Podcasts about salpeter

Als das Schießpulver im Mittelalter aus Fernost nach Europa kam, machte es rasch Karriere im Militär. Für Feuerwaffen wurde Schwarzpulver zum unverzichtbaren Zündstoff. Die Mischung aus Holzkohle, Schwefel und Salpeter blieb über Jahrhunderte im Wesentlichen unverändert - eine Erfindung, mit der sich der Mensch die Welt untertan machte. Von Thomas Grasberger

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Join Dr. Jay and Brad as they interview the founder of Neufit and author of The Neufit Method, Garrett Salpeter. In 2007, Garrett Salpeter, who was studying physics and engineering and playing college hockey, suffered a wrist injury that necessitated surgery. Before undergoing surgical intervention, a chiropractic neurologist introduced him to functional neurology and early forms of DC devices as an alternative treatment. Salpeter used himself as a test subject, and remarkably, within just three weeks, he achieved complete recovery, sidestepping the need for surgery and returning to hockey. This sparked his interest in the nervous system and how it could be used to help people heal. He even started treating some of his hockey teammates in his dorm room with DC devices, noticing better results compared to AC devices and traditional therapy. To further his knowledge, Salpeter dedicated himself to self-study and took graduate level neuroscience classes. In 2009, he opened his first clinic in a small room within a chiropractor's office. As he gained more experience, he became convinced that he could create a more effective device to help people recover. In 2015, he started developing the Neubie® device, and NeuFit was eventually launched in 2017. Since then, the company has experienced significant growth and has helped thousands of people unlock their healing potential and achieve significant results. NeuFit provides doctors, therapists, and other professionals with leading-edge technology, research-backed methods, and unparalleled clinical support to supercharge their practices and help them get transformational outcomes with their patients. For more information on NeuFit or Garrett Salpeter, follow these two Instagram accounts: @neufitrfp or @garrett.salpeter. Be sure to check out Garrett's book here: www.neu.fit/book/ and his podcast here: www.neu.fit/podcast/. Lastly, visit www.neu.fit/techtalk/ for a special offer from NeuFit to TechTalk's listeners! ACT FAST!

Die Legende besagt, dass sich alle vier Jahre zwei Typen um vier treffen um einen Podcast aufzunehmen. Wie die Legende weitergeht wissen wir um die Zeit auch gerade nicht, aber was wir wissen: Väter lieben Salpeter, Studenten lieben Monatsenden, in Cloppenburg gibts viel Geburt! Zwischenwasser-Podcast-Playlist: http://bit.ly/ZwiwaPlaylist Du willst Teil der ZWIWA-Community werden? Folgen, Teilen und mit uns in Kontakt treten! Zwischenwasser auf Instagram: http://bit.ly/ZwiwaInsta

I have a repeat guest on our podcast today, Garrett Salpeter! On today's episode, we talk about new research on the newbie device that was specifically performed in people with multiple sclerosis. So we'll get an idea on how effective it is and benefits for those with MS. The MSing Link Episode 41 with Garrett Salpeter: https://www.doctorgretchenhawley.com/podcasts/the-msing-link/episodes/2147683426 Garrett's book & Audiobook: The NeuFit Method Unleash the Power of the Nervous System for Faster Healing and Optimal Performance Hardcover The NeuFit Method Unleash the Power of the Nervous System for Faster Healing and Optimal Performance Audiobook Additional Resources: https://www.doctorgretchenhawley.com/insider Reach out to Me: hello@doctorgretchenhawley.com Website: www.MSingLink.com Social: ★ Facebook: https://www.facebook.com/groups/mswellness ★ Instagram: https://www.instagram.com/doctor.gretchen ★ YouTube: https://www.youtube.com/c/doctorgretchenhawley?sub_confirmation=1 → Game Changers Course: https://www.doctorgretchenhawley.com/GameChangersCourse → Total Core Program: https://www.doctorgretchenhawley.com/TotalCoreProgram → The MSing Link: https://www.doctorgretchenhawley.com/TheMSingLink

Panicked about climate? Wondering what to do? Nate Salpeter and Shira Jacobson join us to discuss Sweet Farm, a sanctuary that is attacking the climate crisis from many different angles. From animal rescue to the most sophisticated agriculture technology, from plant-based regenerative ag to composting, Sweet Farm will give you hope and inspire you on your journey!   ABOUT OUR GUESTS…

We are joined by Tony Award winning Producer, Creative Director, and Film Producer, Adrian Salpeter, for our monthly Industry Insider episode! Adrian shares his story from starting out as an assistant to supporting artists and facilitating their projects as a successful producer. Mel and Brooke dive into the conversation to discuss Adrian's insights on the importance of relationships, the need for fearlessness, and making sure you're always putting people first and projects second. Even if you're not in theater/film/tv, Adrian has a lot of wisdom and encouragement to share, so don't miss it! Visit our affiliate: Moonlite Moonlite turns your smartphone into a storybook projector! Light up your child's imagination with playful projections, vivid sound effects, and read-a-long features. Snuggle up and start reading! Don't forget to use the coupon code “Moonlite10” to receive an extra 10% off, and this stacks on top of any other discounts or promotions! Ratethispodcast.com/momsarttoo Momsarttoo.com --- Send in a voice message: https://podcasters.spotify.com/pod/show/momsarttoo/message Support this podcast: https://podcasters.spotify.com/pod/show/momsarttoo/support

How do we harness the power of the nervous system to help you heal, adapt, and grow? Garrett Salpeter explains how in today's episode. Salpeter supplies doctors, therapists, and other professionals with leading-edge technology, research-backed methods, and unparalleled clinical support to supercharge their practices. ★ - Learn more about Project 90: www.alcoholfreelifestyle.com/Project90 ★ - (Accountability & Support) Speak verbally to a certified Alcohol-Free Lifestyle coach to see if, or how, we could support you having a better relationship with alcohol: https://www.alcoholfreelifestyle.com/schedule ★ - (Free Guide) The Alcohol Freedom Formula For Over 30s Entrepreneurs & High Performers: https://social.alcoholfreelifestyle.com/podcast

Want to be on the cutting edge of disease treatment? Learn how companies like Immunyx Pharma are on the front lines in the battle against unknown diseases with the JLABS/BARDA Blue Knight program. Seth Salpeter, Co-Founder and CEO of Immunyx Pharma guests on BioTalk with Rich Bendis

