35 Burst results for "Brigham"
Leading Saints Podcast
A highlight from Is There a Correlation Between Losing Faith and Moving? | An Interview with Ryan Gottfredson
"So you're checking us out as maybe a potential podcast you could start listening to. I know many of you have been listening for a long time, but let me just talk to the newbies for a minute. What is Leading Saints? What are we trying to do here with this podcast? Let me explain. Leading Saints is a nonprofit organization, a 501c3 is what they call it, and we have a mission to help Latter -day Saints be better prepared to lead. Now, of course, often means in the context of a calling. It may mean in your local community, your work assignments. We've heard about our content influencing all sorts of leaders in all sorts of different contexts. We invite you to listen to this episode and maybe a few others of our 500 plus episodes that we have out there, jump in and begin to learn and begin to consider some of these principles we talk about on the Leading Saints podcast. Here we go. Well, you're always in for a treat when Ryan Gottfordsen is on the podcast. I've forgotten how many times we've been on the podcast, but if you go to Google and type in Leading Saints and then Ryan Gottfordsen and look at all the episodes that come up, by the way, that's the easiest way to search for content on Leading Saints. Just go to Google, type in Leading Saints, then whatever keyword, and you'll usually find what you're looking for. Now, Ryan, if you're not familiar with Ryan, he's a Ph .D., really smart fellow. He's a mindset author, researcher and consultant. He's written some phenomenal books. Here's another Leading Saints tip. If you go to LeadingSaints .org slash books, you will find a list of our top most recommended books for church leaders in the context of, in various contexts, depending on what issue you're dealing with. Then Ryan's books are on that list and they're so helpful and awesome. Ryan's also currently a leadership and management professor at the College of Business and Economics at California State University, Fullerton. He holds a Ph .D. in organizational behavior and human resources from Indiana University and a bachelor's from Brigham Young University. He basically has the career path, the education path. If I was a better student, I probably would have gone the path of Ryan, and it's going to be obvious why in this discussion. We talk about this dynamic that happens, maybe you haven't noticed, maybe you have, but when people leave the church or step away from their faith, they often do it in conjunction with a move. Right? That they'll think, I'm not sure about this gospel and it's kind of hard to sort of stop going to church, so why don't we move? And then we have a big reset and continue on a different path within a new neighborhood, around new people. And our board will just think, hey, we moved, and hopefully they'll forget about us and not worry about us. And so we want to dissect that, why that is, and it leads to a great discussion about community, about building culture, about how do we find those individuals earlier on in the process rather than going to their home and begging them to come to the word barbecue because they've been inactive for a year, how do we find them earlier on so that we can establish connection and relationship and find, help them see that they have a home here and believe it or not, that'll actually stimulate faith and develop faith in our gospel tenants and whatnot. So it's a phenomenal discussion. We both get on soap boxes at various times, especially me, and this isn't like an interview as much as a discussion. We want to model a discussion about this topic and we hope that you take this discussion to what I frame as the revelation machine to your word council or to your word altogether and talk about this. How can we anticipate those who are stepping away and create a culture in our word where they feel like they can stick around a little bit longer? So here's my discussion with Ryan Gottfredson.
Northwest Newsradio
"brigham" Discussed on Northwest Newsradio
"Brigham and Women's Hospital in Massachusetts. He was part of a team that wanted to see what the effects be would with multivitamins and coco flavonoids and brain health. Those participants that were randomized to take a multivitamin compared to those that were randomly assigned to given placebo had improvements in memory, not just over a one -year period of time, but also it was sustained over three years of follow up. Dr. Sesso tells me he's not sure which individual vitamins or minerals in a multivitamin tablet are the specific ones that do the trick. For a multivitamin, you have lots of essential vitamins and minerals contained in it, so it's not easy for us to pinpoint vitamin B12 or vitamin C or vitamin D or some of the minerals contained it as the explanation for some potential benefits on cognition. He adds it could be all of them working in tandem or one specific component at work, so they plan to continue to find out why. He does say it's not one specific thing that can ensure that we retain or improve our diet, whether it's exercise, diet, perhaps multivitamin. Socialization, just staying social and out there and busy, all all these things contribute not just toward retaining our cognitive health but also physical health as well. health as Dr. Sesso says he thinks our brain health can benefit from a variety of factors. Certainly at least our our findings in the context of cognition are promising and we really want to continue to evaluate these findings more well. Thank you. Thank you. for either improving memory or retaining memory, kind of a cognitive resilience if you will, Especially in an aging population. But like any supplement you are considering, talk to your doctor. Marina Rockinger, Northwest News Radio. News Radio traffic from the high performance homes traffic center. No blocking incidents or stalls getting in the way in the fourth county area so good news there about five though still slow from the michigan curve into downtown Seattle south on five heavy from north gate into downtown as well. Floating bridges are looking pretty good though and we are still seeing some heavy traffic westbound 90 between highway 18 and it's a quad do the road work only one lane getting through there. So expect delays or take an route. alternate Your next northwest. The news radio 1000 FM 97 7 forecast from the northwest crawl space services weather center.
AP News Radio
Taking a daily multivitamin appears to boost brains of adults over 60, but more study is needed
"A new study shows taking a daily multivitamin, may boost memory function in some people. But the research is not comprehensive enough to warrant a broad recommendation. Researchers at Columbia University and Brigham and women's hospital tracked more than 3500 people over the age of 60 for several years, some got a multivitamin. Others got a dummy pill, and they were tested online for memory function. Given a list of 20 words, after a year, participants who took the daily vitamins had better memory function, recalling 7.81 words, while those with the placebo improved to 7.65 words. The study leader says multivitamins may work by providing micronutrients that can enhance function of the hippocampus, an area in the brain that controls learning and memory. U.S. dietary guidelines lean against vitamin supplements, recommending nutrients be obtained through food. Researchers say more memories study is needed. I'm Jackie Quinn
Follow Him: A Come, Follow Me Podcast
"brigham" Discussed on Follow Him: A Come, Follow Me Podcast
"It must be a storm and you just go back to bed. But now they're out there because they followed him. The boat itself causes some of the problems. I mean, if the church is the boat, think about this, you get in this boat and you get splinters. The boat is not constructed perfectly. Everybody's got a pitch in and help hoist the sails and rig whatever or, you know, things are not going to go well. You got to work to be in the boat. And don't get started on some of the other passengers in the boat. How many trials do we get? Because of the other passengers, we're stuck within this boat. Most of them are decent people that are fine, but some of them are annoying or downright offensive. And some of our very trials can be with these people. We're stuck within the boat. And when you're experiencing all that, the temptation can be, well, the boat got me into this mess and the boat is not protecting me from the storms. Therefore, maybe I should get out of the boat, try that. See how that goes. In one message, you can take from the storied Matthews version is, that is not a good idea. The message is still stay in the boat, look to Jesus for the piece you need, but getting out of the boat, not a good idea. And modern apostles have picked up on this message, so for example, elder Ballard, remember a few years ago how to talk titled stay in the boat, stay on the boat. And hold on. This is October 2014. He quotes president Brigham young had the same analogy. Brigham young referred to the church as the old ship Zion and Brigham young said, we are in the midst of the ocean, a storm comes on in a sailor say she labors very hard. I'm not going to stay here, says one. I don't believe this is the ship's iron. But we're in the midst of the ocean. I don't care. I'm not going to stay here. Off goes the coat Timmy jumps overboard. Will he not be drowned? Yes. So we'll be with those who leave this church. It is the old ship's eye, so let's stay in it. This is very Brigham young, right? Kind of humor here. So Brigham young is a bunch of quotes about that. This is the old ship Zion, God is at the helm, stay here. So then elder Ballard picks this up and says, given the challenges we all face today, how do we stay in the old ship Zion? An elder Ballard says here's how we need to experience a continuing conversion by increasing our faith in Jesus Christ. And our faithfulness to his gospel throughout our lives, not just once, but regularly. So, you know, Mark, we talked about exercising faith and looking to Jesus for peace, but Matthew has this added dimension that you don't just vote with your heart. You vote with your feet. Being close to Christ isn't just a matter of trusting him in your heart. It's being with him in that boat. It's staying true to not just him, but his church and doing all you can to be faithful to his gospel, being where he is. Even when being where he wants you to be means that you're going to end out in storms. This reminded me of what elder Holland said in the last general conference in October to be a follower of Jesus Christ, one must sometimes carry a burden. Your own or someone else's and go where sacrifice is required and suffering is inevitable.
Leading Saints Podcast
"brigham" Discussed on Leading Saints Podcast
"If he wasn't too busy if he would meet meet with him. I think at 8 a.m. the next morning. And so elder Holland assured him he would. And so the next morning, over a sleepless night, I'm sure Albert Holland was there, meeting with president hunter. And president hunter extended the call to him. And then brought him immediately over the temple where he was set apart and then went for the rest of the day, full day of meetings. And this has been the pattern, you know, like you didn't have anything else on his calendar that day. I know. I know. It's just fascinating. And it happened in June. It wasn't even like general conference. It was like, we're going to call you. We're just going to jump right there. Now think about this. There has been times where individuals were called into the corner of the 12th and their spouse heard about it over the radio or on TV from general conference. That's how their spouse was notified. For the first time in general conference, you know, for the first time in swimming in church history, held her gong and other Suarez our last two at numbers a 101 102 member members of the corps of the 12. For the first time in church history, president Nelson invited the spouse in. I'm not saying that Joseph Smith Brigham young or anyone else did it wrong. But president Nelson has set a new precedent. We're going to call the spouse in and have them be unfold with the call. And with each of these president Nelson, has taken the individual and their wife by the hand and they sat there in a little triangle, okay? And they each held hands when he extended the call. And so this is something new that's never happened in history. Something else that's new that president Nelson has is how he organized the first presidency. Typically what takes place is when the first presidency is dissolved. The core of the 12 meets together, and sometimes as many as 14 members of the corner of the 12, you know, meet together, and the second in seniority will nominate the first in seniority. And then set them apart. He has set apart, he's not ordained a profit. He's already been a profit for years for decades. But they were set apart as the president of president of the church. So president Nelson was set apart by president oaks. This has been the pattern that's gone through except for Joseph F Smith was set about by the church patriarch. The only exception. Now one thing is unique about president Nelson is as this meeting with brought together president Nelson decided to interview every member in that room. Interviewed them separately. And each of them brought forth names of who they thought they should be in the first presidency. And they were not allowed to counsel with one another. Not to compare to Khmer notes or anything like that. They had a sit in silence, has he interviewed each of those individuals? Oh, wow..
