15 years of the CrossFit Games from 2007 to 2021 were written, tested and unveiled to the world by one man, Dave Castro. This year it was Adrian Bozman's turn to step up to the plate to deliver a test of fitness to crown The Fittest on Earth. Did it deliver? Sean Woodland joins the show after the unofficial announcement Tia is going for 7... or she's still retired... we are not sure. CULT Collection: https://sherpawerks.com/collections/cult OG Collevtion: https://sherpawerks.com/collections/the-og-collection BUBS Naturals use the code "GETWITH20": https://www.bubsnaturals.com/ Element 26 "GETWITH15": https://element26.co/
In this week's episode, Rachel is joined by Tia Fernandinho. Tia is the founder of Ease and Grace Counseling and is a Professional Conscious Counselor. Tia takes a self-love approach to help her clients heal. Tia shares her story about how moving to Colorado at the age of 13 really shaped and formed her and allowed her to be given her “Holy Medicine” in order for her healing journey to begin. She dives into the depths of what her experience was like living with a narcissist. She offers signs to look for and beautiful advice on what you can do if you resonate with her story to find the courage and strength to get out of the relationship and begin your own healing journey. This is truly her service to the world.You can connect with Tia through the following links:Website: https://www.easeandgrace.online/Email: Easeandgracecounseling@gmail.comToday's Sponsors: Forij Granola: Start your day with mental focus and natural energy from whole food ingredients & anti-inflammatory functional mushrooms. Enjoy the handcrafted mouth-watering flavors that leverage spice for flavor rather than sugar. Feel the difference with 100% real ingredients & anti-inflammatory mushroom extracts that provide real energy & focus benefits. Eat guilt-free knowing this is the lowest sugar granola on the market. Visit forij.co and enter liveraw15 for 15% off.Rachel would love to hear what you enjoyed most about this conversation. Let her know through the following:IG: @liveyourrawlifeF: Live Your RAW Life Y: Live Your RAW LifeE: email@example.comWeb: www.liveyourrawlife.comIf you'd like to support this podcast you can do so through:Patreon link:https://www.patreon.com/liveyourrawlifeIf something resonated with you from this week's episode please subscribe to the show and leave a review while you are there. Every time a review or rating is received it opens up the platform that allows the show to reach a wider range of listeners. Your support is greatly appreciated.
Bobby will wear a g-string but won't do an accent. Tia chooses Wayne over the Bay. Khalyla invites the enemy. We talk Celebrity Apprentice, acting with Brando, and a new generation of cum. Sponsors: Our listeners get 10% off their first month at www.betterhelp.com/belly
Last year, Fred Gibson (under the moniker Fred again..) quietly dropped an electronic album that sampled audio from his actual life, and gave it the fitting title, ‘Actual Life (April 14 - December 17 2020)'. Since then, the artist has gained seismic traction and a global following, including KEXP's Social Media Manager Tia Ho. In this episode, Tia travels track-by-track with Fred through the album, and the two discuss choosing to be joyful, keeping journals, and whiskey preferences. Support the show: https://www.kexp.org/sound/See omnystudio.com/listener for privacy information.
What does it mean to find home where you least expect it? For Tia Thomas, it meant moving in with her partner, children, her parents, and siblings. When the pressures of life became too great, Tia and her partner felt their best chance for success as a family unit was to take the awkward risk of living with her parents. Today, Tia is telling us the story of the pressure, the beauty, and all the in-between that helped her learn how to come home again. Thanks for listening! ———— The Uncomfortable Grace Podcast is mixed & produced by Kaylene Brown. Connect with Mandy & Heather on Instagram: @mandycapehart @heatherconverse12 @UncomfortableGracePodcast Or on Twitter: @MandyCapehart @UNCGracePod
The 2022 No Bull CrossFit Games are in the books. Tia Toomey wins her sixth title while Justin Medeiros gets his second. Sean tells us what led up to him announcing Tia's retirement during the broadcast. The guys break down what happened on the final day of competition and talk about why they are optimistic for the future.
In this episode, Tia talks about defining which sex goddess you are and personal branding. Sex Goddess Quiz: https://uquiz.com/quiz/bgLbEx/what-type-of-sex-goddess-are-you Connect with Tia: IG: https://www.instagram.com/cosmic_witch_goddess Podcast IG: https://www.instagram.com/enchantress_society_podcast Website: https://tiamariejohnson.com
This is the one hundred sixty-seventh episode of the live winestream. I open, taste, review a Saltram S2 2019 Shiraz from Australia that cost under $4! Is it a bona fide bargain or just a crummy cheap wine? We'll find out. Plus toasts, dad jokes and an original, silent Super 8mm short film never before seen on the Internet! Need graphics or animation for your podcast, Twitch channel, YouTube videos or website? Tia is accepting commissions! She does all the graphics and animation for Drink With Rick and she can do them for your projects too. Visit tiasavoia.com to check out her gallery of work! Want to support the show? Buy me a coffee! This podcast is the audio version of the video winestream, edited with consideration for the listener. Did I enjoy the wine? Do I recommend it? Listen to find out. Do you have a favorite wine you would recommend? Is there a wine you are curious about and would like me to try? Tell me what it is and I may give it a review on a future Winestream. Send your suggestions and comments to rick(at)savoiamedia.com or send them through the contact form on my website at drinkwithrick.com! Drink With Rick is a member of the new Savoia Media Network.
Greetings in love, light, and wisdom as one. For the channeling session for August, we are departing from the legacy series this month. This one is from 1998 and thus is one of the clearest sounding recordings we've posted recently. Kiri starts things off by informing us that Tia wasn't on the base and she had requested that one of her assistants take over in her stead. The gentleman chosen got the assignment due to his research into the subject being discussed. We find out his name is Taal, just like the Wing Commander but this Taal is Sirian and not one of the pilots. His English skills are comparable to the Wing Commander's. He reveals these approximately 500 years old and new Kiri and Karra's father as well as them when they were very young. Much of what he goes over is the Defcon status which is what the base was using to determine the status quo of the planet much as NORAD would. Kiri comes back on and we learn that only Oath Keepers like Lyka eat meat among the Sirians. She also begins to explain relationships on a higher dimension and would be expanding on the subject significantly when she would speak at the end of the tape. Omal takes questions and one that had been going around recently in the news was on the Tailwind incident which involved a government cover-up about Sarin gas used by the US during the Vietnam War. Also, we get to hear about the odds of a comet hitting our planet due to a movie that had come out called "Armageddon". Mark and Kiri's son Leonedies finishes up the side with an address he'd like passed on to the other races taking part in the intergalactic conference being organized. He may be only three years old, but he's a super operant and supremely intelligent. The note on the person that we discuss in Northern California on side two is that she is a channel for Ashtar Athena who has spoken once in a channeling session of ours. Now we were looking at enlisting her help to see if her participation might be included. Side two notes include as well Karra coming on to help out our female guest with a woman to woman chat. Karra had been doing some research on drugs and alcohol and had some great information to pass on to our guest about those subjects as they had been a problem until recently. This is the first time we would hear about the population of Sirius being about 15 to 20 million. An amazingly small number of people for an entire planet. To expand on that subject, Kiri now explains the sexual side of being higher dimensional. She goes into depth about the difference between sex and making love. The short version is that one is spiritual and one is not. August gives us an opportunity to leave the legacy series of channeling sessions and go back to a session from 1998 and with it, the clarity we saw with the better recording equipment of the later years. It also introduces us to a new speaker we don't have an image to add to his profile as he only spoke the one time. He is an assistant to Tia enlisted to take her place while she is away from the base. He covers topics of a similar nature starting with the wildfires that were taking place in Florida. What we discover in our discussion with him is that is over five hundred years old and a skier on the base team. Skiing is the thread that connects him to the Tanaka family as he recalls times when he knew Kiri and Karra's dad before having daughters was even considered.He recalls as well seeing both girls as they were just learning how to ski. From him we change speakers over to Omal who is familiar with the topic brought up which was called the Tailwind incident which happened during the Vietnam War. It had made news so Omal helps debunk the latest rumors. We move on to a movie recently released called "Armageddon" and his knowledge of spacial dynamics allows him to spell out what would happen with a comet of a similar size. It is a sad state the world is left in with survivors facing a grim future. With odds of a thousand to one, that is odds that can help a person sleep at night. We end with his explanation to a question about keywords where he reminds us that both he and Korton are using them already and to look to their past conversations to spot them. We end the side with Kiri and Mark's infant son who is more university professor than a three-year-old child. While not a regular speaker, when he did join it was to help with the organization of the intergalactic Conference being organized that would bring together all the races involved with our planet and people. In this appearance, he lays out a challenge to the other races to demonstrate their willingness to participate in the talks. For full transcripts of this session and more information about Hades Base and the 6th dimension, please visit our website: http://hadesbasenews.com The sessions lasted from 1992 to 2001 with this one being taped on 07/07/1998. Side one includes: 1.)(3:18)- Taal, an assistant of Tia's, come on to take her place is discussing the status of the Earth. We also discover that he is old enough to have known both Kiri and Karra as well as their dad as youngsters. 2.)(5:37)- Kiri explains why only Oath Keepers eat meat and how the relationships between those of a higher dimension are not restricted to the taboos of same sex relationships found on this dimension. 3.)(25:15)- Omal discusses a current Government scandal from the Vietnam era that threatened to advance the Defcon level the base had in place. The movie "Armageddon" lets Omal give us the odds. 4.)(41:58)- Three-year-old Leonedies comes on to add some impetus to the intergalactic Conference being planned in the form of a challenge to the other races that were expected to participate through channels.
