Hard object produced within a living shelled mollusc
This week's publisher episode focuses on one of our very favorites: Dalkey Archive. Founded nearly 40 years ago, Dalkey specializes in “lesser-known and often avant-garde works.” Trevor and Paul each share a few of their favorite titles and announce an exciting Dalkey giveaway. Be sure to share your favorite for a chance to win!Giveaway DetailsWe are excited to give away three Dalkey Archive books to a lucky listener with a U.S. address*.Please send us an email (or dm on Instagram or Twitter) telling us your interest in The Dalkey Archive! That's it! We recommend getting these to us by the end of day Friday, December 15 because we will be drawing the winner early the next day!*Unfortunately, due to high shipping costs, this giveaway is limited to U.S. addresses. We are sorry! We do love our international listeners!Shownotes* Basic Black with Pearls, by Helen Weinzweig* The Woman Who Borrowed Memories, by Tove Jansson, translated by Thomas Teal and Sylvester Mazzarella* The Summer Book, by Tove Jansson, translated by Thomas Teal* Fair Play, by Tove Jansson, translated by Thomas Teal* The True Deceiver, by Tove Jansson, translated by Thomas Teal* Joseph and His Brothers, by Thomas Mann, translated by John E. Woods* Afterword, by Nina Schuyler* Christmas at Thompson Hall: And Other Christmas Stories, by Anthony Trollope* A Christmas Carol, by Charles Dickens* The Life and Adventures of Santa Claus, by L. Frank Baum* A Merry Christmas: And Other Christmas Stories, by Louisa May Alcott* The Night Before Christmas, by Nikolai Gogol, translated by Konstantin Makovsky* The Nutcracker, by E.T.A. Hoffmann, translated by Joachim Neugroschel* The Warden, by Anthony Trollope* Can You Forgive Her?, by Anthony Trollope* The Brothers Karamazov, by Fyodor Dostoevsky, translated by Michael R. Katz* Red Comet: The Short Life and Blazing Art of Sylvia Plath, by Heather Clark* Vlad, by Carlos Fuentes, translated by E. Shaskan Bumas and Alejandro Branger* Miss MacIntosh, My Darling, by Marguerite Young* Atagony, by Luis Goytisolo, translated by Brendan Riley* Götz and Meyer, by David Albahari, translated by Ellen Elias-Bursac* Bottom's Dream, by Arno Schmidt, translated by John E. Woods* At Swim-Two-Birds, by Flann O'Brien* The Dalkey Archive, by Flann O'Brien* Reticence, by Jean-Philippe Toussaint, translated by John Lambert* Europeana: A Brief History of the 20th Century, by Patrik Ouredník, translated by Gerald Turner* Suicide, by Edouard Levé, translated by Jan Steyn* Through the Night, by Sting Sæterbakken, translated by Seán Kinsella* Autoportrait, by Edouard Levé, translated by Lorin Stein* Trilogy, by Jon Fosse, translated by May-Brit Akerholt* Demolishing Nisard, by Eric Chevillard, translated by Jordan Stump* Eros the Bittersweet, by Anne CarsonAbout the PodcastThe Mookse and the Gripes Podcast is a book chat podcast. Every other week Paul and Trevor get together to talk about some bookish topic or another.Please join us! You can subscribe at Apple podcasts or go to the feed to import to your favorite podcatcher.Many thanks to those who helped make this possible! If you'd like to donate as well, you can do so on Substack or on our Patreon page. Patreon subscribers get regular bonus episode and early access to all episodes! Every supporter has their own feed that he or she can use in their podcast app of choice to download our episodes a few days early. Please go check it out! This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit mookse.substack.com/subscribe
On "The Kardashians" Kim, Kendall, and Kylie went to the Met! North had all the opinions about the fashions and Kim lectured her about loyalty. Meanwhile, back in LA, Khloe interviewed Cousin CiCi and Kris teased a Kris Jenner documentary. Send Tyra Mail to email@example.com
Annie Im, MD, is an Associate Professor of Medicine at the University of Pittsburgh Medical Center. She is also the Program Director for Hematology & Oncology Fellowship program. Her research is focused in hematologic malignancies, drug development, stem cell transplantation, and graft-versus-host-disease. She received her medical degree from Stony Brook School of Medicine in New York, and then completed both her residency in internal medicine and her hematology/oncology fellowship from UPMC. “I think the most impressive thing is when a physician can make you feel like you're the most important person in that moment.” Encouraging us to go the extra mile for patients by being present, Dr. Annie Im joins us in this episode of the Medicine Mentors as we discuss the fine details of empowering patients by giving them our full presence. Tune in as Dr. Im spreads the message of staying present for all parts of our lives, reminding us that we won't escape the rush hour busyness of physician life but that by being present we can learn to find a balance that works for any given moment. Pearls of Wisdom: 1. Even though you might be busy in your day, your patients will remember you as you are in the time that you meet with them. So be sure to stay focused and present so they can feel like they're the most important person to you at that moment. 2. When finding a work-life balance, think of it like rush hour traffic. Sometimes it will be easy to balance things and move with ease, but it's important to know that there will be times in your career when work or your personal life will take precedence and need more attention. The key is to find balance in all of those phases. 3. Whether it's research, personal life, or career trajectory, mentors don't all come with the same expertise so be sure to find a variety of mentors that can help you in each part of your life. 4. The onus is on the mentee to reach out to a mentor so when looking out for hiccups in the relationship, stay empathetic and realize that a mentor will have their own business and may not tend to every need. Long lasting relationships require work but pay off in the long run. 5. Successful people are those that find their drive through passion. Seeing that extra patient and going the extra mile isn't just about dedication but also passion. When working passionately, things like burnout and work-life balance become easy.
Lawyers are gladiators of the English language. Words are their weapons. So if you're entering the arena of legal practice, you'd better hone your vocabulary. This week, Ben and Nathan encourage listeners to keep a dictionary handy and to embrace a growth mindset when it comes to their English proficiency. Later, the guys roast some of the internet's most bizarre LSAT advice. They probe the motives of WashU's “redacted review.” And they consider the benefits of taking a gap year before law school. LSAT Demon LSAT Demon iOS App LSAT Demon Daily Watch Episode 430 on YouTube Thinking LSAT YouTube LSAT Demon YouTube 0:00 - January LSAT Registration - The January LSAT registration deadline is upon us. Ben and Nathan explain why November test takers should plan to retake in January. 8:32 - Vocabulary - Nathan and Ben explain how to approach unfamiliar words on the LSAT. 21:44 - Word of the Week - Ben and Nathan upbraid LSAT students who don't make efforts to expand their vocabulary. 27:08 - Pearls vs. Turds - Nathan and Ben are flummoxed by a blog post that advises LSAT students to align their LSAT prep with their future law school specializations. 45:56 - Score Increase Addendum - Some law schools require applicants to write addendums addressing significant LSAT score increases. Nathan and Ben recommend a one-sentence response. 52:12 - WashU “Redacted Review” - Washington University School of Law allows applicants to redact their LSAT or GPA on their applications. What's the catch? The redacted info is still considered when awarding scholarships. Ben and Nathan view “redacted review” as just another tactic to solicit applications. 1:10:45 - Scholarship Estimator - Year after year, law schools play the same old scholarship game. The LSAT Demon Scholarship Estimator helps applicants play along. 1:17:29 - Gap Years - Should you take a gap year? Probably. Nathan and Ben discuss how taking an extra year to increase your LSAT score can transform you as a law school applicant. 1:24:28 - Shoutouts - LSAT Demon student Tanya thanks teachers Ala and Brandon for helping her on her LSAT journey.
Bryan Matthews, Caleb Jones, Brian Stultz and Jay G. Tate reconvene for a new edition of The Rundown, which focuses on the Tigers' stinging loss in the Iron Bowl. We're not here to re-litigate the fourth-quarter follies, but we go back through them briefly before taking a look at what comes next for this football program. It's time to take stock of what helps make the Tigers better in 2024 and add what's missing and cut what isn't needed. That sounds cutthroat, but college football is a cutthroat world these days. Caleb and B-Matt recap what was a very busy weekend from a recruiting perspective. They review the eight biggest visitors and make some predictions about what happens during the next three weeks. The early signing period begins soon. The guys also discuss the Fightin' Pearls, who have games against Virginia Tech and Appalachian State this weekend. The show ends with a bodacious array of commendations and shoutouts for the most outstanding members (this week) from our outstanding message board. The show is presented by VooDoo Wing Company with locations in Auburn, Mobile, Tuscaloosa, Florence, Charlotte and Las Vegas. Check them out IN PERSON for delicious chicken or on the web at www.voodoowingco.com.
In this dynamic session from the 2022 Midyear Clinical Meeting, content matter experts present pearls of knowledge focusing on medication safety and quality. The information presented during the podcast reflects solely the opinions of the presenter. The information and materials are not, and are not intended as, a comprehensive source of drug information on this topic. The contents of the podcast have not been reviewed by ASHP, and should neither be interpreted as the official policies of ASHP, nor an endorsement of any product(s), nor should they be considered as a substitute for the professional judgment of the pharmacist or physician.