Leading Saints Podcast
"brigham" Discussed on Leading Saints Podcast
"And so he'll remove their quorum and kind of bring them down a notch or two. And so you can see during bringing young's era, if you look at the core of the 12, they're still trying to figure a few things out and people's people come into the quorum with different background. And so they're still trying to figure out how does this function? How is the quorum really work in the world? In fact, the quorum had been out serving missions for so long that they went for 32 years without ever meeting together as a quorum. Wow. There's always somebody gone. There's always somebody missing. And it was so momentous that they all got back together in 1868 that they decided to take a photo. The first presidency and the corps of the 12 for the first time together in 32 years. Always gone. Always always working. And so wow. Yeah. The quorum, you know, how the quorum functions just worked line upon line and as Brigham gets older, he begins to do things to help alleviate some burden at one point he will call roughly 6 to 7 counselors in the first presidency, because the core of the 12 primarily functioned as missionaries, and running the administration of the church became taxing as he got older. And so he'll call, I think there'll be 8 people in the first presidency at one point to help bear off the weight of the administrative burden that they're carrying. And all these individuals aren't always necessarily coming recalled from the corner of the 12 like we see today. No, no. Some will be apostles. We'll hold the priesthood office as a fossil, but not all come from the quorum. He doesn't pull them out because that would pull them away from the primary responsibility of preaching gospel. And he doesn't want to he doesn't want to pull him out of the field. And so he'll bring in other individuals. And when this was happening was, I mean, because now if you're in the first presidency, like when was president, he presided, you know, he was the presiding authority in meetings, even if president Nelson was there, right? And so did that tradition was that tradition still there where there's a presiding component of the first presidency over the corn of the 12?.
Leading Saints Podcast
"brigham" Discussed on Leading Saints Podcast
"As an apostle. You know, as part of his apology, he would make that trademark statement. So when they removed them, you know, William was removed from the quorum, was it didn't Joseph wasn't Joseph in the meeting and say, hey, don't do that. It's not a big deal. We're just family here, or these decisions that the corps of the 12 was just making. The charges were brought against them, and there was a bit of a feeling that this was inappropriate behavior. And so once word got back to William, you know, William, he takes a little time. It takes a couple of weeks to cool off. He'll go back to Joseph and apologize. And what I've noticed is you can do just about anything to Joseph. And he would forgive you. You know, Joseph will have good qualities rough qualities. He's still being polished, but one quality that Joseph has that I think is very impressive is on most instances he would forgive if you just came back and apologized. From a beating with fists to a misspoken word, Joseph to William mcclellan Orson hide, he just says, I frankly forgave them. You know, and that's Joseph's just kind of personality trait. One that I wish I had, you know, how quickly he would forgive. As far as the you mentioned, peculiarities in the 12. What are some stories in that room? Yeah, yeah. You know, and when the 12 was first organized, they organized the core of the 12 by age. And so by their organizing in February by about May they have had this organization where the oldest who is about 35 down to about 23, all corn of the 12, but they really had to determine how the quorum functions and who's in charge. And so what they would often do is they would rotate who was president for a while. And they'd go the senior would be president and then they'd go down to the next senior and down all the way down. So everyone had a turn to conduct and practice being in charge of the meetings. Eventually, Thomas B marsh will be set apart or recognized as president of 12, but this idea of age will stick for a while. And they have trouble getting this idea out of their head that if you're older, you should be in charge. And so when new members when members of the corn 12 fall out and new ones come in, something interesting happens. And they'll call Wilford Woodruff as a member of the quorum of the 12, and John Taylor had been serving for about four months. But because Wilfred Woodruff was older, they leapfrogged him in seniority. And this leapfrog would stay in until about 1861. And so for the next almost 20 years, Wilford Woodruff would have seniority over John Taylor. And it wasn't until Brigham young decided no, this needs to be time in the 12 and not age. Now Brigham is an eclectic individual and he has a lot of interesting ideas. And so he will flip flop on this occasionally..
X96
"brigham" Discussed on X96
"This has been kind of hard to track down because I wanted more confirmation than then. Then there was available and, um, it's about the Peach Days Parade in Brigham City. The first thing that appeared was a woman. I don't have it right in front of me Tiktok video that she did. And it was a picture. There was a picture there of somebody marching in the Brigham City Peach Days parade with a Confederate flag. Uh, And that's bad enough. But then there were reports of and I've been sent a picture of somebody marching in the Peach Days Parade, apparently with a Flag that, says F. Biden. But not just death. It's it's you know the whole thing. Yeah, it's the whole whole word. And I was contacted by the managing editor of the, uh, box. Elder County box Elder news journal, Sean Hales. And he said, I think these these things did happen. I'm going to try and trying to write a story on it right now. What do you know about it? And I told him what I knew about it and so forth, he said. He's going to send me a copy of his story that will appear in the box. Elder news journal. I haven't seen that yet. But apparently this did happen, Uh, people marching in the Peach Days parade, which is a lovely parade and a terrific Thing to do, but not with the Confederate flag Confederate battle flag as a matter of fact from from the state of Georgia, and it's and awful and another person carrying a flag that says F. Biden Boehner, candidate number three Stay classy Brigham City All right. Let's review the first two and vote. Let's see there. We had a boner candidate number one. The brain thief in Russia is stealing brains and corpses from ex husband's cryogenic lab. Uh, you know, it doesn't seem possible, but I think this really did happen. Boehner, candidate number two. How about this to pay my tour? Uh huh. I'll just show you my junk instead of throwing some money in there, and Boehner, candidate number three Stay classy Brigham City. Okay..
Watts Involved
"brigham" Discussed on Watts Involved
"Counseling racer goes. We never hit any lads bacteria. There are so many issues. Because i was not there. A lo why. France with my my my comrades who several alleging ended. I just wish that we shouldn't be good to not is the turnover. It's an incredible story. But now how how do you feel now. I mean about about the anc itself. Because i know in today's times in our countries if you look back to the freedom charter and know what it originally stood for and where we stand today they not necessarily the same thing. All you still a supporter or are you still an exotic in terms of of mk. I know the ideal way fighting for a noble. The i can say a. See them coming to Back now because the free don't charlton was just a symbol. The demand were on fighting. But now i see that deviate from brigham been chanted in the win as a simple digital and because what we we are now we are not anyway those might sue annoy go said true to achieve as agent was stay note as to achieve we try.
KIRO Nights
Job-Hunters, Have You Posted Your Resume on TikTok?
"Job applicants going forward, calling all recruiters. These are the reasons why you should hire me. That's right. Resumes Harv making their way. To tick talk. That's right. It's a new trend Taking over the nation. The world tick talkers everywhere are trying to get jobs via the app. They're basically taking what they would have put on a piece of paper and saying it throughout 1 to 2 minute videos of them on tic tac dough, and let me tell you something. Some of them are correct, quite creative, including one from clearly Roberts, a student at Brigham Young University in Utah. She's 23. She said She was inspired by Elle Woods. Little montage in the movie Legally Blonde that basically was her like You know her tape. I don't if you've seen legally blonde, Shane, Have you seen it? Oh, yeah. You know, it's kind of my ultra persona actually is I like to pretend I'm in legally blonde? I really have a long haired blond attorney. Yeah, I'm sure I'd like to do when I go home at night. Yeah, I'm sure that works Well, anyway, so give a little look there. Uh, let me tell you something. She she was inspired by illegally blondes, Hollywood's and decided to put together her own version on Tiktok. Oh, hi. My name is Kelly Roberts. And for my marketing internship application. I'm going to tell all of you and take talk Why I would make an amazing injury. So I'm going to stop it there to avoid the cringe iness of the rest of the video. As it doesn't meet FCC standards. If you go beyond those first five seconds, this has become a trend, and it's worked for some people, including Christian Medina, who said he's an aspiring product manager who's gotten six different job leads since posting a tiktok video last month seeking a product management role. Yeah, six in just the last month, so it's working for some people. Now that being said,
Untangle
Jon Levy - How to Build Deeper Connections with Anyone
"So let's dive in by understanding a little bit about why human connection is so important we all know. It's important intuitively. Can you put some words around it for us. Oh for sure. So i'll just start off by saying i grew up. Pretty lonely was super kid. And i didn't really quite fit in. This was like before you could actually have cool geeks now. Everybody likes marvel superheroes back then. It was me and like three other kids in my school. So the weird thing is. I thought that that was like a unique experience. Because i would see shows on television where like everybody was hanging out and everybody had friends. Even the geeks and as i was researching my new book. You're invited. I came across something pretty startling in one thousand nine hundred eighty five the average american had just about three close friends besides family by two thousand four must in a generation later. We were down to just about to so nineteen years. We lost a third of our close social ties besides family and that is terrifying terrifying for two reasons. One is that we'd like to blame things. Like social media and technology the real culprit is probably people moving more for work or after school and it resets their social ties but now that trend is probably progressed and with the pandemic and people being locked in their homes and avoiding physical contact. That numbers probably even lower and for me. The most concerning thing about that is that research. From brigham young looked at what are the actual greatest predictors of human long jetty especially the ones that are in our control and after genetics. Which we can't really control for and i'm meeting meaningful way. At least not yet to is close social ties of close friends or family and number one is social integration which is essentially measured by the number of social contact. You have throughout the day
Broken Brain with Dhru Purohit
The Number One Predictor of Longevity
"Welcome to the podcast. It's a pleasure and an honor to have you here. Brother i you kidding. I've been hearing such wonderful things about you from our common friends. That i was like i want nothing more than to hang up and kind of just explore ideas with you. Well i appreciate that. I'd love to jump right in. And then we'll come back and said a little bit more context by telling your story and why we're here in the book and the whole deal but i wanna start at longevity and want to ask you a question because i think that if there's people that are listening to this podcast who are super health which there are. You're interested in the topic of longevity now with longevity. There's so many layers. There's our diet lifestyle supplements. there's there's our health span is spanish so many factors but in your new book. You have a whole section where you go into. What is one of the greatest predictors of longevity. And i think that's a great place to kick off the conversation so tell us a little bit about brigham young university. Some of their work over there and the greatest predictor of longevity. So i love this topic. Because i've a lot of friends who are like in silicon valley their bio hackers and. They're doing everything they can to extend their life and they ended up buying these like crazy machines and going on these like fast and all this stuff and you know that kind of stuff may or may not really actually help anything. But when researchers looked at many years of data of what actually predicts your longevity aside from genetics which we currently don't have any ability to effect. It wasn't which papaya cleanse you. Were on or how much kale you. The number. Two greatest predictor was close social ties having friends or close fan number one with social integration.
