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1. Major U.S.–Israel Strike on Iran President Trump ordered a large-scale coordinated U.S. and Israeli bombing campaign on Iran. Over 900 U.S. airstrikes and ~1,200 Israeli strikes occurred within the first day. The attack reportedly killed Iran’s Supreme Leader and several senior Iranian officials. The hosts emphasize that intelligence was “exquisite,” enabling targeted strikes on leadership meetings. 2. Rationale for the Attack (as described by the speakers) Iran is portrayed as: Leading state sponsor of terrorism for decades. Responsible for killing ~1,000 Americans historically. Financing Hamas, Hezbollah, and the Houthis. Claims that Iran’s nuclear program was being rebuilt after earlier strikes. Trump reportedly consulted senators on Air Force One before the strike. The speakers describe Iran as militarily weakened from a previous “Twelve-Day War.” 3. Expected Global and U.S. Consequences Escalation risk is stressed, particularly: Terror attacks from Iran-backed proxies (Hamas, Hezbollah, Houthis). Possible retaliation within the U.S. Middle Eastern airspace and the Strait of Hormuz were reportedly shut down amid fears of mines and missile activity. 4. Austin, Texas Mass Shooting Separate event discussed as possibly terrorism-related, though not confirmed. Shooter: 53‑year‑old naturalized U.S. citizen from Senegal. Wore clothing with “Property of Allah” and an Iranian flag underneath. Fired into a crowded bar district; killed 2 victims and was shot by police. Authorities had not yet confirmed motive at the time of reporting; investigation is ongoing. Please Hit Subscribe to this podcast Right Now. Also Please Subscribe to the 47 Morning Update with Ben Ferguson and The Ben Ferguson Show Podcast Wherever You get You're Podcasts. And don't forget to follow the show on Social Media so you never miss a moment! Thanks for Listening YouTube: https://www.youtube.com/@VerdictwithTedCruz/ Facebook: https://www.facebook.com/verdictwithtedcruz X: https://x.com/tedcruz X: https://x.com/benfergusonshowYouTube: https://www.youtube.com/@VerdictwithTedCruzSee omnystudio.com/listener for privacy information.

Dr. Lakshmi Rajdev and Dr. Manish Shah join the podcast to discuss the updated guideline on immunotherapy and targeted therapy in unresectable locally advanced, advanced, or metastatic gastroesophageal cancer. They share first-line and subsequent-line recommendations for both gastroesophageal adenocarcinoma and esophageal squamous cell carcinoma based on actionable biomarkers including PD-L1 expression, MMR and/or MSI, CLDN18.2 expression, and HER2 status. They note the importance of the algorithms and tables in the guidelines that provide visual illustrations and quick reference guides of the evidence-based recommendations. They also comment on ongoing and recently presented trials that may impact future guidelines in this space. Read the full guideline, "Immunotherapy and Targeted Therapy for Advanced Gastroesophageal Cancer: ASCO Guideline Update" at www.asco.org/gastrointestinal-cancer-guidelines" TRANSCRIPT This guideline, clinical tools and resources are available at www.asco.org/gastrointestinal-cancer-guidelines. Read the full text of the guideline and review authors' disclosures of potential conflicts of interest in the Journal of Clinical Oncology,  https://ascopubs.org/doi/10.1200/JCO-25-02958      Timestamps ·       00:00 – 02:15 Introduction and Overview ·       02:16 - 08:20 First-line treatment for patients with pMMR/MSS, HER2-negative gastroesophageal adenocarcinoma ·       08:21 –10:29 First-line treatment for patients with pMMR/MSS, HER2-positive gastroesophageal adenocarcinoma ·       10:30 – 14:39 First-line treatment for patients with dMMR/MSI-H, gastroesophageal adenocarcinoma ·       14:40 – 18:03 First-line treatment for ESCC ·       18:04 – 22:04 Second- and third-line therapy for gastroesophageal adenocarcinoma and ESCC ·       22:05 – 24:38 Importance of guideline ·       24:39 – 27:45 Outstanding questions and future research   Brittany Harvey: Hello and welcome to the ASCO Guidelines podcast, one of ASCO's podcasts delivering timely information to keep you up to date on the latest changes, challenges, and advances in oncology. You can find all the shows, including this one, at asco.org/podcasts.   My name is Brittany Harvey, and today I am interviewing Dr. Lakshmi Rajdev from the Icahn School of Medicine at Mount Sinai and Dr. Manish Shah from Weill Cornell Medicine, co-chairs on "Immunotherapy and Targeted Therapy for Advanced Gastroesophageal Cancer: ASCO Guideline Update." Thank you for being here today, Dr. Rajdev and Dr. Shah. Dr. Lakshmi Rajdev: Thank you. Dr. Manish Shah: Thank you for having us. It is wonderful. Brittany Harvey: And then just before we discuss this guideline, I would like to note that ASCO takes great care in the development of its guidelines and ensuring that the ASCO conflict of interest policy is followed for each guideline. The disclosures of potential conflicts of interest for the guideline panel, including Dr. Rajdev and Dr. Shah, who have joined us here today, are available online with the publication of the guideline in the Journal of Clinical Oncology, which is linked in the show notes. So then to dive into what we are here today to talk about, Dr. Shah, I would like to start first with what prompted the update to this guideline, which was previously published in 2023, and what is the scope of this updated guideline? Dr. Manish Shah: Yes, terrific. So even in the last few years, the pace of drug development in gastroesophageal cancers has just been astounding. So, what prompted this guideline is actually the practice-changing results for a new biomarker, CLDN18.2 hat was based on the GLOW and SPOTLIGHT studies, as well as a practice-changing study in HER2-positive disease where we added pembrolizumab to trastuzumab and chemotherapy for tumors that are HER2-positive and PD-L1 CPS 1 or greater. And then there were also new studies and new approvals in esophageal squamous cell cancer that you will hear about as well. So there were several studies, overall more than 5,000 patients were reported on, and that led to several new therapies, new indications, and it really necessitated this guideline. Brittany Harvey: Excellent. It is great to hear about all of these exciting updates in this space. So then to next review the key recommendations of this guideline by clinical question that the expert panel addressed. So, Dr. Rajdev, what is the recommended first-line treatment for patients with proficient mismatch repair, microsatellite stable, HER2-negative gastroesophageal adenocarcinoma? Dr. Lakshmi Rajdev: Thank you for that question. So historically, we have sort of used fluoropyrimidine and platinum doublets, which yielded a survival of about one year. More recently, immunotherapy and targeted therapy options have improved outcomes in patients with advanced esophageal and gastric adenocarcinoma, as well as squamous cell carcinoma. Patients with gastric and GE junction adenocarcinoma have a high rate of actionable alterations, so it is imperative that physicians test the following biomarkers upfront so that it can help guide therapy. The markers recommended by the ASCO panel are HER2, MMR or MSI, CLDN18.2, and PD-L1. And also, it was recommended to use NGS if feasible in this patient population. HER2, as we know, is expressed in about 15% to 25% of patients; PD-L1 expression occurs in about 80% of patients; MSI-high, deficient MMR is present in about 5% to 8% of patients; and CLDN18.2 expression is present in about 40% of patients. There is, of course, biomarker overlap. About 13% to 22% of CLDN18.2 patients are also PD-L1 positive. For patients with pMMR or microsatellite stable HER2-negative disease with PD-L1 expression greater than 1 and absence of CLDN18.2, the panel recommended a first-line therapy with fluoropyrimidine and platinum-based therapy in combination with immunotherapy. These recommendations stem from large phase 3 trials, and the agents approved in the United States are pembrolizumab, nivolumab, and tislelizumab. It has been shown that immunotherapy benefit is greater in patients with higher PD-L1 expression, and it is not possible to comment on the individual PD-L1 cutoff scores and sort of identify the optimal PD-L1 cutoff score that sort of balances benefits and harms. But what is recommended is that immunotherapy-based treatments can be offered in patients with a CPS score of greater than 1. With regard to the choice of immunotherapy agents, that is pembrolizumab, nivolumab, or tislelizumab, these agents are considered to have similar efficacy, and the selection of an agent could be based on dosing schedule, cost considerations, toxicity, and the method of administration. Typically, clinicians should avoid withholding the start of chemotherapy while awaiting biomarker testing, depending on the clinical scenario. Now, for patients with pMMR microsatellite stable disease that is HER2-negative with PD-L1 expression less than 1 and positive CLDN18.2 expression, zolbetuximab-based treatments or in combination with chemotherapy is recommended, and this is based on two global phase III randomized controlled trials, the GLOW and the SPOTLIGHT. And across both studies, the hazard ratio for the overall survival was 0.78, and similarly, there was also an improvement in progression-free survival favoring the zolbetuximab group compared to the chemotherapy group alone. An important note is that nausea, vomiting is commonly associated with zolbetuximab-based treatments, and the panel recommended prophylactic antiemetics, adjusting zolbetuximab infusion rates, pausing infusion temporarily, using non-prophylactic antiemetics, and hydration intravenously prior to discontinuation of zolbetuximab-based chemotherapy. So effective handling of the GI-related symptoms with zolbetuximab is recommended prior to discontinuation of therapy. Now, for patients with pMMR microsatellite stable HER2-negative gastric, GE junction adenocarcinoma with PD-L1 expression greater than 1 and CLDN18.2 positivity, the ones with the dual expression with CLDN18.2 as well as PD-L1 chemotherapy, the choice of therapy can be based on the degree of PD-L1 expression, the toxicity profile, the burden of symptoms, and the anticipated improvement in symptoms associated with response to treatment, the patient comorbidities, the prior medical and treatment history. So this decision needs to be made on a case-by-case basis, and these are some of the factors that we suggested that could potentially influence the choice of therapy. For patients with pMMR microsatellite stable disease that is HER2-negative and a PD-L1 expression less than 1 and an absence of CLDN18.2 expression, first-line therapy with fluoropyrimidine and platinum-based chemotherapy is recommended. So you can see we have segmented out patients based on PD-L1 expression, pMMR and microsatellite stable disease expression, and also based on CLDN expression. Brittany Harvey: Absolutely. And that first point you noted, I think is really important, that biomarker testing is really critical for treatment decision-making in this space. So then the next subgroup of patients that the panel looked at, Dr. Shah, what first-line therapy is recommended for patients with proficient mismatch repair, microsatellite stable, HER2-positive gastroesophageal adenocarcinoma? Dr. Manish Shah: So this was an update from a few years ago. So we have known for 15 years now that if you are HER2-positive, you should get trastuzumab plus chemotherapy. That was based on the ToGA trial. And the update now is based on a trial called KEYNOTE-811, where it examined the addition of pembrolizumab to trastuzumab and chemotherapy versus trastuzumab and chemotherapy, and there was a progression-free and overall survival benefit. And again, here, the biomarkers are important. If your CPS PD-L1 is less than 1, we would not recommend Pembrolizumab in that setting, so you would still get trastuzumab and chemotherapy. But if it is 1 or greater, the PD-L1 CPS score, then we do recommend pembrolizumab unless there is a contraindication to immunotherapy. The take-home message really is from the onset of diagnosis, please check your biomarkers. And I will just, it is worth repeating, it is important to check your PD-L1 status, HER2 status, mismatch repair status, and CLDN18.2 status. And then the optimal therapy, and it is outlined in the publication, is really biomarker-driven. We know that if we are able to hit the target that is overexpressed, we are going to have a better outcome. And Dr. Rajdev did mention where there is overlap, there can be a lack of data, and that is where we are with both PD-L1 positive and CLDN positive. Here we do have data in HER2-positive cases where if you are both HER2-positive and PD-L1 positive, you would combine trastuzumab and pembrolizumab for the best outcomes. Brittany Harvey: Understood. I really appreciate you detailing what is most important for each individual biomarker combination that patients may have. So then following that, Dr. Rajdev, what does the expert panel recommend for first-line treatment for patients with esophageal squamous cell carcinoma that is not amenable to definitive chemoradiation? Dr. Lakshmi Rajdev: There are three phase III randomized clinical trials that have influenced practice in patients with esophageal squamous cell carcinoma examining the benefit of immunotherapy in this patient population. The RATIONALE-306 was a randomized trial of tislelizumab plus chemotherapy with platinum and fluoropyrimidine or paclitaxel versus placebo with chemotherapy. And then you have the KEYNOTE-590, which compared pembrolizumab plus chemotherapy versus chemotherapy alone. And then you have CheckMate-648, which included comparisons of nivolumab plus chemotherapy versus nivolumab plus ipilimumab or chemotherapy. And the primary endpoints for these studies were overall survival, and they did look at subgroups with PD-L1 expression. They used TPS score greater than 1% in CheckMate-648 and PD-L1 CPS greater than 10 in KEYNOTE-590. The bottom line is that the overall hazard ratio for overall survival across this patient population was 0.72. So clearly, there is benefit in patients that express PD-L1 CPS greater than 1 for benefit for the addition of immunotherapy. Now, the benefit again in patients with a PD-L1 expression less than 1 remains limited, and so the panel has made a recommendation for using immunotherapy in combination with platinum-based chemotherapy in patients with a PD-L1 greater than 1. Again, we know that it is hard to make recommendations on what PD-L1 cutoffs are recommended in this patient population, meaning that should it be limited to patients with a PD-L1 of 1 to 4 or greater than 10? I think that the general consensus that has been gleaned from the data is that the higher the PD-L1 expression, the greater the benefit. I do want to comment on another option that is available in patients with squamous cell carcinoma compared to adenocarcinoma, and that is the combination of nivolumab and ipilimumab. Now, in CheckMate-648, nivolumab with ipilimumab was also recommended as a treatment option in patients that have a PD-L1 score of greater than 1. There was a survival benefit demonstrated with this combination compared to chemotherapy alone. And an important observation in this study is that, although there was a slightly increased rate in early death, but there was really no significant difference in PFS and OS compared to chemotherapy alone. Importantly, the treatment appeared to be pretty well tolerated by the study population. There was a notable difference in the objective response rate, which was 35% in the nivolumab plus ipilimumab group compared to patients receiving nivolumab and chemotherapy, where it was 53%. So superiority is, so the importance of chemotherapy in patients with esophageal squamous cell carcinoma is to be noted. However, there is no difference in overall survival and progression-free survival when using the combination of nivolumab and ipilimumab, and thus it affords a chemotherapy-free option for this patient population with esophageal squamous cell carcinoma and a CPS with a score of greater than 1. Brittany Harvey: Understood. I appreciate you reviewing the evidence underpinning those recommendations as well. So then the next patient population that the guideline panel addressed, what first-line therapy is recommended for patients with deficient mismatch repair, microsatellite instability-high, gastroesophageal adenocarcinoma or esophageal squamous cell carcinoma? Dr. Lakshmi Rajdev: The rate of MSI-high expression is about 3% to 7% across different studies. Now, the KEYNOTE-158 was a tumor-agnostic study in patients with non-colorectal cancers, and again, the problem with the MSI-high population, given that it is so rare, the numbers in the individual studies are fairly small. But consistent outcomes do emerge, indicating high response to immunotherapy. So in KEYNOTE-158, a response rate of about 46% was noted. The number of patients was small, it was about 24. In CheckMate-649, which is a study of chemotherapy plus or minus nivolumab in patients with advanced gastric adenocarcinoma, there was again a very small number of patients, and patients that were MSI-high or deficient MMR did experience substantial benefits with the addition of immunotherapy, with hazard ratios in the order of about 0.38. In KEYNOTE-062, again, it was a very small number of patients, again about 6% or so, and similar to CheckMate-649, a substantial benefit was noted in combination with chemotherapy, but also there were benefits noted with pembrolizumab alone. The RATIONALE-305 again was a study of tislelizumab in combination with chemotherapy and similarly showed benefits to the combination of chemotherapy plus immunotherapy in this patient population. I think that we are all aware of the dramatic benefits of immunotherapy in this particular subset of patients, deficient MMR MSI-high, and also we have seen in CheckMate-649 they did have a subset of patients that received nivolumab and ipilimumab. And in this patient population, they noted unstratified hazard ratio of 0.28. So I think that the overall consensus is that immunotherapy is a very important treatment modality in patients with deficient MMR MSI-high disease, given that a lot of the trials in gastroesophageal adenocarcinoma have utilized chemotherapy-based options, that is certainly a recommendation of the panel to use chemotherapy in combination with immunotherapy. However, on a case-by-case basis, the panel recommended immunotherapy alone as well, and given the high response rates noted in trials across different diseases as well as noted in this disease as well. Brittany Harvey: Certainly. And I appreciate you both for reviewing these first-line recommendations. So moving to later lines of therapy, Dr. Rajdev, what recommendations did the expert panel make for second or third-line therapy for gastroesophageal adenocarcinoma and esophageal squamous cell carcinoma? Dr. Lakshmi Rajdev: So, I think that the RAINBOW trial that investigated the utility of the addition of ramucirumab as second-line therapy has been around since 2014, and those results have led to the addition of ramucirumab to taxane-based therapy in the second-line setting. Based on the utilization of oxaliplatin and platinum-based therapy in the front-line setting, there may be patients that have an underlying neuropathy, and so we wanted to really include treatment options for this patient population so that an agent that is less neurotoxic could also be recommended in combination with ramucirumab. The RAMIRIS trial is one such trial where ramucirumab was combined with FOLFIRI, and it demonstrated benefit in combination with ramucirumab. So we have listed that as a potential treatment option for patients in the second-line setting who may have an underlying neuropathy or even for whatever reason that based on the toxicity profile, that needs to be the preferred option by a physician, that recommendation is new from the older guidelines that we have. With regard to the utility of PD-1 inhibitors, there really has been no benefit noted in the second-line setting with regard to overall survival or progression-free survival, so no recommendation is made for that option. I think an important study that has been recently presented is the DESTINY-Gastric04 trial, which really has been practice-changing and has led to the recommendation for trastuzumab deruxtecan in patients that have HER2-positive metastatic gastric or GE junction adenocarcinoma. Now, this is a phase III trial in patients who retained HER2-positive disease after progressing on front-line trastuzumab-based treatments, and the comparator for this trial was trastuzumab deruxtecan versus ramucirumab plus paclitaxel. There was significant improvement and progression-free survival in patients that received trastuzumab deruxtecan. The patients that were excluded from the trial are patients that have pulmonary problems, interstitial lung disease; that is one of the toxicities of this particular agent, and close monitoring and prompt initiation of therapy such as glucocorticoid treatment in patients who develop this toxicity was also highlighted by the panel. So to summarize, the new guidelines highlight the possibility of FOLFIRI plus ramucirumab as a second-line option and then trastuzumab deruxtecan as a later-line option in patients that still retain HER2 expression. And that is very important because the trial did retest patients whether they expressed HER2. As we know, in a substantial number of patients, there is downregulation of HER2, and there is emerging data that the benefit for subsequent HER2-directed therapies is best noted in patients that still retain HER2 expression. Brittany Harvey: Great. So as our listeners have heard, there are many recommendations and new treatment options for advanced gastroesophageal cancer. Dr. Shah, earlier you highlighted the importance of biomarker testing, but I would like to hear in your view, what is the importance of this guideline and how will it impact both clinicians and patients with gastroesophageal carcinoma? Dr. Manish Shah: So as we have discussed throughout this podcast, the treatment for gastroesophageal cancer, both adenocarcinoma and squamous cell cancer, is increasingly complex, increasingly biomarker-driven. And I think the value of the guideline is to place all of that into context. So it provides the data for why certain biomarkers are important, what therapies should be indicated. Not only that, but if you are able to review the guideline, it provides the details of each of these studies and summarizes them in a meta-analysis fashion to sort of give you the context, because sometimes the individual studies can be maybe a little bit discordant or confusing and the guideline attempts to harmonize all that. And then also, I think the tables are very, very interesting because they give you actual numbers in terms of how many patients over a thousand would this benefit or how many patients over a thousand would this cause harm in terms of nausea, vomiting, or other things like that. So it gives you context for helping clinicians and patients weigh the potential benefits of the novel treatment strategies against the potential adverse events. And then finally, the guideline does also provide an algorithm that you are able to follow based on the biomarkers, and those are in figures 4 and 5. So I think overall, it is a very comprehensive guideline. It intends to make more manageable a very complex subject, and you know, I really encourage our listeners to review it after listening to the podcast. Dr. Lakshmi Rajdev: If I can add to that, I think that what is also really good about the guidelines is there are quick summaries. So if someone is busy in the clinic, of course, there is the opportunity to review the data supporting the guidelines in great depth in the manuscript, but what is also really good is that there are good summaries. In the event that you are very busy, you can easily identify what the recommendations should be for that particular patient based on these summaries. Brittany Harvey: Absolutely. Listeners are encouraged to review the full guideline, including those tables and figures that may be more helpful when they are looking for something quick to look at in the clinic as well. So, as you both mentioned, there have been a number of recent practice-changing trials in this area. So I imagine there is still a lot of ongoing research as well. So Dr. Shah, what are the outstanding questions regarding treatment options for patients with locally advanced unresectable, advanced, or metastatic gastroesophageal carcinoma? Dr. Manish Shah: I think we touched upon it a little bit. The guidelines are based on the data available, and they are primarily examining one novel therapy with chemotherapy in a specific biomarker population. But as you know, the biomarkers are not either/or; you are not either CLDN18.2 positive or PD-L1 positive. A portion of patients could have dual biomarkers, and you know, I think that we are generating data on how to manage those patients. At the recent GI Symposium in January this year, the ILUSTRO trial was presented by Dr. Shitara, which looked at combining zolbetuximab and chemotherapy with immunotherapy for dual-positive biomarkers, and that is leading to a phase III study that has begun to enroll. So unanswered questions are: how do we manage dual-positive biomarkers? The other thing that was mentioned is that the current data for mismatch repair deficiency involve chemotherapy plus immunotherapy. Only squamous cell cancer is there a study with a positive non-chemotherapy kind of backbone, that is CheckMate-648 that Dr. Rajdev mentioned. As we move forward, it will be good to get data on non-chemotherapy options in certain biomarker-positive populations. And then finally, another update, which is likely to be practice-changing, is the HERIZON-GEA-01 study that looked at zanidatamab, which is another biparatopic antibody that targets HER2, and that is likely to change practice. And as that data gets published, we may look to even do a rapid update for the current immunotherapy and targeted therapy guideline that is just being published. Dr. Lakshmi Rajdev: So, if I can add to that, there are numerous ADCs that look very interesting. There are bispecific antibodies; in fact, the zanidatamab is a bispecific antibody showing improved activity in patients with HER2-positive disease. So I think there are studies from Asia looking at CLDN CAR T-based therapies. So, I think that there are a lot of novel agents and a lot of excitement in the field. We know that the bemarituzumab study, unfortunately, the FGFR2 inhibitor failed to demonstrate any benefit, but I think that there are other agents that are being explored, so there are newer targets, newer agents, ADCs, bispecifics that could potentially change the field in the future. Brittany Harvey: Yes, we will look forward to the data to address these unanswered questions and new agents and inform future guideline updates. So, I would like to thank you both for all of your work to review the evidence here and update this important guideline, and for your time today, Dr. Rajdev and Dr. Shah. Dr. Lakshmi Rajdev: Thank you. Dr. Manish Shah: Thank you. Brittany Harvey: And finally, thank you to all of our listeners for tuning in to the ASCO Guidelines podcast. To read the full guideline, go to www.asco.org/gastrointestinal-cancer-guidelines. You can also find many of our guidelines and interactive resources in the free ASCO Guidelines app, which is available in the Apple App Store or the Google Play Store. If you have enjoyed what you have heard today, please rate and review the podcast and be sure to subscribe so you never miss an episode. The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.

