Podcasts about their impact

In this episode Marc and Kristitna welcome special guest Andrea to the discussion. This is the first in a new segment that we will revisit from time to time, in which we discuss popular genX movies and examine the "life lessons" they try to impart. Here we speak about some of the life lessons in the Breakfast Club (if you mess with the bull, you get the horns; don't judge a book by its cover) as well as dig into the stereotypes of each of the character and how and how they come to show us more of who they really are. Thanks for coming to listen to us each week! Please join us on social media @seriousproduce and @marceatspeach on Twitter and @genxtemporaneous on facebook and instagram. Hughes, John. 1985. The Breakfast Club. United States: Universal Pictures. Gora, Susana. You Couldn't Ignore Me If You Tried: The Brat Pack, John Hughes, and Their Impact on a Generation. 2011. Crown. --- Support this podcast: https://anchor.fm/marc-snediker/support

For as long as we've been building things, the construction industry has successfully found ways to navigate tough times.  In recent years the industry once again has adapted to rapidly changing conditions in ways that will impact how construction businesses operate moving forward.  Two leaders from CRB , Greg Casper , Director of Estimating, and Marc Hanson , Senior Director of Construction Operation – Midwest Region, join the show to share the lessons they've learned while navigating these recent challenges.  We discuss: The biggest areas of risk 3 strategies for navigating uncertainty and risk New approaches to prefabrication Examples of technology improving project delivery    Mentioned during the show: Worried about construction cost inflation?  EP 22 - Construction Contracts & Payments: Tips for Subcontractors & GCs w/ Karalynn Cromeens  Harnessing the Data Advantage in Construction  After the Revolution: Understanding a Decade of Change in Project Delivery Systems and Their Impact on Project Performance   Digital Builder is hosted by Eric Thomas of Autodesk .  Hear more episodes like this one by subscribing to Digital Builder on Apple Podcasts , Spotify , Google Play , YouTube , or wherever you listen to podcasts.  Can't see the links? Just search for Digital Builder in your favorite podcast player.

Moms and Their Impact on the Home: Mark 1:29-38 Pastor Ronnie preaches from Mark 1: Jesus heals Simon's mother-in-law. This week, Pastor Ronnie challenges the audience to consider whether or not the home they've created is a place where Jesus is welcomed, where ministry happens and is a place of prayer. Is yours?

Every week, the team at Better Than Success round up the biggest and most important news, policy changes, funding sources and investing opportunities for real estate investors and small business owners. It's the market information you need to know before pulling the trigger on your next or first investment. The Latest Tax Proposals and Their Impact on Real Estate Investing https://www.eisneramper.com/real-estate-investing-tax-proposal-0422/   How to Make a Fortune in Long-Distance Real Estate Investing https://www.msn.com/en-us/money/realestate/how-to-make-a-fortune-in-long-distance-real-estate-investing/ar-AAWtWt1?ocid=finance-verthp-feeds&cvid=208796d7219b4d458519b3b4f95c1d75 ‘It Will Take Time for Surging Mortgage Rates To Rebalance the Market': Home Prices Continue To Skyrocket, but Buyers Could See Relief Soon https://www.realtor.com/news/real-estate-news/it-will-take-time-for-surging-mortgage-rates-to-rebalance-the-market/ To see our upcoming events, visit betterthansuccess.com/events. Check out our YouTube channel at youtube.com/betterthansuccess.

Driverless vehicles may help improve transportation efficiency. Today's vehicles come with many types of driver-assist technology, but will the vehicles of the future be completely driverless? Steve Karamihas, PhD, from the University of Michigan Transportation Research Institute, explores the current and future state of autonomous vehicles.   The post Autonomous Vehicles & Their Impact on the Infrastructure Network appeared first on AgileAssets.

Our podcast's mission is to inform the public about how one's diet when pregnant directly affects their baby and the negative effects of malnutrition for both the mother and the baby. We talk about many different side effects a poor diet when pregnant can lead to and even bring up solutions for this problem such as government intervention. Sources "The role of Nutrition in Infant Mortality: A Public Health Perspective", https://asphn.org/wp-content/uploads/2017/10/The-Roll-of-Nutrition-in-Infant-Mortality-A-Public-Health-Perspective-ASPHN-Brief.pdf "Predictors of Dietary Quality in Low-Income Pregnant Women: A Path Analysis" :NIH,https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3164915/ "Minerals in Pregnancy and Their Impact on Child Growth and Development":NIH, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7730771/ "6 facts about economic inequality in the U.S.: Pew Research Center", https://www.pewresearch.org/fact-tank/2020/02/07/6-facts-about-economic-inequality-in-the-u-s/

Dr. Peter J. Hotez, M.D., Ph.D. (https://peterhotez.org/), is Dean of the National School of Tropical Medicine and Professor of Pediatrics and Molecular Virology and Microbiology at Baylor College of Medicine where he is also Chief of the Section of Pediatric Tropical Medicine and the Texas Children's Hospital Endowed Chair of Tropical Pediatrics . Dr. Hotez is also Rice University's Baker Institute fellow in disease and poverty and Co-Director of Parasites Without Borders (https://parasiteswithoutborders.com/), a global nonprofit organization with a focus on those suffering from parasitic diseases in subtropical environments. Dr. Hotez is an internationally recognized physician-scientist with expertise in neglected tropical diseases and vaccine development. He leads the only product development partnership for developing new vaccines for hookworm, schistosomiasis and Chagas disease, and is just coming off a major win for emergency use approval of his team's Corbevax protein sub-unit COVID-19 vaccine, of which he, and previous guest to the show, Dr. Maria Elena Bottazzi, were recently nominated for a Nobel Prize. Dr. Hotez is the author of more than 400 original papers, as well as the books Forgotten People, Forgotten Diseases - The Neglected Tropical Diseases and Their Impact on Global Health and Development, Blue Marble Health - An Innovative Plan to Fight Diseases of the Poor amid Wealth, Vaccines Did Not Cause Rachel's Autism: My Journey as a Vaccine Scientist, Pediatrician, and Autism Dad, and Preventing the Next Pandemic: Vaccine Diplomacy in a Time of Anti-science. Dr. Hotez previously served as president of the American Society of Tropical Medicine and Hygiene, the Sabin Vaccine Institute and as founding editor-in-chief of PLoS Neglected Tropical Diseases. He is an elected member of the Institute of Medicine (IOM) of the National Academy of Sciences. In 2011, he was awarded the Abraham Horwitz Award for Excellence in Leadership in Inter-American Health by the Pan American Health Organization of the World Health Organization. In 2015, the White House and U.S. State Department selected Dr. Hotez as a United States science envoy. Dr. Hotez obtained his undergraduate degree in molecular biophysics from Yale University (Phi Beta Kappa), followed by a Ph.D. in biochemical parasitology from Rockefeller University, and an M.D. from Weill Cornell Medical College.

We know from last week's episode that estrogen plays a vital role in bone, breast, vaginal health and more and that too little estrogen can be concerning. But what happens when we have too much estrogen? Tune in to learn about symptoms of excessive estrogen, reasons for estrogen dominance, and our thoughts on the various forms of estrogen replacement therapy.    In this episode, we discuss risks of synthetic estrogen including pills, creams, vaginal rings, patches and more. Learn how to address estrogen dominance in a functional medicine perspective, what testing is needed before going on any form of hormone replacement therapy, and how bioidentical hormones are different. Plus we discuss risks of excessive estrogen and how you can balance out levels with diet, lifestyle, and supplemental support.    Also in this episode:  Episode 280 Why You Need Estrogen Episode 233 Estrogen Dominance Drivers of Excessive EstrogenBirth Control ConcernsEpisode 106 Regulating Your Cycle Episode 107 Regulating Your Cycle Part 2 Types of Estrogen Replacement Therapy Functional Approach to Hormone ReplacementNeurohormone Lab Episode 149 Getting Your Cycle Back Julva Cream The Difference Between Bioidentical and Synthetic Hormones Estrogen Dominance Symptoms Risks of Excessive Estrogen Lifestyle Support  Consider Removing DairyHormones in Dairy Foods and Their Impact on Public Health Episode 82 Pros and Cons of Dairy Grassfed Whey Protein Remove Plastics from the HouseholdBamboo Kids Dining Set Poop DailyPhytoFiber Relax and Regulate Probiotic Challenge Maintain Healthy Body Composition and Muscle Mass12 Week Ketosis Program 10 Day Real Food Detox Food As MedicineWhole Roasted Cauliflower  Kale Chips Supplement SupportBroccoDetox Reset Restore Renew Detox Packs Phytofiber Relax and Regulate B-Complex Women's Hormone Bundle Stress Manager Bundle Bio-C Plus Estrogen Dominance Protocol   Sponsors for this episode:  This episode is sponsored by Santa Cruz Medicinals, makers of potent and affordable CBD with effective dosing. For more information check out www.scmedicinals.com and use code ALIMILLERRD for 15% off your order. 