History That Doesn't Suck
90: Epilogue to the Wild West
"So because of how rapidly technology's changing. I mean it's basically like it's the carphone of its era. You know it is sexy for like five minutes and then it's gone it's done that's really well put thank you. I mean we have discussed these things before but that like that valve olympic boom. It's a if only if only that up so recorded. Yeah that'd been it's okay. That's what the applause for. And i think that the pony express is another good example of non just how quickly this technology changing but also how we remember the west and how we remember the frontier because the pony express like greg said is only here for eighteen
Scientific Sense
"brigham" Discussed on Scientific Sense
"The head wherever wherever system talking about major maitree and so going back to the paper up so transcription ucla. Finding suggested transcription factors induced early after political nova jewelry confer the cylinder processes wide for some sweet neurons to transform it to a regional state. So sick would you explain that. A bit Transcription factors are proteins. That are in the nucleus of sell that. Tell the cell wind turn on into high and how much to turn on a given gene and so they're kind of the master regulators of gene expression those jeans or what kind of make the make the which the knicks from teams through the building blocks of of yourself and and so they they set the fresh holds in expression levels for all of us genes and proteins. Things that we really wanted to understand was made this kind of bizarre observation that after Sensory neurons or are are damaged their gene expression profiles dramatically change and it turns out that these genes that are turned on our to Regenerate the he acts on the damaged and so we spent a lot of time trying to understand as processing exquisite eighteen and within different cell types within the sensory neurons many different types. Some detect touch some pets colds and he And so we the math out the responses in each cell types they turned With similar it's still in perth -peutic standpoint it might be really Really useful and we think that in some patients especially thinking about it. Like phantom limb. Pain were at where leg amputated the nerves don't aren't able to regenerate properly because they don't have their end organ to to to to grow back into and in so we think that bag better understanding these mechanisms that drive the generation of the oxo began in some cases. Actually prevent the cells from being hyperactive and an angry of speak after surgical procedures. It's a bit like i eighty value but just like anita carnegie shipment given the wrong the.
Scientific Sense
"brigham" Discussed on Scientific Sense
"Of the artifacts and so we went through some Databases that we and others have venerated and founded perhaps the most highest The part of the body that tends to express the highest lease data subsidy have or actually enteric neurons meeting in certain. Iran's that promote parasol service in your gut need help to by gesture And this let us. I think in early two thousand eighteen proposed that That maybe constipation. a major problem use medications pricing leak in the clinical trials largely or there was a small sigh bone a couple of The major medical clinical trial for rent which is have you seek europe. of moncloa antibodies. I'm really show statistically if you can signal four or prosecution trials and so we were surprised by not as many of us are still. Are that often show up And and given their experience in the world now one of the most common complaints by patients who dayton's -cations the extra just say they're rarely limiting and treatment. Sometimes they are but most people are able to take to take medications to take over the counter supplements to prevent this from being a major problem. But in rare cases it can cause a complete paris complete illnesses and in places where you cannot pass stool And and that's a that's a real medical emergency so this is not been something that has really prevented asians very rare but it is something that that detect in clinical trials in something. That's come out afterwards. And so i think your point about interest to highlight that we many of these things can be predicted ahead of time by By some new singles technologies that use and so so practically. How would it won't so you will you take a blood test or something and it will tell you some sort of probability that you might have. Cd's side effect like concentration yet predict who is going to have a side effect. And who isn't what we're actually proposed in study..
Scientific Sense
"brigham" Discussed on Scientific Sense
"And and i think that Maybe different individuals have susceptibility to migrate and his different parts of this pathway. are affected. So maybe some people have neurons in the central nervous system of hyperactive that increased likelihood for For triggering migraine attack in other people may not have anything wrong with their their excitability their central nervous system but their patrons in in their face in and around their head are just really easy to get kind of stimulated get activated a much lower threshold than someone else and so they might experienced the pain associated with migraine much. Much more easily and so. I think that that's why. I'm starting to conceptualize. This and the next step is to try to understand how these individual variants that have been associated with migraine caused suction in the in the salt experts. Thurs i You would it be correct will to think about migraine sort of a diverse set of Diseases that that all have some sort of symptoms. The are using symptoms has a diagnosis. But as you say could originate from many many different parts of the body. Right so are recalling. Mike leads the bucket off from diseases. I think i think that almost certainly there are different categories of migraine within this broad stroke diagnosis for sure The question is what is the most meaningful way to separate people out and right now you know if you respond to the medications used to treat migraines such as sumatra tan or soms new. Cgip antagonists you know me. Were comfortable with calling that migraine but for people who don't respond you know there there. There's a real value to two separate people out to the medications that they were most likely to respond to. I think that's That's that's kind of the next step here is to figure out who's responsible which medication i i should just kind of take a step back and say when people have chronic migraine more fifteen days of this month we often have to start out with.
Scientific Sense
"brigham" Discussed on Scientific Sense
"Welcome to the site of accents. Podcast where we.
Solvable
Interview With Paul Farmer on Global Health Inequity
"Paul farmers it professor at harvard medical school chief of global health equity at brigham and women's hospital in boston and the co founder of the organization partners in health began by asking him to describe the global health care situation in his own words. Well right now. We could focus almost entirely on the setbacks. You know one of the biggest problems we faced all over. The world is that with a shutdown. Obviously people aren't able to readily accessed their their care. What if they have cancer. Whatever they have diabetes have severe hypertension. So those are ranking problems. I think to anybody who's involved in global health. But that's just the tip of the iceberg. A lot of the efforts that we have engaged in to address. Social determinants of health are also being set back economic educational programs cultural endeavors employment opportunities There's been a major contraction. An anti poverty efforts overall. so it's going to be Troubling reflection on what's happened this past year and a lhasa worried it's gonna be projected poured into a futures. Will
Cardionerds
Managing Atrial Fibrillation With Lifestyle Changes Dr. Christine Albert
"Thought we could start by discussing some of your major contributions to the management of atrial fibrillation even since my medical school days. It seems like the emphasis. On lifestyle management for diseases such as atrial fibrillation has increased exponentially as we learn more about arrhythmia mechanisms and now we specifically screen patients for sleep apnea diet alcohol use et cetera. So from all of the landmark clinical research that you've conducted over your career. That's far could you. Maybe summarize for us. What you feel are the biggest takeaways whether in eighth hundred prevention or in any of your other areas that sudden cardiac death. Thank you when i started doing. Research on the epidemiology of heart rhythm disorders really wasn't an emphasis as you say on. Risk factors for h. fibrillation or sudden cardiac death. And then you know a group of us not just myself but amelia benjamin in the premium study and patrick eleanor. We all started to get interested in looking at atrial fibrillation as you would cardiovascular disease and some of the major findings are really related to lifestyle and how it can impact each relation including body mass index. And wait and wait reduction. We've done several studies. One who first authors tetreault who's also electro physiologist at brigham women's hospital and she published a very important study in jack. Where we showed in bunks women. Even being slightly overweight had elevated to risk of fibrillation. And then if you lost weight you lower that risk. And in addition some of the other research we did was around. Exercise and showing that exercise is beneficial to atrial fibrillation. But as we all know too much. Exercise can actually have an adverse effect and this again was a study that was done by tony acer who was also an electro physiologist and his now at nyu worked with me for a while. So both of those manuscripts were very important. With regards management of atrial fibrillation. In addition we also published one of the first studies looking at alcohol intake and h fibrillation. Now there have been multiple multiple studies showing that alcohol is related to atrial fibrillation. And as you know a randomized trial now that shows that if you abstained from alcohol you lower your risk of atrial fibrillation so all of these studies are not just by myself but multiple. Investigators have really changed the practice where we as clinicians think about lowering. Risk factors as electra physiologists event and approach sanders. Work in australia really took it to another level by actually doing clinical trial in showing that reduction of weight and modifying risk factors lowers incidence of atrial fibrillation. So now it's really one of our pillars of treatment and it is rewarding to see something go from observational research to clinical trials in actually to
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"brigham" Discussed on Cardionerds
"You for joining us. Thanks so much for having us. This is awesome. Thank you now. I'd like to introduce our acp. Our speaker dr kerry schafer who is an attending in the department of cardiology at children's hospital at brigham and women's hospital and at boston medical center. Dr schaffer is an adult congenital. Heart disease specialists who loves to take talents all across the city of boston and is the perfect person to offer an easy. Pr perspective on this fantastic case. So thanks dr schaffer. We look forward to hear your thoughts. Hi this is keri schaefer. I'm an adult congenital cardiologist. And i'll be discussing this very interesting please. That we've heard about today so in seventy eight year old woman. With the sinus minnows defect partial in almost pulmonary. Venus return and coronary artery disease. We really have a lot of physiology to think through one of the critical parts. When we integrate such complex physiology is to really understand each individual component. Well so that we can kind of identify which parts are related to each abnormality for that reason. I'd like to focus a little bit just on the sinus. The knows steve. Act and the partial anomalous pulmonary venus return and as we go through this physiology. I just want to remind all of the listeners out there that when you do. Ach physiology really have the opportunity. To kind of apply the knowledge you have for medical school about just truth. Physiology to the human heart can't make assumptions as we sometimes do in the setting of normal cardiac anatomy and so we really need to think about exactly what are the compliances of the downstream structures and whereas the blood flow. Okay so let's start off with this patient's issues so she has a sinus venosa defects with partial anomalous pulmonary vein so first. Let's talk about sinus. Venus sixty x so sinuses defects happen about five percents of the atrial level defects. Many of you might have heard of atrial septa defects as being part of this family. I think we as cardiologists really need to refine that definition and remind ourselves that the defect. We're talking about today. The sinus defect actually isn't in the true atrial. septum atrial septum defects are really just. The ostiense accused him in austin primum defects that we see much more commonly sinus knows. Defect is actually a defect as the pulmonary vein. The typically right upper pulmonary vein runs behind this superior vena cava and it's the lack of that wall that results in this defect the shunt physiology is quite similar to asd's and so i think physiologically kind of both them all together. When we think about a sinus analysis defect when i see a patient with an with a sinuses defect the first thing. I do is really get a lay of the land in terms of anatomy. One of the most important associations is what we've talked about today. This partial anomalous pulmonary venus return and typically the vein drains into the sbc near the sinus defect however. It isn't entirely uncommon for patients to have another anomalous pulmonary veins and so as we think through cases like our patient today. We want to be sure that we do an anatomy scan including the assessment of the. Sv see up to the level of the anonymity because on occasion there can be higher pulmonary vein anomaly and that will radically change our strategy for repair so after we get through assessing all of our anatomy we wanna make the next step in to determining what is the effect of the shunt and there's really two main ways to look at the effects of the shunt the first way which is nicely outlined in our case is to look at the cardiac physiology on imaging so typically we start with trans theoretic echo and we look at what the size of the right atrium and right ventricle and this is an important part in which we think about where the shunt goes so. Let's just pause for a second in think about this blood flow as it goes through the shunted area so if we have a sinus noces defect but we really have is a defect right. Where the right upper pulmonary vein would be. Coming into the left atrium. That wall is missing. And so what can happen. Is that left. Atrial blood goes into the right atrium. Really very very superior -ly near the sbc so the Go left atrium right atrium right ventricle pulmonary artery pulmonary vein and then back to the left atrium again to make that shunted cardiac output so then we look for the effects of shunting. We wanna look at all those structures. Do we see right atrial. Dilation do we see right ventricular dilation. Do we see pulmonary vein. Dilation in pulmonary artery dilation and in this case we saw all of those things. And i think it's it's especially important to think through the effects of that volume loading of these chambers so our patient had significant tricuspid regurgitation. At least in part due to the fact that the right ventricle was dilated and dust. The tricuspid in euless. We can also think about the fact that she has atrial fibrillation now. Certainly there is definitely plenty of reason for a seventy eight year old woman with a history of heart failure with preserved ejection fraction in coronary artery disease to have pulmonary vein dilation but even patients who are younger than this patient who only have a partial in almost pulmonary vein and scientists noces defect. They also can have a fifth in the reason the same as every other patient. That when you how this shunted blood that goes through the pulmonary vein that dilates the pulmonary vein indus- puts the patient at risk very so she really had plenty of reasons. Not just the standard ones to have adrian relation so after we get through assessing the anatomy and we get through assessing the effect of shunting on imaging. The next thing we typically do is assess the effect of shunting on the human of this patient. And that's really where we make our final decision in terms of our next steps and in this case we talked about the fact. This patient had a significant left to right shunt. We don't discuss a ton about the possibility of a bidirectional shelton. I think that's appropriate because there's going to be plenty of reason for a patient like this with la hypertension to have a left to right shunt and when we do the shunt calculations we find that. There's probably shunt fraction of about two point. Five to marie depending on how we make our calculations and what that means essentially is that. There's two and a half to three times as much blood going through the lungs and the pulmonary veins and the right ventricle. Dan the normal amount of cardiac output going out of the left ventricle. And a wardha. When we think about that we have to remind ourselves that the pulmonary vascular resistance is going to be calculated based on the flow through it and we might remind ourselves of the law which is how we calculate all pulmonary vascular resistances where the resistance is the change in pressure over the flow. So in this case we would use the trans pulmonary gradient and we would divide it by the q p so.
