Podcasts about Stratification

CardioNerds (Dr. Billy-Joe Mullinax, Dr. Dinu Balanescu, and Dr. Jane Ehret) discuss risk stratification in acute pulmonary embolism with Dr. Stavros Konstantinides, Chair of the 2019 ESC Pulmonary Embolism Guidelines. Using a real-world case, this episode explores how modern PE care has moved beyond “massive” and “submassive” labels toward a dynamic, physiology-based approach. The discussion highlights the limitations of static risk scores, the importance of right ventricular dysfunction and biomarkers, and why normotension does not imply stability. Special emphasis is placed on intermediate-high risk PE, early identification of impending hemodynamic collapse, and the role of lactate, serial reassessment, and PERT teams in guiding escalation of care. Audio editing by CardioNerds intern, Joshua Khorsandi.The 2026 American multi-society PE guidelines were published after this episode was recorded. Dr. Dinu Balanescu and Dr. Billy-Joe Mullinax are Co-chairs for the CardioNerds PE Series, developed in collaboration with the PERT Consortium.   Enjoy this Circulation 2022 Paths to Discovery article to learn about the CardioNerds story, mission, and values. CardioNerds Pulmonary Embolism PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Pearls Stable blood pressure does not mean low risk in PEHypotension is a late finding. Patients may have severe RV failure, hypoxia, and tissue hypoperfusion while remaining normotensive — a key concept behind “normotensive shock.” Risk stratification in PE must be dynamic, not staticLegacy scores like PESI and Bova provide a snapshot and predict 30-day mortality, but they do not capture short-term trajectory or impending hemodynamic collapse. Intermediate-high risk PE is a dangerous and heterogeneous groupPatients with RV dysfunction, positive biomarkers, tachycardia, hypoxemia, and elevated lactate may have in-hospital mortality approaching 15%, rivaling STEMI. Lactate is a critical but underutilized marker in PEElevated lactate reflects tissue hypoxia and early circulatory failure and may identify patients at risk for collapse before blood pressure declines. PERT enables physiology-driven, patient-centered PE carePERT teams operationalize continuous reassessment, integrate imaging, labs, and clinical trajectory, and allow timely escalation — shifting PE management from rigid categories to real-time decision-making. Notes Drafted by Dr. Jane Ehret. 1. What is the contemporary framework for risk stratification in acute pulmonary embolism? Modern PE risk stratification prioritizes hemodynamics and right ventricular (RV) function rather than clot burden. The 2019 ESC Guidelines classify PE into high risk, intermediate risk (low vs high), and low risk, based on: Hemodynamic status, RV dysfunction on imaging, and Cardiac biomarkers. This framework emphasizes early mortality risk but requires clinical context to guide escalation decisions. 2. Why is normotension insufficient to define “stability” in PE? Blood pressure is a late marker of circulatory failure in PE. Patients can maintain normal BP through Tachycardia, Increased sympathetic tone, and RV compensation. Many patients with preserved BP may already have shock physiology, including hypoxemia, elevated lactate, and RV failure — sometimes referred to as “normotensive shock.” 3. How should intermediate-risk PE be conceptualized clinically? Intermediate-risk PE is heterogeneous, ranging from patients who do well on anticoagulation to those who deteriorate rapidly. Intermediate-high risk PE is defined by RV dysfunction on imaging and positive cardiac biomarkers. Clinical features such as tachycardia, increasing oxygen requirement, and elevated lactate identify patients at highest risk within this group. 4. What are the strengths and limitations of commonly used PE risk scores? Legacy scores are useful for initial risk categorization but are static and limited in predicting short-term deterioration. Most scores were developed to predict mortality or complications at fixed time points rather than dynamic clinical trajectory. 5. What are the commonly used risk scores and clinical tools in PE, and what is each designed to predict? ESC Risk Stratification Algorithm: Identifies high-risk PE by hemodynamics. Uses PESI or sPESI in normotensive patients to distinguish low-risk from non–low-risk PE. Uses RV dysfunction and biomarkers to differentiate intermediate-low from intermediate-high risk. Forms the basis of many institutional PE pathways. PESI and sPESI: Validated to predict 30-day mortality. Widely used to identify low-risk patients appropriate for outpatient management. Heavily influenced by age and comorbidities. Bova Score: Predicts 30-day PE-related complications in normotensive patients. Composite PE Shock Score (CPES): Predicts normotensive shock in hemodynamically stable PE patients. Pulmonary Embolism Progression (PEP) Score: Predicts progression from intermediate-risk to high-risk PE within 72 hours of diagnosis. PE Short-term Clinical Outcomes Risk Estimation (PE-SCORE): Predicts clinical deterioration or death within 5 days of PE diagnosis. Hestia Criteria: Identifies low-risk PE patients safe for outpatient treatment. Wells' Criteria and Revised Geneva Score: Determine pretest probability for diagnostic triage. PERC Score: Rules out PE in very low-risk patients. 6. What is the role of biomarkers in PE risk stratification? Troponin and natriuretic peptides reflect RV myocardial injury and strain. Current guidelines treat biomarkers as binary (positive vs negative), despite risk being continuous. Biomarkers are most helpful for: Initial risk classification. They are less useful for: Short-interval monitoring and Detecting rapid clinical deterioration. 7. Why is lactate an important physiologic marker in PE? Lactate reflects global tissue hypoxia and impaired perfusion. Elevated lactate may identify patients with: Early circulatory failure and Increased risk of imminent hemodynamic collapse. Lactate is not currently included in ESC risk algorithms but may add important prognostic information in intermediate-risk patients. 8. How does trajectory influence decision-making in PE management? Risk stratification should be viewed as a dynamic process, not a one-time label. Worsening clinical trajectory may include: Rising heart rate, Increasing oxygen needs, Rising lactate, and Progressive RV dysfunction. Serial reassessment is essential for timely escalation of care. 9. What role do Pulmonary Embolism Response Teams (PERT) play in risk stratification? PERT facilitates: Multidisciplinary decision-making and Integration of imaging, biomarkers, and clinical physiology. PERT is most valuable for: Intermediate-risk and high-risk PE and Patients with complex comorbidities or uncertain trajectory. PERT enables a shift from category-based to physiology-driven PE care. References 1. Konstantinides SV, Meyer G, Becattini C, et al. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS): The Task Force for the diagnosis and management of acute pulmonary embolism of the European Society of Cardiology (ESC). Eur Respir J. 2019;54(3):1901647. Published 2019 Oct 9. doi:10.1183/13993003.01647-2019 2. Leidi A, Bex S, Righini M, Berner A, Grosgurin O, Marti C. Risk Stratification in Patients with Acute Pulmonary Embolism: Current Evidence and Perspectives. J Clin Med. 2022;11(9):2533. Published 2022 Apr 30. doi:10.3390/jcm11092533 3. Choi WH, Kwon SU, Jwa YJ, et al. The pulmonary embolism severity index in predicting the prognosis of patients with pulmonary embolism. Korean J Intern Med. 2009;24(2):123-127. doi:10.3904/kjim.2009.24.2.123 4. Jiménez D, Aujesky D, Moores L, et al. Simplification of the pulmonary embolism severity index for prognostication in patients with acute symptomatic pulmonary embolism. Arch Intern Med. 2010;170(15):1383-1389. doi:10.1001/archinternmed.2010.199 5. Chen X, Shao X, Zhang Y, et al. Assessment of the Bova score for risk stratification of acute normotensive pulmonary embolism: A systematic review and meta-analysis. Thromb Res. 2020;193:99-106. doi:10.1016/j.thromres.2020.05.047 6. Zhang RS, Yuriditsky E, Zhang P, et al. Composite Pulmonary Embolism Shock Score and Risk of Adverse Outcomes in Patients With Pulmonary Embolism. Circ Cardiovasc Interv. 2024;17(8):e014088. doi:10.1161/CIRCINTERVENTIONS.124.014088 7. Zhang RS, Alam U, Sharp ASP, et al. Validating the Composite Pulmonary Embolism Shock Score for Predicting Normotensive Shock in Intermediate-Risk Pulmonary Embolism. Circ Cardiovasc Interv. 2024;17(2):e013399. doi:10.1161/CIRCINTERVENTIONS.123.013399 8. Ehret J, Wakefield D, Badlam J, Antkowiak M, Erdreich B. Development of the Pulmonary Embolism Progression (PEP) score for predicting short-term clinical deterioration in intermediate-risk pulmonary embolism: a single-center retrospective study. J Thromb Thrombolysis. 2025;58(2):243-253. doi:10.1007/s11239-024-03051-5 9. Weekes AJ, Raper JD, Lupez K, et al. Development and validation of a prognostic tool: Pulmonary embolism short-term clinical outcomes risk estimation (PE-SCORE). PLoS One. 2021;16(11):e0260036. Published 2021 Nov 18. doi:10.1371/journal.pone.0260036 10. Zondag W, Hiddinga BI, Crobach MJ, et al. Hestia criteria can discriminate high- from low-risk patients with pulmonary embolism. Eur Respir J. 2013;41(3):588-592. doi:10.1183/09031936.00030412 11. Wells PS, Anderson DR, Rodger M, et al. Excluding pulmonary embolism at the bedside without diagnostic imaging: management of patients with suspected pulmonary embolism presenting to the emergency department by using a simple clinical model and d-dimer. Ann Intern Med. 2001;135(2):98-107. doi:10.7326/0003-4819-135-2-200107170-00010 12. Wolf SJ, McCubbin TR, Feldhaus KM, Faragher JP, Adcock DM. Prospective validation of Wells Criteria in the evaluation of patients with suspected pulmonary embolism. Ann Emerg Med. 2004;44(5):503-510. doi:10.1016/j.annemergmed.2004.04.002 13. Le Gal G, Righini M, Roy PM, et al. Prediction of pulmonary embolism in the emergency department: the revised Geneva score. Ann Intern Med. 2006;144(3):165-171. doi:10.7326/0003-4819-144-3-200602070-00004 14. Kline JA, Mitchell AM, Kabrhel C, Richman PB, Courtney DM. Clinical criteria to prevent unnecessary diagnostic testing in emergency department patients with suspected pulmonary embolism. J Thromb Haemost. 2004;2(8):1247-1255. doi:10.1111/j.1538-7836.2004.00790.x 15. Kline JA, Courtney DM, Kabrhel C, et al. Prospective multicenter evaluation of the pulmonary embolism rule-out criteria. J Thromb Haemost. 2008;6(5):772-780. doi:10.1111/j.1538-7836.2008.02944.x

