Podcasts about UpToDate

In this episode of BackTable Urology, Dr. Bagrodia and Dr. Jay Raman, the chair of urology at Penn State Health, discuss advancements and future directions of medical education for trainees. --- SHOW NOTES First, the doctors discuss the need for medical education to incorporate multimedia and active learning into residency curriculums and CME courses. Dr. Raman notes that although the copious amounts of articles and videos online may be overwhelming, integrating quality videos, textbook chapters, and journal articles into a standardized curriculum for urology residents can teach them the fundamentals of urology. Additionally, he notes that this approach takes into consideration different learning styles. Dr. Bagrodia emphasizes how the AUA core curriculum has leveled the playing field for trainees, as it has standardized education across all training programs. He suggests a model of having residents do pre-work by learning from the AUA curriculum on their own time and then using valuable in-person time with attendings to review case examples. Dr. Raman agrees that meeting in person for resident lectures or conference courses should be interactive and incorporate active learning exercises. They then reflect on the social value of getting together in order to network and discuss cases casually, but concede that virtual meetings can be more convenient for family life and comfort. Next, the doctors discuss the role of simulation in education. Dr. Bagrodia notes that simulation increases practice opportunities for residents, which makes them safer and more competent surgeons. Dr. Raman is excited about virtual reality technology, which makes simulation more feasible and realistic for many training programs. The doctors then discuss the possibility of incorporating simulation into board exam certifications. Dr. Raman explains the traditional arc of residency training and proposes changes to this arc to help align resident education better with their future practice types and meet the current need for more general urologists. Finally, they end the episode by addressing the need to expand resident and CME education beyond clinical education to include topics like social determinants of health, time management, wellness, and environmental stewardship.

Episode 120: Immune Reconstitution Inflammatory Syndrome (IRIS) Abeda Faharti and Dr. Schlaerth present the definition, diagnosis, and treatment of IRIS. Moderated by Dr. Arreaza. Written by Abeda Farhati, MS4, Ross University School of Medicine. Editing and comments by Katherine Schlaerth, MD, and Hector Arreaza, MD.You are listening to Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California, a UCLA-affiliated program sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. This podcast was created for educational purposes only. Visit your primary care provider for additional medical advice.Definition.Have you heard of IRIS? No, not the color portion of our eyes. IRIS is short for Immune Reconstitution Inflammatory Syndrome. This condition occurs in immunocompromised patients with HIV/AIDS due to an overactive inflammatory response. In most cases, it occurs after initiating antiretroviral therapy (ART). To understand IRIS in HIV patients, we must first understand HIV.HIV.The Human Immunodeficiency Virus (HIV) infection was first reported in 1981. The virus attacks the immune system, destroying white blood cells called CD4+ T lymphocytes, which are part of our body's defense mechanism. These cells are also known as "helper T cells" and are responsible for destroying viruses, bacteria, and other germs that make us sick.When your CD4+ count is low, you are more likely to get serious infections from viruses, bacteria, and fungi, which usually do not cause problems in otherwise healthy individuals. These infections are called Opportunistic infections, and they can be deadly. To restore CD4+ T lymphocytes, HIV patients are started on ART to normalize their immune response to pathogens. As a result of these treatments, HIV patients' lives have been significantly improved and prolonged. [Comment by Dr. Arreaza: It is paradoxical, but some HIV patients are among the healthiest patients I have seen.]Despite this, no treatment is guaranteed to be without side effects. Increases in CD4+ T lymphocytes trigger the immune system to respond to any persisting antigen, regardless of whether it is fragments or intact organisms. As a result, a hyperinflammatory response may occur.Diagnosis.There are no established criteria for diagnosing IRIS. It is generally accepted that IRIS requires the worsening of an existing infection or an unrecognized, preexisting infection in the context of improved immune function. For a diagnosis to be made, most, if not all of the following features must be present:The presence of a low CD4 count (less than 100 cells) before initiating treatment with ART (Except IRIS secondary to preexisting TB infection can occur with CD4 counts >200 cells).The presence of an inflammatory condition, especially after ART is initiated.The absence of drug-resistant infection, bacterial superinfection, drug allergy, or other adverse drug reactions.The absence of patient noncompliance or reduced drug levels due to drug-drug interactions or malabsorption.Clinical Manifestations.IRIS can be presented in patients in 2 ways:Patient's with a preexisting infectious disease that has NOT been treated, getting paradoxically worse after initiating treatment with ART ---this is known as “unmasking IRIS” ORPatient's with a preexisting infectious disease that has been previously diagnosed and treated but regained capacity after treatment with ART, causing it to mount an inflammatory response – this is known as “paradoxical IRIS.”In summary: Unmasking IRIS and paradoxical IRIS.Patients with IRIS have clinical features that vary widely. The presentations are strongly dependent on the type of preexisting opportunistic infection. For example, about 75% of patients with a mycobacterial or cryptococcal-related infection will develop a fever. In contrast, fever is rarely seen in cytomegalovirus (CMV) infections.Risk & Prevention.Researchers have found that lower CD4 cell counts or high HIV RNA levels at the time of anti-retroviral treatment initiation increase the risk of developing IRIS. One way to prevent IRIS development is to treat opportunistic infections prior to starting ART. Although this reduces the risk of IRIS development, it does not guarantee it.Treatment.In “unmasking IRIS,” patients can be treated with antibiotics, antivirals, or antifungals against the underlying infectious organism. In severe cases, steroids can also be used to suppress inflammation until the infection has been eradicated. Unfortunately, there is no treatment for paradoxical IRIS. Most patients who experience “paradoxical IRIS” reactions will get better spontaneously without additional therapy.Incidence of IRIS.The overall incidence of IRIS is unknown; however, studies have shown that anywhere from 25 to 30% of HIV patients who start antiretroviral treatment develop IRIS in the first six months. You may ask, which preexisting infections can lead to patients developing IRIS?Pathogens associated with IRIS.Different pathogens have been associated with the development of IRIS. The leading pathogens include:Mycobacterium tuberculosisMycobacterium avium complexCytomegalovirusCryptococcus neoformansPneumocystis jiroveciiHerpes simplex virusHepatitis B virusHuman herpes virus 8 (associated with Kaposi sarcoma)Non-HIV etiologies.IRIS can also be seen in other immunocompromised conditions, such as:Solid organ transplant recipients Postpartum period – 3 to 6 weeks after giving birthNeutropenic patients – with an absolute neutrophil count of less than 500Patients on Tumor Necrosis Factor Antagonists (TNF antagonists)- are used to treat chronic conditions such as ulcerative colitis, Crohn's disease, or sarcoidosis.In summary, Immune Reconstitution Inflammatory Syndrome (IRIS) is a hyper-inflammatory state seen after initiating ART in HIV patients whose improved immune system responds to previously acquired opportunistic infection, whether treated or not.The treatment is directed to the unmasked specific opportunistic infection or support therapy if no active infection is found.____________________________Conclusion: Now we conclude episode number 121, “Immune Reconstitution Inflammatory Syndrome (IRIS).” This syndrome presents in about 30% of HIV patients when they start ART. A stronger immune system means a stronger immune reaction. So, keep in mind this diagnosis when your HIV patients get sicker when they are supposed to get better after starting ART. This week we thank Hector Arreaza, Abeda Farhati, and Katherine Schlaerth. Audio edition by Adrianne Silva.Even without trying, every night you go to bed a little wiser. Thanks for listening to Rio Bravo qWeek Podcast. We want to hear from you, send us an email at RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. See you next week! _____________________Links:“CD4 Lymphocyte Count: MedlinePlus Medical Test.” Medlineplus.gov, accessed on November 4, 2022.https://medlineplus.gov/lab-tests/cd4-lymphocyte-count/#:~:text=A%20CD4%20count%20is%20mostly,have%20trouble%20fighting%20off%20infections.Sun HY, Singh N. Immune reconstitution inflammatory syndrome in non-HIV immunocompromised patients. Curr Opin Infect Dis. 2009 Aug;22(4):394-402. doi: 10.1097/QCO.0b013e32832d7aff. PMID: 19483618. https://pubmed.ncbi.nlm.nih.gov/19483618/Thapa, Sushma, and Utsav Shrestha. “Immune Reconstitution Inflammatory Syndrome.” PubMed, StatPearls Publishing, 2022, www.ncbi.nlm.nih.gov/books/NBK567803/.Wolfe, Cameron. Immune reconstitution inflammatory syndrome, UpToDate. ww.uptodate.com, https://www.uptodate.com/contents/immune-reconstitution-inflammatory-syndrome. Accessed November 14, 2022.Royalty-free music used for this episode: “Keeping Watch,” New Age Landscapes. Downloaded on October 13, 2022, from https://www.videvo.net/royalty-free-music-albums/new-age-landscapes/. 

Myelofibrosis is a rare myeloproliferative neoplasm characterized by the buildup of scar tissue in the bone marrow, leading to decreased erythropoiesis, progressive bone marrow failure, and anemia. Currently, the discovery of the Janus kinase-signal transducer and activator of transcription (JAK-STAT) pathway's role in the pathogenesis of myelofibrosis is transforming the landscape with novel agents that improve patients' outcomes. However, correctly diagnosing and managing this disease using novel therapies and strategies remains challenging for clinicians.

One of the challenges churches face is making sure people know and are up to date with everything going on in the life of your church. In this episode, we share 5 simple ways you can do that. Welcome to episode 302 of Practical Church Planting. Here are the 5 ways we discuss in this episode: Add givers to your newsletter Start your sermon with an important announcement if you can't preach it Host a church business meeting over Zoom Be intentional about personally telling people things Make sure staff/leaders know what is coming up ---------------------------------------- Mission Support Mission Support knows you want to be effective in ministry, but if you are like most pastors you probably feel like you never have enough time, energy or expertise to get everything done.   Mission support comes alongside pastors like you as a guide to provide the expertise to do the things you don't know how to do and give you back the time you desperately need.  So whether it is bookkeeping, SEO, Payroll, websites or one of our other services, talk with a guide today at missionsupport.com and go from feeling scattered to focused on your mission. It's possible to love being a pastor again.  P.S. Tell them you heard about Mission Support from Practical Church Planting and you'll get 10% off your product or service. CONNECT AND NEVER MISS AN EPISODE Be sure to subscribe to the podcast to get practical tips delivered right to you. For free resources to help you plant a church that thrives, check out practicalplanting.com.  You can also watch the video version of the podcast on our YouTube channel.

