Podcasts about Raas

DAMIONCarnival Corporation's data breach exposed personal data of nearly 6 million customers: An April social engineering attack on an employee account compromised names, dates of birth, and government-issued ID numbers. WHO DO YOU BLAMESkills: Technology & Cybersecurity: Experience with information technology and cybersecurity matters is increasingly important to mitigate the risks our business faces, promote innovation and maintain a competitive edge in a rapidly evolving technological ageLeast represented 5/11CEO Josh WeinsteinNO: at Carnival since 2002, started as General CounselSir Johathon BandNO: First Sea Lord and Chief of Naval Staff, the most senior officer position in the British Navy (2006 to 2009, when he retired); Admiral and Commander-in-Chief Fleet (2002 to 2006); Served as a naval officer in increasing positions of authority (1967 to 2002)Jason CahillyNO: CEO Dragon Group LLC, provides capital and business management consulting and advisory services worldwide; The NBA: CFO & Chief Strategic Officer; Goldman Sachs: Partner; Global Co-Head of Media and Telecommunications; Head of Principal Investing for Technology, Media & TelecommunicationsNelda ConnorsNO: CEO/Chair Pine Grove Holdings, a privately held investment company; CEO Atkore International, manufacturer of electrical, safety and infrastructure solutions; VP Eaton Corporation, electrical and automotive supplierLaura WeilNO: Founder Village Lane Advisory LLC, specializes in providing executive and strategic consulting services to retailers COO New York & Company, women's apparel and accessories retailer; CEO Ashley Stewart, women's apparel retailer; CEO Urban Brands, apparel retailer; COO AnnTaylor Stores, women's apparel retailer; CFO American Eagle Outfitters, apparel retailerAudit Committee: Oversee management's risk assessment processes to identify principal and emerging risks, including financial, IT, cybersecurity and non-HESS operational risksLaura Weil*: NOJason Cahilly: NOJeffrey Gearhart: NOWalmart Corporate Secretary and lawyerStuart Subotnick: NOCEO at Metromedia Company, wireless/communications, until 2010; Carnival director since 1987 Health, Environmental, Safety and Security Committee: Oversee management's processes to identify principal and emerging health, environmental, safety, security and sustainability-related risks, including those related to ship operations and cybersecurity, RAAS health, environmental, safety, security audits, IAG and external investigations into significant ship incidents, and health, environmental, safety, security-related hotline complaints, and assess the steps management has taken to minimize such risks.Sir Johathon Band*: NONelda Connors: NOHelen Deeble: NOFormer CEO P&O Ferries Division Holdings, shipping and logistics businessKatie Lahey: NOExecutive Chair Korn Ferry Australasia, leadership and talent firmMicky Arison (75%): Exec Chair and former CEO and 7% stockholderThe CEO Pay Ratio1,063:124 retail CEOs made as much in a day as their typical employee earned in a year — and a big one didn't. WHO DO YOU BLAMEThe separation of CEO and Chair: Hamilton E. James Chair/Ron Vachris MMNot uniqueOnly 50% of the board is men. WTF?uniqueOne share = one voteNot uniqueState of HQ = WashingtonAlso StarbucksState of Inc = WashingtonAlso StarbucksPledge of allegiance to stakeholdersCostco generally has: Higher wages; Better benefits; Lower turnover; Higher sales per employee.Industry-leading employee compensation AND Self-imposed low-margin pricing philosophyWalmart only low-margin pricingOther comps:Todd Vasos of Dollar General, Shane O'Kelly of AutoZone, Gerald Morgan of Texas Roadhouse, Jack Sinclair of Sprouts Farmers Market, William Stengel of Genuine Parts Company, Michael Creedon of Dollar Tree, Ronald Sargent of Kroger, Lauren Hobart of Dick's Sporting Goods, Joshua Kobza of Restaurant Brands Inc., Kecia Steelman of Ulta Beauty, Scott Boatwright of Chipotle, Ted Decker of Home Depot, Bob Eddy of BJ's Wholesale Club, Corie Barry of Best Buy, James Conroy of Ross Stores, Chris Turner and David Gibbs of Yum Brands, Chris Kempczinski of McDonald's, Marvin Ellison of Lowe's, Brian Cornell of Target, Ernie Herrman of TJX Companies, Doug McMillon of Walmart, Brian Niccol of Starbucks, Hal Lawton of Tractor Supply Co, Laura Alber of Williams-SonomaFigma Gets an Activist Investor. Exhibit A on Why Companies Don't Want to Go Public. Figma's first year as a public company hasn't gone well. Findell Capital Management said it needs to take steps to shed its unwarranted reputation as an artificial-intelligence “loser.” WHO DO YOU BLAME?Figma founder and CEO Dylan Field: Owns 10% of shares but 72% of voting power: Class B shares worth 15 votes per shareDylan owns 158 Class A Shares (or 0.00003556% of 444,278,887)And Chair$5B net worth$865M total summary compensation in 2025; $91M in 2024Nominating Agreement:Figma must nominate Dylan Field to be a director and include him in the proxy statementThe company must use its resources to back him up and actively convince other shareholders to vote for him In response to a question about how he was going to change the world, Dylan said he was going to build better software for drones.Bro fest sausage party2 of 9 directors are womenTop 5 NEOs all dudesPeter ThielForced Dylan to drop out of Brown for a dumb fellowshipVC Blowhardiness on the BoardVC dude John Lilly (Greylock): Lead Independent Director2nd longest tenure (2014)Member of the Audit Committee; Member of the Nominating Committee (only Lilly and Rimer)VC dude Andrew Reed (Sequoia)Director at debt-maker Klarna Group (also way down since IPO): down roughly 54% from its initial $40.00 IPO price, and down nearly 68% from its all-time highMember of the Compensation Committee (which modeled Dylan's pay package after Elon Musk)VC dude Danny Rimer (Index Ventures)Director since 2014B.A. in History and Literature from HarvardMember of the Compensation Committee (which modeled Dylan's pay package after Elon Musk)Member of the Nominating Committee (only Lilly and Rimer)Luis von AhnDuolingo co-founder and CEO2025: shared an internal email outlining Duolingo's new "AI-first" strategy where Duolingo would “gradually stop using contractors to do work that AI can handle”Stated that "AI is a better teacher than humans" and that the future role of teachers would be reduced to providing "childcare."Blamed the controversy on a "lack of context" in his original statements"AI-First" memo goes viral: $389; today $118MATTDanone, Starbucks shine in methane-reduction rankingDanone is the only company in the group aligned with the Global Methane Pledge, an initiative backed by 150 countries that targets a 30 percent reduction in global levels of the gas by 2030. The French multinational also leads the pack in progress toward its target, having come close to hitting it five years ahead of schedule.WHO DO YOU CREDIT?Chair of the CSR committee Lise Kingo (9% influence), one of three directors tagged as merit directorsmaster's degree in Responsibility & Business from the University of Bathbachelor degrees in Religions and Ancient Greek Artbachelor's degree in Marketing and Economicscertificate as International Director from INSEADEx Novo Nordisk environmental affairs, internal audit, compliance, human resources, communication, branding and sustainabilityHelped create the UN SDGs and the UN Global CompactSomehow only bats 559 on carbon intensity (career) and 415 for scope 1/2 (career)Also, using deference metrics, the ONLY DIRECTOR tagged as fully independentEmployee rep member of the CSR committee Bettina Theissig (5% influence) and the employees of DanoneThe committee charter mandates employees get a say: At least two thirds of the CSR Committee must be independent, as defined by the AFEP-MEDEF Code. At least one Director representing employees must be a member of the Committee.In France (Danone's domicile), the European Investment Bank found that French employees were the most aware of environmental issues - 82% of French employees said they were highly concerned about environmental issues, highest in EuropeLead Independent Director and chair of the Nom/comp committee who put together the comp plan, Valerie Chapoulaud-Floquet15% influence, second to the 18% influence CEO (democracy!!), got 99.16% shareholder approval in April (even as CEO got 89.73% approval and pay got 93.19% approval)20% of short-term pay and 30% of long-term pay is based on hitting sustainability targetsWhen you pay a CEO to do a thing, they are more likely to do a thingEx-CEO Emmanuel FaberOusted in 2021 by the board of directors and activist investors, he transformed Danone into an “enterprise a mission” (a French version of a B corp)Investors voted 99% in favor of the move and a year later ousted Faber, the board resigned, and the new board and CEO are basically moving back towards being environmental leaders because it paid offShort term share price laggedHe said in 2024 that nature is “at the core” of Danone, It took the stock 3 years from Faber's ousting to return to Faber levels - and in the meantime, they were sued for plastics and emissionsIsn't this HIS win?Current CEO Antoine de Saint-AffriqueBecause CEOGM Board Director Jonathan McNeill Stepping DownCEO of DVx Ventures. Ex COO at Lyft Inc. and ex president, Global Sales, Delivery and Service at Tesla, current director at Lululemon, GM director since 2022, on the Governance and Corporate Responsibility committee and Risk and Cybersecurity committee.We know that half of boards on average think someone on the board should be replaced - did the GM board not like McNeill?WHO/WHAT WOULD WE BLAME FOR PUSHING MCNEILL OUT?Outsider dude bro DRLet's be honest, McNeill worked at much more… modern?... companies than GMThe board is OLD SCHOOL - ex Northrop Grumman, ex Visa, ex Lazard, ex HP, ex eBay, ex Novartis, ex Walmart, other directorships at Goldman, Huntsman, P&G… these are professional, insular boardsMeanwhile, he's investing as a VC in AI, other auto/mobility startups, comes from boards that are bro founder lead (Tesla, Lyft) He's invested in AI, crypto, heavy tech, intertwined with VCs all overNot deferential enoughBarra is connected to 94% - THE ENTIRE - boardMcNeill has the highest network power on the board at $9tn, higher than even Mary Barra (who is super connected), but is NOT a power player in the board community of GM - the dominant board communities for GM are massive blue chip US companies, where McNeill has deeper connections in smaller IT/tech focused companiesHe doesn't need the pay, he gets nothing for the connections really, he has connection to Barra but his network is different - was he too independent?Pissed he doesn't have enough influence McNeill has the LOWEST influence on the GM board at 4%He's relatively new, younger, working as a VC where you have a lot of power of capital allocation“I don't need this shit” effect?Too many womenMcNeill's dvX ventures portfolio team is 6 dudes and 1 womendvX entire operations staff is two woman - guess what they do“Chief of Staff” (ie, HR)Executive Assistant (yes, listed on the team)Board is 2 women, 3 men (McNeill not on board)This one seems unlikely I guess?Too busy, meh, move onOne of dvX portfolio companies is curbee, with GM Ventures' Kurt Baumgarten on the board (and the dvX co-founder is founder of Curbee)McNeill on at least 3 of his portfolio boards or advisory committees, plus LULU and GM…

Mari Wæraas har aldri hatt en plan. Og likevel har livet ført henne akkurat dit hun skal.Etter 11 år som kommunikasjonsrådgiver i NCC – der hun rakk å bli både betongekspert, asfaltnerden og rektor for Barnas Byggeskole – pakket hun opp hele familien og flyttet tilbake til Alta. Ny jobb, nye skoler, nytt nabolag, nye skuffer og skap. Mye nytt. Men også mye kjent.I dag jobber Mari tett med faren om å videreutvikle Kunnskapsparken Alta – det største kontorfellesskapet i byen, med 15 000 kvadratmeter og drømmer om å bli en ekte kunnskapspark i ordets rette forstand.I denne episoden snakker vi om:– Overgangen fra stor bedrift til familiebedrift– Hva god employer branding egentlig handler om (hint: det er mest internt arbeid)– Gjennomslag i tunnel, tropisk hage i Trondheim og et arbeidssted bygget for alle– Backpacking i 11 land, tsunami-varsel i Peru og et bilde som skal henge på kontoret– Å vokse opp uten plan – og hvorfor det ikke alltid er dumt– Hva hun sier til ungene sine hver dag: ta gode valgMari er direkte, varm og genuint engasjert i menneskene rundt seg. Dette er en samtale om å stå i det, ta konsekvensene av valgene sine – og kjenne at skuldrene faktisk er nede.God lytting!

Send us Fan MailRansomware actors are getting quieter, faster, and more custom and that should change how you study for the CISSP and how you defend your environment. We start with a quick personal update on a new CISSP Sprint: an eight-week live cohort built to give you structure, accountability, and weekly sessions so you can realistically target exam day without paying boot camp prices. Seats are limited, with an early bird option, because the whole point is real feedback and momentum. From there we dig into a timely threat story: Trigona ransomware and its use of a custom data exfiltration tool designed to evade common detection patterns. We break down what it means when attackers move away from popular utilities and how bandwidth saturation, connection rotation, and encrypted outbound traffic can slip past monitoring. If you're studying CISSP security operations and incident thinking, this is a clean example of how credential theft, endpoint interference, and network visibility all connect. Then we shift into CISSP Domain 3 cryptography and make the rules stick: symmetric versus asymmetric encryption, what key does what for confidentiality, and how digital signatures actually deliver integrity and non-repudiation. We also cover elliptic curve cryptography, key size advantages, and why quantum computing is forcing real post-quantum cryptography planning now, not later. Finally, we share a board briefing framework for CISOs and security leaders so you can translate technical risk into business impact, loss cases, and a clear ask the board can act on. Subscribe for weekly CISSP-focused cybersecurity training, share this with a study partner or a security leader, and leave a review so more people can find the show. What part do you want us to go deeper on next: crypto rules, ransomware tradecraft, or board communication?Gain exclusive access to 360 FREE CISSP Practice Questions at FreeCISSPQuestions.com and have them delivered directly to your inbox!  Don't miss this valuable opportunity to strengthen your CISSP exam preparation and boost your chances of certification success. Join now and start your journey toward CISSP mastery today!

