Capability of producing the desired result
EP299 - Thanksgiving Week 2022 with Rob Garf of Salesforce A discussion of Thanksgiving Week 2022 from a retail perspective with Rob Garf, Vice President and General Manager, Retail at Salesforce. This is Robs' fourth time on the show, having previously been on episodes 110, 248, and 282. Thanksgiving week 2022 will go down as one of the most complicated holiday weeks on record. With covid impacts still in place, a global economic crisis, supply chain disruptions, labor shortages, new retailer discounting practices, and new consumer behaviors we have a lot to unpack. This episodes covers a wide range of topics around the most important shopping week of the year. We make liberal use of real-time data from Salesforce Shopping Insights HQ, which tracks how 1.5+ billion consumers are shaping shopping trends. You can see a real-time holiday dashboard, powered by Tableau so you can interact with the data yourself on the Salesforce Holiday Insights page. Episode 299 of the Jason & Scot show was recorded on Tuesday November 29th, 2022. http://jasonandscot.com Join your hosts Jason "Retailgeek" Goldberg, Chief Commerce Strategy Officer at Publicis, and Scot Wingo, CEO of GetSpiffy and Co-Founder of ChannelAdvisor as they discuss the latest news and trends in the world of e-commerce and digital shopper marketing. Transcript Jason: [0:23] Welcome to the Jason and Scot show this is episode 299 being recorded on Tuesday November 29th 2022 the day after Cyber Monday I'm your host Jason retailgeek Goldberg and as usual I'm here with your co-host Scot Wingo. Scot: [0:41] Hey Jason and welcome back Jason and Scot show listeners Jason it wouldn't be a delicious turkey five if we didn't have our regular holiday guests robbed our van Rob is the vice president and general manager I think it's total maybe longer than yours a retail at Salesforce let's see those two forces that's like eight words so you need to get to work this is Rob's fourth appearance on the Jason Scott show he was here for episode 1 10 to 40 9282 and back for number four here and episode 299 Rob welcome back. Rob: [1:15] Gentlemen it is such a pleasure to join you today I can't wait to talk about cyber week. Jason: [1:21] It wouldn't be a several week if we weren't talking to you Rob and as a I feel like a special bonus for me two of the three people on this podcast have received a 10 out of 10 rating from room Raider. Rob: [1:33] Hmm who Could That Be Well I know you did it because you have a sweet pillow that shows it off. Jason: [1:39] And I think I feel like you got up before me. Rob: [1:42] I think so you know I gotta tell a really funny story quickly if I can I was doing early on in the pandemic a webinar I think it was probably with. Business Insider and they brought like a staging expert online and I thought I had the best background I had like a. Something like my wife got me for my 40th birthday long time ago by the way I like 1910 or 1920 National Cash Register in the background I felt all good about that and she totally. Blew up my room and thankfully she did cuz I turned out on top with a 10/10. [2:18] I know I probably shouldn't have given that away but I felt pretty cool about it. Scot: [2:21] Jason had a team of 10 people at publicist set his up so don't don't don't listen to him. Rob: [2:26] Either and he probably gets like product placement dollars as well as a influencer for all the cool things he has in the. Scot: [2:33] And they came in from France. Jason: [2:34] And side note on that the jury is out on whether giant marketing holding companies can actually help your sales but they can for sure help you win Awards. Rob: [2:43] Congratulations. Scot: [2:46] Well Rob weird. Rob: [2:47] Scot the trifecta anyways we digress. Scot: [2:49] Well yes some of us I guess my day job I'm like I don't know not really working on my room. Rob: [2:55] Actually you are about to say you're actually working or aren't ya. Scot: [2:59] Well yeah the so in case even though this is your fourth time around let's there's definitely we always pick up millions of new listeners so let's if you could recap the data that you guys have at Salesforce where it comes from and then you know we're recording this the day after Cyber Monday you've got some hot delicious fresh data will jump in after you kind of give the high-level overview in case people aren't aware. Rob: [3:25] I can't wait I'm loving it we've been swimming through this data for a better part of the we can't wait to share it with your crowd your audience yeah so by way of introduction again Rob Garf here. With Salesforce I came to Salesforce by way of the demandware acquisition which is about. Six years ago I spent five years prior at demandware on the GM for retail what that means is I oversee our product. And solution strategy along with our industry insights team and that's what gives me the great pleasure of talking cyber week and actually providing insights and intelligence for our customers all year long and the way we do that is all the data that flows through the platform we bubble that up we obviously strip out all pii data. And in its aggregate form billions of billions Shoppers it gives us an amazing read and pulse on the industry and we publish at throughout cyber week on our shopping insights HQ it's an interactive dashboard, built on Tableau and it really allows our customers the broader industry to understand what's going on in digital and be able to Benchmark themselves. Scot: [4:32] Frequent thanks for that summary so let's start with the kind of the elephant in the room I get this question and Jason does a lot as well you know I'm a CNBC junkie and all they talk about is inflation and recession so so anything kind of in the macroeconomics showing up in the data that you've seen. Rob: [4:51] Yeah absolutely and I think it's important to understand this holiday while the global numbers look really promising much of that if not all of that growth was concentrated. In the u.s. there's a bunch of headwinds happening for various reasons across Europe and UK along with Australian and Zealand but the US consumer who was really happy this. Cyber week and we'll talk about the data but yeah in terms of inflation are shopping index which the shopping insights ahq is built off of, has been showing an average selling price increase for the last seven quarters and that's been pretty steady and so, that's definitely played a key role in this holiday season in that much if not all of the growth that we're seeing, is driven by increased pricing not necessarily people buying more, product and I think that's a really important distinction now what I will say and I'm happy to say this in the first time we're seeing a leveling off of that inflation globally over cyber week it was only I say only a three percent increase which is promising as we're looking forward to the new year. Scot: [6:02] Yeah I think it's Cressida at least the macroeconomic around 10% so so 3 is 3 is a pretty good. Rob: [6:09] Yeah exactly it's promising. Scot: [6:12] And then that ASP increase is, does that account for mix shift so like you know if people buy more luxury goods than our and then another segment goes value could that factor into that ASP or you normalize for that in some way. Rob: [6:27] We normalize for that because to your point obviously average order value for luxury versus value segments are going to be different but we really normalize that look at it across the board, and so it's taking into account of the various factors based on segments. Jason: [6:44] Yeah and as the resident Debbie Downer it's. We always want to have simple sound bites to describe this weekend like all of these Trends to me are super complicated because you just highlighted the, conflicting Trend that like we have inflation goods are costing more / we're probably going to talk about discounting later to help Goose holiday sales which of course brings prices down and when people are nervous about the economy they shift to more needs which have higher inflation than the wants and it seems when you really dive into it it's really complicated kind of inflation seems different on online versus offline and category by category. Rob: [7:25] Yeah it is complex you're right there's not a single kind of soundbite answer although if we stay on long enough I'm sure I'll come up with one or two. But you know you're right in terms of the discount right so if I dive into that for a sec Jason to put a little color around it we saw for the week in the US there was a 30%. Average discount rate globally it was twenty-seven percent and we can talk about how that looks your rear and how it looked, compared to 2019 but even with those large discounts and by the way those are large discounts compared to any normal day. During the year we're looking at 15 16 percent discount rate so it's you know in the double of what we typically see, the reality is the reality is people are still paying more for a particular product than they were two years ago so people are feeling really good obviously that average is 30 in the us but we all saw over the last couple days, 40% 50% even yesterday 60% in the massive amount of emails that I got trying to push and really. Incentivize people to actually click the buy button so my point here though is even with these high discount rates people are still spending more for a particular product than they did a couple of years ago. Jason: [8:42] Yeah I like to say 40% off is the new 30% off for this holiday. Rob: [8:48] Yeah I mean my father was in retail growing up so we would get discounts at the various apparel and Footwear companies he worked for and he always would joke that my mother would save us so much money we're going to go broke. Jason: [8:58] I love that we might come back to this counting but I do want to zoom out for just a second. Traditionally Black Friday is the official heart start of the holiday shopping season here in the u.s. is that even true anymore. Rob: [9:15] Well certainly retailers don't want that to be true they want it obviously to be pulled earlier and earlier in the season and that's another story line that we've seen here you know we actually saw a little bit. Of holiday happen over the summer don't forget and I know you two wouldn't of Amazon Prime day or the first Amazon Prime day and for those retailers not named, Amazon we saw a 21% year over year increase looking at the second week of July compared to the second week of July two thousand twenty one so there was a little bit, very little pull forward and then of course people getting retailers Brad's wanted to take advantage of the halo effect of the second. [9:56] Prime day that happened in October and once again we saw a little bit of a bump interestingly enough some of the larger retailers front ended that with Weekend sales and that pulled a lot of growth during that time you know the weekend before Prime day in October, but the reality Jason after a couple years of spreading out of that demand earlier earlier for various reasons which we can talk about, there was so much of a concentration that happened, over cyber week meaning and based on our data the pulling forward of the couple of percentage points to earlier, in November really we're taking back, this year and were put back in cyber week and it all came down to discounts it all came down to Consumers being really patient. Not seeing what they liked in terms of the lackluster deals and waiting for. Cyber week which really contributed some very positive growth particularly in the US. Jason: [10:57] Yeah it's super interesting because as you pointed out Amazon added a second sale day which I think they technically don't call Prime day right is like Prime Early Access today. Rob: [11:05] Right right right get behind the Velvet Rope and be able to get some early deals. Jason: [11:09] Exactly and Walmart Target and others all counter programmed against that with big sales but it cut it kind of feels like all that got defeated by the fact that consumers are well aware that the discounts are going to be deep this year and it almost seems like they may have decided to wait for deeper discounts. Rob: [11:29] Yeah yeah we call this and I've said it before on the show but I gotta do it right it's an annual tradition, discount chicken right the idea that retailers go into the holiday season with a really well thought out. Plan for the promotional calendar and by the first weekend they typically rip it up and call inaudible. And really try to chase the deals and you know that's what happened this year contrary or in contrast to last year if you remember I know you do gentlemen. Because you track this closer than anyone you know their inventory inventory scarcity issues there was high demand so retailers didn't feel compelled to Discount they didn't we saw the lowest discount rates. In recent history last year and so retailers thought that the consumer was reprogrammed reconditioned and they would buy earlier the problem was, the Retailer's didn't come to the table with the biggest discounts again discount chicken the consumers are going to wait it out and wait for that. [12:29] Best deal and finally the retailers came to the table during cyber week and the consumers answered, in kind you know again last year was probably the first year that retailers won the game of discount chicken this year consumers you know, fought with their leverage and wait and they ended up winning and got some really good deals again 30 percent discount rate in the US over the course of. Thanksgiving it really peaked at Black Friday with 31 percent in the US so they really finally came to the table. Scot: [13:04] Wow, you know we were reading all about last year all those cargo ships were sending off the coast of Long Beach where it is and then you know I've heard a lot of retailers in their commentary talk about being overstocked, do you think do you think that played a role in these big discounts is just retailers or just kind of we got a really clear the shelves out kind of thing. Rob: [13:27] Absolutely absolutely both in the store and in warehouse space they got spooked a little bit right in terms of, them waiting it out didn't quite work and so the Retailer's really had to step up Scott to your point they don't want to go into the new year with too much inventory they really needed a free up both inventory and cash now of course they did that. At the feet of margin right because you see I don't care how great your margin is alright some probably are that great particularly in the luxury segment but 50 60 70 percent discount or you know I saw some it was 50% oh and by the way we'll give you an extra ten percent just to make it sound like they weren't really giving away everything but the reality is. Really margin took a hit because of the deeper discounts that retailers just had to do and to your point they have to free up both the inventory the Shelf space and the cash. Jason: [14:26] Yeah I think even Makin where's I've had a number of clients come to me and say hey we've got too much inventory but even worse it's the wrong inventory that like a lot of that stuff that we ordered for mid-year all the Home Improvement and outdoor furniture stuff that they were trying to get four last year is all in stock now and so what even further incentive fising retailers to discount. Rob: [14:52] Yeah yeah and I give credit to some of the big box players who took a hit over the summer recognizing they tear Point Jason had the wrong inventory and they did something about it they tried to clear it out earlier they were public about it and they took a hit but I think they're going to come back strong you know it's interesting I was a, analysts back in the day and one of our Focus was on supply chain and Mr research was known for supply chain got acquired by Gartner for their supply chain and industries practice, and you know always tracked the gentleman how Lee who came up with the bullwhip effect the idea that, you know any shock in the supply chain will just have this ripple effect that could last, quite some time I got it conceptually heard some examples of it but we've been living that over the last couple of years you know going from inventory scarcity buyers getting really excited thinking of the demand would really. [15:47] Keep steady and then when finally dear points got it came through the port of LA got through the domestic supply chain it was the wrong product or enough people had bought, you know a new monitor or TV or a desk or some cool background to get you know 10 out of 10 on rumerator and the demand wasn't there anymore so you're right I mean some of the things, in terms of replenishable products sure they have a long shelf life they have a long turn but some don't they have an expiration date and retailers are struggling with that and certainly, coming back around it is driving the discount strategy it's not over either will continue to see probably not the same heightened levels but now that we have an extended holiday season because, of create a fulfillment options will see some more discounts it's not the end of it. Scot: [16:34] Yeah that that's a good segue into kind of talking about the shape of the holiday so last year sounds like you saw the data we started a bit earlier and maybe maybe we kind of ended around after the turkey five or kind of came off a cliff there seems like this year consumers waited they won discount chicken and then we've had a robust turkey five maybe walk us through the days we've talked a little bit about Black Friday Cyber Monday anything else you want to hit there and then what do you think happens kind of post. Rob: [17:07] Yeah absolutely to round it out actually and just give that perspective for the entire shape as you talked about the anatomy of the Season as a bunch of my customers talk about. Um there are some kind of pretty nervous people in the industry coming out of the first two weeks of November the last two weeks of October and the first two weeks, of November you know sales kind of words Riri we saw a negative seven percent during that time again little bit of a spike the first. Week in October because of prime day and then it really leveled off quite dramatically 27 percent decline, globally and so we're really worried is this a trend is this going