In this episode, we discuss the fundamentals and approaches to chronic management and treatment for patients with known inherited hemophilia. What is hemophilia?* As name suggests, tendency to bleed* Two types: genetic and acquiredInherited hemophilia: * Genetic: sex-linked, meaning males will express it, females will, by and large be carriers * Main ones to be worried about: Hemophilia A and Hemophilia B** Hemophilia A: deficiency in factor VIII (1:5000 men)** Hemophilia B: deficiency in factor IX (1:30,000 men)** Thousands of underlying mutations * We grade the severity of hemophilia using the factor activity levels: ** Severe: 1 bleed into the joints for patients with severe hemophilia (goal is to keep levels >1%)** In patients with moderate or mild can do intermittent dosing *Hemophilia A/Factor VIII replacement (many options; here is what we use at Rouleaux): **Recombinant factor concentrates: Advate**Plasma-derived concentrates: Humate-P* Factor IX replacement: ** Recombinant factor concentrates: BenefIX*Bypassing agents: For patients with inhibitors (to be discussed in a future episode) or can be used for Hemophilia A or B*Options:** Novoseven (activated recombinant factor VII): Activates the extrinsic pathway to bypass the need for factors VIII or IX** FEIBA (factor eight inhibitor bypassing agent): Activated prothrombin complex concentrate (FIIa, VIIa, Xa)* Emicizumab (Hemlibra): bispecific monoclonal antibody that binds factor activated IX and X → essentially doing the job of factor VIII and leads to activation of the downstream common pathway** Note that it binds activated factor IX not inactivated factor IX and this is why you won't just constantly form clots by forcing down the common pathway like you would by giving a bypassing agent***cannot be used in Hemophilia B because it relies on the presence of factor IX**** Several new therapies have been introduced in recent yearsReferences:https://www.uptodate.com/contents/hemophilia-a-and-b-routine-management-including-prophylaxis?search=hemophilia%20treatment&source=search_result&selectedTitle=2~150&usage_type=default&display_rank=2: UpToDate article on current management of Hemophilia DOI: 10.1055/s-0042-1756188: “The More Recent History of Hemophilia Treatment.” Semin Thromb Hemost. 2022. Love what you hear? Tell a friend and leave a review on our podcast streaming platforms!Twitter: @TheFellowOnCallInstagram: @TheFellowOnCallListen in on: Apple Podcast, Spotify, and Google Podcast

Did you know that a mild respiratory infection could be the culprit of an adverse respiratory event during a patient undergoing anesthesia? Dr. Pedro Solorzano and Dr. Ana Mavarez join Krishna Shah to discuss the evaluation and management of upper respiratory infections for patients undergoing anesthetic care. Specifically, they will:   Recall key aspects of the preoperative assessment performed by the pediatric anesthesiologist prior to perform an anesthetic.   Understand why an upper respiratory infection (URI) affects the pediatric anesthesiologist's decision to proceed or postpone a surgery or procedure requiring anesthesia or sedation.   Identify the severity of the URI symptoms that would increase the likelihood of perioperative respiratory adverse events (PRAE).   Understand the anesthetic management of a patient with an URI to minimize the risk of PRAE requiring emergent anesthesia and the timing to postpone it if the surgery is elective.  Initiate interventions to optimize the pediatric patient's respiratory status with URI prior to receiving anesthesia.   FREE CME Credit (requires free sign-up): Link coming soon! References:  Davis, Peter J. and Cladis, Franklyn, "Smith's Anesthesia for Infants and Children. 9th ed. (2017). Chapter 45. Respiratory disorders. Page 1127-1128. Von Ungern-Sternberg BS, Boda K, Chambers NA, Rebmann C, Johnson C, Sly PD, Habre W. Risk assessment for respiratory complications in paediatric anaesthesia: a prospective cohort study. Lancet. 2010 Sep 4;376(9743):773-83. doi: 10.1016/S0140-6736(10)61193-2. PMID: 20816545. Regli A, Becke K, von Ungern-Sternberg BS. An update on the perioperative management of children with upper respiratory tract infections. Curr Opin Anaesthesiol. 2017 Jun;30(3):362-367. doi: 10.1097/ACO.0000000000000460. PMID: 28291127. Cote C, Lerman J amd Anderson B, A Practice of Anesthesia for Infants and Children. 6th ed. (2019). Chapter 13. Essentials of pulmonology. Page 285-286. Houck, P. Anesthesia for the child with a recent upper respiratory infection. In: UpToDate, Post TW (Ed), UpToDate, Waltham, MA

Episode 118: Wernicke's Encephalopathy Dr. Malave explains the diagnosis and treatment of Wernicke's encephalopathy. Editing and comments by Hector Arreaza.  Written by Maria Fernanda Malave, edited by Hector Arreaza, MD.You are listening to Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California, a UCLA-affiliated program sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. This podcast was created for educational purposes only. Visit your primary care provider for additional medical advice.Definition.As a reminder for everyone, vitamin B1 and thiamine are the same substance with different names. Wernicke's encephalopathy (WE) is a neurological syndrome secondary to severe, short-term B1 deficiency. In the past, but less frequently nowadays, it was more commonly associated with alcohol use disorder. However, today we know that any condition that decreases dietary intake and increases thiamine use, or its elimination, puts patients at risk of developing this encephalopathy. Causes:Chronic alcoholism is the most important cause of WE. Around 70-80% of the causes are associated with chronic alcohol consumption. Non-alcoholic WE may be caused by Decreased intake: Some types of WE may be caused by a psychiatric illness that decreases the dietary intake of B1, such as anorexia nervosa, schizophrenia, or dementia. Arreaza: Also, prolonged fasting or starvation.Lack of absorption of B1: Other causes might be related to malabsorptive syndromes, bariatric surgeries, or hyperemesis gravidarumIncreased use of B1: Any disease that increases the use of B1 and, therefore, low levels of thiamine, such as cancer, thyrotoxicosis, and systemic illnesses like infections. High-carb diets are associated with high thiamine use. Also, patients who receive IV glucose w/o supplements are at risk of developing Wernicke's encephalopathy.Increased elimination of B1: Other causes are related to increased elimination of B1, such as dialysis.Immunodeficiencies: Immunodeficiency syndromes and transplantation also cause WE.Why is thiamine important?Thiamine is one of the main cofactors in three key enzymes for energy metabolism: alpha-ketoglutarate dehydrogenase, pyruvate dehydrogenase, and transketolase. If we go back to biochemistry in med school, we can remember these enzymes play a significant role in the Krebs cycle and pentose phosphate pathways. Thiamine uses Mg+2 as a cofactor, so a magnesium deficiency can mimic WE.Pathophysiology.B1 deficiency causes lactic acid accumulation due to anaerobic glycolysis, leading to neuronal cytotoxic edema and vasogenic edema with petechial hemorrhages. MRI of the brain shows symmetrical hyperintensities, most commonly in the thalamus, mammillary bodies, cerebellum, and the periaqueductal area surrounding the third and fourth ventricles. The diagnosis of WE is made clinically, even though the MRI is a useful complementary tool to the clinical diagnosis. Diagnosis.WE presentation has always been described as the classic triad of ophthalmoplegia (or nystagmus), encephalopathy (confusion or memory impairment), and gait ataxia. However, this presentation is present only in less than 20% of patients, and most of the patients present with a neurologic syndrome that includes 2 out of the classic triad plus nonspecific symptoms such as hallucinations, hypothermia, hypotension, indifference or inattentiveness, seizures, behavioral disturbances, and bilateral lower extremity weakness. In 1997, Caine et al. suggested that a diagnosis of WE can be made if 2 out of 4 of these criteria were present in a patient with ophthalmoplegia/nystagmus + ataxia + memory impairment or confusion and clinical evidence of malnutrition or from laboratory data. Thiamine levels can be normal in patients with WE, so thiamine level is not a requirement for diagnosis.Almost 80% of WE cases are diagnosed on autopsy, which means this disease goes undiagnosed most of the time. The diagnosis is clinical, and MRI can assist in cases that are uncertain. Treatment.Thiamine supplementation is inexpensive, accessible, and easy to administer, so if we have a patient with a suspicious neurologic syndrome that could be WE, B1 must be given as soon as possible. Treatment should not be delayed while waiting for MRI results, The treatment consists of IV thiamine 500mg TID for 2-3 days, followed by 250 IM or IV for additional 5 days, in combination with other B vitamins. Because GI absorption of thiamine is impaired in alcoholics and malnourished patients, oral administration is contraindicated during initial treatment for WE. Thiamine 100 mg PO should be continued after the completion of parenteral treatment and after discharge from the hospital until patients are no longer considered at risk. Magnesium and other vitamins are replaced as well, along with other nutritional deficits if present.B1 blood levels or erythrocyte transketolase activity (which is a way to evaluate thiamine deficiency) are measured before and after thiamine pyrophosphate supplementation. A low transketolase and a more than 25 percent stimulation are positive for thiamine deficiency. This test is often not readily available, especially at the ED. High-quality liquid chromatography can also measure serum thiamine or TPP level in serum or whole blood.For practical purposes, and given high undiagnosed rates and mortality, IV thiamine should be given to all patients with malnutrition admitted to the hospital or seen in clinic. __________________________Conclusion: Now we conclude episode number 117 “Wernicke's Encephalopathy.” Dr. Malave explained that a low thiamine level is not required for the diagnosis of Wernicke's encephalopathy. Start supplementation if you have a high suspicion of thiamine deficiency, especially before giving IV glucose to a malnourished patient. We were reminded that GI absorption of thiamine is impaired in patients with chronic alcohol use, so make sure you give thiamine IV or IM. This week we thank Hector Arreaza and Maria Fernanda Malave. Audio edition by Adrianne Silva.Even without trying, every night you go to bed a little wiser. Thanks for listening to Rio Bravo qWeek Podcast. We want to hear from you, send us an email at RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. See you next week! _____________________Links:He Jingqi, Li Jinguang, Li Zhijun, Ren Honghong, Chen Xiaogang, Tang Jinsong. A Case Report of Wernicke's Encephalopathy Associated with Schizophrenia. Frontiers in Psychiatry. Vol 12. Year 2021. DOI=10.3389/fpsyt.2021.657649. https://www.frontiersin.org/articles/10.3389/fpsyt.2021.657649/fullOta, Y., Capizzano, A.A., Moritani, T. et al. Comprehensive review of Wernicke encephalopathy: pathophysiology, clinical symptoms and imaging findings. Jpn J Radiol 38, 809–820 (2020). https://doi.org/10.1007/s11604-020-00989-3.Yuen T So, MD, PhD, Wernicke encephalopathy, last updated: Feb 11, 2020, UpToDate. Retrieved October 25, 2022.https://www.uptodate.com/contents/wernicke-encephalopathy.Patel S, Topiwala K, Hudson L. Wernicke's Encephalopathy. Cureus. 2018 Aug 22;10(8):e3187. doi: 10.7759/cureus.3187. PMID: 30364782; PMCID: PMC6199146. https://pubmed.ncbi.nlm.nih.gov/30364782/Royalty-free music used for this episode: Simon Pettersson – good vibes_ Fashionista, downloaded on October 1, 2022, from https://www.videvo.net 