Shamini Rajarethnam is the CEO of RATIONALE, the cult Australian luxury skincare house known for its science-first formulations and luminous-skin rituals. She joined RATIONALE in 2011 and became CEO in 2017, leading its transformation from a dermatology-aligned business into a modern luxury skincare brand with expansion into the US.Shamini holds a BA in Linguistics and a Master of Commerce, and is based in Melbourne with her young family. As both a mom of 3 and CEO, she speaks with us on balancing ambition and purpose, combatting imposter syndrome, showing up with a calm resiliency in both life/motherhood,  and championing women (especially mothers) in business.  Follow Rationale hereShop Rationale Skincare here Follow Shamini on Instagram Connect with Shamini on Linkedin  *Use code  THEBIGMOVE10 for 10% off your purchase on all Rationale products.Link to the one product I am always topping up on (the Rationale glow is REAL)Follow The Big Move Podcast hereFollow Host Em here  

Historian Faisal Husain wrote the book "Rivers of the Sultan: The Tigris and Euphrates in the Ottoman Empire" and in this episode, helps us explore the history of the Tigris and Euphrates. He argued for the necessity of understanding human history within the context of geological time, discussing the rivers' origins roughly 20 million years ago, tracing their influence on civilization from the "agricultural revolution" (which some scholars argue was a mistake leading to health issues) to the rise of early urban centers like the Sumerian cities. The conversation highlights the difference between the gentle Euphrates, which attracted early settlements, and the fast and unpredictable Tigris. Shifting to the Ottoman era, Husain examines the environmental challenges of Ottoman Iraq, which was poor in essential resources like grain, metal, and wood suited for construction, and details the extraordinary story of the Euphrates river changing its course in the late 1600s due to a poorly dug irrigation canal. He emphasizes the cultural importance of the palm tree and the vital role of water buffaloes, which made life possible for a quarter of the Iraqi population in the wetlands, whose fate would have otherwise been migration to seek resources and refuge elsewhere. 0:00 Introduction1:47 When Did the Tigris and Euphrates Start?3:04 The Importance of Deep History5:49 Geological Origins: 20 Million Years Ago7:37 When the Rivers Began to Matter to Homo Sapiens10:40 The Rationale for Writing Deep History12:00 Starting Middle East History Before 6th Century Arabia14:45 The Difference Between the Twin Rivers17:05 Why Sumerian Civilization Clustered on the Euphrates20:36 Questioning the Agricultural Revolution23:16 How Agriculture Began: Trial and Error27:00 The Consequences of Taming Nature30:40 The Ottoman Conquest of Iraq32:20 Why Iraq Was Environmentally Poor for a Major Power36:06 Iraq's Default Status Under Iranian States38:25 Baghdad in the 16th Century42:25 The Euphrates Shifts Course (Late 1600s)47:09 Water Buffaloes: The Essential Technology of the Wetlands49:28 Ranking the Most Important Crops51:03 Evliya Çelebi: The Traveler54:49 Ottoman vs. European Traveler Perspectives58:35 The Book Cover: Baghdad on the Tigris Faisal Husain is an environmental historian of the Ottoman Empire, with a geographical focus on its eastern provinces in Anatolia and Iraq and a temporal focus on the early modern period. His first book "Rivers of the Sultan" examined the role of the Tigris and Euphrates in the establishment of Ottoman state institutions in the Ottoman eastern borderland between the sixteenth and eighteenth centuries. His second book project is an environmental history of Ottoman frontier expansion east of the Euphrates during the sixteenth century. He is co-editing a book on the global histories of animals (under contract with Oxford University Press) with Emily Wakild (Boise State University) and Nancy Jacobs (Brown University). In 2024-2025, he served as a senior lecturer at Boğaziçi University's Department of History in Istanbul through the Fulbright U.S. Scholar Program. He serves on several editorial boards, including those of Marmara Türkiyat Araştırmaları Dergisi (Marmara University), Global Environment (White Horse Press), and the “Middle East Environmental Histories” book series (Leiden University Press). Hosted by: Mikey Muhanna

What do you do when metastatic urothelial cancer responds dramatically to systemic therapy? In this episode of BackTable Urology, Dr. Abhinav Khanna (Mayo Clinic) speaks with host Dr. Daniel Roberson about the growing question of consolidative surgery after enfortumab vedotin plus pembrolizumab. They discuss how EV-pembro has reshaped treatment expectations, why unexpected complete or near-complete responses are prompting tumor board debates about cystectomy, and how careful multidisciplinary decision-making guides which patients may be considered for surgery. --- SYNPOSIS The conversation reviews early outcomes showing high rates of pathologic downstaging and the possibility that many patients may avoid additional systemic therapy after surgery, while emphasizing this approach is not yet standard of care. Dr. Khanna highlights coordination with medical oncology, radiology, and pathology, postoperative considerations, and the potential future role of biomarkers such as ctDNA. Ultimately, the episode underscores the need for clinical trials and thoughtful patient selection as clinicians navigate integrating surgery into an evolving systemic therapy landscape. --- TIMESTAMPS 00:00 - Introduction02:19 - The Evolution of Urothelial Carcinoma Treatment05:23 - Rationale for Consolidative Surgery12:32 - Patient Selection Criteria15:23 - Surgical Approach and Considerations23:58 - Pathologic Findings31:34 - The Role of Radiation39:38 - Biomarkers44:10 - Prospective Trials and Future Directions53:06 - Guidance for Urologists --- RESOURCES Consolidative Surgery for Advanced Urothelial Carcinoma Following Induction Enfortumab Vedotin and/or Immune Checkpoint Inhibitor Therapy: A Multicenter Analysishttps://pubmed.ncbi.nlm.nih.gov/40425390/ Enfortumab Vedotin and Pembrolizumab in Untreated Advanced Urothelial Cancerhttps://www.nejm.org/doi/full/10.1056/NEJMoa2312117 Standard or Extended Lymphadenectomy for Muscle-Invasive Bladder Cancerhttps://www.nejm.org/doi/abs/10.1056/NEJMoa2401497