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"brigham" Discussed on Cardionerds
"What is presumed to be group to pulmonary hypertension who presented to the hospital with recurrent disney onyx or shan notably. She's had multiple admissions in the past year for was ultimately diagnosed with heart failure with only really mild interval improvement in her symptoms. Each time this time she again complains of dismay that was worsened over a period of several days and at the time presentation she really denied worth. Thought mia perks. Zeman nocturnal dismissed or cough. She had not noticed significant change in her appetite and didn't really have significant abdominal or extremity. Swelling she did reports on exerts lightheadedness. Though she had not had be she also describes him exertion chest pain that was sharp nature. Alex thanks history. We so often take care of patients with heart failure and admissions compensation that it's almost hard to zoom back out and think about their overall trajectory right. But when i hear a patient who has hartfield in his head multiple admissions over the course of the year that pretends very bad prognosis over all right so my level of concern is already pretty high this particular admission when she's denying the usual review systems for fluid overload or thought me up. Pnd i m curious what this particular. Admission is about regardless. It'd be helpful to know more about the context of this presentation like her overall the rest of her medical history. Just c-can start identifying the reasons why she's having so many presentations. What else do we know about her for. Sure i think the social and medical history context is super important in this case in terms of her social history. She had recently emigrated to boston to live with her daughter. From haiti as she did not drink any alcohol smoke. Tobacco use any illicit drugs. Her family history. She really didn't know what time She had no known allergies and in terms of her medications. You really was not on a time. She was on looting. Hypertension and then froze might forty milligrams. Vip for her heart. Failure begs alex. I think one thing to highlight is that she really did not get much medical care in haiti and she had been having kind of disney a- and symptoms similar to this for several years. And so it's kind of unclear as we'll see as the case involves how much medical care in the past. She'd received but she did not remember really being worked up for this in any meaningful way. Prior to moving to the boston area exactly So moving onto some objective data from her initial presentation. Vials are notable for a hurry. That range from seventy two to eighty nine. She had a blood pressure on thirty over seventy in her. Auctions duration was ninety five percent on room air on physical exam. She was a learn ranted times three. She was in no obvious distress in speaking dress. In full sentences cardiac exam was remarkable for irregularly irregular rhythm a normal s one in a fix let s to she had an elevated jvp to twelve centimeters of water. Her lungs were clear to osco tation bilaterally. She had some mild diffuse abdominal tenderness but did not appear are distended and then she had traced long extremity edina so alex i was a great description of this patient's presentation and it's it's not an uncommon presentation that we see and we say that frequently on the cardio nurse case reports on the podcast in general that these patients present sometimes quite similarly but the key is trying to differentiate those small little tidbits from the history of the small tidbits from the exam that can of differentiate the next steps. So i'm trying to start thinking through if putting in buckets the large bucket. The symptom is dyslexia. And it's in someone. That's older and the carries a diagnosis of half half and a lot of times when we get that half path diagnosis. It ends there for a lot of clinicians. We fail to ask why. And we know. And we're learning from people like sanjiv shop and dr sherma at hopkins and across the country. That have half has so many different types and then we really have to near down in what we're talking about when we speak about half half so one of the first things that i'm thinking about here is. What is this diagnosis right. It's a chart bagnis as far as we know at this time right. But is it truly a diagnosis. Where the patient. One of the things that sometimes helpful is the half half score. And we put a link to that in the show notes and that can be distinguisher. What's the likelihood they have some of the markers of that. Are they heavier. The hypertensive afib history and echo parameters of filling pressures and. This patient certainly has a higher half half score and just clinically. This is someone that fits that phenotype right afesip is. Hypertensive is older. So certainly we're thinking about that but they're also factors. That doesn't quite fit for me. this is someone you're describing with a bmi around twenty eight someone that isn't grossly volume overloaded so striking to me. Is there something else going on. And what could be. The ideology of the patients have path on my thinking. When i start to hear it think about. Could this be an amyloid diagnosis on my exam. I'm gonna be really paying attention for clues that may be fitting to that. Ought autonomic rathi or the multi organ involvement as their suggestion of Pat omega lee or dysfunction on the lives could this be a patient that has a another restrictive cardiomyopathy the prominent right sided symptoms. So we're not going to delve into the full differential of what can be half path but the key question is always asking. Why and i think you guys are setting that up nicely of what could be going on. And is it just have path is that phenotype that we're all so familiar with or is there something else that's brewing here. That's actually right. Garon especially when patients come back with recurrent hospitalizations. I think it's always important to revisit every time and always think about. Do we have the right diagnosis for this patient. This time so her labs are notable for a cbc with a white count of four point. Five human trump point one in platelets of one fifty six. Her bmp was notable for gratton in of one point. Four eight with the un of thirty five was elevated at point two three and subsequently up trended slightly two point two four three her. Bnp was eight hundred eleven and it had been about five hundred to eight hundred on her. Prior admissions her chest x ray demonstrated cardio magli pulmonary vascular enlargement with no consolidations or fusions ekg demonstrated fibrillation with right axis deviation in an incomplete. Right bundle branch block her. Most recent echo had been one month prior this demonstrated normal. Cavities is wall thickness at the upper limit of normal injection fraction of fifty five percent. Interestingly she had a severely dilated. Rv with reduce global systolic function with a taxi of one s prime of flattening of the septum in both sicily. And i asked. She had severe by a drill marchmont. There was also severe. Tr and her pony artery systolic pressure was estimated at fifty nine millimeters mercury. So this really kind of piques. My interests and i'm kind of honing in on some of the exam findings as well as what you just talked about on echo alex when i mentioned a severely dilated and similarly dysfunctional right ventricle. I think that in the context of split as to on exam really makes me suspicious for initial central defect. Which i think we all probably remember from step one being highly associated with an ast the asked can cause longstanding rv volume overload lead to profound right-sided failure symptoms leading to this patient's presentation. Now we didn't note an inter atrial shunt on the t. t. e. But that means we may have to look further. Go hunting and rb failure. You know the right ventricle can sometimes be considered the forgotten ventricle. But it's really a huge mistake. Discount this half of the pump because so many patients can present with isolated right ventricular failure and have life limiting symptoms and have a very high mortality especially in the setting of heff path. Rv failure and try casper regurgitation when thinking about rv failure. I find it helpful to break down the causes in two buckets specifically volume overload pressure overload or primary cardiomyopathy processes and so some of the volume overload issues that lead to right ventricular failure include valvular disease like tricuspid regurgitation or insufficiency as well as intra cardiac shunts like atrial central defects. And then some of the biaggi's right heart failure that fall into the pressure overload. Category include things like pulmonary. Embolism or chronic thromboembolic pulmonary hypertension pulmonary hypertension from other ideologies or severe. Lv failure leading to elevated right sided pressures. That also goes along. With mitral valve disease have path anything that can elevate pressures on the left side can lead to pressure overload on the right side and then things like chronic hypoc see mia and onyx to know sis that also lead to elevated pressures for the right ventricle. The see i meant things that lead to cardiomyopathy is causes right. Ventricular failure are cardiomyopathy area. C current mentioned previously amyloid and things like right ventricular septic cardiomyopathy post transplant. Rv dysfunction just kinda round card in my pathak diagnosis. So right now. Based on our patients presentation. I'm kind of leaning into more the volume overload ideology for her right ventricular dysfunction. But this is kind of super super interesting. I can't wait to see more diagnostics. That may lead us to specific geology. So they need. That was truly a fantastic description of what your thought process of going through here in this cases interpreting the exam findings in the echo findings. And i wholeheartedly agree with some of the things you mentioned on your differential and also thinking about what's going on is this rv volume overload rv pressure overload. What's going on the left side. And i'm still trying to reconcile in my own. Mind what this patient has been diagnosed with in the past and what they're presenting right now this diagnosis of half path. And then what. We're seeing a least on exam and echo predominantly right side symptoms. And so some of the things that i'm trying to figure out is danny. Alexey both mentioned at this. Point is what's the contribution to each side of the heart of these patients symptoms. How much is the lv contributing. How much is the left. Atrium contribute which is critical aspect of thinking through half path. Sanjiv will say when we think of raff. It's an issue of lv failure when we're thinking about half path it's a issue of atrial failure and then thinking again. What combination of these factors is. What's leading to the patient's symptoms so to me what you've described so far is a patient has some evidence. Potentially of lv stiffness or essentially a disease or cardia. My empathic process there. You're describing some wall thickness at the upper limit of normal ejection. Fraction approaching borderline area's predominantly a patient. That has rv dysfunction. So is this isolated p. h. Is this a combination of pre and post capillary. Ph or is this predominantly. Lv and one of the things that sometimes it's helpful especially for me not just on the symptoms which we've discovered on previous episodes including predominantly right side. Symptoms like pat omega aside as lower. Extremity dima isn't as an echo finding paying attention to some of the diastolic and eat at a can be a marker of predominantly. Lv verses rv involvement in our listeners. That are still training and not in cardiology. The a meaning. What the inflow across the mitral valve is the velocity of it and early and late diagnostically and impatience with predominantly. Rv dysfunction that ebay is less than one and the reason is that there's tends to be increased resistance across the pulmonary vascular meaning that there's reduced filling of the lv and it tends to occur later. So when i see a patient characterized with half path. And then they have a either a less than one. then i'm starting to think well Is this really an. Lv issue or is this predominantly rv issue and what's leading to that rv issue. Now it's a crude marker but it's one of the things that's helpful to me so as we begin to think that a differential one of the big buckets that i'm thinking about here is this isolated v. combination of lv. Rv are predominately rv. And that's going to help me break down difference further almond any other thoughts. You wanted yucca. And that was beautiful. And i think the question you asked is sort of existential one. But it's so important when you say what is half path and we're still trying to figure that out but it's not just heart failure in the lv f. is preserved. Right i mean if you have heart failure because you have mitral valve quarter rupture in so now. You're in acute heart failure. It's not that you had sought dysfunction in the lv right and so two categorized Who would do the patient of service right insult in this context by looking at the echo that alex beautifully outlined for us. It's really the right side that suffering great. I mean you've got the right side. It's our dilated. The septum is flattening and blowing into the left side. Both during sicily indicating rv pressure overload diaster indicating volume overload. And then i think okay is the lv. Just an innocent bystander. Here right i mean. It's just trying to do his job. And so i go back to danny's categorization of how he approaches rights had heart failure. Nothing is this volume overload and we certainly have a suspicion for volume overload dystopic simple flattening and that may be presumably from the severe. T are now. We didn't hear anything in the equerry to suggest. A primary tricuspid valve pathology if you recall from our last few episodes from carcenoid valvular heart disease with severe tr. But here it may just be functional tr. So is there rv pressure overload predominantly from says the pulmonary hypertension and here we do have an elevated vs sp which in the context of severity are may actually under call. Maybe the pulmonary hypertension is worse than it actually is. There is systolic central flattening indicating pressure overload. Right in. if that's the case the question is why is it that the patient may have pulmonary hypertension right so at this point in the case. I'm really excited to dive into the next phase of diagnostics. Right in one of my favorite things about cardiology is to use all with multi modality diagnostics to identify lesion. So here i'm thinking. Okay danny outpointed out fixed but as to is there a shunt at a level that we can see in a trance theoretic echocardiogram. You may consider getting a trans office. Echocardiogram cross sectional imaging and then also further. Interrogate the cause of pulmonary hypertension. Right heart. cath could potentially be useful especially with with