Podcasts about Uncontrolled

Asthma is driven by ongoing airway inflammation, not just occasional breathing difficulty. Experts, including Dr Dwayne Koot, a Medical Manager at Sanofi South Africa, say frequent symptoms, night-time waking and regular inhaler use may point to poor control. Early Breakfast with Africa Melane is 702’s and CapeTalk’s early morning talk show. Experienced broadcaster Africa Melane brings you the early morning news, sports, business, and interviews politicians and analysts to help make sense of the world. He also enjoys chatting to guests in the lifestyle sphere and the Arts. All the interviews are podcasted for you to catch-up and listen. Thank you for listening to this podcast from Early Breakfast with Africa Melane For more about the show click https://buff.ly/XHry7eQ and find all the catch-up podcasts here https://buff.ly/XJ10LBU Listen live on weekdays between 04:00 and 06:00 (SA Time) to the Early Breakfast with Africa Melane broadcast on 702 https://buff.ly/gk3y0Kj and CapeTalk https://buff.ly/NnFM3N Subscribe to the 702 and CapeTalk daily and weekly newsletters https://buff.ly/v5mfetc Follow us on social media: 702 on Facebook: https://www.facebook.com/TalkRadio702 702 on TikTok: https://www.tiktok.com/@talkradio702 702 on Instagram: https://www.instagram.com/talkradio702/ 702 on X: https://x.com/Radio702 702 on YouTube: https://www.youtube.com/@radio702 CapeTalk on Facebook: https://www.facebook.com/CapeTalk CapeTalk on TikTok: https://www.tiktok.com/@capetalk CapeTalk on Instagram: https://www.instagram.com/ CapeTalk on X: https://x.com/CapeTalk CapeTalk on YouTube: https://www.youtube.com/@CapeTalk567 See omnystudio.com/listener for privacy information.

Drs. Saver and Sanossian discuss ISC 2026 data highlighting neurologists' frequent inaction on markedly uncontrolled hypertension in high‑risk stroke patients and the need for specialists to “own” blood pressure management at every visit. They also review refinements in patent foramen ovale (PFO) risk stratification, including Pascal algorithm-defined “possible” PFO cases, and explore how a “clinical trial effect” may lower stroke risk through greater patient engagement.

The eye rolls came during the pain. Her children's statements. Eric's family's grief. The therapists describing what those boys endured. Kouri rolled her eyes, smirked, and mouthed objections through all of it.The tears came during the praise. Her mother. Her sister. Her brother. Telling her she was innocent. Telling her she was the center of the family. Then the sobbing started. Visible. Uncontrolled. The first real emotion of the day.That tells you everything you need to know about what happened next — forty-five minutes at the podium, aimed at three boys who'd asked the judge for life without parole. "Never apologize for something you didn't do." Not comfort. Not a goodbye. An instruction. A seed. A recruitment pitch from a mind that can't stop producing narrative, even when the narrative's only remaining audience is three frightened children.The final episode in a five-part series. The broken brain on full display. And three boys who deserve to be free of it.Join Our SubStack For AD-FREE ADVANCE EPISODES & EXTRAS!: https://hiddenkillers.substack.com/Want to comment and watch this podcast as a video? Check out our YouTube Channel. https://www.youtube.com/channel/UC8-vxmbhTxxG10sO1izODJg?sub_confirmation=1Instagram https://www.instagram.com/hiddenkillerspod/Facebook https://www.facebook.com/hiddenkillerspod/Tik-Tok https://www.tiktok.com/@hiddenkillerspodX Twitter https://x.com/TrueCrimePodThis publication contains commentary and opinion based on publicly available information. All individuals are presumed innocent until proven guilty in a court of law. Nothing published here should be taken as a statement of fact, health or legal advice.#KouriRichins #EricRichins #KouriRichinsTrial #Psychology #TrueCrime #HiddenKillers #FentanylPoisoning #SummitCounty #TrueCrimeCommunity #Justice

Have you ever said something and wished instantly you could take it back? Solomon confronts one of the most destructive forces hiding in plain sight: the unbridled tongue. Drawing from Ecclesiastes 10:11-15, this sermon illuminates how careless words — like an uncharmed serpent — strike without warning, escalating from minor frustration into lasting relational ruin. The fool's mouth becomes a trap door, destroying not only others but the speaker's own character and credibility. Listeners are challenged to practice the pause — measuring every word against whether it is true, helpful, and necessary before speaking.Eastland is a Place to BelongEastland Baptist Church is located in Tulsa, Oklahoma. We are a welcoming and close-knit family community that loves to care for each other through the Church. We strongly believe in loving and supporting each other and our neighbors. Our members don't just attend our Church; they feel a strong sense of belonging.Join UsFind service times and our location at https://www.eastlandbaptist.org/join.Connect with UsWebsite: https://www.eastlandbaptist.orgFacebook: https://www.facebook.com/eastlandbaptisttulsaInstagram: https://www.instagram.com/eastlandbaptistTo support the ministry of Eastland Baptist Church, tap here: https://www.eastlandbaptist.org/give

Videos can lift a business presentation, but they can also hijack it. In the Age of Distraction, leaders, executives and salespeople cannot afford to let a slick corporate video, slide deck or screen become the star of the show. The presenter must remain the dominant force in the room. Why can videos weaken a business presentation? Videos weaken presentations when they take control away from the speaker. The audience may enjoy the production quality, but that does not mean they remember the message. Business events, audiences in Tokyo, Sydney, Singapore, London and New York are already conditioned by TikTok, YouTube Shorts, Netflix, gaming, live sport, fireworks, music and fast-cut visual storytelling. Against that competition, a presenter standing with a slide advancer can look very small unless they bring energy, conviction and control. The problem is not video itself. The problem is using video as a substitute for presence, persuasion and leadership. Do now: Use video only when it strengthens your message. Never let it replace your role as the communicator. Should presenters use videos in speeches and corporate talks? Yes, presenters can use videos, but only when the video serves a clear business purpose. A video should support the speaker, not become the presentation. A product launch, recruitment event, sales meeting or company town hall may benefit from video if it shows proof, customer emotion, technical evidence or a hard-to-explain process. Toyota, Rakuten, Salesforce, Apple and other major brands understand the power of visuals, but strong presenters still frame what the audience should notice. SMEs and startups often make the mistake of thinking "slick" equals "persuasive". It does not. The video creates an impression; the speaker creates conviction. Do now: Before playing a video, ask: what exact point does this prove, and why is the speaker still necessary? How should you introduce a video during a presentation? A presenter should introduce a video by telling the audience exactly what to look for. This creates anticipation and turns passive watching into active listening. Instead of saying, "Let's watch this short video," give the audience a mission. For example: "In this clip, listen carefully to what our Chief Scientist says about the future of this technology. That one point may change how you see the whole issue." This works in boardrooms, sales pitches, leadership training and conference keynotes because it focuses attention. In Japan, where audiences may be polite but reserved, this framing is especially useful because it gives people permission to engage mentally before the clip begins. Do now: Always provide a verbal set-up before the video. Tell people what matters before they press play in their minds. What should a presenter do after showing a video? After the video, the presenter must connect the evidence back to the core message. Without that wrap-up, the video becomes entertainment rather than persuasion. A strong outro sounds like this: "What I like about that message is that it shows we can control our future if we choose to take that route." That sentence links the video to the speaker's argument. In B2B sales, leadership communication and investor presentations, this is where authority returns to the presenter. The video supplies colour, proof or emotion; the speaker supplies meaning. Without the follow-through, the audience forgets the clip within thirty seconds. Do now: After every video, summarise the lesson, connect it to your thesis and tell the audience what to think about next. Why is handing out slide decks before a presentation risky? Handing out the slide deck beforehand often destroys audience connection. When the speaker is on slide two and the audience is already reading slide eighteen, the presentation has split in two. Slides, videos and documents can all become competitors for attention. In an executive briefing, the audience may stop watching the presenter and start analysing the deck. In a sales meeting, procurement may jump straight to pricing. In a training room, participants may scan ahead and miss the emotional build-up. This is especially dangerous in the smartphone era, where one small moment of boredom sends people to email, chat apps or social media. Do now: Control the timing of visual information. Keep the audience with you, not ahead of you. What is the biggest mistake company presidents make with videos? The biggest mistake is hiding behind a corporate propaganda video instead of speaking as the chief evangelist. A president, CEO or country manager should not surrender the room to a screen. Senior leaders must win trust through voice, conviction, eye contact and message ownership. When a company president plays a long corporate video to avoid speaking, the audience notices. In Japan, the US, Europe and Asia-Pacific, employees and clients expect leaders to embody the enterprise, not outsource belief to a production agency. A polished video cannot replace courage. It cannot answer questions, read the room or create human connection. Do now: Leaders should speak first, frame the video, return after it and make the message unmistakably personal. Final summary Videos in presentations are not the enemy. Uncontrolled videos are the enemy. The speaker must dominate the room, guide the audience's attention and use every visual element as a servant to the message. In the Age of Distraction, presenters need energy, structure and authority. Otherwise, the screen wins and the speaker disappears. Author bio Dr. Greg Story, Ph.D. in Japanese Decision-Making, is President of Dale Carnegie Tokyo Training and Adjunct Professor at Griffith University. He is a two-time winner of the Dale Carnegie "One Carnegie Award" and recipient of the Griffith University Business School Outstanding Alumnus Award. As a Dale Carnegie Master Trainer, Greg is certified to deliver global leadership, communication, sales and presentation programmes, including Leadership Training for Results. He has written several books, including three best-sellers — Japan Business Mastery, Japan Sales Mastery and Japan Presentations Mastery — along with Japan Leadership Mastery and How to Stop Wasting Money on Training. His works have been translated into Japanese, including Za Eigyō, Purezen no Tatsujin, Torēningu de Okane o Muda ni Suru no wa Yamemashō and Gendaiban "Hito o Ugokasu" Rīdā. Greg also publishes daily business insights on LinkedIn, Facebook and Twitter, and hosts six weekly podcasts, plus YouTube shows including The Cutting Edge Japan Business Show, Japan Business Mastery and Japan's Top Business Interviews.

