Podcasts about Surpass

Mexico has surpassed the United States with the highest obesity rates, and the cause of this rise in obesity may surprise you. Dr. Berg's Keto and IF Lab: https://www.facebook.com/groups/drbergslab/ How to Bulletproof your Immune System FREE Course: https://bit.ly/39Ry3s2 FREE MINI-COURSE ➜ ➜ Take Dr. Berg's Free Keto Mini-Course! ADD YOUR SUCCESS STORY HERE: https://bit.ly/3z9TviS Find Your Body Type: https://www.drberg.com/body-type-quiz Talk to a Product Advisor to find the best product for you! Call 1-540-299-1557 with your questions about Dr. Berg's products. Product Advisors are available Monday through Friday 8 am - 6 pm and Saturday 9 am - 5 pm EST. At this time, we no longer offer Keto Consulting and our Product Advisors will only be advising on which product is best for you and advise on how to take them. Dr. Eric Berg DC Bio: Dr. Berg, 51 years of age is a chiropractor who specializes in weight loss through nutritional & natural methods. His private practice is located in Alexandria, Virginia. His clients include senior officials in the U.S. government & the Justice Department, ambassadors, medical doctors, high-level executives of prominent corporations, scientists, engineers, professors, and other clients from all walks of life. He is the author of The 7 Principles of Fat Burning. Dr. Berg's Website: http://bit.ly/37AV0fk Dr. Berg's Recipe Ideas: http://bit.ly/37FF6QR Dr. Berg's Reviews: http://bit.ly/3hkIvbb Dr. Berg's Shop: http://bit.ly/3mJcLxg Dr. Berg's Bio: http://bit.ly/3as2cfE Dr. Berg's Health Coach Training: http://bit.ly/3as2p2q Facebook: https://www.facebook.com/drericberg Messenger: https://www.messenger.com/t/drericberg Instagram: https://www.instagram.com/drericberg/ YouTube: http://bit.ly/37DXt8C Pinterest: https://www.pinterest.com/drericberg/

The SURPASS program of phase 3 clinical trials led to the 2022 FDA approval and positive CHMP opinion of the first GIP/GLP-1 receptor agonist, tirzepatide. Join Prof Carol Wysham for an examination of the clinical data from these trials and their potential impact on type 2 diabetes management. By completing this activity, you can qualify for 0.25 CME credits. To claim your credits, you must listen to the podcast and successfully pass the post-module assessment at https://diabetes.knowledgeintopractice.com, where you can find all past episodes of the podcast as well as other free CME resources. Learning objective After listening to this podcast series, learners will be able torecall the results of recent clinical trials for GIP/GLP-1 dual agonists References available here Disclosures Prof. Carol Wysham declares the following financial relationships from the past 24 months: Research Funding: Novo Nordisk; Eli Lilly Liberum IME staff, ACHL staff, and others involved with the planning, development, and review of the content for this activity have no relevant affiliations or financial relationships to disclose. The Academy for Continued Healthcare Learning (ACHL) requires that the faculty participating in an accredited continuing education activity disclose all affiliations or other financial relationships (1) with the manufacturers of any commercial product(s) and/or provider(s) of commercial services discussed in an educational presentation and (2) with any commercial supporters of the activity. All conflicts of interest have been mitigated prior to this activity. The content for this series was developed independently of the ineligible companies. All materials are included with permission. The opinions expressed are those of the faculty and are not to be construed as those of the publisher or grantors. This educational activity was planned and produced in accordance with the ACCME Standards for Integrity and Independence in Accredited Continuing Education. Recommendations involving clinical medicine in continuing medical education (CME/CE) activity must be based on evidence that is accepted within the profession of medicine as adequate justification for their indications and contraindications in the care of patients. All scientific research referred to, reported, or used in CME/CE in support or justification of a patient care recommendation must conform to the generally accepted standards of experimental design, data collection, and analysis. This CME/CE activity might describe the off-label, investigational, or experimental use of medications and/or devices that may exceed their FDA-approved labeling. Physicians should consult the current manufacturers' prescribing information for these products. ACHL requires its speakers to disclose that a product is not labeled for the use under discussion. Funding: This independent educational activity is supported by an educational grant from Eli Lilly. The educational content has been developed by Liberum IME in conjunction with an independent steering committee; Eli Lilly has had no influence on the content of this education.

