Podcasts about acutely

In this episode, Kelly Brownell speaks with Jerold Mande, CEO of Nourish Science, adjunct professor at the Harvard School of Public Health, and former Deputy Undersecretary for Food Safety at the USDA. They discuss the alarming state of children's health in America, the challenges of combating poor nutrition, and the influence of the food industry on public policy. The conversation explores the parallels between the tobacco and food industries and proposes new strategies for ensuring children reach adulthood in good health. Mande emphasizes the need for radical changes in food policy and the role of public health in making these changes. Transcript So, you co-founded this organization along with Jerome Adams, Bill Frist and Thomas Grumbly, as we said, to ensure every child breaches age 18 at a healthy weight and in good metabolic health. That's a pretty tall order given the state of the health of youth today in America. But let's start by you telling us what inspired this mission and what does it look like to achieve this in today's food environment? I was trained in public health and also in nutrition and in my career, which has been largely in service of the public and government, I've been trying to advance those issues. And unfortunately over the arc of my career from when I started to now, particularly in nutrition and public health, it's just gotten so much worse. Indeed today Americans have the shortest lifespans by far. We're not just last among the wealthy countries, but we're a standard deviation last. But probably most alarming of all is how sick our children are. Children should not have a chronic disease. Yet in America maybe a third do. I did some work on tobacco at one point, at FDA. That was an enormous success. It was the leading cause of death. Children smoked at a higher rate, much like child chronic disease today. About a third of kids smoked. And we took that issue on, and today it's less than 2%. And so that shows that government can solve these problems. And since we did our tobacco work in the early '90s, I've changed my focus to nutrition and public health and trying to fix that. But we've still made so little progress. Give us a sense of how far from that goal we are. So, if the goal is to make every child reaching 18 at a healthy weight and in good metabolic health, what percentage of children reaching age 18 today might look like that? It's probably around a half or more, but we're not quite sure. We don't have good statistics. One of the challenges we face in nutrition is, unfortunately, the food industry or other industries lobby against funding research and data collection. And so, we're handicapped in that way. But we do know from the studies that CDC and others have done that about 20% of our children have obesity about a similar number have Type 2 diabetes or the precursors, pre-diabetes. You and I started off calling it adult-onset diabetes and they had to change that name to a Type 2 because it's becoming so common in kids. And then another disease, fatty liver disease, really unthinkable in kids. Something that the typical pediatrician would just never see. And yet in the last decade, children are the fastest growing group. I think we don't know an exact number, but today, at least a third, maybe as many as half of our children have a chronic disease. Particularly a food cause chronic disease, or the precursors that show they're on the way. I remember probably going back about 20 years, people started saying that we were seeing the first generation of American children that would lead shorter lives than our parents did. And what a terrible legacy to leave our children. Absolutely. And that's why we set that overarching goal of ensuring every child reaches age 18 in good metabolic health. And the reason we set that is in my experience in government, there's a phrase we all use - what gets measured gets done. And when I worked at FDA, when I worked at USDA, what caught my attention is that there is a mission statement. There's a goal of what we're trying to achieve. And it's ensuring access to healthy options and information, like a food label. Now the problem with that, first of all, it's failed. But the problem with that is the bureaucrats that I oversaw would go into a supermarket, see a produce section, a protein section, the food labels, which I worked on, and say we've done our job. They would check those boxes and say, we've done it. And yet we haven't. And if we ensured that every child reaches age 18 at a healthy weight and good metabolic health, if the bureaucrats say how are we doing on that? They would have to conclude we're failing, and they'd have to try something else. And that's what we need to do. We need to try radically different, new strategies because what we've been doing for decades has failed. You mentioned the food industry a moment ago. Let's talk about that in a little more detail. You made the argument that food companies have substituted profits for health in how they design their products. Explain that a little bit more, if you will. And tell us how the shift has occurred and what do you think the public health cost has been? Yes, so the way I like to think of it, and your listeners should think of it, is there's a North star for food design. And from a consumer standpoint, I think there are four points on the star: taste, cost, convenience, and health. That's what they expect and want from their food. Now the challenge is the marketplace. Because that consumer, you and I, when we go to the grocery store and get home on taste, cost, and convenience, if we want within an hour, we can know whether the food we purchased met our standard there. Or what our expectations were. Not always for health. There's just no way to know in a day, a week, a month, even in a year or more. We don't know if the food we're eating is improving and maintaining our health, right? There should be a definition of food. Food should be what we eat to thrive. That really should be the goal. I borrowed that from NASA, the space agency. When I would meet with them, they said, ' Jerry, it's important. Right? It's not enough that people just survive on the food they eat in space. They really need to thrive.' And that's what WE need to do. And that's really what food does, right? And yet we have food, not only don't we thrive, but we get sick. And the reason for that is, as I was saying, the marketplace works on taste, cost and convenience. So, companies make sure their products meet consumer expectation for those three. But the problem is on the fourth point on the star: on health. Because we can't tell in even years whether it's meeting our expectation. That sort of cries out. You're at a policy school. Those are the places where government needs to step in and act and make sure that the marketplace is providing. That feedback through government. But the industry is politically strong and has prevented that. And so that has left the fourth point of the star open for their interpretation. And my belief is that they've put in place a prop. So, they're making decisions in the design of the product. They're taste, they gotta get taste right. They gotta get cost and convenience right. But rather than worrying what does it do to your health? They just, say let's do a profit. And that's resulted in this whole category of food called ultra-processed food (UPF). I actually believe in the future, whether it's a hundred years or a thousand years. If humanity's gonna thrive we need manmade food we can thrive on. But we don't have that. And we don't invest in the science. We need to. But today, ultra-processed food is manmade food designed on taste, cost, convenience, and then how do we make the most money possible. Now, let me give you one other analogy, if I could. If we were CEOs of an automobile company, the mission is to provide vehicles where people can get safely from A to point B. It's the same as food we can thrive on. That is the mission. The problem is that when the food companies design food today, they've presented to the CEO, and everyone gets excited. They're seeing the numbers, the charts, the data that shows that this food is going to meet, taste, cost, convenience. It's going to make us all this money. But the CEO should be asking this following question: if people eat this as we intend, will they thrive? At the very least they won't get sick, right? Because the law requires they can't get sick. And if the Midmanagers were honest, they'd say here's the good news boss. We have such political power we've been able to influence the Congress and the regulatory agencies. That they're not going to do anything about it. Taste, cost, convenience, and profits will work just fine. Couldn't you make the argument that for a CEO to embrace that kind of attitude you talked about would be corporate malpractice almost? That, if they want to maximize profits then they want people to like the food as much as possible. That means engineering it in ways that make people overeat it, hijacking the reward pathways in the brain, and all that kind of thing. Why in the world would a CEO care about whether people thrive? Because it's the law. The law requires we have these safety features in cars and the companies have to design it that way. And there's more immediate feedback with the car too, in terms of if you crashed right away. Because it didn't work, you'd see that. But here's the thing. Harvey Wiley.He's the founder of the food safety programs that I led at FDA and USDA. He was a chemist from academia. Came to USDA in the late 1800s. It was a time of great change in food in America. At that point, almost all of families grew their own food on a farm. And someone had to decide who's going to grow our food. It's a family conversation that needed to take place. Increasingly, Americans were moving into the cities at that time, and a brand-new industry had sprung up to feed people in cities. It was a processed food industry. And in order to provide shelf stable foods that can offer taste, cost, convenience, this new processed food industry turned to another new industry, a chemical industry. Now, it's hard to believe this, but there was a point in time that just wasn't an industry. So these two big new industries had sprung up- processed food and chemicals. And Harvey Wiley had a hypothesis that the chemicals they were using to make these processed foods were making us sick. Indeed, food poisoning back then was one of the 10 leading causes of death. And so, Harvey Wiley went to Teddy Roosevelt. He'd been trying for years within the bureaucracy and not making progress. But when Teddy Roosevelt came in, he finally had the person who listened to him. Back then, USDA was right across from the Washington Monument to the White House. He'd walk right over there into the White House and met with Teddy Roosevelt and said, ' this food industry is making us sick. We should do something about it.' And Teddy Roosevelt agreed. And they wrote the laws. And so I think what your listeners need to understand is that when you look at the job that FDA and USDA is doing, their food safety programs were created to make sure our food doesn't make us sick. Acutely sick. Not heart disease or cancer, 30, 40 years down the road, but acutely sick. No. I think that's absolutely the point. That's what Wiley was most concerned about at the time. But that's not the law they wrote. The law doesn't say acutely ill. And I'll give you this example. Your listeners may be familiar with something called GRAS - Generally Recognized as Safe. It's a big problem today. Industry co-opted the system and no longer gets approval for their food additives. And so, you have this Generally Recognized as Safe system, and you have these chemicals and people are worried about them. In the history of GRAS. Only one chemical has FDA decided we need to get that off the market because it's unsafe. That's partially hydrogenated oils or trans-fat. Does trans-fat cause acute illness? It doesn't. It causes a chronic disease. And the evidence is clear. The agency has known that it has the responsibility for both acute and chronic illness. But you're right, the industry has taken advantage of this sort of chronic illness space to say that that really isn't what you should be doing. But having worked at those agencies, I don't think they see it that way. They just feel like here's the bottom line on it. The industry uses its political power in Congress. And it shapes the agency's budget. So, let's take FDA. FDA has a billion dollars with a 'b' for food safety. For the acute food safety, you're talking about. It has less than 25 million for the chronic disease. There are about 1400 deaths a year in America due to the acute illnesses caused by our food that FDA and USDA are trying to prevent. The chronic illnesses that we know are caused by our food cause 1600 maybe a day. More than that of the acute every day. Now the agency should be spending at least half its time, if not more, worrying about those chronic illness. Why doesn't it? Because the industry used their political power in Congress to put the billion dollars for the acute illness. That's because if you get acutely ill, that's a liability concern for them. Jerry let's talk about the political influence in just a little more detail, because you're in a unique position to tell us about this because you've seen it from the inside. One mechanism through which industry might influence the political process is lobbyists. They hire lobbyists. Lobbyists get to the Congress. People make decisions based on contributions and things like that. Are there other ways the food industry affects the political process in addition to that. For example, what about the revolving door issue people talk about where industry people come into the administrative branch of government, not legislative branch, and then return to industry. And are there other ways that the political influence of the industry has made itself felt? I think first and foremost it is the lobbyists, those who work with Congress, in effect. Particularly the funding levels, and the authority that the agencies have to do that job. I think it's overwhelmingly that. I think second, is the influence the industry has. So let me back up to that a sec. As a result of that, we spend very little on nutrition research, for example. It's 4% of the NIH budget even though we have these large institutes, cancer, heart, diabetes, everyone knows about. They're trying to come up with the cures who spend the other almost 50 billion at NIH. And so, what happens? You and I have both been at universities where there are nutrition programs and what we see is it's very hard to not accept any industry money to do the research because there isn't the federal money. Now, the key thing, it's not an accident. It's part of the plan. And so, I think that the research that we rely on to do regulation is heavily influenced by industry. And it's broad. I've served, you have, others, on the national academies and the programs. When I've been on the inside of those committees, there are always industry retired scientists on those committees. And they have undue influence. I've seen it. Their political power is so vast. The revolving door, that is a little of both ways. I think the government learns from the revolving door as well. But you're right, some people leave government and try to undo that. Now, I've chosen to work in academia when I'm not in government. But I think that does play a role, but I don't think it plays the largest role. I think the thing that people should be worried about is how much influence it has in Congress and how that affects the agency's budgets. And that way I feel that agencies are corrupted it, but it's not because they're corrupted directly by the industry. I think it's indirectly through congress. I'd like to get your opinion on something that's always relevant but is time sensitive now. And it's dietary guidelines for America. And the reason I'm saying it's time sensitive is because the current administration will be releasing dietary guidelines for America pretty soon. And there's lots of discussion about what those might look like. How can they help guide food policy and industry practices to support healthier children and families? It's one of the bigger levers the government has. The biggest is a program SNAP or food stamps. But beyond that, the dietary guidelines set the rules for government spending and food. So, I think often the way the dietary guidelines are portrayed isn't quite accurate. People think of it in terms of the once (food) Pyramid now the My Plate that's there. That's the public facing icon for the dietary guidelines. But really a very small part. The dietary guidelines are meant to help shape federal policy, not so much public perception. It's there. It's used in education in our schools - the (My) Plate, previously the (Food) Pyramid. But the main thing is it should shape what's served in government feeding programs. So principally that should be SNAP. It's not. But it does affect the WIC program- Women, Infants and Children, the school meals program, all of the military spending on food. Indeed, all spending by the government on food are set, governed by, or directed by the dietary guidelines. Now some of them are self-executing. Once the dietary guidelines change the government changes its behavior. But the biggest ones are not. They require rulemaking and in particular, today, one of the most impactful is our kids' meals in schools. So, whatever it says in these dietary guidelines, and there's reason to be alarmed in some of the press reports, it doesn't automatically change what's in school meals. The Department of Agriculture would have to write a rule and say that the dietary guidelines have changed and now we want to update. That usually takes an administration later. It's very rare one administration could both change the dietary guidelines and get through the rulemaking process. So, people can feel a little reassured by that. So, how do you feel about the way things seem to be taking shape right now? This whole MAHA movement Make America Healthy Again. What is it? To me what it is we've reached this tipping point we talked about earlier. The how sick we are, and people are saying, 'enough. Our food shouldn't make us sick at middle age. I shouldn't have to be spending so much time with my doctor. But particularly, it shouldn't be hard to raise my kids to 18 without getting sick. We really need to fix that and try to deal with that.' But I think that the MAHA movement is mostly that. But RFK and some of the people around them have increasingly claimed that it means some very specific things that are anti-science. That's been led by the policies around vaccine that are clearly anti-science. Nutrition is more and more interesting. Initially they started out in the exact right place. I think you and I could agree the things they were saying they need to focus on: kids, the need to get ultra-processed food out of our diets, were all the right things. In fact, you look at the first report that RFK and his team put out back in May this year after the President put out an Executive Order. Mostly the right things on this. They again, focus on kids, ultra-processed food was mentioned 40 times in the report as the root cause for the very first time. And this can't be undone. You had the White House saying that the root cause of our food-caused chronic disease crisis is the food industry. That's in a report that won't change. But a lot has changed since then. They came out with a second report where the word ultra-processed food showed up only once. What do you think happened? I know what happened because I've worked in that setting. The industry quietly went to the White House, the top political staff in the White House, and they said, you need to change the report when you come out with the recommendations. And so, the first report, I think, was written by MAHA, RFK Jr. and his lieutenants. The second report was written by the White House staff with the lobbyists of the food industry. That's what happened. What you end up with is their version of it. So, what does the industry want? We have a good picture from the first Trump administration. They did the last dietary guidelines and the Secretary of Agriculture, then Sonny Perdue, his mantra to his staff, people reported to me, was the industries- you know, keep the status quo. That is what the industry wants is they really don't want the dietary guidelines to change because then they have to reformulate their products. And they're used to living with what we have and they're just comfortable with that. For a big company to reformulate a product is a multi-year effort and cost billions of dollars and it's just not what they want to have to do. Particularly if it's going to change from administration to administration. And that is not a world they want to live in. From the first and second MAHA report where they wanted to go back to the status quo away from all the radical ideas. It'll be interesting to see what happens with dietary guidelines because we've seen reports that RFK Jr. and his people want to make shifts in policies. Saying that they want to go back to the Pyramid somehow. There's a cartoon on TV, South Park, I thought it was produced to be funny. But they talked about what we need to do is we need to flip the Pyramid upside down and we need to go back to the old Pyramid and make saturated fat the sort of the core of the diet. I thought it meant to be a joke but apparently that's become a belief of some people in the MAHA movement. RFK. And so, they want to add saturated fat back to our diets. They want to get rid of plant oils from our diets. There is a lot of areas of nutrition where the science isn't settled. But that's one where it is, indeed. Again, you go back only 1950s, 1960s, you look today, heart disease, heart attacks, they're down 90%. Most of that had to do with the drugs and getting rid of smoking. But a substantial contribution was made by nutrition. Lowering saturated fat in our diets and replacing it with plant oils that they're now called seed oils. If they take that step and the dietary guidelines come out next month and say that saturated fat is now good for us it is going to be just enormously disruptive. I don't think companies are going to change that much. They'll wait it out because they'll ask themselves the question, what's it going to be in two years? Because that's how long it takes them to get a product to market. Jerry, let me ask you this. You painted this picture where every once in a while, there'll be a glimmer of hope. Along comes MAHA. They're critical of the food industry and say that the diet's making us sick and therefore we should focus on different things like ultra-processed foods. In report number one, it's mentioned 40 times. Report number two comes out and it's mentioned only once for the political reasons you said. Are there any signs that lead you to be hopeful that this sort of history doesn't just keep repeating itself? Where people have good ideas, there's science that suggests you go down one road, but the food industry says, no, we're going to go down another and government obeys. Are there any signs out there that lead you to be more hopeful for the future? There are signs to be hopeful for the future. And number one, we talked earlier, is the success we had regulating tobacco. And I know you've done an outstanding job over the years drawing the parallels between what happened in tobacco and food. And there are good reasons to do that. Not the least of which is that in the 1980s, the tobacco companies bought all the big food companies and imparted on them a lot of their lessons, expertise, and playbook about how to do these things. And so that there is a tight link there. And we did succeed. We took youth smoking, which was around a 30 percent, a third, when we began work on this in the early 1990s when I was at FDA. And today it's less than 2%. It's one area with the United States leads the world in terms of what we've achieved in public health. And there's a great benefit that's going to come to that over the next generation as all of those deaths are prevented that we're not quite seeing yet. But we will. And that's regardless of what happens with vaping, which is a whole different story about nicotine. But this idea success and tobacco. The food industry has a tobacco playbook about how to addict so many people and make so much money and use their political power. We have a playbook of how to win the public health fight. So, tell us about that. What you're saying is music to my ears and I'm a big believer in exactly what you're saying. So, what is it? What does that playbook look like and what did we learn from the tobacco experience that you think could apply into the food area? There are a couple of areas. One is going to be leadership and we'll have to come back to that. Because the reason we succeeded in tobacco was the good fortune of having a David Kessler at FDA and Al Gore as Vice President. Nothing was, became more important to them than winning this fight against a big tobacco. Al Gore because his sister died at a young age of smoking. And David Kessler became convinced that this was the most important thing for public health that he could do. And keep in mind, when he came to FDA, it was the furthest thing from his mind. So, one of it is getting these kinds of leaders. Did does RFK Jr. and Marty McCarey match up to Al Gore? And we'll see. But the early signs aren't that great. But we'll see. There's still plenty of time for them to do this and get it right. The other thing is having a good strategy and policy about how to do it. And here, with tobacco, it was a complete stretch, right? There was no where did the FDA get authority over tobacco? And indeed, we eventually needed the Congress to reaffirm that authority to have the success we did. As we talked earlier, there's no question FDA was created to make sure processed food and the additives and processed food don't make us sick. So, it is the core reason the agency exists is to make sure that if there's a thing called ultra-processed food, man-made food, that is fine, but we have to thrive when we eat it. We certainly can't be made sick when we eat it. Now, David Kessler, I mentioned, he's put forward a petition, a citizens' petition to FDA. Careful work by him, he put months of effort into this, and he wrote basically a detailed roadmap for RFK and his team to use if they want to regulate ultra-processed stuff food. And I think we've gotten some, initially good feedback from the MAHA RFK people that they're interested in this petition and may take action on it. So, the basic thrust of the Kessler petition from my understanding is that we need to reconsider what's considered Generally Recognized as Safe. And that these ultra-processed foods may not be considered safe any longer because they produce all this disease down the road. And if MAHA responds positively initially to the concept, that's great. And maybe that'll have legs, and something will actually happen. But is there any reason to believe the industry won't just come in and quash this like they have other things? This idea of starting with a petition in the agency, beginning an investigation and using its authority is the blueprint we used with tobacco. There was a petition we responded, we said, gee, you raised some good points. There are other things we put forward. And so, what we hope to see here with the Kessler petition is that the FDA would put out what's called an advanced notice of a proposed rulemaking with the petition. This moves it from just being a petition to something the agency is saying, we're taking this seriously. We're putting it on the record ourselves and we want industry and others now to start weighing in. Now here's the thing, you have this category of ultra-processed food that because of the North Star I talked about before, because the industry, the marketplace has failed and gives them no incentive to make sure that we thrive, that keeps us from getting sick. They've just forgotten about that and put in place profits instead. The question is how do you get at ultra-processed food? What's the way to do it? How do you start holding the industry accountable? Now what RFK and the MAHA people started with was synthetic color additives. That wasn't what I would pick but, it wasn't a terrible choice. Because if you talk to Carlos Monteiro who coined the phrase ultra-processed food, and you ask him, what is an ultra-processed food, many people say it's this industrial creation. You can't find the ingredients in your kitchen. He agrees with all that, but he thinks the thing that really sets ultra-processed food, the harmful food, is the cosmetics that make them edible when they otherwise won't I've seen inside the plants where they make the old fashioned minimally processed food versus today's ultra-processed. In the minimally processed plants, I recognize the ingredients as food. In today's plants, you don't recognize anything. There are powders, there's sludges, there's nothing that you would really recognize as food going into it. And to make that edible, they use the cosmetics and colors as a key piece of that. But here's the problem. It doesn't matter if the color is synthetic or natural. And a fruit loop made with natural colors is just as bad for you as one made with synthetics. And indeed, it's been alarming that the agency has fast tracked these natural colors and as replacements because, cyanide is natural. We don't want to use that. And the whole approach has been off and it like how is this going to get us there? How is this focus on color additives going to get us there. And it won't. Yeah, I agree. I agree with your interpretation of that. But the thing with Kessler you got part of it right but the main thing he did is say you don't have to really define ultra-processed food, which is another industry ploy to delay action. Let's focus on the thing that's making us sick today. And that's the refined carbohydrates. The refined grains in food. That's what's most closely linked to the obesity, the diabetes we're seeing today. Now in the 1980s, the FDA granted, let's set aside sugar and white flour, for example, but they approved a whole slew of additives that the companies came forward with to see what we can add to the white flour and sugar to make it shelf stable, to meet all the taste, cost, and convenience considerations we have. And profit-making considerations we have. Back then, heart disease was the driving health problem. And so, it was easy to overlook why you didn't think that the these additives were really harmful. That then you could conclude whether Generally Recognized as Safe, which is what the agency did back then. What Kessler is saying is that what he's laid out in his petition is self-executing. It's not something that the agency grants that this is GRAS or not GRAS. They were just saying things that have historical safe use that scientists generally recognize it as safe. It's not something the agency decides. It's the universe of all of us scientists generally accept. And it's true in the '80s when we didn't face the obesity and diabetes epidemic, people didn't really focus on the refined carbohydrates. But if you look at today's food environment. And I hope you agree with this, that what is the leading driver in the food environment about what is it about ultra-processed food that's making us so sick? It's these refined grains and the way they're used in our food. And so, if the agency takes up the Kessler petition and starts acting on it, they don't have to change the designation. Maybe at some point they have to say some of these additives are no longer GRAS. But what Kessler's saying is by default, they're no longer GRAS because if you ask the scientists today, can we have this level of refined grains? And they'd say, no, that's just not Generally Recognized as Safe. So, he's pointing out that status, they no longer hold that status. And if the agency would recognize that publicly and the burden shifts where Wiley really always meant it to be, on the industry to prove that there are foods or things that we would thrive on, but that wouldn't make us sick. And so that's the key point that you go back to when you said, and you're exactly right that if you let the industry use their political power to just ignore health altogether and substitute profits, then you're right. Their sort of fiduciary responsibility is just to maximize profits and they can ignore health. If you say you can maximize profits, of course you're a capitalist business, but one of the tests you have to clear is you have to prove to us that people can thrive when they eat that. Thrive as the standard, might require some congressional amplification because it's not in the statute. But what is in the statute is the food can't make you sick. If scientists would generally recognize, would say, if you eat this diet as they intend, if you eat this snack food, there's these ready to heat meals as they intend, you're going to get diabetes and obesity. If scientists generally believe that, then you can't sell that. That's just against the law and the agency needs them to enforce the law. Bio:   Jerold Mande is CEO of Nourish Science; Adjunct Professor of Nutrition, Harvard T.H. Chan School of Public Health; and a Non-Resident Senior Fellow, Tisch College of Civic Life, Tufts University. Professor Mande has a wealth of expertise and experience in national public health and food policy. He served in senior policymaking positions for three presidents at USDA, FDA, and OSHA helping lead landmark public health initiatives. In 2009, he was appointed by President Obama as USDA Deputy Under Secretary for Food Safety. In 2011, he moved to USDA's Food, Nutrition, and Consumer Services, where he spent six years working to improve the health outcomes of the nation's $100 billion investment in 15 nutrition programs. During President Clinton's administration, Mr. Mande was Senior Advisor to the FDA commissioner where he helped shape national policy on nutrition, food safety, and tobacco. He also served on the White House staff as a health policy advisor and was Deputy Assistant Secretary for Occupational Health at the Department of Labor. During the George H.W. Bush administration he led the graphic design of the iconic Nutrition Facts label at FDA, for which he received the Presidential Design Award. Mr. Mande began his career as a legislative assistant for Al Gore in the U.S. House and Senate, managing Gore's health and environment agenda, and helping Gore write the nation's organ donation and transplantation laws.  Mande earned a Master of Public Health from the University of North Carolina at Chapel Hill and a Bachelor of Science in nutritional science from the University of Connecticut. Prior to his current academic appointments, he served on the faculty at the Tufts, Friedman School of Nutrition Science and Policy, and Yale School of Medicine.

