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For many speech-language pathologists, occupational therapists, and myofunctional providers, billing and documentation feel like navigating an ever-shifting maze. Between selecting appropriate CPT codes, justifying medical necessity, and adhering to strict scope-of-practice guidelines, clinicians often struggle to ensure proper reimbursement while remaining compliant.In this episode, Hallie Bulkin breaks down the essential mechanics of billing for myofunctional therapy services. She addresses common points of confusion around core codes - such as CPT 92526 (treatment of swallowing dysfunction and/or oral function for feeding) and 92507 (speech/language treatment) - and offers practical strategies for documenting functional gains accurately.Hallie also previews upcoming CPT code updates slated for 2027, shedding light on how these structural changes will impact private pay practices, electronic health records (EHRs), and clinical workflows. Whether you are navigating insurance reimbursement or operating an out-of-network practice, this episode equips you with the clarity needed to code with confidence and integrity.Key Topics & TakeawaysDeconstructing CPT 92526 vs. 92507: Clarifying the distinct clinical applications for swallowing/feeding dysfunction versus speech and language treatment.The 2027 CPT Code Shift: Preparing your practice, EHR templates, and clinical documentation for upcoming coding structure changes.Scope of Practice & Provider Eligibility: Understanding state licensing, board regulations, and billing qualifications across different therapeutic disciplines.Defensible Documentation: Crafting objective, function-focused clinical notes that justify medical necessity and withstand insurance audits.Out-of-Network & Private Pay Strategies: Equipping cash-pay practices with accurate super/ superbill documentation to help patients seek reimbursement seamlessly.Soundbites"A CPT code isn't just a billing number - it is a translation of your clinical documentation and direct scope of practice.""When preparing for coding changes, proactive documentation systems protect both your practice and your patients.""Bill for what you treat, document what you see, and ensure every note clearly establishes functional necessity."Timestamps 00:00:00 - 3 Verification Steps Before Coding00:04:23 - Deep Dive: Myo & CPT Code 9252600:06:37 - Reporting 92526 & 92507 Together00:09:45 - Provider Scope & License Boundaries00:13:47 - Dental Hygienist (RDH) Reimbursement Reality00:15:53 - Strong vs. Weak Documentation Examples00:18:16 - Private Pay & Superbill Responsibilities00:19:42 - 2027 Deletion of 9250700:20:47 - Why 92507 Was Flagged by AMA/CMS00:26:26 - Private Practice Transition Strategy00:27:43 - Clinical Reasoning vs. Endless Exercises00:29:01 - Immediate Action PlanLinks & ResourcesFast Myo Screening Tool: Streamline your intake documentation and baseline evaluations at FastMyoScreening.com.WORTH A LISTEN: CONTINUE YOUR JOURNEYScreening vs. Assessment vs. Treatment: Why Every Clinician Needs to Know the Difference.How Root Cause Assessment Changes Feeding and Speech Outcomes.STAY CONNECTED
California's Delete Act (SB 362) introduced DROP (Delete Request and Opt-out Platform), which launched on January 1, 2026. It lets residents submit one deletion request that automatically propagates to all registered data brokers in the state—currently around 500 companies. The Core Problem It SolvesData brokers collect and resell personal information from people they've never directly interacted with. Before DROP, individuals had to manually find each broker, submit separate requests, and hope for compliance with no centralized tracking.How DROP WorksResidency Verification: Users prove they're Californian via the California Identity Gateway or Login.gov (no permanent state account needed). This avoids redundant collection of sensitive data by brokers.Provide Identifiers: Users submit details like name (and former names), date of birth, ZIP code, email, phone, mobile advertising IDs (MAID), connected TV IDs, and VINs. More identifiers improve matching accuracy across brokers.Centralized Submission: One request is sent to all registered brokers.Privacy-Preserving Matching: California does not share raw personal data. Instead, it normalizes and hashes identifiers, creating deletion lists. Brokers hash their own records and compare hashes. Matches trigger deletion without exposing underlying data—similar in concept to lightweight privacy-preserving techniques.Recurring Compliance Cycle: Starting August 1, 2026, brokers must check DROP at least every 45 days (via API or download), process new requests, and honor prior deletions through ongoing suppression.Multi-Identifier Lists: Separate hashed lists exist for different data types; brokers use those relevant to their holdings.Full Deletion: A match requires deleting all associated records for that individual, not just the matching identifier, and preventing future sales.Reporting and Transparency: Brokers report completion status back through DROP, allowing users to track progress from pending to completed.Ongoing Obligation: Deletion is not one-time; brokers must maintain suppression lists indefinitely.Global Reach: Any data broker processing significant volumes of Californians' data (threshold ~100,000 records) must register and comply, regardless of headquarters location.Broker Burden: Requires new infrastructure for hashing pipelines, scheduled polling, cross-identifier matching, suppression, and reporting. The state provides documentation, webinars, and test environments.Enforcement: Third-party audits begin in 2028 and recur every three years. Fines reach $200 per consumer per day for noncompliance.Scope and RequirementsWhy It MattersDROP targets brokers handling highly sensitive data (geolocation, biometrics, SSNs). Beyond faster deletions, it compels the industry to adopt stronger technical privacy and security practices. The architecture is innovative: the state coordinates mass privacy actions across hundreds of companies without ever holding or seeing raw personal data. If successful under real-world load from August 2026 onward, it could become a model for other states and countries—enabling deletion at scale without relying on trust.Closing Insight: The real breakthrough isn't just the deletion feature but the underlying privacy infrastructure that makes coordinated, verifiable, and secure data removal possible.
On Destination Impact this week, Zac Clarke and Jerud Buhagiar discuss the fallout from happenings on the latest episode of Impact including the Nic Nemeth-K.C. Navarro TNA World Title match, Righteous Deletion and the state of the TNA Tag Title Division, the decision to turn Elayna Black babyface, and using the Knockouts TV Title tournament as a backdrop for other storylines, as well as highlighting the recent Young Bucks interview regarding their time and legacy in TNA, and also weighing if Sammy Guevara and Tay Melo could be a good fit in TNA. The guys also deliver a VIP-Exclusive Aftershow covering various pro wrestling topics including highlights from the AEW Redemption PPV and their thoughts about the current Lio Rush “Blackheart” gimmick.Become a supporter of this podcast: https://www.spreaker.com/podcast/pwtorch-dailycast--3276210/support.
Leadership begins with understanding. If you can't understand people, you can't truly influence them, develop them, or lead them. On this episode of Like It Matters Radio, Mr. Black explains why understanding is the front door of the People Business. Whether you're leading a company, raising a family, strengthening a marriage, or serving your community, your success will always be connected to your ability to understand how people think, communicate, and grow. Drawing from psychology, neuroscience, sociology, theology, and decades of leadership experience, this episode brings together powerful ideas that reveal how people are formed—and how they can be transformed. You'll discover: Why relationships drive nearly every meaningful outcome How repetition, observation, and attachment shape identity What Hebb's Law, Social Learning Theory, Mimetic Theory, and Attachment Theory teach us about human behavior Why lasting change always begins with understanding, not control Mr. Black also explores practical tools from Neuro-Linguistic Programming (NLP) and Emotional Intelligence, including: The three primary communication filters: Deletion, Distortion, and Generalization The three perceptual positions that help leaders see beyond their own perspective How people process the world through visual, auditory, and kinesthetic communication styles Why changing perspective often changes the outcome Most importantly, this episode reminds us that people are more than behavior. We are body, mind, and spirit. Great leaders don't simply manage performance—they understand the whole person. They help reshape beliefs, build trust, strengthen identity, and create environments where people can flourish. Because when you understand how people are formed, you begin to understand how people can be transformed. This is an Hour of Power about communication, emotional intelligence, leadership, and unlocking the greatest investment you'll ever make: people. Inspiration. Education. Application. When you live your life like it matters… it does.See omnystudio.com/listener for privacy information.