On Episode 11 of the Stroke Alert Podcast, host Dr. Negar Asdaghi highlights two articles from the December 2021 issue of Stroke: “Baseline Cognitive Impairment in Patients With Asymptomatic Carotid Stenosis in the CREST-2 Trial” and “Serious Adverse Events and Their Impact on Functional Outcome in Acute Ischemic Stroke in the WAKE-UP Trial.” She also interviews Dr. Mark Parsons about his article “Stroke Patients With Faster Core Growth Have Greater Benefit From Endovascular Therapy.” Dr. Negar Asdaghi:         1) Can the presence of a high-grade asymptomatic carotid stenosis result in development of early dementia? 2) Have you ever wondered if a random poststroke urinary tract infection or hospital-acquired pneumonia can impact the 90-day poststroke outcome? 3) When it comes to the beneficial effect of endovascular thrombectomy, what is the concept of late window paradox, and why do we need to know about this and its relation with the speed of infarct growth? These are the questions that we will tackle in our December podcast. We're covering the best in Stroke. Stay with us. Dr. Negar Asdaghi:         Welcome back to the Stroke Alert Podcast. My name is Negar Asdaghi. I'm an Associate Professor of Neurology at the University of Miami Miller School of Medicine and your host for the monthly Stroke Alert Podcast. For the December 2021 issue of Stroke, we have a large selection of topics, from whether adjusting antiplatelet therapies after stenting for intercranial aneurysms can potentially reduce ischemic events, to studying the outcomes of patients with reversible cerebral vasoconstriction syndrome and analysis from a nationwide study in the United States, which I encourage you to review in addition to listening to our podcast today. Later in the podcast, I have the pleasure of interviewing Dr. Mark Parsons, from the University of New South Wales in Sydney, Australia, on his work suggesting that the beneficial effect of endovascular thrombectomy may be modified based on the speed of infarct growth, from the time of symptom onset to the time when the patient is being considered for reperfusion therapies. But first with these two articles. Dr. Negar Asdaghi:         It has been suggested that the presence of chronic high-grade carotid stenosis can result in early cognitive decline, even in the absence of ischemic stroke secondary to the carotid disease. Multiple mechanisms for this decline have been proposed, including an alteration of cerebrovascular reactivity and ipsilateral hemispheric hypoperfusion. Now, if this is true, then asymptomatic patients harboring a high-grade carotid stenosis would have a lower cognitive status than their age and risk factor in matched counterparts. And this is the exact topic that Dr. Ronald Lazar from the Department of Neurology at the University of Alabama and colleagues studied in this issue of the journal, in their article titled “Baseline Cognitive Impairment in Patients With Asymptomatic Carotid Stenosis in the CREST-2 Trial.” Dr. Negar Asdaghi:         Now, a very quick recap of the CREST-2 Trial. You will recall that CREST-2 is an ongoing randomized trial of patients over 35 years of age with asymptomatic carotid disease of equal or greater than 70%. Asymptomatic is defined as absence of ipsilateral stroke or TIA symptoms within 180 days prior to randomization. Also, a reminder, that to be able to be enrolled in the CREST-2 Trial, patients had to be independent, with no diagnosis of dementia, and they were then randomized to either intensive medical management versus carotid artery stenting, or intensive medical management alone versus carotid endarterectomy. It's important to keep in mind that a secondary outcome of CREST-2 is to see whether carotid intervention over intensive medical management is better in reducing cognitive decline over time in this patient population. Dr. Negar Asdaghi:         Obviously, we'll have these results after the completion of the CREST-2 trial and its follow-up completion, but in the current study, the authors were interested to compare the baseline cognitive function of the CREST-2 candidates, and they were able to compare this baseline cognitive status to participants of the REGARDS population-based study. Now, the acronym for REGARDS stands for "Reasons for Geographic and Racial Differences in Stroke." This was a population-based study in the United States that included over 30,000 community-dwelling White and Black adults over the age of 45. So, think about the REGARDS cohort as the stroke-free participants without the high-grade carotid stenosis. Dr. Negar Asdaghi:         So, to match the two populations, the authors included only CREST-2 participants that were older than 45 years of age and did not have any prior strokes. So, that gave them a sample size of 786 patients for the current analysis with a complete neurocognitive battery of four tests administered over the phone, in the same order in both studies. So, let's go over these cognitive tests. The test included the Word List Learning Sum, assessing the cognitive domain of learning; the Word List Recall, which is a test of memory; and the two tests for executive function, Word Fluency for animal names and fluency for the single letter 'F'; and a brief screen for depression. Dr. Negar Asdaghi:         So, simply put, we have four cognitive tests assessing the three cognitive domains of learning, memory, and executive function. And depending on how the person did on each test, it gave the investigators Z scores for each participant in each category and then they compiled the Z scores in a percentile tabulation for the CREST-2 population and compared these percentiles to the normative data obtained for the REGARDS population. Dr. Negar Asdaghi:         So, what they found was that, well, not surprisingly, the population of CREST-2 had a higher prevalence of cardiovascular risk factors, things like hypertension, elevated lipids, smoking and diabetes. Slightly more than half, exactly 52% of the CREST-2 patients, had a target carotid stenosis vessel on the right side. And then they did some complex statistical models, adjusting for age, race and educational level, and then further adjusting for some vascular risk factors, such as hypertension, diabetes, dyslipidemia, and smoking, for each cognitive test, and they found that the overall Z score for patients in CREST-2 was significantly below expected for higher percentiles and marginally below expected for the 25th percentile for all four cognitive tests, as compared to the normative population. Dr. Negar Asdaghi:         For example, if they were expecting that 90% of the CREST-2 population would score in the 75th percentile for a particular test, or at 95th percentile on a different test, these percentages were significantly lower in the CREST-2 candidates. The greatest cognitive differences were detected for Word List Delay, which is a test of memory, followed with the Word List Learning, which is a test for learning. And the results really did not change when they adjusted for the vascular risk factors, and importantly, unchanged when they adjusted for right- or left-sided stenosis of the carotid, which is important, as language plays an important role in assessment of memory function. Dr. Negar Asdaghi:         So, what did we learn from this study? Well, number one, poor cognition is associated with harboring high-grade asymptomatic carotid occlusive disease, an effect that was only modestly attenuated by further adjustment for other risk factors. Number two, patients with high-grade carotid stenosis showed a significantly lower cognitive performance in the learning and memory domains. This profile of cognitive decline is different than what was typically expected to be seen in the case of vascular dementia, where abnormalities are predominately seen in the test of executive function. Number three, though we don't know the precise mechanism for cognitive impairment in the setting of carotid stenosis, cerebral hypoperfusion seemed to be the leading plausible cause as hippocampus and amygdala are known to be susceptible to hypoperfusion, and the findings of the current study show that the predominant impairment seen in patients with carotid disease seemed to be involving memory and learning. So, really important findings, and lots to still learn on this topic. Dr. Negar Asdaghi:         The occurrence of adverse events during acute treatment and within the first few weeks of acute ischemic stroke are common and can negatively influence the course and clinical outcomes of stroke patients. Serious adverse events, or SAEs, are defined as life-threatening events resulting in death or requiring hospitalization, prolongation of hospitalization, or resulting in significant disability, and they can be either neurological, such as recurrent ischemic events, hemorrhagic complications, seizure disorders, but also can include a myriad of systemic complications, including, but not limited to, occurrence of deep vein thrombosis, pulmonary emboli, cardiac arrhythmias, various infections, GI bleeds, to name a few. Dr. Negar Asdaghi:         In a setting of a clinical trial, patients are regularly and systematically monitored for SAEs, and from these studies we know that, indeed, both adverse events, or AEs, and SAEs are quite common poststroke and are reported in up to 95% of participants of prior randomized trials. Intravenous thrombolysis increased the risk of symptomatic intracerebral hemorrhage, but in general, the rate of SAEs are similar in thrombolyzed and non-thrombolyzed patients. Which clinical characteristics prone stroke patients to what type of side effects is, of course, an intriguing subject for a stroke neurologist. Similarly, it's important to know how, for example, a seemingly indirect complication of ischemic stroke, such as a hospital-acquired urinary tract infection, can potentially affect the stroke outcomes. Dr. Negar Asdaghi:         So, in this issue of the journal, Dr. Iris Lettow from University Medical Center in Hamburg, Germany, and colleagues looked at the subject in the paper titled “Serious Adverse Events and Their Impact on Functional Outcome in Acute Ischemic Stroke in the WAKE-UP Trial.” This was a post-hoc analysis of the WAKE-UP Trial, which was a multicenter randomized trial of MR-guided intravenous thrombolysis with alteplase in ischemic stroke patients with unknown time of onset. The WAKE-UP Trial included 503 patients, and they had 199 SAEs reported for 110 patients, meaning that one in five patients had at least one serious adverse event in the trial. Of those patients who did suffer an SAE, 20 patients, which was 10%, had a fatal outcome. Dr. Negar Asdaghi:         The rate of SAEs were not different between thrombolyzed and non-thrombolyzed patients. But, when they categorized the patients based on who did and who did not experience an SAE, they found that those who experienced an SAE were older, presented with more severe strokes, and were more likely to have a large vessel occlusion. But only higher age and male sex were independent predictors of development of an SAE poststroke. So, let's pause and think about these findings. This was in contrast to the previous studies, where traditionally, the severity of stroke was a predictor of complications, and importantly, the first study to identify male sex as an independent predictor of SAE, whereas, traditionally, female sex had been identified as a risk factor for development of adverse events poststroke. Dr. Negar Asdaghi:         Perhaps what we're seeing with a paradigm shift in improvement in poststroke quality of care. Now, another important finding of this study was that the presence of any SAE, whether neurological or non-neurological, resulted in reduction of favorable outcome by half and almost quadrupled the odds of poor outcome, defined as modified Rankin Scale of four to six at 90 days, even after accounting for all the known confounders. Now, the authors also looked at some interesting details. The organ most effected by serious adverse events poststroke was indeed the nervous system. Almost 50% of all SAEs were neurological in nature. This was then followed by cardiac events. Some examples would include an acute coronary syndrome, MI, various arrhythmias. And the surgical and medical procedures were the third most common category of serious adverse events in this study. Dr. Negar Asdaghi:         And what they found was that SAEs by organ of involvement had a significant association with 90-day outcomes, where any neurological serious adverse events significantly affected 90-day functional outcome poststroke. When adjusting and accounting for important variables, such as age, sex, LVO, this still remained true in terms of a predictor of outcome. In contrast, cardiac serious adverse events, infectious serious adverse events, did not have any effect on the 90-day functional outcome. Dr. Negar Asdaghi:         So, what are the top takeaway messages from this study? Number one, SAEs occur commonly poststroke, and in this particular study, occurred in one in five ischemic stroke patients. Number two, 10% of those who suffer from an SAE had a fatal outcome. Number three, nervous system disorders and cardiac disorders were the most frequent classes of side effects poststroke. And finally, patients suffering from at least one serious adverse event had a lower odds of reaching favorable outcome at 90 days. These findings emphasize the importance of dedicated stroke care, neurointensive care units, and all poststroke efforts to reduce preventable adverse events poststroke. Dr. Negar Asdaghi:         Time is an exceedingly important concept in treatment of patients with acute ischemic stroke. As an example, in a typical stroke related to a proximal large vessel occlusion, the ischemic brain loses an average of two million neurons per minute. Now, endovascular therapy is the standard reperfusion treatment for patients with acute ischemic stroke secondary to a large vessel occlusion. It is an effective treatment to restore blood flow and reperfusion to the brain and had been shown to improve outcomes in stroke patients. Dr. Negar Asdaghi:         Therefore, one would naturally anticipate that the benefits of endovascular therapy would be dramatically reduced with treatment so late. If this is true, then why is it that the beneficial treatment effect from endovascular therapy was even larger in patients treated in the late time window trials, and you will recall that these were patients included from 6 to 16 hours, or 6 to 24 hours, from their symptom onset time. This compared to treatment effects noted in patients enrolled in the early time window trials. This concept is known as the "late window paradox" and does not mean that we have to wait to provide reperfusion therapies to patients. It actually refers to those fortunate few that have robust collaterals and, as a result, have slow infarct growth, which will afford them that extra precious time to remain eligible to receive this life-saving treatment. Dr. Negar Asdaghi:         Joining me now on the podcast is Dr. Mark Parsons from the University of New South Wales in Sydney, Australia, to talk to us about the concept of infarct growth. Dr. Parsons is one of the senior authors of the study published in the current issue of the journal titled “Stroke Patients With Faster Core Growth Have Greater Benefit From Endovascular Therapy,” and will discuss how the beneficial effect of endovascular treatment may be modified by the speed of infarct growth in the early time window after symptom onset. As in every podcast, when I have the pleasure of interviewing a pioneer in the field of stroke, that my guest needs no introduction, but truly Dr. Parsons needs no introduction to our listeners. He's a Professor of Neurology at the University of New South Wales in southwestern Sydney. He's an internationally recognized leader in the field of stroke, stroke clinical trials, and brain imaging whose research has helped improve patient selection for acute stroke reperfusion therapies. It's truly an honor to have him on the podcast today. Welcome, Mark. Thank you so much for joining us all the way in Sydney on a Saturday morning. Dr. Mark Parsons:           Yes, thank you, Negar. It's OK, I have been up for a little while. So, yes, lovely to chat with you, and we haven't chatted in person for quite a long time, and I think I actually remember the last time was in Hamburg, in Germany, at a big stroke conference. I remember it quite well. We had a very pleasant evening with a group of Canadians and Australians, and I had to present a major tenecteplase study finding the next day, and I was a little bit off my game, some of my friends said, and I think that's probably your fault, Negar. Dr. Negar Asdaghi:         Mark, you did really great, and we really, truly, look forward to getting back to in-person meetings. So, let's start with the study here. Can you please tell us about the INSPIRE registry? Dr. Mark Parsons:           So, the INSPIRE registry, that's an acronym. So, it's best to spell out this acronym, so that stands for the "International Stroke Perfusion Imaging Registry." So, that was something we set up quite a while ago when perfusion CT was quite considered advanced or novel. We set that up, I think, in about 2010, and because that was obviously one of my areas of interest, perfusion imaging, we started collecting perfusion CT and CT angiography , and noncontract CT, for that matter, from our stroke patients from a number of centers in several countries. And over time, that built up to over 20 centers around the world, so predominantly Australia and China, because of the close connections that we've got there, but also one site in Canada, actually two sites now. We have so many sites that I sometimes overlook a few. Dr. Mark Parsons:           So, it is international. And what we do is, we collect prospective data from stroke patients, both clinical and their acute imaging, follow-up imaging, follow-up clinical information, and in the majority of patients, we also get three-month Rankin. So, there's now over 3,000 patients in that database with complete datasets from acute baseline imaging through to three months. And that was the dataset that we used for this current study. Dr. Negar Asdaghi:         So, Mark, this is truly an impressive registry. It is not easy to do large-scale imaging-based registries, and this is really impressive to have so many centers involved. Can you tell us about the current study population? Who did you include in the current study paper? Dr. Mark Parsons:           Firstly, we specifically looked at patients that had a large vessel occlusion, or LVO. Of course, the definition of large vessel occlusion varies a bit from place to place, but essentially, that means a clot in a proximal artery to the brain that's potentially retrievable via endovascular thrombectomy. I guess the beauty of the INSPIRE registry is, we started collecting stroke patient data well before endovascular thrombectomy was a routine treatment. We had quite a large number of large vessel occlusion patients in this study who didn't receive endovascular thrombectomy because it simply wasn't available at the time. And then, of course, with all of those big trials that came out in 2015, as you know, and beyond, with thrombectomy becoming routine at all of our INSPIRE sites and many other places around the world, we then had a, I guess, a historical cohort comparison of large vessel occlusion patients that were not given EVT and then, more recently, a cohort of large vessel occlusion patients who were treated with thrombectomy. Dr. Mark Parsons:           The non-thrombectomy patients, in the vast majority, received intravenous thrombolysis because they were in the 4.5-hour time window. I guess the only other thing, the main other inclusion criteria, was we specified that patients in this particular study needed to have a relatively small infarct core, less than 70 mL, and we can talk more about that later, if you like, and a significant area of tissue that's potentially salvageable with reperfusion, the so-called penumbra. Dr. Negar Asdaghi:         Thank you. Just to recap for our listeners, so your current study population included patients presenting early on, within 4.5 hours from symptom onset, with a large vessel occlusion, and because, as you mentioned, the study had been ongoing even before endovascular therapy became a standard of care, you have a group of patients in whom endovascular therapy was offered and you have the comparison to this group to those patients who had an LVO, large vessel occlusion, but simply received intravenous thrombolysis only. Can you now tell us about these two groups, basically, IV thrombolysis versus endovascular therapy group. What were the differences between the two groups, and what were the main clinical outcomes in your study? Dr. Mark Parsons:           Yes. We had about 400 patients in each arm. And though reasonably well matched, I mean, of course, registry, it's not randomized, so you can't have perfectly matched groups, and indeed, in the more recent era where most patients with large vessel occlusion, particularly with this small core, big penumbra on imaging, would go to thrombectomy because they had the so-called ideal target population. So, in the modern era, if patients don't receive EVT, then there's probably a good reason for that. But, essentially, they are around 70 years of age. Their NIH Stroke score was around 15, or the median score, so that's reasonably consistent with large vessel occlusion. And then if you look at the perfusion imaging, so this was all with perfusion CT in our studies, so the core volume was quite small, 15 mL, but there was quite a large range. And the median penumbra volume was actually a bit bigger in the EVT group; it was 80 versus 65 in the penumbral group. Dr. Mark Parsons:           We probably don't need to go into the details of how those core penumbral volumes are calculated, but that might be a bit over-technical for our audience, but happy to elucidate further if you want. Dr. Negar Asdaghi:         Actually, I think it's important to, just briefly, talk about how those values were measured. Dr. Mark Parsons:           Yes, OK. The other thing I should say is that, interestingly enough, we specified the 4.5-hour time window, but in fact, the median time from stroke onset to imaging was just under two hours in both groups, which is quite short. Dr. Mark Parsons:           And indeed, some of the people that are less enthusiastic about perfusion CT than I am would say, "Well, maybe measures of core are not so reliable in that early time window with perfusion CT." I would probably debate that to some degree. But, if we talked to the technicalities, there's quite a lot of data to suggest that the cerebral blood flow threshold is probably the most robust for identifying core, or at least tissue that's destined to infarct. It may not actually be infarcted at the time we measure it, particularly at two hours, but there's quite a lot of data now showing that with perfusion CT with a cerebral blood flow threshold of 30%, depending on software variations, that's a pretty accurate estimate of the final infarct in people that have rapid reperfusion fairly quickly after the perfusion CT. Dr. Mark Parsons:           So, all of these figures that we use are based on, for example, the core threshold on perfusion CT relates to, we validate that from patients, particularly that have had thrombectomy, so we know when they've reperfused. And the theory should be that if the CT perfusion core is an accurate measure of the final infarct, that there should not be much change from the baseline CT perfusion core to the follow-up infarct because there's been reperfusion not long after the perfusion scan. Now, with the penumbral volume, we use software that measures a delay time. Other software, particularly in North America, you would use a Tmax, but they're both basically direct measures of collateral flow. Dr. Mark Parsons:           So, as you know, when you have a large vessel occlusion, say, of a middle cerebral artery and in one segment, the way that blood gets to the cortex, it's typically supplied from the middle cerebral, is via retrograde flow from the anterior cerebral and the posterior cerebral via leptomeningeal collateral, so you actually get blood coming back retrograde bypassing the occlusion. And these measures on perfusion CT delay time in Tmax, actually, give you a measurement in seconds of how long it takes the blood to travel to that part of the brain. And, obviously, the longer the delay in seconds means the poorer the collateral flow. And then, typically, that means the poorer the collaterals, the less time you've got to salvage the penumbra, and the quicker the infarct core will expand. Dr. Negar Asdaghi:         Right. So, in your study, using these perfusion parameters. First, before even we come to the perfusion parameters, you found that overall, when you adjusted for all confounders, endovascular-treated patients had a better, or higher, odds of achieving good 90-day outcomes. This was not a surprising finding when you compare this population of endovascularly-treated patients to those treated with intravenous thrombolysis alone. But what was interesting was, indeed, those analyses related to infarct growth rate. Can you tell us a little bit about this concept of infarct growth rate, and you already mentioned how you measured infarct growth by perfusion imaging. Dr. Mark Parsons:           Thanks, Negar. I guess that's the novel part in it. I guess it would have been quite surprising if we didn't show that EVT was superior to IVT in the early time window. So, that certainly wasn't unexpected, that finding. But I guess the novel part of this study is this relatively new concept of infarct core growth rate. I'm not saying we're the first that's described it because, as you know, there are a number of papers in the literature and talking about the concept of slow infarct core growers versus fast infarct core growers. And you mentioned the late time window thrombectomy studies, DAWN and DEFUSE 3, which actually showed a dramatic benefit in the later time window, up to 24 hours after stroke, in patients who had evidence of perfusion core mismatch. And the concept then was suggested that the reason that these people benefited so much in that late time window was that they had very slow infarct core growth because they had great collaterals. Dr. Mark Parsons:           The treatment effect was bigger in those late time window studies than it was in the early time window thrombectomy studies, which was hypothesized might have included a lot of patients with fast infarct core growth rate, which wasn't really measured in a number of the thrombectomy studies in the early time window. We wanted to look more at, does the rate of infarct core growth have an influence on the effective treatment, with both IV and endovascular treatment? Dr. Mark Parsons:           So, the way we measured infarct core growth was pretty simple, actually. It's basically, we excluded patients with uncertain time of stroke onset because we had more than double this total number of LVO stroke patients with target mismatch, but we had to exclude the patients with uncertain time of onset, which included wake-up stroke and others. So, in this group, where there was a defined time of onset, basically, the infarct core growth rate was simply measured from the volume of the infarct core measured on perfusion CT divided by the time from stroke onset. So, just simplistically, if you've got a core of 50 mL, and it's two hours after stroke onset, then the infarct core growth rate is 25 mL per hour. That's simple, but that obviously assumes a linear core growth rate. And we based that linear model on previous studies of repeated diffusion MR imaging, which is another measure of core, that showed that the core growth rate was linear. Dr. Mark Parsons:           Now, of course, you could criticize that because I suspect, in some patients, the core growth rate is not linear. This is an estimate of core growth rate. Dr. Negar Asdaghi:         Right. So, your study actually found something quite interesting, which I really want you to go over for us and for our listeners, and that's that the beneficial effect of endovascular therapy is superior in those with a fast infarct growth rate, and was not superior, in fact not any different, in those patients who had a slow infarct growth rate. Can you walk us through that, and also tell us how that does not contradict what we've found as part of DAWN and DEFUSE with the slow infarct growers? Dr. Mark Parsons:           Thanks, Negar. It is slightly complicated, so we'll go one step at a time. So, first of all, the core growth rate varied quite a bit in this population. A number of patients, and this is because you saw that the median core in this group was 15 mL, so there was quite a large population of patients that had a core growth rate of less than 15 mL per hour. So, they're your traditional slow growers, slow core growers, who have really great collateral flow. You probably have a number of hours to save the penumbra. Now, I'm not saying that you should waste time in this group of patients, but it might be particularly relevant, for example, if you're transferring from a primary stroke center to a comprehensive stroke center. You know that you're going to have time to save that penumbra because the infarct core is going to grow slowly. Dr. Mark Parsons:           In, for example, in Australia, at least half of our thrombectomy patients come from regional or out of metro centers, where there is a significant transfer time from the primary stroke center to the comprehensive center. So, that may be a particularly important finding to look at in the future for longer transfer times from primary to comprehensive stroke centers. So, then, at the other end of the scale, we had a proportion of patients who had what we call a fast core growth rate of more than 25 mL per hour. And then there were people in the middle between 15 and 25 who we called sort of moderate core growth. So greater than 25 mL per hour was a fast core growth. Dr. Mark Parsons:           We categorized it into those sort of three categories. Again, that's a bit arbitrary, but the reason we did that was that if you look at the IVT group alone, those who had slow core growth rate, less than 15 mL per hour, their rates of good outcome, so a Rankin 0 to 2, so getting back to close to normal function at three months, their rates of a good outcome were almost 60% in the slow core growth rate with IVT. Then, if you go to the other end of the scale with fast core growth with intravenous therapy, the rates of good outcome in that group were only 30%. So, there was a clear decline in terms of three-month good outcomes with intravenous thrombolysis versus core growth rate. So, as the core growth rate increased, the chances of good outcome with intravenous thrombolysis decreased. Dr. Mark Parsons:           Then, if you looked at the EVT group, it was quite interesting that this core growth rate effect had minimal impact on the outcome of the EVT patients. So, in the EVT patients with slow core growth rate, less than 15 mL, the rates of good outcome at three months were, again, close to 60% and identical to the IV therapy group. But, at the other end of the scale, with fast core growth rate above 25 mL with the EVT group, they had a much higher rate of good outcome compared to the IVT group. Their rates of good outcome were around 45%. So, they are a little bit lower than the slow core growers with EVT, but there wasn't much drop-off with core growth rate, and there was a significant increase in good outcomes in the EVT group who had fast core growth compared to the IVT group. Dr. Negar Asdaghi:         So, I just want to summarize this so that I understand it and, of course, want to make sure that it's simplified also for our listeners. So, you found that those people, and it should be noted these are all within the first 4.5 hours. Dr. Mark Parsons:           Yes. Dr. Negar Asdaghi:         So, we understood in that time frame. Those people who had a fast growth rate, they had the greatest benefit from endovascular therapy in this time frame. And those people who had the slow growth rate, that is defined in your study as less than 15 cc per hour, they actually had a similar benefit from endovascular therapy as they did with intravenous thrombolysis. Did I summarize that? Dr. Mark Parsons:           Yes. That's correct. Dr. Negar Asdaghi:         So, Mark, how do you explain this from a pathophysiological standpoint? Dr. Mark Parsons:           Fortunately, there's a relatively simple explanation. So, because of the way that we set up INSPIRE, we collected follow-up infarct volumes as well. From the time window for follow-up infarct measurement was a little bit variable, but it was around 48 hours after stroke onset. In this group of patients, we actually were able to measure final infarct volume and essentially, in the slow core group, so less than 15 cc growth per hour, in that group, with both IVT and EVT, there was minimal infarct growth by the time we measured it at 48 hours. So, both therapies basically led to minimal infarct growth after the treatment, whereas in the fast core growth group, more than 25 cc per hour, the IVT group had much greater infarct growth by 48 hours, about 40 or 50 mL more, on average, than the EVT group. Dr. Mark Parsons:           I guess also, to explain that a touch more, if you look at the slow core growth EVT group versus the fast core growth EVT group, there was still more infarct growth in the fast core growth rate. And this is because you measure the core at a certain time on the CT or the MR. And then, even with the very best system, you're not going to get reperfusion with EVT for at least 30 minutes after that because you have got to get into the angio lab, you have to puncture the groin, and you have got to get up there, and you have got to pull the clot. So, even if you get complete perfect circumstances, it's still usually at least a 30- to 60-minute delay between the perfusion CT and when you're fully reperfused. Dr. Mark Parsons:           But the theory should be, if there's a minimal delay from the perfusion CT to reperfusion, the core at that time should be identical to the follow-up, final infarct volume. And that's what we actually found in the slow core group. It was almost the same. The interesting thing was, it was the same in both IVT and EVT, which basically, we don't know for sure, because we don't know exactly when the IVT group reperfused, but it probably means that because the core growth is so slow in this group, even if you reperfuse later with IV therapy, which we know is the case, often with IV thrombolysis the recanalization is a bit slower than with EVT, so even if you've got delayed reperfusion, if you've got slow core growth rate, you may not get much infarct expansion at all, whereas if you've got fast core growth rate, getting reperfusion as quickly as possible after your CT is crucial to limit subsequent infarct growth before reperfusion. And that's exactly what we found in the fast core growers, that EVT substantially limited that subsequent infarct growth and led to better clinical outcomes as well. Sorry, again, that was a long explanation. Dr. Negar Asdaghi:         Mark, but these are really important findings, and as you alluded to earlier, I believe that they have major implications in how the systems of care are organized and our transfers are going to be decided upon in the future. We have a few minutes before we end the podcast here, and I want to ask you, do you think it's fair to have a similar concept that's studying the infarct growth rate in the late time window, especially in the sort of past 12 hours time window in the future? Dr. Mark Parsons:           Yeah, it's a fascinating question, Negar. In fact, we do have a paper somewhere under review. I think Stroke might have knocked it back. Anyway, but it's actually looking exactly at this concept, but the fascinating thing is, in the late time window, you see very few true fast growers because they actually present early. This is what the paper under review is talking about. So, in fact, most people that you see with a favorable imaging pattern in the late time window, such as DAWN and DEFUSE 3, the core is relatively small. In patients with fast core growth, by the time you get to six hours, you've got a massive core and no penumbra, so they are typically not offered endovascular therapy because there's no salvageable tissue and there's already lots of damage, even on the non-con CT. Dr. Mark Parsons:           So, it would be actually really interesting to look just at the late time window, and I'm sure others are doing that, too, but I suspect what we'll find is that the distribution of core growth is pretty narrow. It's mostly the slower core growers, and it's very clear that most of the really fast, and we're actually looking at this now in people with large infarct core over 70 mL, in fact, they present, the ones that we've got at least, present very early. So, it'll be a fascinating area to look at, for sure. Dr. Negar Asdaghi:         Mark, it is definitely fascinating. We look forward to covering that paper, hopefully in our future podcast. But I want to leave you, reminding you that I'm a mild stroke person, so I am definitely interested in looking at these slow grow rate infarct patients because there are also, as you know, some studies suggesting that the slow growth infarct actually can happen sub-clinically on only a radiographic basis, and especially important in the mild group patients. But, we are out of time. Professor Mark Parsons, thank you so much for joining us all the way from Sydney, and it's been a pleasure interviewing you. Dr. Mark Parsons:           Thank you, Negar. Lovely to chat and hope to see you very soon in person. Dr. Negar Asdaghi:         Thank you. Dr. Negar Asdaghi:         And with that, we end our podcast for the December 2021 issue and close the first year of the Stroke podcast. A year ago, Dr. Ralph Sacco, the Editor-in-Chief of Stroke, approached me to talk about the importance of starting a podcast for Stroke as an accessible means to highlight the great work published in the journal, and also introduce me to the amazing Stroke editorial staff. Dr. Negar Asdaghi:         One year, hundreds of reviewed papers, and 11 podcasts later, from missed deadlines to late night emails, early morning texts, and weekend recordings, our podcast has become a bit more than just a quick review of the literature. It has truly become our podcast family. Overcoming the time differences and impossible schedules, you made time to interview with us, listen to us, and work with us as we reached out to researchers across the globe who contributed to this journal and to the podcast. Lots of laughter and a few tears. Like every family, ending the year reminds us of some good times and, of course, the difficult times. Dr. Negar Asdaghi:         So, I want to end our final podcast of the year with a topic that we haven't really covered in our journal, but I think may sprinkle some magic on your holiday season, and that's the topic of quantum biology. Wrapped in mysticism with a pseudoscientific flavor, physicists, neurologists, anesthesiologists, and philosophers have been hard at work deciphering whether consciousness may have similar properties to quantum particles. From superposition to entanglement and coherence, is it possible that your mind may have something to do with the epigenetics, up and down regulation of genes and presentation treatment and, importantly, outcome of various medical or neurological disorders? Now, even if this was proved to have a low scientific validity, as a stroke scientist, isn't it amazing to be working in the one field that ensures the brain, which is the home of consciousness, remains healthy? So, let's think about the power of consciousness in altering the outcome of medical conditions with our ever-excitement to stay alert with Stroke Alert. Dr. Negar Asdaghi:         This program is copyright of the American Heart Association, 2021. The opinions expressed by speakers in this podcast are their own and not necessarily those of the editors or of the American Heart Association. For more, visit AHAjournals.org.

During our Holiday Giving Drive, we are presenting Jung in the World, a weekly series of interviews by Patricia Martin. In this series, she'll be talking with people whose work intersects with Jung's ideas to tell a more contemporary story about his enduring impact in a brave new world. Mark Saban joins us to talk […] The post Jung in the World: Jung's Two Personalities & Their Impact on Jungian Thought & Training with Mark Saban appeared first on Jungianthology: A Podcast & Blog.

