Podcasts about EPUB

In this insightful interview, Chad Herst shares his transformative journey through yoga, personal grief, and coaching. He discusses the profound lessons from his book 'The Performance Trap,' exploring themes of vulnerability, surrender, and self-acceptance. Chad began practicing Ashtanga Yoga in 1993, with David Williams as his first teacher, and was authorized to teach by Sri K. Pattabhi Jois in 2003. He made the pilgrimage to Mysore for fourteen years, studied with Tim Miller, Chuck Miller, and Eddie Stern, and went on to found three Mysore-style programs. He still practices today. He's also a former licensed acupuncturist and has spent the last twenty years coaching high performers. His new book, The Performance Trap, is in part a reckoning with what the practice did to his body, and with the harder question underneath: why he kept going back long after he knew better, and what it means to still be on the mat at fifty-something. He lives in Northern California with his wife, Melissa.   Main Topics: ·       The impact of grief on personal growth ·       The role of discipline and surrender in yoga ·       The importance of honesty and vulnerability in coaching ·       How the desire for success can mask deeper ache Websites: herstwellness.comChad's Book:  The Performance Trap: The Ache No Success Will Ever Fix Listen to the first chapter in Chad's voice: herstwellness.com/chapter-one  Full audiobook, EPUB, and PDF for anyone who wants to read the whole thing herstwellness.com/book  SUPPORT KEEN ON YOGA Become a Patron: https://www.keenonyoga.com/patrons/ Buy us a coffee: https://www.buymeacoffee.com/infoRf FULL PODCAST LIST https://www.keenonyoga.com/keen-on-yoga-podcast-guests/   CONNECT WITH ADAM https://linktr.ee/Keenonyoga WATCH: https://www.youtube.com/@keenonyoga LISTEN Apple podcast:  https://podcasts.apple.com/us/podcast/keen-on-yoga-podcast/id1509303411 Spotify: https://open.spotify.com/show/5iM9lcw52JskHUZ2eFvVxN

How is AI transforming accessibility for indie authors — and why should you care even if you consider yourself able-bodied? What happens when the tools designed to help people with disabilities end up making everyone's creative business better? Jeff Adams, accessibility expert and romance author, explores how AI is opening doors that were previously closed. In the intro, Spotify Audiobook Innovations; The Economics of Convention Life [The Indy Author]; Friction in your Author Business [Self-Publishing with ALLi]. Today's show is sponsored by Draft2Digital, self-publishing with support, where you can get free formatting, free distribution to multiple stores, and a host of other benefits. Just go to www.draft2digital.com to get started. This show is also supported by my Patrons. Join my Community at Patreon.com/thecreativepenn Jeff Adams is the author of YA thrillers and gay romance, and the co-author of Content for Everyone, a practical guide for creative entrepreneurs to produce accessible and usable web content. You can listen above or on your favorite podcast app or read the notes and links below. Here are the highlights and the full transcript is below. Show Notes How ending a long-running podcast made space for more writing — and how to know when it's time to let go of a good thing What accessibility really means for indie authors and why your digital content might be excluding part of your audience How AI agents like Claude Cowork are removing physical and cognitive barriers for authors with disabilities, chronic pain, or limited energy The culture of shame around AI use in the writing community and why blanket anti-AI statements can be ableist Practical tools including NotebookLM, ElevenReader, and ChatGPT for marketing copy, metadata management, and multimodal research Exciting futures in personalised reading, real-time translation, and AI browser agents that could change how everyone interacts online You can find Jeff at JeffAdamsWrites.com. Jeff also now has a SubStack at contentforeveryone.substack.com Transcript of the interview with Jeff Adams Jo: Jeff Adams is the author of YA thrillers and gay romance, and the co-author of Content for Everyone, a practical guide for creative entrepreneurs to produce accessible and usable web content. Welcome back to the show, Jeff. Jeff: Thanks so much, Jo. It's good to be back. Jo: It is. You were last on the show in March 2023, so over three years ago now. Give us a bit of an update on your writing and publishing business and what it looks like at the moment. Jeff: Sure. I think the biggest thing that happened is that my husband Will, who is also a writer, we ended the Big Gay Fiction Podcast at the end of 2024, after 470-something episodes. It was basically time to do that. So we both focused on writing from that point. In 2025 we had some of our biggest successes in getting writing out into the world. I refound my groove—my difficulty in writing went away finally. We talked a little bit about that back in 2023 too. Will started a new pen name and started producing again, and it was really good to be able to move in that direction. Jo: Was this the hockey romance that really hit at the right time? Jeff: You know, I wish I could have capitalised more on Heated Rivalry when it came out, but I did get hockey books out, and I think I did get to ride that wave a little bit there too. Jo: Yes, and if people don't know about that, that was a super popular streaming series. Was that based on a book? Jeff: It was, yes. Rachel Reid was the author of that book and that series that then Jacob Tierney optioned and made into what fairly turned into a global phenomenon at the end of 2025. Jo: Yes, absolutely. Although I particularly liked Red, White and Royal Blue. That was the one I liked. Not so much into hockey. But anyway, I just wanted to ask you about the Big Gay Fiction Podcast. As you say, you did hundreds of episodes over many years. You and I met over podcasting. You've had lots of connections with people. You ended it, and I know you struggled with ending it, but it sounds like it went really well for you. So maybe you could talk a bit about— How do you know when it's time to end something—a good thing rather than something bad? Does that make more space for writing, essentially? Jeff: It absolutely did make more space for writing for both of us, in particular for me because I have a day job. I balance everything on the creative side with the day job. Will and I had been talking about it for over a year. It just was like, it's really time. After nine years, getting to that 470 mark, we thought about trying to get to 10 years and we thought about, if not 10, then getting to 500 and ending on a milestone. As we looked at everything in our creative business, it was like, this is fun, we enjoy it, but we're not getting as much out of it as we might be if we were actually also writing books, which we also really want to do. It became a time thing and what was the best use of the time. We absolutely miss it occasionally. The whole Heated Rivalry thing, I would've loved to have had episodes to talk about that on, but in the long run, it was worth it. Jo: I mean, one of the things with a podcast, particularly around fiction, was that it was a marketing angle for your fiction. This show is a marketing angle mainly for my nonfiction. So what did you replace the podcast with, in terms of book marketing? Jeff: It was really stepped-up email marketing. I'd always had a list. Will started a list, of course, as he started his new pen name. So it was really turning on that, focusing on that, getting some email marketing with a Bargain Booksy and a Fussy Librarian and a BookBub occasionally to do that work. To be honest, even though we covered things in our genre that if you like what we're talking about, you should like our books, there was never as much of a connection there as you'd want there to be. Even from that book marketing angle, these other things that we can do, it's also a better spend of the money to get those types of promos than it was to continue running the show. Jo: Yes, that is interesting. I mean, obviously I think about podcasting a lot since I have this one, and I put Books and Travel on a hiatus and that was meant to help my fiction and definitely didn't help my fiction sales. But I want to bring it back again because I love doing it. Do you have this hankering sometimes? Do you think you'd ever do the podcast again? Because you are also quite into all the technical stuff and all that. Jeff: It's possible. I've toyed with the idea of doing a short accessibility podcast geared towards creatives, tilting to the same audience that Content for Everyone does. Then I come back and look at the time—is my time better served writing new fiction or perhaps starting a Substack, which I also toy with the idea of, for accessibility stuff? So it bounces around in my head to do another show, but I haven't really decided to jump on that yet. Jo: Yes, and I think that waiting is really good. As you say, you quit a big thing and you don't have to rush to fill it again. I love that you guys are writing more books. So I wanted us to talk about that up front because I know people who listen to this show—I encourage people to start podcasts if you want to, but equally it can take a lot of time. So that's fantastic. Now, you mentioned accessibility, and I feel like the word can be quite difficult for people. So let's just start with a definition. What is accessibility? Why do you care and why should we care? Jeff: So accessibility is really about making sure that whatever the thing is, whether it's something out in the physical world or in the online world, that everybody has access to it. Access to the information, access to getting into a building or being able to cross the street appropriately, whatever that is—that the accessibility of the thing is high. So that regardless of who is approaching it, they can interact with whatever the thing is. If we put that into the digital world, it's about making sure that text on a screen can be perceived by anybody, whether they're trying to read it visually or if they're trying to read it through a screen reader or through a braille monitor. Whatever that is, they need to be able to interact with it, get the information they need, do all the functions of whatever it is on the screen. Check out on Amazon, check out at their favourite e-commerce place, be able to get the products in their cart, check out, et cetera. For creatives, it's about the things that we do: the websites that we build for ourselves, the e-commerce platforms that we use, our email marketing, our social media posts. Making all of that as accessible as we can so that we're not perhaps missing a part of our audience or our prospective audience from being able to engage with our work and in turn, hopefully, buy our books and enjoy our books and become a fan. This became important to me because of my day job. I hadn't really considered this—like, I think most people don't—until I started working at UsableNet. It's going to be 15 years I've been at that company come this autumn, and I really started to see the impacts because UsableNet is all about accessibility on the digital front. I really started to learn, being a project manager for them, what all of that meant and how it impacted people who couldn't buy something online, couldn't book a hotel room, couldn't book an airline ticket. It just really became something I got passionate about. I ended up writing the book because I realised that nobody talks to creatives about this. Nobody tells the independent author what they should do to help make their digital stuff accessible so that they don't miss people. I never expected my day job to interact with my creative side so much, but this certainly has over the last few years. Jo: I mean, has it got better? Like we said, you were on here three years ago. We did talk about some of the things around EPUB formats and taking off DRM and what we need to do on our websites—labelling images, for example, and that kind of thing. Do you think accessibility has gotten better? Jeff: I think the awareness of it has improved, both within the creative community and in the broader web ecosphere, that the awareness is better. There's so much knowledge that needs to go into creating something that is accessible. Sometimes there's so much that you have to think about with colours and alt tags on images and all the little bits and pieces, if it doesn't really come to muscle memory, it's easy for it to fall off. There's a survey that's done by WebAIM every year about the top one million homepages out in the universe, and they surveyed those for just the things that an automated scan can detect, which is a small portion of overall accessibility, and the number of errors across that top million actually ticked up this year. Even though there's all these laws around the world—people get sued all the time in the US—the number of errors ticked up for the first time in a few years. So I think the awareness is up, but I think being able to take action on it and make the time to take action on it isn't where it needs to be. Jo: So last time you gave us all those tips. I'll refer people back to that and also to your book Content for Everyone, which has got loads of great stuff in. I wanted to talk to you for this show because I was sitting watching Claude Cowork—now I use Claude Code a lot more—but updating 140 titles on IngramSpark, where me clicking things and there's like 15 clicks per record on IngramSpark updates for pricing, is an absolute nightmare. I was watching the AI do the work and I realised this isn't just saving me time, it's actually saving my wrist and my arm from repetitive strain injury. That's when I thought about this accessibility thing. As you mentioned, for example being physically accessible into a building, say someone's in a wheelchair, they can't necessarily get into a building if there's no ramp. I was thinking that for many years, being an indie author, being a writer online, there's also been these physical barriers because there's a lot of plumbing and clicking for us. So I wondered, starting with an attitude around a shift in who this is opening up to— How is AI starting to help people with these accessibility issues? Jeff: Yes, there's so much opportunity around this. We should note, just to timestamp this, that we're talking on 14th April 2026, because who knows what will change, even in an hour from now. I think Cowork was one of the first things that we saw, and that's only been out since the very top of this year. Being able to do actual agentic tasks. Other things have sort of gotten there, but Cowork really opened it up. You mentioned the repetitive stress that you would've had clicking all of those forms on IngramSpark across 140 books. But there's that type of stress, chronic pain, cognitive drain for somebody who may have some cognitive disability and trying to work through that form. The cognitive energy just might drain out and maybe knock them out for several days after trying to get through that, or the tasks take them multiple days to do. Someone who has lower vision, someone who's trying to work through that form with a screen reader—all of that draws energy, draws focus. Now we've got something where, with plain language, we could say something like: here's all my pricing information, I've logged into IngramSpark, go update these books. Obviously the prompt's going to be a little more than that, but in broad terms, that's what we're going to tell it. Jo: Hmm. Jeff: And being able to have it go through and do the thing. If it gets stuck, have it come back and say, “Hey, I've got trouble with this. Please help me.” That can just free up so much of the drains that people can have—the things that can take them out of doing the part of the work that they need to do for an author business. They can go write the book through whatever process you're going to use to do that, rather than getting caught up in something like having to update all those books on IngramSpark. Jo: You mentioned writing the book there. I have this real sense of being an able-bodied indie author in terms of my computer use and my ability to write a whole book, a 70,000-word thriller that I write regularly. We're all special in some way, but I do have a reasonably normal brain where I can do this work without too much strain. It's hard work, but I can do it. I meet people who are now using AI to help them write, to help them organise their work—maybe someone has dyslexia or ADHD or cognitive issues or pain—there's just so many things that I take for granted that don't affect me. I hear from people who, at this point in time in the community, are almost shamed for using AI to write. So I wanted to bring this up to discuss it under the terms of accessibility. Do you have any thoughts on that? Jeff: I have real difficulty with people who will say anything in the broad range of, “I don't need to use this thing, and therefore you should not either.” Which is adjacent to indie anti-AI speak that there is out there. Certainly we're living right now at probably the highest point that it's ever been, where more and more there's a sentiment towards not using AI for whatever the reason is. I totally respect that people can have concerns about the environment and about energy use and water use, et cetera. Not to mention all the other things that are on the more difficult side of AI. To shame someone who may not be able to put their story out there without the use of that AI, whichever one they're using, or to shame them because they're using AI to run part of their business—updating IngramSpark, doing other things like that—I think it can come down to there being some ableism there. Ther is some privilege behind that too, where they're just like, “I don't need this, and you shouldn't have it either.” I want to give people just a sliver of an idea of what this can mean for someone who is disabled and what AI can unlock for them. There is a person on LinkedIn that I follow whose name is Hannah Desmond. She's an ADHD coach and a former software developer, and very recently she posted this on LinkedIn. This is a paraphrase of what she said, but: having something that can meet you where you are and help you bridge that gap is what I think I have found so helpful about using AI. Here's what I keep coming back to. Without that support, I wasn't more motivated or more capable. I was just stuck. That's the bit that gets lost. We've been taught that struggling is how you know you're doing it properly. So when something reduces the struggle, it can feel wrong—even when it's the thing that actually makes the work possible. Because there's a difference between avoiding thinking and being able to think at all. I think that rounds it up. She's talking about her time as a software developer, but you can apply that to any realm of AI when we're thinking about trying to shame someone for why they may be using it. We may not know that they have a disability because we don't always share that part of ourselves. So I really feel strongly about that and how we are in this culture of shame. Jo: Yes. It drives me up the wall, actually. But I will also say: you don't have to have a disability or accessibility issues in order to use AI in whatever way you personally decide is okay—talking to the listeners now. I think Orna Ross from the Alliance of Independent Authors says it well, which is you should have your own AI policy. So you personally decide where your lines are, how it helps you, what you want to keep for you, and what you want help with. I was also thinking in terms of accessibility around money. Again, for many of us, professional cover design, professional editing, professional human-level translation, these are things that are pretty pricey for many people. So again, this makes it more accessible. One of the reasons we got into the indie way and being indie authors was to try and remove the barriers to entry to people who have been excluded from the environment of publishing. So, yes, it is really hard to talk about this, and yet that's why I wanted to talk about it, because— There's so many variables for each individual and there's no situation that's the same, really, is there? Jeff: No, not at all. The things that I may need to do my work in the most efficient way possible is different from the way that you're going to work, is different than the way my husband's going to work, is different than every other person and the way that they're going to work. Which is why any kind of blanket statement about “I don't need something and therefore you shouldn't need it either” can just be so problematic, because we have no idea what someone else is going through. Either it's a permanent part of their lives or maybe it's something that is happening temporarily with them where they might need to leverage other tools. Jo: Yes. Talking about that temporary, I think I really got the first sense of this when I had COVID the first time, which was really bad. I remember I was so sick, the only thing I could do was listen to an audiobook. I couldn't think, I couldn't read. It was really probably months of not having my brain back. Then the other thing that's happened as I age, as women age, is menopause kicks in and the brain fog is a real thing. I've heard from other people too who've said having Claude or whoever, an AI tool, to help with the brain fog is so important because otherwise I just wouldn't be able to gather my thoughts. Again, as you said— Even if we don't need these things now, it's quite likely we're going to need them at some point, given ageing, given the potential for injury and disease. I mean, we don't escape this alive, do we? Jeff: Yes, that's a great point because unless we're extremely lucky as individuals, we're all likely to have some sort of a disability in our lives at some point. I know for me, as I age and my eyes get more and more tired after being in front of a screen all day for work, and then whatever creative stuff I do in the afternoon on a book—when it comes near bedtime and I do want to read, I probably want to do that with an audiobook, much more audio, especially for any long reading project. That can also be like, if I have a long document or a long article to read, I am likely to give it to ElevenReader, let it load itself up, and then listen to it, because I take the information in better than trying to follow words across a screen. Jo: Yes. Jonathan, my husband, now also listens to a lot of academic papers on ElevenReader. Most of us will know it as where we publish some audiobooks from ElevenLabs, or you can also publish other things there. So it is super useful to think about what we can do with ElevenReader. Another thing that I found really useful recently is NotebookLM. On NotebookLM, there is a free tier. You can put various things in there and then create a custom audio. So this is something I've been doing as part of research. You can put in, say, 10 YouTube videos or some PDFs or your book or whatever, and then you can create a custom audio. Then I'll go for a walk and I'll listen to the custom audio, and then I'll go back and look at the detail of what it was. It gives me the framework of whatever I'm thinking about on a broader level, and then I can come back to the details. So again, it's this multimodal approach that can help us manage our energy, I guess. Jeff: And it's all about the managing of the energy, I think, too. That is a great way to think about the accessibility of it all. You mentioned a great use there for NotebookLM. That could also be putting your book in there and having it help you build a world bible or something like that. Or building marketing materials off of that. There's a lot of things now that NotebookLM can do in terms of helping you create FAQs maybe for a newsletter or for your website, and building video stuff off of the material that it has. So there's a lot of options there, and ever-growing options that can be useful for someone to manage any number of the things that they may need in their creative business. Jo: Yes. In fact, talking about Claude, there are a lot of Claude plugins now, skills and integrations. Shopify just released a Claude plugin and many of us now have Shopify stores. I have a lot of products with a lot of different variations and the metadata. There's so much metadata. And again, I'm just so pleased now that I can work with Cowork and get it to actually update directly into Shopify. In fact, coming back, you mentioned updating alt tags earlier. That's something again that AI could help you update—the back list of your alt tags on a website. I've now got my Cowork doing EPUBs so I could finally update all my EPUBs with back matter and all of this kind of thing. So I feel like perhaps we could go beyond accessibility to talk about amplification. All the things that we didn't do because it was too tiring and we just couldn't be bothered, or it would just be way too much work, that now it's opened up as a possibility because of these tools. Jeff: Absolutely. I mean, you look at a backlist as large as yours and the things that you're now able to do. I didn't know that Claude had a Shopify plugin. So the abilities that we have now to maybe do things in the business that we hadn't before. One of the things I've been working with Claude on is rewriting my website and creating a more proper website for Will. I'm really making sure that it is not only SEO prepared but also GEO prepared, with all the metadata and all the backend code schema that it needs so that LLMs can find me, can understand what I do, can understand the books, branch out to the other areas that it needs to. Doing that through WordPress would've been so much more difficult, even with Claude, that to be able to rewrite the site in a way that is going to let me manage it better so that I will do it on a more consistent basis. Whatever that thing is, we're now able to do these things. That could be updating keywords in Amazon or making sure we're aligned across all of the sales platforms that we might be on and things like that, that Claude can do and do well. Jo: Yes, I think marketing is just the killer app really for people, isn't it? I think most authors do not enjoy marketing. I find Claude better for creative work, for strategic work, for doing work through Cowork or Code, but— ChatGPT with marketing copy is very, very good. So I've actually been using that as we record this. I've got a Kickstarter launching next week, so I've been getting it to do ad copy and social media copy and all that kind of thing. This is stuff when you have to produce—give me 20 taglines, give me 20 hooks, give me another 20 and another 20. I mean, we just cannot do it as humans, right? Jeff: Yes, I have found GPT wildly helpful. I mentioned trying to get Bargain Booksy and Fussy Librarian promos. Jo: Mm. Jeff: And you have to give it the marketing hook, and it can't just be the blurb that's on Amazon—it's got to be something fresh, and they each have slightly different requirements. Having GPT—here's the blurb, give me a dozen different options—and then I may take pieces of all of them and create one of my own. But it reworks that much faster than my brain was ever going to try to find the right thing I want to give to Bargain Booksy. Jo: Yes, you are right. Or it says write this in 300 characters or less. Jeff: Yes. Jo: I do exactly the same. That kind of transformative work can be really good. In fact, there was somebody I know who has been rampantly anti-AI for years and then said, “Would this help me? I have to do a synopsis for an agent, so I've got this 100,000-word book and it needs to be a 10-page synopsis. How would I do that with AI?” So I was encouraging her to take each chapter and ask it to summarise the chapter, and of course read through it and everything. But I mean, doing a synopsis once you've actually written a book—that can be super useful. So I think what we're saying is— There are levels of need in terms of both the author and the audience. Then there are levels of your personal use from one end of the spectrum to the other in terms of how far you want to go in every area of the business. And in that way, it's just different for everyone. Jeff: Yes, and I think getting to that mindset shift that we were talking about a little bit—it can be so easy to dip your toes in. That one author came to you and said, “Do you think it could do this?” And I think that's the beginning exploratory area for perhaps anyone. People are going to hear us talk about this and it might inspire them to go try something that we've talked about. But these things, whether it's Claude or GPT or Gemini or whichever one it is, you can come to it and say, “I'm an author, I have X, Y, Z going on in my life”—whether that's a disability, whether that's a time constraint because you have a day job and maybe you have kids and a family that need your attention—”I have these time constraints, I want to do X, Y, and Z in my business. How can you help me with that?” It's going to tell you what it can do to help you with that. I would even say, if you have the ability to have multiples of these, you could ask the same question to GPT and Claude, and they're going to give you similar answers in some instances, but they may also have different ones because of the abilities that the different platforms have around these things as well. That can help you make that mindset shift of, “Well, now I see that it can do that. Could it also do this?” And then ask it if it could do that. Because I know for me, Jo, I've taken so much from you and your journey with Cowork that it's like, “Oh, she did that. I wonder if I could do this.” And all of that piles on top of itself. Then eventually I think your brain starts to think on its own, “Oh, I have to do this task. Can Claude maybe do this for me? Let's go find out.” Jo: Yes, and if it couldn't do it for you yesterday, you never know, it might be able to do it tomorrow. Jeff: Right? Because I haven't tested yet its new ability to actually use your computer. Jo: Mm. Jeff: And I'm curious what that might open up. Because one of the things that I've seen that I wish it would do is be able to take the EPUB that's on my drive and actually put it into a platform I'm trying to upload to. Cowork on its own hasn't been able to cross that barrier, but I wonder if with computer use added to that, if it could. Like, “here's the EPUB, upload that over there,” be able to pick it from the file picker, essentially. Jo: Yes. I think, well, a little tip for everyone: I wouldn't give access to your entire file system to the AI. Jeff: That's a good point too. Jo: Yes. I have a Claude folder in my drive and it only has access there. So if you put files in that drive, it might be able to do that. But I know what you mean. I have been using it to help me publish things in German on KDP. Now I can use the browser, so you can actually do that. In terms of uploading the actual file, I know what you mean. These things will change. As we record this, again middle of April, we are almost about to get the next models being Mythos, which might be Claude 4.7 Opus, or also ChatGPT has a new model coming, and these models are getting very powerful. With every shift they can do more things. So as you say, the very first thing to do is ask it, “I want to do this—what are my options?” And some of them, for example, doing an AI-narrated audiobook, ChatGPT and Claude don't do that. You want ElevenLabs or one of the other services for that, but they can tell you what your options are. So that's one thing, but I wondered if you have any thoughts on the gaps that you are seeing. You mentioned one there around file uploads, but— What do you hope might come and some of the things that might be exciting if they arrive? Because you never know, they might be here already. Jeff: There's certainly some movement in some areas. One of the things I'll share is, in March I was at the 2026 CSUN Assistive Technology Conference—CSUN is California State University, Northridge—and they've run this conference for some 40 years now. One of the sessions I went to was from Tara Maisel—I hope I'm pronouncing her last name right. She's a senior project manager in books accessibility at Amazon, and she was doing a session specifically on readability. She had all kinds of statistics and information about what goes into making something readable. One of the things she talked about with AI was the future of personalised reading. If you think about the Kindle app, for example, there's a lot of settings you can make there—font size, colours, brightness, text spacing. There's a lot of tools in there. She was pointing out that potentially readers don't even know what they actually need for the optimised visual reading experience. She sees a world where AI can perhaps do an analysis of your reading behaviour and then help you find the optimal settings. Maybe even multiple optimal settings for, say, if you were reading in a room that had daylight versus at bedtime, and the ways you might shift it. I was almost thinking of this like when you're at the optometrist and they're like, “Which lens is better—this one or that one?” Jo: Oh, sometimes that is very hard. Jeff: Yes. It's that AI could step you through that a little bit to help you find that optimal reading experience in that moment. And then it might even notice, potentially, if you're changing something in the way that you're moving through a page, that it might flag to say, “Hey, do we need to adjust something?” Some other areas that I think are really exciting, for everyone and perhaps particularly for people who are disabled and needing the support of some assistive technology, is what we're seeing in the browsers. OpenAI's Operator has been out for quite a while now, since sometime I think autumn of last year. Perplexity Comet has been around even longer. Then we've got browser extensions from Gemini and Claude that are available, that can let you just type natural language. You know, “Please go find for me jeans in this size that are on sale on this website. Find me the best price for blue jeans on this site and this size,” and it'll just go do it. Which can certainly speed things up for people in the disabled community to find things quickly, to spend time navigating less, and maybe ending up with the AI coming back and saying, “I found these five things. Which one would you like me to buy for you?” Or, “I found this one thing that you do need and it's waiting for you in your shopping cart.” The ability for that on the horizon is an amazing jump from an accessibility point of view. But really it's one of those things that accessibility will then help everyone because we can all just shop that way, if we choose to. These are early days for these browsers and these extensions. The other side of it comes back to basic web accessibility too, because I've seen these types of activities not work so well on a site that may not actually be accessible on its own. A great example is something I ran into with Claude Cowork about a month ago. I was testing to see if it could help me navigate and get things uploaded together for a site where I wanted to upload books, knowing again that it's not going to upload the actual file, but it could fill in the metadata from my master database of metadata stuff. There were areas on the site that it actually couldn't hit the button, because the site itself was also not functional to a screen reader. So there are gaps there. It's early days, but I really see that as an interesting future that'll really help people with disabilities—but again, help everybody too, just manage time better. Jo: I know exactly what you mean there. I've done some collaborative work with Claude Code when it's like, “I can't click the button,” and I'm like, well, I'll click the button—you fill in everything else. Jeff: Exactly. Jo: It's actually quite a funny situation. But goodness, coming back to IngramSpark again—these things need APIs. We need better functions. It's funny because I think a lot of traditional publishers have these APIs or backend upload things that you can do. I'm like, well, we need to get to that with these systems. But I think things will change. Another thing that I think has also shifted is the use of voice. Voice for dictation—it used to be with dictation that you would have to say “comma,” “open quote,” “new line,” and all of that. And you'd also have to make sense. Whereas now I feel like you can just dictate a whole load of things to these AIs and then say, “Tidy that up,” and they will do a lot more than the old situation. So I think voice will also help. Also automatic translation. I don't know if you know this about X, and if you're on X anymore, but just this week they've made it multi-language. So I can read tweets by people who've posted in another language in English. I can read something from Korean or read something that someone French has posted and it gets translated. It has made a huge difference to the content I'm seeing, which is fascinating because I don't think we've ever had this kind of automatic “everything is translated into your language” situation. It's really got me thinking about how [automatic translation] might work for eBooks or other things if the rights are there. I don't know. Have you seen stuff like that? Jeff: There's so much available now with voice and the ability to not have to speak all the other stuff that went with it—comma, full stop, next line. It was a little mind-bending sometimes, trying to think about quote marks and all that stuff. And now it's so good. Different platforms do it to different degrees of ability. Even being able to speak your prompts into the very platforms themselves without having to type all of it. Chronic pain comes to mind, any kind of mobility thing—all the typing would be a drain or maybe even impossible. So the voice ability is so powerful there and unlocks more things. At the same time, those translation abilities—I believe AirPods now have the ability, if you've got the right stuff on your phone, that you could be talking to somebody, they may speak back to you in a language you don't speak, but your AirPods will give it to you in your language. Jo: Hmm. Jeff: Google has, I believe, a live captioning app that you can use. I think there's even a split screen—I don't know if that's available now or something in their future—where you could put the phone on the table and tell it who's looking at what side of the screen, and it'll put the language that I need on my side and the language the other person needs on the other. So there continues to be such a shift in how we're being able to translate stuff that really opens up communication and can open up our books to so many more people. I'm very interested to see—I haven't pulled the trigger on this yet—but how Amazon's auto-translation rolls out and how that's received in terms of the accessibility around our books and being able to put it in someone's hands who doesn't speak—I think it's only English to other languages right now—but who doesn't speak the language it was written in but wants to read that book. We could never, as indies, or really even big five publishers, wouldn't have the money to create custom translations everywhere. But if the AI can help do that and spread those books around so that everybody could have the story they want to read, I think that's such a win for the reading audience. Jo: Yes, I think it's so exciting to think what might be coming, and that's what I want to stay on the side of on the AI discussion. There's enough negativity out there and you can get that information somewhere else, but for me I want us to stay on the positive side of how this helps both the author and the reader. And hopefully the community, to create more and read more and enjoy being human more. Right? Because I find that I do get out more and listen to stuff, or I'm out walking instead of at my desk, and I mean, that's what it's about. I'm pretty excited about the future. How about you? Jeff: I am. I think there are, quite honestly, some scary things that could be out there in the future. I mean, there's been a lot of talk about what Mythos is capable of. But on the other side of it, there are all these advances. I also look back at Google and AlphaFold and what DeepMind was able to do there for science. There's more of that stuff out there, and individually for each of us, spending a little bit of time—and I do have to say, I think you need to spend time on a paid plan because the free stuff doesn't give you the idea of what these platforms are actually capable of. So if you only drop in, even briefly, to experiment on one of the $20-a-month plans and give it your situation, ask it what it can do for you, I think you'll see where, on a personal level, AI will help you unlock some things. It can help you move some things to the next level in your business that for whatever reason you haven't been able to do. You don't have to use it for everything. You may decide that it's still not for you for whatever reason, and that's fine. But I think there's so much to explore here and to let your curiosity run for a little bit to see what's possible and what you might unlock with it. Jo: Brilliant. So where can people find you and your books and everything you do online? Jeff: So pretty much everything lives at JeffAdamsWrites.com. Jo: Well, thanks so much for your time, Jeff. That was great. Jeff: I loved it, Jo. Thanks for having me..The post Accessibility And AI: How New Tools Are Opening Doors For Indie Authors With Jeff Adams first appeared on The Creative Penn.