to continue in really what it told us is, that cyber week becomes back into Focus again people were willing to wait people are willing to be patient waiting for those deals you know what we saw for cyber week with again a higher concentration probably around 25 percent of all, digital sales will be when it's all said and done over the course of cyber week in the way we look at it sales force is, the Tuesday before American Thanksgiving through Cyber Monday so we put another two days and it just to make it a full week but we can slice and dice it anyway, you want especially on the dashboard via Tableau on our shopping insights. [18:30] HQ but for the overall cyber week for us we saw nine percent growth. [18:38] And for Global we saw two percent growth. That again as you can tell because of the global number largely buoyed By Us sales Black Friday really strong us we saw. 12% in the US and we saw. [18:57] 3.5 percent growth globally that's Black Friday Cyber Monday we saw eight percent growth in us and we saw four percent growth, globally so very strong what we also saw by the way is healthy traffic we even saw healthy traffic. Earlier in the season so what that told us is people were interested they showed intent to buy but they weren't given the right incentive to actually purchase so you know there's a demand there's. Need there's a want earlier in the season because of the traffic we saw that traffic stayed pretty steady both us and globally, throughout the week as well and obviously that turned into higher conversion rate because people are actually now buying. Scot: [19:47] Cool and then from your day to do you think Cyber Monday was the biggest day we've ever had is do you guys pontificate on them. Rob: [19:54] Yeah we do we do we actually saw a turn of the corner about 3 or 4 years ago where Black Friday. Digitally became the largest day and really what that was, primarily driven by many retailers were actually shuttering their doors both on Thanksgiving either part of or all of Black Friday and they were encouraging people to shop online that was a great altruistic message from a brand perspective but it was also great you know to actually give their Workforce some time off, as well and so n obviously Drive traffic towards digital while providing great deals, online the other piece to it that really helped drive that change was mobile. Really the huge increase in Mobile we saw a mobile traffic this year through the course of cyber week account for about seventy nine percent. [20:52] All traffic and so people were on the go it was more accessible. And they either did more of their shopping during Black Friday or actually what we started to see and it really came into Focus this year buying on the couch in the later days after Thanksgiving meal. In the u.s.a. people got sick of their family needed to digest a little watch football and they took out their phone you know they either got distracted or I don't know if you're a marketer inspired by something they saw on their phone and they started shopping so that's my long way saying we actually see Black Friday of a higher concentration a bigger, overall sales volume for online then Cyber Monday. Scot: [21:38] Interesting okay and then there used to be this big disparity between mobile traffic and sales so used to be if you had 80% traffic you could knock that in more than half or is that number closed into you guys track that. Rob: [21:50] We do we do yeah it hovers around 60% of orders and that has progressively gone up up until about. How long have we been, going through this pandemic up until a pandemic because what happened is people are actually at home they weren't visiting their friends and family they weren't as much on the go so they actually went to their computer during Thanksgiving you know for me I spent the last couple years out by my fire pit and, you know came in from the cold and went to my computer instead of my phone to check out the latest deals on Thanksgiving or. The day after two Black Friday so we did see a dip. Last couple years in Mobile because people were at home but it spiked back up this year both traffic and orders and I give you know retailers credit because, and I know Jason you spent a lot of time with your customers thinking about customer experience and design and really breaking down that friction between inspiration and purchase, you know retailers are getting much better at making it easier to actually not only find the product they want on their phone but make that purchase. Scot: [22:58] Okay so that brings us up to Cyber Monday and then you kind of hinted that you think they'll be some more discounting seems like if consumers One retail chicken you can't you can't kind of go off of it right so if you've got this inventory left you're going to have to either discount further at least keep the discounts on is that what you think is going to happen. Rob: [23:17] Yeah exactly I mean we typically see a little bit of a dip coming off of cyber week to just. Retailers take a breath analyze what they have what they did how their margin looks and then get back at it a little bit but we we are going to see perhaps not higher rates, because retailers I'm sorry consumers are getting really, crafty around price adjustments so it's not only dipping further into their margin but it's creating more operational expenses and headaches as well for the retailer and so I don't necessarily anticipate, higher discount rates but a steady drumbeat of discounts particularly those retailers that have physical stores and can extend the shipping cut off window by offering, store fulfillment options so you'll see you know a real leaning into discounts promotion. Overall just attracting people hey you haven't missed the window yet you can get that last gift for your cousin or uncle or family member and oh by the way you don't have to pay for it and you're more guaranteed to get it because you can pick it up in an around the store or will get it. To you through some sort of last mile delivery that is shipped from the store. Scot: [24:35] I think one takeaway is you know so Jason's hearing there's some concerns about revenue and stuff and then you know I'm hearing discounting could be a rough earning season as we kind of come out of the holiday if all this discounting is go on but at least I guess they'll start the year kind of having flushed out all this massive inventory. Rob: [24:54] Yeah yeah you know coming into this year we do our predictions all the way back in June and we kind of look at the data what we've seen what the storylines are and. Start craft the narrative we were big Partners in that a couple of years ago where you coin ship a get in and you know we were both early on seeing man there's some issues with this surge going on in the capacity issues with. The carriers but you know one of those storylines or the main storyline just last June was. And here's comes your soundbite so get ready are you ready to rumble. I just set way too high expectations sorry about that but you know we're really concerned that margin will be the Grinch That's deals, Christmas and to your point we don't see that until the February timeframe after the Retailer's close out their fiscal year and start reporting again some retailers got ahead of it and caution what this is going to look like but I'm. Anticipating that will be a key storyline come February Scott. Scot: [25:57] All the who's in Whoville loved prophets a lot but. Rob: [26:00] Oh nice I like it I like it and we haven't even talked about returns yet right because that's I know that's one of Jason's favorite topping that's going to certainly come into play as well as we talk about margin. Jason: [26:12] You guys are bringing me down and actually I'm afraid I might want to bring us down even more because, I would say like I came into this holiday season thinking hey top binds going to be okay because of inflation because of you know pent-up demand a variety of things but that you know the story was going to be about profits as you guys just perfectly laid out um and then you know the Cyber weekend happen and Rob's been on every news program I've watched for the for the last 12 hours and you know they're also citing these like Salesforce vanity stats right that like oh my gosh e-commerce was higher than it's ever been before which is not shocking right like. And then the internet came out with a study today more people went shopping this weekend than ever before which again. There are more people in the United States than ever before so that's not that's not shocking I have in talking with retailers, they're more guarded like they all did scenario planning for like sort of good good weekends and bad weekends and they're all like talking about being on the low end of those, scenario plantings I know you have great data for the online portion of spending but you know 74 ish percent of all this spending is in stores I know you have some signals for the in-store sales but do you. [27:38] Like are you confident that this was a really strong turkey 5 I'm I'm not clear if it was or wasn't. Rob: [27:46] Yeah I think it remains to be seen if we're defining it as Jason we should be. Retail in totality and the fact that a vast majority of sales still happen in the physical store right and we're seeing that traffic. Is up but oh by the way it was Don the last couple years so what's that comparison set right is it actually up from 2018 or 2019 I'm not, convinced it necessarily, is and so we don't track that but we look at smart people like you Jason and Scott and some other friends in the industry and the word on literally the street or the mall or whatever strip center anyways I digress, is that it was the physical traffic a bit lighter and so we can say that. [28:37] Also online sales were strong but I also to your point want to temper that by if somebody or a retailer was reading this in almost any country in Europe. They probably wouldn't believe that headline right because it just you know they've been visiting head wins, not only during cyber week for the better part of this year and so most categories saw a negative growth, throughout Europe and you can see the data specifically by each country, on our dashboard and so it to your point earlier Jason it's not a sound bite that we'll be able to tell you the entire story right and so it was positive I'm feeling pretty good about the sales and you know the retailers I'm talking to who are forecasting closer to Fat flat not fat flat, growth were pretty happy but I think it still remains to be seen in terms of stores what that looks like margin what that's going to look like and if you're a global brand how does it look in totality. Jason: [29:44] Yeah for sure, decided I'm going to make a prediction most of the good store traffic data is about three days leg so we don't have it yet but I think what I think you called it exactly right I think store traffic is going to be up from last year but still below, 2019 levels and what's confusing it is there's a few Pockets there's a few a malls that did really well this weekend as they always do and so I think journalists went to these a malls and saw a bunch of people and they you know they're talking about how it was a robust in-store holiday but I I am going to be eager to see that that store data which brings me to my next question a lot of people use your tool set for Boba so I'm imagining that you got to see. Some of the trends in both us and like did that reveal anything in terms of people that might be going to store to pick up orders. Rob: [30:37] Yeah I think that's interesting and it also talks about Jason like what are the new metrics given this new world like do. Bo piss or curbside orders count as traffic I don't know you know the consumers come in close. To the store or they're going to the pickup area within the store in many cases they buy more product so I think again if. [31:00] Weaving in those stats it helps definitely the online traffic I don't think by the way many retailers are looking at it that way just yet and I think it's an important factor to consider. But he has your question yeah I mean I think. [31:16] Bo pasts and create a fulfillment options from the store are helping Elevate traffic and driving people to brick-and-mortar based on our data what we saw is botes usage. Overthrew we'll call it cyber weekend we saw close to 10% growth compared to earlier, in the holiday season what super interesting what we typically see is the lead up to a big holiday like for instance we looked at Halloween for the two days leading up to Halloween we actually saw. Double the amount of, Opus orders because people realize they didn't get the costume or the candy or whatever other ornaments that they needed and they knew it wouldn't get shipped in time they also want to make sure it would be available if they actually purchased it. And they did both this the other really interesting thing is throughout cyber week and again we look at that for the full seven days but even no matter how we slice it it's high what we saw is and this is u.s. specifically by the way, retailers that had bo piss they offered it grew online Revenue by 38% more. [32:33] Then those without this creative fulfillment option and so it does speak to. How important the store is to your digital business right so you know another stat. [32:47] Why not I'm on a roll that I'll say is. Our research shows that 60% of digital orders are influenced by the physical store whether that's where demand is being generated or demand, is being fulfilled in this case it's being fulfilled because somebody's buying it from the comfort of their own home and it's convenient and they're able to pick it up with the confidence that the product would actually, be there so again the new rules of you know both how do you provide the incentives to the store associate how their role is changing and how you measure, Effectiveness because of such the interplay between digital and physical is super interesting to be a part of. Jason: [33:29] Yeah that to me I saw that stat about the bow purpose retards that offering boat best outperforming returns that don't and, that was super interesting and kind of tragic Rob because I don't know if you've noticed this but so both this isn't universally offered by all retailers more retailers were offering both pissed last year than this year like everybody scrambled in the pandemic to come up with some version of bow pose and a number of them turned it off either because they didn't have a robust implementation or they couldn't hire enough labor this year to support. Rob: [34:05] Yeah yeah it's less about a technology. [34:09] Project or initiative and it is to your point it's about operations and you know part of the reason people turned it off you mentioned some of them is. They couldn't get down the operational efficiency we're seeing more retailers lean into Automation and, more productivity to really refine their fulfillment operations and it's not easy it's not just about having. The right amount of labor but it's having them focused on the right tasks based on the time of day and what. The priorities are and that's not easy to do at all especially you know when consumers are standing right in front of the associate and the associate is you know tasked with having to make a call do they. Fulfill this. Bullpen disorder because they have to within 15 minutes or do they serve the consumer who explicitly came in the store because they wanted to be in a physical space and talk to a human. And get some knowledgeable service so it's my long way saying it's not easy those retailers that have been able to move from Scrappy which many did to scale really thinking about how to automate some of the processes, how to really focus on efficiency and productivity will be winners because they're not only helping with loyalty serving the consumers who want to shop that way but also thinking about the margin pressures they're feeling otherwise. Jason: [35:35] Yeah that totally agree and I can definitively answer one thing I rarely I'm almost always guessing but in terms of whether both is counts a store traffic or not I have no idea whether it should count or not or whether returns would like it to counter not but I can tell you when it does and doesn't count most retailers in America have a device on their front door that counts how many people walk in the store and it excludes employees and so two companies sell those devices sensor Matic and Retail next and they both publish Anonymous store traffic data so if you see data from either of those companies it did not include dopest but Place Rai is the third company that provides that data and they use the GPS in the consumers phone which does Campo. Rob: [36:23] Yes. Jason: [36:24] So in three days you're going to see data from all three of those companies and it's not going to agree and that is why. Rob: [36:31] That's super rich I've been that right there that is the best nugget of the last however long we've been talking that's. Jason: [36:37] Six hours. Rob: [36:38] It feels like it I could talk another six though that's the fun part but that's Jason that's super interesting and that's the type. Data you know it typically use whichever one helps tell the story you want but understanding the differences like you just dissected is so important. Scot: [36:54] Cool let's we're getting towards the end so we know you had a long day but one of my favorite things about your data is you can peel the onion on categories I have a sixteen-year-old daughter and I can vouch for the Beauty and athleisure categories but did you see those kind of pop in any other categories up or down that you want to talk about. Rob: [37:15] Yeah absolutely well again there is a correlation between performance and discounts at least from a top-line perspective and so yeah we saw some strong performance in health and beauty for sure. We also saw in consumer electronics. And we also saw it in actually General apparel and Footwear as well believe it or not particularly on the Footwear side we saw it because people are actually putting on shoes and sneakers again and getting out the. You know world again whereas I guess I can't live in my slippers or flip-flops anymore actually when we looked at the data by actual product, we saw flip-flops