AP correspondent Karen Chammas reports on a new study confirming that Israel's aid blockade is leading to acute malnutrition amongst tens of thousands of Gazan children.

Summary The podcast discusses a recent pilot study on the effects of passive blood flow restriction (BFR) exercise on muscle atrophy following total knee replacement surgery. The conversation highlights the significant muscle mass loss that occurs post-surgery and the potential of BFR to mitigate this loss. The study design, methodology, and key findings are explored, emphasizing the importance of early intervention and the feasibility of implementing BFR in clinical settings. The hosts discuss the implications of the findings for rehabilitation practices and future research directions. Chapters 00:00 Introduction and Overview of the Study 03:15 Understanding Muscle Atrophy Post-Surgery 07:12 The Role of Blood Flow Restriction in Rehabilitation 12:53 Study Design and Methodology 15:35 Key Findings and Implications of the Study 20:54 Exploring Remote Ischemic Preconditioning 22:42 Functional Outcomes and Clinical Significance 25:11 Grip Strength Recovery and Clinical Changes 27:01 Safety and Feasibility of BFR 28:42 Implementing BFR in Clinical Practice 30:25 Prehabilitation and Postoperative Care 32:47 Expanding Applications of BFR in Acute Care Podcast Intro Attribution Song: Legendary Music by: CreatorMix.com Video: https://youtu.be/_oaZzkn0bW4 Podcast Outro Attribution Song: Smoke Rising Music by: CreatorMix.com Video: https://youtu.be/_oaZzkn0bW4

In this World Shared Practice Forum Podcast, Dr. Padmanabhan Ramnarayan discusses the findings of the clinical trial comparing high-flow nasal cannula (HFNC) therapy to continuous positive airway pressure (CPAP) therapy in pediatric critical care. The trial, which was published in JAMA, explores the effectiveness of HFNC as a non-inferior alternative to CPAP for respiratory support in acutely ill children. Dr. Ramnarayan reviews the trial's design, key outcomes, and implications for clinical practice, providing valuable insights for healthcare professionals involved in pediatric respiratory care. LEARNING OBJECTIVES - Understand the design and methodology of the clinical trial comparing HFNC and CPAP in pediatric critical care - Identify the primary and secondary outcomes of the trial and their significance - Discuss the implications of the trial findings for clinical practice and future research in pediatric respiratory care AUTHORS Padmanabhan "Ram" Ramnarayan, MBBS, MD, FRCPCH, FFICM Professor of Paediatric Critical Care Imperial College London Jeffrey Burns, MD, MPH Emeritus Chief Division of Critical Care Medicine Department of Anesthesiology, Critical Care and Pain Medicine Boston Children's Hospital Professor of Anesthesia Harvard Medical School DATE Initial publication date: August 26, 2025. ARTICLES REFERENCED Ramnarayan P, Richards-Belle A, Drikite L, et al. Effect of High-Flow Nasal Cannula Therapy vs Continuous Positive Airway Pressure Therapy on Liberation From Respiratory Support in Acutely Ill Children Admitted to Pediatric Critical Care Units: A Randomized Clinical Trial. JAMA. 2022;328(2):162-172. doi:10.1001/jama.2022.9615 RENOVATE Investigators and the BRICNet Authors, Maia IS, Kawano-Dourado L, et al. High-Flow Nasal Oxygen vs Noninvasive Ventilation in Patients With Acute Respiratory Failure: The RENOVATE Randomized Clinical Trial. JAMA. 2025;333(10):875-890. doi:10.1001/jama.2024.26244 Pelletier JH, Maholtz DE, Hanson CM, et al. Respiratory Support Practices for Bronchiolitis in the Pediatric Intensive Care Unit. JAMA Netw Open. 2024;7(5):e2410746. Published 2024 May 1. doi:10.1001/jamanetworkopen.2024.10746 TRANSCRIPT https://cdn.bfldr.com/D6LGWP8S/as/whctgh753rgnhc7rxn7w3mn/20250712_WSP_Ramnarayan_Transcript Please visit: http://www.openpediatrics.org OPENPediatrics™ is an interactive digital learning platform for healthcare clinicians sponsored by Boston Children's Hospital and in collaboration with the World Federation of Pediatric Intensive and Critical Care Societies. It is designed to promote the exchange of knowledge between healthcare providers around the world caring for critically ill children in all resource settings. The content includes internationally recognized experts teaching the full range of topics on the care of critically ill children. All content is peer-reviewed and open-access thus at no expense to the user. For further information on how to enroll, please email: openpediatrics@childrens.harvard.edu CITATION Ramnarayan P, O'Hara JE, Burns JP. High-Flow Nasal Cannula vs CPAP in Acutely Ill Children. 08/2025. OPENPediatrics. Online Podcast. https://soundcloud.com/openpediatrics/high-flow-nasal-cannula-vs-cpap-in-acutely-ill-children-by-p-ramnarayan-openpediatrics

 Critical care nurse practitioners have few opportunities to care for obstetric patients in the critical care setting and, therefore, may lack competence and confidence in caring for them. In this podcast, Jennifer Brower and Caitlin Luebcke describe their work and insights from an integration of obstetric-focused, multimodal instruction in an acute care nurse practitioner program. They share more details about their strategies for integration of a critical care obstetric curriculum in a nurse practitioner program and describe the challenges and opportunities they experienced in their article.

Does the idea of pitching, selling, and putting yourself forward feel selfish? Obnoxious? Acutely self-consciousness? It's time to challenge that.  We're going to rethink what it means to show up, boldly ask for what we want, and put ourselves in the right rooms — without guilt, hesitation, or the weight of outdated beliefs about worthiness. You'll learn: Why our Hustle & Heart Life's a Pitch!™ isn't just for sales — it's a mindset of optimism, confidence, and creative problem-solving The biggest pitch mistakes most people make that leave them looking and feeling like a doofus – and what to do instead Why micro and small businesses are the canary in the coalmine of the economy, and how to market and sell in times of uncertainty, crisis, and chaos The paradox of selfishness: why putting yourself forward actually deepens your empathy, connection, and collaboration My Life's a Pitch!™ approach to writing pitches that are clear, engaging, and impossible to ignore Why enthusiasm and energy is so much more important than qualifications How to turn cold outreach into warm, human-centered conversations that lead to real opportunities, and money in your bank. Tune in to learn how embracing your “selfish” side can unlock new opportunities, relationships, and success in business. I invite you to join our Life's a Pitch!™ party, which kicks off February 10. It's FREE and it'll change everything: hustleandheart.com.au/pitch

Hello, Hello, Hello! In what is another one of our director retrospective episodes, Dhruv, Amartya, and Aryan (from America) talk about the 3 feature films directed by much-revered horror director Robert Eggers, whose latest film, “Nosferatu," just recently released this week in India! (We have a whole “Nosferatu" themed ep planned to be recorded and released in the coming week, which includes an extended discussion on the 1922 silent film directed by F.W. Murnau, the 1979 version directed by Werner Herzog, and the 2024, one directed by Eggers!) We begin the episode by positioning Eggers as a (or the) key figure who kickstarted the patented-A24-brand-of-elevated horror cinephiles have increasingly grown weary of now, and how his first film, “The Vvitch,” in particular, sets a template for that specific type of arty horror film that's never really been replicated as successfully afterward. Except, maybe by himself, with “The Lighthouse" (2019) – his second film, also distributed by A24, that pushes even further into the type of horror film that thrives on ambiguity and atmosphere vs. satisfying generic thrills. And then comes “The Northman" (2022). Listen to the full episode to hear us argue, in detail, about the value (or lack thereof) of his third film, which Aryan—rather worryingly—warns Amartya and Dhruv is better than his recent foray into mainstream cinema, "Nosferatu. TIMECODES Episode Intro - [00:00 – 05:39] Introduction to Robert Eggers - [05:39 – 15:37] Eggers & Horror Cinema Today - [15:37 – 33:29] “The Vvitch" (2015) - [33:29 – 01:10:38] Aryan's Warning for “Nosferatu" - [01:10:38 – 01:12:07] “The Lighthouse" (2019) - [01:12:07 – 01:34:58] “The Northman” (2022) - [01:34:58 - 02:00:57] Episode Outro - [02:00:57 – 02:04:02] Do hit 'Follow' on Spotify if you haven't already to help the podcast reach more people! Follow our Instagram page: ⁠https://instagram.com/queenisdead.filmpodcast PROFILE PIECES MENTIONED IN THIS EPISODE 1. “Robert Eggers' Historical Visions Go Mainstream" (Sam Knight) - https://www.newyorker.com/magazine/2022/04/04/robert-eggerss-historical-visions-go-mainstream. Follow us on Instagram at: Amartya: ⁠https://www.instagram.com/amartya25/⁠ Dhruv: ⁠https://www.instagram.com/terminalcinema/⁠ Aryan: ⁠https://www.instagram.com/aryantalksfilm/⁠ Follow us on Letterboxd at: Amartya - ⁠https://letterboxd.com/amartya/⁠ Dhruv - ⁠https://letterboxd.com/aterminalcinema/⁠ Aryan: ⁠https://letterboxd.com/aryantalksfilms/⁠  Audio Excerpts are taken from the promotional material for The Vvitch, The Lighthouse & The Northman.

Alex Wagner looks at expectations for the new Trump regime, from his cabinet appointments to his plan for "mass deportations," to his attacks on federal government agencies.

Today, we're speaking to Dr Amy Clark and Dr Kathryn Hughes. Amy is a resident doctor in North West Anglia Foundation Trust, and Kathryn who is a GP and a Senior Clinical Lecturer based at PRIME Centre Wales within Cardiff University. Title of paper: Assessing acutely ill children in general practice using the National PEWS and LqSOFA clinical scores: a retrospective cohort studyAvailable at: https://doi.org/10.3399/BJGP.2023.0638The validity of the current NICE-recommended scoring system for identifying seriously ill children in general practice, the Traffic Light system, was recently investigated and shown to perform poorly. A new National PEWS (Paediatric Early Warning Score) has just been introduced in hospital settings with hopes for subsequent implementation in general practice, to improve the identification of seriously unwell children. To the authors' knowledge, the score has not previously been validated in general practice. This study found that the National PEWS would not accurately identify children requiring hospital admission within two days of presenting to general practice with an acute illness and therefore should not be recommended for this purpose without adjustment. Another score, the Liverpool quick Sequential Organ Assessment (Lq-SOFA), was also investigated and found to perform poorly in general practice.