oxygen. Saturation is to calculate a shunt fraction to both diagnosed plumbing. Hypertension consider the causes pulmonary hypertension. Whether or not. It's left cited as well as interrogate for a possible shunt. So what was the next step here. We've got a number of questions resulting in to the fact that this patient probably has a picture that's more complicated than just have pets alone. What did you do next to figure it out. Absolutely i'll also echo karan's point about what is the contribution from the left side. What is the contribution from the right side. I think when we saw this patient in heart failure consultation we were really struck actually by her lack of left sided symptoms. And so we were also really thinking about. Why does she have such profound rights and rights dysfunction on her echo absolutely so back to our case. The patient initially had been restarted on her frozen night. Infusion at the prior effective diuretic dose and after about a day or so of attempted diary says cranny began to rise in her symptoms were really unchanged and at that time. Actually the team. That was taking care of her. Pursued a cd pulmonary angiogram. Due to the persistent dismissing really kind of limited signs of crime overload. The exam showed no evidence of pe but did show in anomalous insertion of the right superior pulmonary vein into the sbc this partial Venus return was a super interesting finding especially in light of her. Rv dysfunction and really helps the blow it off this case. So partial anomalous pulmonary venous. Return is a rare congenital. Finding and knowing about the associated congenital lesions can be super helpful. In clinical practice re flee harshly novelist pulmonary venous return or pa. Vr exists when one or more but not all of the primary veins return blood from the lungs to stomach venus system. It's actually very commonly associated with scientists minosos defect. There's also a variant called scimitar syndrome. That exists when part of our all of the right long has drained anomalous into the ib see it gets its name from appearance on chest x ray given the appearance of you gusta scimitar in ancient sword. Our patient didn't have that. But i still think it's a really great name. So based on this we're thinking about what study we could do next. So alex i just want to clarify. When we partial anomalous pulmonary venous return essentially anatomy. You've got four major pulmonary veins that are draining. Oxygenated blood into the left atrium in this case won the pulmonary veins right upper pommery vein instead of training onto left side. It's training to the right side of the level of the spca and so essentially functionally. This is a left right. Shut and could help explai- some of the findings. In this case. I agree with the blows. The lid off the case here. I know about what what we're gonna do next diagnostic imaging and going back through the patient's history and so forth. But as you mentioned. I think there's still a couple of things here left to explain right and tell me if i'm thinking through this right alex danny but a partial anomalous henry munis return is a is a volume issue and the question is what we saw on. Echo was definitely evidence of diastolic sept flattening. Which would be indicative of volume of lord of the rb. Well we still have to explain the pressure overload. So the question is is this from longstanding anomalous pulmonary vein return or is there something else that's contributing to it. That's a great point koran. And i think that this comes up all the time when left to read schanzer found and as you diluted too long standing left to right shunts can cause volume load to the right ventricle and eventually cause pulmonary hypertension from that longstanding volume overload leading to elevated pressures in the right side circulation and can oftentimes lead to this both volume and pressure phenomenon that we see in this patients and as you had said. I don't think we've necessarily performed all the necessary cardiac diagnostics and even in the setting of partial anomalous pulmonary venus return. It's highly associated with sinus. Vanessa's were to talk about but are a form of st. That is not necessarily seen on super well so as you'd mentioned there's a lot of other diagnostics that we still have yet to do. And so the team. In this case proceeded after they found this partial anomalous pulmonary venous return. They sent the patient for transit. Safa jill echocardiogram which did in fact identify science knows minosos defect with a left to right shuts and so that kind of additional left to read shunts was probably the reality. For long standing right ventricular pressure volume overload. So i wanted to talk a bit about sinus. Vanessa's because we hear about these and we know that they're not well seen on t. e. but it can sometimes be a blackbox people in that they don't really know. Exactly what the senate knows. This is what a senator minosos defect can present like. So not as mrs defect accounts for ten to fifteen percent of all these and is commonly seen in association with an anomalous pulmonary vein often superior. Sinus defect goes along. With a right upper partial anomalous pulmonary venous return an inferior sinus. Vanessa's defect goes with right. Inferior partial anomalous pulmonary venous return and one big takeaway should be that in cases of right. Heart enlargement were an. Ast is not readily visualized on t. e. a. t. e. or a cardiac. Mri can be extremely helpful. Diagnostic tools to assess for sinus analysis or coronary sinus defects. Which often sit in a place. That's not readily visualized from the trans-pacific thoracic imaging modality danny. That was such a great explanation and thinking about the sinus vanessa's defects along with a partial anomalous public. Venus return to essentially have left right shunting at two levels whether it's a superior centers Effect but i'm just kind of thinking about all the different types of ast needs whether it's awesome premium rostrums dome scientists noses etc. What is the sinus of enosis structure. You're talking about. Can you take me through that a little bit absolutely so. Let's roll back the clock and put back on our embryology hats and pretend were sitting in the primitive atrium so in the beginning the primitive adria are one chamber and the science knows is entry way for multiple primitive venus structures to drain. Blood into this single atrium. So the sinus been assist sits behind this primitive dream between the two developing vena cava an early on the primitive venus structures including the common cardinal veins the fiddling veins and the umbilical vans all drained through the says into this atrium and then into the primitive ventricles so slowly as heart develops hemodialysis shifts. Forced this sinus venosa towards the right specifically three major things happen number one. These anterior cardinal veins anastomosis to become the internal jugular veins and sbc and this naturally drains more towards the right side of the sinus fenosa polling blood and pulling pressures towards the right. The second thing that happens is the left umbilical and villain veins degenerates which directs blood towards the right side of the sinus thrombosis again and third. The right umbilical vein. Degenerates with more blood. Coming through the right villain vein from the caudal portion of the developing fetus. Now these he dynamic shifts in this primitive sinus von assists and primitive single atrium shift blood towards the right side of the sinus. And this leads to degeneration of the left side of the sinus. Vanessa's which then becomes the coronary sinus. And the oblique vein of the left failure of the left side of the sinus fano. Cystic completely degenerate can leave a little tunnel or a little israel. Central defect between the left atrium. And the right atrium. Then in adults the sinus vigneault says becomes the smooth poster wall of the right atrium or what is called the sinus venire and adults and this is separated from the rest of the atrial wall by the crista term analysis. Danny you outline the steps within the embryology so beautifully. I just have to say he had to take a moment to appreciate you. Not just how amazing this whole processes in how incredible it is that we don't see defects more often. Miami's just fascinating at. It's so true. It is remarkable heart twists and folds turns and degenerates. It's a true miracle it really is but yeah let's let's go back to your case which you do next. So we've identified an anonymous right superior pulmonary vein and a science knows this effect but as you kind of alluded to before the next step is really to quantify the shunts assess for complementing pulmonary hypertension and kind of get in there and measure some pressures volumes and some oxygen saturation. So she proceeded to the table of truth. The catholic taylor to define the extent of the shots. At possible sequentially stewart. Take us through the right heart. Cath absolutely danny. Let's start with her. Initial pressure measurements. So i like this sort of imagine myself walking through the heart and of magic school bus style. So let's go. We start in. The ra were patients are a pressure was twenty one as a reminder normal being less than eight so next we moved through tricuspid valve into the rv where we find significantly elevated pressures with a systolic pressure of seventy two and an edp of twenty four. Notice that rb diastolic pressure will remain similar to the ira pressure. The absence of significant valvular disease next. We move through the pulmonary valve and into the pony artery here. The pressure measurements. Were sixty eight over thirty. Six was a mean. Pa pressure of forty seven pa. Sp is normally similar to that of the rv but we expect to see a step up in the diastolic pressure due to pulmonary vows preventing backflow of blood. We continue our journey into the pulmonary circulation with our balloon inflated and wedge ourselves into the distal pulmonary circulation. The wedge pressure approximates la pressure which we take our proxy of lv edp. In the absence of significant mitral stenosis. Our patients kohner capillary. Wedge pressure was estimated than six significantly above the normal of eight to twelve so in summary. This was super helpful. We nassau that. She's volume overloaded and confirmed a diagnosis opponent hypertension as a reminder as of the six world symposium on pulmonary hypertension the definition of is now immune pony artery pressure of greater than twenty danny. We know she has sinus noses. Defect on t. e. now we've seen these elevated pressures. How can evaluate the shunt fraction while. She's on the table. This is really great stuff. Let's dive right into it. So shut slow from the systemic circulation to the pulmonary circulation or so left to right shunt can be localized and quantified during a right heart. Cath by performing. What's called an symmetry. Saturation run or sat. Run or a shunt run and to do this as the catheter is passing through the great vessels to the pa. Or should i say as the magic school bus drives down the wonderful vascular that is the cardio pulmonary circulation. Small amounts of blood can be obtained and sent symmetry in each different chamber. So never gonna perform a complete sat run. We take the chambers from the proximal and distal. Sbc the proximal and distal the right atrium the right ventricle the pulmonary artery and the to obtain a true systemic saturation taking multiple samples in each chamber can also be done but are only necessary when the level of a suspected shunt is unknown. And you really want to identify where it is in which particular chamber so a left to right shunt detected when you detect an asymmetry. Step up where oxygenated blood from the systemic circulation mixes with dioxin jaded blood from the venous circulation up with more than seven percents is considered significant at the level of the great veins. And the right atrium. While i step up of more than five percent is considered significant at levels distance. The right atrium. The degree of left to right shunting can be quantified by calculating the ratio of pulmonary blood flow to systemic blood flow or the q p q s and this ratio is calculated using the fick principle for cardiac output and by making a few subjects. So i because the cardiac shunts will affect the mixed venous oxygenation or the pulmonary artery oxygen saturation a systemic mixed venus. Saturation needs to be calculated to essentially reflect pre shunt mixed venus. Oh too and this is defined by slams formula or three times. The sbc plus one times divided by four next. We make the assumption that oxygen consumption hemoglobin concentration. An atmospheric pressure are constant. This allows for many of the terms in the complex equation to cancel out leaving only the asymmetry saturation's to calculate the peak. Us ultimately wants simplified. The equation boils down to difference in saturation across the systemic circulation or a arctic saturation minus your calculated mixed saturation divided by the difference across the pulmonary circulation or the pulmonary veins sat minus the pulmonary artery. Sat at practically the pulmonary administration cannot be obtained without a transept Puncture or retrograde catheterization through the left side valves but in the absence of a significant right to left shunt. We expect the systemic arterial saturation and the venus situation. Thirty the same in other words. The left atrial. Saturation should be the same as the arctic. Saturation and so the pulmonary venice situation is often replaced by the stomach. Arterial saturation the arctic saturation. Ns equation. danny. That was such beautiful explanation about how to interrogate are cath saturation's for admiral shunting. The formerly went over to help us. Determine what we call the cue s where you know we can't get it noninvasive lee using echocardiogram again marai but a gold standard gray p being the cardiac output through the pulmonary circulation and q. S being card apple through the systemic circulation such that q s is a ratio of the put in the pulmonary circulation over the cardiac output systemic circulation. And given that normally everything is in a series without communication the ratio normally. It should be very close to one so when you go through the math. Danny how do you interpret the q. S beyond that. That's on it so as you say. In normal situations the pulmonary circulation and the systemic circulation should have an equal amount of blood flow so ratio should be one but when the pulmonary circulation has more blood flow going through it than the stomach circulation that ratio will become greater than one. And so what. We typically think of as a small left to right shunts is accused of less than one point five but when we think of a large left to right sean to wear a lot. More blood flow is going through the pulmonary circulation. A ratio of greater than too often indicates a larger left to right shunt and these are patients who often present symptomatically who require closure or some other procedure to.