actually had some of the largest decline that we saw your every year because again people are getting out in the world again. The good news is two by the way again to plug the shopping insights HQ you can slice and dice by I think it's at least nine if not about 12. Categories and see what it looks like for orders and sales and the like along with traffic as well. Jason: [38:27] I did. Notice so I've been playing with the dashboard a lot and side note as you know my pandemic hobby as I learned to have well so it's super exciting for me that you you are publishing the data and Tabla, it does seem like some categories popped that like. Had been underperforming for most of the pandemic so like you know Electronics had not been a very bright spot but it does seem like they they had a pretty decent weekend like do you have a, am I seeing that data right and do you think like that that might mean they've turned the corner or do you think that that could be a holiday anomaly. Rob: [39:07] It's hard to say because again discounts drove so much of the buying there was such a correlation between discounts and sales and so it's a little hard to say and it's really interesting to understand to like some of that. Binge shopping that we all did over the pandemic and it subsided perhaps over the last 6 to 12 months, and then in gift-buying times you're seeing a pop again so I wouldn't necessarily stake the claim on this is now what's going to happen for the next 12 months in terms of demand for these categories, because a lot of it again is correlated to Discount a lot of it is correlated to what people have pot over the purchased excuse me over the last couple of years. Jason: [39:51] That's totally fair so let's pivot to how they paid for it you alluded earlier to buy now pay later traction like can you share what you saw in the data and where there any other interesting Trends in terms of payment methods. Rob: [40:06] Yeah totally this was kind of fun because we put it in there as we did each of the mornings early early early particularly those that are on the west coast thank you to the team by the way I should have done this at the beginning but it's not just me I have the fun part to have this conversation with you and speak to so many people about this including a lot of retailers not just today but we have through the rest of the holiday season we have a way to go. But it's make possible through the team that brings these data and insights to life and, the reason I say that is we are trauma through the data one morning and we got the normal like what the sales look like what does traffic look like what are the hot categories biggest discounts, and then Kayla Schwartz on my team who really is the master behind the shopping index was that. This is super interesting around buy now pay later because of the Divergence between orders. [41:04] For buy now pay later and at the average order value and what I mean by that is specifically we saw. A five percent this is throughout the course of cyber week. In the u.s. in particular where we saw in the increase of 5% year-over-year, of orders with buy now pay later and by the way this is after, a couple of years of really nice growth so five percent based on the bass is really we consider noticeable however on the other side we saw. [41:37] Average order value for the same transactions decrease by five percent so it's indicating to us. [41:46] Again you know this better than anyone buy now pay later really was hatched as a finance option for. Bigger ticket items home appliances television couches and other Home Furniture but what we're seeing is a turning of the corner. Because of the ubiquity and he is and also I think the desire to finance and spread payments over the course of a given time period rather just at once for lower price for less expensive goods and gifts, compared to 2021. Jason: [42:21] Yeah I will say you know a lot of the retailers that are like looking at the economic snapshot for next year and I really concerned about. The consumers discretionary dollar they're they're kind of concerned about this you know. Acceleration of buy now pay later and other credit means as kind of a an early indicator that the consumer might be overextending themselves. Rob: [42:47] Yeah I mean we don't look at that very closely but it is fairly intuitive to see it that way that people are leaning on. Newer creative finance options over the holiday and what does that mean for the subsequent quarters will be keeping an eye on that really closely for sure. Jason: [43:05] Yeah so we are coming up on time Rob there's one other topic I just wanted to touch on with you you know you you alluded to capacity concerns in pass holidays and of course you know we've talked a lot on the show about ship again um I'm kind of worried about a new thing this year. With the moat with this really prevalent version of discount chicken if a bunch of consumers are thinking they're going to wait till the very last minute. To get the best discount we have all the usual things in place we have like a fragile inventory that might start running out. But we also this year have lower labor levels like stores tried to hire less people and they weren't able to hire all the people they tried to hire UPS and FedEx didn't get all the people they want so I'm a little worried if consumers way too long that we you know might have another ship again in situation on our hands where there just isn't enough labor capacity to get all these orders out the last week of the year. Rob: [44:04] Yeah that's a super interesting point one that I haven't dove into very deep but I'm with you Jason that's going. Potentially be an issue I mean I'm a sample size of one but I see it any time I shop or any restaurant I go in there not taking reservations or they're not limiting reservations based on tables there. You know basically limiting it because of waitstaff and so, that's true too in the physical store when the associate is being asked to do so many things now right it's not just about scanning and bagging at the cash wrap, it's you know they're becoming social media managers that are fulfillment experts there live streamers so you're stretching them thin. Capacity gets issue by the way the other interesting thing that we didn't touch upon was returns we saw such an increase of returns heading into cyber week than we ever have in our thesis is that. People who bought product earlier in the season. Star the better discounts and we're doing price adjustments in way of returning a product and then buying it back, at the cheaper price so there may be earlier returns that are playing and usually that's not, a storyline that we talked about until you know January at NRF right but now it's actually happening more so add that to your Litany of things that will create capacity issues. Jason: [45:30] Oh my gosh know for sure and you know it's already a distant memory but with all those early sales that people tried to do one of the things that may have gone unnoticed is a lot of retailers also extended the return window because the fear was will never get people the holiday shop early if they don't think that gift recipients will be allowed to return the gifts so a bunch of these sales are on more liberal return policies, then ever before and again you know the economist are like come January we could be in stagflation and you know we don't know what returns might even look like in that kind of economic environment so it's, it's a concern for sure and that on that happy note Rob we've used up our allotted time. Because on top of everything else during this show I received about 1,000 emails from the Salesforce marketing cloud with even better deals than Cyber Monday so I'm gonna, after to go a little early so that I can get some more shopping. Rob: [46:28] Go for it please do shop on of course Salesforce Commerce Cloud websites if you may. Jason: [46:33] I didn't know there were other kinds. But in all seriousness Rob it's always a pleasure to talk to you about anything and for sure to talk about the the holiday sales loyal listeners will know the number one piece of feedback we get is they like to hear more from Kayla and from Michelle and I have to keep telling him that you always insist on coming. Rob: [46:54] Hey that will happen they are amazing I gotta say though before we go Jason Scott first of all as I mentioned before I love doing this like seriously this is. Highlight it's our Super Bowl or dare I stake a World Cup given where we are right now go us but you know. More than anything I just really appreciate your friendship it's so amazing to have friends like you and the retail industry and the amazing Community we have and I also love how humble you are in terms of you asking me these questions but the reality is you're so on top of what's Happening Now and in the future and I really value that so A big thank you all around. Scot: [47:34] Boom and you just secured yourself a fifth spot there you go Rob thanks for joining us on Twitter you are retail Rob Garf you're very active on LinkedIn I've noticed we will put a link to the hub of activity in the show notes thanks for joining us. Jason: [47:54] And until next time happy Commercing.
In this week's special collaboration with The World of Work Project we explore the importance of being able to speak up and have your say in healthy organisations. One of the defining features of cultic organisations is that the members have no meaningful voice and are encouraged to be obedient. How can we avoid this danger in our team? If you'd like to support the podcast you can do so by becoming a patron for just £1 ($1.50) https://www.patreon.com/culthackers/posts Reference Guided Team Self-Correction: Impacts on Team Mental Models, Processes, and Effectiveness. Smith-Jentsch, A. and Cannon-Bowers, J. DOI: 10.1177/1046496408317794
TITLE Improve Your Sales OutreachSUMMARY Ralph talks about the importance of always learning, no matter what level you are at in your sales career. It is important to never stop learning new things and to always have a growth mindset. Even if you are already a sales champion, there is always something new for you to learn. Reading books, watching videos, and listening to podcasts are all ways that sales professionals can continue to learn and sharpen their skills.Ralph believes that cold calling is not dead, despite popular belief. He believes that the phone is still the best way to close a sale, as opposed to other methods of communication like email or text. Google stats support his claim that the majority of business is still conducted over the phone.TIMESTAMPS 0:00:00 The Importance of Learning and Mindset in Sales0:03:20 Sales Rep Prospecting: Best Practices0:04:36 The Benefits of Cold Calling0:06:04 The Advantages of Picking Up the Phone in Sales0:07:44 The Benefits of Engaging with Your Prospects Before Making a Cold Call0:09:23 The Importance of Earning the Trust of Your Prospects0:11:16 The Importance of Researching Your Prospects0:13:31 The Importance of Knowing the Buying Committee in the Sales Process0:15:50 The Importance of Asking Questions in the Sales Process0:17:14 The Impact of a Fixed Mindset in Sales0:21:09 The Power of a Growth Mindset in the Workplace0:22:34 The Risks of Automated Sales Outreach0:27:06 The Importance of a Transformational Mindset in SalesHIGHLIGHTS Sales is definitely one of the hardest jobs there is in the world. So prepare your mindset to know that it's going to be tough, it's going to be hard.That way of thinking, the transformational is what's in now. Now they want to figure out and work with people that are going to transform their business. People are going to transform their lives, help them out, make their life easier at work and help their business run smoother and easier.But the other thing that you mentioned in that whole conversation about where do sales reps get it wrong, you mentioned something along the lines of, you have to be able to demonstrate that something about the company, the industry, the person in all of your outreach that you're doing.That's something that a lot of sales leaders will run into. And I think the point that stood out in your explanation is that you said, hey, look, I'm not in competition with you.When you're talking about growth mindset and openness to learn and asking for help, there is a component. You reference it as you got to let go of your pride.Music Credit: Maarten Schellekens - Riviera Follow us at: www.cascadingleadership.comlinkedin.com/in/drjimklinkedin.com/in/1lawrenceobrown
In this bonus episode, Jersey Joe and I pre-recorded an episode discussing the effectiveness of the New Jersey Devils' defense. Joe introduced me to a new stat that he created called the "Sasq Stat". It pays homage to the nickname that he gave our defense (The Sasquatch Squad). Follow Jersey Joe's new Twitter: @SasquatchNJD Subscribe to Locked On Devils! Follow me on Twitter: @treymatt4 Follow the show on Twitter: @LockedOnDevils Listen to Locked On Devils: https://linktr.ee/LockedOnDevils Support Us By Supporting Our Sponsors! Built Bar: Built Bar is a protein bar that tastes like a candy bar. Go to builtbar.com and use promo code “LOCKEDON15,” and you'll get 15% off your next order. BetOnline: BetOnline.net has you covered this season with more props, odds and lines than ever before. BetOnline – Where The Game Starts! SimpliSafe: With Fast Protect™️ Technology, exclusively from SimpliSafe, 24/7 monitoring agents capture evidence to accurately verify a threat for faster police response. There's No Safe Like SimpliSafe. Visit SimpliSafe.com/LockedOnNHL to learn more. Learn more about your ad choices. Visit podcastchoices.com/adchoices
Learning outcomes •Identify key concepts to keep in mind when communicating across differences •Acquire effective strategies that will help take the adversity out of diversity dialogues •Develop an action plan for improving your effectiveness around diversity and building more inclusive work environments Description Nowadays, organizations are actively seeking to diversify their workforce, not only because of the impact of demographic changes but also because of the proven benefits diversity brings. Unfortunately, as our workplaces diversify, so does our level of discomfort in working across differences. Many of us feel unprepared for such encounters and, as a result, end up widening the diversity gap. For example, we may say something and unintentionally offend someone. Other times, we say nothing at all because we are afraid to say the wrong thing. We may also wish to take action when witnessing an act of intolerance but lack the skills to educate in an effective and respectful manner. In this podcast, you will gain understanding about how comments such as, “I don't see color,” and many others impact coworkers despite good intentions, learn strategies to help increase your diversity skills and competence, and develop an action plan for improving your effectiveness around diversity. --- Support this podcast: https://anchor.fm/fwi/support
Be an expert in your field. In this episode, Captain Integrity Bob Wade talks compliance program development and effectiveness with Steve Sugrue, Chief Compliance Officer of DocGo. Hear why you should hire people smarter than you, always be relentlessly in pursuit of best practices, seriously consider an approach towards ESG (Environmental, Social, and Governance), how big your compliance team should be, and how the delegation process should work. Learn more at CaptainIntegrity.com
It's been 10 years since the Murray-Darling Basin Plan was signed into law, with aims to restore the river system to health. Conservation groups are calling for more to be done, while farmers are pushing back against further government intervention.
Sean Duggan, VP of Advertising, SXM Media, talks about surprises and ongoing trends in the use of audio ads for political and advocacy campaigns. Decisions for media buys were delayed this year which meant that inventory was scarce, and campaigns found themselves making hasty decisions. The 2022 election cycle demonstrated that the audio audience could effectively be persuaded with compelling messages that leveraged geotargeting. This was particularly true in the most competitive congressional races. We talk about: Impact of audio ads in the last few weeks of the midterm campaigns Campaigns that deployed GOTV takeovers of premium inventory in the hottest contested races meant a dominant share of voice Frequency and targeting best practices First election cycle with political ads on podcasts targeted at a state level The life cycle of the ads for ballot initiatives New and old mistakes that campaigns made in 2022 media buys Predictions for 2023 and 2024 advertising strategies @SXMmediaGroup #VoterPersuasion #GOTV #AudioPoliticalAds #PodcastAds SXMmedia.com/ad-solutions
Time is the currency of productivity. How we spend it is - in effect - how we spend our lives. But often we can allow time to simply slip through our fingers and find that no matter how hard we may work, it feels like we're simply falling behind. It's almost like we're running on a treadmill that someone occasionally comes and moves slightly closer to our objectives, but we never seem to arrive.Today's show is all about leveraging time effectively. In the first part, I'm going to share why some common advice we hear is not entirely accurate.In today's interview, we have return guest and best-selling author Laura Vanderkam. Laura's work has appeared in publications including The New York Times, The Wall Street Journal, USA Today, City Journal, Fortune, and Fast Company. Her new book is called Tranquility by Tuesday: 9 Ways to Calm the Chaos and Make Time for What Matters, and it offers specific strategies for carving space for what's most important. Mentioned in this episode:Please Support Our SponsorsAthletic Greens: Visit athleticgreens.com/ACCIDENTAL to take ownership over your health and pick up the ultimate daily nutritional insurance! Shopify: Sign up for a FREE trial at shopify.com/accidentalcreative.Sponsored by Nordpass BusinessWith the NordPass Business password manager, you will save time and energy – allowing your team to focus on what matters most. See NordPass Business in action now with a 3-month free trial at nordpass.com/accidental with code ACCIDENTAL.