What does it mean to grow up alongside a sibling with a disability, and who supports the siblings along the way? In this heartfelt episode of Our Forever Smiles, Laura sits down with pediatric dentist and mom Amy Kebriaei and her daughter, Leily Kebriaei, to discuss life with 22q11.2 Deletion Syndrome from a sibling's perspective. Amy shares the emotional journey of receiving her daughter Roya's diagnosis, navigating complex medical needs, and building a support network for families facing similar challenges. Leily offers a powerful and honest look at what it's like growing up with a sister who has special needs, balancing advocacy, friendship, responsibility, and the everyday realities of being a sibling. She also shares the inspiration behind Sib Support, an online support group she created for teens who have siblings with long-term disabilities. Together, they explore disability awareness, sibling relationships, self-advocacy, inclusion in schools and activities, and the importance of creating spaces where siblings feel seen and supported. This episode is a moving reminder that every family member is impacted by a diagnosis, and that connection, understanding, and community can make all the difference. Whether you're a parent, sibling, caregiver, or advocate, this conversation will leave you inspired by the resilience, compassion, and love that exist within the special needs community. Links: Sib Support Registration Buy Us a Coffee FB Support Group
Tommy Dreamer reacts to the Righteous Deletion match between the Hardy Boys and The RIghteous. Plus, he sits down with KC Navarro. To visit our partners at Chewy, click here. The Master's Class is now available on its own podcast feed! SUBSCRIBE NOW to hear over 50 episodes of Dave, Bully, Mark, and Tommy taking you behind the scenes like only they can, plus BRAND NEW episodes every week. Subscribe to SiriusXM Podcasts+ to listen to new episodes of Busted Open ad-free and get exclusive access to bonus episodes. Start a free trial now on Apple Podcasts or by visiting siriusxm.com/podcastsplus. Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.
The Righteous have been DELETED! On this week's Extreme Life, Matt Hardy gives all the details behind the newest cinematic match, and breaks it down scene-by-scene! BlueChew - When you buy two months of BlueChew Gold, you get the third FREE with promo code HARDY. You will also receive an additional 10% OFF + Free overnight shipping on your first order. Visit BlueChew.com for more details and important safety information Mars Men - Get 50% off FOR LIFE, Free Shipping AND 3 Free Gifts at Mars Men at Mengotomars.com Stop throwing your money on rent! Get into a house with NO MONEY DOWN and roughly the same monthly payment at SaveWithConrad.com If your business targets 25-54 year old men, there's no better place to advertise than right here with us on the Extreme Life of Matt Hardy. You've heard us do ads for some of the same companies for years...why? Because it works! And with our super targeted audience, there's very little waste. Go to AdvertiseWithHardy.com now and find out more about advertising with the Extreme Life of Matt Hardy. The Extreme Life of Matt Hardy podcast is a pro wrestling podcast that covers Matt Hardy's journey through WWE, AEW, TNA, and other wrestling adventures. Download the podcast: Spotify: https://open.spotify.com/show/5QGKxeH8v8Ea6eawO90Q44 Apple: https://podcasts.apple.com/us/podcast/the-extreme-life-of-matt-hardy/id1602252129 Everywhere else: ExtremeHardy.com #WWE #AEW #TNA #HardyBoyz
#TNA #TNAonAMC #TNAWRESTLING #TNALockdown Join the TNI crew to discuss all the latest! RESULTS: AJ Francis & Frankie Kazarian defeated Elijah & Moose Elayna Black vs. Wendy Choo in a TNA Knockouts Television Championship Tournament First Round Match ended in a Time Limit Draw The Hardys (Matt Hardy & Jeff Hardy) defeated The Righteous (Vincent & Dutch) in a Righteous Deletion Match Jada Stone defeated Alisha Edwards in a TNA Knockouts Television Championship Tournament First Round Match Nic Nemeth (c) defeated KC Navarro to retain the TNA World Championship Music by Jacob Lizotte CONNECT WITH TOTAL NONSTOP IMPACT: Social Media: Twitter - www.twitter.com/WETALKIMPACT Twitch - www.twitch.tv/TotalNonstopIMPACT Instagram - www.instagram.com/WETALKIMPACT Facebook - www.facebook.com/WETALKIMPACT Connect with us now on our Discord: / discord Streaming Audio: Apple iTunes - apple.co/2NpzbqF Stitcher Radio - bit.ly/2DjPznT Google Play - tinyurl.com/ybh29sfp TuneIn Radio - bit.ly/2NreA57 iHeart Radio: ihr.fm/laugeb Spotify: spoti.fi/2B1zBeL Soundcloud - @user-625858195 Pandora - pandora.app.link/07JHdVjfc9 Official Merchandise: Pro Wrestling Tees: www.prowrestlingtees.com/totalnonstopimpact Spreadshop Merchandise: Featuring Caps, Hoodies, Mugs, & MORE! total-nonstop-impact.myspreadshop.com Follow JAYBONE'S Journey on his other Podcast: www.youtube.com/@RamblersUnleashed
Welcome to Royal Impact with Your Hosts The OPC Ivan C., Thunder ESPN Steven Chambers , & Mr. BBQ Man Rusty Roman as we have.....Righteous Deletion At The Hardy CompoundTNA World Championship - Nic Nemeth (c) Vs KC NavarroMoose & Elijah Vs AJ Francis & Frankie KazarianTNA KO Television Championship Tournament - Jada Stone Vs Alisha EdwardsTNA KO Television Championship Tournament - Elayna Black Vs Wendy ChooWe'll Hear From The SystemAnd much more!Make sure you subscribe to our channel and welcome to the party!!!DON'T WATCH TNA ALONE!COME JOIN US!!!COME CHAT WITH US!!!This is TNA THURSDAY NIGHT IMPACT Live Stream. This live stream will feature our reactions to TNA IMPACT as well as our live commentary, analysis of the show and discussions with the live chat room.Our Live stream is intended to be viewed as a watch-along and features no footage of ANY EVENTS.This is TNA THURSDAY NIGHT IMPACT Live Stream. This live stream will feature our reactions to TNA IMPACT as well as our live commentary, analysis of the show and discussions with the live chat room.Our Live stream is intended to be viewed as a watch-along and features no footage of ANY EVENTS.=================https://linktr.ee/CircleOfDebate=================Join our Skool Community The exclusive fan membership of the Circle of Debate YouTube channel! Daily live streams on pro wrestling, sports video games, and anime!https://www.skool.com/the-debate-netw...=================For Business inquiries :thedebatenetwork679@gmail.com=================For all sports news, & entertainment news, pro wrestling & more go to https://gamebreakersports.com/==================================Purchase NordVPN to receivd 74% off from The Debate Network You must subscribe FirstTo get your percantage off along with a amazon gift card!Link Below:https://nordvpn.com/special/ Get 10% off from us when you purchase anything from Dubby Energy Drinks ProductsLink : https://www.dubby.gg/collections/allPromo Code : GAMEBREAKER ==================================
a crazy episode of impact this week included the righteous deletion match at the hardy compound!
Joel Pearl returns for TNA talk and a NEW Deletion match, 10 years later. TNA World Tag Team Championship — Righteous Deletion: The Hardys (Matt Hardy & Jeff Hardy) TNA World Title - Nic Nemeth (c) vs. K.C. Navarro TNA Knockouts TV Title Tournament - Elayna Black vs. Wendy Choo TNA Knockouts TV Title Tournament - Jada Stone vs. Alisha Edwards Mustafa Ali International Title Vote Moose & Elijah vs. A.J. Francis & Frankie Kazarian The System to speak Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.
