Village in Western Norway, Norway
POPULARITY
15 episodes with Vats
6 episodes with Vats
2 episodes with Vats
4 episodes with Vats
3 episodes with Vats
2 episodes with Vats
2 episodes with Vats
2 episodes with Vats
2 episodes with Vats
A visionary agreement between Höegh Autoliners and green industry pioneer Nordic Circles launches a national project that will revolutionize the handling of decommissioned ships. Using Norwegian technology, labor, and industry, old ships will be upcycled in Norway into certified building materials - without melting, without export, and with up to 97% lower emissions to create green ship upcycling. Nordic Circles and Höegh Autoliners are announcing the agreement on the Blue Talks stage at Nor-Shipping, in front of maritime leaders from around the world, including high-profile speakers such as John Kerry and Andrew Forrest of Fortescue, underscoring the global significance of the initiative. Norwegian green ship upcycling adventure The project establishes a circular value chain in which decommissioned ships are repurposed as environmentally friendly building materials in Norway. The agreement covers up to eight ships from Höegh Autoliners, to complete the first upcycling in 2026. These eight ships alone could reduce carbon emissions in the construction industry by 100,000 tons of CO2. "We aim to be the greenest in deep-sea shipping and have set a net-zero target by 2040. That's why we're building the world's largest and most environmentally friendly car carriers and investing in making green ammonia a viable fuel already from 2027," says Sebjørn Dahl, COO of Höegh Autoliners. "With this agreement, we ensure sustainability from cradle to grave and lay the foundation for a new green industrial adventure in Norway. We are extremely proud of that." The agreement is worth NOK 1.3 billion. The first vessel is scheduled for decommissioning at AF Offshore Decom in Vats. Norway's Minister of Climate and Environment, Andreas Bjelland Eriksen, will comment on the agreement at the Maritime Bergen stand (C04-33) at Nor-Shipping on Wednesday 3 June from 11:15 to 12:00. There will be interview opportunities with Höegh Autoliners, Nordic Circle and the Minister. Norway as a green industrial leader in Europe Globally, the construction industry accounts for 40% of greenhouse gas emissions, with steel being one of the largest contributors. That's why the core of the project is simple: Steel should not be exported and melted down - it should be reused in Norway and Europe. Norwegian shipyards and the steel industry are being developed into a competitive alternative to Turkey, which currently holds the EU's only large-scale ship recycling capacity. The result is mass-produced steel with minimal emissions, under commercial terms. The project is already supported by the full range of Norwegian public funding instruments through the Green Platform initiative. The founders of Nordic Circles are behind the initiative and lead the consortium. AF Offshore Decom is the main contractor. Participants include leading companies from across the value chain, such as Statsbygg, the municipalities of Oslo and Bergen, Skanska, Green Yard, Equinor, DNB, and SINTEF. "This is circular economy at its best - managing to build a sustainable industry from what we used to export as hazardous waste to Asia. The eight ships will save society around 100,000 tons of CO2 and pave the way for mobilizing shipyards and shipping companies across Europe," says John Jacobsen, CEO of Nordic Circles and Oppsirk. Unlocking a global potential Norway has the fifth largest merchant fleet by value, and when including the EU's share, we see a market potential covering 45% of the world's merchant fleet. A doubling in decommissioning assignments is expected, driven by new climate regulations and an aging fleet. Along the Norwegian coast, the maritime industry has developed seven EU-approved shipyards capable of decommissioning and upcycling. Among them, AF Offshore Decom at Vats is considered the world's most environmentally friendly decommissioning facility. All Norwegian yards have additional capacity, and several are equipped to handle large vessels. This agreement is therefore the first ...
An Airbnb inside a beer vat. F*ck Jelly Roll. ALSO: Walton Goggins, avatar. Giving America a wedgie. PLUS: Murder drones, Monty Python and a song of the week from The Damned!!!The Damned - "Neat Neat Neat": https://www.youtube.com/watch?v=gXKDtkCzSCwCold Brew Patreon: Patreon.com/ChrisCroftonChannel Nonfiction: ChannelNonfiction.com
25.04.25 Pt 1 - Gareth, Ben, and Simphiwe unpack the whirlwind around the recent VAT retraction — was it a smart move or just political damage control? Then, in the ever-bizarre world of celebrity drama, could Diddy actually be Ye's long-lost cousin? We try to make sense of Kanye's latest headline moment. And finally, we cross over to Nigeria where one Pastor is flipping the traditional church model on its head… and gaining a global following while he's at it. The Real Network
Jona | Kjetil Vatsøy | Påskegudstjeneste 21.4.2025 by Salem Bergen
John Murray, Ian Dennis & Ali Bruce-Ball talk commentary life. From Ian's penchant for pies at Celtic to whether the ‘dull' Premier League should have play-offs to make it more interesting. One listener sets a new record for clubs with a slash in their names, and there's a whole heap of controversy in a Clash of the Commentators basement battle. Plus, BBC Sport chief football writer Phil McNulty joins for the Great Glossary of Football Commentary.02:55 Who ate all the pies? 05:40 Would Arsenal fans rather have Saka or Gabriel? 11:35 5 Live's weekend commentaries 14:10 Should the ‘dull' Premier League have play-offs? 20:35 A new record for clubs with a slash in their names 28:10 Controversy in Clash of the Commentators 37:20 Phil McNulty joins for the Great GlossaryBBC Sounds / 5 Live commentaries this weekend: Fri 2000 England women v Belgium in the UEFA Women's Nations League, Fri 1915 Wales women v Denmark on the BBC Sport website, Sat 1500 Crystal Palace v Brighton in the Premier League, Sat 1730 Aston Villa v Nottingham Forest in the Premier League, Sun 1400 Fulham v Liverpool in the Premier League, Sun 1400 Brentford v Chelsea on Radio 5 Sports Extra, Sun 1400 Tottenham v Southampton on the BBC Sport website, Sun 1630 Man Utd v Man City in the Premier League.
Nyheter och fördjupning från Sverige och världen. Lyssna på alla avsnitt i Sveriges Radio Play.
A banger of a Q&A this week! Featuring topics like: Brady airdates and hiatuses, Robert Reed vs Gene Hackman, eating the food during takes, Chris's experience on a Gregg Araki film, jumping the shark, and more! It's Q&A #60! Get your questions for the next Q&A submitted to Ed on our Facebook page @realbradybros To advertise on this podcast please email: ad-sales@libsyn.com Or go to: https://advertising.libsyn.com/therealbradybros
In this month's episode of The Atrium, host Dr. Alice Copperwheat speaks with Dr. Thomas D'Amico about VATS lobectomy. Chapters 00:00 Introduction 01:47 Background 04:11 Indications 04:51 Preoperative Assessment 07:12 Setup 08:21 Patient Positioning 11:26 Basics 13:36 D'Amico's Port Placement 16:46 Uniportal 22:03 Steps 22:44 Anterior-Posterior Order 25:45 Anatomy 26:45 Instruments 30:54 Pleural Dissection 31:33 Inferior Pulmonary Ligament 31:39 Pulmonary Vein 32:01 Artery/Bronchus Dissection 33:38 Nodal Resection 36:25 Tips & Tricks 38:48 Specimen Removal 39:10 Closure 40:02 Postoperative Care 45:01 Outcomes 45:31 CT Surgery Training Advice They discuss the set-up, patient positioning, port placement, dissection of hilar structures, tips and tricks, and more. They also discuss preoperative assessment, nodal resection, specimen removal, closure, and outcomes. The Atrium is a monthly podcast presenting clinical and career-focused topics for residents and early career professionals across all cardiothoracic surgery subspecialties. Watch for next month's episode on ECMO. Disclaimer The information and views presented on CTSNet.org represent the views of the authors and contributors of the material and not of CTSNet. Please review our full disclaimer page here.
This week on The Beat, CTSNet Editor-in-Chief Joel Dunning examines surgical staplers. He explores the history of surgical staplers, the evolution of surgical staplers, and discusses the company that created the first automated minimally invasive surgical stapler—United States Surgical Corporation (USSC). He also discusses details about the AutoSuture Premium Poly stapler and why it is still being created. Joel also shares details about when he visited a production line that is responsible for creating surgical staplers. He discusses his experience and his highlights from this event, which includes meeting Dr. Rene Petersen and Dr. Laurens Ceulemans. Joel also reviews recent JANS articles on heart transplantation and donation after circulatory death in children, priorities for medical device regulatory approval, transplantation of a genetically modified porcine heart into a live human, and mechanisms of repair failure after mitral valve repair using chordal replacement. In addition, Joel explores treating intractable hiccups by clipping the phrenic nerve using VATS, robotic totally endoscopic CryoMaze ablation under ventricular fibrillatory arrest, and a new podcast episode from Dr. Alice Copperwheat, “The Atrium: Internal Mammary Artery Harvesting,” with expert guest Dr. David Taggart. Before closing, he highlights upcoming events in CT surgery. JANS Items Mentioned 1.) Heart Transplantation and Donation After Circulatory Death in Children. A Review of the Technological, Logistical and Ethical Framework 2.) Priorities for Medical Device Regulatory Approval: A Report From the European Society of Cardiology Cardiovascular Round Table 3.) Transplantation of a Genetically Modified Porcine Heart Into a Live Human 4.) Mechanisms of Repair Failure After Mitral Valve Repair Using Chordal Replacement CTSNET Content Mentioned 1.) Treating Intractable Hiccups by Clipping the Phrenic Nerve Using VATS 2.) The Atrium: Internal Mammary Artery Harvesting 3.) Robotic Totally Endoscopic Cryo-Maze Ablation Under Ventricular Fibrillatory Arrest Other Items Mentioned 1.) Career Center 2.) CTSNet Events Calendar Disclaimer The information and views presented on CTSNet.org represent the views of the authors and contributors of the material and not of CTSNet. Please review our full disclaimer page here.
In this month's episode of The Atrium, host Dr. Alice Copperwheat speaks with Dr. David Taggart about internal mammary artery harvesting. They discuss indications, patient preparation, internal thoracic artery anatomy, and key steps—sternotomy, free parietal pleura, incised endothoracic fascia, cutting of IMA, and more. They also discuss the pedicled technique, the skeletonized technique, and complications. The Atrium is a monthly podcast presenting clinical and career-focused topics for residents and early career professionals across all cardiothoracic surgery subspecialties. Watch for next month's episode on VATS lobectomy. Disclaimer The information and views presented on CTSNet.org represent the views of the authors and contributors of the material and not of CTSNet. Please review our full disclaimer page here.
This week on The Beat, CTSNet Editor-in-Chief Joel Dunning speaks with Dr. Husam Balkhy, Professor of Surgery and the Director of Robotic and Minimally Invasive Cardiac Surgery at University of Chicago Medicine and President of The International Society for Minimally Invasive Cardiothoracic Surgery (ISMICS), about robotic totally endoscopic cardiac surgery procedures. They discuss potential ways to get the world to perform more robot-assisted surgeries, the building blocks to learning robotics, the future of learning robotics, and what to expect this year at the ISMICS 2025 Annual Meeting. They also explore Dr. Balkhy's new President's Series on CTSNet and provide insights into the first video of this series. Joel also highlights some of the videos in the CTSNet Resident Video Competition and the robotics vs VATS debate in Britain. Joel also reviews recent JANS articles on the impact of restricted chests on long-term lung function parameters following lung transplantation in patients with interstitial lung disease, determinants of inadequate cardioprotection in adult patients with left ventricular dysfunction, engineered heart muscle allografts for heart repair in primates and humans, and risk factor analysis for 30-day mortality after surgery for infective endocarditis. In addition, Joel explores open repair of descending thoracic and thoracoabdominal aortic aneurysms, totally 3D endoscopic third tricuspid valve replacement, and how to use the Impella for on-pump CABG in patients with low EF. Before closing, he highlights upcoming events in CT surgery. JANS Items Mentioned 1.) The Impact of Restricted Chests on Long-Term Lung Function Parameters Following Lung Transplantation in Patients With Interstitial Lung Disease 2.) Determinants of Inadequate Cardioprotection in Adult Patients With Left Ventricular Dysfunction 3.) Engineered Heart Muscle Allografts for Heart Repair in Primates and Humans 4.) Risk Factor Analysis for 30-Day Mortality After Surgery for Infective Endocarditis CTSNET Content Mentioned 1.) Open Repair of Descending Thoracic and Thoracoabdominal Aortic Aneurysms 2.) Totally 3D Endoscopic Third Tricuspid Valve Replacement 3.) ICC 2024 | How I Use the Impella for On-Pump CABG in Patients With Low EF: Insertion, Intraoperative Management, and Weaning/Removal Other Items Mentioned 1.) President's Series With Husam Balkhy | ISMICS President 2.) ISMICS 2025 Annual Meeting 3.) Career Center 4.) CTSNet Events Calendar Disclaimer The information and views presented on CTSNet.org represent the views of the authors and contributors of the material and not of CTSNet. Please review our full disclaimer page here.
In this Film Ireland podcast, Gemma Creagh talks to Vera Drew, Director & Co-Writer of ‘The People's Joker, which has a special Trans Image/Trans Experience (TITE) Film Festival preview screening at the Light House Cinema on 14th February 2025. The People's Joker is a DIY parody film and hilarious reimagining of the classic autobiographical coming-of-age story follows an unconfident, closeted trans girl as she moves to Gotham City to make it big as a comedian by joining the cast of UCB Live – a government-sanctioned late night sketch show in a world where comedy has been outlawed. As mainstream success eludes our heroine, leading her to unite with a ragtag team of rejects, misfits, and a certain love interest named Mister J, “Joker the Harlequin” is born again as a confident (and psychotic) joker on a collision course with the city's fascist caped crusader. Vats of feminizing chemicals, sexy cartoon interludes, scarecrow psychiatrists, CGI Lorne Michaels, and psychedelic gender dysphoria all play supporting roles. Helmed by writer/director/editor/star Vera Drew and using her own life experiences as a basis for the film, The People's Joker is a deeply personal journey that's as much documentary as it is parody. Trans Image/Trans Experience (TITE) Film Festival https://tite.ie/
The Idaho Farm Bureau Federation put out a fun, entertaining and informative video on one of Idaho's hardiest crops sugar beets.
Chris Thomson, DVM, DACVS-SA from Ethos Veterinary Health will discuss the Minimally Invasive Metastasectomy in Canines (MIMIC) clinical trial which will assess the feasibility and tolerability of VATS for lung metastasis and eventually deliver this care as an outpatient procedure. In addition to assessing the therapeutic benefit in canine patients, the study will also pave the way to conduct accelerated studies to identify new drugs to prevent lung metastases in both human and canine osteosarcoma. The hypothesis that a cross-species approach to metastasis biology and drug development will improve outcomes has been widely discussed and adopted but has not delivered on this promise. Better alignment with the OS pediatric and comparative oncology approaches is needed to understand metastasis biology and optimize drug development. Until now, metastasectomy has rarely been performed in veterinary medicine due to the perceived invasiveness of the procedure in older large-breed dogs. Nonetheless, hints of a benefit to canine OS metastasectomy patients exist.Ethos Discovery, a non-profit incubator of scientific innovation, seeks to evolve the existing perspective regarding OS metastasis in dogs and improve the translational approach via their MIMIC (Minimally Invasive Metastasectomy in Canines) trial to create alignment of the dog model with the OS patients of highest need, those with distant metastasis. In this discussion, Dr. Thomson shares their progress and review preliminary findings from the high-level evidence Ethos-MIMIC clinical trial which suggests that there is more hope for patients than initially thought.