Research and data are paramount if we want to improve physical, mental, and emotional wellbeing across the board. These not only concern those who are already struggling with illness; healthcare should also focus on being preventive, rather than waiting for people to get sick. However, the longstanding institutions that we rely on actually create a roadblock for researchers to do their job. Instead of keeping the population healthy, institutions are merely waiting for the people to get sick. In such a set-up, are we truly maximizing the capabilities and technologies that we have developed for the good of humanity? In today's episode, Alexander McCaig and Jason Rigby talk about exchanging healthcare data and its importance to the world. Join them as they listen to comments made by Lex Fridman and David Sinclair on bioinformatics and more. Challenging the Data Barrier in Bioinformatics   To gain research info regarding healthcare, companies must first collect data. Data collection gives us the opportunity to detect certain diseases, their properties, and how the human body reacts to these. Perhaps the biggest obstruction that bioinformaticians face are the privacy and ethical concerns when collecting data. Because health institutions aren't able to disclose and share data regarding their patients, research slows down. With TARTLE, you have the chance to purchase datasets to help your bioinformatics research or any study for that matter. Data that is being collected by TARTLE is consensually gathered, as users share their information for financial incentives. Data collection through TARTLE is also ethical because companies are buying ownership from consenting owners. Through this, the privacy and ethical barrier brought on by HIPAA is no longer an issue. TARTLE benefits everybody. It gives users the power and knowledge on selling their data while paying them for doing so. It also offers companies massive amounts of datasets that they're able to use, like medical research. Insurance Companies and Their Impact on Data Collection   In the podcast, Alexander McCaig and Jason Rigby listen to a video of David Sinclair discussing his checkup with a doctor. Through this, we discover that proactively collecting data about one's self gives doctors better insight into your health, more than they ever could with a simple consultation. In addition to this, we find out that doctors may opt to not perform lab tests that are not immediately needed, or if you do not have a family history for a particular disease. They are disallowed by insurance companies who do not want to spend on anything preventive. Insurance companies only shell out money when someone is already sick. Insurance companies are only incentivized to save money. Therefore, preventative healthcare becomes impossible for those of a lower socioeconomic profile, and thus cannot afford private lab results. A Proactive vs. Reactive Approach on Healthcare Development The TARTLE marketplace is one of the means for preventative healthcare to grow and develop. Because insurance companies aren't incentivized from giving away data, nor are hospitals allowed to. Because hospitals are a reactive system, we are not able to act on someone or gather data until someone is already sick. That is why preventative care is so important. Sickness is better understood, and hopefully lessened, in a world where we are encouraged to actively look out and test for our own health.  Hospitals are part of a system that's economically driven, forcing people into two-dimensional systems that prioritize money before the well-being of a person. The system views unique individuals not as people, but as numbers and statistics without uniqueness.  The metric that medical institutions should focus on is the maintenance of a disease-free population. How long someone is being kept healthy or how long someone lives should be the defining statistic that healthcare systems should prioritize. Not only this, but a deeper understanding of preventative measures is a must, that will not only lengthen the life expectancy of every individual, but empower those same individuals with the ability to sell their data. Through a higher volume of data acquisition, researchers and companies can better develop better ways to prevent sickness and disease.   What's your data worth? www.tartle.co     TCAST is brought to you by TARTLE. A global personal data marketplace that allows users to sell their personal information anonymously when they want to, while allowing buyers to access clean ready to analyze data sets on digital identities from all across the globe.   The show is hosted by Co-Founder and Source Data Pioneer Alexander McCaig and Head of Conscious Marketing Jason Rigby.   What's your data worth?   Find out at: https://tartle.co/   YouTube: https://www.youtube.com/c/TARTLE   Facebook: https://www.facebook.com/TARTLEofficial/   Instagram: https://www.instagram.com/tartle_official/   Twitter: https://twitter.com/TARTLEofficial   Spread the word!  

This week, we're taking a turn for the cryptid and spooking local with the legend of West Virginia native son, the Mothman. For a little over a year leading up to December 1967, sightings of a winged humanoid with glowing eyes were reported in and around Point Pleasant, WV. Since then, Mothman has evolved from evil omen to legend to meme. In this episode, we'll explore the legend, collective memory, and the power of portents. Links Paranormal Activity in West Virginia (Marshall University) Mothman: The Facts Behind the Legend (West Virginia Book Company) Mothman myth rooted in Messenger reporter's work (Athens Messenger) Is the Mothman of West Virginia an Owl? (Audubon Society) Silver Bridge tragedy still haunts river city residents (Charleston Gazette-Mail) Tu-Endie-Wei State Park (WV State Parks) Point Pleasant, West Virginia: Making a Tourism Landscape in an Appalachian Town (Southeastern Geographer) West Virginian Urban Legends and Their Impact on Cultures Both Local and Abroad (Bowling Green State University) The Mothman and Other Strange Tales: Shaping Queer Appalachia Through Folkloric Discourse in Online Social Media Communities (University of Kentucky) UFOs Were Born Among America's Cold War Fears (Foreign Policy) Welcome To The 'TNT Area,' Home Of The Mothman (NPR) Federal Facilities Restoration Program (WV Dept of Environmental Protection) Contact Email the Dirt Podcast: thedirtpodcast@gmail.com ArchPodNet APN Website: https://www.archpodnet.com APN on Facebook: https://www.facebook.com/archpodnet APN on Twitter: https://www.twitter.com/archpodnet APN on Instagram: https://www.instagram.com/archpodnet Tee Public Store Affiliates Wildnote TeePublic Timeular

This week, we're taking a turn for the cryptid and spooking local with the legend of West Virginia native son, the Mothman. For a little over a year leading up to December 1967, sightings of a winged humanoid with glowing eyes were reported in and around Point Pleasant, WV. Since then, Mothman has evolved from evil omen to legend to meme. In this episode, we'll explore the legend, collective memory, and the power of portents. Links Paranormal Activity in West Virginia (Marshall University) Mothman: The Facts Behind the Legend (West Virginia Book Company) Mothman myth rooted in Messenger reporter's work (Athens Messenger) Is the Mothman of West Virginia an Owl? (Audubon Society) Silver Bridge tragedy still haunts river city residents (Charleston Gazette-Mail) Tu-Endie-Wei State Park (WV State Parks) Point Pleasant, West Virginia: Making a Tourism Landscape in an Appalachian Town (Southeastern Geographer) West Virginian Urban Legends and Their Impact on Cultures Both Local and Abroad (Bowling Green State University) The Mothman and Other Strange Tales: Shaping Queer Appalachia Through Folkloric Discourse in Online Social Media Communities (University of Kentucky) UFOs Were Born Among America's Cold War Fears (Foreign Policy) Welcome To The 'TNT Area,' Home Of The Mothman (NPR) Federal Facilities Restoration Program (WV Dept of Environmental Protection) Contact Email the Dirt Podcast: thedirtpodcast@gmail.com ArchPodNet APN Website: https://www.archpodnet.com APN on Facebook: https://www.facebook.com/archpodnet APN on Twitter: https://www.twitter.com/archpodnet APN on Instagram: https://www.instagram.com/archpodnet Tee Public Store Affiliates Wildnote TeePublic Timeular

My special guest today is Lisa Samuel, ASID, NCIDQ, CAPS; President of Samuel Design Group in Santa Fe, New Mexico, and the woman who coined the word, Feelosophy™.  On today's show, Lisa takes us on a deep and delicious dive into her journey of what it means to be a fully conscious human being in her work as an interior designer, and how she designs deeply meaningful, spiritual and soulful spaces for her clients by curating spaces that activate our senses. You'll hear how Lisa moves through her world of interior design with reverence and dignity for all humans who touch a project she is involved in. I asked Lisa if she believes a home is alive, and I think her answer will surprise you. Join me for this deeply nourishing conversation with Santa Fe's Best Interior Design 2021 award recipient, Lisa Samuel.Connect with Lisa and Samuel Design Group on social media:Instagram: https://www.instagram.com/samueldesigngroup/LinkedIn: https://www.linkedin.com/in/lisa-samuel-76a5a7bb/Dunn Edwards paint colors that make Lisa feel like she's walking into a hug in a room:Fine Grain - https://www.dunnedwards.com/colors/browser/de6213Crisp Muslin - https://shop.dunnedwards.com/products/crisp-muslin-de6212Book resources that Lisa shares in this episode:“Beauty, Neuroscience, and Architecture: Timeless Patterns and Their Impact on Our Well-Being” by Donald H. Ruggles“The Eyes of the Skin: Architecture and the Senses” by Juhani Pallasmaa

CoD Champs was INSANE & ROSTERMANIA has Already Begun! We're doing FULL Rostermania Predictions, our breakdown of CoD Champs (and Rex's reaction to NYSL beating OpTic), the potential for expansion teams, the importance of coaching staffs in CoD, the new CDL format, CoD Vanguard leaks & gameplay thoughts, OpTic's real problem, and the big debate...is ATL FaZe a DYNASTY? This is without a doubt the most packed episode of the whole year and it's not close! So buckle in! For another wild episode!   ◾ Intro - 00:00 ◾ News of the Week - 4:46 --- Surge's New COACH?! // COACHING in CoD & the importance of coaching staffs  New of the week Pt. 2 --- Expansion Teams POSSIBLE! Cloud 9 Teases...Rise...EU? // Johanna Faries not “commish” any more // Adam Apicella's FORMAT proposal for CDL...Champs & World Cup?! ◾ CoD Vanguard! -  28:52 --- The LEAKS, Alpha, Gameplay, and hopes & expectations for Vanguard...this is HUGE ◾ CoD Champs Reaction! -  37:00 --- Overall Event Thoughts // Is FaZe a Dynasty...the DEBATE ◾ CoD Champs Reaction Pt. 2! -  56:06 --- Ultra, Empire, Rokkr & FaZe! Their IMPACT on CDL // Rex's NYSL VICTORY LAP & their future // OpTic's flop & the real problem // 2 Most DISAPPOINTING Teams at Champs (Florida & LAT // John... ◾ FULL Rostermania Predictions (Each Team) -  01:19:58 --- ◾ How MANY teams Change & BOLD PREDICTIONS for ROSTERMANIA - Intelligent or Irrelevant - 02:10:40 The Best of 3 CoD Esports Podcasts covers and its hosts Josh "SalvationsElite," Rex "ShadyNero," and Sam "Bash" cover all things Call of Duty Esports in regards to the Call of Duty League, CoD Cold War, CoD League news, updates, predictions, breakdowns, summaries, game patches, meta, gameplay, gamebattles, competitive gaming, the news of the official CoD League with all the pro teams like the Dallas Empire, Seattle Surge, OpTic Chicago, Atlanta FaZe, LA Thieves, Minnesota Rokkr, NY Subliners, London Royal Ravens, Florida Mutineers, the LA Guerillas, Toronto Ultra and the Paris Legion! We do predictions and breaking news, updates, roster changes rostermania, free agency, trades, with players like Scump, Crimsix, Simp, Huke, Dashy, Skrapz, Octane, Abezy, Gunless, Arcitys, FormaL, ILLeY, Shotzzy, Prestinni, Clayster, Cellium, Priestahh, Attach, Temp, and others! We are the Best of 3 Call of Duty Esports Podcast!   -CONNECT- YOUTUBE Watch on YouTube HERE (https://www.youtube.com/salvationselite)   TWITTER Follow Josh “SalvationsElite” - https://twitter.com/SalvationsElite Follow Rex  “ShadyNero” - https://twitter.com/ShadyNero Follow Sam “Bash_Bo3” - https://twitter.com/Bash_BO3   PODCAST The Best of 3 CoD Esports Podcast is available on YouTube, Spotify, and Apple Podcasts and will be coming to more apps soon! Links here: APPLE: https://podcasts.apple.com/us/podcast/the-best-of-3-cod-esports-podcast/id1490028421 SPOTIFY https://open.spotify.com/show/7jgzkfT6uc7wyU2L4UCh0B?si=Z6XhfUCcQ2exwOgyjfJFDA ---------------- SALVATIONSELITE SOCIALS The DISCORD CoD Community Server! Join for community tourneys, live streams, finding teammates and more! https://discord.gg/wJh6BCC   TWITTER -- https://twitter.com/salvationselite INSTAGRAM -- https://www.instagram.com/josh.roeloffs/ TWITCH -- https://www.twitch.tv/salvationselite DISCORD -- https://discord.gg/wJh6BCC   #TheBestOf3Podcast #CoDEsports #CallofDutyLeague #podcast #CallofDuty #Esports #CoDPodcast #EsportsPodcast #CallofDutyEsports #CompetitiveCoD

Expert layman Matt Goodwin (@TheCorkedMatt) and fake baseball economist Alexander Chase (@chase_rate) talk about evaluating good relievers based on skills and finding value based on ratios, holds and saves. We also discuss how player movement at the trade deadline impacts relief pitchers, how to adjust if your guy gets moved and dive into a couple of trades that have already gone down. Email: dugoutstudyhall@gmail.com Eno Sarris Article: https://theathletic.com/2731381/2021/07/27/eleven-mlb-trades-the-numbers-say-need-to-be-made-this-week/ note: episode recorded on Wednesday 7/28 prior to Friday release. Apple | Spotify | Google | Stitcher | Amazon | TuneIn | Radio.com | Deezer Timestamps | Gallo Deal in the Moment (01:05); The Olympics (05:10); Numbers of the Week (09:24); Matt Waxes Poetic About Holds + Reliever Stats (19:25); Central Question: What Makes Relievers Good versus Valuable? (24:15); Reliever Trades, Their Impact, and How to Adapt (40:37); Pass/Fail: Jesús Luzardo / Starling Marte Deal (55:14); Very Quick Off the Books: Eno Sarris Article (1:06:38)

Expert layman Matt Goodwin (@TheCorkedMatt) and fake baseball economist Alexander Chase (@chase_rate) talk about evaluating good relievers based on skills and finding value based on ratios, holds and saves. We also discuss how player movement at the trade deadline impacts relief pitchers, how to adjust if your guy gets moved and dive into a couple of trades that have already gone down. Email: dugoutstudyhall@gmail.com Eno Sarris Article: https://theathletic.com/2731381/2021/07/27/eleven-mlb-trades-the-numbers-say-need-to-be-made-this-week/ note: episode recorded on Wednesday 7/28 prior to Friday release. Apple | Spotify | Google | Stitcher | Amazon | TuneIn | Radio.com | Deezer Timestamps | Gallo Deal in the Moment (01:05); The Olympics (05:10); Numbers of the Week (09:24); Matt Waxes Poetic About Holds + Reliever Stats (19:25); Central Question: What Makes Relievers Good versus Valuable? (24:15); Reliever Trades, Their Impact, and How to Adapt (40:37); Pass/Fail: Jesús Luzardo / Starling Marte Deal (55:14); Very Quick Off the Books: Eno Sarris Article (1:06:38) Get PL+ and join our Discord: https://pitcherlist.com/plus

In this week's episode, the girls discuss chronic stress and how it affects not only dogs, but also their human companions. Stacey leads them in a guided meditation and Ness discloses her greatest fear of dark cupboards full of cockroaches. . Demographic Change Across the Lifespan of Pet Dogs and Their Impact on Health Status  https://www.frontiersin.org/articles/10.3389/fvets.2018.00200/full . Understanding, Identifying, and Coping with Canine Stress  https://www.dropbox.com/s/fnuum00kg7qfgt8/Page%2012-19%20Cover%20Story.pdf?dl=0 . Long-term stress levels are synchronized in dogs and their owners, Sundman et al, 2019, https://www.nature.com/articles/s41598-019-43851-x) . Dogs Smell Your Emotional State and It Affects Their Mood (2017) Neurobiologist Biagio D'Aniello of the University of Naples, https://indianexpress.com/article/explained/how-dogs-smell-fear-why-they-wear-that-sad-look-puppy-dog-face-doge-research-4903474/v . Healthline (https://www.healthline.com/health/mental-health/fight-flight-freeze#in-the-body) . Long-term stress in dogs is related to the human–dog relationship and personality traits, Amanda Höglin et al, https://www.nature.com/articles/s41598-021-88201-y?fbclid=IwAR1yb1yWbYxjZDqcTnys3A-ZfBuQO9DYhXC70LxV6j8l5_l4ayZ5rsmkP6I .

"We began to see the fish show up in the river with sores all over their body. And my son and I started to get the sores on our bodies, the same as the fish," says Rick Dove, the first Neuse Riverkeeper. He's talking about when he first started seeing large-scale fish kills on the Neuse back in the 1990's. Fish kills can largely be traced back to waste coming from CAFOs.In this episode of CAFOs & Communities, Larry Baldwin, the Crystal Coast Waterkeeper, explains how CAFOs impact the environment. He discusses the impacts on aquatic life, starting with the large scale fish kills Dove talks about.Produced by Larry Baldwin, Kayla Guilliams, and Laura Bratton in collaboration with Dr. JoAnn Burkholder, Rick Dove, Kemp Burdette, Elsie Herring, and Sherri White-Williamson. Special thanks to Larry Baldwin of Coastal Carolina Riverwatch for making this podcast possible.Music: Pure Water by Medyn, Thoughts by ANBR,  Aquarius by Spearfisher. Photos by Laura Bratton. References:CBS 17, "Hog lagoon contamination just beginning," 2018. https://www.youtube.com/watch?v=3HlRv_RWxyA CDC, "Understanding Concentrated Animal Feeding Operations and Their Impact on Communities," 2010. https://www.cdc.gov/nceh/ehs/docs/understanding_cafos_nalboh.pdf MD Sea Grant, "Pfiesteria Update: An Enduring Debate," 2009. https://www.youtube.com/watch?v=IAFVC1T0KpU   Riverlaw, "Fish Kills."  http://www.riverlaw.us/fish-kills/   Sierra Club, "Why are CAFOs bad?" https://www.sierraclub.org/michigan/why-are-cafos-bad UNC Med TV, "Neuse River," 2008. https://www.youtube.com/watch?v=hi2oDDdep04

http://www.UnderThePuppet.com - Noreen Young is an incredibly influential puppeteer, puppet builder and producer who has been working in the business for decades.  She had a hand in creating several iconic Canadian TV Shows including Hi Diddle Day and Pencil Box, she built puppets for TV Shows like Today’s Special and Telefrancais, and she created, produced and puppeteered on the show Under the Umbrella Tree which ran on the CBC and then The Disney Channel for years.  Several of Noreen’s puppets are housed at the Canadian Museum of History and in 1995 she was awarded the Order of Canada, that country’s highest civilian honor, for her work in children’s television.  I talk toNoreen Young about her career on this episode of Under The Puppet. Also, this month you can win a copy of Out of the Shadows - The Henson Festivals and Their Impact on Contemporary Puppet Theater by Leslee Asch courtesy of Inform Press.  Listen to find out how to enter. For even more of my talk with Noreen Young, check out the Under The Puppet app for iOS and Android and click the Gift icon in the listing for this episode. Transcript of this interview is available to the Saturday Morning Media Patreon Patrons! CONNECT WITH NOREEN: WIKIPEDIA: https://en.wikipedia.org/wiki/Noreen_Young IMDB: https://www.imdb.com/name/nm1168562/ ENCYCLOPEDIA OF PUPPETRY ARTS: https://wepa.unima.org/en/noreen-young/ RETROSPECTIVE: https://youtu.be/RiNL8iL8gOI DISCUSSED ON THE SHOW: Kukla, Fran & Ollie Howdy Doody Patrick Watson Stephen Brathwaite Ontario College of Art Hi Diddle Day Ronnie Burkett CBC Ottawa Nina Keogh Pencil Box TV Ontario Readalong Telefrancais Canadian Museum of History Today’s Special The Noddy Shop Under the Umbrella Tree Encore+ The Friendly Giant Order of Canada Puppets Up International Festival Frogtown Mountain Puppeteers  Sleeping Rough CLIPS HEARD IN THIS EPISODE: PENCIL BOX: https://youtu.be/pq54ZbJQkK8 UNDER THE UMBRELLA TREE: https://youtu.be/FzLxslAlxSA RESEARCH: http://mikeyspuppetryblog.blogspot.com/p/noreen-2006-at-puppets-up-international.html https://youtu.be/0c44wPHsGBU HEAR NEW EPISODES EARLY! GET BONUS CONTENT! DOWNLOAD THE FREE UNDER THE PUPPET APP! IOS - https://apple.co/2WZ4uZg ANDROID - https://bit.ly/2RwcFev CONNECT WITH THE SHOW http://www.instagram.com/underthepuppet http://www.twitter.com/underthepuppet CONNECT WITH GRANT http://www.MrGrant.comhttp://www.twitter.com/toasterboy https://instagram.com/throwingtoasters/ Art by Parker Jacobs Music by Dan Ring Edited by Stephen Staver Help us make more shows like this one.  Become a patron of Saturday Morning Media and get cool rewards!  Visit www.patreon.com/saturdaymorningmedia for info! ©2021 Saturday Morning Media - http://www.saturdaymorningmedia.com

Episode 156 of the Institute of Performance Nutrition's "We Do Science" podcast! In this episode, I (Laurent Bannock) discuss "Omega 3 Fatty Acids and Impact on Physical Training & Performance" with Dr Chris McGlory PhD (Queen’s University, Canada) and Professor Kevin Tipton PhD (The Institute of Performance Nutrition, UK).Discussion Topics Include:Overview of omega-3 fatty acidsOmega-3 Fatty Acids on Skeletal Muscle Protein TurnoverBenefits of consuming omega-3 fatty acids: from health to skeletal muscleCan omega-3 fatty acids influence recovery from injury?Omega-3 fatty acids: food first and is there a case for supplementation?Podcast Episode Transcript: Download PDF CopyKey Paper(s) Discussed / Referred to:The Influence of Omega-3 Fatty Acids on Skeletal Muscle Protein Turnover in Health, Disuse, and DiseaseOmega-3 Fatty Acids: A Detailed Look at Omega-3 Fatty Acids and Their Impact on Physical PerformanceRelated Podcast Episodes:#153 - "Muscle Protein Synthesis and Response to Exercise & Nutrition" with Professor Kevin Tipton#150 - "Muscle Protein Breakdown in Response to Nutrition and Exercise" with Professor Kevin Tipton#115 - "Dietary Fat and Elite Endurance Performance" with Dr Jill Leckey#110 - "Nutrition Support for Exercise Induced Injury" with Professor Kevin TiptonCheck out our other podcasts, publications, events, and professional education programs for current and aspiring sports nutritionists at www.TheIOPN.com and follow our social media outputs via @TheIOPN