On today's episode, I'm joined by fellow Arizona agent and my good friend, Tia Moore. We talk about the power of having clarity and boundaries in our businesses, and why it's not wrong to choose what gives us joy. One of the most admirable things about Tia is how clear she is on what matters to her, where she's going and what she wants, and never letting her real estate business, work and clients take her off course. Not only does it make running her business less draining, it actually makes her value proposition so much stronger. “I've gotten more business from saying no and being okay with it than I have from being a yes-woman.” Tia Moore is the business owner and team leader of the NextView Home Professionals Team. Tia started her real estate career in 2001, with the Mortgage Servicing Division of Citibank. During Tia's banking career she was responsible for complex projects and dozens of employees. Relationship management was a critical skill Tia developed and strengthened when working in high profile roles that involved internal partners, government agencies, and nonprofit organizations. Her gift of deal making, problem solving, and ability to analyze data made Tia's transition into Real Estate Sales seamless. Tia continues to rank among the top Real Estate agents and truly a force to be reckoned with. When we start optimizing our energy, we become immune to pain-in-the-ass, difficult and draining clients. We become comfortable with saying no to what doesn't serve us. Taking on a new client or deal won't be as simple as a yes or no question. It will be a deeper decision based on our values and the life we envision for ourselves. Real estate has room for agents who live authentically and dictate the terms of their business - and Tia Moore is one of them. She has built a business that doesn't conflict with her values, but actually supports and reinforces them. She shares how she built a business that put joy first, and her badass strategies for learning to say no to what doesn't serve us. Website: https://www.nextviewre.com/ Instagram: @nextviewtia Time Stamps 01:03 - How Tia found her way into real estate and why she values her freedom. 09:47 - How to become more comfortable with setting boundaries and protecting our energy. 15:05 - Why agents struggle to say no to clients that don't align with their values. 17:25 - How to prioritize energy management the way we prioritize time management. 22:49 - How to define success for yourself. 26:25 - The power of clarity and authenticity in this business. Guest Info Tia Moore is the business owner and team leader of the NextView Home Professionals Team. Tia started her real estate career in 2001, with the Mortgage Servicing Division of Citibank. During Tia's banking career she was responsible for complex projects and dozens of employees. Relationship management was a critical skill Tia developed and strengthened when working in high profile roles that involved internal partners, government agencies, and nonprofit organizations. Her gift of deal making, problem solving, and ability to analyze data made Tia's transition into Real Estate Sales seamless. Tia continues to rank among the top Real Estate agents and truly a force to be reckoned with. Website: https://www.nextviewre.com/ Instagram: @nextviewtia CTA Please leave us a review at https://ratethispodcast.com/nla
In this episode Kim and Tia announce their decision to pivot. Tia has decided to focus on her coaching business as well as potentially move into some new endeavors of her own. Kim is working on launching a new business and more details about that will follow. For now, Kim is continuing the Masks Off Podcast on her own. Episodes will still be released weekly. This was an amicable decision and like the quote says, “everything on this earth is in a continuous state of evolving and improving….” If we are not changing then we are not growing. Kim and Tia are evolving into what works for them individually. “Look around you. Everything changes. everything on this earth is in a continuous state of evolving, refining, improving, adapting, enhancing, and changing. You were not put on this earth to remain stagnant.” ~ Dr. Steve Mataboli To Contact Us: Instagram: @masksoffcommunity FB Masks Off Community: https://www.facebook.com/groups/masksoffcommunity Masks Off Email: firstname.lastname@example.org Masks Off YouTube Channel: https://youtube.com/channel/UCaWJfO7ZFd4aYBX3e-clj9Q Tia Fagan Website: tiafagan.com Facebook: @tiafagancoach Instagram: @tiafagancoach Email: email@example.com Kim Gross Website: unlock-yourmind.com Facebook: @unlockyourmindhypnotherapy Email: firstname.lastname@example.org
We're back twerkin and werkin! Welcome back to The Insecure Experience with Bre, Candice, and Tia! Tune is as we say our goodbyes to Grandmother Ernestin in this week's episode of #PValleyStarz, the intimacy with Uncle Clifford and Lil Murda, and wrap things up as we discuss the evolution of Mercedes and Terricka's relationship. Support Purchase some merchandise! Use the hashtags #TheInsecureExperience, #TheInsecureExp, #TISE, on social media when live listening and posting about the show! Share this podcast with a friend, a loved one, a coworker, or even a stranger! Contact Twitter: @TheInsecureExp | @NotSoNewlywedPC | @TeeTheGem | @_ItsMissBre Instagram: @TheInsecureExperience | NotSoNewlywedPC | BreTastical | _TeeTheGem Facebook: The Insecure Experience Email: TheInsecureExperience@gmail.com Website: The Insecure Experience Patreon: Patreon.com/FlawlessNoises The Insecure Experience™️ is a Flawless Noises Media Network presentation. #FNMediaProd --- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app
In this episode, Tia discusses who goddesses Lilith and Aphrodite are and misconceptions, provides oracle readings from those goddesses, provides ways to invoke them and what to expect from working with Lilith and Aphrodite. Connect with Tia: IG: https://www.instagram.com/cosmic_witch_goddess Podcast IG: https://www.instagram.com/enchantress_society_podcast Website: https://tiamariejohnson.com
Jill Stuber has served on FSQ teams for several multi-million-dollar food companies and food industry support companies, at both the corporate and frontline facility levels. She has defined expectations and programs for company-wide FSQ systems and has been responsible for verifying the implementation of those systems. Jill has led multi-plant teams to clearly define team and individual roles, expectations, and boundaries to more fully integrate and collaborate across organizations. Jill holds B.S. and M.S. degrees in food science from the University of Wisconsin (at River Falls and Madison, respectively); as well as an M.S. degree in quality management from Eastern Michigan University. She is a professional coach certified through Learning Journeys, an accredited program through the International Coaching Federation. She is also HACCP Certified, PCQI Certified, an SQF Practitioner, an IFT Certified Food Scientist, a Lean Facilitator, and a Six Sigma Black Belt. Additionally, Jill is an active member of the International Association for Food Protection, serving as the Developing Food Safety Professional's Professional Development Group Vice Chair. Tia Glave is a food safety, quality, and regulatory professional with almost a decade of experience in large food manufacturing, food retail, and startup food environments. She is formally trained as a chemical engineer and holds a B.S. degree from the University of Tennessee. She is a qualified individual trained in PCQI and FSVP, is knowledgeable in GFSI schemes, and has worked with many food product categories. Tia has a passion for helping manufacturing and retail organizations of all sizes build and strengthen their FSQ programs. She uses systems, data, and proven methods to develop and implement FSQ strategies that create efficiencies, are effective, and identify cost savings, all while using servant leadership principles. She has led small and large teams across multiple functions, including operations and maintenance, giving her a unique approach to implementing a strategy cross-functionally. Tia's passion also extends to championing Black talent in food safety and quality, and she's the founder of the Black Professionals in Food Safety Group to foster sharing, development, and connection to support Black talent. You can find the group on LinkedIn! Tia is also an active member of the International Association for Food Protection, serving as the Retail and Foodservice Professional Development Group Vice Chair. In this episode of Food Safety Matters, we speak with Tia and Jill [23:30] about: The importance of “meeting people where they're at” when assessing a company's level of food safety and crafting a plan for improvement The various factors that consultants must consider when guiding a company along its food safety journey Cultivating an effective FSQ leadership team to help build a robust and healthy food safety culture How an FSQ leader can embrace their role and lead their team by discerning and evaluating workload capacity How “coaching” is different from “mentoring” or “consulting,” and why coaching may be a more effective approach when helping clients improve food safety culture How the Black Professionals in Food Safety and Quality networking group creates an avenue for Black professionals to grow in their FSQ careers and includes them in critical industry conversations Why focusing on a company's people, programs, and progress can reveal the "maturity stage" of its food safety culture Common growing pains within a food business operation, and how growing pains can be addressed through emotionally intelligent leadership Why FSQ leaders must take an active, intentional role in cultivating positive change within a company's food safety culture How FSQ can become a trusted business asset by “stepping up instead of sitting back.” News and Resources: FSIS Summarizes Foodborne Illness Outbreak Investigations for FY 2021 [03:22]FSIS Releases FY2020 Foodborne Illness Outbreak Investigations Summary Report FDA Publishes Guidance on FSMA-Compliant Preventive Controls for Pet Food [07:50] FDA Finds Harmful PFAS in Imported Canned Clams [09:16] FDA Tests Nationally Distributed Processed Foods, Finds Almost No Evidence of PFAS FDA Provides Update on Sampling and Testing Efforts of PFAS in the Food Supply The Growing Challenge of Safe Water for Use in Food Processing Operations NEHA Surveys Retail Food Regulatory Community [16:32] Food Safety Insights Column, Bob Ferguson The Return to Normal—Ready to Travel Again? [17:27] We Want to Hear from You! Please send us your questions and suggestions to email@example.com
