Podcasts about yale new haven

Drex covers essential cybersecurity reports including the HIMSS Survey, Cincinnati's Healthcare Cybersecurity Benchmarking Study, CrowdStrike's 2025 Global Threat Report, and Verizon's DBIR. Also highlighted: an Oracle engineering error affecting 45 hospitals' EHRs, Yale New Haven's breach impacting 5.5 million patients, and Blue Shield of California's Google Analytics configuration mistake exposing 4.7 million patients' data.Remember, Stay a Little Paranoid X: This Week Health LinkedIn: This Week Health Donate: Alex's Lemonade Stand: Foundation for Childhood Cancer

March 6, 2024: In this episode of This Week Health, it's a double Interview In action with Terri Couts from the Guthrie Clinic and then Laura O'Toole of Suretest & Mike Mattews at Yale New Haven. They delve into the transformative journeys of healthcare institutions as they navigate through the complexities of modern IT challenges and innovations. From the expansive operations of the Guthrie Clinic to the intricate automation projects at Yale New Haven Health, our guests share their firsthand experiences. How does Guthrie Clinic defy the common perception of a 'clinic' with its extensive network and multifaceted services? What drives their focus towards IT efficiency and the creation of a data lake, and how do they manage the balance between cost and quality in healthcare IT? Yale New Haven Health's exploration into automation and its impact on operational efficiency and patient care further enriches our understanding. What lessons can we learn from their approach to automation in clinical systems, and how does this reflect on the broader trends in healthcare technology? These discussions not only provide insights into the challenges faced but also highlight the innovative strategies employed to overcome them.This Week Health SubscribeThis Week Health TwitterThis Week Health LinkedinAlex's Lemonade Stand: Foundation for Childhood Cancer Donate

Estás escuchando #JUNTOSRadio¿Cuáles son las diferencia entre las primeras vacunas y las actuales?, ¿Cada cuando debo vacunarme?, ¿Existe contraindicación si me vacuno con diferentes tipos de marcas de vacunas?. El Dr. Fernando Merino profesor asistente de medicina en la División de Enfermedades Infecciosas del Departamento de Medicina del Sistema de Salud de la Universidad de Kansas, nos responde a estas y otras preguntas.     Sobre nuestro invitado:  El Dr. Fernando Merino es médico internista en el Centro Médico de la Universidad de Kansas. Recibió su título de médico de la Universidad del País Vasco, en España. Tras graduarse en la Facultad de Medicina, obtuvo un Máster en Medicina Tropical en la Universidad de Valencia, en España.  Residencia de Medicina Interna. Hospital Newton Wellesley. Universidad Tufts. Newton, MA  Asociación de Enfermedades infecciosas. Hospital de Yale-New Haven. Universidad de Yale. New Haven, CT    También está certificado por la Junta en Enfermedades Infecciosas. Es miembro de la Infectious Diseases Society of America y también miembro del American College of Physicians.      Recursos informativos en español   CDC  https://espanol.cdc.gov/coronavirus/2019-ncov/vaccines/index.html  Vacunas.gov  https://www.vaccines.gov/es/  FDA  https://www.fda.gov/about-fda/fda-en-espanol/vacunas-contra-el-covid-19    Facebook: @juntosKS     Instagram: juntos_ks     YouTube: Juntos KS   Twitter: @juntosKS     Página web: http://juntosks.org         Suscríbete en cualquiera de nuestras plataformas de Podcast: Podbean, Spotify, Amazon Music y Apple Podcast - Juntos Radio          Centro JUNTOS Para Mejorar La Salud Latina     4125 Rainbow Blvd. M.S. 1076,     Kansas City, KS 66160       No tenemos los derechos de autor de la música que aparece en este video. Todos los derechos de la música pertenecen a sus respectivos creadores.   

Vizient Pharmacy Vision Awards celebrate the values and achievements of our pharmacy members. 3 winners of the 2022 Excellence in Public Policy Award, Drs. Amber Zaniewski, Steph Luon, and Marie Renauer, all from Yale New Haven join Gretchen Brummel, Pharmacy Executive Director in the Center for Pharmacy Practice Excellence at Vizient, and your program host to discuss advancing pharmacy practice through public policy. Guest speakers: Steph Luon, PharmD, BCPS, BCACP Manager, Ambulatory Clinical Pharmacy Services Yale New Haven Hospital Marie M. Renauer, PharmD, MBA, BCACP  Associate Director, Ambulatory Clinical Pharmacy Services Yale New Haven Hospital Amber Zaniewski, PharmD, BCPS, BCCCP System Director, Clinical Pharmacy Services Yale New Haven Hospital, Corporate Pharmacy Services Moderator: Gretchen Brummel, PharmD, BCPS Pharmacy Executive Director Vizient Center for Pharmacy Practice Excellence Show Notes: [00:43-01:28] Amber, Marie and Steph backgrounds [01:29-5:17] Identifying the need for public policy changes [5:18 - 06:36] Key stakeholders they partnered with [06:37-11:58] How the process unfolded and results [11:59-12:55] Challenges along the way [12:56 - 15:59] Positive impacts [16:00 - 18:12] Advice for Pharmacy Professionals [18:13 - 18:41] Future plans Links | Resources: Vizient Pharmacy Vision Awards Overview document About the program 2022 award winners Subscribe Today! Apple Podcasts Amazon Podcasts Google Podcasts Spotify Stitcher Android RSS Feed

Estás escuchando #JUNTOSRadio¿Qué es la Hepatitis C?, ¿Cuantos tipos existen?, ¿Cuáles son las formas más comunes de transmisión? El Dr. Fernando Merino profesor asistente de medicina en la División de Enfermedades Infecciosas del Departamento de Medicina del Sistema de Salud de la Universidad de Kansas, nos responde a estas y otras preguntas. Sobre nuestro invitado: El Dr. Fernando Merino es médico internista en el Centro Médico de la Universidad de Kansas. Recibió su título de médico de la Universidad del País Vasco, en España. Tras graduarse en la Facultad de Medicina, obtuvo un Máster en Medicina Tropical en la Universidad de Valencia, en España. Residencia de Medicina Interna. Hospital Newton Wellesley. Universidad Tufts. Newton, MA Asociación de Enfermedades infecciosas. Hospital de Yale-New Haven. Universidad de Yale. New Haven, CT También está certificado por la Junta en Enfermedades Infecciosas. Es miembro de la Infectious Diseases Society of America y también miembro del American College of Physicians.   Recursos informativos en español sobre Hepatitis C  Organización Mundial de la Salud (OMG) https://www.who.int/es/news-room/fact-sheets/detail/hepatitis-c Organización Mundial de la Salud (OMG) Centro para el Control y la Prevención de enfermedades  (CDC) https://www.cdc.gov/hepatitis/hcv/pdfs/hepcgeneralfactsheet_sp.pdf Clinica Mayo https://www.mayoclinic.org/es/diseases-conditions/hepatitis-c/symptoms-causes/syc-20354278#:~:text=La%20hepatitis%20C%20es%20una,trav%C3%A9s%20de%20la%20sangre%20contaminada.   Síguenos en las redes sociales de JUNTOS   Facebook: @juntosKS    Instagram: juntos_ks    YouTube: Juntos KS   Twitter: @juntosKS    Página web: http://juntosks.org     Suscríbete en cualquiera de nuestras plataformas de Podcast: Podbean, Spotify, Amazon Music y Apple Podcast - Juntos Radio    Centro JUNTOS Para Mejorar La Salud Latina    4125 Rainbow Blvd. M.S. 1076,    Kansas City, KS 66160    913-945-6635   

In this episode, we are joined again by Alan Condon, Editor-in-Chief at Becker's Healthcare, to discuss different mergers & acquisitions including - Illinois greenlighting the Atrium, Advocate Aurora merger, Yale New Haven's proposed acquisition of 3 Connecticut hospitals, and more.