This week on The Beat, CTSNet Editor-in-Chief Joel Dunning spoke with DuyKhanh P. Ceppa about the new Women in Thoracic Surgery (WTS) fellowship. They discuss the goals of this program, who should apply, and how you can contribute to the funding for this program. They also discuss the advantages of leadership programs and the WTS Annual Meeting. Joel also highlights how to build an incredible and happy team across many fields, the importance of a feedback loop within the team, and how to use the holidays to show appreciation for your coworkers. Joel also reviews recent JANS articles on five-year outcomes after bicuspid aortic valve replacement with a novel tissue bioprosthesis, transcatheter valve replacement in severe tricuspid regurgitation, quality of life after transcatheter tricuspid valve replacement, and multicenter validation of the RESECT-90 prediction model for 90-day mortality after lung resection. In addition, Joel explores percutaneous femoral venous cannulation, surgical removal of percutaneously placed pulmonary flow reducers, and uniportal non-ntubated VATS thoracic sympathectomy. Before closing, he highlights upcoming events in CT surgery. JANS Items Mentioned 1.) Five-Year Outcomes After Bicuspid Aortic Valve Replacement With a Novel Tissue Bioprosthesis 2.) Transcatheter Valve Replacement in Severe Tricuspid Regurgitation 3.) Quality of Life After Transcatheter Tricuspid Valve Replacement: One-Year Results From TRISCEND II Pivotal Trial 4.) Multicentre Validation of the RESECT-90 Prediction Model for 90-Day Mortality After Lung Resection CTSNET Content Mentioned 1.) Percutaneous Femoral Venous Cannulation—How to Do It 2.) Surgical Removal of Percutaneously Placed Pulmonary Flow Reducers 3.) Uniportal Non-Intubated VATS Thoracic Sympathectomy Other Items Mentioned The Society of Thoracic Surgeons Expert Consensus for the Surgical Treatment of Hyperhidrosis CTSNet Events Calendar Disclaimer The information and views presented on CTSNet.org represent the views of the authors and contributors of the material and not of CTSNet. Please review our full disclaimer page here.
This week on The Beat, CTSNet Editor-in-Chief Joel Dunning had the opportunity to speak with Dr. Hazem Fallouh about his latest invention for diagnosing cardiac tamponade at the 2024 Birmingham Review Course. They discussed the purpose of this invention, how it went from an idea to being created, and how Dr. Hazem will get this product on the market. Joel also reviews recent JANS articles on initial experience with transcatheter aortic valve replacement before and after lung transplant, a report of salaries of academic cardiothoracic surgeons based on race and ethnicity, chest wall resection and reconstruction for primary chest wall sarcomas, and seven-year outcomes following aortic valve replacement with a novel tissue bioprosthesis. In addition, Joel explores an introduction to redo sternotomy, emergency VATS esophagectomy for T4 esophageal cancer with massive hematemesis in an elderly patient, and pectus excavatum with hemodynamic repercussion corrected by the cross-bar technique with cryoanalgesia. Before closing, he shares upcoming events in CT surgery. JANS Items Mentioned 1.) Initial Experience With Transcatheter Aortic Valve Replacement Before and After Lung Transplant 2.) A Report of Salaries of Academic Cardiothoracic Surgeons Based on Race and Ethnicity 3.) Chest Wall Resection and Reconstruction for Primary Chest Wall Sarcomas: Analysis of Survival, Predictors of Outcome, and Long-Term Functional Status 4.) Seven-Year Outcomes Following Aortic Valve Replacement With a Novel Tissue Bioprosthesis. THE COMMENCE Trial - Looking at RESILIA CTSNet Content Mentioned 1.) An Introduction to Redo Sternotomy 2.) Emergency VATS Esophagectomy for T4 Esophageal Cancer With Massive Hematemesis in an Elderly Patient 3.) Pectus Excavatum With Hemodynamic Repercussion Corrected by the Cross-Bar Technique With Cryoanalgesia Other Items Mentioned CTSNet Events Calendar Disclaimer The information and views presented on CTSNet.org represent the views of the authors and contributors of the material and not of CTSNet. Please review our full disclaimer page here.
Dogman and Paranormal Research
The debut of the infamous ChubFrog! Vats, UFO50, Fischer's meddling, podcast therapy, Aidalon talk, and much more! (00:00:00) Intro (00:09:15) Work Stories (00:32:53) Fischer Books (00:59:05) Listener Questions (01:09:45) Stuff We're Into Email: info@earthbornegames.com Website: https://earthbornegames.com Discord: https://discord.com/invite/mXN2cUNPXE Gamefound: https://gamefound.com/en/creators/earthborne-games BGG: https://boardgamegeek.com/boardgame/342900/earthborne-rangers Twitter: https://twitter.com/EarthborneGames Instagram: https://www.instagram.com/earthbornegames/ Facebook: https://www.facebook.com/earthbornegames
We got green goo, we got blue slime, we got orange viscous fluid. Vats of it! Wholesale style. Come on down and get a whiskey barrel full of ooze! We have internet reviews for old people spearmint candy, the Rugrats reboot, a horse racing novel, and a quaint little McDonalds. For the segment, we deep dive into reviews for the late, great Bob Newhart. Shout out my mucus. Want more party? Check it out at https://www.reviewpartydotcom.com/ !
El Dr. Fred Hirsch, oncólogo médico con PhD, Doctorado en Ciencias por la Universidad de Copenhague en Dinamarca, y Director Ejecutivo del Centro de Oncología Torácica en The Tisch Cancer Institute del Hospital Mount Sinai en Nueva York, discute sobre la evolución del tratamiento del cáncer de pulmón en los últimos años. El experto comienza explorando el impacto de la medicina de precisión y las terapias dirigidas, que han revolucionado el manejo del cáncer de pulmón de células no pequeñas (CPCNP). Afirma que estas terapias han demostrado mayor eficacia y menor toxicidad comparadas con la quimioterapia tradicional, gracias a la identificación de mutaciones accionables como EGFR, ALK, ROS1, BRAF y NTRK. Además, la inmunoterapia ha representado otro avance crucial en el tratamiento de esta enfermedad. Este panorama subraya la creciente importancia de las pruebas de biomarcadores, recomendadas por las guías NCCN, para optimizar la selección del tratamiento desde el momento del diagnóstico. El Dr. Hirsch pasa a discutir sobre las etapas tempranas de la enfermedad, aclarando que la detección con tomografías de baja dosis ha reducido la mortalidad al identificar cánceres tratables, mientras que técnicas quirúrgicas mínimamente invasivas como VATS y cirugía asistida por robot han mejorado la recuperación postoperatoria. También, estudios más recientes sobre la terapia sistémica adyuvante y perioperatoria, ya sea terapia dirigida o inmunoterapia, han demostrado beneficios en esta población. Por otro lado, en pacientes con CPCNP en estadios avanzados, la radioterapia estereotáctica ha ofrecido excelente control local con mínima toxicidad en aquellos que no son candidatos para cirugía. De igual forma, la integración de terapias dirigidas e inmunoterapias ha revolucionado las opciones de tratamiento de consolidación, incluso con resultados positivos en pacientes con cáncer de pulmón de células pequeñas. En el contexto metastásico, la combinación de quimioterapia con inmunoterapia o terapias dirigidas ha redefinido el estándar de tratamiento. Estudios recientes han mostrado mejoras en la supervivencia global y respuestas duraderas, abriendo nuevas esperanzas para estos pacientes. En resumen, estos avances permiten personalizar el tratamiento del cáncer de pulmón y mejorar la supervivencia. El experto invita a fomentar la colaboración y la adaptabilidad, ya que son la clave para continuar innovando y alcanzar nuevos logros en el cuidado de estos pacientes. Gracias al apoyo educativo de AstraZeneca México. Videograbado: 27 de junio de 2024 Todos los comentarios emitidos por los participantes son a título personal y no reflejan la opinión de ScienceLink u otros. Se deberá revisar las indicaciones aprobadas en el país para cada uno de los tratamientos y medicamentos comentados. Las opiniones vertidas en este programa son responsabilidad de los participantes o entrevistados, ScienceLink las ha incluido con fines educativos. Este material está dirigido a profesionales de la salud mexicanos exclusivamente.
Contributor: Aaron Lessen, MD Educational Pearls: Hemothorax: blood in the pleural cavity, most commonly due to chest trauma Treatment: thoracostomy tube for blood drainage helps to avoid clotting, scarring, and infection A recent study looked at patients with hemothorax who either received or did not receive thoracic irrigation with saline Evaluated incidence of secondary intervention, such as video-assisted thoracoscopic surgery (VATS), for persistent hemothorax Patients who received irrigation had a slight decrease in secondary intervention frequency Multi-center study - all patients who had the irrigation procedure were at two centers Study limitation: variability in approaches at each location could be a confounder Technique that could potentially prevent future complications References Carver TW, Berndtson AE, McNickle AG, et al. Thoracic irrigation for prevention of secondary intervention after thoracostomy tube drainage for hemothorax: A Western Trauma Association multi-center study. J Trauma Acute Care Surg. Published online May 20, 2024. doi:10.1097/TA.0000000000004364 Yi JH, Liu HB, Zhang M, et al. Management of traumatic hemothorax by closed thoracic drainage using a central venous catheter. J Zhejiang Univ Sci B. 2012;13(1):43-48. doi:10.1631/jzus.B1100161 Summarized by Meg Joyce, MS | Edited by Meg Joyce & Jorge Chalit, OMS3 Donate: https://emergencymedicalminute.org/donate/
This week on The Beat, Editor in Chief Joel Dunning speaks with Brian Houseman about VATS vs robotic lobectomy. They discuss training programs, the speed and efficiency of VATS, advanced chemotherapy cases, instruments used, safety, and the difference in pain for robotic-assisted surgery vs VATS. Joel also discusses EACTS/STS guidelines for diagnosing and treating acute and chronic syndromes of the aortic organ, percutaneous versus surgical femoral cannulation in minimally invasive cardiac surgery, 2024 ESC guidelines for the management of chronic coronary syndromes, and transcatheter myotomy to reduce left ventricular outflow obstruction SESAME technique. In addition, Joel highlights a robotic-assisted left lower lobectomy for NSCLC after neoadjuvant chemoimmunotherapy, chordal repair of P2 and P3 and left atrial appendage stapling through an upper mini sternotomy, and the Bookwalter retractor. Before closing, he shares upcoming events in CT surgery. JANS Items Mentioned 1.) EACTS/STS Guidelines for Diagnosing and Treating Acute and Chronic Syndromes of the Aortic Organ 2.) Percutaneous Versus Surgical Femoral Cannulation in Minimally Invasive Cardiac Surgery: A Systematic Review and Meta-Analysis 3.) 2024 ESC Guidelines for the Management of Chronic Coronary Syndromes 4.) Transcatheter Myotomy to Reduce Left Ventricular Outflow Obstruction CTSNET Content Mentioned 1.) Robotic-Assisted Left Lower Lobectomy for NSCLC After Neoadjuvant Chemoimmunotherapy 2.) Chordal Repair of P2 and P3 and Left Atrial Appendage Stapling Through an Upper Mini Sternotomy 3.) The Bookwalter Retractor—A Resident's Best Friend Other Items Mentioned CTSNet Events Calendar Disclaimer The information and views presented on CTSNet.org represent the views of the authors and contributors of the material and not of CTSNet. Please review our full disclaimer page here.
This week on The Beat, Editor in Chief Joel Dunning speaks with Ahmed Abbas about the recent 2024 Warith International Cardiology and Cardiothoracic Surgery Conference he organized at the University of Warith Al-Anbiyaa in Karbala, Iraq. They discuss the quality of heart surgery in Iraq, how many available facilities there are, how cardiothoracic surgery differs in Iraq from other countries, and the challenges of performing cardiothoracic surgery in Iraq. Additionally, Joel spoke with medical students to gain their perspectives on studying medicine in Iraq and their aspirations for the future. He also discusses several JANS items including VATS thoracoscopic S1 segmentectomy, restoring discarded porcine lungs, emergent coronary revascularization with PCI and CABG, heart transplant for a patient with left superior vena cava, pathways to cardiothoracic surgery, defining resectability, and outcomes following heart valve surgery in patients with infective endocarditis. In addition, Joel discusses a trans-subxiphoid robotic-assisted thymectomy, Apple Vision Pro spatial computing for endoscopic mitral valve, and the Aswan technique for extended septal myectomy. Before closing, Joel discusses upcoming events in CT surgery. JANS Items Mentioned 1.) VATS Thoracoscopic S1 Segmentectomy, Right Upper Lobe: Alternative Posterior Approach 2.) Restoring Discarded Porcine Lungs by Ex Vivo Removal of Neutrophil Extracellular Traps 3.) Emergent Coronary Revascularization With PCI and CABG in Patients Receiving Extracorporeal Cardiopulmonary Resuscitation 4.) Heart Transplant for a Patient With Left Superior Vena Cava—Case Report and Surgical Technique 5.) Pathway to Cardiothoracic Surgery: A Primer for Aspiring Students 6.) Defining Resectability: When Do You Try to Take It Out? 7.) Outcomes Following Heart Valve Surgery in Patients With Infective Endocarditis and Preoperative Septic Cerebral Embolism CTSNet Content Mentioned 1.) The Aswan Technique for Extended Septal Myectomy 2.) Apple Vision Pro Spatial Computing for Endoscopic Mitral Valve and VSD Surgery 3.) Trans-Subxiphoid Robotic-Assisted Thymectomy Other Items Mentioned CTSNet Events Calendar Disclaimer The information and views presented on CTSNet.org represent the views of the authors and contributors of the material and not of CTSNet. Please review our full disclaimer page here.
The heroes gain access to the Serpent Person facility inside the volcano and find unspeakable horrors If you like what you hear please support the show at Patreon to get early access, exclusive content and more AP Thackery is played by Archie Logan Selby is played by Kenneth Richard Chesterton is played by Nicky Amar is played by Karl In the epic Pulp campaign Two-Headed Serpent from Chaosium, written by Paul Fricker, Scott Dorward, and Matthew Sanderson. Edited by Mike Mason.