Speaker: Edmarks; Scripture Reading: Rev. 3:7-22. Subject: LOVING THE LORD AND LOVING ONE ANOTHER FOR THE ORGANIC BUILDING UP OF THE CHURCH AS THE BODY OF CHRIST Source: New York

Speaker: Edmarks; Scripture Reading: Rev. 3:7-22. Subject: LOVING THE LORD AND LOVING ONE ANOTHER FOR THE ORGANIC BUILDING UP OF THE CHURCH AS THE BODY OF CHRIST Source: New York

Editor Sydny Shepard sits down with NFPA LiNK Director Kyle Spencer to talk all about NFPA's inspiration for LiNK, recent updates to the program and the future of digitization at NFPA.   A special thank you to the National Fire Protection Association. The National Fire Protection Association (NFPA) is a global self-funded nonprofit organization, established in 1896, devoted to eliminating death, injury, property and economic loss due to fire, electrical and related hazards. NFPA delivers information and knowledge through more than 300 consensus codes and standards, research, training, education, outreach and advocacy; and by partnering with others who share an interest in furthering their mission. NFPA LiNK™ is the information delivery platform set to revolutionize how you work. Put safety expertise at your fingertips with digital NFPA® codes and standards. Utilize dynamic search functionality, bookmarking, and the ability to share and collaborate with others to save time and get the job done right. With NFPA LiNK™ you can go by the book without the book to get the job done right faster and more efficiently.

Welcome to our Podcast #2,053! We appreciate your listening and hope you find the time to go through the 100's of episodes that we have recorded already. They're short, so listen to a few every day! I promise you will learn all you need to know about one of the happiest countries on the planet! Here's some links that will get you started in learning more about Costa Rica! If you're thinking about moving to Costa Rica, we can assist! Visit "Royal Palms Costa Rica Real Estate". . we are DEDICATED BUYER'S AGENTS. Check out our website at www.costaricaimmigrationandmovingexperts.com/buyersagent.html Here's our NEW Costa Rica Good News Report YouTube Channel. Over 100 Short, Entertaining Videos that will get you excited about Costa Rica: https://www.youtube.com/channel/UCBqa-IZdK4sKrNi32AEGazw/videos Check out an amazing travel website catering to those travelers age 50 and over! Dozens of incredible expert contributors writing about so many destinations: https://www.travelawaits.com/ Here's our 1st contribution to the TravelAwaits website: https://www.travelawaits.com/2789789/questions-to-ask-if-thinking-about-retiring-in-costa-rica/ Here's a link to our 2nd article on the TravelAwaits website as promised: https://www.travelawaits.com/2798638/tips-for-driving-in-costa-rica/ Here's a link to our 3rd article on the TravelAwaits website: https://www.travelawaits.com/2794704/how-to-gain-residency-status-in-costa-rica/ Check out our NEW COSTA RICA LOVE STORIES! There's ONE THING BETTER than falling in love. . falling in love in COSTA RICA! Here's the link: https://www.costaricagoodnewsreport.com/lovestories.html So many GOOD-NEWS stories coming out of Costa Rica. We'd love to share them with all of you! Way over 100 stories ready right now. Learn all about one if the Happiest Countries on the Planet. . Costa Rica! Here's a link: https://vocal.media/authors/skip-licht Become a "COSTA RICA PURA VIDA" Brand Ambassador & Share the LIFESTYLE with EVERYONE! Here's the link: https://www.costaricagoodnewsreport.com/brandambassador.html Here's a link to the US Embassy here in Costa Rica: https://cr.usembassy.gov/ --- Send in a voice message: https://anchor.fm/costa-rica-pura-vida/message

Episode 117: Anxiety Screening. Adriana and Ikleel explain the new recommendation given by the USPSTF in October 2022 regarding screening for anxiety in children and adolescents 8-18 years old. Dr. Arreaza discusses the SCARED tool to screen for anxiety in pediatric patients. By Adriana Rodriguez, MS3, and Ikleel Moshref, MS3. Ross University School of Medicine. Moderated by Hector Arreaza, MD. You are listening to Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California, a UCLA-affiliated program sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. This podcast was created for educational purposes only. Visit your primary care provider for additional medical advice.Recommendation.The USPSTF recommends screening for anxiety in children and adolescents aged 8 to 18 years. Grade of recommendation: B (offer this service to your patients)The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for anxiety in children 7 years or younger. Grade of recommendation: I (insufficient evidence, unknown benefits vs. harms)USPSTF concludes this new screening guideline for anxiety in this population has a moderate net benefit. For children 7 and younger, evidence is insufficient to determine screening tools accuracy and its effects, and benefit-to-risk balance. Anxiety. Anxiety disorder is characterized by excessive, persistent worry and or fear that is difficult to control, resulting in significant distress or impairment. Anxiety disorder manifests in psychological/emotional and physical/somatic symptoms. DSMV recognizes 7 types of anxiety disorders: GAD, social anxiety disorder, panic disorder, agoraphobia, specific phobias, separation anxiety disorder, and selective mutism. Comment: Anxiety is not your patient's fault. In some cultures, anxiety is seen as a weakness. America seems to be a highly stressful society.Epidemiology.Anxiety disorder is a common mental health condition in the United States. According to the National Survey of Children's Health in 2018-2019, 7.8% of people aged 3-17 yrs. old had an anxiety disorder that was current. In the adult population, past studies have shown ~3% past-year prevalence and ~5-12% lifetime prevalence of anxiety disorder in adults. Topic Importance.Anxiety disorders are the most common childhood-onset mental health condition. Childhood and adolescent anxiety disorder is associated with an increased likelihood of poor academic performance and co-occurring psychiatric conditions. It is also associated with future anxiety disorder, secondary depression, substance abuse, psychosocial functional impairment, chronic mental/somatic health conditions, and/or suicide. Screening anxiety disorder in youth may serve to improve potential prevent burdens in the future. Assessment of Risk. Although this new screening guideline is meant for children and adolescents aged 8-18 who have not been diagnosed with an anxiety disorder and without signs and symptoms, it is important to note what factors would increase their chances of developing any of the aforementioned anxiety disorders: Genetic, personality, and environmental factors: biopsychological vulnerability, attachment difficulties, child maltreatment, adverse childhood experience Demographic factors: poverty, low socioeconomic statusRacial and ethnic factors: racial discrimination, historic trauma, structural racismOther factors: LGBTQ youth, older adolescents 12-17Screening Tools.Although there are many screening tests for anxiety, two are widely utilized in clinical practice for screening purposes: (1) SCARED (Screen for Child Anxiety Related Disorders), and (2) Social Phobia Inventory. These screening instruments are insufficient for the actual diagnosis of any particular anxiety disorder listed earlier; if positive, however, a confirmatory assessment and follow-up is required to establish diagnosis using DSM V criteria for any of the recognized anxiety disorders (GAD, social anxiety disorder, panic disorder, agoraphobia, specific phobias, separation anxiety disorder, and selective mutism).SCARED (Screen for Children Anxiety Related Disorders): It is a 41-Item questionnaire, each question can be answered from 0-2 (0=not true or hardly true, 1=somewhat true or sometimes true, 2=very true or often true). A score greater than or equal to 25 is highly associated with anxiety disorder; panic disorder, significant somatic symptoms, generalized anxiety disorder, separation anxiety disorder, social anxiety disorder, and significant school avoidance. SCARED is available online (here). There is a child version and a parent version. The only difference between the two is the different pronouns, for example, question 17 is “My child worries about going to school” vs “I worry about going to school”. Although the USPSTF could not find optimal screening intervals, these screenings may be best used in older adolescents aged 12-17 yrs. old with risk factors for anxiety disorder. Other anxiety screening tools have been assessed by the USPSTF but were insufficient for the purposes of this guideline because they were too specific to a specific anxiety disorder (for example, the Social Phobia and Anxiety Inventory for Children), were for a particular set of disorders, or were too long to use for screening in a primary care setting. In studies found by the USPSTF, social anxiety disorder and GAD were the most common detected anxiety disorder in children and adolescents. Fun fact: What is the most common phobia in the US? Public speaking, AKA glossophobia.Treatment. Anxiety disorders can be treated with medications, psychotherapy, a combination of both, or multidisciplinary care. Of the variety of psychotherapies available, cognitive behavioral therapy (CBT) is the most used. As for pharmacotherapy, US FDA has only approved duloxetine, an SNRI, for the treatment of GAD in children 7 yrs. and older. Off-label prescriptions of other drugs have been reported to treat anxiety in youth. Potential Harms.False-positive screening results may lead to an unnecessary burden on the patient and family from avoidable referrals, monetary costs, anxiety, the stigma of illness, and adverse effects of pharmacotherapy (weight loss, cholesterol, etc.)Bottom line: Anxiety is a treatable mental condition and detection in childhood is now recommended by the USPSTF. Screen if you have a way to treat (refer or treat yourself).____________________________Conclusion: Now we conclude episode number 117 “Anxiety Screening.” Adriana and Ikleel explained that screening for anxiety disorders in children between 8-18 is now a grade B recommendation by the United States Preventive Services Task Force. During this episode, you heard about “SCARED”, a useful screening tool to help in the diagnosis of anxiety disorders in children. Once diagnosed, anxiety is treated with psychotherapy, medications, or a combination of both. This week we thank Hector Arreaza, Adriana Rodriguez, and Ikleel Moshref. Audio edition by Adrianne Silva.Even without trying, every night you go to bed a little wiser. Thanks for listening to Rio Bravo qWeek Podcast. We want to hear from you, send us an email at RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. See you next week! _____________________Links:Final Recommendation Statement, Anxiety in Children and Adolescents: Screening, United States Preventive Services Task Force, https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/screening-anxiety-children-adolescents#fullrecommendationstart, accessed on Oct 11, 2022. Screen for Child Anxiety Related Disorders (SCARED), available online, for example: Oregon Health & Science University: https://www.ohsu.edu/sites/default/files/2019-06/SCARED-form-Parent-and-Child-version.pdfBennett, Shannon, et al. Anxiety disorders in children and adolescents: assessment and diagnosis, UpToDate, last updated: Aug 19, 2022. https://www.uptodate.com/contents/anxiety-disorders-in-children-and-adolescents-assessment-and-diagnosis.Baldwin, David, et al. Generalized anxiety disorder in adults: Epidemiology, pathogenesis, clinical manifestations, course, assessment, and diagnosis, UpToDate, last updated: Apr 18, 2022. https://www.uptodate.com/contents/generalized-anxiety-disorder-in-adults-epidemiology-pathogenesis-clinical-manifestations-course-assessment-and-diagnosis.Craske, Michelle, et al. Generalized anxiety disorder in adults: Management, Up to Date, last updated Nov 12, 2021. https://www.uptodate.com/contents/generalized-anxiety-disorder-in-adults-management.Royalty-free music used for this episode: Real Live by Gushito, downloaded on October 1, 2022, from https://www.videvo.net/. 

