Podcasts about pcv

Episode 204: Adult Pneumococcal Vaccines in 2025.  Luz Perez (MSIV) presents all the available pneumococcal vaccines for adults. Dr. Arreaza guides the discussion about what to do with adults who have previously received pneumococcal vaccines. Written by Luz Perez, MSIV, Ross University School of Medicine. Comments by Hector Arreaza, MD.You are listening to Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California, a UCLA-affiliated program sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. This podcast was created for educational purposes only. Visit your primary care provider for additional medical advice.Today we're answering a clinic classic: Which pneumococcal vaccine should my adult patient get—and when? This is an update of episode 90.Why pneumococcal vaccines matter?Pneumococcal vaccines prevent infections caused by the bacteria Streptococcus pneumonia. These bacteria can cause serious infections like pneumonia, meningitis, and bacteremia. In 2017, the CDC reports that there were more than 31,000 cases of pneumococcal infections and 3,500 deaths from invasive pneumococcal disease. Children are vaccinated in early childhood, before age 5, with PCV15 or PCV 20, at the age of 2, 4, 6 months and a last dose around 12-15 months. Why do we vaccinate adults?Adults are vaccinated because they're at higher risk of getting pneumococcal disease or of having worse outcomes if they do. Vaccines are important because they protect these at-risk patients and reduce the spread of infections among communities. What are the available vaccines? PCV vs PPSV.There are two pneumococcal vaccines used in practice: a polysaccharide vaccine (PPSV) and a conjugate vaccine (PCV). Both protect by targeting capsular polysaccharides from pneumococcal serotypes most often responsible for invasive disease. In simple terms, these vaccines target a part of the bacteria “coating” and create antibodies or proteins that protect the body when the strep enters the body. PPSV (polysaccharide): PPSV is made from purified pieces of the pneumococcal capsule or coating. The current vaccine PPSV23 (Pneumovax®) covers 23 serotypes (or strains) that were the leading cause of pneumococcal infections in the 1980s. PCV (conjugate): Pneumococcal conjugate vaccines (PCVs) take capsular polysaccharides from the bacterium and chemically link them to a carrier protein, which changes and strengthens the immune response. Current PCVs come in four versions: PCV13 (Prevnar 13)PCV15 (Vaxneuvance)PCV20 (Prevnar 20)PCV21 (Capvaxive) The number indicates the amount of pneumococcal capsule types covered by each vaccine. PCV21 was designed around adult disease patterns and covers many serotypes currently driving invasive disease in adults. However, it does not include serotype 4, but this serotype is covered by the PCV20 and PCV15.Who should be vaccinated? In 2024, the United States Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices (ACIP) updated their recommendations on Pneumococcal vaccinations for adults. Their recommendations are: Everyone 50 years or olderAdults age 19–49 with risks: chronic lung/liver disease, heart failure, diabetes; CSF leak or cochlear implant; immunocompromised states (e.g., HIV, hematologic malignancy, CKD/nephrotic syndrome); functional/anatomic asplenia.Patients with history of prior invasive pneumococcal disease: still vaccinate. What vaccine should be given for adults that have never received the Pneumococcal vaccine?For eligible adults with no prior pneumococcal vaccines, there are three choices:PCV21 oncePCV20 oncePCV15 now, followed by PPSV23 later, usually 1 year; 8 weeks if immunocompromised, CSF leak, or cochlear implant.PCV 20 or PCV21 seem more convenient. Once and done. If available, PCV21 is a great one-and-done pick for most adults because it's tailored to current adult serotypes.Serotype 4 caveat: If your patient is at higher risk for serotype 4 disease—think Navajo Nation, or folks in the Western US/Canada with substance use disorders or experiencing homelessness—choose PCV20 (or PCV15 followed by PPSV23 if PCV20 isn't available).What if the patient already received a Pneumococcal vaccine in the past?Plan depends on which vaccine they received and when.PPSV23 only: give PCV21 ≥1 year later (or PCV20 if serotype-4 risk or PCV21 unavailable).PCV10 or PCV13 only: give PCV21 (or PCV20 if PCV21 unavailable) ≥1 year later. If a PCV is not available, discuss PPSV23 now vs waiting until PCV is available.If patient receives PPSV23 now will need to return ≥1 year later to receive a PCV vaccine, and no more vaccines are needed after that.Is it safe to administer the Pneumococcal vaccine with other vaccines?Coadministration is fine with other non-pneumococcal vaccines, as long as we use different syringes and sites. Data support same-day administration of PPSV23 + influenza, and PCV20 with influenza or mRNA COVID-19 vaccines.Some patients are hesitant to receive vaccines, Are there side effects and contraindications to the vaccine?Local reactions are most common: pain/tenderness; swelling/induration (~20%); redness (~15%). Some people “baby” the arm for a couple of days. These typically resolve in 3–4 days; NSAIDs and warm compresses help.Systemic symptoms: fatigue, headache, myalgias/arthralgias, chills; fever ≥38°C is uncommon (

