Podcasts about rowin

Bridget, Caitlin, and Hilda cover "Enchantra," the follow-up to last year's devilishly delightful hit "Phantasma" by Kaylie Smith. Did they like it as much as the first book? Yes, they did, and Bridget will give you all the details to let you know why they did.  Join our Patreon for exclusive behind-the-scenes content and let's be friends!Instagram > @Booktokmademe_podTikTok > @BooktokMadeMe

In this powerful episode of Relentlessly Resilient, I sit down with Emma Jean Rowin, the author of When Things Collapse, a gripping and emotionally charged memoir about her journey through mental illness, narcissistic abuse, and domestic violence. Emma opens up about the raw and painful experiences that shaped her story, sharing how she found the strength to heal and reclaim her life. Her vulnerability and honesty are both heart-wrenching and inspiring as we discuss the complexities of trauma, the toll it takes, and the resilience it takes to rebuild. Emma's insights into the psychological impact of abuse and her path toward healing will leave you feeling both moved and empowered. Join us for an intimate and powerful conversation about survival, healing, and finding strength when everything seems to fall apart. This is an episode you don't want to miss. Find her book on Amazon here: https://a.co/d/cIWs7H5

Zorgverleners, ondernemers, boeren en burgers raken steeds meer verstrikt in een woud van regels. Hoe is het zover gekomen? Waarom is het zo moeilijk om de regeldruk te verminderen, ondanks de vele beloften en ambities van de politiek? Komen er alleen maar meer regels bij, of is er nog zicht op verandering? En zo ja, wat is er nodig voor verandering – zowel van de wetgevers, de uitvoerende instanties als de burger zelf? Luister naar deze Radboud Actualiteitenpodcast, waarin jurist Rowin Jansen en ethicus Marcel Becker in gesprek gaat met filosoof en programmamaker Bas van Woerkum-Rooker over de regeldruk. In het huidige Regeerakkoord wordt de wens om de regeldruk te verminderen veelvuldig benadrukt. Het kabinet lijkt vastbesloten om de bureaucratie en regelgeving in Nederland terug te dringen. Maar deze belofte is niet nieuw. Vorige kabinetten zeiden hetzelfde, terwijl de afgelopen jaren juist het aantal regels alleen maar is toegenomen. Luister en vorm je eigen mening. Over de sprekers Rowin Jansen is jurist aan de Radboud Universiteit. Hij onderzoekt de controle en het toezicht op de AIVD en de MIVD en publiceert ook over cyberoperaties, grondrechten in het digitale tijdperk, gegevensverwerkingen in het nationale veiligheidsdomein en vertrouwelijke informatieverstrekking aan het parlement. Marcel Becker is filosoof aan de Radboud Universiteit. Hij is deskundig op het gebied van praktische filosofie en toegepaste ethiek, met name ethiek van het openbaar bestuur, ethiek van de digitale media en juridische (beroeps)ethiek. Radboud Actualiteiten Podcast De Radboud Actualiteiten Podcast biedt wetenschappelijke duiding bij prangende politieke vragen. Elke aflevering spreken we met Radboudwetenschappers over een actuele maatschappelijke kwestie. Verdieping en duiding in een kort vraaggesprek. Bekijk de playlist van de Radboud Actualiteitenpocasts. Like deze podcast, abonneer je op dit kanaal en mis niks. Bekijk ook de agenda voor nog meer verdiepende lezingen over actuele thema's: https://www.ru.nl/services/sport-cultuur-en-ontspanning/radboud-reflects/agenda

[Excuses voor de mindere kwaliteit van het geluid.] We komen om in de regels. Wil je iets regelen met de overheid, een zorgeninstelling of bedrijf, zet je dan maar schrap voor de formulieren, de bijlagen en de lappen tekst. En in onze poging om dingen eenvoudiger te maken stellen we vaak alleen maar meer regels op. Wat zegt dit over hoe wij mensen denken en de samenleving inrichten? Wat gebeurt er als onze instituties verder dichtslibben door meer regels? Zijn we gedoemd om steeds dieper in het regeldoolhof te verdwalen, of is er een uitweg? Luister naar jurist Rowin Jansen en filosoof Marcel Becker over de vraag waar de wildgroei aan regels vandaan komt, wat de gevolgen ervan zijn en of het allemaal makkelijker kan. Omkomen in de regels | Lezing en gesprek met jurist Rowin Jansen en ethicus Marcel Becker Dinsdag 24 september 2024 | 20.00 – 21.30 uur | Collegezalencomplex, Nijmegen Radboud Reflects en Faculteit der Rechtsgeleerdheid Lees hier het verslag: https://www.ru.nl/services/sport-cultuur-en-ontspanning/radboud-reflects/nieuws/omkomen-in-de-regels-lezing-en-gesprek-met-jurist-rowin-jansen-en-ethicus-marcel-becker Bekijk de video: https://www.youtube.com/watch?v=FEA_Lw9Jpck Like deze podcast, abonneer je op dit kanaal en mis niks. Bekijk ook de agenda voor nog meer verdiepende lezingen: www.ru.nl/radboud-reflects/agenda Wil je geen enkele verdiepende lezing missen? Schrijf je dan in voor de nieuwsbrief: www.ru.nl/rr/nieuwsbrief

When Trace was a kid he was a sleepwalker. His parents closed the door to his bedroom. They heard him bonking against the door over and over. They love to tell this story. Now I'm telling you! Sleepwalking is weird, right? Are we the only ones who do that? Julian looks into it. Plus, as long as we're wondering things … have you ever wondered if you could fling an animal into space? Like a marmot or a coyote! Could a coyote actually go to orbit on top of a giant pile of TNT? (He definitely isn't going to catch that pesky road runner; does anyone under 30 even get this reference?). Trace explores what is clearly a Julian-focused question.

Hope Vargas from the Gainesboro and Jackson County Chamber Of Commerce and Gainesboro Mayor Randy Heady are in the studio to talk about Rowin' On The River and all things Gainesboro

W tym odcinku spotkaliśmy się z Kamilą Rowińską – jedną z najbardziej cenionych trenerek biznesu i kompetencji miękkich. Rozmawiamy o finansach w związku oraz o podejściu niezależnych kobiet do swoich partnerów. Poruszamy też temat budowania marki osobistej, która pomaga w osiąganiu celów finansowych oraz dodatkowo o poradach dotyczących wychowania swoich dzieci, aby miały lepszy start niż my.

THE BOYS IN THE BOAT MOVIE REVIEW Sure are some boys in that boat. Yep. Look at those boys. In the boat. What's goin' on in that boat? Oh, ya know, they're rowin'. Rowin' you say? Sure, sure, college boys rowin'. Any good? Sure, sure, they gonna be in the Olympics and make that Hitler… Read More »Highly Suspect Reviews: The Boys in the Boat

THE BOYS IN THE BOAT MOVIE REVIEW Sure are some boys in that boat. Yep. Look at those boys. In the boat. What's goin' on in that boat? Oh, ya know, they're rowin'. Rowin' you say? Sure, sure, college boys rowin'. Any good? Sure, sure, they gonna be in the Olympics and make that Hitler… Read More »Highly Suspect Reviews: The Boys in the Boat

Our next-to-last episode features the return of Andrew Mitchell, back to play all of our hilarious songs from the past years, plus a brand new Herman's Hermits parody, as "Something Good" turns into a Pinocchio tune - "Something Wood."Songs:- Hey Mary's Lamb (Carrie Anne by the Hollies)- Walking to Grandma's (Walking in Memphis by Mark Cohn)- Wonderland (Margaritaville by Jimmy Buffett)- Gals in High Places (Friends in Low Places by Garth Brooks)- Ichabod Crane (Sweet Baby James by James Taylor)- Willy Wonka (Sugar, Sugar by The Archies)- Tom Petty Medley (Tree Fallin', I Don't Know How It Feels, The Dating, Rowin' Down a Stream)- Something Wood (Something Good by Herman's Hermits)

Ep. 169: Synecdoche, New York with Michael Joshua Rowin, plus Brakhage, Resnais, Duras Welcome to The Last Thing I Saw. I'm your host, Nicolas Rapold. I've been hosting a screening series recently called New Essentials at the Roxy Cinema in New York. This weekend I'm presenting Charlie Kaufman's directorial debut feature, Synecdoche, New York (2008), the sprawling story of a playwright (Philip Seymour Hoffman) attempting to stage a truly world-sized drama while navigating his wrecked personal life. For the latest episode, I discuss Kaufman's rich and strange and funny movie with critic Michael Joshua Rowin, who wrote about it for Reverse Shot. We also compare notes on the last things each of us has seen, including films by more adventurers in subjectivity: Stan Brakhage, Alain Resnais, and Marguerite Duras. Please support the production of this podcast by signing up at: rapold.substack.com Music: “Tomorrow's Forecast” by The Minarets, courtesy of The Minarets Photo by Steve Snodgrass

Since 2014, Rowin Snijder has been designing and building with his company Le Compostier “worm hotels” for community composting projects. A worm hotel is a structure in which an ecosystem of compost organisms work together to transform organic waste into beautiful worm compost. With a garden on top of each worm hotel, they give space to nature in neighborhoods and show us we can use organic waste to create a circular city.· www.compostier.nl · www.oneplanetpodcast.org · www.creativeprocess.info