Chuck and Chris continue the initiative working with The Journal of Hand Surgery on a quarterly journal club.  Nash and Macerena choose the articles from the previous quarter and Chris and Chuck review the articles and discuss practical implications.  See articles below.In addition, we discuss a case of possible pronator syndrome together with carpal tunnel syndrome including debate on the role of nerve studies, physical examination, and ultrasound.1) Rames JD, Emanuels AF, Tunaboylu MF, Moran SL. A 40-Year Retrospective Evaluation of Vascularized Bone Grafting for Kienböck Disease. J Hand Surg Am. 2026 Jan;51(1):13.e1-13.e9. doi: 10.1016/j.jhsa.2025.07.025. Epub 2025 Aug 29. PMID: 40879579.2) Suzuki T, Kiyota Y, Matsumura N, Sato K, Nakamura M, Iwamoto T. Anatomical Reconstruction of the Terminal Tendon and Lateral Band for Severe Chronic Tendon Mallet Injury. J Hand Surg Am. 2026 Jan;51(1):92.e1-92.e7. doi: 10.1016/j.jhsa.2025.04.025. Epub 2025 Jun 21. PMID: 40542795.3) Lee C, Shin S, Fraipont G, Hung V, McGarry MH, Lee TQ. Dermal Allograft Augmentation With Proximal Row Carpectomy: A Biomechanical Study. J Hand Surg Am. 2026 Feb;51(2):143-152. doi: 10.1016/j.jhsa.2025.05.006. Epub 2025 Jul 4. PMID: 40613810.4) Jaarsma EH, Ring D, Tonn MD, Brinkman N. Do Patients Older Than 40 Years with Work Claims for Unilateral Wrist Symptoms Have Symmetric, Bilateral MRI Signal Changes That Do Not Correspond with Symptoms? J Hand Surg Am. 2026 Mar;51(3):313-320. doi: 10.1016/j.jhsa.2025.11.012. Epub 2026 Jan 29. PMID: 41609546.5) Pohl NB, Brush PL, Parson JP, Fitzgerald P, Charlton A, Beredjiklian PK, Fletcher DJ. Incidence and Predictors of Subsequent Triggering Requiring Treatment After Trigger Finger Release. J Hand Surg Am. 2026 Feb;51(2):203.e1-203.e8. doi: 10.1016/j.jhsa.2025.02.009. Epub 2025 Apr 9. PMID: 40202483.We are in need of a podcast intern!  We would appreciate any referrals!See www.practicelink.com/theupperhand for more information from our partner on job search and career opportunities.The Upper Hand Podcast is sponsored by Checkpoint Surgical, a provider of innovative solutions for peripheral serve surgery. To learn more, visit https://checkpointsurgical.com/.As always, thanks to @iampetermartin for the amazing introduction and concluding music.For additional links, the catalog.  Please see https://www.ortho.wustl.edu/content/Podcast-Listings/8280/The-Upper-Hand-Podcast.aspx

In this episode, Yoga Medicine founder Tiffany Cruikshank and Katja Bartsch take a deep dive into the latest stretching research and what it means for yoga teachers, athletes, and movement professionals. Together, they unpack the latest recommendations around stretching for flexibility, stiffness, strength, hypertrophy, vascular health, recovery, and injury prevention while exploring the limitations of stretching as a standalone tool. Tiffany and Katja discuss why prolonged static stretching before explosive activity may impair athletic performance, how longer-held yin-style stretches may influence tissue stiffness, and why emerging vascular research around stretching is generating so much interest. They also explore why yoga recovery likely involves far more than just stretching mechanics, including nervous system regulation, breathwork, and relaxation. "We do not overestimate or underestimate what stretching can do." — Katja Bartsch. — What You'll Learn: What the new 2025 stretching consensus paper reveals about flexibility research [02:57] • Definitions of static, dynamic, and PNF stretching in both research and yoga practice [06:00] • Acute vs. chronic stretching effects on range of motion and mobility [13:54] • Recommendations for improving long-term flexibility and maintaining mobility with age [20:09] • The "Goldilocks" principle of tissue stiffness and athletic performance [27:24] • Why longer yin-style holds may influence connective tissue adaptation [32:12] • How stretching impacts strength, explosive performance, and warm-ups [34:32] • Research on stretching for strength gains and muscle hypertrophy [37:36] • Emerging evidence around stretching and vascular health [42:01] • Breathwork, nervous system regulation, and yoga's broader therapeutic effects [51:24] • Why stretching alone may not improve recovery or prevent soreness [54:07] • The limitations of flexibility-only approaches for injury prevention [1:00:13] • Why individualized mobility, stability, and strength work matter in yoga practice [1:01:40] • Final takeaways on stretching frequency, recovery, and long-term mobility [1:04:32] — Links Mentioned: Watch this episode on YouTube Warneke K, Thomas E, Blazevich AJ, Afonso J, Behm DG, Marchetti PH, Trajano GS, Nakamura M, Ayala F, Longo S, Babault N, Freitas SR, Costa PB, Konrad A, Nordez A, Nelson A, Zech A, Kay AD, Donti O, Wilke J. Practical recommendations on stretching exercise: A Delphi consensus statement of international research experts. J Sport Health Sci. 2025 Dec;14:101067. doi: 10.1016/j.jshs.2025.101067. Epub 2025 Jun 11. PMID: 40513717; PMCID: PMC12305623. — Learn More: Find the full show notes at YogaMedicine.com/podcast-167. Learn more about insider tips, online classes or information on our teacher trainings at YogaMedicine.com. To support our work, please leave us a 5 star review with your feedback on iTunes/Apple Podcasts or wherever you listen to podcasts. 

Join me in sisterhood as we part the mists and have a gal hang in Avalon together. This month we're focusing on the apple as creative projects. Tapping into our latent sexual energy to create and disperse stuck sacral chakra vibes.Also this month we're committing to Sisters in Service as we send good energy, uplifting thoughts, and high vibes of support to all of our front line Bringers of the Light in the Inner Worlds. They're the invisible armies that could really use our support right now.And we'll finish with a little time for our Twin Flame Sisters in a show of solidarity and support for the very unique and often confounding thing that is the twin flame journey.THANKS FOR Being here

Visual Studio 2026, ventanas de contexto LLM, estructura EPUB, gestión térmica Mac, pantallas nano-texturizadas ### Fallos críticos en Visual Studio 2026 y validación mediante rollback ### Optimización de ventanas de contexto en traducciones con LLM

Credits: 0.25 AMA PRA Category 1 Credit™   CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-485 Overview: Teenagers are at higher susceptibility for hearing loss and often engage in behaviors that greatly increase their risk of permanent damage. In this episode, we look at current prevalence data and the pathophysiology of adolescent hearing loss, providing practical, office-ready prevention strategies to identify at-risk teens and intervene early. Episode resource links: Reijers SNH, Vroegop JL, Paping DE, Pronk M, Goedegebure A, Kremer B, van der Schroeff MP. Longitudinal Insights into Sensorineural and Noise-Induced Hearing Loss in Adolescents Aged 13-18 Years. Otolaryngol Head Neck Surg. 2025 Dec;173(6):1385-1392. doi: 10.1002/ohn.70042. Epub 2025 Oct 14 Byeon H. Associations between adolescents' earphone usage in noisy environments, hearing loss, and self-reported hearing problems in a nationally representative sample of South Korean middle and high school students. Medicine (Baltimore). 2021 Jan 22;100(3):e24056. doi: 10.1097/MD.0000000000024056. Guest: Robert A. Baldor MD, FAAFP   Music Credit: Matthew Bugos Thoughts? Suggestions? Email us at FranklySpeaking@pri-med.com  The views expressed in this podcast are those of Dr. Domino and his guests and do not necessarily reflect the views of Pri-Med.

En este episodio conversamos sobre la novela y serie El Caso Holst de Søren Sveistrup . Vuelve los personajes de Thulin y Hess. Una inquietante rima infantil grabada en un bosque, mensajes de texto anónimos que dicen "Te encontré" y una desaparición que reactiva un caso cerrado hace 30 años.Compartimos nuestras impresiones (¡sin spoilers!) sobre la nueva producción/temporada de la serie, debatiendo si logra capturar la atmósfera opresiva y el horror psicológico que plantea el libro.Consigue el libro digitalSíguenos en nuestras redes sociales

Credits: 0.25 AMA PRA Category 1 Credit™   CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-485 Overview: Teenagers are at higher susceptibility for hearing loss and often engage in behaviors that greatly increase their risk of permanent damage. In this episode, we look at current prevalence data and the pathophysiology of adolescent hearing loss, providing practical, office-ready prevention strategies to identify at-risk teens and intervene early. Episode resource links: Reijers SNH, Vroegop JL, Paping DE, Pronk M, Goedegebure A, Kremer B, van der Schroeff MP. Longitudinal Insights into Sensorineural and Noise-Induced Hearing Loss in Adolescents Aged 13-18 Years. Otolaryngol Head Neck Surg. 2025 Dec;173(6):1385-1392. doi: 10.1002/ohn.70042. Epub 2025 Oct 14 Byeon H. Associations between adolescents' earphone usage in noisy environments, hearing loss, and self-reported hearing problems in a nationally representative sample of South Korean middle and high school students. Medicine (Baltimore). 2021 Jan 22;100(3):e24056. doi: 10.1097/MD.0000000000024056. Guest: Robert A. Baldor MD, FAAFP   Music Credit: Matthew Bugos Thoughts? Suggestions? Email us at FranklySpeaking@pri-med.com  The views expressed in this podcast are those of Dr. Domino and his guests and do not necessarily reflect the views of Pri-Med.

Part 3 of the Women's Health SeriesBloating, gas, urgency, abdominal pain, and that relentless “what if something happens?” loop can turn sex from a close connection into stress fast. Digestive symptoms can quietly impact some of the most vulnerable parts of our lives...including intimacy, relationships, and self-esteem. And often, the shame surrounding those experiences feels heavier than the symptoms themselves. If you've ever pulled away from connection because your gut felt unpredictable, this conversation is for you. In this episode, we're opening up an honest and empowering discussion about gut health, confidence, and reclaiming intimacy without fear or embarrassment.We dive into this topic with our expert guest, Dr. Alyse Bedell, GI psychologist and Certified Sex Therapist, covering: • Why digestive functions feel taboo in sexual relationships • How IBS and IBD symptoms can impact desire, relaxation, and satisfaction • Myth-busting the idea that sex must be spontaneous to be pleasurable • Scripts and “reset” strategies for handling symptoms in the moment • Redefining intimacy so closeness does not always imply intercourse • Flexible planning around meals, energy, triggers, and symptom patterns • Partner support that reassures without becoming patronizing • The circular sexual response cycle and starting from sexual neutrality • Rebuilding sexual self-esteem with stigma work and acting with "as if” confidence This episode has been sponsored by Ardelyx. References: Ballou S, McMahon C, Lee HN, et al. Effects of Irritable Bowel Syndrome on Daily Activities Vary Among Subtypes Based on Results From the IBS in America Survey. Clin Gastroenterol Hepatol. 2019 Nov;17(12):2471-2478.e3. Fretz KM, Hunker KE, Tripp DA. The Impact of Inflammatory Bowel Disease on Intimacy: A Multimethod Examination of Patients' Sexual Lives and Associated Healthcare Experiences. Inflamm Bowel Dis. 2024 Mar 1;30(3):382-394. doi: 10.1093/ibd/izad106. PMID: 38206426; PMCID: PMC10906359.Wang J, Varma MG, Creasman JM, et al. Pelvic floor disorders and quality of life in women with self-reported irritable bowel syndrome. Aliment Pharmacol Ther. 2010;31(3):424-431. doi:10.1111/j.1365-2036.2009.04180.xDubinsky MC, Potts Bleakman A, Schreiber S, et al.. Impact of moderate-to-severe ulcerative colitis and Crohn's disease on sexual activity: United States and European patient perspectives from the communicating needs and features of IBD experiences (CONFIDE) survey. Curr Med Res Opin. 2025 Jun;41(6):1017-1030. doi: 10.1080/03007995.2025.2530736. Epub 2025 Jul 17. PMID: 40635574.Come As You Are: Revised and Updated: The Surprising New Science That Will Transform Your Sex Life by Emily Nagoski Ph.D.  Becoming Cliterate: Why Orgasm Equality Matters--And How to Get It by Laurie MintzThe American Association of Sexuality Educators, Counselors and Therapists (AASECT) (great resources as well as a place to find a certified sex therapist)Give us a follow us on social media @TheGutHealthPodcast, where we'd love for you to share your thoughts, questions, and experiences. Learn more about Kate and Dr. Riehl:Website: www.katescarlata.com and www.drriehl.comInstagram: @katescarlata @drriehl and @theguthealthpodcastOrder Kate and Dr. Riehl's book, Mind Your Gut: The Science-Based, Whole-body Guide to Living Well with IBS.  The information included in this podcast is not a substitute for professional medical advice, examination, diagnosis or treatment.  Always seek the advice of your physician or other qualified health care provider before starting any new treatment or making changes to existing treatment.