Diamonds & Pearls is HERE! We are going to use this opportunity to talk about the expansive Super Deluxe edition the way that little teenage Josh experienced the album as we start with Glam Slam ‘91, Gett Off (Damn Near 10 Min.), Horny Pony, and the Special Olympics Opening Ceremonies.Visit us on Facebook: https://www.facebook.com/TMATSPodcast/Twitter: @TMATSPodcastEmail: TMATSPodcast@gmail.com
Today's Episode Dr. Raj talks with his mother, Tita Dasgupta, about their experiences with having a loved one suffer from Alzheimer's Disease. They discuss her background as a midwife and nurse, how she met her husband and started a family, and the importance of reaching out for support when dealing with an Alzheimer's diagnosis. About Dr. Raj Dr Raj is a quadruple board certified physician and associate professor at the University of Southern California. He was a co-host on the TNT series Chasing the Cure with Ann Curry, a regular on the TV Show The Doctors for the past 7 seasons and has a weekly medical segment on ABC news Los Angeles. Want more Dr. Raj? Check out the Beyond the Pearls lecture series! The Ultimate High Yield Bundle: The complete review of high-yield clinical medicine topics necessary for graduate medical education board exams including NBME, USMLE Steps 1/2/3, ITE and ABIM Boards. You can also listen to the Beyond the Pearls podcast. Check out our other shows: Physiology by Physeo Step 1 Success Stories The InsideTheBoards Study Smarter Podcast The InsideTheBoards Podcast Produced by Ars Longa Media To learn more about us and this podcast, visit arslonga.media. You can leave feedback or suggestions at arslonga.media/contact or by emailing firstname.lastname@example.org. Produced by: Christopher Breitigan and Erin McCue. Executive Producer: Patrick C. Beeman, MD Legal Stuff The information presented in this podcast is intended for educational purposes only and should not be construed as professional or medical advice. Learn more about your ad choices. Visit megaphone.fm/adchoices
Happy Thanksgiving! Haunted Walks.com, selling death, ashes to cash, haunted chimps and cash, failing podcast grammar, and not being able to read our own notes. To become a Ghostie, and get updates first, as well as illustrations, join us: www.Patreon.com/DonnaBarr. For everything I do, come to www.donnabarr.com. Use Anchor.fm/donna-barr to record messages for inclusion - or send me your story in a double-spaced pdf at donnabarr01 @ gmail.com and be sure to tell me if you want me your use your name or not. --- Send in a voice message: https://podcasters.spotify.com/pod/show/donna-barr/message
Picture yourself alone in the middle of the Atlantic Ocean during the worst hurricane season on record. Your boat has no motor or sail, and you've lost all communication with those on shore. Your watertight sleeping area is the size of a double-wide coffin, and as the hurricane rages outside, waves frequently pound your little rowboat with the force of a small car crash, pitching your body all around that tiny space. While this probably sounds more than a bit daunting to you, this was the exact situation faced by Louisville resident Tori Murden when in June of 1998 she set off on a quest to become the first woman and the first American to row solo across the Atlantic Ocean. She ultimately achieved that goal, thanks to the support of her friends– including words of wisdom from Muhammad Ali and encouragement from Gerard d'Aboville, the first man to row solo across two oceans–the love of the new man in her life, Mac McClure, and a second journey across the ocean. Tori Murden McClure captured the details of her suspenseful and exciting adventure in “A Pearl in the Storm: How I Found My Heart in the Middle of the Ocean,” which was adapted into the musical “Row” in 2021. And in this week's episode we have the honor of speaking with her! Join us for this fascinating interview with author and world record-holder, Tori Murden McClure. Unlike Tori, you can enjoy this hero's journey from the comfort of your own home! If you'd prefer to view the episode, visit our YouTube channel at: https://www.youtube.com/@scandalwaterpodcast35 Support Scandal Water by visiting www.BuyMeaCoffee.com/ScandalWaterPod #ScandalWaterPodcast #TuesdayTea #TheHerosJourney #ToriMurdenMcClure #TenacioustoaT #Overcomer #Inspiring #Thanksgiving #HometownHero #MuhammadAli #APearlintheStorm #Row #Musicals #Theatre #Book #Author #APearlintheStorm #Writer #Biography #WorldRecord #Louisville #Kentucky #AtlanticOcean #EmpoweringWomen
Pastor Travis and Lisa talk about gratitude and the Numbers 11 account of the grumbling Israelites, including our distorted memories the good ol' days, remembering God's power and goodness, and practicing daily gratitude. This is an episode of Pearls & Swine on the Evangel Houghton Podcast from Evangel Community Church, Houghton, Michigan, November 21, 2023.
Bryan Matthews, Caleb Jones, Brian Stultz and Jay G. Tate reconvene for a new edition of The Rundown, which focuses on the Tigers' troubling loss on the football field. New Mexico State? Twenty-one points? Seriously? Yeah, it happened. The Iron Bowl still will be played Saturday and Auburn can win the game. What will it take? A massive effort. Is this team capable of putting together a massive effort in its current state? We have theories. Why does Hugh Freeze look sullen? Stultz thinks it's "merely" disappointment. Caleb gets us up to speed on some recruiting situations — most notably the Tigers' efforts to flip both Cam Coleman (from Texas A&M) and Ryan Williams (from Alabama). The Fightin' Pearls are 3-1 after a pair of straightforward wins in New York. Bruce Pearl is giddy about his depth and why shouldn't he be? This team has a lot of players. Alabama A&M awaits Tuesday. The show ends with a satisfying array of commendations and shoutouts for the most outstanding members (this week) from The Bunker. The show is presented by VooDoo Wing Company with locations in Auburn, Mobile, Tuscaloosa, Florence, Charlotte and Las Vegas. Check them out IN PERSON for delicious chicken or on the web at www.voodoowingco.com.
Planet LP host Ted Asregadoo and Popdose writer Keith Creighton are inching closer to the end of the year with the November New Music Report. This episode is jam-packed with some stellar music recommendations just in time for the holidays. Segment One: The Big Album It's Prince! Known at various times as The Purple One, Christopher, His Royal Badness, The Artist, or Jamie Starr, Prince was at the top of his game between 1980 and 1987 with an impressive music output that few in the music world could match. Why? Because of The Vault. A prolific writer, Prince vaulted roughly 8,000 songs. In 1991, after a series of lackluster albums, Prince released “Diamonds and Pearls” with his new backing band, the New Power Generation. The result was his fifth (and final) #1 hit in the US with “Cream,” a #3 hit with the title track, and two top 20 hits with “Gett Off” and Money Don't Matter 2 Night.” Overall, “Diamonds and Pearls” was an absolute commercial success for Prince. On October 27, 2023, Sony released a super deluxe version with three CDs of vaulted tracks, a double live album, a remaster of the original record, and a disc with singles and different mixes. That's a lot of music, and Ted and Keith break it all down into digestible bits to highlight what's brilliant about the super deluxe edition, what's good, and what misses the mark. Segment Two: New Music Releases The Transcanada Highwaymen's “Explosive Hits Vol #1 is mostly a carefully curated album of cover songs popular in the 1970s. These are Mellow and Radio Gold songs sung by a supergroup consisting of Moe Berry from The Pursuit of Happiness, Chris Murphy from Sloan, Craig Morthey from Odds, and Steven Page formerly of the Barenaked Ladies, but has gone on to a fantastic solo career. Featured songs include their cover of Andy Kim's “Rock Me Gently, and “Which Way You Goin' Billy” by The Poppy Family. Samples of both songs are embedded in this episode. Lol Tolhurst (former drummer from The Cure), Budgie (from Siouxsie & The Banshees), and producer Jackknife Lee have created a cinematic mindscrew of an album entitled “Los Angles.” Orchestral Maneuvers in the Dark are back with what will likely be the final album of their career, and boy what a way to go out! Nowhere on the record are songs that sound like their biggest US hit, “If You Leave.” Rather, as Keith says, this is a soundtrack for the end of the world. Ted compares “Bauhaus Staircase” to Tears for Fears' “The Tipping Point” for its strength, its familiarity at times, and the satisfying way it's all put together. Duran Duran is back with Dance Macabre, a Halloween-theme mashup of covers, updated obscure deep cuts, and some originals. Also, guitarist Andy Taylor returns to the group, and so does the drummer of 17 years with the band, Warren Cuccrullo. If you want to go on a journey with a musician who is a bit of an acquired taste, give Christian Kjellvander a try. “Hold Your Love Still” may not be for everyone, but once you become familiar with Kjellvander's voice, you'll find this record mesmerizing — as you will hear. Nat Jay's latest EP, “Turns Out It's Not The End” is one of Keith's favorites this year. Comparing her to an outlier star to Taylor Swift's galaxy-consuming supernova, Jay's song “Something More” could have been included in the new Hunger Games soundtrack — and you'll be able to hear why. Shplang! has been on the music scene for almost three decades, and is part of the International Pop Overthrow scene. Their latest song, “Understood” is featured in this episode. Segment Three: Stream It Before You Buy It Quick hit recommendations. "Pretty Vicious" by The Struts “Telephone Line” by Juliana Hatfield “New Blue Sun” by Andre 3000 “Revisions of Truth” by One Square Mile “Chronicles of a Diamond” by Black Pumas “Can't Find The Brakes” by Dirty Honey “Purple Rain” by Dolly Parton “Harridan” (Live) by Porcupine Tree
Event Objectives:Become familiar with new evidence for the management of community acquired pneumonia.Understand how to improve your antimicrobial stewardship in management of community pneumonia by decreasing unnecessary use of broad spectrum antibiotics and prescribing antibiotics for the shortest effective duration.Learn about free Connecticut Children's resources available to outpatient pediatric providers to keep up to date with the management of community acquired pneumonia and other infectious diseases.Resources:https://www.connecticutchildrens.org/clinical-pathways/https://app.firstline.org/en/clients/187-connecticut-childrensClaim CME Credit Here!