Til denne fredagsepisoden har Annette huket inn en kortreist vikar, nemlig sønn Magnus! Annette og Magnus ringer til Emil Wæraas, og han forteller om hvordan det var å være med i TV2-programmet Boksen, og hvordan deltakelsen ikke ble helt som han først forventet.Produsert av PLAN-B. Hosted on Acast. See acast.com/privacy for more information.

CME credits: 1.00 Valid until: 10-03-2027 Claim your CME credit at https://reachmd.com/programs/cme/igan-soc-strengths-and-limits/54682/ IgA nephropathy (IgAN) remains the most common primary glomerulonephritis worldwide and a leading cause of chronic kidney disease and end-stage kidney disease in adolescents and young adults. The 2025 KDIGO clinical practice guideline updates represent a major paradigm shift, lowering the optimal proteinuria target from

CME credits: 1.00 Valid until: 10-03-2027 Claim your CME credit at https://reachmd.com/programs/cme/the-4-hit-hypothesis-foundations-of-igan-pathogenesis/51035/ IgA nephropathy (IgAN) remains the most common primary glomerulonephritis worldwide and a leading cause of chronic kidney disease and end-stage kidney disease in adolescents and young adults. The 2025 KDIGO clinical practice guideline updates represent a major paradigm shift, lowering the optimal proteinuria target from

CME credits: 1.00 Valid until: 10-03-2027 Claim your CME credit at https://reachmd.com/programs/cme/mechanism-based-targeting-why-april-matters-in-igan/54681/ IgA nephropathy (IgAN) remains the most common primary glomerulonephritis worldwide and a leading cause of chronic kidney disease and end-stage kidney disease in adolescents and young adults. The 2025 KDIGO clinical practice guideline updates represent a major paradigm shift, lowering the optimal proteinuria target from

CME credits: 1.00 Valid until: 10-03-2027 Claim your CME credit at https://reachmd.com/programs/cme/april-uncovered-an-upstream-driver-in-igan/54680/ IgA nephropathy (IgAN) remains the most common primary glomerulonephritis worldwide and a leading cause of chronic kidney disease and end-stage kidney disease in adolescents and young adults. The 2025 KDIGO clinical practice guideline updates represent a major paradigm shift, lowering the optimal proteinuria target from

CME credits: 1.00 Valid until: 10-03-2027 Claim your CME credit at https://reachmd.com/programs/cme/beyond-raasi-and-approved-therapies-the-unmet-needs-in-igan/54683/ IgA nephropathy (IgAN) remains the most common primary glomerulonephritis worldwide and a leading cause of chronic kidney disease and end-stage kidney disease in adolescents and young adults. The 2025 KDIGO clinical practice guideline updates represent a major paradigm shift, lowering the optimal proteinuria target from

CME credits: 1.00 Valid until: 10-03-2027 Claim your CME credit at https://reachmd.com/programs/cme/emerging-evidence-igan-disease-modifying-agents/54684/ IgA nephropathy (IgAN) remains the most common primary glomerulonephritis worldwide and a leading cause of chronic kidney disease and end-stage kidney disease in adolescents and young adults. The 2025 KDIGO clinical practice guideline updates represent a major paradigm shift, lowering the optimal proteinuria target from

CME credits: 1.00 Valid until: 10-03-2027 Claim your CME credit at https://reachmd.com/programs/cme/emerging-therapies-in-igan-who-could-benefit-the-most/54685/ IgA nephropathy (IgAN) remains the most common primary glomerulonephritis worldwide and a leading cause of chronic kidney disease and end-stage kidney disease in adolescents and young adults. The 2025 KDIGO clinical practice guideline updates represent a major paradigm shift, lowering the optimal proteinuria target from

CME credits: 1.00 Valid until: 10-03-2027 Claim your CME credit at https://reachmd.com/programs/cme/targeting-lower-proteinuria-levels-shifting-the-goalpost-in-igan/54686/ IgA nephropathy (IgAN) remains the most common primary glomerulonephritis worldwide and a leading cause of chronic kidney disease and end-stage kidney disease in adolescents and young adults. The 2025 KDIGO clinical practice guideline updates represent a major paradigm shift, lowering the optimal proteinuria target from

CME credits: 1.00 Valid until: 10-03-2027 Claim your CME credit at https://reachmd.com/programs/cme/translating-guidelines-to-action-in-igan-embracing-a-simultaneous-dual-concordant-approach/54687/ IgA nephropathy (IgAN) remains the most common primary glomerulonephritis worldwide and a leading cause of chronic kidney disease and end-stage kidney disease in adolescents and young adults. The 2025 KDIGO clinical practice guideline updates represent a major paradigm shift, lowering the optimal proteinuria target from

WHAT YOU'LL LEARN Why retail is now a demand chain, not a supply chain How AMRs deliver 6–12 month ROI in high-variability e-commerce Why robotics-as-a-service changes peak capacity planning The real bottleneck in AI adoption: structured WMS data Why dashboards are dying and exception-based orchestration is rising How consolidation will reshape 3PL economics Why operational excellence remains the ultimate differentiator HIGHLIGHTS 00:01–00:12 | Consumer expectations and the “fast + free + cheap” reality 00:12–00:15 | AMRs, ASRS, RaaS, and 6–12 month automation ROI 00:15–00:16 | Buy vs build: what's commodity vs “secret sauce” 00:16–00:19 | Agentic AI in warehouse ops: labor planning + execution 00:19–00:22 | AI proof, case studies, and demand planning as the next frontier 00:22–00:24 | Dashboards vs operators: turning analytics into actions 00:24–00:28 | Operator advice: efficiency, mechanization, and competition shifts 00:29–00:31 | Manifest trends: retail channels evolving + tech-driven 3PL future QUOTES  [00:04:10] “One of the biggest changes is you used to have a choice. You could either have it fast, you could have it free, or you could have it cheap. The consumer today wants all three.” – Jeff Wolpov [00:05:10] “We as logistics supply chain companies need to lean in and figure out how to do more with less. Today it's a necessity.” – Jeff Wolpov [00:07:30] “You need automation... We need to be faster and more flexible. Peaks have gotten much higher.” – Jeff Wolpov [00:16:00] "The hard part isn't building AI or using AI. It's what do you do with the results?" - Gary Allen [00:16:50] “Operators shouldn't hunt dashboards, they should get alerts, exception-based triggers. AI takes analytics to the next level.” – Gary Allen [00:23:00] "Reporting is the death of analytics." - Gary Allen  ABOUT THE GUESTS Jeff Wolpov Jeff Wolpov is Senior Vice President of E-commerce and Ryder Last Mile at Ryder System, Inc., where he leads the vision and strategy for omnichannel fulfillment and big & bulky home delivery. Previously, he served as CEO of Whiplash (formerly Port Logistics Group), achieving nearly 30% year-over-year revenue growth before its acquisition by Ryder in 2022. Earlier in his career, Jeff founded Distribution Solutions, scaling it from a startup into a $50 million regional logistics firm that became the foundation of Whiplash's national network. He holds a degree from the University of Michigan. Gary Allen Gary Allen is Vice President of Supply Chain Excellence at Ryder, overseeing Solution Design, Continuous Improvement, Data Analytics, and Automation across the supply chain organization. With more than 32 years of experience, he previously led EY's logistics consulting practice and held leadership roles at DHL and FedEx in product innovation, solution design, sustainability, and operations. Gary helped launch and co-author the “Annual Third Party Logistics Study” with Dr. John Langley of Penn State University and holds a Bachelor of Arts in Materials and Logistics Management from Michigan State University. LINKS MENTIONED Ryder report: https://www.ryder.com/en-us/insights/white-papers/e-comm/2025-ryder-e-commerce-consumer-study Ryder website: https://www.ryder.com/en-us Subscribe and Keep Learning!If you're a logistics leader looking to scale sustainably, don't miss out! Subscribe for more expert strategies on tackling modern supply chain challenges.Be sure to follow and tag the eCom Logistics Podcast on LinkedIn and YouTube

Ransomware as a service has turned cybercrime into a franchise business — and in this episode, Dr. Mike Saylor and I break down exactly how it works, who's buying, and why the buyer might end up as the patsy.If you thought ransomware was just a lone hacker writing code in a basement, this episode is going to change how you think about it. Ransomware as a service means that today, literally anyone — no technical skills required — can pay someone to launch a ransomware attack on their behalf. You hand over the money, tell them what you want, and sit back and watch your crypto wallet. That's it. No portal. No dashboard. No login. Just a chat on the dark web through the TOR network and a prayer that they actually do what you paid for.Dr. Mike Saylor walks us through the full criminal ecosystem — from the initial access brokers who collect and sell validated email addresses, to the botnet operators who rent out millions of compromised computers by the hour, to the affiliate programs that tie it all together. We cover the franchise model, the "no honor among thieves" reality of these transactions, and why the person who buys into ransomware as a service might just end up as law enforcement's fall guy.This is one of those episodes where the more you learn, the more you realize how much the threat picture has changed — and why your backups are more important than ever.Chapters:00:00:00 - Episode Intro00:01:17 - Introductions & Welcome00:03:25 - Setting the Stage: CryptoLocker and the Birth of a Criminal Industry00:07:17 - Defining Ransomware as a Service: The Franchise Model00:10:36 - The Amazon/AWS Analogy and How Botnets Power the Attacks00:17:10 - No Portal, No Dashboard: How Dark Web Transactions Actually Work00:19:17 - Why Do RaaS Operators Offer the Service? The Lottery Ticket Theory00:21:59 - The Affiliate Model: How the Criminal Ecosystem Specializes00:26:33 - How Many RaaS Groups Exist — and Who's Buying?00:29:36 - RaaS as Subterfuge: The Conti Group and the Costa Rica Attack00:30:49 - Who Are These Criminals, Really?

Srimad Bhagavatam [Bhagwat Katha] – Part 38 | Swami Mukundananda  Swamiji narrates the divine Raas Leela that began on the sacred night of Sharad Purnima, when Shree Krishna played His enchanting flute and called the gopis of Braj. Leaving everything behind, they ran to Him in complete surrender, their hearts absorbed only in Krishna.  Before beginning the Raas, Krishna tested them. He reminded them of their worldly duties and asked them to return home. But the gopis responded with profound wisdom — declaring that He is the Soul of all souls, and by serving Him, all duties are fulfilled. Pleased with their unwavering love, Krishna began the Maharas through His divine Yogmaya power.  Yet when subtle pride entered their hearts — the feeling “God is dancing with me” — Krishna disappeared, teaching a powerful lesson: in the path of divine love, ego and God cannot coexist.  Swamiji highlights two key lessons from this leela:  God tests His devotees to elevate their love to a higher level. • True devotion is egoless, selfless, and centered only on God. The Raas Leela reveals that prem bhakti — pure, unconditional love — is the highest spiritual attainment.  About Swami Mukundananda:    Swami Mukundananda is a renowned spiritual leader, Vedic scholar, Bhakti saint, best‑selling author, and an international authority on the subject of mind management. He is the founder of the unique yogic system called JKYog. Swamiji holds distinguished degrees in Engineering and Management from IIT and IIM. Having taken the renounced order of life (sanyas), he is the senior disciple of Jagadguru Shree Kripaluji Maharaj, and has been sharing Vedic wisdom across the globe for decades. 

CME credits: 0.25 Valid until: 16-02-2027 Claim your CME credit at https://reachmd.com/programs/cme/case-based-approach-managing-hyperkalemia-in-patients-with-ckd-and-heart-failure/37617/ Using a real-world patient case, Drs. Ellie Kelepouris and Nihar Desai examine clinical challenges in managing hyperkalemia among patients with chronic kidney disease (CKD) and heart failure (HF). They explore the use of modern potassium binders to sustain guideline-directed medical therapy (GDMT) with renin–angiotensin–aldosterone system (RAAS) inhibitors and break down the differences between patiromer and sodium zirconium cyclosilicate (SZC). Their discussion includes guideline recommendations from KDIGO and European societies, the sodium-related safety signals with SZC, and supporting data from trials such as REALIZE-K and DIAMOND. Findings from the CARE-HK registry are also discussed, highlighting low potassium binder use despite high rates of recurrent hyperkalemia and underutilization of GDMT in advanced CKD.=

