Podcasts about Caris

In this episode, we're thrilled to have our guest Caris join us! Get ready for a lively discussion as we explore the hilarious idea of a nightmare blunt rotation, share which body part we'd choose to apologize to, and reminisce about our unforgettable 21st birthday celebrations.Sponsor:https://www.instagram.com/attorneydallas/Socials:https://www.instagram.com/brewsandbanter_pod/

"Le Classico" de Sébastien Ministru : « Le Quai de Ouistreham » de Florence Aubenas. En 2009, Florence Aubenas part pour Caen et s'inscrit au chômage, avec un bac pour tout bagage et sans révéler qu'elle est journaliste. À Pôle Emploi, on lui propose de saisir sa chance : devenir agent de propreté dans des entreprises. Le Quai de Ouistreham est le récit saisissant de cette plongée dans le monde de la précarité. Un monde où on ne trouve plus d'emploi, mais des « heures ». Merci pour votre écoute Entrez sans Frapper c'est également en direct tous les jours de la semaine de 16h à 17h30 sur www.rtbf.be/lapremiere Retrouvez l'ensemble des épisodes et les émission en version intégrale (avec la musique donc) de Entrez sans Frapper sur notre plateforme Auvio.be : https://auvio.rtbf.be/emission/8521 Abonnez-vous également à la partie "Bagarre dans la discothèque" en suivant ce lien: https://audmns.com/HSfAmLDEt si vous avez apprécié ce podcast, n'hésitez pas à nous donner des étoiles ou des commentaires, cela nous aide à le faire connaître plus largement. Vous pourriez également apprécier ces autres podcasts issus de notre large catalogue: Le voyage du Stradivarius Feuermann : https://audmns.com/rxPHqEENoir Jaune Rouge - Belgian Crime Story : https://feeds.audiomeans.fr/feed/6e3f3e0e-6d9e-4da7-99d5-f8c0833912c5.xmlLes Petits Papiers : https://audmns.com/tHQpfAm Des rencontres inspirantes avec des artistes de tous horizons. Galaxie BD: https://audmns.com/nyJXESu Notre podcast hebdomadaire autour du 9ème art.Nom: Van Hamme, Profession: Scénariste : https://audmns.com/ZAoAJZF Notre série à propos du créateur de XII et Thorgal. Franquin par Franquin : https://audmns.com/NjMxxMg Ecoutez la voix du créateur de Gaston (et de tant d'autres...)

Kühlschrank, Toaster, Staubsauger, Wecker, Klobürste - es gibt viele Gegenstände, die man im Haushalt tagtäglich benutzt. Wir bewerten heute typische Haushaltsgegenstände und -geräte. Am Ende haben wir eine besondere Challenge für euch!   Transkript und Vokabelhilfe Werde ein Easy German Mitglied und du bekommst unsere Vokabelhilfe, ein interaktives Transkript und Bonusmaterial zu jeder Episode: easygerman.org/membership   Sponsor Lingoda: Commit to your New Year's resolution with the Lingoda Flex. Get a 10% discount and up to 45 free private classes when you sign up today with our code EASYPOD2025: try.lingoda.com/EasyPod2025 Hier findet ihr unsere Sponsoren und exklusive Angebote: easygerman.org/sponsors   Top oder Flop: Haushaltsgegenstände Caris neuer Staubsauger: Dyson V12 Detect Slim Absolute Manuels Lichtwecker: PHILIPS SmartSleep Wake-up Light   Wichtige Vokabeln in dieser Episode das Haushaltsgerät: Gerät oder Maschine, die in der Wohnung oder im Haus verwendet wird, um alltägliche Aufgaben zu erleichtern, wie z.B. Kochen, Putzen oder Wäschewaschen der Gegenstand: Ding oder Objekt, das man berühren kann und das einen bestimmten Zweck oder Nutzen hat die Truhe: großer, oft rechteckiger Behälter mit Deckel auswringen: Flüssigkeit aus einem feuchten oder nassen Objekt entfernen, indem man es fest zusammendrückt und verdreht das Luxusgut: Gegenstand von hoher Qualität und oft hohem Preis, den man nicht zwingend braucht der Zungenbrecher: Satz oder Phrase, die schwer auszusprechen ist   Support Easy German and get interactive transcripts, live vocabulary and bonus content: easygerman.org/membership

The boys discuss nerdy news on todyay's Nerd Report like David Lynch's passing, Elon Musk's lying about his gaming skills, and the announcement of the Nintendo Switch 2. Also, what is the origin of the practice of knocking on wood? CJ and Spenny discover on today's Did You Know!? And Austin Chronicle editor Caris stops by to highlight this year's Music Awards poll. Support the show: https://www.101x.com/cjSee omnystudio.com/listener for privacy information.

Caris, Kenny, and the Cavs destroyed the Nets in Brooklyn, behind a tremendous bench showing and super efficient frontcourt play.  Caris exploded for 19 in the first half, Georges cut up the Nets on the interior, and Kenny got a win against his former team as the Cavs set the stage for a matchup with the Bucks on Friday. Bob Schmidt, of Fox Sports Radio, breaks it all down.

Lauren Caris Cohan is a filmmaker and the chief creative officer of the chic and sustainable womenswear brand Reformation. Lauren got her start as a styling assistant at Free People in Philadelphia in the late 2000s, eventually working her way up to the title of artistic director. While looking to pursue a newfound interest in screenwriting, she was given carte blanche to create a series of narrative short films for the brand. In 2017, she left the company to look for new opportunities to explore filmmaking. She consistently worked on her projects, creating short films, writing scripts, and co-founding a creative services agency called Lolly Would. In 2017, she co-founded the industry-disrupting lingerie brand Cuup, again bringing her distinctive creative flair to craft the storytelling around the start-up. In 2020, she was brought in by Reformation to consult on projects, and in 2022, she was appointed the role of chief creative officer. In her time as CCO, she's guided Reformation through some truly amazing collaborations—from the New York City Ballet to Monica Lewinsky.See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

For another take on Catholic parts work look like in action, join Marion Moreland as she accompanies Caris in connecting, understanding, and loving Caris' parts – not just the manager parts who are usually in front, but also some of Caris' hidden exiled parts in this demonstration. Sarah is present in an observing role. This demonstration illustrates very typical ways of accompanying parts in inner work. Marion and Caris address themes of striving for productivity and perfection, control and rebellion, the pain of love rejected, among others and escape, and self-soothing. You are invited into the “observer role” with Sarah to connect with your own parts in your human formation as you experience the demo and your parts resonate with parts coming up in Caris' work. 