The last collection, sorry, Treasury of Pearls Before Swine comics was 2021's Pearls Awaits the Tide, a celebration of sorts for cartoonist Stephan Pastis' enjoying its twentieth anniversary of survival as a dying medium (comic strips) published via a dying medium (newspapers), reprinted though a surprisingly resilient medium (paperback books). It arrived smack dab in the middle of the world-shuttering Covid-19 pandemic.
This is the next episode of our Push Dose Pearls miniseries with ED Pharmacist, Chris Adams. In this ongoing series we'll dig into some of the questions we all have about medications we commonly see and use in the ED. This episode again focuses on common antibiotics we use in the ED. What has changed and what are the latest recommendations? We'll answer these questions and more! Did this episode change your practice? Let us know on social media @empulsepodcast or at ucdavisem.com Hosts: Dr. Sarah Medeiros, Associate Professor of Emergency Medicine at UC Davis Dr. Julia Magaña, Associate Professor of Pediatric Emergency Medicine at UC Davis Guests: Christopher Adams, PharmD, Emergency Department Senior Clinical Pharmacist and Assistant Professor at UC Davis Resources: CDC STI Treatment Guidelines Metlay JP, Waterer GW, Long AC, et al. Diagnosis and Treatment of Adults with Community-acquired Pneumonia. An Official Clinical Practice Guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respir Crit Care Med. 2019 Oct 1;200(7):e45-e67. doi: 10.1164/rccm.201908-1581ST. PMID: 31573350; PMCID: PMC6812437. ACEP EMRA Antibiotic Guide. *** Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Productions for audio production services.
Starting a podcast isn't easy, and we are genuinely grateful for those who have followed us on this journey. In this special Thanksgiving episode of the Pearls of Wisdom Podcast, grab some turkey leftovers and join us as we take a reflective trip through the highs and lows of this past year. Unlike our usual episodes with guests, this time, it's just Elisa and me sharing our thoughts on the challenges and triumphs that 2023 brought to the jewelry industry. It hasn't been smooth sailing for everyone, but that makes the journey interesting, right? As we sit down before Thanksgiving, we acknowledge the difficulties many have faced this year and emphasize the importance of gratitude and finding reasons to be thankful. We look back to the many wonderful people we introduce to you on this platform, from vendors to retailers, who shared their experiences, insights, and wisdom, providing a unique perspective on the jewelry business from both sides of the fence. We talk about the experiences and unexpected joys that Pearls of Wisdom has brought to our lives and the lives of our listeners. We reminisce about memorable guests like the late Kate Peterson and recognize everyone's impact on the industry. We also shared a heartwarming story of how our podcast played matchmaker! This year wouldn't have been as incredible without all of you tuning in and supporting us. But the love and views you've thrown our way have made it worth every moment. From the industry's challenges to heartwarming stories of love found, join Elisa and I as we celebrate and reminisce memorable and enriching conversations we shared in this Thanksgiving episode that make Pearls of Wisdom a podcast close to our home. We're here to share stories, make connections, and, who knows, maybe help you find a date or a job. Brought to you by: Southern Jewelry News: https://southernjewelrynews.com/ Jewelry Store Marketers: https://jewelrystoremarketers.com/ Learn more about the Pearls of Wisdom Jewelry Podcast https://southernjewelrynews.com/podcast Subscribe on your favorite podcast platform: • Apple Podcast = https://podcastsconnect.apple.com/my.-.. • Amazon Music/Audible = https://www.audible.com/pd/Pearls-of.-.. • iHeartRadio = https://www.iheart.com/podcast/263-pe... • Spotify = https://open.spotify.com/show/6IU1OHw... • Google Podcast = https://podcasts.google.com/feed/aHR0...
Listen to The Kiddush Club Podcast!https://www.kiddushclubpodcast.com/On Apple PodcastsOn SpotifyDonate to Meir Panim and Help Israel!Click here to support our soldiers!Click here to support Israel's soup kitchens!Order " A Brief and Visual History of Antisemitism"by Israel Bittonhttps://twitter.com/IsraelBittonAdvertisers: Grab a ONE MINUTE SPOT on the podcast:Email Chanalesings@gmail.com or WhatsApp for details:https://wa.link/efqjihJoin The Weekly Squeeze WhatsApp Chathttps://chat.whatsapp.com/I7fhs9clBTi3Vc9SJv2yxUhttps://www.instagram.com/mybeautifullandofisraelHave an opinion you want to share?Leave me a voicenote on SpeakPipe!No app needed. Tap and Record.
Health Pilots continues with our next feature from the Resilient Beginnings Network! Today, we welcome pediatrician Dr. Sheshashree "She" Seshadri and pediatric care coordinator Melissa Pereda from Bay Area Community Health (BACH), discussing their comprehensive approach to pediatric care, specifically in administering screenings to identify adverse childhood experiences (ACEs). Beyond sharing insights into workflows and processes, they discuss navigating the complexities that arise post-identification of ACEs and underscore the significance of establishing trust and rapport between providers and families.Tune in to hear about BACH's collaborative efforts to compile a network of community-based organizations and their innovative use of technology to swiftly connect families with essential social and economic resources, ranging from housing needs to early intervention programs.Learn more about the people, places, and ideas in this episode: "What are adverse childhood experiences (ACEs)?"Pediatric ACEs and Related Life Events Screener (PEARLS)Example of PEARLS tool (for screening children)"What are social determinants of health (SDOH)?"Visit Bay Area Community Health (BACH), formed during the middle of the COVID-19 pandemic, BACH brings more than 70 years of combined service to the area that stretched from Union City to Gilroy, across Alameda and Santa Clara Counties. BACH serves more than 100,000 people who rely on high-quality healthcare services, regardless of their immigration status, ethnicity, disabilities, or ability to pay.More on Resilient Beginnings Network (RBN), a Center for Care Innovations learning program dedicated to advancing pediatric care delivery models that are trauma- and resilience-informed so that 100,000 young children and their caregivers have the support they need to be well and thrive.Pediatric Care Coordinators: Closing the Loop to Help Children at Risk Thrive - an article featuring BACH (April 2023)ACEs Aware, is a first-in-the nation effort and initiative to screen patients for adverse childhood experiences (ACEs) to help improve and save lives. ACEs Aware is bringing communities together in ways never before imagined to prevent, screen for, treat, and heal trauma-induced toxic stress. Together, we are getting to the root cause of some of the most harmful, persistent, and expensive health challenges facing our state and nation.HOPE Framework, or Healthy Outcomes from Positive Experiences can ease toxic stress and help children and youth grow into more resilient, healthier adults. HOPE identifies ways that our communities and systems of care can better ensure that all children have more positive experiences and that all families have support to nurture and celebrate their strengths. The Four Building Blocks of HOPE are composed of key positive childhood experiences (PCEs). The sources of those experiences and opportunities are the foundation for healthy childhood development.
Robert Brodsky, MD, is a world-renowned hematologist and the current Director of the Division of Hematology, as well as Professor of Medicine at Johns Hopkins University. He focuses on bone marrow failure states, specifically the use of bone marrow transplants in sickle cell disease and aplastic anemia. His lab studies complement mediated disorders and he has also developed the diagnostic assay that is used to diagnose PNH around the world. Dr. Brodsky is a recipient of numerous national awards and was recently elected as the President of the American Society of Hematology, the largest professional society of hematologists in the world. “I remember driving down 83. I just couldn't wait to get into work…that excitement, that flutter in your heart, that's what defines success for me.” A sentiment passed down through now three generations of hematologists, Dr. Robert Brodsky, Director of the Division of Hematology at Johns Hopkins and President of the American Society of Hematology, joins us for a grounding conversation. Tune in as we dive into the leaders that showed him what it truly means to love your job, how asking the right research questions is the biggest predictor of success, and why it takes decades to build a career that's worth having. Pearls of Wisdom: 1. Work-life balance is not every day. That is a critical distinction to understand, that overall, our lives should be balanced, but it's not an expectation we should come to work with every day. We should try to achieve the work-life balance globally, but not in a day-to-day, hour-to-hour fashion. 2. What is one of the biggest predictors of success? We connect it to the purpose behind the project: the Research Question. That's going to start the journey and create the flutter for us to come to work and pursue something that's actually going to have a meaningful change. 3. Life is likely to get more complicated as we move forward. The difficulty levels keep going up as we go to the next level, and therefore, if there's not a strong force driving us, we should not get to the next level just for the sake of getting there. It should be to reach an ultimate goal.