The world changes rapidly, and technologies improve yearly, affecting business industries. You might think, how can your business adapt, utilize new technologies, and surpass your business competitors? As a business owner and a marketer, you first need to know your customer. Today's customers are much more sophisticated. They tend to have done much more homework before they pick up the phone, contact you, or whatever. Thus, you must acknowledge that and start creating content that resonates with your consumer. In this episode, we have Jonathan Rosenfeld. He is the owner and managing attorney of Rosenfeld Injury lawyers LLC. His company is a full-service personal injury law office that handles cases in Chicago and around the United States, intending to provide the best possible counsel for people and families who have been gravely wounded or died in accidents. In today's episode, Jonathan will share his company's difficulties and how they coped with them, excelled, and left their competitors behind. He will also give us some advice that will be helpful to business owners. Resources Jonathan Rosenfeld in Jury Lawyers Official SiteRosenfeld Injury Lawyers Facebook PageRosenfeld Injury Lawyers LinkedinRosenfeld Injury Lawyers YouTube ChannelPersonal Injury Law Podcast By Jonathan Rosenfeld Podcast

Last updated : 2022.09.22 The latest news from home and abroad, with a close eye on Northeast Asia and the Korean Peninsula in particular

In this episode the guys discuss the ever growing industry of plugins. Will we one day have no use for analog gear? Or will we always have a need for both.Please subscribe to our YouTube and rate our podcast it helps us alot!  https://www.helpmedevvon.com  Follow Us And Watch Video https://youtube.com/helpmedevvon https://www.instagram.com/helpmedevvon Follow The Cast Devvon Terrell https://instagram.com/helpmedevvon  LJ https://instagram.com/iamlevensjean  Courtney Taylor https://instagram.com/officialcourtneytaylor  

Chuck Heinz and Jamie Lent look back at the 1988 Mets, Zach Thomas' birthday, the talent of the Texas Tech running backs, and what position group will surpass preseason expectations.  

Welcome to Open Mic. A TJCS show where we just take your comments, theories and questions. YOU determine what we talk about! Support the sponsors of today's Open Mic: Mint Mobile - Wireless at Your Doorstep Go to https://www.mintmobile.com/CAMPEA to get your new wireless plan for $15 bucks a month and get the plan shipped to your door for FREE. Become A John Campea Channel Member - https://www.youtube.com/channel/UCYyDbdaja1UDNdFSwUrYVGA/join Learn more about your ad choices. Visit megaphone.fm/adchoices

In this episode, Jeremy and co-host Andrew Adams take on whether or not Students Should Surpass Instructors. Students Should Surpass Instructors - Episode 737 Are today's martial artists better than yesterday? Are instructors letting their students be better than them? In this episode, Jeremy and co-host Andrew Adams take on whether or not Students Should Surpass Instructors. After listening to the episode, it would be exciting for us to know your thoughts about it. Don't forget to drop them in the comment section below!

Intro  Janna Koch is the Community Manager. Janna used BookShark curriculum with her three daughters for several years, and she eventually joined the team as a convention representative, helping homeschoolers choose the right programs for their families at in-person events. Now she assists homeschoolers across the world in her new role as a community manager and host of the BookShark-sponsored podcast, Homeschool Your Way. She loves it when a parent, unsure of their ability to homeschool their child, discovers they are more than capable with the right curriculum!  Top three takeaways  Homeschool students surpass their public school peers because homeschooling teaches them to love to learn.   With the book shark curriculum you are not pigeon holing your child to fit into an age group but rather a reading level that is not age specific because children learn at different rates. Which lessens comparison amongst peers.   There is no right or wrong way or right or wrong time to homeschool, you are able to tailor this curriculum to your lifestyle.   Call to Action  Resources: https://www.bookshark.com/  Books: https://www.bookshark.com/browse-homeschool-products/  Promotions:  20% discount for All Subject Package 10% discount on single-subject packages.  Social Media Links  Website: https://www.bookshark.com/  Facebook: https://www.facebook.com/bookshark  Instagram: https://www.instagram.com/bookshark/  Twitter: https://twitter.com/bookshark/  YouTube: https://www.youtube.com/c/Bookshark  Pinterest: https://www.pinterest.ph/bookshark/  What is Next!  Thank you for supporting this show by listening and sharing with friends! If you like this podcast please rate and write a review of how this show has impacted or helped you!   Great ratings will accelerate the show's visibility to the nation so others can learn more about homeschool and find quality curriculum and the potentially join the homeschool community thus change the face of education forever!!   Who would have thought that we could change the education world with a click and a share!  Also if you would like to hear more about any specific educational topic please email me at realedtalk@gmail.com I would love to support your families educational needs in all areas!!   Bex Buzzie  The Homeschool Advantage Podcast  

Also in the news: Highland Park council passed resolution calling for tighter gin restrictions; Northern Illinois Food Bank opened new, larger facility; Retired Blackhawks play-by-play man Pat Foley will call Cubs game and more.