One of the fastest female marathoners of all time - Lonah Salpeter joins the Sweat Elite Podcast during the Sweat Elite Kenya Training Camp taking place in Iten during January. This interview took place during the Sweat Elite Kenya Training Camp #4. During this conversation Lonah shares insights into her training, her discovery of running, her future goals, competing for NN Running team and more. Sweat Elite Subscribers access 450+ articles on elite run training and right now subscribers access a limited time offer: get a free training plan (5k, 10k, Half Marathon or Marathon - normally $39) by subscribing for 1 year ($48). Support the podcast and access all Sweat Elite content: https://www.sweatelite.co/subscribe-now/ This podcast episode if sponsored by Saysky. Use code SWEAT15 for 15% off at their global store today. There is a great winter sale currently taking place. Visit: https://saysky.us/ This podcast episode is sponsored by Precision Fuel & Hydration - one of the world's leading sports fuelling companies. Score 15% off all products at this link https://visit.pfandh.com/sweatelite by using code SWEATELITE

Kelly Salpeter sits on our couch and shares her POV on whether your sexuality defines your identity, normalizing being transparent on your platform as a content creator while creating boundaries, and developing confidence in yourself. Head to www.theconversationalist.com/povz to watch the interview! Are the Mets really the best? Answers these questions with Kelly Salpeter during this episode by texting "POVZ" to 1 (877) 222-1119 to share your POVz! The Conversationalist is a non partisan platform that doesn't affiliate or identify with any viewpoints, beliefs, or opinions that may be featured throughout our content.

A closer look at supernovae as seeds for galactic magnetization by Evangelia Ntormousi et al. on Thursday 24 November Explaining the currently observed magnetic fields in galaxies requires relatively strong seeding in the early Universe. One theory proposes that magnetic fields of the order of $mu$G were expelled by supernova (SN) explosions after primordial, nG or weaker fields were amplified in stellar interiors. In this work, we calculate the maximum magnetic energy that can be injected in the interstellar medium by a stellar cluster of mass $M_{cl}$ based on what is currently known about stellar magnetism. We consider early-type stars and adopt either a Salpeter or a top-heavy IMF. For their magnetic fields, we adopt either a Gaussian or a bimodal distribution. The Gaussian model assumes that all massive stars are magnetized with $10^3 < langle B_* rangle < 10^4$ G, while the bimodal, consistent with observations of Milky Way stars, assumes only 5-10 per cent of OB stars have $10^3 < langle B_* rangle < 10^4$ G, while the rest have $10 < langle B_* rangle < 10^2$ G. We find that the maximum magnetic energy that can be injected by a stellar population is between $10^{-10}-10^{-7}$ times the total SN energy. The highest end of these estimates is about five orders of magnitude lower than what is usually employed in cosmological simulations, where about $10^{-2}$ of the SN energy is injected as magnetic. Pure advection of the stellar magnetic field by SN explosions is a good candidate for seeding a dynamo, but not enough to magnetize galaxies. Assuming SNe as main mechanism for galactic magnetization, the magnetic field cannot exceed an intensity of $10^{-7}$ G in the best-case scenario for a population of $10^{5}$ solar masses in a superbubble of 300 pc radius, while more typical values are between $10^{-10}-10^{-9}$~G. Therefore, other scenarios for galactic magnetization at high redshift need to be explored. arXiv: http://arxiv.org/abs/http://arxiv.org/abs/2211.12355v1

A closer look at supernovae as seeds for galactic magnetization by Evangelia Ntormousi et al. on Wednesday 23 November Explaining the currently observed magnetic fields in galaxies requires relatively strong seeding in the early Universe. One theory proposes that magnetic fields of the order of $mu$G were expelled by supernova (SN) explosions after primordial, nG or weaker fields were amplified in stellar interiors. In this work, we calculate the maximum magnetic energy that can be injected in the interstellar medium by a stellar cluster of mass $M_{cl}$ based on what is currently known about stellar magnetism. We consider early-type stars and adopt either a Salpeter or a top-heavy IMF. For their magnetic fields, we adopt either a Gaussian or a bimodal distribution. The Gaussian model assumes that all massive stars are magnetized with $10^3 < langle B_* rangle < 10^4$ G, while the bimodal, consistent with observations of Milky Way stars, assumes only 5-10 per cent of OB stars have $10^3 < langle B_* rangle < 10^4$ G, while the rest have $10 < langle B_* rangle < 10^2$ G. We find that the maximum magnetic energy that can be injected by a stellar population is between $10^{-10}-10^{-7}$ times the total SN energy. The highest end of these estimates is about five orders of magnitude lower than what is usually employed in cosmological simulations, where about $10^{-2}$ of the SN energy is injected as magnetic. Pure advection of the stellar magnetic field by SN explosions is a good candidate for seeding a dynamo, but not enough to magnetize galaxies. Assuming SNe as main mechanism for galactic magnetization, the magnetic field cannot exceed an intensity of $10^{-7}$ G in the best-case scenario for a population of $10^{5}$ solar masses in a superbubble of 300 pc radius, while more typical values are between $10^{-10}-10^{-9}$~G. Therefore, other scenarios for galactic magnetization at high redshift need to be explored. arXiv: http://arxiv.org/abs/http://arxiv.org/abs/2211.12355v1

A closer look at supernovae as seeds for galactic magnetization by Evangelia Ntormousi et al. on Wednesday 23 November Explaining the currently observed magnetic fields in galaxies requires relatively strong seeding in the early Universe. One theory proposes that magnetic fields of the order of $mu$G were expelled by supernova (SN) explosions after primordial, nG or weaker fields were amplified in stellar interiors. In this work, we calculate the maximum magnetic energy that can be injected in the interstellar medium by a stellar cluster of mass $M_{cl}$ based on what is currently known about stellar magnetism. We consider early-type stars and adopt either a Salpeter or a top-heavy IMF. For their magnetic fields, we adopt either a Gaussian or a bimodal distribution. The Gaussian model assumes that all massive stars are magnetized with $10^3 < langle B_* rangle < 10^4$ G, while the bimodal, consistent with observations of Milky Way stars, assumes only 5-10 per cent of OB stars have $10^3 < langle B_* rangle < 10^4$ G, while the rest have $10 < langle B_* rangle < 10^2$ G. We find that the maximum magnetic energy that can be injected by a stellar population is between $10^{-10}-10^{-7}$ times the total SN energy. The highest end of these estimates is about five orders of magnitude lower than what is usually employed in cosmological simulations, where about $10^{-2}$ of the SN energy is injected as magnetic. Pure advection of the stellar magnetic field by SN explosions is a good candidate for seeding a dynamo, but not enough to magnetize galaxies. Assuming SNe as main mechanism for galactic magnetization, the magnetic field cannot exceed an intensity of $10^{-7}$ G in the best-case scenario for a population of $10^{5}$ solar masses in a superbubble of 300 pc radius, while more typical values are between $10^{-10}-10^{-9}$~G. Therefore, other scenarios for galactic magnetization at high redshift need to be explored. arXiv: http://arxiv.org/abs/http://arxiv.org/abs/2211.12355v1