Bestselling author Gill Paul returns with a brilliant novel about Lady Evelyn Herbert, the woman who took the very first step into the tomb of Pharaoh Tutankhamun, and who lived in the real Downton Abbey, Highclere Castle, and the long after-effects of the Curse of Pharaohs. Jenny: We're in our second episode of Encore, the new show for Binge Reading On Patreon supporters, talking to favorite authors, people who've already been on the podcast, about their latest release. And today we've got international best seller Gill Paul who's already been on the podcast twice before talking about her latest book, The Collector's Daughter, Gill Paul: The Collector's Daughter Gill's previous JOBR shows: Gill Paul's Famous Fabulous Lives, from November 2019: https://thejoysofbingereading.com/gill-paul-famous-fabulous-lives/ And: Love and Betrayal from September 2020: https://thejoysofbingereading.com/jackie-kennedy/ I love the way Gill makes historical events come alive in her fiction, and this book is no exception. The Collector's Daughter is a dual timeline novel moving between the 1920s and the 1970s telling the story of Lady Evelyn Herbert, the English aristocrat who was involved with the opening of Tutankhamun's tomb in the 1920s, and went on to live through the long-term after-effects of the supposed Curse of the Pharaohs She's also got the claim to fame of having grown up in the ‘real' Downton Abbey, Highclere Castle, where the popular TV series was filmed. Gill, It's great to have you with us again. Jenny: So welcome to the show Gill, and tell us about Pharaoh's tomb and Lady Eve part in it all. Gill: Thanks so much for inviting me on the journey. It's lovely to talk to you. Evelyn was there with her father, the Earl of Carnarvon and Howard Carter when the tomb was discovered and opened in 1922. And all the evidence is that they sneaked in by night without the Egyptian authorities watching over them Lady Eve first to enter tomb And the Eve was the first one to crawl in and she was a young lady from the English aristocracy. And I thought ‘Gosh', what would it have been like for her, I'd always been interested in Egyptian stories from school days, but it only really came home to me in 2011 when I visited Egypt. And I went to the Valley of the Kings. We went down that long corridor that Eve and her father and Howard Carter would have gone down in 1922 and saw where his tomb had been and then went up to Cairo and saw all the artefacts in the Egyptian museum. And that was staggering. I mean the enormous wealth of all the gold tombs and the funeral masks and the jewelry, and then little personal details like Tutankhamun's had sandals that pictures of Nubians on the soles, the Nubians were the enemies of the Egyptians so every time he walked, he was walking on his enemies. I loved all the little personal touches I saw in the tomb. That's what really brought it to life for me. Jenny: It's amazing. Now, one of the themes of the story is penetrates the whole story really is the long-term belief that there was some sort of curse involved in opening the tomb and Lady Evelyn did actually suffer quite a lot of personal misfortune in her life, including being involved in a massive car accident, which resulted in a series of small TIA's, as they're called and later more serious strokes. And part of the story is her as an older lady in the 1970s, when her memory is impaired with memory loss and things, that's an interesting part of it because quite a significant part of the story is told by this older character who's impaired. That was obviously something you deliberately chose to handle that way. Two photographs bookmarked life Gill: My inspiration for this novel when I decided to write about Lady Eve's part and this huge historical event or two photographs that kind of bookmarked her life. Lady Eve at tomb entrance with her father and Howard Carter
Tia McGraff has nine international CD releases and several awards, including two Grammy nominations, and an emPower Posi Music Award for her 2021 single, "Go Your Own Way," that's featured on her upcoming EP, With Love. Tia joins me on this edition of Americana Music Profiles.
TriFecta Airsoft Podcast 97 Tryhards Event Drug Wars 2Talking with Laz and Tia, the founders of the Tryhards airsoft team in Miami, Florida. They're hosting their 7th airsoft event in the Miami area next weekend July 30, 2022 from 4pm-10pm at Matrix Tactical field. Tickets are still available and there may be tickets for walk-ons the day of the event. For more info, contact them on there IG page herehttps://www.instagram.com/tryhards_airsoft/Matrix Tactical Paintballhttps://matrixtactical.com/https://www.instagram.com/matrix_tactical/Follow All Their Partners and Teammates herehttps://www.instagram.com/tryhard_drop/https://www.instagram.com/tryhard_salsa_airsoft/https://www.instagram.com/feyachi_outdoors/https://www.instagram.com/pmc.airsoft/https://www.instagram.com/c.i.a_airsoft/https://www.instagram.com/miamiinfidelsmilsim/Thank you for watching!Our Website: https://www.TriFectaAirsoft.comSupport the show
The CrossFit Games are coming, the CrossFit Games are coming!!!! Whether or not this is earth shattering news to you or you just had to Google what the h, e, double hockey sticks the CrossFit Games are, you should definitely tune into this episode. We dive into to what to expect this year in Madison.... That's in Wisconsin! Who we think has a realistic chance at winning..... Spoiler alert..... smart money is on Tia! Does competitive CrossFit have a PED problem???? If we got to program some events for the Games what would they look like?? Hope you enjoy it.... Don't forget to like, subscribe, share, etc!!
On Episode 18 of the Stroke Alert Podcast, host Dr. Negar Asdaghi highlights two articles from the July 2022 issue of Stroke: “Impact of Shunting Practice Patterns During Carotid Endarterectomy for Symptomatic Carotid Stenosis” and “Socioeconomic Inequalities in Reperfusion Therapy for Acute Ischemic Stroke.” She also interviews Dr. Magdy Selim about his article “Effect of Deferoxamine on Trajectory of Recovery After Intracerebral Hemorrhage: A Post Hoc Analysis of the i-DEF Trial.” Dr. Negar Asdaghi: Let's start with some questions. 1) Is deferoxamine mesylate yet another failed agent for treatment of patients with intracerebral hemorrhage, or is deferoxamine getting us closer than ever to an approved therapy for this deadly form of stroke? 2) Are different strokes happening to different folks due to their disadvantaged socioeconomic status? 3) And finally, how does a surgeon's personal practice preference to either routinely or selectively use carotid shunting during carotid endarterectomy impact the recurrent risk of stroke or death in patients with symptomatic carotid disease? We'll tackle these questions and a lot more in today's podcast as we continue to cover the cerebrovascular world's latest and greatest because, without a doubt, this is the best in Stroke. Dr. Negar Asdaghi: Welcome back to the July issue of 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. The July 2022 issue of Stroke contains a range of really interesting papers that I'd like to highlight here. As part of our Cochrane Corner articles, giving us short summaries of the long systematic review of a given topic, we have two short articles, one on the issue of local versus general anesthesia for carotid endarterectomy, where we learn that based on the current evidence, there's no convincing difference between local versus general anesthesia in the risk of stroke and death within 30 days after the procedure. In the second Cochrane Corner article, titled "Information Provision for Stroke Survivors and Their Carers," we learn that stroke survivors and their caregivers routinely report dissatisfaction with information provided to them by their clinicians about their condition and how active approaches to information provision is superior to its passive forms in improving patients' involvement in their care, their satisfaction, and, ultimately and not surprisingly, their stroke outcome. Dr. Negar Asdaghi: As part of our original contributions in this issue of the journal, we have an important paper titled "The Risk of Early Versus Later Rebleeding From Dural AV Fistulas With Cortical Venous Drainage." We are reminded in this paper that cranial dural arteriovenous fistulas are classified based on their venous drainage into those with or those without cortical venous drainage, or CVD. Dural AV fistulas without CVD rarely cause intracranial bleeding, while those with CVD may cause hemorrhage. In this study, the authors show that the risk of rebleeding of dural AV fistulas with CVD presenting with hemorrhage is increased in the first two weeks after ICH, emphasizing the importance of early detection of these malformations by vascular imaging and early treatment of AV fistulas with cortical drainage. This paper is another analysis from the CONDOR registry. Our devoted Stroke Alert listeners recall that we covered this registry in more detail when we interviewed Dr. Amin-Hanjani last October on the outcomes of intracerebral hemorrhage patients found to have dural AV fistulas. I encourage you to review these articles in addition to listening to our podcast today. Dr. Negar Asdaghi: Later in the podcast, I have the distinct honor of interviewing Dr. Magdy Selim from Harvard Medical School on a critical analysis from i-DEF trial to examine the long-term outcome of patients with ICH who were randomized to receive deferoxamine versus placebo. As an expert in the field of intracerebral hemorrhage and a member of the recently published American Heart Association Guidelines Committee, Dr. Selim was not fazed at all about the neutral results of the trial. "The future of ICH is bright," he says, and in the interview, he tells us why. But first, with these two articles. Dr. Negar Asdaghi: Since its first reported successful surgery in 1953, carotid endarterectomy, or CEA, has become a common surgical procedure to prevent ischemic stroke in patients with carotid disease. CEA requires a temporary clamping of the carotid artery that is being worked on. During this time, the ipsilateral hemisphere is, of course, dependent on collateral flow from the posterior circulation or from the contralateral anterior circulation to maintain its perfusion pressure. Intraoperatively, various methods are used to monitor cerebral perfusion, and the risk of clamping-induced hypoperfusion is obviously variable for each patient depending on the patient's specific anatomy, their collateral status, and other risk factors. One way to protect the brain against possible clamp-induced ischemia is to do carotid shunting. The problem is that carotid shunting also comes with its own set of risks and problems. There's the risk of causing carotid dissection, embolization of pieces of the plaque during shunt insertion, or the risk of causing air embolism. Dr. Negar Asdaghi: There are also other shunt-related local complications that should be noted, such as possibility of causing injuries to the cranial nerves or development of neck hematoma related to the more extensive surgical exposure required for shunting. So, it's