If you have asthma, there is a good chance you have learned to live around it. You sleep with your inhaler on the nightstand. You skip the walk because you know it will leave you breathless. This is called uncontrolled asthma, and it is more common than you think. But here is the thing: none of that is normal, and none of it is something you have to accept. Dr. Juanita Mora, allergist and immunologist, joins Kortney and Dr. Gupta to help patients figure out whether their asthma is actually being managed the way it should be, and what to do if it is not. What we cover in this episode about asthma symptoms and control What well-managed asthma actually looks like. Dr. Mora explains what life should feel like when your asthma is properly treated, and why so many patients have accepted a version of their life that is smaller than it needs to be. Why frequent flare-ups are a warning sign. Why underlying airway swelling is dangerous and why catching it early matters. The Rules of 2. Five questions covering daytime symptoms, nighttime waking, rescue inhaler use, inhaler refills, and steroid use that can help you figure out if your asthma needs more attention. When to ask for a referral. If you are answering yes to any of these questions and your treatment plan is not changing, it may be time to push for a referral to an allergist or pulmonologist who has more tools to help. First steps you can take with ControlYourAsthma.org. Dr. Mora walks through the campaign website, available in English and Spanish, including videos, the Rules of 2 quiz, and access to a free asthma coach. More resources ControlYourAsthma.org ControlarTuAsma.org Free Asthma Coach Program __________ Made in partnership with The Allergy & Asthma Network. Thanks to Sanofi-Regeneron for sponsoring today's episode.  This podcast is for informational purposes only and does not substitute professional medical advice. Always consult with your healthcare provider for any medical concerns.  

In this eye opening message, I explain that mankind transitioned from a stable, God-controlled existence in the Garden of Eden to an "uncontrolled life" due to The Fall of man. This instability is characterized by being "double-minded" and "unstable in all his ways" (James 1:8), a state that began when Eve chose to entertain Satan's thoughts over God's. This decision introduced a corruptible nature where negative thoughts directly birthed destructive emotions such as guilt [Genesis 3:7], fear [Genesis 3:10], blame and anger [Genesis 3:12]. Ultimately, the imaginations of man's heart became "only evil continually" (Genesis 6:5). As a result, mankind became alienated from God, leading to a life ruled by the "lust of the flesh, the lust of the eyes, and the pride of life" (1 John 2:15-16). To reclaim the "garden life," I emphasize that Jesus Christ came to reconcile mankind to God, freeing us from the "law of sin and death" through the "law of the Spirit of life" (Romans 8:2). Although man was previously an "enemy in [his] mind by wicked works" (Colossians 1:21), the path to stability now requires "renewing the mind" by choosing to think God's thoughts instead of Satan's. By actively yielding one's "members as servants to righteousness" (Romans 6:19) and replacing ignorance with the knowledge of God's Word, a person can transition from a state of being "past feeling" with a darkened understanding [Ephesians 4:17-19] to a life of self-discipline and stable emotions. This restored control allows the fruit of the Spirit to flow, enabling believers to maintain an intimate relationship with God and peace with one another. Join me as we study these Scriptures and others for wisdom, understanding and counsel from God's Word of Life, Love, Light and Liberty. Selah! [For more: Copy and Paste or Enter into ChatGPT.com, "Create a Study Guide for Episode #802 The Uncontrolled Life from Abounding Love Ministries" ].         www.aboundinglove.org

Merlin G. Butler, MD, Medical Geneticist and Professor, Departments of Psychiatry & Behavioral Sciences and Pediatrics, University of Kansas Medical Center, Kansas City, and one of the pioneers in Prader–Willi syndrome research, discusses the clinical features of this very rare disease and the critical importance of early identification. Prader–Willi syndrome was first reported in 1956, and deletions in chromosome 15 were first identified in the 1980s. Dr. Butler has been working on the genetics of Prader–Willi syndrome since that decade. Dr. Butler said that Prader–Willi syndrome was the first example of a disorder caused by “genetic imprinting,” in which it matters whether genes are contributed by the mother or the father. In 70% of the cases of this disorder, the father's contribution is missing from chromosome 15q13, and 25% of cases are the result of both copies of chromosome 15 being from the mother (referred to as “disomy”). Babies born with this genetic anomaly have severe hypotonia, and they have no interest in sucking or feeding. They often have decreased muscle mass and energy. “These infants look like they have a major problem at birth,” stated Dr. Butler. They need to be tube-fed. Once a genetic cause is suspected, Prader-Willi syndrome is quickly diagnosed; it is a very rare disease that also has very unique features. Pediatricians may see only one of these patients every 10 years. Therefore, according to Dr. Butler, “it is the parents who oftentimes make the diagnosis, through what they have seen on the Internet, prompting genetic testing.” Despite their problems with feeding in the neonatal period, infants with Prader–Willi syndrome will begin to gain an interest in feeding by around age 2 to 3 years. By age 6 years, they develop hyperphasia. “Once their appetite is turned on,” he said, “it is never off.” Uncontrolled, this results in obesity and life-threatening conditions, such as type 2 diabetes and stomach rupture.Early identification is key, and determining the genetic subtype is extremely important to building a multidisciplinary care team. There are seven different genetic subtypes, which can impact outcomes and management. Typically, the care team will include the medical geneticist and genetic counselors, endocrinologists (to manage the use of growth hormone and diabetes-related treatment), dietitians to manage and monitor caloric intake, mental health experts to address behavioral issues and the risk of self-injury, gastroenterologists, and potentially even sleep medicine professionals. The specialists comprising the care team will change over the patient's lifespan; occupational therapy and speech therapy may well be required as the patient ages. The treatment of hyperphagia associated with Prader–Willi syndrome, the number 1 issue, is a particularly active area of research. The idea is to avoid the onset of obesity, which can lead to most of the comorbidities and complications.  

If you treat patients with asthma, this episode is for you. Not just allergists, but GPs, pediatricians, family medicine doctors, urgent care providers, and anyone who sees a patient with asthma in their practice. Dr. Cherie Zachary, current president of the American College of Allergy, Asthma and Immunology, joins Kortney and Dr. Payel Gupta to talk about why uncontrolled asthma remains a serious and largely preventable problem, and what providers can do differently starting with their next patient visit. What we cover in this episode about uncontrolled asthma The data behind the problem. ER visits, hospitalizations, and asthma deaths have not improved in years, and Dr. Zachary explains why that should concern every provider who treats asthma patients. An ER visit is a treatment failure. Dr. Zachary makes the case that any asthma patient who ends up in urgent care or the emergency room should trigger an immediate reassessment of their treatment plan, not just a course of steroids and a send-home. Five questions every provider should be asking. The episode walks through a standardized set of control questions designed to help providers catch uncontrolled asthma before it becomes a crisis, covering steroid use, ER visits, rescue inhaler use, nighttime waking, and daily activity limitations. Why patients normalize their symptoms. Providers hear what controlled asthma should actually look like, and why patients often don't volunteer the information needed to catch a problem. Who is most at risk. Dr. Zachary shares which patient populations are most likely to have uncontrolled asthma and least likely to be identified, and what providers can do to close that gap. More resources about uncontrolled asthma ControlYourAsthma.org  Free AAN Asthma Coach Program Find an allergist Understanding Oral Corticosteroid Overuse in Asthma Made in partnership with The Allergy & Asthma Network. Thanks to Sanofi-Regeneron for sponsoring today's episode.  This podcast is for informational purposes only and does not substitute professional medical advice. Always consult with your healthcare provider for any medical concerns.

Uncontrolled anger can quietly damage relationships, distort communication, and pull us away from God’s design for righteous living. James 1:19–20 offers clear, practical wisdom: be quick to listen, slow to speak, and slow to become angry. Sinful anger isn’t just about emotion—it’s often rooted in pride and self-focus, leading us to say things we don’t mean and hurt the people we care about most. Highlights Unrestrained anger often leads to hurtful words and broken connection Sinful anger is usually rooted in pride and self-centeredness James 1:19–20 calls us to listen first, speak carefully, and slow down anger Interrupting and reacting quickly fuels conflict instead of resolving it The Holy Spirit helps us respond with patience and humility Repentance and forgiveness restore relationships after conflict Growth in handling anger is part of ongoing spiritual maturity Do you want to listen ad-free? When you join Crosswalk Plus, you gain access to exclusive, in-depth Bible study guides, devotionals, sound biblical advice, and daily encouragement from trusted pastors and authors—resources designed to strengthen your faith and equip you to live it out boldly. PLUS ad free podcasts! Sign Up Today! Full Transcript Below: The Harm of Sinful Anger By: Emily Rose Massey Bible Reading: “Know this, my beloved brothers: let every person be quick to hear, slow to speak, slow to anger; for the anger of man does not produce the righteousness of God” (James 1:19-20, ESV). My husband and I have been married for sixteen years, and although we would never admit to “having it all together,” one thing that we have always fought to hold onto is our pursuit to work through our disagreements, however heated they may become, and never go to sleep angry with one another. With the help of the Holy Spirit, we try our best to be quick to forgive and ask for forgiveness. But since we are still on this side of eternity, we are continually being sanctified every day, and sometimes our flesh and pride get in the way of that pursuit for peace, and that was the case in a recent argument that he and I experienced. The two of us became so angry with one another that we continued to go in circles and rehash the argument. I found myself not thinking clearly and saying things that were hurtful towards my husband, things that I did not believe to be true. I would constantly interrupt my husband with what I wanted to say and never let him voice his concerns. In my frustration, I became so exhausted and confused that I didn’t have any energy to continue the conversation. Thankfully, before we drifted off to sleep, we both took some time to calm down and began to apologize for our anger and hurtful words. Knowing anger that is not restrained can often lead to sin, and in this case, it did; we both repented to the Lord and to each other. We can find much instruction and wisdom in the Bible regarding the sin of unrestrained anger. James 1 has some beautiful instruction for us that is a wonderful reminder for our hearts, especially in a marriage relationship: “Know this, my beloved brothers: let every person be quick to hear, slow to speak, slow to anger; for the anger of man does not produce the righteousness of God” (James 1:19-20, ESV). Intersecting Faith & Life: Do you notice how our conversations with each other can be tied to the misuse of anger? This is especially true if we are not considering others before ourselves when we want to voice our opinion or concerns. The misuse of anger is called unrighteous anger because it is selfish and prideful in nature. Those who do not think of others when speaking are walking in pride, which can often lead to anger if met with resistance and tension. When anger is unrestrained and rooted in pride, we are not walking righteously before God. We are to be quick to listen before speaking and patient when engaging in a tense discussion. What wise advice for married couples! Anger is sure to occur when two people disagree, but we do not have to give into the temptation to allow that anger to fuel hurtful or hate-filled words towards the other person, sinning against them and, more importantly, sinning against God who calls us to walk in righteousness. We need to prefer others above ourselves in our conversations with one another. May the Lord help us and sanctify us in our marriages and relationships with others. The Word has so much to say on the sin of anger, yet we give in to this temptation all the time when we are challenged in our selfishness. This is especially true in marriage. We must be careful not to allow our pride to lead us into unrestrained anger by lashing out and interrupting in disagreements. The Lord will help you be slow to speak and quick to listen so that anger does not cause you to walk in unrighteous behavior towards your spouse and brothers and sisters in Christ. The Holy Spirit will give you grace to empower you to walk more Christ-like. Further Reading: Ephesians 4:26-27 Proverbs 16:32 Proverbs 29:22 Discover more Christian podcasts at lifeaudio.com and inquire about advertising opportunities at lifeaudio.com/contact-us.