Norm returned to "The Norm Pattis Show," along with North Carolina attorney Michael Boyer to talk about a variety topics. One of the bigger topics was a question Norm posted on Twitter revolving around the 2024 election (0:00). After that, the show took a local turn as Norm talked about a story at Yale-New Haven Hospital and a lawsuit that was filed by a parent who alleges that their son was left unattended for hours following an overdose and ultimately passed away (26:01). Image Credit: Darwin Brandis / iStock / Getty Images Plus

Meet Marna Borgstrom:Marna Borgstrom is CEO of Yale New Haven Hospital and Yale New Haven Health. She started her career at Yale New Haven over 40 years ago, and advanced through positions of increasing responsibility in administration, management, and operations. In 2005, she was selected to serve as CEO, and after 17 years will be retiring in March of 2022. She received a Bachelor's in Human Biology from Stanford and a Master of Public Health from Yale University School of Medicine. Key Insights:Marna Borgstrom has decades of experience in healthcare. She reflects on her career journey and leadership, and shares what she will do next. Operations and Strategy Inform Each Other. Good healthcare leadership requires both operations and strategic expertise. Being a good operator requires the strategic foresight to innovate, and being a good strategist requires understanding the business. (5:00)How to Develop Talent. Marna shares that she spent at least 25% of her time as CEO on talent development. Yale New Haven created a Lean In group to promote mentorship for both women and men. This work strengthened company culture and promoted internal succession. (15:42)Is Retirement the End? Not for Marna! After 43 years at Yale New Haven, she is excited to leave the organization in good hands. She is working on becoming a career coach, taking bucket list tips, and continuing her volunteer work with the Connecticut Center for Arts and Technology (21:16)This episode is hosted by Joanne Conroy, M.D. She is a member of the Advisory Council for Her Story and is the CEO and President of Dartmouth-Hitchcock and Dartmouth-Hitchcock Health.Relevant Links:“YNHHS CEO Marna Borgstrom to retire in 2022”Read “Parting thoughts, advice from Yale New Haven Health's retiring CEO”Listen to “'It's Important to Have a Vision:' Retiring Yale New Haven Health CEO”

Please join first author Yuan Lu and Guest Editor Jan Staessen as they discuss the article "National Trends and Disparities in Hospitalization for Acute Hypertension Among Medicare Beneficiaries (1999-2019)." Dr. Carolyn Lam: Welcome to Circulation on the Run: your weekly podcast, summary and backstage pass to the journal and it's editors. We're your co-hosts. I'm Dr. Carolyn Lam, associate editor from the National Heart Center and Duke National University of Singapore. Dr. Greg Hundley: And I'm Dr. Greg Hundley, associate editor, and director of Pauley Heart Center at VCU health in Richmond, Virginia. Dr. Carolyn Lam: Greg, today's feature discussion is about the national trends and disparities and hospitalizations for hypertensive emergencies among Medicare beneficiaries. Isn't that interesting? We're going to just dig deep into this issue, but not before we discuss the other papers in today's issue. I'm going to let you go first today while I get a coffee and listen. Dr. Greg Hundley: Oh, thanks so much, Carolyn. My first paper comes to us from the world of preclinical science and it's from professor Christoff Maack from University Clinic Wursburg. Carolyn, I don't have a quiz for you, so I'm going to give a little break this week, but this particular paper is about Barth syndrome. Barth syndrome is caused by mutations of the gene encoding taffazin, which catalyzes maturation of mitochondrial cardiolipin and often manifests with systolic dysfunction during early infancy. Now beyond the first months of life, Barth syndrome cardiomyopathy typically transitions to a phenotype of diastolic dysfunction with preserved ejection fraction, one of your favorites, blunted contractile reserve during exercise and arrhythmic vulnerability. Previous studies traced Barth syndrome cardiomyopathy to mitochondrial formation of reactive oxygen species. Since mitochondrial function and reactive oxygen species formation are regulated by excitation contraction coupling, these authors wanted to use integrated analysis of mechano-energetic coupling to delineate the pathomechanisms of Barth syndrome cardiomyopathy. Dr. Carolyn Lam: Oh, I love the way you explained that so clearly, Greg. Thanks. So what did they find? Dr. Greg Hundley: Right, Carolyn. Well, first defective mitochondrial calcium uptake prevented Krebs cycle activation during beta adrenergic stimulation, abolishing NADH regeneration for ATP production and lowering antioxidative NADPH. Second, Carolyn, mitochondrial calcium deficiency provided the substrate for ventricular arrhythmias and contributed to blunted inotropic reserve during beta adrenergic stimulation. And finally, these changes occurred without any increase of reactive oxygen species formation in or omission from mitochondria. So Carolyn what's the take home here? Well, first beyond the first months of life, when systolic dysfunction dominates, Barth syndrome cardiomyopathy is reminiscent of heart failure with preserved rather than reduced ejection fraction presenting with progressive diastolic and moderate systolic dysfunction without relevant left ventricular dilation. Next, defective mitochondrial calcium uptake contributes to inability of Barth syndrome patients to increase stroke volume during exertion and their vulnerability to ventricular arrhythmias. Lastly, treatment with cardiac glycosides, which could favor mechano-energetic uncoupling should be discouraged in patients with Barth syndrome and left ventricular ejection fractions greater than 40%. Dr. Carolyn Lam: Oh, how interesting. I need to chew over that one a bit more. Wow, thanks. But you know, I've got a paper too. It's also talking about energetic basis in the presence of heart failure with preserved ejection fraction, but this time looking at transient pulmonary congestion during exercise, which is recognized as an emerging and important determinant of reduced exercise capacity in HFpEF. These authors, led by Dr. Lewis from University of Oxford center for clinical magnetic resonance research sought to determine if an abnormal cardiac energetic state underpins this process of transient problem congestion in HFpEF. Dr. Carolyn Lam: To investigate this, they designed and conducted a basket trial covering the physiological spectrum of HFpEF severity. They non-invasively assess cardiac energetics in this cohort using phosphorous magnetic resonance spectroscopy and combined real time free breathing volumetric assessment of whole heart mechanics, as well as a novel pulmonary proton density, magnetic resonance imaging sequence to detect lung congestion, both at rest and during submaximal exercise. Now, Greg, I know you had a look at this paper and magnetic resonance imaging, and spectroscopy is your expertise. So no quiz here, but could you maybe just share a little bit about how novel this approach is that they took? Dr. Greg Hundley: You bet. Carolyn, thanks so much for the intro on that and so beautifully described. What's novel here is they were able to combine imaging in real time, so the heart contracting and relaxing, and then simultaneously obtain the metabolic information by bringing in the spectroscopy component. So really just splashing, as they might say in Oxford, just wonderful presentation, and I cannot wait to hear what they found. Dr. Carolyn Lam: Well, they recruited patients across the spectrum of diastolic dysfunction and HFpEF, meaning they had controls. They had nine patients with type two diabetes, 14 patients with HFpEF and nine patients with severe diastolic dysfunction due to cardiac amyloidosis. What they found was that a gradient of myocardial energetic deficit existed across the spectrum of HFpEF. Even at low workload, the energetic deficit was related to a markedly abnormal exercise response in all four cardiac chambers, which was associated with detectable pulmonary congestion. The findings really support an energetic basis for transient pulmonary congestion in HFpEF with the implication that manipulating myocardial energy metabolism may be a promising strategy to improve cardiac function and reduce pulmonary congestion in HFpEF. This is discussed in a beautiful editorial by Drs. Jennifer Hole, Christopher Nguyen and Greg Lewis. Dr. Greg Hundley: Great presentation, Carolyn, and obviously love that MRI/MRS combo. Carolyn, these investigators in this next paper led by Dr. Sara Ranjbarvaziri from Stanford University School of Medicine performed a comprehensive multi-omics profile of the molecular. So transcripts metabolites, complex lipids and ultra structural and functional components of hypertrophic cardiomyopathy energetics using myocardial samples from 27 hypertrophic cardiomyopathy patients and 13 controls really is the donor heart. Dr. Carolyn Lam: Wow, it's really all about energetics today, isn't it? So what did they see, Greg? Dr. Greg Hundley: Right, Carolyn. So hypertrophic cardiomyopathy hearts showed evidence of global energetic decompensation manifested by a decrease in high energy phosphate metabolites (ATP, ADP, phosphocreatine) and a reduction in mitochondrial genes involved in the creatine kinase and ATP synthesis. Accompanying these metabolic arrangements, quantitative electron microscopy showed an increased fraction of severely damaged mitochondria with reduced crystal density coinciding with reduced citrate synthase activity and mitochondrial oxidative respiration. These mitochondrial abnormalities were associated with elevated reactive oxygen species and reduced antioxidant defenses. However, despite significant mitochondrial injury, the hypertrophic cardiomyopathy hearts failed to up-regulate mitophagic clearance. Dr. Greg Hundley: So Carolyn, in summary, the findings of this study suggest that perturbed metabolic signaling and mitochondrial dysfunction are common pathogenic mechanisms in patients with hypertrophic cardiomyopathy, and these results highlight potential new drug targets for attenuation of the clinical disease through improving metabolic function and reducing myocardial injury. Dr. Carolyn Lam: Wow, what an interesting issue of our journal. There's even more. There's an exchange of letters between Drs. Naeije and Claessen about determinants of exercise capacity in chronic thromboembolic pulmonary hypertension. There's a "Pathways to Discovery" paper: a beautiful interview with Dr. Heinrich Taegtmeyer entitled,"A foot soldier in cardiac metabolism." Dr. Greg Hundley: Right, Carolyn, and I've got a research letter from Professor Marston entitled "The cardiovascular benefit of lowering LDL cholesterol to below 40 milligrams per deciliter." Well, what a great issue, very metabolic, and how about we get onto that feature discussion? Dr. Carolyn Lam: Let's go, Greg. Dr. Greg Hundley: Welcome listeners to our feature discussion today. We have a paper that is going to address some issues pertaining to high blood pressure, or hypertension. With us, we have Dr. Yuan Lu from Yale University in New Haven, Connecticut. We also have a guest editor to help us review this paper, Dr. Jan Staessen from University Louvain in Belgium. Welcome to you both and Yuan, will start with