Also in the news: Highland Park council passed resolution calling for tighter gin restrictions; Northern Illinois Food Bank opened new, larger facility; Retired Blackhawks play-by-play man Pat Foley will call Cubs game and more.

Also in the news: Highland Park council passed resolution calling for tighter gin restrictions; Northern Illinois Food Bank opened new, larger facility; Retired Blackhawks play-by-play man Pat Foley will call Cubs game and more.

This week Mike and Scott discuss Disney subscriber numbers surpassing Netflix, Pandemic Stocks Hit hard, Jobless claims on the rise, Meta releasing a user's messenger data for abortion case, and Twitter may have as many as 50% bots on the platform.

What does the Chinese word: 超 (chāo) mean and what related words can we create from it? Listen to this podcast episode where Teacher Lin will explain the points below in under 5 minutes! Listen to learn: - The definition of 超 (chāo) - Related words that you can create with the word 超 (chāo) - Sentences that you can create using the related words Access the podcast transcript in the forum section on www.everydayeasychinese.com. You can access even more free Chinese language resources and downloadables. See you over there!

China deploys new AI to manage its power grid, TikTok to overtake Facebook in influencer marketing spending, and anti-piracy ads may be encouraging pirating.

In this week's episode of Autology, S&P Global Mobility experts discuss the topic of how automakers generate revenue from Connected Car data. Our experts from the connected car team discuss the connected services market forecast, automaker strategies, vehicle hardware capabilities, connected services and software paid subscriptions and consumer perceived value within different regions. We will also explore future approaches to increase revenue from connected cars, as more connected vehicles operate on the roads. These include leveraging connected technology to power over the air updates, features, and more. Tune in to find out the answers, and much more! Speakers: Anna H. Buettner, Principal Analyst, Connected Car & Vehicle Experience, S&P Global Mobility Fanni Li, Principal Analyst, Connected Car & Vehicle Experience, S&P Global Mobility Aseem Uppal, Senior Analyst, Connected Car & Vehicle Experience, S&P Global Mobility We'd love to hear your thoughts on this episode at our autology@ihsmarkit.com email, and you can find out much more across the autotechinsight.ihsmarkit.com website.

Steiny, Guru, and the callers discuss. 

Pastor Gutierrez continues to preach through the book of Matthew and the Sermon on the Mount.

On this episode of Locked On Spurs, host Jeff Garcia welcomes KENS 5's Tom Petrini to discuss the Las Vegas win total projection for the Spurs. Will the team surpass it or not? Also, is ex-Spur Dejounte Murray right when he says it will be more than a decade for the Spurs to be relevant again? Support Us By Supporting Our Sponsors! Built Bar Built Bar is a protein bar that tastes like a candy bar. Go to builtbar.com and use promo code “LOCKED15,” and you'll get 15% off your next order. BetOnline BetOnline.net has you covered this season with more props, odds and lines than ever before. BetOnline – Where The Game Starts! Rock Auto Amazing selection. Reliably low prices. All the parts your car will ever need. Visit RockAuto.com and tell them Locked On sent you. Learn more about your ad choices. Visit podcastchoices.com/adchoices

Adam Cheek and Mike Bachmann discuss the possibility of 16 different NASCAR Cup winners, Christopher Bell's New Hampshire win and more.

First day total online U.S. sales surpasses $6.0B, says Vivek Pandya on Amazon Prime Day. He recaps Amazon's (AMZN) sales performance from its annual Prime Day. He discusses the biggest discounts across online retailers, as well as how other retailers fared with their own online sales such as Costco (COST), Target (TGT), and Walmart (WMT). He then goes over the outlook for online retail. Tune in to find out more.

Randi Haseman gives updates on the Clinical Leadership industry.

Miguel-Anxo Murado, Madrid-based reporter, tells us about how a heatwave, soon to spread across Europe, is affecting Spain.