Heute geht es nach Chile, genauer gesagt: in den Norden Chiles und dort in die Geisterstadt Humberstone. In Humberstone, mitten in der Atacama-Wüste gelegen, wurde einst Salpeter abgebaut. Heute ist die verlassene Stadt eine beliebte Touristen-Attraktion. Was es in Humberstone alles zu entdecken gibt, verrät euch der Journalist und Fotograf Kai Behrmann. Viel Spaß beim Zuhören!

CARMA-NRO Orion Survey: unbiased survey of dense cores and core mass functions in Orion A by Hideaki Takemura et al. on Tuesday 22 November The mass distribution of dense cores is a potential key to understand the process of star formation. Applying dendrogram analysis to the CARMA-NRO Orion C$^{18}$O ($J$=1--0) data, we identify 2342 dense cores, about 22 % of which have virial ratios smaller than 2, and can be classified as gravitationally bound cores. The derived core mass function (CMF) for bound starless cores which are not associate with protostars has a slope similar to Salpeter's initial mass function (IMF) for the mass range above 1 $M_odot$, with a peak at $sim$ 0.1 $M_odot$. We divide the cloud into four parts based on the declination, OMC-1/2/3, OMC-4/5, L1641N/V380 Ori, and L1641C, and derive the CMFs in these regions. We find that starless cores with masses greater than 10 $M_odot$ exist only in OMC-1/2/3, whereas the CMFs in OMC-4/5, L1641N, and L1641C are truncated at around 5--10 $M_odot$. From the number ratio of bound starless cores and Class II objects in each subregion, the lifetime of bound starless cores is estimated to be 5--30 free-fall times, consistent with previous studies for other regions. In addition, we discuss core growth by mass accretion from the surrounding cloud material to explain the coincidence of peak masses between IMFs and CMFs. The mass accretion rate required for doubling the core mass within a core lifetime is larger than that of Bondi-Hoyle accretion by a factor of order 2. This implies that more dynamical accretion processes are required to grow cores. arXiv: http://arxiv.org/abs/http://arxiv.org/abs/2211.10215v2

CARMA-NRO Orion Survey: unbiased survey of dense cores and core mass functions in Orion A by Hideaki Takemura et al. on Monday 21 November The mass distribution of dense cores is a potential key to understand the process of star formation. Applying dendrogram analysis to the CARMA-NRO Orion C$^{18}$O ($J$=1--0) data, we identify 2342 dense cores, about 22 % of which have virial ratios smaller than 2, and can be classified as gravitationally bound cores. The derived core mass function (CMF) for bound starless cores which are not associate with protostars has a slope similar to Salpeter's initial mass function (IMF) for the mass range above 1 $M_odot$, with a peak at $sim$ 0.1 $M_odot$. We divide the cloud into four parts based on the declination, OMC-1/2/3, OMC-4/5, L1641N/V380 Ori, and L1641C, and derive the CMFs in these regions. We find that starless cores with masses greater than 10 $M_odot$ exist only in OMC-1/2/3, whereas the CMFs in OMC-4/5, L1641N, and L1641C are truncated at around 5--10 $M_odot$. From the number ratio of bound starless cores and Class II objects in each subregion, the lifetime of bound starless cores is estimated to be 5--30 free-fall times, consistent with previous studies for other regions. In addition, we discuss core growth by mass accretion from the surrounding cloud material to explain the coincidence of peak masses between IMFs and CMFs. The mass accretion rate required for doubling the core mass within a core lifetime is larger than that of Bondi-Hoyle accretion by a factor of order 2. This implies that more dynamical accretion processes are required to grow cores. arXiv: http://arxiv.org/abs/http://arxiv.org/abs/2211.10215v2

CARMA-NRO Orion Survey: unbiased survey of dense cores and core mass functions in Orion A by Hideaki Takemura et al. on Monday 21 November The mass distribution of dense cores is a potential key to understand the process of star formation. Applying dendrogram analysis to the CARMA-NRO Orion C$^{18}$O ($J$=1--0) data, we identify 2342 dense cores, about 22 % of which have virial ratios smaller than 2, and can be classified as gravitationally bound cores. The derived core mass function (CMF) for bound starless cores which are not associate with protostars has a slope similar to Salpeter's initial mass function (IMF) for the mass range above 1 $M_odot$, with a peak at $sim$ 0.1 $M_odot$. We divide the cloud into four parts based on the declination, OMC-1/2/3, OMC-4/5, L1641N/V380 Ori, and L1641C, and derive the CMFs in these regions. We find that starless cores with masses greater than 10 $M_odot$ exist only in OMC-1/2/3, whereas the CMFs in OMC-4/5, L1641N, and L1641C are truncated at around 5--10 $M_odot$. From the number ratio of bound starless cores and Class II objects in each subregion, the lifetime of bound starless cores is estimated to be 5--30 free-fall times, consistent with previous studies for other regions. In addition, we discuss core growth by mass accretion from the surrounding cloud material to explain the coincidence of peak masses between IMFs and CMFs. The mass accretion rate required for doubling the core mass within a core lifetime is larger than that of Bondi-Hoyle accretion by a factor of order 2. This implies that more dynamical accretion processes are required to grow cores. arXiv: http://arxiv.org/abs/http://arxiv.org/abs/2211.10215v1

This episode is also available as a blog post: https://thecitylife.org/2022/08/13/world-championships-medalists-gotytom-gebreslase-lonah-chemtai-salpeter-and-hellen-obiri-to-join-womens-field-at-2022-tcs-new-york-city-marathon-on-november-6/ --- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app --- Send in a voice message: https://anchor.fm/citylifeorg/message Support this podcast: https://anchor.fm/citylifeorg/support