you. Could you describe for us some of the background that went into formulating your hypothesis and then state for us the hypothesis that you wanted to address with this research? Dr. Yuan Lu: Sure. Thank you, Greg. We conducted this study because we see that recent data show hypertension control in the US population has not improved in the last decades, and there are widening disparities. Also last year, the surgeon general issued a call to action to make hypertension control a national priority. So, we wanted to better understand whether the country has made any progress in preventing hospitalization for acute hypertension. That is including hypertension emergency, hypertension urgency, and hypertension crisis, which also refers to acute blood pressure elevation that is often associated with target organ damage and requires urgent intervention. We have the data from the Center for Medicare/Medicaid, which allow us to look at the trends of hospitalization for acute hypertension over the last 20 years and we hypothesize we may also see some reverse progress in hospitalization rate for acute hypertension, and there may differences by population subgroups like age, sex, race, and dual eligible status. Dr. Greg Hundley: Very nice. So you've described for us a little bit about perhaps the study population, but maybe clarify a little further: What was the study population and then what was your study design? Dr. Yuan Lu: Yeah, sure. The study population includes all Medicare fee-for-service beneficiaries 65 years and older enrolled in the fee-for-service plan for at least one month from January 1999 to December 2019 using the Medicare denominator files. We also study population subgroups by age, sex, race and ethnicity and dual eligible status. Specifically the racial and ethnic subgroups include Asian, blacks, Hispanics, North American native, white, and others. Dual eligible refers to beneficiary eligible for both Medicare and Medicaid. This study design is a serial cross sectional analysis of these Medicare beneficiaries between 1999 and 2019 over the last 20 years. Dr. Greg Hundley: Excellent. Yuan, what did you find? Dr. Yuan Lu: We actually have three major findings. First, we found that in Medicare beneficiaries 65 years and older, hospitalization rate for acute hypertension increased more than double in the last 20 years. Second, we found that there are widening disparities. When we look at all the population subgroups, we found black adults having the highest hospitalization rate in 2019 across age, sex, race, and dual eligible subgroup. And finally, when we look at the outcome among people hospitalized, we found that during the same period, the rate of 30 day and 90 day mortality and readmission among hospitalized beneficiaries improved and decreased significantly. So this is the main findings, and we can also talk about implications of that later. Dr. Greg Hundley: Very nice. And did you find any differences between men and women? Dr. Yuan Lu: Yes. We also looked at the difference between men and women, and we found that actually the hospitalization rate is higher among females compared to men. So more hospitalizations for acute hypertension among women than men. Dr. Greg Hundley: Given this relatively large Medicare/Medicaid database and cross-sectional design, were you able to investigate any relationships between these hospitalizations and perhaps social determinants of health? Dr. Yuan Lu: For this one, we haven't looked into that detail. This is just showing the overall picture, like how the hospitalization rate changed over time in the overall population and by different population subgroups. What you mentioned is an important issue and should definitely be a future study to look at whether social determine have moderated the relationship between the hospitalization. Speaker 3: Excellent. Well, listeners, now we're going to turn to our guest editor and you'll hear us talk a little bit sometimes about associate editors. We have a team that will review many papers, but when we receive a paper that might contain an associate editor or an associate editors institution, we actually at Circulation turn to someone completely outside of the realm of the associate editors and the editor in chief. These are called guest editors. With us today, we have Dr. Jan Staessen from Belgium who served as the guest editor. He's been working in this task for several years. Jan, often you are referred papers from the American Heart Association. What attracted you to this particular paper and how do you put Yuan's results in the context with other studies that have focused on high blood pressure research? Dr. Jan Staessen: Well, I've almost 40 years of research in clinical medicine and in population science, and some of my work has been done in Sub-Saharan Africa. So when I read the summary of the paper, I was immediately struck by the bad results, so to speak, for black people. This triggered my attention and I really thought this message must be made public on a much larger scale because there is a lot of possibility for prevention. Hypertension is a chronic disease, and if you wait until you have an emergency or until you have target organ damage, you have gone in too late. So really this paper cries for better prevention in the US. And I was really also amazed when I compared this US data with what happens in our country. We don't see any, almost no hospitalizations for acute hypertension or for hypertensive emergencies. So there is quite a difference. Dr. Jan Staessen: Going further on that, I was wondering whether there should not be more research on access to primary care in the US because people go to the emergency room, but that's not a place where you treat or manage hypertension. It should be managed in primary care with making people aware of the problem. It's still the silent killer, the main cause of cardiovascular disease, 8 million deaths each year. So this really triggered my attention and I really wanted this paper to be published. Dr. Greg Hundley: Very nice. Jan, I heard you mention the word awareness. How have you observed perhaps differences in healthcare delivery in Belgium that might heighten awareness? You mentioned primary care, but are there any other mechanisms in place that heighten awareness or the importance? Dr. Jan Staessen: I think people in Belgium, the general public, knows that hypertension is a dangerous condition. That it should be well treated. We have a very well built primary care network, so every person can go to a primary care physician. Part of the normal examination in the office of a primary care physician is a blood pressure measurement. That's almost routine in Belgium. And then of course not all patients are treated to go. Certainly keeping in mind the new US guidelines that aim for lower targets, now recently confirmed in the Chinese study, you have to sprint three cells. And then the recent Chinese study that have been published to the New England. So these are issues to be considered. I also have colleagues working in Texas close to the Mexican border at the university place there, and she's telling me how primary care is default in that area. Dr. Jan Staessen: I think this is perhaps part of the social divide in the US. This might have to be addressed. It's not only a problem in the US, it's also a problem in other countries. There is always a social divide and those who have less money, less income. These are the people who fell out in the beginning and then they don't see primary care physicians. Dr. Jan Staessen: Belgium, for instance, all medicines are almost free. Because hypertension is a chronic condition prevention should not only start at age 65. Hypertension prevention should really start at a young age, middle age, whenever this diagnosis of high blood pressure diagnosis is confirmed. Use blood pressure monitoring, which is not so popular in the US, but you can also use home blood pressure monitoring. Then you have to start first telling your patients how to improve their lifestyle. When that is not sufficient, you have to start anti hypertensive drug treatment. We have a wide array of anti hypertensive drugs that can be easily combined. If you find the right combination, then you go to combination tablets because fewer tablets means better patient adherence. Dr. Greg Hundley: Yuan we will turn back to you. In the last minutes here, could you describe some of your thoughts regarding what you think is the next research study that needs to be performed in this sphere of hypertension investigation? Dr. Yuan Lu: Sure. Greg, in order to answer your question, let me step back a little bit, just to talk about the implication of the main message from this paper, and then we can tie it to the next following study. We found that the marked increase in hospitalization rate for acute hypertension actually represented many more people suffering a potential catastrophic event that should be preventable. I truly agree with what Dr. Staessen said, hypertension should be mostly treated in outpatient setting rather than in the hospital. We also find the lack of progress in reducing racial disparity in hospitalization. These findings highlight needs for new approaches to address both the medical and non-medical factors, including the social determinants in health, system racism that can contribute to this disparity. When we look at the outcome, we found the outcome for mortality and remission improved over time. Dr. Yuan Lu: This means progress has been made in improving outcomes once people are hospitalized for an acute illness. The issue is more about prevention of hospitalization. Based on this implication, I think in a future study we need better evidence to understand how we can do a better job in the prevention of acute hypertension admissions. For example, we need the study to understand who is at risk for acute hypertensive admissions, and how can this event be preempted. If we could better understand who these people are, phenotype this patient better and predict their risk of hospitalization for acute hypertension, we may do a better job in preventing this event from happening. Dr. Greg Hundley: Very nice. And Jan, do you have anything to add? Dr. Jan Staessen: Yes. I think every effort should go to prevention in most countries. I looked at the statistics, and more than 90% of the healthcare budget is spent in treating established disease, often irreversible disease like MI or chronic kidney dysfunction. I think then you come in too late. So of the healthcare budget in my mind, much more should go to the preventive issues and probably rolling out an effective primary care because that's the place where hypertension has to be diagnosed and hypertension treatment has to be started. Dr. Greg Hundley: Excellent. Well, listeners, we've heard a wonderful discussion today regarding some of the issues pertaining to hypertension and abrupt admission to emergency rooms for conditions pertaining to hypertension, really getting almost out of control. We want to thank Dr. Yuan Lu from Yale New Haven and also our guest editor, Dr. Jan Staessen from Louvain in Belgium. On behalf of Carolyn and myself, we want to wish you a great week and we will catch you next week on the run. This program is copyright of the American Heart Association, 2021. The opinions express by speakers in this podcast are their own and not necessarily those of the editors or of the American Heart Association for more visit aha journals.org.

