Podcasts about Chou

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Dr. Timothy Gilligan and Dr. Calvin Chou discuss the updated guideline on patient-clinician communication in oncology. They highlight clinical recommendations and strategies on topics such as communication skills and practices that apply at every visit, principles for telehealth interactions, cross-disciplinary communication, facilitating involvement of the patient's support network, discussing prognosis, goals of care, treatment selection – including clinical trials, end-of-life discussions, overcoming barriers to communication, facilitating discussions of cost of care and financial toxicity, mitigating stigma, and setting boundaries with patients. Dr. Gilligan and Dr. Chou also share how clinicians can enhance their communication skills through skills practice opportunities and experiential learning. They discuss how fundamental communication is to optimal patient care and look to the future on how generative AI may impact healthcare communication. Read the full guideline, "Patient-Clinician Communication: ASCO Guideline Update"  TRANSCRIPT This guideline, clinical tools and resources are available at www.asco.org/supportive-care-guidelines. Read the full text of the guideline and review authors' disclosures of potential conflicts of interest in the Journal of Clinical Oncology,  https://ascopubs.org/doi/10.1200/JCO-26-00118       Brittany Harvey: Hello and welcome to the ASCO Guidelines podcast, one of ASCO's podcasts delivering timely information to keep you up to date on the latest changes, challenges, and advances in oncology. You can find all the shows, including this one, at asco.org/podcasts. My name is Brittany Harvey, and today I am interviewing Dr. Timothy Gilligan from Taussig Cancer Institute and the Center for Excellence in Healthcare Communication at Cleveland Clinic, and Dr. Calvin Chou from the University of California and Veterans Affairs Health Care System in San Francisco, co-chairs on "Patient-Clinician Communication: ASCO Guideline Update." Thank you for being here today, Dr. Gilligan and Dr. Chou. Dr. Timothy Gilligan: Thank you for having us. Dr. Calvin Chou: Delighted to be here. Brittany Harvey: And then just before we discuss this guideline, I would like to note that ASCO takes great care in the development of its guidelines and ensuring that the ASCO Conflict of Interest Policy is followed for each guideline. The disclosures of potential conflicts of interest for the guideline panel, including Dr. Gilligan and Dr. Chou who have joined us here today, are available online with the publication of the guideline in the Journal of Clinical Oncology, which is linked in the show notes. So then I would like to dive into what we are here really today to talk about. So Dr. Gilligan, this guideline updates the patient-clinician communication guideline that was first published in 2017. What prompted this update and what is the scope of this updated guideline? Dr. Timothy Gilligan: So I think with the first guideline, that was the first draft of it that we published five or six, seven years ago, really we were focused on getting the content right, what was the state of the knowledge at that time, and I was very happy with what came out of that. But when I looked back on it, I thought there were ways we could make it more accessible and more practical. Because what we really would like would be for people to apply what we know and then communicate more effectively with patients and colleagues. And one of the reasons I was really excited on the membership of the panel we had this time was I thought they were very well selected to help us do that, is to really think about what are practical guidelines, practical steps we can tell people to take that will improve their own experience and the experience of patients and the quality of care. Brittany Harvey: Absolutely, thinking about operationalizing that guideline really improves the dissemination and the uptake of these recommendations. So then, Dr. Chou, I would like to review the key recommendations and strategies across the clinical questions that the guideline addressed. I realize today with our limited time we may not be able to go through every recommendation and strategy, so we will start with some of the highlights. First, let's address the highlights of the process of communication with patients and their support networks. This includes the questions that address what communication skills and practices apply at every visit across the continuum of care, principles for telehealth interactions, cross-disciplinary communication, and facilitating involvement of the patient's support network. In your view, what are the most important recommendations across these clinical questions? Dr. Calvin Chou: I think the thing that all clinicians know in their bones that they want to be able to do effectively with patients is to communicate information clearly, as well as to communicate in a way that really deepens the relationship, demonstrates empathy, and also demonstrates understanding bilaterally between the various parties. So the communication guidelines that we established in this group, they are fundamental to communication in all conversations throughout healthcare. And the first guideline talks about how clinicians and their team can communicate effectively with the patient and the patient's support network. And those include things like preparing ahead of time; getting a list of the topics that are important to the patient support network so that we can consider them in the visit; making certain that we are hearing what the patients' and the patients' support networks are saying very, very closely; responding to those empathically; and being able to have conversations about care throughout the visit that demonstrate respect and deepen the trust; and then finally, to have some kind of bidirectional understanding, usually through teach-back, that allow both sides to know that communication has occurred as opposed to just been downloaded. The guidelines also talk about applying these same communication skills throughout telehealth communication - that is both in terms of synchronous communication, audio or video, as well as asynchronous communication, i.e., through secure messaging. We also talk about how we can use these same communication skills to communicate effectively with members of our own team. Interprofessional communication is an important part of all the work that we do, and how we can use these very, very same skills in communication with colleagues, with nursing staff, with social workers, and other allied health professionals. These are all very, very important, crucial members of our healthcare team in the delivery of care to our patients. And that is something that we really need to emphasize throughout to try to bring the best of communication in every conversation that we have. Dr. Timothy Gilligan: I totally agree with that. Those are really important points. When I was looking over it in preparation for this podcast, it struck me that we have a lot of recommendations and a lot of small things that we can do either well or not well. And it reminded me of a quotation from a famous chef, Marco Pierre White, who said that perfection is a lot of little things done well. This guideline has a lot of little things that if you do them well, you get better outcomes. And I think the chef's point was that if you want a really delicious dish, you have to pay attention to all those little details. And I think if people go through the guidelines carefully and apply the skills that are along the lines of what Dr. Chou was talking about, we get better results. And those results are really important results. It is not only patient satisfaction, which is really important, but it is also quality of care and outcomes for patients. It is better medical care. It is a better day for us, we have a better day if we have better conversations. Poor communication creates endless headaches for everybody. What I see in the guidelines is it is a lot of little best practices and it requires discipline to learn those. The good news is none of them I don't think are all that hard. The bad news is doing it consistently well every day requires discipline and practice. And what I would hope for these guidelines is that people will read them carefully and think about what they can do to apply what we know more consistently. And I think the interprofessional communication piece, that was something we added this year, is really critical. Medicine has a bad history of really disrespectful behavior. It was almost normalized that different specialties would make fun of each other, that different professions would talk disrespectfully of each other. And we know now that uncivil behavior results in more healthcare errors. And it is not only bad for our teams and our culture, but it is bad for our patients if we are not communicating well with each other. So I thought it was really critical that we added that piece to the update. Brittany Harvey: Absolutely. Those fundamental principles that Dr. Chou outlined are really key across every healthcare interaction, including those interdisciplinary interactions. And as you alluded to, Dr. Gilligan, I think it will really serve clinicians well to review the details and go through every table to read the recommendations and each individual strategy to help them improve their communication in day-to-day interactions. Moving to some of those day-to-day clinical communication scenarios, Dr. Gilligan, I'd like to think through some of those key points. So what is recommended for discussion of prognosis, goals of care, treatment selection, including discussion of clinical trials, and end-of-life discussions? Dr. Timothy Gilligan: So my perspective is that there is a broad theme of flattening the hierarchy that runs through these recommendations and this part of the guideline - that the sections that Dr. Chou just talked about really have a lot to do with the details. What does good communication look like? What are best practices that we can adopt? And I think these other sections are a little bit more, they also have a lot of specific guidelines, but there is a philosophical point that we do better when we talk to the patient at their own level. And we sometimes fail to do that. I remember from about 10 years ago I was in a room with a patient and one of the other doctors said to the patient, "We're going to bronch you tomorrow." And I was trying to think, like, what do they think the patient hears when we use language like that? Like they don't understand what the word means. We are just expecting them to step up to our level. We are not accommodating them, and I think that really interferes with our ability to form effective relationships with patients and communicate clearly. So if we are going to talk about prognosis, goals of care, treatment selection, clinical trials, end of life, the first step for me is that we have to get down to the patient's level, which means listening. We have to ask them what they know, we have to get their perspective. We have to understand what their health literacy level is so that we can have a conversation that takes into account the patient's perspective. And we need to be humble and remember that the patient often has information that we do not have yet unless we ask them and listen to what they say. That is going to change what we think is the best plan of care. And so shared decision-making is really a critical piece of that. One of my favorite trainers who I follow online says, "I make suggestions, you make decisions." And I like to bring that attitude into the room when I talk to patients. It is their life, it is their body, it is their health, it is their decision. It is not my decision. I don't get to tell them what to do. I want to make sure that they make a decision that is based on the best available evidence, but also a decision that is based on who they are and what their values are. And we try to give pointers to how we can have these conversations in a way that is really fully respectful of the patient's autonomy and the importance of the patient's expertise in their own body, their own lived experience. Because there is a risk that we come in with our white coat and we overpower them with our authority, our medical authority, our medical knowledge, and no one likes to be overpowered. And I think we all have a better day if we go in and have a conversation as human beings with each other. Dr. Calvin Chou: I want to underscore this point of having the patient and their support network make the ultimate decisions. Reviewing the evidence from more general literature, it is clear that across demographics that only 10% of patients want us to make decisions for them. 90% of patients want to have at least some say, if not full say, in the decisions that they make, and this is true across age, across gender, educational status, socioeconomic status, veteran status. This is a very, very important point. I think oftentimes we go in thinking we know what's going to happen and we need to make them do that. Thinking about this as a conversation as opposed to a download is an important point. Dr. Timothy Gilligan: And one thing that I think that the guidelines are relevant for here, which is I think one way to achieve honoring the patient autonomy, is to really make a commitment to having a good process, to not be committed to an outcome. So that when we start the conversation, we're not going to say it's a good conversation based on whether it ends up where I wanted it to end up. It's a good conversation based on whether we have a good process, a fair process. And the steps of good communication that are outlined in this guideline help us to establish a good process. And I think if we have a good process, we can trust it will take us to the appropriate outcome, which may be different than the outcome we thought was going to be the appropriate outcome when we started the conversation. Brittany Harvey: Definitely. I think, as you mentioned, tailoring discussions to each individual patient and situation is really critical. And I think in every other podcast episode across guidelines we've really emphasized the importance of shared decision-making. And so talking through the process of it in this guideline will really have impacts across all of ASCO's guidelines. Moving on to the next section of the guideline, this guideline also addresses barriers in the communication process. So Dr. Gilligan, what highlights are there for overcoming barriers to communication, facilitating discussions of cost of care and financial toxicity, mitigating stigma, and setting boundaries with patients? Dr. Timothy Gilligan: Yeah, it's interesting. I want to hear Dr. Chou's perspective on this too. I thought that the communication skills are really important for these conversations, but less powerful or less effective, potentially. For instance, barriers to communication, the big one that comes to mind is language differences. If the patient and the clinician do not share the same language, that results in less good care unfortunately. It results in less good communication. Having skilled translators or interpreters there is essential, and using them with skill is essential, but it does not get us to equality. I mean the best thing for a patient is to have a clinician who speaks their language. Unfortunately, that's not possible. So the second best thing we can do is to have good interpreters or translators to help us work. And then for us to use those people effectively, because oftentimes we cut corners when working with interpreters and shortchange the patient. So it is important to do the best we can. I think it is also important to acknowledge that it's a challenge and no matter how good your communication skills are, it's not going to be the same conversation if you're talking through another person versus directly to the patient. Similarly, with financial toxicity, it is important to talk about it. We need to be open about it. We need to talk to patients about it, but financial stress from healthcare is a real problem, and however well you communicate it, it doesn't make that problem go away. You know, in oncology, our drugs are obscenely expensive, and I can't communicate my way to lower prices. So I can talk about it and legitimize it and empathize, but I feel like I have more power in the other sections to really change the