“Know first of all that we are not separate from nature, but that we are part of it. To not even think of what is the benefit for me from it. I find it a very beautiful the concept of the food forest. Like you're actually building soil, and then the surplus is that you get some food back. To focus more on giving than on taking, especially for children. What I like to teach my children–really look at what is your talent, what drives you and how you think you can use that to improve and to create more harmony. I think is very important. Do not think so much about what others expect from you, but what is really driving you? I think that's very important to find out and go for it.” Since 2014, Rowin Snijder has been designing and building with his company Le Compostier “worm hotels” for community composting projects. A worm hotel is a structure in which an ecosystem of compost organisms work together to transform organic waste into beautiful worm compost. With a garden on top of each worm hotel, they give space to nature in neighborhoods and show us we can use organic waste to create a circular city.· www.compostier.nl · www.oneplanetpodcast.org · www.creativeprocess.info

In de rechtspraak werken inmiddels meer vrouwen dan mannen. Heeft dat de rechtspraak veranderd? En wat is het belang van een goede genderbalans in de publieke sector? Denk mee met juristen Ashley Terlouw, Marc de Werd en Rowin Jansen over de rol van gender bij publieke dienstverleners. Te veel vrouwen in de rechtspraak? | Lezingen en gesprek met juristen Ashley Terlouw, Marc de Werd en Rowin Jansen | Dinsdag 30 november 2021 | 20:00 – 21.30 uur | Online | Radboud Reflects en Faculteit der Rechtsgeleerdheid Lees het verslag: https://www.ru.nl/radboudreflects/terugblik/terugblik-2021/terugblik-2021/21-11-30-vrouwen-rechtspraak-lezingen-gesprek/ Of bekijk de video: https://youtu.be/fW-w3fVvf_0 Like deze podcast, abonneer je op dit kanaal en mis niks. Bekijk ook de agenda voor nog meer verdiepende lezingen: https://www.ru.nl/radboudreflects/age... Wil je geen enkele verdiepende lezing missen? Schrijf je dan in voor de nieuwsbrief: https://www.ru.nl/rr/nieuwsbrief

Since 2014, Rowin Snijder has been designing and building with his company Le Compostier “worm hotels” for community composting projects. A worm hotel is a structure in which an ecosystem of compost organisms work together to transform organic waste into beautiful worm compost. With a garden on top of each worm hotel, they give space to nature in neighborhoods and show us we can use organic waste to create a circular city.· www.compostier.nl · www.oneplanetpodcast.org · www.creativeprocess.info

“Know first of all that we are not separate from nature, but that we are part of it. To not even think of what is the benefit for me from it. I find it a very beautiful the concept of the food forest. Like you're actually building soil, and then the surplus is that you get some food back. To focus more on giving than on taking, especially for children. What I like to teach my children–really look at what is your talent, what drives you and how you think you can use that to improve and to create more harmony. I think is very important. Do not think so much about what others expect from you, but what is really driving you? I think that's very important to find out and go for it.” Since 2014, Rowin Snijder has been designing and building with his company Le Compostier “worm hotels” for community composting projects. A worm hotel is a structure in which an ecosystem of compost organisms work together to transform organic waste into beautiful worm compost. With a garden on top of each worm hotel, they give space to nature in neighborhoods and show us we can use organic waste to create a circular city.· www.compostier.nl · www.oneplanetpodcast.org · www.creativeprocess.info

Separated from their dear friend Pipistrelle, our brave duo now find themselves washed out onto Loch Katrine.

We cram a good 65-minute show into a half hour this week and not through editing. James explains that conundrum at the top of the program. What's left is Covid face-licking (no, really), Lord Digby Jones in a Twitter throw down with BBC presenter Alex Scott and Toby's moment of athletic glory. Opening sound this week of Lord Digby Jones courtesy of GBNews. Source

We cram a good 65-minute show into a half hour this week and not through editing. James explains that conundrum at the top of the program. What’s left is Covid face-licking (no, really), Lord Digby Jones in a Twitter throw down with BBC presenter Alex Scott and Toby’s moment of athletic glory. Opening sound this week of Lord Digby Jones courtesy of GBNews.

Since 2014, Rowin Snijder has been designing and building with his company Le Compostier “worm hotels” for community composting projects. A worm hotel is a structure in which an ecosystem of compost organisms work together to transform organic waste into beautiful worm compost. With a garden on top of each worm hotel, they give space to nature in neighborhoods and show us we can use organic waste to create a circular city.· www.compostier.nl · www.oneplanetpodcast.org · www.creativeprocess.info

“Know first of all that we are not separate from nature, but that we are part of it. To not even think of what is the benefit for me from it. I find it a very beautiful the concept of the food forest. Like you're actually building soil, and then the surplus is that you get some food back. To focus more on giving than on taking, especially for children. What I like to teach my children–really look at what is your talent, what drives you and how you think you can use that to improve and to create more harmony. I think is very important. Do not think so much about what others expect from you, but what is really driving you? I think that's very important to find out and go for it.” Since 2014, Rowin Snijder has been designing and building with his company Le Compostier “worm hotels” for community composting projects. A worm hotel is a structure in which an ecosystem of compost organisms work together to transform organic waste into beautiful worm compost. With a garden on top of each worm hotel, they give space to nature in neighborhoods and show us we can use organic waste to create a circular city.· www.compostier.nl · www.oneplanetpodcast.org · www.creativeprocess.info

Frecon's back! Bringing tales of hanging with PJ, some Vikes, and a whole lotta Wild stuff. Thanks to State Farm agent Tony Hoaglund (https://champlininsurance.com/)

Frecon’s back! Bringing tales of hanging with PJ, some Vikes, and a whole lotta Wild stuff.

For Take 90 we have Rowin Amone on! Talking about her recent series King Ester and Salacia. We love all you sweets and are grateful for all the support! About Rowin (6:50) TC & Rowin were probs neighbors in NYC (9:00) "King Ester" King Ester and what it was like to take on this role as a Black Trans Woman (12:25) What it's like to be a role model in the Trans community (18:30) How to support the Trans Community (26:45) https://www.lgbtcenters.org/Donate ROWIN AND WILL SMITH SHARE A MOM AKA AUNT VIV AKA JANET HUBERT (27:10) Who does Rowin want to work with most (29:50) hi Brandy come on the pod Working with Dui Jarrod, director and creator of "King Ester" (33:00) "Salacia" Working with Tourmaline (34:20) Seneca Village story (35:00) Working with Keanu Reeves (37:30) What does Black Lives Matter mean to Rowin (41:15) Rowin's future (45:30) "Cinderella" with Whitney Houston Review (47:20) ROWIN'S TOP 5 MOVIES (56:30) WE LOVE Y'ALL STAY SWEEEEEET

Carmen Guerrero was an American inmate tortured and killed within 8 hours of being placed in a cell with a convicted murderer.Also I this episode there were 25 murders of transgender Americans in 2019 including the last, Yahira Nesby in Brooklyn. 2020 has already seen one transgender murder, Dustin Parker. Saved By The Bell reboot to include transgender character. JK Rowling reconfirms her TERF stance as a transphobe. Marvel retracts that future superhero film will include specifically transgender character. And of course, we are finally able to discuss the Imara Jones opinion piece "OPINION: Confronting Black men’s roles in the murders of Black transgender women may be the only way to save our lives."https://thegrio.com/2019/06/24/confronting-black-mens-roles-in-the-murder-of-black-transgender-women/ Trans Panic is a true crime podcast which chronicles the lives and deaths of transgender murder victims in America.Hosted by Travis Ferguson and Feathers Wise.  Follow Us and Subscribe:https://twitter.com/PanicTranshttps://www.instagram.com/transpanicthepodcast/https://www.facebook.com/transpanic/www.transpanic.com 

In today's episode, our host Jana Six is joined by Rowin Alfons. In this episode you will find out how to find what works for you and how to stick to it. Student Brains and Fitness Gains is a podcast by Jana Six that is committed to helping people to get fit in every single episode. Make sure to hit SUBSCRIBE for new episodes. Follow me, Jana Six on social media: Instagram: www.instagram.com/janasix Website: www.fitlifesix.com TikTok: http://vm.tiktok.com/ay9jfm Twitter: https://twitter.com/janasix96 LinkedIn: https://www.linkedin.com/in/jana-six-b52bb874 Pinterest: https://www.pinterest.com/fitlifesix/ Follow Rowin on social media: Instagram: www.instagram.com/rowinalfons Website: https://totallyinshape.nl/rowin-alfons/ Join the FREE Student Brains and Fitness Gains Facebook community here: https://www.facebook.com/groups/studentbrainsandfitnessgains/ --- Send in a voice message: https://anchor.fm/janasix/message

Texas' Congressional District 17, was held by Rep. Bill Flores, who announced he would not seek re-election. So now, 12 Republican Candidates have signed up to run, and see who comes out on top. In this program, we visit with Kristen Alamo Rowin, a Conservative Christian woman from Lorena, TX, just a few miles south of Waco. In this interview, we get to know what Kristen thinks about CD-17, the issues, and her desire to represent the people of CD-17. Listen and Share!