Professor of Sociology at LSE, Aaron Reeves joins Katie in the Sociology Staffroom to discuss elites in the UK and his book "Born to Rule". Useful for all sociology teachers and students, and especially those exploring Stratification and Differentiation.

Previous literature has demonstrated that an increased number of preoperative anterior shoulder instability episodes is associated with recurrent anterior shoulder instability after arthroscopic Bankart repair (ABR). However, a threshold for the number of preoperative instability episodes that increases the risk of recurrent anterior shoulder instability is not well established.   A threshold of ≥2 preoperative anterior shoulder instability episodes best predicted recurrent anterior shoulder instability after ABR. Stratification beyond 1 versus ≥2 preoperative anterior shoulder instability episodes did not increase predictive ability. This finding may help surgeons to counsel patients and consider earlier surgical stabilization in those who have sustained anterior shoulder instability episodes.   Click here to read the article.

Pranav Garimella joins host Catherine Glass to explore why early detection of chronic kidney disease remains challenging. From high-risk populations to emerging plasma and urine biomarkers, this episode examines how earlier diagnosis and improved risk stratification can transform patient outcomes. Timestamps: 00:59 – Challenges of early detection 05:12 – Populations for intensive screening 09:08 – Plasma and urine biomarkers 13:45 – Biomarker-driven risk stratification

AEM Podcast host Ken Milne, MD, and guest skeptic Christina Shenvi, MD, PhD, MBA. Learn more in the accompanying Hot Off the Press article available in The Skeptics' Guide to Emergency Medicine.

Send us Fan MailPerioperative anticoagulation management is a common and complex clinical challenge. In this episode of CLOT Conversations, Drs. James Douketis and Joseph Shaw discuss new ISTH guidance on surgical and procedural bleed risk stratification in anticoagulated patients.The discussion explores why updated guidance was needed, addressing inconsistencies in prior schemas, and introduces a more detailed, procedure-specific framework. The authors outline a three-tier classification—minimal, low/moderate, and high bleed risk—and its implications for anticoagulation management.The episode focuses on real-world application, including patient-specific factors, procedural variability, and interdisciplinary communication. It also highlights evidence gaps and ongoing research such as PAUSE2 and ACE-HIGH.https://www.jthjournal.org/article/S1538-7836(26)00055-3/abstract [Subscription required for full paper]Support the showhttps://thrombosiscanada.caTake a look at our healthcare professional and patient resources, videos and publications on thrombosis from the expert members of Thrombosis Canada

What we cover Risk stratification is ranking patients by probability of an adverse outcome. Traditional indices like the Charlson Comorbidity Index use clinician-designed scoring systems. ML-based approaches automate feature generation and let the model surface correlations that a heuristic would miss. The tradeoff is interpretability: with tens of thousands of computations per prediction, explaining a ranking to a clinician requires additional tooling. The data layer is harder than the model layer. Schema differences between organizations are structural: different table names, different column types, different ways of representing the same event. ML tolerates directional imperfection in a way that population analytics does not, but the cleanup is still slow and dependent on tribal knowledge that data owners often can't fully explain. Feature engineering is building hypotheses the model can test. An example we discussed was “if I'm trying to risk stratify kidney stones, what would my naive, non-doctor brain look into seeing if there's any relationship? Maybe soda intake. Maybe dehydration. Maybe SDOH. Those three things are all “features” in this context. The platform ClosedLoop built could generate complex clinical features in about ten minutes, which was most of the competitive advantage. Failure modes tend to be around operations, not accuracy of the algorithm. Buyers without a clear care management strategy can't actually impact patients on the list. ROI attribution takes years, by the which case people might revert to the mean. And without tracking what the clinical program is actually doing, you can't separate a model problem from a workflow problem ETHOS is Epic's transformer trained on serialized clinical event histories from 300 million patients. The way I think about this is if LLMs “predict the next word most likely to occur”, then ostensibly you could get a training set of healthcare events and “predict the next {event} most likely to occur” where {event} is NICU stay Brought to you by Toboggan Labs: A consultancy for healthcare builders. If you have a health product that needs engineers, product people, or experienced operators to help you build or fix something, go talk to them at https://bit.ly/oop-readmission For inquiries about sponsoring the podcast, email sales@outofpocket.health Find Shay https://www.linkedin.com/in/shaayaan-sayed-8097b1100/ Timestamps [02:07] Shay's background: training models from scratch at Closed Loop [04:22] How Shay got into ML in high school by cold-emailing every professor in Houston. By contrast, Alex really got into Dynasty Warriors in high school [10:43] The CMS (Centers for Medicare & Medicaid Services) AI Health Outcomes Challenge. ClosedLoop won $1 million against some big names: Mayo Clinic, Geisinger, and Mathematica. The two components: predictive performance across 13 to 15 adverse outcomes, and interpretability for clinical teams [16:00] A layperson's definition of risk stratification: a ranked patient list by probability of an adverse outcome. The Charlson Comorbidity Index as a standard example, and why ML outperforms it once you need more than one outcome. [29:27] The data layer you need. Claims, EHR (Electronic Health Record) dumps, SDOH (Social Determinants of Health) feeds, ADT (Admission, Discharge, Transfer) data. This is hard because everybody has different schema: payer one's data looks nothing like payer two's, and the data “owner” often can't explain their own tables. [41:50] Feature engineering: building hypotheses the model can test. The difference between "feature" as a PM uses the word and "feature" as a data scientist uses it. [47:52] Interpretability: being able to tell a human being why a patient ranked where they did. Two structural issues: incomplete data and unknown causal frameworks [54:14] Failure modes: Buyers without a care management strategy. Reversion to the mean within two years and you don't know whether you made a difference. Not knowing where to cut the list (Patient number 50 vs 51?). And a related issue: missing data on what the clinical program is actually doing, which makes it impossible to separate a bad model from a bad workflow [01:09:39] Whether anyone should still learn traditional ML, or just LLMs. Shay's answer: gradient boosted trees and transformers are on a spectrum so it's kind of a false dichotomy. Then: the ETHOS paper from Epic, a transformer trained on 300 million patient records that enables one model for many outcomes and counterfactual inference. And what Shay is watching next: robotics and the last-mile problem. AI can identify a list of people with fall risk but something or someone still has to act on it