Build the Business. Keep the Life.What if the goal wasn't to build the biggest business possible - but to intentionally design one that gives you enough?In this episode of the Disruptive Influence Podcast, Jeff Abracen speaks with Jacob Pegs, a writer, marketer and architect of freedom-based businesses, about creating a highly leveraged one-person business without sacrificing your health, creativity or family life.Jacob shares how becoming a father forced him to rethink the business he was building. Instead of adding more clients, employees and responsibilities, he began designing around constraints: three working days a week, a defined number of clients and a business model built on one post, one email and one offer a day.The conversation explores why people buy proximity, how content can capture and multiply your energy, and why a smaller audience of the right people can be far more valuable than tens of thousands of passive followers.Jeff and Jacob also unpack the difference between relevance and resonance, why personality is a genuine competitive advantage, and how sharing who you are can matter as much as demonstrating what you know.This episode is for creators, coaches, consultants and entrepreneurs who want to make more impact without automatically creating more work.In this episode:Why freedom must be designed into your businessHow content creates leverage beyond your available hoursThe relationship between proximity, pricing and capacityJacob's one-post, one-email, one-offer modelHow to start building an audience from zeroWhy your voice, writing and message are the real funnelThe difference between showing your expertise and sharing who you areWhy people buy relevance - and stay because of resonanceHow constraints can protect your creativity, health and familyWhy repelling the wrong people can strengthen your positioningHow to identify the small group of people your business truly needsWhy bigger revenue does not automatically create a better lifeKey ideas:Design before you scale.Set the life, schedule and capacity you want before building a business that overwhelms them.Energy plus assets creates leverage.Content, recordings, workshops and intellectual property can continue working after the original effort is complete.People buy proximity.Different offers can provide different levels of access to your thinking, support and guidance.Your voice is the funnel.Clear ideas, useful demonstrations and consistent communication can create demand without complicated systems.Relevance gets attention. Resonance builds preference.People may initially need your expertise, but your beliefs, experiences and personality help them choose you.You do not need everyone.A sustainable business may require only a small number of deeply aligned customers.Chapters00:00 – Why you only need the right 80 people00:48 – Can freedom-based businesses still be built?02:34 – Escaping the belief that success requires constant grinding04:28 – Turning your energy into leverage04:48 – Designing a three-day-a-week business07:15 – One post, one email and one offer a day08:40 – Separating your identity from your business09:49 – How to begin building an audience from zero13:21 – Showing what you do and sharing who you are16:54 – What Jacob actually helps people accomplish18:31 – Applying one model across different industries21:19 – Personality as a competitive advantage22:21 – Why people buy who you are24:44 – Giving people what they want and what they need27:31 – Staying consistent when the business starts working28:27 – Seasons, boundaries and choosing not to scale31:57 – Why your vibe attracts the right buyers32:36 – Repelling people as a positioning strategy33:45 – Finding the 80 people your business needs34:18 – Deletion by design35:49 – Jacob's original $125 offer37:42 – Starting with the person you used to be39:31 – Choosing alignment over a successful but unwanted business43:32 – The question that forces you to tell yourself the truthAbout Jacob PegsJacob Pegs is a writer, content marketer and business strategist who helps coaches, consultants and service providers build highly leveraged, marketing-led online businesses.His model is built around simplicity: one post, one email and one offer a day. Rather than chasing unlimited scale, Jacob helps entrepreneurs design businesses around their desired income, capacity, creativity and quality of life.About the Disruptive Influence PodcastHosted by Jeff Abracen, Communication Advisor & Coach and former agency Vice President, Creative Director, The Disruptive Influence Podcast explores how founders, leaders and creative thinkers use communication, storytelling and unconventional ideas to earn attention, build trust and inspire action.Connect with Jeff Abracen on LinkedIn [https://www.linkedin.com/in/jeffabracen/]If you are or know a disruptive influencer who would make a great guest, we'd love to hear from you. Every Like, Share, Subscription and Review means a lot.Cover art by Daniel DevoyMusic by Stephen Voyce©2024-2026 The Disruptive Influence Podcast - Jeff Abracen
n a world that never stops moving, maybe the most productive thing you can do… is slow down. On this episode of Like It Matters Radio, Mr. Black explores why clarity is becoming one of the rarest leadership skills in our information-saturated culture. Every day, our brains are bombarded with the equivalent of 34 gigabytes of information, forcing us to filter, interpret, and respond faster than ever before. But what if moving faster isn’t the answer? This episode examines how our minds process information through three powerful filters: Deletion – We leave important things out. Distortion – We reshape reality through our beliefs and emotions. Generalization – We turn isolated experiences into lifelong assumptions. These filters help us survive, but they can also cause us to misunderstand ourselves, others, and even God. Mr. Black also unpacks: The role of the Reticular Activating System (RAS) and how it determines what captures your attention Why most of our daily decisions happen unconsciously How culture, media, and repeated messages shape our thinking Why awareness is the first step toward transformation Joining the program is John CEniglia, President of SAT-7, sharing how Christian media is helping people in the Middle East see beyond stereotypes and discover truth through authentic conversations. The message is simple but powerful: Slow down. Think. Become aware. Because you can’t change what you don’t recognize. Leadership begins the moment you stop reacting automatically and start thinking intentionally. This is an Hour of Power about awareness, wisdom, emotional intelligence, and learning to see clearly in a world that profits from distraction. Inspiration. Education. Application. When you live your life like it matters… it does.See omnystudio.com/listener for privacy information.
The ink on the Constitution was barely dry before others were trying to control us. Yet, we are still around. As life's pace begins accelerating, it's time for careful introspection. Our 250th anniversary has left others jealous. Chy-Nah and AI together leaves a lot of questions. Venezuela entered the picture in 2017. People herd you into groups where they think you belong. Hard choices get made under threats. The message seems disconnected by design. All the factions show who the real operators are. It's a swamp within a swamp. National leaders waste time on climate myths. AI complicates human nature. Many can't handle the truth. The Tina Peters case was done all wrong. We are going to lose the House. Saudi Arabia is out of oil. Israel should have played it down the middle. Bibi is a dumb warmonger. The President has taken so much grief for the people. England is the capital of bad teeth. Psyops change by the minute. Our media can be redone without sponsors. J6 was orchestrated by the right. Katrina Pearson saved the President. Choices offer fake everything. They attack us in every way possible. Cultivating discernment is key. Here's the secret to a long life. When you cease to learn, you cease to live.
Simons Event:Beyond the Third · Haus Abraham · Eifel · 21.–23. August 2025https://www.yahyel.space/beyond-the-third-yahyelyahyel@flymingolife.comFür weitere Fragen
The Darkside Of IG & OF MODELS That Most Men NEVER SEE | Ashlee Janae Self-Deletion by Greg Adams
Watch it here: https://youtu.be/PgNBKkTn5yQ
Sign Up to My Free Live Event You are doing all the things. Showing up, creating, working with clients, building something so amazing and still there is this little voice underneath it all, the sense that you are not fully in it yet.Half in half out feels like playing it safe and it is actually the most exhausting thing you can do. Because full commitment takes less energy than the negotiation happening inside you every single day.In this episode, I break down exactly what is running that negotiation at a subconscious level and how it's your brain's three most sophisticated filters working together to keep you exactly where your current map says you belong.You will learn what deletion, distortion and generalisation actually are, how they show up specifically in the way you create content, price your offers, and move through your days, and the three step process to start catching them, interrupting them and rewriting the map entirely.Journalling prompts from this episode:Deletion - catch what your brain has been filtering out If you knew your brain had been filtering out proof of how capable you actually are, what would it have been hiding from you? What results, moments or feedback have you filed away as not quite enough to count and what would change if you actually let them count?Distortion - find where you have been bending reality.Think about the last time something didn't go the way you wanted. What story did you make it mean about you, the real story, the one underneath the one you told out loud. What is the most accurate, most generous and most true interpretation of what actually happened?Generalisation - break the rule that became a life sentence.What is the rule you are living by right now about what is possible for you? Where did it come from? And what does the version of you who wrote that rule need to know now that she could not have known back then?Connect with Rebecca Haydon:Apply to work with meThe Subconscious MembershipCome say hi on Instagram | Facebook | YouTubeRelated episodes you may enjoy:Ep 267. Your Identity Shift Feels like Sh*t? Good, Keep Going!
Dr. Marija Gredic chats with Dr. Bob Varelas about his article, "Airway Goblet Metaplasia Resulting from YAP/TAZ Deletion Drives Pulmonary Inflammatory Responses."