outcome by communicating well than I do with these. But it is important to talk about it. Patients are hugely affected by the cost of care and we need to talk about it with them. I do think for mitigating stigma and setting boundaries, then our communication skills become more powerful. We see everyone in the healthcare system, and when working with individuals who have been subject to stigma because of aspects of their identity, we can help lessen their vulnerability and fear by proactively letting them know that we will strive to avoid perpetuating that stigma, that we will treat them with respect and address them as they wish to be addressed, that we will care for them as dignified and valued human beings. That is not always their experience in the system, but we can choose to be different. We can choose to do better. And our communication skills are important because listening and curiosity are super important in that space. Because if we are talking to people who may be different from us, we need to learn about them by listening and being open and being curious, and replacing, if we have any tendency towards judgment, to replace judgment with curiosity. With setting boundaries, I think it is also really important. I don't think you can show up and be fully present with patients the way I want to, the way we want other people to, if we don't know that there are boundaries. And we know this in other aspects of our care, right? I go into the room and I do intimate physical exams and I ask about intimate aspects of the patient's life. And I'm allowed to do that because there is a non-negotiable barrier to any kind of sexual or romantic contact between me and my patients. We know there's a hard wall there that we don't cross that line, so that when I am doing an intimate exam, we know where that stops and that we're not going to cross boundaries there. But the same thing applies verbally, and I think doctors sometimes and other healthcare professionals sometimes feel like they need to accommodate the patient no matter what. I was hoping the guidelines would send a strong message that, you know, we don't need to put up with disrespectful behavior. That when you go into the room, as a clinician or as a patient, you should be treated with respect. You should feel safe, you should feel like you belong, and if patients are behaving in a way that violates that, then clinicians have a right to speak up and to set limits and to set boundaries. And if we know those boundaries are there, then I think we can lean in closer. If we don't know those boundaries are there, then we kind of have to hold back to protect ourselves. And just to give one of like a million examples you can give, I don't know a woman in healthcare who hasn't had a patient say something sexually inappropriate to them at some point. And that's not okay. I want my colleagues to know that's not okay, and it's okay to set boundaries and they don't have to put up with that. And my hope is that if we know where the boundaries are, then we can step in closer. That's my perspective on these, but Calvin, please, I'd love to hear your thoughts. Dr. Calvin Chou: I want to double-click on everything that you said, Tim. It is so important that we recognize what we have control over and what we don't have control over. And what we don't have control over, for example, language discordance or financial woes of a patient, I have no possible way of controlling that. And so the best I can do in those situations is to sit with them, empathize, and do what I can, whatever power I might have in advocacy or I often refer folks to a social worker that I work very, very closely with, because I have no agency over any of that. At the same time, when we talk about mitigating stigma in healthcare encounters, we have full control over the biases that we have. We may not be aware of them, but we do have control over them ultimately. And so it is up to us really to examine our practices, to see where we have maybe been steered in the wrong direction, where we double down on internal implicit biases that we have carried for our entire lives. And that requires that we approach all of our encounters with everybody in healthcare, with humility, and with an extra eye toward understanding how we are coming across to them, and whether or not at least some of those interactions are infused with bias that we can decrease. And then finally, with the idea of boundaries, there are boundaries in two directions, as Tim was saying a moment ago, that there are boundaries that we must place in between ourselves and patients during examinations and also during interactions. And there's also boundaries that we have to set up that require that we uphold the standards ethically of clinical medicine. And that is, there are certain things- I would never ask a patient out, for example, on a date. And that's an important proscription; that's an important boundary that we must set up between ourselves and patients. Those are clear barriers that we must not breach. There are some barriers that are a little bit less clear. For example, there are some instances where physicians are asking patients who have means to perhaps contribute to a foundation or contribute to the university or to make a large donation to an institution. In some instances, that's a much less clear boundary. For myself, I feel uncomfortable making those kinds of requests, and there are other instances where those requests are actually not just okay to do, but the patient is willing to do those kinds of things. So I think we need to consider that these boundaries are not always set in stone. Sometimes the boundaries move, sometimes the boundaries are different. Brittany Harvey: Absolutely. I think this latest question covered a lot of ground, and I think some key points here are that treating everyone with dignity is really paramount to this guideline. Recognizing the challenges even when they're not solvable is really important, such as thinking about financial issues or perhaps not speaking the same language as a patient. And then building trust and mutual respect between patients and clinicians to establish clear boundaries is really important as well. So, I want to thank you both for reviewing at a high level the recommendations and the strategies from this guideline, and I encourage listeners to review the full guideline and tables for all of the recommendations and strategies to implement these clinical recommendations. So, Dr. Chou, this guideline panel also addressed one education question. So, what are the recommendations for effective ways for clinicians to enhance their communication skills? Dr. Calvin Chou: Thanks for asking, Brittany. When we talk about all of these communication skills, Dr. Gilligan and I have talked for a long time about all these individual communication skills. These are not skills that are necessarily naturally formed within us and that we just roll out without any practice. And that's why we both feel, if I can speak for you, Tim, that we both feel that communication skills training, and high-quality communication skills training, is deeply important. This is training that is less about I'm listening to this podcast and therefore I can communicate better, it's more about skills practice opportunities, experiential learning, oftentimes using that horrifying word 'roleplay' that people don't like to think about roleplay before they're in it, but then once they've done those skills exercises they realize how important it is to actually have practiced some of these skills so that when you get into the real situation, you have an approach to it as opposed to trying to just improvise or make it up on the fly. The other aspect of communication skills training that is deeply important is not just forming the words and speaking to somebody else, it also needs to incorporate practitioner self-awareness and situational awareness that allows us to understand what's going on within us emotionally and attitudinally so that we are interacting moment by moment with patients and their support networks in a way that's authentic, that brings the appropriate amount of vulnerability and expertise to deepen trust between all of those relationships. And finally, when we talk about communication skills training, there are ways to do this kind of training that, I've used ChatGPT, for example, when I'm having some difficulty wondering how to navigate a particular situation, sometimes you can use ChatGPT to give you some suggestions on how to approach that interaction. But at the same time, the most important thing is to be able to have really meaningful practice with other people, with other human beings. Because as much as I might interact with a computer, that computer is not a human being. And what we are talking about is interpersonal communication with emphasis on 'person'. And us as human beings, we understand, in a way that ChatGPT probably will never fully understand, the nuances of the emotional reactions and the importance of human connection between people when we talk to each other. And so therefore, if we can't depend on computers to do this communication skills training, we need institutions to emphasize and invest in all of our continuing ability to communicate effectively with everybody in healthcare. This is probably one of the most important outcomes of this guideline, is not just that communication skills are important, and not just that communication skills training is important, it's that we need everybody to invest in everybody's ability to communicate with each other on the highest possible level that we can bring. Brittany Harvey: Yes, I think it's really important that the panel addressed this question, to emphasize that it's not just individual clinicians, but institutions that really need to value communication and this training to make sure that clinicians are being the most effective communicators that they can be. So, I'd like to move on to the next question, and Dr. Gilligan, ask, in your view, what is the importance of this guideline and how will it impact both clinicians and people with cancer? Dr. Timothy Gilligan: So I would build off of what Dr. Chou was just talking about, which is what we're hoping is that it will serve as a resource that will give people interested in communicating better guidance on where to go, what to do, what are the best practices, what do we know at this time. if you want to get better, what are the methods that are going to help you get better. And ideally I hope it will inspire people to want to get better. Communicating is such a fundamental part of our day-to-day work in healthcare that it needs to be something that we're very, very good at. And as professionals we should aspire to be as good as possible. A lot of this stuff is pretty basic, but we forget to do it. When I had young kids and was teaching them to ski, one of the ski instructors said to me once that there were Olympic skiers who trained at the same mountain where my kids were learning. And he said they would go down easy slopes and just practice basic techniques still. They were good enough to ski in the Olympics going at crazy speeds, but they kept going back to their fundamentals. And my son is a serious soccer player and they do role plays in soccer. They practice drills. They have scenarios they know are going to come up and they artificially recreate that scenario and they practice it over and over again. There's a famous line from a college football coach that you don't practice it until you get it right, you practice it until you can't get it wrong. And I think if people would bring that sense of professionalism to communication, it's a lifelong journey. I'm still trying to get better. It requires practice, it requires discipline. There's a lot that we know, but it doesn't happen without practice. And as Dr. Chou was saying, it's a motor skill. You don't learn it by reading about it. You don't learn it by listening to us talk about it. You learn it by practicing it. And I practice with patients. Not in the sense that I'm doing an experiment, but I work on my skills with patients. And I see how it goes. And when things don't go well, I think of what I could have done differently. And when things do go well, I think of what did I do that helped it go well that I need to make sure I do again next time. And I think I'd love to see people adopt an attitude that they want to be fantastic communicators and they want to get better. And I think the guidelines provide a lot of clues and steps to take for all of us to get better. Dr. Calvin Chou: I heard Tim, you talk about communication being a procedure and that we would never think about going into a room and sticking a central line into a patient without having practiced that over and over and over again to get it right. Not to get it right, to never get it wrong, like you were just saying. And so if we think about communication as the most common procedure in healthcare, then it behooves us all to do the best we can with it. It is a frame shift because we are communicating with each other all the time, oftentimes without thinking. And what we're advocating right now is for everyone to really bring it in terms of communication skills in all settings, because the effect of ineffective communication is not necessarily just making people feel bad. As Tim said at the top of the program, it also impinges on quality of care. It's not just the right thing to do, it's the safe thing to do. Brittany Harvey: Absolutely. And highlighting the fundamentals here and practicing them as clinicians will improve each healthcare interaction. So then, finally, to wrap us up, Dr. Chou, earlier you mentioned ChatGPT and thinking about maybe some technological advances and how those will impact in the future. What are the outstanding questions and priorities for future research for optimal patient-clinician communication? Dr. Calvin Chou: I think there's a lot we still need to learn about in this very, very nascent time of interacting with generative artificial intelligence. We won't know what things are going to be like probably even tomorrow given the vast advances that AI is allowing us to do. And also, as I was mentioning earlier, what AI can never do is to bring the human element into these interactions. And I think that's part of what, maybe that's a lot of what brings people to healthcare, is if they're in need and they have some physical issue that we need to help them solve, it's not just a physical issue, it also is a deep emotional experience. And we have heard many times now cautionary tales of when AI has led people astray to then, for example, allow them to die by suicide. And that is the last thing that we can allow to happen in healthcare. That is the ultimate low-quality item. We need to make certain that everybody is cared for with high quality and high safety. And we're definitely not there yet with AI. We hope that at some point we'll be able to work with AI in order to bring even better healthcare than we have right now, and I think that has been demonstrated to be possible. That is one major outstanding question that we're all going to have to wrestle with. Brittany Harvey: I think that's absolutely a key point. With generative AI quickly evolving, there need to be guardrails in place. And like any intervention, thinking about how to maximize the benefits of it and reduce the harms to make sure that you're preserving that human interaction and communicating effectively, and that patients can receive their health information in an appropriate way. So I want to thank you both so much for your work to update this guideline, to draft all of these recommendations and the strategies, and work with the entire panel to create this excellent product. So thank you for all that work and thank you for your time today, Dr. Chou and Dr. Gilligan. Dr. Timothy Gilligan: Thank you. Dr. Calvin Chou: Thank you, Brittany, so much. Brittany Harvey: And finally, thank you to all of our listeners for tuning in to the ASCO Guidelines podcast. To read the full guideline, go to www.asco.org/supportive-care-guidelines. You can also find many of our guidelines and interactive resources in the free ASCO Guidelines app available in the Apple App Store or the Google Play Store. If you have enjoyed what you have heard today, please rate and review the podcast and be sure to subscribe so you never miss an episode. 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.