This week on The Beat, Editor in Chief Joel Dunning speaks with Dr. Raja Flores about VATS lobectomy. They discuss his experience and studies in VATS lobectomy and Dr. Flores's technique for this procedure. He also discusses the evolution of the treatment of non-small cell lung cancer, percutaneous coronary intervention versus coronary artery bypass grafting for left main disease, current indications and surgical strategies for myocardial revascularization in patients with left ventricular dysfunction, and pneumonectomy following penetrating trauma with ECMO as postoperative support. In addition, Joel discusses a bilateral internal mammary artery harvest using an SSi MANTRA, sinus venosus atrial septal defect repair using a beating heart technique, and another installment in Dr. Tristan Yan's aortic repair series focused on mega-thoracic aortic aneurysm repair. Before closing, Joel discusses upcoming events in CT surgery. JANS Items Mentioned 1.) The Evolution of the Treatment of Non-Small Cell Lung Cancer: A Shift in Surgical Paradigm to a More Individualized Approach 2.) Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting for Left Main Disease According to Age 3.) Current Indications and Surgical Strategies for Myocardial Revascularization in Patients With Left Ventricular Dysfunction 4.) Pneumonectomy Following Penetrating Trauma With ECMO as Postoperative Support: Case Report—(Lung Trauma and ECMO) CTSNET Content Mentioned Bilateral Internal Mammary Artery Harvest Using an SSi MANTRA Sinus Venosus Atrial Septal Defect Repair Using a Beating Heart Technique Deep Dive Into Aortic Surgery: Mega-Thoracic Aortic Aneurysm Repair Other Items Mentioned CTSNet Events Calendar Disclaimer The information and views presented on CTSNet.org represent the views of the authors and contributors of the material and not of CTSNet. Please review our full disclaimer page here.
This week, The Musafir Stories speaks to a traveler and product manager, Anaya Vats, as she takes us to the princess of hills! Today's destination: Kodaikanal!! Nearest Airport: Madurai International airport (IXM) Nearest Railway Station: Kodaikanal railway station (KQN) Requirements: n/a Packing: Pack depending on the weather, winters are cool and summers can be HOT! Time of the year: June to Feb Length of the itinerary: 7 days Itinerary Highlights: Ananya covers some of the highlights from her trip to Kodaikanal, which started out as a weekend getaway but turned into a longer workcation. Some of the points of interest covered on the podcast include Dolphin's nose Waterfalls including - Silver cascade waterfall, Bear Shola waterfall, Liril waterfalls, Pambar waterfalls Lakes including Kodaikanal lake, Mannavanur lake, Kookal lake Poombrai village Pine forest Coaker's walk Guna caves or Devil's kitchen Pillar rocks View points Kodaikanal Solar Observatory Food - including Altaf's cafe, Abby's cafe, Mia's treats, Astoria Links: Link to Ananya's newsletter: https://ananyavats.substack.com/ Link to Instagram: https://www.instagram.com/ananya_vats?igsh=MXFmOXJ4NTFqcHpvaw== Photo by Preethi RB on Unsplash Follow the Musafir stories on: Twitter : https://twitter.com/musafirstories?lang=en Facebook: https://www.facebook.com/themusafirstories/ Instagram: https://www.instagram.com/musafirstoriespodcast/?hl=en website: www.themusafirstories.com email: themusafirstories@gmail.com Do follow IVM Podcasts on social media. We are @IVMPodcasts on Facebook, Twitter, & Instagram. Follow the show across platforms: Spotify, Google Podcasts, Apple Podcasts, JioSaavn, Gaana, Amazon Music Do share the word with your folks! See omnystudio.com/listener for privacy information.
FLT podcast official Interview with the designer of the VATS clothing brand and creator of the OH SO BOLD “Why are white men obsessed with Black Dicks?!”Collection Douglas Shindler. We got up close and personal with the man behind the brand and found out what really inspired this buzz worthy collection. --- Send in a voice message: https://podcasters.spotify.com/pod/show/fashion-talk/message
Welcome to another Tired and Tested podcast! In which Sophie reflects on the fallout from her 40th birthday party, featuring a drunken cameo from Lucy with the Fringe. Brace yourself for microneedling chat, Pizza Express junkets and another visit to Urban Urban Dictionary corner.Want to win a FREE ICONIC MASCARA? Submit your parenting tale to tiredandtested@acast.com - and if we pick yours, we'll send you a free mascara!Tickets for Sophie's 'work in progress' show at the Edinburgh Fringe are here Hosted on Acast. See acast.com/privacy for more information.
Doctors Vamsi Velcheti, Sandip Patel, and Michael Zervos discuss recent updates on the management of early-stage non-small cell lung cancer (NSCLC), including the optimization of neoadjuvant and adjuvant treatment options for patients and the role of surgery in the era of targeted therapy and immuno-oncology in lung cancer. TRANSCRIPT Dr. Vamsi Velcheti: Hello, I'm Dr. Vamsi Velcheti, your guest host for the ASCO Daily News Podcast today. I am a professor of medicine and director of thoracic medical oncology at the Perlmutter Cancer Center at NYU Langone Health. On today's episode, we'll be discussing recent updates on the management of early-stage non-small cell lung cancer (NSCLC), including the optimization of neoadjuvant and adjuvant treatment options for our patients, and the evolving role of surgery in the era of targeted therapy and immuno-oncology in lung cancer. Today, I am delighted to be joined by two renowned experts in this space, Dr. Sandip Patel and Dr. Michael Zervos. Dr. Patel is a professor of medicine and a medical oncologist specializing in lung cancer at UCSD. Dr. Mike Zervos is the clinical chief of the Division of Robotic Thoracic Surgery and Director of General Thoracic Surgery at NYU Langone. Our full disclosures are available in the transcript of this episode, and disclosures relating to all episodes of the podcast are available at asco.org/DNpod. Dr. Patel and Dr. Zervos, it's a great honor to have you on the podcast today. Welcome aboard. Dr. Sandip Patel: Great to be joining you. Dr. Vamsi Velcheti: Let's get started with Dr. Patel. As you know, over the last decade we've had dramatic advances in systemic therapy options for patients with metastatic non-small cell lung cancer, in both the realms of targeted therapy and immunotherapy. These have significantly improved outcomes for our patients with metastatic lung cancer. What's exciting is that more recently, we've seen the incorporation of these agents, both targeted therapies and immunotherapies, in early-stage non-small cell lung cancer. Dr. Patel, can you tell our listeners about these exciting recent advances and why do you think it's so important to incorporate these personalized systemic therapy options for our early-stage patients? Dr. Sandip Patel: I think it's a great point and a great question. And so, I think one thing to understand is that non-small cell lung cancer is actually multiple diseases. We give it one name based on how it looks under the microscope, but the vast majority of our advances to improve outcomes for patients have come from our ability to understand specific subgroups. Many of our therapies have had activity in the advanced setting. We have our patients with metastatic or more widespread disease, which naturally led to the thought that could we utilize these therapies in earlier stage disease and potentially increase the rate of cure for many of our patients, lung cancer being the most common cancer killer worldwide. And so to your point, trying to understand how to best treat a patient really involves personalized medicine, typically driven by understanding the genomic profile of their tumor and two of the genes that have graduated from being tested for in the metastatic setting and now in the localized setting are EGFR and ALK. And these in particular are mutations that confer sensitivity to small molecule inhibitors, EGFR with osimertinib, ALK in the localized setting with alectinib based on the data that we've seen. And so, one of the areas that's been particularly exciting is our ability to maximize a patient's chance for durable remissions by integrating these therapies after surgery, after chemotherapy when appropriate, and continuing generally for a finite amount of time, two to three years depending on the agent in the study we're discussing for these patients. Additionally, immunotherapy, which has revolutionized our treatment of patients with metastatic disease, may be particularly well-suited for the localized setting of non-small cell lung cancer as well. Dr. Vamsi Velcheti: Excellent points, Sandip. You're absolutely right, in the metastatic setting, we've all come to accept molecular testing, sequencing, and biomarker profiling as a standard, but unfortunately, that hasn't quite yet percolated into the early-stage setting. Can you talk about some of the challenges that we face as we have these therapeutic options available now for more early-stage patients? Dr. Sandip Patel: So, I think there are 3 flavors of localized therapy in non-small cell lung cancer. One is the advanced, unresectable stage 3, for which the approach is often concurrent chemo-radiation followed by some form of consolidated therapy. We're about to hear the results of LAURA, which is the study looking at EGFR-mutated non-small cell lung cancer. For other patients, historically, the treatment has been durvalumab, an anti-PD-L1 directed immunotherapy. The other two are operative treatment of localized cancer: adjuvant treatment after surgery, or neoadjuvant or perioperative, in which chemoimmunotherapy begins before surgery. And testing depends on the settings. For the stage 3 patient who's likely getting concurrent chemo-radiation, they may have a very small amount of tissue, and so often these are done by pulmonary EBUS biopsies and that's how we pathologically confirm that advanced stage 3B. There may not be a lot of tissue available for molecular testing. In fact, if you look at the PACIFIC analysis, just looking at PD-L1, which is just an IHC off a single slide, a third of patients weren't able to even get a PD-L1, let alone a genomic result. And so, I think that's one of the areas of LAURA that's going to be particularly interesting to see as we try to implement it into our practice after seeing the full data. I think in the adjuvant setting, we're lucky because our surgeons, Dr. Mike Zervos here, will get us a large amount of tissue in the surgical resection specimen, so we tend to get enough tissue to do genomics while they're under chemotherapy, there tends to be time to wait for their genomic result. Where this really gets complicated is in the neoadjuvant or perioperative setting, where time is everything. The most important thing we can do for a patient in the localized space is get them to the operating room, get them started on radiation, their curative local modality, and that's where we have a time pressure but also a sample pressure because that is a diagnostic biopsy. It's a very small piece of tissue. Initially, there are multiple stains that have to be done to identify this lung cancer as opposed to another tumor. And so that's an area that I think we're going to need additional approaches given that cell-free DNA tends to have lower yield in lower stage disease in giving us a result. Dr. Vamsi Velcheti: Great points, Sandip. How do you deal with this issue in San Diego? The challenge is now we have a lot of trials, we'll talk about those neoadjuvant immunotherapy trials, but we know that immunotherapy may not be as effective in all patients, especially those with EGFR or ALK or some of these non-smoker, oncogene-driven tumors. So, we don't want to be giving patients treatments that may not necessarily be effective in the neoadjuvant space, especially when there is a time crunch, and we want to get them to surgery and all the complications that come with giving them targeted therapy post-IO with potential risk for adverse events. Dr. Sandip Patel: Absolutely. It is a great point. And so, the multidisciplinary team approach is key, and having a close relationship with the interventional pulmonary oncs, interventional radiology surgery, and radiation oncology to ensure that we get the best treatment for our patients. With the molecularly guided therapies, they are currently more on the adjuvant setting in terms of actually treating. But as you mentioned, when we're making a decision around neoadjuvant or perioperative chemo IO, it's actually the absence of EGFR now that we're looking for because our intervention at the current time is to give chemoimmunotherapy. Going back to the future, we used to use single gene EGFR within 24 hours, which was insufficient for a metastatic panel, but it often required five slides of tissue input. ALK can be done by IHC, and so some of these ‘oldie but goodie' pathologic techniques, and that pathologists, if I haven't emphasized, understanding what we're trying to do at a different context is so key because they are the ones who really hold the result. In the neoadjuvant and perioperative setting, which many of us favor, especially for stage 3A and stage 2B disease, understanding how we can get that result so that we can get the patient to the operating room in an expeditious way is so important. There is a time pressure that we always had in the metastatic setting, but I think we feel much more acutely in the neoadjuvant and perioperative setting in my opinion. Dr. Vamsi Velcheti: Fascinating insights, Dr. Patel. Turning to Dr. Zervos, from a surgical perspective, there has been an evolution in terms of minimally invasive techniques, robotic approaches, and enhanced recovery protocols, significantly improving outcomes in our patients post-surgery. How do you see the role of surgery evolving, especially with the increasing complexity and efficacy of these systemic therapies? How do you envision the role of surgery in managing these early-stage patients, and what are the key considerations for surgeons in this new era? Dr. Michael Zervos: Thanks, Vamsi. Thanks, Sandip. Thank you for having me on the podcast. Obviously, it's an honor to be a part of such a high-level discussion. I have to say, from a surgeon's perspective, we often listen to you guys talk and realize that there's been a lot of change in this landscape. And I think the thing that I've seen is that the paradigm here has also changed. If we were having this discussion 10 years ago, a lot of the patients that I am operating on now, I would not be operating on. It really has been amazing. And I think the thing that stands out to me the most is how all of this has changed with neoadjuvant chemotherapy checkpoint inhibition. I think, for us as surgeons, that's really been the key. Whether it's CheckMate 816 or whatever you're following, like PACIFIC, the data supports this. And I think what we're seeing is that we're able to do the surgery, we're able to do it safely, and I think that the resectability rates are definitely high up there in the 90% range. And what we're seeing is pretty significant pathologic responses, which I think is really amazing to me. We're also seeing that this has now shifted over to the oligometastatic realm, and a lot of those patients are also being treated similarly and then getting surgery, which is something that we would not have even thought of ever. When you look at the trials, I think a lot of the surgery, up to this point, has been done more traditionally. There's a specific reason why that happens, specifically, more through thoracotomy, less with VATS, and less with robotic. Sandip, I think you guys have a pretty robust robotic program at UCSD, so I'm sure you're pretty used to seeing that. As you guys have become so much more sophisticated with the treatments, we have also had to modify what we do operatively to be able to step up to the plate and accept that challenge. But what we are seeing is yes, these treatments work, but the surgeries are slightly more complicated. And when I say slightly, I'm minimizing that a little bit. And what's complicated about it is that the treatment effect is that the chemo-immune check inhibition actually has a significant response to the tumor antigen, which is the tumor. So it's going to necrose it, it's going to fibrose it, and wherever there is a tumor, that response on the surgical baseline level is going to be significant. In other words, there are going to be lymph nodes that are stuck to the pulmonary artery, lymph nodes that are stuck to the airway, and we've had to modify our approaches to be able to address that. Now, fortunately, we've been able to innovate and use the existing technology to our advantage. Personally, I think robotics is the way we have progressed with all this, and we are doing these surgeries robotically, mainly because I think it is allowing us, not only to visualize things better, but to have sort of a better understanding of what we're looking at. And for that matter, we are able to do a better lymph node dissection, which is usually the key with a lot of these more complicated surgeries, and then really venturing out into more complicated things, like controlling the pulmonary artery. How do we address all this without having significant complications or injuries during the surgery? Getting these patients through after they've successfully completed their neoadjuvant treatment, getting them to surgery, doing the surgery successfully, and hopefully, with minimal to no morbidity, because at the end, they may be going on to further adjuvant treatment. All of these things I think are super important. I think although it has changed the landscape of how we think of things, it has made it slightly more complicated, but we are up for the challenge. I am definitely excited about all of this. Dr. Vamsi Velcheti: For some reason, like medical oncologists, we only get fixated on the drugs and how much better we're doing, but we don't really talk much about the advances in surgery and the advances in terms of outcomes, like post-op mortality has gone down significantly, especially in larger tertiary care centers. So, our way of thinking, traditionally, the whole intergroup trials, the whole paradigm of pneumonectomies being bad and bad outcomes overall, I think we can't judge and decide on current treatment standards based on surgical standards from decades ago. And I think that's really important to recognize. Dr. Michael Zervos: All of this stuff has really changed over the past 10 years, and I think technology has helped us evolve over time. And as the science has evolved for you with the clinical trials, the technology has evolved for us to be able to compensate for that and to be able to deal with that. The data is real for this. Personally, what I'm seeing is that the data is better for this than it was for the old intergroup trials. We're able to do the surgery in a better, more efficient, and safer way. The majority of these surgeries for this are not going to be pneumonectomies, they are going to be mostly lobectomies. I think that makes sense. I think for the surgeons who might be listening, it doesn't really matter how you're actually doing these operations. I think if you don't have a very extensive minimally invasive or robotic experience, doing the surgery as open is fine, as long as you're doing the surgery safely and doing it to the standard that you might expect with complete lymph node clearance, mediastinal lymph node clearance, and intrapulmonary lymph node clearance. Really, I think that's where we have to sort of drive home the point, really less about the actual approach, even though our bias is to do it robotically because we feel it's less morbidity for the patient. The patients will recover faster from the treatment and then be able to go on to the next phase treatments. Dr. Vamsi Velcheti: In some of the pre-operative trials, the neoadjuvant trials, there have been some concerns raised about 20% of patients not being able to make it to surgery after induction chemo immunotherapy. Can you comment on that, and why do you think that is the case, Sandip? Dr. Sandip Patel: Well, I think there are multiple reasons. If you look, about half due to progression of disease, which they might not have been great operative candidates to begin with, because they would have early progression afterwards. And some small minority in a given study, maybe 1% to 2%, it's an immune-related adverse event that's severe. So, it's something that we definitely need to think