This episode is brought to you by MEDHOST, a Trusted EHR for Healthcare Facilities. To learn more, go to Medhost.com. Dr. Keith Churchwell is the president of Yale New Haven Hospital. A strategic and innovative leader, Dr. Churchwell is leading Yale New Haven into the new era of hospital care with an eye towards equity and diversity. With his roots here in Nashville, Dr. Churchwell shares with us how his family's commitment to excellence shaped his career – he and his two brothers are all hospital system leaders. And we talk about what it takes to make the tough calls in healthcare that take guts but result in true breakthroughs. For more insights from Dr. Churchwell, read the following resources: Call to action in Circulation: structural racism as a major driver of health disparities: https://www.ahajournals.org/doi/10.1161/CIR.0000000000000936 Working towards more equitable communities: https://www.ynhh.org/publications/bulletin/111220/an-interview-with-keith-churchwell-md-president-yale-new-haven-hospital.aspx Fighting Covid-19 vaccine hesitancy: https://www.newhavenindependent.org/index.php/archives/entry/ynhh_naacp_town_hall/ Pushing for diversity in clinical trials: https://www.newhavenindependent.org/index.php/archives/entry/churchwell_interview/

Today, Nick and Fei are back with Dr. Merima Ruhotina to talk even more about laparoscopy! We review everything pneumoperitoneum: how does it affect the organ systems? Why do we use CO2?  Dr. Ruhotina is a minimally invasive gynecology fellow at Yale-New Haven.  Instagram: @creogsovercoffee Facebook: www.facebook.com/creogsovercoffee Website: www.creogsovercoffee.com Patreon: www.patreon.com/creogsovercoffee You can find the OBG Project at: www.obgproject.com

In larger health systems, finance and strategy teams tend to speak different languages and work more in parallel than in tandem. In this week's episode of Sg2 Perspectives, Yale New Haven Health's CFO Vincent Tammaro and CSO Matthew Comerford discuss how their two teams partner to drive strategic planning and focus the organization on growth initiatives, as well as “the art of team play” that goes beyond just strategy and finance to incorporate a true team effort to work on behalf of the health system and—most importantly—the patients.   We are always excited to get ideas and feedback from our listeners. You can reach us at sg2perspectives@sg2.com, find us on Twitter as @Sg2HealthCare, or visit the Sg2 company page on LinkedIn.

Today, Nick and Fei have Dr. Merima Ruhotina back on the show to continue the third part of the laparoscopic series on our show. Dr. Ruhotina is a minimally invasive gynecology fellow at Yale-New Haven.  Instagram: @creogsovercoffee Facebook: www.facebook.com/creogsovercoffee Website: www.creogsovercoffee.com Patreon: www.patreon.com/creogsovercoffee You can find the OBG Project at: www.obgproject.com

Tom Robertson, Executive Director of the Vizient Research Institute sits down with Marna Borgstrom, CEO of Yale New Haven Health, to discuss everything from a purposeful restart following the COVID-19 crisis to creative approaches to dealing with the manifestations of social determinants of health...in the meantime offering insights into what American medicine does particularly well and where we could do better.   Guest speaker: Marna Borgstrom, MPH CEO Yale New Haven Health System   Moderator: Tom Robertson Executive Director Vizient Research Institute   Show Notes: [01:00] What health care gets right: It's a great “sick care system” [01:48] Where we fall short: We are not a health care system, we're a sick care system [02:15] Marna likes the book The Paradox of America's Health Care by Betsy Bradley and Lauren Taylor. Marna says it says if you combine social infrastructure spending and health care spending per capita the United States doesn't  spend more than other developed countries.   [3:00] The authors say since many illnesses are a function of socioeconomic issues; countries that invest in social infrastructure treat fewer catastrophic health care events. [4:44] Health care organizations have a unique role to be both investor and conveners of other businesses and government. [5:22] In Connecticut there are no safety city/county hospitals to act as safety net hospitals, so Yale New Haven Health academic medical centers must support Bridgeport and New Haven communities – two of the 50 poorest  midsize cities in the United States. [6:18] Yale New Haven has a joint venture with federally qualified community health centers to create integrated, primary ambulatory care and access to specialty care for medically indigent patients. [6:38] Yale New Haven has a “Promise” program which guarantees a 4-year college experience for high school students who have a B average, low absenteeism, and family support. Over the past 10-years, that program has dramatically increased the graduation rate. It not only educates but gives students skills.  [7:40] They also cooperate with Habitat for Humanity and other corporate community partners to improve social infrastructure. [8:55] Beyond financial investments, Yale New Haven brings organizational skills and people who can drive the community's socioeconomic initiatives [11:11] Have about 40 rapid-cycle performance improvement initiatives going [12:37] Electronic Health Record prompts pathways to diagnostics for diagnosis [13:26] Signature care when anyone you care about can come into the health system, and you don't feel compelled to make a call for a work-around to give them good care. Instead, the system works well for each patient. Making progress to achieve that.    [16:50] Volume-based procedures are driven by local physician requests  and local competition [18:00] “Academically-based health system” where you can make your physicians part of an integrated network that moves around the physicians to different health system facilities a few days a week to provide specialty care.  In aggregate you're getting more volume, expertise delivered to local markets without having it all come from those markets.   Links | Resources: Marna Borgstrom's biographical information Click here   Subscribe Today! Apple Podcasts Google Podcasts Android Spotify Stitcher RSS Feed  

Today, Nick and Fei have Dr. Merima Ruhotina back on the show to continue the second part of the laparoscopic series on our show. Dr. Ruhotina is a minimally invasive gynecology fellow at Yale-New Haven.  Instagram: @creogsovercoffee Facebook: www.facebook.com/creogsovercoffee Website: www.creogsovercoffee.com Patreon: www.patreon.com/creogsovercoffee You can find the OBG Project at: www.obgproject.com And... for our brand new project check out: www.obgyninternchallenge.com 

Today, Nick and Fei have Dr. Merima Ruhotina on the show to start off the laparoscopic surgery series on our show. Dr. Ruhotina is a minimally invasive gynecology fellow at Yale-New Haven.  Instagram: @creogsovercoffee Facebook: www.facebook.com/creogsovercoffee Website: www.creogsovercoffee.com Patreon: www.patreon.com/creogsovercoffee You can find the OBG Project at: www.obgproject.com And... for our brand new project check out: www.obgyninternchallenge.com 

In this episode, Dr. Meeks speaks with Drs. Cron and Meiss from the OBGYN residency program at Yale New Haven hospital about their article in the Journal of Graduate Medical Education titled, Training as a Doc with Disabilities. They also discuss the road to Lauren’s “match”, the process of disclosing a disability in residency applications, seeking accommodations as a trainee, Yale’s newly founded advocacy/support group for trainees with disabilities, and Dr. Cron and Meiss’s commitment to educating OBGYN programs about the benefits of training physicians with disabilities. Guest: Dr. Lauren Meiss, OBGYN Resident, Yale New Haven Hospital Dr. Julia Cron, Assistant Professor; Department of Obstetrics, Gynecology and Reproductive Sciences; Residency Program Director, Obstetrics, Gynecology & Reproductive Sciences JGME article: https://meridian.allenpress.com/jgme/article/12/2/229/442179/Training-as-a-Doc-With-Disabilities?searchresult=1 Citation: Lauren Meiss, Julia Cron; Training as a “Doc With Disabilities”. J Grad Med Educ 1 April 2020; 12 (2): 229. doi: https://doi.org/10.4300/JGME-D-20-00050.1

In this episode, Dr Vonda Wright is joined by Interventional Radiologist, Dr John Lipman, founder of the Atlanta Fibroid Center as they talk about the hidden impact of uterine fibroids and the non-surgical way, he is saving women from hysterectomy and restoring their quality of life. Uterine fibroids are an incredibly common diagnosis for women. In fact, out of every four women in America, three of them usually have fibroids during their lifetime. Only one in three women usually experiences symptoms, so it can easily go undiagnosed. Atlanta Fibroid Center. and Dr John Lipman treats fibroids without surgery and saves the U.  Dr. John Lipman is a nationally recognized fibroid expert who has made it his life’s goal to educate and treat women who suffer from uterine fibroids. He is most known for his pioneering work in the non-surgical UFE procedure, Uterine Fibroid Embolization. Dr. Lipman attended Georgetown University School of Medicine. He served as chief resident at Brigham & Women’s Hospital at Harvard Medical School. Dr. Lipman was awarded the Vascular & Interventional Radiology Fellowship at Yale New-Haven hospital, at the Yale School of Medicine, the Fellowship of Society of Interventional Radiology and the Fellowship in American College of Radiology. His current academic appointment is as an Adjunct Clinical Assistant Professor in the Department of Obstetrics & Gynecology at the Morehouse School of Medicine.

Pamela Kunz, MD, is an expert in GI cancers and a courageous voice against gender discrimination and harassment in health care. In this episode, Kunz shares her story and provides guidance for those facing these types of challenges. Intro :04 About Kunz :13 The interview 1:45 How did you get where you are now? 2:04 Can you tell us about your recent transition from Stanford to Yale? 3:40 How did you decide to start speaking out? 6:54 How do you guide women who find themselves in a similar situation? 9:11 What happened after you came out with this information? 11:32 If you don’t witness it, you may not know it’s happening 14:27 What are some of the challenges you encountered after going public? 17:16 Don’t read the comments 18:45 Did you tell Yale this would come out before transitioning from Stanford? 20:43 The importance of having support 22:40 Moving the needle 24:56 At what point should people be reporting these things? 28:58 If no one’s reporting, things won’t change 43:07 The importance of mentors and sponsors 34:24 Do you think this experience has changed you as a leader? 36:21 Kunz’s take-home message 40:48 How to reach Dr. Kunz 42:00 Pamela Kunz, MD, is an associate professor of medicine in the Division of Oncology at Yale University School of Medicine; leader of the Gastrointestinal Cancers Program at Smilow Cancer Hospital at Yale New Haven and Yale Cancer Center; and director of GI Medical Oncology within the Section of Medical Oncology. We’d love to hear from you! Send your comments/questions to Dr. Jain at oncologyoverdrive@healio.com. Dr. Kunz can be reached on Twitter at @PamelaKunzMD and via email at pamela.kunz@yale.edu. Follow us on Twitter @HemOncToday @ShikhaJainMD Disclosures: Jain reports she is a paid freelance writer for Lippincott. Kunz reports stock and other ownership interests in Guardant Health; consulting or advisory roles with Advanced Accelerator Applications, Ipsen, Lexicon and Novartis; and research funding from Advanced Accelerator Applications, Brahms (Thermo Fisher Scientific), Ipsen, Lexicon and Xencor.

