspicion of vascular injury that needs exploration, especially in penetrating trauma. Otherwise, chest xray will tell you everything you need to know in children – especially in blunt trauma. Hemo or pneumothoraces are readily picked up by US or CXR. Rib fractures on CXR predict pulmonary contusions. If you are concerned about great vessel injury, then CT Chest may be helpful; otherwise consider omitting it. CT Abdomen and Pelvis, IV contrast: helpful in grading splenic and liver lacerations with goal to manage non-operatively. Abdominal tenderness to palpation, significant bruising, or a seat belt sign are concerning and would generally warrant a CT. Also, consider in liver function test abnormalities, or hematuria. Extremity injuries: in general can be evaluated with physical exam and plain films. However, some injuries in high-risk anatomically complex areas such as the hand and wrist, tibial plateau, and midfoot may be missed by plain films, and CT may be helpful here. Remember: you can help to mitigate post-traumatic stress and risk for adult healthcare aversion. Summary Massive transfusion in children is at 40 mL/kg of total blood products. Think about it if you are giving your second transfusion to the traumatized child. Do everything you can to support perfusion and avoid the death spiral of hypothermia, coagulopathy, and acidosis. Keep the child perfused with blood as needed, correct coagulopathy, avoid too much crystalloid, and make sure to use the least high-tech of all of these interventions – keep him dry and covered with warm blankets. Do a careful physical exam, and use CT selectively with an end-point in mind – the default is not the pan-scan – evaluate possible injuries depending on your suspicions from history, physical, and lab tests. Become familiar with the relatively new modalities in trauma such as TXA, cryoprecipitate and the emerging technology of thromboelestogram – red wine is good for you, champagne is weak, and a puffer fish is trouble. Selected References Dehmer JJ, Adamson WT. Massive transfusion and blood product use in the pediatric trauma patient. Semin Pediatr Surg. 2010 Nov;19(4):286-91. doi: 10.1053/j.sempedsurg.2010.07.002. Fox JC, Boysen M, Gharahbaghian L, Cusick S, Ahmed SS, Anderson CL, Lekawa M, Langdorf MI. Test characteristics of focused assessment of sonography for trauma for clinically significant abdominal free fluid in pediatric blunt abdominal trauma. Acad Emerg Med. 2011 May;18(5):477-82. Harvey V, Perrone J, Kim P. Does the use of tranexamic acid improve trauma mortality? Ann Emerg Med. 2014 Apr;63(4):460-2. Holscher CM, Faulk LW, Moore EE, Cothren Burlew C, Moore HB, Stewart CL, Pieracci FM, Barnett CC, Bensard DD. Chest computed tomography imaging for blunt pediatric trauma: not worth the radiation risk. J Surg Res. 2013 Sep;184(1):352-7. Nosanov L, Inaba K, Okoye O, Resnick S, Upperman J, Shulman I, Rhee P, Demetriades D. The impact of blood product ratios in massively transfused pediatric trauma patients. Am J Surg. 2013 Nov;206(5):655-60. Ryan ML, Van Haren RM, Thorson CM, Andrews DM, Perez EA, Neville HL, Sola JE, Proctor KG. Trauma induced hypercoagulablity in pediatric patients. J Pediatr Surg. 2014 Aug;49(8):1295-9. Scaife ER, Rollins MD, Barnhart DC, Downey EC, Black RE, Meyers RL, Stevens MH, Gordon S, Prince JS, Battaglia D, Fenton SJ, Plumb J, Metzger RR. The role of focused abdominal sonography for trauma (FAST) in pediatric trauma evaluation. J Pediatr Surg. 2013 Jun;48(6):1377-83. This post and podcast are dedicated to Larry Mellick, MS, MD, FAAP, FACEP. Thank you for your dedication to medical education, and sharing your warm bedside manner, extensive knowledge and talents, and your patient interactions with the world. Powered by #FOAMed — Tim Horeczko, MD, MSCR, FACEP, FAAP

This week's five: 1. Police funding reduced PCCs threaten to take Home Secretary to Court 2. Tory MP admits to taking illegal drugs & watching internet porn. 3. Tom Jones wants to do DNA test see if he has black ancestry 4. Scientist propose to NASA to re-write messages on the Voyager probes. 5. Toilet-themed Russian restaurant appeals to novelty diners. www.colourfulradio.com/podcast/5itE newspodcast

In the second part of this epic 2-part authoritative episode, Anticoagulants, PCCs & Platelets, we have Dr. Walter Himmel (also known as 'The walking encyclopedia of EM') along with Dr. Katerina Pavenski (Head of Transfusion Medicine at St. Michael's Hospital) & Dr. Jeannie Callum (Head of Transfusion Medicine at Sunnybrook Hospital) who will discuss the latest on comparative efficacy and reversal of Warfarin vs Dabigatran vs Rivaroxiban vs Abixaban, the use of prothrombin complex concentrates (PCCs), the ins and outs of thrombocytopenia & platelet transfusions, ITP, TTP, anti-platelet associated intracranial bleeds, indications for Tranexamic Acid & more... The post Episode 37: Anticoagulants, PCCs and Platelets appeared first on Emergency Medicine Cases.