not surprising that the practice patterns with regards to shunting is quite variable amongst different surgeons. There are surgeons that are considered routine shunters, and those who are considered selective shunters, meaning that the shunt is inserted only in cases with a particular indication. The question is whether the surgeon's preference for shunting can impact the CEA outcomes. In the current issue of the journal, we have an interesting study led by Dr. Randall DeMartino from the Division of Vascular and Endovascular Surgery at Mayo Clinic, Rochester, where the authors look at the impact of shunting practice patterns during carotid endarterectomy on the following post-CEA outcomes: number one, in-hospital stroke and in-hospital death rates, and number two, combined stroke and death in patients with a recent symptomatic carotid disease, that is, carotid stenosis associated with a history of either ipsilateral stroke or TIA within the past 14 days of endarterectomy. Dr. Negar Asdaghi: So, the data for the study came from the ongoing Vascular Quality Initiative database, which comprises a network of more than 600 North American academic and community hospitals, and collects data on 12 different vascular procedures, one of which is CEA. The study included over 13,000 carotid endarterectomies performed from 2010 to 2019 for symptomatic carotid patients. This number came after they applied their exclusion criteria to all CEAs performed in the database during this timeframe, importantly excluding any asymptomatic carotid surgeries or those in whom surgery was performed after the two-week mark post qualifying TIA or stroke. Now, before we go over the results, let's go over some definitions used in the study. They had to classify surgeons to be able to do the study into two categories of routine versus selective shunters. So, what they did was to analyze all consecutive CEAs, whether they were done on symptomatic or asymptomatic carotids, in this database, aggregated at the surgeon level. Surgeons routinely shunting in over 95% of their procedures were gauged as routine shunters. Otherwise, they were classified as selective shunters. Dr. Negar Asdaghi: Now, coming to each case included in this study, each surgical case was, in turn, classified into four categories based on whether or not a shunt was actually used for that particular case: category one, no shunt used; category two, shunt used as a routine procedure; number three, shunt used for a preoperative, mostly anatomical indication; number four, shunt was used for an intraoperative indication, which, as we mentioned before, these are mostly intraoperative hemodynamic compromised situations. And here are the results: In total, 3,186 of surgeries, that is 24% of surgeries, were performed by routine shunters versus 76% by selective shunters. So, most surgeons were selective shunters in this study. The demographic of patients operated by the routine versus selective shunters were more or less similar with regards to the age of the patients, most of their vascular risk factors, and the degree of ipsilateral or contralateral carotid stenosis or occlusion, with a few notable exceptions, in that patients undergoing surgery by routine shunters were more likely White, more likely to have had a prior CABG, more likely to undergo the operation while taking a P2Y12 inhibitor antiplatelet agent, and these patients were more likely to have had a TIA rather than a stroke as their qualifying event, which probably explains why they were more likely to be operated on within 48 hours of symptom onset as well. So, the authors accounted for these differences when they did their multivariate analysis. Dr. Negar Asdaghi: The other thing to note was that overall, routine shunters used a shunt in 98.1% of their cases, whereas selective shunters used them in 46% of their cases. Now, in terms of their study outcomes, the shunting practice pattern did not impact the primary outcomes of in-hospital stroke or death, or a combination of these two outcomes, or even the odds of development of cranial nerve injuries or hemorrhage in the adjusted model, which is really good news here. But interestingly, in the final adjusted model, whether or not an actual shunt was placed during surgery did significantly increase the risk of postoperative stroke, with the odds ratio of 1.29, an effect that was entirely driven by the use of shunt by a surgeon classified as a selective shunter in this study. Dr. Negar Asdaghi: So, in simple terms, if a shunt was placed during CEA, it did increase the risk of stroke only if that surgeon was a selective shunter. Another interesting association was that amongst selective shunters, placing a shunt for a patient with a very recent ischemic event, that is, TIA or stroke within the past 48 hours prior to surgery, and placing a shunt for an intraoperative indication, meaning shunt placement was not pre-surgically planned, also significantly increased the risk of postoperative stroke. So, what we learned from the study is that, though a surgeon's shunting practice pattern did not have an impact on the overall postoperative risk of stroke or death, the placement of a shunt did indeed increase the risk of postoperative stroke only if it was placed by a surgeon who is a selective shunter, especially for an intraoperative indication in a patient with a recent ischemic event. Dr. Negar Asdaghi: So, shunts can be tricky, especially if they're done by a surgeon who doesn't place them routinely. So, my take-home message is that ultimately, like every other procedure in medicine, clinical outcomes are as much operator dependent as they are patient dependent, and for every procedure, it's fair to say that practice makes perfect. Dr. Negar Asdaghi: It is now more than 25 years since intravenous thrombolytic therapy has been approved for treatment of patients with acute ischemic stroke and more than seven years since randomized control trials demonstrated the efficacy of mechanical thrombectomy to improve clinical outcome in ischemic stroke patients with large vessel occlusions. To date, reperfusion therapies are the only available acute treatments for select patients with ischemic stroke. What do we mean by "select"? "Select" meaning that not all patients will benefit from these therapies, making it absolutely necessary for clinicians to be up to date with various indications and contraindications to use these therapies. Needless to say that the criteria for reperfusion therapies do not and should not consider the socioeconomic status of patients, but sadly, socioeconomic inequalities seem to impact the use of reperfusion therapies. Dr. Negar Asdaghi: In this issue of the journal, in the study titled "Socioeconomic Inequalities in Reperfusion Therapy for Acute Ischemic Stroke," Dr. Øgendahl Buus from Aarhus University Hospital in Denmark and colleagues studied the impact of the socioeconomic status of stroke patients on the odds of receiving reperfusion therapies in the large nationwide Danish Stroke Registry, or DSR. Now a bit about the registry: DSR contains prospectively collected nationwide data on all stroke patients admitted to Danish hospitals. It's interesting to note that in Denmark, stroke patients are exclusively admitted to public hospitals, and all departments treating stroke patients are obligated to report data to DSR. Now, for this study, they included over 63,000 stroke patients from 2013 to 2018. After excluding hemorrhagic stroke, TIAs, and other exclusion criteria of the study, they arrived at their sample size of 37,187 patients that were included in this study. Dr. Negar Asdaghi: Now, a few definitions. The socioeconomic status of each patient was determined based on three parameters. Parameter number one, their educational level. It was categorized into three levels of low, medium, or high levels of education. Category number two, income level. This was calculated based on the average family equivalent disposable income, or FED income, during five years prior to stroke onset, again classified into three categories of high, medium, or low income. And the third factor was the employment status of the patient during the calendar year prior to the stroke onset, also categorized into three categories of employed, unemployed, and retired. And, of course, the authors used various definitions to be able to fit special situations into these categories. For instance, a person who is temporarily unemployed due to illness or other special situation was still categorized under the employed category. So, that gave them, in total, nine groups to analyze across these three categories. Dr. Negar Asdaghi: And here are their findings. The median age of total stroke patients in the cohort was 73.2 years, 44.1% were women, 41% categorized under low educational level, 68% retired, and 33.3% had low income levels. Not surprisingly, patients and hospital characteristics varied tremendously across these nine groups of education, employment, and income, and a univariate analysis in general, low socioeconomic status was associated with more severe strokes, living alone, living at an assisted living residency, having had prior stroke, high comorbidity index score, hypertension, and late hospital arrival. So, they accounted for these differences in their multivariate analysis. Dr. Negar Asdaghi: Now, overall, the treatment rates of IV thrombolysis was 17.6%, which is actually considered a very high percentage as compared to other registry-based studies, but the percentage of IV thrombolytic use dramatically varied based on the different socioeconomic designation. So, let's look at this. In the univariate analysis, for education, intravenous thrombolysis rates were 19.3% among patients with high educational level compared to 16.2% among patients with low educational level. Let's look at income. For income, IV thrombolytic treatment rates reach 20.7% for high-income patients compared to 14.8% for low-income patients. For employment status, thrombolytic rates were 23.7% among employed patients compared to 15.7% for unemployed patients. In their fully adjusted models, unemployed patients were less likely to receive IV lytics as compared to their employed counterparts. Dr. Negar Asdaghi: Now, for thrombectomy, socioeconomic gradients were also noted for these three categories. For education, thrombectomy rates were 4.5% among patients with high education level compared to 3.6% among patients with low educational level. For income, treatment rates were 3.2% among low-income patients compared to 4.7% among high-income patients. But arguably, the most robust differences were noted again across the category of employment. Employed patients were nearly twice more likely to receive thrombectomy as compared to unemployed patients, rates being 5.1% versus 2.8%, respectively. Now, when they adjusted their analysis to only those patients presenting within the reperfusion time