Bryan Matthews, Caleb Jones, Brian Stultz and Jay G. Tate reconvene for a new edition of The Rundown, which focuses on the Tigers extending their three-game win streak at Arkansas. What a performance! The Hogs were toast within five minutes and the home fans were beside themselves. It was a moment of exhiliration for Hugh Freeze, who finally saw his team dominate an opponent in all three phases. So what now? Let me tell you what now. Auburn plays a pretty good New Mexico State team that has won eight games for the first time since the 1960s. Is this team good enough to beat Auburn? Probably not, but looking ahead to the Iron Bowl is not adviseable. There are more questions: • Is Payton Thorne actually good now? • What does Auburn's strong work in the 2025 recruiting class mean moving forward? • Which one of the Tigers' latest commits has Caleb thinking BIG? • What did we learn from the Fightin' Pearls' loss to Baylor? Auburn basketball plays Notre Dame on Thursday night followed by a game against Oklahoma State or St. Bonaventure on Friday. The show ends with a cornucopia of commendations and shoutouts for the most outstanding members (this week) from The Bunker. The show is presented by VooDoo Wing Company with locations in Auburn, Mobile, Tuscaloosa, Florence, Charlotte and Las Vegas. Check them out IN PERSON for delicious chicken or on the web at www.voodoowingco.com.
Pastor Levi and Lisa talk about King David's sin and repentance, including active repentance, sin is hard to conceal, and consequence of sin. This is an episode of Pearls & Swine on the Evangel Houghton Podcast from Evangel Community Church, Houghton, Michigan, November 14, 2023.
The holy Word of God is entrusted to the church, and we have the precious pearl of the gospel of the Kingdom. We are to share these things with all who will listen, but there are also times when we must choose who is worthy to receive the precious things of God.
11/13/2023 | CT of Calyceal Abnormalities in the Kidney: Pearls and Pitfalls - Part 2
Welcome to Pearls of Wisdom! In this episode of “Chatting with Chuck,” our special guest, Shelia Bayes of Gem + Jewel, will share her journey in the jewelry industry and what she has accomplished so far to help other jewelers. Her first step in the industry began in Lexington, Kentucky, where she worked for a jewelry business while attending the University of Kentucky. After nearly a decade of experience, she boldly opened her store, and this year marks her impressive 30th anniversary! With no prior family background in the industry, her story is indeed an inspiration to all aspiring jewelers. Her passion for connecting with people and celebrating life's special moments through jewelry is evident in her incredible journey. She's witnessed the industry's evolution from green books and landline phones to the digital age of e-commerce. Speaking of e-commerce, Sheila witnessed how many jewelers struggle with building and maintaining online stores and was determined to change that. In a groundbreaking move, she founded Gem + Jewel in 2018, an award-winning e-commerce aggregator. This platform provides solutions for those struggling with online sales intricacies. It makes e-commerce more accessible for retailers, vendors, and consumers. What's even more exciting is the accessibility of this platform to Jewelers Mutual Insurance policyholders. For a mere $69 a month, retailers can start their e-commerce business without the hefty upfront costs, with the platform taking a modest 10% commission only when a sale is made. If you think that's impressive, wait until you hear more from Sheila Bayes . Tune in now and don't miss this episode to gain invaluable insights into jewelry and e-commerce. Join us as we Chat with Chuck and Shelia Bayes of Gem + Jewel. Brought to you by: Southern Jewelry News: https://southernjewelrynews.com/ Jewelry Store Marketers: https://jewelrystoremarketers.com/ Learn more about the Pearls of Wisdom Jewelry Podcast https://southernjewelrynews.com/podcast Subscribe on your favorite podcast platform: • Apple Podcast = https://podcastsconnect.apple.com/my.-.. • Amazon Music/Audible = https://www.audible.com/pd/Pearls-of.-.. • iHeartRadio = https://www.iheart.com/podcast/263-pe... • Spotify = https://open.spotify.com/show/6IU1OHw... • Google Podcast = https://podcasts.google.com/feed/aHR0...
Discover how Community Medical Centers (CMC) in California's Central Valley transformed healthcare over the past decade with trauma-informed practices. Partnering with Resilient Beginnings Network at the Center for Care Innovations, they deepened their commitment, hiring community health worker Victoria Franco and social worker case manager Maria Moreno. Together, they administer ACEs screenings, conduct follow-ups, and support care teams, empowering providers to prioritize quality medical care. Join Victoria, Maria, and CMC's Chief Behavioral Health Officer, Alfonso Apu, as they discuss providing guidance in trauma-informed care and the evolving focus on cultural sensitivity and patient-centered approaches.Learn more about the people, places, and ideas in this episode: Community Medical Centers (CMC), a growing non-profit network of neighborhood health centers serving San Joaquin and Solano counties in Northern California. CMC provides primary medical, dental, and behavioral health care along with supportive services to individuals and families in need.Resilient Beginnings Network (RBN), a Center for Care Innovations learning program dedicated to advancing pediatric care delivery models that are trauma- and resilience-informed so that 100,000 young children and their caregivers have the support they need to be well and thriveWhat are adverse childhood experiences (ACEs)?About the Pediatric ACEs and Related Life Events Screener (PEARLS)Example of PEARLS tool (for child)"How One California Clinic Tapped a Bilingual Medical Assistant to Lead ACEs Work" - article featuring CMC (May 2023)
Event Objectives:Review the most common causes of joint pain in kids and how to distinguish benign pain from features with red flags.Review the concept of hypermobility in kids and the link to frequent joint pain.Review the concept of growing pains.Claim CME credit Here!
Today's Episode Dr. Raj talks with Todd Keitz, the creator of My Care Friends, a community of advocates for patients and caregivers. Together, they delve into their own caregiving journeys, shedding light on the significance of advocacy in fostering empathy and enhancing mutual understanding within the healthcare sphere. Today's Guest Todd has been a lifelong social good evangelist! His personal ethos is “Paying It Forward” in a myriad of ways. He has woven community engagement and social impact into his life since he was a teenager volunteering in senior living centers. Over decades, he has created intergenerational programs to build bridges within families and communities, volunteered as a strategist and “hugger” for Special Olympics, developed business curriculum for high schools, taught for Junior Achievement within intercity Philadelphia, and been a group mentor for Big Brothers Big Sisters. Through all of this, Todd became even more driven to translate his personal ethos on a much larger scale within his professional life. In 2012, he co-founded and served as CEO of Stock4Good, to make the process infinitely easier for individuals to donate stock of publicly held companies to 501(c)3 organizations. In 2018, he relocated to Florida to become caregiver and patient advocate for his mom and dad – each with life threatening diseases. During those experiences, Todd saw first-hand the many challenges all caregivers and patient advocates face. That led him to create My Care Friends, a unique web app for caregivers and patient advocates to connect and support each other. Additionally, Todd is Founder/CEO of 17 Commerce, which represents products at the crossroads of healthcare and technology. In addition to his role with AACY, he currently serves on the board of Say Ah! – a health literacy nonprofit changing the way people think about their health and healthcare, and the way the healthcare system interacts with the people who need it. Todd earned a B.S. in Business Administration from Temple University in Philadelphia, PA. My Care Friends Website About Dr. Raj Dr Raj is a quadruple board certified physician and associate professor at the University of Southern California. He was a co-host on the TNT series Chasing the Cure with Ann Curry, a regular on the TV Show The Doctors for the past 7 seasons and has a weekly medical segment on ABC news Los Angeles. Want more Dr. Raj? Check out the Beyond the Pearls lecture series! The Ultimate High Yield Bundle: The complete review of high-yield clinical medicine topics necessary for graduate medical education board exams including NBME, USMLE Steps 1/2/3, ITE and ABIM Boards. You can also listen to the Beyond the Pearls podcast. Check out our other shows: Physiology by Physeo Step 1 Success Stories The InsideTheBoards Study Smarter Podcast The InsideTheBoards Podcast Produced by Ars Longa Media To learn more about us and this podcast, visit arslonga.media. You can leave feedback or suggestions at arslonga.media/contact or by emailing email@example.com. Produced by: Christopher Breitigan and Erin McCue. Executive Producer: Patrick C. Beeman, MD Legal Stuff The information presented in this podcast is intended for educational purposes only and should not be construed as professional or medical advice. Learn more about your ad choices. Visit megaphone.fm/adchoices
Understanding the intricacies of your team's personalities can greatly contribute to building a cohesive and efficient practice.In this episode, I am joined by Dr. Andrew Sarpotdar as we delve into how orthodontists can leverage personality types, particularly the Myers-Briggs Type Indicator (MBTI), to enhance their practice management and team dynamics.Personality types are essential tools for promoting self-awareness, understanding team members, and facilitating conflict resolution within an orthodontic practice.By using MBTI or similar frameworks, team members can identify their triggers and understand their colleagues' reactions. This self-awareness can lead to more effective and less emotional conflict resolution. The focus is on addressing the issues rather than personalities.While personality tests cannot be used for hiring, they can be immensely beneficial in creating a harmonious work atmosphere. They can help you understand how a potential employee might fit into your practice's culture.In addition to personality types, a big part of our discussion centers around Dr. Sarpotdar's other interests. He plays a big role in organizing the Mother of Pearls Conference and the Orthodontic Pearls Facebook group.Not too long ago, many online groups and forums were plagued by malevolent operators who aimed to disrupt and cause discord. However, there has been a noticeable shift in recent years.The toxic elements that once marred these platforms seem to have receded into the background. The online culture has shifted towards more collegial and respectful discussions.Join us in this conversation as we dive deep into these topics and more! Key Takeaways- Intro (00:00)- The changing online culture in orthodontic groups (06:13)- Mother of Pearls conference (14:18)- The challenges of organizing a conference (15:35)- The value of in-person meetings (20:52)- Why you need personality testing (22:32)- Introspection, self-awareness, and leadership (29:48)- Role of personality tests in hiring (34:04)Additional Resources
Pastors Levi and Travis talk about Nehemiah 8 when the people read the word of God and remembered to be obedient. This is an episode of Pearls & Swine on the Evangel Houghton Podcast from Evangel Community Church, Houghton, Michigan, November 7, 2023.