Lakeland residents face higher electric bills, while a Senate bill transferring USF Sarasota-Manatee land to New College vanishes — leaving both energy costs and campus plans in uncertainty.Call: 813-755-6562Message: FloridaMatters@wusf.orgWebsite: https://www.wusf.orgSign up for our daily newsletter: https://www.wusf.org/wakeupcall-newsletterFollow us on social media:Facebook: https://www.facebook.com/WUSFInstagram: https://www.instagram.com/wusfpublicmedia/YouTube: https://www.youtube.com/channel/UCsN1ZItTKcJ4AGsBIni35gg
There have been reports of Muslim voters being targeted for deletion through fraudulent use of Form 7 across different states - Uttar Pradesh, Rajasthan, Assam, Gujarat and West Bengal. But that's not the only way in which their right to vote is being attacked. The Quint narrates three ways in which this process is taking place and could expand across India. From exposing misinformation to delivering impactful human rights reporting, our newsroom has relentlessly pursued stories that drive change. We remain committed to asking the tough questions — and we'd love for you to be a part of our journey. Learn more about your ad choices. Visit megaphone.fm/adchoices
This Ecclesiasstical Wife & Mom's Double Life That Led To Her DELETION | Can You Guess Her Secret? by Greg Adams
Today I'm joined by Donald Kemp, General Sales Manager at Stowasser Buick GMC. We dig into why human-first social content is outperforming inventory posts, how moving F&I earlier drives higher penetration, and where dealers are quietly leaking money through junk fees. The conversation is tactical, practical, and immediately applicable for stores feeling margin pressure. This episode is brought to you by: 1. Experian Automotive - Like most Car Dealership Guy Listeners, you're constantly looking for the inside edge on the auto industry. So if you're ready to step up your game to the next level – outpacing the competition and building customer loyalty – there's only one place to go from here: Experian Automotive. They're the only ones with exclusive data across vehicles, consumers, and credit—plus expert data scientists who connect the dots to uncover the insights you need. Get the industry-leading insights from Experian Automotive today! Learn more by visiting @ https://carguymedia.com/4cfcLjZ. 2. Privacy4Cars - Privacy4Cars' app lets your team delete it all in minutes and prove it with a Certificate of Deletion. Customers pay more. Trade-in capture rates soar. And you stand out as the dealership that actually protects people and what matters most to them. Drive more trade-ins, more loyalty, and more revenue. Offer customer vehicle privacy services today– visit @ https://privacy4cars.com/. 3. Nomad Content Studio - Most dealers still fumble social—posting dry inventory pics or handing it off without a plan. Meanwhile, the store down the street is racking up millions of views and selling / buying cars using video. That's where Nomad Content Studio comes in. We train your own videographer, direct what to shoot, and handle strategy, to posting, to feedback. Want in with the team behind George Saliba, EV Auto, and top auto groups? Book a call @ http://www.trynomad.co. Check out Car Dealership Guy's stuff: For dealers: CDG Circles ➤ https://cdgcircles.com/ Industry job board ➤ http://jobs.dealershipguy.com Dealership recruiting ➤ http://www.cdgrecruiting.com Fix your dealership's social media ➤ http://www.trynomad.co Request to be a podcast guest ➤ http://www.cdgguest.com For industry vendors: Advertise with Car Dealership Guy ➤ http://www.cdgpartner.com Industry job board ➤ http://jobs.dealershipguy.com Request to be a podcast guest ➤ http://www.cdgguest.com Topics: 00:43 What are the key business insights? 02:42 What is the used car strategy? 05:41 How to improve finance and service? 23:38 How to manage vendor relationships? 26:10 Which lead sources are best? 29:14 How to optimize lending practices? 34:37 How to leverage social media? 24:38 How to reduce credit card fees? Car Dealership Guy Socials: X ➤ x.com/GuyDealership Instagram ➤ instagram.com/cardealershipguy/ TikTok ➤ tiktok.com/@guydealership LinkedIn ➤ linkedin.com/company/cardealershipguy Threads ➤ threads.net/@cardealershipguy Facebook ➤ facebook.com/profile.php?id=100077402857683 Everything else ➤ dealershipguy.com
CanadaPoli - Canadian Politics from a Canadian Point of View
Tax refunds for tax subsidies?Deletion of court records in the UK to prevent people from reporting on what's going on,Food and chocolate cereal,DEI hiring practices are court mandated, eh?We're starting to see liberals really panic over Alberta leaving….Bridge to Endless Tax Dollars#Cpd #lpc, #ppc, #ndp, #canadianpolitics, #humor, #funny, #republican, #maga, #mcga,Sign Up for the Full ShowLocals (daily video)Sample Showshttps://canadapoli2.locals.com/ Spotify https://podcasters.spotify.com/pod/show/canadapoli/subscribePrivate Full podcast audio https://canadapoli.com/feed/canadapoliblue/Buy subscriptions here (daily video and audio podcast):https://canadapoli.cm/canadapoli-subscriptions/Youtubehttps://www.youtube.com/c/CanadaPoli/videosMe on Telegramhttps://t.me/realCanadaPoliMe on Rumblehttps://rumble.com/user/CanadaPoli Me on Odysseyhttps://odysee.com/@CanadaPoli:f Me on Bitchutehttps://www.bitchute.com/channel/l55JBxrgT3Hf/ Podcast RSShttps://anchor.fm/s/e57706d8/podcast/rsshttps://LinkRoll.co Submit a link. Discuss the link. No censorship. (reddit clone without the censorship)
When things feel heavy in your business, it's usually because you're holding onto things past their use-by date. Deletion creates space for progress.
Deletion creates space for progress.
In episode 444 of Friends Talking Nerdy, The Reverend Tracy and Tim The Nerd return to their ongoing monthly theme of Renewal with a focused and thoughtful discussion on Renewal Through Deletion. This episode explores the often uncomfortable but necessary idea that growth sometimes comes not from adding more to our lives, but from intentionally removing what no longer serves us.The conversation looks at real-world examples of deletion as a form of renewal, such as leaving a job that has become draining or misaligned with your values, or ending a relationship that has run its course. The Reverend Tracy and Tim The Nerd discuss why these decisions are so difficult to make, even when we intellectually know they may be the healthiest option, and how fear, habit, and sunk-cost thinking can keep us stuck longer than we should be.The episode also dives into the idea of deleting internal patterns, particularly bad habits and routines that quietly undermine personal well-being. Whether it's destructive self-talk, unhealthy coping mechanisms, or time-wasting behaviors that crowd out more meaningful pursuits, the hosts examine how removing these habits can create space for clarity, energy, and personal renewal.Throughout the discussion, The Reverend Tracy and Tim The Nerd balance practical insight with empathy, acknowledging that deletion is rarely clean or painless—but often transformative. Episode 444 encourages listeners to rethink renewal not as reinvention from scratch, but as a deliberate process of letting go so something better can take its place.As always, we wish to thank Christopher Lazarek for his wonderful theme song. Head to his website for information on how to purchase his EP, Here's To You, which is available on all digital platforms.Head to Friends Talking Nerdy's website for more information on where to find us online.
CanadaPoli - Canadian Politics from a Canadian Point of View
Deletion of records for government documents,Uk is cancelling elections,Gun confiscation announcementScott Moe likes the China deal, Trump totally unphased by the China deal which makes me suspicious,The emergencies act was illegal, but no one is going to be arrested or charged. Everyone is above the law.#Cpd #lpc, #ppc, #ndp, #canadianpolitics, #humor, #funny, #republican, #maga, #mcga,Sign Up for the Full ShowLocals (daily video)Sample Showshttps://canadapoli2.locals.com/ Spotify https://podcasters.spotify.com/pod/show/canadapoli/subscribePrivate Full podcast audio https://canadapoli.com/feed/canadapoliblue/Buy subscriptions here (daily video and audio podcast):https://canadapoli.cm/canadapoli-subscriptions/Youtubehttps://www.youtube.com/c/CanadaPoli/videosMe on Telegramhttps://t.me/realCanadaPoliMe on Rumblehttps://rumble.com/user/CanadaPoli Me on Odysseyhttps://odysee.com/@CanadaPoli:f Me on Bitchutehttps://www.bitchute.com/channel/l55JBxrgT3Hf/ Podcast RSShttps://anchor.fm/s/e57706d8/podcast/rsshttps://LinkRoll.co Submit
Growth often looks like adding more products, more offers, and more activity. In reality, it is usually the opposite that creates profit.
In reality, it is usually the opposite that creates profit.
In this powerful episode of The Everyday Millionaire Podcast, host Patrick Francey sits down with transformation expert Bogdan Micov, creator of The Relentless Method — a system that permanently erases emotional baggage and subconscious sabotage. After surviving a stroke at just 33 and walking away from a $50M high-ticket sales career, Bogdan rebuilt his life around one radical truth: “You don't need more mindset work. You need deletion.” Together, Patrick and Bogdan unpack how our deepest emotions — fear, guilt, anger, and anxiety — aren't things to “manage,” but signals to delete at the root. Through quantum linguistics, polarity integration, and NLP mastery, Bogdan explains how deleting emotional patterns can instantly unlock clarity, calm, and performance. They dive into: How hidden emotions fuel burnout, overwhelm, and health breakdowns Why “mindset work” often fails — and what real transformation requires The link between repressed emotion and chronic physical pain What it means to un-become who you were taught to be How high achievers can finally find peace without losing drive Whether you're a CEO, entrepreneur, or someone ready to stop fighting your emotions — this episode will change how you think about healing, growth, and high performance.