Podcast: Lining up your ducks in a rowIn this video:00:24 – Becoming a better and more consistent trader01:02 – Tips to help you create a trading plan01:46 – Lining up everything in your favour02:25 – Get the bigger picture from the Monthly charts03:12 – You’ll still need a good strategy and identify a good trade03:54 – Take a look at the USD/CHF price level05:33 – Line the ducks in a row to help your trading resultsLining up all the ducks in a row to make you a more profitable trader. How does that work? Let's talk about that and more right now.Hi, Forex Traders. It's Andrew Mitchem here from the Forex Trading Coach with video and podcast number 326.Becoming a better and more consistent traderI want to talk about how you can become a better and more profitable trader with consistent trades by lining up all the ducks in a row.Let me explain more about that. You see, trading is all about probabilities. There are no certainties in trading, and the other thing that you have to work out when you are wanting to become a trader, is you need to have a plan and you need to stick to it. But, how do you create that plan? What do you do in order to create a plan? Because, everybody says, "Hey, you need a plan to become a good trader." Well, where do you start? What do you do?Tips to help you create a trading planI've got some really beneficial and realistic practical tips to help you with this because, like I said, trading is about probabilities. Nothing is certain. You can have the best looking set up and it won't work. It's not absolute guaranteed to work. Nothing's really guaranteed in life, is it? You probably have to go to school when you're a child. You probably and should be paying taxes when you're an adult, and you are going to die. So, really, the last one's the only certainty, but in trading there are no certainties. You can have absolute everything looking really good. Doesn't mean to say it's going to work. But, if you do that often enough with the high probability behind you, then chances are you're going to do really well as a trader.Lining up everything in your favourGetting all that lined up, everything lined up, is really, really important. I was on a webinar last night with my clients and I was discussing with some of my more experienced and more successful clients, about what they do to line up all the ducks on a row. It was really interesting about the philosophy that they have, and what we are looking at here is getting all different timeframes lining up.Now, I'm not saying go through your MT4 charts and get every single one lining up absolutely perfectly because that's not going to happen.Get the bigger picture from the Monthly chartsWhat we're saying is, at the beginning of the month look at your monthly charts and write down a list of likely directions of where you see strength or weakness, your bias for the bigger picture of the monthly directions. It's a real simple exercise. You just need to do it once a month. It might take you 10, 15 minutes once a month. And then, at the beginning of the week, do the same on the weekly charts. Try and line up pairs that have the same direction or potential same direction as the monthly charts. And then, on a daily basis, we then scale down and write on the membership site. We also put the weekly charts, but also the daily charts with specific trades. But, if you have the daily charts lining up with the weekly charts, and that lines up with the monthly charts, then surely that has to start to line up a few ducks in a row there for you.You’ll still need a good strategy and identify a good tradeNow, of course, you don't just randomly go and say, "Oh, the monthly's looking like it's heading down. So is the daily and … So is the weekly and now the daily.

After braving the dangers of the Dark Lake, the party discovers a lost temple and it’s strange inhabitant.The party makes their plan for traversing the deep lake dividing themselves amongst three Kuo-toa boats.[00:13:00] Take the deep bridge.The party confronts many environmental dangers of the deep lake and finds a secret passage that was sealed away many years ago.[00:59:30] Rowin, rowin, rowin, keep them caps a rowin. Let’s hiiiiiiide!The party finds a long lost temple that is covered in slime and is slowly filling with water.A sentient gelatinous cube named Glabagool greets the party and offers to escort them through the dungeon.In a fountain, Kenner finds a strange book written in some strange language. It is marked with a crest containing three quills.The party escapes the flooding dungeon and regroups with their squad.

First of all big thanks to Rowin from The 6 Pod for letting us post these episodes too. Be sure to give his podcast some love too! This episode is an episode that Rowin did with Serena which dives more in depth into her creative journey. She talks about why she uses plants in her photos, her experiences with burnout, and why people stay in the dreaming state instead of doing. Thanks for listening and definitely give them some support here! The 6Pod, on Spotify and iTunes! Serenachandesign - design & ampersands Serenawychan - food photography Serenachangallery - travel, portrait photography Website --- Send in a voice message: https://anchor.fm/2mcreativelabs/message Support this podcast: https://anchor.fm/2mcreativelabs/support

De leukste interviews uit ZuidWest in de Morgen (ZuidWest FM) van april. Met o.a. Frans Bauer, Raymon Hermans, Nicky Baegen en Rowin van Fessem.

What up podcast! Thanks again for listening to the 2M Creative Labs Podcast. This episode's a little bit different. We collab with Rowin from The 6Pod. Such an incredibly hard working and humble dude who's got his own podcast. Check out this episode where we bounce back and forth with questions for each other. This is part two of a two part series so check the first one out if you haven't yet. And definitely give his podcast, The 6Pod, on Spotify and iTunes! --- Send in a voice message: https://anchor.fm/2mcreativelabs/message Support this podcast: https://anchor.fm/2mcreativelabs/support

What up podcast! Thanks again for listening to the 2M Creative Labs Podcast. This episode's a little bit different. We collab with Rowin from The 6Pod. Such an incredibly hard working and humble dude who's got his own podcast. Check out this episode where we bounce back and forth with questions for each other. This is part one of a two part series so be sure to check both out. And definitely give his podcast, The 6Pod, on Spotify and iTunes! He's also available on 8 other platforms! --- Send in a voice message: https://anchor.fm/2mcreativelabs/message Support this podcast: https://anchor.fm/2mcreativelabs/support