SurPASS: Automating device-based measurement in cohort study research- Prof Andreas Holtermann & Dr Nidhi Gupta Audio of the ProPASS' 4th Annual Meeting 27-28 April 2022 --- SurPASS is a sister project to ProPASS. SurPASS aims to develop and evaluate an e-system for measuring daily physical behaviours (physical activity, sedentary behaviours, and sleep) at work and non-work time of working adults. ​ The vision of the SurPASS project is to develop a system for measuring physical behaviours in large adult populations that: accurately measures physical behaviours has low participant burden (e.g. easy to use and high hygiene) has low administrative burden (e.g. cheap in cost, automated analytics, low logistic burden, high data security, low expertise demands) can be used in large-scale surveillances and cohorts ​can be used at national and international levels.   The system will consist of: A SENS motion® patch-based tri-axial sensor for long-term monitoring of physical behaviours to be attached to the thigh. Such device can be sent to participants via postal mail and participants can attach the sensor themselves. The device can measure and store data for several weeks, and encrypt and transmit data to a secured server. An app on participants' smartphone to initialise the measurements, provide a user guide, automatically upload data to a secured server, and provide visual feedback on the physical behaviours to the participants after the measurement period. A web application for administrators for registering participants, managing sensors, and viewing and exporting data. A secured server based on SENS motion® technology for automatically importing encrypted data from a sensor (via app), decrypting it and storing it regularly cleaning and analysing sensor data based on previously validated algorithms to identify physical behaviours. --- Physical Activity Researcher Podcast, ProPASS, and ISPAH collaborate to be able to bring you the events and webinars content in easy-to-consume audio format to your favourite podcast app. The video recording is now available the Members Area of the ISPAH Website.

0:00 - Intro 0:48 - Jets 15:14 - Dolphins 28:18 - Patriots 38:34 - Bills We have made it to the end of our divisional breakdown, ending with the AFC East. We talk about what kind of offense we expect to see from the Miami Dolphins, if anyone on the Patriots will have significant fantasy value, Garrett Wilson's impact on Zach Wilson, and why we expect a massive 3rd season from Gabriel Davis!

Dr. Robin Lavitch talks with Josh, Mike, & Maurice about the importance of recharging your batteries.

Overview: Today, we discuss Konga, the Nigerian e-commerce company. We'll explore the Konga story across 5 areas: We'll give some context about the Nigerian e-commerce sector Konga's early history Product & Monetization strategy Konga sale Overall outlook This episode was recorded on July 3, 2022 Companies discussed: Konga, Jumia, Naspers, Kinnevik, Jiji, OLX, Amazon, Takealot, Yudala & Zinox Business concepts discussed: Ecommerce, marketplaces, classifieds, fundraising strategy, Blitzscaling risks, market readiness & Africa expansion Conversation highlights: (01:13) - Konga background and why we're talking about it (09:19) - Nigeria background and context (14:00) - Nigeria commerce context c. 2012 (17:00) - Background on Sim Shagaya (29:02) - Konga launch strategy and fundraising (45:55) - Konga monetization (50:51) - Competition with Jumia (1:04:35) - Konga's business lines (1:08:10) - Konga's declining fortunes and sale to Zinox (1:27:00) - Lessons for startups from Konga (1:39:28) - Bankole's overall thoughts and outlook (1:53:57) - Olumide's overall thoughts and outlook (1:57:34) - Recommendations and small wins Olumide's recommendations & small wins: Recommendation: Eboys - Book about the history of Benchmark Recommendation: Different kinds of smart (Morgan housel blog post). Article so good that I subscribed to his entire blog Small win: Listening to 20MinVC episode with Fabrice Grinda (OLX founder) the day after I published Afrobility OLX episode Interested in investing in Africa Tech with Olumide: Read about Adamantium fund & contact me at olumide@afrobility.com Founders looking for funding: If you're a B2B founder working on Education, Health, Finance or food, please contact me for funding at olumide@afrobility.com Bankole's recommendations & small wins: Recommendation: Business Breakdowns Podcast - Amazon Aggregators Small win: in-person meetings with friends at work Other content: Chinese E-Commerce to Surpass 50% of Total Retail Sales | BoF - link Listeners, Operators & Investors: Email info@afrobility.com, we'd love to partner or get your feedback. All episodes on Afrobility.com

WWJ's John McElroy - GM, Ford to surpass Tesla in EV share

We're talking all things Prizm Basketball as the latest edition of the highly anticipated product comes out this Friday. The guys discuss this year's rookie class and if this year's edition will have staying power despite it's late release. Plus, the guys discuss the state of high end baseball releases with the release of 2022 Topps Definitive, what PSA's decision to grade 84/85 Star Michael Jordan cards will do to his rookie card market and Dan & Cody sit down with Jeremy, the lucky man who now owns the massive 1 of 1 Mac Jones Flawless RPA pulled by Dan a few weeks back.