Faith for the Coming Wilderness (4) (audio) David Eells – 9/14/25 I want to back up a little from what I shared last time, when we knew we were to move to Florida and share how we got a little ahead of the Lord. Sometimes the Lord will wait before He answers because He wants to see if we are going to get out there in the flesh and that's what we did. We came over a little early and started looking around Pensacola, but we didn't see anything, and we went back home. We started crying out to the Lord, “Okay, Lord, we know this is the time; we know it's coming,” and so on. And the next time, we waited until the Lord sent us. We even had a Christian realtor in Pensacola looking around for us, and we described the house to him because we had already seen it in dreams and visions. He was looking all over Pensacola, trying to find the house, until, finally, one day, in a little frustration after having sought the Lord, I stopped the man. I said, “Look, let's get your map.” So he got his map and we stretched it out on the hood of his car, and I said, “Listen, this is where the house is, right here!” I wasn't even looking where I was pointing, but I stuck my finger down on the map and he said, “Okay, we'll go there and look.” As we were looking, I told the man just exactly how much we were going to pay for the house. I could tell he wasn't used to that, but he said, “Okay.” He drove us through the area where my finger came down and we passed by the house we had seen in our dreams and visions. The lady who owned it had just stuck a “For Sale By Owner” sign in the ground. And since this was a realtor and it was a For Sale By Owner sign, he was just driving right on by, but I had my pad and pencil out. I wrote down the phone number and called her later. So after we looked at the house, I felt led to offer her $1000 less than I knew I was going to pay because some people like to haggle. She said, “Well, I don't know.” And I said, “Well, I tell you what, leave the curtains,” which I knew she was planning on doing anyway, “and I'll give you this much,” which was the amount the Lord told me. And she said, “Okay.” Praise the Lord! I do want to tell you that the realtor was a good Christian man who had done a good job looking for the house, and we actually gave him his commission. He had worked for his due, and we figured we'd give it to him anyway. He told us, “Man, I could never have found you a deal like this!” Now this lady was a Baptist, but one of her relatives was the pastor of a large, full-Gospel church in Pensacola. He and other people had been witnessing to her. And at the time when we came to Pensacola, she was having a problem with her eyes, so we asked her, “Would you let us pray for you? Will you let us lay hands on you for those eyes, so God will heal them?” I pointed out some verses to her and so on. She said, “Well, I don't know so much of that laying on of hands stuff, but I would like you to pray for me.” I answered, “Okay, we will pray for you without the laying on of hands.” That's what we did; we prayed for her, and God healed her. She was so jubilant to come to find out that God would do this for her because her doctrine didn't permit that kind of miraculous healing. She didn't really believe in those kinds of miraculous healings, but she received a miraculous healing, and her eyes were suddenly opened to the true Gospel. Then, when the time came for us to move in, she still wasn't ready to move out for another week, so she lived with us for a week, and we were able to witness to her even more. We had our stuff all piled up on one end of the house, and we were kind of living together like that until, finally, we had the house to ourselves. You see, God did a miracle. And it was through our weakness that we got this miracle. God paid for it; we didn't pay for anything. The money He gave us was enough to buy the house and a new car because our small car was a Toyota, which was good for doing small jobs, but we had five kids. So we bought a large, brand new station wagon, and God also did many miracles on that station wagon for us over the years. But the miracle was that God paid for both of these. We didn't have any money or save any money, and we just continued to give to any need that came our way. Whenever we saw a need, we gave to it. We didn't believe in storing up our treasures on earth, so we put no money in the bank. We did what Jesus says. (Luk.12:33) Sell that which ye have, and give alms; make for yourselves purses which wax not old, a treasure in the heavens that faileth not, where no thief draweth near, neither moth destroyeth. “Faileth not.” I want to remind you that no credit goes to us. Eph 2:8  for by grace (unmerited favor) have ye been saved through faith; and that not of yourselves, it is the gift of God; 9  not of works, that no man should glory.  When you store up your treasures in Heaven by meeting the needs of the brethren, you can always get it back because as the Lord said, it “faileth not.” For many years, I made a very good living, and I met the needs of the brethren around me. Whenever I saw a need, it wasn't a burden to me to take care of it by the grace of God, Who put it in my heart to do that. When you read the Word of God and you love the Word of God, and you love to act and live on the Word of God, the Word gets into your heart. The Word in you is Jesus in you. So we just gave where we saw to give; we didn't save up money and we didn't borrow money. Borrowing was out of the question for us because we were walking by faith, and even up to today, I haven't for 55 years. But because I give, the money is always there when I need it. As I've shared with you, the Lord taught me never to borrow, never to tell my needs, never to go into the business of buying and selling. Another was, never to take any government help. Recently the Lord had me sighn up for Social Security at 76 which didn't belong to the government but me, but I have given it away ever since. One of the things the young man said happened in his dream was that when he walked up to me, I told him, “I'm never going to work for man again,” and it was true. After I retired from Exxon, I never worked for man again. Now, everybody has to work, as the Bible says: (2Th.3:10) For even when we were with you, this we commanded you, If any will not work, neither let him eat. So I've worked diligently for the Lord and still do, but I've never been a burden on people. I made sure of that, and I never made my needs known. I haven't received any income from UBM. God put it in people's hearts to meet our needs separately. I don't believe in being a freeloader or “mooching.” It's wrong and it's evil. If you're truly walking by faith, God's going to support you. (Luk.10:7) And in that same house remain, eating and drinking such things as they give: for the laborer is worthy of his hire. Go not from house to house. (Mat.10:10) Get you no gold, nor silver, nor brass in your purses; (10) no wallet for your journey, neither two coats, nor shoes, nor staff: for the laborer is worthy of his food. God supports those who work for Him. Apostle Paul is our example. At the beginning of his ministry, he worked for a living. (1Co.9:11) If we sowed unto you spiritual things, is it a great matter if we shall reap your carnal things? (12) If others partake of [this] right over you, do not we yet more? Nevertheless we did not use this right; but we bear all things, that we may cause no hindrance to the gospel of Christ. But later on (2 Corinthians 9; Philippians 2), it seems very clear that Paul was receiving freewill offerings from brethren so that he could continue on with his ministering and not be distracted by any work. It was that way for the first part of my ministry, too. I worked for many years while I ministered. I learned to walk by faith and, in that weakness, God was miraculous. Most people don't get to see the miracles of God because they are not willing to be weak. They're always strong and do for themselves; it's salvation by works. Remember that the Greek word for “salvation,” which is the noun soteria or the verb sozo, is translated in many different ways to cover every kind of salvation. For instance, when Jesus healed someone, (Mat.9:22) But Jesus turning and seeing her said, Daughter, be of good cheer; thy faith hath made thee whole (sozo). And the woman was made whole (sozo) from that hour. When He delivered people from demons, (Luk.8:36) And they that saw it told them how he that was possessed with demons was made whole (sozo). When the disciples were in the sinking boat, (Mat.8:25) And they came to him, and awoke him, saying, Save (sozo), Lord; we perish. Salvation is very, very big! Jesus saved us from sin and its curse. (2Co.5:21) Him who knew no sin he made [to be] sin on our behalf; that we might become the righteousness of God in him. Did you know, in the Scriptures, poverty is a curse? (Deu.28:47) Because thou servedst not the Lord thy God with joyfulness, and with gladness of heart, by reason of the abundance of all things; (48) therefore shalt thou serve thine enemies that Jehovah shall send against thee, in hunger, and in thirst, and in nakedness, and in want of all things: and he shall put a yoke of iron upon thy neck, until he have destroyed thee. Unless it is a sacrificial self-imposed poverty for the sake of others, it's a curse. How many of you know that Jesus wasn't poverty-stricken? He had His needs met everywhere He went. Now, He didn't have riches, according to the way the world likes riches. The world likes the material kind of riches in which they can trust. Jesus didn't have that, but His needs were met wherever He went, and so were His disciples. They weren't poor, but they were poor to the world. (Jas.2:5) Hearken, my beloved brethren; did not God choose them that are poor as to the world to be rich in faith, and heirs of the kingdom which he promised to them that love him? People who are poor to the world are in a position of weakness, where they have to trust in God. You have to come out from under the principles of the world and the teachings of the worldly, Babylonish Church. You learn to obey the principles that Jesus gave us in the New Testament. Make sure your brother's needs are met sacrificially out of what you have, and God will make sure you don't ever have a need that isn't met by God's faith in us. Paul said, (Php.4:19) And my God shall supply every need of yours according to his riches in glory in Christ Jesus. He said that because his needs were being met by the brethren and He made that promise to the Philippians. Well, we lost a car, had been injured, and didn't have any money, but in our weakness, God was made strong. We didn't have to sell or borrow or beg or do anything of the sort; all we did was give. I want you to walk in the same blessings, and God will do that for you if you start living according to His principles. By the way, because the second part of the money that came in from the wreck was delayed and delayed, God made an opportunity for me to give away my first station wagon that I had when I was in Baton Rouge. I gave it away to a mission in town where I had preached quite a few times because they needed transportation for the people in the mission. God blessed me with that car, and I never had any problems with it that Father didn't fix. When we prayed for a car, my youngest daughter had a vision of that car being in New Orleans. She even saw the color of the car. Sure enough, I couldn't find anything in Baton Rouge that I liked, so I went to New Orleans, and I saw the car and bought it. That was the car I gave to the mission. And I'd never put any spares in that car because I was trusting God to keep my tires, but the day I put the keys in the preacher's hand in my living room and we walked outside, it was sitting on a flat. I never had a flat as long as I had that car because I never carried a spare, but as soon as it got out of my hand and into his, it had a flat. And since I mentioned New Orleans, think about what happened there, folks. God brought a Category 5 hurricane (Hurricane Katrina: August 29, 2005) to that big sin city and, just as it was about to hit land, He sent in a wave of dry air from the northwest that suddenly knocked that hurricane down to a Category 3. That same gust of dry air pushed the hurricane to the east. A Category 5 hurricane that was about to hit that area would have driven the waters of Lake Pontchartrain over into the city and drowned 40,000 to 50,000 people because the water would have come in there so fast. Think about man's efforts to save himself with the levees and those great big monster pumps that they have in that city. They thought they could keep that city dry. Had a Category 5 hit that city head-on, or even a Category 3, it would have pushed the water in there faster than the pumps could handle. Most of New Orleans is 20 feet below sea level and some of it is more than 20 feet below sea level. What chance did man have to save himself from just one of God's judgments? As it was, He didn't let the city escape, even after moving the hurricane over a little bit. The levees gave out when they became saturated and the city started filling up with water, but it was slow enough to give people a little time to move out of the way. It was astounding how the mercy of God saved those people. The meteorologists pointed out on radar how this gust of dry air came in and moved the hurricane; they were totally amazed by it. They had never seen anything like it. That was purely an act of God that spared them when they couldn't have saved themselves, even with all of their efforts. They knew if a major hurricane hit them, the city would drown. God didn't completely spare the city, but He spared an untold number of people, including many brethren. I'm sure some people in New Orleans with faith were praying until God, at the last moment, suddenly dropped the strength of that hurricane and moved it over. Hurricane Dennis did exactly the same thing as it was coming toward Pensacola. I was praying the whole time and I was asking, “Lord, do you want me to command that hurricane to back off and go the other way?” The Lord said, “No. Just wait,” so I didn't do anything. All of a sudden, when it hit the land, I felt in my heart that the Lord wanted me to command it to be broken up, and that's exactly when it started breaking up. The strength dropped down, and it veered a little bit to the right of Pensacola. I know that there were some people over there in New Orleans doing the exact same thing and God answered the exact same way. You see, God has it all planned out. He just uses His faith in us to bring it to pass. We can put our trust in the living God. Nothing that man can do will save you from the judgments that are coming. The wilderness is where you learn to walk by faith in the Lord. You learn to put your faith in Him and you give up your efforts and your power; you give up your ability to do anything. The promises of God are past tense. He became a curse for you, He bore your curse, and He healed your body. He already did all of this, and since all of these promises are past tense, what can you do to bring it to pass? Jesus taught us, (Mar.11:24) Therefore I say unto you, All things whatsoever ye pray and ask for, believe that ye received them, and ye shall have them. If you believe you have received, there's nothing for you to do to bring them to pass. Believing the promises brings us into a position of weakness where we can't save ourselves. You've probably heard the old saying, “God helps those who help themselves.” Well, that's a lie. The Bible says just the opposite: (Jer.17:5) Thus saith the Lord: Cursed is the man that trusteth in man, and maketh flesh his arm, and whose heart departeth from the Lord. The power of God is made perfect in weakness; that's what He told Paul: (2Co.12:9) And he hath said unto me, My grace is sufficient for thee: for my power is made perfect in weakness. Most gladly therefore will I rather glory in my weaknesses, that the power of Christ may rest upon me. Paul couldn't save himself in those situations that he got into, but he said, (2Ti.4:18) The Lord will deliver me from every evil work, and will save me unto his heavenly kingdom: to whom be the glory forever and ever. Amen. In his weakness, and faith, God's power was made perfect. Keep the Sabbath, and don't bring a burden into God's Holy City on this Sabbath. Cease from your own works or, in other words, cease from the works of man. As God told Moses and the children of Israel, (Exo.14:13) And Moses said unto the people, Fear ye not, stand still, and see the salvation of the Lord, which he will work for you to-day: for the Egyptians whom ye have seen to-day, ye shall see them again no more for ever. (14) The Lord will fight for you, and ye shall hold your peace. He said, “Stand still.” They were trying to figure out what to do. Here was Pharaoh's army coming up behind them and they would have never thought about parting the Red Sea. (Exo.14:15) And the Lord said unto Moses, Wherefore criest thou unto me? speak unto the children of Israel, that they go forward. (16) And lift thou up thy rod, and stretch out thy hand over the sea, and divide it: and the children of Israel shall go into the midst of the sea on dry ground. You see, God has ways far beyond our ways. (Isa.55:8) For my thoughts are not your thoughts, neither are your ways my ways, saith the Lord. (9) For as the heavens are higher than the earth, so are my ways higher than your ways, and my thoughts than your thoughts. That's why He had to tell them, “stand still.” It's the same for us. Sometimes we're just so busy running around, trying to figure out a way out of this or a way out of that. We've been trained from our youth to solve our problems for ourselves, when God just wants us to be believers in His promises. Get your Bible and diligently read it. Underline those promises and start acting on them. (Jas.2:17) Even so faith, if it have not works, is dead in itself. Faith without works is dead. Remember that Jesus told us, (Mar.11:24) … All things whatsoever ye pray and ask for, believe that ye received them, and ye shall have them. How would you act if you believed you had received what you prayed for? You would stop trying to bring it to pass for yourself. You would cease from your own labors and, if you cease from your own labors on His Sabbath, you will find God's power is made perfect. Glory be to God! Now, I want to remind you that the Lord hardened Pharaoh's heart over and over before the Israelites were set free from Egypt to go into their wilderness. (Exo.7:1) And the Lord said unto Moses, See, I have made thee as God to Pharaoh; and Aaron thy brother shall be thy prophet. (2) Thou shalt speak all that I command thee; and Aaron thy brother shall speak unto Pharaoh, that he let the children of Israel go out of his land. (3) And I will harden Pharaoh's heart, and multiply my signs and my wonders in the land of Egypt. (4) But Pharaoh will not hearken unto you, and I will lay my hand upon Egypt, and bring forth my hosts, my people the children of Israel, out of the land of Egypt by great judgments. (5) And the Egyptians shall know that I am the Lord, when I stretch forth my hand upon Egypt, and bring out the children of Israel from among them. Why did He do that? Why did the Lord harden Pharaoh's heart? (Exo.10:1) And the Lord said unto Moses, Go in unto Pharaoh: for I have hardened his heart, and the heart of his servants, that I may show these my signs in the midst of them, (2) and that thou mayest tell in the ears of thy son, and of thy son's son, what things I have wrought upon Egypt, and my signs which I have done among them; that ye may know that I am the Lord. The Lord hardened Pharaoh's heart because He wanted to judge Egypt and He wanted to prove His great power to deliver the Israelites. By the time the Israelites left Egypt, the land had been devastated, and the economy was in ruins. (Exo.10:7) And Pharaoh's servants said unto him, How long shall this man be a snare unto us? let the men go, that they may serve the Lord their God: knowest thou not yet that Egypt is destroyed? You know, He's going to do that again in our day! (Ecc.1:9) That which hath been is that which shall be; and that which hath been done is that which shall be done: and there is no new thing under the sun. History is going to repeat. Judgments are coming upon the United States, but God is merciful, and He sends warnings to us so His people will pray. I'm totally convinced that the prayers of the saints have delayed a time of judgment. We have been receiving many revelations of judgments, some of them with actual dates that have since come and gone, and the Lord showed me that these were true revelations, yet they didn't come to pass. You see, the Lord gives you a warning of things to come for the purpose of having you seek Him for grace. (Jas.4:2) … ye have not, because ye ask not. God's people don't pray and they don't seek Him for His grace and mercy! It takes a threat for His people to seek Him for grace and mercy. When God wants to give us grace and mercy, He almost has to tell us what's going to happen if we don't seek Him. I know what the Lord did with those revelations that never came to pass: He put those warnings out there so His people would seek Him for grace and He gave it. By the way, if you don't believe God dates prophecies, you haven't read very much of the Bible because there are many of them in there (Daniel 7; 9; Jonah 3; Revelation 12; etc.) The brethren who share these warnings sometimes wonder if God just forgot about them or if He left them, or if they were deceived. The same thing happened with Jonah. (Jon.4:1) But it displeased Jonah exceedingly, and he was angry. Jonah had prophesied Nineveh would be overthrown in 40 days, and yet, God had mercy when the people cried out to Him. God had mercy, and Jonah was angry because now he was going to look like a false prophet. (2) And he prayed unto the Lord, and said, I pray thee, O Lord, was not this my saying, when I was yet in my country? Therefore I hasted to flee unto Tarshish; for I knew that thou art a gracious God, and merciful, slow to anger, and abundant in lovingkindness, and repentest thee of the evil. (3) Therefore now, O Lord, take, I beseech thee, my life from me; for it is better for me to die than to live. Jonah didn't want to face the world. He felt as if the Lord had let him down. He had prophesied their destruction, but he also knew that God was merciful and would repent of the prophesied evil. However, God reminded Jonah there was something a lot more important than his pride. (Jon.4:11) And should not I have regard for Nineveh, that great city, wherein are more than six score thousand persons that cannot discern between their right hand and their left hand; and also much cattle? Can you imagine, He was even having mercy on the cattle! God was showing it wasn't important that Jonah might look like a false prophet, but it was important that God was going to have mercy on these people. That's the thing we have to keep in mind. Remember, we've been put here to be of no reputation anyway, according to the Scriptures. (Php.2:5) Have this mind in you, which was also in Christ Jesus: (6) who, existing in the form of God, counted not the being on an equality with God a thing to be grasped, (7) but emptied himself, taking the form of a servant, being made in the likeness of men; (8) and being found in fashion as a man, he humbled himself, becoming obedient even unto death, yea, the death of the cross. We're supposed to have the same mind as Christ. We're here to lose our reputation in the eyes of the world. The wilderness is a place of hopelessness for the flesh because the flesh really can't help God. Just like the wilderness was a place of weakness for Israel, a place where the world couldn't supply the needs of God's people, so it is, and will be, for us in our day. What the Church has been teaching for so long is, “God helps those who help themselves.” That's their doctrine. Well, God doesn't like that and it's a stench in His nostrils. The Bible says (Eph.2:8) For by grace have ye been saved through faith; and that not of yourselves, it is the gift of God. We are saved by His works, His efforts, and His wisdom. The Lord has already accomplished everything for us at the cross. (Php.4:19) And my God shall supply every need of yours according to his riches in glory in Christ Jesus. He supplied our needs at the cross, so God doesn't appreciate that the Church is preaching salvation by works. He said, (2Co.12:9) … My grace is sufficient for thee: for my power is made perfect in weakness.... I'd like to share with you the difference between assurance and insurance because this is part of my wilderness. Many people have their trust in the “idol” of insurance. They think they've insulated themselves from anything bad that could come from this world, but it's going to fail. Every idol that you stand up to the Lord will fall over and be crushed like Dagon. (1Sa.5:3) And when they of Ashdod arose early on the morrow, behold, Dagon was fallen upon his face to the ground before the ark of the Lord. And they took Dagon, and set him in his place again. (4) And when they arose early on the morrow morning, behold, Dagon was fallen upon his face to the ground before the ark of the Lord; and the head of Dagon and both the palms of his hands lay cut off upon the threshold; only the stump of Dagon was left to him. God is going to judge all the idols of Egypt; they will all fail. Even insurance companies are not going to be able to save America. As a matter of fact, insurance companies have been leaving several states, including Florida, where judgments such as hurricanes are becoming more and more frequent. They've been leaving those states to avoid going bankrupt. And they get permission to not pay up if doing so would harm them. But God's going to continue hitting big sin cities all around the United States with one form of judgment or another, and there aren't enough insurance companies in the world to save America. If you're interested in my wilderness experiences and teachings from the Bible, I ask that you get our free e-book, Sovereign God For Us And Through Us, on our website: ubm1.org. He is sovereign for us and He wants to be sovereign through us. He wants to administer His authority in this earth through His people. I want to share some excerpts with you here from Chapter 18. It's titled “Assurance Versus Insurance,” and I hope it will give you a desire to read the rest of the book. We receive testimonies every day of people who are being empowered by God and helped and delivered by this book. (The excerpts are italicized, and my commentary is in parentheses.) (Psa.91:9) For thou, O Lord, art my refuge!.... This confession of faith and the deliverance that comes of it are merely acting on what the Word says. I received a revelation years ago in Louisiana, before it was a law to have any form of auto insurance. Even now there are are laws to have the minimum PIP/PD but that covers the other guy, not you. So I have had this to obey the law and have been rewarded greatly because the other guy was a fault and paid me. The Lord began spiritually to reason with me. It occurred to me that God is sovereign over what we call “accidents.” (We're always insulating ourselves with insurance, but there is really no such thing as an accident, is there?) (Joh.3:27) A man can receive nothing, except it have been given him from heaven. That doesn't sound like there are accidents (It sounds like there is a sovereign God!); therefore, an accident could not come without God sending it. Since He said that if we prayed believing we would receive, then I could ask Him to keep my vehicles, or let the other guy be at fault and pay me, which has profited me greatly. Why would I need insurance if I believed the assurance just given in His promises? (Psa.91:9) For thou, O Lord, art my refuge! (Notice the good confession and its resulting benefit. (Jas.2:26) For as the body apart from the spirit is dead, even so faith apart from works is dead. Faith without works is dead, but the good confession brings a benefit.) Thou hast made the Most High thy habitation; (10) There shall no evil befall thee, Neither shall any plague come nigh thy tent. (I know a lot of people don't believe or teach this nowadays, but it's the Word of the Lord. Who are we to say otherwise!) (11) For he will give his angels charge over thee, To keep thee in all thy ways. (12) They shall bear thee up in their hands, Lest thou dash thy foot against a stone. (Or, in other words, “lest you have an accident.”) Notice that when we abide in Christ by faith (and hold fast this good confession; that's the promise of God), angels keep us from what men call “accidents.” An exception to this can be an experience like Job's to show hidden faults (Job.32:1-2). As in his case, God strictly controls the chastening and later restores what is taken. God restored to Job twice as much as he had and without insurance. God desires to be our security. We don't need security in the world; we need our God to be our security. (Psa.119:122) Be surety (Hebrew: “to give or be security”) for thy servant for good.... (Heb.7:22) By so much also hath Jesus become the surety of a better covenant. God and His promises are the believers' assurance of provision and protection. After seeing what the Lord was saying to me, I dropped my auto insurance back before it was required. Then I called my life insurance man and he came over. I told him that I would not need insurance anymore because God would be my assurance. He was a good Lutheran man who sincerely tried to reason with this fanatic, but to no avail. The week after I did this, I drove to a Stop-N-Go mart and went in to get some food. While I was walking down an aisle, I heard a crash that shook the store windows. I looked up over the isle to see that my car had been in a wreck without me! I went out and found a heavy old Buick's front end wrapped around the back corner of my Datsun station wagon. The driver backed the car up a foot or so, and we both stood there speechless. We just couldn't really understand how this could happen. The hood, grill and bumper of his all steel car were notched back about six inches, as if it had hit a big oak tree. Here is the good part. Datsun station wagons were tin boxes and could be dented with an elbow. This tank hit my car on the left rear wrap-around, plastic tail lens! I reached out and with my thumbnail, scraped a piece of paint from his hood off the plastic tail lens, and we stood there for a moment looking at this miracle. There was not a scratch, dent or crack on my car anywhere. Awesome God! He made my wimpy car, which should have been totaled, invincible to this old tank of a car. The assurance of God saved me from any need of insurance. The man said, “I think my brakes went out,” and then he mumbled, “They sure make ‘em better than they used to.” As I was thinking about how ludicrous that statement was (and I knew he didn't believe it anyway), he got in his car and left. Suddenly, it hit me that I missed the best chance in the entire world to witness to someone. I jumped into my car and caught him at the next red light (where his brakes, obviously, had stopped him). I grabbed some tracts out of the glove box and hurried to his door. I said, “Sir, that was a miracle.” He said, “It had to be.” I said, “I didn't have any insurance on my car and I was trusting God to keep it and He did.” The light turned green and we parted company. Since then, I have never had any insurance that covers our family, vehicles or home, other than what the law demands. We now have to have liability, which covers the other guy but not you. However, when the Lord tells you that you do not need insurance He means it. That first wreck, or lack thereof, was an awesome testimony, but we did not plunder Egypt, as we did with later wrecks. Since then, God has not always protected our vehicles or bodies, but in every case, it was to our advantage, for He healed our bodies once and greatly blessed us financially. (When you trust in the Lord, He's working all things for your good, as Romans 8:28 says.) During this time, though we sued no one, the other guy's insurance blessed us with money for the following: to repair a motorcycle with money leftover in my pocket for a new one; to repair a Toyota pickup that needed painting anyway, and I ended up after fixing the pickup, painting it with a beautiful paint job with $1,500 left in my pocket; to buy two cars, one new; to buy our home; to enable us to buy and give cars to others; to enable us to give our home away; and to buy a travel trailer for a homeless woman and her son. Besides all that and more, we have not spent God's money on many years' worth of insurance. (If you obey God, you can't lose! If you obey God and walk by faith in Him and let His assurance be your insurance and not the world, then you'll see the miracles of God.) Now, I can hear someone say, “But David, what if ... ?” What if what? What if God Almighty fell off His throne? (God made these promises; we're just depending upon Him.) (Rom.10:11) For the scripture saith, Whosoever believeth on him shall not be put to shame. (The devil tells you that you will be put to shame, but that's a lie.) (Jer.17:7) Blessed is the man that trusteth in the Lord, and whose trust the Lord is. By the grace of God, it has been many years since we have had a wreck. Praise God! (So God can keep you from wrecks, but when you do get into them, He can make them bless you.) One day, in that same Datsun station wagon, I was driving along rather frustrated because I had had three flats on relatively new tires. Most people would be complaining to the manufacturer, but I believed that God was in control, so I was complaining to the Lord. A little frustrated, I said, “Lord, can't You keep my tires?” He said to me very clearly, “Don't you believe that I can keep your tires?” I replied in my ignorance, “Yes, I believe You can keep them.” He replied, “Then why do you keep putting that spare back there?” To be honest, I put the spare in the trunk because it was traditional and I had not questioned it, but also, the underlying reason was in case God didn't keep my tires. (I'm not trying to make a new doctrine on spares, just share a lesson God gave to me.) Fear and unbelief cause us to try to insulate ourselves from any possibility of lack, loss or threat. Since we are trusting in insurance besides the Lord, we usually end up needing it. (That's what people don't understand. If you trust in something besides the Lord, you end up having to use it. Of course, some people say, “Aha! You see, I needed it!” But they have it all backwards. When you trust in any idol and not in the Lord, you're going to need it.) Jesus sent out His disciples in a way that would make them dependent on living by faith. He sent them without their own provision so that in their weakness His power would be proven. (Mat.10:9) Get you no gold, nor silver, nor brass in your purses; (10) no wallet for [your] journey, neither two coats, nor shoes, nor staff: for the laborer is worthy of his food. Later, Jesus wanted to see what they learned from this experience of depending upon God's supply. (Luk.22:35) And he said unto them, When I sent you forth without purse, and wallet, and shoes, lacked ye anything? And they said, Nothing. (For those of you who believe that only applied to the disciples, remember Jesus commanded His disciples to make disciples and teach them to observe everything that He commanded the first disciples to observe (Matthew 28:20). In other words, what He spoke to them, He spoke to us, but man came in there with religion and thwarted the whole mission that God sent us on.) In the wilderness of man's supply, God's provision was evident. (When Jesus sent out the disciples without their own supply, He basically made a wilderness wherever these men went because they didn't bring enough with them out of “Egypt” to supply their needs.) God starts His works when we finish ours. His power is made perfect in our weakness. That was my experience with those tires. I threw out my spare and I never had another flat on that car, and the neighbors who used to borrow it quit! (I would tell them, “Look, if you're going to drive this car, you have to drive it by faith because I don't have a spare back there.” Well, they quit borrowing my car, which I guess was another benefit.) The moral of that story is, if you prepare for a rainy day, it will come. With the next car, I had the same experience: no flats. When I decided after many years to give it to a mission, I put the keys and title into the hand of the pastor in my living room. We walked outside and the car was on a flat. (I was the one walking by faith and now that it was his car, now that the key was in his hand, it was sitting on a flat! Well, inside I just chuckled. I understood exactly what He was saying to me.) God made His point. As long as I owned the car, putting my trust in Him, there was never a flat. In other words, trusting in God takes away the need for insurance. (And, again, I'm not making any laws about this; I'm not condemning anybody for having spares. God was teaching me, and He'll teach you. He may use other methods, but He wants to teach you to walk in this wilderness, to walk in a lack of man's provision, but in your weakness, God will be made strong.) Men serve insurance companies, H.M.O.s, banks and store up their treasures on earth for the security they think it gives them. (Mat.6:19) Lay not up for yourselves treasures upon the earth, where moth and rust consume, and where thieves break through and steal. Y2K revealed the paranoia and lack of trust in those who stored up their treasures on earth, contrary to the Lord's command. (It's fear that causes people to do such things, but God's power is made perfect in our weakness.) Quite a few I showed these principles to went home to give their store away and found it full of bugs, just as Jesus said, “thieves break through and steal.” Jesus told of a man who found peace in the insurance of storing up his goods in greater barns (Luke 12:18). He said to himself, (Luk.12:19) ...Soul, thou hast much goods laid up for many years; take thine ease, eat, drink, be merry. (That's the thinking of man: “I have all I need; this will keep me for a long time.”) His misplaced trust brought judgment. (20) But God said unto him, Thou foolish one, this night is thy soul required (Greek: “they require thy soul”) of thee; and the things which thou hast prepared, whose shall they be? (21) So is he that layeth up treasure for himself, and is not rich toward God. (Now, to be “rich toward God” is to be “rich in faith and heirs of the Kingdom.” (Jas.2:5) Hearken, my beloved brethren; did not God choose them that are poor as to the world to be rich in faith, and heirs of the kingdom which he promised to them that love him? Why did He choose the “poor as to the world”? He chose them because they have to trust in God, they have to put their faith in God. That's what God did with the Israelites when He brought them into the wilderness. He made them poor to the world, and He expected them to put their faith in Him.) Notice that it was his stored-up treasures that required his soul. Jesus promised the unfailing Kingdom provisions to those who would store up their treasures in Heaven by giving. (32) Fear not, little flock; for it is your Father's good pleasure to give you the kingdom. (33) Sell that which ye have, and give alms; make for yourselves purses which wax not old (not storing up), a treasure in the heavens that faileth not, where no thief draweth near, neither moth destroyeth. As long as we are on this earth, we can draw on our Heavenly bank account if we have deposited by giving to the needs of others. “Give, and it shall be given unto you.” If we have stored up on earth instead, the promise is that it will be stolen by thieves of one kind or another. Our heart will be on our treasures, falsely thinking them to be our security. (Luk.12:34) For where your treasure is, there will your heart be also. (And God cannot lie!) (I'm told that Psalm 118:8 is the center verse in the Bible and I'm sure that it is at least central to God's heart.) (Psa.118:8) It is better to take refuge in the Lord than to put confidence in man. Our trust in man is what brings the curse to pass. (Jer.17:5) Thus saith the Lord: Cursed is the man that trusteth in man, and maketh flesh his arm, and whose heart departeth from the Lord. (People are trusting in their insurance of many different kinds; they're trusting in their insurance companies, but they are all going to fail. Everything but God is going to fail in the days ahead!) As we can see, the insurances themselves bring the curse that they are thought to relieve. (The man who stored up “much goods” found that they brought the curse upon him. God is not offended with the world doing it; He's offended with His people doing these things.) God is offended with those who call themselves believers, yet trust in man's strength and insurances. This is a heart that departs from the Lord. In 2 Chronicles 16:1-6, Asa, king of Judah, put his trust in the worldly king of Syria for insurance against his enemies. This offended God, Who sent judgment. (2Ch.16:7) And at that time Hanani the seer came to Asa king of Judah, and said unto him, Because thou hast relied on the king of Syria, and hast not relied on the Lord thy God, therefore is the host of the king of Syria escaped out of thy hand. (8) Were not the Ethiopians and the Lubim a huge host, with chariots and horsemen exceeding many? yet, because thou didst rely on the Lord, he delivered them into thy hand. (9) For the eyes of the Lord run to and fro throughout the whole earth, to show himself strong in the behalf of them whose heart is perfect toward him. Herein thou hast done foolishly; for from henceforth thou shalt have wars. God is eager to show signs and wonders to those who trust in Him with a perfect heart. (Obviously, a “perfect heart” is not one that trusts in the world.) You would think that Asa would have learned this lesson, but his trust in man cost him his life, as it does for so many. (12) And in the thirty and ninth year of his reign Asa was diseased in his feet; his disease was exceeding great: yet in his disease he sought not to the Lord, but to the physicians (13) And Asa slept with his fathers.... Christians justify their misplaced trust in man's insurances, not realizing that this brings the judgment in the first place. Let me share this experience with you. M.J. and I were about to go to work on a large crude oil pump for Exxon. The process department had blocked it out of line and drained it, or so we thought. What we did not know was that the pressure gauge read “0” because it was broken and the drain valve, though open, was stopped up, so there was a little pressure still in the pump. We took the bolts out of the head plate to remove it, but it was stuck. I stood up and took about four steps away to get something to break it loose when I heard a “pop” sound and turned around to see M.J. drenched with black crude from head to foot. As he opened his eyes, he sarcastically looked at me and said, “David, you did this to me.” Well, I could not contain myself and busted out laughing. The thought of me stepping away in the nick of time so that M.J. could get plastered was too much for me. Attempting to sound serious, he said, “Dave, you're never going to do this to me again.” I said, “M.J., you had better watch those self-confident statements. You know God is listening.” Then, he repeated his statement and said, “Bring me up to the shower house. I have a spare set of clothes up there.” I said, “Oh, now I know why you got it instead of me.” He asked, “Why?” I said, “Because I don't have a spare set of clothes and God knew it.” He looked at me kind of inquisitively. I explained that planning for a catastrophe is the same as having faith for it. It also proves that you do not believe that God will protect or provide. Later that day, we were working on another pump. M.J. was next to me as we used an impact gun to take off some bolts. Suddenly, slurry squirted down one of the open bolt holes and hit M.J. in the middle of his chest, leaving me untouched. (Slurry is a crude that will stain anything; you cannot get it out. If it gets on your clothes, you can just forget it because that's the color they are now. In fact, it's that way on skin; it's just terribly staining. So this slurry squirted down the bolt hole, down the side of the thread and hit him right in the chest.) He looked at me in disbelief. I playfully said, “M.J., I told you God doesn't like those self-confident statements,” but we both knew that God was speaking in this. We could not remember when this had happened to us before, much less twice in one day. (Truly, in the wilderness that's coming, we can put our trust only in the living God; nothing else is going to save us.) Now, back to that old Datsun station wagon; I want you to know the Lord used that vehicle to teach me many other lessons. When I was about to buy a new car, I really kind of favored the Toyota because I felt it was the better car, but I always left things up to the Lord. I asked, “Lord, which one do you want me to buy, the Toyota or the Datsun?” And I was surprised when the Lord said, “I want you to get the Datsun station wagon.” Now, a person would think that when the Lord tells you to do something, everything would be just fine since, obviously, the Lord is looking out for your good. Well, He was looking out for my good, but not in the way you would think sometimes. I told you the tire story, but other things went wrong with that car. Sometimes God wants you to have victory in trials. It wasn't all that long after I bought the car that the carburetor started acting erratically. And since I was a pretty good machinist and a pretty good mechanic, I knew the carburetor was plugged. I also knew that I didn't feel like tearing down the carburetor because the most precious thing in my life is my time. I used every spare moment I had to read the Bible, to study the Word. I was literally drawn, hungering and thirsting for the Word. Anyway, I just commanded that thing to be healed and kept on driving the Datsun. It went on like that, acting kind of erratically for a couple of weeks, but I just kept on holding fast to my confession. (Heb.10:23) Let us hold fast the confession of our hope that it waver not; for he is faithful that promised. The Lord will try you; just because you don't get the answer right away doesn't mean He hasn't heard you. After I held on like this for a couple of weeks, suddenly it started getting better and better until the problem was gone. In a few more weeks, I was faced with a different problem. The transmission started slipping and I thought it was just crazy for a relatively new car to be doing things like this, but I did all the normal things that a mechanic would do, like checking the fluid, for example, to make sure it was at the right level. And again, I knew that I didn't want to mess with that transmission by working on it myself, and I didn't want to take it to a shop. My time was valuable to me. In the wilderness, it will be a different story. You may not be able to find somebody to work on it, or you may not have the money to work on it, or the parts may not be available, etc. Even though in those days I had plenty of money, I just wouldn't spend it. I considered that what I made belonged to the Kingdom, and I wanted to use it to meet the Kingdom's needs, not spend it on vehicles and things like that. So instead, I just commanded that transmission to “Be healed in the name of Jesus,” but it still went on slipping for a while. Of course, your mind is telling you, “Hey, if you keep letting it slip like that, you're going to have to replace the clutch,” and all the other things that normally go bad when it starts slipping. I just ignored it and kept on going, and as I held fast my confession, my transmission gradually got better and better, until I never had any more problems with it. So, the Lord had me by that car so He could try me and show me He could fix anything. Some of the times when the Lord was teaching me these lessons, I got in the flesh to do things myself, and nothing worked out right. For instance, I told you how, when the insurance money came in, I bought a new Chevrolet station wagon. Well, I'd watched a lot of advertisements for a product called “Slick 50” that showed how you could put it in an engine, run it in there a while, and afterward actually dump out the oil and the engine would still run. I was impressed with that. I thought, “Wow! That will keep my engine. It will make it last a long, long time.” But, folks, I already had a God Who would keep my engine and make it last a long, long time. He's a jealous God. He really wanted me to put my trust in Him. Do you know what I did? I put that Slick 50 in there, even though they said not to use it unless you have 40,000 or 50,000 miles on the car. Well, I stuck it in there a little early and they warn you that you can break some rings doing that. At the time, I still lived in Florida, and I had to go on a teaching tour in Texas. So all of my family and I got in the car and we took off, and before I got very far down the road, the car started pouring smoke out of the tailpipe. I looked in the rear-view mirror, and it was just solid smoke back there. I said, “What in the world has happened to my new car?” I checked the PCV and things like that but couldn't find anything wrong. The only thing I determined was that I must have broken rings, as they said I might do if I put Slick 50 in an engine that didn't have extra clearance in it. I would go a few miles down the road and pour a quart of oil in it, go a few miles and pour another quart in it, so I decided I was going to pray over the engine. I said, “Lord, forgive me for getting in the flesh, and I'm going to trust You to keep this engine.” So I prayed over the engine and I commanded it to be healed in the name of Jesus. I don't know where I got into the terminology of calling it “healed.” I've prayed over vehicles, refrigerators, washing machines, and things like that, and I would always just call it “healing.” Anyway, I prayed over that engine and commanded it to “be healed in the name of Jesus,” because it's not the terminology that you use. Your theology might be a little bit wrong, but the Lord knows what you're meaning. Well, I got back into the car and we went on our way. We got a lot farther down the road, and I think I had to put one more quart in that car on the whole trip to Texas and back. God repaired those broken rings and we had no more problem with that. I didn't have much trouble with that car for many, many years, but I had the water pump stop working on it once when my wife and I were out driving. She cranked the car, and water started just pouring out on the ground. I asked her to get out of the car and come lay hands on the hood with me, which we did. We laid hands on the hood and commanded that water pump to “stop leaking in the name of Jesus.” And that water pump seal immediately sealed back up and we drove off. I've had many miracles like that, but most people never think about doing that. The first thing that comes to their mind is, “Well, I have a warranty on this car; or “I have enough money to hire a mechanic to fix it.” I wanted to stay in the wilderness because I wanted to learn those lessons that, one day, everybody is going to have to learn, so I took every opportunity to stay in the wilderness The Israelites wanted to run back to Egypt whenever they came into a place where God would try them, but God put it in my heart to want to stay out there. I wanted to learn; I wanted to see God do these miracles. Besides that, God told me, “I'm bringing you through a wilderness, so you can tell My people that I still supply there.” I treasured these experiences. Some people would call them terrible tribulation, but I treasured them and I enjoyed seeing God do these things. Let me tell you about my washing machine. One time, after we had moved to Florida, the washing machine started leaking. Mary came and told me, “The seal in the washer has gone out; the pump is leaking onto the ground.” I thought, “I'm going to go pray for it.” So I went and prayed for it and commanded it to be healed, then I sopped up the water and told her to go ahead and use it. Well, she did the rest of the laundry, and the machine didn't leak any more water. Then, just a few weeks later, she said, “That machine is leaking again,” so I went back in there and did the same thing. It went for a few more weeks, and for a third time she said to me, “David, that washer is leaking again.” I said, “No, it's not. It's not leaking; that thing is healed. It's okay, it's fine, just wash and don't worry about it.” You see, I didn't want to go back on what I had spoken. I wanted to keep my trust in the Lord and, sure enough, it sealed up. I told my wife, “If you see it leak, don't confess it, just thank God that it's not leaking and it's fixed.” And, you know, I kept that washing machine until somebody gave me another one that was a lot newer. I remember another time, back when we were in Louisiana, when my two young sons were playing in the living room and I was sitting there studying. My wife came in and she said, “That washing machine won't run. It won't even come on.” I said, “Well, Corban and Nathan, you two go back there and lay hands on that washing machine and just command it to run in the name of Jesus and it will run.” So they did that; they went back there and they laid hands on that thing and they commanded it to run and it took off. I taught all my children to lay hands on this and that, and they got to see the power of God in their simple, childlike faith. Children will always have awesome faith if you teach them about God and you show them the truths in the Bible. We had this lawnmower, and we pulled it out after the winter so we could cut the grass in the early spring. I pulled and pulled and pulled on this lawnmower, but it wouldn't start. My boys were really young at the time, and they were just standing around, looking at me. Well, I pulled the spark plug wire off, put it alongside the block, and pulled it. There was no spark. Now, by this time, I was sweating, tired and I wanted to get it over with. I called my boys to me and said to them, “Let's pray for this thing. Let's command it to run in the name of Jesus. I don't care if it has a spark or not; I just want it to run.” So my boys came over and we all laid hands on the lawnmower, and I commanded it to run in the name of Jesus. Then I cranked it up and mowed the lawn. I don't know if it ever had a spark or not. That didn't make any difference; it just had to run. (Mat.21:21) And Jesus answered and said unto them, Verily I say unto you, If ye have faith, and doubt not, ye shall not only do what is done to the fig tree, but even if ye shall say unto this mountain, Be thou taken up and cast into the sea, it shall be done. (22) And all things, whatsoever ye shall ask in prayer, believing, ye shall receive. The Lord told us, if you speak to a mountain and don't doubt, that what we say will come to pass, and I tell you, teach your children. They have more faith than you. When you tell a child something, the child just believes you, and that's the way we ought to be with God. (Mat.18:2) And he called to him a little child, and set him in the midst of them, (3) and said, Verily I say unto you, Except ye turn, and become as little children, ye shall in no wise enter into the kingdom of heaven. We need to become like a child and, with childlike faith, just believe in our God, just believe that He will do it.

https://thecommunists.org/2025/07/01/news/communist-party-venezuela-pcv-new-stage Anti-imperialist and loyal to the Bolivarian process, the PCV keeps marching forward. The recent history of the Communist Party of Venezuela furnishes further proof that the class struggle must be waged relentlessly on every front, both inside and outside the party. It highlights the necessity of keeping leaders accountable and members engaged with every development of a party's organisational and political life. And it underscores the need for constant vigilance against opportunist ideas and careerist motivations with which our enemies constantly try to infiltrate the organisations of the working class. Subscribe! Donate! Join us in building a bright future for humanity! www.thecommunists.org www.lalkar.org www.redyouth.org Telegram: t.me/thecommunists Twitter: twitter.com/cpgbml Soundcloud: @proletarianradio Rumble: rumble.com/c/theCommunists Odysee: odysee.com/@proletariantv:2 Facebook: www.facebook.com/cpgbml Online Shop: https://shop.thecommunists.org/ Education Program: Each one teach one! www.londonworker.org/education-programme/ Join the struggle www.thecommunists.org/join/ Donate: www.thecommunists.org/donate/

This week Foo finds the perfect Ulanzi (not a sponsor) phone tripod and holder. Gym and his girls go check out the bats at Yolo Wildlife Sanctuary. Gym has a minor, and slightly dfficult, PCV repair to the Caddy. Trapped engine heat can casue all kinds of issues. In the electric era are cars getting harder or easier to fix or mod? Foo goes to a school board meeting with Zander and gets angry. Plus more!

