Podcasts about CUS

Join Lead Time+: https://www.skool.com/leadtimeplus/aboutLearn more about Lead Time+: https://www.uniteleadership.org/support/leadtimeplusJust days before the 2026 LCMS Convention, the debate over the future of the Concordia University System has reopened.Concordia University, Nebraska President Dr. Bernard Bull joins Tim Ahlman to explain why he believes the Synod should preserve the current CUS structure while completing deeper financial, legal and governance due diligence. They examine the proposed $600,000-$1.2 million in savings, Bull's concern that as much as $20 million in designated gifts could become more complicated, and the responsibility of overseeing more than $1 billion in university assets.Beyond the numbers, this conversation asks a much larger question: Will the LCMS pursue an expansive vision for Lutheran higher education, or narrow the Concordia system to only one or two institutions? What should delegates do with Resolutions 7-01 and 7-08? Share your perspective respectfully below.Support the show⬇️⬇️⬇️⬇️⬇️⬇️⬇️⬇️⬇️⬇️⬇️⬇️⬇️⬇️⬇️⬇️⬇️Care about the future of the LCMS?Join the LCMS Current! (LCMS Current Events Newsletter)https://www.uniteleadership.org/thelcmscurrent⬆️⬆️⬆️⬆️⬆️⬆️⬆️⬆️⬆️⬆️⬆️⬆️⬆️⬆️⬆️⬆️⬆️To learn more, visit uniteleadership.org

En Habacuc 3:3-15, el profeta evoca la majestuosa intervención de Dios en la historia de Israel. La teofanía descrita —Dios viniendo de Temán, el resplandor como la luz, los rayos en sus manos, la pestilencia y la fiebre que marchan delante, la tierra que se estremece, las montañas que se deshacen, el sol y la luna que se detienen— es un recordatorio de que el mismo Dios que libró a su pueblo en el pasado sigue siendo el Señor soberano del presente. Habacuc no olvida: «En medio de los años hazla conocer». Este recuerdo no es un ejercicio nostálgico, sino un ancla para la fe en medio del caos. Recordar las obras de Dios es la clave para confiar en su fidelidad cuando el horizonte se oscurece. La fe se fortalece cuando miramos atrás y vemos la mano de Dios en nuestra historia. Banda sonora: Drop the Tapes - Biblioteca de audio de YouTube Donaciones local: https://iglesiadeciudadreal.es/donaciones Web: http://iglesiadeciudadreal.es/ Podcast: http://www.ivoox.com/podcast-iglesia-. YouTube: https://www.youtube.com/channel/UCPq8l9Q7KcX7j6iOGDPP_zg x (antes Twitter): https://x.com/home?lang=es Instagram: https://www.instagram.com/ Facebook: https://www.facebook.com/IglesiaCristianaEvangelicaDeCiudadReal Nota informativa: En todos nuestros videos se pueden traducir los SUBTÍTULOS a cualquier idioma. Ir a configuración y elegir idioma de subtitulo 12/07/2026 - PREDICACIÓN DE LA TARDE - SERIE: HABACUC Habacuc 3 Reina-Valera 1960 Oración de Habacuc 3 Oración del profeta Habacuc, sobre Sigionot. 2 Oh Jehová, he oído tu palabra, y temí. Oh Jehová, aviva tu obra en medio de los tiempos, En medio de los tiempos hazla conocer; En la ira acuérdate de la misericordia. 3 Dios vendrá de Temán, Y el Santo desde el monte de Parán. Selah Su gloria cubrió los cielos, Y la tierra se llenó de su alabanza. 4 Y el resplandor fue como la luz; Rayos brillantes salían de su mano, Y allí estaba escondido su poder. 5 Delante de su rostro iba mortandad, Y a sus pies salían carbones encendidos. 6 Se levantó, y midió la tierra; Miró, e hizo temblar las gentes; Los montes antiguos fueron desmenuzados, Los collados antiguos se humillaron. Sus caminos son eternos. 7 He visto las tiendas de Cusán en aflicción; Las tiendas de la tierra de Madián temblaron. 8 ¿Te airaste, oh Jehová, contra los ríos? ¿Contra los ríos te airaste? ¿Fue tu ira contra el mar Cuando montaste en tus caballos, Y en tus carros de victoria? 9 Se descubrió enteramente tu arco; Los juramentos a las tribus fueron palabra segura. Selah Hendiste la tierra con ríos. 10 Te vieron y tuvieron temor los montes; Pasó la inundación de las aguas; El abismo dio su voz, A lo alto alzó sus manos. 11 El sol y la luna se pararon en su lugar; A la luz de tus saetas anduvieron, Y al resplandor de tu fulgente lanza. 12 Con ira hollaste la tierra, Con furor trillaste las naciones. 13 Saliste para socorrer a tu pueblo, Para socorrer a tu ungido. Traspasaste la cabeza de la casa del impío, Descubriendo el cimiento hasta la roca. Selah 14 Horadaste con sus propios dardos las cabezas de sus guerreros, Que como tempestad acometieron para dispersarme, Cuyo regocijo era como para devorar al pobre encubiertamente. 15 Caminaste en el mar con tus caballos, Sobre la mole de las grandes aguas. 16 Oí, y se conmovieron mis entrañas; A la voz temblaron mis labios; Pudrición entró en mis huesos, y dentro de mí me estremecí; Si bien estaré quieto en el día de la angustia, Cuando suba al pueblo el que lo invadirá con sus tropas. 17 Aunque la higuera no florezca, Ni en las vides haya frutos, Aunque falte el producto del olivo, Y los labrados no den mantenimiento, Y las ovejas sean quitadas de la majada, Y no haya vacas en los corrales; 18 Con todo, yo me alegraré en Jehová, Y me gozaré en el Dios de mi salvación. 19 Jehová el Señor es mi fortaleza, El cual hace mis pies como de ciervas, Y en mis alturas me hace andar. Al jefe de los cantores, sobre mis instrumentos de cuerdas. © Sociedad Bíblica de España

Habacuc 3:1-2 es una oración que surge después de que el profeta ha escuchado el juicio de Dios. Clama: «Oh Señor, he oído tu palabra, y temí. Señor, aviva tu obra en medio de los tiempos, en medio de los años hazla conocer; en la ira acuérdate de la misericordia». El profeta no pide escapar del juicio, sino que la obra de Dios sea viva y manifiesta, incluso en medio de la adversidad. Este grito de avivamiento reconoce que solo Dios puede hacer que su obra florezca cuando las circunstancias son adversas. Es una oración para hoy: que el Señor renueve su obra en nosotros y a través de nosotros. Banda sonora: Drop the Tapes - Biblioteca de audio de YouTube Donaciones local: https://iglesiadeciudadreal.es/donaciones Web: http://iglesiadeciudadreal.es/ Podcast: http://www.ivoox.com/podcast-iglesia-. YouTube: https://www.youtube.com/channel/UCPq8l9Q7KcX7j6iOGDPP_zg x (antes Twitter): https://x.com/home?lang=es Instagram: https://www.instagram.com/ Facebook: https://www.facebook.com/IglesiaCristianaEvangelicaDeCiudadReal Nota informativa: En todos nuestros videos se pueden traducir los SUBTÍTULOS a cualquier idioma. Ir a configuración y elegir idioma de subtitulo 05/07/2026 - PREDICACIÓN DE LA MAÑANA - SERIE: HABACUC Habacuc 3 Reina-Valera 1960 Oración de Habacuc 3 Oración del profeta Habacuc, sobre Sigionot. 2 Oh Jehová, he oído tu palabra, y temí. Oh Jehová, aviva tu obra en medio de los tiempos, En medio de los tiempos hazla conocer; En la ira acuérdate de la misericordia. 3 Dios vendrá de Temán, Y el Santo desde el monte de Parán. Selah Su gloria cubrió los cielos, Y la tierra se llenó de su alabanza. 4 Y el resplandor fue como la luz; Rayos brillantes salían de su mano, Y allí estaba escondido su poder. 5 Delante de su rostro iba mortandad, Y a sus pies salían carbones encendidos. 6 Se levantó, y midió la tierra; Miró, e hizo temblar las gentes; Los montes antiguos fueron desmenuzados, Los collados antiguos se humillaron. Sus caminos son eternos. 7 He visto las tiendas de Cusán en aflicción; Las tiendas de la tierra de Madián temblaron. 8 ¿Te airaste, oh Jehová, contra los ríos? ¿Contra los ríos te airaste? ¿Fue tu ira contra el mar Cuando montaste en tus caballos, Y en tus carros de victoria? 9 Se descubrió enteramente tu arco; Los juramentos a las tribus fueron palabra segura. Selah Hendiste la tierra con ríos. 10 Te vieron y tuvieron temor los montes; Pasó la inundación de las aguas; El abismo dio su voz, A lo alto alzó sus manos. 11 El sol y la luna se pararon en su lugar; A la luz de tus saetas anduvieron, Y al resplandor de tu fulgente lanza. 12 Con ira hollaste la tierra, Con furor trillaste las naciones. 13 Saliste para socorrer a tu pueblo, Para socorrer a tu ungido. Traspasaste la cabeza de la casa del impío, Descubriendo el cimiento hasta la roca. Selah 14 Horadaste con sus propios dardos las cabezas de sus guerreros, Que como tempestad acometieron para dispersarme, Cuyo regocijo era como para devorar al pobre encubiertamente. 15 Caminaste en el mar con tus caballos, Sobre la mole de las grandes aguas. 16 Oí, y se conmovieron mis entrañas; A la voz temblaron mis labios; Pudrición entró en mis huesos, y dentro de mí me estremecí; Si bien estaré quieto en el día de la angustia, Cuando suba al pueblo el que lo invadirá con sus tropas. 17 Aunque la higuera no florezca, Ni en las vides haya frutos, Aunque falte el producto del olivo, Y los labrados no den mantenimiento, Y las ovejas sean quitadas de la majada, Y no haya vacas en los corrales; 18 Con todo, yo me alegraré en Jehová, Y me gozaré en el Dios de mi salvación. 19 Jehová el Señor es mi fortaleza, El cual hace mis pies como de ciervas, Y en mis alturas me hace andar. Al jefe de los cantores, sobre mis instrumentos de cuerdas. © Sociedad Bíblica de España

"The schools in the Concordia University System are an incredible gift; we have a responsibility to steward them well for the next generation," says Dr. Peter Nafzger, associate professor of Practical Theology at Concordia Seminary, St. Louis. In this conversation Nafzger and Rev. Jeff Cloeter, pastor of Christ Memorial Lutheran Church, compare their experiences as alumni and as parents of students attending a Concordia University. "Concordia Universities are a ligament of the church," said Cloeter. "The relational connectivity that happens in the classroom or on the basketball court benefits the kingdom of God." Join us in a discussion of the benefits and potential disadvantages of studying at a CUS school.

Look, the movie is about a time loop, it's got Sandy B (our favorite baked bean, etc.) and it's an okay time. More importantly, are you folks ready for some flippin' ADVERTISEMENTS? Cus this episode is full of super legit, definitely real ads! It also includes jokes like: how to diffuse a bomb, the Electro Crow, Jim gets a jelly jamming, new Tide pods(?) and a WHOLE lot of moth wing extract.

What does the Concordia University System Board of Directors do? The Rev. Mark Braden (Chairman, Concordia University System Board of Directors) joins Andy and Sarah to talk about his experience prior to serving on the CUS Board of Directors, how that experience helps him lead this group, why the Board of Directors is important and how they serve the Concordia University System, how the campus visitation process works and the Lutheran Identity Mission Outcome Standards, and updates on the CUS Scholarships, Direct Admit, and other current CUS news. Learn more about the Concordia University System at CUS.edu. As you grab your morning coffee (and pastry, let's be honest), join hosts Andy Bates and Sarah Gulseth as they bring you stories of the intersection of Lutheran life and a secular world. Catch real-life stories of mercy work of the LCMS and partners, updates from missionaries across the ocean, and practical talk about how to live boldly Lutheran. Have a topic you'd like to hear about on The Coffee Hour? Contact us at: listener@kfuo.org.

Glen speaks with the CEOs of two sub-$100 million CUs  (Josh Urbick and Doug Wadsworth) about their respective efforts to advance the small credit union cause. Also, the latest developments at Anthropic and Coinbase highlight the perils facing CUs- and financial services in general.   Links related to this episode: The NSCUA's LinkedIn page:  https://www.linkedin.com/company/national-small-credit-union-association/ The Endangered Small Credit Union Defense's LinkedIn group: https://www.linkedin.com/groups/14776042/  CU Daily's coverage of the NSCUA's formation: https://thecudaily.com/new-group-for-cus-under-500-million-in-assets-unveils-its-name/ Doug Wadsworth's Profitability Guidebook for Small CUs: https://www.amazon.com/dp/B0FP4D9FZM Doug's recent CU Daily article: https://thecudaily.com/you-cant-regulate-bad-managers-into-good-ones-but-you-can-do-this/ Wellesley Hill's thoughtful analysis of Coinbase's new Federal Trust Charter: https://www.wellesleyhillsfinancial.com/2026/04/12/coinbase-wins-federal-trust-charter-what-it-means-for-crypto-custody/ Reuters on the race for FIs to defend against threats posed by Anthropic's new capabilities: https://www.reuters.com/business/finance/bessent-powell-warn-bank-ceos-about-anthropic-model-risks-bloomberg-news-reports-2026-04-10/   Our recent episode recapping CU Unplugged, including an interview with small CU CEO Maggie Sayer: https://www.big-fintech.com/mission-rock-accomplished/  Join us for our next CU Town Hall- Wednesday April 15 at 3pm ET/Noon PT- a live and lively interactive conversation tackling the major issues facing credit unions. The Town Hall is free to attend, but advance registration is required:  https://www.cutownhall.com/     If CU Unplugged's style of hands-on problem solving sounds like your cup of collaborative tea, check out our Innovation Club. This group of forward thinkers meets virtually each month, and our twice-annual in-person session is coming up in May. Reach out about a guest pass: https://www.big-fintech.com/innovation-club/     Follow us on LinkedIn:  https://www.linkedin.com/company/best-innovation-group/   https://www.linkedin.com/in/jbfintech/ https://www.linkedin.com/n/glensarvady/