I’m back from Africa - what a trip it was!  I got to spend multiple days hunting, eating, living, dancing, and adventuring with the Hadza of Tanzania… In this week’s podcast episode (Fundamental Health, available at heartandsoil.co, Apple podcasts, and YouTube), @dranthonygustin and I sat down to answer many of your questions about our trip and share some of our biggest takeaways…  We discuss how the Hadza eat, what they don’t eat, how healthy they are, how happy they are, salt?, hunting, eating baboon, and a ton more… I talked about my takeaways from this trip in this week's newsletter - If you didn't get it, you’re missing out! Join the tribe at heartandsoil.co!    Timestamps: 0:09:35 Paul's baboon brainy beard 0:12:49 The "Why" behind the trip 0:17:40 You can't believe everything you read 0:23:54 Bush berries are no joke! 0:27:33 Why do the Hadza hunt baboons | The government restrictions on the Hadza 0:39:39 Tubers as Fallback Foods and Their Impact on Hadza Hunter-Gatherers https://onlinelibrary.wiley.com/doi/abs/10.1002/ajpa.21040 0:39:44 The world's foremost meat enthusiasts 0:47:54 What about prions? 0:50:20 Are we westerners just pansies? 1:00:32 The Hadza's secret to happiness 1:13:02 Physical activity patterns and biomarkers of cardiovascular disease risk in hunter-gatherers Https://onlinelibrary.wiley.com/doi/abs/10.1002/ajhb.22919 1:19:24 Hunter-gatherers as models in public health Https://onlinelibrary.wiley.com/doi/full/10.1111/obr.12785 1:20:09 It's not all about diet - The healing power of nature 1:29:58 Gender roles and family life of the Hadza 1:36:38 The immense contentment of the Hadza 1:39:50 Why do the Hadza choose their way of life? 1:50:15 The life expectancy of Hunter-gatherers - The Blue Zones are a myth! 1:59:40 Chronic illness always comes back to seed oils 2:06:54 Why did the Hadza have brown teeth? 2:07:56 The effects of excessive fluoride intake https://ajph.aphapublications.org/doi/pdf/10.2105/AJPH.57.4.651   Heart & Soil: Heartandsoil.co for grass-fed desiccated organ supplements White Oak: Use “CarnivoreMD” at whiteoakpastures.com Belcampo: Use “CarnivoreMD” or “Carnivore10” at www.belcampo.comBlublox: Blublox.com, use “CarnivoreMD” for 15% off  Joovv: www.joovv.com/paul

HEY “MY CREATIVES” .....IT'S BEEN A WHILE SINCE WE LAST ENJOYED A JOURNEY of C.U.T.S. We had a ***EXCLUSIVE*** conversation with The DOWE TWINS!!! We were conducting a meeting regarding of becoming their mentor, and just the levels of knowledge that displayed during the conversations ....….definitely felt it was right to turn this into an episode. #MyCreatives you will not be let down with this EXCLUSIVE Interview!!!! We Touched on: Their Impact with their Brand What did they take or learn from 2020? Being Youth Leaders Much More!!!!!! FOLLOW US: @cuts_podcast YOU TUBE CHANNEL: [[SUBSCRIBE]] - https://www.youtube.com/channel/UCbVNj5NtHbfenXkoxa3xAKg?view_as=subscriber GUEST: DOWE TWINS: @DOWETWINS https://www.instagram.com/dowetwins/ *****FOR SERIOUS INQUIRES & FUTURE GUEST(S) APPEARANCES - CutsPodcast1@gmail.com ******Please LEAVE COMMENTS, FEEDBACK, and [[SUBSCRIBE]] the PODCAST on ALL MAJOR STREAMING PLATFORMS!!! --- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app Support this podcast: https://anchor.fm/cutspodcast/support

In this talk, Steve Richardson shares their knowledge on Thoughts, Belief Systems and Their Impact. These talks come from the archive of The Best You EXPO. The Best You EXPO talks are live talks recorded at events in London and Los Angeles. The talks are approximately 45 minutes long and cover all aspects of personal and professional growth. Talks on public speaking, finding love, increasing confidence and low self-esteem, how to make more money, get more clients, increase your social media presence, talks on NLP and so much more. We are talking about over 500 talks and more being recorded all over the world, so there is something for everyone.

In this talk, Steve Richardson shares their knowledge on Thoughts Belief Systems and Their Impact. These talks come from the archive of The Best You EXPO. The Best You EXPO talks are live talks recorded at events in London and Los Angeles. The talks are approximately 45 minutes long and cover all aspects of personal and professional growth. Talks on public speaking, finding love, increasing confidence and low self-esteem, how to make more money, get more clients, increase your social media presence, talks on NLP and so much more. We are talking about over 500 talks and more being recorded all over the world, so there is something for everyone.

Pour ce nouvel épisode de Meet The dev, je reçois Guillaume Benoit. Guillaume est enseignant en game design et responsable pédagogique dans une école spécialisée. Les recommandations de Guillaume: Level Up, Scott Rogers David Perry on Game Design An architecture approach to level design, Christopher W. Totten Getting Gamers: The Psychology of Video Games and Their Impact on the People Who Play Them, Jamie Madigan Youtueb Extracredits GDC vault Alt 236 Suivez le podcast sur Twitter : @PodMeetTheDev Meet The dev est disponible sur Spotify, iTunes, Apple Podcast, Google Podcast, Podcast Addict et pleins d'autres agrégateurs ! Music : The Nobody - Blockhttps://soundcloud.com/nobody17

Over the past two centuries, archaeologists have found bones, footprints, and artifacts showing that people like ourselves have existed on earth for many millions of years. But many scientists have forgotten or ignored these remarkable facts. Why? Primarily because they contradict the now dominant evolutionary views about human origins and antiquity. According to these views, humans like ourselves have existed for only about 100,000 or 200,000 years, and before that there were only more primitive human ancestors. This evolutionary paradigm, to which influential groups of scientists are deeply committed, has acted as a "knowledge filter." And the filtering, intentional or not, has left us with a radically incomplete set of facts for building our ideas about human origins. Recovering the complete set of facts takes us on a fascinating expedition, across five continents to various archaeological sites, some long forgotten, some the center of ongoing controversy. On the other hand, the complete set of facts is consistent with the accounts of extreme human antiquity found in the Puranas, the historical writings of ancient India. Michael A. Cremo is research associate in history of archeology. He is a member of the World Archaeological Congress (WAC) since 1993. His WAC3 paper "Puranic Time and the Archaeological Record" was published in the Routledge One World Archaeology series volume Time and Archaeology (1999), edited by Tim Murray. He is also a member of the European Association of Archaeologists (EAA). In 2004 Cremo's paper "The Later Discoveries of Boucher de Perthes at Moulin Quignon and Their Impact on the Moulin Quignon Jaw Controversy," presented at the XXth International Congress for History of Science, Liege, Belgium, was published in a conference proceedings volume of this congress, by the scientific publisher Brepols. This event took place Sept 25th, 2014.  Visit https://g.co/talksatgoogle/michaelcremo to watch the video.

In this final episode of our three-part series, Faith-Based Programs and Their Impact on Rural Communities, which we're doing in collaboration with and supported by The Duke Endowment, Michelle chats with three experts about efforts rural churches are making to narrow the academic achievement gap and improve literacy rates for students in rural North Carolina: Dr. Helen Chen, consultant and researcher, Sharon Locklear, Director of the Sandy Plains United Methodist Church Summer Literacy Program in Pembroke, N.C., and David Reeves, Senior Minister at Cullowhee United Methodist Church in Cullowhee, N.C. During summer months, Dr. Chen notes, there is often a dearth of academic enrichment opportunities in rural communities, and literacy programs implemented by rural churches can help ensure that students meet mandatory grade-level literacy requirements and prevent "summer slide." The Duke Endowment’s Rural Church summer literacy initiative, whose roots date back to 2012, provides churches with grants to host six-week reading camps that ,include 90 hours of instruction, coupled with wraparound services, such as breakfast and lunch, transportation, and family engagement activities. Reeves' church hosted its first camp last year, which was extremely successful. It prompted them to continue the camp this year, albeit with a shorter program and a focus on children who did not have access to remote learning, while also adhering to CDC safety recommendations. Dr. Chen points out that the pandemic accentuates the literacy gap in rural communities and necessitated increased virtual learning this summer. Locklear's program, which also began last year and has continued this year, provides Native American students, "who are more tactile learners," with additional hands-on activities, such as magnet boards for sentence structure and poster boards for vocabulary instruction. This episode is sponsored by The Duke Endowment, www.dukeendowment.org.

This is the second episode in a new series called Faith-Based Programs and Their Impact on Rural Communities, which we’re doing in collaboration with and supported by The Duke Endowment. This private philanthropic organization serves North Carolina and South Carolina in four distinct grantmaking areas: health care, child & family well-being, higher education, and rural United Methodist churches. Michelle chats with Heather Kilbourne, Program Manager of the Faith in Rural Communities Initiative at the North Carolina Rural Center; Nicole Johnson, Associate Director for the Partners in Health and Wholeness program of the North Carolina Council of Churches; and Michelle Osborne, the Program Manager for Come to the Table, one of many initiatives of the Rural Advancement Foundation International-USA. Their conversation focuses on how rural congregations are filling gaps in local communities during the COVID-19 pandemic and covers a wide range of critical issues, including food systems, public health, and community development. Kilbourne says her program helps churches and other faith communities use their resources to meet the significant needs of residents and that “rural churches thrive when they help their communities thrive.” She also describes how, during COVID-19, churches have purchased meals for community members in need, delivering them directly to residents or via drive-throughs. Johnson says her program assists faith communities in addressing a variety of essential issues, including food security, mental health, and substance abuse, and that faith communities are particularly gifted in “reminding people that they are whole.” She also discusses how her program and local churches have pivoted during the pandemic to offer food drops, deliver COVID-19 kits, and establish testing sites. Osborne describes how her organization works to connect the hunger relief programs of churches to local agriculture to address food security, poverty, and strengthen justice in the state’s food system. She also shares details about a grant program designed to provide churches with funds to purchase food from local farmers and give it to families in need.  The Duke Endowment (http://www.dukeendowment.org) sponsored this episode.  

The European Union is making sweeping updates to how retailers need to calculate Value-Added Tax (VAT) when selling goods into its member countries, effective July 1, 2021. Peter Boerhof, EU VAT director for Vertex, explains the various changes and their significance, and the impact for companies selling goods into Europe. The post Coming EU VAT Updates and Their Impact, Explained appeared first on Multichannel Merchant.

Episode Guest:Malika Fair, MD, MPH, is senior director of health equity partnerships and programs at the AAMC and an associate clinical professor and practicing physician in the Department of Emergency Medicine of the George Washington University School of Medicine and Health Sciences.Episode Credits:Hosted by David Skorton, MD, president and CEO of the AAMC.Produced by Stephanie Weiner, AAMC manager of digital strategy; Gabrielle Redford, AAMCNews director and managing editor; and Patrick Boyle, AAMCNews staff writer.Edited by Laura Zelaya, AAMC production manager.You Might Also Be Interested In:Racism and Health - Resources for the Academic CommunityAAMC Press Conference: Racism and Health: How and Where to Make Changes (June 12, 2020)“Academic medical leaders and learners reflect on police brutality, racism, and the path forward" (AAMCNews, June 5, 2020)AAMC Statement on Police Brutality and Racism in America and Their Impact on Health (June 1, 2010)“Why is my community suffering more from COVID-19?” (AAMCNews, May 20, 2020)Season 1 of the “Beyond the White Coat” Podcast

In this podcast, we will be discussing the consequences resulting from the abstinence-stressed curriculums taught within the majority of counties in Georgia. Then we will convey solutions as to how these consequences can be solved. References '-Rape Case-Gwinett County Clip: https://www.ajc.com/news/crime--law/gwinnett-student-accused-raping-classmate-school-bathroom/Uv3oODreAq3SjEYx8QrksO/ -Stanger-Hall, Kathrin F, and David W Hall. “Abstinence-Only Education and Teen Pregnancy Rates: Why We Need Comprehensive Sex Education in the U.S.” PloS One, Public Library of Science, 2011, www.ncbi.nlm.nih.gov/pmc/articles/PMC3194801/#pone.0024658-Martin1. -“Abstinence Education Programs: Definition, Funding, and Impact on Teen Sexual Behavior.” Women's Health Policy, KFF, 1 June 2018, www.kff.org/womens-health-policy/fact-sheet/abstinence-education-programs-definition-funding-and-impact-on-teen-sexual-behavior/. -“GEORGIA.” State Profiles Fiscal Year 2017, SEICUS, 2017, siecus.org/wp-content/uploads/2018/07/GEORGIA-FY17-FINAL.pdf. -Morris, Jessica L, et al. “Sexually Transmitted Infection Related Stigma and Shame among African American Male Youth: Implications for Testing Practices, Partner Notification, and Treatment.” AIDS Patient Care and STDs, Mary Ann Liebert, Inc., Sept. 2014, www.ncbi.nlm.nih.gov/pmc/articles/PMC4135319/. -Santelli, John S, et al. “Abstinence-Only-Until-Marriage: An Updated Review of U.S. Policies and Programs and Their Impact.” Journal of Adolescent Health, vol. 61, 18 May 2017, pp. 273–280., https://www.jahonline.org/article/S1054-139X(17)30260-4/pdf. -Shannon, Chelsea L, and Jeffrey D Klausner. “The Growing Epidemic of Sexually Transmitted Infections in Adolescents: a Neglected Population.” Current Opinion in Pediatrics, U.S. National Library of Medicine, Feb. 2018, www.ncbi.nlm.nih.gov/pmc/articles/PMC5856484/. -“Sexually Transmitted Diseases by State.” National Council For Home Safety and Security, www.alarms.org/std-statistics/. -Thechampionnewspaper.com, thechampionnewspaper.com/news/local/std-rates-shock-local-health-expert/. -Sneen, S. Y. . (2019). The Current State of Sex Education and Its Perpetuation of Rape Culture. California Western International Law Journal, 49(2), 463–490.

Hosts Mat Bradley-Tschirgi, Thrasher, Jersey Jason, and guests Susannah Gorah (Author of You Couldn't Ignore Me If You Tried: The Brat Pack, John Hughes, and Their Impact on a Generation) and James (Home Alone Enthusiast) discuss Home Alone. A boy mutilates two robbers.  A Tom and Jerry cartoon writ large with cartoon violence and a hero who is an asshole, Home Alone is a perverse family classic. John Hughes' subplot involving the creepy neighbor has some nice heart to it, and John Candy has an all too brief cameo.  Huge thanks to Podcorn for sponsoring this episode. Explore sponsorship opportunities and start monetizing your podcast by signing up here: https://podcorn.com/podcasters/ Follow the show on Twitter @Sequelcast2 Like our Sequelcast 2 Facebook Page Sequelcast 2 is delighted to be a member of The Batman Podcast Network. Hear more great podcasts here! Watch Thrasher's tabletop RPG YouTube show d-infinity Live!. Listen to Marc with a C's music podcast Discography. Buy One Starry Night, a Cthulhu Live scenario Thrasher contributed to, from DriveThruRPG!  Buy Mat's new book The Films of Uwe Boll Vol. 1: The Video Game Movies!  Watch Alex Miller's YouTube series The Trailer Project!

In a world where we are so quick to blame our lack of results on our diet and exercise, we forget one of the most fundamental necessities of optimal health...our sleep! Find out why it may actually be your sleep that is sabotaging your progress in our latest episode. Take Advantage of our Discount Code: Blue Light Blockers → enter promo code “TRAIN15” at checkout for 15% off → https://safetyblueblockers.com/collections/collection-2/products/sleep-savior-ultra?rfsn=3371938.f22983&utm_source=refersion&utm_medium=affiliate&utm_campaign=3371938.f22983 Connect With Us: Email: Trainitforlife@gmail.com Instagram: www.instagram.com/makeittrain (Company) Instagram: www.instagram.com/donuts_then_deadlifts (Dr. Andrew Stewart DPT, PT) Instagram: www.instagram.com/jvromo3 (John Romanelli) Youtube: Bit.ly/watchmit (Company) Facebook: www.facebook.com/makeittrain (Company) Research Cited in This Episode: • Association of Sleep Duration With Weight Gain and General and Central Obesity Risk in Chinese Adults: A Prospective Study: https://pubmed.ncbi.nlm.nih.gov/31876384-association-of-sleep-duration-with-weight-gain-and-general-and-central-obesity-risk-in-chinese-adults-a-prospective-study/ • Poor Sleep Quality's Association With Soccer Injuries: Preliminary Data: https://pubmed.ncbi.nlm.nih.gov/31711034-poor-sleep-qualitys-association-with-soccer-injuries-preliminary-data/ • Chronic Lack of Sleep Is Associated With Increased Sports Injuries in Adolescent Athletes: https://pubmed.ncbi.nlm.nih.gov/25028798-chronic-lack-of-sleep-is-associated-with-increased-sports-injuries-in-adolescent-athletes/ • Sleep, Health and Wellness at Work: A Scoping Review: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5707986/ • Workplace Interventions to Promote Sleep Health and an Alert, Healthy Workforce: https://jcsm.aasm.org/doi/10.5664/jcsm.7734 • A Systematic Review of Worksite Interventions and Their Impact on Employee Sleep: https://academic.oup.com/sleep/article/41/suppl_1/A219/4988626 • Employee Sleep and Workplace Health Promotion: A Systematic Review: https://pubmed.ncbi.nlm.nih.gov/30957509-employee-sleep-and-workplace-health-promotion-a-systematic-review/ • Short Sleep Duration Is Associated with Reduced Leptin, Elevated Ghrelin, and Increased Body Mass Index: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC535701/ • Impact of sleep and sleep loss on glucose homeostasis and appetite regulation: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2084401/ • Sleep Hygiene and Recovery Strategies in Elite Soccer Players: https://hal-insep.archives-ouvertes.fr/hal-01661020/document • Sleep Interventions Designed to Improve Athletic Performance and Recovery: A Systematic Review of Current Approaches: https://pubmed.ncbi.nlm.nih.gov/29352373-sleep-interventions-designed-to-improve-athletic-performance-and-recovery-a-systematic-review-of-current-approaches/ • Effects of Training and Competition on the Sleep of Elite Athletes: A Systematic Review and Meta-Analysis: https://pubmed.ncbi.nlm.nih.gov/30217831-effects-of-training-and-competition-on-the-sleep-of-elite-athletes-a-systematic-review-and-meta-analysis/ • Noise Pollution: A Modem Plague: https://pubmed.ncbi.nlm.nih.gov/17396733-noise-pollution-a-modem-plague/ • Dietary Sources and Bioactivities of Melatonin: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5409706/#B28-nutrients-09-00367

I.             Mary’s Caring of Jesus – Luke 1:26 – 38 A.           She was Chaste – v. 27 B.           She was Committed – v. 27 C.           She was Commended – v. 28 – 30 D.           She was Commissioned – v. 31 – 33 E.           She was Convinced – vs. 34-37 F.           She was Compliant – v. 38 II.            The Shepherd’s Sharing of Jesus – Luke 2:8-18 A.          Their Profession – v. 8 B.          The Proclamation – vs. 9-14 C.          Their Purpose – vs. 15-16 D.          Their Privilege – v. 16 E.          Their Publication – v. 17 F.          Their Impact – v. 18

Episode 22 - News and Information, Air Medical Crashes, RoadID, and an Interview of Scott Kunkel, a paramedic, flight nurse, and an air medical executive who will be talking about Updates on New Developments in EMS and Their Impact on Air Medical Services

Episode 22 - News and Information, Air Medical Crashes, RoadID, and an Interview of Scott Kunkel, a paramedic, flight nurse, and an air medical executive who will be talking about Updates on New Developments in EMS and Their Impact on Air Medical Services

“We call them neglected tropical diseases…but the truth is, they're really diseases of extreme poverty; you ordinarily do not get a neglected tropical disease unless you live in extremely impoverished conditions where there's environmental degradation, poor-quality housing, inadequate sanitation,” says Dr. Peter Jay Hotez, Dean of the National School of Tropical Medicine at Baylor College of Medicine. He continues by explaining that contrary to what many people may think, these diseases are not rare, and they're not found only in developing countries: they are global health issues found right here in the United States, and affect hundreds of millions of people worldwide. Despite these numbers, the major pharmaceutical companies aren't focused on developing drugs or vaccines to combat their spread. As a result, these responsibilities fall on the nonprofit sector. Dr. Hotez discusses the efforts within this sector and by the National School of Tropical Medicine toward implementing vaccination for some of the most common neglected tropical diseases, including hookworm infection, Chagas disease, and schistosomiasis. In today's podcast, you will discover: Where some of the most common neglected tropical diseases originate, how they are contracted, and what they do to the body How the significant financial barriers to the development of vaccines in the nonprofit sector might be mitigated Which neglected tropical disease is a major cofactor in Africa's AIDS epidemic How much progress has been made toward developing vaccines for neglected tropical diseases Press play to hear the full conversation, check out Dr. Hotez's book, Forgotten People, Forgotten Diseases: The Neglected Tropical Diseases and Their Impact on Global Health and Development, and learn more by visiting https://www.bcm.edu/education/schools/national-school-of-tropical-medicine/.