Marc Bullard's here. He's been with me many, many years and he's got his own stuff on the side. And he's written I don't know how many books now on YouTube marketing. He's going to talk about all the YouTube updates that are around. Screw The Commute Podcast Show Notes Episode 668 How To Automate Your Business - https://screwthecommute.com/automatefree/ Internet Marketing Training Center - https://imtcva.org/ Higher Education Webinar – https://screwthecommute.com/webinars See Tom's Stuff – https://linktr.ee/antionandassociates 02:31 Tom's introduction to YouTube Updates with Marc Bullard 03:34 Setting up Chapters 09:09 Creating "Shorts" videos 16:28 Using YouTube Handles 24:04 Secret keyword tool in YouTube 26:57 YouTube #hashtags Entrepreneurial Resources Mentioned in This Podcast Higher Education Webinar - https://screwthecommute.com/webinars Screw The Commute - https://screwthecommute.com/ Screw The Commute Podcast App - https://screwthecommute.com/app/ College Ripoff Quiz - https://imtcva.org/quiz Know a young person for our Youth Episode Series? Send an email to Tom! - orders@antion.com Have a Roku box? Find Tom's Public Speaking Channel there! - https://channelstore.roku.com/details/267358/the-public-speaking-channel How To Automate Your Business - https://screwthecommute.com/automatefree/ Internet Marketing Retreat and Joint Venture Program - https://greatinternetmarketingtraining.com/ KickStartCart - http://www.kickstartcart.com/ Copywriting901 - https://copywriting901.com/ Disabilities Page - https://imtcva.org/disabilities/ Tom's Patreon Page - https://screwthecommute.com/patreon/ Tom on TikTok - https://www.tiktok.com/@digitalmultimillionaire Marc's books on Amazon - https://www.amazon.com/Marc-Bullard/e/B005LO24GS Email Marc: marc@antion.com Email Tom: Tom@ScrewTheCommute.com Internet Marketing Training Center - https://imtcva.org/ Related Episodes YouTube Secrets - https://screwthecommute.com/82/ NEW YouTube Stuff with Marc Bullard - https://screwthecommute.com/398/ Beginning Video Editing - https://screwthecommute.com/522/ Beginning Videography - https://screwthecommute.com/524/ John Jonas - https://screwthecommute.com/667/ More Entrepreneurial Resources for Home Based Business, Lifestyle Business, Passive Income, Professional Speaking and Online Business I discovered a great new headline / subject line / subheading generator that will actually analyze which headlines and subject lines are best for your market. I negotiated a deal with the developer of this revolutionary and inexpensive software. Oh, and it's good on Mac and PC. Go here: http://jvz1.com/c/41743/183906 The Wordpress Ecourse. Learn how to Make World Class Websites for $20 or less. https://screwthecommute.com/wordpressecourse/ Join our Private Facebook Group! One week trial for only a buck and then $37 a month, or save a ton with one payment of $297 for a year. Click the image to see all the details and sign up or go to https://www.greatinternetmarketing.com/screwthecommute/ After you sign up, check your email for instructions on getting in the group.

With just a few days left of the 2022 season, the guys play the waiting game on what comes next for the Dodgers. Certainly, fans are ready to move and begin the build toward a championship-caliber team for next season. But first, the Phillies and the Astros need to finish battling it out. We look at the latest news out of Dodgers Nation, including Mookie Betts winning his 6th Gold Glove award, and Justin Turner bringing home the coveted Roberto Clemente award for his service to the community. We also discuss the unfair difference in media coverage when it comes to Clayton Kershaw's postseason numbers and Justin Verlander's numbers in October. Onto the Hot Stove talk, there are a lot of question marks for this LA front office coming up this winter. Insiders and pundits have already taken to linking the Dodgers to several big names that will be and could be available this offseason, including Aaron Judge and Shohei Ohtani. Plus Doug shares a great trade idea for the Dodgers and Brewers. Learn more about your ad choices. Visit megaphone.fm/adchoices

More people might be looking for a good film or series to watch as the weather begins to cool. Up To Date invited two movie critics to share suggestions of box office hits and movies and series worth streaming from home.