SpaceX Shifts Focus From Mars to Lunar Base: The Strategic Pivot and Its ImplicationsElon Musk announced on X that SpaceX has shifted its primary focus from Mars to establishing a self-sustaining city on the Moon. This strategic change comes despite SpaceX's long-standing goal of Mars colonization. The company plans an uncrewed lunar landing by March 2027 and has integrated XAI's AI capabilities through a historic $1.25 trillion merger. Factors influencing the pivot include faster lunar mission iteration cycles, fewer setbacks compared to Mars missions, and the strategic race against China to return humans to the Moon. SpaceX's recent FCC filing for 1 million orbital data center satellites and upcoming IPO, valued at $1.5 trillion, are also interconnected with this new focus. Despite these ambitious plans, challenges such as radiation exposure and extreme temperatures remain. Nevertheless, SpaceX aims to start building a Moon base within the next 10 years while maintaining long-term Mars ambitions.00:00 SpaceX's Shift from Mars to the Moon00:41 The Strategic Pivot Explained01:41 Financial and Engineering Insights02:04 Musk's Rationale and Future Plans03:26 NASA and International Competition05:10 The XAI Merger and Its Implications06:48 Orbital Data Centers and IPO Strategy08:55 Challenges and Skepticism10:26 Conclusion: Betting on the Moon

Wieso gibt es Streiks? Rationale Spieler könnten doch das Ergebnis des Streiks vorwegnehmen und gleich dorthin springen. Was passiert während eines Streiks aus Sicht der Rationaltheorie? Diese und weitere spieltheoretische Fragen zu Streik und Verhandlung behandelt diese Episode. Zum Webinar über spieltheoretisches Verhandeln: https://www.rieck-verlag.de/verhandlungsinfo WEITERE INFORMATIONEN Das Hicks-Paradoxon: Warum Streiks ökonomisch irrational scheinen Aus Sicht der klassischen Spieltheorie ist ein Streik ein Symptom kollektiver Ineffizienz. Das nach Sir John Hicks benannte Hicks-Paradoxon postuliert: Da ein Streik den zu verteilenden „Kuchen" (die ökonomische Rente) durch Produktionsausfälle verkleinert, müssten rationale Akteure, die das Endergebnis antizipieren, dieses sofort akzeptieren. Man würde die Streikkosten sparen und das identische Resultat ohne Wohlstandsverluste erzielen. Dass Streiks dennoch stattfinden, ist primär auf asymmetrische Informationen zurückzuführen. In einem Szenario unvollständiger Information fungiert der Streik als kostspieliges Signaling-Device. Da Lippenbekenntnisse in Verhandlungen billig sind („Cheap Talk"), nutzen Parteien den Streik, um die „Wahrheit" über die Schmerzgrenze der Gegenseite zu erzwingen. Nur ein wirtschaftlich schwaches Unternehmen gibt schnell nach; nur eine wirklich entschlossene Gewerkschaft hält lange durch. Der ökonomische Verlust ist somit der Preis für die Offenbarung privater Informationen über die tatsächliche Machtverteilung. Externe Effekte und „Parasitäre Kooperation" Ein gravierendes Problem bei Streiks in der kritischen Infrastruktur ist die Divergenz zwischen privaten und sozialen Kosten. Während in der Industrie die Streikkosten weitgehend internalisiert werden (Gewinneinbußen vs. Lohnverzicht), beobachten wir im Transportsektor massive negative externe Effekte. Wenn Akteure eine Einigung erzielen, deren Kosten durch Effizienzverluste der Gesamtwirtschaft getragen werden, sprechen wir spieltheoretisch von einer Kooperation zu Lasten Dritter. Die Beteiligten nutzen ihre strategische Position, um Renten zu extrahieren, die nicht aus eigener Produktivität stammen, sondern aus der „Geiselnahme" gesamtwirtschaftlicher Wertschöpfungsketten. Der Streik wird zum Hebel, um Ressourcen von Unbeteiligten anzuzapfen. Strategische Selektivität: Die Macht des Flaschenhalses Das „Bottleneck-Problem" folgt der Logik der Verhandlungsmacht in komplexen Netzwerken. Besetzt eine kleine Gruppe einen unverzichtbaren Knotenpunkt (z. B. Stellwerker), steigt ihr strategischer Wert massiv an – nicht durch ihre Arbeitsleistung, sondern durch ihre Fähigkeit, den maximalen Stillstand zu erzwingen. Dies führt zu einer Verzerrung der Lohnstrukturen: Nicht Produktivität bestimmt das Gehalt, sondern die „Veto-Macht". Der Beamtenstatus als strategisches Bindemittel Die Forderung nach Verbeamtung ist der Versuch, das Spiel durch ein Commitment-Device zu beenden. Der Staat garantiert lebenslange Sicherheit; im Gegenzug verzichtet der Akteur auf sein strategisches Instrument, das Streikrecht. Auch falls diese Konstruktion juristisch Bestand haben sollte, bleibt die Herausforderung: Wie schafft man Leistungsanreize in einem System ohne Wettbewerb und ohne die Drohkulisse des Arbeitskampfes? Die Verbeamtung tauscht spieltheoretische Instabilität gegen administrative Starrheit. Instagram: https://www.instagram.com/profrieck/ X/Twitter: https://x.com/profrieck?s=21 LinkedIn: https://www.linkedin.com/in/profrieck

The Chairman Of The Church of Pentecost, Apostle Eric Nyamekye, throws more light on this in this insightful message titled "Rationale For Theme 2026" at the Pentecost Convention Centre in Kasoa. Hosted on Acast. See acast.com/privacy for more information.

The Chairman Of The Church of Pentecost, Apostle Eric Nyamekye, throws more light on this in this insightful message titled "Rationale For Theme 2026" at the Pentecost Convention Centre in Kasoa. Hosted on Acast. See acast.com/privacy for more information.

As the number of patients and survivors of cancer grows each year, awareness of the disease's emotional toll—including depression, anxiety, and deep existential distress—is increasingly recognized as a critical aspect of cancer care. In response, psychedelic-assisted therapy is gaining attention as a promising alternative to traditional mental health interventions, providing relief for some patients. To shed light on the patient experience with this treatment, CANCER BUZZ spoke with breast cancer survivor Judy Wight; Jennifer Bires, MSW, LCSW, OSW-C, FACCC, executive director of Life with Cancer and Patient Experience at Inova Health System; and Manish Agrawal, MD, cofounder and CEO of Sunstone Therapies, about the human side of psychedelic-assisted therapy, promising existing research, and how it can shape the future of psychosocial care. "It's not that I'm a different person. It's more like I'm becoming the person I was meant to be. And all those layers of trauma and sadness...I've been able to shed a lot of that." – Judy Wight "When I started to learn about psychedelic-assisted therapy, read some of the patient accounts, and see some of the research, I said, 'I've got to learn about this. I think that this could be another tool that would be useful for people in this space where we don't have the perfect answer, and we don't have the perfect treatments.'" – Jennifer Bires, MSW, LCSW, OSW-C, FACCC "When I give talks around this, I have an iceberg. Above the iceberg I have chemotherapy, surgery, and radiation, and underneath the iceberg I have what's called psychosocial, psycho-spiritual, psychological care. And I think true cancer care is treating everything in the iceberg, not just what's above the water." – Manish Agrawal, MD   Guests: Jennifer Bires, MSW, LCSW, OSW-C, FACCC  Executive Director, Life with Cancer and Patient Experience Inova Health System Fairfax, VA   Judy Wight Breast Cancer Survivor   Manish Agrawal, MD Cofounder and CEO Sunstone Therapies REKINDLE Investigator   This podcast is sponsored by Reunion Neuroscience.   Resources: The REKINDLE Study ClinicalTrials (NCT07002034) REKINDLE Brochure Reunion Neuroscience Adjustment Disorder Associated With Medical Illness: Unmet Needs and Rationale for RE104 as a Novel Psychedelic Therapy Exploring Psychedelic-Assisted Therapy in Oncology Addressing the Psychological Burdens of Cancer on World Mental Health Day Psychosocial Care in Oncology: Advocating for Policy Changes that Improve the Culture of Care Collaborative Care: A Model for Embedding Counseling in Oncology and Palliative Care Spirituality and Cultural Humility: Core Components of Comprehensive Palliative Care Psychosocial Care in Oncology Collaborative Care: A Solution for Increasing Access to Psychosocial Care in Cancer Programs and Practices Scan to learn more about the REKINDLE study:  

On Wednesday, Maharashtra was hit with the tragic news of NCP leader and Deputy Chief Minister, Ajit Pawar, passing away in a plane crash. Just three days later, in a move that has left many stunned, his wife, Sunetra Pawar, took the oath as the new Deputy Chief Minister of Maharashtra. Why was this transition so swift, and what does it really mean for the future of the NCP or Nationalist Congress Party?See omnystudio.com/listener for privacy information.

Vahe Gregorian, of the KC Star and NGL Hall of Fame voter, joined The Drive to explain why he did not vote for Bill Belichick.

Alanoud Althonayan, Director and Head of Events and Sponsorship at Saudi Arabia's Public Investment Fund, joins the podcast to explain PIF's sponsorship strategy and dig into its current key partnerships. In the first episode of a new series exploring PIF's growing sponsorship portfolio, Alnothayan sits down with David Cushnan in Riyadh for an extended conversation, outlining what PIF looks for in partners, and the ways it is striving to help solve societal and sporting challenges across its portfolio. She explains the rationale behind the new PIF WTA Maternity Fund programme, which provides WTA players up to 12 month of paid leave; how the AI powered PIF TennisIQ platform is revolutionising and democratising data for players and coaches on the ATP Tour; how the Electric 360 initiative co-developed with Formula E, Extreme E and E1 is supporting the growth of electric transportation; how the appeal of golf is being unlocked for locals through work with Golf Saudi; and how partnerships in football, notably with CONCACAF, are giving PIF a platform in the world's most popular sport. Leaders Week London is moving to Stamford Bridge, home of Chelsea FC. We'll see you on Wednesday 7th and Thursday 8th October. For more details visit leadersinsport.com/leadersweek

Art Rooney's rationale for hiring Mike McCarthy. Hear award-winning columnist Dejan Kovacevic's Daily Shots of Steelers, Penguins and Pirates -- three separate podcasts -- every weekday morning on the DK Pittsburgh Sports podcasting network, available on all platforms: https://linktr.ee/dkpghsports Learn more about your ad choices. Visit megaphone.fm/adchoices

Art Rooney's rationale for hiring Mike McCarthy. Hear award-winning columnist Dejan Kovacevic's Daily Shots of Steelers, Penguins and Pirates -- three separate podcasts -- every weekday morning on the DK Pittsburgh Sports podcasting network, available on all platforms: https://linktr.ee/dkpghsports Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

Hear award-winning columnist Dejan Kovacevic's Daily Shots of Steelers, Penguins and Pirates -- three separate podcasts -- every weekday morning on the DK Pittsburgh Sports podcasting network, available on all platforms: https://linktr.ee/dkpghsports Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

In this episode of the Hands-On, Hands-Off Podcast, Dr. Trenton Rehman sits down with Dr. Shane McClinton to discuss plantar heel pain and the role of physical therapy in both clinical outcomes and healthcare costs.Dr. McClinton walks through a series of studies stemming from his doctoral research, including a randomized clinical trial, a detailed case series, and a three-year cost-effectiveness analysis. Together, they explore how adding physical therapy to usual podiatry care impacts pain, function, quality of life, and long-term costs.Key themes include manual therapy, impairment-based exercise, proximal contributions to heel pain, interdisciplinary collaboration, and why plantar heel pain may deserve the same clinical mindset as low back pain.Key Takeaways (Listener-Facing)Plantar heel pain is a multidimensional condition with local and proximal contributors.Adding physical therapy to usual podiatry care improved outcomes and reduced costs over three years.Manual therapy and exercise were delivered pragmatically and tailored to impairments.Strengthening may be underutilized in plantar heel pain management.Collaboration between physical therapists and podiatrists benefits patients and reduces downstream burden.⏱️ TIMESTAMPED CHAPTERS (YouTube + Podcast)00:00 – Introduction to the episode and guest00:01 – Dr. Shane McClinton's background and research focus00:03 – Why plantar heel pain referrals to PT are low00:07 – Rationale for studying cost-effectiveness00:10 – Study design overview (RCT + pragmatic approach)00:15 – Description of podiatry-only vs podiatry + PT care00:17 – Inclusion and exclusion criteria00:22 – Case series: why eight different heel pain presentations00:26 – Manual therapy strategies used in the study00:30 – Clinical practice guidelines and decision-making00:32 – Pain mechanisms, education, and chronicity00:35 – Proximal vs local treatment decisions00:38 – Three-year cost-effectiveness results explained00:44 – Implications for referrals and collaboration00:48 – Final take-home message from Dr. McClinton

The crew checks in live from Rockefeller Center and quickly veers from Patreon housekeeping into Polymarket absurdities, restaurant closures, and the grim mechanics of auctioning off a closed kitchen. Jean details liquidating equipment (including a Rationale), while Dave unloads on bureaucracy, safety grounds left floating inside a brand-new Bosch oven, and the theoretical physics of jacking oven temps via PT1000 resistance sensors—plus reversible home steam-injection hacks that don't involve drilling holes.Quinn talks risotto-style oats and fresh milling, and Dave breaks down grain texture, grinder damage myths, and why oats are mushy compared to rice. Listener questions round things out with astringency in drinks beyond tannins (bitters, resins, aromatics), blood-sausage preferences across styles, and how phosphoric acid can anchor a cola-like, carbonated amaro build. Hosted on Acast. See acast.com/privacy for more information.