Die „Peking“: Sie transportierte das „weiße Gold“, war Drehort für Miss Marple. Unser neuer Podcast aus der Reihe „Der Tag, an dem…“. Heute: Der 25. Februar 1911 – der Tag, an dem die „Peking“ vom Stapel lief. Sie ist das neue maritime Wahrzeichen Hamburgs, der sprichwörtliche „Hamborger Veermaster“, einer der legendären Flying P-Liner: die „Peking“. Vor 111 Jahren wurde die Viermastbark in Dienst gestellt, um das „weiße Gold“ Südamerikas nach Europa zu holen. Salpeter! Ein Stoff, der so wertvoll war, weil er sich erstens perfekt als Dünger eignete und zweitens auch noch gebraucht wurde, um Sprengstoff zu produzieren. Ohne den Salpeterboom wären weder die „Peking“ noch eins ihrer vielen Schwesternschiffe je gebaut wurde. Wieso die Reederei F. Laeisz das Schiff dann 1932 plötzlich nach England verkaufte und wie es kam, dass es als Kulisse für einen Miss-Marple-Film mit Margarete Rutherford diente – darüber und über noch viel mehr unterhalten sich in unserem Podcast Matthias Lorenz-Meyer und MOPO-Chefreporter Olaf Wunder.

Talking with Nate Salpeter and Cameron Mills, new owners of the Penn Yan Diner. --- Send in a voice message: https://anchor.fm/phillip-rahr/message Support this podcast: https://anchor.fm/phillip-rahr/support

Garrett Salpeter is using direct electrical stimulation to help recovery, chronic pain and maximizing workout results. Find out more about the Neubie here Watch the testimonial of Amy, who went from paralyzed from the waist down...to walking with a walker!!! In this episode we cover: •Mimicking hundreds and hundreds of repetitions of muscle contractions. •From wheelchair for 25 years to a walker for one user •Repair injuries faster through the Central Nervous System •Using the body's software to recover, heal and build through direct current •Demystifying the common held beliefs about injuries and how your body protects itself. •Training more effectively during injury recovery •How the Neubie identifies the root cause of ongoing injury or discomfort. •Addressing the criticisms of the tech •Which biohacking equipment work well in tandem with Neubie •Amy goes from paralyzed to walking...

Garrett Salpeter, Founder and CEO of Neufit shares a new technology used in healing.     Garrett Salpeter, Founder and CEO Engineer & Neuroscientist Started NeuFit in 2009 Creator of The NEUBIE device Owner of multiple US Patents Proud Husband & Father of 2 beautiful girls Always pushing the limits of human recovery and performance Former College Hockey Player Resources: neu.fitThe Neufit Method Book on Amazon The Neufit Under Current Podcast Neufit YouTube Channel The Cox 8 Table by Haven Medical thebackdoctorspodcast.com  

On This Episode We Have Kelly Salpeter A TikTok Content Creator With Over 1.1 Million. Today She Will Be Sharing What It Is Like Being A TikTok Creator, Her TikTok Journey and Much More. Check Out Reyes Socials Below Instagram: https://www.instagram.com/kellysalpeter/ TikTok: https://www.tiktok.com/@kellysalpeter?lang=en --- Support this podcast: https://podcasters.spotify.com/pod/show/jonathan-ascencio5/support

Nate Salpeter, entrepreneur and founder from Sweet Farm and Sno.llc, joins Shely to talk about how agtech can transform the future of agriculture and food to help feed the world's growing population while reducing the impacts of industrialized farming on animals and plants.  

Gabriela Borrelli #Segurola con Julia Mengolini, Fito Mendonca Paz y gran equipo por Futurock.FM

Verified TikTok star Kelly Salpeter joins us for a tell all interview! She talks all things Tiki's Tok and life in general and gives tips and secrets how to grow and what it takes to make a career off of being a creator. --- Support this podcast: https://podcasters.spotify.com/pod/show/glimpseofreality/support

In this episode, Brian sits down with Nate Salpeter to discuss the process of starting a farm. From welcoming the very first rescue animals to harvesting the very first seeds, Nate takes us along the journey of how he established his very own agricultural sanctuary and how you can too.For show notes and past guests, please visit www.reducetarian.org/podcast.  Follow Reducetarian: Twitter: twitter.com/reducetarian Instagram: instagram.com/reducetarian Facebook: facebook.com/reducetarian LinkedIn: linkedin.com/company/reducetarian-foundation

In dieser Episode geht es um Stickstoff, Guano und Salpeter.

"We kept going through this logical exercise of how do we help more and more animals. And every single time the logical end point was - it's not dogs and cats, it's animals in the food system. It’s not a matter of tens of millions of animals. It's a matter of tens of billions of animals and hundreds of billions of fish." - Nate Salpeter What do you get when two tech geniuses start an animal sanctuary? The first non-profit sanctuary in the world to address the global impacts of factory farming across animals, the plants and the planet. Nate Salpeter and Anna Sweet are the founders of Sweet Farm, an animal sanctuary in Half Moon Bay, California, that links veganic agriculture, farm-animal rescue, and technology that is revolutionizing food and agriculture production. The technology initiatives that are happening at Sweet Farm are going to change the way that we eat forever. It’s the future of food. Everything that is going on at Sweet Farm is pretty astounding, but not terribly surprising when you learn that by day, Nate is a nuclear engineer and Anna is a computer scientist and the CEO of Bad Robot, JJ Abrams gaming company. Sweet Farm is also the home of Goat-2-Meeting, which Nate and Anna started when the sanctuary had to close to visitors because of the pandemic. Instead of going in person, people can invite the farm animals into their video conferences. Llamas, goats, cows, and others are still making appearances at meetings all over the planet.

Dagens begrepp:Salpetersjudare, golem, maja, humoralpatologi.Kontakt:historielingo@gmail.comInstagram: historielingo See acast.com/privacy for privacy and opt-out information.