Episode 115: Erectile Dysfunction Diagnosis.  Discussion about the diagnosis of erectile dysfunction with Andrew, Adriana, and Dr. Arreaza. Causes, labs, and physical exam is briefly discussed. Written by Andrew Kim, MSIV, Western University of Health Sciences, College of Osteopathic Medicine of the Pacific. Comments by Adriana Rodriguez, MS3, Ross University School of Medicine; and Hector Arreaza, MD.September 22, 2022.You are listening to Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California, a UCLA-affiliated program sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. This podcast was created for educational purposes only. Visit your primary care provider for additional medical advice.In episode 39 o erectile dysfunction, Dr. Ihejirika gave us an overview, but today we will be more detailed about the diagnosis of ED. Definition.The American Urological Association (AUA) published an erectile dysfunction guideline in May 2018, which is available online at no cost. Based on that guideline, erectile dysfunction can be defined as “the consistent or recurrent inability to attain and/or maintain penile erection sufficient for sexual satisfaction, including satisfactory sexual performance.” Comment: This guideline provides 25 principles for diagnosing and treating ED. Diagnosis.Getting a good history is important when diagnosing erectile dysfunction. The patient should be asked about the onset of symptoms, severity, how much it hinders his sexual performance, whether the patient can get and maintain an erection, psychological factors, social factors, and presence of morning erections. One can use different questionnaires: the five-question International Index of Erectile Function (IIEF-5) or a single-question self-assessment. Single-question self-assessment:Impotence means not being able to get and keep an erection that is rigid enough for satisfactory sexual activity. How would you describe yourself?Not impotent: always able to get and keep an erection good enough for sexual intercourse.Minimally impotent: usually able to get and keep an erection good enough for sexual intercourse.Moderately impotent: sometimes able to get and keep an erection good enough for sexual intercourse.Completely impotent: never able to get and keep an erection good enough for sexual intercourse.Comment: Basically, the single-question self-assessment is a self-diagnosis of erectile dysfunction; the patient is giving you the severity of his condition. This questionnaire seems to be very subjective. International Index of Erectile Function (IIEF-5):IIEF-5 asks five questions, and the patient answers on a scale of 1 to 5 (1 is the worst, 5 is the best)How do you rate your confidence that you could get and keep an erection?When you had erections with sexual stimulation, how often were your erections hard enough for penetration?During sexual intercourse, how often were you able to maintain your erection after you had penetrated your partner?During sexual intercourse, how difficult was it to maintain your erection to completion of intercourse?When you attempted sexual intercourse, how often was it satisfactory for you?Diagnosis can be made based on the total score. 1 to 7: severe ED, 8 to 11: moderate ED, 12 to 16: mild-moderate ED, 17 to 21: mild ED, and 22 to 25: no ED.This is a self-reported questionnaire, and the score should be interpreted in a clinical context. Answers will likely be biased if, for example, the questionnaire is asked by a female medical assistant. Causes of ED:It is important to assess for medical conditions, psychological conditions, and medications because ED can be caused by vascular, neurological, psychological, and hormonal problems.  Cardiovascular: Some common conditions related to ED are cardiovascular disease (PAD, CAD) and HTN.Endocrine: DM, HLD, obesity, testosterone deficiency (hypogonadism), hyperprolactinemia, thyroid disorder, metabolic syndrome.Neurologic: Neurologic conditions (multiple sclerosis, stroke, spine injury), trauma, and venous leakage.Lifestyle causes: sedentary lifestyle, tobacco use.Psychological: Performance anxiety, relationship issues, anxiety, depression, and stress are common psychological causes.Medications and substances: Alcohol, illicit drugs, and nicotine are important causes of ED, but some medications also cause or worsen ED: opiates, diuretics (spironolactone), antifungals (azoles), anticonvulsants, antidepressants (SSRIs), antihistamines, H2 blocker (cimetidine) antihypertensives, nasal decongestants, and antipsychotics. Remember to ask about over-the-counter medications and supplements.Physical exam: Measure blood pressure, BMI, and a complete exam, especially a genital exam. A comprehensive genitourinary exam should include the inspection of the testicles (atrophy, varicocele, signs of hypogonadism). The penis should be inspected and palpated (look for scar tissue and Peyronie's plaques) and assessment of penile stretch/flaccid length (it is done by stretching the penis. An elastic penis is a healthy penis). Dr. Winter's expert opinion: consider a prostate exam in older patients presenting with ED.Labs: Following physical examination, some lab tests can be ordered to further evaluate possible causes of ED. -A1C and glucose levels can be ordered to look for diabetes. -Lipid panel for hyperlipidemia.-TSH should be checked for thyroid function and to rule out hypothyroidism. -Testosterone deficiency can be assessed by measuring morning serum total testosterone level, which is defined as total testosterone < 300 with signs and symptoms. -Prolactin (perform pituitary MRI in any degree of hyperprolactinemia. In patients taking medications that cause hyperprolactinemia, get MRI if prolactin is above 100) Why is it important to diagnose ED?ED can be linked to organic causes.- Glucose: ED is linked to increased fasting serum glucose levels (diabetes). People with PMH of DM are 3 times more likely to develop ED. The longer the patient had diabetes, the stronger association with ED. Fasting glucose levels are associated with the highest risk of ED. The probability of having undiagnosed DM is 1/50 in the age group 40 to 59 without ED but increases to 1/10 for those with ED.- Testosterone and obesity: Low serum testosterone levels can contribute to the link between metabolic syndrome and ED. In men with obesity, the adipose tissue enzyme aromatase is more prevalent and can convert testosterone into estradiol to cause hypogonadism. Furthermore, adipocytes can cause inflammation and recruit inflammatory cytokines, leading to impaired endothelial function and ED. - Cardiovascular disease: ED and CVD have some common risk factors: older age, HTN, dyslipidemia, smoking, obesity, and DM. ED is related to an increased risk of CVD, CAD, and stroke. Usually, it is thought that ED arises two to five years prior to CAD. If a patient develops signs and symptoms of ED before CAD, the patient can be counseled and educated to make lifestyle modifications to prevent CAD.Furthermore, men with ED are more likely to experience angina, MI, stroke, TIA, CHF, and cardiac arrhythmias when compared to their counterparts without ED. A study from 2003 suggested that patients with ED have a 75% increased risk of developing peripheral vascular disease. Studies suggest ED can predict silent CAD, and one study concluded that the incidence of CAD in men below 40 years of age with ED was seven times higher than that of the control population without ED. It is important to diagnose ED because it can be used as a marker for assessing cardiovascular risk.ED can be linked to many causes, and we as clinicians should be able to identify those causes to prescribe a more specific treatment. Not all ED will respond to “the blue pill”. We will talk about treatment in another episode. Conclusion: Now we conclude episode number 115, “Erectile Dysfunction Diagnosis.” Male sexual health sometimes can be taboo, and patients may not fully disclose personal issues like erectile dysfunction. Andrew and Adrianna explained that an open discussion about erectile dysfunction can help you diagnose underlying conditions, including cardiovascular disease. Dr. Arreaza reminded us that the diagnosis of erectile dysfunction should prompt a deeper investigation in most cases before you attribute it to psychological factors. This week we thank Hector Arreaza, Andrew Kim, Adriana Rodriguez, and Fiona Axelsson. Audio edition by Adrianne Silva. Even without trying, every night you go to bed a little wiser. Thanks for listening to Rio Bravo qWeek Podcast. We want to hear from you, send us an email at RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. See you next week! ___________________________________________________References:Burnett AL, Nehra A, Breau RH, et al. Erectile Dysfunction: AUA Guideline. Journal of Urology. 2018;200(3):633-641. doi:10.1016/j.juro.2018.05.004. https://www.auajournals.org/doi/epdf/10.1016/j.juro.2018.05.004.Rew KT, Heidelbaugh JJ. Erectile Dysfunction. American Family Physician. 2016;94(10):820-827. Accessed September 19, 2022. https://www.aafp.org/pubs/afp/issues/2016/1115/p820.html.Khera M. Evaluation of male sexual dysfunction. UpToDate. www.uptodate.com. Last updated: April 28, 2020. Accessed September 19, 2022. https://www.uptodate.com/contents/evaluation-of-male-sexual-dysfunction.Abrams H, Winter A, Williams PN, Watto MF. “#317 Erectile Dysfunction”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list. January 24, 2022.Royalty-free music used for this episode: Gushito, Burn Flow. by Videvo, downloaded on May 06, 2022, from https://www.videvo.net/royalty-free-music-track/good-vibes-alt-mix/1017292/

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Evon Mendrin, CFP talks about a basic estate planning tool that every optometrist should keep an eye on - keeping beneficiaries up to date on different accounts and life insurance policies. He walks through a few things to keep an eye on as you review your beneficiaries over time. Have questions on anything discussed or want to have topics or questions featured on the show? Send Evon an email at evon@optometrywealth.com.Check out www.optometrywealth.com to get to know more about Evon, his financial planning firm Optometry Wealth Advisors, and how he helps optometrists nationwide. From there, you can schedule a short Intro call to share what's on your mind and learn how Evon helps ODs master their cash flow, build their net worth, and plan purposefully around their money and their practices. 

Q: is your sfuxSFUx course up to date bro. I want to buy it in 2022. A: ဘယ်သောအခါမှ digital marketing course တွေက up to date ဖြစ်မနေပါဘူး။ ကျွန်တော် SFUx မှာ ပြောပြခဲ့တာက digital marketing အတွက်ကို critical knowledge တွေပေးထားခဲ့တာပါ။ ဆိုတော့ ကျွန်တော်သည် ဘာပြီးရင်ဘာနှိပ်ပါဆိုတာထက် ဘယ်လိုမျိုးအခြေအနေမျိုးရောက်ရင် ဘယ်လိုမျိုး တွေးတယ် ဘယ်လိုမျိုးစဉ်းစားသင့်တယ်ဆိုတာမျိုးကို ပြောပြခဲ့တာပါ။ up to date ဖြစ်တဲ့ course တွေကို သင်ချင်တယ်ဆိုရင်တော့ Facebook blue print တို့ think quick google တို့ရှိပါတယ်။ အဲ့မှာသွားသင်ပါ။ linkedIn မှာလည်း linkedIn running ရှိတယ်ပေါ့နော်။ အဲ့တာတွေက platform တွေဘက်ကနေ အလကား သင်ပေးနေတဲ့ဟာတွေဆိုတော့ ဥပမာ- Facebook ရဲ့ ads feature ကဘယ်လိုမျိုးသုံးရတာဆိုတာမျိုးကို အသေးစိတ်မြင်ရပါလိမ့်မယ်။ ကျွန်တော့်ဟာကတော့ အဲ့လောက်ကြီး step by step အနေနဲ့ပြောပြ ထားတာမရှိဘူး။ ကျွန်တော်ကတော့ ဘယ် platform လာလာ ဘယ်လိုမျိုးစဉ်းစားလို့ရတယ်ဆိုတဲ့ concept ကိုပဲသင်ပေးထားတာပါ။ #marketing #digitalmarketing #market #career #askalex #askalexmm

www.tadeclinicagem.com.br/guia - Conheça o Guia TdC com 7 dias grátis Um serviço de revisão e atualização continuados em clínica médica. A informação que você precisa, do jeito que você prefere. Junte-se aos mais de 700 assinantes. Assine o Guia, ganhe tempo e atualize-se sem esforço Joanne e Marcela discutem 4 principais tópicos sobre violência por parceria íntima: - O que é? Qual é a apresentação clínica? - Como suspeitar? - Fatores de risco e como rastrear? - Conduta Referências: Weil A, Elmore JG, Givens J. Intimate partner violence - Diagnosis and screening. UpToDate. Acesso em out/22. Weil A, Elmore JG, Givens J. Intimate partner violence - Intervention and patient management. UpToDate. Acesso em out/22. Weil A, Elmore JG, Givens J. Intimate partner violence - Epidemiology and health consequences. UpToDate. Acesso em out/22. Brasil. Ministério da Saúde. Secretaria de Políticas de Saúde. Violência intrafamiliar: orientações para prática em serviço / Secretaria de Políticas de Saúde. – Brasília: Ministério da Saúde, 2001. https://www.paho.org/pt/topics/violence-against-women Projeto Gênero, Violência e Direitos Humanos – Novas Questões para o Campo da Saúde. O que devem saber os profissionais de saúde para promover os direitos e a saúde das mulheres em situação de violência doméstica. 2a edição, 2003.

This week: new research into using nanoparticles and programmable magnets to clean your teeth; a potentially breakthrough study on a drug for Alzheimer's disease featuring the first positive trial ever for a disease of aging; recapping NASA's recent Double Asteroid Redirection Test mission; and a look into how much control you actually have over what Youtube decides to show you.

