Podcasts about generalized

Dr. Aaron Zelikovich discusses a phase 3 trial that looked at the use of inebilizumab in generalized myasthenia gravis.  Show reference:  https://www.nejm.org/doi/full/10.1056/NEJMoa2501561

Having Generalized Pustular Psoriasis (GPP) can steam roll your life. Hear how dermatologist Dr. Oanh Lauring and patient advocate Jordan Hicks overcame the challenge of recognition to treating this rare form of psoriasis. GPP is far more than just psoriasis. Recognition of this form of psoriasis with a unique cytokine presents challenges when symptoms are not so apparent and confusing. Join host Alan Simmons as he dives into the diagnosis journey, and treatment from acute to chronic flares with dermatologist Dr. Oanh Lauring, and what it means to live and stand up for yourself with GPP with Jordan Hicks. This episode offers a heartfelt look at life with generalized pustular psoriasis (GPP) and the value of standing up for your health. Join GPP Awareness Day in August. Timestamps: ·       (0:00)          Intro to Psound Bytes & guest welcome dermatologist                          Dr. Oanh Lauring and patient advocate Jordan Hicks. ·       (1:08)          Jordan's diagnosis journey with generalized pustular                             psoriasis (GPP). ·       (2:37)          What is generalized pustular psoriasis and Dr. Lauring's                         first encounter with GPP. ·       (8:00)          How GPP is different from plaque psoriasis but they can                      coexist together. ·       (9:53)          Treatment of acute GPP flares vs ongoing flare                                         management. ·       (12:29)       The impact of GPP on Jordan's life. ·       (13:22)        How to support those who live with GPP in the clinic                             setting and their mental health. ·       (15:24)        Tips for working with other specialists in management                         of  GPP. ·       (17:30)        Feelings associated with being diagnosed with GPP. ·       (20:43)        Being a self-advocate is important to your healthcare                             journey. ·       (22:18)        If you have GPP, you are not alone. Initiation of GPP                              Awareness Day. 4 Key Takeaways: ·       Diagnosis of generalized pustular psoriasis can take time given its confusing presentation in the early stages but can shift rapidly to urgent care when in the acute phase of the disease. ·       Generalized pustular psoriasis and plaque psoriasis are distinct forms but can coexist together. 50% of patients with GPP also have plaque psoriasis. ·       The impact of living with GPP is significant and finding support from those who understand, including health care providers, is critical to treating and coping with the disease. ·       If you have GPP be a strong advocate for your health and your self-worth. Your symptoms are valid and you deserve to be heard. Guest Bios: Dr. Oanh Lauring is a board-certified dermatologist in private practice at Lauring Dermatology where she provides the utmost care and expertise for patients with serious skin diseases such as psoriasis that impact the skin, scalp, hair, and nails. She offers a variety of the latest medical treatments including generalized pustular psoriasis to help her patients achieve a natural and refreshed appearance. Jordan Hicks took her health into her own hands. She moved from a small Texas town to Las Vegas in order to obtain care for her generalized pustular psoriasis or GPP. Once there she found her community and learned to speak up for herself and others. Jordan and her dog have been active advocates for GPP and Psoriasis ever since. Resources: Ø  Find Support through GPP Circles and others who understand what it means to live with GPP https://www.psoriasis.org/gpp-circles/   Ø  Join us to create awareness for the first GPP Awareness Day August 13, 2025. Request your tool kit.     https://www.psoriasis.org/gpp-toolkit/

In this episode Pastor Ryan and Corryn dig into strategies in dealing with Generalized Anxiety and also help those walking with individuals who battle Generalized Anxiety to know how to help.

In this episode Pastor Ryan and Corryn define Generalized Anxiety and help us understand the nuances of it.

CME credits: 1.00 Valid until: 02-04-2026 Claim your CME credit at https://reachmd.com/programs/cme/ocular-to-generalized-mg-how-and-why-the-disease-evolves/32733/ While traditional therapies for generalized myasthenia gravis (gMG) have proven beneficial in the short term, new treatment options with fewer debilitating side effects and longer-term benefit are needed. The emergence of targeted inhibitors of the neonatal Fc receptor (FcRn) have demonstrated in clinical trials and real-world experience that they address both of these needs. Join Drs. Vera Bril, Nicholas Silvestri, and Hans Katzberg as they discuss this exciting new therapeutic option and how it may change the treatment landscape of gMG.

CME credits: 0.75 Valid until: 02-04-2026 Claim your CME credit at https://reachmd.com/programs/cme/treatment-advances-in-generalized-myasthenia-gravis-clinical-and-laboratory-criteria-for-diagnosis-and-optimal-treatment-selection/29533/ The adult and pediatric diagnostic and treatment landscapes of generalized myasthenia gravis (gMG) are both similar and different. While current traditional therapies are often effective in the short term, selecting the most appropriate short- and longer-term treatment for each patient, whether adult or pediatric, brings with it unique individual challenges. These challenges include how best to utilize newer targeted agents in the treatment of gMG, such as the neonatal Fc receptor (FcRn) inhibitors. Join Drs. Vera Bril and Jonathan Strober as they tackle these issues from both the adult and pediatric perspective.=

James F. Howard Jr, MD - Beyond FcRn and Complement Inhibitors: Why We Need Novel Treatment Options for Generalized Myasthenia Gravis

James F. Howard Jr, MD - Beyond FcRn and Complement Inhibitors: Why We Need Novel Treatment Options for Generalized Myasthenia Gravis

James F. Howard Jr, MD - Beyond FcRn and Complement Inhibitors: Why We Need Novel Treatment Options for Generalized Myasthenia Gravis

James F. Howard Jr, MD - Beyond FcRn and Complement Inhibitors: Why We Need Novel Treatment Options for Generalized Myasthenia Gravis

James F. Howard Jr, MD - Beyond FcRn and Complement Inhibitors: Why We Need Novel Treatment Options for Generalized Myasthenia Gravis

James F. Howard Jr, MD - Beyond FcRn and Complement Inhibitors: Why We Need Novel Treatment Options for Generalized Myasthenia Gravis

You may want a more fit-looking body, but other things are likely important to you as well: strength, mobility, balance, flexibility, endurance, bone density, cardiovascular health, and more. Can strength training really tick all of those boxes? Dr. Shannon and Dr. Payton address this today. Does Strength Training Double as Cardio episode0:00: Introduction to hybrid training 2:50: How to exercise to improve posture 9:25: Mobility 15:15: Flexibility 18:56: Stability 23:54: Strength vs. muscle mass 26:45: Muscle endurance31:36: Balance 33:20: Bone density, VO2max, cardio, and fat loss 35:10: The ideal fitness routineTo take our free 35-minute Upper Body Build class taught by Dr. Shannon, visit portal.evlofitness.com.

I'm back, baby. I've been away traveling for podcasts and am excited to bring you new ones with Michael Levin, William Hahn, Robin Hanson, and Emily Riehl, coming up shortly. They're already recorded. I've been recovering from a terrible flu but pushed through it to bring you today's episode with Urs Schreiber. This one is quite mind-blowing. It's quite hairy mathematics, something called higher category theory, and how using this math (which examines the structure of structure) allows one manner of finding "something" from "nothing." Here, "nothing" means the empty set, and "something" is defined as fermions and even 11D supergravity. It's the first time this material has been presented in this manner. Enjoy. NOTE: Link to technical details are here from Urs Schreiber: https://ncatlab.org/schreiber/show/Peri+Pantheorias As a listener of TOE you can get a special 20% off discount to The Economist and all it has to offer! Visit https://www.economist.com/toe Join My New Substack (Personal Writings): https://curtjaimungal.substack.com Listen on Spotify: https://tinyurl.com/SpotifyTOE Become a YouTube Member (Early Access Videos): https://www.youtube.com/channel/UCdWIQh9DGG6uhJk8eyIFl1w/join Links Mentioned: - nLab website: https://ncatlab.org/nlab/show/HomePage - Paper on category theory: https://people.math.osu.edu/cogdell.1/6112-Eilenberg&MacLane-www.pdf - “Higher Topos Theory for Physics” (Urs's talk): https://www.youtube.com/watch?v=GD20W6vxMI4 - “Higher Topos Theory for Physics” (Urs's paper): https://arxiv.org/pdf/2311.11026 - Stephen Wolfram on TOE: https://www.youtube.com/watch?v=0YRlQQw0d-4 - Feynman's thesis: https://faculty.washington.edu/seattle/physics541/2012-path-integrals/thesis.pdf - Differential cohomology in a cohesive ∞-topos (Urs's paper): https://arxiv.org/pdf/1310.7930 - M-Theory from the Superpoint (paper): https://arxiv.org/pdf/1702.01774 - Character Map in Non-Abelian Cohomology, The: Twisted, Differential, and Generalized (textbook): https://amzn.to/4bFuz7H - TOE's String Theory Iceberg: https://www.youtube.com/watch?v=X4PdPnQuwjY Timestamps: 00:00 Introduction 01:27 The Creation of nLab 04:36 Philosophy Meets Physics 07:55 The Role of Mathematical Language 09:32 Emergence from Nothing 16:25 Towards a Theory of Everything 22:21 The Problem with Modern Physics 25:31 Diving into Category Theory 35:30 Understanding Adjunctions 41:46 The Significance of Duality 52:54 Exploring Toposes 1:14:20 The UNEDA Lemma and Generalized Spaces 1:16:37 Charts in Physics 1:20:55 Introduction to Infinitesimal Disks 1:23:56 The Emergence of Supergeometry 1:27:33 Transitioning to Gauge Theories 1:28:11 Exploring Singularities in Physics 1:32:50 The Role of Superformal Spaces 1:36:44 Functors and Their Implications 1:40:51 From Nothing to Emergent Structures 1:43:04 Hegel's Influence on Modern Physics 1:54:07 Discovering Higher-Dimensional Structures 1:56:30 The Path to 11-Dimensional Supergravity 1:57:21 Universal Central Extensions 2:03:21 The Journey to M-Theory 2:11:19 Globalizing the Structure of Supergravity 2:15:36 Understanding Global Charges in Physics 2:23:31 Dirac's Insights into Gauge Potentials 2:30:21 The Quest for Non-Perturbative Physics 2:39:04 Conclusion Support TOE on Patreon: https://patreon.com/curtjaimungal Twitter: https://twitter.com/TOEwithCurt Discord Invite: https://discord.com/invite/kBcnfNVwqs #science #theoreticalphysics Learn more about your ad choices. Visit megaphone.fm/adchoices

Get 10% Off Marek Health at https://marekhealth.com using code: SYATTIn this episode of The Jordan Syatt Mini-Podcast, I shoot the breeze and answer questions from listeners with my podcast producer, Tony, and we discuss:- Heart attacks from intense workouts?- Are chiropractors legit?- How to curb your sweet tooth- Specialized vs. generalized workouts...- Pre and Post workout meals for weight loss- Performance goals vs weight goals- What to do during rest periods- And more...Check out my podcast with Inner Circle member Rachel: https://podcasts.apple.com/us/podcast/the-jordan-syatt-mini-podcast/id1348856817?i=1000683664508Do you have any questions you want us to discuss on the podcast? Give Tony a follow and shoot him a DM on Instagram: https://www.instagram.com/tone_reverie/ I hope you enjoy this episode and, if you do, please leave a review on iTunes (huge thank you to everyone who has written one so far).Finally, if you've been thinking about joining The Inner Circle but haven't yet... we have hundreds of home and bodyweight workouts for you and you can get them all here: https://www.sfinnercircle.com/