about. The flip side of that coin, only about 2 in 3 patients get adjuvant therapy, whether it be chemotherapy, immunotherapy, or targeted therapy. And so, our goal is to deliver a full multimodal package, where, of course, the local therapy is hugely important, but also many of these other molecular or immunologically guided agents have a substantial impact. And I do think the point around neoadjuvant and perioperative is well taken. I think this is a discussion we have to have with our patients. I think, in particular, when you look at higher stage disease, like stage 3A, for example, the risk-benefit calculus of giving therapy upfront given the really phenomenal outcomes we have seen, really frankly starting with the NADIM study, CheckMate816, now moving on into studies like KEYNOTE-671, AEGEAN, it really opens your eyes in stage 3. Now, for someone who's stage 1/1b, is this a patient who's eager to get a tumor out? Is there as much of an impact when we give neoadjuvant therapy, especially if they're not going to respond and may progress from stage 1 and beyond? I think that's a reasonable concern. How to handle stage II is very heterogeneous. I think two points that kind of happen as you give neoadjuvant therapy, especially chemo-IO that I think is worth for folks to understand and this goes to Mike's earlier point, that is this concept if they do get a scan during your neoadjuvant chemo immunotherapy, there is a chance of that nodal flare, where the lymph nodes actually look worse and look like their disease is progressing. Their primary tumor may be smaller or maybe the same. But when we actually go to the OR, those lymph nodes are chock-full of immune cells. There's actually no cancer in those lymph nodes. And so that's a bit of a red herring to watch out for. And so, I think as we're learning together how to deliver these therapies, because the curative-intent modality is, in my opinion, a local modality. It's what Mike does in the OR, my colleagues here do in the OR. My goal is to maximize the chance of that or really maximize the long-term cure rates. And we know, even as long as the surgery can go, if only 2 or 3 patients are going to get adjuvant therapy then 1 in 10, of which half of those or 1 in 20, are not getting the surgery and that's, of course, a big problem. It's a concern. I think better selecting towards those patients and thinking about how to make these choices is going to be hugely important as we go over. Because in a clinical trial, it's a very selective population. A real-world use of these treatments is different. I think one cautionary tale is that we don't have an approval for the use of neoadjuvant or perioperative therapy for conversion therapy, meaning, someone who's “borderline resectable.” At the time at which you meet the patient, they will be resectable at that moment. That's where our best evidence is, at the current time, for neoadjuvant or perioperative approaches. Dr. Vamsi Velcheti: I think the other major issue is like the optimal sequencing of immune checkpoint here. Obviously, at this point, we have multiple different trial readouts, and there are some options that patients can have just neoadjuvant without any adjuvant. Still, we have to figure out how to de-escalate post-surgery immunotherapy interventions. And I think there's a lot of work that needs to be done, and you're certainly involved in some of those exciting clinical trials. What do you do right now in your current clinical practice when you have patients who have a complete pathologic response to neoadjuvant immunotherapy? What is the discussion you have with your patients at that point? Do they need more immunotherapy, or are you ready to de-escalate? Dr. Sandip Patel: I think MRD-based technologies, cell-free DNA technologies will hopefully help us guide this. Right now, we are flying blind along two axes. One is we don't actually know the contribution of the post-operative component for patients who get preoperative chemo-IO. And so this is actually going to be an ongoing discussion. And for a patient with a pCR, we know the outcomes are really quite good based on CheckMate816, which is a pure neoadjuvant or front-end only approach. Where I actually struggle is where patients who maybe have 50% tumor killing. If a patient has only 10% tumor killing ... the analogy I think in clinic is a traffic light, so the green light if you got a pCR, a yellow light if you have that anywhere from 20%-70% residual viable tumor, and then anything greater than that, you didn't get that much with chemo-IO and you're wondering if getting more chemo-IO, what would that actually do? It's a bit of a red light. And I'm curious, we don't have any data, but my guess would be the benefit of the post-op IO is because patients are in that kind of yellow light zone. So maybe a couple more cycles, we'll get them an even more durable response. But I am curious if we're going to start relying more on MRD-based technologies to define treatment duration. But I think it's a very complicated problem. I think folks want to balance toxicity, both medical and financial, with delivering a curative-intent therapy. And I am curious if this maybe, as we're looking at some of the data, some of the reasons around preferring a perioperative approach where you scale it back, as opposed to a neoadjuvant-only approach where there's not a clean way to add on therapy, if you think that makes sense. But it's probably the most complicated discussions we have in clinic and the discussion around a non-pCR. And frankly, even the tumor board discussions around localized non-small cell lung cancer have gone very complex, for the benefit of our patients, though we just don't have clean data to say this is the right path. Dr. Vamsi Velcheti: I think that the need for a really true multidisciplinary approach and discussing these patients in the tumor board has never been more significant. Large academic centers, we have the luxury of having all the expertise on hand. How do we scale this approach to the broader community is a big challenge, I think, especially in early-stage patients. Of course, not everyone can travel to Dr. Zervos or you for care at a large tertiary cancer centers. So, I think there needs to be a lot of effort in terms of trying to educate community surgeons, community oncologists on managing these patients. I think it's going to be a challenge. Dr. Michael Zervos: If I could just add one thing here, and I completely agree with everything that has been said. I think the challenge is knowing beforehand. Could you predict which patients are going to have a complete response? And for that matter, say, “Okay. Well, this one has a complete response. Do we necessarily need to operate on this patient?” And that's really the big question that I add. I personally have seen some complete response, but what I'm mostly seeing is major pathologic response, not necessarily CR, but we are seeing more and more CR, I do have to say. The question is how are you going to predict that? Is looking for minimal residual disease after treatment going to be the way to do that? If you guys could speak to that, I think that is just tremendously interesting. Dr. Vamsi Velcheti: I think as Sandip said, MRD is looking very promising, but I just want to caution that it's not ready for primetime clinical decision making yet. I am really excited about the MRD approach of selecting patients for de-escalation or escalation and surgery or no surgery. I think this is probably not quite there yet in terms of surgery or no surgery decision. Especially for patients who have early-stage cancer, we talk about curative-intent treatment here and surgery is a curative treatment, and not going to surgery is going to be a heavy lift. And I don't think we're anywhere close to that. Yet, I'm glad that we are having those discussions, but I think it may be too hard at this point based on the available technologies to kind of predict CR. We're not there. Dr. Michael Zervos: Can I ask you guys what your thought process is for evaluating the patient? So, when you're actually thinking about, “Hey, this patient actually had a good response. I'm going to ask the surgeons to come and take a look at this.” What imaging studies are you actually using? Are you just using strictly CT or are you looking for the PET? Should we also be thinking about restaging a lot of these patients? Because obviously, one of the things that I hate as a surgeon is getting into the operating room only to find out that I have multiple nodal stations that are positive. Which really, in my opinion, that's sort of a red flag. And for me, if I have that, I'm thinking more along the lines of not completing that surgery because I'm concerned about not being able to provide an R0 resection or even having surgical staple lines within proximity of cancer, which is not going to be good. It's going to be fraught with complications. So, a lot of the things that we as surgeons struggle with have to do with this. Personally, I like to evaluate the patients with an IV intravenous CT scan to get a better idea of the nodal involvement, proximity to major blood vessels, and potentially even a PET scan. And though I think in this day and age, a lot of the patients will get the PET beforehand, not necessarily get it approved afterwards. So that's a challenge. And then the one thing I do have to say that I definitely have found helpful is, if there's any question, doing the restaging or the re-EBUS at that point to be particularly helpful. Dr. Sandip Patel: Yeah, I would concur that having that pathologic nodal assessment is probably one of the most important things we can do for our patients. For a patient with multinodal positive disease, the honest truth is that at our tumor board, that patient is probably going to get definitive chemoradiation followed by their immunotherapy, or potentially soon, if they have an EGFR mutation, osimertinib. For those patients who are clean in the mediastinum and then potentially have nodal flare, oftentimes what our surgeons will do as the first stage of the operation, they'll actually have the EBUS repeated during that same anesthesia session and then go straight into surgery. And so far the vast majority of those patients have proceeded to go to surgery because all we found are immune cells in those lymph nodes. So, I think it's a great point that it's really the pathologic staging that's driving this and having a close relationship with our pathologists is key. But I think one point that I think we all could agree on is the way that we're going to find more of these patients to help and cure with these therapies is through improved utilization of low-dose CT screening in the appropriate population in primary care. And so, getting buy-in from our primary care doctors so that they can do the appropriate low-dose CT screening along with smoking cessation, and find these patients so that we can offer them these therapies, I think is something that we really, as a community, need to advocate on. Because a lot of what we do with next-generation therapies, at least on the medical oncology side, is kind of preaching to the choir. But getting the buy-in so we can find more of these cases at stage 1, 2 or 3, as opposed to stage 4, I think, is one of the ways we can really make a positive impact for patients. Dr. Vamsi Velcheti: I just want to go back to Mike's point about the nodal, especially for those with nodal multistation disease. In my opinion, those anatomic unresectability is a moving target, especially with evolving, improving systemic therapy options. The utilization for chemo radiation has actually gone down. I think that's a different clinical subgroup that we need to kind of think differently in terms of how we do the next iteration or generation of clinical trials, are they really benefiting from chemo-IO induction? And maybe we can get a subset of those patients in surgery. I personally think surgery is probably a more optimal, higher yield to potentially cure these patients versus chemo radiation. But I think how we identify those patients is a big challenge. And maybe we should do a sequential approach induction chemo-IO with the intent to kind of restage them for surgery. And if they don't, they go to chemo consolidation radiation, I guess. So, I think we need to rethink our approach to those anatomically unresectable stage 3s. But I think it's fascinating that we're having these discussions. You know, we've come to accept chemo radiation as a gold standard, but now we're kind of challenging those assumptions, and I think that means we're really doing well in terms of systemic therapy options for our patients to drive increased cures for these patients. Dr. Michael Zervos: I think from my perspective as a surgeon, if I'm looking at a CT scan and trying to evaluate whether a patient is resectable or not, one of the things that I'm looking for is the extent of the tumor, proximity to mediastinal invasion, lymph nodes size. But if that particular patient is resectable upfront, then usually, that patient that receives induction chemo checkpoint inhibition is going to be resectable afterwards. The ones that are harder are the ones that are borderline resectable upfront or not resectable. And then you're trying to figure out on the back end whether you can actually do the surgery. Fortunately, we're not really taking many patients to the operating room under those circumstances to find that they're not resectable. Having said that, I did have one of those cases recently where I got in there and there were multiple lymph node stations that were positive. And I have to say that the CT really underestimated the extent of disease that I saw in the operating room. So, there are some challenges surrounding all of these things. Dr. Sandip Patel: Absolutely. And I think for those patients, if upfront identification by EBUS showed multi nodal involvement, we've had excellent outcomes by working with radiation oncologists using modern radiotherapy techniques, with concurrent chemo radiation, followed by their immunotherapy, more targeted therapy, at least it looks like soon. I think finding the right path for the patient is so key, and I think getting that mediastinal pathologic assessment, as opposed to just guessing based on what the PET CT looks like, is so important. If you look at some of the series, 8% to 10% of patients will get a false-positive PET on their mediastinal lymph nodes due to coccidioidomycosis or sarcoidosis or various other things. And the flip side is there's a false-negative rate as well. I think Mike summarized that as well, so I think imaging is helpful, but for me, imaging is really just pointing the target at where we need to get pathologic sampling, most commonly by EBUS. And getting our interventional pulmonary colleagues to help us do that, I think is so important because we have really nice therapeutic options, whether it's curative-intent surgery, curative-intent chemo radiation, where we as medical oncologists can really contribute to that curative-intent local therapy, in my opinion. Dr. Vamsi Velcheti: Thank you so much Sandip and Mike, it's been an amazing and insightful discussion, with a really dynamic interplay between systemic therapy and surgical innovations. These are really exciting times for our patients and for us. Thank you so much for sharing your expertise and insights with us today on the ASCO Daily News Podcast. I want to also thank our listeners today for your time. If you value the insights that you hear today, please take a moment to rate, review, and subscribe to the podcast wherever you get your podcasts. Thank you so much. [FH1] Dr. Sandip Patel: Thank you. Dr. Michael Zervos: Thank you. Disclaimer: The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement. Follow today's speakers: Dr. Vamsidhar Velcheti @VamsiVelcheti Dr. Sandip Patel @PatelOncology Dr. Michael Zervos Follow ASCO on social media: @ASCO on X (formerly Twitter) ASCO on Facebook ASCO on LinkedIn Disclosures: Dr. Vamsidhar Velcheti: Honoraria: ITeos Therapeutics Consulting or Advisory Role: Bristol-Myers Squibb, Merck, Foundation Medicine, AstraZeneca/MedImmune, Novartis, Lilly, EMD Serono, GSK, Amgen, Elevation Oncology, Taiho Oncology, Merus Research Funding (Inst.): Genentech, Trovagene, Eisai, OncoPlex Diagnostics, Alkermes, NantOmics, Genoptix, Altor BioScience, Merck, Bristol-Myers Squibb, Atreca, Heat Biologics, Leap Therapeutics, RSIP Vision, GlaxoSmithKline Dr. Sandip Patel: Consulting or Advisory Role: Lilly, Novartis, Bristol-Myers Squibb, AstraZeneca/MedImmune, Nektar, Compugen, Illumina, Amgen, Certis, Eli Lilly, Roche/Genentech, Merck, Pfizer, Tempus, Iovance Biotherapeutics. Speakers' Bureau: Merck, Boehringer Ingelheim Research Funding (Inst.):Rubius, Bristol-Myers Squibb, Pfizer, Roche/Genentech, Amgen AstraZenece/MedImmune, Fate, Merck, Iovance, Takeda Dr. Michael Zervos: No relationships to disclose
The robotic-assisted biopsy platform Ion is a “game-changer” for patients with lung cancer, as it provides a quicker, less invasive surgical method for conducting a lung biopsy, according to Richard Lazzaro, MD. In a conversation with CancerNetwork, Lazzaro, the chief of Thoracic Surgery at the Southern Region of RWJBarnabas Health, spoke about his experience with adopting the Ion robotic bronchoscopy platform for the early detection of lung cancer at Monmouth Medical Center. He highlighted how the tool may enable practices to acquire tissue and perform disease staging with fewer complications, which may particularly benefit those who plan to undergo induction chemotherapy or immunotherapy. In terms of other potential advancements in the lung cancer surgery field, Lazzaro discussed how he anticipates the use of video-assisted thoracoscopic (VATS) surgery to evolve. Specifically, he mentioned the development of technologies such as augmented reality as tools that may help minimize the variability of surgical procedures. Regarding his practice, Lazzaro highlighted how a multidisciplinary thoracic tumor board—including medical oncologists, radiologists, pathologists, and pulmonary physicians, among others—has helped in producing long-term survival improvements. He emphasized collective discussions and shared decision-making as part of determining appropriate courses of care for his patients. When it comes to a multidisciplinary approach, Lazzaro stated that “you want to take care of patients” like they were part of “your family.” Overall, Lazzaro noted how the lung cancer treatment landscape has changed over time. He emphasized referring patients for CT scans as well as evaluations at nodule or thoracic oncology clinics as part of a multidisciplinary strategy. “The management of lung cancer is different than it was even 5 years ago. If we can detect lung cancer early, we have options for treating patients today that we never had before,” Lazzaro said. “This is the time where we really need to make a huge difference in lung cancer.” Reference Latest most advanced treatments for lung cancer now available at Monmouth Medical Center. News release. RWJBarnabas Health. January 22, 2024. Accessed April 17, 2024. https://tinyurl.com/ty8st3hm
"Honor the Lord with your wealth and with the best part of everything you produce. Then he will fill your barns with grain, and your vats will overflow with good wine." - Proverbs 3:9-10 NLT
Karen Robinovitz and Sara Schiller had each been through multiple traumas when they found reinvention and joy through the unlikeliest of substances: slime. Yes, slime. They explain to hosts Diana Ransom and Christine Lagorio-Chafkin how they channeled their newfound joy, and passion for sensory play, into a business, the Sloomoo Institute. Sloomoo is a growing slime-museum business with four locations that makes some 600 gallons of slime each day. This episode was recorded live on-site in SoHo, New York, at the Sloomoo Institute Links: Inc.com article: www.inc.com/christine-lagorio/from-the-ground-up-sloomoo-institute-karen-robinovitz-sara-schiller-grief-as-startup-fuel.html Episode transcript: www.inc.com/transcript-from-the-ground-up-podcast-sloomoo-institute-founders-karen-robinovitz-sara-schiller.html The Sloomoo Institute: https://sloomooinstitute.com/pages/new-york-2-0?utm_source=google.com&utm_medium=organic Slime play and care (PSA about slime removal!): https://sloomooinstitute.com/pages/slime-care *note to listeners: The concepts of death and depression, are mentioned in this episode, as is the fact of a school shooting, though none are discussed in depth.