Bright on Buddhism - Episode 133 - Who was Daosheng? What did he do? What is his significance to East Asian Buddhism?Resources: Blum, Mark (2003). "Daosheng". In Buswell, Robert E. (ed.). Encyclopedia of Buddhism. New York: Macmillan Reference Lib. pp. 201–202. ISBN 0028657187.Buswell, Robert Jr; Lopez, Donald S. Jr., eds. (2013). Princeton Dictionary of Buddhism. Princeton, NJ: Princeton University Press. ISBN 9780691157863.Hsiang-Kuang, Chou (1956). A History of Chinese Buddhism. Allahabad: Indo-Chinese Literature Publications.Kanno, Hiroshi (1994). "An Overview of Research on Chinese Commentaries of the Lotus Sutra". Acta Asiatica. 66: 87–103.Kim, Young-Ho (1985). Tao-Sheng's Commentary on the Lotus Sutra: A Study and Translation. dissertation, Albany, NY.: McMaster University. Archived from the original on 2014-02-03.Kim, Young-ho (1992). Tao-Sheng's Commentary on the Lotus Sutra: A Study and Translation. SUNY Press. ISBN 978-1-4384-0898-9.Lai, Whalen (1982). "Sinitic speculations on buddha-nature". Philosophy East and West. 32 (2): 135–149. doi:10.2307/1398712. JSTOR 1398712.Lai, Whalen (1991). "Tao Sheng's Theory of Sudden Enlightenment Re-examined". In Peter N. Gregory (ed.). Sudden and Gradual. Approaches to Enlightenment in Chinese Thought. Delhi: Motilal Banarsidass Publishers Private Limited. pp. 169–200.Tanabe, George J. (1992). "Review: Tao-sheng's Commentary on the Lotus Sutra: A Study and Translation, by Young-he Kim". Philosophy East and West. 42 (2): 351–355. doi:10.2307/1399301. JSTOR 1399301. Archived from the original on August 17, 2011._______________________If you like our show and would like to support us, we encourage you to give your money or resources to a worthy cause. We can get through this. Our strongest weapon is solidarity. Stay strong and help where you can. Thank you.Do you have a question about Buddhism that you'd like us to discuss? Let us know by emailing us at Bright.On.Buddhism@gmail.com.Credits:Nick Bright: Script, Cover Art, Music, Voice of Hearer, Co-HostProven Paradox: Editing, mixing and mastering, social media, Voice of Hermit, Co-Host

Ingrédients : 1 chou vert 7 carottes 8 pommes de terre 1 oignon 1 morceau de lard maigre 4 viennoises 4 saucisses à cuire 4 côtelettes Sel, poivre Bouillon   Préparation : Nettoyer le chou et le couper. Peler et couper les carottes. Peler et couper les pommes de terre en deux. Peler et émincer l'oignon. Mettre un peu de matière grasse dans une grande cocotte et y mettre l'oignon . Faire revenir quelques minutes. Ajouter le chou, les carottes et les pommes de terre. Mélanger les légumes et rajouter un demi-litre d'eau avec un bouillon. Ajouter le morceau de lard. Laisser cuire 1 h 30 à feu doux. Au bout d'une heure, rajouter les saucisses à cuire. Faire revenir les côtelettes quelques minutes et les ajouter dans la cocotte. En fin de cuisine, rajouter les viennoises. • La suite sur https://www.radiomelodie.com/podcasts/14030-potee-de-chou.html

Ingrédients : 1 chou-fleur ½ litre de lait 50 g de farine 50 g de beurre Sel, poivre Muscade Fromage râpé   Préparation : Couper le chou-fleur en bouquets et le cuire à l'eau salée pendant 15 minutes. L'égoutter et le mettre dans un plat allant au four. Préparer la béchamel : faire un roux avec le beurre et la farine. Ajouter le lait au fur et à mesure et remuer. Assaisonner avec sel, poivre et noix de muscade. Verser la béchamel sur le chou-fleur et recouvrir de fromage râpé. Mettre le plat au four 30 minutes à 180°. • La suite sur https://www.radiomelodie.com/podcasts/14029-gratin-de-chou-fleurs.html

C’tu juste Benoit qui trouve que le français n’est pas si difficile que ça à apprendre? C’tu juste moi ? Tribune téléphonique. Regardez aussi cette discussion en vidéo via https://www.qub.ca/videos ou en vous abonnant à QUB télé : https://www.tvaplus.ca/qub ou sur la chaîne YouTube QUB https://www.youtube.com/@qub_radio Pour de l'information concernant l'utilisation de vos données personnelles - https://omnystudio.com/policies/listener/fr

durée : 00:02:13 - Les Brigades du Pire - "ici Gascogne" Vous aimez ce podcast ? Pour écouter tous les autres épisodes sans limite, rendez-vous sur Radio France.

Ingrédients : 1 chou blanc 1 oignon 500 g de hachis de bœuf Huile Sel, poivre Paprika Cumin   Préparation : Faire revenir un gros oignon dans de l'huile dans une cocotte et ajouter la viande hachée. Couper et émincer le chou en lanières. L'ajouter dans la cocotte. Assaisonner avec le sel, le poivre, le cumin et le paprika. Ajouter un verre d'eau et laisser mijoter 1 h à feu doux. Il s'accompagne de pommes de terre à l'eau. • La suite sur https://www.radiomelodie.com/podcasts/14028-chou-suisse.html

Ingrédients : 1 chou rouge 1 grosse pomme 1 morceau de lard maigre 2 verres de vin rouge 2 verres d'eau Sel, poivre 1 bocal de marrons   Préparation : Nettoyer et couper le chou en fines lamelles. Émincer l'oignon. Peler la pomme et la couper en 2. Faire revenir l'oignon et le morceau de lard dans un peu d'huile et faire revenir quelques minutes. Ajouter le chou, le vin, l'eau, la pomme coupée en 2, le sel et le poivre. Laisser mijoter 1 h 30 à feu doux et ajouter les marrons 30 minutes avant la fin de la cuisson. Il s'accompagne avec de la purée et des roulades, par exemple. • La suite sur https://www.radiomelodie.com/podcasts/14027-chou-rouge.html

durée : 00:06:42 - L'invité de 8h15 de "ici Gascogne" Vous aimez ce podcast ? Pour écouter tous les autres épisodes sans limite, rendez-vous sur Radio France.

Ingrédients : 500 g de choux de bruxelles 100 g de lardons de bacon 1c. à s. d'huile d'olive 180 ml de bouillon de volaille 1 c. à s. de moutarde à l'ancienne   Préparation : Dans une poêle, faire dorer les lardons de bacon dans l'huile d'olive quelques minutes. Les sortir et les réserver. Dans la même poêle, dorer les choux quelques minutes. Saler et poivrer. Déglacer avec le bouillon et la moutarde. Porter à ébullition et laisser mijoter 15 minutes jusqu'à ce que les choux soient tendres et que le bouillon soit évaporé. Rectifier l'assaisonnement si nécessaire. Rajouter les lardons de bacon et servir. • La suite sur https://www.radiomelodie.com/podcasts/14026-chou-de-bruxelles-au-bacon.html

¿Quién no hizo una locura en la adolescencia… y juró que NADIE se enteraría?

durée : 00:03:37 - Charline explose les faits - par : Charline Vanhoenacker - Un appel national a été lancé… à manger des poireaux, des patates et des chou-fleur, pour venir en aide à la filière, en raison d'une surproduction. Vous aimez ce podcast ? Pour écouter tous les autres épisodes sans limite, rendez-vous sur Radio France.

durée : 00:03:37 - Charline explose les faits - par : Charline Vanhoenacker - Un appel national a été lancé… à manger des poireaux, des patates et des chou-fleur, pour venir en aide à la filière, en raison d'une surproduction. Vous aimez ce podcast ? Pour écouter tous les autres épisodes sans limite, rendez-vous sur Radio France.

Hay opiniones que no son populares, pero tampoco son cancelables. Y de eso va este episodio de Deja el Chou junto a Willy Martin, Jesús Guerrero y Lui Vizcaya, conductores del streaming Miamor con Te Quiero. Nos sentamos a hablar de esas ideas que a veces pensamos en silencio porque no sabemos cómo van a caer. No son ofensivas, no son dañinas, pero tampoco son mayoría. Y hoy en día eso parece suficiente para que alguien te mire raro. En esta conversación nos metimos en temas incómodos con humor, honestidad y sin poses. Hablamos de relaciones, de dinámicas sociales que todo el mundo aplaude pero que tal vez no convencen tanto, de la presión por ser políticamente correctos y de la línea tan fina entre tener criterio propio y que te quieran etiquetar. Lo que más me gustó fue escuchar cómo ellos, que están todos los días frente a una audiencia opinando en Miamor con Te Quiero, manejan el miedo a decir algo que no sea popular. ¿Hasta dónde uno se cuida? ¿Hasta dónde uno se mantiene fiel a lo que piensa? Yo también compartí mis propias opiniones incómodas, porque sí, soy empática, sobrepienso todo, pero también tengo posturas que no siempre coinciden con lo que está de moda decir. Este episodio no busca provocar por provocar. Busca abrir espacio para pensar distinto sin atacar. Para disentir sin destruir. Para reírnos un poco de lo dramáticos que nos ponemos como sociedad cuando alguien simplemente no opina igual. Si alguna vez te has quedado callad@ por miedo a que te malinterpreten, este episodio es para ti. Si te gustan las conversaciones reales, con humor y sin guion, suscríbete al canal, activa las notificaciones y compártelo con esa persona con la que siempre tienes debates eternos. Y si quieres apoyar Deja el Chou y acceder a contenido exclusivo, puedes sumarte a Patreon por cinco dólares al mes. El link está en la descripción. Para seguir a willy: https://www.instagram.com/willymartin/?hl=en a Jesus: https://www.instagram.com/soyjesusguerrero/?hl=en a Lui: https://www.instagram.com/luivizcaya/?hl=en Miamor con te quiero: https://www.instagram.com/losmiamorcontq/?hl=en COMPRA EL NUEVO JUEGO DE CARTAS DE CONVERSACIÓN DE DEJA EL CHOU! https://urlgeni.us/amzn/Juegodejaelchou DEJAME UN REVIEW! COMENTARIO! Y FOLLOW! NO SEAS MALITO! EL GRUPITO DE WHATSAPP: https://www.whatsapp.com/channel/0029VbAv1apGufImi8L6Ol25 QUIERES OTRO EPISODIO? MÁS CONTENIDO ? VEN A MI PATREON! https://www.patreon.com/danydigiacomo SIGUEME EN MI NUEVO CANAL DEL PODCAST " DEJA EL CHOU " https://www.youtube.com/channel/UC9n3llcxTpbc_lT5OHkYg6w QUIERES VER DEJA EL CHOU? CLICK AQUI: https://urlgeni.us/youtube/playlist/playlistdejaelchou PRUEBA SOLID8! Quieres dormir mejor, estás cansad@ de roncar? O que te ronquen al lado? entra aqui para más: www.solid8sleep.com 20% con tu prim era compra, código: DEJAELCHOU SÍGUEME: INSTAGRAM: https://www.instagram.com/danydigiacomo/?hl=en FACEBOOK: https://www.facebook.com/danydigiacomofanpage TIKTOK: https://www.tiktok.com/@danydigiacomo DISCORD: https://discord.gg/tEhFmFy GRUPO DE FACEBOOK: https://www.facebook.com/groups/danydigiacomo QUÉ USO EN MIS VIDEOS: Cámara: https://urlgeni.us/amzn/micamara_dg Luz: https://urlgeni.us/amzn/miluz_dg Trípode: https://urlgeni.us/amzn/mitripode_dg Micrófono: https://urlgeni.us/amzn/microfono_dg MI TEAM: LA MEJOR ESCUELA DE IA: https://www.instagram.com/wplash/ ESTUDIO: https://www.instagram.com/gradvity/ PR: https://www.instagram.com/aletremola/  MI WEB (HECHA POR @WEPLASH): https://www.danydigiacomo.com/ CONTÁCTAME: contact@danydigiacomo.com MI MERCH: https://shopdanydigiacomo.com/ #danydigiacomo #miamorcontequiero #dejaelchou