Dr. Paul Wong:                  Welcome to the monthly podcast, On The Beat, for Circulation: Arrhythmia and Electrophysiology. I'm Dr. Paul Wong, editor in chief, with some of the key highlights from this month's issue. We'll also hear from Dr. Suraj Kapa, reporting on new research from the latest journal articles in the field. In our first article, Ratika Parkash and associates examined whether the outcomes following escalated antiarrhythmic drug therapy, or catheter ablation, depended on whether ventricular tachycardia with amiodarone refractory or sotalol refractory in patients with prior myocardial infarction in the VANISH study. At baseline, 169, or 65%, were amiodarone refractory, while the remaining were sotalol refractory. Amiodarone refractory patients had more renal insufficiency; 23.7% versus 10%. Worse, new ARC Heart Association class, 82.3% versus 65.5% class II or III; and lower ejection fraction, 29% versus 35%. Within the amiodarone refractory group, ablation resulted in a reduction of any ventricular arrhythmias compared to escalated drug therapy, with a hazard ratio of 0.53, P = 0.02. Sotalol refractory patients had trends towards higher mortality in VT storm with ablation, with no effect on ICD shocks. Within the escalated drug arm, amiodarone refractory patients had a higher rate of composite endpoint, with a hazard ratio of 1.94 and a P value of 0.01. In a trend toward higher mortality, hazard ratio 2.4, P = 0.07. While mortality was not different between amiodarone and sotalol refractory patients within the ablation treatment group. In our next study, Junaid Zaman and associates examined 57 cases in which local ablation of persistent atrial fibrillation terminated to sinus rhythm or organized tachycardia. The authors analyze unipolar electrograms collected during atrial fibrillation from multi-polar basket catheters to reconstruct isochronal activation maps for multiple cycles, and computational modeling and phase analysis were used to study mechanisms of map variability. At all signs of atrial fibrillation termination, localized, repetitive activation patterns were observed, 21% with complete rotational activity, 46% with partial rotational circuits, and 33% with focal patterns. In computer simulations incomplete segments of partial rotations coincided with areas of slow conduction, characterized by complex, multi-component electrograms. In our next article, Matthew Kalscheur and associates sought to use a novel machine-learning approach to predict outcomes following resynchronization therapy in the companion trial. The random forest algorithm resulted in the best performing model. In 595 CRTD patients in the companion trial, 105 deaths occurred, with a median follow-up of 15.7 months. The survival difference across subgroups differentiated by bundle branch block morphology and cure restoration did not reach significance, P = 0.08. The random forest model, however, produced quartiles of patients with an eight-fold difference in survival between those with the highest and lowest predictive probability for events, hazard ratio 7.96 with a P value of less than 0.0001. The model also discriminated the risk of composite endpoint of all cause mortality, or heart failure hospitalization, better than subgroups based on bundle branch block morphology and cure restoration. Future studies are needed to validate this model in other populations. In our next paper, Amr Barakat and associates examined the clinical outcomes of trans-venous lead extraction for CIED infection based on renal function. The authors examined 1,420 consecutive patients undergoing trans-venous lead extraction of infected CIEDs over a 14 year period. Groups with normal renal function, Group 1, consisting of 1,159 patients, Group 2, 163 patients with renal dysfunction not requiring dialysis, and Group 3, 98 patients on dialysis. Complete procedural success rates were comparable in the three groups: 94%, 96%, and 94% in Groups 1, 2 and 3, respectively. This was not statistically significant. The mortality rates were significantly higher in dialysis patients at one month. The procedure-related complication was 12.2% in dialysis patients versus 6.5% in Group 1 and 6.1% in Group 2. Other factors associated with mortality were lead material retention, functional New York Heart Association Class, and occurrence of procedural complications. In our next paper, Eric Johnson and associates studied the contribution of the current ITO, two left ventricular re-polarization in the human heart, since the current has been shown to have an important role in animal models. The authors found that using whole-cell voltage clamp recordings from myocytes, isolated from the left ventricle, non-failing human hearts, that there were two, distinct transient currents, ITO fast and ITO slow. The two currents have significantly different rates of recovery from inactivation and pharmacological sensitivities. ITO fast recovers in about 10 milliseconds, 100 times faster than ITO slow, and it's selectively blocked by KV4 channel toxin SNX 482. Using current clamp experiments, they found that regional differences in action potential wave forms, with a notch in phase one in the left ventricular subepicardial myocytes. In failing, left ventricular subepicardial myocytes, ITO fast was reduced, while ITO slow was increased. In addition, the notch and plateau potentials were depolarized, and action potential durations were prolonged, both statistically significantly. Slowing ITO fast inactivation results in a dramatic action potential shortening. The authors concluded that remodeling of ITO fast in failing, human left ventricular subepicardial myocytes, attenuates transmural differences in action potential wave forms. In our next paper, Ravi Vaidyanathan and associates examine the interaction between Caveolin 3 domain in the inward rectifier potassium channels. Although the IK1 current is mainly composed of Kir2.1, there are Kir2.2 and Kir2.3 heterotetromerisoforms that occur and modulate the IK1 current, but these have not been studied. Kir2.x isoforms have unique, subcellular co-localization in human cardiomyoctyes and co-immunoprecipitate with Cav3. Using induced pluripotential stem-cell-derived cardiomyocytes, the LQT9 Cav3 mutation, F97CCav3 resulted in actual potential prolongation. Based on the technique FRET, which is Fluorescent Resonance Energy Transfer, the authors calculated the distance between KR2.2 and cath ray proteins to be 6.61 nanometers. LQT9 is caused by Cav3 mutations. Prior work has shown that F97CCav3 mutation increases the late sodium current, and decreases KR2.1 current density by distinctive mechanisms. This study extends the authors' previous observations on the impact of LQT9 Cav3 mutation on Kir2.1 current, by demonstrating that mutation affects the Kir2.2 current. LQT9 causing Cav3 mutation differentially regulates current density and cell surface expression of Kir2.x homomeric and heteromeric channels. The authors show that the mutation does not affect Kir2.3 current, but the heterotetromer Kir2.2-2.3 demonstrated loss of function. Using the Li-Rudy [inaudible 00:09:45] model and myocyte mathematical model, the authors' data suggest that both loss of IK1 and increased sodium L are required for arrhythmia generation in LQT9. In our next study, Christophe Teuwen and associates use high resolution epicardial mapping electrodes, 128 or 192, with an inter-electrode distance of 2.0mm of the entire atrial surface in 164 patients. These patients were undergoing open-chest cardiac surgery. This study was designed to examine the conduction of atrial extrasystoles. The authors found that a higher degree of aberrancy was associated with a higher instance of conduction disorders. Most conduction disorders were provoked by atrial systoles emerging as epicardial breakthroughs. Atrial extrasystoles cause most conduction disorders in patients with left atrial dilatation or diabetes mellitus. In our next paper, Yuki Komatsu and associates examine 31 patients with idiopathic ventricular arryhthmias, using a two french microcatheter placed in a communicating vein between the great cardiac vein and small cardiac venous system, which passes between the aortic and pulmonary annulae, and is located in close associated with the left ventricular summit. They found that 14 patients had summit ventricular arryhthmias. The remaining 17 patients control group had ventricular arryhthmias originate from the right ventricular outflow track in the aortic cusps.  In patients with summit ventricular arryhthmias, the earliest activation during ventricular arryhthmias in the summit, preceded to cure as onset by 34 milliseconds. The summit ventricular arryhthmias exhibited inferior axes, negative polarity in lead one, deeper Q wave in AVL than AVR, nonspecific bundle branch morphology with an RS ratio in lead V1 of 0.67, distinguishing them from arryhthmias originating from the right ventricular outflow track or right ventricular cusp. Overall, ablation success was achieved in 10, or 71% of patients with summit ventricular arryhthmias, and 88% in the control group, P = 0.24. In our final paper, Deepak Padmanabhan and associates examine differences in mortality in patients with non-MRI conditional CID undergoing brain MRI compared to controls. Patients with CIDs undergoing brain MRI were compared with three control groups matched for age, sex, imaging year, and type of CID. These groups included 1) no CID and brain MRI, 2) CID in brain-computed CT, and 3) no CID in brain CT. They estimated all cause mortality at five years for CID MRI group, was not significantly different from patients who underwent CT, with or without a device. There was a significant increase in the mortality between CIED versus no CID MRI groups, hazard ratio 1.46 with a P value of 0.04. That's it for this month, but keep listening. Saraj Kapa will be surveying all journals for the latest topics of interest in our field. Remember to download the podcasts On the Beat. Take it away Saraj. Saraj Kapa:                          Thank you Paul, and welcome back to On the Beats where this month we'll be focusing on articles that are particularly hard-hitting, published across the literature in December of 2017. It's my pleasure to introduce 20 different articles that seem to have either particular interest or might change the field in the future. First, within the area of atrial fibrillation, we'll focus within the area of anticoagulation and stroke prevention. In the Journal of the American College of Cardiology, Vivek Reddy et al published on the five-year outcomes after left atrial appendage closure, from the Prevail and Protect AF trials. They included a total of 1,114 patients, with a total of 4,343 patient years of follow-up, randomized two to one to closure versus Warfarin. While ischemic stroke and systemic embolism of [inaudible 00:14:32] were numerically higher with closure, this did not reach statistical significance in terms of hemorrhagic stroke, unexplained death, and post-procedure bleeding favor left atrial appendage closure. These findings further support a role for left atrial appendage closure in the specific groups of patients enrolled in the Protect and Prevail Studies. Of course, we always need to understand, that extrapolation to patients who may not have met inclusion criteria will be difficult. In particular, given both trials had their own fundamental limitations in the Prevail study. There was a relatively low rate of [inaudible 00:15:09] in the Warfarin arm. And in turn, there was a relatively high complication rate in Protect AF with left atrial appendage closure. Part of the differences might be due to the fact that, with more experience, complication rates might decrease. Furthermore, a comparison with more novel agents, such as the new oral anticoagulants, remains to be seen. Next, within the realm of cardiac mapping and ablation for atrial fibrillation, we review an article by Vlachos et al published in the Journal of Cardiovascular Electrophysiology entitled Low-Voltage Areas Detected by High-Density Electroanatomical Mapping for Recurrence of Ablation after a Paroxysmal Atrial Fibrillation. They presented the results from a series of 80 patients undergoing ablation for paroxysmal atrial fibrillation, performing high-density voltage mapping to characterize the total area involved by low voltage. They demonstrated, when low voltage areas, defined as less than 0.4 millivolts, were seen in greater than 10% of the left atrial surface area, this served as an independent predictor of atrial fibrillation recurrence. These data support prior research, including that of MRIs, suggesting the characterization of the atrial substrate may correlate with likelihood of ablation success. Identifying methods however, to accurately and reproduce will identify these patients with more atrial substrate prior to ablation, remains to be seen. The importance of this, however, is our ability to better counsel patients on the likelihood of treatment success. Next within the realm of atrial fibrillation, we review elements of risk stratification managements. First, in the December issue of the Journal of American College of Cardiology, Takimoto et al published on how Eplerenone may reduce atrial fibrillation burden without preventing atrial electrical remodeling. In a randomized controlled ovine atrial tachy pacing model of atrial fibrillation. The authors provided daily, oral Eplerenone and compared this with a placebo. They showed that Eplerenone significantly reduced the rate of left atrial dilatation, with less smooth muscle actin protein, atrial fibril [inaudible 00:17:17]. Furthermore, Eplerenone further prolonged the time to persist in atrial fibrillation in 26% of animals. However, interestingly, Eplerenone did not prevent AF-induced electrical remodeling.  