This week’s episode includes author Jeffrey Testani and Associate Editor Justin Grodin as they discuss empagliflozin heart failure, including diuretic and cardio-renal effects. TRANSCRIPT: Dr Carolyn Lam: Welcome to Circulation on the Run, your weekly podcast summary and backstage pass to the journal and its editors. I'm Dr Carolyn Lam, associate editor from the National Heart Centre and Duke National University of Singapore. Dr Greg Hundley: And I'm Greg. I'm the director of the Pauley Heart Center at VCU Health in Richmond, Virginia. Dr Carolyn Lam: Greg, the SGLT-2 inhibitors have really revolutionized heart failure treatment, but we still need to understand a bit better how they work. And today's feature paper is so important, talking about diuretic and cardio-renal effects of Empagliflozin. That's all I'm going to tell you though, because I want to talk about another paper in the issue very related. And it's from John McMurray from the University of Glasgow with insights from DAPA-HF. But maybe a question for you first. Have you ever wondered what to do about loop diuretics doses in patients with heart failure and whom you're thinking of initiating an SGLT-2 inhibitor, Greg? Dr Greg Hundley: Absolutely, Carolyn. That comes up all the time and how do you make that transition. Dr Carolyn Lam: Exactly. And so this paper is just so important, and Dr McMurray and his colleagues showed that in the DAPA-HF trial, the SGLT-2 inhibitor, dapagliflozin, first, just as a reminder, reduce the risk of worsening heart failure and death in patients with heart failure and reduced ejection fraction. And in the current paper, they examined the efficacy and tolerability that dapagliflozin falls in relation to background diuretic treatment and change in diuretic therapy, following randomization to dapagliflozin or placebo. They found that 84% of patients randomized were treated with a conventional diuretic, such as the loop or thiazides diuretic. The majority of patients did not change their diuretic dose throughout follow-up. And the mean diuretic dose did not differ between the dapagliflozin and placebo group after randomization. Although a decrease in diuretic dose was more frequent with dapagliflozin than with placebo, the between-group differences were small. So treatment with dapagliflozin is safe and effective regardless of diuretic dose or diuretic use. Dr Greg Hundley: Very nice, Carolyn. That's such a nice practical article. I really enjoyed your presentation of that. My next article comes from Professor Karlheinz Peter, and it's investigating the reduction of shear stress and how that might impact monocyte activation in patients that undergo TAVI. So this group hypothesized that the large shear forces exerted on circulating cells, particularly in the largest circulating cells, monocytes, while passing through stenotic aortic valves results in pro-inflammatory effects that could be resolved with TAVI. So to address this, the investigative team implemented functional essays, calcium imaging, RNA gene silencing and pharmacologic agonist and antagonist to identify the key mechanical- receptor mediating the shear stress sensitivity of the monocytes. In addition, they stained for monocytes in explanted, stenotic, aortic human valves. Dr Carolyn Lam: Lots of work done in a very translational study. So what did they find Greg? Dr Greg Hundley: They found monocyte accumulation at the aortic side of the leaflets in the explanted aortic valves. That was the human subject study. In addition, they demonstrated that high shear stress activates multiple monocyte functions and identify PZ1 as the main responsible mechanoreceptors representing, therefore, a potentially druggable target. So reducing the shear stress from a stenotic valve promotes an anti-inflammatory effect and, therefore, could serve as a novel therapeutic benefit of those undergoing TAVI procedures. Dr Carolyn Lam: Really nice, Greg. Thanks. We're going to switch tracks a bit, Greg. What do you remember about Noonan's syndrome? Dr Greg Hundley: Oh boy. Impactful, congenital disease for both the probands, as well as the family. Dr Carolyn Lam: That's truly beautifully put and you're right. Noonan syndrome is a multisystemic developmental disorder characterized by common clinically variable symptoms, such as typical facial dysmorphism, short stature, developmental delay, intellectual disability, as well as cardiac hypertrophy. Now the underlying mechanism is a gain of function of the RAs MAPK signaling pathway, kinase signaling pathway. However, our understanding of the pathophysiological alterations and mechanisms, especially of the associated cardiomyopathy, really remains limited. So today's paper contributes significantly to our understanding and is also notable for the methods that these authors use to uncover this novel potential therapeutic approaches. The paper is from Dr Cyganek and Wollnik as co-corresponding authors from the University Medical Center Göttingen in Germany. And they presented a family with two siblings, displaying an autosomal recessive form of Noonan syndrome with massive hypertrophic cardiomyopathy. As the clinically most prevalent symptom caused by allelic mutations within the leucine zipper like transcription regulator 1. They generated induced pluripotent STEM cell derived cardiomyocytes of the effected siblings and investigated the patient-specific cardiomyocytes on the molecular and functional level. Dr Greg Hundley: Carolyn, is such a thorough investigative initiative. So what did they find? Dr Carolyn Lam: They found that the patients induced, pluripotent STEM cell cardiomyocytes recapitulated the hypertrophic phenotype and uncovered, a so far not described, causal link between this leucine zipper like transcription regulator 1 dysfunction and ras map, kinase signaling hyperactivity, as well as, the hypertrophic gene response and cellular hypertrophy. Calcium channel blockade and MEK inhibition could prevent some of the disease characteristics providing a molecular underpinning for the clinical use of these drugs in patients with Noonan syndrome. In a proof of concept approach, they further explored a clinically translatable intronic CRISPR repair and demonstrated a rescue of the hypertrophic phenotype. Massive amount of work in a beautiful paper. Dr Greg Hundley: You bet, Carolyn, and boy giving hope to address some of that adverse phenotype in the heart. What an outstanding job. Dr Carolyn Lam: You're right, Greg. But now switching tracks a yet again. What do you know about ischemic preconditioning? Ischemic preconditioning refers to the process in which non-lethal ischemic stress of the heart prevents subsequent lethal ischemia reperfusion injury and provides important intrinsic protection against ischemia reperfusion injury of the heart, as well as other organs. So in this paper co-corresponding authors, Doctors, Zhang, Xiao and Cao from Peking University and colleagues provided multiple lines of evidence that a multifunctional TRIM family protein, the Mitsugumin-53 or MG53 is secreted from the heart in rodents in response to ischemic, preconditioning or oxidative stress. Now this secreted MG53 protected the heart against ischemia reperfusion injury. In the human heart, MG53 was expressed at a level about 1/10th of its skeletal muscle counterpart. And MG53 secretion was triggered by oxidative stress and human embryonic STEM cell derived cardiomyocytes, while deficiency exacerbated oxidative injury in these cells. Dr Greg Hundley: Very nice, Caroline. Tell me the take home message. How do I incorporate this information, maybe even clinically? Dr Carolyn Lam: Well, these results really defines secreted MG53 as an essential factor, conveying ischemic preconditioning induced cardioprotection. Now, since systemic delivery of MG53 protein restored ischemic preconditioning mediated cardioprotection in deficient mice, recombinant human MG53 protein could perhaps, or potentially be developed, into a novel treatment for various diseases of the human heart in which indigenous MG53 may be low. Dr Greg Hundley: All right, Carolyn. I'm going to tell you about a couple of letters in the mailbag. First, there's a research letter from Richard Vander Heide regarding unexpected feathers in cardiac pathology in COVID-19. And then, there's a large exchange of letters between Dr Yuji MIura, Chuanli Ren and Laurent Azoulay regarding a prior publication, entitled "Aromatase Inhibitors and the Risk of Cardiovascular Outcomes in Women With Breast Cancer, A Population-Based Cohort Study." And then finally, Carolyn, there's another research letter from professor, Nilesh Samani, entitled "Genetic Associations with Plasma ACE2 Concentration: Potential Relevance to COVID-19 Risk." Dr Carolyn Lam: Wow, interesting. There's also an "On My Mind" paper by Dr Kimura on "contextual imaging, a requisite concept for the emergence of point-of-care ultrasound." There's an ECG challenge, by Dr Dewland, with a case of an intermittent -wide QRS complexes. There's a cardiovascular case series presentation by Dr Nijjar on "a solitary left ventricular septal mass and amaurosis fugax." Dr Greg Hundley: That's great, Carolyn. How about we move on to the feature discussion. Dr Carolyn Lam: Let's do that. Dr Greg Hundley: Well listeners, we are here to discuss again, another important paper related to SGLT-2 inhibition. And we have with us, Dr Jeff Testani from Yale New Haven and our own associate editor, Dr Justin Grodin from University of Texas Southwestern Medical Center. Welcome gentlemen. Jeff let's start with you. Can you describe for us some of the background behind this study, and then also the hypothesis that you wanted to address? Dr Jeffrey Testani: Our lab is very interested in understanding volume overload and heart failure, why does the kidney retain sodium and why it stops responding to loop diuretics. Several years ago, when the SGLT-2 first came out, we saw them as a diuretic with the side effect of glucosuria. Back when they were still being thought of as primarily diabetes medications. But as the story unfolded and we saw that the SGLT-2 seemed to be doing something much more than just control blood glucose in diabetics and was demonstrating, particularly, a pronounced effect on heart failure outcomes, we got very interested in, better understanding this. We know that loop diuretics, they're really a double-edged sword. Loop diuretics are our mainstay of therapy to relieve congestion and heart failure patients, but they do so at the expense of quite a bit of toxicity. And we know that the loop diuretics directly cause neuronal activation, elaboration of rennin, norepinephrine, etc. through their effects directly on the kidney. In addition to causing normal moral activation through the volume depletion they cause. And as we all know, blocking the neurohormonal activation is one of the primary therapies we use in heart failure. So even though it helps our patients keep the fluid off, it does that at an expense of potentially some very negative effects. The interesting thing with the SGLT-2 inhibitors is, we've seen that in the diabetic populations, that they seem to actually improve volume status in diabetics, more so than one would really expect by the week diuretics that they are. And by and large, they were doing that without a pronounced activation of the neurohormonal system. So this led us to the conclusion that we really need to rigorously study this in heart theory and see what exactly are these effects of diuretics volume status and how much negative impact will any of those effects bring towards normal activation, kidney dysfunction, etc. Dr Greg Hundley: Very clever, Jeff. How did you go about addressing this question? What was your study design and what was your study population? Who did you enroll? Dr Jeffrey Testani: We wanted to have a pretty clean mechanistic study here. We weren't looking at ethnicity. We were really trying to understand a mechanism here and what are these agents doing to sodium handling in the kidney, etc. We enrolled diabetic patients that were stable. Per their advanced heart failure position, they were at added at a stable volume status. They hadn't had recent changes in medications diuretics, and we use the crossover design where we brought the patient in for about an eight-hour rigorous GCRT type study where we administered empagliflozin in 10 milligrams and then did some pretty rigorous characterization of them. As far as