In this second part of the Abnormal Liver Function Test podcast series, Dr. Tara McMichael continues her discussion and case presentation around abnormal liver function tests. Enjoy the second part of the "Abnormal Liver Function Test" podcast! Objectives:     Upon completion of this podcast, participants should be able to: Identify the appropriate next steps when discovering abnormal liver function tests. Identify how to diagnose cirrhosis, autoimmune hepatitis, and cholecystitis. Address appropriate 2nd and 3rd line testing for abnormal LFTs. CME credit is only offered to Ridgeview Providers for this podcast activity. Complete and submit the online evaluation form, after viewing the activity.  Upon successful completion of the evaluation, you will be e-mailed a certificate of completion within 2 weeks.  You may contact the accredited provider with questions regarding this program at  rmccredentialing@ridgeviewmedical.org. Click on the following link for your CME credit: CME Evaluation: "Abnormal Liver Function Tests (LFTs) - Part 2" (**If you are listening to the podcasts through iTunes on your laptop or desktop, it is not possible to link directly with the CME Evaluation for unclear reasons. We are trying to remedy this. You can, however, link to the survey through the Podcasts app on your Apple and other smart devices, as well as through Spotify, Stitcher and other podcast directory apps and on your computer browser at these websites. We apologize for the inconvenience.)  The information provided through this and all Ridgeview podcasts as well as any and all accompanying files, images, videos and documents is/are for CME/CE and other institutional learning and communication purposes only and is/are not meant to substitute for the independent medical judgment of a physician, healthcare provider or other healthcare personnel relative to diagnostic and treatment options of a specific patient's medical condition.”    FACULTY DISCLOSURE ANNOUNCEMENT  It is our intent that any potential conflict should be identified openly so that the listeners may form their own judgments about the presentation with the full disclosure of the facts. It is not assumed any potential conflicts will have an adverse impact on these presentations. It remains for the audience to determine whether the speaker’s outside interest may reflect a possible bias, either the exposition or the conclusions presented. Planning committee members and presenter(s) have disclosed they have no significant financial relationship with a pharmaceutical company and have disclosed that no conflict of interest exists with the presentation/educational event. SHOW NOTES: PART-2:   CASE 2: 69 yo female with 2 days of low back pain. Also some dark urine for about a week. She has some fatigue as well. No jaundice or bowel changes. She's not much of a drinker, minimal wine. PMH incudes obesity, hyperlipidemia and a prediabetic state. She take vitamins, calcium and glucosamine. No drugs and no significant family history. She's had about a 10 lb unintential weight loss. Also some early satiety. Her BMI is 32, but otherwise her VS and entire exam is normal. Additionally, she's been taking aspirin for her back pain. Laboratory eval reveals AST of 767,  ALT 818, and ALP 173. These are all modestly to significantly elevated. The AST and ALT are over 4 times upper limit of normal. Basically she's not really ill appearing at this point. Differential diagnosis at this point includes acute viral hepatitis. We must consider testing for A, B, C as well as EBV and CMV. These are IgM and IgG studies typically. Billiary obstruction and cirrhosis seems less likely in this case. Also not likely ETOH related. NASH is a possibility. We should also review her meds as a potential cause. Was she actually taking aspirin, or is she just calling it aspirin. Let's not forget some of the less common diseases like autoimmune hepatitis, Wilson's hemochromatosis and other rare infections. Right-sided heart failure may be an option. Hepatitis serologies, EBV, CMV, Tylenol level, iron and copper levels, ESR as well as PT/INR would be appropriate. CRP was a bit elevated at 11. Gamma globulins are obtained and noted to be elevated. The rest of the labs were all normal as well. A liver ultrasound reveals no abnormalities. A GI consult was obtained and it was felt this is a case of autoimmune hepatitis. Typically this is a dx of exclusion, and now that we've excluded a lot, we will shift to various autoimmune tests. ANA. This may be positive, however there are more specific tests for this condition, such as anti-smooth muscle, antimitochondrial, and anti liver-kidney microsomal antibodies, and various other antibody tests. Gamma globulins are also often elevated in AIH What is this condition? We don't fully know. There are several types of autoimmune hepatitis, however type-1 is the most common. It is actually not an entirely uncommon disease with a prevalence in Europe of 11 to 25 per 100,000. In the U.S., there is no exact data. One could infer that it would be similar. Ultimately, the body is attacking the liver for unclear reasons. Concurrent autoimmune thyroiditis can accompany this. A known hx of inflammatory bowel dz can predispose to this condition. Typically AST and ALT are 10-20 times upper limits of normal, usually therefore much higher than cirrhosis. Imaging is usually normal, unless the disease has advanced by the time diagnosis is made. Remission is not uncommon, upwards of 50 to 60%. Corticosteroids and azathioprine are common medications given for this. These can be tapered, and LFTs are rechecked on a regular basis throughout the taper and discontinuation of the medications. Sometimes, stronger immunosuppressants are needed. GI at minimum but sometimes hepatology referral is warranted for this diagnosis. Liver biopsy is often done for this condition. And indeed was on this patient which showed findings consistent with autoimmune hepatitis. Often, a degree of fibrosis is seen in AH. Well people, that's a wrap. for autoimmune hepatitis. Stay tuned for the final case presentation in the next segment, coming up shortly with Dr. McMichael here on Ridgeview Podcast CME series. CASE 3: So, the final caser is an 80 yo male with fever and confusion. He's high functioning at baseline, lives alone at home. He called his daughter and she noted he wasn't "acting himself". Altered mental status can be caused by many things, as we know. The differential diagnosis includes infection, hypoxia, metabolic derangement, toxin related, dementia, CNS lesions and so many more! This guy has a hx of CLL and type 2 DM, as well as HTN and BPH. Not a big drinker, about 1 to 2 beverages per day. He has a fever of 100.8. VS are normal otherwise. He's uncomfortable and restless appearing. Alert and oriented to person. Sepsis now is a big concern. What's causing it? He still has a gallbladder, but we need to know some more about his exam reveals not much more, other than tenderness in the epigastric and LUQ areas of the abdomen. Preliminary labs include normal UA, EBC 35.8, but remember the cLL hx. BMP unremarkable but a little dry with BUN 32. ALP is 256. AST and ALT are just bumped over normal. Lipase and trop are normal. Total bili is normal. So probable not ascending cholangitis. CXR was normal. So prompted a CT abdomen to rule out abdominal pathology. This revealed cholelithiasis. Compared to ultrasound, CT is not as helpful in terms of ruling out biliary obstruction, although often we will see pericholecystic inflammation. For cases of acute cholecystitis (AC), CT scan findings include the following: gallstones within the gallbladder (GB), the cystic duct, or both; more than 3mm of focal or diffuse thickening of the GB wall in a non-contracted GB; indistinct liver-GB interface; fluid in the GB fossa in the absence of ascites, enlargement of the GB, with the transverse diameter measuring more than 5 cm; infiltration of the surrounding fat; increased bile attenuation, caused by biliary sludge; and GB mucosal sloughing. At the same time, ultrasound is the gold standard. So this was done, and antibiotics were ordered. There is a non-mobile gallstone in the gallbladder neck. The CBD also has a small distal stone. He was admitted, taken to surgery for lap cholecystectomy and cholangiogram which confirmed the distal CBD stone. He was taken for ERCP and stenting the next day. In cholestatic presentations, the ALP is usually higher than AST and ALT. Serum bilirubin is not as helpful in delineating hepatocellular vs cholestatic picture. The Tokyo guidelines? Not widely used at this point. They're used to grade who needs to go to surgery first. In general, it's recommended to follow the American Anesthesiology guidelines for physical status. There are several grading systems, but there is little banter about this when it comes down to the decision to go to surgery or not. According to a paper in 2017 in the American Journal of Surgery by Madni et al, "Most grading scales which have been developed are used to predict the risk of conversion to an open cholecystectomy. There is a paucity in the literature of scoring systems to predict other metrics such as hospital length of stay, iatrogenic injury, and total operative time." HIDA scan can be done if there is no obvious stone, and whether you think this is truly gallbladder dysfunction and the patient should go to surgery, according to the World Society of Emergency Surgery Guidelines. Now, if this were a woman child-bearing age, while there could be a gallbladder etiology, always be sure to check a pregnancy test. HELLP syndrome must be considered. Fitz Hugh Curtis syndrome should also be considered in sexually active women with abdominal pain and elevated LFTs. Remember, especially in patients with altered mental status to keep your net cast wide. Our elderly patients are notorious for unusual presentations of common disease. Just a fair warning. A special thanks to Dr. McMichael for joining us and sharing these cases today. Have a great month everyone and we'll see you soon. REFERENCES:1. D'Amico et al. J Hepatology, 2006, Natural History and Prognostic Indicators in Cirrhosis: A systematic review 2. Salpeter et al. Am J Med. 2012. Systematic Review of Noncancer Presentations with a median survival of  months or less. 3. Wond et al, Gastroenterology, 2015. Nonalcoholic Steatohepatitis is the second leading cause of liver disease in adults awaiting liver transplantation in the United States.