Episode 212: Managing HFpEFHyo Mun and Jordan Redden (medical students) explain how to manage HFpEF with medications and touch some basics about nonpharmacologic treatments. Dr. Arreaza asks insightful questions to guide the discussion. Written by Hyo Mun, MSIV, American University of the Caribbean; and Jordan Redden, 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.Treatment of HFpEFArreaza: Mike, if you had to name the one therapy everyone with HFpEF should be on, what is it?Mike: That's easy! SGLT-2 inhibitors. This is the one slam-dunk we have in HFpEF. Empagliflozin (Jardiance) or dapagliflozin (Farxiga) should be started in essentially every patient with HFpEF, and it doesn't matter if they have diabetes or not.Jordan: And that's worth repeating, because people still think of these as “diabetes drugs.” They're not anymore. In HFpEF, SGLT-2 inhibitors reduce heart-failure hospitalizations, improve symptoms, improve quality of life, and even reduce cardiovascular death.Dr. Arreaza: They're also simple. Empagliflozin 10 mg daily or dapagliflozin 10 mg daily. No titration, no drama. The effectiveness of these meds was established around 2019 with DAPA-HF and later with DELIVER. These were trials thatdemonstrated that dapagliflozin reduces worsening heart failure and cardiovascular events across the full spectrum of heart failure, from reduced to preserved ejection fraction, independent of diabetes status.Mike: And the number needed to treat is about 28 to prevent one heart-failure hospitalization. That's excellent for a disease where we historically had almost nothing that worked.Jordan: They're also safe in chronic kidney disease down to an eGFR of about 25, which makes them even more useful in this population.Dr. Arreaza: Alright. We got SGLT-2 inhibitor, what's next?Mike: Volume management. Loop diuretics are still the backbone of symptom control in HFpEF. If the patient is volume overloaded, you diurese, and you diurese aggressively.Jordan: The goal is euvolemia. Dry weight, no edema, no orthopnea, no waking up gasping for air. A lot of these patients end up needing chronic oral loop diuretics to stay there.Dr. Arreaza: Something to remember: HFpEF patients don't tolerate congestion well, and being “a little wet” is not benign. Let's move into RAAS inhibition. Where do ARBs and ACE inhibitors fit in?Mike: Between ARBs and ACE inhibitors, ARBs are the winners in HFpEF. They actually reduce heart failure hospitalizations—drugs like candesartan, losartan, valsartan. ACE inhibitors? Not so much. They showed minimal benefit in older HFpEF patients, which is why we go with ARBs instead.Jordan: But a lot of clinicians get nervous about ACE inhibitors and ARBs because of kidney function, so it's worth talking through how these drugs actually work in the kidney.Dr. Arreaza: Yes, misunderstanding may lead to unnecessary drug discontinuation.Jordan: Under normal conditions, the afferent arteriole brings blood into the glomerulus, and the efferent arteriole is constricted by angiotensin II. That constriction keeps pressure high in the glomerulus and maintains filtration.Mike: Here's what happens with an ACE inhibitor: you block angiotensin II, the efferent arteriole relaxes, glomerular pressure drops, and GFR dips slightly. Creatinine bumps up a little, and that scares people, but that's actually the whole point—that's how you get kidney protection long-term.Jordan: High intraglomerular pressure causes hyperfiltration injury and scarring over time. Lowering that pressure protects the kidney long-term. The short-term GFR drop is the price you pay for long-term benefits.Dr. Arreaza: So let's talk about CKD, because this is where people panic.Mike: Right. ACE inhibitors and ARBs are not contraindicated in chronic kidney disease. In fact, they're recommended even in advanced stages. They reduce progression to kidney failure by about a third.Jordan: The key is how you use them. Start low. Check creatinine and potassium one to two weeks after starting, then periodically. A creatinine rise up to 30% from baseline is acceptable. That's not kidney injury, that's physiology.Dr. Arreaza: And what about potassium creeping up?Mike: You adjust the dose or add a potassium binder. You don't just automatically stop the drug.Dr. Arreaza: Now there is one absolute contraindication everyone needs to know about! (board exam test)Jordan: Bilateral renal artery stenosis. This is the big one. In these patients, the kidneys are completely dependent on angiotensin II–mediated efferent constriction to maintain GFR. Take that away, and GFR collapses.Mike: Creatinine can jump dramatically within days. If you see a creatinine rise of 20% or more shortly after starting an ACE inhibitor, you should be thinking about bilateral renal artery stenosis and stopping the drug immediately.Dr. Arreaza: After revascularization, though, many patients can tolerate ACE inhibitors again, so this isn't always permanent. What about cardiorenal syndrome? That's where things get uncomfortable.Mike: It is uncomfortable, but cardiorenal syndrome isn't a contraindication. These patients have severe heart failure and kidney disease, and their mortality is actually higher than patients with heart failure alone.Jordan: ACE inhibitors still reduce mortality and slow kidney disease progression in this group. Studies show that stopping ACE inhibitors during acute heart-failure admissions increases in-hospital mortality three- to four-fold.Dr. Arreaza: So we are cautious, but we don't avoid it.Mike: Exactly. Start low, titrate slowly, monitor labs closely, accept up to a 30% creatinine rise. You only stop if kidney function keeps worsening, or potassium gets dangerously high.Dr. Arreaza: Alright. Let's move on. What about mineralocorticoid receptor antagonists… MRA?Jordan: Spironolactone or eplerenone might reduce hospitalizations in HFpEF, but the data is mixed. This is more of a “select patients” situation.Mike: And you have to watch potassium and kidney function carefully, especially if they're already on an ACE inhibitor or ARB.Dr. Arreaza: What about sacubitril-valsartan, also known as Entresto®?Mike: Entresto may help patients with mildly reduced EF roughly in the 45 to 57% range. It's not first-line for HFpEF, but in select patients, it's reasonable.Dr. Arreaza: Now let's clarify one of the biggest sources of confusion: beta blockers.Jordan: Beta blockers are not a treatment for HFpEF itself. They're only indicated if the patient has another reason to be on them, like coronary disease or atrial fibrillation.Mike: And timing really matters here. You absolutely do not start beta blockers during acute decompensated heart failure. Their negative inotropic effects can make things worse when patients are volume overloaded.Jordan: But, and this is critical, you also don't stop them if the patient is already taking one. Abrupt withdrawal causes a sympathetic surge and dramatically increases mortality.Dr. Arreaza: If a patient is admitted on a beta blocker, what do we do?Mike: Continue it at the same dose or reduce it slightly if they're really unstable. Once they're euvolemic and stable, you can carefully titrate up.Jordan: And watch for chronotropic incompetence. HFpEF patients often rely on heart-rate response to exercise, and beta blockers can worsen exercise intolerance.Dr. Arreaza: Beyond medications, HFpEF is really about treating comorbidities. Aerobic activity can be an initial strategy to improve exercise intolerance and has evidence of improving aerobic function and quality of life. Sodium restriction: improves symptoms, does not decrease risk of death or hospitalizations.Mike: Hypertension control is huge. For diabetes, the SGLT-2 inhibitors will perform double duty. For obesity, weight loss improves symptoms, and GLP-1 agonists like semaglutide are absolute gamechangers.Jordan: Don't forget sleep apnea, atrial fibrillation, and lifestyle. Exercise improves the quality of life, even if it doesn't change hard outcomes. Lifestyle is the main treatment. Dr. Arreaza: And when should you refer to cardiology?Mike: You should refer when the diagnosis isn't clear; symptoms are not responding to treatment, difficult volume management, end-organ dysfunction, or if you are concerned about advanced heart failure.Dr. Arreaza: So, it has been a great discussion. What is the takeaway?Mike: HFpEF treatment isn't about one magic drug -- it's about volume control, SGLT2 inhibitors, smart use of RAAS blockade, and aggressive management of comorbidities.Jordan: And it's understanding the physiology, so you don't withhold life-saving therapies out of fear.Dr. Arreaza: Well said. If you found this helpful, share it with a friend or colleague and rate us wherever you listen. This is Dr. Arreaza, signing off.Jordan/Mike: Thanks! Even without trying, every night you go to bed a little wiser. Thanks for listening to Rio Bravo qWeek Podcast. We want to hear from you, send us an email at RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. See you next week! _____________________References:Barzin A, Barnhouse KK, Kane SF. Heart Failure With Preserved Ejection Fraction. Am Fam Physician. 2025;112(4):435-440.Heidenreich PA, Bozkurt B, Aguilar D, et al. 2022 AHA/ACC/HFSA guideline for the management of heart failure. Circulation. 2022;145(18):e895-e1032.Kittleson MM, Panjrath GS, Amancherla K, et al. 2023 ACC expert consensus decision pathway on management of heart failure with preserved ejection fraction. J Am Coll Cardiol. 2023;81(18):1835-1878.Anker SD, Butler J, Filippatos G, et al. Empagliflozin in heart failure with a preserved ejection fraction. N Engl J Med. 2021;385(16):1451-1461.Solomon SD, McMurray JJV, Claggett B, et al. Dapagliflozin in heart failure with mildly reduced or preserved ejection fraction. N Engl J Med. 2022;387(12):1089-1098.Pitt B, Pfeffer MA, Assmann SF, et al. Spironolactone for heart failure with preserved ejection fraction. N Engl J Med. 2014;370(15):1383-1392.Yusuf S, Pfeffer MA, Swedberg K, et al. Effects of candesartan in patients with chronic heart failure and preserved left-ventricular ejection fraction. Lancet. 2003;362(9386):777-781.Solomon SD, McMurray JJV, Anand IS, et al. Angiotensin-neprilysin inhibition in heart failure with preserved ejection fraction. N Engl J Med. 2019;381(17):1609-1620.Kosiborod MN, Abildstrøm SZ, Borlaug BA, et al. Semaglutide in patients with heart failure with preserved ejection fraction and obesity. N Engl J Med. 2023;389(12):1069-1084.Xie Y, Xu E, Bowe B, Al-Aly Z. Long-term cardiovascular outcomes of COVID-19. Nat Med. 2022;28(3):583-590.Puntmann VO, Carerj ML, Wieters I, et al. Outcomes of cardiovascular magnetic resonance imaging in patients recently recovered from COVID-19. JAMA Cardiol. 2020;5(11):1265-1273.Basso C, Leone O, Rizzo S, et al. Pathological features of COVID-19-associated myocardial injury. Eur Heart J. 2020;41(39):3827-3835.Nalbandian A, Sehgal K, Gupta A, et al. Post-acute COVID-19 syndrome. Nat Med. 2021;27(4):601-615.Badve SV, Roberts MA, Hawley CM, et al. Effects of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers in adults with estimated GFR less than 60 mL/min per 1.73 m². Ann Intern Med. 2024;177(8):953-963.Navis G, Faber HJ, de Zeeuw D, de Jong PE. ACE inhibitors and the kidney: a risk-benefit assessment. Drug Saf. 1996;15(3):200-211.Textor SC, Novick AC, Tarazi RC, et al. Critical perfusion pressure for renal function in patients with bilateral atherosclerotic renal vascular disease. Ann Intern Med. 1985;102(3):308-314.Hackam DG, Spence JD, Garg AX, Textor SC. Role of renin-angiotensin system blockade in atherosclerotic renal artery stenosis and renovascular hypertension. Hypertension. 2007;50(6):998-1003.Ronco C, Haapio M, House AA, et al. Cardiorenal syndrome. J Am Coll Cardiol. 2008;52(19):1527-1539.Prins KW, Neill JM, Tyler JO, et al. Effects of beta-blocker withdrawal in acute decompensated heart failure. JACC Heart Fail. 2015;3(8):647-653.Jondeau G, Neuder Y, Eicher JC, et al. B-CONVINCED: Beta-blocker CONtinuation Vs. INterruption in patients with Congestive heart failure hospitalizED for a decompensation episode. Eur Heart J. 2009;30(18):2186-2192.Theme song, Works All The Time by Dominik Schwarzer, YouTube ID: CUBDNERZU8HXUHBS, purchased from https://www.premiumbeat.com/.

AI is transforming cybersecurity for better and for worse, with Irish organisations now operating on the front line of this AI-driven threat landscape. AI technology is now embedded on both sides, enabling threat actors to launch highly sophisticated attacks at the click of a button, while helping defenders to detect and respond at machine speed. From automated phishing campaigns to self-adapted malware, AI is accelerating the speed and the scale of cybercrime across Ireland's digital economy. To keep pace, regional organisations are deploying equally advanced AI-driven security solutions, including Arctic Wolf's Aurora Platform, which delivers AI-powered detection and response at scale. But technology alone isn't enough for full protection. Unlike threat actors, Irish businesses must operate within strict legal, regulatory and ethical constraints. They cannot move as freely or illicitly as their adversaries, leaving even the most advanced AI systems constrained. As this technological warfare continues, it's people, processes and security culture that will determine the outcome of cyber incidents. For channel partners, recognising this shift is critical. Long-term value no longer comes from transactional product resale, but from delivering continuous protection, advisory-led services and measurable security outcomes. Arctic Wolf is driving this change across the Irish channel ecosystem through its AI-enabled managed detection and response (MDR) services, it's 24/7 concierge security model and its stronger-together partner approach which sees it work side-by-side with local resellers to help them build scalable, services-led security practices. Threat landscape escalation and the human factor Ransomware remains the dominant threat across Ireland and the wider UK&I region, with ransomware-as-a-service (RaaS) platforms dramatically lowering the barrier to entry for less-skilled attackers. At the same time, AI-powered phishing, deepfake fraud and self-adapting malware are becoming mainstream tools for cybercriminals. Supply chain vulnerabilities and third-party risk are also rising sharply, exposing organisations across industry. For resellers in the region, the growth in attack sophistication is driving demand for always-on monitoring, rapid incident response and third-party risk management services, accelerating the shift toward managed security offerings. Compounding this is the persistent human threat. Low phishing awareness, the rapid adoption of ungoverned AI tools and simple user error continue to play a role in some of the most damaging breaches. Even in highly regulated and technologically mature environments, the human layer remains the most exploited. Arctic Wolf research shows that nearly two-thirds of IT managers admit to having clicked on a phishing link themselves, proving cyber risk isn't confined to junior staff or non-technical users – it's a universal issue. This is why developing a strong, trust-based security culture is as vital as deploying tools. Employees must feel confident in recognising suspicious activity and empowered to report it quickly, without fear of blame. This openness can be the difference between containing an incident quickly or having an entire operation shut down. While Arctic Wolf's platform analyses over nine trillion security events a week, it is the company's 24/7 human-led SOC and concierge security teams that are transforming insight into action for Irish customers and partners, helping prioritise risk, contain active threats and strengthen their security posture. For resellers, this means they can deliver enterprise-grade security operations without having to build or staff their own SOC. Why this matters to the channel For channel partners in the UK&I, this technological evolution marks a shift away from transactional-based resale towards high-value, recurring managed security and advisory services. Customers want products, but also guidance, visibility and assurance in an increa...