If you're in SF, join us tomorrow for a fun meetup at CodeGen Night!If you're in NYC, join us for AI Engineer Summit! The Agent Engineering track is now sold out, but 25 tickets remain for AI Leadership and 5 tickets for the workshops. You can see the full schedule of speakers and workshops at https://ai.engineer!It's exceedingly hard to introduce someone like Bret Taylor. We could recite his Wikipedia page, or his extensive work history through Silicon Valley's greatest companies, but everyone else already does that.As a podcast by AI engineers for AI engineers, we had the opportunity to do something a little different. We wanted to dig into what Bret sees from his vantage point at the top of our industry for the last 2 decades, and how that explains the rise of the AI Architect at Sierra, the leading conversational AI/CX platform.“Across our customer base, we are seeing a new role emerge - the role of the AI architect. These leaders are responsible for helping define, manage and evolve their company's AI agent over time. They come from a variety of both technical and business backgrounds, and we think that every company will have one or many AI architects managing their AI agent and related experience.”In our conversation, Bret Taylor confirms the Paul Buchheit legend that he rewrote Google Maps in a weekend, armed with only the help of a then-nascent Google Closure Compiler and no other modern tooling. But what we find remarkable is that he was the PM of Maps, not an engineer, though of course he still identifies as one. We find this theme recurring throughout Bret's career and worldview. We think it is plain as day that AI leadership will have to be hands-on and technical, especially when the ground is shifting as quickly as it is today:“There's a lot of power in combining product and engineering into as few people as possible… few great things have been created by committee.”“If engineering is an order taking organization for product you can sometimes make meaningful things, but rarely will you create extremely well crafted breakthrough products. Those tend to be small teams who deeply understand the customer need that they're solving, who have a maniacal focus on outcomes.”“And I think the reason why is if you look at like software as a service five years ago, maybe you can have a separation of product and engineering because most software as a service created five years ago. I wouldn't say there's like a lot of technological breakthroughs required for most business applications. And if you're making expense reporting software or whatever, it's useful… You kind of know how databases work, how to build auto scaling with your AWS cluster, whatever, you know, it's just, you're just applying best practices to yet another problem. "When you have areas like the early days of mobile development or the early days of interactive web applications, which I think Google Maps and Gmail represent, or now AI agents, you're in this constant conversation with what the requirements of your customers and stakeholders are and all the different people interacting with it and the capabilities of the technology. And it's almost impossible to specify the requirements of a product when you're not sure of the limitations of the technology itself.”This is the first time the difference between technical leadership for “normal” software and for “AI” software was articulated this clearly for us, and we'll be thinking a lot about this going forward. We left a lot of nuggets in the conversation, so we hope you'll just dive in with us (and thank Bret for joining the pod!)Timestamps* 00:00:02 Introductions and Bret Taylor's background* 00:01:23 Bret's experience at Stanford and the dot-com era* 00:04:04 The story of rewriting Google Maps backend* 00:11:06 Early days of interactive web applications at Google* 00:15:26 Discussion on product management and engineering roles* 00:21:00 AI and the future of software development* 00:26:42 Bret's approach to identifying customer needs and building AI companies* 00:32:09 The evolution of business models in the AI era* 00:41:00 The future of programming languages and software development* 00:49:38 Challenges in precisely communicating human intent to machines* 00:56:44 Discussion on Artificial General Intelligence (AGI) and its impact* 01:08:51 The future of agent-to-agent communication* 01:14:03 Bret's involvement in the OpenAI leadership crisis* 01:22:11 OpenAI's relationship with Microsoft* 01:23:23 OpenAI's mission and priorities* 01:27:40 Bret's guiding principles for career choices* 01:29:12 Brief discussion on pasta-making* 01:30:47 How Bret keeps up with AI developments* 01:32:15 Exciting research directions in AI* 01:35:19 Closing remarks and hiring at Sierra Transcript[00:02:05] Introduction and Guest Welcome[00:02:05] Alessio: Hey everyone, welcome to the Latent Space Podcast. This is Alessio, partner and CTO at Decibel Partners, and I'm joined by my co host swyx, founder of smol.ai.[00:02:17] swyx: Hey, and today we're super excited to have Bret Taylor join us. Welcome. Thanks for having me. It's a little unreal to have you in the studio.[00:02:25] swyx: I've read about you so much over the years, like even before. Open AI effectively. I mean, I use Google Maps to get here. So like, thank you for everything that you've done. Like, like your story history, like, you know, I think people can find out what your greatest hits have been.[00:02:40] Bret Taylor's Early Career and Education[00:02:40] swyx: How do you usually like to introduce yourself when, you know, you talk about, you summarize your career, like, how do you look at yourself?[00:02:47] Bret: Yeah, it's a great question. You know, we, before we went on the mics here, we're talking about the audience for this podcast being more engineering. And I do think depending on the audience, I'll introduce myself differently because I've had a lot of [00:03:00] corporate and board roles. I probably self identify as an engineer more than anything else though.[00:03:04] Bret: So even when I was. Salesforce, I was coding on the weekends. So I think of myself as an engineer and then all the roles that I do in my career sort of start with that just because I do feel like engineering is sort of a mindset and how I approach most of my life. So I'm an engineer first and that's how I describe myself.[00:03:24] Bret: You majored in computer[00:03:25] swyx: science, like 1998. And, and I was high[00:03:28] Bret: school, actually my, my college degree was Oh, two undergrad. Oh, three masters. Right. That old.[00:03:33] swyx: Yeah. I mean, no, I was going, I was going like 1998 to 2003, but like engineering wasn't as, wasn't a thing back then. Like we didn't have the title of senior engineer, you know, kind of like, it was just.[00:03:44] swyx: You were a programmer, you were a developer, maybe. What was it like in Stanford? Like, what was that feeling like? You know, was it, were you feeling like on the cusp of a great computer revolution? Or was it just like a niche, you know, interest at the time?[00:03:57] Stanford and the Dot-Com Bubble[00:03:57] Bret: Well, I was at Stanford, as you said, from 1998 to [00:04:00] 2002.[00:04:02] Bret: 1998 was near the peak of the dot com bubble. So. This is back in the day where most people that they're coding in the computer lab, just because there was these sun microsystems, Unix boxes there that most of us had to do our assignments on. And every single day there was a. com like buying pizza for everybody.[00:04:20] Bret: I didn't have to like, I got. Free food, like my first two years of university and then the dot com bubble burst in the middle of my college career. And so by the end there was like tumbleweed going to the job fair, you know, it was like, cause it was hard to describe unless you were there at the time, the like level of hype and being a computer science major at Stanford was like, A thousand opportunities.[00:04:45] Bret: And then, and then when I left, it was like Microsoft, IBM.[00:04:49] Joining Google and Early Projects[00:04:49] Bret: And then the two startups that I applied to were VMware and Google. And I ended up going to Google in large part because a woman named Marissa Meyer, who had been a teaching [00:05:00] assistant when I was, what was called a section leader, which was like a junior teaching assistant kind of for one of the big interest.[00:05:05] Bret: Yes. Classes. She had gone there. And she was recruiting me and I knew her and it was sort of felt safe, you know, like, I don't know. I thought about it much, but it turned out to be a real blessing. I realized like, you know, you always want to think you'd pick Google if given the option, but no one knew at the time.[00:05:20] Bret: And I wonder if I'd graduated in like 1999 where I've been like, mom, I just got a job at pets. com. It's good. But you know, at the end I just didn't have any options. So I was like, do I want to go like make kernel software at VMware? Do I want to go build search at Google? And I chose Google. 50, 50 ball.[00:05:36] Bret: I'm not really a 50, 50 ball. So I feel very fortunate in retrospect that the economy collapsed because in some ways it forced me into like one of the greatest companies of all time, but I kind of lucked into it, I think.[00:05:47] The Google Maps Rewrite Story[00:05:47] Alessio: So the famous story about Google is that you rewrote the Google maps back in, in one week after the map quest quest maps acquisition, what was the story there?[00:05:57] Alessio: Is it. Actually true. Is it [00:06:00] being glorified? Like how, how did that come to be? And is there any detail that maybe Paul hasn't shared before?[00:06:06] Bret: It's largely true, but I'll give the color commentary. So it was actually the front end, not the back end, but it turns out for Google maps, the front end was sort of the hard part just because Google maps was.[00:06:17] Bret: Largely the first ish kind of really interactive web application, say first ish. I think Gmail certainly was though Gmail, probably a lot of people then who weren't engineers probably didn't appreciate its level of interactivity. It was just fast, but. Google maps, because you could drag the map and it was sort of graphical.[00:06:38] Bret: My, it really in the mainstream, I think, was it a map[00:06:41] swyx: quest back then that was, you had the arrows up and down, it[00:06:44] Bret: was up and down arrows. Each map was a single image and you just click left and then wait for a few seconds to the new map to let it was really small too, because generating a big image was kind of expensive on computers that day.[00:06:57] Bret: So Google maps was truly innovative in that [00:07:00] regard. The story on it. There was a small company called where two technologies started by two Danish brothers, Lars and Jens Rasmussen, who are two of my closest friends now. They had made a windows app called expedition, which had beautiful maps. Even in 2000.[00:07:18] Bret: For whenever we acquired or sort of acquired their company, Windows software was not particularly fashionable, but they were really passionate about mapping and we had made a local search product that was kind of middling in terms of popularity, sort of like a yellow page of search product. So we wanted to really go into mapping.[00:07:36] Bret: We'd started working on it. Their small team seemed passionate about it. So we're like, come join us. We can build this together.[00:07:42] Technical Challenges and Innovations[00:07:42] Bret: It turned out to be a great blessing that they had built a windows app because you're less technically constrained when you're doing native code than you are building a web browser, particularly back then when there weren't really interactive web apps and it ended up.[00:07:56] Bret: Changing the level of quality that we [00:08:00] wanted to hit with the app because we were shooting for something that felt like a native windows application. So it was a really good fortune that we sort of, you know, their unusual technical choices turned out to be the greatest blessing. So we spent a lot of time basically saying, how can you make a interactive draggable map in a web browser?[00:08:18] Bret: How do you progressively load, you know, new map tiles, you know, as you're dragging even things like down in the weeds of the browser at the time, most browsers like Internet Explorer, which was dominant at the time would only load two images at a time from the same domain. So we ended up making our map tile servers have like.[00:08:37] Bret: Forty different subdomains so we could load maps and parallels like lots of hacks. I'm happy to go into as much as like[00:08:44] swyx: HTTP connections and stuff.[00:08:46] Bret: They just like, there was just maximum parallelism of two. And so if you had a map, set of map tiles, like eight of them, so So we just, we were down in the weeds of the browser anyway.[00:08:56] Bret: So it was lots of plumbing. I can, I know a lot more about browsers than [00:09:00] most people, but then by the end of it, it was fairly, it was a lot of duct tape on that code. If you've ever done an engineering project where you're not really sure the path from point A to point B, it's almost like. Building a house by building one room at a time.[00:09:14] Bret: The, there's not a lot of architectural cohesion at the end. And then we acquired a company called Keyhole, which became Google earth, which was like that three, it was a native windows app as well, separate app, great app, but with that, we got licenses to all this satellite imagery. And so in August of 2005, we added.[00:09:33] Bret: Satellite imagery to Google Maps, which added even more complexity in the code base. And then we decided we wanted to support Safari. There was no mobile phones yet. So Safari was this like nascent browser on, on the Mac. And it turns out there's like a lot of decisions behind the scenes, sort of inspired by this windows app, like heavy use of XML and XSLT and all these like.[00:09:54] Bret: Technologies that were like briefly fashionable in the early two thousands and everyone hates now for good [00:10:00] reason. And it turns out that all of the XML functionality and Internet Explorer wasn't supporting Safari. So people are like re implementing like XML parsers. And it was just like this like pile of s**t.[00:10:11] Bret: And I had to say a s**t on your part. Yeah, of[00:10:12] Alessio: course.[00:10:13] Bret: So. It went from this like beautifully elegant application that everyone was proud of to something that probably had hundreds of K of JavaScript, which sounds like nothing. Now we're talking like people have modems, you know, not all modems, but it was a big deal.[00:10:29] Bret: So it was like slow. It took a while to load and just, it wasn't like a great code base. Like everything was fragile. So I just got. Super frustrated by it. And then one weekend I did rewrite all of it. And at the time the word JSON hadn't been coined yet too, just to give you a sense. So it's all XML.[00:10:47] swyx: Yeah.[00:10:47] Bret: So we used what is now you would call JSON, but I just said like, let's use eval so that we can parse the data fast. And, and again, that's, it would literally as JSON, but at the time there was no name for it. So we [00:11:00] just said, let's. Pass on JavaScript from the server and eval it. And then somebody just refactored the whole thing.[00:11:05] Bret: And, and it wasn't like I was some genius. It was just like, you know, if you knew everything you wished you had known at the beginning and I knew all the functionality, cause I was the primary, one of the primary authors of the JavaScript. And I just like, I just drank a lot of coffee and just stayed up all weekend.[00:11:22] Bret: And then I, I guess I developed a bit of reputation and no one knew about this for a long time. And then Paul who created Gmail and I ended up starting a company with him too, after all of this told this on a podcast and now it's large, but it's largely true. I did rewrite it and it, my proudest thing.[00:11:38] Bret: And I think JavaScript people appreciate this. Like the un G zipped bundle size for all of Google maps. When I rewrote, it was 20 K G zipped. It was like much smaller for the entire application. It went down by like 10 X. So. What happened on Google? Google is a pretty mainstream company. And so like our usage is shot up because it turns out like it's faster.[00:11:57] Bret: Just being faster is worth a lot of [00:12:00] percentage points of growth at a scale of Google. So how[00:12:03] swyx: much modern tooling did you have? Like test suites no compilers.[00:12:07] Bret: Actually, that's not true. We did it one thing. So I actually think Google, I, you can. Download it. There's a, Google has a closure compiler, a closure compiler.[00:12:15] Bret: I don't know if anyone still uses it. It's gone. Yeah. Yeah. It's sort of gone out of favor. Yeah. Well, even until recently it was better than most JavaScript minifiers because it was more like it did a lot more renaming of variables and things. Most people use ES build now just cause it's fast and closure compilers built on Java and super slow and stuff like that.[00:12:37] Bret: But, so we did have that, that was it. Okay.[00:12:39] The Evolution of Web Applications[00:12:39] Bret: So and that was treated internally, you know, it was a really interesting time at Google at the time because there's a lot of teams working on fairly advanced JavaScript when no one was. So Google suggest, which Kevin Gibbs was the tech lead for, was the first kind of type ahead, autocomplete, I believe in a web browser, and now it's just pervasive in search boxes that you sort of [00:13:00] see a type ahead there.[00:13:01] Bret: I mean, chat, dbt[00:13:01] swyx: just added it. It's kind of like a round trip.[00:13:03] Bret: Totally. No, it's now pervasive as a UI affordance, but that was like Kevin's 20 percent project. And then Gmail, Paul you know, he tells the story better than anyone, but he's like, you know, basically was scratching his own itch, but what was really neat about it is email, because it's such a productivity tool, just needed to be faster.[00:13:21] Bret: So, you know, he was scratching his own itch of just making more stuff work on the client side. And then we, because of Lars and Yen sort of like setting the bar of this windows app or like we need our maps to be draggable. So we ended up. Not only innovate in terms of having a big sync, what would be called a single page application today, but also all the graphical stuff you know, we were crashing Firefox, like it was going out of style because, you know, when you make a document object model with the idea that it's a document and then you layer on some JavaScript and then we're essentially abusing all of this, it just was running into code paths that were not.[00:13:56] Bret: Well, it's rotten, you know, at this time. And so it was [00:14:00] super fun. And, and, you know, in the building you had, so you had compilers, people helping minify JavaScript just practically, but there is a great engineering team. So they were like, that's why Closure Compiler is so good. It was like a. Person who actually knew about programming languages doing it, not just, you know, writing regular expressions.[00:14:17] Bret: And then the team that is now the Chrome team believe, and I, I don't know this for a fact, but I'm pretty sure Google is the main contributor to Firefox for a long time in terms of code. And a lot of browser people were there. So every time we would crash Firefox, we'd like walk up two floors and say like, what the hell is going on here?[00:14:35] Bret: And they would load their browser, like in a debugger. And we could like figure out exactly what was breaking. And you can't change the code, right? Cause it's the browser. It's like slow, right? I mean, slow to update. So, but we could figure out exactly where the bug was and then work around it in our JavaScript.[00:14:52] Bret: So it was just like new territory. Like so super, super fun time, just like a lot of, a lot of great engineers figuring out [00:15:00] new things. And And now, you know, the word, this term is no longer in fashion, but the word Ajax, which was asynchronous JavaScript and XML cause I'm telling you XML, but see the word XML there, to be fair, the way you made HTTP requests from a client to server was this.[00:15:18] Bret: Object called XML HTTP request because Microsoft and making Outlook web access back in the day made this and it turns out to have nothing to do with XML. It's just a way of making HTTP requests because XML was like the fashionable thing. It was like that was the way you, you know, you did it. But the JSON came out of that, you know, and then a lot of the best practices around building JavaScript applications is pre React.[00:15:44] Bret: I think React was probably the big conceptual step forward that we needed. Even my first social network after Google, we used a lot of like HTML injection and. Making real time updates was still very hand coded and it's really neat when you [00:16:00] see conceptual breakthroughs like react because it's, I just love those things where it's like obvious once you see it, but it's so not obvious until you do.[00:16:07] Bret: And actually, well, I'm sure we'll get into AI, but I, I sort of feel like we'll go through that evolution with AI agents as well that I feel like we're missing a lot of the core abstractions that I think in 10 years we'll be like, gosh, how'd you make agents? Before that, you know, but it was kind of that early days of web applications.[00:16:22] swyx: There's a lot of contenders for the reactive jobs of of AI, but no clear winner yet. I would say one thing I was there for, I mean, there's so much we can go into there. You just covered so much.[00:16:32] Product Management and Engineering Synergy[00:16:32] swyx: One thing I just, I just observe is that I think the early Google days had this interesting mix of PM and engineer, which I think you are, you didn't, you didn't wait for PM to tell you these are my, this is my PRD.[00:16:42] swyx: This is my requirements.[00:16:44] mix: Oh,[00:16:44] Bret: okay.[00:16:45] swyx: I wasn't technically a software engineer. I mean,[00:16:48] Bret: by title, obviously. Right, right, right.[00:16:51] swyx: It's like a blend. And I feel like these days, product is its own discipline and its own lore and own industry and engineering is its own thing. And there's this process [00:17:00] that happens and they're kind of separated, but you don't produce as good of a product as if they were the same person.[00:17:06] swyx: And I'm curious, you know, if, if that, if that sort of resonates in, in, in terms of like comparing early Google versus modern startups that you see out there,[00:17:16] Bret: I certainly like wear a lot of hats. So, you know, sort of biased in this, but I really agree that there's a lot of power and combining product design engineering into as few people as possible because, you know few great things have been created by committee, you know, and so.[00:17:33] Bret: If engineering is an order taking organization for product you can sometimes make meaningful things, but rarely will you create extremely well crafted breakthrough products. Those tend to be small teams who deeply understand the customer need that they're solving, who have a. Maniacal focus on outcomes.[00:17:53] Bret: And I think the reason why it's, I think for some areas, if you look at like software as a service five years ago, maybe you can have a [00:18:00] separation of product and engineering because most software as a service created five years ago. I wouldn't say there's like a lot of like. Technological breakthroughs required for most, you know, business applications.[00:18:11] Bret: And if you're making expense reporting software or whatever, it's useful. I don't mean to be dismissive of expense reporting software, but you probably just want to understand like, what are the requirements of the finance department? What are the requirements of an individual file expense report? Okay.[00:18:25] Bret: Go implement that. And you kind of know how web applications are implemented. You kind of know how to. How databases work, how to build auto scaling with your AWS cluster, whatever, you know, it's just, you're just applying best practices to yet another problem when you have areas like the early days of mobile development or the early days of interactive web applications, which I think Google Maps and Gmail represent, or now AI agents, you're in this constant conversation with what the requirements of your customers and stakeholders are and all the different people interacting with it.[00:18:58] Bret: And the capabilities of the [00:19:00] technology. And it's almost impossible to specify the requirements of a product when you're not sure of the limitations of the technology itself. And that's why I use the word conversation. It's not literal. That's sort of funny to use that word in the age of conversational AI.[00:19:15] Bret: You're constantly sort of saying, like, ideally, you could sprinkle some magic AI pixie dust and solve all the world's problems, but it's not the way it works. And it turns out that actually, I'll just give an interesting example.[00:19:26] AI Agents and Modern Tooling[00:19:26] Bret: I think most people listening probably use co pilots to code like Cursor or Devon or Microsoft Copilot or whatever.[00:19:34] Bret: Most of those tools are, they're remarkable. I'm, I couldn't, you know, imagine development without them now, but they're not autonomous yet. Like I wouldn't let it just write most code without my interactively inspecting it. We just are somewhere between it's an amazing co pilot and it's an autonomous software engineer.[00:19:53] Bret: As a product manager, like your aspirations for what the product is are like kind of meaningful. But [00:20:00] if you're a product person, yeah, of course you'd say it should be autonomous. You should click a button and program should come out the other side. The requirements meaningless. Like what matters is like, what is based on the like very nuanced limitations of the technology.[00:20:14] Bret: What is it capable of? And then how do you maximize the leverage? It gives a software engineering team, given those very nuanced trade offs. Coupled with the fact that those nuanced trade offs are changing more rapidly than any technology in my memory, meaning every few months you'll have new models with new capabilities.[00:20:34] Bret: So how do you construct a product that can absorb those new capabilities as rapidly as possible as well? That requires such a combination of technical depth and understanding the customer that you really need more integration. Of product design and engineering. And so I think it's why with these big technology waves, I think startups have a bit of a leg up relative to incumbents because they [00:21:00] tend to be sort of more self actualized in terms of just like bringing those disciplines closer together.[00:21:06] Bret: And in particular, I think entrepreneurs, the proverbial full stack engineers, you know, have a leg up as well because. I think most breakthroughs happen when you have someone who can understand those extremely nuanced technical trade offs, have a vision for a product. And then in the process of building it, have that, as I said, like metaphorical conversation with the technology, right?[00:21:30] Bret: Gosh, I ran into a technical limit that I didn't expect. It's not just like changing that feature. You might need to refactor the whole product based on that. And I think that's, that it's particularly important right now. So I don't, you know, if you, if you're building a big ERP system, probably there's a great reason to have product and engineering.[00:21:51] Bret: I think in general, the disciplines are there for a reason. I think when you're dealing with something as nuanced as the like technologies, like large language models today, there's a ton of [00:22:00] advantage of having. Individuals or organizations that integrate the disciplines more formally.[00:22:05] Alessio: That makes a lot of sense.[00:22:06] Alessio: I've run a lot of engineering teams in the past, and I think the product versus engineering tension has always been more about effort than like whether or not the feature is buildable. But I think, yeah, today you see a lot more of like. Models actually cannot do that. And I think the most interesting thing is on the startup side, people don't yet know where a lot of the AI value is going to accrue.[00:22:26] Alessio: So you have this rush of people building frameworks, building infrastructure, layered things, but we don't really know the shape of the compute. I'm curious that Sierra, like how you thought about building an house, a lot of the tooling for evals or like just, you know, building the agents and all of that.[00:22:41] Alessio: Versus how you see some of the startup opportunities that is maybe still out there.[00:22:46] Bret: We build most of our tooling in house at Sierra, not all. It's, we don't, it's not like not invented here syndrome necessarily, though, maybe slightly guilty of that in some ways, but because we're trying to build a platform [00:23:00] that's in Dorian, you know, we really want to have control over our own destiny.[00:23:03] Bret: And you had made a comment earlier that like. We're still trying to figure out who like the reactive agents are and the jury is still out. I would argue it hasn't been created yet. I don't think the jury is still out to go use that metaphor. We're sort of in the jQuery era of agents, not the react era.[00:23:19] Bret: And, and that's like a throwback for people listening,[00:23:22] swyx: we shouldn't rush it. You know?[00:23:23] Bret: No, yeah, that's my point is. And so. Because we're trying to create an enduring company at Sierra that outlives us, you know, I'm not sure we want to like attach our cart to some like to a horse where it's not clear that like we've figured out and I actually want as a company, we're trying to enable just at a high level and I'll, I'll quickly go back to tech at Sierra, we help consumer brands build customer facing AI agents.[00:23:48] Bret: So. Everyone from Sonos to ADT home security to Sirius XM, you know, if you call them on the phone and AI will pick up with you, you know, chat with them on the Sirius XM homepage. It's an AI agent called Harmony [00:24:00] that they've built on our platform. We're what are the contours of what it means for someone to build an end to end complete customer experience with AI with conversational AI.[00:24:09] Bret: You know, we really want to dive into the deep end of, of all the trade offs to do it. You know, where do you use fine tuning? Where do you string models together? You know, where do you use reasoning? Where do you use generation? How do you use reasoning? How do you express the guardrails of an agentic process?[00:24:25] Bret: How do you impose determinism on a fundamentally non deterministic technology? There's just a lot of really like as an important design space. And I could sit here and tell you, we have the best approach. Every entrepreneur will, you know. But I hope that in two years, we look back at our platform and laugh at how naive we were, because that's the pace of change broadly.[00:24:45] Bret: If you talk about like the startup opportunities, I'm not wholly skeptical of tools companies, but I'm fairly skeptical. There's always an exception for every role, but I believe that certainly there's a big market for [00:25:00] frontier models, but largely for companies with huge CapEx budgets. So. Open AI and Microsoft's Anthropic and Amazon Web Services, Google Cloud XAI, which is very well capitalized now, but I think the, the idea that a company can make money sort of pre training a foundation model is probably not true.[00:25:20] Bret: It's hard to, you're competing with just, you know, unreasonably large CapEx budgets. And I just like the cloud infrastructure market, I think will be largely there. I also really believe in the applications of AI. And I define that not as like building agents or things like that. I define it much more as like, you're actually solving a problem for a business.[00:25:40] Bret: So it's what Harvey is doing in legal profession or what cursor is doing for software engineering or what we're doing for customer experience and customer service. The reason I believe in that is I do think that in the age of AI, what's really interesting about software is it can actually complete a task.