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Anger, when left unchecked, becomes a costly master. Proverbs 19:19–21 reveals the destructive cycle of impulsive reactions and the wisdom found in surrendering to God's guidance. Uncontrolled anger not only harms relationships but also traps individuals in a repetitive pattern of consequences from which others cannot continually save them. In contrast, the text calls believers to a posture of humility and teachability—listening to counsel and embracing instruction. Ultimately, it reminds us that while human hearts devise many plans, the Lord's purpose will stand. Together, these verses invite the reader to exchange impulsive reactions for patient wisdom and to trust God's sovereign direction over the fleeting impulses of the moment.

Self-Control or Impulsivity which controls you more?

CME credits: 1.00 Valid until: 24-03-2027 Claim your CME credit at https://reachmd.com/programs/cme/turning-flares-into-function-flag-uncontrolled-disease/54770/ This program examines treat-to-target (T2T) principles in generalized myasthenia gravis (gMG), emphasizing measurable goals such as minimal manifestation status (MMS) and minimal symptom expression (MSE). Faculty review validated tools—including MG-ADL, QMG, and MG-QoL15r—to assess disease activity, identify uncontrolled disease, and guide escalation using the ≥2-point MG-ADL threshold. Key data from FcRn inhibitor trials, including ADAPT, MycarinG, and VIVACITY-MG3, are discussed alongside practical considerations on patient selection, IgG kinetics-based redosing, and patient-centered, interdisciplinary care.

Words are powerful. Though small and easily spoken, they can carry immense weight—capable of bringing comfort or causing deep wounds. Scripture compares the tongue to a fire, something that can quickly grow out of control and cause lasting damage. In James 3, we are reminded that even a small spark can set an entire forest ablaze. In the same way, a single careless or angry word can leave scars that linger far longer than we expect. Many of us know what it feels like to be on the receiving end of those words—to be hurt, discouraged, or deeply wounded by something spoken in anger. And if we’re honest, we also know what it’s like to be the one who spoke too quickly. Anger itself is not the problem—but unrestrained anger often leads to words we cannot take back. In those moments, our natural response may be to fight fire with fire—to return hurt for hurt. But Scripture calls us to a different way. Jesus modeled this perfectly. Even when He was insulted and mistreated, He did not respond with harsh words. Instead, He chose restraint, grace, and trust in the Father. His example shows us that strength is not found in reacting quickly, but in responding wisely. When we are hurt by others, forgiveness can feel incredibly difficult. Yet holding onto anger only continues the cycle of pain. God invites us to release that burden, to forgive as we have been forgiven, and to allow His Spirit to guide our responses. Likewise, when we are tempted to speak in anger, we can ask God to help us pause—to listen more than we speak, and to choose words that build up rather than tear down. The same mouth that can wound also has the power to heal. Through the work of the Holy Spirit, our words can become instruments of encouragement, truth, and grace. Main Takeaways Words have the power to deeply wound or to bring healing. Uncontrolled anger can lead to harmful speech. Believers are called to respond to hurt with grace, not retaliation. Jesus modeled restraint and love even when facing harsh words. The Holy Spirit helps guide our speech and transform our responses. Today’s Bible Verse “When we put bits into the mouths of horses to make them obey us, we can turn the whole animal. Or take ships as an example. Although they are so large and are driven by strong winds, they are steered by a very small rudder wherever the pilot wants to go. Likewise, the tongue is a small part of the body, but it makes great boasts. Consider what a great forest is set on fire by a small spark. The tongue also is a fire, a world of evil among the parts of the body. It corrupts the whole body, sets the whole course of one’s life on fire, and is itself set on fire by hell” (James 3:3-6, NIV). Your Daily Prayer Prayer excerpt for listeners: “Lord, help me respond with grace and use my words to bring healing, not harm.” Listen to the full prayer here. To view the prayer in written format, visit the links below. Want More? Relevant Links & Resources Continue growing in faith and encouragement: LifeAudio.com – Christian podcasts and devotionals Crosswalk.com – Daily prayers, articles, and Bible study resources This episode is sponsored by Trinity Debt Management. If you are struggling with debt call Trinity today. Trinity's counselors have the knowledge and resources to make a difference. Our intention is to help people become debt-free, and most importantly, remain debt-free for keeps!" If your debt has you down, we should talk. Call us at 1-800-793-8548 | https://trinitycredit.orgTrinityCredit – Call us at 1-800-793-8548. Whether we're helping people pay off their unsecured debt or offering assistance to those behind in their mortgage payments, Trinity has the knowledge and resources to make a difference. https://trinitycredit.org Discover more Christian podcasts at lifeaudio.com and inquire about advertising opportunities at lifeaudio.com/contact-us.

More than a million dollars is being put into desexing dogs to tackle uncontrolled breeding in Auckland and Northland. Auckland Council's director community Rachel Kelleher spoke to Ingrid Hipkiss.