Heather Happenstance Rockaway Pointe's girl about town and roving reporter is at it again as she joins an adventure to find the hairy man beast terrorizing the beings at Whistling Gulch Retreat in the Forest of the Forbidden. She'll encounter multiple paramours, strange creatures, the Forest of the Forbidden Bears, and her own inner secrets and shadows as she works with the newly appointed Ranger Haniford to solve the mystery of the beast and the strangely severed hand that weirdly resembles that of her ex husband and rock star Blaze Mulholland. THANKS FOR Being here

No weights for home pole dance conditioning? No problem! Dr. Rosy Boa addresses how pole dancers can build strength at home without gym access or heavy weights. She explains the basic strength principle of applying load and allowing recovery, noting weights are the most efficient for rapid, targeted gains, with free weights often preferable to machines for pole due to stabilization and range-of-motion demands. She then covers three accessible alternatives: isometrics (80–100% maximal effort holds for 1–5 seconds, scaling well but joint-angle specific), scalable bodyweight training (using variations such as changing points of contact, lever length, duration, reps, and power), and resistance bands (types, selecting by length/shape/resistance, variable tension through range, latex cautions, and use for assistance/spotting). She emphasizes consistency, enjoyable training, and doing the conditioning you will actually do.Are you a pole nerd interested in trying out online pole classes with Slink Through Strength? We'd love to have you! Use the code “podcast” for 10% off the Intro Pack and try out all of our unique online pole classes: https://app.acuityscheduling.com/catalog/25a67bd1/?productId=1828315&clearCart=true  Chapters:00:00 Welcome and Topic00:58 Membership Shoutouts02:59 Strength Basics05:56 Isometrics Explained09:11 Bodyweight Training12:04 Scaling Difficulty16:55 Resistance Bands24:52 Consistency Over Intensity28:47 Wrap Up and Invite Citations: Weights (machines or free weights) do have the largest effect size in building strength... but that's not necessarily our only goalWiedenmann T, Held S, Morat T, Rappelt L, Isenmann E, Berndsen E, Hopp NH, Donath L. The Effects of Different Resistance Training Modalities on Muscle Strength in Community-Dwelling Older Adults: A Network Meta-Analysis. Gerontology. 2025;71(7):576-588. doi: 10.1159/000546346. Epub 2025 May 27. PMID: 40452461. Isometrics scale with strength! (but you gotta PUSH: 80 - 100% effort and hold for a couple seconds)Lum D, Barbosa TM. Brief Review: Effects of Isometric Strength Training on Strength and Dynamic Performance. Int J Sports Med. 2019 May;40(6):363-375. doi: 10.1055/a-0863-4539. Epub 2019 Apr 3. PMID: 30943568. Bands do help with strength, might be more helpful with explosive/powerStanković D, Lazić A, Trajković N, Okičić M, Bubanj A, Vencúrik T, Gašić T, Bubanj S. Effects of Elastic Band Training on Physical Performance in Team Sports: A Systematic Review and Meta-Analysis. J Funct Morphol Kinesiol. 2025 Oct 17;10(4):402. doi: 10.3390/jfmk10040402. PMID: 41133592; PMCID: PMC12551113.

Send us Fan MailIn this episode of Journal Club, we wrap up a marathon recording session with a deep dive into the world of neonatal neuroprognostication. Daphna reviews a systematic review and meta-analysis from Pediatric Neurology that evaluates whether combining EEG and MRI provides better answers for families of preterm infants. While MRI remains a powerful tool for structural assessment, the data suggests that adding the functional insights of EEG significantly boosts specificity, particularly when predicting severe neurodevelopmental outcomes. We discuss the importance of timing these studies and the clinical value of sleep-wake cycling as a developmental milestone at the bedside.----Combined Use of Electroencephalography and Magnetic Resonance Imaging in the Prognostication of Neurodevelopmental Outcomes in Preterm Infants - A Systematic Review and Meta-Analysis. Forrest CD, Biagioni T, Liley HG, Lai MM, Colditz PB, Ware RS, Boyd RN, Roberts JA.Pediatr Neurol. 2026 Feb;175:116-129. doi: 10.1016/j.pediatrneurol.2025.11.005. Epub 2025 Nov 13.PMID: 41337899 Support the showAs always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below.Enjoy!

Spring is a season of rapid change inside the hive, and in this Bee Science segment, Dr. Dewey Caron walks through what drives colony expansion—and how beekeepers can respond effectively.   Dewey emphasizes that spring growth is fundamentally tied to pollen availability and favorable flying weather. Colonies in warmer climates may expand gradually, while northern colonies often experience a compressed and intense buildup. This variability makes local awareness and timing essential. Nutrition plays a central role. Research going back to Heather Mattila's 2006 work shows that colonies receiving pollen or protein supplements begin brood rearing earlier and build stronger populations. More recent work reinforces that locally sourced pollen may improve effectiveness, and emerging commercial feeds are showing measurable gains in overwinter survival and pollination strength. As colonies grow, so does the risk of swarming. Dewey underscores the importance of proactive management—providing adequate space, maintaining ventilation, and monitoring brood nest congestion. Once swarm preparation begins, options narrow quickly, making early intervention key. The episode also introduces the "Goldilocks effect" in evaluating colony strength. Colonies that are too weak struggle to build, while overly strong colonies risk swarming. The goal is finding that "just right" balance through regular inspection, brood assessment, and strategic frame movement. Health risks remain present during this expansion phase. Diseases like European foulbrood and chalkbrood, along with pesticide exposure and nutritional stress, can limit colony development. At the same time, brood expansion creates ideal conditions for varroa reproduction, reinforcing the need for integrated management. Dewey's central message is clear: spring requires active, informed management—but not overmanagement. Listen to the bees, respond to conditions, and aim for balance between growth and control. Links and references mentioned in this episode: Caron, Dewey M. Bee MD Bee MD [https://idtools.org/thebeemd/index.cfm?pageID=3094] Mattila, Hearther R. and Gard W Otis. 2006. Influence of pollen diet in spring on development of honey bee (Hymenoptera: Apidae) colonies. J. Econ Entomol. 99(3):604-13. doi: 10.1603/0022-0493-99.3.604 Kulhanek, Kelly, et. al.  2026. Enhanced Honey Bee Colony Strength and Economic Returns from Fall and Winter Feeding with a Complete Pollen-Replacing Feed. Insects 2026, 17(3), 243; https://doi.org/10.3390/insects17030243 Basu, Priya. 2024 Honey bee Nutrition HBHC https://honeybeehealthcoalition.org/nutritionguide/ Tew, James. 2025. Giving it Your Best Guess. March. Bee Culture DeGrandi-Hoffman G, Gage SL, Corby-Harris V, Carroll M, Chambers M, Graham H, Watkins DeJong E, Hidalgo G, Calle S, Azzouz-Olden F, Meador C, Snyder L, and  Ziolkowski N. 2018. Connecting the nutrient composition of seasonal pollens with changing nutritional needs of honey bee (Apis mellifera L.) colonies. J Insect Physiol.109:114-124. doi: 10.1016/j.jinsphys.2018.07.002. Epub 2018 Jul 7.PMID: 29990468 Hoover SE, Ovinge LP, and Kearns JD.  2022. Consumption of Supplemental Spring Protein Feeds by Western Honey Bee (Hymenoptera: Apidae) Colonies: Effects on Colony Growth and Pollination Potential. J. Econ Entomol.115(2):417-429. doi: 10.1093/jee/toac006.PMID: 35181788Free PMC article. ______________ Brought to you by Betterbee – your partners in better beekeeping.   Betterbee is the presenting sponsor of Beekeeping Today Podcast. Betterbee's mission is to support every beekeeper with excellent customer service, continued education and quality equipment. From their colorful and informative catalog to their support of beekeeper educational activities, including this podcast series, Betterbee truly is Beekeepers Serving Beekeepers. See for yourself at www.betterbee.com _______________ We hope you enjoy this podcast and welcome your questions and comments in the show notes of this episode or: questions@beekeepingtodaypodcast.com Thank you for listening!  Podcast music: Be Strong by Young Presidents; Epilogue by Musicalman; Faraday by BeGun; Walking in Paris by Studio Le Bus; A Fresh New Start by Pete Morse; Wedding Day by Boomer; Christmas Avenue by Immersive Music; Red Jack Blues by Daniel Hart; Bolero de la Fontero  by Rimsky Music; Perfect Sky by Graceful Movement; Original guitar background instrumental by Jeff Ott. Beekeeping Today Podcast is an audio production of Growing Planet Media, LLC ** As an Amazon Associate, we may earn a commission from qualifying purchases Copyright © 2026 by Growing Planet Media, LLC

Send us Fan MailIs your NICU considering the shift to 24 hour in house attending coverage? In this episode of Journal Club, we explore a provocative brief communication from the Journal of Perinatology. Ben and Daphna discuss the impact of moving from home call to on site presence at UC Davis. While the change was intended to improve patient care, the data reveals a surprising 15 percent decrease in work RVUs. We examine how proactive weaning and bedside presence might actually lower billing levels under current CPT codes. Are we being penalized for doing the right thing for our patients?----From on-call to on-site: the impact of 24-hour in-house neonatology on billing patterns and physician productivity. Donohue L, Lakshminrusimha S.J Perinatol. 2026 Feb;46(2):289-292. doi: 10.1038/s41372-025-02530-8. Epub 2026 Jan 5.PMID: 41490931 Free PMC article. No abstract available.Support the showAs always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below.Enjoy!

GLOW stands for Guided Layout & Output Workflow — a guided, confidence-building accessibility experience built for real publishing workflows. The GLOW Accessibility Toolkit helps authors, publishers, and organizations produce documents that comply with the American Council of the Blind Large Print Guidelines and WCAG 2.2 Level AA. The toolkit audits, fixes, and templates Word, Excel, PowerPoint, Markdown, PDF, and ePub documents for accessibility. Presenter Contact Info Email: jeff@jeffbishop.com GLOW website: https://glow.bits-acb.org/about/

En este episodio con motivo del día de las madres en México, Any trae una recomendación que habla de La Madre una novela de Fiona Barton. También hablamos de algunos recuerdos y anécdotas de esos días festivos. La trama se dispara cuando se encuentran los restos de un bebé en una zona de construcción en Londres, un hallazgo que desentierra un misterio de hace décadas. La narrativa se estructura a través de varias perspectivas:Kate Waters: La periodista que busca la exclusiva, pero que se ve envuelta emocionalmente en el caso.Angela: Una madre cuyo bebé fue robado del hospital años atrás y que vive con la eterna esperanza de encontrar respuestas.Emma: Una joven que guarda secretos oscuros sobre su propio pasado y su familia.“A veces, los secretos son la única forma de mantener a una familia unida, hasta que el peso de la verdad se vuelve insoportable”.La Madre - Fiona BartonSíguenos en nuestras redes sociales

In this special Complex Care Journal Club podcast episode, co-hosts Drs. Emily Goodwin, Kristie Malik, and Kathleen Huth interview presenters of posters and oral abstracts relevant to the care of children with medical complexity at the Pediatric Academic Societies (PAS) 2026 annual meeting, as well as at a pre-PAS event focused on home- and community-based care and training in complex care. Speakers describe their key findings, messages for care teams including patients and families, and opportunities to translate their findings into practice.‌ SPEAKERS Flor Arellano, MPH Clinical Research Coordinator, University of California, Los Angeles Jennifer Arnold, MD, MSc Medical Director, Skeletal Health, Boston Children's Hospital Ryan Brewster, MD Neonatal- Perinatal Medicine Fellow, Stanford University School of Medicine Meg Comeau, MHA Senior Project Director, Center for Innovation in Social Work & Health, Boston University School of Social Work John Greenwood, PT Executive Director for Physical Therapy, Occupational Therapy and Rehabilitation Services, Boston Children's Hospital Elaine Lin, MD Complex Care Pediatrician, Boston Children's Hospital Michelle Macy, MD, MS Professor of Pediatrics, Northwestern University Feinberg School of Medicine Scientific Director, Community, Population Health, and Outcomes, Research and Evaluation Center, Ann & Robert H. Lurie Children's Hospital of Chicago Ashley Nmoh, BA Medical Student, Duke University School of Medicine Jennifer Peralta, MD, MSHPN Assistant Clinical Professor, University of California, Los Angeles Nora Renthal, MD, PhD Assistant Professor of Pediatric Endocrinology, Boston Children's Hospital Erin Ward, MEd Patient Engagement Consultant, Complex Care Service, Boston Children's Hospital HOSTS Emily J. Goodwin, MD Clinical Associate Professor of Pediatrics, University of Missouri Kansas City School of Medicine Pediatrician, General Academic Pediatrics Beacon Program, Children's Mercy Kansas City Kristina Malik, MD Assistant Professor of Pediatrics, University of Colorado School of Medicine Medical Director, KidStreet Pediatrician, Special Care Clinic, Children's Hospital Colorado Kathleen Huth, MD, MMSc Pediatrician, Complex Care Service, Division of General Pediatrics, Boston Children's Hospital Assistant Professor of Pediatrics, Harvard Medical School DATE Initial publication date: May 11, 2026. ARTICLES REFERENCED - Brewster RC, Kats DJ, Elborki M, Chilukuri N, Ray M, Shaar N, Hron J, Khan A. Clinical Outcomes of Postedited Artificial Intelligence Translation for Discharge Instructions. Hosp Pediatr. 2026 Apr 10:e2025008986. doi: 10.1542/hpeds.2025-008986. Epub ahead of print. PMID: 41956490. - FamilyCIRCLE. University of Wisconsin–Madison, Department of Pediatrics. Accessed May 4, 2026. https://familycircle.pediatrics.wisc.edu/ - Pediatric Academic Societies. Online program guide. Accessed May 4, 2026. https://2026.pas-meeting.org/ - Pediatric Academic Societies. Who we are. Accessed May 4, 2026. https://www.pas-meeting.org/about/ - Pediatric Academic Societies. Academic Pediatric Association (APA) awards. Accessed May 4, 2026. https://www.pas-meeting.org/2026-awards-apa/‌ TRANSCRIPT https://cdn.bfldr.com/D6LGWP8S/as/k7qqm93qqpqgb5k3jw4f3w2t/PAS_2026_conference_transcript_5-8-26‌ Clinicians across healthcare professions, advocates, researchers, and patients/families are all encouraged to engage and provide feedback! You can recommend an article for discussion using this form: https://forms.gle/Bdxb86Sw5qq1uFhW6. CITATION Goodwin EJ, Malik K, Arellano F, Arnold J, Brewster R, Comeau M, Greenwood J, Lin E, Macy M, Nmoh A, Peralta J, Renthal N, Ward E, Huth K. Practice-Changing Research in Complex Care at the Pediatric Academic Societies 2026 Annual Meeting. 05/2026. OPENPediatrics. Online Podcast. https://soundcloud.com/openpediatrics/practice-changing-research-in-complex-care-pediatric-academic-societies-2026.

In this episode of PICU Doc on Call, Dr. Monica Gray and Dr. Pradip Kamat chat about flexible fiberoptic bronchoscopy (FFB) in the pediatric ICU. They walk through a case involving an eight-year-old who's dealing with respiratory failure after a stem cell transplant. Along the way, they talk about when and why you might use bronchoscopy both for diagnosis and treatment—plus how to approach sedation and what effects the procedure can have on the heart and lungs. They also dive into important topics like managing hypoxia, handling increased airway and pulmonary vascular resistance, and what to keep in mind if your patient has a traumatic brain injury. The episode wraps up with tips for managing fever after the procedure and a quick look at how rigid bronchoscopy compares.Show Highlights:Use of flexible fiberoptic bronchoscopy (FFB) in the pediatric ICU (PICU)Indications for performing bronchoscopy (diagnostic and therapeutic)Management of sedation and analgesia during bronchoscopyCardiovascular effects associated with bronchoscopy proceduresRespiratory effects and complications during bronchoscopySpecial considerations for bronchoscopy in patients with traumatic brain injury (TBI)Post-procedure complications, including fever and its managementOverview of rigid bronchoscopy and its indicationsImportance of understanding physiological changes during bronchoscopyEducational focus on acute pediatric care for current and aspiring PICU internsReferences:Reference 1: Sachdev A, Chhawchharia R. Flexible Fiberoptic Bronchoscopy in Pediatric Practice. Indian Pediatr. 2019 Jul 15;56(7):587-593. PMID: 31333214.Reference 2: Li SX, Tao XF, Wu HJ, Jin F, Zhu GH, Wang YS, Tang LF, Chen ZM, Wu L. Advances in pediatric flexible bronchoscopy. World J Pediatr. 2025 Oct;21(10):945-956. doi: 10.1007/s12519-025-00967-7. Epub 2025 Oct 4. PMID: 41045338; PMCID: PMC12578761.Reference 3: Truitt BA, Kasi AS, Kamat PP, Fundora MP, Simon DM, Guglani L. Cryoextraction via flexible bronchoscopy in children with tracheobronchial obstruction. Pediatr Pulmonol. 2023 Sep;58(9):2527-2534. doi: 10.1002/ppul.26540. Epub 2023 Jun 23. PMID: 37350368.

In which we interview Rani Elwy about her work at the intersection of implementation science and policy as she served as a Robert Wood Johnson health policy fellow in the US Senate focusing on menopause care. We discuss menopause policy, stigma, implementation and deimplementation challenges for menopause care, and what it was like to work as a policy fellow for Senator Patty Murray. Discussed on today's show:  Bauer MS, Kirchner J. Implementation science: What is it and why should I care? Psychiatry Res. 2020 Jan;283:112376. doi: 10.1016/j.psychres.2019.04.025. Epub 2019 Apr 23. PMID: 31036287. Lane-Fall MB, Curran GM, Beidas RS. Scoping implementation science for the beginner: locating yourself on the "subway line" of translational research. BMC Med Res Methodol. 2019 Jun 28;19(1):133. doi: 10.1186/s12874-019-0783-z. PMID: 31253099; PMCID: PMC6599376.

I say this with my full chest — Undertone was not lying when it said that it is "the scariest movie you'll ever hear." And I cannot un-hear it!In this spoiler-free episode, I explore Undertone (2025) and the psychology of sound.I talk about:How sound can help us form secure attachments The psychology behind "therapist voice"How sound helps regulate our nervous systemsWhy we are naturally drawn to live music as a primal actHow silence can help grow your brainHow the 8 of wands tarot card helps us explore our relationship to silence and the unknown Mental Health is Horrifying is hosted by Candis Green, Registered Psychotherapist and owner of Many Moons Therapy...............................................................Show Notes:Tarot for Creative Therapists — Join the waitlist for this course designed for mental health professions who want to learn how to confidently and ethically incorporate tarot into clinical work. (https://candisgreen.podia.com/tarot-for-creative-therapists)Podcast artwork by Chloe Hurst at Contempo MintTheme music is by Sound Gallery by Dmitry Taras via pixabay Thunder by Music by John Britton from PixabayAll sound effects and music via pixabay Undertone (2025)See ‘Undertone' with Dolby Atmos, or You'll Miss Half the HorrorEnhancing the Raw Sound of ‘Undertone' – with David Gertsman and Jon LawlessIan Tuason haunted his own house when making his new horror filmBady SL. The voice as a curative factor in psychotherapy. Psychoanal Rev. 1985 Fall;72(3):479-90. PMID: 3931132. Soma CS, Knox D, Greer T, Gunnerson K, Young A, Narayanan S. It's not what you said, it's how you said it: An analysis of therapist vocal features during psychotherapy. Couns Psychother Res. 2023 Mar;23(1):258-269. doi: 10.1002/capr.12489. Epub 2021 Nov 18. PMID: 36873916; PMCID: PMC9979575. Sawamura, Yasuaki, Why We Overstimulate Ourselves: How Sensory Overload Blocks Memory and Weakens Learning (March 31, 2025). How Music Resonates in the BrainGentle Whispering ASMR Moonlight Cottage ASMR 

You know how, when teaching finishes for the summer, you feel all-powerful and end up vastly over-estimating how much you'll be able to get done before the new academic year? And, have you ever noticed that the opposite happens once term starts up again: you're overwhelmed, you panic because you don't think you're going to manage to do everything, but then you surprise yourself and it's all fine in the end? Yeah, well, there's a reason for that. Join your imperfectionist pal for a speculative little dive into the psychology of perception, and some ideas about how you can smooth out the bumps and make nice, sensible plans all year round.ReferencesBalcetis E, Dunning D. Cognitive dissonance and the perception of natural environments. Psychol Sci. 2007 Oct;18(10):917-21. doi: 10.1111/j.1467-9280.2007.02000.x. PMID: 17894610.Balcetis E, Dunning D. Wishful seeing: more desired objects are seen as closer. Psychol Sci. 2010 Jan;21(1):147-52. doi: 10.1177/0956797609356283. Epub 2009 Dec 17. PMID: 20424036.Proffitt DR, Bhalla M, Gossweiler R, Midgett J. Perceiving geographical slant. Psychon Bull Rev. 1995 Dec;2(4):409-28. doi: 10.3758/BF03210980. PMID: 24203782.Proffitt DR, Stefanucci J, Banton T, Epstein W. The role of effort in perceiving distance. Psychol Sci. 2003 Mar;14(2):106-12. doi: 10.1111/1467-9280.t01-1-01427. PMID: 12661670.Schnall S, Zadra JR, Proffitt DR. Direct evidence for the economy of action: glucose and the perception of geographical slant. Perception. 2010;39(4):464-82. doi: 10.1068/p6445. PMID: 20514996; PMCID: PMC3298360.