Dopo la pausa estiva ritorna la nostra rubrica domenicale L'Atletica Internazionale, in compagnia di Alberto Stretti. Questo fine settimana a Vienna si è svolto un test di INEOS 1:59, quella che sarà una impresa storica, il prossimo 12 ottobre, con Eliud Kipchoge protagonista. Il norvegese Sondre Moen ha corso i 10.000mt. in pista in 27'24'', stabilendo il nuovo record nazionale e facendo il minimo per i mondiali di Doha e prossime Olimpiadi. A Tilburg in Olanda, sui 10km su sstrada, l'israeliana Lonah Salpeter vince con 30.05, nuovo record europeo, secondo miglior tempo di sempre e miglior prestazione dell anno. E per concludere, l'atleta tedesca Gesa Krause ha stabilito il nuovo record mondiale sui 2000siepi in pista, 5.52.80. --- Send in a voice message: https://anchor.fm/giovanni-certom/message

Wir springen etwa 100 Jahre zurück und beschäftigen uns mit Chemiegeschichte: Es geht um Salpeter. Ein Stoff, Kaliumnitrat, von dem Europa im 19. Jahrhundert abhängig war, denn er war Hauptbestandteil von Schießpulver und Basis von Düngemittel für die Landwirtschaft. Mitte des 19. Jahrhunderts begann dann der industrielle Abbau von Salpeter. Nach dem Salpeterkrieg, ab 1884, sicherte sich Chile praktisch das Monopol auf den Handel mit Salpeter, das vor allem in der Atacama-Wüste abgebaut wurde. Doch der Boom währte nur kurz: Mit dem Haber-Bosch-Verfahren stand bald eine Alternative bereit, die dazu führte, dass der Handel mit Salpeter in den 1920er Jahren zusammenbrach und die vielen Fabriken in der Atacama-Wüste zu Geisterstädten wurden – die heute Teil des UNESCO Weltkultur-Erbes sind.

Und er sagt ihr, "Womit soll ich anfangen, antworte mir, ich werde Brot kaufen, eine Wohnung mieten… Bleib mich nicht allein erwachsen, es ist schlechter als Hölle. Ich spiele Blues und trage Ohrring, ich weiß nicht was ich für dich machen kann, aber es ist ist mir garstig an Dich verschuldet zu sein, und Du freust Dich auch nicht Er sagt ihr, ich hab niemanden hereingerufen, ich hab Bühne und Bahnhof, aber jetzt hab ich derselben Licht gesehen und befühlt, anscheinend. Im Gibtrag hab ich 5 Rubel, ich schlafe nie ohne Attacken. Aber Du siehst an mich SO, und meine Haut wällt auf. Ich war ein Kind, ich lebte leichtblütig, ich bin nicht dieser, der bis zu blauen Adern strampelt. Ich hab Dich vielleicht nicht verernt, aber wer ist Arbiter. Ich pennte bei verschiedenen, und spielte sehr viel. Und hab mich erfrecht, zu Dir zu kommen. Und rauche viel, aber es schmeckt wie Salpeter. In sieben Jahre des Gestankes und Bars sterbe ich, werde einen kahlköpfigen Bulle. Werde dicke Flanken haben, schmutzig bewitzeln, belehren und ächzen. Aber jetzt bin ich lebendig und Dein, ich rieche nach Rauch, Salz und feuchtes Blätterwerk. Peter Pan, Hänsel, Butzemann. Lass mich nicht solchen Weg wählen, wo es nur Sehnsucht und Lust gibt". Und sie sagt ihm. "Und im Wald, beim Romen mit engem Ring in der Nase, ich rette DIch von der Zeit nicht - wir treffen sie dort zusammen. Ich kann trauen und umarmen, aber ich werde Dich nicht wie Mutter sorgen, beschönigen, anheben - ich bin nicht dazu gekommen. Wie alle Kinder, die ohne Väter erwachsen sind, wollen wir Spielsachen und Bonbons, ziehen sehr feierlch an, damit niemand Schramme sieht. Aber es gibt keinen solchen Weg in der Welt, wo wir alle immer jünger als zwanzig sind, und alles was wir machen müssen ist erfreuen und blühen wie es ist immer am Anfang. Wenn das Licht bricht, und das Ende kommt, Du brauchst einen Mann, nicht den Jungen Kai. Entwöhn Dich, meine Güte, mutlos zurück zu gehen. Es gibt Bahnhof und Bühne, aber es gibt auch der Wohnraum, und Schicksal nimmt gewöhnlich was ihr gehört. Und von solchen, die davon rennen, nur ein bisschen grober". Und sie stehen in Stille, sind mit diesem neuen Sinn der Stille eingeschlossen, und alle Wolken auch kann man hören - sie bleiben, rennen nicht. Wie lebendige Steine stehen sie zusammen, und die Erde steht im Juli, blau und nackt. Wera Polozkowa, Übersetzung vom Russischen Musik: New Ones - Road 80s Instagram: russischpur