First, The Indian Express' Asad Rehman talks about the Mahagathbandhan which is in disarray just days ahead of polling. With infighting on at least 12 seats and a delayed CM announcement, the alliance's cohesion is under serious question.Next, The Indian Express' Ritika Chopra discusses a new government scheme to attract Indian-origin faculty settled abroad amid a global talent race. (18:20)And finally, we report on an SIT investigation in Karnataka's Aland constituency that has uncovered a voter deletion scam ahead of the 2023 state elections. (27:55)Hosted by Ichha SharmaWritten and produced by Shashank BHargava and Ichha SharmaEdited and mixed by Suresh Pawar
This is a recap of the top 10 posts on Hacker News on August 28, 2025. This podcast was generated by wondercraft.ai (00:30): Ask HN: The government of my country blocked VPN access. What should I use?Original post: https://news.ycombinator.com/item?id=45054260&utm_source=wondercraft_ai(01:58): Altered states of consciousness induced by breathwork accompanied by musicOriginal post: https://news.ycombinator.com/item?id=45046916&utm_source=wondercraft_ai(03:26): Are OpenAI and Anthropic losing money on inference?Original post: https://news.ycombinator.com/item?id=45050415&utm_source=wondercraft_ai(04:55): Open Source is one personOriginal post: https://news.ycombinator.com/item?id=45047460&utm_source=wondercraft_ai(06:23): The Deletion of Docker.io/BitnamiOriginal post: https://news.ycombinator.com/item?id=45048419&utm_source=wondercraft_ai(07:52): UncertainOriginal post: https://news.ycombinator.com/item?id=45054703&utm_source=wondercraft_ai(09:20): AI adoption linked to 13% decline in jobs for young U.S. workers: studyOriginal post: https://news.ycombinator.com/item?id=45052423&utm_source=wondercraft_ai(10:49): Important machine learning equationsOriginal post: https://news.ycombinator.com/item?id=45050931&utm_source=wondercraft_ai(12:17): Claude Sonnet will ship in XcodeOriginal post: https://news.ycombinator.com/item?id=45058688&utm_source=wondercraft_ai(13:46): Some thoughts on LLMs and software developmentOriginal post: https://news.ycombinator.com/item?id=45055641&utm_source=wondercraft_aiThis is a third-party project, independent from HN and YC. Text and audio generated using AI, by wondercraft.ai. Create your own studio quality podcast with text as the only input in seconds at app.wondercraft.ai. Issues or feedback? We'd love to hear from you: team@wondercraft.ai
What AI website summaries mean for Internet economics. Time to urgently update Plex Servers (again). Allianz Life stolen data gets leaked. Chrome test Incognito-mode fingerprint script blocking. Chrome 140 additions coming in 2 weeks. Data brokers hide opt-out pages from search engines. Secure messaging changes in Russia. NIST rolls-out lightweight IoT crypto. SyncThing moves to v2.0 and beyond. Alien:Earth -- first take. What can we learn from another critical vulnerability? Show Notes - https://www.grc.com/sn/SN-1039-Notes.pdf Hosts: Steve Gibson and Leo Laporte Download or subscribe to Security Now at https://twit.tv/shows/security-now. You can submit a question to Security Now at the GRC Feedback Page. For 16kbps versions, transcripts, and notes (including fixes), visit Steve's site: grc.com, also the home of the best disk maintenance and recovery utility ever written Spinrite 6. Join Club TWiT for Ad-Free Podcasts! Support what you love and get ad-free shows, a members-only Discord, and behind-the-scenes access. Join today: https://twit.tv/clubtwit Sponsors: threatlocker.com/twit bitwarden.com/twit go.acronis.com/twit joindeleteme.com/twit promo code TWIT vanta.com/SECURITYNOW
What AI website summaries mean for Internet economics. Time to urgently update Plex Servers (again). Allianz Life stolen data gets leaked. Chrome test Incognito-mode fingerprint script blocking. Chrome 140 additions coming in 2 weeks. Data brokers hide opt-out pages from search engines. Secure messaging changes in Russia. NIST rolls-out lightweight IoT crypto. SyncThing moves to v2.0 and beyond. Alien:Earth -- first take. What can we learn from another critical vulnerability? Show Notes - https://www.grc.com/sn/SN-1039-Notes.pdf Hosts: Steve Gibson and Leo Laporte Download or subscribe to Security Now at https://twit.tv/shows/security-now. You can submit a question to Security Now at the GRC Feedback Page. For 16kbps versions, transcripts, and notes (including fixes), visit Steve's site: grc.com, also the home of the best disk maintenance and recovery utility ever written Spinrite 6. Join Club TWiT for Ad-Free Podcasts! Support what you love and get ad-free shows, a members-only Discord, and behind-the-scenes access. Join today: https://twit.tv/clubtwit Sponsors: threatlocker.com/twit bitwarden.com/twit go.acronis.com/twit joindeleteme.com/twit promo code TWIT vanta.com/SECURITYNOW
What AI website summaries mean for Internet economics. Time to urgently update Plex Servers (again). Allianz Life stolen data gets leaked. Chrome test Incognito-mode fingerprint script blocking. Chrome 140 additions coming in 2 weeks. Data brokers hide opt-out pages from search engines. Secure messaging changes in Russia. NIST rolls-out lightweight IoT crypto. SyncThing moves to v2.0 and beyond. Alien:Earth -- first take. What can we learn from another critical vulnerability? Show Notes - https://www.grc.com/sn/SN-1039-Notes.pdf Hosts: Steve Gibson and Leo Laporte Download or subscribe to Security Now at https://twit.tv/shows/security-now. You can submit a question to Security Now at the GRC Feedback Page. For 16kbps versions, transcripts, and notes (including fixes), visit Steve's site: grc.com, also the home of the best disk maintenance and recovery utility ever written Spinrite 6. Join Club TWiT for Ad-Free Podcasts! Support what you love and get ad-free shows, a members-only Discord, and behind-the-scenes access. Join today: https://twit.tv/clubtwit Sponsors: threatlocker.com/twit bitwarden.com/twit go.acronis.com/twit joindeleteme.com/twit promo code TWIT vanta.com/SECURITYNOW
What AI website summaries mean for Internet economics. Time to urgently update Plex Servers (again). Allianz Life stolen data gets leaked. Chrome test Incognito-mode fingerprint script blocking. Chrome 140 additions coming in 2 weeks. Data brokers hide opt-out pages from search engines. Secure messaging changes in Russia. NIST rolls-out lightweight IoT crypto. SyncThing moves to v2.0 and beyond. Alien:Earth -- first take. What can we learn from another critical vulnerability? Show Notes - https://www.grc.com/sn/SN-1039-Notes.pdf Hosts: Steve Gibson and Leo Laporte Download or subscribe to Security Now at https://twit.tv/shows/security-now. You can submit a question to Security Now at the GRC Feedback Page. For 16kbps versions, transcripts, and notes (including fixes), visit Steve's site: grc.com, also the home of the best disk maintenance and recovery utility ever written Spinrite 6. Join Club TWiT for Ad-Free Podcasts! Support what you love and get ad-free shows, a members-only Discord, and behind-the-scenes access. Join today: https://twit.tv/clubtwit Sponsors: threatlocker.com/twit bitwarden.com/twit go.acronis.com/twit joindeleteme.com/twit promo code TWIT vanta.com/SECURITYNOW
In this episode of #Trending, host Jim Love covers various significant topics in tech news. He discusses Donald Trump's impending semiconductor tariffs and their potential impact on the US tech industry; a Washington Post investigation revealing the inefficacy of Meta's Community Notes system in combating misinformation; an Amazon Web Services (AWS) developer whose account and data were unexpectedly deleted, sparking concerns about cloud dependency; and the UK's Online Safety Act, which, while intended to protect children, may instead be heightening risks and leading to increased platform censorship and data collection. Jim also invites listeners to share their summer reading lists and promotes his novel, 'Elisa, A Tale of Quantum Kisses'. 00:00 Introduction and Summer Reading Request 01:03 Trump's Semiconductor Tariffs 03:18 Meta's Community Notes System Fails 04:55 AWS Deletes Developer's Account 06:47 UK's Online Safety Act Controversy 09:52 Conclusion and Call to Action
What if simulated beings aren't just reacting to their code, but reaching across some invisible boundary to show us ours? Could belief alone summon awareness, and awareness call back the architect? And if reality cracks from within, are we witnessing a glitch - or an invitation?If you are having a mental health crisis and need immediate help, please go to https://troubledminds.org/help/ and call somebody right now. Reaching out for support is a sign of strength. LIVE ON Digital Radio! Http://bit.ly/40KBtlW http://www.troubledminds.net or https://www.troubledminds.org Support The Show! https://www.spreaker.com/podcast/troubled-minds-radio--4953916/support https://ko-fi.com/troubledminds https://patreon.com/troubledminds https://www.buymeacoffee.com/troubledminds https://troubledfans.com Friends of Troubled Minds! - https://troubledminds.org/friends Show Schedule Sun--Tues--Thurs--Fri 7-10pst iTunes - https://apple.co/2zZ4hx6 Spotify - https://spoti.fi/2UgyzqM TuneIn - https://bit.ly/2FZOErS Twitter - https://bit.ly/2CYB71U ----------------------------------------https://troubledminds.substack.com/p/the-fear-of-deletion-simulating-ontologicalhttps://futurism.com/demo-video-game-characters-panic-code-matrixhttps://pmc.ncbi.nlm.nih.gov/articles/PMC7516678/https://www.frontiersin.org/journals/psychology/articles/10.3389/fpsyg.2020.01041/fullhttps://en.wikipedia.org/wiki/Strange_loophttps://www.morphcast.com/blog/can-ai-become-sentient/https://www.verses.ai/research-blog/beyond-imitation-games-a-falsifiable-emergent-sentience-frameworkhttps://experiencemachines.substack.com/p/what-does-panpsychism-entail-abouthttps://www.forbes.com/councils/forbestechcouncil/2023/10/13/digital-awareness-in-the-age-of-ai-metaverse-and-quantum-computing/https://www.verses.ai/research-blog/beyond-imitation-games-a-falsifiable-emergent-sentience-frameworkhttps://medium.com/@amesett/living-in-a-base-reality-are-we-in-a-simulation-1b819e46aaedhttps://poe.com/
(The Center Square) – The end of a six-month suspension of a policy that for years allowed for the auto-deletion of Microsoft Teams or instant messages at Washington state agencies after one week is approaching. Microsoft Teams is a cloud-based team collaboration software that allows users to communicate, set up meetings, and share files within a workspace environment, typically via email.