[00:25:56] Bret: It can actually do a job, which is very different than the value proposition of [00:26:00] software was to ancient history two years ago. And as a consequence, I think the way you build a solution and For a domain is very different than you would have before, which means that it's not obvious, like the incumbent incumbents have like a leg up, you know, necessarily, they certainly have some advantages, but there's just such a different form factor, you know, for providing a solution and it's just really valuable.[00:26:23] Bret: You know, it's. Like just think of how much money cursor is saving software engineering teams or the alternative, how much revenue it can produce tool making is really challenging. If you look at the cloud market, just as a analog, there are a lot of like interesting tools, companies, you know, Confluent, Monetized Kafka, Snowflake, Hortonworks, you know, there's a, there's a bunch of them.[00:26:48] Bret: A lot of them, you know, have that mix of sort of like like confluence or have the open source or open core or whatever you call it. I, I, I'm not an expert in this area. You know, I do think [00:27:00] that developers are fickle. I think that in the tool space, I probably like. Default towards open source being like the area that will win.[00:27:09] Bret: It's hard to build a company around this and then you end up with companies sort of built around open source to that can work. Don't get me wrong, but I just think that it's nowadays the tools are changing so rapidly that I'm like, not totally skeptical of tool makers, but I just think that open source will broadly win, but I think that the CapEx required for building frontier models is such that it will go to a handful of big companies.[00:27:33] Bret: And then I really believe in agents for specific domains which I think will, it's sort of the analog to software as a service in this new era. You know, it's like, if you just think of the cloud. You can lease a server. It's just a low level primitive, or you can buy an app like you know, Shopify or whatever.[00:27:51] Bret: And most people building a storefront would prefer Shopify over hand rolling their e commerce storefront. I think the same thing will be true of AI. So [00:28:00] I've. I tend to like, if I have a, like an entrepreneur asked me for advice, I'm like, you know, move up the stack as far as you can towards a customer need.[00:28:09] Bret: Broadly, but I, but it doesn't reduce my excitement about what is the reactive building agents kind of thing, just because it is, it is the right question to ask, but I think we'll probably play out probably an open source space more than anything else.[00:28:21] swyx: Yeah, and it's not a priority for you. There's a lot in there.[00:28:24] swyx: I'm kind of curious about your idea maze towards, there are many customer needs. You happen to identify customer experience as yours, but it could equally have been coding assistance or whatever. I think for some, I'm just kind of curious at the top down, how do you look at the world in terms of the potential problem space?[00:28:44] swyx: Because there are many people out there who are very smart and pick the wrong problem.[00:28:47] Bret: Yeah, that's a great question.[00:28:48] Future of Software Development[00:28:48] Bret: By the way, I would love to talk about the future of software, too, because despite the fact it didn't pick coding, I have a lot of that, but I can talk to I can answer your question, though, you know I think when a technology is as [00:29:00] cool as large language models.[00:29:02] Bret: You just see a lot of people starting from the technology and searching for a problem to solve. And I think it's why you see a lot of tools companies, because as a software engineer, you start building an app or a demo and you, you encounter some pain points. You're like,[00:29:17] swyx: a lot of[00:29:17] Bret: people are experiencing the same pain point.[00:29:19] Bret: What if I make it? That it's just very incremental. And you know, I always like to use the metaphor, like you can sell coffee beans, roasted coffee beans. You can add some value. You took coffee beans and you roasted them and roasted coffee beans largely, you know, are priced relative to the cost of the beans.[00:29:39] Bret: Or you can sell a latte and a latte. Is rarely priced directly like as a percentage of coffee bean prices. In fact, if you buy a latte at the airport, it's a captive audience. So it's a really expensive latte. And there's just a lot that goes into like. How much does a latte cost? And I bring it up because there's a supply chain from growing [00:30:00] coffee beans to roasting coffee beans to like, you know, you could make one at home or you could be in the airport and buy one and the margins of the company selling lattes in the airport is a lot higher than the, you know, people roasting the coffee beans and it's because you've actually solved a much more acute human problem in the airport.[00:30:19] Bret: And, and it's just worth a lot more to that person in that moment. It's kind of the way I think about technology too. It sounds funny to liken it to coffee beans, but you're selling tools on top of a large language model yet in some ways your market is big, but you're probably going to like be price compressed just because you're sort of a piece of infrastructure and then you have open source and all these other things competing with you naturally.[00:30:43] Bret: If you go and solve a really big business problem for somebody, that's actually like a meaningful business problem that AI facilitates, they will value it according to the value of that business problem. And so I actually feel like people should just stop. You're like, no, that's, that's [00:31:00] unfair. If you're searching for an idea of people, I, I love people trying things, even if, I mean, most of the, a lot of the greatest ideas have been things no one believed in.[00:31:07] Bret: So I like, if you're passionate about something, go do it. Like who am I to say, yeah, a hundred percent. Or Gmail, like Paul as far, I mean I, some of it's Laura at this point, but like Gmail is Paul's own email for a long time. , and then I amusingly and Paul can't correct me, I'm pretty sure he sent her in a link and like the first comment was like, this is really neat.[00:31:26] Bret: It would be great. It was not your email, but my own . I don't know if it's a true story. I'm pretty sure it's, yeah, I've read that before. So scratch your own niche. Fine. Like it depends on what your goal is. If you wanna do like a venture backed company, if its a. Passion project, f*****g passion, do it like don't listen to anybody.[00:31:41] Bret: In fact, but if you're trying to start, you know an enduring company, solve an important business problem. And I, and I do think that in the world of agents, the software industries has shifted where you're not just helping people more. People be more productive, but you're actually accomplishing tasks autonomously.[00:31:58] Bret: And as a consequence, I think the [00:32:00] addressable market has just greatly expanded just because software can actually do things now and actually accomplish tasks and how much is coding autocomplete worth. A fair amount. How much is the eventual, I'm certain we'll have it, the software agent that actually writes the code and delivers it to you, that's worth a lot.[00:32:20] Bret: And so, you know, I would just maybe look up from the large language models and start thinking about the economy and, you know, think from first principles. I don't wanna get too far afield, but just think about which parts of the economy. We'll benefit most from this intelligence and which parts can absorb it most easily.[00:32:38] Bret: And what would an agent in this space look like? Who's the customer of it is the technology feasible. And I would just start with these business problems more. And I think, you know, the best companies tend to have great engineers who happen to have great insight into a market. And it's that last part that I think some people.[00:32:56] Bret: Whether or not they have, it's like people start so much in the technology, they [00:33:00] lose the forest for the trees a little bit.[00:33:02] Alessio: How do you think about the model of still selling some sort of software versus selling more package labor? I feel like when people are selling the package labor, it's almost more stateless, you know, like it's easier to swap out if you're just putting an input and getting an output.[00:33:16] Alessio: If you think about coding, if there's no ID, you're just putting a prompt and getting back an app. It doesn't really matter. Who generates the app, you know, you have less of a buy in versus the platform you're building, I'm sure on the backend customers have to like put on their documentation and they have, you know, different workflows that they can tie in what's kind of like the line to draw there versus like going full where you're managed customer support team as a service outsource versus.[00:33:40] Alessio: This is the Sierra platform that you can build on. What was that decision? I'll sort of[00:33:44] Bret: like decouple the question in some ways, which is when you have something that's an agent, who is the person using it and what do they want to do with it? So let's just take your coding agent for a second. I will talk about Sierra as well.[00:33:59] Bret: Who's the [00:34:00] customer of a, an agent that actually produces software? Is it a software engineering manager? Is it a software engineer? And it's there, you know, intern so to speak. I don't know. I mean, we'll figure this out over the next few years. Like what is that? And is it generating code that you then review?[00:34:16] Bret: Is it generating code with a set of unit tests that pass, what is the actual. For lack of a better word contract, like, how do you know that it did what you wanted it to do? And then I would say like the product and the pricing, the packaging model sort of emerged from that. And I don't think the world's figured out.[00:34:33] Bret: I think it'll be different for every agent. You know, in our customer base, we do what's called outcome based pricing. So essentially every time the AI agent. Solves the problem or saves a customer or whatever it might be. There's a pre negotiated rate for that. We do that. Cause it's, we think that that's sort of the correct way agents, you know, should be packaged.[00:34:53] Bret: I look back at the history of like cloud software and notably the introduction of the browser, which led to [00:35:00] software being delivered in a browser, like Salesforce to. Famously invented sort of software as a service, which is both a technical delivery model through the browser, but also a business model, which is you subscribe to it rather than pay for a perpetual license.[00:35:13] Bret: Those two things are somewhat orthogonal, but not really. If you think about the idea of software running in a browser, that's hosted. Data center that you don't own, you sort of needed to change the business model because you don't, you can't really buy a perpetual license or something otherwise like, how do you afford making changes to it?[00:35:31] Bret: So it only worked when you were buying like a new version every year or whatever. So to some degree, but then the business model shift actually changed business as we know it, because now like. Things like Adobe Photoshop. Now you subscribe to rather than purchase. So it ended up where you had a technical shift and a business model shift that were very logically intertwined that actually the business model shift was turned out to be as significant as the technical as the shift.[00:35:59] Bret: And I think with [00:36:00] agents, because they actually accomplish a job, I do think that it doesn't make sense to me that you'd pay for the privilege of like. Using the software like that coding agent, like if it writes really bad code, like fire it, you know, I don't know what the right metaphor is like you should pay for a job.[00:36:17] Bret: Well done in my opinion. I mean, that's how you pay your software engineers, right? And[00:36:20] swyx: and well, not really. We paid to put them on salary and give them options and they vest over time. That's fair.[00:36:26] Bret: But my point is that you don't pay them for how many characters they write, which is sort of the token based, you know, whatever, like, There's a, that famous Apple story where we're like asking for a report of how many lines of code you wrote.[00:36:40] Bret: And one of the engineers showed up with like a negative number cause he had just like done a big refactoring. There was like a big F you to management who didn't understand how software is written. You know, my sense is like the traditional usage based or seat based thing. It's just going to look really antiquated.[00:36:55] Bret: Cause it's like asking your software engineer, how many lines of code did you write today? Like who cares? Like, cause [00:37:00] absolutely no correlation. So my old view is I don't think it's be different in every category, but I do think that that is the, if an agent is doing a job, you should, I think it properly incentivizes the maker of that agent and the customer of, of your pain for the job well done.[00:37:16] Bret: It's not always perfect to measure. It's hard to measure engineering productivity, but you can, you should do something other than how many keys you typed, you know Talk about perverse incentives for AI, right? Like I can write really long functions to do the same thing, right? So broadly speaking, you know, I do think that we're going to see a change in business models of software towards outcomes.[00:37:36] Bret: And I think you'll see a change in delivery models too. And, and, you know, in our customer base you know, we empower our customers to really have their hands on the steering wheel of what the agent does they, they want and need that. But the role is different. You know, at a lot of our customers, the customer experience operations folks have renamed themselves the AI architects, which I think is really cool.[00:37:55] Bret: And, you know, it's like in the early days of the Internet, there's the role of the webmaster. [00:38:00] And I don't know whether your webmaster is not a fashionable, you know, Term, nor is it a job anymore? I just, I don't know. Will they, our tech stand the test of time? Maybe, maybe not. But I do think that again, I like, you know, because everyone listening right now is a software engineer.[00:38:14] Bret: Like what is the form factor of a coding agent? And actually I'll, I'll take a breath. Cause actually I have a bunch of pins on them. Like I wrote a blog post right before Christmas, just on the future of software development. And one of the things that's interesting is like, if you look at the way I use cursor today, as an example, it's inside of.[00:38:31] Bret: A repackaged visual studio code environment. I sometimes use the sort of agentic parts of it, but it's largely, you know, I've sort of gotten a good routine of making it auto complete code in the way I want through tuning it properly when it actually can write. I do wonder what like the future of development environments will look like.[00:38:55] Bret: And to your point on what is a software product, I think it's going to change a lot in [00:39:00] ways that will surprise us. But I always use, I use the metaphor in my blog post of, have you all driven around in a way, Mo around here? Yeah, everyone has. And there are these Jaguars, the really nice cars, but it's funny because it still has a steering wheel, even though there's no one sitting there and the steering wheels like turning and stuff clearly in the future.[00:39:16] Bret: If once we get to that, be more ubiquitous, like why have the steering wheel and also why have all the seats facing forward? Maybe just for car sickness. I don't know, but you could totally rearrange the car. I mean, so much of the car is oriented around the driver, so. It stands to reason to me that like, well, autonomous agents for software engineering run through visual studio code.[00:39:37] Bret: That seems a little bit silly because having a single source code file open one at a time is kind of a goofy form factor for when like the code isn't being written primarily by you, but it begs the question of what's your relationship with that agent. And I think the same is true in our industry of customer experience, which is like.[00:39:55] Bret: Who are the people managing this agent? What are the tools do they need? And they definitely need [00:40:00] tools, but it's probably pretty different than the tools we had before. It's certainly different than training a contact center team. And as software engineers, I think that I would like to see particularly like on the passion project side or research side.[00:40:14] Bret: More innovation in programming languages. I think that we're bringing the cost of writing code down to zero. So the fact that we're still writing Python with AI cracks me up just cause it's like literally was designed to be ergonomic to write, not safe to run or fast to run. I would love to see more innovation and how we verify program correctness.[00:40:37] Bret: I studied for formal verification in college a little bit and. It's not very fashionable because it's really like tedious and slow and doesn't work very well. If a lot of code is being written by a machine, you know, one of the primary values we can provide is verifying that it actually does what we intend that it does.[00:40:56] Bret: I think there should be lots of interesting things in the software development life cycle, like how [00:41:00] we think of testing and everything else, because. If you think about if we have to manually read every line of code that's coming out as machines, it will just rate limit how much the machines can do. The alternative is totally unsafe.[00:41:13] Bret: So I wouldn't want to put code in production that didn't go through proper code review and inspection. So my whole view is like, I actually think there's like an AI native I don't think the coding agents don't work well enough to do this yet, but once they do, what is sort of an AI native software development life cycle and how do you actually.[00:41:31] Bret: Enable the creators of software to produce the highest quality, most robust, fastest software and know that it's correct. And I think that's an incredible opportunity. I mean, how much C code can we rewrite and rust and make it safe so that there's fewer security vulnerabilities. Can we like have more efficient, safer code than ever before?[00:41:53] Bret: And can you have someone who's like that guy in the matrix, you know, like staring at the little green things, like where could you have an operator [00:42:00] of a code generating machine be like superhuman? I think that's a cool vision. And I think too many people are focused on like. Autocomplete, you know, right now, I'm not, I'm not even, I'm guilty as charged.[00:42:10] Bret: I guess in some ways, but I just like, I'd like to see some bolder ideas. And that's why when you were joking, you know, talking about what's the react of whatever, I think we're clearly in a local maximum, you know, metaphor, like sort of conceptual local maximum, obviously it's moving really fast. I think we're moving out of it.[00:42:26] Alessio: Yeah. At the end of 23, I've read this blog post from syntax to semantics. Like if you think about Python. It's taking C and making it more semantic and LLMs are like the ultimate semantic program, right? You can just talk to them and they can generate any type of syntax from your language. But again, the languages that they have to use were made for us, not for them.[00:42:46] Alessio: But the problem is like, as long as you will ever need a human to intervene, you cannot change the language under it. You know what I mean? So I'm curious at what point of automation we'll need to get, we're going to be okay making changes. To the underlying languages, [00:43:00] like the programming languages versus just saying, Hey, you just got to write Python because I understand Python and I'm more important at the end of the day than the model.[00:43:08] Alessio: But I think that will change, but I don't know if it's like two years or five years. I think it's more nuanced actually.[00:43:13] Bret: So I think there's a, some of the more interesting programming languages bring semantics into syntax. So let me, that's a little reductive, but like Rust as an example, Rust is memory safe.[00:43:25] Bret: Statically, and that was a really interesting conceptual, but it's why it's hard to write rust. It's why most people write python instead of rust. I think rust programs are safer and faster than python, probably slower to compile. But like broadly speaking, like given the option, if you didn't have to care about the labor that went into it.[00:43:45] Bret: You should prefer a program written in Rust over a program written in Python, just because it will run more efficiently. It's almost certainly safer, et cetera, et cetera, depending on how you define safe, but most people don't write Rust because it's kind of a pain in the ass. And [00:44:00] the audience of people who can is smaller, but it's sort of better in most, most ways.[00:44:05] Bret: And again, let's say you're making a web service and you didn't have to care about how hard it was to write. If you just got the output of the web service, the rest one would be cheaper to operate. It's certainly cheaper and probably more correct just because there's so much in the static analysis implied by the rest programming language that it probably will have fewer runtime errors and things like that as well.[00:44:25] Bret: So I just give that as an example, because so rust, at least my understanding that came out of the Mozilla team, because. There's lots of security vulnerabilities in the browser and it needs to be really fast. They said, okay, we want to put more of a burden at the authorship time to have fewer issues at runtime.[00:44:43] Bret: And we need the constraint that it has to be done statically because browsers need to be really fast. My sense is if you just think about like the, the needs of a programming language today, where the role of a software engineer is [00:45:00] to use an AI to generate functionality and audit that it does in fact work as intended, maybe functionally, maybe from like a correctness standpoint, some combination thereof, how would you create a programming system that facilitated that?[00:45:15] Bret: And, you know, I bring up Rust is because I think it's a good example of like, I think given a choice of writing in C or Rust, you should choose Rust today. I think most people would say that, even C aficionados, just because. C is largely less safe for very similar, you know, trade offs, you know, for the, the system and now with AI, it's like, okay, well, that just changes the game on writing these things.[00:45:36] Bret: And so like, I just wonder if a combination of programming languages that are more structurally oriented towards the values that we need from an AI generated program, verifiable correctness and all of that. If it's tedious to produce for a person, that maybe doesn't matter. But one thing, like if I asked you, is this rest program memory safe?[00:45:58] Bret: You wouldn't have to read it, you just have [00:46:00] to compile it. So that's interesting. I mean, that's like an, that's one example of a very modest form of formal verification. So I bring that up because I do think you have AI inspect AI, you can have AI reviewed. Do AI code reviews. It would disappoint me if the best we could get was AI reviewing Python and having scaled a few very large.[00:46:21] Bret: Websites that were written on Python. It's just like, you know, expensive and it's like every, trust me, every team who's written a big web service in Python has experimented with like Pi Pi and all these things just to make it slightly more efficient than it naturally is. You don't really have true multi threading anyway.[00:46:36] Bret: It's just like clearly that you do it just because it's convenient to write. And I just feel like we're, I don't want to say it's insane. I just mean. I do think we're at a local maximum. And I would hope that we create a programming system, a combination of programming languages, formal verification, testing, automated code reviews, where you can use AI to generate software in a high scale way and trust it.[00:46:59] Bret: And you're [00:47:00] not limited by your ability to read it necessarily. I don't know exactly what form that would take, but I feel like that would be a pretty cool world to live in.[00:47:08] Alessio: Yeah. We had Chris Lanner on the podcast. He's doing great work with modular. I mean, I love. LVM. Yeah. Basically merging rust in and Python.[00:47:15] Alessio: That's kind of the idea. Should be, but I'm curious is like, for them a big use case was like making it compatible with Python, same APIs so that Python developers could use it. Yeah. And so I, I wonder at what point, well, yeah.[00:47:26] Bret: At least my understanding is they're targeting the data science Yeah. Machine learning crowd, which is all written in Python, so still feels like a local maximum.[00:47:34] Bret: Yeah.[00:47:34] swyx: Yeah, exactly. I'll force you to make a prediction. You know, Python's roughly 30 years old. In 30 years from now, is Rust going to be bigger than Python?[00:47:42] Bret: I don't know this, but just, I don't even know this is a prediction. I just am sort of like saying stuff I hope is true. I would like to see an AI native programming language and programming system, and I use language because I'm not sure language is even the right thing, but I hope in 30 years, there's an AI native way we make [00:48:00] software that is wholly uncorrelated with the current set of programming languages.[00:48:04] Bret: or not uncorrelated, but I think most programming languages today were designed to be efficiently authored by people and some have different trade offs.[00:48:15] Evolution of Programming Languages[00:48:15] Bret: You know, you have Haskell and others that were designed for abstractions for parallelism and things like that. You have programming languages like Python, which are designed to be very easily written, sort of like Perl and Python lineage, which is why data scientists use it.[00:48:31] Bret: It's it can, it has a. Interactive mode, things like that. And I love, I'm a huge Python fan. So despite all my Python trash talk, a huge Python fan wrote at least two of my three companies were exclusively written in Python and then C came out of the birth of Unix and it wasn't the first, but certainly the most prominent first step after assembly language, right?[00:48:54] Bret: Where you had higher level abstractions rather than and going beyond go to, to like abstractions, [00:49:00] like the for loop and the while loop.[00:49:01] The Future of Software Engineering[00:49:01] Bret: So I just think that if the act of writing code is no longer a meaningful human exercise, maybe it will be, I don't know. I'm just saying it sort of feels like maybe it's one of those parts of history that just will sort of like go away, but there's still the role of this offer engineer, like the person actually building the system.[00:49:20] Bret: Right. And. What does a programming system for that form factor look like?[00:49:25] React and Front-End Development[00:49:25] Bret: And I, I just have a, I hope to be just like I mentioned, I remember I was at Facebook in the very early days when, when, what is now react was being created. And I remember when the, it was like released open source I had left by that time and I was just like, this is so f*****g cool.[00:49:42] Bret: Like, you know, to basically model your app independent of the data flowing through it, just made everything easier. And then now. You know, I can create, like there's a lot of the front end software gym play is like a little chaotic for me, to be honest with you. It is like, it's sort of like [00:50:00] abstraction soup right now for me, but like some of those core ideas felt really ergonomic.[00:50:04] Bret: I just wanna, I'm just looking forward to the day when someone comes up with a programming system that feels both really like an aha moment, but completely foreign to me at the same time. Because they created it with sort of like from first principles recognizing that like. Authoring code in an editor is maybe not like the primary like reason why a programming system exists anymore.[00:50:26] Bret: And I think that's like, that would be a very exciting day for me.[00:50:28] The Role of AI in Programming[00:50:28] swyx: Yeah, I would say like the various versions of this discussion have happened at the end of the day, you still need to precisely communicate what you want. As a manager of people, as someone who has done many, many legal contracts, you know how hard that is.[00:50:42] swyx: And then now we have to talk to machines doing that and AIs interpreting what we mean and reading our minds effectively. I don't know how to get across that barrier of translating human intent to instructions. And yes, it can be more declarative, but I don't know if it'll ever Crossover from being [00:51:00] a programming language to something more than that.[00:51:02] Bret: I agree with you. And I actually do think if you look at like a legal contract, you know, the imprecision of the English language, it's like a flaw in the system. How many[00:51:12] swyx: holes there are.[00:51:13] Bret: And I do think that when you're making a mission critical software system, I don't think it should be English language prompts.[00:51:19] Bret: I think that is silly because you want the precision of a a programming language. My point was less about that and more about if the actual act of authoring it, like if you.[00:51:32] Formal Verification in Software[00:51:32] Bret: I'll think of some embedded systems do use formal verification. I know it's very common in like security protocols now so that you can, because the importance of correctness is so great.[00:51:41] Bret: My intellectual exercise is like, why not do that for all software? I mean, probably that's silly just literally to do what we literally do for. These low level security protocols, but the only reason we don't is because it's hard and tedious and hard and tedious are no longer factors. So, like, if I could, I mean, [00:52:00] just think of, like, the silliest app on your phone right now, the idea that that app should be, like, formally verified for its correctness feels laughable right now because, like, God, why would you spend the time on it?[00:52:10] Bret: But if it's zero costs, like, yeah, I guess so. I mean, it never crashed. That's probably good. You know, why not? I just want to, like, set our bars really high. Like. We should make, software has been amazing. Like there's a Mark Andreessen blog post, software is eating the world. And you know, our whole life is, is mediated digitally.[00:52:26] Bret: And that's just increasing with AI. And now we'll have our personal agents talking to the agents on the CRO platform and it's agents all the way down, you know, our core infrastructure is running on these digital systems. We now have like, and we've had a shortage of software developers for my entire life.[00:52:45] Bret: And as a consequence, you know if you look, remember like health care, got healthcare. gov that fiasco security vulnerabilities leading to state actors getting access to critical infrastructure. I'm like. We now have like created this like amazing system that can [00:53:00] like, we can fix this, you know, and I, I just want to, I'm both excited about the productivity gains in the economy, but I just think as software engineers, we should be bolder.[00:53:08] Bret: Like we should have aspirations to fix these systems so that like in general, as you said, as precise as we want to be in the specification of the system. We can make it work correctly now, and I'm being a little bit hand wavy, and I think we need some systems. I think that's where we should set the bar, especially when so much of our life depends on this critical digital infrastructure.[00:53:28] Bret: So I'm I'm just like super optimistic about it. But actually, let's go to w