Dva bratři a sestra mluví o tom, jak dětství a dospívání s manipulativním otcem ovlivnilo jejich vztahy. Táta psychicky týral je i jejich mámu, ale na lidi mimo rodinu působil jako super sympatický a zábavný člověk. Poslechněte si, jak konflikty s tátou zasahovaly do vztahů v rodině a jak se jim dnes daří hledat k sobě cestu.

Have a product challenge around retention? Quick intro chat → professorgame.com/chat Stop feeling like you're grinding without a progress bar. In this episode, we explore the behavioral science of "leveling up" in real life to combat burnout and invisible growth. By applying the Octalysis Framework we discusse how to map your career as an evolving skill tree. Whether you are a product leader looking to build meaningful user progression or an individual seeking to reclaim your "Player 1" status, this episode provides a blueprint for turning disjointed milestones into a cohesive, high-functioning journey of mastery. Rob Alvarez is Head of Engagement Strategy, Europe at The Octalysis Group (TOG), a leading gamification and behavioral design consultancy. A globally recognized gamification strategist and TEDx speaker, he founded and hosts Professor Game, the #1 gamification podcast, and has interviewed hundreds of global experts. He designs evidence-based engagement systems that drive motivation, loyalty, and results, and teaches LEGO® SERIOUS PLAY® and gamification at top institutions including IE Business School, EFMD, and EBS University across Europe, the Americas, and Asia.   Links to episode mentions: The Octalysis Framework Yu-kai Chou's first episode on Professor Game! 10000 Hours of Play by Yu-kai Chou   Lets's do stuff together! Let's chat about your gamification project YouTube LinkedIn Instagram Facebook Start Your Community on Skool for Free Ask a question Looking forward to reading or hearing from you, Rob

durée : 00:03:04 - Les recettes avec le chou kale Vous aimez ce podcast ? Pour écouter tous les autres épisodes sans limite, rendez-vous sur Radio France.

durée : 00:03:39 - La recette du guacamole de chou romanesco Vous aimez ce podcast ? Pour écouter tous les autres épisodes sans limite, rendez-vous sur Radio France.

This Teisho was given by the Rev. Do'on Roshi at the Buddhist Temple of Toledo on November 08, 2025. In this talk Do'on Roshi continues her discussion on the 52nd case from the Blue Cliff Record known as Chao Chou Lets Asses and Donkeys Cross and provides commentary on The Sayings of Layman P'ang.   If you would like to learn more about the Buddhist Temple of Toledo or to make a donation in support of this podcast please visit buddhisttempleoftoledo.org.   Part of Rev. Do'on Roshi's Teisho on the Blue Cliff Record series.

Alexandre Boulerice ne peut pas se présenter à Québec solidaire… Séquence difficile pour Poilièvre. Fréchette s’en est bien sortie. La rencontre Tougas-Dutrizac avec Stéfanie Tougas. Regardez aussi cette discussion en vidéo via https://www.qub.ca/videos ou en vous abonnant à QUB télé : https://www.tvaplus.ca/qub ou sur la chaîne YouTube QUB https://www.youtube.com/@qub_radio Pour de l'information concernant l'utilisation de vos données personnelles - https://omnystudio.com/policies/listener/fr

durée : 00:03:11 - Les goûts d'ici en Béarn Bigorre Vous aimez ce podcast ? Pour écouter tous les autres épisodes sans limite, rendez-vous sur Radio France.

Send us a textLynne Chou O'Keefe is the Founder and Managing Partner of Define Ventures, one of the largest early-stage health tech investment firms, with $800 million in assets under management.With deep experience across digital health, venture capital, and frontline healthcare systems, Lynne brings a clear-eyed view of why the industry is changing now and where AI can make a meaningful difference. She is widely recognized for her work backing companies that rethink access, outcomes, and patient experience, and is a trusted voice on how technology, ethics, and human judgment must come together to move healthcare forward.In this conversation, we discuss:Why healthcare still runs on fragmented systems and what that means for where AI can truly move the needle.How the shift from fee-for-service to value-based care changes incentives and pushes the system toward prevention over volume.Why patients now expect healthcare to work like transportation or food delivery, and how that expectation reshapes care delivery.The three phases of AI in healthcare, from administrative efficiency to clinical workflow support and, eventually, clinical decision-making.Where the ethical boundary sits today between AI-assisted care and AI-led decisions, especially when access to care is limited.Why the future of healthcare is hybrid by design, with AI augmenting clinicians rather than replacing human judgment.Resources:Subscribe to the AI & The Future of Work NewsletterConnect with Lynn on LinkedInAI fun fact articleOn how AI is fixing the biggest problem faced by doctors.

In this episode of Beat Motel, Andrew and Dr. Sam attempt to discuss "Great Songs with Questionable Lyrics" but mostly end up talking about accidental calls to the emergency services and the thermal advantages of having an itchy jumper for a face. We dive into the grottier side of grindcore with Edinburgh's CHOU, wonder why Wolf Alice has a drummer singing in a thicket, and Dr. Sam tries to justify why he once owned a Limp Bizkit record. Also featuring: Slade being sued for sounding like a brickyard, Jimmy Page "borrowing" songs again, and why you should never store your Lego boxes in a greenhouse. It's less of a music podcast and more of a documented descent into madness. Riffs of the week Dr Sam's Riff CHOU - Vulnerable Blether Andrew's Riff Wolf Alice - White Horses Dr Sam's track choices Slade - Let's Call It Quits Limp Bizkit - Counterfeit Public Enemy - Sophisticated Bitch Cannibal Corpse - I Cum Blood Andrew's track choices Led Zeppelin - Babe I'm gonna leave you Steve Miller Band - The Joker Sonic Youth - Kool Thing Suede - Stay Together Email us - beatmotel@lawsie.com

Le chou de Bruxelles peut-il venir d'ailleurs que de Bruxelles ? En effet, le nom de ce légume semble indiquer directement sa provenance. Mais dans les faits, ce n'est pas toujours le cas. Tous les jours, retrouvez en podcast les meilleurs moments de l'émission "Ça peut vous arriver", sur RTL.fr et sur toutes vos plateformes préférées.Hébergé par Audiomeans. Visitez audiomeans.fr/politique-de-confidentialite pour plus d'informations.

2/6/26: Your State U Max/Page-Carolyn Chou, head of Homes for All, rent control & Jamie Hartmann-Boyce on exploding health care cost Lev BenEzra-Community Action—Peter Wingate, Director of Energy & Weatherization Programs: It's Freezing Salman Hameed—Mr. Universe— Science, Kids, Learning & A Galaxy Far, Far Away Art Beat with Donnabelle Casis—Elizabeth Stone, ZRzosalyn Driscoll, Tori Lawrence, Light Being—darkness & LIGHT.

¡Hola a todos! Bienvenidos de nuevo a Deja el Chou. No saben la falta que nos hacía sentarnos a hablar paja con ustedes. En este episodio de reencuentro, nos quitamos las máscaras y hablamos de todo lo que nos ha pasado mientras estábamos "desaparecidos". Primero que nada: ¡NO, Vicky no está embarazada!. Empezamos aclarando los chismes antes de meternos en el tema que nos tiene obsesionados: el CRINGE. ¿Alguna vez han sentido esa pena ajena tan fuerte que les dan ganas de desaparecer?. Hablamos de cuando respondes "igualmente" al mesero por inercia o, peor aún, la historia de Checho que, por pensar en inglés, terminó pidiendo "disculpas" en un funeral como si él hubiera matado a la persona. ¡Una locura! También abrimos el debate sobre las amistades adultas y la exclusión. Dani nos expone en vivo por habernos visto sin ella. ¿Está mal no invitar a todo el grupo siempre? ¿Deberíamos dejar de postear en Instagram para no herir susceptibilidades?. De paso, confesamos las mentiras piadosas que inventamos para cancelar planes y quedarnos durmiendo, porque aceptémoslo: ¡ya somos unos señores!. Si te molesta el ruido excesivo, amas las siestas y te dan ganas de llorar cuando alguien canta a capela en una boda, este episodio es para ti. Además, Vicky nos da un tip de oro para no caer en las garras de Amazon y comprar cosas que no necesitamos (como termos que ya tenemos). ¿Qué encontrarás en este episodio? La verdad sobre nuestra pausa y el chisme del embarazo. Historias de pena ajena que te harán sentir mejor con tu vida. El drama de los grupos de WhatsApp y las madres. Tips de ahorro y por qué el magnesio es el mejor amigo del adulto. ¡Dale like si tú también has dicho "igualmente" cuando no debías! Déjanos en los comentarios cuál ha sido tu momento más cringe y no olvides suscribirte para que no te pierdas nada de este desorden. ¡Únete a nuestro Patreon para contenido exclusivo y para ayudarnos a montar nuestro estudio soñado! COMPRA EL NUEVO JUEGO DE CARTAS DE CONVERSACIÓN DE DEJA EL CHOU! https://urlgeni.us/amzn/Juegodejaelchou DEJAME UN REVIEW! COMENTARIO! Y FOLLOW! NO SEAS MALITO! EL GRUPITO DE WHATSAPP: https://www.whatsapp.com/channel/0029VbAv1apGufImi8L6Ol25 QUIERES OTRO EPISODIO? MÁS CONTENIDO ? VEN A MI PATREON! https://www.patreon.com/danydigiacomo SIGUEME EN MI NUEVO CANAL DEL PODCAST " DEJA EL CHOU " https://www.youtube.com/channel/UC9n3llcxTpbc_lT5OHkYg6w QUIERES VER DEJA EL CHOU? CLICK AQUI: https://urlgeni.us/youtube/playlist/playlistdejaelchou PRUEBA SOLID8! Quieres dormir mejor, estás cansad@ de roncar? O que te ronquen al lado? entra aqui para más: www.solid8sleep.com 20% con tu prim era compra, código: DEJAELCHOU SÍGUEME: INSTAGRAM: https://www.instagram.com/danydigiacomo/?hl=en FACEBOOK: https://www.facebook.com/danydigiacomofanpage TIKTOK: https://www.tiktok.com/@danydigiacomo DISCORD: https://discord.gg/tEhFmFy GRUPO DE FACEBOOK: https://www.facebook.com/groups/danydigiacomo QUÉ USO EN MIS VIDEOS: Cámara: https://urlgeni.us/amzn/micamara_dg Luz: https://urlgeni.us/amzn/miluz_dg Trípode: https://urlgeni.us/amzn/mitripode_dg Micrófono: https://urlgeni.us/amzn/microfono_dg MI TEAM: LA MEJOR ESCUELA DE IA: https://www.instagram.com/wplash/ ESTUDIO: https://www.instagram.com/gradvity/ PR: https://www.instagram.com/aletremola/  MI WEB (HECHA POR @WEPLASH): https://www.danydigiacomo.com/ CONTÁCTAME: contact@danydigiacomo.com MI MERCH: https://shopdanydigiacomo.com/ #dejaelchou #juandemontreal #yllegamostarde

Ecoutez Vous allez en entendre parler avec Tom Lefevre du 29 janvier 2026.Hébergé par Audiomeans. Visitez audiomeans.fr/politique-de-confidentialite pour plus d'informations.

durée : 00:15:56 - Les choux à la crème du Labo sont tendant à Pau - Le chou à la crème, dessert iconique de la pâtisserie française, séduit toujours autant par sa légèreté et sa gourmandise. À travers des créations modernes et audacieuses, Le Labo - à Pau - redonne vie à ce classique en l'enrichissant de nouvelles saveurs. Vous aimez ce podcast ? Pour écouter tous les autres épisodes sans limite, rendez-vous sur Radio France.