Top 5 Predictions for Digital Assistants and Their Impact on MarketingBy Bianca Ignacio aumcore.comThis audio is available in the UK, US, Canada,Australia and India as a Flash Briefing on @amazonecho devices and the #Alexa app (even without a device). Search for The Smart Speakers. The links referred to are at: https://www.thesmartspeakers.com/links ‬Also check out my 28 Day Flash Briefing Briefing - a step-by-step course in building a better briefing for your brand or business or self. It's available in the Alexa Skills store ‬https://skills-store.amazon.co.uk/deeplink/deviceType=app&shdp/B07N75H7HM?are&refSuffix=ss_copy Produced by Peter Stewart (@TweeterStewart) ‬#voice #voicefirst #voiceAI #smartspeakers #Alexa #flashbriefing‬ #WomenInVoice #AI #VUI #FlashBriefing #FlashBriefings #podcasts #technology #AlexaLive #Voice19 #Echo #smarthome

Top 5 Predictions for Digital Assistants and Their Impact on MarketingBy Bianca Ignacio aumcore.comThis audio is available in the UK, US, Canada,Australia and India as a Flash Briefing on @amazonecho devices and the #Alexa app (even without a device). Search for The Smart Speakers. The links referred to are at: https://www.thesmartspeakers.com/links ‬Also check out my 28 Day Flash Briefing Briefing - a step-by-step course in building a better briefing for your brand or business or self. It's available in the Alexa Skills store ‬https://skills-store.amazon.co.uk/deeplink/deviceType=app&shdp/B07N75H7HM?are&refSuffix=ss_copy Produced by Peter Stewart (@TweeterStewart) ‬#voice #voicefirst #voiceAI #smartspeakers #Alexa #flashbriefing‬ #WomenInVoice #AI #VUI #FlashBriefing #FlashBriefings #podcasts #technology #AlexaLive #Voice19 #Echo #smarthome

Top 5 Predictions for Digital Assistants and Their Impact on MarketingBy Bianca Ignacio aumcore.comThis audio is available in the UK, US, Canada,Australia and India as a Flash Briefing on @amazonecho devices and the #Alexa app (even without a device). Search for The Smart Speakers. The links referred to are at: https://www.thesmartspeakers.com/links ‬Also check out my 28 Day Flash Briefing Briefing - a step-by-step course in building a better briefing for your brand or business or self. It's available in the Alexa Skills store ‬https://skills-store.amazon.co.uk/deeplink/deviceType=app&shdp/B07N75H7HM?are&refSuffix=ss_copy Produced by Peter Stewart (@TweeterStewart) ‬#voice #voicefirst #voiceAI #smartspeakers #Alexa #flashbriefing‬ #WomenInVoice #AI #VUI #FlashBriefing #FlashBriefings #podcasts #technology #AlexaLive #Voice19 #Echo #smarthome

Top 5 Predictions for Digital Assistants and Their Impact on MarketingBy Bianca Ignacio aumcore.comThis audio is available in the UK, US, Canada,Australia and India as a Flash Briefing on @amazonecho devices and the #Alexa app (even without a device). Search for The Smart Speakers. The links referred to are at: https://www.thesmartspeakers.com/links ‬Also check out my 28 Day Flash Briefing Briefing - a step-by-step course in building a better briefing for your brand or business or self. It's available in the Alexa Skills store ‬https://skills-store.amazon.co.uk/deeplink/deviceType=app&shdp/B07N75H7HM?are&refSuffix=ss_copy Produced by Peter Stewart (@TweeterStewart) ‬#voice #voicefirst #voiceAI #smartspeakers #Alexa #flashbriefing‬ #WomenInVoice #AI #VUI #FlashBriefing #FlashBriefings #podcasts #technology #AlexaLive #Voice19 #Echo #smarthome

Top 5 Predictions for Digital Assistants and Their Impact on MarketingBy Bianca Ignacio aumcore.comThis audio is available in the UK, US, Canada,Australia and India as a Flash Briefing on @amazonecho devices and the #Alexa app (even without a device). Search for The Smart Speakers. The links referred to are at: https://www.thesmartspeakers.com/links ‬Also check out my 28 Day Flash Briefing Briefing - a step-by-step course in building a better briefing for your brand or business or self. It's available in the Alexa Skills store ‬https://skills-store.amazon.co.uk/deeplink/deviceType=app&shdp/B07N75H7HM?are&refSuffix=ss_copy Produced by Peter Stewart (@TweeterStewart) ‬#voice #voicefirst #voiceAI #smartspeakers #Alexa #flashbriefing‬ #WomenInVoice #AI #VUI #FlashBriefing #FlashBriefings #podcasts #technology #AlexaLive #Voice19 #Echo #smarthome

Part 6 of 7The sixth installment of the 2014 Pikes Peak Regional History Symposium, Bigwigs & Benefactors of the Pikes Peak Region.Mike Olsen — Emcee"The Ethical Industrialist: William Jackson Palmer & the Gilded Age," by Katherine Scott Sturdevant​"The Palmer Girls & Their Impact on Colorado Springs," by Susan Fletcher Right click here to download and save the mp3 file. [...]

For Christ's Sake - 3 Veils in the Bible and Their Impact on People Coming to Jesus by Grace Capital Church

About Episode 48: Access to education is not equal across all demographics. What might we do about that? In this episode, rockstar scholar Dr. Chuck Dziuban joins hosts Tom and Kelvin to discuss equity and the affordances of digital learning. Podcast Recording Download Transcript: [PDF] Episode 48 Show Notes: Kelvin Thompson, Charles Dziuban, and Thomas Cavanagh recording TOPcast episode 48 in the studio. Episode Synopsis via Twitter View complete list of episode highlights via Twitter Coffee Links Mexico Chiapas from UCF’s Foxtail Coffee Company (featured in this episode) Foxtail Coffee Company Content Links Dr. Charles D. (“Chuck”) Dziuban’s Online Profile Dr. Dziuban’s GoogleScholar Citations Tangelo Park Program Case Study: "Tangelo Park Program: A Broader, Bolder Approach to Education" UCF Downtown UCF and the Parramore Community From the Pell Institute: "Indicators of Higher Education Equity in the United States" Book (recommended by Dr. Dziuban): "Factfulness" by Hans Rosling Wall Street Journal Article (cited by Dr. Dziuban): "Even at Top Colleges, Graduation Gaps Persist for Poor Students" Katrina Meyer Article (recommended by Dr. Dziuban): "Common Metaphors and Their Impact on Distance Education: What They Tell Us and What They Hide" Video: "UCF Online: My Why"

Michael A. Cremo is research associate in history of archeology. He is a member of the World Archaeological Congress (WAC) since 1993. His WAC3 paper "Puranic Time and the Archaeological Record" was published in the Routledge One World Archaeology series volume Time and Archaeology (1999), edited by Tim Murray. He is also a member of the European Association of Archaeologists (EAA). In 2004 Cremo's paper "The Later Discoveries of Boucher de Perthes at Moulin Quignon and Their Impact on the Moulin Quignon Jaw Controversy," presented at the XXth International Congress for History of Science, Liege, Belgium, was published in a conference proceedings volume of this congress, by the scientific publisher Brepols. Cremo is the principal author of the book Forbidden Archeology, a comprehensive historical survey of archaeological anomalies. In a review in British Journal for History of Science, Tim Murray said the book "provides the historian of archaeology with a useful compendium of case studies in the history and sociology of scientific knowledge, which can be used to foster debate within archaeology about how to describe the epistemology of one's discipline." Recent Books:Cremo, M. A., and Thompson, R. L. (1993) Forbidden Archeology. San Diego: Bhaktivedanta Institute (reviews and notices in American Journal of Physical Anthropology, Geoarcheology, Journal of Field Archeology, Antiquity, Journal of Unconventional History, L'Homme, L'Anthropologie, British Journal for the History of Science, Social Studies of Science, and Ethology, Ecology, and Evolution. Translated into German as Verbotene Archaeologie (1994) Essen: Bettendorf. Cremo, M. A., and Thompson, R. L. (1994) The Hidden History of the Human Race. Badger: Govardhan Hill. Popular edition of Forbidden Archeology. (Spanish, Italian, Japanese, Hungarian, Polish, and Russian rights sold, other translation rights under negotiation). Cremo, M. A., and Goswami, M. (1995) Divine Nature: A Spiritual Perspective on the Environmental Crisis. Los Angeles: Bhaktivedanta Book Trust (released on Earth Day, April 22; 200,000 copies in print).Michael Cremo Websites http://www.mcremo.comhttp://www.mysciencemyreligion.comhttp://www.forbiddenarcheologist.comhttp://www.humandevolution.comhttp://www.forbiddenarcheology.com

I am excited to bring you this mid-week mini series over the next 4 weeks with prior show guests Dr. Noah Moos (episode 78) and Rogue Trail guru Jason Brooks (episodes 94 and 105). These episodes will post on Wednesdays in addition to my normal weekly episodes that come on Sundays. In this series, we discuss the beyond-training elements that might impact human performance such as stress, diet, sleep, systemic inflammation, and more. Dr. Moos is a chiropractor by training but practices many eastern medicine concepts in his Austin-based clinic HealthPlus ATX (www.healthplusaustin.com). Jason Brooks is our resident trail guru and leader for our Rogue Virtual (https://www.roguerunning.com/roguevirtual) one-to-one training programs. He is also an admitted nerd on these topics. Naturally, the idea for this series was born on a trail run between Jason and Dr. Moos, and we decided to bring their trail musings to you. Eventually, the idea is to form a spin-off podcast on this topic with the two of them. Here are the topics we will cover in the series: Episode 1: Stress and How It Affects Performance Episode 2: The Model of Degeneration and How Things go Wrong in Your Body Episode 3: Diet/Nutrition and Their Impact on How You Feel Episode 4: Adaptive Healthcare and Coaching. How You Learn and Adapt Your Life and Training Based on Episodes 1-3. 

In the late 1800s Chicago families bought their Christmas trees from the decks of schooners that had ferried them across Lake Michigan. In this week's episode of the Futility Closet podcast we'll meet Herman Schuenemann, known as "Captain Santa," who brought Christmas to the city for 30 years until a fateful storm overtook him. We'll also peruse some possums and puzzle over a darkening phone. Intro: In 1991 a Yale physician proposed naming toes. No one's quite sure how cats navigate. Photo: Herman Schuenemann, center, with W.K. Vanaman, left, and a Mr. Colberg aboard a Christmas tree ship in the Chicago River, 1909. Sources for our story: Fred Neuschel, Lives & Legends of the Christmas Tree Ships, 2007. Larry Peterson, "The Legend of the Christmas Ship," Wisconsin Magazine of History 96:2 (Winter 2012/2013), 28-39. Glenn V. Longacre, "The Christmas Tree Ship," Prologue 38:4 (Winter 2006), 6-12. Shannon Marie Lange, Chicago Shipwrecks: Disasters and Their Impact on Maritime Law, dissertation, Southern New Hampshire University, 2017. Fred Neuschel, "Sailors as Entrepreneurs in a Great Lakes Maritime Village," Northern Mariner 8 (1998), 65-82. Fred Hollister, "Loss of the Christmas Tree Schooner," Sea Classics 39:5 (May 2006), 50-55. Amy Meyer, "Rouse Simmons Mystery Still Relevant," [Manitowoc, Wis.] Herald Times Reporter, Nov. 1, 2015. Kevin Collier, "Is 'Christmas Tree Ship' a Ghost of Christmas Past?" TCA Regional News, Dec. 22, 2014. "Lake Michigan Almost Canceled Christmas," Battle Creek [Mich.] Enquirer, Nov. 30, 2014. Doug Moe, "Film Tells Tale of Christmas Tree Ship," Wisconsin State Journal, Nov. 29, 2013. John Gurda, "'Christmas Tree Ship' Went Down on the Lake 100 Years Ago," Milwaukee Journal Sentinel, Dec. 1, 2012. Meg Jones, "Events Mark 100 Year Anniversary of Sinking of Christmas Tree Ship," Milwaukee Journal Sentinel, Nov. 22, 2012. Jordan Tilkens, "Centennial Celebration Commemorates Sunken Ship," [Appleton, Wis.] Post-Crescent, Nov. 22, 2012. Jordan Tilkens, "Two Rivers Museum Marks 100th Anniversary of 'Christmas Tree Ship' Sinking," Green Bay [Wis.] Press Gazette, Nov. 21, 2012. Tony Trowbridge, "When the Christmas Spirit Foundered in Chicago," Chicago Tribune, Nov. 11, 2012. Kristopher Wenn, "Smaller Stories Fill Christmas Tree Ship's History," [Manitowoc, Wis.] Herald Times, Nov. 18, 2007. Dennis McCann, "Christmas Tree Ship Surfaces in Memory," Milwaukee Journal Sentinel, Nov. 12, 2006. Mike Michaelson, "Algoma Remembers 19th-Century Christmas Tree Ships," [Arlington Heights, Ill.] Daily Herald, Nov. 21, 2004. Susan Smith, "89 Years Later ... ; Legend of Famed But Ill-Fated Christmas Tree Ship Revived," Wisconsin State Journal, Dec. 2, 2001. "Coast Guard Re-Enacts 'Christmas Tree' Voyages," Associated Press, Dec. 4, 2000. David Young, "The Fir Trade Separating Fact From Legend in Loss of Christmas Tree Ship," Chicago Tribune, Dec. 26, 1999. David Young, "A Tall Order Milwaukee Schooner Being Built to Meet a Solid Heritage," Chicago Tribune, Oct. 4, 1998. Margaret H. Plevak, "The Ship That Never Arrived Schooner Loaded With Yule Trees Vanished in Lake," Milwaukee Journal, Dec. 8, 1992. "Large Christmas Tree Crop," Michigan Manufacturer & Financial Record 14:24 (Dec. 12, 1914), 27. "Heart to Heart Talks," Successful Farming 12:12 (December 1913), 81. "Chicago Notes," Horticulture 18:18 (Nov. 1, 1913), 611. "Christmas Tree in Crepe; Mourning Recalls to Chicagoans Death of Lake Captain and Crew," New York Times, Dec. 26, 1912. "Has Christmas Tree Widow; Chicago to Be Supplied with Firs, Despite Schooner's Wreck," New York Times, Dec. 11, 1912. "Had Fifteen on Board," Lemmon [S.D.] Herald, Dec. 6, 1912. "Christmas Tree Ship Lost; Wreckage of Old Schooner Washed Ashore in Lake Michigan," New York Times, Dec. 5, 1912. "Vessel With 15 Men Lost," Rock Island [Ill.] Argus, Dec. 4, 1912. "To Greet Santa Claus," Fruit Trade Journal and Produce Record 46:10 (Dec. 9, 1911), 6. "Notes," American Florist 35:1174 (Dec. 3, 1910), 937. Listener mail: Wikipedia, "Opossum" (accessed Nov. 21, 2018). Wikipedia, "Powhatan Language" (accessed Nov. 21, 2018). Ann Gibbons, "Why 536 Was 'The Worst Year to Be Alive,'" Science, Nov. 15, 2018. Church of Jesus Christ of Latter-day Saints, Saints: The Story of the Church of Jesus Christ in the Latter Days: The Standard of Truth: 1815–1846, 2018. "Downing Street's Larry the Cat Gets a Helping Hand From Police," BBC News, Nov. 20, 2018. "Hilarious Moment Downing Street Policeman Knocks on Number 10 to Let Larry Cat In," Sun, Nov. 20, 2018. This week's lateral thinking puzzle was contributed by listener Scott Richards. You can listen using the player above, download this episode directly, or subscribe on Google Podcasts, on Apple Podcasts, or via the RSS feed at https://futilitycloset.libsyn.com/rss. Please consider becoming a patron of Futility Closet -- you can choose the amount you want to pledge, and we've set up some rewards to help thank you for your support. You can also make a one-time donation on the Support Us page of the Futility Closet website. Many thanks to Doug Ross for the music in this episode. If you have any questions or comments you can reach us at podcast@futilitycloset.com. Thanks for listening!