Episode 211: Understanding HFpEF.  Hyo Mun and Jordan Redden (medical students) explain the pathophysiology of heart failure with preserved ejection fraction (HFpEF) and how it differentiates from HFrEF. Dr. Arreaza asks insightful questions and summarizes some key elements of HFpEF. Written by Hyo Mun, MS4, American University of the Caribbean; and Jordan Redden, MS4, Ross University School of Medicine. Comments and edits 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.What is EF? Just imagine, the heart is a pump, blood gets into the heart through the veins, the ventricles fill up and then squeeze the blood out. So, the percent of blood that is pumped out is the EF. Let's start at the beginning. What is HFpEF?Mike: HFpEF stands for heart failure with preserved ejection fraction. Basically, these patients squeeze normally—their ejection fraction is 50% or higher—but here's the thing: the heart can't relax and fill the way it should. The muscle gets stiff, almost like a thick leather boot that just won't stretch. And because the ventricle can't fill properly, pressure starts backing up into the lungs and the rest of the body. That's when patients start experiencing shortness of breath, leg swelling, fatigue—all those classic symptoms.Dr. Arreaza: And this is where people get fooled by the ejection fraction.Mike: Exactly. The ejectionfraction tells you total left ventricular emptying, not just forward flow.Jordan: The classic example is severe mitral regurgitation. You can eject 60% of your blood volume and still be in cardiogenic shock because most of that blood is leaking backward into the left atrium instead of going into the aorta. So, you get pulmonary edema, hypotension, fatigue, all with a “normal” EF. Which is honestly terrifying if you're over-relying on echo reports without thinking clinically.Dr. Arreaza: And in HFpEF, functional mitral regurgitation often shows up later in the disease. It's not usually the primary cause; it's more of a marker of advanced disease. Moderate to severe MR in HFpEF independently predicts worse outcomes, including a higher risk of mortality or heart failure hospitalization. So, let's contrast this with HFrEF. How are these two different?Mike: HFrEF—heart failure with reduced ejection fraction—is a pumping problem. The heart muscle is weak and can't contracteffectively. Ejection fraction drops below 40%, and this is your classic systolic dysfunction.Jordan: HFpEF, on the other hand, is diastolic dysfunction. The heart muscle is thick, fibrotic, and noncompliant. It squeezes fine, but it just doesn't relax, even though the EF looks reassuring on paper.Mike: I like to explain it this way: HFrEF is a weak heart that can't squeeze. HFpEF is a stiff heart that can't relax. Totally different problems.Dr. Arreaza: And then there's the gray zone: heart failure with mildly reduced EF, or HFmrEF. That's an EF between 41 and 49% with evidence of elevated filling pressures. It really shares the features of both worlds. So, what actually causes HFpEF versus HFrEF?Jordan: HFpEF is basically what happens when all the problems of modern living catch up with you. You've got chronic hypertension, obesity, diabetes, metabolic syndrome, aging, systemic inflammation—all of these things slowly remodel the heart over years. The muscle gets thick and stiff, and eventually the ventricle just loses its ability to relax. So, HFpEF is really a disease of metabolic dysfunction and chronic stress in the heart. Mike: HFrEF is more about direct injury. Think about myocardial infarctions, ischemic cardiomyopathy, viral myocarditis, alcohol toxicity, chemotherapy like doxorubicin, genetic cardiomyopathies, or chronic uncontrolled tachycardia. These insults actually damage or kill heart muscle cells, leading to a dilated, weak ventricle that can't pump effectively.Dr. Arreaza: So the short version: HFpEF is caused by chronic metabolic and hypertensive stress, while HFrEF is caused mainly by myocardial damage. A question we get a lot: does HFpEF eventually turn into HFrEF? What do you guys think?Mike: In most cases, no. HFpEF patients usually stay HFpEF throughout their disease course. They don't just “burn out” and turn into HFrEF.Jordan: They're generally separate disease entities with different pathophysiology. A patient with HFpEF can develop HFrEF if they have a big myocardial infarction or ongoing ischemia that damages the muscle, but that's not the natural progression.Mike: Interestingly though, the opposite can happen. Some HFrEF patients actually improve their ejection fraction with good medical therapy—that's called HF with improved EF—and it's a great sign that treatment is working.Dr. Arreaza: Another question. How do HFpEF and HFrEF compare to restrictive cardiomyopathy and constrictive pericarditis?Jordan: Clinically, they can all look very similar: dyspnea, edema, fatigue, but the underlying mechanisms are completely different.Mike: In HFpEF, the myocardium itself is stiff from hypertrophy and fibrosis. The problem is intrinsic to the heart muscle, and EF stays preserved. Echoshows diastolic dysfunction with elevated filling pressures.Jordan: In HFrEF, the myocardium is weak. The ventricle is often dilated and contracts poorly, with a reduced EF.Mike: Restrictive cardiomyopathy is different. Here, the myocardium gets infiltrated by abnormal stuff—amyloid, iron, sarcoid—and that makes it extremely stiff. It can look like HFpEF on the surface, but it's usually more severe. On Echo You'll see biatrial enlargement, small ventricles, and preserved EF. And importantly, it's a pathologic diagnosis, so you need advanced imaging or biopsy to confirm it.Jordan: Constrictive pericarditis is another mimic, but here the myocardium is usually normal. The problem is that the pericardium is thickened, calcified, and rigid. This will physically prevent the heart from being filled. Imaging shows pericardial thickening, septal bounce, and respiratory variation in flow, and cath shows equalization of diastolic pressures, which is the hallmark of constrictive pericarditis.Dr. Arreaza: So the takeaway is: HFpEF is a clinical syndrome driven by common metabolic and hypertensive causes, while restrictive and constrictive diseases are specific pathologic entities. If “HFpEF” is unusually severe or not responding to treatment, you need to think beyond HFpEF. Which type of heart failure is more common right now?Mike: Good question, the answer is: HFpEF. It now accounts for up to 60% of all heart failure cases, and it's still rising.Dr. Arreaza: Why is that?Jordan: Because people are living longer, gaining weight, and developing more metabolic syndrome. HFpEF thrives in older, or people with obesity, hypertension, or diabetes: basically, the modern American population. At the same time, better treatment of acute MIs means fewer people are developing HFrEF from massive heart attacks.Mike: HFpEF is the heart failure epidemic of the 21st century. It's honestly the cardiology equivalent of type 2 diabetes.Dr. Arreaza: Let's talk aboutCOVID-19. (2025 and still talking about it) Does it actually increase heart failure risk?Mike: Yes, absolutely. COVID increases both acute and long-term heart failure risk.Jordan: During acute infection, COVID can cause myocarditis, trigger massive inflammation, and precipitate acute decompensated heart failure, especially in patients with pre-existing disease. It also causes microthrombi, which can injure the myocardium.Mike: And after infection, even mild cases are linked to a significantly higher risk of developing new heart failure within the following year. Both HFpEF and HFrEF rates go up.Dr. Arreaza: I remember seeing this in 2021, we had a patient with acute COVID and HFrEF, her EF was about 10%, I lost contact with the patient and at the end I don't know what happened to her. What's the pathophysiology of COVID and heart failure?Mike: COVID causes direct viral injury through ACE2 receptors, triggers massive inflammation that damages the endothelium and heart muscle, leads to microvascular clotting and fibrosis—all mechanisms that promote HFpEF.Jordan: Add autonomic dysfunction, persistent low-grade inflammation, and worsening metabolic syndrome, and you've got a perfect storm for heart failure.Dr. Arreaza: Bottom line: COVID is a cardiovascular disease as much as a respiratory one. If someone had COVID and now has unexplained dyspnea or fatigue, think about heart failure. Get an echo, get a BNP, start treatment. Last big question: why did we have so many therapies for HFrEF but essentially none for HFpEF for years?Mike: HFrEF is mechanistically straightforward. You've got a weak heart with excessive neurohormonal activation going on — so you block RAAS, block the sympathetic system, drop the afterload. The drugs make sense.Jordan: HFpEF is messy. It's not one disease. It's stiffness, fibrosis, inflammation, microvascular dysfunction, metabolic disease, atrial fibrillation, all overlapping. One drug can't fix all of that.Mike: And some drugs that worked beautifully in HFrEF actually made HFpEF worse. Take Beta blockers, for example.  They slow heart rate, which is a problem because HFpEF patients rely on heart rate to maintain their cardiac output.Jordan: The breakthrough came with SGLT-2 inhibitors: diabetes drugs that unexpectedly addressed multiple HFpEF mechanisms at once: volume, metabolism, inflammation, and myocardial energetics.Dr. Arreaza: The miracle drug for HFpEF! Alright, let's wrap up.Mike: Bottom line: HFpEF is common, complex, and dangerous: even if the EF looks “normal.”Jordan: And if you're relying on ejection fraction alone, HFpEF will humble you every time.Dr. Arreaza: If you liked this episode, share it with a friend or a colleague and rate us wherever you listen. This is Dr. Arreaza, signing off.Even without trying, every night you go to bed a little wiser. Thanks for listening to Rio Bravo qWeek Podcast. We want to hear from you, send us an email at RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. See you next week! _____________________References:Barzin A, Barnhouse KK, Kane SF. Heart Failure With Preserved Ejection Fraction. Am Fam Physician. 2025;112(4):435-440.Heidenreich PA, Bozkurt B, Aguilar D, et al. 2022 AHA/ACC/HFSA guideline for the management of heart failure. Circulation. 2022;145(18):e895-e1032.Kittleson MM, Panjrath GS, Amancherla K, et al. 2023 ACC expert consensus decision pathway on management of heart failure with preserved ejection fraction. J Am Coll Cardiol. 2023;81(18):1835-1878.Anker SD, Butler J, Filippatos G, et al. Empagliflozin in heart failure with a preserved ejection fraction. N Engl J Med. 2021;385(16):1451-1461.Solomon SD, McMurray JJV, Claggett B, et al. Dapagliflozin in heart failure with mildly reduced or preserved ejection fraction. N Engl J Med. 2022;387(12):1089-1098.Pitt B, Pfeffer MA, Assmann SF, et al. Spironolactone for heart failure with preserved ejection fraction. N Engl J Med. 2014;370(15):1383-1392.Yusuf S, Pfeffer MA, Swedberg K, et al. Effects of candesartan in patients with chronic heart failure and preserved left-ventricular ejection fraction. Lancet. 2003;362(9386):777-781.Solomon SD, McMurray JJV, Anand IS, et al. Angiotensin-neprilysin inhibition in heart failure with preserved ejection fraction. N Engl J Med. 2019;381(17):1609-1620.Kosiborod MN, Abildstrøm SZ, Borlaug BA, et al. Semaglutide in patients with heart failure with preserved ejection fraction and obesity. N Engl J Med. 2023;389(12):1069-1084.Xie Y, Xu E, Bowe B, Al-Aly Z. Long-term cardiovascular outcomes of COVID-19. Nat Med. 2022;28(3):583-590.Puntmann VO, Carerj ML, Wieters I, et al. Outcomes of cardiovascular magnetic resonance imaging in patients recently recovered from COVID-19. JAMA Cardiol. 2020;5(11):1265-1273.Basso C, Leone O, Rizzo S, et al. Pathological features of COVID-19-associated myocardial injury. Eur Heart J. 2020;41(39):3827-3835.Nalbandian A, Sehgal K, Gupta A, et al. Post-acute COVID-19 syndrome. Nat Med. 2021;27(4):601-615.Badve SV, Roberts MA, Hawley CM, et al. Effects of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers in adults with estimated GFR less than 60 mL/min per 1.73 m². Ann Intern Med. 2024;177(8):953-963.Navis G, Faber HJ, de Zeeuw D, de Jong PE. ACE inhibitors and the kidney: a risk-benefit assessment. Drug Saf. 1996;15(3):200-211.Textor SC, Novick AC, Tarazi RC, et al. Critical perfusion pressure for renal function in patients with bilateral atherosclerotic renal vascular disease. Ann Intern Med. 1985;102(3):308-314.Hackam DG, Spence JD, Garg AX, Textor SC. Role of renin-angiotensin system blockade in atherosclerotic renal artery stenosis and renovascular hypertension. Hypertension. 2007;50(6):998-1003.Ronco C, Haapio M, House AA, et al. Cardiorenal syndrome. J Am Coll Cardiol. 2008;52(19):1527-1539.Prins KW, Neill JM, Tyler JO, et al. Effects of beta-blocker withdrawal in acute decompensated heart failure. JACC Heart Fail. 2015;3(8):647-653.Jondeau G, Neuder Y, Eicher JC, et al. B-CONVINCED: Beta-blocker CONtinuation Vs. INterruption in patients with Congestive heart failure hospitalizED for a decompensation episode. Eur Heart J. 2009;30(18):2186-2192.Theme song, Works All The Time by Dominik Schwarzer, YouTube ID: CUBDNERZU8HXUHBS, purchased from https://www.premiumbeat.com/. 