Our first batch of coverage from Americas Credit Unions' Government Affairs Conference features an interview with the three leaders behind CUltivate- the new credit union-owned and curated foundational AI engine- plus our annual meetup with the ACU Economics Team to discuss their take on the outlook for CUs and the US economy overall.    Links related to this episode: CUltivate: https://getcultivate.ai/ Filene Research Institute: https://www.filene.org/ Vizo Financial Corporate Credit Union: www.vfccu.org   Vertice AI: www.verticeanalytics.ai OpenEvidence, the Mayo Clinic's purpose-built AI tool for healthcare professionals cited as a model my CUltivate: https://www.openevidence.com/   America's Credit Unions' Economic Update/Blogs: https://www.americascreditunions.org/blogs/americas-credit-unions/all-about-affordability   Check out CU Unplugged, an unscripted, participant-powered gathering designed to foster unfiltered conversation on the topics participants deem most critical. The event is open to all credit union leaders, but the group will be kept intentionally small for maximum impact. Join us March 30 – April 2 at Visa's Market Support Center in San Francisco- Visit https://www.cu-unplugged.com/  to learn more and register.    Join us for our next CU Town Hall- Wednesday March 18 at 3pm ET/Noon PT- a live and lively interactive conversation tackling the major issues facing credit unions. This month we'll discuss key takeaways from the recent Government Affairs Conference. If you missed GAC it's a great chance to catch up. If you were there, compare notes with your colleagues. The Town Hall is free to attend, but advance registration is required:  https://www.cutownhall.com/     Follow us on LinkedIn:  https://www.linkedin.com/company/best-innovation-group/  https://www.linkedin.com/in/jbfintech/ https://www.linkedin.com/in/glensarvady/

Glen speaks with two Associate Professors- Anna-Leigh Stone (Samford University) and Jordan Van Rijn (University of Wisconsin) about the recent Credit Union Research Workshop and Stone's paper analyzing the impact of CUs acquiring banks. Also- KYC risks morphing into Know Your Citizenship.   Links related to this episode: Anna-Leigh Stone: https://www.samford.edu/business/directory/Stone-Anna-Leigh Jordan Van Rijn: https://aae.wisc.edu/faculty/vanrijn/  The CU Research Workshop: https://sites.google.com/view/jordan-van-rijn/home/credit-union-research-workshop The Cato Institute on the proposed requirement for FIs to collect account holders' citizenship data: https://www.cato.org/blog/know-citizenship-says-trump-banks TruStage's announcement of its TSDA stablecoin for credit unions: https://www.trustage.com/newsroom/2026-press-releases/trustage-launches-stablecoin  The CU Daily on the latest Alabama brushfire re: a CU acquiring a bank: https://thecudaily.com/bankers-use-latest-cu-purchase-of-bank-to-criticize-tax-exemption-americas-cus-says-claimes-are-lies/  Check out CU Unplugged, an unscripted, participant-powered gathering designed to foster unfiltered conversation on the topics participants deem most critical. The event is open to all credit union leaders, but the group will be kept intentionally small for maximum impact. Join us March 30 – April 2 at Visa's Market Support Center in San Francisco- Visit https://www.cu-unplugged.com/  to learn more and register.   Join us for our next CU Town Hall- Wednesday March 18 at 3pm ET/Noon PT- a live and lively interactive conversation tackling the major issues facing credit unions today. The Town Hall is free to attend, but advance registration is required:  https://www.cutownhall.com/     Follow us on LinkedIn:  https://www.linkedin.com/company/best-innovation-group/ https://www.linkedin.com/in/jbfintech/ https://www.linkedin.com/in/glensarvady/  

Do you know why God put you on this planet? Cus He did. Or why He would put you in His church? Cus that's where He wants you. Why should you even care to know?

Most people assume hospitals are automatically safe, but few are taught how to protect themselves once admitted. This episode explores how awareness and simple questions can dramatically reduce risk during hospital stays. Hosted by Sayan Bhattacharjee on Healthy Mind, Healthy Life, this conversation is for patients, caregivers, and families who want clarity, confidence, and agency during medical care—without fear or panic. You'll learn how to stay mentally grounded while actively partnering with healthcare teams. About the Guest: Dr. Julie Siemers is a patient safety consultant, nurse leader, educator, and speaker with over 30 years of experience in hospitals. She is the author of Surviving Your Hospital Stay and focuses on educating patients and families about preventing medical harm. Key Takeaways: Hospital care carries risk, and awareness is the first layer of protection Medication errors are common and often caused by system breakdowns, not individuals Track vital signs, lab results, and changes in behavior during a hospital stay Use the “3 Ps”: be present, polite, and persistent when concerns arise Apply the CUS framework to clearly communicate safety concerns How to Connect With the Guest Website & social media: https://drjuliesiemers.com/    Want to be a guest on Healthy Mind, Healthy Life? DM on PM - Send me a message on PodMatch DM Me Here: https://www.podmatch.com/hostdetailpreview/avik Disclaimer: This video is for educational and informational purposes only. The views expressed are the personal opinions of the guest and do not reflect the views of the host or Healthy Mind By Avik™️. We do not intend to harm, defame, or discredit any person, organization, brand, product, country, or profession mentioned. All third-party media used remain the property of their respective owners and are used under fair use for informational purposes. By watching, you acknowledge and accept this disclaimer. Healthy Mind By Avik™️ is a global platform redefining mental health as a necessity, not a luxury. Born during the pandemic, it's become a sanctuary for healing, growth, and mindful living. Hosted by Avik Chakraborty, storyteller, survivor, and wellness advocate. With over 6000+ episodes and 200K+ global listeners, we unite voices, break stigma, and build a world where every story matters.

You know those moments when something just “feels off?” That's when you should trust your instincts and speak up because timing can completely change a patient's outcome.In this episode, Sarah is joined by Dr. Oscar Mitchell, Associate Director of the Center for Resuscitation Science and Director of the Medical Rapid Response Team at the Hospital of the University of Pennsylvania. They break down one septic shock case across two timelines: first, when rapid response is called early and there's still time to intervene, and later, when the patient is already crashing.You'll hear what a calm, collaborative rapid response call looks like, which signs of deterioration should never be ignored, and how to effectively share your concerns with a provider. This episode is for anyone who might call a rapid response AND for those who respond to emergencies.Topics discussed in this episode:Introduction to the patient and the 5PM timelineWhat the ideal provider–nurse collaboration looks likeEarly signs of deterioration that were missedWhy some nurses hesitate to call rapid responseThe patient's vitals at 10AM and why rapid response was calledWhy the documented respiratory rate might not be reliableWhy blood pressure can be misleadingSBAR and CUS frameworks for escalationDr. Mitchell's research on delays in RRT activation and mortalityEarly warning signs you should never ignoreRegister for the REVIVE Conference and use code RAPID50 to get $50 off!https://www.revive-conference.com/Check out Dr. Mitchell's research here:https://pubmed.ncbi.nlm.nih.gov/36349290/Mentioned in this episode:AND If you are planning to sit for your CCRN and would like to take the Critical Care Academy CCRN prep course you can visit https://www.ccrnacademy.com and use coupon code RAPID10 to get 10% off the cost of the course!CONNECT

Send us a textSafe Harbor, the Golden CO based cannabis banking pioneer, is alive and growing and that's the message of today's guest Terry Mendez, the recently installed CEO.Mendez took over the seat that had been occupied by Sundie Seefried, onetime ceo of Partner Colorado Credit Union who left that post to helm Safe Harbor.  Sundie, by the way, was the guest in CU 2.0 Podcast #139 which posted 4+ years ago, link in the show notes. A lot had happened in those intervening years and, to my eyes  at least, Safe Harbor seemed on the edge of extinction.But Mendez is on the show to share his optimism about growing the business, how it hit financial troubles in 2023-24, how he says the troubles were abated, and why now is the time for more credit unions to take a fresh look at cannabis banking.Probably Mendez is right, probably legal cannabis now is with us and, indeed, reliable, legally compliant banking has to be part of that package and Safe Harbor says it is well positioned to provide those services to credit union customers.The reality is that there are many wrinkles to cannabis banking. That's where a Safe Harbor - a guide that knows the legal route - comes in.Want to know more about CUs and cannabis? Listen to episode 364 where Wright-Patt Credit Union talks about its experiences.Listen up.Like what you are hearing? Find out how you can help sponsor this podcast here. Very affordable sponsorship packages are available. Email rjmcgarvey@gmail.com  And like this podcast on whatever service you use to stream it. That matters.  Find out more about CU2.0 and the digital transformation of credit unions here. It's a journey every credit union needs to take. Pronto

Linktree: ⁠https://linktr.ee/Analytic⁠Join The Normandy For Additional Bonus Audio And Visual Content For All Things Nme+! Join Here: ⁠https://ow.ly/msoH50WCu0K⁠Analytic Dreamz delivers a detailed, concise analysis of Valve's November 2025 Steam Machine reveal, alongside the Steam Controller and Steam Frame VR headset, all launching early 2026. Steam Machine Specs: Compact 6-inch cube (2.6kg), AMD Zen 4 6-core/12-thread CPU (up to 4.8GHz, 30W TDP), RDNA3 GPU (28 CUs, 2.45GHz, 110W TDP, 8GB GDDR6), 16GB DDR5 RAM, 512GB/2TB NVMe SSD + microSD. Delivers 6x Steam Deck power for 4K/60FPS gaming with FSR; handles Cyberpunk 2077 medium settings. SteamOS 3 optimized for couch play, full Steam library, Proton Windows support, desktop mode. Connectivity: 2x USB-A 3.2, USB-C, DP 1.4 (4K@240Hz), HDMI 2.0 (4K@120Hz, HDR/FreeSync), Wi-Fi 6E, Ethernet, internal PSU.Steam Controller: Deck-inspired with TMR joysticks, dual trackpads, gyro, 36-hour battery, customizable profiles; compatible across Steam devices. Steam Frame: Streaming VR (2160x2160/eye, 110° FOV), capacitive controllers, Wi-Fi 6, full Steam integration. Valve challenges consoles with PC flexibility at estimated $449-$599. Analytic Dreamz breaks down performance, features, and 2026 impact. Support this podcast at — https://redcircle.com/analytic-dreamz-notorious-mass-effect/donationsAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Finovate Awards Winner InvestiFi on the changing investment landscape, consumer education, and bringing investment assets back to banks and CUs. Detailed Summary: In this episode of the Finovate Podcast, host Greg Palmer interviews Kian Sarrestheh, co-founder and CEO of InvestiFi the 2025 Finovate Awards winner in the Best Alternative Investment Solution category. InvestiFi provides a digital investment platform specifically designed for banks and credit unions, allowing their customers to invest in stocks, ETFs, crypto, and roboadvisory portfolios directly from their checking or savings accounts without transferring money to third-party platforms. This innovative approach keeps deposits on the financial institution's balance sheet while providing a seamless user experience that eliminates the friction of moving money between accounts. The conversation explores how consumer investment behavior is rapidly shifting toward third-party apps like Robinhood, Coinbase, and SoFi, with financial institutions losing between 5-10% of their deposits to these platforms. Kian explains that these fintech companies are expanding beyond investing into traditional banking services, including mortgages, checking accounts, and savings products, creating a significant competitive threat to community banks and credit unions. InvestiFi addresses this challenge by enabling financial institutions to offer comparable digital investment experiences while maintaining the customer relationship and deposit base within their own ecosystem. Looking toward the future, Sarrestheh predicts that banks and credit unions will ultimately prevail over third-party investment apps due to their physical presence, established community trust, and ability to provide in-person customer service when issues arise. He believes that financial institutions offering similar digital investment capabilities through platforms like InvestiFi will leverage their 150-year track record of resilience and local relationships to win back customers who have migrated to fintech alternatives. The discussion emphasizes the importance of consumer education and the value of maintaining that crucial primary financial institution relationship in an increasingly digital investment landscape. More info: Tenerity PrivacyGuard: https://investifi.co/; https://www.linkedin.com/company/investifi-cuso/ Kian Sarreshteh: https://www.linkedin.com/in/technologykian/ Greg Palmer: https://www.linkedin.com/in/gregbpalmer/ Finovate: https://www.finovate.com; https://www.linkedin.com/company/finovate-conference-series/ #Finovate #InvestiFi #FinovateAwards #investing #wealthmanagement #podcast #fintechpodcast #financialservices #creditunions #banks #cryptocurrency #digitraltransformation #fintech #finserv #modernization #innovation #startup #banking

Join the LCMS Current!(bi monthly newsletter covering relevant LCMS topics!): https://www.uniteleadership.org/thelcmscurrentIn this episode, Dr. Jamison J. Hardy, President of the Concordia University System, joins Tim to discuss the exciting progress being made across LCMS universities — from record growth in church work enrollment to new scholarship initiatives and strategic partnerships.Dr. Hardy unpacks the $5,000 Church Work Scholarships, the refocus on Lutheran identity, and how the CUS is working with Set Apart to Serve and the seminaries to strengthen pathways for the next generation of pastors and teachers.They also discuss:- The latest on Concordia Ann Arbor- The push to unite around mission rather than division- Transparency in the “prior approval” process- What it really means to uphold “Lutheran identity”- How the LCMS can move forward together in love, truth, and courageThis candid, hope-filled conversation models how LCMS leaders can engage tough topics with both conviction and grace.Support the showJoin the Lead Time Newsletter! (Weekly Updates and Upcoming Episodes)https://www.uniteleadership.org/lead-time-podcast#newsletterVisit uniteleadership.org

In this episode of EM Pulse, guest host Dr. Neelou Tabatabai joins Julia in a discussion with ED nurse and TeamSTEPPS advocate, Leigh Clary, to explore how structured communication tools can transform even the most high-stress medical and trauma resuscitations. Through a real-life story of conflict and resolution in the emergency department, Leigh illustrates how TeamSTEPPS strategies—like assertive communication, the Two-Challenge Rule, and CUS words—empower teams to speak up, de-escalate tension, and protect patient safety. Together, they unpack how calm, composed dialogue preserves respect, strengthens teamwork, and ensures every voice is heard when it matters most. Do you use TeamSTEPPS or a similar model in your ED? We'd love to hear what has been successful for your team. Hit us up on social media @empulsepodcast or connect with us on ucdavisem.com Hosts: Dr. Julia Magaña, Professor of Pediatric Emergency Medicine at UC Davis Guest Host: Dr. Neelou Tabatabai, Assistant Professor of Emergency Medicine at UC Davis Guest: Leigh Clary, RN, BSN, RN, CEN, ADCES, MICN , ED Nurse and TeamSTEPPS Project Lead at UC Davis Resources: TeamSTEPPS Player of the Month Program, Presentation by Leigh Clary and Jose Metica TeamSTEPPS™: Team Strategies and Tools to Enhance Performance and Patient Safety Heidi B. King, MS, CHE, James Battles, PhD, David P. Baker, PhD, Alexander Alonso, PhD, Eduardo Salas, PhD, John Webster, MD, MBA, Lauren Toomey, RN, BSBA, MIS, and Mary Salisbury, RN, MSN. TeamSTEPPS Pocket Guide - Agency for Healthcare Research and Quality EM Pulse: TeamSTEPPS, September 17, 2021  **** Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Productions for audio production services.