In the second part of this epic 2-part authoritative episode, Anticoagulants, PCCs & Platelets, we have Dr. Walter Himmel (also known as 'The walking encyclopedia of EM') along with Dr. Katerina Pavenski (Head of Transfusion Medicine at St. Michael's Hospital) & Dr. Jeannie Callum (Head of Transfusion Medicine at Sunnybrook Hospital) who will discuss the latest on comparative efficacy and reversal of Warfarin vs Dabigatran vs Rivaroxiban vs Abixaban, the use of prothrombin complex concentrates (PCCs), the ins and outs of thrombocytopenia & platelet transfusions, ITP, TTP, anti-platelet associated intracranial bleeds, indications for Tranexamic Acid & more... The post Episode 37: Anticoagulants, PCCs and Platelets appeared first on Emergency Medicine Cases.

Police and Crime Commissioners, it was argued, would make the police more accountable by providing oversight by a directly elected individual, who would in turn be subject to strict checks and balances. Yet, the electorate failed to vote in high numbers for such an idea; the November 2012 elections recorded an average turnout of just 15%. A string of headlines in recent weeks has questioned the judgement of some PCCs, whether it's claiming expenses for two limousine journeys costing £700, attempting to hire a full-time youth commissioner, or appointing friends and former colleagues to well-paid jobs in the Police and Crime Commissioner office. Six months after they were elected, Simon Cox investigates how well Police and Crime Commissioners are getting on in the job. The Report will investigate why some Commissioners appear to be more active than others and will explore the different styles they have adopted. The programme will speak to a selection of Commissioners elected in 41 areas across England and Wales about the key decisions they've made on budgets, staffing and policing priorities. Producer: Hannah Barnes.

Prothrombin complex concentrates (PCCs) are used mainly for emergency reversal of vitamin K antagonist therapy. Historically, the major drawback with PCCs has been the risk of thrombotic complications. The aims of the present review are to examine thrombotic complications reported with PCCs, and to compare the safety of PCCs with human fresh frozen plasma. The risk of thrombotic complications may be increased by underlying disease, high or frequent PCC dosing, and poorly balanced PCC constituents. The causes of PCC thrombogenicity remain uncertain but accumulating evidence indicates the importance of factor II (prothrombin). With the inclusion of coagulation inhibitors and other manufacturing improvements, today's PCCs may be considered safer than earlier products. PCCs may be considered preferable to fresh frozen plasma for emergency anticoagulant reversal, and this is reflected in the latest British and American guidelines. Care should be taken to avoid excessive substitution with prothrombin, however, and accurate monitoring of patients' coagulation status may allow thrombotic risk to be reduced. The risk of a thrombotic complication due to treatment with PCCs should be weighed against the need for rapid and effective correction of coagulopathy.

Eduardo da Cruz, MD from Children’s Hospital Colorado discusses the roles of innovation, collaboration, and new technologies in the future of pediatric cardiac critical care both locally and globally. This was recorded at our last international meeting in London as a collaboration between PCICS, PICS-UK (now PCCS), and EPNCIC. Please register for our 2020 PCICS virtual meeting now for more great content from leaders in our field! Host/Editor: Saidie Rodriguez, MD (Children’s Healthcare of Atlanta). Producer: David Werho, MD (UC San Diego). 

A multidisciplinary team from the Hospital for Sick Kids in Toronto discusses the story of a remarkable young girl’s resilience during her prolonged hospitalizations as well as the development of their Care By Parent protocol to allow VAD patients off the cardiac unit. This was recorded at our last international meeting in London as a collaboration between PCICS, PICS-UK (now PCCS), and EPNCIC. Please register for our 2020 PCICS virtual meeting now for more great content! Off-label use discussed - PCICS does not endorse specific devices or care practices. Host/Editor: Dr. Raj Sahulee (NYU Langone - Hassenfeld Children’s Hospital). Producer: Dr. David Werho (UC San Diego). 

Peter Rimensberger from Geneva, Switzerland and Stacey Bedford from London, UK discuss the varied practices for noninvasive and invasive mechanical ventilation in Europe. This was recorded at our last international meeting in London as a collaboration between PCICS, PICS-UK (now PCCS), and EPNCIC. Please register for our 2020 PCICS virtual meeting now for more great content! PCICS does not endorse specific devices or care practices. Host: Dr. Sarah Tabbutt (UCSF Benioff Children’s Hospital). Editor/Producer: Dr. David Werho (UC San Diego).

A multidisciplinary team from the Hospital for Sick Kids in Toronto discusses the story of a remarkable young girl’s resilience during her prolonged hospitalizations as well as the development of their Care By Parent protocol to allow VAD patients off the cardiac unit. This was recorded at our last international meeting in London as a collaboration between PCICS, PICS-UK (now PCCS), and EPNCIC. Please register for our 2020 PCICS virtual meeting now for more great content! Off-label use discussed - PCICS does not endorse specific devices or care practices. Host/Editor: Dr. Raj Sahulee (NYU Langone - Hassenfeld Children’s Hospital). Producer: Dr. David Werho (UC San Diego). 

Eduardo da Cruz, MD from Children’s Hospital Colorado discusses the roles of innovation, collaboration, and new technologies in the future of pediatric cardiac critical care both locally and globally. This was recorded at our last international meeting in London as a collaboration between PCICS, PICS-UK (now PCCS), and EPNCIC. Please register for our 2020 PCICS virtual meeting now for more great content from leaders in our field! Host/Editor: Saidie Rodriguez, MD (Children’s Healthcare of Atlanta). Producer: David Werho, MD (UC San Diego). 

The regular team are joined by special guest Mark Hayman, one of our churchwardens, to talk about the recent Annual Parochial Church Meeting, the work of the Parochial Church Council, the role of churchwardens and the film, Pride which was this month's Cinema Club film.