En este episodio de La Güera y el Callado el Chou nos pusimos de detectives… pero de los malos

La conspiration des poudres de 1605 est l'un des attentats politiques les plus célèbres de l'histoire britannique. Un projet radical : faire exploser le Parlement anglais pour décapiter le pouvoir d'un seul coup. Nous sommes dans l'Angleterre du début du XVIIᵉ siècle, sous le règne du roi Jacques Ier.Pour comprendre, il faut revenir au contexte religieux. Depuis la Réforme, l'Angleterre est officiellement protestante. Les catholiques, minoritaires, subissent une série de restrictions : amendes pour ceux qui refusent d'assister au culte anglican, exclusion de certaines fonctions, suspicion permanente. Beaucoup espèrent qu'avec Jacques Ier — qui succède à Élisabeth Iʳᵉ en 1603 — les tensions vont s'apaiser. Mais le roi maintient une politique dure.C'est dans ce climat qu'un petit groupe de catholiques anglais décide de passer à l'action. Leur chef est Robert Catesby, noble charismatique et déterminé. Le plan est simple et terrifiant : stocker des barils de poudre sous la Chambre des Lords, puis les faire exploser le jour de l'ouverture du Parlement, quand le roi, les lords et les représentants seront réunis. L'idée n'est pas seulement de tuer : c'est de provoquer un choc national, puis de rétablir un pouvoir catholique.Pour mettre ce plan en œuvre, les conspirateurs louent un local puis une cave proche du Parlement. Ils parviennent à accumuler 36 barils de poudre. Pour surveiller et déclencher l'explosion, ils recrutent un homme : Guy Fawkes, soldat ayant combattu en Europe, et surtout spécialiste des explosifs.Mais le complot échoue à la dernière minute. Le 26 octobre 1605, une lettre anonyme avertit un lord catholique de ne pas se rendre au Parlement. L'information remonte aux autorités. Dans la nuit du 4 au 5 novembre, les gardes fouillent les sous-sols. Ils trouvent Guy Fawkes avec des allumettes et du matériel pour enflammer la mèche.Fawkes est arrêté, torturé, puis finit par avouer. Les conspirateurs sont traqués. La plupart sont tués ou capturés. Ceux qui survivent sont condamnés à la peine la plus terrible : pendaison, éviscération et démembrement.L'échec du complot a un impact immense : il renforce la méfiance contre les catholiques pendant des générations. Et paradoxalement, Guy Fawkes devient une figure mythique. Chaque 5 novembre, l'Angleterre commémore toujours cet événement : “Remember, remember the Fifth of November…”. Hébergé par Acast. Visitez acast.com/privacy pour plus d'informations.

En este episodio hablamos con Daniela Di Giacomo sobre crecer, el paso del tiempo y cómo muchas de las presiones que sentimos en nuestros 20 cambian completamente con los años. Hablamos de la ansiedad por tener la vida resuelta, la comparación constante, el miedo a “ir tarde” y cómo aprender a bajar la urgencia de hacerlo todo ya.Join the club!--0:00 - Intro3:10 - La relevancia del Miss Venezuela8:30 - El miss como un espacio para las mujeres12:10 - Nuestra generación analiza todo17:40 - Qué etapa se ha disfrutado mas Dany?22:25 – Dany a los 20 vs los 20 de ahora27:10 - La angustia de tener todo resuelto37:40 - Cómo Dany ve el autocuidado 43:07 - Gen Z vs Millenials51:35 - Jugamos “Deja el Chou!”--Episodios extra todos los Viernes y contenido exclusivo https://www.patreon.com/alcontrariopodcast Tu voz es súper importante para nosotras! Ingresa aquí - https://forms.gle/JYQbq8tDnf9NRaRS7 Link del buzón secreto - https://forms.gle/ZBsMfe2cBhhJr8aM8

durée : 00:20:27 - Journal de 12h30 - Sébastien Lecornu échoue à faire adopter un budget pour 2026 avant la fin de l'année. Ce matin même, les 14 membres de la commission mixte paritaire ont acté l'impossibilité de trouver un compromis, ouvrant ainsi la voie à une loi dite "spéciale".