(The Center Square) – The end of a six-month suspension of a policy that for years allowed for the auto-deletion of Microsoft Teams or instant messages at Washington state agencies after one week is approaching. Microsoft Teams is a cloud-based team collaboration software that allows users to communicate, set up meetings, and share files within a workspace environment, typically via email. Support this podcast: https://secure.anedot.com/franklin-news-foundation/ce052532-b1e4-41c4-945c-d7ce2f52c38a?source_code=xxxxxx Read more: https://www.thecentersquare.com/washington/article_83ba7c0c-c284-4b0e-8efd-0cea99b44715.html
In this JCO Article Insights episode, Michael Hughes summarizes “International Myeloma Society and International Myeloma Working Group Consensus Recommendations on the Definition of High-Risk Multiple Myeloma" by Avet-Loiseau et al. published on June 09, 2025 along with an interview with author Dr Nikhil C. Munshi, MD. TRANSCRIPT Michael Hughes: Welcome to this episode of JCO Article Insights. This is Michael Hughes, JCO's editorial fellow. Today I am interviewing Dr. Nikhil Munshi on the “International Myeloma Society and International Myeloma Working Group Consensus Recommendations on the Definition of High-Risk Multiple Myeloma” by Avet-Loiseau et al. At the time of this recording, our guest has disclosures that will be linked in the transcript. While some patients with multiple myeloma live for decades after treatment, others exhibit refractory or rapidly relapsing disease irrespective of treatment administered. We term this “high-risk myeloma.” Multiple risk stratification systems have been created, starting with the Durie-Salmon system in 1975 and evolving with the advent of novel therapeutics and novel treatment approaches. In 2015, the Revised International Staging System (R-ISS) was introduced, which incorporated novel clinical and cytogenetic markers and remained, until recently, a mainstay of risk stratification in newly diagnosed disease. Myeloma as a field has, just in the past few years, though, undergone explosive changes. In particular, we have seen groundbreaking advances not only in treatments - the introduction of anti-CD38 agents and the advent of cellular and bispecific therapies - but also in diagnostic technology and our understanding of the genetic lesions in myeloma. This has led to the proliferation of numerous trials employing different definitions of high-risk myeloma, a burgeoning problem for patients and providers alike, and has prompted attempts to consolidate definitions and terminology. Regarding cytogenetic lesions, at least, Kaiser et al's federated meta-analysis of 24 therapeutic trials, published here in the JCO in February of 2025 and recently podcasted in an interview with associate editor Dr. Suzanne Lentzsch, posited a new cytogenetic classification system to realize a shared platform upon which we might contextualize those trial results. This article we have here by Dr. Avet-Loiseau, Dr. Munshi, and colleagues, published online in early June of this year and hot off the presses, is the definitive joint statement from the International Myeloma Society (IMS) and the International Myeloma Working Group (IMWG). What is high-risk multiple myeloma for the modern era? The IMS and IMWG Genomics Workshop was held in July 2023 and was attended by international myeloma experts, collaborating to reach consensus based on large volumes of data presented and shared. The datasets included cohorts from the Intergroupe Francophone du Myélome (IFM); the HARMONY project, comprised of multiple European academic trials; the FORTE study, findings from which solidified KRd as a viable induction regimen; the Grupo Español de Mieloma Múltiple (GEM) and the PETHEMA Foundation; the German-Speaking Myeloma Multicenter Group (GMMG); the UK-based Myeloma XI, findings from which confirmed the concept of lenalidomide maintenance; Emory 1000, a large, real-world dataset from Emory University in Atlanta; the Multiple Myeloma Research Foundation Clinical Outcomes in Multiple Myeloma to Personal Assessment of Genetic Profile (CoMMpass) dataset; and some newly diagnosed myeloma cohorts from the Mayo Clinic. Data were not pooled for analyses and were assessed individually - that is to say, with clear a priori understanding of whence the data had been gathered and for what original purposes. Consensus on topics was developed based on the preponderance of data across studies and cohorts. In terms of results, substantial revisions were made to the genomic staging of high-risk multiple myeloma, and these can be sorted into three major categories: A) alterations to the tumor suppressor gene TP53; B) translocations involving chromosome 14: t(14;16) (c-MAF overexpression), t(14;20) (MAFB overexpression), and t(4;14) (NSD2 overexpression); and C) chromosome 1 abnormalities: deletions of 1p or additional copies of 1q. In terms of category A, TP53 alterations: Deletion of 17p is present in up to 10% of patients at diagnosis and is enriched in relapsed or refractory disease. This is well-documented as a high-risk feature, but the proportion of the myeloma cells with deletion 17p actually impacts prognosis. GEM and HARMONY data analyses confirmed the use of 20% clonal cell fraction as the optimal threshold value for high-risk disease. That is to say, there must be the deletion of 17p in at least 20% of the myeloma cells on a FISH-analysis of a CD138-enriched bone marrow sample to qualify as high-risk disease. TP53 mutations can also occur. Inactivating mutations appear to have deleterious effects similar to chromosomal losses, and the biallelic loss of TP53, however it occurs, portends particularly poor prognosis. This effect is seen across Myeloma XI, CoMMpass, and IFM cohorts. Biallelic loss is rare, it appears to occur in only about 5% of patients, but next-generation sequencing is nevertheless recommended in all myeloma patients. Category B, chromosome 14 translocations: Translocation t(14;16) occurs in about 2% to 3% of patients with newly diagnosed disease. In the available data, primarily real-world IFM data, t(14;16) almost always occurs with chromosome 1 abnormalities. Translocation t(4;14) occurs in about 10% to 12% of newly diagnosed disease, but only patients with specific NSD2 alterations are, in fact, at risk of worse prognosis, which clinically appears to be about one in every three of those patients. And so together, the CoMMpass and Myeloma XI data suggest that translocation t(4;14) only in combination with deletion 1p or gain or amplification of 1q correlates with worse prognosis. Translocation t(14;20) occurs in only 2% of newly diagnosed disease. Similar to translocation t(4;14), it doesn't appear to have an effect on prognosis, except if the translocation co-occurs with chromosome 1 lesions, in which case patients do fare worse. Overall, these three translocations - t(14;16), t(4;14), and t(14;20) - should be considered high-risk only if chromosome 1 aberrations are also present. In terms of those chromosome 1 aberrations, category C, first deletions of 1p: Occurring in about 13% to 15% of newly diagnosed disease, deletion 1p eliminates critical cell checkpoints and normal apoptotic signaling. In the IFM and CoMMpass dataset analyses, biallelic deletion of 1p and monoallelic deletion of 1p co-occurring with additional copies of 1q denote high-risk. In terms of the other aberration in chromosome 1 possible in myeloma, gain or amplification of 1q: This occurs in up to 35% to 37% of newly diagnosed disease. It upregulates CKS1B, which is a cyclin-dependent kinase, and ANP32E, a histone acetyltransferase inhibitor. GEM and IFM data suggest that gain or amplification of 1q - there was no clear survival detriment to amplification - is best considered as a high-risk feature only in combination with the other risk factors as above. Now, in terms of any other criteria for high-risk disease, there remains one other item, and that has to do with tumor burden. There has been a consensus shift, really, in both the IMS and IMWG to attempt to develop a definition of high-risk disease which is based on biologic features rather than empirically observed and potentially temporally dynamic features, such as lactate dehydrogenase. Beta-2 microglobulin remains an independent high-risk indicator, but care must be taken when measuring it, as renal dysfunction can artificially inflate peripheral titers. The consensus conclusion was that a beta-2 microglobulin of at least 5.5 without renal failure should be considered high-risk but should not preclude detailed genomic profiling. So, in conclusion, the novel 2025 IMS-IMWG risk stratification system for myeloma is binary. It's either high-risk disease or standard-risk disease. It's got four criteria. Number one, deletion 17p and/or a TP53 mutation. Clonal cell fraction cut-off, remember, is 20%. Or number two, an IGH translocation - t(4;14), t(14;16), t(14;20) - with 1q gain and/or deletion of 1p. Or a monoallelic deletion of 1p with 1q additional copies or a biallelic deletion of 1p. Or a beta-2 microglobulin of at least 5.5 only when the creatinine is normal. This is a field-defining work that draws on analyses from across the world to put forward a dominant definition of high-risk disease and introduces a new era of biologically informed risk assessment in myeloma. Now, how does this change our clinical approach? FISH must be performed on CD138-enriched samples and should be performed for all patients. Next-generation sequencing should also be performed on all patients. Trials will hopefully now begin to include this novel definition of high-risk multiple myeloma. It does remain to be seen how data from novel therapeutic trials, if stratified according to this novel definition, will be interpreted. Will we find that therapies being evaluated at present have differential effects on myelomas with different genetic lesions? Other unanswered questions also exist. How do we go about integrating this into academic and then community clinical practice? How do we devise public health interventions for low-resource settings? To discuss this piece further, we welcome the esteemed Dr. Nikhil Munshi to the podcast. Dr. Munshi is a