ASUS ROG XBOX ALLY X , LE TEST par Yohann LemoreÀ savoir► Constructeur : Asus► Modèle : ROG XBOX ALLY X► Prix : 899€► OS : Windows 11 Home► Ecran 7” FHD (1080p) IPS, 500 nits, 16:9, taux de rafraîchissement120Hz ► SSD 1To,► RAM 24Go DDR5► GPU : AMD Radeon™ Graphics (AMD RDNA™ 3, 12 CUs, up to 2.7 GHz, up to 8.6 Teraflops)► CPU : AMD Ryzen™ AI Z2 Extreme► Connectique : 1x USB4® avec DisplayPort ™, 2.1 / Power Delivery 3.0, compatible Thunderbolt™4, 1x USB 3.2 Gen 2 Type-C® avec DisplayPort™ 2.1 / Power Delivery 3.01x lecteur de carte microSD UHS-II (supports SD, SDXC and SDHC ; UHS-I avec DDR200 mode), 1x 3.5mm Combo Audio Jack► Poids : 715 g► Dimension : 290.8 (L) x 121.5 (P) x 50.7 (H) mmCrédits audio :Endless Night by Karl Casey @WhiteBatAudio ► https://www.youtube.com/watch?v=vpci3Mt-aUY&t

How is the Concordia University System helping young people attend Concordia Universities? The Rev. Dr. Jamison Hardy (President of Concordia University System) and the Rev. Dr. Douglas Spittel (Vice President of Concordia University System) join Andy and Sarah for the monthly update from the Concordia University System, including what's been happening in the first few weeks of classes at our universities, how LCMS church work programs are funded, feedback from students receiving scholarships, and how CUS is related to the LCMS District Presidents. Learn more about CUS and sign up to receive their e-newsletter at cus.edu. As you grab your morning coffee (and pastry, let's be honest), join hosts Andy Bates and Sarah Gulseth as they bring you stories of the intersection of Lutheran life and a secular world. Catch real-life stories of mercy work of the LCMS and partners, updates from missionaries across the ocean, and practical talk about how to live boldly Lutheran. Have a topic you'd like to hear about on The Coffee Hour? Contact us at: listener@kfuo.org.

In Part Three of our Mike Tyson Career Profile, we cover one of the most pivotal stretches of his life: his first year as a professional fighter. Bursting onto the scene in 1985, Tyson racked up knockout after knockout, showcasing the devastating speed and power that would make him a global sensation. But behind the highlight reels and rapid ascent, Tyson was also dealing with a profound personal loss—the passing of his legendary mentor and trainer, Cus D'Amato. This episode explores how Tyson channeled his grief into the ring, using boxing as both an outlet and a way to honor Cus's vision. We'll walk through the stories of his early opponents, the growing media frenzy around the young phenom, and the intense buildup to his shot at the heavyweight title. Learn more about your ad choices. Visit podcastchoices.com/adchoices

In Part Three of our Mike Tyson Career Profile, we cover one of the most pivotal stretches of his life: his first year as a professional fighter. Bursting onto the scene in 1985, Tyson racked up knockout after knockout, showcasing the devastating speed and power that would make him a global sensation. But behind the highlight reels and rapid ascent, Tyson was also dealing with a profound personal loss—the passing of his legendary mentor and trainer, Cus D'Amato. This episode explores how Tyson channeled his grief into the ring, using boxing as both an outlet and a way to honor Cus's vision. We'll walk through the stories of his early opponents, the growing media frenzy around the young phenom, and the intense buildup to his shot at the heavyweight title. Learn more about your ad choices. Visit podcastchoices.com/adchoices

“My best hack is always keeping my why in focus. Work is part of my why, but also my kids are my why too." – Linda LafortuneThank you for tuning in to The CUInsight Network, with your host, Robbie Young, Vice President of Strategic Growth at CUInsight. In The CUInsight Network, we take a deeper dive with the thought leaders who support the credit union community. We discuss issues and challenges facing credit unions and identify best practices to learn and grow together.My guest on today's show is Linda Lafortune, Director of Learning and Client Support here at CUInsight! She joins me in this episode to share her winding story, not having set out to land in credit unions at all. In fact, her early passions were teaching and horses, and she spent her teen years working at a horse farm, teaching lessons, and absorbing the strong sense of community of that world. After trying her hand at journalism and realizing that it wasn't the right fit, it was a conversation at the farm that steered her toward her very first credit union job—from there she built a 25-year career across multiple CUs before joining our team at CUInsight five years ago.In our conversation, Linda shares how those varied experiences—from the teller line to leadership development—have shaped the way she approaches her role today. She talks about CUInsight as a “centralized hub” for credit union professionals and why she's passionate about making learning accessible and meaningful across the industry.As we wrap up, we also get into the mentors who helped Linda grow, why she'd rather splurge on experiences than things, what book she believes everyone should read, and the important role that her kids play in keeping her grounded when it comes to maintaining a work-life balance. I hope that you enjoy my conversation with Linda Lafortune!Find the full show notes on cuinsight.com.Connect with Linda:Linda Lafortune, Director of Learning and Client Support at CUInsightcuinsight.comLinda: LinkedInCUInsight: LinkedIn | Instagram | Facebook | YouTube | X

What are the latest updates on Concordia University System scholarships and the new school year? The Rev. Dr. Jamison Hardy (President of Concordia University System) and the Rev. Dr. Douglas Spittel (Vice President of Concordia University System) join Andy and Sarah to talk about their time at the LCMS Youth Gathering, what it was like for them to represent CUS and meet thousands of Lutheran youth, the scholarships available from CUS, what these scholarships mean for CUS students entering a new school year, where Dr. Hardy and Dr. Spittel will be present for opening services, and upcoming conferences. Learn more about CUS and how you can support the scholarship fund at cus.edu. As you grab your morning coffee (and pastry, let's be honest), join hosts Andy Bates and Sarah Gulseth as they bring you stories of the intersection of Lutheran life and a secular world. Catch real-life stories of mercy work of the LCMS and partners, updates from missionaries across the ocean, and practical talk about how to live boldly Lutheran. Have a topic you'd like to hear about on The Coffee Hour? Contact us at: listener@kfuo.org.

We sat down with Elizabeth Eurgubian, former NCUA Board Member, to explore the current state of the National Credit Union Administration and what it means for the financial services industry. The NCUA is structured to operate with a bipartisan, three-member board--with members appointed by the President and confirmed by the Senate. Since the election, the NCUA Board has been functioning with fewer than three members, raising important questions about oversight, governance, and decision-making. This episode will examine the practical and policy implications for the financial services industry when the NCUA Board is not fully staffed, and whether this could lead to an environment of more centralized regulators. We will also discuss the difference in regulatory conduct between Credit Unions and Banks and the recent hot topic of tax-exempt status for CUs.Send us a textPresented by Remedy ConsultingTechnology Contract Negotiation & System Assessments, T&C Improvements, and FI Strategic Planning.For more information on BankTalk:BankTalk WebsiteSubscribe to BankTalk NewsRemedy Consulting WebsiteRemedy LinkedInTo speak on the BankTalk Podcast, please email us.

Not only do we never underestimate the power of sunglasses, we bring you another show after a "sick" week off.  We've got some external storage to review, Threadripper high-wattage benchmarks, and some Zen time on top of all the other high quality news items and spontaneous commentary you know you want.  And need.  Topics below.Timestamps:00:00 Intro01:04 Patreon1:35 Food with Josh03:24 Next-gen Radeon may have 96 CUs, 384-bit memory14:18 Threadripper PRO 9995WX's insane Cinebench score (and power draw)17:57 AM5 motherboards revised for Zen 6 CPUs?22:55 We mention an exhaustive study of AMD memory speeds28:30 NVIDIA adding native RISC-V support to CUDA30:19 Each of us blocks Wi-Fi in our own special way33:49 MAINGEAR goes retro39:34 Self-destructing SSDs42:03 Belkin notifies users that Wemo products will be bricked45:22 (In)Security Corner1:01:26 Gaming Quick Hits1:12:00 Crucial X10 Portable SSD review1:16:52 Picks of the Week1:26:42 Outro ★ Support this podcast on Patreon ★

In Search of Excellence Podcast - with Randall KaplanMy guest today is Mike Tyson, a former heavyweight boxing champion of the world and one of the greatest boxers of all time!  At the age of 20, he became the youngest boxer ever to win a heavyweight title.  He was the first heavyweight boxer to simultaneously hold WBA, WBC, and IDF titles and a member of the international boxing Hall of Fame.Mike has appeared in many movies and TV shows.  He is the actor and creator of a one-man Broadway show Undisputed Truth, and the author of the best-selling book of the same name.Mike is also a very successful entrepreneur and a founder of two cannabis companies, including Tyson 2.0.  He is an incredible person and a dedicated philanthropist through his Mike Tyson's Care foundation, and the support of other charities including The Make a Wish Foundation and The Special Olympics.00:00 Mike's childhoodHis dad was a pimp, his mom an alcoholic and a sex industry workerHe was bullied in his childhood ("you can't run from them, you must confront them")Started robbing people to buy food for his pigeonsA traumatic event with the birds that changed himMike's first fight and from being bullied, to being the bullyWent pick-pocketing and stealing with his friendsStarted with crime at 11, by the age of 13, he was arrested more than 37 timesThe stealing mentality - nobody else mattersHis mom encouraged him to steal (his goal was to be a professional criminal)18:13 Juvenile facilities and Mike's first steps in boxingWatched the movie “The Greatest”, the story of Mohammed AliTransferred to Elwood CottageMike was always handcuffed in a dangerous environment Met Bobby Stewart who inspired him to finish school and started training himAt 13, Bobby wanted to take him to the next level - introduced him to Cus D'Amato21:14 Mike's first mentor - Cus D'AmatoRelationship with Cus D'Amato (Cus taught him to never give up)Cus became a father figure for himThe time Mike first experienced loveCus saw in him the future world championWorking out for 6 hours a day while going to schoolWanted to get kicked out of school, but Cus didn't allow thatThere is no progress without struggle (study about rats)29:32 The beginning of his fighting careerAt 18, a fight with Hector Mercedes - beat him in one roundWasn't afraid of losing, but being a bad loserMike's desire to be the world champion consumed him completelyBecame the youngest boxing champion everHis mother's reaction - never got affirmed by her34:47 From millions of dollars to bankruptcyStarted making millions of dollars (became highest paid athlete in the world)Went bankrupt being reckless, didn't know how to manage money as a street kidBeing rich and going broke multiple timesFame and money won't make you happyBecome your own alarm systemThe pain is the same at the top and the bottom of the worldListen to this episode on the go!

Glen speaks with the CU De Novo Collective's Denise Wymore about the grassroots groundswell of interest in starting new credit unions, overcoming the challenges of progressing from concept to market, and why a voice for CU creation is needed to counter a one-way trend. Also- Fiserv's stablecoin play, The FTA's attempt to preserve open banking, and how AI regulation became a budget issue.                Links related to this episode:   The CU De Novo Collective: https://www.cudenovocollective.org/    The University of North Carolina's student-led credit union initiative: https://www.dailytarheel.com/article/2025/06/university-student-credit-union  George Washington University's initiative: https://gwucui.com/  America's Credit Union Museum: https://www.acumuseum.org/ (check the Herstory exhibit) Finovate's take on Fiserv launching a “bank-friendly stablecoin”: https://finovate.com/fiserv-launches-stablecoin-for-banks/  The Bank Policy Institute/Fintech Association Open Banking standoff: https://thecudaily.com/fintechs-tell-court-banks-want-to-thwart-open-banking-to-stop-competition/    Join us for our next CU Town Hall- Wednesday July 9 at 3pm ET/Noon PT- for a live and lively interactive conversation tackling the major issues facing credit unions today. For this session we'll be focusing on youth banking and how CUs can appeal to the next generation of members. The CU Town Hall is free to attend, but advance registration is required:  https://www.cutownhall.com/   Join us on Bluesky!  @bigfintech.bsky.social;  @154advisors.bsky.social (Glen); @jbfintech.bsky.social (John) And connect on LinkedIn for insights like the Friday Fintech Five: https://www.linkedin.com/company/best-innovation-group/  https://www.linkedin.com/in/jbfintech/ https://www.linkedin.com/in/glensarvady/

This is a free preview of a paid episode. To hear more, visit www.wethefifth.com* ABBA's Vietnam* Barnen i Nicaragua* Mike Tyson, Ratso, and Cus the Communist* Burning down the house / sort of scolded by a firefighter * The rent is too damn free* Everyone is contemptuous of everyone * Is Trump the Bernie Goetz of Harvard?* Rebutting “higher ed is just fine” revisionism* From YAF to Students for Liberty to Turning Point…* Dating apps, height discrimina…

In this eye-opening episode of the Wild Health Podcast, Dr. Carl Seeger talks with Dr. Julie Siemers—a nurse leader, patient safety consultant, and bestselling author of Surviving Your Hospital Stay. Drawing on 40+ years in healthcare, Dr. Siemers discusses how communication breakdowns, misdiagnoses, medication errors, and lack of patient advocacy continue to threaten safety in hospitals. Listeners will learn crucial, actionable tips: from checking hospital safety scores to speaking up using her "Three P's" (Be Present, Be Polite, Be Persistent) and “CUS” words (Concerned, Uncomfortable, Scared, Safety). Whether you're a patient, caregiver, or clinician, this conversation reveals how being informed and assertive can save lives.