Dr Deb Muth 00:03Well, welcome back to Let’s Talk Wellness Now. I am your host, Dr. Deb. And what is the most talked-about peptides in functional medicine? aren’t actually FDA approved. Not because they don’t work, but because no one’s funded the research to prove it yet. The truth is, some of the compounds that dominate wellness forums, BPC-157, TB-500, thymosin beta-4, epitalin, occupy a fascinating space between breakthrough science and unregulated experimentation. In today’s episode, we’re stepping into that grey zone, the world of investigational peptides, to separate mechanism from marketing. I’m going to walk you through the science that actually shows and where it stops, how to evaluate claims when human data don’t yet exist, and the quality, purity, and safety red flags that you need to recognise. Dr Deb Muth 01:06I created it in a previous episode, so go check that one out. And why honesty is the most important prescription in peptide medicine. If you’ve ever wondered whether these research-only peptides are the frontier of healing or the next functional medicine fad, this episode is for you. So grab your cup of tea or coffee, get comfortable, and let’s talk about what it really means to use peptides that are promising but still under investigation. So we’re going to break just for a second here and have a word from our sponsor. It is because of them that we stay on the air. So thank you for this. And we will be right back. Did you know sweating can literally heal your cells? Infrared saunas don’t just relax you. They detox your body, balance hormones, and boost mitochondrial energy. I’m obsessed with my Health Tech sauna. And right now, you can save $500 with my code at healthtechhealth.com slash dr-muth-req-25. Dr. Deb Muth 02:15All right, guys, welcome back. Let’s dive into investigational peptides, the evidence gap. So the following peptides we’re about ready to discuss are extensively in integrative, functional, and regenerative medicine circles. They may have intriguing mechanisms and promising preclinical data. However, they lack FDA approval, and the evidence quality varies dramatically. from interesting preliminary research to essentially no human data at all. And this distinction is really critical for maintaining scientific integrity. So let’s talk about immune-modulating peptides. There’s thymus and alpha-1, and this is an international story on the thymic peptides. Thymusin alpha-1, known as TA1, is marketed internationally as zidaxin. Dr. Deb Muth 03:16It’s a 28-amino acid polypeptide originally isolated from thymusin fraction 5, which was extracted from bovine thymus tissue. Modern production uses synthetic peptide synthesis. The thymus gland is located behind the sternum and is the primary site for T cell maturation, and thymic peptides like TA1 play roles in human system development and regulation. Now, I love thymus peptides. I love thymus glandular products. I’ve used thymus glandular products for decades. Ground-up animal thymus gland is basically what it is. There are a couple of different supplement companies that I’ve used over the years that are amazing with this. And they do a fantastic job, and they really do help to support the immune system. So when thymus peptides came out, it was really exciting because it took the whole idea of thymus support to a new level. Dr. Deb Muth 04:17The mechanism actually behind the thymus in alpha-1 is complex and involves multiple aspects of immune function. At the cellular level, TA1 enhances T cell maturation and differentiation, particularly the development of helper T cells and cytotoxic T cells. It modulates T cell receptor expression and can influence the balance between Th1 cell-mediated immunity and Th2 humoral immunity responses. And it also enhances the natural killer cell activity and modulates dendritic cell function, which are critical for antigen presentation. and initiation of adaptive immune responses. And on the cytokine level, TA1 influences production of interleukin-2, IL-2, interferon gamma, IFN-γ, and interleukin-10, IL-10. Dr. Deb Muth 05:19These create immune modulatory rather than simple immune stimulatory effects. This is a very important distinction because TA1 appears to help balance the immune system rather than simply ramping this up, which theoretically makes it safer in conditions where immune overstimulation would be a problem, such as an autoimmune disease. Hashimoto’s, autoimmune, lupus, Sjogren’s, any of those autoimmune diseases, we don’t want to overstimulate their immune system. So you want to use a product like this that’s non-stimulating. Now, the regulatory status on TA1 is geographically variable and represents one of the challenges in discussing this peptide with patients. It is not FDA-approved in the United States. However, it is approved in several other countries for specific conditions. Dr. Deb Muth 06:19In Italy, it’s approved for the treatment of chronic hepatitis B and hepatitis C. In China, it’s approved for chronic hepatitis B and adjunct immune compromised patients receiving vaccinations or suffering from certain infections. It has an orphan drug designation in the United States for certain cancer indications, but its designation does not constitute approval. It simply provides regulatory incentives for further development. So the evidence base for thymosin alpha-1 is substantial in some areas but comes primarily from non-US populations and research groups, which creates challenges in evaluating quality and generalizable information. So in hepatitis B and C, multiple clinical trials, many conducted in China and Italy, have examined TA1 as an adjunct to antiviral therapy. Dr. Deb Muth 07:21A meta-analysis by Wu and colleagues published in the Journal of Viral Hepatitis in 2013 examined 23 randomized controlled trials, including over 2,000 patients with chronic hepatitis B. The analysis found that combining TA1 with nucleoside analogs like LAMVDUDE or an and TCAVAR improved the hepatitis antigen seroconversion rates by HBV DNA clearance compared to its nucleoside analogs alone. And the effect sizes were modest but statistically significant, with the HBE-AG seroconversion rates improving from about 24% with antivirals alone to 38% in combined therapy. Now in hepatitis C, early trials before the development of direct-acting antivirals showed that TA1 combined with interferon alpha improved sustained virological responses, and compared to interferon alpha, Dr. Deb Muth 08:30Furon alone, particularly in difficult-to-treat populations like those with a genotype one or a high viral load. However, the advent of highly effective direct acting antivirals that achieve SRV rates, sorry, SVR rates exceeding 95%, the role of TA1 in hepatitis C has become less clear. Now in sepsis and critical illness, more recent interest has focused on TA1 in severe cases of sepsis and septic shock. Ren and colleagues published a systematic review and meta-analysis in the Frontiers of Immunology in 2022, analyzing 18 randomized controlled trials, including 1787 patients with severe sepsis or septic shock the pooled analysis showed that ta1 administration was associated with reduced 28-day mortality relative risk at 0.70 meaning a 30 reduction in mortality compared to the standard care alone and the effect appeared Dr. Deb Muth 09:39most pronounced in patients with sepsis-induced immunosuppression measured by HLA-DR expression in monocytes. Now, this is amazing because going forward, we’re going to talk about something that’s commonly known as cytokine storm. Now, cytokine storm really became apparent since 2020 with the viral infection that we’re dealing with in the world today. But they were already looking at this kind of cytokine storm produced by sepsis or sepsis-induced immunosuppression. And it triggered this hyperinflammatory response called the cytokine storm. And many patients who survived the initial phase of the immune suppressed stata, characterized by a T cell exhaustion, reduced antigen presentation, and increased susceptibility to secondary infections. Thymusin alpha-1, TA1, may help restore this immune competence in this phase. However, it’s important to note that patient selection and timing are critical. Dr. Deb Muth 10:43Giving this immune stimulant during a hyperinflammatory phase could theoretically worsen outcomes. So you don’t want to give it to them while they’re in the flare up or the sepsis or the infection, but given to them during the immunosuppression phase afterwards might be beneficial. Now there is also some cancer immunotherapy that we see with TA1 and has been studied as an adjunct in cancer treatment with the hypothesis that it could enhance immune surveillance and response to tumors. And a comprehensive review of Garci and colleagues published in Expert Opinion on Biological Therapy in 2007 examined multiple trials in melanoma, lung cancer, hepatocellular carcinoma, and other malignancies. And the results were mixed. Some trials showed improvement in the immune parameters, increased CD4 in T-cells. improved lymphocyte proliferation responses and some actually showed trends toward improved progression free survival but overall survival benefits were inconsistent and the heterogeneity of the cancer types treatment protocols and outcome measures makes a definitive conclusion difficult as a vaccine adjunct several studies particularly from china have examined ta1 as an adjunct to enhance vaccine responses Dr. Deb Muth 12:11in immune-compromised populations, including the elderly, dialysis patients, and transplant recipients. The rationale is sound. These populations often mount suboptimal antibody responses to vaccines, and TA1’s immune-enhancing effects might improve protection. There are small trials. They have shown improvement in seroconversion rates of hepatitis B vaccines and influenza vaccine in these populations. And though large-scale confirmatory studies are limited, there is a possibility here. Now, on their safety profile, one of the appealing aspects of thymusin alpha-A TA1 is that it’s apparently favorable safety profile in clinical trials. There are some injection site reactions with a little redness, a mild discomfort, and most commonly reported adverse effects. is that their severe adverse events attributable to TA1 have been rare in published trials. However, comprehensive long-term safety data are limited Dr. Deb Muth 13:13And theoretically, concern exists that immune modulation could potentially trigger or exasperate autoimmune conditions in susceptible individuals. Though this hasn’t been clearly demonstrated in clinical trials, integrative medicine considerations for integrative practitioners concerning the thymus and alpha-1, several factors require careful thought. First, sourcing and quality control are critical concerns. Since it’s not FDA approved, TA1 available in the United States typically will come from a compounding pharmacy or an international supplier with variable quality assurance. And pharmaceutical grade product with certificates of analysis showing purity, sterility, and endotoxin testing is essential, but it is readily available from many of these companies. Second, patient selection matters immensely. TA1 should be considered in complex cases where conventional approaches have been insufficient, such as chronic viral infections not responding adequately Dr. Deb Muth 14:21to standard antivirals, post-viral syndromes with evidence of immune dysfunction, cancer patients with immune suppression in consultation with oncology, and it should generally be avoided in active autoimmune disease unless there’s a compelling rationale and close monitoring. Now, TA1 is not a standalone therapy. In cases of chronic viral infection, Comprehensive immune support includes addressing nutritional deficiencies, optimizing vitamin D levels to be between 50 and 80, adequate zinc, selenium, and vitamin A, optimizing gut health since 80% of our immune function is in the gut, you need to optimize gut function. Managing stress from the HPA access dysfunction, chronic cortisol elevation, suppression, and immunity, ensuring adequate sleep, immune memory consolidations during sleep, addressing any metabolic dysfunction, insulin resistance, repairs in the immune function, and the bottom line on thymus and alpha-1 is Dr. Deb Muth 15:26is that it represents legitimate medicine in other countries with a substantial evidence base in specific contexts, but it remains experimental in the U.S., and practitioners using it should provide comprehensive, informed consent about its regulatory status, evidence quality, and source verification. while ensuring it’s part of comprehensive protocols. It is not a magic bullet. And again, what you’re gonna hear me say quite often here is that many of these peptides should be used in conjunction with something else. They should not be used alone. And can peptides be stacked? The answer is yes, they can. So if somebody has an insulin resistance, or a metabolic dysfunction, they can tier TA1 with a GLP-1 like terzepatide or semiglutide. That is not a problem to do that. You need to just work with a practitioner that understands how to do that effectively. So let’s look at BPC-157. Dr. Deb Muth 16:26This is a phenomenon I love BPC-157. Let’s separate it from marketing to actual mechanism of actions here. So BPC-157 stands for Body Protection Compound 157. It is a chain of 15 amino acids that are described as a partial sequence of body protection compound, a protein found in human gastric juice. It has become one of the most hyped peptides in regenerative medicine inside the athletic performance and biohacking communities with claims ranging from healing tendons and ligaments to repairing gut lining or reversing organ damage. The challenge is separating the legitimate mechanisms of science from the marketing hype. The proposed mechanism of BPC-157 are biologically plausible and intriguing. The research suggests that it may influence several growth factor pathways, including vascular endothelial growth factor, VEGF, which promotes new blood vessel formation and has improved better supply of blood flow to injured tissues, theoretically accelerating healing. Dr. Deb Muth 17:40It may also affect fibrous blast growth factor, FGF, and transforming growth factor beta, TGF beta pathways. both involved in tissue repair and remodeling. And some studies actually suggest that BPC-157 modulates inflammatory cascades, potentially reducing excessive inflammation while promoting the resolution phase that allows tissue rebuilding. Now I want to talk just a few moments here about these different tests that we’re talking about tgf beta veg f for those of you who are in our mold world you are very familiar with these uh lab tests we do this to see if you have a mold exposure what’s happening to your body and it’s been very challenging to try to heal this part of the mold illness and manipulate these VEGFs and TGF betas. And so with the fact that BPC helps us modulate this inflammatory cascade, BPC can be very helpful in the world of mold or mycotoxin illness in repairing those parts of the body that have been damaged by the mycotoxins. Dr. Deb Muth 18:48Now there is animal research on BPC-157. It is extensive and primarily from a research group led by pre-drag, oh, I can never say these names, Cyrek at the University of Zagreb in Croatia. Published studies in animal models have shown accelerated healing in a remarkable variety of injury types. A 2011 paper by Chang and colleagues in the Journal of Applied Physiology demonstrated that BPC-157 improved therapy tendon healing in rats with Achilles tendon injuries, and the treated rats showed increased tendon outgrowth, better cell survival in the injured area, enhanced cell migration to the injury site, and improved biochemical strength of the healed tendon compared to controls. Multiple other animal studies have shown similar promising effects. Ligament tears, healing faster in rabbits, muscle damage recovering more quickly in rodent models, gastric ulcers healing in rats given experimental induced ulcerations, inflammatory bowel lesions improving in mouse models of colitis, and even bone to tendon healing showing enhancement in animal