Episode 6 is all about female sexual dysfunction: What it is, what it isn't, controversy, hormones, lube, and so much more. This is something that SO MANY women deal with & maybe it could answer some questions you have about your own body or someone elses! Give it a listen & don't judge me too hard on my sick voice, theme of the week is don't get the flu. This episode was sponsered by BetterHelp. You can sign up for 10% off your first month here: www.betterhelp.com/sassyspeculumAnd, you can contact me at sassyspeculum@gmail.com, on Insta @Sassyspeculum or anonymously at www.beatingheartdoula.com/sassyspeculumSources for Episode 6: Institute of Medicine (US) Committee on a National Surveillance System for Cardiovascular and Select Chronic Diseases. A Nationwide Framework for Surveillance of Cardiovascular and Chronic Lung Diseases. Washington (DC): National Academies Press (US); 2011. 2, Cardiovascular Disease. Available from: Moynihan R. The making of a disease: female sexual dysfunction. BMJ. 2003;326(7379):45-47. doi:10.1136/bmj.326.7379.45Bancroft J. The endocrinology of sexual arousal. J Endocrinol. 2005;186(3):411-427. doi:10.1677/joe.1.06233Berman JR, Berman LA, Toler SM, Gill J, Haughie S; Sildenafil Study Group. Safety and efficacy of sildenafil citrate for the treatment of female sexual arousal disorder: a double-blind, placebo controlled study. J Urol. 2003;170(6 Pt 1):2333-2338. doi:10.1097/01.ju.0000090966.74607.34Tiefer L (2006) Female Sexual Dysfunction: A Case Study of Disease Mongering and Activist Resistance. PLoS Med 3(4): e178. https://doi.org/10.1371/journal.pmed.0030178Addyi. UpToDate. (n.d.). Retrieved October 8, 2022,Vylessi. UpToDate (n.d.) Retrieved October 8, 2022 Sarwer DB, Durlak JA. A field trial of the effectiveness of behavioral treatment for sexual dysfunctions. J Sex Marital Ther 1997; 23:87.Addyi (flibanserin): 25 things you need to know. Addyi (Flibanserin): 25 Things You Need to Know: Sex & Relationship Therapist: Stephen Snyder, MD: (n.d.). Retrieved October 8, 2022, Berman JR, Berman L, Goldstein I. Female sexual dysfunction: incidence, pathophysiology, evaluation, and treatment options. Urology. 1999;54(3):385-391.Sexual Dysfunction Caused by Selective Serotonin Reuptake Inhibitors. UpToDate. (n.d.). Retrieved October 8, 2022, Overview of Sexual Dysfunction in Women Management. UpToDate. (n.d.). Retrieved October 8, 2022Gaber MA, Shaltout SA. Assessment of autologous platelet-rich plasma as a local therapy for female sexual dysfunction. Menoufia Med J 2021;34:61-5Platelet-rich plasma (PRP) injections. Johns Hopkins Medicine. (2021, August 23). Retrieved October 8, 2022,Krakowsky Y, Grober ED. A practical guide to female sexual dysfunction: An evidence-based review for physicians in Canada. Can Urol Assoc J. 2018;12(6):211-216. doi:10.5489/cuaj.4907CBS Publishers & Distributors, Pvt. Ltd. (2017). Diagnostic and statistical manual of mental disorders: Dsm-5. Dr. Tammy Ashney, 2022, Female Sexual Dysfunction, National University of Natural Medicine, Winter 2022

It's time for your weekly update from the Checkpoint team with all the latest info you need to survive another week in the video games industry! Join Elliot, Charlie and... LEARN MORE The post Up To Date: Melbourne International Games Week – we discuss what's happening on the biggest week for Aussie gamers! appeared first on Checkpoint.

Join hosts Dr. Mikaela Rush, an OBGyn, and Dr. Anne Sharkey, a Podiatrist, for the second of a three part series of episodes covering menopause.  This week's episode covers the work-up involved when diagnosing menopause.  We cover every symptom that contributes to diagnosis, lab tests, and more. Learn which labs are useful and which labs aren't. Are the symptoms even menopause, or something else? Download and listen to learn more! Have a question we didn't cover or a story you want to share? Send it to us via the link below, or DM us on Instagram @fromtitstotoes or email us at titstotoespodcast@gmail.com.  Don't forget to follow us on Instagram @fromtitstotoes for more information on each episode and behind-the-scenes recording fun! Episode sources- Up To Date. --- Send in a voice message: https://anchor.fm/from-tits-to-toes/message

The first episode of KCUR's Up to Date aired on Sept. 30, 2002. Two decades later, the Up To Date team remembered a few of host Steve Kraske's best and worst live interviews.

www.tadeclinicagem.com.br/guia - Conheça o Guia TdC com 7 dias grátis Um serviço de revisão e atualização continuados em clínica médica. A informação que você precisa, do jeito que você prefere. Junte-se aos mais de 600 assinantes. Assine o Guia, ganhe tempo e atualize-se sem esforço. Referências EAU Guidelines. Edn. presented at the EAU Annual Congress Amsterdam, the Netherlands 2022.ISBN 978-94-92671-16-5 THOMAS C. MICHELS, MD, MPH, AND JARRET E. SANDS, DO. Dysuria: Evaluation and Differential Diagnosis in Adults; Am Fam Physician. 2015;92(9):778-788 James R. Johnson, M.D., and Thomas A. Russo, M.D., C.M. Acute Pyelonephritis in Adults; N Engl J Med 2018; 378:48-59 DOI: 10.1056/NEJMcp1702758 Current cilinical management of renal and perinephric abscesses; Department of Urology, AOUI, Verona - Italy. DOI: 10.5301/urologia.5000044 Stephen Bent, MD et al. Does This Woman Have an Acute Uncomplicated Urinary Tract Infection?. JAMA 2002, The Rational Clinical Examination Kalpana Gupta, MD, MPH. Acute simple cystitis in adult males; UpToDate 2022 Kalpana Gupta, MD, MPH. Acute complicated urinary tract infection (including pyelonephritis) in adults; UpToDate 2022 Thomas L Holland, MDVance G Fowler, Jr, MD. Clinical manifestations of Staphylococcus aureus infection in adults; UpToDate 2022

Amanda Wagner is the President and CEO of Immunitas and was a founding member of the company at its launch in 2019. During her time at Immunitas, she has contributed to the company's fundraising efforts totaling nearly $100 million; led the structuring and negotiation of multiple strategic collaborations with leading academic institutions; and driven the advancement of the lead asset IMT-009, a CD161 inhibitor, and robust pipeline based on the company's proprietary discovery engine. Prior to joining Immunitas, she was Vice President of Corporate Development at Q32 Bio, where she contributed to the company's $46 million Series A. Previously, Amanda was at Concert Pharmaceuticals, where she managed a $250 million asset sale, directly contributed to the Initial Public Offering, and identified and led the development of a preclinical therapeutic for autoimmune disease, now in Phase 3. Prior to Concert, Amanda was an early member of the team at UpToDate, Inc. She also sits on the Board of Directors of the National Alopecia Areata Foundation. Amanda has a master's degree in business administration from the Simmons School of Management.

It's time for your weekly update from the Checkpoint team with all the latest info you need to survive another week in the video games industry! Join Luke, Elliot, David... LEARN MORE The post Up To Date: Grand Theft Auto VI Leaks Confirmed True appeared first on Checkpoint.

The Fellas bringing you anther episode. Just catching up via IG Live & taking about a multitude of Barbershop Chronicles. Thanks for your continued support & comment, download & subscribe. YouTube: https://www.youtube.com/channel/Icutmywayoutpodcast Apple  podcast link: https://podcasts.apple.com/us/podcast/i-cut-my-way-out/id1534702989 Spotify Link: https://open.spotify.com/show/0RliFis3lc25CSOgy4dieV?si=OlW5227TSJW9ZViOU46YGg iHeartRadio: https://www.iheart.com/podcast/269-i-cut-my-way-out-74638487?cmp=ios_share&sc=ios_social_share&pr=false&autoplay=true Pandora: https://pandora.app.link/SW8IWrCkMcb --- Support this podcast: https://anchor.fm/cut-my-way-out/support

Esta semana comentamos varias noticias relevantes en el mundo de la tecnología. --- Send in a voice message: https://anchor.fm/hipolitodelgado/message Support this podcast: https://anchor.fm/hipolitodelgado/support

It's time for your weekly update from the Checkpoint team with all the latest info you need to survive another week in the video games industry! Join Luke, Elliot, Lisa... LEARN MORE The post Up To Date: Australian Game Developer Awards finalists announced and much more gaming news! appeared first on Checkpoint.

This episode we talk with Dr. Laura Fortner, an OB/Gyn, about medical malpractice, the distress associated with it, some statistics, and how physicians can get support if needed. Highlights: Statistics: Average malpractice cases last around 5 years ~75% of primary care will get sued ~99% of surgical specialties will get sued Most cases don't go to trial The ones that do go to trial are usually won by the physician Biggest myths surrounding MedMal: you cannot talk about it it's normal to be sued (see statistics above) Definitions: Litigation stress is intrusive thoughts, buffering behaviors, taking things out on spouses, etc, but still going about your day. Around 95% of physicians get this. Medical Malpractice Stress Syndrome is in the DSM! It a depressive state characterized by depression, anxiety, and apathy. Common reactions to being sued: wanting to quit medicine feeling alone and isolated second guessing your decisions equating this with some judgement about yourself as a doctor or a human avoiding feelings about the situation Helpful charting tips: Include your differential and plan Inlcude "not limited to" for risk/benefit discussions The number one reason people sue is they think something has been hidden or they were not told everything about what happened and why. So be honest, empathetic and open about complications Patient's want to heard - so LISTEN way more than you talk when there is a complication If you get sued, DO NOT to a chart review or even look up related topics on Up To Date from the work computer. Everything is electronically time stamped on these systems. If you must do a Google search, do it from your home computer. If you get sued today: Don't look at the chart until your lawyer talks to you and has a copy Don't read the language in what you're served - your lawyer will help you Write down the caring advice you'd give a best friend in this situation and carry it around with you. Give yourself this same advice. Repeat as often as you need: "It's okay to be sued. It's normal to be sued." Go to TheMedMalCoach.com for more information. There is a free mini-course and group coaching classes available. It isn't reportable, can be very anonymous, and most importantly, can give you the support you likely need in this stressful time. If you're interested in working with us at The Whole Physician, head to our website: www.thewholephysician.com. If you're considering own-occupation insurance or other insurance needs, head to: patternlife.com/drivetime (full disclosure, we do receive a small finders fee if you use our affiliate link above)