Send us Fan MailPaper Discussed in this Episode:Reliable classification of polyps based on artificial intelligence: a development and validation study. Julbø FMI, Henriksen AL, et al. eClinicalMedicine 2026;93: 103826.Episode Summary:In this journal club deep dive, we explore a groundbreaking 2026 study that tackles the massive bottleneck in gastrointestinal pathology caused by successful colorectal screening programs. We examine POLARIS, an AI triage system designed to safely clear over 50% of a pathologist's routine workload. But what happens when the algorithm fiercely disagrees with the human diagnosis? In a blinded showdown, the AI proves it's not just an efficiency tool—it might just be the ultimate safety net for catching high-risk cancer cells that human eyes overlook.In This Episode, We Cover:• The Pathology Bottleneck: Why the success of colorectal screening programs is drowning labs in biopsy slides, and how the subjective, visual nature of diagnosing polyps leads to dangerous inter-observer variability.• The 5:2 Triage Strategy: How POLARIS categorizes gigapixel slide images into five biological classes (0 to 4) and translates them into two highly actionable buckets: "Review" (the complex and malignant) and "No Review Required" (normal tissue and routine tubular adenomas with low-grade dysplasia).• Beating the "Clever Hans" Effect: How researchers prevented the AI from "cheating" by recognizing the digital fingerprints of different scanner brands, like Aperio vs. NanoZoomer. By using an image registration tool called elastix to perfectly align slides scanned on both machines, they heavily penalized the algorithm mathematically for relying on color profiles, forcing it to focus purely on biological morphology.• The Showdown - Humans vs. AI: A blinded consensus review was conducted on 40 highly contentious cases where the AI aggressively disagreed with the original patient medical record. Three independent expert pathologists were brought in to break the tie without knowing the AI's or the original doctor's diagnosis.• The Shocking Results: The expert panel sided with the AI over the original human diagnosis in a staggering 92.5% of the disputed cases, proving the established clinical "ground truth" isn't infallible.• The RGBA Heat Map: How POLARIS functions as an active assistant, leaving normal tissue transparent (scaling the alpha channel to zero) while highlighting severe cellular atypia in glowing red, acting as a hyper-accurate topographical map for pathologists.Key Takeaway:AI in digital pathology isn't about autonomously replacing human experts; it's a hyper-sensitive navigational aid. By safely managing the flood of routine low-grade cases and accurately highlighting hidden high-risk dysplasias that exhausted human eyes miss, POLARIS corrects human errors and elevates the baseline standard of diagnostic care across the entire pipeline.Support the showGet the "Digital Pathology 101" FREE E-book and join us!

In this AJNR Article Summary, Dr. George Vilanilam discusses the article, "Risk Stratification for Traumatic Subarachnoid Hemorrhage Enlargement and Surgical Intervention: Guides to Follow-Up Imaging in Patients with Trauma." Not all traumatic subarachnoid hemorrhages behave the same - risk factors such as coagulopathy, concurrent intracranial hemorrhage, and low Glasgow Coma Scale scores predict hemorrhage progression and need for intervention. A risk-stratified imaging approach may reduce unnecessary repeat CT scans while focusing surveillance on patients most likely to deteriorate.

In this episode, Laura Hart and Elena Becker-Barroso speak with Niklas Mattsson-Carlgren (Lund University) about the use of blood biomarkers in the diagnosis and stratification of Alzheimer's disease. They discuss two particular plasma biomarkers—p-tau217 and eMTBR-tau243—including what they measure and how a proposed practical two-step approach that uses p-tau217 as an initial screen in a neurology clinic, and then eMTBR-tau243 for those who test positive, could support diagnostic decisions. Click here to read the full article:https://www.thelancet.com/journals/laneur/article/PIIS1474-4422(26)00029-3/fulltextMedical imaging and theranostics are revolutionising how we diagnose, treat, and understand disease. To meet this moment, The Lancet group is happy to announce the launch of, The Lancet Medical Imaging and Theranostics. You can visit https://www.thelancet.com/medical-imaging-theranostics to learn more.Continue this conversation on social!Follow us today at...https://thelancet.bsky.social/https://instagram.com/thelancetgrouphttps://facebook.com/thelancetmedicaljournalhttps://linkedIn.com/company/the-lancethttps://youtube.com/thelancettv

We walk you through what Emergency Physicians need to know to recognize, risk stratify, and manage endometriosis safely and pragmatically. We answer question such as: When should endometriosis rise to the top of the differential for pelvic pain? How do we distinguish an endometriosis flare from a  dangerous endometriosis complication? from Pelvic Inflammatory Disease? Why hemorrhagic cyst the most common misdiagnosis for endometriosis and how can we tell the difference between hemorrhagic cyst and endometrioma? Which hormonal therapy is safe, reasonable and effective to start in the ED? What are the most common life-threatening complications of endometriosis we should be on the lookout for in the ED? How do we discharge patients with suspected endometriosis safely and reduce repeat visits? and many more... Please consider a donation to EM Cases to ensure continued free open access medical education here: https://emergencymedicinecases.com/donation/

Совместный с ИИ ковер на композицию Alexy.Nov - Stratification Theme

Совместный с ИИ ковер на композицию Alexy.Nov - Stratification Theme

Reader in Sociology at the University of Warwick, Dr Stella Chatzitheochari, joins Katie in the Sociology Staffroom, to discuss the experiences of pupils with disabilities in education and its impact on later educational and employment experiences and opportunities. This is a fascinating discussion for those teaching the Education and Stratification topics and for all of us as practising teachers.

02 11 26 Nutrient Stratification by Ag PhD

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME/MOC/NCPD/AAPA/IPCE information, and to apply for credit, please visit us at PeerView.com/CTJ865. CME/MOC/NCPD/AAPA/IPCE credit will be available until February 6, 2027.Key Steps to Success With CDK4/6 Inhibition in Early Through Metastatic Breast Cancer: Stratification, Selection, Sequencing, and Specialty Management In support of improving patient care, this activity has been planned and implemented by PVI, PeerView Institute for Medical Education, and Living Beyond Breast Cancer. PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by educational grants from Lilly and Novartis Pharmaceuticals Corporation.Disclosure information is available at the beginning of the video presentation.