Founder Clint Brauer explains how Greenfield Robotics builds compact, row-running robots that mow weeds and lay mulch while enabling nighttime foliar feeding—helping farms reduce herbicides and improve soil biology. He shares the personal catalyst (his father's Parkinson's), why tillage damages soil ecosystems, and how small, autonomous swarms can cover large acreages more cheaply than traditional machinery. We dig into go-to-market (from RaaS to equipment sales with software/telemetry fees), manufacturing with partners, and adoption curves from organic innovators to conventional growers. Brauer outlines the roadmap (attachments, reliability, self-charging), unit counts across 17 states, and potential exit paths with ag OEMs like John Deere—all while keeping the mission clear: get chemicals out of agriculture.Highlights include...Why “weed by day, foliar-feed by night” changes farm economicsHow mulch from cut cover crops suppresses weeds & feeds soilRaaS → leases → direct sales: what farmers prefer (and why)Swarm autonomy vs. ever-bigger tractors—cost & uptime mathManufacturing scale via Amity Technologies; why small wins hereEarly-adopter profile: regenerative, organic, and safety-driven growersExit lanes with major OEMs—and the case for remaining independent

In this episode, Joe Crane sits down with Ryan Hogan, a Navy veteran who transitioned from enlisted aircrewman to Surface Warfare Officer while building a career as an entrepreneur. With 15 years of active duty experience and a tenure in the Reserves, Ryan discusses the "trial-by-fire" lessons learned from early ventures like WarWear and Run For Your Lives, emphasizing the unique challenges of managing a business while serving on active duty. The conversation centers on Ryan's success as the co-founder of Hunt A Killer, the high-growth mystery game he eventually sold. He credits much of his scaling success to the Entrepreneurial Operating System (EOS) and peer-to-peer learning through Vistage, which helped him transition from a founder-led startup to a systems-driven organization. Following the sale, Ryan launched Talent Harbor to fix the inefficiencies he encountered in the hiring industry. He introduces the "Recruiting as a Service" (RaaS) model, which replaces traditional high-commission headhunting with a transparent, flat-fee monthly rate. By treating recruiting as a core operational competency rather than a one-off task, Ryan is now helping other founders build more efficient systems for finding and retaining top-tier talent. Episode Resources: Talent Harbor Ryan Hogan - LinkedIn   About Our Guest Prior to founding Talent Harbor, Ryan Hogan co-founded Hunt A Killer, a subscription-based interactive murder mystery experience. In 2019, Hunt A Killer was named by Fast Company as one of the World's Most Innovative Companies. In 2020, Inc Magazine named it the fastest-growing CPG company. Ryan started his career enlisting in the U.S. Navy as an MH-53E aircrewman, and transitioned to officer where he served as a Surface Warfare Officer onboard various warships. Along the way, Ryan founded WarWear and Run For Your Lives, honing the entrepreneurial skills that he would use in Hunt A Killer, and now Talent Harbor.   About Our Sponsors Navy Federal Credit Union   Navy Federal Credit Union offers exclusive benefits to all of their members. All Veterans, Active Duty and their families can become members. Have you been saving up for the season of cheer and joy that is just around the corner? With Navy Federal Credit Union's cashRewards and cashRewards Plus cards, you could earn a $250 cash bonus when you spend $2,500 in the first 90 days. Offer ends 1/1/26. You could earn up to 2% unlimited cash back with the cashRewards and cashRewards Plus cards. With Navy Federal, members have access to financial advice and money management and 24/7 access to award-winning service. Whether you're a Veteran of the Army, Marine Corps, Navy, Air Force, Space Force or Coast Guard, you and your family can become members. Join now at Navy Federal Credit Union. At Navy Federal, our members are the mission.      Join the conversation on Facebook! Check out Veteran on the Move on Facebook to connect with our guests and other listeners. A place where you can network with other like-minded veterans who are transitioning to entrepreneurship and get updates on people, programs and resources to help you in YOUR transition to entrepreneurship.   Want to be our next guest? Send us an email at interview@veteranonthemove.com.  Did you love this episode? Leave us a 5-star rating and review!  Download Joe Crane's Top 7 Paths to Freedom or get it on your mobile device. Text VETERAN to 38470. Veteran On the Move podcast has published 500 episodes. Our listeners have the opportunity to hear in-depth interviews conducted by host Joe Crane. The podcast features people, programs, and resources to assist veterans in their transition to entrepreneurship.  As a result, Veteran On the Move has over 7,000,000 verified downloads through Stitcher Radio, SoundCloud, iTunes and RSS Feed Syndication making it one of the most popular Military Entrepreneur Shows on the Internet Today.

In this episode of The Cybersecurity Defenders Podcast, we discuss some intel being shared in the LimaCharlie community.A newly disclosed vulnerability in the workflow automation platform n8n, tracked as CVE-2026-21858 and rated CVSS 10.0, allows unauthenticated remote attackers to fully compromise exposed instances.Two malicious Chrome extensions impersonating a legitimate product from AITOPIA were found exfiltrating sensitive user data, including full AI chat histories, according to a report from OX Security.The recent U.S. military operation in Venezuela that led to the capture of President Nicolás Maduro may have included cyber operations, but official confirmation of cyber's role remains ambiguous.Two U.S. citizens with professional backgrounds in cybersecurity have pleaded guilty to acting as affiliates of the ALPHV/BlackCat ransomware group, a prominent ransomware-as-a-service (RaaS) operation.Support our show by sharing your favorite episodes with a friend, subscribe, give us a rating or leave a comment on your podcast platform.This podcast is brought to you by LimaCharlie, maker of the SecOps Cloud Platform, infrastructure for SecOps where everything is built API first. Scale with confidence as your business grows. Start today for free at limacharlie.io.

Read our Macrovey deal analysis (closed) on KingscrowdRobotics hype is everywhere—but who actually makes robots work on real warehouse floors? In this episode, Chris sits down with Macrovey Director of Business Development Matt Labinski to unpack how Macrovey designs fully autonomous, material-handling systems that act like a warehouse “Robotics OS.” We start with what Macrovey is and isn't (00:03)—the company doesn't manufacture robots, it integrates best-in-class OEMs through proprietary orchestration software. Matt explains the model (00:32): up-front design + install and recurring software/maintenance—plus a Robots-as-a-Service option that lowers CapEx. We dive into who buys (06:28): e-commerce, 3PLs, pharma, defense (U.S. Air Force) and even smaller 10k–100k sq ft facilities. Category context (07:31): warehouse robotics penetration is still surprisingly low; Macrovey targets the SMB/mid-market others ignore. We cover why OEMs and warehouses need an integrator (09:09), the sales cycle and deal sizes (12:22)—from $50k pilots to $3M+ programs—and how modular, mobile systems (25:03) move with demand. Finally, we hit the AI layer (27:31): machine learning that optimizes slotting, picking, and vision-based QA. If you want exposure to warehouse autonomy without betting on a single robot, Macrovey's middle-layer, recurring-revenue approach may be the de-risked way to play it.

Housekeeping carts that move themselves. Trash that “walks” to the compactor. In this episode, Seth talks with Reid (President, Nightfood Holdings) about the rise of robots-as-a-service for hotels and venues. No lobby gimmicks—these bots live behind the scenes, moving dirty linens, clean deliveries, and waste so staff can focus on higher-value guest work. We cover real operations (elevators, mapping, safety), privacy (U.S. servers, on-prem options), and why the biggest ROI is fewer injuries + faster turns, not flashy concierge robots.What you'll learnWhy back-of-house automation beats front-of-house gimmicksHow robots “tour,” self-learn maps, call elevators, and run scheduled routesRobots-as-a-service: implementation, supervision, and uptime guaranteesPrivacy by design: U.S. servers, on-prem “island” installs for sensitive sitesExpansion beyond hotels: malls, convention centers, medical, governmentSeth's Companies Vstock Transfer – https://www.vstocktransfer.com/ Share Media – https://www.sharemedia.co/Connect with Seth LinkedIn – https://www.linkedin.com/in/sethfarbman/Instagram – https://www.instagram.com/sethfarbmanstockTikTok – https://www.tiktok.com/@sethfarbmanTwitter (X) – https://x.com/sethfarbman1About the Show From Startup to Stock Exchange, hosted by Seth Farbman, unpacks how founders scale from idea to public markets—covering growth, capital strategy, branding, and the mindset it takes to build companies that last.Timestamps00:00 Intro — robotics > buzzword, real hotel use-cases 01:02 What TechForce Robotics actually does (and why the pivot) 02:08 Back-of-house focus: trash & linens, not lobby greeters 03:30 Do staff feel threatened? How bots remove drudgery 05:02 Property fit: 80-room inns → 400-room hotels, conventions 06:30 RaaS model: implementation, supervision, no robot babysitting 08:05 Data & privacy: U.S. servers, on-prem “island” installs 09:34 Form factor & safety: small, frequent runs beat 300-lb carts 11:12 Mapping in 1.5 days: robot “tours,” self-teaches routes & elevators 13:35 Why this now: injuries, workers' comp, and repeatable ROI 16:02 Beyond hotels: malls, food courts, deliveries, back corridors 18:12 Milestones: cutting steps in code, true automation (no waiting) 20:05 Pipeline: new pilots outside hospitality (details pending) 22:10 How to learn more & engage (sites, outreach) 24:05 Wrap & debriefConnect with Seth LinkedIn – https://www.linkedin.com/in/sethfarbman/ Instagram – https://www.instagram.com/sethfarbmanstock TikTok – https://www.tiktok.com/@sethfarbman Twitter (X) – https://x.com/sethfarbman1

 Podcast Show Notes: Alex Dantas (Circuit Launch & Mechlabs) Guest: Alex Dantas, CEO of Circuit Launch and Mechlabs Guest LinkedIn: https://www.linkedin.com/in/alexrfdantas/ About the Guest & Companies Alex Dantas is the CEO of two organizations that define the hardware and robotics ecosystem in the San Francisco Bay Area: Circuit Launch (The "Cofacturing" Space): A coworking and physical center for electronic hardware development and robotics education. It provides private offices, shared electronic labs, and prototype labs for startups, growing companies, and inventors. (http://circuitlaunch.com) Mechlabs (Mechatronic Education): An educational platform emphasizing a "build-it-to-learn-it" approach to Mechatronic Engineering education. (http://www.mechlabs.io or http://www.mechlabs.ai) Episode Highlights & Discussion Points Robotics Today & Public Perception Alex shares his background and the journey that led him into the world of robotics and startups. What first sparked his interest in robotics? A look at how the robotics landscape has changed over his career. Automation All Around Us: What's a robot or automation technology that most people use daily but don't even realize it? Addressing public fear: What is the biggest misconception about robotics Alex encounters from the general public? AI Convergence: How are advances in AI and machine learning changing the pace and capabilities of robots today? Building & Funding a Robotics Startup Startup in 2025: What does it fundamentally take to build a robotics startup today? Hardware vs. Software: If someone is starting a robotics company, what extra challenges (product development, capital needs) should they be aware of compared to a software startup? The Go-to-Market Journey: How are robots actually built, funded, and launched? What does that journey look like from prototype to market? Common Mistakes: What is the most common mistake first-time robotics founders make? RaaS (Robotics-as-a-Service): Explaining the RaaS trend, what this ecosystem looks like, and why this business model is gaining traction. Investor Strategy & The Future VC Evaluation: How do top robotics venture capitalists evaluate new opportunities today, and what do they prioritize? Are investors becoming more open to hardware-heavy startups now that AI and automation are converging? Metrics & Milestones: What kinds of metrics or milestones do robotics founders need to show to get serious investor attention? The Next Decade: How does Alex think robotics will reshape the labor market over the next decade? Future Frontiers: What does Alex think the next frontier in robotics will be—humanoid robots, swarm robotics, or something completely new? Connect with Alex Dantas & His Work Circuit Launch Website: http://circuitlaunch.com Mechlabs Website: http://www.mechlabs.io or http://www.mechlabs.ai Alex Dantas LinkedIn: https://www.linkedin.com/in/alexrfdantas/

Welcome to episode 100! I'm joined by Chuck Ganapathi, Gainsight's new CEO, for a wide-ranging, candid conversation about where customer success is headed and what leaders should do right now.We start with Chuck's career through four platform eras: mainframe to client/server to cloud to AI - and how those shifts shape strategy. He shares the little-known origin story of “Customer Success” at Salesforce, Gainsight's early days, and why integrations (Salesforce, SAP CX, Microsoft Dynamics) are never “done”—they're living systems that demand clean data and constant tuning.Then we dig into Chuck's concept of Retention-as-a-Service. In a world where retention is existential, the 80/20 mindset breaks. Every dollar matters, which means every customer matters. We talk agentic AI (augmentation vs autonomy), how a “renewal agent” can cover the long tail, and why the magic is orchestration—letting agents handle the repeatable while humans lean into judgment, relationships, and value.We close with practical automation stories, a few resources Chuck follows, and a reminder that the human-to-human piece isn't going anywhere.Links in Today's Episode:Ethan Mollik: One Useful ThingSaanya OjhaJamin Ball: Clouded JudgementAndrej Karpathy on the Dwarkesh Podcast: AGI is still a decade away Support the show+++++++++++++++++Like/Subscribe/Review:If you are getting value from the show, please follow/subscribe so that you don't miss an episode and consider leaving us a review. Website:For more information about the show or to get in touch, visit DigitalCustomerSuccess.com. Buy Alex a Cup of Coffee:This show runs exclusively on caffeine - and lots of it. If you like what we're, consider supporting our habit by buying us a cup of coffee: https://bmc.link/dcspThank you for all of your support!The Digital Customer Success Podcast is hosted by Alex Turkovic

Tom, Julie, and Eric run through their game plan for Essen Spiel 2025, including where they'll be, and what games are on the internet's radar, as well as trying to narrow down what three games are of the most interest to them personally. 00:59 - Bookkeeping: Dice Tower East, West, Cruise 01:57 - The Weather in Germany 03:12 - Eric's First Time Back Since 2019, What's Changed? 07:18 - Where Will We Be? Dice Tower Booth: 3 R315 Van Ryder Booth: 2 E280 Live Show, Sunday 1:30pm: Hall 4 09:30 - Dice Tower Essentials Interlude: Aquatica Duel, On Stage, Raas 11:44 - Live Plays 13:47 - Warning from Julie 14:38 - Sunday's Live Show 16:35 - Eric's Growing Wishlist and Shipping Woes 22:20 - The Games of Essen - So Many 28:20 - Orloj 29:27 - Recall 30:07 - SETI: Space Agencies 30:32 - Feya's Swamp 31:51 - Nature 33:15 - Covenant 35:00 - Ada's Dream 35:43 - Sanctuary 37:16 - Coming of Age 38:55 - Castle Combo: Out of the Oubliette! 39:08 - Echoes of Time 40:52 - White Castle Duel 41:33 - The Voynich Puzzle 42:15 - Underwater Cities: Data Era and LOTR Duel: Allies 42:38 - Luthier 43:12 - Aquaria 44:14 - Julie: Use Up All Your Sick Days 45:32 - Eric: Severton 45:56 - Tom: Cereal Killer 46:52 - Julie: The Stalker 47:30 - Eric: Leylines 48:35 - Tom: Kronologic Cuzco 1450 50:22 - Julie: Parks and Potions 51:29 - Eric: Winnie the Pooh: Serious Detective 52:47 - Tom: A Carnivore Did It Questions? Tales of Horror? tom@dicetower.com