JCO PO author Dr. Alok A. Khorana, MD, FASCO, Professor of Medicine, Cleveland Clinic and Case Comprehensive Cancer Center, shares insights into the JCO PO article, “Molecular Differences With Therapeutic Implications in Early-Onset Compared With Average-Onset Biliary Tract Cancers.” Host Dr. Rafeh Naqash and Dr. Khorana discuss how multiomic analysis shows higher FGFR2 fusions and immunotherapy marker variations in early-onset biliary cancer. TRANSCRIPT Dr. Rafeh Naqash: Hello, and welcome to JCO Precision Oncology Conversations, where we bring you engaging conversations with authors of clinically relevant and highly significant JCO POarticles. I'm your host, Dr. Rafeh Naqash, Podcast Editor for JCO Precision Oncology and Assistant Professor at the OU Health Stephenson Cancer Center at the University of Oklahoma.  Today, we are joined by Dr. Alok A. Khorana, Professor of Medicine at the Cleveland Clinic and Case Comprehensive Cancer Center, and also the Senior Author of the JCO Precision Oncology article titled, “Molecular Differences With Therapeutic Implications in Early-Onset Compared With Average-Onset Biliary Tract Cancers.”  At the time of this recording, our guest disclosures will be linked in the transcript.  Dr. Khorana, it's an absolute pleasure to have you here today, and welcome to the podcast. Dr. Alok A. Khorana: Thank you. It's an absolute pleasure to be here and thank you for highlighting this article. Dr. Rafeh Naqash: Absolutely. We're going to talk about science, obviously, and a few other things. So to start off, for the sake of our audience, which comprises academicians and community oncologists as well as trainees, can you tell us a little bit about biliary tract cancers, what we have learned over the last decade or so, where the standard of treatment currently lies. And then we can dive into the article that you published. Dr. Alok A. Khorana: As many of you who treat GI cancers know, biliary tract cancers for a long period of time were sort of the orphan cancer in the GI cancer world. They're not nearly as common as, say, pancreatic cancer, and certainly not as common as colorectal cancer. They're sort of also, in this weird ‘no man's land' between well known sort of adjuvant therapy trials in pancreatic cancer or colorectal cancer, but because they're not as high in volume, there weren't really large trials done in this population. What's really changed in the past decade, especially, has been the slow but sure realization that biliary tract cancers are in fact a target rich cancer, almost similar to what you would see with lung cancer, and that's only a slight exaggeration. And in some studies, as many as up to 40% of patients with biliary tract cancers can have something that's targetable. And that's really revolutionized the way we think of biliary tract cancers. It also separated this field from pancreatic cancer where formerly the two used to be lumped together, and even within biliary tract cancers, we are now slowly realizing that there are differences between intrahepatic, extrahepatic and gallbladder cancers. Big change is really afoot in this field, particularly with the identification of mutation directed targets. Dr. Rafeh Naqash: Thank you for that explanation.  Now, another question I have is, although I don't see any GI cancers, but I have good colleagues of mine at our cancer center who see a lot of GI pancreatic/biliary cancers, and one of the things that comes up in our molecular tumor board often is how certain cancers of unknown primary end up being identified or categorized as biliary tract cancers based on NGS. And again, the uptake for these NGS is perhaps isn't optimal in the field yet, but in your practice, how do you approach situations like that? Do you use NGS in certain cases where the tissue of origin or the patterns of the mutations indicate that this might be biliary tract cancer and then treat the patient accordingly?  Dr. Alok A. Khorana: Yeah, that's true. And that's certainly how I approach things, and I would say even in my own personal practice, that has been a change. I was a little bit skeptical about the benefit of sort of tissue of origin type of testing in carcinoma of unknown, primarily, especially if you can sort of narrow it down to one or other area of the GI tract. But with the identification of sort of targeted subpopulations, especially of biliary tract cancer, I think it's become imperative. And I know we're going to get into the paper, but if you want to learn nothing else from this 20, 25 minute podcast, one lesson I just want to make sure everybody gets is that any patient with biliary tract cancer should have NGS done as soon as possible. Dr. Rafeh Naqash: Thank you for highlighting that important aspect.  Now, going to the topic at hand, what was the driving factor? I've heard a lot about colorectal cancers, early onset versus later onset. What was the reason that you looked at biliary tract cancers? Is that something that you've seen on a rise as far as early onset biliary tract cancers is concerned?  Dr. Alok A. Khorana: Yeah. So we got into this subject also from starting out at colorectal cancer. And as you know, and I'm sure most of your audience knows, there's been a lot of literature out there over the past five, six, seven years suggesting and then documenting and then sort of proving and reproving that colorectal cancer is on the rise, and especially in people younger than age 50. And even in that population, it's on the rise in two different subpopulations, people in their 20s and 30s and then people in their 40s that are close to the screening colonoscopy rates. That's been investigated heavily. We still don't fully understand why that's happening, but it's not restricted to the United States. It's a worldwide phenomenon. You can see it in the United States, in North America. You can see it in western Europe, but you can also see it in many Asian countries with specific sort of subpopulations. For instance, in some countries, men are more likely to have early onset cancers.   And then a newer finding that sort of emerged over the past couple of years is that this early onset increase in cancers is not just restricted to colorectal cancer, although that's the one that sticks out the most, but in fact, is widespread across a bunch of different types of cancers. In my own research program, we had gotten into a sort of better understanding of early onset colorectal cancer a couple of years ago, driven primarily by the sort of patients that I saw in my practice. And it's just, as you know, when you have a couple of those heartbreaking cases and they're just impossible to forget, and it sort of just drives your attention, and then you want to do something to help them. And if you can't help them personally, then you want to do something that can change the field so that more of these patients are not coming in your clinic next year or the year after.  So a couple years ago, at the Cleveland Clinic where I practice, we created a center for young onset cancers, and at the time it was primarily focused on colorectal cancer. But as we are getting into colorectal cancer, we realize that beyond colorectal cancer, we are also starting to see more younger people with other cancers, including pancreas cancer, including gastric cancer, and including bile duct cancers. And we realized that because so much attention was being focused on colorectal, that maybe we should also be paying a little bit of attention to what was happening in this space. I want to, for your listeners, point out that the problem in bile duct cancers is not to the same degree as you see in colorectal cancer. Just a couple numbers to sort of, to set this in perspective: about 5%, 7% of bile duct cancers are young onset - it's not a huge proportion - 90%+ percent of patients are not young onset. But the impact on society, the impacts on those providing care, is obviously substantial for younger patients. And it is true that even though the proportion of patients is not that high, the incidence is rising.   And there's a very nice study done a couple of years ago and published that looked at what the cancers are that are rising at the highest rates. And bile duct cancer and gallbladder cancers were listed amongst the two with the highest rate, so about an 8% rate per year of increase. And so that's really what drove our interest was, as we're seeing early onset bile duct cancers, it's rising year by year, and what is this disease? Is it the same as you see in sort of the average patient with bile duct cancer? Is it different? How do we characterize it? How do we understand it? What are some of the causes precipitating it? And so that's what led us to sort of one of the investigations that we've documented in this paper.  Dr. Rafeh Naqash: Excellent.   So, talking about this paper, again, can you describe the kind of data that you use to understand the molecular differences and also look at potential immune signatures, etc., differences between the groups? Dr. Alok A. Khorana: Yeah. So the objective in this paper was to look at genomic differences between early onset and usual onset, or average onset biliary tract cancers. And this sort of followed the paradigm that's already been established for early onset colorectal cancer, where you take a bunch of people with early onset disease, a bunch of patients with average onset or usual onset disease, and then look at the profiling of the tumors. And we've done this for genomics, we've done this for microbiomics, we've done it for metabolomics. And the lessons we've learned in colorectal cancer is that, in many ways, the profiles are actually quite substantially different. And you can almost think of them as diseases of the same organ, but caused by different processes, and therefore leading to different genotypes and phenotypes and microbiomes. We had absorbed that lesson from colorectal cancer, and we wanted to replicate it in this type of cancer.  But as we discussed earlier, this is a relatively rare cancer, not that many cases per year. For colorectal, we could do a single institution or two institution studies. But for this, we realized we needed to reach out to a source of data that would have access to large national data sets. We were happy to collaborate with Caris Life Sciences. Caris, many of you might know, is a provider of genomics data, like many other companies, and they house this data, and they had the age categorization of patients less than 50, more than 50. And so we collaborated with investigators at Caris to look at all the specimens that had come in of bile duct cancers, identified some that were young onset and some that were older onset. It was roughly about 450 patients with the early onset or young onset, and about 5000 patients with usual onset cases. And then we looked at the genomics profiling of these patients. We looked at NGS, whole exome sequencing, whole transcriptome sequencing, and some immunohistochemistry for usual, like PDL-1 and MSI High and things like that. And the purpose was to say, are there differences in molecular profiling of the younger patient versus the older patient? And the short answer is yes, we did find substantial differences, and very crucial for providers treating these patients is that we found a much higher prevalence of FGFR2 fusion. And that's important because, as I'm sure you've heard, there's a ton of new drugs coming out that are targeting specifically FGFR fusion in this and other populations. And hence my statement at the outset saying you've got to get NGS on everybody, because especially younger patients seem to have higher rates of some of these mutations.  Dr. Rafeh Naqash: Excellent. You also looked at the transcriptome, and from what I recollect, you identified that later onset tumors had perhaps more immune favorable tumor microenvironment than the early onset. But on the contrary, you did find that FGFR2 early onset had better survival. So how do you connect the two? Is there an FGFR link, or is there an immune signature link within the FGFR cohort for early onset that could explain the differences? Dr. Alok A. Khorana: Yeah, that's a great question. So, to kind of summarize a couple of these things you talked about. So, one is we looked at these genomic alterations, and, yes, FGFR2 fusion was much more prevalent. It's close to 16% of young onset patients, as opposed to roughly 6% of average onset patients. So almost a threefold increase in FGFR fusion. And because there's so many drugs that are targeting FGFR fusion, and because the population included a period of time when these drugs had already been approved, we think some of the benefit or the improvement in median survival associated with being younger is likely driven by having more FGFR fusion and therefore having more drugs available to treat FGFR fusion related tract cancer with corresponding increase and increase in survival. And that was part of it. There was one other alteration, NIPBL fusion, that's been sort of known to be associated with a certain subtype of cholangiocarcinoma, but it doesn't really have a drug that targets it, so it's not sort of very useful from a clinical perspective.   The other two things you talked about, so transcriptome and immuno oncology markers, we found a couple different results on this. So one is that we found in younger people, angiogenesis was enriched, and why this is so we don't quite have a good answer for that. The other was inflammatory responses. So there's a couple of gamma interferon pathways and a couple other types of pathways that you can sort of do pathway analysis, and we found that those were enriched in the older patients or the average onset patients. But the benefit for immunotherapy was similar across the two groups. So even though we saw these differences in signaling in terms of which pathways are upregulated or downregulated, it didn't seem to translate into the current generation of immune checkpoint inhibitors that we're using in terms of benefit for patients. But we did see those differences.  Dr. Rafeh Naqash: I completely agree, Doctor Khorana. As you mentioned, that one size fits all approach does not necessarily work towards a better, optimal, personalized treatment stratification. So, as we do more and more sequencing and testing for individuals, whether it's early onset cancers or later onset cancers, figuring out what is enriched and which subtype, I think, makes the most sense.   Now, going to the FGFR2 story, as you and most listeners probably already know, FGFR is an approved target, and there are a band of FGFR inhibitors, and there's some interest towards developing specific FGFR2, 3 fusion inhibitors. What has your experience with FGFR inhibitors in the clinic been so far? And what are you personally excited about from an FGFR standpoint, in the drug development space for GI cancers?  Dr. Alok A. Khorana: Yeah, I think the whole FGFR fusion story sort of actually deserves more excitement than it's gotten, and it may be because, as I mentioned earlier, biliary tract cancers are a relatively low volume type of cancer. But the results that we are seeing in the clinic are very impressive. And the results that we are anticipating, based on some ongoing phase two and phase three trials, appear to be even more impressive for the very specific inhibitors that are about to hopefully come out soon.   Also, the possibility of using successive lines of FGFR inhibitors - if one fails, you try a second one; if the second one fails, you try a third one because the mechanisms are subtly different - I think it will take a little while to figure out the exact sequencing and also the sort of the rates of response in people who might previously have been exposed to an FGFR inhibitor. So that data may not be readily available, because right now most patients are going in for longer trials. But having that type of possibility, I think, kind of reminds me of the excitement around CML back when imatinib suddenly became not the only drug and a bunch of other drugs came out, and it's kind of like that. I think again, it's not a very common cancer, but it's really wonderful to see so many options and more options along the way for our patients. Dr. Rafeh Naqash: Thank you. Now, going to your personal story, which is the second part of this conversation, which I think personally, for me, is always very exciting when I try to ask people about their personal journeys. For the sake of the listeners, I can say that when I was a trainee, I used to hear about Dr. Khorana's course, I always thought that Dr. Alok Khorana was a hematologist. My friends corrected me a few years back and said that you're a GI oncologist. Can you tell us about your love for GI oncology and the intersection with hematology thrombosis, which you have had a successful career in also? Can you explain how that came about a little bit? Dr. Alok A. Khorana: Yeah, sure. So it is a common, I guess I shouldn't say misperception, but it's certainly a common perception that I'm a hematologist. But I'll sort of state for the record that I never boarded in hematology. I did do a combined hem-onc fellowship, but only boarded in oncology. So I'm actually not even boarded in hematology. My interest in thrombosis came about- it's one of those things that sort of happen when you're starting out in your career, and things align together in ways that you don't sort of fully understand at the time. And then suddenly, 10 years later, you have sort of a career in this.   But it actually came about because of the intersection of, at the time, angiogenesis and coagulation. And this is the late ‘90s, early two ‘00s, there was a lot of buzz around the fact that many of the factors that are important for coagulation are also pro angiogenic and many factors that are coagulation inhibitors. These are naturally occurring molecules in your body, and can be anticoagulant and anti angiogenic. A great example of this is tissue factor, which is, as you'll remember from the coagulation pathways, the number one molecule that starts off the whole process. But less widely appreciated is the fact that nearly every malignancy expresses tissue factor on its cell surface. This includes breast cancer, it includes leukemia cells, it includes pancreatic cancer. In some cancers, like pancreatic cancer, we've even shown that you can detect it in the blood circulation. And so for me, as a GI oncologist who was seeing a lot of patients get blood clots, it was particularly fascinating to sort of see this intersection and try and understand what is this interaction between the coagulation and angiogenic cascades that's so vital for cancers. Why is coagulation always upregulated in cancer patients? Not all of them get blood clots, but subclinical activation of coagulation always exists. So I would say I was fascinated by it as an intellectual question and really approached it from an oncology perspective and not a hematology perspective.   But then as I got deeper into it, I realized not everybody's getting blood clots, and how can I better predict which patients will get blood clots. And so I had both a hematology mentor, Charlie Francis, and an oncology mentor, Gary Lyman. And using sort of both their expertise, I drafted a K23 career development award specifically to identify predictors of blood clots in cancer patients. And that's the multivariate model that later became known as the Khorana Score. So again, I approach it from an oncology perspective, not a hematology perspective, but really a fascinating and still, I would say an understudied subject is why are cancer patients having so many clotting problems? And what does it say about the way cancer develops biologically that requires activation of the coagulation system across all of these different cancers? And I think we still don't fully understand the breadth of that. Dr. Rafeh Naqash: Very intriguing how you connected two and two and made it a unique success story. And I completely agree with you on the tissue factor. Now there's ADCs antibody drug conjugates that target tissue factor, both a prude as well as upcoming.   Now, the second part of my question is on your personal journey, and I know you've talked about it on social media previously, at least I've seen it on social media, about your interactions with your uncle, Dr. Har Gobind Khorana, who was a Nobel Prize winner in medicine and physiology for his work on DNA. Could you tell us about how that perhaps shaped some of your personal journey and then how you continued, and then also some personal advice for junior faculty trainees as they proceed towards a successful career of their own? Dr. Alok A. Khorana: Yeah, thank you for bringing that up. So very briefly, this is about my uncle. He's actually my great uncle. So he's my grandfather's youngest brother. And I grew up in India in the ‘70s and ‘80s, and at the time, I ran away from this association as fast as I could, because growing up in India in the 70s and ‘80s, it was a socialist economy. There wasn't a lot going on. There was certainly none of the IT industry and all of everything that you see right now. And so there were very few icons, and my great uncle was definitely one of those few icons. As soon as you mentioned your last name, that would sort of be the first question people would ask. But he did serve as a role model, I think, both to my father, who was also a physician scientist and a professor of medicine, and then to myself in sort of making me realize, one, that you can't really separate medicine from science. I think those are really integrated, and we want to ask questions and answer questions in a scientific manner. He chose to do it in a basic science world. My father did it in a clinical science world, and I have done it in a clinical and a translational science world. Again, sort of using science as the underpinning for sort of understanding diseases, I think, is key. And so that was certainly a massive inspiration to me.  And then after I immigrated to the US in the late ‘90s, I met him on a regular basis. He was certainly very inspirational in his successes, and I realized the breadth of what he had done, which I did not realize in my youth growing up. But this is a person who came to the US. This was before Asian immigration was even legal. So he got here and they had to pass a special bill in Congress to let him be a citizen that was based on the sort of work that he had done in Canada and in the UK before he came here. And then he sets up shop in the University of Wisconsin in Madison and hires tons of these postdocs and essentially converted his lab into this massive factory, trying to figure out the genetic code. Really just the type of dedication that that needs and the amount of work that that needs and the ability to do that in a setting far removed from where he grew up, I think it's just really quite mind boggling.  And then he didn't stop there. He got the Nobel for that, but I have these letters that he wrote after he got the Nobel Prize, and he was just completely obsessed with the possibility that getting the Nobel would make him sort of lose his mojo and he wouldn't be as focused on the next aspects of science. And he was just really dedicated to synthesizing DNA in the lab, so creating artificial DNA, which he ended up doing. And the offshoot of that work, so not just the genetic code, but PCR essentially was developed by his lab before it became sort of what we now know as PCR. And then ditches all of that in the ‘80s and ‘90s and moves to understanding the retina and just focuses on retinal disorders. And then signal transduction, essentially trying to figure out when a single photon of light hits your eye, what happens biologically. It's a completely different field. And just took that on and spent the next 20,30 years of his life doing that. So the ability to sort of change fields, I thought that was very inspirational as well, that you don't have to just stick to one question. You can get into one question, answer it as much as possible, and then find something else that's really interesting to you and that really grabs your attention, and then stick with that for the next couple of decades. So lots to learn there. Dr. Rafeh Naqash: Thank you. Thank you. And then, based on some of your personal lessons, what's your advice for junior faculty and trainees as you've progressed in your career?  Dr. Alok A. Khorana: I think, number one, and I can't emphasize this enough, and sometimes it actually causes a little bit of anxiety, but it is finding the right mentor. And for me, certainly that was key, because my mentor, who was Charlie Francis, was not an oncologist who was a hematologist, but was like me, sort of supported this idea of trying to understand, hey, why does coagulation interact with cancer? And so he approached it from a hematology perspective, I approached it from a cancer perspective, but he sort of gave me the freedom to ask those questions in his lab and then later on in the clinical setting and clinical translational setting, and then got me access to other people who are experts in the field and introducing you and then getting you on committees and making sure you sort of get into clinical trials and so on. And so having a mentor who sort of supports you but doesn't stifle you, and that's really key because you don't want to just ask the question that the mentor is interested in. And as a mentor now, I don't want to have my mentee ask the question that I'm interested in, but also a question that the mentee is interested in. And so there's a little bit of a chemistry there that's not always replicable, and it can go wrong in sort of five different ways, but when it goes right, it's really vital. And I mentioned it causes anxiety because, of course, not every day is great with your mentor or with your mentee, but over a period of time, has this person done sort of their best to get your career off to a start? And have you served that mentor well by doing the things that are– there's responsibilities on both sides, on both on the mentor and on the mentee. And if you can find that relationship where there's a little bit of chemistry there and both of you are effectively discharging both your responsibilities and satisfying your intellectual curiosity, I think that can't be beat, honestly. To me, sort of number one is that and everything else follows from that. So, the networking, making sure your time is sort of allocated appropriately, fighting with sort of the higher ups to make sure that you're not having to do too much, things that are sort of away from your research interests, all of that sort of flows from having the right person. Dr. Rafeh Naqash: Couldn't agree with you more, Dr. Khorana, thank you so much. It was an absolute pleasure. Thank you for sharing with us the science, the personal as well as the professional journey that you had. And hopefully, when you have the next Khorana Score, Khorana score 2.0, JCO Precision Oncology will become the home for that paper and we'll try to have you again maybe in the near future.  Thank you for listening to JCO Precision Oncology Conversations. Don't forget to give us a rating or review and be sure to subscribe so you never miss an episode. You can find all ASCO shows at asco.org/podcast. Thank you so much.   The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions.   Guests on this podcast express their own opinions, experience and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity or therapy should not be construed as an ASCO endorsement.   Disclosures: Dr. Khorana  - Honoraria Company: Pfizer, Bayer,  Anthos, Sanofi, BMS, WebMD/MedscapeConsulting or Advisory Role Company: Janssen, Bayer, Anthos, Pfizer, Sanofi, BMS Research Funding Company: Anthos, Bristol-Myers,  Squibb Travel, Accommodations, Expenses Company: Janssen, Bayer, Bristol-Myers Squibb 