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME/MOC/NCPD/AAPA/IPCE information, and to apply for credit, please visit us at PeerView.com/CTJ865. CME/MOC/NCPD/AAPA/IPCE credit will be available until February 6, 2027.Key Steps to Success With CDK4/6 Inhibition in Early Through Metastatic Breast Cancer: Stratification, Selection, Sequencing, and Specialty Management In support of improving patient care, this activity has been planned and implemented by PVI, PeerView Institute for Medical Education, and Living Beyond Breast Cancer. PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by educational grants from Lilly and Novartis Pharmaceuticals Corporation.Disclosure information is available at the beginning of the video presentation.

Assistant Professor at the Indian Institute of Technology, Rituparna Patgiri, joins Katie in the Sociology Staffroom to discuss online/remote learning and its impact on women and girls and marginalised groups, especially in India. This is a fascinating discussion which might be of particular interest with regard to those teaching the topics of Education, Global Development, Culture & Identity and Stratification, but also to all of us as teachers.

On this week’s episode, we’re continuing our Guidelines Series exploring the 2022 ESC/ERS Guidelines for the diagnosis and treatment of Pulmonary Hypertension. If you missed our first episode in the series, give it a listen to hear about the most recent recommendations regarding Pulmonary Hypertension definitions, screening, and diagnostics. Today, we’re talking about the next steps after diagnosis. Specifically, we’ll be discussing risk stratification, establishing treatment goals, and metrics for re-evaluation. We’ll additionally introduce the mainstays of pharmacologic therapy for Pulmonary Hypertension. Meet Our Co-Hosts Rupali Sood  grew up in Las Vegas, Nevada and made her way over to Baltimore for medical school at Johns Hopkins. She then completed her internal medicine residency training at Massachusetts General Hospital before returning back to Johns Hopkins, where she is currently a pulmonary and critical care medicine fellow. Rupali’s interests include interstitial lung disease, particularly as related to oncologic drugs, and bedside medical education. Tom Di Vitantonio  is originally from New Jersey and attended medical school at Rutgers, New Jersey Medical School in Newark. He then completed his internal medicine residency at Weill Cornell, where he also served as a chief resident. He currently is a pulmonary and critical care medicine fellow at Johns Hopkins, and he’s passionate about caring for critically ill patients, how we approach the management of pulmonary embolism, and also about medical education of trainees to help them be more confident and patient centered. Key Learning Points 1) Episode Roadmap How to set treatment goals, assess symptom burden, and risk-stratify patients with suspected/confirmed pulmonary arterial hypertension (PAH). What tools to use to re-evaluate patients on treatment Intro to major PAH medication classes and how they map to pathways. 2) Case-based diagnostic reasoning Patient: 37-year-old woman with exertional dyspnea, mild edema, abnormal echo, telangiectasias + epistaxis → raises suspicion for HHT (hereditary hemorrhagic telangiectasia) and/or early connective tissue disease. Key reasoning move: start broad (Groups 2–5) and narrow using history/exam/testing. In a young patient without obvious left heart or lung disease, think more about Group 1 PAH (idiopathic/heritable/associated). HHT teaching point: HHT can cause PH in more than one way: More common: high-output PH from AVMs (often hepatic/pulmonary) Rare (1–2% mentioned): true PAH phenotype (vascular remodeling; associated with ALK1 in some patients), behaving like Group 1 PAH. 3) Functional class assessment WHO Functional Class: Class I: no symptoms with ordinary activity, only with exertion Class II: symptoms with ordinary activity Class III: symptoms with less-than-ordinary activity (can't do usual chores/shopping without dyspnea) Class IV: symptoms at rest Practical bedside tip they give: Ask if the patient can walk at their own pace or keep up with a similar-age peer/partner. If not, think Class II (or worse). 4) Risk stratification at diagnosis: why, how, and which tools Big principle: treatment choices are driven by risk, and the goal is to move patients to low-risk quickly. ESC/ERS approach at diagnosis (as described): Use a 3-strata model predicting 1-year mortality: Low: 20% ESC/ERS risk assessment variables (10 domains discussed): Clinical progression, signs of right heart failure, syncope WHO FC Biomarkers (NT-proBNP) Exercise capacity (6MWD) Hemodynamics Imaging (echo; sometimes cardiac MRI) CPET (peak VO₂; VE/VCO₂ slope) They note: even if you don't have everything, the calculator can still be useful with ≥3 variables. REVEAL 2.0: Builds on similar core variables but adds further patient context (demographics, renal function, BP, DLCO, etc.) Case result: both tools put her in intermediate risk (ESC/ERS ~1.6; REVEAL 2.0 score 8), underscoring that mild symptoms can still equal meaningful mortality risk. 5) Treatment goals and follow-up philosophy What they explicitly prioritize: Help patients feel better, live longer, and stay out of the hospital Use risk tools to communicate prognosis and to track improvement Reassess frequently (they mention ~every 3 months early on) until low risk is achieved “Time-to-low-risk” is an important treatment goal Also emphasized: The diagnosis is psychologically heavy; patients need clear counseling, reassurance about the plan, and connection to support groups. 6) Medication classes for the treatment of PAH Nitric oxide–cGMP pathway PDE5 inhibitors: sildenafil, tadalafil Soluble guanylate cyclase stimulator: riociguat Important safety point: don't combine PDE5 inhibitors with riociguat (risk of significant hypotension/hemodynamic effects) Endothelin receptor antagonists (ERAs) “-sentan” drugs: bosentan (less used due to side effects/interactions), ambrisentan, macitentan Teratogenicity emphasized Hepatotoxicity that requires LFT monitoring Can cause fluid retention and peripheral edema Prostacyclin pathway Prostacyclin analogs/agonists: Epoprostenol (potent; short half-life; IV administration) Treprostinil (IV/SubQ/oral/inhaled options) Selexipag (oral prostacyclin receptor agonist) 7) Sotatercept (post-guidelines) They note sotatercept wasn't in 2022 ESC/ERS but is now “a game changer” in practice: Mechanism: ligand trap affecting TGF-β signaling / remodeling biology Positioned as potentially more disease-modifying than pure vasodilators Still evolving: where to place it earlier vs later in regimens is an active question in the field 8) How risk category maps to initial treatment intensity General approach they outline: High risk at diagnosis: parenteral prostacyclin (IV/SubQ) strongly favored, often aggressive early Intermediate risk: at least dual oral therapy (typically PDE5i + ERA); escalate if not achieving low risk Low risk: at least one oral agent; many still use dual oral depending on etiology/trajectory For the case: intermediate-risk → start dual oral therapy (they mention tadalafil + ambrisentan as a typical choice), reassess in ~3 months; add a third agent (e.g., selexipag/prostacyclin pathway) if not low risk.  References and Further Reading Humbert M, Kovacs G, Hoeper MM, Badagliacca R, Berger RMF, Brida M, Carlsen J, Coats AJS, Escribano-Subias P, Ferrari P, Ferreira DS, Ghofrani HA, Giannakoulas G, Kiely DG, Mayer E, Meszaros G, Nagavci B, Olsson KM, Pepke-Zaba J, Quint JK, Rådegran G, Simonneau G, Sitbon O, Tonia T, Toshner M, Vachiery JL, Vonk Noordegraaf A, Delcroix M, Rosenkranz S; ESC/ERS Scientific Document Group. 2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension. Eur Heart J. 2022 Oct 11;43(38):3618-3731. doi: 10.1093/eurheartj/ehac237. Erratum in: Eur Heart J. 2023 Apr 17;44(15):1312. doi: 10.1093/eurheartj/ehad005. PMID: 36017548. Condon DF, Nickel NP, Anderson R, Mirza S, de Jesus Perez VA. The 6th World Symposium on Pulmonary Hypertension: what’s old is new. F1000Res. 2019 Jun 19;8:F1000 Faculty Rev-888. doi: 10.12688/f1000research.18811.1. PMID: 31249672; PMCID: PMC6584967. Maron BA. Revised Definition of Pulmonary Hypertension and Approach to Management: A Clinical Primer. J Am Heart Assoc. 2023 Apr 18;12(8):e029024. doi: 10.1161/JAHA.122.029024. Epub 2023 Apr 7. PMID: 37026538; PMCID: PMC10227272. Hoeper MM, Badesch DB, Ghofrani HA, Gibbs JSR, Gomberg-Maitland M, McLaughlin VV, Preston IR, Souza R, Waxman AB, Grünig E, Kopeć G, Meyer G, Olsson KM, Rosenkranz S, Xu Y, Miller B, Fowler M, Butler J, Koglin J, de Oliveira Pena J, Humbert M; STELLAR Trial Investigators. Phase 3 Trial of Sotatercept for Treatment of Pulmonary Arterial Hypertension. N Engl J Med. 2023 Apr 20;388(16):1478-1490. doi: 10.1056/NEJMoa2213558. Epub 2023 Mar 6. PMID: 36877098. Ruopp NF, Cockrill BA. Diagnosis and Treatment of Pulmonary Arterial Hypertension: A Review. JAMA. 2022 Apr 12;327(14):1379-1391. doi: 10.1001/jama.2022.4402. Erratum in: JAMA. 2022 Sep 6;328(9):892. doi: 10.1001/jama.2022.13696. PMID: 35412560.