In this episode, our expert panel dives into the critical, historically debated topic of early burn wound excision using a real-world case of a patient with massive surface area burns. We explore the dramatic shift from the pre-1970s "wait and watch" approach to the modern standard of early source control, backed by landmark literature showing reduced mortality and shorter hospital stays. The discussion also highlights the nuances of this timeline, covering specific scenarios where delaying surgery is actually safer due to physiologic instability, uncertain burn depths, or mass casualty events. Tune in to hear the evidence behind these clinical decisions and learn why modern burn surgeons believe that removing necrotic eschar early is the best way to dominate the day!Hosts: - Kathleen Romanowski – University of California Davis Hospital, Shriners Hospital Sacramento- Laura Johnson – Grady Memorial Hospital- Lauren Nosanov – Grady Memorial Hospital-  Victoria Miles – Louisiana State University Health Science Center, University Medical Center New OrleansLearning Objectives:- Review the historical development of early burn excision and understand how these studies shaped modern burn surgical practice.-  Evaluate contemporary evidence on the timing of burn excision.- Apply current evidence and clinical principles to operative decision-making, identifying key patient and injury factors that influence the timing of excision and grafting in patients with major thermal injury.References:- Thompson P, Herndon DN, Abston S, Rutan T. Effect of early excision on patients with major thermal injury. J Trauma. 1987 Feb;27(2):205-7. doi: 10.1097/00005373-198702000-00019. PMID: 3820353. https://pubmed.ncbi.nlm.nih.gov/3820353/-  Gray DT, Pine RW, Harnar TJ, Marvin JA, Engrav LH, Heimbach DM. Early surgical excision versus conventional therapy in patients with 20 to 40 percent burns. A comparative study. Am J Surg. 1982 Jul;144(1):76-80. doi: 10.1016/0002-9610(82)90605-5. PMID: 7046487. https://pubmed.ncbi.nlm.nih.gov/7046487/- De La Tejera G, Corona K, Efejuku T, Keys P, Joglar A, Villarreal E, Gotewal S, Wermine K, Huang L, Golovko G, El Ayadi A, Palackic A, Wolf SE, Song J. Early wound excision within three days decreases risks of wound infection and death in burned patients. Burns. 2023 Dec;49(8):1816-1822. doi: 10.1016/j.burns.2023.06.003. Epub 2023 Jun 15. PMID: 37369613; PMCID: PMC10721718. https://pubmed.ncbi.nlm.nih.gov/37369613/- Ramsey WA, O'Neil CF Jr, Corona AM, Cohen BL, Lyons NB, Meece MS, Saberi RA, Gilna GP, Satahoo SS, Kaufman JI, Schulman CI, Namias N, Proctor KG, Pizano LR. Burn excision within 48 hours portends better outcomes than standard management: A nationwide analysis. J Trauma Acute Care Surg. 2023 Jul 1;95(1):111-115. doi: 10.1097/TA.0000000000003951. Epub 2023 Apr 11. PMID: 37038260. https://pubmed.ncbi.nlm.nih.gov/37038260/- Hayashi K, Sasabuchi Y, Matsui H, Nakajima M, Otawara M, Ohbe H, Fushimi K, Ono K, Yasunaga H. Does early excision or skin grafting of severe burns improve prognosis? A retrospective cohort study. Burns. 2023 May;49(3):554-561. doi: 10.1016/j.burns.2023.01.013. Epub 2023 Feb 3. PMID: 36774244. https://pubmed.ncbi.nlm.nih.gov/36774244/- Janzekovic Z. Once upon a time ... how west discovered east. J Plast Reconstr Aesthet Surg. 2008;61(3):240-4. doi: 10.1016/j.bjps.2008.01.001. Epub 2008 Feb 1. PMID: 18243082. https://pubmed.ncbi.nlm.nih.gov/18243082/

En este episodio compartimos una lectura conjunta que disfrutamos muchísimo. Todo comenzó cuando Any empezó a leer El último invitado de la boda de Jason Rekulak, autor del que ya habíamos reseñado una obra anteriormente. Como Mixbuscaba algo distinto a sus lecturas habituales, le pidió una recomendación a Any, quien ya llevaba más del 50% del libro. Decidieron terminarlo juntos, compartiendo dudas y teorías hasta llegar al final.La historia nos presenta a Frank, un padre que siempre ha intentado darle lo mejor a su única hija, Maggie. Sin embargo, tras una serie de decisiones rebeldes por parte de ella, la comunicación entre ambos se rompió por completo. Después de un largo tiempo de silencio, Frank recibe una llamada inesperada: Maggie lo invita a su boda.Resulta que Maggie tiene una relación con un joven artista y hay planes de matrimonio. Ahora, Frank deberá viajar para conocer no solo a su futuro yerno, sino también a toda su nueva familia política. Y lo que todo parece felicidad se convertirá en un desenlace inesperado para Frank.Amamos los personajes de Frank, la hermana Tammy y la niña Abigail.Consigue la novela en el siguiente enlace y no te olvides de compartir este episodio, coméntanos que te pareció, si ya has leído esta novela o algo mas de este autor. El último invitado de la boda - Jason RekulakSíguenos en nuestras redes sociales

The belief that IV dextrose is necessary to clear ketones in hyperemesis gravidarum originated from a logical, and now known to be outdated, extrapolation of basic starvation ketosis physiology and the treatment paradigm for diabetic ketoacidosis (DKA). The original experiments that led to this conclusion go back to the 1960s (Foster data). Not only is this outdated, but it is also physiologically incorrect. We've learned a lot about IV fluid replacement about hyperemesis gravidarum in the last several years- in the last data review was in January 2026 in Lancet. Even the correction of hyponatremia has evolved. Should we be following urine ketones for patients being treated for HG? Is Dextrose needed? Listen in for details.1. Nana M, Painter R, Williamson C et al. Hyperemesis gravidarum. The Lancet, Jan 2026; 407, 78-892. Clark SM, Zhang X, Goncharov DA. Inpatient Management of Hyperemesis Gravidarum. Obstet Gynecol. 2024 Jun 1;143(6):745-758. doi: 10.1097/AOG.0000000000005518. Epub 2024 Feb 1. PMID: 38301258.3. Ayus JC, et al.Correction rates and clinical outcomes in hospitalized adults with severe hyponatremia: a systematic review and meta-analysis. JAMA Intern Med. 2025;185(1):38-51. 4. ACOG Clinical Epert Series: Inpatient Management of Hyperemesis Gravidarium. Obstet Gynecol; 2024

Tara and Ben tend bees. Tara's a mystic and Bens a healer. And the bees…the bees are always talking. Are you listening?THANKS FOR Being here

From Barbara Robertson and Nancy Mohrbacher: Using new research in clinical practice? How do we do this? When is it time to let go of our old ways of doing things and incorporate new information? These are some of the questions Nancy and Barbara discuss in this episode of All Things Breastfeeding. Sometimes, incorporating new research in clinical practice is easy. It can be an “ah-ha” moment. Nancy had this when she learned about Suzanne Colson’s research on releasing babies’ reflexes to stimulate breastfeeding. She knew Suzanne’s description was true and immediately began incorporating Suzanne’s ideas into her practice. Barbara had this type of moment when she read Nancy’s article, “The Magic Number.” On the other hand, we can also suffer from confirmation bias. We may want to believe that we can use human milk for longer than the current recommendations (see article below), so we are happy when a study suggests this might be true. On the other hand, it can take 17 years or longer for research to become clinical practice. When should we wait? When is it time to change? Some clear guidance both Nancy and Barbara use is: “Will it be harmful?” It does not harm anyone to start playing around with latch and positioning, or adding extra milk removals, for someone struggling with milk supply. Take a listen to learn more about Nancy’s and Barbara’s thoughts on this subject. Enjoy! Resources: Colson SD, Meek JH, Hawdon JM. Optimal positions for the release of primitive neonatal reflexes stimulating breastfeeding. Early Hum Dev. 2008 Jul;84(7):441-9. doi: 10.1016/j.earlhumdev.2007.12.003. Epub 2008 Feb 19. PMID: 18243594.: https://pubmed.ncbi.nlm.nih.gov/18243594/ Anders, L. A., Mesite Frem, J., & McCoy, T. P. (2025). Flange size matters: A comparative pilot study of the Flange FITSTM guide versus traditional sizing methods. Journal of Human Lactation, 41(1), 54-64. https://pubmed.ncbi.nlm.nih.gov/39614713/ Mohrbacher, N. (2011). The Magic Number and Long-Term Milk Production. Clinical Lactation 2(1), 15-18. https://lactalearning.com/wp-content/uploads/2025/07/MohrbacherMagicNumber2011.pdf All Things Breastfeeding Episode 108: Tongue Tie Update: https://lactalearning.com/tongue-tie-update/ Scharff, A. Z., Sedlacek, L., de Oliveira Mekonnen, A., Liolios, I., Ritter, S., Fuchs, F., & Happle, C. (2026). Leftover Infant Milk After Bottle Feeding: Parental Practices and Microbiological Findings. medRxiv, 2026-02. https://www.medrxiv.org/content/10.64898/2026.02.13.26346179v1 The post All Things Breastfeeding Episode 110: Using Research in Clinical Practice appeared first on The Breastfeeding Center of Ann Arbor.

En el episodio de esta semana, nos sumergimos en una joya de la fantasía contemporánea que demuestra que no hace falta ser el mago más poderoso del mundo para ser el héroe que tu comunidad necesita. Analizamos "Mago Menor" de T. Kingfisher.Oliver es un niño de 12 años con un problema muy real: es un mago, pero "menor". Sus habilidades se limitan a manipular alergias y poco más. Sin embargo, cuando una sequía extrema amenaza con destruir su aldea, la presión de los adultos recae sobre sus hombros. Acompañado por su sarcástico y maravilloso familiar (un armadillo), Oliver emprende un viaje para "traer la lluvia"."A veces, la valentía no es no tener miedo, sino ser el único que se mueve mientras los demás están paralizados por la sequía."Mago Menor - T. KingfisherSíguenos en nuestras redes sociales

In this episode of "PICU Doc on Call," Drs. Monica Gray and Pradip Kamat from Children's Healthcare of Atlanta dive into the use of inhaled anesthetics, especially isoflurane, in the pediatric ICU. We're focusing on those tough cases: refractory status asthmaticus and status epilepticus. We'll chat about why isoflurane is our go-to over other agents like sevoflurane, desflurane, or nitrous oxide, and break down its bronchodilatory and anticonvulsant properties. We'll also touch on important pharmacology concepts, such as MAC and the blood-gas partition coefficient, and discuss how we approach dosing and ventilator management when using isoflurane.Of course, we'll also discuss the potential adverse effects that can come with prolonged use, and why it's important to stop other sedatives and beta-agonists once you start isoflurane. Join us as we walk through the practical aspects and pearls for using inhaled anesthetics in the PICU!Show Highlights:Use of inhaled anesthetics in pediatric intensive care units (PICU)Focus on isoflurane for managing refractory status asthmaticus and status epilepticusComparison of inhaled anesthetic agents: isoflurane, sevoflurane, nitrous oxide, and desfluraneImportance of minimum alveolar concentration (MAC) and blood-gas partition coefficient in anesthetic pharmacodynamicsMechanism of action of isoflurane in airway management and bronchodilationClinical administration techniques for isoflurane in critically ill childrenVentilator management principles for intubated children with status asthmaticusRole of isoflurane in refractory and super-refractory status epilepticusPotential adverse effects and considerations for prolonged isoflurane useSummary of pharmacologic concepts essential for safe isoflurane therapy in pediatric patientsReferences:Rogers Text Book of Pediatric Intensive Care: Chapter 47: Acute Severe Asthma. Stewart C, Brilli RJ. pages 763-775Reference 1: Stetefeld HR, Schaal A, Scheibe F, Nichtweiß J, Lehmann F, Müller M, Gerner ST, Huttner HB, Luger S, Fuhrer H, Bösel J, Schönenberger S, Dimitriadis K, Neumann B, Fuchs K, Fink GR, Malter MP; IGNITE Study Group, with support from the German Neurocritical Care Society (DGNI). Isoflurane in (Super-) Refractory Status Epilepticus: A Multicenter Evaluation. Neurocrit Care. 2021 Dec;35(3):631-639. doi: 10.1007/s12028-021-01250-z. Epub 2021 Jul 20. PMID: 34286464; PMCID: PMC8692280.Reference 2: Zeiler FA, Zeiler KJ, Teitelbaum J, Gillman LM, West M. Modern inhalational anesthetics for refractory status epilepticus. Can J Neurol Sci. 2015 Mar;42(2):106-15. doi: 10.1017/cjn. 2014.121. Epub 2015 Jan 9. PMID: 25572922.Reference 3: Werner HA. Status asthmaticus in children: a review. Chest. 2001 Jun;119(6):1913-29. doi: 10.1378/chest. 119.6.1913. PMID: 11399724.Reference 4: Gill B, Bartock JL, Damuth E, Puri N, Green A. Case report: Isoflurane therapy in a case of status asthmaticus requiring extracorporeal membrane oxygenation. Front Med (Lausanne). 2022 Nov 8;9:1051468. doi: 10.3389fmed. .2022.1051468. PMID: 36425104; PMCID: PMC9679515.

CardioNerds Drs. Dinu Balanescu, Billy-Joe Mullinax, and Mariana Garcia discuss systemic thrombolysis in pulmonary embolism with expert Dr. Allison Burnett. Audio editing by CardioNerds Academy intern, student doctor, Pace Wetstein. Pulmonary embolism is the third leading cause of cardiovascular death in the US, and high-risk PE carries a 30-day mortality risk as high as 30-50%. In this episode, we discuss the indications for systemic thrombolysis, including high-risk PE and cardiac arrest. We addressed how to appropriately select candidates for systemic thrombolysis, balancing the high risk of bleeding. Additionally, we discussed anticoagulation management and timing concurrent with lytic therapy, as well as the importance of multidisciplinary PERT teams.  The 2026 American multi-society PE guidelines were published after this episode was recorded. Dr. Dinu Balanescu and Dr. Billy-Joe Mullinax are Co-chairs for the CardioNerds PE Series, developed in collaboration with the PERT Consortium.   Enjoy this Circulation 2022 Paths to Discovery article to learn about the CardioNerds story, mission, and values. CardioNerds Pulmonary Embolism PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Pearls Risk stratification is crucial in acute pulmonary embolism care. Based on the ESC 2019 guidelines, low-risk PE patients are those who are normotensive with no evidence of right ventricular dysfunction. Intermediate risk includes two categories: intermediate-low, with normotensive patients who have a high PE score with negative biomarkers, and intermediate-high risk, which has elevated biomarkers or signs of RV strain. High-risk PE includes hemodynamically unstable patients (SBP