On todays show we welcome back guest Caris Snider, an author and speaker, to discuss the prevalent issue of anxiety among teenagers. Caris, who has written extensively on the subject, shares her insights, experiences, and results from a survey conducted with teens to uncover the symptoms and coping mechanisms associated with anxiety. The discussion covers the pressures teens face from academic expectations, social media, and societal norms, and emphasizes the importance of awareness, healthy coping strategies, and the role of faith.  The episode aims to empower moms with tools and knowledge to support their children through anxious seasons, highlighting that seeking professional help is a sign of strength, not failure. To connect with Caris:  Website~Anxiety Elephants for Teens~Instagram Connect with Courtney: Website~Instagram~Facebook

How does a brand formulate and promote skincare products that retain brand equity for decades?

After another magnificent summer league outing, Jaylon Tyson demands coverage.  Today, Bob Schmidt is joined by the radio voice of the Cal Golden Bears, Justin Allegri, who shares stories of his experiences with Jaylon during his time at Cal.  Then we go to the audio mailbag, where Brett has thoughts about the future of Isaac and Mikal Bridges.  (0:00) Justin Allegri, the voice of the Bears talks Jaylon Tyson(21:25) Audio Mailbag: Brett Clapper on the future of Isaac and Caris

On this episode, Justin sits down with Doug Caris and Eric Rector of Arizona Painting Company. The discussion covers company growth, branding, state expansion, and commercial painting challenges. The conversation delves into their acquisition strategy, EOS implementation, client experience, training processes, and advice for those looking to one-up their sales and entrepreneurial game.

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Hey, i'm Caris welcome to my YouTube channel where I talk about all things tinnitus!

Hey, i'm Caris welcome to my YouTube channel where I talk about all things tinnitus!

Earth's common earthworms live deep under soil while red wiggler worms prosper just under topsoil beneath decomposing organic matter. Robert, Olivia, Elliott, and Caris share what life is like in the 4th grade caring for worm buckets and how they use nutrients made from compost tea or castings.

About the Arizona Painting Company Arizona Painting Company has been in business since 2001.We have three office locations, one in Tucson, AZ, one in Chandler, AZ, and one in Glendale, AZ. We pride ourselves in being the company that sets the standard for all other painting companies in Phoenix and Tucson.At our company employees must pass our rigorous training program and ongoing monthly skill-building training we do with them. Our main company goal is to build a company culture of success and amazing customer service.About Doug CarisArizonaPaintingCompany.comI'm Doug Caris, an Experienced Partner with a rich background in the consumer services sector. My journey has been defined by a mastery of skills such as Negotiation, Coaching, Sales, Sales Operations, and Customer Retention.My accomplishments span a diverse spectrum, including the co-ownership of reputable enterprises like Arizona Painting Company, Nevada Painting Company, Guaranteed Painting Company, and Andys Painting Company. This hands-on entrepreneurship experience has honed my strategic mindset and operational acumen, driving business success while maintaining a strong focus on customer satisfaction.Beyond my entrepreneurial ventures, I thrive as a skilled public speaker, specializing in fostering personal growth and employee engagement. Through dynamic presentations, I inspire individuals and teams to reach their full potential while contributing to organizational growth.My journey is anchored by a commitment to continuous learning, growth, and excellence. Let's connect and explore how our shared passion for consumer services and personal development can lead to exciting collaborations. Thank you for visiting, and I'm excited to engage with fellow professionals who are dedicated to pushing boundaries and achieving remarkable results.

This is the final episode of our 2024 Lent podcast series.  Ps. Katie, Jojo and Caris wrap up this season by discussing glorification, the culmination of God's redemptive work in our lives. 

In Romans 5:3-5, we're told that hope starts with suffering.  Why?  Join Ps. Katie, Jojo and Caris as they continue chatting about sanctification, focusing specifically on how we can build hope

Hey, i'm Caris welcome to my YouTube channel where I talk about all things tinnitus!

On the podcast this week, Ps. Katie, Jojo and Caris start a deep dive into sanctification by discussing what faith looks like as we grow and mature in our relationship with God.

One thing I love about author, speaker and life coach Caris Snider is her heart for God and her message on how to overcome anxiety with the Word of God! I guess that's really two things! This week, Caris gives us practical steps that we can take in order to not just deal with anxiety and depression, but overcome them once and for all! Ladies, there is hope! There is freedom!!Be sure to check out Caris Snider's new Devotional for Teens! This is a must-have book for everyone ages 13 through 18!Here's a little sneak peek below:From "Anxiety Elephants for Teens: a 90-Day Devotional:"Anxiety is more prevalent now in the lives of teens than ever before.As the world has become more confusing, and the pressures are on the next generation for a host of anxiety-inducing issues, teenagers may find themselves crippled under the weight of their fears. Nevertheless, Scripture has something to say about the mental health issues our teens face. Anxiety expert Caris Snider will walk readers through how to manage their symptoms and trust in God through this ninety-day devotional.Caris's relatable prose and kind voice will ease readers through their daily struggles as they see God's providential hand in their lives.As teens face an unprecedented world, ensure they are equipped with this guide on tackling their fears…and embracing the future God has paved for them.Anxiety Elephants for Teens: A 90-Day DevotionalAvailable March 5, 2024!  Pre-Order Your Copy Now:Amazon     Barnes & Noble     Christianbook   End Game PressThe Beautiful Movement now has the March box available for pre-sale! Grab your box before they sell out! The theme is “He is Risen,” a box to prepare your hearts for Easter! You don't want to miss this one! Go to www.jointhebeautifulmovement.com to sign up! Use discount code: uncommonteen for 15% OFF your 1st box! Ladies, we have had challenges recently with the UncommonTEEN App and you all haven't been able to ask your questions for our Ask Me Anything podcast episodes...so to make that easier for you, we added a brand new RED button at the top of the UncommonTEEN website that says, "Ask Me Anything!" If you want to submit your questions for upcoming Ask Me Anything episodes, be sure to head on over to UncommonTEEN.com and ask your questions there! Connect with Us!Website: UncommonTEEN.comInstagram: @uncommon.teenUncommonTEEN Live Conference: UncommonTEENlive.com

Through the blood and saving grace of Jesus, the debt of death is paid and we are no longer slaves to sin. On this week's episode, special guest Ps. Sam Picken joins Caris to discuss salvation through justification.

Welcome to the Marketing 101 Podcast for Small Business Owners, where you will find practical tips and guidance on developing marketing plans and content marketing strategies and tactics. Your host Philippa Channer, owner of Channer Consulting, is a content marketing strategist looking to help entrepreneurs like yourself to succeed.   In this episode of "Marketing 101 for Small Business Owners," host Philippa Channer and guest Jacob Caris discuss the critical role of marketing in the pre-sale experience. They explore the importance of a strong brand identity, storytelling, and the power of social media in building customer relationships. Jacob, an experienced marketer, shares insights on leveraging personal brands and effective strategies for monetizing online businesses. The conversation emphasizes authentic content creation and the impact of personal connections on consumer behavior and loyalty, offering valuable advice for small business owners on engaging their audience before the sale.   Whenever you are ready, here are some ways that we can help you: Free 1-Hour Marketing Consultation: https://tidycal.com/philippa/free-marketing-consultation   Free Marketing Assessment: Do you know if your marketing is working?   Are you sure that all of the work you're doing to grow your business is actually working? You might be surprised by how much money and time you could save by taking our free marketing assessment. It only takes a few minutes, but it will give you an in-depth look at how effective your current strategy really is. Click here to get started: https://bit.ly/3xnrJ1W   Subscribe for regular content on developing a solid marketing plan, marketing strategy, and marketing tips.   Connect with us:   Linkedin: https://www.linkedin.com/company/channer-consulting-llc Facebook: https://www.facebook.com/channerconsulting/ Instagram: https://www.instagram.com/channerconsulting/   Get in touch: info@channer-consulting.com

This is episode 2 of our 2024 Lent Podcast series.  This week Ps. Katie, Jojo and Caris will continue the conversation about grace, diving deeper into God's character as an abundant gift giver.

Hey, i'm Caris welcome to my YouTube channel where I talk about all things tinnitus!

Welcome to the first episode of our 2024 Lent Podcast series.  Listen in as Ps. Katie, Jojo and Caris remind us about the purpose behind the season of lent and kick off the conversation by discussing the differences between common grace and saving grace.