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In this month's EM Quick Hits podcast: Mike Weinstock discusses with Anton a case of upper back pain in this month's Medmal Cases, Andrew Petrosoniak on traumatic pneumothorax and hemothorax decision making: risk stratification, imaging cutoffs and chest tube choices, Justin Morgenstern on brain injury guidelines risk stratification for neurosurgical consult, repeat imaging and admission, Andrew Tagg on management of post-circumcision bleeding and when to escalate care, Hans Rosenberg & Ariel Hendin on evaluation and management of CT contrast allergy and why steroids are out, Shawn Seregren on emotional contagion in resuscitation teams: how tone, pace and volume of your voice and body language effect team rescucitation dynamics and outcomes...

This week, we introduce a new episode for our myeloma series, this time focusing on risk stratification and response criteria. The initial workup and surveillance labs are expansive, but all of the studies we do have a purpose. Many present-day studies also use “minimal residual disease” (MRD) testing. What does this mean? How do we use this?We go through all of this and more in this incredibly high yield episode. Content:- How do we risk stratify patients with newly diagnosed MM? - What are the criteria used to risk stratify? Why does this matter?- How do we define response to treatment? Progression?- What is the role of "minimal residual disease" in myeloma? ** Want to review the show notes for this episode and others? Check out our website. Love what you hear? Tell a friend and leave a review on our podcast streaming platforms!Twitter: @TheFellowOnCallInstagram: @TheFellowOnCallListen in on: Apple Podcast, Spotify, and Youtube

CME credits: 0.25 Valid until: 31-12-2026 Claim your CME credit at https://reachmd.com/programs/cme/gmg-patient-stratification-and-antibody-profiling-personalizing-the-disease-lens/39029/ This discussion between Drs. Diana Castro and Jonathan Strober focuses on the clinical utility of patient stratification and antibody profiling in generalized myasthenia gravis (gMG). The conversation addresses how age of onset, antibody status (acetylcholine receptor, MuSK, LRP4), and comorbidities can influence diagnosis and management plans. The speakers highlight the limitations of current pediatric assessment tools and the implications of antibody status for access to targeted therapies. Practical considerations for repeat testing, use of modified clinical scales, and individualized communication strategies with pediatric patients and families are also examined, emphasizing the nuanced approach required in younger populations.=

01:00 I Make It Hard For People To Get Close To Me, https://lukeford.net/blog/?p=165831 02:00 The Bondi Massacre Reveals The Moral & Intellectual Bankruptcy Of Australia's Jewish Leaders, https://lukeford.net/blog/?p=165455 07:00 Why America can't have nice things, https://www.youtube.com/watch?v=SMgoXdv5S84 10:00 The LAFD Didn't Put Out A Key Fire Because They Valued Plants More Than People, https://lukeford.net/blog/?p=165760 28:00 Claire Khaw joins to help me with my self-loathing 1:04:00 Michael joins, https://x.com/Michaelmvlog 1:06:00 The Lost Generation, https://www.compactmag.com/article/the-lost-generation/ 1:07:00 The Vanishing White Male Writer, https://www.compactmag.com/article/the-vanishing-white-male-writer/ 1:08:00 Are There Anti-Male, Anti-White Spaces? https://lukeford.net/blog/?p=165785 1:19:00 Conservatism's Long Con, https://thebaffler.com/salvos/the-long-con Status Closure and The Lost Generation, https://lukeford.net/blog/?p=165638 1:43:00 The Credential Society: An Historical Sociology of Education and Stratification, https://lukeford.net/blog/?p=165627 1:44:00 Credentialing Theory: What is Credential Inflation? 1:55:00 How Might AI Shift The Balance Of Power At Work? https://lukeford.net/blog/?p=165775 1:58:00 Credential creep, https://www.youtube.com/watch?v=Gu0DzTAo4uY 2:10:000 Status Closure and The Lost Generation, https://lukeford.net/blog/?p=165638 Experts Need More Power For Your Own Good, https://lukeford.net/blog/?p=165809 The Vanishing Jew by Jacob Savage, https://lukeford.net/blog/?p=165804 Why does Gemini capitalize Black and not White?, https://lukeford.net/blog/?p=165799 We Have Never Been Woke: The Cultural Contradictions of a New Elite, https://lukeford.net/blog/?p=165796 The Guild War: Why Credentials Won't Save the Incompetent Elite, https://lukeford.net/blog/?p=165765

Real talk for real Airmen. I drop blunt, battle-tested insight on leadership, excellence, discipline, and the warrior ethos. No fluff, no shortcuts, no easy bus. Just the truth, the standard, and how to rise above average. Charge into the storm & Stay hard to kill.Article here

In this episode, Michael welcomes Lightbeam Health CTO Mike Hoxter to discuss how advanced analytics and social determinants of health (SDOH) data are reshaping population health management. As organizations deepen their commitment to value-based care, Mike explains how modern risk stratification tools help identify at-risk populations earlier, reduce avoidable costs, and drive more equitable, proactive care. With real-world examples and practical insights, this conversation offers a clear look at what's working—and what's next—in population health innovation.

Dr Neil Greening and Dr Hnin Aung join Diana Stanley to discuss a new multidimensional prognostic risk stratification model for COPD exacerbations.click here to read the full article: https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(25)00362-5/fulltextContinue this conversation on social!Follow us today at...https://thelancet.bsky.social/https://instagram.com/thelancetgrouphttps://facebook.com/thelancetmedicaljournalhttps://linkedIn.com/company/the-lancethttps://youtube.com/thelancettv

Dr. Emile Daoud, Deputy Editor of JACC Clinical Electrophysiology, discusses Risk Stratification in LBBB after TAVI: Comparison Between a Novel ECG Algorithm and ESC Criteria.

Dr. Emile Daoud, Deputy Editor of JACC Clinical Electrophysiology discusses Risk Stratification in LBBB after TAVI: Comparison Between a Novel ECG Algorithm and ESC Criteria.