Welcome to the Personal Development Trailblazers Podcast! In this episode, we'll explore practical advice, inspiring stories, and actionable strategies to help veterans rebuild their sense of connection and reignite their inner power.  Garret Biss is a retired Marine Corps Pilot.  Post-retirement in 2015, Garret confronted challenges common among Veterans: anxiety, depression, and a sense of displacement. Turning to alcohol as a crutch, it wasn't until suicidal ideation took hold that he sought change. Rather than traditional addiction treatments, Garret's path was shaped by mentoring that emphasized self-worth, rediscovering identity, and tapping into inherent strengths. This approach not only alleviated his addictive behaviors but also reignited his passion for life. In 2017, he co-founded an addiction recovery residence in North Carolina. For this recovery residence, Garret designed the positivity-focused and strengths-based programming and curriculum which are deeply rooted in positive psychology and the principles of human flourishing. A TEDx Speaker, Garret is known for the insight into the unspoken trauma of military transition. As a professional recovery coach, Garret works exclusively with military Veterans. Acutely aware of the hurdles they face, he is driven to ensure that Veterans' potential isn't overshadowed by emotional turmoil or addiction. Developed by Garret, ValiantPath™️ is a virtual program tailored specifically for Veterans, blending group coaching, one-on-one emotional processing, and evidence-based recovery methods. Connect with Garret  here: https://linkedin.com/in/gbbiss https://facebook.com/garretBissFan https://twitter.com/garretbiss https://youtube.com/@thrivingrecovery https://www.instagram.com/garretbiss https://garretbiss.com Grab the freebie here: https://thewarriorreset.com =================================== If you enjoyed this episode, remember to hit the like button and subscribe. Then share this episode with your friends. Thanks for watching the Personal Development Trailblazers Podcast. This podcast is part of the Digital Trailblazer family of podcasts. To learn more about Digital Trailblazer and what we do to help entrepreneurs, go to DigitalTrailblazer.com. Are you a coach, consultant, expert, or online course creator? Then we'd love to invite you to our FREE Facebook Group where you can learn the best strategies to land more high-ticket clients and customers.  Request to join here:  https://www.facebook.com/groups/profitablecoursecreators QUICK LINKS:  APPLY TO BE FEATURED: https://app.digitaltrailblazer.com/podcast-guest-application GET MORE CLIENTS: https://app.digitaltrailblazer.com/client-acquisition-accelerator-pdf DIGITAL TRAILBLAZER: https://digitaltrailblazer.com/ JOIN OUR FREE FACEBOOK GROUP: https://www.facebook.com/groups/profitablecoursecreators

Case Discussion 117 Answer: VTE prophylaxis in hospitalized patients

Tim Braheem Interviews Steve DorfmanTim sits down with Steve Dorfman. Steve was the Chief Experience Officer for Apex Home Loans and is now the head of community for The Loan Atlas. With a long history of working in customer service, Steve brings an incredible attention to detail to all aspects of the customer journey. While with Apex, Steve led the charge in elevating their Net Promoter Score (NPS) to a sustained high of 96. In addition, he was instrumental in implementing internal changes which earned Apex the designation of “Best Place to Work” in Washingtonian Magazine, The Washington Business Journal, and The Washington Post.You Will Learn: How to turn a negative customer experience into a net positive Four elements to turn a new prospect into an advocate for your businessThe difference between meeting and anticipating consumer needs The importance of communication to get repeat business and referralsThe importance of positive feedback in fostering employee successWho is Steve Dorfman?Transitioning from the hospitality industry in 1995, Steve Dorfman spent the next 11 years selling Acuras. Acutely aware of the long-standing stigma associated with car salesmen, Steve entered the business at age 23 determined to elevate the profession by intentionally crafting thoughtful and remarkable experiences for his prospects and clients. His unwavering commitment to a customer-centered process paid off: Steve earned "Salesman of the Year" seven years in a row, maintained a six-figure income from a 35-hour workweek, and achieved a Customer Satisfaction Index rating in the top 1% nationally. He worked by appointment only, with repeat clients and referrals accounting for 70% of his business. More than two decades later, Steve's best practices are still taught by corporate trainers. Steve and his wife, Maggie, live in Maryland (just outside of Washington, DC) with their two children. During the summer, they enjoy gathering with family and friends on their ski boat at Lake Anna in Virginia.Brought to you by The Loan Atlas theloanatlas.com

Website(s): www.drcarlamanly.com Facebook: https://www.facebook.com/drcarlamanly Twitter: https://www.twitter.com/drcarlamanly/ Who among us hasn't, at one time or another, felt stuck in an unhealthy relationship or lamented our inability to find that “perfect” someone? Clinical psychologist Dr. Carla Marie Manly knows the secret to creating genuine, joy-filled relationships — and it has nothing to do with perfection. In her latest book, The Joy of Imperfect Love: The Art of Creating Healthy, Securely Attached Relationships, Dr. Manly emphasizes that real love is messy and imperfect, and she offers profound, yet easily digestible insights for building healthy relationships. Acutely aware of the role relationships play in mental health and well-being, Dr. Manly is available to share her insights with your audience. Please let me know if you are interested in scheduling an interview with Dr. Carla Marie Manly, or if you would like to see a copy of her book for interview/review/article purposes. To watch an interview with Dr. Manly about two of her previous books, please visit: https://www.youtube.com/watch?v=xfPUUmMIkMA. (This press release may be published in part or entirety by any print, broadcast, or internet/digital media outlet, or used by any means of social media sharing.) FOR IMMEDIATE RELEASE Release the Illusion of Perfection: New Book Empowers Readers to Be Authentic With Romantic Partners NEW YORK, Jan. 29, 2024 — “The key to healthy relationships is accepting that real love is messy, imperfect, and a work in progress,” says clinical psychologist Dr. Carla Marie Manly, whose fourth book, The Joy of Imperfect Love, guides readers into a transformative journey toward compassionate, healthy connections. “As we release the illusion of perfection and channel our energy into positive actions, we naturally become more connected to ourselves and others,” Dr. Manly notes. In The Joy of Imperfect Love, Dr. Manly provides research-backed insights, captivating case examples and empowering exercises to lead readers through an exploration of how attachment issues and unresolved trauma negatively impact both self-love and relationship quality. Then, Dr. Manly offers sound solutions for creating the awareness and healthy habits that promote lasting love. Her inclusive narrative makes her insights accessible to all demographics and sexual orientations, and key concepts such as communication skills and emotional intelligence can be applied to romantic relationships, friendships, social relationships, and work relationships. Well-researched and fact-based with an emphasis on replacing destructive patterns such as negative self-beliefs and toxic inner narratives with healthy, awareness-based dynamics, The Joy of Imperfect Love aims to foster the positive mental and emotional health the world so desperately needs. “Readers will breathe a sigh of deep relief as they discover the doable, real-life secrets to creating joy-filled relationships and genuine, imperfect love,” Dr. Manly offers. About Dr. Carla Marie Manly

In the September episode of Critical Decisions in Emergency Medicine, Drs. Danya Khoujah and Wendy Chang discuss management of the acutely agitated patient and metabolic acidosis. As always, you'll hear about the hot topics covered in CDEM's regular features, including a feared complication of cystic fibrosis in Clinical Pediatrics, Morel-Lavallée lesions in Critical Cases in Orthopedics and Trauma, phimosis treatment in The Critical Procedure, headache presentations in the emergency department in the LLSA Literature Review, and a cyanotic infant in The Critical Image.

In 2007, I spent six weeks in a hostel in the middle of Guatemala just “because”.Truly, I'd never felt so free.The two years prior had been spent working like a donkey, with good people but in a field I hated.The endgame? Admission to the Supreme Course of Queensland as a lawyer.It was an accolade I spent 7 years working towards..Only to quit, 6-weeks to the day later. And so, there I found myself in a computer shop in Puerto Escondido, Mexico, on a steaming April afternoon checking my emails when my brothers friend messaged us on Facebook.“Wanna come visit?” – he wrote, “I'm just down the road in Guatemala!”We looked at each other.Of course we would. It wasn't even a QUESTION.We were free. The world was our oyster. And we could do anything, be anyone, go anywhere!And so it came to be that I ended up spending the best, most carefree, most FUN 6-weeks of my life living out of a backpack in a dingy hostel dorm room in Antigua.Acutely aware that I had opted out of life for a little minute, and feeling grateful as heck for it.Five years later, I started my online business chasing that kind of freedom again.And on the surface, the promise of it all felt..  intoxicating.Time freedom – to work when I wanted!Location freedom – to go back to Central America, or London, or ANYWHERE BUT HERE!Financial freedom – to make more than a doctors wages working on the goddamn INTERNET!I wanted it.The sense of adventure.The possibility.The wonder that came from not knowing what would come next.The Tuesday afternoons spent outside (and not in an air-conditioned cubicle)ALL OF IT.

Guest: Tiana Dodson Tiana Dodson is Fat. Queer. Parent. Biracial Black and Guamanian/Chamorro Person of Color. Chronically ill. Acutely aware. Book lover. Music fanatic. Compulsive dancer. Part of my work is to guide people feminine-of-center toward reconnecting with their bodies through pragmatic self-care practices so they can come to see that there is nothing wrong with living in a larger body. Other parts of my work include being unapologetically fat, living my best fat life in Germany, and uncovering systems of oppression in the most important game of hide-and-seek in my lifetime. She joins Auntie Vice to chat about her work, her life, and moving toward a more liberated world. Sites and Socials: https://tianadodson.com/about/ Live Your Best Fat Life Instagram  Other things mentioned in this episode: Da'ShaunHarrison Belly of the Beast Vanessa Rochelle Lewis Reclaiming Ugly ----more----

JAMA Executive Editor Gregory Curfman, MD, speaks with Richard G. Bach, MD, professor of medicine and medical director of the cardiac intensive care unit at the Washington University School of Medicine in St. Louis, about the use of traditional Chinese medicine to treat patients with acute ST-segment elevation myocardial infarction. Related Content: Traditional Chinese Medicine Meets Evidence-Based Medicine in the Acutely Infarcted Heart

Link to bioRxiv paper: http://biorxiv.org/cgi/content/short/2023.07.29.551071v1?rss=1 Authors: Bartke, R., Hockemeyer, D. Abstract: Telomeric DNA ends in a 3' single stranded overhang that is implicated in the protective function of telomeres ensuring genomic stability in mammals. Telomere overhang formation relies on the coordinated interplay between DNA synthesis and exonuclease activity. DCLRE1B/hSNM1B/Apollo generates an initial resection at the newly synthesized, blunt-ended leading strand telomere. This resection is thought to be required for further nucleolytic processing at the leading strand telomere. Here, we investigated the functional relevance of Apollo in human pluripotent stem cells (hPSCs) by generating Apollo deficient cells. Leveraging CRISPR/Cas9 technology, we generated locally haploid hPSCs (loHAPs) that lack one allele of Apollo. Subsequently, we mutated the remaining Apollo allele and monitored the resultant allele spectrum over 3 weeks. Surprisingly, cells survived regardless of Apollo status. These results suggest that, in hPSCs, Apollo is not acutely essential for cellular survival. Copy rights belong to original authors. Visit the link for more info Podcast created by Paper Player, LLC

Join Premium! Ready for an ad-free meditation experience? Join Premium now and get every episode from ALL of our podcasts completely ad-free now! Just a few clicks makes it easy for you to listen on your favorite podcast player.  Become a PREMIUM member today by going to --> https://WomensMeditationNetwork.com/premium So breathe, And let yourself relax. Breathing out all the pieces of life that are unsettled inside of you, All the pieces that feel anxious or stressed. And feel your body relax deeper with every breath out.  PAUSE… Let your face soften, As your jaw releases, And drop your tongue from the roof of your mouth. Breathe… Lower your shoulders, And open your chest, Feeling the air expanding and cleansing you with every inhale.  PAUSE… Let yourself drop deeper into this moment, Acutely aware of where you are, And who you are, Right now.  And on your next breath in, inhale deeply into your entire body, Anchoring yourself in the now. Accepting what is. Grateful, And full of love. PAUSE... I know there are things you want to accomplish,  Goals you want to achieve, Directions in which you want your life to move.  But be here in this moment, my love, And trust the journey. PAUSE… It isn't always easy to see,  The progress, The changes, The tiny shifts that impact the path you're constantly co-creating.  But they're all here,  Moving you, Working with you, And for you. So keep showing up, beautiful. With intention, With love, With grace. And let it all unfold with time, In its own, special way. LONG PAUSE… So melt deeper into your bed, my love, Deeper into the arms of sleep, Deeper into the pools of trust that make you feel free, Loved, Supported, Guided, Protected. PAUSE... Relax, And surrender to the beauty of your journey. The one that is yours and yours alone.  The one whose roads twist and turn without warning, The one whose hills are covered in the most gorgeous wildflowers, Waiting for you to stop and notice. Lay back and surrender to its curves, Its beauty, Its divine design. PAUSE... Tonight, may you trust the journey, And root yourself deeply in the beauty of the present moment. Sweet Dreams, Beautiful.  

"...the 80 assessment is a fundamental tool used to provide a quick assessment for a patient who is critically ill it follows an order going through the potentially life-threatening problems giving priority to the most severe issues all right so the stands for Airway and what we're doing here is basically checking that there's no obstruction but also evaluating the likelihood that the patient will be able to maintain the airway if they deteriorate further there are several things you can do to assess the airway you can watch the patient and look for signs of an obstruction such as paradoxical chest or abdomen movements cyanosis which is a blue discoloration of the skin or use of accessory muscles you can also listen for sounds for example if the patient is talking that a fairly conclusive sign that the airway is obstructed however if you hear sounds extruder which is a high pitch sound mostly in inspiration or even a wheeze these sounds are indicative of a partial obstruction so what happens if you hear nothing you're either have to try and hear the breath sounds using a stethoscope or you'll have to try and feel for it the way you do this is by putting your hand or your ear next to the patient's nose or mouth and feeling for the air flow causes of an airway obstruction include the patient's tongue a foreign body swelling and even fluid it's such as vomiting or blood so what do we do about it well if it's obstructed the patient can rapidly deteriorating die or suffer hypoxic damage to organs such as the brain and heart so the first thing you do is you get help depending on the cause the patient may be moved into the recovery position so on this side you may perform movers like back slaps or the abdominal thrusts in order to help dislodge a foreign body it's patient ventilating and normal respiratory rate is between 12 and 20 breaths per minute hide and 25 is a marker that the patient may deteriorate quickly we would also look at the depth and the effort of the breathing are they using the accessory muscles is the chest expansion symmetrical is the trachea displaced or is the hyper resonance investigations include the use of a pulse oximeter so measuring the oxygen saturation generally we aim at for to 95% with a minimum of eighty eight percent however you need to be careful in COPD patients not to overdo the oxygen therapy because you can end up suppressing their breathing life-threatening causes of breathing issues include acute severe asthma pulmonary edema and tension pneumothorax the treatment again depends on the cause oxygen is given in most cases if no obstruction is present then non-invasive ventilation..." Learn more about your ad choices. Visit megaphone.fm/adchoices

"...the 80 assessment is a fundamental tool used to provide a quick assessment for a patient who is critically ill it follows an order going through the potentially life-threatening problems giving priority to the most severe issues all right so the stands for Airway and what we're doing here is basically checking that there's no obstruction but also evaluating the likelihood that the patient will be able to maintain the airway if they deteriorate further there are several things you can do to assess the airway you can watch the patient and look for signs of an obstruction such as paradoxical chest or abdomen movements cyanosis which is a blue discoloration of the skin or use of accessory muscles you can also listen for sounds for example if the patient is talking that a fairly conclusive sign that the airway is obstructed however if you hear sounds extruder which is a high pitch sound mostly in inspiration or even a wheeze these sounds are indicative of a partial obstruction so what happens if you hear nothing you're either have to try and hear the breath sounds using a stethoscope or you'll have to try and feel for it the way you do this is by putting your hand or your ear next to the patient's nose or mouth and feeling for the air flow causes of an airway obstruction include the patient's tongue a foreign body swelling and even fluid it's such as vomiting or blood so what do we do about it well if it's obstructed the patient can rapidly deteriorating die or suffer hypoxic damage to organs such as the brain and heart so the first thing you do is you get help depending on the cause the patient may be moved into the recovery position so on this side you may perform movers like back slaps or the abdominal thrusts in order to help dislodge a foreign body it's patient ventilating and normal respiratory rate is between 12 and 20 breaths per minute hide and 25 is a marker that the patient may deteriorate quickly we would also look at the depth and the effort of the breathing are they using the accessory muscles is the chest expansion symmetrical is the trachea displaced or is the hyper resonance investigations include the use of a pulse oximeter so measuring the oxygen saturation generally we aim at for to 95% with a minimum of eighty eight percent however you need to be careful in COPD patients not to overdo the oxygen therapy because you can end up suppressing their breathing life-threatening causes of breathing issues include acute severe asthma pulmonary edema and tension pneumothorax the treatment again depends on the cause oxygen is given in most cases if no obstruction is present then non-invasive ventilation..." Learn more about your ad choices. Visit megaphone.fm/adchoices

"...the 80 assessment is a fundamental tool used to provide a quick assessment for a patient who is critically ill it follows an order going through the potentially life-threatening problems giving priority to the most severe issues all right so the stands for Airway and what we're doing here is basically checking that there's no obstruction but also evaluating the likelihood that the patient will be able to maintain the airway if they deteriorate further there are several things you can do to assess the airway you can watch the patient and look for signs of an obstruction such as paradoxical chest or abdomen movements cyanosis which is a blue discoloration of the skin or use of accessory muscles you can also listen for sounds for example if the patient is talking that a fairly conclusive sign that the airway is obstructed however if you hear sounds extruder which is a high pitch sound mostly in inspiration or even a wheeze these sounds are indicative of a partial obstruction so what happens if you hear nothing you're either have to try and hear the breath sounds using a stethoscope or you'll have to try and feel for it the way you do this is by putting your hand or your ear next to the patient's nose or mouth and feeling for the air flow causes of an airway obstruction include the patient's tongue a foreign body swelling and even fluid it's such as vomiting or blood so what do we do about it well if it's obstructed the patient can rapidly deteriorating die or suffer hypoxic damage to organs such as the brain and heart so the first thing you do is you get help depending on the cause the patient may be moved into the recovery position so on this side you may perform movers like back slaps or the abdominal thrusts in order to help dislodge a foreign body it's patient ventilating and normal respiratory rate is between 12 and 20 breaths per minute hide and 25 is a marker that the patient may deteriorate quickly we would also look at the depth and the effort of the breathing are they using the accessory muscles is the chest expansion symmetrical is the trachea displaced or is the hyper resonance investigations include the use of a pulse oximeter so measuring the oxygen saturation generally we aim at for to 95% with a minimum of eighty eight percent however you need to be careful in COPD patients not to overdo the oxygen therapy because you can end up suppressing their breathing life-threatening causes of breathing issues include acute severe asthma pulmonary edema and tension pneumothorax the treatment again depends on the cause oxygen is given in most cases if no obstruction is present then non-invasive ventilation..." Learn more about your ad choices. Visit megaphone.fm/adchoices

The second episode in our Medical and Surgical Emergencies series! In this episode, Dr Manoharan is joined by Dr Rajasekar to discuss how to recognise an unwell patient and the management of haemorrhage and sepsis.