Join hosts Dr. Mikaela Rush, an OBGyn, and Dr. Anne Sharkey, a Podiatrist, for the first of a three part series of episodes covering menopause.  This week's episode explains what menopause actually is, and details the symptoms experienced prior to, during, and after menopause.  We cover everything from hot flashes and weight gain to mood and skin changes.  Download and listen to learn more! Have a question we didn't cover or a story you want to share? Send it to us via the link below, or DM us on Instagram @fromtitstotoes or email us at titstotoespodcast@gmail.com.  Don't forget to follow us on Instagram @fromtitstotoes for more information on each episode and behind-the-scenes recording fun! Episode sources- Up To Date. --- Send in a voice message: https://anchor.fm/from-tits-to-toes/message

www.tadeclinicagem.com.br/guia - Conheça o Guia TdC com 7 dias grátis Um serviço de revisão e atualização continuados em clínica médica. A informação que você precisa, do jeito que você prefere. Junte-se aos mais de 600 assinantes. Assine o Guia, ganhe tempo e atualize-se sem esforço. Referências: 1- Uptodate Jan 2022. Approach to the patient with unintentional weight loss. Renuka Gupta, Arthur T Evans, Joann G Elmore, Lisa Kunins. 2- METALIDIS, Christoph et al. Involuntary weight loss. Does a negative baseline evaluation provide adequate reassurance?. European journal of internal medicine, v. 19, n. 5, p. 345-349, 2008. 3- BOSCH, Xavier et al. Unintentional weight loss: Clinical characteristics and outcomes in a prospective cohort of 2677 patients. PloS one, v. 12, n. 4, p. e0175125, 2017. 4- Uptodate 2022. Pathogenesis, clinical features, and assessment of cancer cachexia. Aminah Jatoi,Charles L Loprinzi, Paul J Hesketh, Diane MF Savarese 5- Elizabete Viana de Freitas, Ligia Py. Tratado de Geriatria e Gerontologia. Quarta Edição. Capítulo de Sarcopenia - Marcelo Valente 6- BOURAS, Ernest P.; LANGE, Stephen M.; SCOLAPIO, James S. Rational approach to patients with unintentional weight loss. In: Mayo Clinic Proceedings. Elsevier, 2001. p. 923-929.    7- GADDEY, Heidi L.; HOLDER, Kathryn K. Unintentional weight loss in older adults. American family physician, v. 89, n. 9, p. 718-722, 2014. 8- CRUZ-JENTOFT, Alfonso J. et al. Sarcopenia: revised European consensus on definition and diagnosis. Age and ageing, v. 48, n. 1, p. 16-31, 2019. 9- MCMINN, Jenna; STEEL, Claire; BOWMAN, Adam. Investigation and management of unintentional weight loss in older adults. Bmj, v. 342, 2011.

Apr 21, 2022 Healthcare is being pulled from all angles as it balances a rapidly evolving industry with a tight talent pool. With Invest:Insights, Dean of USF College of Nursing and Senior Associate Vice President of USF Health Usha Menon discussed how big data is transforming healthcare, innovative approaches to meeting healthcare staffing needs and the difficulty of keeping curriculum aligned with a rapidly evolving industry.

It's time for your weekly update from the Checkpoint team with all the latest info you need to survive another week in the video games industry! Join Elliot, Edie, Charlie... LEARN MORE The post Up To Date: Disney and Marvel games showcase appeared first on Checkpoint.

Starting The New Season off fresh, we have our same cast, same vibes and new topics. On this episode we get into how far would you go to protect your child. Bullying, Baby shower etiquette, and the line between privacy over safety in your relationship. Let us know what you think…Leave comments 

Valen Vain is a performer, a sex educator and a "filth wizard" and if that doesn't entice you in then I don't know what will! A lifelong performer, Valen like many creatives did took to the internet dring lockdown, initially to talk about performance. But as the lockdown rolled on and performances dried up he was left with the question "what else could I entertain this audience with" and the answer was sex... education that is! Sex education as many of us will know is still stuck in the dark ages and for anyone who doesn't subscribe to "normal" (think heterosexual, missionary position and anything else just labels you a pervert) sex is left with a drastic lack of representation or even information. Valen and his community aim to change all of that, by embracing all (consentual) forms of sex so long as you are safe, informed and on the same page. His streams are a combination of very up to date sex education and of course entertainment, whilst simultaneously holding space for the mental health of his community too! Or to put it in other words... wholesome chaos!

Technology isn't going anywhere, anytime soon. We must make the most of it by educating ourselves on the latest advancements in medical practice and understanding what benefits we can reap from them. Here to talk through some interesting aspects and some of the history behind Medtech from her hands-on point of view – Dr. Gillian Halley. Tune in and let us know, how do you view technology's role in your own relationship with health and the medical system.

Find out what anxiety is, what is happening in your body & brain and why and how to treat it. If you experience anxiety, this podcast will hopefully help you feel less alone with your symptoms & help you to understand your own body better. Episode 3 resources:Acute Simple Cystitis in Women. UpToDate. Published 2022. Accessed August 29, 2022. Second most common infection in the US proving harder to treat with current antibiotics. Science Daily. Published 2012. Accessed August 29, 2022. Urinary Tract Infections: Causes, Symptoms & Treatment. Cleveland Clinic. Published 2022. Accessed August 26, 2022.Foxman, B. The epidemiology of urinary tract infection. Nat Rev Urol 7, 653–660 (2010). The Link Between UTIs and Sex: Causes and How to Prevent Them. EverydayHealth.com. Published 2022. Accessed August 26, 2022.. 7 Reasons Why Women Get More UTIs Than Men. Virginia Physicians for Women. Published 2022. Accessed August 27, 2022. Genitourinary Problems Worse for Sexually Abused Girls. Medscape. Published 2022. Accessed August 26, 2022.Wiles TJ, Kulesus RR, Mulvey MA. Origins and virulence mechanisms of uropathogenic Escherichia coli. Exp Mol Pathol. 2008;85(1):11-19. Bladder Dysfunction in Sexual Abuse Survivors | Journal of Urology. Journal of Urology. Published 2022. Accessed August 25, 2022.Asselstine M. Body experiences of women survivors of child sexual abuse, implications for therapeutic intervention. Tspace.library.utoronto.ca. Published 1997. Accessed August 29, 2022.Episode 4 resources:Generalized anxiety disorder in adults: epidemiology, pathogenesis, clinical manifestations, course assessment, and diagnosis. Up to Date. Published 2022. Accessed September 5, 2022.Crocq MA. A history of anxiety: from Hippocrates to DSM. Dialogues Clin Neurosci. 2015;17(3):319-325. Furuyashiki T, Narumiya S. Stress responses: the contribution of prostaglandin E(2) and its receptors. Nat Rev Endocrinol. 2011;7(3):163-175. Andreescu C, Lee S. Anxiety Disorders in the Elderly. Adv Exp Med Biol. 2020;1191:561-576. Hoge E, Bickham D, Cantor J. Digital Media, Anxiety, and Depression in Children. Pediatrics. 2017;140(Suppl 2):S76-S80. Tully PJ, Harrison NJ, Cheung P, Cosh S. Anxiety and Cardiovascular Disease Risk: a Review. Curr Cardiol Rep. 2016;18(12):120. Sexual dysfunction & anxiety: Basson R, Gilks T. Women's sexual dysfunction associated with psychiatric disorders and their treatment. Womens Health (Lond). 2018;14:1745506518762664. Mulvey B. Molecular and Functional Sex Differences of Noradrenic Neurons in the Mouse Locus Coeruleus. Cell.com. Published 2022. Accessed September 6, 2022.Facts & Statistics | Anxiety and Depression Association of America, ADAA. Adaa.org. Published 2022. Accessed September 6, 2022.Why Kids and Teens May Face Far More Anxiety These Days. Washington Post. Published 2018. Accessed September 6, 2022.Bickett A, Tapp H. Anxiety and diabetes: Innovative approaches to management in primary care. Exp Biol Med (Maywood). 2016;241(15):1724-1731. doi:10.1177/1535370216657613Bendau A, Petzold MB, Wyka S, Pyrkosch L, Plag J, Ströhle A. Ängste in Zeiten von COVID-19 und anderen Gesundheitskrisen [Anxiety in times of COVID-19 and other health crises]. Nervenarzt. 2021;92(5):417-425. Megan Thee Stallion: Anxiety

When it comes to the Covid-19 pandemic, we've come a long way since March 2020. National shutdowns and event restrictions are seemingly over (knock on wood) and many business owners are wondering whether they still need to address Covid-19 within their contracts.   The short answer? Yes.    The Covid-19 virus is still an issue, people are getting sick with new variants, and the CDC has kept quarantine measures in place for those that test positive. By no means is Covid-19 obsolete – but it also looks a lot different than it did three years ago. Many people are vaccinated, stores and businesses are fully open, events are happening on schedule, and the scary part of the pandemic seems to be behind us. With all that in mind, it's important to review your business' Covid-19 policies and adjust them to align with the times.   In Episode 139 of The Legal Paige Podcast, I stay at the forefront of the pandemic and share my legal perspective on how to keep your business legit and protected with the ever-changing nature of Covid-19. It has been a long three years since this virus appeared and it's important to adapt your policies to protect yourself and your assets as the world adapts to the new normal. Covid-19 is here to stay but that doesn't mean you should be losing money or compromising your policies indefinitely. Here are a few important things to consider:    COVID-19 POSTPONEMENT + CANCELLATION CLAUSES  ARE A THING OF THE PAST    At the beginning of the pandemic, many entrepreneurs added our Covid-19 Postponement & Cancellation Clause to their contract. From March-December 2020, that was100% appropriate as new clients were trying to book and wanted a little ‘pressure release' on rescheduling in case of issues with hosting their wedding/event due to Covid.    Now, as Covid-19 has become a permanent fixture in today's world, entrepreneurs have to make hard business rules surrounding their rescheduling and cancellation policies. More and more people in the event and wedding industry are NOT allowing clients to reschedule or cancel anymore due to Covid-19. This is because if clients are choosing to plan an event right now, they are accepting the risk that Covid poses and choose voluntarily to proceed with those planning risks. Not to mention, if you are willing to block out dates on your calendar and say no to other clients; you cannot afford to allow unending reschedules or cancellations forever.     Ultimately, it makes sense for business owners to no longer give this “pressure release valve” or “open-ended rescheduling opportunity” to their clients. In fact, this is what I recommend as we move into the foreseeable future. AN ACKNOWLEDGEMENT OF COVID-19 AND NO RESCHEDULING CLAUSE IS THE WAY TO GO MOVING FORWARD    The Acknowledgement of Covid-19 and No Rescheduling Clause is a resource that still deserves a spot in your contract. This clause will help you communicate to your clients that you DON'T allow rescheduling due to Covid and that you have business policies in place that will apply if they try to change their date due to fear of Covid (i.e. rescheduling fees should apply!)    This clause also outlines that you will continue to perform your services for their wedding/event as long as you are legally able to do so (aka as long as there isn't a stay-at-home order in place, you contract Covid, or you have been deemed a “close contact” with someone who tested positive and is supposed to quarantine for the health and safety of others). Thus, as long as you can operate your business and do what you are contracted to do for your clients, you will continue to do so and maintain the utmost safety and health precautions.    Furthermore, if your clients contract Covid, you will want to explain in this type of clause what type of policy is in place should that occur. Usually, here, it would be similar to if you tested positive and a one-time reschedule would occur. This would quite literally be the only exception to your strict rescheduling fee policy. All to say, since Covid-19 is still around it makes sense to have your clients continue to acknowledge what will happen if you or they test positive a few days before or the week of the event.    MORE FROM THIS EPISODE   Tune into Episode 139 of The Legal Paige Podcast and learn more about:   How to stay legally protected now that Covid-19 is here to stay. My take on the necessity of Covid Liability Waivers. The CORE protection clauses that should always be in your contract.   If you want more helpful business advice as you'll hear on the podcast, be sure to join The Legal Paige Facebook Community where thousands of entrepreneurs just like you are getting real-time answers about running a professionally and legally legit business.