ASCO: You're listening to a podcast from Cancer.Net. This cancer information website is produced by the American Society of Clinical Oncology, known as ASCO, the voice of the world's oncology professionals. The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guests' statements on this podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement. Cancer research discussed in this podcast is ongoing, so data described here may change as research progresses. In this podcast, Cancer.Net Associate Editor for Lung Cancer, Dr. Charu Aggarwal, and Cancer.Net Specialty Editor for Thymoma, Dr. Ryan Gentzler, discuss what people with early-stage non-small cell lung cancer should know about their treatment options before and after surgery, called neoadjuvant therapy and adjuvant therapy, respectively. Dr. Aggarwal is the Leslye Heisler Associate Professor of Medicine in the Hematology-Oncology Division at the University of Pennsylvania's Perelman School of Medicine. Dr. Gentzler is a thoracic medical oncologist and Associate Professor of Medicine in the Division of Hematology/Oncology at the University of Virginia (UVA) Comprehensive Cancer Center. View disclosures for Dr. Aggarwal and Dr. Gentzler at Cancer.Net. To begin, Dr. Gentzler will discuss what people with early-stage non-small cell lung cancer should know about neoadjuvant treatment options before lung surgery. Welcome, Dr. Gentzler. Dr. Gentzler: Hi, this is Ryan Gentzler from the University of Virginia. We're here to discuss the role of neoadjuvant chemotherapy and immunotherapy for the treatment of locally advanced non-small cell lung cancer. So first, I thought I'd address some of the data and definition of what is neoadjuvant treatment. So when we think about treating lung cancer that is not metastatic, that is earlier stage disease, there typically involves multimodality treatment. Sometimes these lesions or tumors can be very small and can be stage I and treated with surgery alone or perhaps radiation alone and no further treatment is needed. But the vast majority of lung cancers that are considered early stage are in fact either larger tumors, involve lymph nodes, and typically fall into the category of stage II or III lung cancers. And these are cancers that often require multiple treatments beyond the local surgery approach alone. When we think about how we deliver that treatment, it can either be given before surgery or after a surgery. If we give treatment before a surgery, we call that neoadjuvant. If it is given after the surgery, we call that adjuvant. And most of the data that we have today in lung cancer uses one or the other of these approaches, and we don't typically give treatments both before and after, at least in terms of the chemotherapy part of that treatment. Historically, most of the data exists in the adjuvant treatment of lung cancer going back several decades that showed that the benefit of chemotherapy after a surgery, particularly for those with stage II and stage III lung cancer, derived a clear benefit of survival by giving chemotherapy after surgery. More recently, with the advent of immune therapy, which we have used in patients with stage IV lung cancer as well as those with stage III lung cancer who cannot undergo surgery, those immunotherapy drugs have been shown to improve overall survival and improve clinical outcomes for a wide range of patients with more advanced disease. And so in the last 4 or 5 years, we have really looked at new trials that have added immunotherapy in what we call perioperative space, either before surgery or after surgery for those that have surgically resectable disease. I'm going to focus on the neoadjuvant approaches that we have seen today, and this largely all started with data from Patrick Forde out of Johns Hopkins and Jamie Chaft from Memorial Sloan Kettering looking at single agent treatment with nivolumab immunotherapy. This was no chemotherapy given for 3 treatments prior to or three cycles prior to surgery. And that trial demonstrated a high degree of patients with tumor reduction and more importantly, we saw that the pathologic response, meaning how much tumor was left under the microscope at the time of surgery, was higher than what anyone anticipated with just immunotherapy alone. That launched a whole series of larger randomized prospective trials evaluating largely the combination of chemotherapy and immune therapy prior to surgery. Now, before we get into some of the results of these trials, I really wanted to emphasize some of the theoretical advantages to neoadjuvant approach. Now, the first potential advantage of giving neoadjuvant treatment is that we know when you start with immunotherapy and chemotherapy regimens and that's the first type of treatment, everyone is guaranteed to get that treatment. And we know that the completion rate prior to surgery is higher than it is after surgery. These patients can get all of the prescribed treatment and will be more likely to get it than if they get it after surgery. So this is one advantage. The other is potentially starting these medications which go throughout the body and treat the cancer, wherever it may be, earlier. We know that one of the risks of all cancers, but lung cancer in particular, is that even with good surgery and removing all of that cancer, there is a chance that there are cancer cells left behind, which leads to risk of recurrence in the years to come after surgery. Naturally, if we start the treatment that can eliminate those cancer cells, wherever they may be, and do that first, perhaps we catch this earlier with fewer cells that have escaped and have a more likely chance of success of eliminating the cancer and resulting in a cure. The third, I think, is one that we still have yet to learn more about, but if we give immunotherapy in particular, these are medications that activate the immune system, particularly the type of immune system cell called a T cell. If that T cell is able to recognize tumor cells, it is more likely to be able to continue to attack those tumor cells. And if we give that treatment prior to removal of the tumor, perhaps that activates the immune system in a more robust way that it can go after these cancer cells and eliminate those that are left behind after the surgery. If you give the immunotherapy after a surgery and the bulk of the tumor, most of the cancer cells have been removed, it may be harder to find those antigens or foreign proteins that are expressed in cancer cells. So the immune system may not be as robustly able to go after cancer if you give it solely after a surgery. Another potential advantage of neoadjuvant approaches is that it really helps us learn as oncologists how well a cancer is responding to a treatment. If we give these treatments for 4 cycles after a surgery, we don't know whether it's eliminating those residual cancer cells or whether it is totally ineffective. If we give it before a surgery and we see that there is tumor reduction or that there is a complete elimination of the cancer, we know that that treatment was an effective treatment at attacking the cancer cells and eliminating them. We know that the cancer was sensitive to that treatment. We can then better prognosticate how well the patients are going to do after surgery. We know based on the latest data that if you achieve what we call a pathologic complete response with chemotherapy and immunotherapy prior to surgery, meaning there are no cancer cells left when we look at that surgical specimen under the microscope, we know that those patients have a much better likelihood of surviving for longer periods of time than those who have active cancer at the time of surgery after prior treatment. And so neoadjuvant approaches allow us in a 2-month time frame to get a great sense of how well our treatments are working and able to prognosticate outcomes based on how well those cancer cells have been eliminated at the time of surgery. One large phase 3 trial called the CheckMate 816 trial was a randomized phase 3 trial and that enrolled patients with stage IB through IIIA non-small cell lung cancer using the old staging system of the 7th edition. These would all now be categorized as stage II and stage III non-small cell lung cancer patients. And it randomized these patients to 3 cycles of chemotherapy plus nivolumab, which is an immunotherapy drug, and compared that to patients treated with chemotherapy alone for 3 cycles. After these 3 cycles of chemotherapy, which is about a 9-week time frame, patients had surgical resection of their tumors. And then after surgery, patients received no further treatment, although treating physicians were allowed to give additional treatments like chemotherapy or radiation if they thought it would be beneficial for these patients, although it was not mandated by the study. One of the first results we saw from this study was that there was a much higher rate of pathologic complete response of 24% of patients achieving a path CR [pathologic complete response] with the nivolumab plus chemotherapy combination compared to only 2.2% with chemotherapy alone. This was highly statistically significant and demonstrated a clear benefit for those receiving the immunotherapy. The other main endpoint of this study was event-free survival, meaning that the time that the patients were alive and without any significant event like cancer progression or death after the enrollment of the trial. And in this analysis, the median event-free survival was significantly longer in those who have received the immunotherapy plus chemotherapy combination prior to surgery. One of the potential concerns about neoadjuvant treatment is that it may render patients unfit for surgery who otherwise could have had their cancer removed. When we look at the outcomes from this CheckMate 816 trial, it actually did not appear to be the case to a large degree. In fact, those that got the nivolumab plus chemotherapy combination were more likely to proceed on with surgery, and the majority did; 83% received the planned surgery. There were patients who were unable to receive surgery due to adverse events of their treatment, but that was only 1% of patients enrolled in the trial. Other reasons for canceling the surgery included disease progression, meaning the cancer got worse to the point where they could not undergo surgery, or other reasons, such as the patient declined surgery, or it was found to be unresectable at the time the surgeon wanted to remove the cancer, or poor lung function. One of the insights we got from the surgical data from this trial were that those who received the combination of chemotherapy and immunotherapy had slightly higher rates of smaller surgeries like a lobectomy compared to a