CardioNerds (Drs. Amit Goyal and Dan Ambinder) join Dr. Emily Lee (LAC+USC Internal medicine resident) and Dr. Charlie Lin (LAC+USC Cardiology fellow) as the discuss an important case of stimulant-related (methamphetamine) cardiovascular toxicity that manifested in right ventricular dysfunction due to severe pulmonary hypertension. Dr. Jonathan Davis (Director, Heart Failure Program at Zuckerberg San Francisco General Hospital and Trauma Center) provides the ECPR for this episide. Audio editing by CardioNerds Academy Intern, student doctor Akiva Rosenzveig. With the ongoing methamphetamine epidemic, the incidence of stimulant-related cardiovascular toxicity continues to grow. We discuss the following case: A 36-year-old man was hospitalized for evaluation of dyspnea and volume overload in the setting of previously untreated, provoked deep venous thrombosis. Transthoracic echocardiogram revealed severe right ventricular dysfunction as well as signs of pressure and volume overload. Computed tomography demonstrated a prominent main pulmonary artery and ruled out pulmonary embolism. Right heart catheterization confirmed the presence of pre-capillary pulmonary arterial hypertension without demonstrable vasoreactivity. He was prescribed sildenafil to begin management of methamphetamine-associated cardiomyopathy and right ventricular dysfunction manifesting as severe pre-capillary pulmonary hypertension. CardioNerds is collaborating with Radcliffe Cardiology and US Cardiology Review journal (USC) for a ‘call for cases', with the intention to co-publish high impact cardiovascular case reports, subject to double-blind peer review. Case Reports that are accepted in USC journal and published as the version of record (VOR), will also be indexed in Scopus and the Directory of Open Access Journals (DOAJ). CardioNerds Case Reports PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Case Media - stimulant-related (methamphetamine) cardiovascular toxicity Pearls - stimulant-related (methamphetamine) cardiovascular toxicity 1. Methamphetamine, and stimulants in general, can have a multitude of effects on the cardiovascular and pulmonary systems. Effects of methamphetamine are thought to be due to catecholamine toxicity with direct effects on cardiac and vascular tissues. Acutely, methamphetamine can cause vascular constriction and vasospasm, while chronic exposure is associated with endothelial damage. Over time, methamphetamine can cause pulmonary hypertension, atherosclerosis, cardiac arrhythmias, and dilated cardiomyopathy. 2. Methamphetamines are the second most commonly misused substances worldwide after opiates. Patients with methamphetamine-associated pulmonary arterial hypertension (PAH) have more severe pulmonary vascular disease, more dilated and dysfunctional right ventricles, and worse prognoses when compared to patients with idiopathic PAH. Additionally, patients with methamphetamine-associated cardiomyopathy and PAH have significantly worse outcomes and prognoses when compared to those with structurally normal hearts without evidence of PAH. Management includes multidisciplinary support, complete cessation of methamphetamine use, and guideline-directed treatment of PAH. 3. The diagnosis of pulmonary hypertension (PH) begins with the history and physical, followed by confirmatory testing using echocardiography and invasive hemodynamics (right heart catheterization). Initial serological evaluation may include routine biochemical, hematologic, endocrine, hepatic, and infectious testing. Though PH is traditionally diagnosed and confirmed in a two-step, echocardiogram-followed-by-catheterization model, other diagnostics often include electrocardiography, blood gas analysis, spirometry, ventilation/perfusion assessment,

CME credits: 1.25 Valid until: 28-04-2024 Claim your CME credit at https://reachmd.com/programs/cme/as-different-as-day-and-night-managing-acutely-agitated-patients-in-the-emergency-setting/15414/ This program discusses the need to quickly and accurately recognize the signs and symptoms of agitation in patients with schizophrenia and bipolar disorder and to differentiate agitation from akathisia and other disease therapy-induced symptoms that may mimic it. Agitation can escalate quickly into aggressive and potentially dangerous behavior that puts healthcare personnel (HCP) and families at risk of verbal or bodily harm. Nationally recognized expert consensus best-practice guidelines provide clear direction on how to triage and manage agitation in the emergency room setting, but knowledge and implementation gaps remain. As data emerges for new approaches to treatment, clinicians need to know the novel pharmacological and nonpharmacological options to care for agitation in patients with schizophrenia and bipolar disorder. This program focuses on the recognition and management of agitation, best practices, and novel treatments. It will distill essential information for everyday clinical practice that offers an alternative to the “sedate and restrain” treatment approaches of the past.

Samantha (@samanthasparksstl) and sister-in-law Paige Sparks, founders of Sparks Law, are stacking up the clients. And they do it all spending close to nothing on marketing. How? Social media. But they won't partner with just anyone. Acutely aware that their personal brands are synonymous with their business, they curate an authentic experience on TikTok. The result is high engagement and a whole lot of trust. Samantha reveals how she gets the most out of each piece of content and how smaller cases can lead to a lifetime of value. Links Want to hear more from elite personal injury lawyers and industry-leading marketers? Follow us on social media for more. Rankings.io Instagram Chris Dreyer Instagram Rankings.io Twitter Rankings.io Website Samantha Sparks TikTok Sparks Law Website What's in This Episode Who is Samantha Sparks? How can you repurpose content for more views? Why are break-even cases important for a firm? Replicate Samantha's getting incredible engagement. Past Guests Past guests on Personal Injury Mastermind: Brent Sibley, Sam Glover, Larry Nussbaum, Michael Mogill, Brian Chase, Jay Kelley, Alvaro Arauz, Eric Chaffin, Brian Panish, John Gomez, Sol Weiss, Matthew Dolman, Gabriel Levin, Seth Godin, David Craig, Pete Strom, John Ruhlin, Andrew Finkelstein, Harry Morton, Shay Rowbottom, Maria Monroy, Dave Thomas, Marc Anidjar, Bob Simon, Seth Price, John Gomez, Megan Hargroder, Brandon Yosha, Mike Mandell, Brett Sachs, Paul Faust, Jennifer Gore-Cuthbert Additional Episodes You Might Enjoy 80. Mike Papantonio, Levin, Papantonio, & Rafferty — Doing Well by Doing Good 84. Glen Lerner, Lerner and Rowe – A Steady Hand in a Shifting Industry 101. Pratik Shah, EsquireTek — Discovering the Power of Automation 134. Darryl Isaacs, Isaacs & Isaacs — The Hammer: Insights from a Marketing Legend 104. Taly Goody, Goody Law Group — Finding PI Clients on TikTok 63. Joe Fried, Fried Goldberg LLC — How To Become An Expert And Revolutionize Your PI Niche 96. Brian Dean, Backlinko — Becoming a Linkable Source 83. Seth Godin — Differentiation: How to Make Your Law Firm a Purple Cow 73. Neil Patel, Neil Patel — Digital A New Approach to Content and Emerging Marketing Channels

Buckle up for a wide-ranging conversation with author and business coach Daryl Urbanski! With an unconventional voice that cuts through the noise, Daryl has helped businesses to be more successful, published five books and studied the science of business success - and then studied the studies. (Very meta!) Acutely aware of the realities of business today and what the future of leadership might look like, he embraces technology from a foundation of people and connection and advocates for self-awareness above all else! Daryl shares where he thinks leadership of the future is heading and the work we will need to do to get there.   Shownotes See more at  http://www.zoerouth.com/podcast/leadership-future-daryl-urbanski  

https://psychiatry.dev/wp-content/uploads/speaker/post-10798.mp3?cb=1668430052.mp3 Playback speed: 0.8x 1x 1.3x 1.6x 2x Download: Exercise for acutely hospitalised older medical patients – PubMed Review Peter Hartley et al. Cochrane Database of Systematic Reviews. 2022. Approximately 30%Full EntryExercise for acutely hospitalised older medical patients – PubMed

This episode of EMS One-Stop with Rob Lawrence is brought to you by Lexipol, the experts in policy, training, wellness support and grants assistance for first responders and government leaders. To learn more, visit lexipol.com.  Faroukh M. Mehkri is an assistant professor of emergency medicine at the University of Texas SW Medical Center as well as a SWAT physician with the Dallas Police Department. He recently presented a session at the International Association of Police Chiefs Conference in Dallas, “Management of the acutely agitated behavioral health emergency: A patrol nightmare.” In this edition of EMS One-Stop, Host Rob Lawrence chats with Dr. Mehkri about his lecture and his 15-month deep dive into behavioral health emergency patients, their outcomes, the situations surrounding the calls, and both police and EMS interventions. Dr. Mehkri delivers key takeaways for both a police and EMS audience:   Words matter, in your documentation and on your body camera Physical restraint kills – so we must minimize this activity Chemical sedation for medication management saves. “Inviting” the medic to “just give them something” is a slippery slope Monitor, monitor, monitor The person is the patient! Read more about treating behavioral emergencies Expert tips for EMS handling of behavioral emergencies Reel Emergency Vodcast: Patient with delirium and agitated behavior 5 keys for responding to excited delirium patients The fourth 911 option: Mental health services Quick Take: 988 and the future of crisis response

Weronika Potok and Nicole Wenderoth discuss their paper, “Transcranial Random Noise Stimulation Acutely Lowers the Response Threshold of Human Motor Circuits,” published in Vol. 41, Issue 17 of The Journal of Neuroscience, with Editor-in-Chief Marina Picciotto. Find our upcoming webinar schedule here. With special guests: Weronika Potok and Nicole Wenderoth Hosted by: Marina Picciotto On Neuro Current, we delve into the stories and conversations surrounding research published in the journals of the Society for Neuroscience. Through its publications, JNeurosci, eNeuro, and the History of Neuroscience in Autobiography, SfN promotes discussion, debate, and reflection on the nature of scientific discovery, to advance the understanding of the brain and the nervous system.  Find out more about SfN and connect with us on Twitter, Instagram, and LinkedIn.  

Link to bioRxiv paper: http://biorxiv.org/cgi/content/short/2022.10.11.511013v1?rss=1 Authors: Baskin, B. M., Logsdon, A. F., Lee, J. S., Foresi, B. D., Peskind, E., Banks, W. A., Cook, D. G., Schindler, A. G. Abstract: Background: Repetitive blast-related mild traumatic brain injury (mTBI) caused by exposure to high explosives is increasingly common among warfighters as well as civilians. While women have been serving in military positions with increased risk of blast exposure since 2016, there are few published reports examining sex as a biological variable in models of blast mTBI, greatly limiting diagnosis and treatment capabilities. As such, here we examined acute and chronic outcomes of repetitive blast trauma in female and male mice in relation to potential behavioral, inflammatory, microbiome, and vascular dysfunction. Methods: In this study we utilized a well-established blast overpressure model to induce repetitive (3x) blast-mTBI in both female and male mice. Acutely following repetitive exposure, we measured serum and brain cytokine levels, blood-brain barrier (BBB) disruption, fecal microbial abundance, and locomotion and anxiety-like behavior in the open field assay. Chronically, in female and male mice we assessed behavioral correlates of mTBI and PTSD-related symptoms commonly reported by Veterans with a history of blast-mTBI using the elevated zero maze, acoustic startle, and conditioned odorant aversion paradigms. Results: Repetitive blast exposure resulted in similar and disparate patterns of acute serum and brain cytokine as well as gut microbiome changes in female and male mice. Acute BBB disruption following repetitive blast exposure was apparent in both sexes. While female and male blast mice both exhibited acute locomotor and anxiety-like deficits in the open field assay, only male mice exhibited chronic adverse behavioral outcomes. Discussion: Representing a novel survey of potential sex differences following repetitive blast trauma, our results demonstrate unique similar and divergent patterns of blast-induced dysfunction in female vs. male mice and highlight novel targets for future diagnosis and therapeutic development. Copy rights belong to original authors. Visit the link for more info Podcast created by PaperPlayer

Date: September 15, 2022 Reference:  Ramnarayan P et al. Effect of high-flow nasal cannula therapy vs continuous positive airway pressure therapy on liberation from respiratory support in acutely ill children admitted to pediatric critical care units: a randomized clinical trial. JAMA July 2022 Guest Skeptic: Dr. Spyridon Karageorgos is a Pediatric Resident at Aghia Sophia […]