These data suggest that Eplerenone, or other medications that can be used to prevent or reverse structural remodeling, may offer an upstream therapy to reduce atrial fibrillation burden, and decrease likely the persistent atrial fibrillation. Giving the ever-growing population of patients suffering from atrial fibrillation, identifying upstream approaches to prevent it will be critical. Of course, these need to be taken with due consideration, however. Specifically, the model used here, namely that of an atrial tachy pacing model, might not be applicable to all human atrial fibrillation. Thus, whether or not such therapies actually offer benefit in clinical models, is as of yet unclear. Finally, from the realm of atrial fibrillation, we review the article by Rowin et al published in circulation entitled Clinical Profile of Consequences of Atrial Fibrillation Hypertrophic Cardiomyopathy. In patients presenting with hypertrophic cardiomyopathy, atrial fibrillation is known to be a significant co-morbidity. However, the implications of atrial fibrillation in terms of worsening of heart failure status, or long-term morbidity mortality are less clear. Rowin et al reviewed the natural history of atrial fibrillation amongst 1,558 patients, prospectively followed at a single center. Nearly 20% of the population developed atrial fibrillation with the majority having symptomatic paroxysmal atrial fibrillation. However, atrial fibrillation was not associated with any increase in cardiovascular mortality or worsening of heart failure status. Furthermore, mortality that was directly related to atrial fibrillation was nearly exclusively related to thrombolic stroke. Anticoagulation [inaudible 00:19:13] reduced this risk. The traditional scoring systems fared poorly in assessing the stroke risk of this population. About 121 patients underwent invasive rhythm control approaches, including 72 patients undergoing maze and 49 catheter ablation. The success rate of maze was significantly greater at around 75%. These data are important when counseling hypertrophic cardiomyopathy patients presenting with new-onset atrial fibrillation. While it is clear that paroxysmal atrial fibrillation has a significant impact on symptoms and quality of life, it does not cause worsened, overall, long-term outcomes. However, it does highlight the importance of anticoagulation in this population, nearly irrespective of the underlying risk score. In terms of rhythm control options, it appears that rhythm control options can be successful in these patients. Finding that catheter ablation is associated with a 40 to 50% success rate is in keeping with prior published data. Thus, consideration of when a patient needs to be referred to maze, needs to be considered in the clinical inpatient context. Changing gears, we will next review articles within the realm of ICDs, pacemakers, and CRT. In the New England Journal of Medicine this past month, Nazarian et al published on their experience regarding the safety of magnetic resonance imaging in patients with cardiac devices. They performed a prospective non-randomized study of the safety of, specifically, 1.5 tesla-strength MRI scans on legacy. In other words, not MRI conditionally-safe pacemakers and defibrillators. A total of 2,103 scans were done among 1,580 patients. They demonstrated no long term clinically significant adverse events. Nine patients did experience a reset to a backup mode, though eight of which were transients. The most common change seen acutely was a decrease in PVA amplitude in one percent of patients, and in a long term follow-up, 4% of patients experiencing a decrease in PVA amplitude, increase in atrial catheter sheer threshold, or increase in right or left ventricular capture threshold. However, none of these events were considered clinically significant. Furthermore, there was not a good [inaudible 00:21:23] group to know if this long term change in amplitudes or thresholds might have been seen in patients who had devices that were not exposed to MRI. These findings are complimentary to multiple, prior, published reports, indicating the safety of performing MRIs under clinical protocol in legacy pacemakers and defibrillators. It calls into question whether MRI conditional devices truly offer an additional safety factor furthermore, over legacy devices. Next we review an article by Lakkireddy et al published in Heart Rhythm entitled A Worldwide Experience, the Management of Battery Failures and Chronic Device Retrieval of the Nanostim Leadless Pacemaker. Lakkireddy et al reported their large multi-center experience on the overall risk of battery failure. Amongst 1,423 implanted devices there were 34 battery failures occurring, on the average, three years after implants. Furthermore, about 73 patients underwent attempted device retrieval, and this was successful in 90%, with the seven failures of retrieval being due to either inaccessibility of the docking button, or dislodgement of the docking button in one patient, in whom it embolized to the pulmonary artery. An additional 115 patients interestingly received an additional pacemaker after release of the device advisory. These data suggest that there may be as high as an overall 2% risk of battery failure with the Nanostim device, even late after implants. This highlights the need for close follow-up, even if the battery appears relatively stable up to two year after implants. Furthermore, almost 10% of devices cannot be successfully retrieved. However, in those patients, even with re-implantation of a separate device, there was no device-device interaction seen. Further innovation will be needed to optimize device longevity, and close follow-up of all patients undergoing implantation will be critical to understand the overall long term efficacy and safety when compared to other traditional devices. Finally, within the realm of device care, we focus on an article by Kiehl et al, again published in Heart Rhythm this past month entitled Incidence and Predictors of Late Atrial Ventricular Conduction Recovery Among Patients Requiring Permanent Pacemaker for complete heart block after cardiac surgery. They reviewed the likelihood of recovery of conduction in their retrospective cohort of 301 patients. Interestingly, 12% of patients had recovery of AV conduction on average six months after surgery. Those who did not recover tended to more likely have preoperative conduction abnormalities. Saraj Kapa:                          Findings that suggested a higher likelihood of long term conduction recovery included female sex and the existence of transient periods of AV conduction postoperatively. These data highlight that recovery of AV conduction is possible in a significant number of patients undergoing cardiac surgery. However, being able to predict long term recovery may assist in device selection, to avoid more costly device implantations that may not be needed over chronic follow-up. Prospective studies amongst larger numbers of patients are needed to better understand mechanisms of block, mechanisms of recovery, an optimal device in patient selection. Changing focus, we will next review two articles within the realm of supraventricular tachycardias. First we read an article by Han et al published in JACC Clinical Electrophysiology, entitled Clinical Features in Sites of Ablation for Patients With Incessant Supraventricular Tachycardia From Concealed Nodofascicular and Nodoventricular Tachycardias. Han and group describe three cases of concealed nodovascicular, nodoventricular re-entrant tachycardias, and focus on the different mechanisms of proving their participation in tachycardia. In all cases, atrial ventricular re-entering tachycardia was excluded. Successful ablation for these tachycardias occurred either at the slow pathway region, the right bundle branch, or the proximal coronary sinus. This is the first described case of incessant, concealed tachycardias related to these pathways. The importance of this article highlights an understanding the mechanisms proving the contribution to tachycardia, and the importance of recognition when performing electrophysiology studies, and being unable to reveal traditional mechanisms, which exist in most patients, such as atrial tachycardia, AVNRT or AVRT. Next we review an article by Guo et al published in Europace entitled Mapping and Ablation of Anteroseptal Atrial Tachycardia in Patients With Congenitally Corrected Transposition of the Great Arteries: Implications of Pulmonary Sinus Cusps. They reviewed three separate cases of anteroseptal atrial tachycardias in the setting of congenitally corrected transposition. They demonstrated that in these cases, there was successful ablation performed with the pulmonary sinus cusps. The result is successful and durable suppression. The reason this article is important lies in the fact that it's critical to understand both cardiac anatomy and cardiac nomenclature. The pulmonary valve in CCTJ is affectively the systemic ventricular arterial valve, given that the right ventricle is the systemic ventricle. Thus, mapping in this region of CCTJ abides the same principles as mapping the aortic valve in structurally normal hearts for similar tachycardias. However, understanding the nomenclature and that despite the variant anatomy, the utility of similar approaches to mapping of the systemic outflow are important when matching these complex, congenital anatomy or arrhythmia patients. Changing gears yet again, we review an article within the realm of sudden death and cardiac arrest. Baudhuin et al published in Circulation and Genetics entitled Technical Advances for the Clinical Genomic Evaluation of Sudden Cardiac Death. Baudhuin et al reviewed the utility of formal and fixed paraffin-embedded tissue, which is routinely obtained in an autopsy, to perform post-mortem, genetic testing. One of the main limitations to advising family members who have had prior family history of sudden death in closely related relatives, is that blood is often not available to perform DNA screening late after death. DNA however is often degraded in the tissues that are commonly available at autopsy, namely the formal and fixed paraffin-embedded tissues. The authors sought to evaluate if your next generation techniques could make these types of tissue adequate for diagnosis. They demonstrated amongst 19 samples, that performance characteristics were similar between whole blood and these tissue samples, which could be as old as 15 years. It can be critical to identify disease-causing mutations in family members, as individuals who might not yet be affected, but at risk, need to know about that overall risk. Given that decision to sequence might also not be universally applied at all centers, or in all situations, oftentimes these paraffin-embedded tissues might be the only available option, sometimes over a decade after death. This represents the first report of using next-generation sequencing approaches to successfully and accurately sequence for specific mutations using paraffin-embedded tissue. This may offer additional options to help family members achieve diagnoses for sudden death-inducing conditions. Within the realm of cellular electrophysiology, we review an article by Lang et al published in Circulation Research entitled Calcium-Dependent Arrhythmogenic Foci Created by Weakly Coupled Myocytes in the Failing Heart. Lang et al reviewed the effect of cell-cell coupling on the likelihood of triggered arryhthmias. In a [inaudible 00:28:45] model, they demonstrated the myocytes that are poorly synchronized with adjacent myocytes were more prone to triggered activity due to abnormal calcium handling when compared to myocytes with normal connection to adjacent cells. Thus, adequate coupling leads to voltage clamping during calcium waves, thus preventing triggering arrhythmias. While poorly coupled myocytes aren't able to to this due to a weakened currency, making them more prone arrhythmogenesis. These data highlight another critical cellular basis for arrhythmogenesis. In heart failure, while the focus for clinical management is typically areas of scar, there's clearly a role at the cellular level where cell-cell coupling abnormalities can lead to dynamic changes that can increase tendencies to arrhythmogenesis. The role in understanding the varying, arrhythmogenic risk based on varying factors, is important, and might have importance in the future advances in mapping technologies. Changing gears, we review an article published in the Journal of the American College of Cardiology by Mazzanti et al within the realm of genetic channelopathies entitled Hydroxyquinoline Prevents Life-Threatening Arrhythmic Events in Patients With Short QT Syndrome. They reviewed a cohort of 17 patients and demonstrated that hydroxyquinoline resulted in a reduction of arrhythmic events from 40% to 0% of patients. QTc prolongation was seen in all patients. These data clearly demonstrate that hydroxyquinoline plays a role in lowering the incidence of arrhythmic events in patients suffering from short QT syndrome. However, it's important to note that in many markets, quinoline has been difficult to access. In the specific case of QT syndrome thus, there's clearly a role for hydroxyquinoline. However, it also must be noted, the comparative efficacy with more commonly available drugs still needs to be evaluated. This past month has been of particular interest in the realm of ventricular arrhythmias, with multiple, potentially ground-breaking articles. One of the well-recited articles published this past month already is by Cuculich et al entitled Noninvasive Cardiac Radiation for Ablation of Ventricular Tachycardia published in the New England Journal of Medicine. Cuculich et al reported the first in-human data on the use of stereotactic body radiation therapy to perform noninvasive ablation of ventricular arryhthmias. Using a combination of noninvasive electrocardiographic imaging curing ventricular tachycardia, and stereotactic radiation, patients were treated with a single fraction of 25 [inaudible 00:31:15] while awake. A total of five patients were included with a mean ablation time of only 14 minutes. During the three months prior to treatment, there was a total of 6,577 VT episodes seen, and during a six week post-ablation period, considered a blanking period, there were 680 episodes. After this blanking episodes, there were only four episodes of VT seen over the ensuing 46 patient months. This study is important because it reflects the first in-human proof of concept that noninvasive ablation using radiation therapy traditionally as for treatment of solid tumors, may be affective in targeting cardiac tissue. Furthermore, modern techniques such as noninvasive electrocardiographic imaging might allow for a fully noninvasive experience for the patients. This is a vast advance seen within the realm of cardiac electrophysiology. In the early days, all we could do was map invasively and then have to go to much more invasive, open-heart surgery to treat arryhthmogenic substrates. Since the advent of catheter and radiofrequency ablation, surgical ablation is relatively fallen by the wayside, to a less invasive approaches. A completely noninvasive approach to successfully targeting tissue is potentially ground-breaking. However, there are several limitations in this study that can only be ascertained by reading the actual article. When we actually review the patients included, the long term follow-up was limited to only four patients, as one patient actually died within the blanking period, and in fact, this patient suffered from the largest burden overall of VT. Furthermore, amongst the remaining four patients, one required a redo ablation within the blanking period, and one had to be restarted on amioderone