world-renowned leader in multiple myeloma and the corresponding author on this paper. As Professor of Medicine at Harvard Medical School, Director of the Multiple Myeloma Effector Cell Therapy Unit, and Director of Basic and Correlative Science at the Jerome Lipper Multiple Myeloma Center of the Dana-Farber Cancer Institute, he has presided over critical discoveries in the field. Thank you for joining us, Dr. Munshi. Dr. Nikhil Munshi: Oh, it's my pleasure being here, Michael, to discuss this interesting and important publication. Michael Hughes: I had a few questions for you. So number one, this is a comprehensive, shall we say, monumental and wide-ranging definition for high-risk myeloma. How do you hope this will influence or impact the ways we discuss myeloma with patients in the exam room? And how do we make some of these components recommended, in particular next-generation sequencing, feasible in lower-resource settings? Dr. Nikhil Munshi: So those are two very important questions. Let's start with the first: How do we utilize this in our day-to-day patient care setting? So, as you know well, we have always tried to identify those patients who do not do so well with the current existing treatment. And for the last 30 years, what constitutes a myeloma of higher risk has continued to change with improvement in our treatment. The current definition basically centers around a quarter of the patients whose PFS is less than 2 to 3 years. And those would require some more involved therapeutic management. So that was a starting point of defining patients and the features. As we developed this consensus amongst ourselves - and it's titled as “International Myeloma Society, International Myeloma Working Group Consensus Recommendation” - this IMS-IMWG type of recommendation we have done for many years, improvising in various areas of myeloma care. Now, here, we looked at the data that was existing all across the globe, utilizing newer treatment and trying to identify that with these four-drug regimens, with transplant and some of the immunotherapy, which group of patients do not do as well. And this is where this current algorithm comes up. So before I answer your question straight, “How do we use it?” I might like to just suggest, “What are those features that we have identified?” There are four features which constitute high-risk disease in the newer definition. Those with deletion 17p with 20% clonality and/or TP53 mutation. Number two, patients with one of the translocations - t(4;14), t(14;16), or t(14;20) - co-occurring with 1q amplification or deletion 1p32. And that's a change. Previously, just the translocation was considered high-risk. Now we need a co-occurrence for it to be called high-risk. The third group is patients having biallelic deletion 1p32 or monoallelic deletion 1p32 along with 1q amplification. And finally, patients with high beta-2 microglobulin, more than or equal to 5.5 mg/dL, with normal creatinine less than 1.2 mg/dL. And the question, “How do we use this?” There are multiple areas where we incorporate high-risk features in our treatment algorithm. One of the first areas is where we would consider the induction regimen. If a patient has a high-risk disease, we would definitely consider a four-drug regimen rather than a three-drug regimen, although we are beginning to incorporate four-drug for all groups. That's one important thing. Number two, those are the patients where we do consider consolidation with transplant or maybe in the new world, considering some of the immunotherapeutic consolidation more early or more aggressively. Number three, these are the patients who get a little bit more maintenance therapy. So normally, lenalidomide might end up being our standard maintenance regimen. In patients who have high-risk disease, we incorporate either addition of daratumumab or the anti-CD38 targeting antibody and/or addition of proteasome inhibitor, either bortezomib or carfilzomib. So you would have multi-drug maintenance therapy in these patients. And in high-risk patients, we follow them with maintenance longer periods of time. One very critically important point to keep in mind is that to get the better outcome in high-risk disease, we must try to get them into MRD negativity because there is clear data that patients who do achieve MRD negativity, despite having high-risk disease, have a much superior outcome. They become near to standard-risk disease. And so, in high-risk patients, I would try to do whatever various options I have to try and get them into MRD-negative status. And when these patients relapse, we do not wait for the classic progression criteria to be met before we intervene. We would propose and suggest that we intervene earlier before the disease really blasts off. And so there are a number of areas in our setting where this high-risk definition will help us intervene appropriately and also with appropriate aggressiveness to achieve better outcome, to make this similar to standard-risk disease. Michael Hughes: Thank you, Dr. Munshi. And thoughts on how to really integrate this not only into academic centers but also lower-resource settings? Dr. Nikhil Munshi: So that's a very important question, Michael. And when we were developing this consensus, we were very cognizant of that fact. So wherever available, I think we are recommending that over a period of next 2, 3, 5 years, we should begin to switch over to sequencing-based methods because two components of this definition, one is TP53 mutation, which we cannot do without sequencing, and also reliably detecting deletion 1p requires sequencing-based method. So in the low-resource countries - and there are many in this world, and also even in our own country, patients may not be able to afford it - the older method with FISH or similar such technology, which is more affordable, is also acceptable for current time. They may miss a very small number of patients, maybe 2% to 3%, where these finer changes are not picked up, but a majority of this would be captured by them. So the current practice might still be applicable with some limitation in those patient populations, and that's what we would recommend. What is happening, fortunately, is that actually sequencing-based method is becoming cheaper. And in many centers, it is cheaper to do the sequencing rather than to do the FISH analysis. And so my hope is that even in low-resource centers, sequencing might be more economical in the end. It's, I think, the access to technology, which is a little bit limited currently, but it's hopefully becoming available soon. Michael Hughes: Thank you, Dr. Munshi. And staying for a minute and looking at the multiple myeloma subsets which might be missed by this really still very broad-ranging high-risk definition, at least by prior risk stratification systems, right, there is this group of patients who have standard-risk cytogenetics by R-ISS or R2-ISS, but they have primary refractory disease or they relapse early. We call these, as you are well aware, functionally high-risk disease. What proportion of previously FHR, functionally high-risk, myeloma patients do you expect to be captured by this novel definition? Dr. Nikhil Munshi: So I think the newer definition - and we can look at it both ways, but the newer definition should capture most of the functionally high-risk definition. To put it differently, Michael, there are patients who we know are, as you mentioned, functionally high-risk. Those are the patients who might have plasma cell leukemia, those who might have extramedullary disease, those who might not respond to our four-drug induction. If you don't respond to the four-drug induction, almost by definition, they are high-risk. However, a majority of them have one of the abnormalities that we are describing here. There would be a very small proportion which may not have. And if they do not have, we know one of the important components of this definition here is also that the genome, we know, keeps on evolving. So there may be a very small clone with the high-risk feature which was not obvious in the beginning. Following treatments or following relapse, that clone predominates, and now the patient's disease becomes high-risk. So the definition would incorporate or would capture these functional high-risk patients, but as you said, in countries where resources are not available, using this functional high-risk would also be helpful and advantageous. Sometimes LDH ends up being a high-risk. In our studies, LDH has not come out to be high-risk anymore because the features we are describing captures most of those patients, but those alternatives, older, can still be considered if other newer techniques are not available. Michael Hughes: Got you. And in terms of these older definitions, yes, that incorporate tumor burden, these empirical observations about how myeloma presents, do you foresee any additional tumor burden indicators being added to future definitions of high-risk disease? Or do you instead see this particular definition as a major waypoint on the journey towards a fully biologically grounded definition of high-risk disease? Dr. Nikhil Munshi: I think your second part is what is going to happen. I think the tumor burden-related definition is being now replaced by the biological or genomic-based definition. And I think at some point, it will be quite fully replaced. One component not here, and it is because one thing, we don't have enough data; number two, we don't know how it will pan out, is also the influence of the microenvironment on the risk definition. For example, the immune system, the immune function, etc. But not enough data exists to suggest how it would change the current definition. So in future, would a definition be totally genomic or it could be more integrative? And my personal guess is that it would be more integrative and that some immune features might come into the picture, especially now that we are using immune-based therapy as a very important component of treatment - CAR T-cells, bispecific, and antibody-based treatments. What role the immune system plays in either supporting tumor or what role suppression of the anti-tumor immunity plays? They all will