In the hospital setting, neurologists may be responsible for managing common end-of-life symptoms. Comprehensive end-of-life care integrates knowledge of the biomedical aspects of disease with patients' values and preferences for care; psychosocial, cultural, and spiritual needs; and support for patients and their families. In this episode, Teshamae Monteith, MD, FAAN, speaks with Claudia Z. Chou, MD, author of the article "End-of-Life Care and Hospice" in the Continuum® December 2025 Neuropalliative Care issue. Dr. Monteith is the associate editor of Continuum® Audio and an associate professor of clinical neurology at the University of Miami Miller School of Medicine in Miami, Florida. Dr. Knox is an assistant professor of neurology and a consultant in the Division of Community Internal Medicine, Geriatrics and Palliative Care at Mayo Clinic in Rochester, Minnesota. Additional Resources Read the article: End-of-Life Care and Hospice Subscribe to Continuum®: shop.lww.com/Continuum Earn CME (available only to AAN members): continpub.com/AudioCME Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Host: @headacheMD Full episode transcript available here Dr Jones: This is Dr Lyell Jones, Editor-in-Chief of Continuum. Thank you for listening to Continuum Audio. Be sure to visit the links in the episode notes for information about earning CME, subscribing to the journal, and exclusive access to interviews not featured on the podcast. Dr Monteith: This is Dr Teshamae Monteith. Today I'm interviewing Dr Claudia Chou about her article on end-of-life care and hospice, which is found in the December 2025 Continuum issue on neuropalliative care. Welcome to our podcast. How are you? Dr Chou: I'm doing well. Thank you for having me. This is really exciting to be here. Dr Monteith: Absolutely. So, why don't you introduce yourself to our audience? Dr Chou: Sure. My name is Claudia Chou. I am a full time hospice and palliative medicine physician at Mayo Clinic in Rochester. I'm trained in neurology, movement disorders, and hospice and palliative medicine. I'm also passionate about education, and I'm the program director for the Hospice and Palliative Medicine fellowship here. Dr Monteith: Cool. So just learning about your training, I kind of have an idea of how you got into this work, but why don't you tell me what inspired you to get into this area? Dr Chou: It was chance, actually. And really just good luck, being in the right place at the right time. I was in my residency and felt like I was missing something in my training. I was seeing these patients who were suffering strokes and had acute decline in functional status. We were seeing patients with new diagnosis of glioblastoma and knowing what that future looked like for them. And while I went into neurology because of a love of neuroscience, localizing the lesion, all of those things that we all love about neurology, I still felt like I didn't have the skill set to serve patients where they perhaps needed me the most in those difficult times where they were dealing with serious illness and functional decline. And so, the serendipitous thing was that I saw a grand rounds presentation by someone who works in neurology and palliative care for people with Parkinson's disease. And truly, it's not an exaggeration to say that by the end of that lecture, I said, I need to do palliative care, I need to rotate in this, I need to learn more. I think this is what I've been missing. And I had plans to practice both movement disorders neurology and palliative care, but I finished training in 2020… and that was not a long time ago. We can think of all the things that were going on, all the different global forces that were influencing our day-to-day decisions. And the way things worked out, staying in palliative care was really what my family and I needed. Dr Monteith: Wow, so that's really interesting. Must have been a great lecturer. Dr Chou: Yes, like one of the best.  Dr Monteith: So why don't you tell me about the objectives of your article? Dr Chou: The objectives may be to fill in some of the gaps in knowledge that may be present for the general neurologist. We learn so much in neurology training, so much about how to diagnose and treat diseases, and I think I would argue that this really is part and parcel of all we should be doing. We are the experts in these diseases, and just because we're shifting to end-of-life or transitioning to a different type of care doesn't mean that we back out of someone's care entirely or transition over to a hospice or palliative care expert. It is part of our job to be there and guide patients and their care partners through this next phase. You know, I'm not saying we all need to be hospice and palliative care experts, but we need to be able to take those first steps with patients and their care partners. And so, I think objectives are really to focus in on, what are those core pieces of knowledge for end-of-life care and understanding hospice so we can take those first steps with patients and their care partners? Dr Monteith: So, why don't you give us some of those essential points in your article? Dr Chou: Yeah. In one section of the article, I talk about common symptoms that someone might experience at the end of life and how we might manage those. These days, a lot of hospitals have order sets that talk us through those symptoms. We can check things off of a drop-down menu. And yet I think there's a little bit more nuance to that. There may be situations in which we would choose one medication over another. There may be medications that we've never really thought of in terms of symptom management before. Something that I learned in my hospice and palliative medicine fellowship was that haloperidol can be helpful for nausea. I know that's usually not one of our go-tos in neurology for any number of reasons. So, I think that extra knowledge can take us pretty far when we're managing end of life symptoms, particularly in the hospital setting. And then I think the other component is the hospice component. A lot of us may have not had experience talking about hospice, talking about what hospice can provide, and again, knowing how to take those first steps with patients. We may be referring to social work or palliative medicine to start those conversations. But again, I think this is something that's definitely learnable and something that should be part of our skill set in neurology. Dr Monteith: Great. And so, when you speak about symptom management and being more comfortable with the tools that we have, how can we be more efficient and more effective at that? Dr Chou: Think about what the common symptoms are at end of life. We may know this kind of intuitively, but what we commonly see are things like pain, nausea, dyspnea, anxiety, delirium or agitation. And so, I think having a little bit of a checklist in mind can be helpful. You know, how can I systematically think through a differential, almost, for why my patient might be uncomfortable? Why they might be restless? Have I thought through these different symptoms? Can I try a medication from my tool kit? See if that works, and if it does, we can continue on. If not, what's the next thing that I can pivot to? So, I think these are common skills for a little bit of a differential diagnosis, if you will, and how to work through these problems just with the end-of-life lens on it. Dr Monteith: So, are there any, like, validated tools or checklists that are freely available? Dr Chou: I don't think there's been anything particularly validated for end-of-life care in neurologic disease. And so, a lot of our treatments and our approaches are empiric, but I don't think there's been anything validated, per se. Dr Monteith: Great. So, why don't we talk a little bit about the approach to discussions on hospice? We all, as you kind of alluded to, want to be effective neurologists, care for our patients, but we sometimes deal with very debilitating diseases. And so, when we think that or suspect that our patient is kind of terminally ill, how do we approach that to our patients? Of course, our patients come from different backgrounds, different experiences. So, what is your approach? Dr Chou: So, when we talk about hospice and when a patient may be appropriate for hospice, we have to acknowledge that we think that they may be in the last six months of their disease. We as the neurologist are the experts in their disease and the best ones to weigh in on that prognosis. The patient and their care partners then have to accept that the type of care that hospice provides is what makes sense for them. Hospice focuses on comfort and treating a patient's comfort as the primary goal. Hospice is not as interested in treating cancer, say, to prolong life. Hospice is not as interested in life-prolonging measures and treatments that are not focused at comfort and quality of life. And so, when we have that alignment between our understanding of a patient's disease and their prognosis and the patient care partner's goal is to focus on comfort and quality of life above all else, that's when we have a patient who might be appropriate for hospice and ready to hear more about what that actually entails. Dr Monteith: And what are some, maybe, myths that neurologist healthcare professionals may have about hospice that you really want us to kind of have some clarity on? Dr Chou: That's a great question. What we often tell patients is that hospice's goal is to help patients live as well as possible in the time that they have left. Again, our primary objective is not life prolongation, but quality of life. Hospice's goal is also not to speed up or slow down the natural dying process. Sometimes we do get questions about that: can't you make this go faster or we're ready for the end. But really, we are there to help patients along the natural journey that their body is taking them on. And I think hospice care can actually be complex. In the inpatient setting, in particular in neurology, we may be seeing patients who have suffered large strokes and have perhaps only days to a few weeks of life left. But in the outpatient setting and in the home hospice setting, patients can be on hospice for many months, and so they will have new care needs, new urinary tract infections, sometimes new rashes, the need to change their insulin regimens around to avoid extremes of hyperglycemia or hypoglycemia. So, there is a lot of complexity in that care and a lot that can be wrapped up under that quality-of-life and comfort umbrella. Dr Monteith: And to get someone to hospice requires a bit of prognostication, right? Six months of prediction in terms of a terminal illness. I know there's some nuances to that. So how can you make us feel more comfortable about making the recommendations for hospice? Dr Chou: I think this is a big challenge in the field. We're normally guided by Medicare guidelines that say when a patient might be hospice-appropriate. And so, for a neurologic disease, this really only encompasses four conditions: ALS, stroke, coma, and Alzheimer's dementia. And we can think of all the other diseases that are not encompassed in those four. And so, I think we say that we paint the picture of what it means to have a prognosis of six months or less. So, from the neurologic side, that can be, what do you know about this disease and what end-stage might look like? What is the pattern of the patient's functional decline? What are they needing more help with? Are there other factors at play such as heart failure or COPD that may in and of themselves not be a qualifying diagnosis for hospice, but when it's taken together in the whole clinical picture, you have a patient who's very ill and one that you're worried may die in the next six months or less? Dr Monteith: Then you also had some nice charts on kind of disease-specific guidelines. Can you take us a little bit through that? Dr Chou: The article does contain tables about specific criteria that may qualify someone for hospice with these neurologic conditions. And they are pretty dense. I know they're a checklist of a lot of different things. And so, how we practice is by trying to refer patients to hospice based on those guidelines as much as possible and then using our own clinical judgment as well, what we have seen through taking care of patients through the years. So, again, really going back to that decline. What is making you feel uncomfortable about this patient's prognosis? What is making you feel like, gosh, this patient could be well supported by hospice, and they could have six months or less? So, all of that should go into your decision as well. And all of that should go into your discussion with the patient and their care partners. Dr Monteith: Yeah. And reading your article, what stood out was all the services that patients can receive under hospice. So, I think sometimes people think, okay, this is terminal illness, let's get to hospice for whatever reasons, but not necessarily all the lists and lists and lists of benefits of hospice. So, I don't know that everyone's aware of all those benefits. So, can you talk to us a little bit about that? Dr Chou: Yeah, I like that you brought that up because that's also something that I often say to patients and their care partners when we're talking about hospice. When the time is right for a patient to enroll in hospice, they should not feel like they're giving anything up. There should be no more clinical trial that they're hoping to chase down, and so they should just feel like they're gaining all of those good supports: care that comes to their home, a team that knows them well, someone that's available twenty-four hours a day by phone and can actually even come into the home setting if needed to help with symptom management. Hospice comes as well with the psychosocial supports for just coping with what dying looks like. We know that's not easy to be thinking about dying for oneself, or for a family member or care partner to be losing their loved one. So, all of those supports are built into hospice. I did want to make a distinction, too, that hospice does not provide custodial care, which I explain to patients as care of the body, those daily needs for bathing, dressing, eating, etc. Sometimes patients are interested in hospice because they're needing more help at home, and I have to tell them that unfortunately, our healthcare system is not built for that. And if that's the sole reason that someone is interested in hospice, we have to think about a different approach, because that is not part of the hospice benefit.  Dr Monteith: Thank you for that. And then I learned about concurrent care. So why don't you tell us a little bit about that? That's a little bit of a nuance, right? Dr Chou: Yeah, that is a little bit of a nuance. And so, typically when patients are enrolling in hospice, they are transitioning from care the way that it's normally conducted in our healthcare system. So, outpatient visits to all of the specialists and to their primary care providers, the chance to go to the ER or the ICU for higher levels of care. And yet there are a subset of patients who can still have all of those cares alongside hospice care. That really applies to two specific populations: veterans who are receiving care through the Veterans Administration, and then younger patients, so twenty six years old and less, can receive that care through, essentially, a pediatric carve out. Dr Monteith: Great. Well, I mean, you gave so much information in your article, so our listeners are going to have to read it. I don't want you to spill everything, but if you can just kind of give me a sense what you want a neurologist to take away from your article, I think that would be helpful. Dr Chou: I think what I want neurologist to take away is that, again, this is something that is part of what we do as neurologists. This is part of our skill set, and this is part of what it means to take good care of patients. I think what we do in this transition period from kind of usual cares, diagnosis, full treatment to end of life, really can have impact on patients and their care partners. It's not uncommon for me to hear from family members who have had another loved one go through hospice about how that experience was positive or negative. And so, we can think about the influence for years to come, even, because of how well we can handle these transitions. That really can be more than the patient in front of us in their journey. That is really important, but it can also have wide-reaching implications beyond that. Dr Monteith: Excellent. And I know we were talking earlier a little bit about your excitement with the field and where it's going. So why don't you share some of that excitement? Dr Chou: Yeah. And so, I think there is a lot still to come in the field of neuropalliative care, particularly from an evidence base. I know we talked a lot about the soft skills, about presence and communication, but we are clinicians at heart, and we need to practice from an evidence base. I know that's been harder in palliative care, but we have some international work groups that really are trying to come together, see what our approaches look like, see where standardization may need to happen or where our differences are actually our strength. I think there can be a lot of variability in what palliative care looks like. So, my hope is that evidence base is coming through these collaborations. I know it's hard to have a conversation these days without talking about artificial intelligence, but that is certainly a hope. When you look at morbidity, when you look at patients with these complicated disease courses, what is pointing you in the direction of, again, a prognosis of six months or less or a patient who may do better with this disease versus not? And so, I think there's a lot to come from the artificial intelligence and big data realm. For the trainees listening out there, there is no better time to be excited about neuropalliative care and to be thinking about neuropalliative care. I said that I stumbled upon this field, and hopefully someone is inspired as well by listening to these podcasts and reading Continuum to know what this field is really about. And so, it's been exponential growth since I joined this field. We have medical students now who want to come into neuropalliative care as a profession. We have clinicians who are directors of neuropalliative care at their institutions. We have an international neuropalliative care society and neuropalliative care at AAN. And I think we are moving closer to that dream for all of us, which is that patients living with serious neurologic illness can be supported throughout that journey. High-quality, evidence-based palliative care. We're not there yet, but I think it is a possibility that we reach that in my lifetime. Dr Monteith: Well, excellent. I look forward to maybe another revision of this article with some of that work incorporated. And it's been wonderful to talk to you and to reflect on how better to approach patients that are towards the end of life and to help them with that decision-making process. Thank you so much.  Dr Chou: Yeah, thank you for having me. And we're very excited about this issue. Dr Monteith: Today. I've been interviewing Dr Claudia Chou about her article on end-of-life care and hospice, which is found in the December 2025 Continuum issue on neuropalliative care. Be sure to check out Continuum Audio episodes from this and other issues, and thank you to our listeners for joining today. Dr Monteith: This is Dr Teshamae Monteith, Associate Editor of Continuum Audio. If you've enjoyed this episode, you'll love the journal, which is full of in-depth and clinically relevant information important for neurology practitioners. Use the link in the episode notes to learn more and subscribe. AAN members, you can get CME for listening to this interview by completing the evaluation at continpub.com/audioCME. Thank you for listening to Continuum Audio.