Glen connects with Paylume's Andrew Gomez to unpack the burgeoning pay by bank model, explore lessons learned from other countries' rollouts, and consider the pros and cons facing banks and credit unions. Also- a possible open banking do-over, more stadium naming rights, and resisting the urge to spike the ball before the goal line.    Links related to this episode:   Andrew Gomez/Paylume: https://www.linkedin.com/in/r-andrew-gomez/    Nacha's Remote Connect, June 6-9: https://payments.nacha.org/remote-connect    Part One of our Nacha Payments conference coverage: https://www.big-fintech.com/getting-direct-about-ach/    CU Daily's coverage of a positive sign for CUs' tax exemption: https://thecudaily.com/in-victory-for-credit-unions-cu-tax-exemption-not-targeted-in-committees-bill    The recent CU Town Hall on which we debated implications of the tax exemption: https://www.cutownhall.com/    Bloomberg Law's coverage of potential Open Banking (Section 1033) reconsideration: https://news.bloomberglaw.com/banking-law/cfpb-plans-to-revisit-open-banking-rule-despite-workforce-cuts    BECU's partnership with the WNBA's Seattle Storm, one of several recent naming rights deals: https://storm.wnba.com/news/storm-announce-becu-as-partner-for-performance-center   Join us for our next CU Town Hall- Wednesday May 21 at 3pm ET/Noon PT- for a live and lively interactive conversation tackling the major issues facing credit unions today. This session will feature a round robin on the countless recent regulatory twists and turns. The Town Hall is free to attend, but advance registration is required:  https://www.cutownhall.com/   Join us on Bluesky!  @bigfintech.bsky.social;  @154advisors.bsky.social (Glen); @jbfintech.bsky.social (John) And connect on LinkedIn for insights like the Friday Fintech Five: https://www.linkedin.com/company/best-innovation-group/  https://www.linkedin.com/in/jbfintech/ https://www.linkedin.com/in/glensarvady/

Exploring CU-specific fintech solutions, with a preview of the CU Spotlight session at FinovateSpring. Detailed Summary: In this episode of the Finovate Podcast, host Greg Palmer interviews Nick Evens, President and CEO of Curql, ahead of FinovateSpring. Nick shares his journey from working within credit unions to leading Curql, a strategic investment fund focused on credit union innovation. He explains how Curql was born from a need to support credit unions in staying competitive with big banks by pooling resources to invest in transformative financial technology. With its roots in the credit union community, Curql helps these institutions gain access to tech solutions they otherwise couldn't afford on their own. Nick then elaborates on Curql's mission to connect credit unions with fintechs and vice versa, underscoring its role in helping credit unions adopt cutting-edge technology. He discusses the company's current and upcoming funds and how they support a growing portfolio of tech firms. Curql not only invests in startups but also fosters an ecosystem where over 130 credit unions collaborate and share resources. Additionally, Curql emphasizes regulatory modernization and strategic partnerships, often co-investing in companies that serve both banks and credit unions. Looking ahead to FinovateSpring, Nick and Greg discuss the special Credit Union Spotlight session, designed to highlight fintechs that cater specifically to CUs. This curated environment ensures that attendees from various roles—whether in lending, compliance, or cybersecurity—can discover relevant solutions. With a diverse lineup of presenting companies, including those focused on AI and member-facing technologies, the session aims to meet the broad needs of credit union professionals and further Curql's mission of bridging the gap between fintech and credit unions. More info: Curql: https://www.curql.com/ ; https://www.linkedin.com/company/curql/ Nick Evens: https://www.linkedin.com/in/nick-evens-76b75316/ Greg Palmer: https://www.linkedin.com/in/gregbpalmer/ Finovate: https://www.finovate.com ; https://www.linkedin.com/company/finovate-conference-series/ FinovateSpring: https://informaconnect.com/finovatespring/ #fintech #CU #creditunions #financialservices #innovation #digitaltransformation #finovate #finovatespring

How and why was the Concordia University System established? The Rev. Dr. Jamison Hardy (President, Concordia University System) and the Rev. Dr. Douglas Spittel (Vice President, Concordia University System) join Andy and Sarah to talk about how and why the Concordia University System was established, some of the long history of higher education in the LCMS, the relationship of the Concordias to the LCMS, challenges and benefits to this relationship, and how the Concordias serve the Church. Learn more and sign up for the CUS newsletter at cus.edu, and follow on Facebook here. Today's episode of The Coffee Hour is underwritten in part by Concordia University Nebraska. You can learn more about Concordia University Nebraska at cune.edu. As you grab your morning coffee (and pastry, let's be honest), join hosts Andy Bates and Sarah Gulseth as they bring you stories of the intersection of Lutheran life and a secular world. Catch real-life stories of mercy work of the LCMS and partners, updates from missionaries across the ocean, and practical talk about how to live boldly Lutheran. Have a topic you'd like to hear about on The Coffee Hour? Contact us at: listener@kfuo.org.

Send us a textI'd expected this to be an AI free show but, let's face it, that just isn't likely in 2025 but the good news is that in the show Pete Major,  vice president of fintech services at CUSO MDT, offers concrete AI use cases at work in MDT and he also, importantly, offers cautions about security and the leading AI tools.In a rush to stay abreast of the fast moving AI universe are some credit unions losing sight of the need to be very sure of the security of the tools they use? Maybe.Major provides tips on how to stay secure while still using AI tools..But there's a lot more in this show.We talk for instance about the need of CUs to keep security in mind when using any technology tools.  If there are flaws - and there have been some doozies in recent years - it's the credit union that will be saddled with the bulk of the blame.On a happier note Major discusses a suite of tools for small business members at credit unions - and, he says, demand for the tools is very hot.  Is offering good tools a path to winning more business members? Just maybe.We close the show pondering what the developments in Washington DC - anything from an end to credit union tax exemption to an end to NCUA - might mean for credit unions and also the rising CU interest in merging.There's a lot to unpack in this show.  Listen up.Like what you are hearing? Find out how you can help sponsor this podcast here. Very affordable sponsorship packages are available. Email rjmcgarvey@gmail.com  And like this podcast on whatever service you use to stream it. That matters.  Find out more about CU2.0 and the digital transformation of credit unions here. It's a journey every credit union needs to take. Pronto

El biólogo español Òscar Cusó y el cámara Sebastián Guzmán nos trasladan al rodaje de 'The Americas' (BBC Studios y NBC Universal), el documental de naturaleza narrado por Tom Hanks, con música de Hans Zimmer, que muestra la biodiversidad del continente americano y que ya está disponible en Movistar+.

El biólogo español Òscar Cusó y el cámara Sebastián Guzmán nos trasladan al rodaje de 'The Americas' (BBC Studios y NBC Universal), el documental de naturaleza narrado por Tom Hanks, con música de Hans Zimmer, que muestra la biodiversidad del continente americano y que ya está disponible en Movistar+.

Diving into the early life of Mike Tyson and how legendary trainer, Cus D'Amato, help Mike become the youngest boxing heavyweight champion.-----SourcesIron Ambition - Mike TysonThe Turbulent True Story of Mike Tyson-----1:55 - Poverty and crime6:50 - The turning point12:10 - Meeting Cus D'Amato 13:30 - Cus's training techniques/journey to becoming champion35:15 - Lessons/takeaways-----You can check stay connected below:WebsiteBook: Chasing Greatness: Timeless Stories on the Pursuit of Excellence  ApparelInstagramX

In this episode of Firing the Man, we sit down with Kurt Elster, founder of EtherCycle and host of The Unofficial Shopify Podcast. Kurt shares his journey from flipping Beanie Babies and Furbies on eBay to becoming one of the most trusted Shopify experts. He discusses key strategies for building and scaling a successful Shopify store, including the importance of branding, storytelling, and optimizing your website for conversions. Kurt also highlights the biggest mistakes store owners make—like neglecting their checkout page and cluttering their navigation menu—and offers practical solutions to fix them. Whether you're just starting out or looking to scale, this episode is packed with actionable insights to help you grow your e-commerce business.We also dive into customer acquisition strategies, including the role of Amazon vs. direct-to-consumer sales, how to drive traffic beyond Facebook and Google ads, and why content marketing is a game-changer. Kurt shares his take on the value of trying things yourself before hiring experts, the importance of understanding your unit economics, and how to build trust with potential customers. Plus, in our signature Fire Round, Kurt talks about his favorite book, his passion for e-biking and restoring vintage cars, and what sets successful entrepreneurs apart from those who struggle. Don't miss this conversation filled with expert advice and behind-the-scenes insights from one of Shopify's top consultants!How to connect with Kurt?Website: https://kurtelster.com/               https://ethercycle.com/Podcast: https://unofficialshopifypodcast.com/Twitter: https://twitter.com/kurtincLinkedin: https://www.linkedin.com/in/kurtelsterYouTube: https://www.youtube.com/user/ethercycle Support the show

The prior approval process for LCMS leaders lacks transparency and is creating distrust and division when qualified candidates are removed without explanation. Family dysfunction in the church is exacerbated when decisions are made without clarity.Pat Ferry, Bill Cario, and Tim Ahlman discuss the topic at length:• Two distinct processes exist for presidents versus theology faculty appointments• Presidential approval requires sign-off from two of three key leaders: LCMS President, District President, and CUS board chair• Theology faculty approvals follow a different, increasingly unclear process• Concordia Wisconsin's presidential search illustrates the challenges when preferred candidates are rejected without explanation• Leaders advocate for transparency while maintaining appropriate church oversight• Relational trust is broken when decisions are made without discussing rationales• Worship practices and associations may impact eligibility without explicit guidelines• The process has evolved over decades with decreasing clarity in recent yearsWe need to continue working together for greater transparency. If we're going to break down walls between us, even little ones, we have to work at it together.Support the showJoin the Lead Time Newsletter! (Weekly Updates and Upcoming Episodes)https://www.uniteleadership.org/lead-time-podcast#newsletterVisit uniteleadership.org

“Member experience is everybody's responsibility because every employee has an impact on member experience.” - Laura LoyThank you for tuning in to The CUInsight Network, with your host, Robbie Young, Vice President of Strategic Growth at CUInsight. In The CUInsight Network, we take a deeper dive with the thought leaders who support the credit union community. We discuss issues and challenges facing credit unions and identify best practices to learn and grow together.My guest on today's show is Laura Loy, Chief Experience Officer at On the Mark Strategies. Laura helps credit unions sharpen their strategies and marketing in order to build stronger, more resilient organizations. She takes us inside On the Mark's approach to creating consistency in the member journey.In our conversation, Laura explains how On the Mark Strategies helps credit unions create consistency in every member interaction and breaks down what she calls the “four success markers”. We also talk about staying ahead of industry shifts, what's changing for credit unions right now, and how CUs can adapt in advance rather than play catch-up later on.As we wrap up the episode, Laura talks about her great boss, her love of the book “The Let Them Theory” by Mel Robbins, and talks about the importance of manifesting work/life balance. Enjoy my conversation with Laura Loy!Find the full show notes on cuinsight.com.Connect with Laura:Laura Loy, Chief Experience Officer at On the Mark Strategiesmarkarnold.comLaura: LinkedInOn the Mark Strategies:: LinkedIn | YouTubeWant to learn more about On the Mark Strategies? Click here.

Why do we have a Concordia University System? The Rev. Dr. Jamison Hardy (President, Concordia University System) and the Rev. Dr. Douglas Spittel (Vice President, Concordia University System) join Andy and Sarah to talk about what the Concordia University System (CUS) is, where each of the Concordias are and how this has changed over the long history of CUS, their visits to campuses and what happens on an official visit, the incredible things going on at our Concordia Universities, and where you can find both of them at upcoming conventions this year. Subscribe to the CUS newsletter and learn more about CUS at cus.edu. As you grab your morning coffee (and pastry, let's be honest), join hosts Andy Bates and Sarah Gulseth as they bring you stories of the intersection of Lutheran life and a secular world. Catch real-life stories of mercy work of the LCMS and partners, updates from missionaries across the ocean, and practical talk about how to live boldly Lutheran. Have a topic you'd like to hear about on The Coffee Hour? Contact us at: listener@kfuo.org.

“When done responsibly, student loans can be one of the most important and empowering investments someone can make in themselves.” - Scott PattersonThank you for tuning in to The CUInsight Network, with your host, Robbie Young, Vice President of Strategic Growth at CUInsight. In The CUInsight Network, we take a deeper dive with the thought leaders who support the credit union community. We discuss issues and challenges facing credit unions and identify best practices to learn and grow together.My guest on today's show is Scott Patterson, President and CEO of CU Student Choice. He joins me to discuss a wide range of topics from his eighth-grade adventures in China to pioneering the early virtual presence of credit unions via Callahan & Associates, as well as the innovation that he has cultivated via his current position at Student Choice.During our conversation, Scott discusses the origins of CU Student Choice, we explore the increasing importance of gap financing, and we talk about potential policy changes under the current administration and how CU Student Choice is positioning itself to support CUs through whatever comes next. Scott also gives us a behind-the-scenes look at OPAL, their newly launched $8 million loan origination platform that's changing the game for student lending.As we wrap up the episode, Scott gives us an inside look at his love for pinball machines, San Antonio, and a certain sci-fi novel from the '90s. Enjoy my conversation with Scott Patterson!Find the full show notes on cuinsight.com.Connect with Scott:Scott Patterson, President & CEO of CU Student Choicestudentchoice.orgScott: LinkedInCU Student Choice:: LinkedIn | Facebook | Instagram | XWant to learn more about CU Student Choice? Click here.