studies. Dr. Deb Muth 20:02The breadth of injury types showing benefit in preclinical models explains the enthusiasm of this peptide. However, this is critical. These animal studies, primarily in rodents and rabbits, animal models of injury healing don’t reliably translate to human clinical outcomes. And the doses used in these animal studies when converted to human equivalent doses vary widely. And optimal human dosing is completely unknown at this point. it is all considered experimental and perhaps most importantly there are essentially no peer-reviewed controlled clinical trials in human published in humans published in major medical journals in a 2001 review of arthroscopy and the journal of arthroscopic and related surgery specifically examined in the evidence of bpc 157 and other peptides in musculoskeletal medicine The authors concluded bluntly that BPC-157 lacks evidence from randomized controlled trials and has an unknown safety profile in humans. Dr. Deb Muth 21:09 They emphasized that the jump from animal data to recommending peptides for humans use bypasses the fundamental requirement for Phase I safety studies, Phase II dose-finding studies, and Phase III efficacy trials that would establish whether BPC-157 actually works in humans and whether or not it’s safe. The absence of human safety data is particularly concerning given BPC-157’s proposed mechanisms. Peptides that influence growth factor signaling and angiogenesis could theoretically have off-target effects. Uncontrolled angiogenesis, for instance, is a hallmark of cancer progression. Tumors require blood vessel formation to grow beyond a certain size. And while there’s no evidence that BPC 157 promotes cancer, The complete absence of long term human safety studies means we simply don’t know. This isn’t fear mongering. It’s acknowledging uncertainty and uncertainty exists and understanding that if you’re choosing to use peptides like BPC 157, you are doing it in an experimental model. Dr. Deb Muth 22:17We’re experimenting with the doses that are being used. And there is potential for it to cause cancer cells in your body to grow. And you need to be aware of this and understand the risks that you’re taking when you’re using an investigational or off label use peptide. Now, quality control issues with BPC also exist. It’s not FDA approved for any indication in the US. It’s not approved in any major regulatory jurisdiction worldwide. It’s marketed as a research chemical explicitly to bypass FDA oversight. And commercial sources selling BPC-157 range from compounding pharmacies, which have some quality standards but are not FDA inspected. You can take that for what you want to believe on that one. to overseas suppliers operating with absolutely no quality assurance whatsoever. If you are choosing to use BPC-157, you have to understand who’s manufacturing it for you, where you are getting it from, how pure it is. Dr. Deb Muth 23:26You want to make sure that you have the certificate of analysis and that it does not contain bacterial endotoxins that can contaminate the peptide or degrade the peptide and cause other issues for you. So when you talk about peptides with patients regarding BPC-157 or if you’re listening to this and you’re already using BPC-157 or other peptides, that are quote-unquote not for human consumption, an evidence-based response acknowledges both the appeal and the limitations. And you want to talk about the animal data that’s definitely showing some progress and some potential, but we don’t know what we don’t know in humans. If people are willing to take that risk, that is up to them to do that. But using BPC right now is experimental and people need to be aware of that. Are there evidence-based alternatives for patients with tendon or ligament injuries? Dr. Deb Muth 24:26And there are. There’s PRP, which has been studied in multiple randomized controlled trials. for conditions like lateral epicondylitis, tennis elbow, Achilles issues, patellar issues, knee issues. However, I want to caution you on this too. So the study that was done by Cox and colleagues in muscles, ligaments, and tendons in the Journal of 2014 showed modest benefits in pain and function compared to controls. And though the effects vary by injury type, PRP preparations can be helpful. You have to understand that a lot of times when people are doing PRP injections in their office, they are not doing it exactly the same way it was done in the study. And not to mention, if you’re using your own PRP to heal a ligament or a tendon or help your arthritis and you’re 60 or 70 years old, That is not good quality protein rich plasma. It is old protein rich plasma. And you’re not going to see necessarily the same benefits that you would see if you were using placental tissue or umbilical tissue. Dr. Deb Muth 25:33You also want to address the nutritional deficiencies or support that’s needed for connective tissue healing. And these are collagen peptides dosed at 15 grams a day. And this has been shown in a study by Shaw and colleagues in the American Journal of Clinical Nutrition in 2017 to augment collagen synthesis when combined with intermittent loading. Vitamin C is also an essential cofactor for collagen production and stabilization of collagen structure at a dose of around 500 to 1000 milligrams a day to support this process. You also need to have good adequate intake of copper and zinc. These are cofactors in collagen. Silica is also important. This comes from horsetail extract. This provides additional support as well. So more importantly, I think remembering that rehabilitation matters as well. Doing these protocols without doing some rehab is not going to get you where you want to go. Dr. Deb Muth 26:33There’s a research study by Alfredson and others for Achilles tendinopathy using the control lengthening of muscle tendon units under load to promote tendon remodeling and healing. These protocols have solid evidence and cost nothing beyond professional guidance from a physical therapist. They are important for patients seeking cutting edge regenerative approaches. Stem cell therapies, growth factors, concentrates derived from patients’ own tissues like PRP. These have a lot of good endogenous materials and they have good safety profiles. BPC-157 represents the perfect example of how promising Preclinical science gets marketed far beyond the evidence and it may eventually prove to be valuable. I think it will. But right now that determination does require some human studies and hopefully with the administration that we have right now and Bobby Kennedy, we will actually start to see some of that occur. Now the next peptide I want to talk about is TB4, thymus and beta-4. Dr. Deb Muth 27:36This is a wound healing peptide. It is a 43 amino acid peptide that’s naturally present in virtually all human cells except red blood cells. It’s actually one of the most abundant peptides in the human body, particularly concentrated in blood platelets, wound fluid, and many tissues. It’s naturally ubiquity makes it mechanistically interesting. The body wouldn’t produce it in such abundance if it didn’t serve a function. So the primary role of TB4 involves building G-actin. It’s a form of monomeric actin. And it’s structural protein that forms the microfilaments within the cells, providing cellular structure and enabling cell movement. TB4 prevents from F-actin filaments. I’m not going to talk too much about this. It’s really critical for wound healing as cells need to migrate into the injury sites. Dr. Deb Muth 28:37so the cell shape changes and the cellular response to the injury. So think of this as though you tore your meniscus and the body created all this TB4 to come to that injury to try to heal that site. That’s exactly what the TB4 is doing inside the body when there’s an injury. It’s been shown in research to help produce new blood vessel formation, promote endothelial cells, It helps modulate inflammatory cytokines, potentially reducing TNF-alpha, IL-1, and possibly protecting in programmed cell death, which we call apoptosis. And some studies suggest that it is cardioprotective in its effects in animal models of myocardial infarction, so heart attack, and neuroprotective in other models for brain injury. Now, these remain to be preliminary, but they are being seen. So the regulatory status on TB4 can create some confusion. Dr. Deb Muth 29:40The natural TB4 molecule itself is not FDA approved as a drug. However, TB4 based drug candidates called RGN259, formerly TB4, has been in the development by regen tree for corneal injuries of the dry eye disease. And as of recent updates, this drug is completed phase three trials for its neurotrophic keratopathy, severe corneal condition. But the FDA approval is still pending. So that means that the most advanced TB4-based pharmaceuticals hasn’t yet crossed the finish line for approval. The commercial peptide market further muddies the picture with TB500, which is often described as the synthetic fragment of TB4. However, this extract’s relationship between TB500 and TB4 varies depending on the source. Dr. Deb Muth 30:41So some claim that TB500 is identical to TB4, but positions 1 through 4 suggest it’s a different fragment. and the quality control across suppliers is not existent. So this confusion is part of why recommending TB500 becomes problematic for practitioners and patients, often because they aren’t certain what molecule they’re actually getting. The evidence base for TB4 in humans is limited, primarily to eye research, and the studies from Sohn’s and colleagues published in journals like Vitamins and Hormones in 2016 have examined topical TB4 for corneal injuries and neurotrophic keratopathy, dry eye, and other surface diseases. Now, these studies showed some promise in promoting this, and there is, however, a topical application to the cornea that is vastly different from a systemic injection. So for systemic use in wound healing, musculoskeletal issues, Dr. Deb Muth 31:42cardiac protection, neuroprotection, human clinical trials. There is scarce to non-existent evidence in humans. Most of the evidence remains in animal models or cell culture studies. And a review by Flip and colleagues in the Journal of Investigational Dermatology in 2006 detailed TB4’s effects on the matrix remodeling during wound repair in animal models, showing effects on collagen disposition, granulation, tissue reformation, and wound contraction. Another review by Ho and colleagues in expert opinion on biological therapy in 2007 discussed TB4’s potential in tissue regeneration and regenerative medicine, but noted the field remained largely blank. preclinical. So this is really important again to understand that there is just not enough human data. So there is a concern with cell division and migration. This theoretically exists Dr. Deb Muth 32:45for the potential effects on cancer cells, which would also rely on migration and division and other intended consequences of disrupting normal cellular architecture. These aren’t proven risks, but they are unexplored questions that we need to be aware of when we’re using peptides. This can cause cancerous tissue to grow. Very similar to what we talked about with BPC-157. These are also sold as research chemicals. There is no FDA oversight. So purity, potency, contaminations all still exist for these peptides. Now from an integrative perspective, the natural presence of TB4 in wound fluid and its biological roles in healing are legitimate science. in presence does not equal therapeutic utility. The body tightly regulates where and when and how much TB4 is present through natural production and bypassing that regulation with external dosing may or may not cause us to have beneficial or introduce risk. Dr. Deb Muth 33:49So we need to know that this is experimental use. Those people who are seeking wound healing and tissue repair the evidence-based approach of the body’s own capacity to heal is huge definitely want to be increasing your protein intake optimizing your zinc copper vitamin c and vitamin a and then managing glucose is really important during this time as well so let’s talk about a fun topic now and that’s growth hormone secretagogues this is the anti-aging hype machine these peptides in this category are things like semoralin ipameralin cjc 1220 1295 and others and among the most aggressively marketed in anti-aging and longevity medicine they all share a common goal stimulating the pituitary gland to release more growth hormone and the appeal is understandable. GH levels decline with age, and this decline is associated with increased fat mass, decreased lean muscle, reduced bone density, and other aspects of aging. Dr. Deb Muth 34:55The other times we’ll see growth hormone levels decline significantly is with chronic illness, and the logic is to restore youthful GH levels and youthful physiology. Now, semirelin from an FDA approved diagnostic to compound anti-aging product. Semirelin is a 29 amino acid peptide representing the first 29 amino acids of the full 44 amino acid human growth releasing hormone, GHRH. We talked about this on another episode of the podcast. And you can go back and listen to that one a little bit if you want. This fragment contains the complete biological activity of the full GHRH molecule and it binds to GHRH receptors in the anterior pituitary and stimulates growth releasing peptides, growth hormone releasing peptides. Semirelin was previously FDA approved as diagnostic testing of growth hormone secretion, essentially, to determine if the pituitary could still respond to GHRH stimulation in patients being evaluated for growth hormone deficiency. Dr. Deb Muth 36:06However, the manufacturer was discontinued and there was no longer an FDA approved semirelin product on the market in the United States. What exists now is semirelin available from compounding pharmacies used off label for anti-aging, body composition, and general growth hormone optimization purposes. This represents a significant gray area. Again, compounding medications serve a very important role, but they need to meet certain recommendations and regulations, as we’ve talked about in the past. You want to make sure that your compounding pharmacy that you’re obtaining semirelin from is qualified to do that, that they are doing best practices, and that you’re getting a good product. The theoretical advantage to semirelin over direct growth hormone administration is that it preserves more of the physiological growth hormone secretion patterns. Natural GH is released in pulses, primarily during sleep, not as a continuous elevation. Dr. Deb Muth 37:07So semirelin stimulates the pulses rather than providing a constant super physiological growth hormone level. And that pulsatile pattern is thought to reduce some of the side effects and metabolic concerns that we have with continuous growth hormone exposure. However, the evidence supporting semirelin for anti-aging and body composition in healthy adults is minimal. Most of the data comes from studies conducted in the 1990s when the FDA approved product existed. Not that that means it’s bad. We have drugs that have been in the market for over a hundred years that are still there, that still have the research and are still being used successfully and safely today. So we don’t want to let that really make us think that this product isn’t safe. So a 2006 review from Walker in Clinical Interventions of Aging suggested that semirelin might be a better approach than direct GH for adult onset growth hormone insufficiency, but they do acknowledge that the evidence was limited. Dr. Deb Muth 38:12And although we don’t have any large scale trials that we can examine for semirelin’s efficacy, it is now commonly prescribed. And the optimal dosing for anti-aging purposes is still unknown. It is considered experimental and it does vary from person to person, but it is still unstudied. The effects on cancer risk, cardiovascular disease, metabolic dysfunction over long time periods are also still unknown. I would argue that the side effects or the risk factors of not having growth hormone are equally as bad as the unknowns that we have here. We’re not looking to try to get super physiological