Welcome to this ASCO in Action Podcast. This is ASCO's monthly podcast series where we explore policy and practice issues that impact oncologists, the entire cancer care delivery, and, most importantly, the individuals we care for-- people with cancer. My name is Cliff Hudis and I'm the CEO of ASCO, as well as the host of the ASCO in Action Podcast series. For today's podcast, I am delighted to welcome Dr. Ray Page who's chair of ASCO's clinical practice committee as our guest today. Ray was recently awarded the prestigious ASCO Advocate of the Year Award for his exceptional efforts to shape health care policies to have a direct impact on our ability to provide high-quality cancer care for our patients. Our conversation today is going to focus on one of those policy-related issues that Ray has spent so much time on, and it's an area of growing concern to all oncology practices, that is, the emergence of pharmacy benefit managers in the cancer care delivery system. Now some of you will know that ASCO recently released a position statement on pharmacy benefit managers, or PBMs, as they're known, specifically focusing on their impact on cancer care. And as a little bit of background on this, in terms of policy work, ASCO has a formal process for vetting and adopting the society's policy priorities. Typically, we will develop and release a position or policy statement when we learn about an issue or a development that is impacting, or may, in the future, have an impact, on the delivery of and access to cancer care. We determined that a position statement was necessary on PBMs because serious concerns were being raised by our members through our state affiliate council, our clinical practice committee, and in direct conversation with other ASCO leaders. So as we often do, we analyze the issue carefully. We gather evidence, such as is available. We describe the issue. And, then, most importantly, we identified steps that could be taken to at least begin to address the challenges. The result was the ASCO position statement on "Pharmacy Benefit Managers and Their Impact on Cancer Care." So with that as background, I want to turn and welcome Dr. Page. And thank you for joining me today to discuss this important topic. Welcome. Thank you, Cliff, for having me here today. Great. So I want to start off with a level set, Ray. Some who may be listening today may not be familiar with PBMs, what and who they are, or what purpose they serve. Can you give a general overview of pharmacy benefit managers? How do they work? Sure, Cliff. In its simplest form, a pharmacy benefit manager, or PBM, is a middleman company that was originally utilized by payers as a third-party manager of prescription drug claims. Why did these companies ever come into being in the first place? Well, this largely developed out of the Medicare Modernization Act of 2003 and when the Medicare Part D program for oral drugs was implemented in 2006. Cliff, I believe that they had good original intent, as their primary objective was the simplification of the transactions between pharmacies and health plan sponsors. However, over time, they have evolved to where they now include a variety of new business functions in an effort to better manage drug benefits and reduce the overall drug spending cost for plan sponsors. They claim that they're controllers of cost but, in reality, they have created huge and extremely complex business relationships to where they now have put personal profits before patients. So how extensive is the PBM system? And has it increased in the last few years? And if so, why? Yeah. Today, PBMs are ubiquitous. They were involved in the transaction of several hundred billion dollars of drugs across the United States. PBMs control the pharmacy benefits of over 253 million Americans. What is concerning is after numerous acquisitions and consolidations, and this is often called horizontal integration, there are now only three behemoth companies that control 85% of the prescription drug benefit transactions in this country. These three companies are familiar to all of us. They are CVS Health, Express Scripts, and OptumRx. So one may ask, what's wrong with those guys? They're all reputable pharmacies that are managing and distributing drugs. Well, they've grown to be far more. CVS, for example, started out as a drugstore. But now they are a PBM, specialty pharmacy, a mail-order pharmacy, an insurer, a benefit plan sponsor, and now they have medical clinics and own doctors. So part of the perversity that arises is when PBMs vertically integrate with the sponsors, the insurers, the pharmacies, and clinics all into one big package to now they have complete control of the patients and the flow of all their prescriptions. Then may make transactional relationships between these entities and the drug manufacturers, distributors, and providers to where they generate enormous profits off the management of these drugs, yet none of these profits are ever passed on to the patients. Practicing oncologists and ASCO have concerns that some of these utilization management policies can have an adverse impact on our nation's most vulnerable patients, which are our cancer patients. Well, last year, ASCO released a policy statement on utilization management strategies. And these are payer-imposed practices that may, in some cases, restrict access to, or deny coverage for, selected treatments. The major concern, at that time, was that certain payer practices, such as prior authorization, step therapy, specialty tiers, and restricted formularies, all of these could hinder access to high-quality cancer care. The question we have, I think, with regard to PBMs is whether we share these same concerns when we turn to PBMs. And if that's so, can you explain some of the practices that PBMs might use and what that might mean to the cancer patient, specifically with regard to access to most appropriate therapies? Yeah, Cliff. There's several concerns that I have with the PBMs managing drugs that could adversely impact our cancer patients. And let me just describe a few. As cancer doctors, we always want to give what we think is the best personalized drug for that individual patient for the right diagnosis at the right time. I may prescribe a cancer drug that is not on a preferred formulary of the PBM because, perhaps, they have negotiated a better price with another manufacturer that gives them more profit. So they recommend replacement with another drug. This is called a step edit. And, oftentimes, your preferred drug cannot be prescribed until there is a fail-first policy with an alternative drug. So for such things as nausea and vomiting control with highly emetogenic chemotherapy, I would prefer to have no vomiting with a preferred drug rather than dealing with nausea with a fail-first inferior drug. Second, we have PBMs that want to deliver storage sensitive toxins, chemotherapy drugs, and injections to the patient's doorstep and then have them brown bag these drugs to our office for administration, although we have no record of the pedigree and the accountability of those dangerous drugs. Third, we now have PBMs refusing to give such things as IVIg infusions in our office. And for some of our patients, they have to go to the street corner CVS box and get their IVIg at the CVS infusion center. Yet I am accountable for the outcomes of that patient. Lastly, and worst, we're seeing cost shifting onto the patients. Based on their packaging and dispensing methods, the patients often have to pay multiple huge co-pays because of partial fills of oral chemotherapy drugs. So if I understand you correctly, while PBMs did not end step therapy, specialty tiers, and restrictions and formularies, they're using these previously recognized tactics as a way of notionally controlling costs, but at least having a downstream effect of potentially restricting access to what is oncologist-driven best care. Is that a fair summary? That is correct. So it is those utilization management techniques that create significant administrative burdens and impairments on getting patients appropriate, and timely, and affordable access to care. Well, you must see this firsthand, right? You're in private oncology practice at the Center for Cancer and Blood Disorders in Aledo, Texas. And I know that you have an active practice and you see a large number of patients. I'm wondering if you've had, yourself, firsthand experience of PBMs and what you've seen it has meant for your patients to have their care influence that way. And what it's meant for you and your colleagues as you work to provide highest quality care. Are there vignettes or aspects of this that come to mind? Yes. In my private practice in Fort Worth, Texas, I have firsthand experience with PBMs every day. What it means for our patients is an interference in the physician-patient relationship, pushing of care outside our Cancer Center, creating an impact on our ability to provide value-based care in an oncology medical home, causing delays in care, alterations in treatment plans, potential increases in toxicities, and more out-of-pocket costs for the patients. So let me give you a quick case of a patient that I have. Tom was diagnosed with a stage 3 rectal cancer and I recommended capecitabine and radiation therapy. I prescribed, for him, capecitabine 500 milligrams, three tablets BID, on the days of radiation therapy, which would be 180 pills, which he went down to my pharmacy to get. At my pharmacy, he was told that he was out-of-network and he would have to get this through CVS Caremark. So I saw the patient in his third week of treatment. And I found out that they had filled 120 of the 180 pills. And they told the patient that they only packaged the capecitabine in 120-pill bottles. So his first co-pay, for that first three weeks, was $400. So then he got a second bottle of 120 pills and paid a second co-pay of $400. And that was a prescription of excess pills. And so CVS, they told him just to throw away the extra 60 pills that he did not use. Now this was financially impactful for both the patient and my practice. The drug cost, if a single script was given through my practice, would have been $3,900. The drug cost for the two scripts with the extra unused pills was $7,200 through the PBM. Now under the new MACRA, MIPS payment model that we're all subject to, or under the Oncology Care Model, which is an alternative payment model, this kind of thing negatively impacts our resource use. So this process is completely out of my control, yet I get peened for not being a good steward of drug utilization. Well, that's a pretty compelling example. And I assume there are others, right? Yes, there is. There's many. Well, I think if we turn a little bit to one of the points you raised already, it was about the in-office pharmacy in your practice. Can you, for people who might not be familiar with this, can you briefly describe how it works to have an in-office pharmacy? Is this something that all oncology practices have? And how have the PBMs impacted its operation in your experience? Yes, Cliff. Most all cancer centers across the country have their own retail pharmacy, regardless of whether they're an academic center, a hospital-based practice, or an independent community practice. The impact of the PBMs affects the delivery of cancer care no matter how small or great your cancer center is. More and more cancer centers, as well as large hospital systems, are trying to get specialty pharmacy status to be able to combat some of the PBM tactics of being out-of-network, or having direct and indirect remuneration DIR fees, rebate clawbacks, and gag clauses. So let me just say that PBMs may be a place for managing common drugs for diabetes, and heart, and thyroid, and infectious diseases. But there are reasons that cancer centers prefer to have complete control of the cancer therapies that we prescribe. In general, cancer drugs not only have the risk of substantial physical toxicities that need close pharmacy management, but they also have tremendous financial toxicities for the patient that we help manage with our pharmacy staff and in which those resources do not exist within the PBMs. So it's highly preferable that cancer patients get their prescriptions through a highly-trained oncologic pharmacist at the Cancer Center who has access to their full electronic health records and drug lists and who knows them, personally, by name. Our pharmacy staff has resources to educate the patients, to work on foundation and financial assistance, and to be immediately available, by name, to triage further questions or symptoms. It is what is best for the patient. Unfortunately, PBMs are redirecting our treatments from our pharmacies to theirs, and they are trolling for other drugs that we have historically prescribed to our patients. So this loss of prescription authority and drugs to the PBMs is at a rate that's increasing at about 10% a year to where, currently, 60% of our prescriptions go outside our pharmacy to the PBM. I see. And, presumably, that has not only concerns raised for you in terms of business, but quality of care. Is that right? That's exactly right. So there's always a business aspect to the management and control of the drugs. But, most importantly, is that value-based quality care that we feel provides the safest, highest quality, most affordable care to our patients when they have access through our own individual pharmacies at the cancer centers. Well, at ASCO, as you know, we, last year, spent some time and, ultimately, we declared core values-- evidence, care, and impact. And what derives from that, for us, is we do not write papers or issue statements simply to check a box and say we did that. Instead, what we want to do is go beyond identifying, and analyzing, and reporting on a problem to, in fact, contributing to solutions. And so, to that end, what we frequently have to do is initiate conversations with stakeholders, propose ideas that might affect real change, and have a positive impact on cancer care and our patients. ASCO's recommendations on health care system changes are often sent directly to Congress. We present them to government agencies. We speak to payers, certifying bodies, and, really, everybody across the entire health policy environment and health care spectrum. So given that our desire is to make a difference, to have an impact, to effect change, can you, Dr. Page, can you outline some of the recommendations that ASCO has described as a path forward and a way to address the issues that our discussion has raised? Sure. ASCO has several suggestions. And these can get very complex and have nuances, but I'll just try to make these suggestions as simple as possible. But several things that ASCO has recommended is that PBMs and the payers, in order to address quality of care concerns related to cancer patients that they serve, they should assure that changes to prescribe therapies for the patients with cancer are made only in the context of prior consultation and approval of their physician. So, in other words, if I write a prescription for a set number, and duration, and dosing schedule for a patient, it should be given that way. And the PBM should not be making alterations in my prescription, like I gave in my example. Pharmacies should not be prevented from sharing, with the patients, their most cost effective options for purchasing needs of medications. So in other words, there's gag causes that PBMs have to where there could be a drug that the PBM is going to charge the patient $180 a month for, but the local pharmacy can prescribe that same drug for $30. But they are prohibited from disclosing that they can actually distribute that drug to them cheaper outside the PBM. CVS should leverage its regulatory authority to number one, require that PBMs provide detailed accounting of these DIR fees and instruct contractors and PBMs to use measures and standards that are more appropriate to the specialty. CMS should also enforce its any willing provider provisions in Medicare Part D preventing PBMs from excluding qualified provider-led pharmacies from its networks. So we, at ASCO, really desire that any cancer center that has a pharmacy would have the opportunity to be included in the PBM network and be able to prescribe the drugs within that network on site. And then, CMS should maximize the accountability of drug waste through the PBMs. Lastly, pharmacy and therapeutic committees of the PBMs should include full and meaningful participation by oncology specialists. So one issue that was raised in the ASCO statement, and we haven't directly touched on it yet, is simply the lack of transparency, that is, the opaque nature of PBM practices and their policies. How do you think that issue, specifically, can be addressed? Yeah, Cliff, the transparency issues are being addressed nationally at several legislative levels. There are several federal bills that are in support of the Trump blueprint to address drug costs. And they have to do with safe harbor laws that the PBMs are taking advantage of. They have to do with undoing the gag causes that I previously mentioned. And, also, to examine the fiduciary status of the PBMs. At the state level, there's dozens of bills going after the PBMs, state by state, on all fronts. And, lastly, as an ASCO delegate to the AMA, a few months ago, we submitted a resolution that we got accepted into AMA policy that requests that our AMA gather more data on the erosion of the physician-led medication therapy management in order to assess the impact of the pharmacy benefit manager tactics that they may have on the patients' timely access to medications, patient outcomes, and the physician-patient relationship, and that the AMA examine issues related to PBM-related clawbacks and those DIR fees to better inform existing advocacy efforts. And so I think it's always good to have the weight of the AMA behind our ASCO advocacy efforts to assure that our cancer patients can continue to get the best, affordable access to care. Well, that's really great to hear. You've covered a lot, both in terms of background and explanations, the history of the development of the PBMs, and what challenges have now emerged. Are there any additional steps ahead that ASCO should be taking that you know about? Is there anything else, for example, that listeners should know about pharmacy benefit managers that we've not yet touched on? Yeah. I think I just want to emphasize that this is really a David and Goliath scenario. It is very difficult to control a rapidly growing, unregulated, complexly integrated $300 billion industry that is benefiting three gargantuan companies more than our patients. And ASCO will continue to partner with fellow like-minded advocates to optimize the affordable delivery of cancer care and conquer cancer. Well, that's certainly an upbeat-sounding ending. And I'm sure with you fighting the good fight, this effort will go on and will make good progress. That seems clear. I want to thank you, Dr. Page, for joining me today for this ASCO in Action Podcast. I want to remind everybody that at ASCO, we are committed to preserving and enhancing access to high-quality cancer care for everybody with cancer. This statement on PBMs is just one of many in which ASCO's voice, and the collective voice of our members, is helping to shape the future of cancer care for everybody and refine the delivery system. I encourage our listeners to read the statement, and other policy and position statements, all of which are available on the policy and advocacy pages of our website at ASCO.org. And until next time, again, thanking Dr. Page for joining all of us, I want to thank all of you for listening to this ASCO in Action Podcast.