Hey, i'm Caris welcome to my YouTube channel where I talk about all things tinnitus!

JCO PO author Dr. Amit Mahipal shares insights into his JCO PO article, “Tumor Mutational Burden in Real-world Patients with Pancreatic Cancer: Genomic Alterations and Predictive Value for Immune Checkpoint Inhibitor Effectiveness.” Host Dr. Rafeh Naqash and Dr Mahipal discuss real world evidence of immune checkpoint inhibitors in pancreatic ductal adenocarcinoma. TRANSCRIPT Dr. Rafeh Naqash: Welcome to JCO Precision Oncology Conversations, where we bring you engaging conversations with authors of clinically relevant and highly significant JCO PO articles. I'm your host, Dr. Rafeh Naqash, Social Media Editor for JCO Precision Oncology and Assistant Professor at the OU Health Stephenson Cancer Center, University of Oklahoma. Today we are joined by Dr. Amit Mahipal, Professor of Medicine and Director of GI Oncology at the Case Western Reserve University in Seidman Cancer Center. Dr. Mahipal is also the author of the JCO Precision Oncology article titled "Tumor Mutational Burden in Real World Patients with Pancreatic Cancer: Genomic Alterations and Predictive Value of Immune Checkpoint Inhibitor Effectiveness."  Our guest disclosures will be linked in the transcript. For the sake of this conversation, we will refer to each other using our first names. So Amit, welcome to our podcast and thank you for joining us today. Dr. Amit Mahipal: Thanks for having me here. Dr. Rafeh Naqash: Excellent. We came across your article in JCO Precision Oncology and it really aroused my interest because the topic and the audience that it caters to is very important in the current times. Because immunotherapy generally is considered- pancreas cancer the graveyard in immunotherapy in essence, based on what I have seen or what I have encountered. And now you're the expert here who sees people with pancreas cancer or has done a lot of work in pancreas cancer research side. So can you tell us the context of this work and why you wanted to look at immune checkpoint inhibitors in pancreas cancer? Dr. Amit Mahipal: Absolutely, Rafeh. As you mentioned, pancreatic cancer is considered a what we call "cold tumors." They don't typically respond to immunotherapy. And when we talk to our patients or patient advocates, as you know, patients are very excited about immunotherapy. Immunotherapy has transformed the treatment for a lot of different cancers and not only has increased survival, but the quality of life is so much different than with chemotherapy. This work came from based on the KEYNOTE-158 trial, which was a tumor-agnostic trial which accrued patients who had TMB high tumor. What that means is that tumor mutation had more than 10 mutations per megabase. And what happens is because of that trial, more than 200 patient trial, the FDA actually approved this immunotherapy or pembrolizumab as a single agent pembrolizumab for any patient with a solid tumor who has high TMB. Again, tumor mutation burden, more than 10 mut/Mb. This question comes in now. Does this apply to our pancreatic cancer patient groups? Especially as we know these are "cold tumors" that typically do not respond. There have been multiple trials looking at immunotherapy, single agent, dual immunotherapy agents, as well as combinations with chemotherapy, with somewhat very, very limited success. So that was kind of the basis. So we wanted to look at this retrospective kind of review of a big database to see how many patients we can find who have high TMB and see in that patient population is immunotherapy really active based on the FDA approval or is pancreatic cancer not a tumor where we should try immunotherapy unit as a selective group.    Dr. Rafeh Naqash: Thank you for that explanation. Taking a step back again, since you see these individuals with pancreatic cancer I imagine day in and day out in the space of drug development, what is the general current standard of care approach for individuals with pancreas cancer in your clinic? I'm talking about what are the most common approaches that you utilize that seem to be working or have FDA approvals in the pancreas cancer space. Dr. Amit Mahipal: As with any tumor, the first thing is obviously staging. So depending on whether we're dealing with early stage or advanced stage and what are the goals of treatment. At this point, the only thing that can cure pancreatic cancer patients that would be considered conventional therapy is surgical resection. So any patient who is a candidate for surgical resection is in a different bucket compared to advanced patients. For early stage patients, we try to do what we call neoadjuvant treatment or neoadjuvant chemotherapy. We shrink the tumor or at least maintain it, look at the biology of the disease, and then take them to surgery, which typically involves a Whipple procedure if it's a head of the pancreatic mass.   Moving on to advanced patients, that's where we know the goal of treatment is palliative to increase survival, but unfortunately, most of the times we cannot cure them. And there the standard of care options include systemic chemotherapy. We have two typical regimens that we use, one is called FOLFIRINOX, which is a three-drug regimen of 5-fluorouracil, leucovorin, oxaliplatin, and irinotecan. And another regimen is gemcitabine plus abraxane, which is a two-drug regimen of gemcitabine plus abraxane. These are considered the standard of care. Unfortunately, the median survival even with the best standard of care chemotherapy is only about a year, 12-13 months, depending on what trials we look at.  Dr. Rafeh Naqash: I still remember some of these regimens from my fellowship, where we had to decide which to give to each individual based on their performance status and clinical status, etc. But now I can see a lot of ongoing drug development in the space of pancreas cancer. I'm guessing that's why you wanted to assess both the molecular genomic landscape of pancreas cancer in this study and also look at the immune biomarker aspect. Could you tell us a little bit about the Foundation Medicine Clinical Genomic Database? How did you identify the patients, how many patients did you identify, what you narrowed down in the criteria, and the eventual sample size of what you were looking at?  Dr. Amit Mahipal: FoundationOne has a rich database. They have two or three things. One is a genomic database only. So in our clinical practice, I think it's some sort of next-generation sequencing or mutational testing for all patients with advanced solid tumors. All of these goes into their database. All of the samples that are sent to FoundationOne that goes into their database where they know the diagnosis of the patient and the know the sequencing results of these patients. In addition, they also have a clinical database called Flatiron. Basically, they collaborated with them. Flatiron has about 280 or so cancer clinics throughout the country, so a lot of community settings and some academic sites as well. They did not only have a genomic database, but they actually have a clinical database. They have demographics, clinical features, baseline clinical features, comorbidities, what kind of treatment they received, what would be the stage of the cancer, how many months of treatment they received, and their overall survival, and so on. So from that perspective, the FoundationOne has access to this partnership with Flatiron, clinical genomic database where they have both clinical data as well as genomic database for a lot of these patients.  In our study, we only focused on patients with advanced pancreatic cancer. We excluded a lot of patients who did not have sequencing results available, they cannot be performed due to lack of tissue. So the first we talked about the genomic database and we found about about 21,932 patients, so almost 22,000 patients and there we had the sequencing and we also had the data on TMB or tumor mutational burden. So here, we classified them into two groups: high TMB and low TMB. High TMB was seen in 1.3% of the patients, and about 98.3% of the patients had low TMB. Here we looked at the genomic alterations between the two groups. So these are like our genomic group, so to speak of about 22,000 patients. And among them, as mentioned, that the clinical data was available for about 3300 patients or 3279 patients to be exact.   After excluding some of those patients, we found about 51 patients who received immunotherapy. And when we say immunotherapy, it is single agent immuno checkpoint inhibitor like pembrolizumab or nivolumab. And then we classified them into high TMB versus low TMB and then we also looked at patients with high TMB and compared them to who received immunotherapy versus other therapies. Just to recap, we had about 22,000 patients where we have the genomic database and about 3300 or so patients who we have both genomic and clinical data for this patients. One of the key findings was that high TMB was present in only 1.3% of the patients, or about 293 patients out of 21,932.  Dr. Rafeh Naqash: Definitely an interesting sample size that you had utilizing this resource, which, of course, is more or less real-world. It is important to gather real-world outcomes that you did.   So, going to the TMB story of this paper, where you looked at immune checkpoint inhibitor use in these individuals, was there a reason why some of the individuals with low TMB were also given immune checkpoint inhibitors? From my understanding, I did see some checkpoint inhibitor use there. What could be the explanation for that? Dr. Amit Mahipal: So this data is from 2014 to 2022. So from the span of about eight or so years. And as you know, immune checkpoint inhibitors were approved in the last decade. And there were a lot of not only trials, but even in the non-trial setting, people had tried immune checkpoint inhibitors in, frankly, different tumor types because of the success in some of the common tumor types, like melanomas, lung cancer, and so on. So I agree, as of today, we probably would not use immune checkpoint inhibitors in patients with low TMB or MSS. But at that time, I think that information was not available. So people with low TMB and MSI-stable tumors also received immune checkpoint inhibitors. But those numbers are again low. So it's not very high numbers. Dr. Rafeh Naqash: Understandable. That makes it a little more clear.  Now, you looked at the TMB aspect. I'm guessing you also looked at the MSI aspect of PDAC. What is your understanding, or what was your understanding before this study, and how did it enhance your understanding of the MSI aspect of PDAC? And I'm again guessing, since TMB high individuals are on the lower side percentage, so MSI high is likely to be low as well. Did you see any interaction between those MSI highs and the TMB highs on the PDAC side?  Dr. Amit Mahipal: Yeah, absolutely. So we are very excited in general about MSI-high tumors for solid tumors because of their response to immunotherapy. Although I would do a caveat because we still don't know how MSI-high pancreatic cancer responds although there have been some real-world, very, very small series as well. In this study, one of the things is, is high TMB totally driven by MSI-high? That's a question that comes up, and TMB high may not matter. It's only the MSI-high that might matter. So definitely when we look at this patient population, we found that the patients who were 35-36% of patients who were TMB high also had MSI-high patients. So we do expect MSI-high patients to have a higher TMB compared to MSS patients. But there were about 66 or two-thirds of the patients who did not have MSI-high tumors and still had high TMB, as defined by, again, ten mutations per megabase. So we did see patients with MSI-stable tumors who had high TMB. And I think that was one of our biggest questions. I think MSI-high patients, we all tend to think that we would try immunotherapy even if it's in pancreatic cancer. I think what is not clear, at least from the real-world or any of the trial data, is if we were to give MSI-stable patients who have high TMB, if we give immunotherapy, are there any responses or any disease control that we see? And that was one of the reasons for this study.  Dr. Rafeh Naqash: Now, one of the things that comes to mind, and again, I think you based it on the FDA approval for TMB high, which is ten mutations per megabase, as you defined earlier. I do a lot of biomarker research, and oftentimes you come across this aspect of binary versus a linear biomarker, in this case being TMB, where about ten, less than ten. Do you think, in general, an approach where you maybe have tertiles or quartiles or a biomarker, or perhaps a better approach in trying to stratify individuals who may or may not benefit from immunotherapy? Dr. Amit Mahipal: That's a great point. I think when we use ten mutations per megabase as a biomarker, as a binary endpoint, do we apply it to all tumor types? I don't think that's a fair comparison, frankly speaking. We do know that high TMB, even in different tumor types, do tend to respond a little bit better to or do have better outcomes for patients treated with immune checkpoint inhibitors in different tumor types. But what that cutoff is not known in most of the tumor types. And also, one of the problems is how do you measure TMB and is it standard across different platforms? Like I'm just giving some names like FoundationOne, Tempus, Caris, and some obviously like MSKCC and some other university-owned panels as well. And frankly, I think if you look at different panels and if you send the same tumor tissue, you will get different measurements. So I think standardization is a problem as well.  