Join host Alex Crespo, MD as he chats with author Michael Weaver, MD about the Journal of Orthopaedic Trauma article on the Frailty Index as a possible stratification tool in the CMS hip fracture bundle. To access the abstract, click here. For additional educational resources visit OTA.org

Could ongoing trials redefine the management of oligometastatic and advanced prostate cancer? In this installment of BackTable Tumor Board, leading prostate cancer experts Dr. Neeraj Agarwal, a medical oncologist from the University of Utah, and Dr. Tyler Seibert, a radiation oncologist from UC San Diego, join host Dr. Parth Modi to share their insights on the latest clinical trials and persistent challenges in managing prostate cancer.---This podcast is supported by:Ferring Pharmaceuticals https://ad.doubleclick.net/ddm/trackclk/N2165306.5658203BACKTABLE/B33008413.420220578;dc_trk_aid=612466359;dc_trk_cid=234162109;dc_lat=;dc_rdid=;tag_for_child_directed_treatment=;tfua=;gdpr=${GDPR};gdpr_consent=${GDPR_CONSENT_755};gpp=${GPP_STRING_755};gpp_sid=${GPP_SID};ltd=;dc_tdv=1---SYNPOSISThe multidisciplinary discussion addresses clinical decision-making in active surveillance versus early intervention, the role of PSMA PET imaging in detection and treatment planning, and evolving strategies for metastatic and castration-resistant disease. They also evaluate the therapeutic potential of alpha emitters and radioligand therapies, consider the evidence behind treatment intensification and de-intensification, and explore how these approaches can be individualized to optimize patient outcomes.---TIMESTAMPS0:00 - Introduction1:48 - Active Surveillance in Low-Risk Prostate Cancer7:08 - Molecular Testing and Risk Stratification8:28 - Radiation Therapy Approaches20:16 - PSA Recurrence and PSMA PET Scans32:40 - The Role of ADT37:15 - PSMA PET Scans40:58 - Genetic Testing in High-Risk and Metastatic Prostate Cancer46:54 - Treatment Intensification vs. De-Intensification Trials55:59 - Castration-Resistant Prostate Cancer

In this week's episode, host Paul Wirkus, MD, FAAP, and guests Kristi Glotzbach, MD, and Laura Wood, PhD discuss recommendations for recognizing and addressing neurodevelopmental risks in infants and children with congenital heart disease (CHD). Listen in as they review strategies for risk identification, protection, screening, and evaluation, and focus on how clinicians can stratify risk for neurodevelopmental challenges in this vulnerable population. Have a question? Email questions@vcurb.com. Your questions will be answered in week four.For more information about available credit, visit vCurb.com.ACCME Accreditation StatementThis activity has been planned and implemented in accordance with the accreditation requirements and policies of the Colorado Medical Society through the joint providership of Kansas Chapter, American Academy of Pediatrics and Utah Chapter, AAP.  Kansas Chapter, American Academy of Pediatrics is accredited by the Colorado Medical Society to provide continuing medical education for physicians. AMA Credit Designation StatementKansas Chapter, American Academy of Pediatrics designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Back after a long break, Caasim, Celeste, Dev, and Upo get a little stupid. Bevs were flowing so apologies for the peaks in this episode. Enjoy!

CME credits: 0.75 Valid until: 22-08-2026 Claim your CME credit at https://reachmd.com/programs/cme/risk-stratification-and-patient-selection-for-perioperative-icis/36633/ This online CME activity examines advances in managing resectable locally advanced head and neck squamous cell carcinoma (HNSCC), focusing on the integration of perioperative immune checkpoint inhibitors (ICIs) and multimodal approaches. Faculty review current standards of care and highlight unmet needs that have driven investigation into combining radiation and immunotherapy. Emerging clinical trial data are discussed, including the impact of perioperative ICIs on event-free survival and pathologic response, with attention to patient selection informed by risk stratification and biomarkers. The program also addresses practical considerations for multidisciplinary care, including immune-related adverse event management and strategies to support patient access to these evolving treatment paradigms.

CME credits: 0.75 Valid until: 22-08-2026 Claim your CME credit at https://reachmd.com/programs/cme/risk-stratification-and-patient-selection-for-perioperative-icis/36633/ This online CME activity examines advances in managing resectable locally advanced head and neck squamous cell carcinoma (HNSCC), focusing on the integration of perioperative immune checkpoint inhibitors (ICIs) and multimodal approaches. Faculty review current standards of care and highlight unmet needs that have driven investigation into combining radiation and immunotherapy. Emerging clinical trial data are discussed, including the impact of perioperative ICIs on event-free survival and pathologic response, with attention to patient selection informed by risk stratification and biomarkers. The program also addresses practical considerations for multidisciplinary care, including immune-related adverse event management and strategies to support patient access to these evolving treatment paradigms.

Dr. Robert Frantz breaks down the key metrics behind risk stratification—functional class, six-minute walk distance, and brain natriuretic peptide levels—and explains how they shape treatment plans. He also explores the role of echocardiography, right heart catheterization, and cutting-edge therapies in improving patient outcomes. Read the proceedings of the Task Force on Risk Stratification from the Seventh World Symposium on Pulmonary Hypertension.  This Special Edition Episode Sponsored by: Johnson & Johnson Learn more about pulmonary hypertension trials at www.phaware.global/clinicaltrials. Follow us on social @phaware Engage for a cure: www.phaware.global/donate #phaware Share your story: info@phaware.com #phawareMD #RiskStratification @MayoClinic @MayoMedEd @TeamPHHope @JNJInnovMed

In this episode of Tech it to the Limit, Dr. Rachel Harrington (NCQA) joins hosts Sarah Harper and Elliott Wilson to unpack how digital tools are reshaping healthcare—and why equity must be part of the equation. From fixing biased data to evolving HEDIS and designing with communities, it's a sharp look at the future of human-centered, tech-powered care.Key TakeawaysStart with the right data: If we don't ask the right questions and reflect real diversity, we're guessing, not solving.Co-create with communities: Don't design for people—design with them to build solutions that actually work.Go beyond broad stats: Break down the data to see what different groups really need.Tackle the root causes: Health isn't just about doctors—it's about housing, food, transport, and more.Act, don't just assess: Finding problems is easy. Solving them takes real action.In this episode:[00:00:00] Welcome to Tech it to the Limit[00:01:43] Insights from the Mayo Clinic AI Summit[00:04:05] Segment spotlight – “Guess That Quality Data Acronym”: [00:11:05] Conversation with Dr. Rachel Harrington, NCQA: advancing equity through data and measurement[00:26:15] Collaborating across sectors: the importance of community-based partnerships[00:27:12] Stratification and the role of data transparency in identifying quality gaps[00:27:44] Transitioning to HEDIS: why equity must be embedded in quality measurement[00:29:15] The impact of race and ethnicity stratification in performance metrics[00:32:13] Aligning incentives across payers, providers, and systems for greater accountability[00:39:12] Designing for equity: avoiding bias in digital health tools through inclusive development[00:42:57] A call to action: how digital health leaders can make equity core to their strategy[00:46:02] Final reflections and key insightsOur GuestDr. Rachel Harrington is the Assistant Vice President of Health Equity at the NCQA, where she leads the Equity and HEDIS initiative. With a Ph.D. in pharmacy systems and a background in regulatory science, health economics, and public policy, Rachel has a wealth of experience in healthcare data, quality improvement, and social determinants of health. Her work ensures that healthcare systems deliver equitable, effective care for all communities.ResourcesDr. Rachel HarringtonNCQADr. Rachel HarringtonWe Ask Because We Care campaignTech It To The Limit PodcastWebsite Apple Podcast