This week we sit down with Matt Hawkins, organizer of North Carolina's Croatan Buck Fifty and founder of Ridge Supply. The special origin story of Ridge Supply and ultimately the Croatan Buck Fifty have lead Matt to create an amazing early season event. Episode sponsor: Bike Index  Ridge Supply  Croatan Buck Fifty  Support the Podcast Join The Ridership  Automated Transcription, please excuse the typos: Croatan Buck Fifty [00:00:00] Craig Dalton: Hello, and welcome to the gravel ride podcast, where we go deep on the sport of gravel cycling through in-depth interviews with product designers, event organizers and athletes. Who are pioneering the sport I'm your host, Craig Dalton, a lifelong cyclist who discovered gravel cycling back in 2016 and made all the mistakes you don't need to make. I approach each episode as a beginner down, unlock all the knowledge you need to become a great gravel cyclist. This week on the podcast, we've got Matt Hawkins. Matt is the founder of Ridge supply, as well as the creator of the CRO 10 buck, 50. Oh, super well-regarded gravel race out in North Carolina. I've been wanting to get Matt on the show for a few years after meeting him at sea Otter. And I'm excited to have you get to know the Crow 10 buck 50. I believe there's still some spots available for the 2023 edition. It's one of those early season races. So a great way to get tuned up for a fantastic 2023. Before we jump in. I want to thank this week. Sponsor, bike index. Bike index is a bicycle registry and stolen bike recovery platform. No one likes to think about getting their bikes stolen. I unfortunately have had two stolen over the course One was a BMX bike when I was a kid. And I feel like that scarred me. I've always been super careful about how I lock my bike up, which is probably a good thing, but ultimately, a garage that housed my bikes in San Francisco got broken into and I lost a track mountain bike. Neither one of them were ever recovered. Bike index is really the only game in town that focuses on stolen bike recovery. They've built a platform to blast your bike out to local social media channels. And they can provide you all the best advice on how to increase the chances of success in getting your bicycle recovered it's a nonprofit. All the services are free. All you need to do is get your serial number and add your make model and color to the platform. And there you go. It's like insurance. That didn't cost you anything. Simply visit www.bike index.org and get your bike registered today. With that said let's jump right into my conversation with matt [00:02:10] Craig: Hey, Matt, welcome to the show. [00:02:12] Matt: Hey, Hey Craig, [00:02:14] Craig: I'm excited to get into the Croatan buck. 50. Am I saying it? Correct? [00:02:18] Matt: you are, you are a lot of people say Croatian but 50, but I think they do that just to make me mad. [00:02:24] Craig: Yeah, and we'll get into it. We'll get into it. Cuz I think people are gonna need to get out a map and you're gonna tell us where it is in the country. I, I had to do that myself. I knew it was in North Carolina, but I didn't know exactly where and it's actually pretty interesting part of the state, but we'll table that question for the moment, cuz I was like just starting out by. Just a little bit about your backstory, where you grew up, how you got into riding. And I think we should talk about your company Ridge supply, because I think it will filter into why you created the event and you know, the vibe behind it. [00:02:53] Matt: Sure, [00:02:55] Craig: Yeah. So let's start with that question. [00:02:57] Matt: wanna know? [00:02:58] Craig: Yeah. So, where'd you grow up and when did you start riding and when did you decide, when did you discover drop bar gravel riding. [00:03:04] Matt: Well, I, I my wife and I both are from central Virginia. So up near the Charlottesville area born and raised there. My family's been there a long time, many generations. And I, I grew up in a real rural kind of county, a lot of farming communities there, but we just happen to have a race. That started back when the tour Deon and the tour to Trump rode, they came through our town. And we had a, we had a local race called the tour to Madison, and I did that with a buddy of mine on some, some Huffies. And we started racing and riding when I was really young. I've literally been riding bikes for, for almost 40 years. And yeah, so that's, that's kind of how I started. I, I of course I, I crashed on my first race and and loved it, loved doing it, but I was a swimmer by trade and I swam my whole life and swam through college. So I really picked up cycling after college sort of as my primary. And I've been doing that, you know, every, every chance I get as my soul sport really, since I got outta college, [00:04:18] Craig: Were you, were you more excited about the roadside or did you start off road riding as well back? [00:04:22] Matt: You know, actually I did a whole lot of mountain biking to start and did used to, you know, race 24 hour team races with, with the, with a team and did some road racing and some crit racing gravel obviously didn't exist back then. When I moved here to North Carolina back in oh five. I, I, you know, the first place I went to ride was the Croatan because I could go there at night with lights and be off the road. And it felt like, you know, that's where I could take my mountain bike and I could just go kind of ride. And I didn't really know. CRO, Tan's a pretty big, you know, a surface area and it, it has a lot of roads, but they're not all connected. So a lot of it's kind of sketchy. You're just like, I don't know what's down that road. So we started, you know, exploring a little bit more on road bikes with, you know, 25 sea tires or whatever is probably a bad idea. But we are just seeing, Hey, what's down that road. And I got my first cross bike and started really. Exploring it and doing, doing proper gravel, if you will, kind of before the gravel boom, but more like 2013, something like that. And and yeah, so I was like one of the first people here in our little town to do Strava. And so I made a lot of the segments originally. And and that's kind of how I got into, got into gravel was the Croatan was, was here and then everywhere I've travel. That's the bike. I primarily will take, you know, I ride a rodeo labs trail donkey now, and I'll just everywhere. I'm gonna go. I'll take that. So I can, I can ride road or, or gravel or whatever suits a fancy, [00:06:08] Craig: Yeah, exactly. When you first started on Strava and it probably sounds like the same vintage I did. When you created a segment, you could actually name it, right? Like you could name, you could name the, you name, the climbs, all the climbs. You could put your own names on them. [00:06:22] Matt: Yeah. Yeah. My, my mother-in-law sends me things all the time. Bless her heart. If she's listening, I love her to death, but she'll just send like a text message with some, with some cycling related news article and. If you, if you're like us and you follow cycling, it's things that you've already heard two or three days before, but when they hit the mainstream media and maybe my mother-in-law would see it, I would always be like, yeah, yeah, yeah. But she sent me this article about Strava, which I'd never heard of before. I think this was 2011. And I kind of clicked on it. I was like, oh, this is kind of cool. And I thought, well, I wonder who's using it around here. and I, I, I downloaded the, it might have been a beta app or something at the time. And, and of course there was no segments anywhere everywhere. I went for the first six months I was telling you gotta try this, you know? And Yeah, I made all, I made all the segments in the beginning which was kind of funny. And tho the GPS on your phone back then was horrible and it, it was all squarely lines looked like spaghetti everywhere. And so, yeah, Stravos come a long way with better head units and yeah. You know, all that stuff. [00:07:28] Craig: Yeah, yeah. A hundred percent. So it sounds like the Croton is, is actually rideable from where you live right now. Is that [00:07:34] Matt: Yeah. Yeah. So we are, we are surrounded by it's 200 miles a road gravel road. And it's right here. It's five, five miles from where I'm sitting right now, so I can ride over there linked together all I can handle and, and come back pretty and it's open, you know, year round. There's no closures. It's they're public roads. [00:07:57] Craig: And to position it. So it's in North Carolina, but very close to the coast is what I saw. [00:08:01] Matt: Yes. Yeah. So we're, we're in Eastern North Carolina. It's totally flat. There's zero elevation. And the Croatan is what's called a pacoin. So, pacoin is like an elevated section of low lands. So there's a lot of water in. In the Croatan and it has nowhere to go because there's no elevation and there's really no drainage. So what they did was back in the sixties They dug canals to create the roads. So they would go in there, they would scoop out, you know, along the left and the right side, create these canals for drainage and that, and they'd put the earth in the middle and then they'd elevate that section for the roads. And so a lot of what we're riding on is you know, as gravel roads that were built in a swamp essentially. So, that. It's pretty cool. Like when I first started going in there and riding, I was a little bit like, because you, you can be like 20 miles from nothing, you know, which it's really hard to say that, especially over on the east coast, you know, if you're in Montana or something. Sure. You could maybe, but like out here, man, you can't be that far from civilization. And we have this beautiful, you know, national forest that is like kind of weirdly isolated We can, we have it right here in our backyard, which is, which is great. So this is a [00:09:24] Craig: Yeah, isn't [00:09:25] Matt: to start a start a bike race. [00:09:27] Craig: Isn't that one of the, that's just one of those amazing things about having a gravel bike. You can just sort of explore and get into these pockets of wilderness. And in, in this case, pretty large pocket considering where you are now in, in the, in the four, is there, what's the canopy, like, are there large trees in there? Are we looking at kind of [00:09:45] Matt: Yeah. So Eastern North Carolina is filled with pine. And a lot of it is plantation planted pine. So RO you know, long, straight rows of, of pine Warehouser and places like that own. Ridiculous amount of land down here with just pine trees and the Croatan is essentially mostly that except for there are maybe six pretty big lakes that are in the Croatan. And then there's a lot of, you know, tributary, swamp creeks that are coming in and out of that, when we. A lot of rain here, which, which is pretty often it's heading towards the coast, which isn't that far away. It's just that we, we tend to we te we tend to fill the sound is right here, where we're at. So we have the sound and the ocean in a barrier island. That's like 25 miles long. So, it's all connected. And you know, it's three miles off the beach basically is where the, where the place starts. [00:10:48] Craig: Got it. And are there other kind of offroad recreators in there? Are there, you know, jeepers and four wheelers and [00:10:55] Matt: Some, some of that, mostly it's hunters in the, in hunting season. And other than that, honestly, it's, it's pretty much just for us. There, none of the roads really connect to each other. So we, we get to use them. A lot of days when I go out there, man, it's like, I can't believe, you know, just it's like, it's just, it's all. It's just you. And that's, that's, that's a blessing for sure. It also means that the roads aren't maintained as well as they could be. And like we had the, we had hurricane Florence sorry, if you hear that helicopter, just the sound of freedom here. We got the Marine Corps here. So, the hurricane Florence in 2018, which. Yesterday 2018. I mean, we just got devastated and we still haven't had the roads fixed since then. So that's been four years. You, you just can only imagine the amount of potholes and damage and stuff that's there, but that's what makes our race a little interesting too, is that you never know what the roads are gonna be like [00:11:56] Craig: Yeah. Yeah, yeah. [00:11:57] Matt: the new change. They're like a lot. [00:11:59] Craig: before we get into the race itself, let's talk a little bit about Ridge supply and what, what led to you founding the company and the vision? Cause I've when I heard the story, I found it super interesting and frankly made me want to just jump on the website and order some socks. [00:12:13] Matt: I appreciate that. I, I need that. I need that. Yeah. If, if, for folks who don't know, I, you know, I own and operate Ridge supply, which is a which is a cycling apparel. Running apparel brand. I'm a one man show, so I I've got no employees. I've been doing it seven years and it's an online, only business. We, we, we primarily sell direct. So you know, the pretty much the only place you can get our product is, is at our our website. And I, I, I ship everything myself. I started doing. Back in 2015 and I didn't know what I was doing. I, I, I knew that I had I had a pretty good job at the time. And I, the, the, the quick story is I, I got I got run over by a pickup truck while I was riding my bike. And it was a hit and run and I was sort of very, very fortunate to be alive and. Acutely aware of that in the hospital that a lot of folks wanted to know if I was gonna keep riding my bike. And I, I immediately that I had to resolve that was just like, of course I was, I wasn't, it was never like, I'm scared of riding on the road. I, I certainly was aware of the danger prior to this happening. And I knew that that day I was wearing all black. and that's kind of the easy color to find in cycling apparel. Everybody makes black apparel. And I knew that if I was gonna continue to do it, I wanted to try to figure out how to do it safer. And so while I was laid up with a broken pelvis, I started doing some research and I put two sort of premises together. One was that Blocked color was more visible than solid color. And what that means is if you have the brightest, you know, pink or orange, that neon pink or orange, and we, we love it in our products. If you put it by itself and you stick it down the road like you would see from a car, you might, you might not know what that is. It, it, it looks like. anything could look like a road sign. It could look like whatever. It could just be a bright thing that you're not quite identifying yet, but when you put blocked color together like a dark color, a light color and a bright color, it catches the eye in a way that makes it stand out. It's not necessarily as. As the solid bright color, but it's more eye-catching. So that was one premise and was sort of a scientific premise there. And the other was bio motion mechanics. And what that means is that the human, the human brain recognizes another human's movement. And when that, that happens, that that brain will then acknowledge that that's a human and treat it like a. and I think what happens in cycling, the phenomenon that we all experience when we're riding is we're not treated like humans at all. And it isn't because people are driving around saying, you know, oh, these Kirsty cyclists, you know, it's actually that when they're driving, they're just not acknowledging that, that thing that they see is. Another person. It's, it's just an object. It's not, it's not dangerous. But when you think that that's a person, you notice it's a person, you will, then you don't wanna run somebody over. You know, that's not what anybody's trying to do. Then you will start acknowledging that that's person treat 'em like a person. So I took those two premises together and I said, well, I knew defeat is here in North Carolina. I had been to visit. and I was kind of their neon poster child after my accident. And I realized like I could make my own sock. All I had to do was make 72 pair and. I took the most trite design. If you, if you're seeing this on YouTube or something, it's right behind me. But I took the blue Ridge mountains that I grew up with in central Virginia. Everything is blue Ridge, blue Ridge, blue Ridge. It's the most trite non-original thing I could have come up with, but I'd never seen it in a sock. And so I took that design and a contour line also was something I had never seen. I only has it really seen straight. They're easier to knit straight. Or vertical line. So I took that contour line. I made this five color sock and that was my idea was like, if I make a bright eyecatching multicolor sock and it's moving all the time there, you get your bio motion, you get your most visible. And and yeah, so that's what I did. I mean, I. I, I did that in 2015. I, I had no idea what I was doing. I thought, man, if I could just sell these 144 pair that I ended up buying the first time I maybe I could do a sock of the month club or something. I no idea how to ship them nothing. And I made a phone call to a buddy who owns a bike shop. And he was like, oh, this is great. You know, I'll buy six pair. And I called another buddy who owns a bike shop. And he was like, oh, I'll order 18. And I was like, oh my gosh, whoa, I've sold 23 pair. What am I gonna do? You know how I was just panicked. And so I, I, I really worked hard for like a week and I like created a website and did got the shipping integrated and I did all these. Back in 2015, these tools were just becoming available to people like me, who really didn't know what they were doing, but pretty dangerous on a computer, but like, I can't do code, you know, and I could do all these things, like sort of cookie cutter and just like work hard at it and do it. And so that's, that's how I was, it was just dangerous enough to, to get 'em sold. And then I sold them within two weeks and then I was like, well, I'll just take that. And I'll reinvest it in a new, new color and I just keep flipping it. And that's how my business started in 2015. And I literally never put another dime into it. I bet I was able to do that for a while, while still having a regular job. And then yes, slowly but surely it's grown to the point. , you know, I think a lot of people think Ridge supply is a lot bigger than it is. But you gotta sell a lot of $17 socks to make a living. And I'm fortunate to sell a lot of socks. So, we that's, that's what I do, which is kind of, kind of crazy when people ask me, like, what do you do? I'm like, I sell socks and they're like, well, what do you do for a living? I'm like, I sell a lot of socks. I don't know. I mean, that's the deal. [00:18:43] Craig: I, I love that Matt. And for the listener, like I'll put a, a, a link to Ridge supply, so you can check out the color ways and whatnot. And I think it's the type of design that once you see it, as you said, you've, you've iterated on the color ways. Numbers and numbers and numbers of times now. And there's lots of different options there, but the core elements are generally the same, that skyline design that you've talked about early on from the blue Ridge mountains. So it's super cool and visual. And I think I also heard you mention to others that, you know, you, you do find that people talk about their socks, which I think is, is interesting. And you know, in probably a great way that has, has helped the company. [00:19:20] Matt: Yeah. A AB I mean, absolutely. I had no idea. The. The a community nature that was being created. And then the, the virals, not the right word, the personal connection that the Sox would make with other people out in the world. Like I'm always blown away at the number of new customers that rich supply gets every month that I'm not, I'm not advertising to get them. They're they're coming through grassroots. You know, people on a group ride, people, seeing something on Instagram, people telling somebody else about 'em and that excitement around it is something that is, is the blessing of why this is actually a business. And isn't, wasn't just something I did. And , and, and it, and I can't take credit for it because a lot of that is timing. And the MIS the, the mistakes or risks that were taken early on with the business that worked at the time when nobody else was really doing that now in revisionist history, it looks like, wow, you really knew, I didn't know what I was doing, you know, like, so, I, I can't sit back now and be like, yeah, look at this. I, I, I still just in awe and my wife and I will look at each other sometimes and be like, what is going on? Like, we , we both had, you know, Big time jobs and corporate blah, blah, blah. And all of a sudden it's like, we're sell socks for a living. And, and, you know, it's bizarre. It's a bizarre life, but I think I got the best job in the world for me, you know? So [00:20:59] Craig: Yeah, that's amazing. And I, I do, I mean, I think as a consumer, we all appreciate like the transparency and authenticity of business owners. Like now that I've heard the story, the origin story about why the SOC design is the way it is. You better believe if anybody asks me about those socks or says like, oh, those are kind of cool. I'm gonna tell them, oh, they were designed for increased visibility. And like, there's no doubt in my mind that customers relay that story if they hear about it. Because it's just, so it's just an interesting talking point. Like most socks are boring. These aren't. [00:21:33] Matt: and I appreciate that. And you know, you, can't not, everybody can listen to a 45 minute podcast to let me get long winded about telling that story either. So it's, it's hard to, it's hard to get that message out there. I assume everybody knows it, but of course they don't. And so I'm, I'm happy that you've. You know, you, you brought it up because it's, it is a, it's not marketing. I it's the last thing from marketing, it's really the, kind of the core design philosophy of what I do. It, it, isn't just, it's either mountain related, you know? So like the names, the style, the design is kind of related. It also has that five color. I try to do five sometimes I can't, but. And once I that's my brand identity, I don't have a logo that people recognize. I don't have a text that somebody's like, oh yeah, it's it's that. And when I started that in 2015, nobody was doing that. And so when you see my socks in a picture, they really stand out because of that branding. And that I've I've I like to say like, You know, like a dog, like peed around my tree. So many times, like you come near that tree, you're like, oh, that's where it supplies tree. Whoa. You know? And it's because that's what , that's what that did. And I didn't know that's what was gonna happen. But now I, I, it's funny, like I have like, Social media watchdogs out there. You know, if somebody does anything with five colors or contour lines, I get these text messages. Like they're stealing from you. You know, it's, it's not that there's only so much you can do on a sock. That's not really what happens, but that's, what's made it unique. Is it it, you can tell what it is without seeing the words or some, you know, a swoosh logo or. [00:23:17] Craig: Yeah. I love it. I love it. I'm in the listener. Well knows that I can geek out about the basic business behind any enterprise. Cause I love it. I'm fascinated by it, but I definitely wanted to transition to the Caran buck 50. And learn, learn more about the event. So what, when did you get the idea for it and what was the inspiration? Why, you know, it's a lot of work to put on an event as you can attest. And why did you tackle that? [00:23:42] Matt: Well, I mean, ignorance is is a great motivator to do something ridiculous because I had no idea. I had never, I don't think I'd ever volunteered for a race and nor had I ever put one on I'd done a lot of them. And I just knew that I knew that our area was kind of unique. Gravel was something that it hadn't quite taken off. There weren't a lot of big events outside of, you know, like Mid-South and dirty Kansas at the time. And there was really no, and there's there still aren't many events on the east coast, outside of like Vermont. And so I knew we had the Crow team here and I. The better part of six months or so, just kind of riding the Croatan, giving a feel for it and, and trying to come up with something that could work. The, the one challenge we have most, because we're on the coast, you can't go in our case south, because we're south facing, which is kind of strange. They don't, we're like long island, you know, when you go south, you go into the water. So. We don't have options for loops. You kind of go into the Croatan and the way that it's structured with its lakes and its swamps and stuff, some of the roads just don't go anywhere. And they're really kind of like fire access. So we couldn't do like a, a traditional loop, like you would normally like almost every course is. So we had to do an out and back. That's interesting. Nobody really does that. And I wasn't sure people are gonna like that. And so I kind of wrote it enough. So I was like, you know what, I don't hate this. I could do this, you know, and enjoy it. And it is different an out and back's always different. It's going another direction, a different view, different thing, different turns. So, but yeah, in 2017, I, I did that. I, I had a. A buddy at the time that was helping me kind of promote it. And we got it started. And, and we had 250 people, I think in 2018 come and do it. And I like I've told some other folks too, like I had no idea what I was doing and a lot of bike races, you know, you just kind of show up, they start you and then you finish. Sometimes there's timing. Sometimes there's not. If you're not on the podium, you just kind of, you know what I mean? Like there's nobody there to finish. I finished races before here, locally, where I got back to the finish line and there was literally nothing there, you know, I've won event like that where I'm like, there's no finish line. There's nobody to, to document it. You just ride across and you're like, I won. You don't win anything. You're just the first person to finish. So with this race, We just winged it that first year it was a success. People loved it. We do start and stop at the Speedway here, which is, which is one of our crown jewels. We, we have a a, a NASCAR short track. If you don't know what that is, it's essentially like, you know, less than a half mile track. And it is. they call it the nicest one in the country. And the reason that is, is it's built like a, like a Speedway where it's got, it's got like eight or nine bars. It has grandstands, it has towers. It has a restaurant in the middle. It's got a garage. It's I mean, it's, it's amazing, but we, we are able to use it for our start and our finish and it, and it provides this ambiance about. The start and finish in a way that is real communal and has the right vibe. And it's right beside the Croatan so short, little, little paved section to get out there and then you're in the woods. And just that combo together was a good, it just worked in 2018. [00:27:33] Craig: Yeah. And was it 150 mile race? Or did you have other [00:27:37] Matt: Yeah, no. So we have three. We call it the buck 50, because there's 150 mile race. We have a race called the buck, which is a hundred miles and we have a race called the 50. That is 50 miles. W the first year we basically had a course that was almost 50 miles and we did one lap, two laps or three laps. It's a mass start. Everybody started at the same exact time. And we had. We had sections of the course. It changes every year, the course changes a little bit every year, but that first year we had this section of road that was really primitive and abandoned road that was, had a lot of potholes, a lot of mudhole and we called it Savage road. And that was a section that was about three miles long that really broke the race up. It was the, it was the animated piece. And that was a big hit. We were able to use that the first two years. And since then we haven't been able to use it, which is fine. And we've changed the course a little bit, but now, now we have three races. The 50 uses that same out and back to start. And then the hundred uses a 60 mile loop and then a 40 mile loop. And then the buck 50 uses 2 75 mile loops. So what's kind of nice is we have all these people out there in the course, and it kind of is three different courses, but there's a big section of the course where it's it's everyone uses it. So unlike a lot of races, we have a lot of back and forth traffic. So, out there on the course, you will find other riders heading the other direction that are 40 miles. You know, away from you in the race. But the way that we stagger it and that provides a lot of, we found that that provides a lot of positive comradery. Yeah. There's that small group in the front, that's drilling it for the race lead and they're not waving it people. But everyone else seems to be really encouraging of the other groups. And that community aspect, I think, is something unique about our race that people really like. [00:29:49] Craig: Yeah, that sounds super interesting. And I agree. I mean, there's, it's very few races where you double back on yourself and see other people. And it, it's fascinating as, you know, as a mid packer to see. to get an opportunity to see the front front leaders of the men's and women's race go by. That's a lot of fun and inspiring to see. [00:30:06] Matt: Yeah. And I think makes people feel a little bit safer too, you know, if you had a catastrophic situation you're, you're not alone. The Croatan is very remote and you could be. You wouldn't be out there by yourself forever, but the way our race is set up, you know, you're not alone very long. And I think people, like, I think people like that. [00:30:26] Craig: For sure. You talked a little bit about how the terrain was laid out early on in this conversation. What type of equipment do you see people riding? What kind of tires, et C. [00:30:36] Matt: Yeah. You know, the more I've tr traveled around and don't know other races and stuff, I, people that have never done this race, they actually, they just don't believe that the terrain, this terrain exists, you know, and they've never really ridden terrain like this because it is it's perfectly flat and what that means for you is that you never are able to coast or, you know, there's no climb, so there's no dissent and you never stop peddling. And in the course of a 50 mile, even just a 50 mile ride, it can really drain you when you do 150. It is a, it is a serious effort. So as far as gearing and stuff is concerned, you could literally ride. , you know, you could ride road gearing here and be fine. But a lot of folks, you know, this is a great single speed course, because if you get the right gear, that's, you know, the right cadence you want and can get you at the speed you wanna go, you don't need to change your gear. So it's a perfect course for just grinding out on a single speed tires. You know, we've got really good surface area or surface that is not like sharp rocket rocks at. It can be a little Sandy at times. So a little bit of volume is important, but I mean, the race has been one on like 30 fives and 30 twos. So I wouldn't ride it on a 32 myself. I'd rather I ride like a 38. And I feel fine on that, but I ride a slick out here all year round. So even, even if it's wet a slick is fine. Our corners. Our corners are a little Sandy. So tires tend to not do anything for you. You just gotta take 'em a little gingerly. If you go in a corner too hot, you're just gonna eat it. But we don't have many corners, you know, so a lot of the roads are straight and you're what you really have to do is find your line. That's the other thing you can't ever explain to somebody until they come and do it? We have. We we, you call 'em potholes, but like we have small indentations, like a pothole in the gravel and they're everywhere. They're everywhere. And so imagine you're in a group of 800 people and you're nine, 10 riders back. You're not gonna see any of that. And all of a sudden, you're just like, bam, you hit the bottom of this pothole with your rim. It becomes this thing where as the course opens up and as people start to spread out, picking your line, it's like a snake, you know, and it just winds around and, and the groups are all doing it. You can be on the left, you can be on the right. If you're in the middle of the road, it is a nightmare because there is just no way that you're not gonna have some catastrophic pothole in your way. It, it's a weird kind of way to race your bike. But one really cool thing is like, you'll never calm down and just like tune out. You have to be on the Razor's edge mentally the whole time. And I think that's actually a great way to grab a race, you know? Cause if you're just like, you always talk about people, like I just had to grind through this thing, which is so boring. Like this course is not. It's flat and it's an out and back, and that sounds boring to people until they do it. But then when they do it, you throw in these potholes it's, there's something special about it. [00:34:03] Craig: A heck of a lot of peddling and a heck of a lot of attention required. It sounds like [00:34:08] Matt: Yes. [00:34:09] Craig: when you think about the event, were you looking to put something on the calendar that attracted sort of a highly competitive crowd or what was, what was kind of the vibe and intention of the, the race design in your mind? [00:34:20] Matt: Yeah. You know, I, I set out to create something that could be the first gravel race you've ever done in the 50. That is like, You know, like, even if you're going pretty slow, you can complete that course in four hours. And I felt like four hours is like, you know, if, if you're really riding and training, some, you can do that. Even if you never train more than two, you could still pull out a four hour effort. The buck 50. Was always gonna be a challenge just from a time perspective, because like even the fastest people who are blazing this course at like 21 and a half miles an hour, they're still in the seven hour range. And that is that's goes all the way up to 12, you know, depending on who who's doing it. What I tried to do was make a race. and this is the magic of the Croatan being flat. If you're the, if you're the, the person who just wants to come out and experience it and ride, you can line up against, you know, Ian Boswell, who's gonna go, maybe win it. And you both have. An equally rewarding experience. It isn't that the person in the back is just lollygagging. The course they're gonna have to do something really special for them to complete it, but the people at the front are gonna get this unique experience of a March race that doesn't have crazy elevation. Doesn't have, you know, high altitude doesn't have extreme weather and yet it's. But it's just hard enough for wherever your fitness is at. And I think that's one of the sweet spots and we don't bill it. I know it's called the buck 50, but it, we split it about a third. So we have, you know, a third of the people sign up for the 50, a third of the people sign up for the a hundred and a third of people for the buck 50 and. One of the unique things about our race too, is like, we let you switch the distance up until a month out because people will sign up and then they'll be like, ah, my fitness, isn't what I want it to be. Or they maybe have a great winner and they're like, you know what? I wanna do. I wanna bump up from the a hundred to the 150. So we allow people to do that and change it on their own. And that's, that's been a big, a big blessing because it, it, we were seeing 150 people. Change, which is a nightmare for a race director to have to deal with all that. So we just let him do that one bike edge until January. [00:36:53] Craig: Nice. Yeah. It's interesting that March date on the calendar, I think it's like, it's such a great focal point for your energy. Like through the winter to say, oh, I gotta, I gotta stay fit. Cuz I wanna do something big in March and it just sets the table for a great year on the bike. I think if you're fit at that time. [00:37:10] Matt: Yeah. I think people that we, so registration just opened up yesterday and on, on the 15th of September and it's a long way out, but it really isn't. When you think about your holidays. Your new, year's all these things. And people do use this as their carrot. I know I do. I use it as my, I gotta get on swift. You know, I gotta do another workout, even though I don't ride it. I just know that that's what people do and then they, it's not, you wanna come outta your, come out of your, you know, to start your season at the buck, 50 Andy blazing, but you know that you don't really have to perform at a weird, you. Extreme level, you just have to grind and that's, that's kind of a neat way to start your year too. And I think, I think it's worked for people that really wanna set, you know, set a goal, an early season goal and then pick up their June and, you know, July things later, cuz they built that base. [00:38:08] Craig: Yeah. Yeah. It sounds like from your description that the, the race track has just created this very important piece of infrastructure. For the overall event, how are you kind of harnessing that? Obviously like a lot of gravel events try to foster a nice after race party or an event or experience for the community. How do you kind of manage that? And, and what should we expect when we show up? [00:38:32] Matt: Yeah. You know, we're, we're, we're super blessed. We we've got all of these things in this background where you're you're you're on this NAS. You know, short track it's paved. It has a pit lane. We, we have the finish line there, right? Where, right where the the vending is and the food and all that stuff. So it's this communal effort once you've, once you either are coming through for a lap, you get to see everybody or at the finish right after you finish you're right there. And it's been an interesting. It's evolved, but it's been an interesting environment because we also have free camping there on site. So basically like you can literally come in there the night before pitch a tent inside of the track, wake up, you're basically at the start finish line and start the races re reminds me a little bit of the, some of the mountain bike events that you get to do or camping's involved. But we, we offer, you know, meal afterwards and beverage, we typically will have like a, you know, a, a beer, a partner that'll that'll have beer. We do like. A, a full catered buffet style meal, which, which is kind of nice because just some, you know, where we are. It's not like we got eight, 900 people. There's not a lot of restaurants and stuff, you know, you can't just like, say, Hey, go get yourself something to eat. We kind of have to provide it. So we do that. And the big thing that because of Ridge supply and because of who I am as a business person, if you will like. I've always made. I've always tried to set out to make this race a value, even though it's not inexpensive race. There's. I feel like there's peer races that are of our size or bigger that are more expensive. And the return that you get from the buck 50, I've always tried to maximize the return and make every decision that we make. I say we, that I make about the race is rider focus. Because I think what happens with race directors and I'm not pointing any fingers at anyone else, I'm saying this happens, happens to me. You get this registration, you sell your registration, which is great. Then you have to provide services with that, with the, that revenue and the amount of services you provide. There's like a minimum and a lot of folks stop there. They're just like, this is all you gotta do. . And what I try to do is give back enough a in services, but also in product, we give away a huge swag package. Nobody does this, but I do it because a that's what I do. I sell stuff, you know? But like this year, when you come and do this race, you're paying for the entry, but you're get, you're gonna get basically a, a, everything that we do is fully custom just for racers too. So it isn't like you can buy this on this, on the website or. Somebody printed a cooi and gave it to you. It's like you get a custom pair of socks. You get a custom race tee that is not like your typical race tee. It's a legit piece of garment. You get a finisher's hat. When you finish, that's specific to your race, you're gonna get a pair of gloves that are custom long fingered, hand up gloves that you're gonna get. You may get some other things and I'm not gonna say out loud what they are. Those things all add up. It's well, over a hundred dollars worth of stuff. You get a meal afterwards, you get beverage afterwards, you get free camping. It isn't about what you get back, but when you do all those things, and then the value of the race experience in itself is what it is. And people do really enjoy doing this event. I hope that they tell other people about it and then they wanna come do it again. Otherwise, you know, it's a giant waste of time. I've found that from, from a race director's standpoint, if, if it stretches me a little bit where I'm just kinda like, oh man, I got, you know, when you have 900 people, every dollar that you spend is a thousand dollars, you know, and those add up very quickly. And there's a lot of times that that feeling that you have, you're like, well, I don't have to do that. They won't, they don't really, you know, you don't really need that. That's almost the, the surefire indication I need to. And I, the one thing we don't do that a lot of big races have, I don't really have a whole lot. I really don't have any corporate P partners. I don't sell sponsorship. Nobody's presenting this. And I like that because it keeps it, the vibe is the right vibe for March. I don't think a March race should feel like the world championships of anything. It's like, bro, you're just coming outta hibernation in the Northeast. This is your first time to see the sunshine and you wanna ride your bike, but you know, you, you don't need all that pressure yet. And so we try to keep it like that. And I think it's translated. I think the, the race track does provide that. And that's kind of what we use it for. It's just a backdrop. We really don't, you know, you do get to ride around it and finish and you come in and out of it to do your pit. But yeah, I'm not sure if I answered that question correctly, but [00:43:35] Craig: You you, you, you did for sure, Matt. No, I love it. And I do think, you know, by my likes again, like it's come to me through a number of different sources that this is a fun event. If you can get it on your calendar and you're close to the east coast where you can get there. So I think you're doing all the right things and I'm, I'm happy to have you on the podcast and just hopefully expose this race to a broader audience. I really love the idea. Encourage encouraging people to travel, to ride gravel in different parts of the country. Cuz as you expressed early on in this conversation, it's such a unique part of our country that has these funny little attributes that you're not gonna experience elsewhere. [00:44:14] Matt: Yeah. Yeah, I appreciate that. It, it is it, when you live here, you're kind of like, why would anybody want to come here and ride our little gravel and then you make the bike race, and then everyone's like, It's amazing. And you're like, really? Is it, you know, and, and that's kind of been an eyeopener too, is that you realize that it is unique. The art terrain is unique and I've, I, I spent a lot of time in Vermont. I I spent a lot of time in Colorado, kind of all those kind of areas. I'm like, you can't mimic those things. They're just, they are what they are. And they're amazing. It's just that what we have is just. Squished flat and you can get away from everything in a way that is just kind of bizarre. You know, there's no homes, there's no buildings. There's no nothing. You're just on a gravel road in the middle of a forest, as far as your eyes can see. And that's kind of cool. [00:45:04] Craig: Yeah. And thank you. Thank you for just putting a hand up in creating this. I mean, it, I always like to express that sentiment to advent organizers cuz it's, it's hard, hard work, but I know it's, it's a virtual, it's a love story to your local community in the, the trails that you've explored the last few years. [00:45:22] Matt: I appreciate that, man. Yeah. I mean, I would do it again if I, if I knew, but if I knew it was this hard, I would think really hard about starting it. I'm glad, I'm glad the ignorance is, is prevalent for me. [00:45:35] Craig: it, it totally is. It totally is. I don't think you start a business. If you know everything you're gonna have to go through and you probably don't start an event either if you know everything that's in front of you, but cool. Thanks again, Matt. I really appreciate it. [00:45:48] Matt: Craig. Appreciate it. [00:45:48] Craig Dalton: That's going to do it for this week's edition of the gravel rod podcast. Big, thanks to Matt for coming on board and talking about his backstory for Ridge supply and that amazing sounding Croatan buck 50 race coming up in early 20, 23. Big thanks to bike index for supporting the show this week. And big thanks to you for listening. I may not say this enough, but I very much appreciate you listening to the show. And making me part of your gravel cycling experience. If you're interested in connecting with me, you can visit the ridership that's www.theridership.com. It's a free global cycling community where you can interact with gravel, cyclists from all over the world. If you're able to support the show, ratings and reviews are hugely appreciated. Or head on over to buy me a coffee.com/the gravel ride. If you're able to contribute financially. Until next time. Here's to finding some dirt under your wheels