Disruptive Trends and Their Impact on Canadian Corporations

Jane Ferguson: Hi everyone. Welcome to episode 20 of Getting Personal Omics of the Heart, the podcast brought to you by the Circulation: Genomic and Precision Medicine Journal and the American Heart Association Council on Genomic and Precision Medicine. I'm Jane Ferguson from Vanderbilt University. It's September 2018 and let's dive straight into the papers from this month's issue of Circulation: Genomic and Precision Medicine.                                 We're starting off with some pharmacogenomics. Bruce Peyser, Deepak Voora and colleagues from Duke University published an article entitled, "Effects of Delivering SLCO1B1 Pharmacogenetic Information in Randomized Trial and Observational Settings."                                 Although statins are generally well tolerated, 5-15% of patients taking statins for LDL lowering and cardiovascular protection end up developing statin associated muscular symptoms. Because onset of muscular symptoms associated with discontinuing statin use, as well as increased cardiovascular morbidity, there is a clear need to identify ways to prevent or reduce symptoms in these people. Variants affecting statin related myopathy have previously been discovered through GWAS, including a variant in the SLCO1B1 gene, which also has been shown to relate to statin myalgia and discontinuation of statin use. The risks appear to be greatest with simvastatin, indicating the people at risk of muscle complications may do better on either low-dose Simvastatin or another statin. However, there's still some uncertainty surrounding the risks and benefits of various statins as they pertain to risk of muscular symptoms.                                 The authors have previously shown that pharmacogenetics testing led to increased number of people reporting statin use, but effects of pharmacogenetic testing on adherence, prescribing, and LDL cholesterol had never been tested in a randomized control trial. In this study, they randomized 159 participants to either genotype informed statin therapy or usual care, and then followed them for months to eight months.                                 25% of participants were carriers of the SLCO1B1 star five genotype. The authors found that statin adherence was similar in both groups, but gene type guided therapy resulted in more new statin prescriptions and significantly lower LDL cholesterol at three months, and levels that were lower but no longer significantly different at eight months.                                 In individual's randomized to usual care who then crossed over to genotype informed therapy after the trial period ended, there was an additional decrease in LDL cholesterol. Overall, genotype informed statin therapy led to an increase in re-initiation of statins and decreases in LDL cholesterol, but did not appear to affect adherence.                                 The authors also examined the effects of commercial genetic testing for SLCO1B1 variants in an observational setting by looking at over 92000 individuals with data available in the EHR. They found the people who receive genetic testing results had a larger drop in LDL cholesterol compared to untested controls. Overall, the study indicates that carriers of the SLCO1B1 risk variant may benefit from genotype informed statin therapy, while for non-carriers receiving their results may has limited effects.                                 If you want to read more on this, Sony Tuteja and Dan Rader from UPenn wrote an editorial to accompany this article, which was published in the same issue.                                 We're staying on the topic of statins and LDL for our next paper. This article comes from Akinyemi Oni-Orisan, and Neil Risch and colleagues from the University of California and is entitled, "Characterization of Statin Low-Density Lipoprotein Cholesterol Dose-Response Utilizing Electronic Health Records in a Large Population-Based Cohort."                                 They were interested in understanding what determines variation in statin induced LDL reduction, particularly the genetic component, and they used a large EHR derived data set, the Kaiser Permanente Genetic Epidemiology research on adult health and aging cohort to address this important question. An EHR dataset does have intrinsic limitations, but also has some clear strengths, not only as a readily available and cost-effective data source for large sample sizes, but also because it reflects real world clinical care in diverse individuals, which is not always well represented within the selective constraints of a randomized trial.                                 There were over 33000 individuals who met their inclusion criteria. To account for differences in potency between different statins and doses, the authors generated a defined daily dose value, with one defined daily dose equal to 40 milligrams per day of Lovastatin. The slope of the dose response was similar across statin types and across different sex and race or ethnicity groups. But there were differences by statin type in the response independent of dose, as well as differences in absolute responses by sex, age, race, smoking, and diabetes.                                 Based on these differences, the authors revised the defined daily doses and they highlight how previously defined equivalencies between different statins may not be accurate. They found that individuals with East Asian ancestry had an enhanced response to therapy compared with individuals of European ancestry.                                 The authors identified related individuals within the data set and the estimated heritability of statin response using parent-offspring and sibling pairs. They found only modest heritability, indicating that non-genetic factors may be more important in determining variability in statin response. Overall, this large single cohort study adds to our knowledge on determinants of statin response and raises further questions on the relative effects of different statins and doses within patient subgroups.                                 Okay, so now let's talk about GWAS and Athero. Sander van der Lann, Paul de Bakker, Gerard Pasterkamp and coauthors from University Medical Center Utrecht published a paper entitled, "Genetic Susceptibility Loci for Cardiovascular Disease and Their Impact on Atherosclerotic Plaques."                                 Over the past decade, genome-wide association studies in large cohorts have been very successful in identifying cardiovascular risk loci. However, relating these to subclinical disease or two mechanisms has been more challenging. The authors were interested in understanding whether established GWAS loci for stroke and coronary disease are associated with characteristics of atherosclerotic plaque, the idea being that some of the risk loci may alter disease risk by determining the development and stability of plaque. They identified seven plaque characteristics to study and histological samples, including intraplaque fat, collagen content, smooth muscle cell percentage, macrophage percentage, calcification, intraplaque hemorrhage, and intraplaque vessel density.                                 They selected 61 known loci and examined association of those SNiPA with black phenotypes in over 1400 specimens from the athero express biobank study. Out of the 61 loci, 21 were associated with some black phenotype compared with zero of five negative control loci, which were chosen as established GWAS loci for bipolar disorder, which, presumably, should share limited mechanistic etiology with plaque. They used the software package VEGAS to run gene-based analyses. They also assessed SNiPA relationships with gene expression and methylation in multiple tissues derived from two independence Swedish biobanks, which included atherosclerotic arterial wall, internal mammary artery, liver, subcutaneous fat, skeletal muscle, visceral fat, and fasting whole blood.                                 One CAD locus on chromosome 7q22 that survived correction for multiple testing was associated with intraplaque fat, and was also an EQTL for expression of several genes across multiple tissues. In addition, it was also a methylation QTL.                                 The authors focused on this locus and looked at correlation of expression within the LDL receptor and noted associations with HDL and LDL cholesterol in the global lipids genetics contortion data, which suggests that this locus may have a role in the metabolism. At this locus, the HBP1 gene expressed foam cells may be an interesting candidate as a causal gene in determining plaque-lipid accumulation and cardiovascular risk.                                 So next up, we have a paper that is also about athero and is coauthored by many of the same group as did that previous study. So yeah, this group's productivity is kind of making the rest of us look bad this month. So Martin Siemelink, Sander van de Lann, and Gerard Pasterkamp and their colleagues published, "Smoking is Associated to DNA Methylation in Atherosclerotic Carotid Lesions."                                 Okay. So I think one of the few things we can all definitely agree on is that smoking is bad. But, does smoking exert any of its cardiovascular damage by altering within atherosclerotic plaques? That's the question this group set out to answer.                                 They carried out a two-stage epigenome-wide association study, or EWAS, with discovery and replication of differentially methylated loci with tobacco smoking within carotid arteriosclerotic plaques of a total of 664 patients undergoing carotid endarterectomy and enrolled in the arthero-expressed biobanks study. In discovery, they found 10 CpG loci within six genes that associated with smoking. Four of the CpG loci replicated. These four loci mapping within six genes showed reduced methylation in current smokers compared with former or never smokers.                                 However, there was no difference in specific plaque characteristics based on methylation at any of the four loci. There was also no significant difference in plaque gene expression at these loci based on smoking status. However, a SNiPA at a nearby locus located in the 3' UTR of the PLEKHGB4 Gene was associated with methylation at AHRR, and was a [inaudible 00:09:58] QTL for PLEKHGB4 of expression but not a AHRR expression. The authors speculate that PLEKHGB4 may co-regulate AHRR expression. The authors also examined blood methylation in a subset of the same subjects, and they were able to replicate previously identified CPG sites associated with smoking.                                 This is a really complex area, and it's hard to identify mechanisms and causality from these multiple layers of data, but the authors demonstrate the importance of using disease relevant tissues to start to understand how environmental factors interact with genetics and other underlying physiology to modify methylation and function within the vasculature.                                 Our final full-length research paper this issue from Brian Byrd and colleagues Michigan, is actually the subject of our interview today. So I won't go into too much detail on it right now, but keep listening for an interview with Brian about their paper, "Human Urinary mRNA as a Biomarker of Cardiovascular Disease: A Proof-of-Principle Study of Sodium-Loading in Prehypertension."                                 Our review article this month is about the "Dawn of Epitranscriptomic Medicine" from Konstantinos Stellos from Newcastle University and Aikaterini Gatsiou from Goethe-Universität Frankfurt. In this paper, they're taking us to the next level beyond just RNA, but towards RNA epigenetics. Given the large number of possible modifications that can and are made to RNA during RNA name metabolism, there's huge potential to gain a new biological and mechanistic understanding by studying the RNA epitranscriptome. I think we'll ignore this at our peril. So if you need to catch up on this new field, this comprehensive review will get you right up to speed.                                 Moving on, our research letters are short format papers that allow authors to present focused results. These are also a great avenue to submit findings from replication studies that might not necessitate a full-length paper. So if you have some data from a replication study that you've been procrastinating writing up, a short research letter is a great format to consider.                                 This month, Bertrand Favre, Luca Borradori and coauthors from Bern University Hospital published a letter entitled, "Desmoplakin Gene Variants and Risk for Arrhythmogenic Cardiomyopathy: Usefulness of a Functional Biochemical Assay." The desmoplakin is essential for the cell-cell adhesion complex's desmosomes. Mutations in this gene have been associated with a wide range of phenotypes, including some in skin and hair, but also in heart, which can manifest arrhythmogenic or dilated cardiomyopathy. This protein anchors intermediate filaments, so mutations that alter binding to intermediate filaments may pathogenicity.                                 The author selected seven reported amino acid altering mutations in desmoplakin, and they screened for effects on binding using a novel fluorescence binding assay. They found that three of the seven mutations had a clear impact on binding. This assay is a novel way to assess functional impact of desmoplakin variants, and may be useful to inform the severity of future phenotypes in individuals carrying a desmoplakin mutation.                                 Finally, if you want to stay up-to-date on the genetics of aortic disease and Marfan syndrome, you can find a letter from Christian Groth and colleagues and an author response from Norifumi Takeda and colleagues regarding their previously published paper on impact of pathogenic FBN1 variant types on the progression of aortic disease in patients with Marfan syndrome.                                 I am joined today by Dr. Brian Byrd from the University of Michigan, who is the senior author on a Manuscript published in this month's issue, entitled, "Human Urinary mRNA as a Biomarker of Cardiovascular Disease: A Proof-of-Principle Study of Sodium-Loading in Prehypertension."                                 So welcome Brian. Thanks so much for coming on the podcast. Brian Byrd:          Thank you for having me. Jane Ferguson: So before we get started, could you give a brief introduction of yourself to the listeners and maybe tell us a little bit about how you got into the field? Brian Byrd:          Absolutely. So I am a cardiologist and a physician scientist. I'm an assistant professor at the University of Michigan, where I have a laboratory engaged in clinical investigation. My background is that I did my Internal Medicine Residency at Vanderbilt University. And after I finished residency, I entered Nancy Brown's lab. She's the Chair of Medicine at Vanderbilt, as I know you're aware. And she had a laboratory focused, and still does have a laboratory focused, on the investigation of high blood pressure, with a lot of focus on understanding high blood pressure as it occurs in humans. And I got a Master of Science degree in clinical investigation while I was in her lab, and we did some work on a number of topics related to the renin-angiotensin-aldosterone system, which has been a long-standing interest of mine ever since then.                                 So, at the same time, I was learning how to take care of patients with very complex blood pressure problems, who required three, or four, or five, or six blood pressure medications, in some cases, to control. And it's with that background that I became very interested in the science that underlies treatment-resistant high blood pressure in people and what we might be able to do about that. Jane Ferguson: Wow. Nice. Yeah and I think that background of sort of the combination of clinical and experimental is really nice and really important. I think your paper actually exemplifies that really nicely, so using humans but also some basic science techniques and combining them to really have a very patient focused instead of mechanistic interrogation.                                 So as I mentioned, you just published this really nice manuscript using urine as a source of mRNA biomarkers, which has relevance to hypertension and potentially also to other diseases. But before we get sort of too much into the weeds on the specific details, for any of our listeners who didn't get a chance to read your paper yet, maybe you could briefly summarize what you did? Brian Byrd:          Okay, so the general overview of what we were interested in was that the patients who have treatment resistant high blood pressure tend to have a lot of activation of a receptor in the kidney called the mineralocorticoid receptor. And this receptor helps control salt in bladder in the body. Obviously the amount of salt in the blood stays very, very homeostatic, but we if eat more salt one day then the next and there needs to be a system to help regulate the homeostasis. And so, you waste more or less salt in the urine depending upon how much sodium you're taking in.                                 And one of the functions of the mineralocorticoid receptor is to control this salt and bladder regulation or to fine tune it anyway. And the reason we know that that's an important receptor in patients with treatment-resistant high blood pressure is because of a series of studies done by David Calhoun and Brian Williams and others, showing that mineralocorticoid receptor blockers, or antagonists, are very effective in the treatment of tough to control high blood pressure.                                 And so, we had some insight that there would be something interesting to study there, and one of the things that we knew was that the mineralocorticoid receptor is a ligand activated transcription factor. So when it gets activated by it's ligan which canonically is a steroid hormone from the adrenal gland aldosterone, the receptor, which is in the cytoplasm, ordinarily dimerizes and translocates to the nucleus, where it controls the regulation of a number of genes. We also were aware that cells secrete RNA, and others had the idea that it might be inside vesicles because there's a lot of ribonuclease and biofluids. And you would think it might be difficult to pass the RNA if it were sort of naked as it were.                                 And it turns out that that's right. If you, for example, introduced synthetic RNAs into biofluids, the RNAs will be gone very quickly in a matter of seconds. So, we had this idea that we might be able to look at RNA that was being secreted by cells probably in vesicles, and assay the activity of the receptor potentially. We weren't sure if that was going to be possible or not.                                 One of the things we did was we used part of the available data to look at the transcriptome of vesicles in the urine that had been isolated from 3300 milliliters of urine by ultracentrifugation [inaudible 00:18:57]. Jane Ferguson: So it's a big centrifusion. Brian Byrd:          Exactly. Jane Ferguson: Like you [inaudible 00:19:00] Brian Byrd:          It must have been some project. So that was the work of Kevin Miranda and colleagues, and we were able to compare that transcriptome to the transcriptome of human kidney cortex samples from the GTEx project, which a large consortium focused on human transcriptomics.                                 And that was sort of the first part of what we presented in this paper, and the second thing that we did was we looked within a crossover study in a collaboration with Scott Hummel, one of my close collaborators here at the University of Michigan. We looked at individuals who had been put on a low salt diet activating renin-angiotensin-aldosterone system and causing more activation of the mineralocorticoid receptor. And then, those same individuals underwent saline infusion, so salt loading, and we knew that that would suppress the renin-angiotensin-aldosterone system. And we measured the [inaudible 00:20:02] measures of the renin-angiotensin-aldosterone system, but we also took the urine samples that had been recently banked from that experiment and we centrifuged them to try to palette the cells. We took the supernatant and we extracted RNA after trying to enrich for extracellular vesicles.                                 And with that approach, we measure targets that we thought would be regulated my the mineralocorticoid receptor, as well as some things that we did not think would be regulated by mineralocorticoid receptor. So that's the general overview of what we undertook. Jane Ferguson: Great. Right. So it's very cool. I guess we can break it down into sort of the two different parts, because I think it was a really nice examples of using public data to sort of start addressing your question and then actually doing a human experiment. But so for the GTEx data and the urinary data, you looked at few different tissues, right? And was kidney the one that you were thinking upfront would sort of most likely to correlate, or were you also looking at bladder and other sort of tissues that could potentially be of relevance to urine? But what sort of the ... I guess sort of tell me more about those different tissues that you looked at and what you found and what surprised you or not. Brian Byrd:          Great question. So, the kidney was on our minds from the outset. We knew that Mark Knepper at the National Institute of Health had published in the [inaudible 00:21:25] National Academy of Sciences back in 2004 that there are urinary extracellular vesicles. And he had found proteins that are very characteristic of the aldosterone sensitive distal nephron, that part of the kidney that we're interested in, embedded in the vesicles.                                 So we became quite interested in the idea that it seemed that there was likely a population of vesicles in the urine that is of kidney origin. And that's not to say that there weren't also plenty of vesicles from other origins as well, and there could very well be RNA that is not vesicle enclosed, but is rather ribonucleic protein bound or even bound to other carriers potentially. That could be there as well, and it's possible that the origin of those things could be any number of tissues. I don't really think that we know yet where the possible tissue origins are.                                 But we were curious to know ... I guess the direct answer to your question is we thought from the outset that we probably would find some sort of signal related to the kidney. But we wanted to also consider the possibility that our findings were not very specific to the kidney. And so we thought that the brain would be an interesting negative control. If we say very high correlation with the brain, it would suggest that maybe what we're looking for is a signal that's not really coming from the kidney.                                 And we also wanted to look at the bladder just to try to understand whether or not the signals that we're detecting could be coming from the bladder. It's certainly true that some aspects of the system that we're interested in are present in the bladder, so I wondered whether that might even serve as a signal amplifier for what we were looking for since there's, presumably, quite a bit of bladder tissue right around the urine. It might be contributing vesicles.                                 So that's sort of the rationale for why we looked at those things. Jane Ferguson: And you found mostly enrichment for kidneys. So sort of I guess what you were hoping to find came true? That actually there was sort of evidence that even though there may be contribution from other tissues, that really kidney seem to be the predominant contributor to the expression of the genes in the urine. Brian Byrd:          I think there's a lot of truth to that. One of the things I would say is we found high correlation looking across all genes. But it occurred to us ... As soon as we thought that, we realized, wait a second, that could be driven by ubiquitously expressed genes. Housekeeping genes.                                 So we really wanted to stratify our analysis by things we thought would be expressed in the kidney as well as things that we thought would be ubiquitously expressed to make sure that we could see signals that correlate ... That the transcriptome of the kidney, per se, had a good correlation with those same in terms of the abundance of the gene counts or recounts. They said it was similar to what was in the vesicles.                                 And so, we looked in the literature, and we found that a group had already established a number, 55 genes actually, that were highly kidney enriched as well as over 8000 genes that were ubiquitously expressed. And so we started the analysis from this perspective of the stratification. We thought that was a very important aspect of the analysis. And it's definitely true that if you look at our findings with respect to the kidney enriched genes, as you might expect, they correlate quite well with what is in the urinary extracellular vesicles compared to the kidney cortex.                                 You look at the brain as you might expect the expression of those kidney enriched genes is not well correlated with what's happening in the urine. And then, with respect to the bladder, it's sort of somewhere in between. Jane Ferguson: Okay. Interesting. So I know that some people look at small non-coding RNAs in urine, but you were mostly focused on mRNAs. Is that right? Brian Byrd:          That's right. I thought of this as sort of frontier, something that I knew from some early publications was probably measurable. But I didn't know what it would signify, if anything, with respect to physiology. And I knew that there were quite a few papers about micro RNAs and I wanted to do something a little bit innovated, partly.                                 But the main reason that I was interested in the RNAs was because I could relatively easily tie those to the existing literature from animal models. Preclinical animal models and cell culture studies showing what happens when the mineralocorticoid receptor's activated. That was really the driving reason that I was interested in the RNA. Because if you think about what is the approximate event that might be a readout for activation of a new growth hormone receptor like the mineralocorticoid receptor, it's really the transcriptional events that happen when the receptors translocates to the nucleus and serves its ligan activated transcription factor role. Jane Ferguson: Right. So, [inaudible 00:26:43] sort of the first part of analysis, you saw these really nice correlations between expression and kidney and in urine. And then, a lot of the times when you tried to publish that kind of thing, people are like, "Okay, so what? So you didn't do any intervention. We don't really know what that means."                                 But I like that you took it to the next step and you did sort of a human intervention experimental model. So tell me more about that model and how that worked. Brian Byrd:          Right. Well, I'll just mention also that the work that was done in terms of RNA [inaudible 00:27:14] was done in collaboration with Mark Bertini in Italy as well as Dr. [inaudible 00:27:19]. They were fundamental to getting that work done.                                 With respect to the collaboration with Scott Hummel, one of my colleagues here at the University of Michigan, what we did in that setting was to look at whether or not we could identify within these urinary mRNA signals that are in the supernatant in the urine, whether we could identify changes in physiology. That was the question that was of greatest interest scientifically.                                 And for a very practical or blind perspective, the question was could we detect the activation of the receptor that might determine whether or not people should get a certain medication. Of course, we're not saying that that's an established fact yet, but this is sort of concept, that there's something here to explore further.                                 And so, what we found was that a number of genes that are regulated by the mineralocorticoid receptor, including genes encoding the subunits of the amiloride-sensitive epithelial sodium channel that regulates the salt that I was talking about earlier. We found that those genes changed with sodium loading in terms of their abundance in the expected direction.                                 We also found that several of the assays that we made changed ... I'm sorry. That they correlated with the serum aldosterone concentration. So the concentration of the ligan for the receptor whose readout we were looking for. And we also noticed an inverse correlation with urinary sodium excretion, which is what we would expect if we really identified a readout of the mineralocorticoid receptor's activity.                                 So this study supported the idea that we have identified a way to measure this nuclear hormone receptors activity in living humans. Jane Ferguson: Right. Which is really nice. So there's probably a huge amount of extra things you could do with this, some sort of different ways you could look at it. So how did you pick the time point? So, I suppose when you think about it, I mean the genes, they're transcribed and then that takes a little bit of time, and then it takes a little bit of time for that to sort of make its way into the urine and to be excreted.                                 So how did you decide on sort of what time points to use, and do you think you would see the same things or different things [inaudible 00:29:39] if you did repeated sampling or if you looked at different time points? Brian Byrd:          That's a fantastic question. So this was a study that had already been completed, and I had mentioned to Scott what we were working on. And he said, "You know, we have these samples from this study and it might be possible for us to collaborate."                                 So, we didn't get to pick the timeframes. Jane Ferguson: Right. Brian Byrd:          So, that's a great point. And what I would say is that, as you can imagine, we're very focused on exactly the questions you're asking now. What about sort of signal refinement? What about the chrono-biology of these signals, and how do we understand when we see what in the urine?                                 So, I'm actively pursuing those questions. Jane Ferguson: Right. So, I know as well, there was quite a lot of sort of technical challenges I think to doing this work. Sort of getting to be even able to amplify and get a signal from these RNAs that are really present, sort of pretty low abundance in urine compared to tissues or biofluids that we're used to working with.                                 So tell me maybe a little bit about that process and sort of how much optimization was required to get these essays to work? Brian Byrd:          Great question. So, I had known [inaudible 00:30:58] since 2014 when I took a course on isolation of extracellular vesicles in Heidelberg, Germany. And I had talked to him at a meeting in Washington DC, and I had mentioned what we were trying to do. And he said, "You know, if you were trying to do that, you might want to consider preamplification." You know, using something like 15 cycles of preamplification. And he was willing to share that protocol that he had with me, because they were interested in similar issues. So, I was able to use that protocol to evaluate these gene targets in the urine. And so that was immensely helpful.                                 And the other thing that we did was we used locked nucleic acid probes to try to increase the sensitivity and specificity of our assays. Finally, we just tried to use good logic in the design of the assays. So we were concerned that the RNA might be fragmented, so where it was possible to do so within the design constraints that I'll mention in a second, we made multiple assays per gene target just in case this was fragmented. Which makes the analysis a little more complicated, but I think it was probably the right thing to do, given the state of knowledge that we had then.                                 And one of the other things we did was we made sure that the primers either ... Within a primer, there was an intron or between the primers there was an intron, so that if we actually did try to amplify DNA, abundant amounts of DNA, with those primers just to make sure that our theorizing about the inability to amplify things was actually factual. And that turned out that we couldn't amplify anything at 40 cycles with those.                                 So, we spent a lot of time thinking about how not to get fooled, but also to have adequate signal detection. And have included in the supplement quite a bit of information about the technical merits of the assays and showing how close the technical replicates were. They tended to be very, very similar to one another. We didn't see a signal in every urine sample for every participant at both time points, and I think that was interesting to me about that there tended to be a very binary result, so that you'd either see three technical replicants for the QPCR assays, our QPCR assays that were extremely similar to each other, or you would see no CT value detected.                                 [inaudible 00:33:47] That these were valid assessments of very low copy numbers. Jane Ferguson: Right. And that's probably related to up front of what happens to urine right after it's collected and stored, or during that RNA extraction. But it seems like once you've got RNA, then downstream assays were sort of ... They held through, but I guess ... I mean, and you obviously didn't have necessarily a huge amount of control over how these urine samples were collected. So it's kind of nice that you were able to see something even though these were collected possibly in a way that was not optimized for preserving RNAs.                                 But do you think those ... Are there ways that you could make this even sort of more streamlined and better as far from the get go of how you collect the urine, whether you could be extracting stuff right away? Is that anything you sort of looked into of how this could be improved? Brian Byrd:          That's really been the focus of the labs work since we completed that project, is sort of understanding how would we do this in a prospective study in the best possible way so that the results are highly repeatable, that we get a CT value in everybody so that we're really ... I mean, as you can imagine, that actually has something to do with the input volume of urine that you use. So if you have too little input volume, then you won't be able to detect the targets that you might be interested in every person.                                 However, if you have more, then you can do more with that. But then you have to think about how you're going to deal with the larger volumes of urine. There are lots of questions that we've been interested in related to extract the RNA and the stability of the RNA. And so we have done some experiments of that type, and we continue to work in that area. And I do think that those questions you're asking are the right questions with respect to next steps. Jane Ferguson: All right. So you looked at sort of specific targets, which I think made a lot of sense. Sort of this proof of principle. But do you think this would work on a transcriptome wide level? I mean, could you look at all the genes, or do you think that's just sort beyond the possibility right now given sort of the RNA fragmentation and how you have to sort of amplify it before being able to detect anything? Brian Byrd:          I think it's possible. So the group that had preceded our work with 3300 mils of urine, isolating the vesicles from there, eight have showed that that's something that can be done. The question that's of interest to me is does it actually require such large volumes of urine? And I think the answer to that question is going to be no from what we're overseeing so far.                                 And so, we're thinking along exactly the lines that you are. And certainly some of the feedback we've gotten as we've discussed this project with people is, "Hey, could you look at everything rather than picking targets at [inaudible 00:36:41]."                                 I think there's advantages and disadvantages. I think we chose based on prior knowledge in a way that was rational. But at the same time, it may turn out that there are many things about activation of the mineralocorticoid receptor in humans, especially in the living in-tact human, that don't exactly mirror what's found in rabbits, rats, mice or cells, which are really the systems that have been evaluated the most thoroughly in the past.                                 So I'm very interested in exactly what you're proposing. Jane Ferguson: Yeah. I mean, I think it's exciting because it's obviously relevant for hypertension, but potentially a lot of other conditions, to be able to look at that sort of dynamic change. So I think it's really exciting. It's very cool. Brian Byrd:          And I appreciate your asking about this study. We were excited to do this work and very, very excited to see where we can in the future with this. And I agree with the point you were making, that here we've gone from a rather specific application driven question and we've, I think, made some insights that are probably useful outside the application that we had in mind. And it may turn out that the application where this is the most important is not even the one that we considered in the first place at all.                                 And so I'm pleased by that. I'm pleased by the fact that I think in a sense we're working in what Donald Stokes described as pasture's quadrant, which is a sense that the work is driven both by curiosity and by an intent to use the results. Jane Ferguson: Right. Brian Byrd:          And so that's really what gets me out of bed in the morning, is working that exact space. So that's what we were glad to have done and continue to do. Jane Ferguson: Yeah. No, I think it's grea.t and I feel like a lot of people will read this paper and be like, "Hey, I have urine stored in the freezer. What can I do with this now?" Brian Byrd:          Contact me. Let's talk. We'll see what we can do. But we certainly tried to describe the methods in such a way that people could easily follow in our footsteps if they want to apply these methods. Jane Ferguson: Yeah. Now having read through them, I think that ... Really thorough. I really liked the sort of attention to detail. It was definitely one of those ones where I was like, "Oh yeah. I can see exactly how I could do this if I wanted to. So I think that was great. Brian Byrd:          Thank you. Jane Ferguson: So yeah. Congratulations on the paper. Really nice work and thanks so much for talking to me. Brian Byrd:          Thank you. It was a delight. Jane Ferguson: That's it from me for September. If you haven't had enough yet, you can access all the papers online and you can choose to digest the papers in video format. Available on our website or the Circulation YouTube channel. Thank you for listening and subscribing. I look forward to bringing you more next month.  

With the release of CAF America’s Cross-Border Giving: A Legal and Practical Guide (Charity Channel Press, 2018), we are excited to bring to you on CAF America Radio Network  a series of conversations with the contributing authors. This edition, the host Ted Hart, President and CEO of CAF America, is joined by Kay Guinane, Director at the Charity and Security Network to discuss the book and her chapter she co-authored titled “US Financial Transaction Laws and Their Impact on International Grantmaking”.

(NSFW) Getting ready for Episode 50 so we dug deep into the archive and pulled out episode 16. This is the first episode that Chris, Nate, and Jeff were on together. This time in our newest format, and unedited. So there will be breaks and there will be crazy things said before we come back from those breaks. Enjoy! Long time listener, and friend of the show Jeff Breckon joins the guys to talk about AZ Wilderness of course! New breweries showing up in the valley, beers of the week, horrible parking, and they may talk a little about the recent buyout of Wicked Weed Brewing to they who shall not be named. Oh and he brought us some beer from Tucson’s Thunder Canyon Brewing! Beer mail from our friend in the Pacific Northwest. And more beer from AZ Wilderness. Episode Articles Draft Magazine - Best Beers We Tasted this Week AZ Wilderness No Ticky No Taco Barrio Mesa Gateway Last Call for IBUs: Fact, Fiction and Their Impact on Your Beer Watership Down Wicked Weed Buy Out Funkatorium Attendes  (Update May 9th: 52 of the 74 dropping out) AZ Wilderness Response Rare Barrel Response Jester King Response What it’s like to work for a brewery that “sold out” Wren House Can Release Spell Binder Buying Northwest  Beers Drank AZ Wilderness Chocolate Bunny Porter  Thunder Canyon Sky Island IPA Great Notion Brewing Blueberry Sour Our Information: Music Credit: Takotsubo Men The assorted sounds of three ageing humans hitting things in a studio for five days. Beautifully nasty and pretty vile at times but ultimately gorgeous. Enjoy! Intro: Skint But Free Outro: Takotsubo Man Follow them! Facebook: https://www.facebook.com/TakotsuboMen Twitter: https://twitter.com/TakotsuboMen YouTube: https://www.youtube.com/TakotsuboMen Contact us! Instagram: @hoppycraftsmen Twitter: @hoppycraftsmen Facebook: https://www.facebook.com/Hoppycraftsmen/ E-mail: hoppycraftsmen@gmail.com Blog: http://hoppycraftsmenpodcast.com/ YouTube: Hoppy Craftsmen – Craft Beer Podcast Support US! Buy Us a Beer! For as little as a dollar a month you can help a bearded white guy drink a good craft beer. Your generous donation will help supply thousands with the gift of more podcasts and we are pretty sure inappropriate humor as well. Invest in Us!  Rate us on iTunes! Want to help us reach a bigger audience and keep the episodes coming? Then head over to iTunes and Give us a rating and feedback! Tell A Friend! Tell someone you know about our show! If you know that a friend likes or loves craft beer tell them to give us a listen. Or if you know someone who is new to craft beer and you are tired of telling them about the scene, let us be your soap box! Or have an amazing whale that you want to share with the world. Go on your social media platform of choice and give us a shout out. Use the hashtag #hoppycraftsmen and we’ll respond in kind. Probably in some form of emoji and maybe a super rad type of comment. You get the picture. Extra Special Thanks to: Beer and Other Shhhh for the Rapid Round inspiration. Give them a listen and a like on iTunes, or watch some videos on their YouTube

NASN School Nurse Editor, Cynthia Galemore, interviews authors Charles R. Davis and Erik J. Lynch about their article "Administrator Leadership Styles and Their Impact on School Nursing Part II. A High-Performance School Nurse-Building Administrator Relationship Model."  To view the article, click here.