Picture this: a patient with early-stage breast cancer is sitting in front of you in the clinic. You are about to offer your expert management plan. The age-old question arises—should you really perform a sentinel lymph node biopsy, or could omission actually help this patient more? Today, we're tackling one of the hottest debates in modern breast cancer care.Should we rethink sentinel lymph node biopsy for select patients, and can skipping it actually improve quality of life without sacrificing cancer control? The stakes couldn't be higher—balancing accurate cancer staging and minimizing harm is the name of the game. Together, we're breaking down the latest evidence from the SOUND and INSEMA trials. What do these landmark studies mean for your patients, your practice, and the future of axillary management? Ready for a journal review that might just change your next consult? Hosts:- Rashmi Kumar, MD, PhDResident, University of Michigan General Surgery Residency ProgramTwitter/X: @RashmiJKumar- Melissa Pilewskie, MDAttending Breast Surgical Oncologist, Co-Director of the Weiser Family Center for Breast Cancer, Michigan Medicine Twitter/X: @MPilewskie- Stephanie Downs-Canner, MDAttending Breast Surgical Oncologist & Physician-Scientist, Memorial Sloan Kettering Cancer Center, Program Director of the Breast Surgical Oncology Fellowship Training Program Twitter/X: @SDownsCannerLearning Objectives:- Understand when and for whom it is safe and beneficial to omit sentinel lymph node biopsy (SLNB) in early-stage breast cancer patients.- Identify the risks associated with foregoing SLNB, including loss of nodal staging, and analyze how this impacts treatment selection and prognosis.- Review key findings from the SOUND and INSEMA trials and their influence on axillary management.- Discuss implications for adjuvant therapy, genomic profiling, and multidisciplinary clinical practice.- Recognize which patient populations should still receive SLNB, and the importance of individualized, multidisciplinary decision-making.References:- Gentilini OD, Botteri E, Sangalli C, et al. Sentinel Lymph Node Biopsy vs No Axillary Surgery in Patients With Small Breast Cancer and Negative Results on Ultrasonography of Axillary Lymph Nodes: The SOUND Randomized Clinical Trial. JAMA Oncol. 2023;9(11):1557–1564. doi:10.1001/jamaoncol.2023.3759 https://pubmed.ncbi.nlm.nih.gov/37733364/- Reimer T, Stachs A, Veselinovic K, et al. Axillary surgery in breast cancer – primary results of the INSEMA trial. N Eng J Med. 2024. doi:10.1056/NEJMoa2412063.https://pubmed.ncbi.nlm.nih.gov/39665649/- Sparano JA, Gray RJ, Makower DF, Albain KS, Saphner TJ, Badve SS, Wagner LI, Kaklamani VG, Keane MM, Gomez HL, Reddy PS, Goggins TF, Mayer IA, Toppmeyer DL, Brufsky AM, Goetz MP, Berenberg JL, Mahalcioiu C, Desbiens C, Hayes DF, Dees EC, Geyer CE Jr, Olson JA Jr, Wood WC, Lively T, Paik S, Ellis MJ, Abrams J, Sledge GW Jr. Clinical Outcomes in Early Breast Cancer With a High 21-Gene Recurrence Score of 26 to 100 Assigned to Adjuvant Chemotherapy Plus Endocrine Therapy: A Secondary Analysis of the TAILORx Randomized Clinical Trial. JAMA Oncol. 2020 Mar 1;6(3):367-374. doi: 10.1001/jamaoncol.2019.4794. PMID: 31566680; PMCID: PMC6777230. https://pubmed.ncbi.nlm.nih.gov/31566680/- Slamon DJ, Fasching PA, Hurvitz S, Chia S, Crown J, Martín M, Barrios CH, Bardia A, Im SA, Yardley DA, Untch M, Huang CS, Stroyakovskiy D, Xu B, Moroose RL, Loi S, Visco F, Bee-Munteanu V, Afenjar K, Fresco R, Taran T, Chakravartty A, Zarate JP, Lteif A, Hortobagyi GN. Rationale and trial design of NATALEE: a Phase III trial of adjuvant ribociclib + endocrine therapy versus endocrine therapy alone in patients with HR+/HER2- early breast cancer. Ther Adv Med Oncol. 2023 May 29;15:17588359231178125. doi: 10.1177/17588359231178125. Erratum in: Ther Adv Med Oncol. 2023 Sep 29;15:17588359231201818. doi: 10.1177/17588359231201818. PMID: 37275963; PMCID: PMC10233570. https://pubmed.ncbi.nlm.nih.gov/37275963/Sponsor Disclosure: Visit goremedical.com/btkpod to learn more about GORE® SYNECOR Biomaterial, including supporting references and disclaimers for the presented content. Refer to Instructions for Use at eifu.goremedical.com for a complete description of all applicable indications, warnings, precautions and contraindications for the markets where this product is available. Rx only Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listenBehind the Knife Premium:General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-reviewTrauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlasDominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkshipDominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotationVascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-audio-reviewColorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-audio-reviewSurgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-audio-reviewCardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-audio-reviewDownload our App:Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

In this episode, I'm joined by Virginie Raphael — investor, entrepreneur, and philosopher of work — for a wide-ranging conversation about incentives, technology, and how we build systems that scale without losing their humanity. We talk about her background growing up around her family's flower business, and how those early experiences shaped the way she thinks about labor, value, and operating in the real economy. That foundation carries through to her work as an investor, where she brings an operator's lens to evaluating businesses and ideas. We explore how incentives quietly shape outcomes across industries, especially in healthcare. Virginie shares why telehealth was a meaningful shift and what needs to change to move beyond one-to-one, supply-constrained models of care. We also dig into AI, venture capital, and the mistakes founders commonly make today — from hiring sales teams too early to raising too much money too fast. Virginie offers candid advice on pitching investors, why thoughtful cold outreach still works, and how doing real research signals respect and fit. The conversation closes with a contrarian take on selling: why it's not a numbers game, how focus and pre-qualification drive better outcomes, and why knowing who not to target is just as valuable as finding the right people. If you're thinking about the future of work, building with intention, or navigating entrepreneurship in an AI-accelerated world, this episode is for you. And for more conversations like this, join us at Snafu Conference 2026 on March 5th, where we'll keep exploring incentives, human skills, and what it really takes to build things that last. Start (0:00) Reflections on Work, Geography, and AI Adoption Virginie shares what she's noticing as trends in work and tech adoption: Geographic focus: she's excited to explore AI adoption outside traditional tech hubs. Examples: Atlanta, Nashville, Durham, Utah, Colorado, Georgia, North Carolina, parts of the Midwest. Rationale: businesses in these regions may adopt AI faster due to budgets, urgency, and impatience for tech that doesn't perform. "There are big corporates, there are middle and small businesses in those geos that have budget that will need the tech… and/or have less patience, I should say, for over-hub technologies that don't work." She notes that transitions to transformational technology never happen overnight, which creates opportunities: "We always underestimate how much time a transition to making anything that's so transformational… truly ubiquitous… just tends to think that it will happen overnight and it never does." Robin adds context from her own experience with Robin's Cafe and San Francisco's Mission District: Observed cultural and business momentum tied to geography Mentions Hollywood decline and rise of alternative media hubs (Atlanta, Morocco, New Jersey) Virginie reflects on COVID's impact on workforce behaviors: Opened a "window" to new modes of work and accelerated change: "There were many preexisting trends… but I do think that COVID gave a bit of a window into what was possible." Emphasis on structural change: workforce shifts require multi-year perspective and infrastructure, not just trends. Investor, Mission, and Capital Philosophy Virginie clarifies she is an investor, not a venture capitalist, resisting labels and prestige metrics. "I don't call myself a venture capitalist… I just say investor." Focuses on outcomes over categories, investing in solutions that advance the world she wants to see rather than chasing trendy tech sectors. "The outcome we want to see is everyone having the mode of work that suits them best throughout their lives." Portfolio themes: Access: helping people discover jobs they wouldn't otherwise know about. Retention / support: preventing workforce dropouts, providing appropriate healthcare, childcare, and caregiving support. "Anyone anywhere building towards that vision is investible by us." Critiques traditional venture capital practices: Raising VC money is not inherently a sign of success. "Raising from a VC is just not a sign of success. It's a milestone, not the goal." Concerned about concentration of capital into a few funds, leaving many founders unsupported. "There's a sense… that the work we do commands a lot less power in the world, a lot less effectiveness than holding the capital to hire that labor." Emphasizes structural, mission-driven investing over chasing categories: Invests in companies that prevent workforce dropouts, expand opportunity, and create equitable access to meaningful work. Portfolio strategy is diversified, focusing on infrastructure and long-term impact rather than quick wins. "We've tracked over time what type of founders and what type of solutions we attract and it's exactly the type of deal that we want to see." Reflects on COVID and societal trends as a lens for her investment thesis: "COVID gave a bit of a window into what was possible," highlighting alternative modes of work and talent distribution that are often overlooked. Labor, Ownership, and Durable Skills Virginie reframes the concept of labor, wages, and ownership: "The word labor in and of itself… is something we need to change." Interested in agency and ownership as investment opportunities, especially for small businesses transitioning to employee ownership. "For a very long time… there's been a shift towards knowledge work and how those people are compensated. If you go on the blue-collar side… it's about wages still and labor." Emphasizes proper capitalization and alignment of funds to support meaningful exits for smaller businesses, rather than chasing massive exits that drive the VC zeitgeist. AI fits into this discussion as part of broader investment considerations. Childhood experience in family flower business shaped her entrepreneurial and labor perspective: Selling flowers, handling cash, and interacting with customers taught "durable skills" that persisted into adulthood. "When I think of labor, I think of literally planting pumpkin plants… pulling espresso shots… bringing a customer behind the counter." Observing her father start a business from scratch instilled risk-taking and entrepreneurial spirit. "Seeing my dad do this when I was seven… definitely part of that." Skills like sales acumen, handling money, and talking to adults were early lessons that translated into professional confidence. Non-linear career paths and expanding exposure to opportunity: Concerned that students often see only a narrow range of job options: "Kids go out of high school, they can think of three jobs, two of which are their parents' jobs… Surely because we do a poor job exposing them to other things." Advocates for creating more flexible and exploratory career pathways for young people and adults alike. Durable skills and language shaping work: Introduction of the term "durable skills" reframes how competencies are understood: "I use it all the time now… as a proof point for why we need to change language." Highlights the stigma and limitations of words like "soft skills" or "fractional work": Fractional roles are high-impact and intentional, not temporary or inferior. "Brilliant people who wanna work on a fractional basis… they truly wanna work differently… on a portfolio of things they're particularly good at solving." Work in Progress uses language intentionally to shift perceptions and empower people around work. Cultural significance of language in understanding work and people: Virginie notes that language carries stigma and meaning that shapes opportunities and perception. References Louis Thomas's essays as inspiration for attention to the nuance and power of words: He'll take the word discipline and distill it into its root, tie it back into the natural world." Robin shares a personal anecdote about language and culture: "You can always use Google Translate… but also it's somebody learning DIA or trying to learn dharia, which is Moroccan Arabic… because my fiance is Moroccan." Human-Positive AI, Process, and Apprenticeship Virginie emphasizes the value of process over pure efficiency, especially in investing and work: "It's not about the outcome often, it's about the process… there is truly an apprenticeship quality to venture and investing." Using AI to accelerate tasks like investment memos is possible, but the human learning and iterative discussion is critical: "There's some beauty in that inefficiency, that I think we ought not to lose." AI should augment human work rather than replace the nuanced judgment, particularly in roles requiring creativity, judgment, and relationship-building: "No individual should be in a job that's either unsafe or totally boring or a hundred percent automatable." Introduces the term "human-positive AI" to highlight tools that enhance human potential rather than simply automate tasks: "How do we use it to truly augment the work that we do and augment the people?" Project selection and learning as a metric of value: Virginie evaluates opportunities not just on outcome, but what she will learn and who she becomes by doing the work: "If this project were to fail, what would I still learn? What would I still get out of it?" Cites examples like running a one-day SNAFU conference to engage people in human-centered selling principles: "Who do I become as a result of doing that is always been much more important to me than the concrete outcomes of this thing going well." AI Bubble, Transition, and Opportunity Discusses the current AI landscape and the comparison to past tech bubbles: "I think we're in an AI bubble… 1999 was a tech bubble and Amazon grew out of it." Differentiates between speculative hype and foundational technological transformation: "It is fundamental. It is foundational. It is transformative. There's no question about that." Highlights the lag between technological introduction and widespread adoption: "There's always a pendulum swing… it takes time for massively transformative technology to fully integrate." AI as an enabler, not a replacement: Transition periods create opportunity for investment and human-positive augmentation. Examples from healthcare illustrate AI's potential when applied correctly: "We need other people to care for other people. Should we leverage AI so the doctor doesn't have to face away from the patient taking notes? Yes, ambient scribing is wonderful." Emphasizes building AI around real human use cases and avoiding over-automation: "What are the true use cases for it that make a ton of sense versus the ones we need to stay away from?" History and parallels with autonomous vehicles illustrate the delay between hype and full implementation: Lyft/Uber example: companies predicted autonomous vehicles as cost drivers; the transition opened up gig work: "I was a gig worker long before that was a term… the conversation around benefits and portability is still ongoing." AI will similarly require time to stabilize and integrate into workflows while creating new jobs. Bias, Structural Challenges, and Real-World AI Experiments Discusses the importance of addressing systemic bias in AI and tech: Shares the LinkedIn "#WearThePants" experiment: women altered gender identifiers to measure algorithmic reach: "They changed their picture, in some cases changed their names… and got much more massive reach." Demonstrates that AI can perpetuate structural biases baked into systems and historical behavior: "It's not just about building AI that's unbiased; it's about understanding what the algorithm might learn from centuries of entrenched behavior." Highlights the ongoing challenge of designing AI to avoid reinforcing existing inequities: "Now you understand the deeply structural ingrained issues we need to solve to not continue to compound what is already massively problematic." Parenting, Durable Skills, and Resilience Focus on instilling adaptability and problem-solving in children: "I refuse to problem solve for them. If they forget their homework, they figure it out, they email the teacher, they apologize the next day. I don't care. I don't help them." Emphasizes allowing children to navigate consequences themselves to build independence: "If he forgets his flute, he forgets his flute. I am not making the extra trip to school to bring him his flute." Everyday activities are opportunities to cultivate soft skills and confidence: "I let them order themselves at the restaurant… they need to look the waiter in the eye and order themselves… you need to speak more clearly or speak loudly." Cultural context and exposure shape learning: Practices like family meals without devices help children appreciate attention, respect, and communication: "No iPad or iPhone on our table… we sit properly, enjoy a meal together, and talk about things." Travel and cultural exposure are part of teaching adaptability and perspective: "We spent some time in France over the summer… the mindset they get from that is that meals matter, and people operate differently." Respecting individuality while fostering independence: "They are their own people and you need to respect that and step away… give them the ability to figure out who they are and what they like to do." Parenting as a balance of guidance and autonomy: "Feel like that was a handbook that you just offered for parenting or for management? Either one. Nobody prepares you for that… part of figuring out." Future of Work and Technology Horizons Timeframes for predicting trends: Focus on a 5-year horizon as a middle ground between short-term unpredictability and long-term uncertainty: "Five years feels like this middle zone that I'm kind of guessing in the haze, but I can kind of see some odd shapes." Short-term (6–18 months) is more precise; long-term (10–15 years) is harder to anticipate: "I'm a breezy investor. Six months at a time max… deal making between two people still matters in 18 months." Identifying emerging technologies with latent potential: Invests in technologies that are ready for massive impact but haven't yet had a "moment": "I like to look at technologies that have yet to have a moment… the combo of VR and AI is prime." Example: Skill Maker, a VR+AI training platform for auto technicians, addressing both a labor shortage and outdated certification processes: "We are short 650,000 auto technicians… if you can train a technician closer to a month or two versus two years, I promise you the auto shops are all over you." Focuses on alignment of incentives, business model innovation, and meaningful outcomes: "You train people faster, even expert technicians can benefit… earn more money… right, not as meaningful to them and not as profitable otherwise." Principles guiding technology and investment choices: Solving enduring problems rather than temporary fads: "What is a problem that is still not going to go away within the next 10–15 years?" Ensuring impact at scale while creating economic and personal value for participants: "Can make a huge difference in the lives of 650,000 people who would then have good paying jobs." Scaling, Incentives, and Opportunity Re-examining traditional practices and identifying opportunities for change: "If you've done a very specific thing the exact same way, at some point, that's prime to change." Telehealth is an example: while helpful for remote access, it hasn't fundamentally created capacity: "You're still in that one-to-one patient's relationship and an hour of your time with a provider is still an hour at a time." Next version of telehealth should aim to scale care beyond individual constraints: "Where do we take telehealth next… what is the next version of that that enables you to truly scale and change?" Incentives shape outcomes: "Thinking through that and all the incentives… if I were to change the incentives, then people would behave differently? The answer very often is yes, indeed." Paraphrasing Charlie Munger: "Look for the incentives and I can tell you the outcome." Founders, Pitching, and Common Mistakes Pet peeves in founder pitches: Lack of research and generic outreach is a major turn-off: "I can really quickly tell if you have indeed spent a fraction of a minute on my site… dear sir, automatic junk. I won't even read the thing." Well-crafted, thoughtful cold inbound pitches get attention: "Take some time. A well crafted cold inbound will get my attention… you don't need to figure out an intro." Big mistakes entrepreneurs make: Hiring too early, especially in sales: "Until you have a playbook, like don't hire a sales team… if you don't have about a million in revenue, you're probably not ready." Raising too much capital too quickly: "You get into that, you're just gonna spend a lot more time fundraising than you are building a company." Comparing oneself to others: "You don't know if it's true… there's always a backstory… that overnight success was 15 years in the making." Sales Strategy and Non-Sales Selling Approach is contrarian: focus on conversion, not volume: "It is not a numbers game. I think it's a conversion game… I would much rather spend more time with a narrower set of targets and drive better conversion." Understanding fit is key: "You gotta find your people… and just finding who is not or should not be on your list is equally valuable." Recognizes that each fund and business is unique, so a tailored approach is essential: "The pitch is better when I'm talking to the quote unquote right people in the right place about the right things." Where to Find Virginie and Her Work Resources for listeners: Full Circle Fund: fullcirclefund.io  Work in Progress: workinprogress.io  LinkedIn: Virginie Raphael  Where to Access Snafu Go to joinsnafu.com and sign up for free.  