Danielle Hayden, CEO and founder of Kickstart Accounting, Inc., is joined by Kelsey Chester, Kickstart's Lead Account Manager, to explore a game-changing topic for your business, specialized KPIs (Key Performance Indicators), and how Kickstart's CFO services and financial Snapshot help small business owners (like you!) track the right financial metrics for your business in order to support sustainable growth and achieve your goals.  While many fall into the trap of focusing on top-line revenue, Kelsey and Danielle dive into how true financial health comes from understanding profitability, cash flow, expenses, and other key indicators that are specific to your business.  Key Takeaways:  What are KPIs: Understanding key performance indicators and their impact on business growth.   Generalized vs. Specialized KPIs: Why customized metrics matter more than one-size-fits-all benchmarks.    Client Success Stories: Real-life examples of businesses optimizing growth through specialized KPIs.  Kickstart's CFO Services & KPI Tracking: How Kickstart's CFO expertise and Snapshot helps you monitor financial health at both a high level and with precision.  CFO Services Process: A step-by-step look at how we onboard business owners, set goals, and create financial strategies.  Topics Discussed: What are KPIs and Why They Matter (00:01:26 – 00:05:35) Client Case Study: Tracking Every Cost for Healthy, Sustainable Growth  (00:05:35 – 00:09:15) Kickstart's CFO Services & Onboarding Process (00:09:15 – 00:15:15)   Resources: CFO Services | https://kickstartaccountinginc.com/the-cfo-solution/  Book a Call with Kickstart Accounting, Inc.: https://www.kickstartaccountinginc.com/book    Connect with Kickstart Accounting, Inc.: Instagram | https://www.instagram.com/Kickstartaccounting YouTube | https://www.youtube.com/@businessbythebooks  Facebook | https://www.facebook.com/kickstartaccountinginc