Ce 17 décembre marque le 15e anniversaire de la « révolution du jasmin » en Tunisie. En 2010, dans la ville de Sidi Bouzid, le jeune vendeur ambulant Mohamed Bouazizi s'immole par le feu devant le gouvernorat, après la saisie de ses marchandises par la police. Un geste de désespoir, qui illustre la détresse socio-économique dans le pays et la répression généralisée du régime de Ben Ali, qui sera renversé par une révolte populaire inédite un mois plus tard. L'événement inspire les populations du Maghreb et d'une partie du Moyen-Orient, et donne naissance à un vaste mouvement de contestation : le « Printemps arabe ». Quinze ans après, la Tunisie est désormais dirigée d'une main de fer par Kaïs Saïed. Quel bilan tirer de cette révolte populaire ? Notre grand invité Afrique est l'ancien dirigeant tunisien Moncef Marzouki, premier président élu démocratiquement après la chute du clan Ben Ali, et actuellement en exil. Il répond aux questions de Sidy Yansané. RFI : Quinze ans après l'immolation par le feu du jeune vendeur Mohamed Bouazizi, quel est l'héritage de la « révolution du jasmin » que son sacrifice a provoqué ? Moncef Marzouki : Quand on voit la situation actuelle, on se dit que la révolution a complètement échoué parce qu'on est revenu au point de départ, c'est-à-dire à l'ère Ben Ali. Nous avons un président, Kaïs Saïed, qui s'est fait élire à 90% après avoir éliminé tous ses concurrents. Le retour de la peur, le retour des prisonniers politiques, tous les chefs de partis politiques sont soit en exil, soit en prison, etc. Donc on est revenu vraiment à la case départ. Sauf que quelque chose de profond a été instauré ou instillé dans l'esprit du peuple tunisien : le goût de la liberté. À un moment donné, ils ont vu que la liberté de critiquer le président n'était pas dangereuse. Donc quelque chose est resté dans l'esprit des gens et je pense que ça va repartir. Maintenant, ceux qui disent que le printemps arabe c'est la fin ne comprennent rien à rien. Parce qu'en fait, le printemps arabe, il vient juste de commencer. Sidi Bouzid, à l'époque déjà, faisait partie de ces villes, de ces régions tunisiennes qui disent subir la marginalisation et l'abandon de l'État, « la hogra ». Quinze ans plus tard, est-ce que vous pensez qu'un acte aussi désespéré que celui de Mohamed Bouazizi puisse se reproduire en Tunisie ? En fait, ça a continué. La Tunisie est devenue malheureusement un pays où cette horreur absolue se répète tout le temps. Vous parlez de cette région déshéritée, mais toutes les régions de Tunisie sont restées déshéritées. Donc, au contraire, la Tunisie est en train de s'appauvrir chaque jour de plus en plus. Les classes moyennes sont en train de s'appauvrir. Le pouvoir actuel se retrouve exactement dans la même situation où se trouvait Ben Ali, à savoir qu'il a contre lui les classes les plus aisées parce qu'il leur a retiré toutes les libertés fondamentales sans apporter quoi que ce soit à la population et contre la pauvreté. Donc toute cette énergie contenue aussi bien chez le petit peuple, comme on dit, que chez la bourgeoisie, tout cela va exploser. Voilà encore une fois pourquoi le volcan va de nouveau exploser. Un volcan, dites-vous, d'abord provoqué par le sacrifice de ce jeune vendeur, qui dénonçait non seulement l'extrême précarité socio-économique de la jeunesse tunisienne, mais aussi l'asphyxie des libertés à tous les niveaux. Sur ces deux points, quelle évolution notez-vous entre la présidence de Ben Ali et celle de Kaïs Saïed, contre qui vous concentrez les critiques ? Les trois années où j'étais à la tête de l'État, nous avons vraiment mis en place un État de droit. La justice était indépendante, les libertés étaient respectées, il n'y avait personne dans les prisons pour des motifs politiques. Nous avons même commencé à lutter contre la corruption. Sauf que comme il y avait ce que j'appellerais un « veto régional » sur la démocratie en Tunisie et que nous manquions d'appui dans les démocraties occidentales, malheureusement, la révolution a échoué. Elle a échoué à cause des erreurs que nous avons commises, nous Tunisiens. Mais aussi, encore une fois, à cause de ce veto régional, essentiellement algérien. Le voisin algérien était une dictature corrompue et violente. Il était hors de question pour elle d'accepter un État, une démocratie tunisienne qui aurait pu donner le mauvais exemple si je puis dire. Et les généraux algériens avaient raison de se méfier de la révolution tunisienne, parce que le Hirak en 2019, c'était tout simplement la queue de la comète, c'était la continuation de ces révolutions. Tout le système politique arabe, aussi bien en Égypte que dans les Émirats arabes unis, en Arabie saoudite qu'en Algérie… Tout ce système-là se sentait menacé par cette vague de révolutions. Ils ont mis le paquet pour faire avorter ces révolutions. Ils l'ont fait avorter par la guerre civile en Syrie, par le coup d'État militaire en Égypte, par la guerre civile en Libye, par l'utilisation de l'argent sale, de l'information, de la désinformation et du terrorisme en Tunisie. Donc, il y a eu encore une fois un veto régional contre les révolutions démocratiques arabes. Le président Kaïs Saïed a su s'attirer les faveurs de l'Union européenne, notamment sur le volet migratoire. L'Europe est quand même un grand partenaire de la Tunisie. Comment voyez-vous l'évolution de la Tunisie sur les droits humains, la démocratie dans ce monde qui est en pleine redéfinition ? L'attitude des Européens, je ne peux pas dire que ça leur fait grand honneur. Ils appuient des dictatures, notamment le gouvernement italien, ils sont prêts à aider Kaïs Saïed à se maintenir au pouvoir. Ce sont des politiques de courte vue. On n'a pas arrêté de répéter à nos amis européens : « Vous pariez sur des régimes autoritaires, uniquement pour vous en servir comme gardes-frontières ». Mais ce n'est pas ça la solution. La solution, c'est qu'il y ait du développement social et économique. C'est comme ça qu'on règle le problème de fond. C'est pour ça que je dis et je répète, la démocratisation du monde arabe, c'est une affaire à l'intérieur du monde arabe et qu'il ne faut pas du tout compter sur les pays européens pour nous aider à cela. À part quelques déclarations hypocrites, je pense qu'il n'y a rien à espérer.

Pour ce dernier "vrai" épisode de l'année, on se farcis tous mes échecs ET ce que j'ai appris en 2025. Vous le savez, j'adore étaler ma psychologie 2 comptoir donc la liste est longue ! Hébergé par Acast. Visitez acast.com/privacy pour plus d'informations.

En este episodio de La Güera y el Callado el Chou, destapamos traumas navideños… porque sí, todos tenemos ese regalo que nos arruinó la ilusión.Desde intercambios que dolieron más que una ruptura, regalos reciclados, “detallitos” con cero amor y sorpresas que mejor se hubieran quedado envueltas.Ríete con nosotros recordando el peor regalo que hemos recibido en Navidad y descubre que no estás solo… a alguien también le dieron calcetines usados.

Abner Chou • Selected Scriptures • Crossroads

Abner Chou • Selected Scriptures

Josh Thomson and Rich Chou discuss their long-standing friendship and Rich's extensive experience in MMA promotions, including his involvement with Elite XC, Strikeforce, and the recent CBS and Paramount deal. They reflect on the evolution of MMA's acceptance in mainstream media, the challenges of matchmaking in the welterweight division, and the potential returns of Ronda Rousey and Gina Carano. Follow Josh on X/Instagram @therealpunk Intro 00:00 Rich Chou's Past Career in MMA 01:03 New UFC TV Rights 02:06 Strikeforce Nashville Brawl 05:41 TV Deal and How Many Fights Will Be On The Cards 19:04 Welterweight Division and Making The Best Matchups 23:08 Managing Two Fighters Who Want To Fight 47:04 Ronda Rousey vs Gina Carano 55:02 Paul vs Joshua 56:39 Back to Ronda vs Gina 59:52 Wrap Up 1:05:24

Josh Thomson and Rich Chou discuss their long-standing friendship and Rich's extensive experience in MMA promotions, including his involvement with Elite XC, Strikeforce, and the recent CBS and Paramount deal. They reflect on the evolution of MMA's acceptance in mainstream media, the challenges of matchmaking in the welterweight division, and the potential returns of Ronda Rousey and Gina Carano. Follow Josh on X/Instagram @therealpunk Intro 00:00 Rich Chou's Past Career in MMA 01:03 New UFC TV Rights 02:06 Strikeforce Nashville Brawl 05:41 TV Deal and How Many Fights Will Be On The Cards 19:04 Welterweight Division and Making The Best Matchups 23:08 Managing Two Fighters Who Want To Fight 47:04 Ronda Rousey vs Gina Carano 55:02 Paul vs Joshua 56:39 Back to Ronda vs Gina 59:52 Wrap Up 1:05:24

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December is here, Advent is upon us, and while the world is speeding up, this conversation is an invitation to slow down, breathe deep, and remember that anxiety does not magically clock out for the holidays. In this episode, we talk with Ruth about what it looks like to set the tone for the month of Advent with intention, slowness, and a heart that is more focused on Jesus than on performance, expectations, or a perfectly curated Christmas. Episode Overview So often, December becomes a pressure cooker: Packed calendars Parties and performances Family expectations Untended relationships Mom guilt and spiritual guilt If we are honest, it is easy to end the month exhausted, anxious, and wondering if we missed what Advent was really about. This episode is a gentle reset. Together we talk about: Why your anxiety around the holidays is understandable How to set expectations and boundaries without guilt How to stop treating December like a spiritual performance review How to carry Advent rhythms into January, February, and beyond Practically preparing Him room in your actual life, not just your ideal one And underneath all of it: the reminder that God really does see you, loves you, and is not grading your Christmas performance. Key Themes From the Conversation Advent as a beginning, not a box Instead of cramming all spiritual depth into four weeks, we talk about Advent as the starting line for rhythms that can continue all year. The goal is not a perfect December, but a reoriented heart that remembers Emmanuel, God with us, in every season. Letting go of holiday perfectionism Naming how much of our striving is actually about approval, worth, and wanting to be seen as a good mom, good host, or good Christian. Asking honest questions: What do I think I will gain from doing all of this? Is this truly about honoring Jesus or about proving something? Heart clutter and preparing Him room Ruth shares how her work on Advent came out of her own struggle to feel like everything had to happen in December. The phrase "prepare Him room" assumes there is clutter in our hearts that needs to be cleared, not just in our schedules. Permission to say no You do not have to say yes to every party, event, or opportunity, even if they are all good things. Sometimes the holiest thing you can do is guard a blank square on the calendar as "occupied by rest, family, and presence." Repairing relationships without putting all the pressure on one month We often try to fix a year's worth of tension or distance in a single holiday season. Advent is a beautiful time to begin the work of reconciliation, but not a demand to tie everything up with a bow by December 25. Parenting, anxiety, and what our kids actually see Our kids are learning what Christmas is by watching us. When they see us frantic, angry, and stressed, they learn that "this is what Christmas feels like." When they see us repent, reset, and re-center on Jesus, they witness the Gospel in real time. Scripture Threads in This Episode 3 John 1:2 Beloved, I pray that you may prosper in all things and be in health, just as your soul prospers. Luke 12:27 Consider how the wild flowers grow. They do not labor or spin. We talk about how Jesus pointed anxious hearts to birds and flowers as living reminders that the Father is not forgetful, and that our worth is not held together by our hustle. Practical Ways To Set the Tone for This Month Here are some simple, realistic practices that came up in the conversation: Decide your non negotiables A daily or weekly family moment to pray, read a verse, or use an Advent resource. A small rhythm that fits your actual life: after dinner, Saturday mornings, or before bed. Mark the "nothing" days on your calendar Literally block off blank days as taken. Protect margin so there is room for real conversations, unhurried play, and quiet with God. Saturate your environment with reminders of Jesus Scripture on the walls, art that points your eyes up, worship and Advent music playing in the background, an open Bible on the table. Let what you see, hear, and read pull your attention back to Him throughout the day. Practice quick repentance, not long self condemnation When you catch yourself spiraling, snapping, or worshiping your to do list, pause. Talk with Jesus first: Lord, I put this party, this list, or this image of myself on the throne. I am sorry. Please reorder my heart. Then talk with your people: Hey, I am sorry for how I just acted. That is not what I want this season to feel like for us. Can we reset and try again? Pay attention to embodied people, not just online life Online community is a gift, but the people under your roof and the ones who know your everyday life matter first. Ask God to help you see them, listen to them, and be fully present with them. Reflective Questions For You You might want to jot these down in a journal or talk them through with a friend or spouse: What is my real emotional temperature going into this month: anxious, hopeful, numb, overwhelmed? Where am I secretly hoping that a "perfect" Christmas will heal or fix something that actually needs long term tending with God? What are three things I can say no to this month so I can say a deeper yes to Jesus, my family, and rest? How can I build in daily "touch points" with God's Word that fit my real life, not my ideal life? Where do I need to humble myself, apologize, or reset the tone in my home? Sponsor: CrowdHealth It is open enrollment season, which is exactly when traditional health insurance hopes you will just click "renew" on high premiums and confusing fine print. CrowdHealth is a refreshingly different alternative. With your monthly membership you get: A team that helps negotiate medical bills Lower lab tests and many prescriptions Access to a network of vetted doctors And when something major happens, you pay the first 500 dollars and then the rest of the community steps in to help This is not insurance, but it is a way to opt out of a broken system and take some power back over your health care. To get started: Visit joincrowdhealth.com Use the code speak easy Pay just 99 dollars for your first three months Again: joincrowdhealth.com, code speak easy. Sponsor: PreBorn PreBorn is doing incredible, life saving work by providing free ultrasounds to women considering abortion. Women are about twice as likely to choose life after seeing an ultrasound or hearing a heartbeat. This year alone, PreBorn has helped rescue tens of thousands of babies. Their care does not stop at birth: they offer counseling, classes, and even practical help up to two years after the baby is born. You can literally be part of saving a baby's life today: 28 dollars funds one free ultrasound Go to preborn.com slash speak easy That is preborn.com slash speak easy Thank you for standing in the gap for moms and babies.