Meralgia Paresthetica Education and the Pain Boards This podcast episode from the NRAP Academy features Dr. David Rosenblum discussing Meralgia Paresthetica, a mononeuropathy affecting the lateral femoral cutaneous nerve. The condition involves entrapment or compression of this purely sensory nerve as it passes under the inguinal ligament near the anterior superior iliac spine, causing burning pain, tingling, and numbness in the anterior lateral thigh. Key clinical points covered include the nerve's L2-3 origin from the lumbar plexus, common causes such as obesity, tight clothing, pregnancy, and diabetes, and the absence of motor weakness or reflex changes. Diagnosis is primarily clinical, though ultrasound can visualize nerve entrapment effectively. Treatment approaches range from conservative management including weight loss, avoiding tight clothing, physical therapy, and neuropathic pain medications (gabapentinoids, duloxetine, tricyclics) to interventional procedures. Dr. Rosenblu strongly advocates for ultrasound-guided nerve blocks over fluoroscopic or blind approaches, citing better visualization and reduced risk of nerve trauma. Advanced treatments mentioned include peripheral neuromodulation and cryoablation for refractory cases. The episode emphasizes that this condition is commonly tested on pain management board examinations (ABA, ABPM, FIPP, osteopathic boards) and can be significantly more painful and disabling than typically appreciated. Upcoming Courses and Training Opportunities: Ultrasound training available at nrappain.org Regenerative medicine training courses Comprehensive Question Bank for Pain Management board preparation covering ABA, ABPM, FIPP, and osteopathic examinations CME credits available through the platform Clinical consultation services available at Dr. Rosenblu's Brooklyn office for patients seeking treatment   Meralgia Paresthetica Education and Clinical Guidance Overview: Focused on definition, anatomy, diagnosis, management, and board exam relevance for meralgia paresthetica. Anatomy and Pathophysiology: Nerve: lateral femoral cutaneous nerve (sensory only), typically arising from L2–L3. Course: traverses across the iliacus, passes under or through the inguinal ligament just medial to the ASIS, then enters the thigh. Sensory distribution: anterolateral thigh; anterior cutaneous division extends toward the knee. Etiology and Risk Factors: Common contributors: obesity, tight belts or clothing, pregnancy, prolonged sitting, diabetes, prior pelvic or hip surgery. Entrapment site: under the inguinal ligament near the ASIS (most frequent). Clinical Presentation: Symptoms: burning pain, tingling, numbness, dysesthesia localized to the anterolateral thigh. Provocation/relief: worse with standing or walking; relief with sitting or hip flexion. Neurologic exam: no motor weakness; no reflex changes. Diagnosis: Primarily clinical; Tinel's sign over the inguinal ligament may reproduce symptoms. EMG and nerve conduction studies are typically normal. Ultrasound: superficial nerve, generally easy to visualize, including in obese patients; can identify entrapment. Management Recommendations: First-line conservative care: weight loss; avoidance of tight belts/clothing; physical therapy; NSAIDs for inflammation. Pharmacologic options: gabapentin, pregabalin, duloxetine, tricyclic antidepressants; consider topical analgesic creams (e.g., lidocaine or anti-inflammatory combinations). Interventional approach: Ultrasound-guided nerve block is strongly recommended; the nerve lies lateral to the sartorius; real-time visualization enables precise, safe injection. Avoid fluoroscopic and blind approaches due to risk of further nerve trauma and post-procedure pain. Advanced interventions: Peripheral neuromodulation may provide benefit in select cases. Cryoablation has shown beneficial outcomes for the lateral femoral cutaneous nerve. Surgery is rarely required; options include neurolysis, decompression, or neurectomy as a last resort. Board Exam Preparation Emphasis: Key facts commonly tested: Involved nerve: lateral femoral cutaneous nerve. Nerve roots: L2–L3 (with population variants). Sensory-only nerve; absence of motor deficits. Compression site: under the inguinal ligament near the ASIS. First-line therapy: conservative measures; refractory cases: ultrasound-guided nerve block. Keywords to study: meralgia paresthetica; lateral femoral cutaneous nerve (also called lateral cutaneous nerve of the thigh). Practice Considerations: Severity: can be profoundly painful and disabling; often underappreciated. Referral: clinicians not trained in interventional techniques should refer patients to an interventionalist for diagnosis and treatment. Decisions and Recommendations Ultrasound guidance is the preferred modality for lateral femoral cutaneous nerve interventions, superseding fluoroscopic or blind approaches. Rationale: superior visualization, real-time feedback, and reduced risk of nerve trauma and post-procedural pain. Outreach and Resources NRAP Academy resources: Ultrasound training, regenerative medicine training, CME credits, and a comprehensive pain board question bank (ABA, ABPM, FIPP, osteopathic, and related exams). Clinical availability: Patient consultations for meralgia paresthetica offered in Brooklyn at www.AABPpain.com 718 436 7246 .

Meralgia Paresthetica Education and the Anesthesiology Boards This podcast episode from the NRAP Academy features Dr. David Rosenblum discussing Meralgia Paresthetica, a mononeuropathy affecting the lateral femoral cutaneous nerve. The condition involves entrapment or compression of this purely sensory nerve as it passes under the inguinal ligament near the anterior superior iliac spine, causing burning pain, tingling, and numbness in the anterior lateral thigh. Key clinical points covered include the nerve's L2-3 origin from the lumbar plexus, common causes such as obesity, tight clothing, pregnancy, and diabetes, and the absence of motor weakness or reflex changes. Diagnosis is primarily clinical, though ultrasound can visualize nerve entrapment effectively. Treatment approaches range from conservative management including weight loss, avoiding tight clothing, physical therapy, and neuropathic pain medications (gabapentinoids, duloxetine, tricyclics) to interventional procedures. Dr. Rosenblu strongly advocates for ultrasound-guided nerve blocks over fluoroscopic or blind approaches, citing better visualization and reduced risk of nerve trauma. Advanced treatments mentioned include peripheral neuromodulation and cryoablation for refractory cases. The episode emphasizes that this condition is commonly tested on pain management board examinations (ABA, ABPM, FIPP, osteopathic boards) and can be significantly more painful and disabling than typically appreciated. Upcoming Courses and Training Opportunities: Ultrasound training available at nrappain.org Regenerative medicine training courses Comprehensive Anestheisia and Question Bank for Pain Management board preparation covering ABA, ABPM, FIPP, and osteopathic examinations CME credits available through the platform Clinical consultation services available at Dr. Rosenblum's Brooklyn office for patients seeking treatment. Call 718 436 7246 or go to www.AABPpain.com    Meralgia Paresthetica Education and Clinical Guidance Overview: Focused on definition, anatomy, diagnosis, management, and board exam relevance for meralgia paresthetica. Anatomy and Pathophysiology: Nerve: lateral femoral cutaneous nerve (sensory only), typically arising from L2–L3. Course: traverses across the iliacus, passes under or through the inguinal ligament just medial to the ASIS, then enters the thigh. Sensory distribution: anterolateral thigh; anterior cutaneous division extends toward the knee. Etiology and Risk Factors: Common contributors: obesity, tight belts or clothing, pregnancy, prolonged sitting, diabetes, prior pelvic or hip surgery. Entrapment site: under the inguinal ligament near the ASIS (most frequent). Clinical Presentation: Symptoms: burning pain, tingling, numbness, dysesthesia localized to the anterolateral thigh. Provocation/relief: worse with standing or walking; relief with sitting or hip flexion. Neurologic exam: no motor weakness; no reflex changes. Diagnosis: Primarily clinical; Tinel's sign over the inguinal ligament may reproduce symptoms. EMG and nerve conduction studies are typically normal. Ultrasound: superficial nerve, generally easy to visualize, including in obese patients; can identify entrapment. Management Recommendations: First-line conservative care: weight loss; avoidance of tight belts/clothing; physical therapy; NSAIDs for inflammation. Pharmacologic options: gabapentin, pregabalin, duloxetine, tricyclic antidepressants; consider topical analgesic creams (e.g., lidocaine or anti-inflammatory combinations). Interventional approach: Ultrasound-guided nerve block is strongly recommended; the nerve lies lateral to the sartorius; real-time visualization enables precise, safe injection. Avoid fluoroscopic and blind approaches due to risk of further nerve trauma and post-procedure pain. Advanced interventions: Peripheral neuromodulation may provide benefit in select cases. Cryoablation has shown beneficial outcomes for the lateral femoral cutaneous nerve. Surgery is rarely required; options include neurolysis, decompression, or neurectomy as a last resort. Board Exam Preparation Emphasis: Key facts commonly tested: Involved nerve: lateral femoral cutaneous nerve. Nerve roots: L2–L3 (with population variants). Sensory-only nerve; absence of motor deficits. Compression site: under the inguinal ligament near the ASIS. First-line therapy: conservative measures; refractory cases: ultrasound-guided nerve block. Keywords to study: meralgia paresthetica; lateral femoral cutaneous nerve (also called lateral cutaneous nerve of the thigh). Practice Considerations: Severity: can be profoundly painful and disabling; often underappreciated. Referral: clinicians not trained in interventional techniques should refer patients to an interventionalist for diagnosis and treatment. Decisions and Recommendations Ultrasound guidance is the preferred modality for lateral femoral cutaneous nerve interventions, superseding fluoroscopic or blind approaches. Rationale: superior visualization, real-time feedback, and reduced risk of nerve trauma and post-procedural pain. Outreach and Resources NRAP Academy resources: Ultrasound training, regenerative medicine training, CME credits, and a comprehensive pain board question bank (ABA, ABPM, FIPP, osteopathic, and related exams). Clinical availability: Patient consultations for meralgia paresthetica offered in Brooklyn at www.AABPpain.com 718 436 7246 .

Meralgia Paresthetica Education and the PM&R Boards This podcast episode from the NRAP Academy features Dr. David Rosenblum discussing Meralgia Paresthetica, a mononeuropathy affecting the lateral femoral cutaneous nerve. The condition involves entrapment or compression of this purely sensory nerve as it passes under the inguinal ligament near the anterior superior iliac spine, causing burning pain, tingling, and numbness in the anterior lateral thigh. Key clinical points covered include the nerve's L2-3 origin from the lumbar plexus, common causes such as obesity, tight clothing, pregnancy, and diabetes, and the absence of motor weakness or reflex changes. Diagnosis is primarily clinical, though ultrasound can visualize nerve entrapment effectively. Treatment approaches range from conservative management including weight loss, avoiding tight clothing, physical therapy, and neuropathic pain medications (gabapentinoids, duloxetine, tricyclics) to interventional procedures. Dr. Rosenblu strongly advocates for ultrasound-guided nerve blocks over fluoroscopic or blind approaches, citing better visualization and reduced risk of nerve trauma. Advanced treatments mentioned include peripheral neuromodulation and cryoablation for refractory cases. The episode emphasizes that this condition is commonly tested on pain management board examinations (ABA, ABPM, FIPP, osteopathic boards) and can be significantly more painful and disabling than typically appreciated. Upcoming Courses and Training Opportunities: Ultrasound training available at nrappain.org Regenerative medicine training courses Comprehensive PM&R  Question Bank for Pain Management board preparation covering ABA, ABPM, FIPP, and osteopathic examinations CME credits available through the platform Clinical consultation services available at Dr. Rosenblum's Brooklyn office for patients seeking treatment   Meralgia Paresthetica Education and Clinical Guidance Overview: Focused on definition, anatomy, diagnosis, management, and board exam relevance for meralgia paresthetica. Anatomy and Pathophysiology: Nerve: lateral femoral cutaneous nerve (sensory only), typically arising from L2–L3. Course: traverses across the iliacus, passes under or through the inguinal ligament just medial to the ASIS, then enters the thigh. Sensory distribution: anterolateral thigh; anterior cutaneous division extends toward the knee. Etiology and Risk Factors: Common contributors: obesity, tight belts or clothing, pregnancy, prolonged sitting, diabetes, prior pelvic or hip surgery. Entrapment site: under the inguinal ligament near the ASIS (most frequent). Clinical Presentation: Symptoms: burning pain, tingling, numbness, dysesthesia localized to the anterolateral thigh. Provocation/relief: worse with standing or walking; relief with sitting or hip flexion. Neurologic exam: no motor weakness; no reflex changes. Diagnosis: Primarily clinical; Tinel's sign over the inguinal ligament may reproduce symptoms. EMG and nerve conduction studies are typically normal. Ultrasound: superficial nerve, generally easy to visualize, including in obese patients; can identify entrapment. Management Recommendations: First-line conservative care: weight loss; avoidance of tight belts/clothing; physical therapy; NSAIDs for inflammation. Pharmacologic options: gabapentin, pregabalin, duloxetine, tricyclic antidepressants; consider topical analgesic creams (e.g., lidocaine or anti-inflammatory combinations). Interventional approach: Ultrasound-guided nerve block is strongly recommended; the nerve lies lateral to the sartorius; real-time visualization enables precise, safe injection. Avoid fluoroscopic and blind approaches due to risk of further nerve trauma and post-procedure pain. Advanced interventions: Peripheral neuromodulation may provide benefit in select cases. Cryoablation has shown beneficial outcomes for the lateral femoral cutaneous nerve. Surgery is rarely required; options include neurolysis, decompression, or neurectomy as a last resort. Board Exam Preparation Emphasis: Key facts commonly tested: Involved nerve: lateral femoral cutaneous nerve. Nerve roots: L2–L3 (with population variants). Sensory-only nerve; absence of motor deficits. Compression site: under the inguinal ligament near the ASIS. First-line therapy: conservative measures; refractory cases: ultrasound-guided nerve block. Keywords to study: meralgia paresthetica; lateral femoral cutaneous nerve (also called lateral cutaneous nerve of the thigh). Practice Considerations: Severity: can be profoundly painful and disabling; often underappreciated. Referral: clinicians not trained in interventional techniques should refer patients to an interventionalist for diagnosis and treatment. Decisions and Recommendations Ultrasound guidance is the preferred modality for lateral femoral cutaneous nerve interventions, superseding fluoroscopic or blind approaches. Rationale: superior visualization, real-time feedback, and reduced risk of nerve trauma and post-procedural pain. Outreach and Resources NRAP Academy resources: Ultrasound training, regenerative medicine training, CME credits, and a comprehensive pain board question bank (ABA, ABPM, FIPP, osteopathic, and related exams). Clinical availability: Patient consultations for meralgia paresthetica offered in Brooklyn at www.AABPpain.com 718 436 7246 .