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Will China Surpass US Military Power in Asia?

Robin talks about dealing with difficult people and the adjustments people make to obtain clarity  or avoid escalation.

Derrick Jenkins, Head of Marketing, discusses the importance of digital personalization in B2B marketing. Your data is only as good as its expiration date and the case is no different for competitive intelligence. How will you be able to anticipate your competitor's next move and the data you have on them is out of date? Today, Derrick talks about using sales intelligence to surpass the competition. Show NotesConnect With:Derrick Jenkins: Website // LinkedInThe MarTech Podcast: Email // Newsletter // TwitterBenjamin Shapiro: Website // LinkedIn // TwitterSee Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

BRONCO FOCUS EVERY MONDAY-THURSDAY AT 3:45 P.M. ON 95.3 FM AND KTIK APP: Bob Behler, the voice of Boise State athletics, has a conversation about over/under win totals for Mountain West football teams in 2022. Can BSU reach 9.5 wins this season?

In this 3 part series, Dr. Robin Lavitch talks to Mike, Maurice, & Josh about the differences between Goal Setting vs Goal Getting.

Alison Mitchell, Brett Sprigg and Charu Sharma discuss the future of Test cricket following comments made by the ICC chairman, Greg Barclay who's questioned the direction of the longest format of the game, particularly in women's cricket. The team celebrate Joe Root's milestone moment during the first Test with New Zealand at Lord's, becoming the 14th player to reach 10,000 Test runs and ask if the former England captain could surpass the legendary Sachin Tendulkar's run record. We wave goodbye to another Indian legend, as Mithali Raj announces her retirement from international cricket. Plus we speak to the President of the Nigeria Cricket Federation after they received a global award from the ICC for their efforts to use cricket as a tool for good. Photo: Joe Root of England is applauded all the way back into the pavilion after steering England to victory during Day 4 of the First Test match between England and New Zealand at Lord's Cricket Ground. (Credit: Getty Images)

► Why Bitcoin WILL Surpass the Market Cap of Gold ($11T) We dive into a few articles outlining golds benefits but also its failures, and why it didn't become money. ► Fail: Imagine getting paid to have sex with a partner or alone? Look no further some shitcoiners have made this into a useless token, we dive into this travesty of a project. ✔ Software Releases: Nix-bitcoin-0.0.72 ► https://github.com/fort-nix/nix-bitcoin/releases/tag/v0.0.72 ✔ Check out our Sponsors, support Bitcoin ONLY Businesses: ✔ Crypto Cloaks: ► http://www.cryptocloaks.com?afmc=2h&utm_campaign=2h&utm_source=leaddyno&utm_medium=affiliate ► For all of your 3D printed needs: Bitcoin Node Cases, Lightning Network Code Cases, BTC keychains, coasters, 3D Printed Honey Badgers, wallet mounts and a whole lot more ! ► USE PROMO CODE 'SIMPLYBITCOIN' FOR 5% OFF THE CRYPTOCLOAKS.COM STORE! ✔ Citadel21: ► https://www.citadel21.com ► A Bitcoin cultural zine. Bitcoin culture is rich and varied. It contains a multitude of voices, opinions and flavors. Only 1000 of each volume are made. ✔ Swan: ► https://www.swanbitcoin.com ► Swan is the best way to build your Bitcoin stack, with automated Bitcoin savings plans and instant purchases. Serving clients of any size, from $10 to $10M+ ✔ CypherSafe: ► https://cyphersafe.io ► When you've decided to be your own bank and hold your bitcoin yourself, it's time to create a physical backup to protect those keys and your bitcoin. CypherSafe offers a full line of physical stainless steel products to help you protect your bitcoin from various modes of failure. ✔ Represent Clothing: ► https://www.representltd.com ► Check out Represent LTD's full clothing line including collabs, originals & collections. Super comfortable, great fit and Style, there is something for everyone: hoodies, tees, tanks, jackets and more! It's your life...represent accordingly. ► USE PROMO CODE SIMPLY-BITCOIN FOR 10% OFF ANYTHING IN THE REPRESENT CLOTHING STORE! ✔ NODL : ► https://www.nodl.eu ► Running Bitcoin, just like in Hal Finney's legendary tweet. Use all the Lightning features thanks to your always on device. Easy to Use, Everyone can run a NODL. Privacy focused. ✔ Join our Telegram, Give us Memes to Review! ► https://t.me/TheSimplyBitcoinChannel ✔ Follow Us! ► https://twitter.com/SimplyBitcoinTV ► https://twitter.com/BITVOLT7 ► https://twitter.com/Coinicarus ✔ Special Thanks to these Awesome Bitcoiners: ► https://bitcoin.clarkmoody.com/dashboard/ ► https://t.me/nobullshitbitcoin ► https://twitter.com/DocumentingBTC ✔ Descriptions & Thumbnails by, Meg: ► https://twitter.com/btcmeg ► We are a proud supporter of Bitcoin only businesses. ⚡️ simplybitcoin@getalby.com DISCLAIMER: All views in this episode are our own and DO NOT reflect the views of any of our guests or sponsors. Timecodes: 0:00 - Intro 0:15 - BTC Stats 8:45 - Daily Fail 24:55 - Meme Review 32:14 - BTC News 53:47 - Software Release #Bitcoin #BitcoinDailyNews #BitcoinDailyRecap