Sponsor OneSkin improves your skincare routine with science-backed skin care products. With over 10,000 five-star reviews and validation from clinical studies, OneSkin has made a name for itself in the skincare industry. If you’re interested in trying OneSkin for yourself, you can get 15% off your order with the code OVERTIRED at oneskin.co/OVERTIRED. Chapters 00:00 Gang Back Together 01:23 Mental Health Corner 01:39 Back Pain Diagnosis 07:09 Dental Insurance Racket 12:34 Post Surge Recovery 19:24 Surgery And Withdrawal 24:36 Sponsor One Skin 26:23 Terminal Widget Reveal 31:24 Widgets And Visualizations 34:51 Release Plans And Review 36:56 Universal Bundle Pricing 37:38 AI Boosts Mark II Sales 39:20 Leaving Oracle Behind 40:03 Ninety Hour Workweeks 41:55 NV Ultra Vaporware Woes 43:17 Missing Collaborators Online 45:09 Dan Peterson Secret App 46:23 The Pit TV Complaints 50:49 ER Nostalgia and Cast 54:01 Season Two and Other Shows 58:33 Gratitude App Picks 01:00:09 AI Tools and Claude Code 01:04:35 Bookshelves and Audiobooks 01:07:10 Wrap Up and Sleep Show Links TerminalWidget Marked 3 Bezel BookShelves Claude app Join the Conversation Merch! Come chat on Discord! Twitter/ovrtrd Instagram/ovrtrd Youtube Get the Newsletter Thanks! You’re downloading today’s show from CacheFly’s network BackBeat Media Podcast Network Transcript Projects and Pitt-falls Gang Back Together Christina: [00:00:00] What’s that? Do you see a podcast update in your feed? Well that’s because you’re back on, on Overtired and, uh, and I’m Christina Warren and I’m joined by, uh, Jeff Severns Guntzel and Brett Terpstra. What do you know? The whole gang is back together. Overtired, everybody what Jeff: Hi everybody. Brett: I need a, we need a party sound. We need a Christina: we do. We need a soundboard. We need a soundboard and we need a, a way to be like what Gangs all here. Some sort of a like a either a a we need a horn. That’s what we need. We need one of those. Those horns they play at at at football games. Jeff: would like that very much. Brett: or that like B. Christina: exactly. Jeff: yeah, Brett: That would really wake people up. Christina: It really would. And, and especially, um, all of us. ’cause I we’re recording this earlier than we ever do. Brett’s been up for a really long time and, uh, I think Jeff is probably like raring to go, but I’m like, I, well now Jeff: raring to go, but I’m warming [00:01:00] up. Christina: Yeah, I, I, I’ve been up since like five 30, so I’m okay too, but yeah. Brett: I wrote an entire shortcuts in shortcut intense interface for my new app this morning, and it’s actually working. I’ve never written for shortcuts before. Christina: Well, Ooh, we will, yeah, you gotta talk to us more about that ’cause I wanna hear more about that. Mental Health Corner Christina: Um, but first I think we should probably do, um, because it’s been a while since we’ve all been together, we should probably do a little bit of a mental health corner. Brett: yeah, Who wants to kick that off? Okay, fine. I will. Jeff: health. Mental health. Silence. Back Pain Diagnosis Brett: I, uh, I, I, my sleep has gotten a little worse than it was before when I told you it was bad. Um, I’m, now, I’m back down to like five hours a night and I just wake up at like 2:00 AM. And like I go to bed by eight or nine and I get up at [00:02:00] 2:00 AM every morning and I just cannot, for the life of me fall back asleep. And for like the first hour I’m up, I’m not even really awake. Um, I’m just kind of sitting on the couch staring at my computer and not be, not able to do anything After about an hour. Um. I, I, I’ll get some coffee, I’ll take my meds and like then it’s kind of like most people’s, like maybe 10:00 AM 11:00 AM um, by, by like 3:00 AM but it’s still wearing me down. Um, I got, so I’ve had back pain, um, for a while now. Uh, I can’t stand up for more than about five minutes and I can’t walk for more than three to five minutes, which has really put a dent in my, um, ability to exercise. And, um, so I finally got, I got an MRI [00:03:00] done, and they. Diagnose me with stenosis, which I think is kind of a, a broad term, but like a couple of the discs in my lower back have collapsed and, um, they, they, they think I can be treated with, uh, with shots and not surgery. Um, so I’m hoping, I’m hoping to get that figured out because, okay, so right now, uh, we, we always go on walks in the wildlife refuge, um, like the wetlands refuge near us, and I love it. We, we see so much cool stuff there and I hadn’t really been able to, but what I found was this little, it’s like. Folded up, it’s like two feet tall, uh, camp chair and it, it’s like a camp stool. And so I carry that with us while we walk and then like every three minutes I’ll like have to set it up on [00:04:00] the side of the trail sit. And if I sit for two minutes, the pain goes away, I can then walk again immediately. Um, but like after, after three to five minutes, like my back freezes up and I, like, I literally, I can’t move anymore. Um, so this little, uh, take carrying a chair and doing it in three minutes stints, um, has at least allowed me to get out and get some green time. But that’s kinda where I’m at. Jeff: What does this little chair look like? Uh Brett: It’s blue Jeff: huh. Brett: and it has four legs and it’s can canvas. Jeff: is it like an adorable little camp chair that you’re supposed to be able to like Brett: I think it’s a toddler’s ch camp chair. Jeff: Excellent. This is the detail I Brett: like, it’s smaller than my butt. Like I’m perching on it, but it’s enough to like get my back, uh, into feeling. Okay. And it’s not too heavy to like carry[00:05:00] Jeff: Show art, but the art, the art is you perching. Just to be really clear. Brett: Yes. My, my 280 pounds pound perched on a two foot camp stool, it’ll be great. Jeff: Wow. Well, I’m glad there’s something like some kind of thing Brett: Yeah, no, it’s actually really good. It’s really good to get the stenosis diagnosis and ’cause for a long time I just assumed because I gained weight, my, my back wouldn’t work anymore, which was depressing. But the more I thought about it, the more I realized I’ve been this heavy before and I have not had this pain. And even after my first like 50 pound sudden weight gain, I didn’t have back pain. So it didn’t make sense that my body just couldn’t handle it, uh, like something else had to be going on. So it was actually much like any diagnosis, I think, um, other than, you know, terminal illness, but for like A [00:06:00] DHD or stenosis or any like mental health condition, it’s a relief to get a diagnosis and find out you weren’t crazy, you weren’t making things up. So yeah, I’m, I’m grateful. Christina: No, I completely like, can, can relate to that. ’cause when I, like with my back, well my cervical spine, um, it was kind of a similar thing. Obviously mine was more acute and it was a different scenario because I got, um, like the, you know, diagnosis relatively quickly, although it still felt like it took longer than, than I wanted it to, to, to get my MRIs and whatnot. Um, but it was similar to you. It was like kind of a relief to be like, oh, okay, so you have like a major problem. This isn’t just you being a wimp and, Brett: Yeah, exactly. Christina: exhilarating pain. Right. Like excruciating pain. Right. And, and just even having that, even knowing, okay, I don’t love that I have to go through [00:07:00] this whole thing. Um, I’m, I’m still like relieved to have a diagnosis and a plan forward. Dental Insurance Racket Brett: Oh, and also I, so I’m on state. Healthcare, and that includes, um, Delta Dental, but it’s this weird version of Delta Dental that nobody in my town accepts. Um, so I have to, I have to drive 45 minutes to get dental care and even then they can’t, he can’t do root canals or anything. And I needed two root canals and that would’ve involved driving two and a half hours or three hours and then going back to the 45 minute away place. And so what I did was I took the extra money I had saved outside of my, like, nest egg savings, but like my working savings. And I paid for a year of actual Delta Dental, um, and started going to a place [00:08:00] just really close to me and, um. It turns out that the best dental health insurance is still shit like it. I don’t know how much dental work you guys get done, but it is, Christina: it’s, it is crappy. Brett: it’s a, it’s, it’s a racket. And I actually watched a YouTube video on why dental insurance is a scam. And it like interviewed Dennis who actually take these like Delta Dental and the Medicaid dentists. Um, and it is truly a scam. And what I found, and this is much the same experience, uh, Christina talked about with her, um, MRII think it was that you did a cash pay. Um, I talked to the dentist and I said, do you have a cash paid discount? And he’s like, oh yeah. And basically. I can just pay cash and do everything for about 60% of the normal cost, and that is better than what [00:09:00] Delta does for me in most cases. Plus, I need so much work that my $2,000 cap with Delta is gone. Christina: Well, I was, I was gonna say like, so when I joined Microsoft, Microsoft used to have really good. Dental insurance, um, respectively speaking as, as good as it can be. But there were still, you know, caps on how much work would be done. But I found like a good person to go to. ’cause I had an incident, um, about a year after I moved to Seattle, maybe less than that, where um, I had to have an emergency root canal and like that sucked. Um, like I went into a normal dentist. She was like, this is what you need. And then I had to like, take an Uber, like over to a guy and see him like that day at like 5:00 PM and I’m like, you know, all like drugged up and, and getting the root canal. And that was not great. And I needed a lot of, of, of work done. Um, and so we split it over like she was a really good dentist and so we split it over. We were like, I was coming close to. The, the end of the calendar year. So she was like, okay, we’re gonna do all of this work and then we will start the next year [00:10:00] when things go forward. And like she knew how to play the system and was like a really good dentist. Well then Micro, then I went to GitHub. GitHub used, um, you know, uh, Delta Dental. And, and that can vary based on plan. Microsoft is apparently on them too. Google also had them on a slightly different plan, and it’s like you never know what you’re getting. And yeah, to your point, because if you need a lot of work done, if you have anything specialized, if you’re, you’re lucky if you get the right plan and you can see a provider in your area, great. But if you don’t, to your point, it is often, this is just fucked up. Like, especially if you’re having to pay out of pocket for it anyway. If it’s part of your employer, you know, benefits, maybe it’s a little different, but it’s like even then it can still wind up being less expensive to just pay the cash stuff than whatever your deductibles are, which have a cap anyway. And, and, and, and, and then, yeah, the, the, the way that the, the Medicaid or, or even insurance pricing works, stuff that they might charge you a very nominal fee for, for like a cleaning or whatever is, or a cavity fill [00:11:00] is gonna be, you know, they’re gonna bill insurance like three or four times that Brett: Right, exactly. So I pay, I pay like 800 bucks for a year of Delta, and that gives me basically $2,000 to work with, plus whatever price they can negotiate. Um, but like you said, like they, they bill three times. Um, so like what still comes out of my like $2,000 pot, um, is higher than I would’ve paid with Christina: If you just paid cash, if you just had an $800 budget, or if you got like, yeah, that’s the thing. Okay. This is an AI app that somebody should build. And I’m saying this hoping that maybe something the audience will, or maybe one of us could vibe code it, because this seems like this would be a relatively easy calculator to do with like certain providers if they, if they, you know, list their things where you could like run the costs and be like, okay, this is, I’m gonna put in this number. This is what my, you know, provider’s fees are. This is what my [00:12:00] insurance thing is. Um, Brett: what my cash pay Christina: this is what my cash pay is. Is it cheaper for me to spend $800 a year on Delta Dental or to just pay cash directly with my, my dentist? Brett: Yeah. Have you as I’ve, as I’ve said to people who have pitched ideas to me in the past, you’re talking about a spreadsheet? Christina: Yes. It is a spreadsheet to be completely out. Yes. But I can now use cloud code to, to to, to, you know, figure out the formula for me is the real thing. Brett: Yeah. There you go. All right. Who’s up? Post Surge Recovery Jeff: Dr. To, um, I can talk, uh, uh, I’m, I mean, I’m doing really well. Uh, I we’re a couple months past, or, you know, a couple months past the operation Metro surge stuff here in January and February, in a little bit of December, but really January. And that was, I’d never kind of experienced like a, a full [00:13:00] taxing of every single person and kind of person I knew and which was amazing. Um, and, uh, and it took a minute when things settled here, um, to, for everybody to kind of figure out what. How to just even enter into the world every day because everything had been driven by what was happening on a almost hourly to hourly basis for, for some time. And, um, and so I kind of moved through that, that period, which was like quite a sort of come down, uh, of adrenaline and, and amygdala sparking. Um, and, and have kind of smoothed a little bit. And, um, and I’m just doing well. I’m having a nice, a nice goal of it right now. Christina: Good. Great to hear. Brett: I, I guess that everything’s relative. Right? Jeff: Yeah. Everything’s relative. Yeah. Yeah. But I think I would call this a nice go of it, uh, even outside the context of comparing [00:14:00] to, to Operation Metro Surge. Brett: that’s, that’s, I, I’m happy for you. That’s awesome. Jeff: I think actually the last time I was on the podcast was with you, Christina, in January right after we had had a raid in our alley, which was even before the surge Christina: You before the big surge, even before Jeff: of an early start. Christina: I was gonna say even before, like I, I, I don’t even know if, if, if the, the, the murder had happened. Um, Jeff: not at all. In fact, we only had 100 extra ice agents here at the time and within a couple of weeks there’d be a woman in front of my house, uh, being pulled out of her car ’cause she was following ice agents and throwing me her phone as she gets tossed into a, into a fucking ice truck. And like it was just, everything happened so fast and so slowly all at the same time. And, and obviously there’s still all sorts of stuff going on, but it is indisputably not what it was in January and February. Brett: I was gonna ask you about that. ’cause like the total number of deportations is only slightly [00:15:00] lower right now than it was during the surge. Um, and they, they removed, they added like, what, 3000 agents and they removed like 800 of them. So, Jeff: they’ve removed way more than Brett: Hey, have they Jeff: oh, yeah. We’re down to, I haven’t, I don’t wanna say the numbers because I haven’t looked at them. We’re, we’re back down to like the high hundreds and we, our baseline is like 1 25. Brett: Okay. Jeff: Yeah. You can tell. Um, it’s, yeah, you can tell. And I, and I’ve been down to the WPO Federal building a a few times, um, which is where ICE was kind of headquartered and there’s just the level of activity there is very low. Um, they had some new vehicles come in at one point about a month ago, but mostly those are replacing rentals that they were using. So it wasn’t like people took it as kind of an indication that they were, you know, staffing up or suiting up again. But it was really just kind of replacing their, their really weird, like sort of duct tape together invasion. Um, it’s kinda like in Iraq when they decided they were gonna [00:16:00] actually armor the Humvees, it was kind of like a little bit of a switch of, of vehicles. Um. Yeah, it’s much different. And like, you know, all the people either in my life or in my community that were in hiding or not, I mean, for the most part, not in hiding anymore vulnerable folks and undocumented folks. And, um, so it’s like, it’s qualitatively and nervous, systemly different Brett: Yeah. Yeah. Jeff: for everybody and still sucks. And there’s still a risk and a threat and, and a horror. And a terror. Brett: Yeah, down here in southern Minnesota, I have not gotten a call to do a food delivery or a grocery delivery for, yeah, a couple months. Um, so yeah, I guess it really has calmed down across the state. Jeff: Yeah. Thank God. I mean, who knows what they’re up to that isn’t as visible, but thank God Brett: exactly. Jeff: over. So yeah, I, I mean it’s, and I actually just had my, my brother’s been in town and every time someone kind of comes to visit, they wanna like. You know, kind of hear or take in what the thing was and you start describing it again, and [00:17:00] now it just, I mean, it felt like a dream at the time. It just felt like, how could this be real? But you were just so in it, like every single person, like you said, Brett, like people were doing grocery deliveries or people were, you know, cooking food for the people that were kind of on the front lines, or you were following ice, or you were dispatching people to follow ice, whatever. It was like every. Single person I could think of as doing something. And uh, and, and so when you try to describe it now, when you look around, especially in my neighborhood where they were all over, um, it it, it seems like, was this, was this real, um, like, was it even real because like, I don’t know, like the end here. ’cause this could go on forever, but I don’t know if any of you saw the footage that went around of a high school called Roosevelt High School, where, uh, where Bovino showed up and there was all this crazy shit and the, the footage of this, um, went around the country and like it was, you know, reposted by freaking everybody that was my son’s school in my neighborhood. And, and so like, it was just this constant thing of like, bovino at my son’s school, binos at my gas station. Like, it was just [00:18:00] utterly insane. And now, and, and every street felt almost, you could feel ice on the streets. Like you would see ghost cars where they had taken people or whatever. You could like, feel ’em on the streets. And so you walk around, you walk around the same streets now, and it’s just birds and kids playing and you’re just like, did that, was that real? Brett: There, there was a tow truck driver that was interviewed who had taken it upon himself to tow those ghost cars for free back to their origin. Um, and just like leave them for people. Jeff: at least, or he would take them in and not charge if you came in for them. And it’s, and that’s just it. Everybody, everybody. It was incredible. It was incredible. Christina: It’s crazy. Jeff: Yeah. All Christina: I hope, I genuinely hope that they’ve lost interest and, and have moved on to other things. Brett: Like Seattle. Christina: yeah. Well, I mean, Seattle is obviously a very different situation and, and that had a, a longstanding, I think, impact. Um, and, and I, I, I. I’ve said this, I said this at the time, people who made that really bad were the [00:19:00] activists who came in outside the so-called activists and putting that in quotation marks who came in, who didn’t even live in the city and agitated things and made things way worse than, than they, than it should have been. Um, but yeah, but I hope that it’s like Seattle, that it just kind of falls like the, the government doesn’t come back and, and continue this, you know, reign of terror. Jeff: Yeah, yeah, yeah, for sure. Surgery And Withdrawal Christina: Um, well, I’ll, I’ll be quick. So I, I had surgery since I guess the last time I was on, Jeff: Sure did. Christina: that went well. Um, the surgery itself, I’m still in some pain, um, in my shoulder after the surgery, uh, which was not like you were fi fixing my cervical spine. But, um, they, uh, I guess however it worked, like I, I think as muscular, um, I, I’ve been going to to to PT for the last few weeks. Um, but I still having some, some shoulder pain. That’s, that’s getting better. Um, the hardest thing was actually some of the medication stuff. So [00:20:00] I, uh, gabapentin, um, I know it’s a lifesaver for a lot of people. I don’t have a good reaction to it. Like I’m one of those people. Like, it, it a, it makes me feel kind of loopy. I don’t like it. B it’s very difficult for me to sleep on it. Um, which, which is a problem and, you know, but, but the big thing is it just kind of makes me like, feel like I’m not kind of in my own head. Like I feel like, don’t know, like, um, altered on it. I, I would say. And so I went off they gabapentin and no one told me, and I am gonna put this as a PSA out there. ’cause I know a lot of people take it. Do not go off of that cold Turkey. Jeff: mm. Christina: They didn’t tell me that. Um, which someone should have, but no one told me that. And it can actually cause seizures if you do other things. But in my case, the real thing was that I had withdrawal. That was some of the worst withdrawal I’ve ever had. In my life ever. And, um, it like awful, like awful, awful, awful to the point that to go off the Gabapentin and they had me on like a, a decent dosage. It [00:21:00] took me a month because I had to keep going basically down like one pill like every week to step down. And, but I mean, I was getting, you know, like, like hot and cold sweats, you know, like feeling like my teeth were gnashing, you know, like nauseous, just like awful, awful stuff. So it took me, you know, a month to go off of that. I had to extend my medical leave in part because of the medication withdrawal stuff, because I was like, I can’t go back to work if I’m gonna be like, still dealing with, with medication bullshit. Um, so, um, that was actually, you know, in some ways like more, uh, of an issue than like recovering from the surgery itself, which was major. Like I, I tried to kind of downplay like what it was, but it was, it was major surgery and um. Um, I’m glad that it’s over. So, you know, onwards and upwards. I’m, I’ve been back at work for a couple weeks. Um, still kind of settling in on that, but, uh, but yeah. Brett: That [00:22:00] withdrawal sounds terrible. Usually you have to do opiates to get that kind of fun. Christina: Yeah, well that was the thing. I saw somebody on, I read it, which of course is anecdotal. I don’t usually look for this stuff, but sometimes you just wanna feel like, okay, is it, is it common for me to have this withdrawal or not? And somebody, and one of the subreddits was like, this was worse than coming off of heroin and I in a jail cell, and I should know because I’ve done that. And I was like, okay, I, I’m not going to equate it at that level, you know, for, for me. But it was definitely like that bad. It was, let me put it this way, it was bad enough that at first I thought. It was the opiate withdrawal because I, they gave me some, some oxy, um, um, contin. Um, and then the doctor was like, no, that’s not a high enough dosage. This is, you know, um, it, it, it probably was gabapentin and, and it, it. What pissed me off is that one of the physician’s assistants or whatever, when I’m telling like my doctor about this, I’m like, okay, if I need another nerve drug, then we need to find something [00:23:00] else. I can go on select so I can go on, you know, something else. But, but I, I clearly can’t stay on this. A, they kind of gaslit me because I’m a woman and obviously my pain and my symptoms can’t be real. So that’s like number one. And that’s just a fact. I don’t care if you’re a male or female doctor, they don’t take you seriously. I’ve complained about that before. Um, b like she had the nerves to say, she was like, well, you know, if the withdrawal is that bad, then why don’t you just stay on the medic medication? It’s not that it, it, it, it’s fine. I’m like, no, it’s not fine. It makes me feel altered. You’re telling me that it’s for nerve pain, that my nerve pain should be fixed if my nerve pain isn’t fixed and if I need something for nerve stuff, then that’s one thing and we could maybe look at an alternative, something that doesn’t make me feel loopy and lets me sleep. But if your suggestion is, oh, to avoid the bad withdrawal, just stay on the drug. I’m sorry, what the fuck are we doing? Um, and, and then the doctor’s like, well, you know, we get this all the time. We never see side effects. And then I looked it up, you know, in the actual drug literature and no, there are side effects exactly like the ones I experienced. So I was like, I recognize that. [00:24:00] I always am usually that like one percentile person who gets like the weird side effect. Like, that’s who I am. I get that. But Brett: crazy. I’ve, I’ve gone off of gabapentin. It sucks. I You’re not crazy at all. Christina: yeah. But, but it just, it just was frustrating to me that like the, the suggestions like, we’ll just stay on it. It’s like, no, like that’s, that’s, that’s not actually gonna be a thing anyway, but onward and upward. Jeff: Yeah. Wow. I’m glad you’re through that. Like Christina: Yeah, me too. Me too. Okay. Sponsor One Skin Christina: Well, I know we have some other topics we wanna get to, but before we do that, um, let’s take a moment to talk about our sponsor of today’s episode One Skin. So, um, you know, I, I’ve gone through a number of different things with my skincare routine over the years. Some have been more effective than other. Um, you know, um, my skin kind of goes back and forth between being too oily and too dry. I’m kind of in a dry [00:25:00] phase right now, and, um, there are tons of products out there that, that promise results. And then you, you get them in the, and they’re, they don’t necessarily work. So, uh, I wanna talk to you about One Skin, which was founded by scientists, and it’s dedicated to longevity. And, um, the, the brand is actually committed to being real science over marketing hype. And so, uh. What they wind up. Uh, what, how, how this works is that they use OSO uh, zero one, which is a proprietary peptide, which is designed to help deactivate the damaged cells that contribute to aging skin. And, um, I’ve been using one skin, um, for a little bit, and I, I’m, I’m liking it. I like how it makes my face feel. Um, I like, um, the fact that, uh, it’s. You know, what the peptides are supposed to do is help basically, uh, support collagen, uh, uh, of production and, and, and strengthening the skin barrier. Um, I’m not alone. There are over 10,005 star reviews and there’s validation from clinical studies and, and it’s making a name for itself in the skincare industry.[00:26:00] So if you are interested in trying one skin for yourself, you can get 15% off your order with the code Overtired at one skin.co/ Overtired. That’s 15% off at one skin. Do co slash Overtired and use that code Overtired. So thank you one skin for supporting our show and check them out. Brett: Awesome. Terminal Widget Reveal Brett: Do you guys, can I tell you about terminal widget? Jeff: Terminal widget. Yes. Set it up. Terminal widget. Brett Terpstra. What’s Brett: so I, I, I wanted, I had scripts running in the background and I wanted a quick way to check them and I thought it should be easy to put. Script output into a, like a widget on the desktop. And I could not find anything that actually worked. Like Shellfish has a widget, but it, it takes minutes to update and it’s flaky and, and the other apps out there [00:27:00] did not work for me. So I thought I would build my own. So I think I started it a month ago. Um, I built a, just something for, you can run a terminal command and update a progress bar or an image or, uh, like sparkline text or just straight up text output from your. Terminal, all kinds of charts and everything, and, and it updates instantly on your desktop, uh, with like a 0.5 to one second delay, uh, which I wasn’t able to find anywhere else. I had to like, use JSON payloads and like basically a cloud kit watcher, um, cloud kit because I did also port it to iOS. And, um, so I can run one command in my terminal or from a script in the background and have my iPhone and my desktop update with progress. Um, I am working [00:28:00] on a watch version of it that is not, I, I have it working in the app, but I wanna make it so it works as a complication. Um, that’s gonna take a little more doing, uh, but this morning and yesterday I spent working on. The Apple script and shortcuts interfaces for it. And I hate designing Apple Script dictionaries, uh, because there’s no, like, there’s no standard for like terminology and there’s no like golden way to do it. And I always end up messing it up even when I do have a plan. This time I think I actually succeeded in building out a dictionary that makes semantic sense and is somewhat. Predictable if you’ve ever written Apples script before, but I also added all of the widgets can be controlled from shortcuts. You just drag in like a chart widget into your shortcut and pass in like a value or like a, a chart of values. It can [00:29:00] do matrices and sign waves and, and line grass and bar charts, and it’s pretty nuts. You can check it out. It’s not available yet, but all of the documentation and all of the screenshots are at Terminal widget app. Um, and I am, I’m pretty impressed with myself and Christina: yeah. Brett: that’s what I’ve been working on while waiting for Mark III to make it through app store reviews so I can finally publish that. I, my latest rejection first, I got rejected, like a couple legitimate. Uh, concerns, but then I had a CLI that I wrote that was embedded in the app bundle and there was an option to create a sim link in your, in your terminal to use the CLI. And this was just a convenience method for like, you give it command line flags and it converts it into URL handlers and they rejected me for Christina: [00:30:00] I was gonna say, I was gonna say, they don’t let you do that. Like what I’ve seen with other apps do is usually there’s like a, um, in the app store is that usually you have to download a helper to install the CL. Brett: right. So what I did, uh, to get past the rejection was completely rip out the binary from the bundle. Uh, if you go to the install cli CLI tool menu item, it simply takes you to a webpage where there’s a, a notarized signed PKG file, or you can install from Homebrew, but it’s completely separate from the app store. And the last rejection said that I was requiring users to download an external app in order to use the app. Which is ridiculous on its face. Like it’s, it’s a convenience method. In no way do you need to download it. Um, there’s no requirement. In fact, it’s almost buried that you would even want it. Um, [00:31:00] and so I argued with the reviewer for a couple days ’cause they were replying like once a day. Um, and then they told me I had to go through a re uh, the appeal process. So I submitted an appeal at four 50 this morning. We’ll see how long that takes now. But in the meantime, terminal Widget is keeping me sane. I’m having a lot of fun with that. Widgets And Visualizations Jeff: I have some terminal widget questions. I’m looking at the site right now. Um, so talk to me about, um, talk to us about your, your initial use case, like was, which you’ve kind of described already, which is you just wanted to be able to check on these scripts Brett: Yeah. I just wanted a progress Jeff: But then Brett Terpstra kicks in ’cause like I just wanted a progress bar and now I’m looking at all the flags and everything else that you could have. You know, I’m curious like of all of the options that are in there, I want you to just share something that might not be intuitive or might not guess you can do. And then I’m curious of like if you have something you’re like, and what I [00:32:00] really want it to be able to do is. Brett: So you can pass it up to a hundred numbers, like a, a list of space or canvas, separated numbers that you can output from whatever script you’re developing. And you can have it, uh, output a sine wave or a um, uh, a waveform. I like the waveform visualization for it. And so you can get like pretty cool visualizations out of. Tabular data basically. And I also just added, um, tabular, like you can, you can give it a CSV file and it’ll generate a table for you. And it really only works well on like the large widget size. Um, but on both, on both iOS and Mac, uh, the tables look pretty good. Jeff: Nice. Christina: That’s awesome. I, I have a, I have a nerdy, uh, well, but less nerdy question. [00:33:00] Um, on the Terminal WIT app website, um, you have like a, a video of a, like, you know, showing off like, um, you know, your, your, your terminal app open and, um, the, the text being typed out. What did you use to create that? Did you use a remotion or did you use something else to generate that Brett: I scripted that, um, I, I wrote if there’s a helper Christina: charm or something? Brett: No, Christina: Okay. Brett: I, it’s a helper. It’s a helper script that it, it clears the screen and then it takes a table of commands and it types the command out with like a jitter delay. So it looks somewhat natural, like typing. And then it actually runs the command in the background. And then once the command’s finished, it clears the screen and does the same thing with the next one. Um, so I can just feed it like a, a, uh, a file with all the commands. I wanna run one per line. Um, and it just types them out and executes them. Jeff: That’s awesome. Christina: Cool. Brett: I know, [00:34:00] like I looked into like using like as, as as cinema. Um, and it just to get that kind of really. Smooth, rapid typing out of it, uh, without, you know, all the backspace and everything. I, it was, I found it difficult to program it to, to code it. And by the time I had it figured out, I figured I should just write my own script for it. Christina: Yeah. There’s, um, there, there’s a, a. Service called Remotion, which can do some of that sort of graphical work, which is what I thought you might’ve used at first. Um, charm has a thing called VHS, which is basically like a CLI home home recorder, which is pretty cool. Um, and I’ve used that before, but yeah, I was just kind of curious, um, what you did, but yeah, you just built your own. That’s awesome. Very cool. Release Plans And Review Christina: Um, now for your, your, when do you think like, because I, I noticed that you have like for for blog book and for terminal widget, you have like coming soon. Is that like, ’cause [00:35:00] you’re still kind of like working on stuff or, um, are you going through review hell with those as well? Brett: I haven’t even tried getting either of those reviewed. Um, blog book I is approved for test flight, um, and anyone who wants in on that can just contact me. It is getting the slowest development out of all my projects right now just because it is, it’s a more niche app that I don’t think is gonna make a ton of money. But, um, mark III is where most of my effort is going. Then I’m working on porting mark three’s, uh, store kit stuff into NV Ultra, and then I can focus on trying to usher terminal widget through app review. Um, I have a feeling that’s going to go very poorly and I may end up just releasing outside the app store, but because it has an iOS Christina: I was gonna say with the iOS component is the hard part. Brett: I kind of have to, so we’ll see what happens. Christina: Yeah. [00:36:00] ’cause I was gonna say, ’cause like, I mean I guess what you could do is if you did something for the iOS F would make it different though. Like if it’s just, ’cause I’m sure it has, it’s working out. It’s pretty much just remote instance that’s showing Brett: No, no, it’s got, it’s a, Christina: you, you built in your own terminal emulator into it. Brett: no, there’s no, no, no, no, no, no. There’s no terminal in this app at all. Like, you use it from whatever terminal or from shortcuts. Um, so it’s all native widgets on both. Christina: right. I was just saying in terms of the app store thing, like, I guess like if since there’s not a native terminal on, on iOS, it’s, I’m assuming that it’s, it’s a remote widget is what I was trying to get at. Brett: Essentially, yes. But if you write a shortcut on iOS that updates the widget, it updates both iOS and Mac os. So it is usable entirely. You could just buy it for iOS and, and it would be a functional app. Christina: okay. Okay. Universal Bundle Pricing Brett: But I do intend, I hope [00:37:00] to sell it as one universal bundle. So you pay like 9 99 and you get the iOS, the Mac, and the watch app without having to buy for every platform separately. Um, I just don’t see it being like such a valuable app that it’s worth making people go through that rigamarole. Christina: right. No, I was just trying to think. Brett: and everyone I’ve shown it to so far has been excited about it and the most common response I get is I will buy this as soon as I figure out what I would use it for. I’m like, yeah, okay. Jeff: Okay, fine. Awesome. AI Boosts Mark II Sales Jeff: And can you talk about how, because the whole world now works in markdown marked, has gotten a bump because I think that’s an amazing story. Brett: Well, yeah, it was. was a few months ago now, maybe six months. Um, my sales just started increasing and I was looking everywhere through all my traffic and all my logs [00:38:00] to figure out where this, where these people were coming from. Um, and it was eventually pointed out to me that if you ask any agent, any AI agent what you should use to view markdown, um, they would point you to Mark two. And it was now, for the last four months, five months, it’s been doing five times the sales year over year. What it was doing, Jeff: How close is it to the highest it ever was? Brett: um, the highest it ever was was actually when it was only 2 99. And Gruber wrote about it. Uh, back in this is like 2000. This was over a decade ago. And, um, back when, like one tweet from Gruber meant like success and that I made that year, I made almost a hundred thousand dollars on it.[00:39:00] Um, this is nowhere near that. This is doing like Jeff: But it’s a highly unexpected bump, right? Like in a delightful, delightful bump. Brett: yeah. It’s doing, it’s doing without even releasing Mark iii, I’m making about half of my former salary off of it. Jeff: Nice. I’m happy for you. Leaving Oracle Behind Brett: Also, uh, one year, um, in two days I’ll be one year out of Oracle and I quite happy about it. Jeff: that’s great. I was wondering about that, Brett: I don’t miss my corporate job. I miss, I miss some aspects, health insurance, paychecks, things like that. But Jeff: that aren’t at all about the content of the job, right? Brett: Well, like that stuff has never mattered all that much to me if I’m happy doing the work. And I really wasn’t happy doing the work. Christina: Well, that’s, that’s the thing. I’m glad that you’re, I’m glad things have been going well. I’m glad that, that the, the agents have, uh, been telling everybody about Mark two. Hopefully they will also tell them [00:40:00] about Mark three. Um. Ninety Hour Workweeks Brett: My, my dentist was doing was doing small talk with me, and he knows I’m a app developer and he asked me, so how many hours a week do you work? And I happen to know the answer because I had just read my timing app report for last week and I said, 90. And he said, oh wow. How much do you make? And he’s like, if you don’t mind me asking. So I told him and uh, it saying it out loud, it’s basically like 20 bucks an hour I get paid. And like, it’s not nothing, but once these apps are out and I can sit back and just make some passive income off of it, I will, I’ll be much Jeff: So it’s 90 because you’re, you’re developing multiple things right now and, and you love it. Brett: I’m pretty much, I’m pretty much on my machine all day except for like an hour for [00:41:00] like getting out, exercising, getting on my recumbent bicycle and an hour for eating. Um, Jeff: Is it time for you to get a trike? I’m serious. Brett: I don’t, I don’t know, I, I actually want to try just getting back on a regular bicycle. Jeff: Hmm. Brett: Um, but I, yeah, like a recumbent tricycle, that’d be pretty awesome. Jeff: dad uses him. He actually just converted one to an to an E-bike. Plus it’s hot now ’cause of DTF St. Louis. Christina: right. Jeff: Awesome. Uh, is that it for your app development because wow, that’s like, uh, quite a, quite a deal. You got anything else in the cooker? Brett: Well, like we talked about blog book. Right? Jeff: Yep. Brett: Okay. Yeah, that’s, that’s what I got. Jeff: Nice. Brett: that’s my big ones. NV Ultra Vaporware Woes Brett: NV Ultra is, um, literally only waiting on me to [00:42:00] get Mark three out and then NV Ultra will be out. And it is well passed a time when it would’ve been a smash hit. Um, when, when Nv, when NVL first started dying before, uh, before something like obsidian really Christina: I was gonna say, if sitting is unfortunately Brett: yeah, they obsidian and five or six other apps have really eaten up market share for, uh, NV Ultra. But it would be nice just to get it published. I have been talking about a replacement for NV for over a decade, and Jeff: Am I gonna get sued if I say this is not your fault. Brett: It’s, it’s not my fault, like none of them have been my fault. Like they’ve all fallen through on me. Um, but I think people don’t believe me anymore when I say it’s coming. In fact, it, in fact, if you ask an AI agent, they will tell you that MB Ultra is vaporware.[00:43:00] Christina: Well, Jeff: a lot ai. Christina: I mean, look at this point, even though yeah, it’s been in beta and you’ve had other things going on. I mean, like it, you know, again, it wasn’t your fault, but, but, but you know, we’ve all been in those situations where you’re like, it’s coming, it’s coming. Or this thing is like, at a certain point you’re like, okay. Like Brett: Yeah. Missing Collaborators Online Brett: Well that there was Bit Writer Christina: TechMate too. Brett: Bit Writer was one that preceded NV Ultra and I was working on that with David Halter, who was a co contributor on VT and. He disappeared. I don’t know if he died or what, but about years ago he just stopped replying to emails, disappeared off of Slack, disappeared from the internet. Just I, and I don’t ha I don’t know his next of kin. I don’t have anyone I can like ask, Hey, whatever happened to David. So if you’re out there, if you’re listening, I’d love to hear from you just to know you’re alive. Just to, just to [00:44:00] check in. Um, I’ve actually had a few people disappear over the last couple months that ha it’s been disconcert when, when you’re used to hearing from someone at least, you know, once a week even. But some of these people were like every day, um, I. Jeff: from them, meaning seeing them somewhere or corresponding or. Brett: Uh, online. These are, these are people I only know online. So like seeing them on Macedon or Facebook or getting emails or text messages from them. Um, a couple of them were in their eighties or nineties, and so it’s not, Jeff: That might be your problem. Brett: it, it’s not out of the realm of the possibility that they have passed on. Um, but some of them were younger than me and one of them has come back after two weeks of messaging, like every other day, like, Hey, are you okay? Haven’t heard from you. Um, finally they’re like, oh, yeah, I’m here. [00:45:00] And offered no explanation for where they’d been or why they went silent, but I didn’t pry either. So. Dan Peterson Secret App Jeff: What is your project with Dan Peterson? That’s on our, our list. Brett: I don’t know if I’m allowed to say a lot about it, but I’ve been working. Dan Peterson is one, the original designer of one password and worked with them for like 20 years before he struck out on his own. And we’ve teamed up, we’re working on a couple things, but one is a a, an IO iOS app that he has put in. I, I don’t even know how many hours into the design of it, like 3D modeling, spline rendering, and um, and then we ported it into an iOS interface. And it is gorgeous. It, it will it when, when it gets to market, which we’re hoping to have it in [00:46:00] testate in time for Max stock in July. Um, it’ll be the best looking app I’ve ever been a part of. It’s gonna be so cool. Jeff: Nice. Christina: That’s awesome. Jeff: Busy time. Brett: Yeah. Jeff: It’s Christina: That’s awesome. Jeff: What else do we got? I mean, Brett, you showed up with a big list. The Pit TV Complaints Christina: I was gonna, is anybody watching anything? Uh, good on TV or rewatching anything? Jeff: I have a serious complaint to put into the world, so I’ve avoided the pit for a long time. Uh, just ’cause I’m, I don’t, I’m not a huge like yeah, Brett: drama. Jeff: it is great. Except are there two separate writing teams for the stars and staff and the people that come in as patients? Because the writing for the people that come in patients is. Awful. They acting sometimes too. Sometimes there’s some people that sell it. I’m only through season one, uh, but I was like, I have been yelling at the tv, uh, about this [00:47:00] for some time. Um, besides also yelling at the TV for the point at which, um, our young friend with a w as a last name Whitaker, who, uh, gets blood all over his face and then they don’t actually immediately clean it up. Um, uh, so I yell at the screen and I like the show, but I yell. I haven’t had a TV show that I’m like, oh, for fuck’s sake now. I mean, I can handle that in The Walking Dead. I can handle that in that kind of movie. But in the ER thing I’m like, come on, you can’t get a writer to handle the patients. I don’t understand. You’ve got an incredible cast, like an incredible cast. Brett: It’s actually all ad-libbed. Jeff: all ad-libs, like the clown. There’s a clown, I won’t give it up, but there’s a, there’s a clown that has been through a mass event and he’s in the, uh, he’s in the ER with his clown makeup on still, and some blood going down his face and at some point he looks around and he goes, what a circus. I just think they, I think, I don’t understand. This confuses me very much [00:48:00] in TV shows when you’re like, okay, you’ve got a great writing team, but clearly you have a separate writing team that is doing just this little job that is actually quite important. So that’s my complaint about the pit. Otherwise, I like it quite a bit. I’m very excited to start season two, probably this weekend. Christina: it’s a good season. It’s a good season. So, yeah, ’cause, because, because I, I, I, um, it, it ended last week and I’m, I’m a big fan of the pit. I will say this, the pit fandom is insane and not in a good way. Like these are people who don’t understand how to watch television shows and don’t understand. Like how television shows work, and, and then also become very entitled about like, how, like their vision of the characters and things should be on a level. Like the last time I’ve seen it, it it’s the same, it’s similar with heated rivalry, but it’s somehow worse because this isn’t like a genre show like that. It’s like low quality for like, you know, middle aged like white women, um, in the suburbs. Um, who, who just like to see two, two hockey players. [00:49:00] You know? Fuck. Um, like, like the pit is actually like, I’m not gonna call it Prestige TV because it’s not er level, but it’s a very good show and it’s extremely well acted. And I think the writing, um, I, I think make a good point about the, uh, the patients not getting as good of storylines as the doctors. But, um, Jeff: no. I don’t need storylines. I Christina: no, I I mean the Jeff: words they Christina: Yeah. Yeah. No, that, that’s, that, that, that that’s what I mean, like, like that, that, that, that I, I, I hear, I hear your Jeff: Because where there’s a patient storyline, those are almost exclusively great. Christina: Yeah, it, so you’re more talking about like, like, like the kind of the background characters, like, kind of like the, the, the one-offs. Yeah, I think, I think that’s fair. Well, a lot of the writing staff and like executive producers are doctors or people who have like, you know, worked, um, extensively in healthcare. And so I, I, I wonder if like, that’s kind of part of it, um, where Brett: they’re really good at writing the doctor’s parts. They’re not so good at Jeff: so good. Oh my God, so Christina: so good at doing the doctor’s parts and, and the procedures. Like they wanna be medically [00:50:00] accurate and like they really, they really are committed to that. There are, um, there are a couple of, I’m trying to think, um, the, the Whitaker thing, I think that was just, I enjoyed that myself. Like the fact that he’s always getting blood Jeff: Oh, I loved the bit, I just couldn’t believe that. I couldn’t believe that through quite, you know, a couple of different bits after that. The blood’s still on his face. I’m like, there has to be a protocol to get blood off your face. Christina: No, there definitely has to be, but I mean, part also one of the running gags first season two. And, and sorry for spoilers, for anyone who hasn’t watched the pit Jeff: Wait, I’m gonna close my ears. Okay. Go ahead. Wave when you’re done. Christina: Rob Robbie can’t pee. And, uh, this wasn’t a real spoiler, but like, but one of the things is like, you know, Robbie’s never able to like, go to the bathroom. Like he can never find a way to pee. So Jeff: I’m back. Brett: you’re safe now. Jeff: I’m back. Christina: you, you’re safe. And I didn’t spoil anything. I was ER Nostalgia and Cast Jeff: The other thing I’ll say about the pit that surprised I did not watch ER and not ’cause out of bad attitude. Uh, it was just a point in my life when I wasn’t watching a lot of tv. Um, I also didn’t realize until I was [00:51:00] like five episodes in that Noah Wiley was a big character in er. I think that’s really cool. Um, Christina: Okay. Okay. I, I understand you weren’t watching TV then, but how did you not realize that Noah Wiley was Jeff: I didn’t know Noah Wiley’s name. Like I, this is just not, I don’t hold names of people. I, you know, I also, on the albums, I love that. I don’t remember song, I don’t know song titles half the time. Um, so I don’t mind You can, you can be very disappointed and express it. And I will accept it. I will receive it. Christina: No, I’m just shocked Jeff: to be better. Christina: because I, I mean, ’cause because I was like 10 years old when ER came out and like, I don’t know, like they were like, that was the number one show on television Jeff: Totally. And I mean, Clooney, come on. I know Clooney. Christina: course Clooney, but, but like, but it was Clooney. It was, but but like the, the, the, the, the original, it was Clooney, it was uh, uh, Sherry Stringfeld, it was um, um, uh, Eric Lesal. It was Juliana Margolis, it was Noah Wiley, and it was Anthony Edwards. So like, Jeff: Oh, my favorite Timber Christina: and I was gonna say ironically going into when er came out, like the, the name was Anthony [00:52:00] Edwards, like, he was like number one on the call sheet, right? Like Clooney I think was like four. Um, and, and then, and then Clooney because he’s a good guy, like blew the fuck up and then still did them a solid and did like a full freaking five years on that show, Jeff: Yeah, which is awesome. Christina: he did not, David, David Caruso, it like David Caruso, who famously like had one, you know, big season of NYPD Blue fucks off to go do a movie career. The movie career implodes, there’s a clause in his contract because A, b, C was so furious about how the way he quit NYPD Blue, that they were like, okay, well you can’t do any television for x number of years. And then his movie career dies and then he has to like come like hat in hand to like CSI Miami. Jeff: Yeah. Yeah. Well I love the pit and this thing that surprised me is the thing I always stayed away from is like I can handle gore in almost every context except real life. And so like I can do all the gore of the Walking Dead. I can do all the gore of Game of Thrones or something, but like, I was like, I don’t know if I want, [00:53:00] yeah. Gore. I love it. I mean, I love it. ’cause I’m fascinated. I’m just fascinated. I’m like, oh, that’s what it looks like when you do that. Like, right. Like you just snip the fingertip off. That’s what it looks like when you do that. Like, Christina: no, Jeff: the first Christina: they show some of the stuff, Jeff: yeah, the first half. I did this every time I covered my face whenever it was like that. And then all of a sudden I could handle it. And I was like, this is fascinating. This is totally Christina: What episode are you, are you up to? How many do you Jeff: I actually, I only have 15 left. I have the last episode left. Um, and unfortunately, like we’ve had, like my brother’s, not unfortunately, my brother’s been, we had stuff every night until late for like three or four days. And I’m so ready to watch that thing. And now, now my wife’s going outta town, so I’m not sure we’ll even see it for another week. It’s making me crazy. Brett: are you watching it together? And you have to wait for her. Jeff: Yeah. Well, and we, and, and sometimes it’s easy for us to find a show together and sometimes there’s just a long dry spell. And so it’s also just like nice. It’s just nice to have a show together always. Um, and so it’s the combination of like, that’s just nice to do and I’m right at the end and I’m just ready to Christina: And you just wanna do that together? [00:54:00] Yeah, no, it makes sense. Season Two and Other Shows Christina: Um, I, I’m, I’m curious to see what you’ll think of season two. Um, I, I, um, it’s, it’s different in some ways. It doesn’t have like the, the, I’m not spoiling anything, but like, it doesn’t have like a big like, catalyzing event, like, like season one does. Um, but I still think it’s, it’s really good TV and, uh, yeah, definitely one of my favorite shows, um, hacks is Back for its final season. That’s definitely one of my favorite Brett: That Jeff: I never Brett: good. I, I finished season one. Um, I think there’s three seasons or is there more? Christina: This, it is now in its fifth season. Yeah. Brett: Okay. Yeah. I, I finished season one and then kind of forgot about it, and then I just saw some trailers for the new season and thought, oh, I should get back into this. It looks, it looks like it, it, it looks like it did well, um, Christina: No, I mean, shrinking. Yeah. Brett: I was gonna say, the new season of shrinking is really good too. Christina: Yeah, it is. Yeah. Um, well, well, uh, bill Lawrence is, is, uh, who created that and he created Scrubs and Spin City and [00:55:00] some other things. Like he’s, he’s really, really, um, good. He also did Rooster, which is now on HBO Max. Um, but, oh, the Scrubs Revival. Speaking of, of new shows, I don’t know if it’s gonna get like renewed because it hasn’t been renewed yet. And so I’m a little bit concerned that it hasn’t been renewed yet, and I only did nine episodes for the first season. But the, the Scrubs reboot, revival, whatever you wanna call it, and I say this is somebody who was a huge scrub fan. I, I don’t consider the, the final season to be scrubs like that. It is not part of Canon to me. Like, I feel like that, that, that wasn’t it, but I thought they actually did an amazing job, um, with the, with the reboot. Like I actually. And, and it was hard for them too because John c McGinley is on Rooster and, um, uh, Judy Reyes is on, um, uh, high Potential. And, um, so, you know, the only like, you know, main characters from the original that they have back in every single episode [00:56:00] are, um, uh, Elliot, JD and Turk. Um, but, uh, and then, and then you see, you know, kind of like, like Carla just isn’t in the office sometimes, but she has some guest appearances. Um, but they actually managed to, to do this, they managed to do like a next generation type of story, but still focused on like the main characters you love, but still kind of bring in like new younger doctors in like a way that I’m genuinely really impressed with how they did it. And, and like it kept the heart and kind of the, the feel of the original, like I, it, it was, I was very, very impressed that they were able to recapture. What made that show so good, um, for, its, I guess they’re calling it its 10th season, but, um, I, I really hope that it comes back because that’s a really good show. Brett: Speaking of reboots, um, they’re rebooting, um, Malcolm in the middle, Jeff: I Christina: Yes, they did. [00:57:00] Yeah. They did a four episode thing. Brett: but what I saw an, I saw Hot ones versus with, um, uh, Frankie Muni and whatever. How Christina: Yeah. Brian Cranston. Who, Brian Cranston. Who, who was, who was the, the father of, of, of Mel King on the pit. Brett: Oh, there you go. Jeff: is so cool. I love her so much. Brett: but anyway, they’re talking about why Dewey wouldn’t come back and basically he was like, I haven’t acted since I was nine. He’s like, he is busy. He is got a life Christina: He’s in grad school, like he went to Harvard and stuff like, like, he’s like, uh, I, which I, I love. And I’m like, okay. You know, I mean, I would’ve loved to see Joey too, but I don’t blame him for being like, no. Brett: Yeah. Jeff: Yeah. Yeah. Brett: neither, neither did the other actors, I don’t think. I think, uh, it, it wasn’t necessary to Christina: no, I was gonna say he wasn’t because Brett: the Yeah, Christina: mean, look, they were able to do Fuller House without the Olson [00:58:00] twins who were a much bigger part of that show Jeff: Fuller Christina: ever was. And, and I, I, I’m not even like defending Fuller house. Like it was, it was fine. It was whatever. But like, even that, you were like, there were enough characters where you’re like, okay, so, so Michelle isn’t here. And that would’ve been weird, to be honest. I don’t think that, like I know that everybody would’ve loved having the cameo, but it’s like, how in the hell are you gonna have the Olson twins, like as adults, even in a cameo on Fuller House without just completely taking you out of the whole thing. You know what I mean? Brett: Yeah. Christina: Like, it just, it just wouldn’t be possible. But Gratitude App Picks Brett: we try to fit in a gude before Jeff: Should we grab, Christina: yeah. Let’s do a gratitude. Brett: Um, I can kick it off. I got one I’m excited about. Um, found this app called Bezel. Um, I needed to do iOS screenshots and I needed to do iOS recordings, and I played around with using Screen flow and screen Studio and Camtasia, and I didn’t like [00:59:00] any of the ways that they recorded iOS movies. And then I found Bezel and I mean, c So screen recording built into iOS, in my opinion, is better than any of the like screen casting apps can do. Um, but bezel, if you, if you hard co hardwire your phone to your computer and turn on screen, mirroring it can record. Perfect. Um. iOS recordings, and it’s really good at just taking screenshots with a single key key command. You get a screenshot with a bezel like the outline of the phone and a desktop background behind it. So I can just hit command S as I like, move through my phone, uh, and then my right hand on my phone, my left hand on my keyboard, and I can get a dozen iOS screenshots in five minutes, and they’re ready to go, like ready to [01:00:00] publish. It’s really nice. Jeff: That’s really awesome. I’m gonna try that. Christina: Same, same. Do you have one Brett, or do you want me to, or uh, Jeff do or do you want me to go. AI Tools and Claude Code Jeff: Uh, I’m happy to go. Um, so this is, this is, uh, an easy one in a way, but I, I wanna be specific about what’s been so useful. So I’ve been using cloud code and vs code forever. I mean for the last, I’d say two or three months. ’cause I’ve got really, really deep into using cloud code actually for qualitative work. Um, but also a totally bananas project I built that has both a. Physical component and a heavy duty code component, which I’ll talk about sometime. Um, but, um, I, and I’ve used the desktop app for cowork and for like just the standard chat and I’ve loved that, but I never used it for cloud code until this latest update, which added like a really amazing interface for cloud code. Um, which is kind of my gratitude is that tab of the desktop app, which like, when you open it up, it gives you like just an awesome little like, work summary of like comedy sessions [01:01:00] you’ve had, how many total tokens you’ve used, like overall the last 30 days, the last seven days, what your peak hour is your longest streak. It has the like GitHub, like little chart that fills in. Um, and, uh, and, and that’s like been really cool to see. Um, and you can also see your usage of various models. It’s just a nice little thing that pops up. And then when you’re actually working, it’s really amazing because you can pull up these sidebars that have like diffs or like a preview or you can just get a terminal open in there. Um, and I have. I have loved that. I still like feel more at home in the VS.