Interested in further study of the Bible? Join us at Logos Bible Software. Sign up to attend Westminster Seminary California's Annual Conference and Seminary for a Day here. Get a copy of the Family Worship Bible Study, The Works of William Perkins, & the RHB Store! Please help support the show on our Patreon Page! Welcome to our Canons of Dort Series! This week we go through the Second Head of Doctrine, Articles 6-9. Want to follow along week-to-week? Canons of Dort Have Feedback or Questions? Email us at: email@example.com Find us on Instagram: @guiltgracepod Follow us on Twitter: @guiltgracepod Watch the video on YouTube: Guilt Grace Gratitude Podcast Please rate and subscribe to the podcast on whatever platform you use! Looking for a Reformed Church? North American Presbyterian & Reformed Churches --- Support this podcast: https://anchor.fm/gggpodcast/support
This week on Pharm5: BCEMP starting in 2023 FDA hints at OTC naloxone Elahere for advanced ovarian cancer Pharmacogenomics reduces risk of ADRs Tzield delays T1DM symptom onset Connect with us! Listen to our podcast: Pharm5 Follow us on Twitter: @LizHearnPharmD References: Jean-Baptiste A. First Administration of the emergency medicine pharmacy certification examination announced for 2023. Board of Pharmacy Specialties. http://bit.ly/3EeGIQx. Published November 10, 2022. Accessed November 17, 2022. The Federal Register. Safety and Effectiveness of Certain Naloxone Hydrochloride Drug Products for Nonprescription Use; Request for Comments. http://bit.ly/3tGEQLu. Published November 16, 2022. Accessed November 17, 2022. Pharmacy Practice News. http://bit.ly/3EepDq5. Published November 16, 2022. Accessed November 16, 2022. Dunleavy K. Four decades in, immunogen gets landmark green light in Advanced ovarian cancer. Fierce Pharma. http://bit.ly/3Ao8Hw9. Published November 15, 2022. Accessed November 17, 2022. Immunogen announces FDA accelerated approval of ELAHERE™ (Mirvetuximab Soravtansine-gynx) for the treatment of platinum-resistant ovarian cancer. ImmunoGen, Inc. http://bit.ly/3gjvHp5. Accessed November 17, 2022. Robinson J. Adverse drug reactions reduced by nearly one third after genetic testing, major trial results to show. The Pharmaceutical Journal. http://bit.ly/3TQK1TQ. Published November 14, 2022. Accessed November 17, 2022. FDA approves first drug that can delay onset of type 1 diabetes. U.S. Food and Drug Administration. http://bit.ly/3gd9j0G. Published November 17, 2022. Accessed November 17, 2022.
Happy 100th episode, Gary's Gulch! I give some quick reflections on the midterm elections and follow that with an impactful discussion on raising your personal and team performance and predictably growing wealth with fellow Wealth Strategist Brandon Jenkins. Highlights What might happen after the election? Who is Brandon Jenkins From deployment to being a certified life underwriter The importance of lifelong learning in the military Having a growth mindset in business Leadership lessons from the Navy Using personal development in creating high-performing teams How he was able to grow and improve in terms of leadership and personal growth What Brandon is up to Finding ways how he can help others Links and Resources from this Episode Connect with Gary Pinkerton https://www.paradigmlife.net/ firstname.lastname@example.org https://garypinkerton.com/ Connect with Brandon Jenkins https://www.tieronelifeinsurance.com/our-story/ https://www.linkedin.com/in/brandon-l-jenkins Review, Subscribe and Share If you like what you hear please leave a review by clicking here Make sure you're subscribed to the podcast so you get the latest episodes. Subscribe with Apple Podcasts Follow on Audible Subscribe with Listen Notes Subscribe with RSS
LIVE from the GNFCC 2022 Women in Leadership Summit: Tiffany Greenway, Chick-fil-A Corporate (North Fulton Business Radio, Episode 574) Tiffany Greenway, Director of Effectiveness & Operations at Chick-fil-A Corporate, joined host John Ray LIVE from the GNFCC 2022 Women in Leadership Summit. They discussed her work at Chick-fil-A, career mapping, the high points of the […] The post LIVE from the GNFCC 2022 Women in Leadership Summit: Tiffany Greenway, Chick-fil-A Corporate appeared first on Business RadioX ®.
It's often thought that the pillar of a good leader is someone with the ability to put the needs of the team before their own. But neglecting your needs does nothing but hold your team back and limits your effectiveness. By denying the primal needs of your mind, body, and soul, you won't have the mental, physical, or emotional strength to fulfill the duties you've taken on. You strengthen your skills when you take control of how you operate as a leader, by prioritizing and honoring the needs of your well-being. When you do this, you develop a sound foundation for leadership that allows you to perform at your highest capacity for those around you every day. When you develop a mindset that understands the importance of your needs and how it affects your team's ability to succeed, you take steps toward becoming resilient. And being resilient is one of the most important skills leaders can have. In the latest episode of The Enlightened Executive podcast, we welcome guest Jim Hotaling, former Commander in Chief Master Sergeant of the Air National Guard, with 20+ years in Special Forces, who is currently the head of leadership development and assessment at N2Growth. Jim previously served as an advisor to senior executives within the US Department of Defense, which gave him a unique perspective on leadership and resilience. Jim practices and teaches leadership from the fundamental belief that to weather the pressures of leadership and maintain the strengths of a leader's various skills, you must learn to put your needs first. In this episode, Jim demystifies the idea of being selfish while sharing what it takes to build resiliency and a healthy approach to the “never quit” mentality.
Jodi Sternoff Cohen is a bestselling author, an award-winning journalist, a functional practitioner, and the founder of Vibrant Blue Oils. She combined her training in nutritional therapy and aromatherapy to create unique proprietary blends of organic and wild-crafted essential oils. In addition, she helped over 50,000 clients heal from brain-related challenges, which include anxiety, insomnia, and autoimmunity. For the past ten years, she lectured at wellness centers, conferences, and corporations on brain health, essential oils, stress, and detoxification. She's been on The New York Times, Wellness Mama, Elephant Journal, and numerous publications. Furthermore, her website, vibrantblueoils.com, is visited by over 300,000 natural health seekers every year. And she rapidly became a top resource for essential oils education on the Internet. In this episode, we focus on the important role fascia plays in our health. And in addition, how to use essential oils to release restrictions in the fascia. The fascia is something many people are not aware of and learning how to release it can help with pain, tightness, mood, and more. Links Special $15 Fascia Release Essential Oil offer* Free shipping! Timestamps [03:17] This is What Fascia Is [10:19] Is a Fascia Blend Before Exercise or Yoga Beneficial? [20:13] The Effectiveness of Oils On Your Scars [23:42] The Special Fascia Release Essential Oil Ingredients [25:50] This is Where You Should Apply the Oil if You Have a Large Area [30:35] How to Get the Oil and Final Tips
LINKS BELOW | OUR EPISODE THIS WEEK INCLUDES:Previous Pain Management OptionsPRP InjectionsTypes of InjectionsLimitations and Preparing For ConsultSpine Health & BacteriaFuture of Medicine With Much More⏱ Time Stamps:0:00 Introduction2:11 Introduction to Dr. Knab6:08 Need For Innovation12:11 Lack of Communication 17:34 Complexity of Pain23:25 Where PRP Injection Came From and What It Is30:14 How Much Blood Do You Need33:49 Quantity of Growth Factor35:48 Age Limitations38:50 PRP For My Back42:50 Bacteria in Your Spine46:11 Effectiveness in Areas of The Body50:03 Mechanism For PRP Injections51:35 Supplementing With Exercise52:22 Preparing For Injection59:11 Contraindication to Injections1:05:40 Importance of Routine Testing1:06:25 Procedure For Injections1:11:17 Looking Within To Solve Problems In Medicine1:14:15 Cord Blood 1:19:10 How To Get PRP Injections1:27:08 Health Me, Health You
Na escola, é um clássico. No ambiente corporativo, também é comum. Acontece entre crianças, adolescentes e até mesmo pessoas adultas. Afinal, o que é bullying? E como lidar com esse tipo de situação?Confira o papo entre o leigo curioso, Ken Fujioka, e o cientista PhD, Altay de Souza.> OUÇA (55min 41s)*Naruhodo! é o podcast pra quem tem fome de aprender. Ciência, senso comum, curiosidades, desafios e muito mais. Com o leigo curioso, Ken Fujioka, e o cientista PhD, Altay de Souza.Edição: Reginaldo Cursino.http://naruhodo.b9.com.br*PARCERIA: ALURAA Alura é a maior escola online de tecnologia e negócios digitais do Brasil.Com uma matricula você tem acesso as centenas de cursos online, com lançamentos e atualizações constantes nas áreas de programação, front-end, DevOps, Mobile, Data Science, UX & Design, Inovação e Gestão.Além de instrutoras e Instrutores reconhecidos, Discord exclusivo e a comunidade mais engajada do Brasil.Mas hoje vim aqui falar para você NÃO SE MATRICULAR!Por quê? Porque está chegando a Black Friday Alura e ela terá descontos incríveis nas matrículas.Então aguarde que você não irá se arrepender.Vem aí a Black Friday Alura!*REFERÊNCIASBullying and Peer Victimization at School: Perceptual Differences Between Students and School Staffhttps://www.tandfonline.com/doi/abs/10.1080/02796015.2007.12087929Do the victims of school bullies tend to become depressed later in life?A systematic review and meta-analysis of longitudinal studieshttps://njbullying.org/documents/Ttofi2011.pdfBullying Behaviors Among US Youth: Prevalence and Association With Psychosocial Adjustmenthttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC2435211/Emotional Nuance: Examining Positive Emotional Granularity and Well-Beinghttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8901891/Emotional granularity is associated with daily experiential diversityhttps://psyarxiv.com/24mpf/Exploring spatiotemporal changes in the multi-granularity emotions of people in the city: a case study of Nanchang, Chinahttps://link.springer.com/article/10.1007/s43762-021-00030-xRethinking School-Based Bullying Prevention Through the Lens of Social and Emotional Learning: a Bioecological Perspectivehttps://link.springer.com/article/10.1007/s42380-019-00019-5Workplace Bullying and Harassment in South Korea https://www.jil.go.jp/english/reports/documents/jilpt-reports/no.12.pdf#page=97Cyber-Harassment: A Study of a New Method for an Old Behavior https://www.researchgate.net/profile/Tanya-Beran/publication/240793105_Cyber-Harassment_A_Study_of_a_New_Method_for_an_Old_Behavior/links/02e7e52d6b9365ad15000000/Cyber-Harassment-A-Study-of-a-New-Method-for-an-Old-Behavior.pdfBullying and Peer Victimization at School: Perceptual Differences Between Students and School Staffhttps://www.tandfonline.com/doi/abs/10.1080/02796015.2007.12087929Developing an Understanding of Emotion Categories: Lessons from Objectshttps://journals.sagepub.com/doi/full/10.1177/1529100619832930Emotional Expressions Reconsidered: Challenges to Inferring Emotion From Human Facial Movementshttps://journals.sagepub.com/doi/full/10.1177/1529100619832930Translating Research to Practice in Bullying Preventionhttps://www.apa.org/pubs/journals/releases/amp-a0039114.pdfSchool-Based Programs to Reduce Bullying and Victimizationhttps://onlinelibrary.wiley.com/doi/pdf/10.4073/csr.2009.6Natural emotion vocabularies as windows on distress and well-beinghttps://www.nature.com/articles/s41467-020-18349-0The Development of Emotion Reasoning in Infancy and Early Childhoodhttps://childemotion.waisman.wisc.edu/wp-content/uploads/sites/318/2020/12/Ruba-Pollak-2020.pdfEffectiveness of the KiVa Antibullying Program: Grades 1-3 and 7-9https://www.researchgate.net/publication/259452909_Effectiveness_of_the_KiVa_Antibullying_Program_Grades_1-3_and_7-9The theory of constructed emotion: an active inference account of interoception and categorizationhttps://academic.oup.com/scan/article/12/1/1/2823712Emotion Words, Emotion Concepts, and Emotional Development in Children: A Constructionist Hypothesishttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6716622/Naruhodo #164 - Podemos ler emoções com base em expressões faciais?https://www.youtube.com/watch?v=cq4oeBZ5kgo&ab_channel=Cient%C3%ADstica%26PodcastNaruhodo*APOIE O NARUHODO PELA PLATAFORMA ORELO!Um aviso importantíssimo: o podcast Naruhodo agora está no Orelo: https://bit.ly/naruhodo-no-oreloE é por meio dessa plataforma de apoio aos criadores de conteúdo que você ajuda o Naruhodo a se manter no ar.Você escolhe um valor de contribuição mensal e tem acesso a conteúdos exclusivos, conteúdos antecipados e vantagens especiais.Além disso, você pode ter acesso ao nosso grupo fechado no Telegram, e conversar comigo, com o Altay e com outros apoiadores.E não é só isso: toda vez que você ouvir ou fizer download de um episódio pelo Orelo, vai também estar pingando uns trocadinhos para o nosso projeto.Então, baixe agora mesmo o app Orelo no endereço Orelo.CC ou na sua loja de aplicativos e ajude a fortalecer o conhecimento científico.https://bit.ly/naruhodo-no-orelo
Join TELESTO for a special breakdown of Accuracy, Aim Assist, and Airborne Effectiveness as we currently understand them to work. Special guest Kyt_Kutcha fetches coffee and plays a supporting role. BECOME A PATRON: https://www.patreon.com/massivebreakdownpodcastPVE POD: https://pve-podcast-versus-enemies.captivate.fm/listenSTAR WARS POD: https://beneath-twin-suns.captivate.fm/listenCHAT SERVER: https://discord.gg/TheyfeQHOME PAGE: https://destinymassivebreakdowns.comYOUTUBE: https://www.youtube.com/channel/UCqCi3pvTA17HLRaow-K3U5wEditing and Post Production by Nettie Smith.