doses. We’re trying to restore youthful GH levels. Typically, we’re not trying to restore back to a 20-year-old. We’re trying to restore back maybe 10 years. That is a better way of doing this. And I think that’s important for people to understand. Now, ipamirelin is the ghrelin mimicker. Dr. Deb Muth 39:12Ipamirelin is a pent-up peptide, five amino acid, that acts as a growth hormone secretagogue receptor, a GHS-R agonist. It mimics the action of ghrelin, the hunger hormone, that also stimulates growth hormone release. The proposed advantage over earlier secretagogues is that ipamirelin stimulates growth hormone release without significantly affecting cortisol, prolactin, or other glucose things, which can be increased by growth hormone secretagogues. The regulatory status is clear. Ipamirelin is not FDA approved for any indication. It’s sold as a research chemical. Human evidence is thin. It’s limited to single dose studies examining how quickly it’s absorbed and metabolized with minimal data on dosing and clinical outcomes. Now there are marketing claims for ipamirelin and they are extensive. Dr. Deb Muth 40:13It increases lean muscle mass, it decreases body fat, it improves sleep quality, faster recovery from workouts, enhanced injury healing, better skin quality. The evidence supporting these claims in humans is not available we don’t have it these are claims that are made by the effects that we know from growth hormone so it’s not necessarily a bad thing we know what growth hormone does we know growth hormone does all of these things if ipamorelin is a precursor to that it will obviously help improve those things making that correlation of what growth hormone does So there are safety concerns that mirror the same as any other growth hormone elevating therapy. It can cause fluid retention, joint pain, carpal tunnel syndrome, insulin resistance, glucose intolerance, and theoretically, can it increase calcium? cancer risks? It can because IGF-1 promotes cell proliferation and can inhibit apoptosis in cancer cells. Now remember, your body makes IGF-1. Dr. Deb Muth 41:15If it’s not making enough of it, that’s a problem. If it’s making too much of it, That’s a problem. So just understand that if you are adding these things, and especially in elevated doses, you are taking a potential risk. So there is also now CJC 1295 is a modified GHRH analog of 30 amino acid peptide based on GHRH structure, but with modifications. So it includes the addition of drug affinity complex, DACC, DAC, which involves conjugation with a small albumin binding molecule, dramatically extends the peptide’s half-life from minutes to as much as potentially a week or more. And this creates sustained growth hormone elevation rather than that pulsatile release. There are actually two versions of this. There’s CJC 1295 with DAC, longer acting version, and CJC 1295 without DAC, which is essentially a shorter duration of semirelin. Dr. Deb Muth 42:19And so when we’re comparing products, it is… only the difference between long acting and short acting. The human evidence for CJC 1295 is limited to a single published phase one study by Techman and colleagues in the Journal of Clinical Nutrition and Metabolism in 2006. And the study involves 18 healthy young adults showed that CJC 1295 with DAC produced a sustained elevation of GH and IGF-1 lasting several days after the injection. That’s essentially the entire published human evidence of this peptide. There are no phase two studies examining optimal dose. So that is all considered experimental. And there is no phase three studies examining clinical efficacy. So the sustained GH levels created by CJC 1295 with DAC raises specific concerns because the natural GH secretion It goes up and down, up and down, up and down. Dr. Deb Muth 43:19And that constant elevation may have a different metabolic and cellular effect. And we just really don’t know what that’s going to be yet. So we can understand that elevated IGF-1 levels can theoretically increase cancer concerns and metabolic risks. So rather than always injecting peptides, which are very expensive… You can do other things. And there was a study by Hartman and colleagues in the Journal of Clinical Endocrinology and Metabolism in 1992 that demonstrated the 48-hour fast increased integrated growth hormone secretion five-fold through increased GH levels. Now, the problem with this is fasting for 48 hours is a challenge. And how long is it going to increase the growth hormone secretion without causing issues? Or in general, how long is it going to go up? Dr. Deb Muth 44:19So we have to be cautious about that as well. Sleep optimization is non-negotiable. The majority of growth hormone secretion occurs during sleep, slow wave sleep, typically the first sleep cycle, and poor sleep quality or insufficient sleep typically. can dramatically affect your growth hormone levels. And then high intensity interval training, HIIT resistance training can stimulate growth hormone as well. This was seen in a study by Godfrey and colleagues in sports medicine in 2003 and was examined in exercise-induced growth hormone responses to athletes. So we definitely see these kinds of things. So let’s talk about some longevity peptides now. These expand the telomere. So there’s epitalin and epithalamin and when these are used in anti-aging they can produce some amazing results. Dr. Deb Muth 45:22So epitalin is a synthetic terapeptide, just four amino acids. It was originally synthesized as a simplified version of epithalamine. a pineal gland extract containing multiple peptides. The synthetic four amino acid version was created to isolate what researchers believed might be the active anti-aging component. The mechanism produced for epitalin centers on telomere and telomerase, Telomeres are protective caps at the end of the chromosomes consisting of repetitive DNA sequencing. And every time a cell divides, telomeres shorten slightly because DNA polymers cannot fully replicate the ends of the linear chromosomes. So this progressive shortening acts as a molecular clock. After 50 or 70 divisions, the telomeres become critically short, triggering a cellular senescence. Dr. Deb Muth 46:22This telomere shortening is one mechanism of cellular aging and telomeres in the enzyme that can rebuild telomeres by adding these caps back onto the end of the chromosome. It’s active in stem cells, germ cells, and unfortunately in about 85 to 90% of the cancer cells. In most adult somatic cells, telomerase is inactive or present at very low levels, allowing the telomeres to shorten with division. The research on epitalin suggests it might activate this telomeres act telomeres process primarily from a research group led by Vladimir in Russia. Vladimir Kavasan in Russia. He is a huge peptide researcher or was he passed away with publications dating back to the early 2000s and a study published in bio gerontology in 2000 by Kavasan Dr. Deb Muth 47:25and colleagues examined the effect of epitalin on the lifespan of fruit flies, and they treated fruit flies that showed a modest increase in mean and maximum lifespan compared to its controls by approximately 10 to 15% lifespan extension in some experimental groups. And there were other studies in 2003 that examined epitalamine in a female Swiss-derived mouse. This was done by Ann Simove and colleagues. And the researchers reported that epitalin treatment was associated with increased lifespan as well. And the most cited mechanistic work comes from cell culture studies. And that is also Cavason’s group that published this research in 2003, showing increased telomeres activity in cultured somatic cells again. More recently, between 20 and 25, the series of publications have continued to explore epithelial effects on telomere dynamics in cell cultures. Dr. Deb Muth 48:32So there is a lot of research that’s been done. The mass majority has been done on epithelin. And most of it has been done by a single research group in Russia. There is some restrictions on some of the cell culture data that we’re seeing. And it does show that epithelin sometimes can be described as a regulating hormone. Carcadian rhythm for melatonin production, which is derived by the penile extracts. And however the evidence for this affects minimally and mechanistically unclear, the pineal gland primarily functions as melatonin secretion in that light-dark cycles. So Epithalin or epitalin is not FDA approved. It is not approved for any major regulatory jurisdiction. It is sold as a research chemical only. Dr. Deb Muth 49:33So you need to follow the same safety profiles that we’ve talked about in other episodes and in today’s episodes. And when we’re talking about epithalin, and we’re excited about it being an anti-aging science, we should balance this with the honesty and the evidence of the quality of that evidence. We don’t know its safety effect. We don’t know if it’s going to increase the risk of cancer. We can’t verify that. And we need to be using it in an experimental use of unknown risks only. Of course, diet, physical activity, stress management, sleep quality, all of those things are important for us to be looking at when we’re looking at these peptides. Now, I want to get into some of the brain peptides. This is the nootrophic frontier. C-Max and C-Lank, there is Russian pharmacology that’s done. C-Max and C-Lank represent an interesting case study in how different regulatory environments and research traditions Dr. Deb Muth 50:36create challenges in evaluating this evidence. Both peptides were developed in Russia, are approved for their specific indications and have substantial Russian language and literature supporting their use. However, the FDA approval in the United States is still not there. C-Max is a seven amino acid. It’s a synthetic analog. It is a fragment, particularly ACTH 4 through 10. It’s sometimes called the melanocortin effects because it involves the melanocortin receptors of the central nervous system. CMAX was developed by the Institute of Molecular Genetics of Russia Academy of Sciences and is approved in Russia for several indications, including acute stroke, transient ischemic attacks, cognitive disorders. It has Russian approval and is based on clinical trials primarily in Russia. Dr. Deb Muth 51:39It does help to increase brain-derived neurotrophic factor, BDNF, a protein critical for neuroplasticity, the brain’s ability to form new connections and adapt to the challenges. BDNF supports neuronal survival and promotes growth of these new neurons. C-Max also influences neurotransmitter systems, particularly dopamine and serotonin, and there is some research that suggests it affects on metabolism as well, and endogenous opioid peptides that involve pain reception and mood regulation. So it has some good potentials there. There is also C-Link, which is a hepatopeptide structurally similar to Tufts’ and an immune modulatory peptide. It was also developed in Russia and was approved for anxiety disorders as a neurotropic. Its effects involve anxiolytic effects, possibly through the GABAnergic system or the GABA system of the brain, and immune modulation. Dr. Deb Muth 52:44The Russian research is examined by C-Link for anxiety disorders. and finding reductions in anxiety without sedation. There is a dependency potential or cognitive impairment does not exist like it does with benzodiazepines with C-Link. So that is really good. And they do report attention and memory improvement using C-Link. There is a study that was done in neuroscience and behavioral psychology in 2018 that examined C-Linx effects and proposed that it exerts cytoprotective effects through BDNF pathways similar to C-Max. So both of these are Russian research-based They’re not wrong or fraudulent. It’s just that they are from Russia and we all have our concerns with Russia. However, that does not necessarily mean their research doesn’t hold quality. Dr. Deb Muth 53:49Neither peptide is approved by the FDA, and so you are using this off-label. The same rules apply for all of the other peptides that we’ve talked about that are produced off label. You want to do the same things that you would do with anything else. Good protein, omegas, B vitamins, acetylcarnitine, exercise, sleep, all of that still applies when we’re using these peptides. So I want to talk briefly about clinical decision and framework when we’re looking at this. First and foremost, we always want to go to FDA-approved peptides. Secondly, we would look at international approval with peptides that are established in other countries but lack FDA approval. And then preclinical evidence only or experimental peptides. These can be used, but they are not ethically recommended in the traditional medicine world. Dr. Deb Muth 54:50 If patients use them, we need to have appropriate counseling about the evidence surrounding them, the safety, and where to find them. how to find them and how to ask for these certificates of analysis. So I think it’s really good that we were exploring all these peptides and understanding what they are. There’s a lot of controversy out there. There’s a lot of concern out there. And what we can say with confidence is that peptides are powerful biological signaling molecules. Some peptide based medications, semi-glutide, triseptide, PT 141, Lupron that are all FDA approved. can dramatically improve outcomes in patients that are obviously selected for the correct ones. There are many other peptides that we address that are integrative and longevity space in the regenerative medicine. These peptides are all experimental. That does not automatically make them wrong. Dr. Deb Muth 55:50It just means that we need to be honest about what we’re doing with them and we need to be cautious with the patients so that they can make a decision to be part of an experimental study. in looking at how to use these peptides. So peptides are tools like any other tools. They work best in the hands of skilled people, and they are applied to appropriate situations, integrating into comprehensive approaches that address root causes. The most powerful peptide administered to a patient with untreated inflammation, hormonal chaos, nutritional deficiencies, and disorders of sleep will disappoint. The simplest evidence-based interventions apply. to a patient whose foundational physiology has been optimized. And this is the art of the science of peptide, right? If done right, respecting both the power of these molecules and the complexity of human beings that we are privileged to serve can make a difference in their lives. So thank you for listening to this episode. Dr. Deb Muth 56:52I hope this was helpful. If you can know of somebody that might benefit from this, please like, share, and subscribe. It means a lot to us. And I hope you join us for our next episode of Let’s Talk Wellness Now. Welcome to Let’s Talk Wellness Now, where we bring expert insights directly to you. Please note that the views and information shared by our guests are their own and do not necessarily reflect those of Let’s Talk Wellness Now, its management, or our partners. Each affiliate, sponsor, and partner is an independent entity with its own perspectives. Today’s content is provided for informational and educational purposes only and should not be considered specific advice, whether financial, medical, or legal. While we strive to present accurate and useful information, we cannot guarantee its completeness or relevance to your unique circumstances. We encourage you to consult with a qualified professional to address your individual needs. Dr. Deb Muth 57:54Your use of information from this broadcast is entirely at your own risk. By continuing to listen, you agree to indemnify and hold Let’s Talk Wellness Now and its associates harmless from any claims or damages arising from the use of this content. We may update this disclaimer at any time and changes will take effect immediately upon posting or broadcast. Thank you for tuning in. We hope you find this episode both insightful and thought-provoking. Listener discretion is advised.The post Episode 258 – Investigational Peptides: What's Promising, What's Hype & What You Must Know first appeared on Let's Talk Wellness Now.