Osteosarcoma Webinar Series: Amanda Marinoff, MD, a physician-scientist from UCSF will discuss clinical biomarkers for osteosarcoma stratification (cBOSS): Insights from a working group.Despite decades of research, osteosarcoma remains one of the few pediatric cancers without validated molecular biomarkers to guide treatment. The Clinical Biomarkers for Osteosarcoma Stratification (cBOSS) initiative is an international effort to change that. Modeled after a successful framework in Ewing sarcoma, cBOSS convened experts from North America and Europe to systematically evaluate emerging molecular features with the greatest potential for near-term clinical translation. Through a series of structured sessions, the group assessed the biological plausibility, clinical relevance, and implementation feasibility of candidate classifiers across five domains: genomic, transcriptomic, epigenetic, immune, and circulating analytes. This webinar will provide an overview of the cBOSS approach, key findings to date, including the maturity of circulating tumor DNA and MYC amplification as prognostic tools, and the path forward for incorporating molecular stratification into future clinical trials. The goal: to move beyond one-size-fits-all therapy and build a precision medicine framework for osteosarcoma.Dr. Amanda Marinoff is a pediatric oncologist and translational researcher at UCSF, where she focuses on developing molecular biomarkers to improve risk stratification and treatment for children and young adults with osteosarcoma. She co-leads the international cBOSS initiative (Clinical Biomarkers for Osteosarcoma Stratification), which brings together experts across North America and Europe to evaluate and prioritize emerging classifiers for clinical use. Her research aims to bridge the gap between genomic discovery and therapeutic application, advancing precision medicine approaches for patients with high-risk disease. Dr. Marinoff earned her medical degree from Harvard Medical School, completed her pediatrics residency at Boston Children's Hospital, and completed her pediatric hematology/oncology fellowship at UCSF Benioff Children's Hospital. She is an active member of the pediatric solid tumor and early-phase clinical trials groups at UCSF.

Get access to The Backroom (70+ exclusive episodes) on Patreon:https://www.patreon.com/OneDimeIs the Marxist conception of class outdated? In this episode of 1Dime Radio, I'm joined by Dave from Theory Underground to unpack the “Post-Class Fractured Mass” (PCFM): why the working class, the “proletariat”  no longer coheres the way Marxists imagined, how media + schooling carve us into niches and swarms, and what this means for organizing today. We talk about why the decline of working-class power is due to real material factors in the economy, and not just due to ideology and “class consciousness.”  This brings us to the pivotal question: in the age of the gig economy, is the working class obsolete as the agent of revolutionary change? If so, who is the revolutionary subject today? In the backroom, we discuss the issues with the term “Post-Left”, how people burn out from politics, and how bourgeois pseudoprogressive libertine attitudes bleed into leftist circles (like polyamory, non-monogamy, etc). Become a patron at Patreon.com/OneDime if you haven't already!Timestamps: 00:00:00 The Backroom Preview05:15  The Post-Class Fractured Mass (PCFM)  07:08 Jobs, Careers, & Time-energy 10:33 “Progressive” schooling as sorting/gatekeeping  25:54 From Class Power to Popular Front of "The Vulnerable"30:14 Outsourcing, deindustrialization & Stratification  36:35  The “Dictatorship of the Proletariat”  42:27 Can the Democratic Party be “reformed”?  50:10 The Gig Economy and The Breakdown of Solidarity 01:02:08  Ideological Gerrymandering01:21:45 AI & Transition to The Backroom GUEST:Dave — Theory Underground• Check out the Theory Underground YouTube Channel: https://www.youtube.com/@theory_underground• Check out the Underground Theory Book (Im in it too!) : https://www.amazon.com/Underground-Theory-David-McKerracher/dp/B0CH2CXSGN• Check out the Dave's Timenergy Book: https://www.amazon.com/Timenergy-Why-Have-Time-Energy/dp/B0D285C1TV/ref=sr_1_1?dib=eyJ2IjoiMSJ9.uWMeog7v0Fzxa2o7vYK7_OuDzbW0mXjpYddGDa84LDHzaHN7WUeL3O_T1zrzPCEr4Tw75Pn1KD82Jmmdem3hjQKq0TW4WLFIA3DIhDNVaV4.mgTh5f1Lm2lcEPI24AzA_GwBr-Gs5nOCIyzU_5-BfEg&dib_tag=se&qid=1753806927&refinements=p_27%3ADavid+McKerracher&s=books&sr=1-1&text=David+McKerracherFOLLOW 1Dime:• X/Twitter: https://x.com/1DimeOfficial •  Follow me on Instagram: instagram.com/1dimeman •Check out my main channel videos: https://www.youtube.com/@1Dimee Outro Music by Karl CaseyGive the Podcast a 5-star Rating if you enjoyed the show!

If you're a fan of fans, this is the podcast for you! In this short podcast episode, Bryan shares how installing ceiling fans can be a smart HVAC design strategy (even though he wasn't a fan of fans!). Ceiling fans break the "don't blow air on people" rule we usually refer to in duct design, but they can solve quite a few basic comfort problems, especially in homes with lower loads than we've historically seen. They're great for creating high-velocity airstreams and mixing air. Low-load homes have systems with lower tonnages; they don't move as much air and could use a little bit of help from a ceiling fan. Air mixing is also poor in homes that have a greater distance between the air and the ceiling. Stratification of the air causes comfort problems due to temperature differences, and hot or cold surfaces can also contribute to these issues for similar reasons. Moisture and eventual growth are also concerns when we allow rooms to have those temperature differences (especially on the ceiling, as water vapor is lighter than air). Ceiling fans disrupt the stratification of air and water vapor. They solve air mixing problems while they dispel odors and maintain more consistent dew points throughout the air. Modern fans with ECMs can also run at a low speed without taking a large energy efficiency hit. Ceiling fans are great and relatively inexpensive solutions that can solve comfort and IAQ problems in high-performance homes.   Have a question that you want us to answer on the podcast? Submit your questions at https://www.speakpipe.com/hvacschool. Purchase your tickets or learn more about the 7th Annual HVACR Training Symposium at https://hvacrschool.com/symposium. Subscribe to our podcast on your iPhone or Android. Subscribe to our YouTube channel. Check out our handy calculators here or on the HVAC School Mobile App for Apple and Android

July 3, 2025: Alan Smith, SVP and CIO of Lifepoint Health, joins Bill for a discussion on the top challenges facing CIOs. How do you balance immediate system stability when your organization is built through constant acquisitions? Al discusses his approach to the "CIO escape room" scenarios that define modern healthcare IT, from major partner outages to the ongoing tension between cloud-first strategies and financial realities. As healthcare organizations grapple with cost pressures while demanding more from their IT departments, Alan reveals how LifePoint navigates these competing forces and what it takes to build resilient systems in an industry where failure isn't an option. Key Points: 04:57 CIO Escape Room 14:14 The Importance of Inquisitiveness 17:31 Strategies in Virtual Leadership 26:12 Advice for Future Healthcare IT Leaders X: This Week Health LinkedIn: This Week Health Donate: Alex's Lemonade Stand: Foundation for Childhood Cancer

In this week's episode, we'll learn more about social determinants of health that impact access to allogeneic hematopoietic cell transplantation in patients with acute myeloid leukemia, or AML; use of megakaryocyte growth factor receptor-based stem cell depletion as part of pretransplant conditioning in ex vivo autologous gene therapy; and identification of an eight-protein risk signature as well as a novel single protein biomarker, soluble oncostatin M receptor, for risk stratification in AML.Featured Articles:Social Determinants of Health and Access to Allogeneic Hematopoietic Cell Transplantation for Acute Myeloid LeukemiacMPL-Based Purification and Depletion of Human Hematopoietic Stem Cells: Implications for Pretransplant ConditioningBlood-Based Proteomic Profiling Identifies OSMR as a Novel Biomarker of AML Outcomes