In one of the studies involving cholangiocarcinoma, for example, we found that a TMB of 5 was enough to have an additive effect of immunotherapy, same with chemotherapy, so to speak. But again, this needs to be validated.  So you're absolutely correct. I don't know why we use the binary endpoint, but on the same token, the binary endpoint is easy to understand as a clinician. Like, “Hey, someone has this, do this, not this.” And when we look into a continuous range, I think the benefit obviously varies between high and low, different tertiles, and becomes somewhat challenging. How do you classify patients and what treatments to give? So I think in clinical decision-making, we like the cutoffs, but I think in reality, I don't know if the cutoff is a true representation. And maybe with the more use of AI or computing, we can just input some values, and then it can tell us what the best treatment option might be for the patient. But that's way in the future. Dr. Rafeh Naqash: That would definitely be the futuristic approach of incorporating AI, machine learning perhaps, or even digital pathology slides in these individuals to ascertain which individuals benefit.  Going back to your paper, could you highlight some of the most important results that you identified as far as which individual is better, whether it was immunotherapy, and you've also looked at some of the mutation co-mutation status. Could you highlight that for our listeners? Dr. Amit Mahipal: So the first thing we looked at was the genomic database of almost 22,000 patients, and then we classified them into high TMB and low TMB, with about 300 patients in the high TMB group and the rest in the low TMB group. And what we found was, talking about again in the genomic database, that patients who have high TMB actually have low KRAS mutation. So if we think about KRAS mutation, pancreatic cancer, almost 85% or so of patients have KRAS mutation who have pancreatic adenocarcinoma. So patients in this subgroup, so in the high TMB group, only about two-thirds of the patients had KRAS mutation, compared to 92% of the patients with low TMB who had KRAS mutation. So just giving that perspective. So KRAS mutation, which is the most common mutation in pancreatic cancer and is a driver mutation, their rates vary differ from the high TMB group versus the low TMB group.   And then in addition, in the high TMB group, we found higher rates of BRCA mutation, BRAF mutation, interestingly, and then obviously from the DNA damage repair genes like PALB2 mutation, MSH2 or MSH6, MLH1, and PMS2. So all these mismatch repair protein mutations were higher. As I mentioned before, one-third of the patients with high TMB also had MSI-high. So it's not a totally unexpected finding. I think the biggest finding was that we found more KRAS wild-type pancreatic adenocarcinoma in the high TMB group, almost a third. And those tend to have different targetable mutations like BRCA2, BRAF, and PALB2 mutations. So I think one of the interesting findings is that patients in the high TMB group actually tend to have KRAS wild-type or less KRAS mutations. So they're not necessarily KRAS-driven tumors, and they have a higher chance of having other targetable mutations like BRAF and so on, for which we have therapies for. So it's always something to keep in mind. Dr. Rafeh Naqash: Would you think that from a DDR perspective, the mutations that you did  identify that were more prevalent in individuals with high TMB, do you think that this is linked to perhaps more DNA damage, more replication stress, more neoantigens leaning toward more tumor mutation burden perhaps? Or is there a different explanation?  Dr. Amit Mahipal: For sure. As we said, MSI-high tumors have mutations in the DNA damage repair pathway and they definitely tend to have higher TMB. So I don't think that is very surprising that we found PALB2, or other MMR genes like MSH2, MSH6, MLH1, and PMS2 at much higher rates. I think the interesting finding is the fact that the KRAS wild-type and having BRAF alterations at least that's not suspected to definitely increase TMB. Although if we look at colorectal cancer, BRAF mutation and MSI are somewhat correlated to patients with BRAF mutations and to have high rates of MSI-high tumors. But that's not the case in pancreatic cancer. We also found an increase in BRCA2 mutations as well. So I agree that the DNA damage pathway repair gene alteration is not unexpected because they tend to increase TMB, but I think the other mutations were interesting. Dr. Rafeh Naqash: And I think one other aspect of this, which I'm pretty sure you would've thought about is the germline implications for some of these mutations where you could very well end up screening not only the individual patient, but also their family members and have measures in place that we're trying to enhance screening opportunities there. In your current practice, you are at an academic center but I'm talking about in general with your experience, how common is it to sequence broad sequencing panels in individuals with pancreas cancer? The reason I asked that is I do a lot with lung cancer and even now despite having all those targets in lung cancer which sort of paved the pathway for targeted therapy in many tumor types, we still don't see a full uptake for NGS Phase I drug development. And I get a lot of referrals from outside and I often see that it's a limited gene panel. So what is your experience with pancreatic cancer? Dr. Amit Mahipal: We kind of changed our practice. Similar to you, I'm involved in drug developments. I've been a big proponent of NGS for almost a decade now, when didn't even have targeted therapies but these companies first came in and they're like, “Okay. We're very very low chance.” But now obviously, we transformed the treatment for a lot of different cancers. Especially lung cancer, you don't sometimes even start treatment before you get an NGS panel like you said in situ. So what we're finding, at least for pancreatic cancer, as you know, the targetable mutations are there but they are somewhat not that common, I would say, in the 10-15% range. So many people would get dissuaded and then it's like, what's the point of doing it?   But I think for those 10% to 15% of the patients, firstly we can really change their treatment course and their prognosis. Secondly, if you don't do it and they cannot go in a different clinical trials, now we have trials targeting KRAS G12C, but not only that, KRAS G12D which is the most common mutation we see in pancreatic cancer and so on. So it's becoming very very important. One thing, at least with our practice we adopted last two or three years is sending liquid biopsies or liquid based NGS or blood-based NGS testing. Otherwise, what's happening I would send a solid tumor NGS from the tissue. And pancreatic cancer as you know has sometimes a very small amount of tissue obtained from FNA. And inevitably after four weeks, we'll get the result that there's not enough tumor to do NGS testing. And then the patient comes one or two months later and then we order the test, and that just delays everything.  So now we adopted a practice where we are trying to send both blood based NGS and solid tumor NGS at the same time the first time of diagnosis when we see the oncologist for the first time. And that has really increased the rate of NGS testing results for our patient population. And it's not 100%, even in blood-based NGS, sometimes they may not be able to find enough circulating tumor cells to do this blood-based NGS testing, but at least they're having these. But you're correct. I think we still see about one third of the patients who had not had NGS testing or referred for phase I clinical trial and have gone through more than two or three line of therapies which is unfortunate for our patients.  Dr. Rafeh Naqash: That's a very interesting perspective on how important it is to sequence these individuals. As you said, it may not be that all of them may benefit, but the ones that have those important alterations, especially BRCA, PALB, and KRAS could benefit from novel precision medicine-based approaches.  A question that came to my mind, I saw that you were trying to look at MYC and turmeric low tumors as well. So what is the role of MYC in the context of these individuals? Is there any drug development that's going on? Because I see small cell lung cancer. MYC is an important target there. These are two different tumors, but it looks like there was a hint of some correlation with respect to some of the findings that you showed. Is that something that you're currently looking at or planning to look at?  Dr. Amit Mahipal: I think that if we just talk about MYC in general, it is present at somewhat lower rate. I think we found MYC amplification in about 5% or so of TMB-low patients who had that and not really seen in the TMB-high patients. So right now, I am not aware of any trials targeting MYC in pancreatic cancer. But as you said, if it's successful in lung cancer, maybe that's when we can transform into the pancreatic cancer group. Dr. Rafeh Naqash: Of course we can all learn from each other's specialties.We learned a lot from melanoma with respect to therapy. Hopefully, other fields can also benefit from each other's experiences in the space of drug development.  Thank you so much for this interesting discussion. The last few questions are more or less about you as an individual researcher. So could you tell us briefly on your career trajectory and what led you into the space of GI oncology, pancreas cancer, even for that matter, drug development? And some of the advice that you may want to give to listeners who are trainees or early career individuals? Dr. Amit Mahipal: Sure. So I have gone through some different institutions. During my fellowship, that's when I really decided that I wanted to do GI oncology. Prior to that, I actually have a Masters in Public Health, where I learned about epidemiological research and how to design clinical trials, how to design cohort studies. My focus was on, actually there was somewhat a lot, but one of my mentors was working on colorectal cancer, and they had this huge database called the Iowa Women's Health Study Database of 100,000 patients. So that's where I started by clearly getting into colorectal cancer and GI cancer in general and how to learn from this database, how to mine these databases, how to do analyses, which seems easy but is actually quite complicated.  During my fellowship, I think the key to it is finding a good mentor during the fellowship. And I worked with one of the top GI oncologists in the country who's practicing. And I worked under her and learned a lot not only from the clinic side but also from the research perspective and how sometimes you'll come up with the ideas during the clinic itself.Like, “Hey, this patient had this and why aren't we looking into this.” And she would even do some of the therapies based on phase II trials and she was a part of a lot of these trials and learning from those experiences.  And following my fellowship, I joined Moffitt Cancer Center, where I led the phase I program there. So I was heavily involved in drug development programs, all training programs I've been to, NIH in Bethesda, an observership in the CTEP program, and also did the ASCO/AACR Vail workshop, where you really learned a lot in just like one week. So those are kind of opportunities present for fellows and even the early investigators and attendings as well in the first few years can go there, have your proposal. And really they are the world experts in trial design and they'll talk about how to design trials, how to add collaborators, improve your trial, and basically learn the whole protocol in a week so to speak.   And then I was at Moffitt Cancer Center for about five, six years. My home was GI so I did both GI oncology as well as phase I. And in terms of the GI oncology, my main focus was pancreatic cancer and liver tumors. Then I was at Mayo Clinic in Rochester for about seven or so years. I kind of did the same thing and solidified my career at GI oncology, looking at liver tumors, and pancreatic cancer and then being a part of the phase I division program. And now, most recently, about a year or so ago, I joined Case Western to lead the GI program here. Dr. Rafeh Naqash: Are the winters in Cleveland better than the winters in Minnesota? Dr. Amit Mahipal: For sure. I always say, you don't know cold until you go to Minnesota. It's a different kind of cold. I'm sure people in Dakota might say the same thing, but the cold in Minnesota is very brutal and different compared to any other place I've been to.  Dr. Rafeh Naqash: Well, it was great learning about you. Thank you so much for spending this time with us and for sharing your work with our journal. We hope you'll continue to do the same in the near future.  Thank you for listening to JCO Precision Oncology Conversations. Don't forget to give us a rating or review, and be sure to subscribe so you never miss an episode. You can find all ASCO shows at ascopubs.org/podcasts. Dr. Amit Mahipal: Thank you for having me here, Rafeh. Good luck. Take care. Dr. Rafeh Naqash: Thank you so much. The purpose of this podcast is to educate and inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions.   The guests on this podcast express their own opinions, experiences, and conclusions. Their statements do not necessarily express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.   Dr. Mahipal: Consulting or Advisory Role:QED TherapeuticsAstraZeneca/MedImmuneTaiho Oncology Speakers' Bureau:AstraZeneca Research Funding:Taiho Pharmaceutical"