Credits: 0.25 AMA PRA Category 1 Credit™   CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-467 Overview: Join us as we discuss recent changes to newborn hepatitis B vaccination recommendations and review the risks, benefits, and rationale for immunizing this patient population. Come away with confidence to navigate new guidance, thoughtfully address parental concerns, and provide evidence-based care that promotes both infant and public health. Episode resource links: N Engl J Med 2019;380:2041-2050  DOI: 10.1056/NEJMra181047 Clin Infect Dis. 2021 Nov 2;73(9):e3317-e3323. doi: 10.1093/cid/ciaa898.  Guest: Robert A. Baldor MD, FAAFP   Music Credit: Matthew Bugos Thoughts? Suggestions? Email us at FranklySpeaking@pri-med.com  

From "clean beauty" fairy tales experts wish you’d forget to the marketing myths clogging your feed, today’s guest is stripping away the bullshit to reveal the cold, hard science of skin. On this week's episode of The Formula, content creator and evidence-based advocate Sam [By The Counter] breaks down why reading an ingredient list is like trying to guess a cake recipe without the measurements, the truth about who actually pays for "cruelty-free" research, and why your favourite luxury products might actually be worth the splurge. Plus, Sam explains why fragrance isn't the enemy, the "moral superiority" trap in sustainable packaging, and the indie products he swears by for a perfect barrier. PRODUCTS MENTIONED: build [skincare] b-cream, $30. Biologique Recherche Lotion P50, $260. Rationale #5 The Milk Concentrate, $214. DAB by Augustinus Bader Science Supercharged Glow Complex, $138. CHANEL SUBLIMAGE LA CRÈME TEXTURE SUPRÊME Ultimate Cream, $670. CHANEL COCO MADEMOISELLE Foaming Shower Gel, $215. The Eco Well (Jen Novakovic) Lab Muffin Beauty Science (Michelle Wong) FOR MORE WHERE THIS CAME FROM: Hosts: Kelly McCarren Guest: Sam [By The Counter] Producer: Sophie Campbell Audio Producer: Tegan Sadler Video Producer: Artemi Kokkaris Just so you know — some of the links in these notes are affiliate links, which means we might earn a small commission if you buy through them. It doesn’t cost you anything extra, and it helps support the show. Happy shopping! Mamamia acknowledges the Traditional Owners of the Land we have recorded this podcast on, the Gadigal people of the Eora Nation. We pay our respects to their Elders past and present, and extend that respect to all Aboriginal and Torres Strait Islander cultures.Become a Mamamia subscriber: https://www.mamamia.com.au/subscribeSee omnystudio.com/listener for privacy information.

Credits: 0.25 AMA PRA Category 1 Credit™   CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-467 Overview: Join us as we discuss recent changes to newborn hepatitis B vaccination recommendations and review the risks, benefits, and rationale for immunizing this patient population. Come away with confidence to navigate new guidance, thoughtfully address parental concerns, and provide evidence-based care that promotes both infant and public health. Episode resource links: N Engl J Med 2019;380:2041-2050  DOI: 10.1056/NEJMra181047 Clin Infect Dis. 2021 Nov 2;73(9):e3317-e3323. doi: 10.1093/cid/ciaa898.  Guest: Robert A. Baldor MD, FAAFP   Music Credit: Matthew Bugos Thoughts? Suggestions? Email us at FranklySpeaking@pri-med.com  

Welcome to the NeurologyLive® Mind Moments® podcast. Tune in to hear leaders in neurology sound off on topics that impact your clinical practice.In this episode, "Bexicaserin, the PACIFIC Trial, and Treating Developmental Epileptic Encephalopathies," Johannes Streffer, MD, PhD, discusses phase 1/2 findings from the PACIFIC trial evaluating bexicaserin in developmental epileptic encephalopathies, presented at the American Epilepsy Society 2025 Annual Meeting. Streffer, senior vice president of clinical development at Lundbeck, outlines the scientific and clinical rationale for studying DEEs as a unified population, emphasizing the unmet need and complexity of trial design in this highly vulnerable group. He reviews key efficacy outcomes, including sustained reductions in countable motor seizures and strong patient retention through long-term open-label extension and expanded access follow-up. The discussion also explores safety and tolerability considerations in patients receiving multiple concomitant antiseizure medications, the highly selective mechanism of action of bexicaserin, and how Lundbeck's broader strategy in rare neurological disorders aims to de-risk development early while addressing populations with limited therapeutic options.Looking for more Epilepsy discussion? Check out the NeurologyLive® Epilepsy clinical focus page.Episode Breakdown: 1:05 – Rationale for studying developmental epileptic encephalopathies as a unified group 3:05 – Challenges of trial design and retention in vulnerable pediatric DEE populations 5:25 – Key PACIFIC efficacy findings and long-term open-label extension results 7:05 – Neurology News Minute 9:15 – Safety, tolerability, and drug-drug interaction considerations for bexicaserin 11:20 – Lundbeck's strategy across rare and severe neurological disorders The stories featured in this week's Neurology News Minute, which will give you quick updates on the following developments in neurology, are further detailed here: Remyelinating Agent PIPE-307 Falls Short in Phase 2 Trial of Relapsing Multiple Sclerosis Semaglutide Linked to Improved Neurological Outcomes in Large Vessel Occlusion Without IV Thrombolysis FDA Approves Generic Glatiramer Acetate Injection for Multiple Sclerosis Treatment Thanks for listening to the NeurologyLive® Mind Moments® podcast. To support the show, be sure to rate, review, and subscribe wherever you listen to podcasts. For more neurology news and expert-driven content, visit neurologylive.com.

Rebecca Dent, MD, FRCP (Canada) - TROP2 and Triple-Negative Breast Cancer: The Rationale and Emerging Evidence for Exploring the Therapeutic Potential of TROP2-Targeted Antibody-Drug Conjugates in Earlier Lines and Disease-Stage Settings

Rebecca Dent, MD, FRCP (Canada) - TROP2 and Triple-Negative Breast Cancer: The Rationale and Emerging Evidence for Exploring the Therapeutic Potential of TROP2-Targeted Antibody-Drug Conjugates in Earlier Lines and Disease-Stage Settings

Rebecca Dent, MD, FRCP (Canada) - TROP2 and Triple-Negative Breast Cancer: The Rationale and Emerging Evidence for Exploring the Therapeutic Potential of TROP2-Targeted Antibody-Drug Conjugates in Earlier Lines and Disease-Stage Settings

Hour 2 of the WIP Afternoon Show dives into Nick Sirianni's rationale for resting the starters vs. the Commanders, with former Eagles head coach Dick Vermeil sharing his take on the controversial move.

Democracy in the UK is under strain. Many voters feel deeply alienated from politics, believing that those elected to represent them often pursue narrow or personal interests rather than the public good. Political polarisation, intensified by changes in the media landscape, is undermining constructive debate. And for many citizens, it can feel as though money (rather than votes) is what really speaks loudest in politics.Against this backdrop, there is growing interest in how democratic systems might be reformed to function better and become more resilient. A wide range of proposals has emerged, tackling different aspects of democratic decline. While we can't cover them all in a single episode, today's discussion focuses on two specific reform ideas explored in recent articles published in the journal The Political Quarterly.The first examines the role of donations to political parties, asking how political finance shapes power, influence, and public trust in the democratic system. The second looks at the position of smaller parties in the House of Commons, exploring how parliamentary procedures affect their ability to contribute meaningfully to debate and scrutiny.To discuss these ideas, we're joined by the authors of both pieces:Iain McMenamin, Professor of Comparative Politics at Dublin City University, is an expert on political finance and co-author of the article on party donations.Louise Thompson, Senior Lecturer in Politics at the University of Manchester, is a leading scholar of parliamentary politics and the author of the study on the role of small parties in the Commons.Together, we explore whether reforming party funding and giving smaller parties a stronger voice in Parliament could help rebuild trust, improve representation, and strengthen UK democracy.Mentioned in this episode:‘Unbroken, but Dangerous: The UK's Political Finance Regime and the Rationale for Reform', by Logan De la Torre, Kevin Fahey, and Iain McMenamin 'Modernising the House: Why the 2024 Parliament Highlights the Need to Formalise Party-Group Rights in the House of Commons', by Louise Thompson.  UCL's Department of Political Science and School of Public Policy offers a uniquely stimulating environment for the study of all fields of politics, including international relations, political theory, human rights, public policy-making and administration. The Department is recognised for its world-class research and policy impact, ranking among the top departments in the UK on both the 2021 Research Excellence Framework and the latest Guardian rankings.

Chegou o episódio escolhido por vocês! Marcela Belleza e Joanne Alves convidam Carol Millon para conversar sobe 6 clinicagens de inibidores de SGLT2, as gliflozinas:Indicações além do DMRisco de CAD euglicêmicaQuando não usar?⁠Cuidados com doença aguda (sick day) e hipovolemia⁠Cuidados pré-operatórioRisco de fratura e amputaçãoReferências:1. Bailey CJ, et al. Dapagliflozin add-on to metformin in type 2 diabetes inadequately controlled with metformin: a randomized, double-blind, placebo-controlled 102-week trial. BMC Med. 2013;11:43. Published 2013 Feb 20. doi:10.1186/1741-7015-11-432. Bersoff-Matcha SJ, et al. Fournier Gangrene Associated With Sodium-Glucose Cotransporter-2 Inhibitors: A Review of Spontaneous Postmarketing Cases. Ann Intern Med. 2019;170(11):764-769. doi:10.7326/M19-00853. Chang HY, et al. Association Between Sodium-Glucose Cotransporter 2 Inhibitors and Lower Extremity Amputation Among Patients With Type 2 Diabetes. JAMA Intern Med. 2018;178(9):1190-1198. doi:10.1001/jamainternmed.2018.3034 4. Clar C, et al. Systematic review of SGLT2 receptor inhibitors in dual or triple therapy in type 2 diabetes. BMJ Open. 2012 Oct 18;2(5):e001007. doi: 10.1136/bmjopen-2012-001007. PMID: 23087012; PMCID: PMC3488745.5. Das SR, et al. 2020 Expert Consensus Decision Pathway on Novel Therapies for Cardiovascular Risk Reduction in Patients With Type 2 Diabetes: A Report of the American College of Cardiology Solution Set Oversight Committee. J Am Coll Cardiol. 2020 Sep 1;76(9):1117-1145. doi: 10.1016/j.jacc.2020.05.037. Epub 2020 Aug 5. PMID: 32771263; PMCID: PMC7545583. 6. Fralick M, et al. Risk of amputation with canagliflozin across categories of age and cardiovascular risk in three US nationwide databases: cohort study. BMJ. 2020;370:m2812. Published 2020 Aug 25. doi:10.1136/bmj.m28127. Li D, et al. Urinary tract and genital infections in patients with type 2 diabetes treated with sodium-glucose co-transporter 2 inhibitors: A meta-analysis of randomized controlled trials. Diabetes Obes Metab. 2017;19(3):348-355. doi:10.1111/dom.128258. Neal B, et al. Rationale, design, and baseline characteristics of the Canagliflozin Cardiovascular Assessment Study (CANVAS)--a randomized placebo-controlled trial. Am Heart J. 2013;166(2):217-223.e11. doi:10.1016/j.ahj.2013.05.0079. Nyirjesy P, et al. Evaluation of vulvovaginal symptoms and Candida colonization in women with type 2 diabetes mellitus treated with canagliflozin, a sodium glucose co-transporter 2 inhibitor. Curr Med Res Opin. 2012;28(7):1173-1178. doi:10.1185/03007995.2012.69705310. Perkovic V, et al. Canagliflozin and Renal Outcomes in Type 2 Diabetes and Nephropathy. N Engl J Med. 2019;380(24):2295-2306. doi:10.1056/NEJMoa181174411. Rosenwasser RF, et al. SGLT-2 inhibitors and their potential in the treatment of diabetes. Diabetes Metab Syndr Obes. 2013 Nov 27;6:453-67. doi: 10.2147/DMSO.S34416. PMID: 24348059; PMCID: PMC3848644.12. Sridharan K, Sivaramakrishnan G. Risk of limb amputation and bone fractures with sodium glucose cotransporter-2 inhibitors: a network meta-analysis and meta-regression. Expert Opin Drug Saf. 2025;24(7):797-804. doi:10.1080/14740338.2024.237775513. Ueda P,  et al. Sodium glucose cotransporter 2 inhibitors and risk of serious adverse events: nationwide register based cohort study. BMJ. 2018;363:k4365. Published 2018 Nov 14. doi:10.1136/bmj.k436514. Watts NB, et al. Effects of Canagliflozin on Fracture Risk in Patients With Type 2 Diabetes Mellitus. J Clin Endocrinol Metab. 2016 Jan;101(1):157-66. doi: 10.1210/jc.2015-3167. Epub 2015 Nov 18. PMID: 26580237; PMCID: PMC4701850.15. Zhuo M, et al. Association of Sodium-Glucose Cotransporter-2 Inhibitors With Fracture Risk in Older Adults With Type 2 Diabetes. JAMA Netw Open. 2021;4(10):e2130762. Published 2021 Oct 1. doi:10.1001/jamanetworkopen.2021.3076216. Emerson Cestari Marino, Leandra Anália Freitas Negretto, Rogério Silicani Ribeiro, Denise Momesso, Alina Coutinho Rodrigues Feitosa, Marcos Tadashi Kakitani Toyoshima, Joaquim Custódio da Silva Junior, Sérgio Vencio, Marcio Weissheimer Lauria, João Roberto de Sá, Domingos A. Malerbi, Fernando Valente, Silmara A. O. Leite, Danillo Ewerton Oliveira Amaral, Gabriel Magalhães Nunes Guimarães, Plínio da Cunha Leal, Maristela Bueno Lopes, Luiz Carlos Bastos Salles, Liana Maria Torres de Araújo Azi, Amanda Gomes Fonseca, Lorena Ibiapina M. Carvalho, Francília Faloni Coelho, Bruno Halpern, Cynthia M. Valerio, Fabio R. Trujilho,  Antonio Carlos Aguiar Brandão, Ruy Lyra e Marcello Bertoluci. Rastreamento e Controle da Hiperglicemia no Perioperatório – Posicionamento Conjunto da Sociedade Brasileira de Diabetes (SBD), Sociedade Brasileira de Anestesiologia (SBA) e Associação Brasileira para o Estudo da Obesidade e Síndrome Metabólica (ABESO). Diretriz Oficial da Sociedade Brasileira de Diabetes (2025). DOI: 10.29327/5660187.2025-10 , ISBN: 978-65-5941-367-6.17. Singh LG, Ntelis S, Siddiqui T, Seliger SL, Sorkin JD, Spanakis EK. Association of Continued Use of SGLT2 Inhibitors From the Ambulatory to Inpatient Setting With Hospital Outcomes in Patients With Diabetes: A Nationwide Cohort Study. Diabetes Care. 2024;47(6):933-940. doi:10.2337/dc23-112918. Mehta PB, Robinson A, Burkhardt D, Rushakoff RJ. Inpatient Perioperative Euglycemic Diabetic Ketoacidosis Due to Sodium-Glucose Cotransporter-2 Inhibitors - Lessons From a Case Series and Strategies to Decrease Incidence. Endocr Pract. 2022;28(9):884-888. doi:10.1016/j.eprac.2022.06.00619. Umapathysivam MM, Morgan B, Inglis JM, et al. SGLT2 Inhibitor-Associated Ketoacidosis vs Type 1 Diabetes-Associated Ketoacidosis. JAMA Netw Open. 2024;7(3):e242744. Published 2024 Mar 4. doi:10.1001/jamanetworkopen.2024.274420. Fleming N, Hamblin PS, Story D, Ekinci EI. Evolving Evidence of Diabetic Ketoacidosis in Patients Taking Sodium-Glucose Cotransporter 2 Inhibitors. J Clin Endocrinol Metab. 2020;105(8):dgaa200. doi:10.1210/clinem/dgaa20021. Neuen BL, Young T, Heerspink HJL, et al. SGLT2 inhibitors for the prevention of kidney failure in patients with type 2 diabetes: a systematic review and meta-analysis. Lancet Diabetes Endocrinol. 2019;7(11):845-854. doi:10.1016/S2213-8587(19)30256-622. Braunwald E. Gliflozins in the Management of Cardiovascular Disease. N Engl J Med. 2022;386(21):2024-2034. doi:10.1056/NEJMra211501123. Zinman B, Wanner C, Lachin JM, et al. Empagliflozin, Cardiovascular Outcomes, and Mortality in Type 2 Diabetes. N Engl J Med. 2015;373(22):2117-2128. doi:10.1056/NEJMoa150472024. Neal B, Perkovic V, Mahaffey KW, et al. Canagliflozin and Cardiovascular and Renal Events in Type 2 Diabetes. N Engl J Med. 2017;377(7):644-657. doi:10.1056/NEJMoa161192525. Wiviott SD, Raz I, Bonaca MP, et al. Dapagliflozin and Cardiovascular Outcomes in Type 2 Diabetes. N Engl J Med. 2019;380(4):347-357. doi:10.1056/NEJMoa181238926. McMurray JJV, Solomon SD, Inzucchi SE, et al. Dapagliflozin in Patients with Heart Failure and Reduced Ejection Fraction. N Engl J Med. 2019;381(21):1995-2008. doi:10.1056/NEJMoa191130327. Packer M, Anker SD, Butler J, et al. Cardiovascular and Renal Outcomes with Empagliflozin in Heart Failure. N Engl J Med. 2020;383(15):1413-1424. doi:10.1056/NEJMoa202219028. 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. doi:10.1056/NEJMoa210703829. Heerspink HJL, Stefánsson BV, Correa-Rotter R, et al. Dapagliflozin in Patients with Chronic Kidney Disease. N Engl J Med. 2020;383(15):1436-1446. doi:10.1056/NEJMoa202481630. The EMPA-KIDNEY Collaborative Group, Herrington WG, Staplin N, et al. Empagliflozin in...