Danielle Hayden, CEO and founder of Kickstart Accounting, Inc., is joined by Kelsey Chester, Kickstart's Lead Account Manager, to explore a game-changing topic for your business, specialized KPIs (Key Performance Indicators), and how Kickstart's CFO services and financial Snapshot help small business owners (like you!) track the right financial metrics for your business in order to support sustainable growth and achieve your goals.  While many fall into the trap of focusing on top-line revenue, Kelsey and Danielle dive into how true financial health comes from understanding profitability, cash flow, expenses, and other key indicators that are specific to your business.  Key Takeaways:  What are KPIs: Understanding key performance indicators and their impact on business growth.   Generalized vs. Specialized KPIs: Why customized metrics matter more than one-size-fits-all benchmarks.    Client Success Stories: Real-life examples of businesses optimizing growth through specialized KPIs.  Kickstart's CFO Services & KPI Tracking: How Kickstart's CFO expertise and Snapshot helps you monitor financial health at both a high level and with precision.  CFO Services Process: A step-by-step look at how we onboard business owners, set goals, and create financial strategies.  Topics Discussed: What are KPIs and Why They Matter (00:01:26 – 00:05:35) Client Case Study: Tracking Every Cost for Healthy, Sustainable Growth  (00:05:35 – 00:09:15) Kickstart's CFO Services & Onboarding Process (00:09:15 – 00:15:15)   Resources: CFO Services | https://kickstartaccountinginc.com/the-cfo-solution/  Book a Call with Kickstart Accounting, Inc.: https://www.kickstartaccountinginc.com/book    Connect with Kickstart Accounting, Inc.: Instagram | https://www.instagram.com/Kickstartaccounting YouTube | https://www.youtube.com/@businessbythebooks  Facebook | https://www.facebook.com/kickstartaccountinginc