body fluids spaces, renal function, normal activation, your sodium excretion. Then they would continue that therapy for two weeks, come in for a terminal visit, that was a very similar protocol. Then we'd wash them out for two weeks and cross them over to the alternative therapy. And they were randomized whether they had placebo or epilobium first in order. Dr Greg Hundley: Very good. So a crossover design. And what were your study results, Jeff? Dr Jeffrey Testani: We were quite interested in the overall effects and it was actually quite surprising. We know the loop diuretic resistance is common and when physicians and patients are not responding well enough, oftentimes we add thiazides. And thiazides waste potassium. They waste magnesium. They increase uric acid. They usually cause renal dysfunction and significant normal activation. That was the default hypothesis that we would see that. And to the contrary, we pretty much saw the opposite of what a thiazide did. We saw a modest, but clinically significant natriuresis. So as a monotherapy, these drugs are quite weak. Although we saw a doubling of a baseline level of sodium excretion, that's sort of a clinically irrelevant amount as an acute diarrheic. However, when we added the eplerenone to a loop diuretic, we got a 30, 40% increase in sodium excretion. And just to benchmark that, if you look at the dose trial where they compared low dose to high dose Lasix, which were one X versus two and a half X, their home loop diuretic, they got a similar increase in sodium excretion. So even though 30, 40% increase in sodium excretion doesn't sound like a lot, it's all of our normal interventions. It's actually a pretty significant increase. We found that happened acutely. And to our surprise, that natriuretic effect had not completely gone away by two weeks. So the patient was still in a negative sodium balance at the two-week time point. And they actually had a reduction in their blood volume, in their total body water, in their weight, as a result of that kind of slow persistent, natriuresis that had happened over those two weeks. We were unable to detect any signs of normal MAL activation with this. There was actually a statistically significant better change in norepinephrine during the dapagliflozin period versus placebo. And there's some evidence that, that might be an actual finding of saccharolytic effect of these drugs. As in many of the other trials we've seen no, despite a reduction of blood pressure and probably volume status, heart rate stays the same or even goes down. And we saw an improvement in uric acid. We saw no additional potassium wasting. We saw an improvement in serum magnesium levels. So really kind of like I started this way is the opposite, in many ways of what we see, side effect wise, with the diuretic is what we saw with addition of an SGLT-2 inhibitor. Dr Greg Hundley: Listeners, we're going to turn now to Dr Justin Grodin, who's one of our associate editors and is also an editorialist for this paper. And Justin, we've heard some really exciting results here. The addition of a dapagliflozin to a loop diuretic enhancing the neurohormonal access and receiving some unexpected benefits on the electrolyte portfolio. Can you tell us a little bit about how you put this work in the context of everything else that we have been reading about this exciting new class of drug therapy? Dr Justin Grodin: This certainly is exciting because with the release of the DAPA-HF clinical trial, just about a year ago, we've really come to recognize that there really are substantial, long-term beneficial effects with SGLT-2 inhibition in patients with heart failure, and as Jeff alluded to, a lot of these effects, we saw that they were beneficial in individuals that are high risk or who already had heart disease and diabetes. And we weren't sure if that was going to translate to individuals with heart failure. We really saw beneficial effects in both, individuals with heart failure, with or without diabetes. So this is an interesting paradigm because, although we saw dramatic effects in long-term survival quality of life, the mechanism was actually somewhat murky. And a lot of this was transitive based on prior works. We obviously had a strong hypothesis that they would work through reducing incident heart failure and diabetics, but then we were left questioning what is the mechanism? And I think Jeff highlighted it quite well. There was the early thought that this was perhaps just a weak diuretic and that it was additive, and these patients were just getting long-term natiurer recess. And then others thought that there might've been, perhaps, some positive influence by some very low level, blood pressure reduction with these therapies. So in that sense, I think Jeff's paper really is put in context and when we reviewed it, we thought it was quite fascinating because I think as Jeff showed in his paper quite elegantly and actually in a very, very careful study, which the reviewers and your editorial staff appreciated, we really saw that there was a probably more robust response to natriuresis than we had anticipated. And importantly, this was independent of glycosuria, which is a very important observation. And if I might take a 10,000-foot view of at least this therapy and how we might think about it as an incremental therapy in heart failure, it's really doing something else. So we thought that with SGLT-2 inhibition, you get a little sodium and a little natriuresis, maybe perhaps a little bit extra, as it complexes with glucose. I think if you look at what the potential physiology would be with this therapy is that it's doing far more than that. And I think Jeff's study at least supports some of the speculation. And again, I'm going to perhaps look beyond SGLP-2 inhibitor, and then more so focus on the physiology of the proximal convoluted tubule. And given the location of the blockade, this is really priming the kidney, or at least Jeff's manuscript, and Jeff's analysis, supports the hypothesis that SGLT-2 inhibitors influence the proximal tubule environment, such that the kidney is ready to reset in natriuresis. And I think Jeff's data it at. least supports that because if we look at the proximal tubule physiology, there's really a lot more going on, then SGLT-2 inhibition. There are other receptors that it can influence that might also promote natriuresis. It can also promote increased distal sodium delivery to other areas of the nephron. And in essence, this almost, and in Jeff has put it this way before, which I totally agree. This gives the opportunity for the kidney to taste the salt, as opposed to the more common state that we have in somebody with heart failure and congestion, where, and I talk about this on rounds all the time, the kidney's response to a failing heart is to retain salt and water. So this kidney is in this perpetual state of dehydration. And I think the idea that Jeff's analysis is at least supporting, is that somehow, we were influencing the physiology in the proximal convoluted tubule, we are actually priming the kidney and readying it. We're almost hitting reset, where the kidneys may lose this physiology, thinking that the body is dehydrated and in essence, really readying it to assist with decongestion. Dr Greg Hundley: I love the way you explained that. It's almost as if I'm on ward rounds with you that just knocks home a lot of the message here, and the importance of Jeff's work. Understanding the physiology of the proximal tubule and then readying the kidney, instead of moving into a mode of retaining salt and water, actually allowing that to flow and facilitating a diaresis. I'll start with you, Jeff, and then come back to Justin. You might have unlocked a really special key here. What do you see as the next steps in research in this particular field? Dr Jeffrey Testani: I think Justin really, really captured the essence of what excites us so much about this is, most diuretics are a brute force sort of approach to getting salt out of the body. They are a stick, not a carrot and SGLT-2 inhibitors, when you look at them as how they would work as a brute force diarrheic, they are really wimpy and there is every opportunity for the kidney to defeat the of a SGLT-2 inhibitor, if it wanted to buy where they work and what they block. But the reality is, is that they really seem to be the carrot almost. if you think of resetting the sodium set point of the kidney, kind of quenching some of that salt first or sodium humidity that Justin was referring to. And the thing that's really interesting is when we look at trials like DAPA-HF. So despite the fact that they do seem to have this natural effect in blood pressure lowering effect and these different effects, they don't tend to cause hypertension, over diaresis, it's a much more of a natural, where the kidneys regulatory mechanisms are still operative. we have this duality of not causing over diaresis but causing diaresis. So it's really when the body needs to get rid of salt, it helps it do that. And so I think the next steps, at least for our research program is, we want to understand taking these drugs out of the context of stable, relatively euvolemic chronic heart failure patients. And when we put them into the acute setting of actual volume overload, do we see more robust diathesis and that natriuresis in that setting. The second thing is we want to dig into what is the internal mechanisms that are allowing the kidney to do these things. How is it that it's able to dump out salt when it's beneficial, but not leaked over to uresis. Since we're digging into those mechanisms, I think will give us some additional insight into this class. Dr Greg Hundley: Justin. Dr Justin Grodin: I think Jeff really encapsulated, or at least certainly highlighted some very important points, that are largely in parallel with where I foresee this. Because really, if you look at just study, a lot of these patients were quite stable. So the questions that come along are whether or not that this synergistic effect number one, is sustained long-term. Because there are some data, at least in diabetic individuals, that this might not be the case. So Jeff's paper elegantly highlights the influence of these therapies in two weeks. Now, whether that's sustained is certainly unclear. I think the logical next step is, "Okay. We show that we have a therapy that might prime the kidney for increased natriuresis" what are its effects and individuals that might need the natriuresis even more. So as Jeff highlighted individuals with more decompensated heart failure, that are more congested and more hypervolemic. And then obviously individuals that might be quite diarrheic resistant. This is something that I think Jeff and I have given talks on. And Jeff is clearly one of the world's experts in this space, but it's obviously a very attractive possibility that this might influence individuals whose kidneys are teased or trained into just holding onto sodium, no matter what. Or really no matter what therapies we give the kidney. I don't know if Jeff mentioned this, but at least in his analysis, they also showed through indicator dilution methods that there was a reduction in plasma volume in these individuals. And I think that's really important because we at least hypothesize that in many heart failure phenotypes, plasma volume is certainly a component of decompensation. So whether these kidneys have a more pleiotropic effect on the fluid balance from your status between the interstitium and the vascular space, long-term is really unknown. Dr Greg Hundley: I want to thank both Jeff and Justin. What an incredible, exciting discussion. And this paper, Jeff, were so thrilled to have the opportunity to publish it in circulation. And the clarity, helping us understand some of the mechanism of the efficacy of SGLT-2 inhibition. And then this unique combination of SGLT-2 with loop diuretics, potentiating, dieresis natriuresis without some of the harmful effects on serum electrolytes. And then I really appreciate both of you giving us an insight into the future where more work is needed to understand, is this a sustainable beyond two-week effect? And then, can these therapies, this combination, be helpful in those with decompensated heart failure. On behalf of Carolyn and myself, we wish you a great week and we look forward to catching you next week on the Run. This program is copyright, the American Heart Association 2020.  