The Tennessee Titans should have been watching closely on Monday when Los Angeles Rams star Aaron Donald got new money on his contract as young star Jeffery Simmons will be expecting a pay day in the near future. Can Jeffery Simmons take away the top interior defensive linemen spot from Donald?? Also, what should we reasonably expect from Derrick Henry in 2022? Finally, what expected win for the Titans will ultimately be a loss in 2022? Tyler dives in to your questions on today's Twitter Tuesday!! Follow Tyler on Twitter @TicTacTitans Follow the show on Facebook @LockedOnTitansPod Subscribe to the Locked On Titans YouTube channel: https://www.youtube.com/c/LockedOnTitans Support Us By Supporting Our Sponsors! Built Bar Built Bar is a protein bar that tastes like a candy bar. Go to builtbar.com and use promo code “LOCKED15,” and you'll get 15% off your next order. BetOnline BetOnline.net has you covered this season with more props, odds and lines than ever before. BetOnline – Where The Game Starts! Rock Auto Amazing selection. Reliably low prices. All the parts your car will ever need. Visit RockAuto.com and tell them Locked On sent you. Blue Nile Make your moment sparkle with jewelry from Bluenile.com, and LOCKED ON SPORTS listeners get $50 off purchases of $500 or more using code LOCKEDON. Learn more about your ad choices. Visit podcastchoices.com/adchoices

Shaun and Ryan lay out some numbers and hypotheticals to see what kind of chance Aaron Judge has to become the Yankees' new single-season home run king. Subscribe to Bomber Brothers HERE! Learn more about your ad choices. Visit podcastchoices.com/adchoices

Shaun and Ryan lay out some numbers and hypotheticals to see what kind of chance Aaron Judge has to become the Yankees' new single-season home run king. Subscribe to Bomber Brothers HERE! Learn more about your ad choices. Visit podcastchoices.com/adchoices

Shaun and Ryan lay out some numbers and hypotheticals to see what kind of chance Aaron Judge has to become the Yankees' new single-season home run king. Subscribe to Bomber Brothers HERE! Learn more about your ad choices. Visit podcastchoices.com/adchoices