Giacomo Asquini (e-mail, ResearchGate, Twitter), physical therapist at the Italian Stomatologic Institute in Milan, Italy and Birmingham University (England), is interviewed by Stephen M. Shaffer regarding a publication from the Journal of Oral Rehabilitation titled, “Effectiveness of manual therapy applied to craniomandibular structures in temporomandibular disorders: A systematic review.” This episode contains information that will be interesting for practitioners who want to learn about the relative depth and breadth of the available evidence as it pertains to orthopaedic manual therapy and the temporomandibular joint.Find out more about the American Academy of Orthopaedic Manual Physical Therapists at the following links:Academy website: www.aaompt.orgTwitter: @AAOMPTFacebook: https://www.facebook.com/aaompt/Instagram: https://www.instagram.com/officialaaompt/?hl=enPodcast e-mail: email@example.comPodcast website: https://aaomptpodcast.simplecast.fm
On today's episode of The Transition, we tried something new. Mike chats with CJ Hughes, Audio Engineer and Producer for The Transition podcast, and Head of Production at IRONBOUND Media. We take a deep dive into the concept of learned effectiveness, and how crucial it is to implement when things get tough and the world feels like it's battling against you. Be sure to subscribe to the Transition Newsletter on Substack here: https://bit.ly/37Bb8Ne"Learned Effectiveness" LinkedIn Post: https://www.linkedin.com/posts/iron-mike-steadman-3387586a_learnedeffectiveness-yourstrongerthanyouthink-activity-6996152272388767744-bQAg?utm_source=share&utm_medium=member_desktop
We are back! And in this episode of Hard Shop Life we are discussing how you can maximize your employees effectiveness by accentuating their different personalities, and strengths. Not everyone who works for you will be like you, and thats a great thing. A dealership is a symphony that has to seamlessly work together, but
Robert Koehler is the Director of Customer Success Effectiveness at Compass. Robert gives his insights on building sales effectiveness teams and helping them function both as individuals and as a group. He shares about his time managing marathon runners and how this eventually helped him see the importance of accountability within sales effectiveness and the many people involved in each process. He also talks about understanding the buyer framework more extensively. HIGHLIGHTS Setting up and understanding the roles of sales effectiveness teams Connecting accountability groups with sales teams The buyer persona framework relating to what you want the customer success manager and account executive to know Knowing what the buyer needs from the seller to help them make a decision QUOTES The role of sales effectiveness teams - Robert: "What I care about is results and helping sellers be more effective in helping buyers. And that's what it's about at the end of the day. That has an implication that we have to get sharper on what we measure, what we communicate, and we're focused on performance rather than just knowledge." On building human connections first and foremost - Robert: "Part of that trust is just being comfortable talking to them human to human, understanding their business, and an area that doesn't get much attention is understanding the economics of their business when they may not.” Asking the right questions to identify what you're missing - Robert: "There's another question that I love that more experienced CROs and VPs of Sales ask internally which relates to the concept of opportunity cost that you raised and that is, 'why are we going to lose this deal?' Because I find that's the best anecdote or vaccination for happy ears." Find out more about Robert in the links below: LinkedIn: https://www.linkedin.com/in/rkoehler/ Email: firstname.lastname@example.org More on Andy: Connect on LinkedIn Get Andy's new book "Sell Without Selling Out" on Amazon Learn more at AndyPaul.com Sponsored by: Revenue.io | Unlock exponential growth with an AI-powered RevOps platform | Revenue.io Scratchpad | The fastest way to update Salesforce, take sales notes, and stay on top of to-dos | Scratchpad.com Blueboard | World's leading experiential rewards & recognition platform | Blueboard.com Explore the Revenue.io Podcast Universe: Sales Enablement Podcast RevOps Podcast Selling with Purpose Podcast
Sin is mean, harmful and will carefully lead one away from the blessings God has. Let us see it’s harmful effects but be thankful for our Father Who through Christ makes it possible for us to not be led away, but to lean closer to God.
“For those without cancer or other illnesses, we often have a resolution or relief of this fatigue. ‘Oh, I'm just going to go to bed early and get a couple more hours of sleep tonight.' Or ‘I'm going to have a cup of coffee.' But for people with cancer, it's not an easy fix. People with cancer describe fatigue as something much more long-lasting,” ONS member Paula Anastasia, MN, RN, AOCN®, clinical nurse specialist for UCLA Health in Los Angeles, CA, told Jaime Weimer, MSN, RN, AGCNS-BC, AOCNS®, oncology clinical specialist at ONS. Anastasia discussed fatigue in patients with cancer undergoing PARP inhibitor maintenance therapy, management strategies, and nursing considerations. This podcast episode is supported by a sponsorship from AstraZeneca. ONS is solely responsible for the criteria, objectives, content, quality, and scientific integrity of its programs and publications. Music Credit: "Fireflies and Stardust" by Kevin MacLeod Licensed under Creative Commons by Attribution 3.0 Episode Notes NCPD contact hours are not available for this episode. Clinical Update: Ovarian Cancer Focus Group Summary ONS Get Up, Get Moving resources ONS Guidelines™ on Fatigue Oncology Nursing Podcast Episode 227: Biomarker Testing, PARP Inhibitors, and Oral Adherence During Ovarian Cancer Maintenance Therapy ONS Voice articles: Symptom Assessments: Use a Team-Based Approach to Inform Care and Optimize Outcomes Master the Essentials of Effective Communication What the Evidence Says About Music Therapy for Cancer-Related Fatigue Acupuncture for Cancer-Related Fatigue Biomarkers Are Advancing Understanding of Cancer-Related Fatigue Clinical Journal of Oncology Nursing articles: The Impact of a Nurse-Led Exercise Activity for Cancer-Related Fatigue in Patients With Leukemia Exercise Intervention: A Pilot Study to Assess the Feasibility and Impact on Cancer-Related Fatigue and Quality of Life Among Patients With High-Grade Glioma Oncology Nursing Forum article: The Effectiveness of Yoga on Cancer-Related Fatigue: A Systemic Review and Meta-Analysis National Comprehensive Cancer Network Guidelines > Supportive Care > Cancer-Related Fatigue ASCO Answers: Cancer-Related Fatigue To discuss the information in this episode with other oncology nurses, visit the ONS Communities. To provide feedback or otherwise reach ONS about the podcast, email pubONSVoice@ons.org. Highlights From Today's Episode “Fatigue is not necessarily life threatening, so I think unfortunately, it's underplayed at how disruptive it can be in somebody's quality of life and day-to-day life.” Timestamp (TS) 03:10 “For those without cancer or other illnesses, we often have a resolution or relief of this fatigue. ‘Oh, I'm just going to go to bed early and get a couple more hours of sleep tonight.' Or ‘I'm going to have a cup of coffee.' But for people with cancer, it's not an easy fix. . . . People with cancer describe fatigue as something much more long lasting.” TS 04:02 “I think it's really important when we educate our patients to let them know that this is a common side effect. Research tells us, and also patient experience, that fatigue does plateau after about four to eight weeks. It's not zero, but it gets much more manageable for our patients. So, I think priming our patients with what to expect can be very helpful.” TS 07:48 “I want patients to have some sort of physical activity. It doesn't have to be hours or marathons. Just a 10-minute walk in the morning and then maybe a 10-minute walk in the afternoon. Things like that. We try to, if possible, refer patients to a physical therapy-type setting initially, and that will help give them tools on how to be active and safe activities, and also gets them motivated. So, that's really helpful for patients.” TS 09:41 “I think it's important to assess the cause of the fatigue. Ruling out anemia, hypothyroidism, vitamin deficiencies, things like that. So, that is ruled out and we know what we're doing to our poor patient with the interventions; they've had surgery, they've had chemotherapy, now we're going to put them on a PARP inhibitor, all of these lifestyle changes.” TS 12:20 “I think since COVID-19, there's a lot more awareness of how much people have anxiety and depression. I think we're more in tune with that and how stressful life is, and that's not even having cancer and all of the challenges with that. So, I think that plays into it. Depression and anxiety can contribute to fatigue.” TS 16:53 “One of the biggest misconceptions about fatigue is that there's nothing that you can do about it. Just accept it. And I totally disagree with that. It's an undervalued side effect. It's not necessarily life threatening, but it's definitely something that can interfere with patients' day-to-day quality of life. So, we really need to address it. We need to assess, communicate, and plan for it.” TS 28:39
In this episode of The New CISO, Steve is joined by Tyler Farrar, the CISO at Exabeam. With malware-free attacks becoming increasingly common, Tyler understands the best ways to bridge the effectiveness gap. With this in mind, he shares his SOC philosophy and the importance of threat detection. Listen to the episode to learn more about the act of prevention, the pillars of a SIEM product, and why attackers gravitate toward credential techniques. Listen to Steve and Tyler discuss the steps to success in an age of constantly increasing data : Meet Tyler (2:06) Host Steve Moore introduces our guest today, his colleague, Tyler Farrar. Before working at Exabeam, Tyler was a customer. With his impressive background in the security field, Tyler explains Exabeam's perspective on "defender behavior" and balancing incident response and crisis management with prevention. The Focus On Prevention (5:50) Steve presses Tyler on how you should balance your methods to increase prevention. Tyler lists different preventative tools, such as firewalls, and stresses the importance of detecting suspicious activity early on. Tyler gives his take on how response becomes prevention in crisis management. Preventative tools can fail, so being able to detect suspicious behaviors is critical. Addressing The Gap (10:36) Addressing the gap in analytics, Tyler recognizes that there is a difference between what the security team needs and what the SIEM product delivers. Every company faces an immense volume of data, an inefficient manual cyber process, and software that can fail to detect the attacker's behaviors. Tyler lists the solutions that can counteract these problems, including behavioral analytics. The Rise Of Malware-Free Attacks (14:32) Steve points out how 71% of cyber-attacks are credentialed and malware-free. Tyler explains that attackers use the compromised credentials approach because it is easy. CISOs can miss the mark because legacy software can be ineffective at detecting threats. New-Scale SIEM (20:43) According to Tyler, new-scale SIEMs would be able to securely ingest data from anywhere, parse through that information quickly, and then store that information and make it searchable. Tyler also explores his philosophy on how to design a SOC. One example of a productive SOC is conducting risk assessments throughout the organization to identify gaps and then acting on those results. Life Of The Analyst (28:52) Steve presses Tyler on how the experience of the investigation factors into meaningful work for the analyst. Tyler stresses the importance of SOC leadership to make the team effective. A stressed SOC can lead to the loss of talented workers and affect the company's security. New Software Ahead (33:16) Tyler discusses the products he is looking forward to on the horizon. Every CISO's goal is to keep their company safe. Being able to show all the threats and vulnerabilities in place would be hugely valuable, which is why Tyler is interested in Systems Navigator. SOC Philosophy (49:55) Tyler's top SOC philosophy is to be aligned with your adversaries and learn how they think in addition to your defenders. Understanding both perspectives can create a culture of empowerment and protect the organization from threats. Links mentioned: https://www.linkedin.com/in/tyler-j-farrar/ (LinkedIn)
On the podcast today we have Matt Cromwell. Matt is Senior Director of Operations and Marketing at StellarWP, and also one of the founders of GiveWP, a donations plugin which uses the freemium model. He's on the podcast today to talk about whether the WordPress.org plugin repository is still an effective place to host your free plugin. Over the past few weeks, the repository has been in the news for the unexpected removal of stats which many plugin developers said they relied upon. The podcast focus' on a post by Alex Denning in which he spells out why he thinks the repository is no longer viable. Matt disagrees and puts his side of the argument. Can you get noticed given the enormous reach of the incumbent plugins? Is it possible to convert enough users to your paid plugin to make it worthwhile? What can be done to improve the repository for plugin authors? It's a fascinating chat and is sure to interest anyone thinking about starting a freemium plugin.
Erik set up an advertising campaign on LinkedIn several months ago, targeting Managing Partners of law firms in the United States with a lead generation magnet called Everything You Need to Know About Hiring a Digital Marketing Agency. Erik share his advertising practices in this episode. — Erik J. Olson is the Founder & CEO of Array Digital - a marketing agency that provides bold marketing which helps managing partners grow their law firms. He is also: Author of Million Dollar Journey: How to launch a seven-figure business, available on Amazon.com. Host of the Journey to $100 Million daily podcast—sharing tips, tricks, and lessons learned from scaling Array Digital into be a world-class digital marketing powerhouse. Host of The Managing Partners Podcast—interviews with America's top managing partners about how they're running and growing their law firms. Erik speaks often on the topics of entrepreneurship, building freelance businesses, and digital marketing. Connect with Erik on Instagram at @erik.j.olson. — Kevin Daisey is an award-winning digital marketer & entrepreneur. He started his first company when he was just 23, and is the Founder & CMO of Array Digital. Kevin is also the co-host of the Journey to $100 Million Flash Briefing and daily podcast, and the co-organizer of the Marketers Anonymous monthly meetups. — For more information on the show, and to check out past episodes, go to journeyto100million.com!
Guests discuss governance issues, including overreach, ethics, and effective board governance. We unpack recent events at Michigan State University as a case study to explore governance issues for higher education institutions across the United States. Drs. Brendan Cantwell, Felecia Commodore, Demetri Morgan, and Kris Renn discuss engagement vs. overreach, negative partisanship, board accountability, and the possibility of today's challenges being leveraged to create transformational change for reimagining boards for greater effectiveness for higher education as a public good.
JAMA Associate Editor Linda Brubaker, MD, MS, discusses medication abortion as an alternative to a procedural abortion to terminate a pregnancy in an interview with Stephanie Teal, MD, MPH, University Hospitals Cleveland Medical Center, and Rebecca Cohen, MD, OB/GYN, University of Colorado. Related Content: Medication Abortion Contraception Selection, Effectiveness, and Adverse Effects Conflict of Interest Disclosures: Dr Cohen serves as an unpaid board member for Cobalt, a reproductive rights advocacy group. No other disclosures were reported.
After a long hiatus, Dr. Matt Brodhead returns to Behavioral Observations. In this episode, we discuss the use of punishment in the context of creating effective, ethical behavioral interventions. Of course, pursuant to the Behavior Analysis Certification Board's Ethics Code for Behavior Analysts, punishment should only be considered, "only after demonstrating that desired results have not been obtained using less intrusive means, or when it is determined by an existing intervention team that the risk of harm to the client outweighs the risk associated with the behavior-change intervention" (Code Element 2.15, page 12). So Matt and I talked about what this means in practice, the role of coercive or aversive events in everyday life, weighing the pros and cons of treatment choices, and much more. As we state in the first few minutes of the show, we made the editorial decision not to discuss the ABAI Task Force report on Contingent Electric Skin Shock. It's not that we don't have opinions on this topic; rest assured, we certainly do. But we felt like it would be more helpful for practitioners to hear Matt's thoughts on things like response cost, time-out, and so forth, as these are procedures that are more likely to be used by "everyday" practitioners. We also meandered into a few other topics, like the necessity of teaching cooperation and compliance under certain stimulus conditions, the utility or role of descriptive assessments vs. analog functional analyses, as well as other digressions. On a stylistic note, because Matt and I have gotten to know each other pretty well, this is an even more conversational episode that usual (versus one that is a series of questions and answers), with the attendant joking around that we usually engage in. If you're interested in Matt's work, go over to his website, betteraba.com, and pick up a copy of his excellent workbook, Behavioral Systems Analysis and Ethical Behavior. It's a bargain at $25 bucks... and remember, the holidays are right around the corner Matt is also available for workshops and consultations, and you can reach him through the same website. And while I'm plugging Matt's stuff, the popular text book he co-authored with Drs. David Cox and Shawn Quigley, is out in its second edition (disclosure: Amazon Associates Link). Other resources we discussed: Brodhead and Oteto (2022): Ethics and Ethical Problem Solving. Thomas and Brodhead (2022): Bringing Challenge to Coercion and the Status Quo. Matt's earlier appearances on the BOP. Musical references: "I Love this Bar" and "Check Yo Self" Hanley et al. (2005). On the Effectiveness of and Preference for Punishment and Extinction-Based Components of Function-Based Interventions. Hanley (2012): Functional assessment of problem behavior: dispelling myths, overcoming implementation obstacles, and developing new lore. Congenital Insensitivity to Pain. Perone (2003): The Negative Effects of Positive Reinforcement. The Importance of Red Teams, Peter Attia, MD. Michael (1975): Positive and Negative Reinforcement, a Distinction That Is No Longer Necessary; Or a Better Way to Talk about Bad Things. MacKenzie (2021): Caring by Lying. Fisher et al. (1996): On the reinforcing effects of the content of verbal attention. CBIT for Tic Disorders. Inside JABA #3 with Iser DeLeon on Accumulated vs. Distributed Reinforcement. This podcast is brought to you with the generous support of: Behavior University. Their mission is to provide university quality professional development for the busy Behavior Analyst. Learn about their CEU offerings, including their brand new 8-hour Supervision Course, as well as their RBT offerings over at behavioruniversity.com/observations. Abaspeech.org - the brainchild of Session 203 guest, Rose Griffin, is giving listeners a 30% discount on all of her courses which include, The Advanced Language Learner, Help Me Find My Voice, and Start Communicating Today. The offer is valid through December 1st, 2022. Go to abaspeech.org, check out the ‘courses' link, and use the promo code, aba30, at checkout. Behavior Development Solutions For BCBA and BCaBA candidates, they report a 98.5% pass rate for first-time exam takers… plus a money-back guarantee! They also have solutions for RBT aspirants, plus CE courses, and live webinars (most of which are free for anyone to attend). To learn more, head over to bds.com/bop for a special offer for podcast listeners!