Cardionerds
"brigham" Discussed on Cardionerds
"Their experience.
Women's Health By Heather Hirsch
"brigham" Discussed on Women's Health By Heather Hirsch
"You'll start to demand more. You know, you can also join me in that cry. You can repost these you can send them to your friend like you can even send these to your Physicians who are you know, hopefully my colleagues across the country so that we start to really realize that there's a Common Thread here one that woman's health education is lacking both among internal medicine and family trained doctors and even among jio me just because they are so focused on those two extremes, which is obstetric of medicine and really complex surgery that they need a lot of time to train for so that leaves is Gray Zone of pelvic exams. GYN Health GYN cancers Sexual Health menopause sort of in the middle sort of in the gray zone. So what am I doing? Well, certainly I am not dead. Alone in feeling this way numerous of my colleagues and friends and mentors across the country feel the same way. And so we are trying to build and bridge the gap that gray zone between OB-GYN and internal medicine. So that interest really can start to take over some of these conditions questions, whatever you want to call them because a lot of times these are chronic and a lot of times internet's are really well trained in managing things long-term. They're really good at in the like and enjoy and have a little bit more time to counsel and sit and talk with you through what this means in terms of the other medications that you're taking in the other chronic diseases that you have and how long this treatment is and what the risks and benefits of that is with your other medications. And so they're well equipped to do things like this and she can take that model of teaching interest in Family Medicine doctors a lot about contraception and how to put long-acting contraception devices in place like iuds and explanations and we can transfer phone. That to the later reproductive years Peri menopause menopause genitourinary syndrome of menopause osteoporosis Sexual Health. We can really build that Gap. So a lot of us are educating Ang. We educate at many different levels. I educate locally. I teach medical students at Harvard Med. I teach residents at the Brigham and Women's Hospital where I work in see patients. I also get numerous local lectures Regional lectures and the national lectures on how to to help your patience with these conditions that I just rattled stuff and that's one way I can do it. I certainly have a podcast and a YouTube and a social media where I can vent and I can continue to encourage the spread of ideas off and you know, certainly I am not alone many of my other colleagues have either engaged with me or if interacted with me or are already doing amazing research projects on these dog. Topics. In fact, there are numerous thought leaders that I look up to that. I am so excited to read their Publications and to see what they're researching in terms of medical education and how they're expanding some of these women's health issues into the internal medicine Family Medicine is fear. So it's happening and that's really exciting. So I'm certainly trying to do my part wage and I know that there are so many other people who are trying to do their part so that you can your life can be a little bit more streamlined so that you don't have to get unnecessary tests so that you can walk in Doctor Who Could eventually do everything for you. So as promised what are the things that you can do? Well, it's actually really not so far-fetched to actually just start by talking with your doctor asked them what they can and.
WBZ Midday News
Family of man killed by Boston police after Brigham and Women’s confrontation continues push for new investigation
"Times by police in Boston last February. Is now calling on state officials to open a new investigation into his death. Justin Roots family are among those talking, taking part Rather in a rally yesterday at the Statehouse organizer's want governor, Charlie Baker and state Eiji Maura Healey to reopen the case. Norfolk D. A. Michael Morrissey's office had concluded the officers use of force was objectively reasonable and justified. Justin route was shot at close range after threatening security guards at Brigham and Women's Hospital with a BB gun last February. Lady Gaga Stolen
WBZ Midday News
Tiger Woods "awake" and "responsive" after surgery for injuries from crash
"After suffering serious orthopedic and leg injuries in a single car rollover crash in L. A. Technically it was an SUV. But I spoke with Dr Michael Weaver, chief of orthopedic trauma at the Brigham and Women's Hospital in Boston, who says they did emergency surgery on his muscle tissue. As well. The reports were that they had to release the fashion or the tissue covering the muscles of his leg. Oftentimes in a high energy injury, there could be swelling. And if the pressure inside the muscle builds up too much can A risk the blood supply to his leg and foot and so often in that situation, that tissue is released to release the pressure and that allow the blood to flow that suggest to you that he was in danger of losing his leg. I'm not sure that he was in danger of losing his leg, but I think it is an indication that this was a very severe injury. Human women's doctor Michael Weaver. Thank you for your time. He was going right into the O. R to perform a surgery when we caught up with them. Woods team issuing a statement saying Woods is awake, responsive and recovering one Oh, eight. Mona Rivera from Bloomberg. Good
Consider This from NPR
Extraordinary Boston Patient Offers Surprising Clues To Origins Of Coronavirus Variants
"Are trying to learn more about corona virus burien by studying the case of one extraordinary covid. Nineteen patient and this patient was a forty five year old man who admitted to a boston hospital last spring doctors at brigham and women's hospital treated him he got better and he was discharged but his infection never went away. This is a of an extraordinary individual who was readmitted over the subsequent five months for recurrence of his covid infection and severe pneumonia. Dr jonathan lee. One of the doctors who treated the man says he was not a so-called long. Hauler a person who clears their covert infection but has lingering after-effects sometimes for bunce. This man says had living growing virus in his body for one hundred and fifty four days. That is one of the remarkable aspects of this case and in fact he was highly infectious even five months after the initial diagnosis re spoke to npr science reporter. Mike lean duke left. Who picks up the story from here. These says the man's immune system wasn't working normally. He was taking any suppressive drugs for chronic illness. So his body couldn't fight off the virus very well but we also wondered if perhaps the virus was taking advantage of this unusual situation with so much time inside the man. The virus might have the unity to test out different versions of itself in find. More infectious versions. So lena's colleagues begin to examine the viruses genes. How shocked shocked because of virus was mutating very quickly inside the man's body these mutations allowed it to evade his immune system to escape detection by antibodies when i saw the virus and the viral sequence. I think i knew then that does that. We're dealing with completely different at a potentially important completely different because the virus had a whole collection of mutations not just one or two but more than twenty scientists had never seen this before during the whole pandemic. The in his team published the findings in the new england journal of medicine. The report didn't even make big news. That was november twenty twenty then about a month later a new corona virus variant causing international concern is. Npr's david greene reported. Scientists this past december detected new genetic variants of the virus one in the uk one in south africa and then later when in brazil guess what these variants have in common with the virus in the boston patient. A sudden collection of multiple mutations in a combination. That is worrisome. That's jeremy lubin he's a virologist at the university of massachusetts medical school he says these new variants look remarkably similar to the virus lee and his colleagues found in their patient. They the same but they share important characteristics. They both have about twenty mutations and they have ones that make the virus more contagious in so right now. Lubin says one hypothesis is that the new variants the one from the uk south africa and brazil arose inside. People like the boston patient people with these long term infections and who are immunocompromised because their immune system was not working and normally they could eliminate the virus and over time the first and acquired a collection of mutations that otherwise did not insieme. let's work in other words. The virus this long-term infection as a testing ground to try out different mutations in c which one's v the immune system become more infectious in eventually spread more easily around the world.