The Bitches this week are toeing the line with spoilers this week as they discuss Leigh Bardugo's Ninth House! We've got magic, mythology, frat house shenanigans, and so much more for you in this episode. Join our hosts as they discuss their only collective experience with Yale/New Haven, Gilmore Girls, how Ginnye would love to live the life of Pamela Dawes, and as they share some exciting personal news that will affect the rest of season 2! Book & Bitch is a bi-weekly podcast that combines all the juicy bits of the book with the insightfulness of the forward. Highlighting author backstories with cultural context and writing theory, we’re the book club you’ve always wanted to join. A reader lives thousands of lives. And we bitch about them all.  

 Bio: Brenda Mierzejewski is the founder and CEO of Mizzi Cosmetics. Affectionately known as the "Lip Lady," Brenda puts her passion for natural beauty products and knowledge of pharmaceutical supply chain together in this indie brand. She is the visionary that created their signature LipLuxe product line (artisan lip balms and lip scrub). Realizing that most of the lip balms on the market were toxic, Brenda made a commitment to using all-natural ingredients and healing essential oils. LipLuxe products are naturally made, with safe, non-toxic ingredients and no petroleum. Brenda’s dream of changing the landscape for lip care became a reality in 2015, when LipLuxe was discovered and organically endorsed by celebrities like Kylie Jenner and Kate Hudson. This helped to propel Mizzi Cosmetics to the next level. Mizzi Cosmetics believes in helping people slow down and focus on self-care, starting each day with healthy beautiful lips, powered by LipLuxe.  Before her role as CEO of Mizzi Cosmetics, Brenda's skills and experience included leveraging material purchasing, planning, production, and supply ordering. A wiz at managing inventory control in fast-paced, large-scale warehouse environments, she was able to achieve maximum performance through operation refinement, process efficiency and improvement. What Brenda has to say in her 5 star review of the Clean Beauty Podcast: "Important topics and very easy to listen to. It's a great way to get information and recommendations on current, trending clean beauty companies and products."  Mizzi company mission : A sophisticated, understated, luxurious, down to earth, natural brand to help you embrace your own beauty and boost self confidence by adding a healthy, beautiful shine to your lips. Never settle for feeling anything less than beautiful, always look beneath the surface, don't conform to norms and expectations, create your own definition of what beauty is. Be your own beautiful. The Mizzi Guarantee: Never any petroleum, no chemicals, no toxins, no sulphates, no parabens, no artificial flavors or scents, no animal by products (maybe the occasional beeswax or wild honey) and never animal testing, not ever. What does Mizzi support ?: "A variety of organizations with missions near and dear to our heart: The American Heart Association and Lily's Kids Inc. in honor of my son, Brady, who was diagnosed with Congenital Heart Defect and received open heart surgery at six months old, and in support to heart disease awareness. Smilow Cancer Center at Yale New Haven in honor of my sister and mother, both breast cancer survivors and in support of breast cancer awareness and prevention. The Jordan Porco Foundation in support of mental health awareness and suicide prevention. The Brain Injury Association of America in honor of our chemist, Elizabeth Dickerson and in support of research and awareness of brain injuries. Plus, many local charities, organizations, and fundraisers."   Podcast sponsored by: http://lashbinder.com More information: http://cassandramcclure.com  

February is American Heart Month! Cardiologist Dr. Josephine Chou from Yale New Haven Health joined Anna and Raven to discuss how heart disease can affect pregnancy and what to do if you have a pre-existing heart condition and are looking to start a family.

#TuneIn to hear part 2 of this dark horse story featuring Kat Kuzmeskas, CEO & Cofounder of SimplyVital Health (aka

#TuneIn to this part 1 of our conversation with Katherine Kuzmeskas, CEO & Cofounder of SimplyVital Health (aka

How to Win Friends and Influence by Dale Carnegie The Magic of Thinking Big by David Schwartz What's So Amazing About Grace by Philip Yancey Fearfully and Wonderfully Made by Philip Yancey and Dr Paul Brand A brief biography: Dr Bob Lewis was born in Pontiac, Michigan in 1944. His father (Lynox) was the first in his family to graduate from college (Mississippi State). Lynox established connections with the YMCA while persuing a Masters in teaching at George Williams college in Chicago. His mother (Elizabeth) was working at a settlement house in Chicago when Lynox and Betty met. In 1948 Lynox accepted an offer from the International Committee of the YMCA to be the director of the Mexico City YMCA canp (Camohmila) near Cuernavaca, Mexico. Bob and his older sister lived at Camohmila in and adobe house (no electricity or running water) for 3 years before the family moved into Mexico City. His elementary education was at the American School in Mexico City where half the courses (by Mexican law) were in Spanish. In 1958 Lynox and Betty declined the YMCA's offer to move to Columbia (South America) and took the family to Berkeley, California. There Bob and his siblings got to experience an integrated school system just about the time the Civil Rights movement was begining in this country.. He helped form a group called Students for Equality. Bob graduated from Berkeley High School with a passion for reading, science, and music. His college years at Harvard were enriched by music by Mozart, Bach and Gilbert and Sullivan. A biochemistry major led to a wonder of the miracle of life at the cellular and electrical level. The idea of becoming a physician came more from his friends in college than from family members. Georgetown Medical School proved to be a great fit for his interests in science and his passion for working with people. Bob met Laurie (his wife) at Yale New Haven hospital where she was working as a new head nurse on a medical ward, and Bob was starting his internship. Bob and Laurie married during his residency and when they headed to Los Angeles for his infectious disease fellowship at UCLA they were proud parents. The experience at UCLA included two years on the faculty before Bob chose patient care over laboratory science. Laurie and he set up a solo medical practice in San Pedro, California (before managed care contracts made it impossible to start a solo practice). The dream was big enough to overcome 22% interest rates and a number of people who told me it couldn't be done. Having a plan, doing the work, getting out of the office to meet people, making and keeping promises all were instrumental in making it work. The 30 years of medical practice in LA led to growing the preeminent Infectious Disease practice in the area. We partnered with hard working, extremely bright physicians. In our private life Laurie and I coached soccer and baseball. Laurie volunteered as PTA president. We were blessed with four wonderful children, all of whom are now married and proud parents in their own right. When a stroke abruptly ended my medical practice over 14 years ago I had the opportunity (and necessity) to reinvent myself. I began the journey back by training for and walking marathons (over 10 now). I had to regain my balance in the process. I subsequently became a teacher of ESL (english as a second language) and then a teacher of ESL teachers. More recently I became a certified nutritionist and a proponent of a diet rich in antioxidants. Most chronic debilitating diseases are associated with low antioxidant levels in our blood streams. Our journey along this path has been enhanced by a new health and wellness company (Jeunesse) and their study of youth enhancing science and products.