On this episode, Jen & Greg will take a sharp turn from their recent conversations involving biblical community and address the issue that if we're being honest, so many Fraternity members struggle with, and that is being alone.  In fact, the couple will be addressing what it means to be Acutely Alone, and how members of the Fraternity can live in community and at the same time go through severe, intense seasons of feeling alone. Finally, Jen & Greg will look to Jesus and glean from Him what to do in those moments of being acutely alone. See omnystudio.com/listener for privacy information.

Treatment for a mental health condition begins with the correct diagnosis.  At age 9, Emily's mental health issues surfaced. Acutely aware of her physical/mental/ emotional symptoms, her parents sought professional help for their daughter. Emily's condition was complex, and some of the medical experts were helpful and others not. Carol shares her heart-wrenching nine-year journey to find the right medical professionals to help Emily and finally provide a correct diagnosis and course of treatment for their daughter. Carol Hancock is a wife, a mother of two beautiful young women, and the grandmother of two young boys.  In addition to her devotion “mothering” and “grand-mothering”, she has had a life-long career as a professional hair stylist in Loudoun County, Virginia.

Editor's Summary by Kristin Walter, MD, Senior Editor of JAMA, the Journal of the American Medical Association, for the July 12, 2022 issue.

CHEST June 2022, Volume 161, Issue 6 David Jimenez, MD, PhD, and Tobias Tritschler, MD, MSc, join CHEST Podcast Moderator, Gretchen Winter, MD, to discuss whether therapeutic heparin should be administered to acutely-ill hospitalized patients with COVID-19. DOI: https://doi.org/10.1016/j.chest.2022.01.036 DOI: https://doi.org/10.1016/j.chest.2022.01.037  DOI: https://doi.org/10.1016/j.chest.2022.01.038  DOI: https://doi.org/10.1016/j.chest.2022.01.039 

Great discussion with Dr Emma Ridley a dietitian from Australia about how they planned to look after the nutritional requirements of COVID patients. A lot of pointers about how we care for their needs when they haven't got COVID too.  The post Podcast- Nutrition management for critically and acutely unwell hospitalised patients with coronavirus disease 2019 (COVID-19) in Australia and New Zealand appeared first on Critical Care Practitioner.

Emergencies happen in hematology and oncology. This is a fact. But how do we manage these emergencies? Look no further. In this episode, we talk all about our third oncologic emergency: new brain mets. Cord compression:- If someone has a pathologic fracture, think about the following differential as underlying etiologies: - Females: rule out breast cancer - Males: Prostate cancer- Others: multiple myeloma, lymphoma, lung cancer, renal cell carcinoma, bladder - If cord compression, administer steroids; may require radiation to help with shrinking; also may need involvement of neurosurgery if there is lack of spine stability. Role of radiation in cord compression: -MRI is beneficial to help with radiation planning-Where is the disease in proximity to the spinal cord? In the bone? In the epidural space? Or pushing against the spinal cord +/- blocking CSF?-Is the spine stable? Use SINS scoring (https://radiopaedia.org/articles/spinal-instability-neoplastic-score-sins-2?lang=us) -If good spine stability (low SINS) or is not surgical candidate or radio-sensitive tumor: radiation up front-If poor spine stability (high SINS) then may need surgery up frontRadiosensitive tumors examples:LymphomaGerm cell tumors Small cell lung cancer Radio-resistant tumor examples (resistant does not mean that radiation cannot be used, however):MelanomaColorectal Renal cell Continue steroids as they are undergoing radiation to prevent flare up from inflammation and acute worsening from the mass on the spinal cordRole of neurosurgery: - What is a reasonable time that we can wait before operating for a new cord compression?- As noted above, cord compression has various degrees- Questions to ask: What neurologic symptoms? Over what time period? - Asymptomatic: You have time! Perhaps investigate why mass may be there. - Progressive over a couple of weeks: You have a little bit of time (a few days to get them to surgery)- Acutely having symptoms: You should intervene. - Spinal stability: are the weight-bearing components (ligaments) intact? Assessed via upright X-rays - If the tumor is radio-sensitive, may opt for radiation first (if diagnosis is known)A HUGE thank you to our special guests:Ryan Miller, MD, MS: PGY5 in Radiation Oncology at Thomas Jefferson University Hospital, Philadelphia, PAJoshua Lowenstein, MD, MBA: Neurosurgery Attending, REX Neurosurgery and Spine Specialists, Raleigh, NC Please visit our website (TheFellowOnCall.com) for more information Twitter: @TheFellowOnCallInstagram: @TheFellowOnCallListen in on: Apple Podcast, Spotify, and Google Podcast

Salvation, Eternal Security, and Are You Acutely Saved? - Jim Schettler

Aaron Rabinowitz identifies as an atheist, skeptic, and philosopher. He's also a faithful trans ally, and considers the adjective “religious” an insult. Acutely aware of his cisheteronormative privilege, he willingly sacrifices himself on the altar of Heterodorx because “my humanity is not being questioned in this particular debate.” The resultant conversation is even more fascinating than it is long (1:46, our longest yet!). Listen closely and you just might have a religious experience. Embrace the Void podcast: https://voidpod.com/podcasts Philosophers in Space podcast: https://0gphilosophy.libsyn.com/ Aaron Rabinowitz at The Skeptic: https://www.skeptic.org.uk/author/aaronrabinowitz/ I Enjoy Being a Girl: https://youtu.be/iEW_nXwWvd4 --- Support this podcast: https://anchor.fm/heterodorx/support

Let's meet Mr. Three.He is:Acutely aware of social nicetiesImpressive range of accomplishmentsExtremely busy and on the goJam-packed schedules and meetingsMay have interests in improvisation or actingRefined taste in outer appearanceCharismatic; makes good first impressionsIn a Truity study of more than 54,000 respondents, Type Threes were found to make up approximately 11% of the population. About 10% of women and 12% of men are Threes.Are you a #3? In today's episode we're diving into this fascinating discussion.

In response to a series of incidents – and with the intention of protecting, restoring and ensuring safety in the local ecological environment – China enacted the Yangtze River Protection Law on 26 December 2020, which then came into force on 1 March 2021.

Bestselling Vermont author Jessica Lahey is done with keeping secrets. In her new book, The Addiction Inoculation: Raising Healthy Kids in a Culture of Dependence, she reveals her best kept secret: she is an alcoholic. The story begins before she sips her first glass of wine, when she becomes aware that alcoholism runs in her family. Acutely conscious of this, she takes precautions to stay away from alcohol as a young adult. As a student at UMass Amherst, she becomes a drug and alcohol counselor, teaching her classmates about the perils of addiction. But in her thirties, after having two kids, Lahey begins drinking wine. She is soon drinking a bottle a day, then more, then liquor. Finally, she blacks out drunk at a family birthday celebration, and her father confronts her. “I know what an alcoholic looks like,” he tells her, “and you're an alcoholic.” That night, Lahey attends her first 12-step program meeting. She has been attending meetings ever since. “There are lots of people that are going through this and you don't have to be alone,” she counsels. Jessica Lahey, a former teacher and author of the 2015 bestselling parenting guide, The Gift of Failure, is now on a mission to teach parents how they can "inoculate" their children from substance misuse. “Inoculation theory” starts with knowing the facts about substance misuse and other risky behavior. “It raises the likelihood that your children will refuse that high risk behavior -- which could be drinking, or sex before they're ready, or driving in the car with someone who's drunk,” says Lahey.

MS4 Sarah Islam pilots her own medical care with Non-Radiographic Axial Spondyloarthritis in a system that failed to provide affirmative care. Acutely aware of homogeneity and heteronormativity in healthcare, she emphasizes the involvement of LGBTQ+ providers in gender-affirming surgery and care through the emergence of wraparound clinics. Sarah advocates for self-care and therapy, especially for her South Asian parents. She is an MS4 at Indiana University School of Medicine who recently matched to a psychiatry residency in Hennepin Healthcare and Regions. Check us out @QueerDiagnosis.com and @QueerDiagnosis on Twitter/Instagram!

Ben Farr (Creative Boundaries) on Content Creation, YouTube, Social Media + More! During these hyper-early test stages of my podcast, I sat down with Ben Farr to chat about content creation, branding, social media, and YouTube. Ben has accumulated an extensive repertoire of top-notch quality YouTube videos and his podcast has a degree of professionalism that is rare with most new podcasters. As a highly skilled photographer and videographer, Ben works for a local media company, a job that he got via Instagram (more on that in this episode). Acutely aware of trends and the direction of our digital world, in this conversation Ben has broken down some useful and practical tips for Creating on the Internet. Please enjoy this episode and checkout Ben by following these links to his work. Links: YouTube, Benji -> https://www.youtube.com/channel/UCygtI4UWECLjR3x3Ne1DeEA Instagram -> https://www.instagram.com/benjaminfarr_/?hl=en Podcast -> anchor.fm/creativeboundaries

Rabbi Shloime Schwartzberg is arguably the“Rosh Yeshiva of the largest Yeshiva in the world without walls”.He is one of the architects of the multi-media online program Daf Hachaim.Shwartzberg excels in preternatural comfort in front of the camera, presenting even the most involved Sugya in a straightforward easy-to-understand Shiur ,which remains attentive to carefully and accurately translate every Aramaic word on the printed page.That day's Daf is displayed in crystal clarity alongside Svwartzberg's immaculate talking head.The exposition is melded with state of the art graphics, visual tools that help entrench the Talmud's complicated concepts and arguments through easy to read charts.Talented artists,informed by specialized archaeological and sociological expertise, have crafted representations of the arcane objects and ancient occupations that the Tannaim and Amaroim lived with and ruled on.These pop up on the screen precisely at the point that Schwartzberg sites their relevance.Building on the scholastic evidence for what insures retention of new knowledge,Rabbi Schwartzberg and the Daf HaChaim team offer a brief review of each lesson which as their advertising states"etches the Daf in stone."The Corona bubble has spawned an explosion of cyber options for effective Talmud study,yet Daf HaChaim towers above them all as the quintessential provider,having established itself close to a decade ago remarkably as a vehicle that attracts equally well seasoned Daf Yomi learners and beginners to the experience.Rabbi Kivelevitz attempts to extract from Rabbi Schwartzberg details of how the project came to be,and how the Charedi world lined up behind a project that was so dependent on internet connectivity.Assuming that a teacher should always be looking to enhance their methods, Kivelevitz is surprised that Schwartzberg hasn't spent time sampling what other presenters are doing in this challenging space.The pair shmooz about methodology and the level of reliance Daf Yomi teachers have on Ras'hi s running guide in their daily concise interpretations.Schwartzberg touches briefly on his occupation as a successful psychotherapistin private practice ,and how his secular education and real life experience has deepened his ability to convey the psychological underpinnings of many Talmudic statements.Rabbi Kivelevitz inquires to the next arena for Harbatzas Torah that Schwartzberg is setting his sights on.While he is attracting a large audience to his live ZOOM shiurim on each day's Tosfos,featured on the OU's AllDaf platform, he is most passionate about his own pet enterprise which he feels can eclipse all his myriad accomplishments in education,the "Self Project."Quoting a novel etymological analysis of the word Torah by Rav Shamshon Raphael Hirsch that sees in learning a method of self-actualization,Rabbi Schwartzberg, would like to follow in the path sketched by Rav Yisroel Salanter, who exhorted the brilliant yeshiva students of his day that the true purpose of Torah is creating a more moral holier persona.Acutely aware of the present Zeitgeist,the Self Project will use video clips and music tailored for specific audiences(Men and Women,and Teens) served up with Schwartzberg's inimitable style.Please leave us a review or email us at ravkiv@gmail.comFor more information on this podcast visityeshivaofnewark.jewishpodcasts.org See acast.com/privacy for privacy and opt-out information. This podcast is powered by JewishPodcasts.org. Start your own podcast today and share your content with the world. Click jewishpodcasts.fm/signup to get started.