pneumonectomy for those who had received [chemotherapy alone.] There were also fewer numbers of patients who required a conversion from a minimally invasive surgical procedure to an open surgical procedure if they were getting the immunotherapy combination. A higher number of patients also were able to have complete resection of their tumor if they received the immunotherapy/chemotherapy combination. The length of hospitalization was slightly lower, and the rates of pain were slightly lower in those who received the combination as well. These comparisons were not statistically significantly different, but numerically, there seems to be at least a trend toward benefit in surgical outcomes in this neoadjuvant chemotherapy/immunotherapy approach. And I think this makes sense. We know that this combination is more able to eliminate a cancer and make it a pathologic complete response when we look at it under the microscope, and therefore, if there is shrinking the tumor to a higher degree, naturally, it seems there would be more likely of completely removing the tumor, using a smaller incision to remove that tumor, shortening the length of stay in the hospital and recovery time and pain control. All makes sense if we know that the treatment itself is able to reduce that size of the tumor. There are many other phase 3 trials ongoing studying the impact of immunotherapy plus chemotherapy in the neoadjuvant setting. The AEGEAN trial has recently reported data at the AACR meeting this year in 2023 with similar results that we saw with the CheckMate 816 trial. There are 3 other phase 3 trials that are ongoing, one of which we will see later this summer called the KEYNOTE-671 trial evaluating pembrolizumab plus chemotherapy in the neoadjuvant setting and then 2 other trials evaluating nivolumab, the CheckMate 77T trial, or atezolizumab in the IMpower030 trial. Each of these more recent trials typically have used 4 cycles of chemotherapy plus immunotherapy prior to surgery and also continued the immunotherapy after surgery for a period of time, most commonly approximately 1 year. From the data we have seen so far, it remains uncertain whether additional immunotherapy beyond the 3 or 4 cycles given in the neoadjuvant setting provides any additional benefit. We still do not understand what to do with patients who did not achieve a pathologic response whether further treatment would be of any additional benefit. We do not know if there will be further benefit even in those that achieved a pathologic complete response whether a slightly longer duration of immunotherapy would further improve outcomes in that group. We suspect with longer-term follow-up over the years of all of these phase 3 trials that some of these questions will be answered. So what are some key questions that patients should ask when considering a neoadjuvant chemotherapy/immunotherapy approach? I think the first question that's key is what is my tumor stage? We know that the trials that enrolled patients with a neoadjuvant approach enrolled patients using our current staging system would be a stage II or stage III lung cancer. And this is where it gets really tricky is, what subdivision of stage III is it? We tend to think of stage IIIA's as being one that it would be surgically resectable, with a smaller number of stage IIIBs, and then stage IIIC, one that we would not typically recommend surgery for. I think the next question within the tumor stage is, is this based on imaging or based on the biopsies? And we know that biopsies are really the best way to stage locally advanced cancers, particularly getting samples of lymph nodes in the mediastinum. Sometimes what looks like a stage I or stage II on imaging is, in fact, a stage III based on biopsies that are done at the time of surgery. It's ideal to know that information prior to making the decision about surgery so that that surgery is not futile. On the opposite side, sometimes there is imaging suggestive of lymph nodes that are enlarged in the mediastinum, and it's presumed that this is a more advanced stage III and is not surgically resectable. However, if you go and biopsy those lymph nodes, sometimes they are benign. Sometimes they are inflammation related to infection or cancer but do not actually contain cancer cells. And so we typically advise that getting biopsies of lymph nodes in the mediastinum, at least any that are particularly suspicious, is highly recommended for these locally advanced cancers. I think the next question that's key to ask is, what are my tumor biomarkers? And there are multiple biomarkers that we look at in non-small cell lung cancer that help us decide what is the best treatment. What is the best approach? What is the best medicine to treat the cancer? We know that one of these biomarkers that is a key is a mutation. So multiple different mutations can occur in lung cancers, particularly those that are adenocarcinoma subtypes. And these mutations may be less likely to benefit from immunotherapy and we may want to take a different approach with surgery, chemotherapy, and potentially targeted therapies that specifically target that mutation that exists in the tumor. The other key biomarker here is PD-L1. We know that tumors with a higher level of PD-L1 are more likely to respond and benefit from immunotherapy. As of right now, that PD-L1 status plays a more important role in the adjuvant setting. All of the chemotherapy plus immunotherapy combinations in the neoadjuvant setting seem to benefit the group as a whole regardless of that PD-L1 status. But still, an important biomarker that we should have prior to making all final decisions on treatment. I think another question that should be asked any time you have an earlier stage cancer is, is my tumor surgically resectable? And there can be many reasons why cancers are not resectable, perhaps due to the anatomy of where the tumor is located, if it invades into the mediastinum, for example, or is near large blood vessels, or perhaps because there are too many lymph nodes and this is a more advanced stage. And so I think the main reasons for not being surgically resectable would be the tumor is too large, if the stage is too high, or is it more of a function of fitness for surgery and that can be because of other underlying lung disease. Perhaps removing part or all of a lung would not be safe due to impaired lung function to begin with. And I think it's important to understand that sometimes stage III lung cancers are resectable and sometimes they are not, and understanding the reason why they are not, I think, is important. And then I think lastly and ultimately when we're talking about a neoadjuvant approach, you want to ask your treating oncologist, "Would it be better to give my treatment before surgery or after surgery?" And really discuss the pros and cons with the physician and have them incorporate all of the factors that go into these treatment decisions. How well you'll tolerate chemotherapy, other medical conditions that may play a role in the likeliness of getting through those treatments safely, perhaps underlying diseases that may increase the risk of immune-related side effects with immunotherapy. You really want to factor in all of these things and discuss the pros and cons of a systemic treatment first versus surgery first before making final decisions on how to treat locally advanced lung cancer. All right. Thank you. ASCO: Thank you, Dr. Gentzler. Next, Dr. Aggarwal will discuss what people with early-stage non-small cell lung cancer should know about their adjuvant treatment options for after lung surgery. Dr. Aggarwal: This is Dr. Charu Aggarwal. I'm the Leslye Heisler Associate Professor for Lung Cancer Excellence at University of Pennsylvania's Abramson Cancer Center. And today I will talk to you about the use of adjuvant immunotherapy in the setting of early-stage non-small cell lung cancer. We'll start by discussing what adjuvant therapy is, what types of options we have for adjuvant therapy, what kind of testing is important, and what options there may be in terms of adjuvant immunotherapy. So let's get started. Early-stage lung cancer comprises of stages between stage I to stage III. These stages vary by the size of the tumor as well as the level of lymph node involvement. In the setting of very early-stage lung cancer, such as stage I and stage II, as well as some select stage III lung cancers, we recommend surgical resection. And in these patients, the use of additional treatment is recommended based upon the pathological determination of the tumor size as well as the lymph node status. If usually lymph nodes are involved, we recommend adjuvant chemotherapy, and also, many experts will deliver adjuvant chemotherapy for tumors that may be larger than 4 centimeters even in the absence of lymph node involvement. The data for adjuvant chemotherapy comes from several large clinical trials that were conducted about a couple of decades ago now that demonstrated not only an improvement in preventing recurrence of the cancer but also a modest improvement in overall survival, really laying the ground for improvement and therefore becoming the gold standard. Four cycles of chemotherapy are usually administered about 6 to 12 weeks following surgical resection, and this is really the basis of our treatment in the early-stage setting. In today's time and age, we now have several other options. We have treatment options that include molecular therapy, which is biomarker driven, as well as the use of immunotherapy. So it's actually very important for us in the adjuvant setting--or in the post-surgical setting--to test for mutations such as EGFR. It's also important for us to test PD-L1 status. So let's dive into why each of these may be important. Patients with EGFR mutations, especially those with sensitizing mutations in EGFR exon 19 or 21, now have the opportunity to receive a targeted therapy in the form of osimertinib, which is an oral drug, very targeted and specific for the EGFR mutation that has been studied in a clinical trial setting in patients with early-stage non-small cell lung cancer. In patients with stage IB to IIIA non-small cell lung cancer with EGFR mutation, use of osimertinib was associated with a significant improvement in our ability to delay the recurrence of cancer. Based on this significant improvement, FDA approved therapy with osimertinib, and it is currently available and ready to use. We usually recommend it for 3 years, so daily therapy for 3 years, and patients are monitored with routine CAT scans and lab work. For patients who don't have an EGFR mutation, we do recommend broad panel testing. Of course, this is not the standard, but I think it's important for us to identify patients