Raul Rattray and Graham Hill discuss "Sacrificial Succession and Releasing Pioneering Christian Leaders." The GlobalChurch Project, podcast episode #102. Paul Rattray is the “Impact-a-Nation” Manager for Christian Vision Asia Pacific. Christian Vision is a global Christian ministry with a strategic goal to reach a billion people with the Gospel. Their “Impact-a-Nation” projects equip the church with evangelism and discipleship strategies. They work with partners to resource and encourage the church in its presence and growth in local communities. Aside from serving with Christian Vision in the Asia Pacific, Paul Rattray also oversees leadership development and training programs in evangelism and discipleship across the globe. He has a huge heart for reaching people for Christ, is fluent in Indonesian, and is passionate about providing people of many cultures with the opportunity to follow Jesus.

What is it about adding mindfulness to the mix that makes this one the real deal? Quite simply, because it works. In the same way things like whole food diets and yoga were once fringe trends, we’ve experienced a tipping point where enough people have accepted these things as an integral part of their lives. Mindfulness is no different. - Amy Baglan JOIN THE FACEBOOK GROUP | REVIEW THIS PODCAST 20% OFF ORGANIFI - USE CODE: WELLNESSFORCE Instead of immediately focusing on getting in shape, what if you spent time becoming emotionally fit to kick off 2018? Get ready to dive into the authentic masculine and feminine self in addition to understanding how relationships can be a catalyst for mindfulness. On Wellness Force Radio 157, CEO and Founder of the dating app, MeetMindful, Amy Baglan, explains how you can make more meaningful, authentic connections with other people to enhance your personal wellness. Not just in a romantic relationship, but with others who also want to live a more mindful, health-focused life. Learn how to grow from a place of authenticity.  Join MeetMindful Today MeetMindful is a relationships company that inspires people to make meaningful connections every day, revolutionizing the way you meet and connect with others in daily life. Maybe you're looking for long-term love with a partner who shares your core values. Perhaps you just want to meet more like-minded friends to grab a coffee with on a Saturday afternoon. The bottom line? You're looking for people to connect with, people who get you. At MeetMindful, we experience life to its fullest potential; we live deeply and with intention. We thrive by exploring, learning and growing. Here, we bring together a community that encourages you to embrace the friction and vulnerability that comes with growth. MeetMindful is the meeting ground for your most life-changing and inspiring connections. We don’t create the magic moments; we create the space for you to make your own. Listen To Episode 157 As Amy Baglan Uncovers: Why any relationship with someone else is the fastest way for you to grow. The reason why authenticity was so important to her; even at a young age. How her relationship with her family inspired her to design MeetMindful. Why working in a huge corporation setting just wasn't right for her and why she loves working in startups. How yoga gave her the peace of mind and stillness that allowed her to realize she could make the changes that she wanted to see happen in her life. The different routes you can take through the Institution for Integrated Nutrition and why she decided to create a social network instead of do something like coaching. Why websites like Match.com don't allow you to truly see whether or not you can connect with someone on an authentic level. Her past event company, Yoga Dates, in Denver, Colorado and how they helped give people the permission to bond and talk over their passion for yoga. How mindfulness can help you create a more enriching experience in relationships in addition to the natural chemistry and attraction you have with someone else. The signs that will tell you whether or not you can trust someone from a dating app. Variable awards on MeetMindful and why the ultimate goal is to help people find a wonderful relationship so that they can leave the app. Why you should listen to your body and not your mind to tell you what you feel in the moment and more importantly, with someone else. How companies can improve their communications tactics between employees by being more mindful and open about emotions. Why a relationship with someone new can actually help you grow and heal. Ghosting and how it's become something acceptable in our society even though it shouldn't be accepted at all. How to nicely say to someone that the relationship just isn't going to work out. Power Quotes From The Show "There's always going to be work to do in a relationship, but you get to choose who you want to do it with. You and your partner have to learn how to be in conflict together. So, if doing that work and being in conflict together always brings out the worst in both of you, that tells you something about your relationship." - Amy Baglan "I've always had this desire that people show up as their authentic self rather than put on a front or be superficial. I can't connect with others when they're not being true about themselves." - Amy Baglan "I always urge people to look at how a potential partner acts and not pay attention to what they say. The way that people show up in the world, their behavior, and how they treat other people including yourself cannot be filtered by words." - Amy Baglan "Dating apps are almost like a trigger happy, fast food style atmosphere where there's almost too many options and choices. This is teaching younger generations that this is all there is. They learn that people can be disposable and that the quantity of connections over quality is better." - Amy Baglan "If all a person does is share pictures of selfies on a dating app and they only care about what their body looks like, then they probably don't value anything else about themselves. If that's the case, then I certainly don't think they're going to value much else about myself either." - Amy Baglan Links From Today's Show: MeetMindful Facebook Instagram Twitter YouTube Amy Baglan: LinkedIn Twitter Amy Baglan - Mindful Dating on the Untangle Podcast Mindful Dating is Now a Thing - And This Buzzy New App is Here to Prove It 5 Rules for Mindful Dating & Relationship-Intention Setting this Holiday Season by Amy Baglan Variable Rewards: Want To Hook Users? Drive Them Crazy Emotional Expressions Beyond Facial Muscle Actions. A Call for Studying Autonomic Signals and Their Impact on Social Perception Milk and Honey by Rupi Kaur Arielle Ford Conscious Leadership Group Internet Dating Conference Double Your Dating Success 3.0 Summit Institution for Integrated Nutrition Wellness Force Community WFR #149 Johnny Blackburn WFR #048 Nir Eyal About Amy Baglan Amy Baglan is the Founder of MeetMindful, an online dating site where mindful singles connect with one another to find true love. MeetMindful is a relationships company that inspires people to make meaningful connections every day. They are not only a dating app, but a meeting ground for people who want to live their happiest, healthiest lives—and connect with others who feel the same. Amy has created a business for people who value healthy living, yoga, meditation, authentic connections and more and she believes relationships are the fastest way to personal growth Get More Wellness In Your Life Join the WFR Community on facebook Send Josh Trent a personal message Tweet me on Twitter: Send us a fun tweet (or a what's up) Comment on the Facebook page Sign up to get an email alert whenever we release a new episode Support This Podcast Leave a 5 star review on iTunes Share this episode with someone you care about Contact Wellness Force Radio for podcast sponsorship and partnership opportunities Rate & Review Wellness Force ---> REVIEW THE PODCAST Ask A Live Question For The Next Episode ---> Click here to leave a voicemail directly to Josh Trent to be read live on the air.  You May Also Like These Episodes Food Freedom Forever With Melissa Hartwig Nir Eyal: Breaking Bad Habits, Technology Addiction, & Emotional Triggers Healthy, Happy & Harder To Kill w/ Steph Gaudreau of Stupid Easy Paleo Beyond Meditation: How To Get A Better Brain With Ariel Garten Living A Healthy Lifestyle In A Modern World With Dan Pardi Creating A Life Worth Living With Michael Strasner Join the Wellness Force Newsletter: www.wellnessforce.com/news Don't miss next week's show: Subscribe and stay updated Did you like this show on Ketosis? Rate and review Wellness Force on iTunes You read all the way to the bottom? That's what I call love! Write to me and let me know what you'd like to have to get more wellness in your life.

Quote:  “The devil is always in the details, right?” —Mark Baird   About: If the State of Jefferson ever formed, it’s unlikely Anthony Bourdain would ever travel there for its pizza or burritos. Mark Baird, the “unofficial” leader of the State of Jefferson movement, likes to think they’d be known for their buffalo burgers. Though, he’ll admit, he’s in the minority. Most people behind this movement, he says, would probably prefer beef. Being in the minority is a feeling he’s had for quite some time. Living in Northern California with Baird’s heavy libertarian point-of-view would likely drive most people crazy, and out of the state. But Baird wants to stay. He’d just prefer he was living in a new state, a State of Jefferson. Feeling that he’s had no representation in how Sacramento operates, this semi-retired pilot and former buffalo rancher has spent the past several years convincing thousands of citizens along with cities, counties and mayors to join his grass-roots movement. In Part II of II of this story, we ask how Baird plans to form this new state and look into the financials, legality and likelihood of whether the State of Jefferson can ever live up to being more than just a state of mind. Show Notes: [00:25] Mark Baird’s speech on 05.31.17 in front of California State Capitol building in Sacramento [00:55] “Borough” by Blue Dot Sessions [02:25] See Citizens for Fair Representation et al. v. Padilla Recommended: A recent 60 Minutes profile of Gov. Brown (CBS News) [02:30] The photo of California Gov. Jerry Brown looking at a flag of the State of Jefferson [04:15] “This Land Is Your Land” performed by Sharon Jones & the Dap Kings [04:50] Recommended: Listen to Part I before listening to this episode [09:35] Light reading on Kevin Hendrick (The Union) Earlier profile of the movement (The Sacramento Bee) [11:45] One of the first counties the State of Jefferson movement made its case back in 2013 (Siskyou Daily News) Results of Ballot Measure A in 2014 on the matter of state-split question And an economic overview [12:00] Light reading on Tehama County [12:25] Results of Del Norte County’s state-split ballot measure (Associated Press) [13:05] “Jefferson State of Mind” performed by local musician CQ [13:20] Official map of the State of Jefferson and its declared counties Results of Measure G on state-split question The county’s Board of Supervisors placing issue on the ballot (The Sacramento Bee) A short news brief on the results of the vote (USA Today) And an economic overview [13:40] Light reading on Lassen County [13:45] Map of the State of Jefferson according to Keep It California [16:30] “Borough-Alternate Opening” by Blue Dot Sessions [16:55] Richard Seel’s presentation on the State of Jefferson’s financial model called “Show Me the Money” An earlier presentation of his model The latest spreadsheet detailing the financial model [17:00] Light reading on Steve Baird And on budgets and spending (NASBO) And on state budgets and the federal government (NASBO) And a break down of how state budgets are formed (California Budget Project) [17:45] A short primer on state taxes and revenue (National Association of State Budget Officers) [19:05] List of U.S. States by budget size [19:10] A bigger breakdown of state budgets including Nebraska Holistic overview of California’s total debt (California Policy Center) Related: An old report from 60 Minutes on the state budget crisis Unrelated: A primer on the federal debt and deficit [20:30] The $340 billion number comes from a 2014 report (Los Angeles Times) [20:55] “Borough Celeste-Solo” by Blue Dot Sessions [21:35] Light reading on zero-percent interest rates (Investopedia) And additional reading on the California wildfires (BBC News) [22:05] Light reading on Montana’s wildfires and its budget short fall (Rapid City Journal) Related: New Mexico’s list of state departments [22:30] California’s list of 343 state agencies [24:50] Light reading of an old profile on Peter Thiel (The New Yorker) [25:00] “Sunset on the Ganja Farm” by The State of Jefferson Band [25:10] More on the Colorado pot boom (The Denver Post) [26:15] More on Dan Walters (@DanCALmatters) here [27:00] An overview of California’s economic output by region (The Sacramento Bee) And an economic forecast (Calif. Department of Transportation) [28:30] Current breakdown of Siskyou County, where Baird lives [30:05] Light reading on U.S. history and the partitioning of states Additional reading on how to become a state (How Stuff Works) [30:25] Light reading on how admission into the Union And Puerto Rico (Newsweek) President Donald Trump comments on San Juan Mayor Carmen Yulín Cruz Soto (Fox News) [32:10] More on the Washington D.C.’s bid for 51 (NPR) A much deeper and thorough dive on how Tennessee became a state [32:40] Light reading on the Tennessee Plan (The Orlando Sentinel) [32:55] “Tennessee” by Jimmy Martin [34:05] Light reading on the City (Town) of Fort Jones [35:15] The original lawsuit filed against California Secretary of State Alex Padilla [36:20] “Lamb Drop-Minor Feel” by Blue Dot Sessions [38:05] “Coronea” by Blue Dot Sessions [38:20] Note: The Citizens for Fair Representation is technically a DBA for the State of Jefferson Formation, which is based in Nevada, as noted here. And confirmed here. (Yreka News) California’s State Constitution of 1879 (see: Article V) [38:50] California’s population growth over the years [39:15] Representation ratio based on California population in 1879 Additional reading here Recent column on the measure in the New York Times [39:40] Light reading on the Apportionment Act of 1929 [40:10] More on the Hamilton-Vinton Model Power In Numbers: Reapportionment and the Constitution (Constitution Center) Congressional Apportionment: Past, Present and Future (Duke University) The House of Representatives Apportionment Formula: An Analysis of Proposals for Change and Their Impact on States (Congressional Research Service) The 1911 House Reapportionment (House.gov) Op-ed for enlarging the number of representatives (The New York Times) Methods of Apportionment (US Census) [39:40] Related reading on Congressional Apportionment: [41:40] Herbert Hoover’s full speech in St. Louis, MO in 1932 (CSPAN) [42:50] Assemblymember Paul Fong on Local Edition [42:55] See Article XIX here [43:15] Light reading on the Chinese Exclusion Act of 1882 [43:30] More on California’s apology to the Chinese here (TIME) [46:10] “Velejo-Atmo” by Blue Dot Sessions [47:50] “Lord Weasel-Thoughtful Bridge” by Blue Dot Sessions [48:00] Full text of the Declaration of Independence (National Archives) [48:25] Background on Margalynne Armstrong [48:40] “March on Gumdrop Field-Cello Leader” by Blue Dot Sessions The 14th Amendment The impeachment of Andrew Johnson (Politico) Recommend Listen: More Perfect’s American Pendulum II [48:45] Light reading on: Recommend Listen: More Perfect’s The Political Thicket [50:15] Audio from Baker v. Carr (Oyez) [50:20] Audio from Reynolds v. Simms (Oyez) [50:40] “The Telling” by Blue Dot Sessions Related: The Guarantee Clause and California’s Republican Form of Government (UC Berkeley) [53:10] Guarantee Clause [53:30] Citizen for Fair Representation and Baird’s motion to intervene in LaVergne v. United States House of Representatives [52:10] More on the State of California’s motion to dismiss the Citizens for Fair Representation lawsuit (Siskyou Daily News) [54:25] More on Scott Stafne [01:00:40] “Velejo-Tense” by Blue Dot Sessions Historian Robert Calhoon polls support for the Revolution around 40 percent US Department of Veteran Affairs numbers Some additional forum chatter on Reddit’s r/AskHistorians Some light reading on Three Percenters Some recommended viewing on the Three Percenters (VICE) More additional reading on the Three Percenters (Anti Defamation League) And one last bit on the Three Percenters (politicalresearch.org) Light reading on the Oath Keepers (VICE) Additional reading on the Oath Keepers (Washington Post) A profile on the Oath Keepers (Mother Jones) [01:00:50] Some links to debunk the “three-percent myth” Excerpt played from this airing [01:01:55] “Jefferson State of Mind” on KCNR 1460 Southern Poverty Law Center’s spotlight on the State of Jefferson Oregon Public Broadcasting Quartz Gawker St. George News Los Angeles Times [01:03:30] More on LaVoy Finicum from [01:03:50] Light reading on the Malheur Standoff (The Oregonian) [01:04:10] Released video of Finicum’s traffic stop [01:07:00] “Olsted Harten” by Blue Dot Sessions [01:10:00] Recommended Podcast: Closer Than They Appear[01:10:10] Recommended Podcast Newsletter: Constant Listener

Discover how to Build Your Digital Business by Leveraging Membership Sites   Introduction to Membership Sites and Their Impact on Consumers Did you know that membership sites have the potential to generate an additional source of revenue and can also be used to create an amazing customer experience? I. This video series is for you […]

Lloyd Baugh, S.J. delivers the second of two lectures in his Theology and Film series, titled "The "God Question" in Contemporary Cinema, Part 2: Respecting Holy Mystery. McDonald Family Lectures on the Life & Teachings of Jesus & Their Impact on Culture.

Lloyd Baugh, S.J. delivers the first of two lectures in his Theology and Film series, titled "The "God Question" in Contemporary Cinema, Part 1: A Courageous Break With Tradition. McDonald Family Lectures on the Life & Teachings of Jesus & Their Impact on Culture.

Lloyd Baugh, S.J. delivers the second of two lectures in his Theology and Film series, titled "The "God Question" in Contemporary Cinema, Part 2: Respecting Holy Mystery. McDonald Family Lectures on the Life & Teachings of Jesus & Their Impact on Culture.

Jeremy Michael Cohen is a writer, director, and producer of films and other moving images. He has produced and 1st A.D.ed millions of dollars of content, including seven feature films and  commercials for major brands, including Honda, Scion, and Reebok. His current project is a micro-budget feature film, Yinz, that Jeremy will direct. Yinz will be shot in Western Pennsylvania during winter 2015-2016.Show NotesCrowdfunding Articles-- How I raised $125,000 on Kickstarter by Ryan Koo-- How to Plan a Kickstarter for Your Film - The Ultimate Guide by Jeremy Michael Cohen -- 9 tips to break Crowdfunding Records by Lucas McNelly-- Hacking Kickstarter by Tim FerrissCrowdfunding Campaigns-- Yinz: A Rust Belt Movie by Jeremy Michael Cohen (ends 9/3/15)-- Raymond Chandler's Star on the Hollywood Walk of Fame by Bill Boyle (ends 9/11/15)Movies & Other helpful links-- Mean Creek-- Dog Day Afternoon-- Reservoir Dogs-- Trapped in Paradise-- Pittsburgh Film Office-- Philadelphia Film Office-- Pennsylvania Industry Association (PaFIA)-- Blue Ruin kickstarter -- Chris Soth-- Bill Boyle-- The Rise of Superheroes and Their Impact on Pop Culture via Smithsonian X (class is free and I'm a TA)ContactJeremy Michael Cohen - Official Site- TwitterDave Bullis- Official Site- Twitter- Facebook- YoutubeSupport the Podcast1. Sign Up for Dave's email list2. Rate the Podcast on iTunes3. Buy on Amazon.com using my affiliate link4. Buy Final Draft screenwriting software using my affiliate link5. Buy Jason Brubaker's, 'How to Sell Your Movie' course via my affiliate link6. Buy Jason's Brubaker, '101 Short Film Ideas' book for only $7!7. My Podcast Amazon wish list 8. Dreamhost offer get a free domain name plus unique IP - use promo code, DBPodcastSubscribe to the Podcast-- Podbean -- iTunes -- Stitcher-- Soundcloud

Have you had an influential person in your life - one that stood by you, believed in you, built into you, maybe even helped shape your spiritual development and affirm you? I have. In Season 1 Episode 5 - Mentors and Their Impact, I speak about mentors who have impacted me for Christ and I am fortunate to have such men in my life. I speak to the committed role of a mentor, not a chance relationship with someone we look up to or who possesses a business skill or talent we want. Rather, it is an intentional relationship with someone whose values, spiritual maturity, and life skills we not only admire but they agree to this Christ-centered role in our lives and hold us accountable even when it may not be wanted or convenient. Be sure to listen and be encourage to foster or seek these meaningful relationships in your life.

'The Diffusion of Truth Commissions and Their Impact on Human Rights Practices'. Presented by Dr Hunjoon Kim, Research Fellow, Griffith Asia Institute.

The George Washington University’s Marc Lynch, director of the Project on Middle East Political Science, speaks with James Toth, an anthropologist at New York University Abu Dhabi. He has taught at the American University of Cairo and at Northeastern University. He is the author of Rural Labor Movements in Egypt and Their Impact in the State, 1961-1992. Lynch and Toth discuss his experience as an anthropologist in Egypt and his recent release Sayyid Qutb: The Life and Legacy of a Radical Islamic Intellectual. - See more at: http://pomeps.org/2013/10/pomeps-conversations-25-with-james-toth-10102013/#sthash.6MAnjtdY.dpuf

The George Washington University’s Marc Lynch, director of the Project on Middle East Political Science, speaks with James Toth, an anthropologist at New York University Abu Dhabi. He has taught at the American University of Cairo and at Northeastern University. He is the author of Rural Labor Movements in Egypt and Their Impact in the State, 1961-1992. Lynch and Toth discuss his experience as an anthropologist in Egypt and his recent release Sayyid Qutb: The Life and Legacy of a Radical Islamic Intellectual. - See more at: http://pomeps.org/2013/10/pomeps-conversations-25-with-james-toth-10102013/#sthash.6MAnjtdY.dpuf

Parallel Session IV-A, Sunday Afternoon, 3 August 2008, Alternative Energy Sources and Their Impact; Engineering and Appropriate Technology

Parallel Session IV-A, Sunday Afternoon, 3 August 2008, Alternative Energy Sources and Their Impact; Engineering and Appropriate Technology

Parallel Session IV-A, Sunday Afternoon, 3 August 2008, Alternative Energy Sources and Their Impact; Engineering and Appropriate Technology

Parallel Session IV-A, Sunday Afternoon, 3 August 2008, Alternative Energy Sources and Their Impact; Engineering and Appropriate Technology