This week on CTSNet's flagship podcast, Editor in Chief Joel Dunning discusses presentations from the SCTS annual meeting on the future of aortic valve replacement surgery and the continued debate among surgeons about the benefits of TAVR versus those of SAVR. In addition, Joel discusses a review of heart valve surgery in resource limited settings, long term outcomes of heart transplantation in adults with congenital heart disease, and intervention for symptomatic moderate aortic stenosis. He also talks about an interview and surgical video with Dr. Lars Svensson, how to position the heart in off-pump CABG, and a lobectomy for a hydatid cyst using uniportal VATS. Before saying goodbye, he discusses upcoming events in CT surgery. JANS Items Mentioned A Global Systematic Review of Open-Heart Valvular Surgery in Resource Limited Settings Long-term Outcomes of Heart Transplantation in Adults With Univentricular Versus Biventricular Congenital Heart Disease Great Debate: Symptomatic Moderate Aortic Stenosis Should Undergo Intervention CTSNet Content Mentioned World's Best United States: Aortic Root Replacement and an Interview With Lars Svensson Deep Dive Into Total Arterial Anaortic Off-Pump Coronary Artery Bypass Grafting: How to Position the Heart Right Upper Lobectomy for a Hydatid Cyst Using U-Vats Other Items Mentioned CTSNet Events Calendar Disclaimer The information and views presented on CTSNet.org represent the views of the authors and contributors of the material and not of CTSNet. Please review our full disclaimer page here.
Join us on this episode, as we sit down with Jerome de Guigne, a seasoned expert in international business and Amazon marketplace strategies. We take a trip across Jerome's impressive business career, which stretches from France to Luxembourg, and uncover the crucial steps he took to carve a niche in the world of Amazon. Listen in as Jerome lays out the intricate process of aiding brands in scaling their operations and mastering the art of value creation on this global platform. This conversation also welcomes Jacob McQuoid from Avask and throws light on the hurdles U.S. companies face when stretching their commercial footprint to European shores, such as VAT intricacies, regulatory hoops, and the ever-present language barriers. But it's not a one-way street; European entities eyeing the U.S. market have their fair share of VAT tax complexity to navigate. We bring in perspectives from professionals at firms like Avask and explore tools like Pacvue and Helium 10, providing a lot of insights for Amazon brands planning to cross these transatlantic bridges. Finally, we touch upon the wisdom of starting small and testing the waters when it comes to international expansion. This approach allows businesses to minimize risks and optimize for market receptivity, a strategy underscored by the shared knowledge from this episode. So whether you're an experienced Amazon seller or new to this realm, this episode is packed with invaluable advice and strategies for taking your Amazon business to new international heights. In episode 543 of the Serious Sellers Podcast, Bradley, Jerome, and Jacob discuss: 00:01 - Expanding Amazon Sales With European Experts 02:49 - Value Creation Through Amazon Specialization 06:45 - International Expansion Strategies for Amazon Sellers 09:25 - IRS and European Tax Authority Comparison 16:51 - Navigating International Business and Online Presence 20:10 - Navigating VAT and E-Commerce Expansion 22:38 - Understanding VAT for American Sellers 29:39 - US Sellers' VAT Number in Europe 31:08 - Comparing Import Tariffs 35:24 - Starting Small for Market Testing ► Instagram: instagram.com/serioussellerspodcast ► Free Amazon Seller Chrome Extension: https://h10.me/extension ► Sign Up For Helium 10: https://h10.me/signup (Use SSP10 To Save 10% For Life) ► Learn How To Sell on Amazon: https://h10.me/ft ► Watch The Podcasts On YouTube: youtube.com/@Helium10/videos Transcript Bradley Sutton: Are you a North American seller interested to expand to Amazon Europe, or maybe vice versa? Are you interested in advanced Amazon advertising strategies? Well, today, I went to Germany to interview in person two experts on these topics. How cool is that? Pretty cool, I think. Bradley Sutton: Want to keep up to date with trending topics in the e-commerce world? Make sure to subscribe to our blog. We regularly release articles that talk about things such as shipping and logistics, e-commerce in other countries, the latest changes to Amazon Seller Central, how to get set up on new platforms like New Egg, how to write and publish a book on Amazon KDP and much, much more. Check these articles out at h10.me/blog. Bradley Sutton: Hello everybody and welcome to another episode of the Serious Sellers Podcast by Helium 10. I'm Bradley Sutton and this is the show that's completely BS-free, unscripted and unrehearsed organic conversation about serious strategies for serious sellers of any level in the e-commerce world. Another episode here coming from the opposite side of the world. I'm in Frankfurt, Germany and was able to interview a lot of different people. For the first time on the show, we've got Jerome here. Jerome, welcome. Jerome: Thank you very much. I'm super happy to be here and it's nice to see you on this part of the world. Bradley Sutton: Excellent. So you know, like I do with first time guests, we need to find out about you. And this is important too, because, like I don't know much about your back stories. What country in Europe are you from? Germany, France, so I have. Jerome: I'm all about going international, so my background is international also. I was born and raised in France but my mom is British. My dad is French. I lived in France but I also lived in Turkey. I lived a bit in Germany, in the UK and now I'm office design Luxembourg. So a lot of different experiences all over the world. Bradley Sutton: Okay, excellent, excellent. Now, what did you? Where did you go to university? In what country? Jerome: So I went to university mainly in France, so first in the nice city of Grenoble, which is not too far from Lyon. It's in the Alps Mountains, really nice to do like business and management. And then afterwards I did an MBA in a school in Basin Paris but had campuses in Germany and in the UK and also in the States. I did a week in Texas, for example. It was really interesting. So like multinational is really my thing. Bradley Sutton: Okay, excellent. Now, upon graduation, did you enter right into the business world and what you had studied, or what did you do? Jerome: So I went to work two years into the chemical business at that time it was called Atofina Archema. Now, it's like I was helping the head of the subsidiary there. So doing a lot of things, helping on IT topics, on business topics for two years. And then I came back and I worked for 10 years for a Chinese group and that's where I started to work in Luxembourg. And then afterwards, I was looking for a job and couldn't find one. So I said I'll start my own company. Bradley Sutton: Okay, and what was that company? Jerome: So at the beginning my idea was say, okay, I want to bring value, because when I did my MBA it was all about okay, how do you create value for your ecosystem? Because value has a price and you know, and then you can sell. So my first idea was to help people expand and grow in terms of sales. But I had been doing a lot of Amazon business in my previous company and like, step by step, I found out that a big pain point for people in Europe at that time so 10 years ago was not understanding Amazon and I said, oh people, it's simple, let me explain to you. So I went into step by step into the Amazon business and that's where we become specialized in Amazon. Bradley Sutton: Amazon is not a typical segue from somebody just coming from the business world. How did you first, just you know, think about that as a good aspect, you know, like Google or friends? Jerome: So my background was really distribution, since I was head of Europe and EMEA for this Chinese brand and we were expanding into countries having subsidiaries, having distributors, and so it's about selling right and then I started to work with companies and helping them expand and actually even 10 years ago, the or even more 10 years ago, the fastest way to expand was Amazon and it actually really started when a German brand I knew from before told me okay, take care of the international distribution of our brand, which was binoculars, and I said, okay, well, you know, the best way is really Amazon and that's where we really started to go there. So we mostly started from vendor background because bigger brands were working on vendor and now we have probably 70% seller, 30% vendor in terms of people we help. Bradley Sutton: So what about you? During this time, were you selling on Amazon yourself as well? Jerome: So I never sold on Amazon myself. I was always selling in the name of a company and, like I said, I started as a vendor, so selling to Amazon rather than selling on Amazon, and I've been helping a lot of sellers but never sold myself. Help friends. But, yeah, never went into it. It's a bit of a dream at some point to do that. Bradley Sutton: For your agency for the last few years, are you focused on any particular aspect of Amazon or like PPC, for example, or it's A to Z? What is your focus on? What you help sellers with? Jerome: It's very much A to Z we focus. We've got three main topics we focus on. One is global expansion, so it's helping anyone to go from Europe to the US, from US to Europe to US to Japan, to anywhere in the world, and it's really whatever they need. That's the first thing we focus on. The second thing is retail media. It's one of the big topics we do is like how do we help them expand better thanks to retail media. So advertising, PPC, DSP, AMC, whatever there is. And the last thing is technology. Jerome: So we're not a SaaS company but we use a lot of tools. So Helium 10 is one, Pacvue is another one. We also partner with SalSify, for example, on the PIM side, and we have built our own dashboard. So those three topics Global Expansion, Retail Media, technology are three topics we're very focused on and we try to help people through those different things. So it's really, for me, it's A to Z especially in those aspects. So anybody, for example, we've started to sell on our own accounts for brands who can't sell. So for me, it's like an additional. We're not really a distributor, but if a brand can't sell themselves, it's okay. We'll set up a seller account and we have one in the US. We have a seller account in Europe and we have one in India also, for example. So anyone who wants to expand in any way, we are here to help them. Bradley Sutton: Let's talk about the first thing you mentioned about the international expansion. I mean, there's probably 35 different combinations you can have. You know, Japanese person selling on America, European person selling in Japan, a person from Dubai selling in Mexico, you know, etc. etc. Let's talk about some of the more common ones. Probably the most common for our listeners would be I'm a US-based company doing pretty well. Now I want to get started in Europe because that's the second and third biggest marketplaces, UK and Germany. The thing the elephant in the room for a lot of people is like oh my goodness, VAT and things like that. So what are some of the main obstacles and maybe difficult things to navigate for an American company who wants to get started in Europe? Jerome: Great question. For me, the three things. The first thing is regulations and taxes. Regulations. So the thing is like am I allowed to sell those products in Europe? We're talking with a supplements brand, for example, in the States, and it's like okay, the way you talk probiotics, for example, or can you have that keyword on your listing all of that? So that's a first hurdle. We today were speaking with AVASK and AVASK is a great partner. We partner with to deliver, like VAT services and also help on regulation. Jerome: The second thing is languages. Obviously, you need to have a great service and you need to have great content for the local people and that's something we are partnering also with a company, YLT Yanak Krekic, who's delivering great service, for example. So typically, we create a hub of people we work with. And the third part is logistics, supply chain. It's like, okay, how do we? Will you get your products to Europe? Like, will you have a warehouse in Holland? Will you go directly to FBA? Who will be your importer of record? That also we work with AVASK and some logistics company. So, even before going into advertising, content and everything, you've got those three things as regulation, translations, in a sense and supply chain. Bradley Sutton: What are some of the steps that somebody needs to take as far as the basics that everybody needs to do? Like you know, there are some things that are kind of like nice to have. There's some things that are need to have. For example, let's talk, you know, let's talk about the need to have for getting started in Europe. I don't need to form a company in Europe. I can use my US company, but I need to. What something that everybody has to do? Is it the VAT register for VAT? Jerome: Yeah. So one thing you can't. Well, same way as in the US you can't play around with IRS, right, and in Europe you can't play around with the tax authority. So VAT is a must and my recommendation is that, typically, Amazon tends to underplay and when they sell the service of expansion, they tend sometimes to be a bit optimistic about the simplicity of VAT. It's not that simple, it's not over complicated, but you need to speak with people who know this stuff. AVASK is a great example of people who really know this stuff. So that's the one thing you need to be set up in at least one country. I don't know, we want to go in all the details, but you need at least one country. Best is to be listed in or having VAT in every countries in Europe but you need at least one to be legal and compliant. Bradley Sutton: Let's do the opposite. I'm a European based company. I want to sell in the biggest marketplace in the world Amazon, USA. You know, I know like way in the old days and now on Walmart, you know, actually still for in some situations you do have to have like a US corporation, but nowadays I can. You know, I'm registered in Germany. I can go ahead and register as an individual or as a person. What are some things that I, absolutely, have to do that are in obstacle to some Europeans for selling in USA? Jerome: So our assumption as Europeans that everything is simple in the US and generally doing business in the US is much easier than in Europe. Like you have much less regulations, there's less hurdles. Now on the tax side, it's still quite complicated and as a European, I had to learn okay to navigate that. Because you can have a company in the States, in one state who's like, its addresses one state but if most of your sales is in another state, the other state where you're doing the sales might say no, no, I want you to pay your taxes where you're doing your turnover. Or if you have employees, it will start say no, then there's a fight between the different states. Jerome: For us in within one country, that doesn't happen. Like if I'm living France, you won't have the south of France trying to fight for you to pay your taxes and south of France doesn't make sense. Yes, so this you have to learn. So here again, you need to speak to the professionals, because taxes, you can't play around with and it's once you've understood, you've understood it or you have someone doing it for you it really goes smoothly. It's also that in some states in the US the tax accuration is automated between Amazon and the states, but in other states it's not. So it's like navigating that and understanding that is a bit complicated and if you're not an accountant, you'd rather work with someone who's a specialist and we work a lot with, like AVASK, for example, or specialists who will help you navigate that. So for me, it's focus on what you're good at and try to outsource what you're less good at to make sure you don't make mistakes. Bradley Sutton: What are you using Pacvue for? For your clients and maybe you know, some people out there might be wondering what kind of amazon seller or large corporate or large company might have use for Pacvue as opposed to Helium 10. So what are you using now Pacvue for? Jerome: So I think, we probably started to work