Political Rallies are a staple of the political process. They help the candidates and their parties to engage with their bases and also offer an indicator of public support. Based on recent changes to the political calendar, we weigh up the effectiveness of political rallies in the current election cycle. Benue state Governor, Samuel Ortom and former Vice President, Atiku Abubakar have been caught in a public spat which once again highlights the failures of the PDP to get its house in order. Get the breakdown of all this and more. Subscribe to Stomach Infrastructure here
In Episode 64, we discuss how to spot winning political campaigns. How to estimate the likeliness of a win. What signs to look for. We discuss what makes a poll accurate. The quality and effectiveness of materials being distributed. When a campaign should get started. The ratio for those in the office to those in the field. All of these topics can be taken into account to spot a winning campaign.
"Submission" and "authority" are two words that tend to make us bristle. Most of us have seen the ugly side with people in leadership abusing that power, and it can make us hostile to the very idea. What does healthy, godly submission look like? How can we reframe our perspective, walk it out, and experience God's blessing through humility and trust?
Welcome to The Nonlinear Library, where we use Text-to-Speech software to convert the best writing from the Rationalist and EA communities into audio. This is: Using artificial intelligence (machine vision) to increase the effectiveness of human-wildlife conflict mitigations could benefit WAW, published by Rachel Norman on October 28, 2022 on The Effective Altruism Forum. 1. Overview This report explores using artificial intelligence (AI) to increase the effectiveness of human-wildlife conflict (HWC) mitigations in order to benefit wild animal welfare (WAW). Two concrete examples are providing more funding, research and direct work into reducing fatalities due to 1) collisions between bats and wind turbines, and 2) culling crop-raiding starlings. The report aims merely to raise awareness of this topic and introduce the idea for discussion, but not yet strongly suggest it is a cost-effective intervention on par with other interventions - see uncertainties, limitations, and potential for harm. What's the problem profile? HWC is increasing due to human expansions and climate change, (Gross et al., 2021) and is starting to be considered in government strategies and policy. The expected future impact of innovative and effective solutions to HWC could be even larger than currently appreciated. Lethal control or other methods which significantly impact animal welfare are still widely used (such as culling), despite preventative non-lethal strategies growing in more recent wildlife management approaches. Currently deployed AI systems directed towards HWC could be expanded further within the next 10-20 years as they become more reliable, more effective, and cheaper. We should not assume they will prioritize WAW concerns, or be widely used for animals of WAW concern, so this should be embedded before they are potentially rolled out at scale. There are already companies working on AI solutions for specific problems involving endangered species, such as protected areas using AI assisted technology for poacher detection. There is already proof-of-concept of an NGO-backed early warning AI system, ‘WildEyes', with this type of solution being invested in by a local governmental department in Tamil Nadu, India. Buy-in from a range of stakeholders (especially when it benefits humans and profits too) offers a way in with conservationists and researchers who may not otherwise consider WAW. Research and development (R&D) on AI-assisted HWC mitigations would likely attract researchers who would not otherwise consider or be motivated by WAW concerns. What should we be doing differently? A very tentative theory of change: if machine vision-based methods prevent HWC, they could be adopted, even on a small scale helps drop prices allowing for systems to be more widely adopted leads to more support and R&D continued price drops and adoption could create space for legislation to ban harmful or lethal methods of animal control preventing HWC could reduce apathy and antagonism towards “problem species” and make it easier for people to consider the welfare of animals, while also directly reducing negative WAW effects of HWC. This report highlights two examples of HWC where advocates could influence AI-assisted mitigation to directly affect substantial numbers of animals, and spread welfare considerations in software and norms: Wind turbine collisions are a leading anthropogenic cause of bat deaths and cause a significant number of bird deaths (600,000 to 949,000 bats and 140,000 to 679,000 birds annually in North America). We should expect fatalities to increase due to expansions in wind power. Culling of crop-raiding species. In one year, the USDA's Wildlife Services culled 1,028,642 European starlings responsible for agricultural crop damage, because other mitigations are ineffective. Despite this, starlings still cause extensive damage each year. More effective mitigation measures would hold value and could prevent culls. There are a number of r...
This recording features audio versions of November 2022 Journal of Vascular and Interventional Radiology (JVIR) abstracts:Inferior Vena Cava Filter Litigation Review: An Analysis of Medicolegal Cases Pertaining to Inferior Vena Cava Filters ReadManagement of Symptomatic Vascularized Retained Products of Conception by Proximal Uterine Artery Embolization with Gelatin Sponge Torpedoes ReadStent Diameter, Not Cephalic Arch Anatomy, Predicts Stent Graft Patency in Cephalic Arch Stenosis ReadComputed Tomography Fluoroscopy–Guided Percutaneous Transhepatic Bleomycin/Ethiodized Oil Sclerotherapy for Symptomatic Giant Hepatic Hemangioma ReadSafety and Effectiveness of Transhepatic Access for Percutaneous Renal Mass Cryoablation: A Multicenter Cohort ReadEvaluation of an Integrated Spectroscopy and Classification Platform for Point-of-Care Core Needle Biopsy Assessment: Performance Characteristics from Ex Vivo Renal Mass Biopsies ReadJVIR and SIR thank all those who helped record this episode:Host:Daniel Kim, Edward Via College of Osteopathic Medicine, VirginiaAudio editor:Stephan Lazar, Virginia Commonwealth University School of MedicineAbstract readers:Aleksandr Zyskin, MS, Eastern Virginia Medical SchoolMonika Neale, PhD, MBA, Kansas City University, MissouriMack Hale, Edward Via College of Osteopathic Medicine, South CarolinaEric Juang, MS, Creighton University School of Medicine, ArizonaRichard Liang, New York Institute of Technology College of Osteopathic Medicine, New YorkPriya Gupta, MBS, Rutgers New Jersey Medical School© Society of Interventional RadiologySupport the show
We take a look at two peer reviewed studies that appeared in academic journals that show whether influencer marketing is better or worse vs. social media paid advertising. The results may surprise you.This is a Marketing Monday episode. Listen each Monday to the EDGE to get the latest marketing research, trends, and tips to give you an edge up on your competition.CONNECT WITH USSign up for our NewsletterOver 17,200 listeners and countinghttps://edge.ck.page/bea5b3fda6EPISODE LINKS:Influencer Marketing Effectiveness Study in Journal of Marketinghttps://journals.sagepub.com/doi/abs/10.1177/00222429221102889Effectiveness of Influencer Marketing vs Social Media Sponsored Advertisinghttps://www.researchgate.net/publication/346412871_Effectiveness_of_Influencer_Marketing_vs_Social_Media_Sponsored_Advertising_Eficacia_del_marketing_influyente_Vs_la_publicidad_patrocinada_por_medios_sociales HELPFUL FREE RESOURCES:How to Write a Business Plan in 13 easy to Build Slides. FREE 30+ page ebookhttps://www.buildabusiness.io/guide-to-building-the-perfect-business-plan1600276207655Rather have someone build your business plan, pitch deck and financials for you, reach out to Brandon directly at B at BrandonCWhite.com EDGE PODCAST INFO:Apple Podcastshttps://podcasts.apple.com/us/podcast/edge/id1522407349Spotify https://open.spotify.com/show/7a3WcnSn9PlvwwF5hn4p4SYouTube Channel: https://www.youtube.com/channel/UCabV9Rcw4MohWvTGr3OTzFwWebsite https://MyEDGEPodcast.comRSS Feed https://buildabusinesssuccesssecrets.libsyn.com/rssEDGE Podcast. A top podcast for entrepreneurs!https://myedgepodcast.com
Slam the Gavel welcomes back Laurie Smith, LMSW on the podcast. Laurie Smith was last on the podcast September 12, 2022, Season 3, Episode 103. Shehas been practicing social work for 18 years and is well versed in multiple modalities, theories and evidence-based practices. Her work has continuously involved working with marginalized populations. Her passion is working with Trauma Survivors (individuals, providers and systems ), through offering self-guided, self-paced journeys that point towards Harnessing the Power of Our Own Internal GPS, Wielding Our Survival Skills and Building Armor Strategically to improve Quality of Life, Effectiveness and Sustainability for all and dig into our Birthright to Our Power and Joy. What has impacted her work the most is her own Trauma Transformations and Utilization of Universal Laws in everyday life. We discussed how she loves working with trauma survivors and the shame that keeps them small. Laurie also mentioned a book, "The Myth of Normal, Trauma, illness & Healing In A Toxic Culture," by Gabor Mate, MD. Laurie discussed how trauma causes shame and, "you're not allowed to feel these things." If we don't look at these things we cannot heal, and it is victimization over and over again. If we don't talk about these experiences we won't get the job done which is healing. We have worth and value and to claim meaning in purpose in the face of trauma is the only way to begin healing. Excellent conversation with Laurie Smith, LMSWTo reach Laurie: https://linktr.ee/cloudedcompass?utm_source=linktree_profile_share<sid=091d2af8-748e-4677-b464-5cad5d280515https://www.linkedin.com/in/laurie-smith-a598b247https://linktr.ee/cloudedcompasshttps://cloudedcompass.mykajabi.com/offers/Bboo3gp3/checkoutSupportshow(https://www.buymeacoffee.com/maryannpetri)http://beentheregotout.com/http://www.dismantlingfamilycourtcorruption.com/Support the showSupportshow(https://www.buymeacoffee.com/maryannpetri)http://beentheregotout.com/http://www.dismantlingfamilycourtcorruption.com/
Welcome to the Women in Tech Series from the Global Tech Leaders Podcast. Today we are speaking to Shanthi Rajaram President & CEO at Amazech Solutions. Technologist, leader, and problem solver with over 20 years of experience in areas of Business Management developing and driving strategic initiatives, technology adoption, software products, selling and implementing IT solutions, recruitment, etc. Highly energetic and driven in identifying opportunities and providing suitable solutions with a roadmap using cost-effective models with the right mix of global professionals. Demonstrates trust, accountability, thought leadership, and a customer-centric approach in all areas of work. We kick off by asking Shanthi to share with us her career journey and what has led her to where she is today. Technology came easy. Civil Engineer. Always been fascinated with solving problems. Developer. Small fish in a big company. Built for a small company ecosystem. We asked Shanthi what would be her advice for parents to steward kids to explore developing tech and software. Technology isn't going anywhere. All careers have the technology. Data science. Get comfortable with it. It comes intuitively to younger people to figure out technology. Don't curb curiosity. Collaboration between parents to share different skills. Then we ask Shanthi, a big advocate for women in tech, to share some of the initiatives she is involved in. Women in business & women in technology. DFW Alliance of Technology and Women (DFW*ATW) GirlsInSTEM Ignite. What to expect in business. Next, we ask Shanthi how you teach resilience. Bounce back. Effectiveness. Think before doing. Navigate and balance growth. Then we ask Shanthi to share the story of Amazech. Companies and websites. Started as a services company. Showcase capabilities. Marketing solutions and marketing services. Embrace what helps you. Security Apps. Lastly, we ask Shanthi what tips and tracks she has for productivity. Phone. Laptop. Excel. Microsoft Teams. Calendar. --- Send in a voice message: https://anchor.fm/gloabl-tech-leaders/message
"Doesn't grace mean that I can do whatever I want and just repent later?" No one enjoys discipline, but when we really examine it, we find that it's crucial for helping us live in the sweet spot. If we would begin to see God's correction it in a new light, it could literally change our lives.