Episode 96: Tirzepatide. By Maria Beuca, MS3, Ross University School of Medicine. Comments by Hector Arreaza, MD.  Today is May 19, 2022, and we want to talk about a new drug that was recently approved by the FDA on May 13, 2022, for the treatment of type 2 diabetes.  This is Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California. Our program is affiliated with UCLA, and it's sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home.This podcast was created for educational purposes only. Visit your primary care physician for additional medical advice.This drug is known as tirzepatide, also known by the brand name Mounjaro®. It is an injection given once a week that mimics the effects of two hormones: GIP (Glucose-dependent Insulinotropic Polypeptide) and GLP-1 (Glucagon-Like Peptide-1). These two hormones are involved in lowering blood glucose levels after eating by stimulating insulin release, they are “incretin” hormones.  What is unique about this new drug, tirzepatide, is that it is the first and only approved single molecule that binds and activates BOTH GIP and GLP-1 receptors. Because of this dual incretin action, it has also been referred to as a “twincretin.” It increases first and second-phase insulin secretion AND decreases glucagon levels in a glucose-dependent manner, and this lowers both fasting blood glucose levels and post-meal glucose levels.  It is also an appetite suppressant, causing significant weight loss in patients with type 2 diabetes.  Tirzepatide vs semaglutide: Semaglutide (Ozempic®) was approved for the treatment of type 2 Diabetes in December 2017, and then approved for weight loss in June 2021 under the brand name Wegovy®. Semaglutide is a GLP-1 receptor agonist, but it does not work on GIP receptors. Due to this dual incretin action of tirzepatide, it has now been shown to be superior at all doses to semaglutide.  Evidence: There was a 40-week study done in July 30, 2019- February 15, 2021, called “SURPASS-2” where 1879 patients were assigned in a 1:1:1:1 ratio to either semaglutide 1 mg or to the 3 different doses of tirzepatide (5 mg, 10 mg, 15 mg). The patients all had a mean HbA1c of 8.28% at the start of the study.  By the end of the study, the patients on tirzepatide at the different doses had an A1c of 6.2% for the 5mg dose, 6 % for the 10 mg dose, and 5.9% for the 15 mg dose, whereas the patients on semaglutide had their HbA1c at 6.42%. On tirzepatide, about 82-86% of patients decreased their HbA1c below 7.0%, compared to 79% of the patients on semaglutide. Comment: It seems like a race: All GLP-1 RA are competing to reach the lowest A1C and get the lowest weight. What is more amazing is that up until now, an A1c level < 5.7% without a risk of hypoglycemia was not considered attainable with current treatment options, but with tirzepatide, this goal was met.  Fasting Serum glucose levels prior to treatment: 173. Fasting Serum glucose after treatment with:Tirzepatide 5 mg: 117.0,     10 mg:  111.3,    15 mg:  109.6. Semaglutide 1 mg: 124.4.Comment: No hypoglycemia. Weight loss for patients on Tirzepatide was also greater, patients lost about 4 to 12 lbs more (1.9 to 5.5 kg) than with semaglutide. Weight loss in 40 weeks: Tirzepatide:  5mg: 16 lbs (7.6 kg), 10 mg: 20 lbs (9.3 kg), 15 mg: 24 lbs (11.2 kg). Semaglutide: 12 lbs (5.7 kg). Other positive effects that many patients experience were: improved lipid profile, blood pressure, liver enzymes, and improved biomarkers of insulin sensitivity. Another Phase 3 clinical trial of tirzepatide that is currently ongoing is the SURMOUNT-1, which focuses on the weight loss benefits of the drug, and results are expected in 2023. Preliminary data shows that tirzepatide has similar weight loss as bariatric surgery.  Cost: Tirzepatide (Mounjaro) is a rival for Novo Nordisk's semaglutide sold as Ozempic and Wegovy. Institute for Clinical and Economic Review (ICER) released the final report for tirzepatide cost: $5,500-5,700/year. Semaglutide: Ozempic, Wegovy ~ $16,000/year without insurance. Comment: [3 times cheaper]. 4x more expensive in the US, rarely covered by health insurance for weight loss Administration: 1x week, any time, with or without meals.  Doses: 2.5 mg, 5 mg, 7.5 mg, 10 mg, 12.5 mg, 15 mg. Week 1-Week 4: Start with 2.5 mg injection 1x week. Treatment initiation, not intended for glycemic control. Week 5-Week 8:  Increase to 5.0 mg 1x week. >Week 9: may increase dose another 2.5 mg every 4 weeks as needed for glycemic control. Maximum dose: 15 mg 1x week. Adverse Reactions: Nausea, diarrhea, decreased appetite, vomiting, constipation, dyspepsia, abdominal pain.  Drug Interactions:  Delays gastric emptying, can affect absorption of oral medications taken at the same time. Warfarin = monitor more closely. Contraindications: Type 1 diabetes, pregnancy, personal or family history of medullary thyroid carcinoma or Multiple Endocrine Neoplasia syndrome type 2 (MEN 2: medullary thyroid cancer, parathyroid tumors, and pheochromocytoma). Thyroid c-cell tumors were noticed in rats. Symptoms of thyroid cancer: mass in neck, dysphagia, dyspnea, persistent hoarseness. Warnings & Precautions:Pancreatitis: Has been reported in clinical trials. Discontinue if suspected. Hypoglycemia: May cause hypoglycemia if used with insulin or insulin secretagogues (sulfonylurea). Reducing dose of these may be necessary.Hypersensitivity is possible.Acute Kidney Injury: No dosage adjustment needed, but monitor renal function if patient has renal impairment with severe GI reactions. It may cause nausea, vomiting and diarrheaà dehydrationà acute kidney injury. Can worsen chronic renal disease or renal impairment.Severe gastrointestinal disease: May cause Gastrointestinal adverse reactions, sometimes severe. Not recommended in patients with severe gastrointestinal disease, may aggravate symptoms, has not been studied.Acute gallbladder disease: Also has occurred in 0.6% of patients in trials. monitor and follow-up if cholelithiasis is suspected. Diabetic retinopathy: Not studied, monitor for complications. Rapid glucose control can cause temporary worsening of diabetic retinopathy, monitor these patients. Pregnancy: May cause fetal harm.Females of Reproductive potential: If using oral contraceptives, switch to non-oral contraceptive or add a barrier method for 4 weeks after starting drug and for 4 weeks after increasing dose.____________________________Now we conclude our episode number 96 “Tirzepatide.” Maria explained that tirzepatide has a dual effect on both GLP-1 and GIP receptors. The medication has been approved for the treatment of type 2 diabetes, but it has been proven to be very effective for weight loss also, almost comparable to bariatric surgery. Remember the contraindications and side effects of this medication to use it appropriately. The good news with tirzepatide is the cost —almost 3 times lower cost than its main competitor. Even without trying, every night you go to bed being a little wiser.This week we thank Hector Arreaza and Maria Beuca.Audio edition: Suraj Amrutia. Thanks for listening to Rio Bravo qWeek Podcast. If you have any feedback, contact us by email at RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. See you next week! _____________________References:Dockrill, Peter. “Experimental Drug Breaks Record for Weight Loss in Latest Clinical Trial Results.” ScienceAlert, 9 May 2022, https://www.sciencealert.com/experimental-drug-breaks-record-for-weight-loss-in-latest-clinical-trial-results.Frías, Juan P., et al. “Tirzepatide versus Semaglutide Once Weekly in Patients with Type 2 Diabetes: Nejm.” New England Journal of Medicine, 5 Aug. 2021, https://www.nejm.org/doi/full/10.1056/NEJMoa2107519. “Label as Approved by FDA. - Pi.lilly.com.” Mounjaro Prescribing Information, Lilly USA, LLC, May 2022, https://pi.lilly.com/us/mounjaro-uspi.pdf. Mounjaro. Prescribing Information. Lilly USA, LLC.  May 2022. https://pi.lilly.com/us/mounjaro-uspi.pdf?s=pi