with Pacvue and Helium 10 both the same time, a long time ago. So I think we started in 2019. I think, the first agency in Europe using Pacvue. Basically, we were looking for a tool and what I did is I asked the teams. I said I don't want to take the decision. I wanted the really the users to audit the different tools and decide which one they wanted to work with. And they decided to work with, at that time, to with Pacvue. Jerome: What we did is there's a lot of rules on a lot of features sorry on Pacvue, for example, rules to like improve your campaigns and as an agency, you've got you know 50, 70, 100 brands you work with. So you have a lot of campaigns and you have to have rules which help you optimize. You can't be checking every campaigns all the time. So you have rules really helping you optimize things. So we've been using Helium 10 from day one also to understand the market, make research, and we've used Pacvue really to optimize campaigns and do a better job in terms of advertising for our customers. Bradley Sutton: Are you using Pacvue for non-Amazon platforms at all? Jerome: Yeah, so we've started to go on Walmart, for example, in the US. So we are using Pacvue on Walmart on the platforms in Europe. Not all of them are linked on Pacvue because some of them are smaller. So it really depends. But on the major, we try to use Pacvue, as much as possible, because it's our sort of system of record today in the company. Bradley Sutton: And Helium 10, what is your team using Helium 10 like? What particular tools or what kind of strategies are you guys using? Jerome: So they are using it every day, I would say. So they are checking on the consulting side. Our consultants are checking, like the Market Tracker, for example, or the keyword researchers, like, example, when you were saying, okay, should we go into a new market? Okay, let's see what. You know how many researchers are done on the brand or on the type of product. Then the teams are also working when they're doing their SEO, like checking, you know, keywords and backing keywords and also campaign keywords. They checking all of the tools. Jerome: For me, Helium 10 is amazing because each time I go, it's like, wow, there's so many tools and I feel like there's a new one each time. So I have a hard time keeping track of all of them but I know they're using it daily to really on one or the other bit to improve things altogether. And because we have a content team, we have an advertising team, we have a consulting team, an analytics team, they check different things, each of them for different purposes and Helium 10 has always been amazing to me, like the amount of wealth and value they provide on so many things and that's as a day, as I said, a day to day tool we use. Bradley Sutton: Okay, excellent. Now what kind of, you know, strategy help that can you give to our users? We usually ask our guests like, hey, give us a tip or a strategy. You know it could be about international expansion, could be about PPC, could be about health, could be about which French football team to follow. Anything that you want to talk about. What some strategies you can give our listeners? Jerome: So, yeah, I'm not a big soccer man so I won't go there because I might embarrass myself. No, the thing I typically say when you talk about global expansion is there's a lot of potential but there's a lot of hurdles. So probably you want to start small or start focused. So if you're in the US and you want to go into Europe, maybe you start in Germany and or in the UK because language is easier. Just make a proof of concept, go there, be successful and then start to expand. Because if you start to go in six, five, six, seven countries, then you have five, six, seven campaigns to build, translations to do. There's a lot of work. Jerome: So probably do one, show that you can be successful in one of the European countries and then expand. Same in the US, you probably don't want to maybe take all of your catalog and take a smaller part of the catalog, make sure you're successful and then expand. So for me it's like start small and grow from there. Learn, try to learn. Because international we're talking about earlier with other people today is like, you know, we say they're saying culture eats strategy at breakfast is like cultural things are very strange, like what happens how customer behaviors are different. So get used to it and to start with something and build on it. Bradley Sutton: Love it, alright. Now, one way I know people can find and reach out to your company is if you go to hub.helium10.com type in E-C-O-M-A-S. Is that right? What are other ways that people can find you, your company, on the interwebs out there? Jerome: So we're very vocal on LinkedIn and the team produces a lot of content on retail media on the street topics like retail media, technology and global expansion, so we do try to share as much as possible with everyone. I was honored to be named one of the Amazon Retail Media Advertising Ambassadors, so one of our job is really to share as much content as possible on advertising specifically and one of the advice I gave it was about globalization. If I talk about retail media is like AMC. Amazon marketing cloud is one thing which today is open. Really, if you're doing DSP and PPC, hopefully tomorrow it will open to PPC also only. I would really recommend people to look into it. This is giving you advice, like learnings, which will get you to the next level in terms of advertising. Bradley Sutton: What is the first thing that somebody just getting into DSP or AMC? What is the first thing they should maybe if they're just getting their feet wet? Jerome: So one feature, for example, which is already in Pacvue, which is day parting with AMC you will get even more granular information, a bit like with Facebook. You will know we've run some studies for some of our brands where you get information on the persona, like who is buying your products, like is it you know male, what age, what location, and then you can tailor your messaging, your content, everything you're doing, to really focus on that target customer you have. So that's one example and there's many others you can bring on AMC. We're just starting and people are just starting to get like insights from it. So for me, it's like get first, get into it, and it's not super easy so there's a bit of a barrier to entry. So, once again, either you can, you have got enough knowledge to go in yourself or ask for people for support, and there's a lot of great people. We can help. But there's a lot of great people on AMC which can really help you. Pacvue, for example, has got embedded some AMC features already. So I really look into it because that will be a game changer and for me, like they will probably be a change of like a crossroads people getting into it and who will win? And the others lagging behind. Bradley Sutton: Okay, all right. Well, thank you so much for coming on and hopefully, see you on my side of the pond next time. Jerome: Indeed, thank you very much. Bradley Sutton: All right. So our next guest is one of the hosts for today from AVASK. We're in AVASK, Frankfurt office. This is not your main office. I believe the main office is in London. Jacob: Southampton, so it's about an hour south of London. Bradley Sutton: We're here in Frankfurt, Germany. And this is Jacob, who I met originally in Korea, spoke at an event that I did over there. And what is your title here? Jacob: So I'm the head of business development and commercial services, so responsible for client acquisition. You know have a team based here in Germany, in UK, in Spain and in Italy. So we're supporting, consulting clients, helping them expand. Bradley Sutton: Okay. Now, how did you get into the e-commerce world? Like, what's your backstory? What did you? Where did you go to university? What did you study? And then your entry into the job world. Jacob: Okay. So in terms of studying, I actually did Creative Media in college and then just directly went into working straight from there. So I started as an Account Manager for a finance company and then transitioned to AVASK. I've been here for five years. So that's the kind of a short background but yeah, been at the company for a good amount of time now. Bradley Sutton: Okay. Now, last time we had somebody from AVASK was Melanie, was on maybe, probably almost three years now ago. There's some people who might not know about you guys. So you know elevator pitch with an amazon seller and elevator. How do you tell them what you guys do? Jacob: Yeah, so we help people expand cross-border, so getting to different markets and try and make it as frictionless as possible. Kind of the biggest area for us and kind of the one we've been working in the longest is Europe. So supporting US sellers, you know, Chinese sellers, European sellers, sell all around Europe but that's not it. But like kind of in a nutshell, that's our main service, but essentially we help people get into different markets and make it as frictionless as possible. Bradley Sutton: Okay, so now you know, we just had Jerome on a couple minutes before you. He talked about some of the you know things that people need to be concerned about going from US to Europe, vice versa, maybe going to another marketplace. And he mentioned you guys too. So let's talk a little bit more in the weeds. About some of the you know, like this is what I call the unsexy side of e-commerce. You know the sexy side is PPC and Keyword Research and finding new products and developing your brand. The unsexy side is stuff that actually is arguably even more important, you know, getting your taxes in order and your business entity. So we touched a little bit with Jerome about the VAT and things like that. Bradley Sutton: But let's, let's dig into it because, like me, it just I've never sold. I've never done VAT here myself in Europe, and it's for a lot of, you know, US base sellers, like it's kind of like this monster of a thing that we have to worry about. Like, do I need to get it in every country? Do I have to report to every single country? Is it only if I am at a certain level of sale? So you are very familiar with what American sellers probably need to be educated on as far as this goes. So just take it away and let us know what we need to know about VAT in Europe to start, I would say, there's a bit of a, especially in the us. Jacob: I've been at the company for five years. Especially now over the last few years, has been a lot more regulation introduced in Europe. So when I first started at the company, there was a lot more US sellers who were interested in expanding because there was less regulation and people weren't as advised. But governments have caught up a little bit. There was a lot of that fraud so people weren't actually paying VAT. And that's not just you know American sellers, that, sellers from all over the world. But now marketplaces are Amazon a lot more regular, regulated, so they have to enforce it. So it stops people from wanting to expand. You know a lot of Americans they say, okay, VAT, how do I do of that? Okay, they don't worry about it, and I think that's quite a lot of the story in America. Jacob: For a lot of clients that I've spoken to, essentially VAT, like the system that we have in Europe, and in lots of other places as well, is completely different to the US system. Obviously, the US system, you have tax added on at checkout so you only have to worry about pricing your product and then in the majority of places, i.e. Amazon, and they're going to add the tax on, whereas here in Europe, you are responsible for adding the tax. So when you're listing your product, so you know, if you create a new listing and you need to make sure you include VAT. So I've had lots of customers who want to expand into Europe. They've gone for it. They didn't consider that the VAT would be part of the price that they actually put on the listing. And then you know, a month later, two months later, they've got the VAT bill and they have to pay that and they hadn't actually priced it into the product. Bradley Sutton: So like you're saying, like the buy box price should indicate it or it needs to be, it's separate? Jacob: No, it's just inclusive. So like, if you list your product for 24 pounds, for example in the UK, that 24 pounds is inclusive of the VAT. That's not going to add any VAT at the end. Bradley Sutton: What is the approximate VAT? Jacob: So for the UK, it's 20%. Bradley Sutton: So that means if I've got a product that I'm selling for the equivalent of 25 dollars, let's just say, I need to make that at least like 30, 31, 32 dollars, to include that VAT, because that's what I'm going to end up paying the government. Jacob: Yeah, exactly. So you have to look at the net price. So 25 dollars add to the 20 percent, so add another five dollars to get it to 30. And then out of that 30 dollar sale, once it's converted, the portion which was the five dollars would be paid to the government and the rates are there or there about. So like we're here in Germany right now, the rate here in Germany is 19% so slightly different, but there are there abouts. Bradley Sutton: Now in America, you know, after three years ago or so, we have the Marketplace Facilitator Rax. You know, like that was a huge headache before, where people didn't know in America. Like, all right, I live in California, I know I got to pay California Sales Tax, but you know, do I have a Nexus or whatever we call it in all the different states. And then Amazon's like or actually all online marketplaces were like there's some law passed or something where it's like, all right, you guys are the ones who have to collect it. Now we as Amazon sellers, hopefully we don't have to. That's what I've been doing. We don't have to worry anything about it. We don't add it to our price or anything. The customer is paying for it but Amazon collects it. They remit it. Now in Europe, what it sounds like number one, we do have to add it to the price, as you just said. And also, Amazon is not remitting that. I've got to hold on to that money. Jacob: And then so previously that would have been correct. But as of a couple of years ago, Amazon and now and marketplaces are responsible for collecting and remitting VAT for non-European and non-EU sellers in the EU. You still need to price it so, like in that example we had, that was $30. That $5 would actually be deducted from you and be paid to the government on your behalf. However, you still need to report all of those sales via VAT returns in different countries where you've got different liability, like similar to Nexus. Nexus means you've got a liability, basically. You'll have to get a VAT number when you have a liability and you can create different liabilities and free different kinds of means, but the actual money will be deducted and paid by Amazon but you still have to report it. Bradley Sutton: So that's at least one burden off. And then now is Amazon withholding that from your disbursement? Then each two weeks? Jacob: Yeah. So that would get completely withheld. So Amazon should be withholding it and then paying it on your behalf. Bradley Sutton: Okay. Scenario A, I plan to open in all European marketplaces plus UK. So UK, Germany, France, Netherlands, Spain, Italy, et cetera, et cetera. How many VATs am I needing to register for? Jacob: Depends. So you've got options. So with Amazon, you've got options for how you can actually use the FBA system. So, like obviously, in US, you send to a single FBA center. You have no control over where they're good to go. Amazon can transfer them to different warehouses. It's one country. It's lots of different states, lots of different tax laws, but it is one country, whereas with Europe you've got many different countries. So UK, we separated from the European Union the free flow of moving goods essentially. So whenever good to travel from UK to EU, they need to go through official borders. So customs checks, there needs to be paperwork, there needs to be declarations, et cetera. A lot of sellers now treat the UK separately and they just have their own separate supply chain directly into the UK. You need a VAT number there as a US seller so you can store your products there and sell your products, whereas in Europe, for FBA purposes, you've got options. Jacob: Amazon have their main fulfillment centers in Germany, France, Italy, Spain, Poland and the Czech Republic. You can select which ones you want to have your goods in. Whichever country you decide, you allow