Fear the 'Fro is back as the Cavs held off the Chicago Bulls despite a late 25-3 run from Chicago.  Bob Schmidt, of Fox Sports Radio, breaks down the win.  The bench was heroic in the first half, and some late game heroics from Donny, Caris, and Dean helped the good guys pull away.  The 'Fro pod audio mailbag is back with a questions from Anna regarding the drippiest of all movable contracts... Mr. Dean Jackson Wade.(0:00) Intro and Cavs vs. Bulls Breakdown - A Near Collapse Avoided(9:48) JB's Faith In Sam Merrill(14:00) Mike Brown Works The Refs After Bucks Calls(17:53) Audio Mailbag: Anna Wants To Talk Dean Deals...Matisse Thybulle Anyone?

Mack reacts to the Cleveland Cavaliers victory over the Brooklyn Nets in Paris including: Donovan Mitchell's 45 Point explosion Caris LeVert's continued 6MOTY play Sam Merrill's rough shooting night and more!

Caris Precision Oncology Alliance Chairman, Dr. Chadi Nabhan, sits down for an engaging podcast interview with Dr. Ari VanderWalde, Global Head of Clinical Trials at Caris Life Sciences. Join them as they delve into the world of clinical trials, exploring the intricacies of clinical research, providing valuable insights into Caris' contributions, and the accessibility of these transformative opportunities. For more information, please visit: www.CarisLifeSciences.com

David Traylor is Senior Managing Director at Golden Eagle Partners, and organizer of the CannMed 24 Capital Markets Workshop. After advising on various transactions in the life science sector, David took an interest in the cannabis sector and started advising cannabis companies before eventually re-foundeding Golden Eagle Partners in 2014 to focus on advising companies across the cannabis sector. Before Golden Eagle Partners, David served at leading investment banking firms including Pacific Growth Equities, Caris & Company, and Headwaters MB. During his banking tenures he has advised private and public biotechnology and medical device companies in various transactions including IPOs, public offerings, private offerings, mergers and acquisitions totaling over $500 million in value. David and Golden Eagle Partners will host a Capital Markets Workshop at CannMed 24 which will explore a global perspective of the hurdles, issues, and concepts around funding cannabinoid and cannabis innovation.  During our conversation we discuss: What attendees can expect from the Capital Markets Workshop Redefining the cannabis nomenclature The likelihood the DEA will reschuelde cannabis this year Pharma's growing interest in cannabis-derived compounds Challenges cannabis innovators face when raising capital Thanks to This Episode's Sponsor: Golden Eagle Partners Golden Eagle Partners are transactional experts, specializing in mergers, acquisitions, reverse mergers, financings and incremental transactions such as licensing, joint ventures and co-development arrangements. Their combined experience in the early stages of the cannabis and life science sectors allows them to confidently close strategic and financing transactions that match the near- and long-term goals of their clients. Learn more at goldeneaglepartners.com  Additional Resources Reclassifying Cannabis: What The HHS Recommendation Means For The Cannabis Market [Benzinga Podcast] David Traylor on LinkedIn Register for CannMed 24 Review the Podcast! CannMed Archive

Caris Snider shares how we can choose to find sacred pauses even in the car line while waiting to pick up our kids. Connect with Caris on Facebook and Instagram. Get your copy of Car Line Mom.   Show Notes: Dr. Saundra Dalton-Smith: Welcome, everyone. This is Dr. Saundra, and you're listening to I Choose My Best Life. Today, we are going to talk about how we enter the presence of God, even when we have a lot going on, especially if you're a mom with kids and you're transporting them all over the place. I have Caris Snider with me today, the author of a new devotional called Car Line Mom. I want us to talk about that because I feel like there are certain seasons in our lives where it seems impossible to break away and find time for God. But there are always opportunities. Caris, thank you so much for joining me. Caris Snider: Thank you for having me today. I'm excited to be here. Dr. Saundra Dalton-Smith: I Want to start just by learning a little bit about you. You wrote a book. With a title that I adore because it brings back so many memories of sitting in that car line. I just want to know a little bit about your background. Tell us a little bit about who you are and your family. Caris Snider: Absolutely. So, I am a car line mom. I have two daughters. I have a daughter. We are in high school. We have entered into that season of life as well. She's a ninth grader. And I also have a daughter who is in fifth grade. So we have a teen and a tween if you will. So we are absolutely in the car a lot going and coming. My husband and I, Brandon, have been married for 19 years and we live in the great state of Alabama. I have practically literally lived here my whole entire life. So if you hear that accent, everyone, yes, I am. It's that Southern drawl, if you will. But we love living here. We even have a little mini golden doodle. He's a part of our family as well, but I graduated from the University of Alabama with a child development degree. Over the past few years, I have been speaking and writing and just sharing my own journey with moms and with teens and with any generation that needs to know, Hey, your faith and mental health go together. God cares about it. And there is hope. And so to have this opportunity to write about it, to encourage our moms who are feeling stressed and overwhelmed, I am just thankful how God, never wastes anything and how he's brought everything together. For good in my life. So that's a little bit of me and who I am and what I do. Dr. Saundra Dalton-Smith: I really wanted to speak with you because I feel like you, you truly get it. And I think that for a lot of us when we approach motherhood, we approach it with a can-do attitude, which is good. We need some of that to be able to persevere, but we also, I find, sometimes we. Almost forget in the process as we're nurturing other people that we have to be nurtured as nurturers of ourselves. We have to keep that part of ourselves that can reflect on our own needs and the places where we need to be restored and where we need to seek help and assistance. There was a study that you mentioned from a 2023 state of Motherhood survey. And it said that it revealed that the top source of worry for mothers is mental health concerns. Share a little bit about why that's concerning.  Caris Snider: I think that's concerning because mothers are aware of this mental health crisis that we have going on, not just for our Children and our teenagers, but for ourselves. They are struggling to find those safe places where they can talk to you about what they're struggling with and what they're going through. I think, for our moms for all of us. We put this expectation of perfection on ourselves to get it right. When those sweet babies are put into our hands, we leave the hospital to know all the answers, to know what to do, and we just don't know. And then we put ourselves on the back burner and we give everyone the steak, the mashed potatoes, the good salad. And then we give ourselves the leftovers, and moms are seeing. This is not working. They are feeling exhausted. They are feeling burnt out, and they are wondering, is God mad at me? Did he get it wrong? Am I the right person for the job? And so the concern that we are seeing that moms have for their mental health, knowing there's a problem that they are feeling anxious. They're fearful, with all the things going on in the world, that they're isolating themselves away; they don't have that community. I am grateful that we are seeing the problem, but our moms are also saying to themselves, what are the solutions? What can I do? Because they do not want to operate in this way anymore, they want to take care of themselves, they want to take care of their mental health, but they don't know, they don't know what to do, and they don't know what the solutions are. Dr. Saundra Dalton-Smith: Yes, and that's what I want us to talk about during this time together because I feel like when you know that there's a problem and you don't know what to do next, that can sometimes be even more stressful and I wanted that particular survey even talked about nearly half of the mothers are currently seeking some type of assistance or therapy with over 32 percent of them reporting anxiety as the area of Concern. And I know anxiety is a topic that is near and dear to your heart. You've written quite a few other books actually about anxiety. What has been your own personal mental health journey? Caris Snider: Yes, about 11 years ago, anxiety and depression almost took my life. I was a master of the mask. My husband and I, at that time, were worship leaders at our church. I had a successful business going on within my home and my daughter, who's in 9th grade now. She was living her best toddler life then, man. Everything on the outside. side looks great and looked perfect, but I was being crushed by the weight of the anxiety on the inside feeling; my heart would race, or I would feel breathless, and I would have those thoughts, those what ifs, you know, the worst case scenarios playing out in my mind that would paralyze me. In my own life, I was also in a season, if I was being very honest with you, where I didn't think anxiety and depression were real. And if anyone came to me wanting help and advice, my advice would be to pray harder, try harder, do more, and suck it up. And those are not. Those are not healthy things. Those were not the best things for me to say. And I found myself in the bottom of the bottom wing, maybe a hundred pounds with the weight of the world on my shoulders, thinking that I was hopeless, worthless, and useless, and God couldn't use a mom like me. God couldn't use a woman like me, but at the bottom of that pit, I'll never forget feeling like God just whispered, look up. And when I looked up, there were helpers. There was a counselor and a doctor, and my church family was there, and I wasn't alone, and I began to realize, Hey, anxiety is very real. Depression is very real. These mental struggles that we face are real, and we're not alone. They are happening to adults and teenagers and our children all across the world. So we need to bring light to the darkness. I began to realize then, why are we in the faith community not talking about this? Why are we not championing The idea that God has given us practical skills that are connected to his word, connected to truth? And when we can put action and truth together, that gives me chills to think about how powerful that is. And so that began me on this journey of wanting to learn to study and how to talk about it in a way that we can all begin to practice these healthy, practical action steps that can really be life-giving and life-changing for us. As long as we go through this process it is a process. And I have people ask me all the time, are you free? Do you ever have anxiety or depression anymore? And I wish I could say yes, but there, I still have days, and I still have moments, but I've learned God has equipped me with what to do when those moments in those anxious thoughts try to come in and steal my life. I'm learning now how to push through instead of trying to push away. Does that make sense?  Dr. Saundra Dalton-Smith: It absolutely does. And I'm so glad you said that because I think that's a misconception that people have: You arrive at some point in time, and you never feel any of this stuff. And that's not reality. I'm a mom; my oldest son is actually at the University of Alabama in his sophomore year; he just went there. And so you can imagine when you release your first child into the world. You're gonna have some thoughts that hit your head because they are not in your. They're not in your back pocket anymore where you can know everything that's going on. And so I think it's wisdom to realize that you're gonna have these waves where things come at you. Life happens. And the tools that you mentioned, that is, I think, is the key. Truth in action. Understanding what the truth is you believe that you can ground and solidify your faith on and then what are some of the practical action steps you can do. So for yourself, what are a couple of scriptural references or even specifics from the Bible? Maybe it's not a specific scripture. Maybe it's just a concept from the Bible that you have grounded yourself within the truth. Caris Snider: Yes, I think of three specifically very quickly. First of all, on the anxious thoughts, I go quite a bit to Philippians 4:8 to think about what is instead of what if. Those what-ifs want to loop in our minds, and everybody's what-ifs are different. So when those anxious thoughts are coming when we go to remind ourselves, what is true? What is holy? What is pure? What is excellent? What is praiseworthy? Let's think about those things and practice shifting those thoughts. That's one thing that helps me take those thoughts captive and replace them with truth. Second, it is this idea that we need community. Friends, you are not meant to live a life alone. Galatians 6:2 says we are to bear one another's burdens and so fulfill the law of Christ. So, that idea that we have to be isolated that is a lie of the enemy. We need to be surrounded. We need those arm bearers. When we are going through those difficulties, that'll hold us up and say, hey, I got you. And then, when it's our turn to be the arm bearers for them, we can return that favor. And then the third is gratitude, man. Gratitude is so powerful. When we think of those good things in our life, when we look to those things that we can be grateful for and thankful for, not that we're ignoring the situations and pretending that everything is fine, but choosing to focus on the good. I'll never forget. I was in a school, and we were. Practicing some of these coping skills together and gratitude is one we do. While I was in an eighth-grade class, a young man raised his hand to say what he was thankful for, and everybody was just waiting for him to say something funny to get the class riled up. And he said, Hey, Caris, I'm grateful for the foster family I'm with right now because they're nice to me. And the whole class, you could see, they were like, okay. We understand what she's trying to tell us. So gratitude is powerful. Community is powerful, and changing those "what if thoughts" to what is again? This is a process that I go through things that I cling to on a daily basis to go to those tools because I don't want to live in a place of anxiety and depression. I've been there and done that, and it doesn't get to steal my life anymore. So let's all work through these things together and practice these things and imagine a dream and vision about what my life could be like if I tried this on a regular basis. How could it look different in seven days, 21 days, a year from now? Dr. Saundra Dalton-Smith: Anxiety and depression do not get to steal my life. I love that when we're looking at some of the action steps that someone can take. I feel like this was where I was just so impressed with your new devotional, Car Line Mom, because the thing that we often hear and that I, I myself, said for many years, I don't have time. I'm so busy as a mom. And you know what? There is some bit of truth to that. There's a lot of stuff that if you're working from home or if you're homeschooling, the day gets filled up with all the things. There's so much that we need to do to make sure everybody's where they're supposed to be, make sure food's on the table, make sure there's food in the kitchen to put on the table. So many things, what, if we looked at this in some type of stepwise approach, what would you say would be step one, two, and three that a mom who's looking at her life and she's saying, Caris, I don't know, girl, if I can do this. I don't know if I have time for a devotional. Caris Snider: I really love that question. And I'm giggling as I think about the rest of my day that I have ahead as a mom of all the things that we have to do. So if we're talking about this, man, we are friends. All of us as moms are coming together here, a couple of steps that I think we could take number one, instead of looking at it in the big picture, let's look at it in the moments, what moments do you have where you can pause and read a devotional, spend time with God, go to God in prayer. When you're in that car line, when you go there for just a few extra minutes, pause in that moment and give that to the Lord, open up that devotional book, if it is car line mom or your Bible or the Bible app. So number one, let's give it a moment and look at it in that way instead of big chunks. I think that can be helpful. Number two, look at your time. Can you get up earlier in the morning? Are you in a season where you can do that? Are your children where they're a little bit more independent, and so you're not having to stay up late to rock a baby to get up in the middle of the night? You're going to have to give yourself grace in there. I think that's part of that moment as well. Give yourself grace because these seasons are going to change. If you can get up early. If you're going to bed, maybe a little bit later because you've gotten everyone asleep, take that time when you're going to bed a little bit later to just pause again at that moment to give it to the Lord. I think that's going to be helpful for us as well. I think, too, for you as a mama, what are the expectations you're putting on yourself? We have to acknowledge this. That's a powerful thing. Are you expecting perfection from yourself? Are your expectations unrealistic? And if they are, let's shift out of that. Let's put a realistic expectation on yourself. What is doable for you as a mom right now in this season? Are your children in a lot of activities? Are you involved in your church and the PTO? Look at your schedule and put doable expectations on yourself. And finally, and I hope this gives somebody freedom today, Say no. Where can you say no? Those two letters are so powerful, and they can change a lot of things in your life. No is not a bad word. It is a powerful word that God's given you because you're saying no to all the filler things, and you're saying yes to all the God things that he has for you. So where are you saying yes to please others to fill your schedule where you can finally say no and nope? That doesn't fit right now for this season, it might fit for another season. But right now, my answer is. No, and that's okay. Dr. Saundra Dalton-Smith: Yes. No is okay. I feel no is the most underused word. Caris Snider: Amen Dr. Saundra Dalton-Smith: We really need to practice it more often. Start with just practicing saying no to a couple of things just to get it back into our vocabulary. I think hustle culture is just the real thing. It's something that it permeates not only. The business world, but it permeates the family now. So I would just love your insights on how you feel hustle culture is affecting just the quality of motherhood, our ability to enjoy it and to embrace it. Caris Snider: Amen again to that. So hustle culture is telling us to go do this. This is how you are a successful mom. And the difficult part that I'm personally seeing with that is the goalpost move. And then you, it just adds more hustle in there, and it's I got no hustle left, man. I don't know where to fit anymore in. And so it's always trying to please to achieve. And the great thing for us to remember is that God. And he is already pleased with us, not by what we do, but because of who he is; he made us, he said, we are fearfully and wonderfully made. And the hustle is taking away these opportunities for us as moms to just stop and see our children. Being children, it is not just affecting us, but now it's trickling down into our kids, and they feel like their schedules have to be filled. They feel like they've got to constantly be doing things. And I think this plays into why our children are feeling so anxious. There's no rest in there. And I know you could speak great greatly to that, but. They are feeling that pressure to constantly be doing, constantly be moving, and that's not what God wants for us. And I think something that I have been convicted about with the hustle culture is to put margin in there. We have to have margin in our life and our schedule. If you read a book, there's a margin in the lines for your brain and your eyes to take a break and process what you're doing there. There are margins in good, healthy businesses, and in our finances, there are margins in our clothes. We need margin in our lives. We need those opportunities where we can have those pauses, and we can have those moments as a family and with our kids to just see that it's okay not to do all the sports and not do all the things to just pause. And so I think if we will embrace the culture of pause and stillness that can push that idea away that we have to hustle, that we have to do all the things because then we're seeing that we're walking in the way that God truly wants us to walk. And I think there's more, there's peace there. I think our moms want peace. Don't you? I think that's what they, that they really long for. And when we can put in a culture of pause, that can help them bring in peace. What do you think about that? I totally Dr. Saundra Dalton-Smith: agree. I think that a culture of pausing, resting, reflecting, being still on purpose. I think that is how we recapture the joy of parenting, recapture motherhood, recapture marriage if we're going to expand it throughout the entire family. I think it's such; there's such wisdom in what you've shared, and I'm so excited about your new book. We're chatting with Caris Snider. She's the author of Car Line Mom Devotional. And Caris, I want to conclude with this. I would love to just hear your heart to a mother who is maybe even sitting in the car line right now, listening to this, thinking this is all I do all day. I cart my people from one spot to another. I'm the unpaid chef, cleaner, cook, driver, all the things. How do I get back to a place of just me and God? Caris Snider: I think about her, I just imagine maybe if she's sitting in her minivan or a car and there's goldfish in the backseat, and there's sweatshirts in the trunk and all the equipment, and maybe she's looking over at her passenger seat with all of her books and her, maybe her purse and her phone is sitting there and her snacks. I just see her with tears running down her face, just wondering, have I failed? Have I let Kai down? Have I let my family down? Am I up for this job as a mom, and can I just say to you? Yes, you are. God did not get it wrong. He does not make mistakes, and the way that He brought the children into your life, however, that looks, whatever that journey was, He knew exactly what He was doing, and He called you, and He created you for this. I think of Ephesians 2:10. He created good works in advance for you to do, and Mama, you are in the midst of doing a good work. And I just want you to know that God hears you, he sees you, and he loves you. And he thinks of you as his daughter, and he's right there with you. So just take a moment now, pause, pour your heart out to him, pour your requests out to him, and just ask him for his help to help you. Get in his word to help you take those moments of pause to shift out of hustle and to move in a new way of living a new way of being a mom and being all that he's called you to be and to walk in his grace today. Amen. Dr. Saundra Dalton-Smith: Amen. Caris, I want to make sure everyone knows how to get in touch with you, learn more about the work you're doing, and get a copy of your new book. Caris Snider: Absolutely. You can find me. I like to hang out on Instagram and Facebook at @carissnider, and I'd love for you to join us on my website and my email list family. That's my name as well, carissnider.com. All my books are there. And if you want a quick place to find Car Line Mom, head on over to carlinemom.com. And you're going to be able to find it there and all the things, and I would love to just get to know you and just be a part of your journey. Dr. Saundra Dalton-Smith: So wonderful, Caris, to have a chance to chat with you, and we will link to your book, your website, and your social media within the show notes so that people be able to get a copy and begin their own journey of getting closer with God every day. Thank you so much for joining me. Thanks for having me. Until next time, everyone live fully, love boldly and rest intentionally. ​ I Choose My Best Life Podcast is one of the  Top 20 Christian Women Podcasts I Choose My Best Life Books: Colorful Connections, Sacred Rest, Come Empty, Set Free to Live Free Connect with Saundra: Twitter: @DrDaltonSmith Pinterest: https://www.pinterest.com/drdaltonsmith Facebook: https://www.facebook.com/DrSaundraDaltonSmith