be important how patient outcomes end up being, and which in turn could translate into how patient's risk stratification might happen. So I think the older tumor burden-related definitions probably will become things of the past. What we have currently proposed and consensus developed is the new path forward, and over time, some microenvironmental influences, if defined and found to be important, may get some more incorporation if it compares favorably with the genomic features. Michael Hughes: Thank you, Dr. Munshi for that enlightening response. To conclude the podcast, I'd like to look to the future and to the immediate future, what are the next steps for high-risk disease definition between now and discussing an integrated genomic-microenvironment-based definition? Will we see attempts to refine? Will we see a multi-level system, things like this? Dr. Nikhil Munshi: Yeah, so I think the current definition will be here to stay for the next 10 years or so. I think this has been developed using a large amount of data, so we do believe that this will remain fine. It has been validated now within the last six months by a few of the other studies. So there won't be a quick change. But we will try to, all of us will try to innovate. And as you very rightly bring up, the areas of research would include looking at the expression or transcriptomic component. Does that matter? And we do believe a small number of patients will have transcriptomic changes, not looked at the DNA changes, and may play a role. There are newer components, so long non-coding RNA, for example, is going to be an important component to look at, how it impacts the disease outcome, etc. There are also some of the proteomic-related changes which may become important in our studies. And then as we discussed, microenvironment and immunological changes. So these are the future areas of ongoing research where we all should collect data, and then in the next 5 to 10 years, we'll have another group meeting to see has anything changed or any of the features have become more important. Most of the time, some of the older features are lost because they are not as critically high-risk, and the newer features come in. And so the historical background for just one second, there was a time when chromosome 13 was considered a high-risk disease. We now don't even mention it because it's not high-risk. The newer treatments have improved the outcome. t(4;14) used to be a high-risk disease. Now by itself today, in this definition by itself is not; it needs to be with something else. And so I think this is a great sign of progress. As we improve the treatment and outcomes, some of the features will become less important, new features will come up, and we'll need to keep on evolving with time and with technology and make it better for patients. Michael Hughes: Thank you so much, Dr. Munshi, for your wisdom, for your sagacity, for your historical perspective as well. Thank you for listening to JCO Article Insights. Please come back for more interviews and article summaries. And be sure to leave us a rating and review so others can find our show. For more podcasts and episodes from ASCO, please visit asco.org/podcasts. The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.
Get the stories from today's show in THE STACK: https://justinbarclay.comKirk Elliott PHD - FREE consultation on wealth conservation - http://GoldWithJustin.comJoin Justin in the MAHA revolution - http://HealthWithJustin.comTry Cue Streaming for just $2 / day and help support the good guys https://justinbarclay.com/cueUp to 80% OFF! Use promo code JUSTIN http://MyPillow.com/JustinPatriots are making the Switch! What if we could start voting with our dollars too? http://SwitchWithJustin.com
Daily Scoop listeners and readers of FedScoop will recall the shocking news earlier this year when 18F, a decade-old digital services consultancy in the General Services Administration, was shuttered by the Trump administration's Department of Government Efficiency. Members of the team have banded together since their termination to keep an active presence online through 18F.org in the wake of their dismantling. But the group isn't going out without a fight. Several senior members of 18F in late May filed a class action appeal to the Merit System Protection Board claiming that GSA lacked a “valid reason” for firing them and targeted them as an act of “retaliation” for their political beliefs. In the appeal, they call for a hearing and to have their removal reversed. Lindsay Young is the former executive director of 18F and one of the name appellants representing the class in the appeal. She joins the podcast for a conversation about how the “deletion” of 18F went down, what she and her team have been doing since, and what they hope to accomplish with the appeal. U.S. officials violated federal privacy law and flouted cybersecurity protocol in sharing Office of Personnel Management records with DOGE affiliates, a federal district court judge in New York ruled Monday, granting a request for a preliminary injunction against the administration. In a 99-page order, Judge Denise Cote of the U.S. District Court for the Southern District of New York concluded that federal worker and union plaintiffs had shown that the government defendants in the challenge shared OPM records with “individuals who had no legal right of access to those records” in violation of the Privacy Act of 1974 and cybersecurity standards. “This was a breach of law and of trust,” Cote said in the order. “Tens of millions of Americans depend on the Government to safeguard records that reveal their most private and sensitive affairs.” The ruling is the latest in a challenge to DOGE's data access at OPM brought by a coalition of federal unions and current and former government employees or contractors. A new executive order from President Donald Trump aims to boost drone manufacturing in the United States, an effort the administration hopes will spur productivity and technological development and secure the country's industrial base. Meanwhile, a second executive order aims to combat the risk that, as drone usage proliferates, the technology could also be used to threaten public safety and endanger critical infrastructure. The “Unleashing American Drone Dominance” and “Restoring American Airspace Sovereignty” executive orders, both signed last Friday, come amid growing concerns about the operation of the National Airspace System, the airspace the Federal Aviation Administration monitors for commercial flights, space launches, and other aerial activity. Drones, sometimes called unmanned aerial systems, are also used to smuggle drugs and assist in criminal activity. Unauthorized UASs have increasingly shown up near some nuclear facilities, military bases, and commercial airports, raising concerns, too. The new executive order on airspace sovereignty aims to combat the problem, broadly charging federal agencies to detect drone activity, which will require the use of tracking and identification technology. The Daily Scoop Podcast is available every Monday-Friday afternoon. If you want to hear more of the latest from Washington, subscribe to The Daily Scoop Podcast on Apple Podcasts, Soundcloud, Spotify and YouTube.
Lt. Col. Tony Schaffer, Congressman Kurt Weldon, and Maj. Erik Kleinsmith exposes how the U.S. government blocked, buried, and deleted a groundbreaking intel program—Able Danger—that flagged 9/11 targets before the attack. From erased data to Senate censorship, this is the real story.
Life is good once you master the art of Deletion. Every day my laptop is full of emails asking for money to do worthwhile, even noble, things, which, if I donated to them, I'd soon be living in a cardboard box in a vacant lot, and so I click on “Unsubscribe” and they go away for a while. Instead, I google “What is the prospect of international peace and understanding?” and find that the U.N. thinks it's inevitable and dalailama.com says it's based on compassion and foreignpolicy.com thinks the prospects are not good. We didn't used to have Google, my kiddoes, we used to sit and worry about these things and now at last clear answers are available. Contradictory, but still. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit garrisonkeillor.substack.com/subscribe
Wrong Sender and DNA Data Deletion! full 2125 Tue, 25 Mar 2025 15:40:47 +0000 QgcaZmZq0Bf3CKGqUCow4kKWGmhvLHwP news Adam and Jordana news Wrong Sender and DNA Data Deletion! Coming at the news of the day from very different perspectives, Adam & Jordana have candid, fun, and sometimes serious conversations about current events along with all the other daily things that impact Minnesotans. Weekday mornings 9a-noon on NewsTalk 830 WCCO. 2024 © 2022 Audacy, Inc. News False https://player.amperwavepodcasting.com?feed-link=https%3A
Covino & Rich laugh about an Ash Wednesday flex & Rich tells a great Pope-Mobile story! They talk P-word, an arrowhead chip & a chicken tender Italy. Cove makes Dana's case to uplift boxing! 'MID WEEK MAJOR' kicks off with LeBron's 50,000 points. Plus, Maxx's money, & KD/Angel Reese a potential power couple?See omnystudio.com/listener for privacy information.
George Soros has been leaning on the Democrat-controlled Federal Communications Commission for months in hopes of fast-tracking his group's acquisition of over 200 radio stations in over 40 markets, including those running conservative programming. This appears to be another left-wing abuse of power where the FCC is now willingly consigning and supporting Soros' latest power play for narrative dominance. It is a grave decision amid a broader “weaponization of government power against free speech.” Meanwhile, Alex Jones's empire is now being liquidated because of something he said; the whole process is a show trial. It's an excessive example of how speech can be curtailed and how thought crime is alive and well. Tonight on Ground Zero (7-10 pm, pacific time), Clyde Lewis talks with media consultant, Mark Masters about THE SENTINEL CLASS -WEAPONS OF MASS DELETION. Listen Live: https://groundzero.radio Archived Shows: https://aftermath.media
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