On Episode 21 of the Stroke Alert Podcast, host Dr. Negar Asdaghi highlights two articles from the October 2022 issue of Stroke: “Oral Contraceptives, Hormone Replacement Therapy, and Stroke Risk” and “Effectiveness and Safety of Antithrombotic Medication in Patients With Atrial Fibrillation and Intracranial Hemorrhage.” She also interviews Dr. Shadi Yaghi about his article “Direct Oral Anticoagulants Versus Vitamin K Antagonists in Cerebral Venous Thrombosis.” Dr. Negar Asdaghi: Let's start with some questions. 1) Do hormone replacement therapies or oral contraceptives increase the risk of stroke? And if yes, does the age of the individual or the duration of therapy modify this risk? 2) Should survivors of intracranial hemorrhage who have atrial fibrillation be treated with antithrombotic therapies for secondary prevention of stroke? 3) And finally, what is the anticoagulant of choice for treatment of cerebral venous sinus thrombosis? We have the answers and much more in today's podcast as we continue to bring you the latest in cerebrovascular disorders. You're listening to the Stroke Alert Podcast, and this is the best in Stroke. Stay with us. Welcome back to another amazing issue of the Stroke Alert Podcast. My name is Negar Asdaghi. I'm an Associate Professor of Neurology at the University of Miami Miller School of Medicine, and your host for the monthly Stroke Alert Podcast. The October issue of Stroke covers a number of timely topics. As part of our October Literature Synopsis, we have a nice paper by Dr. Farida Sohrabji and colleague, which summarizes three recently published animal studies to evaluate the association between small vessel ischemic injury and either development of Parkinsonism or the future risk of Parkinson's disease. These studies looked at how ischemia, specifically involving the lenticulostriate arteries, can modulate the nigrostriatal dopaminergic pathway and ultimately lead to Parkinsonism. As part of our Original Contributions, we have the results of a small randomized trial out of Korea, which was led by Dr. Yun-Hee Kim from Sungkyunkwan University School of Medicine in Seoul, where we learned that doing 20 sessions of transcranial direct current stimulation for about 30 minutes for each session at home can improve post-stroke cognition. This was found to be specifically effective in patients with post-stroke moderate cognitive decline. Now, transcranial current stimulation can be given using a handheld device at home, and if truly proven safe and efficacious in larger studies, can dramatically change the landscape of stroke recovery in cognitive rehabilitation. I encourage you to review these articles in addition to listening to our podcast today. Later in the podcast, I have the great pleasure of interviewing Dr. Shadi Yaghi from Brown University. Shadi will walk us through a systematic review and meta-analysis of published studies to compare the safety and efficacy of direct oral anticoagulants to that of vitamin K antagonists in patients with cerebral venous sinus thrombosis. Our devoted Stroke Alert Podcast listeners recall that we did cover this topic in our March podcast when we reviewed the results of ACTION-CVT, a multicenter international study that was led by none other than Shadi himself. I'm delighted to have him as a guest on my podcast today to talk more about the seminal study and all things cerebral venous sinus thrombosis. But first, with these two articles. Millions of women worldwide use exogenous hormones, most commonly in the form of oral contraceptives and hormone replacement therapies. Despite the many different formulations of these drugs that are now available on the market, the two therapies are similar in that both combined oral contraceptives and hormone replacement therapies, or HRTs, contain various dosage of estrogen and progestin. Now, the principal difference between them being that the hormone contents of oral contraceptives are at high enough dosage to prevent ovulation, whereas hormone replacement therapies are considered more physiological as their aim is to return post-menopausal hormone levels to what they were before menopause. Well, by now, you must wonder how is any of this even relevant to vascular neurology? Well, the answer lies in the close relationship between hormonal therapies and stroke. But before we get to that, we have to review a few things. First of all, it's long been known that the endogenous estrogen has strong and protective effects on the arteries. It promotes vasodilation and cell survival of the endothelial layer. It increases the endothelial mitochondrial efficiency and stimulates angiogenesis. In other words, endogenous estrogen is good for vascular health. And in fact, that's why we think that premenopausal women, in general, are at a lower risk of stroke as compared to their age and vascular risk factors–matched male counterparts. And to make things even better for estrogen, there's enough evidence to suggest that exogenous estrogen also does all of these good things for the endothelium. So, why are we even talking about an increased risk of stroke associated with use of hormonal therapies? The problem is, we have to remember that exogenous estrogen also does other things. It can increase the blood concentration of procoagulants, which, in turn, can increase the risk of thromboembolism, especially venous thrombosis. But there's still a lot of unknown on this topic. For instance, the majority of the prior research on the topic involves postmenopausal women using hormonal therapies. Some of that research has actually suggested that HRTs may be protective against vascular events, while others showed the opposite. Well, we know that a majority of oral contraceptive users are actually much younger and use these medications premenopausal. So, there seems to be a lot of gaps in our current knowledge on the simple question of whether or not oral contraceptives and hormonal replacement therapies do, in fact, increase the risk of stroke or not. In the current issue of the journal, a group of researchers led by Drs. Therese Johansson, Torgny Karlsson, and Åsa Johansson from the Department of Immunology, Genetics and Pathology at Uppsala University in Sweden set out to fill some of these gaps with their study titled, "Oral Contraceptives, Hormone Replacement Therapy, and Risk of Stroke," as part of a large UK Biobank population-based cohort. Just a bit about the UK Biobank. This was a large population-based cohort from 2006 to 2010 that included over 500,000 residents of the United Kingdom between the ages of 37 and 73. Participants at the time of enrollment would have extensive information collected from them through questionnaires, interviews, health records, physical measures, as well as some imaging and biological samples. Data on each participant was collected from the time of their birth all the way to the day of assessment, which is interesting, because the day of assessment would then count as the end of the follow-up for each participant. Now, for the current study, they included over 250,000 women of White race in whom information required for the study on whether or not they use hormonal therapies, duration of treatment, age at the time of exposure was available. And just a quick comment about their methodology. They analyzed their cohort once for oral contraceptive use and once for HRT use and compared each group to a reference group of either women who never used their set therapy or the number of years they contributed to the study prior to initiating that set treatment. So, for instance, if a person started using oral contraceptives at the age of 21, all of the years that she contributed to the study before that age would count as non-exposed user years and were included in the control cohort. So now, on to their findings. A total of 3007 stroke diagnosis of any type were identified prior to the initial visit to the assessment center, which, as we mentioned, was the end of the follow-up in the study. Of these, 578 were ischemic strokes, 177 intracerebral hemorrhage, and 478 were subarachnoid hemorrhages. But as expected for any large cohort, over half of total strokes were self-reported as stroke of any type and could not be classified into any of the above subtypes. Now, let's look at the effects of oral contraceptives on the outcome of stroke. Overall of the women included in the study, 81% were classified as oral contraceptive users, while 19% reported never having used oral contraceptives at any point during the study. On the association between oral contraceptive use and the risk of stroke, at first glance, things looked OK. The hazard rates of any stroke for any stroke subtypes were not different between women who had used oral contraceptives as compared to those in the reference group. That's great news. But when they looked deeper, they realized that the odds of development of any stroke was actually quite high during the first year after the initiation of oral contraceptives with hazard rate of 2.49 for any stroke, while there was no difference in hazard rates found during the remaining years of use and after discontinuation of oral contraceptive use. So, meaning that there was no lingering effects of oral contraceptives on increased risk of stroke after the first year or after discontinuing the medication. Now, on to HRTs. In total, 37% of women in the study had initiated HRTs at some point during the study, while 63% had never used this therapy. Here's the bad news. Overall, HRTs did increase the risk of stroke. An approximately 20% increase event rate of any stroke was noted among women who had initiated HRTs as compared to those who had not. When analyzing stroke subtypes, the use of HRTs was associated with increased risk of only the subarachnoid hemorrhage subtypes. We don't know why. Diving deeper, in considering timing of HRT initiation, very similar to what was observed for the oral contraceptives, during the first year after starting the HRTs, the treatment group was twice more likely to suffer from any type of stroke, and the hazard rate was also increased for all three stroke subtypes that were available in the study. But, unlike oral contraceptives, the hazard rate of any stroke remains significantly high even after the first year of use, not just for those who continued HRTs, but sadly, even for those who discontinued the therapy. Though the risk remained high, the hazard ratio declined over time as we went further away from the first year when treatment was initiated. So, bottom line, if women had initiated HRTs at some point in their life, the hazard risk of any stroke increased significantly in the first year. That hazard risk did decline over time, but it always remained significantly higher than non–HRT users. Now, what about timing of treatment in relation to the onset of menopause? Is the risk of stroke any different if women start on HRTs prior to or after their menopause? The answer is no. Initiation of HRTs was associated with an increased hazard rate of any stroke if it was started pre- or postmenopausal, but the risks were higher if the treatment was started prior to menopause. So, in summary, this large population-based cohort has truly given us some very important practical findings. We learned that both oral contraceptives and hormone replacement therapies do, in fact, increase the risk of stroke, an effect that was most notable in this study in the first year after initiation of both of these therapies, and in the case of oral contraceptives, was just actually limited to that one year alone. Why does this happen? I guess the easy answer is that these drugs, as we noted earlier, have an immediate prothrombotic effect, which gradually weakens over time. That's one plausible explanation, but for instance, why HRTs increase the risk of subarachnoid hemorrhage is something we can't explain based on the prothrombotic effects of HRTs. So, we have to come back to the vessels, the impact of hormone therapies and estrogen specifically on the blood vessels, on the endothelial cells, the potential increase in blood pressure, especially early on in the course of treatment with these medications. And also, we have to think about the role these drugs may play in increasing inflammatory markers, providing a more suitable milieu for accelerated atherosclerosis, as to why these associations were noted in this study. And it's fair to say that we need more research on this topic in the future. One challenging scenario that we commonly face in our daily practice is deciding whether or not we should resume antithrombotics in patients with atrial fibrillation who have survived an intracranial hemorrhage. The majority of intracranial hemorrhage survivors with atrial fibrillation actually have a very high CHA2DS2-VASc score, which means that they are actually at a very high risk of future ischemic stroke and systemic embolic events unless they're treated with anticoagulants. On the other hand, the risk of spontaneous intracranial bleeding is substantially higher in a person who has previously suffered from one, let alone if we treat them with anticoagulants. And to make matters worse, we have little evidence from the literature to guide us. So, in the current issue of the journal, in the study titled "Effectiveness and Safety of Antithrombotic Medication in Patients With Atrial Fibrillation and Intracranial Hemorrhage," a group of researchers from the UK led by Dr. Deirdre Lane, Professor of Medicine at the University of Liverpool, performed a much needed systematic review and meta-analysis of the available evidence on this subject. I have to say that lately, it seems that we've been covering a few of these reviews in our podcasts, and we are just getting started. In fact, my next paper in today's episode is also a systematic review and meta-analysis. These papers are packed with details, a testament to the work needed to complete them, but I have to say that even summarizing these papers for a podcast has been a bit challenging. So, feel free to put me on pause, go get some coffee, and let's power through this one together. For their methods, they used the usual search engines looking for papers that included adults over the age of 18 with atrial fibrillation who had survived a non-traumatic spontaneous intracranial hemorrhage of any size, any type, and any location, be it lobar, brain stem, deep, cerebellar, subdural, epidural, or subarachnoid hemorrhage. And very importantly, they included even those with evidence of microbleeds on neuroimaging. The intervention of interest was either long-term oral anticoagulation or antiplatelet therapy versus no antithrombotic use for the following three outcomes of interest: number one, recurrent thromboembolic events; number two, recurrent intracranial hemorrhage; and number three, all-cause mortality. Just a quick note that for this analysis, they excluded studies that looked at either short-term anticoagulation or non-oral anticoagulation use for any reason that was given to the patient other than for secondary prevention of stroke. For example, if a patient suffered from a pulmonary embolism and was treated with IV heparin or, for a short period of time after that, with oral anticoagulation, those patients or those studies were excluded from this meta-analysis. So, with this criteria, they pulled over 4,000 citations and abstracts, and finally included 20 papers that were published between 2015 and 2021 for a total of over 50,000 participants for this meta-analysis, very nice sample size. Most of the papers included were observational cohorts, but in addition, we had two small randomized trials, and I want to take a moment and review these trials for our listeners. The first one was a small noninferiority pilot trial out of the UK, the SoSTART trial, that looked at any anticoagulant versus either antiplatelet therapy or no antithrombotics in this population, and the other trial was the Phase 2 trial, the APACHE-AF, that studied apixaban versus no anticoagulation after anticoagulant-associated intracerebral hemorrhage. A reminder that both of these trials were published in Lancet Neurology in 2021. And before we move on to the findings of the meta-analysis, it's worth noting that they had included a mix of patients, some were oral anticoagulant–naive, and some had developed their index intracranial hemorrhage while already on treatment with anticoagulants or antiplatelet therapies. OK, now on to their findings, as mentioned, we're going to review three outcomes of recurrent thromboembolism, recurrent intracranial hemorrhage, and all-cause death for the following three groups: group one, oral anticoagulant therapy versus no therapy; group two, oral anticoagulation therapy versus either antiplatelet treatment or no therapy; group three, comparing new oral anticoagulants versus warfarin. So, for the first outcome of recurrent thromboembolic events in group one, when comparing oral anticoagulant therapy to no therapy, the study showed a significant reduction in thromboembolic events in favor of oral anticoagulation compared to no therapy. That's great news. Next, analysis of the studies that compared oral anticoagulation versus either antiplatelets or no therapy didn't show the same difference in prevention of embolic events in favor of either groups. Actually, no difference was noted between the two groups. Number three, now, in terms of comparing NOACs to warfarin, three studies had the information on this comparison, and they reported a significant reduction in the risk of thromboembolic events with NOAC as compared to warfarin. So, great news for oral anticoagulation overall, and especially for NOACs. Now, on the next outcome. Our second outcome was a recurrent intracranial hemorrhage. Keeping in mind that they included some studies where the outcome was defined as any form of intracranial hemorrhage, meaning they included subdurals, epidurals, etc., and some studies only included the outcome of intracerebral hemorrhage. So, on to the first group, comparing oral anticoagulants to no therapy, the pooled estimate revealed no statistically significant difference between oral anticoagulant–treated patients to those who were not treated with any antithrombotics on the risk of recurrent intracranial hemorrhage. That's great news. Next, on our second group, for the same outcome of recurrent intracranial hemorrhage, comparing oral anticoagulants to either antiplatelet therapy or no treatment, they found that oral anticoagulation was associated with a higher risk of recurrent intracranial