Greetings from Cologne, Germany! To learn all about the ASUS and Xbox partnership, I'm joined by Sascha Krohn, Director of Technical Marketing at ASUS and ROG. Unveiled at Gamescon, this handheld gaming PCV is wild.Speaking of PCs, there are deals to be had over Inter Gamer Days, from August 25th through September 7th, on select Intel-powered gaming laptops and desktops -- as you'll hear from Intel's Samy Saif.But we first kickstart a brand-new Tech It Out, to get the 4-1-1 on Brane Audio and its portable Brane X speaker and its integrated subwoofer. We're joined by Joe Pinkerton, Co-Founder & CEO of Brane AudioThank you to Visa and Sandisk for your support!

BACK on Air is THE podcast for operators who have compliance on their mind and road transport at the heart of their business. This podcast is a recording of our live fortnightly webinar held every other Friday.  So, if you like what you hear and fancy joining the live event where you can ask questions, and vote on our interactive polls, Just register through this link: https://backhousejones.co.uk/free-webinar/This time on BACK on Air, we ask: How confident are you that your driver recruitment and management processes are truly compliant and effective? With growing reliance on agency drivers, evolving legal requirements, and ongoing shifts in the driver labour market, it's more important than ever to get it right.Our employment law experts are joined by specialists from C9 Recruitment to explore how to tighten onboarding, ensure right-to-work checks are up to scratch, manage agency drivers correctly, avoid legal pitfalls under the Equality Act, and spot red flags before they become liabilities. We'll also look at current trends across HGV and PCV recruitment, the role of smarter tech in speeding up hiring, and what a successful operator–agency relationship really looks like.As always, this podcast is correct at the time of broadcast and is not a substitute for tailored legal advice. If you need specific help, please seek professional legal guidance.Like the episode? Leave us a review and let us know what you'd like us to cover next. We read every one, and your feedback helps others find us.Contact: marketing@backhouses.co.ukwww.backhousejones.co.uk

I'm never excited when I diagnose a cat with anaemia: vague signs, confusing diagnostics, and what feels like a not-so-great prognoses. But are they really that hopeless?In this episode, feline medicine specialist Dr Rachel Korman joins us demystify the anaemic cat and offer a clear, practical diagnostic framework that will give you more confidence and better outcomes the next time you see a cat with a low PCV.Some highlights from this conversation:A step-by-step approach to categorising anaemia.Regenerative vs. non-regenerative: what it actually means in cats, and how to interpret the data.Why IMHA in cats doesn't look like IMHA in dogs — and how to recognise it.Haemoplasma infections (like Mycoplasma):  When to treat, how to treat, PCR testing, and what the results really tell you.Age-specific differentials: what to prioritise in young vs. older cats.Supportive care: what works, what's myth.Prognosis pitfalls: why PCV alone doesn't predict survival.This episode will help you approach feline anaemia with more clarity, structure, and - dare we say - optimism.

Dr. Sarah Mrejen (France), Associate Professor Salomon Cohen (France), and Associate Professor Dinah Zur (Israel) explore how neovascular AMD phenotype may influence imaging choices, patient dialogue, and treatment plans. From proactive vs. conservative strategies to new anti-VEGF agents and PCV diagnosis, this expert-led discussion offers key insights into personalising care in retinal disease.

The widespread use of pneumococcal conjugate vaccine (PCV) in children has dramatically lowered the incidence of pneumococcal disease through direct and indirect effects. Despite this progress, pneumococcal pneumonia still leads to more than 200,000 adult hospitalizations annually in the United States. Older adults, individuals with underlying health conditions, and certain racial groups continue to experience higher rates of pneumococcal disease. Dr. John Schoen, Senior Clinical Manager of Drug Information at the Vizient Center for Pharmacy Practice Excellence, joins Program Host Stacy Lauderdale to discuss the newest adult pneumococcal vaccine, PCV21, and recent updates to age-based pneumococcal vaccine recommendations.   Guest speakers:  John Schoen, Pharm.D, BCPS Senior Clinical Manager of Drug Information Vizient Center for Pharmacy Practice Excellence   Host:  Stacy Lauderdale, Pharm.D, BCPS Associate Vice President Vizient Center for Pharmacy Practice Excellence VerifiedRx Host   Show Notes:  [01:25-02:53] Background on PCV21 [02:54-07:56] Difference between PCV20 and PCV21 [07:57-16:15] Discussing the new ACIP recommendation to move the universal age for pneumococcal vaccination from 65 years of age down to 50 years of age and older [08:31-16:15] Why a healthy 50-year-old who has no risk factors for invasive pneumococcal disease should get a pneumococcal vaccination [16:16-17:57] Summary of other changes in the most recent MMWR [17:58-19:34] What organizations consider when selecting specific pneumococcal vaccines [19:35-21:18] What's in the pipeline for  pneumococcal vaccines   Links | Resources:  Publicly available resources Previous VerifiedRx podcasts on pneumococcal vaccines: What's pneu with pneumococcal vaccines? – March 29, 2022 What's pneu part 2: pneumococcal vaccines update – February 13, 2024 January 2024 MMWR - ACIP recommendations for the use of PCV in adults ≥ 50 years of age Vizient client exclusive resources 2025 pneumococcal vaccines side-by-side comparison   Subscribe Today! Apple Podcasts Amazon Podcasts Spotify Android RSS Feed

Thanks to our sponsor Promotive! Find your dream job today: gopromotive.com/jeff Find our guests online!Mr. Subaru | YouTube | TikTokCheck Engine Chuck | YouTube | TikTokBrandon Sloan/Performance Transmissions LLC | YouTube | TikTokMr. Subaru, Check Engine Chuck, and Brandon Sloan join Jeff again this week. Mr. Subaru highlights the complexities of assisting DIYers, emphasizing the limitations of remote diagnostics. Brandon Sloan discusses the ongoing challenges of mentorship and apprenticeship, sharing personal experiences with both successful and problematic trainees. Check Engine Chuck addresses the need for higher labor rates to attract and retain skilled technicians, stressing the importance of transparent communication with consumers. 00:00 Check manuals and data first for troubleshooting.05:46 Used to have patience for teaching comments.09:21 Discussed GM vehicle basics; lacked foundational knowledge.10:14 Update the PCV valve and software to fix the issue.14:22 Frustration with customer's dismissive attitude towards repairs.18:57 Understanding repair costs through detailed explanations.22:05 Answered $5 TikTok follower's Camaro question.25:24 Knowledge empowers consumers and enhances understanding and trust.27:20 Amateur guesses are ineffective; scan codes for diagnosis.31:53 Employee left due to denied raise request.33:48 A tech claims don't match actual skills.37:21 Industry struggles to nurture next-generation technicians.41:39 The industry indirectly caused my father's death.45:30 Mentorship ensures continuity and respect for emerging generations.48:30 Industry must change to effectively retain youth.51:17 Excited about meaningful conversation and potential influence. Follow/Subscribe to the show on social media! TikTok - https://www.tiktok.com/@jeffcompton7YouTube - https://www.youtube.com/@TheJadedMechanicFacebook - https://www.facebook.com/profile.php?id=100091347564232

Check out this week's QuadCast as we discuss if PCV is better than TMZ for oligodendroglioma, discuss results of the hypo-FLAME trial for prostate cancer, highlight adjuvant RT for high risk bladder cancer in the BART trial, and more. Check out the website and subscribe to the newsletter! www.quadshotnews.com Founders & Lead Authors: Laura Dover & Caleb Dulaney Podcast Host: Sam Marcrom

In this episode, Adisa, Engr. Increase, and Zizi discuss the problems caused by a bad PCV valve, its impact on vehicle performance, and how to diagnose and address the issue.

On this episode of the Flatirons Syndicate Podcast, we go through your questions about our Pikes Peak WRX STI! We collected your questions from a post on our Youtube channel last week about our car, the issues that we have had, and some of the details about running up Pikes Peak. The topics covered in this episode include talking about our current and past engine failures, chassis stiffening, running a turbo at high elevation, oil pressure and oil starvation, and the over all results that we have seen running the STI Type RA block. Thanks for your questions and thanks for watching! Stay Tuned! In this Episode: 00:00 - Introduction 00:23 - Your Youtube questions about our Pikes Peak WRX STI 01:08 - Thoughts on chassis stiffening, and difference in approach between a caged and non-caged car 08:52 - How does the suspension and tires react to the change in elevation as we run up Pikes Peak? 12:21 - What caused the original failure of our STI Type-RA engine? 15:08 - What caused our current engine failure? What did we do to address the risk of another failure? What head studs did we use and are we still using the same turbo? 17:23 - How do you deal with the turbo getting less air at the top of Pikes Peak? 22:43 - The car set a record time with a stock EJ block; are there any plans to upgrade the internals, etc.? 23:57 - How do we deal with the issues of oil sloshing and moving through the PCV system with the high incline and g-loads? 27:35 - What caused the decrease in oil pressure on our race run up Pikes Peak? 32:20 - Final thoughts

Is a new COVID vaccine coming out? Which RSV vaccine is better? Are there new PCV vaccines? Which vaccines can be given together? When is the new flu shot available? Our guest is Sandra Fryhofer, MD, AMA's liaison to the Advisory Committee on Immunization Practices (ACIP), and a member of ACIP's COVID-19 Vaccine Workgroup. American Medical Association CXO Todd Unger hosts.

El Dr. Rogelio Trejo Rosales, oncólogo médico, especialista en el Centro Oncológico Personalizado (COPE) de la Ciudad de México, México, nos comenta sobre lo más destacado en tumores del sistema nervioso central, presentado en el Congreso de ASCO 2024, resaltando los siguientes estudios: Abstract 2004: resultados de supervivencia del estudio que evaluó el uso de PCV (procarbazina, CCNU y vincristina) en primera línea frente a temozolomida, ambos en combinación con radioterapia, para pacientes con oligodendroglioma de grado 3 con mutación IDH y codeleción 1p/19q. Los objetivos fueron evaluar la supervivencia global (SG) y supervivencia libre de progresión. GBM AGILE: estudio fase II/III diseñado para evaluar múltiples terapias para el glioblastoma recién diagnosticado y recurrente de manera eficiente y adaptativa. El objetivo primario fue mejorar la SG. Abstract 2071: estudio fase 0/I que se centró en la evaluación de brigimadlin para el tratamiento del glioblastoma multiforme (GBM) con amplificación de MDM2. El objetivo fue desarrollar un modelo de farmacocinética, farmacodinámica y eficacia para brigimadlin utilizando xenoinjertos derivados de pacientes con GBM. Este modelo se utilizará para informar sobre el desarrollo clínico del medicamento en combinación con radioterapia en GBM recién diagnosticado y no metilado en MGMT. Fecha de grabación: 11 de junio de 2024.               Todos los comentarios emitidos por los participantes son a título personal y no reflejan la opinión de ScienceLink u otros. Se deberá revisar las indicaciones aprobadas en el país para cada uno de los tratamientos y medicamentos comentados. Las opiniones vertidas en este programa son responsabilidad de los participantes o entrevistados, ScienceLink las ha incluido con fines educativos. Este material está dirigido a profesionales de la salud exclusivamente.

Odcinek #165, w którym z Mariuszem Czubajem rozmawiamy w Warszawie o tym ile jest Czubaja w jego nowej  P jak powieści „Krótkie pożegnanie”. Wychodzi nam na początku, że pisarz to nie postać co ma kręgosłup z rurek PCV.Pytam Mariusza, czy nie boi się dezaktualizacji W jak wątków w swojej prozie?Pojawia się D jak dzienniczek do zapisów ciśnienia. Jest sympatia do tego, co ludzie potrafią stworzyć. Bo do samych ludzi to już mniej.I w końcu jest B jak bohater powieść, czyli B jak Błażej, któremu bliska jest kultura A ja analogowa.  Przy postaci tej stawiamy pytania o U jak ucieczki, I jak imperatyw i ironię. Wypływa nam w rozmowie T jak tajemnica śmierci siostry Błażeja.Zastanawiamy się, czy literatura jest od tego, by wszystko wyjaśniać i co można zostawić czytelnikowi do wyjaśniania, D jak dopełnienia. I jest jeszcze jedno D - jak domysły.Sprawdzamy Mariuszowi Czubajowi pisarskie LP czyli linie papilarne. I czy da się pracować w owocowe czwartki, czy się nie godzi? - to dopiero jest pytanie. Na koniec gapimy się W jak winylową płytę- jak się kręci, kręci się, kręci.Partnerem tego odcinka jest Audioteka- Dobrze opowiedziane historie.

May 6, 2024 Rockingham County Board of Commissioners MeetingAGENDA1. MEETING CALLED TO ORDER 2. INVOCATION3. PLEDGE OF ALLEGIANCE4. APPROVAL OF MAY 6, 2024 AGENDA5. CONSENT AGENDA (Consent items as follows will be adopted with a single motion, second and vote, unless a request for removal from the Consent Agenda is heard from a Commissioner)A) Trey Wright, Health Director1. Approval- Add new items to the fee schedule:Service Description                                                                            Rate                          Code CCA/Psychiatric Diagnostic Evaluation                                        $250.00                       90791 CCA/ Psychiatric Diagnostic Evaluation w/ medical services      $234.00                       90792Individual Counseling/ Psychotherapy (30 mins)                           $ 95.00                        90832Psychotherapy w/E/M (30 mins)                                                         $104.00                         90833Individual Counseling/Psychotherapy (45 mins)                            $135.00                       90834Psychotherapy w/E/M (45 mins)                                                     $118.00                       90836Individual Counseling/ Psychotherapy (60 mins)/EMDR               $190.00                       90837Psychotherapy w/EIM (60 mins)                                                      $147.00                       90838CBT Group/Multi Family Group                                                      $ 50.00                       90849TFCBT Group Therapy                                                                     $ 50.00                       90853Approval - Remove items from the fee schedule:Service Description                                            Rate                                    CodeCOVID Home Bound Admin                            $45.00                                M02012. - Approval- Add new items to the fee schedule:Service Description                                            Rate                                    CodeRemoval of Sutures                                        $15.00                                 15853Removal of Staples                                          $21.00                                  15854Prevnar 20 (PCV)                                           $315.00                                  90677* Approval - Increase items to the fee schedule:Service DescriptionMeningococcal (2 doses) MenQuadfi VaccineTdaP Vaccine (Boostrix) (> 10 and older)*Approval - Remove items to the fee schedule:Service Description                                             Rate                                       CodeDT Vaccine, < 7 years                                     $ 81.00                                     90702Prevnar 13 TM Vaccine                                  $315.00                                     906703. Approval- Add new items to the fee schedule:Service Description                                             Rate                                        CodeActHiB Vaccine (Private) (4 dose)                    $20.00                                     90648B) Justin Thacker, Deputy Finance Director1. Approval- Amend the Rural Operating Assistance Program (ROAP) budget for $14,761 due to additional grant dollars awarded to the ROAP program in the Final Disbursement formula. The additional expenses will be remitted to AD1'S for monthly expense requests in the following areas:EDTAP: $12,609RGP: $2,122Work-First Grant: $30Total: $14,7612. Approval - Budget amendment in the amount of $1, I00.000 for the sale of 128.79 acres on US 29, Pickrell Road and Grooms Road. $550,000 is to be remitted to the City of Reidsville due to their 50% ownership in the property. The additional $550,000 will be placed in non-departmental reserve and can only be used with Board action. If not used before year end the funds will roll into the fund balance.C) Pat Galloway, Finance Director1. Approval - Amend the Investment Policy to add NCGS 159·30(e)(IO) authorized investment "commingled investment pool established by interlocal agreement by two or more units of local government pursuant to G.S. 160A-460 through G.S. 160A·464...". The North Carolina Investment Pool is organized under this criteria and is endorsed by the NCACC. Increase the limit of commercial paper investment in a single issuer from $3,500,000 to $5,000,000. Many high-quality names that we typically invested in now have a minimum of $5,000,000 and restricts the county's ability to invest in high earnings short-term options.2. Approval- Appropriate $10,225 of donations made to the Animal Shelter to purchase a new dishwasher that will replace the original one purchased in 2011.3. Approval - Appropriate $24,000 for the Library ADA Door Project. The Library was awarded $10,000 in grant funds from the American Library Association for this project. Available funds ofS14,000 in the Public Buildings All County Buildings Repair line will be used for the balance of the project cost.D) Captain Jennifer BrownApproval- Request to use Federal Forfeiture funds to purchase training ammunition and duty ammunition. We have been told that ammunition powder may become harder to get and that prices are expected to increase 4% - 5% for orders place after July 1, 2024.E) Todd Hurst, Tax AdministratorApproval - Refunds for April 3, 2024 thru April 16, 2024F) Rodney Stewart, RCEMS Operations SupervisorApproval - Accounting reports of billing and collections activity for March 2024 and approval of accounts uncollected that are to be written off. Lists of accounts are maintained and available for inspection in the EMS office.G) Susan O. Washburn, Clerk to the BoardApproval- Regular meeting minutesH) Kelly K. Stultz, AICP, Director Planning & Community Development Department Approval - Reappointment of Steve Morgan to the Eden Planning Board as ETJ representative whose term will be upon approval until May 5. 2026.6. PUBLIC COMMENT7. Public HEARING:A. Ronnie Tate, Director of Engineering and Public UtilitiesApproval - For a Second Public Hearing and public reading for the Rockingham County Landfill Franchise Agreement for Operations and Maintenance of the facility. The Franchise Agreement is with Wall Recycling Inc. The length of the Franchise Agreement is for the Life of Site (LOS) until 2055.B. Hiram Marziano, Community Development Director1. Approval- Case 2023-19: Zoning Map Amendment (Rezoning) - Request to rezone a parcel of land from Residential Agricultural (RA) to Light industrial (LI) Conventional (Straight) Rezoning: Applicant - Carrollwood Farms; Tax PIN: 792103-32-0975,574 Ogburn Mill Rd., Stokesdale - Huntsville Township.2. Approval - Case 2024-10: Zoning Text Amendment: Consideration of an amendment to the text of the Rockingham County Unified Development Ordinance (UDO) that will establish a citizens UDO Advisory Committee to review zoning text amendments. The ordinance included with this agenda item is in DRAFT form and may be amended after Commissioners' review.C. Melissa Joyce, Fire MarshalApproval- Resolution expanding the Northern Ruffin area of the Ruffin Fire Service District to provide for future financing and maintenance of fire protection services and abolish the Pelham fire service district in Rockingham County.8. Ronnie Tate, Director of Engineering and Public UtilitiesApproval - WAGA Energy to construct, operate, maintain and manage a Renewable Natural Gas facility at the County Landfill. Staff and Facility and Grounds Committee are recommending Option #2 of WAGA's proposals for the County for gas sales.9. NEW BUSINESS10. COMMISSIONER COMMENTS11. ADJOURN###

疫苗是公共卫生中至关重要的一环。对疫苗接种以及供给的各方面政策制定、统筹安排也是国家以及国际社会所面临的核心问题。疫苗纳入国家免疫规划的标准是什么？国际组织又是如何进行价格的商定以及疫苗的运输？面对人群中对于疫苗的认知差距，我们应该如何进行科普教育？近年来，疫苗研发以及资源分配又取得了哪些发展？正值世界免疫周，我们请到了王伟炳教授与张丽老师，为我们分享关于疫苗的方方面面，欢迎收听！ - 本期话题成员 - 程衍樑（微博@GrenadierGuard2） 王伟炳，复旦大学公共卫生学院流行病学教研室主任，教授 张丽，前全球疫苗免疫联盟（Gavi）战略创新与投资者中心主任，现大自然保护协会亚太区董事总经理 - 时间轴 - 04:45 冬春季被低估的病原体：肺炎链球菌 11:30 国家免疫规划：让中国人免费打上疫苗 16:30 全球疫苗市场里的中国，从受助国到支援国 28:00 自费疫苗动辄上千元的价格，很难由国家规划 32:00 “以量换价”也许会是HPV疫苗的破局之道 36:15 全球疫苗免疫联盟的疫苗采购逻辑：分级定价、长期跟进、资金补贴 43:30 冷链疫苗链路里的中国制造与中资外援 47:30 为什么要在海南进行肺炎链球菌疫苗研究？ 52:00 RSV病毒疫苗面世的曙光就在前方 01:02:00 疫苗认知的普及可能比疫苗供给更重要 - 本期术语 - Gavi （Gavi, The Vaccine Alliance 全球疫苗免疫联盟） Gavi联合了世界卫生组织、联合国儿童基金会、世界银行，以及盖茨基金会。自从2000年创立以来，Gavi帮助来自79个低收入国家的超过十亿名儿童接种了疫苗，并防止了超过1730万例的潜在死亡。 HiB（乙型流感嗜血杆菌）疫苗 乙型流感嗜血杆菌（Haemophilus influenzae b, Hib）是一种能引致严重侵入性感染的细菌，尤其影响幼童，大多数患者为5岁以下的幼童。与其名称相反，乙型流感嗜血杆菌并不会引起流感。 侵入性感染最常见出现脑膜炎的病征，细菌入血也经常同时出现。全程接种需要四针疫苗。 PCV（肺炎球菌结合）疫苗 PCV疫苗主要是针对的是儿童肺炎、脑膜炎、菌血症等疾病。与肺炎球菌多糖疫苗相比，PCV作为一种结合疫苗不仅能诱导B细胞免疫，也能诱导T细胞免疫，这样在2岁以下儿童体内可诱导有效的免疫应答，而2岁以下儿童恰恰是肺炎球菌的主要易感人群。目前PCV的单增价格在 700 块左右，全程接种一共要四针疫苗。 HPV（人乳头瘤病毒）疫苗 HPV疫苗是预防宫颈癌的疫苗。在女性恶性肿瘤中，宫颈癌的发病率仅次于乳腺癌，并且大多数宫颈癌都是由HPV感染所致。我国一些城市已经开始试点工作，针对HPV疫苗进行筹资，以鼓励市民接种HPV。 RV（轮状病毒）疫苗 轮状病毒疫苗是预防轮状病毒（Rotavirus）肠炎的疫苗，主要接种对象为2月龄至3岁儿童。轮状病毒感染性腹泻是婴幼儿急诊和死亡（除呼吸道感染之外）的第二位病因。我国每年大约有1000万婴幼儿患轮状病毒感染性胃肠炎，占婴幼儿总人数的1/4。五价轮状疫苗每支约为300-500元，全程共三次口服接种。 - 制作团队 - 声音设计 hotair 节目统筹 禾放 节目运营 小米粒 节目制作 hualun logo设计 杨文骥 特别感谢 丁晋亮 - 音乐 - Danse Macabre - Busy Strings - Kevin MacLeod - 支持我们的赞助商是对我们最好的支持 - 忽左忽右旅行团即将再次出发！这次我们选择的目的地是格鲁吉亚。 地处亚欧交界处的前苏联成员国，葡萄酒的发源地之一，雪山和密林占据着天际线，高加索山脉和天然峡谷贯穿其间。和平与冲突，宗教与美酒，人文景观与自然风光并重，精神和肉体都能被妥帖安放。 春天是格鲁吉亚的最佳旅行时节，今年端午节假期，不如和我们一同前往！6月6日到6月13日，程衍樑将和陆大鹏一起带队前往格鲁吉亚，品世界级葡萄酒，逛斯大林博物馆，你可以在公众号忽左忽右leftright回复【格鲁吉亚】了解详情 - 本节目由JustPod出品 © 2024 上海斛律网络科技有限公司 - - 互动方式 - 商务合作：ad@justpod.fm 微博：@忽左忽右leftright @播客一下 @JustPod 微信公众号：忽左忽右Leftright / JustPod / 播客一下 小红书：JustPod气氛组 / 忽左忽右 B站：忽左忽右leftright 抖音：忽左忽右