In response to increasing surgeon burnout, unsustainable clinical demands, and ongoing loss of surgeon autonomy in the setting of employee-based models, the American College of Surgeons is speaking out. In this episode, hosts Dr. Steven Thornton and Dr. Emma Burke sit down with Dr. Douglas Wood, Chair of Surgery at the University of Washington and Dr. Thomas Varghese, Editor-in-Chief of the Journal of the American College of Surgeons, to discuss the new ACS Workplace Standards Framework. The conversation covers how this initiative grew out of discussions around unionization, what domains the framework addresses — from call intensity and OR block access to administrative burden and inpatient census limits — and how specialty-specific guidelines can be developed and implemented at the local level. Dr. Wood and Dr. Varghese also reflect on the culture of "unlimited endurance" that has long defined surgery, why meaningful systems-level change is both necessary and achievable, and how improving workplace sustainability could transform the pipeline of future surgeons for generations to come.Hosts: Emma Burke and Steven ThorntonGuests: Dr. Douglas Wood & Dr. Thomas Varghese Jr.Papers Discussed:1. Wood DE, Wolinsky PR, Dodgion CM, et al. Developing Specialty-Specific Workplace Standards for Surgeons: A Framework to Support Sustainable Surgical Careers. Journal of the American College of Surgeons, 2026. DOI: 10.1097/XCS.0000000000001880 https://pubmed.ncbi.nlm.nih.gov/41773743/2. Varghese TK Jr. Toward Sustainable Surgical Practice: Defining Workplace Standards for the Modern Era. J Am Coll Surg. 2026 Mar 3. doi: 10.1097/XCS.0000000000001888. Epub ahead of print. PMID: 41773737. https://pubmed.ncbi.nlm.nih.gov/41773737/***Fellowship Application Link: https://forms.gle/QSUrR2GWHDZ1MmWC6Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listenBehind the Knife Premium:General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-reviewOral Board Simulator: https://app.behindtheknife.org/oral-board-simulatorTrauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlasDominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkshipDominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotationVascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-audio-reviewColorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-audio-reviewSurgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-audio-reviewCardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-audio-reviewDownload our App:Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