In this episode we sit down with Ven, Director of Information Security at ArmorPoint. The discussion dives deep into the rising threat of Ransomware as a Service (RaaS), where ransomware developers create and sell or lease their malicious software to other criminals. The episode explores the roles of RaaS operators, affiliates, and initial access brokers, highlighting the rapid deployment and wide-reaching impact on businesses, particularly small businesses. We also touch on the adaptation strategies for cybersecurity professionals, the role of AI in these attacks, and practical steps businesses can take to improve their defenses. Join us to understand the evolving landscape of cybersecurity and how to build a culture of resilience in your organization.Learn more about ArmorPoint here

John Fokker, Head of Threat Intelligence at Trellix is discussing "Gang Wars: Breaking Trust Among Cyber Criminals." Trellix researchers reveal how the once-organized ransomware underworld is collapsing under its own paranoia. Once united through Ransomware-as-a-Service programs, gangs are now turning on each other — staging hacks, public feuds, and exit scams as trust evaporates. With affiliates jumping ship and rival crews sabotaging each other, the RaaS model is fracturing fast, signaling the beginning of the end for ransomware's criminal empires. The research can be found here: ⁠⁠⁠⁠Gang Wars: Breaking Trust Among Cyber Criminals Learn more about your ad choices. Visit megaphone.fm/adchoices

John Fokker, Head of Threat Intelligence at Trellix is discussing "Gang Wars: Breaking Trust Among Cyber Criminals." Trellix researchers reveal how the once-organized ransomware underworld is collapsing under its own paranoia. Once united through Ransomware-as-a-Service programs, gangs are now turning on each other — staging hacks, public feuds, and exit scams as trust evaporates. With affiliates jumping ship and rival crews sabotaging each other, the RaaS model is fracturing fast, signaling the beginning of the end for ransomware's criminal empires. The research can be found here: ⁠⁠⁠⁠Gang Wars: Breaking Trust Among Cyber Criminals Learn more about your ad choices. Visit megaphone.fm/adchoices

In this episode of KP Unpacked, KP and Nick break down one of the toughest choices for hardware and robotics founders in AEC: Should you sell the equipment, offer it as a service, or self-perform the work?We cover how to size distribution and reduce friction, when CapEx vs OpEx tilts the deal, what risk transfer really costs, and why your choice is not static. We also get into channel pitfalls like exclusivity and rights of first refusal, and share field lessons from companies building real robots for construction.What you'll learnA simple way to map distribution size vs friction before you pick a modelWhen RaaS wins due to OpEx and risk transferWhen to sell equipment because the interface is mature and buyers have CapExWhen to go Prime/self-perform for fast payback and controlHow maintenance, spares, and uptime reshape your marginsWhy channel exclusivity and ROFR can box you inHow to use customer conversations to validate the model earlyExamples referencedLumina: electric construction equipment and why self-perform can align incentivesOkibo: drywall finishing robots and why RaaS speeds product learningTimestamps00:00 Intro and warm-up03:05 Why cheerful, constructive podcasts work04:45 Founders Podcast and dense learning07:06 The big question: sell, service, or prime09:20 Framework start: distribution size vs friction14:35 Leasing, risk transfer, and unfamiliar tech17:20 RaaS realities: maintenance, spares, support22:35 Heuristics for RaaS, sell, and prime25:20 Incentives when you operate your own machines28:36 Okibo case: production scale and feedback loops33:26 CapEx vs OpEx and incentive alignment on projects39:44 Channels, exclusivity math, and distribution maturity40:39 The ROFR trap and how it kills deals42:19 Ask customers early and often47:39 Wrap If you're building in AEC and wrestling with go-to-market, send us your scenario. We'll pressure-test it on a future episode.Sounds like you? Join the waitlist at https://kpreddy.co/Check out one of our Catalyst conversation starters, AEC Needs More High-Agency ThinkersHope to see you there!

Brendan shares his first impressions of three games he tried out recently, and one he dusted off. Join us, won't you?Fountains (2025)The Gardens (2022)Carcassonne (2000)Ready Set Bet (2022)Hot Streak (2025)Raas: A Dance of Love (2026)Tzolkin: The Mayan Calendar (2012)Dice Miner (2021) (revisited)What games have you been playing lately? Share your thoughts over on boardgamegeek in guild #3269.

In this episode of The New Warehouse Podcast, Kevin chats with Akash Gupta, Co-Founder and CEO of GreyOrange, and Jim Barnes, CEO of enVista. The conversation centers on their new partnership, bringing together GreyOrange's AI-powered orchestration platform, GreyMatter, and enVista's decades of supply chain consulting and systems integration expertise. Together, the companies are introducing “enMotion,” a joint solution designed to orchestrate warehouse automation technologies, optimize fulfillment outcomes, and make robotics more accessible to warehouses of all sizes. The discussion highlights how orchestration, interoperability, and robotics-as-a-service (RaaS) are reshaping the industry while delivering measurable ROI for operators.Find EPG at IntraLogistex Miami in September! Get better visibility with Surgere. Follow us on LinkedIn and YouTube.Support the show

This week on the Inside EMS podcast, Chris Cebollero and Kelly Grayson shine a spotlight on the kidneys and their impact on patient outcomes. What starts as a chat about chronic kidney stones quickly dives into a sharp, clinical breakdown of renal anatomy, physiology and the far-reaching consequences of kidney dysfunction in EMS care. Chris and Kelly unpack the kidneys' role in fluid balance, blood pressure regulation and acid-base stability, including how the renin angiotensin aldosterone system (RAAS) system can either save a patient … or make things worse. They outline the key types of acute kidney injury (pre-renal, intrinsic, post-renal), tie them back to underlying anatomy, and explain why perfusion matters long before labs confirm failure. With field-focused tips on what to ask (yes, diaper counts matter), what to look for and how to manage critical complications, this episode gives medics the tools to recognize renal red flags early — and act fast. Additional resources: Acute kidney injury assessment and treatment The science behind shock: Why providers must understand the RAAS Caring for the dialysis patient One for the Road: Is this a kidney stone? Memorable quotes “In EMS, we don't really pay attention to the functioning of the kidneys until everything goes south.” “They're not lying when they say the kidneys are the windows to the viscera.” “Kidney problems don't happen in isolation.” Enjoying the show? Email theshow@ems1.com to share feedback or suggest guests for a future episode. 

Episode 200: All About Ascites.     Jesica Mendoza explains the pathophysiology, diagnosis and management of ascites. Dr. Arreaza adds input about early detection and prevention of spontaneous bacterial peritonitis. Written by Jesica Mendoza, OMS IV, Western University, College of Osteopathic Medicine of the Pacific. Edits and 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.Welcome to our episode 200! It is an honor to welcome back a wonderful medical student, her name is Jesica, and she has prepared this topic, and she is excited to share this information with us. Jesica presented in June this year an episode about gestational diabetes (episode 193) and today she will talk about ascites. Jesica, please tell us who you are again. What is ascites?Ascites is the buildup of fluid in between the visceral peritoneum and the parietal peritoneum in the abdomen. This is often caused by cirrhosis of the liver due to the increased portal HTN which leads to increased nitrous oxide (NO) and prostaglandins which then causes splanchnic vasodilation and decreased effective arterial volume. The decrease in arterial volume then causes an increase in the renin–angiotensin–aldosterone system (RAAS) and antidiuretic hormone (ADH) from the renal system which leads to sodium and water retention. This then causes a net reabsorption of fluids and ascites.Evaluation of ascites.Once someone has been found to have ascites the next step will be a diagnostic paracentesis. This includes removing fluid from the peritoneal cavity in order to determine the SAAG (Serum Ascites Albumin Gradient) score. SAAG : (serum albumin) − (albumin level of ascitic fluid). The two values should be measured at the same time.This score helps determine the cause of the ascites with a score >1.1 g/dL indicating portal hypertension usually due to liver disease such as cirrhosis. A SAAG score of 250 PMNS/mL. Fluid should be sent to the lab for culture and then antibiotics should be started. IV 3rd generation cephalosporins are typically used. Fluoroquinolones are also used to prevent the recurrence of SBP.If you desire to learn more about SBP, listen to our episode 123. By the way, propranolol is a frequently used medication to prevent GI bleeding from esophageal varices in cirrhosis and also to decrease the development of ascites. It should be used in patients who have compensated cirrhosis and must be avoided in patients with refractory ascites, hypotension, renal dysfunction or active infection. So, to wrap things up we should remember that once we identify ascites with our physical exam of the patient, we should make sure to obtain a paracentesis as these results will be the main guide for our treatment. The treatment can then range from medical treatment such as spironolactone and/or loop diuretics to TIPS procedures, PleurX or even liver transplant. Always be on the lookout for SBP in patients with ascites and always remember to obtain a culture on the ascitic fluid prior to starting antibiotics. Even without trying, every night you go to bed a little wiser. Thanks for listening to Rio Bravo qWeek Podcast. We want to hear from you, send us an email at RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. See you next week! _____________________References:Ascites, Cleveland Clinic, https://my.clevelandclinic.org/health/diseases/14792-ascites.Huang LL, Xia HH, Zhu SL. Ascitic Fluid Analysis in the Differential Diagnosis of Ascites: Focus on Cirrhotic Ascites. J Clin Transl Hepatol. 2014 Mar;2(1):58-64. doi: 10.14218/JCTH.2013.00010. Epub 2014 Mar 15. PMID: 26357618; PMCID: PMC4521252. https://pmc.ncbi.nlm.nih.gov/articles/PMC4521252/.Theme song, Works All The Time by Dominik Schwarzer, YouTube ID: CUBDNERZU8HXUHBS, purchased from https://www.premiumbeat.com/.

This week on the Inside EMS podcast, Chris Cebollero and Kelly Grayson shine a spotlight on the kidneys and their impact on patient outcomes. What starts as a chat about chronic kidney stones quickly dives into a sharp, clinical breakdown of renal anatomy, physiology and the far-reaching consequences of kidney dysfunction in EMS care. Chris and Kelly unpack the kidneys' role in fluid balance, blood pressure regulation and acid-base stability, including how the renin angiotensin aldosterone system (RAAS) system can either save a patient … or make things worse. They outline the key types of acute kidney injury (pre-renal, intrinsic, post-renal), tie them back to underlying anatomy, and explain why perfusion matters long before labs confirm failure. With field-focused tips on what to ask (yes, diaper counts matter), what to look for and how to manage critical complications, this episode gives medics the tools to recognize renal red flags early — and act fast. Additional resources: Acute kidney injury assessment and treatment The science behind shock: Why providers must understand the RAAS Caring for the dialysis patient One for the Road: Is this a kidney stone? Memorable quotes “In EMS, we don't really pay attention to the functioning of the kidneys until everything goes south.” “They're not lying when they say the kidneys are the windows to the viscera.” “Kidney problems don't happen in isolation.” Enjoying the show? Email theshow@ems1.com to share feedback or suggest guests for a future episode. 

Hazel is joined by threat intelligence researcher James Nutland to discuss Cisco Talos' latest findings on the newly emerged Chaos ransomware group. Based on real-world incident response engagements, James breaks down Chaos' fast, multi-threaded encryption, their use of social engineering and remote access tools like Quick Assist, and the group's likely connections to former BlackSuit operators. James also shares what defenders should be watching for and how to stay ahead of evolving ransomware tactics.Read the full research blog: https://blog.talosintelligence.com/new-chaos-ransomware

If you've ever felt overwhelmed trying to piece together how blood pressure, fluid balance, and heart failure meds all connect, this episode is for you. In this lesson, we're diving into the RAAS pathway, also known as the renin-angiotensin-aldosterone system, and how this one system plays a major role in so many things you'll encounter in nursing school and beyond. You'll learn how RAAS helps regulate systemic vascular resistance and fluid volume, which ultimately impact cardiac output and blood pressure. I'll walk you through the three main components—renin, angiotensin, and aldosterone—and show you exactly how they interact to keep the body in balance. We'll also cover the medications that disrupt this pathway, including ACE inhibitors, ARBs, and aldosterone receptor blockers. These are foundational drugs used to treat hypertension and heart failure, and understanding the pathway gives you a deeper understanding of why and how they work. Plus, we touch on the role of pharmacologic angiotensin II in hypotension and septic shock. This episode highlights how mastering one system—just one!—can give you a big-picture view of multiple conditions and treatments. It's a perfect example of what I teach in my free class, How to Thrive in Nursing School Without It Taking Over Your Life. And if you're ready to keep building that strong foundation, I'll also tell you how to join me inside Crucial Concepts Bootcamp. Ready to make the RAAS system finally click? Let's do it! ___________________ Full Transcript - Read the article and view references FREE CLASS - If all you've heard are nursing school horror stories, then you need this class! Join me in this on-demand session where I dispel all those nursing school myths and show you that YES...you can thrive in nursing school without it taking over your life! Crucial Concepts Bootcamp - Start nursing school ahead of the game, or reset after a difficult first semester with my nursing school prep course, Crucial Concepts Bootcamp. Learn key foundation concepts, organization and time management, dosage calculations, and so much more. Straight A Nursing App - Study on-the-go with the Straight A Nursing app! Review more than 5,000 flashcards covering a wide range of subjects including Fundamentals, Pediatrics, Med Surg, Mental Health, Maternal Newborn, and more! Available for free in the Apple App Store and Google Play Store. Pharmacology Success Pack - Want to get a head start on pharmacology? Download the FREE Pharmacology Success Pack.  Nursing School Thrive Guide - Get the book that many nursing students consider the ultimate survival guide for nursing school! Available in paperback, Kindle and audio formats.