Should a nonprofit create its own foundation? The answer is surprisingly simple and at the same time, relentlessly hard: will it raise more money? Foundations only make sense when organizational complexity, donor access, privacy, or governance limitations are actively holding philanthropy back. Done well, a foundation creates focus, opens doors, and frees leadership to pursue deeper donor relationships. Done poorly (or too early) it adds cost, confusion, and duplication without impact.

US S&P futures slightly firmer but Nasdaq lower. European opened with modest gains and Asian's broadly higher. Bond yields mixed. US 10-year up 2 bps at 4.2%. Gilts off 1 bps at 4.5% after soft UK data. Dollar slightly firmer versus yen and sterling, softer elsewhere. Oil up. Gold edges higher. Industrial metals mixed. Bitcoin gains. Economists are aligning views with ECB Executive Board member Schnabel that next move in rates is likely to be a hike. Bloomberg survey of economists showed 60% of respondents think the ECB is more likely to raise rates than lower them, which is a meaningful shift from October when only a third shared that outlook. However, rate hikes will not likely come anytime soon with the majority expecting deposit rate to remain at 2% for the next two years. Rationale for extended period of unchanged policy is the improving macro backdrop.Companies Mentioned: Destination XL Group, Citigroup, Warner Bros. Discovery, Paramount Skydance

The U.S. is now highlighting its significant seizure of a Venezuelan oil tanker as part of a larger effort to fight drug trafficking, even as Venezuela describes the move as “piracy.” Plus, DHS Secretary Kristi Noem faced a heated hearing on Capitol Hill over immigration raids and FEMA's storm response. Critics are now calling for her resignation. And in Indiana, a political shockwave. Republican state senators teamed up with Democrats to sink a Trump-backed redistricting plan in a clear and very public break from the president. These stories and more highlight your Unbiased Updates for Friday, December 12, 2025.

The U.S. is now highlighting its significant seizure of a Venezuelan oil tanker as part of a larger effort to fight drug trafficking, even as Venezuela describes the move as “piracy.” Plus, DHS Secretary Kristi Noem faced a heated hearing on Capitol Hill over immigration raids and FEMA's storm response. Critics are now calling for her resignation. And in Indiana, a political shockwave. Republican state senators teamed up with Democrats to sink a Trump-backed redistricting plan in a clear and very public break from the president. These stories and more highlight your Unbiased Updates for Friday, December 12, 2025.

Mavericks TRADED Luka Doncic for THIS reason?!

Today on Truth in Politics and Culture, we will talk about the latest peace proposals for ending war in Ukraine. The US, Ukraine, and Europe are now on the same page, but will Putin get on board? The Trump Administration appears to be on the verge of invading Venezuela...what are some possible reasons for talking this bold action? Also, the GOP faces a tough challenge in a red district in Tennessee. A Republican victory is a must.

Are you up to date with the latest guidelines on deep venous thrombosis (DVT) management? Dr. Steven Abramowitz, vascular surgeon at MedStar Health, joins host Dr. Chris Beck for a deep dive into emerging clinical data in DVT management, where they review the evolving indications for mechanical thrombectomy and the implications of studies like the ATTRACT trial, the CLOUT registry, and the ongoing DEFIANCE trial. --- This podcast is supported by: Inari Medicalhttps://www.inarimedical.com/artix-system --- SYNPOSIS Dr. Abramowitz reviews recent data comparing outcomes of mechanical intervention versus lytic-based therapy, outlining how each approach fits into current practice. He underscores the critical role of IVUS in determining treatment endpoints, while noting the ongoing challenge of an absent standardized definition. The conversation also offers practical insights on procedural techniques and the evolving role of anticoagulation, emphasizing the importance of close collaboration and open communication with referring physicians. --- TIMESTAMPS 00:00 - Introduction00:45 - Overview of DVT Management02:50 - New Guidelines for DVT Treatment07:30 - Technical Endpoints in DVT Treatment13:26 - Clout Registry and Its Findings17:57 - Anticoagulation and DVT23:05 - Defining Acute DVT Management27:00 - Evolving Approaches to Acute DVT28:19 - Patient Experience and Quality of Life31:08 - Referring Providers and Data Impact37:01 - Single Session Treatments and Stenting41:07 - Chronic Venous Disease Management --- RESOURCES (ATTRACT) Weinberg I, Vedantham S, Salter A, et al. Relationships between the use of pharmacomechanical catheter-directed thrombolysis, sonographic findings, and clinical outcomes in patients with acute proximal DVT: Results from the ATTRACT Multicenter Randomized Trial. Vasc Med. 2019;24(5):442-451. doi:10.1177/1358863X19862043https://pubmed.ncbi.nlm.nih.gov/31354089/ (CLOUT) Shaikh A, Zybulewski A, Paulisin J, et al. Six-Month Outcomes of Mechanical Thrombectomy for Treating Deep Vein Thrombosis: Analysis from the 500-Patient CLOUT Registry. Cardiovasc Intervent Radiol. 2023;46(11):1571-1580. doi:10.1007/s00270-023-03509-8https://pubmed.ncbi.nlm.nih.gov/37580422/ (DEFIANCE) Abramowitz SD, Marko X, D'Souza D, et al. Rationale and design of the DEFIANCE study: A randomized controlled trial of mechanical thrombectomy versus anticoagulation alone for iliofemoral deep vein thrombosis. Am Heart J. 2025;281:92-102. doi:10.1016/j.ahj.2024.10.016https://pubmed.ncbi.nlm.nih.gov/39491572/

Wendy Pickett, Co-Founder & EVP of Sales, RationAle Brewing. Bringing 25 years of consumer goods experience to the non-alcoholic craft brewing brand, Wendy has a long history of building legacy brands in the grocery/mass, natural, and specialty channels. As one of the few female leaders in the male-dominated alcohol space, she's helping reshape the future of NA craft beer, tapping into the surging demand for NA options driven by wellness-minded consumers.what we chat about:RationAle's mission is to “crush society's drinking rules.” How do you see mindful drinking reshaping not just the NA beer industry, but drinking culture at large?As a woman co-founder in the beer industry—an industry historically dominated by men—what challenges and opportunities have you experienced in carving out space for both yourself and RationAle?The Crush the Crisis initiative ties RationAle directly to mental health and wellness. Can you share more about the impact of that program and why it was important to bake into the brand's DNA from the start?IG rationalebrewing.com | rationalebrewingFind Me:IG + TikTok citrusdiaries.studiocitrusdiaries.com | hello@citrusdiaries.comCreate your ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠podcast⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ today! ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠#madeonzencastr

We all know that huge sums of money are invested in creating new, more effective weapons of war.  Brian Abrams sees an opportunity to invest instead in what he calls "peace tech," emerging businesses using technologies and creative methods designed to prevent war from happening in the first place. He's created a new firm, B Ventures, and in this Blue Sky episode he describes with infectious optimism his exciting vision for the future.    Chapters: 00:00 Introduction to Brian Abrams  Bill Burke introduces Brian Abrams, founder of B Ventures Group, an investment fund focused on global peacebuilding and conflict resolution through "peace tech." Brian's extensive background in managing over $1 billion in assets and his human-centric investment philosophy are highlighted.  02:09 From Founder to Venture Capitalist  Brian shares his career journey, starting as an entrepreneur in India where he experienced failure, which led him to realize his strength in spotting opportunities rather than operationalizing them. He then transitioned to venture capital in Israel, building a fund from $2 million to over $1.2 billion, emphasizing the role of luck and a pivotal moment in fostering peace initiatives.  08:28 The Genesis of Peace Tech  Brian reflects on his past experiences, including a startup's condition to include Palestinian teammates during an acquisition, which planted the seed for his current work. He explains his philosophy of using money to serve people and approaching problems from a bottom-up perspective, leading him to focus on peace tech as an alternative to military tech.  10:17 The Rationale for Peace Tech  Drawing inspiration from Thich Nhat Hanh's philosophy of 'interbeing,' Brian articulates why war is illogical and a form of collective self-harm. He emphasizes the enormous economic cost of violent conflict, totaling $19 trillion annually, and how venture capital's bottom-up, experimental approach can offer innovative solutions for peacebuilding.  15:28 AI in Crisis Simulation  Brian describes an investment in a startup founded by a Harvard researcher who developed an AI-powered crisis simulation platform. This technology aims to anticipate and prevent future conflicts, like potential World War III over Taiwan, by running thousands of scenarios daily, far exceeding traditional war games.  21:32 Business Model for Peace Tech  Brian explains the twofold business model for peace tech startups: selling to friendly governments and to companies for competitive landscape analysis. He emphasizes that a for-profit model ensures scalability and continuous funding, unlike grants, allowing for exponential growth and a virtuous cycle to prevent major conflicts.  29:23 Peace Tech: Agile and Ethical  Brian highlights the agility of venture-backed peace tech companies compared to traditional government or academic initiatives, citing an example of a startup rapidly forming after the dismantling of the US Institute of Peace. He defines peace tech as anything that preempts, mitigates, or resolves violent conflict, adhering to a 'first do no harm' principle.  34:26 Peace Tech Investments and Ecosystem  Brian discusses additional investments, including a company creating digital twins of societies to understand and model civil conflicts like those between Armenia and Azerbaijan. He describes the growing Peace Tech ecosystem, drawing parallels to the private space industry's exponential growth, and aims to build a global community of founders and investors.  41:12 Conclusion and Call to Action  Bill Burke reflects on how technology's ability to show the grim reality of war might increase the fervent desire for peace. Brian encourages listeners to connect via LinkedIn and join the Peace Tech community, expressing his strong optimism for the future impact of this movement.   