“GOOD VIBRATIONS”: Its not just a Marky Mark song, but it is also part of GYNECOLOGIC SEXUAL HEALTH! In this episode, we will highlight an April 2026 new qualitative study on women's vibrator use, as well as a separate publication (on a similar topic) also released in April 2026 in the journal Menopause.1. Leong KA, Carlton CE, Deverdis EC, Grimes CL, Jacobs BE, Rogers RG, Roberts BL. Intimacy and empowerment in urogynecology: a qualitative exploration of vibrator use. Am J Obstet Gynecol. 2026 Apr;234(4):1103-1111. doi: 10.1016/j.ajog.2025.11.037. Epub 2025 Dec 2. PMID: 41344528.2. Lehmiller JJ, Graham CA, Ferrall L, Mendelson EA, Prine MS. The role of masturbation in relieving symptoms associated with menopause. Menopause. 2026 Apr 1;33(4):384-394. doi: 10.1097/GME.0000000000002675. PMID: 41217890; PMCID: PMC13011940.

Contributor: Aaron Lessen, MD Educational Pearls: What are the common causes of agitation in the elderly? Baseline dementia causing a behavioral disturbance Delirium precipitated by an acute medical problem such as a UTI, pneumonia, overdose/side effect of home medications, urinary retention, constipation, pain, hypoxia, electrolyte abnormality, etc. Exacerbation of a primary psychotic condition such as schizophrenia or bipolar disorder. What environmental changes can help reduce agitation? Maintain a quiet, calm, uncluttered environment Dim the lights Ensure the patient has their glasses, hearing aids, and dentures Avoid excessive lines such as foleys Minimize restraints and other forms of immobilization Reassure the patient frequently and have the family check in with the patient What are the best options if medications are required? If the patient is unsafe or non-pharmacologic measures fail, consider a second-generation ("atypical") antipsychotic using the lowest effective dose: Olanzapine Risperidone Quetiapine One special consideration is Dementia with Lewy Bodies, which can be very sensitive to antipsychotics. In this case, Quetiapine is the preferred agent. Avoid when possible: Diphenhydramine and other anticholinergics, which can worsen delirium (including urinary retention and sedation) Benzodiazepines, which may worsen confusion, falls, and respiratory depression Haloperidol, which has a higher risk of extrapyramidal symptoms and QT prolongation than many atypicals References Badwal K, Kiliaki SA, Dugani SB, Pagali SR. Psychosis Management in Lewy Body Dementia: A Comprehensive Clinical Approach. J Geriatr Psychiatry Neurol. 2022 May;35(3):255-261. doi: 10.1177/0891988720988916. Epub 2021 Jan 19. PMID: 33461372. Kurlan R, Cummings J, Raman R, Thal L; Alzheimer's Disease Cooperative Study Group. Quetiapine for agitation or psychosis in patients with dementia and parkinsonism. Neurology. 2007 Apr 24;68(17):1356-63. doi: 10.1212/01.wnl.0000260060.60870.89. PMID: 17452579. Shenvi C, Kennedy M, Austin CA, Wilson MP, Gerardi M, Schneider S. Managing Delirium and Agitation in the Older Emergency Department Patient: The ADEPT Tool. Ann Emerg Med. 2020 Feb;75(2):136-145. doi: 10.1016/j.annemergmed.2019.07.023. Epub 2019 Sep 26. PMID: 31563402; PMCID: PMC7945005. Summarized and edited by Jeffrey Olson, MS4 Donate: https://emergencymedicalminute.org/donate/ Join our mailing list: http://eepurl.com/c9ouHf

Continuamos con el segundo libro de la autora Lindy Ryan, titulado Another Fine Mess, una novela con giros inesperados entre los personajes principales. Any disfrutó mucho esta lectura, principalmente por la forma en que la autora logra sumergirte en la historia.En esta entrega, Lenore y Luna deberán descubrir qué está sucediendo en el pueblo tras una serie de muertes de animales ocurridas de forma totalmente salvaje. Aunque el sheriff y su ayudante sospechan de un asesino serial, las cosas no son lo que parecen. El pasado persigue a las Evans y el tiempo es primordial.Si te interesa esta novela, toma en cuenta que solo está disponible en inglés. Aquí abajo encontrarás el enlace para más información.Another fine mess - Lindy RyanSíguenos en nuestras redes sociales

Marijuana can feel like a miracle fix for ADHD, quieting the noise and taking the edge off. But this short-term relief comes with trade-offs. In this episode, Dr. J breaks down why ADHD brains are drawn to weed, what the research actually says about the long-term consequences, and healthier alternatives. If you've ever wondered whether you're self-medicating, this one's worth your attention. For more on this topic Watch: ADHD and: self-medicating Listen: ADHD and shopping addiction For a transcript and more resources, visit MissUnderstood on Understood.org. You can also email us at podcast@understood.org. Sources: Froude, A. M., Fawcett, E. J., Coles, A., Drakes, D. H., Harris, N., & Soko, J. M. (2024). The prevalence of cannabis use disorder in attention-deficit hyperactivity disorder: A clinical epidemiological meta-analysis. Journal of Psychiatric Research, 171, 48-55. Ryan, J. E., Herens, A., Fruchtman, M., Veliz, P., Kelly, E. L., & Worster, B. (2026). Cannabis use in a community-based sample of adults diagnosed with ADHD: Prevalence, impact on symptoms, and stimulant side effects. Journal of Attention Disorders, 30(3), 407-422. Kaul M, Zee PC, Sahni AS. Effects of Cannabinoids on Sleep and their Therapeutic Potential for Sleep Disorders. Neurotherapeutics. 2021 Jan;18(1):217-227. doi: 10.1007/s13311-021-01013-w. Epub 2021 Feb 12. PMID: 33580483; PMCID: PMC8116407. Suraev, A., McGregor, I. S., Marshall, N. S., et al. (2025). Acute effects of oral cannabinoids on sleep and high-density EEG in insomnia: A pilot randomized controlled trial. Journal of Sleep Research, 34(4), e70124. Chang, Z., Lichtenstein, P., Halldner, L., D'Onofrio, B., Serlachius, E., Fazel, S., ... & Larsson, H. (2014). Stimulant ADHD medication and risk for substance abuse. Journal of Child Psychology and Psychiatry, 55(8), 878-885. Quinn, P. D., Chang, Z., Hur, K., Gibbons, R. D., Lahey, B. B., Rickert, M. E., ... & D'Onofrio, B. M. (2017). ADHD medication and substance-related problems. American Journal of Psychiatry, 174(9), 877-885. Listen to Everyone Gets a Juice Box, a new podcast from Understood.org where host Jessica Shaw has honest talks with parents raising kids who learn and think differently.Understood.org is a nonprofit organization dedicated to empowering people with learning and thinking differences, like ADHD and dyslexia. If you want to help us continue this work, donate at understood.org/give Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

Yes we have covered antenatal corticosteroids in the late preterm interval on several episodes in the past- it's DEJA VU! However, there is new data in the American Journal of Perinatology (April 2026 ) that is helpful for us as clinicians as we do “shared decision making” with patients in offering betamethasone in the late preterm interval. Listen in for details.1. Zigron R, Rotem R, Erlichman I, Rottenstreich M, Rosenbloom JI, Porat S, Rottenstreich A. Factors associated with the development of neonatal hypoglycemia after antenatal corticosteroid administration: It's all about timing. Int J Gynaecol Obstet. 2022 Aug;158(2):385-389. doi: 10.1002/ijgo.13975. Epub 2021 Oct 30. PMID: 34625970.2. Asirwatham A, Loke R, Rose S, Ho J, Leung K, Leftwich HK. Neonatal Hypoglycemia after Antenatal Late Preterm Steroids. Am J Perinatol. 2026 Apr;43(5):616-620. doi: 10.1055/a-2663-5798. Epub 2025 Aug 4. PMID: 40759170.3. ALPS Trial. NEJM. Published April 7, 2016;374:1311-1320

A career in surgery has a profound impact on those who practice the craft. High rates of poor mental health are well described but incompletely understood. One potential mechanism for advancing our understanding of surgeon well-being is studying surgeons' emotional experiences. Shame, a self-conscious emotion reflecting how an individual feels about themselves, could be a particularly powerful lens. In this series on shame in surgery, we explore what we know about shame in surgery and what shame can tell us about learning and working as surgeons.In this third episode, we talk with Drs. Sheina Theodore and Tejal Brahmbhatt about their study examining the relationship between internalized shame states and burnout among surgery residents. They make a compelling case that addressing the well-being crisis in surgery requires looking beyond external stressors to the internal experience of shame: the quiet, invisible voice that tells residents they aren't good enough, and ask what role the culture of surgery plays in that internal monologue. Host: Steven ThorntonGuests:1.    Sheina Theodore (Assistant Professor of Surgery, Boston University)2.    Tejal Brahmbhatt (Associate Professor of Surgery, Cedars Sinai Medical Center) Publications Discussed:1.    Smith SM, Kobzeva-Herzog A, McGillen P, Castagne-Charlotin M, Davies J, Sanchez SE, Dechert T, Brahmbhatt TS, Theodore S. Internalized Shame Experiences and Burnout in General Surgery Residents. J Surg Educ. 2025 Apr;82(4):103447. doi: 10.1016/j.jsurg.2025.103447. Epub 2025 Feb 6. PMID: 39919584. https://pubmed.ncbi.nlm.nih.gov/39919584/***Fellowship Application Link: https://forms.gle/QSUrR2GWHDZ1MmWC6Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listenBehind the Knife Premium:General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-reviewOral Board Simulator: https://app.behindtheknife.org/oral-board-simulatorTrauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlasDominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkshipDominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotationVascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-audio-reviewColorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-audio-reviewSurgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-audio-reviewCardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-audio-reviewDownload our App:Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

A career in surgery has a profound impact on those who practice the craft. High rates of poor mental health are well described but incompletely understood. One potential mechanism for advancing our understanding of surgeon well-being is studying surgeons' emotional experiences. Shame, a self-conscious emotion reflecting how an individual feels about themselves, could be a particularly powerful lens. In this series on shame in surgery, we explore what we know about shame in surgery and what shame can tell us about learning and working as surgeons. In this second episode, we talk with Dr. ElAbd and Dr. Zammit about their study examining the relationship between shame-based learning, grit, and burnout across surgical specialties. Their findings highlight how grit may both protect against burnout and mediate whether residents go on to shame others. Host: Steven ThorntonGuests:1.    Rawan ElAbd (Plastic Surgery Resident, McGill University)2.    Dino Zammit (Assistant Professor of Plastic Surgery, McGill University)Publications Discussed:1.    ElAbd R, Pu L, Esmonde-White C, ElHawary H, Vorstenbosch J, Zammit D. Association of Grit and Shame Based Learning on Burnout in Surgical Training: A Single Institution Analysis. J Surg Educ. 2025 Sep;82(9):103583. doi: 10.1016/j.jsurg.2025.103583. Epub 2025 Jun 27. PMID: 40580606.https://pubmed.ncbi.nlm.nih.gov/40580606/***Fellowship Application Link: https://forms.gle/QSUrR2GWHDZ1MmWC6Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listenBehind the Knife Premium:General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-reviewOral Board Simulator: https://app.behindtheknife.org/oral-board-simulatorTrauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlasDominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkshipDominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotationVascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-audio-reviewColorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-audio-reviewSurgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-audio-reviewCardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-audio-reviewDownload our App:Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

A career in surgery has a profound impact on those who practice the craft. High rates of poor mental health are well described but incompletely understood. One potential mechanism for advancing our understanding of surgeon well-being is studying surgeons' emotional experiences. Shame, a self-conscious emotion reflecting how an individual feels about themselves, could be a particularly powerful lens. In this series on shame in surgery, we explore what we know about shame in surgery and what shame can tell us about learning and working as surgeons.In this first episode, we talk with Dr. Will Bynum and Professor Luna Dolezal about how they understand shame in medicine, why it's so hard to see even when it's everywhere, and how developing what they call "shame competence" might be one of the most important steps we can take toward humanizing surgical training.Host: Steven ThorntonGuests: Will Bynum (Associate Professor of Family Medicine, Duke University) Luna Dolezal (Professor of Philosphy and Medical Humanities, Exeter University) Publications Discussed: Dolezal L, Bynum W. Shame competence: addressing the effects of shame in health care. Lancet. 2024 Oct 19;404(10462):1514-1515. doi: 10.1016/S0140-6736(24)02269-4. PMID: 39426826. https://pubmed.ncbi.nlm.nih.gov/39426826/ The Nocturnists. Shame in Medicine: The Lost Forest [podcast series]. The Nocturnists; 2022. https://thenocturnists.org/shameinmedicine Nguyen LN, Bynum WE 4th. When I Say…self-conscious emotions. Med Educ. 2021 Mar;55(3):291-292. doi: 10.1111/medu.14425. Epub 2020 Dec 23. PMID: 33289140. https://pubmed.ncbi.nlm.nih.gov/33289140/ Tracy, J. L., Robins, R. W., & Tangney, J. P. (Eds.). (2007). The self-conscious emotions: Theory and research. The Guilford Press. ***Fellowship Application Link: https://forms.gle/QSUrR2GWHDZ1MmWC6Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listenBehind the Knife Premium:General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-reviewOral Board Simulator: https://app.behindtheknife.org/oral-board-simulatorTrauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlasDominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkshipDominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotationVascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-audio-reviewColorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-audio-reviewSurgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-audio-reviewCardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-audio-reviewDownload our App:Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

Iron-deficiency anemia during pregnancy is associated withseveral adverse pregnancy outcomes, including severe maternal morbidity, preeclampsia, placenta previa, and placental abruption. It makes sense that diagnosing and treating anemia and its underlying causes in earlypregnancy may reduce the risk of adverse outcomes, but evidence has been scarce…until now. In this episode, we will review a new retrospective study based on nationwide data that examines this very issue (Green journal, April 2026).Listen for details. 1.  Booman A, Bateman BT, Siadat S, Berube C, Igbinosa I, Leggett C, Lyell DJ, Main EK, Leonard SA. Pregnancy Outcomes Associated With Anemia in the First Trimesterand Anemia Resolution by Late Pregnancy. Obstet Gynecol. 2026 Apr 1;147(4):518-527. doi: 10.1097/AOG.0000000000006183. Epub 2026 Feb 6. PMID:41643193; PMCID: PMC12880618.2.  ACOG OCC 5: Severe Maternal Morbidity: Screening and Review; 2016 and reaffirmed 20253.  ACOG PB 233

Contributor: Aaron Lessen, MD Educational Pearls: Patients with pulmonary embolism (PE) are divided into three risk categories Low risk (non-massive PE): patients are stable Treatment: prescribe anticoagulants and discharge home Intermediate risk (submassive PE): patients are stable but display evidence of clot burden such as elevated troponin, elevated BNP, and/or right heart strain Treatment is controversial High risk (massive PE): patients are unstable with hypotension, hypoxia, and/or respiratory distress Treatment: IV thrombolysis to prevent decompensation A recent randomized controlled trial evaluated treatment of intermediate risk PE patients Patients were randomized to receive either thrombectomy with anticoagulation or anticoagulation alone The primary outcome evaluated changes in right ventricular enlargement at 48 hours A controversial primary outcome because it does not speak to mortality or incidence of other necessary aggressive interventions Low clinical significance The study found that thrombectomy significantly reduced right ventricular enlargement faster than anticoagulation alone. However, there was no statistical difference in mortality or need for other treatments Treatment for intermediate risk PE patient remains controversial The same study will have second follow-up at 90 days to see if there are other benefits References Lookstein RA, Konstantinides SV, Weinberg I, Dohad SY, Rosol Z, Kopeć G, Moriarty JM, Parikh SA, Holden A, Channick RN, McDonald B, Nagarsheth KH, Yamada K, Rosovsky RP; STORM-PE Trial Investigators. Randomized Controlled Trial of Mechanical Thrombectomy With Anticoagulation Versus Anticoagulation Alone for Acute Intermediate-High Risk Pulmonary Embolism: Primary Outcomes From the STORM-PE Trial. Circulation. 2026 Jan 6;153(1):21-34. doi: 10.1161/CIRCULATIONAHA.125.077232. Epub 2025 Nov 3. PMID: 41183181. Summarized by Meg Joyce, MS2 | Edited by Meg Joyce & Jorge Chalit, OMS4 Donate: https://emergencymedicalminute.org/donate/