Contributor: Alec Coston, MD Educational Pearls: For patients presenting to the emergency room with hypertension, clinicians should determine if it is isolated and uncomplicated, or involves comorbidities with more complex underlying pathophysiology.  For uncomplicated and isolated hypertension, first-line treatment is thiazide diuretics.  How do thiazide diuretics work to treat hypertension? Thiazide diuretics work by blocking sodium and chloride resorption in the kidneys.  “Where sodium goes, water follows,” thus promoting diuresis and lowering blood pressure. Examples of thiazide diuretics and their benefits? Hydrochlorothiazide (HCTZ): First-line medication in uncomplicated and chronic hypertensive states. Cheaper and fewer significant adverse effects compared to chlorthalidone. HCTZ can be associated with decreased risk of stroke and myocardial infarction. However, for more complicated hypertension, especially in the setting of heart failure, Angiotensin Converting Enzyme (ACE) Inhibitors should be considered.  How do ACE Inhibitors manage blood pressure? The body's kidneys drive the Renin-Angiotensin-Aldosterone-System (RAAS) to regulate blood pressure. It is easiest to understand RAAS as being pro-hypertensive as a response to decreased renal perfusion. As renal perfusion decreases, renin is released and activates angiotensin I, which is converted by ACE to Angiotensin II, which causes release of aldosterone. ACE Inhibitors prevent the conversion of Angiotensin I to Angiotensin II, thus decreasing the kidneys' production of Angiotensin II and Aldosterone levels. Why, in the context of heart failure, are ACE Inhibitors preferred? In heart failure, especially left-sided or left-ventricular heart failure, a vicious cycle can develop wherein the left ventricle fails to perfuse the kidneys due to over-dilation. The kidneys are hypoperfused and activate RAAS to try to retain volume and increase peripheral vasoconstriction, promoting renal perfusion. The increase in blood pressure puts further strain on the heart, thereby further decreasing cardiac output. The cycle develops, and extremely elevated blood pressures can develop. ACE Inhibitors can directly block this cycle, hence their preference in heart failure. Big takeaway? In uncomplicated hypertensive patients, consider thiazide diuretics. When comorbidities, especially heart failure, are introduced, then consider ACE Inhibitors. References Carey RM, Moran AE, Whelton PK. Treatment of Hypertension: A Review. JAMA. 2022;328(18):1849-1861. doi:10.1001/jama.2022.19590 Fan M, Zhang J, Lee CL, Zhang J, Feng L. Structure and thiazide inhibition mechanism of the human Na-Cl cotransporter. Nature. 2023;614(7949):788-793. doi:10.1038/s41586-023-05718-0 Hripcsak G, Suchard MA, Shea S, et al. Comparison of Cardiovascular and Safety Outcomes of Chlorthalidone vs Hydrochlorothiazide to Treat Hypertension. JAMA Internal Medicine. 2020;180(4):542-551. doi:10.1001/jamainternmed.2019.7454 Yu D, Li JX, Cheng Y, et al. Comparative efficacy of different antihypertensive drug classes for stroke prevention: A network meta-analysis of randomized controlled trials. PLoS One. 2025;20(2):e0313309. doi:10.1371/journal.pone.0313309 Summarized by Dan Orbidan, OMS2 | Edited by Dan Orbidan & Jorge Chalit, OMS4 Donate: https://emergencymedicalminute.org/donate/  

THE LANCET 2003;362:772-776Background: Angiotensin converting enzyme inhibitors (ACEi) reduce mortality and morbidity in patients with systolic heart failure (see CONSENSUS and SOLVD trials). However, registry data showed that up to 20% of patients with systolic heart failure were not taking ACEi. One of the frequent causes for intolerance to ACEi is cough. Angiotensin converting enzyme inhibitors work by blocking the conversion of angiotensin I to angiotensin II, a key step in the renin–angiotensin–aldosterone system (RAAS). Angiotensin II receptor blockers were tolerated in patients with systolic heart failure who were intolerant to ACEi. However, data on long term effectives as an alternative to ACEi were lacking.Cardiology Trial's Substack is a reader-supported publication. To receive new posts and support our work, consider becoming a free or paid subscriber.The Candesartan in Heart failure: Assessment of Reduction in Mortality and morbidity (CHARM)-Alternative trial sough to assess if the angiotensin-receptor blocker (ARB) candesartan, could improve outcomes in patients with systolic heart failure who are intolerant to ACEi.Patients: Eligible patients had left ventricular ejection fraction of 40% or less and NYHA class II, III or IV symptoms of at least 4 weeks duration. Patients had also to be intolerant to ACEi.Exclusion criteria were not provided in the main manuscript.Baseline characteristics: Patients were recruited from 618 centers in 26 countries. The trial randomized 2,028 patients – 1,013 randomized to receive candesartan and 1,015 to receive placebo.The average age of patients was 67 years and 68% were men. The average left ventricular ejection fraction was 30%. Cardiomyopathy was ischemic in 68% of the patients. The NYHA class was II in 48% of the patients, III in 49% and IV in 4%.Approximately 50% had hypertension, 27% had diabetes, 61% had prior myocardial infarction, 9% had stroke, 25% had atrial fibrillation and 14% were current smokers.At the time of enrollment, 85% were taking a diuretic, 46% were taking digoxin, 55% were taking beta-blockers and 24% were taking spironolactone.The most common reasons for ACEi intolerance were cough in 72% of the patients, hypotension in 13%, renal dysfunction in 12% and angioedema or anaphylaxis in 4%.Procedures: The trial was double-blinded. Patients were assigned in a 1:1 ratio to receive candesartan starting at 4 or 8mg once daily or placebo. The treatment was doubled every two weeks to a target dose of 32mg once daily.After randomization, follow up occurred at 2, 4, and 6 weeks, 6 months and every 4 months thereafter.Endpoints: The primary outcome was a composite of cardiovascular death or heart failure hospitalizations. All deaths were classified as cardiovascular unless there was a clear non-cardiac cause.Analysis was performed based on the intention-to-treat principle. The estimated sample size to have 80% power at 5% alpha was 2,000 patients. The sample size calculation assumed 18% relative risk reduction in the primary outcome with candesartan assuming a 15% annual event rate in the placebo arm.Results: The median follow up time was 34 months. The mean candesartan daily dose was 23mg at 6 months.Candesartan reduced the primary endpoint of cardiovascular death or heart failure hospitalizations (33.0% vs 40.0%, adjusted HR: 0.70, 95% CI: 0.60 – 0.81; p< 0.001). Candesartan reduced the individual components of the primary outcome - (21.6% vs 24.8%; p= 0.02) for cardiovascular death and (20.4% vs 28.2%; p< 0.001) for heart failure hospitalizations. All-cause death was also lower with candesartan (26.2% vs 29.2%, adjusted HR: 0.83, 95% CI: 0.70–0.99; p= 0.033). The number of patients who had any hospitalization as well as the total number of hospitalizations were numerically but not statistically significantly lower with candesartan (60.2% with candesartan vs 63.3%; p= 0.16) and (1,718 vs 1,835; p= 0.06).Candesartan was associated with more hypotension (3.7% vs 0.9%), more increase in creatinine (6.1% vs 2.7%) and more hyperkalemia (1.9% vs 0.3%). Angioedema occurred in three patients in the candesartan group and none in the placebo group. Cough occurred in two patients taking candesartan and four taking placebo.Authors reported no significant subgroup interactions, however, a corresponding graph was not provided.Conclusion: In patients with systolic heart failure who are intolerant to ACEi, candesartan reduced the primary composite outcome of cardiovascular death or heart failure hospitalizations with a number needed to treat of approximately of 14 patients over 34 months of follow up. Candesartan also reduced all-cause death with a number needed to treat of approximately 33 patients. Adverse events including hypotension, increase in creatinine and hyperkalemia were more common with candesartan.The reduction in the primary endpoint with candesartan was significant and offers an alternative for patients who are unable to tolerate ACEi. Of note, 72% of the patients enrolled in the trial were intolerant to ACEi due to cough. This trial did not include a head-to-head comparison between ARBs and ACEi, and therefore does not address which agent should be preferred as first-line therapy. Only 24% of participants were receiving spironolactone. The combination of ARBs with spironolactone, may increase the risk of adverse events, particularly hyperkalemia and kidney injury.Cardiology Trial's Substack is a reader-supported publication. To receive new posts and support our work, consider becoming a free or paid subscriber. 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N Engl J Med 2001;345:1667-1675Background: Angiotensin II is a peptide hormone that is part of the renin–angiotensin–aldosterone system (RAAS). Angiotensin II is a potent vasoconstrictor and growth-stimulating hormone. Data suggested that it plays a role in ventricular remodeling and progression of heart failure. Although treatment with angiotensin-converting enzyme inhibitors (ACEi) reduce angiotensin II levels, physiologically active levels of angiotensin II may persist despite long-term therapy.Cardiology Trial's Substack is a reader-supported publication. To receive new posts and support our work, consider becoming a free or paid subscriber.The Valsartan Heart Failure Trial (Val-HeFT) sough to assess whether the angiotensin-receptor blocker valsartan, could reduce mortality and morbidity when added to optimal medical therapy in patients with systolic heart failure.Patients: Eligible patients had left ventricular ejection fraction less than 40% and left ventricular dilation, in addition to having clinical heart failure for at least 3 months with NYHA class II, III or IV symptoms. Patient also had to have been receiving a fixed-dose drug regimen for at least two weeks, that could include ACEi, diuretics, digoxin, and beta-blockers.There were many exclusion criteria. We mention some here: Postpartum cardiomyopathy, acute myocardial infarction within 3 months, coronary artery disease likely to require intervention, serum creatinine >2.5 mg/dL and life expectancy less than 5 years.Baseline characteristics: Patients were recruited from 302 centers in 16 countries. The trial randomized 5,010 patients – 2,511 randomized to receive valsartan and 2,499 to receive placebo.The average age of patients was 63 years and 80% were men. The average left ventricular ejection fraction was 27%. Cardiomyopathy was ischemic in 57% of the patients. The NYHA class was II in 62% of the patients, III in 36% of the patients and IV in 2%.Approximately 26% had diabetes and 12% had atrial fibrillation.At the time of enrollment, 86% were taking a diuretic, 67% were taking digoxin, 35% were taking beta-blockers, and 93% were taking ACEi.Procedures: The trial was double-blinded. The trial had an initial run-in period for 2 - 4 weeks where patients received placebo twice daily. This was performed to confirm patients' eligibility, clinical stability and compliance.Patients were assigned in a 1:1 ratio to receive valsartan or placebo. Randomization was stratified according to whether or not they were receiving a beta-blocker.Valsartan was started at a dose of 40 mg twice a day, and the dose was doubled every two weeks to the target dose of 160 mg twice a day. Placebo doses were adjusted in a similar way.Follow up occurred at 2, 4, and 6 months and every 3 months thereafter.Endpoints: The trial had two primary end points. The first was all-cause mortality. The second was the combined end point of mortality and morbidity, which was defined as cardiac arrest with resuscitation, hospitalization for heart failure, or administration of intravenous inotropic or vasodilator drugs for four hours or more without hospitalization.The estimated sample size was 5,000 patients. The sample size calculation assumed 20% relative risk reduction in mortality with valsartan assuming 906 patients would die during the trial. This sample size would provide the trial 90% power at 0.02 alpha. Alpha was 0.02 instead of the traditional 0.05 since the trial had two primary endpoints and to adjust for the interim analyses.Results: The target valsartan dose of 160 mg twice a day was achieved in 84% of the patients. The reduction in systolic blood pressure was greater with valsartan vs placebo – mean of 5.2 ± 15.8 mm with valsartan compared to 1.2 ± 14.8 mm Hg with placebo, at 4 months.All-cause mortality was not different between both groups (19.7% with valsartan vs 19.4% with placebo, RR: 1.02, 95% CI: 0.88 – 1.18; p= 0.80). The second co-primary endpoint was reduced with valsartan (28.8% vs 32.1%, RR: 0.87, 95% CI: 0.77 – 0.97; p= 0.009). This was driven by reduction in hospitalizations for heart failure (13.8% vs 18.2%). Cardiac arrest with resuscitation was 0.6% with valsartan and 1.0% with placebo. All-cause hospitalization was numerically lower with valsartan, however, this was not statistically significance (2,856 vs 3,106; p= 0.14). The mean change in ejection fraction was higher with valsartan (4.0% vs 3.2%; p= 0.001). More patients had improvement in NYHA classification with valsartan (23.1% vs 20.7%; p