Amazon to store. You've got an Enable Infantry Replacement on a Seller Central so you can disable and enable. If it's enabled, you have to have a VAT number because Amazon store your products there and that's creating a Nexus. Essentially, you create a liability. You've got to have a VAT number there. Jacob: So you could just start with one for the EU and you can list your products. So you could say right, I'm going to store my products in Germany, I'm going to list them in Italy, I'm going to list them in France, I'm going to list them in Spain, but they will all be fulfilled from Germany. Now the pitfall to doing that is Amazon charges you a significantly larger fee for fulfillment. So whenever I speak to sellers as long as they understand that because I've got people who you know they only want to get the one VAT number, because getting six or seven or however many you need to get is complicated and it means a lot of paperwork et cetera to get set up but at the same time, they don't quite realize the Amazon fees that you get charged. And I've come across cases where, yeah, it was an extra three or 4,000 pounds to get the VAT numbers but they ended up spending extra 40,000 pounds in fulfillment fees. So, like understanding, that's quite clear, but you can start off with not too many, which makes it easier for sellers. Bradley Sutton: A lot of American sellers are very familiar with rough costs of like tariffs and importing custom duties from China to the United States. Some have more. That's why you know maybe some people are moving their factory to India or other places. How does it compare, though, because most I would say 90% of Amazon sellers are probably manufacturing their products in China or India? How does the custom duties and tariffs compare on a percentage wise importing to the US as opposed to importing to Europe? Are there differences between like UK and EU? Jacob: Yeah. Depending on the products, the UK and EU used to have the same tariffs because of the UK separation. We've got the UK Global Trade Tariff and EU's got what's called the TARIC system. The rates for those two systems I would say probably 99% of the same and that will change over the course of time, but it wasn't going to all change immediately. There is some differences but you might find certain products have much higher rates in Europe. So you also get anti-dumping duty. Jacob: I'm not too sure if there is anti-dumping duty in the US, but this can be products that might be damaging to the environment or harmful to the environment so they put the rates up really high. But understanding it before you actually start shipping the products is easy to do. As long as you've got the right people to do it. You can understand the rates, understand if there's a difference between the rate. One thing you do need to be careful of, especially as a US-based business, not just US as a non-EU-based business, the particular country we're in right now, Germany the way that they look at imports for non-EU-based companies is sometimes different to an EU-based company. So I've had a lot of clients who they've imported stock directly from their supplier in China or in India into Germany, and the German customs office have revalued that stock. So instead of using the transactional value, so the cost of your products, the insurance and the freight, say €10,000, they've looked at it and they've taken the retail price and then minus Amazon fees, minus VAT, so to say 60% of retail, which then that 10,000 does end up getting to 50,000, and then they've been charged 5% on the 50,000 instead of 10,000, so suddenly you've got five extra costs. So that's something to look out for and be aware of, because I've seen it happen quite a few times. Bradley Sutton: Okay. Now, before we get into your last strategy of the day, just as a reminder, if this is all overwhelming to you, it's not something that you just can't ignore and pretend that it's not there. It's stuff that you have to take care of if you're doing cross-border or getting into new marketplaces. If you guys want to reach out to AVASK, the easiest way to remember to contact them just go to hub.helium10.com and then just type in AVASK, A-V-A-S-K right there inside there you can have the portal. There might be some specials depending on your level of Helium 10 membership that you might have available to you. Other ways that people can find you guys on the interwebs out there. Jacob: Yeah, so all the general means like LinkedIn, Instagram or just avaskgroup.com, so A-V-A-S-K group.com, and yeah, you can contact us directly for those means. Bradley Sutton: Okay, all right. Now what's your last, you know, something I like to ask some guests is like a 30 or 60 second tip or strategy, that it could be about any topic you've talked about today. Jacob: Yeah, okay. So I would say, first of all, do consider Europe, but maybe take it slow, because there's a lot of red tape and there's a lot of history with American sellers in Europe and people getting stung by governments because of certain situations that happened in the past. Things are different now, so there's a lot more regulation that makes it easier for sellers to make sure they're doing the right thing, but it also puts more barriers to entry. You can start small. Like I said, you don't have to go for all of the countries. Start small with one. Start looking at the other countries, so like if you wanted to start in Germany, what are the biggest markets? Open your listings in the other markets and see if you start getting sales trickle in and then kind of make targeted decisions based on where you start to see growth. And that's what I think is good because we get a lot of people that are like right, I need to go for everything, I need to go for it straight away. Some cases really good, some cases they don't get the sales they expect and then they have to attract. So, depending on your position, obviously, would depend on what you decided to do, but if you're just considering it, you're not sure. Try that way because you're limiting your exposure in terms of compliance. You can start off small, your costs are lower and you can just see how the market goes. Bradley Sutton: Alright. Well, thank you very much for sharing your knowledge and thank you for hosting us here for our first onsite podcast here in Germany and our AVASK and Helium 10 Elite event, and maybe we'll be seeing you at a future conference again. Jacob: Thanks, Bradley.
In this episode of CTSNet's flagship podcast, editor in chief Joel Dunning runs through the latest, most popular content on ctsnet.org—the largest online community of CT surgeons and source of CT surgery information—and breaking cardiothoracic surgery news and research from around the world. Joel discusses the long-term outcomes of bioprosthetic valves in the mitral position and the role of the diagnostic wedge resection in the era of segmentectomy. He also talks about the three winners of the Innovation Video Competition: a demonstration of tricuspid valve replacement with the right atrial appendage valve, VATS duct ligation with ICG imaging, and the percutaneous closure of peripheral ECMO cannulation sites. This episode also includes Joel's interview with Prof. Ahmad Ali Amirghofran, the Innovation Video Competition winner. JANS Items Mentioned Long-Term Outcomes of Bioprosthetic Valves in Mitral Position: A Systematic Review of Studies Published in the Last 20 Years The Role of the Diagnostic Wedge Resection in the Era of Segmentectomy CTSNet Content Mentioned Tricuspid Valve Replacement with the Right Atrial Appendage Valve: The First Report Video-Assisted Thoracoscopic Thoracic Duct Ligation with Indocyanine Green Fluorescence Imaging Percutaneous Closure of Peripheral ECMO Cannulation Sites Other Items Mentioned CTSNet Events Calendar Innovation Video Competition Submissions Disclaimer The information and views presented on CTSNet.org represent the views of the authors and contributors of the material and not of CTSNet. Please review our full disclaimer page here.
We have just come through Halloween. It is a festive time to be really present in your neighborhood and have some fun while getting your steps in, as you follow wild, costumed children trick-or-treating down the middle of the street. Vats of chili are cooked, hot dogs are roasted, and themed cocktails with outlandish names are served. The reason we do this is somehow lost on us or has been forgotten. In the original sense, Halloween was done to mock evil. Yes, that is right—the way Satan is defeated is through laughter and joy. This week we see something similar in Habakkuk. Without giving too much away, the vision God gives Habakkuk is not only that the just will live by faith alone—sort of socially grinding out a righteousness—no, this week we see the rest of the story. The bulk of the vision is a series of taunts or mockery of evil. Five taunts are leveled at Babylon. It is like God is making fun of Babylon and showing God's people that, as they live by faith in the midst of a reign of terror, they are not to forget laughter because they can see the rest of the story. Sound weird? Join me Sunday as we unfold this strange passage and then land where the chapter ends—in silence and awe before the glory of a God so vast that he will defeat all the evil in the world, and all will be laughter and joy. Joy is always the final word in the Bible.
We have just come through Halloween. It is a festive time to be really present in your neighborhood and have some fun while getting your steps in, as you follow wild, costumed children trick-or-treating down the middle of the street. Vats of chili are cooked, hot dogs are roasted, and themed cocktails with outlandish names are served. The reason we do this is somehow lost on us or has been forgotten. In the original sense, Halloween was done to mock evil. Yes, that is right—the way Satan is defeated is through laughter and joy. This week we see something similar in Habakkuk. Without giving too much away, the vision God gives Habakkuk is not only that the just will live by faith alone—sort of socially grinding out a righteousness—no, this week we see the rest of the story. The bulk of the vision is a series of taunts or mockery of evil. Five taunts are leveled at Babylon. It is like God is making fun of Babylon and showing God's people that, as they live by faith in the midst of a reign of terror, they are not to forget laughter because they can see the rest of the story. Sound weird? Join me Sunday as we unfold this strange passage and then land where the chapter ends—in silence and awe before the glory of a God so vast that he will defeat all the evil in the world, and all will be laughter and joy. Joy is always the final word in the Bible.
In this episode of CTSNet's flagship podcast, editor in chief Joel Dunning runs through the latest, most popular content on ctsnet.org—the largest online community of CT surgeons and source of CT surgery information—and breaking cardiothoracic surgery news and research from around the world. Joel discusses new findings on treatment for mesothelioma, a study on quality of life after acute type B aortic dissection, and a new real-time blood monitor for high-risk surgeries. He also talks about a quick technique for aortic hemiarch replacement, a video on the subannular Bentall technique, and an alternative technique to mimic robotic thoracic surgery using VATS. After discussing upcoming events in the CT surgery world, he closes with a shoutout to the late Dr. David Sugarbaker, a pioneer in mesothelioma surgery. JANS Items Mentioned MARS2: Decortication Plus Chemotherapy Associated with Worse Outcomes for Resectable Mesothelioma Long Term Health Related Quality of Life After Acute Type B Aortic Dissection: A Cross Sectional Survey Study Real-Time Blood Monitor Saves Doctors Critical Time During Surgery CTSNet Content Mentioned Aortic Hemiarch Replacement: The 7-Minute Technique Subannular Bentall in Pseudoaneurysm of Mitral-Aortic Intervalvular Fibrosa Right Upper Lobectomy with Surgeon Powered Robotics Other Items Mentioned CTSNet Events Calendar Disclaimer The information and views presented on CTSNet.org represent the views of the authors and contributors of the material and not of CTSNet. Please review our full disclaimer page here.
@KaneB is a public philosopher who focuses on the philosophy of science, the source of knowledge, and the construction of beliefs. We discuss the nature of reality, how it's possible to justify knowledge, the source of conspiracies, skepticism as a philosophical lifestyle, the difficulty of knowing if we're really alive or if we're just a brain in a vat, and if it's really that difficult to evaluate if we're living in a dream or not. 00:00:00 Go! 00:00:17 Who is Kane Baker? 00:01:58 What's left in Philosophy 00:06:14 Gap in physics and philosophy 00:12:51 Condensing ideas & transforming scales of ideas 00:18:39 Choosing Beliefs 00:20:46 Patreon Ask 00:24:44 Brains in vats? 00:29:58 Observation, knowledge, & simulations 00:35:33 Dreaming coherence 00:45:35 Philosophy of Mind 00:50:53 Zombies 00:53:06 Epistemology of the academe 01:04:58 Water off a Duck's Back 01:18:35 Ideal Claims 01:27:23 Math as Language 01:32:31 End of Inquiry 01:39:42 Realists, Antirealists & Synthesists 01:47:26 Science as Interrelation 01:54:10 Why Bother? 02:01:27 Laying Blame 02:10:00 The right knob to twist 02:22:12 Philosophers argue for everything 02:30:00 Closing thoughts Support the scientific revolution by joining our Patreon: https://bit.ly/3lcAasB Tell us what you think in the comments or on our Discord: https://discord.gg/MJzKT8CQub #philosophyofscience #philosophy #skepticism #truebeliefs #epistemology #knowledge Check our short-films channel, @DemystifySci: https://www.youtube.com/c/DemystifyingScience AND our material science investigations of atomics, @MaterialAtomics https://www.youtube.com/@MaterialAtomics Join our mailing list https://bit.ly/3v3kz2S PODCAST INFO: Anastasia completed her PhD studying bioelectricity at Columbia University. When not talking to brilliant people or making movies, she spends her time painting, reading, and guiding backcountry excursions. Shilo also did his PhD at Columbia studying the elastic properties of molecular water. When he's not in the film studio, he's exploring sound in music. They are both freelance professors at various universities. - Blog: http://DemystifySci.com/blog - RSS: https://anchor.fm/s/2be66934/podcast/rss - Donate: https://bit.ly/3wkPqaD - Swag: https://bit.ly/2PXdC2y SOCIAL: - Discord: https://discord.gg/MJzKT8CQub - Facebook: https://www.facebook.com/groups/DemystifySci - Instagram: https://www.instagram.com/DemystifySci/ - Twitter: https://twitter.com/DemystifySci MUSIC: -Shilo Delay: https://g.co/kgs/oty671
In this episode of CTSNet's flagship podcast, editor in chief Joel Dunning runs through the latest, most popular content on ctsnet.org—the largest online community of CT surgeons and source of CT surgery information—and breaking cardiothoracic surgery news and research from around the world. Joel discusses donor-transmitted coronary artery disease in heart transplant recipients, multiple arterial grafting in diabetic populations, and outcomes of transcatheter versus surgical aortic valve replacement with prior CABG. He also talks about VATS documentation of intraoperative unilateral pulmonary artery clamping test, a demonstration of a Cabrol patch with Cooley fistula, and a recording of Duke Cameron's talk from the 2021 Birmingham Review Course. After discussing upcoming events in the CT surgery world, he closes with a shoutout to Lorena Montes, CTSNet's new Cardiac Senior Editor. JANS Items Mentioned Prevalence, Characteristics, and Prognostic Relevance of Donor-Transmitted Coronary Artery Disease in Heart Transplant Recipients Survival of Multiple Arterial Grafting in Diabetic Populations: A 20-Year National Experience Comparison of Outcomes and Discharge Location After Transcatheter vs. Surgical Aortic Valve Replacement with Prior Coronary Artery Bypass Grafting CTSNet Content Mentioned Intraoperative Unilateral Pulmonary Artery Clamping Test: A First VATS Documentation of a Years Old Technique Cabrol Patch with Cooley Fistula: A Useful Tool for Difficult-to-Control Bleeding Aortopathies: Birmingham Review Course 2021 Other Items Mentioned CTSNet Events Calendar Disclaimer The information and views presented on CTSNet.org represent the views of the authors and contributors of the material and not of CTSNet. Please review our full disclaimer page here.