Caris Snider is a speaker, author, coach, and podcaster. Her latest book is There's an Elephant on My Chest, a picture book for children she wrote to help kids understand what anxiety feels like. Today, Caris shares her story of growing up in a Christian home in the Bible belt feeling like she had to be perfect. Trying to live up to her beliefs led to anxiety and depression until she was willing to accept help. Caris shares with us how she found hope over anxiety and the Lord's closeness during the process. Caris' story reminds us that we need community and don't have to be perfect to be loved. Listen to Caris' story in your favorite podcast player today! Children's Picture Book- There's an Elephant on My Chest Stories Caris shared: Overcoming anxiety and helping others Growing up in Alabama in a Christian family as a twin Her mom's example as a prayer warrior Having to overcome cerebral palsy on the left side of her body Trying out for cheerleader and not making it Studying early childhood development Meeting her husband who was in a Christian boy band Buying her own childcare center and realizing that it wasn't for her The season of uncertainty after giving up the childcare center Trying to pull herself up by her bootstraps and finding it impossible Having anxiety attacks with increasing frequency Trying to numb her pain by not eating Having a miscarriage and how that affected her Realizing she had to accept help to get out of her depression Giving up the idea of perfection for herself Learning the identities that the Lord has for her Writing books about anxiety and helping others Great quotes from Caris: When I looked up the things I was believing were proven to be lies. I had to recognize that help was not bad. I had to stop believing that I had to be perfect to be loved by Him. Those struggles are real but there is real hope. Resources we mentioned: Caris' website There's An Elephant On My Chest by Caris Snider Car Line Mom Devotional: 100 Days of Encouragement for the Mama Who Gets Everybody Everywhere by Caris Snider Related episodes: Edith Leland and Intimate Friendship with God Jon Fugler and Ditching Performance Christianity Christy Boulware and Love That Casts Out Fear The post Caris Snider and Hope Over Anxiety appeared first on Eric Nevins.

Caris Snider is a speaker, author, coach, and podcaster. Her latest book is There’s an Elephant on My Chest, a picture book for children she wrote to help kids understand what anxiety feels like. Today, Caris shares her story of growing up in a Christian home in the Bible belt feeling like she had to be […] The post Caris Snider and Hope Over Anxiety appeared first on Eric Nevins.

Are you already feeling overwhelmed by this holiday season? Y'all know that every November is NO-vember here on the podcast, and learning how to say no confidently and find peace amidst the holiday chaos.   I am so excited that my next Turquoise Talk guest, Caris Snider, is joining us for the second time. Caris is an incredible mom and author, and I am thrilled to have her back on the show. She is here to talk about building relationships, reducing anxiety, and finding fulfillment as a mom.   If you've ever struggled with saying no or find it challenging to prioritize your own needs, this episode is for you. Caris shares her insights and practical tips on how to cultivate the courage to say no and create a life that aligns with your values and goals.   Contact Caris through her website https://www.carissnider.com or www.carlinemom.com   You can also connect with her on social media @CarisSnider on both Instagram and Facebook.   Check out shop.martinesfavoritethings.com for my favorite books and items to make life and business a little more simple and a lot more fun!   Click here to book your free clarity call: https://calendly.com/martinewilliams/clarity-call   Connect with me on your favorite social media platform: Instagram: www.instagram.com/martine31williams Facebook: facebook.com/martinenwilliams   Be sure to follow this podcast to automatically receive your episodes!!!   Hey!! Send me a DM on IG and tell me what you think about the show!   Believing in YOU always! Martine   Podcast edited and managed by Haili Murch LLC.   If you are interested in starting a podcast or you are currently a podcaster needing help managing or relaunching your podcast, you may email Haili Murch at hello@hailimurch.com or you can click here to book a call: https://calendly.com/hailimurch/podcast-discovery-call

Author, speaker, life coach, Caris Snider talks today about how she struggled with anxiety and depression and how that's not a bad thing, it's just a thing that can be progressed through with the help of community, the truths of God's Word and presence, and possibly a  coach and/or therapist. Overwhelmed with all the things a mom faces, she began a little podcast that's become a big one called "Car Line Mom" - what we think about while we're in all the lines waiting with our kids or for our kids. Her latest book, by the same title is available today: Car Line Mom: 100 Days of Encouragement for the Mama Who Gets Everyone Everywhere.   Some gems from today's podcast: When negative thoughts come in, don't let them stay! No matter how we struggle as moms, we are never alone.  No one in the Bible did their journey alone; ask God for a friend to journey with you as a mom. I learned through my own feelings of inadequacy and living an over-committed life that it's okay to say "no" and create healthy margins A coach helps us Zoom Out on your life map to see how we can get where we want to go. Jesus was a our model even in negative feelings so we don't need to be afraid to have them. We don't need to be afraid to talk about faith and mental health. As mom's we feel like we can't fail which adds chaos and "overwhelm" to our lives.  We need to live from the overflow of God's presence. He promises peace; we need to live in and from that peace. CARIS SNIDER loves to share the hope of God through speaking, writing, coaching, and leading worship. She is the author of “Anxiety Elephants: 31 Day Devotional” and “Anxiety Elephants: 90 Day Devotional for Tween Boys and Girls.” From her own personal experience, she helps women in their journey of overcoming depression, anxiety, fear, and shame. Caris lives with her husband, Brandon, and two daughters in Cullman, Alabama. A word from Caris: I am so glad that you have found your way here. You see, I know what it is like to be shackled in guilt and shame, feeling hopeLESS and purposeLESS. BUT, I also know the freedom of those shackles being broken and beginning to live a life FULLfilled. I have my good days and I have my bad days. I have had some pretty dark days as well. I don't know what type of day you are having, but just know that many of us have been where you are, and there is hope to make it out. Find free resources HERE. Follow her instagram to learn more: @carissnider And her website is carissnider.com    

Join me as I chat with Caris Snider, author of Car Line Mom Devotional.  Caris's bio:  CARIS SNIDER loves to share the hope of God through speaking, writing, coaching, and leading worship. She is the author of “Anxiety Elephants: 31 Day Devotional” and “Anxiety Elephants: 90 Day Devotional for Tween Boys and Girls.” From her own personal experience, she helps women in their journey of overcoming depression, anxiety, fear, and shame. Caris lives with her husband, Brandon, and two daughters in Cullman, Alabama. You've got the Holy Spirit! You can do it, mama! Links: (This may contain some affiliate links, which means I receive a small commission, at no extra cost to you, if you make a purchase using these links. For more information, please see my disclosure policy.) Free Consult Call Facebook Group Carissnider.com instagram.com/carissnider Car Line Mom Devotional Playfully Faithful Parenting Podcast is a ministry of CreatedtoPlay.com. For more resources, tips, devotions, and tools check us out online: https://createdtoplay.com . Freebies for you: Want to work with me? Sign up for a 15-minute free coaching call: https://createdtoplay.com/free-coaching Free Bible Study on 3 Traits of God to Guide Your Discipline: https://createdtoplay.com/freebiblestudy Join my free 5-day Bible Play Challenge:  https://createdtoplay.com/challenge Get 17 fun, free kid's blessings for meals: https://createdtoplay.com/kids-blessings Even though I'm an introvert, I'm social!  Let's connect! Instagram: https://instagram.com/createdtoplay Facebook: https://facebook.com/created2play Twitter: https://twitter.com/createdtoplay Pinterest: https://pinterest.com/createdtoplay Are you looking for a speaker for your next women's, parenting, family, or Children's Ministry event? I'm now booking for 2023. I'm available for virtual and live conferences, brunches, MOPS meetings, retreats, trainings, and more. More details and sample video here: createdtoplay.com/speaking Did you enjoy the show? Subscribe and leave me a 5-star review on Apple Music and make me giddy. Music by jorikbasov from Pixabay. --- Send in a voice message: https://podcasters.spotify.com/pod/show/joy-wendling/message