In this episode, Patrick Wallace and Sameed Shaikh, DO discuss the approach to working up an acutely Psychotic patient. Mr. Wallace is a medical student at Rocky Vista University and '17-‘18 RSA Education Committee member. Dr. Shaikh is an emergency physician at UCHealth Memorial Hospital in Colorado Springs.

Pastor Andy Davis preaches a sermon on Ephesians 6:1-3 and how children must honor their parents through obedience, by the Spirit's power. - SERMON TRANSCRIPT - Introduction This morning we're going to be looking in our continuing study in the book of Ephesians, in chapter 6:1-3, which you just heard Brad read. For me, I love biographies. I love missionary biographies. I love the heroic spread of the Gospel, some of which I just prayed about a moment ago. The Life of John Paton One of the most moving biographical accounts I've ever read or heard about is the story of John Paton, the courageous Scottish missionary to the cannibal infested islands of the New Hebrides in the mith century in the South Pacific. Through Paton's influence, 3500 cannibals, through his direct influence, 3500 cannibals renounced their heathenism for Christ in the tiny island of Aneityum where he poured out his labors. In Fiji, 79,000 cannibals were converted by missionaries that he mobilized mostly from Australia. 79,000 converted. In Samoa, 34,000 cannibals professed Christianity through the labors of those same missionaries. In the New Hebrides where he focused his attention, which is a chain of islands, 12,000 were converted, and he said 133 of them were trained, specially trained, raised up, and sent out as missionaries to their own people. Amazing fruitfulness in an overwhelmingly challenging and terrifying situation because a mere 18 years before he arrived there in 1858, in 1840 the first two missionaries to the island of Tanna, where he first began his missionary service, were clubbed to death and cannibalized immediately on the beach in the full view of the ship that brought them. 18 years later, he got on a boat and went to that same exact island with amazing courage. And he risked his life, his family. His wife died, his child died, he himself, 18 times stricken with fevers, the exact same fever that took the life of his wife. And with amazing courage, for those many, many years, led so many people to Christ. What are the roots of John Paton's character, his courage, his calling as a missionary? How can we understand what led to that kind of character, what led to a man like that? And I would have to say at the human level, in large measure, it was his relationship with his father, James Paton. James Paton was a poor tradesman who raised his 11 children in the Scottish, Calvinistic heritage that he had inherited. Raised 11 children. He himself yearned to be a minister of the Gospel but providentially was prevented from doing so. And so, he entrusted himself to the Lord and poured himself into his family. When John was born, he and his wife, metaphorically, laid him on the altar before God with prayer, and dedicated him to the Lord's service that, if God saw fit, he could be a missionary of the cross. He did that just days after he was born, after John was born. And then this godly father bathed John in prayer as he was growing up, every day, family altar, solid doctrine, an intellectual depth to their faith that was unmatched. Also, the Covenanters heritage of martyrdom also was preached and taught in that household. Their father, James, had a prayer closet that he retired to three times a day, and he prayed with great passion for the conversion and for the discipleship of his own children. When the time came for John to leave home for good and go off and serve as a missionary, the very thing that his mother and father had wanted when he was born, his father walked with him six miles along the road until the place came where they had to part. And as the two of them, father and son, were walking along the road together, the father was weeping, praying, pouring out heavenly counsels, prayers, advice, scripture, in these last few minutes they had together. And when the time came when he couldn't even speak anymore, he just continued to pray silently, his lips moving, and John remembered this many, many years later. No words could come out, but he knew his father was burning in prayer for him, tears flowing down his face. And they stood there, they were at the parting place, they had no more time together, the time had ended, and all he could say at that point was this. "God bless you, my son. May your father's God prosper you, and may He keep you from all evil." Then they embraced one last time and he walked away. John waved his hat in saying good-bye to his father, but his heart was breaking. And so, he dove into a ditch to just have a good cry, and he's just laying there weeping about the separation, but also eager to begin his work. And after he'd been there some time he climbed up the dike to see if his father could still be seen along the road as he returned back to their home village. And just at that moment, his father also was climbing up the dike to look back to see if he could still see his son. There were some distance apart, and it was clear the father, James, didn't see him, but then just continued to talk, and he assumed, John assumed, praying for him as he walked on his way. And he watched through blinding tears, John did, until he could see his father no more. Then he got up and hastened on his way to serve Christ as a missionary. These are his own words. "Vowing deeply and oft, by the help of God, to live and act so as never to grieve and dishonor such a father and mother." So that is on my mind as I preach on “children obey your parents in the Lord, honor your father and mother.” As we come to Ephesians 6, we come to the next section in Ephesians, but for me, a very powerful and moving one. My desire is to be that kind of a father. My desire is all you fathers listening to me would be fathers like that. And beyond that, you children, at whatever age, some of you are coloring, scribbling, some of you listening as best you can, some very attentive as you get older. I understand. The text is written to you. I'm going to be speaking also to your parents about the text. I desire that a generation of servants of Christ like this would be raised up. There's a lot of missionary work left to be done, and also I think it's going to take an unusual amount of courage for you to be a Christian in America going forward, more than perhaps in our generation. So I want you to be ready to face the challenges you're going to face in the years ahead. In Ephesians, as we come to chapter 6, I want you to see it in continuity. It's not just popping up out of nowhere but it's a flow that we've seen in this beautiful book. The Parent-Child Relationship: A Subset of the Christian Life This idea of the parent-child relationship is a subset, or a part, of the Christian life that Jesus bought for us with His own blood. It's part of the life he bought. It's part of what it means to “walk in a manner worthy of the Lord,” for us to be godly parents and children. It's a life that flows from the salvation that's been so clearly taught in this magnificent book of Ephesians. "For it is by grace you have been saved through faith, and this not of yourselves, it's a gift of God, not by works, so that no one can boast." We were saved, we were justified, we were forgiven by grace through faith in the shed blood of Christ, “having been chosen in Christ before the creation of the world, having been predestined to be adopted as his sons and daughters, having received the hearing of the Gospel, having believed, having been marked in Him with the seal of the promised Holy Spirit, all of this flowing. Having been rescued from the dominion of darkness and transferred into the kingdom of the beloved Son, having all of these blessings, we are now called on to do good works.” Ephesians 2:10, "For we are God's workmanship created in Christ Jesus to do good works which God prepared in advance for us to do." The Rising Temple of God Now the centerpiece of those good works is the building of an eternal temple, a dwelling place, rising in every generation described beautifully at the end of Ephesians 2, as a dwelling in which God lives by His Spirit. And this dwelling, this temple, this holy structure, which I think is the Church of Jesus Christ. I think we could also say it as the Heavenly Zion. It is the New Jerusalem. It is rising in every generation as living stones are quarried from Satan's dark kingdom and rescued and brought over and set in this spiritual wall, this image of the structure that we have at the end of Ephesians 2. Bringing in 1Peter 2:5, "you are living stones." And we are put into this rising temple. This magnificent, glorious structure is presently under construction. Amen? But it's looking really good, I've been told, by the Spirit of God in my heart. It is magnificent and glorious and it's better than it was a month ago, much better than it was 10 years ago. Every generation of elect people who hear the Gospel and come over and believe, beautify and glorify it even more, and none of them ever gets lost. And it's just getting better and better. This is the work of our lives, the glory of God, and the rising of this spiritual holy dwelling place. Now I believe, in the end when we get to heaven we're going to hear all the stories. Not just John Paton and his father, and not just what happened with those cannibals. We're going to hear them all. And we're going to be so eager to hear them. I'm telling you, all of you are going to be super PhDs in church history. You're going to love it, you're going to want to hear all the details, and you're going to hear from the heavenly perspective what God did by His sovereign grace to get those people saved. And we are going to glory in those stories. But I believe, I can't prove this, but I believe that when we get to heaven and we find out how it all happened, the overwhelming majority of those in Heaven will be there primarily and first and foremost because their parents led them to Christ. "Overwhelming majority. What is that Pastor? 55%?" I don't know what overwhelming majority means. Parents and Missions When I was at the IMB last week, or last month, knowing I was going to preach this, I went to five of the best missiologists and veteran missionaries in the Southern Baptist Convention, in the IMB. And I asked them this question. "Worldwide, what percentage of genuine believers do you think had Christian parents who led them to Christ, essentially?" They said, "Well do you want a number? I said, "Yes." Obviously, it's anecdotal, I don't know. But the numbers ranged anywhere from 60%-75%. These are veteran missionaries. Because what happens is the missionaries go to that land, and none of them are Christians. They find some bridge people, those bridge people come to faith in Christ. Immediately, what do those bridge people do? They turn to the people they know, first and foremost their own families, their parents, their siblings, their children. And they begin to share the Gospel. Some of them believe, receive, and trust. Some of them turn in hostility and persecute. But that's where it all starts. Give it two, three, four generations, ask what's going on in that nation, the overwhelming majority had Christian parents. It just happens again, and again, and again. And it's a powerful thing to see this. So fundamentally, we believe that this parent-child relationship is essential to God's sovereign plan for the rising of the Church of Jesus Christ, for the building of this holy temple. It's foundational, it's vital. "We believe that this parent-child relationship is essential to God's sovereign plan for the rising of the Church of Jesus Christ, for the building of this holy temple. It's foundational, it's vital. " When I was there at the commissioning service there were 36 missionaries commissioned. 29 of the 36 in their written testimonies, which I as a trustee get to read, 29 out of 36 said, "Effectively, my parents led me to Christ." 29 out of 36. It's amazing. And how my own son, when he was baptized a few weeks ago, zeroed in on 2 Timothy 3:15, which says, "How from infancy you have known the Holy Scriptures, which are able to make you wise for salvation through faith in Christ Jesus." I believe this is the very thing that was promised to Abraham in Genesis 12:3 when He said, "I will bless those who bless you, and whoever curses you, I will curse. And through you all the families of the Earth will be blessed." The families. In all of the types or patterns of evangelism that there is in the world, workplace evangelism, street evangelism, missionary type work, contact evangelism, airplane evangelism, which I love. Where can they go? They're captive. Especially if they have the window, and I have the aisle, where are they going to go? So we're going to talk about Jesus until they don't want to talk about Jesus anymore. I try to be kind, I try to find out if they're interested. But of all of the types of evangelism there is, by far, overwhelmingly, the most effective is parent-child evangelism. Nothing else even close. This is by God's will and by His power. And so, my desire is to put inside you, parents, especially, a zeal and a fervency for the souls of your children. The healthy Christian family is a great, magnificent factory, a machine, for the production of children of God who will live before Him forever. And it's been working now for centuries. So we come to Ephesians 6:1-4. Listen again. I'm going to read verse four even though I'm not dealing with it today. But look at the text again. "Children obey your parents in the Lord, for this is right. Honor your father and mother, which is the first commandment with a promise, so that it may go well with you and that you may enjoy long life on the Earth. And Fathers do not exasperate your children or provoke them into wrath, instead bring them up in the nurture and admonition of the Lord." We’ll deal with verse four next week, God willing. The Blessings and Challenges of Children Children: One of God’s Greatest Blessings So I want to start by talking about the blessings and challenges of children. Children are one of the greatest blessings that God can ever bring into your life. They are endlessly fascinating, endlessly unpredictable. They are a rich Biblical blessing, and we need to be told that because in our nation, in our culture, there is a negativity toward children. A negativity like children are a burden, children are almost what feels somewhat like a curse. But in Psalm 127 it says, "Behold, children are a heritage from the Lord. The fruit of the womb is a reward.” And to borrow a phrase, an idea from 1 Timothy 4:8 about godliness, Paul is talking there about godliness and it says, "godliness has value for all things", listen, "holding promise both for the present life and the life to come." Children are like that. They hold promise both for the present life, to bless you in this present life, and to bless you in the life to come. So in this present life, when Noah was born, his father Lamech called him Noah, which sounds like the word comfort, because he said, "He will comfort us in the labor and painful toil of our hands caused by the ground that the Lord has cursed." He's going to alleviate our suffering here, just to have a child. And then in Ruth chapter 4, the women said to Naomi, when Obed had been born to Ruth, her daughter-in-law, the women said to Naomi, "Praise be to the Lord, who this day has not left you without a kinsman redeemer. May he become famous throughout Israel. He will renew your life and sustain you in your old age." Think about that. How beautiful is that? "For your daughter-in-law who loves you and who's better to you than seven sons has given him birth. Then Naomi took the child, laid him in her lap, and cared for him. And the women living there said, 'Behold Naomi has a son.' And they named him Obed." He was the father of Jesse, the father of David,” the father of Jesus, Matthew 1:1. And so, in God's sovereign plan we see the beauty of children. Children hold promise for this present life in more ways than we can count. There are just the joys of watching them grow and develop, speaking their first words, taking their first steps, continuously acquiring greater and greater capabilities. It's really a stunning thing to watch. I've mentioned this before, but I still can't get over it. When Christy and I were missionaries in Japan, the first year our primary job was to learn the language, the Japanese language. And that was hard. And I'll never forget, we had tutoring sessions, we had books, we had tapes, we had flash cards, we had all these things going on. We also had a one-year-old daughter named Jenny who came over with us basically inarticulate, and left two years later fluent in English. No flash cards, no tapes, nothing, no effort. I was so jealous. It's like, "How can this be?" And I figured there was some corresponding Japanese kid who was one-year-old when he came over, couldn't speak a word of Japanese. Two years later, fluent, conversational. And I just think it's amazing, going on right before your eyes as it's happening. It's a marvel. So also you parents can testify how many earthly blessings have come to you from having children. The unforgettable moments, the things that can never be repeated and you treasure forever. I have drawers and drawers of memorabilia. What am I going to do with it? I don't know, but I'm not giving them away. Toward the end when the kids were getting older, I didn't accept just any art work, it had to be good. Okay? They had to have put some work into it, there had to be some thought. Just a couple of scribbles and crayon on the… We're not putting that on the refrigerator. But if you worked at it we would put it up on the fridge and it would be there for a while. And then I'd take it down. And I learned in the course of time to write on the back the circumstances, because what happens is, five years later it's like I don't even know what it is. Is it a tree, is it a mountain? I don't know. When was it given? But to write on the back who gave it when, same thing with cards, different things that are written, it's just absolutely precious. At every moment the way they just look up to you for approval, for love, the way that they just trust you at an early stage, the way that they are obedient at a certain level, and the way they just grow and grow and grow before your very eyes. I've likened them before to a sunset. You can just picture that, and just the colors of it. And it's just different colors and it's continually changing so that if you look away for just a minute or two and talk to your friend and look back, it's different now. And that's the way it is with the children. They go through these stages, and you can't hold on, they're not going to be in them for long. They mispronounce a word, kind of really cute. And you actually want, at least I did, wanted them to keep mispronouncing the word because it was so cute. But they don't, they learn how to say it right. But it's just these sweet things. And then they just keep growing and they challenge you and they ask questions and you share experience. You go to national parks together and you share that, and they remember that. Pretty soon, they're teens, and they're so intelligent, so gifted, so full of promise, so aware of your failures and weaknesses. Acutely aware. And you know it, and it's an interesting relationship, and you're just kind of along for the ride, and you're able to celebrate their amazing achievements academically or in athletics, or in music, or art, or other things that they love to do, things that are different than you love to do. And then come the later blessings as the kids get even older, walking your daughter down the aisle to give her to somebody else's precious son. Or seeing your son receive somebody else's precious daughter. And to be commanded by your son to do that wedding and not cry. That's just cruel. How am I going to get through a wedding like that and not cry? He asked me if I could, he's not here, so I can just talk about him. "Dad, I want you to be my best man." I remember he said that to me. "But I also want you to do the service. Can you do both?" I said, "I don't think so because the best man stands over here and I'll have to stand here. So the only way could do it is if I wear a sign, 'By the way, I'm also best man.' So that's not really going to work." But my daughters have asked, are you going to both walk me down the aisle and then receive me?" And I haven't figured that one out yet. I got maybe some time on that one. But all of those things. And then,. I've been told, we don't have this experience yet. But grandchildren come in and you have most of the blessings and almost none of the challenges. Amen, hallelujah. Looking forward to that. So we're looking for all of that. The Challenge of Children But then you've got the challenges of children too, and we have to be honest about that. Honestly, the challenges of the parent-child relationship is caused by the spiritual warfare that we're about to get into in Ephesians 6, and by indwelling sin. The Bible teaches the clear doctrine of Original Sin. Every human baby is born in Adam, and they come into your family with that Adamic nature, a commitment to sin. Romans 5:12 says, "Sin entered the world through one man, and death through sin, and in this way death came to all men because all sinned." You have to meditate on the words "because all sinned". Every human sinned in Adam. And so it says in 1 Corinthians 15:22, "In Adam all die." And we've seen in Ephesians 2:1 that we were dead in our transgressions and sins in which we used to live. And verse 3 in that same chapter, "All of us also lived among them at one time, gratifying the cravings of our flesh and following its desires and thoughts, and like the rest, we were by nature objects of wrath." Now, this sin nature may not be obvious to new parents immediately when their precious little child is wrapped up in a sweet smelling blanket. But what it is, is, as I've mentioned before, fanatical commitment to self-interest. And that you can see immediately in an infant. That fanatical commitment to self-interest is the essence of the trouble you'll have in raising them. And you have the same thing too. There was a police study in San Francisco on juvenile delinquency, this is cited by Jim Eliff. These are striking words, because they're not written from a Christian perspective, they were just written from a secular policing perspective. This is what it said. "Every baby starts life as a little savage. He is completely selfish and self-centered, he wants what he wants, his bottle, his mother's attention, his playmate's toys, his uncle's watch, or whatever. Deny him these and he seethes with rage and aggressiveness, which would be murderous were he not so helpless. He is dirty, he has no morals, no knowledge, no developed skills. This means that all children, not just certain children, but all children, are born delinquent. If permitted to continue in their self-centered world of infancy, given free rein to their impulsive actions to satisfy everyone, every child would grow up a criminal, a killer, a thief, a rapist." Well, that's the essence of parenting, the negative side of parenting, is that's what you're facing, the sin nature. Fanatical commitment to self. "That's the essence of parenting, the negative side of parenting is that's what you're facing, the sin nature. Fanatical commitment to self." Along with that, as I just mentioned in passing, but it's very much the issue as well. We ourselves, even redeemed in Christ, we still have that flesh nature. We still have a fanatical commitment to self in there too. So we struggle with pride, we struggle with anger, we struggle with sins and selfishness and habitual patterns of evil. And our children, I have found, pick those up much more readily than they pick up our good habits in Christ. They pick up your particular habits and patterns, which is a great source of shame to parents, where they can see that in their own kids. The Future of American Parenting So, beyond that there's a constant demonic satanic side, and a world side, that Satan is cleverly assaulting your children's souls, and the world