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Credits: 0.25 AMA PRA Category 1 Credit™   CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-292   Overview: Alcohol use disorder is common, but effective medications to treat this disorder are not widely prescribed in the outpatient primary care setting, despite being available and having relatively good formulary coverage. Join us to hear how the use of medical treatment can decrease the incidence and progression of alcohol-associated liver disease.   Episode resource links: Augustin G. L. Vannier et al, Incidence and Progression of Alcohol-Associated Liver Disease After Medical Therapy for Alcohol Use Disorder, JAMA Network Open (2022).  DOI: 10.1001/jamanetworkopen.2022.13014   Tetreault JM, O'Connor PG. Risky drinking and alcohol use disorder: Epidemiology, pathogenesis, clinical manifestations, course, assessment, and diagnosis. UpToDate. Published April 28, 2022. Accessed June 11, 2022.    Holt SR, Tetrault, JM. Ambulatory Management of alcohol withdrawal. UpToDate. Published May 19, 2022. Accessed June 11, 2022.   Holt SR. Approach to treating alcohol use disorder. UpToDate. Published March 22, 2022. Accessed June 11, 2022.   Guest: Jillian Joseph, MSPAS, PA-C   Music Credit: Richard Onorato

Credits: 0.25 AMA PRA Category 1 Credit™   CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-292   Overview: Alcohol use disorder is common, but effective medications to treat this disorder are not widely prescribed in the outpatient primary care setting, despite being available and having relatively good formulary coverage. Join us to hear how the use of medical treatment can decrease the incidence and progression of alcohol-associated liver disease.   Episode resource links: Augustin G. L. Vannier et al, Incidence and Progression of Alcohol-Associated Liver Disease After Medical Therapy for Alcohol Use Disorder, JAMA Network Open (2022).  DOI: 10.1001/jamanetworkopen.2022.13014     Tetreault JM, O'Connor PG. Risky drinking and alcohol use disorder: Epidemiology, pathogenesis, clinical manifestations, course, assessment, and diagnosis. UpToDate. Published April 28, 2022. Accessed June 11, 2022.    Holt SR, Tetrault, JM. Ambulatory Management of alcohol withdrawal. UpToDate. Published May 19, 2022. Accessed June 11, 2022.   Holt SR. Approach to treating alcohol use disorder. UpToDate. Published March 22, 2022. Accessed June 11, 2022.   Guest: Jillian Joseph, MSPAS, PA-C Music Credit: Richard Onorato

Hey, it's a late show because we wanted to have the most UP TO DATE rumors about the Apple Event so we could spend upwards of THREE MINUTES talking about it. Also, if we had recorded earlier in the week, we would have missed out on the activision news, and wouldn't have gotten caught up in the twitter zeitgeist. Luckily, we are forward thinkers and we have thought forwardly.

A variety of topics are covered on today's podcast as Caleb contemplates business and life while vacationing at the Gulf of Mexico.   https://www.TheHardscapeAcademy.com Auman Landscape on YouTube Linktree/AumanLandscape @aumanlandscapellc www.CycleCPA.com (Use code "Auman" to save $200 when signing up. www.GetJobber.com/Auman (14 Day Free Trial) https://www.greenfoundryco.com/ www.companycam.com/kcpodcast 14 days FREE and 50% off the first 2 months SteinerTurf.com Unilock.com Khohler Lawn & Landscape Society Event LMN Software Code: AUMAN25 Latux Diamond Blades: AUMAN   NDS Drainage Certification FREE: www.lawntrapreneuracademy.com  Mailing Address: Caleb Auman PO Box 203 Carroll, OH 43112 **********  

Adolescents represent a portion of the fastest growing demographic for development of sexually transmitted infection. Studies have found that STIs have some of the highest rates in individuals aged 15-24, and 20% of new HIV diagnoses occur in people aged 13-24. Pre-exposure prophylaxis (PrEP) is medicine people at risk for HIV take to prevent getting HIV from sex or injection drug use and is an effective tool to dramatically decrease the risk of HIV acquisition in at-risk youth. Dr. Cheryl Newman, a board certified infectious disease specialist joins medical students Patrice Collins and Elise Liu to discuss PrEP for HIV prevention in the adolescent population.  After listening to this podcast, learners should be able to: Learn the approach to sexual health screening in adolescents. Understand the risks of HIV exposure in adolescents. Define PrEP and how it works. Understand the requirements for starting PrEP, including demographics and preliminary testing. Explain the federal and/or state laws that govern the prescription of HIV prevention medicine for adolescents. FREE CME Credit (requires free sign-up):  https://mcg.cloud-cme.com/course/courseoverview?P=0&EID=11407    References:  Agwu A. Sexuality, Sexual Health, and Sexually Transmitted Infections in Adolescents and Young Adults. Top Antivir Med. 2020;28(2):459-462. Centers for Disease Control and Prevention. Prep for HIV Prevention in the U.S. Accessed Apr 15, 2022. https://www.cdc.gov/nchhstp/newsroom/fact-sheets/hiv/PrEP-for-hiv-prevention-in-the-US-factsheet.html Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents Living with HIV. National Institute of Health. Updated Jun 03, 2021. Accessed Apr 15, 2022. https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-adult-and-adolescent-arv/adolescents-and-young-adults-hiv#:~:text=Preventive%20Measures%20and%20Supporting%20Long,%2C%20osteoporosis%2C%20and%20neurocognitive%20impairment. Hsu K, Rakhmanina N. Adolescents and Young Adults: The Pediatrician's Role in HIV Testing and Pre- and Postexposure HIV Prophylaxis. Pediatrics. 2022; 149(1):e2021055207 Hosek S, Henry-Reid L. PrEP and Adolescents: The Role of Providers in Ending the AIDS Epidemic. January 2020; 145 (1): e20191743. 10.1542/peds.2019-1743 Truvada Website. https://www.truvada.com/truvada-safety/clinical-studies. Accessed Apr 15, 2022. Descovy Website. https://www.descovy.com/#isi. Accessed Apr 15, 2022. FDA Approves First Injectable Treatment for HIV Pre-Exposure Prevention. Dec 20, 2021. Accessed Apr 15, 2022. https://www.fda.gov/news-events/press-announcements/fda-approves-first-injectable-treatment-hiv-pre-exposure-prevention Landovitz RJ, Donnell D, Clement ME, et al. Cabotegravir for HIV Preention in Cisgender Men and Transgender Women. N Engl J Med. August 2021; 385:595-608. https://www.nejm.org/doi/full/10.1056/NEJMoa2101016 Highleyman L. US approves injectable cabotegravir for PrEP. Accessed Apr 15, 2022. https://www.aidsmap.com/news/dec-2021/us-approves-injectable-cabotegravir-prep Trial results reveal that long-acting injectable cabotegravir as PrEP is highly effective in preventing HIV acquisition in women. Nov 9, 2020. Accessed Apr 15, 2022. https://www.who.int/news/item/09-11-2020-trial-results-reveal-that-long-acting-injectable-cabotegravir-as-prep-is-highly-effective-in-preventing-hiv-acquisition-in-women FDA approves second drug to prevent HIV infection as part of ongoing efforts to end the HIV epidemic. Oct 3, 2019. Accessed Apr 15, 2022. https://www.fda.gov/news-events/press-announcements/fda-approves-second-drug-prevent-hiv-infection-part-ongoing-efforts-end-hiv-epidemic#:~:text=The%20U.S.%20Food%20and%20Drug,who%20have%20receptive%20vaginal%20sex Centers for Disease Control and Prevention. Pre-exposure Prophylaxis (PrEP). Accessed Apr 15, 2022. https://www.cdc.gov/hiv/clinicians/prevention/prep.html#:~:text=For%20oral%20PrEP&text=Assess%20creatinine%20clearance%20once%20every,creatinine%20clearance%20every%206%20months Tanner M, Miele P, et al. Preexposure Prophylaxis for Prevention of HIV Acquisition Among Adolescents: Clinical Considerations, 2020. CDC Recommendations and Reports. 2020; 69(3):1-12 Cowan EA, McGowan JP, Fine SM, et al. Diagnosis and Management of Acute HIV [Internet]. Baltimore (MD): Johns Hopkins University; 2021 Jul. Available from: https://www.ncbi.nlm.nih.gov/books/NBK563020/ Sax PE. Screening and diagnostic testing for HIV infection. In: Post TW, ed. UpToDate; 2022. Accessed May 15, 2022. https://www.uptodate.com/contents/screening-and-diagnostic-testing-for-hiv-infection?search=hiv%20screening&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1 Jaspard M, Le Moal G, Saberan-Roncato M, Plainchamp D, Langlois A, Camps P, Guigon A, Hocqueloux L, Prazuck T. Finger-stick whole blood HIV-1/-2 home-use tests are more sensitive than oral fluid-based in-home HIV tests. PLoS One. 2014 Jun 27;9(6):e101148. doi: 10.1371/journal.pone.0101148. PMID: 24971842; PMCID: PMC4074152. NBC News. 2022. PrEP, the HIV prevention pill, must now be totally free under almost all insurance plans. [online] Available at: [Accessed 19 May 2022].