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME information, and to apply for credit, please visit us at PeerView.com/SZN865. CME credit will be available until January 20, 2026.Individualized Treatment for Generalized Myasthenia Gravis: Targeting the Cause and Prioritizing the Patient In support of improving patient care, PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an educational grant from Janssen Biotech, Inc., administered by Janssen Scientific Affairs, LLC (which are both Johnson & Johnson companies).Disclosure information is available at the beginning of the video presentation.

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME information, and to apply for credit, please visit us at PeerView.com/SZN865. CME credit will be available until January 20, 2026.Individualized Treatment for Generalized Myasthenia Gravis: Targeting the Cause and Prioritizing the Patient In support of improving patient care, PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an educational grant from Janssen Biotech, Inc., administered by Janssen Scientific Affairs, LLC (which are both Johnson & Johnson companies).Disclosure information is available at the beginning of the video presentation.

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME information, and to apply for credit, please visit us at PeerView.com/SZN865. CME credit will be available until January 20, 2026.Individualized Treatment for Generalized Myasthenia Gravis: Targeting the Cause and Prioritizing the Patient In support of improving patient care, PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an educational grant from Janssen Biotech, Inc., administered by Janssen Scientific Affairs, LLC (which are both Johnson & Johnson companies).Disclosure information is available at the beginning of the video presentation.

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME information, and to apply for credit, please visit us at PeerView.com/SZN865. CME credit will be available until January 20, 2026.Individualized Treatment for Generalized Myasthenia Gravis: Targeting the Cause and Prioritizing the Patient In support of improving patient care, PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an educational grant from Janssen Biotech, Inc., administered by Janssen Scientific Affairs, LLC (which are both Johnson & Johnson companies).Disclosure information is available at the beginning of the video presentation.

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME information, and to apply for credit, please visit us at PeerView.com/SZN865. CME credit will be available until January 20, 2026.Individualized Treatment for Generalized Myasthenia Gravis: Targeting the Cause and Prioritizing the Patient In support of improving patient care, PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an educational grant from Janssen Biotech, Inc., administered by Janssen Scientific Affairs, LLC (which are both Johnson & Johnson companies).Disclosure information is available at the beginning of the video presentation.

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME information, and to apply for credit, please visit us at PeerView.com/SZN865. CME credit will be available until January 20, 2026.Individualized Treatment for Generalized Myasthenia Gravis: Targeting the Cause and Prioritizing the Patient In support of improving patient care, PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an educational grant from Janssen Biotech, Inc., administered by Janssen Scientific Affairs, LLC (which are both Johnson & Johnson companies).Disclosure information is available at the beginning of the video presentation.

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME information, and to apply for credit, please visit us at PeerView.com/SZN865. CME credit will be available until January 20, 2026.Individualized Treatment for Generalized Myasthenia Gravis: Targeting the Cause and Prioritizing the Patient In support of improving patient care, PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an educational grant from Janssen Biotech, Inc., administered by Janssen Scientific Affairs, LLC (which are both Johnson & Johnson companies).Disclosure information is available at the beginning of the video presentation.

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME information, and to apply for credit, please visit us at PeerView.com/SZN865. CME credit will be available until January 20, 2026.Individualized Treatment for Generalized Myasthenia Gravis: Targeting the Cause and Prioritizing the Patient In support of improving patient care, PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an educational grant from Janssen Biotech, Inc., administered by Janssen Scientific Affairs, LLC (which are both Johnson & Johnson companies).Disclosure information is available at the beginning of the video presentation.

CME credits: 1.00 Valid until: 17-01-2026 Claim your CME credit at https://reachmd.com/programs/cme/understanding-disease-progression-the-shift-from-ocular-to-generalized-mg/32236/ The burden of generalized myasthenia gravis (gMG) on patients and caregivers is substantial. Current traditional therapies are often effective in the short term but bring with them many debilitating side effects. A more targeted approach to treatment that focuses on inhibition of the neonatal FcRn receptor complex is offering an exciting and different treatment option. Join Drs. Nicholas Silvestri and James Howard, Jr, as they discuss the expanding landscape of gMG treatments.