Cardionerds
Nuclear and Multimodality Imaging Coronary Ischemia
"Welcome back everyone. It's time for car. Dealers go nuclear with today's discussion about the multitude of clinical utilities of nuclear cardiovascular imaging within the broader context of multi modality imaging. We are just so thrilled to be joined by our imaging nerds colleagues doctors. Eric hut elbow skinny and wild jaber erica. It gives me so much joy heavy back on our audience will remember you from our cleveland clinic. Cnc are episode episode number. Seventy six on our patient with spontaneous. Pap ruptured related to vascular. Eller donald syndrome so for everyone. Erica was born and raised in costa rica where she received her medical degree from university. Costa rica she trained in internal medicine at the cleveland clinic. Where fortunately for us. She couples matched to stay here for cardiology along with mr dr. Eric hut aka jose. Aguirre truly power couple. Erdo will be staying here for cardiovascular imaging fellowship at beyond being clinical and a research powerhouse. Erica is a leader within the program as her classes fell representative erika. Thanks for joining us high. And it's a pleasure to be back. Thank you for that very kind introduction. I gotta say that. It's thanks to my mentors family and friends that i'm where i am today and i'm more than excited to introduce one of those individuals. Although skin on the cardiovascular imaging fellow at brigham and women's hospital he obtained his medical degree from Willing willingness swallow and completed his internal medicine residency including chief year at cleveland clinic and then moved on to cardiovascular fellowship at this institution although not only a spurt clinician and a researcher but also an exceptional mentor and a friend. And i actually met all during my interview at ccf when he was achieved I blame him. For recruiting me and six more latin americans to my residency class all of which actually became very close friends on one. My husband so thank you all for guiding my steps and really molding future so got. Thank you for those kind words. We have great times back into clinic. Both control mason in the work hard to try to you to the clinic somber. Happy that's the case. You're following through the path of of imaging so an amid. Thank you for the invitation diseases. Great session we're looking forward to do these for some time. So he's my to pressure to actually introduce the doco alligator book. Java's attended cardiologists at the cleveland clinic. He's director of new collapse. And director of the core lab. For the cleveland clinic. But beyond that the jerry's is is a friend of father to me as a person who has been all the way through. My journey in cardiology now could imaging in half neural networks expressed Grateful i am to have him in my life. We call him l. hefei just as a way to show him respect and gratitude and show him how we like him hale. Thank you so much for these kind words. now thank you for having a Show in guys is basically. There's no better time to spend your saturday this except of course watching boss place football but again. It's you know you look at these at yourself and you hear these words you think of yourself thank you all feel old inspect only comes with age and thank you guys old florida or not. Only keeping us always up to date but fighting us and You started shows again how you can change the way. We actually learn medicine. Cardiology from an up down up down way of delivering information. What everybody's waiting for the people in gray hair sitting in now. Beautiful offices in universities threatening us web to waiting for them to come up with a verdict every four or five years guidelines versus you taking this down to the level of practicing and cardiologists toward actually in training or early career and disseminating information. Because you can reflect. Shine the light on. The most important issues is face every day clinics and in the hospital home floors globally with the pandemic and then you can also actually at transcend all these rigid structures. We developed over the past. Maybe thousands of years cardiology and make these structures louis invade democrat. So thank you so much that and there's nobody that person actually reflect this new method or way of learning than erica. Erica is amazing amazing. Amazing human being an amazing physician. And i for the feel fuelling vitals of had in my life over the past two years have been at the cleveland clinic. It's such a pleasure to spend after
Morning Edition
Massachusetts coronavirus vaccine sign-ups plagued by problems as Phase 2 rollout begins
"Medical researchers who work remotely have been rolling up their sleeves to get the covert vaccine. Meanwhile, seniors are waiting on the sidelines not yet eligible. Massachusetts has one of the nation's largest hospital workforces, and officials there have decided to put all of them at the front of the line. Gabriela Emanuel of member station GBH in Boston reports. Carol Helper set is 82. She's been in her apartment just outside Boston. Since the beginning of the pandemic. Nobody comes in. Nobody goes out. I become more and more despairing and lonely cut off some human contact helpers that has a long list of complex medical issues. The most urgent one. She's going blind, She says. She's desperate for ice surgery. But in order to safely be in the hospital, she needs a vaccine. The vaccine would change my life. It would give me the future for weeks. She's been desperately trying to figure out how to get a shot. I am still Totally Totally in the dark. She's watched with jealousy as seniors in many other states have started receiving vaccines. She studied data from the CDC finding Massachusetts in the bottom half of states in per capita vaccinations. But perhaps most baffling is seeing healthy young people get inoculated before the elderly and the sick. We're seeing just a huge number of people get vaccinated. Who I think you know, should frankly be way down the line. Michael Mina is at Harvard School of Public Health, the other people who have nothing to do at all with Cove ID or with Patient care. We're really with the hospitals. They just happen to be employed by a hospital, and thus they can get the vaccine. Ah, few things are happening here. First, the federal level nationally, vaccines are being distributed to states based on their total population. The federal government has told states to prioritize certain groups like healthcare workers with lots of hospitals. Massachusetts has lots of health care professionals at the front of the line and effectively means that the elderly and vulnerable people who might need the vaccine first will generally be pushed back the second factor state and hospital level decisions. Here. The health care worker category has been defined to include all hospital employees. Those in research labs and telemedicine in HR, including people working remotely. Paul Bettinger oversees the vaccine rollout at the Mass General Brigham. He says his hospital network needed to bring in some of those working from home during the first surge. They called up researchers and administrators and others in the intensive care unit listening for the alarms of ventilators because the federal surge ventilators that we had wouldn't plug into our alarm systems now a third issue, individuals have been flaky. Dana Farber Cancer Institute sent out a mass email saying quote we have had far too many researchers not show up for covert 19 vaccinations over the past week. The result of the email says, is vaccines that may have been wasted. These challenges have been compounded by communication missteps and technical glitches, and Massachusetts has admitted hundreds of thousands of doses are sitting unused in hospital and pharmacy freezers. Governor Charlie Baker has announced. Those over 75 will be eligible on the first of February, and he's hoping they'll have enough vaccines to meet all the pent up demand. For NPR News and Gabriella
Unexplained Mysteries
Near-Death Experiences
"Accounts of near death. Experiences can be polarizing indie. Most often happened while people are unconscious so researchers are incredibly limited in what they can actually measure. They must rely on human testimony to fill in. What's actually happening in other words. Andy ease exist near the intersection of two seemingly contradictory ideas science and faith which is why after a neurosurgeon reported in n. d. e. it became central to the conversation in nineteen eighty eight. Dr eban alexander began his career in boston at one of the most prestigious hospitals in the country. Brigham and women's well working as a neurosurgeon. Dr alexander simultaneously target his father's alma mater. Harvard medical school in both institutions. He had access to some of the most cutting edge medical technology in the world. Soon dr alexander became an expert in a non invasive. Surgical treatment called stereo tactic. Radio surgery a procedure that uses targeted radiation to address medical abnormalities. In the brain it can even eliminate tumors without needing to open the skull in his own practice. Doctor under-used stereo tactic. Radio surgery to treat cancer. Epilepsy mentoring nerves and tangled blood vessels and for nearly a decade in the field of medicine. His star was on the rise until two thousand one when an elderly woman from arizona. Whom will call. Rose contacted him to remove a benign tumor in her brain. Dr alexander was one of the few surgeons in the country capable of performing the procedure. So rose flew from arizona all the way to boston but she didn't receive the treatment that she expected when rose arrived at the hospital orderlies placed her in a wheelchair and brought her into the operation. Room apparently no one spoke to her or explain what was happening. After doctors strapped into a device rendering it immobile rose demanded to meet. Dr eben alexander. She was about to go under and he had yet to introduce himself mere minutes before the operation began. Dr alexander stepped in front of her said. Hello and assured her that she was in good hands then she drifted into unconsciousness and the surgery began when rose woke up in the icu. She couldn't move the left side of her face. Dr alexander never warned her about the risks associated with her surgery and though he'd successfully eliminated her tumor half of her face was now permanently paralyzed. Ultimately rose filed a lawsuit. Her lawyers asked to see the paperwork she'd signed before entering surgery. But apparently dr alexander could only produce a single sheet of paper. It didn't even have rose's signature on it. Apparently dr alexander had misplaced a number of her forms. The case was eventually settled out of court shortly after. Brigham and women's fire dr alexander from their roster administrators have not stated whether or not the dismissal was related to the lawsuit. Either way dr alexander moved on to work for umass memorial medical center located in worcester massachusetts. Where apparently his careless behavior continued during one operation. Dr alexander reportedly left a small piece of plastic inside a woman's nick. In addition to the pain this caused her she needed another intensive surgery to have it removed then in august two thousand three umass suspended dr sanders for an error made during an operation. On another patient's brain stem the specific details surrounding. These punitive measures remain confidential by early two thousand seven. Dr alexander relocated to lynchburg virginia and began work as a staff surgeon at lynchburg general hospital but his lack of professionalism and care continued
The Site Shed
Why Your Employee Experience Probably Sucks
"David america. Welcome to the podcast. All the way from snowy utah and sunny texas luli rear very happy to be here man. Be on the show matt. Good to have you on getting out of this. Thanks for sending the thomas auden at this time of an normandy. Doing other things here. we're we're gone. You're having us said we would do anything for podcasts. You have a great. So he goes from palestinian pros rundown on what you guys do and power. We also While wearing contacts Little bit into this boy while we're gonna be talking about after that -solutely awesome power still in pros. We are a coachee accountability organization. So we actually do training in coaching exclusively in the home services industries so heated in air electrical plumbing and in a few outliers as well but really our our main goal is to to help companies grow by doing that. They win more moments. They while more customers in really ultimately they make more money. So it's it's not only just about creating the our experience for the customer but what we've discovered we'll talk about. Today is really take care of the employees and you get the engaged employees that employ experience. Will you know late over an influence what. The customer experiences parasailing pros. We've been around for eleven. Years was started by brigham and dickinson in brigham. I've actually presented with from stage. Thousand burgum is great We bring her boss. Of course we love. What am i going to say. Getting actually service roundtable event in sydney dag comeback was years ago. Yeah sorry definitely has changed over the years. So we have about forty five coaches that work with us and we should do training we do. What's really unique with us. Man is of course. Training training is great but we do ongoing accountability coaching though it really starts to help shift the mindset in that really affects the behavior and natural you start to see the real change takes place over time. Yup aleki certainly preaching Here because we put a lot of emphasis in episode type of years into accountability. And you know the difference between a dream and a golf betting a strategy italy's contest sophon. They'd myself over the years since since having accountability partners implies things things might quick show sorrow. Moulik decide this will be extremely well recites and you guys obviously in different locations is that is that because of the recent recent events or is that always been the case. I try to stay as far away as possible to erica. why i'm in texas. He's in utah. She's awesome but man. We actually have an autonomous company in. We don't have a brick and mortar building. We literally have coaches in denver. Florida oregon californian but i would i would definitely say the majority of our there in the beautiful state of utah while okay. So we're we hated. I touched on slave in this series of crowded. Today is the first episode of the creating amazing employee experience. Now we've done the whole customer experience in the past and some it was very well received and think in lots of current global economic situations with the off the back of the pandemic romell your experiences villanova. There's a lot of guys out there. A freaked up to the whole conversation around that staffer attention you know grinding good employees here experience deciding on just funding and i think now more than ever this sort of a situation where the the baby of talent around because for one reason or another people living that guy from the jobs and you know especially after year anyway of the years as miss this constant screen for office off. Now there's now this debate people around so they bang biking that in yourself. More appealing message is paying dividends. Sooner maybe even just now literally just before this podcast outed of Had job applications coming from adds that we're running. I just question whether or not. I don't recall having applicants coming in the fall. It's working in the fiber of the business owner to a degree. I think again. I go to make sure that you stand out against the rest. So we're gonna first step aside which we're talking about why your employees experience probably socks and nothing that would relate to most listeners Second upside we're talking about what you purpose at. In feticide we talking about what the successful companies to retain the employees are through. That you're gonna come up with those topics and you come up with original. What is that reason. So haven't employee experienced for shore is not just creating an employee experience where you have everyone coming into office. Because that's not normal anymore. You got coming into office than your get sent home against. You gotta figure out how to work from home in the now you gotta come back into the office. Now you're going to have an employee experience at home. How do you take care of your people right now. It's always been important but you definitely have to juggle all these different dynamics and one of the things that we have really seen. Is that your culture either by default or by design and it's really setting your employees up for success and even though you know contractors were not the disneyland's not the amazons the googles in t. mobile's or whatever we're not huge corporations where you hear of all these things or evil get one year off when they have their first kid from work paid like we're we can't do that kind of staff but we still have to nurture and take care of the people that we have and find ways we can help them grow and be successful regardless of the size of our company.