Send us a textIf I say a temp worker, probably you think of a fill in receptionist and that's true as far as it goes.  But talk with O2 Consulting Group and it's a plunge into a whole new world - especially impacting smaller credit unions, ones under perhaps $500 million in assets.  Where exactly does that CU find the talent to, say, implement an AI program? Just maybe a fractional e CTO - shared by two or more CUs - or a temporary exec is exactly the cure.Enter Bonnie Ortiz,  CEO of O2 and longtime COO at the Partnership Credit Union, She's worked inside at credit unions  - she knows the terrain - but now she also has assembled a team of seasoned credit union talents who are available for fractional and temporary roles at credit unions, to help solve anything from tech issues to compliance matters.It's a fact: credit union operations have become increasingly complex. The day of the shoebox credit union is long gone.  Real talent is needed but that talent may be too  costly for a smaller CU.  The O2 solution is  a potential lifesaver.Also on the show is David Martinez, CIO at $500 million  Arlington Federal Credit Union, a credit union that  has used O2 talent many times.  Martinez is a happy customer.He's also a past guest on this show. There a link in the show notes and the topic is about how mid sized CUs can survive, indeed thrive.Keep listening to this episode and Ortiz offers keen insights into the nuts and bolts of a credit union merger. She's looking at the issue with a COO's eyes: how exactly will this merger work? The concerns she raises are keen.  .  Any CU considering a merger - and who isn't? - needs to give this a close attention.Listen up.Like what you are hearing? Find out how you can help sponsor this podcast here. Very affordable sponsorship packages are available. Email rjmcgarvey@gmail.com  And like this podcast on whatever service you use to stream it. That matters.  Find out more about CU2.0 and the digital transformation of credit unions here. It's a journey every credit union needs to take. Pronto

Glen connects with Payfinia CUSO General Manager Keith Riddle and Star One Credit Union's EVP of Operations Minal Gupta about the newly minted CUSO aiming to streamline CUs' provision of instant payment services. Also, newly released FedNow data- plus reporting from the more mature RTP network- reveals some unexpected twists.   Links related to this episode:   Payfinia: https://tyfone.com/payfinia/ (or contact Keith Riddle: keith.riddle@tyfone.com) Star One Credit Union: https://www.starone.org/   FedNow volume statistics through September 2024: https://www.frbservices.org/resources/financial-services/fednow/quarterly-volume-value-stats Glen's 2023 article featuring Minal Gupta/Star One (as well as other early FedNow Adopters) in Credit Union Magazine: https://media.americascreditunions.org/articles/123351-real-time-relevance   Join us for our final CU Town Hall of 2024- Wednesday December 11 at 3pm ET/Noon PT- for a live and lively interactive conversation tackling the major issues facing CUs today. It's free to attend (credit union employees might even win a door prize!), but advance registration is required:  https://www.cutownhall.com/  Find us on BlueSky at @bigfintech, @jbfintech and @154Advisors Follow us on LinkedIn: https://www.linkedin.com/company/best-innovation-group/   https://www.linkedin.com/in/jbfintech/ https://www.linkedin.com/in/glensarvady/

Insightful conversations with three founders whose startups stood out at VentureTech: Joe Gracia of Pitch Competition winner Nickels/CardFit, Blesson Abraham of Aviary AI and Danial Jameel of Saris AI. Also, the Kelce brothers and Joe Montana unexpectedly find their way into the discussion.   Links related to this episode:   CardFit, the new offering from Nickels: https://nickels.us/acquire Saris AI: https://www.saris.ai/ Aviary AI: https://www.helloaviary.ai/ Our previous VentureTech episode, featuring interviews with Ribbon and Wysh: https://www.big-fintech.com/Media?p=good-ideas-good-investments Glen's blog recapping VentureTech highlights: https://www.big-fintech.com/Media?p=going-deep-hitting-the-gaps-at-venturetech VentureTech: https://myventuretech.com/   Join us for our final CU Town Hall of 2024- Wednesday December 11 at 3pm ET/Noon PT- for a live and lively interactive conversation tackling the major issues facing CUs today. It's free to attend (credit union employees might even win a door prize!), but advance registration is required:  https://www.cutownhall.com/  Find us on BlueSky at @bigfintech, @jbfintech and @154Advisors Follow us on LinkedIn: https://www.linkedin.com/company/best-innovation-group/   https://www.linkedin.com/in/jbfintech/ https://www.linkedin.com/in/glensarvady/

Continuing our annual tradition, John and Glen glide through a fintech wonderland with Anne Legg (Thrive Strategic Services) and John Janclaes (Nymbus CUSO), sharing thoughts on things they're thankful for across our collaborative community- from the expected (AI, the innovative spirit) to the counter-intuitive (fraud levels, fintech funding).      Links related to this episode:   THRIVE Strategic Services: https://www.anneleggthrive.com/ Nymbus CUSO: https://www.nymbus.com/cuso/ BIG's Innovation Club: https://www.big-fintech.com/Innovation-Club/Technology Open AI's Sam Altman discusses the prospects for Artificial General Intelligence (AGI) in 2025: https://www.youtube.com/watch?v=xXCBz_8hM9w After our podcast discussion of real time payments, the Fed issued its first data on FedNow volumes: https://www.frbservices.org/resources/financial-services/fednow/quarterly-volume-value-stats   Join us for the next CU Town Hall on Wednesday December 11 at 3pm ET/Noon PT for a live and lively interactive conversation tackling the major issues facing CUs today. It's free to attend (credit union employees might even win a door prize!), but advance registration is required:  https://www.cutownhall.com/  Find us on X at @bigfintech, @jbfintech and @154Advisors You can also follow us on LinkedIn: https://www.linkedin.com/company/best-innovation-group/   https://www.linkedin.com/in/jbfintech/ https://www.linkedin.com/in/glensarvady/

"You never know where a podcast can lead you." Reena Friedman Watts welcomes Dick Frost, the host of the "On the Throne" podcast, to the Better Call Daddy Show. Dick, a dedicated father and industry professional, shares his journey from the oil and gas sector to becoming a podcast host. Discover how his experiences in the blue-collar world have shaped his views on family, work, and personal growth. From the challenges of balancing a demanding career with fatherhood to the unexpected twists of podcasting, Dick's story is a testament to resilience and adaptability. He opens up about the evolution of his podcast, expanding from oil and gas topics to include diverse stories from the trades and beyond. Dick also shares his insights on the changing dynamics of the industry, the integration of technology, and the importance of maintaining strong family ties. Join Reena and Dick for an engaging conversation that highlights the significance of storytelling, the power of connection, and the value of learning from one another. This episode is a reminder that life is a series of unexpected moments, and sometimes the best stories are the ones we least expect. (00:00) Each week I interview a guest, share the stories with my dad (03:50) You first started out interviewing oil and gas workers, then you pivoted (07:44) I miss a lot of things when I'm away from home, right (11:20) I try not to miss important things, right? Like, with birthdays (12:50) How did you get involved in the industry? Is it in your family (16:25) I'm curious how has the industry changed from the time you were 18 (18:04) You talk about cheating and the drugs and stuff. You said that that is common, right? (19:46) You make a segment called the morning dookie for your podcast (24:29) If you want to know how things work, oil and gas shows would be huge (26:40) Robotization in oil and gas is actually adding jobs, right (29:52) Cus says he always wanted kids, but had trouble conceiving (33:41) A girl needs her dad. Right. So I hope that you get that with your daughters (35:29) Better Call Daddy is a podcast that helps fathers connect with their daughters Connect with Dick Frost: - TikTok: On the Throne Podcast - YouTube: @DickFrost - Listen on: Amazon, Spotify, Apple, Good Pods Connect with Reena Friedman Watts: - Website: bettercalldaddy.com - LinkedIn: Reena Friedman Watts - Twitter: @reenareena - Instagram: @Reena Friedman Watts - Instagram Podcast: @bettercalldaddypodcast We love hearing your feedback. Leave us a review, share your thoughts, and spread the word about this enriching episode. Share it with someone who values community, generosity, and the power of storytelling.