after the blanking period was over. Thus further data is really needed to clarify efficacy, given the overall success rate appears to be less than 50% on a per patient basis. Though on an overall episode basis, there was significant reduction. The exact type of radiation to be used also needs to be considered, within the realm of solid oncology. Stereotactic radiation is considered an older modality, with proton beam, and more recently, carbon beams offer more directed therapy. Thus, a lot more data is required to identify the promise of radiation therapy. Though again, this is a significant advance. Next, within the realm of invasive electrophysiology, we review an article by Turagam et al published in the JACC Clinical Electrophysiology entitled Hemodynamic Support in Ventricular Tachycardia Ablation: An International VT Ablation Center Collaborative Group Study. The utility of hemodynamic support during VT ablation is relatively unclear. Studies have been variable and limited. This group included 1,655 patients who underwent 105 VT ablations using hemodynamic support with a percutaneous ventricular assist device. Those undergoing support overall tend to be sicker, including lower ejection fractions and [inaudible 00:34:07] classes, and more VT events, including ICD shocks and VT storm. Hemodynamic support use interestingly, was an independent predictor of mortality with a hazard ratio of 5, though there was no significant difference in VT recurrence rates irrespective of the subgroup considered. These data indicate that, while patients are receiving hemodynamic support were overall sicker, there was no clear incremental benefit in use of hemodynamic support in terms of long term outcomes. In the area of substrate ablation, whether use of hemodynamic support to facilitate mapping during VT, actually alters outcomes remains to be seen. This study highlights the potential importance of randomized clinical approaches to better evaluate whether hemodynamic support truly alters the long term outcomes of the VT ablation. Next, we review an article by Munoz et al that focuses more on prediction of those patients who might be at risk for ventricular arrhythmias, again published in the last edition of JACC Clinical Electrophysiology and entitled Prolonged Ventricular Conduction and Repolarization During Right Ventricular Stimulation Predicts Ventricular Arrhythmias and Death in Patients With Cardiomyopathy. Munoz et al reviewed the relationship between paced QRS and pace Qtc and long term risk. A total of 501 patients with mean ejection fractions of 33% were included. Longer paced ventricular QRS and Qtc was associated with a higher risk of ventricular arrhythmia, and all caused death or arrhythmia, irrespective or ejection fraction. A paced QRS duration of 190 milliseconds was associated with 3.6 fault higher risk of arrhythmia, and a 2.1 fault higher risk of death or arrhythmia. These data suggest that findings during [inaudible 00:35:47] pacing and otherwise normal rhythm, including paced QRS and QTc may independently result in elevation of overall risk of ventricular arrhythmia and death. Physiologically these data make sense. In light of the fact that longer cure restorations are probably related to a greater degree of myopathy. While these data offer a prognostic indication, whether they alter outcomes or decision making regarding ICM implantation, remains to be seen. Next, also published in JACC Clinical Electrophysiology, Vandersickel et al reviewed a more cellular basis for toursades in an article entitled Short-Lasting Episodes of Toursades de Pointes in the Chronic Atrial Ventricular Model Have Focal Mechanism While Longer-Lasting Episodes are Maintained by Reentry. Vandersickel et al reviewed the mechanisms underlying toursades, and demonstrated that both focal and reentry mechanisms may exist. In five canines they used broadly distributed neuro electrodes to simultaneously map across the heart. They demonstrated that initiation and termination was always focal, but longer and non-terminal episodes always had reentry mechanisms. These data suggest that the mechanisms underlying toursades actually reflect a spectrum of potentially dynamic, electrophysiologic phenomenon the heart, including both focal and reentry activity. Understanding these mechanisms, and the fact that focal mechanisms almost universally underlie initiation may bring into consideration the optimal treatments whether in the form of pacing and defibrillation techniques or medication techniques for toursades. Finally, in the realm of ventricular arrhythmia, we review an article published in the last month's edition of Heart Rhythm by Penela et al entitled Clinical Recognition of Pure Premature Ventricular Complex-Induced Cardiomyopathy at Presentation. As we know, it's sometimes difficult to recognize patients when they present with frequent PVCs and a depressed injection fraction in terms of, whose injection fractions are purely caused by the presence of PVCs, and whose PVCs are only exacerbated by the presence of an underlying myopathy. The group included 155 patients and excluded all patients who did not normalize their elevated ejection fraction, or who had previously diagnosed structural heart disease, leaving a total cohort under consideration, of 81 patients. About 50% were diagnosed as having a PVC-induced cardiomyopathy on the basis of normalization of elevated function after PVC suppression. While the remainder was considered to have PVC exacerbated cardiomyopathy on the basis that things did not entirely resolve, and thus had an independent mechanism for nonischemic myopathy. Characteristics that suggested patients with a lower likelihood of EF normalization included those with longer intrinsic QRSs, above 130 milliseconds, a lower PVC burden of baseline, considered less than 17%, and larger [inaudible 00:38:33] greater than 6.3 cm. PVCs as a cause of [inaudible 00:38:35] are obviously a well-recognized treatable cause of myopathy, however again, it might be difficult to differentiate. Those patients whose PVCs are a result of the underlying myopathy versus those whose PVCs are the cause, and for whom ablation or suppression may reverse the myopathic process. The work of Penela et at offers an initial attempt at helping differentiate these processes, however validation of larger cohort is necessary. Next we review an article within the realm of syncopy entitled Prohormones in the Early Diagnosis of Cardiac Syncopy by Badertscher et al published in the Journal of the American Heart Association this month. They review the utility of circulating prohormones [inaudible 00:39:14] autonomic dysfunction or neurohormonal abnormalities, to differentiate cardiac from non-cardiac causes of syncopy in the emergency departments. They measured four novel prohormones in a multi-center study. In the emergency departments there is a specific protocol used to determine the perceived likelihood of the cause of syncopy to be cardiac versus non-cardiac. In addition to this, the prohormones are drawn. After this, everyone's final diagnosis was reached. Two independent cardiologists reviewed the cases to determine if it was a truly cardiac or non-cardiac cause of syncopy. Among 689 patients included, 125 overall were adjudicated as cardiac syncopy. Measure of the specific marker MR-proANP in combination with emergency department suspicion of syncopy, performed better than suspicion alone, to differentiate cardiac causes of syncopy. A combination of a circulating MR-proANP, less than 77, picomoles per liter, an [inaudible 00:40:17] probability of cardiac syncopy could be less than 20%, had a very high sensitivity negative predictive value of 99%. The significant resources are often used to manage patients with syncopy presenting to the emergency departments, and it's often extremely difficult at this stage to differentiate cardiac from non-cardiac causes of syncopy. And the amount of evaluation that can be done in the emergency department is often limited. Cardiac caused of syncopy are not good to miss, however, since these can include ventricular arrhythmias, and transient AV block, that might result in death as well. As is well-recognized, emergency department evaluation in clinical [inaudible 00:40:49] are limited in terms of their utility. This raises the utility of objective measures to help differentiates. These data suggest that circulating prohormones [inaudible 00:40:59] your hormonal function drawn during your emergency department evaluation, may be a useful adjunct to differentiate cardiac from non-cardiac syncopy. Whether they can be used to prospectively differentiate those patients requiring inpatient admission or now, however, remains to be seen. The last two articles we'll choose to focus on will fall under the realm of broader, other EP concepts. The first article we will review is by Varghese et al published in Cardiovascular Research entitled Low-Energy Defibrillation With Nanosecond Electric Shocks. Varghese et al reviewed the potential of low-energy nanosecond duration shocks for defibrillation in rapid hearts. In induced fibrillation examples, the repeated defibrillated nanosecond impulses as low as three kilovolts demonstrated effective defibrillation. The energy required is significantly lower than from monophasic shocks and longer pulse durations. Furthermore, there was no detectable evidence of electroporation, namely cardiac or so injury after defibrillation. Using nanosecond impulses, it may be feasible to defibrillate the heart with significantly lower energies. The implications for patients experiencing defibrillation, for example pain, is unclear without in-human studies. However, the ability to use lower energies could have implications in battery life. Further [inaudible 00:42:11] studies will be critical to study ambulatory efficacy as this research is performed in [inaudible 00:42:19] hearts. Finally, we review an article published in Circulation entitled Mortality in Supravascular Events After Heart Rhythm Disorder Management Procedures by Lee et al. Amongst three centers, a retrospective cohort study regarding the mortality and risk of supravascular events, was performed. They included a variety of heart rhythm [inaudible 00:42:40] procedures, including defibrillation threshold testing, lead extraction, device implant, and invasive electrophysiology studies and ablation procedures. Amongst 48,913 patients, 62,065 procedures were performed and an overall mortality of .36% was seen. Supravascular [inaudible 00:42:58] was lower at .12%. Interestingly, and expectedly, the highest risk was seen with lead extraction patients, with an overall mortality risk of 1.9%. Less than half of the deaths seen, however, were directly attributable to the procedure itself. The most common cause of procedural death was cardiac tamponade, largely seen amongst device implant patients. This is critical, as the number of ablation and other invasive electrophysiology procedures performed, is increasing. These data provide a large, contemporary experience regarding the overall risk attributable to a variety of heart rhythm disorder procedures. Interestingly, half of the procedure related deaths were associated with device implantation procedures. With the predominant cause being tamponade, highlighting the importance of early recognition of this treatable complication. Tamponade may not always be considered as a major issue after device implantation, however these data clearly suggest that it is. In addition, extraction, as expected, carried the highest incident of both supravascular events and mortality. Though, this is likely related to the higher rate of core morbidity in this population, including active infection. In summary, this month, we have reviewed 20 articles in various areas of electrophysiology published across the literature. Particularly high impact articles range from those reviewing experience regarding left atrial appendage closure and the efficacy of this, to the utility of using atrial fibrillation to predict risk and long term morbidity and mortality in hypertrophic cardiomyopathy, to further evidence regarding the safety of magnetic resonance imaging in legacy pacemakers and defibrillators, and novel considerations regarding supraventricular tachycardias and there diagnosis and management, especially invasively. Other potential groundbreaking articles included evidence that we can successfully use formal and fixed paraffin-embedded tissue that can be as old as 15 years, to successfully identify genetic mutations that might be responsible for sudden death. And evidence that using novel techniques, we might be able to perform completely noninvasive therapies for arrhythmias by using radiation therapies. However questions were also raised such as regarding the role of hemodynamic support for VT ablation. How to better differentiate those patients who will have recovery of AV conduction from those who won't, as they meet class I indications post cardiac surgery? And whether other factors such as right ventricular pacing during [inaudible 00:45:28] study might further differentiate patients at risk for ventricular arrhythmias in spite of a low ejection fractions. Many of the papers had to deal with tranlational work that still remains to be proven in terms of value at a clinical level, such as demonstrating mechanisms underlying trousades de pointes. Or the potential value of low-energy defibrillation with nanosecond electric shocks. Clinical protocols involving the use of prohormones in the early diagnosis of cardiac syncopy. How to differentiate PVC induced from other causes of myopathy, and how to manage, in the long term, these devices. Also, likely requires further study. Finally, covering all areas of electrophysiology, we reviewed one large article focusing on mortality in supravascular events after heart rhythm management disorder procedures at large. This article highlights the importance of considering institutional experience and reporting it to use as a benchmark to help better optimize our counseling of patients, as well as our procedures and protocols. I appreciate everyone's attention to these key and hard-hitting articles that we just focused on from this past month of cardiac electrophysiology across the literature. Thanks for listening. Now, back to Paul. Dr. Paul Wong:                  Thanks Seraj. You did a terrific job surveying all journals for the latest articles on topics of interest in our field. There's not an easier way to stay in touch with the latest advance. These summaries, and a list of all major articles in our field each month, can be downloaded from the Circulation Arrhythmia and Electrophysiology website. We hope you'll find the journal to be the go-to place for everyone interested in the field. See you next month.  