windows in the fully adjusted models, unemployment and low income remain significant negative predictors of receiving both of these reperfusion therapies. So, what we learned from this study is that stroke patients who were unemployed, earned a relatively low income, or had fewer years of formal education were less likely to receive life-saving reperfusion therapies despite potentially being eligible for these treatments. Dr. Negar Asdaghi: Now, let's take a moment to really understand that data presented here are in the context of a tax-funded, universal healthcare offered across Denmark, where we can at least make the assumption that financial constraints potentially preventing access to therapies are likely minimized. There are many countries around the globe where patients or family members have to pay for these therapies before even receiving them. So, these findings from the current study from Denmark are alarming in that they point to possibly more robust inequalities across the globe in other healthcare systems. Dr. Negar Asdaghi: Intracerebral hemorrhage, or ICH, is an aggressive form of stroke, typically carrying a higher morbidity and mortality than its ischemic counterpart. Yet much of the research in the field of intracerebral hemorrhage has followed the ischemic stroke footsteps, including defining the optimal primary outcome for the randomized trials of ICH. For ischemic stroke, the 90-day functional outcome, as measured by the modified Rankin Scale, is commonly used as a primary outcome in clinical trials. There are many reasons for this selection, including the ease of use and the fact that the majority of functional recovery post-ischemic stroke occurs during the first 90-day time period. But time to maximum recovery and, importantly, the trajectory of recovery may be different in hemorrhagic as compared to ischemic stroke. Defining the long-term outcomes and longitudinal trajectory of recovery in ICH is, therefore, important to better understand its prognosis and, of course, selecting the appropriate primary outcome measure for future randomized trials of ICH. Dr. Negar Asdaghi: In the recent years, the safety and efficacy of various agents to improve ICH outcomes have been tested. Deferoxamine mesylate, an iron-chelating agent, is one such agent that was recently studied as part of the i-DEF multicenter randomized trial, and the main results of the study were published in Lancet Neurology in 2019. In the current issue of the journal, in the study titled "Effect of Deferoxamine on Trajectory of Recovery After Intracerebral Hemorrhage," we learn about the results of a post hoc analysis of i-DEF that looks at the trajectory of functional outcome in patients enrolled in the trial with a special attention on their continued recovery after the 90-day post-ICH mark. Dr. Negar Asdaghi: Joining me now is the senior author of this paper, Dr. Magdy Selim, who's also one of the primary investigators of i-DEF trial. Dr. Selim is a Professor of Neurology at Harvard Medical School and Chief of Stroke Division at Beth Israel Deaconess Medical Center in Boston. He's a world renowned researcher in the field of cerebrovascular disorders with special focus on treatment of patients with intracerebral hemorrhage. Dr. Selim has led and currently leads multiple National Institutes of Health-funded clinical trials of intracerebral hemorrhage, including the ongoing SATURN trial. I'm delighted to welcome him to our podcast today. Good afternoon, Magdy. Thank you for joining us today. Dr. Magdy Selim: Thank you, Dr. Asdaghi. It's really my pleasure to be here with you, and I'm certainly honored to do this today. Dr. Negar Asdaghi: That's great. Thank you. So, let's start with some background on deferoxamine and the literature supporting the use of deferoxamine before i-DEF. Dr. Magdy Selim: So, as you mentioned, deferoxamine is an iron chelator; it binds to iron and removes excess iron from the body. The unique thing about it is that it has other neuroprotective properties, which are good for hemorrhagic stroke and ischemic stroke. It also has anti-inflammatory and anti-apoptotic effects. It even lowers the blood pressure, which we know sometimes is helpful in intracerebral hemorrhage. The rationale behind this or why this would be effective really comes from animal studies. After you have a hemorrhage, there is hemolysis of the red blood cells, there is a release of hemoglobin degradation products, in particular, iron, and the accumulation of iron in the hematoma and the surrounding tissue triggers a cascade of molecular and cellular events that lead to what we call secondary injury, characterized by inflammation, hydroxyl radical formation, and cell death. And many animal studies, animal models of intracerebral hemorrhage, whether in pigs or in rats, young or aged rats, have shown that treatment with deferoxamine can reduce iron in the brain after intracerebral hemorrhage and also results in improved performance on behavioral tests. And that was the reason why we moved into clinical testing. Dr. Negar Asdaghi: So, a lot of encouraging data before the trial. Can we hear a little bit about the trial, its design, and inclusion criteria, please? Dr. Magdy Selim: Sure. So i-DEF was a phase 2 study, and actually it started as Hi-DEF, which was high dose deferoxamine, and then became i-DEF, which intermediate dose deferoxamine. So, it's a randomized, double blind, placebo control trial. We used something called futility design, which is actually sort of new in the stroke field. And we had 294 patients who had supratentorial hemorrhage that were randomized within 24 hours to either get placebo or deferoxamine. And deferoxamine initially was given at 62 mg per day for three days, but then we ran into some safety issues with this high dose, and that's why we lowered it to 32, and that became the intermediate dose, or the i-DEF. So, the only kind of thing unique about inclusion/exclusion criteria was that there was an age cutoff, patients had to be 80 or younger. They needed to have some deficit on the exam, so their NIH Stroke Scale had to be 6 or greater, and their GCS had to be greater than 6, and their modified Rankin before the onset of the hemorrhage had to be less than 1. Dr. Negar Asdaghi: And so, what were the primary and secondary outcomes in i-DEF? Dr. Magdy Selim: The primary outcome was twofold actually. One of them was safety. One of the issues we ran into with the high dose is that the drug is associated with increased risk for adult respiratory distress syndrome, ARDS. So, we wanted to make sure that this lower dose was safe, and it does not increase the instance of ARDS. The second thing was, as I said, we used something called the futility design, and we wanted to compare the outcome of patients treated with deferoxamine versus placebo to determine whether it's futile to move to a large phase 3 trial or not. And what we were looking at is a difference in outcome and modified Rankin 0 to 2 at 90 days, and the difference would be at least 12% in favor of deferoxamine in order for us to move forward. You asked about the secondary outcomes as well? Dr. Negar Asdaghi: Yes. Dr. Magdy Selim: So, actually, the secondary outcomes, they're relevant because they're relevant to the study that we just published. So, the secondary outcomes was also to look at modified Rankin 0 to 3, instead of 0 to 2, at 90 days and the difference between the two treatment groups. We wanted to look at the ordinal distribution of the Rankin at the same time point. And we also wanted to look at all the outcomes at six months, 180 days. And that came a little bit later in the course of the study because there was some evidence emerging at that time that maybe assessment of outcome later in intracerebral hemorrhage would be more accurate than assessing it early on. Dr. Negar Asdaghi: So, I want to come back to the secondary outcome, of course, that's sort of the topic of your current paper in this issue of the journal, but can you just briefly tell us, please, the primary outcome and the sort of results of what was published in 2019 with i-DEF before we move on to the current paper? Dr. Magdy Selim: Yeah. So, as I said, the primary outcome was the difference in the proportion of patients that achieved modified Rankin 0 to 2 at 90 days, and what we wanted to see is a difference of around 12%. Unfortunately, the primary outcome was neutral, we did not see that. But what we saw actually, almost all the secondary outcomes were positive, except for the primary outcome. So, when we looked at the secondary outcome using modified Rankin 0 to 3, instead of 0 to 2, the difference was 12.1%. When we looked at the difference in the modified Rankin 0 to 2 at six months, the difference was 15.6% in favor of deferoxamine, but these were secondary outcomes and not the primary outcomes. Dr. Negar Asdaghi: So, the trial is almost positive. It just depends on how you define the primary outcome, which is really a nice segue to your current study. In the current study, you looked at this secondary outcome in a longitudinal way and looked at the mRS of 0 to 2 at six months from ICH. Can you please tell us about this current paper? Dr. Magdy Selim: Yeah. So, one of the things that we did with i-DEF is that we were checking the modified Rankin at different time points for all the patients. So, we had it after one week, after one month, after two months, after three months, and after six months. And what we wanted really was a couple of things, just in patients with intracerebral hemorrhage without any treatment, what's the natural course of recovery? And the interesting thing we found out is that patients actually continue to improve over time, and that's what you expect, but what we didn't expect is that they even continue to improve after 90 days. Dr. Magdy Selim: We always used to think that maximum recovery is around 90 days from ischemic stroke literature, but we saw a lot of patients getting better after 90 days. And this turns out to be also the case with deferoxamine, but the interesting thing is that the percentage of patients that had a good outcome, modified Rankin 0 to 2, was higher with deferoxamine at day seven, at day 30, at day 60, not at 90 days, but again at six months. So, actually, it was higher at all time points except our primary endpoint. Dr. Negar Asdaghi: So, Magdy, you've already answered my next question, which is exactly what you alluded to, deferoxamine seemed to have improved the outcomes at all of those time points, except for the 90 day, which was the primary outcome of your trial. Why do you think the magic was lost at 90 days? Dr. Magdy Selim: This is really the million-dollar question. I think we obviously struggled over this. And we went back, we thought maybe there was misrating of the modified Rankin in some of the patients. We tried to correct for this. The difference was bigger, but still not significant. So, we