疫苗是公共卫生中至关重要的一环。对疫苗接种以及供给的各方面政策制定、统筹安排也是国家以及国际社会所面临的核心问题。疫苗纳入国家免疫规划的标准是什么？国际组织又是如何进行价格的商定以及疫苗的运输？面对人群中对于疫苗的认知差距，我们应该如何进行科普教育？近年来，疫苗研发以及资源分配又取得了哪些发展？正值世界免疫周，我们请到了王伟炳教授与张丽老师，为我们分享关于疫苗的方方面面，欢迎收听！- 本期话题成员 -程衍樑（微博@GrenadierGuard2）王伟炳，复旦大学公共卫生学院流行病学教研室主任，教授张丽，前全球疫苗免疫联盟（Gavi）战略创新与投资者中心主任，现大自然保护协会亚太区董事总经理- 时间轴 -04:45 冬春季被低估的病原体：肺炎链球菌11:30 国家免疫规划：让中国人免费打上疫苗16:30 全球疫苗市场里的中国，从受助国到支援国28:00 自费疫苗动辄上千元的价格，很难由国家规划32:00 “以量换价”也许会是HPV疫苗的破局之道36:15 全球疫苗免疫联盟的疫苗采购逻辑：分级定价、长期跟进、资金补贴43:30 冷链疫苗链路里的中国制造与中资外援47:30 为什么要在海南进行肺炎链球菌疫苗研究？52:00 RSV病毒疫苗面世的曙光就在前方01:02:00 疫苗认知的普及可能比疫苗供给更重要- 本期术语 -Gavi （Gavi, The Vaccine Alliance 全球疫苗免疫联盟）Gavi联合了世界卫生组织、联合国儿童基金会、世界银行，以及盖茨基金会。自从2000年创立以来，Gavi帮助来自79个低收入国家的超过十亿名儿童接种了疫苗，并防止了超过1730万例的潜在死亡。HiB（乙型流感嗜血杆菌）疫苗乙型流感嗜血杆菌（Haemophilus influenzae b, Hib）是一种能引致严重侵入性感染的细菌，尤其影响幼童，大多数患者为5岁以下的幼童。与其名称相反，乙型流感嗜血杆菌并不会引起流感。 侵入性感染最常见出现脑膜炎的病征，细菌入血也经常同时出现。全程接种需要四针疫苗。PCV（肺炎球菌结合）疫苗PCV疫苗主要是针对的是儿童肺炎、脑膜炎、菌血症等疾病。与肺炎球菌多糖疫苗相比，PCV作为一种结合疫苗不仅能诱导B细胞免疫，也能诱导T细胞免疫，这样在2岁以下儿童体内可诱导有效的免疫应答，而2岁以下儿童恰恰是肺炎球菌的主要易感人群。目前PCV的单增价格在 700 块左右，全程接种一共要四针疫苗。HPV（人乳头瘤病毒）疫苗HPV疫苗是预防宫颈癌的疫苗。在女性恶性肿瘤中，宫颈癌的发病率仅次于乳腺癌，并且大多数宫颈癌都是由HPV感染所致。我国一些城市已经开始试点工作，针对HPV疫苗进行筹资，以鼓励市民接种HPV。RV（轮状病毒）疫苗轮状病毒疫苗是预防轮状病毒（Rotavirus）肠炎的疫苗，主要接种对象为2月龄至3岁儿童。轮状病毒感染性腹泻是婴幼儿急诊和死亡（除呼吸道感染之外）的第二位病因。我国每年大约有1000万婴幼儿患轮状病毒感染性胃肠炎，占婴幼儿总人数的1/4。五价轮状疫苗每支约为300-500元，全程共三次口服接种。- 制作团队 -声音设计 hotair节目统筹 禾放节目运营 小米粒节目制作 hualunlogo设计 杨文骥特别感谢 丁晋亮- 音乐 -Danse Macabre - Busy Strings - Kevin MacLeod- 支持我们的赞助商是对我们最好的支持 - 忽左忽右旅行团即将再次出发！这次我们选择的目的地是格鲁吉亚。地处亚欧交界处的前苏联成员国，葡萄酒的发源地之一，雪山和密林占据着天际线，高加索山脉和天然峡谷贯穿其间。和平与冲突，宗教与美酒，人文景观与自然风光并重，精神和肉体都能被妥帖安放。春天是格鲁吉亚的最佳旅行时节，今年端午节假期，不如和我们一同前往！6月6日到6月13日，程衍樑将和陆大鹏一起带队前往格鲁吉亚，品世界级葡萄酒，逛斯大林博物馆，你可以在公众号忽左忽右leftright回复【格鲁吉亚】了解详情- 本节目由JustPod出品 © 2024 上海斛律网络科技有限公司 -- 互动方式 -商务合作：ad@justpod.fm微博：@忽左忽右leftright @播客一下 @JustPod 微信公众号：忽左忽右Leftright / JustPod / 播客一下小红书：JustPod气氛组 / 忽左忽右B站：忽左忽右leftright抖音：忽左忽右