In this two-part episode our team debates management of complex pleural effusions and empyema. Our surgical team is joined by Dr. Jed Gorden, an interventional pulmonologist, as we explore the nuances of deciding on fibrinolytic therapy (part 1) versus surgical management (part 2). Part 1: https://behindtheknife.org/podcast/clinical-challenges-in-thoracic-surgery-complex-pleural-effusions-empyema-part-1-of-2/ Learning Objectives: -Discuss the pros and cons of small bore versus large bore chest tubes for complex pleural effusions -Review the evidence for fibrinolytic therapy for management of complex pleural effusions -Describe the surgical management of a complex pleural effusion including VATS, open thoracotomy, empyema tube, Eloesser flap, and Clagett window -Create a framework for shared-decision making with patients regarding management of a complex pleural effusion Hosts: Kelly Daus MD, Peter White MD, Jed Gorden, MD and Brian Louie MD Referenced Material https://pubmed.ncbi.nlm.nih.gov/15745977/ Maskell NA, et al. First Multicenter Intrapleural Sepsis Trial (MIST1) Group. U.K. Controlled trial of intrapleural streptokinase for pleural infection. N Engl J Med. 2005 Mar 3;352(9):865-74. doi: 10.1056/NEJMoa042473. Erratum in: N Engl J Med. 2005 May 19;352(20):2146. PMID: 15745977. https://pubmed.ncbi.nlm.nih.gov/21830966/ Rahman NM, et al. Intrapleural use of tissue plasminogen activator and DNase in pleural infection. N Engl J Med. 2011 Aug 11;365(6):518-26. doi: 10.1056/NEJMoa1012740. PMID: 21830966. https://pubmed.ncbi.nlm.nih.gov/35830586/ Wilshire CL, et al. Comparing Initial Surgery versus Fibrinolytics for Pleural Space Infections: A Retrospective Multicenter Cohort Study. Ann Am Thorac Soc. 2022 Nov;19(11):1827-1833. doi: 10.1513/AnnalsATS.202108-964OC. PMID: 35830586. https://pubmed.ncbi.nlm.nih.gov/37043201/ Wilshire CL, et al. Effect of Intrapleural Fibrinolytic Therapy vs Surgery for Complicated Pleural Infections: A Randomized Clinical Trial. JAMA Netw Open. 2023 Apr 3;6(4):e237799. doi: 10.1001/jamanetworkopen.2023.7799. PMID: 37043201; PMCID: PMC10098968. Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more. If you liked this episode, check out more thoracic surgery episodes here: https://behindtheknife.org/podcast-category/cardiothoracic/
In this two-part episode our team debates management of complex pleural effusions and empyema. Our surgical team is joined by Dr. Jed Gorden, an interventional pulmonologist, as we explore the nuances of deciding on fibrinolytic therapy (part 1) versus surgical management (part 2). Learning Objectives: -Discuss the pros and cons of small bore versus large bore chest tubes for complex pleural effusions -Review the evidence for fibrinolytic therapy for management of complex pleural effusions -Describe the surgical management of a complex pleural effusion including VATS, open thoracotomy, empyema tube, Eloesser flap, and Clagett window -Create a framework for shared-decision making with patients regarding management of a complex pleural effusion Hosts: Kelly Daus MD, Peter White MD, Jed Gorden, MD and Brian Louie MD Referenced Material https://pubmed.ncbi.nlm.nih.gov/15745977/ Maskell NA, et al. First Multicenter Intrapleural Sepsis Trial (MIST1) Group. U.K. Controlled trial of intrapleural streptokinase for pleural infection. N Engl J Med. 2005 Mar 3;352(9):865-74. doi: 10.1056/NEJMoa042473. Erratum in: N Engl J Med. 2005 May 19;352(20):2146. PMID: 15745977. https://pubmed.ncbi.nlm.nih.gov/21830966/ Rahman NM, et al. Intrapleural use of tissue plasminogen activator and DNase in pleural infection. N Engl J Med. 2011 Aug 11;365(6):518-26. doi: 10.1056/NEJMoa1012740. PMID: 21830966. https://pubmed.ncbi.nlm.nih.gov/35830586/ Wilshire CL, et al. Comparing Initial Surgery versus Fibrinolytics for Pleural Space Infections: A Retrospective Multicenter Cohort Study. Ann Am Thorac Soc. 2022 Nov;19(11):1827-1833. doi: 10.1513/AnnalsATS.202108-964OC. PMID: 35830586. https://pubmed.ncbi.nlm.nih.gov/37043201/ Wilshire CL, et al. Effect of Intrapleural Fibrinolytic Therapy vs Surgery for Complicated Pleural Infections: A Randomized Clinical Trial. JAMA Netw Open. 2023 Apr 3;6(4):e237799. doi: 10.1001/jamanetworkopen.2023.7799. PMID: 37043201; PMCID: PMC10098968. Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more. If you liked this episode, check out more thoracic surgery episodes here: https://behindtheknife.org/podcast-category/cardiothoracic/
Prakhar Vats is a founding member of LimeChat, which leverages conversations in WhatsApp and Instagram to double your ecommerce sales. With their innovative AI technology, LimeChat is able to be seamlessly implemented into chat platforms and has created a productive way to advertise brands to customers and increase sales.On this episode, we discuss conversational marketing, the importance of linguistics in this new marketing strategy, why messaging channels will be the primary buying mediums in the next five years, and much more.
Welcome back book nerds! On today's episode we have one of our book swap pairings. This time it's Bailey and Kristin talking about Kristin's pick Hamnet by Maggie O'Farrell. Join us as we talk Shakespeare, grief, selfish 16th-century men, and how we want to go out in a Viking funeral pyre. Topics also discussed in this episode: Shakespeare was kinda a dead-beat dad! Bailey is mad that ol' Willy Shakes was successful! Women didn't have it great in the 16th century! Shakespearean generational trauma!! Bailey hates and respects this book! If Bailey saw Shakespeare today, she'd punch him for Judith! What do we do with art that we love by horrible people?!? Kristin offends Taylor Swift's army of fans! Guys, the Bubonic Plague was scary! Vats of acid, The Joker, Mordor, and dragons! Theme music by Wolves Incidental music by Colorfilm --- Send in a voice message: https://podcasters.spotify.com/pod/show/book-prose/message
In the first episode of season 10, we turn our attention to an extraordinary story about online retail sales, China, VAT and HMRC.Despite all the apparent jargon, it is just an everyday tale of 11,000 companies all suddenly deciding to register to a private address where the owner had never heard of them.Which didn't stop him being sent £500,000 in debt enforcement letters.And, in a first for The Dark Money Files, this podcast is now sponsored which will secure the ongoing future of the podcast and ensure we can continue to deliver a quality product.Here's a link to our sponsor's website: https://www.deep-pool.com/Support the show
Guitarist, Chris Rest of RKL and Lagwagon joins the show this week and talks about getting labeled 'a bunch of Rich Kids on LSD', buying his first amp from Tom Sims, early days with Bomber, Jason Sears vert ramp, kicking it at Dead Ted's, opening for the Ramones in Santa Barbara, lil Joe joining the band, having their roadie die on their first Euro tour, practicing at the Vats in SF, the origin story of the beanie baby, Day at the Farm, releasing a new RKL album in 2022 and much more... Hope you enjoy this one and during the hard times always remember to "Keep a grin and think positive!" --------------------------------------- SUBSCRIBE NOW: https://bit.ly/2RYE75F --------------------------------------- FOLLOW CHRIS: http://www.instagram.com/chrisrestguitar --------------------------------------- TALKIN' SCHMIT SOFT GOODS IN JAPAN: https://www.instagram.com/underdogdistribution --------------------------------------- INTRO MUSIC: "Mary's Cross" by Natur INTERVIEW & EDITED: Greg "Schmitty" Smith CREDITS MUSIC: “Adirondack gate” by Shane Medanich CLOSING MONOLOGUE: Noelle Fiore EXECUTIVE DIRECTOR: Sharal Camisa If you want to help support the show, head over to https://www.talkinschmit.com/ and pick up some merchandise. There's also lots of photos, video and extras to help complement each interview. WEBSITE: https://talkinschmit.com/ YOUTUBE: http://www.youtube.com/TalkinSchmit INSTAGRAM: @Talkin_Schmit FACEBOOK: https://www.facebook.com/TalkinSchmit/ --------------------------------------- SUPPORT OUR SPONSORS: BLOOD WIZARD (http://bloodwizard.com/) BLUE PLATE (http://www.blueplatesf.com/) EXPOSURE: (https://www.exposureskate.org/) --------------------------------------- CONTACT with comments or suggestions: TalkinSchmit@Gmail.com #skateboarding #podcast #TalkinSchmit #ChrisRest #RKL #Lagwagon --- Send in a voice message: https://podcasters.spotify.com/pod/show/talkin-schmit/message Support this podcast: https://podcasters.spotify.com/pod/show/talkin-schmit/support
MesoTV Podcast: Conversations Impacting the Mesothelioma Community
Dr. Andrea Wolf is Director of the New York Mesothelioma Program at the Mount Sinai Health System, which provides comprehensive, multidisciplinary clinical care for patients with suspected or diagnosed malignant pleural mesothelioma. She has expertise in surgery for pleural mesothelioma and VATS lobectomy, and research interests in mesothelioma, health care disparities, and lung cancer. Dr. Wolf graduated Cum Laude from Princeton University and earned highest honors and her medical degree at Harvard Medical School. She trained in General Surgery and served as Chief Resident at Massachusetts General Hospital in Boston. Dr. Wolf earned a Master in Public Health with a focus on Clinical Effectiveness at Harvard University School of Public Health while researching malignant pleural mesothelioma and early stage lung cancer as a Thoracic Oncology Research Fellow at Brigham and Women's Hospital, also in Boston. She completed her training in Cardiothoracic Surgery after serving as Chief Resident in Thoracic Surgery at Brigham and Women's Hospital. Dr. Wolf is interviewed by Shannon Sinclair, RN, BSN, OCN, who serves as the patient services director at the Mesothelioma Applied Research Foundation. www.curemeso.org.
This week on Toilet Radio: Joe supported the scene - huge mistake. / A visit to an early 2000s Hot Topic-themed bar turns sour as we discuss watching your own youth get regurgitated back into your mouth like a lil baby bird / Ash from Sumerian has decided now, three years after he could have made some hay with it, to be an antivax guy. Let's dive into Ash, Sumerian, and his extremely successful movie director father. / Tim Lambesis has a few new side projects (including one with the giant bodybuilder guy Joe has been following for years) / Venom Prison have succumbed to a terminal illness: being from the UK / Monuments refuse to get gouged by merch cuts and VATs on European shows and the guy from Stick to Your Guns presents a shockingly articulate vision of solidarity and organization among musicians. Folks, this is a show. Music featured on this show: Temptress – Serpentine This program is available on Spotify. It is also available on iTunes or whatever they call it now, where you can rate, review, and subscribe. Give us money on Patreon to get exclusive bonus episodes and other cool shit.
In this episode, Anjali Vats, Associate Professor of Law at the University of Pittsburgh School of Law, discusses her book "The Color of Creatorship: Intellectual Property, Race, and the Making of Americans," which is published by Stanford University Press. She explains how critical race theory can and should inform our understanding of the history of intellectual property. Vats is on Twitter at @raceip.This episode was hosted by Brian L. Frye, Spears-Gilbert Professor of Law at the University of Kentucky College of Law. Frye is on Twitter at @brianlfrye. Hosted on Acast. See acast.com/privacy for more information.
Lung cancer is one of the most commonly diagnosed type of cancer and so it is fitting that we start the first of our disease-specific oncology series with this diagnosis. This week, we sit down with Thoracic Surgeon, Dr. Jane Yanagawa to discuss surgical considerations in treatment of NSCLC. * How do you choose what type of surgical resection to do?- Considerations: --Lung anatomy --Location of the nodule within lung--Lymph node involvement-Options: --Pneumonectomy: removal of whole lung --Lobectomy: remove a whole lobe--Segmentectomy/sublobar resection: part of a lobe* What does “adequate margins” mean? And how do you know if it's enough?- If you're removing the whole lobe, it does not matter as much - If you're doing a segmentectomy, you want to have samples evaluated while in the OR because if there is signs of more disease that initially thought, you would take this one step further and do a lobectomy. - Need to consider the patient's situation - how good is their status * Why does preoperative workup matter?- Pulmonary function tests: Surgeons are looking at the %FEV1 and %DLCO to then predict what their function would be AFTER surgery. After surgery, they want to ensure patient has %FEV1 or %DLCO >40%. - Lung anatomy: In patients with COPD and endobronchial lesions, sometimes they also get V/Q scans to evaluate ratio- Cardiac echo: Important in pneumonectomy where removal of lung tissue will also remove a significant amount of blood vessels. Want to rule out pulmonary hypertension pre-operatively. - Pulmonary hypertension can also affect someone's survival while they're ventilating with only one lung during the procedure (“single lung ventilation”). - Smoking status: Smoking can increase complications by ~60%. - Pre-habilitation: Encouraging patients to be fit prior to surgery with walking, nutrition, +/- pulmonary rehabilitation* What is “VATS”?- VATS stands for video-assisted thoracoscopic surgery; it is not, in itself, a procedure. But a VATS allows for minimally invasive surgery through the use of a camera. - It involves three incisions (axilla, lowest part of mid-axillary line, one posterior)* In what scenario is a mediastinoscopy warranted? - Needed after EBUS if there is still high index of suspicion for cancer involvement in lymph nodes, even if lymph nodes are negative from EBUS* What is “systematic lymph node sampling”?- An organized way to sample lymph nodes, including all lymph nodes that are along the way, not just the ones that may be involved * As a surgeon, how do you determine if a patient is okay for surgery if the mass is invading another structure?- Need to take the anatomy into consideration - are there major blood vessels or nerves there, for instance, which can impact outcome and recovery.* When should we consider induction chemotherapy from a surgeon's perspective?- Lots of changes in this sphere coming; lots of discrepancy between institutions when there is N2 disease - In Dr. Yanagawa's opinion, anyone with N2 disease should get neoadjuvant therapy * If there is neoadjuvant chemoradiation given, how does that effect your surgery?- Radiation increases scar tissue in the lung tissue. But what is worse is that radiation neoadjuvantly may make wound healing more difficult. She does not prefer radiation pre-operatively- Chemotherapy also adds scar tissue*How does neoadjuvant IO therapy affect scar tissue formation?- The hilum and lymph nodes are more swollen, but does not translate to more complications - She has even seen patients who had gotten IO for another cancer and then get lung cancer, she can still appreciate swollen nodes!* How long after surgery is it safe to start adjuvant therapy?- If patient has a complication from surgery, would not start right away. It is important to discuss with the surgeon about when it is okay to proceed with adjuvant therapy. - If patient has good recovery/without complications, okay to start about 4 weeks after- There is no good guidance yet about when it is safe to start IO after surgery About our guest: Jane Yanagawa, MD is an Assistant Professor of Thoracic Surgery at the UCLA David Geffen School of Medicine and the UCLA Jonsson Comprehensive Cancer Center. She completed medical school at Baylor College of Medicine, after which she went to UCLA for her surgical residency. She went onto Memorial Sloan-Kettering for her Thoracic Surgery Fellowship. In addition to her practice as a thoracic surgeon at UCLA, Dr. Yanagawa also sits on the NCCN NSCLC guidelines committee! We are so grateful she was able to join us despite her very busy schedule! Please visit our website (TheFellowOnCall.com) for more information Twitter: @TheFellowOnCallInstagram: @TheFellowOnCallListen in on: Apple Podcast, Spotify, and Google Podcast
© 2020-2025 Ivy Podcast Discovery LLC