Dr. Julie Brauer // #GeriOnICE // www.ptonice.com  In today's episode of the PT on ICE Daily Show, join Modern Management of the Older Adult lead faculty Julie Brauer discusses important tools for acute care PTs: a good attitude, a backpack, a white board, resistance bands, sticky notes, and gait belts. Take a listen to learn how to better serve this population of patients & athletes, or check out the full show notes on our blog at www.ptonice.com/blog. If you're looking to learn more about live courses designed to better serve older adults in physical therapy or our online physical therapy courses, check our entire list of continuing education courses for physical therapy including our physical therapy certifications by checking out our website. Don't forget about all of our FREE eBooks, prebuilt workshops, free CEUs, and other physical therapy continuing education on our Resources tab. EPISODE TRANSCRIPTION JULIE BRAUER Good morning crew. Welcome to the PT on Ice daily show. My name is Julie. I am a member of the older adult division. and I am coming to you live from my garage. So this morning what we are going to dive into are fitness forward tools that you can use in acute care and I'm going to do my best to demonstrate some of these tools that you can use to start loading these really sick folks up early. All right so We are going to dive in first by talking about the most important tools that you need to have with you as you go through the hospital and you go visit your patients in their rooms. TOOL #1 - THE RIGHT ATTITUDE So number one, the most important tool that you need is the right attitude. You have to have the right attitude about this. So let me unpack that. Bringing fitness forward care to sick older adults in the hospital. It is not about getting them to do a sexy deadlift with a dumbbell. It's not the sexy thing. It is not, holy crap, I just got this patient, they're in a hospital gown, they're super sick, and they're doing a deadlift with a dumbbell in the hospital. It's not about that. It's not about being able to get the video of that or the picture of that and being able to share that. That is sexy and that is cool and it is badass. However, the meaning is deeper. What the attitude you need to have is, is that you have this beautiful, amazing opportunity to plant a fitness forward seed in this patient who is sick, who has a ton of medical complexity, and you only get to see them potentially one time. You've got one shot to plant that seed and potentially be the catalyst that sets this person up on a better trajectory of health. That's an amazing opportunity. And I would encourage you all to be obsessed with that opportunity. Okay. Every single time I would go into a room, I thought, wow, I have this opportunity. I've got one shot. I could be the catalyst that changes their lives. And the thing about you all who work in acute care, man, you are doing some dirty work, right? You are seeing folks, whether they're young or old, they have multiple types of diagnoses and medical complexities. You are seeing them at their worst and you are seeing them in a very, very vulnerable situation. The fact that you are able to plant that seed yet you don't get to see the sexy outcome and yet you give them your whole heart and whole soul is so important. And it's hard to be in acute care and know that you're not going to get to see a sexy discharge where a patient is lifting a super heavy barbell or they are going all out on an assault bike. You're not going to see that. And that's tough, but you have to reframe it to be, I'm going to be obsessed with having the attitude that I could go into every single one of these rooms, plant the seed, and the patient is able to walk into an outpatient clinic. They want to do fitness-forward care because I planted that seed. And I think that's an incredibly, incredibly important story to tell yourselves so that you can continue to have the motivation to go in and see these folks who are sick day after day. And many times you may not actually get to get them to do the cool fitness board stuff. Okay. So that's the most important thing is having that right attitude. Okay. TOOL #2 - A BACKPACK So the second tool that you're gonna need to bring along with you to every single room is a backpack, all right? You absolutely need a backpack. So this is not the backpack I used in acute care. I used the backpack that they gave us as like a Christmas gift one year. This is a Nomadic. This is my travel backpack. This is a very sturdy, but very expensive and nice backpack. I do not recommend getting something like this to go into hospital rooms, okay? But I do recommend that you get something that's sturdy because you're going to be carrying around a lot of stuff in it. So get yourself the backpack. So what are we putting in the backpack? You're going to put weights in the backpack. No, most acute care therapy offices do not have weights. But you can bring your own. So I would bring a 15 pound dumbbell. and an eight-pound dumbbell, and I would put that in my backpack. Now, some of you are not able to bring a backpack potentially into the patient's room. Cool, then you bring it around and you leave it at the nurse's desk, okay? But the idea here is that you're bringing everything with you so that there is no excuse that you don't have the equipment because you're in the hospital. So you have your weights. Now, I've had people say, well, Julie, isn't that tough to carry around? And I say, yes, it is tough, it's heavy, but who else would want to be able to go rucking through the hospital with weights more than fitness-forward clinicians who are here listening this morning? I thought it was awesome. I felt like I was getting a lot of fitness in by carrying this stuff around throughout the hospital all day. TOOL #3 - THE WHITEBOARD Okay, so after weights, you're gonna have a whiteboard, okay? I'm using a whiteboard right now for my talking notes for this podcast. you all are going to want to use a whiteboard to create workouts with your patient. So have your dry erase markers and as you are digging into their meaningful goals and you're coming up with functional movements that match those meaningful goals, you are writing this stuff down, you are coming up with reps and sets, you are doing this with your patient. Now, I will say, you're not going to buy these and leave these in patient's rooms, right? This stays with you, okay? You can take a picture of this and give it to your patient, or the really cool thing about acute care is that they typically have whiteboards in the patient's rooms, and they're usually filled with some random information many times they are covered up with Call don't fall signs Those become great whiteboards. Okay, so I usually they're not helpful We all can can agree that call don't fall signs are not something that prevents somebody from falling. So I they're great whiteboards so I would take those down turn them around and with my dry erase markers cut right down the whiteboard on those signs then I would leave that in the patient's room maybe I would go find a couple extras and I would put some motivational phrases on there like uh i remember one very specifically i'm trying to kick covid's ass so i can get home in shopwood something like that or something that lets the providers know a little bit more about this patient their name is something that i always put on these signs their name and something about them a goal an interesting fact i want to try and have every provider who walks into the room treat this person a little bit more like a human than a number or a diagnosis and that's a way to do that so whiteboard, slash use the hospital whiteboards, use those signs that are all around the room, turn them over, use those as your whiteboard. TOOL #4 - RESISTANCE BANDS Okay, next, resistance band and TheraBands. Okay, so both. So resistance band is something like this, okay? These offer a lot more resistance than a TheraBand. However, I usually would bring a bag of theravans because i want to be able to leave some with patience right you can do endless things with the TheraBands. I would tie them to the bed rails many times. So even folks who are typically they're just lying supine majority of the day because they're so deconditioned, you can tie those around on the bed rails. They can pull from above, they can pull from the side, there's a lot of stuff you can do with them just tying them to the bed rails. with the resistance bands, this is where I would many times get people up into standing and I would do something like a paloff press. So if they're standing here and this is attached to the bed rail, I can have them do a paloff press to work some core. I can have them do some rotations, you can do rows, you can do a whole bunch of stuff with those resistance bands, but those come with me. I'm not leaving those in the room. TOOL #5 - STICKY NOTES Okay, next are sticky notes. Okay, sticky notes are amazing because they're versatile. So I have sticky notes and then even better than sticky notes, I have a really bright, uh, note card. And then I've also used paint swatches that you can get for free at Lowe's or Home Depot. Okay. So what I do with sticky notes or these things, they become targets, right? So if I'm gonna have folks be reaching for things or stepping to things and maybe I'm calling out colors or I will write on a sticky note a number and then they're not only doing a motor task, they're also doing a cognitive dual task perhaps, These are great tools. They're light, they're easy, they're cheap. The other thing I like with the sticky notes is I'd like to put little notes on them for people. So if I'm using targets with a sticky note, perhaps to show them exactly where I want them to do their deadlift, pick the weight up from and put it down on, I will put a note here that just says like, you're a badass or never give up or something like that. And then that's something that the patient can keep. So they're wonderful for targets. They are wonderful to do some dual tasking. So you can have people reach for yellow or reach for a number that is written on one of the colors. So you can yell out the color or the number. Very versatile tools, very easy to carry around with you. TOOL #6 - GAIT BELTS All right, and then also obviously a gait belt. You need to have a gait belt. obvious reasons for safety but also i have used a gait belt before and i have put it around the bed rail and okay i have never ripped a bed rail off of anything by putting the gait belt around it and tugging on it okay so i'll just say that are they the most sturdy things in the world no i've never ripped one off so that's my preface there. But I have looped this around the bed rail and then perhaps someone is sitting in a wheelchair and they have a really hard time just sitting up tall in their wheelchair, their core is very weak, I will do almost a modified rope climb where the gait belt is around the bed rail and they are pulling themselves up to sit tall, and then going back to the back of their seat, the back of their wheelchair, and then pulling themselves up to sit tall. I've done this in home health, where I looped this to the end of the bed, the bed frame, what am I calling it, footboard. But typically, in acute care, there really isn't a big enough space in those footboards, maybe some of them, but definitely a really cool tool to use to do unmodified rope climb really get that core activated for someone who is so weak that they barely can even sit tall in their wheelchair. TOOL #7 - SNACKS Okay and then lastly You need snacks, okay? Don't forget your snacks. I became so much more efficient and so much more productive when I started bringing food up on the floor with me and putting that in my backpack. So, get you some nuts, get you a bar, a little bit of healthy sugars, maybe some, I always had like clementines or mandarins, those were one of my favorite snacks. Make sure that you have some fuel so you are not having to really put a big stop in the middle of your day. You're not going down to the cafeteria, getting crappy cafeteria food, and it just kind of keeps you focused. When you take that break and go down to get a snack or a coffee, I think it just puts you in that mindset of like, I'm going to just chill and not work as hard. When you just keep hammering throughout your day and you're able to do that because you have fuel, it's really important. Okay, so that is what I put in my backpack. All right, so let's talk about some specific acute care hacks to load up your patients when you don't use the weights. Okay, so let's throw the weights out. My favorite hack, one of them, is to use towels. All right, now this is a towel that I have soaked in water. All right, because a soaked up towel is really heavy compared to a towel that's not soaked in water. So I will roll a towel up and I will put it in the toiletry buckets that are in every single patient's room. So usually these buckets come with soaps and little doodads, things like that. I just get rid of that and I soak up towels and I put them in the basin. Now, you can do a whole bunch of stuff with this. So for someone even in sitting, even having to hold on to this basin, can be very challenging. We can increase the difficulty by going overhead. We can increase the difficulty by doing some marching in sitting. We can do a deadlift from sitting. We can then get up into standing and we can do a deadlift as well. So the great thing about this is it's a great way to introduce the hinge to a patient who is post-op lumbar fusion. Yes, I am loading up someone who is post-op lumbar fusion day one. Why? Because they're going to be discharged. They were probably never taught how to do a hinge in the first place, which contributed to them ending up having surgery. and I want to be the person to break that cycle, right? They're gonna go home, they gotta empty the dishwasher, lift up Fluffy's kitty litter box, whatever it is, why not teach them here and now? So I will put the towel in the basin, and then I will teach them how to properly hinge with an elevated surface in the basin. So I'm teaching them a hinge pattern, loading it up a little bit so that they know how to properly hinge when they go home, okay? And less amounts of things you can do with that basin. The next piece of equipment that I love are your bedside commode buckets. Yes, the things that poop usually goes in. But this is not what we're using them for. We are using clean bedside commode buckets, okay? So the cool thing, buckets, they usually have a handle, okay? So it makes it a lot easier to hold on to than potentially the basin. So what I will do is I will put a bunch of crap in the bucket. So I will put my weights in there or I will go and get a bunch of ankle weights because typically therapy departments and acute care have ankle weights, put them in the bucket and now we got some load. So you can do the same thing. You can deadlift with the bucket, okay? you could do my favorite, which are carries. Okay, so loaded carries. So as you're walking with your patient, they could carry on to the bucket. And the cool thing is that it adds a little bit of a perturbation. Okay, so they're getting an internal perturbation just by holding on to an object. There's a truck coming by, I'm sorry. I am out in my garage. and there is destruction going on in my neighborhood. And it's disruptive. So I'm gonna wait until they go by. Okay, they're hanging out. I'm just gonna talk louder. Okay, so with the bucket, Come on, my friends, keep it moving, keep it moving. Don't say no on a live podcast. Okay, with the bucket, what you can do is if someone is non-ambulatory, they can hold on to the bed rail and they can go like this, back and forth with that bedside commode bucket full of equipment and full of weights, okay? They could hold on to it, hold on to the bed rail and march, just like this. They can swing that bucket forward and backwards. There's a lot of things you can do with the bedside commode buckets to add in a little bit of a perturbation. Okay, lastly, we'll talk a little bit about how to put all this stuff together. So when you are with your whiteboard, right? And you're talking and you're sitting with your patient and you're figuring what movements that you're going to do. This is where you can start introducing what an EMOM is every minute on the minute. You could start introducing what a rounds for time is. So very, very early on, typically patients don't hear about this stuff or feel what intensity is like or load until they're way into their journey and they go into outpatient potentially, right? So the amazing thing is that you get to start introducing them to what a workout is like this early on. Imagine that seed that you've planted, then your patient will understand what it's like to lift heavy and to work hard. They go to home health or they go to inpatient rehab and then they go to outpatient and they're able to advocate for themselves and understand, okay, This is too easy. I don't need that yellow TheraBand or I'm not working hard enough. This isn't challenging enough for me. You are able to give them that opportunity, which is absolutely amazing. And remember, you can be the one that has an impact on them. Farther down the road, you are not going to see that sexy discharge, but you were able to be the catalyst to spark some change. Okay. All right, my friends, that is all. The next time I come on here, I will actually show you an example of like an EMOM or a rounds for time, some examples of what I would actually do with patients in acute care. I will also, on the ice stories, I will post some of my reels I made back when I was in acute care, going back into the archives. I will post on our story my reels that show some of this stuff in action. Lastly, talking about our courses that are coming up. MMOA Live will be in Alabama, we will be in Minnesota, Wyoming, and Oregon for the rest, not the rest of September, we're not in September yet, but in September, so many opportunities to catch us live on the road. Alright everyone, have a wonderful rest of your Wednesday. OUTRO Hey, thanks for tuning in to the PT on Ice daily show. If you enjoyed this content, head on over to iTunes and leave us a review, and be sure to check us out on Facebook and Instagram at the Institute of Clinical Excellence. If you're interested in getting plugged into more ice content on a weekly basis while earning CUs from home, check out our virtual ice online mentorship program at ptonice.com. While you're there, sign up for our Hump Day Hustling newsletter for a free email every Wednesday morning with our top five research articles and social media posts that we think are worth reading. Head over to ptonice.com and scroll to the bottom of the page to sign up.

Dr. Justin Dunaway // #ClinicalTuesday // www.ptonice.com  In today's episode of the PT on ICE Daily Show, Spine Division lead faculty Justin Dunaway takes a deep dive into a series of three studies tracking the same cohort of patients over 10 years and what they say about the importance of short term changes! Take a listen to the episode or check out the full show notes on our blog at www.ptonice.com/blog. If you're looking to learn more about our Persistent Pain Management course or our online physical therapy courses, check our entire list of continuing education courses for physical therapy including our physical therapy certifications by checking out our website. Don't forget about all of our FREE eBooks, prebuilt workshops, free CEUs, and other physical therapy continuing education on our Resources tab. EPISODE TRANSCRIPTION JUSTIN DUNAWAYAll right, team, good morning. I am Justin Dunaway, lead faculty with the Institute of Clinical Excellence, coming at you live from Portland, Oregon. Welcome to another Clinical Tuesday. I am lead faculty for Total Spine Thrust and also our Persistent Pain Comprehensive Management course. 32nd cohort just began yesterday. So if you're thinking about jumping in that will the registration will remain open for another day or so So if you're thinking about it, go ahead and take a look But enough about that. Let's get into today's topic today we're gonna talk about full thickness a traumatic rotator cuff tears and looking at physical therapy or Surgery and what what kind of predicts that stuff? and it's really cool because it's a series of three studies over a decade that looked at the same same kind of cohort of humans and And while I'm going to talk a bunch about these three studies, realize that this really is more than a story about rehab for rotator cuff tears. This is really a story about the importance of our ability to demonstrate within session and between session change, early, often, and frequently. And at Ice, we often hear that we are obsessed with incessant change. We are obsessed with our ability to show short-term changes. And I couldn't agree with that sentence more. Like, totally. I am absolutely obsessed with that. The second half of that, though, which I don't agree with, is that short-term change, within-session change, those things don't matter. What we're really talking about is regression of mean or natural history. And short-term change doesn't predict long-term change. And I couldn't disagree with those sentences more on lots of different levels. But I think that the story I'm about to tell, the three studies that we're about to walk through, give some of the best evidence and support for the need for short-term and within-session change, for at least one of the many reasons why this stuff is so important. So let's dive in. First study, study number one, the effectiveness of physical therapy in treating atraumatic full-thickness rotator cuff tears, multi-center prospective cohort study by Kuhn and Dunn, 2013. Mouthful. But basically what they did is they took a whole bunch of humans, 452 of them, that had full-thickness chronic degenerative rotator cuff tears, and all of them got six weeks of physical therapy. And then at the end of the six weeks, they were asked, you know, how are you doing? And they got one of three options. They could stay cured, in which case they were done, and we'll just check in at 12 weeks, and then at a couple time points over the next two years, or they're improved, in which case they would get another six weeks of physical therapy, or no better, and then they could opt for surgery. And then at the 12-week mark, the people that were left, that weren't cured in the first six, asked them the same question. If they were cured, awesome. If they were anything but cured, they were offered surgery, and then tracked over the next two years. The physical therapy protocol, I couldn't get my hands on the full version of Appendix A that went into detail about what they actually did, but in the study, in the methodology they just talked about doing the physical therapy was range of motion, was postural control, was scapular training, was mobilizations, was general strength training stuff. And I've got some thoughts on that and we'll dive into here in just a second. But the outcome here is what they found is that less than 25%, okay, full thickness chronic degenerative rotator cuff tears, less than 25% of the 452 people in the trial at the end of the 12 weeks needed surgery. At the six week mark, only 6% of people opted for surgery. At the 12 week mark, that number was up to 15. And then over the next two years, a few more trickled in and that went up to like 24%. So at gut shot, 75% of people with full thickness rotator cuff tears went on to have excellent results in pain, disability, range of motion, strength, functional stuff, and went totally back to life. That's awesome. That's huge, right? The second piece The thing I want to think about here, though, is I think that number could be a bit better, right? I'm going to make an assumption that once we dive into the exercise protocols there, were they really doing strength stuff? Were they really looking at multi-joint movements, overhead presses, rows, pushes, horizontal presses, things like that, and dosing them appropriately for strength? you know, thinking about low or high sets, low reps, two to three minute rest at roughly 80% of their calculated one rep max, or are they doing like three sets of 15 with a band? And call it strength. I have no idea. My assumption is that we probably could be a bit more aggressive with exercise, and I bet that number could get a bit better. But 75% is awesome. So let's run with that. And the conclusion of this first study, which is super important, That if I'm just gonna read the quote if a patient avoids surgery in the first 12 weeks He or she is unlikely to undergo surgery at a later time point up to 12 up to two years So this is the first point here if the patient doesn't opt for surgery in the first 12 weeks They're probably not going to get surgery so our ability to to show them functional improvements in the first six, in the first 12 weeks, is absolutely huge. Because if they don't feel like they need surgery at the end of the 12 weeks, they're not going to get it probably ever. And when we think about conservative management versus surgery, both these things can be effective. But there is massive risk to surgery, right? There's massive financial risk. It's super expensive. And then thinking about the risks of anesthesia, of something going wrong during the surgery, of infection, of interactions, adverse events with the medications, opioid addiction. All of these things are risks of surgery that don't exist in conservative management. Okay, so that's the first study. If you don't opt for surgery in the first 12 weeks, it's unlikely that you're going to. 75% of humans got totally back to life without needing surgery. Study number two, predictors of failure of non-operative treatment of chronic symptomatic full thickness rotator cuff tears. Same research team. This was published in 2016. Again, looking at the same cohort of 452 individuals, This time what they wanted to see is, okay, 25% of you failed conservative management, failed physical therapy. Why? Is there anything in there? Is there anything about you that predicts whether you will or won't do well with physical therapy? And this was really cool. So they looked at all the patient demographics. They looked at age, they looked at sex, they looked at pain, severity of the tear, disability, chronicity, activity levels. They looked at work status and education and handedness and really everything under the sun. And what they found, the first thing they found is that structural factors were not predictive at all. Tear didn't matter, pain didn't matter, disability didn't matter, what your MRI didn't look like. None of that stuff predicted whether you needed surgery or not. The number one most powerful and really only significant predictor of whether you went on to need surgery or not for your full thickness rotator cuff tear was belief that physical therapy wouldn't help you. That was it. If you believe physical therapy would help you, you succeeded, you didn't need surgery. If you didn't believe that, then you opted out and went for surgery. And then smoking status moved the needle just a little bit, which makes sense. If you're smoking, your body is widely inflamed. Things heal slower. Your pain systems are far more sensitive. And then the other thing that was a very small predictor was activity levels. If you had higher activity levels, you were slightly more likely to opt for surgery early. And that makes sense too, right? My shoulder hurts. I can't do all the things I want to do. I'm still trying to do them. Things aren't getting better quick enough. Give me the magic bullet. The important thing here, again, one, structure was not predictive. Two, the only real strong predictor was your belief in physical therapy. Now, this is where it gets interesting, right? If that is the thing that determines whether you get surgery in the first six to 12 weeks, or that's the thing that determines whether you get surgery, and most humans are gonna make that decision within the first six to 12 weeks, you cannot make the argument that within session change and short term changes don't matter and probably aren't the most important thing there is, right? Because I cannot, if the thing that determines whether you need surgery or not, whether you get into that MRI tube, whether you get in the OR suite, whether you're getting those injections, pills, things like that, is your belief that physical therapy can help you, I cannot think of a more powerful way to foster that relief than having some tools in my toolbox that when you walk in the door, very quickly, I can modulate your pain, I can change your pain, your pain pressure threshold, turn on painfully inhibited muscles, gain some access to proprioception, and then get out into the gym and do some things that actually build capacity in humans, and demonstrate that thing within session, and then session after session after session. Short-term change and within-session change are the things that get patients to believe in physical therapy. And belief in physical therapy is the thing that keeps the patient out of the OR. Simple as that. That is the most important tool we have to foster those beliefs. Okay, study number three. This one just came out like last month. The predictors of surgery for symptomatic, atraumatic, full thickness rotator cuff tears change over time. Same research team, again, looking at these same humans that were in this study. Now this is tracking them down 10 years later. The first thing that pops out is that at the 10 year mark, only 27% of these people went on to get surgery. So you think about that, at the two-year mark, it was around 24%. So just a few more people kicked into the surgery over the next two, between two years, year two and year 10. Most of them, over half, opted for surgery before the six-month mark, and then the rest of them slowly trickled in over the next 10 years, with it kind of being less and less each year down the road. At the six-month mark, And everything prior to that, the most predictive thing, again, whether you need surgery or not, was belief in physical therapy and nothing else, right? So those beliefs are gonna be powerful all the way up to the six month mark. Everything we can do in that window to convince patients. that this is the path they need is gonna be the thing that keeps them off the other path. Beyond six months, it doesn't switch to structure, it doesn't switch to pain and disability and any of that stuff. The only two predictors beyond six months were if you were on worker's comp, and again, if you reported high levels of activity. Now this is super important too, right? Because okay, we're six months, we're a year, we're two years, we're five years out. We've done physical therapy, it didn't work, we've kind of forgot about it, that's off the table. And now, the stuff that's really bugging us is the fact that, okay, we're still having trouble at work, we're on workers' comp, we're kind of in that system, we still have all these activities that we want to do that we can't do the way we want to do them, now it's time to do something else. It's important to realize that overall, at the 10-year mark, 70-ish percent of humans, again, didn't need the surgery. And this is an interesting bullet point, too, because one of the things that you'll frequently hear is that, great, people do well with conservative management for rotator cuff tears. But if you don't repair it anyway, you set the patient up for degenerative changes, arthritis, problems down the road. What this study showed us is that the 10-year mark, the 70% of humans that did well with conservative management 10 years ago in that six to 12-week PT window, All of them were successful. And the success that they gained 10 years ago didn't decline over time. They didn't have more disability. They didn't have increased pain or arthritis or things like that. Their gains stuck. And this is one of a few studies that look at conservative management for rotator cuff tears, track them out over long periods of time, and show that there is no negative mechanical effects from not repairing that thing. So, the important stuff here, the key clinical factors here, is that team, at the end of the day, beliefs and expectations are the foundation. They're everything. They're the thing that drive the decisions that patients make, right? And if we don't have the ability to demonstrate change to our patient, if we don't have the ability to show them, not just tell them, But show them time and time again, ruthlessly, within session and between sessions, slowly building up functional outcomes, session after session after session, they're not going to buy this. And if they don't believe in what they're doing, if they don't believe in physical therapy, if they don't think that this is the thing, that's the stuff that determines, OK, am I going to get shots? Am I going to be taking pain medications? Am I going to end up in the OR suite? We need, what this research tells me is that we really need to drill down on our ability to have tools in the toolbox that create quick, transient changes in pain, range of motion, muscle activation. And I get that that's transient, but what we're doing is we're open a window. And then once that window is open, we absolutely have to jump through it, get right into the gym and start doing the large functional movements that build capacity in humans. And then be ruthless about your comparable measures, your functional stuff between sessions and your objective stuff within sessions. and make sure that multiple times every session, you're showing patients change. In every session, when they walk in the door, you can show them change over time. This is where you started. This is where we were after the first week. This is where we were after the second week. The better we get at that, the better we get at demonstrating change in the moment and showing them incremental change over time in the short term, the better our odds of keeping these patients out of the surgical suite. If the only thing that separates these two groups, physical therapy or going under the knife, is their belief in the power of what we're doing in the clinic, then we have to invest everything we have in our ability to demonstrate those changes. All right, team, hope you're half as excited about these three studies as I am. I think it's a really cool thing to look at and then track these patients over the last 10 years. If you got any questions, throw them in the chat. Have an awesome day in the clinic, and I look forward to seeing you out there. OUTROHey, thanks for tuning in to the PT on Ice daily show. If you enjoyed this content, head on over to iTunes and leave us a review and be sure to check us out on Facebook and Instagram at the Institute of Clinical Excellence. If you're interested in getting plugged into more ice content on a weekly basis while earning CUs from home, check out our virtual ice online mentorship program at ptonice.com. While you're there, sign up for our Hump Day Hustling newsletter for a free email every Wednesday morning with our top five research articles and social media posts that we think are worth reading. Head over to ptonice.com and scroll to the bottom of the page to sign up.