This is our very first segment of " I Love Being a Death Doula". In this episode we talk with Doulagiver Specialist Nathalie Bonafe of New Haven Connecticut. Nathalie has trained in all 3 Doulagiver trainings and has a full service consultanting business called A Gentler Parting. In this episode, Nathalie shares her journey from Yale New Haven researcher to End of Life specialist. Reflectiong on her passion and experiences from 2017, Nathalie inspires listeners with sharing her rewards of the Doulagiver journey and her plans for 2018. Nathalie offers free consultations in person and via phone/Zoom. Please see her contact and website information below. Enjoy the show and please leave a comment and review so we can continue to improve and grow our global community. - Suzanne B. O'Brien RN Nathalie Bonafe PHD 203-815-5743 Website: www.agentlerparting.com Email: agentlerparting@gmail.com FREE DOULA TRAININGIf you're a family caregiver, community volunteer, or are interested in becoming a certified end of Life Doula Practitioner, CLICK HERE to join Suzanne for her FREE Introductory End-of-Life Doula Training! http://freetraining.doulagivers.com/ OR Learn how to give the gift of Peace of Mind at the End of Life to yourself and your family members by signing up for Suzanne's Peace of Mind Planner course! CLICK HERE to learn about the five keys to achievingPeace of Mind at the End of Life.https://planner.doulagivers.com/about  

websites  https://www.crowdrise.com/nicolelyonnais http://chrisklugfoundation.org/ To be on the show please fill out the intake at http://bit.ly/1MLJSLG. To look at our sponsorships go to https://ssekodesigns.com/buttfly?acc=537d9b6c927223c796cac288cced29df and https://ssekodesigns.com/.     My name is Nicole Lyonnais, I’m 40, married, & a full-time working mom of a 7 and five-year-old. I played sports growing up but never loved to run as that the coaches made us do to torture us, so I thought. After college, I ran sporadically. After the birth of my son, I was dark and depressed. A year later, in January of 2010, I needed to do something to feel better. I chose a goal to run a half marathon that April. I bought sneakers & started to run consistently. I ran the half, then a full that November. I didn’t run much after that until 2014 when I began running just to run, to make my head. No music, just me and the sounds of my footsteps. I ran 1000 miles in 2016, each mile outside-not one on a treadmill. Through the heat, the snow and the rain…I ran. I have become a better person through running, not perfect but better. While all of this was going on, my Uncle Yves was suffering. This man who was my ‘crazy’ Uncle, not the craziest but he was crazy, energetic and I just loved him. He worked 22 years in a manufacturing plant in CT where he was exposed to chemicals that he was unaware of. The company was relocating in 1995. Instead of moving, he decided to become a Certified Nurse’s Aide, then a Licensed Practical Nurse specializing in Geriatrics. He loved working with the elderly; they probably laughed at his jokesJ. In 2004, he was so sick. He was vomiting so terribly & was taken to the emergency room. He was diagnosed with cirrhosis of the liver. My Uncle? He didn’t drink, maybe a cocktail at a wedding! The insurance company for the plant made him go to 8 doctors; all provided the same diagnosis of NASH cirrhosis (Non-alcoholic Steatohepatitis disease). His liver would not regenerate, and he would need to receive one from a cadaver. He was living a relatively healthy life while waiting until he developed breathing problems, confusion, and stamina problems. In 2009, he had to stop working as a nurse, something he loved dearly. He waited, waited patiently for a liver. In January of 2014, they found a cancerous tumor on his liver. This moves him up on the transplant list rather quickly. Yale New Haven recommended him to NYU in June of 2014. He was so sick; my strong, funny Uncle was now so pale, weak and he couldn’t even sit for a family visit for more than 20 minutes. Seeing him like this just broke my heart every time I saw him. Finally a new liver! He was sent home still weak, on 16 pills a day, twice a day & 9 additional pills, once a day for six months. He had 21 vials of blood work weekly and saw a doctor every two weeks. Now two years after his transplant, he takes three pills a day, twice a day. He sees the doctor every three months. He has been admitted three times to the hospital with complications from complications, BUT he is so much healthier than he had been in the ten years previous to the transplant. Because of the transplant, he walked my little cousin down the aisle in October of 2015. Yesterday, she had a baby girl, and my Uncle was there to hold her. As my Aunt Chris says, LIFE IS GOOD! I am going to run the 2016 NYC marathon for the Chris Klug Foundation to help raise awareness for tissue and organ donation. I was wrong, running is not torture. It provides more life in so many ways. I am lucky to be able to run for my Uncle and my little cousin; that story is for another time.

Join Joel Ayala Ayapana for many countless inspiring and highly anticipated interviews as his once retired podcast platform in Quantum Mindfulness Radio... is reborn. After building a growing and thriving network in RealRevolutionRadio.com, during his rather brief rendezvous from the Podcast World, Joel has returned back with even more Angelic Force and Quantum Theoretical Momentum. Special Guest: M.A. CarranoGuest Biography: M. A. Carrano is an experimental philosopher and systems consultant living and working out of Yale-New Haven, Connecticut, as the Senior Intelligence Analyst and Vice President of Avatar Paradigms: a consulting agency whose mission is to bring the message of holism, synergy and conscious evolution into the homes, universities and corporate board rooms throughout the United States. As a former U.S. Congressional candidate and author of Asleep in the Helix: Survival & the Science of Self-Realization, at present Carrano resides as the sitting Chair of Philosophy for The Libertarian Party of Connecticut as well as an acting representative of the Global Association of Systems Thinkers.Hosted by: Joel Ayala AyapanaProduced by: Joel Ayala Ayapana Disclaimer by: Tiffany Renee Ayapana Introduction by: Rahman Ali Podcast Radio Network: Real Revolution Radio 2.0Network Link: http://www.realrevolutionradio.comArchives: http://www.realrevolutionradioarchives.comNOTICE: By accessing this Podcast, I acknowledge that the entire contents and design of this Podcast, are the property of Quantum Mindfulness Radio LLC and REAL REVOLUTION RADIO X.0, or used by Quantum Mindfulness Radio LLC (QMR) and REAL REVOLUTION RADIO X.0 (RRRX) with permission, and are protected under U.S. and international copyright and trademark laws. Except as otherwise provided herein, users of this Podcast may save and use information contained in the Podcast only for personal or other non-commercial, educational purposes. No other use, including, without limitation, reproduction, retransmission or editing, of this Podcast may be made without the prior written permission of QMR/RRRX, which may be requested by contacting the QMR/RRRX office via the following contact email: awaken@realrevolutionradio.com or by calling the studio by phone at: (216) 618-3252DISCLAIMER: By accessing this Podcast, I acknowledge that QMR and/or RRRX makes no warranty, guarantee, or representation as to the accuracy or sufficiency of the information featured in this Podcast. The information, opinions, and recommendations presented in this Podcast are for general information only and any reliance on the information provided in this Podcast is done at your own risk. This Podcast should not be considered professional advice. Unless specifically stated otherwise, QMR/RRRX does not endorse, approve, recommend, or certify any information, product, process, service, or organization presented or mentioned in this Podcast, and information from this Podcast should not be referenced in any way to imply such approval or endorsement. The third party materials or content of any third party site referenced in this Podcast do not necessarily reflect the opinions, standards or policies of the QMR/RRRX. QMR and/or RRRX assumes no responsibility or liability for the accuracy or completeness of the content contained in third party materials or on third party sites referenced in this Podcast or the compliance with applicable laws of such materials and/or links referenced herein. Moreover, QMR/RRRX makes no warranty that this Podcast, or the server that makes it available, is free of viruses, worms, or other elements or codes that manifest contaminating or destructive properties.

YALE NEW HAVEN HEALTH SYSTEM CASE STUDY With an increase in cyber attacks across industries, and in particular healthcare with medical-related identity theft accounting for 43 percent of all identity thefts reported in the United States last year according to the Identity Theft Resource Center, managing risk has never been more pressing for organizations. With risk growing daily and the consequences -- both in terms of data loss, patient and employee confidence and potential fines -- looming large, one healthcare organization that takes cyber security seriously is Yale New Haven Health System. Steve Bartolotta, who heads the health system's information security and risk management program talks about the challenges facing organizations today across verticals and what measures he recommends taking.  In this podcast with securitycurrent's Vic Wheatman, Bartolotta talks about the actual tools he uses to support Yale New Haven's risk management system and what he has gained.             

Professor Diana Kleiner, Dunham Professor of the History of Art and Classics and Principal Investigator of Open Yale Courses, discusses the change that Cleopatra believed in and how it led to a rendezvous with the destiny of Rome. Cleopatra effected change through such dramatic acts as rolling out of carpet and committing death by asp. She also used education, status, wealth, and celebrity to craft a dramatic strategy to unite East and West. Her story can be best told through works of art and other remnants of what was once an opulent material culture. This lecture is part of Connect with Yale New Haven, organized by the Association of Yale Alumni.