Dr Carolyn Lam:                Welcome to Circulation On The Run, your weekly podcast summary and backstage pass to the journal and its editors. I'm Dr Carolyn Lam, associate editor from the National Heart Center and Duke National University of Singapore.                                                 This week's journal features two papers. One a research letter and the second an original article, both focusing on the effect of ionizing radiation on interventional cardiologists. I'm sure that cuts close to the heart, so please stay tuned. Coming up right after these summaries.                                                 The first two original articles in this week's journal describe a metabolic adaptation that is good for the abnormal cell but bad for the patient. This is a shift in glucose metabolism called the Warburg phenomenon where there is failure of two fundamental pathways. Number one glucose metabolism and number two mitochondrial oxygen sensing. This Warburg phenomenon enables a reliance on glycolysis despite an abundance of available oxygen. These two circulation articles uncover new players in the Warburg phenomenon, both in the setting of pulmonary arterial hypertension. One in the pulmonary arterial endothelial cells, and the second in fibroblasts.                                                 In the first paper, first and corresponding author Dr. Caruso and co-corresponding author Dr. Morrell from the University of Cambridge examined the microRNA and proteomic profiles of blood outgrowth endothelial cells from patients with heritable pulmonary arterial hypertension due to mutations in the bone morphogenetic protein receptor type two, or BMPR2 gene, and in patients with idiopathic pulmonary arterial hypertension. They demonstrated that reduced expression of microRNA-124 in pulmonary arterial hypertension endothelial cells was responsible for the dysregulation of the splicing factor polypyrimidine tract binding protein 1, and its target pyruvate kinase M2 or PKM2, which is a major regulator of glycolysis and which contributes to abnormal cell proliferation. Reduced BMPR2 levels were associated with reduced microRNA-124 expression.                                                 In the second paper first author Dr. Zhang, corresponding author Dr Stenmark and colleagues from the University of Colorado studied pulmonary adventitial fibroblasts isolated from cows and humans with severe pulmonary hypertension. PKM2 inhibition reversed the glycolytic status of pulmonary hypertension fibroblasts, decreased their cell proliferation and attenuated macrophage interleukin beta expression.                                                 Normalizing the PKM2 to M1 ratio in pulmonary hypertension fibroblasts by using microRNA-124 over expression, or by PTBP1 knockdown, reversed the glycolytic phenotype, rescued mitochondrial reprogramming and decreased cell proliferation. Finally, pharmacological manipulation of PKM2 activity or treatment with histone deacetylase inhibitors produced similar results. These findings provide new avenues for the treatment of pulmonary arterial hypertension and are discussed in an accompanying editorial by Stephen Archer from Queen's University in Ontario Canada.                                                 The next paper tells us that the addition of ezetimibe to simvastatin in patients stabilized after acute coronary syndrome reduces the frequency of ischemic stroke, with a particularly large effect seen in patients with a prior stroke. First and corresponding author Dr. Bohula and colleagues from the TIMI study group investigated the efficacy of the addition of ezetimibe to simvastatin for prevention of stroke in the IMPROVE-IT trial where post ACS patients were randomized to placebo and simvastatin or ezetimibe and simvastatin and followed for a median of six years.                                                 The current study focused on patients with a history of stroke prior to randomization. The authors found that the addition of ezetimibe to simvastatin reduced the frequency of ischemic stroke with a hazards ratio of 0.79, with a particularly large effect seen in patients with a prior stroke, where the hazards ratio was 0.52, compared to patients without a prior stroke where the hazards ratio was 0.84. Hemorrhagic strokes were rare and a non significant increase in hemorrhagic stroke was observed with the addition of ezetimibe. Thus, the authors concluded that it is reasonable to consider the addition of ezetimibe, a generic lipid lowering therapy with an acceptable safety profile, to a moderate to high intensity statin regimen for the prevention of ischemic stroke in patients with established ischemic heart disease, with or without a prior stroke.                                                 Atrial fibrillation is the most common sustained arrhythmia in hypertrophic cardiomyopathy, but the influence of atrial fibrillation on clinical course and outcomes in hypertrophic cardiomyopathy had remained incompletely resolved. That is until today's paper in circulation. First and corresponding author Dr. Rowin and colleagues from Tufts Medical Center accessed the records of 1,558 consecutive patients followed at the Tufts Medical Center hypertrophic cardiomyopathy institute for an average of 4.8 years from 2004 to 2014.                                                 20% of patients had episodes of atrial fibrillation, of which 74% were confined to symptomatic paroxysmal atrial fibrillation, while 26% developed permanent atrial fibrillation. They found that the timing and frequency of paroxysmal atrial fibrillation events were unpredictable with an average two year interval between the first and second symptomatic episodes but progressing to permanent atrial fibrillation uncommonly. They further found that atrial fibrillation was not a major contributor to heart failure morbidity, nor a cause of arrhythmic sudden death, and when atrial fibrillation was treated it was associated with low disease related mortality, no different than for patients without atrial fibrillation. Finally, atrial fibrillation was an uncommon primary cause of death in hypertrophic cardiomyopathy, but this was virtually limited to embolic stroke, thus supporting a low threshold for initiating anticoagulation therapy.                                                 That warps it up for our summaries. Now for our feature discussion. This week's journal carries two papers that refer to the health risks of ionizing radiation to interventional cardiologists. Yes, you heard me right. You're going to want to listen up. These are going to send chills up our spine, or rather maybe chills into our brains and into our blood according to the papers.                                                 To discuss these two papers I have with us associate editor from UT Southwestern, Dr. Manos Brilakis, as well as the corresponding author of the first paper Dr. Maria Andreassi from CNR Institute of Clinical Physiology from Pisa Italy. Maria, could you start us off by telling us what you found in your research letter? Dr Maria Andreassi:        In our study we evaluated the circulating microRNA profile in interventional cardiologists in order to provide insights into the molecular and the biological situation and the underlying association between occupational low dose radiation exposure in cath lab and the potential long term disease risk. The hypothesis of our study was based on the evidence that the microRNAs are crucial regulators of gene expression. And they have been shown to be dysregulated in many human disease. Moreover, the stability and the tissue selectivity of circulating microRNAs make them ideal biomarkers to explore disease potential clinical disease risk.                                                 In summary, our findings exhibited the dysregulation and the down regulation of acute specific circulating microRNA, the brain specific microRNA-154 and the microRNA-2392. This tells us significantly involved in the deregulation of the three brain pathways and the brain cancer pathway as demonstrated by systematic analysis. In particular, the dysregulated labels so the brain specific microRNA-154 in interventional cardiologists support the notion that the brain damage is one of the main potential long term risk on unprotected head radiation in interventional cardiologists with possible long lasting consequences on the cognitive function. Dr Carolyn Lam:                That is really striking. Brain specific microRNA was shown to be dysregulated in interventional cardiologists compared to controls who were not exposed to radiation. As I understand it, these dysregulated microRNAs can be seen in certain forms of epilepsy and Alzheimer's disease and certain brain cancers and so the concern is very obvious for those of us who are interventional cardiologists. But your study did not actually relate these two specific adverse events. Is that correct? Dr Maria Andreassi:        You're right. Yes. microRNA-154 was first identified as a brain specific microRNA which is involved with inner synapse development and the directly implicated in [inaudible 00:12:15] and memory. Additionally, decreased expression of this microRNA class, was previously reported in several brain disorders including the thymus disease and bipolar disorder. This microRNA has also been shown to be down regulated in several brain cancers such as neuroblastomas. The reduced expression of the microRNA-154 is a predictor of progression and prognosis of human gliomas. This data strongly support it's important role in brain tumors. Our findings are of particular interest in relation the handle exposure to the pathology of the head, the [inaudible 00:13:13] 20, 50 millisieverts. The equivalent to 1,000, 2,000 chest x-rays and can reach a lifetime cumulative exposure around two sieverts for left hippocampus and one sievert for right hippocampus. Dr Carolyn Lam:                That really makes me go, yikes. But Manos, as an interventional cardiologist yourself, what are your thoughts? And also your thoughts please on that other paper that's in this week's journal? Dr Manos Brilakis:            First of all, let me just congratulate Maria Andreassi, she's been one of the leaders in this area and published several papers and this is one of them. It's really important to have these studies because unfortunately we as interventional cardiologists tend to forget about the negative affects of radiation because as you hear, people don't really see them and this can happen many years down the line. And by the time they happen, it's too late. It's really useful to have the studies to bring our attention the importance of keeping the radiation exposure to the patient and to ourselves as low as possible.                                                 The other paper in addition to the one just discussed, is a paper that looks at DNA damage on operators performing endovascular aortic repair. As a preface, these are procedures demonstrated the aortic aneurism repairs which are very intense radiation wise. They are long procedures, fielding can sometimes be challenging for the operator. There is significant exposure of the operator to x-ray. What they did is they measured some markers of DNA damage and repair. Specifically gamma-H1AX and DDR, the DNA damage response marker and the pATM. They measured them in circulating lymphocytes in operators who performed the endovascular aortic aneurism. What they found is that there were significantly higher levels of those markers immediately after those operators performed those procedures. And they did the same thing after x-ray using leg shielding.                                                 That's a very good reminder for us that the x-ray tube actually is not on the top of the table, but the x-ray tube, the generator, of the x-rays is actually on the bottom. Then the x-ray goes through the patient and the detector is at the top of the table and what happens is the x-ray comes from below the patient and gets scattered from the patient and coming towards the operator so actually it's the legs get the higher dose during any sort of x-ray guided procedure. Sometimes we're forgetting importance of shielding the legs 'cause we think the legs, whatever the muscles, the bones, they're fine. But as the study shows, it's not just the muscles and the bones there but the whole circulation blood gets exposed to x-ray in the lower extremity circulation and that can translate to many other potentially adverse events. Dr Carolyn Lam:                Manos, I love that you manage both these papers. What important messages for increase in risk awareness. This was really very, very well accomplished by both these papers. As well by the editorial that you asked for and that was so well written by Dr. Charles Chambers on both these papers. But beyond risk awareness, what I really love is what you brought up just a while earlier about risk reduction and methods that we can take, for example, in the second paper, by Dr. Modoari and colleagues about shielding the legs. What are the implications for example, wearing a helmet or shielding the head for interventional cardiologists? What do you think? Dr Manos Brilakis:            These are very, very good points. The reality is for the head there have been a couple studied that looked at shielding with lead caps or there's some lead free caps that can be worn and also there are radiation protective glasses. However, what was interesting, there was a paper earlier last year that showed that because the radiation actually comes from below the operator that wearing those helmets, although it seems appealing, it is simple to do obviously, it actually did not significantly reduce the dose to the brain and it only partially reduced the dose to the eyes. Though shielding is useful but may not be as good as we think it is.                                                 In my mind, the starting point of all this is the basics of radiation safety which again, sound very simple and we learn about them in the beginning of training, unfortunately what happen is people tend to forget them as time goes by. These are things like don't step on the x-ray pedal unless you need to look at the pictures and that's very common done. People just have this heavy foot syndrome. They keep on x-raying when they don't need to. There's also the important things having the patient as high as possible and the detector as close to the patient so there is not as much distance for the x-ray to travel. Things like using low, not very steep angles so there is not as much radiation because they have to go through less amount of tissue. And there's some technologies actually coming along there's some technologies that focus the radiation beam only specific areas. And cut the overall dose. And there are x-ray machines that also can have much less radiation overall for the patient and the operator. As you said, having good shielding habits is very important. Dr Carolyn Lam:                Yeah, that's exactly it. That risk awareness should lead to action. I'm just curious, who do you think should primarily take hold of these risk reduction and safety procedures and the enforcement and so on? Us as a community, but what do you think of the role of things like professional societies, quality improvement programs, FDA even? Dr Manos Brilakis:            It's a great point. What we hear here Maria's comments on this as well. But my feeling is absolutely societies are very important for leading these efforts and they do have actually guidelines. There's procedural guidelines for radiation protection. But the end of the day it's the individuals themselves, the operators, each and every one who is in charge of this in their care or his own cath lab and their procedures. Dr Maria Andreassi:        I agree. We all of our findings can contribute to the increase of cross cultural assessment in cath lab and by promoting the diffusion but not the reduction technologies whereas diligent about your protection habits. Moreover it is important to let the design, the relationship between occupational radiation exposure, clinical risk and there are very important future studies studying larger population. We should focus on the molecular epidemiology studies by using biomarkers and this will be clinical and points as early predictors of a clinical event. Because this information is a model likely to better define the risk of radiation use disease at low doses as a comparative tool, the classical epidemiological approach that require a very large sample sizes spread over [inaudible 00:20:51].                                                 Now it's time where largest studies involving scientific societies at an international level. Possible breaking the additional exposure in already recruited the Roth case. And by combining the conventional epidemiology, and the molecular studies and the expected results to better define the clinical risk as a good lesson to implement a more effective protection program. And better as the surveillance at the individual level. Dr Carolyn Lam:                That is wonderful. And thank you, this truly is an international call, isn't it? Another thing that we should keep in mind that all measures that we use to protect our patient from receiving excessive radiation is likely to help us as well as cardiologists.                                                 Thank you so much, both of you, for joining me today on this podcast. What an important message and I'm sure that our listeners will agree. Thank you listeners for joining us. Tune in again next week.  