Dr. Cody Gingerich // #ClinicalTuesday // www.ptonice.com  In today's episode of the PT on ICE Daily Show, Extremity Division lead faculty member Cody Gingerich discusses how to know when to challenge or change movement patterns vs. when to be ok with more freedom of movement Take a listen to the episode or check out the full show notes on our blog at www.ptonice.com/blog. If you're looking to learn more about our Extremity Management course or our online physical therapy courses, check our entire list of continuing education courses for physical therapy including our physical therapy certifications by checking out our website. Don't forget about all of our FREE eBooks, prebuilt workshops, free CEUs, and other physical therapy continuing education on our Resources tab. EPISODE TRANSCRIPTION CODY GINGERICHGood morning PT on ICE Daily Show. My name is Cody Gingerich. I'm one of the lead faculty with the extremity division and I'm jumping on here today to talk about when to be picky about movement. So, The last several years in PT, there has been kind of this shift in differing opinions on how specific do we need to correct every tiny little movement fault that we see in people, all the way to like, hey, however they move, this is just kind of how this person moves and we can just get strong in whatever positions that they feel comfortable with. And so I want to talk about a little bit of the like, finding that middle ground and there's a time when yes, we need to just let somebody potentially move how their body is going to naturally move versus also, hey, that moving pattern doesn't look good, isn't efficient, could be leading to the injury that they're dealing with and how should we and when should we correct that? So the old adage kind of, uh, that I like to use in that like thought process is it doesn't matter until it does, which is basically saying nothing other than, um, there are gonna be points in time where you have to understand that person moving in front of you and understand where their pain is coming from and then is that movement pattern the problem for their pain, okay? And so the number one thing is that there is no way without any context behind the person in front of you. Like if you just see a video of somebody that you have never met and you watch them move and you say, oh yeah, we need to correct that, that would be not a time where you can fully say that. Okay. And so I would encourage you to, to kind of get rid of that out of your brain of like, if you don't have any context behind that person moving and you just think, well, that movement pattern is incorrect and we would definitely need to fix that. I would argue that that wouldn't be the correct mindset going into that. However, if you have that same person and you see their movement pattern and you understand the sport or the activity that they're doing, and potentially if they are dealing with pain, then all of a sudden we can have that conversation of, is that movement pattern creating some of the issues? Are we putting undue stress on different tissues because of the way that they're moving? Okay, and so a couple examples of this, a lot of times this is going to be if we talk about patient population. If we're dealing with someone who is an older adult and they have a very low movement standard already, like they have not really done much moving and they are generally deconditioned and just need to create any type of strength adaptation as possible. Of course we want to teach them how to hip hinge and teach them how to squat and do some of that, but does it need to be the cleanest, prettiest squat or hinge that you've ever seen? Arguably no. Okay, right now we need to just get all of their muscles moving together in whatever capacity they can in order to just start that strength training process, change their their homeostasis change their overall body structure so that they can move one thing to another. Okay. And so with that population, I would say, go more on the air of how they're moving is not quite as important as what they're doing and what they're moving. Okay. Of course, changing from a squat to a hinge or whatever pattern you're wanting to look at a lunge, a step up those type of things. But if their knee shifts a little bit one way or the other, or they have a bit of like a hip shift when they're squatting, or it's not the prettiest hand you've ever seen, like their chest isn't quite upright, like all of those things, you want to try and work towards them, but you don't want to limit their ability to do that movement because it doesn't look perfect. Additionally, if you're dealing then, if we flip the coin and we talk about more high level athletes, If we talk about high level athletes and you are just watching them move and don't have any context yet, and you see them and they say like, potentially this is like top of the top, right? They have potentially created adaptations and movement standards and movement positions that create the proper adaptation for whatever sport they are doing. So if you think more unilateral sports, I've been watching the Olympics the last couple weeks, right? There are some incredible, incredible athletes. Those people are not going to be symmetrical. So if you think about a shot put thrower, like those people are incredible. Both men and women like throwing those weights incredible distances. They are not doing that on both sides. So they're going to naturally have one of their their push off leg and they're throwing arm is going to be stronger. And so when they do then bilateral movements, there is a chance that that might not look exactly the same every time. But if they are not dealing with any pain or discomfort, then maybe that's not really a big deal at all. And that's actually helpful for them. When we want to start looking at actually diving into some of those, like, hey, we need to really adjust how you're moving and pay really close attention is going to be when A, either that same athlete that I just talked about is dealing with pain and it's more of a unilateral thing, or B, if potentially the way they're moving is inefficient for the sport that they're doing, right? So sometimes when we think about, especially our fitness athletes, When the clock is going, their body just says, hey, I need to get from point A to point B as fast as possible. And a lot of times, as fast as possible does not necessarily mean as efficient as possible, and they end up overloading one joint, one muscle, something, because that is the way their body has just started to adapt, because there is a weakness lying somewhere. Okay, so then in those moments when there is actually pain involved, that's when without that context, you're not going to have any idea. But with context, we can start teasing out, are there weak points? Are there mobility deficits? Are there different reasons why they're moving in these poor movement patterns? Okay. And so a lot of times that's where just a poor movement pattern, but if you end up looking at it and say, well, everything is moving or everything is strength wise, pretty equal. Their mobility is pretty equal. Now we're dealing with something a little bit differently, but if there is a weakness leading to a movement restriction or a mobility leading to a odd movement pattern that ends up overloading those tissues, Now we need to start looking at, well, we need to potentially strengthen that area of weakness or improve that area of mobility. And then that freedom of movement can increase. And now we have a little bit less stress taken off of the tissue that's irritated and the other potential tissues can take up some slack as we build them up. So as opposed, this is kind of going backwards again. So in our heads, when we're watching movement patterns, think more so, is this something where we are creating an overload of a tissue that is unnecessary and creating pain? And what is weak that is trying to make that happen? And sometimes the weakness area can be the thing that's irritated or sometimes you could actually have that stronger side or stronger tissue area be the thing that is just constantly being used repetitively, repetitively, repetitively. So with the example of our fitness athletes, think one of those athletes that does, if they're doing burpees and they do like to do step back or step up burpees and they like one side over the other, okay? A lot of times that is not a problem at all. And they just continue to build some strength there and they might have side to side issues. But then all of a sudden, if that starts to show up in their squat and they have a big shift when they're trying to get out of the hole, that is now their body trying to utilize that stronger side to do a lot of that work. And it's going to start showing up in other areas over time. And then if they develop pain along that whole route, these is the context that you want with movement patterns. Now, all of a sudden, we need to build up that strength at the other side, maybe clue them into, hey, when you're doing burpees, I need you to alternate legs every single time so you're not just repeatedly lunging on one side or the other. Okay. And so at that moment, now we are adjusting movement patterns and then working on their squat patterns. So it might, we might need to say, okay, we need a pause and we need to make sure that when we drive out of that hole, we aren't getting any type of shifting this side to side, and we're not overloading that one hip or that one quad that you feel dominant in. Okay? So that's where, with this, when does it matter versus when does it not? Okay? When we're talking about our lower level athletes, people who have not necessarily moved in a long time, those first six months potentially, of course we're building into, like, we want to still coach good movement patterns, but don't limit their ability to move weight and get stronger just because it isn't exactly perfectly correct. Still allow them, still you're always fighting for good movement patterns, but keep letting them build some strength just as they're naturally growing. And then as that starts to build up, now we can hone in on some of those nuances. As an elite athlete, if they potentially need those differences in movement patterns, but in the absence of any type of pain, or anything like that, don't just automatically assume they need to really change how they're moving or that asymmetry in their squat or their deadlift or something like that is a problem. It might be an adaptation that they literally need. When we need to start changing and looking a little bit more closely and honing in on very specific movement patterns, think more so if pain comes on board, with any of those movement patterns or you notice a big mobility deficit or a big strength deficit that causes that shift or that change in movement pattern and if you can then either coach that out or change their strength or mobility, that's then when we can start teasing out some of these nuances in movement. In the extremity course, we talk a lot about extrinsic versus intrinsic cueing. Our extrinsic meaning not saying, hey, squeeze your lats, squeeze your glutes. Those are more intrinsic things that people think about. But instead, it's like, hey, I want you to drive your head through the ceiling. Okay, so doing something like that, I want you to punch that bar through the ceiling, or I want you to drive, like break a board under your feet when you're standing up out of the squat, something like that, where you're going extrinsic cueing. And that's gonna be more so, can you cue some of these movement patterns out? If we notice more of that weakness or a mobility type of deficit, that's when we need to really hone in on, are we really thinking about moving in the right patterns and using the correct tissues and muscles that we want? And can we get a little bit more specific? If you're noticing, hey, that lateral hip is a little bit weak or their quad is a little bit weak, Now, all of a sudden, if you're doing more specific movement patterns, you can start thinking, hey, I really need your brain at your quad and you can like tap the quad, you can have some kind of stimulus at the quad, I really need your brain focusing in on this quad. And that's where at the out of the bottom of that squat, I need you squeezing that really, really hard. or I really need you thinking like that muscle that we just got burning from a leg lifter or doing the side steps like that's that area in your hip that I really need you honed in on. And that's going to create some of those movement pattern shifts as well. So utilize both our extrinsic coaching and or intrinsic cueing in order to change some of those movement patterns. If you have determined like you have that context with your patient, you understand like there needs to be some nuance to this movement pattern that's going to be more efficient for that person. And they have been working around something for a very long time and their muscles have adapted to that. And now it's getting to a point where it needs to be addressed. Okay, that's what I've got for you today. Hope y'all have a wonderful weekend. We have an extremity course coming to you next weekend. I believe Lindsey's going to be up in Bozeman, Montana. So as far as if you're trying to find a late last minute jump into a course, we'd love to see you out there. Otherwise, hope everybody has a great day. OUTROHey, thanks for tuning in to the PT on Ice daily show. If you enjoyed this content, head on over to iTunes and leave us a review and be sure to check us out on Facebook and Instagram at the Institute of Clinical Excellence. If you're interested in getting plugged into more ice content on a weekly basis while earning CUs from home, check out our virtual ice online mentorship program at ptonice.com. While you're there, sign up for our Hump Day Hustling newsletter for a free email every Wednesday morning with our top five research articles and social media posts that we think are worth reading. Head over to ptonice.com and scroll to the bottom of the page to sign up.