One of the stress points when a patient taking chronic opioids presents with acute pain is that we feel we have little to offer them. Are more opioids the answer? That's often what happens, but might not be the best next step. In this episode, Reuben Strayer presents the argument in favor of haloperidol for analgesia and why more opioids can do more harm than good.    Episode Guide In the introduction, preview of a project we're working on for Essentials of Emergency Medicine (May 15-17). Opioid induced hyperalgesia: compared to those not taking opioids, patients on chronic opioids may have a more unpleasant experience when exposed to painful stimuli. In other words, they are more sensitive pain. The meds used to treat pain, actually worsen pain. A patient who uses chronic opioids will have marginal gains in analgesia with escalating doses while getting closer to potentially lethal adverse effects. Haloperidol is an analgesic option for patients taking chronic opioids. Reuben's strategy for using haloperidol for analgesia in chronic opioid patients: 10 mg IM haloperidol if there is no IV,  5 mg IV if they have a line. If they don't fall asleep shortly after (or have improvement of pain) he repeats the dose.  If that doesn’t work, he uses analgesic dose ketamine. For analgesic dose ketamine in these patients, Reuben uses 30 mg IV. This may cross over into the 'recreational' or 'partial dissociation' dose where the patient can have disturbing psycho-perceptual effects. He has found that the pretreatment with haloperidol leads to less distress from these psycho-perceptual effects. For more information on ketamine dosing, see Reuben's post on the Ketamine Brain Continuum. Haloperidol and the prolonged QTc: Butyrophenones (of which haloperidol is one) are known to prolong the QTc. Should we get an EKG prior to giving haloperidol to see if the QTc is already prolonged? Reuben feels that the negative effects of butyrophenone QTc prolongation are overblown and does not routinely get an EKG prior to giving haloperidol. This includes initial and subsequent doses.  Take that with a grain of salt because there are many docs who do get an EKG before the first or second dose of haloperidol, especially if there is a known QTc prolonging drug on the patient's med list (like methadone). Some hospitals even have policies that before a second dose is given, there is a hard stop for EKG and QTc check. Check out Reuben's blog Emergency Medicine Updates and follow him on Twitter   References Opioid Hyperalgesia Marion Lee, M., et al. "A comprehensive review of opioid-induced hyperalgesia." Pain physician 14 (2011): 145-161 Full text link. PMID: 21412369  Hooten, W. Michael, et al. "Associations between heat pain perception and opioid dose among patients with chronic pain undergoing opioid tapering." Pain Medicine 11.11 (2010): 1587-1598 Full text link.  PMID: 21029354 Droperidol for analgesia Richards, John R., et al. "Droperidol analgesia for opioid-tolerant patients." Journal of Emergency Medicine 41.4 (2011): 389-396.  PMID: 20832967 Amery, W. K., et al. "Peroral management of chronic pain by means of bezitramide (R 4845), a long-acting analgesic, and droperidol (R 4749), a neuroleptic. A multicentric pilot-study." Arzneimittel-Forschung 21.6 (1971): 868. PMID: 5109279 Admiraal, P. V., H. Knape, and C. Zegveld. "EXPERIENCE WITH BEZITRAMIDE AND DROPERIDOL EN THE TREATMENT OF SEVERE CHRONIC PAIN." British journal of anaesthesia 44.11 (1972): 1191-1196. PMID: 4119073 Early studies on Haloperidol for analgesia Maltbie, A. A., et al. "Analgesia and haloperidol: a hypothesis." The Journal of clinical psychiatry 40.7 (1979): 323-326. PMID: 222741 Cavenar, Jo, and A. A. Maltbie. "The analgesic properties of haloperidol." US Navy Med 67 (1976): 10. Cavenar, Jesse O., and Allan A. Maltebie. "Another indication for haloperidol." Psychosomatics 17.3 (1976): 128-130. Haloperidol for pain Seidel, Stefan, et al. "Antipsychotics for acute and chronic pain in adults." Cochrane Database Syst Rev 4 (2008). PMID: 18843669 Ramirez, R., et al. “Haloperidol undermining gastroparesis symptoms (HUGS) in the emergency department.” The American journal of emergency medicine (2017). PMID:28320545 Reviewed in this ERCast episode Salpeter, Shelley R., Jacob S. Buckley, and Eduardo Bruera. "The use of very-low-dose methadone for palliative pain control and the prevention of opioid hyperalgesia." Journal of palliative medicine 16.6 (2013): 616-622. PMID: 23556990 Afzalimoghaddam, Mohammad, et al. "Midazolam Plus Haloperidol as Adjuvant Analgesics to Morphine in Opium Dependent Patients: A Randomized Clinical Trial." Current drug abuse reviews 9.2 (2016): 142-147. PMID: 28059034