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It's impossible to fully convey the staggering toll of COVID-19, with the number of deaths in the U.S. from the virus equal to losing the entire populations of Boston and Pittsburgh. But numbers describe just one part of this and the lives it has impacted. Ed Yong, of The Atlantic, who has been writing about the COVID-19 for more than two years, joins Judy Woodruff to discuss. PBS NewsHour is supported by - https://www.pbs.org/newshour/about/funders

Today's Co-Hosts: Ben Criddle (@criddlebenjamin) Subscribe to the Cougar Sports with Ben Criddle podcast:Apple Podcastshttps://itunes.apple.com/us/podcast/cougar-sports-with-ben-criddle/id996764363Google Podcastshttps://www.google.com/podcasts?feed=aHR0cHM6Ly93d3cuc3ByZWFrZXIuY29tL3Nob3cvMTM2OTkzOS9lcGlzb2Rlcy9mZWVkSpotifyhttps://open.spotify.com/show/7dZvrG1ZtKkfgqGenR3S2mPocket Castshttps://pca.st/SU8aOvercasthttps://overcast.fm/itunes996764363/cougar-sports-with-ben-criddle-byuSpreakerhttps://www.spreaker.com/show/cougar-sports-with-ben-criddleStitcherhttps://www.stitcher.com/s?fid=66416iHeartRadiohttps://www.iheart.com/podcast/966-cougar-sports-with-29418022TuneInhttps://tunein.com/podcasts/Sports-Talk--News/Cougar-Sports-with-Ben-Criddle-p731529/