Generalized approaches can never adequately address distinct disciples. In order to see legitimate discipleship take place in your life and in the lives of those around you, we cannot depend upon widespread methods hoping to address the specific needs of everyone.

Episode description: We continue our campaign to #EndNeurophobia, with the help of Dr. Aaron Berkowitz. This time, Dr. Sebastian Green presents a case of generalized weakness to Aye. Neurology DDx Schema Aye Chan Moe Thant ( @AyeThant94 ) Aye is a physician from Myanmar and now working as a clinical research team member at the… Read More »Episode 372 : Neurology VMR – Generalized Weakness

Did you know that anxiety disorders are the most common mental illnesses in the U.S. today? You might assume that we have a major anxiety problem just by the number of commercials you see for new medicines to treat these disorders, but is anxiety really a new thing?The Reality Of AnxietyModern medicine recognizes anxiety in many forms: generalized anxiety disorder, panic disorder, social anxiety, and various phobias. Data shows nearly a third of all U.S. adults will experience some form of anxiety in their lifetime. The cost of treating anxiety disorders in the U.S. runs into the tens of billions of dollars, with an even higher economic impact due to lost productivity.What causes this widespread anxiety? According to the Mayo Clinic, the causes aren't fully understood but likely include physical and mental health issues, as well as negative life events such as job loss or financial troubles.If you're struggling with persistent anxiety, it's crucial to see a doctor. Medication and counseling can be transformative.Jesus' Teachings On AnxietyDespite appearing like a modern affliction exacerbated by hectic schedules, technology overload, and perhaps even diet, anxiety is not new. We know this because Jesus addresses it in the Bible, particularly Matthew 6 and Luke 12.Matthew 6:25-26 says: “Therefore I tell you, do not be anxious about your life, what you will eat or what you will drink, nor about your body, what you will put on. Is not life more than food, and the body more than clothing? Look at the birds of the air: they neither sow nor reap nor gather into barns, and yet your heavenly Father feeds them. Are you not of more value than they?”Imagine the disciples traveling around Galilee and Judea, relying on donations for their needs. It's easy to see why they might have felt anxious about where they'd sleep or their next meal. Jesus encourages them to have faith. In Matthew 6:31-33, He says:“Therefore do not be anxious, saying, ‘What shall we eat?' or ‘What shall we drink?' or ‘What shall we wear?' For the Gentiles seek after all these things, and your heavenly Father knows that you need them all. But seek first the kingdom of God and his righteousness, and all these things will be added to you.”Resisting The Love Of MoneyJohn Rinehart, founder of Gospel Patrons, explains that Jesus aims to free us from fear and anxiety to be distinct from the world. The world often idolizes money and seeks comfort and security through wealth. While financial planning is important, it shouldn't be for the sake of leisure alone. Rinehart notes that the world is preoccupied with wealth, which can be perilous for Christians.Jesus warns of this temptation, emphasizing the need to resist the love of money by recognizing our value to God. He made us with a purpose. Jesus instructs us to seek God's Kingdom and righteousness first, promising our needs will be met.We must actively participate in our provision and trust God to fulfill His promise. When we understand our worth to God, we'll pursue His Kingdom and boldly share the Gospel, glorifying Him in the process.The Choice We All Have To MakeUltimately, we all face a choice: will we follow the world or seek the Kingdom of God and His righteousness? We can't do both. As Jesus states in Matthew 6:24:“No one can serve two masters, for either he will hate the one and love the other, or he will be devoted to the one and despise the other. You cannot serve God and money.”Choose God over money and watch the cares of the world fade away.Look At The Sparrows: A 21-Day Devotional from FaithFiIf you want to transform your approach to money through faith and find peace in God's provision, you can purchase a copy of Look at the Sparrows: A 21-Day Devotional on Financial Fear and Anxiety at FaithFi.com/sparrows. This devotional will take you on a journey through Scripture to help you discover how to move from financial fear to a life anchored in trust and generosity.Also, if you become a  FaithFi Partner at $35 per month, you can receive our latest studies and devotionals before they are even available to the general public. That's just our way of saying thank you for supporting the vital work of this ministry.On Today's Program, Rob Answers Listener Questions:My mom recently passed away, leaving some inheritance to the family. I'm the executor of the estate, and I want to see if there's a godly formula for giving to the church, missions, and retirement and investments.I'm about to lose my job soon, and I have a paid-off condo, but my HOA fees are increasing, and I don't have much savings. I'm considering getting a home equity loan to have money for a down payment on a new home, whether I rent out the condo or sell it. What do you think about that?I've lived in my house for 18 years and am considering selling it. What is home equity, and how can I use it to my advantage when selling the house?Resources Mentioned:National Christian Foundation (NCF)Compassion Gift CatalogGospel PatronsLook At The Sparrows: A 21-Day Devotional on Financial Fear and AnxietyRich Toward God: A Study on the Parable of the Rich FoolFind a Certified Kingdom Advisor (CKA) or Certified Christian Financial Counselor (CertCFC)FaithFi App Remember, you can call in to ask your questions most days at (800) 525-7000. Faith & Finance is also available on the Moody Radio Network and American Family Radio. Visit our website at FaithFi.com where you can join the FaithFi Community and give as we expand our outreach.

Feeling anxious? Generalized Anxiety Disorder (GAD) is a thing and most of us have probably experienced it. Tune in for our coping techniques before holiday anxiety kicks in!

Feeling anxious? Generalized Anxiety Disorder (GAD) is a thing and most of us have probably experienced it. Tune in for our coping techniques before holiday anxiety kicks in! Learn more about your ad choices. Visit megaphone.fm/adchoices

Suppose something important will happen at a certain unknown point. As someone approaches that point, you might be tempted to warn that the thing will happen. If you're being appropriately cautious, you'll warn about it before it happens. Then your warning will be wrong. As things continue to progress, you may continue your warnings, and you'll be wrong each time. Then people will laugh at you and dismiss your predictions, since you were always wrong before. Then the thing will happen and they'll be unprepared. Toy example: suppose you're a doctor. Your patient wants to try a new experimental drug, 100 mg. You say “Don't do it, we don't know if it's safe”. They do it anyway and it's fine. You say “I guess 100 mg was safe, but don't go above that.” They try 250 mg and it's fine. You say “I guess 250 mg was safe, but don't go above that.” They try 500 mg and it's fine. You say “I guess 500 mg was safe, but don't go above that.” They say “Haha, as if I would listen to you! First you said it might not be safe at all, but you were wrong. Then you said it might not be safe at 250 mg, but you were wrong. Then you said it might not be safe at 500 mg, but you were wrong. At this point I know you're a fraud! Stop lecturing me!” Then they try 1000 mg and they die. The lesson is: “maybe this thing that will happen eventually will happen now” doesn't count as a failed prediction. I've noticed this in a few places recently. https://www.astralcodexten.com/p/against-the-generalized-anti-caution

In this week's episode, Patrick and Greg discuss the benefits and limitations of generalized estimating equations as an approach to dealing with data that violate the assumption of independence. Along the way they also mention: goat rodeos, haunted houses, jump scares, liberos, Haikyu!!, Whoa Ace!, dadenfreude, Otto, cutting the baguette, this just in, American Idiot, bing bong bing bong, my dad drinks Pepsi, and fine print.Stay in contact with Quantitude! Web page: quantitudepod.org TwitterX: @quantitudepod YouTube: @quantitudepod Merch: redbubble.com

A review of a follow up study which fails to replicate one of the very few pieces of evidence supporting the benefits of generalized perceptual-cognitive training for sports. Articles:No transfer of 3D-Multiple Object Tracking training on game performance in soccer: a follow-up study My Research Gate Page (pdfs of my articles) My ASU Web page Podcast Facebook page (videos, pics, etc)   Subscribe in iOS/Apple Subscribe in Anroid/Google   Support the podcast and receive bonus content   Credits: The Flamin' Groovies – ShakeSome Action Mark Lanegan - Saint Louis Elegy via freemusicarchive.org and jamendo.com

***Trigger Warning: Given the sensitive nature of this topic, please proceed cautiously.*** Jay and Lori tackle the struggle of not feeling physically desired by the husband. They explore the intricate dynamics of femininity, desire, and physical appearance within a marriage. The discussion delves into misconceptions about desire versus lust. Lori shares her personal journey of reclaiming her own femininity, and how it started with unlikely sources. The episode also addresses the risks of a guy who only stays on the surface, encouraging listeners to cultivate confidence, while building a relationship where desire is communicated. Timestamps 00:00 Introduction, (deeply vulnerable) question & the 3 issues we'll address 01:11 Addicts are surprisingly prudish (one solution)* 04:00 Traditionally gorgeous women are cheated on (his looks) 05:42 Society confuses desire all the time (the part in us screaming to be desired) 08:08 Solution: Femininity and how I reclaimed mine* 09:16 What my Counselor said about arm-candy 10:39 Healing on our Saturday Dates (with other men?)* 13:14 It's usually about “novelty” (… or his maturity) 15:26 Appealing to THAT side of men 16:20 Changing the conversation where desire = lust (solution: what helped Jay) 17:11 Becoming addicted to your wife 18:00 Generalized vs Specialized Sexuality (fetishes vs “I really like her!”)* -- https://thecouplecure.com/contact-me/ - Jay and Lori's website https://pornpainhealed.com/contact-me/ - Lori's site for betrayed partners https://porniskillingme.com/contact-me/ - Jay's site for porn addiction recovery #betrayal #relationships #pornaddiction #marriageadvice

Megan H. Noe, MD, MPH, FAAD; Joseph Zabinski, PhD interviewed by Vinod Nambudiri, MD, MBA, EDM

Are you constantly feeling anxious before a challenging workout or a race?  Wondering if your digital screen is making it worse?   Today's guest is Jennie Ketcham Crooks, who is a licensed clinical social worker, anxiety specialist and author of LOOK UP: The 30-Day Path to Digital Minimalism and Real Life Maximalism. The book guides readers through 30 consecutive days of evidence-based interventions for managing our out-of-control digital consumption to improve our meaningful real-world connections and better align our actions with our values.   As our digital overconsumption continues to be fed with the release of each shiny new gadget and screaming fast app, it's becoming increasingly challenging to put down our screens and interact meaningfully with the world and people around us. This constant barrage of digital engagement negatively affects both the quality of our relationships and our mental health.   However, all hope is not lost; Jenny's expertise gives us actionable ways to adjust our behavioral patterns toward healthier digital habits.   In this episode, we discuss how the relentless allure of digital screens throttles our creativity and heightens our anxiety, the concept of psychological inflexibility as the cornerstone of our digital habits, and how to develop more mindful behaviors around interacting with our devices.   If you are currently anxious or feel like you are spending way too much time in front of your screen and it's affecting your relationship with running or your personal relationships, this is the episode for you!   We cover these topics and so much more!   Why Jennie felt compelled to address digital overconsumption Generalized anxiety disorder vs. performance anxiety  The surprising impacts of digital overuse Mental health, interpersonal relationships and digital overuse Reducing digital clutter can spark more creativity LOOK UP: The 30-Day Path to Digital Minimalism and Real Life Maximalism book How does the 30-day challenge unfold and what are the rules? First step recommendation on limiting digital overuse Success stories who've transformed their relationship with their devices What does world mental health day mean to Jennie Misconception about anxiety   Listen to my previous episode about healthy mindset tips for runners here! Listen to my previous episode about why I quit my job to pursue my passion without anxiety here! Listen to my previous episode about mantras and mental health strategies for race day here! Follow along with my 25 minute strength training routine for runners here!   There are 6-steps to growing as a runner and mindset is one of them!  Learn all six within this FREE e-book!   Want a stronger mind and running body so you can stay healthy during your next training cycle to crush your running goals?   Get the structured run and strength plan with motivation and accountability to enjoy lifelong injury free running by booking a call and learn more about Healthy Runner coaching here!   Get the full deep dive story on how Duane Scotti became a healthy runner    A big thanks to Naboso for your support for this episode!   Want to know how I prioritize foot health and connect my mind to my body as a runner?  Kinesis board and toe splays from Naboso.   Naboso's Kinesis board features dual sensory stimulation, a micro-wobble system and a single-leg platform to improve my stability for running!   Click here and use code HEALTHYRUNNER for 20% off your entire Naboso order!    Connect with Jennie Ketcham Crooks: - Instagram: @becomingjennie - Website: https://westcoastanxiety.com/ - Facebook: https://www.facebook.com/jennie.ketcham - Linkedin: https://www.linkedin.com/in/jennieketchamcrooks/ Connect with Dr. Duane: - Instagram - @sparkhealthyrunner - Join Our Healthy Runner Facebook Community - Subscribe to our YouTube Channel - duane@sparkhealthyrunner.com - www.sparkhealthyrunner.com Listen & Subscribe: Apple Podcasts Spotify Stitcher Google Play iHeartRadio Amazon Music Website  

Join Julie as she takes you through a workout you can use with your hospitalized patients that hits on gait, strength, balance, and power!