I am not sure the term “unstoppable” is good enough for our guest Denise Meridith. Denise was born in Brooklyn NY and, in part, attributes her “get things done” attitude to her upbringing in New York. As a child she wanted to be a veterinarian, but such was not to be. Denise explains that colleges back then didn't consider women capable of assuming veterinarian positions. So, Denise got a BS degree in Wildlife Biology.   She then joined the U.S. Bureau of Land Management where, for 29 years, assumed a number of position including serving as the deputy director. We get to hear stories of her time with the bureau and how she moved around, something that was fairly common for government employees for awhile.   After serving with the bureau for more than 20 years Denise was offered “early retirement” due to the long time she served there. After retiring she became the CEO of Denise Meridith Consultants Inc (DMCI), a public and community relations firm. In 2019 she also became the CEO of The World's Best Connectors LLC, a virtual community for C-suite executives that helps other executives enhance their connections with family, employees, clients, government & the media. If running two companies weren't enough Denise also has formed a 501C3 nonprofit organization, Read to Kids US Inc to promote literacy and family bonding.   See what I mean about being unstoppable? Denise is quite engaging and I am sure you will discover that the time listening to our conversation goes by quickly and you may even wish to give this episode a second listen.   About the Guest:   Denise Meridith is a highly accomplished senior executive, entrepreneur and thought leader, with more than 40 years of success in government, technology, sports, and entertainment. When sexism denied her access to her childhood dream of becoming a veterinarian, she earned a BS in Wildlife Biology from Cornell University and became the first professional woman hired by the Federal Bureau of Land Management. During her 29 years with the Bureau, Meridith served in multiple states and, while Deputy Director in Washington, DC, she oversaw 200 offices, 10,000 employees and a $1.1 billion budget.   After early retirement from the Federal government and for the past 20 years, she has been CEO of Denise Meridith Consultants Inc (DMCI), a public and community relations firm. Since 2019, Meridith has also been CEO of The World's Best Connectors LLC, a virtual community for C-suite executives that helps other executives enhance their connections with family, employees, clients, government & the media. Recently she created a 501(c)3 non-profit Read to Kids US Inc to promote literacy and family bonding.   During the past 25 years in Arizona, Denise founded the Phoenix Black Chamber of Commerce, Linking Sports & Communities (a youth sports non-profit for 14 years), and was a Governor-appointed member of the original Arizona Sports & Tourism Board. She helped win approval for State Farm Stadium for the Arizona Cardinals.  In academia, she taught sports marketing for undergraduates at Arizona State University and business operations for executives at eCornell. As a freelance reporter, she has even written 1000 articles about small businesses. Denise Meridith has won many awards for business and community development in Arizona.   ** ** Ways to connect with Denise:   FREE OFFERS:   JOIN DENISE MERIDITH'S MAILING LIST   http://tinyurl.com/3ttt5rsu   Make your first New Year's Resolution Now: Schedule a 15-min call to see if Denise Meridith's Gen X & Baby Boomer Executives Regaining Your Mojo  counseling or masterminds starting in January are right for you https://calendly.com/dmci2021/mastering-the-metaverse   LEARN MORE ABOUT Denise Meridith:   By reading her self-biographies published on Amazon: o   Thoughts While Chillin'  https://www.amazon.com/dp/1791662323 o   The Day a Roof Rat Ate My Dishwasher https://www.amazon.com/dp/1729211127   Social Media:   Facebook:    http://www.facebook.com/denise.meridith.7 LinkedIn:     http://www.linkedin.com/in/denisemeridtih Twitter:  @MeridithDP2023       About the Host: Michael Hingson is a New York Times best-selling author, international lecturer, and Chief Vision Officer for accessiBe. Michael, blind since birth, survived the 9/11 attacks with the help of his guide dog Roselle. This story is the subject of his best-selling book, Thunder Dog.   Michael gives over 100 presentations around the world each year speaking to influential groups such as Exxon Mobile, AT&T, Federal Express, Scripps College, Rutgers University, Children's Hospital, and the American Red Cross just to name a few. He is Ambassador for the National Braille Literacy Campaign for the National Federation of the Blind and also serves as Ambassador for the American Humane Association's 2012 Hero Dog Awards.   https://michaelhingson.com https://www.facebook.com/michael.hingson.author.speaker/ https://twitter.com/mhingson https://www.youtube.com/user/mhingson https://www.linkedin.com/in/michaelhingson/   accessiBe Links https://accessibe.com/ https://www.youtube.com/c/accessiBe https://www.linkedin.com/company/accessibe/mycompany/   https://www.facebook.com/accessibe/       Thanks for listening!   Thanks so much for listening to our podcast! If you enjoyed this episode and think that others could benefit from listening, please share it using the social media buttons on this page. Do you have some feedback or questions about this episode? Leave a comment in the section below!   Subscribe to the podcast   If you would like to get automatic updates of new podcast episodes, you can subscribe to the podcast on Apple Podcasts or Stitcher. You can also subscribe in your favorite podcast app.   Leave us an Apple Podcasts review   Ratings and reviews from our listeners are extremely valuable to us and greatly appreciated. They help our podcast rank higher on Apple Podcasts, which exposes our show to more awesome listeners like you. If you have a minute, please leave an honest review on Apple Podcasts.     Transcription Notes: Michael Hingson ** 00:00 Access Cast and accessiBe Initiative presents Unstoppable Mindset. The podcast where inclusion, diversity and the unexpected meet. Hi, I'm Michael Hingson, Chief Vision Officer for accessiBe and the author of the number one New York Times bestselling book, Thunder dog, the story of a blind man, his guide dog and the triumph of trust. Thanks for joining me on my podcast as we explore our own blinding fears of inclusion unacceptance and our resistance to change. We will discover the idea that no matter the situation, or the people we encounter, our own fears, and prejudices often are our strongest barriers to moving forward. The unstoppable mindset podcast is sponsored by accessiBe, that's a c c e s s i capital B e. Visit www.accessibe.com to learn how you can make your website accessible for persons with disabilities. And to help make the internet fully inclusive by the year 2025. Glad you dropped by we're happy to meet you and to have you here with us.   Michael Hingson ** 01:21 Well, a pleasant hello to you wherever you happen to be. I am your host, Michael Hingson. And you are listening to unstoppable mindset. We're really glad you're with us. And today we get to talk to Denise Meridith, who has a really interesting story, a few factoids, and then we will just go from there. She as a child wanted to be a veterinarian, but had some sexist issues. And they wouldn't let her do it. I want to know about that. I think the world has changed in that regard. Some but nevertheless, when she was wanting to do it, it was different. She is the first female professional hired by the Bureau of Land Management. And that's fascinating. And she's got a lot of other things to talk about. So I don't think we're going to have any problem filling up an hour Denise. So I want to welcome you to unstoppable mindset. And thanks for being here.   Denise Meridith ** 02:13 Well, thank you, Michael. I appreciate being invited. Looking forward to it. Well,   Michael Hingson ** 02:18 why don't we start then, with you talking a little bit about the the early Denise the child and all that, you know, what, where you grew up and some of that kind of stuff. And what made you interested in being a veterinarian and you know, we can take it from there? Sure.   Denise Meridith ** 02:34 Well, I am born in Brooklyn, like so many people in New York City, a lot of people born in Brooklyn, and then they migrate different boroughs.   Michael Hingson ** 02:43 Where are the best bagels in Brooklyn? Well, I   Denise Meridith ** 02:47 didn't stay there long enough to find okay. Yeah.   Michael Hingson ** 02:53 Well, okay, we're the best bagels and Queens.   Denise Meridith ** 02:55 We had so many people grew up in New York City. Every block will have a good bagel. So yeah,   Michael Hingson ** 03:03 I know. That's why I asked the question, trying to be cute. It's just like I lived in Chicago for five years. I was born in Chicago moved out when I was five. And so I don't know when things like Garrett Popcorn started. But I know that whenever I go through Chicago, I do need to go to get popcorn in O'Hare. Or if I'm in the city that I'll go to one of the places downtown. We do. We do tend to do some of the things in the world buy our food. What can I say?   Denise Meridith ** 03:29 Yes. All right. If that's hotdogs, yeah, that would be asking you where to get their best hotdog in Chicago. Sure.   Michael Hingson ** 03:34 When they're in Chicago pizza, which is different than New York pizza, but that's okay, too. Yeah, they're both great. Ah, what a world anyway.   Denise Meridith ** 03:44 Yeah, so I sort of grew up in knots, whatever I did grew up in Queens, and I had what I call a Norman Rockwell childhood. If you seen his paintings and pictures, that's pretty much my childhood, but some Boxster ovaries, three houses, that type of thing. My dad had grown up on a ranch in Texas. So that's why he moved to Queens. You want more land around his house there. And so we had a big lot in our house became the center of attention in the neighborhood. We had the barbecues parties. We had a finished basement with a pool table and ping pong table and all that stuff. So we were at the center of things. My dad was a renaissance man, he believe it I didn't ride horses when he grew up. He thought horses would work. He couldn't understand why people rode horses for fun once he became an adult, so instead, he hears the musician. Big bands, he played in big bands,   Michael Hingson ** 04:41 what did he play   Denise Meridith ** 04:43 any horn and also the drums and also the guitar. Anything he can get his hands on? He was an Army and Army veteran. So I played an Army band as well. He was Avature tennis player, a poet, professional photographer, you name it. You did it. And then my mom was a community organizer. So church, PTA, anything that needed somebody in charge she was it. So when you merge those two together, you get me. So I liked a lot of pay for things. My mom, she belonged to the animal association or now Humane Society. So I had all kinds of pets growing up. So it's logical that I would want to be a vet. Because there's not too many professions in New York. It could be go to Broadway and I did take dancing lessons most of my life. But you could go to Broadway, you could be a doctor, you gotta be a lawyer or bid. That was pretty much it. So I picked the vet, because Cornell was in New York one. Yeah. Got vet schools and world. Yes. When I got up there, I found out that they weren't too keen on women being vets, they were just letting like one woman a year and into vet school. And pretty much to be that woman. I knew it was gonna be me, because there'll be somebody who pretty much grew up on a farm or something, or whose parent wasn't? Preferably who went to Cornell.   Michael Hingson ** 06:08 What was what was their logic? I mean, of course, I'm looking at it from today's standpoint, and today's point of view, but what was there was   Denise Meridith ** 06:19 physical physical, that went on weren't capable being that's the women, the few that I let them know, you had to be a small animal that they work with horses or anything like that. So which I thought was pretty ironic. Could you pick up all the women, cow girls and stuff? Yeah. Why? Why they would think women in fact, why went to Cornell, I had a lot of offers when I went to Cornell, was because I had the best equine contract program in the country. And I do like horses. So anyway, I got to do a lot of horse stuff there without being a vet, my roommate, actually was from a town, she just wanted to live in a dorm. So no breaks, all the kids go, you know, I guess what I do now biking, or vaping, or something. We would go horseback riding during breaks. So during lunch, or any kind of break, after school, we would go horseback riding. So it was pretty ideal setting for me growing up. And going to that point, the ideal part of it, of course, was what a lot of people don't know about the North. isn't that different from the south in a lot of ways and that I integrated junior high school, all white, you're in high school, I integrate it in a whole white high school. Cornell there were, like 75 African Americans in my entering class of 3000. So I had a lot of experience, being in the first study only our breaking glass ceilings. So that was my growing up. And my bed story how I got not to be a bit of what happened with that was, which was fortuitous, or actually more beneficial was that I wound up majoring in wildlife biology. Have any women but they didn't say they didn't want any women. So it was a lot different atmosphere there. So three women, three women graduated with degrees in wildlife biology.   Michael Hingson ** 08:23 What did you do with it? Then when you got that degree? My   Denise Meridith ** 08:27 first job was as a wildlife biologist, believe it or not? The Bureau of Land Management. So that was I got to be the first woman in that agency.   Michael Hingson ** 08:37 Were there a lot of challenges in getting that job? Or were you pretty well accepted? Right from the outset? Or what?   Denise Meridith ** 08:44 There was always going to be challenges. Yeah. Dave, and but essentially, and that was I interviewed earlier today. And it reminded me when you're a senior in college, now, you don't just go online, put in entries, but you would have to write write letters. So people remember that you had to write letters to them and agency companies asking to be considered. And I as a wildlife biologist, there are not a lot of options are state government. Maybe that's not likely because people die in place and the state government openings there.   Michael Hingson ** 09:21 So what was what year was it that you graduated?   Denise Meridith ** 09:25 I was graduated 73.   Michael Hingson ** 09:27 Okay. All right. All right. Yeah. Because I'm thinking of of things like it was much later than that was like 23 years later. Well, it was actually more than that. It was like 26 years. It was like 1999 my fourth guy Doug Linney became ill with glomerular nephritis and the, the emergency vet or actually the specialists that we took her to was a woman in in a veterinarian facility that was mostly women. So, clearly there was a lot of change. But anyway, that   Denise Meridith ** 10:03 Yeah, well, it's I would say it's all women. Now you've made pretty   Michael Hingson ** 10:07 hard, but very much a lot. It is. Yeah. Yeah. Yeah, it's   Denise Meridith ** 10:11 timing is everything. Yeah, that's hardly very few men anymore. I don't sure exactly why. But there are very few men anymore in that field. So I wrote my letters to places that would harm wildlife people. So Fish and Wildlife Service in a Forest Service and the Bureau of Land Management. The Park Service and Forest Service both told me they didn't hire women. That was pretty plain. And what's interesting now and I talked to younger people, sort of horrified. People could say that then it wasn't. It wasn't uncommon. It wasn't thought to be different, or rude or discriminatory or anything. They. And so now, you know, I wish I kept the letters. You didn't keep going wasn't anything different. Before, right, and forest service offered me a job as a secretary, they liked my degree from Cornell. They thought I'd make a pretty good secretary. So the Bureau of Land Management is the only one that said, okay, and probably I said, it's a perfect storm. Why I got that particular job. That job had been vacant for two years. They couldn't find anybody   Michael Hingson ** 11:21 to take it. So they figured what the heck, we'll give her a try.   Denise Meridith ** 11:24 Yeah, all right. Gotta have somebody in here sooner or later. So I took that job and which was in Las Vegas, of all things of all places. And it was turned out great with an office, small office 25 people or so in office, the average age was 27. Because nobody wanted to live in Vegas at that time. We had a if you can imagine. People that age in Vegas, we had a great time. We had a great time to that office. And it's a lot of fun. I was one of six wildlife biologists in the state. Because now people have seen all the movies and the shows and everything. But at that time, while kingdom was it, the only show it mentioned, you know, that wildlife Marlon Perkins. Yep. So he was an inspiration to me and everybody who went into the field and at that time, but there weren't many of us. So I had 10 million acres to play with by myself.   Michael Hingson ** 12:26 With a lot of fun and what was it you were to do with those 10 million acres?   Denise Meridith ** 12:30 Wildlife Biology it pretty much studying patterns and populations, identifying ingredient species, we need to do the preserve them. What the big change for me was I went to school in upstate New York. And my first job was in the desert of Nevada. Yes. Completely different wildlife. So I got to learn a lot about a lot of different wildlife. In fact, the main wildlife there was desert tortoises, and my favorite, yeah, they're nice. And pup fish and the old era. That's about it.   Michael Hingson ** 13:09 That's about it. Well, I had desert tortoises as pets growing up. And then we lived in Mission Viejo and California in 1982 through 1989. And my in laws lived, but 2025 miles away in San Clemente. And one day they were outside and a tortoise came walking up their driveway. And they advertise because they wanted to find it. They figured it was so Taurus that belonged to someone and nobody ever claimed it. And I said I would love it. So we named him et turtle because his face was like ET. And he lived with us for for a number of years. And then the gardener left the gate open and he got out but it was fun. He loved cantaloupe. He loved rose petals.   Denise Meridith ** 14:02 Yeah, yeah, they're interested in pets. I had one one time that also got out. And it's something you don't think about, you know, think about you know, you think of dogs running away. You don't think your Taurus is gonna run away but   Michael Hingson ** 14:17 curious. Yeah. Well, it happens Mukunda What do you do, but by the same token, it was fun when he was around with us. And he figured out that we had a screen door in the backyard that went into the house and wouldn't latch but he figured out he could use his front feet and open the door and come in. That's great. And what he liked to do is go live right in front of the refrigerator because the refrigerator was nice and warm and and that caused great consternation with our cat who couldn't figure out what he was so   Denise Meridith ** 14:55 that's good. Well, they're smarter than we think. They are. Yeah, Well, people are asking me today Well, earlier as if you will have a master's degree in public administration, and I said, Yeah, I have a people degree and an animal degree. Yeah. And believe me, the people agree as a lot harder. Oh, yeah. Animals wildlife would do fine on its own. Okay. The reason why we have wildlife biologists is to actually figure out what to do with about the people, much   Michael Hingson ** 15:28 more than the animals. You're right. Exactly. So you became a wildlife biologist? And how long did she do that?   Denise Meridith ** 15:36 I did that for a couple of years there in Vegas. And then what I figured out was that while being from New York, you know, I'm very decisive, or aggressive or assertive, is that biologists don't make decisions. They make recommendations, I figured that out. It was like, I could do a lot more for wildlife being in more decision making capacity. So I switched from wildlife biology to environmental science, because the environmental scientists are the ones that wrote the environmental assessments, and the rules and regs and all of that type of thing. And so I was able to do a lot more for wildlife, from that position than I did from being a bog biologist.   Michael Hingson ** 16:25 Was that also in Las Vegas? Yeah,   Denise Meridith ** 16:27 so I did that for two years. And then after that I was on the road I moved at that time, which is different now. Because I assumed government can't afford it. They wanted you to move every three or four years, just like the military. So you did. So that was four years time ago. Again, because still a bit. Some people think the good old days or the bad old days, depending on what side you're on. couldn't really get another job as a first woman. And most of the western areas, they're back east where I was hired in and our job was in Silver Spring, Maryland. So I hopped back after that, I hopped back and forth across the country. Guess where the best opportunities?   Michael Hingson ** 17:18 Were you've been in a number of positions where you're kind of the first or first woman to do it. What were what were some of the others? Yeah,   Denise Meridith ** 17:28 every job in the bureau after that pretty much was the first. No, I was the first the somebody but I was deputy for resources and New Mexico, Santa Fe, New Mexico. I was associate state director lesson number two person in California. That was great. I was the head person and eastern region, which covered 31 states, West that bordered on that nice for the Mississippi. And then I was the first in only woman. Personnel call a deputy director in the United States, for the Bureau of Land Management. And Washington, DC during the Clinton Administration. That's pretty much in charge. It's a political visit the directors political position. So the deputy is sort of the one that sort of runs things as us almost a CEO type of Ryan. Oh, and that I had 10,000 employees and billion dollar budget and 200 offices. So that was very exciting.   Michael Hingson ** 18:34 A little bit more expensive to live in DC than in Vegas. And but but I don't know, today, Vegas is getting pretty expensive.   Denise Meridith ** 18:41 Yeah, I guess it's funny because Vegas even then was relatively expensive to other parts of the Southwest. Luckily, I moved to DC, you know, so long ago, and then I kept my house and move away and don't move back. I was in DC a couple of times, luckily kept my house. So it was that the thing with the government. The other reason that government doesn't move you all over the place now is that they will buy your house. And I'm sure they can't afford to do that type of thing anymore. Yeah. If you? Yeah, if you didn't want to sell it, or you couldn't sell it, the government would buy it   Michael Hingson ** 19:16 and move you. Do you still have your house in DC now. Now? Yeah,   Denise Meridith ** 19:20 I kept it I'd be very well off. But oh, yeah, I left it. So I moved to LA. Well, it's interesting selling my house in DC I could afford two houses. In Phoenix. I didn't buy two houses. Probably should have done that too. But I how low the price of the housing was here. Yeah. And now since pass COVID Since everybody knows that figured out. It's a wonderful place to live. I think it had the highest rise in prices in the country. Well, Phoenix. This past year   Michael Hingson ** 19:54 gets pretty hot in the summer. Now I live in Victorville. So we're on the high desert weekend. had over 100 in the summer, but you get a lot more hot for longer periods of time than we do. We'll be in the high 90s Low hundreds or so. But Phoenix tends to get hotter.   Denise Meridith ** 20:12 Yeah. Why about saves that has no humidity whatsoever.   Michael Hingson ** 20:15 Right? Most cases where I am pretty much the same thing. Yeah.   Denise Meridith ** 20:20 So here are the ideal temperature is probably 100 100. And Summertime is fine. Yeah.   Michael Hingson ** 20:27 That's when it gets to 110 115. It's a little bit a little bit different.   Denise Meridith ** 20:32 And we haven't been having much of that. So I guess climate change. We haven't been having as much of that. lately.   Michael Hingson ** 20:38 You did this summer, though, right? This past summer.   Denise Meridith ** 20:41 This summer. Yeah. But it was like one stretch. Yeah.   Michael Hingson ** 20:47 It did make national news. You're right. But still,   Denise Meridith ** 20:49 it was just like, a week or two. And I will trade that for 11 months and perfect. Navi   Michael Hingson ** 20:56 I hear you.   Denise Meridith ** 20:59 So but yeah, Victorville that was in my my area, you know, and I was I had a California here. So high desert was pretty interesting. It's like two different countries. In Northern California and Southern California.   Michael Hingson ** 21:15 Well, in Southern California, the high desert is different than the Inland Empire somewhat and both different than right on the coast. So So what do you do? It's, it's, it's the way it is, but it was 26 this morning when I woke up. Yeah. Oh, not too bad. And it was high was 59. I was pretty impressed with it. It went up by 33 degrees. So that's pretty cool. Oh,   Denise Meridith ** 21:43 neat sense of the word. Yeah. And we were having a fit here. Because it was a high was like 59 or 68. We're ready to jump out windows here. It was. I don't know. And nothing is here. We complain about it being cold. But we don't have jackets. You know what I mean? We don't have Cokes? We don't have anything that would make it not fairly that bad, right.   Michael Hingson ** 22:12 For a while I lived in the Bay Area. And there were times up in Novato where we could get over 100. But typically, it wasn't too bad. So we didn't have an air conditioner in the summer.   Denise Meridith ** 22:22 Oh, wow. Okay. Yeah, I lived in Sacramento. The class difference. Yeah. Yeah, that was hot. But I would tell people, you know, they come visit. And of course, you have to take them to San Francisco. They're coming to visit you. They're really not coming to visit you. So I need to always forewarn them. Okay, San Francisco, it's got to be cool. The same? And still, everybody's surprised and they get the air for Cisco. And freeze.   Michael Hingson ** 22:48 Yeah. Yeah. Well, yeah. Like Mark Twain said, he said this. I spent a what a winter there one week in the summer or something like that. But yeah, well, so how long did you stay with the Bureau of Land Management in   Denise Meridith ** 23:02 29 years, I was with them. Oh, my gosh, yeah. And I left. After I left the DC current administration, when I was had the 200 offices. And even a 200 officers didn't bother me as much as the issue is in DC. I'm a very, like I said, sort of decisive kind of person, I like results. And DC is not designed for that. You know, it's not nobody's fault. It's just not designed to make decisions. So I wanted to go back where you could actually do things, have projects that are finished, etc. So after a couple of years, I moved to Arizona, where I am now. So I've been here for 28 years. And it was great when I moved back here as the state director, and I wound up designating for national monuments. So helping get the Arizona Trail doesn't made it I upgraded all the RV parks, a lot of campgrounds, etc, etc, etc. So I was able to do things. And I love that.   Michael Hingson ** 24:14 And then what did you do? And   Denise Meridith ** 24:16 so when I left Oh, they had an early out, which they don't do that anymore, you but they used to say, Okay, have they like every so many years they would say okay, you can leave if you have based on yours, not your age. So guess what, since I started two weeks out of college, I had a lot of years and no age, so I got to retire super super early in life. And what I did is Denise married a consultant Incorporated, which is a public and community relations firm. It's actually wound up doing a lot of the same things, tourism recreation. Thanks for the outdoors I helped. Also well thanks like I Have the get the stadium built the NFL stadium built here. Several other spring training stadiums designated not just a lot of parks and star help get them designated a lot of things like that. So I did, yeah, pretty similar types of work. Except I'm from the private industry president.   Michael Hingson ** 25:22 So what made you leave BLM and start your own company? Just because of the out the years? Yeah,   Denise Meridith ** 25:30 yeah. Hard to pass that up. Or retire at that age. So yeah, got that. And and you know, it's can make up what I used to preach to people, they didn't believe me, because people go, Oh, government, so boring, and bla bla bla bla bla bla, well, it ceases to be boring when you have a pension and health care. Right. So well,   Michael Hingson ** 25:55 I can make it as fun as you want at all. It's all about mental attitude to   Denise Meridith ** 26:00 Yeah. And I was less than working for the Bureau of Land Management, because what you had, it's all scientists. Right? So this geologists, it's science, people doing science, happiest people in the world, you know, so I really enjoyed. I enjoyed them, they were enjoying their work, I enjoyed them. It was just, to me a wonderful opportunity to work with people for that long, who enjoy their work. And it's not too many people who can say that anymore. But it was unusual that why in government with our agency.   Michael Hingson ** 26:38 So you what, what made you start the company, you just wanted to continue doing the same sorts of things. And that was the easiest way to do it. Or, yeah,   Denise Meridith ** 26:47 I probably should have stayed retired now. Now, I've enjoyed what I've done. But essentially, two weeks after retirement, the story was, well, two weeks after retirement. And I'm thinking boy, gee, I can do anything. How does this you know, it's sort of a shock when you're working all the time. And like, when I was in DC, I was on the road 75% of the time, so And Arizona, I travel a lot. Oh, I could do anything. So a friend of mine called and said, Well, why don't we go to the movies, and it was like the middle of the day. And I thought, oh my god, this is good. Go to the movies. So we went to see a movie very bad. Well, I know I shouldn't but and I came back and water was coming out my front door. I've sunburst blah, blah, blah. I spent the next five weeks in a hotel. And so the only thing I can think is that I was lost my mind. Because it had happy hour every night. When I invited somebody else to join, join me and happy hour, and they go, Oh, nice. What is great opening job opened up and I think I had too much wine. This great opening open up but heading up this nonprofit. You should take a look at that. And so I did. Some I retirement didn't last very long. So I ended up that nonprofit. And I've been doing something ever since.   Michael Hingson ** 28:15 Just what was that nonprofit?   Denise Meridith ** 28:19 It was the Arizona Trail Association. You know, they were one of the longest trails in the United States. And it goes from border to border from the northern border, Arizona, New Mexico. And spectacular trail. Because Arizona is beautiful. So it's a very beautiful trail. But they were having problems getting it designated. Because yes, politics and I understand politics. I help them. Actually it was me and John McCain got together and helped get that trail designated. But I'm sort of a restless person. Sorry, I was only there for a year with them. I had my own Disney spirit consultants started anyway. So then I just did a variety of things. I like projects start finished start finish. Until about, you know pretty much on my own. until five years ago, I decided, well, why don't you get a whole group of people who like to do that. And that's when world's best connectors was started. So the current organization that I manage, and what it just made up of a bunch of folks like myself, they all have their own businesses. But we get together and people throw out ideas and we jump on them or not. We're consulting firm. If n were CEO, the CEO, we're not B to B or C it'd be all those things. We're CEO, the CEO, that what we do is help other executives what problems they come in, they need a tech person, they need a HR person, they need whatever come to us. We either have a person like that, or we can get them a person like that. So that's what we've done in the past five years   Michael Hingson ** 30:03 is disease murders consultants still functioning? So you have two companies? Yeah.   Denise Meridith ** 30:10 Well, I actually three, but we want if it gets too complicated, but no, I have a nonprofit to read to kids, us. I'm trying to get parents to read to the kids again, like they did in the old days. But the days for consultants where that comes in is, and really the reason that I met you really, at do a lot of conferencing and whatever. But I do coaching, professional coaching, or people, and particularly for Baby Boomers and Gen X, what I do is help them rediscover their mojo. That's what I call it. And so I think both of those groups pretty much had it made in the beginning of 2020. Yeah, they had figured it out. They were doing well, economy's doing well, it's all kinds of opportunities going. Everything looks fantastic. I as an example, was that in Miami for Super Bowl week with my group, a group from world's best connectors, and we were networking and going to a lot of special events, thinking of future partnerships, future contracts. And two weeks later, I come back COVID Close everything down. So and that happened to a lot of what happened, everybody but baby, I think Baby Boomers and Gen X is crooked, because it was more of a disappointment. He thought you had it figured out you could actually had everything made. And then when President says COVID stuff and pandemics over those people ran back to work. And guess what? Nobody only wants to came back. Nobody else was in the office. Yeah. Nobody else wanted to be in the office   Michael Hingson ** 31:57 and a bunch of them got COVID.   Denise Meridith ** 31:58 Yeah, so it was just, to me devastating for a lot of people in my age group. So what I do is, work with them. You can't go backwards, it's not going to change. It's not going to go back to what it was. What can we do to find your happiness? Again? A place in a position and a life that can make you happy again? Yeah, a lot of people don't notice that. Really? COVID gave them a second chance. Yes. Okay, you're gonna have another opportunity. Maybe they didn't even like that job. You know that they're complaining about low job anyway. So what can we do? They get you something that you do like or no job at all. That's delicate, and people have a hard time transitioning sometimes to retirement. And so I help people over those humps. That's what I tried to help you. So   Michael Hingson ** 32:55 you do a lot of coaching and helping people and so when I should explain to the folks listening out there that Denise and I met through PATA Palooza that people know what PATA Palooza is, we've talked about it a number of times on on unstoppable mindset. And for those who don't know PATA Palooza is a program that meets four times a year and the people who come are either podcasters interested in being podcasters, or want to be interviewed by podcasters. Pretty much. Those are the people that usually come. And Denise and I met there. And here we are.   Denise Meridith ** 33:29 Yeah, we had a, you know, I think a lot in common as far as the way we look at the world, and achieving things and being happy. So I yeah, I was very impressed with what you do what you've overcome. I do a lot of speeches. Well, now it's coming up on Black History Month. So for that Women's History Month back, but I get request, obviously. Because people want to know how, yeah, obviously, all these all these things could have been obstacles, not being a vet, that not, you know, getting certain jobs, they not getting promotions, all of that. You can look at that as an obstacle that it is, or you can figure out a way to overcome that. But   Michael Hingson ** 34:20 you But you made a choice, somewhere in your psyche, that you weren't going to let those kinds of things stop you and that you were going to continue to   Denise Meridith ** 34:28 move on. Exactly. And that's that's the only way to do it. Thanks for not gonna be equal, you know, and that's one thing that's sort of hard to take those true. Baby bonus. Well, what we see is what we see, what we see is what we get. So I if you think about I was a kid when Civil Rights Act was passed, and everybody thought everything was going to change. And it hasn't been something strange, but women can be better Now, you know, overall, they're still allowed to obstacle. So I worked with people, well, I not work with people, I hope to be a role model for people, and how not to give up. And, and I say, essentially, wonder closes, God opens another one to take it.   Michael Hingson ** 35:20 What's hot? What's ironic is so the same thing in a sense with the Americans with Disabilities Act, everybody thought everything was going to change, and it hasn't. Unemployment rates have dropped a little bit. But they're still incredibly high. Internet websites aren't accessible, for the most part. And we're not included in a lot of the conversations when you talk about diversity that doesn't generally include disabilities. So some of us like, like I and I've talked about it on the podcast here talk about inclusion, you either are inclusive, or you're not, there's no middle ground, you either are gonna be or you're not. But at the same time, the thing that we have, and continue to face is not included in a lot of the conversations. So I don't hear anybody talking about a disability history Awareness Month or anything like that, although there is a month dealing with disabilities, but it is not nearly as well discussed and mentioned and talked about, or included as other minorities, even though we're a larger minority than all of them.   Denise Meridith ** 36:24 Wow. And everybody has the potential to be in that group. And   Michael Hingson ** 36:29 everybody has the potential to be in that group. Every well. Well, of course, actually, in, in a technical sense, everybody is a member of that group, I believe that we've misinterpreted the definition of disability, and that disability is a characteristic that everyone has, it manifests in different ways like you can see, and your disability, at least one of your disabilities, is your light dependent, you know, the power goes out, what are you going to do, you gotta go off and try to find a light source. Thomas Edison fixed it mostly, but not totally. And so it still creeps in. So the bottom line is, everybody has a disability. You know, it's something that we, we we really should think more about, but there's a lot of fear. And people know that they can become a person with a physical disability or whatever. And so the fear keeps us from being really included, like we ought to be.   Denise Meridith ** 37:21 And I've always had empathy along those lines, whatever reason why parents whatever reason was, but I, when I became the director, the deputy director of the Bureau, Ada, just pretty much passed. Right. And so I hired a person to, you know, interpret that legislation for us and help people with that legislation. Or did that set off a firestorm? How couldn't you be wasting a position on that? Nobody cares about that, and nobody needs to know that. Anyway, so but I do what I do. Right. So So I went ahead. And in this case, she was a hearing impaired, but as soon as she got there, things changed people. Oh, I have a question. Oh, I don't understand this, oh, how can I do this better? And   Michael Hingson ** 38:19 of course, today, and of course, today, most people rightfully so would not be caught dead saying hearing impaired because people who are deaf or hard of hearing recognize impaired is, is a negative thing. And we're not even cared, you know, the, and that hasn't really translated into blindness, because so many people continue to say visually impaired, and it shouldn't be blind or low vision. Because why are we Why do you equate how much sight you have with whether you're impaired or not? And that's the issue that we're Why do you equate, whether you how much you hear is to whether you're impaired or not. That's the whole thing we have to change and it's just so hard to do, because it's so ingrained in society.   Denise Meridith ** 39:01 Yeah, that'll be GQ. T I A plus. As an example, you know, the it's just the getting across what we need to get credit. It's getting harder, not easier to talk to people about anything. All right. Unfortunately, it's getting harder. So but she went on to be pretty popular pretty, pretty much in demand. But I I'm doing right now, one of the projects that we're working on, and world's best connectors is business education for college athletes. So again, it sort of comes up. Most people when they think about the NCAA is ruling on name image and likeness, nio that kid's gonna get paid for playing. Like a football, man and men and footballs. That's the whole thing. And if you look at this statistic, that's where the money is. That's where it nio money is going, blah, blah, blah, man and football and so my group, we're looking at students overall. And our program is open to any student in any sport in any school. And I want people that want to go to the Olympics, I want Paralympic people, I want LGBTQ T people, I want any athlete. But again, that's different. People aren't saying that they're not thinking that at all. So we're going to be a little different that way. But I always have been different. But I think if anything, those other groups all need it more. Because right now 2% of NCAA athletes in college, become professional athletes. 2% Okay, 98% What are they gonna do afterwards? And, you know, college is not really prepared for them for that. It's no, but just they have different goals. Okay. And I don't begrudge them that they have different goals, different objectives. But what we're doing is teaching them how to create a business run a business. So they have something when they leave college, they leave our program with a business license. So they have something when they leave college, what they do with it after that, we up to them, but at least it gives them a chance and opportunity to be I say something besides a pitcher in a yearbook? Yeah.   Michael Hingson ** 41:25 Which is something that certainly makes sense to do.   Denise Meridith ** 41:30 So where it's called Project Nylo. And so I encourage people to look into it. It's pretty simple. It's www dot project. Nylo. And I l.com Pretty simple, but the O is for ownership. And what we do is want to put ownership in the NFL, on the side of the good. Oh, that's just something different. Okay, now, I was gonna say, but you know, the things why I like liked you when I met you. And why I like your program, is there's such a need for educating the public about things. And it's getting harder and harder to do that. On paper. You know, to me, that's the anti intellectual approach that's being taken to so many things. It makes it more difficult. So I appreciate what you're doing.   Michael Hingson ** 42:27 You have you have in your life I'm sure had. Well, you talk a lot about mentoring, and you've been mentored a number of people who are some of the people who have been your mentors?   Denise Meridith ** 42:40 Um, yeah, it's interesting. Obviously, I didn't have many women. I didn't have any women mentors in Bureau, I was it so I became the permanent woman, mentor, and the Bureau of Land Management. But I did have a lot of male mentors. And that's one thing I try to get across to people know not to make stereotypes of people judgments about people you never know. My first mentor and Bureau of Land Management was older Anglo guy, and I say older, we thought he was really old, because he was 55. He's like, 2020 to 21, and whatever. So and he was a sagebrush specialist, right? That was his site. So you wouldn't think, and it was Republican conservative, you could go down the line. And we hit it off perfectly, which you wouldn't think so you can't make judgments about people. And he really helped me in the beginning, because like I said, I dealt with wildlife in New York. And we were in Nevada, though, he taught me a lot of desert, survival skills that I needed the half, and really helped me understand the bureau and it's what it did and how it did. It sounds like that. So Jim Bruner was my first mentor there. But then I had others while I'm away at hasty was the director of California for like, 30 years. He was the bureau director in California. He was awesome. Oh, God said and he would say, I like women better they work harder. Here's a big guy, Marine veteran, you know, tough guy and buzz cut until he died, you know? And so to have someone like that, except you Yeah, you know, promote you as like Kevin a year on pet Pitbull. Right. But it was very helpful. So I've had people like that. JOHN MCCAIN, ARIZONA. So I had mainly just because of the nature of the work I was said, mainly male mentors, mainly Anglo male mentors. So I do Estelle people keep an open mind about things you can learn from everyone. And I've had great support.   Michael Hingson ** 45:05 Was your mom, a mentor to you? Yeah,   Denise Meridith ** 45:09 yeah, I talked about that your parents if you're lucky. I'd be the first mentor. So I described my dad and everything that he did. And my mom was community organizer, a very strong, liberated woman, so to speak. And so for both of them, I got a little bit from both of them that helped shape me. And I, and really, they're the ones said, you could do anything? Honestly, you bet. They didn't say that, you know, they were very supportive. The track the track to get to Cornell is no easy track. In New York, it starts my mother figured it out. It pretty much started when I graduated from elementary school. I was valedictorian there. And she knew you had to get into the right Junior High School to get into the right high school to get to Cornell. Okay, she was that far ahead. So I'm thinking, so that's why I integrated the junior high school. And it was all white. I think there was 20 people of color in that whole school. And then I integrated the high school that I went to as well. And yeah, that was no easy thing. But I keep your eye on the prize and what you want out of it, what you got, and then that high school was sort of a feeder type of high school for for now.   Michael Hingson ** 46:40 Here's an off the wall question. Going back to mentors for a second. You mentioned John McCain. How about Cindy McCain?   Denise Meridith ** 46:46 Cindy is wonderful. Yeah, people I don't know, maybe most people outside of Arizona don't realize or the southwest. It was a it was a couple. Yeah. He was very important. And his decision making. And just being an I love them both. There was such a strong couple. And she's carried on she's so she has   Michael Hingson ** 47:17 you know, he was the visible one. Pretty much in the news and all that but she is clearly continue to move. Move forward in is a vibrant force in her own right, which is great.   Denise Meridith ** 47:30 Yeah, and she has I'm gonna approach her about my program, too. But hey, you know, it's Yeah, yeah. And politics in general. You know, I just don't have many I care right now, are Republican and Democrat. I've been independent all my life. So it hasn't mattered, obviously. But, but the just, we need people that have conviction, you know, and make honest decisions, not based on, you know, contributions or anything like that.   Michael Hingson ** 48:05 Yeah, that's really the issue is having true convictions. And we just don't see that much of it. In the world in general, like we should know.   Denise Meridith ** 48:13 And, you know, who knows when we'll get there again. But it's very price people. He people never really knew what he was gonna vote, you know, how he's gonna vote, even though he was a conservative Republican. So you could guess some of it. But he did a lot of environmental work this Yeah, I know, as I was working with him on it, right. So that would shock people. They would not think that would happen. But there were   Michael Hingson ** 48:37 a few decisions he made. I thought were a little bit strange, but you know, but that's okay. You You do what you can, but clearly, he was a man of convictions and, and was was one of the good ones. Yeah,   Denise Meridith ** 48:53 he was also effective. And that's one thing. There you go. You know, well, I don't know if we have to leave effective politicians anymore. But he brought a lot of money to the state. He was very obviously supportive of the military. So veterans, he did a lot to help veterans. He did a lot of, to me. Very important things that involve getting money, you have to get money to do good things. And he did. had, you know, did a good job of doing that. But, you know, so a lot of politicians now you don't see them getting money for anyone but themselves in a lot of cases. Yeah. It's pretty sad.   Michael Hingson ** 49:32 Yeah, we don't have the role models that we used to have them true models that you can look up to in terms of ethics and everything else. Yeah.   Denise Meridith ** 49:42 Sandra Day O'Connor, another person we lost. I said another wonderful person. I met her obviously through my stuff with the Bureau of Land Management. But again, you know, people couldn't predict. Yeah, she voted accordingly, you could not predict or assume, you know that she was going to do this or do that. He evaluated every issue that came up and, and, you know, stuck to her guns with it. She was very important. She also what I liked about her is that she rarely promoted education. Right now, Arizona, I don't know, I didn't look this past year are pretty much been number 49 out of 50. States and education. And she was did a lot to try to rectify that by really pushing education. She thought that people choose, right. Don't know enough about government. Yeah, it's not taught anymore. People don't know how government works. How, what is public service? Now that is, I know, Bureau and other federal agencies have a hard time getting anyone anymore. And believe me, we need civil servants. We need public servants. So who are honest, and they're just to do a good job. We need   Michael Hingson ** 51:09 to get leaders and it isn't just civil servants. They need to, to understand and other civil servants we need to grow leaders to write.   Denise Meridith ** 51:21 And I just really, a lot of people been discouraged. Like, even aside, even the science, they can't do science anymore. Right. So scientists are not happy campers as there used to be. Yeah, it's gotten very politicized. Yeah, exactly. So I don't know. But I, my, what I've decided from here on I have a few years left, maybe just a few. But anyway, is to legacy, my legacy, hopefully, would be developing future leaders. So that's what I'm doing. That's why I'm doing like this education program. We're gonna create a whole new generation of business leaders, which will be nice people that in the past, or qualities have been overlooked athletes, people don't think about them, except how fast I can run or how high they can jump. Yeah. And when you think about it, that discipline there that they had to go through to be to where they are charismatic, a lot of them are charismatic leader type people. And, you know, we're missing all of that, by just, you know, throwing them out if they can't run out in the field anymore. Yeah. I'm hoping to give them some alternatives. In turn, they can take that business degree, go back home, hire people in their area, and their community back home with a business degree and have a family business. You know, it's it's multiple, as the effects multiply dramatically, I hope, what they were doing with this program,   Michael Hingson ** 53:00 you mentioned earlier, read to kids tell me a little bit more about that.   Denise Meridith ** 53:04 Yeah, that's, that's my fun project. But I feel one I've been writing since I was 10 years. Well, probably before, but since I wrote my first book when I was 10 years old, right, dreading it, too. I was pretty good artists. But I'm concerned that people aren't. I think reading is the crux of a lot of things. Decision making, you know, rationality, everything, but my angle on it is in the past, parents rented our kids, it was one moment, you know, bedtime stories. One moment, bedtime alone, if your child quietly do something together. Now, it's pretty much an ima ComiCon fan, so not knocking marvel in particular, but now it's, you know, syndicated on another TV, watch Marvel until this time because parents are very busy. I got a lot of different jobs. It's just, to me, that's something that's been lost. And when I read the kids, us the mascot is my dog, my miniature poodle, airy, and he has five books on Amazon. And the adventures of airy are about what he's doing as he grows up so to speak. So   Michael Hingson ** 54:30 every right Harry writes his own books. Yeah,   Denise Meridith ** 54:33 he does a good job. This book sell more than my Yes. So his first haircut our first target went to the doctor right those types of issues, though he helps kids overcome those fears that they might have. But to be the key is there. I'm what I might our model is to read to a kid three to six years old 15 minutes a day. So you take that 15 minutes read in 15 Min. So we have a lot of authors in our group, you can read those books, 15 minutes. And that's just 15 minutes, which doesn't seem long, but it's, you know, face to face. Total attention, working on something together, and it just doesn't happen much anymore. Know what to say. And when we go to book shows or whatever, and type of thing, and so all the people that go to these giant, you know, now they still have a few, I was glad to find out a few giant book fairs going on. And one in Tucson, I guess. 100,000 people go to that one. It's pretty incredible. But everybody that will come up to our booth say, oh, yeah, my mom used to read to me. It's passed along. Yeah, passed along. And these people that are coming up to you are very educated, erudite people, right. So that's what I hope to do. And luckily, I had a RT O'Hagan and I'll give a shout out to him. He, during pandemic, he bought Aires books, and distributed them to nurses and hospitals. So that they could go home and read to their kids. And so you get nice letters. Oh, it's first time. My kid read out loud. Or it's the first time that ghost I hope that nice books that people would get some lessons from them dedicate my talk about? Oh, you didn't know that your kid was afraid of such and such? Yeah. You didn't know the kid was being bullied at school? Or you didn't know these things? It? Yeah. So it could open up a lot of discussions. So it's the region kids got us is that site. And it's just a little thing I do on the side. But I'm hoping it has some impact on parents, grandparents in particular, I thought grandparents were really sort of left out during COVID. You know, they couldn't even see anybody and got separated from their grandkids. My books are various books, obviously, you can get them on Kindle. You can get them on online. And so it's something that you can do now what technology you can do over what we're doing zoom, right. You can read to hear grant kid on the other side of the country through zoom. So that's what I'm hoping. Right now. I appreciate your asking about it. So the little thing I do on the side but reallocates us that's as my heart. It's something that I really like to see happen.   Michael Hingson ** 57:36 So how does the program work? What do you do?   Denise Meridith ** 57:39 What we do is just write books there online. And what we had breach over it, or we'll have starting again this year, is go to schools, you know, go to school, go to libraries. You know, Eric goes, I take Gary. And he goes, and we have, you know, the books there. And parents. Yeah, by the books we read. We have readings for our office from our, you know, our group COMM And I read some of the kids there, and whatever. So it's just getting kids excited about reading again. And parents like it too.   Michael Hingson ** 58:16 Alright, so I get to that is that is really cool. What books have you written?   Denise Meridith ** 58:20 I just have to have my own. But anyway, so he has five, but I have   Michael Hingson ** 58:26 He's got four paws though. So he's got a porter, right?   58:30 That's true thoughts, while chillin and a C h i l l i n what no G is really covers my career from being born in Brooklyn, I guess, up into my career through the Bureau of Land Management. So it's funny when you write something like that, and you call it an autobiography, because when you're young, you don't think you're gonna live that long. And then it was like, Gee, wow, I guess I had some more living to do I should write something else. So the other book is the sequel to that and it's called the year roof rat ate my dishwasher. Which people go I'd say what Okay. Roof rats are I don't know that their I guess their data. Arizona. I don't know. Anyway, we have roof rats here. A lot of people have different kinds of pests than their areas but we have roof rats, and they eat there. They have big teeth. And not like normal rats. They have big teeth. They climb trees and they eat through pipes. They eat through all kinds of things. So literally, the story opens so that book the first story is about the My dishwasher stopped working. And I had the guy come to repair it and he opened stuff up but he like jumps back and scrapes I go whoa. And he goes look at a pipe. So the rat should eaten through the PCV pipe. And that's why my dishwasher what's not working. And so what I wanted to do with this book is it's very much about Arizona. So it's an Arizona Survival Guide is what I call it. Arizona is a very particular place with very unique problems like roof rats. And so I talk about as a business person, how to survive here in Arizona, what kinds of things to consider and look out for. And I tried to tell people, it's a great place to live. People know that already. But there are some things that are different here that you have to look out for Scorpio, roof rats, rattle steaks, black nose, yeah, 115 degree temperatures now one ban. But I tried to keep it very upbeat. And I also tried to acknowledge people here in Arizona that are doing very positive things like McCain, I mentioned in there, people who, because Arizona doesn't get any recognition really has a very strange reputation outside of Arizona. And I wanted to get across that is very normal place. With it's a purple state that much into that, but it's we have people all kinds and all religions and all people think there are people of color hair for some reason, because it sort of looks that way if you walk through parts of Scottsdale, but it's gonna be majority minority state a couple of years. So there are plenty of people of color here. And it's just a wonderful place to live. So my second book while it's out, it's about me and people. I never hear what they've accomplished. It's also i My love you but who? Arizona.   Michael Hingson ** 1:01:51 So do you see desert tortoises these days?   1:01:56 I hear are Phoenix not anymore? Because it's so built up? Yeah. But the thing is, Phoenix is also spread out, believe it or not, it's the biggest city now geographically in the country. surpassed LA. So now it's the biggest Yeah. And so around the edges, people live around the edges. So they see tortoises, but they also see coyotes and rattlesnakes. So I, you know, I had my years as a wildlife biologist, I don't need that anymore.   Michael Hingson ** 1:02:29 Well, if people want to reach out and contact you, how do they do that? Okay.   1:02:34 Pretty simple. You could get my website that's about me is Denise. Meridith.   Michael Hingson ** 1:02:41 Can you spell that, please? Yeah, I   Denise Meridith ** 1:02:43 was about to do that. Oh, great. Yeah, that's people fill it in correctly. So thats D e n i s e m e r i d i t h.com. Meridith is normally spelt with two E's, so I don't get much junk mail. But it's denisemeridith.com is my website. And you can sort of go from there links you to all things, world's best connectors is the wbcs.com. Again, and my ComiCon routine, but we're the WBCs that's what we pretend to be. But it's t h e w b c s.com. And that's the other site they can go to. And I really welcome people to go in and read to kids.us if you want to see airy, and hear about airy, and get some kids books, but I really want to encourage people to read to their children and read to their grandchildren. It's like a lot of stars, Michael. It's getting to be a lost art. And if   Michael Hingson ** 1:03:43 people go to our our show notes, and so on. You have some gifts that you're giving away. Yes,   Denise Meridith ** 1:03:49 yes, I have. It's called the we're talking about mentors, right. So it's called a mentors almanac. One of the gifts that I'm giving away in which you can, and what it is is 365 tips on how to be a great leader. And so I have a sort of a mantra every day that you can use, that you can use in helping you mentor other people, and also hopefully help yourself at the same time. And then people can call me and when they go to my site, they can get the phone number there too. And set up a call with me about coaching. Again, I have masterminds. I'm starting a mastermind here, probably the end of the month, so call me about that. And I also do personal coaching private coaching. And while I emphasize Gen X and baby boomers I you know, really executive coach for anyone. It's just those groups are pretty in need. Right now of that. I get it kids through my events, like world's best connectors through my events with the educational program. So I'm going to be helping kids. I'm not discriminating against younger people. I'm going to be helping them. But I coach, Baby Boomers and Gen X primarily. Cool.   Michael Hingson ** 1:05:10 Well, again, I want to thank you for being here. This has been a lot of fun. Can you believe it? We've been doing it over an hour now, which   Denise Meridith ** 1:05:18 I appreciate it. It's, well, I went I'm once I met you, I know this is gonna be great. I think we're gonna stay in touch and do a   Michael Hingson ** 1:05:26 lot of good things. Well, I sincerely hope so and definitely want to do that. So I want to thank you again. And thanks for listening wherever you are, we really appreciate it. Whether you're listening or watching on YouTube or some other podcast source would really appreciate it. If you give us a five star rating we value your ratings very highly. And of course, needless to say, Love five star rating. So please do that. Love your opinions, any thoughts that you have about what we did today and we appreciate your opinions. If you know of anyone who ought to be a guest on unstoppable mindset. Denise, you as well. Please let us know we're always looking for additional guests, people who we can have on to tell their stories and talk about what they'd like to talk about. If you wish to reach out to me you can do so by emailing me at Michael m i c h a e l h i, at accessiBe A C C E S S I B e.com. You can also go to our podcast webpage, www dot Michael hingson.com/podcast. And Michael Hingson is m i c h a e l h i n g s o n So www dot Michael hingson.com/podcasts. And again, love those ratings really appreciate it. And we definitely want to hear from you and get your thoughts. So, one last time, Denise, I want to thank you for being here and taking so much time to be with us.   Denise Meridith ** 1:06:57 Thank you, Michael and I wish you continued success.   **Michael Hingson ** 1:07:03 You have been listening to the Unstoppable Mindset podcast. Thanks for dropping by. I