don't really have a good reason to tell you why, at this particular time point, we didn't see the difference except bad luck, I think. But I mean, there are reasons, I think, the question that people actually ask me is the opposite, is why do you think a drug that you give for three days early on is going to make a difference after six months? And I think there are biological reasons to explain this. Dr. Magdy Selim: So, what happened is that those hemorrhage patients have a lot of other problems. They have increased ICP, they have hydrocephalus, they have intraventricular hemorrhage, and actually iron has been implicated in the development of hydrocephalus in chronic white matter injury. So, my explanation is that you start early on with the treatment, it does help, but it takes a while for it to kick in and for this kind of medical complication to resolve until actually you see the true effect of the drug. And maybe that's why you see the unmasking at the end between the two groups. Dr. Negar Asdaghi: Yeah, I think I want to recap this for our listeners. Very important to, again, think about those things that some of the acute therapies that we offer the patients may not have a measurable improvement outcome difference early on, certainly with intravenous thrombolysis, we saw that, whereas we saw measurable outcome difference at 90 days, or maybe in this case at six months, but not quite early on. So, it doesn't mean that they don't work. We just are unable to measure that difference and improvement early on. So, what do you think the future holds for deferoxamine? Are we going to see another trial? Dr. Magdy Selim: Well, I certainly hope so. We're working on some few ideas for that. A lot of people think that maybe we should just do the same thing, but look at six months as the primary outcome. But I think we're actually, that's probably not our primary thinking at this point in time. So, we have published other papers, other analysis, to show that the effect of deferoxamine actually relates to the volume of the hemorrhage. So, if the hemorrhage is very small, there is very minimal benefit. If the hemorrhage is very large, also there is very minimal benefit. And that's really to get kind of the big bang for your buck. You really want people who have mild-to-moderate size hemorrhages. So, we're thinking of a couple of ways to go about deferoxamine with this, whether alone or in combination with other interventions. So, hopefully, we'll have some stuff to share with you in the coming few years, two or three. Dr. Negar Asdaghi: We'll definitely look forward to reading about those or being involved in the trials as a site, but there's a great way of just actually talking about my next question. It's just completely different than the current paper. I wanted to digress a bit and talk about the recently published intracerebral hemorrhage guidelines, which just published a few months ago. You were part of the guidelines committee. Can you give us a little bit of your point of view of what are the top two most important updates from the guidelines in ICH treatment? Dr. Magdy Selim: Actually, the guidelines, for the first time this year, in the first page, they have the top 10 take-home messages or top 10 new ones. So, in my opinion, the most important ones, we usually tell you what to do, but here we tell you what not to do because we think it's not good for the patients. So, for example, using steroids just as a prophylactic therapy is actually not recommended. The same thing, we see a lot of people put patients with hemorrhage on hypertonic saline, hyperosmolar therapy, just prophylactically. I don't think there's any benefit that this helps as well, and the same thing for antiepileptic drugs. So, that was one important point. The second one was blood pressure lowering, and there is emphasis now that whatever you use to lower the blood pressure, you want to make sure that the blood pressure variability is very minimal and that there is a smooth kind of control over blood pressure that has been shown to be actually important in terms of help. I'm going to make them three, not two, because I think the third one is important. Dr. Negar Asdaghi: Okay. I'll give you one more then. Dr. Magdy Selim: Which is the first time we include this in the guideline, and with emphasis on the role of the home caregiver for hemorrhage patients and the psychological support, the education that they need, and the training that they need to actually care for these patients and how to improve their quality of life. So, I think that's an important aspect that we didn't touch upon before, and obviously very important. Dr. Negar Asdaghi: Very important points. Let me just review them again for our listeners. So, don't do steroids, hypertonics, and preemptive antiepileptic therapies. They don't work. The second point that you raise is reduction of blood pressure, important to keep that in mind, but paying attention to blood pressure variability. And the third one, the importance of social aspect of care of patients with intracerebral hemorrhage. That's great for us. Let me just end with one last question. Magdy, thank you so much for all of this wonderful take-home messages from the current study from i-DEF and also the guidelines. There's been a lot of excitement in the field of ischemic stroke with the success of reperfusion therapies, and yet not much for intracerebral hemorrhage. What is your hope in terms of future therapies for ICH? Dr. Magdy Selim: So, I happen to be one of the people who is very optimistic about the future of ICH. I think it's just a matter of time. But I think we need to make some changes. We need to really treat ICH as an emergency, so time is really important. And I think right now, you see a hemorrhage patient, they just put them on the side because they think that there's nothing to do. But the way I see the future evolving, and probably the breaking point to be, is that we can diagnose ICH in the field. You immediately lower the blood pressure, reverse coagulopathy if you can, and even kind of use hemostatic agents, if the FASTEST trial shows evidence to support that, and then you take them to the hospital where there might be some role for hematoma reduction using minimally invasive therapy and some other treatments like deferoxamine, or there are a lot of other agents to target the secondary injury at the same time. So, I think it's going to be a combination of things, and they need to happen in tandem and continuously, but we need to start quickly on these patients. Dr. Negar Asdaghi: Dr. Magdy Selim, it's been a pleasure interviewing you on the podcast. We look forward to having you back and covering more of your work. Thank you for joining us. Dr. Magdy Selim: Thank you very much for having me. Dr. Negar Asdaghi: And this concludes our podcast for the July 2022 issue of Stroke. Please be sure to check out this month's table of contents for a full list of publications, including a series of Focus Updates on the very topic of, you guessed it, intracerebral hemorrhage. These updates are great complements to the newly published American Heart Association guidelines for the management of patients with spontaneous intracerebral hemorrhage in May 2022. Dr. Negar Asdaghi: And with this, we end our July podcast and draw inspiration from one particular July story, which unfolded on July 20. In 1969, on this day, Commander Neil Armstrong and lunar module pilot Buzz Aldrin landed on the moon, and Armstrong became the first person to walk on the moon. The crew of Apollo 11 changed the course of history, landing humanity on another celestial body for the first time and later safely returning everyone back to earth. Armstrong, an experienced naval aviator, a test pilot, a decorated veteran, astronaut, and university professor, passed away in 2012 from complications of coronary artery disease, reminding us that every step we take in understanding, diagnosing, and treating vascular disorders is truly part of that giant leap to save the mankind. And what better way to do this than to stay alert with Stroke Alert. Dr. Negar Asdaghi: This program is copyright of the American Heart Association, 2022. 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.
In this episode, Tia discusses what sex magick is, how to use it for abundance and manifestation, and how to maintain you level of magick at a strong and high level. Gain access to Activating Your Inner Goddess at: https://tiamariejohnson.com/activating-your-inner-goddess/ Connect with Tia: IG: https://www.instagram.com/cosmic_witch_goddess Podcast IG: https://www.instagram.com/enchantress_society_podcast Website: https://tiamariejohnson.com
“I look forward to working on Let the Healing Begin” – Gerry Oldman This is the finale episode of Season 5 of Teachings in the Air titled “The Healing Road” Season 5 of TIA titled “Strong Mind, Body, Spirit, & Heart” has come to a close, and host Gerry shares his stories and experiences with the latest season, reflecting on how he wants to remain on the Healing Road. Gerry goes in depth about his many journeys in life, with healing and wellness being a constant, even in the most difficult times. Gerry & the TIA team express major appreciation for Season 5's amazing guests who shared their beautiful teachings and gifts with everyone.
Welcome to Reimagining Company Culture, a series discussing emerging trends and priorities shaping the future of workplace culture and employee wellbeing. We highlight thought leaders who are constantly evolving their strategy and can provide insight to folks about how to address new business challenges. AllVoices is on a mission to create safe, happy, and healthy workplaces for all, and we're excited to learn from experts who share our mission. In this episode of Reimagining Company Culture, we're chatting with Tia Smith, Vice President of Talent at Collaborative Solutions. She is an experienced and innovative certified Human Capital Strategist with the ability to translate business vision into HR initiatives that improve performance, sustain growth, and foster employee engagement. Tune in to learn Tia's thoughts on resetting values, incorporating values into onboarding and sales collateral, leveraging employee feedback, and more!About AllVoices In today's workforce, people often don't feel empowered to speak up and voice their opinions about workplace issues, including harassment, bias, and other culture issues. This prevents company leadership from making necessary changes, and prevents people from feeling fulfilled, recognized, and included at work. At AllVoices, we want to change that by providing a completely safe, anonymous way for people to report issues directly to company leaders. This allows company leadership real transparency into what's happening in their companies—and the motivation to address issues quickly. Our goal is to help create safer, more inclusive companies.