Dr. Julie Brauer // #GeriOnICE // www.ptonice.com  In today's episode of the PT on ICE Daily Show, join Modern Management of the Older Adult lead faculty Julie Brauer provides a comprehensive guide to creating a general workout for hospitalized patients. She emphasizes the importance of incorporating loading strategies and circuit training elements, such as EMOMs, to address the needs of sick patients. The workout focuses on key areas including gait, balance, strength, and power, while ensuring the experience remains enjoyable. Julie highlights the necessity of tailoring exercises to align with each patient's meaningful goals, encouraging listeners to develop activities that mimic the demands of those goals. The episode features a discussion around a specific patient avatar requiring mid to moderate assistance for standing and minimal assistance for walking, demonstrating how to adapt workouts based on individual capabilities. Take a listen to learn how to better serve this population of patients & athletes, or check out the full show notes on our blog at www.ptonice.com/blog. If you're looking to learn more about live courses designed to better serve older adults in physical therapy or our online physical therapy courses, check our entire list of continuing education courses for physical therapy including our physical therapy certifications by checking out our website. Don't forget about all of our FREE eBooks, prebuilt workshops, free CEUs, and other physical therapy continuing education on our Resources tab.

Download The SPRINT-EMBER Guide: https://iep-guides.com/sprintember-guideTake The Free IEP Assessment: https://iep-assessment.com/Behind The Mic:Scott HowellJake LabhartAaron DuggerJacob HeppnerIEP Programs:◼️Strength Program: https://iepstrength.com/◼️Speed & Power Program: https://iepspeedandpower.com/◼️Capacity Program: https://iepcapacity.com/◼️Performance Track: https://iepperformance.com/Download In Extremis Performance Free Guides:◼️https://iep-guides.com/Follow IEP:◼️Website - https://inextremisperformance.com/◼️Instagram - https://www.instagram.com/inextperformance/

OCD doesn't like to show up alone. In fact, it often brings “friends” along — other mental health conditions that can tag along and make life even more challenging. This is called comorbid OCD. In today's video, we're going to dive into the most common conditions that often accompany OCD and what that means for those who are managing it.  0:00 What is comorbid OCD2:02 Tic Disorders2:37 Hoarding3:13 Trichotillomania3:59 Excoriation disorder 4:23 Depression5:30 Anxiety6:48 PTSD7:17 Phobia8:09 Social anxiety disorder9:13 Generalized anxiety disorder 10:17 It's NOT schizophrenia 11:50 Treating these conditions Follow us on social media:https://www.instagram.com/treatmyocd/https://twitter.com/treatmyocdhttps://www.tiktok.com/@treatmyocd

Dr. Lara Zakaria is an integrative pharmacist, nutritionist, professor, and public health professional specializing in Functional Medicine. A graduate of the Ernest Mario School of Pharmacy, at Rutgers University, she spent 20 years in community pharmacy practice. After developing an interest in nutrition, she earned a MS in Nutrition from the University of Bridgeport and subsequently qualified as a Certified Nutrition Specialist (CNS) as well as an Institute for Functional Medicine Certified Practitioner (IFMCP). Lara currently practices as part of a multi-disciplinary Functional Medicine practice and supervises a professional mentorship program for nutrition and FxMed. Lara is passionate about prevention and reversal of metabolic and autoimmune disease and working with pharmacy professionals to leverage their unique expertise in medication management, drug-drug/drug-nutrient interactions, and genomics to optimize patient medical and nutritional programs.   Together Lara and I discuss the role of the independent pharmacist; drug nutrient interactions and depletions; and Lara's passion about the prevention and reversal of metabolic allergic and autoimmune disease as well as her passion for teaching about the practical application of nutrition and supplements into community pharmacy practice. We explore ideas for providing foundational support for patients, including personalization offerings and consultations; the critical need to evolve and change the way that pharmacy is done while still meeting the needs of patients; and the impressive herbal medicine research findings from a global, cultural and historical perspective that support the work of both pharmacists and functional medicine nutritionists.  I'm your host, Evelyne Lambrecht, thank you for designing a well world with us. Episode Resources: Lara Zakaria - https://larazakaria.com/ Design for Health Resources: Designs for Health - https://www.designsforhealth.com/ Designs for Health Practitioner Exclusive Drug Nutrient Depletion and Interaction Checker - https://www.designsforhealth.com/drug-nutrient-interaction/ Visit the Designs for Health Research and Education Library which houses medical journals, protocols, webinars, and our blog. https://www.designsforhealth.com/research-and-education/education Chapters: 00:00 Intro 04:15 Lara's transition from major retailer pharmacist to a community pharmacy to functional medicine and nutrition.  09:45 Lara's pharmacy background provides the ideal groundwork for her focus on herbalism and supplements.  13:17 Implementing the practical application of nutrition and supplements in community pharmacy practice.  18:04 Ideas for providing foundational support for patients, including personalization offerings and consultations. 22:27 Generalized billing clarification regarding collaboration.  23:49 Key changes regarding insurance reimbursement with third-party payers.  27:18 The critical need to evolve and change the way that pharmacy is done while still meeting the needs of patients. 28:34 Details of drug nutrient interactions, depletions and supportive interaction checkers.  34:10 Addressing the myths of the supplement industry in favor of being productively critical and supportive of clinically relevant research.  39:01 Herbal medicine research findings from a global, cultural and historical perspective.  44:13 Lara's teaching and volunteer work centers around a holistic and integrative approach to pharmacology.  46:15 Lara's work on the board of the Ocular Wellness and Nutrition Society.  49:01 Connecting with Dr. Lara and resources for pharmacists who want to learn more about functional medicine specific to their profession. 51:42 Lara's personal favorite supplements, top health practices to stay balanced, and the idea that she has changed her mind about in recent years.  

Living with pustular psoriasis is tough. Hear the latest updates about heritable aspects of GPP, diagnosis, management tips, and treatment options such as the IL-36 inhibitor spesolimab, how it works and how effective it is from dermatologist Dr. Laura Ferris, Professor of Dermatology at the University of Pittsburgh and moderator Alan Simmons. This episode is provided with support from our Psoriasis Action Month sponsors. 

In the final episode of this two-part series, Dr. Joe Conway will discuss four biologic therapies that have been approved in recent years by the FDA for the treatment of adults with generalized myasthenia gravis. In this episode, he will talk about two of the treatment medications: Ravulizumab + zilucoplan. Show references: https://doi.org/10.1016/s1474-4422(21)00159-9 https://www.thelancet.com/journals/laneur/article/PIIS1474-4422(23)00077-7/abstract      

What do you do when your child ruminates on anxious thoughts, can't sleep in their room alone, or doesn't have friends due to social anxiety? In this episode, Hunter talks to Dr. Stephen Whiteside of the Mayo clinic about how parents can address each of these challenges, as well as the most common types of child anxiety and what causes it. ABOUT HUNTER CLARKE-FIELDS: Hunter Clarke-Fields is the host Mindful Parenting Podcast (Top 0.5% podcast ), global speaker, number 1 bestselling author of “Raising Good Humans” and “Raising Good Humans Every Day,” Mindfulness Meditation teacher and creator of the Mindful Parenting Course and Teacher Training. Find more podcasts, Hunter's books, blog posts, free resources, and more at MindfulMamaMentor.com. Discover your Unique-To-You Podcast Playlist at mindfulmamamentor.com/quiz/ We love the sponsors that make this show possible! You can always find all the special deals and codes for all our current sponsors on our website: /mindfulmamamentor.com/mindful-mama-podcast-sponsors/ Learn more about your ad choices. Visit megaphone.fm/adchoices

In the first episode of a two-part series, Dr. Joseph Conway will discuss four biologic therapies that have been approved in recent years by the FDA for the treatment of adults with generalized myasthenia gravis. In this episode, he will talk about two of the treatment medications: Efgartigimod and Rozanolixizumab.  Show references: https://doi.org/10.1016/s1474-4422(21)00159-9 https://www.thelancet.com/journals/laneur/article/PIIS1474-4422(23)00077-7/abstract  

Today's episode is filled with deep and meaningful knowledge on how entrepreneurs can better take care of their mental health. I'm joined by Dr. Kelly Vincent, a Licensed Clinical Psychologist (PSY30672) and owner of Nourished Wellness Group, a holistic mental health group practice in Encinitas, California. In this episode we hear how to look deeper within to find the emotional root of a variety of mental roadblocks that can cause fear and anxiety while experiencing our entrepreneurship journey. Dr. Vincent shares techniques for getting curious to bring the root of issues to light and tips for how to overcome them and move forward to find success. She takes a deep dive into: High functioning anxiety Generalized anxiety Imposter Syndrome and how we perceive competency The importance of healthy self talk How critical restorative rest can be Sustainable habits and routines to combat burnout Why slowing down matters   Resources & Links: The 5 Minute Journal [affiliate link] The Secret Thoughts of Successful Women: Why Capable People Suffer from the Imposter Syndrome and How to Thrive in Spite of It by Valerie Young [affiliate link] Profit Mavens Summit 150 Free Hooks List Building 101 Manychat Stories that Sell IG University Kajabi 30 day free trial + 20 free story templates Around the Clock Masterclass Kahlea's Negotiation Playbook and FREEBIE Brand Partnership Pitch Template   Connect with Dr. Vincent: Follow on Instagram @dr.kellyvincent Visit her website Download her FREEBIES: Anxiety Toolkit Imposter Syndrome Workbook Holistic Strategies to Boost Mood Nourish Your Nervous System Somatic Practices to Support Your Nervous System   Connect with Mya: Follow on Instagram @myanichol Join my email list Check out my website Now on YouTube   Make sure to hit subscribe/follow so you never miss an episode! Find the full show notes here: https://myanichol.com/2024/07/02/the-critical-role-of-restorative-rest-in-entrepreneurship-w-dr-kelly-vincent-dr-kellyvincent-episode-74/ 

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This episode will help you realize how specific questions, quality sex based on the answers to those questions and building friendship creates a strong sex relationship.Subscribe to my YouTube:https://www.youtube.com/channel/UCiCp3BxQ_pz4-tQRZQCd6swWORK WITH ME 1:1 https://stephanieganowski.typeform.com/to/Fm6LGfa9Join Sex Meditationshttps://www.stephanieganowski.com/offers/2gA2VzBH