who may not benefit from immunotherapy. Patients that have an ALK mutation, for example, or ROS1 translocation, may not have the best chances of responding to adjuvant immunotherapy, and therefore, I think testing should be performed to make sure that we are having a shared decision-making conversation with our patients about the use of the correct adjuvant options. In terms of adjuvant immunotherapy, we now have 2 approved agents. One of them is atezolizumab, and the other one that was just recently approved is pembrolizumab. Atezolizumab was approved on the basis of a large clinical trial called the IMpower010 study, which randomized 1,280 patients with stage IB to IIIA non-small cell lung cancer to either 1 year of atezolizumab or best supportive care. Of note, all of these patients had to have had adjuvant chemotherapy that included a cisplatin platinum chemotherapy. In the first analysis, we found that the disease-free survival or the probability of the patients remaining cancer-free was significantly improved in those patients that had a tumor expression of PD-L1 greater than or equal to 1% and received atezolizumab compared to patients who did not receive atezolizumab. On the basis of this positive primary endpoint, the U.S. FDA approved the use of adjuvant atezolizumab for patients with stage II to IIIA resected non-small cell lung cancer after surgical resection and adjuvant chemotherapy. Recently, we heard that this does lead to small but significant improvement in overall survival. There is a trend towards improvement in overall survival. However, the data are quite immature at this point, and we do need longer follow-up to be able to follow this trend. The greatest magnitude of overall survival benefit was found in patients who had the PD-L1 greater than or equal to 50%. So it's important to know what the PD-L1 level of a patient may be when I'm thinking about adjuvant immunotherapy because adjuvant immunotherapy is most likely to benefit those that don't have an actionable mutation, such as EGFR, and those that have the highest PD-L1 staining, at least in the IMpower trial. Secondly, the PEARLS clinical trial is a clinical trial that evaluated the use of pembrolizumab, which is another immunotherapy agent, again, in the adjuvant setting. For this clinical trial as well, there was a small but significant improvement in disease-free survival, again preventing the probability of recurrence in all patients that received pembrolizumab compared to the best supportive care. And basically, this led to also an approval by the FDA for the use of pembrolizumab. Again, now we have 2 options. Both of these are administered for 1 year. What should patients know about therapy? These drugs are usually administered once every 3 weeks. They are given intravenously. Sometimes, we can change the treatment schedule to be either once every 4 weeks in the case of atezolizumab or every 6 weeks in the case of pembrolizumab. These may be associated with some side effects. Immunotherapy side effects that are most common are fatigue, chills, myalgias, or basically a feeling of pains in the body or joints. But also, some serious life-threatening reactions can occur such as activation of the immune system to such an extent that the immune system may start to attack the body's organs. So this may lead to swelling or inflammation in the organs that may manifest itself as colitis if the gut gets inflamed, or pneumonitis if the lungs were to get inflamed, or pancreatitis if the pancreas were to get inflamed. Any organ in the body can really get inflamed. We've certainly seen cases of thyroiditis. We've seen cases of polyarthritis. We've seen cases where the brain may also get inflamed or the pituitary may get inflamed. So there are definitely some life-threatening reactions or side effects that can occur with the use of immunotherapy that should be closely monitored. The benefit of having used immunotherapy in the metastatic setting is that now we have a lot of experience managing these side effects. And if recognized early, these side effects can be managed appropriately with the use of steroids as well as holding therapy. Many of the times, we can even reinstitute immunotherapy without significant harm to the patients. However, I think immunotherapy benefits as well as side effects should be discussed in detail with the provider, especially in the adjuvant setting. Patients may ask if neoadjuvant immunotherapy along with chemotherapy is a better approach compared to adjuvant immunotherapy. At this time, we don't have a clinical trial that is comparing neoadjuvant chemoimmunotherapy followed by surgery to an approach that is surgery followed by adjuvant immunotherapy. In general, I would say that if the decision by a multidisciplinary team has been made to proceed with surgery, careful discussion should be had about adjuvant chemotherapy as well as the use of adjuvant immunotherapy, and molecular testing should be performed. All patients with early-stage disease should have a multidisciplinary tumor board discussion, which includes engagement with surgeons, radiation oncologists, pulmonologists, pathologists, and medical oncologists so that they can ensure that many experts have had the chance to weigh into their case as well as come to the right conclusion on whether or not to use new adjuvant chemoimmunotherapy or just to proceed with surgical resection. ASCO: Thank you, Dr. Aggarwal. You can learn more about neoadjuvant and adjuvant treatment options for early-stage non-small cell lung cancer at www.cancer.net/lung. 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11/06/2023 | CT of Calyceal Abnormalities in the Kidney: Pearls and Pitfalls - Part 1
Contributor: Travis Barlock MD Educational Pearls: Common sedatives used in the Emergency Department and a few pearls for each. Propofol Type: Non-barbiturate sedative hypnotic agonizing GABA receptors. Benefit: Quick on and quick off (duration of action is approximately 2-7 minutes), helpful for suspected neurologic injury so the patient can wake up and be re-evaluated. Also has the benefit of reducing intracranial pressure (ICP). Downsides: Hypotension, bradycardia, respiratory depression. What should you do if a patient is getting hypotensive on propofol? Do not stop the propofol. Start pressors. May have to reduce the propofol dose if delay in pressors. Dexmedetomidine (Precedex) Type: Alpha 2 agonist - causes central sedation Uses: Patients are more alert and responsive and therefore can be on BiPAP instead of being intubated. Does not cause respiratory depression. Downsides: Hypotension and Bradycardia. Caution in using this for head injuries, its side effects can mask the Cushing reflex and make it more difficult to spot acute elevations in ICP and uncal herniation. Ketamine Type: NMDA antagonist and dissociative anesthetic, among other mechanisms. Benefits: Quick Onset (but slower than propofol). Does not cause hypotension, but can even increase HR and BP (Thought to potentially cause hypotension if patient is catecholamine-depleted (ie. sepsis, delayed trauma)). Dosing ketamine can be challenging. Typically low doses (0.1-0.3mg/kg (max ~30mg)) can give good pain relief. Higher doses (for intubation/procedural sedation) are generally thought to have a higher risk of dissociation. Downsides: Emergence reactions which include hallucinations, vivid dreams, and agitation. Increased secretions. Benzos Type: GABA agonists. Benefits: Seizure, alcohol withdrawal, agitation due to toxic overdoses. Push doses are useful because doses can stack. Longer half-life than propofol. Downsides: Respiratory depression. Longer half-life can make neuro assessments difficult to complete. Etomidate MOA: Displaces endogenous GABA inhibitors. Useful as a one-time dose for quick procedures (cardioversion, intubation). Often drug of choice for intubation since it is thought to have no hemodynamic effects. Downsides; If used without paralytic - myoclonus. Though to have some adrenal suppression. Fentanyl Type: Opioid analgesic. Not traditional sedative. Benefits: There are many instances in emergency medicine in which sedation can be avoided by prioritizing proper analgesia. Fentanyl can even be used to maintain intubated patients without needing to keep them constantly sedated. Downsides: Respiratory depression. Patients may have tolerance. References Chawla N, Boateng A, Deshpande R. Procedural sedation in the ICU and emergency department. Curr Opin Anaesthesiol. 2017 Aug;30(4):507-512. doi: 10.1097/ACO.0000000000000487. PMID: 28562388. Keating GM. Dexmedetomidine: A Review of Its Use for Sedation in the Intensive Care Setting. Drugs. 2015 Jul;75(10):1119-30. doi: 10.1007/s40265-015-0419-5. PMID: 26063213. Lundström S, Twycross R, Mihalyo M, Wilcock A. Propofol. J Pain Symptom Manage. 2010 Sep;40(3):466-70. doi: 10.1016/j.jpainsymman.2010.07.001. PMID: 20816571. Matchett G, Gasanova I, Riccio CA, Nasir D, Sunna MC, Bravenec BJ, Azizad O, Farrell B, Minhajuddin A, Stewart JW, Liang LW, Moon TS, Fox PE, Ebeling CG, Smith MN, Trousdale D, Ogunnaike BO; EvK Clinical Trial Collaborators. Etomidate versus ketamine for emergency endotracheal intubation: a randomized clinical trial. Intensive Care Med. 2022 Jan;48(1):78-91. doi: 10.1007/s00134-021-06577-x. Epub 2021 Dec 14. PMID: 34904190. Mihaljević S, Pavlović M, Reiner K, Ćaćić M. Therapeutic Mechanisms of Ketamine. Psychiatr Danub. 2020 Autumn-Winter;32(3-4):325-333. doi: 10.24869/psyd.2020.325. PMID: 33370729. Nakauchi C, Miyata M, Kamino S, Funato Y, Manabe M, Kojima A, Kawai Y, Uchida H, Fujino M, Boda H. Dexmedetomidine versus fentanyl for sedation in extremely preterm infants. Pediatr Int. 2023 Jan-Dec;65(1):e15581. doi: 10.1111/ped.15581. PMID: 37428855. Summarized by Jeffrey Olson MS2 | Edited by Jorge Chalit, OMSII
Undecided about your career path? From clinical to specialty pharmacy, informatics to ambulatory care — the options seem endless. In the Career Pearls for Students podcast series you will hear from pharmacists who work in various pharmacy practice settings to learn more about what a day in the life is like. Take away information about careers you have interest in but never took the time to learn about — you may even find something you never knew existed. The information presented during the podcast reflects solely the opinions of the presenter. The information and materials are not, and are not intended as, a comprehensive source of drug information on this topic. The contents of the podcast have not been reviewed by ASHP, and should neither be interpreted as the official policies of ASHP, nor an endorsement of any product(s), nor should they be considered as a substitute for the professional judgment of the pharmacist or physician.