The reason for all that Paul has instructed thus far in his letter is found in this section. God's grace and the gospel is the foundation upon which everything else stands. Memorizing these words allows us to keep them as our focus as we study Paul's instructions for this Cretan church and the church today. All teaching, doctrine, and patterns of relating with one another must be built upon the good news of Jesus' redemption.  For this week continue to **work on memorizing Titus 2:13** stacking it onto vs 11-12For the grace of God has appeared that offers salvation to all people. It teaches us to say “No” to ungodliness and worldly passions, and to live self-controlled, upright and godly lives in this present age, while we wait for the blessed hope—the appearing of the glory of our great God and Savior, Jesus Christ, ---Titus 2:11-13

On this week's show we have an essay from one of our listeners on why he wants to stick with his DVR over streaming. We also take a deep dive into Automatic Content Recognition and how to turn it off on your smart TVs. As usual we also read your emails and take a look at the week's news. News: Disney pulls channels from YouTube TV as carriage deal expires DIRECTV now offering the Disney Bundle free to select customers TV Set-Top Box Losing Market Dominance Please support Movember and enter to win great prizes from Bright Side Home Theater Movember Raffle — Bright Side Home Theater Swimming against the Stream - An essay from Jorge Beltran  I know I will sound old and swimming against current, but I would like to go back to my world where we had our cable subscriptions, DVR and Netflix.  Simple, vs having to manage 5-7 subscriptions to watch what we want at a cost we can pay. The proliferation of streaming services is turning out to be a way for content owners to extract more value from customers and significantly increase the amount of work customers have to do to find and track the content we want to watch.  Even sports.  Furthermore, it has backfired to content producers, with less opportunity to monetize content, driving them to look for economies of scale again.  I follow or used to follow La Liga, Premier League Soccer, ski, college football, and formula 1 racing. Back in the day I knew what channel carried all of these sports on my cable line up, would set it to record on my DVR and done.  I could watch it when I wanted and where I wanted since I could access my DVR from anywhere but the plane.  Netflix was just growing and buying "older" content from the major networks and allowed us to binge watch old series we had missed.  Some new exclusive content was coming out and that made paying the 10 - 12 $/mo a good value. Fast forward to today: The best games of Premier League have been taken off the over the air or regular cable channels are now behind a Paramount or someone else's paywall.  Why am I going to pay for access to content that is mostly CBS that I can get over the air?.  Worst of all, you can not skip commercials when you stream this content nowadays.  You can't DVR the content and skip the commercials. I have lost track of who is now airing La Liga, but last time I checked was behind some other streamer.  Fubo has a lot of soccer but is now super expensive too.   Conclusion:  I have stopped following La Liga and Premier League.  My enthusiasm for good Futbol has gone down tremendously.  I turned my eyes to college football and Formula 1.  The worst part is that now I fear the same is going to happen with College Football, moving from free over the air or in basic cable channels to some exclusive need-to-pay streaming service.  You guys praised Formula 1 going to Apple.  I dread it!!! I do not pay for Apple TV(plus or not plus) and I catch Formula 1 over ESPN.   Does it mean I will have to drop ESPN, that gives me other content and add AppleTV?  If I were an NFL fan I would have lost it. Some content is on Amazon, other in the different networks or streamers.  I do not know how much you have to pay to be able to watch the NFL consistently.  Call me old school.  I still have a cable service that gives me the right to HBO, ESPN, Fox, and the likes.  I can watch and record all the related content in Hulu from the major networks. I only keep paying for Netflix that I see as a premium channel (like paying for HBO back in the day).  Rationale - we get a lot of exclusive content there.  I only keep the Disney/Hulu bundle cause it comes free with my wireless bill. And Amazon Prime (now with commercials) free for the shipping.  But I barely watch Primer or Hulu cause I can't stand the commercials! In a world with many streamers, the economies of scale enjoyed by bundling content in cable packages have been lost and thus it costs more per viewer for content owners to create and distribute given the less # of eyeballs.  Yes, it sounds counter intuitive, but that translates into higher bills for consumers, through different bills but when you add it all up, it has to be more expensive, no way around it.  The positive is more content and innovation for sure.  You can definitely find more quality content.  But I foresee more partnerships coming to allow the industry to benefit from economies of scale and be able to distribute the cost of expensive content through more subscribers / viewers.  Or they will have to continue to increase our subscription bills.  I listened to an interview recently with a Hollywood producer detailing how cost efficient they have to be nowadays to be able to turn a profit on content produced given the lower number of ultimate viewers. This is a good thing, do not get me wrong.  But my point is we are coming full circle and a lot of inefficiencies have been introduced in the content value chain and made the experience more time consuming and difficult for viewers in the process.  I think the industry has shot itself on the foot.  Content that used to be free over the air is now behind a paywall and ALSO with commercials.   Apologies from my broken record Long live my DVR! Jorge What is Automatic Content Recognition (ACR)? Automatic Content Recognition (ACR) is built into most smart TVs (Samsung, LG, Vizio, Roku, Fire TV) and silently identifies everything you watch via your smart TV or any attached device via HDMI. It monitors your streaming, cable, and physical media.  It will even identify any ads you watch. It grabs screen samples, sends them online, and feeds data to manufacturers, streamers, and advertisers for recommendations, targeted ads, and ratings.  Usually on by default, it needs the internet to work. Privacy groups like the EFF warn it tracks your habits without clear ongoing notice. How Does ACR Collect Data from Your TV Viewing? ACR operates passively and continuously (or at set intervals) while the TV is on and tuned to a channel or app.  Here's a step-by-step breakdown of the process: Content Sampling: The TV's built-in software periodically "grabs" a short clip or snapshot of the audio, video, or both from what's currently displayed on the screen. This could be every few seconds or minutes, creating a digital "fingerprint" rather than storing full video. For example: Video fingerprinting: Analyzes pixels, colors, or scene changes (similar to how Shazam identifies songs). Audio fingerprinting: Listens for sound patterns in the broadcast. Watermarking: Detects invisible digital markers embedded in content by broadcasters or studios. This sampling works even for non-smart inputs, like cable or gaming consoles, because it captures whatever is output to the screen. Local Processing: The TV processes the sample on-device to generate a compact fingerprint. Raw clips aren't stored long-term on the TV itself—the data is anonymized to protect bandwidth and privacy (though critics argue these can still be re-identified when combined with other data like your location or device ID). Database Matching: The fingerprint is sent to the manufacturer's cloud servers where it's compared against a massive reference database. This database is built by: Monitoring live TV broadcasts in real-time via data centers. Cataloging known content like shows, movies, ads, and even timestamps for commercials. Matches reveal details such as the program title, channel, duration watched, and ad exposures. Data Aggregation and Transmission: Matched data is aggregated with metadata like your TV's IP address, viewing time, and household size. It's then used or shared: Internally for features like "fewer repetitive ads" or recommendations. With third parties like advertisers and Nielsen for ratings and for cross-device targeting which means you'll see the same ad on your phone after TV exposure. The entire process is designed to be invisible and efficient, running without impacting TV performance noticeably. Why Is This Data Collected? Personalization: To suggest shows/movies based on what you've watched. Advertising: Measures ad views for pricing, retargets viewers across devices, and optimizes campaigns. Measurement: Provides device-specific viewership stats, replacing outdated panel-based surveys. TV Manufacturers Using Automatic Content Recognition (ACR) for Data Collection Manufacturer ACR Usage Details How to Disable (General Steps) Samsung Uses built-in ACR on Tizen OS smart TVs to track viewing behavior, including programs, ads, OTT apps, and gaming. Data supports ad retargeting and is used internally for recommendations. Go to Settings > General > System Manager > Samsung Account > Privacy > Viewing Information Services > Toggle off. (10-37 clicks; also opt out via Samsung account online.) LG Integrates ACR on webOS TVs to fingerprint video/audio for viewing history and ad targeting. Captures screenshots every 10 milliseconds in some models. Settings > All Settings > General > System > Additional Settings > Live Plus > Toggle off. (Buried in menus; check privacy controls.) Vizio Owns Inscape, which licenses ACR data from its SmartCast TVs. Historically sold data to third parties; now requires opt-in after 2017 FTC settlement. Settings > Privacy & Security > Smart Home > Viewing Data > Limit Ad Track > Toggle off. (Opt out during setup or later.) Sony Employs ACR on Google TV/Android TV models to collect viewing data for personalization and ads, often via third-party integrations like Samba TV. Settings > Privacy > Automatic Content Recognition > Toggle off. (Varies by model; check Google account privacy if linked.) Roku (powers TVs from TCL, Hisense, Philips, Sharp) "Smart TV Experience" feature uses ACR on Roku OS to track content across linear TV, streaming, and devices. Data shared for ads and measurement. Settings > Privacy > Advertising > Smart TV Experience > Toggle off. (11-24 clicks; not on Roku sticks, only TVs.)  

In this conversation, May Zabaneh breaks down PayPal's move into stablecoins with PYUSD and why it matters for financial inclusion. We explore how PYUSD could lower costs for cross-border payments, deliver faster settlement, and plug directly into PayPal's existing ecosystem. The discussion covers why PayPal built a proprietary stablecoin, early adoption and real-world use cases, and plans for international expansion. We also examine the role merchants play in crypto acceptance, how DeFi and traditional finance are converging, and why interoperability will be essential in the next phase of digital payments.Chapters00:00 PayPal's Vision for Stablecoins02:47 Why PYUSD? Rationale and Goals05:18 Stablecoin Advantages: 24/7, Inclusion, Cross‑Border08:22 Why Proprietary vs Supporting Others11:06 Unlocking B2B and Rebuilding On‑Chain12:20 PYUSD in the PayPal/Venmo Ecosystem14:21 International Expansion and Global Transfers17:02 Merchant Fit: Categories, Costs, Declines19:32 User Segments: Crypto‑Curious to Super Users23:28 Pay with Crypto: Scaling to Larger Merchants29:38 PYUSD in DeFi: Open and Multi‑Chain32:01 Liquidity, Partnerships, and the Three Pillars35:56 Interoperability and Evolving Roles39:11 AI x Payments: Agent‑Driven Commerce40:42 Finding the Flywheel, What's Next

Pakistan's Military Calculus: Jailing Imran Khan to Disintegrate His Party Hussein Khan (Ambassador Husain Haqqani) Ambassador Husain Haqqani explains the Pakistani military's rationale for keeping Imran Khan imprisoned despite his status as a former Prime Minister. Khan faces various lawfare charges brought by the government, but the underlying strategy is political rather than judicial. The military's calculus is that Khan's party lacks alternate leadership or a succession plan, unlike Pakistan's traditional dynastic parties. Since Khan serves as the sole rallying point and the party stands primarily for good governance under his leadership, the military believes that prolonged imprisonment will cause the party to fade or that Khan will become too old to lead effectively when released.

Is meningeal artery embolization the key to ending the cycle of chronic subdural hematomas? In this episode of the Back Table Podcast, Dr. Paul Gullota from Ochsner Health joins host Michael Barraza to share his technical insights on middle meningeal artery embolization, including patient workup, procedure technique, and post-operative care.---SYNPOSISThe episode begins with a discussion on the evolving role of middle meningeal artery embolization in preventing chronic subdural recurrence. The doctors talk through patient selection and procedural planning for middle meningeal artery embolization, emphasizing the importance of assessing collateral pathways and hemorrhage laterality. Dr. Gullota shares his access techniques, microcatheter and embolic options, and the critical role of teamwork with neurosurgery. He also shares his approach to navigating complex vascular anatomy as well as ensuring appropriate patient follow up.---TIMESTAMPS00:00 - Introduction03:12 - Middle Meningeal Artery Embolization: Rationale and Process04:17 - Patient Evaluation and Procedure Steps06:09 - Outpatient Procedures and Billing07:06 - Candidates for Embolization Post-Evacuation07:56 - Unilateral vs. Bilateral Embolization10:34 - Procedure Techniques and Tools19:48 - Post-Procedure Care and Follow-Up21:35 - Final Thoughts and Conclusion

The Supreme Court's decision in Students for Fair Admissions v. Harvard ended decades of race-conscious admissions in higher education. Supporters argue the ruling restores colorblind fairness, while critics warn it risks undoing decades of progress toward equal opportunity. On this week's Stay Tuned with Preet, Yale Law Professor Justin Driver, author of The Fall of Affirmative Action: Race, the Supreme Court, and the Future of Higher Education, joins Preet to trace the history of affirmative action — from Lyndon Johnson's call for “true equality” in 1965 to the Court's recent decision — and to explore what colleges can still do to build diverse classrooms within the confines of the law. Then, Preet answers your questions about the recent court ruling on deploying the National Guard to Portland, Oregon. In the bonus for Insiders, Justin Driver reflects on how his father's sacrifices shaped his understanding of opportunity and education. Join the CAFE Insider community to stay informed without hysteria, fear-mongering, or rage-baiting. Head to cafe.com/insider to sign up. Thank you for supporting our work. Show notes and a transcript of the episode are available on our website.  You can now watch this episode! Head to CAFE's Youtube channel and subscribe. Have a question for Preet? Ask @PreetBharara on BlueSky, or Twitter with the hashtag #AskPreet. Email us at staytuned@cafe.com, or call 833-997-7338 to leave a voicemail. Stay Tuned with Preet is brought to you by CAFE and the Vox Media Podcast Network. Learn more about your ad choices. Visit podcastchoices.com/adchoices

Misery is manufactured and dark forces continue to profit from it. But our light does not die. Let's root ourselves in truth. It will always outlast the empire of lies. The kingdom of God is not confusion, but clarity. In Syria, a one time terrorist is now a statesman. When governments play with human lives. The Spiral Case. Inuit population control from Denmark in the 90's. Implants for twelve year olds. Zero informed consent. Considered too stupid. Compensation is in process. Implementing the eugenics book. Add an extra zero to the numbers. Trump is pressuring them. Child health care at it's worst. Scary similarities to the Covid policies. It's almost like colonialism. Oh, and we funded Smartmatic in Venezuela. A history of USA overthrow policy. Are there voices bold enough to speak out? A historical Syrian speech at the UN. Operation Cyclone is the precedent. It was dripping everywhere with everything. Israel has other plans. It's not just Gaza. Iran nukes are now in play. The status of our assets is constantly changing. Ireland is in the censorship news. Sometimes in intelligence, the environment is the message. Always take the high level and skeptical view. Those skills will serve us all very well in the future.

Merriam-Webster's Word of the Day for September 18, 2025 is: rationale • rash-uh-NAL • noun Rationale refers to an explanation or reason for something said or done. It is often used with for, behind, or of. // City council members who oppose the zoning change should be ready to explain their rationale for voting against it. // She's explained the rationale behind her early retirement. See the entry > Examples: “There is a rationale for commercializing seagrass production, but ecologically sustainable production needs to be at the heart of that business model, and the numbers for doing that simply don't add up at the moment.” — Richard Lilley, quoted in Smithsonian Magazine, 7 Oct. 2024 Did you know? If someone asserts that the word rationale refers to a ration of ale, they are wrong, but that doesn't mean they don't have an actual rationale (a reason, explanation, or basis) for such a claim. “Rationale looks like the words ration and ale jammed together,” they could offer, and while that is true you'd be justified in responding: “Appearances can be deceiving.” Rationale is a direct borrowing of the Latin word rationale, with which it shares the meaning “an explanation of controlling principles of opinion, belief, practice, or phenomena.” The Latin rationale comes from a form of the adjective rationalis (“rational”), which traces back to the noun ratio, meaning “reason.” While the Latin ratio is also the forebear of the English noun ration, referring to a share of something, rationale has nothing to do with a tankard (or stein, or even a pony) of beer.