is pouring acid on them as you seek to develop them, etcetera. And so you've got all of this at work. Furthermore, we just need to understand the future of American parenting. Where are we going? Where are we heading here? I do fear for the future of our country. I already hinted at it in my prayer. But we have moved quickly beyond gay marriage at this point to an acceleration of wickedness and bizarreness that I just don't know where we're heading as a nation, as a culture. And there is a direct worldly attack on the right and responsibility of Christian parents to bring their children up in the Gospel of Jesus Christ. You're going to see that more and more. I believe that the government is going to try to put a wedge between Christians and their children, and assert their right to indoctrinate our children. It's happened many, many times before. We, Christian fathers, feel the authority and the responsibility we have to say to the surrounding pagan world, in the words of Joshua 24:15, saying to the pagan world, "If serving the Lord seems undesirable to you, then choose for yourselves this day whom you will serve, whether the gods your forefathers served beyond the river, or the gods of the Amorites in whose land you are now living. But as for me and my household, we will serve the Lord." But I was on a website recently that said every child should have the freedom to choose for himself or herself what religion they will follow. The website is, I don't know how to pronounce this, but humanium.org. Wow. Listed the fundamental rights of children. Right to Freedom. "Children have the right to have an opinion different from their parents." By the way, they know that. "I have an opinion different from you." I'm aware. Alright. "A child should not be the victim of the pressure of an adult who would try to force him or her in order to influence them in their opinion." That's just called parenting. I'm sorry, I'm editorializing. Let me just read. "Children have a right to be informed, so they can make their own minds up about important subjects." Now, next heading, Freedom of Religion. "Children have the right not to undergo constraint or oppression which will injure their freedom of religion or other rights. Children can freely determine the religion or conviction of their choice. A religion doesn't have to be imposed on them." So basically, I'm supposed to, as a father, just be a world religion instructor. "This is what Buddhism teaches, this is what Hinduism... So now you make your own decision." It's actually abusive then it seems to bring them up “in the nurture and admonition of the Lord.” My daughter Carolyn showed me a tweet sometime ago that shocked me at how weird things are getting. It said effectively that it's child abuse to name a newborn baby before they've had a chance to choose their own gender. I don't know how that works. "Baby one, baby two." Here, the tweet said, "Use gender inclusive pronouns like baby-self or toddler-self until they are old enough to make their own choice." So in the name of individual freedom, all children should be free to choose everything for themselves, and not have anything forced on them. And yet it's plain that in the Bible parents are to bring their children up “in the nurture and admonition of the Lord.” Borrowing from the old covenant language in Deuteronomy 6:7-9, they're talking about these precepts and ordinances, but I'm going to just talk about the Gospel of Jesus Christ. "Impress them", the words of God, "On your children. Talk about them when you sit at home and when you walk along the road, when you lie down and when you get up. Tie them as symbols on your hands, bind them on your foreheads, write them on the door frames of your houses and on your gates." If I can just summarize, brainwash your kids. Just brainwash them in the word of God. Let them be transformed by the renewing of their mind, because I'm telling you, the world will try to do it. It's not going to stand idly by, it's going to try to brainwash your kids in its direction. Along with this is the danger, as I just mentioned a moment ago, of ever encroaching government rights to the training of the future generation. Reading about what school was like in Nazi Germany in the 1930s, basically every child there was indoctrinated in Nazi ideology, and frequently got to the point in their teen years where then they would start turning their parents in to the Gestapo. So also the same kinds of things happened in communist countries during the Cold War. John McArthur cited a letter he received from a man in his church who emigrated from Czechoslovakia during the Cold War. This is what he said. "My wife and I experienced the dissolution of the family unit by the communist government. From our own experience, the godless doctrine pumped into our little children's souls brought up the most cynical generation you can imagine." Parenthetically, less than 1% of Czechs in the Czech Republic are believers. 93% are atheists. But this individual said, "Most young people do not believe in anything, not even God. The godless system destroyed, in great part, the will of the people and produced an obeying array of cynical and different disposable robots. The same thing is beginning to happen to us now in this country." So, blessings and challenges. God’s Goal for Parenting: His Glory in their Salvation What is the Purpose of Parenting Let's talk about God's goal for parenting, and that is His glory. Now, your outline says they're salvation, but I'm going to actually amend it. God's goal in parenting is His glory in your salvation too. So, just put "... His glory in their salvation... and yours." because God's going to be at work in both of you, and you're not any of you done being saved. So God has a wise purpose in all of this. Okay? So what is the purpose of parenting? I would say it's the exact same purpose of why God made the world. His glory, ultimately. God made all things for His glory. And the thing that glorifies him the most is the salvation of human souls. So that's the goal of parenting too, is His glory in the salvation of your children and of yourself. But let's focus on the children. Key Verse A key verse I use for parenting is one with which you should be very familiar. It's in Mark 8:36-37. "What good would it be? What would it profit a man if he should gain the whole world and forfeit his soul?" Or what would a man give in exchange for his soul? So let me put that in parenting language. “What good would it be for your child if he or she should gain the whole world, whatever that means, and forfeit their souls? And what would you give in exchange for the souls of your children?” I know parents want to give their children so many good things. Good character, education, fine clothing, a comfortable lifestyle, fruitful career, athletic success, academic achievement, acceptance at a prestigious college. All the material blessings of prosperity, good morals, legacy, heritage, sweet memories, all of that. All of those earthly blessings are sweet, good things from God. But what would it profit you or your child if they gained all of them and they had to hear on Judgment Day, "Depart from me, you who are cursed, into the eternal fire prepared for the devil and his angels"? What good would it be if after they've been well-fed, well-clothed, well-educated, well-employed, worldly successful, you can boast to all your friends in your retirement home about what your kids are achieving and all that, if in the end they're lost, then what good would it be? So my desire in this sermon and next is that God would be glorified in the salvation of your children. That's my center desire. “You Didn’t Come with a Training Manual!” So, let's turn to the text, and here's the text, the Bible. I remember my father used to say to us in exasperation, because we drove him crazy, and we did. But he said, "You didn't come with a training manual." Here it is. Here's the training manual. The Bible is sufficient for raising your children “in the nurture and admonition of the Lord.” I'm not saying there's not good materials out there, there are. But it's sufficient. Here again, 2 Timothy 3:15-17. "How from infancy you have known the Holy Scriptures, which are able to make you wise for salvation through faith in Christ Jesus. All scripture is God-breathed, and is useful for teaching, rebuking, correcting and training in righteousness, so that the man of God may be thoroughly equipped for every good work." That sounds like parenting to me. Thoroughly equipped and ready for any good thing God wants them to do. Now we're focusing this morning on 6:1-3, that's the command to the children. Next week I want to focus, God willing, on the command to fathers and mothers, parents. God’s Command to Children: Obey and Honor Your Parents So, the words are going to come to children, but I want the parents to listen as well because it's the parent's job to hold these commands over their children and pray toward and act toward them obeying them. If the parents don't train their children to honor and obey them, they never will. And so the parents really need to embrace these words before the children do. These commands need to be on your heart, and then you can impress them on your children. Alright? So God's command to children is, "Obey and honor your parents." That's the order it gives in the text. Children are Those Who are Still Dependent on Parents Look at it, "Children, obey your parents in the Lord, for this is right. Honor your father and mother, which is the first commandment with a promise, that it may go well with you and that you may enjoy long life on the Earth." The address is to children, and the first command here that's given is, "obey." Now, you may say, "Alright, does this go on forever?" No, it doesn't. I think the word children would be certainly minors and teens and all that. And then on up until they are no longer dependent on you financially. There's still a pattern of obedience in Jacob's life. It says in Genesis 28:7, "Jacob had obeyed his father and mother and gone to Paddan-aram to seek a wife." The word obey is there. Now, I do not need to obey my mother anymore. When I got married, I left my father and mother, and I was united to my wife, and I started my own home. I need to honor her the rest of our lives, but I don't need to obey her. So there is a weaning off of parental obedience until they're on their own. That's the challenge. The Meaning of “Obey” Now, the word “obey” has to do with external behavior patterns. So the text in the order it gives us here is, I think, wise. Parents, to some degree, work on your children's external patterns of compliance, that they would obey you. And then it moves to honor, which is something from the heart. Our goal is a heartfelt obedience that's a genuine work of grace. But it starts with this idea of obey. And it means literally to hear under, it means to submit as in Ephesians 5:21, "Submitting to one another in the fear of Christ." Submission is obedience to God-ordained authority. Authority I define as the God given right to command, the God-given right to command. Parents have that. I feel like we're too squeamish about it. You have this sense of weakness. But we have the right and responsibility to give wise, loving, godly commands to our children. And so, from infancy, they need to be trained to obey their parents. This is coming straight from God. Before they have the capacity to comprehend an invisible being who created them and whom they must obey above all, almighty God, they must first submit their wills to their parents who they can see and be trained to obey them. And they need to be taught that their obedience to their parents is ultimately obedience to God. So that's what you're teaching them. The Moral Beauty of Obedient Children Now, what is obedience? We covered this this morning in Bible for Life in the parenting class. I love it, and it's something that I heard years ago from a parenting curriculum that Kristy and I used early on. And it defined obedience in the pattern, I think, of Matthew 6:10. "May your kingdom come, may your will be done on earth as it is in Heaven." So how is God obeyed in Heaven? And what this curriculum writer said is, "That the angels obey God all the way, right away, with a happy spirit." So those were the standards we used for our kids. All the way means everything we said to do, 100%. So 80% obedience, that's not obedience. Right away means now. It's not hard. Now. No, not later. Now. Okay? No delay. To delay is to disobey. And with a happy spirit means we're ultimately trying to get to the heart. We want you to delight in the commands that were given and see them as wise. Now, this pattern is for infants and young children and going up. And there's this pyramid where you're going to be early on covering your kids lives with commands, just covering them, papering them over with commands when they're young. And then dimmer switch turning them down more and more, until at last, they're ready to just take over their physical lives and look after themselves. And so, there's going to be all of these commands. Now, children it says are to obey their parents “in the Lord.” In the Lord means with a mind to Christ, you're looking to Christ. It implies the parents better be giving godly commands to them. So all authority is ultimately under Jesus. And we see the moral beauty of the obedience. "Children obey your parents in the Lord for this is right." The word gives a sense of morally beautiful. It's attractive when you have an obedient son or daughter. It's just delightful. The Ten Commandments And then he quotes the Ten Commandments. "Honor your father and mother, which is the first commandment with a promise that it may go well with you and that you may enjoy life on the Earth." Now, here's the complexity. I've meditated on this a lot in the last couple of months. The hard thing about Christian parenting is how we have to harmonize or synthesize the Old Covenant and the New Covenant. That's really hard to do. The kids are under the Law, they're under the Old Covenant. They're under the tutor, so to speak, until they are brought to Christ. So they have to be trained, in effect, just like the Jews were in the language of blessings and curses. This is what we've got, this is what you have to do, and this is what will happen if you don't do it. That's what we call in our family the if-then chart. "If you do this, this is what will happen." Alright? That's early on. And then as you go further and further in, you're wanting them to move into a New Covenant walk with Christ. In which from the heart, from a transformed nature, they are loving God and loving His Law, and His commands, and by the power of the Spirit, are fulfilling the Law. And that's the challenge. You need to therefore, teach them the fullness of what the Law means. Talk about how when the Ten Commandments were given what the circumstances were, how God descended from Heaven in fire to the top of Mount Sinai, and how the ground shook beneath their feet, and how it became supernaturally dark. And how God spoke with a voice so loud and so terrifying that everyone in the camp trembled and they begged to not hear that voice anymore. "I am the Lord your God who brought you out of Egypt." And He is the one who's saying, "Honor your father and mother." So there's a sense of the terror of the Law, a sense of the judgment that comes if there's disobedience to the Law, all of that has to come. But that's not enough, that's not enough. You have to move from the Law to the Gospel. And so it says in Romans 3:20-24, "Therefore no one will be declared righteous in his sight by observing the Law." They're not going to get saved by obeying you. They're not going to get saved by the Law. Instead they're going to find out that they're sinners in need of a savior by the Law. And so, Romans 3:20-24, it says, "No one will be declared righteous in His sight by observing the law, rather through the Law we become conscious of sin. But now a righteousness from God apart from the Law has been made known to which the Law and the prophets testify. This righteousness from God comes through faith in Jesus Christ to all who believe. There is no difference, for all have sinned and fall short of the glory of God, and are justified freely by His grace through the redemption that came by Christ Jesus." So you're going to want, every time they sin and you're disciplining them and you're training them, to preach the Gospel to them, to tell them that Jesus came for exactly these kinds of sins. Jesus came to take out the heart of stone and to give you the heart of flesh. Jesus came to change your very nature. "They're not going to get saved by obeying you. They're not going to get saved by the Law. Instead they're going to find out that they're sinners in need of a savior by the Law. " What is the Command? Honor Your Father and Mother And so, the command here given to the child is fascinating. "honor." "Honor your father and mother." What does that mean, “honor”? Been thinking about this. It's related to worship, I think. But it's obviously at a lower level. You only worship God. But it has to do with an esteem, it comes from the heart, a respect. Love is involved in there, but it's a sense of esteem and honor in the family of, or the relationship of worship. But ultimate honor is given to God in worship. And so the idea here is a heart attitude of respect toward the parents. I honor my father, I honor my mother. And that's something that parents have to teach to their children. Do you teach your children to honor you? Do you teach, each of you, teach your child to honor the opposite parent? The father's telling their children to honor their mother, and not speak disrespectfully. And the mother doing the same thing in reference to the father. A heart attitude. Now, we, as parents don't have power over the heart. I can't make my child honor me, something they do with their heart. But I can show them the word, I can pray that God would work in them, I can yearn for the Holy Spirit to work this. Now, as your kids get older, as they get to be teens, as I already mentioned, it's not funny but it's just true, they just know your sins. But here's the thing, you don't have to be a sinless parent to be worthy of honor. You're worthy of honor because you're the father or the mother. Do you member when Noah got drunk and lay exposed in his tent? Remember that story in Genesis 9? And how one son, it seemed, mocked him. But two other sons put a cloak on their shoulders and walked in backward and covered their naked father. That's a timeless lesson on how you honor a sinful parent. The requirement to honor is not tied to how righteous your father and mother is, but to God's will. Now, what is the promise that comes to children? Well earthly and heavenly blessedness. "Honor your father and mother, which is the first commandment with a promise, that it may go well with you and that you may enjoy long life on the Earth." So there's a promise here. It zeros in on a promise. This is the first commandment that gives you a promise. And it's blessedness, it's going to go well with you, you're going to have a good rich blessed life if you do this. And long life, in other words you won't be struck dead. I meditate on this. There is an Old Covenant feel here and both quality and quantity of life is linked to honoring your parents. We know that God struck two of Judah's sons dead. Ur was wicked so God put Him to death, and Onan was wicked so God put Him to death. Nadab and Abihu were struck dead by fire that came out from the Lord because they were irreverent. Ananias and Sapphira, this happened in the New Covenant era, God struck them dead for their lying. So children, honor your father and mother so that you may live long on the earth, and that it may be a richly blessed life, a quality of life. Ultimately, this is what I yearn for. Early conversion, growth and discipleship from these kids, a development in spiritual gifts and knowledge of the Word of God so that they are unleashed in ministry for the Lord, just as James Paton did for John Paton. That's my desire. Application Value Children as Fellow Image-Bearers So, quickly, applications. Start by just delighting in the blessings of children. Behold, they are “fearfully and wonderfully made.” “God knit them together in their mother's wombs.” Cherish them, they are created in the image of God. They're not yours to command like they're your slaves. Alright? They are precious human beings. As I said about the husband-wife relationship, by far more significant than that she's wife is that she's human, and redeemed. And the same thing is going to end up true of your children. Far more significant that they're your children is that they are created in the image of God, and that they can believe the Gospel. So cherish them, and just cherish these times. You know what I mean. You older parents know exactly. The days, the years go by like the wind. Like the wind. Don't waste these days, don't waste the time. So parents, embrace your responsibility to bring your children up in the nurture and admonition of the Lord. More next week. Embrace your responsibility to preach the Gospel to them. "How from infancy they have known the Holy Scriptures." Saturate them. Spurgeon’s Thoughts of Child-Rearing Charles Spurgeon said this, "Some wrongly say, 'Do not teach your children, they'll be converted in God's own time, if it be His purpose. Therefore leave them to run wild in the streets.' Well, people who do that will certainly both sin against the child and the Lord Jesus. We might as well say, 'If that patch of ground over there is to grow a harvest, God will do it if it's God's good pleasure. Therefore, leave it and let the weeds overgrow it. And do not endeavor for a moment to kill the weeds or to sow any good seed.' Why such reasoning as this would not only be cruel to our children, but grievously displeasing to Christ.” Parents, I do hope you are all endeavoring to bring your children to Christ by teaching them the things of God. Let them not be strangers to the plan of salvation." This is Spurgeon, listen though. "Never let it be said that a child of yours reached years in which his conscience could act, and he could judge between good and evil, without knowing the doctrine of the atonement. Without understanding the great substitutionary work of Christ. Set before your child life and death, Hell and Heaven, judgment and mercy, his own sin, Christ's most precious blood. And as you set these things before him, labor with him, persuade him as the apostle did his congregation with tears and weeping to turn unto the Lord. And your prayers and supplications shall be heard so that the Spirit of God shall bring them to Jesus." Say a final word to children, especially to teenagers. Let me speak directly to you teens. By now you are fully aware of your parents' strengths and weaknesses. By the way, they do have some strengths. You'll find that out more and more as you get older. But it is your time now, and these words I think are most understandable to you, because they are written to you. "Children, obey and honor." That's what God's calling on you to do. Remember how Noah's sons were blessed by respecting their father, even at his weakest, most sinful moment. Ask the Lord to give you a heart of honor toward both your mother and father. Ask Him to bless you with long life in the richness of the Gospel. And you younger children, I'm almost done, praise God. Love your parents, do what they tell, study the Bible, pray, ask your mom and dad questions that are on your hearts. And mom and dad be ready for them to do it, because they'll keep saying, "Why, why, why?" Until you have no other answer, and just say, "Because God wanted it that way, that's why." Close with me in prayer. Prayer Father, we thank you so much for children. We thank you for the blessing that they are. Thank you that this church is so lavishly blessed. Every year, O Lord, at Mother's Day we see how many babies were born in our church, and as their parents yearn to dedicate them to Christ. We thank you for the blessing. We thank you for how we can see, at every stage, children that we've been blessed with. Lord, give parents grace to parent well, and give the children grace to be obedient and to honor. In Jesus' name, amen.