On April 3, 2010 in Manchester, England, 12-year-old, Tia Rigg's uncle, John Maden phoned her mother, Lynne, to ask if Tia could come over to babysit his young daughter. Lynne agreed, and Tia went to John's home, hoping to catch some of the football game that day, as her favorite team, Manchester United, was playing but she had no idea what awaited her at her uncle's home. John drugged Tia before raping her, committing a variety of sexual acts on her, and then stabbing and strangling her to death. Social services had many chances to take Tia from the care of her mother, Lynne, as Lynne had a history of drug abuse, suicide attempts, and domestic violence, however, they failed little Tia. OG Release Date: 06/15/2020 Sources: True Crime England (2020, February 4) Daily Mail UK (2011, May 13) Express (2010, April 5) The Guardian (2010, October 4) Daily Mail UK (2011, May 13) Audio: Daily Motion DCI David Warren
Tia Castle is an entrepreneur who's been published and nationally recognized in diverse fields including TV production, Airbnb/real estate investment and most recently the founder of “The Token Authority” start-up. She is a contributing author to the new book Hospitable Hosts: Inspiring & Memorable Stories From Airbnb Hosts Around The World available on Amazon and in this episode we discuss the ins and outs of purchasing and managing short-term "BNB" rental properties. Tia is a Realtor® with Preferred SHORE and owner of Castle Lux Rentals, a property management company that specializes in BNB procurement and management. Tia is a lifelong learner and has attained certifications including “Crypto Certified” Realtor and a “Wharton” graduate of “Economics of Blockchain and Digital Assets. Tia has traveled extensively having been born in Bangkok to a Thai mother and a European Father who served in the US Air Force. She has lived in Japan, New Jersey, Minnesota, Los Angeles, Miami and now Sarasota where she has resided the longest. In her spare time, she loves to take in nature with her Yorkie named Chewie. Tia is a former ballroom dance competitor and was a national champion in the mid-'90s. She is also the patent holder for a jewelry storage device that hangs in the closet. Please enjoy this conversation about short-term rental properties with Tia Castle. . . Tia Castle https://tiacastle.com/ . . Subscribe to our podcast: Apple Podcast: https://tinyurl.com/yyt84zoh Google Podcast: https://tinyurl.com/y4apzzn3 Spotify: https://tinyurl.com/y69pjqsk Join Preferred ShoreJoinShore.com Sell with Preferred Shore https://winmorewithshore.com/ Follow us on Facebook https://www.facebook.com/PreferredShore/ #Tampa #TampaRealEstate #PreferredSHORE #stpete #stpeterealestate #sarasota #sarasotarealestate #srq #srqrealestate #lakewoodranch #lakewoodranchrealestate #stpetersburg #stpetersburgrealestate #floridarealtor #siestakey #siestakeyrealestate #luxuryrealestate #milliondollarlisting #bradenton #bradentonrealestate #realtor #floridarealestate #realestate #realestatebroker #winmorewithshore #100commission #sellingsunset #Miami #MiamiRealEstate
TRIGGER WARNING: This episode discusses suicide and suicide ideation. We're back twerkin and werkin! Welcome back to The Insecure Experience with Bre, Candice, and Tia! Today we are discussing episodes 6 (Savage) of #PValleyStarz. Tune in to hear how the beginning and the end of Big Teak's story brought us to tears. Enjoy the show and share your thoughts! If you or someone you love is considering harming themselves, please dial 911 or 988 for help and you can visit Lifeline to chat with someone live. Support Purchase some merchandise! Use the hashtags #TheInsecureExperience, #TheInsecureExp, #TISE, on social media when live listening and posting about the show! Share this podcast with a friend, a loved one, a coworker, or even a stranger! Contact Twitter: @TheInsecureExp | @NotSoNewlywedPC | @TeeTheGem | @_ItsMissBre Instagram: @TheInsecureExperience | NotSoNewlywedPC | BreTastical | _TeeTheGem Facebook: The Insecure Experience Email: TheInsecureExperience@gmail.com Website: The Insecure Experience Patreon: Patreon.com/FlawlessNoises The Insecure Experience™️ is a Flawless Noises Media Network presentation. #FNMediaProd
In this episode Kim and Tia share different life experiences where they have felt bittersweet. Having that bittersweet feeling can show up in a multitude of ways including watching your kids grow up, having your child move out or go off to college, losing a loved one, returning from a vacation or leaving a job. This feeling or emotion of bittersweet is such a good representation of what life is really like because it is nondual. It is not an either/or emotion. It is actually both bitter and sweet which is how life really is. To hear more about Kim and Tia's experiences tune in. “The bittersweet side of appreciating life's most precious moments is the unbearable awareness that those moments are passing.” ~ Marc Parent To join us on our Free 2022 Summer “Connect & Grow” live calls the 1st Tuesday of each month at 12 pm Eastern time through August 2nd – please click this link https://bit.ly/3xLVnRK to register for the Zoom link. Go to our Teachable Online School and check out our courses including our signature FREE “Balancing Your Backpack” and “I AM WHOLE” Courses https://masksoff.teachable.com/courses To Contact Us: Instagram: @masksoffcommunity FB Masks Off Community: https://www.facebook.com/groups/masksoffcommunity Masks Off Email: firstname.lastname@example.org Masks Off YouTube Channel: https://youtube.com/channel/UCaWJfO7ZFd4aYBX3e-clj9Q Tia Fagan Website: tiafagan.com Facebook: @tiafagancoach Instagram: @tiafagancoach Email: email@example.com Kim Gross Website: unlock-yourmind.com Facebook: @unlockyourmindhypnotherapy Email: firstname.lastname@example.org
In this episode, Tia discusses ways to embody the sex goddess energy, especially during the Summer, what sex goddess energy is, and how to own it. Gain access to Activating Your Inner Goddess at: https://tiamariejohnson.com/activating-your-inner-goddess/ Connect with Tia: IG: https://www.instagram.com/cosmic_witch_goddess Podcast IG: https://www.instagram.com/enchantress_society_podcast Website: https://tiamariejohnson.com
Are you ready for some GOOD news?!? Unless you've had your head in the sand, you've heard of elliTek's new Automation Partner, so this company shouldn't be unfamiliar to you.Over the past many months, we have been working closely with a fantastic company. It's a huge, behemoth company. It's the largest industrial manufacturing company globally and one in which elliTek is extremely privileged to partner. This is the official announcement that elliTek is now an authorized distributor for Siemens Digital Industries and Controls products!Our special guest is Ryan Wood. Ryan is the East Region Partner Sales Manager for Siemens.We talk with Ryan about Siemens technology including what Digital Industries is and the products it encompasses.Why did Siemens sign elliTek as a Digital Industries and Controls partner?What impressed Brandon about Siemens? Hint, cybersecurity! They are way ahead of their competition when it comes to cybersecurity, and Ryan explains how.We explore Siemens PLCs and the advancements made by Siemens TIA (Totally Integrated Automation) Portal. TIA is Integrated engineering software from the Enterprise to the field level with all devices programmed and communicating within the TIA engineering platform.Stay tuned to hear what Siemens does that outpaces its competition!If you'd like to learn more about Ryan Wood, here's his LinkedIn profile, https://www.linkedin.com/in/ryan-wood-2251138/.This is a good article about the history of Siemens TIA (Totally Integrated Automation), https://ingenuity.siemens.com/2021/11/25-years-of-tia-a-trip-back-in-time-through-maximum-consistency-at-all-levels/.Learn more about the Charter of Trust, https://www.charteroftrust.com/. Here's a link to Siemens press release about the Charter of Trust, https://press.siemens.com/global/en/feature/charter-trust-takes-major-step-forward-advance-cybersecurity.Here's the link to Brandon's interview in Food Engineering magazine, https://www.foodengineeringmag.com/articles/99100-keeping-machines-and-ot-networks-and-it-safe-from-cyberattacks.Learn about IEC 62443, https://en.wikipedia.org/wiki/IEC_62443 and IEC 61131, https://en.wikipedia.org/wiki/IEC_61131.If you'd like to learn more about NIST 800-82, here's a link https://csrc.nist.gov/publications/detail/sp/800-82/rev-2/final.Wherever you are in your Automation Journey, elliTek will meet you there!Reach out with any questions or future topics.Website: www.ellitek.com/contact-usLinkedIn: www.linkedin.com/company/ellitek-incInstagram: www.instagram.com/ellitekFacebook: www.facebook.com/ellitekTwitter: www.twitter.com/elliTek_Inc/mediaWatch
Welcome back! Kate and Marcie are kicking things off for Rachel and Gabby's season - The BacheloretteS!First, we dive into some Bachelor Nation news including Nayte and Michelle's break up, fan favorite Tia's pregnancy and our thoughts on Becca proposing to Thomas.Then, we get into this historic season and discuss the limo entrances and how Gabby and Rachel's tastes in men are already quite different - BUT there is sure to be drama and messiness nonetheless.What are you looking forward to most this season? Follow us on @bachelorettebuds on Instagram and let us know!