So, the Doctor and Romana finally get to the planet Tigella after deliberately fluffing their lines ... and we have just noticed that Tigella has autocorrected itself to Nigella which has made us giggle and certainly puts the Meglos luring Caris into his dark cupboard and suggestively showing her what is in his hands in a completely new light! Haha. Well, guest Frazer Gregory won't be choosing that as his favourite thing of the epsiode, but will he be able to convince you, and host Toby Hadoke, that Meglos is worth more love than it currently gets?   Please support these podcasts on Patreon, where you will get advance releases, exclusive content (including a patron-only podcast - Far Too Much Information), regular AMAs and more. Tiers start from as little as £3 per month.  patreon.com/tobyhadoke   Or there is Ko-fi for the occasional donation with no commitments: ko-fi.com/tobyhadoke   Follow Toby on Twitter @tobyhadoke And these podcasts @HadokePodcasts And his comedy club @xsmalarkey   www.tobyhadoke.com for news, blog, mailing list and more.   

Are you a mom feeling overwhelmed, over-worried, and overstressed? Caris Snider understands! Her latest devotional, Car Line Mom, offers you encouragement with 100 fun, warm, and on-the-go devotions that remind you of God's love. As you take in each day's devotion, and enjoy relatable stories, life-giving passages of Scripture and daily action steps, too. Connect with Caris Snider at https://www.carissnider.com/The Significant Women podcast is full of personal stories, dynamic hope, and sage wisdom from women who have gleaned all that they can from the ordinary days of an uncommon life. They aren't significant because of their fame or success…they are significant because Jesus is in the details of their lives. Connect with Carol McLeod at https://www.carolmcleodministries.com/

Overcome your anxious thoughts. Let's talk about mental health.It's no secret anxiety and depression is a battle for many. Many of you have shared your stories with us. So on this episode we're excited to welcome Caris Snider!Caris shares her story and battle with anxiety & depression, and offers hope, practical life skills and strategies to help. She wants everyone to live a life full of hope, purpose and worth!We also chat about her latest release—Car Line Mom Devotional! 100 devos to encourage those mommas who are getting everybody everywhere!Listen wherever you get your podcasts or use the link in our profile.And as always, we'd love if you'd share this episode with your friends and/or leave us a review. (Five star reviews are our faves—hint, hint, wink, wink, lol. Thank you!)Connect with Caris:Website: https://www.carissnider.comCar Line Mom Devotional: carlinemom.comSupport the showWhat's Your Story on Instagram http://www.instagram.com/whatsyourstory.podcast To connect with Hannah visit http://www.hannahrconway.com To connect with Stephani visit http://www.stephanicook.org

Are you “Shoulding” all over the place?  Should pack the healthy snacks Should have our kids in all these activities Should be the PTO leader Should be posting every day on social media Should be the bible study leader Yet you are falling apart?  This episode may be sensitive for some. If you or anyone you know is battling depression,  anxiety, or thoughts of suicide please be aware we discuss these topics on today's show.    HELP is not a bad four letter word! Medication is not the enemy!  Boundaries are a good thing!   Connect with Caris Snider:  Website~Instagram~Car Line Mom~There's an Elephant on my Chest Connect with Courtney: Website~Instagram~Facebook  

Everything we talked about in this episode can be found here: https://www.buildyourbestfamily.com/podcast/episode-227

Welcome back to the kitchen table. As moms, we know just how hectic life can get. Our days are often a whirlwind of school drop-offs, pickups, errands, and everything in between. You've probably found yourself sitting in the carline at school, scrolling through your phone, and wondering how to catch a moment of peace in the chaos.    Join Bethany and author Caris Snider as they bring listeners into an incredible and valuable conversation. Life as a mom is full of ups and downs, and it's easy to get caught up in the anxiety and stress that can come with it. We worry about our kids, homes, to-do lists, and a thousand other things. During those moments of waiting in the carline, Caris realized we needed something to ground us, to bring us back to what truly matters. Caris and Bethany dive deeper into Cari's book, The Carline Mom Devotional, and how it's designed specifically for those precious moments when we find ourselves parked in the car, waiting for our children. It's a reminder that we don't need hours of solitude to connect with our faith. Even a few minutes can make a world of difference.   Caris and Bethany's conversation encourages you to pause and remember that we aren't seeking perfection. And, when we open the car door to greet our children with a sense of calm instead of chaos, we've allowed God to free us from whatever had us tangled. It's a beautiful reminder that we don't have to carry our burdens alone. Connect with Caris on Instagram @carissnider Learn more about Caris  Purchase the Car Line Devotional  Connect with Bethany: Website Instagram Facebook  

Are you the master of wearing a mask?  The one you put on to hide what's really going on…the one who responds with “I'm great, how are you?” Or “we're good, you?”. However, deep down that's not what you are really thinking and feeling…living in that artificial world isn't too comforting.  So many long for authenticity but like with Caris, struggle to make their way to that point. Listen into today's episode to hear Caris share her tough moments of doubting her purpose and finding herself feeling breathless.  She describes her anxiety as if feeling like an elephant was on her chest. Caris is super transparent in sharing that before she was diagnosed and battled on her own, she was someone who believed anxiety and depression was not real. She starved her anxiety to the point of numbing the pain. Caris pulled away from everything she possibly could in order to keep hiding from her true pain. When the darkest moments came, she felt like a burden to everyone. Please listen in to hear how God pulled her from the trenches and how He has used this in her life for His Glory! Our guest this week, Caris Snider, is a Christian Communicator who shares the hope of God as a speaker, writer, certified life coach, and podcaster on her weekly show, Car Line Conversations. She is the author of Anxiety Elephants 31 Day Devotional and Anxiety Elephants 90 Day Devotional for Tween Boys and Girls. She has two new books that have just released. A Children's Picture Book, There's an Elephant on My Chest, and a book for moms titled, Car Line Mom Devotional. She shares personal experiences of overcoming depression, anxiety, fear, and shame. Caris desires to help people of all generations see their value and worth through the eyes of the Lord to grow in their faith and mental health. Caris offers inspiration to those who feel purposeless to discover their God-given calling no one else can accomplish. Caris lives with her husband, Brandon, and two daughters in Alabama.  For more information about Caris, her ministry, books, or speaking, go to: https://www.carissnider.com/ Caris Snider website Link to all her books: Books Follow Caris on Instagram   Sunlighten Sauna:  Save Up to $600      Join our community on Facebook and connect with us on Instagram!  Write an apple review and YOUR review could be read on our next episode!  Hosted by Tori Shirah and Tracy Stine Contact us ➡️ UnlikelyJoCo@gmail.com    

On this weeks episode we discuss...how to be still, how to overcome the "should bully," and how being still is an action and a choice. Caris Snider is an author of 5 books. CARIS SNIDER loves to share the hope of God through speaking, writing, coaching, and leading worship. She is the author of “Anxiety Elephants: 31 Day Devotional” and “Anxiety Elephants: 90 Day Devotional for Tween Boys and Girls.” From her own personalexperience, she helps women in their journey of overcoming depression, anxiety, fear, and shame. Caris lives with her husband, Brandon, and two daughters in Cullman, Alabama.

Does back-to-school have your head spinning? Do you feel overwhelmed with the demands of parenting in this season? Are you struggling to find time with God? Today I'm talking with my new friend Caris Snider, author of Car Line Mom: 100 Days of Encouragement for the Mama Who Gets Everybody Everywhere. And Caris is doing just that…she's giving us encouragement in this busy season of back-to-school, fall sports and activities, and the many carlines we are starting to find ourselves waiting in. You'll hear us talk about… Handling the mental load of motherhood Getting time with God amidst the chaos The importance of community Caris's back-to-school hacks Caris Snider is a Christian Communicator who shares the hope of God as a speaker, writer, certified life coach, and podcaster on her weekly show, Car Line Conversations. GET ALL THE SHOW NOTES   CONNECT WITH CARIS Instagram | Facebook | Website   LISTEN TO THE SUMMER OF FRIENDSHIP SERIES   CONNECT WITH GIRLS TALKING LIFE Get the GTL Newsletter | Instagram | Facebook

Have you ever wondered how you can deal with anxiety and depression? In this episode, Camille welcomes Caris Snider, the author of Anxiety Elephants and has built a business helping others deal with anxiety.Caris shares her personal experience of dealing with anxiety and depression and the tools she used to overcome them. She gives her advice on the different techniques that you can use to handle your anxious thoughts, as well as manage your children's anxieties across different age ranges.If you're interested in learning about how you can break down those anxious thoughts, tune into this episode so that you too can find peace in your work and family.Resources: Interested in becoming a virtual assistant? Join the 60 Days to VA Course:www.camillewalker.co/VAAccess the 5-day email sequence to help you discover your purpose: www.callmeceopodcast.comPurchase Caris Snider's books at: www.amazon.com/stores/author/B082PKGB7PConnect with Caris Snider:Follow Caris on Instagram: www.instagram.com/carissniderFollow Caris on Facebook: www.facebook.com/conversationswithcarisVisit her website at: www.carissnider.com/Connect with Camille Walker:Follow Camille on Instagram: www.instagram.com/CamilleWalker.coFollow Call Me CEO on Instagram: www.instagram.com/callmeceopodcast

Manuel ist im Urlaub und Caris Freund Klaus ist zu Gast im Podcast. Klaus berichtet von seinen Erfahrungen im Zeltlager am vergangenen Pfingstwochenende und vom Verkehrslärm, der ihn in letzter Zeit genervt hat. Im Anschluss sprechen Cari und Klaus über seinen Alltag als Lehrer in Deutschland und vergleichen, inwiefern sich sein Tagesablauf von Caris unterscheidet.   Transkript und Vokabelhilfe Werde ein Easy German Mitglied und du bekommst unsere Vokabelhilfe, ein interaktives Transkript und Bonusmaterial zu jeder Episode: easygerman.org/membership   Sponsoren Hier findet ihr unsere Sponsoren und exklusive Angebote: easygerman.org/sponsors   Zu Gast: Klaus Spargel-Wahnsinn: Wir kochen das Lieblingsgemüse der Deutschen (Easy German 504) At the Emsland (Easy German 53) German Traditions: Boßeln (Easy German 189) Fußball in Deutschland (Easy German Podcast 124)   Wichtige Vokabeln in dieser Episode das Zeltlager: Ort, an dem Menschen in Zelten übernachten, oft im Freien und für eine begrenzte Zeit der Pfadfinder: Mitglied einer Jugendorganisation, die Outdoor-Aktivitäten, Gemeinschaft und persönliche Entwicklung fördert frösteln: leicht zittern oder sich kalt fühlen, oft aufgrund von Kälte oder Unbehagen die Einfachverglasung: Fenster mit nur einer Glasschicht, das sehr dünn ist und deshalb u. a. viele Geräusche und Lärm durchlässt der Ganztagsunterricht:Schulform, bei der Schüler den ganzen Tag in der Schule verbringen, einschließlich Mittagessen und zusätzlicher Aktivitäten die Mensa: Speisesaal oder Cafeteria in einer Schule, Universität oder anderen Bildungseinrichtung, in dem Mahlzeiten angeboten werden   Support Easy German and get interactive transcripts, live vocabulary and bonus content: easygerman.org/membership