WRKO AM680
"brigham" Discussed on WRKO AM680
"Researchers at Brigham and Women's Hospital say vitamin D appears to lessen the severity. BU basketball about to make history. It's home opener against Holy Cross. We'll be the first college game to feature both teams wearing face masks and strange bedfellows at the Statehouse and state legislation. State. Rep. Jack Foley pushes a bill for a state dinosaur, like many of the others looked to explore things with it more whimsical. I'm Jeff Brown. Now. W RKO traffic from the my pillow dot com Traffic center. Some light snow falling out there, Rutherford have is still shut down both sides between Causeway Street in Austin Street. Moliere earlier situation there, and the ramp from the Tobin to Rutherford Average closed as well. The right lane blocked on the Gilmore Bridge North bound Because of that. It's also affecting the South bound side of the Gilmore and 28 South and Cambridge between Land Boulevard and leverage circles so serious situation they're tough situation in a crash being cleared in Revere. It's gone right now on Route one by Copeland Circle the North bound side, So it is much better there little bit slow on the expressway South bound before the Braintree split. Not too bad, though. Pike's wide open from Boston out to 1, 28 and back looking good on the upper and lower ends of 1 28 you find on Route three to the South shore from Braintree, down the Plymouth, both sides. Tape card highways are okay as well and Route three towards New Hampshire's wide open between Burlington and National No delays on both sides of 4 95. For now, I'm Dave Gardner in the W. RKO traffic center. Welcome back to customize and save with Liberty Mutual insurance Company. The game show where you only pay for what you need, and we're out of time. On Lee. Pay for what you need at liberty mutual dot com. Now W RKO Weather Channel forecast stubborn low pressure off the coast, bringing in some Sprinkles some snow flurries here today and in and out of the rain and snow showers here today. We do get above freezing this afternoon up into the mid thirties and weather radar showing the mixed bag of preset moving to the west Southwest. This is that stubborn low that came in this past weekend Still sitting off our coast. Close enough by to keep us cloudy tonight 29 degrees little brighter weather tomorrow up to 39 Thursday be the warm day of the week sunshine with a high of 41. Meteorologist Scott Lawrimore at the Weather Channel on the Voice of Boston. Am 6 80. W RKO I. Heart radio goes one on one with various wrecker to talk about Kenny.
Radio Fajri 99.3FM
"brigham" Discussed on Radio Fajri 99.3FM
"Hell yeah. Massey was about the humble alah. He won't be able to agree. That regret my duke era. He and libby bike logic. Sue the young but at a somewhat young. Keep on maliki dilemma. Do any because young. Good were john. Ama- kita the bussan bludger anger get this. Does he adowa highly talk. Salah lou the very good near fifty yanko jiangyin daddy. Brigham be rasima. Bogey can memoir keita yogi gita sedan de tips. Janka ma'am lanka patil. At our there is a war. Loan patton the survey dave's younger dude. You can monitor In and Up on one thing can dan. Mum fatt can walk through the balloon bladder. Libby by the bernard allow salou burpee. Gator def- also thinking here. Because look this very humble ally. The candle to granada's villiers number. I mean we saw the last two.
WBZ Afternoon News
Report From Boston's Brigham and Women's Hospital Finds Pregnant Women, New Moms Struggling With Mental Health During Pandemic
"Typically, it's exciting time for a family. But a new report finds pregnant women and new mothers have been struggling with mental health during the pandemic. A recent survey from Brigham and Women's Hospital with pregnant or postpartum women finds 36% reported clinically significant levels of depression. Rates were typically 15 to 20% pre pandemic that is, CBS is the only ROCKEM experts say pregnant women should acknowledge their grief and get professional help if they need it. With the need
All Things Considered
Coronavirus among health workers: Exposure, lack of testing
"Workers are still having a hard time getting coronavirus tests and as NPR's Laurel Wamsley reports, the lack of testing means there could be lots of asymptomatic healthcare workers caring Pretty sick people. In a recent round table with Joe Biden. Mary Turner, a nurse in Minnesota, told the president elect something he found surprising. Do you know that I have not been tested yet? And I have been on the front lines in the ice to you since February. You're kidding me. No guidelines from the Centers for Disease Control say that healthcare personnel should be tested if they're symptomatic or haven't known exposure to the corona virus. But treating covert 19 patients while wearing personal protective equipment, or pee pee Doesn't count as exposure that warrants testing. A recent survey by national nurses United, the nation's largest nurses union, found that only 42% of registered nurses in hospitals said they had ever been tested for covert 19. It continues to amaze me that we are not doing this. Michael Mina is an epidemiologist at the Harvard School of Public Health. He says, Well, PPE generally offers good protection. There have been outbreaks of hospitals at Brigham and Women's Hospital in Boston, where Minna runs the virology Lab. One outbreak involved 42 employees and 15 patients. Hospital blamed patients not wearing masks, staff without eye protection and employees failing to social distance while eating. Now that is an outbreak that shouldn't have happened. I believe very firmly that we would not have seen an outbreak grow so so quickly and it wouldn't have even been able to get started. If we were doing frequent testing. There are so many ways that hospital could be doing this and they're not Ministers. Hospitals could either use rapid auntie gin tests or pool PCR tests to do screening for the virus more cheaply they get Have ever on swab and put 50 swabs that a time into 12 and run that one tube and cool the test for very, very cheap. You could do a whole hospital departments with one Past for 50 Bucks a day. California State Health Department announced new guidance two weeks ago that strongly recommends weekly testing of healthcare personnel. But hospitals have struggled just to get enough tests for patients. Susan Butler. Wu is associate professor of clinical pathology at USC, and she directs the clinical microbiology lab at a large hospital in Los Angeles. So we were to take something like this recommendation. Where, Okay, let's say we screen everybody weekly. There's very few clinical hospital labs that would be able to have that much testing available to be able to do that. Color. Woo says that her hospital there are 10,000 workers that would likely need testing under the new guidance, and she says, without operational support from the state, the new protocols are going to cause problems. Including greater testing backlogs, but as a country because we don't have a national plan or national strategy, these air this This is the situation we find ourselves. Football players can get tests people choosing to socialize and wanting to feel safer doing so, even though it's a pandemic can get tests but a program to test the country's health care workers. Nope. Many nurses and doctors suspect hospitals are worried that widespread testing could reveal asymptomatic cases and then result in quarantining critically needed staff. And for Mina, the Harvard epidemiologist, The lack of regular testing of health care workers raises other questions. There's a clear problem when we're saying that the greatest risk people, the people who are at the greatest risk to themselves and to their patients or the health care workers, and so that's why we're going to give them vaccines before anyone else. But then when we don't have a vaccine, and it's just testing, we say, don't worry about it. It's not a big deal. You don't need to be tested. It's an approach, he says. That doesn't make sense.
Entrepreneur on FIRE
Grow and Scale to Unlimited Processing with KhaazRa MaaRanu
"Cadre say was up to fire nation and sure something interesting about yourself that most people don't know fire nation. Hello. How're you doing? So glad to be here John One interesting thing about me is that I'm really. Fun Guy I just love doing things by Tanis -ly travel at the drop of a dime I'll do anything and everything at least one time fire nation where Zesbaugh. Naty like you can't blame Cova forever. You still have to be spontaneous from time to time and I think that that is something that caused red definitely has in spades there'll be communicating over the past few weeks I feel like you're just always traveling cadre. Used to travel a lot more before this whole pandemic thing. So that bug is absolutely there unlike you I loved tropical vibes. Places A Beautiful Landscapes Yeah, absolutely. I love her brother and I also personally love your arch Merill Journey, but I want to share with fire nation now. So talk to us about Your Arch Moreau journey to get you to where you are today. Sure. Many years ago with been around for maybe twelve to thirteen years. Now Time Flies John and I started as a door to door sales. Read Right I was working at an Elementary School in Orlando Florida and working my tail off to get into like twenty eight, thousand dollars a year a two weeks vacation hoping seven thirty to three thirty at whatever time off of work and I wanted to do something they gave me more time. Gives me more time and I work hard is up. Can I do something that doesn't can't my income but I, really just wanted to have more time. I'm like you after I just WanNa sit at the beach I. Just WanNa look out the window I just want to play basketball or actually I wanted to do with my children by how can I do that and so I went online inbound a position In a one, hundred percent commission sales opportunity. before and to California wasn't successful at all initially. Because he was trying to do with the corporate way with you know the sales pitch in the book and. Corporate approach in just got turned down. At. Every business that I went to drop it right now. So you know what? Let me just Relate to people from Detroit Michigan School of hard knocks in the thing I I know how to do is connect with people. You know winner talk we're not to talk sometimes and I did that in super. Just to speed it up really quick I. had a triple my income that year a quadruple did the next year. But then I realized that what I was doing wasn't what I thought. I was doing meaning that I was selling the product that I didn't even understand myself rice. Even though I had dropped the sales pitch book, still have the spirit of that particular company in the industry itself, and that is the spirit of confusion. So you know I was selling merchant programs where the be rates were. There'd be tough with at least not by Terminal Benign, bucks you Lisa for three hundred bucks. This is especially for brick and mortar businesses. You can lease terminal could cost ninety nine dollars you can. Literally Lisa the terminal but three to sometimes a thousand dollars per month for forty eight months in into the least they do not own the machine and it was just you know even the in the way we would pitch them. It was just a real messy thing once I realized what I was doing because I had never read the contract I had never really met the contract myself. I was just starting the program. And once I realized I had to move decision it was totally against particular companies I guess goes to really client on what's really happening behind the scenes by the time decline realize what going on it was too late they were locked into. A four, five year contract with all kinds of these anti get out of it was it will require legal entanglement right with them as you have to hire attorneys go through this other stuff in its contract. So it's Kinda hard to get out of it. So. I had to make a decision to leave that company, lead all the money that had all the recurring incumbent had to. It's up deleted lead cable right and so I did that I went to work with another company and in six months I had. Replaced the incumbent Henry the other company, man those bags were not. They were robbing me and I was by taking advantage of announced robbing Murchison's basically right or Robin clients. So. Same thing had been there all of a sudden. They create money out of thin air when I say thin air veneer. So as an example, there's something called Pi compliance that every business needs to happen in particular Brigham mortar businesses by you don't necessarily. Do but something healthy you it helps protect