A Justiça estadual decidiu que Fernando Moraes Pereira Pimenta, o "Marujo", deverá ficar preso em uma cela com regras mais rigorosas, individual, com controle de visitas e monitoramento de entrevistas. Com a decisão, ele foi incluído no Regime Disciplinar Diferenciado (RDD), sistema semelhante ao aplicado nas unidades federais. Ele foi detido em operação policial realizada na última sexta-feira (08), após quatro meses de investigação. Ainda na sexta-feira, ele deu entrada na Penitenciária de Segurança Máxima II (PSMA II), em Viana. Marujo era chefe do tráfico de drogas do Bairro da Penha e Bonfim, na Capital, e líder do Primeiro Comando de Vitória (PCV). Em entrevista à CBN Vitória, o secretário de Estado da Justiça, Rafael Pacheco, detalha como funciona uma prisão desse tipo. Ouça a conversa completa!

Welcome to The Nonlinear Library, where we use Text-to-Speech software to convert the best writing from the Rationalist and EA communities into audio. This is: Copenhagen Consensus Center's best investment papers for the sustainable development goals, published by Vasco Grilo on January 10, 2024 on The Effective Altruism Forum. This is a linkpost to Copenhagen Consensus Center's 12 best investment papers for the sustainable development goals (SDGs), which were published in the Journal of Benefit-Cost Analysis in 2023. Some notes: Each paper does a cost-benefit analysis which accounts for health and economic benefits. The benefit-to-cost ratios across the 12 papers range from 18 (nutrition) to 125 (e-Government procurement). All 12 ratios are much higher than the 2.4 estimated for GiveDirectly's cash transfers to poor households in Kenya. 4 are similar to and 8 are higher than GiveWell's cost-effectiveness bar of around 24 (= 10*2.4), equal to 10 times the above. Cash transfers are often preferred due to being highly scalable, but the 12 papers deal with large investments too. As can be seen in the table below, taken from a companion post, all 12 interventions together have: An annual cost of 41 G 2020-$ (41 billion 2020 USD). Annual benefits of 2.14 T 2020-$ (2.14 trillion 2020 USD), of which 1.12 T 2020-$ are economic benefits corresponding to 14.6 % (= 1.12*1.13/(8.17 + 0.528)) of the gross domestic product (GDP) of low and lower-middle income countries in 2022. A benefit-to-cost ratio of 52.2 (= 2.14/0.041), 21.8 (= 52.2/2.4) times that of GiveDirectly's cash transfers to poor households in Kenya. I expect the benefit-to-cost ratios of the papers to be overestimates: The paper on malaria estimates a ratio of 48, whereas I infer GiveWell's is: 35.5 (= 14.8*2.4) for the Against Malaria Foundation (AMF), considering the mean cost-effectiveness across 8 countries of 14.8 times that of cash transfers. 40.8 (= 17.0*2.4) for the Malaria Consortium, considering the mean cost-effectiveness across 13 countries of 17.0 times that of cash transfers. The paper on malaria studies an annual investment of 1.1 G 2020-$, whereas GiveWell's estimates respect marginal donations. Consequently, assuming diminishing marginal returns, and that GiveWell's estimates are more accurate, that of the paper on malaria is a significant overestimate. I guess the same reasoning applies to other areas. I think 3 of the papers focus on areas which have not been funded by GiveWell nor Open Philanthropy[2]: e-Government procurement (benefit-to-cost ratio of 125). Trade (95). Land tenure security (21). As a side note, I wonder why GiveWell's (marginal) cost-effectiveness estimates do not roughly match its bar of 10 times that of cash transfers. Agricultural research and development Paper: Benefit-Cost Analysis of Increased Funding for Agricultural Research and Development in the Global South. Benefit-to-cost ratio: 33. Investment: Basic research and development, including capacity building, and technical and policy support with special focus on Low- and Lower Middle-Income countries. Research outcomes are difficult to predict, but an example could be crop yield increases using precision genetic technologies. Childhood immunization Paper: SDG Halftime Project: Benefit-Cost Analysis using Methods from the Decade of Vaccine Economics (DOVE) Model. Benefit-to-cost ratio: 101. Investment: Raise immunization coverage from 2022 levels to 2030 target for pentavalent vaccine, HPV, Japanese encephalitis, measles, measles-rubella, Men A, PCV, rotavirus, and yellow fever. Maternal and newborn health Paper: Achieving maternal and neonatal mortality development goals effectively: A cost-benefit analysis. Benefit-to-cost ratio: 87. Investment: Sufficient staff and resources at all birth facilities to deliver a package of basic emergency obstetric and newborn care and family planning services, including bag and mask for neonatal resuscitation, removal of retained products of...

This episode covers Assist Control, but also talks about CMV and PCV. I discuss how AC can be set using pressure or volume control settings and how the breaths look in this mode. Finally, I cover indications and hazards of using AC. For more information and practice go to www.myvresp.com You can also find RT Study Hall on Facebook and Youtube.

In this Healthed lecture, public health physician and infectious diseases epidemiologist, Professor Paul van Buynder presents an update on the current prevalence of pneumococcal disease and the burden of disease it represents. He will also discuss the latest pneumococcal vaccine, PCV 15, its risks and benefits and where it will fit into our recommended Australian vaccination program.  See omnystudio.com/listener for privacy information.

Dos hermanos hispanos fueron impactados por un rayo.Desde el 12 de mayo  se hará efectivo el título 8.Un tornado ocasionó daños a un gran número de viviendas en Florida.Con la llegada del verano el estado de Nueva York entregará aires acondicionados gratuitos.Caos y enfrentamiento en el senado mexicano.La reserva federal supervisó mal al Silicon Valley Bank.Aprueban vacuna PCV 20 para menores de 17 años.Consejos para ahorrar gasolina.Cohetes rusos impactan edificios ucranianos.      

Although it is a fairly common practice for goat owners to treat anemic animals with Red Cell after deworming, there had not been any research on whether it was helpful — until now.Today's guest, Joan Burke, PhD, Research Animal Scientist at the USDA, ARS Dale Bumpers Small Farms Research Center, is one of the co-authors on a study that looked at whether using Red Cell could help an anemic goat or sheep recover more quickly after being treated with a dewormer.Dr. Burke talks about the 4 different experiments that were done, using different dewormers, with and without Red Cell. She talks about how much Red Cell was used and the effect on the animals' packed cell volume (PCV) and fecal egg count (FEC) after one week and two weeks.We also get into a similar study that was done using injectable iron, and she even gives you a bonus tip at the end on treating strogyloides (threadworm).See full show notes here >> https://thriftyhomesteader.com/red-cell-for-goats/ To see the most recent episodes, visit  ForTheLoveOfGoats.comWant to support the content you love?Head over to -- https://thrifty-homesteader.ck.page/products/love-goats-tip-jarThanks for listening!No one ever said raising goats was easy, but it doesn't have to cost a fortune or drive you crazy! You just need the right information. Click here to learn more about our Goats 365 membership. Or see my other goat courses in Thrifty Homesteader Academy.

This episode from our clinical series is brought to you by Elanco, makers of the broadest range of parasiticides including Advocate, Milbemax, Seresto and Credelio Plus. "The question about the biochemistry is really interesting, because what your question now is, is 'what is it, and where is it?' And the problem that we have is that the liver enzymes aren't gonna tell us, because it's really hard to separate hepatic from post-hepatic on bloods. ALP is very insensitive in the cat and will go up with both hepatic and post-hepatic. ALT will go up with hepatic and post-hepatic. Bilirubin will be up. So what?!" We recorded this case-based interactive session about how to work up the jaundiced cat with one of the world's leading Small Animal Medicine specialists and teachers, ⁠Prof Jill Maddison⁠ at session our live event in 2022. Prof Jill Jill Maddison, BVSc, DipVetClinStud, PhD, SFHEA, MRCVS, is a professor of general practice, the director of professional development, and the BVetMed and CertAVP course director at Royal Veterinary College. She is also a coordinator for London Vet Show and is a consultant at a local veterinary practice and at Beaumont Sainsbury Animal Hospital in London. Dr Maddison is the senior editor of the second edition of Small Animal Clinical Pharmacology and the senior editor of Clinical Reasoning in Small Animal Practice. She has lectured worldwide on clinical problem-solving, small animal internal medicine, and clinical pharmacology.  In this session she helps us reason through a case of jaundice in a cat to create a deeper understanding, rather than a simple list of facts. She also shifts some long-standing beliefs around diagnostic testing in liver disease in both dogs and cats. Topic list: 5:07 Where to begin your workup. 6:05 Defining the problem and localising the problem: Pre-hepatic, hepatic or post-hepatic? 9:17 How much does dehydration actually affect PCV? 10:43 Bilirubin - how useful is it? "It's the most over-interpreted test I reckon. I have so many vets tell me, “Oh, the bilirubin is 16, it has to have a problem with its liver…” No, it probably just has inflammatory disease." 13:14 Dd's for hepatic disease in cats. 14:20 Dd's for post-hepatic causes of jaundice. 16:04 Biochem in jaundice: ALP, ALT, GGT. "The problem that we have is that the liver enzymes aren't going to tell us." 19:51 Why bile acids are useless in the diagnosis of liver disease. "The bile acids don't tell you anything more than you already know. There is no relationship between the level of bile acids and the prognosis or reversibility of the lesion." 24:25 Can't I just trial-treat? 26:16 Ultrasound. 28:27 Signalment: how useful is it? 29:36 Cholesterol and liver disease. 30:52 Pancreatic lipase and pancreatitis in cats. "What we found was that we had 24% false negatives. So we had a quarter of our cats who had what seemed to be pancreatitis that did not have an increased Pli." 36:54 Hepatic lipidosis. For more world-class specialists in an easy-to-consume format join our community of Vet Vault Nerds at vvn.supercast.com. Visit thevetvault.com for the show notes for this episode. Join us in at Vets on Tour in Wanaka, New Zealand on 13 - 18 August 2023 for great CE, more live podcasting and snow... lots of snow! --- Send in a voice message: https://podcasters.spotify.com/pod/show/vet-vault/message

Crappy caller phone connections aside, this week the boys talk about the art behind engine piston technology and design. Long Island & Brooklyn's rich history in automotive, motorcycle and music lead to some interesting triviadiscussion, then the voltage spikes when ray laments about Interstate battery failures.The C4 Corvette IAC valve and a PCV failure leads to talk about aftermarket parts quality.

Vaccination against disease has saved countless lives, yet it remains a controversial topic because of concerns some hold about safety and potential harms. Should we be legally required to vaccinate ourselves and our children? How important is individual choice when balanced against saving lives? To what extent should vaccination of children be a matter for parents or the state?This lecture considers the challenges we face in fighting disease while remaining a democratic, liberal society.A lecture by Imogen Goold recorded on 16 January 2023 at Barnard's Inn Hall, London.The transcript and downloadable versions of the lecture are available from the Gresham College website: https://www.gresham.ac.uk/watch-now/mandatory-vaccinationGresham College has offered free public lectures for over 400 years, thanks to the generosity of our supporters. There are currently over 2,500 lectures free to access. We believe that everyone should have the opportunity to learn from some of the greatest minds. To support Gresham's mission, please consider making a donation: https://gresham.ac.uk/support/Website:  https://gresham.ac.ukTwitter:  https://twitter.com/greshamcollegeFacebook: https://facebook.com/greshamcollegeInstagram: https://instagram.com/greshamcollegeSupport the show

This week Gym recommends you see 8-Bit Christmas with Neil Patrick Harris, that leads into a short discussion about the old consoles, we talk about the breakdown of gender specific roles, Gym performs what should be a simple PCV surgery on his Caddy, Foo goes snowboarding with the fam and Gym is sad, plus more!

In this podcast short Glenn and I talk about a car that has an oil smoke issue. The first thing we did was to check the piston rings.1:42 What's wrong with your engine?3:52 What happens to the oil when it's vented into the intake.5:48 PCV valves and oil separators that fail five times a day.7:15 How to fix an old Bentley with a Bentley.8:53 --- Send in a voice message: https://anchor.fm/thejamescast/message

In this episode we welcome Dr Marina Sibila from the animal research institute CReSA-IRTA in Catalunya, Spain. Her research line focuses mainly on the epidemiology, diagnosis, animal model development and prevention/treatment strategies of porcine respiratory pathogens, mainly porcine circoviruses (PCV-2 and PCV-3) and porcine mycoplasmas. With Dr Sibila we shall discuss the diagnostics of Porcine Circovirus – type 2.