White Oak Baptist Church

White Oak Baptist Church

Chapter six is one of the darkest chapters in the Bible, as Solomon describes how dissatisfaction can sidetrack and destroy our lives. Our uncontrolled appetites will end up consuming us unless we are willing surrender to the power of Jesus. (Ecclesiastes 6:1-12)

One of the barriers to good communication is uncontrolled anger. Lashing out at your spouse amounts to declaring war. The good news is we can control our anger instead of being controlled by anger.Donate to Moody Radio: http://moodyradio.org/donateto/lovelanguageminuteSee omnystudio.com/listener for privacy information.

6.His uncle went to Europe on business a week ago and he is now either in London or in Paris.他叔叔一周前去欧洲出差，他现在要么在伦敦，要么在巴黎。7.Early man used his fingers and toes to count the animals he owned, or the measures of grain he had stored.远古时代的人用他的手指和脚趾来计量他拥有的动物，或者他们储存的谷物。8.This book aims to provide an explanation of modern Japanese grammar that is as systematic and as easily understood as possible.这本书的目的是系统地是提供一个容易理解的现代日语语法。9.I'd rather go by train. I have a license, but no real driving experience, so I'm not very sure of myself behind the wheel.我宁愿坐火车去。我有驾照，但没有真正的驾驶经验，所以我不太确定自己可以开车。10.Uncontrolled, these forces may be dangerous and destructive, but once mastered they can be bent to man's will and desire.这些力量非常危险，且具有破坏性，不受控制，但一旦掌握，它们就会服从于人类的意志和愿望。

Editor's Summary by Linda Brubaker, MD, and Preeti Malani, MD, MSJ, Deputy Editors of JAMA, the Journal of the American Medical Association, for articles published from January 31-February 6, 2026.

Dr. Don and Professor Ben talk about the risks from drinking water from an "uncontrolled" Sintra Portugal water fountain. Dr. Don - risky ☣️ Professor Ben - risky ☣️ Fountain on Google Maps Energy Drink | 2:1 Fructose | Great Tasting Energy Nutrition | HIGH5 water - Risky or Not? Water

He believes the best way to engage people in matters of science and technology, especially nonscientists, is through stories. A fascinating story that frames the technology issues in understandable terms can capture the interest of a wide audience, therefore, "100 Years to Extinction." is made palatable.He claims society faces a potential 11-foot rise in sea level, more violent storms, and wildfires caused by the climate crisis. There are thirteen thousand nuclear weapons in nine countries, just a small fraction of which could destroy our civilization. Fifty percent of AI experts believe that there is a 10 percent chance that AI could lead to human extinction. Uncontrolled genetic engineering could lead to bioweapons, new deadly viruses, giant soldiers, and new humanoid superspecies. The technology is easy enough to use, so that a kit is available for hobbyists to change the DNA of frogs. Uncontrolled information on the internet's social media is leading to a post truth society. Controlling these technologies is extremely urgent, he says.He is the author of 100 YEARS TO EXTINCTION: The Tyranny of Technology and the Fight for a Better Future. https://100yearstoextinction.com/http://www.yourlotandparcel.org

Our flaws can wreck our life or drive us into a deeper, more intimate relationship with the Lord.See omnystudio.com/listener for privacy information.

A person walking around with power they haven't learned to hold is like lightning with no sky to land in. That's the whole spirit of Dangerous Controlled. This episode digs into the raw truth: when someone carries strength, vision, calling, or influence but hasn't recognized it yet, the energy leaks everywhere. It spills into relationships, decisions, and self-doubt. Uncontrolled power turns into frustration. Controlled power becomes destiny.In this conversation, you explore why so many people are walking around unaware of the weight they carry, how hidden confidence becomes chaos, and what shifts when you finally learn to channel your fire instead of letting it burn you. It's part psychology, part spiritual alignment, part personal accountability—wrapped in a message meant to wake up the parts of you that have been asleep.

WarRoom Battleground EP 892: The Crisis In The Catholic Church And The Harm Of Uncontrolled Colonial-Era-Inspired Legal Migration

Title: Reject or Receive: “Esau: The Folly of Uncontrolled Appetites” (the Unrestrained Self)Text: Genesis 25:29-34; 27:37-42; 28:6-9; Romans 9:12-13Chris Hefner 1. The Causes of the Unrestrained SelfNatureNurture2. The Casualties of the Unrestrained SelfDiscernmentSelf-awarenessRelationshipsHoliness and morality3. The Cure for the Unrestrained SelfA Changed Heart

Is uncontrolled anger a problem in your marriage? Proverbs 29:11 says, "A fool gives full vent to his anger, but a wise man keeps himself under control.Donate to Moody Radio: http://moodyradio.org/donateto/lovelanguageminuteSee omnystudio.com/listener for privacy information.

More from ESC including: Valvular HD guidelines, a new drug class for HTN, myosin inhibition in HCM, vericiguat, and digoxin are the topic discussed by John Mandrola, MD. This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I New European Valvular Heart Disease Guidelines 2025 ESC/EACTS Guidelines for the management of valvular heart disease  https://doi.org/10.1093/eurheartj/ehaf194 Debate: Does Asymptomatic Aortic Stenosis Warrant Early Intervention? https://exp.medscape.com/debates/does-asymptomatic-aortic-stenosis-warrant-early-intervention/ Surgical Ablation of Atrial Fibrillation during Mitral-Valve Surgery https://www.nejm.org/doi/full/10.1056/NEJMoa1500528 Surgical ablation of atrial fibrillation: a systematic review and meta-analysis https://doi.org/10.1093/europace/eux336 II  New Drug for Resistant HTN Baxdrostat: A 'Game Changer' for Hypertension? https://www.medscape.com/viewarticle/baxdrostat-game-changer-hypertension-2025a1000mz7 Efficacy and Safety of Baxdrostat in Uncontrolled and Resistant Hypertension https://www.nejm.org/doi/full/10.1056/NEJMoa2507109 Lorundrostat Efficacy and Safety in Patients with Uncontrolled Hypertension https://www.nejm.org/doi/10.1056/NEJMoa2501440 III HCM News at ESC New Trials Clarify Role of Myosin Inhibitors for Hypertrophic Cardiomyopathy https://www.medscape.com/viewarticle/new-trials-clarify-role-myosin-inhibitors-hypertrophic-2025a1000myv MAPLE HCM https://www.nejm.org/doi/full/10.1056/NEJMoa2504654 SEQUOIA HCM https://www.nejm.org/doi/10.1056/NEJMoa2401424 ODYSSEY HCM https://www.nejm.org/doi/full/10.1056/NEJMoa2505927 IV Vericiguat at ESC New Data Said to Support Vericiguat as Standard Therapy for Heart Failurehttps://www.medscape.com/viewarticle/new-data-said-support-vericiguat-standard-therapy-heart-2025a1000mz9 VICTOR https://doi.org/10.1016/S0140-6736(25)01665-4 VICTORIA https://www.nejm.org/doi/full/10.1056/NEJMoa1915928 An individual participant data analysis of the VICTORIA and VICTOR trials https://doi.org/10.1016/S0140-6736(25)01682-4 V More on Digoxin RATE AF substudy https://doi.org/10.1002/ejhf.70022 Main RATE-AF trial https://jamanetwork.com/journals/jama/fullarticle/2774407 Efficacy of β blockers in patients with heart failure plus atrial fibrillation: an individual-patient data meta-analysis https://doi.org/10.1016/S0140-6736(14)61373-8 You may also like: The Bob Harrington Show with the Stephen and Suzanne Weiss Dean of Weill Cornell Medicine, Robert A. Harrington, MD. https://www.medscape.com/author/bob-harrington Questions or feedback, please contact news@medscape.net

This hour, Scoot is joined by Kermit Ruffins, celebrated jazz trumpeter, singer, and composer, who shares his Hurricane Katrina story, his journey to the top of the local music scene, and what it's like representing New Orleans on the world stage. Also, Scoot addresses the church shooting in Minneapolis and in a road rage incident in Tangipahoa Parish.

Hour 1 of A&G features... John Bolton's house gets raided & ass control Katie Green's Headlines! Both guys forgot C.O.W. Clips of the Week, John Bolton & Lil Naz Mailbag! See omnystudio.com/listener for privacy information.

Hour 1 of A&G features... John Bolton's house gets raided & ass control Katie Green's Headlines! Both guys forgot C.O.W. Clips of the Week, John Bolton & Lil Naz Mailbag! See omnystudio.com/listener for privacy information.