hemorrhage as compared to antiplatelets or no therapy. And finally, third group comparing new oral anticoagulants to warfarin for the same outcome, the risk of recurrent intracranial hemorrhage was significantly reduced in patients treated with NOACs as compared to warfarin. And now, we're finally on to our last outcome of the study, which is the outcome of all-cause mortality. So, again back to group one, comparing oral anticoagulants to no therapy, this meta-analysis showed a significant reduction in all-cause mortality rate associated with oral anticoagulation. That's, again, great news. Next group, for the same outcome of mortality, comparing oral anticoagulants to either antiplatelet therapy or no treatment, they found no significant difference in the mortality rates between the two groups. And finally, comparing NOACs to warfarin, the pooled estimate showed that NOACs were associated with a significantly reduced risk of all-cause mortality. Amazing news for NOACs. So, in summary, here's what we learned from this big study. Oral anticoagulation use after intracranial hemorrhage in patients with atrial fibrillation did significantly reduce the risk of thromboembolic events and all-cause mortality without significantly increasing the risk of recurrent intracranial hemorrhage. In general, new oral anticoagulants, or NOACs, are preferred to warfarin as they do prevent embolic events with a lower risk of recurrent intracranial hemorrhage. But, of course, we still have a lot more questions. For instance, would any of the outcomes mentioned above be different in patients with lobar intracerebral hemorrhage, a condition typically associated with amyloid angiopathy, which carries a high risk of development of intracerebral hemorrhage? Also, we have to keep in mind that the majority of the studies included in the meta-analysis were observational. So, there remains an urgent need for a larger randomized trial on this subject, and we have to stay tuned for more research. Cerebral venous sinus thrombosis, or CVST, is an uncommon form of stroke resulting in headaches, seizure, or focal neurological symptoms due to either intracranial hemorrhage or venous ischemic infarcts. The rarity of the disease has made it difficult to study as part of randomized trials, so current treatment guidelines for CVST are consensus-based with much of the recommendations extrapolated from data on treatment of patients with systemic deep vein thrombosis. In general, based on the current evidence, the field agrees that a patient with CVST should be anticoagulated. The decision that is difficult and sometimes inappropriately delayed in the setting of acute hemorrhage in the brain. And not surprisingly, there's significant equipoise around the choice of anticoagulant, duration of therapy, and the role of heroic therapies, especially in the acute setting. Currently, there are a number of ongoing trials to address some of these issues. The direct oral anticoagulants present an attractive alternative to vitamin K antagonists for treatment of patients with CVST. This is partly because of their convenience of use. But how do direct anticoagulants compare in safety and efficacy to the vitamin K antagonists in the setting of CVST is less known. In our March podcast, we reviewed the results of ACTION-CVT, which was a multicenter international study that compared the safety and efficacy profile of the direct oral anticoagulants to that of warfarin in routine practice. The study included over a thousand imaging-confirmed CVST patients from multiple centers in the US, Italy, Switzerland, and New Zealand. And if you missed it, no worries at all. We're here to review some of the results again, as in this issue of the journal, many of the ACTION-CVT investigators, led by Dr. Shadi Yaghi, present the results of a systematic review and meta-analysis comparing the safety and efficacy of DOACs, or direct oral anticoagulants, to that of vitamin K antagonists. I'm joined today by Dr. Yaghi himself to discuss ACTION-CVT and the current meta-analysis. Dr. Yaghi is a Director of Vascular Neurology at Lifespan and Co-Director of Comprehensive Stroke Center and a Director of Research at the Neurovascular Center at Rhode Island Hospital. Good afternoon, Shadi, and welcome to our podcast. Dr. Shadi Yaghi: Good afternoon, Dr. Asdaghi. Thank you so much for having me. Dr. Negar Asdaghi: Thank you. And please call me Negar. Congrats on the paper. Before we talk about the meta-analysis, can you please remind us of the results of ACTION-CVT and why the systematic review, in your opinion, was an important next step to that effort? Dr. Shadi Yaghi: Thank you so much for having me and for bringing up ACTION-CVT. So ACTION-CVT is a real-world multicenter international study that used real-world observational data to compare the safety and efficacy of direct oral anticoagulants to vitamin K antagonists in patients with cerebral venous thrombosis. The reason why we did ACTION-CVT was, as you know, cerebral venous thrombosis is a rare disease, and it's hard to have large studies that would be powered enough to compare the safety and efficacy of direct oral anticoagulants to vitamin K antagonists. So, most of the studies that were done are small, retrospective. There's one randomized controlled trial, but most of them are underpowered to detect the difference between the two groups. So, we decided to do a large-scale international multicenter study using real-world data to compare the safety and efficacy of both. Dr. Negar Asdaghi: OK, so we're glad you did. Let's start with the methodology of the current meta-analysis. Can you please give us an overview of the inclusion criteria for selection of the papers and the intervention and outcomes that you were interested in? Dr. Shadi Yaghi: Of course. So, this is a systematic review and meta-analysis that included studies comparing direct oral anticoagulants to vitamin K antagonists in patients with cerebral venous thrombosis. The studies needed to have the two groups included, the direct oral anticoagulants and vitamin K antagonists, and they need to include at least one of the outcomes in our study to compare this outcome between the two groups. In addition, we included articles published in English, and we also included papers that had five patients or more in each group. Dr. Negar Asdaghi: Perfect. So just recap for our listeners, in order to have been included in the meta-analysis, the paper had to have a reasonable number of patients, and you put that reasonable at the number five, and also they had to have at least one of the outcomes of interest reported in their papers. And those outcomes were either recurrent venous thromboembolism or recanalization rates. Right? Dr. Shadi Yaghi: Correct. Yes. Dr. Negar Asdaghi: Perfect. So with that, how many papers did you have to go through to come up with the current number of papers included? Dr. Shadi Yaghi: That's a great question. We had a little over 10,000 papers, and then we went through a screening process. We used this tool that was developed by Brown University. It's called Abstrackr, and what you do is, we did the search and using several databases like PubMed, Cochrane, and then we included all these studies. We uploaded them in Abstrackr, and Abstrackr was utilized to be able to review all these abstracts and select studies that may or will probably qualify and then go through the studies and details that would qualify. So, we had about 10,000 studies with the initial search, and we had two reviewers go through each abstract, and from these 10,665, we excluded 10,411, and that left us with 254 studies. And then we went through these 254 studies in details. And then finally, we had 19 studies included that met our inclusion/exclusion criteria. And these 19 studies included three randomized control trials and 16 observational studies. Dr. Negar Asdaghi: Incredible effort. So, three randomized trials in this meta-analysis and 16 observational studies. I think we're very ready to hear the primary outcomes. Dr. Shadi Yaghi: Yeah, so, the primary outcomes were recurrent venous thrombosis, and that included recurrent venous thromboembolism like peripheral DVTs or PEs, for example, and including recurrent cerebral venous thrombosis. And we know that most of the events are recurrent VTEs, not CVTs, like probably about two-thirds to three-quarters were VTEs, and a third to a quarter were CVT. And then the other efficacy outcome is venous recanalization on follow-up imaging. And we found that direct oral anticoagulants and warfarin were not significantly different in the primary efficacy outcomes. Dr. Negar Asdaghi: Thank you. I just want to repeat this for our listeners. So, you mentioned some important information here. First one was the fact that about three-quarters of recurrent events were actually systemic thromboembolic events rather than cerebral thromboembolism. So, an important outcome to keep in mind for our practicing physicians. And the fact that DOACs did the same as compared to vitamin K antagonist. So, I think you can already guess my next question, and that is, was there any compromise on the safety profile when using DOACs as compared to vitamin K antagonists in this meta-analysis? Dr. Shadi Yaghi: Thank you. That's a great question. In ACTION-CVT, we found that there was a lower risk of major hemorrhage with direct oral anticoagulants compared to vitamin K antagonists. In this systematic review and meta-analysis, we didn't find a significant difference, but there were fewer events in patients treated with direct oral anticoagulants versus vitamin K antagonists. This did not reach statistical significance, but if you look at the raw data, it's kind of along the same lines as ACTION-CVT, so the risk of major hemorrhage was about 3.5% with warfarin, and that was about 2% with direct oral anticoagulants. Dr. Negar Asdaghi: So, again, very important finding, and I want to repeat this for our listeners. So, important finding number one was that there was a superiority in favor of DOACs that you found in terms of a reduced risk of intracerebral hemorrhage in ACTION-CVT. You didn't find this superiority in the meta-analysis, but there was sort of a hint to perhaps lower risk of intracerebral hemorrhage in patients that were treated with DOACs. Did I get that right? Dr. Shadi Yaghi: Yes, that is correct, and in addition, also major hemorrhage in general, and that included also ICH. Dr. Negar Asdaghi: Oh, OK, so not just intracranial, but systemic hemorrhages as well. All right. Very good. So, I think my next question would be, why do you think that DOACs have a lower chance of causing hemorrhage? Dr. Shadi Yaghi: Yeah, that's a really good question. This is not unexpected with DOACs as opposed to vitamin K antagonists. We saw these same trends in patients with atrial fibrillation. We saw improved bleeding profiles with direct oral anticoagulants as compared to vitamin K antagonists. And the risks were along the same lines that we found in patients with cerebral venous thrombosis in ACTION-CVT. Also in the VTE trials as well, there was also reduced bleeding complications with direct oral anticoagulants as compared to vitamin K antagonists. So, it was kind of reassuring to see the same results in patients with cerebral venous thrombosis. Dr. Negar Asdaghi: Perfect, so kind of expected based on what we know from treatment of systemic conditions with DOACs. The next question I have for you is that in routine practice, treatment of cerebral venous sinus thrombosis almost always starts parenterally with either unfractionated heparin or low molecular weight heparin and then we switch to an oral agent. In the observational studies, did you find any differences in terms of timing of this switch or characteristics of the patients in whom vitamin K antagonists were chosen over direct oral anticoagulants? Dr. Shadi Yaghi: Thank you very much. Most of the studies did not report these details. I think the one study, off the top of my head, that does report the differences in characteristics between the two groups is RESPECT-CVT. That's the randomized controlled trial comparing dabigatran to vitamin K antagonists. In this study, there was a treatment with parenteral anticoagulation for several days, I think seven to 14 days, prior to transitioning to oral anticoagulation. And this is generally my practice. I typically would treat patients with at least seven days or so parenteral anticoagulation, and once they're clinically stable, then I would transition them to oral anticoagulation, either vitamin K antagonists or direct oral anticoagulant. Dr. Negar Asdaghi: And I think my next question is along the lines of this question as well. We have several direct oral anticoagulants now available on the market. What was the most common DOACs used for treatment of CVST in these studies, and did you note a preference for the use of any particular agent over others? Dr. Shadi Yaghi: Thank you so much for the question. Anti-Xa inhibitors were much more common than dabigatran, and the anti-Xa inhibitors most commonly used were apixaban and rivaroxaban. It's in line with what we saw in ACTION-CVT as well, although most of the randomized controlled trials or the largest randomized controlled trial, RESPECT-CVT, used dabigatran, but overall people have been using anti-Xa inhibitors, more particularly apixaban, which was also in line with what we saw in ACTION-CVT. Dr. Negar Asdaghi: But I think it's fair to say that we don't really have data on superiority of one over others. Is that fair? Dr. Shadi Yaghi: Yes, that is correct. Dr. Negar Asdaghi: OK, and so now, where are we at in terms of the future of studies on this topic? We have one ongoing randomized trial now? Dr. Shadi Yaghi: Yes, we have one randomized controlled trial ongoing, and this is the SECRET trial, and it's looking at rivaroxaban versus vitamin K antagonists in patients with cerebral venous thrombosis. There's another study, it's a prospective observational study that's called the DOAC-CVT study. It's an international study also looking at real-world data prospectively to see if there's a difference in outcomes between the two groups. Dr. Negar Asdaghi: So, we look forward to the results of those studies. Shadi, a follow-up question I have on this topic is, how long should a duration of therapy be in idiopathic cases of cerebral venous sinus thrombosis? Dr. Shadi Yaghi: Thank you so much for this question. So, it's unknown at this point for how long should we treat. The key things from the treatment are first achieving venous recanalization, and second is preventing another venous thromboembolic event from happening. So, regarding the venous recanalization, studies have shown that there's not a lot of recanalization beyond four months of treatment. So, a lot of the recanalization really happens early, and continuing anticoagulation beyond the six-months interval, for example, in order to achieve further venous recanalization probably has limited utility. And the second important reason why we treat patients with anticoagulation is also to reduce the risk of a recurrent venous thromboembolic event or cerebral venous thrombosis. And for that, if it's a provoked CVT, then I think usually it's three to six months. If it's unprovoked, up to maybe six to 12 months or even longer, depending on the profile. And if there's a persistent provoking factor, such as cancer, antiphospholipid antibody syndrome, then the treatment is lifelong or until this condition subsides. There's a lot of controversy about the duration of treatment. The European guidelines were very helpful in identifying the duration of treatment. Hopefully, also, we have some guidelines or at least a scientific statement by the AHA that also doles details out and provides some guidance to practitioners. Dr. Negar Asdaghi: Shadi, what should be our top two takeaways from the current meta-analysis and also ACTION-CVT? Dr. Shadi Yaghi: So, really, the top two from ACTION-CVT and the meta-analysis are, first is direct oral anticoagulants have a comparable efficacy to vitamin K antagonists in terms of recurrent venous thrombosis and achieving venous recanalization on follow-up imaging. And then the second point is direct oral anticoagulants are probably safer than vitamin K antagonists. We have to keep in mind that this data is based mostly on observational studies. And, as we mentioned earlier, we need more randomized controlled trials to support these findings. Dr. Negar Asdaghi: Dr. Shadi Yaghi, it was a pleasure interviewing you on the podcast. Thank you very much for joining us, and we look forward to having you back on the podcast and reviewing this topic again in the future. Dr. Shadi Yaghi: Thank you so much. I appreciate you having me. Dr. Negar Asdaghi: Thank you. And this concludes our podcast for the October 2022 issue of Stroke Please be sure to check out this month's table of contents for the full list of publications, including an important update from the European Stroke Organisation by Prof. Martin Dichgans. I also want to draw your attention to this month's InterSECT paper, which is our International Stroke Early Career and Training section, to discuss the key topic of burnout and mental health amongst physicians, especially amongst neurologists and stroke neurologists. It's alarming to read in this article that neurology is one of the specialties with the highest reported rates of burnout syndrome, and stroke neurologists are at particularly higher risk than other neurological subspecialties. The article tackles some tough subjects, such as the barriers for physicians to seek help and important strategies to mitigate burnout and how to improve mental health in general. I think it's also timely to know that October is the Mental Health Awareness Month, and the theme for October 2022 is "Back to Basics." The basics of recognizing the burden of stress, anxiety, the burden of isolation and depression, not only on those who we take care of, but also on those who give care to us. So, whether you're a stroke physician, a stroke caregiver, or whether you've been touched by this disease in some way or shape, please know that you are part of the stroke community and a part of our Stroke podcast family. Thank you for listening to us, and, as always, stay alert with Stroke Alert. This program is copyright of the American Heart Association, 2022. The opinions expressed by speakers in this podcast are their own and not necessarily those of the editors or of the American Heart Association. For more, visit AHAjournals.org.