10/16/22The Healthy Matters PodcastEpisode - 23 - Community Immunity - Let's Talk Vaccines!Shingrix, PCV-15, PCV-23, Flu Shots, Bivalent....From Shingles, to Pneumonia, to Influenza, and even a little thing called COVID-19 - there's a lot to know when it comes to vaccines.  Most of us have been living with them our entire lives, and there are likely more ahead!  Join us for Episode 23 of the podcast where we chat with Dr. Kate Hust, Medical Director of the Internal Medicine Clinic at Hennepin Healthcare, to get an overview of the wide world of vaccines and their importance for you and your community.Got a question for the doc?  Or an idea for a show?  Contact us!Email - healthymatters@hcmed.orgCall - 612-873-TALK (8255)Twitter - @drdavidhildenFind out more at www.healthymatters.org

Dr. Carole Keim MD takes listeners through vaccines in today's episode. She explains everything from how vaccines are created to common myths and misconceptions about them. She then details each baby and childhood vaccine, and what disease each prevents.Dr. Keim breaks down how vaccines work and what criteria they must meet in disease to be effective. She explains the four main types of vaccines and lays each vaccination out in a clear manner, covering what age your baby or child will be when they receive the vaccine and how the immune response works. These vaccines are proven to protect your baby against everything from tetanus to mumps to pertussis and more.This episode will cover: How vaccines workCriteria to create a vaccineThe 4 different types of vaccinesCommon myths or misconceptions about vaccinesSpecific vaccines (all routine childhood vaccines)Total number of vaccinesCommon side effects and red flags, how to treat How vaccines work: 00:44The purpose of vaccines is to trigger an immune response faster and with less harm than the original disease.The immune system is a lot like a microscopic team of superheroes, made up of white blood cells, antibodies, the complement system, and a few others.  These superheroes fight villains such as bacteria, viruses, and other pathogens.  If they cannot fight them fast enough, the villains will multiply and cause symptoms of disease.  Vaccines give your superhero team information about what the villains look like, so they can recognize them as soon as they enter the body, and fight them off quicker and easier.Vaccine criteria: 01:26In order to make a vaccine, certain conditions must be metIt has to be effective.  We must be able to become immune to the pathogen; diseases like RSV and HFM are ones we can catch multiple times.  Chickenpox is one that you become immune to after catching it once.The pathogen must not be able to mutate faster than the vaccine can be given - we do flu boosters annually because the flu virus mutates about that often.  HIV and common cold mutate too fast for a vaccine to be developed.The vaccine must be cost-effective; it has to be cheaper to prevent the disease than to treat itThere are 4 main types of vaccines: 02:31Inactivated (killed pathogens)Live attenuated (weakened pathogens)Toxoid (a piece of what's inside the pathogen)mRNA vaccines Inactivated vaccines 03:44Most common typeThe bacteria or viruses in the vaccine are killed, so your immune system can safely learn to recognize the pathogen that it is trying to fight off.  These vaccines do not have the potential to cause actual disease.  What they do is cause the immune system superheroes to practice fighting the villains, kind of like practicing on dummies, which may cause mild signs of illness - fever, sore muscles, crankiness, or other symptoms.  Examples: IPV (polio), HPV (human papillomavirus), HiB (Haemophilus influenzae B), pneumococcus (Streptococcus pneumoniae), meningococcus (Neisseria meningitidis), and Hepatitis A and B vaccines.Live attenuated vaccines 04:02Made from bacteria or viruses that have been exposed to chemicals that make them weaker than the natural or “wild type” bacteria or virus.  Since these pathogens are not killed completely, your superheroes aren't just practicing on dummies, they are actually fighting the weakened villains.  So it is possible to have symptoms of the disease, but milder.  Some people with weakened immune systems may not be able to fight them off, and can get the actual disease.  People taking steroid medications or immune suppressants, or who have HIV or other immune deficiencies should consult a doctor about whether it is safe to receive these vaccines.  Examples: oral polio vaccine, MMR (measles, mumps, and rubella), Varicella zoster (chickenpox), and rotavirus vaccines.Toxoid vaccines 04:55Made from just part of the pathogen, and protect against the kinds of bacteria that cause symptoms after the toxins inside them are released.  These toxin-carrying bacteria are like villains carrying around a bottle of poison, and the toxoid vaccine gives the superheroes the poison to sample and build up resistance to it.  Example: DTaP (diphtheria, tetanus, and acellular pertussis).MRNA vaccines 05:23Newest typemRNA is like a copy of instructions. These give your immune system something like a sewing pattern to print out and make the dummies for your body to fightExample: some COVID vaccinesMyths and misconceptions about vaccines: 05:45Many parents have concerns about vaccinating their children.  It only takes one serious reaction to call into question the safety of vaccines.  And it has been so long since the vaccine-preventable diseases have run rampant that we in the United States don't fully understand the scope of what is being prevented.  Here are some of the top concerns that I have heard from parents, and the truth behind them.Aluminum.  There is aluminum in vaccines, but the amount is far less than babies get from other sources.  The total amount of aluminum that babies get from vaccines in the first 6 months is 4.4mg.  Breastfed babies consume 7mg, formula-fed babies consume 38mg, and babies on soy formula consume 114mg of aluminum in the first 6 months of life.  Consuming aluminum vs. having it injected in a vaccine looks the same to the body, so the tiny amount of aluminum in vaccines will not harm your babyAntigens.  An antigen is any microscopic substance that has the possibility to elicit an immune response.  Babies are exposed to over a trillion antigens in the first year that naturally occur in the environment.  The entire vaccine series that children receive today contains just over 150 antigens.  A young baby's immune system can easily recognize these few antigens and make antibodies to the diseases without getting sick.Autism.  It has been proven that vaccines do NOT cause autism.  The age that children first start showing signs and can be tested for autism is 15-24 months.  This is the same age that children receive booster vaccines, so it is understandable that some parents think they are related. Long-term protection.  Vaccines will protect a person for just as long as if they got the original disease.  So a person who had chickenpox as a child is just as protected from getting it again as a person who has received the chickenpox vaccine.  Some people do not seroconvert (develop antibodies to that disease) - that depends on their immune system and is not a failure of the vaccine itself.Mercury.  There used to be a preservative called thimerosal in vaccines.  That preservative (which contains mercury) has been removed from all vaccines in the US that children receive.  The only vaccine that still contains thimerosal is the adult flu vaccine.Unnatural exposure.  Some people worry that getting exposed to a disease through an injection is not the same as getting it “naturally” by being exposed to a sick person.  This is not true; any disease will get into your bloodstream, which is where it is recognized by the body, and once in there the body has no idea how it got in.  So getting an injection looks exactly the same to your immune system as getting the disease from a sick person.Doctors DO NOT get paid to vaccinate childrenVaccines are NOT a punishment for children who are behaving badlySpecific vaccines: 10:47Hep B - 0, 2, 6 mos.  Hepatitis B is a viral infection that can be passed from mom to baby through the placenta or during delivery.  90% of babies born with HepB will develop chronic infection and are at risk of liver cancer later in life.DTaP - 2, 4, 6, 15 mos, 4 years.  Tdap - age 11, every 10 years.  DTaP has more diphtheria, Tdap has more tetanus. Bacterial infections.  Diphtheria causes severe sore throat and enlarged tonsils, and can block the airway from swelling/tonsils being so enlarged.  Tetanus makes spores that live in soil; any penetrating wound could have tetanus in it (nail/thumbtack, dog or cat bite) and tetanus is not killed by antibiotics so it must be prevented.  Pertussis is whooping cough and causes babies less than a year old to stop breathing.  Everyone who takes care of the baby should be current on their TDaP (within 10 years).  Polio - 2, 4, 6 mos, 4 years.  Polio is a virus that attacks nerves and causes paralysis.  Sometimes it's minor, and sometimes it's the diaphragm that's affected and they stop  breathing.  There is no specific treatment for polio.HiB - 2, 4, 6, 12-18 mos.  HiB (haemophilus influenzae B) bacterial infection that affects children less than 5 years, and especially those under 1 year of age.  It used to cause severe infections like epiglottitis, sepsis, pneumonia, and meningitis.  PCV - 2, 4, 6, 12-18 mos.  PCV = pneumococcal conjugate vaccine, pneumococcus is another name for streptococcus pneumonia, which is a kind of strep that gets into the bloodstream and causes sepsis, pneumonia, and meningitis.  PCV has 13 strains of strep in it right now.Rotavirus - 2, 4, 6 mos. Viral infection that causes severe diarrhea and dehydration in babies. Hep A - 12 and 18 mos. Hep A is a type of food poisoning, there's no specific treatment.  MMR - 1 and 4 years.  Measles causes high fever, rash, and can cause brain damage, hearing loss, and death.  Mumps causes parotitis (infection of salivary glands), but in boys also causes orchitis (inflammation of testicles) and can lead to sterility.  Rubella is a fever and rash; more dangerous to unborn babies, causes miscarriages and birth defects.VZV - 1 and 4 years.  Varicella Zoster virus (chickenpox) causes cold symptoms, fever, and an itchy and painful rash in children, and shingles in adults.  VZV in pregnancy causes miscarriages and birth defects.MCV - 11 and 16 years.  Meningitis A, C, W, Y are viruses that cause inflammation around the brain that develops quickly and can be fatal.  HPV - 11 years.  Human papilloma virus causes warts and dysplasia and can lead to cancer of the mouth, throat, anus, cervix, and penis.  Currently 9 strains of HPV in the vaccine.  Flu: recommended annually COVID: recommendations are still evolvingVaccines that are available but not given routinely: MenB, PPSV23, Dengue, Typhoid, japanese encephalitis, yellow fever, rabiesTotal numbers of vaccines: 22:351 at birth (Hep B)2 mos: DTaP, polio, HiB, Hep B, PCV, rotavirus - 1 or 2 combo vaccines, PCV and rota = 2 or 3 shots plus an oral vaccine4 mos: DTaP, polio, HiB, PCV, rotavirus - 1 combo plus PCV and rota = 2 shots and one oral6 mos: DTaP, polio, HiB, Hep B, PCV, rotavirus - 1 or 2 combo vaccines, PCV and rota = 2 or 3 shots plus an oral vaccine6+ mos: flu vaccine annually12-18 mos: 2 doses Hep A, 1 of DTaP, HiB, PCV, MMR, VZV.  5-7 shots depending on combos.4-6 years: DTaP, polio, MMR, VZV, typically given as 2 combo vaccines11 years: Tdap, MCV, 2 doses HPV16 years: MCV21+ years: Tdap every 10 years; booster if you have a wound and it's been less than 5 years, booster while pregnant9 shots and 3 oral before 1 year of age, 5-7 shots from age 1-2, 2 shots age 4-6, 4 at age 11, 1 at age 16 = 21-23 total shots before adulthood.  18 flu shots.  Common vaccine reactions: 23:53Birth: nothing; sometimes redness/swelling2-6 mos: redness and swelling (local reaction), can be as much as the entire thigh and still be considered normal.  Low grade fevers.12-18 mos and 4-6 years: muscle soreness, MMR and VZV cause fevers, VZV sometimes causes rash, other vaccines can cause local reactions11yrs: muscle soreness, local reaction with Tdap and MCV, fainting with HPV16 yrs: local reaction from MCVTdap boosters: muscle sorenessFlu, COVID: flu-like symptomsIt is NOT normal to have a body rash or vomiting after vaccines; those are signs of allergyLarge local reactions and muscle soreness can be treated with cool compresses (wet washcloth) and/or acetaminophen or ibuprofen.  Fever or flu-like symptoms: acetaminophen or ibuprofenI DON'T recommend pre-medicating your child before vaccinesIf your child has an adverse reaction to a vaccine, you should report it to VAERS (vaccine adverse event reporting system).  Remember that VAERS is like Yelp for vaccines, so take that about as seriously as you would a Yelp review.All of this information is also in The Baby Manual book, which is available for purchase. Remember it is always okay to call your doctor or emergency services if you have concerns about your baby's health.  Resources discussed in this episode:The Baby Manual - Available on AmazonVAERS--Dr. Carole Keim MD: linktree | tiktok | instagram

Checkout​.com launches 24/7 stablecoin settlement in partnership with Fireblocks - https://cointelegraph.com/news/checkout-com-launches-24-7-stablecoin-settlement-in-partnership-with-fireblocks?utm_source=Telegram&utm_medium=social Boba's hybrid compute launches on Fantom and why it is important - https://fantom.foundation/blog/boba-network-to-integrate-with-fantom/ Solace investment insurance is live on Fantom - https://twitter.com/SolaceFi/status/1532802908999254017 Robin D. Ji | LiquiFi (Carta for crypto) @robindavidji outlines current launch tokenomics vs past and what projects should do - https://twitter.com/robindavidji/status/1534553671203139584?s=20&t=bqbP-ogxXg4rsyYV_1cDpA Haym Salomon - @SalomonCrypto on PCV and the projects that have it right - https://twitter.com/SalomonCrypto/status/1532751499486498816 --- Support this podcast: https://anchor.fm/missiondefi/support

See all the Healthcasts at https://www.biobalancehealth.com/healthcast-blog/ 50% of men who receive Testosterone replacement therapy (TRT) have elevated Red Blood cell counts, and high Hemoglobin and Hematocrits. The numbers that are considered normal are usually normal for men at sea level, and an elevated H/H doesn't necessarily mean that a man will have any negative effects If you have lung problems, or disease: For those men who have COPD, Chronic Bronchitis, or asthma, high counts are an adaptation that help you live with a compromised ability to oxygenate your blood. You should not get your blood dumped because the high counts are keeping you alive!  If you live at high altitude or if you spend a large amount of time at high altitudes, then you don't necessarily need your blood phlebotomized because you need higher counts to live or vacation there. Men who live at high altitude have adapted to a lower oxygen level making more RBCs. If you are an extreme athlete, or you train excessively you may have high red blood counts to help you collect and distribute oxygen during your exercise. You won't have to remove blood unless this level remains a year after you stop excessive exercise. Why are doctors telling us to get phlebotomies (blood dumped) all the time? The problem with having a diagnosis of Erythrocytosis from TRT is that it is almost always confused with the disease called Polycythemia Vera (PCV).  PCV does carry with it a high risk of blood clots, strokes and heart attacks.  The two conditions are completely different, but ER doctors and surgeons only know that a high H/H is a sign of PCV, and PVC causes blood clotting…but they don't know that elevated H/H from TRT or adaptation to a disease doesn't cause the same medical problems as Polycythemia vera.. One of the ways we can separate the disease of PVC from the condition of Erythrocytosis: The CBC will show us the difference.  PVC his elevated RBCs, H/H, Platelets and WBCs…all of them are elevated.  Erythrocytosis only has an elevated RBC, and H/H. If your doctor gets excited about your elevated blood count, please tell him we have evaluated you for PVC and you don't have that, so you are not in danger for clotting or CVDx. Here are the differences between PCV and Erythrocytosis from TFT:   Polycythemia Vera Erythrocytosis Blood test: high RBC, High H/H and High platelets, High WBC Blood test: only high H/H and RBC Abnormal Platelets, increase clotting Normal Platelets, no increase clotting Genetics: + Jak 2 mutation Genetics: no mutation Cause is genetic requires blood dumping to lower all counts or hydroxyurea meds Causes: High Altitude, TRT, COPD, Familial cause Treatment: requires blood dumping to lower all counts or hydroxyurea meds Treatment not necessary to keep it below HCT of 50.  Some people do better with higher counts especially COPD, High Altitude Living, exercise at high altitude. A lot of Research that supports the theory that these patients are at risk for blood clots and coronary artery disease. No research paper that says high H/H from T causes CVDX, Stroke, or Blood clots. Abnormal platelet number and function cause the vascular diseases and clotting TFT is associated with normal platelet counts and functions. Jak 2 increases clotting factors and platelet production, and erythropoietin from the kidneys  and increases clotting. Way it works:  T directly stimulated the bone marrow to make more RBCs. No other blood products are elevated Remember: It is not T that causes high H/H to require blood dumping, it is the confused medical community that goes crazy when they see high H/H and cry malpractice!  In many cases we are dumping blood to appease the primary care doctors.  We ideally would like to keep a man's H/H below 20/55.   Other reasons for elevated H/H: Do you have COPD, Asthma or chronic bronchitis? Don't get your blood dumped. The high counts are helping you. Do you have, or have you had elevated platelet count with your elevated red blood cell count? If you have, please tell your primary or your BioBalance Health Nurse Practitioner you will be evaluated for PCV with a genetic test. Do you live for part of the year at high elevation? If yes, then it is not necessary to phlebotomize you to get your counts down because you need those RBCs. Do you eat high iron foods (liver, braunsweiger, pate, bone marrow, Deep green leafy veggies) ? If so of if you are taking iron, you can stop because you shouldn't need it while taking T, because the bone marrow is stimulated to make more red cells with T. Do men in your family die of CVDX before age 50? Then you might have PCV! Get an iron panel + a Jak 2 genetic test. Blood Phlebotomies: Men over 70, should only have 250 cc removed at one time and told not to exercise for a few days. Blood pressure and blood volume take longer to equilibrate after the age of 70. Make sure these patients have a lot of water and that they drink it and eat something after the phlebotomy.  Remember you just removed blood sugar, dropped their blood pressure, and dehydrated them by removing blood. They may be dizzy, but they have to sit until they are stable.   Blood tests for erythrocytosis/ PCV: CBC Iron panel Ferritin Jak-2 mutation Hereditary hemochromatosis

Did you know you can potty train your six months old infant? Dr. Carole Keim MD talks about potty training, babyproofing, routines, and stranger anxiety. Your six-month-old should be recognizing familiar faces and reacting to their own name. Now is also a good time to use your support network to help with tasks, get a babysitter and go on a date. It is ok to leave your infant for a few hours and ask for help when overwhelmed. Dr. Carole Keim MD goes into great detail about the power of routines. Routines for feeding, winding down, sleeping, and leaving the house. Your infant will start to recognize these patterns and know what you are doing. Check out this episode for more information about your six-month-old infant. Parents: (00:43)For many this is a “golden” age - you've got a good handle on things, sleeping fairly well, have routines down, parents show confidence with infant (it's ok if you're not! But also keep postpartum depression in mind.)Establish routines Interact with baby, respond to cues Talk/sing, read, play peek a booUse support networks, balance parent roles/responsibilities Date night with trusted babysitter Development: (02:25)Socially interactiveHappy feet Recognizes familiar faces BabblesTakes turns babbling / making sounds like squeals, blowing raspberries, rrrStarts to know own nameVisual and oral exploration to learn about environmentRolls over both ways Tripod sit / sit with support (baby seat, high chair)Stands and bounces (johnny jump up / activity center)“Swims” on land (pre-crawling)Turns while sitting to look at thingsRaking graspCan bring hands together, transfer hand to hand, and put objects in mouthNo object permanence yetToys: soft toys, crinkly toys, rubber/silicone toys, rattles no hard eyes/noses, no small parts (choking hazard)Sleep: (09:14)Safe sleep: alone, on their back, in a crib. Crib should be in parents' room until 1 year of ageLower crib mattress (pull to stand)No blankets until 1 year, no pillows til age 2 - very high risk at this age - rollingMaintain a bedtime routine;  feed, brush teeth/gums with water, read, sing, set down awake but drowsy Things that can help, but only if they need it: blackout blinds, white noise machine, musicNutrition: (11:48)Primarily breastmilk or formula; starting solidsHow to start solids: Baby-led weaning vs. purees (traditional)rice/oat cereal optional (pros/cons)progression green veggies - orange veggies - fruits; ok to give anything other than honey and cow's milk (dairy products are ok)one new food every 3-4 days signs of food allergy: rash, vomitinggive water (ounce per ounce with foods)Start consolidating meal timesConsider 3-5 “meals” of breastmilk/formula with 1-3 “snacks” of baby foodExpect them to eat about 1-2oz of food at a sitting when starting out; soon will go up to 4oz, watch cuesGagging is normal, choking is notTeeth: (19:30)Teeth can appear anytime; brush 2x per day with water and soft toothbrushTeething toys, frozen washcloths, frozen fruit/breastmilk/formula in mesh bagsMedicines: tylenol (ask your doctor for the dose), topical teething gel like orajelFluoride: check if it's in tap water, if not, can consider using fluoride toothpaste (grain of rice sized amount)Avoid laying them down with a bottle, never prop a bottlePeeing/pooping: (24:49)Peeing about 4-6x per 24hPoop is now more solid because they are eating foods; can consider starting potty training nowSkin: (26:40)Bathing 2-4x per week; wipe skin folds a few times per dayCan use lotion or cream or ointment after baths - watch those folds for rashes thoughSunscreen, insect repellant: any baby sunscreen is ok, citronella works for insects and is safe Diaper rash and drool/food/skin fold rash - might be infected if it lasts more than 2-3 days despite normal diaper cream (zinc-oxide-based like Desitin or petroleum-based like Vaseline or Aquaphor)Candida (yeast/fungal) - solid pink area with tiny pinpoint-sized pink dots around it (satellite lesions). Can try mixing apple cider vinegar and water 1:1, OTC antifungal cream, or call a doctor for a prescription for Nystatin.Cradle cap - olive oil / vaseline / aquaphor at night, soft baby brush in the morningThe 6 month checkup: (30:23)Baby should have gained about 2-3lbs since last checkup, should be more than twice birth weightThird round of vaccines: DTaP, Polio, Hib, Hep B, PCV, rota (2-3 shots, one oral)Anticipatory guidance: Safety: use rear-facing car seat until age 2, avoid secondhand smoke, set water temp to 120'F to avoid scald burns, no infant walkers, remember safe sleep, start baby proofing, bathroom and kitchen are most dangerous rooms (burns, sharp objects, poisons, drowning), choking hazards, avoid plastic bags / balloons, limit finger foods to those soft enough to crush easily with fingersDevelopment:  Stranger anxiety can inspire crawling/rolling with toys placed just out of reach. Anticipate sitting on their own and crawlingNext WCC in 3 mos; no vaccines (might get flu shot)Reminder: flu shot is given in 2 doses, 1 mo apart, for baby's first flu season, then 1 annuallyPast few visits were q2mo, now q3mo (9, 12, 15, 18 mos)Resources discussed in this episode:The Baby Manual - Available on AmazonEdinburgh Postnatal Depression Scale - Downloadable--Dr. Carole Keim MD: linktree | tiktok | instagram