Wallstreet Trapper discusses how unchecked anger can take control, leading to an "out of body" experience and regrettable actions. He highlights the importance of managing emotions and understanding their impact. Tap in to gain wisdom on navigating challenging feelings and fostering peace within. 

In this episode of Building Better Developers with AI, Rob Broadhead and Michael Meloche revisit one of the most persistent challenges in software projects: scope creep. Using AI prompts, we revisit a past episode on “Mastering Scope Creep: Navigating the Hidden Challenges in Software Development.” In that discussion, we explored what scope creep is, why it happens, and how to prevent it from stalling projects, draining teams, and eroding trust. Today, we're building on that conversation with fresh insights and practical strategies. Listen to the full episode for more real-world stories and practical strategies to keep your projects on track. What Is Scope Creep? Scope creep occurs when requirements change after development begins—often without proper planning or agreement. Rob describes it as “moving the goalposts” for what “done” means. This differs from: Iteration – Evolving requirements after review and delivery. Agile flexibility – Adjusting before a sprint starts, not mid-execution. Uncontrolled changes shift the destination while you're already driving toward it. Scope Creep vs. Feature Creep Michael introduces feature creep—adding extra features—as a related but distinct problem. Feature creep bloats the product, while midstream requirement changes alter agreed-upon work. Both can waste time and resources, but shifting requirements often cause rework and missed deadlines. Why It Happens The hosts highlight common causes: Poorly defined requirements Lack of regular checkpoints Stakeholder indecision or shifting priorities Underestimating the impact of “small” changes Without a process to control evolving requirements, teams risk chasing ever-changing goals. The Impact of Unmanaged Scope Creep Burnout from Endless Adjustments When requirements keep shifting, tasks drag on for weeks instead of days, creating “death march” projects that drain morale. If the definition of done changes mid-task, close the ticket and open a new one. Damaged Trust in Estimates Developers see moving targets, clients see missed deadlines, and both lose faith in estimates and planning. Growing Technical Debt Repeated changes often necessitate quick fixes, making the system more challenging to maintain. Stories from the Trenches Rob recalls a four-week integration project that stretched to nine months due to unclear ownership of data mappings. Michael shares a modular app that was copied into six separate projects instead of being built for reuse. One small change multiplied into six updates—an expensive lesson in poor change control. How to Prevent Scope Creep Expansion Define “Done” Clearly – Every task needs explicit completion criteria. Set Regular Checkpoints – Confirm that requirements remain relevant throughout the project. Separate New Work – Treat changes as new tickets with new estimates. Clarify Ownership – Assign responsibility for every requirement and integration. Challenge “Quick” Changes – Always Assess the Real Impact. Key Takeaways Unmanaged scope creep—or any uncontrolled change—can sink a project. By defining requirements early, revisiting them often, and isolating new work from current work, teams can adapt without losing control. Managing changes well is the difference between a project that adapts and one that never ends. Your Scope Creep Challenge Think about the last project you worked on. Did requirements change midstream? Were there regular checkpoints to confirm priorities? How did those changes impact the timeline, quality, or team morale? This week, choose one active project and: Review its requirements with the team. Confirm whether they are still valid. If anything has changed, document it as a new item rather than altering the current work in progress. By doing this, you'll practice catching and managing evolving requirements before they cause unnecessary rework. Stay Connected: Join the Developreneur Community We invite you to join our community and share your coding journey with us. Whether you're a seasoned developer or just starting, there's always room to learn and grow together. Contact us at info@develpreneur.com with your questions, feedback, or suggestions for future episodes. Together, let's continue exploring the exciting world of software development. Additional Resources Sprint Planning – Setting The Scope A Positive Look At Scope Creep The Importance of Properly Defining Requirements Getting It Right: How Effective Requirements Gathering Leads to Successful Software Projects The Developer Journey Videos – With Bonus Content Building Better Developers With AI Podcast Videos – With Bonus Content

08-11-25 - Chinese Woman Has Uncontrolled Constant Orgasms - Flat Earther Emails In Accusing Us Of Being Indoctrinated And Paid By Round Earthers - John's Looking For A Pool Teacher Since He Has Two Pool TablesSee Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

08-11-25 - Chinese Woman Has Uncontrolled Constant Orgasms - Flat Earther Emails In Accusing Us Of Being Indoctrinated And Paid By Round Earthers - John's Looking For A Pool Teacher Since He Has Two Pool TablesSee Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

Uncontrolled hypertension continues to drive cardiovascular risk and remains a major gap in chronic disease management. This episode discusses what pharmacists need to know to support treatment adherence, identify therapeutic gaps, and address barriers to blood pressure control. Listen to strengthen your role in helping patients achieve meaningful, sustained outcomes. HOSTJoshua Davis Kinsey, PharmDVP, EducationCEimpactGUESTRyan Jacobsen, PharmD, BCPSClinical Pharmacy SpecialistU of Iowa HealthCareJoshua Davis Kinsey and Ryan Jacobsen have no relevant financial relationships to disclose. Pharmacists, REDEEM YOUR CPE HERE!CPE is available to Health Mart franchise members onlyTo learn more about Health Mart, click here: https://join.healthmart.com/CPE INFORMATION Learning ObjectivesUpon successful completion of this knowledge-based activity, participants should be able to:1. Identify common causes and consequences of uncontrolled hypertension in various patient populations.2. Describe the pharmacist's role in recognizing gaps in therapy, addressing adherence, and supporting blood pressure control.0.05 CEU/0.5 HrUAN: 0107-0000-25-271-H01-PInitial release date: 8/11/2025Expiration date: 8/11/2026Additional CPE details can be found here.

In this special episode on Treatment of Hypercortisolism in Uncontrolled Diabetes our host, Dr. Neil Skolnik, will discuss a case based approach to uncontrolled diabetes addressing new evidence showing the surprising prevalence of Hypercortisolism in people with uncontrolled Type 2 Diabetes, and the effect of treatment.  This special episode is supported by an independent educational grant from Corcept. Presented by: Neil Skolnik, M.D., Professor of Family and Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University; Associate Director, Family Medicine Residency Program, Abington Jefferson Health John Buse, MD – The Verne S. Caviness Distinguished Professor and director of the Diabetes Center at the University of North Carolina at Chapel Hill School of Medicine, a past president of medicine & science at the American Diabetes Association (ADA), and recipient of the ADA Outstanding Achievement in Clinical Diabetes Research Award John Anderson, MD - Practices internal medicine and diabetes at the Frist Clinic in Nashville Tennessee. Servied as a Past President of the 38-member multi-specialty clinic, and has served leadership roles at Centennial Medical Center, a 670 bed HCA tertiary care referral hospital. He has served as Chair of the Department of Medicine for two separate terms. Served two separate terms on the National Board of Directors for the American Diabetes Association, and in 2013 he received the Banting Medal for service as President of Medicine and Science for the ADA.   Reference:   Prevalence of Hypercortisolism in Difficult-to-Control Type 2 Diabetes. Diabetes Care dc242841 https://doi.org/10.2337/dc24-2841   Inadequately Controlled Type 2 Diabetes and Hypercortisolism: Improved Glycemia With Mifepristone Treatment. Diabetes Care June 2025  

AP correspondent Charles de Ledesma reports Spanish firefighters work through the night as wildfires continue to burn near Madrid.

In this special episode on Treatment of Hypercortisolism in Uncontrolled Diabetes our host, Dr. Neil Skolnik, will discuss new evidence showing the surprising prevalence of Hypercortisolism in people with uncontrolled Type 2 Diabetes, and the effect of treatment.  This special episode is supported by an independent educational grant from Corcept. Presented by: Neil Skolnik, M.D., Professor of Family and Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University; Associate Director, Family Medicine Residency Program, Abington Jefferson Health John Buse MD – The Verne S. Caviness Distinguished Professor and director of the Diabetes Center at the University of North Carolina at Chapel Hill School of Medicine, a past president of medicine & science at the American Diabetes Association (ADA), and recipient of the ADA Outstanding Achievement in Clinical Diabetes Research Award, References: Prevalence of Hypercortisolism in Difficult-to-Control Type 2 Diabetes. Diabetes Care dc242841 https://doi.org/10.2337/dc24-2841 Inadequately Controlled Type 2 Diabetes and Hypercortisolism: Improved Glycemia With Mifepristone Treatment. Diabetes Care June 2025  

Editor's Summary by Kirsten Bibbins-Domingo, PhD, MD, MAS, Editor in Chief, and Preeti Malani, MD, MSJ, Deputy Editor of JAMA, the Journal of the American Medical Association, for articles published from June 28-July 3, 2025.

There are likely more foreign-born people in the United States today than at any time in our entire history.Legal immigrants come to this country to thrive. But this wave of uncontrolled immigration, like those that washed over the country during the Biden administration, those waves have implications for the country that we cannot ignore.

Two large wildfires burning uncontrolled in northeastern Minnesota grew significantly overnight. The Jenkins Creek fire more than doubled in size and has now burned more than 20,000 acres of forest, or about 31 square miles. It's burning north in a long, narrow band east of Hoyt Lakes and south of Babbitt. Meanwhile the Camp House Fire grew modestly to about 15,000 acres. That fire near Brimson has destroyed at least 144 structures.That story and more in today's evening update. Hosted by Kelly Bleyer. Music by Gary Meister.

Daily Study: Most Christians are controlled by their feelings, which is completely backward from God's viewpoint. At times, it may seem impossible, but God has designed us to control our feelings instead of the other way around. When our feelings are out of control, we become stressed, which leads to constant irritability and long-term depression. On the other hand, controlled feelings lead to sustainable peace and unshakable faith. Partner with Us: https://churchforentrepreneurs.com/partner Connect with Us: https://churchforentrepreneurs.com                  

Uncontrolled lust inevitably leads to devastation. The events involving Amnon and his half-sister Tamar make this blatantly clear. Hear their story, and learn the best question to ask yourself in any situation, on Truth For Life with Alistair Begg. ----------------------------------------- • Click here and look for "FROM THE SERMON" to stream or read the full message. • This program is part of the series ‘A Study in 1 and 2 Samuel, Volume 8' • Learn more about our current resource, request your copy with a donation of any amount. Helpful Resources - Learn about God's salvation plan - Read our most recent articles - Subscribe to our daily devotional Follow Us YouTube | Instagram | Facebook | Twitter This listener-funded program features the clear, relevant Bible teaching of Alistair Begg. Today's program and nearly 3,000 messages can be streamed and shared for free at tfl.org thanks to the generous giving from monthly donors called Truthpartners. Learn more about this Gospel-sharing team or become one today. Thanks for listening to Truth For Life!