Segment 1 CTG Interview Middle market companies face unique challenges in the ever-evolving cyber environment. Developing a comprehensive cybersecurity approach is a business imperative for middle market companies, and Chad Alessi will discuss the threat landscape, what's keeping IT decision-makers awkward at night, and the best approach to creating a proactive security measure. Cyber Resilience in Action: A Guide for Mid-Market Firms This segment is sponsored by CTG. Visit https://securityweekly.com/ctgrsac to learn more about them! Nightwing Interview Nightwing divested from Raytheon in April 2024 and is entering another year of redefining national security. Amid emerging threats and shifting industry regulations and compliance frameworks, traditional security measures are no longer cutting it. As Cyber Incident Response Manager at Nightwing, Nick Carroll discusses how organizations can continue to build cyber resiliency and stay one step ahead in today's threat landscape. This segment is sponsored by Nightwing. Visit https://securityweekly.com/nightwingrsac to learn more about them! Segment 2 Libraesva Interview Generative AI is having a transformative effect across almost every industry, but arguably the area it has had the most significant impact is cybercrime. Discriminative AI can now learn to recognize what constitutes normal communication patterns, so anything out of the ordinary can be flagged. AI is also enabling human security analysts to automate the triage of reported emails, to rapidly identify false positives and keep up with emerging cybercriminal tactics. Finally, specialized Small Language Models (SLMs) using neural networks are able to analyze and comprehend the semantic intent of the message. This segment is sponsored by Libraesva. Visit https://securityweekly.com/libraesvarsac to learn more about them! IRONSCALES Interview Phishing has evolved—fast. What started as basic email scams has transformed into AI-powered cyber deception. Phishing 1.0: Early phishing relied on spam emails, fake banking alerts, and malware links to trick users into clicking Phishing 2.0: Attackers got smarter—instead of mass emails, they started impersonating real people Phishing 3.0: Now, cybercriminals are using AI to generate fake but highly convincing voices, videos, and images IRONSCALES discusses the current gaps in SEG technology and will showcase industry-first innovations for protection against deepfakes. Assessing Organizational Readiness in the Face of Emerging Cyber Threat Using AI to Enhance Defensive Cybersecurity white paper The Hidden Gaps of SEG Protection white paper This segment is sponsored by IRONSCALES. Visit https://securityweekly.com/ironscalesrsac to learn more about them! Segment 3 Illumio Interview In the post-breach world, speed and clarity are essential for effective cybersecurity. Security teams are inundated with vast amounts of data, much of which is not actionable. To combat cyber threats—and level the playing field—defenders need precise intelligence to identify attacks, dynamically quarantine threats, and prevent cyber disasters, highlighting the power of the security graph. Segment Resources: Rethinking Threat Detection in a Decentralized World Illumio Insights Announcement More information about Illumio Insights This segment is sponsored by Illumio. Visit https://securityweekly.com/illumiorsac for information on Illumio Insights or to sign up for a private preview! ESET Interview The ransomware landscape is rapidly changing. ESET global research team has been closely following ransomware gang disruptions, new players and how the RaaS business model continues to evolve. In this segment, Tony Anscombe will take a look into recent research, hacks and attacks, and explore how the industry and businesses are responding to combat financial risk and mitigate threats. Segment Resources: https://www.welivesecurity.com/en/eset-research/shifting-sands-ransomhub-edrkillshifter/ https://www.welivesecurity.com/en/eset-research/eset-threat-report-h2-2024/ This segment is sponsored by ESET. Visit https://securityweekly.com/esetrsac to learn more about them! Visit https://www.securityweekly.com/esw for all the latest episodes! Show Notes: https://securityweekly.com/esw-409

Segment 1 CTG Interview Middle market companies face unique challenges in the ever-evolving cyber environment. Developing a comprehensive cybersecurity approach is a business imperative for middle market companies, and Chad Alessi will discuss the threat landscape, what's keeping IT decision-makers awkward at night, and the best approach to creating a proactive security measure. Cyber Resilience in Action: A Guide for Mid-Market Firms This segment is sponsored by CTG. Visit https://securityweekly.com/ctgrsac to learn more about them! Nightwing Interview Nightwing divested from Raytheon in April 2024 and is entering another year of redefining national security. Amid emerging threats and shifting industry regulations and compliance frameworks, traditional security measures are no longer cutting it. As Cyber Incident Response Manager at Nightwing, Nick Carroll discusses how organizations can continue to build cyber resiliency and stay one step ahead in today's threat landscape. This segment is sponsored by Nightwing. Visit https://securityweekly.com/nightwingrsac to learn more about them! Segment 2 Libraesva Interview Generative AI is having a transformative effect across almost every industry, but arguably the area it has had the most significant impact is cybercrime. Discriminative AI can now learn to recognize what constitutes normal communication patterns, so anything out of the ordinary can be flagged. AI is also enabling human security analysts to automate the triage of reported emails, to rapidly identify false positives and keep up with emerging cybercriminal tactics. Finally, specialized Small Language Models (SLMs) using neural networks are able to analyze and comprehend the semantic intent of the message. This segment is sponsored by Libraesva. Visit https://securityweekly.com/libraesvarsac to learn more about them! IRONSCALES Interview Phishing has evolved—fast. What started as basic email scams has transformed into AI-powered cyber deception. Phishing 1.0: Early phishing relied on spam emails, fake banking alerts, and malware links to trick users into clicking Phishing 2.0: Attackers got smarter—instead of mass emails, they started impersonating real people Phishing 3.0: Now, cybercriminals are using AI to generate fake but highly convincing voices, videos, and images IRONSCALES discusses the current gaps in SEG technology and will showcase industry-first innovations for protection against deepfakes. Assessing Organizational Readiness in the Face of Emerging Cyber Threat Using AI to Enhance Defensive Cybersecurity white paper The Hidden Gaps of SEG Protection white paper This segment is sponsored by IRONSCALES. Visit https://securityweekly.com/ironscalesrsac to learn more about them! Segment 3 Illumio Interview In the post-breach world, speed and clarity are essential for effective cybersecurity. Security teams are inundated with vast amounts of data, much of which is not actionable. To combat cyber threats—and level the playing field—defenders need precise intelligence to identify attacks, dynamically quarantine threats, and prevent cyber disasters, highlighting the power of the security graph. Segment Resources: Rethinking Threat Detection in a Decentralized World Illumio Insights Announcement More information about Illumio Insights This segment is sponsored by Illumio. Visit https://securityweekly.com/illumiorsac for information on Illumio Insights or to sign up for a private preview! ESET Interview The ransomware landscape is rapidly changing. ESET global research team has been closely following ransomware gang disruptions, new players and how the RaaS business model continues to evolve. In this segment, Tony Anscombe will take a look into recent research, hacks and attacks, and explore how the industry and businesses are responding to combat financial risk and mitigate threats. Segment Resources: https://www.welivesecurity.com/en/eset-research/shifting-sands-ransomhub-edrkillshifter/ https://www.welivesecurity.com/en/eset-research/eset-threat-report-h2-2024/ This segment is sponsored by ESET. Visit https://securityweekly.com/esetrsac to learn more about them! Visit https://www.securityweekly.com/esw for all the latest episodes! Show Notes: https://securityweekly.com/esw-409

What You'll Learn:Why orchestration platforms are the future of 3PLs, and how they outperform legacy WMS systems.The real ROI of small automation solutions for 3PLs with low upfront costs.How to evaluate fulfillment tech and avoid costly pilot mistakes.What the Greenfield vs. Brownfield debate means for your automation strategy.Why incremental scaling is the best approach for implementing automation in 3PLs.How AI and robotics are transforming the supply chain and fulfillment operations.Key takeaways from Promat and other industry conferences on next-gen warehouse tech. Highlights: [00:00:00] – Introduction to the episode & guest introductions[00:06:13] – The evolution of decision-making with AI[00:10:30] – Why orchestration-first is replacing WMS in modern warehouses[00:13:52] – Evaluating fulfillment tech and avoiding common pitfalls[00:18:10] – The ROI of small-scale automation for 3PLs[00:30:00] – Greenfield vs. Brownfield for automation—where should you start?[00:34:32] – Closing thoughts on smart scaling and what's next for 3PLsQuotes: [00:06:39] “So I can spend 10%, 15% of my time compiling, and theoretically 80% of my time thinking. And that's going to be a game changer for us as an industry.” — Will O'Donnell[00:10:56] “The warehouse of the future is automation, robots, and an orchestrator. Not just a WMS.” — Erhan Musaoglu[00:19:18] “Innovation happens when you remove constraints. And a lot of constraints are self-imposed.” — Will O'Donnell[00:27:00] “Don't underestimate the simple solutions that are usually the best.” — Marv Cunningham  About the Guests: Will O'Donnell — Global Head of Corporate Development at Prologis & Managing Partner of Prologis Ventures. Will leads investment into emerging supply chain tech with a macro lens on real estate and fulfillment convergence. https://www.linkedin.com/in/will-odonnell-553aa0a/Marv Cunningham — Global Head of Operations, Essentials at Prologis. Formerly of Amazon and GXO, Marv brings deep operational expertise and a track record of warehouse optimization at scale. https://www.linkedin.com/in/marvcunningham/Erhan Musaoglu — CEO of Logiwa. A serial WMS builder, Erhan now focuses on orchestration-first fulfillment software that integrates robotics, AI, and warehouse logic. https://www.linkedin.com/in/erhanmusaoglu/ Subscribe and Keep Learning!If you're a logistics leader looking to scale sustainably, don't miss out! Subscribe for more expert strategies on tackling modern supply chain challenges.Be sure to follow and tag the eCom Logistics Podcast on LinkedIn and YouTube

N Engl J Med 1999;341:709-717Background: The renin–angiotensin–aldosterone system (RAAS) is activated in patients with systolic heart failure. While this activation initially helps increase blood volume and maintains blood pressure, chronic activation promotes cardiac fibrosis and remodeling. In patients with systolic heart failure, inhibition of the RAAS with angiotensin-converting enzyme inhibitors (ACEi) significantly reduced mortality and morbidity, as seen in the CONSENSUS and SOLVD trials.Cardiology Trial's Substack is a reader-supported publication. To receive new posts and support our work, consider becoming a free or paid subscriber.Preliminary data suggested that adding the aldosterone-receptor blocker spironolactone to ACEi, reduced the levels of atrial natriuretic peptide and did not lead to serious hyperkalemia.The Randomized Aldactone Evaluation Study (RALES) sought to test the hypothesis that spironolactone would significantly reduce the risk of all-cause death in patients with severe systolic heart failure.Patients: Eligible patients had left ventricular ejection fraction of 35% or less, had NYHA class IV heart failure within the 6 months before enrollment and NYHA class III or IV at the time of enrollment, and were treated with ACEi (if tolerated) and a loop diuretic.Patients were excluded if they had primary operable valvular disease (other than mitral or tricuspid regurgitation), congenital heart disease, unstable angina, primary liver failure, active cancer or any life-threatening condition, other than heart failure, prior heart transplant or awaiting heart transplant, serum creatinine >2.5 mg/dL, or serum potassium > 5.0 mmol/L.Baseline characteristics: Patients were recruited from 195 centers in 15 countries. The trial randomized 1,663 patients – 822 randomized to receive spironolactone and 841 to receive placebo.The average age of patients was 65 years and 73% were men. The average left ventricular ejection fraction was 25%. Cardiomyopathy was ischemic in 55% of the patients and non-ischemic in the rest. The NYHA class was III in 71% of the patients and IV in 29%.Data on baseline comorbid conditions were not provided.At the time of enrollment, 100% were taking loop diuretics, 94% were taking ACEi, 73% were taking digitalis, and 10% were taking beta-blockers. The mean daily dose of ACEi were as following: 63mg for captopril, 15mg for enalapril, and 14mg for lisinopril.Note: Max daily dose is 450mg for captopril, 40mg for enalapril, and 40mg for lisinopril.Procedures: The trial was double-blinded. Patients were assigned in a 1:1 ratio to receive spironolactone 25mg PO daily or placebo.The dose could be increased to 50mg daily after 8 weeks of treatment, If the patient had worsening heart failure and had no evidence of hyperkalemia. In the event of hyperkalemia, the dose could be lowered to 25 mg every other day. Laboratory testing including potassium were performed every 4 weeks for the first 12 weeks, then every 3 months for up to 1 year and every 6 months thereafter until the end of the study.Endpoints: The primary outcome was all-cause death. Secondary end points included death from cardiac causes, hospitalization for cardiac causes and change in the NYHA class.Analysis was performed based on the intention-to-treat principle. The planned sample size was not mentioned in the methods. However, the results mention that recruitment was complete. The sample size calculation assumed 38% mortality rate in the placebo group and that spironolactone would reduce mortality by 17% (relative risk reduction). The power of the study was set at 90% with a two-sided alpha of 5%.Results: Recruitment was complete in Dec, 1996 with follow up planned through Dec, 1999. However, the study was stopped early on Aug, 1998 after interim analysis showed significant reduction in mortality with spironolactone. The mean follow up time was 24 months. After 24 months of follow up, the mean daily dose of spironolactone was 26 mg.Spironolactone reduced all-cause death (35% vs 46%, RR: 0.70, 95% CI: 0.60 - 0.82; p< 0.001). Death from cardiac causes was also reduced with spironolactone (27% vs 37%, RR: 0.69, 95% CI: 0.58 - 0.82; p

Ransomware has become more difficult for organizations to defend against, but easier for adversaries to deploy. The rise of ransomware-as-a-service (RaaS) — a model in which ransomware operators write the malware and affiliates pay to launch it — has lowered the barrier to entry so threat actors of all skill levels can participate and profit.   OCULAR SPIDER is one such operator. This adversary, newly named by CrowdStrike, is associated with the development of ransomware variants including Cyclops, Knight, and RansomHub. They targeted hundreds of named victims between February 2024 and March 2025, according to CrowdStrike intelligence, and they focus on industries such as professional services, technology, healthcare, and manufacturing in regions including the United States, Canada, Brazil, and some European countries.   But OCULAR SPIDER is one of many operators in the ransomware space. Adam and Cristian take listeners back to the early days of ransomware and track its evolution, variants, and key players from the mid-2010s through the launch of RansomHub in 2024. They explain how RaaS works, why it appeals to adversaries and complicates attribution, and how defenders can prepare to face today's ransomware threats.   Come for an update on Adam's adventures in bread-making; stay for a deep-dive into the RaaS evolution and the threat actors driving it.