COME TO INDIA WITH US!Emma & Bruce are leading our FIRST EVER Hidden Pearls international journey to INDIA!!March 16-30 (yes two full weeks)Only 20 spots available.Here is the sign up link:https://nandajourneys.wetravel.com/trips/india-mindfulness-and-cultural-journey-with-bruce-and-emma-kittle-nanda-journeys-delhi-division-31169708There is a ton of information in the linked PDF's so keep scrolling and clicking around :) While the 49ers are enjoying the bye week and getting some much needed R&R, we would like to introduce our Hidden Pearls tribe to Nicola Balmain and Pam Gibson MacDougall. Nicola is the founder of Nanda Journeys and Pam is the Emmy award winning Director of Marketing for Operation Freedom Paws. On this journey we will explore the sights and sounds of India while also participating in mindful practices with Bruce and Emma to enhance your wellness journey! Participate in meaningful service and adventure while also supporting the impactful mission of 501(c)(3) nonprofit Operation Freedom Paws. Your journey of physical and mental well-being to India will empower OFP to support the physical and mental well-being of veterans, first responders, children, and other individuals with disabilities.If you are interested in learning more you are welcome to reach out to us through firstname.lastname@example.org or email@example.com.You can learn more about OFP here - https://operationfreedompaws.orghttps://www.nandajourneys.comHPP 128 with Operation Freedom Paws:https://www.youtube.com/watch?v=oGOcanc1aag&t=1564sCAN'T WAIT TO SEE YOU IN INDIA!Emma & Bruce
This month Zack gives some pearls from his travels to Prague for Jan Behlolavek's ECPR school, Poland to meet with Marek Dabrowski, and ELSO with the entire crew. Zack also interviews Saul Levine for the first of what may be a recurring conversation about the San Diego Resuscitation Consortium. His efforts along with Kristi Koenig, Shawn Evans, Todd Baumbacher, and many others have paved the way for an OHCA ECPR protocol that may change more than just San Diego cardiac care. Listen to Saul explain how the first 3 months of this process has expanded the minds of what cardiac arrest care can look like.
Prince's live show evolved rapidly in the lead-up to the Diamonds And Pearls Tour. NPG members Michael B. Nelson, Mayte Garcia, Damon Dickson, Tony Mosley, Levi Seacer, Sonny Thompson, and Kirk Johnson talk about Prince's unforgettable live performances. Learn more about your ad choices. Visit podcastchoices.com/adchoices
"The reality is, and the catchy way to remember it is, 'If it needs a sign, it's bad design.' You see a teakettle, and you immediately know how to use it. " —Gregory Khodorov, MD, MBAAs part of a new series from the SIR Medical Student Council (MSC) Biodesign Committee, hosts Eleanor Lee, MPH, and Savraj Saggu speak with Gregg Khodorov, MD, MBA, on identifying problems to solve in interventional radiology, how to recognize bad design and more.Note: Submissions for the committee's next biodesign competition will be due on Jan. 15, 2024. Watch for more details in the SIR Connect RFS Community. Related resources:Competition themeRegistrationSyllabus(c) Society of Interventional Radiology.Support the show
Most people want to live forever. They desire long, healthy, fulfilling lives. But God has a bigger, better plan, though it comes at a cost. There is a training process that we need to go through. More than that, a complete change of heart is needed – we must be born again. And to follow Christ, our will must be submitted to His will, and our lives must be filled with His Spirit. There is only one way to eternal life. The Apostle Peter signed up for a life like that. He left his career, his family, and whatever meager enjoyments he might have had to follow a humble, nondescript Teacher named Jesus. During those three years of training, Peter was taught by the Master. Some of those lessons were not easy at all; yet Peter was given grace in the eyes of the Lord, and when he fell, the Lord forgave him, strengthened him, and kept him to the end. What about you? Do you need courage, strengthening, and training? In this book, J. Wilbur Chapman admonishes, teaches, and encourages. Chapman's love for the Lord and for His people shines clearly in his messages. He expounds on Scripture, relates real-life stories, and tells us about the only way to be saved – and how we may experience the fullness of life in Christ.
It's impossible to discuss Diamonds And Pearls without mentioning Prince's co-starring vocalist, Rosie Gaines. Where is she now? You'll find out with the help of Rosie's daughter, LaToya Gaines—and hear a special message from Rosie herself. Learn more about your ad choices. Visit podcastchoices.com/adchoices
The era of LSAT logic games is coming to a close. Beginning in August 2024, the exam's Analytical Reasoning section will be removed, making room for a second section of Logical Reasoning. Ben and Nathan share their take on the news and offer advice to present and future LSAT students. Later, the guys cast doubt on income-driven loan repayment programs. They urge listeners to see the LSAT as a stepping stone, not a stumbling block. And they assess the admissions prospects of low-GPA splitters. LSAT Demon LSAT Demon iOS App LSAT Demon Daily Watch Episode 425 on YouTube Thinking LSAT YouTube LSAT Demon YouTube 1:28 - Logic Games Going Away Nathan and Ben lament LG's imminent demise. 20:37 - Pearls vs. Turds Should listener Taylor attend an overpriced law school and trust a federal income-driven repayment program to help pay off their debt? Ben and Nathan caution Taylor to steer clear of loan forgiveness traps. 26:04 - LSAT Pressure An anonymous listener struggles with burnout and anxiety. Nathan and Ben counsel Anonymous to accept a long-term LSAT study plan that doesn't put life on hold. 39:50 - Return to Fundamentals Despite recent success in their prep, an anonymous LSAT Demon student has reverted to some bad habits. Ben and Nathan recommend taking some time off from the LSAT and returning to fundamentals. 59:00 - Appealing to Retake Listener TH shares the story of how they successfully appealed to take the LSAT a seventh time. 1:06:13 - Applying to HYS An anonymous listener considers applying to a few elite law schools this year, then applying more broadly next cycle if necessary. Nathan and Ben worry that this plan could shut the door on scholarships from other excellent schools. 1:10:40 - GPA Questions The guys address a series of questions from listeners with low undergraduate GPAs. Crushing the LSAT won't erase an applicant's low GPA, but it's their best shot at tipping the scales in their favor.
The roots of The New Power Generation extend back to Prince's childhood growing up in North Minneapolis. Founding NPG members Tony Mosley, Sonny Thompson, Kirk Johnson, Damon Dickson, and Prince's high school girlfriend Cari Price shed light on what the community meant to Prince. Learn more about your ad choices. Visit podcastchoices.com/adchoices
The boys let things go while trying to not be sued by Disney. Just in time for the tenth anniversary of the animated movie Frozen—which for some reason Producer Ron is really excited about—the boys challenge each other to ‘let it go,' whatever that means to them individually. Featuring standup comedy clips from Miriam Moreno and Ben Bryant! This episode is brought to you by our newest sponsor, Adam's Pearls! LINKS: See the Grawlix live standup show at the Bug Theatre in Denver, Colorado on Saturday, October 28th with Chris Fairbanks and Liv Carter! See Adam on November 17-18th at the Laughing Tap in Milwaukee, Wisconsin See Ben and Adam on December 9th at Cumston Hall in Monmouth, Maine See Andrew at a Don't Tell Comedy show near you Support us on Patreon for ad-free episodes, Act 4, birthday shout-outs, stickers, exclusive merch, every episode of Boi Crazy, bonus videos and so much more Give us a follow and say hello on Instagram, Twitter, TikTok, Facebook, YouTube and Discord! Let go of the things that are holding you back... and then strut off into the sunset wearing nothing but official Grawlix merch Learn more about your ad choices. Visit megaphone.fm/adchoices
As the ‘80s drew to a close, Prince set his sights on completely redefining his look, sound, and band for the new decade. Musicians Michael Bland, Levi Seacer Jr., Rosie Gaines, Tommy Barbarella, and Sonny Thompson explain how Prince assembled the live band. Learn more about your ad choices. Visit podcastchoices.com/adchoices