Dan, Manny, & Billy invite friend & fan of the pod Meghan P. Nolan to put the 1985 action/adventure comedy The Goonies to the ultimate test—THE NOSTALGIA TEST! “I had this epiphany while I was watching it this time where I was like, ‘Holy shit! Like Goonies are just like a bunch of nerds, they're all just sitting around playing D&D, Mikey is the dungeon master, and this is their quest.” -Meghan P. Nolan Around 2 years ago, Meghan sent us a suggestion to put The Goonies to the ultimate test and because Dan is super lazy it took him this long to get her on the pod. This episode is off the rails from the start filled with classic Nostalgia Test drops and a live Zoom audience of one, (haha! it's a start) Courtney from the Fiction Fixation Podcast who added some hilarious ideas while Billy dealt with his North Carolina internet service. The gang talks about “Goonies” comes from their town name The Goon Docks, what did the parents of these kids do to get all their houses foreclosed on, why was Troy and his flunkies hanging around a wishing well, are the Fratellis really Italian, and who was resetting One Eyed Willie's booby traps in the 1600s. They also analyze all the amazing characters, unpack the stereotypes, plot holes, and put Cindy Lauper's song to a quick Nostalgia Test. Most importantly, they talk about the real heroes of this movie Rosalita and Sloth. This episode is what The Nostalgia Test is all about, laughter, hot takes, and a bunch of hypothetical scenarios for what a Goonies sequel or TV series might look like. This is a must-listen for any fan of 80s classics. Email us (thenostalgiatest@gmail.com) your thoughts, opinions, and questions about this episode or anything else nostalgic on your mind and we'll read it for next time on the pod!   APPROXIMATE RUN OF SHOW: 00:00 Introduction to the Nostalgia Test Podcast 00:45 Welcoming the Hosts and Guest 01:15 Discussing The Goonies and Nostalgia 02:10 The Goonies' Cultural Impact 04:08 Analyzing Characters and Stereotypes 10:07 Plot Holes and Funny Observations 15:47 The Goonies' Opening Scene and PG Rating 26:51 Music and Product Placement in The Goonies 30:41 Kids' Reactions to The Goonies 31:36 Comparing The Goonies to Other 80s Movies 33:35 Modern Movie Music and Final Thoughts 36:06 Revisiting 'The Goonies': Childhood Memories and Cable TV 37:03 Tree Climbing Adventures and Childhood Mischief 38:24 The Goonies' Treasure Hunt Begins 39:03 Decoding the Pirate Map and Family Dynamics 40:27 The Goonies' Quest: Booby Traps and Town Secrets 42:19 Character Dynamics and 80s Stereotypes 50:14 The Fratelli Family: Villains or Victims? 52:21 Sloth: The Unlikely Hero 56:21 The Goonies' Final Adventure: Treasure and Triumph 01:10:35 Nostalgic Jail Cell Memories 01:11:02 The Idiot Mob in Astoria 01:11:42 Chunk's Hilarious Car Encounter 01:12:22 Goonies Theme Park and Escape Room Ideas 01:14:21 Mikey's Iconic Speech 01:16:02 Speculating on the Goonies Sequel 01:22:25 The Goonies' Legacy and Trivia 01:34:56 Final Thoughts and Nostalgia Test   Meghan P. Nolan, MFA, MA, PhD, is an Associate Professor of English and Chair of the Honors program at State University of New York, Rockland. She is a recipient of the SUNY Chancellor's Award for Excellence in Teaching. She is a multi-genre writer, who focuses on(Neo-)Victorian and Modern literature/ crime writing and fragmented perceptions of self-hood through academic works, fiction, non-fiction, and poetry. Her book The Crossroads of Crime Writing: Unseen Structures and Uncertain Spaces was published by Anthem Press (March 2024). She is the author of the poetry collection, Stratification (2008) and her poems have been in many literary journals over the years. Recently, her works have been on public display as a part of the “Writing on the Walls” exhibits at the Hudson Valley Museum of Contemporary Art (HVMOCA) and she regularly performs her poetry and monologues as a part of productions by both Studio Theater in Exile and Tutti Bravi respectively. Her works have appeared in Approaches to Teaching the Works of Fernando Pessoa (2025), Mean Streets (2021), Persona Studies (2021 and 2015), Transnational Crime Fiction: Mobility, Borders, and Detection (2020), Exquisite Corpse: Studio Art-Based Writing in the Academy (2019), The 100 Greatest Detectives (2018), and Thread (2017). For more info visit mpnolan.com.  Order Meghan's book The Crossroads of Crime Writing: Unseen Structures and Uncertain Spaces at Barnes & Nobel & Amazon   Book The Nostalgia Test Podcast Bring The Nostalgia Test Podcast's high energy fun and comedy on your podcast, to host your themed parties & special events!  The Nostalgia Test Podcast will create an unforgettable Nostalgic experience for any occasion because we are the party! We are the most dedicated guests! We bring it 100% of the time! Email us at thenostalgiatest@gmail.com or fill out the form at this link. LET'S GET NOSTALGIC!     Keep up with all things The Nostalgia Test Podcast on Instagram | Substack | Discord | TikTok | Bluesky | YouTube | Facebook   The intro and outro music ('Neon Attack 80s') is by Emanmusic. The Lithology Brewing ad music ("Red, White, Black, & Blue") is by PEG and the Rejected

Ponds can naturally separate with warm oxygenated water near the surface and a cooler, unoxygenated layer in deeper areas. Join Joe and Drew as they discuss pond stratification, summer fish kills, and how aeration may help maintain a thriving pond ecosystem. Dr. Joe Gerken and Dr. Drew Ricketts are extension specialists and faculty members in the Wildlife and Outdoor Enterprise Management Program at Kansas State university. Find out more about the program at http://hnr.k-state.edu/academics/undergraduate-programs/wildlife-outdoor-management.html

Darrick Hamilton, director of the Institute for the Study of Race, Stratification, and Political Economy at the New School talks about Trump's Platinum Plan and whether it was a bait and switch move on Black America. Become a supporter of this podcast: https://www.spreaker.com/podcast/tavis-smiley--6286410/support.

The JournalFeed podcast for the week of April 21-25, 2025.These are summaries from just 2 of the 5 articles we cover every week! For access to more, please visit JournalFeed.org for details about becoming a member.Wednesday Spoon Feed:This preplanned subgroup analysis of the TOMAHAWK Trial of patients with ROSC after OHCA found no EKG findings (excluding STEMI) that predicted the presence of coronary artery lesions.Thursday Spoon Feed:In this substudy of the Canadian TIA Score cohort, researchers found score utilization with subsequent MRI imaging could improve the outcome of patients suffering from TIA or stroke, particularly in the medium-risk category, scoring between 4-8 points.

How do you predict which intermediate-risk patients will suddenly deteriorate? What role do risk scores, biomarkers, imaging, and hemodynamics play in decision-making? Should these patients receive anticoagulation alone, or is thrombolysis warranted? When should you consider catheter-directed or surgical interventions? This podcast focuses us to think critically about risk stratification, early interventions and escalation in care in PE. We include an algorithm in the show notes. Not all patients fit neatly into classification boxes, making clinical judgment crucial. Join Dr. Lauren Westafer, Dr. Justin Morgenstern, Dr. Bourke Tillman and Anton as they explore the key decision points, pitfalls, and lifesaving strategies for managing intermediate-risk PE in the ED...

Every civilization is shaped by its ruling elite, but what happens when those planning your society cannot understand the average person? Authors Charles Murray and Christopher Lasch have both discussed the dangers of cognitive stratification and how it could destroy social fabric. We will be discussing how that problem recently manifested itself in the debate over immigration and employment. Follow on: Apple: https://podcasts.apple.com/us/podcast/the-auron-macintyre-show/id1657770114 Spotify: https://open.spotify.com/show/3S6z4LBs8Fi7COupy7YYuM?si=4d9662cb34d148af Substack: https://auronmacintyre.substack.com/ Twitter: https://twitter.com/AuronMacintyre Gab: https://gab.com/AuronMacIntyre YouTube:https://www.youtube.com/c/AuronMacIntyre Rumble: https://rumble.com/c/c-390155 Odysee: https://odysee.com/@AuronMacIntyre:f Instagram: https://www.instagram.com/auronmacintyre/ Learn more about your ad choices. Visit megaphone.fm/adchoices