Dr. Merritt Tuttle is both a Pediatric Intensivist and Medical Toxicologist at Brenner Children's Hospital in North Carolina associated with Atrium Health and Wake Forest Baptist Health. She completed her Pediatric Critical Care and Medical Toxicology training at the Medical College of Wisconsin.Learning Objective: By the end of this podcast, listeners should be able to discuss an evidence based and expert guided approach to the evaluation and management of the critically ill child with calcium channel blocker toxicity.References:St-Onge M, Anseeuw K, Cantrell FL et al, Experts Consensus Recommendations for the Management of Calcium Channel Blocker Poisoning in Adults. Crit Care Med. 2017 Mar;45(3):e306-e315.2023 American Heart Association Focused Update on the Management of Patients With Cardiac Arrest or Life-Threatening Toxicity Due to Poisoning: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular CareLevine M, Curry SC, Padilla-Jones A, Ruha AM. Critical care management of verapamil and diltiazem overdose with a focus on vasopressors: a 25-year experience at a single center. Ann Emerg Med. 2013 Sep;62(3):252-8. doi: 10.1016/j.annemergmed.2013.03.018. Cole JB, Arens AM, Laes JR, Klein LR, Bangh SA, Olives TD. High dose insulin for beta-blocker and calcium channel-blocker poisoning. Am J Emerg Med. 2018 Oct;36(10):1817-1824. doi: 10.1016/j.ajem.2018.02.004. Epub 2018 Feb 6.Slamowitz A, Sweberg T, Labgold K, Nickerson T. Extracorporeal Membrane Oxygenation for Calcium Channel Blocker Intoxication: A Multicenter Retrospective Registry Review. ASAIO J. 2025 Oct 31. Poison Control: (800) 222-1222Questions, comments or feedback? Please send us a message at this link (leave email address if you would like us to relpy) Thanks! -Alice & ZacSupport the showHow to support PedsCrit:Please complete our Listener Feedback SurveyPlease rate and review on Spotify and Apple Podcasts!Donations are appreciated @PedsCrit on Venmo , you can also support us by becoming a patron on Patreon. 100% of funds go to supporting the show.Please remember that all content during this episode is intended for educational and entertainment purposes only. It should not be used as medical advice. The views expressed during this episode by hosts and our guests are their own and do not reflect the official position of their institutions. If you have any comments, suggestions, or feedback-you can email us at pedscritpodcast@gmail.com.  You can also check out our website at http://www.pedscrit.com. Thank you for listening to this episode of PedsCrit!

Join Dr. Jeff Jarvis as he interviews podcase friend and frequent contributor, now-Dr Tanner Smida for the first of a two-part interview where we discuss his defense of his PhD. Dr Smida discusses four papers that inform cardiac arrest resuscitation, as well as lessons he learned about conducting well-designed observational studies. Although his dissertation was built around only 4 papers, here is Dr Smida's entire bibliography:1.        Smida T, Willson C, Salerno J, Weiss L, Salcido DD. Can you get there from here? An analysis of walkability among PulsePoint CPR alert dispatches. Resuscitation. 2020 Mar 1;148:135-139. doi: 10.1016/j.resuscitation.2019.12.038. Epub 2020 Jan 18. PMID: 31962177.2.        Patterson PD, Weiss LS, Weaver MD, Salcido DD, Opitz SE, Okerman TS, Smida TT, Martin SE, Guyette FX, Martin-Gill C, Callaway CW. Napping on the night shift and its impact on blood pressure and heart rate variability among emergency medical services workers: study protocol for a randomized crossover trial. Trials. 2021 Mar 16;22(1):212. doi: 10.1186/s13063-021-05161-4. PMID: 33726840; PMCID: PMC7962082.3.        Smida T, Koller AC, Menegazzi JJ, Salcido DD. Early cytotoxic lymphocyte localization to the brain following resuscitation in a porcine model of asphyxial cardiac arrest: A pilot study. Resusc Plus. 2021 Apr 28;6:100125. doi: 10.1016/j.resplu.2021.100125. PMID: 34223383; PMCID: PMC8244478.4.        Smida T, Salerno J, Weiss L, Martin-Gill C, Salcido DD. PulsePoint dispatch associated patient characteristics and prehospital outcomes in a mid-sized metropolitan area. Resuscitation. 2022 Jan;170:36-43. doi: 10.1016/j.resuscitation.2021.11.007. Epub 2021 Nov 11. PMID: 34774964.5.        Smida T, Menegazzi JJ, Crowe RP, Weiss LS, Salcido DD. Association of prehospital hypotension depth and dose with survival following out-of-hospital cardiac arrest. Resuscitation. 2022 Sep 30;180:99-107. doi: 10.1016/j.resuscitation.2022.09.018. Epub ahead of print. PMID: 36191809.6.        Smida T, Menegazzi JJ, Crowe RP, Bardes J, Scheidler JF, Salcido DD. Association of prehospital post-resuscitation peripheral oxygen saturation with survival following out-of-hospital cardiac arrest. Resuscitation. 2022 Dec;181:28-36. doi: 10.1016/j.resuscitation.2022.10.011. Epub 2022 Oct 19. PMID: 36272616.7.        Smida T, Menegazzi J, Crowe R, Scheidler J, Salcido D, Bardes J. A Retrospective Nationwide Comparison of the iGel and King Laryngeal Tube Supraglottic Airways for Out-of-Hospital Cardiac Arrest Resuscitation. Prehosp Emerg Care. 2023 Feb 13:1-7. doi: 10.1080/10903127.2023.2169422. Epub ahead of print. PMID: 36652451.8.        Smida T, Menegazzi J, Scheidler J, Martin PS, Salcido D, Bardes J; CARES Surveillance Group. A retrospective comparison of the King Laryngeal Tube and iGel supraglottic airway devices: A study for the CARES surveillance group. Resuscitation. 2023 Apr 28:109812. doi: 10.1016/j.resuscitation.2023.109812. Epub ahead of print. PMID: 37120129.9.        Smida T, Price BS, Scheidler J, Crowe R, Wilson A, Bardes J. Stay and play or load and go? The association of on-scene advanced life support interventions with return of spontaneous circulation following traumatic cardiac arrest. Eur J Trauma Emerg Surg. 2023 May 10. doi: 10.1007/s00068-023-02279-9. Epub ahead of print. PMID: 37162554.10.  Smida T, Menegazzi JJ, Crowe RP, Salcido D, Martin PS, Scheidler J, James Bardes. The Association of Combined Prehospital Hypotension and Hypoxia With Outcomes Following Out-of-Hospital Cardiac Arrest Resuscitation. Prehosp Emerg Care. 2023 Jul 26:1-9. doi: 10.1080/10903127.2023.2238820. Epub ahead of print. PMID: 37494278.11.  Smida T, Menegazzi JJ, Crowe RP, Salcido DD, Bardes J, Myers B. The Association of Prehospital End-Tidal Carbon Dioxide with Survival Following Out-of-Hospital Cardiac Arrest. Prehosp Emerg Care. 2023 Sep 26:1-7. doi: 10.1080/10903127.2023.2262566. Epub ahead of print. PMID: 37751228.12.  Smida T, Bonasso P, Bardes J, Price BS, Seifarth F, Gurien L, Maxson R, Letton R. Reverse shock index multiplied by the motor component of the Glasgow Coma Scale predicts mortality and need for intervention in pediatric trauma patients. J Trauma Acute Care Surg. 2024 Jan 26. doi: 10.1097/TA.0000000000004258. Epub ahead of print. PMID: 38273438.13.  Suchko S, Smida T, Crowe RP, Menegazzi JJ, Scheidler JF, Shukis M, Martin PS, Bardes JM, Salcido DD. The association of clinical, treatment, and demographic characteristics with rearrest in a national dataset. Resuscitation. 2024 Mar;196:110135. doi: 10.1016/j.resuscitation.2024.110135. Epub 2024 Feb 7. PMID: 38331343.14.  Smida T, Crowe R, Jarvis J, Ratcliff T, Goebel M. A retrospective comparison of upper and lower extremity intraosseous access during out-of-hospital cardiac arrest resuscitation. Prehosp Emerg Care. 2024 Feb 28:1-23. doi: 10.1080/10903127.2024.2321285. Epub ahead of print. PMID: 38416867.15.  Smida T, Crowe RP, Martin PS, Scheidler JF, Shukis M, Price BS, Bardes JM. A retrospective, multi-agency ‘target trial emulation' for the comparison of post-resuscitation epinephrine to norepinephrine.  Resuscitation.  2024 April; doi: 10.1016/j.resuscitation.2024.110201. Epub ahead of print.16.  Smida T, Crowe RP, Merrill PW, Scheidler JF. A Simpler Method for Choosing Adult i-gel Size: An Evaluation of Real-World Prehospital Data. Air Med J. 2024 May-Jun;43(3):259-261. doi: 10.1016/j.amj.2024.03.011. Epub 2024 Apr 5. PMID: 38821710.17.  Niemann B, Zarfoss E, Victory J, Smida T, Petros K, Sestito M, Bardes J. Evaluation of Oral Vasoactive Medications to Maintain Mean Arterial Pressure in Spinal Cord Injury. J Surg Res. 2024 Aug 12;302:339-346. doi: 10.1016/j.jss.2024.07.059. Epub ahead of print. PMID: 39137515.18.  Smida T, Price BS, Mizener A, Crowe RP, Bardes JM. Prehospital Post-Resuscitation Vital Sign Phenotypes are Associated with Outcomes Following Out-of-Hospital Cardiac Arrest. Prehosp Emerg Care. 2024 Aug 15:1-8. doi: 10.1080/10903127.2024.2386445. Epub ahead of print. PMID: 39088816.19.  Smida T, Voges L, Crowe R, Scheidler J, Bardes J. Prehospital Transcutaneous Cardiac Pacing in the United States: Treatment Epidemiology, Predictors of Treatment Failure, and Associated Outcomes. Prehosp Emerg Care. 2024 Sep 4:1-8. doi: 10.1080/10903127.2024.2393768. Epub ahead of print. PMID: 39150824.20.  Smida T, Dayal S, Bardes J, Scheidler J. Association of Prehospital Rearrest With Outcome Following Out-of-Hospital Cardiac Arrest: A Systematic Review and Meta-Analysis of Observational Studies. Prehosp Emerg Care. 2024 Oct 18:1-9. doi: 10.1080/10903127.2024.2408628. Epub ahead of print. PMID: 39321386.21.  Smida T, Cheskes S, Crowe R, Price BS, Scheidler J, Shukis M, Martin PS, Bardes J. The association between initial defibrillation dose and outcomes following adult out-of-hospital cardiac arrest resuscitation: A retrospective, multi-agency study. Resuscitation. 2025 Jan 23:110507. doi: 10.1016/j.resuscitation.2025.110507. Epub ahead of print. PMID: 39855423.22.  Smida T, Crowe R, Price BS, Scheidler J, Martin PS, Shukis M, Bardes J. A retrospective 'target trial emulation' comparing amiodarone and lidocaine for adult out-of-hospital cardiac arrest resuscitation. Resuscitation. 2025 Jan 23:110515. doi: 10.1016/j.resuscitation.2025.110515. Epub ahead of print. PMID: 39863130.23.  Nordstrom NK, Smida T, Bardes JM, Brown C, Wilson A. A contemporary analysis of pr...

Listener discretion is advised. References: Cook CE, Thigpen CA. Five good reasons to be disappointed with randomized trials. J Man Manip Ther. 2019 May;27(2):63-65. doi: 10.1080/10669817.2019.1589697. Epub 2019 Mar 14. PMID: 30935322 Fernainy P, Cohen AA, Murray E, Losina E, Lamontagne F, Sourial N. Rethinking the pros and cons of randomized controlled trials and observational studies in the era of big data and advanced methods: a panel discussion. BMC Proc. 2024 Jan 18;18(Suppl 2):1. doi: 10.1186/s12919-023-00285-8. Erratum in: BMC Proc. 2024 Aug 16;18(1):16. doi: 10.1186/s12919-024-00299-w. PMID: 38233894 Ramchurn TP, Nundy S. Randomised clinical trials in surgery: are we at a crossroads? Ann Med Surg (Lond). 2023 Nov 7;86(1):3-6. doi: 10.1097/MS9.0000000000001457. PMID: 38222736

Welcome to the free audiobook of The Book of Elon: A Guide to Purpose and Success. This is Part 1 of 4. I've made all of my books available for free. This is the third book I've published, and like the others, it's available in all formats—PDF, EPUB, and audio—and in dozens of languages. More than 5 million people have read the free version of The Almanack of Naval, and I wanted to do the same here. You can find the full book and bonus content on my website. I do this because I believe that if you can't comfortably afford the Kindle version or an Audible credit, then you should have access to this information even more. I want to personally gift it to you. I believe the ideas in this book can benefit anyone—and the more people who have good ideas in their heads, the better the future will be for all of us. If you're enjoying the free version, here are a few no-cost ways to support me and this project: Leave a review on Amazon, Goodreads, or Audible—these make a huge difference and help new readers discover the book Subscribe to my podcast Smart Friends, and follow along on YouTube, X, LinkedIn, or Instagram Join the email list at ejorgenson.com And most importantly, if this resonates with you, share it directly with a friend. A quick text or email recommendation is how most people decide what to read—and it means a lot. I appreciate you listening, reading, and helping spread the word.

Welcome to the free audiobook of The Book of Elon: A Guide to Purpose and Success. This is Part 1 of 4. I've made all of my books available for free. This is the third book I've published, and like the others, it's available in all formats—PDF, EPUB, and audio—and in dozens of languages. More than 5 million people have read the free version of The Almanack of Naval, and I wanted to do the same here. You can find the full book and bonus content on my website. I do this because I believe that if you can't comfortably afford the Kindle version or an Audible credit, then you should have access to this information even more. I want to personally gift it to you. I believe the ideas in this book can benefit anyone—and the more people who have good ideas in their heads, the better the future will be for all of us. If you're enjoying the free version, here are a few no-cost ways to support me and this project: Leave a review on Amazon, Goodreads, or Audible—these make a huge difference and help new readers discover the book Subscribe to my podcast Smart Friends, and follow along on YouTube, X, LinkedIn, or Instagram Join the email list at ejorgenson.com And most importantly, if this resonates with you, share it directly with a friend. A quick text or email recommendation is how most people decide what to read—and it means a lot. I appreciate you listening, reading, and helping spread the word.

Welcome to the free audiobook of The Book of Elon: A Guide to Purpose and Success. This is Part 2 of 4. I've made all of my books available for free. This is the third book I've published, and like the others, it's available in all formats—PDF, EPUB, and audio—and in dozens of languages. More than 5 million people have read the free version of The Almanack of Naval, and I wanted to do the same here. You can find the full book and bonus content on my website. I do this because I believe that if you can't comfortably afford the Kindle version or an Audible credit, then you should have access to this information even more. I want to personally gift it to you. I believe the ideas in this book can benefit anyone—and the more people who have good ideas in their heads, the better the future will be for all of us. If you're enjoying the free version, here are a few no-cost ways to support me and this project: Leave a review on Amazon, Goodreads, or Audible—these make a huge difference and help new readers discover the book Subscribe to my podcast Smart Friends, and follow along on YouTube, X, LinkedIn, or Instagram Join the email list at ejorgenson.com And most importantly, if this resonates with you, share it directly with a friend. A quick text or email recommendation is how most people decide what to read—and it means a lot. I appreciate you listening, reading, and helping spread the word.

Welcome to the free audiobook of The Book of Elon: A Guide to Purpose and Success. This is Part 3 of 4. I've made all of my books available for free. This is the third book I've published, and like the others, it's available in all formats—PDF, EPUB, and audio—and in dozens of languages. More than 5 million people have read the free version of The Almanack of Naval, and I wanted to do the same here. You can find the full book and bonus content on my website. I do this because I believe that if you can't comfortably afford the Kindle version or an Audible credit, then you should have access to this information even more. I want to personally gift it to you. I believe the ideas in this book can benefit anyone—and the more people who have good ideas in their heads, the better the future will be for all of us. If you're enjoying the free version, here are a few no-cost ways to support me and this project: Leave a review on Amazon, Goodreads, or Audible—these make a huge difference and help new readers discover the book Subscribe to my podcast Smart Friends, and follow along on YouTube, X, LinkedIn, or Instagram Join the email list at ejorgenson.com And most importantly, if this resonates with you, share it directly with a friend. A quick text or email recommendation is how most people decide what to read—and it means a lot. I appreciate you listening, reading, and helping spread the word.

Modern medicine has come a long way in its fight against diabetes. We now have continuous glucose monitors (CGM) and automated insulin delivery (AIDs) systems. These have revolutionized patient care. The FDA has approved devices for use in pregnancy as “nonadjunctive use” (meaning they may be used alone), although capillary finger stick assessments are currently still considered the Gold Standard. While the most robust data in support of CGMs is for preexisting Type 1 DM (Class B or beyond) and Type 2, there is recent growing support for CGM use in GDM patients, although some limitations still apply. Listen in for details.1. Feig DS, et al; CONCEPTT Collaborative Group. Continuous glucose monitoring in pregnant women with type 1 diabetes (CONCEPTT): a multicentre international randomised controlled trial. Lancet. 2017 Nov 25;390(10110):2347-2359. doi: 10.1016/S0140-6736(17)32400-5. Epub 2017 Sep 15. Erratum in: Lancet. 2017 Nov 25;390(10110):2346. 2. Benhalima K, Durnwald C, Sweeting A et al.Application of continuous glucose monitoring and automated insulin delivery technologies for pregnant women with type 1, type 2, or gestational diabetes: an international consensus statementThe Lancet Diabetes & Endocrinology, 2025; 14, 157-1773. Salmen BM, Reurean-Pintilei D, Salmen T, Bohîlțea RE. Exploring Continuous Glucose Monitoring in Gestational Diabetes: A Systematic Review. Life (Basel). 2025 Aug 28;15(9):1369. doi: 10.3390/life15091369. PMID: 41010309; PMCID: PMC12470761.4. Wyckoff JA, Lapolla A, Asias-Dinh BD, et al.Preexisting Diabetes and Pregnancy: An Endocrine Society and European Society of Endocrinology Joint Clinical Practice Guideline. The Journal of Clinical Endocrinology and Metabolism. 20255. American Diabetes Association Professional Practice Committee for Diabetes*; 15. Management of Diabetes in Pregnancy: Standards of Care in Diabetes—2026. Diabetes Care 1 January 2026; 49 (Supplement_1): S321–S338. https://doi.org/10.2337/dc26-S0156. Burk J, Ross GP, Hernandez TL, Colagiuri S, Sweeting A. Evidence for improved glucose metrics and perinatal outcomes with continuous glucose monitoring compared to self-monitoring in diabetes during pregnancy. Am J Obstet Gynecol. 2025 Sep;233(3):162-175. doi: 10.1016/j.ajog.2025.04.010. Epub 2025 Apr 10. PMID: 40216177.7. Linder T, et al; GRACE study collaborative group. Glycaemic control and pregnancy outcomes with real-time continuous glucose monitoring in gestational diabetes (GRACE): an open-label, multicentre, multinational, randomised controlled trial. Lancet Diabetes Endocrinol. 2026 Jan;14(1):50-61. doi: 10.1016/S2213-8587(25)00288-8. Epub 2025 Nov 24. PMID: 41308662.8. Valent AM, et al. Real-Time Continuous Glucose Monitoring in Pregnancies With Gestational Diabetes Mellitus: A Randomized Controlled Trial. Diabetes Care. 2025 Sep 1;48(9):1581-1588. doi: 10.2337/dc25-0115. PMID: 40730104; PMCID: PMC12368369.9. Kusinski LC, et al. Continuous Glucose Monitoring Metrics and Pregnancy Outcomes in Women With Gestational Diabetes Mellitus: A Secondary Analysis of the DiGest Trial. Diabetes Care. 2025 Aug 19:dc250452. doi: 10.2337/dc25-0452. Epub ahead of print. PMID: 40828742; PMCID: PMC7618813.10. García-Moreno RM, et al. Efficacy of continuous glucose monitoring on maternal and neonatal outcomes in gestational diabetes mellitus: a systematic review and meta-analysis of randomized clinical trials. Diabet Med. 2022 Jan;39(1):e14703. doi: 10.1111/dme.14703. Epub 2021 Oct 13. PMID: 34564868.11. Amylidi-Mohr Set,.et al (DipGluMo): an open-label, single-centre, randomised, controlled trial. Lancet Diabetes Endocrinol. 2025 Jul;13(7):591-599. doi: 10.1016/S2213-8587(25)00063-4. Epub 2025 May 26. Erratum in: Lancet Diabetes Endocrinol. 2026 Mar;14(3):e6. doi: 10.1016/S2213-8587(25)00403-6. PMID: 40441173.