Episode 90: Vaccines and Acne. Updates on pneumococcal and COVID-19 vaccines. Sarah explains the treatment of acne.New Pneumococcal Vaccine Recommendations. Written by Harkiran Bhattal, MS4, Ross University School of Medicine; Timiiye Yomi, MD; and Hector Arreaza, MD.During the recording, we used brand names because they are easier to use. We are not sponsored by the manufacturers of these vaccines. Terminology of pneumococcal vaccines: PCV13: Prevnar13®PPSV23: Pneumovax23®PCV15: Vaxneuvance® PCV20: Prevnar20®Tips about pneumococcal vaccines:-Prevnar13 is no longer used in adults. -Pneumovax23 is still being used in adults.-The two newer members of the pneumococcal vaccines are: Prevnar20® (PCV20) and Vaxneuvance® (PCV15). The following groups of patients are all adults 19-64 with underlying conditions OR >65 years old. Group A: Unknown or no prior doses of Prevnar13 or Pneumovax 23Option 1: Prevnar20 given as a single doseOption 2: Vaxneuvance followed by a dose of Pneumovax23 at least a year later (Consider >8 weeks in patients >19 at the highest risk)Group B: Previously received Pneumovax 23Give Prevnar20 or Vaxneuvance (at least 1 year since the last Pneumovax 23)Group C: Previously Received Prevnar13Give Pneumovax23 or Prevnar20 (if Pneumovax 23 is not available) >1 year since last dose of Prevnar13Group D: Previously completed series of Prevnar13 and Pneumovax23 in any orderNo additional doses are needed. Scenario 1: 68 yo M who has not previously received PCV or whose previous vaccination history is unknown (Group A). This patient should receive: 1 dose of Prevnar20 and be done, or Vaxneuvance followed by a dose of Pneumovax23. Scenario 2: 25 yo F with HIV not previously received PCV or whose vaccination history is unknown (Group A). This patient should receive: 1 dose of Prevnar20 and be done, or Vaxneuvance followed bya dose of Pneumovax 23 given 8 weeks later. This patient is in the highest risk group. Scenario 3: 50 yo M with chronic alcoholism who has not received any vaccine or unknown status (Group A). This patient should receive: 1 dose of Prevnar20 and be done, or Vaxneuvance followed by Pneumovax 23 one year later. Scenario 4: 43 yo M with previous Pneumovax 23 only (Group B). This patient should receive either: a single dose of Prevnar20 or Vaxneuvance and be done with either vaccine. Give either vaccine at least 1 year after Pneumovax 23. Scenario 5: 25 yo F with CSF leak and previously received Prevnar13 (Group C). This patient should receive Pneumovax23 or Prevnar 20 (if Pneumovax 23 is unavailable) at least one year after her las Pneumovax dose. Scenario 6: 35 yo M who previously completed Prevnar13 and Pneumovax in any order because he has a cochlear implant (Group D). This patient should NOT receive any additional dose. Research and MonitoringCDC and ACIP will continue to assess the safety of Vaxneuvance and Prevnar20 vaccines (the new kids on the block), monitor the impact of the implementation of new recommendations, and assess post-implementation effectiveness and recommendations as appropriate. Examples of risk factors to consider administration of pneumococcal vaccines: Chronic renal failure, HIV infection, alcoholism, cigarette smoking, chronic heart, liver, and lung disease. For a complete list of conditions, visit CDC.gov.___________________ A second booster shot of COVID-19 vaccines. By Hector Arreaza, MD.On March 29 and 30, 2022, CDC announced that a second booster dose of any mRNA COVID-19 vaccine may be given to certain individuals who are at risk of severe outcomes from COVID-19(1). Individuals who may choose to receive a second booster are: 1. People older than 12 years of age who have a moderate to severe immunocompromising condition. Remember, use Pfizer for older than 12 yo, and Moderna for older than 18 yo.2. People older than 50 years of age who are NOT moderately or severely immunocompromised.3. People 18-49 years of age who are NOT immunocompromised but received the J&J COVID-19 vaccine as both the primary and booster dose. When can you receive the second booster shot? At least 4 months after the first booster dose.Who is considered up to date? A person is considered up to date when he/she has received all recommended doses in their primary vaccine series, and a booster dose when eligible. A second booster dose is not required to be considered up to date at this time.Underlying medical conditions associated with higher risk for severe COVID-19 include: Cancer, obesity, cerebrovascular disease, diabetes mellitus, HIV, obesity, COPD, smokers, and chronic liver disease.Comment: Remember to give the second booster to your patients. ____________________Acne Treatment.  By Sarah Park, MS3, University of California Los Angeles. Discussed with Hector Arreaza, MD.  Definition: Acne vulgaris is a common inflammatory disorder of the pilosebaceous unit, which includes the hair follicle and sebaceous gland. It is characterized by chronic or recurrent development of papules, pustules, or nodules commonly on the face, chest, or upper back.(1,2) Acne affects nearly 50 million people in the U.S. per year and can cause significant psychological distress in those who are affected. It primarily begins at puberty when the production of androgens and/or sensitivity of androgen receptors increase, thereby commonly affecting adolescents and young adults.(2) Pathophysiology: The pathophysiology of acne involves four main processes: 1) sebum overproduction, 2) hyperkeratinization of the follicle, 3) bacterial colonization by Cutibacterium acnes, and 4) inflammation.(2,3) It can be classified as mild, moderate, or severe based on the extent and types of lesions.3Treatment: Treatment is selected based on the severity of the condition, patient preference, and tolerability. Acne treatment often requires long-term, consistent use of one or more medications.(3) The main objective of treatment is to decrease sebum production, get rid of extra keratin, treat infection and decrease inflammation. You can warn your patients that their skin may feel dryer and more scaly than usual, but that's part of the treatment. For mild and exclusively comedonal acne, topical retinoids like tretinoin are the treatment of choice(4), but topical retinoids can be used in any level of severity for maintenance. Examples: Adapelene, tazarotene, and tretinoin, For mild inflammatory papulopustular acne or mild mixed comedonal and papulopustular acne, topical retinoids may be used in combination with antimicrobial therapy (either combined with benzoyl peroxide or combined with benzoyl peroxide plus clindamycin or erythromycin). If patients cannot tolerate a topical retinoid, alternatives include salicylic acid and azelaic acid. Of note, oral or topical antibiotics should only be used in combination with benzoyl peroxide and retinoids for a maximum of 12 weeks. If unresponsive to these topical therapies, namely retinoids, benzoyl peroxide, and/or clindamycin, alternative therapies may be initiated. These include topical dapsone, minocycline, and clascosterone.Topical dapsone is an effective treatment for both inflammatory papulopustular and comedonal acne lesions. Topical minocycline is an alternative topical antibiotic used for specifically moderate to severe acne. And last but not least is topical clascosterone, a relatively new topical (specifically an androgen receptor inhibitor) approved by the FDA in 2020.(4)Treatment for moderate to severe acne: For moderate to severe acne vulgaris, management is systemic therapy. This includes oral antibiotics or hormonal therapies, often used in conjunction with topical therapy, or monotherapy with oral isotretinoin. 1. Oral antibiotics for acne vulgaris include doxycycline, minocycline, and sarecycline. Treatment should be limited to three to four months.(5)2. For female patients, hormonal therapy with oral contraceptives and/or spironolactone is also an option. A meta-analysis comparing oral contraceptive therapy and oral antibiotic therapy suggests similar efficacy for the treatment of acne. OCP treatment is often the first-line choice for hormonal therapy, especially for patients who desire the added benefit of contraception. Spironolactone is often used for patients who have contraindications to OCP therapy or prefer to avoid OCPs. Both methods work to inhibit acne by reducing the effects of androgen on the pilosebaceous unit.53. For severe, extensive, nodular acne vulgaris, oral isotretinoin is the drug of choice. It is given as a monotherapy and is often used when all other treatment modalities fail.  Oral isotretinoin is the only medication that can permanently affect the natural course of acne by affecting all four factors in acne pathogenesis. Isotretinoin is most notably known for its teratogenic adverse effects and so is contraindicated in pregnant women and pregnancy must be avoided during therapy by using two forms of birth control.(5)Comment about isotretinoin use: Although prescribing isotretinoin (brand name Accutane®) is within the scope of family medicine, many providers choose not to prescribe it because of lack of training, monitoring hassles, fear of side effects, especially due to concerns with teratogenicity. Isotretinoin is an effective treatment for a condition that can not only disfigure and scar the face but can also cause significant psychosocial dysfunction. Dr. Van Durme recommended when you prescribe isotretinoin, you should have a regular schedule of monthly laboratory tests (including pregnancy test), then office visit, and then prescription, in that order. This schedule will improve the likelihood that side effects are managed promptly and medication is taken appropriately(7). If you would like more information about prescribing isotretinoin, visit https://ipledgeprogram.com.Conclusion: Use topical retinoids alone for mild cases of acne; topical retinoids combined with benzoyl peroxide or topical clindamycin or erythromycin for moderate cases; and topical retinoids combined with benzoyl peroxide and oral antibiotics in severe cases. Remember that isotretinoin is an oral treatment reserved for severe inflammatory papules and pustules with nodules. Treating acne effectively can certainly improve the quality of life of your patients. Now we conclude Episode 90 “Vaccines and Acne”. We gave you an update on pneumococcal and COVID-19 vaccines. Prevnar 20 seems to be the new star in the show. PCV15 is also useful but it needs to be followed by a shot of Pneumovax 23. Regarding COVID-19 vaccines, a second shot may be given to patients older than 12 who are immunocompromised or patients older than 50 who are NOT immunocompromised. Then we finished with a discussion about acne and we learned that topical is usually enough for mild cases, but oral therapy may be needed in moderate to severe cases of acne. Even without trying, every night you go to bed being a little wiser. Thanks for listening to Rio Bravo qWeek. Send us your feedback by email to RioBravoqWeek@clinicasierravista.org, or in our website riobravofmrp.org/qweek. This podcast was created for educational purposes only. Visit your primary care physician for additional medical advice. This week we thank Hector Arreaza, Timiiye Yomi, Amardeep Chetha and Sarah Park. Audio edition: Suraj Amrutia. See you next week!  References:Kobayashi M, Farrar JL, Gierke R, et al. Use of 15-Valent Pneumococcal Conjugate Vaccine and 20-Valent Pneumococcal Conjugate Vaccine Among U.S. Adults: Updated Recommendations of the Advisory Committee on Immunization Practices — United States, 2022. MMWR Morb Mortal Wkly Rep 2022;71:109–117. DOI: http://dx.doi.org/10.15585/mmwr.mm7104a1 2. Pneumococcal Vaccination Timing for Adults, CDC. https://www.cdc.gov/vaccines/vpd/pneumo/downloads/pneumo-vaccine-timing.pdf, accessed on March 30, 2022. Interim Clinical Considerations for Use of COVID-19 Vaccines, Centers for Disease Control and Prevention, CDC.gov, https://www.cdc.gov/vaccines/covid-19/clinical-considerations/covid-19-vaccines-us.html#considerations-covid19-vax-booster, accessed April 5, 2022.  Thiboutot, Diane, MD; and Andrea L Zaenglein, MD. Pathogenesis, clinical manifestations, and diagnosis of acne vulgaris, UpToDate. Accessed on April 1, 2022. https://www.uptodate.com/contents/pathogenesis-clinical-manifestations-and-diagnosis-of-acne-vulgaris Leung AK, Barankin B, Lam JM, Leong KF, Hon KL. Dermatology: how to manage acne vulgaris. Drugs Context. 2021 Oct 11;10:2021-8-6. doi: 10.7573/dic.2021-8-6. PMID: 34691199; PMCID: PMC8510514. Oge' LK, Broussard A, Marshall MD. Acne Vulgaris: Diagnosis and Treatment. Am Fam Physician. 2019 Oct 15;100(8):475-484. PMID: 31613567. Graber, Emmy, MD, MBA. Acne vulgaris: Overview of management, UpToDate. Accessed on April 1, 2022. https://www.uptodate.com/contents/acne-vulgaris-overview-of-management Harris C. Clascoterone (Winlevi) for the Treatment of Acne. Am Fam Physician. 2021 Jul 1;104(1):93-94. PMID: 34264597. Acne vulgaris: Management of moderate to severe acne, UpToDate. Accessed on April 1, 2022. https://www.uptodate.com/contents/acne-vulgaris-management-of-moderate-to-severe-acne Van Durme DJ. Family physicians and accutane. Am Fam Physician. 2000 Oct 15;62(8):1772, 1774, 1777. PMID: 11057835. https://www.aafp.org/afp/2000/1015/p1772.html

Your baby is now super cute at 4 months old and are laughing, smiling, and doing happy feet. In this episode, Dr. Carole Keim MD talks about weaning your baby and the difference between the traditional purees method and baby-led feedings. With new foods comes how to handle food allergies and brushing your baby's teeth. She also talks about protecting your baby while outside and safely using sunscreen or bug spray. Bookmark this episode! This information will apply for the next two months.Just like previous episodes Dr. Carole Keim MD will go into detail about your baby's development, sleep patterns, peeing and pooping, skin care, and what to expect at their 4-month check-up. As a new parent, you should be feeling a lot more confident about the overall care of your baby. Also a reminder those little hands are stronger than they look so if it is in grabbing distance be prepared.Parents: (00:24)Feeling more confident overallBaby is laughing and babbling, really interacting - this is when most parents fall in love with the babyStart wearing hair up / no jewelry - baby can grab objects!Development: (01:32)Social smile / laugh / happy feet Consoles selfBabblesDifferent types of cryingIndicates happy/sadResponds to affectionLift chest when prone, roll (typically front to back)Sleep: (03:02)Variable at this age; some have sleep regression, others are sleeping better than everSafe sleep: alone, on their back, in a crib.  (Time to move to a crib!)Crib should be in parents' room until 1 year of age, new studies show babies sleep better in their own room starting at 4mos but it's not an official recommendation yetNo blankets until 1 year, no pillows til age 2 - very high risk at this age - starting to rollStart a bedtime routine;  feed, brush teeth/gums with water, read, sing, set down awake but drowsy Things that can help, but only if they need it: blackout blinds, white noise machine, musicEating: (06:27)Primarily breastmilk or formula; starting to consider solids6-8x per 24 hours, 24-30oz per 24hCan take 4-6oz at a time and be full 4-6 hoursSigns of food readiness: showing interest in food, good head control while seated supported, loss of extrusion reflexHow to start solids: Baby-led weaning vs. purees (traditional)rice/oat cereal optional (pros/cons)progression green veggies - orange veggies - fruits; ok to give anything other than honey and cow's milk (dairy products are ok)one new food every 3-4 days signs of food allergy: rash, vomitingWhen to start water (ounce per ounce with foods)Peeing/pooping: (17:11)They have found their pattern: typical 1-2x per day, the rule of 7's still applies (until they start solids): once per week up to 7x per day is normal; after starting solids should be 1-3x per dayPeeing about 6x per 24hSkin: (17:54)Bathing 2-4x per week; wipe skin folds a few times per dayCan use lotion or cream or ointment after bathsSunscreen, insect repellant: any baby sunscreen is ok but not fully protective til >6mos, citronella works for insects and is safe Diaper rash and drool rash - might be infected if it lasts more than 2-3 days despite normal diaper cream (zinc-oxide-based like Desitin or petroleum-based like Vaseline or Aquaphor)Candida (yeast/fungal) - solid pink area with tiny pinpoint-sized pink dots around it (satellite lesions). Can try mixing apple cider vinegar and water 1:1, OTC antifungal cream, or call a doctor for a prescription for Nystatin.Teething: (22:25)Teeth can appear anytime; brush 2x per day with waterTeething toys, frozen washcloths, frozen fruit/breastmilk/formula in mesh bagsMedicines: tylenol (ask your doctor for the dose), topical teething gel like orajel4-month check up: (26:19)baby should have gained about 2-3lbs since last checkup, or should be about twice their birth weight (avg weight 14lb)Second round of vaccines: DTaP, Polio, Hib, PCV, rota (2 shots, one oral)Anticipatory guidance: Safety: never leave baby on high surfaces, use rear-facing car seat until age 2, avoid secondhand smoke, set water temp to 120'F to avoid scald burnsDevelopment: tummy time (30 mins twice a day), anticipate rolling, laughing, babbling. Can inspire rolling with toys placed just out of reach. They're not sitting on their own yet or crawling (those are at 9 mos).Next WCC in 2 mos; same vaccines as the 2mo visit Resources discussed in this episode:The Baby Manual - Available on Amazon--Dr. Carole Keim MD: linktree | tiktok | instagram

John Schoen, Senior Clinical Manager of Drug Information, at Vizient, shares his insights on the history and current state of pneumococcal vaccines within the practitioner community. He also discusses the complexity of ACIP recommendations after the recent addition of two newer vaccines, PCV 20 and PCV 15, and what the future holds for the vaccines.   Guest speaker: John Schoen, PharmD, BCPS Senior Clinical Manager of Drug Information  Vizient   Moderator: Gretchen Brummel, PharmD, BCPS Pharmacy Executive Director Vizient Center for Pharmacy Practice Excellence   Show Notes: [00:51-1:51] John's background [01:52-4:22] Pneumococcal vaccines history and current [04:23-7:30] Significance of vaccines [07:31-9:33] What's new with Pneumococcal vaccines [09:34-12:00] How expanded serotype coverage changes things [12:01-15:37] Efficacy data points from recent studies [15:38-16:26] Safety concerns from trials [16:27-18:51] Current ACIP recommendations [18:52-23:10] How to deal with the different combinations of vaccines [23:11-24:37] Safety implications of vaccine combinations [24:38-25:43] How frontline staff positions itself for appropriate support [25:44-27:50] What to expect for the future of pneumococcal immunizations   Links | Resources: Side-by-side comparison for the pneumococcal vaccines Public access link: Click Here Member only (comprehensive) link: Click Here   Subscribe Today! Apple Podcasts Amazon Podcasts Google Podcasts Spotify Stitcher Android RSS Feed

Wow! It has already been 2 months since your baby made its way into this great big world. Now is the time to get that all-important 2-month checkup done along with mom's 6 week postpartum appointment, come find out what Dr. Carole Keim MD has in store for you today on The Baby Manual: vaccine protection against diseases like rotavirus; important questions answered about resuming pre baby activities work, etc., but don't worry she still covers eating, peeing, pooping, and skincare routines.The first vaccines: DTaP (Diphtheria, Tetanus, Pertussis), Polio, Hib (Haemophilus influenzae type B), Hep B(Hepatitis B), PCV (Pneumococcal conjugate), rota (Rotavirus). Again we cover the importance of tummy time and ways you can help your baby with their development.Parents (00:23)Starting to resume pre-pregnancy activities and interests, plan return to school or workGetting out with the baby Partner support?  Family support?Mom should have had 6-week postpartum checkupTalk with partner about family planning Hold, cuddle, talk and sing to your babyDevelop strategies for crying Eating (02:48)6-8x per 24 hours, 24-30oz per 24hCan take 4-6oz at a time and be full 4-6 hoursPeeing/pooping (03:23)They have found their pattern: typical 1-2x per day, the rule of 7's still applies: once per week up to 7x per day is normalPeeing with each feed, 6-8x per 24hSkin (04:06) Bathing 1-2x per weekCan use lotion or cream or ointment after bathsDiaper rash - if it lasts more than 2-3 days despite normal diaper cream (zinc-oxide-based like Desitin or petroleum-based like Vaseline or Aquaphor) it might be infected.Candida (yeast/fungal) - solid pink area with tiny pinpoint-sized pink dots around it (satellite lesions). Can try mixing apple cider vinegar and water 1:1, OTC antifungal cream, or call a doctor for a prescription for Nystatin.Bacterial infection: pimples or boils, often MRSA, can try applying Neosporin TID but if it doesn't help, they need mupirocin TID.  Treat the whole family - nails and nose.2 month checkup (08:27)Baby should have gained about 2lbs since last checkup (avg weight 11lb)First vaccines: DTaP, Polio, Hib, Hep B, PCV, rota (2-3 shots, one oral)Neuro/devel: diminishing grasp/tone/moro reflexes, attempts to look at parent, smiles, able to console self, begins to have different types of crying, coos, able to push up a little during tummy time, consistent head control while supported in upright positionAnticipatory guidance - Eating: nothing but breast milk or formula until 4-6 months; wait for our next visit before feeding anything else Sleep: back to sleep, no blankets, put baby to bed awake but drowsySafety: never leave baby on high surfaces, use rear-facing car seat until age 2, avoid secondhand smoke, set water temp to 120'F to avoid scald burns, don't prop bottleDevelopment: tummy timeNext checkup is at 4 months of age and we will do all the same vaccines except they don't need another Hep B at that time (17:43)Resources discussed in this episode:The Baby Manual - Available on Amazon--Dr. Carole Keim MD: linktree | tiktok | instagram

You are starting to get into the groove of this new parenting thing and your baby is now 1 month old. You should start to see those smiles and the super cute cooing. In this episode, Dr. Carole Keim MD talks about what to expect from the 1 month check-up along with eating, peeing, pooping, sleeping, and skincare. She goes into great detail on gas, colic, reflux, and the benefit of a probiotic. It is also a good time for you to start thinking about your relationship again and enjoying a date night.This is the peak age for discoordinate stooling, reflux, and skin issues. Knowing the difference between learning bowel control and constipation or spit up vs green projectile vomit. Knowing what to watch for is half the battle when caring for your little one.Parents: (00:25)Finally feeling in the groove of thingsBaby has nights and days figured outDon't overstimulateStill narrate your day, take turns talking with babyFind time for a date night!Eating: (02:04)8-10x per 24 hours, 24-30oz per 24hStarting to go from q2-3h to q4-6hPeeing/pooping: (02:40)Discoordinate stoolingGas/colic: belly rubs, bicycle legs, up and downs, tiger in a tree pose, tummy time, simethicone drops, probiotic dropsReflux: Explain LES, normal spit ups.  Signs of severe reflux: weight loss, spitting up more than half of their feed every time, arching back and screaming, aspirating (choking/coughing/sputtering)Pyloric stenosis: getting progressively worse, turns green (grass green)Reflux tx: smaller and more frequent feeds, hold upright for 20-30 mins after feeding, sleep in a reclined position (tilt the crib or bassinet with a phone book), NO pillowsSkin: (10:11)Bathing 1-2x per weekCan use lotion or cream or ointment after bathsDiaper rash - if it lasts more than 2-3 days despite normal diaper cream (zinc-oxide-based like Desitin or petroleum-based like Vaseline or Aquaphor) it might be infected.Candida (yeast/fungal) - solid pink area with tiny pinpoint-sized pink dots around it (satellite lesions). Can try mixing apple cider vinegar and water 1:1, OTC antifungal cream, or call a doctor for a prescription for Nystatin.Bacterial infection: pimples or boils, often MRSA, can try applying Neosporin TID but if it doesn't help, they need mupirocin TID.  Treat the whole family - nails and nose.Checkup: (14:08)baby should have gained about 2 pounds from birth weight (based on 7 lb baby)Neuro/devel: grasp reflex, rooting/suckling reflex, moro reflex, responds to calming actions when upset, follows parents with gaze, recognizes familiar voices, communicates needs (hungry/wet), lift head when prone / on parent's chest, fontanels open until 1 year of agepoAnticipatory guidance:Eating - nothing but breast milk or formula for 4-6 monthsMom should eat a wide variety of foods and take PNV while breastfeedingSupplement with 400 IU of vit D daily, or mom can take 6400 IUSleep: back to sleep, no blankets, stop swaddling.  ABC = Alone, on Back, in Crib.Put baby to bed awake but drowsyFever and how to take tempNever leave baby on high surfaceRear facing car seat til age 2Avoid secondhand smokeSet water temp to 120 degrees to avoid scald burnsBathing baby 1-2x per weekSkin care / peeling skinTummy timeNext checkup is at 2 months:  (21:48)First round of vaccines: DTaP, polio, HiB, Hep B, PCV, RotavirusNo need to pre medicate before shots, but DO buy some infants or children's Tylenol / acetaminophen before the visitAsk doctor for the dose of Tylenol at the 2 month visitPooping will consolidate further: rule of 7's at this age is that anything from once a week to 7x per day is normalShould keep peeing every time they eatStill need to wake them up once every 4h to eatResources discussed in this episode:The Baby Manual - Available on Amazon--Dr. Carole Keim MD: linktree | tiktok | instagram

In the first GoodWill Yunting episode of the new year, we have on the two amazing devs, Jai and Joey, from Rari and Fei respectively, who have now merged into TRIBE. This has been a huge merger of two absolute powerhouse protocols, so we were super stoked to have them on. First, we dive into what the merger has been like, what it has created, and what we can expect going forward. We discuss Rari's and FEI's goals and how their alignment led to this merger. Next, we get into Joey's coined term PCV, and what it means to TRIBE and why it's important to all DeFi protocols. All the alpha is leaked as we talk about TRIBE's products like Liquidity As A Service and the game-changing turbo which is soon to come. Finally, we get into what's next for TRIBE and get some market insights from Jai and Joey. There is a lot of laughs, alpha, and enlightening discussion on this perfect episode to kick off the new year in crypto.  If you enjoyed the episode, please subscribe, rate, and share so we can continue to get amazing, alpha dropping guests. We plan to release episodes bi-weekly, so don't sleep!  Big thank you to Jai, Joey and Butters for taking the time out of their day to talk TRIBE and DeFi with us.  As always, Yunt Hard, Yunt Fast, Yunt Capital.  Disclaimer: Nothing said on this podcast is advice or a solicitation to buy or sell any assets or tokens. We may, and often because we're passionate about the projects we bring on, hold investments in the project and even work in their communities. None of this is financial advice, please do your own research; this is a risky field. 

Some breed-to-wean farms that have been vaccinated for porcine circovirus (PCV) have experienced breakdowns in their control of the virus. Clayton Johnson, DVM, outlines his top five steps for managing PCV outbreaks. The post Johnson: Five steps for porcine circovirus control appeared first on Pig Health Today.

Some breed-to-wean farms that have been vaccinated for porcine circovirus (PCV) have experienced breakdowns in their control of the virus. “We've seen disease consequences that we didn't expect in well-managed populations,” Clayton Johnson, DVM, told Pig Health Today. Here he outlines his top five steps for managing PCV outbreaks. 

In 2010, two companies learned their vaccines for a childhood infection (rotavirus) had another virus present: porcine circovirus. Both companies couldn't detect the virus lurking in a key material used for vaccine manufacture, and it went undetected until an academic lab discovered with new technology. Virologist and Vaccine Developer Dick Hesse from Kansas State University joins me and Diane to discuss vaccine contamination.  We are also joined by Julia Schaar with Medgene Labs (https://www.medgenelabs.com/) a local livestock vaccine developer to share best practices for preventing product contamination.  

Swopes documentary about the 2019 Fan Pin Championship is out. Everybody was out at Gateway getting work in yesterday. Iggy's game is rounding into shape. That Fraud Chris Hrabe will  be following the feature group on Sunday. PCV pipe may cause controversy on putts. Cartgate. Design Aire kills it again. Iggy gets to his weather forecast. It is immediately panned. Iggy struggles with direction. 

Capítulo Trece de "La Palabra Compartida", un podcast dedicado a "esa otra Venezuela" que nadie te contó". En esta emisión concluiremos con el análisis, detallado y atento, del proceso de insurgencia revolucionaria de izquierda en Venezuela. Tras la salida de Douglas Bravo del PCV y la fundación de Partido Revolucionario Venezolano, la izquierda insurgente se fragmenta definitivamente. Los principales líderes del Partido Comunista se encuentran en la cárcel o en el exilio y la influencia progresiva de Cuba, en desmedro del imperativo soviético, se hace notar cada vez más. Es este un período de gran beligerancia pero también de negociación y concierto, es el tiempo del "Repliegue". O dicho de otro modo, la antesala de lo que más adelante será la "Pacificación". Todo esto y más en "La Palabra Compartida" - La Guerrilla Insurge [1966 - 1968].

Capítulo Doce de "La Palabra Compartida", un podcast dedicado a "esa otra Venezuela" que nadie te contó". En esta emisión continuaremos con el análisis, detallado y atento, del proceso de insurgencia revolucionaria de izquierda en Venezuela. Tras las elecciones de 1963, que dieron como vencedor al doctor Raúl Leoni, la izquierda insurgente decidió acrecentar sus embates contra la ya limitada institucionalidad republicana. Habiendo fracasado en su llamado a la "abstención militante", la tendencia subversiva y revolucionaria no hace sino acrecentarse hasta convertirse en auténtico terrorismo rural. Entre 1963 y 1964 se consolidan, definitivamente, las propuestas guerrilleras del PCV y del MIR. Sin embargo, es también un tiempo de profunda agitación política dentro de estos partidos. El preludio, podríamos decir, de la profunda y notable escisión que llevará a la salida de Douglas Bravo y al nacimiento del Partido Revolucionario Venezolano. Todo esto y más en "La Palabra Compartida" - La Guerrilla Insurge [1964 - 1966].

A look at this common and controversial topic. Hosts: Brian Gilberti, MD Audrey Bree Tse, MD https://media.blubrry.com/coreem/content.blubrry.com/coreem/Acute_Otitis_Media.mp3 Download Leave a Comment Tags: Pediatrics Show Notes Background: The most common infection seen in pediatrics and the most common reason these kids receive antibiotics The release of the PCV (pneumococcal conjugate vaccine), or Prevnar vaccine, has made a big difference since its release in 2000 (Marom 2014) This, along with more stringent criteria for what we are calling AOM, has led to a significant decrease in the number of cases seen since then 29% reduction in AOM caused by all pneumococcal serotypes among children who received PCV7 before 24 months of age The peak incidence is between 6 and 18 months of age Risk factors: winter season, genetic predisposition, day care, low socioeconomic status, males, reduced duration of or no breast feeding, and exposure to tobacco smoke. The predominant organisms: Streptococcus pneumoniae, non-typable Haemophilus influenzae (NTHi), and Moraxella catarrhalis. Prevalence rates of infections due to Streptococcus pneumoniae are declining due to widespread use of the Prevnar vaccine while the proportion of Moraxella and NTHi infection increases with NTHi now the most common causative bacterium Strep pneumo is associated with more severe illness, like worse fevers, otalgia and also increased incidence of complications like mastoiditis. Diagnosis The diagnosis of acute otitis media is a clinical one without a gold standard in the ED (tympanocentesis) Ear pain (+LR 3.0-7.3), or in the preverbal child,