In this dissertation we study the properties of high-mass X-ray binaries (HMXBs) and hot inter-stellar medium in star-forming galaxies and their relation with the star formation rate (SFR), based on the data from Chandra, Spitzer, GALEX and 2MASS public archives. We constructed a large sample of galaxies for which we collected homogeneous sets of multiwavelength measurements in X-ray, ultraviolet (UV), far-infrared (FIR) and near-infrared (NIR) bands. The sample includes 45 star-forming galaxies in total, divided in two sub-samples: the primary sample, consisting of 29 nearby galaxies, having distance < 40 Mpc, so that Chandra can resolve their X-ray point-like source population; the high-SFR sample, including 16 more distant galaxies that allowed us to extend the dynamical range of SFRs by approximately two orders of magnitude. In this sample we detected 1057 compact X-ray sources, of which ~300 are expected to be background active galactic nuclei (AGN). The majority of remaining ~700 sources are young systems associated with star-formation in the host galaxy. Based on their high X-ray luminosities and analogy with the X-ray populations in the Milky Way and few other very nearby galaxies, we conclude that they are high-mass X-ray binaries, powered by accretion of matter from a massive donor star onto a compact object - a black hole or a neutron star. Such a large number of sources allowed us to perform the most detailed study of the population of HMXBs and its dependence on various properties of the host galaxy, as well as to obtain a very accurate calibration of the X-ray luminosity-SFR relation. The study of the population of HMXBs is based on their X-ray luminosity functions (XLF). To this end, we took a special care to minimize the contamination by LMXBs, background AGN and to control the incompleteness of the Chandra source lists. The shape of the HMXB luminosity function is similar in different galaxies with the power law indexes having rms=0.25 with respect to the average value of ~1.6. The XLF normalizations, on the contrary, show significantly larger dispersion with the rms=0.34 dex around the A-SFR law. Combining the data of all galaxies, which include ~700 X-ray sources, we produced the average XLF of high-mass X-ray binaries in nearby star-forming galaxies. Its statistical accuracy exceeds by far that achieved in any of the previous studies of the HMXB luminosity function. The HMXB XLF has a single power law shape in a broad luminosity range of logLx~35-40 and shows a moderately significant evidence for the high luminosity break or cut-off at logLx~40. We did not find any statistically significant features at the Eddington luminosity limits of neutron stars or a 10 Msun black hole. With the knowledge of the relation between the number of high-mass X-ray binaries and star formation rate of the host galaxy, we estimated that the fraction of compact objects that went through an X-ray active phase at least once in their lifetime, powered by accretion of matter from a massive donor star in a binary system is fx~0.2. This constrains the mass distribution of the secondary in massive binaries. For an independent mass distribution of the secondary, the power law index must be flatter than 0.3. In particular, an independent mass distribution of a Kroupa or Salpeter type is strongly excluded. Assuming that the masses of components in a binary are not independent, our results are consistent with the flat mass ratio distribution. For comparison, we obtained a similar estimate for the fraction of compact objects that become X-ray sources powered by accretion from a low-mass donor star in an LMXB. Based on the scaling-laws by Gilfanov (2004), the fraction of compact objects, X-ray active in LMXBs, is small, fx~1e-6, demonstrating that LMXBs are extremely rare objects. This result is in line with the conclusions of the binary population studies. The collective luminosity of high-mass X-ray binaries is a good tracer of the recent star formation activity in the host galaxy: L_XRB(0.5-8 keV)(erg/s) = 2.5 10^{39} SFR (Msun/yr) The rms of points around this relation is 0.4 dex. The observed dispersion is unlikely to be caused by any of the obvious contaminating factors such as CXB or LMXB sources and is likely to have a physical origin. In addition to the emission from XRB population, the X-ray emission from star-forming galaxies includes a hot diffuse gas component with a mean characteristic temperature of 2-3 10^{6} K. We show that its X-ray luminosity correlates with the star formation rate of the host galaxy. Finally we demonstrate that the total X-ray luminosity of a galaxy scales with the star formation rate: L_tot(0.5-8 keV)(erg/s) = 4.5 10^{39} SFR(Msun/yr) with a dispersion sigma = 0.32 dex. We obtained consistent scale factors for nearby galaxies from the resolved sample and galaxies from the high-SFR sample. Among the latter (eight out of 16) are Chandra Deep Field North galaxies, located at the red-shifts of z~0.2-1.3. This proves that the total X-ray luminosity of a galaxy is a powerful tool to measure the star formation rate in distant galaxies.

We study the initial mass function (IMF) of NGC 3603, one of the most massive galactic star-forming regions, to answer a fundamental question in current astrophysics - is the IMF universal, or does it vary? Using our very deep high angular resolution images obtained with the NAOS-CONICA adaptive optics system at the VLT/ESO, we have successfully revealed the low-mass stellar population in the cluster core down to about 0.4 Msun (50 % completeness limit). Based on the JHKsL' color-magnitude and color-color diagrams, we first derive an average age 0.7 Myr for the pre-main sequence stars, and an upper limit of ~2.5 Myr for the main sequence stars. We find an average foreground extinction of Av = 4.5 +- 0.5 mag, with a radial increase of Delta_Av ~ 2.0 mag towards larger radii (r < 50''). From the infrared excess emission identified in the Ks - L' vs J - H color-color diagram, we measure a disk fraction of ~25 % for stars with M > 0.9 Msun in the cluster center (r < 10''). Applying a field star rejection and correcting for incompleteness, we derive the Ks-band luminosity function (LF) for stars simultaneously detected in the JHKs-bands. The LF follows a power-law with an index of alpha ~ 0.27, and shows no turnover or truncation within the detection limit. The IMF for stars within r < 110'' is reasonably fitted by a single power-law with index Gamma ~ -0.74 in the mass range of $0.4 - 20 Msun. This is substantially flatter than the Salpeter-like IMF (Gamma = -1.35). The IMF power-law index decreases from Gamma ~ -0.31 at r < 5'' to Gamma ~ -0.86 at 30'' < r < 110''. This radial steepening of the IMF mainly occurs in the inner r < 30'' field, indicating mass segregation at the very center of the starburst cluster. Analyzing the radial mass density profile, we derive a cluster core radius of ~4''.8 (~0.14 pc), and a lower limit of ~110'' (~3.2 pc) for the cluster size. We also derive an upper limit of r ~ 1260'' (~37 pc) for the cluster size adopting an estimate of the tidal radius of the cluster. Based on the de-projected stellar density distribution, we estimate the total mass and the half-mass radius of NGC 3603 to be about 1.0 - 1.6 x 10^4 Msun and 25'' - 50'' (~0.7 - 1.5 pc), respectively. The derived core radius is > 6 x 10^4 Msun pc^-3. The estimate of the half-mass relaxation time for stars with a typical mass of 1 Msun is 10 - 40 Myr, suggesting that the intermediate- and low-mass stars have not yet been affected significantly by the dynamical relaxation in the cluster. The relaxation time for the high-mass stars is expected to be much smaller, and is comparable to the age of the cluster. We can thus not conclude if the mass segregation of the high-mass stars is primordial or caused by dynamical evolution. Our observation covers at least ~67 % of intermediate- and low-mass stars in NGC 3603, and the stars residing outside the observed field can merely steepen the IMF by Delta_Gamma < 0.16. Therefore, because of the almost constant IMF beyond a radius r > 30'', we are confident that our IMF adequately describes the whole NGC 3603 starburst cluster. We also thoroughly analyze the systematic uncertainties in our IMF determination. We conclude that the power-law index of NGC 3603 including the systematic uncertainties is Gamma = -0.74^{+0.62}_{-0.47}. Our result thus supports the hypothesis of a top-heavy IMF in starbursts, especially in combination with other studies of similar clusters such as the Arches cluster and the Galactic Center cluster.