We're back twerkin and werkin! Welcome back to The Insecure Experience with Bre, Candice, and Tia! Today we are discussing episodes 5 of #PValleyStarz, and baby we have THOUGHTS. Tune as we discuss the evolution of Keyshawn, from Cinderella to Miss Mississippi. Enjoy the show and share your thoughts! Support Purchase some merchandise! Use the hashtags #TheInsecureExperience, #TheInsecureExp, #TISE, on social media when live listening and posting about the show! Share this podcast with a friend, a loved one, a coworker, or even a stranger! Contact Twitter: @TheInsecureExp | @NotSoNewlywedPC | @TeeTheGem | @_ItsMissBre Instagram: @TheInsecureExperience | NotSoNewlywedPC | BreTastical | _TeeTheGem Facebook: The Insecure Experience Email: TheInsecureExperience@gmail.com Website: The Insecure Experience Patreon: Patreon.com/FlawlessNoises The Insecure Experience™️ is a Flawless Noises Media Network presentation. #FNMediaProd
Do you struggle to speak up and speak your truth with others or maybe even certain people in your life? Do you remember as a child being told that you were wrong or “bad” for thinking, believing or speaking what felt true for you, and thus, did not speak your truth? Are you afraid that if you speak up and “rock the boat” with others that you might be rejected or feel another's disappointment or disapproval? All of this is normal and has happened to many of us. The truth is that if we don't “rock the boat” from a place of integrity we are betraying our authentic self and thus we stunt your growth. To hear more about this listen as Tia and Kim talk about how they step outside of their comfort zone and learn to “rock the boat.” “Forget perfect. Forget flawless. And start speaking your truth. Start speaking what you want and how you want it. And start asking and listening, really listening, to what the people around you say. Maybe, then, we will stop abandoning and hurting each other. Maybe, then, there's hope for us.” ~ Vironika Tugaleva To join us on our Free 2022 Summer “Connect & Grow” live calls the 1st Tuesday of each month at 12 pm Eastern time through August 2nd – please click this link https://bit.ly/3xLVnRK to register for the Zoom link. Go to our Teachable Online School and check out our courses including our signature FREE “Balancing Your Backpack” and “I AM WHOLE” Courses https://masksoff.teachable.com/courses To Contact Us: Instagram: @masksoffcommunity FB Masks Off Community: https://www.facebook.com/groups/masksoffcommunity Masks Off Email: email@example.com Masks Off YouTube Channel: https://youtube.com/channel/UCaWJfO7ZFd4aYBX3e-clj9Q Tia Fagan Website: tiafagan.com Facebook: @tiafagancoach Instagram: @tiafagancoach Email: firstname.lastname@example.org Kim Gross Website: unlock-yourmind.com Facebook: @unlockyourmindhypnotherapy Email: email@example.com
In this episode, Tia has a candid discussion with Alexis Jackson, The Glamour Witch about etiquette in the spiritual community, especially regarding new practitioners, welding magick without responsibility, who you follow on social media, and levels of discernment. Connect with Alexis: Alexis Jackson is a Spiritual Healer, Singer, and Owner Of The Glamour Witch The Glamour Witch Youtube Channel https://www.youtube.com/channel/UCu4mHtA8TO6577y-J86rgxQ?view_as=subscriber IG and TikTok : @theglamourwitchla Find her shop at TheGlamourWitch.com Connect with Tia: IG: https://www.instagram.com/cosmic_witch_goddess Podcast IG: https://www.instagram.com/enchantress_society_podcast Website: https://tiamariejohnson.com
Alphawaves Episode 22 - Toxic Relations ft Tiamarie Ashanti Join us with special guest @Tiamarieashanti as we discuss how toxic relationships, friendships, work places & environments have become so prominent in todays society. Gain an insight into the world of Tia and your hosts Darren and Kam as we share stories of our experiences with toxicity and how to move through it. Follow the team on social media @alphawaves_ & use the hashtag #alphawavespod Send through any topics, dilemmas and join the conversation.
We're back and we have all the feelings about the newest season of "Stranger Things." We talk a lot about cults, and we surprisingly know a lot about them. Tia has some trouble so there may be some static when Tia leaves and goes to the void. Katie's Gaming Update is all about a sheep who is a cult leader. We talk Ms. Marvel and so much more!
Welcome to Protecting Your Nest with Dr. Tony Hampton. Tia Reid is a Certified Dietary Manager, LCHF Nutrition Coach, and is a licensed SUGAR coach. Before she began her low-carb health journey, Tia had been diagnosed with Type 2 Diabetes, Metabolic Syndrome, Non Alcoholic Fatty Liver Disease, Hypertension, and Adrenal Insufficiency. With help from the great Dr. Cywes, she has had an amazing and inspiring recovering. She has come off of twenty medications over the course of her journey! In this discussion, Dr. Tony and Tia talk about: (00:01:33) The definition of omni carnivore (00:06:29) The negative self-perception accompanying obesity and other difficulties (00:11:09) How Tia helps her clients achieve their goals and foster self-confidence; helping them understand their urges, habits, and thoughts surrounding food (00:16:39) How to recognize wether or not you are carb addicted (00:21:08) The diagnostic criteria for sugar/carb addiction (00:23:23) Intermittent fasting (00:26:46) The variety of medications (and their cost) that Tia was on before she discovered the low-carb/high-fat diet (00:33:22) Fruit, nuts, and meat quality on the low-carb diet (00:40:25) Organizations and resources for more info on metabolic health Thank you for listening to Protecting Your Nest. For additional resources and information, please see the links below. Links: Tia Reid: Instagram Nutrition Network Facebook Page Low Carb USA LowCarb Lifestyle Healing Hub Linkedin SMHP Profile Bitten's Addiction Addiction Reset Community Refresh, Renew, and Reboot Support Group Dr. Tony Hampton: Linktree Instagram Account LinkedIn Account Ritmos Negros Podcast
It's all about Nepali uncle हरुको कान्ड this month, from बजेट चलखेल behind चुकुल लाको doors to सुनको लौरो “flying” to Jhapa bypassing the customs office at TIA. Buddha was born in Nepal wala पावन भूमीमा यति धेरैं चलखेल, जालझेल? Boju Bajai thinks Nepal Tourism Board should rethink their promos and maybe add “All बिचौलियाहरु and also Buddha was born in Nepal.” Link to The Nepali Man - https://soundcloud.com/bojubajai/the-nepali-man If you like our laugh and guff gaff, please do consider supporting our work on Patreon: www.patreon.com/bojubajai Follow @Bojubajai on social media for more laughs: Instagram: https://www.instagram.com/bojubajai/ Facebook: https://www.facebook.com/bojubajai Twitter: https://twitter.com/BojuBajai YouTube: https://www.youtube.com/channel/UCNYRGvqtpi1aHAucXGcNWRw Link to all the news stories: घुस संवादले देखाएको न्यायालयको कुरुप तस्वीर - https://www.onlinekhabar.com/2022/06/1146725 Minister Ale losing it (Leaked audio tape) - https://www.youtube.com/watch?v=oM_zIaGySoM सन्की मन्त्रीको गिर्दो मर्यादाः उत्कर्षमा आलेको अश्लीलता - https://nagariknews.nagariknetwork.com/politics/857791-1655511483.html मन्त्री आलेको अश्लील गाली सामाजिक सन्जालमा भाइरल - https://www.onlinekhabar.com/2022/02/1079160 Minister Ale with Salman Bhai - https://www.youtube.com/watch?v=Yu08MdRuBPA मध्यराति बजेटमा जब ‘चुकुल' लाग्यो…- https://annapurnapost.com/news/morning-watch-when-purvanasule-runs-the-budget-206196 ‘सुनको लौरो' बारे अनुसन्धान सुरु, भन्सार कार्यालय अनभिज्ञ - उपहारमा पाएको सुनको लौरो राज्यलाई दिने दुर्गा प्रसाईको घोषणा - https://www.onlinenepal.com/2022/06/19/138720/ महिला कर्मचारीसँग काम गर्न असजिलो हुने भन्दै वडाध्यक्षले मागे पुरुष कर्मचारी - https://www.himalkhabar.com/news/130644 धादिङमा किसानले लुटे दुई ट्रक रासायनिक मल (भिडियो रिपोर्टसहित) - https://www.himalayatv.com/2022/06/18/69643/
I am so excited to have Tia Chapinski and and Daniella Virijevic on today's show. They are co-authors of "The Infertility Doula," which is a brand new book about everything you need to know about the fertility journey. Tia and Daniella met through RESOLVE. They wanted to find a way to share their experiences navigating their fertility journeys and came together to write this book. I hope you'll join us to hear about how to support yourself and others during a fertility journey, how you can continue to find hope even during hard times, and all about what it means to be an Infertility Doula. Read the full show notes on Dr. Aimee's website Subscribe to my YouTube channel for more fertility tips! Join Egg Whisperer School Checkout the podcast Subscribe to the newsletter to get updates Dr. Aimee Eyvazzadeh is one of America's most well known fertility doctors. Her success rate at baby-making is what gives future parents hope when all hope is lost. She pioneered the TUSHY Method and BALLS Method to decrease your time to pregnancy. Learn more about the TUSHY Method and find a wealth of fertility resources at www.draimee.org.
In this interview, Tia and Sean really didn't spend a ton of time talking about CrossFit. Instead, Sean tries to get to know her as a person a little better. Tia talks about her childhood, the values she learned from her parents, what it was like to be the oldest of 3 sisters, how she met her husband, and advice she wishes she could give to her younger self.