Diabetes is an epidemic in the US. Many people have died or lost limbs to the disease. We don't know what else to say because our understanding of diabetes is pretty limited. But we were pretty sure that it was generally thought of as BAD. Someone thinks it's actually a beneficial thing and that person is Craig Rowin. Craig Rowin is a very talented writer and performer and a great ol' friend of ours. He stars in the Adult Swim show, Your Pretty Face Is Going to Hell, wrote for The Jack and Triumph Show, and once tried to convince someone, anyone to give him 1 million dollars and failed. We should also mention that his wife Meryl Rowin is an extremely talented artist and you should check out her stuff. If you’ve got any questions, comments, or concerns about the current, past, or future Make Me Like It podcasts, shoot Dan and Kelly an email at littlepuppyquestions@gmail.com! Theme Music by John Haskell Logo Art by Darin Shuler

gabrus is joined by comedian/friend/devil make up aficionado Craig Rowin. Where they talk about their obsession with commercials from the 90s. Of course there are tangents...Tangents are not only allowed they are encouraged Brought to you by Tidal

Jessica Rowin, inventor of the Broom Huggie, wanted an alternative to bulky traditional mops that used lots of water and found disposable floor mops like the Swiffer created lots of landfill waste. She set out to transform a common technique of wrapping a towel around a broom into a new, efficient cleaning device she calls the Broom Huggie. Join us on The Mompreneur Model Show with Dori DeCarlo June 11 at 10amPT / 1pmET and anytime in archive on WoMRadio - the show for #mompreneurs the new business women.  Thanks to our show sponsors Thirty-One Gifts and Pink Zebra. Meet them and all our sponsors in our Mompreneur Marketplace on our website.  We'do love to connect with you on Facebook and Twitter and email dori@wordofmomradio.com  with questions or comments.  WoMRadio - for the mom in us all.  

Meryl Rowin (Illustrator, Craig's Wife) watches an episode of "Grim Tales" hosted by Rik Mayall from "Drop Dead Fred." Meryl discusses why Rumpelstiltskin is so scary, breaks down the inappropriate made-for-tv-movies she watched as a child, and avoids being a prisoner in her own home.

Michael Rowin (L Magazine, Criterion Collection, Craig's brother) stops by to watch "They Came From Outer Space," an early 90s TV show about two teenage fraternal twin aliens from the planet Crouton. Craig and Michael come face to face with a TV show that only they remember and reminisce about all the TV they watched as kids.

Crazy cook (er, kook) Craig Rowin takes a break from watching tv to hash about running for Student Council, slaving away at awful "DataComm"-esque companies, turning down work, looking up "comedy" on Craigslist, finding improv, being upstaged by Borat impersonators in the audience, writing for "Who Wants to Be a Millionaire," plus the upsides and downsides of winning one million dollars.  Craig also gabs about his hilarious It's That Episode podcast.  There's 57 channels and everything on and this week's WORST GIG EVER!