Subspecialization in physiatry is classically thought of as a process that occurs through fellowship training as a result of narrowing interests during residency, but are there other ways to achieving similar expertise? Our RFC Technology Subcommittee member Michael Blatt met with Dr. Raymond Chou, a hand and upper extremity rehabilitation specialist at Stanford University, to learn more about how his job search as a resident led him to upper extremity rehabilitation.

Te enamoraste del tatuado, del nerd, del más raro o diferente!? Aparentemente en la psicología cada detalle de estos tiene una explicación, la conclusión es que queremos ser protegidas… es cuchi y raro esto! Si hay algún psicólogo viendo esto sería muy cool seguirlo hablando. Espero que les guste este epi! Como se dan cuenta estoy un poco saturada de los invitados y prefiero hablar paja con Uds! Ya volverán! Los quiero mucho Para seguir a Luisana: https://www.instagram.com/luisanavnunez?igsh=cWg2eHFuZ2NrNm44 DEJAME UN REVIEW! COMENTARIO! Y FOLLOW! NO SEAS MALITO! EL GRUPITO DE WHATSAPP: https://www.whatsapp.com/channel/0029VbAv1apGufImi8L6Ol25 QUIERES OTRO EPISODIO? MÁS CONTENIDO ? VEN A MI PATREON! https://www.patreon.com/danydigiacomo SIGUEME EN MI NUEVO CANAL DEL PODCAST " DEJA EL CHOU " https://www.youtube.com/channel/UC9n3llcxTpbc_lT5OHkYg6w QUIERES VER DEJA EL CHOU? CLICK AQUI: https://urlgeni.us/youtube/playlist/playlistdejaelchou PRUEBA SOLID8! Quieres dormir mejor, estás cansad@ de roncar? O que te ronquen al lado? entra aqui para más: www.solid8sleep.com 20% con tu primera compra, código: DEJAELCHOU SÍGUEME: INSTAGRAM: https://www.instagram.com/danydigiacomo/?hl=en FACEBOOK: https://www.facebook.com/danydigiacomofanpage TIKTOK: https://www.tiktok.com/@danydigiacomo DISCORD: https://discord.gg/tEhFmFy GRUPO DE FACEBOOK: https://www.facebook.com/groups/danydigiacomo QUÉ USO EN MIS VIDEOS: Cámara: https://urlgeni.us/amzn/micamara_dg Luz: https://urlgeni.us/amzn/miluz_dg Trípode: https://urlgeni.us/amzn/mitripode_dg Micrófono: https://urlgeni.us/amzn/microfono_dg MI TEAM: LA MEJOR ESCUELA DE IA: https://www.instagram.com/wplash/ ESTUDIO: https://www.instagram.com/gradvity/ PR: https://www.instagram.com/aletremola/  MI WEB (HECHA POR @WEPLASH): https://www.danydigiacomo.com/ CONTÁCTAME: contact@danydigiacomo.com MI MERCH: https://shopdanydigiacomo.com #danydigiacomo #danieladigiacomo #dejaelchou

GS#1026  This week Chia Chou, a world renowned musician and professor, showcases his online program, Audio Golf. The course can help golfers of all skill levels achieve a repeatable rhythm that will result in hitting shots, and stroking putts more consistently. Chou challenges Fred to demonstrate the difficulty of performing contradictory actions while speaking. The discussion highlights the complexities of body language and communication, emphasizing how challenging it is to align verbal and non-verbal cues.This episode is brought to you by Warby Parker with over 300+ locations to help you find your next pair of glasses. You can also head over to warbypaker.com/golfsmarter right now to try on any pair virtually!This episode is sponsored by Indeed. Please visit indeed.com/GOLFSMARTER and get a $75 SPONSORED JOB CREDIT. Terms and conditions apply.This episode is sponsored by HIMS. Start  your free online visit today HIMS.com/golfsmarter and received personalized ED treatment options.This episode is brought to you by Policygenius. Secure your family's future at Policygenius.com to compare free life insurance quotes from top companies and see how much you could save.    This episode is also brought to you by Taelor, an award-winning menswear rental subscription service. Visit taelor.style and get 25% OFF your first month of men's clothing subscription with our exclusive code GOLFSMARTER.If you have a question about whether or not Fred is using any of the methods, equipment or apps we've discussed, or if you'd like to share a comment about what you've heard in this or any other episode, please write because Fred will get back to you. Either write to golfsmarterpodcast@gmail.com or click on the Hey Fred button, at golfsmarter.com

My guest on today's episode of Nudge has spent decades studying leaders.  I asked Prof. Adam Galinsky to share his top five (evidence-backed) leadership tips.  Want to become a better leader?  This is the episode for you.  ---  Watch the bonus episode: https://nudge.kit.com/a53ff22931  Read Adam's book: https://amzn.to/4htZCGc Sign up for my newsletter: https://www.nudgepodcast.com/mailing-list Connect on LinkedIn: https://www.linkedin.com/in/phill-agnew-22213187/ Watch Nudge on YouTube: https://www.youtube.com/@nudgepodcast/ --- Blunden, H., Kristal, A. S., Whillans, A. V., Yoon, J., Burd, K., Bremner, S., & Yeomans, M. (2025). Eliciting advice instead of feedback improves developmental input. Organizational Behavior and Human Decision Processes, 193, 104343. Chou, E. Y., Halevy, N., Galinsky, A. D., & Murnighan, J. K. (2017). The Goldilocks contract: The synergistic benefits of combining structure and autonomy for persistence, creativity, and cooperation. Journal of Personality and Social Psychology, 113(3), 393–412. Hoff, M., Rucker, D. D., & Galinsky, A. D. (2025). The vicious cycle of status insecurity. Journal of Personality and Social Psychology, 128(1), 101–122. Leonardelli, G. J., Gu, J., McRuer, G., Medvec, V. H., & Galinsky, A. D. (2019). Multiple equivalent simultaneous offers (MESOs) reduce the negotiator dilemma: How a choice of first offers increases economic and relational outcomes. Organizational Behavior and Human Decision Processes, 152, 64–82. Liljenquist, K. A., & Galinsky, A. D. (2007). Turn your adversary into your advocate: Strategic requests for advice can transform disputes into amiable problem-solving ventures. Kellogg Insight. Northwestern University. Majer, J. M., Trötschel, R., Galinsky, A. D., & Loschelder, D. D. (2020). Open to offers, but resisting requests: How the framing of anchors affects motivation and negotiated outcomes. Journal of Personality and Social Psychology, 119(3), 582–599. Wu, S. J., & Paluck, E. L. (2022). Having a voice in your group: Increasing productivity through group participation. Behavioural Public Policy, 9(1), 192–211.

Aiming for sustainable retention? Intro chat (no sales pitch): professorgame.com/chat Eight years, 420 episodes, and countless insights later: we celebrate the incredible journey of the Professor Game Podcast. From humble beginnings to becoming the #1 gamification podcast in the world, this episode dives into consistency, growth, and what's next for the Engagers community. Rob Alvarez is Head of Engagement Strategy, Europe at The Octalysis Group (TOG), a leading gamification and behavioral design consultancy. A gamification strategist and TEDx speaker, he founded and hosts Professor Game, the #1 gamification podcast, and has interviewed hundreds of global experts. He designs evidence-based engagement systems that drive motivation, loyalty, and results, and teaches LEGO® SERIOUS PLAY® and gamification at top institutions including IE Business School, EFMD, and EBS University across Europe, the Americas, and Asia.   Links to episode mentions: Episodes mentioned: Episode 000 Episode 1 with Yu-kai Chou! Episode 2 with Scott Reinke, winner of the Educational Gamification Project of the Year 2016 Professor Game, the world's #1 gamification podcast, is recognized by independent rankings such as MillionPodcasts, Feedspot, Player.fm, and others like ListenNotes. Gamification World Congress, this is the most official reference still online I could find! The Octalysis Group Community Building Resources: Game of Skool Community Social Media and Contact Information: LinkedIn Instagram Facebook Professor Game YouTube Channel   Lets's do stuff together! Let's chat about your gamification project 3 Gamification Hacks To Boost Your Community's Revenue Start Your Community on Skool for Free Game of Skool Community YouTube LinkedIn Instagram Facebook Ask a question

Tyler Chou spent nearly two decades as an entertainment attorney in Hollywood, with senior roles at Disney, Skydance, BuzzFeed, before starting her own YouTube channel, which brought her into this world of creators. And today, she helps clients like Sam & Colby, Andy Morris, and Jenny Hoyos stay on the right side of the law. Unfortunately, that's getting harder (and scarier) all the time. But that doesn't mean you can't protect yourself. And Tyler is going to show us how you can start doing so – today. ⁠⁠⁠⁠⁠⁠⁠⁠Full transcript and show notes⁠⁠⁠⁠⁠⁠⁠⁠ Tyler's Website / Instagram / LinkedIn / TikTok / YouTube *** TIMESTAMPS (00:00) Meet the Lawyer Saving YouTube Channels (04:35) Music Publishers and Copyright Strikes (09:54) Getting Strikes Removed (13:08) YouTube Strikes and Litigation Process (15:37) How we use 1of10 (20:28) Resolving Copyright Strikes Creatively (21:46) How Creators Misunderstand Fair Use (27:11) Essential Steps for Creator Protection (30:18) Protecting Partnerships from Future Risks (33:15) Protecting YouTube Channel Ownership (37:37) Photo Licensing and Fair Use (41:05) The Upside of Litigation (42:01) Why This Shouldn't Scare You *** RECOMMENDED NEXT EPISODE → ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠#263: Colin & Samir on the future of their channel and the creator economy *** ASK CREATOR SCIENCE → ⁠⁠⁠⁠⁠⁠⁠⁠Submit your question here⁠⁠⁠⁠⁠⁠⁠⁠ *** WHEN YOU'RE READY

On this week's episode, we welcome voice actor, Holly Chou (Jubilee from X-Men '97), to chat about naughty nickelodeons, voice acting efforts, giant water bottles, and so much more.See Holly Chou at L.A. Comic-Con, booth 867!Jordan and company are going to be at L.A. Comic Con this year, September 26th - 28th at table JO7September 26th - Jordan and Jesse!September 27th - Jordan and Eliza!September 28th - Jordan and Rob!Pre-order Jordan's new Predator comic!Pre-order Jordan's new Venom comic!Donate to Al Otro Lado, any amount helps right now.Buy signed copies of Youth Group and Bubble from Mission: Comics And Art!~ NEW JJGo MERCH ~Be sure to get our new ‘Ack Tuah' shirt in the Max Fun store.Or, grab an ‘Ack Tuah' mug!The Maximum Fun Bookshop!Follow the podcast on Instagram and send us your dank memes!Check out Jesse's thrifted clothing store, Put This On.Follow brand new producer, Steven Ray Morris, on Instagram.Listen to See Jurassic Right!