Dr. Jeff Musgrave // #GeriOnICE // www.ptonice.com  In today's episode of the PT on ICE Daily Show, join Modern Management of the Older Adult lead faculty Jeff Musgrave shares shares how by being too quick to limit risk for our patients we can expedite deconditioning, worsen social isolation and mortality of our patients. Take a listen to learn how to better serve this population of patients & athletes, or check out the full show notes on our blog at www.ptonice.com/blog. If you're looking to learn more about live courses designed to better serve older adults in physical therapy or our online physical therapy courses, check our entire list of continuing education courses for physical therapy including our physical therapy certifications by checking out our website. Don't forget about all of our FREE eBooks, prebuilt workshops, free CEUs, and other physical therapy continuing education on our Resources tab. EPISODE TRANSCRIPTION JEFF MUSGRAVEWelcome to the PT on ICE Daily Show brought to you by the Institute of Clinical Excellence. My name is Dr. Jeff Musgrave, doctor of physical therapy. Super excited to be talking to you about everyone dies, not everyone lives. So I am fresh off an epic motorcycle adventure with the CEO Jeff Moore and Matt in the bike fit division of our company. And it was an epic trip. And a great way to summarize this trip is a quote from a motorcycle brand that I've started following recently. We don't promote this brand in any way, I just thought the quote was great, which is, everyone dies, not everyone lives. So just to kind of set the stage a little bit, I'm new to motorcycling, brand new thing, it's something just recently I decided was Important to me a risk that I wanted to take Lots of people in my life very well-meaning that care about me deeply Wanted to just share all the worst case scenarios. They wanted to instill enough fear in me To maybe prevent me from going or to make sure that I'm super safe and and I get that right there is some inherent risk Taking a motorcycle up a cliff face lots of things can happen Some injuries occurred, there were some wrecks, but most importantly, there was the opportunity to really live life. in a very deep, meaningful way to accept some risk, to have a lot of fun, to have some fun stories, to make some fun memories that are gonna last me, I hope, the rest of my life. And I think this is very relevant whether we're talking about older adults or even younger adults. But I think we come in contact with this type of problem with older adults most common. So commonly with older adults, In that same vein, we're trying to help our patients be safe. We want them to make decisions that are going to prevent injuries, prevent falls, and for a lot of our older adults, a fall can be a very serious thing. I'm not making light of that in any way. We know that lots of our older adults are living with low reserve. and low physical resiliency and reserve, so they have very little margin. So if they fall and they have decades of deconditioning, their bones are weak, their body systems are not prepared to help them recover quickly, and this can have a huge impact on their life. So I want to say I recognize that, and we preach this fitness forward approach to try to help build that reserve and build that resiliency, but still what I tend to see when I interact with clinicians, working with older adults, is we treat older adults with kid gloves and we don't want them to be put at any level of risk. But I think the thing that we forget is what they're missing out on. What are the things that they want to do that are risky and how meaningful may they be to their life? So I'd like to give you a few tips just from my clinical experience to help patients live until they die. We want them to live their life as fully as possible, and I think sometimes we don't think about, when we limit our patients, what the downstream effect is for their life. So I've got a few tips here that I think will be helpful, and then we'll go through an example of what this could look like. So, you know, many of our patients, they're maybe not trying to take a motorcycle adventure into the Rocky Mountains. Maybe it's something like walking without an assisted device, or maybe they really need a walker but they're only willing to use a cane. So I think the first thing that we have to do is we have to have an objective assessment here. We can't just make assumptions. We don't want to look at their past medical history, their diagnoses, and decide for them, or heaven forbid, just their age. We know that people age at different rates and have different functional levels. Their age doesn't dictate their treatment. There are clinical findings should, very accurate clinical findings that meet them where they're at. So the first thing I would advocate for is to get an objective assessment of the risk. So how risky is this activity? Say it's some type of walking or balance activity and we're worried that their balance isn't good enough. Well, first thing we should do is say, hold the phone. We need to do a good assessment here, so we need to match up the patient's physical ability to the objective measure and make sure that the activity is represented in our objective measure. One that we really like to use, it's pretty comprehensive, is a mini best test. The mini best test is a great way to look at dynamic balance, looking at reactive components, as well as anticipatory. as well as a vestibular system, and reactive, like how are they gonna react if they do catch their toe? Do they have the ability to react? So if it's a balance activity, we'll wanna make sure that that activity is represented in our assessment. So we can have a very clear picture of how much risk is this. Maybe it sounds really risky, and we have them do the assessment, and it's like, meh, it's maybe not the best, but it doesn't look like it's that serious, On the other hand, it could be that it is very risky. They can't even do the task at all safely in the assessment. So either way, we need to know objectively what's their physical ability to do this task, whether we're doing the task directly or we're trying to replicate it. We need to get an idea of what's required and get an objective measure for that. The second thing we need to know is how meaningful would this activity be to our patients? How risky is this? But how much reward is there for our patient as well? So there's two sides to this. So if we're thinking about, we've got our assessment, then we've got a good idea how much risk is this based on say like their fall risk. It looks like they're having trouble walking and carrying something. So them wanting to carry in their own groceries without their hands would be a pretty risky task. But maybe that task allows them to be independent in their home. Or maybe they don't have the financial resources to pay someone to bring their groceries to them or for some type of grocery delivery service. So that could change their living arrangement. So we don't want to just make these big blanket statements based on risk. So we've got to figure out how much risk is there based on an objective assessment. We also need to know how much reward is there for our patient on the other end of that. Or what are the downstream effects of them not doing that task anymore. Will there be more deconditioning? Will there be lack of social connection? Social isolation, especially if someone is pre-frail, increases their mortality risk by over 25%. So if we, our choices for safety, take away the social reward, and we reduce the value of their life, we may also hasten their death. which is kind of a wild thing to think about, but our trying to play it safe could actually lead to them dying sooner, which is pretty awful, and I know that's not anyone, what anyone wants to happen that's listening to this. And then the final thing is you have to come to some type of agreement that you can work with, that they can work with, that you can work with, right? So that this therapeutic relationship can continue. So I'll give you an example, I'll kind of work through this, and I think this will help make this a little more clear, So an objective assessment of someone's risk. Say we've got a patient who's an independent community-dwelling older adult who has had some deconditioning, they've got some balance deficits on board. They say, I've got a cat, I'm widowed, I live alone, I need to be able to take care of Fluffy, but my balance, I'm really struggling to be able to get the cat food in from my car up the steps into the house, and I've actually had some falls recently, and I'm at the end of the bag of cat food, now what do I do? So the first thing we're gonna do is based on that task, pick an objective measure that's gonna be helpful. So for a community dwelling older adult, we'll probably do some type of quick screen to get an idea of strength and balance, so something like the short physical performance battery. And then based on that, if it looks like there's some serious balance deficits, we may wanna do a deep dive with a mini best test to get an idea of her dynamic balance, her ability to recover if she catches her toe, while she is carrying, it'll also take away her visual field during parts of the test to get an idea of what's her proprioception like, how well is her vestibular system functioning, and then from there, we can get an idea of what is the objective level of risk. So say we run the mini BEST test, and it looks like she is at risk for having a fall. And then the third thing is, we know, based on this patient, maybe she doesn't have a whole lot of social outlets, and this is one of the only times she gets out of the house for a medical appointment. So we need to really go through this filter of, yes, she could fall. If she continues to do this task, she could fall. But if we take away this trip out of the house, we take away a lot of activity from her daily life. So if she's not able to, if she's not lifting, carrying, working on her dynamic balance through this task, even if it's once every couple weeks, that is still a huge reduction in her overall physical outlet in her physical health. I mean it's built into her life so taking that away from her will actually probably expedite her lack of reserve, resiliency, expedite her deconditioning, as well as potentially isolate her from her pets. So if she's trying to take care of Fluffy, she doesn't have a whole lot of social outlets, that may reduce her willingness or desire to even live moving forward if she doesn't have that outlet with her pet. the lack of reward or the loss that that would represent to just say, no, not safe for you to do that. Let's have someone else bring the food, which she loses the physical attributes or the physical activity that is keeping her strong, at least at some level. But then the second piece is, maybe if we went to the extremes like, you know what, you're just gonna continue to get older and more deconditioned, you should probably just give the cat away. which is probably the worst thing we could say if there's any hope of her getting her strength back. She'll have the social isolation, probably some depression, as well as not being able to have that at least low level of physical activity. A way that I would come at this, if this was my patient, is I would describe the risk. Hey Betty, you know what? You are at risk for falling. You do have some deficits on your balance, but I realize this connection with Fluffy is really important for you, and I think we can work together to find some solutions. So some things I would be thinking about is if she needs some upper extremity support, maybe she's not using an assistive device, or she's not using the right one, which also happens pretty often, Maybe we can meet in the middle. Maybe we can say, you know what? I think if you get a smaller bag of cat food, you can put it in a backpack. And if you can get it, if I can teach you how to put this in a backpack and put it on your back, you're gonna have your hands free. And maybe until we get you stronger, just till then, we can use a walker to get you from your car to the steps, and then if you've got enough support or you've got your cane you usually use in the house, maybe we can get you to use the cane for a very short distance. Or maybe even let her set the backpack down and drag the thing into the kitchen. There's so many ways we could get the job done, but we may have to change what it looks like for a short time. And I would almost guarantee you, if that example was your patient, that they would 100% be okay with buying a smaller bag of cat food, which may get them out more often, which may help us reduce their sedentary behavior, improve their activity frequency, how often they're doing that, could be really good, as well as keep the cat, which I think is the ultimate goal. If they get to keep the cat, keep doing the task, maintain their independence, and we can limit their fall risk by giving them some extra support, but the task gets done and it's temporary, I bet they're gonna be on board. So I hope that helps. So I would really advocate before we just give blanket statements for safety for any patient, but especially for older adults. We want to make sure that they have the opportunity to live their life. We need to consider the risk, absolutely. We need to get an objective measure on that, but we need to consider what we're taking away or what their life will look like and the downstream effects of telling them no. With the heart of safety, we may expedite someone's death or reducing the quality of their life. The final phase, after you figure that out, is we've gotta come to an agreement. We've gotta continue that relationship, do what we can to reduce the risk for them, but maybe we have to meet in the middle. And maybe we can make some agreement that it's like, hey, until we get you to this point, would you agree to use this extra support? Or do this task a little bit differently? And almost 99% of the time that I've come at this type of conversation with a client this way, it has always gone well. Team, I hope that you go out there and you help your patients live. I hope that you're careful assessing risk. I would love, if anyone has any examples or stories they'd love to share, please drop it in the comments. If there's a cool story where you've been able to meet in the middle, help someone continue to do something like that, or just have some thoughts. I would love to hear your thoughts on that. If you're interested in learning more from the older adult crew, We've got our level one is kicking off in less than a week. It's crazy. It's time to sharpen those mental muscles, get back into L1. So if you just came off live and you're wanting to get your specialty in older adult, we would love for you to hop in there. If you've already had L1, I'd recommend you hop into L2. The last cohort sold out. The next one of those is gonna be October 17th. As far as live courses, myself and Ellen Sepe, The woman, the myth, the legend is going to be with me in Anchorage, Alaska. We're going to have a great time. That's going to be August 17th and 18th. Great opportunity for some awesome continuing education. Meet us live, work on your skills, and also take in a beautiful state at a great time of the year. We also have live courses on September 7th and 8th in Minnesota and Alabama. Team, that's what I've got for you for today. Go help those patients live. Have a great day. Catch you next time. OUTRO Hey, thanks for tuning in to the PT on Ice daily show. If you enjoyed this content, head on over to iTunes and leave us a review, and be sure to check us out on Facebook and Instagram at the Institute of Clinical Excellence. If you're interested in getting plugged into more ice content on a weekly basis while earning CUs from home, check out our virtual ice online mentorship program at ptonice.com. While you're there, sign up for our Hump Day Hustling newsletter for a free email every Wednesday morning with our top five research articles and social media posts that we think are worth reading. Head over to ptonice.com and scroll to the bottom of the page to sign up.